Roles of serum uric acid on the association between arsenic exposure and incident metabolic syndrome in an older Chinese population.

Growing evidences showed that heavy metals exposure may be associated with metabolic diseases. Nevertheless, the mechanism underlying arsenic (As) exposure and metabolic syndrome (MetS) risk has not been fully elucidated. So we aimed to prospectively investigate the role of serum uric acid (SUA) on the association between blood As exposure and incident MetS. A sample of 1045 older participants in a community in China was analyzed. We determined As at baseline and SUA concentration at follow-up in the Yiwu Elderly Cohort. MetS events were defined according to the criteria of the International Diabetes Federation (IDF). Generalized linear model with log-binominal regression model was applied to estimate the association of As with incident MetS. To investigate the role of SUA in the association between As and MetS, a mediation analysis was conducted. In the fully adjusted log-binominal model, per interquartile range increment of As, the risk of MetS increased 1.25-fold. Compared with the lowest quartile of As, the adjusted relative risk (RR) of MetS in the highest quartile was 1.42 (95% confidence interval, CI: 1.03, 2.00). Additionally, blood As was positively associated with SUA, while SUA had significant association with MetS risk. Further mediation analysis demonstrated that the association of As and MetS risk was mediated by SUA, with the proportion of 15.7%. Our study found higher As was remarkably associated with the elevated risk of MetS in the Chinese older adults population. Mediation analysis indicated that SUA might be a mediator in the association between As exposure and MetS.

The construction and experimental verification of a 6-LncRNA model based on Lactic acid metabolism in the tumor microenvironment of Wilms tumor.

BACKGROUND: Lactic acid (LA) can promote the malignant progression of tumors through the crosstalk with the tumor microenvironment (TME). However, the function of long non-coding RNAs (lncRNAs) related to LA metabolism in Wilms tumor (WT) remains unclear. METHODS: Gene expression data and clinical data of WT patients were collected from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO). Through the ESTIMATE algorithm and Pearson correlation analysis, lncRNAs related to tumor immunity and LA metabolism were screened. Subsequently, Cox regression analysis and Lasso Cox regression analysis were used to construct a model. Furthermore, candidate genes were identified and a competitive endogenous RNA (ceRNA) network was conducted to explore the specific mechanism of characteristic genes. Finally, based on the strong clinical relevance of UNC5B-AS1, its expression and function were experimentally verified. RESULTS: The immune score and stromal score were found to be closely related to the prognosis of WT. Eventually, a prognostic model (TME-LA-LM) consisting of 6 lncRNAs was successfully identified. The model demonstrated favorable predictive ability and accuracy, with significant variation in immune infiltration and drug susceptibility observed between risk groups. Additionally, the study revealed the involvement of 2 candidate genes and 5 microRNAs (miRNAs) in the tumor's development. Notably, UNC5B-AS1 was highly expressed and found to promote the proliferation and migration of tumor cells. CONCLUSION: This study, for the first time, elucidated the prognostic signatures of WT using lncRNAs related to TME and LA metabolism. The fundings of this research offer valuable insights for future studies on immunotherapy, personalized chemotherapy and mechanism research.

Pristine/magnesium-loaded biochar and ZVI affect rice grain arsenic speciation and cadmium accumulation through different pathways in an alkaline paddy soil.

