Using 3D Printing Technology to Design Split-Piece Sleeve Prosthesis in the Revision Surgery of Tumor-Type Total Elbow Prosthetic Fractures: A Case Report.

BACKGROUND: Revision of tumor-type prosthetic fractures is very challenging in clinical work. Traditional repair methods may not be able to meet the needs of complex cases or cause greater bone damage. Therefore, more effective and reliable solutions need to be found. CASE PRESENTATION: This study presents a novel revision technique for managing fractures of tumor-type total elbow prostheses. A 57-year-old female patient was diagnosed with a left distal humeral bone tumor accompanied by pathological fracture and underwent customized tumor-type total elbow prosthesis arthroplasty. After 5 years, she experienced pain and encountered difficulty in flexing the left elbow while lifting heavy objects. The X-ray examination revealed a fracture of the distal humeral prosthesis. As a response, the elbow joint was initially explored, and the damaged component of the prosthesis was extracted. Subsequently, we utilized 3D printing technology to design a split-piece sleeve prosthesis and effectively restored the fractured left distal humerus implant. During the 2-year follow-up, The X-ray demonstrated satisfactory positioning of the prosthesis, which remained securely affixed without any indications of loosening. The Mayo Elbow Performance Score (MEPS) reached 80 points, the Musculoskeletal Tumor Society (MSTS) attained a score of 28 points, and the range of motion of the elbow was measured between 25° and 110°, revealing favorable functional outcomes. CONCLUSION: The utilization of a 3D printed split-piece sleeve prosthesis presents a viable clinical treatment strategy for addressing fractures in tumor-type elbow prostheses.

Exosomal miR-1202 mediates Brodmann Area 44 functional connectivity changes in medication-free patients with major depressive disorder: An fMRI study.

Previous large-sample postmortem study revealed that the expression of miR-1202 in brain tissues from Brodmann area 44 (BA44) was dysregulated in patients with major depressive disorder (MDDs). However, the specific in vivo neuropathological mechanism of miR-1202 as well as its interplay with BA44 circuits in the depressed brain are still unclear. Here, we performed a case-control study with imaging-genetic approach based on resting-state functional magnetic resonance imaging (MRI) data and miR-1202 quantification from 110 medication-free MDDs and 102 healthy controls. Serum-derived circulating exosomes that readily cross the blood-brain barrier were isolated to quantify miR-1202. For validation, repeated MR scans were performed after a six-week follow-up of antidepressant treatment on a cohort of MDDs. Voxelwise factorial analysis revealed two brain areas (including the striatal-thalamic region) in which the effect of depression on the functional connectivity with BA44 was significantly dependent on the expression level of exosomal miR-1202. Moreover, longitudinal change of the BA44 connectivity with the striatal-thalamic region in MDDs after antidepressant treatment was found to be significantly related to the level of miR-1202 expression. These findings revealed that the in vivo neuropathological effect of miR-1202 dysregulation in depression is possibly exerted by mediating neural functional abnormalities in BA44-striatal-thalamic circuits.

Transitions in Metabolic Health and Onset Age of Cardiovascular Diseases.

INTRODUCTION: The cardiometabolic risk associated with metabolically healthy obesity remains the subject of debate. It is unclear whether changes in metabolically healthy obesity status affect premature cardiovascular disease (CVD) risk. Authors aimed to investigate the association of metabolically healthy obesity and its transition over time with incident CVD by age at onset. METHODS: In a community-based, prospective cohort study, 54,441 adults without CVD in or before 2010 were followed for incident CVD until 2020. This sample was analyzed in 2022. Four age groups were examined (<55, 55-65, 65-75, and ≥75 years) for CVD onset. In each age group, participants were cross-classified by BMI categories and metabolic health. The Cox proportional hazards model with age as the underlying time scale was used to examine the associations of metabolic health status and its transition with CVD across BMI categories. RESULTS: During a median follow-up of 9.59 years, 3,038 participants developed CVD. Individuals with metabolically unhealthy obesity at baseline had the highest hazard ratio for CVD onset at any age, ranging from 2.68 (95% CI=2.02, 3.55) for CVD onset in those aged <55 years to 1.55 (95% CI=1.09, 2.10) for CVD onset in those aged ≥75 years. Individuals who had metabolically healthy obesity at baseline or even remained metabolically healthy during 2006-2010 were still at increased risk of premature CVD, and the association attenuated with increasing age of CVD onset. CONCLUSIONS: The metabolically healthy obesity phenotype is dynamic and its transition to a metabolically unhealthy phenotype or even stable metabolically healthy obesity is associated with an increased risk of CVD. The associations were more evident for CVD onset at younger ages.

