Introduction Comparative long-term outcomes of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in younger patients remain incompletely defined, particularly beyond early follow-up. This study evaluated short-, mid-, and long-term outcomes between TAVR and SAVR in patients aged 50 to 65 years using a multicenter retrospective cohort. Methods Patients with aortic stenosis aged 50-65 years undergoing TAVR or SAVR were identified using the TriNetX database. Patients were matched 1:1 using propensity score matching (PSM). Outcomes were assessed at 30 days, 1 year, and 5 years. The primary endpoint was a composite of all-cause mortality or stroke; secondary endpoints included hospitalization, major bleeding, acute kidney injury (AKI), cardiogenic shock, and valve dysfunction. Hazard ratios (HRs) with 95% confidence intervals (CIs) were used to estimate the overall effect size. Results PSM yielded 1,041 well-balanced pairs. At 30 days, TAVR was associated with a lower risk of the primary composite endpoint (3.0% vs. 5.6%; HR 0.53; 95% CI 0.34-0.82; p=0.004), all-cause mortality (HR 0.50; p=0.03), major bleeding (HR 0.29; p<0.001), AKI (HR 0.39; p<0.001), and cardiogenic shock (HR 0.28; p<0.001). At 1 year, the composite endpoint, mortality, and stroke did not differ significantly between groups; major bleeding remained lower with TAVR (HR 0.50; p<0.001). At 5 years, TAVR was associated with higher risks of the primary composite endpoint (18.6% vs. 15.5%; HR 1.27; 95% CI 1.03-1.57; p=0.02) and all-cause mortality (13.7% vs. 8.3%; HR 1.81; 95% CI 1.39-2.37; p<0.001), while major bleeding remained lower (HR 0.65; p<0.001). Conclusion TAVR demonstrated early safety but a higher long-term risk of mortality and composite adverse outcomes at 5 years compared with SAVR.
Extracranial carotid artery aneurysms (ECAAs) are exceedingly rare in children, with only a limited number of cases reported worldwide. Surgical reconstruction in infancy poses unique challenges owing to vascular fragility and the need for long-term growth compatibility. We report the case of a 1-year-old boy with a large right ECAA who was treated with graft-free internal-to-external carotid artery (ICA-to-ECA) transposition. The aneurysm was completely resected, the proximal ICA was ligated, and the distal ICA was anastomosed adjacent to the ECA. Microsurgical reconstruction was performed under temporary clipping, with an occlusion time of 22 min. Postoperative angiography confirmed excellent flow through the transposed vessel. Serial imaging over a 13-year follow-up period demonstrated persistent patency without stenosis or proportional diameter growth of the reconstructed ICA, with no neurological complications or ischemic events. The anastomotic segment enlarged proportionally to the patient's cervical growth, indicating successful long-term biological integration. This case represents one of the longest documented follow-ups of pediatric ECAA reconstruction using native arterial tissues. Direct ICA-to-ECA transposition provides a durable, infection-free, and growth-adaptive solution superior to prosthetic or vein graft repair. This outcome underscores the central tenet of pediatric neurosurgery: surgical innovation must harmonize with a child's lifelong development.
Mastery of cellular morphology interpretation is fundamental to the professional growth of clinical laboratory physicians. Conventional morphology training has limitations, while digital platforms have their own challenges. There is an urgent need to balance the benefits of traditional and online learning to optimize morphology training. This 12-year longitudinal predictive modeling study used a mixed-methods design. It involved 301 medical professionals from the First Affiliated Hospital of Harbin Medical University, with 244 remaining after applying exclusion criteria. Participants received traditional classroom training and online learning. A pre-training survey was used to stratify participants in 2024. Competency was assessed via a 100-item digital image bank, and multivariate logistic regression and nomogram construction were performed for analysis. The results showed that online learning, professional experience, professional title, and age significantly predicted morphological test scores. Early-career practitioners preferred online modules and performed better digitally, while senior staff showed a strong preference for traditional workshops. After implementing a personalized training program in 2024 based on career-stage preferences, there was a significant improvement in morphology examination scores, with a 6.90-point mean elevation. The program also reduced the incidence of subthreshold performance by 63.19% and optimized resource utilization, reducing training hours by 52.2% and teaching space by 50%. This study validates the importance of aligning training methods with career stage-specific cognitive variations and technological adaptability. It provides a practical prediction tool for cultivating morphological expertise, advancing medical morphology pedagogy in the digital age.
