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Field X, Tong C, Cox S, Crichton J, Goodwin B, Welsh F, Cha R. Outcomes of asymptomatic common bile duct stones detected at intraoperative cholangiography. N Z Med J 2024; 137:73-79. [PMID: 38754115 DOI: 10.26635/6965.6491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
AIMS The aim of this study was to investigate the outcome of common bile duct stones (CBDS) in asymptomatic patients at laparoscopic cholecystectomy (LC) and intra-operative cholangiogram (IOC). METHODS All patients undergoing LC and IOC at Te Whatu Ora - Health New Zealand Waikato between January 2017 and January 2022 were retrospectively reviewed. Electronic records were screened for asymptomatic CBDS. Exclusion criteria were hyperbilirubinaemia, gallstone pancreatitis, cholangitis and imaging-detected CBDS. IOC reports were reviewed to determine presence of CBDS. A second blinded review was undertaken by a radiologist. Outcomes were use of endoscopic retrograde pancreatography (ERCP), complications and readmission with retained CBDS. RESULTS Included were 1,297 patients undergoing LC and IOC. Of these, 150 (24.1%) patients had a positive IOC, of which 58 (38.7%) were asymptomatic. Attempted flushing of CBDS was employed in 49 cases, 10 successfully. Common duct exploration was successful in a further six out of seven cases. Of the remaining 42 patients, 18 were offered ERCP. Seven had no stone at endoscopy. Sixteen had imaging, revealing clear ducts in 14. The remaining two then had ERCP confirming choledocholithiasis. Eight patients were managed expectantly, of whom none required readmission with retained stones. CONCLUSION Rates of retained asymptomatic stones after positive IOC were low. Acknowledging risks associated with intervention and low rates of readmission with retained CBDS, an expectant approach could be more readily considered.
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Affiliation(s)
- Xavier Field
- General Surgery, Waikato Hospital, Te Whatu Ora - Health New Zealand Waikato, Hamilton, New Zealand
| | - Chelsea Tong
- General Surgery, Waikato Hospital, Te Whatu Ora - Health New Zealand Waikato, Hamilton, New Zealand
| | - Sarah Cox
- General Surgery, Waikato Hospital, Te Whatu Ora - Health New Zealand Waikato, Hamilton, New Zealand
| | - James Crichton
- General Surgery, Waikato Hospital, Te Whatu Ora - Health New Zealand Waikato, Hamilton, New Zealand
| | - Bernadette Goodwin
- General Surgery, Waikato Hospital, Te Whatu Ora - Health New Zealand Waikato, Hamilton, New Zealand
| | - Fraser Welsh
- General Surgery, Waikato Hospital, Te Whatu Ora - Health New Zealand Waikato, Hamilton, New Zealand
| | - Ryan Cha
- Radiology, Waikato Hospital, Te Whatu Ora - Health New Zealand Waikato, Hamilton, New Zealand
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Katsiafliaka K, Karlafti E, Tzikos G, Goulas P, Zatagias A, Vouchara A, Psoma E, Tsakona A, Petrakis G, Paramythiotis D. Incidental Finding of an Asymptomatic Jejunal Schwannoma: A Rare Case Report and Review of Literature. Am J Case Rep 2024; 25:e942881. [PMID: 38745406 DOI: 10.12659/ajcr.942881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
BACKGROUND Schwannomas are tumors that arise from Schwann cells that surround and support nerve cells. Most common sites for presentations are head, neck, and extremities. Schwannomas of gastrointestinal tract are rare, slow-growing tumors, usually benign, arising from gastrointestinal tract's neural plexus. They are histologically distinguishable from conventional schwannomas that arise in soft tissue or the central nervous system. Preoperative diagnosis of gastrointestinal schwannoma is challenging, requiring immunohistological confirmation of the nature of the tumor. Here, we report a case of 57-year-old woman with an incidental finding of an asymptomatic submucosal jejunal schwannoma. CASE REPORT A 57-year-old woman with a medical history of hematological disorder underwent a contrast abdominal computed tomography as part of medical follow-up. The imaging revealed the presence of a jejunal mass. The patient underwent laparoscopic surgical resection of the lesion, followed by side-to-side jejuno-jejunal anastomosis with 4-cm clear surgical margins. The final pathologic study revealed the presence of jejunal schwannoma, as tested positive for S-100 protein. The patient was discharged home on the fourth postoperative day, having an uneventful recovery. CONCLUSIONS Jejunal schwannoma are usually benign and asymptomatic, and they are often discovered incidentally during diagnostic tests for other conditions; therefore, it should be included in the differential diagnosis of gastrointestinal tumors. Surgical treatment appears to be necessary to achieve a definitive diagnosis through a biopsy of the tumor tissue. Benign jejunal schwannomas have a good prognosis.
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Affiliation(s)
- Konstantina Katsiafliaka
- 1st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Department of Emergency, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tzikos
- 1st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Patroklos Goulas
- 1st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Zatagias
- 1st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Angeliki Vouchara
- 1st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Psoma
- Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasia Tsakona
- Department of Pathology, University General Hospital of Thessaloniki AHEPA, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Petrakis
- Department of Pathology, University General Hospital of Thessaloniki AHEPA, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniel Paramythiotis
- 1st Department of Propaedeutic Surgery, AHEPA University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Yamanouchi K, Maeda S. Quality-Adjusted Survival in Patients with Recurrence of Breast Cancer Diagnosed by Asymptomatic or Symptomatic Opportunities. Kurume Med J 2024; 69:175-184. [PMID: 38233175 DOI: 10.2739/kurumemedj.ms6934015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
After radical surgery for breast cancer, screening to diagnose recurrence in asymptomatic patients is not recommended. We retrospectively evaluated quality-adjusted survival. Included were fifty-seven recurrent breast cancer patients who died. Survival was partitioned into 3 health states by two different definitions: definition a) time with toxicities due to chemotherapy before progression (TOX1), time from the diagnosis of recurrence to progression without toxicities (TWiST1), and time from progression to death (REL1); definition b) time from the diagnosis of recurrence to death with toxicities (TOX2), without toxicities or hospitalization (TWiST2), and with hospitalization (REL2). Q-TWiST was calculated by multiplying the time in each health state by its utility (uTOX, uTWiST, and uREL). In threshold analyses, uTOX and uREL ranged from 0.0 to 1.0 whereas uTWiST was maintained at 1.0. We compared the patients with (n=32) and without (n=25) symptoms at the time of the diagnosis of recurrence. There was no difference in overall survival after primary surgery, although survival after the diagnosis of recurrence was significantly longer in the asymptomatic patients (p<0.01). Q-TWiST1 and Q-TWiST2 from the diagnosis of recurrence in the asymptomatic patients were significantly longer. Q-TWiST2 from primary surgery in the asymptomatic patients was significantly longer with some combinations of higher uTOX2 and lower uREL2. In conclusion, the asymptomatic detection of recurrence was associated with significantly longer quality-adjusted survival in comparison to symptomatic detection with some combinations of uTOX2 and uREL2. A prospective evaluation would clarify adequate follow-up methods after radical surgery for breast cancer.
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Affiliation(s)
- Kosho Yamanouchi
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization
- Department of Surgery, Nagasaki Prefecture Hospital
| | - Shigeto Maeda
- Department of Surgery, Nagasaki Medical Center, National Hospital Organization
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Israelsen M, Alvarez-Silva C, Madsen BS, Hansen CD, Torp NC, Johansen S, Hansen JK, Prier Lindvig K, Insonere J, Riviere V, Juel HB, Brejnrod A, Jensen LJ, Thiele M, Lelouvier B, Hansen T, Arumugam M, Krag A. Impact of acute alcohol consumption on circulating microbiome in asymptomatic alcohol-related liver disease. Gut 2024; 73:1041-1044. [PMID: 37344168 DOI: 10.1136/gutjnl-2023-330360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/05/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Mads Israelsen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Camila Alvarez-Silva
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Bjørn Stæhr Madsen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Camilla Dalby Hansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
| | - Nikolaj Christian Torp
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Stine Johansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Johanne Kragh Hansen
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Katrine Prier Lindvig
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | | | - Helene Bæk Juel
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Asker Brejnrod
- Department of Health Technology, Technical University of Denmark, Lyngby, Hovedstaden, Denmark
| | - Lars Juhl Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Kobenhavn, Denmark
| | - Maja Thiele
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | | | - Torben Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Manimozhiyan Arumugam
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
| | - Aleksander Krag
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Zhou D, Mao Q, Sun Y, Cheng H, Zhao J, Liu Q, Deng M, Xu S, Zhao X. Association of Blood Copper With the Subclinical Carotid Atherosclerosis: An Observational Study. J Am Heart Assoc 2024; 13:e033474. [PMID: 38700020 DOI: 10.1161/jaha.123.033474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Copper exposure is reported to be associated with increased risk of stroke. However, the association of copper exposure with subclinical carotid atherosclerosis remains unclear. METHODS AND RESULTS This observational study included consecutive participants from Xinqiao Hospital between May 2020 and August 2021. Blood metals were measured using inductively coupled plasma mass spectrometry and carotid atherosclerosis was assessed using ultrasound. Modified Poisson regression was performed to evaluate the associations of copper and other metals with subclinical carotid plaque presence. Blood metals were analyzed as categorical according to the quartiles. Multivariable models were adjusted for age, sex, body mass index, education, smoking, drinking, hypertension, diabetes, dyslipidemia, estimated glomerular filtration rate, and coronary artery disease history. Bayesian Kernel Machine Regression was conducted to evaluate the overall association of metal mixture with subclinical carotid plaque presence. One thousand five hundred eighty-five participants were finally enrolled in our study, and carotid plaque was found in 1091 subjects. After adjusting for potential confounders, metal-progressively-adjusted models showed that blood copper was positively associated with subclinical carotid plaque (relative risk according to comparing quartile 4 to quartile 1 was 1.124 [1.021-1.238], relative risk according to per interquartile increment was 1.039 [1.008-1.071]). Blood cadmium and lead were also significantly associated with subclinical carotid plaque. Bayesian Kernel Machine Regression analyses suggested a synergistic effect of copper-cadmium-lead mixture on subclinical carotid plaque presence. CONCLUSIONS Our findings identify copper as a novel risk factor of subclinical carotid atherosclerosis and show the potential synergistic proatherogenic effect of copper, cadmium, and lead mixture.
