Search Results (13,349)

Background and Objectives: Pediatric both-bone forearm fractures are commonly treated nonoperatively, yet early loss of reduction remains a clinically important problem. Childhood obesity may be associated with reduced early radiographic stability after closed reduction and casting. Materials and Methods: A retrospective single-center cohort study was performed, including children aged 3 to 13 years who presented between 2020 and 2023 with acute both-bone forearm fractures involving the radius and ulna. Patients were categorized as normal weight (BMI 5th–84th percentile) or obese (≥95th percentile); overweight children (85th–94th percentile) were excluded. Fracture morphology and level, initial management (operative vs. conservative), and early loss of reduction were recorded. Multivariable logistic regression was conducted within the conservative cohort to identify independent factors associated with loss of reduction. Results: A total of 895 patients were included (normal weight n = 633; obese n = 262). Obese children had a higher proportion of complete fractures than normal-weight children (82.4% vs. 61.9%, p < 0.001) and underwent operative management more frequently at index presentation (33.6% vs. 13.1%, p < 0.001). Among conservatively treated patients (n = 724), early loss of reduction occurred in 36 cases and was more common in obese than normal-weight children (13.2% vs. 2.4%, p < 0.001). In multivariable analysis, obesity was independently associated with loss of reduction (aOR 5.98; 95% CI 2.89–12.38; p < 0.001). Conclusions: In children aged 3 to 13 years with both-bone forearm fractures treated with casting, obesity was independently associated with early loss of reduction. Weight status may serve as a practical clinical risk marker to support counseling and closer early radiographic surveillance during nonoperative care. Full article

Background/Objectives: Obstructive sleep apnea (OSA) syndrome is characterized by recurrent upper airway obstruction during sleep and is closely associated with systemic inflammation and cardiometabolic risk. α-Klotho and fibroblast growth factor-23 (FGF-23) are emerging biomarkers with potential roles in vascular homeostasis, inflammation, and metabolic regulation. However, their relevance in OSA remains insufficiently elucidated. The aim of this study was to evaluate serum α-Klotho and FGF-23 levels in patients with OSA and to investigate their associations with disease severity. This represents a novel approach that may provide new insights into the pathophysiological mechanisms linking OSA with cardiometabolic risk. Methods: A total of 133 participants were included in this study and categorized into three groups according to apnea–hypopnea index: 1—simple snoring (n = 44); 2—non-severe OSA (n = 44); and 3—severe OSA (n = 45). Comparisons between two groups were performed using Student’s t-test for normally distributed variables. Comparisons among three or more groups were conducted using one-way ANOVA and the Kruskal–Wallis test. ANCOVA was applied to compare α-Klotho and FGF-23 levels between groups after adjustment for age, BMI, diabetes, hypertension, asthma, COPD, and thyroid disease. The predictive performance of α-Klotho and FGF-23 for severe obstructive sleep apnea was evaluated using ROC curve analysis. Results: Serum α-Klotho levels decreased significantly with increasing OSA severity (p = 0.001). Serum FGF-23 levels increased significantly across AHI groups (p = 0.001). After adjustment for age, BMI, diabetes, hypertension, asthma, thyroid disease, COPD and vitamin D levels, α-Klotho levels were lower in the severe and non-severe OSA group (p = 0.001, both) compared to the simple snoring group, whereas FGF-23 levels were higher in the severe and non-severe OSA group (p = 0.001; both) compared to the simple snoring group. In predicting the risk of severe OSA compared with non-severe OSA, an α-Klotho cut-off value of 280.3 yielded a sensitivity of 84.44% and specificity of 75%, whereas an FGF-23 cut-off value of 75.5 yielded a sensitivity of 62.2% and specificity of 72.7%. Conclusions: Serum α-Klotho levels significantly decrease while FGF-23 levels increase in correlation with OSA severity. α-Klotho exhibited superior predictive performance over FGF-23 in identifying severe OSA, suggesting its potential as a more sensitive biomarker for systemic involvement. These results indicate that the α-Klotho/FGF-23 axis is independently associated with OSA and may play a pivotal role in the pathophysiological mechanisms linking intermittent hypoxia to increased cardiometabolic risk. Full article

