Factors Affecting Arterial Stiffness and Brachial-Ankle Pulse Wave Velocity in Patients With Type 2 Diabetes.

Background We defined the progression of atherosclerosis in patients by brachial-ankle pulse wave velocity (ba-PWV) and determined the relationship between ba-PWV and body composition factors, muscle strength, and patient characteristics. Methodology The arterial stiffness index, body composition, anthropometric parameters, blood test data, and background factors were evaluated in 109 patients with type 2 diabetes mellitus (T2DM). Statistical analysis was conducted using logistic regression analysis and analysis of covariance (p < 0.05). Results The mean age of the participants was 62.87 ± 12.11 years, body mass index (BMI) was 25.72 ± 4.35 kg/m², ba-PWV was 1653.08 ± 366.55 cm/s, systolic blood pressure was 138.87 ± 16.74 mmHg, the number of years of disease was 11.17 ± 9.51 years, and hemoglobin A1c value was 6.90 ± 0.74%. Binomial logistic regression analysis of ba-PWV divided into two groups by arterial stiffness index, ≥ (or <) 1,400 cm/s, showed systolic blood pressure (odds ratio = 1.11, 95% confidence interval = 1.05-1.18, p < 0.001), BMI, and number of years of disease were significant independent variables. The cut-off value for BMI was 26.28 kg/m². BMI was a significant explanatory factor for ba-PWV in the analysis of covariance (p < 0.001). Conclusion BMI was associated with the incidence of atherosclerosis in patients with T2DM. We proposed a cut-off value for BMI below which the atherosclerosis index increased, a result that may reflect the influence of the metabolic paradox.

Strong Subseasonal Variability of Oxic Methane Production Challenges Methane Budgeting in Freshwater Lakes.

Methane (CH4) accumulation in the well-oxygenated lake epilimnion enhances the diffusive atmospheric CH4 emission. Both lateral transport and in situ oxic methane production (OMP) have been suggested as potential sources. While the latter has been recently supported by increasing evidence, quantifying the exact contribution of OMP to atmospheric emissions remains challenging. Based on a large high-resolution field data set collected during 2019-2020 in the deep stratified Lake Stechlin and on three-dimensional hydrodynamic modeling, we improved existing CH4 budgets by resolving each component of the mass balance model at a seasonal scale and therefore better constrained the residual OMP. All terms in our model showed a large temporal variability at scales from intraday to seasonal, and the modeled OMP was most sensitive to the surface CH4 flux estimates. Future efforts are needed to reduce the uncertainties in estimating OMP rates using the mass balance approach by increasing the frequency of atmospheric CH4 flux measurements.

Red Wine Consumption and the Impact on Cardiovascular Health: The Methodological Barriers of Observational Study Design.

Cardiovascular disease (CVD) is the leading cause of death among communicable and noncommunicable diseases, and its prevalence is going to rise even more by 2030. The discovery of different "functional" foods containing a plethora of bioactive compounds is considered an ally in the effort to reduce the global CVD burden in the context of primary prevention. It has been about 3 decades since the observation that red wine consumption in French population could lead to lower coronary heart disease risk despite the high dietary consumption of saturated fats, known as the "French paradox." Since then, numerous epidemiological studies, mainly observational, have emerged in order to investigate this association with great enthusiasm. However, due to the nature of these studies, the scientific community has raised concerns about the methodological approach of the studies and thus the generalization of their results. Therefore, the current review aims to summarize some of the major methodological issues deriving from observational studies on the association between red wine consumption and cardiovascular health and to highlight the importance of higher quality study design in the general effort of drawing safer conclusions on this topic.

Hyperbaric oxygen therapy in the ATLS/ACLS resuscitative management of acutely ill or severely injured patients with severe anemia: a review.