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Affiliation(s)
- Denglu Zhou
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Qi Mao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Yapei Sun
- Center of Laboratory Medicine Chongqing Prevention and Treatment Center for Occupational Diseases Chongqing China
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning Chongqing China
- School of Public Health Nanjing Medical University Nanjing China
| | - Hao Cheng
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Jianhua Zhao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Qingsong Liu
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Mengyang Deng
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
| | - Shangcheng Xu
- Center of Laboratory Medicine Chongqing Prevention and Treatment Center for Occupational Diseases Chongqing China
- Chongqing Key Laboratory of Prevention and Treatment for Occupational Diseases and Poisoning Chongqing China
- School of Public Health Nanjing Medical University Nanjing China
| | - Xiaohui Zhao
- Department of Cardiology, Institute of Cardiovascular Research, Xinqiao Hospital Army Medical University Chongqing China
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Young J, Lyngbakken MN, Hveem K, Røsjø H, Omland T. Systolic Blood Pressure, Diastolic Blood Pressure and Pulse Pressure and the Risk of Subclinical Myocardial Injury: The HUNT Study. J Am Heart Assoc 2024; 13:e031107. [PMID: 38639374 DOI: 10.1161/jaha.123.031107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/07/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Subclinical myocardial injury expressed as higher cardiac troponin concentrations may represent an important intermediary between hypertension and the risk of cardiovascular disease. The study aimed to assess the relative strength of associations between systolic blood pressure (BP), diastolic BP, and pulse pressure, and subclinical myocardial injury, and how change in BP variables over time associates with subclinical myocardial injury. METHODS AND RESULTS cTnl (cardiac troponin I) was measured in 32 968 participants of the fourth wave of the population-based cohort HUNT4 (Trøndelag Health Study) without a history of cardiovascular disease. An additional longitudinal analysis included participants from HUNT4 with BP measurements from HUNT3 (n=18 681). Associations between BP variables and cTnI concentrations were assessed by linear and logistic regression analyses. The median cTnI concentration was 1.6 ng/L (25th-75th percentiles, 0.6-3.1 ng/L), median age was 52 years (39.1-65.6 years), and 57% were female subjects. Cross-sectionally, only systolic BP categories ≥130 mm Hg associated with higher cTnI concentrations, compared with a reference systolic BP of <110 mm Hg. All categories of diastolic BP and pulse pressure were positively associated with higher cTnI concentrations when diastolic BP 70 to 79 mm Hg and pulse pressure <40 mm Hg were used as references, respectively. When comparing systolic BP, diastolic BP, and pulse pressure as continuous variables, cross-sectionally, pulse pressure most strongly associated with cTnI concentrations (P for all comparisons <0.001), whereas longitudinally, change in diastolic BP was most strongly associated with cTnI concentrations (P for all comparisons <0.05). CONCLUSIONS Subjects with high pulse pressure and longitudinal increase in diastolic BP are at higher risk for subclinical myocardial injury.
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Affiliation(s)
- Juliet Young
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
| | - Magnus Nakrem Lyngbakken
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Kristian Hveem
- HUNT Research Centre, Department of Public Health and General Practice Norwegian University of Science and Technology Levanger Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust Levanger Norway
| | - Helge Røsjø
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
- Division of Research and Innovation Akershus University Hospital Lørenskog Norway
| | - Torbjørn Omland
- K. G. Jebsen Center for Cardiac Biomarkers Institute of Clinical Medicine, University of Oslo Oslo Norway
- Department of Cardiology Akershus University Hospital Lørenskog Norway
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Bak M, Lee SH, Park SJ, Park J, Kim J, Kim D, Kim EK, Chang SA, Lee SC, Park SW. Perioperative Risk of Noncardiac Surgery in Patients With Asymptomatic Significant Aortic Stenosis: A 10-Year Retrospective Study. J Am Heart Assoc 2024; 13:e032675. [PMID: 38686895 DOI: 10.1161/jaha.123.032675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 03/25/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Aortic stenosis (AS) is a representative geriatric disease, and there is an anticipated rise in the number of patients requiring noncardiac surgeries in patients with AS. However, there is still a lack of research on the primary predictors of noncardiac perioperative complications in patients with asymptomatic significant AS. METHODS AND RESULTS Among the cohort of noncardiac surgeries under general anesthesia, with an intermediate to high risk of surgery from 2011 to 2019, at Samsung Medical Center, 221 patients were identified to have asymptomatic significant AS. First, to examine the impact of significant AS on perioperative adverse events, the occurrences of major adverse cardiovascular events and perioperative adverse cardiovascular events were compared between patients with asymptomatic significant AS and the control group. Second, to identify the factors influencing the perioperative adverse events in patients with asymptomatic significant AS, a least absolute shrinkage and selection operator regression model was used. There was no significant difference between the control group and the asymptomatic significant AS group in the event rate of major adverse cardiovascular events (4.6% at control group versus 5.5% at asymptomatic significant AS group; P=0.608) and perioperative adverse cardiovascular events (13.8% at control group versus 18.3% at asymptomatic significant AS group; P=0.130). Cardiac damage stage was a significant risk factor of major adverse cardiovascular events and perioperative adverse cardiovascular events. CONCLUSIONS There was no significant difference in major postoperative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant AS is an important factor in perioperative risk of noncardiac surgery.
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Affiliation(s)
- Minjung Bak
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Seung-Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Darae Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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Natarajan P, Bellomo TR. Clonal Hematopoiesis Among Patients With Asymptomatic Carotid Stenosis Compounds Risk of Cardiovascular Death. J Am Coll Cardiol 2024; 83:1728-1730. [PMID: 38692826 DOI: 10.1016/j.jacc.2024.03.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Pradeep Natarajan
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA.
| | - Tiffany R Bellomo
- Cardiovascular Research Center and Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Program in Medical and Population Genetics and the Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, USA; Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/BellomoTiffany
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Li GA, Huang J, Wang J, Fan L. Association between the triglyceride-glucose index and subclinical left ventricular systolic dysfunction in obese patients. Cardiovasc Diabetol 2024; 23:161. [PMID: 38715070 PMCID: PMC11077869 DOI: 10.1186/s12933-024-02253-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 04/26/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND The association between the triglyceride-glucose (TyG) index and subclinical left ventricular (LV) systolic dysfunction in obese patients remains unclear. This study aimed to investigate the relationship between the TyG index and LV global longitudinal strain (GLS) in obese patients. METHODS A total of 1028 obese patients from January 2019 to January 2024 were included in the present study. Clinical parameters and biochemical and echocardiographic data were obtained from the participants. LV GLS was obtained from the GE EchoPAC workstation for evaluating subclinical LV function. The TyG index was calculated as Ln (fasting TG [mg/dL] × fasting glucose [mg/dL]/2). LV GLS was compared between obese patients with a high TyG index and those with a low TyG index. RESULTS Obese patients with a high TyG index had greater incidences of hypertension, diabetes mellitus and hyperlipidaemia. The LV GLS was significantly lower in the high TyG index group than in the low TyG index group (P = 0.01). After adjusting for sex, age, body mass index, heart rate, hypertension, diabetes mellitus, dyslipidaemia, blood urea nitrogen, serum creatinine, LV mass and LV hypertrophy, the TyG index remained an independent risk indicator related to an LV GLS < 20% (OR: 1.520, 95% CI: 1.040 to 2.221; P = 0.031). CONCLUSIONS We concluded that an increase in the TyG index is independently associated with subclinical LV systolic dysfunction in obese patients.
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Affiliation(s)
- Guang-An Li
- Department of Echocardiography, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China
| | - Jun Huang
- Department of Echocardiography, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China.
| | - Jing Wang
- Department of Weight Loss Metabolic Surgery, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China
| | - Li Fan
- Department of Echocardiography, The Affiliated Changzhou Second People's Hospital with Nanjing Medical University, 213003, Changzhou, China
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Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril 2023; 121:765-82. [PMID: 38163620 DOI: 10.1016/j.fertnstert.2023.12.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/28/2023] [Indexed: 01/03/2024]
Abstract
There is controversy regarding whether to treat subtle abnormalities of thyroid function in infertile female patients. This guideline document reviews the risks and benefits of treating subclinical hypothyroidism in female patients with a history of infertility and miscarriage, as well as obstetric and neonatal outcomes in this population.
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Banovic M, Iung B, Putnik S, Mahendiran T, Vanderheyden M, Barbato E, Bartunek J. Asymptomatic Aortic Stenosis: From Risk Stratification to Treatment. Am J Cardiol 2024; 218:51-62. [PMID: 38432341 DOI: 10.1016/j.amjcard.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/05/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
Our understanding of the natural history of aortic stenosis has significantly increased over the last decade. There have been considerable advances in the diagnosis and risk stratification of patients with aortic stenosis and in surgical and anesthetic techniques. In addition, transcatheter aortic valve replacement has established itself as a viable alternative to surgical management. Inevitably, these developments have raised questions regarding the merits of waiting for symptom onset in asymptomatic patients with severe aortic stenosis before offering treatment. Recent observational and randomized trial data suggest that early intervention in asymptomatic patients with severe aortic stenosis and normal left ventricular function may confer a prognostic advantage to a watchful waiting strategy. In this review, we highlight advances in the management and risk stratification of patients with asymptomatic severe aortic stenosis with particular consideration of recent findings supporting early valvular intervention.
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Affiliation(s)
- Marko Banovic
- Cardiology Department, University Clinical Center of Serbia, Belgrade, Serbia; Belgrade Medical Faculty, University of Belgrade, Serbia.
| | - Bernard Iung
- Cardiology Department, Bichat Hospital APHP and Université Paris Cité, France
| | - Svetozar Putnik
- Belgrade Medical Faculty, University of Belgrade, Serbia; Cardiac-Surgery Department, University Clinical Center of Serbia, Belgrade, Serbia
| | - Thabo Mahendiran
- Cardiovascular Center, OLV Hospital, Aalst, Belgium; Cardiology Department, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Emanuele Barbato
- Cardiovascular Center, OLV Hospital, Aalst, Belgium; Department of Clinical and Molecular Medicine, Sapienza University, Rome, Italy
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Jain V, Rifai MA, Kanaya AM, Shah NS, Talegawkar SA, Virani SS, Michos ED, Blumenthal RS, Patel J. Association of cardiovascular health with subclinical coronary atherosclerosis progression among five racial and ethnic groups: The MASALA and MESA studies. Atherosclerosis 2024; 392:117522. [PMID: 38583288 DOI: 10.1016/j.atherosclerosis.2024.117522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/27/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS South Asian adults (SA) are at higher risk for atherosclerotic cardiovascular disease (ASCVD) compared with other racial/ethnic groups. Life's Simple 7 (LS7) is a guideline-recommended, cardiovascular health (CVH) construct to guide optimization of cardiovascular risk factors. We sought to assess if the LS7 metrics predict coronary artery calcium (CAC) incidence and progression in asymptomatic SA compared with four other racial/ethnic groups. METHODS We assessed the distribution of CVH metrics (inadequate: score 0-8, average: 9-10, optimal: 11-14, and per 1-unit higher score) and its association with incidence and progression of CAC among South Asians in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study compared with other race/ethnic groups from the Multiethnic Study of Atherosclerosis (MESA). RESULTS We included 810 SA, 2622 Non-Hispanic White (NHW), and 4192 Other adults (collectively 1893 Black, 1496 Hispanic and 803 Chinese American participants, respectively). SA and White participants compared to Other race/ethnicity groups were more likely to have optimal CVH metrics (26% SA vs 28% White participants vs 21% Other, respectively, p < 0.001). Similar to NHW and the Other race/ethnic group, SA participants with optimal baseline CVH were less likely to develop incident CAC on follow-up evaluation compared to participants with inadequate CVH metrics, optimal CVH/CAC = 0: 24% SA, 28% NHW, and 15% Other (p < 0.01). In multivariable linear and logistic regression models, there was no difference in annualized CAC incidence or progression between each race/ethnic group (pinteraction = 0.85 and pinteraction = 0.17, respectively). Optimal blood pressure control was associated with lower CAC incidence among SA participants [OR (95% CI): 0.30 (0.14-0.63), p < 0.01] and Other race and ethnicity participants [0.32 (0.19-0.53), p < 0.01]. CONCLUSIONS Optimal CVH metrics are associated with lower incident CAC and CAC progression among South Asians, similar to other racial groups/ethnicities. These findings underscore the importance of optimizing and maintaining CVH to mitigate the future risk of subclinical atherosclerosis in this higher risk population.
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Affiliation(s)
- Vardhmaan Jain
- Department of Cardiovascular Medicine, Emory University School of Medicine, GA, USA
| | - Mahmoud Al Rifai
- Department of Cardiovascular Medicine, Houston Methodist DeBakey Heart & Vascular Center, TX, USA
| | - Alka M Kanaya
- Department of Medicine, University of California, San Francisco, USA
| | - Nilay S Shah
- Division of Cardiology, Northwestern University Feinberg School of Medicine, IL, USA
| | - Sameera A Talegawkar
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, DC, USA
| | - Salim S Virani
- Department of Cardiovascular Medicine, Baylor College of Medicine, TX, USA & the Aga Khan University, Karachi, Pakistan
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, MD, USA
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, MD, USA
| | - Jaideep Patel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, MD, USA.
