INTRODUCTION: Atherosclerosis is a leading cause of cardiovascular events, requiring accurate risk stratification. Traditional methods rely on subjective imaging and clinical scores, limiting precision. MATERIAL AND METH...INTRODUCTION: Atherosclerosis is a leading cause of cardiovascular events, requiring accurate risk stratification. Traditional methods rely on subjective imaging and clinical scores, limiting precision. MATERIAL AND METHODS: We developed a deep learning (DL) model combining U-Net for lesion segmentation, ResNet for classification, and an attention mechanism to enhance detection of high-risk plaques. Multimodal data - including ultrasound, CTA, and clinical variables - underwent standard preprocessing. The dataset was split (8 : 1 : 1) and evaluated using 5-fold cross-validation. RESULTS: The U-Net achieved a Dice coefficient of 0.88. The ResNet, integrated with clinical features, reached 92% classification accuracy and an AUC of 0.97. The attention mechanism improved vulnerable plaque detection by 10%. Grad-CAM visualizations showed 85% agreement with expert annotations. Processing time was reduced by 70% compared to traditional assessment methods. Multicenter validation confirmed strong generalizability. CONCLUSIONS: This study constructed a multimodal DL model that significantly enhances the clinical value of atherosclerosis risk stratification. The prediction accuracy increased to 92% with an AUC of 0.97, and the average processing time per case was reduced from 6.3 ±1.4 min to 1.9 ±0.4 min (a reduction of approximately 70%). The model demonstrated higher precision in both lesion segmentation and high-risk plaque identification, providing clinicians with a rapid and reliable decision-support tool that is expected to further optimize individualized intervention strategies and improve patient prognosis.
INTRODUCTION: Obesity and aging are established independent risk factors for osteoarthritis (OA). This study aimed to evaluate the correlation between the age-adjusted visceral adiposity index (AVAI) and OA. MATERIAL AND...INTRODUCTION: Obesity and aging are established independent risk factors for osteoarthritis (OA). This study aimed to evaluate the correlation between the age-adjusted visceral adiposity index (AVAI) and OA. MATERIAL AND METHODS: This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2018. The correlation between AVAI and prevalence of OA was explored through receiver operating characteristic (ROC) regression, multivariate logistic regression, restricted cubic spline regression, and subgroup analysis. RESULTS: The study cohort comprised 20,628 participants, of whom 2,297 (11.1%) were diagnosed with OA. An increase in the quartile range of AVAI was correlated with a significant rise in the prevalence of OA (1.5% vs. 5.1% vs. 14.4% vs. 23.6%, < 0.001). Logistic regression analysis demonstrated a significant positive correlation between AVAI and the risk of OA (OR = 1.14, 95% CI: 1.06, 1.23). Subgroup analyses indicated that this correlation was more pronounced in individuals aged over 60 years and those with diabetes. RCS regression analysis further identified a non-linear positive correlation, with an inflection point at -6.03. Finally, the area under the ROC curve (AUC) for AVAI was notably greater (AUC = 0.757, 95% CI: 0.747, 0.766) compared to traditional obesity indices. CONCLUSIONS: This study is the first to demonstrate a significant positive correlation between the prevalence of OA and AVAI, with AVAI exhibiting superior diagnostic performance over traditional obesity indices in identifying OA.
