Cohort Study Research Articles

Associations between serum lipids and glaucoma: a cohort study of 400 229 UK Biobank participants.

To examine the associations of commonly-used serum lipid measures (high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC) and triglycerides (TG)) with glaucoma. This prospective cohort study included 400 229 participants from the UK Biobank. Cox regression and restricted cubic spline models and polygenic risk scores were employed to investigate the associations between serum lipids and glaucoma. Over a mean follow-up of 14.44 years, 6868 (1.72%) participants developed glaucoma. Multivariate Cox regression revealed that higher levels of HDL-C were associated with an increased risk of glaucoma (HR for 1-SD increase in HDL-C 1.05, 95% CI 1.02 to 1.08, p=0.001), while elevated levels of LDL-C (HR 0.96, 95% CI 0.94 to 0.99, p=0.005), TC (HR 0.97, 95% CI 0.94 to 1.00, p=0.037) and TG (HR 0.96, 95% CI 0.94 to 0.99, p=0.008) were all associated with reduced risk. The analysis examining the associations between polygenic risk score of serum lipids and glaucoma showed per 1-SD increment of HDL-C genetic risk was associated with a 5% greater hazard of glaucoma (HR 1.05, 95% CI 1.00 to 1.11, p=0.031). However, the polygenic risk score of LDL-C, TC, and TG did not show a significant association with glaucoma. Elevated HDL-C is associated with an increased risk of glaucoma, while elevated LDL-C, TC, and TG levels are associated with a lower risk of glaucoma. This study enhances our understanding of the association between lipid profile and glaucoma and warrants further investigation of lipid-focused treatments in glaucoma management.

Clinical Outcomes of Fully Arthroscopic Versus Arthroscopically Assisted Latissimus Dorsi Transfer for Irreparable Subscapularis Tear.

Untreated chronic subscapularis (SSC) tears pose a challenging problem to treat owing to the resultant tendon retraction, atrophy, fatty infiltration, and changes in humeral head position, which complicate surgical options. Anterior latissimus dorsi (LD) transfer has shown effective results in treating these tears without glenohumeral arthritis. This study introduces and evaluates fully arthroscopic and arthroscopically assisted anterior LD transfer techniques for reconstructing irreparable SSC tears. The authors hypothesize that both methods will yield promising and comparable clinical outcomes. Cohort study; Level of evidence, 3. This retrospective study reviewed patients who underwent anterior LD tendon transfer between February 2014 and April 2022. Indications for surgery included persistent shoulder pain and functional limitations unresponsive to nonoperative treatment, irreparable SSC tears (Lafosse grade ≥4), significant fatty infiltration (Goutallier grade ≥3), and minimal glenohumeral arthritis (Hamada stage <3). Patients were excluded if they had <2 years of follow-up or if data were lost. For comparison, the study divided patients into 2 groups based on the surgical methods: fully arthroscopic LD tendon transfer and arthroscopically assisted LD tendon transfer. Clinical assessments included pain levels (visual analog scale), Constant score, Subjective Shoulder Value score, and range of motion. Radiologic measurement and complications were assessed. The study included 34 patients (mean ± SD age, 62.4 ± 7.5 years; follow-up, 35.4 ± 15.9 months). Significant improvements were observed in all patient-reported outcomes (pre- to posttest visual analog scale, 7.5 ± 1.2 to 1.2 ± 1.6; Constant score, 28.3 ± 6.0 to 68.8 ± 15.8; Subjective Shoulder Value, 23.2 ± 8.7 to 65.3 ± 22.0; all P < .001), range of motion in all directions, and internal rotation strength. Fully arthroscopic (n = 18) and arthroscopically assisted (n = 16) LD tendon transfers produced comparable clinical outcomes. Complications included 3 retears, 3 infections, and 5 cases of arthritis progression. Fully arthroscopic and arthroscopically assisted anterior LD transfers significantly reduce pain, enhance range of motion, and strengthen internal rotation in patients with irreparable SSC tears, with no significant differences in complications. These techniques offer comparable clinical outcomes, providing different options for surgeons.

Safety and effectiveness of different modes of labor induction among pregnant women delivering at referral hospitals in Dar es Salaam, Tanzania: a cohort study.