For short periods, even without the presence of red blood cells, hyperbaric oxygen can safely allow plasma to meet the oxygen delivery requirements of a human at rest. By this means, hyperbaric oxygen, in special instances, may be used as a bridge to lessen blood transfusion requirements. Hyperbaric oxygen, applied intermittently, can readily avert oxygen toxicity while meeting the body's oxygen requirements. In acute injury or illness, accumulated oxygen debt is shadowed by adenosine triphosphate debt. Hyperbaric oxygen efficiently provides superior diffusion distances of oxygen in tissue compared to those provided by breathing normobaric oxygen. Intermittent application of hyperbaric oxygen can resupply adenosine triphosphate for energy for gene expression and reparative and anti-inflammatory cellular function. This advantageous effect is termed the hyperbaric oxygen paradox. Similarly, the normobaric oxygen paradox has been used to elicit erythropoietin expression. Referfusion injury after an ischemic insult can be ameliorated by hyperbaric oxygen administration. Oxygen toxicity can be averted by short hyperbaric oxygen exposure times with air breaks during treatments and also by lengthening the time between hyperbaric oxygen sessions as the treatment advances. Hyperbaric chambers can be assembled to provide everything available to a patient in modern-day intensive care units. The complication rate of hyperbaric oxygen therapy is very low. Accordingly, hyperbaric oxygen, when safely available in hospital settings, should be considered as an adjunct for the management of critically injured or ill patients with disabling anemia.

Why the Fermi paradox may not be well explained by Wong and Bartlett's theory of civilization collapse. A Comment on: 'Asymptotic burnout and homeostatic awakening: a possible solution to the Fermi paradox?' (2022) by Wong and Bartlett.

Wong and Bartlett explain the Fermi paradox by arguing that neither human nor extra-terrestrial civilizations can escape the time window singularity which, they claim, results from the way in which social characteristics of civilizations follow super-linear growth curves of cities. We question if data at the city level necessarily can lead to conclusions at the civilization level. More specifically, we suggest ways in which learnings from research, foresight, diversity and effective future government might act outside of their model to regulate super-linear growth curves of civilizations, and thus substantively increase the likelihood of civilizations progressing towards higher levels of the Kardashev scale. Moreover, we believe their claimed history of the collapse of terrestrial societies used to evidence their model is difficult to justify. Overall, we cast reasonable doubt on the ability of their proposed model to satisfactorily explain the Fermi paradox.

Unraveling the Obesity Paradox: Exploring the Impact of Body Weight on Cutaneous Melanoma Prognosis in Asian Population.

Background: Obesity has been identified as a significant risk factor for various diseases, including certain cancers; however, its association with melanoma remains a subject of debate. Despite the increasing incidence of cutaneous melanoma in Taiwan, there has been limited research on its correlation with obesity. This study aims to investigate the relationship between obesity and the prognosis of cutaneous melanoma in Taiwan. Methods: Between January 1, 2000, and December 31, 2022, 201 patients were diagnosed with cutaneous melanoma at our hospital, with 61.69% of them diagnosed with acral melanoma. Data on body weight, height, tumor stages and prognosis were collected and analyzed. Results: The result revealed that older age (≥ 65 years old), male, advanced Breslow thickness stage (T3 and T4) and tumor ulceration were identified as risk factors for worse overall survival in both cutaneous melanoma and acral melanoma. In the adjusted multivariable analysis, being overweight was considered a protective factor in both cutaneous and acral melanoma. Conclusion: Contrary to expectations, it was observed that melanoma patients with obesity exhibited better survival rates compared to those with normal or underweight status. Additionally, no significant differences were found between acral melanoma and non-acral melanoma subtypes regarding the impact of body weight on overall survival.

Empirical Bayes Methods, Evidentialism, and the Inferential Roles They Play.

Empirical Bayes-based Methods (EBM) is an increasingly popular form of Objective Bayesianism (OB). It is identified in particular with the statistician Bradley Efron. The main aims of this paper are, first, to describe and illustrate its main features and, second, to locate its role by comparing it with two other statistical paradigms, Subjective Bayesianism (SB) and Evidentialism. EBM's main formal features are illustrated in some detail by schematic examples. The comparison between what Efron calls their underlying "philosophies" is by way of a distinction made between confirmation and evidence. Although this distinction is sometimes made in the statistical literature, it is relatively rare and never to the same point as here. That is, the distinction is invariably spelled out intra- and not inter-paradigmatically solely in terms of one or the other accounts. The distinction made in this paper between confirmation and evidence is illustrated by two well-known statistical paradoxes: the base-rate fallacy and Popper's paradox of ideal evidence. The general conclusion reached is that each of the paradigms has a basic role to play and all are required by an adequate account of statistical inference from a technically informed and fine-grained philosophical perspective.