Cadmium (Cd) and arsenic (As) co-contamination has threatened rice production and food safety. It is challenging to mitigate Cd and As contamination in rice simultaneously due to their opposite geochemical behaviors. Mg-loaded biochar with outstanding adsorption capacity for As and Cd was used for the first time to remediate Cd/As contaminated paddy soils. In addition, the effect of zero-valent iron (ZVI) on grain As speciation accumulation in alkaline paddy soils was first investigated. The effect of rice straw biochar (SC), magnesium-loaded rice straw biochar (Mg/SC), and ZVI on concentrations of Cd and As speciation in soil porewater and their accumulation in rice tissues was investigated in a pot experiment. Addition of SC, Mg/SC and ZVI to soil reduced Cd concentrations in rice grain by 46.1%, 90.3% and 100%, and inorganic As (iAs) by 35.4%, 33.1% and 29.1%, respectively, and reduced Cd concentrations in porewater by 74.3%, 96.5% and 96.2%, respectively. Reductions of 51.6% and 87.7% in porewater iAs concentrations were observed with Mg/SC and ZVI amendments, but not with SC. Dimethylarsinic acid (DMA) concentrations in porewater and grain increased by a factor of 4.9 and 3.3, respectively, with ZVI amendment. The three amendments affected grain concentrations of iAs, DMA and Cd mainly by modulating their translocation within plant and the levels of As(III), silicon, dissolved organic carbon, iron or Cd in porewater. All three amendments (SC, Mg/SC and ZVI) have the potential to simultaneously mitigate Cd and iAs accumulation in rice grain, although the pathways are different.

Health conditions in land transport workers and climate change. Exploratory systematic review.

A systematic exploratory review was carried out to describe the influence of climate change on the health conditions of land transport drivers, both physical and mental. Additionally, actions for the prevention of these complications are described. For the review, several databases, such as Science Direct, MEDLINE, Springer, PubMed, Redalyc, EBSCO, SciELO, and Scopus, were examined. There was the need to extend the search timeframe from 5 years to 10 years. The studies found consisted mainly of review articles, showing an emphasis on public health and a high frequency of possible physical effects on the cardiovascular and respiratory systems. At the mental level, the presence of cases of anxiety, depression and stress were mentioned. As for alternatives for the prevention of these effects, the importance of creating public policies for health promotion and disease prevention was highlighted. It is important to increase scientific production in the field of occupational safety and health and applied studies.

Se realizó una revisión exploratoria sistemática con el fin de describir la influencia del cambio climático en las condiciones de salud de los conductores del transporte terrestre, a nivel físico y mental. Adicionalmente, se describen acciones para la prevención de estas complicaciones. Para la revisión, se examinaron diversas bases de datos, como Science Direct, MEDLINE, Springer, PubMed, Redalyc, EBSCO, SciELO y Scopus. Se identificó la necesidad de aumentar el rango de tiempo de la búsqueda, que pasó de 5 años a 10 años. Los estudios encontrados fueron principalmente de revisión y contaban con un énfasis en salud pública; además, se destacó una alta frecuencia de posibles efectos a nivel físico en los sistemas cardiovascular y respiratorio. A nivel mental, se planteó la presencia de casos de ansiedad, depresión y estrés. En cuanto a alternativas para la prevención de estos efectos, se resaltó la importancia de la creación de políticas públicas de promoción de la salud y prevención de la enfermedad. Es importante incrementar la producción científica en el campo de la seguridad y salud en el trabajo y de estudios aplicados.

Musculoskeletal disorders, associated factors, and literature review for intervention according to gender.

Introduction: The relationship of risk factors with musculoskeletal disorders and their intervention is a topic of interest, given their prevalence among workers. Thus, analyzing risk factors from approaches such as the gender perspective may be an alternative. Objectives: To analyze risk factors in a health entity with a high prevalence of musculoskeletal disorders in upper limbs and to describe possible intervention measures according to scientific evidence, from a gender perspective. Methods: This is an analytical study. A questionnaire was applied to 93 workers on demographic aspects, presence of factors related to the environment, the task, and the organization, extra-work activities related to musculoskeletal disorders in the upper limbs. Chi-square was used to identify significant relationships between the sex variable and individual, occupational, and non-occupational factors, corroborated by Fisher's test and prevalence ratio. According to the associations identified, a literature review was carried out to establish possible strategies. Results: Significant relationships were found between the sex variable and task-related factors such as the presence of repetitive or sudden movements (p < 0.05), supporting postulates of labor segregation. According to the literature consulted, the effectiveness of activities such as physical preparation and adaptation of the workplace under professional guidance, training activities, and breaks is discussed. It is important to review organizational factors. Conclusions: By identifying significant relationships between the sex variable and task-related factors, the present study contributes to the postulate of labor segregation, in terms of concentration of female labor in activities with particular working conditions. Regarding literature and actions, it is important to generate more studies from this perspective.

