Ratio Risk Research Articles

Incidence and risk of infections in patients with ankylosing spondylitis receiving biologic therapies: A prospective observational study using the KOBIO registry

ObjectiveThis study aimed to assess infection occurrence of infection and risk factors among ankylosing spondylitis (AS) patients treated with biologics in a real-world setting.MethodsThis prospective observational cohort study included AS patients from the Korean College of Rheumatology BIOlogics (KOBIO) registry who initiated or switched to biologic agent between December 2012 and July 2023. The primary outcome was the first occurrence of any infection, ranging from mild to severe, classified by organ system. The infection rate per 1,000 person-years (PY), with a 95% confidence interval were calculated using the Poisson distribution method. Cox proportional hazard regression models, adjusted for confounders, estimated hazard ratios for infection risk, considering only the first infection event.ResultsThis analysis included 2,129 patients with a total of 7,107.67 PY of follow-up. The predominant infections observed were of the upper and lower respiratory tract (25.89/1000 PY), followed by herpes zoster (HZ) (6.13/1000 PY). Multivariate Cox regression analysis revealed significant risk factors for infection, including age, ischemic heart disease, complicated diabetes, chronic kidney disease (CKD), and peripheral arthritis. In contrast, male sex was identified as a protective factor against the development of infections.ConclusionThe infection rate was 39 events/1,000 PY with respiratory tract infections being most common, followed by HZ. Significant risk factors included age, female sex, ischemic heart disease, complicated diabetes, CKD and peripheral arthritis for the occurrence of infection in patients with AS treated with biologics.

Impact of Maternal Macronutrient Intake on Large for Gestational Age Neonates’ Risk Among Women with Gestational Diabetes Mellitus: Results from the Greek BORN2020 Cohort

Background/Objectives: The effect of maternal macronutrient composition on the risk of large for gestational age (LGA) neonates among women with gestational diabetes mellitus (GDM) is not well understood. This study aimed to investigate these associations in a pregnant cohort in Northern Greece, considering both pre-pregnancy and early pregnancy dietary intake, and stratifying women by pre-pregnancy body mass index (BMI). Methods: From a total of 797 eligible pregnant women, the 117 (14.7%) who developed GDM (and thus were included in the study) completed the validated Food Frequency Questionnaires (FFQs). Macronutrient intake was assessed for the six months before pregnancy and until mid-gestation, prior to the oral glucose tolerance test. Data were compared with European Food Safety Authority (EFSA) guidelines, and participants were stratified by pre-pregnancy BMI (normal vs. overweight/obese). Multivariate logistic regression was used to estimate adjusted odds ratios (aORs) for LGA risk. Results: In normal-BMI women with GDM, higher dietary fiber (aOR = 1.39) and vegetable protein (aOR = 1.61) intake before pregnancy were both significantly associated with an increased risk of LGA. During early pregnancy, the elevated risk from vegetable protein persisted (aOR = 1.51). Among overweight/obese women, no significant pre-pregnancy associations were observed. However, during early pregnancy, a higher percentage of total carbohydrate intake was linked to increased LGA risk (aOR = 1.11), while maintaining saturated fatty acids “as low as possible” reduced the odds of LGA (aOR = 0.71). Elevated vegetable protein intake also increased LGA risk (aOR = 1.61). Conclusions: Maternal macronutrient intake prior to and during early pregnancy may influence LGA risk in GDM, with distinct patterns according to pre-pregnancy BMI. These findings underscore the importance of tailoring dietary recommendations—especially regarding fiber, vegetable protein, carbohydrates, and saturated fat—to mitigate the risk of LGA in women with GDM.

Incidence of Acute Kidney Injury in Relapsed and Refractory Multiple Myeloma treated with Teclistamab versus CAR T-cells.