The Streptococcus anginosus group (SAG) is emerging as a significant cause of invasive infections, yet data from Vietnam remain scarce. This study characterized the clinical features and outcomes of SAG infections in Ho Chi Minh City. We retrospectively reviewed patients with culture-confirmed SAG infections at the Hospital for Tropical Diseases (January 2017-August 2023). Demographics, clinical, and microbiological data were analyzed. A total of 82 patients (mean age 50.6 ± 16.8 years; 64.6% male) with culture-confirmed SAG infections were included. Comorbidities were present in 56.1% of patients, with diabetes mellitus being the most common (23.2%). S. anginosus was the most frequently isolated species (43.9%), followed by S. constellatus (34.1%) and S. intermedius (22.0%). Bacteremia (35.4%) and intra-abdominal infections (31.7%, mainly hepatic abscesses) were the predominant clinical presentations. Polymicrobial infections occurred in 14.6% of cases, primarily among patients with bacteremia and skin or soft tissue infections. All isolates remained susceptible to ceftriaxone and vancomycin, and 94.3% to ampicillin, but susceptibilities were lower to penicillin (84.3%), erythromycin (65.7%), clindamycin (54.3%), and tetracycline (54.3%). Despite a 92.7% cure rate, 19.5% required drainage procedures, and the 28-day mortality rate was 6.1%. In this cohort, SAG infection most often present as occult bacteremia or hepatobiliary abscess, frequently in patients with comorbidities, but not restricted to immunocompromised hosts. Empirical β-lactam therapy (ampicillin or ceftriaxone) remains appropriate, although rising penicillin and macrolide resistance and the 15% polymicrobial rate, may warrant broader initial coverage when deep soft-tissue foci are suspected.
暂无摘要（点击查看详情）
Adiposity has been reported to be a major contributor to earlier pubertal timing, but most pediatric studies have relied on body mass index (BMI) from single or short-term measurements. Studies tracking growth repeatedly from birth to puberty are needed. To explore the association of growth trajectory and cumulative exposure to different levels of adiposity (CEA) with pubertal onset across the first decade of life and identify sensitive periods for possible weight intervention. This population-based cohort study included data from 2 birth cohorts: the Longitudinal Study of Australian Children (LSAC), conducted from March 2004 to September 2021, with more than a 10-year follow-up, and the Tianjin Birth Cohort Study (TBCS) in China, conducted from May 2021 to April 2024, with follow-up from December 2010 to April 2024. Data analysis was conducted from April 2023 to November 2025. Participant inclusion required at least 4 anthropometric measures in the LSAC and 9 in the TBCS and completed measures of pubertal onset in both cohorts. Prepubertal BMI trajectories, CEA, and rates of BMI increase at each age. Pubertal status and timing were obtained by a parent-reported Pubertal Development Scale. A latent class growth mixed model was used to identify prepubertal BMI trajectories. An interval regression model and the Cox proportional hazards regression model were used to examine the association of the exposures with the age and risk of pubertal onset. A total of 3354 Australian children (1723 boys [51.37%]) and 1105 Chinese children (563 girls [50.95%]) were included. At the last round, the mean (SD) ages were similar across sexes within each cohort, while children in LSAC (14.83 [0.61] years) were overall older than those in TBCS (10.63 [0.60] years). Girls in BMI trajectory groups characterized as high-level or increasing were younger at pubertal onset (from β = -0.36 [95% CI, -0.66 to -0.07] years to β = -1.51 [95% CI, -2.68 to -0.35] years) and were associated with increased risk of pubertal initiation (from hazard ratio [HR], 1.35 [95% CI, 1.04 to 1.74] to HR, 2.80 [95% CI, 1.69 to 4.63]). A higher CEA and average CEA (both >2) were associated with an earlier age at pubertal onset (from β = -0.04 [95% CI, -0.05 to -0.03] years to β = -0.85 [95% CI, -1.48 to -0.23] years), with a greater effect size after averaging. Consistent results were found in boys of the LSAC but not those of the TBCS. Sensitive ages of 3 to 4 years were identified, at which BMI increase was associated with pubertal timing, with greater effect sizes of pubertal timing (from β = -1.35 [95% CI, -2.00 to -0.71] years to β = -3.41 [95% CI, -4.13 to -2.68] years) and greater risk of pubertal onset (from HR, 1.85 [95% CI, 1.29 to 2.67] to HR, 5.59 [95% CI, 3.73 to 8.37]) than at other ages. Notably, the effect sizes of CEA within this period were greater than that outside it. In this cohort study, high-level or increasing prepubertal growth trajectories and greater CEA were associated with earlier and higher risk of pubertal onset. These findings highlight the importance of considering CEA in relation to early pubertal onset and suggest that ages 3 to 4 years may be an important intervention period for earlier pubertal onset monitoring.