Aseptic loosening of tumor prostheses in distal femur after revision surgery: a retrospective study.

BACKGROUND: Tumor prostheses of the distal femur after revision surgery is associated with high rates of aseptic loosening, which has introduced great challenges to the survival of patients, but only a few studies have evaluated their X-ray imaging. The purpose of this study was to analyze the risk factors for recurrence of aseptic loosening and make recommendations to reduce the incidence of aseptic loosening after revision surgery of tumor prostheses in the distal femur. METHOD: A retrospective analysis was performed on 23 patients who had revision surgery for distal femur prostheses due to aseptic loosening between June 2002 and June 2021. They were divided into two groups based on the condition of the prostheses after revision surgery: loosening group (9 patients) and control group (14 patients). Following the initial replacement, the length and diameter of the prosthetic intramedullary stem were measured through the standard full-length anteroposterior X-ray imaging of both lower limbs. The osteotomy length, femoral length and diameter, femoral intramedullary stem diameter, hip-knee-ankle angle (HKAA), mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), and so on were measured as well. Following that, statistical analysis was performed. RESULTS: Patients in the loosening group had statistically significant differences in the ratio of prostheses length to femur length (71.89 ± 6.62) and the ratio of intramedullary stem diameter to femoral diameter (25.50 ± 6.90) (P < 0.05), when compared to the control group. The HKAA (175.58 ± 2.78), mLDFA (94.42 ± 2.57), and the deviation angle between the lower limb alignment and the tibial prostheses force line (2.23 ± 1.09) in the loosening group were significantly different from those in the control group (P < 0.05) on postoperative radiographs of the entire length of the lower limbs. The lowest score in intramedullary manubrium I indicated less osteolysis, while the highest score in intramedullary manubrium III indicated the most serious osteolysis, and the difference was statistically significant (P < 0.05). CONCLUSIONS: Our study suggests that the use of longer and thicker intramedullary stems can effectively decrease the occurrence of aseptic loosening. Additionally, it is important to avoid using the original prostheses and reconstruct the standard line of lower limb force to further reduce the incidence of aseptic loosening. It is crucial to closely monitor the distal segment of the intramedullary stem for osteolysis after surgery.

Resting heart rate and risk of atrial fibrillation in Chinese general population: Kailuan prospective cohort study.

OBJECTIVE: Previous research has shown an association of higher heart rate with an increased risk of atrial fibrillation (AF). However, the relationship between resting heart rate (RHR) and AF is unknown. The aim of this study was to investigate the association between RHR and AF in the general population of China. DESIGN: Prospective observational cohort study. SETTING: Community based. PARTICIPANTS: A total of 46 126 individuals from the Kailuan study who participated in the first three surveys (2006/2007, 2008/2009 and 2010/2011) and were followed up at 2-year intervals were enrolled. PRIMARY OUTCOME MEASURES: The association between RHR and risk of incident AF was evaluated using Cox proportional hazards regression and restricted cubic spline models. RESULTS: Two hundred and forty-one individuals (0.52%) developed AF during 7.5 years of follow-up. After adjustment for age, sex, low-density and high-density lipoprotein, physical activity, alcohol consumption, smoking status, body mass index, mean systolic blood pressure, and history of diabetes and hypertension, the HRs were 2.32 (95% CI 1.45 to 3.72) for an RHR <60 beats/min and 2.80 (1.13 to 6.94) for an RHR ≥100 beats/min in comparison with an RHR of 70-80 beats/min. Restricted cubic spline models revealed a U-shaped relationship between RHR and incident AF. CONCLUSION: These findings indicate that RHR and incident AF have a U-shaped relationship in the Chinese general population. Both lower and higher RHRs were associated with an increased risk of AF.

Prevalence and clinical characteristics of atrial fibrillation in hospitalized patients with coronary artery disease and hypertension: a cross-sectional study from 2008 to 2018.

