Metals are widespread pollutants in the environment which have been reported to be associated with kidney dysfunction in many existing epidemiological studies. However, most of the studies are ...cross-sectional design and mainly focus on several toxic metals including arsenic, lead and cadmium. Therefore, we conducted this prospective study within the Dongfeng-Tongji cohort to evaluate the associations of plasma multiple metals with the decline in kidney function among Chinese middle-aged and elderly. In total, 1434 participants free of chronic diseases at baseline were included in analysis. We measured baseline plasma concentrations of 23 metals and calculated estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation based on serum creatinine, age, sex and ethnicity. Bonferroni correction was used for multiple testing to reduce the probability of a type I error. Principal component analysis was conducted to evaluate the combined effect of multiple metal co-exposure. Most of the plasma metal concentrations were within the literature reported reference values, whereas the concentration of lead and nickel exceeded the guideline value. We found that plasma concentrations of aluminum, arsenic, barium, lead, molybdenum, rubidium, strontium, vanadium and zinc were significantly associated with the decline in kidney function measured by annual eGFR decline, rapid renal function decline (defined as an annual decline in eGFR ≥ 5 mL/min/1.73 m2) or incident eGFR < 60 mL/min/1.73 m2, with the adjusted beta coefficients (95% CI) for annual eGFR decline 0.50 (0.30, 0.69), 0.98 (0.74, 1.23), 0.56 (0.32, 0.79), 0.21 (0.03, 0.39), 0.35 (0.16, 0.54), 0.94 (0.71, 1.17), 0.37 (0.15, 0.60), 0.78 (0.54, 1.02), and 0.74 (0.57, 0.91), respectively. The metals exposures were linked with increased risks of impaired kidney function. Associations of principal components representing these metals with the decline in kidney function were significant and suggest a possible additional health risk by co-exposure. Participants engaged in manufacturing had higher plasma levels of several metals compared with those who had been involved in management- or administration-related work. Our findings suggest that exposure to multiple metals contribute to the decline in kidney function among the middle-aged and elderly. Co-exposure to multiple metals may have synergetic effect on the kidney function. Further studies are warranted to confirm our findings and clarify the potential mechanisms.
•We evaluated the associations of multiple plasma metals with kidney function decline.•We found significant positive associations between arsenic and lead levels with kidney function decline.•We also identified significant associations between other metals (zinc, rubidium, etc.) with kidney function.
This article presents an overview of the concept of social capital, reviews prospective multilevel analytic studies of the association between social capital and health, and discusses intervention ...strategies that enhance social capital.
We conducted a systematic search of published peer-reviewed literature on the PubMed database and categorized studies according to health outcome.
We identified 13 articles that satisfied the inclusion criteria for the review. In general, both individual social capital and area/workplace social capital had positive effects on health outcomes, regardless of study design, setting, follow-up period, or type of health outcome. Prospective studies that used a multilevel approach were mainly conducted in Western countries. Although we identified some cross-sectional multilevel studies that were conducted in Asian countries, including Japan, no prospective studies have been conducted in Asia.
Prospective evidence from multilevel analytic studies of the effect of social capital on health is very limited at present. If epidemiologic findings on the association between social capital and health are to be put to practical use, we must gather additional evidence and explore the feasibility of interventions that build social capital as a means of promoting health.
•Post-COVID syndrome requires, besides symptoms, comprehensive organ damage assessment.•Post-covid syndrome is not limited to severe acute COVID19 patients.•Symptoms are mostly mild, improve with ...time, and with no identified predictors.•Radiological and spirometric changes are mild and observed in 25% of patients.•Our findings contribute to efficiently designing follow-up plans for COVID patients.
This study aims to analyze the incidence of Post-acute COVID-19 syndrome (PCS) and its components, and to evaluate the acute infection phase associated risk factors.