Retrospective cohort study. To compare rates of revision fusion after posterior cervical foraminotomy, anterior cervical decompression and fusion, and total disc replacement for radiculopathy. Cervical radiculopathy is one of the most common conditions in the US. Surgical treatment typically involves a single-level anterior cervical decompression and fusion (ACDF). However, the posterior cervical foraminotomy (PCF) and the total disc replacement (TDR) have become popular options. Few studies have reviewed how rates of subsequent revision surgery differ between the three procedures. The TriNetX Global Collaborative Network database was queried using ICD-10 and CPT codes to identify adult patients (≥ 18 years old) diagnosed with cervical radiculopathy who underwent single-level ACDF, TDR, or PCF within the past 20 years. Propensity score matching (1:1) was performed and rates of revision ACDF were evaluated at 1-year and 3-year post-operatively. At 1-year post-operatively, ACDF (RR 0.63, P = 0.017) had lower risk for subsequent ACDF versus PCF. Foraminotomy had a higher risk for subsequent ACDF compared with index TDR (RR 2.56, P < 0.001). Similar outcomes were seen at 3-years post-operatively. Patients with an index ACDF had a significantly higher risk at 3-year versus TDR (RR = 1.68, P = 0.027), and a non-significant elevated risk of implant-related complication at both 1-year (RR = 1.3, P = 0.45), and 3-year (RR = 1.39, P = 0.28) versus TDR. TDR tended to have the lowest risk of subsequent ACDF and implant failure at both 1-year and 3-year, while PCF had the highest risk of subsequent ACDF compared with both the index ACDF and index TDR group. IV.
Endogenous venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism (PE), is considered a rare event in pediatric patients, and its health care implications are largely unstudied. However, its burden on the health care system may be disproportionately higher owing to age-specific risk factors. To evaluate and characterize the inpatient cohort of children and adolescents with VTE and PE. This nationwide cohort study used data on inpatient cases of VTE in Germany (data source: Federal Bureau of Statistics DESTATIS) from 2020 to 2024. Cases younger than 20 years with VTE as the main or secondary diagnosis, as well as a subcohort with PE as the main diagnosis, were analyzed regarding risk profiles, inpatient care, and outcomes stratified by sex and age. Hospital-based incidence of VTE (VTE cases per 10 000 inpatient cases per year) and in-hospital mortality. This study identified 14 108 pediatric inpatient cases of VTE (mean [SD] age, 9.0 [7.3] years; 7201 male [51.0%]), corresponding to a hospital-based incidence of 15.3 per 10 000 pediatric cases per year. A total of 3311 patients with VTE (23.5%), comprising 1361 of 6907 female patients (19.7%) and 1950 of 7201 male patients (27.1%), were infants younger than 1 year. Risk factors for VTE varied, as rates of infection, chronic organ failure, and congenital diseases decreased with increasing patient age, while cancer was most commonly diagnosed among cases aged 5 to 14 years, and thrombophilia remained a relatively constant risk factor across all age groups. PE occurred in 1564 VTE cases (11.1%); among cases whose main diagnosis was PE, 624 of 888 (70.3%) were female. The in-hospital mortality rate in the VTE cohort was 3.7% (522 of 14 108); mortality risk was significantly increased among infants aged 4 years or younger (OR, 3.52 [95% CI, 2.73-4.57]; P < .001). This cohort study found a marked inpatient health care and economic burden for VTE among children and adolescents. Mortality risk was significantly increased among infants younger than 1 year. Studies are needed to provide evidence-based support for the safety and effectiveness of medical interventions for children and adolescents with VTE.