BACKGROUND: The clinical characteristics of patients with the comorbidities of hypertension and coronary artery disease (HT-CAD) and atrial fibrillation (AF) are largely unknown. This study aimed to investigate the prevalence of AF in patients with HT-CAD and clinical characteristics of patients with both HT-CAD and AF. METHODS: This cross-sectional study was conducted in Chinese People's Liberation Army General Hospital in Beijing, China, and included 20,747 inpatients with HT-CAD with or without AF from August 2008 to July 2018. We examined the overall prevalence, clinical characteristics, comorbidity profiles, treatment patterns, and blood pressure (BP) control of patients with both HT-CAD and AF. Multivariate logistic regression was used to investigate the associations of cardiovascular risk factors with AF in patients with HT-CAD. RESULTS: The overall prevalence of AF in patients with HT-CAD was 4.87% (1011/20,747), and this increased with age; to be specific, the prevalence in women and men increased from 0.78% (2/255) and 1.02% (26/2561) at the age of <50 years to 8.73% (193/2210) and 10.28% (298/2900) at the age of ≥70 years, respectively. HT-CAD patients who had AF had a higher prevalence of cardiovascular-related comorbidities than those without AF. Multivariate logistic regression showed that age, gender (male), body mass index, heart failure, and chronic kidney disease were independently associated with the risk of AF in patients with HT-CAD. For those with both HT-CAD and AF, 73.49% (743/1011) had a CHA 2 DS 2 -VASc score of ≥4, and only about half of them had the BP controlled at <140/90 mmHg, which indicated a high risk of thromboembolism and stroke. The use of oral anticoagulation increased during the study period (10.00% [20/200] in 2008 to 2011 vs. 30.06% [159/529] in 2015 to 2018, P  < 0.01), but remained at a relatively low level. CONCLUSIONS: AF is highly prevalent among patients with HT-CAD. Patients with both HT-CAD and AF have a higher prevalence of cardiovascular-related comorbidities, lower BP control rate, and lower use of oral anticoagulation.

Effect of oral Xiao-xian decoction combined with acupoint application therapy on pediatric adenoid hypertrophy: A randomized trial.

BACKGROUND: This study aimed to observe the clinical effects of Xiao-xian decoction combined with acupoint application therapy (AAT) for treating pediatric adenoid hypertrophy (AH). METHODS: We randomly divided 93 AH children into 3 groups: AAT alone; Xiao-xian decoction + AAT; control: Montelukast oral therapy. All participants were treated for a month. We used the traditional Chinese medicine syndrome score to evaluate the clinical efficacy and the obstructive sleep apnea-18 scale to evaluate the quality of life. RESULTS: The major symptoms (nasal congestion, open mouth breathing, snoring, and tongue image) and secondary symptoms of patients treated with Xiao-xian decoction + AAT significantly improved compared to before treatment. The pairwise comparison between groups showed that snoring, tongue, secondary symptoms, and total effective rate of the combined treatment group were better than the control and AAT alone. Additionally, the open-mouth breathing, quality of life, and recurrence rate did not differ after treatment. CONCLUSION: Oral Xiao-xian decoction combined with AAT significantly improved the symptoms and signs of nasal congestion, open-mouth breathing, snoring, tongue, and quality of life of AH children and may be used as a long-term treatment for AH.

[Effect of Sleep Deprivation on the Metabolism of Hippocampal Amino Acids and Monoamine Neurotransmitters in Mice and Their Behaviors]. / ç¡çœ å‰¥å¤ºå¯¹æµ·é©¬åŒºå•èƒºç±»ç¥žç»é€’è´¨ã€æ°¨åŸºé ¸ä»£è°¢åŠå°é¼ è¡Œä¸ºçš„å½±å“.

