Endoscopic submucosal dissection for colorectal neoplasms: Risk factors for local recurrence and long-term surveillance

Objectives

Endoscopic submucosal dissection (ESD) is an effective procedure for the en bloc resection of colorectal neoplasms. However, risk factors for local recurrence after ESD have not been identified. This study aimed to evaluate such risk factors after ESD for colorectal neoplasms.

Methods

This retrospective study included 1344 patients with 1539 consecutive colorectal lesions who underwent ESD between September 2003 and December 2019. We investigated various factors associated with local recurrence in these patients. The main outcomes were the incidence of local recurrence and its relationship with clinicopathological factors during long-term surveillance.

Results

The en bloc resection rate was 98.6%, the R0 resection rate was 97.2%, and the histologically complete resection rate was 92.7%. Local recurrence was observed in 7/1344 (0.5%) patients and the median follow-up period was 72 months (range 4-195 months). The incidence of local recurrence was significantly higher in lesions ≥40 mm in diameter (hazard ratio [HR] 15.68 [1.88-130.5]; p = 0.011), piecemeal resection (HR 48.42 [10.7-218.7]; p < 0.001), non-R0 resection (HR 41.05 [9.025-186.7]; p < 0.001), histologically incomplete resection (HR 16.23 [3.627-72.63]; p<0.001), and severe fibrosis (F2; HR 9.523 [1.14-79.3]; p = 0.037).

Conclusions

Five risk factors for local recurrence after ESD were identified. Patients with such factors should undergo careful surveillance colonoscopy.

Stentgraft Limb Occlusion After Endovascular Aneurysm Repair: Incidence and Risk Factors

INTRODUCTION

Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors.

METHODS

All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study. Demographic data, cardiovascular risk factors, aneurysm characteristics, arterial anatomy, repair strategy, systemic and stentgraft-related complications, and in-hospital and late mortality were collected. Routine follow-up included duplex examination and/or CT angiography at 3 months, 12 months and annually thereafter. Logistic regression analysis was performed to detect predictors for SLO.

RESULTS

A total of 221 patients (425 stentgraft limbs) were included; of whom 11 patients (5.0%) occluded. Median time to occlusion was 3.3 months and most of the patients presented ischemic signs. Two risk factors for SLO could be identified: symptomatic aneurysm (P .015, odds ratio 4.62, 95% confidence interval 1.35-15.86) and length of the infrarenal abdominal aortic aneurysm (AAA) (P .021, odds ratio 1.31, 95% confidence interval 1.04 - 1.64).

CONCLUSION

The incidence of SLO after EVAR is low, and most occlusions occur within the first year. Predictors for SLO are the symptomatic aneurysm and the length of the infrarenal AAA. Further research is necessary to pool all predictors and to assess the clinical impact of different follow-up strategies for high-vs low-risk patients.

Vitamin D Deficiency in Advanced Laryngeal Cancer and its Association with Pharyngocutaneous Fistula Following Total Laryngectomy

BACKGROUND

Nutritional factors in developing some malignancies have been investigated recently.

OBJECTIVE

In this study, we evaluated the role of vitamin D in advanced laryngeal cancer and its association with the development of pharyngocutaneous fistula (PCF) following total laryngectomy.

STUDY DESIGN

A cross-sectional, case-control study was conducted.

METHODS

Fifty-five patients with advanced laryngeal cancer referred for total laryngectomy were included. We also considered 55 healthy individuals after matching age and sex as a control group. Serum levels of 25(OH)D3 were measured using a commercially available enzyme-linked immunosorbent assay (ELISA) kit. The association of serum 25(OH)D3 with PCF following total laryngectomy was also determined.

RESULTS

Vitamin D was significantly lower in patients with advanced laryngeal cancer than in the control group (p < 0.001). Moreover, our results showed that a mean serum concentration of 25(OH)D3 in patients with PCF was significantly lower than in patients without PCF (p < 0.001).

CONCLUSION

Vitamin D deficiency is highly prevalent in advanced laryngeal cancer, most pronounced in those who develop a PFC following total laryngectomy.