Introducción: La relación de factores de riesgo con desordenes musculoesqueléticos y su intervención es tema de interés, dada su prevalencia entre trabajadores. Así, analizar los factores de riesgo desde enfoques como la perspectiva de género puede ser una alternativa. Objetivos: Analizar factores de riesgo en una entidad sanitaria con alta prevalencia de desordenes musculoesqueléticos en miembros superiores y describir posibles medidas de intervención según evidencia científica, desde la perspectiva de género. Métodos: Éste es un estudio de tipo analítico. Se aplicó un cuestionario a 93 trabajadores sobre aspectos demográficos, presencia de factores relacionados con ambiente, tarea y organización, y actividades extralaborales vinculadas con desórdenes musculoesqueléticos en miembros superiores. Mediante chi cuadrado, se realizó la identificación de relaciones significativas entre la variable sexo y factores individuales, intralaborales y extralaborales, corroboradas por prueba de Fisher y razón de prevalencias. Según las asociaciones identificadas, se efectuó revisión de literatura para establecer posibles estrategias. Resultados: Se encontraron relaciones significativas entre la variable sexo y factores de la tarea como la presencia de movimientos repetitivos o súbitos (p < 0,05), apoyando postulados de segregación laboral. Según la bibliografia consultada, se discute la eficacia de actividades como preparación física y adecuación del puesto de trabajo bajo orientación profesional, actividades de capacitación y pausas. Es importante revisar factores organizacionales. Conclusiones: Al identificarse relaciones significativas entre la variable sexo y factores de la tarea, se aporta al postulado de segregación laboral en cuanto a concentración de mano de obra femenina en actividades con condiciones de trabajo particulares. Sobre la literatura y las acciones, es importante generar más estudios desde esta perspectiva.

A Hypothesis-Driven, Near-Peer Physical Diagnosis Module on Streptococcal Pharyngitis Within the Pediatrics Clerkship.

Introduction: In busy clinical settings, there is limited time to teach physical examination (PE) and procedural skills, particularly when the traditional head-to-toe PE approach is time-consuming. Near-peer teaching of a more efficient approach, the hypothesis-driven PE (HDPE), increases students' learning opportunities. We developed a near-peer HDPE module to improve medical student confidence, knowledge, and skills for diagnosing and managing streptococcal pharyngitis. Methods: During this 1-hour module, residents taught the diagnostic approach for a patient with sore throat and facilitated small groups for practicing PE and throat swab skills. We assessed students using pre- and postmodule surveys including Likert-scale confidence scores (1 = not at all confident, 5= extremely confident), multiple-choice knowledge questions, and a skills rubric. A control group was surveyed at clerkship conclusion. Results: Of the 71 pediatric clerkship students who participated, 69 (97%) completed premodule surveys and 65 (91%) completed skills assessments. Twenty-eight (39%) completed postmodule surveys and skill assessments. After participation, students' survey responses and rubrics indicated significant increase in confidence (Mdn pre = 2 [IQR = 1,2], Mdn post = 4 [IQR = 4,5]; p < .001), knowledge (M pre = 40%, M post = 77%; p < .001), and skills (M pre = 5.3, M post = 7.5; p < .01). Participating students also had significantly higher confidence (p < .005) and knowledge (p < 0.01) compared to the control group. Discussion: This near-peer HDPE module improved students' knowledge, confidence, and skills related to streptococcal pharyngitis diagnosis and management and achieved compliance for a required clerkship skill.

LETter To the EditoR Standards (LETTERS): Considerations for Authors, Reviewers, and Editors.

