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Hypertension and NAFLD risk: Insights from the NHANES 2017-2018 and Mendelian randomization analyses.
Yuan, M, He, J, Hu, X, Yao, L, Chen, P, Wang, Z, Liu, P, Xiong, Z, Jiang, Y, Li, L
Chinese medical journal. 2024;(4):457-464
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Abstract
BACKGROUND Hypertension and non-alcoholic fatty liver disease (NAFLD) share several pathophysiologic risk factors, and the exact relationship between the two remains unclear. Our study aims to provide evidence concerning the relationship between hypertension and NAFLD by analyzing data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 and Mendelian randomization (MR) analyses. METHODS Weighted multivariable-adjusted logistic regression was applied to assess the relationship between hypertension and NAFLD risk by using data from the NHANES 2017-2018. Subsequently, a two-sample MR study was performed using the genome-wide association study (GWAS) summary statistics to identify the causal association between hypertension, systolic blood pressure (SBP), diastolic blood pressure (DBP), and NAFLD. The primary inverse variance weighted (IVW) and other supplementary MR approaches were conducted to verify the causal association between hypertension and NAFLD. Sensitivity analyses were adopted to confirm the robustness of the results. RESULTS A total of 3144 participants were enrolled for our observational study in NHANES. Weighted multivariable-adjusted logistic regression analysis suggested that hypertension was positively related to NAFLD risk (odds ratio [OR] = 1.677; 95% confidence interval [CI], 1.159-2.423). SBP ≥130 mmHg and DBP ≥80 mmHg were also significantly positively correlated with NAFLD. Moreover, hypertension was independently connected with liver steatosis ( β = 7.836 [95% CI, 2.334-13.338]). The results of MR analysis also supported a causal association between hypertension (OR = 7.203 [95% CI, 2.297-22.587]) and NAFLD. Similar results were observed for the causal exploration between SBP (OR = 1.024 [95% CI, 1.003-1.046]), DBP (OR = 1.047 [95% CI, 1.005-1.090]), and NAFLD. The sensitive analysis further confirmed the robustness and reliability of these findings (all P >0.05). CONCLUSION Hypertension was associated with an increased risk of NAFLD.
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Oral Contraceptive Pills Increase Circulating 25-Hydroxy-Vitamin D Concentrations in Women Who Are Lactating.
Huff, LL, Schulz, EV, Richardson, CD, Ebeling, MD, Shary, JR, Hollis, BW, Wagner, CL
American journal of perinatology. 2024;(S 01):e2759-e2766
Abstract
OBJECTIVE This article aims to determine the association between maternal 25-hydroxy-vitamin D [25(OH)D] status and intake of hormonal oral contraceptive pills (OCPs) in women who are lactating. STUDY DESIGN Women who were exclusively breastfeeding participated in a randomized controlled trial assessing vitamin D supplementation at 400, 2,400, or 6,400 international unit (IU)/d from 1 month through 7 months postpartum. This observational, secondary analysis assessed whether OCPs were associated with maternal 25(OH)D concentrations in women who are lactating. Multivariate regression models were used to predict 25(OH)D concentrations and create parameter estimates for each variable. RESULTS In a bivariate analysis, the use of OCPs at 4 months was associated with increased serum 25(OH)D (p = 0.02). OCPs' use at 7 months was associated with a higher trend in 25(OH)D, but this finding was not statistically significant (p = 0.1). In a multivariate regression model at 4 months, independent positive predictors of 25(OH)D concentrations were the use of OCPs (p = 0.03) and treatment with vitamin D at 6,400 IU/d (p ≤ 0.0001). Negative predictors were Black (p = 0.001) and Hispanic (p = 0.0001) race and ethnicity, and body mass index (BMI) greater than 30 (p = 0.0002). The same pattern occurred at 7 months, with more southern latitude as a positive independent predictor (p = 0.04) of 25(OH)D concentration. CONCLUSION The use of OCPs was associated with greater 25(OH)D in women who are lactating. Additionally, treatment with vitamin D at 6,400 IU/d and southern latitude was associated with greater 25(OH)D in women who are lactating. Black and Hispanic race and ethnicity, and BMI greater than 30, were independently associated with lower 25(OH)D in women who are lactating. KEY POINTS · The association of OCP with serum 25(OH)D concentrations during postpartum lactation is unknown.. · OCPs' use was associated with higher 25(OH)D concentrations in postpartum women who are lactating.. · Treatment with vitamin D and southern latitude was associated with greater 25(OH)D in women who are lactating.. · Black and Hispanic, and BMI > 30 were associated with lower 25(OH)D in women who are lactating.. · Practitioners can counsel women who are lactating on OCPs' use and the positive effects on their 25(OH)D status..