Objective: To investigate the effect of sleep deprivation on the metabolism of the hippocampal region in mice. Methods: The mice were randomly assigned to three groups, a control group, a 24-h sleep deprivation (SD) group, and a 48-h SD group. Each group had 10 mice. The sleep deprivation model was induced by the modified multiple platform method. The mice's anxiety-like behaviors were assessed with the open field test (OFT) and their depression-like behaviors were assessed with the sucrose preference test (SPT), the forced swimming test (FST), and tail suspension test (TST). High performance liquid chromatography (HPLC) was performed to determine the levels of 6 monoamine neurotransmitters, including 5-hydroxytryptamine (5-HT), norepinephrine (NE), dopamine (DA), gamma-aminobutyric acid (GABA), 5-dihydroxyphenylacetic acid (5-DOPAC), and homovanillic acid (HVA), and 4 amino acids, including glutamic acid (Glu), aspartic acid (Asp), serine (Ser), and taurine (Tau), in the hippocampal region. Immunofluorescence staining was performed to examine the expression of glial cells in the hippocampal region of the mice. The main indicators measured were the levels of monoamine neurotransmitters and amino acids. Results: According to the results of the behavioral analysis, in comparison with the findings for the control group, the 24-h SD mice exhibited increased consumption of sucrose in SFT, significantly decreased total immobility time in FST and TST, and increased total distance covered in OFT, while the 48-h SD mice showed decreased consumption of sucrose in SFT, prolonged total immobility time in FST and TST, and decreased total distance covered in OFT. The results of the HPLC analysis of the monoamine neurotransmitter showed that 24-h SD mice had in their hippocampal region increased levels of DA (P<0.001) and NE (P<0.01) and decreased levels of GABA (P<0.05) in comparison with those of the control mice, while their 5-HT, 5-DOPAC, and HVA levels were not significantly different from those of the control mice. In comparison with those of the control mice, the 48-h SD mice had, in their hippocampal region, decreased levels of 5-HT and NE (all P<0.05), decreased DA (P<0.01), and increased level of GABA (P<0.01), while the levels of 5-DOPAC and HAV were not significantly different. The 48-h SD group showed a significant decrease in the levels of Tau and Glu in comparison with those of the 24-h SD group (all P<0.05). According to the results of immunofluorescence assay, there was no significant difference between the control group and the 24-h SD group in the cell count of glial fibrillary acidic protein (GFAP)-positive cells, while a decline in GFAP-positive cells in comparison with that of the control group was observed in the 48-h SD group. Conclusion: SD of 24 hours may induce anxiety-like behavioral changes in mice by activating their hippocampal glial cells, upregulating the levels of 5-HT, DA, and NE, and increasing the levels of Glu and Tau in the hippocampal region. SD of 48 hours may induce depression-like behavioral changes in mice by inhibiting the activation of glial cells in the hippocampal region and regulating in the opposite direction the levels of the above-mentioned monoamine neurotransmitters and amino acids in the hippocampal region.

Combined effect of inter-arm systolic blood pressure difference and carotid artery plaque on cardiovascular diseases and mortality: A prospective cohort study.

Objectives: Previous studies have confirmed the relations between inter-arm systolic blood pressure difference (IASBPD) and carotid artery plaque with the risk of cardiovascular diseases (CVD). But it is unclear whether the combined effect of IASBPD and carotid artery plaque further increases the risk of CVD and all-cause mortality. Materials and methods: We enrolled 4,970 participants (≥40 years old) in the prospective Kailuan study. All participants underwent dual-arm blood pressure and carotid artery ultrasounds. IASBPD was the absolute value of the difference between dual-arm blood pressure. All the participants were divided into four groups according to their IASBPD levels and the presence or absence of carotid artery plaque and Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence interval (CI) for incident CVD and all-cause mortality. Results: During a median follow-up of 7 years, 179 CVD events and 266 deaths occurred. Multivariable Cox Regression showed that participants with IASBPD ≥ 10 mmHg and plaque had a significantly higher incidence of CVD, cerebral infarction (CI), and myocardial infarction (10, 7.27, and 1.36%, respectively). After adjusting for covariates, the IASBPD ≥ 10 mmHg and carotid plaque group significantly increased risks for CVD (HR 2.38; 95% CI, 1.40∼4.05), CI (HR, 2.47; 95% CI, 1.31∼4.67), and all-cause mortality (HR, 2.08; 95% CI, 1.20∼3.59). Conclusion: Our study indicated that the combination of IASBPD and carotid artery plaque was associated with incident CVD and all-cause mortality.

Visit-to-visit SBP variability and risk of atrial fibrillation in middle-aged and older populations.

OBJECTIVE: We sought to examine the relationship between visit-to-visit variability of SBP and incident atrial fibrillation in middle-aged and older population. METHODS: This prospective cohort study included 26 999 participants aged 50 years or older at study entry. Visit-to-visit variability of SBP was defined as the average real variability (ARV) of three values of SBP from the examinations of 2006, 2008, and 2010. We categorized participants into four groups according to the quartiles of ARV. Incident atrial fibrillation cases were identified via ECG during biennial resurveys, and reviewing medical insurance record and discharge registers. We used Cox regression models to evaluate the hazard ratios and 95% confidence intervals (CI) for incident atrial fibrillation. RESULTS: After an average follow-up of 9.24 years, a total of 420 atrial fibrillation cases were identified. The incidence of atrial fibrillation from the lowest to the highest quartiles of SBP variability were 1.23, 1.53, 1.81 and 2.19 per 1000 person-years, respectively. After adjusting for potential confounders, including mean blood pressure, we found a graded association between SBP variability and risk of atrial fibrillation. Participants in the third quartile and the highest quartile were associated with 35 and 53% higher risk of developing atrial fibrillation, respectively, compared with participants in the lowest quartile [hazard ratio (95% CI), 1.35 (1.01-1.82) and 1.53 (1.15-2.04)]. The results persisted across sensitivity analyses. CONCLUSION: Increased visit-to-visit variability of SBP is a strong predictor of incident atrial fibrillation in middle-aged and older population. Evaluation of long-term SBP variability could help to identify individuals at higher risk of atrial fibrillation.

