Plasma Epstein-Barr virus (EBV) DNA levels predict the prognosis of extranodal NK/T-cell lymphoma, nasal type (NK/TCL), but its role in other peripheral T-cell lymphomas (PTCL) remains undetermined. This study aimed to determine the prognostic impact of plasma EBV DNA in PTCL patients.

We retrospectively enrolled 134 PTCL patients diagnosed between April 2008 and March 2022, with plasma EBV DNA data available at diagnosis in 124 patients and during post-treatment follow-up in 73 patients.

International Prognostic Index or prognostic index for T-cell lymphoma scores > 1 was associated with higher median plasma EBV DNA levels in all analyzed patients. Plasma EBV DNA positivity at the time of diagnosis was not associated with treatment response, overall survival (OS), or progression-free survival (PFS) in non-NK/TCL patients. In NK/TCL patients, an EBV DNA level < 3255 copies/mL at diagnosis was significantly associated with higher five-year PFS (64.2% vs. 16.7%, p < 0.001) and OS rates (64.4% vs. 20.8%, p < 0.001). Plasma EBV DNA positivity at the time of complete remission and during post-treatment follow-up was significantly linked to lower PFS and OS rates in NK/TCL patients. Multivariate analysis revealed that advanced-stage disease, elevated β2-microglobulin, and EBV DNA level ≥ 3255 copies/mL at diagnosis were independent predictors for OS and PFS in NK/TCL patients.

Plasma EBV DNA at diagnosis and during follow-up predict survival for NK/TCL patients but not for patients with other PTCL subtypes. Detection and monitoring of plasma EBV DNA levels at diagnosis and post-treatment follow-up for NK/TCL patients is recommended.

The evolution of hepatic hydatid cyst can be enameled with complications, mainly biliary fistula, which can be both symptomatic or occult. The aim of this study is to identify the predictive factors of occult cysto-biliary communication.

This is a retrospective study of patients operated-on for uncomplicated hepatic hydatid cyst in Farhat Hached Hospital of Sousse over a period of 10 years.

Two hundred twenty patients were operated-on for uncomplicated hydatid cyst. In univariate analysis, alkaline-phosphatase, gamma-glutamyl-transferase, alanine-transferase elevated levels and multiple type were factors associated with occult fistula, but gamma-glutamyl-transferase level was the only predictor in multivariate analysis.

These predictive factors could contribute to determine preoperative probability of occult fistula, thus indicating additional intraoperative procedures to ensure its identification.

Acute Kidney Injury (AKI) is a health problem worldwide, accounting for high hospital morbidity and mortality. There is little available information regarding the characteristics and incidence of AKI in Latin America (LA), especially in Mexico.

Systematically search the literature and perform a meta-analysis of the epidemiology of AKI in Mexico, to provide data on AKI and kidney replacement therapy (KRT) that would contribute to general knowledge in this matter.

We performed a systematic search for articles in pediatric and adult patients admitted to the general ward, Emergency Room or Intensive Care Unit published between January 1, 2000, and September 30, 2024. MEDLINE LILIACS, EMBASE and SciELO were searched, as additional reports from supplements, abstracts, and conference sessions. We performed a random-effects meta-analysis for clinically and methodologically comparable studies to estimate the frequency of AKI and KRT. We calculated pooled estimates stratified by age group, year of publication, and setting.

83 full-text articles were included. The percentage of AKI was calculated at 35% (95% CI, 28-42). Mortality for AKI adult patients was 36% (95% CI, 28-45). An overall KRT rate was 7% (95% CI, 6-9), all-cause mortality for AKI requiring KRT was 49% (95% CI, 42-56), with a global Ι2 estimated in 99.87% (p < 0.01).

AKI is common in Mexico and remains a main public health problem that needs to be addressed at every level of care. Efforts should be made to reinitiate AKI research and control in Mexico and LA.

Neonatal transportation, when done adequately, has been associated with reduced morbidity and mortality among referred neonates. In many developing countries, safe and specialized system for neonatal transportation has not been adequately considered and this has a contribution to a burden of neonatal morbidity and mortality specifically in sub-Saharan Africa. This study describes attributes of neonatal transportation services from primary to secondary health care facility in rural Tanzania and predictors of short-term outcome.

This was part of the larger study conducted in Iringa Regional Referral hospital conducted from April - June 2023 looking at neonatal mortality and associated factors. Participants were consecutively recruited into study including those who were referred from primary health care facilities across the region and whose parents or care giver provided a written consent. Data were collected by a structured questionnaire and inspection of the transportation vehicle used on arrival. Frequency tables were used to summarize the data with logistic regression performed to assess predictors of poor condition on arrival.

Most of the participants were male neonates (61.3%) weighing more than 2500 g at birth with the gestation age of 37 weeks or more (58.7%). Upon arrival, over half of the participants (53.3%) had referral notes readily available. Majority of the neonates were transported by a public ambulance (72%) but only 1.9% of these had respiratory and cardiovascular system supporting equipment. Two-third of the escorting health personnel had no training on neonatal resuscitation and essential newborn care. Neonates who traveled for over 30 min were more likely to arrive in critical condition, AOR = 6, 95%CI (1.44-18.18) compared to those who used less time.

Enhancing neonatal transportation services in rural Tanzania is crucial for specialized care and safety, ultimately impacting morbidity and mortality rates.

The use of large multi-institutional databases in rotator cuff repair (RCR) research is expanding, but these studies are observational and cannot establish causation. This study examines the prevalence of causal language in clinical RCR database studies published from 2013 to 2022.

Administrative database and clinical registry studies on RCR published in eight orthopaedic journals from 2013 to 2022 were systematically identified and graded by two reviewers for the presence, absence, or inconsistent use of causal language in both the title/abstract and the full text. Chi-squared analyses were conducted to examine if there was an association between the gradings of articles and both the journal and year of publication.

Of 44 eligible articles, 14 were graded as consistently causal, 16 as inconsistent, and 14 as consistently non-causal. Chi-squared analyses revealed no statistically significant associations between the journal or year of publication and the title and abstract grading (p = 0.626, p = 0.277) or the full text grading (p = 0.374, p = 0.822).

Causal language was present in over two-thirds of observational RCR database studies published from 2013 to 2022. Authors should refrain from using causal language in database studies to prevent misleading readers and misinterpretation of findings.

Benzodiazepine (BZD) use in older adults after acute ischemic stroke (AIS) is common. We aimed to assess the risk of falls or fall-related injuries (FRIs) in older adults after the use of BZDs during the acute poststroke recovery period.

We emulated a hypothetical randomized trial of BZD use during the acute poststroke recovery period using linked data from the Get With the Guidelines Stroke Registry and Mass General Brigham's electronic health records. Our cohort included patients aged 65 years and older with an AIS admission between 2014 and 2021, no documented previous stroke, and no BZD prescriptions in the 3 months before admission. The potential for immortal time and confounding bias was addressed separately using inverse probability weighting.

