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Objectives: No study has examined the effects of new constipation treatment drugs released in recent years in pregnant women. This prospective cohort study aimed to examine and compare the perinatal prognosis, efficacy rate, and safety of drugs frequently used to treat constipation. Methods: The study included 211 perinatally managed individuals who answered a self-administered questionnaire during the second trimester and after delivery. The Japanese version of the constipation evaluation scale (Constipation Assessment Scale [CAS] long-term [LT] version) was used for the subjective evaluation of defecation status. Results: Participants aware of constipation had significantly higher CAS scores than those who were unaware. Some participants with a CAS score of 5 points (treatment range) had no subjective symptoms of constipation, whereas some participants with a CAS score of ≤ 5 points were aware of constipation. Regarding the time of onset, 60% of those who had constipation before pregnancy had a high rate of constipation during pregnancy and after delivery. No significant difference was noted in conventional magnesium oxide and polyethylene glycol, a relatively new daily treatment drug, in perinatal prognosis or side effects. Conclusions: Polyethylene glycol preparations alleviate constipation without inducing diarrhea, making them an appropriate therapeutic option for pregnant women. [ABSTRACT FROM AUTHOR]

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Type 2 Diabetes Mellitus (T2DM) is intricately linked with increased cardiovascular risks, primarily due to dyslipidemia, including elevated triglyceride levels. This prospective study aimed to assess the correlation between triglyceride levels and cardiovascular risk factors in T2DM patients. Conducted over a year at a tertiary care center, it involved 150 T2DM patients, using predefined inclusion and exclusion criteria. Data were collected through interviews, medical records review, and laboratory tests, focusing on triglyceride levels and other cardiovascular risk factors like blood pressure, BMI, smoking status, and family history of CVD. Statistical analysis included Pearson's correlation and multivariate regression. The study revealed a male dominance (60%) in the sample, with an average age of 55 years and a predominantly overweight profile (mean BMI of 28.5 kg/m²). Hypertriglyceridemia was prevalent, with only 26.7% showing normal triglyceride levels. Hypertension (66.7%) and dyslipidemia (53.3%) were the most common cardiovascular risk factors. Significant positive correlations were found between triglyceride levels and hypertension (r=0.25, p=0.01), BMI (r=0.30, p<0.001), and diabetes duration (r=0.15, p=0.05). Multivariate analysis suggested high triglycerides significantly increased the odds of hypertension and obesity. Over the year, a slight decrease in mean triglyceride levels was observed, yet obesity prevalence increased. These findings underscore the critical association between elevated triglyceride levels and cardiovascular risks in T2DM patients, highlighting the importance of targeted management strategies for hypertriglyceridemia and obesity in this group. [ABSTRACT FROM AUTHOR]

Purpose: To identify acute predictors of both generic and specific health-related quality of life (HRQoL) 3 months after stroke in individuals from a middle-income country. Materials and methods: A 3-month prospective study with individuals who had suffered their first stroke, without previous disability, discharged from a stroke unit. The dependent outcomes, assessed 3 months after stroke, were generic and specific HRQoL (SF-36 and SSQOL total scores, respectively). The predictors assessed in the stroke unit were age, sex, education level, duration of hospital stay, current living arrangement, stroke severity (National Institutes of Health Stroke Scale-NIHSS), functional independence (Modified Barthel Index-MBI), motor impairment (Fugl-Meyer Assessment), and lower- and upperlimb residual muscle strength deficits. Linear multiple regression analyses were employed to identify predictors of both generic (model-1) and specific (model-2) HRQoL (α=5%). Results: One hundred twenty-six individuals were assessed at 3-month post-stroke (61.3 ± 13.6 years). Regression analysis showed that functional independence was the best predictor of both generic (R²=21%; F=34.82; p<0.001) and specific (R²=29%; F=51.71; p<0.001) HRQoL at 3-month poststroke. Conclusion: Both generic and specific HRQoL at 3-month post-stroke can be predicted by functional independence assessed in the acute phase with the MBI. [ABSTRACT FROM AUTHOR]

Simple Summary: Contradictory research exists on the association of self-reported quality of life at tumor diagnosis (baseline quality of life, bQL) with treatment and disease-specific characteristics in oncological patients. The aim of our prospective study was to examine the role of bQL as a treatment predictor in oncological patients. We show that self-reported pain and low physical functioning or financial burden at tumor diagnosis were linked to lower systemic treatment, reduced surgery or reduced oncological treatment compliance, respectively. Thus, we found for the first time that survival-relevant quality-of-life variables reported during diagnosis are significantly associated with the subsequent oncological treatment of oncological patients. In addition, our results indicate that these treatment patterns were distinguishable between genders, as well as younger or older ages. Linking survival-predicting baseline QL scores to treatment-specific patterns emphasizes the importance of patient baseline physio-emotional state over the course of the disease and paves the way for early integration of patient-reported outcomes into oncological supportive concepts. Background: Baseline quality of life (bQL) has been shown to be a predictor of the clinical outcome of oncological patients. The primary objective of the present study was to examine the role of bQL as a treatment predictor in oncological patients. Methods: In this prospective study, all-stage cancer patients registered in the Network Oncology registry were enrolled, and their bQL at diagnosis was evaluated. Results: Five hundred and thirty-eight oncological patients were eligible (median age 64 years). We show that survival-predicting bQL variables such as pain, low physical functioning or financial burden at tumor diagnosis were linked to lower systemic treatment (p = 0.03), reduced surgery (p = 0.007) or reduced oncological treatment compliance (0.01), respectively. Lastly, female gender and older cancer patients exhibited a tempered bQL. Conclusion: Our study is one of the first to reveal that bQL at tumor diagnosis is significantly associated with the prediction of oncological treatment with distinctive age- and gender-related patterns. Our results emphasize the need to address the physical, psychosocial, and financial burden of cancer patients prior to their oncological treatment with respect to age and gender. The associations found here pave the way for early integration of patient-reported outcomes into oncological supportive concepts. [ABSTRACT FROM AUTHOR]

Background: Pancreatic cancer (PC) is influenced by both genetic and lifestyle factors. However, further research is still needed to comprehensively clarify the relationships among lifestyle, genetic factors, their combined effect on PC, and how these associations might be age-dependent. Methods: We included 340,631 participants from the UK Biobank. Three polygenic risk score (PRS) models for PC were applied, which were derived from the previous study and were categorized as low, intermediate, and high. Two healthy lifestyle scores (HLSs) were constructed using 9 lifestyle factors based on the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) lifestyle score and the American Cancer Society (ACS) guidelines and were categorized as unfavorable, intermediate, and favorable. Data were analyzed using Cox proportional hazards models. Results: There were 1,129 cases of incident PC during a median follow-up of 13.05 years. Higher PRS was significantly associated with an increased risk of PC (hazard ratio [HR], 1.58; 95% confidence intervals [CI], 1.47–1.71). Adhering to a favorable lifestyle was associated with a lower risk (HR, 0.48; 95% CI, 0.41–0.56). Participants with an unfavorable lifestyle and a high PRS had the highest risk of PC (HR, 2.84; 95% CI, 2.22–3.62). Additionally, when stratified by age, a favorable lifestyle was most pronounced associated with a lower risk of PC among participants aged ≤ 60 years (HR, 0.35; 95% CI, 0.23–0.54). However, the absolute risk reduction was more pronounced among those aged > 70 years (ARR, 0.19%, 95% CI, 0.13%–0.26%). A high PRS was more strongly associated with PC among participants aged ≤ 60 years (HR, 1.89; 95% CI, 1.30–2.73). Furthermore, we observed a significant multiplicative interaction and several significant additive interactions. Conclusions: A healthy lifestyle was associated with a lower risk of PC, regardless of the participants' age, sex, or genetic risk. Importantly, our findings indicated the age-dependent association of lifestyle and genetic factors with PC, emphasizing the importance of early adoption for effective prevention and potentially providing invaluable guidance for setting the optimal age to start preventive measures. [ABSTRACT FROM AUTHOR]

Background: The clinical outcome of COVID-19 pneumonia is highly variable. Few biological predictive factors have been identified. Genetic and immunological studies suggest that type 1 interferons (IFN) are essential to control SARS-CoV-2 infection. Objective: To study the link between change in blood IFN-a2 level and plasma SARS-Cov2 viral load over time and subsequent death in patients with severe and critical COVID-19. Methods: One hundred and forty patients from the CORIMUNO-19 cohort hospitalized with severe or critical COVID-19 pneumonia, all requiring oxygen or ventilation, were prospectively studied. Blood IFN-a2 was evaluated using the Single Molecule Array technology. Anti-IFN-a2 auto-Abs were determined with a reporter luciferase activity. Plasma SARS-Cov2 viral load was measured using droplet digital PCR targeting the Nucleocapsid gene of the SARS-CoV-2 positive-strand RNA genome. Results: Although the percentage of plasmacytoid dendritic cells was low, the blood IFN-a2 level was higher in patients than in healthy controls and was correlated to SARS-CoV-2 plasma viral load at entry. Neutralizing anti-IFN-a2 auto-antibodies were detected in 5% of patients, associated with a lower baseline level of blood IFN-a2. A longitudinal analysis found that a more rapid decline of blood IFN-a2 was observed in fatal versus surviving patients: mortality HR=3.15 (95% CI 1.14–8.66) in rapid versus slow decliners. Likewise, a high level of plasma SARS-CoV-2 RNA was associated with death risk in patients with severe COVID-19. Conclusion: These findings could suggest an interest in evaluating type 1 IFN treatment in patients with severe COVID-19 and type 1 IFN decline, eventually combined with anti-inflammatory drugs. Clinical trial registration: https://clinicaltrials.gov, identifiers NCT04324073, NCT04331808, NCT04341584. [ABSTRACT FROM AUTHOR]