A Synergistic Perspective on Multivariate Computation and Causality in Complex Systems.

What does it mean for a complex system to "compute" or perform "computations"? Intuitively, we can understand complex "computation" as occurring when a system's state is a function of multiple inputs (potentially including its own past state). Here, we discuss how computational processes in complex systems can be generally studied using the concept of statistical synergy, which is information about an output that can only be learned when the joint state of all inputs is known. Building on prior work, we show that this approach naturally leads to a link between multivariate information theory and topics in causal inference, specifically, the phenomenon of causal colliders. We begin by showing how Berkson's paradox implies a higher-order, synergistic interaction between multidimensional inputs and outputs. We then discuss how causal structure learning can refine and orient analyses of synergies in empirical data, and when empirical synergies meaningfully reflect computation versus when they may be spurious. We end by proposing that this conceptual link between synergy, causal colliders, and computation can serve as a foundation on which to build a mathematically rich general theory of computation in complex systems.

Epilimnetic oligotrophication increases contribution of oxic methane production to atmospheric methane flux from stratified lakes.

Although considerable attention has been paid to the effects of eutrophication on aquatic methane (CH4) emissions to the atmosphere, the ecosystem-level effects of oligotrophication/re-oligotrophication on aquatic CH4 production and subsequent ecological responses remain to be elucidated. It has been hypothesized that dissolved inorganic phosphorus (DIP)-deficient conditions drive the ecosystem to utilize poorly bioavailable organic phosphorus for biomass formation, thereby generating CH4 as a by-product. To test this hypothesis, a mass balance approach was used to estimate in situ oxic methane production (OMP) in an oligotrophic, deep Lake Fuxian. The isotopic signature of dissolved 13C-CH4, the potential substrates for OMP, and the phnJ/phnD genes associated with microbial demethylation of organic phosphorus compounds were analyzed. Our results indicate that CH4 accumulation was maximal in the surface mixed layer (SML, i.e., Epilimnion) during lake stratification, and ∼ 86 % of the total CH4 flux to the atmosphere was due to OMP. Decomposition of methylphosphonate (MPn) by Alphaproteobacteria (genera Sphingomonas and Mesorhizobium) contributed significantly to OMP. Furthermore, water temperature (Temp), chlorophyll a (Chla), and DIP were the most critical predictors of water OMP potential. Meta-analysis of currently available global data showed that OMP had a negative exponential distribution with DIP (OMP = 2.0 e-0.71DIP, R2 = 0.57, p < 0.05). DIP concentrations below a threshold of 3.40 ∼ 9.35 µg P L-1 triggered OMP processes and increased the atmospheric CH4 emissions. Under future warming scenarios, stratification and catchment management induced oligotrophication or re-oligotrophication may systematically affect the biogeochemical cycling of phosphorus and the OMP contribution to CH4 emission in stratified lakes.

Gender Stereotypes About Career and Family Are Stronger in More Economically Developed Countries and Can Explain the Gender Equality Paradox.

Using data from Project Implicit collected between 2005 and 2020, comprising 1,489,721 observations in 111 countries, we find that implicit and explicit gender stereotypes about career and family are more pronounced in more economically developed countries. Besides, these gender stereotypes are strongly correlated at the country level with gender differences in values (such as family values), self-reported personality traits (such as agreeableness or dependence), and occupational preferences (such as health-related occupations), and may account for the fact that these gender imbalances are "paradoxically" stronger in more economically developed countries (the so-called "gender equality paradox").In line with social role theory, our findings suggest that there are in developed countries strong gender stereotypes about career and family, which may at least partly explain the persistence or even the "paradoxical worsening" of a number of gender differences in these countries, despite generally high levels of gender equality in other areas.

Spatial nonstationarity and the role of environmental metal exposures on COVID-19 mortality in New Mexico.

