Risk Population Research Articles

The effect of body mass index on stroke prognosis: a systematic review and meta-analysis of 32 cohort studies with 330353 patients.

Many studies have explored the impact of body mass index (BMI) on stroke prognosis, yet findings remain inconsistent. The aims of this study were to conduct a systematic review and meta-analyses to summarize the existing evidence on BMI and stroke outcomes. PubMed, Web of Science, Embase, The Cochrane Library, CNKI, CBM, Wanfang Database and VIP Database were systematically searched from inception to Jan.1st, 2023. Cohort studies were included if they reported on a population of patients with stroke, evaluated BMI on stroke outcomes (mortality/recurrence/score of mRs) and reported original data. Data extraction and quality assessment were independently undertaken by two reviewers. Stata 16.0 software was used for meta-analysis. 32 studies involving 330,353 patients (5 Chinese language articles) were included in the analysis. The proportion of underweight, overweight, and obese patients was 1.85%, 18.2%, and 15.6%, respectively. Compared with normal weight, being underweight was associated with an increased risk of mortality (RR 1.78, 95% CI 1.60-1.96), poor functional outcomes defined as modified Rankin scale ≥3 (RR 1.33, 95% CI 1.22-1.45), and stroke recurrence (RR 1.19, 95% CI 1.04-1.37). Being overweight but not obese was associated with reduced mortality (RR 0.81, 95% CI 0.74-0.89) and better functional outcomes (RR 0.92, 95% CI 0.89-0.96), but did not alter the risk of stroke recurrence (RR 1.03, 95% CI 0.90-1.17). Obesity was associated with lower risk of mortality (RR 0.76, 95% CI 0.72-0.81), and better functional outcomes (RR 0.89, 95% CI 0.84-0.94). Our findings indicate that in patients with stroke, being underweight is associated with an increased risk of mortality, poor functional outcomes, and stroke recurrence. In contrast, being overweight but not obese, or being obese, was associated with a decreased risk of mortality and better functional outcomes. This are consistent with the obesity paradox in stroke, whereby obesity increases stroke risk in the general population but is associated with improved outcome in patients suffering stroke.Key Words body mass index; stroke; prognosis; meta-analysis.

Abstract PO3-27-09: A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population

Abstract INTRODUCTION An estimated 13% of women will be diagnosed with breast cancer at some point in their lifetime. There are non-modifiable and modifiable risk factors including family history, genetics, obesity, and estrogen exposure. Interventions that reduce breast cancer risk and/or mortality include screening, chemoprevention, and lifestyle modification. A recent national survey shows that there are significant gaps in providing breast cancer prevention care for female Veterans. We describe the creation of a multi-disciplinary telehealth clinic aimed at reducing breast cancer risk in a high-risk female Veteran population. METHODS The breast cancer prevention clinic (BCPC) team consists of a medical oncologist, geneticist, genetic counselor, dietician, psychologist, and nurse navigator. High risk women are identified through a combination of screening questionnaires at annual mammography and genetics or primary care provider (PCP) evaluation, then referred to the clinic. Criteria for referral include age >=35, Gail 5 year risk >= 1.7%, Tyrer-Cuzick 10 year risk >= 5%, or history of thoracic radiation. At the BCPC telehealth visit, the medical oncologist makes individualized recommendations about chemoprevention by discussing the risks and possible complications of therapy. Use of screening magnetic resonance imaging (MRI) is also recommended to women with lifetime Tyrer-Cuzick score > 20%. Within the same visit, patients meet with a dietician to discuss nutrition modification, and a psychologist to address psychosocial barriers to lifestyle change. Those who start chemoprevention attend a 3 month follow-up with a nurse navigator to discuss tolerability and side effects. Subsequently, the patient’s PCP becomes responsible for management of chemoprevention and annual breast MRI. RESULTS Between January and December 2022, 33 patients were seen in BCPC. Patients had an average age of 52 years (range 42-70), Gail 5-year score of 2.53%, Tyrer-Cuzick 10-year score of 6.65%, and Tyrer-Cuzick lifetime score of 21.5%. Thirteen patients (39.4%) started chemoprevention, the majority of which were selective estrogen receptor modulators (SERM). Nine reported starting the medication at the 3 month follow-up appointment. The most reported side effect was hot flashes in 67%, although only the majority had mild symptoms. Three reported weight gain and one reported vaginal dryness. None reported worsening arthralgia or fatigue. Despite the low incidence of severe symptoms, only 3 continued to fill the medication at the time of chart review in August 2023. Twenty (60.6%) patients did not initiate chemoprevention. Four (20%) did not qualify due to cardiovascular or thrombotic risk factors, and three (15%) did not qualify due to concurrent use of hormone replacement therapy. Two (10%) elected not to start chemoprevention because they were planning for risk reducing mastectomies. Eleven (55%) did not initiate chemoprevention due to patient preferences and concern for side effects. Twenty-eight patients were recommended to obtain breast MRI in addition to mammogram for yearly screening. At time of chart review, 15 had at least one screening breast MRI ordered by PCP after BCPC visit, with 10 MRIs performed. CONCLUSIONS The unique interdisciplinary model of our breast cancer prevention clinic allows for a comprehensive and personalized evaluation for high-risk female Veterans on interventions to reduce their breast cancer risk. However, the current model does not ensure long-term compliance with these interventions. Studies have shown that more frequent/short-term follow up may improve compliance with endocrine therapies. Future directions include clinic expansion and providing additional follow-up with the multidisciplinary team to promote continued adherence to BCPC interventions. Citation Format: Hanqing Shang, Sarah Ansari, Shweta Dhar, Mahdieh Irranejadparizi, Stacey Edwards, Jessica Honkomp, Meagan Siehr, Bethany Aiena, Mary Nikityn, Diana Bearden, Deleene Menefee, Sita Bushan. A Multidisciplinary Telehealth Approach to Breast Cancer Prevention in a Veteran Population [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-27-09.