A prospective cohort study of adult patients who had recovered from COVID-19 (27th February to 29th April 2020) confirmed by PCR or subsequent seroconversion, with a systematic assessment 10–14 weeks after disease onset. PCS was defined as the persistence of at least one clinically relevant symptom, or abnormalities in spirometry or chest radiology. Outcome predictors were analyzed by multiple logistic regression (OR; 95%CI).
Two hundred seventy seven patients recovered from mild (34.3%) or severe (65.7%) forms of SARS-CoV-2 infection were evaluated 77 days (IQR 72–85) after disease onset. PCS was detected in 141 patients (50.9%; 95%CI 45.0–56.7%). Symptoms were mostly mild. Alterations in spirometry were noted in 25/269 (9.3%), while in radiographs in 51/277 (18.9%). No baseline clinical features behaved as independent predictors of PCS development.
A Post-acute COVID-19 syndrome was detected in a half of COVID19 survivors. Radiological and spirometric changes were mild and observed in less than 25% of patients. No baseline clinical features behaved as independent predictors of Post-acute COVID-19 syndrome development.
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This study aimed to describe cardiopulmonary function during exercise 3 months after hospital discharge for COVID-19 and compare groups according to dyspnoea and intensive care unit (ICU) stay.
...Participants with COVID-19 discharged from five large Norwegian hospitals were consecutively invited to a multicentre, prospective cohort study. In total, 156 participants (mean age 56.2 years, 60 females) were examined with a cardiopulmonary exercise test (CPET) 3 months after discharge and compared with a reference population. Dyspnoea was assessed using the modified Medical Research Council (mMRC) dyspnoea scale.
Peak oxygen uptake (
'
) <80% predicted was observed in 31% (n=49). Ventilatory efficiency was reduced in 15% (n=24), while breathing reserve <15% was observed in 16% (n=25). Oxygen pulse <80% predicted was found in 18% (n=28). Dyspnoea (mMRC ≥1) was reported by 47% (n=59). These participants had similar
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(p=0.10) but lower mean±sd
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·kg
% predicted compared with participants without dyspnoea (mMRC 0) (76±16%
89±18%; p=0.009) due to higher body mass index (p=0.03). For ICU-
non-ICU-treated participants, mean±sd
'
% predicted was 82±15% and 90±17% (p=0.004), respectively. Ventilation, breathing reserve and ventilatory efficiency were similar between the ICU and non-ICU groups.
One-third of participants experienced
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<80% predicted 3 months after hospital discharge for COVID-19. Dyspnoeic participants were characterised by lower exercise capacity due to obesity and lower ventilatory efficiency. Ventilation and ventilatory efficiency were similar between ICU- and non-ICU-treated participants.
Surgery is the standard of care for T1bN0M0 esophageal squamous cell carcinoma (ESCC), whereas chemoradiotherapy (CRT) is a treatment option. This trial aimed to investigate the noninferiority of CRT ...relative to surgery for T1bN0M0 ESCC.
Clinical T1bN0M0 ESCC patients were eligible for enrollment in this prospective nonrandomized controlled study of surgery versus CRT. The primary endpoint was overall survival, which was determined using inverse probability weighting with propensity scoring. Surgery consisted of an esophagectomy with 2- or 3-field lymph node dissection. CRT consisted of 2 courses of 5-fluorouracil (700 mg/m2) on days 1–4 and cisplatin (70 mg/m2) on day 1 every 4 weeks with concurrent radiation (60 Gy).
From December 20, 2006 to February 5, 2013, a total of 368 patients were enrolled in the nonrandomized portion of the study. The patient characteristics in surgery arm and CRT arm, respectively, were as follows: median age, 62 and 65 years; proportion of males, 82.8% and 88.1%; and proportion of performance status 0, 99.5% and 98.1%. Comparisons were made using the nonrandomized groups. The 5-year overall survival rate was 86.5% in the surgery arm and 85.5% in the CRT arm (adjusted hazard ratio, 1.05; 95% confidence interval, 0.67–1.64 <1.78). The complete response rate in the CRT arm was 87.3% (95% confidence interval, 81.1–92.1). The 5-year progression-free survival rate was 81.7% in the surgery arm and 71.6% in the CRT arm. Treatment-related deaths occurred in 2 patients in the surgery arm and none in the CRT arm.
