Value For Linear Trend Research Articles

New risk classification adapting SCAI shock stages to patients with pulmonary embolism (RISA-PE).

Pulmonary embolism (PE) treatment is based on risk stratification according to European Society of Cardiology (ESC) guidelines. However, emerging therapies in acute PE may require a more granular risk classification. Therefore, the objective of the present study was to propose a new RIsk claSsification Adapting the SCAI shock stages to right ventricular failure due to acute PE (RISA-PE). This registry included consecutive intermediate-high risk (IHR) or high-risk (HR)-PE patients selected for catheter-directed interventions (CDI) from 2018 to 2023 in 15 Spanish centers (NCT06348459). Patients were grouped according to RISA-PE classification as A (right ventricular dysfunction and troponin elevation); B (A + serum lactate >2 mmol/L OR shock index ≥1); C (persistent hypotension); D (obstructive shock); and E (cardiac arrest). In-hospital adverse events were assessed to evaluate RISA-PE performance. A total of 334 patients were included (age 62.1±15.2 years, 55.7% males). The incidence of in-hospital all-cause death was progressively higher with increasing RISA-PE stage (1.2%, 6.4%, 19.0%, 25.6%, and 57.7% for stages A, B, C, D, and E, respectively, P value for linear trend<0.001). However, using the ESC classification, there was an abrupt difference between IHR- and HR-PE patients regarding mortality (4.3% vs. 29.3%, P<0.001). The incidence of in-hospital major bleeding and acute kidney injury followed a similar pattern. The user-friendly RISA-PE classification may improve the granularity in stratifying PE patients' risk and warrants evaluation in larger studies with different therapeutic approaches in order to detect its utility as a decision-making scale.

Investigating the Origins of Hot Neptunes from Radial Velocity Data

Abstract Hot Neptunes are extrasolar planets that are similar in size to Neptune in our solar system but are much closer to their host stars, completing an orbit in 10 days or less. The origin of hot Neptunes is not fully understood. A potential large third body at a distance can lead to the migration of long-period planets to become much closer to the host star, and such a dynamical process helps explain the origin of hot Jupiters. We investigate whether hot Neptunes could share a similar origin by analyzing radial velocity data from multiple sources for a sample of 34 hot Neptune systems. Hot Neptune systems appear to have similar values of linear trend to hot Jupiter systems. We perform a maximum likelihood analysis to constrain the mass and distance distribution of the putative third body. The overall fraction of hot Neptune systems with third bodies is consistent with unity, higher than 71% at the 2σ level. On average, the mass and distance distribution of the third bodies for hot Neptune systems is consistent with that for hot Jupiter systems. Our results suggest that hot-Neptune systems share the same origin mechanism as hot Jupiters, e.g., through the gravitational effect of third bodies.

Radiation Dose Does Not Affect the Predictive Value of Thyroid Biopsy for Diagnosing Papillary Thyroid Cancer in a Belarusian Cohort Exposed to Chernobyl Fallout

Introduction: The Chernobyl nuclear accident exposed residents of contaminated territories to substantial quantities of radioiodines and was followed by an increase in thyroid cancer, primarily papillary thyroid cancer (PTC), among exposed children and adolescents. Although thyroid biopsy is an essential component of screening programs following accidental exposure to radioiodines, it is unknown whether the predictive value of biopsy is affected by different levels of environmental exposure. Methods: A cohort of 11,732 Belarusians aged ≤18 years at the time of the Chernobyl accident with individual thyroid radiation dose estimates was screened at least once 11–22 years later. Paired cytologic conclusions and histopathologic diagnoses were possible for 258 thyroid nodules from 238 cohort members. Cytologic conclusions were divided into five reporting categories, with all follicular lesion aspirates combined into a single indeterminate category. Standard performance indicators, risk of malignancy (ROM), and odds ratios for a correct cytologic conclusion were calculated, both overall and according to quintile of thyroid radiation dose. Results: The arithmetic mean thyroid dose estimate for the study group was 1.73 Gy (range: 0.00–23.64 Gy). The final histopathologic diagnosis was cancer for 136 of 258 biopsies (52.7%; 135 papillary and 1 follicular). The overall ROM was 96.7% for cytologies definite for PTC, 83.7% for suspicious for PTC, 33.0% for indeterminate, 8.1% for benign, and 31.0% for non-diagnostic. The ROM showed little change according to level of radiation exposure. Overall, there was no association between thyroid radiation dose and the odds ratio for a correct cytologic conclusion (p = 0.24). When analyzed according to dose quintile, the odds ratio for a correct conclusion increased two-fold at 0.10–0.29 Gy compared to a dose of 0.00–0.09 Gy and decreased at doses of 0.3–24 Gy (p value for linear trend = 0.99). Conclusions: At radiation doses received by a cohort of young Belarusians exposed to radioiodines by the Chernobyl accident, the predictive value of thyroid biopsy for diagnosing PTC was not significantly affected by level of radiation exposure.

