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Objectives In 2015, the 20-item Tophus Impact Questionnaire (TIQ-20) was developed as a tophus-specific patient-reported outcome measure. The aim of this study was to determine whether TIQ-20 scores change during urate-lowering therapy. Methods We analysed data from a 2-year clinical trial of allopurinol dose escalation using a treat-to-target serum urate approach. For participants with tophaceous gout, the longest diameter of up to three index tophi was measured, using Vernier calipers, and the TIQ-20 was recorded at study visits. Participants at the one site were invited to participate in a dual-energy CT (DECT) substudy. Participants were included in this analysis if they had tophaceous gout and TIQ-20 scores available at baseline, Year 1 and Year 2 (n  = 58, 39 with DECT data). Data were analysed using a mixed-model approach to repeated measures. Results Improvements were observed in all tophus measures over the 2-year period. The mean (s. d.) TIQ-20 scores reduced over 2 years from 3.59 (1.77) to 2.46 (1.73), P  < 0.0001, and the mean (95% CI) TIQ-20 change over the 2 years was –1.13 (–1.54, –0.71). The effect size (Cohen's d) for the change in the sum of the index tophi diameter over 2 years was 0.68, for the DECT urate volume was 0.50, and for the TIQ-20 was 0.71. Conclusion For people with tophaceous gout treated with allopurinol using a treat-to-target serum urate approach, improvements in TIQ-20 occurred, as did improvements in physical and imaging tophus measures. These findings demonstrate that the TIQ-20 is a responsive patient-reported instrument of tophus impact. [ABSTRACT FROM AUTHOR]

Background: Antenatal corticosteroids for women at risk of preterm birth reduce neonatal morbidity and mortality, but there is limited evidence regarding their effects on long-term health. This study assessed cardiovascular outcomes at 50 years after antenatal exposure to corticosteroids. Methods and findings: We assessed the adult offspring of women who participated in the first randomised, double-blind, placebo-controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome (RDS) (1969 to 1974). The first 717 mothers received 2 intramuscular injections of 12 mg betamethasone or placebo 24 h apart and the subsequent 398 received 2 injections of 24 mg betamethasone or equivalent volume of placebo. Follow-up included a health questionnaire and consent to access administrative data sources. The co-primary outcomes were the prevalence of cardiovascular risk factors (any of hypertension, hyperlipidaemia, diabetes mellitus, gestational diabetes mellitus, or prediabetes) and age at first major adverse cardiovascular event (MACE) (cardiovascular death, myocardial infarction, coronary revascularisation, stroke, admission for peripheral vascular disease, and admission for heart failure). Analyses were adjusted for gestational age at entry, sex, and clustering. Of 1,218 infants born to 1,115 mothers, we followed up 424 (46% of survivors; 212 [50%] female) at mean (standard deviation) age 49.3 (1.0) years. There were no differences between those exposed to betamethasone or placebo for cardiovascular risk factors (159/229 [69.4%] versus 131/195 [67.2%]; adjusted relative risk 1.02, 95% confidence interval [CI] [0.89, 1.18;]; p = 0.735) or age at first MACE (adjusted hazard ratio 0.58, 95% CI [0.23, 1.49]; p = 0.261). There were also no differences in the components of these composite outcomes or in any of the other secondary outcomes. Key limitations were follow-up rate and lack of in-person assessments. Conclusions: There is no evidence that antenatal corticosteroids increase the prevalence of cardiovascular risk factors or incidence of cardiovascular events up to 50 years of age. Established benefits of antenatal corticosteroids are not outweighed by an increase in adult cardiovascular disease. Anthony G B Walters and colleagues assess cardiovascular outcomes fifty years after antenatal exposure to betamethasone, in long-term follow-up of a randomised double-blind, placebo-controlled trial. Author summary: Why was this study done?: Antenatal corticosteroids (ANC) are given to pregnant persons at risk of preterm birth to reduce the risk of death and breathing difficulty for their offspring. Animal studies have shown later adverse effects of ANC on offspring, particularly on their cardiovascular health in adulthood. There is little robust evidence about long-term effects in humans. This study aimed to provide evidence about the long-term effects of ANC on offspring cardiovascular health in adulthood. What did the researchers do and find?: We assessed participants at 50 years of age who had been exposed to ANC or placebo during the first randomised clinical trial of this treatment. We compared cardiovascular disease and cardiovascular risk factors between those exposed to ANC and placebo in 424 participants (46% of those still alive), using a questionnaire and routinely collected administrative data. We found no differences in cardiovascular outcomes between those exposed to ANC and those who were not. What do these findings mean?: There is no evidence that ANC has adverse effects on the cardiovascular health outcomes of offspring up to 50 years of age. The main limitation was the follow-up rate of less than 50% and the use of health questionnaires and routinely collected data rather than in-person assessments. [ABSTRACT FROM AUTHOR]

Introduction: Concurrent diagnosis of gestational diabetes mellitus and mental disorders is associated with adverse outcomes for mother and child, but there is limited information about prevalence or which women are at risk. Material and methods: This study was a prospective cohort study of women with gestational diabetes from 10 hospitals in New Zealand who reported anxiety (6‐item Spielberger State–Trait Anxiety Inventory), depression (Edinburgh Postnatal Depression Scale) and health‐related quality of life (36‐Item Short‐Form General Health Survey) at time of gestational diabetes diagnosis (baseline), 36 weeks' gestation, and 6 months postpartum. Potential predictors were assessed using multivariable logistic regression. Results: Among 414 respondents, 17% reported anxiety, 16% vulnerability to depression and 27% poor mental health‐related quality of life at time of gestational diabetes diagnosis. At 36 weeks' gestation, prevalence decreased for vulnerability to depression (8%) and poor mental health‐related quality of life (20%). Younger maternal age, Pacific ethnicity, previous history of gestational diabetes, and older gestational age at time of gestational diabetes diagnosis were associated with poorer mental health outcomes. At 6 months postpartum the prevalence of mental disorders did not differ from in late pregnancy and they were associated with later gestational age at time of gestational diabetes diagnosis and elevated 2‐hour postprandial glucose concentrations. Conclusions: Perinatal mental disorders are common at time of diagnosis among women with gestational diabetes in New Zealand and had decreased by late pregnancy and at 6 months after birth. These disorders are more common among women with specific risk factors who may therefore benefit from additional support. [ABSTRACT FROM AUTHOR]