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Hofstedt O, Wahlin B, Södergren A. Associations between serological biomarkers and subclinical atherosclerosis in patients with rheumatoid arthritis after 11 years of follow-up. Clin Exp Rheumatol 2024; 42:967-973. [PMID: 38079335 DOI: 10.55563/clinexprheumatol/70qiy8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/11/2023] [Indexed: 05/15/2024]
Abstract
OBJECTIVES To investigate the relationship between biomarkers known to be involved in both chronic inflammation and subclinical atherosclerosis, as measured by carotid intima media thickness (cIMT), in patients with RA compared to controls. METHODS Between 2000 and 2004, all patients under 60 years of age with newly diagnosed RA in the northern region of Sweden were invited to participate in this study. Measurements of cIMT were undertaken at inclusion (T0), after five years of follow-up (T5) and after eleven years of follow-up (T11). Patients were clinically assessed and blood was drawn for analysis of biomarkers. RESULTS In patients with RA (n=54), linear regression models showed that cIMT at T11 was associated with levels of GDF-15 at T5 and T11, but not with baseline levels. GDF-15 was strongly associated with age. At T11, mean level of GDF-15 was elevated compared to controls. Levels of adiponectin, MCP-1, cathepsin S, endoglin and IL-6 were higher in patients with RA compared to controls, but showed no association with cIMT. In multivariable linear regression models with cIMT at T11 as dependent variable, change in GDF-15 from T0 to T11 was associated to an increase in cIMT at T11. Adjusting for systolic blood pressure and age respectively rendered this association statistically non-significant,CONCLUSIONS: Among these patients with RA GDF-15 was associated to cIMT after 11 years of follow-up. GDF-15 should be a biomarker of interest in future research, to further understand its role in the accelerated atherogenesis in patients with RA.
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Affiliation(s)
- Oscar Hofstedt
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Sweden.
| | - Bengt Wahlin
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Sweden
| | - Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Sweden
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Pinelli F, Muzzi M, Pittiruti M. Should ultrasound evaluation for catheter-related thrombosis always be required before PICC removal? J Vasc Access 2024; 25:697-702. [PMID: 36163680 DOI: 10.1177/11297298221125965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Despite several effective preventive strategies peripherally inserted central catheters (PICCs)-as much as centrally inserted central catheters and femorally inserted central catheters-are inevitably associated with the potential development of catheter-related thrombosis. This complication may be symptomatic or-more often-asymptomatic. Even if remote, the chance that PICC removal may mobilize an asymptomatic thrombus and cause pulmonary embolism, is theoretically possible. On the other hand, the diffuse adoption of an ultrasound scan aiming at detecting an asymptomatic catheter-related thrombosis may be logistically difficult and expensive. No clear evidence-based recommendations exist on this issue and whether perform an ultrasound scan before PICC removal in asymptomatic patients remains a matter of debate. For these reasons, the authors propose few common sense recommendations that may help clinicians in weighing the clinical advantages of the exam (optimal safety for the patient) versus its practical disadvantages (logistic cost).
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Affiliation(s)
- Fulvio Pinelli
- AOUC, Anesthesia and Intensive Care, Florence, Tuscany, Italy
| | - Mirko Muzzi
- School of Human Health Science, University of Florence, Florence, Italy
| | - Mauro Pittiruti
- Department of Surgery, University Hospital Agostino Gemelli, Rome, Lazio, Italy
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Hughes TM, Tanley J, Chen H, Schaich CL, Yeboah J, Espeland MA, Lima JAC, Ambale-Venkatesh B, Michos ED, Ding J, Hayden K, Casanova R, Craft S, Rapp SR, Luchsinger JA, Fitzpatrick AL, Heckbert SR, Post WS, Burke GL. Subclinical vascular composites predict clinical cardiovascular disease, stroke, and dementia: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2024; 392:117521. [PMID: 38552474 DOI: 10.1016/j.atherosclerosis.2024.117521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/26/2024] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS Subclinical cardiovascular disease (CVD) measures may reflect biological pathways that contribute to increased risk for coronary heart disease (CHD) events, stroke, and dementia beyond conventional risk scores. METHODS The Multi-Ethnic Study of Atherosclerosis (MESA) followed 6814 participants (45-84 years of age) from baseline in 2000-2002 to 2018 over 6 clinical examinations and annual follow-up interviews. MESA baseline subclinical CVD procedures included: seated and supineblood pressure, coronary calcium scan, radial artery tonometry, and carotid ultrasound. Baseline subclinical CVD measures were transformed into z-scores before factor analysis to derive composite factor scores. Time to clinical event for all-cause CVD, CHD, stroke and ICD code-based dementia events were modeled using Cox proportional hazards models reported as area under the curve (AUC) with 95% Confidence Intervals (95%CI) at 10 and 15 years of follow-up. All models included all factor scores together, and adjustment for conventional risk scores for global CVD, stroke, and dementia. RESULTS After factor selection, 24 subclinical measures aggregated into four distinct factors representing: blood pressure, atherosclerosis, arteriosclerosis, and cardiac factors. Each factor significantly predicted time to CVD events and dementia at 10 and 15 years independent of each other and conventional risk scores. Subclinical vascular composites of atherosclerosis and arteriosclerosis best predicted time to clinical events of CVD, CHD, stroke, and dementia. These results were consistent across sex and racial and ethnic groups. CONCLUSIONS Subclinical vascular composites of atherosclerosis and arteriosclerosis may be useful biomarkers to inform the vascular pathways contributing to events of CVD, CHD, stroke, and dementia.
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Affiliation(s)
- Timothy M Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States.
| | - Jordan Tanley
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Haiying Chen
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Christopher L Schaich
- Department of Surgery, Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Joseph Yeboah
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Joao A C Lima
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Bharath Ambale-Venkatesh
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erin D Michos
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jingzhong Ding
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Kathleen Hayden
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Ramon Casanova
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States; Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Suzanne Craft
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Stephen R Rapp
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - José A Luchsinger
- Departments of Medicine and Epidemiology, Columbia University Medical Center, New York, NY, United States
| | | | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Wendy S Post
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gregory L Burke
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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Shah NV, Lettieri MJ, Kim D, Zhou JJ, Pineda N, Diebo BG, Woon CYL, Naziri Q. The impact of asymptomatic human immunodeficiency virus (HIV)-positive disease status on inpatient complications following total joint arthroplasty: a propensity score-matched analysis. Eur J Orthop Surg Traumatol 2024; 34:1939-1944. [PMID: 38472434 DOI: 10.1007/s00590-024-03872-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE The number of patients with asymptomatic human immunodeficiency virus (AHIV) is increasing as the efficacy of antiretroviral therapy improves. While there is research on operative risks associated with having HIV, there is a lack of literature describing the impact of well-controlled HIV on postoperative complications. This study seeks to elucidate the impact of AHIV on postoperative outcomes after total hip (THA) and knee (TKA) arthroplasty. METHODS The Nationwide Inpatient Sample was retrospectively reviewed for patients undergoing TKA and THA from 2005 to 2013. Subjects were subdivided into those with AHIV and those without HIV (non-HIV). Patient demographics, hospital-related parameters, and postoperative complications were all collected. One-to-one propensity score-matching, Chi-square analysis, and multivariate logistical regressions were performed to compare both cohorts. RESULTS There were no significant differences between AHIV and non-HIV patients undergoing TKA or THA in terms of sex, age, insurance status, or total costs (all, p ≥ 0.081). AHIV patients had longer lengths of stay (4.0 days) than non-HIV patients after both TKA (3.3 days) and THA (3.1 days) (p ≤ 0.011). Both TKA groups had similar postoperative complication rates (p > 0.081). AHIV patients undergoing THA exhibited an increased rate of overall surgical complications compared non-HIV patients (0 vs. 4.5%, p = 0.043). AHIV was not associated with increased complications following both procedures. CONCLUSION Despite lengthier hospital stays among AHIV patients, baseline AHIV was not associated with adverse outcomes following TKA and THA. This adds to the literature and warrants further research into the impact of asymptomatic, well-controlled HIV infection on postoperative outcomes following total joint arthroplasty.
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Affiliation(s)
- Neil V Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA.
| | - Matthew J Lettieri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - David Kim
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Jack J Zhou
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | | | - Bassel G Diebo
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
- Department of Orthopaedic Surgery, Warren Alpert Medical School at Brown University, East Providence, RI, USA
| | - Colin Y L Woon
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
| | - Qais Naziri
- Department of Orthopaedic Surgery and Rehabilitation Medicine, State University of New York (SUNY) Downstate Health Sciences University, 450 Clarkson Ave, MSC 30, Brooklyn, NY, 11203, USA
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Obaitan I, Mohamed MFH, Beran A, Rosenheck M, Obomanu ET, Berzin TM, Ramai D, Wehbe H, Aziz M, Mahendraker N, Al-Haddad M, Easler JJ, Fogel EL. Comparative Risks of Post-ERCP Adverse Events in Patients with Asymptomatic and Symptomatic Choledocholithiasis: A Systematic Review and Meta-Analysis. Dig Dis Sci 2024; 69:1880-1888. [PMID: 38555329 DOI: 10.1007/s10620-024-08374-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/26/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND AIMS Endoscopic retrograde cholangiopancreatography (ERCP) is the standard of care for the management of choledocholithiasis but carries risk of complications which may result in significant morbidity and mortality. While currently available guidelines endorse the use of ERCP for the management of symptomatic common bile duct stones, the need for ERCP in incidentally found asymptomatic choledocholithiasis is more controversial, and practice varies on a geographic and institutional level. This systematic review and meta-analysis is conducted to compare post-ERCP adverse events between asymptomatic and symptomatic choledocholithiasis patients. METHODS We searched PubMed/Embase/Web of Science databases to include all studies comparing post-ERCP outcomes between asymptomatic and symptomatic choledocholithiasis patients. The primary outcome was post-ERCP pancreatitis (PEP), while secondary outcomes included post-ERCP cholangitis, bleeding, and perforation. We calculated pooled risk ratios (RR) and 95% confidence intervals (CIs) using the Mantel-Haenszel method within a random-effect model. RESULTS Our analysis included six observational studies, totaling 2,178 choledocholithiasis patients (392 asymptomatic and 1786 symptomatic); 53% were female. Asymptomatic patients exhibited a higher risk of PEP compared with symptomatic patients (11.7% versus 4.8%; RR 2.59, 95% CI 1.56-4.31, p ≤ 0.001). No significant difference was observed in post-ERCP cholangitis, bleeding, or perforation rates between the two groups. CONCLUSIONS Asymptomatic patients with choledocholithiasis appear to have a higher risk of PEP than symptomatic patients, while the risk of other post-ERCP adverse events is similar between the two groups. Interventional endoscopists should thoroughly discuss potential adverse events (particularly PEP) with asymptomatic patients before performing ERCP and utilize PEP-prevention measures more liberally in this subgroup of patients.