To Evaluate the Association Between Serum Concentration of Vitamin D and Chronic Periodontitis in Non-menopausal Females: A Clinico Biochemical Study

BACKGROUND

Periodontal disease's initiation and propagation is through a dysbiosis of the commensal oral microbiota. But recently, through the extraordinary progress, the interrelationship that exists between periodontal disease and systemic health has been unveiled. Through various studies, it has been revealed that vitamin D deficiency may be associated with a greater risk of developing chronic periodontitis and vitamin D supplementation may help to preserve periodontal health.

AIM

To find a co-relation between 25-hydroxy vitamin D status and the severity of periodontal diseases. To evaluate and compare the effect of non-surgical periodontal therapy alone and in combination with vitamin D supplementation in reducing the severity of periodontal diseases.

METHODS

The present study was conducted on 90 non-menopausal female subjects who divided into 3 groups. Group I comprised of healthy controls. Group II comprised of patients with moderate chronic periodontitis who were assigned to receive only Scaling and root planing (SRP). While group III included patients with moderate chronic periodontitis who were assigned to receive SRP along with Vitamin D supplementation. The periodontal parameters and serum levels of 25- hydroxy vitamin D were recorded for all the participants at baseline. Group II and group III participants were reassessed at an interval of 3 months post-treatment.

RESULTS

The results indicated that vitamin D deficiency affected periodontal health negatively. Statistically highly significant improvement was observed in Group III as compared to group II, signifying the efficacy of vitamin D supplementation adjunctive to SRP.

CONCLUSION

Regular evaluation of Vitamin D levels and supplementation to treat the deficiency may have potential periodontal health benefits.

Risk factors for pre-eclampsia in clinical practice guidelines: Comparison with the evidence

OBJECTIVE

To compare pre-eclampsia risk factors identified by clinical practice guidelines (CPGs) with risk factors from hierarchical evidence review, to guide pre-eclampsia prevention.

DESIGN

Our search strategy provided hierarchical evidence of relationships between risk factors and pre-eclampsia using Medline (Ovid), searched from January 2010 to January 2021.

SETTING

Published studies and CPGs.

POPULATION

Pregnant women.

METHODS

We evaluated the strength of association and quality of evidence (GRADE). CPGs (n = 15) were taken from a previous systematic review.

MAIN OUTCOME MEASURE

Pre-eclampsia.

RESULTS

Of 78 pre-eclampsia risk factors, 13 (16.5%) arise only during pregnancy. Strength of association was usually 'probable' (n = 40, 51.3%) and the quality of evidence was low (n = 35, 44.9%). The 'major' and 'moderate' risk factors proposed by 8/15 CPGs were not well aligned with the evidence; of the ten 'major' risk factors (alone warranting aspirin prophylaxis), associations with pre-eclampsia were definite (n = 4), probable (n = 5) or possible (n = 1), based on moderate (n = 4), low (n = 5) or very low (n = 1) quality evidence. Obesity ('moderate' risk factor) was definitely associated with pre-eclampsia (high-quality evidence). The other ten 'moderate' risk factors had probable (n = 8), possible (n = 1) or no (n = 1) association with pre-eclampsia, based on evidence of moderate (n = 1), low (n = 5) or very low (n = 4) quality. Three risk factors not identified by the CPGs had probable associations (high quality): being overweight; 'prehypertension' at booking; and blood pressure of 130-139/80-89 mmHg in early pregnancy.

CONCLUSIONS

Pre-eclampsia risk factors in CPGs are poorly aligned with evidence, particularly for the strongest risk factor of obesity. There is a lack of distinction between risk factors identifiable in early pregnancy and those arising later. A refresh of the strategies advocated by CPGs is needed.

Development and Validation of a Risk Calculator for Intensive Care Unit Admission After Total Hip Arthroplasty

BACKGROUND

The purpose of this study was to develop and validate a risk stratification calculator to determine the risk of a patient requiring intensive care unit (ICU) admission following primary and revision total hip arthroplasty (THA).

METHODS

Using a database of 12,342 THA procedures, with 132 ICU admissions, from 2005 to 2017, we developed models of ICU admission risk based on previously identified preoperative factors including age, heart disease, neurologic disease, renal disease, unilateral versus bilateral surgery, preoperative hemoglobin, blood glucose, and smoking status. Prior to developing the calculator, a set of logistic regressions were analyzed to determine weight and scoring for each variable. Once developed, we validated the risk calculator using a second independent institution.