Treatment and Control of Hypertension Among Adults With Chronic Kidney Disease, 2011 to 2019.

Hypertension frequently accompanies chronic kidney disease (CKD) as etiology and sequela. We examined contemporary trends in hypertension treatment and control in a national sample of adults with CKD. We evaluated 5% cross-sectional samples of adults with CKD between 2011 and 2019 in the Veterans Health Administration. We defined CKD as a sustained estimated glomerular filtration rate value <60 mL/min per 1.73 m2 or a urine albumin-to-creatinine ratio ≥30 mg/g. The main outcomes were blood pressure (BP) control, defined as a systolic BP <140 mm Hg and a diastolic BP <90 mm Hg based on the mean of monthly BP measurements, and prescriptions for antihypertensive medications. The annual samples ranged between n=22 110 and n=33 039 individuals, with a mean age of 72 years, 96% of whom were men. Between 2011 and 2014, the age-adjusted proportion of adults with controlled BP declined from 78.0% to 72.2% (P value for linear trend, <0.001), reached a nadir of 71.0% in 2015, and then increased to 72.9% by 2019 (P value for linear trend, <0.001). Among adults with BP above goal, the age-adjusted proportion who did not receive antihypertensive treatment increased throughout the decade from 18.8% to 21.6%, and the age-adjusted proportion who received ≥3 antihypertensive medications decreased from 41.8% to 36.3%. Prescriptions for first-line antihypertensive agents also decreased. Among adults with CKD treated in the Veterans Health Administration, the proportion with controlled BP declined between 2011 and 2015 followed by a modest increase, coinciding with fewer prescriptions for antihypertensive medications.

Historical Trend of Exposure to Perfluoroalkyl Surfactants PFOA, ADV, and cC6O4 and its Management in Two Perfluoroalkyl Polymers Plants, Italy.

Perfluoroalkyl acid surfactants are used in the chemical industry for the synthesis of perfluoroalkyl polymers. In one Italian fluoropolymer plant and in the research and innovation center, two major perfluoroalkyl surfactants have been historically used: PFOA and ADV and a third, cC6O4 substituted PFOA from mid-2013. This work is summarizing occupational exposure to these chemicals in the period 2004-2021, assessed by biological monitoring. Moreover, taking advantage of the phasing out of PFOA, the elimination kinetics of PFOA in humans is investigated. Workers exposed to PFOA (from beginning of the sixties to 2013), ADV (since 1996), and/or cC6O4 (since 2012) in the production of fluoropolymers, in the synthesis, research, and analysis, were periodically surveyed from 2004, measuring the concentration of perfluoroalkyl acid surfactants in serum. Workers of the same plants, not directly exposed, were surveyed as well. Applying the first-order kinetics model, the half-life of PFOA was calculated. 809 Workers were investigated with measurements of PFOA (n = 3692), ADV (n = 4288) and cC6O4 (n = 2272) in serum. In the production plant, median PFOA ranged from 1900 to 14 µg/l from 2004 to 2021; median ADV ranged from 434 to 86 µg/l from 2011 to 2021. For cC6O4 the detection percentage ranged from 9 to 47%; in detected samples median cC6O4 ranged from 3 to 16 µg/l in the period 2013-2021. Adopted mitigation measurements included: the phasing out of PFOA, the improvement of the plastomer and elastomer post-treatments; the reinforcement of the staff involved in prevention. Decreasing trends were observed for all chemicals along years (P value for linear trend of means < 0.01). For PFOA, a half-life of 3.16 (95% CI 2.98-3.37) years was calculated. In the study plants, several initiatives to reduce exposure and the risk associated with perfluoroalkyl surfactants were undertaken; results of biomonitoring show that they were effective, with a 5- to 136-fold reduction in the concentration of perfluoroalkyl compounds in the serum of workers.

