Single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and one-anastomosis gastric bypass (OAGB) are increasingly used bariatric procedures, but high-quality comparative evidence remains limited. To compare 1-year efficacy and safety outcomes of SADI-S and OAGB as primary bariatric procedures in patients with severe obesity. Secondary care bariatric surgery center. This was a single-center, prospective, randomized, single-blind controlled trial. Ninety-nine patients aged 18-65 years with body mass index (BMI) 45-50 kg/m2 were enrolled between 2023 and 2024; 90 underwent surgery (43 SADI-S; 47 OAGB). Patients were randomly assigned (1:1) using a computer-generated sequence. The primary outcome was excess weight loss (EWL) at 1 year. The secondary outcomes included total weight loss (TWL), BMI, late complications (>30 days), comorbidity resolution, nutritional deficiencies, and quality of life. At 1 year, no significant differences were observed between groups in EWL (84.34% vs 79.61%; P = .209), TWL (35.85% vs 33.02%; P = .075), or BMI (27.93 vs 28.92 kg/m2; P = .168). Comorbidity resolution rates were comparable. Nutritional deficiencies were infrequent (7.3% vs 4.3%; P = .878), with all cases related to iron deficiency. Late complications were significantly more frequent after OAGB (35.4% vs 7.1%; P = .0003), mainly related to bile reflux and managed conservatively or endoscopically. SADI-S was associated with fewer complications but included two cases requiring surgical reintervention. One death occurred in the SADI-S group and was not directly attributable to the procedure. Quality of life improved similarly in both groups. SADI-S and OAGB achieved comparable weight loss and metabolic outcomes at 1 year in patients with BMI 45-50 kg/m2 but showed distinct complication profiles. OAGB was associated with a higher rate of bile reflux-related events, whereas SADI-S had fewer but more severe complications. These findings support an individualized approach to procedure selection. Longer-term follow-up is required.
w?>Bipolar disorder (BD) is associated with reduced life expectancy, but it is unknown if this extends into later life or if older-age bipolar disorder (OABD) represents a survival cohort. In this prospective cohort study, 227 adults aged ≥50 years with BD from the Dutch Older Bipolars (DOBi) study were compared with 681 matched (on age and sex) controls (CG) from the Longitudinal Aging Study Amsterdam (LASA). All-cause mortality was assessed over 8 years. Kaplan-Meier survival, restricted mean survival time, and Cox proportional hazards models were applied. In total, 37 (16.3%) OABD and 138 (20.3%) CG participants died during the 8-year follow-up. Kaplan-Meier curves indicated earlier mortality in OABD. Restricted mean survival time over 7.5 years was 2500.7 days (95% confidence interval [CI] 2419.9-2581.5) in OABD and 2607.2 days (95% CI 2572.3-2642.0) in CG, corresponding to an average survival difference of 106.4 days (3.5 months; 95% CI 18.4-194.5; p = 0.018). In Cox models, OABD was associated with higher mortality risk compared with CG (hazard ratio (HR) = 1.72; 95% CI 1.17-2.54; p = 0.006). In this longitudinal cohort study, OABD had significantly higher all-cause mortality than age- and sex-matched population controls, with a shorter restricted mean survival time and an increased hazard of death over 8 years. Thus, excess mortality persists into later life, and OABD is not solely a survivor cohort. Targeted strategies addressing modifiable physical health and lifestyle risk factors are warranted to reduce premature mortality in this vulnerable population.
