SD Age Research Articles

Baseline Characteristics of Participants in STAREE: A Randomized Trial for Primary Prevention of Cardiovascular Disease Events and Prolongation of Disability-Free Survival in Older People.

The risk-benefit balance of statin use in healthy older people is uncertain. We describe the baseline characteristics of the STAREE (Statins in Reducing Events in the Elderly) trial, which is a randomized, double-blind, placebo-controlled trial among community-dwelling older people; the trial evaluated the effect of atorvastatin 40 mg for the prevention of major cardiovascular events (cardiovascular death, nonfatal myocardial infarction or stroke), and on disability-free survival (survival free of both dementia and persistent physical disability). STAREE enrolled people aged ≥70 years from 1583 general practices across Australia with no history of clinical cardiovascular disease, diabetes, or dementia. Baseline data collected included demographic, clinical, cognitive (Modified Mini-Mental State Examination), psychological (Center for Epidemiologic Studies Short Depression Scale), lifestyle, medical, physical, blood and urine measures, and quality of life. Demographic and clinical characteristics of study participants were then compared with publicly available landmark statin trials. A total of 9971 participants were recruited (mean±SD age 74.7±4.5 years, 4023 (40%) ≥75 years, 52% women) between July 2015 and March 2023. The mean low-density lipoprotein cholesterol was 3.27 mmol/L (SD=0.72; 126 mg/dL). Hypertension was reported by 43% of participants and the mean blood pressure was 136/80 mm Hg. Compared with previous landmark statin trials that included primary prevention cohorts, STAREE is unique in including such a large number of older (≥75 years) independent-living people. STAREE is the largest primary prevention trial of statins powered to address the important clinical outcomes of major cardiovascular events, disability-free survival, and cognition in older people. https://www.clinicaltrials.gov; Unique identifier: NCT02099123.

Contemporary comparative surgical outcomes of type A aortic dissection in US and China: an analysis of the national inpatient sample database and a Chinese multi-institutional registry.

To investigate the contemporary comparative inpatient prognosis among US and Chinese patients with type A aortic dissection (TAAD). Data from Chinese multi-institutional TAAD registry and the US National Inpatient Sample databases were analyzed. We used multivariable logistic regression models to compare in-hospital mortality and perioperative complication rates between the US and China. Length of stay and overall costs were fitted with quantile regression models. Independent prognostic factors associated with post-operative survival were assessed via Cox proportional hazards models. Among 3,121 eligible TAAD patients, 1,073 were from China (25.0% female; mean ± SD age, 53.9 ± 12.4) and 2,048 were from the US (31.2% female; mean ± SE age, 59.8 ± 0.3). During the study period, the in-hospital mortality rates in China and the US were 15.5% and 13.3%, yet the difference was insignificant after adjustment (aOR, 1.16; 95% CI, 0.69-1.97). While there was no significant difference in overall perioperative complications (aOR, 1.07; 95% CI, 0.52-2.18), the patterns of complications differed between two cohorts. While Chinese TAAD patients experienced significantly longer duration of hospitalization (median difference, + 10.4 days; 95% CI, 9.2-11.5), the US TAAD cohort had significantly greater overall hospitalization costs (49.9; 95% CI, 55.4-44.5, in 1000 USD). Notwithstanding significant differences in demographic and clinical characteristics, TAAD patients from China and the US demonstrated comparable in-hospital mortality and overall perioperative complication rates. Future initiatives should focus on expanding surgical eligibility to the elderly Chinese TAAD patients and optimizing the duration of hospitalization without undermining meaningful clinical outcomes. KY20220425-05, April 5th 25 2022.

Abstract 4123804: Joint associations of sleep and daily step count with cardiometabolic health markers: a pooled analysis of the ProPASS consortium