\nIntroduction: We sought to investigate if the availability of cerebral fuels soon after birth in healthy term babies was associated with developmental progress at 3 years of age. Methods: Healthy term babies had plasma glucose, lactate, and beta-hydroxybutyrate concentrations measured over the first 5 days. At 3 years, parents completed Ages and Stages (ASQ-3) questionnaires between December 2018 and August 2022. Developmental progress, analysed using structural equation modelling, was compared between children whose median fuel concentrations were above and below the mean neonatal concentrations of glucose (3.3 mmol/L) and total ATP-equivalents (140 mmol/L) in the first 48 h and over the first 5 days. Results: Sixty-four (96%) families returned completed questionnaires. We found no differences between developmental progress in children who had median neonatal plasma glucose concentrations <3.3 or ≥3.3 mmol/L in the first 48 h (estimated mean difference in ASQ scores −1.0, 95% confidence interval: −5.8, 3.7, p = 0.66) or 120 h (−3.7, −12.0, 4.6, p = 0.39]). There were also no differences for any other measures of cerebral fuels including total ATP above and below the median over 48 and 120 h, any plasma or interstitial glucose concentration <2.6 mmol/L, or cumulative duration of interstitial glucose concentration <2.6 mmol/L. Conclusions: There was no detectable relationship between plasma concentrations of glucose, lactate, and beta-hydroxybutyrate soon after birth in healthy term babies and developmental progress at 3 years of age. In the Glucose in Well babies and their later Neurodevelopment (GLOWiNg) study, we investigated whether the availability of brain fuels in healthy term babies during the first 5 days after birth was associated with their neurodevelopmental progress at 3 years of age. We had measured plasma glucose, lactate, and beta-hydroxybutyrate concentrations when the children were babies, as these are the most common brain fuels. We used the Ages and Stages questionnaire, which is completed by parents, to assess the child’s development in areas including communication, motor skills (fine and gross), and problem solving.We studied 64 families whose babies were part of the Glucose in Well Babies (GLOW) study in New Zealand. Using both structural equation modelling and linear regression, we found that even though many babies experienced episodes of low plasma glucose concentrations, there was no detectable relationship between these episodes and developmental progress at 3 years of age. We explored other factors, including glucose concentrations, total fuels available, and the duration of low glucose episodes, and found no significant associations. Our results suggest that in healthy term babies, episodes of low glucose concentrations in the first days after birth may be part of the normal metabolic transition after birth and may not have long-term implications for neurodevelopment. However, larger studies using different assessment tools are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Aim: Hypoglycaemia is common in neonates born to mothers with gestational diabetes mellitus (GDM). We aimed to determine predictors of hypoglycaemia among neonates of women with GDM and association with short‐term outcomes. Methods: We conducted a secondary cohort analysis of data from a multi‐centre randomised trial (the TARGET trial) conducted across ten maternity hospitals in New Zealand between May 2015 and November 2017. Data were analysed using univariate analysis and multivariable forward stepwise logistic regression. Results: Among 1085 neonates, those born to Asian mothers had reduced odds of hypoglycaemia (OR [95% CI]: 0.54 [0.38, 0.75], p = 0.001), as did those born at higher gestational ages (0.76 [0.68, 0.85], p < 0.001). Neonates born to Pacific mothers had increased odds of hypoglycaemia (OR [95% CI]: 1.57 [1.04, 2.39], p = 0.034). Neonates who experienced hypoglycaemia were more likely to experience neonatal intensive care unit admission (8.3% vs. 2.1%; p ≤ 0.001), hyperbilirubinaemia (8.6% vs. 3.3%; p ≤ 0.001) and receive respiratory support (11.4% vs. 4.8%; p ≤ 0.001) and less likely to be breastfed at discharge (92.4% vs. 96.2%; p = 0.009). Conclusion: Among neonates of women with GDM, maternal ethnicity and gestation at birth are independent predictors of hypoglycaemia, and hypoglycaemia is associated with short‐term comorbidities. Additional surveillance may be appropriate for neonates in these high‐risk groups. [ABSTRACT FROM AUTHOR]

Background: Fructose consumption has been linked with insulin resistance, obesity and diabetes, which are more prevalent in those of Māori or Pacific ethnicity compared to New Zealand European. Aim: To determine whether the acute effects of fructose consumption on serum glucose, insulin, lipids and C‐reactive protein differs according to body mass index (BMI) and/or ethnicity. Methods: Participants of Māori (n = 25), Pacific (n = 26) or New Zealand European (n = 25) ethnicity consumed a 64 g fructose/16 g glucose solution. Changes in lipids, glucose, insulin and C‐reactive protein were analysed using mixed models for repeated measures. Results: After adjustment for age and gender, those with higher BMI had a higher glucose (P = 0.0064) and insulin (P = 0.0007) response than those with lower BMI. Those of Māori or Pacific ethnicity had similar glucose levels (P = 0.077) to those of New Zealand European ethnicity but higher insulin responses (P = 0.0005), which remained after additional adjustment for BMI (P = 0.001). Reported sugar‐sweetened beverages (SSB) intake was higher among Māori and Pacific than New Zealand European (median 1.0 vs 0.0 SSB/day P = 0.002). Conclusion: Even after adjustment for BMI, those of Māori and Pacific ethnicity have a significantly higher insulin response to fructose than New Zealand Europeans. Higher habitual SSB intake may be a contributing factor. [ABSTRACT FROM AUTHOR]

Background: To describe the long-term mortality of a complete national cohort of acute coronary syndrome (ACS) patients enrolled in 2002, to compare this with a national age, sex and Māori ethnicity matched population, and to assess the influence of baseline factors on the 12-year mortality.Methods: We reviewed 721 patients with a discharge diagnosis of an ACS who were enrolled in the first New Zealand ACS audit group cohort over 14days in May 2002. We matched the cohort to the national mortality database using each patient's unique national identity number.Results: Over a median follow-up of 12.7 years of 721 patients discharged with an ACS, overall mortality was 52%: ST-elevation myocardial infarction (STEMI) (58%), non-ST-elevation myocardial infarction (NSTEMI) (61%) and unstable angina pectoris (UAP) (42%) patients, p<0.0001. In an age-adjusted survival model, males had a 29% increased mortality rate compared to females with a hazard ratio of 1.29 (95% CI 1.04, 1.61, p=0.019). Over 12 years there were 339 (47%) deaths, compared to 284 (39%) deaths observed in the matched population. The standardised mortality ratio for patients admitted with an ACS in New Zealand is 1.3 (95% CI 1.2, 1.5) with eight patients per 100 not surviving to 12 years compared to this matched population.Conclusions: The high mortality rate in this ACS cohort is a stark reminder of the prognostic implications of a presentation with an ACS. It emphasises the on-going need for optimal management of these patients throughout every stage of their initial treatment and subsequent on-going care. [ABSTRACT FROM AUTHOR]

Background Inorganic phosphate is a crucial component of cellular energy metabolism. We have identified an inverse relationship between serum phosphate concentration and fat mass in a cohort of healthy men. This study reports those data and determines whether this association is present in two female populations. Methods Cross-sectional data from three independent cohorts, consisting of healthy adult males (Male Cohort, n = 323) and healthy postmenopausal women (Female Cohort 1, n = 185; and Female Cohort 2, n = 1471), are reported. Associations between serum phosphate and weight, body mass index (BMI), fat mass and bone mineral density (BMD) were assessed. In a fourth cohort of postmenopausal women (FGF23 Cohort, n = 20), associations between fibroblast growth factor 23 (FGF23), weight and BMI were assessed. Results Serum phosphate correlated inversely with weight, BMI and fat mass across all three cohorts ( r = −0·13 to −0·31, P < 0·0001-0·02). Associations were diminished after adjustment for PTH, but remained significant. In the FGF23 Cohort, FGF23 was positively correlated with weight ( r = 0·60, P = 0·007) and BMI ( r = 0·49, P = 0·03). Phosphate was inversely associated with BMD in Female Cohorts 1 and 2 ( r = −0·08 to −0·29, P < 0·0001-0·02). This relationship was attenuated, but remained significant at most sites, following adjustment for age, fat mass, renal function and 25-hydroxyvitamin D. Conclusions Serum phosphate is inversely associated with measures of adiposity in both women and men, largely independently of PTH. FGF23 might mediate these associations. This relationship may be an unrecognized confounder in some of the correlates of serum phosphate already described. [ABSTRACT FROM AUTHOR]

Objectives: Both the FRAX and Garvan calculators are used to estimate absolute risk of fracture, but they sometimes produce different estimates. We sought to determine which patient characteristics contribute to these discrepancies.Study Design: Ten-year hip fracture risk was estimated for 122 women, using both FRAX and Garvan with bone mineral density (BMD).Main Outcome Measures: Differences in estimates of hip fracture were assessed, both in absolute terms and with respect to a treatment threshold of 3%.Results: Garvan estimates were higher than FRAX estimates across the range of ages and BMDs studied. A history of falls or of multiple fractures increased risk calculated by Garvan 3-6-fold, but did not account for all differences between calculators. Discrepancies around a 3% treatment threshold occurred in 31/122 (25%). Women aged 70-74 years, and women with osteopenia were most likely to have discordant estimates. Most discordant estimates (29/31) had a Garvan estimate ≥ 3% and FRAX <3%. Falls, multiple fractures, ethnicity and a history of parental hip fracture contributed to some discordant estimates.Conclusions: Hip fracture risk estimates are usually higher with Garvan than FRAX, and these differences could impact on treatment decisions in about a quarter of patients. Falls and multiple fractures have a strong influence on Garvan risk estimates, when present. Clinically important discrepancies tend to occur in patients who are at borderline fracture risk. In patients with hip fracture risks near the treatment threshold with one calculator, use of the other calculator should be considered to help guide treatment decisions. [ABSTRACT FROM AUTHOR]