Aortic stenosis (AS) is the most prevalent valvular heart disease among adults. The adipocyte-derived hormones, leptin and adiponectin, have profound metabolic actions. We examined whether these adipokines are independently associated with future aortic valve replacement (AVR). In this longitudinal case-control study, we identified 336 cases who had undergone AVR due to AS, and who had previously participated in population-based health surveys. Two referents were matched to each case and leptin and adiponectin concentrations were analysed from stored baseline survey samples. Uni- and multivariable logistic regression analyses were used to estimate the risk of future AVR. An additional cohort was identified for validation including 106 cases with AVR and 212 matched referents. Median age (interquartile range (IQR)) in years at survey was 59.9 (10.4) and at surgery 68.3 (12.7), and 48% were women. An elevated concentration of leptin was not associated with future AVR (odds ratio [95% confidence interval]) (1.10 [0.92–1.32]), although leptin was associated with a higher risk in patients with coronary artery disease (CAD) having more than 5 years between survey and AVR (1.41 [1.08–1.84]). Adiponectin was not associated with higher risk for future AVR (0.95 [0.82–1.11]), although after stratification for age, higher levels were associated with reduced risk for AVR in persons aged ≥60 years at surgery (0.79 [0.64–0.98]). In the validation study, leptin was associated with future AVR whereas adiponectin was not. None of the associations remained significant after adjustment for body mass index (BMI). The adipokine leptin may promote the development of AS. [ABSTRACT FROM AUTHOR]

Background: Traumatic birth experience is an unaddressed arena, especially in Asian women, with several societal stigmas lingering around. Aim: A study was undertaken to simultaneously assess the post-partum mental and physical health follow-up of maternal near-miss (MNM) women and compare it with women of uneventful deliveries. Materials and Methods: The prospective cohort study enrolled 88 MNM women (case cohort) and 80 women with an uneventful peri-partum period (control cohort) at the same time. The participants were followed up with Edinburgh Postnatal Depression Scale (EDPS), PTSD Checklist – Civilian Version (PLC-C), and a 36-item short-form-survey form over 6 months after the delivery. Results: The case group had higher mean EPDS and PLC-C scores, with poor quality of life (QOL) performance, compared to the control group at 6 weeks and 3 months, and 6 months follow-up (P < 0.05). At the sixth-week follow-up visit, the study observed that 28 (31.8%) women from the case group required a psychiatry consultation compared to the control group with only two (2.5%) participants (P < 0.001). At 3 months, an evident difference was noted on various QOL parameters, such as limitations due to physical health and emotional problems, energy fatigue, general health, and health change parameters between the two groups (P < 0.05). The difference persisted at 6-month follow-up as well for limitations due to physical health, energy fatigue, and general health parameters only (P < 0.05). Conclusion: There is an urgent need for a multi-departmental collaborative approach at the hospital level and policy-making decisions at higher levels for the mental health of Asian women facing MNM events. [ABSTRACT FROM AUTHOR]

Background and Objectives: We aimed to evaluate the associations between a combined healthy lifestyle during the second and third trimesters and offspring anthropometric outcomes in China. Methods and Study Design: We examined these associations among 548 participants from nine community health centers and three hospitals in the North China cohort. A pregnant women's healthy lifestyle score (HLS) was constructed based on six lifestyle factors: smoking, alcohol consumption, physical activity, sedentary behavior, diet, and gestational weight gain. Anthropometric indicators at birth like birth weight (BW), head circumference (HC), and birth length (BL) were collected, and weight to head circumference ratio (WHC, kg/m), body mass index (BMI, kg/m2) and Ponderal Index (PI, kg/m3) were calculated. Multivariate linear and logistic regression models were used to examine the effects of HLS during the second and third trimesters on anthropometric outcomes at birth, respectively. Results: In fully adjusted models, we found a negative association between second and third-trimester HLS and offspring HC and a positive relationship between second-trimester HLS and BL (p<0.05). Neonates with mothers in the highest HLS tertile had a 5.6% relatively lower HC and 2.3% relatively longer body length than women in the lowest tertile. Each additional unit in third-trimester HLS had an associated decrease in HC by 0.96 cm. None of the associations between HLS and BW, WHC, BMI, and PI of offspring were observed. Conclusions: A healthy lifestyle score may significantly impact offspring head circumference and body length, supporting the important role of healthy lifestyles in improving the health of offspring. [ABSTRACT FROM AUTHOR]

Background: The influence of overall air pollution on dementia risk and the potential effect modification by other risk factors remain to be clarified.Methods: We selected 459,844 UK residents who were free of dementia and had data on the exposure to PM2.5, PM2.5-10, PM10, NO2, and NOx during baseline recruitment. The combined exposure to various PMs and NOx was estimated by using an air pollution score. Hazard ratios (HRs) and 95% confidence intervals (CIs) for incident dementia were estimated by Multivariable Cox models.Results: During a median 11.7 years of follow-up, 5,905 incident cases of all-cause dementia were identified. With the exception of PM2.5-10, all other air pollutants were separately associated with a higher risk of all-cause dementia (all P-trend <0.001) with generally similar associations for dementia subtypes. An increasing air pollution score was associated with higher risks of all-cause as well as individual dementia outcomes, with adjusted HRs (95% CI) of 1.27 (1.18, 1.37) for all-cause dementia, 1.27 (1.14, 1.43) for Alzheimer's disease, and 1.35 (1.16, 1.57) for vascular dementia when comparing the highest with the lowest quartile of the score (all P-trend <0.001). These associations of air pollution score with dementia and its subtypes were observed among never and former smokers but not among current smokers (all P-interaction <0.030).Conclusions: Air pollution was associated with higher risk of dementia among nonsmokers but not current smokers. Additional studies are required to confirm our findings and to explore the potential mechanisms underlying the possible effect modification by smoking status. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the predictive value of coagulation, thromboelastography, stress response, and immune function indicators for the occurrence of deep venous thrombosis (DVT) following radical resection of cervical cancer and ovarian cancer. We conducted a prospective, single-centre, case-control study that included 230 cervical cancer patients and 230 ovarian cancer patients. In the testing cohort, the final predictive model for cervical cancer patients was: Logit(P)=9.365–0.063(R-value)−0.112(K value) +0.386(α angle)+0.415(MA)+0.276(FIB)+0.423(D-D)+0.195(IL-6)+0.092(SOD). For ovarian cancer patients, the final model was: Logit(P)= −2.846–0.036(R-value)-0.157(K value) +0.426(α angle) +0.172(MA) +0.221(FIB)+0.375(CRP) −0.126(CD4+/CD8+). In the validation cohort, these models exhibited good predictive efficiency, with a false-positive rate of 12.5% and a false-negative rate of 2.9% for cervical cancer patients, and a false-positive rate of 14.3% and a false-negative rate of 0% for ovarian cancer patients. In conclusion, the risk prediction models developed in this study effectively improve the predictive accuracy of DVT following radical resection of cervical and ovarian cancer. What is already known on this subject? Nowadays, surgery is currently the primary treatment for gynecological malignant tumours. However, prior to surgery, these tumours often create a hypercoagulable state, which increases the likelihood of deep vein thrombosis (DVT) following the procedure. Reports have shown that the incidence of DVT after surgery for ovarian cancer is the highest among gynecological malignant tumours, ranging from 13.6% to 27%, with lower extremity DVT being the most common. The occurrence of embolic detachment poses the greatest risk of DVT and can lead to fatal pulmonary embolism. Identifying the factors that influence the occurrence of DVT after gynecological malignant tumour surgery is crucial in order to take necessary preventive measures for patients with high-risk factors and reduce the incidence of DVT. This is of great significance in ensuring the quality of surgery and improving the postoperative quality of life for patients. What do the results of this study add? This prospective, single-centre, case-control study was conducted to investigate the predictive value of coagulation, thromboelastography, stress response, and immune function indicators for the occurrence of deep venous thrombosis (DVT) following radical resection of cervical and ovarian cancer. This study included 230 cervical cancer patients and 230 ovarian cancer patients. Based on our findings, current risk prediction models that incorporate coagulation, thromboelastography, stress response, and immune function laboratory indicators have demonstrated the potential to improve the predictive accuracy of postoperative DVT in patients who have undergone radical resection of cervical and ovarian cancer. What are the implications of these findings for clinical practice and/or further research? Our study found that the final two regression models had a prediction accuracy of 87.9% and 87.4% for postoperative DVT in patients with cervical and ovarian cancer, respectively, which is a significant improvement. Furthermore, both models demonstrated high specificity of 100%. In addition, the models continued to perform well in terms of predictive efficiency, with a false positive rate of 12.5% and a false negative rate of 2.9% for cervical cancer patients and a false positive rate of 14.3% and a false negative rate of 0% for ovarian cancer patients. Our models are effective in predicting the occurrence of DVT in patients with cervical and ovarian cancer following resection. [ABSTRACT FROM AUTHOR]

