Population Studies Research Articles

Association between loneliness, social isolation, and frailty: A two-sample Mendelian randomization

Abstract Objective: This study aimed to examine the causal relationship between loneliness, social isolation, and frailty using Mendelian Randomization (MR) analysis. Methods: Data were obtained from a large-scale genome-wide association study (GWAS) of a European-descent population. Variables included frailty index (FI), two loneliness variables (Feeling lonely, able to confide), and three social isolation variables (Frequency of friend/family visits, number in household, no leisure/social activities).The inverse variance weighting (IVW) method was set as the primary MR analysis, with MR-Egger and weighted median methods employed as complementary approaches. Cochran’s Q test, the MR-Egger intercept test, and MR-PRESSO methods were used to evaluate the robustness of MR results. Bonferroni corrected P values <0.01 were considered statistically significant. Results: Genetic predisposition to feeling lonely (IVW: odds ratio [OR]=1.47; 95% confidence interval [CI]=1.34 to 1.60; P<0.001) and no leisure or social activities (IVW: OR=1.78; 95% CI=1.50 to 2.11; P<0.001) were significantly associated with increased FI. In addition, the genetically predicted ability to confide was positively associated with decreased FI (IVW: OR=0.91; 95% CI=0.87 to 0.95; P<0.001). There was no statistically significant causal association between the number in the household, frequency of friend/family visits, and the risk of frailty. Conclusion: This MR study provides evidence of the causal relationship between loneliness, social isolation, and frailty from a genetic perspective and highlights the importance of decreasing social isolation in the development of frailty prevention and intervention programs.

Increased prevalence of inflammatory arthritis, systemic lupus erythematosus and systemic sclerosis, during 2020-2023 versus 2016-2019 in a Nation-Wide Cohort Study.

Although several studies have explored the geoepidemiology of autoimmune rheumatic diseases (ARD), trends of their frequency overtime are under-investigated. Herein, in a nation-wide study, we examine trends in the prevalence of various ARD over-time, taking also into account the Covid-19 pandemic. In this retrospective study in the entire Greek adult population (approximately 10.000.000 people), we searched the electronic prescription database of the e-Government Centre for Social Security Services using prespecified ICD-10 codes to capture all adult patients with Psoriatic Arthritis (PsA), Rheumatoid Arthritis (RA), Ankylosing Spondylitis (AS), Systemic Lupus Erythematosus (SLE), Systemic Sclerosis (SSc) and Polymyalgia Rheumatica or Giant Cell Arteritis (PMR/GCA). Two sequential 4-year periods, namely 2016-2019 and 2020-2023 were compared. Prevalence of RA, PsA, AxSpA, SLE and SSc increased significantly during 2020-2023 compared to 2016-2019. This applies to both genders and to all age groups for RA, PsA and AxSpA, to female patients in SLE and SSc and to patients 18-39years in SLE and ≥ 60years in SSc. Overall, there was 47% increase in prevalence for AxSpA (0.100% in 2016-19 vs 0.147% in 2020-23), 36.5% for PsA (0.148% vs 0.202%), 20.6% for RA (0.467% vs 0.563%), 19% for SLE (0.137% vs 0.163%) and 13% for SSc (0.023% vs 0.026%). A 16.3% decrease was evident in GCA/PMR, limited to those ≥ 40years old. In a nation-wide study we confirm that ARD prevalence increases over-time, whereas a contribution of Covid-19 pandemic to our results during 2020-2023, cannot be excluded. Additional human, medical and financial resources will be needed to cover the increased needs of ARD patients.

Association of ART regimen and adherence to viral suppression: an observational study of a clinical population of people with HIV

Adherence to antiretroviral therapy (ART) is essential for the effective management of HIV, which includes keeping the HIV viral load undetectable. This study aimed to determine whether certain ART medications are more “forgiving” of poor adherence in achieving viral suppression. We identified subgroups of ART medication usage and determined the extent to which ART adherence is associated with viral suppression across those subgroups. Data came from claims and clinical records (2017–2019) of 3,552 HIV-positive adult members of a Medicaid managed care plan. Pharmacy fill data were examined to characterize ART medications using latent class analysis (LCA), which captures the complexity of real-world ART usage (i.e., multiple medications, ART switching). LCA yielded five ART medication patterns over three years, mostly characterized by recent medications and formulations of ART, though they varied in number of tablets and in medication class. Mixed effects logistic regression models were estimated to determine whether odds of viral suppression differed by ART adherence level. After adjusting for covariates, those with at least 90% adherence (i.e., 90 to < 95%) did not significantly differ from those with 95% adherence or greater in terms of viral suppression, which corroborates existing clinical recommendations. These findings can inform provider-patient communication for people with HIV, especially those who have difficulty maintaining adherence. This includes those experiencing unstable housing, mental health conditions, or substance use.