RESULTS

A separate risk calculator was developed for primary and revision THA. The area under the curve (AUC) for primary THA was 0.808 (95% confidence interval 0.740 to 0.876) and revision THA was AUC 0.795 (confidence interval 0.740 to 0.850). As an example, the primary THA risk calculator had a Total Points scale of 220, with 50 points associated with a 0.1% chance of ICU admission and 205 points associated with a 95% chance of ICU admission. Validation with an external cohort demonstrated satisfactory AUCs, sensitivities, and specificities for both primary THA (AUC 0.794, sensitivity 0.750, and specificity 0.722) and revision THA (AUC 0.703, sensitivity 0.704, and specificity 0.671) CONCLUSION: The externally validated risk calculators developed in this study can accurately predict ICU admission following primary and revision THA based on a number of readily available preoperative factors.

Chronic Venous Insufficiency in A Selected Nurse Population: A Cross-Sectional Study

Chronic venous insufficiency (CVI) causes severe symptoms and complications in the general population, but the prevalence, related risk factors, and treatment of CVI are unknown among nurses. The demographics and occupational factors of nurses from a university hospital were collected by questionnaires, and the presentation of CVI was confirmed by the specialist vascular surgeons. A total of 1606 participants were enrolled, and the prevalence of CVI was 7.5%. After multivariate adjustment, CVI was positively related to deep venous thrombosis history (OR 6.44, 95% CI 2.73-15.22), increased standing time (OR 2.21, 95% CI 1.20-4.10), and increased time in night shift rotation (OR 2.01, 95% CI 1.29-3.14). CVI was negatively related to oral contraceptives (OR .43, 95% CI .21-.87). Of the participants, 72.5% with CVI received compression therapy. For them, wearing compression stockings with a pressure of >20 mmHg or for >4 h/day significantly increased the rate of symptom relief, while the length of compression stockings made no difference. Thus, it was beneficial for nurses to spend less time standing and shorten their time in night shift rotation. Wearing compression stockings with sufficient pressure and for enough time was recommended for CVI symptom relief.

The Systemic Immune-Inflammation Index and Predicting Cardiac Implantable Electronic Device Infections

This study aimed to evaluate the utility of the systemic immune-inflammation index (SII) in predicting the development of Cardiac Implantable Electronic Device (CIED) infections. A retrospective analysis was performed using the medical records of 2185 patients who underwent CIED (including de novo, revision, or upgrade) implantation at our institution from January 2012 to December 2019. We recorded CIED infections and risk factors according to the patient, device, and procedural characteristics during the median 28.7 months (6.2-56.8) follow-up. CIED infections were identified in 52 patients. Diabetes, chronic renal disease, SII before implantation, new cardiac resynchronization therapy (CRT) implantation, CRT-battery replacement, revision or upgrade, and the number of previous procedures were independent predictors of CIED infections. The area under the curve (AUC) of SII to predict CIED infection was .733 (95% CI: .654-.811). A raised SII may be a useful predictor of CIED infection.

Psychological Distress Among Domestic Burglary Victims: A Systematic Review of Possible Risk and Protective Factors

Domestic burglary victimization is a potentially traumatic experience, because most people consider their home as an extension of the self and a place where the self is protected against others. Intrusions to such a highly valued place are therefore considered as attacks to both one's personhood and one's safety and privacy and may render victims at risk of psychological distress. In view of the legal obligations most countries have with regard to screening crime victims for psychological distress, this study systematically reviewed the literature on determinants of psychological distress in domestic burglary victims. Web of Science, EBSCO, and ProQuest databases and reference lists were searched between February and July 2022 to identify relevant studies. In all, 10 studies met all inclusion criteria and were evaluated according to the Cambridge Quality Checklists. These checklists have been developed to assess the methodological qualities of observational research. Findings of included studies suggest that female sex, damages caused by the burglary, and evaluations of the police response are potential determinants of psychological distress. However, given the dearth of research and the old age and theoretical and methodological limitations of included studies, it is too early to draw definite conclusions about the predictive value of these and other factors and to provide directions for screening policies. Future research should use prospective designs to overcome these limitations and ensure that domestic burglary victims at risk of psychological distress are timely referred to adequate professional help services.