A collection of sets is symmetric-difference-free, respectively symmetric difference-closed, if the symmetric difference of any two sets in the collection lies outside, respectively inside, the collection. Recently Buck and Godbole (Size-maximal symmetric difference-free families of subsets of [ n], Graphs Combin. (to appear), ) investigated such collections and showed, in particular, that the the largest symmetric difference-free collection of subsets of an n-set has cardinality 2. We use group theory to obtain shorter proofs of their results. [ABSTRACT FROM AUTHOR]

Background: Dietary supplement use is increasing despite lack of evidence of benefits, or evidence of harm. Press releases issued by the supplements industry might contribute to this situation by using ‘spin’ (strategies to hype or denigrate findings) to distort the results of clinical studies. We assessed press releases issued in response to publication of clinical studies on dietary supplements. Methods and Findings: We analyzed 47 supplements industry press releases and 91 non-industry press releases and news stories, generated in response to 46 clinical studies of dietary supplements published between 1/1/2005 and 5/31/2013. The primary outcome was ‘spin’ content and direction. We also assessed disposition towards use of dietary supplements, reporting of study information, and dissemination of industry press releases. More supplements industry press releases (100%) contained ‘spin’ than non-industry media documents (55%, P<0.001). Hyping ‘spin’ scores were higher in industry than non-industry media documents for studies reporting benefit of supplements (median ‘spin’ score 3.3, 95% CI 1.0–5.5 vs 0.5, 0–1.0; P<0.001). Denigratory ‘spin’ scores were higher in industry than non-industry media documents for studies reporting no effect (6.0, 5.0–7.0 vs 0, 0–0; P<0.001) or harm (6.0, 5.5–7.5 vs 0, 0–0.5; P<0.001) from a supplement. Industry press releases advocated supplement use in response to >90% of studies that reported no benefit, or harm, of the supplement. Industry press releases less frequently reported study outcomes, sample size, and estimates of effect size than non-industry media documents (all P<0.001), particularly for studies that reported no benefit of supplements. Industry press releases were referenced by 148 news stories on the websites of 6 organizations that inform manufacturers, retailers and consumers of supplements. Conclusions: Dietary supplements industry press releases issued in response to clinical research findings are characterized by ‘spin’ that hypes results that are favourable to supplement use and denigrates results that are not. [ABSTRACT FROM AUTHOR]

Exposure to low levels of nitrate in drinking water may have adverse reproductive effects. We reviewed evidence about the association between nitrate in drinking water and adverse reproductive outcomes published to November 2022. Randomized trials, cohort or case–control studies published in English that reported the relationship between nitrate intake from drinking water and the risk of perinatal outcomes were included. Random-effect models were used to pool data. Three cohort studies showed nitrate in drinking water is associated with an increased risk of preterm birth (odds ratio for 1 mg/L NO3-N increased (OR1) = 1.01, 95% CI 1.00, 1.01, I2 = 23.9%, 5,014,487 participants; comparing the highest versus the lowest nitrate exposure groups pooled OR (ORp) = 1.05, 95% CI 1.01, 1.10, I2 = 0%, 4,152,348 participants). Case–control studies showed nitrate in drinking water may be associated with the increased risk of neural tube defects OR1 = 1.06, 95% CI 1.02, 1.10; 2 studies, 2196 participants; I2 = 0%; and ORp = 1.51, 95% CI 1.12, 2.05; 3 studies, 1501 participants; I2 = 0%). The evidence for an association between nitrate in drinking water and risk of small for gestational age infants, any birth defects, or any congenital heart defects was inconsistent. Increased nitrate in drinking water may be associated with an increased risk of preterm birth and some specific congenital anomalies. These findings warrant regular review as new evidence becomes available. [ABSTRACT FROM AUTHOR]

Aims To describe changes in heart failure (HF) epidemiology in New Zealand between 1988 and 2008 using the number of days alive and out of hospital after a first hospitalization for HF, and to use these data to evaluate the overall impact of changing patterns of hospitalization and survival. Methods and results We performed a population analysis of all HF hospitalization and mortality data from 1 January 1988 to 31 December 2008 in New Zealand. The main outcome measures were: days alive and out of hospital, age standardized hospitalization rates, and mortality after an index hospitalization for HF. The number of days alive and out of hospital at 2 years increased by 2 months over the two decades of the study (from 448.8 to 511.3 days). Age standardized index HF hospitalization rates increased from 1988 to 1999, and declined thereafter, current rates are 106.9/100 000 for women and 174.3/100 000 for men. Patient age at index admission progressively increased, and hospital length of stay decreased. Mortality rates progressively decreased until 2000, but there has been no further decrease since then. Total hospital days have decreased up to 2008. Conclusion There have been major changes in the epidemiology of HF in New Zealand between 1988 and 2008, during which time there have been important changes in HF management. Despite increasing age, hospitalization rates are now declining and patients with HF are surviving longer out of hospital and with fewer hospital days. These results support the need for continued emphasis on delivery of effective community-based care for patients with this long-term condition. [ABSTRACT FROM PUBLISHER]

Objective: Despite the benefits of physical activity, people with arthritis are less active than the general population. The aim of this study was to determine the motivators and obstacles to physical activity for adults with arthritis. Methods: Participants were identified from the Obstacles to Action Study, a community based study of 8163 adults, which explored barriers and motivators to physical activity. A 1 : 1 case-control study was designed; cases were identified as those participants who reported arthritis ( n = 1106). Each case was matched with an age, sex and ethnicity-matched non-arthritis control ( n = 1106). Results: Cases were less likely to achieve recommended physical activity targets (58.8% vs. 68.1% P = 0.00001). Furthermore, fewer people with arthritis believed that physical activity would help them lead healthy lives (86.7% vs. 91.3% P = 0.006) or viewed physical activity as a priority (53.8% vs. 59.8% P = 0.005). Cases were less confident in their abilities to try a new activity (37.1% vs. 43.7% P = 0.002) or maintain a healthy weight (65.0% vs. 74.3% P = 0.00001). Cases also reported greater negative impact scores for barriers to activity, particularly arthritis, accessibility, cost and discomfort while exercising. Motivators and environmental barriers to activity were similar for cases and controls. These findings persisted after adjusting for educational level, body mass index and comorbidities. Conclusion: People with arthritis are less active and demonstrate different attitudes toward physical activity. Although people with arthritis identify similar environmental barriers, they have different psychosocial barriers. In order to design effective physical activity programs for people with arthritis, these barriers must be specifically addressed. [ABSTRACT FROM AUTHOR]

Abstract: Background and objective: Doppler echocardiographic assessment of diastolic filling provides a non-invasive estimate of left ventricular (LV) filling pressure and the most advanced diastolic filling grade, the restrictive filling pattern (RFP), has been linked to prognosis in patients post acute myocardial infarction (AMI) and with heart failure (HF). There remains some uncertainty about the prognostic role of RFP in patients with varied levels of systolic function. The objective of this collaboration is to determine whether the presence of RFP offers additional prognostic information over LV systolic function, symptoms or other clinical factors in patients post AMI or with HF. Methods: The Meta-analysis Research Group in Echocardiography (MeRGE) has been established in order to test this through two individual patient meta-analyses. Prospective studies that enrolled patients with either established HF or post AMI and included Doppler-echocardiography and outcome data will be merged into two large datasets (3739 AMI patients and 3540 HF patients) in order to evaluate the independent effects of RFP upon total and cardiovascular mortality using Kaplan–Meier survival analysis methods and Cox proportional Hazards model for multi-variate analysis. Survival will be examined within different bands of LV systolic function based upon ejection fraction (EF). Implications: This unique dataset will provide a very large cohort of patients, which will be adequately powered to provide new and prognostically important information to further aid risk stratification in these two high-risk patient groups. [Copyright &y& Elsevier]