The combined effect of indoor climate and psychosocial stressors on subsequent headaches: A prospective study of the general working population in Norway

This prospective panel study explores the link between indicators of poor indoor climate and psychosocial stressors in the work environment with subsequent headaches. A random sample of the Norwegian working population (18 to 66 years) was examined, using self-reported health symptoms and work exposures collected in 2009, 2013 and 2016. This study included repeated measurements of 6681 workers attending at least two consecutive interviews (16,493 observations). The results were analysed using generalized estimating equations (GEEs), adjusting for sex, birth year, occupation, education, baseline mental health and the presence of headache at baseline. Headaches were prevalent in 25.4% of cases, with odds ratios (ORs) increasing with poor indoor climate (ORcontinuous = 1.14, 95% CI: 1.08–1.19) and number of psychosocial stressors (ORcontinuous = 1.09, 95% CI: 1.04–1.14). The OR amongst individuals concurrently exposed to both poor indoor climate and psychosocial stressors was 1.49 (95% CI: 1.26–1.75). Approximately one in five headache cases were attributable to this combined exposure. Measures implemented to reduce the prevalence of headaches in the work environment should consider the combined impact of a poor indoor climate and psychosocial stressors.

Occupancy dynamics of the mottled owl Strix virgata using object-based image analysis along an urbanized Neotropical gradient

Urbanization has profound effects on wildlife. Although some species benefit or even thrive in urban environments, most species respond differently to the varying degrees of disturbance that can be found across an urbanized landscape. Quantifying the effects of urbanization in wildlife distributions, however, is complicated: species vary in their patterns of presence/absence, abundance, and detectability across spatial and temporal scales, e.g., daily, seasonal, or throughout the annual cycle. Here, we use occupancy models to offer a realistic approach to the study of populations of urban owls. Most studies on owl population dynamics have not considered temporal variation in occupancy between seasons or assess the uneven effects of urbanization along a habitat gradient. We investigated the seasonal habitat associations of mottled owls along an urban gradient in the Neotropical city of Xalapa, Veracruz, Mexico. Using high-resolution satellite images and object-based image classification techniques, were analyzed the relationship between different vegetation and environmental characteristics with the occupancy of mottled owls. We employed different sampling techniques, including playback surveys and silent listening periods, to detect the presence or absence of owls along a gradient from highest to lowest urbanization. Environmental data and different vegetation types were used to analyze the habitat associations of mottled owls during January (late non-breeding season) and May (late breeding season) of 2023. In total, we detected 68 mottled owls during the non-breeding season and 102 during the breeding season, with higher detection rates in areas with >28 % forest surface. Our results revealed that the best occupancy model included forest and forest division (occupancy), ambient noise and moonlight (detection) for the non-breeding season, as well as urban, forest, grass, and forest division (occupancy), and noise (detection) for the breeding season. The percentage of forested and grass areas positively influenced mottled owl occupancy while the percentage of urbanization and forest division influenced it negatively. Moonlight was positively related to mottled owl detection, while ambient noise had a negative effect on detection probabilities of mottled owls during both seasons. Forested areas emerged as pivotal for owl occupancy, indicating their sensitivity to forest changes along the urban gradient. With urban areas increasing, the interplay between forest division, ambient noise, and moonlight unveils critical insights into mottled owl behavior and habitat dynamics, underscoring the necessity for informed conservation strategies amidst urban expansion. Future research should survey different years to provide a more robust assessment of the dynamic occupancy of mottled owls in Neotropical urban gradients.

Estimating Long-Term Survivorship Rates Among Patients With Resected Stage III/IV Melanoma: Analyses From CheckMate 238 and European Organization for Research and Treatment of Cancer 18071 Trials.

Standard-of-care treatments for patients with resected stage III/IV melanoma include the immuno-oncology (IO) agents nivolumab (NIVO) and ipilimumab (IPI). This study used mixture cure models (MCMs) to estimate cure rates among patients treated with NIVO or IPI in the phase III CheckMate 238 (ClinicalTrials.gov identifier: NCT02388906) and European Organization for Research and Treatment of Cancer (EORTC) 18071 (ClinicalTrials.gov identifier: NCT00636168) trials, and to assess the impact of use of adjuvant immunotherapy on cure rates versus watchful waiting. MCMs were applied to patient-level recurrence-free survival data from CheckMate 238 and EORTC 18071. Cured patients were assumed to experience no disease recurrence and mortality risks similar to the general population. Uncured patients were at risk of disease recurrence and all-cause death. The survival trend of the cured patients was estimated using life expectancy data for a general population with the same baseline demographic characteristics. A regression model assessed the odds ratios (ORs) of cure across key subgroups on the basis of baseline characteristics of the study populations. In CheckMate 238, estimated cure rates were 48.3% (95% CI, 41.8 to 54.9) with NIVO and 38.2% (95% CI, 32.7 to 44.1) with IPI. In EORTC 18071, estimated cure rates were 38.0% (95% CI, 32.1 to 44.2) with IPI and 29.2% (95% CI, 24.4 to 34.6) with placebo. In the indirect comparison of the two trials, the odds of cure were significantly higher with NIVO than with placebo (OR, 2.33 [95% CI, 1.49 to 3.65]). Analyses involving two large phase III trials investigating adjuvant IO treatment for resected melanoma demonstrate higher cure rates for both NIVO and IPI than placebo, with NIVO providing the highest cure rate. Similar cure rates were estimated for patients treated with IPI in both trials, despite staging and dosing differences.