Whether hepatitis B surface antigen (HBsAg) seroclearance provides further clinical benefit over complete viral suppression in nucleos(t)ide analogue (NA)-treated chronic hepatitis B (CHB) patients with cirrhosis remained unclear. We aimed to compare the risk of hepatocellular carcinoma (HCC) and hepatic decompensation in treated cirrhotic patients with complete viral suppression versus HBsAg seroclearance. All adult patients with CHB and cirrhosis receiving entecavir/tenofovir between January 2005 and September 2020 were identified. Patients with HCC before or within the first 6 months of baseline, other cancers or liver transplantation before baseline, liver transplantation before HBsAg loss, and without complete viral suppression were excluded. One-year landmark analyses were performed; patients with clinical outcomes or follow-up <1 year were excluded. Of 5,149 patients (mean age 60.1±12.6 years, 66.3% male) included in the one-year landmark analysis, 456/4,988 (9.1%) and 5/161 (3.1%) of patients with complete viral suppression alone and HBsAg seroclearance developed HCC respectively at a median (25th -75th percentile) follow-up of 4.1 (2.5-5.0) years; 334/4,777 (7.0%) and 10/153 (6.5%) patients with complete viral suppression and HBsAg loss developed hepatic events. HBsAg seroclearance was associated with a lower risk of HCC (adjusted subdistribution hazard ratio [asHR] 0.37, 95%CI 0.15-0.91, p=0.030) but not hepatic events (asHR 1.01, 95%CI 0.52-1.95), than complete viral suppression. Similar results on HCC were observed in two-year landmark analysis (asHR 0.37 [0.14-1.04]). HBsAg seroclearance is associated with a lower risk of HCC but not first/further hepatic decompensation in NA-treated CHB cirrhotic patients with complete viral suppression.
What are the trends and developments in preimplantation genetic testing (PGT) in 2019-2021 as compared to previous years? The main trend observed in the 22nd to 24th datasets on PGT is that the implementation of trophectoderm biopsy with comprehensive whole-genome testing is most often applied for PGT for aneuploidies (PGT-A) and concurrent PGT-M/SR/A, while for PGT for monogenic disorders (PGT-M) and PGT for chromosomal structural rearrangements (PGT-SR), single-cell targeted testing with PCR and FISH still prevails. Since it was established in 1997, the PGT Consortium within the European Society for Human Reproduction (ESHRE) has been collecting and analysing data from mainly European PGT centres. To date, 21 datasets and an overview of the first 10 years of data collections have been published. The data for PGT analyses performed between 1 January 2019 and 31 December 2021 with a 2-year follow-up, after analysis were provided by participating centres on a voluntary basis. Data were collected using an online platform; the data reported on a per genetic analysis basis as opposed to the former cycle-based database. Data on biopsy methods, diagnostic technologies, genetic diseases, and clinical outcomes were submitted by 45 centres. Records with multiple PGT-M and/or PGT-SR analyses or inconsistent PGT data were excluded. Embryo transfers performed within 2 years of analysis were included to calculate clinical outcomes, including stratification by biopsy day and cumulative pregnancy rates. Data analysis, calculations, and preparation of figures and tables were carried out by expert co-authors. A total of 14 731 PGT analyses were reported: 3782 for PGT-M, 874 for PGT-SR, 8492 for PGT-A, and 1583 for combined PGT-M/SR with PGT-A, henceforth referred to as combined testing. The use of trophectoderm biopsy increased for PGT-M (33% in 2018 to 49% in 2019-2021), remained stable for PGT-SR (33-36%), and was consistently high for PGT-A (98%) and combined cases (96%). The adoption of genome-wide or targeted technologies following whole-genome amplification (WGA) remained relatively stable for PGT-M (12-14%) and PGT-SR (44-45%), while genome-wide analysis performed on whole-genome-amplified DNA became the standard for PGT-A (99%). The combination of PGT-M/SR with PGT-A was performed either by applying a technology following WGA (74%) or by targeted methods (PCR or FISH, 24%). Diagnostic efficiency was 87% for PGT-M, 92% for PGT-SR, 98% for PGT-A, and 90% for combined testing. Pregnancy rates per embryo transfer were 26% for PGT-M, 26% for PGT-SR, 35% for PGT-A, and 36% for combined testing. Across all groups, Day 5 biopsies yielded better outcomes than Day 3 or Day 6 biopsies. The findings refer to data submitted by 45 participating centres and do not reflect global trends in PGT. Information on the health of babies born following PGT was not included in this manuscript. It should also be noted that final outcomes may be influenced by the number and type of centres submitting data in different years. The Consortium datasets provide a valuable resource for monitoring trends in PGT practice, both from a technological perspective and in terms of clinical outcomes. The study has no external funding, and all costs are covered by ESHRE. There are no competing interests declared. NA.