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Affiliation(s)
- Itegbemie Obaitan
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Mouhand F H Mohamed
- Department of Internal Medicine, Warren Alpert Medical School Brown University, Providence, RI, USA
| | - Azizullah Beran
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael Rosenheck
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Elvis T Obomanu
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Tyler M Berzin
- Center for Advanced Endoscopy, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daryl Ramai
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT, USA
| | - Hisham Wehbe
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Muhammad Aziz
- Division of Gastroenterology, Bon Secours Mercy Health, Toledo, OH, USA
| | - Neetu Mahendraker
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mohammad Al-Haddad
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey J Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan L Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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Chi X, Li X, Wang F, Huang P, Liu J. Simultaneous cholecystectomy for asymptomatic gallstones during elective colorectal cancer surgery. J Gastrointest Surg 2024; 28:656-661. [PMID: 38704202 DOI: 10.1016/j.gassur.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Asymptomatic gallstones are commonly detected using preoperative imaging in patients with colorectal cancer (CRC), but its management remains a topic of debate. METHODS Clinicopathologic characteristics of patients who had asymptomatic gallstones presenting during the colorectal procedure were retrospectively reviewed. Medical records, including postoperative morbidity, mortality, and long-term gallstone-related diseases, were assessed. RESULTS Of 134 patients with CRC having asymptomatic gallstones, 89 underwent elective colorectal surgery only (observation group), and 45 underwent elective colorectal surgery with simultaneous cholecystectomy (cholecystectomy group). After propensity score matching (PSM), the complications were similar in the 2 groups. During the follow-up period, biliary complications were noted in 11 patients (12.4%) in the observation group within 2 years after the initial CRC surgery, but no case was found in the cholecystectomy group. After PSM, the incidence of long-term biliary complications remained significantly higher in the observation group than in the cholecystectomy group (26.5% vs 0.0%; P < .01). Multivariable logistic regression analysis identified female gender, old age (≥65 years old), and small multiple gallstones as independent risk factors for the development of long-term gallstone-related diseases in patients from the observation group. CONCLUSION Simultaneous prophylactic cholecystectomy during prepared, elective CRC surgery did not increase postoperative morbidity or mortality but decreased the risk of subsequent gallstone-related complications. Hence, simultaneous cholecystectomy might be a preferred therapeutic option for patients with CRC having asymptomatic gallstones in cases of elective surgery, especially for older patients (≥65 years old), female patients, and those with small multiple calculi.
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Affiliation(s)
- Xianda Chi
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Xuejie Li
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Fan Wang
- Department of Clinical Medicine, Sun Yat-sen University Zhongshan School of Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Pinjie Huang
- Department of Anesthesiology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
| | - Jianpei Liu
- Department of Gastrointestinal Surgery, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.
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AlMousa SA, Hegazi T, AlKhamis HA, AlTayyar ZA, AlMutairi MD, AlGhamdi SA, Almuhaish MI, Alzaid MM, Alsubaie SS, Alzahrani MM. Cam-type hip morphology in asymptomatic patients. Hip Int 2024; 34:372-377. [PMID: 38263909 DOI: 10.1177/11207000231225184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The alpha angle has been widely used in the assessment of cam-type of impingement, but recent studies have shown that this angle may also be high in asymptomatic patients. The aim of this study is to report the prevalence of cam-type morphology in asymptomatic volunteers and explore its correlation with hip clinical and radiological parameters. METHODS This single-centre prospective study included 48 asymptomatic male volunteers (96 hips). All candidates fulfilled the inclusion and exclusion criteria. Physical examination and 1.5 -T MRI imaging were done for bilateral hips on the same day. Alpha angle measurements were obtained from 4 different positions and cam-type morphology was considered positive using 2 different cut points >55° and >60°. Descriptive statistics were analysed and correlations were performed where appropriate and p-value < 0.05 was considered to be significant. RESULTS The prevalence of cam-type morphology using alpha angle >55° was 68.8%, 87.5%, 50% and 34.4% in the 12, 1, 2 and 3 o'clock positions respectively. While it was 38.5%, 69.8%, 26% and 12.5% in the 12, 1, 2 and 3 o'clock positions of the studied hips respectively using alpha angle >60°. The maximum alpha angle was more frequently prevalent at the 1 o'clock position in 71 (74%). Labral tear was detected in 26 (27.1%) hips and impingement test was positive in 12 (12.5%) hips. There was no correlation between the presence of cam-type morphology and range of motion of the hip, presence of positive impingement test nor labral tears. CONCLUSIONS Cam-type morphology prevalence is high among asymptomatic males, and mostly pronounced at the 1 o'clock position. A correlation between high alpha angle and positive impingement test or labral tear was not found in our cohort. Future studies are required to determine the natural history of asymptomatic cam-type morphology and risk of hip derangement.
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Affiliation(s)
- Sulaiman A AlMousa
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Tarek Hegazi
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hashem A AlKhamis
- Department of Orthopaedic Surgery, Asir Central Hospital, Abha, Saudi Arabia
| | - Ziyad A AlTayyar
- Department of Family Medicine and Community Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mutlaq D AlMutairi
- Department of Orthopaedic Surgery, King Fahd Military Medical Complex, Dhahran, Eastern Province, Saudi Arabia
| | - Salim A AlGhamdi
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mona I Almuhaish
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed M Alzaid
- Department of Radiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Shayma S Alsubaie
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammad M Alzahrani
- Orthopaedic Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Escate R, Padró T, Pérez de Isla L, Fuentes F, Alonso R, Mata P, Badimon L. Circulating miR-6821-5p levels and coronary calcification in asymptomatic familial hypercholesterolemia patients. Atherosclerosis 2024; 392:117502. [PMID: 38513437 DOI: 10.1016/j.atherosclerosis.2024.117502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 02/16/2024] [Accepted: 02/27/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND AIMS Premature atherosclerotic cardiovascular disease (CVD) is a clinic characteristic of familial hypercholesterolemia (FH). Coronary calcium score (CCS) is a highly used imaging modality to evidence atherosclerotic plaque burden. microRNAs (miRNAs) are non-coding RNAs that epigenetically regulate gene expression. Here, we investigated whether CCS associates with a specific miRNA-signature in FH-patients. METHODS Patients with genetic diagnosis of FH (N = 86) from the nationwide SAFEHEART-cohort were investigated by computed tomography angiography imaging and classified depending on the presence of coronary calcification in FH-CCS (+) and FH-CCS (-) groups by the Agatston score. Differential miRNA profiling was performed in two stages: first by Affymetrix microarray technology (high-throughput differential profiling-studies) and second by RT-PCR using TaqMan-technology (analytical RT-qPCR study) in plasma of the two patient groups. RESULTS miR-193a-5p, miR-30e-5p and miR-6821-5p levels were significantly higher in FH-CCS (+) compared to FH-CCS (-). miR-6821-5p was the best miRNA to discriminate FH-patients CCS(+), according to receiver operating characteristic (ROC) analysis (AUC: 0.70 ± 0.06, p = 0.006). High miR-6821-5p levels were associated with older age (p = 0.03) and high LDL-burden (p = 0.014) using a ROC-derived cut-off value. However, miR-6821-5p did not correlate with age in either the CCS- or CCS + group. Genes involved in calcification processes were identified by in silico analysis. The relation of cell-calcification and expression levels of miR-6821-5p, BMP2 and SPP1 was validated experimentally in human vascular smooth muscle cell cultures. CONCLUSIONS Up-regulated levels of miR-6821-5p are found in the plasma of asymptomatic FH-patients with coronary calcified atherosclerotic plaques, as well as in isolated human vascular smooth muscle cells expressing the pro-calcification genes BMP2 and SPP1. These findings highlight the impact of epigenetic regulation on the development of subclinical atherosclerosis.
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Affiliation(s)
- Rafael Escate
- Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain
| | - Teresa Padró
- Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain
| | - Leopoldo Pérez de Isla
- Cardiology Department, Hospital Clínico San Carlos, IDISSC, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Francisco Fuentes
- Lipids and Atherosclerosis Unit, Department of Internal Medicine, Hospital Universitario Reina Sofía, Córdoba, Spain; CIBER Fisiopatologia Obesidad y Nutricion (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Institute for Biomedical Research in Córdoba (IMIBIC), Córdoba, Spain
| | - Rodrigo Alonso
- Fundación Hipercolesterolemia Familiar, Madrid, Spain; Center for Advanced Metabolic Medicine and Nutrition, Santiago de Chile, Chile
| | - Pedro Mata
- Fundación Hipercolesterolemia Familiar, Madrid, Spain
| | - Lina Badimon
- Cardiovascular-Program ICCC, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV) Instituto de Salud Carlos III, Madrid, Spain; Cardiovascular Research Chair, UAB, Barcelona, Spain.
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21
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Viswanathan G, Mathew V, Jeeragi M, George B, Bantwal G, Ayyar V, Michael J. Emerging pattern of asymptomatic hyperparathyroidism in South India - a six-year retrospective study. Folia Med (Plovdiv) 2024; 66:221-226. [PMID: 38690817 DOI: 10.3897/folmed.66.e117637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/30/2024] [Indexed: 05/03/2024] Open
Abstract
INTRODUCTION Primary hyperparathyroidism (PHPT) is a common endocrine disease with a variable presentation. There is a recent increase in the number of asymptomatic cases due to the use of multichannel automated analyzers.
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Affiliation(s)
| | - Vivek Mathew
- VPS Lakeshore Hospital and Research Centre, Kochi, India
| | | | | | | | - Vageesh Ayyar
- St John's Medical College Hospital, Bengaluru, India
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Hou C, Luo Z, Cao N, Hu X, Song L, Fu Q, Zhang J, Huang J. Urethral-sparing laparoscopic simple prostatectomy for the treatment of benign prostatic hyperplasia with asymptomatic urethral stricture after urethral stricture surgery. BMC Urol 2024; 24:99. [PMID: 38685008 PMCID: PMC11059642 DOI: 10.1186/s12894-024-01487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVE To evaluate the efficacy of urethral-sparing laparoscopic simple prostatectomy (US-LSP) for the treatment of large-volume (>80 ml) benign prostatic hyperplasia (BPH) with asymptomatic urethral stricture (urethral lumen > 16 Fr) after urethral stricture surgery. METHODS We retrospectively analyzed clinical data of 39 large-volume BPH patients with asymptomatic urethral stricture after urethral stricture surgery who underwent US-LSP from January 2016 to October 2021. Postoperative follow-ups were scheduled at 1, 3, and 6 months. RESULTS All patients affected by significant BPH-related lower urinary tract symptoms (LUTS) including 22 cases with asymptomatic anterior urethral stricture and 17 cases with asymptomatic posterior urethral stricture. Median operative time was 118 min (interquartile range [IQR]100-145). Median estimated blood loss was 224 ml (IQR: 190-255). 33 patients(84.6%) avoided continuous bladder irrigation. Postoperative complications occurred in 5 patients (12.8%), including 4 cases with Clavien-Dindo grade 1 and grade 2 and 1 case with grade 3a. During follow-up, US-LSP presented statistically significant improvements in LUTS compared to baseline (P < 0.05). A total of 25 patients had normal ejaculation preoperatively and 3 patients (12%) complained retrograde ejaculation postoperatively. Two patients (5.1%) reported stress urinary incontinence (SUI) and no patient reported aggravated urethral stricture during follow-up. CONCLUSIONS US-LSP was safe and effective in treating large-volume BPH with asymptomatic urethral stricture after urethral stricture surgery. Meanwhile, US-LSP could reduce the risk of SUI in patients with asymptomatic posterior urethral stricture and maintain ejaculatory function in a high percentage of patients.