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DOACs vs Vitamin K Antagonists During Cardiac Rhythm Device Surgery: A Multicenter Propensity-Matched Study.
Creta, A, Ventrella, N, Earley, MJ, Finlay, M, Sporton, S, Maclean, E, Kanthasamy, V, Lemos Silva Di Nubila, BC, Ricciardi, D, Calabrese, V, et al
JACC. Clinical electrophysiology. 2024;(1):121-132
Abstract
BACKGROUND There is a paucity of data comparing vitamin K antagonists (VKAs) to direct oral anticoagulants (DOACs) at the time of cardiac implantable electronic device (CIED) surgery. Furthermore, the best management of DOACs (interruption vs continuation) is yet to be determined. OBJECTIVES This study aimed to compare the incidence of device-related bleeds and thrombotic events based on anticoagulant type (DOAC vs VKA) and regimen (interrupted vs uninterrupted). METHODS This was an observational multicenter study. We included patients on chronic oral anticoagulation undergoing CIED surgery. Patients were matched using propensity scoring. RESULTS We included 1,975 patients (age 73.8 ± 12.4 years). Among 1,326 patients on DOAC, this was interrupted presurgery in 78.2% (n = 1,039) and continued in 21.8% (n = 287). There were 649 patients on continued VKA. The matched population included 861 patients. The rate of any major bleeding was higher with continued DOAC (5.2%) compared to interrupted DOAC (1.7%) and continued VKA (2.1%) (P = 0.03). The rate of perioperative thromboembolism was 1.4% with interrupted DOAC, whereas no thromboembolic events occurred with DOAC or VKA continuation (P = 0.04). The use of dual antiplatelet therapy, DOAC continuation, and male sex were independent predictors of major bleeding on a multivariable analysis. CONCLUSIONS In this large real-world cohort, a continued DOAC strategy was associated with a higher bleeding risk compared to DOAC interruption or VKA continuation in patients undergoing CIED surgery. However, DOAC interruption was associated with increased thromboembolic risk. Concomitant dual antiplatelet therapy should be avoided whenever clinically possible. A bespoke approach is necessary, with a strategy of minimal DOAC interruption likely to represent the best compromise.
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Plasma metabolomic and lipidomic profiles accurately classify mothers of children with congenital heart disease: an observational study.
Mires, S, Sommella, E, Merciai, F, Salviati, E, Caponigro, V, Basilicata, MG, Marini, F, Campiglia, P, Baquedano, M, Dong, T, et al
Metabolomics : Official journal of the Metabolomic Society. 2024;(4):70
Abstract
INTRODUCTION Congenital heart disease (CHD) is the most common congenital anomaly, representing a significant global disease burden. Limitations exist in our understanding of aetiology, diagnostic methodology and screening, with metabolomics offering promise in addressing these. OBJECTIVE To evaluate maternal metabolomics and lipidomics in prediction and risk factor identification for childhood CHD. METHODS We performed an observational study in mothers of children with CHD following pregnancy, using untargeted plasma metabolomics and lipidomics by ultrahigh performance liquid chromatography-high resolution mass spectrometry (UHPLC-HRMS). 190 cases (157 mothers of children with structural CHD (sCHD); 33 mothers of children with genetic CHD (gCHD)) from the children OMACp cohort and 162 controls from the ALSPAC cohort were analysed. CHD diagnoses were stratified by severity and clinical classifications. Univariate, exploratory and supervised chemometric methods were used to identify metabolites and lipids distinguishing cases and controls, alongside predictive modelling. RESULTS 499 metabolites and lipids were annotated and used to build PLS-DA and SO-CovSel-LDA predictive models to accurately distinguish sCHD and control groups. The best performing model had an sCHD test set mean accuracy of 94.74% (sCHD test group sensitivity 93.33%; specificity 96.00%) utilising only 11 analytes. Similar test performances were seen for gCHD. Across best performing models, 37 analytes contributed to performance including amino acids, lipids, and nucleotides. CONCLUSIONS Here, maternal metabolomic and lipidomic analysis has facilitated the development of sensitive risk prediction models classifying mothers of children with CHD. Metabolites and lipids identified offer promise for maternal risk factor profiling, and understanding of CHD pathogenesis in the future.