Association between waist-hip ratio and Female Infertility in the United States: Data from National Health and Nutrition Examination Survey 2017-2020.

Obesity has previously been correlated with an elevated risk of reproductive system diseases in women. The waist-hip ratio (WHR) has been shown to be correlated with visceral fat, making it one of the most commonly used indicators of abdominal obesity. However, little is known about the relationship between WHR and infertility. Therefore, the aim of this study was to evaluate the effect of the WHR on infertility in women of childbearing age. The study used cross-sectional data from women aged 20 to 45 who participated in the National Health and Nutrition Examination Survey (NHANES), which was conducted between 2017 and 2020. We collected details of their Waist Circumference, hip Circumference, fertility status and several other essential variables. We used multivariate logistic regression analysis and subgroup analyses to assess the association between WHR and infertility. There were 976 participants, with 12.0% (117/976) who experienced infertility. After adjusting for potential confounding factors, our multivariate logistic regression analysis revealed that every 0.1 unit increase in WHR resulted in a more than 35% higher risk of infertility (OR (95% CI): 1.35 (1.01~1.81), P = 0.043). Compared to the group with WHR <0.85, the risk of infertility increased in the group with WHR ≥0.85, with an adjusted odds ratio (OR) of 1.74 (95% CI 1.06~2.85). When WHR was treated as a continuous variable, it was observed that each 0.1 unit increase in WHR was associated with a relatively high risk in the secondary infertility population after adjusting all covariates, with an OR of 1.66 (95% CI 1.14~2.40, P = 0.01). When WHR was analyzed as a categorical variable, the group with WHR≥0.85 exhibited a significantly higher risk of secondary infertility than the group with WHR<0.85, with the OR of 2.75 (95% CI: 1.35-5.59, P = 0.01) after adjusting for all covariates. Furthermore, the interaction analysis indicated that there was a significant interaction between age status on WHR and the risk of infertility. WHR showed a positive correlation with the risk of infertility. This study highlights the importance of effectively managing abdominal fat and promoting the maintenance of optimal WHR levels to mitigate the progression of infertility, particularly for younger women.

Anal dysplasia and anal cancer screening practices among liver transplant centers in the United States: Results of an online survey.

Solid organ transplant recipients are at an increased risk for anogenital Human Papillomavirus (HPV)-related disease, including anal high-grade squamous intraepithelial lesions (HSIL) and anal squamous cell cancer (ASCC). Guidelines for ASCC screening in transplant recipients are limited. Our aim was to understand current practice of ASCC screening in adult liver transplant (LT) candidates and recipients at transplant centers across the United States. We surveyed medical directors of 113 LT centers across the United States which had publicly available contact information. The survey evaluated center perceptions on cancer and HPV disease risk in transplant populations, ASCC screening, barriers and facilitators for ASCC screening and HPV vaccination practices. We received 26/113 (23%) responses, of which 24 were complete and included in the analysis. Eleven of 24 (46%) centers reported screening for ASCC and 3/24 (12.5%) centers reported having formal guidelines. Centers who perform ASCC screening were more likely to perform transplants in people living with HIV and were more aware of the burden of HPV disease in transplant populations. All respondents believed that additional data on the impact of screening on ASCC incidence would support screening decisions. Increased access to specialists for screening/high-resolution anoscopy was also perceived as a facilitator. Only 7/24 (29%) centers regularly evaluated HPV vaccination status of their patients. This national survey of LT centers reveals non-standardized ASCC screening practices, and identified data, educational and resource needs to improve prevention of ASCC in this population.