Surgical pulmonary valve replacement (SPVR) is the standard therapy for native or patched right ventricular outflow tract (nRVOT) dysfunction. Transcatheter pulmonary valve replacement (TPVR) has emerged as a less invasive alternative, but comparative data are lacking. To compare clinical outcomes and valve performance between TPVR and SPVR in patients with nRVOT dysfunction. Patients with nRVOT dysfunction undergoing TPVR or SPVR were retrospectively identified. TPVR cases were propensity score-matched 1:2 to SPVR. The primary outcome was freedom from all-cause mortality, prosthetic valve endocarditis, or valve-related reintervention. Among 176 patients, 123 (41 TPVR, 82 SPVR) were matched. At 3 years, freedom from the primary outcome was 95.2% for TPVR and 91.5% for SPVR (HR 0.68; 95% CI 0.14-3.29; p = 0.63). TPVR had fewer major in-hospital complications (4.9% vs 18.3%; p = 0.04) and shorter ICU and hospital stays (0.3 ± 0.8 vs 4.8 ± 6.9 days, and 3.1 ± 3.0 vs 12.9 ± 14.6 days; both p < 0.001). Mean gradients were consistently lower with TPVR post-procedure (8.0 vs 9.9 mmHg; p = 0.02), at 1 year (7.9 vs 10.6 mmHg; p = 0.02), and at 3 years (8.4 vs 11.0 mmHg; p = 0.03). Pulmonary regurgitation remained comparable, with most patients having none or mild regurgitation at 3 years (90.0% vs 94.5%; p = 0.22). In the first propensity score-matched comparison of TPVR and SPVR in nRVOT dysfunction, TPVR demonstrated comparable 3-year clinical outcomes, fewer major in-hospital complications, shorter hospital stay, and more favorable valve hemodynamic performance. These findings support TPVR as an effective, less invasive alternative, although longer-term outcomes warrant further study.
Longitudinal studies investigating the relationship between oxidative stress and sarcopenia remain limited. In this study, we aimed to investigate whether oxidative stress, measured using the derivatives of reactive oxygen metabolites (d-ROMs) test, could independently predict progression to sarcopenia in community-dwelling older adults and determine clinically relevant cutoff values for risk stratification. This longitudinal cohort analysis included 200 participants aged ≥60 years followed-up for of >5 years. Sarcopenia was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Participants were classified into a preserved group and declined group (those who developed sarcopenia or presarcopenia during follow-up). Between-group comparisons were conducted, and multivariate logistic regression analysis was performed to identify independent risk factors for sarcopenia progression. Receiver operating characteristic (ROC) curve analysis was applied to determine the optimal cutoff values of oxidative stress markers. Over a mean follow-up of 5.9 years, 51 participants (25.5%) progressed to sarcopenia or presarcopenia. The declined group was significantly older than the preserved group (68.9 vs. 67.1 years; P = 0.029) and demonstrated significantly higher baseline d-ROM levels (357.6 vs. 315.9 U.CARR; P = 0.005), while other blood biomarkers showed no significant differences. Multivariate logistic regression analysis identified elevated d-ROMs as an independent risk factor for sarcopenia progression, with a 2.33-fold increased risk per 50 U.CARR increase (95% confidence interval, 1.37-4.27; P = 0.003). ROC analysis revealed that a d-ROMs cutoff value of 335.0 U.CARR best predicted progression, with an area under the curve of 0.691. Elevated oxidative stress was independently associated with progression to sarcopenia in community-dwelling older adults, suggesting that oxidative stress assessment using d-ROMs may help identify individuals at increased risk and support strategies aimed at reducing reactive oxygen species burden as a potential approach for sarcopenia prevention and future research.
