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Purpose: This study aimed to identify novel prognostic factors for Morbihan disease (MD) treatment outcomes and evaluate the efficacy of combination therapy in an Asian population, addressing the gaps in current understanding of this rare condition., Methods: We conducted a retrospective analysis of MD patients diagnosed and treated at a tertiary hospital between 2017 and 2023. Patients received combinations of oral medications (tetracycline, isotretinoin, corticosteroids), topical treatments (tacrolimus, ivermectin), and intralesional steroid injections. Treatment response (TR) was defined as complete symptom remission, while partial remission or recurrence was considered a poor response (PR). Clinical, histological, and biochemical parameters were analyzed to identify prognostic factors., Results: The study included 24 patients (18 men; mean age 61.3 years). Ten patients (41.7%) achieved TR, while 14 (58.3%) showed PR. Significant prognostic factors for TR included shorter symptom duration (≤ 3 months, p = 0.016), lower LDL cholesterol levels (≤ 89 mg/dL, p = 0.046), combination treatment with oral and topical medications (p = 0.033 at 6 months), and partial response at 1 month (p = 0.017). GLMM analysis identified the number of visits (p < 0.001), symptom duration (p = 0.020), and dyslipidemia (p = 0.006) as significant prognostic factors. Histologically, perivascular and perifollicular lymphocytic infiltration were the most common findings (83.3%). Notably, 50% of patients were ANA-positive, challenging previous diagnostic criteria., Conclusion: This study identifies novel prognostic factors for favorable outcomes in MD, including early intervention and lipid management. Combination therapy, particularly with tacrolimus ointment, shows promise in improving treatment responses. These findings suggest a potential link between lipid metabolism and MD pathophysiology, opening new avenues for targeted therapies., Competing Interests: Declarations Ethics approval and consent to participate All procedures involving human participants in this study were conducted in accordance with the ethical standards of the institutional and/or national research committees, as well as with the 1964 Declaration of Helsinki and its subsequent amendments or comparable ethical standards. This study was approved by the Institutional Review Board of Pusan National University Hospital (IRB no. 2105-040-103). Informed consent was obtained from all participants included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: The objective of this study is to evaluate the impact of using International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) (IG-21) growth standards compared with Fenton growth charts on birthweight classification in a multiethnic newborn cohort in Singapore., Design: Cross-sectional study., Setting: KK Women's and Children's Hospital, Singapore., Patients: Study population included 2541 babies born between 16 December 2019 and 16 March 2020., Interventions: None., Main Outcome Measures: Birthweight classifications of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) were assessed using IG-21 and Fenton growth charts. The level of agreement between the two charts was measured using Cohen's kappa coefficient (K)., Results: Of 2541 neonates, 171 (6.7%) had discordant birthweight classifications. The kappa coefficient indicated moderate overall agreement (K=0.79) between the charts, with decreasing agreement from preterm (K=0.88) to full-term categories (K=0.71). The largest discordance was observed in 98 (60.5%) neonates classified as LGA by IG-21 but AGA by Fenton. In comparison, 60 (2.9%) neonates classified as AGA by IG-21 were SGA by Fenton, while 13 (4.6%) were SGA by IG-21 but AGA by Fenton., Conclusions: The study found discrepancies in birthweight classification between IG-21 and Fenton growth charts, with Fenton charts overclassifying SGA and underclassifying LGA in our study population. These findings suggest the potential need to integrate IG-21 growth standards into local practice to improve accuracy in neonatal growth assessment. Further research is necessary to evaluate the clinical implications of these discordant classifications on neonatal outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To describe Light Adjustable Lens (RxSight, Inc) (LAL) visual and refractive outcomes in a Japanese patient population with and without prior refractive surgery., Methods: In this retrospective chart review of patients with cataract in a private eye clinic, 34 eyes from 21 patients underwent cataract surgery with LAL implantation. Eyes underwent light treatment to adjust the patients' refraction after implantation to meet individual visual goals. Standard visual and refractive outcomes were collected. Contrast sensitivity (to assess quality of vision), clinical defocus and vergence curves (to assess range of vision), and patient satisfaction were also collected., Results: The mean prediction error of the light adjustment was -0.04 ± -0.48. Thirty-one eyes (91%) and 33 eyes (97%) were within ±0.25 and ±0.50 diopters (D) of manifest spherical equivalent target, respectively. Thirty-two eyes (94%) had residual refractive cylinder of 0.50 D or less. The full depth of focus was 3.68 D. Monocular contrast sensitivity shows frequencies equivalent to a normal population aged 50 to 60 years. The mean satisfaction score was 8.8 (scale: 1 to 10). There were no adverse events and no eyes lost corrected distance visual acuity from the light treatment., Conclusions: LALs in cataract refractive surgery hold great promise, including for the Japanese population, which have unique ocular biometrics. By providing a safe procedure and the ability for postoperative adjustments, the LAL provided a tailored approach to vision correction, ultimately improving patient outcomes and satisfaction. [ J Refract Surg . 2024;40(11):e854-e862.] ., Competing Interests: Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Purpose: To investigate whether standard keratometry (K) or total corneal power (TCP) leads to more accurate refractive outcomes for intraocular lens (IOL) power calculation., Setting: Public hospital., Design: Retrospective evaluation of a diagnostic test instrument., Methods: Preoperatively, all patients underwent optical biometry with Anterion, a swept-source optical coherence tomography device providing both K and TCP. The same IOL model was implanted in all cases. The whole sample was divided into a training dataset, used to optimize the formula constants, and a testing dataset, used to investigate the spherical equivalent prediction error (SEQ-PE) of 8 IOL power formulas. Trueness, precision, and accuracy were evaluated by means of the robust 2-sample t test. Cochran Q test was performed to assess whether the percentage of eyes with an SEQ-PE within each threshold was significantly different; in such an event, the McNemar test was then applied., Results: Both the training and testing datasets included 317 eyes. No significant differences were detected for trueness because of constant optimization. Precision and accuracy were better when K was entered, although a statistically significant difference was observed only with the EVO (precision: P = .02 and accuracy: P = .03) and Haigis ( P < .01 for both precision and accuracy) formulas. No significant differences were observed for the percentage of eyes with an absolute SEQ-PE within any threshold., Conclusions: With most formulas, IOL power calculation is not more accurate when TCP is used instead of K., (Copyright © 2024 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Prcis: This study reports 12-month outcomes of combined phacoemulsification and Hydrus Microstent implantation in Asian eyes with moderate-to-severe normal tension glaucoma (NTG), demonstrating a significant reduction in glaucoma medications with an excellent intra and postoperative safety profile., Objective: To evaluate the 12-month safety and efficacy outcomes of combined phacoemulsification and Hydrus Microstent (Ivantis Inc.) implantation in Asian eyes with moderate to severe NTG., Methods: Retrospective study of consecutive surgeries performed from August 2019 to August 2021 in a single tertiary eye centre in Singapore. Outcome measures included a reduction in intraocular pressure (IOP), number of glaucoma medications, and intra and postoperative complications., Results: Data from 21 eyes of 21 subjects were analyzed. All subjects were ethnic Chinese, and the majority were males (14, 66.7%). At baseline, the mean IOP was 13.3 (2.3) mm Hg, all eyes had a Humphrey visual field mean deviation of ≥-6 dB [mean: -13.9 (4.3) dB], and all eyes were on at least one glaucoma medication. There was no statistically significant reduction in IOP at all time points compared with baseline (all P > 0.05). However, the median number of medications was reduced from 2 to 0 at all time points, up to postoperative month (POM) 12 (all P < 0.001). There were no intraoperative complications. No eyes underwent secondary glaucoma procedures nor lost any Snellen line of visual acuity by POM12. One (4.8%) eye experienced numerical hypotony at postoperative day 1, which resolved conservatively. Two (9.5%) eyes underwent laser iridoplasty for stent occlusion by iris. There was no deterioration in Humphrey visual field mean deviation at POM12 compared with baseline (n = 20, P > 0.05)., Conclusion: Combined phacoemulsification and Hydrus Microstent implantation were effective in reducing medication burden in Asian eyes with moderate to severe NTG, up to 12 months postoperatively., Competing Interests: Disclosure: B.C.H.A. has received speaker's honoraria from Alcon, Inc. The other authors declare no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Cultural difference in ensemble emotion perception is an important research question, providing insights into the complexity of human cognition and social interaction. Here, we conducted two experiments to investigate how emotion perception would be affected by other ethnicity effects and ensemble coding. In Experiment 1, two groups of Asian and Caucasian participants were tasked with assessing the average emotion of faces from their ethnic group, other ethnic group, and mixed ethnicity groups. Results revealed that participants exhibited relatively accurate yet amplified emotion perception of their group faces, with a tendency to overestimate the weight of the faces from the other ethnic group. In Experiment 2, Asian participants were instructed to discern the emotion of a target face surrounded by faces from Caucasian and Asian faces. Results corroborated earlier findings, indicating that while participants accurately perceived emotions in faces of their ethnicity, their perception of Caucasian faces was noticeably influenced by the presence of surrounding Asian faces. These findings collectively support the notion that the other ethnicity effect stems from differential emotional amplification inherent in ensemble coding of emotion perception., (© 2024. The Psychonomic Society, Inc.)

Competing Interests: Competing interests: None declared.