Teclistamab, a novel bispecific monoclonal antibody targeting CD3 and B-cell maturation antigen (BCMA), and chimeric antigen receptor T-cell (CAR-T) therapy are promising options for treating relapsed/refractory multiple myeloma (MM). However, the rates of acute kidney injury (AKI) associated with teclistamab remain inadequately characterized. This study aims to compare the incidence, severity, and outcomes of AKI between patients receiving teclistamab and CAR-T therapy. This was a retrospective study involving 64 patients with relapsed/refractory MM treated with either teclistamab or CAR-T therapy. All patients had previously received at least four lines of chemotherapy before being treated with either teclistamab or CAR-T. The primary outcome was the incidence of AKI, and secondary outcomes included AKI severity, kidney recovery rates, and mortality. Kaplan-Meier estimates for AKI-free survival were calculated, and hazard ratios (HRs) for AKI risk were determined using Cox proportional hazards models. Sixty-four patients met inclusion criteria for this study (30 received CAR-T and 34 received teclistamab therapy). Among these patients, 14 AKI events occurred in total (22%), with 10 events (29%) in the teclistamab group and 4 events (13%) in the CAR-T group. AKI-free survival estimates at 180 days after treatment initiation were 68% (95% confidence interval [CI]: 53%-87%) for teclistamab patients and 90% (95% CI: 79%-100%) for CAR-T patients. While patients receiving teclistamab were found to have an increased risk of an AKI event compared to those receiving CAR-T therapy, the results were not statistically significant (HR [95% CI]: 3.38 [0.93-12.31], P=0.065). This study suggests that patients treated with teclistamab may experience a higher incidence of AKI compared to those receiving CAR-T therapy. However, further research is required to determine whether this increased risk is attributable to disease progression or teclistamab itself. These results highlight the need for close kidney function monitoring in patients receiving teclistamab.

Exploring the link between sex hormone-binding globulin levels and prostate cancer risk: a comprehensive systematic review and meta-analysis.

Sex hormone-binding globulin (SHBG) plays a critical role in regulating androgen bioavailability and has been hypothesized to influence prostate cancer risk, though existing evidence is inconsistent. This systematic review and meta-analysis aimed to evaluate the association between SHBG levels and prostate cancer risk. A comprehensive search was conducted across PubMed, Embase, and Web of Science for studies published up to December 1, 2024. Observational studies assessing SHBG levels and prostate cancer risk were included. Effect sizes were pooled using random-effects meta-analysis. Heterogeneity was evaluated using the I2 statistic, and quality assessment was performed using the Newcastle-Ottawa Scale. Statistical analysis was performed using R software version 4.4. Sixteen studies, including 720,298 participants and 90,799 prostate cancer cases, were analyzed. The pooled odds ratio (OR) for prostate cancer risk per unit increase in SHBG was 0.907 (95% CI 0.799-1.030), indicating no statistically significant association. Substantial heterogeneity was observed among the included studies (I2 = 79%; P < 0.0001). Subgroup analyses showed no significant variation in effect sizes by study design. However, a Mendelian randomization analysis conducted in 140,254 European-descent males, including 79,148 prostate cancer cases, suggested a modest protective effect of higher SHBG levels, with an OR of 0.944 (95% CI 0.897-0.993). Sensitivity analyses confirmed the robustness of the pooled findings. This meta-analysis showed a complex relationship between SHBG levels and prostate cancer risk. While overall findings do not support a statistically significant association, higher SHBG levels may confer a protective role in specific contexts. Further research is needed to elucidate mechanisms, reduce heterogeneity, and validate SHBG as a biomarker for risk stratification.

The Role of Simpson Grading System in Spinal Meningioma Surgery: Institutional Case Series, Systematic Review and Meta-Analysis

Background: Although its validity has recently been questioned since its introduction, the Simpson grade has remained one of the most relevant factors in estimating the recurrence risk of intracranial meningiomas. This study aims to assess its role in spinal meningiomas through a retrospective analysis of a mono-institutional surgical series and literature meta-analysis. Methods: We conducted a systematic review and meta-analysis of the literature from 1980 to 2023, complemented by a mono-institutional series of 74 patients treated at “Santa Maria delle Grazie” hospital. Demographic, clinical, neuroradiological, pathological, surgical, and outcome data of case series were analyzed. For the meta-analysis, studies were selected based on predefined inclusion criteria, and a fixed-effects model was used to synthesize data due to assumed homogeneity among included studies. Statistical analyses included odds ratios (OR) for recurrence risk and assessment of publication bias using Peter’s test. Results: Mono-institutional sample included 74 patients, most of whom were women (85%) with a median age of 61.9 years. The thoracic spine was the most common tumor location (81%). Recurrences occurred in patients with Simpson grade II and III resections. The meta-analysis involved 2142 patients from 25 studies and revealed a significantly higher recurrence rate for Simpson grades III–V compared to grades I–II (OR 0.10; CI95 0.06–0.16). Additionally, Simpson grade II had a higher recurrence risk than grade I (OR 0.42; CI95 0.20–0.90). Conclusions: The Simpson grading remains a valid predictor of recurrence also for spinal meningiomas. Our findings revealed a significant increase in recurrence rate with higher Simpson grades. These results support the need to strive for Simpson grade I resection when feasible.