Association Between Immune-Related Disease and Allergic Rhinitis: A Two-Sample Mendelian Randomization Study

BACKGROUND

Immune-related diseases can interact with each other, and growing evidence suggests that these diseases are associated with allergic rhinitis (AR). However, it is unclear whether previously observed associations reflect causal relationships.

OBJECTIVE

This study estimated the genetic association between various immune-related diseases and AR using two-sample Mendelian randomization (MR).

METHODS

Eight immune-related diseases were selected as exposure factors, and AR was selected as the outcome. The 8 immune-related disease categories included atopic dermatitis (AD), Graves' disease (GD), asthma, Crohn's disease (CD), multiple sclerosis (MS), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and ulcerative colitis (UC). Data from GWAS (Genome-Wide Association Studies) were selected to construct instrumental variables (IVs) for each disease, and multiple single-nucleotide polymorphisms (SNPs) were selected as IVs. Corresponding data were retrieved according to the selected SNPs, and all data were summarized and analyzed.

RESULTS

A total of 416 SNPs were screened as IVs, and the results of IVW support a causal relationship between AR risk and AD (OR: 1.026, 95% CI: 1.014-1.038, P = 9.59 × 10-6), asthma (OR: 1.057, 95% CI: 1.029-1.086, P = .0001), and CD (OR: 1.006, 95% CI: 1.002-1.011, P = .0085). Furthermore, GD (OR: 0.995, 95% CI: 0.991-0.999, P = .0213) and SLE (OR: 0.997, 95% CI: 0.995-1.000, P = .025) may be protective factors.

CONCLUSION

This MR study found that AD, asthma and CD increase the risk of AR in populations of European ancestry, GD and SLE may be protective factors. These results suggest that confounding factors may have influenced associations previously reported in observational studies.

Estimating the pertussis burden in adolescents and adults in the United States between 2007 and 2019

We developed a machine learning algorithm to identify undiagnosed pertussis episodes in adolescent and adult patients with reported acute respiratory disease (ARD) using clinician notes in an electronic healthcare record (EHR) database. Here, we utilized the algorithm to better estimate the overall pertussis incidence within the Optum Humedica clinical repository from 1 January 2007 through 31 December 2019. The incidence of diagnosed pertussis episodes was 1-5 per 100,000 annually, consistent with data registered by the US Centers for Disease Control and Prevention (CDC) over the same time period. Among 18,573,496 ARD episodes assessed, 1,053,946 were identified (i.e. algorithm-identified) as likely undiagnosed pertussis episodes. Accounting for these undiagnosed pertussis episodes increased the estimated pertussis incidence by 110-fold on average (34-474 per 100,000 annually). Risk factors for pertussis episodes (diagnosed and algorithm-identified) included asthma (Odds ratio [OR] 2.14; 2.12-2.16), immunodeficiency (OR 1.85; 1.78-1.91), chronic obstructive pulmonary disease (OR 1.63; 1.61-1.65), obesity (OR 1.44; 1.43-1.45), Crohn's disease (OR 1.39; 1.33-1.45), diabetes type 1 (OR 1.21; 1.17-1.24) and type 2 (OR 1.12; 1.1-1.13). Of note, all these risk factors, except Crohn's disease, increased the likelihood of severe pertussis. In conclusion, the incidence of pertussis in the adolescent and adult population in the USA is likely substantial, but considerably under-recognized, highlighting the need for improved clinical awareness of the disease and for improved control strategies in this population. These results will help better inform public health vaccination and booster programs, particularly in those with underlying comorbidities.