INTRODUCTION: The chronic gynecological condition endometriosis affects about 10 percent of reproductive aged women and imposes a heavy physical and psychological burden. The impact of pain and infertility is well docume...INTRODUCTION: The chronic gynecological condition endometriosis affects about 10 percent of reproductive aged women and imposes a heavy physical and psychological burden. The impact of pain and infertility is well documented, but the link between endometriosis and mental health (depressive and anxiety), in particular, is not well studied. In this systematic review and meta-analysis, we synthesize evidence on the association between endometriosis and mental health outcomes, specifically anxiety and depression.Methods: PubMed, Cochrane Library and Google Scholar were searched comprehensively to identify studies that have reported the association of endometriosis and mental health outcomes. Nine studies were included after applying predefined inclusion and exclusion criteria from 1,632 articles screened. The Newcastle-Ottawa Scale (NOS) was used to assess study quality and random effects meta-analyses were performed using R. Relative risk (RR) values for anxiety and depression among women with endometriosis were pooled as the primary outcomes. RESULTS: The meta-analysis revealed a significant association between endometriosis and anxiety (pooled RR = 2.82; 95% CI: 1.69-4.68, < 0.001) and depression (pooled RR = 2.93; 95% CI: 1.63-5.25, < 0.001). Substantial heterogeneity was observed in both analyses ( = 100%), reflecting variability in study designs and populations. Funnel plots showed moderate asymmetry, suggesting potential publication bias. Statistical heterogeneity was further quantified with τ values of 0.6032 for anxiety and 0.794 for depression, indicating considerable between-study variability. These findings underscore the heightened mental health burden in women with endometriosis. CONCLUSIONS: Endometriosis patients are more likely to develop anxiety and depressive symptoms due to pain and diagnostic evaluation and related psychosocial factors. This study stresses the importance of integrated care, which involves screening and treatment for mental health problems in addition to conventional medical care. Future work should aim to reduce heterogeneity and examine potential pathways through which these relationships exist in order to develop specific prevention strategies.
INTRODUCTION: Lipoprotein (a) (Lp(a)) is a largely genetically determined (70-90%) independent risk factor for cardiovascular disease (CVD). However, clinicians often encounter adults/elder adults with elevated Lp(a), wh...INTRODUCTION: Lipoprotein (a) (Lp(a)) is a largely genetically determined (70-90%) independent risk factor for cardiovascular disease (CVD). However, clinicians often encounter adults/elder adults with elevated Lp(a), who are otherwise healthy and asymptomatic for atherosclerosis. We aimed to identify additional risk factors and conditions, apart from elevated Lp(a), which lead to atherosclerosis progression and CVD, and whether any protective factors mitigate Lp(a)-related risk. MATERIAL AND METHODS: In the STAR (Specialist Care Patients) Lp(a) study, we prospectively enrolled 2,594 consecutive patients aged over 50 years, who had elevated Lp(a), referred to two outpatient cardiology clinics. These patients were either healthy, or had established CVD or three or more cardiovascular risk factors. Lp(a) concentration was measured by enzyme-linked immunosorbent assay. RESULTS: Among adults > 50 years with Lp(a) ≥ 30 mg/dl (75 nmol/l) (mean Lp(a), 65.4 vs. 72.7 mg/dl, = 0.118), healthy individuals and patients differed significantly in mean age (62.8 vs. 69.6 years, < 0.001), body mass index (BMI) and prevalence of overweight/ obesity (16.0% vs. 32.7%, = 0.001), mean hsCRP (2.12 vs. 2.35 mg/l, = 0.007), dyslipidemia, mean glucose and HbA levels (5.44% vs. 5.86%, < 0.001), and coronary artery calcium (CAC) scores (43.1 vs. 339.9, < 0.001). In multivariable analysis, the independent predictors of increased CAC in healthy individuals were gender and non-HDL-C, while in patients, the independent predictors were non-HDL-C and age. Correlation analysis showed that in healthy individuals, CAC correlated with gender and non-HDL-C, while in patients, CAC correlated with age, gender, non-HDL-C, HbA, and Lp(a). Comparing sub-groups with Lp(a) > 50 mg/dl (125 nmol/l) (mean age: 62.3 vs. 69.2 years, < 0.001; female: 77.8% vs. 68.5%, = 0.021; mean Lp(a) : 87.8 vs. 88.8 mg/dl, = 0.838), the independent predictors of CAC in healthy individuals were elevated hsCRP and gender, whereas in patients, they were age and Lp(a). Correlation analysis confirmed that Lp(a) was significantly associated with CAC in patients only, and LDL-C and hsCRP correlated with CAC in patients only. CONCLUSIONS: In adults > 50 years with elevated Lp(a), Lp(a) - related risk of atherosclerosis progression can be substantially mitigated by addressing modifiable CVD risk factors, such as obesity, diabetes, inflammation, and dyslipidemia, preferably by early preventive measures. In our study cohort, Lp(a) was independently associated with atherosclerosis progression in the patient group only.
