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BACKGROUND AND AIMS: The objective of this study is to determine the diagnostic accuracy of the American College of Radiology Contrast-Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System LR-5 characterization for HCC diagnosis in North American or European patients. APPROACH AND RESULTS: A prospective multinational cohort study was performed from January 2018 through November 2022 at 11 academic and nonacademic centers in North America and Europe. Patients at risk for HCC with at least 1 liver observation not previously treated, identified on ultrasound (US), or multiphase CT or MRI performed as a part of standard clinical care were eligible for the study. All participants were examined with CEUS of the liver within 4 weeks of CT/MRI or tissue diagnosis to characterize up to 2 liver nodules per participant using ACR CEUS Liver Imaging Reporting and Data System. Definite HCC diagnosis on the initial CT/MRI, imaging follow-up, or histology for CT/MRI-indeterminate nodules were used as reference standards. A total of 545 nodules had confirmed reference standards in 480 patients, 73.8% were HCC, 5.5% were other malignancies, and 20.7% were nonmalignant. The specificity of CEUS LR-5 for HCC was 95.1% (95% CI 90.1%-97.7%), sensitivity 62.9% (95% CI 57.9%-67.7%), positive predictive value 97.3% (95% CI 94.5%-98.7%), and negative predictive value 47.7% (95% CI 41.7%-53.8%). In addition, benign CEUS characterization (LR-1 or LR-2) had 100% specificity and 100% positive predictive value for nonmalignant liver nodules. CONCLUSIONS: CEUS Liver Imaging Reporting and Data System provides an accurate categorization of liver nodules in participants at risk for HCC.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/patología , Neoplasias Hepáticas/patología , Estudios Prospectivos , Estudios de Cohortes , Medios de Contraste , Estudios Retrospectivos , Reproducibilidad de los Resultados , Imagen por Resonancia Magnética/métodos , Europa (Continente) , América del Norte , Sensibilidad y EspecificidadRESUMEN
The American College of Radiology Liver Imaging Reporting and Data System (LI-RADS) standardizes the imaging technique, reporting lexicon, disease categorization, and management for patients with or at risk for hepatocellular carcinoma (HCC). LI-RADS encompasses HCC surveillance with US; HCC diagnosis with CT, MRI, or contrast-enhanced US (CEUS); and treatment response assessment (TRA) with CT or MRI. LI-RADS was recently expanded to include CEUS TRA after nonradiation locoregional therapy or surgical resection. This report provides an overview of LI-RADS CEUS Nonradiation TRA v2024, including a lexicon of imaging findings, techniques, and imaging criteria for posttreatment tumor viability assessment. LI-RADS CEUS Nonradiation TRA v2024 takes into consideration differences in the CEUS appearance of viable tumor and posttreatment changes within and in close proximity to a treated lesion. Due to the high sensitivity of CEUS to vascular flow, posttreatment reactive changes commonly manifest as areas of abnormal perilesional enhancement without washout, especially in the first 3 months after treatment. To improve the accuracy of CEUS for nonradiation TRA, different diagnostic criteria are used to evaluate tumor viability within and outside of the treated lesion margin. Broader criteria for intralesional enhancement increase sensitivity for tumor viability detection. Stricter criteria for perilesional enhancement limit miscategorization of posttreatment reactive changes as viable tumor. Finally, the TRA algorithm reconciles intralesional and perilesional tumor viability assessment and assigns a single LI-RADS treatment response (LR-TR) category: LR-TR nonviable, LR-TR equivocal, or LR-TR viable.