We studied changes in placental weight from the first to the second delivery according to length of the inter-pregnancy interval. We followed all women in Norway from their first to their second successive singleton pregnancy during the years 1999–2019, a total of 271 184 women. We used data from the Medical Birth Registry of Norway and studied changes in placental weight (in grams (g)) according to the length of the inter-pregnancy. Adjustments were made for year and maternal age at first delivery, changes in the prevalence of maternal diseases (hypertension and diabetes), and a new father to the second pregnancy. Mean placental weight increased from 655 g at the first delivery to 680 g at the second. The adjusted increase in placental weight was highest at inter-pregnancy intervals <6 months; 38.2 g (95 % CI 33.0g–43.4 g) versus 23.2 g (95 % CI 18.8g–27.7 g) at inter-pregnancy interval 6–17 months. At inter-pregnancy intervals ≥18 months, placental weight remained higher than at the first delivery, but was non-different from inter-pregnancy intervals 6–17 months. Also, after additional adjustment for daily smoking and body mass index in sub-samples, we found the highest increase in placental weight at the shortest inter-pregnancy interval. We estimated no difference in gestational age at delivery or placental to birthweight ratio according to inter-pregnancy interval. Placental weight increased from the first to the second pregnancy, and the increase was most pronounced at short inter-pregnancy intervals. The biological causes and implications of such findings remain to be studied. • We studied changes in placental weight according to length of the inter-pregnancy interval. • Women in Norway were followed from a first to a second delivery during 1999–2019. • Mean placental weight was 655 g at first delivery and 680 g at the second. • The increase in placental weight was highest at inter-pregnancy intervals <6 months. • A short inter-pregnancy interval may possibly enhance placental growth. [ABSTRACT FROM AUTHOR]

The future of technology use in EFL classrooms is an important subject to investigate in future study because Saudi Vision 2030 is a shift toward modernity and openness to the rest of the world; as English is a global language, the effective use of English is essential to achieving this purpose, and it is by developing its skills with a significant emphasis on listening proficiency. The study aimed to explore how Netflix will impact Saudi EFL learners' strategic listening skills in the future from the teachers' perspectives. This research's significance lies in its alignment with the evolving educational paradigms and the increasing reliance on technology for language instruction; the study specifically sought to understand how the incorporation of Netflix might influence learners' SLS in the future. To achieve this aim, the study involved ninety-six male and female faculty members from Saudi EFL university departments, selected based on their experience in teaching English and familiarity with digital educational tools. A mixed-methods questionnaire was designed and applied to collect the participants' views on how Netflix will enhance the students' SLS in the future. The study revealed high expectations about the role of Netflix in promoting learners' SLS in the future. [ABSTRACT FROM AUTHOR]

The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: −516.59 mL; 95%CI: −578.31, −454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: −1.59 days; 95%CI: −2.69, −0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa. [ABSTRACT FROM AUTHOR]

Background: The connectome, constituting a unique fingerprint of a person's brain, may be influenced by its prenatal environment, potentially affecting later-life resilience and mental health. Methods: We conducted a prospective resting-state functional Magnetic Resonance Imaging study in 28-year-old offspring (N = 49) of mothers whose anxiety was monitored during pregnancy. Two offspring anxiety subgroups were defined: "High anxiety" (n = 13) group versus "low-to-medium anxiety" (n = 36) group, based on maternal self-reported state anxiety at 12–22 weeks of gestation. To predict resting-state functional connectivity of 32 by 32 ROIs, maternal state anxiety during pregnancy was included as a predictor in general linear models for both ROI-to-ROI and graph theoretical metrics. Sex, birth weight and postnatal anxiety were included as covariates. Results: Higher maternal anxiety was associated with weaker functional connectivity of medial prefrontal cortex with left inferior frontal gyrus (t = 3.45, pFDR < 0.05). Moreover, network-based statistics (NBS) confirmed our finding and revealed an additional association of weaker connectivity between left lateral prefontal cortex with left somatosensory motor gyrus in the offspring. While our results showed a general pattern of lower functional connectivity in adults prenatally exposed to maternal anxiety, we did not observe significant differences in global brain networks between groups. Conclusions: Weaker (medial) prefrontal cortex functional connectivity in the high anxiety adult offspring group suggests a long-term negative impact of prenatal exposure to high maternal anxiety, extending into adulthood. To prevent mental health problems at population level, universal primary prevention strategies should aim at lowering maternal anxiety during pregnancy. [ABSTRACT FROM AUTHOR]

This study aimed to update the association between Helicobacter pylori (H. pylori) infection and gastric cancer (GC). We searched PubMed, Embase, and Cochrane Library from 1990 to December 2021 to identify prospective studies. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were summarized to validate the relationship between H. pylori infection and GC. Including 27 studies, findings indicated a strong link between H. pylori and non-cardia gastric cancer (NCGC) in both Europe/North America (OR=5.37, 95%CI:4.39–6.57) and Asia (OR = 2.50, 95%CI:1.89–3.32), and a positive association with cardia gastric cancer (CGC) in Asia (OR = 1.74, 95%CI:1.38–2.19), but an inverse association in European/American populations (OR = 0.64, 95%CI: 0.51 to 0.79). Furthermore, the strength of association was greater in studies that detected H. pylori by immunoblotting versus ELISA, and also in studies testing for H. pylori detection further back in time prior to cancer diagnosis (Ptrend<0.05). Approximately 79% of NCGC in Asia and 87% in Europe/North America, along with 62% of CGC in Asia, could be attributable to H. pylori infection. The meta-analysis supports the significant attributable risk of H. pylori infection for GC and underscores the potential impact of targeting H. pylori in GC prevention programs. CRD42021274120 [ABSTRACT FROM AUTHOR]

Game usage has recently been increasing, but the actual situation of game usage and issues among pregnant women are not clarified. The purpose of this prospective longitudinal study was to examine changes in game usage, lifestyle, and thoughts about game usage during pregnancy depending on parity and to clarify the characteristics of pregnant women who continue to use games. We conducted three web surveys in early, mid- and late pregnancy in 238 pregnant women. For primiparous women who continued to use games, there was a significant increase in game usage time from early to late pregnancy (p = 0.022), and 25.0% of those women had anxiety that they might have a game addiction. For primiparous women in mid-pregnancy and multiparous women in early and late pregnancy, the proportions of women who thought that they could not use gaming sufficiently due to pregnancy and child-rearing were significantly higher in women who continued to use games. In both primiparous women and multiparous women, the proportion of partners who used games was significantly higher in women who continued to use games. It is necessary for midwives to discuss with pregnant women and their partners about game usage and to provide advice about control of game usage in daily life. [ABSTRACT FROM AUTHOR]

Abstract Background The association between macronutrient intake and diabetes is unclear. We used data from the China Health and Nutrition Survey to explore the association between macronutrient intake trajectories and diabetes risk in this study. Methods We included 6755 participants who did not have diabetes at baseline and participated in at least three surveys. The energy supply ratio of carbohydrate, protein, and fat was further calculated from dietary data; different macronutrient trajectories were determined using multitrajectory models; and multiple Cox regression models were used to evaluate the association between these trajectories and diabetes. Results We found three multitrajectories: decreased low carbohydrate‐increased moderate protein‐increased high fat (DLC‐IMP‐IHF), decreased high carbohydrate‐moderate protein‐increased low fat (DHC‐MP‐ILF), and balanced‐macronutrients (BM). Compared to the BM trajectory, DHC‐MP‐ILF trajectories were significantly associated with increased risk of diabetes (hazard ratio [HR]: 3.228, 95% confidence interval [CI]: 1.571–6.632), whereas no association between DLC‐IMP‐IHF trajectories and diabetes was found in our study (HR: 0.699, 95% CI: 0.351–1.392). Conclusions The downward trend of high carbohydrate and the increasing trend of low fat increased the risk of diabetes in Chinese adults.