Polycythemia vera (PV) is a myeloproliferative neoplasm frequently complicated by thromboembolic events. However, data regarding thrombotic burden and long-term outcomes among Asian patients remain limited. We conducted a retrospective cohort study at a tertiary referral center to evaluate thromboembolic events, treatment-related complications, disease progression, and overall survival in patients with PV. A total of 133 patients were included, with a median age of 61 years (range 18-88). Most patients were male (60.2%). Fifty-one patients (38.3%) experienced at least one thromboembolic event, with 54 events in total, of which 87% occurred before or at PV diagnosis. Arterial thrombosis accounted for 90.7% of all events. Age ≥60 years was significantly associated with thromboembolic events, with an odds ratio of 2.34 (95% confidence interval [CI], 1.07-5.11). After a median follow-up of 7.7 years, the 5-year overall survival was 82.7% (95% CI, 74.61-88.35). Prior thrombosis was associated with an increased risk of death (hazard ratio, 1.98; 95% CI, 1.15-3.42). Hydroxyurea resistance or intolerance occurred in 9.8% of patients. Bleeding complications were observed in 6.8%, including major bleeding in 4.5%. Fibrotic transformation, leukemic transformation, and secondary solid malignancies occurred in 4.5%, 3.8%, and 6.0% of patients, respectively. Thromboembolic events were common and predominantly arterial in this Asian PV cohort, occurring mainly before or at diagnosis. Prior thrombosis was associated with inferior survival. Long-term follow-up also revealed disease progression and secondary solid malignancies, underscoring the importance of continued surveillance.
Retrospective multicenter registry. To establish a multidimensional definition of surgical success in ASD surgery and evaluate achievement rates across diverse patient subgroups. Adult spinal deformity (ASD) encompasses diverse deformity types, disability levels, and treatment options. Optimal surgery aims in part to improve function, reduce radicular pain, and minimize revisions. Despite some studies considering combined outcomes, comprehensive multifactorial evaluation remains limited. Success was assessed across disability (2-year ODI ≤20 or ∆ODI >14), radicular pain (NRS Leg ≤3 or ∆NRS Leg >3), and reoperation (no mechanical/neurologic revision). Patients were categorized by preoperative high disability (ODI >40) and/or high pain (NRS Leg >5). Individual and composite success rates were compared across preoperative deficits and deformity types. Satisfaction and treatment repetition willingness were analyzed by success achievement. Of 1,504 patients, 1,084 (71.9%) completed 2-year follow-up (median age 64 years, 75.4% female, 50.7% prior surgery). Median preoperative scores: ODI 44, NRS Back 8, NRS Leg 5. Preoperatively, 40.7% had combined high disability and pain, 21.6% high disability only, 13.5% high pain only, and 20.2% neither. At 2 years, success rates were 60.9% for disability, 64.8% for leg pain, 81.2% for revision avoidance, and 40.5% composite. Composite success was highest without preoperative deficits (59.4%), intermediate with isolated deficits (38.0% high disability, 43.8% high pain), and lowest with combined deficits (32.2%). Severe coronal deformities achieved highest composite success (51.7%) versus 32.0%-41.3% for other types. Composite success strongly correlated with satisfaction (87.2%) and willingness to repeat treatment (94.4%). Success in ASD surgery should reflect both improvement and final outcomes. Composite success measures provide more comprehensive surgical assessment than single metrics. By identifying patient characteristics associated with higher success rates, this framework informs evidence-based patient selection, enables realistic preoperative counseling, and guides outcome-driven surgical planning.