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Carcinoma Hepatocelular , Medios de Contraste , Neoplasias Hepáticas , Ultrasonografía , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/radioterapia , Carcinoma Hepatocelular/diagnóstico por imagen , Carcinoma Hepatocelular/radioterapia , Ultrasonografía/métodos , Sistemas de Información Radiológica , Hígado/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Background The independent contribution of each Liver Imaging Reporting and Data System (LI-RADS) CT or MRI ancillary feature (AF) has not been established. Purpose To evaluate the association of LI-RADS AFs with hepatocellular carcinoma (HCC) and malignancy while adjusting for LI-RADS major features through an individual participant data (IPD) meta-analysis. Materials and Methods Medline, Embase, Cochrane Central Register of Controlled Trials, and Scopus were searched from January 2014 to January 2022 for studies evaluating the diagnostic accuracy of CT and MRI for HCC using LI-RADS version 2014, 2017, or 2018. Using a one-step approach, IPD across studies were pooled. Adjusted odds ratios (ORs) and 95% CIs were derived from multivariable logistic regression models of each AF combined with major features except threshold growth (excluded because of infrequent reporting). Liver observation clustering was addressed at the study and participant levels through random intercepts. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2. Results Twenty studies comprising 3091 observations (2456 adult participants; mean age, 59 years ± 11 [SD]; 1849 [75.3%] men) were included. In total, 89% (eight of nine) of AFs favoring malignancy were associated with malignancy and/or HCC, 80% (four of five) of AFs favoring HCC were associated with HCC, and 57% (four of seven) of AFs favoring benignity were negatively associated with HCC and/or malignancy. Nonenhancing capsule (OR = 3.50 [95% CI: 1.53, 8.01]) had the strongest association with HCC. Diffusion restriction (OR = 14.45 [95% CI: 9.82, 21.27]) and mild-moderate T2 hyperintensity (OR = 10.18 [95% CI: 7.17, 14.44]) had the strongest association with malignancy. The strongest negative associations with HCC were parallels blood pool enhancement (OR = 0.07 [95% CI: 0.01, 0.49]) and marked T2 hyperintensity (OR = 0.18 [95% CI: 0.07, 0.45]). Seventeen studies (85%) had a high risk of bias. Conclusion Most LI-RADS AFs were independently associated with HCC, malignancy, or benignity as intended when adjusting for major features. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Crivellaro in this issue.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Tomografía Computarizada por Rayos X/métodos , Hígado/diagnóstico por imagen , Sistemas de Información Radiológica , Persona de Mediana Edad , MasculinoRESUMEN
BACKGROUND: Higher diet quality has been associated with lower risk of developing inflammatory bowel disease, but associations between diet and gastrointestinal (GI) inflammation in healthy adults prior to disease onset are understudied. OBJECTIVES: The purpose of this project was to examine associations between reported dietary intake and markers of GI inflammation in a healthy adult human cohort. METHODS: In a cross-sectional observational trial of 358 healthy adults, participants completed ≤3 unannounced 24-h dietary recalls using the Automated Self-Administered Dietary Assessment Tool and a Block 2014 Food Frequency Questionnaire to assess recent and habitual intake, respectively. Those who provided a stool sample were included in this analysis. Inflammation markers from stool, including calprotectin, neopterin, and myeloperoxidase, were measured by ELISA along with LPS-binding protein from plasma. RESULTS: Recent and habitual fiber intake was negatively correlated with fecal calprotectin concentrations (n = 295, P = 0.011, 0.009). Habitual soluble fiber intake was also negatively correlated with calprotectin (P = 0.01). Recent and habitual legume and vegetable intake was negatively correlated with calprotectin (P = 0.013, 0.026, 0.01, 0.009). We observed an inverse correlation between recent Healthy Eating Index (HEI) scores and calprotectin concentrations (n = 295, P = 0.026). Dietary Inflammatory Index scores were calculated and positively correlated with neopterin for recent intake (n = 289, P = 0.015). When participants with clinically elevated calprotectin were excluded, recent and habitual fiber, legume, vegetable, and fruit intake were negatively correlated with calprotectin (n = 253, P = 0.00001, 0.0002, 0.045, 0.001, 0.009, 0.001, 0.004, 0.014). Recent total HEI score was inversely correlated with subclinical calprotectin (P = 0.003). CONCLUSIONS: Higher diet quality may be protective against GI inflammation even in healthy adults. This trial was registered at clinicaltrials.gov as NCT02367287.