Background: Poor sleep and physical inactivity are lifestyle-related behaviors that impact cardiometabolic health, but there is limited insight into their combined association with cardiometabolic markers. Aims: This study investigated the joint association of device-measured sleep patterns (regularity and duration) and daily step counts with cardiometabolic biomarkers. Methods: Harmonized individual participant data of 12,223 adults (mean±SD age:54.6±9.5 years; 54.8% female) from the pooled Prospective Physical Activity, Sitting and Sleep consortium (ProPASS), comprising six cohorts with thigh-worn accelerometry data were analysed. Sleep regularity was assessed using the validated Sleep Regularity Index (SRI, range 0-100), quantifying day-to-day sleep consistency. We used generalized linear models to examine cross-sectional joint associations between sleep patterns, regularity (SRI tertiles ≤75.8, low; 75.8-84.5, medium; >84.5, high) and duration (<7h, short; 7-8h, adequate; >8h, long), and daily step counts (step tertiles <8488, low; 8488-11601, medium; >11601, high steps/day) with a composite cardiometabolic health score and individual biomarkers, including BMI, waist circumference, total cholesterol, HDL cholesterol, triglycerides, and HbA1c. Results: Lower sleep regularity, deviation from adequate sleep, along with lower step counts were adversely associated with the composite cardiometabolic health risk score. Compared to optimal sleep patterns (SRI>84.5 or 7-8h/day) and high step groups, low sleep regularity and short sleep duration were separately associated with the least favourable composite cardiometabolic health (z-score [95%CI] 0.32 [0.28,0.37] and 0.25 [0.21,0.29], respectively) among participants with low volume of steps. Low sleep regularity and low daily steps were jointly associated with higher BMI (2.98 [2.67,3.29] kg/m 2 ), waist circumference (8.61 [7.81,9.4] cm), total cholesterol (0.15 [0.08,0.23] mmol/L), and lower HDL levels (0.17 [0.14,0.2] mmol/L), regardless of sleep duration. For short/long sleep duration and low daily step count, such associations were only evident in BMI and waist circumference. Conclusions: Our findings suggest that the potential deleterious associations of irregular or inadequate sleep duration with cardiometabolic health outcomes may be exaggerated by lower daily step counts. Future studies should examine the prospective joint association of sleep patterns and physical activity on cardiometabolic health.

Abstract 4117640: Thirty-Year Prevalence and Prognosis of the Cardiovascular-Kidney-Metabolic Syndrome in U.S. Females and Males

Background: The American Heart Association recently published guidelines on how to clinically identify and categorize individuals with cardiovascular-kidney-metabolic (CKM) syndrome. The extent to which CKM syndrome prevalence and prognosis differ by sex remain unknown. This study aimed to examine the impact of sex on trends in prevalence over 30 years and long-term prognosis of the CKM syndrome in the US. Methods: We analyzed nationally representative NHANES 1988-2018 data collected from 33,868 US adults (age ≥20 years) who were under surveillance for all-cause mortality through December 31, 2019. We examined sex-specific prevalence of CKM syndrome, and sex-specific CKM associations with all-cause mortality. Results: Of the 33,868 adults studied, the mean±SD age was 48.4±18.3 years with 52% female and 56% non-White. Overall prevalence of CKM syndrome increased steadily from 1988 to 2018 in both sexes, with a larger temporal rise in prevalent Stage 3 CKM seen for males (from 18.9% to 22.4%) compared to females (from 13.9% to 15.2%) ( Figure 1 ). Over a median follow-up of 13.3 years, there were 8745 deaths. In multivariable cox-regression analysis, worsening CKM severity was associated with all-cause mortality (P<0.001 for both sexes), with greater magnitudes of risk seen in females (HR=1.24 to 3.33) compared to males (HR=0.85 to 2.60) across all stages (LRT χ 2 =19.0, P interaction <0.001); results were similar for cardiovascular mortality (LRT χ 2 =22.3, P interaction <0.001) ( Table 1 ). Conclusions: Females, compared with males, exhibited a lower prevalence of CKM stage 3 but experienced excess mortality risk across the spectrum of multi-system CKM dysfunction. These findings underscore the importance of identifying mechanisms underlying joint cardiovascular, renal, and metabolic systems pathophysiology to close a potentially widening sex disparities gap in multi-organ disease risk.

Abstract 4137883: Association of Pre-Donation Blood Pressure with Hypertension in Living Kidney Donors