Purpose: The central lower TMH is used as a clinical measure of tear volume in the assessment of contact lens candidates and patients with dry eyes. Ethnic differences in eyelid morphology may influence the measurement of the TMH. Furthermore, with the advent of larger contact lenses, such as scleral lenses, it would be of clinical value to assess the TMH centrally and peripherally. The purpose of this study was to evaluate and compare the TMH at different positions along the palpebral margin between Caucasian and Asian eyes., Methods: This prospective study evaluated the lower TMH in five positions (central, temporal and nasal limbus and temporal and nasal periphery) of the right eye using the Keratograph 5M (Oculus) instrument in Caucasian and Asian participants between 10 am and 12 pm . The TMH at each position was taken three times and averaged and analyzed using a 5 × 2 repeated-measures analysis of variance., Results: Central TMH did not differ significantly ( F = 0.02, p=0.88) in Caucasians (n = 20, aged 24.45 [2.30] years, TMH 0.320 [0.052] mm) and Asians (n = 20, aged 22.25 [3.43] years, TMH 0.325 [0.048] mm). A difference was noted with respect to TMH positions along the lid margin ( F = 64.17, p<0.001), independent of ethnicity ( F = 2.15, p=0.15). A post hoc analysis revealed a significantly higher TMH temporally when compared with centrally or nasally (p<0.001)., Conclusions: This study demonstrated the similarity of the central TMH and the differences in the peripheral TMH within Caucasian and Asian eyes. This may be clinically relevant when using the Tear Film & Ocular Surface Society Dry Eye Workshop II diagnostic algorithm for dry eyes and when fitting scleral contact lenses. Future studies need to consider that ethnic differences may exist for certain tests in order to personalize the care and management of each patient., Competing Interests: Conflict of Interest Disclosure: The authors report no direct conflict of interest with this manuscript., (Copyright © 2024 American Academy of Optometry.)

Background: Among the 3 primary mutations of Leber's hereditary optic neuropathy (LHON), the incidence of LHON with a mutation at nucleotide position 3460 is the lowest in Asians. Therefore, information about the clinical manifestations of LHON mutations in Asians with the 3460 mutation is limited., Objective: To determine the clinical manifestations including visual prognosis of Asians with the LHON 3460 mutation., Methods: We performed a retrospective study of 5 Korean LHON patients with the 3460 mutation., Results: All patients were male, and the age of onset for visual impairment varied from 17 to 35 years, with an average of 25.4 ± 7.16 years. Among the 10 affected eyes, only 1 eye of 1 patient showed visual improvement to 20/50 at 2 years after onset. The remaining patients had a visual acuity of worse than 20/200., Conclusion: The visual prognosis of Korean patients with the LHON 3460 mutation was generally poor. Further studies regarding Asian patients with the LHON 3460 mutation are necessary., Competing Interests: Footnotes and Disclosure Hee Kyung Yang and Moon-Woo Seong contributed equally to this paper. The authors have no proprietary or commercial interest in any materials discussed in this article. Supported by: This work was supported by a National Research Foundation of Korea grant funded by the Korean Government Ministry of Science and ICT (MSIT) (No. 2020R1F1A1074481)., (Copyright © 2024. Published by Elsevier Inc.)

Background: There has long been clinical disagreement over the resumption of antiplatelet therapy in patients with primary intracranial hemorrhage (ICH). This meta-analysis aimed to systematically evaluate the efficacy and safety of restarting antiplatelet therapy after ICH among different races and ethnicities., Methods: All relevant medical studies involving adults with antiplatelet-associated ICH published in PubMed, The Cochrane Library and Chinese National Knowledge Infrastructure from inception to March 2024 were sourced. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study heterogeneity and publication bias, we performed a meta-analysis using random-effects model to assess the strength of association between resumption of antiplatelet therapy and our outcomes.The review was not registered and the review protocol was not prepared., Results: Thirty-five studies were included, with 9758 ICH patients. Subgroup analysis revealed that restarting antiplatelet therapy was associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage in Asians[OR = 1.48, 95% CI (1.13-1.94), P = 0.004]; in Caucasians, on the contrary, reinitiation of antiplatelet therapy was not associated with a significantly higher risk of recurrence or aggravation of cerebral hemorrhage [OR = 0.85, 95% CI (0.67-1.06), P = 0.149]. Reinitiation of antiplatelet therapy was associated with a significantly lower risk of cerebral infarction [OR = 0.61, 95% CI (0.39-0.96), P = 0.033]. Restarting antiplatelet therapy after cerebral hemorrhage was not associated with a higher incidence rate of mortality [OR = 0.79, 95% CI (0.57, 1.08), P = 0.138], myocardial infarction [OR = 2.40, 95%CI (0.53,10.79), P = 0.253], hemiparesis [OR = 0.38, 95%CI (0.03,4.81), P = 0.451], neurological deficit [OR = 0.86,95%CI(0.32,2.33),P = 0.766]., Conclusion: Reinstitution of antiplatelet therapy after ICH was associated with a lower risk of thromboembolic complications.Resumption of antiplatelet therapy was not associated with a higher incidence of cerebral hemorrhage in Caucasians, but may be associated with a higher risk of cerebral hemorrhage recurrence in Asian populations., (© 2024. The Author(s).)

Clinical Relevance: The morphological characteristics of the optic nerve head (ONH) in myopic eyes are a clinically significant issue, especially for high myopia in school-aged children, and this can be monitored using optical coherence tomography., Background: The purpose of this study is to investigate the morphological characteristics of ONH, and the factors associated with peripapillary choroidal thickness in Chinese school-aged high myopia children., Methods: A total of 48 patients, possessing 48 high myopia eyes and 48 contralateral low myopia eyes were enrolled. The ONH characteristic parameters, including peripapillary retinal nerve fibre layer thickness, peripapillary choroidal thickness, peripapillary choroidal blood flow density, Bruch's membrane opening (BMO) characteristic parameters were measured on optical coherence tomography scans., Results: Eyes with high myopia had a larger disc size, higher peripapillary atrophy area proportion, larger peripapillary atrophy area, larger BMO minimum rim width, lower peripapillary choroidal thickness compared with those contralateral low myopia eyes (all P  < 0.001). The BMO distance and border length were longer, and border tissue angle was smaller in the high myopia eyes. The multivariate regression analysis revealed that border length, axial length, and border tissue angle were independently associated with peripapillary choroidal thickness (all P  < 0.05); axial length was associated with peripapillary retinal nerve fibre layer thickness ( P  = 0.007)., Conclusion: The peripapillary atrophy area, BMO area, border length, BMO distance, and BMO minimum rim width increased, but peripapillary choroidal thickness, retinal nerve fibre layer thickness decreased with axial elongation of the globe in young myopia children. Longer axial length and border length were positively correlated with lower peripapillary choroidal thickness, and a smaller border tissue angle was positively correlated with lower peripapillary choroidal thickness were found in this study. Monitoring of border length and border tissue angle is essential in the early stages of myopia in children.

Purpose: To investigate the associations between screening practices and late diagnosis in Asian patients with hydroxychloroquine retinopathy., Methods: In total, 92 Korean patients with hydroxychloroquine retinopathy were included and separated into late diagnosis and earlier diagnosis groups according to the retinopathy stage at the time of diagnosis. Details of screening practices regarding timing and modalities for baseline and annual monitoring examinations were compared between the two groups. Adherence to the current American Academy of Ophthalmology guidelines was compared between the two groups., Results: Timing of baseline and initial monitoring examinations was appropriate as per the Academy of Ophthalmology guidelines in only 5.3% of patients with late diagnosis. There were significant differences in the proportions of patients receiving initial monitoring at 5 years of use and those receiving annual monitoring between the late and earlier diagnosis groups ( P = 0.003 and <0.001, respectively). The duration from the start date of hydroxychloroquine therapy to the first monitoring examination was significantly prolonged in the late diagnosis group ( P < 0.001). Multivariate logistic regression revealed significant association of the time duration with the first monitoring examination ( P = 0.042) and age ( P = 0.028) with late diagnosis., Conclusion: Results of this study suggest that poor adherence to the Academy of Ophthalmology guideline, particularly delayed initial monitoring, may be associated with late diagnosis of hydroxychloroquine retinopathy.

Aims: The performance of circulating soluble urokinase plasminogen activator receptor (suPAR) for predicting the composite endpoint of subsequent heart failure (HF) hospitalisation and/or death at 1 year was assessed in (i) patients with undifferentiated breathlessness, and generalisability was compared in (ii) disparate Western versus Asian sub-cohorts, and in (iii) the sub-cohort adjudicated with HF., Methods and Results: Patients with acute breathlessness were recruited from the emergency departments in New Zealand (NZ, n = 612) and Singapore (n = 483). suPAR measured in the presentation samples was higher in patients incurring the endpoint (n = 281) compared with survivors (5.2 ng/mL vs 3.1 ng/mL, P < 0.0001). The discriminative power of suPAR for endpoint prediction was c-statistic of 0.77 in the combined population, but was superior in Singapore than NZ (c-statistic: 0.83 vs 0.71, P < 0.0001). Although the highest suPAR tertile (>4.37 ng/mL) was associated with risks of >4-fold in NZ, >20-fold in Singapore, and ≥3-fold in HF for incurring the outcome, there was no interaction between country and suPAR levels after adjustment. Multivariable analysis indicated suPAR to be robust in predicting HF/death at 1-year [hazard ratio: 1.9 (95% CI:1.7 to 2.0) per SD increase] and improved risk discrimination for outcome prediction in HF (∆0.06) and for those with NT-proBNP >1000 pg/mL (∆0.02)., Conclusion: suPAR is a strong independent predictor of HF and/or death at 1 year in acutely breathless patients, in both Asian and Western cohorts, and in HF. suPAR may improve stratification of acutely breathless patients, and in acute HF, for risk of later onset of heart failure or mortality., Competing Interests: Declaration of competing interest AMR reports research grant support and speaker's honoraria from Roche Diagnostics, and in-kind support in the form of assay kit reagents from Abbott, Thermo Fisher, and Alere, during the conduct of the study. All other authors report no relationships that could be construed as a conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