Introduction: Neonatal seizures are the most common neurological problem among newborns. To date, scientific studies on the incidence and predictors of neonatal seizures in African countries, including Ethiopia are scarce. Therefore, this study aimed to assess the incidence and predictors of neonatal seizures among neonates admitted to Debre Markos comprehensive Specialized Hospital. Methods: An institutional-based prospective follow-up study was conducted in Debre Markos comprehensive specialized hospital from February 1, 2022 to January 30, 2023. A systematic random sampling technique was used to select a total of 198 neonates. Data were entered into Epi-Data 4.2 and then exported to STATA version 14.1 for analysis. The Kaplan-Meier survival curve and the log-rank test were computed to explore the descriptive statistics. Variables with a p-value ≤0.2 in bi-variable Cox-regression were selected for multivariable Cox-regression analysis. Finally, a p-value of

Aim. To evaluate the relationship of various factors with adherence to therapy in cardiovascular patients after a coronavirus disease 2019 (COVID-19).Material and methods. The study included 284 patients (inpatients — 176, outpatients — 108) with cardiovascular diseases (hypertension, heart failure (HF), coronary artery disease, atrial fibrillation) after COVID-19. We collected data on cardiovascular history, made a questionnaire survey about COVID-19 course (symptoms, their severity, self-assessment of the disease severity). Paraclinical diagnostic investigations were carried out. In addition, 1, 3, 6 months after recovery, all respondents were invited for examination, laboratory tests, and survey using the Hospital Anxiety and Depression Scale (HADS). Cardiovascular therapy adherence was assessed at 1, 3 and 6 months after recovery and adherence to COVID-19 treatment 1 month after inclusion in the study by comparing the compliance of the drugs prescribed at discharge with its actual use.Results. In total, 212 respondents continued study participation after 1 month, while 64,2% were adherent to cardiovascular therapy and 56,6% — to COVID-19 therapy. Compliance at 3 and 6 months was 60,4% (n=212) and 52,8% (n=188), respectively. A moderate correlation was found between adherence to treatment and the persistence of apprehension 1 month after recovery (r=0,33, p25% (n=64, 36,4%) were more adherent to standard cardiovascular therapy, prescribed in accordance with clinical guidelines (r=0,336, p0,05). Compliance after 1, 3, 6 months was positively influenced by COVID-19 severity, the subjective feeling of weakness, apprehension and anxiety during disease and the persistence of a subjective feeling of anxiety after recovery. Adverse events (hypertensive crisis, arrhythmia, decompensated HF) during 1, 3 and 6 months after COVID-19 significantly (p

Distal femur fractures are always a challenge to an orthopedic surgeon. They may be unstable and comminuted. Thin cortex, wide medullary canal, relative osteopenia and short distal segment adds to the complexity. The present study assessed the functional outcome of using locking compression plate fixation for fractures of distal end of femur in patients admitted to JMMC orthopedics department satisfying the inclusion and exclusion criteria from December 2017 to may 2019. Twenty cases were taken in this study. Serial follow up was done at 4, 8, 12, 24 weeks and functional outcome was assessed at the end of 24 weeks using NEERS criteria. 18 patients were treated with open reduction and internal fixation. 2 of the fractures were stabilized via MIPPO technique. No patients had implant failure and none of the cases were complicated by deep infection. 5 of the 20 patients had ‘Excellent’ Neers scores and 14 had ‘Good’ scores. Only one patient had ‘Fair’ score. Conclusion: Locking compression plate fixation is a safe procedure for supracondylar fractures of distal femur with good functional outcome. It can be done on a routine basis with a minimum risk of complications. Keywords: Functional Outcome, LCP, Open Reduction Internal Fixation, Prospective Study, Supracondylar Fracture.

BACKGROUND: Childhood abuse negatively impacts the course of Bipolar Disorder (BD). Yet, no study has examined risk factors associated with prospectively evaluated physical/sexual abuse, specifically, those preceding first abuse among BD youth. We investigate past/intake/follow-up factors preceding first physical/sexual abuse among BD youth. METHODS: Childhood-onset BD participants (n = 279 youth, mean age at intake = 12, mean length of follow-up = 12 years) enrolled in the Course and Outcome of Bipolar Youth (COBY) study. Demographic, clinical and family history variables were assessed every 7 months on average using Longitudinal Interval Follow-up Evaluation and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL). Abuse was evaluated at intake using the K-SADS-PL, over follow-up with a Traumatic Events Screen. Family psychopathology was assessed using Family History Screen/Structured Clinical Interview for Diagnostic Statistical Manual-IV. RESULTS: Fifteen-percent of youth reported new-onset abuse during follow-up (62% physical, 26% sexual; 12% both). Intake predictors included more severe depressive symptoms (HR = 1.29), low socioeconomic-status (SES) in families with substance abuse (HR = 0.84) (physical abuse), and female sex (HR = 2.41) (sexual abuse). Follow-up predictors preceding physical abuse included: older age (HR = 1.42), disruptive disorders (HR = 1.39), and the interaction between low SES and family substance abuse (HR = 0.86). For sexual abuse, female sex (HR = 4.33) and a non-biologically related father presence in the household (HR = 2.76). Good relationships with friends (prospectively evaluated) protected against physical/sexual abuse (HR = 0.72/0.70, respectively). LIMITATIONS: Prospective data was gathered longitudinally but assessed retrospectively at every follow-up; perpetrator information and abuse severity were not available. CONCLUSIONS: Identifying factors temporally preceding new onset physical/sexual abuse may hold promise for identifying high-risk youth with BD.

Objective: This study evaluated the full outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) to predict traumatic brain injury (TBI) outcomes. Methods: Among 107 patients, FOUR and GCS grading systems analyzed emergency department patients within 24 hours. FOUR and GCS were assessed simultaneously. Patients were followed for 15 days/discharge/death to evaluate the results. Modified Rankin scores measured in-hospital mortality, morbidity, and stay. Results: 65.42% of patients were 25–65. 10% were under 25, and 25% were over 65. Patients were 81% male. Road traffic accidents (RTAs) (90%), falls (7.48%), and assaults (1.47%) caused TBI. 19.62% died. 85.7% of 21 non-survivors had GCS

Abstract Background Some studies have suggested the HLA-B27 gene may protect against some infections, as well as it could play a benefit role on the viral clearance, including hepatitis C and HIV. However, there is lack of SARS-CoV-2 pandemic data in spondyloarthritis (SpA) patients. Aim To evaluate the impact of HLA-B27 gene positivity on the susceptibility and severity of COVID-19 and disease activity in axial SpA patients. Methods The ReumaCoV-Brasil is a multicenter, observational, prospective cohort designed to monitor immune-mediated rheumatic diseases patients during SARS-CoV-2 pandemic in Brazil. Axial SpA patients, according to the ASAS classification criteria (2009), and only those with known HLA-B27 status, were included in this ReumaCov-Brasil’s subanalysis. After pairing them to sex and age, they were divided in two groups: with (cases) and without (control group) COVID-19 diagnosis. Other immunodeficiency diseases, past organ or bone marrow transplantation, neoplasms and current chemotherapy were excluded. Demographic data, managing of COVID-19 (diagnosis, treatment, and outcomes, including hospitalization, mechanical ventilation, and death), comorbidities, clinical details (disease activity and concomitant medication) were collected using the Research Electronic Data Capture (REDCap) database. Data are presented as descriptive analysis and multiple regression models, using SPSS program, version 20. P level was set as 5%. Results From May 24th, 2020 to Jan 24th, 2021, a total of 153 axial SpA patients were included, of whom 85 (55.5%) with COVID-19 and 68 (44.4%) without COVID-19. Most of them were men (N = 92; 60.1%) with mean age of 44.0 ± 11.1 years and long-term disease (11.7 ± 9.9 years). Regarding the HLA-B27 status, 112 (73.2%) patients tested positive. There were no significant statistical differences concerning social distancing, smoking, BMI (body mass index), waist circumference and comorbidities. Regarding biological DMARDs, 110 (71.8%) were on TNF inhibitors and 14 (9.15%) on IL-17 antagonists. Comparing those patients with and without COVID-19, the HLA-B27 positivity was not different between groups (n = 64, 75.3% vs. n = 48, 48%, respectively; p = 0.514). In addition, disease activity was similar before and after the infection. Interestingly, no new episodes of arthritis, enthesitis or extra-musculoskeletal manifestations were reported after the COVID-19. The mean time from the first symptoms to hospitalization was 7.1 ± 3.4 days, and although the number of hospitalization days was numerically higher in the B27 positive group, no statistically significant difference was observed (5.7 ± 4.11 for B27 negative patients and 13.5 ± 14.8 for B27 positive patients; p = 0.594). Only one HLA-B27 negative patient died. No significant difference was found regarding concomitant medications, including conventional or biologic DMARDs between the groups. Conclusions No significant difference of COVID-19 frequency rate was observed in patients with axial SpA regarding the HLA-B27 positivity, suggesting a lack of protective effect with SARS-CoV-2 infection. In addition, the disease activity was similar before and after the infection. Trial registration This study was approved by the Brazilian Committee of Ethics in Human Research (CONEP), CAAE 30186820.2.1001.8807, and was registered at the Brazilian Registry of Clinical Trials – REBEC, RBR-33YTQC. All patients read and signed the informed consent form before inclusion.

Abstract Background Research on the effect of pesticide exposure on health has been largely focused on occupational settings. Few reviews have synthesized the associations between dietary pesticide exposure and health outcomes in non-occupationally exposed adults. Objective We aim to summarize the evidence regarding dietary pesticide exposure and non-communicable diseases (NCD) in adults, using a systematic review of prospective studies. Methods Electronic and manual searches were performed until July 2023. The inclusion criteria were the following: 1) adults aged ≥ 18years, 2) (non)-randomized trials, prospective cohort studies, 3) dietary exposure to pesticides. A bias analysis was carried out using the Nutrition Evidence Systematic Review guidelines based on the Cochrane ROBINS-I. Results A total of 52 studies were retrieved and 6 studies that met the above criteria were included. Studies were conducted either in France or in the United States. The studies investigated the risk of cancer (n = 3), diabetes (n = 1), cardiovascular diseases (n = 1), and mortality (n = 1). The quality of the studies varied with overall grades derived from the bias analysis ranging from low to moderate bias. The level of evidence was estimated as low for the risk of cancer while the grading was not assignable for other outcomes, as only one study per outcome was available. Conclusions Although further research is warranted to examine more in depth the relationships between low-dose chronic exposure to pesticides through diet and NCD outcomes in non-occupationally-exposed adults, studies suggest a possible role of exposure to dietary pesticide on health. Standardized methodological guidelines should also be proposed to allow for comparison across studies.