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Affiliation(s)
- Changhao Hou
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Zhiqiang Luo
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Nailong Cao
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Xiaoyong Hu
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Lujie Song
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Qiang Fu
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China
| | - Jiong Zhang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Jianwen Huang
- Department of Urology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
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Carbone A, Baliga RR, Cademartiri F, Bossone E. Does coronary artery calcium screening help cardiovascular risk stratification in asymptomatic young patients with diabetes mellitus? A knowledge gap. Eur J Prev Cardiol 2024; 31:742-743. [PMID: 38445756 DOI: 10.1093/eurjpc/zwae101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Andreina Carbone
- Cardiology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Ragavendra R Baliga
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | | | - Eduardo Bossone
- Department of Public Health, University of Naples Federico II, Naples, Italy
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Andrade JG, Deyell MW, Bennett R, Macle L. Assessment and management of asymptomatic atrial fibrillation. Heart 2024; 110:675-682. [PMID: 37507214 DOI: 10.1136/heartjnl-2023-322428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac dysrhythmia encountered in practice. It is currently estimated that AF affects approximately 2% of the general population; however, the true prevalence of AF is likely to be at least 3%-4% when asymptomatic AF is considered. For clinically apparent AF, the investigations and management are relatively well established. The identification of minimally symptomatic patients is challenging, and furthermore, the optimal management is less certain. Although there is some debate about the ideal treatment pathway for asymptomatic AF, in most cases, the investigations and comprehensive management follow the same recommendations as clinically apparent AF. In contrast, beyond risk factor optimisation, the ideal management of subclinical or device-detected AF remains undefined. The purpose of the current review is to discuss the assessment and management of asymptomatic AF.
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Affiliation(s)
- Jason G Andrade
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marc W Deyell
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada
| | - Richard Bennett
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Cardiovascular Innovation, Vancouver, British Columbia, Canada
| | - Laurent Macle
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
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Najmi I, Benmaamar S, Zejli S, Bouchal S, El Fakir S, El Rhazi K, Belahsen MF. Silent brain infarctions in patients with acute cardioembolic stroke. J Med Vasc 2024; 49:80-89. [PMID: 38697714 DOI: 10.1016/j.jdmv.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/10/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION AND AIM The advances and the wide use of brain imaging have considerably increased the prevalence of silent brain infarctions (SBI). We aim in this study to determine the prevalence of SBI in patients presenting with acute cardioembolic stroke and the predictive cardiovascular risk factors. METHODS This retrospective study included 267 patients presenting with acute cardioembolic stroke in the emergency and/or neurology departments of the Hassan II University Hospital Center. Clinical, biological and echocardiographic characteristics were recorded. All patients were screened for SBI by brain imaging. RESULTS The prevalence of SBI in our series was 46%. A group of 203 non-valvular patients and a group of 64 valvular patients were distinguished. In non-valvular group, the average age was 72.97±10.53years. The prevalence of SBI was 45.3%. Forty-four percent of patients with SBI had atrial fibrillation (AF). In multivariate regression analysis, the history of previous stroke, CHA2DS2-VASc Score≥4, enlarged left atrium (LA), the association of AF with enlarged LA and the lability of International Normalized Ratio in patients initially treated with anticoagulants were significantly associated with the occurrence of SBI (P=0.013, P=0.032, P=0.0001, P=0.01, P=0.03, respectively). Territorial location was significantly the most frequent (P=0.007). In valvular group, the average age was 57.19±14.38years. The prevalence of SBI was 48.4%. In multivariate regression analysis, SBI were significantly associated with moderate or severe mitral stenosis (P=0.02) and with the enlarged LA (P=0.02). In all patients, Modified Rankin Scale at 3 months of discharge from the acute stroke was significantly higher (mRS≥3) in patients with SBI (P=0.04). CONCLUSIONS SBI requires good management of associated cardiovascular risk factors in a population presenting with initial cardioembolic stroke.
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Affiliation(s)
- Imane Najmi
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco.
| | - Soumaya Benmaamar
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Sara Zejli
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco
| | - Siham Bouchal
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Samira El Fakir
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
| | - Mohammed Faouzi Belahsen
- Department of Neurology, Hassan II University Hospital Center, Fez, Morocco; Laboratory of Epidemiology, Clinical Research, and Health Community, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdallah University, Fez, Morocco
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26
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Larik MO, Shahid AR, Shiraz MI, Urooj M. Impact of subclinical hypothyroidism on outcomes after coronary artery bypass grafting: a systematic review and meta-analysis. J Cardiovasc Surg (Torino) 2024; 65:155-160. [PMID: 38483792 DOI: 10.23736/s0021-9509.24.12845-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) is a surgical procedure that restores blood flow to heart muscle by bypassing the blocked or narrowed coronary arteries. On the other hand, subclinical hypothyroidism (SCH) is characterized by an elevated serum concentration of thyroid stimulating hormone with normal levels of serum free thyroxine. With limited research into the impact of SCH on postoperative CABG outcomes, this systematic review and meta-analysis was performed. EVIDENCE ACQUISITION An electronic search of PubMed, Cochrane Library, and Scopus was performed from inception to April 2023. After the inclusion of five studies, a total of 2,786 patients were pooled in this quantitative synthesis. EVIDENCE SYNTHESIS It was observed that SCH significantly increased cardiovascular mortality (OR: 2.80; 95% CI: 1.37, 5.72; P=0.005), and all-cause mortality (OR: 2.62; 95% CI: 1.80, 3.80; P<0.00001). However, no significant differences were observed for secondary outcomes, including major adverse cardiac events, incidence of postoperative stroke, and incidence of postoperative myocardial infarction. CONCLUSIONS To the best of our knowledge, this is the first meta-analysis conducted that evaluates the impact of SCH on outcomes after CABG. The preoperative assessment of thyroid function may be considered prior to cardiovascular procedures, particularly within CABG. However, future comprehensive studies, with individual participant-level data, are necessary in order to arrive at a valid conclusion and recommendation.
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Affiliation(s)
- Muhammad O Larik
- Department of Medicine, Dow International Medical College, Karachi, Pakistan -
| | - Abdul R Shahid
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
| | - Moeez I Shiraz
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
| | - Maryam Urooj
- Department of Medicine, Dow International Medical College, Karachi, Pakistan
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Paraskevas KI, Dardik A, Schermerhorn ML, Liapis CD, Mansilha A, Lal BK, Gray WA, Brown MM, Myrcha P, Lavie CJ, Zeebregts CJ, Secemsky EA, Saba L, Blecha M, Gurevich V, Silvestrini M, Blinc A, Svetlikov A, Fernandes E Fernandes J, Schneider PA, Gloviczki P, White CJ, AbuRahma AF. Why selective screening for asymptomatic carotid stenosis is currently appropriate: a special report. Expert Rev Cardiovasc Ther 2024; 22:159-165. [PMID: 38480465 DOI: 10.1080/14779072.2024.2330660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
INTRODUCTION Two of the main reasons recent guidelines do not recommend routine population-wide screening programs for asymptomatic carotid artery stenosis (AsxCS) is that screening could lead to an increase of carotid revascularization procedures and that such mass screening programs may not be cost-effective. Nevertheless, selective screening for AsxCS could have several benefits. This article presents the rationale for such a program. AREAS COVERED The benefits of selective screening for AsxCS include early recognition of AsxCS allowing timely initiation of preventive measures to reduce future myocardial infarction (MI), stroke, cardiac death and cardiovascular (CV) event rates. EXPERT OPINION Mass screening programs for AsxCS are neither clinically effective nor cost-effective. Nevertheless, targeted screening of populations at high risk for AsxCS provides an opportunity to identify these individuals earlier rather than later and to initiate a number of lifestyle measures, risk factor modifications, and intensive medical therapy in order to prevent future strokes and CV events. For patients at 'higher risk of stroke' on best medical treatment, a prophylactic carotid intervention may be considered.
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Affiliation(s)
| | - Alan Dardik
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
- Department of Surgery, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Marc L Schermerhorn
- Department of Surgery, Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christos D Liapis
- Department of Vascular Surgery, Athens Vascular Research Center, Athens, Greece
| | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Porto, Portugal
- Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal
| | - Brajesh K Lal
- Department of Vascular Surgery, University of Maryland School of Medicine, Baltimore, USA
- Department of Vascular Surgery, Baltimore VA Medical Center, Baltimore, USA
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Martin M Brown
- Stroke Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Piotr Myrcha
- Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Clark J Zeebregts
- Department of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eric A Secemsky
- Smith Center for Outcomes Research, Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy
| | - Matthew Blecha
- Division of Vascular Surgery, Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
| | - Victor Gurevich
- Center of Atherosclerosis and Lipid Disorders, Lab of Microangiopathic Mechanisms of Atherogenesis, Saint-Petersburg State University, Mechnikov, Saint-Petersburgh, Russia
| | - Mauro Silvestrini
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ales Blinc
- Department of Vascular Diseases, Division of Internal Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Alexei Svetlikov
- Division of Vascular & Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency, Department of Hospital Surgery, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Jose Fernandes E Fernandes
- Cardiovascular Center (CCUL), Faculty of Medicine University of Lisbon, Lisbon, Portugal
- Department of Vascular Surgery, Hospital da Luz Torres de Lisboa, Lisbon, Portugal
| | - Peter A Schneider
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, CA, USA
| | - Peter Gloviczki
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Christopher J White
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Ali F AbuRahma
- Department of Surgery, Division of Vascular and Endovascular Surgery, Charleston Area Medical Center/West Virginia University Health Sciences Center, Charleston, WV, USA
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Rantner B, Bellmunt-Montoya S. Beyond Successful Carotid Interventions: A Broader Assessment for Long Term Results in Asymptomatic Patients. Eur J Vasc Endovasc Surg 2024; 67:538-539. [PMID: 38224865 DOI: 10.1016/j.ejvs.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/03/2024] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Barbara Rantner
- Department of Vascular and Endovascular Surgery, Ludwig Maximillian University Hospitals Munich, Munich, Germany.
| | - Sergi Bellmunt-Montoya
- Department of Vascular, Endovascular Surgery and Angiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Universitat Autònoma de Barcelona, Barcelona, Spain
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Hamimi AH, Ghanem AM, Hannah-Shmouni F, Elgarf RM, Matta JR, Gharib AM, Abd-Elmoniem KZ. Ascending Aorta 4D Time to Peak Distention Sexual Dimorphism and Association with Coronary Plaque Burden Severity in Women. J Cardiovasc Transl Res 2024; 17:298-307. [PMID: 37556037 DOI: 10.1007/s12265-023-10422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
Coronary artery disease (CAD) risk and plaque scores are often subjective and biased, particularly in mid-age asymptomatic women, whose CAD risk assessment has been historically underestimated. In this study, a new automatic ascending aorta time-to-peak-distention (TPD) analysis was developed for fast screening and as an independent surrogate for subclinical atherosclerosis in asymptomatic women. CCTA was obtained in 50 asymptomatic adults. Plaque burden segment involvement score (SIS) and automatic TPD were obtained from all subjects. Logistic regression analyses were performed to investigate the association between CAD risk scores and TPD with severe coronary plaque burden (SIS>5). TPD, individually, was found to be a significant predictor of SIS>5. Additionally, sex was a significant effect modifier of TPD, with a stronger statistically significant association with women. Four-dimensional aortic time-to-peak distention could supplement conventional CCTA analysis and offer a quick objective screening tool for plaque burden severity and CAD risk stratification, especially in women.