INTRODUCTION: The aim of this study is to assess the effects of various exercise interventions of differing types and intensities (high-intensity aerobic training, moderate-intensity aerobic training, low-intensity aerob...INTRODUCTION: The aim of this study is to assess the effects of various exercise interventions of differing types and intensities (high-intensity aerobic training, moderate-intensity aerobic training, low-intensity aerobic training, high-intensity aerobic training combined with anaerobic training, high-intensity aerobic training combined with resistance training, moderate-intensity aerobic training combined with resistance training, mind-body exercises, and resistance training) on metabolic and cardiorespiratory function in children and adolescents with type 1 diabetes mellitus (T1DM). MATERIAL AND METHODS: Through systematic searches of databases such as PubMed, Embase, Cochrane, and Web of Science, randomized controlled trials (RCTs) were gathered to examine the effects of eight different types and intensities of exercise interventions on the metabolic and cardiorespiratory functions of children and adolescents with T1DM. RESULTS: A total of 19 RCTs involving 738 children and adolescents with T1DM were included. The network meta-analysis (NMA) results showed that high-intensity aerobic training combined with anaerobic training and high-intensity aerobic training significantly reduced the patients' lipid profile, including total cholesterol (TC) (MD = -1.92, 95% CI = (-2.36, -1.48)), low-density lipoprotein cholesterol (LDL-C) (MD = -1.18, 95% CI = (-1.94, -0.42)), and increased high-density lipoprotein cholesterol (HDL-C) (MD = 1.63, 95% CI = (1.21, 2.05)). CONCLUSIONS: Based on NMA and surface under the cumulative ranking curve (SUCRA) rankings, it was concluded that high-intensity aerobic training combined with anaerobic training and high-intensity aerobic training can improve the metabolic and cardiorespiratory functions of children and adolescents with T1DM, although they did not show significant effects on hemoglobin A1c (HbA1c), blood glucose (BG), peak oxygen consumption (VO peak), or triglycerides (TG).
INTRODUCTION: The global prevalence of estrogen-related cancers is often underappreciated, with a significant impact on women's health. Our goal is to explore the patterns and trends in estrogen-related cancers among wom...INTRODUCTION: The global prevalence of estrogen-related cancers is often underappreciated, with a significant impact on women's health. Our goal is to explore the patterns and trends in estrogen-related cancers among women, both pre- and post-menopausal, spanning from 1990 to 2021. We conducted secondary analyses to assess the burden of estrogen-related cancers using data from GBD 2021. MATERIAL AND METHODS: We sourced data from the Global Burden of Disease Study (GBD) 2021, focusing on the incidence, mortality, and disability-adjusted life years (DALYs) for two predominant estrogen-related cancers: breast and ovarian cancer. This data encompassed 204 countries and territories, covering a period from 1990 to 2021. We calculated the estimated annual percentage changes (EAPC) across different age groups and socio-demographic indices (SDIs) to assess the evolving trends over time. Spearman's correlation analysis was employed to scrutinize the relationship between age-standardized rates and SDI. Furthermore, we utilized the Bayesian age-period-cohort model to forecast the trajectory of estrogen-related cancers from 2021 to 2035. RESULTS: From 1990 to 2021, the global age-standardized incidence rate (ASIR) for pre- and post-menopausal breast cancer and premenopausal ovarian cancer increased, while postmenopausal ovarian cancer declined. Meanwhile, the DALY and age-standardized mortality rate (ASMR) for two cancers showed a downward trend worldwide. Breast cancer is prevalent globally, followed by ovarian cancer, highlighting the disparities in the burden of estrogen-related cancers across different regions. Worldwide, the burden patterns of estrogen-related cancers differ significantly between pre- and post-menopausal women. In 2021, a strong positive correlation was found between the ASIR of two cancers and the ASMR of ovarian cancer with SDI ( > 0, < 0.05), while a negative correlation existed between the ASMR of premenopausal breast cancer concerning SDI ( < 0, < 0.05). Except for a drop in ASIR for postmenopausal ovarian cancer from 2021 to 2035, the ASIR for pre- and post-menopausal breast and premenopausal ovarian cancer is expected to rise. Predictions indicate an increase in the ASMR and DALYs for premenopausal estrogen-related cancers, while a decrease is expected for postmenopausal ones. CONCLUSIONS: Estrogen-related cancers remain a major global health issue, with increasing burden. It is crucial for policymakers to stay informed about these trends, develop targeted screening strategies based on age and region, and allocate resources effectively.