Abstract Objective The effectiveness and security of radiofrequency ablation (RFA) in combination with toripalimab (anti‐PD‐1) for the treatment of recurrent hepatocellular carcinoma (HCC) was studied in this article. Methods Total of 40 patients were enrolled in the study between September 2019 and November 2021. Data follow‐up ends in April 2022. The study’s main focus is on recurrence free survival (RFS), while the secondary objectives was safety. Chi‐square tests, Kaplan‐Meier, and Cox proportional hazards models were utilized to analyze the data. Results The median follow‐up period was 21.40 months, and the median RFS was 15.40 months in the group that received combination therapy, which was statistically significantly different (HR: 0.44, p = 0.04) compared with the RFA group (8.2 months). RFS rates (RFSr) at 6, 12 and 18 months in the combination therapy groups and RFA groups were 80% vs 65%, 62.7% vs 35% and 48.7% vs 18.8%, respectively. Between the two groups, significant difference of RFSr was found at 18 months (p = 0.04). No statistical differences were observed between the two groups in terms of safeness (p > 0.05). The subgroup analysis indicated that the combination of RFA and anti‐PD‐1 led to better RFS than RFA alone. Moreover, patients benefited more from combination therapy in the groups younger than 60 years (HR: 0.26, p = 0.018), male (HR: 0.32, p = 0.028) and Child‐Pugh grade A (HR: 0.38, p = 0.032). Conclusions Combining RFA with anti‐PD‐1 showed improved RFS and was deemed safe for patients with recurrent HCC who had previously undergone RFA treatment alone.

Aims: This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up. Methods: From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed. Results: At 15 years, 28 patients were lost to follow-up (6.1%) and 221 patients (51.9%) had died, with the mean age of the remaining cohort reducing by four years. PROMs response rates among surviving patients were: one-year 63%; five-year 72%; ten-year 94%; and 15-year 59%. OKS and SF-12 scores changed significantly over 15 years (p < 0.001). The mean improvement in OKS was 18.8 (95% confidence (CI) 16.7 to 19.0) at one year. OKS peaked at five years (median 43 years) declining thereafter (p < 0.001), though at 15 years it remained 17.5 better than preoperatively. Age and sex did not alter this trajectory. A quarter of patients experienced a clinically significant decline (≥ 7) in OKS from five to ten years and from ten to 15 years. The SF-12 physical component score displayed a similar trajectory, peaking at one year (p < 0.001). Patient satisfaction was 88% at one, five, and ten years, and 94% at 15 years. In all, 15-year Kaplan-Meier survival was 97.6% (95% CI 96.0% to 99.2%) for any revision, and 98.9% (95% CI 97.9% to 99.9%) for aseptic revision. Conclusion: Improvements in PROMs were significant and maintained following single radius TKA, with OKS peaking at five years, and generic physical health peaking at one year. Patient satisfaction remained high at 15 years, at which point 2.4% had been revised. Cite this article: Bone Jt Open 2023;4(10):808–816.

Background: Limited reports from prospective human studies investigated the possible role of vitamin K in the development of lung cancer although vitamin K’s anticarcinogenic activities were verified from several in vitro and in vivo studies. We investigated the associations between total vitamin K intake from food and the development of lung cancer based on this large prospective cohort study. Methods: A validated food frequency questionnaire was used to examine vitamin K intake among 42,166 (16,341 men and 25,825 women) at the Japan Collaborative Cohort Study’s baseline (1988–1990). Hazard ratios (HRs) and 95% confidence intervals (CIs) of incident lung cancer were calculated using the Cox proportional hazard regression method based on vitamin K consumption quartiles. Results: 430 cases (308 males and 122 women) of lung cancer were documented during a total of 564,127 person-years of follow-up (median follow-up, 14.6 years). Vitamin K consumption was shown to be inversely related to lung cancer risk; the multivariable hazard ratio [HR] for the highest versus lowest quartiles was 0.67 (95% confidence interval [CI], 0.46–0.96; P for trend = 0.010). This relationship appears to be stronger in males (HR 0.62; 95% CI, 0.40–0.96; P for trend = 0.016) than in females (HR 0.82; 95% CI, 0.42–1.61; P for trend = 0.39) (P for interaction = 0.012), and in ever smokers (HR 0.57; 95% CI, 0.36–0.91; P for trend = 0.006) than in never smokers (HR 0.79; 95% CI, 0.40–1.55; P for trend = 0.37) (P for interaction = 0.30). The individuals’ age, body mass index, or alcohol consumption status had no effect on the observed connection. Conclusion: Vitamin K consumption reduces the risk of lung cancer. More research is needed to clarify the molecular processes behind this connection.

Abstract Background The influence of sarcopenic obesity (SO) on overall survival in older adults with hypertension has not been addressed. The aim of this study was to investigate the prevalence and mortality predictive value of various body composition phenotypes, focusing mainly on SO, in older adults with hypertension. Methods We included 1105 hypertensive patients aged ≥ 60 years from the National Health and Nutrition Examination Survey 1999–2004. Sarcopenia was broadly defined based on low lean mass (LLM; as measured by dual-energy X-ray absorptiometry), and was defined using appendicular lean mass (ALM) divided by height squared (ALM/height2), weight (ALM/weight), and body mass index (BMI; ALM/BMI), respectively. Obesity was defined as BMI ≥ 30 kg/m2, body fat percentage ≥ 30/42%, or waist circumference ≥ 102/88 cm. The prevalence of LLM with obesity was estimated according to each ALM index (ALMI). Multivariable Cox regression analysis and sensitivity analysis were used to examine the association between various body composition phenotypes and all-cause mortality. Results In older adults with hypertension, the prevalence of LLM with obesity by the ALM/height2 index (9.8%) was lower relative to the ALM/weight (11.7%) and ALM/BMI indexes (19.6%). After a median follow-up of 15.4 years, 642 deaths occurred. In the fully adjusted models, LLM with obesity was significantly associated with a higher risk of all-cause mortality (hazard ratio [HR] 1.69, 95% confidence interval [CI] 1.14–2.49, P = 0.008; HR 1.48, 95% CI 1.04–2.10, P = 0.028; HR 1.30, 95% CI 1.02–1.66, P = 0.037; respectively) compared with the normal body phenotype, with no statistical differences found in individuals with LLM or obesity alone. Sensitivity analysis confirmed the robustness of the results. Conclusions The prevalence of LLM with obesity markedly differed in older adults with hypertension according to the 3 different ALMIs, varying from 9.8%, 11.7%, to 19.6%. Patients with both LLM and obesity had a higher risk of all-cause mortality. Further large, prospective, cohort studies are warranted to validate these findings and uncover underlying mechanisms.

Objective The proper selection of the lower instrumented vertebra (LIV) remains controversial in the surgical treatment of Scheuermann's disease and there is a paucity of studies investigating the clinical outcomes of fusion surgery when selecting the vertebra one level proximal to the sagittal stable vertebra (SSV‐1) as LIV. The purpose of this study is to investigate whether SSV‐1 could be a valid LIV for Scheuermann kyphosis (SK) patients with different curve patterns. Methods This was a prospective study on consecutive SK patients treated with posterior surgery between January 2018 and September 2020, in which the distal fusion level ended at SSV‐1. The LIV was selected at SSV‐1 only in patients with Risser >2 and with LIV translation less than 40 mm. All of the patients had a minimum of 2‐year follow‐up. Patients were further grouped based on the sagittal curve pattern as thoracic kyphosis (TK, n = 23) and thoracolumbar kyphosis (TLK, n = 13). Radiographic parameters including global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis (SVA), LIV translation, pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured preoperatively, postoperatively, and at the latest follow‐up. The intraoperative and postoperative complications were recorded. The Scoliosis Research Society (SRS)‐22 scores were performed to evaluate clinical outcomes. Results A total of 36 patients were recruited in this study, with 23 in the TK group and 13 in the TLK group. In TK group, the GK was significantly decreased from 80.8° ± 10.1° to 45.4° ± 7.7° after surgery, and was maintained at 45.3° ± 8.6° at the final follow‐up. While in the TLK group, GK was significantly decreased from 70.7° ± 9.2° to 39.1° ± 5.4° after surgery (p 2 and LIV translation less than 40 mm.