Plasma Amino Acids in Early Pregnancy and Midpregnancy and Their Interplay With Phospholipid Fatty Acids in Association With the Risk of Gestational Diabetes Mellitus: Results From a Longitudinal Prospective Cohort.

We prospectively evaluated plasma amino acids (AAs) in early pregnancy and midpregnancy and their interplay with phospholipid fatty acids (FAs) in association with gestational diabetes mellitus (GDM) risk. From a longitudinal pregnancy cohort of 2,802 individuals, concentrations of 24 plasma AAs at 10-14 and 15-26 gestational weeks (GW) were assessed among 107 GDM case subjects and 214 non-GDM control subjects. We estimated adjusted odds ratios (OR) and 95% CI for the associations of plasma AAs and the joint associations of plasma AAs and phospholipid FAs with GDM risk, adjusting for risk factors including age, prepregnancy BMI, and family history of diabetes. Glycine at 10-14 GW was inversely associated with GDM (adjusted OR [95% CI] per SD increment: 0.55 [0.39-0.79]). Alanine, aspartic acid, and glutamic acid at 10-14 GW were positively associated with GDM (1.43 [1.08-1.88], 1.41 [1.11-1.80], and 1.39 [0.98-1.98]). At 15-26 GW, findings for glycine, alanine, aspartic acid, and the glutamine-to-glutamic acid ratio were consistent with the directions observed at 10-14 GW. Isoleucine, phenylalanine, and tyrosine were positively associated with GDM (1.64 [1.19-2.27], 1.15 [0.87-1.53], and 1.56 [1.16-2.09]). All P values for linear trend were <0.05. Several AAs and phospholipid FAs were significantly and jointly associated with GDM. For instance, the lowest risk was observed among women with higher glycine and lower even-chain saturated FAs at 10-14 GW (adjusted OR [95% CI] 0.15 [0.06, 0.37]). Plasma AAs may be implicated in GDM development starting in early pregnancy. Associations of AAs with GDM may be enhanced in the copresence of phospholipid FA profile.

Formal registration of visual impairment in people with diabetic retinopathy significantly underestimates the scale of the problem: a retrospective cohort study at a tertiary care eye hospital service in the UK

AimsTo analyse the prevalence of visual impairment (VI), compare it to certification of visual impairment (CVI) and analyse VI associations in patients with diabetic retinopathy (DR).MethodsRetrospective cohort study, which included...

Predictive capacity of self-rated health on all-cause mortality in Spain: differences across sex, age and educational level

BackgroundPublished evidence on self-rated health’s capacity to predict mortality and its variability across subpopulations lacks consistency. Our objective is to evaluate this predictive association and whether/how it varies by sex,...