Long-term alendronate use has been associated with tendinopathies and ligament disorders that may result in chronic pain and functional impairment. Platelet-rich plasma (PRP) therapy has emerged as a regenerative treatment option for chronic tendinopathies by promoting tissue healing and improving pain and function. A 61-year-old woman with an athletic lifestyle took alendronate for 14 years for osteopenia before she stopped taking it. Nine years later, she reported chronic right hamstring complex pain and loss of function after sustaining a lifting injury. She underwent conservative therapy, including stretching exercises and physical therapy and had an evaluation by an orthopedic surgeon. Her pain and function did not improve. She was referred to an interventional pain management physician who diagnosed her with chronic semimembranosus tendinopathy. She was initially treated with a 3-injection series of 12.5% dextrose prolotherapy which did not provide lasting pain relief nor lasting functional improvement. Her treatment was then changed to a holistic regimen of ultrasound-guided leukocyte-poor platelet-rich plasma injections, a post platelet-rich plasma physical therapy program, and acupuncture. This holistic treatment program enabled her to attain 90%-95% pain relief and a significantly improved functional status and quality of life. Platelet-rich plasma injection therapy is an evolving area in Medicine. It holds much promise for those in need of musculoskeletal repair, pain relief and improved function without the need for surgery or chronic use of medications. Much work remains to be done in developing more standardization of platelet-rich plasma therapy, but medical specialists are moving in the right direction as we become more sophisticated and attune in studying, understanding and implementing the potential that platelet-rich plasma injection therapy holds for healing. Incorporation of leukocyte-poor platelet-rich plasma using holistic treatment of chronic semimembranosus tendinopathy associated with chronic use of alendronate was much more effective for pain reduction and restoration of function as compared to only more conservative therapies of physical therapy, stretching exercises, acupuncture, and dextrose prolotherapy.
Hypertrophic cardiomyopathy (HCM) is a heritable cardiac disorder characterized by increased left ventricular (LV) wall thickness, often leading to heart failure (HF). HF represents a significant burden and is a challenging condition to diagnose in individuals with HCM. Cardiovascular magnetic resonance (CMR) imaging provides detailed insights into cardiac assessment, but its role in predicting new onset of HF symptoms in patients with HCM remains unknown. This study aimed to identify CMR predictors associated with the development of HF symptoms in individuals with HCM. This study was a single center retrospective cohort study that included HCM patients treated at a tertiary referral center in the United States who underwent at least 1 CMR exam, had no HF symptoms at baseline CMR and had a minimum follow-up period of 1 year. Clinical data were collected by review of electronic medical records from 1998-2018. CMR data were collected by analysis of CMR images by blinded expert cardiac radiologist. The primary outcome was new onset of HF symptoms defined as NYHA class ≥ II at follow up. Kaplan-Meier analyses, and univariate and multivariate Cox proportional hazard analyses were performed. Of 1,462 patients diagnosed with HCM who had at least 1 CMR, 276 HCM patients without HF symptoms at baseline were included in the study cohort. Average age at CMR was 52.7 ± 17.7 years and 93 (33.3%) were female. Median maximum left ventricular wall thickness was 19 mm (IQR 17-22) with a median LV ejection fraction of 71% (IQR 66-77). Late gadolinium enhancement (LGE) was detected in 150 (56.2%) patients (60.7% had mild; 30.7% moderate; 8.6% severe). During a median follow-up period of 6.3 years, 93 patients developed HF symptoms (NYHA class II in 56 (60.2%); class III in 31 (33.3%); and class IV in 6 (6.5%). Multivariable analysis adjusted for age showed that LA enlargement (HR 1.626; 95% CI 1.01-2.62; p=0.045) and LV mass index (HR 1.014; 95% CI 1.007-1.022; p= <0.001) at initial CMR along with sex (HR 1.7; 95% CI 1.074-2.691; p=0.023) were independent predictors of new onset of HF symptoms in patients with HCM. Conclusions Nearly half of the patients with HCM developed HF symptoms within 6.3 years. Left atrial enlargement, LV mass index, and sex were independent predictors of new onset of HF symptoms in HCM patients. These findings emphasize the value of CMR in HF risk assessment, in providing insights in management and improving outcomes in patients with HCM.
