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OBJECTIVE: To examine whether body mass index (BMI) changes modify the association between kidney donation and incident hypertension. BACKGROUND: Obesity increases hypertension risk in both general and living kidney donor (LKD) populations. Donation-attributable risk in the context of obesity, and whether weight change modifies that risk, is unknown. METHODS: Nested case-control study among 1558 adult LKDs (1976-2020) with obesity (median follow-up: 3.6 years; interquartile range: 2.0-9.4) and 3783 adults with obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) and Atherosclerosis Risk in Communities (ARIC) studies (9.2 y; interquartile range: 5.3-15.8). Hypertension incidence was compared by donor status using conditional logistic regression, with BMI change investigated for effect modification. RESULTS: Overall, LKDs and nondonors had similar hypertension incidence [incidence rate ratio (IRR): 1.16, 95% confidence interval (95% CI): 0.94-1.43, P =0.16], even after adjusting for BMI change (IRR: 1.25, 95% CI: 0.99-1.58, P =0.05). Although LKDs and nondonors who lost >5% BMI had comparable hypertension incidence (IRR: 0.78, 95% CI: 0.46-1.34, P =0.36), there was a significant interaction between donor and >5% BMI gain (multiplicative interaction IRR: 1.62, 95% CI: 1.15-2.29, P =0.006; relative excess risk due to interaction: 0.90, 95% CI: 0.24-1.56, P =0.007), such that LKDs who gained weight had higher hypertension incidence than similar nondonors (IRR: 1.83, 95% CI: 1.32-2.53, P 5% saw increased hypertension incidence versus similar nondonors, providing support for counseling potential LKDs with obesity on weight management postdonation.

BackgroundApproval of living kidney donors (LKD) with end-stage kidney disease (ESKD) risk factors, such as obesity, has increased. While lifetime ESKD development data are lacking, the study of intermediate outcomes such as diabetes is critical for LKD safety. Donation-attributable diabetes risk among persons with obesity remains unknown. The purpose of this study was to evaluate 10-year diabetes-free survival among LKDs and non-donors with obesity.MethodsThis longitudinal cohort study identified adult, LKDs (1976-2020) from 42 US transplant centers and non-donors from the Coronary Artery Risk Development in Young Adults (1985-1986) and the Atherosclerosis Risk in Communities (1987-1989) studies with body mass index ≥30 kg/m2. LKDs were matched to non-donors on baseline characteristics (age, sex, race, body mass index, systolic and diastolic blood pressure) plus diabetes-specific risk factors (family history of diabetes, impaired fasting glucose, smoking history). Accelerated failure time models were utilized to evaluate 10-year diabetes-free survival.FindingsAmong 3464 participants, 1119 (32%) were LKDs and 2345 (68%) were non-donors. After matching on baseline characteristics plus diabetes-specific risk factors, 4% (7/165) LKDs and 9% (15/165) non-donors developed diabetes (median follow-up time 8.5 (IQR: 5.6-10.0) and 9.1 (IQR: 5.9-10.0) years, respectively). While not significant, LKDs were estimated to live diabetes-free 2 times longer than non-donors (estimate 1.91; 95% CI: 0.79-4.64, p = 0.15).ConclusionsLKDs with obesity trended toward living longer diabetes-free than non-donors with obesity, suggesting within the decade following donation there was no increased diabetes risk among LKDs. Further work is needed to evaluate donation-attributable diabetes risk long-term.