Background/Objectives: Severe oral mucositis is widely viewed as a transient toxicity of antineoplastic therapy. Whether its long-term consequences differ between cancers that directly damage the upper aerodigestive tract (cancers of the lip, oral cavity, pharynx [CLOP]) and systemic hematologic malignancies is unknown. The aim of this study was to compare lifetime risks of mortality, dysphagia, malnutrition, respiratory disease, and cardiovascular disease in propensity-score-matched survivors of CLOP cancer versus leukemia with and without a history of ulcerative oral mucositis. Methods: Population-based retrospective cohort study using the TriNetX US Collaborative Network (90 healthcare organizations, >110 million patients). We identified 80,526 adults with a personal history of CLOP cancer (ICD-10-CM Z85.81) and 43,684 with leukemia (Z85.6) from 2005 to 2024. Cohorts were stratified by presence/absence of severe oral mucositis (K12.31 or K12.33 at any time). Separate 1:1 propensity-score matching was performed within each cancer type on age, sex, race/ethnicity, hypertension, diabetes, BMI, ECOG status, and external causes of morbidity. Exposures included documented severe (ulcerative) oral mucositis. Main outcomes and measures were all-cause mortality and incident dysphagia, malnutrition, respiratory disease (J00–J99), influenza/pneumonia (J09–J18), and circulatory disease (I00–I99) after the index date. Results: After 1:1 matching, 4181 CLOP patients with mucositis were compared with 4181 without, and 2508 leukemia patients with mucositis were compared with 2508 without. In CLOP survivors, mucositis was associated with markedly higher lifetime mortality (adjusted HR 1.94, 95% CI 1.87–2.01), dysphagia (HR 3.42, 95% CI 3.28–3.57), malnutrition (HR 2.81, 95% CI 2.66–2.97), any respiratory disease (HR 1.68, 95% CI 1.63–1.73), and influenza/pneumonia (HR 1.79, 95% CI 1.72–1.86). In leukemia survivors, mucositis conferred only modest or null excess risk (mortality HR 1.12, 95% CI 1.05–1.19; dysphagia HR 1.18, 95% CI 1.07–1.30; malnutrition HR 1.24, 95% CI 1.12–1.37; any respiratory disease HR 1.09, 95% CI 1.03–1.15). Conclusions and Relevance: Severe oral mucositis is a powerful, durable prognostic determinant in cancers of the upper aerodigestive tract, where it identifies patients associated with elevated lifelong risk of swallowing dysfunction, aspiration-related lung disease, malnutrition, and premature death. The markedly attenuated effect in leukemia survivors suggests that direct high-dose radiation-induced structural damage to the pharynx and oral cavity—rather than systemic immunosuppression or chemotherapy intensity alone—is the dominant mechanism. Full article

Computed tomography (CT) at the third lumbar vertebra (L3) is widely used for muscle quantification, but manual segmentation is labor intensive. This study externally validates an AI model, trained on a public dataset, for automated L3 muscle segmentation using an independent cohort, including a subgroup analysis of subject characteristics (e.g., age and a history of cancer). The AI model was trained on 900 CT scans with expert annotations from a publicly available repository. Validation was performed on 232 PET CT scans from the University Hospital Brussels, each manually segmented by experts. Segmentation post-processing employed a density-based clustering algorithm to discard arm muscles and Hounsfield unit (HU) thresholding to refine the muscle segmentation. Performance was assessed using the Dice Similarity Coefficient (DSC) and Segmentation Surface Error (SSE). The model achieved a median DSC of 0.978 and a median SSE of 3.863 cm² across the validation set. At lower BMI values, the model was more prone to overestimation of muscle surface area. Most segmentation errors occurred in the abdominal wall muscles. Analysis showed no significant difference between arm positioning above the head and alongside the body, indicating robustness to minor artifacts from arm positioning. The AI model delivers accurate, automated L3 muscle segmentation, supporting larger-scale body composition studies. However, diminished accuracy at low BMI values and limited demographic diversity of the data highlight the need for broader validation. Full article

Background/Objectives: Tidal volume is determined by height and sex in adults under mechanical ventilation, and it serves as the foundation for implementing a lung-protective ventilation strategy. In children, tidal volume is often calculated based on actual body weight, without established guidelines regarding the predictors of lung volume. The aim of this study was to identify the key predictors of lung volume in children aged 0–5 years. Methods: This retrospective study involved 51 children aged 0–5 years who underwent chest computed tomography (CT) and surgery under general anesthesia between 2014 and 2024. The total lung volume was calculated using three-dimensional segmentation of the CT images. Linear regression models were used to assess predictors, including height, weight, age, sex, and body mass index (BMI). Model performance was evaluated using the adjusted R-squared and Akaike Information Criterion (AIC). Bootstrap validation with 2000 iterations was used to validate model reliability. Results: Height was the strongest predictor of lung volume (adjusted R-squared: 0.5621), and it showed a collinearity with age. The final model included age and sex as the covariates. The Bootstrap validation confirmed the model’s reliability. Conclusions: Age and sex are key predictors of the CT-derived total lung volume in children aged 0–5 years. Further studies are required to validate these findings. In addition, research is needed to derive and validate a tidal volume equation based on these predictors and assess the influence of this equation on clinical outcomes such as atelectasis, oxygenation, and inflammatory markers in pediatric surgery. Full article