Abstract PO3-29-02: Single Nucleotide Polymorphisms (SNPs) in Inflammatory Pathways Associated with Body Mass Index (BMI) and Breast Cancer (BC) Risk: A Scoping Review

Abstract Background: BMI is a risk for BC, with inflammation as a possible link. We conducted a scoping review assessing SNPs in inflammatory pathways posited to modify BC risk by BMI. Design: We followed PRISMA guidelines for scoping reviews. Pubmed, Medline and OVID databases were interrogated for publications between 1/2000-12/2023 using search terms “breast cancer” AND [BMI OR “body mass index” OR elevated BMI OR obesity] AND [SNP OR “single nucleotide polymorphism” OR polymorphism OR mutation] AND [inflammation OR cytokines OR IL-1 OR IL-2 OR IL-4 OR IL-6 OR IL-8 OR IL-10 OR IL-12 OR TNF-A or TGFB OR CRP]. A single reviewer assessed 67 unique publications and determined that 17 met inclusion criteria as a case control or cohort study. Two reviewers extracted the following data: demographics, SNP, number of cases and controls by BMI. Disagreements were resolved by consensus with a third reviewer. High BMI was defined by each study using accepted levels within their population: ≥25 (United States, Mexico) or ≥22 (Korea). Unadjusted odds ratios (OR) for BC risk were calculated by SNP stratified by BMI. Results: Data were extractable from 5 studies, all case controls. We requested patient level data for 12 studies from the corresponding author, without response. When stratified by BMI, we detected heterogenous effects of SNPs on BC risk (Table 1, only significant or trending correlations presented). With high BMI, IL-1β-31 TT (OR 2.19, 0.86-5.59) and GC/CC (OR 0.81, 0.68-0.97) correlated with BC risk (p &amp;lt; 0.05). With normal BMI, STAT3 rs1026916 GA (OR 0.78, 0.62-0.96) and JAK2 rs1536800 TT (OR 1.93, 1.07-3.48) correlated with BC risk. Additional SNPs trended to correlate with BC risk (0.05 &amp;lt; mo &amp;gt;≤&amp;lt;/mo &amp;gt;&amp;lt;/math &amp;gt;"&amp;gt;≤ p &amp;lt; mo &amp;gt;≤&amp;lt;/mo &amp;gt;&amp;lt;/math &amp;gt;"&amp;gt;≤ 0.10) by BMI. Conclusion: The association of inflammatory SNPs and BC risk is complex and can be both protective and predisposing to BC risk, with BMI modifying SNP risk. Future research can assess SNPs and BC risk in more diverse populations. Citation Format: Erina Quinn, Braelyn Wekwerth, Maya Doyle, Ruth Carlos. Single Nucleotide Polymorphisms (SNPs) in Inflammatory Pathways Associated with Body Mass Index (BMI) and Breast Cancer (BC) Risk: A Scoping Review [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-29-02.

Abstract PO4-11-01: Validation of a CARG-BC-based score for the prediction of therapy-induced toxicities in patients with metastatic breast cancer

Abstract Introduction Prediction of treatment-induced toxicities is important in order to tailor and adjust oncologic therapies. As limited tools exist to predict the risk of therapy-induced toxicities in patients with metastatic cancer, we aimed to develop and to validate a score for the prediction of therapy-induced toxicities in patients with metastatic breast cancer treated with chemotherapy and immunotherapy. The score was based on the Cancer and Aging Research Group-Breast Cancer early-stage breast cancer score for prediction of chemotherapy-induced toxicities. Methods All patients treated for metastatic breast cancer with chemotherapy and immunotherapy at the Department of Gynecology, Obstetrics and Reproductive Medicine at Saarland University Hospital between 01/2014 and 05/2022 were included in this retrospective study. Patient characteristics and therapy-relevant oncological parameters were recorded, as well as therapy-induced toxicities (recorded according to CTC), hospitalization rates, toxicity-related dose reductions and therapy discontinuations. In the first cohort (development cohort), a new score for the prediction of therapy-induced toxicities was developed using ROC analysis and multivariate analysis based on the CARG-BC score. In the second cohort (validation cohort), this was validated using Pearson’s correlation coefficient. Results Data from 32 patients were analyzed for the development cohort, and inclusion of 102 patients contributed to the validation cohort. The newly developed score consists of seven independent factors for the prediction of toxicities ≥ CTC III° and includes the parameters “presence of visceral metastases” (yes/no), “received previous lines of therapy” (yes/no), “limited mobility/able to walk less than one kilometer” (yes/no), “a fall in the last six months” (yes/no), “social interactions” (yes/no), “pretherapeutic change of transaminases” (yes/no) and “pretherapeutic change of hemoglobin” (hemoglobin &amp;lt;/&amp;gt; 10 g/dl). Based on the results, three risk groups were defined (low (0-2), medium (3-5) and high (6-15) risk). 28% of patients were in the low-risk group, 37% in the intermediate-risk group and 34% in the high-risk group. Overall, 49% of the patients had toxicities ≥ CTC III°. Distributed across the subgroups, these occurred in 14% in the low-risk group, 34% in the intermediate-risk group and in 52% in the high-risk group (p ≤ 0.01). Risk score results showed a correlation with treatment discontinuation and hospitalization rate (p ≤ 0.01), but not with dose reduction (p = 0.77). Conclusion The available data show a correlation between the risk score results and the occurrence of systemic therapy-induced toxicities in patients with metastatic breast cancer. The results can be used to further identify risk populations and to systematically apply preventive and supportive measures in order to approve quality of life in patients with metastatic breast cancer. Citation Format: Julia SM Zimmermann, Aylin Aygün, Askin Kaya, Marc P Radosa, Christoph G Radosa, Erich F Solomayer, Julia C Radosa. Validation of a CARG-BC-based score for the prediction of therapy-induced toxicities in patients with metastatic breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-11-01.