Risk Factors Related to Resting Metabolic Rate-Related DNAJC6 Gene Variation in Children with Overweight/Obesity: 3-Year Panel Study.

Over a three-year follow-up period, 63.3% of original students participated. Changes in the variables (anthropometrics, blood biochemistry, and dietary intakes) were analyzed and compared between those without obesity (non-OB) and with obesity (OB) classified at the study endpoint. The average MAF of nine SNPs (D-1 to D-IX) was defined as 18.1%. The OB group showed greater increases in RMR, BMI, WC, and SBP, while the non-OB group had significantly greater increases in HDL and intakes of nutrients (e.g., total calories, vitamins B2, C, folate, A, retinol, iron, and zinc). Increased RMR, BMI, BW, and RMR/BW changes were observed with mutant allele of D-I SNP, which was also associated with a higher prevalence of obesity. Greater increases in animal fat intake, including saturated fatty acids and retinol, were noted in the minor alleles of D-VI, D-VII, D-VIII, and D-IX SNPs compared to those of the major alleles. The odds ratio for BMI risk was significantly higher in the mutant alleles of D-I (rs17127601), D-VII (rs1334880), and D-VIII (rs7354899) compared to the wild type, with increases of 2.59 times (CI; 1.068-6.274), 1.86 times (CI; 1.012-3.422), and 1.85 times (CI; 1.008-3.416), respectively. RMR was a mild risk factor in minors of the D-1, D-VII, and D-VIII; however, a higher RMR/BW ratio significantly correlated with decreased BMI risk, and this effect was found in only the major alleles of D-I, D-VII, and D-VIII SNPs, not in the minor alleles. High retinol intake appeared to reduce obesity risk in the minor alleles of the D-I, D-VII, and D-VIII SNPs, even though intake of animal fats and retinol remained higher among minors over the three years. These findings suggest that the RMR/BW ratio and dietary fat/retinol intake should be considered in DNACJ6-gene-based precision medicine approaches for pediatric obesity prevention, particularly for boys.

Sex-based differences in risk of revision for infection after hip, knee, shoulder, and ankle arthroplasty in osteoarthritis patients: a multinational registry study of 4,800,000 implants.

We aimed to determine sex differences for periprosthetic joint infections after primary arthroplasty of the hip, knee, ankle, and shoulder in osteoarthritis patients in an international perspective. This is a multinational combined arthroplasty registry study. Each arthroplasty registry performed Cox-regression analysis of their data and reported the crude and adjusted hazard ratios (HR) with an a priori designed data form. A random-effects model was used to pool these HRs to estimate an overall HR with 95% confidence interval (CI). Adjustment was undertaken for patient age, BMI, ASA grade, type of fixation, and type of implant. 9 arthroplasty registries participated. Patients who received primary total joint arthroplasty for primary osteoarthritis were considered: 2,134,313 hip arthroplasties, 2,658,237 knee arthroplasties, 57,889 shoulder arthroplasties, and 8,445 ankle arthroplasties. We calculated hazard ratios (HR) for the overall risk of complete revision due to infection for each implant type and follow-up. The pooled HR for revision due to infection for men compared with women at 1-year follow-up was 1.60 (95% confidence interval [CI] 1.42-1.80) for hip arthroplasties; 2.06 (CI 1.90-2.46) for knee arthroplasties; 4.51 (CI 2.99-6.80) for shoulder arthroplasties; and 0.87 (CI 0.46-1.62) for ankle arthroplasties. These results remained consistent over time and were identified in both unadjusted and adjusted models. Men have a higher risk of revision due to infection than women after primary hip, knee, and shoulder arthroplasty. No evidence of difference was found for ankle arthroplasty. These elevated relative risks persist in the fully adjusted investigations and over the 10-year postoperative period studied.

Association between waist-to-hip ratio and risk of myocardial infarction: a systematic evaluation and meta-analysis