The linguistic, historical, and subsistent uniqueness of Hmong-Mien (HM) speakers offers a wonderful opportunity to investigate how these factors impact the genetic structure. The genetic differentiation among HM speakers and their population history are not well characterized. Here, we generate genome-wide data from 65 Yao ethnicity samples and analyze them with published data, particularly by leveraging haplotype-based methods. We determined that the fine-scale genetic substructure of HM speakers corresponds better with linguistic classification than with geography. Particularly, parallels between serial founder events and language differentiations can be observed in West Hmongic speakers. Multiple lines of evidence indicate that ~500-year-old GaoHuaHua individuals are most closely related to West Hmongic-speaking Bunu. The strong genetic bottleneck of some HM-speaking groups, especially Bunu, could potentially be associated with their long-term practice of swidden agriculture to some degree. The inferred admixture dates for most of the HM speakers overlap with the reign of the Ming dynasty (1368-1644 CE). Besides a common genetic origin for HM speakers, their genetic ancestry is shared primarily with neighboring Han Chinese and Tai-Kadai speakers in south China. In conclusion, our analyses reveal that recent isolation and admixture events have contributed to the genetic population history of present-day HM speakers., (© 2024 Wiley Periodicals LLC.)

Given the differences in emotion regulation across cultures, it is paramount to ensure that measures of emotion regulation measure the same construct and that conceptualizations of emotion regulation are valid across cultures. Therefore, the present study assessed the measurement invariance (alongside other psychometric properties) of three popular emotion regulation questionnaires, the Emotion Regulation Questionnaire (ERQ), Difficulties in Emotion Regulation Scale (DERS), and the Perth Emotion Regulation Competency Inventory (PERCI), across 434 Singaporeans and 489 Australians. Our study showed that all three questionnaires were measurement invariant, had excellent internal consistency, and relatively good concurrent validity with psychopathology and alexithymia across our Singaporean and Australian sample, justifying their use in comparing Asian and Western cultures. Our findings suggest that measures of emotion regulation have utility across both individualistic and collectivistic cultures. Our findings supports the use of these measures in cross-cultural research and provides support for the utility for personality assessments across cultures.

Purpose: To characterize and compare clinical and immunological features of para(p)-autoimmune retinopathy (AIR) and non-para(np)-AIR and to assess the clinical significance of the presence of serum anti-retinal antibodies (ARAs)., Methods: We retrospectively reviewed 48 Chinese patients with p-AIR or np-AIR who took comprehensive ophthalmic examinations and lab tests of the presence of serum ARAs., Results: p-AIR patients differed from np-AIR patients in terms of disease progression, ocular inflammation, findings of OCT, FFA, and presence of ARAs. No significant difference was found in the band number of serum ARAs between AIR patients and healthy controls. The prevalence of antibodies to recoverin and ɑ-enolase in the sera of p-AIR was significantly higher than that of the healthy individuals., Conclusion: While having many similar clinical signs, patients with p-AIR or np-AIR nevertheless displayed unique characteristics. Detection of ARAs subtypes, rather than their quantity, may be helpful in evaluating the conditions in the verified instances.

Objective: To evaluate the real-world effectiveness of eptinezumab for migraine prevention in Asian patients., Background: Eptinezumab is a monoclonal antibody that targets calcitonin gene-related peptide (CGRP), a potent vasodilator with an important role in migraine pathophysiology. Although there is robust clinical evidence from pivotal Phase 3 placebo-controlled trials of the efficacy of eptinezumab for migraine prevention, there are limited data on the real-world effectiveness of eptinezumab in Asian patient cohorts., Methods: This was a non-interventional, prospective, multisite cohort study of adults with migraine (International Classification of Headache Disorders, 3rd edition criteria) in Singapore who were prescribed eptinezumab (100 mg at baseline and Month 3, administered intravenously) and were followed until Month 6. The primary endpoint was change from baseline in monthly migraine days (MMDs) at Month 3 and Month 6. Secondary endpoints were ≥30% and ≥50% responder rates, and change from baseline in the Headache Impact Test-6 (HIT-6), Migraine Disability Assessment (MIDAS), Migraine-Specific Quality of Life (MSQ), patient-identified most bothersome symptom (PI-MBS), acute medication use at Month 3 and Month 6, and safety., Results: Enrolled patients (completed = 29/30) had on average 3.4 (SD 2.9) previous preventive treatments; 29/30 of the patients had trialed at least one previous preventive treatment without benefit. Most had previously trialed oral preventives (87%, 26/30) and anti-CGRP (70%, 21/30). Relative to baseline, mean MMDs decreased by 4.3 days (95% CI 2.1-6.4; p < 0.001) at Month 3 and 4.9 days (95% CI 2.1-7.7; p < 0.001) at Month 6. At Month 3 and Month 6, 14/30 (47%) and 15/29 (52%) of the patients were ≥30% responders, and 6/30 (20%) and 8/29 (28%) patients were ≥50% responders, respectively. The number of patients with severe life impairment based on the HIT-6 score (total score 60-78) decreased from 24/30 (80%) at baseline to 19/30 (63%) at Month 3 and 19/29 (66%) at Month 6. The mean MIDAS score decreased by 24.6 points (95% CI 2.82-46.38; p = 0.028) at Month 6, and the mean MSQ score increased by 12.2 points (95% CI 5.18-19.20; p = 0.001) at Month 3 and 13.6 points (95% CI 4.58-22.66; p = 0.004) at Month 6. Most patients reported improvement in the PI-MBS at Month 3 (73%, 22/30) and Month 6 (55%, 16/29). Acute medication use for headache relief decreased by 3.3 days/month (95% CI 1.0-5.6; p = 0.007) at Month 3 and 4.7 days/month (95% CI 1.7-7.7; p = 0.003) at Month 6. Treatment-emergent adverse events (TEAEs) were reported in 16/30 (54%) patients, mostly mild/moderate in severity. No serious TEAEs led to treatment discontinuation., Conclusion: Quarterly eptinezumab administration was effective and well-tolerated in Asian patients with chronic migraine., (© 2024 The Authors. Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.)