Abstract PO1-02-05: An exploratory comparison of MINDACT and TAILORx genomic risk proportions and outcomes in patients with HR+/HER2-, node-negative early-stage breast cancer, stratified by clinical risk

Abstract Introduction: Genomic tests provide physicians with critical information to evaluate the risk of distant metastasis and inform treatment plans by identifying those patients who may safely avoid chemotherapy (CT). The 70-gene signature (MammaPrint, MP) through the MINDACT trial and the 21-gene signature (Oncotype DX, ODx) through the TAILORx trial are the only tests validated with level 1A evidence that can be used for CT de-escalation decisions. Differences in trial design have made direct comparison of results difficult. We provide a comparison of MammaPrint and ODx genomic risk distributions and associated survival in patients with HR+/HER2-, node-negative (N0) early-stage breast cancer (EBC), stratified by clinical risk. Methods: Data from the MINDACT 2021 publication in The Lancet Oncology and landmark TAILORx 2019 publication in The New England Journal of Medicine were reviewed, in addition to publicly available data submitted to the Dutch Health Technology Assessment (HTA) authorities regarding survival data in patients with clinical High Risk in TAILORx. In MINDACT, patients were randomized based on both clinical (as per MINDACT definition) and genomic risk (clinical high/MP low, randomized to treatment according to clinical risk [i.e. CT] vs treatment according to MammaPrint risk [i.e. no CT]), while in TAILORx randomization was based on genomic risk alone. In TAILORx, enrollment for the population in the RS 11–25 group was enriched by 73% to account for the larger than expected non-adherence to randomized treatment plan based on the ODx results, as described in the original publication. This enrichment was only done for the RS 11–25 group. In this analysis, this enrollment enrichment was removed by applying the same proportional 73% corrective factor to the RS 11–25 group. Outcome data are reported for Overall Survival (OS), the only comparable endpoint used in both trials. Results: This explorative comparison focuses on patients with HR+/HER2- and N0 EBC in MINDACT (n=4,225) and TAILORx (n=6,686, without population enrichment). Similar proportions of patients identified as candidates for CT de-escalation (MP Low Risk or ODx RS≤25) were observed in this population of MINDACT (75%) and TAILORx (80%) when removing the RS 11–25 population enrichment in TAILORx (Table). In clinical high risk patients, the proportion with genomic low risk of distant metastasis were also comparable between MINDACT (55%) and TAILORx (63%) (Table). In the original clinical high risk but MammaPrint Low Risk population treated without CT in MINDACT the reported 8-year OS was 93.9%. In TAILORx, the comparable population of patients (ie. clinical high risk, low genomic risk, not treated with CT) had a 9-year OS of 89.2% in the RS 0–10 group and 91.6% in the RS 11–25 group (Table). Conclusions: Accounting for differences in trial design and population, comparable proportions of patients with genomic low risk results were observed between MP and ODx, justifying similar rates of CT de-escalation. Patients with clinical high risk tumors who are MammaPrint Low Risk had an excellent survival at 8 years. Genomic risk distributions and associated OS in HR+HER2- N0 patients in MINDACT and TAILORx MP, MammaPrint; OS, Overall Survival; RS, Recurrence Score. Number of patients in the TAILORx RS 11 – 25 group are adjusted to remove the proportional enrichment in the trial. OS data presented per original MINDACT and TAILORx populations. Citation Format: Patrick Neven, Josephine Lopes-Cardozo, Fatima Cardoso, Laura Van ’t Veer. An exploratory comparison of MINDACT and TAILORx genomic risk proportions and outcomes in patients with HR+/HER2-, node-negative early-stage breast cancer, stratified by clinical risk [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-02-05.

Statins Do Not Significantly Affect Oxidative Nitrosative Stress Biomarkers in the PREVENT Randomized Clinical Trial.