We analyzed data from 495 patients who initiated inpatient BZDs within 3 days of admission and 2,564 who did not. After standardization, the estimate was 694 events per 1,000 (95% CI 676-709) for the BZD initiation strategy and 584 events per 1,000 (95% CI 575-595) for the noninitiation strategy. Subgroup analyses showed risk differences of 142 events per 1,000 (95% CI 111-165) and 85 events per 1,000 (95% CI 64-107) for patients aged 65-74 years and 75 years and older, respectively. Risk differences were 187 events per 1,000 (95% CI 159-206) for patients with minor (NIH Stroke Severity Scale score ≤ 4) AIS and 32 events per 1,000 (95% CI 10-58) for those with moderate-to-severe AIS.

Initiating BZDs within 3 days of an AIS is associated with an elevated ten-day risk of falls or FRIs, particularly for patients aged 65-74 years and for those with mild stroke. This underscores the need for caution when initiating BZDs, especially among individuals likely to be ambulatory during the acute and subacute poststroke period.

Loneliness is prevalent currently and could result in increased dementia risks, whereas the associations of prolonged loneliness and its changes with cognitive decline and dementia remain less investigated.

Data were from the English Longitudinal Study of Ageing (ELSA) and Health and Retirement Study (HRS). Loneliness was assessed using the Revised UCLA Loneliness Scale. Health risk factors for dementia included unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations. Cognitive function was assessed using validated tests in both cohorts, with cognitive decline defined as cognitive z-scores < -1.5. Dementia was identified through self- or proxy-reported physician diagnoses. The Cox proportional hazard regression and Aalen's additive hazard regression were performed to calculate the relative and absolute risk for cognitive decline and dementia, respectively. Covariates including socio-demographic characteristics, social networks, and polygenic scores were adjusted.

Of 6721 ELSA and 10,195 HRS participants aged ≥50y, 2129 (13.7 %) and 612 (3.6 %) developed incident cognitive decline and dementia in about 10 years, respectively. Participants with severe (versus no) cumulative loneliness had 42 % and 98 % higher cognitive decline and dementia risks after pooling, corresponding to 791.6 (477.4-1105.8) and 372.8 (223.6-522.0) excess incidence densities (/105 person-years). Additionally, those who recovered from frequent loneliness (versus persistent frequent) were 9 %-31 % less likely to develop unhealthy lifestyles, depressive symptoms, chronic diseases, and functional limitations, and were at 33 % lower risks of dementia, corresponding to -248.6 (-446.0 ~ -51.2) excess incidence density.

Prolonged loneliness could increase the risks of incident cognitive decline and ADRD, while alleviating loneliness may help.

Lower limb lymphoedema, characterized by persistent swelling in the legs due to lymphatic dysfunction, not only imposes a physical burden but is also associated with significant mental depression. While emerging research suggests a strong link between lower limb lymphoedema and depression, the extent of the problem remains underexplored. This study aims to investigate the relationship between lower limb lymphoedema and mental depression through a meta-analysis of existing studies.

A comprehensive search was conducted across databases including PubMed, MEDLINE, EMBASE, International Scientific Indexing, Web of Science, and Google Scholar. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. A weighted inverse variance random-effects model was used for pooled estimates, along with subgroup analysis, heterogeneity assessment, publication bias testing, and sensitivity analysis. The prediction interval was computed to estimate where future observations may fall. The review protocol was registered in PROSPERO (CRD42024541596).

Thirteen studies involving 3503 patients with lower limb lymphoedema due to lymphatic filariasis, podoconiosis, or leprosy were included. The pooled estimate of depression related to lower limb lymphoedema was 38.4 % (95 % CI: 26.3 %, 50.5 %). High heterogeneity (I2 = 81.48 %) highlighted significant variability among the studies. Depression was more prevalent among leprosy patients (38.1 %) and podoconiosis patients (36.4 %), showing little difference between the two. However, the prevalence was notably lower among those with lymphatic filariasis (22.4 %). A higher prevalence of depression was found in Africa (39.4 %) compared to other regions (36.1 %).

Patients with lower limb lymphoedema experience disproportionately high rates of mental depression compared to the general population. Integrating mental health assessment and treatment into care packages for lymphoedema management is essential, with special attention needed for leprosy patients.

Type 2 diabetes mellitus (T2DM) and prediabetes represent a global public health concern, with increasing prevalence in developing countries. Occupational factors such as sedentary behavior and night shift work may play a significant role in their development; however, there is limited information on their impact on Latin American populations.

To determine the incidence of T2DM and prediabetes and to evaluate the association between prolonged sitting time and night shift work with glycemic changes in Peruvian workers.

A retrospective cohort study was conducted with 4200 workers evaluated between 2014 and 2021. Incidence rates of T2DM and prediabetes were calculated, and Cox regression models were used to assess the association between prolonged sitting time and night shift work with glycemic changes. The measure of association was the crude and adjusted hazard ratio (aHR), presented with its respective 95 % confidence interval (95 % CI).

The incidence of T2DM was 33.1 per 1000 person-years, and that of prediabetes was 77.11 per 1000 person-years. Sitting time (≥ 4 h/day) was associated with a higher hazard of diabetes (aHR: 2.84, 95 % CI: 1.58-5.12). Night shift work also significantly increased the hazard of diabetes (aHR: 3.24, 95 % CI: 1.97-5.35).

This study reveals a high incidence of T2DM and prediabetes among Peruvian workers, with significant associations between prolonged sitting time and night shift work with glycemic changes. The results underscore the importance of considering these occupational factors in T2DM prevention strategies. Implementing workplace prevention and early detection programs focused on reducing sedentary time and mitigating the effects of night shift work is recommended.

To explore the content, style, and initiation of medication-related discussions between nurses and patients to understand how nurses support patients with heart failure, especially those with inadequate health literacy.

A cross-sectional design was conducted to observe medication-related conversations between nurses and patients with heart failure in four Dutch outpatient clinics. Conversations were audio-recorded and analyzed using MEDICODE, focusing on content, communication style (monologue or a dialogue), and initiation of the content themes. Health literacy was assessed using the NVS-D and the SBSQ. Results between health literacy groups were compared with descriptive analyses.

A total of 56 patients and 14 nurses participated in the study. Patients classified by one or both of the instruments as having inadequate health literacy (n = 33; 59 %) were generally older, had lower educational levels, and were more often accompanied by informal caregivers. Key themes discussed in the medication-related conversations included how the medication was identified ('medication designation), its dosage and instruction, main effects, side effects, attitude or emotions and other ('various') themes. The 'medication designation' theme was significantly more frequently discussed in the group with adequate health literacy, whereas 'attitude or emotions' and 'various themes' were more commonly discussed among those with inadequate health literacy. Most conversations were nurse-initiated and tended to be monologues, with nurses mainly serving as information providers.

Nurses primarily initiated and dominated medication-related discussions with a focus on factual aspects of medication, while patients initiated more discussions about their concerns regarding medication. While there was overlap in the topics discussed, notable differences emerged between patients with adequate and inadequate health literacy.

