Glycerophosphocholine Metabolites and Cardiovascular Disease Risk Factors in Adolescents: A Cohort Study.

BACKGROUND: Glycerophosphocholine (GPC) metabolites modulate atherosclerosis and thus risk for cardiovascular disease (CVD). Preclinical CVD may start during adolescence. Here, we used targeted serum lipidomics to identify a new panel of GPCs, and tested whether any of these GPCs are associated, in adolescence, with classical risk factors of CVD, namely excess visceral fat (VF), elevated blood pressure, insulin resistance, and atherogenic dyslipidemia. METHODS: We studied a population-based sample of 990 adolescents (12-18 years, 48% male), as part of the Saguenay Youth Study. Using liquid chromatography-electrospray ionization-mass spectrometry, we identified 69 serum GPCs within the 450 to 680 m/z range. We measured VF with MRI. RESULTS: We identified several novel GPCs that were associated with multiple CVD risk factors. Most significantly, PC16:0/2:0 was negatively associated with VF (P=1.4×10-19), blood pressure (P=7.7×10-5), and fasting triacylglycerols (P=9.0×10-5), and PC14:1/0:0 was positively associated with VF (P=3.0×10-7), fasting insulin (P=5.4×10-32), and triacylglycerols (P=1.4×10-29). The Sobel test of mediation revealed that both GPCs mediated their respective relations between VF (as a potential primary exposure) and CVD risk factors (as outcomes, P values<1.3×10-3). Furthermore, a GPC shown recently to predict incident coronary heart disease in older adults, PC18:2/0:0, was associated with several CVD risk factors in adolescents; these associations were less strong than those with the newly identified GPCs. CONCLUSIONS: We identified novel GPCs strongly associated with multiple CVD risk factors in adolescents. These GPCs may be sensitive indicators of obesity-related risk for CVD outcomes in adults, and may improve biological understanding of CVD risk.

The rising burden of acute urological disease at an urban, academic hospital network.

INTRODUCTION: Urological presentations to the emergency department (ED) can represent a significant burden of disease. We aimed to evaluate trends in the incidence, management, and followup of urological presentations to the ED at an urban, academic, tertiarycare hospital network over a 10-year period. METHODS: A retrospective cohort study was conducted to include all patients presenting with renal colic (RC), gross hematuria (GH), or acute urinary retention (AUR) to EDs in the University Health Network in 2008-2009 and 2018-2019. Patient demographics and outcomes were compared between these two periods and between urological presentations. Multilevel regression analyses identified predictors of in-patient admission, return to the ED, and clinic wait time. RESULTS: A total of 2751 patients and 3510 ED visits were included (991 visits from 2008-09 and 2519 visits from 2018-19). Over time, increases were observed in all three presentations, largely driven by an almost five-fold increase in RC presentations. Multilevel regression analyses showed that older patients were more likely to be admitted from the ED, while age, 2018-19 era, and residence within the "downtown core" independently predicted return to the ED within 30 days of initial visit. Time to be seen in urology clinic increased over time for the entire cohort, and 14.4% of clinic visits were preceded by multiple ED visits. CONCLUSIONS: The incidence of acute urological presentations increased significantly over a 10-year period at a tertiary-care hospital network. These findings demonstrate an increasing burden of acute urological disease that is outpacing population growth and straining available resources.

Better safe than sorry? Results from an ex-vivo study demonstrate that the thulium fiber laser may cause eye injury without standard protection.

INTRODUCTION: We conducted a study using an ex-vivo porcine model to evaluate whether a thulium fiber laser (TFL) induces ocular injury in the context of inadvertent exposure to the laser beam. METHODS: A 365 µm TFL was positioned at a set distance (0 cm, 5 cm, 8 cm, and 10 cm) from a freshly harvested (<12 hours) porcine eyeball and the laser was activated for one second at select laser settings for lithotripsy (0.2 J at 50 Hz, 0.5 J at 20 Hz, and 1 J at 10 Hz) and soft tissue ablation (2 J at 10 Hz, 1 J at 50 Hz). The experiment was repeated with laser safety goggles and prescription eyeglasses. Thermal injury was assessed by histopathological analysis. RESULTS: Without eye protection, corneal injury was observed even at 10 cm away for one lithotripsy setting (1 J at 10 Hz) and both tissue ablation settings. All thermal injuries observed were superficial only, except for at 0 cm distance, where deep-layer injury was observed. Laser safety goggles offered complete protection regardless of setting or distance. Partial protection was demonstrated with prescription glasses: histopathological damage was observed for both soft tissue ablation settings and only at 0 cm for two lithotripsy settings (0.5 J at 20 Hz, 1 J at 10 Hz). CONCLUSIONS: The TFL can induce ocular injury at close distances and at higher power settings. The use of laser safety goggles confers complete protection while prescription eyeglasses confer partial protection. Further study is warranted.