Preventing Anthracycline Cardiovascular Toxicity with Statins (PREVENT) (NCT01988571) randomized breast cancer or lymphoma patients receiving anthracyclines to atorvastatin 40 mg daily or placebo. We evaluated the effects of atorvastatin on oxidative and nitrosative stress biomarkers, and explored whether these biomarkers could explain the lack of effect of atorvastatin on LVEF in PREVENT. Blood samples were collected and cardiac magnetic resonance imaging was performed prior to doxorubicin initiation and at 6 and 24 months. Thirteen biomarkers (arginine-nitric oxide metabolites, paraoxonase-1 [PON-1] activity, and myeloperoxidase) were measured. Dimensionality reduction using principal component analysis was used to define biomarker clusters. Linear mixed-effects models determined the changes in biomarkers over time according to treatment group. Mediation analysis determined if biomarker clusters explained the lack of effect of atorvastatin on LVEF. Among 202 participants with available biomarkers, median age was 53 years; 86.6% had breast cancer; median LVEF was 62%. Cluster 1 levels, reflecting arginine methylation metabolites, were lower over time with atorvastatin, although this was not statistically significant (p=0.081); cluster 2 levels, reflecting PON-1 activity, were significantly lower with atorvastatin (p=0.024). There were no significant changes in other biomarker clusters (p>0.05). Biomarker clusters did not mediate an effect of atorvastatin on LVEF (p>0.05) Conclusions: Atorvastatin demonstrated very modest effects on oxidative/nitrosative stress biomarkers in this low cardiovascular risk population. Our findings provide potential mechanistic insight into the lack of effect of atorvastatin on LVEF in the PREVENT trial.

Abstract PO3-08-01: Decision curve analysis to compare breast cancer risk predictions for a polygenic integrated clinical risk model with those of a gold standard

Abstract Risk-based guidelines have been developed to provide advice on options that are available to women who are at increased risk of breast cancer. We and others are focused on improving risk prediction models for general population use. For breast cancer, polygenic risk has been identified as important for risk prediction, especially when combined with clinical risk factors such as family history, anthropometric measures, breast imaging measures, and hormonal and reproductive risk factors. When comparing the performance of risk prediction models, the AUC is most often used but it focuses on performance in terms of distinguishing between affected and unaffected individuals and does not take into account differences in the specificity (true negative rate) and sensitivity (true positive rate) of the models being compared. In contrast, decision curve analysis takes sensitivity and specificity into account and enables the comparison of the net benefit of risk prediction tools at the clinical risk thresholds that are used to guide clinical management decisions. Herein, we use decision curve analysis to compare breast cancer risk prediction guidelines for BRISK and the Breast Cancer Risk Assessment Tool (BCRAT) in the UK Biobank, and for BRISK and IBIS version 7 in the Nurses’ Health Study. We evaluated the net benefit at the 5-year risk thresholds (1.67% and 3%) that are used to guide clinical management decisions around risk-reducing medication and at the remaining lifetime risk of 20% that is used to guide supplemental MRI surveillance. In the UK Biobank, BRISK showed a net benefit over BCRAT at the 5-year risk thresholds of 1.67% and 3.0%. The AUCs were 0.649 (95% CI = 0.640, 0.695) for BRISK and 0.567 (95% CI = 0.556, 0.577) for BCRAT and showed that, overall, BRISK discriminated between affected and unaffected women better than BCRAT (P &amp;lt; 0.001). In the Nurses’ Health Study, BRISK showed a net benefit over IBIS at the remaining lifetime risk threshold of 20%. The AUCs were 0.647; 95% CI = 0.627, 0.668 for BRISK and 0.571; 95% CI = 0.546, 0.595 for IBIS, a statistically significant improvement for BRISK over IBIS (P &amp;lt; 0.0001). We also looked at sensitivity, specificity, positive predictive value and negative predictive value even though these risk models are one-step removed from breast cancer diagnosis by screening/risk-reduction options. The positive predictive values are higher for the BRISK (27.1%) model compared to BCRAT (5.5%) in the UK Biobank dataset and higher for BRISK (15.4%) compared to IBISv7 (14.0%) in the Nurses’ dataset. We have shown the application of a statistical tool that can be used to directly compare risk models at clinically relevant thresholds. We have shown that BRISK, which comprises polygenic risk and clinical risk factors, shows higher net benefit at both 1.67% and 3% thresholds compared to BCRAT and at 20% remaining lifetime risk for IBIS version 7. In breast cancer risk prediction, a tool with high specificity (and therefore a necessary trade-off for low sensitivity) is preferred because we do not want to incorrectly classify women as not being at high risk and deny them the opportunity for intervention in the form of more frequent screening, alternative modes of screening or risk-reducing medication. This improvement in general population risk stratification that BRISK can provide has the potential to have a clinically significant effect on women’s health. Citation Format: Erika Spaeth, Bernard A Rosner, Gill Dite. Decision curve analysis to compare breast cancer risk predictions for a polygenic integrated clinical risk model with those of a gold standard [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-08-01.

Prevalence of Respiratory Viruses in Children With Acute Respiratory Infections in Shanghai, China, From 2013 to 2022.