Improving communication strategies, such as structuring conversations and adopting dialogic approaches may improve patients' engagement and understanding of medication use, leading to more effective management of their condition, particularly benefiting patients with lower health literacy.

Eosinophils have been implicated in mediating the inflammatory response after ST-elevation myocardial infarction (STEMI), but its role as a biomarker predicting major adverse cardiovascular events (MACE) remains unclear. We aimed to evaluate the predictive value of eosinophil response on 30-day and 1-year MACE post primary percutaneous coronary intervention (PCI) after STEMI.

Single centre retrospective cohort study of STEMI patients undergoing PCI. Eosinophil response was defined as the change in peripherally circulating eosinophils cell count at admission minus 48 h post primary PCI. Primary endpoints were 30-day and 1-year MACE. Receiver operating characteristic (ROC) curves were created to identify optimal cut-off predicting MACE. Multivariate logistic regression analyses were used to determine if the ROC cut-off was an independent predictor of MACE.

Of the 366 patients in this study (median age 61 years [53.0-71.0]; 267 males [73 %]), 41 patients (11.2 %) and 78 patients (21.3 %) developed MACE at 30-days and 1-year. The optimal ROC curve cut-off predicting MACE was an eosinophil response of greater than -0.05 × 10^9/L (ΔEos > -0.05). It had a sensitivity, specificity, and positive and negative predictive value of 83, 39, 6 and 98 % for 30-day MACE, and 74, 39, 19 and 88 % for 1-year MACE. An ΔEos > -0.05 change was associated with a threefold higher likelihood of MACE at 30-days (OR 3.1, 95 % CI 1.04-9.07, p=0.042), but not 1-year.

An eosinophil response of -0.05 × 10^9L at 48 h following primary PCI post STEMI is highly sensitive at predicting 30-day MACE, and in its absence, holds a high negative predictive value.

Sickle cell anemia (SCA) is the most common hemoglobinopathy in Brazil and worldwide and is part of a group of chronic genetic diseases resulting from abnormalities in the structure of hemoglobin.

To evaluate the impact of oral health conditions on the quality of life (QoL) of children and adolescents with SCA.

This is a cross-sectional study with a sample of 76 children and adolescents aged 8-14 years. For inclusion, they were required to have a diagnosis of HbSS SCA in their medical records, without a pain crisis or any dental emergency in the last three months. The children and adolescents with SCA were from Hematology and Hemotherapy Center of Maranhão. Demographic characteristics, socioeconomic status, oral hygiene, caries, malocclusion, and oral health-related quality of life (OHRQoL) were assessed. OHRQoL was assessed using the Child Perceptions Questionnaire. Descriptive statistics, Student's t and Mann-Whitney tests were performed (α = 5%).

Brown race was the most prevalent for both age groups (8-10 years-63.2% and 11-14 years-57.9%). Predominant monthly family income for both age groups was below $106. Visible plaque and gingival bleeding were higher in children aged 8-10 years. Dental caries significantly impacted the QoL of adolescents through the domain "oral symptom" (p = .031). Malocclusion significantly impacted the QoL of adolescents ("total score," p = .026; "social well-being", p = .045).

Oral health impairment negatively affected the QoL of adolescents with SCA.

How frequent and whether outcomes are worse for patients with atypical presentation in acute coronary syndrome (ACS) across the literature is not known. We conducted a systematic review of the literature on patients with ACS or acute myocardial infarction who reported whether their symptoms were atypical or typical. We determined the proportion of patients with atypical or no chest pain and used meta-analysis to evaluate predictors of atypical presentation and mortality associated with atypical presentation. A total of 43 studies were included with 1 691 401 patients (mean age: 65.4 years, 63.8% male). The proportion of patients with atypical presentation ranged from 4.6 to 74.2% while for those with no chest pain it ranged from 1.4 to 35.5%. Atypical presentation occurred in 11.6% of patients (28 studies) and no chest pain occurred in 33.6% of patients (16 studies). The three strongest factors associated with increased odds of atypical presentation or no chest pain presentation were non-ST-elevation myocardial infarction [odds ratio (OR): 2.38, 95% confidence interval (CI): 1.55-3.64], greater Killip class (OR: 2.22, 95% CI: 1.84-2.67), and prior heart failure (OR: 1.79, 95% CI: 1.76-1.82). There is a two-fold increase in odds of mortality with atypical or no chest pain presentation in ACS compared with the typical presentation (OR: 2.07, 95% CI: 1.71-2.50, I2  = 99%). Atypical presentation occurs in approximately 1 in 10 patients with ACS but can be as high as 1 in 3 in some populations. Patients who present atypically are at two-fold increased risk of mortality.

Ambient air pollution still represents a major health burden. While the link between short-term air pollution exposures and mortality has been well-documented globally, few studies have applied causal modeling approaches. Therefore, we aimed to quantify the relationship between day-to-day changes in ambient particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) and nitrogen dioxide (NO2) levels and changes in daily natural, cardiovascular (including all-cardiovascular, cardiac, and stroke), as well as respiratory mortality rates using a causal modeling framework. Daily air pollution data and cause-specific death counts at the county, district, or municipality level from California (US), Jiangsu (China), Germany, and Lazio (Italy) were obtained for the years 2015-2019, including urban and rural populations. We used interactive fixed effects models to analyze the effects of air pollutants across different lag periods (0-2, 3-7, and 0-7 days after exposure) while accounting for both measured and unmeasured time-varying spatial unit-specific confounding factors. We observed increases in daily cardiovascular deaths (per 1 million people) per a 10 μg/m3 increase in daily NO2 at lag 0-7: 0.18 (95 % confidence interval: 0.02, 0.38) in California, 0.23 (0.14, 0.32) in Jiangsu, 0.48 (0.27, 0.70) in Germany, and -0.35 (-2.63, 1.92) in Lazio. For PM2.5, the related increases in cardiovascular mortality rates were 0.00 (-0.18, 0.18) in California, 0.04 (0.00, 0.09) in Jiangsu, 0.22 (0.06, 0.37) in Germany, and 1.96 (0.76, 3.16) in Lazio. Additionally, associations were seen for natural, cardiac, stroke, and respiratory mortality, particularly pronounced among individuals aged 75 and older. These associations were strongest with prolonged exposures and remained consistent even in two-pollutant models. This study, using a causal modeling approach and including urban and rural populations, contributes to the growing body of evidence linking increases in short-term exposure to NO2 and PM2.5 with increased cause-specific mortality rates.

COVID-19 survivors may present with cognitive and psychiatric symptoms long after the acute phase of SARS-CoV-2 infection.

To determine subjective cognitive, psychiatric, and fatigue symptoms two years after COVID-19, and their change from six months to two years.