Automated Analysis of Thoracic Aortic Aneurysms Based on Chest Computed Tomography Data: a Population Study in Moscow

Background. Cardiovascular diseases remain a pressing issue associated with great economic burden and loss of earning capacity. Among them, thoracic aortic aneurysms pose a serious threat as they commonly develop asymptomatically. Patients with aneurysms are often diagnosed late, which contributes to higher mortality rates due to complications. For this reason, conducting new epidemiological studies on this problem in our country is relevant.Objective: to study the prevalence of pathological dilatation of the thoracic aorta in Moscow by means of artificial intelligence technologies (AITs) using chest computed tomography (CT) data.Material and methods. A retrospective analysis of chest CT data from 227,149 patients obtained in the period from October 2022 to October 2023 was performed using AITs.Results. The analysis revealed that 13.3% of patients exhibited signs of thoracic aortic dilatation, while 0.8% had aneurysm signs. The prevalence of thoracic aortic aneurysms in Moscow was 12.4 cases per 100,000 individuals. Males were more susceptible than females; aneurysms of the descending aorta were more typical for them, while aneurysms of the ascending aorta were more common in females. The incidence of thoracic aortic dilatation increased with age. Potential causes and strategies to minimize AIT errors were discussed.Conclusion. The results highlight the importance of opportunistic screening for thoracic aortic aneurysms to ensure timely detection and prevention of complications. It would be especially beneficial to men and elderly population. The effectiveness of AITs to support decision-making by radiologists analyzing chest CT results was confirmed. The study provides an important update to the data on the prevalence of thoracic aortic aneurysms in asymptomatic patients in Russia. The identified features make it possible to direct the diagnostic and prevention efforts more effectively.

Polymorphism of ADAMTS-13 gene rs28503257 in Iraqipatients with Hypertension

The aim of this study was to investigate the association of polymorphism of ADAMTS-13 gene to the susceptibility of hypertension in patients with hypertension in an Iraqi population. Forty-five hypertensive patients (23 males and 22 females), their age 40-70 years and 35 healthy controls (18 males and 17 females), their age range between 40-70 years. were selected from Wasit Province using a convenient sampling method. Genetic polymorphism of ADAMTS13) rs28503257 A/G was carried out using TaqMan -PCR. In patients and controls, the genotypic and allelic distributions of adisentgrine and metallopeptedase with a thrombospondin type1 motife13(ADAMTS13) rs28503257 A/G of the study populations were consistent with Hardy-Weinberg equilibrium. The genotypes frequecies of ADAMTS-13 rs 28503257 A/G of patients with hypertension manifested non-significant differences when compared with healthy control group AA =40(89%), AG =5(11) in patients vs. 30(86), 5(14) P=0.67 in controls for each genotype respectively. There were no hypertensive patients or controls carrying the genotype GG in the study sample. The A and G allele frequencies in SNP rs28503257 A/G were not significantly different between the two groups (P&gt;0.05). The A allele was the major one in studied groups with a percent of (0.9286) and (0.9444) in control and patients groups respectively. Whereas the A allele was the minor one with a percent of (0.0714) and (0.0556) in these groups respectively. The association analysis revealed that individuals carrying the homozygous AA genotype were assocaited with hypertension OR=1.3333 (CI95% 0.3537 to 5.0259) and P= 0.6709 indicating that a positive association with the disease.However,the individuals with a hetrozygous AG genotype showed negative association with the disease OR= 0.7500 (CI95% 0.1990 to 2.8271) ,P=0.6709. Although no individuals carrying the genotype GG were observed in patients and controls, the odds ratio can be calculated in the presence of other genotypes OR= 0.7802 (CI95% 0.0151 to 40.2986), P= 0. 9019.These results suggest that the A allele may be considered as a risk allele in hypertension whereas the G allele is a protective allele agianst hypertension. The genetic model for ADAMTS-13 in comparison between hypertensive patients and controls .The dominant model indicated that patients of(AG+GG/AA) genotypes decreased the association with hypertension comparing with control with OR=1.333 CI95%0.3537 to 5.025: patients (40/5 and 0.00) in patients vs.(30/5 and 0.00) with OR== 0.7500(CI95%0.1990 to 2.8271) , P =0.6709,P=0.6709.The recessive model revealed that patients carrier the genotype(AA+AG/GG) increased the association with the disease (0.0/40 and 5) in patients compared with controls(0.00/30 and 5) with OR=1.2817(CI95% 0.0248 to 66.199), P=0. 9019.The Over dominant model revealed that patients carrier the genotype (AA+GG/AG) increased the association with the disease (0.040 and 5) in patients compared with controls (0.00/30 and 5) with OR=1.3333(CI95%0.3537 to5.0259),P=0.6709. In coclusion, the polymorphisms ADAMTS-13 rs28503257 variant A/G with are associated with the susceptibility of hypertension.