Classification and reconstruction of femoral bone defect in the revision of aseptic loosening of distal femoral endoprostheses: a 10-year multicenter retrospective analysis.

OBJECTIVE: This study proposes a system for classifying the aseptic loosening of distal femoral endoprostheses and discusses reconstruction methods for revision surgery, based on different classification types. METHODS: We retrospectively analyzed the data of patients who received revision surgery for aseptic loosening in distal femoral tumor endoprosthesis from January 2008 to December 2020 at 3 bone tumor treatment centers in China. Based on the patient imaging data, we proposed a classification system for the aseptic loosening of distal femoral endoprostheses and discussed its revision surgery strategy for various bone defects. RESULTS: A total of 31 patients were included in this study, including 21 males and 10 females aged 15-75 y (average: 44.3 y). First-revision surgery was performed on 24 patients, whereas second-revision surgery was conducted on 7 patients. The 31 patients were classified into different types based on the degree of aseptic loosening: Type I, 12 patients (38.7%); Type IIa, 7 patients (22.5%); Type IIb, 7 patients (22.5%); Type III, 4 patient (12.9%); and Type IV, 1 patient (3.2%). For type I, 11 patients underwent revisions with standard longer-stem prostheses (one with the original prosthesis), and one patient had the original prosthesis plus cortical allograft strut. For type II (a and b), 10 patients underwent revisions with original prosthesis or longer-stem prosthesis and 4 patients combined with cortical allograft strut. For type III, one patient underwent revision with a longer-stem prosthesis and the other 3 patients with a custom short-stem prosthesis. For type IV, only one patient underwent revision with a custom short-stem prosthesis. CONCLUSIONS: Aseptic loosening of the distal femoral prosthesis can be divided into 4 types: type I, type II (a, b), type III and type IV. The reconstruction methods of our centers for different types of bone defects can offer some reference value in the revision of aseptic loosening.

Successful limb salvage in progressive proximal tibia osteosarcoma following denosumab chemotherapy: A case report.

RATIONALE: Osteosarcoma (OS) is a primary malignant bone tumor that originates in the mesenchymal tissue. It is the most common type of pleomorphic tumor occurring in children and adolescents. Currently, there is no established systematic treatment for OS that progresses during standard preoperative chemotherapy. PATIENT CONCERNS AND DIAGNOSES: We describe a 14-year-old male patient with a 4-month history of pain in the upper right leg. Based on the results of percutaneous biopsy, a diagnosis of OS was made. After admission, the patient was treated with first-line chemotherapy agents. After a single course of treatment, the tumor progressed locally and no limb salvage was feasible. INTERVENTIONS AND OUTCOMES: Intervention with denosumab combined with chemotherapy led to a significant reduction in tumor volume and ossification of soft tissue, which successfully resulted in limb salvage rather than amputation. The patient showed no evidence of recurrent or distant metastasis at 6-month follow-up. LESSONS: Treatment with receptor activator of nuclear factor-ĸB ligand inhibitor denosumab combined with standard chemotherapy is effective for advanced OS progressing after chemotherapy. We recommend denosumab therapy for successful limb salvage in patients with high-grade OS associated with osteolytic bone destruction and refractory to preoperative neoadjuvant chemotherapy.

Frequency of Visit-to-Visit Variability of Resting Heart Rate and the Risk of New-Onset Atrial Fibrillation in the General Population.