CRT is noninferior to surgery and should be considered for the treatment of T1bN0M0 ESCC.
Based on more than 5 years of follow-up of JCOG0502, chemoradiotherapy showed comparable 5-year survival with surgery and should be considered a treatment option for treating T1bN0M0 esophageal squamous cell carcinoma.
The standard curative treatment for patients with esophageal cancer is perioperative chemotherapy or preoperative chemoradiotherapy followed by open transthoracic esophagectomy (OTE). Robot-assisted ...minimally invasive thoracolaparoscopic esophagectomy (RAMIE) may reduce complications.
A single-center randomized controlled trial was conducted, assigning 112 patients with resectable intrathoracic esophageal cancer to either RAMIE or OTE. The primary endpoint was the occurrence of overall surgery-related postoperative complications (modified Clavien-Dindo classification grade 2-5).
Overall surgery-related postoperative complications occurred less frequently after RAMIE (59%) compared to OTE (80%) risk ratio with RAMIE (RR) 0.74; 95% confidence interval (CI), 0.57-0.96; P = 0.02. RAMIE resulted in less median blood loss (400 vs 568 mL, P <0.001), a lower percentage of pulmonary complications (RR 0.54; 95% CI, 0.34-0.85; P = 0.005) and cardiac complications (RR 0.47; 95% CI, 0.27-0.83; P = 0.006) and lower mean postoperative pain (visual analog scale, 1.86 vs 2.62; P < 0.001) compared to OTE. Functional recovery at postoperative day 14 was better in the RAMIE group RR 1.48 (95% CI, 1.03-2.13; P = 0.038) with better quality of life score at discharge mean difference quality of life score 13.4 (2.0-24.7, p = 0.02) and 6 weeks postdischarge mean difference 11.1 quality of life score (1.0-21.1; P = 0.03). Short- and long-term oncological outcomes were comparable at a medium follow-up of 40 months.
RAMIE resulted in a lower percentage of overall surgery-related and cardiopulmonary complications with lower postoperative pain, better short-term quality of life, and a better short-term postoperative functional recovery compared to OTE. Oncological outcomes were comparable and in concordance with the highest standards nowadays.
Background:
Prospective studies have reported that abnormal movement patterns at the trunk, hip, and knee are associated with noncontact anterior cruciate ligament (ACL) injuries. Impaired hip ...strength may underlie these abnormal movement patterns, suggesting that diminished hip strength may increase the risk of noncontact ACL injury.
Purpose:
To determine whether baseline hip strength predicts future noncontact ACL injury in athletes.
Study Design:
Case-control study; Level of evidence, 3.
Methods:
Before the start of the competitive season, isometric hip strength (external rotation and abduction) was measured bilaterally by use of a handheld dynamometer in 501 competitive athletes (138 female and 363 male athletes) participating in various sports. During the sport season, ACL injury status was recorded, and injured athletes were further classified based on the mechanism of injury (noncontact vs contact). After the season, logistic regression was used to determine whether baseline hip strength predicted future noncontact ACL injury. Receiver operating characteristic (ROC) curves were constructed independently for each strength measure to determine the clinical cutoff value between a high-risk and low-risk outcome.
Results:
A total of 15 noncontact ACL injuries were confirmed (6 females, 9 males), for an overall annual incidence of 3.0% (2.5% for males, 4.3% for females). Baseline hip strength measures (external rotation and abduction) were significantly lower in injured athletes compared with noninjured athletes (P = .003 and P < .001, respectively). Separate logistic regression models indicated that impaired hip strength increased future injury risk (external rotation: odds ratio OR = 1.23 95% CI, 1.08-1.39, P = .001; abduction: OR = 1.12 95% CI, 1.05-1.20, P = .001). Clinical cutoffs to define high risk were established as external rotation strength ≤20.3% BW (percentage of body weight) or abduction strength ≤35.4% BW.