BackgroundMyocardial infarction(MI) is one of the most serious health threats. Despite the increasing number of clinical methods used to predict the onset of MI, the prediction of MI is still unsatisfactory and necessitates new methods.ObjectiveTo systematically review observational studies from the past two decades on the association between waist-to-hip ratio (WHR) and MI risk.MethodsOriginal literature on the correlation between WHR and MI was searched in PubMed, Embase, Web of Science, Cochrane Library, Science Direct, CNKI, and Wanfang up to January 31, 2024. Two researchers independently screened, extracted data, and assessed quality using the Newcastle-Ottawa Scale (NOS) and Revman5.3. Meta-analysis with Stata 16.0 calculated the combined Odd ratio (OR) for WHR and MI risk. Heterogeneity was assessed with the I2 statistic to select the appropriate effects model. Subgroup analysis, meta-regression, sensitivity analysis, and funnel plots tested for heterogeneity and publication bias.ResultsA total of 22 observational studies were included, involving 709,093 participants. The meta-analysis showed that an elevated WHR was significantly associated with an increased risk of MI, with a pooled odds ratio (OR) of 1.98 [95% Confidence interval (CI): 1.75–2.24] and high heterogeneity (I2 = 91.5%, P &amp;lt; 0.0001). Subgroup analysis revealed a stronger association between WHR and MI in women (OR: 1.99, 95% CI: 1.43–2.77) compared to men (OR: 1.74, 95% CI: 1.36–2.22). Regional analysis indicated that the association between WHR and MI risk was highest in Asian populations (OR: 2.93 95% CI: 1.61–5.33), followed by American (OR: 1.73, 95% CI: 1.45–2.08) and European populations (OR: 2.19, 95% CI: 1.49–3.22). Sensitivity analysis demonstrated that the results remained stable after excluding one study.ConclusionIn the general adult population, a higher WHR is a potentially significant association for MI and has predictive value for MI.

SUBCLINICAL SEIZURES ON EEG WITH SLEEP PHASES AND CLINICAL SIGNIFICANCE IN PATIENTS WITH FOCAL EPILEPSY

Purpose: It is observed in studies that subclinical seizures have significant impact on the diagnosis, prognosis, and treatment responses. Aim of our study is investigating presence of these seizures, their relationship with sleep, contribution to diagnosis, and impact on treatment selection and prognosis in patients diagnosed with focal epilepsy. Materials and methods: Total of 1,626 EEGs conducted in the EEG unit were examined. Among them, 626 were found to belong to patients diagnosed with focal epilepsy. 140 patients who underwent twenty-minute EEG monitoring and 28 patients who underwent twenty-four-hour EEG monitoring were included in the study. Results: A comparative analysis was conducted between two cohorts of patients: one subjected to a twenty-minute EEG and the other undergoing a 24-hour EEG. In the presence of resistant epilepsy, the risk of SCS is increased by 3.1 times. The presence of SCS in frontal lobe epilepsies demonstrated a 2.2-fold elevation compared to temporal lobe epilepsies (1.0-5.3). A statistically significant relationship between Levetiracetam usage and seizures was observed (p=0.044). The calculated Odds Ratio for risk indicated a 1.2-fold (1-1.6) higher frequency of seizures with Levetiracetam usage. Risk analysis revealed a 1.5-fold (1.2-1.9) higher incidence of seizures with the use of well-known drugs in favor of lacozamide-zonisamide. Conclusion: SCSs are gaining increasing clinical significance in terms of diagnosis, prognosis, and treatment. The relationship between these sleep and SCSs holds importance for future research with a larger number of patients and centers.

Estimating cancer risk in immune-mediated inflammatory diseases exposed to varying doses of tumour necrosis factor inhibitors.

The safety profile of high doses of tumour necrosis factor inhibitors (TNFi) therapy for cancer risk in immune-mediated inflammatory diseases (IMIDs) remains uncertain. We evaluated the risk of cancer development in patients with IMIDs exposed to standard and high doses of TNFi compared with those never exposed to TNFi. A cohort study was conducted using the Japanese claims database encompassing over 4.6 million individuals from 2013 to 2021. The study included patients aged 16years or older with new-onset IMIDs, such as inflammatory bowel disease, rheumatoid arthritis, or psoriasis, who had no cancer history. The subdistribution hazard ratios (SHR) for cancer risk in TNFi standard and high dose groups comparing with TNFi unexposed group were estimated using a Fine and Gray model that accounted for the competing risk of death unrelated to cancer. The high dose of TNFi was defined as either a dose escalation or shortening of the intervals during administrations from the standard dose treatment. We identified a total of 42,006 patients with new-onset IMIDs (40,573 in TNFi unexposed, 876 in TNFi standard dose, and 557 in TNFi high dose) and 1211 (2.8%) patients developed cancer, yielding an incidence rate of 787.8 (739.9-828.1) per 100,000 person-years. Neither the standard nor high doses of TNFi significantly increased the cancer risk (TNFi standard dose vs. TNFi unexposed, adjusted SHR, 0.65 [0.40-1.08]; TNF high dose vs. TNFi unexposed, adjusted SHR, 1.12 [0.67-1.87]). There is no association between varying doses of TNFi therapy and cancer risk in IMIDs.