Secondhand smoke is associated with peptic ulcer disease and gastroesophageal reflux disease in non-smokers in a large Taiwanese population study.

Active smokers are known to be at an increased risk of both gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD), however the role of passive smoking remains unclear. In this study, we aimed to examine whether secondhand smoke (SHS) is associated with PUD and GERD. In this population-based study, we conducted a large-scale analysis with 88,297 never-smokers (male: 18,595; female: 69,702; mean age 50.1 ± 11.0 years) from the Taiwan Biobank. The exposure group was comprised of those who had been exposed to SHS, and the no exposure group as those without SHS exposure. According to the frequency of exposure, we further divided the participants into "no exposure," "<1 h per week," and "≥1 h per week" groups. A cutoff point of 1 h per week was chosen according to the median exposure time in our participants. Associations between SHS and SHS frequency with PUD and GERD were assessed. Of the 88,297 enrolled participants, 11,909 (13.5%) had PUD and 76,388 (86.5%) did not. In addition, 11,758 (13.3%) had GERD and 76,539 (86.7%) did not. Multivariable analysis showed a significant association between SHS with PUD (odds ratio [OR] = 1.166; 95% confidence interval [CI] = 1.084-1.254; p < 0.001), and GERD (OR = 1.131; 95% CI = 1.053-1.216; p = 0.001). Furthermore, those exposed to SHS ≥ 1 h per week (vs. no exposure) were associated with higher risks of PUD (OR = 1.232; 95% CI = 1.121-1.355; p < 0.001) and GERD (OR = 1.200; 95% CI = 1.093-1.319; p < 0.001). SHS was significantly associated with PUD and GERD. Furthermore, exposure to SHS ≥ 1 h per week (vs. no exposure) was associated with a 1.23-fold higher risk of PUD and 1.20-fold higher risk of GERD. This study represents the largest population-based investigation to explore the association between SHS with PUD and GERD in Taiwanese never-smokers.

Cancer mortality risk in the Urals Cohort of Exposed Population Offspring

The objective of the study is to analyze solid cancer mortality and estimate the risk value of solid cancer mortality in the offspring of parents irradiated in the Southern Urals, depending on the dose to the parents' gonads as well as to conduct a preliminary assessment of the mortality risk from cancer of individual locations depending on the gonadal dose. The issue of the transgenerational effects of the human gonad exposure is still very important. There exists conclusive evidence of the presence of such effects in experimental animals. However, there is no proof of the existence of these effects in humans despite a great number of research on this subject. International scientific community and international organizations, UNSCEAR and ICRP being among them, regard this issue as the one that has not been solved yet and requires further studies. Urals Cohort of offspring of the population exposed on the Techa River and on the territory of the East Ural radioactive trace was established in the Urals research Center for Radiation medicine in 2022. The key feature of the cohort is the exclusion of the offspring with postnatal exposure. The size of the cohort as of September 2023 is 31,154 persons. The number of person-years over the whole follow-up period from 1950 through 2020 is 1 226 380. Mean dose to the gonads of mothers of all the cohort members is 41 mGy, to those of the fathers' — 35 mGy, mean combined gonad dose is 76 mGy. Over the whole follow-up period 3,774 deaths from all causes including 284 deaths from solid cancers were registered in the cohort. The mean age of the cohort members at the end of the follow-up period was 42 years. The risk of death was analyzed using Poisson regression by the programs of the EPICURE statistical software package. Three models of dose dependence were tested: linear, quadratic, and linear-quadratic models of paternal gonadal dose, maternal gonadal dose, and total gonadal dose. Mortality risk analysis of all solid cancers in the offspring cohort showed no statistically significant effect with parental gonadal dose (we have obtained positive although statistically insignificant values of solid cancers mortality risk) which is consistent with the results of other studies in human populations. At the same time, the analysis for the first time obtained a statistically significant linear dependence of the solid cancer mortality risk in offspring with father's age over 45 years depending on the dose to the father's gonads. The excess relative risk of death was 8.09/Gy, (0.51-22.93), p &lt; 0.05. Also, for the first time, evidence of dose dependence of the mortality risk of lung cancer in male offspring on maternal gonadal dose, paternal gonadal dose, and combined gonadal dose was obtained. The values of excess relative risk of lung cancer and 95% confidence intervals according to the linear model were 5.39/Gy (0.46; 15.56) from paternal gonad dose, 4.36/Gy (0.15; 13.48) from maternal gonad dose, and - 3.95/Gy (0.55; 12.14) from combined gonad dose. Point risk estimates of lung cancer at this stage are characterized by wide confidence intervals and require additional studies to assess the influence of possible effect modifiers, but with a high degree of probability indicate the presence of dose dependence of this effect. Increasing the follow-up period and attained age, will increase the number of cancers in the future and will reduce dose response uncertainties and provide more accurate estimates of the risk of death in the offspring cohort.