Induction of labor is a medical procedure used to stimulate uterine contractions and promote cervical ripening, facilitating spontaneous vaginal delivery (SVD). Various induction methods are used globally, but data on their safety and effectiveness, especially in developing countries, are limited. This study evaluated the safety and effectiveness of different labor induction methods among pregnant women delivering at referral hospitals in Dar es Salaam, Tanzania. This cohort study enrolled pregnant women who underwent labor induction at referral hospitals in Dar es Salaam from April to May 2021. The induction methods assessed were oxytocin, dinoprostone, misoprostol, and balloon catheter. Data were collected on the proportion of women achieving SVD, median time to delivery, and maternal and neonatal outcomes. Data were analyzed using SPSS version 23, presenting findings as frequencies, percentages, and medians. Cox regression modelling assessed factors associated with SVD and delivery outcomes. Of the 322 women included, 198 (61.5%) were at term, and 210 (65.2%) had comorbidities. Overall, 80% of women achieved SVD following induction. Among women induced with oxytocin, 95% achieved SVD, compared to 69% for dinoprostone, 72% for misoprostol, and 77% for balloon catheter. The median time to SVD was 5.42h (IQR: 4.50-6.00) for oxytocin, 13h (IQR: 12.00-14.00) for dinoprostone, 8.5h (IQR: 7.00-9.00) for misoprostol, and 9.0h (IQR: 8.00-10.00) for the balloon catheter. Maternal blood loss was significantly lower for oxytocin-induced women (p < 0.001), compared to misoprostol, dinoprostone, and balloon catheter. Neonatal outcomes were better for oxytocin-induced women (p < 0.01) and poorer for those induced with misoprostol (p < 0.01). Factors associated with achieving SVD included multigravidity (AoR = 1.57, p = 0.004), comorbidities (AoR = 1.47, p = 0.007), and use of oxytocin (AoR = 3.13, p < 0.001) or dinoprostone (AoR = 0.58, p = 0.003). Oxytocin was the most effective and safest method for labor induction within 24h, resulting in favorable maternal and neonatal outcomes. Healthcare workers should prioritize oxytocin for timely deliveries, while considering alternatives like dinoprostone, misoprostol, and balloon catheter based on individual patient needs and clinical circumstances.

Implementation of a rapid host-protein diagnostic test for distinguishing bacterial and viral infections in adults presenting to urgent care centers: a pragmatic cohort study

BackgroundUrgent care centers (UCCs) are a growing segment of healthcare with high rates of inappropriate antibiotic use. MeMed BV® (MMBV) is a blood test that differentiates bacterial from viral infections. Between April 2022 and March 2023, we introduced MMBV into routine care at ten UCCs. The primary objective was to assess MMBV’s impact on antibiotic use; the secondary objective was to assess whether MMBV aided in patient management.MethodsA pragmatic prospective cohort study. Physicians who ordered MMBV reported electronically (in real-time) whether they intended to prescribe antibiotics before ordering the test and upon UCC discharge whether MMBV aided in patient management. Hospitalizations were recorded for 7 days post-UCC discharge.ResultsDuring implementation, 3920 MMBV tests were ordered for adults (age ≥ 18) by 144 physicians. The study cohort had 59% female patients and the median age was 42 years (IQR 31–58). For the primary objective, 3262 cases were included. MMBV indicated 629/3262 (19.3%) cases of potentially unwarranted antibiotics, of which physicians avoided prescriptions in 397/629 (63.1%). MMBV indicated 405/3262 (12.4%) cases of potentially missed bacterial infections. Physicians prescribed antibiotics to 283/405 (69.9%). MMBV adherence was associated with fewer hospitalizations (7.8% vs. 30.3%, p < 0.001). For the secondary objective, 2901 cases were included. Physicians reported MMBV aided patient management in 2494/2901 (86.0%) cases and contributed to avoiding emergency department referrals in 595/2901 (20.5%).ConclusionsImplementing MMBV aided urgent care center physicians in their clinical decision-making and may have contributed to appropriate antibiotic use, better resource utilization, and patient management.

Weight development in children with obesity without treatment: A Danish cohort study with long-term follow-up.

Limited insight exists into the weight development in children with obesity not receiving obesity treatment. This cohort study included 467 Danish children aged 5-10 years with obesity (iso-BMI >30 kg/m2) not receiving treatment. Data from mandatory health check-ups on school-children's height and weight (converted to BMI z-scores) were merged with the Danish National Registries. A multivariable logistic regression weighted for the duration of follow-up was used to estimate odds ratios (OR) for normalization of BMI (iso-BMI 18.5-25 kg/m2) and obesity remission (iso-BMI 18.5-30 kg/m2). During a median follow-up of more than 6 years, 7.9% of the children normalized their BMI, while 45.4% obtained obesity remission. BMI z-score at inclusion acted as a strong inverse predictor for normalizing BMI (OR 0.14 per one-unit SD, CI: 0.03-0.53) and for obesity remission (OR 0.17 per one-unit SD, CI: 0.08-0.37). No other significant predictors were observed in the weighted multivariable models. Higher BMI z-scores inversely predict normalizing BMI and achieving obesity remission in untreated children. Given that many children naturally achieve obesity remission or weight normalization, resources should focus on understanding barriers of obesity maintenance and to develop effective strategies for those who do not experience improvement.