Aims: To determine axial length (AL) elongation profiles in children aged 3-6 years in an Asian population., Methods: Eligible subjects were recruited from the Growing Up in Singapore Towards Healthy Outcomes birth cohort. AL measurement was performed using IOLMaster (Carl Zeiss Meditec, Jena, Germany) at 3 and 6 years. Anthropometric measurements at birth, cycloplegic refraction at 3 and 6 years, questionnaires on the children's behavioural habits at 2 years and parental spherical equivalent refraction were performed. Multivariable linear regression model with generalised estimating equation was performed to determine factors associated with AL elongation., Results: 273 eyes of 194 children were included. The mean AL increased from 21.72±0.59 mm at 3 years to 22.52±0.66 mm at 6 years (p<0.001). Myopic eyes at 6 years had greater AL elongation (1.02±0.34 mm) compared with emmetropic eyes (0.85±0.25 mm, p=0.008) and hyperopic eyes (0.74±0.16 mm, p<0.001). The 95th percentile limit of AL elongation was 1.59 mm in myopes, 1.34 mm in emmetropes and 1.00 mm in hyperopes. Greater birth weight (per 100 g, β=0.010, p=0.02) was significantly associated with greater AL elongation from 3 to 6 years, while parental and other behavioural factors assessed at 2 years were not (all p≥0.08)., Conclusion: In this preschool cohort, AL elongates at an average length of 0.80 mm from 3 to 6 years, with myopes demonstrating the greatest elongation. The differences in 95th percentile limits for AL elongation between myopes, emmetropes and hyperopes can be valuable information in identifying myopia development in preschool children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Chronic kidney disease (CKD) may elevate susceptibility to age-related macular degeneration (AMD) because of shared risk factors, pathogenic mechanisms, and genetic polymorphisms. Given the inconclusive findings in prior studies, we investigated this association using extensive datasets in the Asian Eye Epidemiology Consortium., Design: Cross-sectional study., Participants: Fifty-one thousand two hundred fifty-three participants from 10 distinct population-based Asian studies., Methods: Age-related macular degeneration was defined using the Wisconsin Age-Related Maculopathy Grading System, the International Age-Related Maculopathy Epidemiological Study Group Classification, or the Beckman Clinical Classification. Chronic kidney disease was defined as estimated glomerular filtration rate (eGFR) of less than 60 ml/min per 1.73 m 2 . A pooled analysis using individual-level participant data was performed to examine the associations between CKD and eGFR with AMD (early and late), adjusting for age, sex, hypertension, diabetes, body mass index, smoking status, total cholesterol, and study groups., Main Outcome Measures: Odds ratio (OR) of early and late AMD., Results: Among 51 253 participants (mean age, 54.1 ± 14.5 years), 5079 had CKD (9.9%). The prevalence of early AMD was 9.0%, and that of late AMD was 0.71%. After adjusting for confounders, individuals with CKD were associated with higher odds of late AMD (OR, 1.46; 95% confidence interval [CI], 1.11-1.93; P = 0.008). Similarly, poorer kidney function (per 10-unit eGFR decrease) was associated with late AMD (OR, 1.12; 95% CI, 1.05-1.19; P = 0.001). Nevertheless, CKD and eGFR were not associated significantly with early AMD (all P ≥ 0.149)., Conclusions: Pooled analysis from 10 distinct Asian population-based studies revealed that CKD and compromised kidney function are associated significantly with late AMD. This finding further underscores the importance of ocular examinations in patients with CKD., Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Progressive Supranuclear Palsy (PSP) is a sporadic neurodegenerative disease without a clear geographic prevalence. Cohorts studied in the UK and India showed no higher prevalence of atypical parkinsonism in South Asian patients. We describe the ethnic and racial background of PSP patients in the Greater Toronto Area (GTA), Canada., Methods: A prospective observational study of patients with clinically probable PSP evaluated at the dedicated Rossy PSP program. Demographic and clinical data were collected at baseline including PSP phenotype. Results were compared with the latest demographic information from the greater Toronto area., Results: Of the 197 patients screened, 135 had probable PSP and resided within the GTA. The mean age at visit was 71.1 years, disease duration 4.4 years, and disease severity moderate. Compared to our catchment area, there was a higher proportion of patients with a South Asian origin and a lower proportion of patients from East and Southeastern Asia and Africa. A secondary analysis using population census data limited to individuals greater than 65 confirmed the significantly higher representation of South Asians in our clinic but found no differences for other racial and ethnic origins., Conclusion: Evaluation of this Toronto cohort found a greater than expected proportion of affected individuals with South Asian ethnic and racial origin. Despite limitations, our results suggest the possibility of a racial and ethnic predisposition to PSP. Further studies are needed to confirm and to address potential associated risk factors, and genome-environmental interactions., Competing Interests: Declaration of competing interest The authors deny any conflict of interest regarding the data described in this article. BC and DDL have no disclosures related to the content of this manuscript. Dr. Lang has served as an advisor for AbbVie, AFFiRis, Alector, Amylyx, Biogen, BioAdvance, BlueRock, BMS, Denali, Janssen, Jazz, Lilly, Novartis, Paladin, Retrophin, Roche, Sun Pharma, and UCB; received honoraria from Sun Pharma, AbbVie and Sunovion; received grants from Brain Canada, Canadian Institutes of Health Research, Edmond J Safra Philanthropic Foundation, Michael J. Fox Foundation, the Ontario Brain Institute, Parkinson Foundation, Parkinson Canada, and W. Garfield Weston Foundation; received publishing royalties from Elsevier, Saunders, Wiley-Blackwell, Johns Hopkins Press, and Cambridge University Press. Dr. Tartaglia receives funding from NIH, Weston Brain Foundation, and in-kind funding from Roche. She conducts clinical trials for Biogen, Anavex, Janssen, Novo Nordisk, Merck, Green Valley, UCB. Dr Fox has received Clinic support from the Edmond J Safra Foundation for Parkinson Research; Parkinson Foundation and the Toronto Western and General Foundation. Research Funding from Michael J Fox Foundation for Parkinson Research, NIH (Dystonia Coalition); Parkinson Canada. Honoraria from the International Parkinson and Movement Disorder Society. Site PI for Clinical Trials for Alexion, Biotie, Consultancy/Speaker fees from AbbVie, Bial, Ipsen, Sunovion; Paladin and Royalties from Oxford University Press., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Moyamoya disease (MMD) is a rare disorder causing ischemic and hemorrhagic juvenile stroke. It is associated with the founder susceptibility variant p.R4810K in the RNF213 gene in East Asia. Our aim was to enhance understanding of MMD in so far poorly characterized Southeast Asians and exploring differences with Caucasian Europeans., Methods: By retrospective analysis of medical records and systematic database search on PubMed for all published cases, we identified Southeast Asian patients with MMD. We extracted and pooled proportions using fixed-effects models. Our own cohort was tested for the East Asian RNF213 founder variant p.R4810K. One of our Southeast Asian patients underwent post-mortem histopathological examination., Results: The study cohort comprised 32 Southeast Asians. Mean age at onset in the entire cohort was 32.5 ± 20.3 years (n = 24), 43.4 ± 8.7 years in patients admitted to our center (n = 11), and 23.4 ± 22.4 years in patients from the international literature (n = 13). Female-to-male ratio was 1.6:1. MMD predominantly affected bilateral anterior intracranial vessels. Cerebral ischemia outnumbered transient ischemic attacks (TIAs) and intracranial hemorrhage. TIAs, arterial hypertension and obesity were significantly less frequent in Southeast Asian patients compared to Caucasian Europeans. p.R4810K was absent in all examined Southeast Asians despite of typical histopathological signs of MMD in one autopsy case., Conclusion: Clinical and histopathological manifestations of MMD in Southeast Asians are similar to those in Caucasian Europeans. The genotype of MMD in Southeast Asians differs from that of most East Asian patients., (© 2024. The Author(s).)

Purpose: To evaluate the association between the endothelial cell density (ECD) and central corneal thickness (CCT) in medium, short, and long eyes of preoperative Han Chinese cataract patients., Design: Retrospective cross-sectional study., Methods: We consecutively enrolled 410 eyes, namely, 50 short eyes (axial length [AL]<22.0 mm), 150 medium eyes (22.0≤AL<24.0 mm), 120 medium-long eyes (24.0≤AL<26.0 mm), and 90 long eyes (AL≥26.0 mm), of 410 adult patients scheduled for cataract surgery. The ECD and CCT were determined preoperatively with a noncontact specular microscope. The association between the CCT and ECD was identified by using a multivariable regression analysis. A thin cornea was defined as having a CCT less than 500 µm., Results: After adjusting for age, the presence of arterial hypertension, the presence of diabetes mellitus, intraocular pressure, and AL, a positive association between the CCT and ECD was identified in short eyes (linear regression coefficient [B]=3.40; standardized B [β]=0.52; P = .03), medium eyes (B = 2.33; β=0.28; P = .002), medium-long eyes (B = 1.84; β=0.25; P = .02), and long eyes (B = 2.69; β=0.41; P = .04). In the total group, the multivariable logistic analysis showed a significant link between the presence of a thin cornea and a lower ECD (odds ratio [OR]=0.80 per 100 cells/mm 2 increase; P = .001)., Conclusions: For cataract patients of Han ethnicity, a significant association between a thin CCT and a lower ECD was shown across the AL spectrum and was most prominent in short eyes. Eyes with a thin cornea are more likely to have a lower ECD., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims: To investigate myopic maculopathy in Chinese children with high myopia and its association with choroidal and retinal changes., Methods: This cross-sectional study included Chinese children aged 4-18 years with high myopia. Myopic maculopathy was classified by fundus photography and retinal thickness (RT) and choroidal thickness (ChT) in the posterior pole were measured by swept-source optical coherence tomography. A receiver operation curve was used to determine the efficacy of fundus factors in classifying myopic maculopathy., Results: In total, 579 children aged 12.8±3.2 years with a mean spherical equivalent of -8.44±2.20 D were included. The proportions of tessellated fundus and diffuse chorioretinal atrophy were 43.52% (N=252) and 8.64% (N=50), respectively. Tessellated fundus was associated with a thinner macular ChT (OR=0.968, 95% CI: 0.961 to 0.975, p<0.001) and RT (OR=0.977, 95% CI: 0.959 to 0.996, p=0.016), longer axial length (OR=1.545, 95% CI: 1.198 to 1.991, p=0.001) and older age (OR=1.134, 95% CI: 1.047 to 1.228, p=0.002) and less associated with male children (OR=0.564, 95% CI: 0.348 to 0.914, p=0.020). Only a thinner macular ChT (OR=0.942, 95% CI: 0.926 to 0.959, p<0.001) was independently associated with diffuse chorioretinal atrophy. When using nasal macular ChT for classifying myopic maculopathy, the optimal cut-off value was 129.00 µm (area under the curve (AUC)=0.801) and 83.85 µm (AUC=0.910) for tessellated fundus and diffuse chorioretinal atrophy, respectively., Conclusion: A large proportion of highly myopic Chinese children suffer from myopic maculopathy. Nasal macular ChT may serve as a useful index for classifying and assessing paediatric myopic maculopathy., Trial Registration Number: NCT03666052., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To investigate the medial pretarsal adipose tissue thickness of the upper eyelid in the Japanese population., Methods: Sixty-two whole upper eyelids were harvested from 35 Japanese cadavers and fixed in paraffin. The samples were cut into 5 µm sagittal microsections and stained with hematoxylin and eosin, as well as Masson's trichrome. Data obtained from images and measurements were taken with Aperio ScanScope and ImageScope software and underwent statistical analysis., Results: The samples were divided into 3 shapes sagittal cross-sections of the eyelid (triangular, rectangular, and flat) corresponding to the shape of the medial pretarsal adipose tissue. Type I (triangular shape, 48.4%) had a ratio of fat thickness at 1⁄2 tarsal height to peak fat thickness of <0.9, and type IIa (rectangular shape, 30.6%) and IIb (flat shape, 21.0%) had pretarsal adipose tissue thickness to tarsal height ratio of ≥0.2 and <0.2, respectively. The mean values of tarsal thickness at 1⁄2 tarsal height were 1021 µm for the type I group, 1100 µm for the type IIa group, and 764.4 µm for the type IIb group ( p = 0.01). The mean values of fat thickness at 1⁄2 tarsal height were 410.6 µm for the type I group, 303.3 µm for the type IIa group, and 242.6 µm for the type IIb group ( p = 0.26)., Conclusions: The thickness of the medial pretarsal adipose tissue was different according to the shape of the sagittal cross-section of the eyelid. Awareness of the medial pretarsal adipose tissue thickness contributes to effective suture placement and safe suture depth during blepharoptosis surgery., Competing Interests: The authors have no financial or conflicts of interest to disclose., (Copyright © 2024 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.)