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Dieta , Frutas , Adulto , Humanos , Estados Unidos , Estudios Transversales , Neopterin , Verduras , Inflamación , Complejo de Antígeno L1 de LeucocitoRESUMEN
BACKGROUND: Polyphenols are dietary bioactive compounds, many of which have anti-inflammatory properties. However, information on the intake of dietary polyphenols at the class and compound level and their associations with gastrointestinal (GI) and systemic inflammation is lacking. OBJECTIVE: Estimate dietary polyphenol intake in healthy adults and examine its relationship with GI and systemic inflammation markers. METHODS: Healthy adults (n = 350) completed the USDA Nutritional Phenotyping Study, an observational, cross-sectional study balanced for age, sex, and body mass index. Dietary intake, assessed via multiple 24-hour recalls, was ingredientized and mapped to FooDB, a comprehensive food composition database. Dietary polyphenol intake (total, class, compound) was estimated and examined for its relationship to GI and systemic inflammation markers using linear models and random forest regressions. RESULTS: Mean total polyphenol intake was approximately 914 mg/1000 kcal per day with flavonoids as the greatest class contributor (495 mg/1000 kcal per day). Tea, coffee, and fruits were among the largest food contributors to polyphenol intake. Total polyphenol intake negatively associated with the GI inflammation marker, fecal calprotectin (ß=-0.004, p=0.04). At the class level, polyphenols categorized as prenol lipids (ß=-0.94, p<0.01) and phenylpropanoic acids (ß=-0.92, p<0.01) negatively associated with plasma lipopolysaccharide-binding protein, a proxy for GI permeability. Food sources of these two classes included mainly olive products. We further detected a positive association between C-Reactive protein and polyphenols in the "cinnamic acids and derivatives" class using hierarchical feature engineering and random forest modeling. CONCLUSION: Even in healthy adults, dietary polyphenol intake was negatively associated with GI inflammation and intake of prenol lipids and phenylpropanoic acids were negatively associated with GI permeability. Relationships between polyphenol intake and inflammatory outcomes varied with the resolution - total, class, compound - of polyphenol intake, suggesting a nuanced impact of polyphenols on GI and systemic inflammation. CLINICAL TRIAL REGISTRY: NCT02367287, ClinicalTrials.gov.
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Marital quality shares ties to inflammatory conditions like cardiovascular disease and diabetes. For decades, research has focused on marital conflict as a primary mechanism given its potential to trigger inflammatory responses. However, longitudinal evidence suggests that marital conflict declines over time, and little attention has been paid to the inflammatory aftermath of other types of marital exchanges. A spouse's emotional distress is an important but overlooked marital context, as partners are exposed to each other's upsetting emotions throughout adulthood. To directly compare reactivity in proinflammatory gene expression to these two marital stressors and to examine differences by age and marital satisfaction, 203 community adults ages 25-90 (N = 102 couples) provided blood samples and rated their negative mood before and after they 1) watched their partner relive an upsetting personal memory and, in a separate visit 1-2 weeks later, 2) discussed a conflictual topic in their relationship. Controlling for age, sex, race/ethnicity, BMI, alcohol use, smoking, and comorbidities, increases in proinflammatory gene expression were significantly larger after the partner's upsetting disclosure than after marital conflict (B = 0.073, SE = 0.031, p = .018). This pattern paralleled emotional reactivity to the tasks, wherein negative mood rose more in response to the partner's disclosure than to marital conflict (B = 4.305, SE = 1.468, p = .004). In sum, proinflammatory and mood reactivity to spousal distress exceeded reactivity to marital conflict, a well-established marital stressor. Findings reveal spousal distress as a novel mechanism that may link marriage to inflammation-related diseases, and even pose risks for both happy and unhappy couples across adulthood.
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Conflicto Familiar , Inflamación , Matrimonio , Esposos , Estrés Psicológico , Humanos , Femenino , Masculino , Persona de Mediana Edad , Conflicto Familiar/psicología , Adulto , Anciano , Esposos/psicología , Estrés Psicológico/psicología , Estrés Psicológico/inmunología , Matrimonio/psicología , Inflamación/inmunología , Inflamación/psicología , Anciano de 80 o más Años , Satisfacción Personal , Emociones/fisiología , Distrés Psicológico , Afecto/fisiologíaRESUMEN
Multiple myeloma (MM) is an incurable cancer and is the leading indication for autologous hematopoietic stem cell transplantation (HSCT). To be eligible for HSCT, a patient must have a caregiver, as caregivers play a central role in HSCT preparation and recovery. MM patients remain on treatment indefinitely, and thus patients and their caregivers face long-term challenges including the intensity of HSCT and perpetual therapy after transplant. Importantly, both patients and their caregivers show heightened depressive and anxiety symptoms, with dyadic correspondence evidenced and caregivers' distress often exceeding that of patients. An extensive psychoneuroimmunology (PNI) literature links distress with health via immune and neuroendocrine dysregulation as well as biological aging. However, data on PNI in the context of multiple myeloma - in patients or caregivers - are remarkably limited. Distress in MM patients has been associated with poorer outcomes including higher inflammation, greater one year post-HSCT hospital readmissions, and worse overall survival. Further, anxiety and depression are linked to biological aging and may contribute to the poor long-term health of both patients and caregivers. Because MM generally affects older adults, individual differences in biological aging may represent an important modifier of MM biology and HSCT treatment outcomes. There are a number of clinical scenarios in which biologically younger people could be prescribed more intensive therapies, with potential for greater benefit, by using a personalized cancer therapy approach based on the quantification of physiologic reserve. Further, despite considerable psychological demands, the effects of distress on health among MM caregivers is largely unexamined. Within this context, the current critical review highlights gaps in knowledge at the intersection of HSCT, inflammation, and biological aging in the context of MM. Research in this area hold promise for opportunities for novel and impactful psychoneuroimmunology (PNI) research to enhance health outcomes, quality of life, and longevity among both MM patients and their caregivers.