Worldwide, the COVID-19 pandemic has been influenced by a combination of environmental and sociodemographic drivers. To date, population studies have overwhelmingly focused on the impact of societal factors. In New Mexico, the rate of COVID-19 infection and mortality varied significantly among the state's geographically dispersed, and racially and ethnically diverse populations who are exposed to unique environmental contaminants related to resource extraction industries (e.g. fracking, mining, oil and gas exploration). By looking at local patterns of COVID-19 disease severity, we sought to uncover the spatially varying factors underlying the pandemic. We further explored the compounding role of potential long-term exposures to various environmental contaminants on COVID-19 mortality prior to widespread applications of vaccinations. To illustrate the spatial heterogeneity of these complex associations, we leveraged multiple modeling approaches to account for spatial non-stationarity in model terms. Multiscale geographically weighted regression (MGWR) results indicate that increased potential exposure to fugitive mine waste is significantly associated with COVID-19 mortality in areas of the state where socioeconomically disadvantaged populations were among the hardest hit in the early months of the pandemic. This relationship is paradoxically reversed in global models, which fail to account for spatial relationships between variables. This work contributes both to environmental health sciences and the growing body of literature exploring the implications of spatial nonstationarity in health research.

Occlusion of functional high-volume intra-atrial shunts in older patients after embolic stroke of undetermined source.

Background: Intra-atrial shunts are associated with an elevated risk of embolic stroke of undetermined source (ESUS). Percutaneous occluder implantation is recommended as secondary prevention in younger patients. This study aims to compare the outcome after shunt occlusion between younger and older patients with a history of presumed paradox embolism and to evaluate the impact of high-volume shunting in an elderly population. Methods: We conducted a single-center, retrospective, observational study, involving 187 patients who underwent interventional percutaneous PFO or ASD occlusion at our center between 2013 and 2023. Results: The mean age of participants was 51.8 ± 11.8 years, with 76 patients aged ≤50 years and 111 patients aged >50 years. Older patients presented more cardiovascular risk factors. The presence of atrial septum aneurysm or large shunting was evenly distributed (ASA 26.3% vs. 28.8%, p = 0.833, mean shunt defect size 6.67 vs. 7.23 mm, p = 0.151). There were no significant differences in procedural or intrahospital complications. The event rate during the 6-month follow-up was low. Recurrence of arterial embolism occurred in 1.6% of the younger and 3.8% of the older patients (p = 0.817). Comparison of high-volume shunts (defect size ≥10 mm or passage ≥20 bubbles during bubble study) with low-volume shunts in this elderly cohort with a mean age ≥50 years showed no significant difference in outcomes. There was a statistically non-significant trend toward a higher rate of residual shunt at the end of the procedure in the high-volume shunt group (2.9% vs. 9.8%, p = 0.0894). This difference was not observed at the 6-month follow-up anymore (14.5 vs. 12.1%, p = 0.628). Two unsuccessful implantation attempts were reported in the high-volume shunt group, while none were observed in the low-volume shunt group (p = 0.372). No intervention-related deaths occurred in this patient cohort during follow-up. Conclusion: Occlusion of relevant, intra-atrial shunting is a safe and effective option for secondary prevention of cryptogenic embolism in patients over 50 years of age. The beneficial outcome was irrespective of a high-volume shunting before implantation.

The obesity paradox exists in Asia: A systematic review and meta-analysis of body mass index effects on clinical outcomes following percutaneous coronary intervention in Asia.

Cardiovascular diseases (CVDs) are major contributors to illness and death globally. Body mass index (BMI) is a well-established prognostic factor on cardiovascular risk outcome. Numerous investigations have provided evidence for the existence of the obesity paradox after percutaneous coronary intervention (PCI). However, the association between BMI and the results following PCI has not been extensively investigated in Asian populations. The research aims to fill the current void in understanding by investigating the association between BMI and clinical consequences following PCI, with a particular focus on Asian individuals. A systematic search was conducted through PubMed, ScienceDirect, and Cochrane Library to identify studies examining the effect of BMI on clinical outcome after PCI in Asia. R Studio 4.3.2 software was used to carry out the analysis of the data. A total of 182,110 patients who had gone through PCI were found in the 5 included cohorts. A meta-analysis conducted on the subjects revealed that patients who were overweight (odds ratio [OR] = 0.60, 95% confidence interval [CI] [0.57, 0.63], P < 0.0001) had a lower risk of all-cause mortality compared to individuals with a healthy weight and patients with obesity (OR = 0.65, 95% CI [0.41, 1.05], P = 0.006) had a lower risk of all-cause mortality than healthy weight individuals. The study also found that overweight patients (OR = 0.60, 95% CI [0.39, 0.91], P = 0.02) had a lower risk of cardiac mortality. In addition, obese patients (OR = 0.41, 95% CI [0.19, 0.88], P = 0.02) had a lower risk of noncardiac mortality. However, the study found that there were no differences in major adverse cardiovascular event, myocardial infarction, and bleeding between all patient groups. This meta-analysis supports the presence of an obesity paradox after PCI in Asian populations. The obesity paradox was evident in all-cause mortality, cardiac mortality, and noncardiac mortality.