We assessed three COVID-19 patient groups of different acute disease severity (ICU-treated, ward-treated, home-isolated) concerning subjective cognitive functioning (AB Neuropsychological Assessment Schedule), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), post-traumatic stress (Impact of Event Scale 6), and fatigue (Multidimensional Fatigue Inventory) with a mailed questionnaire approximately two years after acute COVID-19. We compared the results with those obtained six months after the acute disease. We studied whether any change emerged in the scores of symptomatic patients between six- and 24-month follow-ups.

Two years post-COVID-19, 58 ICU-treated, 35 ward-treated, and 28 home-isolated patients responded to the questionnaire. Subjective cognitive symptoms and fatigue emerged as the most common problems occurring in 30.6 and 35.5% of patients, respectively. In patients with clinically significant symptoms at six months, symptom scores for depression, anxiety, and post-traumatic stress decreased at two years.

Two years after COVID-19, particularly self-reported cognitive symptoms and fatigue remained clinically significant, but also some recovery was evident in depression, anxiety, and post-traumatic stress.

The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care.

This prospective, 7-day observational study was conducted across 19 acute hospital sites within the South West Critical Care Network. All adult inpatients having a procedure under the care of an anaesthetist (excluding cardiac and obstetric procedures) had a surgical outcome risk tool score calculated retrospectively, and their postoperative destination captured. Synchronously, all critical care referrals, admissions and refusal decisions were captured, along with critical care bed capacity.

Of 2222 eligible patients, 1728 (78%) were captured. Retrospective surgical outcome risk tool score calculation revealed 1060 (61%) patients had a low, 418 (24%) a moderate and 250 (15%) a high risk of postoperative mortality. In patients with a moderate predicted risk of postoperative morbidity, 72/418 (17%) received enhanced or critical care and 64/249 (26%) patients with a high predicted risk received critical care. All critical care referral and admission activity was captured; in total, 263/680 (39%) of patients referred were admitted to critical care. Referrals to critical care exceeded the available level 3-equivalent beds on 79% of occasions.

These data describe constraints in access to postoperative and emergency enhanced/critical care in the south-west of England. There is poor compliance with national guidance regarding the postoperative care location of patients with a moderate or high risk of postoperative mortality.

Head and neck squamous cell carcinoma from unknown primary (HNSCCUP) is a rare and challenging condition. This study aimed to investigate the diagnostic pathways of suspected HNSCCUP patients in the United Kingdom.

A retrospective observational cohort study was conducted, over 5 years from January 2015, in UK Head and Neck centres of consecutive adults undergoing 18F-Fluorodeoxyglucose-PET-CT (PET-CT) within 3 months of diagnosis with metastatic cervical squamous cell carcinoma. Patients with no primary site on examination and no previous head and neck cancer were eligible.

Data for 965 patients were received from 57 centres; 68.5% were HPV-related disease. Three investigation cycles were observed: ultrasound with biopsy, cross-sectional imaging (MRI and/or CT) and PET-CT, at median times of 17, 29.5 and 46 days from referral. No primary was identified on PET-CT in 49.8% (n = 478/960). Diagnostic tonsillectomy was performed in 58.2% (n = 278/478) and tongue base mucosectomy (TBM) in 21.7% (n = 104/479). Ipsilateral tonsillectomy carried the highest diagnostic yield (18.7%, n = 52/278), followed by TBM (15.4%, n = 16/104). Contralateral tonsillectomy, performed in 49.0% (n = 234/478), carried the lowest yield (0.9%, n = 2/234). PET-CT with concurrent MRI was associated with higher primary site detection than PET-CT with concurrent CT (p = 0.003). A minority of patients undergoing treatment with curative intent received first-definitive-treatment within 62 days of referral (15.2%, n = 77/505, median 92 days, IQR: 71-117).

Most patients experienced a protracted diagnostic pathway and waited over 3 months for definitive treatment. Earlier PET-CT with concurrent MRI may expedite diagnosis. TBM appears more productive than contralateral tonsillectomy for primary site detection.

The study aimed to investigate the association between quantitative T-SPOT.TB values and the risk of incident and prevalent tuberculosis disease (TBD), identify risk factors, and evaluate test accuracy.

This retrospective cohort study followed patients tested consecutively with T-SPOT.TB at Aarhus University Hospital from 2010 to 2017, with follow-up for incident TBD through 2022. Data on demographics, comorbidities, medications, and TB status were collected from patient records and national registries. Cox proportional hazard models with restricted cubic splines assessed the risk of incident TBD (occurring ≥3 months post-test) by quantitative spot counts. Cox and log-binomial regressions identified risk factors for incident and prevalent TBD (occurring between 3 months before and after the test). Sensitivity, specificity, and predictive values assessed test accuracy. T-SPOT.TB was the index test, and microbiologically and/or clinically confirmed TBD was the reference standard.

Among 8542 individuals with complete follow-up, 59 developed incident TBD over 67 456 person-years. Among 9014 individuals tested once, 162 had prevalent TBD at the time of testing. The risk of incident TBD increased with higher spot counts, plateauing for tests with more than ten spots. The strongest risk factors for both incident and prevalent TBD were categorical T-SPOT.TB results: compared with negative tests (≤4 spots), adjusted hazard ratios for incident TBD were 5.0 (95% CI: 1.9-13.1) for borderline (5-7 spots) and 8.0 (95% CI: 4.0-15.7) for positive tests (≥8 spots). Adjusted risk ratios for prevalent TBD were 14.9 (95% CI: 7.7-28.9) for borderline and 35.6 (95% CI: 21.4-59.2) for positive tests. Sensitivities for incident and prevalent TBD were 54.0% (95% CI: 39.3-68.2%) and 78.4% (95% CI: 71.3-84.5%), respectively. Specificities were 84.8 (84.0-85.4) and 83.7 (82.9-84.4), respectively.

Incident TBD risk increases with T-SPOT.TB values but plateaus beyond 10 spots. Borderline and positive T-SPOT.TB results are strongly linked to TBD risk.

OCD symptoms are well documented in anorexia nervosa (AN) and to a lesser extent in bulimia nervosa (BN), yet remain virtually unstudied in binge-eating disorder (BED).

In this cross-sectional observational study, 5927 participants with lifetime eating disorders (EDs) (i.e., past or current) were categorized into five groups based on their diagnostic histories: AN only (n = 2330), BN only (n = 740), BED only (n = 665), AN and another ED diagnosis (AN Mixed) (n = 1293), and BN and BED (BN-BED) (n = 899). Obsessive-Compulsive Inventory-12 scores were compared across these groups and with OCD (n = 1040), anxiety-related disorders (ANX) (n = 423), and non-clinical community (NCC) (n = 1194) cohorts.

OCD symptoms were common among individuals with lifetime AN, BN, BED, and multiple EDs, with obsessing being the most prevalent dimension, followed by ordering, checking, and washing. The obsessing scale, which captures general intrusive thoughts rather than traditional OCD obsessions, was notably high. ED groups generally scored higher on the OCI-12 subscales than the ANX and NCC cohorts but lower than the OCD cohort, although ordering severity was higher in some ED groups. Positive correlations were found between ED symptoms and OCI-12 subscales, and gender-diverse individuals and men had greater OCD symptoms than women.