Correspondence in the form of letters to the editor serves multiple scholarly purposes, including critiquing previously published articles, engaging in discourse with other correspondents, commenting on the journal's structure or style, and contributing insights for future publications. The composition of such letters warrants meticulous attention, as they play a crucial role in fostering communication between the journal and its readership. Adherence to specific principles is essential in crafting an effective letter to the editor. These communications should be concise, lucid, and adhere to a professional tone. The content should be constructive in nature and substantiated by rigorous scientific evidence and appropriate citations. The structure of a letter to the editor typically encompasses several key components: a title, an opening section, the main body of the correspondence, a closing statement, and a list of references. This article aims to establish Letter to the Editor Standards as a comprehensive guide for authors, reviewers, and editorial boards, thereby enhancing the quality and impact of this crucial form of academic discourse.

Feasibility study of lncRNA DHRS4-AS1 sponge miR-222-3p in the diagnosis of thyroid cancer.

INTRODUCTION: Thyroid cancer is a commonly occurring malignant tumour within the endocrine system, the incidence of which has been increasing steadily in our country. It has been the focus and direction of research in recent decades to continuously explore the diagnostic markers and molecular mechanisms of thyroid cancer and provide new possibilities for the healing of patients. In this study, lncRNA DHRS4-AS1 was identified as the research target, and the regulatory function of abnormal expression of DHRS4-AS1 on thyroid cancer was discussed. MATERIAL AND METHODS: Thyroid cancer (116) and non-cancer normal (82) tissue samples were collected in this paper, and the expression of DHRS4-AS1 and miR-222-3p in tissues and cells were evaluated by RT-qPCR. CCK-8 and flow cytometry were used to detect cell survival status. The mechanism of DHRS4-AS1 sponge miR-222-3p was analysed by dual-luciferase reporter gene detection. RESULTS: In the present study, DHRS4-AS1 was down-regulated in both thyroid tissue and cell samples, while miR-222-3p expression was elevated. The ROC curve reflected the diagnostic value of DHRS4-AS1 in thyroid cancer [area under the curve (AUC) = 0.887, sensitivity = 76.7%, specificity = 95.1%]. DHRS4-AS1 regulates the development of thyroid cancer by targeting miR-222-3p. In addition, in vitro experiments demonstrated that overexpression of DHRS4-AS1 (pcDNA3.1-DHRS4-AS1) inhibited the proliferation of thyroid cancer cells and promoted cell apoptosis, while down-regulating the level of miR-222-3p. CONCLUSIONS: DHRS4-AS1 acts as a miR-222-3p sponge in thyroid cancer, and overexpression of DHRS4 AS1 down-regulates cell proliferation and promotes cell apoptosis. These findings demonstrate the potential of DHRS4-AS1 as a diagnostic factor for thyroid cancer.

Advancing Research, Writing, and Publishing in Nursing: Addressing Challenges and Improving Standards.

Nurses constitute nearly 50% of the worldwide health workforce, and the World Health Organisation has advocated for an enlargement of their roles to guarantee fair health care and address the increasing need for services. The growing specialization in nursing practice has led to a rise in educational options for nurses, including the growth of PhD programs. These programs play a crucial role in preparing nurse researchers and educators. This growth underlines the importance of evidence-based practice and high-quality academic writing in nursing. The article highlights the importance of nurses' involvement in creating evidence-based practice guidelines. The active engagement of nurses in developing evidence-based practice recommendations is essential to ensure the practicality, relevance, and grounding of these guidelines in real-world clinical experiences. The advancement of nursing depends mainly on using rigorous research procedures to generate, analyze, and disseminate knowledge and data. The current article discusses essential research methodologies, including interviews, surveys, and bibliometric and altmetric analyses. It also aims to tackle concerns about inadequate writing skills, plagiarism, and insufficient comprehension of ethical norms in research and publishing. The recommended strategies to promote nursing research and publications encompass enhancing writing skills through specialized education, embracing open-access publishing, and utilizing social media for broader distribution following publication. Implementing these approaches would increase the quality and impact of nursing publications and reinforce nursing's role in defining health policy and enhancing the care of patients.