Resting heart rate (RHR) has been an established predictor for atrial fibrillation (AF). However, the association of visit-to-visit heart rate variability (VVHRV) with new-onset AF risk over long term remains unclear. Our study investigates the relation of VVHRV to new-onset AF in general population in the prospective study of the Kailuan cohort. A total of 46,126 individuals without arrhythmia were included. They underwent 3 health examinations from 2006 to 2010 and performed follow up. VVHRV was measured by coefficient of variation (CV), variability independent of the mean (VIM), and standard deviation (SD). Participants were separately divided into 5 categories by quintiles of visit-to-visit RHR-CV, RHR-VIM and RHR-SD. Multivariate Cox regression and restricted cubic spline models were performed to establish the association between VVHRV and new-onset AF. 241 new-onset AF occurred during a median follow-up of 7.54 years. The incidence of new-onset AF in the group of the lowest (Q1) and highest quintiles (Q5) of RHR-CV were higher than that in other groups. The HRs for the new-onset AF were 2.07 (95% CI, 1.34-3.21, p < 0.01), in the highest quintile group(Q5) compared with group Q2, and 1.89(95% CI, 1.20-2.97, p < 0.01) in the lowest quintile group(Q1) compared with group Q2. The risk for new-onset AF showed a similar trend using RHR-VIM (p < 0.01) and RHR-SD (p < 0.05) parameters. Further sensitivity analyses indicated the consistent results in subjects without prior cardiovascular disease and without taking beta blockers or CCB. To match the covariates, analyses were also performed by propensity score matching, and prominent trends were also found in RHR-SD and RHR-VIM. In conclusion, the study indicated that higher and lower VVHRV were associated with the increasing risk of new-onset AF, which supporting a U-shaped curve existence.

Combined effect of visit-to-visit variations in heart rate and systolic blood pressure on all-cause mortality in hypertensive patients.

Elevated resting heart rate (RHR) and systolic blood pressure (SBP) are independent risk factors for all-cause mortality in hypertensive patients. However, the association of the visit-to-visit variation (VVV) in SBP and RHR with the risk of mortality in hypertensive patients remains unknown. The aim of this study was to investigate the effects of the VVVs in SBP and RHR on the risk of all-cause mortality. We enrolled 16,602 hypertensive patients from the Kailuan cohort study who underwent three health examinations from 2006 to 2010. The VVVs in SBP and RHR were defined by the coefficient of variation, standard deviation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability. Participants were classified numerically according to the number of high-variability parameters (e.g., a score of 2 indicated high variability in two parameters). Cox proportional hazards models were used to estimate hazard ratios for mortality. High VVVs in SBP and RHR were associated with an increased risk of all-cause mortality in hypertensive patients. In the multivariable-adjusted model comparing a score of 0 with a score of 2, the hazard ratios (95% confidence intervals (CIs)) for all-cause mortality were 1.38 (1.11-1.69), 1.52 (1.24-1.87), 1.32 (1.07-1.63), and 1.43 (1.16-1.75) using the coefficient of variation, standard deviation, variability independent of the mean, and average real variability, respectively. High VVVs in SBP and RHR constituted an independent risk factor for all-cause mortality in hypertensive patients. High VVVs in SBP and RHR additively increased the risk of all-cause mortality in hypertensive patients.

Associations of Type 2 Diabetes Onset Age With Cardiovascular Disease and Mortality: The Kailuan Study.

OBJECTIVE: We aimed to explore the associations between type 2 diabetes onset age and cardiovascular disease (CVD) and all-cause mortality in the Chinese population. RESEARCH DESIGN AND METHODS: This study included 101,080 participants free of prevalent diabetes and CVD at baseline from the Kailuan Study. All participants were monitored biennially until 31 December 2017. During follow-up, 11,384 participants were diagnosed as having type 2 diabetes. For each case subject, one control subject was randomly selected, matched for age (± 1 years) and sex. The final analysis comprised 10,777 case-control pairs. Weighted Cox regression models were used to evaluate the average hazard ratios (AHRs) and 95% CIs of incident CVD and all-cause mortality among patients with new-onset type 2 diabetes versus control subjects across age-groups. RESULTS: During a median follow-up of 5.57 years, 1,794 incident events (907 CVD events, of which there were 725 strokes and 887 deaths) occurred. After adjustment for potential confounders, participants with type 2 diabetes diagnosed at age <45 years had the highest relative risks of CVD and all-cause mortality relative to the matched control subjects, with AHRs of 3.21 (95% CI 1.18-8.72) for CVD, 2.99 (95% CI 1.01-9.17) for stroke, and 4.79 (95% CI 1.95-11.76) for all-cause mortality. The risks gradually attenuated with each decade increase in type 2 diabetes onset age. CONCLUSIONS: The relative risks of CVD and all-cause mortality differed across type 2 diabetes onset age-groups, and the associations were more evident in younger-onset type 2 diabetes.