A variety of viruses can cause acute respiratory infections (ARIs), resulting in a high disease burden worldwide. To explore the dominant viruses and their prevalence characteristics in children with ARIs, comprehensive surveillance was carried out in the Pudong New Area of Shanghai. Between January 2013 and December 2022, the basic and clinical information, and respiratory tract specimens of 0-14 years old children with ARIs were collected in five sentinel hospitals in Shanghai Pudong. Each specimen was tested for eight respiratory viruses, and the positive rates of different age groups, case types (inpatient or outpatient) were analyzed. In our study, 30.67% (1294/4219) children with ARIs were positive for at least one virus. Influenza virus (IFV) was the most commonly detected respiratory virus (349/4219, 8.27%), followed by respiratory syncytial virus (RSV) (217/4219, 5.14%), para-influenza virus (PIV) (215/4219, 5.10%), and human coronavirus (HCoV, including 229E, OC43, NL63, and HKU1) (184/4219, 4.36%). IFV was the leading respiratory virus in outpatients aged 5-14 years (201/1673, 12.01%); RSV was the most prevalent respiratory virus in both inpatients (61/238, 25.63%) and outpatients (4/50, 8.00%) for ARI patients aged <6 months old. For PIV, HMPV, HCoV, and HRV, the risk of infection usually was higher among young children. Co-infection with more than two viruses was seen in 3.25% (137/4219). IFV and RSV played important roles in ARIs among children, but the risk populations were different. There are needs for targeted diagnosis and treatment and necessary immunization and non-pharmaceutical interventions.

Dietary vitamin B6 intake and stroke are negatively associated in adults: A cross-sectional study from the NHANES

BackgroundThe relationship between dietary vitamin B6 and stroke risk is controversial; thus, we analyzed their correlation using data from the National Health and Nutrition Examination Survey (NHANES). MethodData from 2005 to 2018 were collected from the NHANES database. Two 24-h dietary recalls and a standard questionnaire were used to evaluate vitamin B6 intake and stroke prevalence. We used logistic regression models to estimate the association between dietary vitamin B6 intake and stroke risk and investigated the nonlinear relationship between them using a restricted cubic spline (RCS). Sensitivity analysis was conducted using propensity score matching (PSM). ResultsAmong 24,214 participants, 921 were patients diagnosed with stroke, while 23,293 were without stroke. The multivariate logistic regression model revealed that individuals in the highest quartile of vitamin B6 consumption had a significantly lower stroke risk than those in the lowest quartile under the fully adjusted model (OR: 0.48, 95 % CI: 0.35–0.66, P < 0.001). Subgroup analyses showed that dietary intake of vitamin B6 was a significant protective factor against stroke risk in different populations, with the most pronounced effect in the population engaging in moderate-intensity physical activity (OR: 0.34, 95%CI: 0.20–0.57). The RCS models revealed a non-linear L-shaped relationship (P for nonlinearity = 0.006) between stroke and dietary intake of vitamin B6. ConclusionsOur study shows that an increased intake of vitamin B6 could be an effective strategy in reducing the risk of stroke.

Prognostic implications of heart failure stages among Chinese community populations: insight from a nationwide population-based study

In light of high burden of heart failure (HF) in China, studies of prognostic implication of HF stages are important. We aimed to evaluate the relationship between HF stages and mortality risk in Chinese community populations. Nationwide representative populations aged ≥35 years (n=23,284, mean age 56.9 years, women 53.2%) were enrolled from 2012 to 2016. According to the international HF guidelines, participants were divided into stage A, B and C, and those who did not qualify these stages were categorized as apparently-healthy group. Association between HF stages and all-cause, cardiovascular [CV] and non-CV death was evaluated using multivariable-adjusted Cox proportional regression analysis. During a median follow-up of 4.7 years (109,902.8 person-years), 1314 deaths occurred. Age-adjusted incidence rate of all-cause death was 5.3 in apparently-healthy, 7.8 in stage A, 8.6 in stage B and 24.6 in stage C groups per 1000 person-years. In reference to apparently-healthy group, adjusted hazard ratio for all-cause death was 1.90 (95% CI: 1.47-2.45), 2.43 (95% CI: 1.89-3.13) and 6.40 (95% CI: 4.56-8.99) for stage A, B and C. Advancing HF stages were associated with increasing risks for all-cause, CV and non-CV death (P-trend <0.05). For all-cause death, population attributable fraction due to stage A, B and C were 21.2%, 33.4% and 4.9%, accounting for 1,933,385, 3,045,993 and 446,867 deaths in China in2018. Advancing HF stages were associated with increasing risk mortality. Development and implementation of early screening and targeted interventions are urgently needed to reduce HF burdens in China. This work was supported by the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (grant 2017-I2M-1-004), the Projects in the Chinese National Science & Technology Pillar Program during the Twelfth Five-year Plan Period (No.: 2011BAI11B01), and the Project Entrusted by the National Health Commission of the People's Republic of China (NHC2020-609).