The impact of occupational sitting time and occupation on cardiometabolic health in Japanese workers.

Prolonged sitting time (ST) has been suggested as a risk factor for CVD. Particularly, occupational ST (OST) is determined by occupation-specific activities and can impact the health status of workers. However, there is limited information on the impact of OST across different occupations among Japanese workers. This study aimed to examine how OST and occupation associate to CVD risks. Using a cross-sectional design, a total of 1874 workers were included in this study. ST was assessed using the Worker's Living Activity-time Questionnaire during working and non-working days. CVD risks were evaluated using a combination of questionnaires and medical checkup records. We conducted multivariable-adjusted logistic regression analyses to assess the associations between occupations (clerical support, professionals, service, and sales) and OST (categorized as long, middle, or short) with CVD risks. All analyses were adjusted for sex, age, smoking status, alcohol consumption, exercise habits, and either OST or occupation, depending on the primary exposure. The results indicated that workers in services and sales had significantly lower odds ratios (ORs) for hypertension (OR = 0.52, 95% CI: 0.40-0.69) and CVD risk (OR = 0.61, 95% CI: 0.47-0.78) compared to clerical support, while professionals showed higher ORs for dyslipidemia (OR = 1.49, 95% CI: 1.16-1.91). When analyzed by OST categories, the short OST group showed reduced risks for obesity (OR = 0.77, 95% CI: 0.59-1.00) compared to the long OST group. This study emphasizes the need to consider both occupation and OST when assessing health risks, highlighting the importance of targeted interventions for specific occupational groups.

Long-term benefit of SGLT2 inhibitors to prevent heart failure hospitalization in patients with diabetes, with potential time-varying benefit.

SGLT2 inhibitors show promise in reducing hospitalization for heart failure in diabetics, but their long-term effects and time-dependency remain unclear. We conducted a retrospective nested case-control study within a large type 2 diabetic cohort (n = 11,209) using electronic health records. Cases (heart failure hospitalization, n = 352) were matched to controls (n = 1372) based on age, sex, cohort entry date, and diabetes duration. Matched-set conditional logistic regression was used to estimate hazard ratios (HRs) for antidiabetic drug class and heart failure hospitalization risk. SGLT2 inhibitors were associated with a significant reduction in heart failure hospitalization risk (adjusted HR 0.56, 95% CI 0.38-0.82, p = 0.028). This protective effect appeared more pronounced with a longer duration of treatment, suggesting a potential cumulative benefit. Time-varying analysis within propensity score-matched cohorts revealed a progressive decrease in hospitalization risk with continued SGLT2 inhibitor use, indicating a strengthening effect over time (greedy nearest neighbor: HR 0.52, CI 0.31-0.87, p = 0.015; optimal matching: HR 0.54, CI 0.34-0.85, p = 0.008). While promising, further investigation with larger datasets is warranted to definitively confirm these findings.

Predictive role of the peripheral blood inflammation indices neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immunoinflammatory index (SII) for age-related cataract risk.

The novel inflammatory markers neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immunoinflammatory index (SII) have not yet been used in the study of age-related cataracts. The aim of this study was to investigate the possible relationships between the NLR, PLR, and SII and age-related cataracts. In the 2005-2008 National Health and Nutrition Examination Survey (NHANES) cross-sectional surveys, we collected complete information on blood counts, whether cataract surgery had been performed, and baseline information for adults. We investigated the independent interactions between the inflammatory markers NLR, PLR, and SII and age-related cataracts via weighted multivariate regression analyses and subgroup analyses. Smoothed curve fitting was performed to identify nonlinear associations and saturation effects between inflammation indices and cataract risk. Finally, receiver operating characteristic (ROC) curves were plotted for factors significantly associated with the development of cataracts to identify the optimal diagnostic inflammation index. This study included 8887 participants without cataracts and 935 participants with cataracts. Multivariate logistic regression analyses after adjusting for covariates revealed that a high SII (OR = 1.000, 95% CI = 1.000-1.000; P = 0.017) and high NLR (OR = 1.065, 95% CI = 1.000-1.134; P = 0.048) were independent risk factors for cataracts. Subgroup analyses did not reveal interactions between the SII, NLR, or cataract and covariates. Smoothed curve fits of the relationships between the SII or NLR and cataracts did not show positive significant saturating effect values for any of the variables. The ROC curve revealed some diagnostic value for cataracts for both the SII (AUC = 0.549, P < 0.001) and the NLR (AUC = 0.603, P < 0.001), but both had weak diagnostic value. Our study suggests that the SII and NLR are independent risk factors for cataracts in U.S. adults, but no such associations was identified between the PLR and cataracts.