Objectives Adapting to stress over time is a process involving various cognitive and emotional assessments; it also depends on the objective situation related to working conditions, as well as on individual factors. The aim of this paper is to outline the dynamic nature of stress experienced by workers employed on oil rigs over a period of 20 years. The presented research is part of a larger project and concerns subjective stress. Material and Methods Longitudinal studies included the analysis of data regarding the period of 1993–2014. They concerned 167 Polish oil rig workers, all men; the average age at the beginning of the study was 29 years. Each employee was surveyed at least 4 times over a period of 20 years at intervals of 4–6 years in the workplace. The subjective level of stress at work (based on the Subjective Job Evaluation Questionnaire ) and the level of declared stress (based on the Stress Survey ) were examined. Results Oil rig workers show different adaptations to stress over a long term, depending on their subjective perception of stress. Baseline stress levels can vary from person to person over the years. The first group was characterized by high initial stress, but the stress decreased systematically over 20 years (“stress resisting”). Employees from the second group were characterized by low initial stress, but declared a systematic increase in stress in the same period (“stress sensitizing”). Finally, employees from the third group adapted to stress in a flexible way, with subjective stress being most strongly associated with objective stress (“flexible group”). Conclusions The presented prospective study showed differences between the subjective levels of stress depending on the distinguished groups over 20 years, i.e., between-group and intra-group variability. The method of prospective research shows that the perception of stress at work is a dynamic process and it changes over time. Int J Occup Med Environ Health. 2023;36(4):477–92

Abstract Purpose Narrow-diameter implants facilitate single‐tooth restoration when interdental or inter-implant spaces and bone volume are inadequate for using standard diameter implants. This study reports the short-term data on the clinical safety and performance of a bone-level-tapered two-piece implant with a 2.9 mm diameter in the clinical practice setting. This study was retrospectively registered on March 1st, 2016 (NCT02699866). Methods Implants were placed in partially healed extraction sockets of the central and lateral incisors in the mandible and lateral incisors in the maxilla for single-tooth replacement. The primary outcome was to assess implant survival at 12 months after placement. Secondary outcomes included implant success, pink esthetic score, marginal bone-level changes, and safety. Results Twenty four males and 17 females with a mean age of 44.5 (± 18.3 standard deviation) received the implant. Three out of 41 implants were lost yielding a survival rate of 92.7% (95%-CI: 79.0%; 97.6%) at 1 year. One patient reported an ongoing foreign body sensation, pain, and/or dysesthesia at month 12. The average pink esthetic score at 6 months was 11.2 (95%-CI: 10.5; 11.9). The bone level was stable with a mean bone-level change of—0.3 mm (± 0.42 mm standard deviation) at 1 year after implantation. No serious adverse events or adverse device events were reported. Conclusions The use of a 2.9 mm diameter bone-level-tapered implant is a safe and reliable treatment option for narrow tooth gaps at the indicated locations. Overall performance and good survival rates support their use in cases, where wider implants are unsuitable. Graphical abstract

Abstract Background There is a paucity of research investigating the harms associated with orthopaedic knee scooter (OKS) use and patient safety perceptions. This prospective study aimed to define the prevalence of OKS-related injuries, describe the patient perceptions of OKS safety, and identify potential risk factors. Methods This study was conducted at a single foot and ankle fellowship-trained surgeon’s community-based clinic from 6/2020 to 4/2021 and enrolled 134 patients. Our primary outcome was an OKS-related event (injury or fall) and informed an a priori power analysis. Point estimate of association magnitude was calculated as an odds ratio (OR) for statistically and clinically significant associations. Results There were 118 (88%) patients eligible for analysis; fourteen enrolled patients did not use OKS, and two withdrew. The prevalence of patient falls was 37% (44/118), and the prevalence of patient injury was 15% (18/118). Four percent of patients would not recommend OKS and 8% would not use an OKS again. Sedentary lifestyle increased risk (OR = 4.67, 1.52–14.35 95 CI) for OKS-related injury. Conclusions Despite a high prevalence of patient falls (37%), there is a low prevalence of injury (15%) and a favorable perception of OKS safety. Sedentary lifestyles may be a risk factor for OKS-related injury and should be considered in the development of a risk model.

Background: There is uncertainty about the utility of multiphase computed tomography (CT) compared with single-phase CT in the routine examination of patients with visible haematuria (VH). Objective: To compare the accuracies of single nephrographic phase (NP) CT and four-phase CT in detecting urothelial carcinoma (UC). Design, setting, and participants: This was a single-centre, prospective, paired, noninferiority study of patients with painless VH referred for CT before cystoscopy between September 2019 and June 2021. Patients were followed up for 1 yr to ascertain UC diagnosis. Intervention: All patients underwent four-phase CT (control), from which single NP CT (experimental) was extracted. Both were independently assessed for UC. Outcome measurements and statistical analysis: The primary outcome was the difference in accuracy between the control and experimental CT using a 7.5% noninferiority limit. Histologically verified UC defined a positive reference standard. Secondary outcomes included differences in sensitivity, specificity, negative (NPV) and positive (PPV) predictive values, and area under the curve (AUC). All results are reported per patient. Results and limitations: Of the 308 patients included, UC was diagnosed in 45 (14.6%). The difference in accuracy between the control and experimental CT was 1.9% (95% confidence interval −2.8 to 6.7), demonstrating noninferiority. Sensitivity was 93.3% versus 91.1%, specificity was 83.7% versus 81.8%, NPV was 98.7% versus 98.2%, PPV was 49.4% versus 46.1%, and AUC was 0.96 versus 0.94 for the control versus experimental CT. Limitations included a low number of UC cases and no definite criteria for selecting a noninferiority limit. Conclusions: The accuracy of NP CT is not inferior to that of four-phase CT for detecting UC. Patient summary: This study shows that a computed tomography (CT) examination with only one contrast phase is no worse than a more complex CT examination for detecting cancer in the urinary tract among patients presenting with visible blood in the urine.

BackgroundAutism spectrum disorder (ASD) involves complex genetics interacting with the perinatal environment, complicating the discovery of common genetic risk. The epigenetic layer of DNA methylation shows dynamic developmental changes and molecular memory of in utero experiences, particularly in placenta, a fetal tissue discarded at birth. However, current array-based methods to identify novel ASD risk genes lack coverage of the most structurally and epigenetically variable regions of the human genome.ResultsWe use whole genome bisulfite sequencing in placenta samples from prospective ASD studies to discover a previously uncharacterized ASD risk gene, LOC105373085, renamed NHIP. Out of 134 differentially methylated regions associated with ASD in placental samples, a cluster at 22q13.33 corresponds to a 118-kb hypomethylated block that replicates in two additional cohorts. Within this locus, NHIP is functionally characterized as a nuclear peptide-encoding transcript with high expression in brain, and increased expression following neuronal differentiation or hypoxia, but decreased expression in ASD placenta and brain. NHIP overexpression increases cellular proliferation and alters expression of genes regulating synapses and neurogenesis, overlapping significantly with known ASD risk genes and NHIP-associated genes in ASD brain. A common structural variant disrupting the proximity of NHIP to a fetal brain enhancer is associated with NHIP expression and methylation levels and ASD risk, demonstrating a common genetic influence.ConclusionsTogether, these results identify and initially characterize a novel environmentally responsive ASD risk gene relevant to brain development in a hitherto under-characterized region of the human genome.

Introduction: The potential utility of inflammatory and hemodynamic plasma biomarkers for the prediction of incident lower extremity arterial disease (LEAD), carotid artery stenosis (CAS), isolated atherosclerotic disease without concomitant abdominal aortic aneurysm (AAA), and isolated AAA without concomitant atherosclerotic disease has not yet been integrated in clinical practice. The main objective of this prospective study was to find predictive plasma biomarkers for cardiovascular disease and to evaluate differences in plasma biomarker profiles between asymptomatic and symptomatic CAS, as well as between isolated atherosclerotic disease and isolated AAA. Methods: Blood samples collected at baseline from participants in the prospective Malmö Diet and Cancer study (MDCS) cardiovascular cohort (n = 5550 middle-aged individuals; baseline 1991–1994) were used for plasma biomarker analysis. Validation of each incident cardiovascular diagnosis was performed by random sampling. Cox regression analysis was used to calculate hazard ratios (HRs) per one standard deviation increment of each respective log-transformed plasma biomarker with 95% confidence intervals (CI). Results: Adjusted lipoprotein-associated phospholipase A2 (Lp-PLA2) activity (HR 1.33; CI 1.17–1.52) and mass (HR 1.20; CI 1.05–1.37), C-reactive protein (CRP) (HR 1.55; CI 1.36–1.76), copeptin (HR 1.46; CI 1.19–1.80), N-terminal pro-B-type natriuretic peptide (N-BNP) (HR 1.28; 1.11–1.48), and cystatin C (HR 1.19; 95% 1.10–1.29) were associated with incident symptomatic LEAD. Adjusted N-BNP (HR 1.59; CI 1.20–2.11), mid-regional proadrenomedullin (HR 1.40; CI 1.13–1.73), cystatin C (HR 1.21; CI 1.02–1.43), and CRP (HR 1.53; CI 1.13–1.73) were associated with incident symptomatic but not asymptomatic CAS. Adjusted HR was higher for Lp-PLA2 (mass) for incident isolated AAA compared to for isolated atherosclerotic disease. Conclusions: Plasma biomarker profile data support that subclinical vascular inflammation and cardiovascular stress seem to be relevant for the development of atherosclerotic disease and AAA.