Adult rectal trauma management has shifted away from fecal diversion, distal rectal washout (DRW) and presacral drainage (PSD) towards primary repair alone, but there is scarce data on children. This study aims to assess the nationwide management of pediatric rectal trauma, its outcomes, and the impacts of the surgical techniques described. Retrospective review of the ACS-TQIP database 2017-2020. Children with rectal injuries (rectal-AIS≥2) were included. Operative management included trans-anal repair (TAnR), transabdominal repair (TAbR), diverting colostomy (DC), DRW, PSD, and resection (LAR); endoscopy (Endo) was assessed as a predominantly diagnostic procedure. Outcomes included infectious complications, unplanned return to OR, unplanned ICU admission, mortality, and length-of-stay (LOS). Multivariate binary logistic regression analyses were performed to identify independent predictors of DC, and the effect of surgical techniques on outcomes. 641 children were included. Mean age was 11±5 years, 62% were male, 65% were blunt injuries, and median ISS was 8 (IQR 4-16). Concomitant injuries included pelvic fracture (21%), small bowel (15%), and colon (15%). Overall, 43% of patients underwent operative intervention, while 31% underwent diagnostic endoscopy. Outcomes were: 2% infectious complications; 3% unplanned return to OR; 1% unplanned ICU admission; 3% mortality; 4 [2-8] days LOS. Higher rectal AIS was the only predictor of DC. Age 6-12 years (lower odds) and higher rectal AIS (higher odds) were independently associated with the composite adverse outcome. This is the largest cohort study of pediatric rectal trauma to date. The majority (57%) were managed non-operatively, consistent with a contemporary practice pattern of selective operative management. When surgery was pursued, primary repair was much more common than fecal diversion, DRW or PSD. The surgical technique was not independently associated with outcomes after adjusting for confounders.
To evaluate radiographic and clinical outcomes following joint-preserving surgery using a modified L-reverse osteotomy for grade II hallux rigidus, with a minimum 5-year follow-up. A retrospective review of a prospectively collected cohort treated between 2015 and 2017 was performed. Radiographic assessment included first metatarsal length, declination angle, elevation distance and first metatarsophalangeal joint space width. Clinical outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOxFQ). Fifty-one patients were included. At 3 months, first metatarsal length decreased by 5.9 mm, declination angle increased by 3.3º, and elevation distance decreased by 2.4 mm (all p < 0.001). These changes remained stable at final follow-up. Median MOxFQ score improved from 42.4 to 16.9 (p < 0.001). Three patients required revision surgery. Joint-preserving surgery using a modified L-reverse osteotomy provided radiographic correction and clinical improvement. Maintenance of postoperative decompression and alignment correction may contribute to outcomes in moderate hallux rigidus. III.
Dynamic DNA methylation differences between epitypes throughout the annual cycle, circannual clocks affect methylation levels, stable methylation marks in the promoters of 30 candidate genes, embryo-adult transmission of methylation marks. DNA methylation can change DNA properties, affecting chromatin accessibility, gene expression, and phenotypic variation. In clonal Norway spruce, warmer (WE) versus cooler (CE) embryogenic conditions produce phenotypically different trees. This climatic memory, induced during embryogenesis, remains stable in the resulting epitype trees, and the epigenetically altered timing of bud phenology persists between WE and CE epitypes even after decades under common garden conditions. We examined DNA methylation patterns in 14-year-old epitypes throughout the annual developmental cycle. Using targeted bisulfite sequencing, we screened for differential DNA methylation over a 3000 bp region in 2744 genes related to the epigenetic machinery, circadian clock, and phenology. Clustering DNA methylation differences in the CG context clearly separated epitype trees, confirming epigenetic mark differences. Differences in methylation of cytosines in all contexts were highly dynamic and varied markedly among annual developmental stages, suggesting the existence of circannual clocks affecting methylation levels in the studied genomic regions. Most stable methylation marks were identified in CG contexts, fewer in CHG and none in CHH contexts, consistent with differences in inheritance among methylation contexts. We identified stable CG and CHG methylation marks in the promoter regions of 30 specific genes. Two ARGONAUTE genes and 4 other genes exhibited stable marks across all time points for CE or WE, and putative embryo-adult transmission for some genes. These findings indicate that DNA methylation marks maintained in genomic regions throughout the annual cycle may contribute to an induced epigenetic memory established in embryos and later manifested as phenologically different epitype trees.