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Ansiedad , Cuidadores , Depresión , Trasplante de Células Madre Hematopoyéticas , Mieloma Múltiple , Psiconeuroinmunología , Trasplante Autólogo , Humanos , Trasplante de Células Madre Hematopoyéticas/psicología , Trasplante de Células Madre Hematopoyéticas/métodos , Mieloma Múltiple/inmunología , Mieloma Múltiple/psicología , Mieloma Múltiple/terapia , Cuidadores/psicología , Depresión/inmunología , Depresión/psicología , Estrés Psicológico/inmunología , Estrés Psicológico/psicología , Envejecimiento/inmunología , Envejecimiento/psicología , Calidad de Vida/psicologíaRESUMEN
BACKGROUND: Young people (YP) with long-term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions. METHODS: Twenty-six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3. RESULTS: Participants preferred a mobile phone app (73% agreement) and a mixture of one-on-one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement). CONCLUSION: There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one-to-one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention. IMPLICATIONS: The results will be important to consider for a future intervention, although further consultation will be needed for app development. PATIENT OR PUBLIC CONTRIBUTION: Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan.
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Emociones , Salud Mental , Niño , Humanos , Adolescente , Consenso , Técnica Delphi , Ansiedad/terapiaRESUMEN
OBJECTIVES: Reporting contrast-enhanced ultrasound (CEUS) for focal liver masses in at risk patients is a challenging task. Traditionally used prose reporting (PR) is inconsistent and lacks standardization. We propose synoptic reporting (SR), encompassing algorithmic interpretation and liver imaging and reporting data system (LI-RADS) categorization. METHODS: A software worksheet from Kailo Medical (Melbourne, AU), incorporates the CEUS algorithm for liver interpretation and CEUS LI-RADS categorization. Part 1. Feasibility of SR: twenty participants of varying experience were presented a brief lecture on SR, algorithmic approach to liver mass interpretation, and CEUS LI-RADS categorization. Ten representative liver masses were shown as unknown cases. Participants inputted data into SR worksheets. Results and LI-RADS category were generated solely by SR. Data were categorized as "correct" or "incorrect." Part 2. Prospective Analysis: Ninety-one patients for SR and 56 for PR, all were tested for completeness, efficiency, and user satisfaction. RESULTS: Part 1: Junior participants, pass rate 81.6%, and senior participants, pass rate 83.3% showed no difference in performance. Part 2: Completeness: SR 98.4% and PR 87.0%. Efficiency: Average total time to completion: SR 11 minutes and PR 20 minutes. User satisfaction: Ultrasound technologists, all referring physicians, and six out of seven radiologists preferred SR over PR. Major benefits cited were total time saved, consistency and accuracy in documentation, and report completeness. CONCLUSIONS: SR is a reliable and useful tool in clinical practice to report liver masses on ultrasound and assign an appropriate LI-RADS categorization and management pathway. This ultimately improves communication with referring clinicians and leads to better patient outcomes.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Estudios Prospectivos , Medios de Contraste , Tomografía Computarizada por Rayos X/métodos , Imagen por Resonancia Magnética/métodos , Estudios RetrospectivosRESUMEN
BACKGROUND: Accessibility of data visualization has been explored for users with visual disabilities but the needs of users with language disabilities have seldom been considered. AIM: This scoping review synthesised what is known about data visualization for adults with language disabilities, specifically the acquired language disability, aphasia and Developmental Language Disorder. It sought to extract key findings and identify what practices support effective visualization for decision making for people with language disabilities. METHOD: Papers were included if they investigated visualization of data, and the consumers of the data visualization were people with aphasia or developmental language disability. Seven databases were searched: CINAHL, Academic Search, Medline, PsychINFO, Ovid, ACM Digital Library and IEEE Xplore. Included studies were charted to extract title, author(s), year, country, paper type, scientific field, participant number(s), participant group(s), main topic, subtopic, method, task description, task category, data visualization, summary, key findings relevant to the review question, and guidelines or recommendations. Narrative synthesis was used to describe how people with language disability have interacted with data visualization from a range of literature. MAIN CONTRIBUTION: Six studies (seven publications) were included in the review. One study came from the field of health, one from a disability rights collaboration and four studies from computer science. No studies satisfying the review criteria explored data visualization for Developmental Language Disorder; however, five studies explored participants with cognitive disabilities that included impairments of language, so these were included. A range of visualization designs were found. Studies predominantly explored