Stephen Hawking's Warning on Contacting Aliens: A Physics Perspective on the Intelligence Trap.

The search for extraterrestrial intelligence is a fascinating and important endeavor, but it raises significant ethical and safety concerns. In the search for extraterrestrial intelligence, scientists use knowledge of physics to identify potential communication methods and signals that may be used by extraterrestrial civilizations. One of the most notable scientists to highlight these concerns was the late physicist Stephen Hawking, who cautioned that actively attempting to communicate with extraterrestrial civilizations could harm humanity. While it is true that we cannot predict the intentions of any potential extraterrestrial civilizations, some scientists argue that the potential advantages of seeking contact outweigh the potential risks. Deciding to initiate contact with extraterrestrial civilizations is a complex issue that requires balancing scientific curiosity with concerns for our own safety. The "Intelligence Trap" is a concept in psychology that suggests that highly intelligent people are more susceptible to cognitive biases and flawed thinking than less intelligent people. It can be argued that Hawking's warnings may be an example of the so-called intelligence trap, as some evidence from the field of physics suggests. Nonetheless, Hawking emphasized that it is crucial for scientists and policymakers to carefully weigh the potential risks and benefits of such efforts and proceed with caution.

The risks and benefits of managing obesity in older adults.

DISCLAIMER: In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: This review discusses weight loss considerations in overweight and obese older adults. SUMMARY: Current US guidelines do not address weight loss in older adults. Waist circumference rather than body mass index (BMI) may be a more accurate assessment tool for obesity in older adults. Weight loss interventions are not recommended in overweight older adults due to the decreased mortality in this population (known as the "obesity paradox"). While weight loss in obese older adults may be beneficial, it is not without risks. The greatest risks include loss of muscle mass, decline in bone mineral density, and development of sarcopenic obesity. Weight loss interventions may be considered in older adults with a BMI of greater than 30 kg/m2 who have metabolic derangements, cardiovascular disease, and/or functional impairments after carefully weighing the risks against the benefits of weight loss and the impact of interventions on the patient's quality of life. Medicare provides limited benefits for weight loss interventions. In older adults, there is no consensus on which lifestyle interventions are best for weight loss and there is a paucity of data on the use of weight loss medications. Careful consideration should be given before utilizing medications for weight loss in older adults given the enhanced adverse effect profiles, interactions, contraindications, and costs. CONCLUSION: Weight loss in older adults should be approached differently from that in the general adult population. More data are needed on the efficacy and safety of weight loss medications in older adults.

Staging Paradox and recurrence pattern among stage IIB, IIC, and IIIA Colon cancers: a retrospective cohort study.

PURPOSE: The survival rates of patients with stage IIB and IIC colon cancer are paradoxically inferior to that of patients with stage IIIA colon cancer. This study aimed to examine the oncological outcomes and investigate the factors that could affect the staging paradox among stage IIB, IIC, and IIIA colon cancers based on a 9-year cancer database. METHODS: Patients with stage IIB (pT4aN0M0), IIC (pT4bN0M0), or IIIA (pT1-2N1M0) colon cancer were retrospectively selected from a prospectively maintained medical database from January 2011 to December 2019. Factors that might influence the staging paradox, including radicality, harvested lymph nodes, and chemotherapy administration, were examined. RESULTS: A total of 282 patients (stage IIB, n = 59; stage IIC, n = 46; and stage IIIA, n = 177) were enrolled. Patients with stage IIB/C cancer demonstrated higher carcinoembryonic antigen levels, larger tumor size, more frequent tumor obstruction, and higher locoregional recurrence than those with stage IIIA cancer. With respect to 10-year locoregional recurrence-free survival and cancer-specific survival, patients with stage IIB and IIC cancers had significantly lower survival rates than did those with stage IIIA cancer (73.7% vs. 66.3% vs. 91.2%, P = 0.0003; 5.4% vs. 10.9% vs. 11.2%, P = 0.0023). The staging paradox persisted in patients who underwent R0 resection, had harvested lymph nodes ≥ 12, and received chemotherapy, as confirmed by multivariate regression analysis. CONCLUSIONS: Based on the inferior oncological outcomes and higher locoregional recurrence rate, this study highlighted the need for intensified cytotoxic chemotherapy specific to this recurrence pattern for patients with stage IIB/C colon cancer.