OBJECTIVE -- Women with type 2 and type 1 diabetes have differing risk factors for pregnancy loss. We compared the rates and causes of pregnancy loss in women with type 1 and type 2 diabetes. RESEARCH DESIGN AND METHODS -- We utilized prospectively collected data on all pregnancies in a 20-year period (1986-2005) from a single center with a high prevalence of type 2 diabetes. Pregnancy losses included terminations for medical reasons and deaths up to 1 month postpartum but not spontaneous pregnancy losses <20 weeks' gestation. RESULTS -- There were 870 pregnancies in women with known diabetes (330 with type 1 and 540 with type 2 diabetes) and 325 in women with diabetes diagnosed in pregnancy but persisting postpartum (97% type 2 diabetes). The rate of pregnancy loss was similar in type 1 and type 2 diabetes (2.6 vs. 3.7%, P = 0.39), but the causes of pregnancy loss differed. In type 1 diabetes >75% were attributable to major congenital anomalies or prematurity; in type 2 diabetes > 75 % were attributable to stillbirth or chorioamnionitis (P = 0.017). Women with type 2 and type 1 diabetes had similar A1C at presentation and near term, but the former were older (P < 0.001) and more obese (P < 0.0001). CONCLUSIONS -- There are significant differences in the main causes of pregnancy loss in women with type 1 and type 2 diabetes. The higher rates of stillbirth in women with type 2 diabetes, suggest that other features, such as obesity, contribute significantly to pregnancy losses. [ABSTRACT FROM AUTHOR]

Abstract: Background: Several studies have reported that the presence of a restrictive filling pattern (RFP) is associated with poor outcome in patients with heart failure (HF). These studies, of variable sample size, have involved different HF patient groups with variable associated mortality rates and follow-up times, and while powered for effects on combined end-points such as death or hospital admission, many were underpowered to reliably determine the overall effect of the RFP on total mortality. Consequently, we performed a meta-analysis to determine the mortality associated with RFP in patients with HF. Methods: We searched several online medical databases for prospective studies of patients with HF. All authors were requested to confirm their data. All-cause mortality was compared between RFP and non-restrictive filling patterns (Non-RFP). Review Manager version 4.2.7 software was used for the analysis. Results: 3024 patients in 27 studies were identified (379 idiopathic cardiomyopathy, 2645 mixed aetiology HF). Average follow-up was between 3 months and 5 years. 1284 (42%) patients had RFP at baseline. 688 deaths occurred and the overall odds ratio for death was 4.36 (CI 3.60, 5.04); idiopathic group: 6.65 (CI 3.86, 11.47); mixed aetiology group: 4.10 (CI 3.34, 5.04). The overall odds ratio for death/transplantation was 4.87 (CI 4.04, 5.86); idiopathic group: 7.62 (CI 4.50, 12.92); mixed aetiology group: 4.56 (CI 3.74, 5.56). Conclusions: Restrictive filling pattern is associated with a four-fold increase in mortality in patients with HF and thus should be an important part of the echocardiographic assessment of such patients. [Copyright &y& Elsevier]

Background: To review medical and ophthalmic findings of primary diabetic vitrectomy patients to examine indices important in progression to fellow eye surgery. Methods: A retrospective analysis was undertaken of all diabetic patients undergoing vitreoretinal surgery at Auckland Public Hospital between January 1992 and July 1996. Kaplan−Meier survival analysis was performed along with univariate and multivariate (Cox Proportional Hazards) data analysis. Results: One hundred and fourteen primary diabetic vitrectomy cases were reviewed with mean follow-up duration of 4 years. Thirty-eight per cent ( n = 43) of the study group underwent fellow eye surgery at a mean time of 1.6 years after first eye surgery. Fourteen patients were already blind in the fellow eye at baseline, and five patients refused second eye surgery on intention to treat. Thus there were 62 (54%) patients with severe (surgical threshold) fellow eye disease diagnosed within the follow-up period. The presence of either tractional retinal detachment or combined rhegmatogenous/tractional retinal detachment but without vitreous haemorrhage in the presenting eye was, in this series, a risk factor for fellow eye surgery (OR 5.56; 95% CI 1.96−15.8). Maori and Pacific Islander ethnicity was significantly associated with traction retinal detachment (OR 2.23; 95% CI 1.05−4.7). At data analysis 57% ( n = 60) of the study patients had died. The mean time to death was 4.3 years, with 84% of these patients having evidence of renal disease at the time of their first eye surgery. Good visual function in at least one eye was maintained in many patients. Conclusions: A substantial proportion of diabetic vitrectomy patients require fellow eye surgery. Absence of vitreous haemorrhage in the presenting eye (i.e. tractional or combined rhegmatogenous/tractional retinal detachments but without vitreous haemorrhage) was predictive of need for fellow eye surgery. The need for diabetic vitrectomy correlates with poor survival in this study population. [ABSTRACT FROM AUTHOR]

Aims: To investigate the effects of tissue harmonic imaging (THI) and contrast chamber opacification (LVO) upon measurement variability and reproducibility of echocardiographic left ventricular (LV) volume and ejection fraction (EF) measurements in patients with heart failure (HF). Background: Echocardiography is often used in HF patients to determine LV volumes and EF. However, current echo methods are variable and may not be applicable for repeat testing in individual patients. THI and LVO have both been shown to improve endocardial visualisation, but it remains to be determined whether this results in better measurement reproducibility. Methods: Thirty-one HF patients and 30 control subjects underwent echocardiography on two separate days. LV volumes were measured under four different imaging conditions: fundamental, THI, LVO and LVO with ECG-triggered Power Doppler. Chamber opacification, pulmonary transit time (PTT), endocardial enhancement, reproducibility and bias were assessed. Results: Chamber opacification was inferior and the PTT longer in the HF patients. PTT was related to LV volumes, EF, jugular venous pressure and mitral filling pattern. THI improved endocardial visualisation, and although LVO improved endocardial visualisation in the controls, it offered no benefit over THI in the HF patients. LV volumes and EF were different for each method and THI was the least variable method for repeat measurements. Conclusions: THI improved endocardial visualisation and was the least variable of the techniques. LVO offered no further advantage in patients with HF and thus cannot be routinely advocated and since LV volumes and EF were different for each, these methods are neither comparable nor interchangeable for follow-up assessments. [ABSTRACT FROM AUTHOR]

Elevated serum urate is the most important causal risk factor for developing gout. However, in longitudinal cohort studies, a small proportion of people with normal urate levels develop gout and the majority of those with high urate levels do not. These observations may be due to subsequent variations in serum urate over time. Our analysis examined whether single or repeat testing of serum urate more accurately predicts incident gout over time. Individual participant data from three publicly-available cohorts were included. Data from paired serum urate measures 3–5 years apart, followed by an assessment of gout incidence 5–6 years from the second urate measure were used to calculate the predictive ability of four measures of serum urate on incident gout: the first measure, the second measure, the average of the two measures, and the highest of the two measures. Participants with prevalent gout prior to the second measure were excluded. Receiver operator characteristic (ROC) curves and area under the curve (AUC) statistics were computed to compare the four measures. A total of 16,017 participants were included across the three cohorts, with a mean follow-up from the first serum urate test of 9.3 years (range 8.9–10.1 years). Overall, there was a small increase in the mean serum urate between the first and second measures (322 μmol/L (5.42 mg/dL) vs. 340 μmol/L (5.71 mg/dL), P<0.001) which were a mean of 3.5 years apart, but the first and second measures were highly correlated (r = 0.81, P<0.001). No differences were observed in the predictive ability of incident gout between the four measures of serum urate measurement with ROC curve AUC statistics ranging between 0.81 (95% confidence intervals: 0.78–0.84) and 0.84 (95% confidence intervals: 0.81–0.87). These data show that repeat serum urate testing is not superior to a single measure of serum urate for prediction of incident gout over approximately one decade. [ABSTRACT FROM AUTHOR]

A letter is presented which described a study that investigated the prevalence of gout in patients with diabetes. The clinical factors linked to gout in a large community-based group of patients with diabetes was likewise examined. Data analyzed was from the Diabetes Care Support Service (DCSS). The findings reportedly supported previous results that have illustrated an inverse relationship between serum urate and hemoglobin A1c (HbA1c) in the general population.