HIV-associated neurocognitive disorder (HAND) remains prevalent despite antiretroviral therapy and involves white matter damage in the brain. Although iron is essential for myelination and myelin maintenance/repair, its role in HAND is largely unexplored. We tested the hypotheses that cerebrospinal fluid (CSF) heavy-chain ferritin (Fth1) and transferrin, proteins integral to iron delivery and myelination, are associated with neurocognitive performance in people with HIV (PWH). Fth1, transferrin, and the pro-inflammatory cytokines TNF-α and IL-6 were quantified in CSF at baseline (entry) in 403 PWH from a prospective observational study who underwent serial, comprehensive neurocognitive assessments. Associations of Fth1 and transferrin with Global Deficit Score (GDS)-defined neurocognitive performance at baseline and 30-42 months of follow-up were evaluated by multivariable regression. While not associated with neurocognitive performance at baseline, higher baseline CSF Fth1 predicted significantly better neurocognitive performance over 30 months in all PWH (p < 0.05), in PWH aged < 50 at 30, 36, and 42 months (all p < 0.05), and in virally suppressed PWH at all three visit time-points (all p < 0.01). Higher CSF transferrin was associated with superior neurocognitive performance at all visits, primarily in viremic individuals (all p < 0.05). All associations persisted after adjustment for neuro-inflammation. In summary, higher CSF Fth1 is neuroprotective over prolonged follow-up in all and virally suppressed PWH, while higher CSF transferrin may be most neuroprotective during viremia. We speculate that higher CSF levels of these critical iron-delivery proteins support improved myelination and consequently, neurocognitive performance in PWH, providing a rationale for investigating their role in interventions to prevent and/or treat HAND.

Aims: The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip, knee, ankle, and shoulder arthroplasty in an active golfing population. Secondary aims will include determining the timing of return to golf, changes in ability, handicap, and mobility, and assessing joint-specific and health-related outcomes following surgery. Methods: This is a multicentre, prospective, longitudinal study between the Hospital for Special Surgery, (New York City, New York, USA) and Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, (Edinburgh, UK). Both centres are high-volume arthroplasty centres, specializing in upper and lower limb arthroplasty. Patients undergoing hip, knee, ankle, or shoulder arthroplasty at either centre, and who report being golfers prior to arthroplasty, will be included. Patient-reported outcome measures will be obtained at six weeks, three months, six months, and 12 months. A two-year period of recruitment will be undertaken of arthroplasty patients at both sites. Conclusion: The results of this prospective study will provide clinicians with accurate data to deliver to patients with regard to the likelihood of return to golf and timing of when they can expect to return to golf following their hip, knee, ankle, or shoulder arthroplasty, as well as their joint-specific functional outcomes. This will help patients to manage their postoperative expectations and plan their postoperative recovery pathway. Cite this article: Bone Jt Open 2023;4(7):490–495.

Abstract Background To combine the benefits of hospice and palliative care, the integration of both seems self-evident. Aim of this study was to explore clinical staff’s and volunteers’ expectations and concerns of the first university hospice in Germany planning for implementation. Methods Staff and volunteers of the Department of Palliative Medicine of the University Hospital in Cologne received questionnaires and were interviewed following three themes of interest: opportunities, challenges, general criteria. Questionnaire results were analyzed descriptively using mean ± SD and percentages, open-ended questions and interviews were analysed using content analysis. Results A total of 28/100 questionnaires was returned (n = 17 clinical staff, n = 11 volunteers) and 18 interviews conducted. The majority of both clinical staff and volunteers estimated the need for a university inpatient hospice as rather to very high (64.7% and 81.8%, respectively). Our findings revealed that most clinical staff and volunteers anticipated improvements with the intended university inpatient hospice, although their expectations were divided between both hope and concern while adhering to legal and general requirements, which they feared might oppose such a project. Participants expressed concern about leadership and staffing plans, albeit most pronounced among clinical staff. Nursing staff repeatedly articulated concerns about being interchanged between the palliative care ward and the intended inpatient hospice while they had explicitly chosen to work in palliative medicine. Conclusions The overall high level of anticipated progress and excitement is very encouraging. Albeit serious concerns were mentioned, our results indicate that all participants believe in a positive impact and highlight the need of developing a solid concept. In order to implement such a hospice within a university setting, it is important to consider multilevel contextual factors such as system-level factors (funding, external and internal regulations), organization-level factors (leadership, staff motivation), and patient-level factors (adaptability to patients' needs). Our findings illustrate the importance of understanding the context of practice before implementation. Our pre-implementation study helps identify critical views from staff members and volunteers that may hinder or advance the implementation. Trial registration The study was registered at the German Clinical Trials Register (#DRKS00021258) on April 17th 2020.

Abstract Objectives To evaluate how peri-implant hard and soft tissue height (BH, MH) alter after final prostheses placement related to labial hard and soft tissue thickness (BW, MW). Materials and methods Forty-five platform-switched implants were classified into four groups according to BW and MW: type 1 (thick BW and thick MW), type 2 (thick BW and thin MW), type 3 (thin BW and thick MW), type 4 (thin BW and thin MW). Tissue resorption was evaluated on cone-beam CT images taken at final prostheses placement, at 1-year follow-up, and at 2-year follow-up. Kruskal–Wallis test and post hoc Mann–Whitney test were applied; significance was set to 0.05. Results BH resorption was 0.13 ± 0.12 mm in type 1, 0.26 ± 0.17 mm in type 2, 0.09 ± 0.09 mm in type 3, 0.94 ± 0.19 mm in type 4. Differences between type 1 and 4, type 2 and 4, and type 3 and 4 were statistically significant (p

Brewers’ spent grain (BSG) is an important waste produced by beer companies and has a high potential to be transformed into commercial by-products. The present paper reports a forecasting technology study with the aid of bibliographic review and patent analysis tools aiming to investigate the maturity of certain technologies, considering the use of BSG on a closed-loop biorefinery and circular bioeconomy concept integrated into a brewery. To evaluate the possibilities of production of high-added-value products in Brazil, we present an overview of BSG’s scientific, technological, and marketing products and applications. The comparison between the numbers of articles versus patents shows that the solutions proposed by research articles are not being transformed into maturated viable technologies. The results suggest that there is a gap between the scientific research in the institutions and their applications in the industry, which lead to the destination of BSG for more economically attractive investments when compared with research in Brazil. Ultimately, from the carried-out analysis, it is possible to propose a brewing process connected to the biorefinery system, showing its possibility in the newly arising brewery industries.

Abstract Background We mainly evaluated whether preserving the inferior mesenteric artery (IMA) sheath to dissecting IMA root lymph nodes (also called No.253 lymph nodes) would benefit patients in terms of comparable lymph-node yield removed during operation and postoperative complications in laparoscopic radical resection of rectal cancer. Methods This is a prospective study included 141 rectal cancer patients who received laparoscopic radical resection during September 2018 to December 2020. All patients were randomly assigned to the preserved group (n = 71) and the peeled group (n = 70). The baseline characteristics, pathological features, intraoperative and postoperative data outcomes and complications were analyzed by independent samples t test, chi-square test or Fisher’s exact test between the 2 groups. Results The baseline characteristic and pathological features had no statistical difference between the 2 groups. The preserved group had a shorter operative time (P = 0.002), a shorter lymph node dissection time (P 0.05) in regard to the total number of lymph nodes cleared, positive lymph nodes, bleeding, anastomotic leakage, pneumonia, wound infection, abscess, ileus, urinary retention, urinary tract infection and chyle leakage. Conclusion Preserving of the IMA sheath in laparoscopic radical surgery for rectal cancer will reduce the total operation time and the length of hospitalization. This surgical method could lead to lower complication rate and faster recovery. Trial registration The study was approved by the Ethics Committee of The First Affiliated Hospital of Wannan Medical College and registered by the China Clinical Trials Registry (ChiCTR2200060830, Date of Registration:2022-06-12 -retrospective registration) http://www.chictr.org.cn/index.aspx .

Haoyuan Xu,&ast; Wanpeng Li,&ast; Huankang Zhang, Huan Wang, Li Hu, Xicai Sun, Dehui Wang Department of Otolaryngology - Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, Shanghai, 200031, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Xicai Sun; Dehui Wang, Department of Otolaryngology - Head and Neck Surgery, Affiliated Eye, Ear, Nose, and Throat Hospital, Fudan University, 83 Fen Yang Road, Shanghai, People’s Republic of China, Email laryngeal@163.com; wangdehuient@sina.comObjective: To investigate the effects of endoscopic endonasal surgery (EES) on longitudinal quality of life (QoL) in patients with malignant tumors of the anterior skull base.Methods: Eligible patients prospectively completed the Anterior Skull Base Surgery Questionnaire (ASBQ) and the 22-item Sino-Nasal Outcome Test (SNOT-22) questionnaires in referring to 3 different periods throughout their treatment and recovery.Results: Forty patients were included. The median volume coronal maximum length of the tumor was 3.6 cm (95% CI 2.7– 4.1cm). Overall QoL significantly worsened at 1 month postoperatively but returned to baseline after 1 year. Unrelieved symptoms in specific domains prompted further evaluation of individual items. Transient worsening of taste (p=0.011) and olfaction (p=0.004) lasted for 1 month but gradually relieved within the first postoperative year, but vision consistently worsened over the course of the treatment (p=0.126). Age> 50 years (p< 0.001), comorbidities (p< 0.001), tumor necrosis (p< 0.001) and recurrence (p=0.001) were associated with worse preoperative QoL. Poor long-term QoL was noted in those undergoing adjuvant therapy (p=0.032). Overall ASBQ scores (p=0.024), subdomain scores in specific symptoms (p=0.016), and vision scores (p=0.009) were worse only in patients with the greater coronal maximum diameter at 1-month postoperatively. Greater coronal maximum diameter was related to worse preoperative subdomain scores regarding specific symptoms (p=0.030) and decreased postoperative long-term decreased vision scores (p=0.014).Conclusion: Long-term site-specific and sinonasal QoL eventually stabilized after EES. Greater coronal maximum diameter was significantly associated with worsened vision function. Temporarily worse olfactory, vision, and taste function may be tied to decreased short-term QoL.Keywords: quality of life, endoscopic endonasal surgery, anterior skull base, malignant tumors, prospective study