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Impact of educational workshops to increase awareness of pelvic floor dysfunction and integrate preventive lifestyle habits.
Pizzoferrato, AC, Deparis, J, Fritel, X, Rousseau, M, Blanchard, V
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics. 2024;(2):596-604
Abstract
OBJECTIVES Our objectives were to evaluate the impact of group pelvic floor education workshops on participants' knowledge, their satisfaction, and the modification of their urinary and digestive behaviors, and to compare health care providers' (HCP) knowledge with that of the general population. METHODS For this prospective observational study, group pelvic floor education workshops were proposed between May 2021 and June 2022 in a web-conference format. Each workshop covered pelvic floor anatomy and physiology, urinary and digestive physiology as well as risk factors of PFD and preventive measures. At the start and the end of the workshops, participants completed a questionnaire on their knowledge and their beliefs about the pelvic floor. Questions about their satisfaction were asked at the end of the workshops. A 2-month questionnaire assessed changes in urinary and digestive habits and whether participants had talked about the workshop around them. RESULTS A total of 856, with an average age 40.1 years, participated and completed the questionnaires before and after the workshops; 694 responded at 2 months. The education workshops significantly improved knowledge about the pelvic floor in the "HCP" and "non-HCP" groups. At 2 months, 591 participants (85.2%) 85.2% had talked about the workshop content; 557 (80.3%) reported having changed, or planned to change, their urinary behaviors and 495 (71.3%) their defecatory behaviors. CONCLUSIONS Pelvic floor education workshops can increase level of knowledge and thus limit risky behaviors for the pelvic floor. The high rate of participation and the satisfaction of the participants shows the interest for the theme.
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Dyslipidemia versus obesity as predictors of ischemic stroke prognosis: a multi-center study in China.
Ruan, H, Ran, X, Li, SS, Zhang, Q
Lipids in health and disease. 2024;(1):72
Abstract
BACKGROUND This multicenter observational study aimed to determine whether dyslipidemia or obesity contributes more significantly to unfavorable clinical outcomes in patients experiencing a first-ever ischemic stroke (IS). METHODS The study employed a machine learning predictive model to investigate associations among body mass index (BMI), body fat percentage (BFP), high-density lipoprotein (HDL), triglycerides (TG), and total cholesterol (TC) with adverse outcomes in IS patients. Extensive real-world clinical data was utilized, and risk factors significantly linked to adverse outcomes were identified through multivariate analysis, propensity score matching (PSM), and regression discontinuity design (RDD) techniques. Furthermore, these findings were validated via a nationwide multicenter prospective cohort study. RESULTS In the derived cohort, a total of 45,162 patients diagnosed with IS were assessed, with 522 experiencing adverse outcomes. A multifactorial analysis incorporating PSM and RDD methods identified TG (adjusted odds ratio (OR) = 1.110; 95% confidence interval (CI): 1.041-1.183; P < 0.01) and TC (adjusted OR = 1.139; 95%CI: 1.039-1.248; P < 0.01) as risk factors. However, BMI, BFP, and HDL showed no significant effect. In the validation cohort, 1410 controls and 941 patients were enrolled, confirming that lipid levels are more strongly correlated with the prognosis of IS patients compared to obesity (TC, OR = 1.369; 95%CI: 1.069-1.754; P < 0.05; TG, OR = 1.332; 95%CI: 1.097-1.618; P < 0.01). CONCLUSION This study suggests that dyslipidemia has a more substantial impact on the prognosis of IS patients compared to obesity. This highlights the importance of prioritizing dyslipidemia management in the treatment and prevention of adverse outcomes in IS patients.