Purpose: To analyse real-world outcomes in Asian eyes of iStent inject, a second-generation trabecular micro-bypass stent, combined with phacoemulsification., Methods: This is a multi-centre, observational study of glaucomatous Asian eyes that have undergone iStent inject implantation combined with cataract surgery. Patient data were extracted from the Fight Glaucoma Blindness! Registry. Outcome measures included those of IOP reduction, glaucoma medication reduction, and adverse events including the need for secondary surgery., Results: 123 eyes of 86 patients with a mean age of 68.4 ± 9.3 years underwent iStent inject implantation with phacoemulsification. At baseline, the mean ± SD preoperative intraocular pressure (IOP) was 16.0 ± 4.4 mmHg, and the mean preoperative number of topical glaucoma medications was 1.9 ± 1.4. At 12 months 30.8% of eyes demonstrated a reduction in IOP greater than 20%, the mean IOP reduction was 12.5% with an additional reduction of 0.7 glaucoma medications. 40% of eyes were using no medications at 12 months compared to 16.3% preoperatively. 8.2% of eyes required a subsequent procedure within the 12-month follow-up window., Conclusion: iStent inject implantation combined with phacoemulsification in Asian eyes showed a reduction of IOP and glaucoma medication use in a real-world clinical setting. The safety profile of the device is good with minimal adverse outcomes, however, a subset of patients required secondary procedures within the 12 month follow up., (© 2024. Crown.)

Background: Schizophrenia (SCZ) is a profound mental disorder with a multifactorial etiology, including genetics, environmental factors, and demographic influences such as ethnicity and geography. Among these, the studies of SCZ also shows racial and regional differences., Methods: We first established a database of biological samples for SCZ in China's ethnic minorities, followed by a serum metabolomic analysis of SCZ patients from various ethnic groups within the same region using the LC-HRMS platform., Results: Analysis identified 47 metabolites associated with SCZ, with 46 showing significant differences between Miao and Han SCZ patients. These metabolites, primarily fatty acids, amino acids, benzene, and derivatives, are involved in fatty acid metabolism pathways. Notably, L-Carnitine, L-Cystine, Aspartylphenylalanine, and Methionine sulfoxide demonstrated greater diagnostic efficacy in Miao SCZ patients compared to Han SCZ patients., Conclusion: Preliminary findings suggest that there are differences in metabolic levels among SCZ patients of different ethnicities in the same region, offering insights for developing objective diagnostic or therapeutic monitoring strategies that incorporate ethnic considerations of SCZ., (© 2024. The Author(s).)

Background: Treg cells play an important role in development of tolerance in maternal immune system against the semi-allogenic embryo. Human forkhead box protein 3 (FOXP3) gene, is the major transcription factor responsible for the regulation of Treg function during pregnancy. Single nucleotide polymorphisms (SNPs) of FOXP3 gene have been reported as a risk factor for Recurrent Pregnancy Loss (RPL), however, results from previous studies are inconsistent., Methodology: We have collected data from different studies to investigate the overall association of FOXP3 SNPs with risk of RPL. PubMed, Google Scholar, Elsevier, and Cochrane databases were searched to identify eligible studies. Odds Ratio (OR) and 95 % Confidence Interval (CI), calculated via fixed effect or random effect models, were used to evaluate strength of association. This meta-analysis included 11 studies (1383 RPL cases and 1413 controls) of 6 SNPs: rs3761548 A/C, rs2232365 A/G, rs2294021 T/C, 2280883 T/C, rs5902434del/ATT and rs141704699C/T, with ≥2 studies per SNPs and at least 1 significant result., Results: We observed that FOXP3 polymorphism was predominantly present in Asian women with history of RPL. rs2232365 A/G, rs3761548 A/C, rs2294021 T/C, rs2280883 T/C and rs5902434del/ATT polymorphisms were significantly associated with risk of RPL in Indian population. Further, among the most commonly seen polymorphism, rs3761548 A/C was significantly associated with risk of RPL in women from Kazakhstan, China and Gaza, Palestine; rs2232365 A/G in populations of Kazakhstan, Egypt, Iran and Gaza, Palestine. Results of this study indicates that FOXP3 polymorphism is significantly associated with risk of RPL, especially in Asians., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose: To investigate the prevalence ratio of primary angle-closure glaucoma (PACG) and primary open-angle glaucoma (POAG) in the Asian population., Methods: Systematic searches of PubMed, Embase, and Cochrane databases for population-based studies in Asia published until August 5, 2022. We conducted a meta-analysis for PACG to POAG prevalence ratio using inverse variance-weighted random-effects meta-analyses so as to combine the study-specific measures of association. Between-study outcome variation (i.e., heterogeneity) was quantified with the I2 statistic. The multiple meta-regression analyses were performed in order to further account for the reasons for heterogeneity., Results: Twenty studies, with a total study population of 52,522 individuals, had been conducted in 13 countries. The pooled PACG to POAG prevalence ratio was 2.204 (95% confidence interval, 1.617-3.004) with high heterogeneity (p < 0.001). In multiple meta-regression model, prevalence of POAG is the most important predictor for heterogeneity (model importance, 0.954), followed continent (0.508), and publication year (0.222). For every additional elevation of POAG prevalence (i.e., increase of 1.0%), the PACG to POAG prevalence ratio is expected to rise by 0.471., Conclusions: We estimated the pooled PACG to POAG prevalence ratio in the Asian population. The POAG prevalence is the most important factor to determine the PACG to POAG prevalence ratio.

All-payer, population-level hospital discharge data have been used to identify health disparities across racial/ethnic and other demographic groups. However, researchers are often unable to identify unique patients in the data sets if a unique patient identifier is not provided. The lack of the unique patient identifier can result in biased estimates of research outcomes using discharge data. This could then mislead the researchers, public, or policy-makers who utilize such biased results. This study examined estimation bias of health disparities due to rehospitalizations considering diabetes-related preventable hospitalizations using 6 years of state-level data from Hawai'i Health Information Corporation. Different analyses methods showed different probabilities of having multiple visits by age, race/ethnicity and payer subgroups. Charge analysis results also showed that ignoring the multiple visits could result in significance error. For a patient with multiple hospitalizations, rehospitalizations are often dependent upon the discharge status of previous visits, and the independence assumption of the multiple visits may not be appropriate. Ignoring the multiple visits in population-level analyses could result in severe health disparities significance errors. In this hospitalization charge analysis, the Chinese group was not significantly different than the White group (relative risk ratio - RR: [95% CI]: 0.93 [0.80, 1.08]), while the difference was signficant (RR [95% CI]: 0.86 [0.77,0.96]) when the multiple visits were ignored., Competing Interests: The author does not identify a conflict of interest., (©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

The Korean Genetic Diagnosis Program for Rare Disease (KGDP) enrolled 1890 patients with rare diseases between March 2017 and October 2022. Children and adolescents accounted for the majority of the patients, and systemic disease was the most common presenting symptom. The exome-based virtual disease-specific multigene panel was the most frequently used analytical method, with an overall diagnostic yield of 33.3%. A total of 629 positive cases were diagnosed, involving 297 genes. All 297 genes identified in these cases were confirmed to be known genes listed in the OMIM database. The nationwide KGDP network and its cooperation with the Korean Undiagnosed Diseases Program (KUDP) provide a more comprehensive genetic analysis of undiagnosed cases. The partnership between the KGDP and KUDP has the potential to improve the diagnosis and treatment options for patients. In conclusion, KGDP serves as the primary access point or gateway to KUDP., (© 2023. The Author(s), under exclusive licence to European Society of Human Genetics.)