Prevalence and Risk Factors of Mitral, Tricuspid, and Aortic Regurgitation: A Population-Based Study from Rural Northeast China

The population-based studies on the epidemiologic features of valvular regurgitation in Northeast China are scarce. We aim to estimate the prevalence and risk factors of mitral regurgitation (MR), tricuspid regurgitation (TR), and aortic regurgitation (AR) in a general population from rural Northeast China. Valvular regurgitation was assessed by color flow Doppler echocardiography in a population-based survey of 11,278 participants aged ≥35 years in rural areas of Liaoning Province during 2012 to 2013. The prevalence of mild or greater MR and TR were 1.6% and 1.5%, respectively. Trace or greater AR was present in 4.1% of the participants. In the multivariable regression model, older age, left atrial dimension, low left ventricular (LV) ejection fraction, and fasting plasma glucose were associated with higher risk of MR in men, whereas only older age and left atrial dimension increased the risk in women. Body mass index was found to be a protective factor for MR in women (odds ratio 0.847, 95% confidence interval 0.741 to 0.969). TR was independently associated with age, heart rate, low LV ejection fraction, current drinking status, and high-density lipoprotein cholesterol. The risk for AR significantly increased with age in both genders. LV mass index and aortic dimension increased the risk of AR in males, and females with higher LV mass index and high-density lipoprotein cholesterol had an increased risk for AR. In both genders, systolic blood pressure presented as a risk factor for AR, while diastolic blood pressure as a protective factor. In this large Chinese population-based study, we found remarkably low prevalence of valvular regurgitation, adding evidence for estimating disease burden and making policy strategies in Northeast China.

Predicting risk of blastocyst aneuploidy among women with previous aneuploid pregnancy loss: a multicenter-data-based multivariable model

STUDY QUESTION

Can blastocyst aneuploidy be predicted for patients with previous aneuploid pregnancy loss (PAPL) and receiving preimplantation genetic testing for aneuploidy (PGT-A)?

SUMMARY ANSWER

Multivariable logistic regression models were established to predict high risk of blastocyst aneuploidy using four identified factors, presenting good predictive performance.

WHAT IS KNOWN ALREADY

Aneuploidy is the most common embryonic chromosomal abnormality leading to pregnancy loss. Several studies have demonstrated a higher embryo aneuploidy rate in patients with PAPL, which has suggested that PGT-A should have benefits in PAPL patients intending to improve their pregnancy outcomes. However, recent studies have failed to demonstrate the efficacy of PGT-A for PAPL patients. One possible way to improve the efficacy is to predict the risk of blastocyst aneuploidy risk in order to identify the specific PAPL population who may benefit from PGT-A.

STUDY DESIGN, SIZE, DURATION

We conducted a multicenter retrospective cohort study based on data analysis of 1119 patients receiving PGT-A in three reproductive medical centers of university affiliated teaching hospitals during January 2014 to June 2020. A cohort of 550 patients who had one to three PAPL(s) were included in the PAPL group. In addition, 569 patients with monogenic diseases without pregnancy loss were taken as the non-PAPL group.

PARTICIPANTS/MATERIALS, SETTING, METHODS

PGT-A was conducted using single nucleotide polymorphism microarrays and next-generation sequencing. Aneuploidy rates in Day 5 blastocysts of each patient were calculated and high-risk aneuploidy was defined as a rate of ≥50%. Candidate risk factors for high-risk aneuploidy were selected using the Akaike information criterion and were subsequently included in multivariable logistic regression models. Overall predictive accuracy was assessed using the confusion matrix, discrimination by area under the receiver operating characteristic curve (AUC), and calibration by plotting the predicted probabilities versus the observed probabilities. Statistical significance was set at P < 0.05.

MAIN RESULTS AND THE ROLE OF CHANCE

Blastocyst aneuploidy rates were 30 ± 25% and 21 ± 19% for PAPL and non-PAPL groups, respectively. Maternal age (odds ratio (OR) = 1.31, 95% CI 1.24-1.39, P < 0.001), number of PAPLs (OR = 1.40, 95% CI 1.05-1.86, P = 0.02), estradiol level on the ovulation trigger day (OR = 0.47, 95% CI 0.30-0.73, P < 0.001), and blastocyst formation rate (OR = 0.13, 95% CI 0.03-0.50, P = 0.003) were associated with high-risk of blastocyst aneuploidy. The predictive model based on the above four variables yielded AUCs of 0.80 using the training dataset and 0.83 using the test dataset, with average and maximal discrepancies of 2.89% and 12.76% for the training dataset, and 0.98% and 5.49% for the test dataset, respectively.

LIMITATIONS, REASONS FOR CAUTION

Our conclusions might not be compatible with those having fewer than four biopsied blastocysts and diminished ovarian reserves, since all of the included patients had four or more biopsied blastocysts and had exhibited good ovarian reserves.