Patients with impaired glucose tolerance (IGT) identified during pregnancy who do not develop gestational diabetes mellitus (GDM) often do not receive additional interventions for their long-term metabolic risks. This nonrandomized pre-post implementation study reports the design process and initial program evaluation for Better Follow-up of Impaired Glucose Tolerance (BRIDGE), a 12-week text-based postpartum support program promoting hemoglobin A1c (HbA1c) completion and primary care provider (PCP) visit scheduling for patients diagnosed with IGT during pregnancy, assessing improvement in desired postpartum transition milestones. The 19-month program was divided into 2 arms lasting 9.5 months each, BRIDGE- (SMS text messaging support alone; October 2021-July 2022) and BRIDGE+ (SMS text messaging and IGT-focused postpartum visit; July 2022-April 2023). We aimed to assess whether BRIDGE improved desired postpartum transition milestones. Patients were eligible for BRIDGE if they received prenatal care at the study site (a northeastern US academic tertiary care center), were diagnosed with IGT during pregnancy, never developed GDM, and could receive English text messages. We performed a program evaluation using a pre/postimplementation design, comparing outcomes for the BRIDGE population to a 19-month historical population. Primary outcomes were (1) completion of HbA1c testing by 1 year postpartum and (2) PCP visit scheduling by 12 weeks postpartum. A comparative analysis between BRIDGE- and BRIDGE+ was performed. Multivariable logistic regressions controlled for the history of IGT after stepwise backward elimination. In the program evaluation, 503 individuals were included (n=342 in historical population, n=82 in BRIDGE- population, and n=79 in BRIDGE+ population), with similar demographic and clinical characteristics across populations. A total of 212 individuals were screened for eligibility in BRIDGE, and 161 individuals participated in the program. BRIDGE participants had increased odds of HbA1c completion by 1 year postpartum (39.8% vs 12.5%; adjusted odds ratio [aOR] 4.28, 95% CI 2.71-6.78) and PCP visit scheduling (31.0% vs 12.0%; aOR 9.58, 95% CI 4.39-20.9) compared to the historical population. BRIDGE+ patients were more likely to complete HbA1c testing by 12 weeks postpartum than BRIDGE- participants. Most patients attended scheduled PCP visits, but rates of IGT counseling at PCP visits were low. Individuals with IGT rarely receive targeted interventions during pregnancy or delivery hospitalization. This innovative study demonstrates that individuals with IGT have high rates of uptake for postpartum SMS text messaging support, which tripled completion rates of HbA1c screening within 1 year postpartum and doubled the scheduling rate for PCP visits by 12 weeks postpartum. While attendance at scheduled PCP visits was very high, <60% of PCP visits included IGT counseling, highlighting key improvement areas in the quality of postpartum transitions to primary care. While a randomized trial is needed to ascertain definitive impact, SMS text messaging support may be an effective tool to improve postpartum transitions of care for this underserved population.
The geriatric nutritional risk index (GNRI) is an indicator of nutritional status and predicts overall survival (OS) in patients with myeloma. A low GNRI score indicates malnutrition associated with venous thromboembolism (VTE). This retrospective study aimed to investigate the clinical relevance of GNRI in VTE in patients with myeloma. We reviewed the medical records of 357 patients who were newly diagnosed with myeloma and treated with proteasome inhibitors and/or immunomodulatory drugs. VTE included deep vein thrombosis and pulmonary embolism diagnosed using imaging studies. The cutoff value for the GNRI was 92, according to previous studies. The median age of the patients was 71 years. The 1-year cumulative incidence of VTE was 4.9%. The median time from diagnosis to VTE was 2.8 months (range, 0.1-86.8 months). A low GNRI was associated with a high incidence of VTE (hazard ratio [HR], 3.885; P < 0.001). During a median follow-up of 37.8 months, OS was significantly shorter in patients with low GNRI scores and those who developed VTE within 1 year than in those with high GNRI scores who did not develop VTE (log-rank test, P < 0.001 and P = 0.047, respectively). Multivariate analysis revealed that low GNRI (HR, 1.562; P = 0.050) and VTE within 1 year (HR, 3.470; P = 0.017) were associated with shorter OS. A low GNRI score is associated with a high incidence of VTE in patients with myeloma. The GNRI and VTE within 1 year were associated with mortality.
The global burden of cutaneous melanoma (CM) remains substantial, yet its temporal trends and relationships with ultraviolet radiation (UVR) and socioeconomic context remain incompletely understood. Global Burden of Disease Study data from 1990 to 2021 were analyzed using Joinpoint regression, mixed-effects models, and time-lagged random forest models to assess CM burden and its associations with MODIS-derived UVR and gross domestic product (GDP). A UVR-enhanced ARIMA-X model projected burden to 2032. CM burden showed marked spatiotemporal heterogeneity. Age-standardized incidence was highest in Australasia (47.71 per 100,000) and lowest in Sub-Saharan Africa. Male mortality exceeded female mortality by 26%, with the largest increases among adults aged ≥70 years. UVR was positively associated with CM incidence (β  =  0.001, P = 0.038). Time-lagged analysis showed a biphasic UVR pattern, with predictive contribution peaking at 18.2% at an 11-year lag. GDP per capita showed an inverse association with CM incidence (β = -0.200, P = 0.040), but this finding should be interpreted as a contextual population-level association. By 2032, mortality and incidence are projected to decline by 1.2% and 1.6%, respectively, whereas prevalence and DALYs are projected to rise. Global CM burden remains heterogeneous and is positively associated with ambient UVR, with the strongest predictive contribution at an 11-year lag. Socioeconomic associations should be interpreted cautiously. UVR-oriented prevention, early detection, and context-specific strategies remain essential.