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Affiliation(s)
- Ahmed H Hamimi
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Ghanem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Fady Hannah-Shmouni
- Internal Medicine, Endocrinology, and Genetics, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Reham M Elgarf
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Jatin R Matta
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
| | - Khaled Z Abd-Elmoniem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
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30
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Sen K, Izem R, Long Y, Jiang J, Konczal LL, McCarter RJ, Gropman AL, Bedoyan JK. Are asymptomatic carriers of OTC deficiency always asymptomatic? A multicentric retrospective study of risk using the UCDC longitudinal study database. Mol Genet Genomic Med 2024; 12:e2443. [PMID: 38634223 PMCID: PMC11024633 DOI: 10.1002/mgg3.2443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Ornithine transcarbamylase deficiency (OTCD) due to an X-linked OTC mutation, is responsible for moderate to severe hyperammonemia (HA) with substantial morbidity and mortality. About 80% of females with OTCD remain apparently "asymptomatic" with limited studies of their clinical characteristics and long-term health vulnerabilities. Multimodal neuroimaging studies and executive function testing have shown that asymptomatic females exhibit limitations when stressed to perform at higher cognitive load and had reduced activation of the prefrontal cortex. This retrospective study aims to improve understanding of factors that might predict development of defined complications and serious illness in apparent asymptomatic females. A proband and her daughter are presented to highlight the utility of multimodal neuroimaging studies and to underscore that asymptomatic females with OTCD are not always asymptomatic. METHODS We review data from 302 heterozygote females with OTCD enrolled in the Urea Cycle Disorders Consortium (UCDC) longitudinal natural history database. We apply multiple neuroimaging modalities in the workup of a proband and her daughter. RESULTS Among the females in the database, 143 were noted as symptomatic at baseline (Sym). We focused on females who were asymptomatic (Asx, n = 111) and those who were asymptomatic initially upon enrollment in study but who later became symptomatic sometime during follow-up (Asx/Sym, n = 22). The majority of Asx (86%) and Asx/Sym (75%) subjects did not restrict protein at baseline, and ~38% of Asx and 33% of Asx/Sym subjects suffered from mild to severe neuropsychiatric conditions such as mood disorder and sleep problems. The risk of mild to severe HA sometime later in life for the Asx and Asx/Sym subjects as a combined group was ~4% (5/133), with ammonia ranging from 77 to 470 μM and at least half (2/4) of subjects requiring hospital admission and nitrogen scavenger therapy. For this combined group, the median age of first HA crisis was 50 years, whereas the median age of first symptom which included neuropsychiatric and/or behavioral symptoms was 17 years. The multimodal neuroimaging studies in female heterozygotes with OTCD also underscore that asymptomatic female heterozygotes with OTCD (e.g., proband) are not always asymptomatic. CONCLUSIONS Analysis of Asx and Asx/Sym females with OTCD in this study suggests that future evidence-based management guidelines and/or a clinical risk score calculator for this cohort could be useful management tools to reduce morbidity and improve long-term quality of life.
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Affiliation(s)
- Kuntal Sen
- Division of Neurogenetics and Neurodevelopmental PediatricsChildren's National Hospital, The George Washington School of MedicineWashingtonDCUSA
| | - Rima Izem
- Center for Translational Sciences, Children's National HospitalThe George Washington UniversityWashingtonDCUSA
- Children's National HospitalWashingtonDCUSA
| | - Yuelin Long
- Columbia University Mailman School of Public HealthNew YorkNew YorkUSA
| | - Jiji Jiang
- Center for Translational Sciences, Children's National HospitalThe George Washington UniversityWashingtonDCUSA
- Children's National HospitalWashingtonDCUSA
| | - Laura L. Konczal
- Center for Human Genetics, University Hospitals Cleveland Medical Center, Department of Genetics and Genome SciencesCase Western Reserve University School of MedicineClevelandOhioUSA
| | - Robert J. McCarter
- Center for Translational Sciences, Children's National HospitalThe George Washington UniversityWashingtonDCUSA
- Children's National HospitalWashingtonDCUSA
| | - Andrea L. Gropman
- Division of Neurogenetics and Neurodevelopmental PediatricsChildren's National Hospital, The George Washington School of MedicineWashingtonDCUSA
- Center for Translational Sciences, Children's National HospitalThe George Washington UniversityWashingtonDCUSA
| | - Jirair K. Bedoyan
- Division of Genetic and Genomic Medicine, Department of PediatricsUPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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Imperiale TF, Porter K, Zella J, Gagrat ZD, Olson MC, Statz S, Garces J, Lavin PT, Aguilar H, Brinberg D, Berkelhammer C, Kisiel JB, Limburg PJ. Next-Generation Multitarget Stool DNA Test for Colorectal Cancer Screening. N Engl J Med 2024; 390:984-993. [PMID: 38477986 DOI: 10.1056/nejmoa2310336] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
BACKGROUND A next-generation multitarget stool DNA test, including assessments of DNA molecular markers and hemoglobin level, was developed to improve the performance of colorectal cancer screening, primarily with regard to specificity. METHODS In a prospective study, we evaluated a next-generation multitarget stool DNA test in asymptomatic adults 40 years of age or older who were undergoing screening colonoscopy. The primary outcomes were sensitivity of the test for colorectal cancer and specificity for advanced neoplasia (colorectal cancer or advanced precancerous lesions). Advanced precancerous lesions included one or more adenomas or sessile serrated lesions measuring at least 1 cm in the longest dimension, lesions with villous histologic features, and high-grade dysplasia. Secondary objectives included the quantification of sensitivity for advanced precancerous lesions and specificity for nonneoplastic findings or negative colonoscopy and comparison of sensitivities for colorectal cancer and advanced precancerous lesions between the multitarget stool DNA test and a commercially available fecal immunochemical test (FIT). RESULTS Of 20,176 participants, 98 had colorectal cancer, 2144 had advanced precancerous lesions, 6973 had nonadvanced adenomas, and 10,961 had nonneoplastic findings or negative colonoscopy. With the next-generation test, sensitivity for colorectal cancer was 93.9% (95% confidence interval [CI], 87.1 to 97.7), and specificity for advanced neoplasia was 90.6% (95% CI, 90.1 to 91.0). Sensitivity for advanced precancerous lesions was 43.4% (95% CI, 41.3 to 45.6), and specificity for nonneoplastic findings or negative colonoscopy was 92.7% (95% CI, 92.2 to 93.1). With the FIT, sensitivity was 67.3% (95% CI, 57.1 to 76.5) for colorectal cancer and 23.3% (95% CI, 21.5 to 25.2) for advanced precancerous lesions; specificity was 94.8% (95% CI, 94.4 to 95.1) for advanced neoplasia and 95.7% (95% CI, 95.3 to 96.1) for nonneoplastic findings or negative colonoscopy. As compared with FIT, the next-generation test had superior sensitivity for colorectal cancer (P<0.001) and for advanced precancerous lesions (P<0.001) but had lower specificity for advanced neoplasia (P<0.001). No adverse events occurred. CONCLUSIONS The next-generation multitarget stool DNA test showed higher sensitivity for colorectal cancer and advanced precancerous lesions than FIT but also showed lower specificity. (Funded by Exact Sciences; BLUE-C ClinicalTrials.gov number, NCT04144738.).
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Affiliation(s)
- Thomas F Imperiale
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Kyle Porter
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Julia Zella
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Zubin D Gagrat
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Marilyn C Olson
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Sandi Statz
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Jorge Garces
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Philip T Lavin
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Humberto Aguilar
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Don Brinberg
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Charles Berkelhammer
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - John B Kisiel
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
| | - Paul J Limburg
- From the Indiana University School of Medicine, Indiana University Melvin and Bren Simon Comprehensive Cancer Center, and Regenstrief Institute, Indianapolis (T.F.I.); Exact Sciences, Madison, WI (K.P., J.Z., Z.D.G., M.C.O., S.S., J.G., P.J.L.); Boston Biostatistics Research Foundation, Framingham, MA (P.T.L.); Louisiana Research Center, Shreveport (H.A.); Great Lakes Gastroenterology Research, Mentor, OH (D.B.); Southwest Gastroenterology, Oak Lawn, IL (C.B.); and the Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN (J.B.K.)
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Botto F, Obregon S, Forcada P, Di Leva A, Fischer Sohn G, Bang JH, Koretzky M, Baratta S, Kotliar C. Prevalence and Burden of Carotid and Femoral Atherosclerosis in Subjects Without Known Cardiovascular Disease in a Large Community Hospital in South-America. High Blood Press Cardiovasc Prev 2024; 31:177-187. [PMID: 38436891 DOI: 10.1007/s40292-024-00627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/22/2024] [Indexed: 03/05/2024] Open
Abstract
INTRODUCTION Clinical guidelines recommend measurement of arterial (carotid and femoral) plaque burden by vascular ultrasound (VUS) as a risk modifier in individuals at low or moderate risk without known atherosclerotic cardiovascular disease (ASCVD). AIM To evaluate the prevalence of carotid and femoral plaques by age and sex, the burden of subclinical atherosclerosis (SA), and its association with classic CVRF in subjects over 30 years of age without ASCVD. METHODS We prospectively enrolled 5775 consecutive subjects referred for cardiovascular evaluation and determined the prevalence and burden of SA using 2D-VUS in carotid and femoral arteries. RESULTS Sixty-one percent were men with a mean age of 51.3 (SD 10.6) years. Overall, plaque prevalence was 51% in carotid arteries, 39.3% in femoral arteries, 62.4% in carotid or femoral arteries, and 37.6% in neither. The prevalence of plaques and SA burden showed an increasing trend with age, being higher in men than in women and starting before the age of 40, both in the carotid and femoral sites. There was also an increasing prevalence of plaques according to the number of CVRF, and interestingly we found a high prevalence of plaques in subjects with 0 or 1 classic CVRF. CONCLUSIONS We observed an increased prevalence and burden of carotid or femoral SA, higher in men, beginning before the fourth decade of life and increasing with age. Despite a significant association with classic CVRF, a significant number of subjects with low CVRF were diagnosed with SA.
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Affiliation(s)
- Fernando Botto
- Clinical Research Unit, Instituto Cardiovascular de Buenos Aires (ICBA), Av del Libertador 6302, Buenos Aires, Argentina.
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina.
| | - Sebastian Obregon
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Pedro Forcada
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Ana Di Leva
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Gabriela Fischer Sohn
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Joon-Ho Bang
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Martin Koretzky
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Sergio Baratta
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
| | - Carol Kotliar
- Hypertension and Vascular Ageing Unit, Hospital Universitario Austral, Pilar, Buenos Aires, Argentina
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Li L, Mangione CM, Ogedegbe G, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wong JB. Screening for Speech and Language Delay and Disorders in Children: US Preventive Services Task Force Recommendation Statement. JAMA 2024; 331:329-334. [PMID: 38261037 DOI: 10.1001/jama.2023.26952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Importance Speech and language delays and disorders can pose significant problems for children and their families. Evidence suggests that school-aged children with speech or language delays may be at increased risk of learning and literacy disabilities, including difficulties with reading and writing. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate benefits and harms of screening for speech and language delay and disorders in children 5 years or younger. Population Asymptomatic children 5 years or younger whose parents or clinicians do not have specific concerns about their speech, language, hearing, or development. Evidence Assessment The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children who do not present with signs or symptoms or parent/caregiver concerns. Recommendation The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for speech and language delay and disorders in children 5 years or younger without signs or symptoms. (I statement).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | | | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Angelidou IA, Stocker H, Beyreuther K, Teichmann B. Validation of the "Perceptions Regarding pRE-Symptomatic Alzheimer's Disease Screening" (PRE-ADS) Questionnaire in the German Population: Attitudes, Motivations, and Barriers to Pre-Symptomatic Dementia Screening. J Alzheimers Dis 2024; 97:309-325. [PMID: 38189757 PMCID: PMC10789340 DOI: 10.3233/jad-230961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Attitudes, motivations, and barriers to pre-symptomatic screening for Alzheimer's disease (AD) in the general population are unclear, and validated measurement tools are lacking. OBJECTIVE Translation and validation of the German version of the "Perceptions regarding pRE-symptomatic Alzheimer's Disease Screening" (PRE-ADS) questionnaire. METHODS A convenience sample (N = 256) was recruited via an online platform. Validation of the PRE-ADS-D consisted of assessments of reliability, structural validity using Principal Component Analysis (PCA) and Exploratory Factor Analysis (EFA) and construct validity using known-group tests. A subscale "Acceptability of Screening", with 5 PRE-ADS-D items, was extracted to measure acceptance of screening in clinical practice. The STROBE checklist was used for reporting. RESULTS EFA revealed a three-factor model for the PRE-ADS-D. Acceptable to good internal consistency was found for the 25-item scale (α= 0.78), as well as for the three factors "Concerns about Screening" (α= 0.85), "Intention to be Screened" (α= 0.87), and "Preventive Health Behaviors" (α= 0.81). Construct validity was confirmed for both the 25-item PRE-ADS-D and the "Acceptability of Screening" scale (α= 0.91). Overall, 51.2% of the participants showed a preference for screening. Non-parametric tests were conducted to further explore group differences of the sample. CONCLUSIONS The PRE-ADS-D is a reliable and valid tool to measure attitudes, motives, and barriers regarding pre-symptomatic dementia screening in the German-speaking general population. Additionally, the subscale "Acceptability of Screening" demonstrated good construct validity and reliability, suggesting its promising potential as a practical tool in clinical practice.