Changes in Incident Schizophrenia Diagnoses Associated With Cannabis Use Disorder After Cannabis Legalization.

Despite public health concerns that cannabis legalization may increase the number of cases of schizophrenia caused by cannabis, there is limited evidence on this topic. To examine changes in the population-attributable risk fraction (PARF) for cannabis use disorder (CUD) associated with schizophrenia after liberalization of medical cannabis and legalization of nonmedical cannabis in Canada. This population-based cohort study was conducted in Ontario, Canada, from January 1, 2006, to December 31, 2022, among 13 588 681 people aged 14 to 65 years without a history of schizophrenia. Diagnosis of CUD in the emergency department or hospital setting (International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada [ICD-10-CA] codes F12x and T40.7). Changes in the PARF for CUD associated with schizophrenia (ICD-10-CA codes F20x and F25x and Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition] [DSM-IV] code 295x) over 3 policy periods: prelegalization (January 2006 to November 2015), liberalization of medical and nonmedical cannabis (December 2015 to September 2018), and legalization of nonmedical cannabis (October 2018 to December 2022). A secondary outcome was diagnosis of psychosis not otherwise specified (NOS) (ICD-10-CA code F29x and DSM-IV code 298x). Segmented linear regression was used to examine changes after the liberalization of medical cannabis in 2015 and the legalization of nonmedical cannabis in 2018. The study included 13 588 681 individuals (mean [SD] age, 39.3 [16.1] years; 6 804 906 males [50.1%]), of whom 118 650 (0.9%) had CUD. A total of 91 106 individuals (0.7%) developed schizophrenia (80 523 of 13 470 031 [0.6%] in the general population without CUD vs 10 583 of 118 650 [8.9%] with CUD). The PARF for CUD associated with schizophrenia almost tripled from 3.7% (95% CI, 2.7%-4.7%) during the prelegalization period to 10.3% (95% CI, 8.9%-11.7%) during the legalization period. The PARF in the postlegalization period ranged from 18.9% (95% CI, 16.8%-21.0%) among males aged 19 to 24 years to 1.8% (95% CI, 1.1%-2.6%) among females aged 45 to 65 years. The annual incidence of schizophrenia was stable over time, while the incidence of psychosis NOS increased from 30.0 to 55.1 per 100 000 individuals (83.7%) in the postlegalization period relative to the prelegalization period. The PARF for CUD associated with schizophrenia increased steadily over the study with no accelerations after cannabis policy changes, while increases in the PARF for CUD associated with psychosis NOS accelerated after medical cannabis liberalization. In this cohort study of individuals aged 14 to 65 years in Ontario, Canada, the proportion of incident cases of schizophrenia associated with CUD almost tripled during a period of substantial liberalization of cannabis policy. Ongoing research is indicated to understand the long-term associations of cannabis policy with the prevalence of psychotic disorders.

Comparison of Hemiarthroplasty, total hip arthroplasty, and internal fixation for hip fractures in patients over eighty years of age: factors affecting mortality: a nationwide cohort study of fifty three thousand, four hundred and ninety five patients from Türkiye

Abstract Purpose Hip fractures are a common cause of mortality in elderly patients. This study aimed to determine the predictive factors affecting mortality among patients over the age of 80 who underwent surgical treatment for hip fractures. Methods We searched the Turkish Ministry of Health’s e-health database to identify patients over 80 years old who had undergone surgery for proximal femoral fractures from 2016 to 2022. This process yielded 53,495 patients. Demographic data as well as comorbidities, blood transfusions, postoperative 90 days medical complications, and mortality was investigated. Multivariate logistic regression analysis was performed to identify risk factors for one year mortality in patients undergoing surgical treatment for proximal hip fractures. Results The mortality rate was 37.2% in the first year. The mean Charlson comorbidity index(CCI) was 6.8 (range: 4–22). In the postoperative period, 68.6% of the patients received blood transfusions. Logistic regression analysis identified significant predictors of one-year mortality in surgical patients, including male gender, increased age, higher CCI scores, AKI, PE, pneumonia, electrolyte imbalance, gastrointestinal bleeding, blood transfusion, and increased mortality risks with hemiarthroplasty and internal fixation compared to total hip arthroplasty. (p &lt; 0.001 for all). Conclusions This large cohort study demonstrated that the mortality rate is high and that the type of surgery, male gender, older age, blood transfusion requirements, and high CCI score are associated with mortality in patients over 80 years of age who have undergone surgery for hip fractures. Preoperative optimization and postoperative care are critical for these vulnerable elderly patients.