Stress fractures affect military personnel at higher rates than the general population. They can lead to serious injury and negatively impact military force readiness. Most prior studies have focused on recruits undergoing basic training. Our goal was to characterize stress fractures over the full spectrum of military career stages to identify whether fracture locations varied by career length. A retrospective chart review was conducted of a 3-year period (January 1, 2017-December 31, 2019) to identify active duty military patients in the National Capital Region diagnosed with a new stress fracture. Patients were stratified by career length: New Recruit (<12 months of service), Early-Career (1-5 years of service), Mid-Career (5-14 years of service), and Late-Career (>14 years of service). The percentage of fractures at each anatomic location was reported and compared by binary career length (New Recruit vs. others) with Chi-square or Fisher's exact tests performed among the full cohort. The total cohort was stratified by sex, and the analysis was repeated separately in males and females. The percentage of patients who presented with multiple fractures was similarly reported and compared by career length, among the full cohort and by sex strata. The study was approved by the Walter Reed National Military Medical Center Institutional Review Board, protocol # WRNMMC-2018-0162. The study population included 446 military members with 537 total fractures. Percentages of femoral neck (11.1% vs. 3.6%, P = .001), femoral shaft (8.1% vs. 1.8%, P = .001) and pelvis fractures (3.8% vs. 0.7%, P = .031) were greater in the New Recruit group compared to the other career-length groups. Percentage of foot fractures was lower (19.2% vs. 34.3%, P < .001) in the New Recruit group vs. the other career-length groups. Percentage of patients presenting with multiple stress fractures (23.7% vs. 10.1%, P < .001) was greater in the New Recruit group vs. the other career-length groups. The significant differences in femoral shaft and foot fractures persisted when males and females were analyzed separately. Our findings support that the distribution of the anatomic locations of stress fractures differs between military members in the New Recruit period versus later in their careers. Specifically, New Recruits had a higher percentage of femoral neck, femoral shaft, and pelvic fractures. Providers may consider having a lower threshold for imaging new recruits with hip pain as this could identify a stress reaction before it becomes a stress fracture. Potential explanations for the findings include sex, training intensity, and force attrition. Some of the significant findings persisted when males and females were analyzed separately, which supports that there are contributions from other factors than patient's sex. Additional studies are needed to build upon these findings. Limitations included the use of ICD-10 codes and physician reporting to identify stress fractures, the lower numbers of patients once the total study population was stratified by sex, unavailability of bone density data, and unclear generalizability of the findings.
Upper gastrointestinal (GI) disorders-including gastroesophageal reflux disorder, peptic ulcer disease, and gastritis-are common with aging, yet their contribution to frailty burden and progression is poorly understood. This study investigated whether upper GI disorders are independently associated with frailty in the Baltimore Longitudinal Study of Aging. We analyzed data from 1,353 participants (mean age 65.6 years; 47.7% men) with documented upper GI disorder status and frailty index (FI). Cross-sectional associations were examined using linear regression adjusted for age, sex, race, education, body mass index, and smoking. Longitudinal trajectories of FI were analyzed in a subset with ≥3 follow-up visits (n = 749) using linear mixed-effects models. Sensitivity analyses were conducted after excluding participants whose diagnosis occurred more than one year before FI assessment and for older adults. Upper GI disorders were significantly associated with higher frailty burden in cross-sectional analyses(β =  0.0303, p = 1.13 × 10-11). Older age, higher body mass index, and lower educational attainment were also associated with higher FI. Longitudinal analyses further demonstrated that upper GI disorders were a significant predictor of FI throughout the follow-up period(β =  0.018, p = 4.3 × 10-9). However, the rate of frailty progression did not differ significantly between participants with and without GI disorders. Associations remained robust in all sensitivity analyses. Upper GI disorders were associated with higher frailty burden and greater degree of frailty that persisted over time, independent of covariates. Further research may be needed to explore the specific mechanisms through which upper GI disorders influence frailty.