Purpose: There is uncertainty about the effect of increased neonatal protein intake on neurodevelopmental outcomes following preterm birth. The aim of this study was to assess the effect of a change in neonatal nutrition protocol at a major tertiary neonatal intensive care unit intended to increase protein intake on ophthalmic and visual development in school‐age children born very preterm. Methods: The study cohort comprised children (n = 128) with birthweight <1500 g or gestational age < 30 weeks born at Auckland City Hospital before (OldPro group, n = 55) and after (NewPro group, n = 73) a reformulation of parenteral nutrition that resulted in increased total protein intake during the first postnatal week and decreased carbohydrate, total parenteral fluid and sodium intake. Clinical and psychophysical vision assessments were completed at 7 years' corrected age, including visual acuity, global motion perception (a measure of dorsal stream function), stereoacuity, ocular motility and ocular health. Composite measures of favourable overall visual, binocular and functional visual outcomes along with individual vision measures were compared between the groups using logistic and linear regression models. Results: Favourable overall visual outcome did not differ between the two groups. However, global motion perception was better in the NewPro group (p = 0.04), whereas the OldPro group were more likely to have favourable binocular visual outcomes (60% vs. 36%, p = 0.02) and passing stereoacuity (p = 0.02). Conclusions: These results indicate subtle but complex associations between early neonatal nutrition after very preterm birth and visual development at school age. [ABSTRACT FROM AUTHOR]

Nutritional intake can promote early neonatal brain development in very preterm born neonates (< 32 weeks' gestation). In a group of 7-year-old very preterm born children followed since birth, we examined whether early nutrient intake in the first weeks of life would be associated with long-term brain function and neurocognitive skills at school age. Children underwent resting-state functional MRI (fMRI), intelligence testing (Wechsler Intelligence Scale for Children, 5th Ed) and visual-motor processing (Beery-Buktenica, 5th Ed) at 7 years. Relationships were assessed between neonatal macronutrient intakes, functional connectivity strength between thalamic and default mode networks (DMN), and neuro-cognitive function using multivariable regression. Greater functional connectivity strength between thalamic networks and DMN was associated with greater intake of protein in the first week (β = 0.17; 95% CI 0.11, 0.23, p < 0.001) but lower intakes of fat (β = − 0.06; 95% CI − 0.09, − 0.02, p = 0.001) and carbohydrates (β = − 0.03; 95% CI − 0.04, − 0.01, p = 0.003). Connectivity strength was also associated with protein intake during the first month (β = 0.22; 95% CI 0.06, 0.37, p = 0.006). Importantly, greater thalamic-DMN connectivity strength was associated with higher processing speed indices (β = 26.9; 95% CI 4.21, 49.49, p = 0.02) and visual processing scores (β = 9.03; 95% CI 2.27, 15.79, p = 0.009). Optimizing early protein intake may contribute to promoting long-term brain health in preterm-born children. [ABSTRACT FROM AUTHOR]

Authorship transgressions, duplicate data reporting and reporting/data errors compromise the integrity of biomedical publications. Using a standardized template, we raised concerns with journals about each of these characteristics in 33 pairs of publications originating from 15 preclinical (animal) trials reported by a group of researchers. The outcomes of interest were journal responses, including time to acknowledgement of concerns, time to decision, content of decision letter, and disposition of publications at 1 year. Authorship transgressions affected 27/36 (75%) publications. The median proportion of duplicate data within pairs of publications was 45% (interquartile range 29–57). Data/reporting discrepancies [median 3 (1–5)] were present in 28/33 (85%) pairs. Journals acknowledged receipt of concerns for 53% and 94% of publications by 1 month and 9 months, respectively. After 1 year, journals had communicated decisions for 16/36 (44%) publications. None of the decision letters specifically addressed each of the concerns raised. Decisions were no action, correction and retraction for 9, 3 and 4 publications, respectively: the amounts of duplicate data reporting and data/reporting discrepancies were similar irrespective of journal decision. Authorship transgressions affected 6/9 (67%) publications for which no action was decided. Journal responses to concerns about duplicate publication, authorship transgressions, and data/reporting discrepancies were slow, opaque and inconsistent. [ABSTRACT FROM AUTHOR]

Objective: To examine whether urate‐associated genetic variants differ in their influence on gout risk according to body mass index (BMI). Methods: This research was conducted using the UK Biobank Resource (n = 358,728). Participants were divided into 3 groups: BMI <25 kg/m2 (low/normal), BMI ≥25 kg/m2–<30 kg/m2 (overweight), and BMI ≥30 kg/m2 (obese). Gene–BMI interactions for gout association were tested by logistic regression using a urate genetic risk score (GRS). Results: Compared to participants with a GRS less than the mean, the prevalence of gout was higher in those with a GRS greater than or equal to the mean in the low/normal BMI group (0.27% versus 0.77%), in the overweight BMI group (1.02% versus 3.02%), and in the obese BMI group (2.49% versus 6.23%). A GRS greater than or equal to the mean was positively associated with gout compared to a GRS less than the mean in the low/normal BMI group (odds ratio [OR] 2.89 [95% confidence interval (95% CI) 2.42–3.47]), in the overweight BMI group (OR 3.09 [95% CI 2.84–3.36]), and in the obese BMI group (OR 2.65 [95% CI 2.46–2.86]). There was a mildly attenuated effect of the GRS on gout risk in the obese BMI group compared to the overweight BMI group, but no difference in the effect of the GRS between the low/normal BMI and overweight BMI groups, nor between the low/normal BMI and obese BMI groups. Conclusion: The association of a urate GRS with gout is mildly attenuated in obese individuals compared to overweight individuals. However, genetic variants have a strong effect on gout risk in those with overweight and obese BMIs, with an effect similar to that observed in low/normal BMI. [ABSTRACT FROM AUTHOR]

Objective: Levels of fibroblast growth factor 23 (FGF23) have been positively associated with measures of adiposity, cardiovascular disease and mortality. It is unclear whether the relationship of FGF23 with cardiovascular disease and mortality is confounded by obesity. We aimed to determine whether FGF23 concentrations decline following a reduction in adiposity after sleeve gastrectomy (SG). Design: The effect of SG on FGF23 was evaluated in 22 obese adults (59% male) with type 2 diabetes. Fat mass, weight, BMI, plasma intact FGF23, parathyroid hormone (PTH) and leptin were determined at baseline and at 12 months following SG. Results: At baseline, median (IQR) age was 51 (43‐54) years, fat mass 47.8 (41.0‐59.4) kg, BMI 40.9 (36.9‐46.9) kg/m2 and FGF23 66.2 (55.3‐82.9) pg/mL. Significant changes in median BMI (−10.8 kg/m2, 95% CI: −12.9 to −7.2, P < 0.0001), fat mass (−20.0 kg, 95% CI: −26.7 to −12.4, P < 0.0001) and weight (−34.7 kg, 95% CI −40.0 to −23.1, P < 0.0001) were observed after SG. FGF23 (−12.4 pg/mL, 95% CI: −19.5 to 2.0, P = 0.005), PTH (−1.1 pmol/L, 95% CI: −1.7 to 0.2, P = 0.009) and leptin (−1687 pg/mL, 95% CI −4524 to −563, P = 0.01) declined following SG. Change in FGF23 was not significantly associated with change in measures of adiposity, PTH or leptin. Conclusions: FGF23 concentrations decline in the setting of significant weight loss following SG, implying that increased FGF23 concentrations are a downstream consequence of obesity, which may confound its association with cardiometabolic dysfunction. Mediators of the relationship between adiposity and FGF23 require further elucidation. [ABSTRACT FROM AUTHOR]