Aesthetic benefit of single-port laparoscopic ileo-caecal resection for Crohn's disease: a comparative study.

Single-port laparoscopy has been mainly studied for colonic cancer or cholecystectomy. Little is known about the cosmetic outcome for patients with Crohn's disease who are the best candidates for single-port surgery. This study aimed to assess cosmetic outcomes with single-port laparoscopy (SPL) vs. multiport laparoscopy (MPL) after ileocolic resection for Crohn's disease. This was a retrospective case-control study of a consecutive monocentric cohort. The study was conducted at a tertiary colorectal surgery referral centre. All consecutive patients who underwent an ileocolic resection by laparoscopy between 2012 and 2020 were included. The main outcomes measures, body image and cosmesis after surgery, were evaluated with a validated questionnaire. Secondary endpoints were conversion, morbidity, length of hospital stay and incisional hernia. Two hundred and six patients were included (SPL, n = 65, 32%). Most patients were operated on for stricturing disease (64%). Conversion rate to laparotomy was 0% in the SPL group and 17.7% in the MPL group (p < 0.001). The complication rate was similar in both groups (SPL, 29.2%; MPL, 38.3%; p = 0.21) as was length of stay (5days [4-7] in both groups). In total 124 (71%) responded to the questionnaire (MPL, n = 74, 67%; SPL, n = 50, 78%; p = 0.11). The SPL group scored better on the cosmesis scale (21.1 vs. 18.4, p < 0.001). In the SPL group, body image scale scores were better for patients with an intraumbilical incision (intraumbilical 5.2 (± 0.6) vs. periumbilical 6.4 (± 2), p = 0.04). After matching, body image scale scores were similar in both groups (SPL, 6; MPL, 6.4; p = 0.24), but cosmesis scale scores remained better in the SPL group (21.1 vs. 19.3, p = 0.03). Ileocolic resection for Crohn's disease with single-port laparoscopy has better cosmetic outcomes than with the multiport approach. Postoperative complications and long-term incisional hernia rate are similar. Routine use of an intraumbilical incision could improve cosmetics.

Daily physical activity habits influence surgeons’ stress in the operating room: a prospective cohort study

Background: Exercise training improves heart rate variability, and evidence suggests it can mitigate the detrimental effects of stress. This study aims to evaluate the relationship between surgeons’ physical activity habits and their stress, assessed as heart rate variability, at the start of surgery. Materials and methods: This multispecialty prospective cohort study included surgeons from fourteen cardiac, endocrine, digestive, gynecologic, orthopedic, thoracic, and urologic surgical departments of four university hospitals. Surgeons wore accelerometers 24/7 from 1 November 2020 to 31 December 2021 to quantify the mean daily step counts and daily sedentary time for 7 days prior to each operation. RMSSD, the root mean square of successive differences between normal heart beats, is a heart rate variability (HRV) metric that reflects cardiac vagal tone. We evaluated RMSSD during the first 5 minutes of surgeries performed over five 15-day periods. Data were analyzed using a multivariable linear mixed model with a random effect for surgeons. Results: We analyzed 722 surgeries performed by 37 surgeons (median age = 47 (IQR 42–55); 29 (78.4%) male). On average (SD), surgeons walked 9762 (2447) steps and were sedentary 391 (102) minutes daily. The model showed a positive relationship between steps and cardiac vagal tone, with an increase in lnRMSSD (0.028, 95% CI 0.003 to 0.053, P = 0.026) for every 1000 more steps per day, but not for sedentary behavior. Senior surgeons presented lower lnRMSSD (−0.437, −0.749 to −0.126, P = 0.006), as did surgeons who spent less total time operating over the study period (−0.337, −0.646 to −0.027, P = 0.033), compared to their counterparts. Conclusions: Higher daily step counts the week before surgery were associated with increased cardiac vagal tone, indicating lower stress levels at the beginning of surgery. This relationship highlights the influence of physical activity on surgeons’ stress in the operating room.

