Incremental value of risk factor variability for cardiovascular risk prediction in individuals with type 2 diabetes: results from UK primary care electronic health records

alexandrossfakianakis shared this article with you from Inoreader Incremental value of risk factor variability for cardiovascular risk prediction in individuals with type 2 diabetes: results from UK primary care electronic health records via International Journal of Epidemiology - Advance Access Abstract BackgroundCardiovascular disease (CVD) risk prediction models for individuals with type 2 diabetes are important tools to guide intensification of interventions for CVD prevention. We aimed to assess the added value of incorporating risk factors variability in CVD risk prediction for people with type 2 diabetes. Methods We used electronic health records (EHRs) data from 83 910 adults with type 2 diabetes but without pre-existing CVD from the UK Clinical Practice Research Datalink for 2004–2017. Using a landmark-modelling approach, we developed and validated sex-specific Cox models, incorporating conventional predictors and trajectories plus variability of systolic blood pressure (SBP), total and high-density lipoprotein (HDL) cholesterol, and glycated haemoglobin (HbA1c). Such models were compared against simpler models using single last observed values or means. Results The standard deviations (SDs) of SBP, HDL cholesterol and HbA1c were associat ed with higher CVD risk (P < 0.05). Models incorporating trajectories and variability of continuous predictors demonstrated improvement in risk discrimination (C-index = 0.659, 95% CI: 0.654–0.663) as compared with using last observed values (C-index = 0.651, 95% CI: 0.646–0.656) or means (C-index = 0.650, 95% CI: 0.645–0.655). Inclusion of SDs of SBP yielded the greatest improvement in discrimination (C-index increase = 0.005, 95% CI: 0.004–0.007) in comparison to incorporating SDs of total cholesterol (C-index increase = 0.002, 95% CI: 0.000–0.003), HbA1c (C-index increase = 0.002, 95% CI: 0.000–0.003) or HDL cholesterol (C-index increase= 0.003, 95% CI: 0.002–0.005). Conclusion Incorporating variability of predictors from EHRs provides a modest improvement in CVD risk discrimination for individuals with type 2 diabetes. Given that repeat measures are readily available in E HRs especially for regularly monitored patients with diabetes, this improvement could easily be achieved. View on Web

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The clinically relevant CYP2C8*3 and CYP2C9*2 haplotype is inherited from Neandertals

alexandrossfakianakis shared this article with you from Inoreader The clinically relevant <i>CYP2C8*3</i> and <i>CYP2C9*2</i> haplotype is inherited from Neandertals via The Pharmacogenomics Journal - Issue - nature.com science feeds The Pharmacogenomics Journal, Published online: 02 July 2022; doi:10.1038/s41397-022-00284-6 The clinically relevant CYP2C8*3 and CYP2C9*2 haplotype is inherited from Neandertals View on Web

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Does three-dimensional intraglandular location predict malignancy in parotid tumors?

alexandrossfakianakis shared this article with you from Inoreader Does three-dimensional intraglandular location predict malignancy in parotid tumors? via International Journal of Oral and Maxillofacial Surgery via MedWorm.com Tumors arising within the parotid encompass a heterogeneous mix of benign and malignant neoplasms and other tissue growths. The purpose of this study was to determine the association between the location of intraparotid masses and the risk of malignancy. A retrospective cohort study was performed of patients diagnosed with parotid tumors following open tumor excision. The primary predictor variable was the location of the epicenter of the tumor in three-dimensional space, as determined from preoperative imaging. (Source: International Journal of Oral and Maxillofacial Surgery) View on Web