8613 Diabetes remission: experience from a randomized control trial conducted in a tertiary care hospital in India

Abstract Disclosure: A.M. Chakraborty: None. R. Waila: None. S. Bhansali: None. H. Bhujade: None. N. Sachdeva: None. S. Bhadada: None. Introduction: The usual perception and interpretation of diabetes mellitus is that of an irreversible and chronic persistent disease with little scope for remission. Following the success of metabolic surgery and intensive lifestyle modification, it is time for pharmacotherapy to sept in. Methodology: It was a single-center, randomized controlled trial conducted in patients having HbA1c below 9 % at randomization and having a duration of diabetes less than 2 years. Patients with organ-threatening chronic diseases and severe diabetes-related complications have been excluded. Study populations have been randomized to 1:1 to receive pharmacotherapy with oral semaglutide, dapagliflozin, and metformin in one arm and vildagliptin, metformin, and titrated glimepiride in the control arm. Duration of therapy was 6 months including 2 months of up titration of semaglutide. Patients have been followed up for 3 months after stopping all therapy following 6 months of therapy. The primary outcome was to find out the remission rates in patients with Type 2 diabetes mellitus treated with a combination of oral Semaglutide and dapagliflozin on top of metformin monotherapy and to compare with the standard diabetes practice. The secondary outcome was to assess the anthropometric change and change in beta cell function parameters with a mixed meal tolerance test. Results: A total of 38 patients have completed therapy, 17 were in the trial arm and 21 in the control arm. Among 17 patients in the trial arm, all the patients were in remission as per the prespecified criteria. Among the patients who completed 6 months of follow-up (n-13), 11 patients (84%) maintained remission in the trial arm. The remission rate was 100% in the trial arm and 48% in the conventional arm (p&amp;lt;0.001) after 3 months and 84% and 27.7% in the trial arm and conventional arm respectively after 6 months of follow-up (p&amp;lt;0.05). Reduction in BMI (p &amp;lt;0.001) and percent body fat (p&amp;lt;0.01) and increase in disposition index after mixed meal tolerance test (p&amp;lt;0.01) was statistically related to remission. Conclusion: Remission of diabetes as defined by ADA in the consensus statement (HbA1c &amp;lt; 6.5 % without glucose-lowering therapy for at least 3 months) is a reality. It can be achieved by pharmacotherapy targeting body weight and adiposity. The main predictors of remission were a reduction of BMI and body fat and an increased disposition Index. Since it is an ongoing study, further follow-up is planned to determine the continuation of the remission phase among those who achieved remission with pharmacotherapy. Presentation: 6/3/2024

8725 Subcutaneous Compared With Intravenous Insulin Protocol For Management Of DKA: A Longitudinal Experience In A Single Center