Effects of zinc supplementation on sleep quality in humans: A systematic review of randomized controlled trials.

Background and Aims: Alternative therapies, such as zinc supplementation, have been explored as potential interventions for sleep disorders. However, the efficacy of zinc supplementation in improving sleep quality remains uncertain. This systematic review aims to examine the impacts of zinc supplementation on sleep quality in humans. Methods: The Web of Science, Medline, Scopus, and Google Scholar databases were comprehensively searched to find studies investigating the effect of zinc supplementation on sleep quality. After identifying relevant studies by screening, relevant data were extracted from them. The quality assessment was conducted using the Cochrane quality assessment tool. Results: This systematic review included eight studies. The interventions ranged from 4 to 48 weeks, with a daily dose of zinc supplementation varying between 10 and 73.3 mg. The majority of the evidence examined in this review pointed to the significant improvement effect of zinc supplementation on sleep quality in adults compared to the control groups. Furthermore, zinc supplementation did not have a significant effect on sleep disorders. However, there was no consensus about these findings. Also, the effect of supplementation on sleep duration in nonadults was contradictory. Conclusions: This systematic review suggests that zinc supplementation may lead to improvements in sleep quality. However, more research, primarily clinical trials, is needed to clarify the beneficial effects of zinc supplementation on sleep quality with consideration of dietary zinc intake and the Recommended Dietary Allowances of zinc (RDA) in the different populations. It is also recommended to investigate the effect of zinc supplementation on sleep quality in people with zinc deficiency in future studies.

HealthCheck: A method for evaluating persuasive mobile health applications.

Objectives: This paper introduces HealthCheck, a novel evaluation method for persuasive mobile health applications, aiming to fill the critical gap in quick and effective evaluation tools for this domain. Methods: Following Design Science Research, HealthCheck was developed through problem identification, solution design, implementation, evaluation, and iterative refinement. The implementation involved testing with seven experts to assess its applicability and effectiveness. Results: Feedback from the evaluators indicated that while a few heuristics in HealthCheck were considered irrelevant by some, the majority found the heuristics to be both pertinent and beneficial, especially within the caregiving context. This feedback highlights the practical value of HealthCheck and its potential to offer meaningful insights into improving the usability of persuasive eHealth applications. Conclusion: The study shows HealthCheck effectively evaluates persuasive mobile health applications, offering actionable insights to enhance usability. This validates the relevance and robustness of HealthCheck's heuristics, advancing information systems and human-computer interaction research.

The perceived long-term impact of peer teaching in the skills lab. A descriptive interview study.

Teaching is an essential skill for future doctors. Peer-assisted learning (PAL)-where students take up a teaching role at an early stage of their training-is widely used in medical curricula. No studies have explored the long-term perceived impact of peer teaching. Therefore, we aimed to determine how former peer teachers reflected on PAL and its perceived long-term impact. In this longitudinal descriptive study, we conducted 42 semi-structured interviews with 11 former peer teachers at the University of Antwerp. Five of them were interviewed 6 months after PAL; 6 of them 9 years after PAL. This latter group was also interviewed during PAL in a previous study. We conducted secondary analyses of previously collected interviews, consistently comparing the findings with new data gathered from the current interviews. Using realist thematic analysis, topic summary themes were generated. Former peer teachers reflected on their PAL experience with a lot of satisfaction. Those meanwhile working as residents are still passionate about teaching. Peer teachers experienced a gain in clinical examination- and professional skills in the long-term, facilitating a smoother transition to their internship. Our findings suggest that PAL selects diverse but committed students. The longitudinal data demonstrate how PAL initiates or stimulates different skills in diverse students, including public speaking, teaching, time management, and self-efficacy in specific clinical skills. Regarding the chicken-and-egg question, our study encompasses both longitudinal cases illustrating the pre-existing skill theory and cases demonstrating how achieved competences were induced by PAL. Former peer teachers experienced long-term benefits of PAL, which eased their transition into the internship. PAL has the potential to ignite a lasting passion for teaching, providing diverse and unique learning opportunities not only for the most talented and 'pre-selected' medical students but also for a range of dedicated future clinicians.