WIDER IMPLICATIONS OF THE FINDINGS

The developed predictive model is critical for counseling PAPL patients before PGT-A by considering maternal age, number of PAPLs, estradiol levels on the ovulation trigger day, and the blastocyst formation rate. This prediction model achieves good risk stratification and so may be useful for identifying PAPL patients who may have higher risk of blastocyst aneuploidy and can therefore acquire better pregnancy outcomes by PGT-A.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the National Natural Science Foundation of China under Grant (81871159). No competing interest existed in the study.

TRIAL REGISTRATION NUMBER

N/A.

A disfiguring neglected tropical disease sweeps war-torn Yemen: a community-based study of prevalence and risk factors of cutaneous leishmaniasis among rural communities in the western highlands

BACKGROUND

Cutaneous leishmaniasis (CL) is a major health problem in Yemen and is endemic in many rural areas across the country.

METHODS

A community-based cross-sectional survey followed by unmatched case-control comparisons was conducted among 612 participants in Utmah district, western Yemen. A total of 223 participants were included in the case-control analysis to identify the significant risk factors. Skin scrapping samples were examined by microscopy and internal transcribed spacer 1 nested polymerase chain reaction.

RESULTS

Overall, 33% (202/612) of the participants had active skin lesions and/or scars that met the clinical criteria for CL. A total of 90 (14.7%) participants had suspected active CL lesions; however, a prevalence of 8.7% (53/612) was obtained based on molecular and parasitological examination, with Leishmania tropica being the only causative agent identified. Multivariable logistic regression analyses showed that being ≤10 y old, being female, living in houses with cracked walls, living in the presence of other family members with typical ulcerating skin diseases and sleeping outside were factors significantly associated with an increased likelihood of having CL. Moreover, keeping livestock on the ground floor of the house was significantly associated with a decreased likelihood of having CL.

CONCLUSION

The study reveals an alarmingly high prevalence of CL among the studied population. Therefore there is an urgent need for effective control measures and improved treatment efforts against this devastating disease.

Baby blues, premenstrual syndrome and postpartum affective disorders: intersection of risk factors and reciprocal influences

BACKGROUND

The aetiology and consequences of 'baby blues' (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history.

AIMS

The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD).

METHOD

Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother-child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder.

RESULTS

A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69-12.25; PMS: OR = 3.29, 95% CI 2.01-5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ2(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017).

CONCLUSIONS

Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.

Epidemiological insights into the burden of feline upper respiratory tract infections in Queensland RSPCA shelters

INTRODUCTION

Feline upper respiratory tract infection (FURTI) is a severe problem in animal shelters where there is high turnover of populations and compromised immunity. This retrospective cohort study explores associations of potential animal-based and environmental-based factors with the risk of FURTI, where a previously modelled infection classification is used as the outcome of interest. The study type is a retrospective cohort and the measures of association include Odds Ratios and conditional predictions.

OBJECTIVES

To gain epidemiological insights into variation in FURTI using retrospective data from one of Australia's leading animal shelters.

METHODS

We stratified FURTI by admission and environmental variables. Predicted infection status, obtained using a machine-learning classifier trained on clinical text (accuracy 0.95 [CI 0.92, 0.97]), was used as the outcome of interest. Prior assumptions were represented by a causal framework or a direct acyclic graph (DAG), which informed creation of multiple Bernoulli models with an observational and prior component.

RESULTS

We analysed 43,431 feline entries over 8 years. Males were 1.24 (95% CI 1.19 to 1.31) times more likely than females to be classified as positive, while already desexed animals were only 0.68 (95% CI 0.60 to 0.72) as likely to be classified as positive compared to those not desexed on entry. Cats (>4 months) were twice as likely (95% CI 1.91 to 2.09) as kittens (0-4 months) to be classified positive. Animals entering the shelter as seized by the inspectorate (n = 415) were more likely to be classified positive compared to animals from other sources. Predicted infection probability increased in winter and showed a linear pattern with how full the shelter was.

CONCLUSION

This study estimates the association between animal and environmental variables of interest and FURTI classification status, thus better interpreting the distribution of disease as predicted by a previously uninterpretable model. This analysis gives much needed insight into the types of changes in an animal's environment that can impact final animal outcomes.