Air pollution has been associated with dysregulated metabolism. However, evidence linking prenatal air pollution exposure to gestational weight gain (GWG) pattern remains limited. This retrospective cohort study of 47,793 pregnant women in Guiyang (2013–2022) assessed associations between air pollutants and GWG pattern. Positive associations were observed between excessive GWG and CO (per 1 μg/m³ increase), NO₂, O₃, PM₁₀, PM_2.5, and SO₂ (per 10 μg/m³ increase) throughout the whole pregnancy period. Specifically, early-pregnancy exposure to CO (OR = 1.377, 95% CI: 1.201, 1.578) and NO₂ (OR = 1.098, 95% CI: 1.068, 1.130), along with exposure to PM₁₀ (OR = 1.058, 95% CI: 1.043, 1.073), PM_2.5 (OR = 1.095, 95% CI: 1.073, 1.118), and SO₂ (OR = 1.135, 95% CI: 1.102, 1.169) during late pregnancy significantly increased excessive GWG risk. Conversely, O₃ exposure was inversely associated with excessive GWG. For insufficient GWG, only early-pregnancy exposures to PM₁₀ (OR = 1.016, 95% CI: 1.001, 1.032), PM_2.5 (OR = 1.022, 95% CI: 1.001, 1.043), and SO₂ (OR = 1.031, 95% CI: 1.004, 1.058) showed significant positive associations. Furthermore, the restricted cubic spline (RCS) model revealed a nonlinear relationship between pollutant exposure and the risk of excessive GWG. Stratified analyses revealed that the air pollution and GWG (continuous) association was stronger among women with pre-pregnancy BMI ≥ 24 kg/m² and aged ≥ 30 years. This study confirms that, even at lower concentrations, exposure to air pollutants during pregnancy is significantly associated with an increased risk of abnormal GWG. Compared to previous studies focusing on high-concentration areas, this finding provides additional evidence for assessing the health risks of air pollution exposure during pregnancy, suggesting that the potential metabolic effects of low-level, long-term exposure should be considered when developing maternal health strategies. Full article

Background: Body mass index (BMI) is commonly used to assess obesity but does not differentiate between fat and lean mass, limiting its effectiveness to assess cardiometabolic risk. Measurements of central adiposity, such as waist circumference (WC), waist-hip ratio (WHR) and waist-to-height ratio (WHtR), are better predictors of metabolic dysfunction, especially with respect to visceral fat. Aim: To examine BMI trends and assess the association between BMI and waist-related anthropometric indicators WC, WHR, and WHtR, among university students in South Africa. Methods: A cross-sectional study involving 842 university students was conducted. Anthropometric measurements were taken according to ISAK standards. Quantile regression models supplemented by ROC curves were used to assess the predictive effects of WC, WHR, and WHtR on BMI across its distribution. Results: A total of 842 participants (63.8% female) were included, with a mean age of 21.8 ± 4.0 years. Significant differences were observed across BMI categories for all demographic and anthropometric characteristics (p < 0.001). Quantile regression analyses showed that WHtR and WC were strong and consistent predictors of BMI in all quantiles, with effect sizes increasing at higher levels of BMI. The WHR showed weaker associations overall, but these became significant in the upper BMI quantiles. Collectively, waist-related indicators, particularly WHtR and WC, exhibited robust predictive values for elevated BMI. Conclusions: Waist-related indicators, especially WHtR and WC are robust predictors of elevated BMI among university students, particularly in higher BMI ranges. These findings highlighted the value of incorporating central adiposity measures alongside BMI for more accurate health risk assessments in young adult populations. Full article

Background: Cardiovascular risk factors may emerge early in life and track into adulthood. Local data from inland and socioeconomically vulnerable regions remain limited. This study aimed to describe cardiovascular risk indicators in school-aged children from inland Portugal, focusing on body mass index (BMI), blood pressure (BP), and physical activity patterns. Methods: A cross-sectional school-based screening study was conducted in 101 children and adolescents aged 10–15 years. Anthropometric measurements and BP were obtained using standardized procedures. BMI categories were classified according to age- and sex-specific WHO references. BP was classified using European pediatric percentiles. Because measurements were obtained during a single visit, results were interpreted as elevated BP at screening. Associations between variables were explored using chi-square or Fisher’s exact tests and Spearman’s correlation. Results: The prevalence of underweight, normal weight, and overweight/obesity was 25.7%, 67.3%, and 6.9%, respectively. Overall, 24.8% of participants presented elevated BP at screening. The BMI category was significantly associated with BP classification (p = 0.003), and BMI correlated positively with systolic BP (ρ = 0.32; p = 0.001). Most children reported only school-based physical education. Conclusions: This school-based screening suggests a high proportion of elevated BP measurements and an unexpectedly high prevalence of underweight children, indicating the coexistence of different nutritional vulnerabilities. Findings should be interpreted cautiously due to the small, single-school sample and single-occasion BP assessment but support the importance of early cardiovascular risk monitoring in vulnerable settings. Full article

