bluuebunny/crossref_metadata_2025_split huggingface dataset:
1147 Long Term Outcomes Following Combined Liver-Kidney Transplantation
Authors: Hennessy C , Monbaliu D 
Published: July 2024

Abstract

Aim
Combined liver kidney transplant (CLKTx) is the mainstay of treatment for concurrent liver failure and end stage renal failure. The use of CLKTx has increased markedly since the introduction of the MELD (Model for End Stage Liver Disease) score for liver allocation. In this study we examined the long-terms outcomes of 25 years of CLKTx in our centre.

Method
From a database of all transplants from 1997 – 2022, 158 recipients of CLKTx were identified. Primary outcomes of interest were mortality and graft failure. Data was analysed in R studio and GraphPad prism.

Results
Overall patient survival was 89% at 1 year, 87% at 2 years, 81% at 5 years, 72% at 10 years and 50% at 20 years. The 20-year patient survival with a pre-transplant (preTx) MELD of &lt;20 was 52%, with a preTx MELD of &gt;20 associated with significantly lower 20-year patient survival of 26% (P&lt;0.05). Death censored (dc) liver graft survival was 99% at 1 year, 98% at 2 years, 97% at 5 years and ten years, and 88% at 25 years. A donor age of &lt;40 showed 20-year liver graft survival (dc) of (100%), which was significantly greater than the donor age &gt;40 group (72%, P&lt;0.05). Death censored kidney graft survival was 96% at 1 year, 95% at 2 and 5 years, 92% at ten years and 84% at twenty years post Tx.

Conclusions
We report favourable long-term outcomes following 25 years of CLKTx. Predictors for better long-term patient and graft survival include pre transplant MELD score and donor age.
37 Evaluation of Prophylactic Negative Pressure Wound Therapy Versus Standard Surgical Dressings on Wound Outcomes in Posterior Spinal Surgery Patients: A Systematic Review and Meta-Analysis
Authors: Rathore Ahmed , Baliga Santosh , Lennox Liam , Bickerton Melanie 
Published: July 2024

Abstract

Aim
Negative pressure wound therapy has frequently been used in a variety of surgical specialities, yet its effectiveness as a prophylactic therapy in spinal surgery remains unclear. A comprehensive systematic review and meta-analysis was performed, incorporating the most recent evidence, addressing this paucity in the literature.

Method
A systematic search of the literature from inception to June 2023 was conducted using the following databases: Ovid Medline, EMBASE, Cochrane Register of Controlled Trials (CENTRAL) and Web of Science. All included studies assessed primary wound closure for posterior spinal surgical incisions. Evidence was quality assessed and outcomes of interest were meta-analysed using odds ratios, comparing negative pressure wound therapy and standard dressing groups.

Results
Seven studies (n = 1319, mean age = 59.9 years, 55.8% male) were included. Patients with negative pressure dressings had a reduced risk of surgical site infection (odds ratio = 0.45, 95% CI 0.29 to 0.72, p &lt; 0.001). Wound dehiscence approached significance favouring negative pressure dressings (odds ratio = 0.53, 95% CI 0.26 to 1.06, p = 0.07). Patients requiring a return to theatre for wound related complications showed no significant difference between groups (odds ratio = 0.66, 95% CI 0.37 to 1.18, p = 0.16).

Conclusions
Negative pressure wound therapy reduces the risk of surgical site infection in posterior spinal surgery patients. Given that surgical site infection in spine surgery is associated with significant morbidity and financial costs, implementation of prophylactic negative pressure wound therapy for this patient demographic may be beneficial.
358 Driving Endovascular Solutions for Abdominal Aortic Aneurysms: A 9-Year International Experience with the Fenestrated Anaconda Endograft
Authors: Jubouri M , Surkhi A O , Tan S , Williams I M , Bashir M 
Published: July 2024

Abstract

Aim
Endovascular aortic repair (EVAR) has become the mainstay treatment for abdominal aortic aneurysms and is associated with optimal outcomes. However, there remains a risk of complications requiring reintervention. Several EVAR devices exist commercially, yet, the Fenestrated Anaconda™ (FA) has demonstrated outstanding results. This study aims to presents a 9-year cross-sectional international analysis of custom-made FA outcomes.

Method
Patient data was collected prospectively in 27 countries over 9 years and stored in an international registry. This was later retrieved and analysed retrospectively.