Complex regional pain syndrome is a rare but disabling post-traumatic pain condition in which delayed recognition and fragmented care may contribute to chronicity. In 2020, a structured fast-track pathway was implemented at a Swiss tertiary hospital to support recognition, early management, and specialist referral. This retrospective cohort study with a historical control group (pre-pathway: 2015-2019; post-pathway: 2020-2023) included adults referred to an outpatient pain clinic with suspected or confirmed disease. The pathway combined standardised screening, early guideline-based treatment initiated by non-pain specialists, and predefined escalation to specialist pain care. The primary outcome was the time from inciting event to first pain clinic consultation; secondary outcomes included time to first documented clinical features, time to first documented suspicion or diagnosis, and clinician-adjudicated improvement at 12 months. Among 3,797 screened records, 179 patients met inclusion criteria (73 pre-pathway, 106 post-pathway). Median time to pain clinic consultation was shorter post-pathway than pre-pathway (165 vs 438 days; P<0.001). At 12 months, 59 of 95 post-pathway patients (62.1%) and 25 of 65 pre-pathway patients (38.5%) were classified as improved (risk difference 23.6%, 95% confidence interval 7.9-37.8; P=0.003). Longer disease duration was associated with lower odds of improvement (adjusted odds ratio per month 0.97, 95% confidence interval 0.95-0.99), with a non-linear association across disease duration. These findings support referral delay as a clinically relevant timing factor in the care of complex regional pain syndrome that health systems can act on. PERSPECTIVE: In this retrospective cohort, a structured fast-track pathway for suspected complex regional pain syndrome was associated with shorter referral latency and higher clinician-adjudicated improvement at 12 months. Longer disease duration was independently associated with lower improvement odds, consistent with a narrowing therapeutic window that health systems can act on.
Nicotine use after bariatric surgery can lead to serious complications. Although smoking cessation prior to surgery is often mandatory, the incidence and risk factors for smoking relapse postsurgery are not well understood. To determine the incidence of smoking relapse 1 year after bariatric surgery and to identify patient, clinical, and smoking-related risk factors for relapse. Statewide quality improvement collaborative of academic and community hospitals, Michigan, United States. Using a statewide bariatric-specific data registry, we conducted a retrospective review of 15,421 former smokers who underwent bariatric surgery between 2014 and 2023. Smoking status was assessed via 1-year follow-up survey; of 28,720 eligible former smokers, 15,421 (53.7%) responded and comprised the analytic cohort. Multivariable logistic regression identified independent risk factors for smoking relapse. The cohort had a mean age of 46.5 years and was predominantly female (80.4%). Sleeve gastrectomy was the most common procedure (81.0%). At 1 year, 7.4% of patients reported resuming smoking. The strongest predictor of relapse was quitting smoking within 1 year before surgery (adjusted odds ratio [aOR]: 14.55; 95% confidence interval [CI]: 8.28-25.56). Uninsured status/self-pay (aOR: 9.25; 95% CI: 1.34-63.77). Additional tobacco product use (aOR: 2.17; 95% CI: 1.07-4.39) and greater number of pack-years (aOR: 1.02 per pack-year; 95% CI: 1.01-1.04) were also associated with higher risk of relapse. More recent surgery was linked to lower odds of relapse (aOR: .75 per year; 95% CI: .64-.88). Nonresponders were younger and more likely to have recently quit and be uninsured, suggesting 7.4% is a lower bound on the true rate. Despite smoking cessation prior to bariatric surgery, 7.4% of patients resumed smoking at 1 year. Shorter duration of smoking cessation before surgery, multiple tobacco product use, and uninsured status increased risk. Identifying at-risk patients may guide targeted postoperative support and improve long-term outcomes.