Clinicians should be vigilant for OCD symptoms in individuals with AN, BN, and BED. These findings call for research on the mechanisms linking EDs and OCD symptoms and support integrated treatment approaches for both conditions.

Statins are associated with liver-related adverse events, with risk varying by statin type. However, current guidelines lack specific recommendations for statin selection in acute myocardial infarction (AMI) patients with elevated liver enzymes.

This cohort study used a target trial emulation approach to include AMI patients treated with percutaneous coronary intervention between 2013 and 2022 from the Tianjin Health and Medical Data Platform, China. Eligible patients with atorvastatin or rosuvastatin prescriptions during hospitalization were matched 1:1 using propensity scores in those with elevated liver enzymes and normal liver enzymes respectively, and tracked for 1 year or until death (intention-to-treat analysis). Nonadherent patients were censored in the per-protocol analysis. The primary outcome was 1-year all-cause mortality, with secondary outcomes including recurrent MI and stroke.

In a matched cohort of 25,728 patients with elevated liver enzymes, 614 deaths (2.4%) occurred. Atorvastatin was associated with higher all-cause mortality compared to rosuvastatin (hazard ratio [HR]: 1.29, 95% confidence interval [CI] 1.10-1.51), consistent in the per-protocol analysis, and the in-hospital mortality difference was confirmed in an independent cohort. No significant differences were observed for recurrent MI (HR: 0.98, 95% CI 0.87-1.11) or stroke (HR: 1.10, 95% CI 0.93-1.28). Similar target trial emulation design among 18,270 AMI patients with normal liver enzymes at admission (9135 per group) found no significant differences between the two statins in all-cause mortality (HR: 1.09, 95% CI 0.88-1.35), recurrent MI (HR: 1.05, 95% CI 0.90-1.23), or stroke (HR: 1.07, 95% CI 0.90-1.28).

Atorvastatin treatment was associated with a higher risk of 1-year all-cause mortality than Rosuvastatin in a target trial emulation study of patients with elevated liver enzymes following AMI.

Athletes who have a history of participation in contact sports appear to subsequently experience elevated rates of neurodegenerative diseases such as dementia but have a lower incidence of cardiovascular disease and selected cancers. We quantified the occurrence of little-examined cardiometabolic and mental health outcomes, plus associated lifestyle factors, in a group of former contact sports athletes and a general population sample.

In this cohort study, male former elite athletes active between 1920 and 1965 in soccer (N=303), boxing (N=281), and wrestling (N=318) were recruited using sports yearbooks and the administrative records of sports associations. A population control group was identified using data from a compulsory medical examination (N=1712). All study members were linked to hospital registers (1970-2015) and a self-completion questionnaire was circulated in 1985.

Across 12 health outcomes, the general pattern of association was null. On the few occasions when statistically significant differences did occur, there were in fact more favourable health characteristics and behaviours in former athletes. For instance, in comparison to population controls, we found a lower prevalence of ever having smoked cigarettes in all contact sports groups (range in odds ratios (95% confidence intervals) of 0.32 (0.21, 0.48) to 0.52 (0.36, 0.75)).

In this study, male retired contact sports athletes had similar cardiometabolic and mental health profiles to those of population controls.

Although studies have explored the development of postoperative anemia after metabolic bariatric surgery, little is known about the effect of metabolic bariatric surgery on anemia recovery in patients with pre-existing anemia. Therefore, the objective of this study was to determine the prevalence of anemia recovery six months after metabolic bariatric surgery and predictors associated with recovery.

This was a retrospective cohort study of 1,664 patients with pre-existing anemia aged 18-80 years who received a primary metabolic bariatric procedure between January 2010 and June 2020. The primary outcome of interest was the percentage of patients who recovered from anemia as defined by the World Health Organization thresholds at six-months post-metabolic bariatric surgery.

Of the 1,664 patients identified with preoperative anemia, 952 (57.2%) recovered six-months post-metabolic bariatric surgery. Female sex (OR 1.93, 95% CI 1.42-2.61, p < 0.001), age between 45-54 years vs. under 35 years (OR 1.48, 95% CI 1.08-2.05, p < 0.05), and receiving sleeve gastrectomy vs. Roux-en-Y gastric bypass (OR 1.41, 95% CI 1.06-.86, p < 0.05) were associated with significantly higher odds of recovery. A preoperative hemoglobin of 11-20 g/L below normal as compared to 0-10 g/L below normal (OR 0.52, 95% CI 0.40-0.69, p < 0.001) was associated with significantly lower odds of recovering from anemia.

More than half of patients with preoperative anemia undergoing metabolic bariatric surgery recover from anemia after their procedure. Age, sex, preoperative hemoglobin, and surgery type all influence recovery. The total body weight lost after six-months post-surgery conferred no significant effect.

Narcolepsy is linked to adverse cardiovascular disease (CVD) outcomes, but few studies have examined its associations with subclinical CVD, including in children. We assessed the relationship between narcolepsy and subclinical CVD outcomes, including hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis.

We conducted a retrospective cohort study using MarketScan Commercial and Medicare Supplemental databases from January 1, 2005 to December 31, 2021. Patients included N=22 293 diagnosed with narcolepsy (NT1 and NT2) and N=63 709 propensity-score-matched without. Patients with narcolepsy were identified as those with ≥2 outpatient insurance claims for narcolepsy (type 1 or type 2) within a 1-year interval with 1 claim being nondiagnostic. Main outcomes were diagnosis of hypertension, hyperlipidemia, diabetes, and nonalcoholic fatty liver disease/nonalcoholic steatohepatitis following index date, as well as a composite measure for CVD and major adverse cardiovascular events. Compared with propensity-score-matched patients without narcolepsy, patients with narcolepsy had an increased risk for hypertension (hazard ratio [HR], 1.40 [95% CI, 1.34-1.47]), hyperlipidemia (HR, 1.41 [95% CI, 1.35-1.47]), diabetes (HR, 1.50 [95% CI, 1.38-1.64), nonalcoholic fatty liver disease/nonalcoholic steatohepatitis (HR, 1.48 [95% CI, 1.28-1.73]), CVD composite (HR,1.61 [95% CI, 1.35-1.47]), and major adverse cardiovascular events (HR,1.69 [95% CI, 1.43-2.00]). Results remained significant following adjustment for narcolepsy medications including stimulants, wake-promoting agents, and oxybates. Results stratified by age groups showed similar findings, including heightened risk for those <25 years old.

Narcolepsy is associated with greater risk of subclinical CVD even in patients as early as childhood. Detection of these outcomes early in the course of narcolepsy could help reduce the burden of adverse cardiovascular events later in life.

Ustekinumab (UST) is commonly used to treat Crohn's disease and ulcerative colitis. However, some patients may experience diminishing response or require increased dosage. Intravenous (IV) UST maintenance is explored as a solution.