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Muscularity of older trauma patients at intensive care unit admission, association with functional outcomes, and relationship with frailty: A retrospective observational study.
Ferguson, CE, Lambell, KJ, Ridley, EJ, Goh, GS, Hodgson, CL, Holland, AE, Harrold, M, Chan, T, Tipping, CJ
Australian critical care : official journal of the Confederation of Australian Critical Care Nurses. 2024;(2):205-211
Abstract
BACKGROUND Older individuals are at an increased risk of delayed recovery following a traumatic injury. Measurement of muscularity and frailty at hospital admission may aid with prognostication and risk stratification. OBJECTIVE This study aimed to describe muscularity at intensive care unit (ICU) admission in patients admitted following trauma and assess the relationship between muscularity and clinical, long-term functional outcomes and frailty at ICU admission. METHODS This retrospective study utilised data from a prospective observational study investigating frailty in patients aged ≥50 years, admitted to the ICU following trauma. Patients were eligible if they had a Computed Tomography (CT) scan including the third lumbar vertebra at ICU admission. Specialist software was used to quantify CT-derived skeletal muscle cross-sectional area. Muscularity status was classified as normal or low using published sex-specific cut-points. Demographic data, frailty, clinical, and long-term functional outcomes (Glasgow Outcome Scale-Extended and EQ-5DL-5L Visual analogue scale and utility score) were extracted from the original study. RESULTS One hundred patients were screened; 71 patients had a CT scan on admission with 66 scans suitable for muscle assessment. Patients with low muscularity (n = 25, 38%) were older and had a higher Acute Physiology and Chronic Health Evaluation II score and lower body mass index than patients with normal muscularity. Low muscularity was associated with frailty at admission (32% vs 5%, p = 0.005) but not with long term outcomes at 6 or 12 months. As a continuous variable, lower muscle cross-sectional area was associated with a poorer outcome on the Glasgow Outcome Scale-Extended at 6 months (mean [standard deviation]: 150 [43] and 180 [44], respectively; p = 0.014), no association was observed after adjustment for age p = 0.43). CONCLUSION In a population of older adults hospitalised following trauma, low muscularity at ICU admission was prevalent. Low muscularity was associated with frailty but not long-term functional outcomes. Larger studies are warranted to better understand the relationship between muscularity and long-term functional outcomes.
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Visceral symptoms in patients with anterior cutaneous nerve entrapment syndrome (ACNES): expression of viscerosomatic reflexes?
Jacobs, MLYE, Janssen, L, Stassen, LPS, Scheltinga, MRM, Roumen, RMH
Hernia : the journal of hernias and abdominal wall surgery. 2024;(1):127-134
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Abstract
PURPOSE Anterior cutaneous nerve entrapment (ACNES) is characterized by neuropathic pain in a predictable, circumscript abdominal area. The diagnostic delay is long, with half of ACNES-affected individuals reporting nausea, bloating, or loss of appetite mimicking visceral disease. The aim of this study was to describe these phenomena and to determine whether treatment could successfully reverse the visceral symptoms. METHODS This prospective observational study was conducted between July 2017 and December 2020 at SolviMáx, Center of Excellence for Chronic Abdominal Wall and Groin Pain, Máxima Medical Center, Eindhoven. Adult patients who fulfilled published criteria for ACNES and reported at least one visceral symptom at intake were eligible for the study. A self-developed Visceral Complaints ACNES Score (VICAS) questionnaire that scores several visceral symptoms (minimum 1 point, maximum 9 points) was completed before and after therapy. The success of treatment was defined as at least 50% reduction in pain. RESULTS Data from 100 selected patients (86 females) aged 39 ± 5 years were available for analysis. Frequently reported symptoms were abdominal bloating (78%), nausea (66%) and altered defecation (50%). Successful treatment significantly reduced the number of visceral symptoms, with a VICAS before of 3 (range 1-8) and after of 1 (range 0-6) (p < 0.001). A low baseline VICAS was associated with successful treatment outcome (OR 0.738, 95% CI 0.546-0.999). CONCLUSION Patients with ACNES may report a variety of visceral symptoms. Successful treatment substantially reduces these visceral symptoms in selected patients.