Abstract 4138488: Association Between Guideline-directed Medical Therapy and Reintervention Risk at 2 Years Following Peripheral Vascular Interventions

Introduction: Patients with peripheral artery disease (PAD) undergoing peripheral vascular interventions (PVI) face frequent reinterventions. The association between the use of guideline-directed medical therapy (GDMT) and reintervention risk is unclear, we therefore aimed to study the association between GDMT and 2-year reintervention risk using the largest national vascular registry. Methods: PVI procedures in patients with claudication or chronic limb-threatening ischemia between 2017-2018 were abstracted from the Vascular Quality Initiative (VQI) registry. GDMT was defined as statin, antiplatelet, and ACE/ARB if hypertensive prescribed at discharge. Reintervention was obtained from Medicare claims data. Propensity score of no GDMT vs. GDMT was calculated using 22 preprocedural variables followed by 1:1 matching of patients. The 2-year cumulative incidence of reintervention and subhazard ratios (sHR) for 2-year reintervention risk in no GDMT vs. GDMT were assessed using Aalen-Johansen method and Fine-Gray model, respectively, to account for the competing risk of death. Results: A total of 13,244 patients (6,622 by GDMT group) were included after 1:1 matching (mean age 72.0 ± 9.9, female 38.9%, white 79.4% Black or African American 15.3%) . At 2 years, the cumulative incidence of reintervention was 43.0% (95% CI 41.0%-44.9%) for patients with no GDMT vs. 41.2% (95%CI 39.4-43.0) for the GDMT group (P=0.293). Not receiving GDMT was not associated with 2-year risk of reintervention (sHR: 1.03 95%CI 0.97-1.10; P=0.293). Conclusion: Around 40% of patients undergoing a PVI will have a reintervention at 2 years. The receipt of GDMT at discharge was not associated with a lower reintervention risk at 2 years, as currently assessed. Further granular measures of GDMT should integrate adherence information, as well as information on other lifestyle and cardiovascular risk management to obtain a more complete assessment of a potential association with reintervention risk.

Abstract 4137484: Clinical implications of combined midodrine and pulmonary vasodilator therapy in Portopulmonary Hypertension

Introduction: Portopulmonary hypertension (POPH) and associated pulmonary vascular resistance (PVR) elevation is seen in the context of underlying portal hypertension and liver disease. In the systemic circulation, liver cirrhosis can cause inappropriate splanchnic and systemic vasodilation with decreased systemic vascular resistance (SVR). Midodrine is used to maintain blood pressure in the setting of low SVR. Pulmonary vasodilators have systemic vasodilatory effects; the implications of combined midodrine and pulmonary vasodilator use in POPH are unanswered questions. Hypothesis: We hypothesized that SVR would decrease over time in patients with POPH started on pulmonary vasodilators, and that use of midodrine (as a surrogate for depressed SVR), may be associated with increased risk of mortality in patients with POPH starting pulmonary vasodilator therapy. Methods: Patients from the 3 Mayo Clinic sites (Rochester, MN; Jacksonville, FL; Scottsdale, AZ) diagnosed with POPH from 1988-2020 were included in the database. Patients met hemodynamic criteria for POPH via right heart catheterization (RHC). Hemodynamics were obtained from echocardiography and RHC at initial and subsequent visits. The hazard ratio for risk of death was estimated using Cox proportional hazards method. SVR was calculated using mean arterial pressure and cardiac output. Results: Analysis included 147 POPH patients, 34 (23%) on midodrine and 113 (77%) not requiring midodrine. There were 116 patients with longitudinal SVR data. The mean initial SVR was 1224 Dyne sec cm-5 and decreased 251 Dyne sec cm-5 [95% CI -337 to -165 251 Dyne sec cm-5, p&lt;0.0001] with no difference between midodrine groups (p=0.57). Patients in the midodrine POPH group had an increased risk of mortality compared to those without midodrine use (HR 1.51, 95% CI: 1.02-2.21, p=0.0371). Conclusions: Patients with POPH starting pulmonary vasodilator have a reduction in SVR related to vasodilator therapy. Midodrine use with pulmonary vasodilator therapy is associated with increased mortality in the POPH population. Further study of the safety of combined midodrine and pulmonary vasodilator use in POPH is needed along with exploration of more selective pulmonary vasodilators.

Cognitive Functioning Influences Mortality Risk Among Older Adults with COPD.