Background Transcatheter aortic valve implantation (TAVI) is considered for severe aortic valve disease at high and now intermediate risk for surgical aortic valve replacement. Risk stratification plays a critical role decision-making for intervention and modality. We compared the prognostic utility of surgical risk scores for TAVI in this meta-analysis. Methods MEDLINE, Embase, Cochrane and Web of Science databases from 1 January 1980 to 31 December 2015 were searched. Studies were systematically reviewed for inclusion, and data extracted for pooled analyses. Results Amongst 1688 articles searched, 47 full-text articles were screened and 24 studies (12,346 TAVI cases) included for analyses. Pooled c-statistics (95% confidence interval) for operative mortality were EuroSCORE 0.62 (0.57–0.67), EuroSCORE II 0.62 (0.59–0.66), STS Score 0.62 (0.59–0.65). Pooled calibration odds ratios (95%CI) were EuroSCORE 0.31 (0.25–0.38), EuroSCORE II 1.26 (1.06–1.51), STS 0.95 (0.72–1.27). C-statistics (95%CI) for 1-year mortality were EuroSCORE 0.62 (0.57–0.67), EuroSCORE II 0.66 (0.61–0.71) and STS Score 0.58 (0.53–0.64). Conclusion Surgical risk scores at most modestly discriminated operative and 1-year mortality. The EuroSCORE grossly over-estimated operative mortality while the EuroSCORE II and STS Scores fitted better to TAVI outcomes with their own limitations. There is a need for the development and validation of TAVI-specific risk models. [ABSTRACT FROM AUTHOR]

Background: There is wide variation in the use of radial over femoral access for patients with ACS. This study evaluates the factors associated with the selection of radial versus femoral angiography in Australia and New Zealand and the effect of access site on clinical events in acute coronary syndrome (ACS) patients.Methods: An analysis of the SNAPSHOT ACS audit was conducted during May 2012 across 286 hospitals in Australia and New Zealand. Data collected included baseline patient characteristics, hospital site details, treatment received, clinical events in-hospital and mortality at 18 months. Univariate and multivariable analyses were performed.Results: Of the 1621 patients undergoing coronary angiography, access was through the femoral artery in 1043 (63%), and the radial in 578 (36%) patients. Radial access dominated in New Zealand (241 out of 327, 73.7%), compared to Australia (337 out of 1293, 26.1%, p=<0.001), with interstate variation (6% to 54%, p=<0.001). Independent predictors of access site included country of admission (Odds of radial, Aus v NZ OR 0.14, 95% CI 0.08-0.24, p=<0.0001), prior CABG surgery (OR 0.16, 95% CI 0.09-0.31, p=<0.0001), high GRACE score (90th decile) (OR 0.44, 95% CI 0.21-0.91, p=0.026) and admission to a centre with high annual PCI volume (>209 cases per year) (OR 1.86, 95% CI 1.06-3.26, p=0.03). After adjustment, there was no difference in clinical events in-hospital or mortality at 18 months CONCLUSION: Coronary angiography in New Zealand rather than Australia is the strongest predictor of radial access in ACS patients. There was no difference in outcomes according to access site in this population based cohort study. [ABSTRACT FROM AUTHOR]

Background: Risk stratification for mitral valve repair or replacement (MVR) is important in the decision-making for treating several mitral valve disease but is rarely studied. We compared the prognostic utility of EuroSCORE, EuroSCORE II, and Society of Thoracic Surgeons (STS) Score for MVR.Methods: The three scores were retrospectively calculated for consecutive patients undergoing isolated MVR at Auckland City Hospital during 2005-2012 and their discrimination and calibration for mortality and morbidities assessed.Results: There were 408 patients (mitral valve repair 48.1% and replacement 51.9%) followed-up for 6.0 ± 2.6 years. The operative mortality was 2.5%. Mean EuroSCORE, EuroSCORE II, and STS Score were 7.6%, 3.4%, and 3.5%. C-statistics were 0.844, 0.817, and 0.850 for operative mortality. Hosmer-Lemeshow test p values were 0.076, 0.541, and 0.306, and Brier scores 0.0246, 0.0035, and 0.0075, respectively, for operative mortality. The numerically highest c-statistic for predicting complications include EuroSCORE for return to the operating room (c = 0.673); EuroSCORE II for stroke (c = 0.669) and mediastinitis (c = 0.801); and STS for renal failure (c = 0.828), ventilation >24 hours (c = 0.789), and composite morbidity (c = 0.732). The individual STS complication models for MVR had a numerically higher c-statistic only for stroke (c = 0.737).Conclusions: All scores discriminated mortality and most morbidities after MVR, although EuroSCORE over-estimated operative mortality. The STS Score was the best overall predictor of mortality and morbidity in the MVR cohort. [ABSTRACT FROM AUTHOR]

Background: Publication of clinical research findings in prominent journals influences health beliefs and medical practice, in part by engendering news coverage. Randomized controlled trials (RCTs) should be most influential in guiding clinical practice. We determined whether study design of clinical research published in high-impact journals influences media coverage. Methods and Findings: We compared the incidence and amount of media coverage of RCTs with that of observational studies published in the top 7 medical journals between 1 January 2013 and 31 March 2013. We specifically assessed media coverage of the most rigorous RCTs, those with >1000 participants that reported ‘hard’ outcomes. There was no difference between RCTs and observational studies in coverage by major newspapers or news agencies, or in total number of news stories generated (all P>0.63). Large RCTs reporting ‘hard’ outcomes did not generate more news coverage than small RCTs that reported surrogate outcomes and observational studies (all P>0.32). RCTs were more likely than observational studies to attract a journal editorial (70% vs 46%, P = 0.003), but less likely to be the subject of a journal press release (17% vs 50%, P<0.001). Large RCTs that reported ‘hard’ outcomes did not attract an editorial more frequently than other studies (61% vs 58%, P>0.99), nor were they more likely to be the subject of a journal press release (14% vs 38%, P = 0.14). Conclusions: The design of clinical studies whose results are published in high-impact medical journals is not associated with the likelihood or amount of ensuing news coverage. [ABSTRACT FROM AUTHOR]

Background: Observational studies (OS) and randomized controlled trials (RCTs) often report discordant results. In the Women’s Health Initiative Calcium and Vitamin D (WHI CaD) RCT, women were randomly assigned to CaD or placebo, but were permitted to use personal calcium and vitamin D supplements, creating a unique opportunity to compare results from randomized and observational analyses within the same study. Methods: WHI CaD was a 7-year RCT of 1g calcium/400IU vitamin D daily in 36,282 post-menopausal women. We assessed the effects of CaD on cardiovascular events, death, cancer and fracture in a randomized design- comparing CaD with placebo in 43% of women not using personal calcium or vitamin D supplements- and in a observational design- comparing women in the placebo group (44%) using personal calcium and vitamin D supplements with non-users. Incidence was assessed using Cox proportional hazards models, and results from the two study designs deemed concordant if the absolute difference in hazard ratios was ≤0.15. We also compared results from WHI CaD to those from the WHI Observational Study(WHI OS), which used similar methodology for analyses and recruited from the same population. Results: In WHI CaD, for myocardial infarction and stroke, results of unadjusted and 6/8 covariate-controlled observational analyses (age-adjusted, multivariate-adjusted, propensity-adjusted, propensity-matched) were not concordant with the randomized design results. For death, hip and total fracture, colorectal and total cancer, unadjusted and covariate-controlled observational results were concordant with randomized results. For breast cancer, unadjusted and age-adjusted observational results were concordant with randomized results, but only 1/3 other covariate-controlled observational results were concordant with randomized results. Multivariate-adjusted results from WHI OS were concordant with randomized WHI CaD results for only 4/8 endpoints. Conclusions: Results of randomized analyses in WHI CaD were concordant with observational analyses for 5/8 endpoints in WHI CaD and 4/8 endpoints in WHI OS. [ABSTRACT FROM AUTHOR]