INTRODUCTION: Glutathione reductase (GR) is a key enzyme that catalyzes the reduction of oxidized glutathione to its reduced form, playing a vital role in protecting cells from oxidative damage caused by the accumulation...INTRODUCTION: Glutathione reductase (GR) is a key enzyme that catalyzes the reduction of oxidized glutathione to its reduced form, playing a vital role in protecting cells from oxidative damage caused by the accumulation of reactive oxygen species. This study employed the ultraviolet enzymatic method to measure serum GR activity, aiming to investigate its distribution among apparently healthy adults and preliminarily establish reference intervals for serum GR. MATERIAL AND METHODS: A total of 6,180 apparently healthy individuals participated in this study. Serum GR activity was measured using the AU5800 fully automated biochemical analyzer and its corresponding commercial kit. The Kolmogorov-Smirnov test was used to analyze the distribution of serum GR activity. Following the guidelines of C28-A3 and WS/T 402-2024, the reference interval for serum GR was determined using the bilateral percentile method, covering the range from the 2.5th to the 97.5th percentile. RESULTS: Serum GR activity in this study exhibited a non-normal distribution. Significant gender-based differences in GR activity were observed, while no significant variations were found across different age groups. Based on these findings, gender-specific reference intervals for serum GR were established: 26.6-51.8 U/l for males and 29.7-55.3 U/l for females. CONCLUSIONS: This study is the first to establish gender-specific reference intervals for serum GR in apparently healthy adults. These intervals provide essential guidance for health screening and improve the diagnosis and management of related clinical conditions.
INTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are commonly used antihyperglycemic medications that also exhibit anti-inflammatory and antioxidant effects. Ovarian cancer, a common gynecological neoplasm...INTRODUCTION: Sodium-glucose cotransporter 2 (SGLT2) inhibitors are commonly used antihyperglycemic medications that also exhibit anti-inflammatory and antioxidant effects. Ovarian cancer, a common gynecological neoplasm, is associated with increased inflammation and oxidative stress. Thus, this study investigated the correlation between the usage of SGLT2 inhibitors and the incidence of ovarian cancer in a population with type 2 diabetes mellitus (T2DM). MATERIAL AND METHODS: A retrospective cohort study was conducted, and patients with T2DM were divided into those who used SGLT2 inhibitors and those who did not. A total of 163 668 and 327 336 patients with T2DM were categorized into the SGLT2 inhibitor and control groups, respectively. The primary outcome was the development of ovarian cancer, as identified using diagnostic codes and laboratory examination findings. Cox proportional hazard regression was adopted to yield the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for ovarian cancer events between the two groups. RESULTS: A total of 167 and 222 patients developed ovarian cancer in the SGLT2 inhibitor and control groups, respectively. The incidence of ovarian cancer was significantly lower in the SGLT2 inhibitor group than in the control group (adjusted hazard ratio: 0.73, 95% CI: 0.60-0.89, = 0.0023). Subgroup analysis stratified by oral medications revealed that the effect of SGLT2 inhibitors on ovarian cancer development was significantly different from the effects of biguanides, sulfonylureas, α-glucosidase inhibitors, and dipeptidyl peptidase-4 inhibitors ( < 0.05). CONCLUSIONS: This preliminary study showed that the administration of SGLT2 inhibitors in patients with T2DM is associated with a lower incidence of ovarian cancer.