Hawai'i is the most ethnically diverse state with the highest proportion of multiracial individuals in the United States. The Stepwise Proportional Weighting Algorithm (SPWA) was developed to bridge the categorization of multiracial Census data into single-race population estimates for common races in Hawai'i. However, these estimates have not been publicly available. A Shiny web application, the Hawai'i Single-Race Categorization Tool, was developed as a user friendly research tool to obtain the age and sex distributions of single-race estimates for common racial groups in Hawai'i. The Categorization Tool implements the SPWA and presents the results in tabular and graphic formats, stratified by sex and age. It also allows the categorization of partial Native Hawaiians as Native Hawaiians in the population estimation. Using this tool, the current paper reports population estimates and distributions for 31 common racial groups using Hawai'i Census 2010 data. Among the major Census races, Asian had the largest population (631 881; 46.5%) in Hawai'i, followed by White (431 635; 31.7%) and Native Hawaiian and Other Pacific Islander (227 588; 16.7%). Among Census detailed races within Asian, Filipino had the largest population estimate (244 730; 18.0%), followed by Japanese (227 165; 16.7%) and Chinese (103 600; 7.6%). Native Hawaiian accounted for 12.3% of the Hawai'i population (166 944). After recategorizing part-Native Hawaiians as Native Hawaiians, Native Hawaiian increased by 150.0%, with the greatest increase among the young. This publicly available tool would be valuable for race-related resource allocation, policy development, and health disparities research in Hawai'i., Competing Interests: None of the authors identify a conflict of interest., (©Copyright 2023 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Importance: Asian American physicians have experienced a dual pandemic of racism and COVID-19 since 2020; understanding how racism has affected the learning environment of Asian American medical students is necessary to inform strategies to promoting a more inclusive medical school environment and a diverse and inclusive workforce. While prior research has explored the influence of anti-Asian racism on the experiences of Asian American health care workers, to our knowledge there are no studies investigating how racism has impacted the training experiences of Asian American medical students., Objective: To characterize how Asian American medical students have experienced anti-Asian racism in a medical school learning environment., Design, Setting, and Participants: This qualitative study included online video interviews of Asian American medical students performed between July 29, 2021, and August 22, 2022. Eligible participants were recruited through the Asian Pacific American Medical Students Association and snowball sampling, and the sample represented a disaggregated population of Asian Americans and all 4 medical school years., Main Outcomes and Measures: The medical school experiences of Asian American medical students., Results: Among 25 participants, Asian ethnicities included 8 Chinese American (32%), 5 Korean American (20%), 5 Indian American (20%), 3 Vietnamese American (12%), 2 Filipino American (8%), and 1 (4%) each Nepalese, Pakistani, and Desi American; 16 (64%) were female. Participants described 5 major themes concerning their experience with discrimination: (1) invisibility as racial aggression (eg, "It took them the whole first year to be able to tell me apart from the other Asian guy"); (2) visibility and racial aggression ("It transitioned from these series of microaggressions that every Asian person felt to actual aggression"); (3) absence of the Asian American experience in medical school ("They're not going to mention Asian Americans at all"); (4) ignored while seeking support ("I don't know what it means to have this part of my identity supported"); and (5) envisioning the future., Conclusions and Relevance: In this qualitative study, Asian American medical students reported feeling invisible within medical school while a target of anti-Asian racism. Addressing these unique challenges related to anti-Asian racism is necessary to promote a more inclusive medical school learning environment.

Introduction: Oral candidiasis is one of the most common fungal infections that has been widely reported around the world. In Malaysia, the available studies for this infection are scarce., Materials and Methods: This is a 20-year retrospective study aimed to investigate the prevalence, demographic characteristics, clinical presentations, and the association of oral candidiasis with clinical parameters in oral candidiasis cases reported in the Faculty of Dentistry, Universiti Malaya from 1999 until 2019. A total of 12,964 histopathological records from the Oral Pathology Diagnostic and Research Laboratory (OPDRL) between 1999 to 2019 were retrieved. Oral candidiasis cases were selected according to the inclusion and exclusion criteria. Information of interest was obtained and analysed., Results: From the total records retrieved, 378 oral candidiasis cases were recorded and 82.8% were diagnosed from smear test. This study showed that oral candidiasis was predominantly reported in female (64.2%) and Indian population (64.2%). The peak incidence was in the sixth decades of life (27.0%). The most commonly affected site was tongue and coated tongue was the most common clinical presentation. More than 50% of the cases had comorbidity and 10.6% were associated with dentures. Ethnicity and site of occurrence were significantly associated (p<0.05) with oral candidiasis., Conclusion: This is the first large-scale study of oral candidiasis cases in Malaysia. The findings of this study are useful for clinical assessment of patients suspected of oral candidiasis.

Background: Addressing contemporary anti-Asian racism and its impacts on health requires understanding its historical roots, including discriminatory restrictions on immigration, citizenship, and land ownership. Archival secondary data such as historical census records provide opportunities to quantitatively analyze structural dynamics that affect the health of Asian immigrants and Asian Americans. Census data overcome weaknesses of other data sources, such as small sample size and aggregation of Asian subgroups. This article explores the strengths and limitations of early twentieth-century census data for understanding Asian Americans and structural racism., Methods: We used California census data from three decennial census spanning 1920-1940 to compare two criteria for identifying Asian Americans: census racial categories and Asian surname lists (Chinese, Indian, Japanese, Korean, and Filipino) that have been validated in contemporary population data. This paper examines the sensitivity and specificity of surname classification compared to census-designated "color or race" at the population level., Results: Surname criteria were found to be highly specific, with each of the five surname lists having a specificity of over 99% for all three census years. The Chinese surname list had the highest sensitivity (ranging from 0.60-0.67 across census years), followed by the Indian (0.54-0.61) and Japanese (0.51-0.62) surname lists. Sensitivity was much lower for Korean (0.40-0.45) and Filipino (0.10-0.21) surnames. With the exception of Indian surnames, the sensitivity values of surname criteria were lower for the 1920-1940 census data than those reported for the 1990 census. The extent of the difference in sensitivity and trends across census years vary by subgroup., Discussion: Surname criteria may have lower sensitivity in detecting Asian subgroups in historical data as opposed to contemporary data as enumeration procedures for Asians have changed across time. We examine how the conflation of race, ethnicity, and nationality in the census could contribute to low sensitivity of surname classification compared to census-designated "color or race." These results can guide decisions when operationalizing race in the context of specific research questions, thus promoting historical quantitative study of Asian American experiences. Furthermore, these results stress the need to situate measures of race and racism in their specific historical context., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Kaniecki, Novak, Gao, Harlow and Stern.)

Background: There are well-established disparities in colorectal cancer (CRC) outcomes between White and Black patients; however, assessments of CRC disparities for other racial/ethnic groups are limited., Methods: The Surveillance, Epidemiology, and End Results database identified patients aged 50-74 years with CRC adenocarcinoma from 2000 to 2019. Trends in age-adjusted incidence rates were computed by stage at diagnosis and subsite across five broad race/ethnic groups (White, Black, Asian/Pacific Islander [API], American Indian/Alaskan Native [AIAN], and Hispanic) and four API subgroups (East Asian, Southeast Asian, South Asian, and Pacific Islander) Multivariable logistic regression evaluated associations between race/ethnicity and diagnosis stage. Multivariable Cox proportional hazards models assessed differences in cause-specific survival (CSS)., Results: Hispanic, AIAN, Southeast Asian, Pacific Islander, and Black patients were 3% to 28% more likely than Whites to be diagnosed with distant stage CRC, whereas East Asian and South Asians had similar or lower risk of distant stage CRC. From Cox regression analysis, Black, AIAN, and Pacific Islanders also experienced worse CSS, while East Asian and South Asian patient groups experienced better CSS. No significant differences in CSS were observed among Hispanic, Southeast Asian, and White patients. When stratified by stage, Black patients had worse CSS across all stages (early, hazard ratio (HR) = 1.38; regional, HR = 1.22; distant, HR: 1.07, p < 0.05 for all)., Conclusion: Despite advances in CRC screening, treatment and early detection efforts, marked racial/ethnic disparities in incidence, stage at diagnosis, and survival persist. Findings demonstrate the extent to which aggregating heterogenous populations masks significant variability in CRC outcomes within race/ethnic subgroups., (© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Objectives: Drawing on social identity theory, present research examined the effects of overlapping racial membership on monoracials' categorization of biracials as in-/out-group members, as well as its impact on monoracials' social perceptions of biracials in Singapore. Within Singapore, it is hypothesized that biracials who share racial membership with monoracials would be rated more as monoracials' racial in-group and be evaluated more positively. Furthermore, monoracials' positive perceptions of biracials with (vs. without) shared racial membership would be less influenced by biracials' confrontation of racial prejudice., Method: Studies 1 ( N = 242) and 2 ( N = 153) sampled Chinese Singaporeans to assess their perceptions of several fictitious biracial targets. Utilizing an experimental confrontation paradigm, Studies 3 ( N = 170) and 4 ( N = 225) investigated the effects of confronting racial prejudice on Chinese Singaporeans' perceptions of biracials., Results: Studies 1 and 2 revealed that Chinese Singaporeans perceive Chinese-other (vs. non-Chinese) biracials as more racially similar to themselves and were more likely to report positive social perceptions of Chinese-other biracials. Compared to non-Chinese biracials, Studies 3 and 4 found that Chinese-other biracials' response to racial prejudice did not negatively affect Chinese Singaporeans' perception of them. Findings revealed that Chinese-other biracials were well-liked regardless of their response to racial prejudice, demonstrating Chinese Singaporeans' recognition of shared racial membership. Interestingly, Chinese Singaporeans increased their liking for Indian-Malay biracials when they confronted antimajority racial prejudice., Conclusion: Perceiving shared racial membership positively influenced Chinese Singaporeans' perceptions and feelings toward biracials. Theoretical and practical implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Thailand is a country where over 60 languages from five language families (Austroasiatic, Austronesian, Hmong-Mien, Kra-Dai, and Sino-Tibetan) are spoken. The Kra-Dai language family is the most prevalent, and Thai, the official language of the country, belongs to it. Previous genome-wide studies on Thailand populations revealed a complex population structure and put some hypotheses forward concerning the population history of the country. However, many published populations have not been co-analyzed, and some aspects of population history were not explored adequately. In this study, we employ new methods to re-analyze published genome-wide genetic data on Thailand populations, with a focus on 14 Kra-Dai-speaking groups. Our analyses reveal South Asian ancestry in Kra-Dai-speaking Lao Isan and Khonmueang, and in Austroasiatic-speaking Palaung, in contrast to a previous study in which the data were generated. We support the admixture scenario for the formation of Kra-Dai-speaking groups from Thailand who harbor both Austroasiatic-related ancestry and Kra-Dai-related ancestry from outside of Thailand. We also provide evidence of bidirectional admixture between Southern Thai and Nayu, an Austronesian-speaking group from Southern Thailand. Challenging some previously reported genetic analyses, we reveal a close genetic relationship between Nayu and Austronesian-speaking groups from Island Southeast Asia (ISEA)., (© 2023. The Author(s).)