understanding of visualization (4/6). One study explored how to express data visually, and one explored the use of the visualization that is, for an action, choice, or decision. Cognitively accessible data visualization practices were described in four papers and synthesized. Supportive practices reported were reducing the cognitive load associated with processing a visualization and increasing personal relevance of data visualization. CONCLUSION: Accessible data visualization for adults with aphasia and Developmental Language Disorder has only minimally been explored. Practices to specifically support users with language disability are not yet apparent. As data use in making everyday decisions is widespread, future research should explore how people with language disabilities make use of data visualization. WHAT THIS PAPER ADDS: What is already known on this subject Visual resources are used widely to support people with language disabilities in understanding of language. That is, icons, maps timelines and so forth, are used to support auditory processing. However, data visualization is used routinely by people without a language disability to support everyday decisions for example, visualization of live traffic data is used to provide users with the best route to their destination. It is unclear whether any work has explored data visualization for people with language disabilities. What this paper adds to existing knowledge This paper brings together research on the use of data visualization by adults with either Developmental Language Disorder or aphasia, collectively people with language disabilities. It highlights a gap in the design of inclusive data visualization for language disabilities and the minimal research exploring the use of data visualization for decision making in these populations. What are the clinical implications of this work? Access to data can be empowering. It has potential to enable agency in decisions and increase social participation. The existing gap in knowledge about how to design inclusive data visualization for people with language disabilities thus poses a risk of exclusion and threats to informed decision making. Highlighting the current field of literature may drive research and clinical activity.
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Sandy sediment beaches covering 70% of non-ice-covered coastlines are important ecosystems for nutrient cycling along the land-ocean continuum. Subterranean estuaries (STEs), where groundwater and seawater meet, are hotspots for biogeochemical cycling within sandy beaches. The STE microbial community facilitates biogeochemical reactions, determining the fate of nutrients, including nitrogen (N), supplied by groundwater. Nitrification influences the fate of N, oxidising reduced dissolved inorganic nitrogen (DIN), making it available for N removal. We used metabarcoding of 16S rRNA genes and quantitative PCR (qPCR) of ammonia monooxygenase (amoA) genes to characterise spatial and temporal variation in STE microbial community structure and nitrifying organisms. We examined nitrifier diversity, distribution and abundance to determine how geochemical measurements influenced their distribution in STEs. Sediment microbial communities varied with depth (p-value = 0.001) and followed geochemical gradients in dissolved oxygen (DO), salinity, pH, dissolved inorganic carbon and DIN. Genetic potential for nitrification in the STE was evidenced by qPCR quantification of amoA genes. Ammonia oxidiser abundance was best explained by DIN, DO and pH. Our results suggest that geochemical gradients are tightly linked to STE community composition and nitrifier abundance, which are important to determine the fate and transport of groundwater-derived nutrients to coastal waters.
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Ecosistema , Arena , Sedimentos Geológicos , ARN Ribosómico 16S/genética , Nitrógeno , AmoníacoRESUMEN
Relative sea level rise (SLR) increasingly impacts coastal ecosystems through the formation of ghost forests. To predict the future of coastal ecosystems under SLR and changing climate, it is important to understand the physiological mechanisms underlying coastal tree mortality and to integrate this knowledge into dynamic vegetation models. We incorporate the physiological effect of salinity and hypoxia in a dynamic vegetation model in the Earth system land model, and used the model to investigate the mechanisms of mortality of conifer forests on the west and east coast sites of USA, where trees experience different form of sea water exposure. Simulations suggest similar physiological mechanisms can result in different mortality patterns. At the east coast site that experienced severe increases in seawater exposure, trees loose photosynthetic capacity and roots rapidly, and both storage carbon and hydraulic conductance decrease significantly within a year. Over time, further consumption of storage carbon that leads to carbon starvation dominates mortality. At the west coast site that gradually exposed to seawater through SLR, hydraulic failure dominates mortality because root loss impacts on conductance are greater than the degree of storage carbon depletion. Measurements and modeling focused on understanding the physiological mechanisms of mortality is critical to reducing predictive uncertainty.