Visit-to-Visit Systolic Blood Pressure Variability and Risk of Ischemic and Hemorrhagic Stroke

Background and Objectives: Systolic blood pressure (SBP) variability has been increasingly associated with cardiovascular outcomes, including stroke. This study aimed to evaluate the association between visit-to-visit SBP variability and the risk of ischemic and hemorrhagic stroke. Materials and Methods: A prospective cohort study was conducted on a set of 208 hypertensive patients over a period of three years, from August 2021 to September 2024, at the County Emergency Hospital “Pius Brinzeu”, Timișoara. Patients included in the study were stroke-free. SBP variability was quantified as the standard deviation of SBP measurements obtained quarterly. Results: This study demonstrated that systolic blood pressure (SBP) variability serves as a robust predictor of stroke incidence, underscoring its important role in cerebrovascular risk. The study cohort had an average age of 65.3 ± 9.1 years, with 53.4% males and 46.6% females. Patients in the highest SBP variability group had a 1.21-fold increased risk (21%, p = 0.031) of ischemic stroke and a 1.73-fold increased risk (73%, p = 0.005) of hemorrhagic stroke compared to those in the lowest variability group, revealing that higher SBP variability is strongly associated with an increased risk of both ischemic and hemorrhagic strokes, with the relationship being particularly pronounced for hemorrhagic stroke. Patients exhibiting greater fluctuations in SBP experienced significantly earlier stroke events and reduced stroke-free survival. Moreover, mortality rates were notably higher among individuals with very high SBP variability, indicating its profound impact on long-term outcomes. Conclusions: Visit-to-visit SBP variability is a significant and independent predictor of both ischemic and hemorrhagic stroke, emphasizing the clinical importance of monitoring and managing blood pressure stability. Further research should explore interventions to mitigate SBP variability and its impact on cerebrovascular outcomes.

Perioperative Outcomes of Staple Line Reinforcement During Laparoscopic and Robotic Sleeve Gastrectomy: An MBSAQIP Cohort Study of 284,580 Patients.

This study evaluated the association between staple line reinforcement (SLR) and 30-day outcomes in patients undergoing laparoscopic (LSG) or robotic sleeve gastrectomy (RSG). Adults undergoing primary LSG or RSG with and without SLR were analyzed from the 2018-2019 Metabolic and Bariatric Surgery Accreditation and Quality Improvement (MBSAQIP) database. Baseline characteristic differences by SLR status for LSG and RSG were adjusted using entropy balancing. Multivariable weighted logistic and linear regression was then performed to examine the association between SLR and primary and secondary outcomes. Of 284,580 patients, 88.6% (n = 252,035) had LSG and 11.4% (n = 32,545) had RSG, of which 63.7% (n = 160,545) and 50.8% (n = 16,541) had SLR, respectively. Compared to LSG and RSG without SLR, both LSG and RSG with SLR encountered higher adjusted odds of emergency department visit (AOR 1.08, 95%CI 1.03-1.10, p < 0.001; AOR 1.10, 95%CI 1.01-1.20, p = 0.029, respectively) as well as lower adjusted odds of leakage (AOR 0.85, 95%CI 0.76-0.94, p = 0.002; AOR 0.71, 95%CI 0.54-0.92, p = 0.011, respectively) and gastrointestinal bleeding (AOR 0.79, 95%CI 0.77-0.91, p < 0.001; AOR 0.77, 95%CI 0.70-0.84, p < 0.001, respectively). LSG with SLR was also associated with greater odds of unplanned intubation (AOR 1.52, 95%CI 1.16-1.99, p = 0.002) and mechanical ventilation (AOR 1.74, 95%CI 1.22-2.50, p = 0.002). RSG with SLR was associated with higher odds of intraoperative conversion (AOR 1.71, 95%CI 1.15-2.54, p = 0.008), and lower odds of acute renal failure (AOR 0.27, 95%CI 0.11-0.65, p = 0.003). This entropy-balanced analysis of the MBSAQIP registry demonstrated an overall association between SLR and lower postoperative leakage and bleeding after RSG and LSG.

Clinical Significance of Sarcopenia Defined by the Cross-Sectional Area of the Masseter Muscle in Cerebrovascular Events: A Retrospective Cohort Study

Background and Objectives: This study aimed to investigate the clinical significance of sarcopenia, defined by the cross-sectional area of the masseter muscle (CSA-M), as an early marker for sarcopenia diagnosis and its association with mortality in patients with cerebrovascular events (CVE). Materials and Methods: In this retrospective cohort study, 120 patients aged 65 years or older with CVE admitted to Bilkent City Hospital between September 2020 and September 2023 were included. Patients with malignancy, prior CVE, or incomplete data were excluded. Parameters such as CSA-M measured via brain CT, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores, Nutritional Risk Score (NRS), duration of ICU and hospital stays, and 28-day mortality were evaluated. The CSA-M thresholds for sarcopenia were defined as &lt;400 mm2 for men and &lt;300 mm2 for women. Results: Sarcopenia prevalence was significantly associated with prolonged ICU (27.0 ± 33.1 days vs. 16.5 ± 22.4 days, p = 0.042) and hospital stays (34.8 ± 38.4 days vs. 21.3 ± 22.3 days, p = 0.017). Right and left CSA-M values were significantly lower in sarcopenic patients (p &lt; 0.001). ROC analysis revealed CSA-M cut-off values of &lt;300 mm2 (AUC = 0.82) for men and &lt;295 mm2 (AUC = 0.83) for women as strong predictors of sarcopenia. Multivariate regression analysis showed a significant association between CSA-M and 28-day mortality (p &lt; 0.05). Sarcopenia also correlated with lower albumin levels, a higher prevalence of ischemic stroke, and increased mechanical ventilation needs. Conclusions: CSA-M measured via brain CT is a reliable marker for sarcopenia and a predictor of clinical outcomes in CVE patients. Early identification and management of sarcopenia could improve patient prognosis. Further research is warranted to explore its potential in broader clinical contexts.