Association of Modifiable Lifestyle Factors with Plasma Branched-Chain Amino Acid Metabolites in Women

BackgroundCirculating branched-chain amino acids (BCAAs—isoleucine, leucine, and valine) are strongly associated with higher risk of incident type 2 diabetes (T2D); however, determinants of elevated fasting BCAA concentrations are largely unknown. ObjectivesWe aimed to characterize the modifiable lifestyle factors related to plasma BCAAs. MethodsWe performed a cross-sectional analysis among n = 18,897 women (mean ± SD age: 54.9 ± 7.2 y) in the Women’s Health Study, free of T2D and cardiovascular disease at baseline blood draw. Lifestyle factors, weight, and height were self-reported via questionnaire, including smoking status, alcohol, leisure-time physical activity (LTPA), diet quality scores [2010 Alternative Healthy Eating Index (without alcohol) (aHEI); alternate Mediterranean Diet (aMED)], and dietary sources of BCAAs. Plasma BCAAs were quantified via NMR spectroscopy. We calculated multivariable-adjusted percentage mean differences (95% CIs) and P values for linear trend of BCAAs stratified by categoric lifestyle factors. We estimated R2 from univariate cubic spline regression models to estimate the variability in BCAAs explained. ResultsCompared with women with BMI (in kg/m2) <25.0, BCAAs were 8.6% (95% CI: 8.0%, 9.3%), 15.3% (95% CI: 14.4%, 16.3%), and 21.0% (95% CI: 18.2%, 23.9%) higher for the BMI strata 25.0–29.9, 30.0–39.9, and ≥40.0, respectively (P-trend < 0.0001). Women with higher LTPA and higher alcohol intake compared with lower had modestly (∼1%) lower plasma BCAAs (P-trend = 0.014 and 0.0003, respectively). Differences in smoking status, aHEI, and aMED score were not related to plasma BCAAs. Women with higher dietary BCAAs had dose-response higher plasma BCAA concentrations, 3.4% (95% CI: 2.5%, 4.4%) higher when comparing the highest with the lowest quintile (P-trend < 0.0001). BMI explained 11.6% of the variability of BCAAs, whereas other factors explained between 0.1% and 1%. ConclusionsOur findings among a large cohort of US women indicate that BMI, but less so diet, physical activity, and other lifestyle factors, is related to plasma BCAAs.This trial was registered at clinicaltrials.gov as NCT00000479.

Financial hardship and social assistance as determinants of mental health and food and housing insecurity during the COVID-19 pandemic in the United States.

BackgroundWhile social assistance through the U.S. federal CARES Act provided expanded unemployment insurance benefits during the COVID-19 pandemic until the summer of 2020, it is unclear whether social assistance was sufficient in subsequent months to meet everyday spending needs and to curb the adverse health-related sequelae of financial hardship.MethodsUsing multivariable Poisson log-binomial regression and repeated cross-sectional Household Pulse Survey data between September and December 2020 on 91,222 working-aged U.S. adults and 28,842 adult housing renters, this study explored the associations of financial hardship with mental health outcomes and food and housing insecurity after accounting for receipt of social assistance.ResultsFinancial hardship rose progressively from September to December 2020, and disproportionately affected Black non-Hispanic and Hispanic Americans and lower-income households. Experiencing considerable financial hardship (vs no hardship) predicted nearly 3-fold higher risks of anxiety and depressive symptoms (e.g., adjusted prevalence ratio, PR of depression = 2.75, 95% CI = 2.54–2.98, P < .001), a 23-fold higher risk of food insufficiency (PR = 22.71, 95% CI = 15.62–33.01, P < .001), and a 27-fold higher risk of a likely eviction (PR = 27.20, 95% CI = 10.63–69.59, P < .001). Across outcomes, these relationships were stronger at each successively higher level of financial hardship (all P values for linear trend <0.001), and more than offset benefits from social assistance.ConclusionsEven after accounting for social assistance receipt, working-aged adults experiencing financial hardship had markedly greater risks of anxiety and depressive symptoms, food insufficiency, and an anticipated housing eviction. These findings point to the urgent need for direct and sustained cash relief well in excess of current levels of social assistance to mitigate the pandemic's adverse impacts on the well-being of millions of Americans, including vulnerable minority and low-income populations.

Socioeconomic position and cardiovascular mortality in 63 million adults from Brazil

BackgroundIt has been suggested that cardiovascular disease exhibits a ‘social cross-over’, from greater risk in higher socioeconomic groups to lower socioeconomic groups, on economic development, but robust evidence is lacking....