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Ecosistema , Tracheophyta , Agua de Mar , Árboles , CarbonoRESUMEN
OBJECTIVE: Social stress-loneliness, isolation, and low relationship quality-increase risks for aging-related diseases. However, the ways in which they intersect to undermine healthy aging remain poorly understood. We utilized latent class analysis to identify groups of older adults based on their social stress in both the United States and Mexico. Thereafter, we examined their cross-sectional associations with markers of functional and biological aging. METHOD: Participants in the Health and Retirement Study (HRS, N = 8,316) and Mexican Health and Aging Study (MHAS, N = 15,001) reported their loneliness, isolation (i.e., living alone), and relationship quality with spouse, children, and friends. Outcomes included C-reactive protein (CRP), functional limitations, self-rated health, comorbidities, gait speed, and grip strength. Models controlled for demographics, health behaviors, and body mass index (BMI). RESULTS: In both countries, five classes emerged, a Supported group and four with elevated social stress: (1) Strained, (2) Isolated, (3) Spousal Ambivalence, and (4) Unhappily Married. Compared to the others, Strained participants in both samples had greater functional limitations, poorer self-rated health, and more comorbidities, as well as slower gait in HRS and weaker grip in MHAS. Generally, Supported participants fared better than the other groups. In HRS, CRP levels differed between the Strained group and others, but these associations were explained by health behaviors and BMI. CONCLUSIONS: Older adults in both countries with strained relationships fared worst in their aging-related outcomes, revealing new insights about the links between toxic social stress and unhealthy aging.
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OBJECTIVE: Depression can promote inflammation and accelerate aging. Metformin, a widely prescribed antidiabetic, has shown promising preclinical evidence of aging-related health benefits, including decreased inflammation. The current study examined whether metformin usage buffers the association between depressive symptoms and inflammatory markers in two large samples of middle-aged and older, primarily white adults, and older Latino adults. METHODS: Data from the Midlife in the United States Study (MIDUS; N = 1255) and the Sacramento Area Latino Study on Aging (SALSA; N = 1786) included information on medication use, depressive symptoms, and inflammatory markers, namely IL-6, TNF-α, and CRP. These data were merged into a harmonized sample, and the sample group variable was included in a three-way interaction for analysis. RESULTS: Specifically, in the MIDUS sample, metformin buffered the association between depressive symptoms and CRP (b = -0.029, SE = 0.013, p = .007) and IL-6 (b = 0.21, SE = 0.010, p = .046), while no significant association was found with TNF-α. Metformin non-users displayed higher depressive symptoms associated with elevated CRP (b = 0.01, SE = 0.003, p < .001) and IL-6 (b = 0.011, SE = 0.003, p < .001), whereas this association was not present among metformin users (ps > .068). Conversely, in the SALSA sample, metformin use did not show a significant protective link. CONCLUSION: Results from mostly white, highly educated adults supported a mitigating role of metformin in ties between depression, a well-known behavioral risk factor, and inflammation, a key source of biological aging. However, the benefits did not extend to a large sample of older Mexican Americans. The findings reveal a hidden potential benefit of this therapeutic agent and raise important questions around its health equity.Trial Registration: The study was pre-registered on OSF (https://osf.io/c92vw/).
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OBJECTIVE: Conflict poses multiple relational and health risks. Dyadic stress theories suggest satisfaction and communication alter cardiovascular and autonomic function, key pathways from troubled relationships to poor health. However, "we-talk," a positive communication pattern, can strengthen relationships and promote health. We examined how each spouse's satisfaction and we-talk were related to conflict's physiological, relational, and emotional toll. METHODS: Married couples ( n = 107 couples, 214 individuals, ages 40-87 years) who were mostly White, highly educated, and higher-income Americans in different-gender relationships engaged in 20-minute conflict discussions while wearing monitors to assess heart rate variability (HRV). Spouses rated their closeness immediately after conflict and their conflict rumination 2 hours later. Conflict transcriptions measured we-talk, or the proportion of first-person plural pronouns (we, us, our). RESULTS: Satisfied spouses or those in mutually satisfying relationships had higher HRV during conflict ( b = 0.0001, p = .049), felt closer immediately after conflict ( b = 0.07, p < .001), and ruminated less about the conflict 2 hours later ( b = -0.26, p = .026). Spouses' HRV was highest ( b = 0.0002, p = .002) and rumination was lowest ( b = -0.49, p = .019) when they or their partners were satisfied and used we-talk more often. Women's HRV ( b = 0.0001, p = .035) and rumination ( b = -0.01, p = .02) benefited when both spouses were satisfied, as did closeness when women were satisfied ( b = 0.10, p < .001). Men's closeness benefited when they ( b = 0.04, p = .003) or their wives ( b = 0.04, p = .002) were satisfied. CONCLUSIONS: The combination of mutually satisfying relationships and we-talk was associated with better relational and health outcomes after conflict. These findings are important for middle-aged and older couples whose relationships are central to their health.