Results
A total of 5058 patients received the FA endograft. This was indicated either due to complex anatomy for competitor devices (n = 3891, 76.9%) or based on surgeon preference (n = 1167, 23.1%). Overall, the FA was utilised to rescue 2987 (59%) failed previous EVARs. The predominant device category and proximal ring stent configuration were bifurcate (83.6%) and standard (64.5%). Most devices were delivered within 6-8 weeks (55.4%) of diagnosis and 95% came with a prototype. As for clinical outcomes, both survival and TVP were 100% during the first 6 postoperative years but dropped to 77.1% and 81% thereafter. A sac regression of 0-30% was observed in 4772 (94.3%) patients over the first 4 years, whilst all patients had 20-45% sac regression in years 5-9 of follow-up. No cases of endograft migration or reintervention were recorded. All clinical outcomes were further stratified by indication group.

Conclusions
The custom-made FA endograft features a highly unique and innovative design which enables it to treat highly complex aortic anatomy while achieving favourable results.
CA125 outperforms NT-proBNP in the prediction of maximum aerobic capacity in heart failure with preserved ejection fraction and kidney dysfunction
Authors: Núñez-Marín Gonzalo , Palau Patricia , Domínguez Eloy , de la Espriella Rafael , López Laura , Flor Cristina , Marín Paloma , Lorenzo Miguel , Miñana Gema , Bodí Vicent , Sanchis Juan , Núñez Julio 
Published: July 2024

ABSTRACT

Background
Heart failure with preserved ejection fraction (HFpEF) often coexists with chronic kidney disease (CKD). Exercise intolerance is a major determinant of quality of life and morbidity in both scenarios. We aimed to evaluate the associations between N-terminal pro-B-type natriuretic peptide (NT-proBNP) and carbohydrate antigen 125 (CA125) with maximal aerobic capacity (peak VO2) in ambulatory HFpEF and whether these associations were influenced by kidney function.

Methods
This single-centre study prospectively enrolled 133 patients with HFpEF who performed maximal cardiopulmonary exercise testing. Patients were stratified across estimated glomerular filtration rate (eGFR) categories (&lt;60 ml/min/1.73 m2 versus ≥60 ml/min/1.73 m2).

Results
The mean age of the sample was 73.2 ± 10.5 years and 56.4% were female. The median of peak VO2 was 11.0 ml/kg/min (interquartile range 9.0–13.0). A total of 67 (50.4%) patients had an eGFR &lt;60 ml/min/1.73 m2. Those patients had higher levels of NT-proBNP and lower peak VO2, without differences in CA125. In the whole sample, NT-proBNP and CA125 were inversely correlated with peak VO2 (r = −0.43, P &lt; .001 and r = −0.22, P = .010, respectively). After multivariate analysis, we found a differential association between NT-proBNP and peak VO2 across eGFR strata (P for interaction = .045). In patients with an eGFR ≥60 ml/min/1.73 m2, higher NT-proBNP identified patients with poorer maximal functional capacity. In individuals with eGFR &lt;60 ml/min/1.73 m2, NT-proBNP was not significantly associated with peak VO2 [β = 0.02 (95% confidence interval −0.19–0.23), P = .834]. Higher CA125 was linear and significantly associated with worse functional capacity without evidence of heterogeneity across eGFR strata (P for interaction = .620).

Conclusions
In patients with stable HFpEF, NT-proBNP was not associated with maximal functional capacity when CKD was present. CA125 emerged as a useful biomarker for estimating effort intolerance in HFpEF irrespective of the presence of CKD.
Cardiac mechanics and the risk of atrial fibrillation in a community-based cohort of older adults
Authors: Inciardi Riccardo M , Wang Wendy , Alonso Alvaro , Soliman Elsayed Z , Selvaraj Senthil , Gonçalves Alexandra , Zhang Michael J , Chandra Alvin , Prasad Narayana G , Skali Hicham , Shah Amil M , Solomon Scott D , Chen Lin Yee 
Published: July 2024

Abstract

Aims
Assessment of cardiac structure and function improves risk prediction of new-onset atrial fibrillation (AF) in different populations. We aimed to comprehensively compare standard and newer measures of cardiac structure and function in improving prediction of AF in a cohort of older adults without history of AF and stroke.