Similarities and differences in trends of changes of the agroclimatic conditions of the main viticulture zones of the Krasnodar region

In this article are presented the results of studying the similarities and differences in the trends of changes of the agroclimatic conditions of the main viticulture zones of the Krasnodar region according to the data of the Temryuk, Anapa and Taman weather stations. The average values of heat and water supply indicators for two thirty-year (1961-1990, 1991-2020) and three twenty-year averaging periods (1961-1980, 1981-2000, 2001-2020) were obtained. Statistically significant changes in the average agroclimatic indicators were noted. The connection of the course of indicators between weather stations is determined, especially a close connection is noted in the indicators of Anapa and Temryuk. The values of linear trends in 1991-2020 for Anapa and Temryuk are calculated. Statistically significant trends are the growth of the accumulated air temperature above +10 °C in Anapa and Temryuk, a decrease in the moisture coefficient and an increase in the dryness index in Temryuk.

Systemic microvascular endothelial dysfunction is associated with reduction of left ventricular ejection fraction in chronic Chagas disease patients

Abstract Introduction Chagas disease (CD) affects millions of patients around the world, many of whom may develop cardiovascular complications, including heart failure and stroke. Notwithstanding, little is known about the effects of CD in the reactivity of the systemic microcirculation. Purpose The present study aims to compare the microvascular reactivity (MR) of a group of patients in the chronic phase of CD with healthy volunteers, matched for sex and age. In addition, we sought to evaluate the association between MR and left ventricular ejection fraction (LVEF) in CD patients. Methods Systemic microvascular flow and endothelium-dependent vasodilation were assessed using laser speckle contrast imaging, coupled with acetylcholine (Ach) iontophoresis in the forearm skin. Vascular reactivity data were expressed as area under the curve (AUC) of Ach-induced vasodilation. Anthropometry, medications, biochemistry, and echocardiographic data were obtained from medical records. Results Thirty-six patients were compared to 25 healthy individuals (controls). Ach-induced vasodilation was higher in controls, when compared to patients (maximum increase of microvascular flow from baseline of 106% and of 48% respectively, P&amp;lt;0.0001; Mann Whitney test). There was a significant association between LVEF, stratified into quartiles, and MR (P value for linear trend = 0.002; one way ANOVA, Figure 1). In addition, there was no difference in MR between CD patients with normal LVEF and the control group. In CD patients, MR was independent of the presence of arterial hypertension or diabetes. Conclusion We have shown that the reduction of MR is associated with a decrease of LVEF in a group of chronic CD patients. The results were not affected by comorbidities, such as hypertension or diabetes. The evaluation of systemic endothelial function may be useful to tailor therapeutic and preventive approaches, targeted at systolic left ventricular failure associated with chronic CD cardiomyopathy. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro

Has the UK living kidney donor population changed over time? A cross-sectional descriptive analysis of the UK living donor registry between 2006 and 2017.

BackgroundA living-donor kidney transplant is the best treatment for most people with kidney failure. Population cohort studies have shown that lifetime living kidney donor risk is modified by sex, age, ethnicity, body mass index (BMI), comorbidity and relationship to the recipient.ObjectivesWe investigated whether the UK population of living kidney donors has changed over time, investigating changes in donor demographics.DesignWe undertook a cross-sectional analysis of the UK living kidney donor registry between January 2006 to December 2017. Data were available on living donor sex, age, ethnicity, BMI, hypertension and relationship to recipient.SettingUK living donor registry.Participants11 651 consecutive living kidney donors from January 2006 to December 2017.Outcome measuresLiving kidney donor demographic characteristics (sex, age, ethnicity, BMI and relationship to the transplant recipient) were compared across years of donation activity. Donor characteristics were also compared across different ethnic groups.ResultsOver the study period, the mean age of donors increased (from 45.8 to 48.7 years, p<0.001), but this change appears to have been limited to the White population of donors. Black donors were younger than White donors, and a greater proportion were siblings of their intended recipient and male. The proportion of non-genetically related non-partner donations increased over the 12-year period of analysis (p value for linear trend=0.002).ConclusionsThe increasing age of white living kidney donors in the UK has implications for recipient and donor outcomes. Despite an increase in the number of black, Asian and minority ethnic individuals waitlisted for a kidney transplant, there has been no increase in the ethnic diversity of UK living kidney donors. Black donors in the UK may be at a much greater risk of developing kidney failure due to accumulated risks: whether these risks are being communicated needs to be investigated.