Children born very preterm can demonstrate social-cognitive impairments, which may result from limbic system dysfunction. Altered development of the subnuclei of the amygdala, stress-sensitive regions involved in emotional processing, may be key predictors of social-skill development. In a prospective cohort study, 7-year-old children born very preterm underwent neurodevelopmental testing and brain MRI. The Child Behavioral Checklist was used to assess social–emotional outcomes. Subnuclei volumes were extracted automatically from structural scans (n  = 69) and functional connectivity (n  = 66) was examined. General Linear Models were employed to examine the relationships between amygdala subnuclei volumes and functional connectivity values and social–emotional outcomes. Sex was a significant predictor of all social–emotional outcomes (P  < 0.05), with boys having poorer social–emotional outcomes. Smaller right basal nuclei volumes (B  = -0.043, P  = 0.014), smaller right cortical volumes (B  = -0.242, P  = 0.02) and larger right central nuclei volumes (B  = 0.85, P  = 0.049) were associated with increased social problems. Decreased connectivity strength between thalamic and amygdala networks and smaller right basal volumes were significant predictors of greater social problems (both, P  < 0.05), effects which were stronger in girls (P  = 0.025). Dysregulated maturation of the amygdala subnuclei, along with altered connectivity strength in stress-sensitive regions, may reflect stress-induced dysfunction and can be predictive of social–emotional outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a therapeutic approach of intensive serum urate lowering results in improved bone erosion scores in patients with erosive gout. Methods: We undertook a 2‐year, double‐blind randomized controlled trial of 104 participants with erosive gout who were receiving serum urate–lowering therapy orally and who had serum urate levels of ≥0.30 mmoles/liter at baseline. Participants were randomly assigned to either an intensive serum urate target of <0.20 mmoles/liter or a standard target of <0.30 mmoles/liter (considered the standard according to rheumatology guidelines). Oral serum urate–lowering therapy was titrated to target using a standardized protocol (with the maximum approved doses of allopurinol, probenecid, febuxostat, and benzbromarone). The primary end point was the total computed tomography (CT) bone erosion score. Outcome Measures in Rheumatology (OMERACT) gout core outcome domains were secondary end points. Results: Although the serum urate levels were significantly lower in the intensive target group compared to the standard target group over the study period (P = 0.002), fewer participants in the intensive target group achieved the randomized serum urate target level by year 2 (62% versus 83% of patients in the standard target group; P < 0.05). The intensive target group required higher doses of allopurinol (mean ± SD 746 ± 210 mg/day versus 497 ± 186 mg/day; P < 0.001) and received more combination therapy (P = 0.0004) compared to the standard target group. We observed small increases in CT bone erosion scores in both serum urate target groups over 2 years, with no between‐group difference (P = 0.20). OMERACT core outcome domains (gout flares, tophi, pain, patient's global assessment of disease activity, health‐related quality of life, and activity limitation) improved in both groups over 2 years, with no between‐group differences. Adverse event and serious adverse event rates were similar between the groups. Conclusion: Compared to a serum urate target of <0.30 mmoles/liter, more intensive serum urate lowering is difficult to achieve with an oral urate‐lowering therapy. Intensive serum urate lowering leads to a high medication burden and does not improve bone erosion scores in patients with erosive gout. [ABSTRACT FROM AUTHOR]

Importance: Prophylactic oral dextrose gel reduces neonatal hypoglycemia, but later benefits or harms remain unclear.Objective: To assess the effects on later development of prophylactic dextrose gel for infants born at risk of neonatal hypoglycemia.Design, Setting, and Participants: Prospective follow-up of a multicenter randomized clinical trial conducted in 18 Australian and New Zealand hospitals from January 2015 to May 2019. Participants were late preterm or term at-risk infants; those randomized in 9 New Zealand centers (n = 1359) were included and followed up between January 2017 and July 2021.Interventions: Infants were randomized to prophylactic 40% dextrose (n = 681) or placebo (n = 678) gel, 0.5 mL/kg, massaged into the buccal mucosa 1 hour after birth.Main Outcomes and Measures: The primary outcome of this follow-up study was neurosensory impairment at 2 years' corrected age. There were 44 secondary outcomes, including cognitive, language, and motor composite Bayley-III scores (mean [SD], 100 [15]; higher scores indicate better performance).Results: Of eligible infants, 1197 (91%) were assessed (581 females [49%]). Neurosensory impairment was not significantly different between the dextrose and placebo gel groups (20.8% vs 18.7%; unadjusted risk difference [RD], 2.09% [95% CI, -2.43% to 6.60%]; adjusted risk ratio [aRR], 1.13 [95% CI, 0.90 to 1.41]). The risk of cognitive and language delay was not significantly different between the dextrose and placebo groups (cognitive: 7.6% vs 5.3%; RD, 2.32% [95% CI, -0.46% to 5.11%]; aRR, 1.40 [95% CI, 0.91 to 2.17]; language: 17.0% vs 14.7%; RD, 2.35% [95% CI, -1.80% to 6.50%]; aRR, 1.19 [95% CI, 0.92 to 1.54]). However, the dextrose gel group had a significantly higher risk of motor delay (2.5% vs 0.7%; RD, 1.81% [95% CI, 0.40% to 3.23%]; aRR, 3.79 [95% CI, 1.27 to 11.32]) and significantly lower composite scores for cognitive (adjusted mean difference [aMD], -1.30 [95% CI, -2.55 to -0.05]), language (aMD, -2.16 [95% CI, -3.86 to -0.46]), and motor (aMD, -1.40 [95% CI, -2.60 to -0.20]) performance. There were no significant differences between groups in the other 27 secondary outcomes.Conclusions and Relevance: Among late preterm and term infants born at risk of neonatal hypoglycemia, prophylactic oral 40% dextrose gel at 1 hour of age, compared with placebo, resulted in no significant difference in the risk of neurosensory impairment at 2 years' corrected age. However, the study may have been underpowered to detect a small but potentially clinically important increase in risk, and further research including longer-term follow-up is required.Trial Registration: anzctr.org.au Identifier: ACTRN12614001263684. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the cellular framework of gouty tophus and determines the incidence of cytokines in the disease. It includes the collection of paraffin-embedded tophus from 12 patients after surgical removal of tophi followed by its analysis through quantitative immunochemistry. Results of the study reveal the presence of multinucleated cells in the corona area and mast cells in tophus samples with the same desnsities.

Abstract: Objective: Coronary angiography is a commonly used diagnostic test for ischemic heart disease. Little is known, however, about how undergoing the procedure impacts on the ways in which individuals perceive their illness. We sought to explore patients'' reactions to an angiogram in terms of changes in symptom appraisal, perceived consequences of their condition, and patients'' illness concern and emotional response to their condition after the receiving diagnostic results. Methods: The Brief IPQ was administered to patients undergoing a diagnostic coronary angiogram (N=57) before and immediately following the procedure. Changes in illness representations were then compared between patients diagnosed with diseased arteries and patients with normal arteries. Results: We found that the number of symptoms patients associated with their condition, illness consequences, and illness emotion decreased for patients receiving normal results but remained unchanged for patients receiving results showing diseased arteries. Illness concern decreased significantly for both patient groups. Conclusions: The results demonstrate that diagnostic results can have clear and immediate effects on how patients'' view and emotionally respond to their symptoms. The results also suggest that patients cognitively prepare themselves to receive an unfavorable diagnosis and the pattern suggests those receiving normal results modify their perceptions in a positive direction rather than those receiving an unfavorable diagnosis. [Copyright &y& Elsevier]