Methods and results
We included 5050 participants without prevalent AF and stroke (mean age 75 ± 5 years, 59% women, and 22% Black) from the Atherosclerosis Risk in Communities (ARIC) study who underwent complete two-dimensional echocardiography, including speckle-tracking analysis of the left ventricle (LV) and left atrium (LA). We assessed the association of cardiac measures with incident AF (including atrial flutter) and quantified the extent to which these measures improved model discrimination and risk classification of AF compared with the CHARGE-AF score. Over a median follow-up time of 7 years, 676 participants developed AF (incidence rate 2.13 per 100 person-years). LV mass index and wall thickness, E/e′, and measures of LA structure and function, but not LV systolic function, were associated with incident AF, after accounting for confounders. Above all, LA reservoir strain, contraction strain, and LA minimal volume index (C-statistics [95% confidence interval]: 0.73 [0.70, 0.75], 0.72 [0.70, 0.75], and 0.72 [0.69, 0.75], respectively) significantly improved the risk discrimination of the CHARGE-AF score (baseline C-statistic: 0.68 [0.65, 0.70]) and achieved the highest category-based net reclassification improvement (29%, 24%, and 20%, respectively).

Conclusion
In a large cohort of older adults without prevalent AF and stroke, measures of LA function improved the prediction of AF more than other conventional cardiac measures.
Frailty Was Associated With Atmospheric NO2 Levels: A Geospatial Approach
Authors: Gonzalez-Bautista Emmanuel , Román-Pérez Susana , Manrique-Espinoza Betty Soledad , Salinas-Rodríguez Aaron , Santos-Luna René 
Published: July 2024

Abstract

Background
Recent evidence has linked air pollution with frailty, yet little is known about the role of NO2 in this association. Our aim was to assess the association between frailty and NO2 air concentrations in Mexican older adults.

Methods
We used georeferenced data from the population-based Nutrition and Health Survey in Mexico (NHNS) 2021, representative of national and subnational regions, to measure a frailty index based on 31 health deficits in adults aged 50 and older. Air pollution due to NO2 concentrations was estimated from satellite images validated with data from surface-level stations. Maps were produced using Jensen’s Natural break method. The association of frailty and NO2 concentrations was measured using the frailty index (multivariate fractional response logit regression) and a frailty binary variable (frailty index [FI] ≥0.36, multivariate logit regression).

Results
There was a positive and significant association of the frailty index with the NO2 concentrations, adjusting for age, sex, urban and rural area, years of education, socioeconomic status, living arrangement, particulate matter smaller than 2.5 microns, and indoor pollution. For each standard deviation increase in NO2 concentrations measured 10 years before the survey, the odds of being frail were 15% higher, and the frailty index was 14.5% higher. The fraction of frailty attributable to NO2 exposure ranged from 1.8% to 23.5% according to different scenarios.

Conclusions
Frailty was positively associated with exposure to NO2 concentrations. Mapping frailty and its associated factors like NO2 air concentrations can contribute to the design of targeted pro-healthy aging policies.
Are Older Adults More Prosocial Than Younger Adults? A Systematic Review and Meta-Analysis
Authors: Li Duo , Cao Yuan , Hui Bryant P H , Shum David H K 
Published: July 2024

Abstract

Background and Objectives
Prosociality refers to voluntary behaviors that intend to benefit others. Most of the existing literature suggests that older adults tend to act more prosocially compared to younger adults, whereas some studies show that older adults might not be that prosocial under certain conditions. The current study aimed to summarize the mixed findings and quantify the age difference in prosociality by conducting a qualitative systematic review and a quantitative meta-analysis.

Research Design and Methods
Literature search was conducted based on 5 databases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and this review was registered at PROSPERO (CRD42022333373).

Results
Based on the qualitative synthesis of 51 studies, older adults (n = 109,911) were more prosocial than younger adults (n = 68,501). The meta-analysis of 46 studies further supported this age effect (Hedges’ g = 0.31, 95% confidence interval [0.24, 0.37]), and this age effect might be moderated by the types of prosociality. We discovered a moderate age effect in sharing (Hedges’ g = 0.53), but a nonsignificant age effect in helping (Hedges’ g = 0.11), comforting (Hedges’ g = −0.20), or mixed prosociality (Hedges’ g = 0.15). Additionally, the age effect was only significant when older adults had higher socioeconomic status than younger adults.