Food is Medicine National Summit: Transforming Health Care.

Food Is Medicine (FIM) interventions reflect the critical links between food security, nutrition security, health, and health equity, integrated into health care delivery. They comprise programs that provide nutritionally-tailored food, free of charge or at a discount, to support disease management, disease prevention, or optimal health, linked to the health care system as part of a patient's treatment plan. Such programs often prioritize health equity. On April 26-27, 2023, Tufts University's Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy and Food & Nutrition Innovation Institute held a two-day National Food is Medicine Summit with leaders, practitioners, and individuals with diverse lived experiences in health care, research, government, advocacy, philanthropy, and the private sector to identify challenges and opportunities to sustainably incorporate FIM services into the health care system and at scale. This report of a meeting describes key themes of the Summit, based on presentations and discussions on momentum around FIM, incorporating FIM in health care, tradeoffs and unintended consequences of various FIM models, scaling of programs, financing and payment mechanisms, educating and engaging the health care workforce, and federal and state government actions and opportunities on FIM. Speakers highlighted examples of recent public and private sector actions on FIM and innovative cross-sector partnerships, including state Medicaid waivers, academic and philanthropic research initiatives, health care system screenings and interventions, and collaborations including community-based organizations and/or entities outside of the food and health care sectors. Challenges and opportunities to broader implementation and scaling of FIM programs identified include incorporating FIM into health care business models, educating the health care workforce, and sustainably scaling FIM programs while leveraging the local connections of community-based organizations. This meeting report highlights recent advances, best practices, challenges, and opportunities discussed at the National Summit to inform future actions on FIM.

ZFHX2-AS1 interacts with DKC1 to regulate ARHGAP5 pseudouridylation and suppress ovarian cancer progression.

Ovarian cancer (OCa) remains a highly lethal disease, largely due to late-stage diagnosis and limited treatment options for recurrent metastatic tumors. Long non-coding RNAs (lncRNAs) have been recognized as key regulators of cancer hallmarks, yet their specific roles in driving OCa progression are not fully understood. In this study, we employed an integrated approach combining clinical correlation, functional assays, and mechanistic investigations to reveal that lncRNA ZFHX2-AS1 is significantly downregulated in OCa tissues and cells, with its reduced expression associated with poor clinical outcomes. Using in vitro and in vivo models, we demonstrated that overexpression of ZFHX2-AS1 suppresses OCa cell proliferation, migration and invasion, whereas ZFHX2-AS1 knockdown enhances these malignant phenotypes. Mechanistically, we defined that ZFHX2-AS1 interacts with and attenuates the enzymatic activity of the pseudouridine synthase DKC1, thereby reducing pseudouridylation and stabilizing the oncogenic ARHGAP5 mRNA. Re-expression of ARHGAP5 could partially reverse the tumor-suppressive effects of ZFHX2-AS1. Further, we found that ARHGAP5 promotes epithelial-mesenchymal transition (EMT) by regulating Rho GTPases activities, and that ZFHX2-AS1 inhibits EMT in OCa by downregulating ARHGAP5 expression and suppressing the Rho GTPase signaling pathway. Taken together, our findings identify ZFHX2-AS1 as a potent tumor suppressor in OCa, acting through the modulation of DKC1-mediated pseudouridylation of ARHGAP5 and the inhibition of the Rho GTPase pathway, thus offering a potential therapeutic target for combating OCa progression.

A pragmatic approach to selecting a grading system for clinical practice recommendations in palliative care.