Background: Living kidney donors (LKD) are at risk for developing hypertension (HTN); however, the levels of pre-donation blood pressure (BP) that may predict post-donation BP are unknown. Hypothesis: Higher pre-donation BP is associated with a greater risk of developing post-donation HTN. Goals: We aim to examine the association between pre-donation BP and the risk of developing HTN in LKD. Methods: A retrospective cohort study using OPTN/SRTR included adult LKD undergoing donation between 6/1972 and 9/2022. Systolic and diastolic hypertension (SHTN and DHTN) were defined by SBP ≥130 and DBP ≥80 mmHg, respectively. Multiple Cox regression was utilized to examine the association between decile of pre-donation BP and time-to-event of developing post-donation SHTN and DHTN. Results: Of 174,311 adult LKD, the mean±SD age was 41±12 years and 60% were female. Mean pre- and post-donation SBP and DBP and deciles of BP are shown in Table 1 and Figure 1, respectively. The median time to follow-up for developing SHTN was 13.2 (IQR 6.8, 24.4) and DHTN was 12.2 months (IQR 6.3, 24.1). The incidence rate of developing SHTN and DHTN was 0.020 and 0.03 person-months, respectively. After adjusting for age (<65 vs. ≥65 y/o), gender, race, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, eGFR, urine protein:creatinine ratio, and the interaction term between decile of pre-donation SBP and age, LKD in deciles 5 to 10 (SBP 119–200 mmHg) had significantly graded increased risk for developing SHTN compared to LKD in decile 4 (SBP 115-118 mmHg; HR decile10 4.82, 95%CI 3.37, 6.91), while those in deciles 1 to 3 had a graded decrease in the risk but were non-significant (HR decile1 0.68, 95CI% 0.42, 1.11). In addition, there was a decreased risk of SHTN observed in elderly LKD (≥65 y/o) in deciles 5 and 10 (P interaction 0.041 and 0.009). The pattern of pre-donation DBP decile – DHTN association was similar to the SBP – SHTN association, but only DBP deciles 8-10 (DBP 81–195 mmHg) were significant (HR decile10 2.10, 95%CI 1.31, 3.34); Figur 2. There was no interaction between pre-donation DBP and age. Conclusions: Elevated pre-donation SBP or DBP greater than 118 or 80 mmHg is associated with a graded increase in developing post-donation SHTN or DHTN, respectively especially in the non-elderly (<65 years old) LKD. BP control during the pre-donation period should be achieved to mitigate the risk of post-donation HTN.

Abstract 4123501: Coronary Artery Calcium in Asymptomatic Arabs: Prevalence and Distribution

Background: Coronary artery calcification (CAC) is an established marker of subclinical atherosclerosis and predictor of cardiovascular events. Despite extensive research on CAC in various populations, data focusing on Arab populations, particularly asymptomatic individuals, is limited. Methods: We analyzed data from 2,739 asymptomatic self-referred Arabs included in the Kuwait Hospital Awareness Campaign for Early Detection of Atherosclerotic Coronary Artery Disease study. Traditional CVD risk factors were assessed, and ECG-gated cardiac CT imaging was used to measure using the Agatston method. Results: The mean±SD age of the sample was 48.4±9.8 and 41.8% were females. Kuwaitis comprised 61.6% of the sample, Egyptians 20.5%, and Levantines 16.4%. CAC was >0 in 32.3%, ≥100 in 11.5%, and ≥400 in 4% of the sample. CAC prevalence increased with age and was higher in Arab males with a 12 year earlier onset in males than females. The 50 th , 75 th , 90 th and 95 th percentiles of CAC for Arab females were, 0, 0, 39, and 167 and for males were 0, 25, 191, and 470, respectively. The presence of CAC was associated with traditional risk factors including diabetes, smoking, hypertension and LDL-C. Levantines and Kuwaitis had the highest prevalence of CAC and CVD risk factors; these groups were independently associated with higher CAC levels. In all age and sex subgroups except older males, the 75 th percentiles of CAC were below 100. Therefore, a larger number of subjects were identified as high risk using the 75 th age- and sex-specific CAC percentile than with CAC≥100 (19.3% vs 11.5%). Conclusion: This study provides comprehensive insights into subclinical atherosclerosis in asymptomatic Arabs, emphasizing the importance of early risk stratification for primary CVD prevention using CAC scoring. Our findings highlight that Arabs are not a homogeneous group with regards to prevalence of CVD risk factors and CAC. This study underscores the need to consider both absolute and age- and sex-specific CAC percentile values to inform primary prevention strategies in this predominantly young population.

Investigating the Correlations between Patient Demographics and Complications Following Total Knee Arthroplasty: A Cross-Sectional Study

Introduction: This study investigates the relationship between patient age, gender, and various complications, such as pain, restricted range of motion (ROM), and hemorrhage following total knee arthroplasty. Materials and Methods: This cross-sectional study included 62 patients (Mean±SD age= 65.9±7.38 years; female participants=74.2%) who underwent total knee arthroplasty at Atieh Hospital in Tehran, Iran, between 2020 and 2021. Pain levels were assessed using the numerical pain rating score. Meanwhile, knee joint ROM was evaluated using a reliable mobile application. Hemorrhage was measured through knee joint drainage. Statistical analyses were performed to analyze the data. Results: Women reported higher pain levels and more restricted ROM in passive knee extension and active/passive knee flexion compared to men (P<0.05). However, no significant differences were observed between genders in active knee extension and hemorrhage. A significant inverse correlation was found between pain and ROM in passive knee extension (rho=-0.41, P≤0.001), as well as in active (rho=-0.5, P≤0.001) and passive knee flexion (rho= -0.59, P≤0.001). However, no significant relationship was observed between pain and active knee extension or hemorrhage. Age showed no statistically significant correlation with the other variables. Conclusion: This study highlights the association between higher pain levels and greater ROM restrictions in passive knee extension and active/passive knee flexion following total knee arthroplasty; however, patient age and gender were not found to be associated with postoperative hemorrhage. These findings underscore the importance of closely monitoring pain and ROM, particularly in women undergoing total knee arthroplasty.