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Affiliation(s)
| | - Hannah Stocker
- Network Aging Research, Heidelberg University, Heidelberg, Germany
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | | | - Birgit Teichmann
- Network Aging Research, Heidelberg University, Heidelberg, Germany
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Gale SA. Language and Meaning: Asymptomatic Alzheimer's Disease in the Clinic and Society. J Alzheimers Dis 2024; 99:489-492. [PMID: 38701152 DOI: 10.3233/jad-240195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
As the biological, biomarker-driven framework of Alzheimer's disease (AD) becomes formalized through revised, consensus clinical criteria, clinicians will confront more and more patients in the earliest, asymptomatic stages of disease. The language and diction used by practitioners to characterize these early patients, whether they are diagnosed with AD, and how their condition is documented in medical and legal records have important implications for both their care and their medical-legal status outside of the health system. Investigation is needed urgently to better understand clinicians' views and practices regarding early AD, as we adapt to new disease definitions in this unprecedented era of care.
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Affiliation(s)
- Seth A Gale
- Department of Neurology, Center for Brain/Mind Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Stanley A, Athanasuleas C. Timing of Surgery for Asymptomatic Primary Mitral Regurgitation: Possible Value of Early, Serial Measurements of Left Ventricular Sphericity. Curr Cardiol Rev 2024; 20:93-101. [PMID: 38351687 DOI: 10.2174/011573403x277223240206062319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/11/2024] [Accepted: 01/24/2024] [Indexed: 04/30/2024] Open
Abstract
Asymptomatic primary mitral regurgitation due to myxomatous degeneration of the mitral valve leaflets may remain so for long periods, even as left ventricular function progresses to a decompensated stage. During the early compensated stage, the ventricle's initial response to the volume overload is an asymmetric increase in the diastolic short axis dimension, accomplished by a diastolic shift of the interventricular septum into the right ventricular cavity, creating a more spherical left ventricular diastolic shape, increasing diastolic filling and stroke volume. Early valve repair is recommended to reduce postoperative left ventricular dysfunction. Early serial measurements of left ventricular sphericity index [LV-Si]. during the compensated stage of mitral regurgitation might identify subtle changes in left ventricular shape and assist in determining the optimal earliest timing for surgical intervention.
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Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham AL and Kemp-Carraway Heart Institute, Birmingham AL, USA
| | - Constantine Athanasuleas
- Department of Surgery, North Alabama Medical Center and Kemp-Carraway Heart Institute, Birmingham AL, USA
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Zhang L, Zeng L. Non-linear association of triglyceride-glucose index with prevalence of prediabetes and diabetes: a cross-sectional study. Front Endocrinol (Lausanne) 2023; 14:1295641. [PMID: 38152130 PMCID: PMC10751584 DOI: 10.3389/fendo.2023.1295641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023] Open
Abstract
Background The Triglyceride-glucose (TyG) index has been acknowledged as a convenient, cost-effective, and relatively simple marker for insulin resistance (IR). Meanwhile, prediabetes, described as an asymptomatic, moderately hyperglycemic state, tends to be more prevalent than diabetes. Thus, the objective of this study was to explore the relationship between the TyG index and the prevalence of both prediabetes and diabetes within the U.S. population. Methods This study utilized a cross-sectional dataset derived from the National Health and Nutrition Survey (NHANES) spanning 1999 to 2018. The subjects were individuals aged 18 years and above, who had available fasting glucose and fasting triglyceride information, permitting a diagnosis of prediabetes or diabetes. The TyG index was computed using laboratory data, and participants were subsequently categorized into quartiles based on this information. The relationship between the TyG index and the prevalence of prediabetes and diabetes was investigated using logistic regression analysis. Results Out of the 25,159 participants, 23.88% were found to have prediabetes, while 16.22% were diagnosed with diabetes. After adjusting for confounding factors, a linear increase in relative odds was observed in Q2 (OR: 1.69; 95% CI: 1.52, 1.89), Q3 (OR: 2.57; 95% CI: 2.30, 2.88), and Q4 (OR: 4.88; 95% CI: 4.33, 5.49) groups in comparison to the reference group, Q1. In addition, a non-linear relationship was observed between the TyG index and the prevalence of prediabetes and diabetes. Specifically, patients with a TyG index greater than 8.00 overall exhibited a significantly higher risk of prediabetes and diabetes, confirming that an increase in the TyG index is associated with a corresponding increase in risk. However, this shift showed gender-specific variations; the threshold was observed at 8.00 in males but shifted to 9.00 in females. Conclusion The TyG index demonstrated a non-linear positive correlation with both prediabetes and diabetes. This suggests that maintaining the TyG index at a certain, reduced level could potentially aid in preventing the onset of prediabetes and diabetes.
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Affiliation(s)
- Linhao Zhang
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Ling Zeng
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
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Ling L, Wang X, Zhang Y, Yin F, Zhang Z, Lyu X. Efficacy of Qingfei Paidu Granules combined with non-drug traditional Chinese medicine therapy in the treatment of patients with asymptomatic coronavirus disease: A retrospective study. Medicine (Baltimore) 2023; 102:e34868. [PMID: 37986280 PMCID: PMC10659728 DOI: 10.1097/md.0000000000034868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 11/22/2023] Open
Abstract
The aim of this study was to retrospectively analyze the clinical efficacy and safety of Qingfei Paidu granules (QFPG) combined with non-drug therapy of traditional Chinese medicine (TCM) in treating patients with asymptomatic coronavirus disease 2019 (COVID-2019). A total of 450 patients admitted to the wards of Chongming Changxing Island isolation site from April 1 to 18, 2022 were retrospectively analyzed and divided into 3 groups according to the treatment that they received. W1 was not treated (control group), and W2 was given QFPG (TCM treatment), W3 (TCM combined with TCM non-drug therapy) was treated with QFPG, five-element music therapy and Gong. We retrospectively analyzed the medical history data, including general information, time of first turning negative, length of hospital stays, number of cases classified as mild or ordinary, number of cases with adverse events/adverse reactions. The conversion to negative time of the 3 groups was 6.50, 4.40, and 3.81 days, respectively, and there were significant differences among the 3 groups (P < .001). The hospital duration in the 3 groups was 8.45, 5.72, and 5.53 days, respectively, and there were significant differences among the 3 groups (P < .001). The number of adverse events W1 (5/150, 3.3%), W2 (8/150, 5.3%), and W3 (4/150, 2.7%) was consistent among the 3 groups (P > .05). QFPG with TCM non-drug therapy is effective in patients with asymptomatic COVID-2019, which can effectively shorten the time to double negative and reduce the proportion of patients with mild disease.
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Affiliation(s)
- Li Ling
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xian Wang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fang Yin
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zhenyuan Zhang
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Lyu
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Li L, Ogedegbe G, Pbert L, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM, Wong JB. Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 330:1666-1673. [PMID: 37934215 DOI: 10.1001/jama.2023.21408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Importance Oral health is fundamental to health and well-being across the lifespan. Oral health conditions affect the daily lives of school-age children and adolescents, leading to loss of more than 51 million school hours every year. Untreated oral health conditions in children can lead to serious infections and affect growth, development, and quality of life. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in children and adolescents aged 5 to 17 years. Population Asymptomatic children and adolescents aged 5 to 17 years. Evidence Assessment The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. Recommendations The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Lori Pbert
- University of Massachusetts Chan Medical School, Worcester
| | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- University of Texas Health Science Center, San Antonio
| | | | - John B Wong
- Tufts University School of Medicine, Boston, Massachusetts
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Vazirian F, Sadeghi M, Kelesidis T, Budoff MJ, Zandi Z, Samadi S, Mohammadpour AH. Predictive value of lipoprotein(a) in coronary artery calcification among asymptomatic cardiovascular disease subjects: A systematic review and meta-analysis. Nutr Metab Cardiovasc Dis 2023; 33:2055-2066. [PMID: 37567791 PMCID: PMC11073574 DOI: 10.1016/j.numecd.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/20/2023] [Accepted: 07/11/2023] [Indexed: 08/13/2023]
Abstract
AIMS Studies have indicated inconsistent results regarding the association between plasma levels of Lipoprotein(a) [Lp(a)] and coronary artery calcification (CAC). We performed a systematic review and meta-analysis to investigate the association between elevated levels of Lp(a) and risk of CAC in populations free of cardiovascular disease (CVD) symptoms. DATA SYNTHESIS PubMed, Web of Science, Embase, and Scopus were searched up to July 2022 and the methodological quality was assessed using Newcastle-Ottawa Scale (NOS) scale. Random-effects meta-analysis was used to estimate pooled odds ratio (OR) and 95% confidence interval. Out of 298 studies, data from 8 cross-sectional (n = 18,668) and 4 cohort (n = 15,355) studies were used in meta-analysis. Cohort studies demonstrated a positive significant association between Lp(a) and CAC, so that individuals with Lp(a)≥30-50 exposed to about 60% risk of CAC incidence compared to those with lower Lp(a) concentrations in asymptomatic CVD subjects (OR, 1.58; 95% CI, 1.38-1.80; l2, 0.0%; P, 0.483); Subgroup analysis showed that a cut-off level for Lp(a) measurement could not statistically affect the association, but race significantly affected the relationship between Lp(a) and CAC (OR,1.60; 95% CI, 1.41-1.81). Analyses also revealed that both men and women with higher Lp(a) concentrations are at the same risk for increased CAC. CONCLUSIONS Blood Lp(a) level was significantly associated with CAC incidence in asymptomatic populations with CVD, indicating that measuring Lp(a) may be a useful biomarker for diagnosing subclinical atherosclerosis in individuals at higher risk of CAC score. PROSPERO REGISTRATION NUMBER CRD42022350297.
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Affiliation(s)
- Fatemeh Vazirian
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Sadeghi
- Department of Epidemiology, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Theodoros Kelesidis
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Zahra Zandi
- Department of Cardiovascular Disease, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sara Samadi
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran; Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
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Paraskevas KI. Best Medical Treatment for Patients with Asymptomatic Carotid Stenosis: Essential, but Not Always Adequate for Stroke Prevention. Ann Vasc Surg 2023; 96:393. [PMID: 37356653 DOI: 10.1016/j.avsg.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/27/2023]
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Huber JH, Ji M, Shih YH, Wang M, Colditz G, Chang SH. Disentangling age, gender, and racial/ethnic disparities in multiple myeloma burden: a modeling study. Nat Commun 2023; 14:5768. [PMID: 37730703 PMCID: PMC10511740 DOI: 10.1038/s41467-023-41223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
Multiple myeloma (MM) is a hematological malignancy that is consistently preceded by an asymptomatic condition, monoclonal gammopathy of undetermined significance (MGUS). Disparities by age, gender, and race/ethnicity in both MGUS and MM are well-established. However, it remains unclear whether these disparities can be explained by increased incidence of MGUS and/or accelerated progression from MGUS to MM. Here, we fit a mathematical model to nationally representative data from the United States and showed that the difference in MM incidence can be explained by an increased incidence of MGUS among male and non-Hispanic Black populations. We did not find evidence showing differences in the rate of progression from MGUS to MM by either gender or race/ethnicity. Our results suggest that screening for MGUS among high-risk groups (e.g., non-Hispanic Black men) may hold promise as a strategy to reduce the burden and MM health disparities.