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Recovery from the damage of cranial radiation modulated by memantine, an NMDA receptor antagonist combined with hyperbaric oxygen therapy

alexandrossfakianakis shared this article with you from Inoreader Recovery from the damage of cranial radiation modulated by memantine, an NMDA receptor antagonist combined with hyperbaric oxygen therapy via Neuro-Oncology Advance Access Abstract Background Radiotherapy is an important treatment option for central nervous system malignancies. However, cranial radiation induces hippocampal dysfunction and white matter injury; this leads to cognitive dysfunction, and results in a reduced quality of life in patients. Excitatory glutamate signaling through N-methyl-D-aspartate receptors (NMDARs) plays a central role both in hippocampal neurogenesis and in the myelination of oligodendrocytes in the cerebrum. Methods We will provide the method for quantifying neurogenesis in human subjects in live brain during the cancer therapy. Neuroimaging using behavioral task we originally create, to examine human hippocampal memory pathway in patients with brain disorders. Results Treatment with memantine, a non-competitive NMDAR antagonist, reversed impairment in hippocampal pattern separation networks as detected by functional magnetic resonance imaging. Hyperbaric preconditi oning of the patients just before radiotherapy with memantine most reversed white matter injury as detected by whole brain analysis with Tract-Based Spatial Statics. Neuromodulation combined with the administration of hyperbaric oxygen therapy and memantine during radiotherapy facilitated the restoration of hippocampal function and white matter integrity, and improved higher cognitive function in patients receiving cranial radiation. Conclusions The method for therapy and diagnosis of hippocampal function we developed can be applicable to the patients received cranial radiation to restore the cognitive decline. The monitoring can be followed during the therapy that production of new neurons by which ability of pattern separation is increased, then recovery of pattern completion, followed by new score elevation. View on Web

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Risk factors for high level cytomegalovirus viremia in liver transplant recipients and associated outcomes

alexandrossfakianakis shared this article with you from Inoreader Risk factors for high level cytomegalovirus viremia in liver transplant recipients and associated outcomes via Transplant Infectious Disease Abstract Purpose To evaluate epidemiology, risk-factors and outcomes of high-level cytomegalovirus (CMV) viremia in liver transplant recipients. Methods Adult patients receiving a liver transplant between 1/1/2017-9/30/2020 were evaluated. Viral loads at UW Health Clinical Laboratories were required to allow for numerical comparison. Primary objective was incidence and outcomes of high-level (HL) CMV viremia (viral-load >100,000 IU/mL). Secondary objective was to elucidate risk factors to allow targeted interventions. Results 209 patients met inclusion criteria; 175 kept their graft for at least 240 days. Of these 9 patients developed HL CMV, 28 developed low-level (LL CMV, viral-load 250–100,000 IU/mL) and 138 did not develop CMV viremia. When comparing these 3 groups via classic statistical methods time from transplant to viremia was similar (HL 158 ± 77 days, LL 150 ± 76 days). Clinical factors were also similar with the exception of donor seropositivity (HL 87.5%, LL 70.4%, No CMV 49.6%, p = 0.025). HL CMV was significantly associated with graft loss (p < 0.0001) on Kaplan-Meier analysis; graft loss in the LL CMV group did not differ from the No CMV group (p = 0.96) To allow valid assessment of risk factors in the total study population (n = 209) models of time-varying covariates were used and Cox proportional hazards ratios were calculated. In this analysis HL CMV was associated with a significantly increased risk of graft loss (HR 5.6, p = 0.0016). When investigating risk factors associated with HL CMV, donor seropositivity significantly increased risk (HR 8.85, 95% CI 1.13–71.43, p = 0.038). Pre-transplant total bilirubin (HR 1.04, 95% CI 0.998–1.07, p = 0.06) trended towards significance. Recipient seronegativity, liver disease, clinical and allocation MELD, transplant surgery duration, age, sex, induction immunosuppression, and maintenance immunosuppression were not significantly associated with development of HL CMV. Conclusion HL CMV after liver transplant is uncommon but is associated with a significantly increased risk of graft loss that is not present in those patients who develop LL CMV or do not develop CMV viremia. Given these negative graft effects, CMV stewardship interventions targeting recipients of CMV seropositive allografts are warranted. Future larger scale studies evaluating the potential role of other factors in risk stratification are needed. This article is protected by copyright. All rights reserved View on Web

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