Discussion and Implications
Future research should develop more comprehensive measures of prosociality, examine more variables that influence aging and prosociality, and investigate the neural mechanism(s) of prosociality to achieve a thorough understanding of the age difference in prosociality.
O-059 ART in PCOS
Authors: Dhillon Pai R , Pai A 
Published: July 2024

Abstract
Polycystic Ovarian Syndrome affects an estimated 8 – 13% of women of reproductive age (WHO).
It is the commonest cause of anovulation and infertility. The high AMH, LH, Insulin resistance and hyperandrogenism seen in PCOS women contributes to infertility along with poor oocyte quality and reduced endometrial receptivity.
ART procedures are recommended as the third line of treatment after ovulation induction, IUI or ovarian drilling.
Prior to IVF, metabolic assessment and lifestyle adjustments with weight management must be done. Adjuvant agents such as metformin melatonin, myoinositol and Vitamin-D have been tried to improve IVF outcomes.
Mild stimulation is an option in patients as high risk for ovarian hyperstimulation syndrome (OHSS).
Conventional stimulation with low dose FSH, GnRH antagonist down regulation, agonist trigger with freezing of all embryos, significantly reduces risk of OHSS without compromising cumulative live birth rates.
Adjustments for stimulation protocols may need to be made for BMI, insulin resistance and AMH. In vitro maturation can be considered in patients with prior severe OHSS, though the results may be inferior.
ART in PCOS patients is challenging and even after pregnancy is achieved, there may be a higher risk of adverse obstetric outcomes.
P-688 Fertility and age at childbirth in polycystic ovary syndrome: results from a longitudinal population-based cohort study
Authors: Forslund M , Melin J , Tay C  T , Loxton D , Teede H , Joham A 
Published: July 2024

Abstract

Study question
How does fertility differ between women with and without polycystic ovary syndrome (PCOS), and which factors are associated with advanced maternal age?

Summary answer
Women with PCOS have less births. PCOS was associated with advanced maternal age, with later diagnosis associated with double the rate of advanced maternal age.

What is known already
PCOS affects 12% or 140 million women globally. Women with PCOS have broad features including ovulatory disturbances and increased infertility; however, few studies have explored reproductive outcomes in PCOS at the end of reproductive age. In the general population advanced maternal age, defined as giving birth after age 35 years, is associated with increased risk of pregnancy complications and reduced fertility. A recent register-based study found increased risk of advanced maternal age in women with PCOS, yet PCOS prevalence was underreported, and the study did not adjust for important confounders.

Study design, size, duration
Prospective cohort study. Women with (n = 981) and without (n = 13 266) self-reported PCOS diagnosis were compared during a 25-year follow-up.

Participants/materials, setting, methods
Women randomly selected from the general population and included in the prospective Australian Longitudinal Study on Women’s Health were assessed with surveys every third year from 1996 (age 18-23 years) to 2021 (age 43-48 years).

Main results and the role of chance
Overall 9.9% of women reported having PCOS and by 43-48 years, those with PCOS had less births (1.7 ±1.3 vs. 1.9 ±1.2, p &lt; 0.001), and more were nulliparous, 23% vs. 18%, p = 0.003. They were older than women without PCOS at their first, and second childbirth (29.5 ±5.49 vs. 28.8 ±5.48 years and 32.1 ±5.16 vs. 31.1 ±5.00 years, p &lt; 0.001 for both).
PCOS was associated with increased odds of advanced maternal age at first childbirth, adjusted odds ratio (aOR) 1.34 (95% confidence interval 1.04-1.75), whereas type 2 diabetes (aOR 0.68 (0.61-1.10)) or hypertension (aOR 0.82 (0.61-1.10)) were not associated with advanced maternal age. Within the PCOS group, a late PCOS diagnosis was associated with increased odds of advanced maternal age, aOR 2.05 (1.24-3.40).

Limitations, reasons for caution
All outcomes were self-reported.

Wider implications of the findings
Women with PCOS have lower parity. Later diagnosis is associated with increased odds of advanced maternal age at first childbirth. Given poor reproductive outcomes with increased maternal age, we highlight the importance of earlier diagnosis, patient education and implementation of a reproductive life-plan to optimize attainment of aspirational family size.

Trial registration number
not applicable
P-708 melatonin alleviates circadian rhythm disruption-induced enhanced luteinizing hormone pulsatility and ovarian dysfunction in vivo and in vitro
Authors: Li Y , Huang W , Pei T 
Published: July 2024

Abstract

Study question
Is melatonin deficiency a reversible cause of abnormal pattern of luteinizing hormone (LH) pulsatility and ovarian dysfunction caused by circadian rhythm disruption (CRD)?

Summary answer
Melatonin could rescue the augmented LH pulsatility and reproductive abnormalities caused by CRD.