We sought to evaluate IV UST maintenance effectiveness and safety in inflammatory bowel disease patients with partial or lost subcutaneous UST response.

This was a multicenter retrospective study of inflammatory bowel disease patients on IV UST maintenance. Clinical response and remission at weeks 12 and 52, defined as Harvey-Bradshaw Index ≤4 for Crohn's disease or partial Mayo score ≤2 for ulcerative colitis. Objective markers reduction (fecal calprotectin, C-reactive protein), UST trough levels pre- and post-IV maintenance, and adverse events were assessed.

A total of 59 patients were included. Clinical remission at weeks 12 and 52 achieved by 47.5% and 64.3% respectively. 96.6% continued IV UST at follow-up. UST serum levels quadrupled. No adverse events reported.

IV UST maintenance effectively sustained remission in most patients at 52 weeks.

Temporal bone fractures (TBFs) can result in long-term adverse outcomes including meningitis, facial nerve disorders (FNDs), and hearing loss (HL) that may require surgical intervention. This epidemiologic study aims to examine the sequelae of adult TBF with HL, including the utilization of cochlear implantation (CI), using data from a large, multinational database.

Using the TriNetX database, a retrospective cohort study was performed of adults (≥ 18 years) using ICD10 codes for other fractures of the base of the skull and hearing loss, an approximation of TBF with hearing loss. A control group of adults without TBF was used. Measured outcomes included meningitis, CI, FND, cerebrospinal fluid (CSF) leak, and labyrinthitis. Propensity score matching (1:1) was used for cohorts smaller than 33,333,333. Ninety-five percent of patient data used was from 2006 to 2023.

Adults with TBF and HL (n = 34,878) had a greater risk of meningitis any time after TBF than those without TBF (n = 105,035,185) (RR: 6.65, 95% CI: 5.74-7.70). Labyrinthitis (RR: 3.56, 95% CI: 2.86-4.41), CSF leak (RR: 40.71, 95% CI: 37.91-43.71), and FND (RR: 12.08, 95% CI: 11.62-12.55) were more common after TBF. CI was more common after TBF (RR: 26.22, 95% CI: 22.12-31.07). Meningitis after TBF was associated with an increased risk of CSF leak (RR: 3.0, 95% CI: 1.52-5.93) compared to those without meningitis.

Adults who sustain TBFs resulting in HL have an increased risk of developing meningitis, labyrinthitis, CSF leak, and FND and are more likely to undergo CI for aural rehabilitation compared to a control cohort.

Level IV.

Previous studies reported a predisposition to major adverse cardiovascular or cerebrovascular events (MACCE) in patients consuming cannabis, which might be exacerbated by interventional or surgical procedures. This study investigated the association of nonmedical cannabis use with MACCE after interventional procedures or surgery.

288,923 adult patients undergoing noncardiac surgery between 2008 and 2020 at a tertiary academic hospital in Massachusetts, United States, were included. The exposure was nonmedical use of cannabis, differentiated into ongoing self-reported recreational use or a diagnosis of cannabis use disorder. The primary outcome was MACCE, defined as ischemic stroke, cardiac arrest, acute heart failure, myocardial infarction, or revascularization within 1 year.

Patients with a diagnosis of cannabis use disorder had a higher risk of MACCE (adjusted odds ratio 1.26; 95%CI 1.05-1.51; p = .02). For recreational users, this was dependent on the patient's baseline cardiac risk, based on the revised cardiac risk index (RCRI) class: among patients at high cardiac risk (RCRI class III/IV), recreational cannabis use was associated with increased risk (adjusted odds ratio 1.41; 1.15-1.74; p = .001), while there was no association among patients with a low RCRI class (I/II; adjusted odds ratio 0.87; 0.75-1.02; p = .09).

Patients with a diagnosed cannabis use disorder are at increased risk of post-procedural MACCE, while for recreational users, this association was dependent on patients' baseline cardiac risk.

This study demonstrates the association between cannabis use and MACCE differentiated by type of use and depending on baseline cardiac risk.

Amongst the main perspectives when evaluating the results of medical studies are statistical significance (following formal statistical testing) and clinical significance. While statistical significance shows that a factor's observed effect on the study results is unlikely (for a given alpha) to be due to chance, effect size shows that the factor's effect is substantial enough to be clinically useful. The essence of statistical significance is "negative" - that the effect of a factor under study probably did not happen by chance. In contrast, effect size and clinical significance evaluate whether a clinically "positive" effect of a factor is effective and cost-effective. Medical diagnoses and treatments should never be based on the results of a single study. Results from numerous well-designed studies performed in different circumstances are needed, focusing on the magnitude of the effects observed and their relevance to the medical matters being studied rather than on the p-values. This paper discusses statistical inference and its relevance to clinical importance of quantitative testing in clinical laboratories. To achieve this, we first pose questions focusing on fundamental statistical concepts and their relationship to clinical significance. The paper also aims to provide examples of using the methodological approaches of superiority, equivalence, non-inferiority, and inferiority studies in clinical laboratories, which can be used in evidence-based decision-making processes for laboratory professionals.

The purpose of this study is to compare short-term outcomes and 1-year incisional hernia rates between intracorporeal anastomosis (IA) and extracorporeal anastomosis (EA) in laparoscopic right hemicolectomy for management of right-sided colonic cancer. The primary outcome was the complication rate assessed by the comprehensive complication index (CCI). Secondary outcomes included time to bowel movement, length of hospital stay, 30-day readmission rate, early warning scores, and 1-year incisional hernia rate.

This was a single-center, prospective cohort study. Patients with right-sided colonic cancer eligible for laparoscopic surgery with primary anastomosis were consecutively included. Patients included in the first period underwent EA, while those in the second underwent IA. Clinical data were collected during the hospital admission up to 30 days postoperatively. Complications were evaluated by the CCI. A routine 1-year CT-scan was used to assess hernias.

One hundred three patients (51 in the EA and 52 in the IA groups) were included. Demographics were similar between the two groups. No significant difference in the CCI-score was found (EA: 17.9 (23.9) vs. IA: 15.0 (17.4), p = 0.85). The mean length of hospital stay was significantly shorter in the IA group (EA 6.6 days, IA 3.9 days, p = 0.02). The groups had no significant differences regarding other outcomes, including hernia rates (p = 0.12).

Laparoscopic right hemicolectomy with IA significantly reduced the length of hospital stay without increasing complication rates compared to EA.

The study is registered at ClinicalTrials.gov (NCT05039762).