Feasibility and psychometric properties of Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW) cognitive screening test.

Intrinsic capacity, a concept proposed by the World Health Organization, includes multidimensions to better understand older adults' health conditions for successful healthy aging. One of the key dimensions of intrinsic capacity is cognition. The present study aimed to examine if the cognitive test in Integrated Care for Older People Screening Tool for Taiwanese (ICOPES-TW) is a suitable instrument for screening cognition impairment. Older adults from community or medical center settings in Tainan were recruited (n=553; mean±SD age=75.80±8.32; 60.8% females). All participants were administered the ICOPES-TW cognitive test, the Mini-Mental State Examination (MMSE), Lawton's Instrumental Activities of Daily Living (IADL), and Barthel Index (BI) in an in-person interview conducted by a well-trained research assistant. The ICOPES-TW cognitive test was highly correlated with the MMSE total score (r=-0.752) and moderately correlated with IADL (r=-0.426) and BI scores (r=-0.390). When using a cutoff score of 1 for the ICOPES-TW cognitive test, its accuracy to identify cognitive impairment defined by the MMSE was 60% (sensitivity=0.98, specificity=0.41). When using cutoff score of 2, the accuracy was 83% (sensitivity=0.69, specificity=0.90). Moreover, the ICOPES-TW cognitive test had similar properties to the MMSE in terms of known-group validity (distinguishing different age and educational level groups). Using ICOPES-TW cognitive test with appropriate cutoff point in different healthcare settings could help providers and researchers quickly identify if an older adult has a cognitive impairment. However, the screening ability of ICOPES-TW cognitive test was deemed fair but future studies are recommended to help improve it.

Self-esteem and social interactions in daily life: An experience sampling study

Theory and empirical evidence suggest that self-esteem and the quality of social relationships are mutually related, however, little is known about the dynamic short-term association in daily life. Experience sampling data of 232 Dutch Master’s students ( M age = 24.6, SD age = 2.7) was collected across four waves; each consisting of 14 days of four daily assessments (23,107 data points). We applied Dynamic Structural Equation Modeling to study the within-day associations between momentary self-esteem (assessed in the morning and evening) and social interactions (anticipated and experienced). First, results showed that quality of social interactions during the day was associated with evening, but not morning self-esteem. Second, positive anticipation of social interactions was associated with morning, but not with evening self-esteem. Third, trait self-esteem did not moderate the within-day associations. Together, results suggest that when having higher self-esteem, people anticipate more positive social interactions at the same time, but they do not experience more positive social interactions later on. Having but not anticipating more positive social interactions seems to contribute to higher self-esteem later on. Differentiating between anticipated and experienced interactions and using multiple daily assessments helps obtain a more fine-grained understanding of the dynamic processes between self-esteem and social interactions.

Work-Related Stress Is Associated With Unfavorable Cardiovascular Health: The Multi-Ethnic Study of Atherosclerosis.

Work-related stress is a psychosocial risk factor linked to a higher risk of cardiovascular disease. However, the association between work-related stress and cardiovascular health (CVH) is not well established. We estimated the association between work-related stress and CVH in a multiethnic sample of adults free of cardiovascular disease at baseline. We performed a cross-sectional analysis of 3579 community-based men and women, aged 45 to 84 years, of the Multi-Ethnic Study of Atherosclerosis from data collected between 2000 and 2002. Work-related stress (yes/no) was assessed by a self-administered questionnaire. CVH was measured by the American Heart Association's Life's Simple 7 metrics (smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose). Each metric contributed 0, 1, or 2 points if in the poor, intermediate, or ideal range, respectively. The aggregated CVH score was 0 to 14 points and categorized as inadequate (0-8 points), average (9-10 points), and optimal (11-14 points). Polytomous logistic regression was used to estimate the association between work-related stress and CVH, adjusting for sociodemographic factors. The mean±SD age was 57±8 years, and 48% were women. Work-related stress was reported by 20% of participants. In fully adjusted models, participants with work-related stress had lower odds of having average (adjusted odds ratio [OR], 0.75 [95% CI, 0.62-0.92]) and optimal (adjusted OR, 0.73 [95% CI, 0.58-0.92]) CVH scores compared with participants without work-related stress. Work-related stress was associated with unfavorable CVH. These findings underscore the importance of workplace psychological well-being and suggest the need for studies on interventions that may reduce work-related stress and promote CVH.

Higher risk and earlier onset glaucoma in Cushing's syndrome.