Risk assessment of exposure to 12 kinds of mycotoxins through consumption of Pericarpium Citri Reticulatae collected from Three Gorges Reservoir area of China

A method for simultaneous determination of 12 mycotoxins in Pericarpium Citri Reticulataeby HPLC-MS/MS was established to analyze the residues of mycotoxins, inwhich from Three Gorges Reservoir area of China, including AFB1, AFB2, AFG1, AFG2, T-2, FB1, FB2, FB3, ZEN, OTA, OTB and DON.In addition, a probabilistic assessment model based on Monte Carlo simulation method was established in combination with pollution data, and the health risk assessment was carried out by the exposure limit method (MOE).The results showed that the method with strong specificity, good linearity and accurate recovery was established and could be used for the determination of 12 mycotoxins in Pericarpium Citri Reticulatae.In general, the total pollution rate of different degrees of pollution in the 36 batches of Pericarpium Citri Reticulatae sampleswas 75 %. It should be noted thatthe proportion of positive samplescontaminated by one toxin was the highest (59.26 %), and the detection rate of FB3 in Pericarpium Citri Reticulataewas the highest (66.67%), followed by AFG1 (44.44 %), indicating that the medicinal material polluted by AFG1 and AFB3 alone or simultaneously was more serious. Specifically, the detection rate of mycotoxins in Chongqing was the highest (92.31%) on account of the high temperature and humidity in Chongqing, followed by Southeast of Sichuan (83.33%) and West of Hubei (45.45%).On the other hand, the MOE of AFB1 and AFB2 calculated were both greater than 10000, indicating that the health risk of AFB1 and AFB2 exposure caused by taking Pericarpium Citri Reticulatae was low, but the risk of high intake population was higher than that of conventional intake population, which needed to be paid attention to. This study can provide a reference for the safety assessment of clinical medication of Pericarpium Citri Reticulatae inThree Gorges Reservoir area.

Combined sodium-glucose-transporters inhibitors and glucagon-like-peptide receptor agonist compared with monotherapy improves long-term survival: A Real-World Registry

BackgroundThe benefits of new glucose-lowering agents on cardiovascular disease have been demonstrated in randomized clinical trials. However, more evidence is required to assess the additive value of a combined therapy based on sodium-glucose transporter inhibitors (SGLT2i) and glucagon-like peptide receptor agonists (GLP1ra) in a real-world population. MethodsA non-concurrent prospective study was conducted using integrated electronic medical records from primary care and hospitals obtained through 'Big data' technologies in a healthy area in Galicia. The study involved patients who were given SGLT2i, GLP1ra, or both treatments between January 2018 and June 2022 and were categorized as either mono or combined therapy (SGLT2i, GLP1ra, or both). The cumulative risk for different events: hospitalization and/or mortality for a) coronary artery disease, b) heart failure, c) cerebrovascular accident, and all-cause mortality were represented by Kaplan Meier curves and multivariate Cox regression analysis to obtain the hazard rate (HR) and (95% confidence interval (CI)). Validation was performed in a subpopulation with a propensity score matching. ResultsThe patients (15,549) who were included were 68 (12) years old, with 41% of them being females and 46% experiencing obesity. The median (interquartile range) of follow-up was 19 (8-33) months. The Kaplan-Meier analysis determined that the cumulative risk for coronary artery disease and cerebrovascular accident events was similar among the 3 different therapy groups. However, the combined therapy vs. SGLT2i reduced the risk of, heart failure events (HR: 0.69 [95% CI; 0.56-0.87]) or all-cause mortality (HR: 0.68 [95% CI;0.54-0.86]). Multivariate Cox regression analysis, after matching with a propensity score, confirmed the benefits of combined therapy regarding SGLT2i or GLP1ra monotherapy. ConclusionCompared to SGLT2i or GLP1ra alone, combined therapy SGLT2i + GLP1ra reduces heart failure risk and all-cause mortality in a real-world population.

DARE-ISC model for prediction of 1-year ischaemic stroke risk in the general population and atrial fibrillation patients: a Danish nationwide cohort study

ObjectivesTo develop a risk assessment model (DAnish REgister Ischaemic Stroke Classifier, DARE-ISC) for predicting 1-year primary ischaemic stroke/systemic embolism (SE) in the general population. Secondly, to validate the accuracy DARE-ISC...

Exposure and health effects of perfluoroalkyl substances (PFAS): Insights from population surveys and risk assessment

Exposure and health effects of perfluoroalkyl substances (PFAS): Insights from population surveys and risk assessment

The Necessity of Type and Screen Result Prior to Proceeding to Operating Room for Scheduled Cesarean Delivery in a Low Hemorrhage Risk Population [ID 2683392

INTRODUCTION: Delays in the operating room (OR) on labor and delivery are common. This leads to inefficiency, patient, and physician dissatisfaction and financial ramifications. One root cause of OR delays involves waiting for type and screen results prior to wheels into the OR. Our objective was to determine whether a type and screen result is necessary prior to wheeling into the OR. METHODS: This was an IRB-approved retrospective cohort study conducted at a single state sponsored academic institution. Chart review was performed identifying all patients who had a scheduled cesarean delivery (CD) from August 1, 2022, through September 31, 2022. We identified all patients who received a blood transfusion intra-op or postoperatively. We excluded all patients who had a medium-risk hemorrhage score or greater. We then calculated timing of blood transfusion from wheels into the OR. RESULTS: We identified a total of 85 patients scheduled for CD. Of these, 7 patients required a blood transfusion, and 4/7 patients received a blood transfusion within 60 minutes of wheels into the OR. There were no patients with a low-risk hemorrhage score on admission who received a blood transfusion within 60 minutes of wheels into the OR. CONCLUSION: There were no patients with a low-risk hemorrhage score scheduled for CD required a blood transfusion within 60 minutes of wheels into the OR. This supports elimination of mandatory type and screen result prior to wheels in for patient scheduled for CD with a low-risk hemorrhage score.