This study identified changes in Korean and heritage language proficiencies across five waves (2011-2015) and examined the association between linguistic acculturation trajectories and adjustment (2016) among Korean adolescents with immigrant family backgrounds (N = 1441; 51.21% female; M age(baseline)  = 9.97). All adolescents were from multiethnic families with 91.65% comprising a non-Korean Asian mother (e.g., Japan, Philippines, China, Thailand) and Korean father. Parallel process latent class growth modeling and multivariate regression analysis were conducted to estimate the trajectories of linguistic acculturation and their effects on adolescents' future adjustment. Linguistic acculturation trajectories were classified into three latent groups. Bilingual adolescents demonstrated better adjustment over adolescents in other trajectories. Findings highlight the importance of considering patterns of change in linguistic acculturation for understanding Korean multicultural adolescents' adjustment., (© 2022 The Authors. Child Development © 2022 Society for Research in Child Development.)

Aim: To establish a model for predicting adverse outcomes in advanced-age pregnant women with preterm preeclampsia in China., Methods: We retrospectively collected the medical records of 896 pregnant women with preterm preeclampsia who were older than 35 years and delivered at the Affiliated Hospital of Qingdao University from June 2018 to December 2020. The pregnant women were divided into an adverse outcome group and a non-adverse outcome group according to the occurrence of adverse outcomes. The data were divided into a training set and a verification set at a ratio of 8:2. A nomogram model was developed according to a binary logistic regression model created to predict the adverse outcomes in advanced-age pregnant women with preterm preeclampsia. ROC curves and their AUCs were used to evaluate the predictive ability of the model. The model was internally verified by using 1000 bootstrap samples, and a calibration diagram was drawn., Results: Binary logistic regression analysis showed that platelet count (PLT), uric acid (UA), blood urea nitrogen (BUN), prothrombin time (PT), and lactate dehydrogenase (LDH) were the factors that independently influenced adverse outcomes (P < 0.05). The AUCs of the internal and external verification of the model were 0.788 (95% CI: 0.737 ~ 0.764) and 0.742 (95% CI: 0.565 ~ 0.847), respectively. The calibration curve was close to the diagonal., Conclusions: The model we constructed can accurately predict the risk of adverse outcomes of pregnant women of advanced age with preterm preeclampsia, providing corresponding guidance and serving as a basis for preventing adverse outcomes and improving clinical treatment and maternal and infant prognosis., (© 2022. The Author(s).)

Background: Gestational Diabetes Mellitus (GDM) is common in South East Asia, occurring at relatively lean Body Mass Index (BMI). Outside pregnancy, cardiometabolic risks increase at lower BMI in Asian populations, justifying Asian-specific thresholds for overweight and obesity. We aimed to explore the effects of GDM and obesity on perinatal outcomes using a WHO expert consultation-recommended Asian-specific definition of obesity., Methods: This is a secondary analysis of a prospective, hospital-based, cohort study in Ho Chi Minh City. Participants were recruited from antenatal clinics between 19 + 0 -22 + 6 weeks gestation and followed until delivery. GDM screening occurred between 24 and 28 weeks using WHO criteria. Obesity was defined as BMI ≥ 27.5 kg/m 2 , based on weight and height at recruitment. We assessed associations between GDM (singly, and in combination with obesity) and perinatal outcomes. Participants were categorised into four groups: no GDM/non-obese (reference group), GDM/non-obese, no GDM/obese and GDM/obese. Outcomes included primary caesarean section, hypertensive disorders of pregnancy (HDP), large-for-gestational-age (LGA), birth weight, preterm birth, and composite adverse neonatal outcome. Logistic and linear regressions were performed with adjustment for differences in baseline characteristics., Results: Among 4,970 participants, 908 (18%) developed GDM. Compared to women without GDM, GDM increased risks for preterm birth (OR: 1.40, 95% CI: 1.09-1.78), higher birthweight (birthweight z-score 0.16 versus 0.09, p = 0.027), and LGA (OR 1.14, 0.89-1.46). GDM without obesity was associated with an increased risk of preterm birth (OR 1.35, 1.04-1.74). Obese women without GDM were more likely to deliver by caesarean section and have an LGA baby (1.80, 1.33-2.44 and 2.75, 1.88-4.03). The highest risks were observed amongst women with both GDM and obesity: caesarean Sect. (2.43, 1.49-3.96), LGA (3.36, 1.94-5.80) and preterm birth (2.42, 1.32-4.44)., Conclusions: GDM was associated with an increased risk of preterm birth and larger newborn size. Using an Asian-specific definition of obesity, we demonstrate obese women with GDM are at the highest risk of adverse outcomes. Using a BMI threshold in pregnancy of 27.5 kg/m 2 (between 19 and 22 weeks gestation) for Asian women can identify women who will benefit from intensified diabetes, nutritional, and obstetric care. This has relevance for obstetric service delivery within Asia, and other health systems providing pregnancy care for Asian expatriate women., (© 2022. The Author(s).)

Background: Antenatal depression (AD) is common in pregnant women and is associated with adverse outcomes for the mother, fetus, infant and child. The influencing factors of AD among pregnant women have been studied; however, the mechanisms of these factors remain unclear. This study was designed to examine the direct and serial mediating roles of coping styles in the relationship between perceived social support and AD among pregnant women., Methods: A cross-sectional study was conducted among 1486 pregnant women who registered to give birth at a tertiary hospital. A self-developed questionnaire was administered to obtain sociodemographic and obstetric data. The Perceived Social Support Scale (PSSS), Simplified Coping Style Questionnaire (SCSQ), and Edinburgh Postnatal Depression Scale (EPDS) were administered to measure the perceived social support, coping styles, and depressive symptoms of pregnant women, respectively. Multiple linear stepwise regression analysis was used, and then, the specific relationships among influencing factors were determined through structural equation modelling (SEM)., Results: The prevalence of AD was 24.02%. The average scores of intrafamily support, extrafamily support, positive coping styles, negative coping styles and EPDS reported by pregnant women were 24.16 ± 3.09, 44.52 ± 6.16, 27.34 ± 4.89, 9.79 ± 3.82, and 7.44 ± 3.56, respectively. Multiple regression analysis showed that pregnant women with a higher level of intrafamily support exhibited a positive coping style and a decreased risk of AD. Compared with extrafamily support, the direct effect (-0.16 vs. -0.10, P < 0.05) and indirect effect of intrafamily support through coping styles (-0.028 vs. -0.027, P < 0.05) on AD were stronger. Two indirect pathways explained 17.46% of the variance in the EPDS scores., Conclusion: Higher social support decreased the likelihood of AD, not only directly but also through the mediating roles of coping styles. Social support should be strengthened, and positive coping styles should be advocated in every stage of pregnancy. Specifically, intrafamily support should be given more attention for pregnant Chinese women., (© 2022. The Author(s).)