Glaucoma incidence in patients with endogenous Cushing's syndrome (CS) has never been established. We aim to assess the risk for glaucoma among CS patients compared to controls and determine the age of disease onset. A nationwide retrospective matched-cohort study of patients with endogenous CS diagnosed between 2000 and 2023. Patients with CS were matched in a 1:5 ratio, with a control group individually matched for age, sex, socioeconomic status and body mass index. Main outcomes were the incidence of glaucoma and disease onset. A total of 609 patients [396 women (65%); mean age 48.1 ± 17 years] were included in the CS group and 3018 controls. Follow-up duration was 14.6 years (IQR 9.8-20.2) for the study group. The aetiology of hypercortisolism was divided into pituitary (259, 42.6%), adrenal (206, 33.8%) and unconfirmed aetiology (144, 23.6%) patients. At baseline, 44 (7.2%) CS patients had a diagnosis of glaucoma, compared with 151 (5%) controls. The overall risk for glaucoma was 74% higher in patients with CS compared with matched controls (hazard ratio = 1.74, p = 0.002). Patients with CS who developed glaucoma were younger (mean age of 62 ± 14.7 years) than controls (mean ± SD age, 62 ± 14.7 years), (p = 0.02). The overall risk for glaucoma in CS was high for both patients in remission and patients with persistent hypercortisolism (p = 0.048). Patients with active hypercortisolism experienced an earlier glaucoma onset (82.1 ± 88.0 months). Endogenous CS is associated with increased risk for glaucoma regardless of remission status and develops at a younger age compared with the general population.

Peripheral Endothelial Dysfunction Is Associated With Incident Major Depressive Disorder.

A subset of individuals with major depressive disorder (MDD) have a high burden of cardiovascular risk factors and cerebral small-vessel disease, implicating vascular disease in the development of depression. Cross-sectional studies demonstrate a link between endothelial dysfunction and MDD, but the prospective association between peripheral endothelial dysfunction (PED) and an incident diagnosis of MDD is unknown. Patients undergoing a baseline assessment of cardiovascular risk were evaluated for PED using reactive hyperemia-peripheral arterial tonometry (≤1.8 consistent with PED). Patient medical records were reviewed to identify those who underwent a formal clinical evaluation of MDD after the index PED evaluation. The frequency of PED was compared in those with and without MDD. Logistic regression analyses were performed to assess the association between baseline PED and incident MDD. Between January 2006 and December 2020, 1614 patients underwent testing for PED. Four hundred eighty-four (30.1%) patients underwent a formal evaluation for MDD after (0-15 years) the index procedure (mean±SD age, 52.8±13.8 years; 65.2% women). Of these, 157 (32.4%) had PED and 108 (31.0%) were diagnosed with MDD. Individuals with MDD had a higher frequency of PED (40.2% versus 30.2%; P=0.034) compared with those without MDD. In multivariable analyses, PED was significantly associated with MDD (odds ratio, 2.3 [95% CI, 1.4-3.8]; P<0.001). PED is significantly associated with incident MDD. Thus, PED may be a useful marker to identify individuals at increased risk of depression who may benefit from more frequent and earlier management strategies.

Pattern Anlysis of Risk-Reducing Strategies in Unaffected Korean BRCA1/2 Mutation Carriers

The lifetime risk of breast and ovarian cancer increases substantially for individuals with mutations in BRCA1/2. The evidence indicates that BRCA1/2 mutation carriers benefit from early cancer detection and prevention strategies. However, data on the patterns of risk-reducing interventions are lacking. This study investigated the patterns of surveillance and risk-reducing interventions among unaffected BRCA1/2 mutation carriers. A cohort of unaffected BRCA1/2 mutation carriers was identified from the Korean Hereditary Breast cAncer (KOHBRA) study database, and a telephone survey was conducted. The survey included questions on the incidence of new cancers, patterns of cancer (breast, ovarian, prostate, other) surveillance, chemoprevention, risk-reducing surgery, and reasons for participating in risk-reducing strategies. Between November 2016 and November 2020, 192 BRCA1/2 mutation carriers were contacted, of which 83 responded. After excluding 37 responders who refused to participate, 46 participants (15 males, 31 females) were included in the analysis. The mean ± SD follow-up time was 103 ± 17 months (median 107, range 68~154), and the mean ± SD age was 31 ± 8 years. Ten BRCA1/2 mutation carriers developed breast cancer, one developed ovarian cancer, and three developed other cancers. Six BRCA1/2 mutation carriers (19.4%) underwent annual breast cancer surveillance as recommended by guidelines, while none underwent ovarian or prostate cancer surveillance. Three carriers (9.7%) used chemoprevention for breast cancer. Risk-reducing salpingo-oophorectomy was performed on only one BRCA1/2 mutation carrier. The rates of breast/ovarian cancer surveillance, chemoprevention, and risk-reducing surgery were low among unaffected Korean BRCA1/2 mutation carriers. Given this cohort’s relatively high risk of developing breast cancer, strategies to encourage active participation in risk reduction are needed.