This study utilized the 1999-2002 National Health and Nutrition Examination Survey (NHANES) and the respiratory mortality data of noninstitutionalized US adults aged over 65 years. Survival curves showing the combined effect of cognitive decline and COPD using the Kaplan-Meier product-limit method to estimate the percent survival of the subject at each point in time were used. The final sample included 2013 older adults, with 39.1% showing low cognitive performance and 12.7% having COPD. Those with low cognitive performance were older, less educated, had lower income, were more likely to be racial/ethnic minorities, and had a history of cardiovascular diseases (CVD); they were also more likely to have COPD or chronic kidney disease (CKD). The adjusted hazard ratio for respiratory-related mortality risk was highest for individuals with both COPD and low cognitive performance (hazards ratio = 8.53), people with COPD alone also had a higher respiratory-related mortality risk (hazards ratio = 4.92), but low cognitive performance alone did not significantly increase respiratory-related mortality risk. These findings provide clearer insights into how cognitive impairment affects mortality risk in older adults with COPD and we discuss potential strategies to address this dual chronic health challenge effectively.

Psoriasis Risk With Immune Checkpoint Inhibitors

Immune checkpoint inhibitors (ICIs) are recognized as revolutionary cancer therapies but have raised concerns about immune-related adverse events, including the development of autoimmune diseases. To evaluate the psoriasis risk associated with the use of ICIs in patients with cancer. This nationwide cohort study with a target trial emulation design used data from the Taiwan National Health Insurance database and the Taiwan Cancer Registry. The participants included were patients who received antineoplastic medications for cancer at stages III and IV between January 1, 2019, and June 30, 2021. Data were analyzed from May 2023 to July 2024. Patients treated with ICIs were classified as ICI users, while those who received chemotherapy or targeted therapies were categorized as non-ICI users. The primary outcome was the incidence of psoriasis during the follow-up period. Stabilized inverse probability of treatment weighting (IPTW) was used to mitigate potential confounders. Cox and Fine-Gray hazard models were used to calculate hazard ratios (HRs) for psoriasis risk between groups. Of 135 230 patients who received antineoplastic medications (mean [SD] age, 62.94 [13.01] years; 45.1% female), 3188 patients were eligible for the ICI user group, while 132 042 patients were eligible for the non-ICI user group. ICI users experienced a higher incidence of psoriasis at 5.76 cases per 1000 person-years, compared to 1.44 cases in the non-ICI group. After adjusting for demographics and comorbidities, ICI users were found to have a 2-fold increase in the risk of developing psoriasis (IPTW-adjusted HR, 3.31; IPTW-adjusted subdistribution HR, 2.43). Both as-started design and on-treatment design showed consistent findings, and the results were consistent and robust across all follow-up intervals and all sensitivity analyses. In this cohort study, patients with cancer treated with ICIs faced an increased risk of psoriasis. Medical professionals should be aware of the potential adverse effects of immunotherapy to ensure optimal cancer care.

Remnant cholesterol, not LDL cholesterol, explains peripheral artery disease risk conferred by apolipoprotein B: a cohort study

Abstract Background Elevated apolipoprotein B (apoB)-containing lipoproteins (=remnants + low-density lipoproteins [LDL]) are a major risk factor for atherosclerotic cardiovascular disease, including peripheral artery disease (PAD) and myocardial infarction. We tested the hypothesis that remnants and LDL both explain part of the increased risk of PAD conferred by elevated apoB-containing lipoproteins. For comparison, we also studied risk of chronic limb-threatening ischemia and myocardial infarction. Methods ApoB, remnant cholesterol, and LDL cholesterol were measured in 93,461 individuals without statin use at baseline from the Copenhagen General Population Study (2003-2015). During up to 15 years of follow-up, 1,207 had PAD, 552 had chronic limb threatening ischemia, and 2,022 had myocardial infarction in the national Danish Patient Registry. Remnant and LDL cholesterol were calculated from a standard-lipid profile. Remnant and LDL particle counts were additionally measured with nuclear magnetic resonance spectroscopy in 25,347 of the individuals. Results were replicated in 302,167 individuals without statin use from the UK Biobank (2004-2010). Results In the Copenhagen General Population Study, multivariable adjusted hazard ratios for risk of PAD per 1 mmol/L (39 mg/dL) increment in remnant and LDL cholesterol were 1.9 (95% confidence interval: 1.5-2.4) and 1.1 (1.0-1.2), respectively; corresponding results in the UK Biobank were 1.7 (1.4-2.1) and 0.9 (0.9-1.0), respectively. In the association from elevated apoB to increased risk of PAD, remnant and LDL cholesterol explained 73% (32-100%) and 8% (0-46%), respectively; corresponding results were 63% (30-100%) and 0% (0-33%) for risk of chronic limb-threatening ischemia, and 41% (27-55%) and 54% (38-70%) for risk of myocardial infarction; results for remnant and LDL particle counts corroborated these findings. Conclusions PAD risk conferred by elevated apoB-containing lipoproteins was explained mainly by elevated remnants, while myocardial infarction risk was explained by both elevated remnants and LDL.