Impact of smoking on procedural outcomes and all-cause mortality following acute myocardial infarction: A misleading early-stage pseudoparadox with ultimately reduced survival.

Background: Smoking has conflicting results on outcomes following acute myocardial infarction (AMI). We evaluated the independent influence of smoking status on patient outcomes. Methods: We included patients with AMI undergoing invasive coronary angiography with available self-reported smoking status. The incidence of death of any cause was evaluated during a median follow-up of 1.14 years (range 0.36-3.40 years). Association between smoking status and long-term mortality was evaluated using multivariable adjusted Cox regression analysis. Results: From 1612 AMI patients (aged 65.7 ± 13.3 years, 72.1 % male), 378 patients (23.4 %) were current-smokers, 311 (19.3 %) ex-smokers, and 923 (57.3 %) non-smokers. Compared with non-smokers, current-smokers were younger (68.5 ± 13.0 vs. 58.6 ± 12.5, p < 0.0001) and more frequently presented with STEMI (21.6 % vs. 35,4 %, p < 0.0001), while ex-smokers with similar frequency of STEMI-manifestation as non-smokers (22.5 %, p = 0.79) constituted an intermediate-group in terms of age (65.8 ± 11,6 years). Although smoking status was not significantly associated with long-term survival in unadjusted-analysis, active-smokers had 56 % higher long-term mortality than non-smokers when adjusting for age, gender, medications and other traditional risk factors, whereas ex-smokers possessed comparable survival probability (current-smokers: 1.56[1.14-2.14], p = 0.006, ex-smokers 1.16[0.84-1.59], p = 0.37). Current-smokers had unadjusted lower NT-proBNP and modestly higher absolute in-hospital left ventricular global longitudinal strain (LV GLS) values that did not differ among groups after the same adjustments (NT-proBNP: -0.08[-0.31; 0.15], p = 0.5, LV GLS: 0.65[-0.26; 1.55], p = 0.16). Conclusion: Active smoking is associated with increased adjusted long-term mortality, earlier onset and more frequent manifestation as STEMI, compared to non-smoking. Comparable adjusted results for LV GLS and NT-proBNP between groups support the presence of the pseudoparadox.

Is there an obesity paradox in cardiovascular outcomes for patients undergoing Transcatheter Edge-to-Edge Repair? A pilot meta-analysis.

Background: The impact of body mass index (BMI) on Transcatheter Edge-to-Edge Repair (TEER) outcomes remains uncertain, with studies showing conflicting results. Some suggest an 'obesity paradox' exists, favoring better outcomes for obese patients and worse outcomes for underweight patients, while others report no significant impact of BMI. Methodology: We systematically searched major databases for studies on baseline BMI and post-procedural outcomes in TEER patients. Patients were grouped by BMI: underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥30 kg/m2). Data were pooled using a random-effects model, with risk ratios (RRs) and their 95 % confidence intervals (CIs) as effect measures. Statistical significance was set at p < 0.05. Results: Our study, analyzing five observational studies with 7580 obese and 74,717 non-obese patients, found no significant difference in in-hospital mortality between the groups (RR: 0.85; p = 0.427). Subgroup analysis indicated a higher mortality risk for underweight patients compared to overweight (RR: 1.48; p = 0.006) and obese patients (RR: 1.40; p = 0.036), though the difference between underweight and normal-weight patients was not significant (RR: 1.18; p = 0.216). The risks of myocardial infarction (RR: 1.10; p = 0.592) and stroke (RR: 0.43; p = 0.166) were also similar between obese and non-obese patients. Conclusions: In conclusion, our analysis found no significant difference in in-hospital mortality, myocardial infarction or stroke risk between obese and non-obese patients undergoing TEER. However, underweight patients may have a higher risk of in-hospital mortality compared to overweight and obese individuals, highlighting the potential impact of BMI on outcomes in TEER patients.