Prognostic staging systems in transthyretin amyloid (ATTR) cardiomyopathy were developed before the introduction of disease-modifying treatment. We therefore evaluated contemporary risk stratification according to different staging systems in patients with ATTR cardiomyopathy. All patients with newly diagnosed ATTR cardiomyopathy and baseline biomarker measurements from 2019 to 2023 were included from Mayo Clinic, Rochester, MN. Prognostic outcomes were calculated with Kaplan-Meier analysis for 3e staging systems in the main analysis: the National Amyloidosis Centre (NAC) staging system; a modified Mayo staging system using hsTNT (high-sensitivity troponin T) cutoff >65 ng/L; the extended NAC model with a fourth stage (NT-proBNP [N-terminal pro-B-type natriuretic peptide] >10 000 ng/L). The study population consisted of 441 patients with a median age of 76 years, 93% were men, 85% were initiated on tafamidis, and 94% had wild-type ATTR. Median follow-up was 3.4 years, and 109 deaths occurred during follow-up. The 3-year survival for the Mayo stages were 92.3% (88.7-95.9) for stage I, 71.6% (63.0-81.3) for stage II, and 43.5% (32.4-58.5) for stage III. For the NAC system, 3-year survival were 92.0% (89.0-95.7), 67.5% (59.0-77.3), and 47.0% (34.7-63.5) for stages I, II, and III, respectively. The 3-year survival by the extended NAC system was 92.0 (69.0-79.2), 69.0% (60.1-79.2), 53.2% (39.9-70.8) and 34.4% (17.4-68.0) for stages I, II, III, and IV, respectively. In a contemporary cohort of patients with ATTR cardiomyopathy, the NAC and modified Mayo staging systems remained equally effective in delineating clinically meaningful prognostic groups, whereas the extended NAC system identified a stage IV subgroup with high mortality.
Time-related sterility maintenance (TRSM) remains common in Japanese operating rooms, requiring re-sterilisation of unopened supplies at fixed intervals, although microbiological evidence indicates that sterility loss is event-driven, not time-driven. Its avoidable burden remains unquantified. To quantify the annual cost, carbon dioxide-equivalent (CO2e) emissions, water use, and labour from re-sterilising expired supplies under TRSM, and the upper-bound proportion avoidable by transition to event-related sterility maintenance (ERSM). Single-centre observational and modelling study integrating a gate-to-gate environmental assessment (a partial boundary rather than a full cradle-to-grave life-cycle assessment), cost-consequence analysis, and discrete-event simulation (DES). A one-month census of expired supplies (746 items) was annualised with the institutional modality mix (steam:VH2O2:EO = 8:1:1) and literature-derived emission factors. As re-sterilisation is predominantly co-loaded, costs were allocated as a marginal increment by load factor. A competing-risk DES, with an event-related contamination hazard from five-year data, yielded a modelled upper bound; conservative scenarios retaining re-sterilisation for legitimate non-time triggers (damage, recall, audit, inventory checks) were added. Uncertainty was assessed by probabilistic (Monte Carlo, 5,000 iterations) sensitivity analysis. An estimated 8,952 items were re-sterilised annually at one 643-bed centre. The avoidable fraction was a modelled upper bound of 99.9% (95% interval 99.6-100%); under conservative scenarios, 80-95% remained avoidable. At the upper bound, median avoidable burden was ¥1.24 million/year (≈US$8,300), 1,768 kg CO2e/year, 10,727 L water/year, and 147 hours/year. TRSM generated approximately 1.8 tonnes of avoidable CO2e, over ¥1 million, and up to 147 hours of avoidable labour annually, supporting evaluation of ERSM as a decarbonisation and efficiency measure.