INTRODUCTION: Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) have been widely used to assess general health quality and function in clinical studies of patients with vertebral fractures. We aimed to investigate t...INTRODUCTION: Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) have been widely used to assess general health quality and function in clinical studies of patients with vertebral fractures. We aimed to investigate the associations of preoperative ODI and EQ-5D with long-term mortality in patients undergoing percutaneous vertebroplasty. MATERIAL AND METHODS: We retrospectively identified adult patients who had a single-level vertebral compression fracture and received percutaneous vertebroplasty between 2013 and 2020. Patients with traumatic fractures, burst fractures, and pathologic fractures, as well as those who had missing information on preoperative assessment of ODI and EQ-5D, were excluded. Survival status of the study patients was confirmed at the end of March 2021. The associations of preoperative ODI and EQ-5D with all-cause mortality were examined using Cox-proportional hazard models. RESULTS: A total of 167 patients were analyzed (mean age: 75.8 ±9.3 years, 25.7% male). There were 28 patients who died during a median follow-up duration of 2.1 years (63.6 per 1000 patient-years). Preoperative ODI was significantly associated with all-cause mortality after vertebroplasty (HR = 1.049, 95% CI: 1.008 to 1.092, = 0.018). In contrast, preoperative EQ-5D was independently associated with a lower risk of all-cause mortality after the surgery (HR = 0.202, 95% CI: 0.043 to 0.936, = 0.041). CONCLUSIONS: Preoperative assessment of ODI (HR = 1.049, 95% CI: 1.008 to 1.092) and EQ-5D (HR = 0.202, 95% CI: 0.043 to 0.936) may help determine postoperative long-term mortality risk in this aging surgical population.
INTRODUCTION: We examined the role of hearing functions as potential mediators in relationships between noise exposures and abnormal body constitution-related results. Additionally, we employed Mendelian randomization (M...INTRODUCTION: We examined the role of hearing functions as potential mediators in relationships between noise exposures and abnormal body constitution-related results. Additionally, we employed Mendelian randomization (MR) to explore the causative connections between hearing problems and bodily composition. MATERIAL AND METHODS: Gene connections pertaining to phenotypes of hearing loss and body constitution were obtained from publicly available summary data collected from adult population genome-wide association studies. Colocalization analysis was utilized to scrutinize the genetic associations pertaining to age-related hearing impairment (ARHI) liability and body mass index (BMI) within the SLC39A8 locus. For a comprehensive examination, we employed bi-directional MR encompassing both the 'forward' direction (from the composition of the body to hearing) and the 'reverse' direction. RESULTS: A common causative variable (rs13107325) for BMI and ARHI at the SLC39A8 locus was supported by colocalization analysis, which revealed that the two diseases shared the variant at the SLC39A8 gene. The forward analyses showed that body fat percentage (BFP) was significantly linked with the risk of ARHI (OR = 0.95 (95% CI: 0.93 to 0.98)) and that waist circumference (WC) was favorably associated with sensorineural hearing loss (SNHL) (OR = 0.83 (95% CI: 0.72 to 0.97)). CONCLUSIONS: We did not find evidence to support a causal relationship between constitution and HL in the reverse MR analysis. Colocalization analysis indicated that the SLC39A8 variant was often the source of high ARHI and BMI risk. In prospective MR, we discovered causal associations between WC and BFP with SNHL and ARHI, respectively. Therefore, our results suggest that lipid metabolic abnormalities leading to adverse health outcome may lead to HL.