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Affiliation(s)
- John H Huber
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
| | - Mengmeng Ji
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Yi-Hsuan Shih
- Department of Electrical and Systems Engineering, Washington University in St. Louis, St. Louis, MO, USA
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Graham Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
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Park HW, Jo S, Park KS, Lee H, Jeon YJ, Park S, Ann SH, Kim YG, Choi SH, Kwon WJ, Cho YR, Suh J, Park GM. Differential Impact of Degree of Hypertension on Subclinical Coronary Atherosclerosis in Asymptomatic Subjects With and Without Diabetes Mellitus. Am J Cardiol 2023; 203:343-351. [PMID: 37517130 DOI: 10.1016/j.amjcard.2023.07.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/02/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
This study sought to evaluate the association between the degree of hypertension and subclinical coronary atherosclerosis in asymptomatic subjects with and without diabetes mellitus (DM). We retrospectively analyzed 7,352 asymptomatic subjects (mean age 52.8 ± 7.8 years; 4,689 [63.8%] men) with no history of coronary artery disease who voluntarily underwent coronary computed tomography angiography as part of a general health examination. The classification of hypertension was adapted from the American College of Cardiology and American Heart Association 2017 guideline. Subclinical coronary atherosclerosis was defined as the presence of coronary plaque by coronary computed tomography angiography. In subjects without DM (n = 6,598), after the adjustment for cardiovascular risk factors, subclinical coronary atherosclerosis was significantly associated with both stage 1 hypertension (adjusted odds ratio [aOR] 1.356; 95% confidence interval [CI], 1.167 to 1.575; p <0.001) and stage 2 hypertension (aOR, 1.614; 95% CI, 1.329 to 1.961; p <0.001) groups compared with the normal group. In contrast, in subjects with DM (n = 754), there was no statistical difference in the aOR of the stage 1 hypertension group for the presence of coronary plaque (aOR, 1.449; 95% CI, 0.982 to 2.136; p = 0.061). However, the stage 2 hypertension group had a significant association with subclinical coronary atherosclerosis (aOR, 2.067; 95% CI, 1.287 to 3.322; p = 0.003). In subjects without DM, both stages 1 and 2 hypertension were associated with subclinical coronary atherosclerosis. However, in subjects with DM, stage 2 hypertension was only associated with an increased risk of subclinical coronary atherosclerosis.
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Affiliation(s)
- Hyun Woo Park
- Department of Cardiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Sangyong Jo
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Kyung Sun Park
- Department of Nephrology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Hyeji Lee
- Department of Emergency Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young-Jee Jeon
- Department of Family Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Sangwoo Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Soe Hee Ann
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Yong-Giun Kim
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Seong Hoon Choi
- Department of Diagnostic Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Woon Jung Kwon
- Department of Diagnostic Radiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Young-Rak Cho
- Department of Cardiology, Dong-A University Hospital, Busan, Korea
| | - Jon Suh
- Department of Cardiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea.
| | - Gyung-Min Park
- Department of Cardiology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea; Basic-Clinic Translational Research Center, University of Ulsan, Ulsan, Republic of Korea.
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Bouzas-Mosquera A, Viladés-Medel D, Muñiz J. Coronary computed tomography angiography in asymptomatic patients with diabetes. Rev Esp Cardiol (Engl Ed) 2023; 76:675-676. [PMID: 37201713 DOI: 10.1016/j.rec.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/10/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Alberto Bouzas-Mosquera
- Unidad de Imagen y Función Cardiacas, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain; Grupo de Investigación Cardiovascular, Departamento de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain. https://twitter.com/@alberto_bouzas
| | - David Viladés-Medel
- Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain; Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. https://twitter.com/@DavidVilades
| | - Javier Muñiz
- Grupo de Investigación Cardiovascular, Departamento de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña, A Coruña, Spain; Centro de Investigación Biomédica en Red Cardiovascular (CIBERCV), Spain.
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Reutersberg B, Stadlbauer T, Düppers P, Meuli L, Zimmermann A. [Revascularisation of Asymptomatic Carotid Stenosis - Reasonable or Obsolete?]. Praxis (Bern 1994) 2023; 112:545-553. [PMID: 37823810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Recommendations for surgical versus conservative treatment of asymptomatic carotid stenosis (ACS) are based on prospective randomized trials, some of which were performed several decades ago. However, during this time, "best medical treatment" (BMT) for conservative therapy of arteriosclerotic patients has evolved significantly. Because of the associated risk reduction of ACS, surgical therapy is increasingly being questioned. By identifying clinical and morphological risk parameters, subgroups could be identified that might, however, benefit from invasive therapy. Consequently, multidisciplinary therapy decision-making requires an increasingly patient-individualized approach.
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Affiliation(s)
| | - Thomas Stadlbauer
- Klinik für Gefässchirurgie. Universitätsspital Zürich, Zürich, Schweiz
| | - Philip Düppers
- Klinik für Gefässchirurgie. Universitätsspital Zürich, Zürich, Schweiz
| | - Lorenz Meuli
- Klinik für Gefässchirurgie. Universitätsspital Zürich, Zürich, Schweiz
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Van Camp G. Response to: Correspondence on "Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics" by José Alberto San Román. Heart 2023; 109:1338. [PMID: 37137677 DOI: 10.1136/heartjnl-2023-322845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- Guy Van Camp
- Cardiology, Onze Lieve Vrouwziekenhuis, Aalst, Belgium
- Cardiology, Hartcentrum OLV Aalst, Aalst, Belgium
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San Román JA. Correspondence on "Outcomes in patients with moderate and asymptomatic severe aortic stenosis followed up in heart valve clinics" by Paolisso et al. Heart 2023; 109:1338. [PMID: 37137679 DOI: 10.1136/heartjnl-2023-322844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Affiliation(s)
- José Alberto San Román
- Cardiology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
- CIBERCV, Madrid, Spain
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Abstract
PURPOSE OF REVIEW Significant progress in characterizing presymptomatic amyotrophic lateral sclerosis (ALS) is ushering in an era of potential disease prevention. Although these advances have largely been based on cohorts of deep-phenotyped mutation carriers at an elevated risk for ALS, there are increasing opportunities to apply principles and insights gleaned, to the broader population at risk for ALS [and frontotemporal dementia (FTD)]. RECENT FINDINGS The discovery that blood neurofilament light chain (NfL) level increases presymptomatically and may serve as a susceptibility biomarker, predicting timing of phenoconversion in some mutation carriers, has empowered the first-ever prevention trial in SOD1 -ALS. Moreover, there is emerging evidence that presymptomatic disease is not uniformly clinically silent, with mild motor impairment (MMI), mild cognitive impairment (MCI), and/or mild behavioral impairment (MBI) representing a prodromal stage of disease. Structural and functional brain abnormalities, as well as systemic markers of metabolic dysfunction, have emerged as potentially even earlier markers of presymptomatic disease. Ongoing longitudinal studies will determine the extent to which these reflect an endophenotype of genetic risk. SUMMARY The discovery of presymptomatic biomarkers and the delineation of prodromal states is yielding unprecedented opportunities for earlier diagnosis, treatment, and perhaps even prevention of genetic and apparently sporadic forms of disease.
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Affiliation(s)
- Michael Benatar
- Department of Neurology, University of Miami, Miami, FL, 33136, USA
| | - Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Joanne Wuu
- Department of Neurology, University of Miami, Miami, FL, 33136, USA
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Barry MJ, Nicholson WK, Silverstein M, Chelmow D, Coker TR, Davis EM, Donahue KE, Jaén CR, Li L, Ogedegbe G, Rao G, Ruiz JM, Stevermer J, Tsevat J, Underwood SM. Screening for Lipid Disorders in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA 2023; 330:253-260. [PMID: 37462699 DOI: 10.1001/jama.2023.11330] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Importance Familial hypercholesterolemia and multifactorial dyslipidemia are 2 conditions that cause abnormally high lipid levels in children, which can lead to premature cardiovascular events (eg, myocardial infarction and stroke) and death in adulthood. Objective The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for lipid disorders in asymptomatic children and adolescents. Population Asymptomatic children and adolescents 20 years or younger without a known diagnosis of a lipid disorder. Evidence Assessment The USPSTF concludes that the current evidence is insufficient and the balance of benefits and harms for screening for lipid disorders in asymptomatic children and adolescents 20 years or younger cannot be determined. Recommendation The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for lipid disorders in children and adolescents 20 years or younger. (I statement).
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Affiliation(s)
| | | | | | | | | | - Esa M Davis
- University of Maryland School of Medicine, Baltimore
| | | | | | - Li Li
- University of Virginia, Charlottesville
| | | | - Goutham Rao
- Case Western Reserve University, Cleveland, Ohio
| | | | | | - Joel Tsevat
- The University of Texas Health Science Center, San Antonio
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Tsuruta K, Takedatsu H, Yoshioka S, Yoshikai M, Tomiyasu K, Morita M, Kuwaki K, Mitsuyama K, Kawaguchi T. Symptoms Contributing to the Diagnosis of Small Bowel Tumors. Digestion 2023; 104:430-437. [PMID: 37437555 DOI: 10.1159/000531215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/22/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Small bowel tumors (SBTs) are difficult to diagnose because of limited opportunities and technical difficulties in evaluating the small bowel. Asymptomatic conditions or nonspecific symptoms make SBT diagnosis more challenging. In Asia, SBTs are reported to be more frequently malignant lymphoma (ML), adenocarcinoma, and gastrointestinal stromal tumor (GIST). In this study, we examined 66 patients diagnosed with SBTs and determined their clinical characteristics. METHODS This retrospective study was conducted from January 2013 to July 2020 at Kurume University Hospital. The modalities used to detect SBTs were computed tomography (CT), positron emission tomography, magnetic resonance imaging, and ultrasonography. Endoscopy was also performed in some cases to confirm SBT diagnosis. The study included 66 patients. The medical data collected included presenting symptoms, tumor location, underlying condition, diagnostic modalities, pathologic diagnosis, and treatment. RESULTS ML and adenocarcinoma were the most common tumors (22.7%), followed by GIST (21.2%) and metastatic SBT (18.2%). Symptoms that led to SBT detection were abdominal pain (44.5%), asymptomatic conditions (28.8%), hematochezia (12.1%), and anemia (10.6%). CT was the most used modality to detect SBTs. Nineteen patients were asymptomatic, and SBTs were incidentally detected in them. GISTs and benign tumors were more often asymptomatic than other malignant tumors. CONCLUSION Abdominal pain was the main symptom for SBTs in particular adenocarcinoma, ML, and metastatic SBT. In addition, GIST, which was highly prevalent in Asia, had fewer symptoms. An understanding of these characteristics may be helpful in the clinical practice of SBTs.
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Affiliation(s)
- Kozo Tsuruta
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan,
| | - Hidetoshi Takedatsu
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Shinichiro Yoshioka
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | | | | | - Masaru Morita
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Kotaro Kuwaki
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Keiichi Mitsuyama
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Fukuoka, Japan
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