Navicular Drop Height Asymmetry as an Intrinsic Risk Factor for Lower Limb Injury in Male Recreational Athletes

Morphological and functional asymmetry of the lower limbs is a well-recognized factor contributing to musculoskeletal injuries among athletes across different levels. However, limited research exists on evaluating foot mobility asymmetry as a potential predictor of such injuries. This study aimed to (1) assess the frequency of foot mobility asymmetries among amateur athletes, (2) investigate the predictive value of foot mobility asymmetry (measured via navicular height drop) for injury risk, and (3) explore the relationship between foot type and injury occurrence. A cross-sectional sampling method was employed to select 45 physically active male amateur athletes (runners and team sports practitioners) from a university. Injury history was retrospectively recorded, and a modified navicular drop test was conducted to classify foot arch height. The predictive power of navicular height drop asymmetry was analyzed using ROC curves, and the relationship between foot type (neutral and defective combinations—pronated or supinated) and injury occurrence was examined using chi-square tests for independence. Multiple logistic regression was applied to calculate injury risk odds ratios across different foot type subgroups. The results revealed a significant frequency (51.1%) of participants with at least one defective foot, including 31.1% with one neutral and one defective foot and 20% with both feet defective. Navicular height drop asymmetry emerged as a valuable predictor of injuries, with a 36% asymmetry identified as the cut-off for increased injury risk (AUC = 0.832, 95% CI: 0.691–0.973, p &lt; 0.001). A significant relationship was found between foot type and injury occurrence. Only one out of 22 participants with neutral feet (4.55%) experienced an injury, compared to 9 out of 14 (64.29%) with one neutral and one defective foot and 5 out of 9 (55.56%) with both feet defective. These differences were statistically significant (χ2 = 16.24, p &lt; 0.001, Cramer’s V = 0.60). The odds ratio for injury risk was 37.8 (p = 0.016) for those with asymmetry (one neutral and one defective foot) and 26.3 (p = 0.102) for those with both feet defective, compared to participants with both feet neutral. In clinical practice, these findings suggest that routine screenings for physically active individuals should incorporate foot mobility asymmetry assessment. However, it is essential to integrate this factor with other risk indicators. For individuals exhibiting high asymmetry, general foot defect correction programs may be beneficial, but injury prevention strategies should adopt a more comprehensive approach, focusing on overall fitness and tailored interventions for high-risk individuals.

Dietary Inflammatory Index is associated with periodontitis risk in pregnant women with gestational diabetes mellitus

Recent studies suggest a link between periodontitis and the Dietary Inflammatory Index (DII). We hypothesize that a more proinflammatory diet is associated with periodontitis risk in pregnant women with gestational diabetes mellitus (GDM). This study aimed to explore the association between DII scores and periodontitis risk in GDM women. In this cross-sectional study, 302 eligible GDM women from a Maternal and Child Health Hospital were enrolled between February and July 2023. DII scores were calculated based on dietary intake data collected using a validated semiquantitative food frequency questionnaire. Periodontal health was assessed through periodontal parameters including bleeding on probing, probing depth, and clinical attachment loss. Logistic regression models were employed to evaluate the odds ratios (ORs) for periodontitis risk across DII tertiles. Our study found that the prevalence of periodontitis across the DII tertiles 1, 2, and 3 was 34.7%, 56.4%, and 54.0%, respectively. Comparing the highest DII tertile (tertile 3) with the lowest (tertile 1), a significant association was found between higher DII scores and periodontitis risk (univariate OR: 2.21; 95% CI: 1.25, 3.90; P = .006), which remained significant in the fully adjusted model (adjusted OR: 2.30; 95% CI: 1.21, 4.37; P = .011). In conclusion, elevated DII scores are associated with an increased risk of periodontitis, underscoring the crucial role of a proinflammatory diet in periodontitis progression. Future well-designed experimental studies are needed to verify if tailored dietary strategies can effectively reduce periodontitis risk among pregnant women with GDM.