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Promoción de la Salud , Matrimonio , Persona de Mediana Edad , Masculino , Humanos , Femenino , Anciano , Adulto , Anciano de 80 o más Años , Matrimonio/psicología , Esposos/psicología , Emociones , Frecuencia CardíacaRESUMEN
OBJECTIVE: In long-term relationships, conflict is inevitable, but physical and psychological aggression is not. Intimate partner violence (IPV) is a known risk factor for age-related disease onset, and inflammation likely links the two. This study explores relationships between frequency of constructive (i.e., negotiation) and destructive (i.e., aggression) conflict tactics with inflammation in both younger and older adulthood. Based on the theory of inflammaging, the study investigates whether these associations were stronger in mid-to-late adulthood. METHODS: At one visit, 214 participants in long-term romantic relationships had their blood drawn to assess six inflammatory markers (interleukin-6, IL-6; tumor necrosis factor-alpha, TNF-α; c-reactive protein, CRP; serum amyloid A, SAA; soluble intercellular adhesion molecule, sICAM; soluble vascular cell adhesion molecule, sVCAM) and reported frequency of destructive and constructive conflict tactics with their partner in the past year on the Revised Conflict Tactics Scale short form. RESULTS: Age interacted with number of destructive conflicts per year to predict serum IL-6 (F(1, 200) = 5.3, p = .022), TNF-α (F(1, 180) = 4.2, p = .043), sICAM (F(1, 193) = 7.0, p = .008), and marginally SAA (F(1, 199) = 3.7, p = .055), such that middle-aged and older adults who reported more destructive tactics had higher inflammation. Also, the relationship between constructive conflict frequency and TNF-α also depended on age (F(1, 177) = 4.9, p = .029), in that older adults who reported a greater number of constructive tactics had lower TNF-α. CONCLUSION: Couples' conflict tactics may influence levels of inflammation, and, therefore, aging rate, in mid-to-late life. Middle-aged and older adults may disproportionately benefit from a healthy partnership and suffer from an unhealthy partnership.
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OBJECTIVE: To investigate the impact of a road safety programme on adolescents' willingness to engage in risky behaviour as probationary drivers, adjusted for covariates of interest. METHOD: The bstreetsmart is a road safety programme delivered to around 25 000 adolescent students annually in New South Wales. Using a smartphone-based app, student and teacher participation incentives, students were surveyed before and after programme attendance. Mixed-methods linear regression analysed pre/post-modified Behaviour of Young Novice Driver (BYNDS_M) scores. RESULTS: 2360 and 1260 students completed pre-event and post-event surveys, respectively. Post-event BYNDS_M scores were around three points lower than pre-event scores (-2.99, 95% CI -3.418 to -2.466), indicating reduced intention to engage in risky driving behaviours. Covariates associated with higher stated intentions of risky driving were exposure to risky driving as a passenger (1.21, 95% CI 0.622 to 2.011) and identifying as non-binary gender (2.48, 95% CI 1.879 to 4.085), adjusting for other predictors. CONCLUSIONS: Trauma-informed, reality-based injury prevention programmes can be effective in changing short-term stated intentions to engage in risky driving, among a pre-independent driving student population. The adolescent novice driver age group is historically challenging to engage, and injury prevention action must be multipronged to address the many factors influencing their behaviour.