Ethnoracial and social trends in breast cancer staging at diagnosis in Brazil, 2001–14: a case only analysis

SummaryBackgroundPolicies for early detection of breast cancer, including clinical breast examinations and mammographic screening, were introduced in Brazil in 2004, but their effect on disease stage at diagnosis is unclear. We aimed to assess whether these policies have led to a decrease in the prevalence of late-stage breast cancer at diagnosis.MethodsIn this case only analysis, using an anonymised nationwide hospital based-cancer registry network, we identified women aged 18–89 years who had been diagnosed with an invasive breast cancer in Brazil during 2001–14. We extracted individual patient-level data on patient demographics, tumour variables, and health-care provider variables for the centre where the patient was diagnosed. Our objectives were to estimate the prevalence of late-stage breast cancer (TNM stage III or IV) at diagnosis overall, across age groups, and by ethnoracial and social strata (ie, self-reported ethnoracial group, as white, black, brown, Asian, or Indigenous, and educational level, marital status, and region of residence) across the study period, and compare these estimates with international data from high-income countries (Norway and the USA). We used logistic regression to estimate odds ratios (ORs) for late-stage versus early-stage (TNM stage I or II) breast cancer at diagnosis in relation to relevant exposures, either minimally adjusted (for age, year of diagnosis, and region of residence) or fully adjusted (for all patient, tumour, and health-care provider variables).FindingsWe identified 247 719 women who were diagnosed with invasive breast cancer between Jan 1, 2001, and Dec 31, 2014, with a mean age at diagnosis of 55·4 years (SD 13·3), of whom 36·2% (n=89 550) identified as white, 29·8% (n=73 826) as black or brown, and 0·7% (n=1639) as Asian or Indigenous. Prevalence of late-stage breast cancer at diagnosis remained high throughout 2001–14, at approximately 40%, was inversely associated with educational level (p value for linear trend <0·0001), and was higher for women who identified as black (minimally adjusted OR 1·61, 95% CI 1·53–1·70; fully adjusted OR 1·45, 95% CI 1·38–1·54) and brown (minimally adjusted OR 1·26, 95% CI 1·22–1·30; fully adjusted OR 1·18, 1·14–1·23) than those who identified as white. The predicted prevalence of late-stage cancer at diagnosis was highest for women who were black or brown with little or no formal education (48·8%, 95% CI 48·2–49·5) and lowest for women who were white with university education (29·4%, 28·2–30·6), but both these prevalences were higher than that of all women diagnosed with breast cancer in Norway before the introduction of mammography screening (ie, 16·3%, 95% CI 15·4%–17·2% in 1970–74). Similar ethnoracial and social patterns emerged in analyses restricted to the age group targeted by screening (50–69 years).InterpretationThe persistently high prevalence of late-stage breast cancer at diagnosis across all ethnoracial and social strata in Brazil, although more substantially among the most disadvantaged populations, implies that early detection policies might have had little effect on breast cancer mortality so far, and highlights the need to focus primarily on timely diagnosis of symptomatic breast cancer rather than on screening for asymptomatic disease.FundingNewton Fund, Research Councils UK, and Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa.