Clinical outcome of vertebroplasty alone versus short-segment posterior instrumentation with vertebroplasty in osteoporotic vertebral fracture: a propensity-score-matched analysis.

Retrospective cohort study with propensity-score-matched analysis. To compare the efficacy of vertebroplasty (VP) versus short-segment posterior instrumentation (SS) with VP in patients with osteoporotic vertebral fractures (OVFs). OVFs significantly affect the aging population, causing pain, reduced mobility, and increased dependence. Treatment guidelines vary, and a consensus on the most effective approach remains unclear. To the best of our knowledge, no previous report focused on the efficacy comparison of VP alone versus SS with VP. The study included patients with OVFs undergoing VP with or without SS from 2017 to 2021. Baseline demographic and patient-reported outcome scores, including Oswestry Disability Index (ODI) and European Quality-of-Life-5 Dimensions (EQ-5D), were collected preoperatively and 1 year postoperatively. Radiographic outcomes, including Cobb angle, sagittal angle reduction, and kyphotic progression, were assessed. Perioperative data were gathered. Propensity-score matching was conducted to compare both groups after adjusting for baseline characteristics. This study included 60 patients. The subsequent analyses included 19 patients in both the SS+VP group and the VP groups after matching patient cohorts across various covariates. The SS+VP group demonstrated better ODI (30.38±17.12 vs. 49.68±19.43, p=0.0025) and EQ-5D scores (0.80±0.19 vs. 0.6±0.31, p=0.0018) at 1 year postoperative. Sagittal angle correction was higher in the SS+VP group (10.63°±6.34° vs. 5.74°±5.91°, p=0.0188). The SS+VP group exhibited higher blood loss and longer operative time. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar between the two groups. SS with VP generated superior patient-reported outcomes and sagittal angle correction for OVFs when evaluated one year postoperatively compared to VP alone. Perioperative complications, kyphotic progression, adjacent fractures, and reoperation rates were similar despite increased blood loss and extended operative time.

High-sensitivity C-reactive protein and risk of retinal artery occlusion and ischaemic stroke: a cross-cohort study

AimsPrevious studies have suggested an association between retinal artery occlusion (RAO) and ischaemic stroke (IS), both associated with elevated inflammatory factors. However, the role of high-sensitivity C-reactive protein (hs-CRP) in...

Characteristics of the parent‐child relationship at 18‐months of age predict the onset and type of mental disorders in childhood and adolescence: A longitudinal nested birth cohort study

AbstractBackgroundThe quality of the parent‐child relationship in the first years of childhood has been associated with various long‐term mental health outcomes. However, it is unclear whether specific characteristics of the early parent‐child relationship predict the onset of mental disorders. The aim of this study was therefore to examine child, parent, and dyadic characteristics of the early parent‐child relationship as predictors of mental disorders in childhood and adolescence.MethodAs a part of the Copenhagen Child Cohort 2000, a child cohort of 295 children participated in the study at 18‐months of age and were subsequently followed until late adolescence. Child, parent, and dyadic dimensions of the early parent‐child relationship were assessed using the observational Parent‐Child Early Relational Assessment. The outcomes were mental disorders subsequently diagnosed in childhood and adolescence.ResultsCox‐regression analyses suggested that parent characteristics involving negative affect and behavior, intrusiveness and insensitivity during early parent child interactions were associated with increased risk of the child being diagnosed with a mental disorder at later ages. However, variation was noted across specific diagnoses. Parental negative affect and behavior was specifically associated with increased risk of attention deficit hyperactivity disorder, while infant dysregulation and irritability was specifically associated with increased risk of autism spectrum disorders. These results remained significant after adjusting for parental mental disorders and early mental health problems of the child.ConclusionDisorder‐specific associations were observed between dysfunctions in the early parent‐child relationship and subsequent mental disorders. Improving such early relational dysfunctions may support the goals of early interventions that aim to mitigate the risk of mental disorders from a very early age.

The incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an observational cohort study.

The relationship between early cardiovascular dysfunction (CVD) in isolated traumatic brain injury (iTBI) and outcome has not been fully described. We aimed to (1) determine the prevalence and phenotype of CVD after iTBI in the hyper-acute phase and (2) compare treatment and outcomes in those with CVD vs non-CVD. An observational cohort database study of severe iTBI patients (Head AIS 3+) at a level 1 trauma centre (2008-2019) and physician-led air ambulance service (2019-2020). CV dysfunction was defined as tachycardia or bradycardia, with hypotension. Physiology, laboratory results, 24-hour transfusion, and computer-topography (CT) findings were recorded. Outcomes were 28-day mortality and Glasgow Outcome Score (GOS). A total of 168 patients met inclusion criteria, average age 46years (IQR 30-61), 77% male, median ISS 25 (IQR 17-29) with 51% Head AIS 5. Time from injury to pre-hospital assessment was 31minutes (IQR 20-42) with 20% demonstrating CVD on initial observations. The CVD group were more shocked (lactate 6.1 (1.7-10.9) vs. 2.4 (1.4-3.3), P <0.001) and coagulopathic (43% vs. 15%, P =0.001). There was no difference in Head AIS or CT findings between groups, except frequency of hypoxic ischemic encephalopathy (HIE) (CVD: 21% vs. non-CVD: 1%, P <0.001). A 24-hour transfusion was higher in CVD patients: 3 (0-8) vs. 0 (0-0) units, P <0.001. Mortality was greater in CVD vs non-CVD iTBI (61% vs. 31%, P =0.002), but in patients with AIS 5, there was no difference (P =0.262). One-third of CVD survivors (13/33) were discharged home, and 4/18 patients with recorded GOS had good neurological outcome. One in five patients with severe iTBI develop early CVD, associated with increased mortality, coagulopathy, and HIE. However, mortality and neurological outcome is highly variable in those with CVD across the iTBI severity spectrum. Further research is needed to define the pathophysiology and optimal treatment to improve outcomes for this subgroup of iTBI.

Predictors of in hospital mortality in cardiogenic shock following ST-elevation myocardial infarction (STEMI)

Objectives: Cardiogenic shock (CS) is a severe complication of ST-Elevation Myocardial Infarction (STEMI) and is associated with high mortality rates. This study aimed to identify predictors of in-hospital mortality in patients experiencing cardiogenic shock following STEMI. Methods: A retrospective cohort study was conducted at Afshar Hospital in Yazd from 2018 to 2023, analyzing clinical data from 62 STEMI patients diagnosed with CS. The mean age of the cohort was 64.9 ± 13.5 years, with a male predominance of 69.5%. Key variables assessed included left ventricular ejection fraction (LVEF), comorbidities, and treatment interventions. Survival analysis and Cox regression were employed to evaluate mortality outcomes. Results: LVEF less than 30% emerged as a significant predictor of in-hospital mortality, with a hazard ratio of 11.1 (95% CI: 2.6–47.4; p &lt; 0.001). The mean survival time was 7.0 days (95% CI: 5.8–8.3). Additionally, hyperlipidemia was associated with increased mortality, presenting an odds ratio of 11.3 (95% CI: 1.1–114.1; p = 0.040). The prevalence of chronic kidney disease was notably higher in the deceased cohort (28.0% vs. 8.1%; p = 0.042). Although urgent percutaneous coronary intervention (PCI) was performed in the majority of cases, mortality remained significant. Conclusions: This study highlights that LVEF and hyperlipidemia are critical predictors of in-hospital mortality in patients with cardiogenic shock following STEMI. Other studies also suggest the prognostic value of LVEF in various cardiac conditions, particularly in the context of acute coronary syndromes [14, 15]. Also, the combination of renal dysfunction left ventricular ejection fraction, and advanced age has been proposed as a predictor of in-hospital mortality [18]. These findings underscore the importance of early identification and targeted management strategies to improve patient outcomes in this high-risk population.

Absolute and Relative Agreement Between Radiographic and Sonographic Calcaneal Ossification Staging: A Pilot Study.