Summary: Objective: Although accumulating evidence suggests that unsaturated fatty acids play an important role in the development of insulin resistance (IR), prospective epidemiologic data on this relationship are scarce. We examined the association of baseline circulating unsaturated fatty acids with subsequent changes in insulin resistance in a Japanese working population. Methods: Participants were 1143 workers aged 22–71 years who were free from severe diseases at baseline and participated in a 3-year follow-up survey. Unsaturated fatty acid concentrations in serum were measured using a gas chromatograph. Multivariable linear regression models were used to estimate mean homeostatic model assessment of insulin resistance (HOMA-IR) scores at follow-up, with adjustment for baseline HOMA-IR and potential confounding variables. Results: Higher concentrations of total n-6 polyunsaturated fatty acids (PUFAs) and linoleic acid at baseline were associated with significantly lower HOMA-IR at follow-up (P for trend=0.001). Meanwhile, higher concentrations of total monounsaturated fatty acids (MUFAs) and oleic acid and lower concentrations of nervonic acid were significantly associated with higher HOMA-IR at follow-up (P for trend ≤0.05). No clear association was found for total or individual n-3 PUFAs. Conclusions: The present results suggest that n-6 PUFAs, especially linoleic acid, may play a protective role against the development of IR. Of MUFAs, oleic acid may worsen IR, while nervonic acid may improve it.

Summary: Background: Previous metabolic profiling of liver cancer has mostly used untargeted metabolomic approaches and was unable to quantitate the absolute concentrations of metabolites. In this study, we examined the association between the concentrations of 186 targeted metabolites and liver cancer risk using prediagnostic plasma samples collected up to 14 years prior to the clinical diagnosis of liver cancer. Methods: We conducted a nested case–control study (n = 322 liver cancer cases, n = 322 matched controls) within the Shanghai Men's Health Study. Conditional logistic regression models adjusted for demographics, lifestyle factors, dietary habits, and related medical histories were used to estimate the odds ratios. Restricted cubic spline functions were used to characterise the dose–response relationships between metabolite concentrations and liver cancer risk. Findings: After adjusting for potential confounders and correcting for multiple testing, 28 metabolites were associated with liver cancer risk. Significant non-linear relationships were observed for 22 metabolites. The primary bile acid biosynthesis and phenylalanine, tyrosine and tryptophan biosynthesis were found to be important pathways involved in the aetiology of liver cancer. A metabolic score consisting of 10 metabolites significantly improved the predictive ability of traditional epidemiological risk factors for liver cancer, with an optimism-corrected AUC increased from 0.84 (95% CI: 0.81–0.87) to 0.89 (95% CI: 0.86–0.91). Interpretation: This study characterised the dose–response relationships between metabolites and liver cancer risk, providing insights into the complex metabolic perturbations prior to the clinical diagnosis of liver cancer. The metabolic score may serve as a candidate risk predictor for liver cancer. Funding: National Key Project of Research and Development Program of China [2021YFC2500404, 2021YFC2500405]; US National Institutes of Health [subcontract of UM1 CA173640].

Abstract Objective: Inflammation is implicated in chronic diseases including cancer and CVD, which are major causes of mortality. Diet can influence inflammation status. We therefore examined whether the inflammatory potential of a person’s diet is associated with mortality. Design: The inflammatory potential of the usual diet was assessed by calculating Dietary Inflammatory Index (DII) scores from repeated FFQ data (collected in 1992, 1994 and 1996), placing each participant’s diet on a continuum from anti- to pro-inflammatory. DII scores were analysed as a continuous variable and as categories by creating quartile groups. Death registry data were used to ascertain all-cause mortality and separately mortality from CVD, cancers and other causes between 1992 and 2022. Cox proportional hazard regression analysis was used to calculate adjusted hazard ratios (HR) with 95 % CI, comparing higher and lowest quartile groups, or HR change per one DII unit increase. Setting: Nambour, Australia. Participants: A community-based sample of 1440 adults aged 25–75 years. Results: During follow-up, 488 participants died, including 188 from CVD, 151 from cancer and 170 from other causes. Participants in the most pro-inflammatory diet group were at increased risk of all-cause mortality (HRQ4 v. Q1 = 1·55; 95 % CI 1·19, 2·03; P < 0·001) and other-cause mortality (HRQ4 v. Q1 = 1·69; 95 % CI 1·12, 2·54; P 0·01). A one-unit increase in DII score was associated with a 36 % increased risk of CVD among those younger than 55 years of age (HR for a one-unit increase in DII score 1·36, 95 % CI 1·04, 1·78). The risk of cancer mortality was also increased for those with a more pro-inflammatory diet in age ≤ 55 years (HR for a one-unit increase in DII score 1·20, 95 % CI 1·02, 1·40) and age 56–65 years (HR for a one-unit increase in DII score 1·11, 95 % CI 1·00, 1·23). Conclusions: A pro-inflammatory diet increases the risk of all-cause mortality. Our results support the promotion of anti-inflammatory diets to help promote longevity.

Abstract Aims Adverse factors in the psychosocial work environment are associated with the onset of depression among those without a personal history of depression. However, the evidence is sparse regarding whether adverse work factors can also play a role in depression recurrence. This study aimed to prospectively examine whether factors in the psychosocial work environment are associated with first-time and recurrent treatment for depression. Methods The study included 24,226 participants from the Danish Well-being in Hospital Employees study. We measured ten individual psychosocial work factors and three theoretical constructs (effort–reward imbalance, job strain and workplace social capital). We ascertained treatment for depression through registrations of hospital contacts for depression (International Statistical Classification of Diseases and Related Health Problems version 10 [ICD-10]: F32 and F33) and redeemed prescriptions of antidepressant medication (Anatomical Therapeutic Chemical [ATC]: N06A) in Danish national registries. We estimated the associations between work factors and treatment for depression for up to 2 years after baseline among those without (first-time treatment) and with (recurrent treatment) a personal history of treatment for depression before baseline. We excluded participants registered with treatment within 6 months before baseline. In supplementary analyses, we extended this washout period to up to 2 years. We applied logistic regression analyses with adjustment for confounding. Results Among 21,156 (87%) participants without a history of treatment for depression, 350 (1.7%) had first-time treatment during follow-up. Among the 3070 (13%) participants with treatment history, 353 (11%) had recurrent treatment during follow-up. Those with a history of depression generally reported a more adverse work environment than those without such a history. Baseline exposure to bullying (odds ratio [OR] = 1.72, 95% confidence interval [95% CI]: 1.30–2.32), and to some extent also low influence on work schedule (OR = 1.27, 95% CI: 0.97–1.66) and job strain (OR = 1.24, 95% CI: 0.97–1.57), was associated with first-time treatment for depression during follow-up. Baseline exposure to bullying (OR = 1.40, 95% CI: 1.04–1.88), lack of collaboration (OR = 1.31, 95% CI: 1.03–1.67) and low job control (OR = 1.27, 95% CI: 1.00–1.62) were associated with recurrent treatment for depression during follow-up. However, most work factors were not associated with treatment for depression. Using a 2-year washout period resulted in similar or stronger associations. Conclusions Depression constitutes a substantial morbidity burden in the working-age population. Specific adverse working conditions were associated with first-time and recurrent treatment for depression and improving these may contribute to reducing the onset and recurrence of depression.

Central obesity has increased rapidly over the past decade and posed a substantial disease burden worldwide. Exposure to metals/metalloids has been acknowledged to be involved in the development of central obesity through regulation of cortisol, insulin resistance, and glucocorticoid receptor reduction. Despite the importance, it is lack of prospective study which comprehensively evaluate the relations between multiple metals exposure and central obesity. We explored the prospective associations of plasma metal concentrations with central obesity in a prospective study of the Dongfeng-Tongji cohort. The present study included 2127 participants with a 6.87-year mean follow-up duration. We measured 23 plasma metal/metalloid concentrations at baseline. The associations between metals and incident central obesity were examined utilizing the Cox proportional hazard regression in single and multiple metals models. Additionally, we applied elastic net (ENET), Bayesian kernel machine regression (BKMR), plasma metal score (PMS), and quantile-based g-computation (Qgcomp) models to explore the joint associations of metal mixtures with central obesity. After adjusting potential confounders, we found significant associations of plasma manganese (Mn) and thallium (Tl) concentrations with a higher risk of central obesity, whereas plasma rubidium (Rb) concentration was associated with a lower risk of central obesity both in single and multiple metals models (all FDR