Multilocus Genetic Risk Scores for Skeletal Fluorosis: A Cross-Sectional, Case-Control Study in China

Background: Previous genetic studies have revealed several single nucleotide polymorphisms (SNPs) related to skeletal fluorosis. We set out to ascertain the genetic association with skeletal fluorosis and to obtain more precise risk predictions using a cross-sectional, case-control design. Methods: We tested six SNPs for association with skeletal fluorosis in a cross-sectional, case-control design including 1319 participants aged 16 years or older (312 participants with skeletal fluorosis and 1007 controls free of the disease) from three provinces of China (Inner Mongolia, Qinghai, Xinjiang). We modeled SNPs as a multilocus genetic risk scores and used logistic regression models to estimate the association of the genetic risk score with skeletal fluorosis. For further analyses we evaluated the potential value of the 5-SNP and 6-SNP genetic risk score in risk predictions for skeletal fluorosis. Findings: The genetic risk score including the five SNPs associated with skeletal fluorosis was associated with the risk of skeletal fluorosis (even after adjustment for sex, age, ethnicity, osteoarthritis, daily fluoride intake and urine fluoride in the model). Participants in the third quartile of the 5-SNP genetic risk score had a relative 2·73-times increased risk of skeletal fluorosis when compared with those in the bottom quartile (95% CI 1·23-6·97, p value for linear trend across the quartiles=0·021). The area under the receiver operating characteristic curve (AUC) estimates for skeletal fluorosis models with 5-SNP genetic risk score or 6-SNP genetic risk score, where sex, age, ethnicity, osteoarthritis, daily fluoride intake and urine fluoride were adjusted, were 0·769 (95% CI 0·740-0·798) and 0·771 (95% CI 0·742-0·800), respectively, and they were significantly higher than the estimates (0·761, 95% CI 0·732-0·791) from the model without any genetic risk score (p=0·049; p=0·034). Furthermore, the 5-SNP genetic risk score did have significant effects on the categorical and continuous net reclassification improvement and integrated discrimination index for skeletal fluorosis (5·21%, 95% CI 0·93%-9·49%, p=0·0171; 0·2474, 95% CI 0·1223-0·3724, p=0·0001; 0·0096, 95% CI 0·0038-0·0154, p=0·0012, for the three measures, respectively). Interpretation: Using a genetic risk score design, we can ascertain the genetic association with skeletal fluorosis in our study population in China. Furthermore, more precise risk predictions for the disease can be obtained. Whether this panel of six SNPs has clinical use and general predictive performance remains to be defined. Funding Statement: National Natural Science Foundation of China (No.81673110). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The study was conducted under the approval of the Ethical Review Board of Harbin Medical University (HMUIRB20120021). All participants provided written informed consent, and the guardians on behalf of the ethnicity provided written informed consent.

Childhood experiences of parenting and age at menarche, age at menopause and duration of reproductive lifespan: Evidence from the English Longitudinal Study of Ageing

ObjectivesThe parent-child relationship is critical for human development, yet little is known about its association with offsprings’ reproductive health outside the context of abuse and neglect. We investigated whether childhood experiences of poor-quality parenting (characterized as decreased parental care and increased parental overprotection) are associated with women’s reproductive timing and lifespan. Study designObservational study of 2383 women aged 55–89 years in 2007 from the English Longitudinal Study of Ageing (ELSA). Multinomial logistic regression models were estimated. Main outcome measuresSelf-reported ages at menarche and menopause and duration of reproductive lifespan. ResultsIncreasing maternal and paternal overprotection were associated with later menarche (≥16 years) after adjustment for age and childhood socioeconomic position (relative risk ratio (RRR) 1.11, 95% CI 1.02–1.21 and 1.11, 95% CI 1.01–1.21, respectively, per unit increase in the predictor). Increasing parental overprotection and decreasing paternal care were associated with earlier menarche (≤10 years). However, these associations were marginally non-significant. Maternal and paternal overprotection were also inversely associated with age at natural menopause after adjustment for age, childhood socioeconomic position and age at menarche (p value for linear trend = 0.041 and 0.004, respectively). Further, increasing paternal overprotection was associated with a shorter reproductive lifespan (≤33 years) (RRR 1.09 (1.01–1.18), per unit increase in the predictor) after adjustment for age and childhood socioeconomic position. Adjustment for additional childhood and adult factors did not explain these associations. ConclusionsWomen who experienced poor-quality parenting in childhood, especially increased levels of parental overprotection, might be at increased risk of an unfavourable reproductive health profile that is characterized by late or early menarche, premature menopause and a shorter reproductive lifespan.