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Conducción de Automóvil , Intención , Humanos , Adolescente , Accidentes de Tránsito/prevención & control , Asunción de Riesgos , Encuestas y CuestionariosRESUMEN
OBJECTIVES: In high-BMI patients with and without fatty liver, we evaluate performance of a commercially available specially designed ultrasound probe (SDP) for scanning at depth. Greyscale and contrast-enhanced ultrasound (CEUS) capability of SDP for parenchymal assessment and liver mass characterization, emphasizing HCC, is compared with standard curvilinear probes. METHODS: This retrospective study included 60 patients. Fifty-five with measured BMI included 46/55 (84%) overweight or obese, and 9/55(16%) in the normal range with severe fatty liver. Fifty-six patients with focal liver abnormality included 37 with a mass and 19 with post-ablative treatment site. Masses included 23 confirmed malignancies, 15 HCC, 4 ICC, and 4 metastases. SDP followed suboptimal ultrasound using a standard probe. Images with varying fat content were compared for depth of penetration on greyscale and ability of CEUS to diagnose tumors. RESULTS: SDP showed statistically significant improvement P = <.05 in CEUS penetration for all degrees of fatty liver (mild, moderate, and severe). In malignant tumors, SDP improved detection of lesion washout in the portal venous/late phase (PVP/LP) at depth >10 cm, and in all malignant masses (P < .05). Fifteen confirmed deep HCC showed arterial phase hyperenhancement on standard probe in 10/15 (67%) and 15/15 (100%) on SDP. PVP/LP washout on standard probe was shown in 4/15 (26%) and on SDP, 14/15, (93%). Therefore, 93% of LR-5 tumors were diagnosed with SDP. Removing necessity for biopsy. CONCLUSIONS: Metabolic syndrome and obesity challenge ultrasound, especially CEUS. SDP overcame limitations of standard probes for CEUS penetration especially in fatty liver. SDP was optimal for the liver mass characterization by detecting washout.
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OBJECTIVES: Following positive surveillance ultrasound (US), magnetic resonance imaging (MRI) is recommended for further characterization. We propose contrast-enhanced ultrasound (CEUS) shows equivalent efficacy. METHODS: This prospective institutional review board approved study recruited 195 consecutive at-risk patients with a positive surveillance US. All had CEUS and MRI. Biopsy (n = 44) and follow-up are gold standard. MRI and CEUS results are classified according to liver imaging reporting and data system (LI-RADS) and patient outcome. RESULTS: As an US-based modality, CEUS is superior in confirming findings from surveillance US, correlation in 189/195 (97%) on CEUS compared to 153/195 (79%) on MRI. Within these negative MRI examinations, there are 2 hepatocellular carcinoma (HCC) and 1 cholangiocarcinoma (iCCA) diagnosed on CEUS and proven by biopsy. From 195 patients, there are 71 malignant diagnoses from all sources, including 58 LR-5 (45 on MRI and 54 on CEUS) and 13 others, including HCC outside of LR-5 category, and LR-M with biopsy proven iCCA (3 on MRI and 6 on CEUS). CEUS and MRI show concordant results in the majority of patients (146/195, 75%), including 57/146 malignant and 89/146 benign diagnoses. There are 41/57 concordant LR-5 and 6/57 concordant LR-M. When CEUS and MRI are discordant, CEUS upgraded 20 (10 biopsy-proven) from MRI LR-3/4 to CEUS LR-5 or LR-M by showing washout (WO) that MRI failed to show. Additionally, CEUS characterized time and intensity of WO and diagnosed 13/20 LR-5 by showing late and weak WO and 7 LR-M by showing fast and marked WO. CEUS is 81% sensitive and 92% specific in diagnosing malignancy. MRI is 64% sensitive and 93% specific. CONCLUSIONS: CEUS performance is at least equivalent if not superior to MRI for initial evaluation of lesions from surveillance US.
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Neoplasias de los Conductos Biliares , Carcinoma Hepatocelular , Neoplasias Hepáticas , Humanos , Carcinoma Hepatocelular/diagnóstico por imagen , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/patología , Estudios Prospectivos , Estudios Retrospectivos , Medios de Contraste , Ultrasonografía/métodos , Imagen por Resonancia Magnética/métodos , Conductos Biliares Intrahepáticos/patología , Sensibilidad y EspecificidadRESUMEN
Marital discord fuels depression, according to decades of research. Most prior studies in this area have focused on macro-longitudinal change in depression over the course of years, and on global ratings of marital satisfaction. Less work has examined fluctuations in depressed mood and marital discord in daily life, and none has investigated associations of short-term patterns with longer-term depressed mood and marital outcomes. Using data from participants in the Midlife in the U.S. (MIDUS) project, the current study examined daily associations between marital discord and depressed mood, as well as their links to concurrent and prospective patterns of past-month depressed mood and marital risk. Results showed that, on average, depressed mood rose on days when individuals had an argument or tension with their spouse (i.e., marital discord). More frequent daily marital discord was also associated with greater past-month depressed mood and marital risk, above and beyond prior levels. Those with larger depressive mood responses to discord in daily life (i.e., greater reactivity) exhibited higher concurrent past-month depressed mood and greater 10-year increases in depressed mood. As the first study to link daily marital patterns to concurrent and prospective changes in depressed mood and marital outcomes, this investigation uncovered two novel processes-daily marital discord and depressive reactivity-as important for understanding long-term patterns of marital risk and depression.