Ceasovschih A, Banjanin N, Bednarek A
… +10 more, Beqiraj A, Cherska M, Ejubović M, Jakubova M, Markos S, Ristovski V, Scicali R, Banach M, Sorodoc V, Gotto AM
Heart failure (HF) and atherosclerosis represent two major cardiovascular diseases that are intricately linked, both contributing significantly to global morbidity, mortality, and healthcare burden. Despite substantial p...Heart failure (HF) and atherosclerosis represent two major cardiovascular diseases that are intricately linked, both contributing significantly to global morbidity, mortality, and healthcare burden. Despite substantial progress in diagnostic methods and therapeutic strategies, the overall impact of these conditions remains considerable. This is largely due to their complex and overlapping pathophysiological mechanisms, persistent residual atherosclerotic risk, and the ongoing challenges associated with implementing guideline-directed medical therapy for HF in routine clinical practice. Recent advancements in the management of diverse HF phenotypes, lipid abnormalities, atherosclerotic cardiovascular disease (ASCVD), and obesity have facilitated the adoption of multidrug regimens. These include β-blockers, renin-angiotensin-aldosterone system inhibitors, sodium-glucose cotransporter 2 (SGLT2) inhibitors, and glucagon-like peptide-1 (GLP-1), which have collectively improved outcomes in HF populations. Lipid-lowering therapy, particularly statins, has demonstrated significant efficacy in reducing ASCVD events and slowing HF progression, as well as lowering the risk of HF-related hospitalizations. Elevated lipoprotein(a) [Lp(a)] has emerged as an independent risk factor for both ASCVD and HF, being associated with increased risk of incident HF, disease progression, hospitalization, and adverse outcomes. However, there remains a lack of conclusive evidence as to whether targeted reduction of Lp(a) leads to a decrease in major adverse cardiovascular events or improves HF incidence or outcomes. In parallel, contemporary therapeutic advances in coronary and peripheral artery revascularization, along with novel pharmacologic treatments for obesity such as GLP-1 receptor agonists including semaglutide and tirzepatide have shown beneficial effects in reducing cardiovascular mortality, HF progression, and body weight, irrespective of HF status. These converging therapeutic strategies underscore the close interrelationship between HF and atherosclerosis. This review aims to elucidate the shared pathophysiological mechanisms linking these conditions and to examine their clinical overlap with ischemic heart disease, cerebrovascular disease, peripheral arterial disease, dyslipidemia, and obesity. A comprehensive understanding of these interrelated cardiovascular entities may offer valuable insights to inform future research directions and optimize the clinical management of patients affected by both HF and atherosclerotic disease.
Wang G, Yan D, Xue L
… +20 more, Weng C, Zhang L, Xu L, Yuan F, Li J, Wu M, Da Z, Wei H, Zhou L, Yin S, Wu J, Lu Y, Su D, Liu L, Ma L, Xu X, Liu H, Ren T, Zang Y, Liu Z
INTRODUCTION: Antinuclear antibodies (ANA) are frequently positive in patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (anti-MDA5+ DM). This study aimed to investigate the associatio...INTRODUCTION: Antinuclear antibodies (ANA) are frequently positive in patients with anti-melanoma differentiation-associated gene 5-positive dermatomyositis (anti-MDA5+ DM). This study aimed to investigate the association between ANA and clinical characteristics as well as prognosis in a cohort of patients with anti-MDA5+ DM. MATERIAL AND METHODS: We conducted a systematic retrospective study of medical records from a Nanjing Medical University cohort of patients with myositis-associated interstitial lung disease (ILD). Various parameters were compared and analyzed between the ANA-positive group and the ANA-negative group. RESULTS: A total of 246 patients with anti-MDA5+ DM were enrolled in this study, with 28.5% males and 71.5% females. The median age was 53.0 years, the median disease duration was 2 months, and the median follow-up period was 12.0 months. The ANA positivity rate at baseline was 52.4% in anti-MDA5+ DM patients. The ANA-positive group showed significantly higher positivity rates of anti-Ro52 antibodies (72.9% vs. 54.7%, = 0.003) and anti-aminoacyl-tRNA synthetase (anti-ARS) antibodies (9.3% vs. 2.6%, = 0.033) compared to the ANA-negative group, but lower ALT levels: 39.0 (21.5, 79.3) vs. 51.3 (36.5, 95.8), = 0.006. No significant differences were observed between the two groups in terms of overall survival, rapidly progressive interstitial lung disease (RPILD) incidence, age, disease duration, and clinical characteristics. In a subgroup analysis of the ANA-positive group, MDA5+++ patients had a higher incidence of RPILD compared to the MDA5+ group ( = 0.028). In the ANA-negative subgroup analysis, MDA5+++ patients had a higher mortality rate and worse prognosis compared to the MDA5+ group ( = 0.026). Multivariate Cox regression analysis showed that elevated lactate dehydrogenase (LDH) levels and the presence of rapidly progressive interstitial lung disease (RPILD) were associated with poor prognosis in ANA-negative anti-MDA5+ DM patients, with hazard ratios of 1.002 (95% CI: 1.001, 1.003, = 0.020) and 13.694 (95% CI: 15.032, 37.267, < 0.001), respectively. CONCLUSIONS: ANA is frequently found in patients with anti-MDA5+ DM. High titers of anti-MDA5 antibodies are associated with mortality and RPILD.