Analisis Prospek Penerimaan Pajak Bumi dan Bangunan Di Kecamatan Asparaga Kabupaten Gorontalo

Gorontalo Province is still one of the newly developed areas that always expect the participation and support from various parties, both morally and spiritually in the form of facility improvement and human resource formation must be developed simultaneously, it is clear that this will encourage economic development for the society as a whole. This study aims to analyze the Prospect of Receipt of Land and Building Tax in District of Asparaga Gorontalo Regency. The main variables used are land tax and building. The analysis method used is Linear Trend analysis. The results showed that the Linear Trend is Y = 900343714,60 + 5006432,80 X which means the variable of the earth and building taxes have good prospects in the District Asparaga. And with the value of linear trend can be calculated the estimated value of land and building tax revenue for the period 2017-2021 in District Asparaga.Analisis Prospek Penerimaan Pajak Bumi dan Bangunan Di Kecamatan Asparaga Kabupaten Gorontalo

Current trends in bilateral internal thoracic artery use for coronary revascularization: Extending benefit to high-risk patients

BackgroundWe sought to identify the trends in bilateral internal thoracic artery use and determine the degree to which the survival advantage of bilateral internal thoracic artery revascularization persists among perceived “high-risk” patients, compared with the use of left internal thoracic artery alone. MethodsA retrospective review was conducted of patients who underwent isolated coronary artery bypass grafting for multivessel coronary artery disease at the Mayo Clinic between January 2000 and December 2015. Propensity score matching was performed between patients with bilateral internal thoracic artery and left internal thoracic artery alone grafts (1011 matched pairs). Effect of bilateral internal thoracic artery use on survival in “high-risk” patients (ejection fraction <40%, body mass index ≥30, age ≥70 years, diabetes, chronic lung disease, cerebrovascular accident) was evaluated. ResultsA total of 6468 isolated coronary artery bypass grafts were performed (5431 using left internal thoracic artery alone, 1037 using bilateral internal thoracic artery). There was an increasing trend in bilateral internal thoracic artery use (P value for linear trend = .005), with the percentage of coronary artery bypass grafting cases with bilateral internal thoracic artery doubling over the last 4 years (13% in 2012 to 27% in 2015). Propensity-matched comparisons showed a survival advantage for bilateral internal thoracic artery (hazard ratio, 0.81; 95% confidence interval, 0.66-0.99; P = .043). Risk of deep sternal wound infection, although higher in the bilateral internal thoracic artery group, was not significant (1.2% vs 0.5%; P = .088). None of the “high-risk” subsets of patients showed an adverse effect of bilateral internal thoracic artery on survival. ConclusionsBilateral internal thoracic artery use in coronary artery bypass grafting is increasing over time. There is a consistent survival benefit with bilateral internal thoracic artery use, extending to patients with higher-risk comorbidities, suggesting the need for further expansion in use of this technique.

Tendencies of multi-year variability of the sea level at the coastal stations of the Аrctic оcean

New estimates of linear trends in the position of the level surface were obtained as a result of analysis of the data of long-term observations of sea level fluctuations at the stations of the seas of the Arctic Ocean. A rise in sea level is observed at almost all stations. In multi-year fluctuations of the level, periods characterized by different values of linear trends are identified. The reasons for the variability of local linear trends in the level of the Arctic seas from the 1950-1980 stage to the 1990-2015 period are analyzed. It is shown that the presence of local trends during the annual average levels at coast stations is a consequence of changes in climatic conditions reflected in changes in atmospheric and hydrosphere climatic indices, as well as in freshwater river runoff.