The association between moderate-to-vigorous physical activity (MVPA) with depression are clear but needs to be investigated considering dynamic changes in MVPA. We investigated the association of longitudinal changes in MVPA with depression-related outcomes among depressed and non-depressed participants. From 209,095 depressed and 3,777,173 non-depressed participants of South Korea, MVPA was assessed from health screenings during period 1 (2014-15) and 2 (2016-17) using self-reported questionnaires. Participants were followed up from January 1, 2018 to 1-year and 3-year for any diagnosis of depression. Adjusted odds ratio (aOR) and 95 % confidence interval (CI) were calculated using multivariable-adjusted logistic regression analysis. From depressed participants, consistently highly active participants showed the lowest odds for incident depression (aOR 0.81; 95 % CI 0.70-0.95), while those who increased MVPA showed the lowest odds for depressive symptom (aOR 0.77; 95 % CI 0.72-0.82). When combining MVPA status during period 0 (2012-13) for the longitudinal analysis, the participant with depression at period 1 showed a lower odds if they maintained to be physically active before and after depression diagnosis (from period 0 to period 2). We found epidemiologic evidence that longitudinal evaluation for MVPA from pre-depression state may be important on analyzing depression-related risk.

To describe the post-marketing safety profile of respiratory syncytial virus prefusion F (RSVpreF) vaccine among pregnant individuals.

This study analysed adverse event (AE) reports submitted to the U.S. Food and Drug Administration's Vaccine Adverse Event Reporting System (VAERS) database following RSVpreF immunisation from 1 September 2023 to 23 February 2024.

VAERS, as a national spontaneous vaccine safety surveillance system, provides insights into the safety profile of the RSVpreF vaccine in a real-world setting.

Surveillance data included all AE reports submitted to VAERS in pregnant individuals following vaccination.

Receipt of RSVpreF vaccine among pregnant individuals in the USA.

Descriptive statistics were used to assess all AE reports with RSVpreF, including frequency, gestational age at vaccination, time to AE onset, reported outcomes and proportion of serious reports. Data mining techniques were employed to identify disproportionate reporting of RSVpreF-event pairs. Reports of preterm births were clinically reviewed.

VAERS received 77 reports pertaining to RSVpreF vaccination in pregnant individuals, with 42 (54.55%) classified as serious. The most frequently reported non-pregnancy-specific AEs were headache, injection site erythema and injection site pain. For pregnancy-specific AEs, preterm birth was the most frequently reported (12.8%), followed by AE terms such as preterm premature rupture of membranes and caesarean section (each at 3.3%), and cervical dilatation, haemorrhage during pregnancy and uterine contractions during pregnancy (each at 1.4%). Our disproportionality analysis indicated signals for various AEs, particularly preterm birth, indicating that reports of preterm birth in conjunction with RSVpreF vaccination were observed more frequently than statistically expected. Most of the reported preterm births were moderate to late, occurring between 32 and less than 37 weeks of gestation. The median time from immunisation to the onset of preterm birth was 3 days, with two-thirds of cases reported within a week of vaccination.

The AEs reported to VAERS among pregnant individuals vaccinated with RSVpreF largely aligned with the safety profile observed in prelicensure studies; however, this analysis also highlights the previously observed safety signal for preterm birth. Active surveillance studies focusing on maternal and perinatal outcomes are needed to further evaluate this signal and guide future clinical recommendations.

Musculoskeletal pain is the biggest contributor to burden of disease, causing excessive use of pain-relief medication. Non-pharmaceutical measures are called on for handling this burden. Guidelines recommend physical activity as an effective non-pharmaceutical measure. However, it is unknown if occupational physical activity has the same preventive effects on redeeming pain-relief medication as when performed during leisure-time ("The Physical Activity Paradox"). We aimed to investigate if the paradox contributes to the redemption of prescribed pain relief-medication. 24-h device-measured physical activity data [sitting, standing, light physical activity, moderate-to-vigorous physical activity (MVPA) and time in bed)] were collected from 824 workers using a thigh-worn accelerometer during work and leisure-time. Redeemed pain-relief prescribed medication was retrieved from the Danish National Prescription Registry during a 4-year follow-up. The prospective association between occupational and leisure-time physical activity and number of redeemed pain-relief prescribed medication was analyzed using a generalized linear model, adjusted for potential confounders. During follow-up, 53% of the workers redeemed a pain-relief medication. In leisure-time, 30 min more of MVPA per day were associated with 23% lower risk (RR = 0.77; 95% CI 0.64 - 0.94) of redeeming pain-relief medication. In contrast, occupational physical activity was not associated with the risk of redeeming pain-relief medication [RR = 1.04 (95% CI 0.89 - 1.20)]. Leisure-time MVPA was associated with lower risk of redeeming pain-relief medication, while no beneficial association was found for occupational MVPA. These findings support the paradox that the domain of physical activity is important for redeeming pain-relief medication. PERSPECTIVE: Leisure-time MVPA differs from occupational MVPA in its association with redeeming pain-relief medication. Increasing leisure-time MVPA may serve as an effective non-pharmacological strategy to reduce pain-relief medication redemption. These findings could potentially inform guidelines for managing musculoskeletal pain, highlighting the need to differentiate between occupational and leisure-time physical activity.

To maintain good standards of care, evaluations of policy interventions or potential improvements to care are required. A number of quality of life (QoL) measures could be used but there is little evidence for England as to which measures would be appropriate. Using data from a pilot Minimum Data Set (MDS) for care home residents from the Developing resources And minimum dataset for Care Homes' Adoption (DACHA) study, we assessed the discriminant construct validity of QoL measures, using hypothesis testing to assess the factors associated with QoL.

Care home records for 679 residents aged over 65 from 34 care homes were available that had been linked to health records and care home provider data. In addition to data on demographics, level of needs and impairment, proxy report measures of social care-, capability- and health-related QoL of participants were completed (ASCOT-Proxy-Resident, ICECAP-O, EQ-5D-5L Proxy 2). Discriminant construct validity was assessed through testing hypotheses developed from previous research and QoL measure constructs. Multilevel regression models were analysed to understand how QoL was influenced by personal characteristics (e.g. sex, levels of functional and cognitive ability), care home level factors (type of home, level of quality) and resident use of health services (potentially avoidable emergency hospital admissions). Multiple imputation was used to address missing data.

All three QoL measures had acceptable construct validity and captured different aspects of QoL, indicated by different factors explaining variation in each measure. All three measures were negatively associated with levels of cognitive impairment, whilst ICECAP-O and EQ-5D-5L Proxy 2 were negatively associated with low levels of functional ability. ASCOT-Proxy-Resident was positively associated with aspects of quality and care effectiveness at both resident- and care home-level.

The study found acceptable construct validity for ASCOT-Proxy-Resident, ICECAP-O and EQ-5D-5L Proxy 2 in care homes, with findings suggesting the three are complementary measures based on different constructs. The study has also provided evidence to support the inclusion of these QoL measures in any future MDS.

To compare the risk of incident dementia in patients prescribed either an anticholinergic medication or mirabegron.