Factors Affecting Outcomes and Complications of Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Study of 110 Patients.

Anterior cruciate ligament injury poses a major effect on the quality of life of patients. Anterior cruciate ligament reconstruction (ACLR) remains the mainstay of treatment. To (1) test for the correlation of patients' characteristics such as body mass index (BMI), age, smoking status, and postoperative infrapatellar numbness with the subjective outcome of primary ACLR and (2) investigate whether postsurgical complications can be related to the studied patients' characteristics. Case series; Level of evidence, 4. Demographic data and operational notes from patients who underwent primary ACLR at the institute between 2011 and 2022 were extracted. Patients' surgical outcomes were evaluated subjectively using the International Knee Documentation Committee (IKDC) score and the Knee injury and Osteoarthritis Outcome Score (KOOS). Pre- and postoperative scoring were completed at postoperative follow-up in December of 2022, patients completed both the IKDC and the KOOS questionnaires. Patients were asked to rate their knee function out of 10 before and after surgery. This rating was based on the patients' self-assessment of their functional ability without the use of a formal instrument. Knee function was assigned as better, worse, or the same through a comparison of patients' reported scores before and after surgery. Male patients comprised 108 (98.2%) of the total cohort, the mean ± SD age at the time of surgery was 27.92 ± 7.39 years, and BMI was 26.54 ± 3.89. The mean follow-up time was 48.92 ± 27.99 months. Most patients did not need postsurgical intervention (n = 97; 88.2%), while 4 (3.6%), 7 (6.4%), and 2 (1.8%) needed revision, debridement, or both, respectively. The mean IKDC score and KOOS, respectively, were 74.37 ± 20.17 and 85.50 ± 14.83. Patients' BMI had a significant effect on IKDC score (74.68 ± 20.0; P < .001), and infrapatellar numbness after surgery also affected patients' IKDC score (P = .002) and KOOS (P = .043). The age at the time of ACLR was associated with contralateral leg surgery (P = .017). This study showed that higher BMI and infrapatellar numbness negatively affect the subjective outcomes after primary ACLR. Older age at the time of primary ACLR was associated with a higher likelihood of surgery in the contralateral leg.

Evaluating laser interstitial thermal therapy for newly diagnosed, deep-seated, large-volume glioblastoma: survival and outcome analysis.

Laser interstitial thermal therapy (LITT) has emerged as an alternative for treating glioblastoma (GBM) in patients deemed unsuitable for resection due to deep-seated or eloquent location, age, or comorbidities. However, its safety and efficacy in large-volume, deep-seated, newly diagnosed GBM (nGBM) tumors remain insufficiently studied. Therefore, the authors aimed to assess the outcomes of LITT in the treatment of deep-seated, large-volume nGBM. A retrospective analysis of patients with nGBM who underwent LITT between February 2013 and August 2023 was conducted. Patients with deep-seated tumor volume ≥ 10 cm3 treated with LITT were compared to patients with deep-seated tumor volume < 10 cm3. Demographic, perioperative, and follow-up data were collected and compared among both groups. Kaplan-Meier survival analysis and Cox proportional hazards regression were performed to evaluate the impact of various clinical and treatment-related factors on patient survival. A total of 33 patients in the study group (mean ± SD age 65.7 ± 10.2 years, 58% male) with mean tumor volume 36.0 ± 21.6 cm3 were compared to 23 controls (mean age 67.0 ± 12.5 years, 61% male) with mean tumor volume 5.2 ± 2.7 cm3. There were no significant differences in hospital length of stay (p = 0.494), temporary neurological deficits and edema within 30 days (p = 0.705 and p > 0.999, respectively), 30-day readmissions (p = 0.139), < 30-day complications (p = 0.918), complications between 30 days and 3 months (p = 0.903), and new motor and speech deficits within 3 months (p = 0.883 and p > 0.999, respectively) between the study and control groups. Kaplan-Meier analysis did not reveal any statistically significant difference in overall survival (OS) between groups (p = 0.227). Multivariate analysis indicated that tumor volume did not significantly affect the hazard ratio for individuals undergoing LITT (HR 1.16, 95% CI 0.83-3.29, p = 0.150). This pilot study suggests that LITT is safe for treating patients with large-volume, deep-seated nGBM compared to those with small-volume tumor. Although there appears to be improved OS in patients with smaller lesions with greater EOA, significance was not achieved in this cohort.