BACKGROUND: The limited palliative care evidence base is poorly amenable to existing grading schemes utilized in guidelines. Many recommendations are based on expert consensus or clinical practice standards, which are often considered 'low-quality' evidence. Reinforcing provider hesitancy in translating recommendations to practice has implications for patient care. AIM: To rationalize the selection of an appropriate grading system for rating evidence to support recommendations made in palliative care clinical practice guidelines. DESIGN: Review of the methodology sections of international palliative care guidelines published in English identified five grading systems comparison: Grading of Recommendations, Assessment, Development and Evaluations (GRADE); the Scottish Intercollegiate Guidelines Network (SIGN); Infectious Diseases Society of America-European Society for Medical Oncology (IDSA-ESMO); Confidence in the Evidence from Reviews of Qualitative research (CERQual) and the National Service Framework for Long Term Conditions (NSF-LTC). RESULTS: There is heterogeneity among grading systems used in published palliative care or terminal symptom management guidelines. GRADE has been increasingly adopted for its methodological rigour and inter-guideline consistency with other medical associations. CERQual has the potential to support recommendations informed by qualitative evidence, but its role in clinical guidelines is less defined. The IDSA-ESMO system has an intuitive typology with the ability to categorize tiers of lower-quality evidence. CONCLUSIONS: It is challenging to apply commonly used grading systems to the palliative care evidence base, which often lacks robust randomized controlled trials (RCTs). Adoption of IDSA-ESMO offers a feasible and practical alternative for lower-resourced guideline developers and palliative clinicians without a prerequisite for methodological expertise.

Comparison of Ultrathin- Versus Thin-Strut Stents in Patients With High Bleeding Risk PCI: Results From the COMPARE 60/80 HBR Trial: An Open-Label, Randomized, Controlled Trial.

BACKGROUND: No randomized data exist on ultrathin-strut stents in patients at high bleeding risk (HBR) undergoing an abbreviated dual antiplatelet therapy after coronary stenting. The aim of this study was to compare the safety and effectiveness of the ultrathin-strut biodegradable-polymer sirolimus-eluting Supraflex Cruz stent with the thin-strut biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent in patients at HBR with abbreviated dual antiplatelet therapy after stenting. METHODS: In the investigator-initiated, randomized, open-label COMPARE 60/80 HBR trial (Comparison of the Supraflex Cruz 60 Micron Stent Strut Versus the Ultimaster Tansei 80 Micron Stent Strut in HBR Percutaneous Coronary Intervention Population), 741 patients at HBR according to the Academic Research Consortium HBR criteria were randomized to receive either the ultrathin-strut biodegradable-polymer sirolimus-eluting Supraflex Cruz stent or thin-strut biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent. Dual antiplatelet therapy was recommended according to the applicable guidelines and trial data for patients at HBR. The primary outcome was net adverse clinical events, the composite of cardiovascular death, myocardial infarction, target vessel revascularization, stroke, and major bleeding, and was powered for noninferiority with an absolute margin of 4.0% at 1-sided 2.5% alpha. RESULTS: Between September 2020 and August 2022, 371 patients were randomized to the ultrathin-strut biodegradable-polymer sirolimus-eluting Supraflex Cruz stent and 370 patients to the thin-strut biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent at 11 sites in the Netherlands. At 1 year, the primary outcome was observed in 56 (15.4%) patients in the ultrathin-strut biodegradable-polymer sirolimus-eluting Supraflex Cruz stent group and 61 (17.1%) in the thin-strut biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent group (risk difference, -1.65%; upper boundary of the 1-sided 95% CI, 3.74; P=0.02 for noninferiority at a 0.025 significance level and P=0.55 for 2-sided superiority at a 0.05 significance level). CONCLUSIONS: Among patients at HBR with abbreviated dual antiplatelet therapy post-stenting, the use of an ultrathin-strut biodegradable-polymer sirolimus-eluting Supraflex Cruz stent was noninferior compared with the use of a thin-strut biodegradable-polymer sirolimus-eluting Ultimaster Tansei stent. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04500912.