Abstract: We continue our study of partitions of the full set of triples chosen from a -set into copies of the Fano plane (Fano partitions) or copies of the affine plane (affine partitions) or into copies of both of these planes (mixed partitions). The smallest cases for which such partitions can occur are where Fano partitions exist, where affine partitions exist, and where both affine and mixed partitions exist. The Fano partitions for and the affine partitions for and 10 have been fully classified, into 11, two and 77 isomorphism classes, respectively. Here we classify (1) the sets of i pairwise disjoint affine planes for , and (2) the mixed partitions for into their 22 isomorphism classes. We consider the ways in which these partitions relate to the large sets of . [Copyright &y& Elsevier]

Purpose: To identify risk factors associated with visual field (VF) loss on first presentation of glaucoma. Methods: A case–control study of 107 consecutive newly diagnosed glaucoma patients was performed. Information collected included demographic data, reasons for referral, ophthalmological assessment and VF testing. VF grading was based on Advanced Glaucoma Intervention Study (AGIS) scoring and was additionally classified for the presence of a nasal step, paracentral scotoma and/or arcuate scotoma. Results: Demographic parameters were: mean age 59 years (standard deviation [SD] 14), mean deviation −4.37 dB (SD 4.5), intraocular pressure 21.4 mmHg (SD 6.6) and cup:disc ratio 0.69 (SD 0.1). Thirty-seven per cent of all participants had a positive family history of glaucoma. Older age was associated with a VF defect at presentation (mean age of 54 years with no VF defect, compared with 63 years for mild, moderate or severe VF defect, P = 0.0014). Multivariate logistic regression analysis identified positive family history (odds ratio [OR] 10.43; 95% confidence interval [CI] 1.67–67.49) and age (OR 1.15; 95% CI 1.06–1.26) as independent risk factors for VF loss at presentation. Fifty-six per cent had a paracentral VF defect at first diagnosis and 29% of patients showed evidence of substantial VF loss with AGIS score of ≥6 on initial presentation. Conclusions: Patients who have a positive family history of glaucoma are 10 times more likely to have a VF defect at the time of glaucoma diagnosis. An increased focus on family history may help identify these patients earlier and prevent significant visual loss at the time of presentation. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) and congestive heart failure (HF) often coexist, but there is conflicting data regarding the association of AF with outcome in HF. To examine this further we have evaluated the prognostic effect of AF in two complementary CHF populations; a population based data set of 55,106 patients admitted to hospital with CHF, and a cohort of 197 patients recruited after a hospital admission with HF into a management clinical trial. Methods: Firstly, data for all hospital admissions in New Zealand from 1988 to 1997 were obtained. Using coding data, 55,106 first admissions for HF were identified, the presence of AF was determined by secondary diagnosis coding, and all cause mortality was obtained. Secondly, patients enrolled in the Auckland Heart Failure Management Study were evaluated for the presence or absence of AF, and for all cause mortality at three years. Results: Mortality at 30 days, 6 and 12 months was significantly lower for AF patients compared to sinus rhythm (SR) in the national admissions cohort. In the clinical trial cohort the presence of AF was also associated with lower three-year mortality, although this difference was not seen when the groups were stratified by Doppler mitral filling pattern (a restrictive filling pattern was associated with reduced longevity compared to SR, non-restrictive or AF). Conclusions: This data shows that the presence of AF in two general HF populations in New Zealand is not associated with an adverse prognosis. HF severity, and in particular a restrictive filling pattern, remain powerful predictors of mortality. [Copyright &y& Elsevier]

Background: To describe self-reported patterns of care for glaucoma of ophthalmologists in Australia and New Zealand and summarize current practice styles and patterns associated with glaucoma management. Methods: A questionnaire of glaucoma management practices was mailed to all ophthalmologists registered with the Royal Australian and New Zealand College of Ophthalmologists in June 2003. The questionnaire assessed practice preferences for medical management, examination techniques and indications for surgery. The results were cross-tabulated by age, country and subspecialty training in glaucoma. Results: Fifty-one per cent of 761 surveys were returned, 14% being from glaucoma specialists. New Zealand ophthalmologists proceeded to surgical management of glaucoma earlier than did their Australian colleagues. Australian ophthalmologists tended to use argon laser trabeculoplasty more frequently. Ninety-six per cent of ophthalmologists routinely use gonioscopy in diagnosing glaucoma. Disc drawings and recording cup:disc ratios were the most commonly used methods of documenting disc morphology; glaucoma specialists were more likely to use imaging technologies. SITA-Standard 24-2 was the most commonly used modality of perimetry, and was favoured by glaucoma specialists. Conclusions: This survey represents the first Australian and New Zealand effort to identify glaucoma management practices. Although a substantial consensus was found in most areas of treatment, a few areas showed diversity. The information gathered will enable ophthalmologists to compare their own practices with those of their colleagues. In addition, this survey provides a baseline allowing future trends in management to be determined. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the incidence and extent of visual recovery in patients with giant cell arteritis (GCA) treated with high doses of systemic corticosteroids. Design: Multicenter prospective case series. Participants: Thirty-four consecutive patients with biopsy-proven GCA and visual loss seen at either Wills Eye Hospital in Philadelphia or Auckland Hospital in New Zealand from 2001 to 2004 were evaluated prospectively. Methods: All patients underwent a complete neuro-ophthalmic evaluation that included Snellen visual acuity, pseudoisochromatic Ishihara color plates, visual fields, intraocular pressure, slit-lamp examination, and binocular ophthalmoscopy. Formal visual field testing was performed on all patients who were capable of completing the test. All patients were treated with a standard protocol of 1 g of IV methylprednisolone daily for 3 days followed by oral prednisone 60 or 80 mg (depending on patient weight). Patients were evaluated initially at 2-week intervals (14–19 days) and then monthly (4–5 weeks), with subsequent dosages of prednisone modified based on erythrocyte sedimentation rate, C-reactive protein, and patient symptoms. At each visit, patients underwent a repeat complete neuro-ophthalmic evaluation. Main Outcome Measures: Alterations in visual acuity, visual field, and color vision. Results: Patients with visual loss from GCA had a mean visual acuity of 20/400. Visual deterioration occurred in 27% of eyes within the first week despite high-dose IV corticosteroids. Fifteen percent of eyes showed an improvement of visual acuity within the first month, but only 5% have corresponding improvement in visual field. Conclusions: Visual recovery is uncommon in patients who lose vision from GCA. Recovery in visual acuity is not associated with visual field or color vision improvement in this series. Visual deterioration occurs in approximately 27% of eyes despite high-dose IV methylprednisolone. The greatest risk of visual deterioration is in the first 6 days. [Copyright &y& Elsevier]

We sought to study the relationship between left ventricular (LV) size and body composition in male endurance athletes and age-matched control subjects.Endurance training is associated with increases in both left ventricular mass (LVM) and left ventricular end-diastolic dimension (LVEDD) in athletes. In other populations, LVM is independently predicted by fat-free mass (FFM). We hypothesized that the increase in LV size and mass observed with training may be a normal response to increased FFM.Twelve young and 18 older male endurance athletes and 10 young and 18 older untrained men underwent exercise testing, echocardiography, and dual-photon x-ray absorptiometry body composition analysis. Univariate correlates (Spearman) and multivariate determinants of LVM and LVEDD were sought from: height, height1.4, height2.7, height3.0, body surface area (BSA), FFM, weight, and body mass index. Un-indexed and indexed LVM and LVEDD were then compared.Athletes were of a similar age, weight, and height, but had higher FFM and maximum oxygen uptake than untrained men. Both LVM and LVEDD were correlated with body size, including FFM, BSA, weight, and height (all p < 0.05). On multivariate analysis, FFM was the only independent predictor of both LVM (R2 = 0.36, p < 0.001) and LVEDD (R2 = 0.35, p < 0.001). Furthermore, LVM and LVEDD (un-indexed and indexed to BSA and height) were different between athletes and non-athletes, but not when indexed to height2.7 or FFM.Both LVM and LVEDD are predicted by FFM in endurance athletes, and when indexed to FFM, no training-related differences were observed. Thus, the extent of LV remodeling (athletic heart) in trained individuals may reflect a normal physiologic response to increased FFM induced by training. [Copyright &y& Elsevier]