Radiographic evaluations are commonly used to determine calcaneal ossification staging throughout pediatric development. Sonographic imaging may offer a less expensive, noninvasive, clinically feasible option for calcaneal developmental assessments. Here, we assessed (1) inter-rater agreement of radiographic and sonographic calcaneal ossification staging of children and adolescent patients with Sever's disease and (2) agreement between radiographic and sonographic calcaneal ossification staging scores. There would be substantial agreement of radiographic and sonographic calcaneal ossification staging across raters, and between imaging measures. Retrospective cohort study. Level 3. Adolescent patients (<18 years of age) with physician-diagnosed Sever's disease who had complete calcaneal sonographic and radiographic imaging available on a retrospective chart review were included. Three independent reviewers with advanced training in musculoskeletal ultrasound each separately assessed radiographic and sonographic imaging data and assigned calcaneal calcification stages (0-5) to blinded images based on established criteria. Fleiss' Kappa analyses were used to determine inter-rater staging agreement for both imaging approaches. Cohen's Kappa analyses were used to determine the agreement between radiographic and sonographic staging. Absolute agreement, and relative agreement within each stage were assessed for both analyses. Data from 19 patients (13 female, 6 male; 12.2 ± 2.3 years) were included. Absolute inter-rater agreement for radiographic and sonographic calcaneal ossification staging was comparable across the 3 raters (radiographs, κ = 0.692, z = 9.02; P < .01; sonographs, κ = 0.713, z = 7.95; P < .01), and perfect relative agreement (κ = 1.0, z = 10.6; P < .01). Consensus scores for radiographic and sonographic staging had moderate (κ = 0.535, z = 4.2; P < .01, and perfect relative (100% relative agreement, z = 6.22; P < .01) agreement. Sonographic evaluations of calcaneal ossification staging was comparable across assessors, and similar to radiographic staging. Clinicians may consider incorporating ultrasound imaging for calcaneal ossification staging for young patients.

Comparison of outcomes of Salter and Varus osteotomies in the treatment of Legg-Calve-Perthes Disease: a retrospective cohort study.

Legg-Calve-Perthes Disease (LCPD) is described as idiopathic avascular osteonecrosis of the capital femoral epiphysis in pediatrics. LCPD is usually present in children between 2 and 15 years and happens more frequently in boys more than girls; this study aims to compare the outcome of two surgical methods in treating LCPD. We included sixty patients with unilateral LCPD who underwent Salter or femoral varus osteotomy from 2007 to 2017. Patients were followed up for at least five years. Patients' claudication, pain, leg circumference, range of motion, lever arm ratio (LAR), neck shaft angle (NSA), migration index, vertical distance, and the presence of teardrop sign, sagging rope sign, and Trendelenburg sign were evaluated five years after surgery. The mean neck shaft angle, the lever arm ratio, migration index and, sagging rope sign incidence in patients undergoing femoral varus osteotomy were significantly lower than those undergoing Salter surgery; the thigh circumference was higher in patients undergoing femoral varus osteotomy than those undergoing Salter osteotomy. There were significant differences in biomechanical indices of hip and acetabulofemoral in salter and femoral varus osteotomy; the results of the current study are highly suggestive of prioritizing femoral varus osteotomy to Salter surgery.

Prognostic impact of gait speed, muscle strength and muscle mass in chronic heart failure-A prospective cohort study.

Heart failure (HF) impairs skeletal muscle mass and function, which contributes to reduced physical performance. We investigated the prognostic impact of gait speed (GS), handgrip strength (HG) and appendicular skeletal muscle index (ASMI) on cardiovascular outcomes in a prospective HF cohort. This single-centre prospective cohort study included adults with stable chronic HF with a previous diagnosis of overtly reduced left ventricular ejection fraction (LVEF) <40% and LVEF<50% at enrolment. GS was measured by the 4m GS test, maximal HG was measured with a hydraulic dynamometer, and ASMI was measured by dual-energy X-ray absorptiometry. The primary combined outcome was cardiovascular death or worsening HF. Fine and Gray regression models were calculated, treating non-cardiovascular death as the competing event. Two hundred five patients (78% male) were analysed. The median age was 66 (quartiles: 58-74) years, 31% had diabetes mellitus, and the median LVEF was 37 (30-43) %. Median GS was 1.0 (0.8-1.0) m/s, median HG was 32 (24-40) kg, and median ASMI was 8.0 (7.2-8.9) kg/m2. During a median follow-up of 4.7 (4.0-5.3) years, the primary outcome was observed in 52 patients. In models adjusted for key clinical covariates, lower GS predicted a higher risk of cardiovascular death or worsening HF [subdistribution hazard ratio (SHR) per 0.1m/s increase=0.81, 95% confidence interval (CI) 0.68-0.95], whereas HG (SHR per 5kg increase=0.97, 95% CI 0.84-1.10) and ASMI (SHR per 1kg/m2 increase=1.17, 95% CI 0.94-1.44) did not. In the analysis of effect modification, these associations were consistent across key clinical subgroups. Higher GS was independently associated with a lower risk of cardiovascular death or worsening HF, whereas HG and ASMI were not. We prospectively confirm GS as a physical performance measure with clear prognostic significance for patients with HF.