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Use of FOLFOXIRI Plus Bevacizumab and Subsequent Therapies in Metastatic Colorectal Cancer: An Age-Stratified Analysis.
Vassilev, ZP, Fan, X, Xu, J, Ostojic, H, Barzi, A
Clinical colorectal cancer. 2024;(3):258-271.e1
Abstract
BACKGROUND Treatment recommendations for metastatic colorectal cancer (mCRC) do not differ by age group; nevertheless, aggressive multiagent chemotherapy comprising FOLFOXIRI+bevacizumab (triplet+bev) is routinely administered in younger patients. This study analyzed real-world data on index triplet+bev use and subsequent systemic therapies. MATERIALS AND METHODS This retrospective, observational cohort study was conducted in patients aged ≥ 18 years with mCRC, who were initiated on triplet+bev. Data were derived from the Optum de-identified electronic health record dataset. RESULTS Of 36,056 patients, 14%, 36%, and 50% were aged 18-49, 50-64, and ≥ 65 years, respectively. During the study period (2010-2021), triplet+bev use increased in patients aged 18-49 years (1%-4%) but remained at approximately 3% and 1% in patients aged 50-64 and ≥ 65 years, respectively. Patient demographics and clinical characteristics varied slightly; of patients receiving triplet+bev (n = 921) versus nontriplet+bev (n = 35,132) most were male (57% vs. 52%), resided in the Midwest (54% vs. 49%) and Northeast (18% vs. 14%) US regions, and had secondary malignancies (86% vs. 73%). Following triplet+bev, most patients received subsequent therapies (including continued triplet component therapies; 97%) or subsequent "new" therapies (therapies that did not include any agents comprising triplet+bev; 57%), most frequently EGFR inhibitors (28%) and regorafenib (21%), with a similar trend among all age groups. CONCLUSIONS Overall, this study shows that younger patients with mCRC are more likely to receive first-line triplet+bev. These results also reveal that nonchemotherapy options are often used beyond first-line triplet chemotherapy for patients with mCRC.
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The role of preoperative FPR and FAR in prognostic evaluation of stages II and III radical colorectal cancer: A single-center retrospective study.
Yan, H, Liu, T, Yu, R, Xia, D
Medicine. 2024;(20):e38145
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Abstract
The inflammatory and nutritional states of body are 2 important causes associated with the initiation and progression of colorectal cancer (CRC). The aim of this study is to investigate the prognostic evaluation value of preoperative fibrinogen-to-prealbumin ratio (FPR) and preoperative fibrinogen-to-albumin ratio (FAR) in CRC. The clinical data of 350 stages II and III patients with CRC who received radical resection were retrospectively analyzed. All patients were followed up for 5 years to observe the overall survival and disease-free survival of 5 years and analyze the relationship between preoperative FPR and FAR and prognosis of all enrolled patients. In addition, we analyzed the diagnostic and application value of combined biomarkers. This study showed high-level preoperative FPR and FAR were significantly associated with poor overall survival and disease-free survival of stages II and III patients with CRC. The elevated preoperative FPR and FAR level was significantly related to age, tumor differentiation level, TNM stage, vascular infiltration, carcinoembryonic antigen, carbohydrate antigen199, etc. The combination of FPR, FAR, neutrophil-to-lymphocyte ratio, and carbohydrate antigen199 had the maximum area under curve (AUC = 0.856, 95% CI: 0.814-0.897, Sen = 78.20%, Spe = 82.49%, P < .05) under the receiver-operating characteristics curve. The preoperative FPR and FAR have important prognostic value and they can be used as independent prognostic marker for patients with stages II and III CRC undergoing radical resection. Moreover, the combination of biomarkers could further enhance the diagnostic and prognostic efficacy of CRC.