Endothelial dysfunction markers syndecan-1 and thrombomodulin are associated with higher albuminuria levels in type 2 diabetes with no history of clinical cardiovascular disease

IntroductionIndividuals with type 2 diabetes and increased albuminuria, a well-established marker of microvascular complications, are at a higher risk for cardiovascular disease (CVD) and premature mortality. Therefore, a better understanding of the underlying pathophysiology is needed to improve risk stratification and tailor prevention and intervention. MethodsWe conducted a cross-sectional study including 463 individuals with type 2 diabetes, various degrees of albuminuria and without CVD. We analysed the association between albuminuria and markers of endothelial function (thrombomodulin and syndecan-1), thrombin generation (thrombin-antithrombin complex, prothrombin fragment 1 + 2), fibrinogen, platelet function (activation using soluble plasma selectin and aggregation using Multiplate® Analyzer) using regression models. ResultsIn the study cohort 33 % were women, the mean ± SD age was 65 ± 9 years, and median [IQR] diabetes duration was 15 [9–20] years. In total, 344 (74 %) individuals had normal albuminuria, 87 (19 %) moderately- and 32 (7 %) severely increased albuminuria levels. Higher markers of endothelial function and fibrinogen were independently associated with higher albuminuria levels (p < 0.01). No association between albuminuria and markers of thrombin generation and platelet was demonstrated. ConclusionWe demonstrated an independent association between albuminuria and markers of endothelial function and fibrinogen in individuals with type 2 diabetes and no history of CVD.

Effect of early tethered cord release on urodynamic findings and lower urinary tract function in myelomeningocele patients.

Detecting neurological deterioration and diagnosing tethered cord syndrome (TCS) in patients with myelomeningocele (MMC) can be challenging due to the presence of symptoms at birth and the lack of objective indicators. This retrospective analysis focused on urological manifestations and evaluated whether tethered cord release (TCR) for TCS at an early stage could improve or stabilize video urodynamic study (VUDS) findings and lower urinary tract function. This study analyzed 55 of 64 children who underwent MMC repair at Miyagi Children's Hospital, Sendai, Japan, between 2003 and 2016. The follow-up duration for these children exceeded 6 years. Clinical records were reviewed, and surgical indicators and outcomes of TCR and preoperative and postoperative results of VUDS were evaluated. The duration of follow-up was mean ± SD (range) 12.6 ± 3.5 (6.0-19.0) years. TCR was performed on 27 (49.1%) of 55 patients with MMC, totaling 33 procedures. Five patients underwent 2 TCR procedures, whereas 1 received 3 TCR procedures. The mean ± SD (range) age was 7.5 ± 2.9 (2.2-12.7) years at the first TCR procedure (n = 27) and the mean (range) was 10.9 (10.1-11.7) years at the second TCR (n = 5); in addition, 1 patient underwent a third TCR procedure at age 15.9 years. There were no identified risk factors associated with the TCS. The first TCR procedure was performed due to worsened lower-extremity (LE) motor symptoms in 1 patient, worsened LE sensory symptoms in 3 patients, and worsened VUDS findings in 26 patients. After the procedure, LE motor symptoms improved in 1 patient (100%), LE sensory symptoms improved in 2 patients (66.7%), and VUDS findings improved in 18 patients (66.7%). Preoperative VUDS revealed urological deterioration characterized by a high-pressure bladder, reduced bladder capacity, increased detrusor overactivity (DO), and vesicoureteral reflux. Postoperative VUDS showed improvements in bladder function, including decreased bladder pressure and DO, increased bladder capacity, and compliance. None of the patients underwent augmentation cystoplasty or had renal dysfunction. Routine VUDS can detect urological deterioration, which can be a significant indicator for early diagnosis of TCS. Performing TCR at an early stage is beneficial, not only to protect renal function but also to improve VUDS findings and lower urinary tract function in patients with MMC. It is important to explore a standardized approach for the diagnosis and treatment of TCS.

Characterizing Non-Articular Pain at Early Rheumatoid Arthritis Diagnosis, Evolution over the First year of Treatment and Impact on Remission in a Prospective Real-World Early Rheumatoid Arthritis Cohort.