Abstract Disclosure: S. Avula: None. M. Salim: None. E. Wetherbee: None. C. Wenner: None. A. Gravely: None. A.D. Westanmo: None. N.G. Ercan-Fang: None. Background: Diabetic ketoacidosis (DKA) is a critical condition requiring immediate medical attention to prevent severe health complications and even death. Typically, patients are placed under the care of the intensive care unit (ICU) to ensure close supervision. With implementation of effective subcutaneous insulin protocol (SIP), patients can be safely managed outside of ICU without any significant change in mortality or morbidity, potentially decreasing financial burden of costly ICU stay. Aim: To review and compare the experience with subcutaneous and intravenous insulin protocols for management of DKA at Minneapolis Veterans Affairs Health Care System (MVAHCS). Methods: We conducted a retrospective chart review of patients who were admitted with DKA at MVAHCS from 2013 - 2023 and were treated with either I.V insulin or SIP. Inclusion criteria: Adults (age &amp;gt;/=18 years) admitted with DKA between 2013 and 2023. Exclusion criteria: Non availability of VBG/ABG and patients who were not treated initially at MVAHCS. Statistical analysis used was basic descriptive analysis, Pearson’s Chi-Square and Two sample T test. Results: Majority of patients included were males: 57 (96.61%) and 16 (88.89) in SIP and I.V insulin, respectively. Racial distribution of patients was skewed towards a white population: Total of 57 (74.03%) were white, 12 (15.58%) were African American (AA). A significant majority of white patients 47 (79.66%) were on SIP, while 10 (55.56%) were on I.V insulin. Mean age of SIP and I.V insulin study populations were 58.9 (SD 16.21) and 59.2 years (SD 12.23), respectively. Baseline mean pH of the SIP and I.V insulin study populations were 7.27 (SD 0.08) and 7.13 (0.13), respectively. Mean bicarb for SIP was 14.9 mEq/L (SD 4.60) and I.V Insulin was 10.1 mEq/L ( SD 4.57). Mean time for anion gap (AG) closure among patients on SIP was modestly higher at 19.7 hours (SD 15.3) when compared to that on I.V insulin of 17.1 hours (SD 12.4) but the difference did not reach statistical significance. Similarly, 55.6% (n=10) of patients on I.V insulin and 58.6% (n=34) of those on SIP had anion gap closure of &amp;gt;/= 12 hours (p = 0.8187). When adjusted for baseline pH and bicarbonate, 46% of patients in the I.V insulin group had AG closure &amp;gt;=12 hours, whereas 67% of those in the SIP group had AG closure &amp;gt;=12 hours with total difference of 21% (p= 0.2098). Conclusion: Our results demonstrate that SIP can be safely implemented outside of the ICU setting. Compared with SIP, baseline pH was slightly less in the IV group (our protocol directs sicker patients with lower baseline pH towards the I.V insulin rather than SIP), however, AG closure time was similar between the two groups even after performing multiple regression analysis where we adjusted for baseline differences between two treatment groups in pH, bicarbonate, AG. These results indicate that SIP could be safe and potentially cost saving alternative for DKA management. Presentation: 6/3/2024

PERBANDINGAN RETURN PENGGUNAAN MOVING AVERAGE CONVERGENCE DIVERGENCE DAN RELATIVE STRANGE INDEX PADA INDEKS SAHAM SYARIAH INDONESIA

This study compares the return levels from the use of the technical indicators Moving Average Convergence Divergence (MACD) and Relative Strength Index (RSI) applied to the simulation of the movement of the Indonesia Sharia Stock Index (ISSI). This research is a population study using panel data in the form of daily closing values over 12 years of the Indonesia Sharia Stock Index movement. The data was processed using a technical analysis approach with two momentum indicators, MACD and RSI, to obtain buy and sell signals based on the principles of each indicator, applied to the ISSI. The use of the MACD and RSI technical indicators on the ISSI shows that MACD yielded a profit of 207% with a success rate (win rate) of 72%, while RSI provided a profit of 125% with a win rate of 55%.

Long-term exposure to third-hand smoke could accelerate biological aging via mitochondrial dysfunction: Evidence from population and animal studies

The relationship between third-hand smoke (THS) exposure and lifespan remains inadequately explored. Our study sought to clarify the effects of THS on aging and lifespan. In this pursuit, our cross-sectional analysis assessed hematological aging markers in 986 non-smokers and examined lifespan alterations using a Drosophila model. THS exposure levels were quantified through survey metrics consistent with the Global Adult Tobacco Survey. The findings revealed that THS exposure significantly accelerated biological aging, with exposed individuals exhibiting an average increase in biological age of 3.04 years compared to their unexposed counterparts (p < 0.05). Correspondingly, the Drosophila model reflected these outcomes, showing a reduction in lifespan by 16.07 days (p < 0.01). Proteomic analyses identified MRPL2 as a pivotal protein in THS-induced aging, linking its expression to mitochondrial dysfunction and oxidative stress. Further metabolomic profiling highlighted disruptions in energy metabolism pathways. Follow-up in vitro experiments confirmed the role of MRPL2 in the aging processes at the cellular level. Overall, our results indicate that THS exposure is a significant accelerant of aging, providing new perspectives on the health consequences of environmental smoke residues.

The importance of IgG glycosylation-What did we learn after analyzing over 100,000 individuals.

All four subclasses of immunoglobulin G (IgG) antibodies have glycan structures attached to the protein part of the IgG molecules. Glycans linked to the Fc portion of IgG are found in all IgG antibodies, while about one-fifth of IgG antibodies in plasma also have glycans attached to the Fab portion of IgG. The IgG3 subclass is characterized by more complex glycosylation compared to other IgG subclasses. In this review, we discuss the significant influence that glycans exert on the structural and functional properties of IgG. We provide a comprehensive overview of how the composition of these glycans can affect IgG's effector functions by modulating its interactions with Fcγ receptors and other molecules such as the C1q component of complement, which in turn influence various immune responses triggered by IgG, including antibody-dependent cell-mediated cytotoxicity (ADCC) and complement-dependent cytotoxicity (CDC). In addition, the importance of glycans for the efficacy of therapeutics like monoclonal antibodies and intravenous immunoglobulin (IVIg) therapy is discussed. Moreover, we offer insights into IgG glycosylation characteristics and roles derived from general population, disease-specific, and interventional studies. These studies indicate that IgG glycans are important biomarkers and functional effectors in health and disease.