Among older adults hospitalized after a fall, receiving a DXA scan was associated with a decreased hazard of sustaining a hip fracture within 2 years. Older age, female sex, dementia, parkinsonism, mental health disorder and intermediate frailty were associated with a higher hazard of having a hip fracture post-discharge. Identify factors associated with increased hazard of having a hip fracture within 2 years of discharge following a fall-related hospitalization. We conducted a retrospective cohort study of all Ontario adults aged 65 + hospitalized after a fall between November 1, 2015 and October 31, 2020 using administrative health databases. We compared individuals who did or did not experience a hip fracture within 2 years of discharge based on socio-demographics, frailty, comorbidities, receipt of a dual-energy X-ray absorptiometry (DXA) scan, and family physician or geriatrician visits. We performed a Cox proportional hazard regression to identify factors associated with having a subsequent hip fracture, accounting for death as a competing risk. Among the 88,140 individuals who were discharged after a fall-related hospitalization, 4.6% suffered a hip fracture within 2 years. Older age (hazard ratio [HR] 1.04 per year, 95% confidence interval [CI] 1.04-1.05), female sex (HR 1.16, 95% CI 1.08-1.24), parkinsonism (HR 1.42, 95% CI 1.19-1.70), dementia (HR 1.28, 95% CI 1.17-1.41), mental health disorders (HR 1.10, 95% CI 1.01-1.20), and intermediate frailty risk by HFRS score (HR 6.68, 95% CI 3.28-13.7) were associated with a higher hazard of having a hip fracture. Post-discharge DXA scanning was associated with a decreased hip fracture hazard (HR 0.75, 95% CI 0.66-0.86), yet only 15% of the study population underwent this assessment. Timely fall risk reduction and bone health optimization efforts should focus on the high-risk groups identified in this study to help prevent hip fractures following fall-related hospitalizations.
Acute limb ischemia (ALI) is a surgical emergency associated with substantial morbidity and mortality. Although management has traditionally emphasized a 6-hour revascularization threshold, emerging evidence suggests that earlier intervention may be critical to limb salvage. The extent to which these data have been incorporated into clinical practice remains unclear. We therefore evaluated contemporary treatment patterns and perioperative outcomes among patients with ALI. Patients with ALI who underwent surgical thrombectomy between March 2018 and April 2025 were identified from a large statewide collaborative. Time from symptom onset to surgical incision and hospital arrival to incision were assessed. Primary outcomes were major amputation at 30 days and 1 year. Multivariable logistic regression was performed to assess association between patient characteristics, time to surgery, and post-thrombectomy outcomes. A total of 1,015 patients underwent open thrombectomy for ALI. Major amputation occurred in 7% of patients within 30 days and in 15.2% within 1 year. Mortality was 2.1% at 30-days and increased to 14% at 1 year. Mean time from hospital presentation to incision was 7.8 + 5.9 hours, with 78% of patients undergoing revascularization >3 hours after arrival. Surgical incision occurring >6 hours after arrival was significantly associated with increased risk of 30-day and 1-year major amputation. ALI requiring surgical thrombectomy continues to result in high morbidity and mortality. Delays from hospital arrival to surgical incision are common and associated with increased amputation risk, identifying door-to-incision time as an important target for system led interventions to improve ALI outcomes.
Research on the etiology of nonsuicidal self-injury (NSSI) has been largely deficit-focused, with emotion dysregulation frequently underscored as a common predictor of NSSI. Meanwhile, strengths-based models have been less frequently employed. This cross-sectional study explored the direct and indirect (through emotion regulation difficulties) potentially protective effects of strengths-based psychological variables (i.e., mindfulness, self-compassion, optimism, and resilience) on the likelihood of reporting past-year NSSI in a cross-national sample of university students (N = 861) residing in Belgium (n = 320), Canada (n = 136), and Australia (n = 406). The fit of the logistic mediation model did not differ when country was included, suggesting that the model was broadly applicable across all three contexts. Greater mindfulness, self-compassion, optimism, and resilience were all indirectly associated with a lower likelihood of reporting past-year NSSI through better emotion regulation. Notably, greater self-compassion and optimism were also directly associated with a lower likelihood of reporting past-year NSSI. Findings lend preliminary cross-national support for the possible protective roles of strengths-based psychological variables in relation to NSSI and for the mediating role of emotion regulation in these relations. Results also underscore the distinct contributions of self-compassion and optimism in relation to past-year NSSI, independent of those explained by emotion regulation, shedding light on a strengths-based etiological model that extends beyond emotion regulation difficulties.