This was a retrospective cohort study of patients treated for OAB with pharmacotherapy between the years 2012 and 2023, using data from the TrinetX Research Collaborative Network. Patients who were diagnosed with OAB who were prescribed Mirabegron, Oxybutynin, Tolterodine, Darifenacin, Trospium, Fesoterodine, or Solifenacin after 1/1/2012 were identified. Anticholinergic medications were stratified into high-risk (Oxybutynin, Tolterodine, and Solifenacin) and low-risk (Darifenacin, Trospium and Fesoterodine) Patients with OAB who were not prescribed medications were included as a control group. The primary outcome was incidence of dementia occurring after initiation of pharmacotherapy or entry into the study (for the control group). Using Cox proportional hazard analyses, and adjusting for age and sex and adjusting for Elixhauser comorbidity index, anticholinergic burden score, and the average treatment effect, the risk of each medication on incident dementia was determined.

A total of 941,402 met inclusion for the final analysis, with 83,550 prescribed any medication. With an average follow-up time of 4.3 years, the only medication not found to be associated with an increased risk of dementia in any group was fesoterodine, while mirabegron was found to have a significant association with dementia across all age groups for both sexes.

Most anticholinergic medications and mirabegron are associated with an increased risk of dementia compared to untreated controls with OAB, while fesoterodine was not found to be associated with an increased risk in any group.

Dual-energy CT (DECT) provides several novel methods to assess thrombus perviousness. We aimed to evaluate whether the novel thrombus perviousness measured with DECT is associated with improved recanalisation and better functional outcomes in acute ischaemic stroke (AIS) patients with endovascular thrombectomy (EVT).

108 AIS patients with middle cerebral artery occlusion who underwent DECT angiography on admission and received EVT treatment between April 2020 and September 2023 were retrospectively analysed. Thrombus attenuation increase (TAI) was evaluated on routine CT angiography and non-contrast CT, and DECT quantitative parameters of thrombus, including iodine concentration (IC) and normalised IC (NIC) were measured. Multivariable logistic regression analysis was used to evaluate the association of thrombus characteristics with arterial occlusive lesion scale and 90-day modified Rankin Scale.

NIC was significantly associated with successful recanalisation (OR 1.372 (95% CI 1.194 to 1.625); p<0.001) and good functional outcome (OR 1.252 (95% CI 1.114 to 1.446); p<0.001). NIC yielded higher performance, with area under curve (AUC) of 0.789 and 0.740, in the prediction of recanalisation and functional outcome than TAI (AUCs=0.635 and 0.592). Compared with low-level NIC thrombus, high-level NIC was associated with 11.4 and 15.4 times higher likelihood of successful recanalisation and good functional outcome. Moreover, NIC was a significant indicator to differentiate large artery atherosclerosis from cardioembolism stroke with high specificity and positive predictive value.

Higher DECT-derived NIC is associated with increased odds of successful recanalisation and good functional outcome for EVT patients, and it yielded higher prediction performance than TAI.

Ethnicity may play a significant role in determining surgical outcomes. This study examines the disease profiles across ethnic groups and investigates whether ethnicity influences the risk of complications following bariatric surgery.

Data from the United Kingdom's National Bariatric Surgery Registry (NBSR) were analysed, encompassing all adult patients undergoing bariatric procedures. Comparative analyses were performed, and a multivariable regression model was developed to identify factors associated with postoperative complications.

A total of 77,710 (78.8% female) patients were included in the analysis, with a median age of 46 (IQR 37-55) years. Most patients were Caucasian (91.6%), followed by Asian (4.1%), Afro-Caribbean (2.5%), and African (1.7%) groups. Afro-Caribbean patients had the highest median BMI (44.5 kg/m2) and the highest prevalence of hypertension (43.2%), while Asian patients were younger (median age 41 years) and had a higher prevalence of diabetes mellitus (29.1%). African and Afro-Caribbean patients were less likely to self-fund their procedures (14.9% and 10.6%, respectively) compared to Caucasians (25.9%). Complication rates were the highest among Afro-Caribbean patients (5.8 vs 4.8%, p < 0.001) compared to Caucasians. Multivariable regression analysis identified ethnicity as an independent predictor of postoperative complications, with Afro-Caribbean (OR 1.47, 95% CI 1.22-1.87, p < 0.001) and African (OR 1.34, 95% CI 1.05-1.70, p = 0.019) patients demonstrating significantly increased risks.

This registry analysis identified ethnic disparities in disease profiles and postoperative outcomes among bariatric surgery patients in the UK, underscoring the need for targeted health policies to improve outcomes in these vulnerable populations.

Diabetes camps for children and adolescents living with Type 1 Diabetes (T1D) offer an important opportunity to foster self-efficacy and 'common humanity', a sense that they are not alone in their challenges. The current study primarily aimed to assess whether psychological wellbeing, diabetes self care behaviours and HbA1c improved amongst campers and their caregivers, and whether these would be sustained at 3- and 6-months.

Children and adolescents aged 7-13 years who attended the 2023 diabetes camp in Auckland, Aotearoa New Zealand and one of their caregivers were invited to participate. Campers and caregivers were assessed at camp enrolment and then at 1-week, 3-months and 6-months post-camp. Guided by the Theoretical Framework of Acceptability, optional qualitative interviews were also used to explore campers' experiences of camp.

Of the 31 children and adolescents who attended the 2023 camp, 27 (87%) participated in the study with a caregiver. Campers showed reduced feelings of isolation (p = 0.036) and overidentification (p = 0.036) 6 months. Caregivers demonstrated overall improvements in self-efficacy (p = 0.034), caregiver distress and burden (p = 0.006) and caregiver quality of life (p = 0.039). Qualitative findings confirmed high acceptability, with participants reporting positive camp experiences.

Diabetes camps can improve caregivers' self-efficacy, diabetes distress and quality of life, and reduce feelings of isolation and overidentification among campers. Future work is needed to promote cultural inclusivity within camps and improve their accessibility, to be able to optimise the wellbeing of all children and adolescents living with T1D and their families.

Various factors and motivations linked to higher education dynamics can impact professional training, academic involvement, student well-being, and dropout. Knowledge of these factors enables the adoption of more appropriate strategies to promote student retention.

Identification of potential motivations for dropping out of university and the relationship with symptoms of depression, anxiety and stress among undergraduate nursing students.

A cross-sectional study was carried out with 179 undergraduate nursing students at a public university in northeastern Brazil. Students who were actively enrolled were included and those who were on withdrawal/leave of absence from university were excluded. Data was collected using the following instruments: Sociodemographic questionnaire; Scale of Reasons for Dropping Out of Higher Education and Depression, Anxiety and Stress Scale.

The variables linked to students' mental health were associated with the motivational domains for dropping out. Among students with depressive symptoms, they were almost 3.5 times more likely to drop out of university for reasons related to 'Academic performance' (3.448); while for anxiety and stress, the chances of dropping out related to 'Lack of support' increased by 3.85 and 3.2 times, respectively.

Indicators of student mental health are significantly related to motivations for dropping out of university. It is hoped that this study will broaden the understanding of this phenomenon, from a multifactorial perspective, and will be a driving force behind the planning of integrated actions to improve the well-being and retention of students.