National Variation in Black Immigrant Preterm Births and the Role of County-Level Social Factors.

Preterm birth rates among Black individuals continue to be inequitably high in the USA. Black immigrants appear to have a preterm birth advantage over US-born counterparts. This national cross-sectional study of singleton non-Hispanic Black individuals in the USA from 2011 to 2018 aimed to investigate if the Black immigrant preterm birth advantage varied geographically and how this advantage associated with county-level social drivers of health. Generalized linear mixed models explored the odds of preterm birth (< 37 weeks) by birthing person's nativity, defined as US- versus foreign-born. In county-level analyses, five measures were explored as possible sources of structural risk for or resilience against preterm birth: percent of residents in poverty, percent uninsured, percent with more than a high school education, percent foreign-born, and racial polarization. County-level immigrant advantage among foreign-born compared to US-born Black individuals was defined by a disparity rate ratio (RR); RR < 1 indicated a county-level immigrant preterm birth advantage. Linear regression models at the level of counties quantified associations between county-level factors and disparity RRs. Among 4,072,326 non-Hispanic Black birthing individuals, immigrants had 24% lower adjusted odds of preterm birth compared to US-born Black individuals (aOR 0.77, 95% CI 0.76-0.78). In county-level analyses, the immigrant advantage varied across counties; disparity RRs ranged from 0.13 to 2.82. County-level lack of health insurance and education greater than high school were both associated with immigrant preterm birth advantage. Future research should explore policies within counties that impact risk of preterm birth for both US-born and immigrant Black individuals.

Systematic review and meta analysis of cross immunity and the smokers paradox in COVID19.

COVID-19 pandemic, caused by the novel SARS-CoV-2 virus, has raised significant interest in understanding potential cross-immunity mechanisms. Recent evidence suggests that T-cells associated with common cold coronaviruses (229E, NL63, OC43, HKU1) may provide some level of cross-immunity against SARS-CoV-2. It is also known that the prevalence of smokers among patients admitted to hospital for COVID-19 is lower than expected according to the corresponding country's smoking prevalence, which is known as smoker's paradox in COVID-19. No clear consensus to explain it has yet been reached. This phenomenon suggests a complex interaction between smoking and immune response. Nonetheless, very few works have studied the prevalence of smokers in those infected by common cold coronaviruses, and its relation to COVID-19 has not been investigated. We performed a systematic review and meta-analysis to study the prevalence of smokers among patients infected by common cold coronaviruses, and to compare them to the corresponding country's smoking prevalence. L'Abbé plots were used to visually assess the consistency of the observed effects across the different studies included in the meta-analysis. Additionally, significant differences were found in smoking prevalence among the various types of ccCoV, indicating the need for further research into the biological mechanisms driving these disparities. The results show that smoking prevalence is higher among those patients infected by these coronaviruses than in the general population (OR = 1.37, 95% CI: 0.81-2.33). A study was separately done for the four coronavirus types, and the prevalence of smokers was higher in three of the four than that corresponding to country, gender and study year: OC43 (OR = 1.93, 95% CI: 0.64-5.82); HKU1 (OR = 3.62, 95% CI: 1.21-10.85); NL63 (OR = 1.93, 95% CI: 0.64-5.82); 229E (OR = 0.97, 95% CI: 0.50-1.90). The heterogeneity of the studies was assessed using the Cochrane Chi-squared test, I-squared (I2), and Tau-squared (τ2). This detailed statistical analysis enhances the robustness of our findings and highlights the variations in smoking prevalence among different ccCoVs. Our data suggest that COVID-19 might be less prevalent among smokers due to greater cross-immunity from a larger number or more recent infections by common cold coronaviruses than the non-smoking population, which would explain smoker's paradox in COVID-19. IMPLICATIONS. The low prevalence of current smokers among SARS-CoV-2 patients is a finding recurrently repeated, even leading to postulate the "smoker's paradox" in COVID-19. This fact compelled us to study the prevalence of smokers among patients infected by common cold coronaviruses, and to compare them to the corresponding country's smoking prevalence. Our data could explain smoker's paradox in COVID-19 by a greater cross immunity due to a larger number, or more recent infections by common cold coronaviruses than the non-smoking population. This manuscript allow understand potential unrevealed mechanism for low prevalence of current smokers among SARS-CoV-2 patients.