Conclusion:
Measures of preseason isometric hip abduction and external rotation strength independently predicted future noncontact ACL injury status in competitive athletes. The study data suggest that screening procedures to assess ACL injury risk should include an assessment of isometric hip abduction and/or external rotation strength.
In our study, we aimed to assess the long‐term risk of gastric cardia adenocarcinoma (GCA) for patients with different histological cardia lesions to inform future guidelines for GCA screening in ...China. We conducted a population‐based prospective study among 9740 subjects who underwent upper endoscopy screening during 2005 to 2009 and followed until December 2017. Cumulative incidence and mortality rates of GCA were calculated by the baseline histological diagnoses, and the hazard ratios (HRs), overall and by age and sex, were analyzed by Cox proportional hazards models. During a median follow‐up of 10 years, we identified 123 new GCA cases (1.26%) and 31 GCA deaths (0.32%). The age‐standardized incidence and mortality rates of GCA were 128.71/100 000 and 35.69/100 000 person‐years, and cumulative incidence rate in patients with cardia high‐grade dysplasia (CHGD), cardia low‐grade dysplasia (CLGD) and atrophic carditis (AC)/cardia intestinal metaplasia (CIM) was 25%, 3.05% and 1.58%, respectively. The progression rate and cancer risk of GCA increased monotonically with each step in Correa's cascade. Individuals aged 50 to 69 years had 4.4 times higher GCA incidence than those aged 40 to 49 years. Patients with CLGD had a significantly higher 3‐year GCA incidence than the normal group, while patients with AC/CIM had a comparable GCA risk during 3‐year follow‐up but a higher risk at 5‐year intervals. Our results suggested a postponed starting age of 50 years for GCA screening, immediate treatment for patients with CHGD, a 3‐year surveillance interval for patients with CLGD, and a lengthened surveillance interval of 5 years for patients with AC/CIM.
The objective of this pilot study was to investigate the potential for long-term overall survival (OS) after liver transplantation for colorectal liver metastases (CLMs).
Patients with nonresectable ...CLMs have poor prognosis, and few survive beyond 5 years. CLMs are currently considered an absolute contraindication for liver transplantation, although liver transplantation for primary and some secondary liver malignancies shows excellent outcome in selected patients. Before 1995, several liver transplantations for CLMs were performed, but outcome was poor (5-year survival rate: 18%) and liver transplantation for CLMs was abandoned. Since then, the survival rate after liver transplantation in general has improved by almost 30%. On the basis of this, a 5-year survival rate of about 50% after liver transplantation for CLMs could be anticipated.
In a prospective pilot study, liver transplantation for nonresectable CLMs was performed (n = 21). Main inclusion criteria were liver-only CLMs, excised primary tumors, and at least 6 weeks of chemotherapy.
Kaplan-Meier estimates of the OS rate at 1, 3, and 5 years were 95%, 68%, and 60%, respectively. Metastatic recurrence of disease was common (mainly pulmonary). However, a significant proportion of the recurrences were accessible for surgery, and at follow-up (after median of 27 months; range, 8-60), 33% had no evidence of disease. Hepatic tumor load before liver transplantation, time from primary surgery to liver transplantation, and progressive disease on chemotherapy were identified as significant prognostic factors.
OS exceeds by far reported outcome for chemotherapy, which is the only treatment option available for this patient group. Furthermore, OS is comparable with liver resection for resectable CLMs and survival after repeat liver transplantation for nonmalignant diseases. Selection strategies based on prognostic factors may further improve the outcome (ClinicalTrials.gov: NCT01311453).
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