What goes wrong with the perceptions of elder financial abuse? Data from older adults, healthcare professionals and students from Greece

This study examines what healthcare professionals, students and older adults believe about elder financial abuse in Greece. Participants responded to two vignettes by choosing which characteristics indicate elder financial abuse. Greeks are less likely to perceive financial exploitation when the perpetrator is a close family member, but are more likely to recognize it when perpetrated by paid caregivers or more distant (male) relatives. Signing over the victim's property to another is less likely to be perceived as elder abuse than is the taking of money from bank accounts, even though the property is often worth more than what is taken from the account. Although there are some differences in perception between healthcare professionals and others in Greek society, these (and other anomalies) make it difficult to accurately report and prevent elder financial abuse in Greece.

Cancer cases attributable to modifiable lifestyle risk factors in Switzerland between 2015 and 2019

Several modifiable lifestyle risk factors have been linked to higher cancer risk in the literature. Determining the proportion and number of cancer cases attributable to these risk factors is pivotal in informing effective cancer prevention and control plans that have the greatest effect on reducing cancer incidence. We aimed to estimate the proportion and number of incident cancer cases that were attributable to modifiable lifestyle risk factors (ie, tobacco smoking, high alcohol consumption, excess body weight, physical inactivity and unhealthy diet) in Switzerland between 2015 and 2019. The exposure prevalence of selected risk factors was estimated based on the representative national nutrition survey menuCH, the associated relative risks were obtained from systematic literature reviews and the numbers of incident cancer cases were provided by the National Institute for Cancer Epidemiology and Registration. The fractions and numbers of attributable cases were calculated overall, by sex and by the three major language regions of Switzerland. The investigated modifiable risk factors combined were linked to 25.2% of potentially preventable incident cancer cases in Switzerland between 2015 and 2019. The proportion and numbers were slightly larger in males (28.4%, 6945 cases per year) than in females (21.9%, 4493 cases per year), and variations were observed between language regions. Tobacco smoking, excess body weight and high alcohol consumption were the leading contributors to lifestyle-attributable cancer cases. The observed differences in the leading risk factors both within Switzerland and compared to other countries underline the need for regionally and nationally tailored cancer prevention and education strategies.

Impact of serum haemoglobin-to-creatinine ratio after transcatheter aortic valve implantation

OBJECTIVE

The association between a combined anaemia and renal failure index and 1-year prognosis of patients undergoing transcatheter aortic valve implantation (TAVI) is unexplored. We aimed to investigate a simple risk score in patients undergoing TAVI.

METHODS

A total of 469 consecutive patients undergoing TAVI between 2015 and 2021 were enrolled. After excluding patients undergoing dialysis, the remaining 458 patients were classified according to three tertiles of the serum haemoglobin-to-creatinine (Hgb/Cr) ratio 1 day before TAVI. The primary clinical outcome measure was all-cause mortality and heart failure hospitalisation 1 year after TAVI.

RESULTS

In the first, second and third tertiles, the 1-year cumulative incidence of all-cause mortality was 16.9% versus 7.2% versus 2.0%, respectively (p<0.01), and that of heart failure hospitalisation was 10.7% versus 3.4% versus 0.7%, respectively (p<0.01). The indexes of the area under the curve of the Hgb/Cr ratio for all-cause mortality and heart failure hospitalisation 1 year after TAVI were both 0.73. Cut-off values were 10.1 for all-cause mortality 1 year after TAVI (OR, 4.78; 95% CI 2.43 to 9.74; p<0.01) and 10.4 for heart failure hospitalisation 1 year after TAVI (OR, 5.3; 95% CI 2.21 to 14.1; p<0.01). In the multivariate analysis, the Hgb/Cr ratio was an independent predictor of all-cause mortality and heart failure hospitalisation 1 year after TAVI.

CONCLUSIONS

Hgb/Cr ratio calculation 1 day before TAVI may help predict midterm all-cause mortality and heart failure hospitalisation in patients with severe aortic valve stenosis undergoing TAVI.

TRIAL REGISTRATION NUMBER

4143 (The Institutional Review Board of Kurashiki Central Hospital).