The emergence and circulation of human immunodeficiency virus (HIV)-1 subtype C.

Introduction. Human immunodeficiency virus (HIV)-1 subtype C is the most prevalent globally and is thought to have originated in non-human primates in the Democratic Republic of Congo.Hypothesis/Gap Statement. Although the global dominance of HIV-1 subtype C is well established, a thorough understanding of its evolutionary history and transmission dynamics across various risk populations remains elusive. The current knowledge is insufficient to fully capture the global diversification and dissemination of this subtype.Aim. We for the first time sought to investigate the global evolutionary history and spatiotemporal dynamics of HIV-1 subtype C using a selection of maximum-likelihood-based phylodynamic approaches on a total of 1210 near full-length genomic sequences sampled from 32 countries, collected in 4 continents, with sampling dates between 1986-2019 among various risk groups were analysed.Methodology. We subsampled the HIV-1 subtype C genomic datasets based on continent and risk group traits, and performed nucleotide substitution model selection analysis, maximum likelihood (ML) phylogenetic reconstruction, phylogenetic tree topology similarity analysis, temporal signal analysis and traced the timings of viral spread both geographically and by risk group.Results. Based on the phylodynamic analyses of four datasets (full1210, locrisk626, loc562 and risk393), we inferred the time to the most recent common ancestor (TMRCA) in the 1930s and an evolutionary rate of 0.0023 substitutions per site per year. The total number of introduction events of HIV-1 subtype C between continents and between risk groups is estimated to be 71 and 115, respectively. The largest number of introductions occurred from Africa to Europe (n=32), from not-recorded to heterosexual (n=40) and from heterosexual to not-recorded (n=51) risk groups.Conclusion. Our results emphasize that HIV subtype C has mainly spread from Africa to Europe, likely through heterosexual transmission.

Population Based Electronic Surveillance Tool to Identify Risk Factors for Developing Cervical Cancer- A Study Protocol

Background: Cervical cancer remains a significant global health concern, with well-established risk factors. Population-based electronic surveillance tools offer a promising avenue for identifying risk factors associated with cervical cancer development way before it becomes an actual concern for a woman. The objective of this study is to understand and to support the app- based decision-making tool for identifying risk factors of cervical cancer for the women between 30-60 years of age. Method: The study will be conducted in the selected Sampoorna Non-Communicable Diseases (NCD) clinics at Lucknow, Uttar Pradesh (UP). A rigorous review of database was conducted to summarize the evidence on informatics available for early identification of cervical cancer app. An app-based decision- making tool will be developed to identify and detect the high- risk population developing cervical cancer. The app then will be shared with health workers at Sampoorna clinics and will be capacitated for using it to collect real time data. Conclusion: The utilization of a population-based electronic surveillance tool will facilitate the identification of various risk factors contributing to cervical cancer development. The methodology process will help to comprehend the analysis providing the insights. This approach has the potential to enhance targeted interventions, public health policies, and personalized screening programs to mitigate the burden of cervical cancer. The objective of this paper is to understand and to support the design of dashboards for creating transparency and accountability.

Can prediction models for hospital readmission be improved by incorporating patient-reported outcome measures? A systematic review and narrative synthesis.

To investigate the roles, challenges, and implications of using patient-reported outcome measures (PROMs) in predicting the risk of hospital readmissions. We systematically searched four bibliometric databases for peer-reviewed studies published in English between 1 January 2000 and 15 June 2023 and used validated PROMs to predict readmission risks for adult populations. Reported studies were analysed and narratively synthesised in accordance with the CHARMS and PRISMA guidelines. Of the 2858 abstracts reviewed, 23 studies met predefined eligibility criteria, representing diverse geographic regions and medical specialties. Among those, 19 identified the positive contributions of PROMs in predicting readmission risks. Seven studies utilised generic PROMs exclusively, eleven used generic and condition-specific PROMs, while 5 focussed solely on condition-specific PROMs. Logistic regression was the most used modelling approach, with 13 studies aiming at predicting 30-day all-cause readmission risks. The c-statistic, ranging from 0.54 to 0.84, was reported in 22/23 studies as a measure of model discrimination. Nine studies reported model calibration in addition to c-statistic. Thirteen studies detailed their approaches to dealing with missing data. Our study highlights the potential of PROMs to enhance predictive accuracy in readmission models, while acknowledging the diversity in data collection methods, readmission definitions, and model evaluation approaches. Recognizing that PROMs serve various purposes beyond readmission reduction, our study supports routine data collection and strategic integration of PROMs in healthcare practices to improve patient outcomes. To facilitate comparative analysis and broaden the use of PROMs in the prediction framework, it is imperative to consider the methodological aspects involved.