Recent data suggest that non-alcoholic fatty liver disease (NAFLD) has become a major public health problem in Asia, with an updated population prevalence of 34%. In parallel, NAFLD-associated hepatocellular carcinoma (HCC) is also on the rise. In this review, we describe the changing epidemiology of HCC in Asia over the past 30 years. While traditional risk factors for HCC (older age, male sex and metabolic factors) are also important in Asia, the PNPLA3 gene polymorphism is particularly prevalent in East Asia and may increase the risk of HCC. NAFLD among non-obese individuals is also commonly described in Asia. Because NAFLD is often undiagnosed, few patients receive HCC surveillance, and the target surveillance population beyond patients with cirrhosis remains poorly defined. As a result, NAFLD-associated HCC is often diagnosed at an advanced stage, rendering curative treatment impossible. Finally, despite around 20-30 years of universal vaccination, chronic HBV infection remains prevalent in Asia, and emerging evidence highlights the importance of metabolic factors and concomitant hepatic steatosis on HCC development in infected patients. Future studies should explore the role of metabolic treatments in HCC prevention among patients with hepatic steatosis and concomitant liver diseases., Competing Interests: Conflicts of interests Grace Wong has served as an advisory committee member for Gilead Sciences and Janssen, and as a speaker for Abbott, Abbvie, Bristol-Myers Squibb, Echosens, Gilead Sciences, Janssen and Roche. Vincent Wong has served as a consultant or advisory board member for 3V-BIO, AbbVie, Allergan, Boehringer Ingelheim, Echosens, Gilead Sciences, Inventiva, Merck, Novartis, Novo Nordisk, Pfizer, ProSciento, Sagimet Biosciences, TARGET PharmaSolutions, and Terns; and a speaker for Abbott, AbbVie, Echosens, Gilead Sciences, and Novo Nordisk. He has received a grant from Gilead Sciences for fatty liver research. Please refer to the accompanying ICMJE disclosure forms for further details., (Copyright © 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Purpose: To assess baseline ocular biometric risk factors for progression from primary angle closure suspect (PACS) to primary angle closure (PAC) or acute angle closure (AAC)., Design: Prospective, observational study., Participants: Six hundred forty-three mainland Chinese with untreated PACS., Methods: Participants underwent baseline clinical examinations, including gonioscopy, anterior segment OCT (AS-OCT) imaging, and A-scan ultrasound biometry as part of the Zhongshan Angle Closure Prevention (ZAP) Trial. Primary angle closure suspect was defined as an inability to visualize pigmented trabecular meshwork in 2 or more quadrants based on static gonioscopy. Primary angle closure was defined as development of intraocular pressure above 24 mmHg or peripheral anterior synechiae. Progression was defined as development of PAC or an AAC attack. Multivariable logistic regression models were developed to assess biometric risk factors for progression., Main Outcome Measures: Six-year progression from PACS to PAC or AAC., Results: Six hundred forty-three untreated eyes (609 nonprogressors, 34 progressors) of 643 participants were analyzed. In a multivariable model with continuous parameters, narrower horizontal angle opening distance of 500 μm from the scleral spur (AOD 500 ; odds ratio [OR], 1.10 per 0.01-mm decrease; P = 0.03), flatter horizontal iris curvature (IC; OR, 1.96 per 0.1-mm decrease; P = 0.01), and older age (OR, 1.11 per 1-year increase; P = 0.01) at baseline were associated significantly with progression (area under the receiver operating characteristic curve [AUC], 0.73). Smaller cumulative gonioscopy score was not associated with progression (OR, 1.03 per 1-modified Shaffer grade decrease; P = 0.85) when replacing horizontal AOD 500 in the multivariable model. In a separate multivariable model with categorical parameters, participants in the lowest quartile of horizontal AOD 500 (OR, 3.10; P = 0.002) and IC (OR, 2.48; P = 0.014) measurements and 59 years of age or older (OR, 2.68; P = 0.01) at baseline showed higher odds of progression (AUC, 0.72)., Conclusions: Ocular biometric measurements can help to risk-stratify patients with early angle closure for more severe disease. Anterior segment OCT measurements of biometric parameters describing the angle and iris are predictive of progression from PACS to PAC or AAC, whereas gonioscopy grades are not., (Copyright © 2021 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: Differences in reproductive health outcomes according to the mothers' origins have been reported in Switzerland, for example, women from European countries and non-European countries. The Swiss Federal Office of Public Health has therefore called for specific Swiss-wide studies on migrant populations. This study explores the pregnancy and antenatal care experiences of Chinese migrants in Switzerland, intending to clarify their maternity care needs., Methods: In-depth interviews of 14 Chinese mothers and 13 family members were conducted in Chinese or English and audio recorded. All audio-recordings were transcribed verbatim. All Chinese transcripts were translated into English. Thematic analysis was performed with the assistance of the qualitative data analysis software, MAXQDA Analytics Pro 2020., Results: Five themes were extracted from the transcripts: (1) Motivations and concerns about having children, (2) The merits of the Swiss maternity care system, (3) The inconveniences and barriers of accessing Swiss maternity care services, (4) Strategies to deal with the inconveniences of the Swiss maternity care system, and (5) The need for culturally sensitive care., Conclusions: The results of our study provide new knowledge and understanding of pregnancy experiences and antenatal care services of Chinese mothers and their families in Switzerland. Their unique positive experiences included: family planning, the continuity of maternity services, humane care with the privacy respected, personalized sensitive care needs, preferences for female obstetricians and obstetricians of Asian origin. Several barriers were highlighted, such as information seeking difficulties, communication difficulties, and a rigid appointment system. Reducing barriers enabling access to maternity care services within the Swiss healthcare system is necessary to provide equal quality maternity care for individuals, irrespective of their origins., (© 2022. The Author(s).)

Objective: To explore the association of single nucleotide polymorphisms (SNPs) of the vitamin D receptor gene ( VDR ) with circulating lipids considering gender differences., Methods: Of the Han Chinese adults recruited from a health examination center for inclusion in the study, the circulating lipids, 25-hydroxyvitamin D (25OHD), and other parameters were measured. The VDR SNPs of Cdx2 (rs11568820), Fok1 (rs2228570), Apa1 (rs7975232), and Taq1 (rs731236) were genotyped with a qPCR test using blood DNA samples, and their associations with lipids were analyzed using logistic regression., Results: In the female participants ( n = 236 with dyslipidemia and 888 without dyslipidemia), multiple genotype models of Fok1 indicated a positive correlation of B (not A) alleles with LDLC level ( P < 0.05). In the male participants ( n = 299 with dyslipidemia and 564 without dyslipidemia), the recessive model of Cdx2 and the additive and recessive models of Fok1 differed ( P < 0.05) between the HDLC-classified subgroups, respectively, and Fok1 BB and Cdx2 TT presented interactions with 25OHD in the negative associations with HDLC ( P < 0.05)., Conclusion: In the Chinese Han adults included in the study, the Fok1 B-allele of VDR was associated with higher LDLC in females, and the Fok1 B-allele and the Cdx2 T-allele of VDR were associated with lower HDLC in males. The interaction of VD and Fok1 BB or Cdx2 TT in males synergistically decreased HDLC levels., (Copyright © 2022 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.)

Background: The extremes of maternal pre-pregnancy body mass index (BMI) are known to be risk factors associated with obstetric and adverse perinatal outcomes. Among Japanese women aged 20 years or older, the prevalence of underweight (BMI < 18.5 kg/m 2 ) was 11.5% in 2019. Maternal thinness is a health problem caused by the desire to become slim. This study aimed to investigate the association between the severity of maternal low pre-pregnancy BMI and adverse perinatal outcomes, including preterm birth (PTB), low birth weight (LBW), and small-for-gestational age (SGA)., Methods: We conducted a prospective cohort study using data from the Japan Environment and Children's Study, which recruited pregnant individuals between 2011 and 2014. Pre-pregnancy BMI was categorized as severe-moderate underweight (BMI < 16.9 kg/m 2 ), mild underweight (BMI, 17.0-18.4 kg/m 2 ), low-normal weight (BMI, 18.5-19.9 kg/m 2 ), high-normal weight (BMI, 20.0-22.9 kg/m 2 ), overweight (BMI, 23.0-24.9 kg/m 2 ), and obese (BMI ≥ 25.0 kg/m 2 ). The high-normal weight group was used as the reference for statistical analyses. Adjusted logistic regression was performed to evaluate the association between pre-pregnancy BMI and PTB, LBW, and SGA., Results: Of 92,260 singleton pregnant individuals, the prevalence was 2.7% for severe-moderate underweight, 12.9% for mild underweight, and 24.5% for low-normal weight. The prevalence of adverse outcomes was 4.6% for PTB, 8.1% for LBW, and 7.6% for SGA. The adjusted odds ratios (aORs) for PTB were 1.72 (95% confidence interval [CI], 1.46-2.03) for severe-moderate underweight and 1.26 (95% CI, 1.14-1.39) for mild underweight. The aORs of LBW were 2.55 (95% CI, 2.27-2.86) for severe-moderate underweight, 1.64 (95% CI, 1.53-1.76) for mild underweight, and 1.23 (95% CI, 1.16-1.31) for low-normal weight. The aORs of SGA were 2.53 (95% CI, 2.25-2.84) for severe-moderate underweight, 1.66 (95% CI, 1.55-1.79) for mild underweight, and 1.29 (95% CI, 1.21-1.38) for low-normal weight., Conclusions: A dose-response relationship was found between the severity of low pre-pregnancy BMI and PTB, LBW, and SGA. Even low-normal BMI (18.5-19.9 kg/m 2 ) increased the risk of LBW and SGA. This study provides useful information for pre-conception counseling in lean individuals., (© 2022. The Author(s).)

Background: Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes., Methods: TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients., Results: A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients., Conclusion: Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers., Trial Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT01947621., (© 2021. The Author(s).)

Aims/hypothesis: Glycerophospholipid (GPL) perturbance was linked to the pathogenesis of diabetes in animal studies but prospective studies in humans are rare, particularly in Asians. We aimed to investigate the associations between plasma GPLs and incident diabetes and to explore effects of lifestyle on the associations in a Chinese population., Methods: The study included 1877 community-dwelling Chinese individuals aged 50-70 years (751 men and 1126 women), free of diabetes at baseline and followed for 6 years. A total of 160 GPL species were quantified in plasma at baseline by using high-throughput targeted lipidomics. Log-Poisson regression was used to assess the associations between GPLs and incidence of diabetes., Results: Over the 6 years of follow-up, 499 participants (26.6%) developed diabetes. After multivariable adjustment, eight GPLs were positively associated with incident diabetes (RR per SD 1.13-1.25; all false-discovery rate [FDR]-corrected p < 0.05), including five novel GLPs, namely phosphatidylcholines (PCs; 16:0/18:1, 18:0/16:1, 18:1/20:3), lysophosphatidylcholine (LPC; 20:3) and phosphatidylethanolamine (PE; 16:0/16:1), and three reported GPLs (PCs 16:0/16:1, 16:0/20:3 and 18:0/20:3). In network analysis, a PC-containing module was positively associated with incident diabetes (RR per SD 1.16 [95% CI 1.06, 1.26]; FDR-corrected p < 0.05). Notably, three of the diabetes-associated PCs (16:0/16:1, 16:0/18:1 and 18:0/16:1) and PE (16:0/16:1) were associated not only with fatty acids in the de novo lipogenesis (DNL) pathway, especially 16:1n-7 (Spearman correlation coefficients = 0.35-0.62, p < 0.001), but also with an unhealthy dietary pattern high in refined grains and low in fish, dairy and soy products (|factor loadings| ≥0.2). When stratified by physical activity levels, the associations of the eight GPLs and the PC module with incident diabetes were stronger in participants with lower physical activity (RR per SD 1.24-1.49, FDR-corrected p < 0.05) than in those with the median and higher physical activity levels (RR per SD 1.03-1.12, FDR-corrected p ≥ 0.05; FDR-corrected p interaction  < 0.05)., Conclusions/interpretation: Eight GPLs, especially PCs associated with the DNL pathway, were positively associated with incident diabetes in a cohort of Chinese men and women. The associations were most prominent in participants with a low level of physical activity., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)