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Background and Aims Guidelines recommend revascularization of intermediate epicardial artery stenosis to be guided by evidence of ischaemia. Fractional flow reserve (FFR) and instantaneous wave-free ratio (iFR) are equally recommended. Individual 5-year results of two major randomized trials comparing FFR with iFR-guided revascularization suggested increased all-cause mortality following iFR-guided revascularization. The aim of this study was a study-level meta-analysis of the 5-year outcome data in iFR-SWEDEHEART (NCT02166736) and DEFINE-FLAIR (NCT02053038). Methods Composite of major adverse cardiovascular events (MACE) and its individual components [all-cause death, myocardial infarction (MI), and unplanned revascularisation] were analysed. Raw Kaplan–Meier estimates, numbers at risk, and number of events were extracted at 5-year follow-up and analysed using the ipdfc package (Stata version 18, StataCorp, College Station, TX, USA). Results In total, iFR and FFR-guided revascularization was performed in 2254 and 2257 patients, respectively. Revascularization was more often deferred in the iFR group [ n = 1128 (50.0%)] vs. the FFR group [ n = 1021 (45.2%); P =.001]. In the iFR-guided group, the number of deaths, MACE, unplanned revascularization, and MI was 188 (8.3%), 484 (21.5%), 235 (10.4%), and 123 (5.5%) vs. 143 (6.3%), 420 (18.6%), 241 (10.7%), and 123 (5.4%) in the FFR group. Hazard ratio [95% confidence interval (CI)] estimates for MACE were 1.18 [1.04; 1.34], all-cause mortality 1.34 [1.08; 1.67], unplanned revascularization 0.99 [0.83; 1.19], and MI 1.02 [0.80; 1.32]. Conclusions Five-year all-cause mortality and MACE rates were increased with revascularization guided by iFR compared to FFR. Rates of unplanned revascularization and MI were equal in the two groups. [ABSTRACT FROM AUTHOR]

Context: Thyrotropin (TSH) receptor antibodies (TRAb) are important when distinguishing between Graves’ and gestational hyperthyroidism, but sparse evidence exists on the recommended cutoff during pregnancy. Objective: This work aimed to establish a method- and pregnancy-specific cutoff for TRAb, to describe the frequency of TRAb positivity in early pregnancy, and to follow up the women in the years after pregnancy. Methods: This cohort study used the North Denmark Region Pregnancy Cohort and Danish nationwide registers of women in the North Denmark Region who had a blood sample drawn in early pregnancy, 2011 to 2015, that was stored in a biobank for assessment of thyroid function and thyroid autoantibodies. A cutoff value for TRAb was established in a reference cohort (n = 524) and used to identify TRAb-positive and TRAb-negative hyperthyroidism in early pregnancy for evaluation of frequency and follow-up. Results: The method- and cohort-specific cutoff for TRAb in early pregnancy was 0.98 IU/L (95% CI, 0.96-0.99 IU/L). Among women with low TSH in early pregnancy and no known thyroid disease (n = 414), 21 women (5.1%) were TRAb positive and 393 (94.9%) were TRAb negative. Follow-up in the years following the pregnancy (median 8.1 years) revealed that 52.4% of women with TRAb-positive hyperthyroidism and 8.4% of the women with TRAb-negative hyperthyroidism were diagnosed with hyperthyroidism. Conclusion: This is the first study to measure TRAb in a large group of women in early pregnancy and to establish a pregnancy-specific cutoff. Results reveal that TRAb-negative hyperthyroidism is predominant in early pregnancy and rarely associated with later development of hyperthyroidism. [ABSTRACT FROM AUTHOR]

The extent to which Danish gender diverse individuals (GDI) self-medicate was unknown, so we have investigated the prevalence of the phenomenon in a clinical sample and a survey sample. Our objective was, moreover, to examine possible significant differences between the subgroup of GDI that seek assessment and gender-affirming treatment, and the general population of GDI, of whom some might seek treatment, and some might not. Data regarding the clinical sample (CS) were collected from records of all the GDI treated at our clinic in 2017. The survey sample (SS) comprised the GDI who answered the questions about self-medication in a larger group of respondents to an internet-based survey carried out in 2019. Our CS included data collected from 115 individuals, while the number of individuals in the SS was 171. The rates of self-medication were 19.1% in the CS and 22.2% in the SS, with no statistically significant difference found. Among individuals who self-medicated, there was a majority of assigned male at birth (AMAB) in both samples (72.7% in CS v. 92.1% in SS). No statistically significant differences were found in self-medication stratified by assigned sex at birth. There was a statistically significant difference concerning the source of self-medication. 9.5% in the CS v. 76.3% in the SS procured self-medication from the internet. Other common sources were foreign clinics, another GDI and the pharmacy. Within the SS, 18.9% of those who self-medicated hadn´t gotten assessment for Gender Incongruence or any previously used diagnostic category. Only 3.8% of those who didn´t self-medicate hadn´t gotten the assessment either. This difference was statistically relevant. Around 93% of both subgroups reported to have completed the diagnostic assessment. While there are very few differences between the two samples, around a fifth of the GDI included have self-medicated. Overall, self-medication reflects an unmet need in the healthcare system. None [ABSTRACT FROM AUTHOR]

Historically in research on gender diverse individuals (GDI), the focus has mostly been put on assigned sex at birth (ASAB) as variable. We wanted to study the possible transition trajectories (TT) of self-identified GDI and to investigate any statistically significant differences (SSD) that might be found, based on the self-defined gender identity (GId). Our study was completed through an anonymous online survey based on an INSERM study (2011), which was developed internationally in six countries. The questionnaire comprises questions regarding the socio-demographic characteristics of the respondents and several other aspects of their lives, among which some concern possible gender affirming interventions, the person has undertaken or plans. Based on the answers to an open-ended question regarding self-definition of GId, our respondents (N=479) were divided into GId-categories: Man, Woman, Trans Man, Trans Woman, Nonbinary, Other GId. When comparing TT based on ASAB, we only found a SSD regarding previous or planned top surgery (p-value 0.0). When analyzing TT based on GId, we found several SSDs regarding application for change of legal gender, previous assessment for Gender Incongruence, previous hormonal treatment, previous or planned top surgery, planned bottom surgery, including planned removal of the gonads (all p-values are 0.0). Furthermore, we found a SSD regarding planned phalloplasty between the group of respondents identifying as Man and those identifying as Trans Man.We moreover found several SSDs regarding application for change of legal gender, previous and planned assessment for Gender Incongruence, previous and planned hormonal treatment (p-value ≤ 0.1) between the group of respondents identifying as Woman and those identifying as Trans Woman. It is, based on our results, relevant to include the self-defined gender identity in the investigation of transition trajectories, and in general in transgender research, policy and healthcare, as it provides a fuller, more nuanced picture of the broad spectrum of gender diversity. None [ABSTRACT FROM AUTHOR]