To evaluate trends in urodynamic study claims submitted by physicians and advanced practice providers using two large administrative claims databases. The MerativeTM MarketScan® database and Medicare Part B were queried for urodynamic study-related procedure codes from 2010-2024. Claims were stratified by patient age: <18, 18 to <65, and ≥65 years; United States Census region; and urbanicity. Outcomes included the number and proportion of claims billed by physicians and advanced practice providers and associated diagnosis codes. Urodynamic study claims declined from 359,099 in 2010 to 162,647 in 2024. In 2010, physicians accounted for 1602 (98.6%), 64,431 (99.3%), and 282,277 (96.5%) claims in the <18, between 18 and <65, and ≥65 year cohorts, respectively. In 2024, physicians accounted for 509 (76.7%), 17,115 (93.4%), and 129,735 (90.3%) claims in the <18, between 18 and <65, ≥65 year cohorts, respectively. Advanced practice provider-billed claims increased across all geographies and urbanicities, with the largest increase in the <18-year cohort between 2022-2023 (11.4% vs 23.5%). The distribution of diagnosis codes was similar between physicians and advanced practice providers in adult patients, but notably different in pediatric patients. Physicians continue to bill for most urodynamic studies; however, the proportion billed by advanced practice providers is increasing significantly, especially in the pediatric population. Further studies are needed to better understand the optimal role advanced practice providers play in performing urodynamic studies in modern urologic practice.
Aims This study aimed to understand the overall experiences of UK dental students, in a longitudinal study, investigating preparedness and confidence for clinical practice over time, from final year of study to the end of dental foundation training/vocational training (DFT/VT), and the transition between.Methods Three phases of in-depth, semi-structured qualitative interviews were conducted with a diverse sample of 17 final-year dental students in the UK, from their final year of study to the end of their DFT/VT year from April 2023-May 2024, with pre-discussion surveys also sent to all respondents to gain quantitative metrics.Results Throughout the respondents' early professional journey, confidence and preparedness were found to peak and trough, initially dropping at the beginning of DFT/VT and then growing over time, with quantitative findings mirroring key qualitative themes.Conclusion DFT/VT bridges the gap between dental school and practice and is vital in preparing dental students for the real world. Recognition of differences between dental school and practice would ease the transition for UK dental students.
The Dietary Approaches to Stop Hypertension (DASH) diet reduces blood pressure and cardiovascular disease risk, but its impact on later coronary artery calcium (CAC) progression is unclear. This study aimed to identify DASH score trajectories from early to middle adulthood and assess their association with CAC progression in middle age, exploring the potential mediating factors. We conducted a prospective analysis of 2238 Black and White adults who were aged 18 to 30 years at CARDIA (Coronary Artery Risk Development in Young Adults) baseline and were followed from study year 20 to year 25. DASH score trajectories from early to middle adulthood were determined using latent class analysis. The primary end point was CAC progression, a validated measure of plaque progression, defined as a >2.5 square root increase in CAC score between years 20 and 25. Two distinct DASH score trajectories were identified: the low-increasing and high-decreasing trajectories. In the fully adjusted model, participants in the high-decreasing trajectory had a 21% lower risk of CAC progression compared with those in the low-increasing trajectory (hazard ratio, 0.79 [95% CI, 0.65-0.98]; P=0.028). The association was partially mediated by diastolic blood pressure, insulin, uric acid, and lipid profiles. DASH score trajectories vary from early to middle adulthood. Maintaining high adherence to the DASH diet from early to middle adulthood is associated with reduced CAC progression in middle age, partially mediated by cardiometabolic risk factors. These findings support the importance of long-term adherence to a healthy dietary pattern for cardiovascular disease primary prevention. REGISTRATION: URL: https://www.clinicaltrials.gov; unique identifier: NCT00005130.