Ella H Leung, Daniel J Oh, Shannon E Alderson, Joshlynn Bracy, Mia McLeod, Litzi I Perez, Alexander Bottini, David Chin Yee, Krishna Mukkamala Georgia Retina, Atlanta, GA, USACorrespondence: Ella H Leung, 833 Campbell Hill St NW, Suite 300, Marietta, GA, 30060, USA, Tel +1 770-218-1888, Email eleung@garetina.comPurpose: To evaluate the initial efficacy and safety of intravitreal faricimab in eyes previously treated for neovascular age-related macular degeneration (nARMD).Patients and methods: A retrospective review of all patients with nARMD previously treated with anti-vascular endothelial growth factor (anti-VEGF) injections who received at least 3 intravitreal faricimab injections with at least 3 months of follow-up.Results: A total of 190 eyes were included. Patients received a mean of 34.2± 23 anti-VEGF injections over 182.41± 128 weeks prior to switching to faricimab. Patients then received a mean of 6.99± 2.3 faricimab injections with an average 34.88± 8.2 weeks of follow-up. The mean best corrected visual acuities improved from 0.33± 0.32 logMAR &ap;20/43 to 0.27± 0.32 logMAR &ap;20/37 (P=0.0022). The central subfield thickness (CST) improved from 312± 87μm to 287± 71μm (P< 0.0001). At the last clinical visit, 24% had no subretinal fluid or intraretinal fluid on optical coherence tomography. The mean dosing interval between the last two consecutive faricimab injections (7.64± 6.2 weeks) was significantly longer than that for ranibizumab (5.16± 2.0 weeks, P< 0.001) or aflibercept (5.57± 3.6 weeks, P< 0.001). No patients developed idiopathic intraocular inflammation.Conclusion: Intravitreal faricimab was associated with improved vision and CSTs, even in treatment-resistant nARMD eyes. The mean last dosing interval for faricimab was longer than for ranibizumab or aflibercept. No significant adverse events were directly attributed to faricimab during the study.Keywords: faricimab, intravitreal injection, neovascular age-related macular degeneration, intraocular inflammation, anti-vascular endothelial growth factor

Introduction: Adrenal gland incidentalomas (AGIs) are found in up to 5% of cross‐sectional images. However, rates of guideline‐based workup for AGIs are notoriously low. We sought to determine if a natural language processing (NLP)‐informed AGI clinic could improve the rates of indicated biochemical evaluation and adrenal‐specific imaging. Methods: An NLP algorithm was created to detect clinically significant adrenal nodules from radiology reports of cross‐sectional images at an academic institution. The NLP algorithm was applied to scans occurring between June 2020 and July 2021 to form a baseline cohort. The NLP algorithm was re‐applied to scans from August 2021 to February 2023 and identified patients were invited to join an outpatient clinic dedicated to AGIs. Patients evaluated in the clinic from March 2022 to February 2023 were included in the intervention cohort. Statistical analysis utilized chi‐square, t‐test, and a multivariable logistic regression. Results: The baseline and intervention cohorts included 1784 and 322 unique patients, respectively. Patients in the intervention cohort were more likely to be female (59% vs. 51%, p = 0.01), be younger (60 ± 13.1 vs. 64 ± 13.2 years, p < 0.001), have smaller nodules (1.7 cm, IQR 1.4–2.1 vs. 1.8 cm, IQR 1.4–2.5 cm, p = 0.017), have had biochemical workup (99% vs. 13%, p < 0.001), and have had adrenal‐specific imaging (40% vs. 11%, p < 0.001). In a multivariable analysis, intervention cohort patients were significantly more likely to have had biochemical workup (odds ratio ,OR 1209, confidence interval ,CI 434–5117, p < 0.001) and adrenal‐specific imaging (OR 8.89, CI 6.42–12.4, p < 0.001). Conclusion: The implementation of an NLP‐informed AGI clinic was associated with a seven‐fold increase in biochemical workup and a three‐fold increase in adrenal‐specific imaging in participating patients. [ABSTRACT FROM AUTHOR]