Higher hair cortisol levels associated with previous cardiovascular events and cardiovascular risks in a large cross-sectional population study

BackgroundStress is today a common feature of patients seeking medical care and a growing public health issue in society. A method has been developed to measure biological chronic stress by Hair Cortisol Concentrations (HCC). This biomarker, for chronic stress, captures information about cumulative cortisol levels over the course of several months. Long-term stress might be one of the factors contributing to the onset of cardiovascular conditions and also affecting different risk factors. The aim of this study was to analyse the association between Hair Cortisol Concentrations and previous cardiovascular diseases and cardiovascular risk factors.MethodsThe method of measuring chronic stress by Hair Cortisol Concentration was applied in a large Swedish national observational cross-sectional study. A population-based random sample of N = 4,821 Swedish middle-aged men and women was analysed for hair cortisol levels in relation to diagnosed previous cardiovascular diseases and biologically measured cardiovascular risk factors.ResultsLong-term stress, measured by hair cortisol, was significantly associated with the classical cardiovascular risk factors hypertension and high cholesterol, but not smoking. Those with elevated HCC levels also had a significantly increased pre-history of myocardial infarction, type 2 diabetes, atrial fibrillation and by-pass surgery, but not regarding stroke, angina pectoris or sleep apnoea. Higher HCC was significantly associated (p < 0.001) with Body mass index and waist circumference, but only for females. HCC was also associated with the risk markers leukocytes, and high-sensitivity CRP, indicating a possible linkage between HCC and inflammation and hypothetically also the bodily immune defense. No association was found between perceived stress and HCC.ConclusionsAn overall conclusion of our results is that health care should put more emphasis on patients reporting that they have been exposed to long term stress. Altogether, these analyses of Hair cortisol levels in a large middle-aged population show that chronically elevated cortisol levels represent a relevant and significant factor associated with cardiovascular diseases and classical cardiovascular risk factors.

Effects of ovarian stimulation on embryo euploidy: an analysis of 12874 oocytes and 3106 blastocysts in cycles with preimplantation genetic testing for monogenic disorders.

Does ovarian stimulation and the ovarian response affect embryo euploidy? Ovarian stimulation and the ovarian response in women undergoing preimplantation genetic testing for monogenic disorders (PGT-M) cycles did not affect the rates of blastocyst euploidy. Whether or not ovarian stimulation in IVF-embryo transfer has potential effects on embryo euploidy is controversial among studies for several reasons: (i) heterogeneity of the study populations, (ii) biopsies being performed at different stages of embryo development and (iii) evolution of the platforms utilized for ploidy assessment. Patients who undergo PGT-M cycles typically have no additional risks of aneuploidy, providing an ideal study population for exploring this issue. A retrospective cohort study including embryos undergoing PGT-M was conducted at a single academically affiliated fertility clinic between June 2014 and July 2021. A total of 617 women with 867 PGT-M cycles involving 12874 retrieved oocytes and 3106 trophectoderm biopsies of blastocysts were included. The primary outcome of the study was median euploidy rate, which was calculated by dividing the number of euploid blastocysts by the total number of biopsied blastocysts for each cycle. Secondary outcomes included the median normal fertilization rate (two-pronuclear (2PN) embryos/metaphase II oocytes) and median blastulation rate (blastocyst numbers/2PN embryos). Comparable euploidy rates and fertilization rates were observed across all age groups, regardless of variations in ovarian stimulation protocols, gonadotropin dosages (both the starting and total dosages), stimulation durations, the inclusion of human menopausal gonadotrophin supplementation, or the number of oocytes retrieved (all P > 0.05). Blastulation rates declined with increasing starting doses of gonadotropins in women aged 31-34 years old (P = 0.005) but increased with increasing gonadotrophin starting doses in women aged 35-37 years old (P = 0.017). In women aged 31-34, 35-37, and 38-40 years old, blastulation rates were significantly reduced with increases in the number of oocytes retrieved (P = 0.001, <0.001, and 0.012, respectively). Limitations include the study's retrospective nature and the relatively small number of patients of advanced age, especially patients older than 40 years old, leading to quite low statistical power. Second, as we considered euploidy rates as outcome measures, we did not analyze the effects of ovarian stimulation on uniform aneuploidy and mosaicism, respectively. Finally, we did not consider the effects of paternal characteristics on embryo euploidy status due to the fact that blastocyst aneuploidy primarily originates from maternal meiosis. However, sperm factors might have an effect on embryo development and the blastulation rate, and therefore also the number of blastocysts analyzed. The exclusion of patients with severe teratozoospermia and the fact that only ICSI was used as the insemination technique for women undergoing PGT-M contributed to minimize the effect of paternal factors. Ovarian stimulation and response to stimulation did not affect blastocyst euploidy rates in women undergoing PGT-M cycles. However, in women aged 31-40 years old, there was a significant decline in blastulation rates as the number of retrieved oocytes increased. This study was supported by the National Natural Science Foundation of China (Grant No. 81701407, 82301826); the National Key Research and Development Program of China (2022YFC2702901, 2022YFC2703004); China Postdoctoral Science Foundation (2022M710261), and China Postdoctoral Innovation Talent Support Program (BX20220020). There is no conflict of interest. N/A.