Epidemiology and clinical outcomes of vasomotor symptoms among perimenopausal women and women aged 65 years or older in the US: a systematic review.

Vasomotor symptoms (VMS) are the hallmark of menopause and negatively affect a large proportion of women over many years. However, studies evaluating the overall impact of VMS are limited. This systematic review (SR) aimed to examine epidemiological, clinical, humanistic, and economic outcomes of VMS among perimenopausal women and among women aged ≥65 years in the US. A systematic search of the MEDLINE and Embase databases was conducted to identify observational studies (2010-2022) reporting on these populations. Data reporting outcomes of interest were extracted and analyzed descriptively. Of 7,613 studies identified, 34 met inclusion criteria, of which 30 reported on perimenopausal women and 4 reported on VMS in women aged ≥ 65 years. VMS and severe/moderate-to-severe VMS were reported by 48.4-70.6 percent and 13.0-63.1 percent, respectively, of perimenopausal women. Mean VMS duration was 2.6 years, and median duration ranged from 7.4 to 10.1 years among women with onset in early perimenopause and from 3.8 to 6.1 years among those with onset in late perimenopause. Among women aged ≥65 years, 20.9-45.1 percent reported VMS; 2.0 percent reported severe symptoms, and 17.6 percent reported moderate symptoms. No studies reported VMS frequency and duration or the economic or humanistic burden among women aged ≥65 years. In conclusion, high VMS frequency and severity were observed among perimenopausal women and women aged ≥65 years in the US in this SR, highlighting the need for (1) better management of VMS to reduce frequency and severity and (2) further research to clarify the impact of VMS on disease burden, quality of life, and economic impact.

Effectiveness of the 5As Model-Based Transitional Care Program among Chinese Patients with Type B Aortic Dissection Post-TEVAR: A Randomized Controlled Trial.

Background: Thoracic aortic endovascular repair (TEVAR) is the primary treatment for Stanford type B aortic dissection (type B AD). However, patients often encounter significant difficulties post-TEVAR that endanger their safety when transitioning from hospital- to home-based care. Moreover, information on the ideal transitional care for patients with type B AD post-TEVAR is scarce in China. This single-masked randomized clinical trial aimed to assess the effectiveness of the Assess, Advise, Agree, Assist, and Arrange (5As) model-based transitional care in improving discharge preparation level and transitional care quality post-TEVAR among patients with type B AD in China. Methods: This study was conducted at a hospital in China between January 2021 and October 2021. Patients with type B AD were randomly divided into intervention and control groups. Participants in the intervention group received the 5As model-based transitional nursing care. The 5As model is an evidence-based intervention strategy comprising: (1) Assess: assessing the preoperative cardiovascular risk behavior of patients with AD. (2) Advise: making suggestions according to the risk behaviors of the patients. (3) Agree: reaching a consensus on goals and action plans by making decisions with the patients and their families. (4) Assist: assisting patients in solving obstacles to implementing health plans. (5) Arrange: arranging follow-up visits according to the actual situation of the patients and guiding them in adhering to a schedule. The control group received the usual nursing care for the same duration and number of follow-up visits. A trained research nurse collected all the baseline data of the patients on admission, assessed discharge readiness level (using the Readiness for Hospital Discharge Scale) on the day of discharge, and collected transitional quality of care (by the Care Transition Measure-15) data on day 30 after discharge. Results: Overall, 72 patients with type B AD were recruited. Discharge readiness level and transitional care quality in the intervention group were significantly superior to those in the control group. Conclusions: This study showed that the 5As model-based transitional care program can effectively promote discharge readiness and transitional care quality of patients with type B AD post-TEVAR. Clinical Trial Registration: The Chinese Clinical Trial Registry Center: ChiCTR2200060797 (https://www.chictr.org.cn/showproj.html?proj=167403).