Introduction: Cancer‐related stigma is a key driver of advanced breast cancer stage in Sub‐Saharan Africa (SSA). We developed and tested the impact of a breast cancer survivor‐led Stigma reduction intervention (SRI) on stigma and treatment adherence of newly diagnosed patients with breast cancer in Tanzania. Methods: Breast cancer survivors were trained on breast cancer knowledge and motivational interviewing. A total of 4 trained survivors delivered a SRI (standardized flipchart breast education talk, personal testimony, and motivational interviewing) to 30 newly diagnosed patients with breast cancer before treatment. Pre‐ and post‐intervention knowledge surveys and stigma scale surveys were analyzed via Fisher's exact test and Wilcoxon rank‐sum tests. A discussion was held with a group of survivors after the intervention period to elicit feedback on their intervention experience. Results: Among the 30 patients, breast cancer knowledge (median overall percent correct) increased from 28% (IQR: 18%–45%) to 85% (IQR: 79%–88%) (p < 0.001) and stigma (median score) decreased from 75 (IQR: 57–81) to 53 (IQR: 44–66) (p < 0.01) following the intervention. All participants were willing to pursue hospital‐based treatment after undergoing the intervention. Eighty‐seven percent (n = 26) initiated treatment at 8‐week follow‐up after the intervention. All survivors endorsed feeling empowered and valued in their role in this intervention. Conclusions: Breast cancer survivors are a powerful group to combat the lack of knowledge and stigma in community and healthcare settings. Expanding the scope and scale of this intervention holds promise for improving treatment‐seeking behavior and ultimately breast cancer outcomes in SSA. [ABSTRACT FROM AUTHOR]

Background: While males present with more adverse clinicopathologic features in papillary thyroid carcinoma (PTC), younger age has previously been shown to be a favorable prognostic factor. We examined the combined effect of male sex and young age on PTC outcomes. Methods: We conducted a retrospective analysis of a prospectively maintained database of thyroid cancer surgery patients (2000–2020) at a single quaternary care institution. We included papillary thyroid carcinoma cases and excluded those with prior cancer‐related thyroid surgery. We examined demographics, cancer stage, surgical outcomes, and complications by age and sex, analyzing groups below and above the age of 40 years. Results: A total of 680 patients with PTC were included. Females constituted 68% (age ≥40 years: 44% and <40 years: 24%) and males 32% (≥40 years: 24% and <40 years: 8%). A significant difference (p < 0.001) of N1 disease distribution was found between the groups. N1a metastasis was greater in patients younger than 40 regardless of sex ((M < 40 (15%), F < 40 (15%), M ≥ 40 (12%), and F ≥ 40 (9%)). While, M < 40 had greater N1b metastasis (36%) than all other groups (M ≥ 40 (28%), F < 40 (22%), and F ≥ 40 (10%)). There was no significant difference in the distribution of T stages between groups. Groups showed no differences in 30‐day outcomes, recurrence at 1 year, reoperation, mortality, nerve injury, or hypocalcemia. Conclusions: Young males with PTC face increased occurrence of nodal metastasis yet experience similar recurrence rates as their female and older counterparts. Subgroup analysis underscores the predictive role of sex and age in advanced PTC cases. [ABSTRACT FROM AUTHOR]

A regional-scale map showing the potential risk of Escherichia coli leaching through soil on flat to rolling land was developed for the soils within the Waikato River catchment. Microbial breakthrough curves were developed for representative soils of the catchment that are commonly under dairy land use. These microbial breakthrough curves were generated under laboratory conditions using large, intact soil lysimeters irrigated with farm dairy effluent followed by continuous clean water irrigation. Some of the lysimeters were later used to monitor E. coli leaching under field conditions. The soils were rated as having a high, medium or low potential for leaching E. coli based on the microbial breakthrough curves or concentrations of E. coli in leachates from the field investigation. The potentials were correlated with the New Zealand Soil Classification to allow regionalisation to all soils within the Waikato River catchment. The catchment-scale map revealed that ~60% of the flat to rolling soils in Waikato are rated as having a low potential for leaching E. coli. These soils are typically Pumice or Allophanic Soils. The map can be used to raise the awareness of management of farm effluent irrigation to minimise microbial pathogen contamination of water bodies. Additional keywords: bypass flow, microbial contamination risk, soil lysimeters. Received 2 August 2018, accepted 4 December 2018, published online 23 January 2019, Introduction The dairy industry is an important contributor to the economy of the Waikato region and New Zealand as a whole. The Waikato region has the greatest concentration of dairy [...]