Gender Differences in Planned Retirement Age Among Medical Students: Are Changes on the Horizon?

ABSTRACT Gender Differences in Planned Retirement Age Among Medical Students: Are Changes On the Horizon? Purpose Planned age of retirement has an important effect on the physician workforce. Earlier studies of practicing physicians have reported that the planned as well as actual retirement age was significantly younger for women. Also, previous reports had shown that rural physicians tended to retire earlier. This paper offers a view earlier in the physician pipeline and reports surveys of medical students and pre-medical college students concerning their retirement plans. Methods During 2015-2019, 70 college students and 41 medical students at a regional rural medical campus completed a career eulogy that included their planned retirement age. Results Combining both groups of students, women planned to retire at a mean age of 61.9 and men at 59.1, P=0.048. A longitudinal comparison of just medical students showed that prematriculation students just before starting medical school had the oldest planned age of 66.9, compared to college students (57.4 to 58.9) and medical students (64.0 to 64.6), P=0.049. There was no difference in planned retirement age in rural vs urban upbringing. Conclusions In this group of pathways students, women planned to retire almost 3 years later than men, which differs from earlier reports of physicians in practice. The men planned retirement almost 5 years earlier than in previous reports of planned retirement age. There was no difference in rural vs urban upbringing. Whether this is a generalizable finding will require similar studies in different student populations on other campuses, and our survey instrument is available for others to look deeper into the process of professional identity formation that may explain any differences in planned retirement age.

Traditional Chinese Medicine Herbs for Breast Cancer Prevention and Survival: A Narrative Review of Epidemiological Studies from Taiwan.

This review aims to describe the association of integrating traditional Chinese medicine (TCM) herbs into conventional medicine (CM) in preventing breast cancer and improving survival rates among breast cancer patients of Taiwan. Of 7 relevant studies, spanning 2014-2023, 4 investigated breast cancer risk in women with menopausal symptoms and other comorbidities. All 4 reported that TCM herbal use was associated with lower risks of developing breast cancer. Three studies investigated survival in newly-diagnosed breast cancer patients receiving CM. All reported that adjunctive TCM users had lower mortality rates than CM-only patients. However, the heterogeneity of study designs, populations, and interventions may limit the generalizability and robustness of the findings. TCM herbs may promote breast cancer prevention and survival when used alongside CM. More rigorous observational research and clinical trials in specific patient populations are needed to guide clinical decision-making.

Signatures of circumbinary disc dynamics in multimessenger population studies of massive black hole binaries

ABSTRACT We investigate the effect of the cutting-edge circumbinary disc (CBD) evolution models on massive black hole binary (MBHB) populations and the gravitational wave background (GWB). We show that CBD-driven evolution leaves a tell-tale signature in MBHB populations, by driving binaries towards an equilibrium eccentricity that depends on the binary mass ratio. We find high orbital eccentricities ($e_{\rm b} \sim 0.5$) as MBHBs enter multimessenger observable frequency bands. The CBD-induced eccentricity distribution of MBHB populations in observable bands is independent of the initial eccentricity distribution at binary formation, erasing any memory of eccentricities induced in the large-scale dynamics of merging galaxies. Our results suggest that eccentric MBHBs are the rule rather than the exception in upcoming transient surveys, provided that CBDs regularly form in MBHB systems. We show that the GWB amplitude is sensitive to CBD-driven preferential accretion onto the secondary, resulting in an increase in GWB amplitude $A_{\rm yr^{-1}}$ by over 100 per cent with just 10 per cent Eddington accretion. As we self-consistently allow for binary hardening and softening, we show that CBD-driven orbital expansion does not diminish the GWB amplitude, and instead increases the amplitude by a small amount. We further present detection rates and population statistics of MBHBs with $M_{\rm b} \gtrsim 10^6 \, {\rm M}_{\odot }$ in Laser Interferometer Space Antenna, showing that most binaries have equal mass ratios and can retain residual eccentricities up to $e_{\rm b} \sim 10^{-3}$ due to CBD-driven evolution.