To characterize non-articular pain (NAP) at early RA diagnosis, the evolution over the first year of treatment, associations with active RA inflammation and impact on remission. This real-world, longitudinal multi-center cohort study followed participants with active early RA (symptoms<1 year, CDAI>2.8,) enrolled between 1/2017 and 1/2022, and who completed a body pain diagram (BPD) over 1-year. Participants were grouped by prespecified definitions of NAP: 1) none 2) regional or 3) widespread. Rheumatologists performed joint counts. Descriptive statistics summarized the frequency and evolution of NAP patterns over 1-year. Chi-square tests compared the proportions of tender and/or swollen joints by presence of pain in each NAP section. Multi-adjusted GEE regression models estimated associations of NAP patterns with remission outcomes. Participants (N=392) were 70% female, mean(Sd) age of 56(14) years and mean symptoms duration of 5.1(2.7) months. Over half reported NAP at baseline with most (73%) presenting with regional NAP. Common patterns of regional NAP were axial (40%) and pain in upper quadrants (17%). 43% of those with regional NAP persisted or worsened over 1-year, whereas 73% of those with widespread NAP resolved or improved. Joint inflammation was more frequently reported in areas with NAP vs areas without NAP. Regional and widespread NAP were associated with lower odds of reaching CDAI remission (adjusted OR [95%CI]):0.42[0.26 to 0.70] and 0.30[0.12 to 0.74], respectively. Regional NAP is common and persistent in early RA and impacts remission. RA activity may contribute to NAP. More attention to NAP in RA care is warranted.

Impact of Extracorporeal Membrane Oxygenation (ECMO) on Serum Concentrations of Cefepime

ECMO is becoming widely used as a life-saving measure for critically ill patients. However, there is limited data on pharmacokinetics and the dosing of beta-lactam antibiotics in ECMO. In this study, we evaluated the serum concentrations of cefepime in patients on ECMO to determine the impact of ECMO circuitry and to guide therapeutic dosing. Methods: Patients 19 years or older admitted to the ICU, treated with ECMO and beta-lactam antibiotics for presumed or documented infection, were enrolled. Three blood samples (peak, midpoint, trough) were obtained before ECMO (pre-ECMO) and during ECMO (intra-ECMO) at a steady state. Results: Eight patients met inclusion criteria; six received cefepime. All patients were male. Average ± SD age was 45.8 ± 14.7. Four patients received ECMO for severe SARS-CoV-2 infection, and one each for Pneumocystis pneumonia and influenza A infection. Mean ± SD APACHE II and SOFA scores prior to ECMO were 24.6 ± 7.1 and 11.0 ± 3.9, respectively. All but one of the patients received venovenous (VV) ECMO. Cefepime 1 g every 6 h intravenously over 2 min was administered to all patients before and during ECMO. Cefepime concentrations were fit to non-compartment analysis (NCA) and area under the serum concentration–time curve averaged ± SE 211.9 ± 29.6 pre-ECMO and 329.6 ± 32.3 mg*h/L intra-ECMO, p = 0.023. No patients displayed signs of cefepime neurotoxicity. Patients received ECMO for 43.1± 30 days. All patients expired. Cefepime dosed at 1 g every 6 h intravenously appears to achieve therapeutic levels for critically ill patients on ECMO.

Airway Mucus Plugs on Chest Computed Tomography Are Associated with Exacerbations in COPD.

Mucus plugs were visually-identified on baseline chest computed tomography (CT) scans from smokers with Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 2-4 COPD enrolled in two multicenter cohort studies: Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) and COPDGene. Associations between ordinal mucus plug score categories (0/1-2/≥3) and prospectively-ascertained AEs, defined as worsening respiratory symptoms requiring systemic steroids and/or antibiotics (moderate-to-severe) and/or ER/hospitalization (severe), were assessed using multivariable-adjusted zero-inflated Poisson regression; subjects were exacerbation-free at enrollment. Among 3,250 participants in COPDGene (mean±SD age 63.7±8.4 years, FEV1 50.6%±17.8% predicted, 45.1% female) and 1,716 participants in ECLIPSE (age 63.3±7.1 years, FEV1 48.3%±15.8% predicted, 36.2% female), 44.4% and 46.0% had mucus plugs, respectively. The incidence rates of AEs were 61.0 (COPDGene) and 125.7 (ECLIPSE) per 100 person-years. Relative to those without mucus plugs, the presence of 1-2 and ≥3 mucus plugs was associated with increased risk (adjusted rate ratio, aRR [95%CI]=1.07[1.05-1.09] and 1.15[1.1-1.2] in COPDGene; aRR=1.06[1.02-1.09] and 1.12[1.04-1.2] in ECLIPSE, respectively) for prospective moderate-to-severe AEs. The presence of 1-2 and ≥3 mucus plugs was also associated with increased risk for severe AEs during follow-up (aRR=1.05[1.01-1.08] and 1.09[1.02-1.18] in COPDGene; aRR=1.17[1.07-1.27] and 1.37[1.15-1.62] in ECLIPSE, respectively). CT-based mucus plugs are associated with an increased risk for future COPD AEs.