What is known already
Melatonin, mainly synthesized and released by pineal gland, engages in regulating circadian rhythms. When circadian rhythms are disrupted, the nocturnal productions of melatonin are suppressed. Evidence suggests that circadian rhythm disruption (CRD) is associated with reproductive dysfunctions, while melatonin plays a vital role for female reproduction as a free radical scavenger and a neuroendocrine regulator. The gonadotrophin-releasing hormone (GnRH) drives pulsatile luteinizing hormone (LH) secretion, which is also essential for fertility.

Study design, size, duration
We used 90 CBA/CaJ mice to establish the chronic jet-lag model in which mice were exposed to an 8 hr time shift every 3 days. After 8 weeks of jet-lag induction, some of the mice were given melatonin treatment for 4 weeks. Furthermore, we used a perfusion system in vitro to mimic the process of CRD-induce high-frequency GnRH pulses stimulation of LβT2 gonadotrope cells.

Participants/materials, setting, methods
Repetitive tail-tip blood collection was used to evaluate the pattern of LH pulsatility. Blood plasma samples were collected from 4 mice at 4-hour intervals to measure levels of melatonin. Follicular development was evaluated by ovarian histology. Reproductive hormones was detected by ELISA. Immunohistochemistry and western blot were used to detect the expression of melatonin receptor 1A (MT1). The LβT2 cells were exposed to pulsatile GnRH at high pulse frequencies to mimic augmented pulsatile GnRH stimulation.

Main results and the role of chance
CRD mice exhibited reproductive-endocrine dysfunction, including irregular estrous cycles, reduced number of corpus lutea (CL), and decreased levels of estradiol and progesterone. Additionally, CRD enhanced the frequency and amplitude of LH pulsatility and pituitary LH beta-subunit expression. Melatonin administration alleviated these CRD-induced reproductive abnormalities and reversed the augmented LH pulsatility. The expression of MT1 decreased in the anterior pituitaries of CRD mice but increased after melatonin treatment, indicating the essential role of MT1 in melatonin’s reversal of CRD-induced enhanced LH pulsatility.

Limitations, reasons for caution
Further research is needed to validate the applicability and safety of these findings in humans.

Wider implications of the findings
The results suggest that melatonin may be a beneficial option for patients with reproductive-endocrine abnormalities, particularly those with circadian rhythm disruption.

Trial registration number
82101719
O-103
Authors: Dalla Zuanna G , Castiglioni M 
Published: July 2024

Abstract
In the mid-1970s, when women born immediately after the Second World War were at full reproductive age, the demographic transition in Europe could be considered concluded. Birth and death rates were around 10 per thousand (a quarter compared to a century earlier), fertility was around two children per woman, and the differences in fertility between countries were modest.
It seemed like the end of a path towards a new demographic stability. In reality, for subsequent cohorts, things continue to change: fertility in many countries declines, while differences between countries grow. The fertility of women born around 1980 in Europe is not far from two children for France and Northern Europe, around 1.6 children in Central and Eastern Europe, around 1.4 children in Southern Europe. Although these differences may seem minimal, the medium-long term consequences on age distributions are enormous.
It would be wrong, however, to say that no similar patterns of fertility exist after the end of the demographic transition. First of all, as already mentioned, there are strong similarities between countries and regions of the same geographical area: Italian fertility patterns, for example, are similar to those of other countries on the northern shore of the Mediterranean, such as Spain, Portugal, Greece and the Balkan states.
Furthermore, all European countries share a progressive increase in the age at birth, both of the first and subsequent children, while late fertility (35+ years of age) increases greatly. The differences between countries are far from irrelevant. However, the variability between countries has been progressively decreasing for thirty years now.
These changes in reproductive behaviours are intertwined with other important changes in Europe's natural demography. The most important is undoubtedly aging, determined by the lengthening of the average lifespan, especially by the spectacular increase in survival beyond fifty years of age. This phenomenon has also been very diversified among European states, less accentuated in particular in Eastern Europe and Russia.
The imbalances in the age structure of the population generated by the joint effect of low birth rates and high survival of the elderly are attenuated by consistent and growing immigration flows from poor countries, where – contrary to what happened in Europe – the working age population grows. These population movements are accompanied by those within Europe, in particular from Eastern and Balkan countries to the other part of the continent.
The future prospects of European demography are traced starting from this global description, underlining in particular what can reasonably be predicted about reproductive behaviour.