Introduction: Obesity is a well-established risk factor for numerous chronic diseases, including type 2 diabetes, cardiovascular disease, and certain cancers. Obesity-related complications can be managed through nutritional therapy, pharmacotherapy, and surgical interventions, each capable of achieving weight loss of over 10%. Understanding patient preferences and the factors that influence treatment choices is crucial to enhancing adherence and effectiveness. This sub-study aimed to identify the factors shaping patient preferences for nutritional therapies in the context of available pharmacological and surgical options. Methods: A participatory action study recruited 43 patients aged 18–75 years with a BMI greater than 35 kg/m² and obesity-related complications, including metabolic dysfunction, diabetes, hypertension, and chronic kidney disease. Participants viewed a 60-min informational video outlining treatment options before taking part in one-to-one interviews. Data were analysed using reflective thematic analysis. Results: This sub-study focuses on patients who expressed distinct attitudes toward nutritional therapy. Of the participants, 47% preferred nutritional therapy, 41% chose pharmacotherapy alone, and 6% selected a combination of pharmacotherapy and nutritional therapy. Five themes emerged to explain the preference for nutritional therapy: patient satisfaction, the personalised approach, effectiveness, empowerment, and side effects. Discussion: Nutritional therapies were still the most popular choice of many patients, suggesting there remain unmet needs of patients and that it should not be assumed that large majorities of patients with obesity only want pharmacotherapies or surgical therapies. Conclusion: Ensuring patients receive comprehensive information and regular guidance from nutritional experts is likely to further strengthen engagement. Full article

Background/Objectives: Sweeteners and sweetness enhancers (S&SEs) have been proposed to potentially impair appetite regulation by stimulating sweet taste receptors beyond the perception of sweetness, similar to caloric sweeteners. The evidence is, however, not clear. Methods: This sub-study investigated the acute effects of a mixture of acesulfame potassium and cyclamate (Ace-K/Cyc) versus water on postprandial appetite sensations and energy intake at baseline, after a two-month weight loss period, and after a four-month weight loss maintenance period, including (S&SE group) or excluding S&SEs (Sugar group) in the diet. A total of 26 participants (18–65 years; BMI ≥ 25.0 kg/m²) were recruited from the one-year randomized controlled SWEET trial. Subjective appetite sensations were measured using visual analogue scales while fasting and nine times during a 250-min postprandial period. During this period, a standardized breakfast (0–10 min) was served and, 2 h later, a test drink containing either Ace-K/Cyc or water (120–130 min) was given. After 265 min, an ad libitum test meal was served. Results: Of 26 participants enrolled, 22 completed test day 2 and 16 completed test day 3. The S&SEs group rated lower prospective consumption and desire to eat something sweet after the test drink with Ace-K/Cyc compared to the sugar group consuming water (p < 0.05), with effects persisting after adjusting for taste. Initial differences in hunger were explained by taste palatability. This was true for all three test days. Ad libitum energy intake did not differ (p > 0.05). Conclusions: Ace-K/Cyc compared to water reduced feelings of prospective consumption and desire to eat something sweet acutely, after two months of weight loss, and after four months of weight loss maintenance. Due to the low sample size and power, larger studies are warranted to confirm these results. Full article

Background: Antimicrobial resistance is a global health crisis associated with high mortality and economic burden. Patients with renal dysfunction and obesity have increased susceptibility to infections and may experience different real-world outcomes, including clinical success and mortality, but are often under-represented in clinical trials. Ceftolozane/tazobactam (C/T) is an innovative therapy used to treat resistant Gram-negative infections. We aimed to describe real-world clinical outcomes in hospitalized adults treated with C/T across categories of renal function and BMI in the SPECTRA study. Methods: SPECTRA was a multi-national observational study on 617 patients who received C/T for ≥48 h. Outcomes included clinical success, all-cause in-hospital mortality, readmission, and ICU admission and length of stay (LOS), with sub-analysis of patients across BMI and renal function strata. Results: Renal function and weight were reported in 597 and 469 patients, respectively, of which 51.9% had lower creatine clearance (<80 mL/min) and 50.7% were overweight. Clinical success and all-cause in-hospital mortality ranged at 59.1–77.8% and 11.1–29.2% across renal function strata and 64.6–68.6% and 18.6–21.4% across weight subgroups. Across renal function and weight subgroups, 38.9–54.2% and 45.9–53.5% of patients were admitted to ICU. Median ICU LOS was 8–21.5 and 14–20 days, respectively. Readmission (30-day all-cause) occurred in 4.5–11.8% and 8.2–11.9% of patients across renal function and weight strata. Conclusions: Results from this sub-analysis suggest real-world clinical effectiveness of C/T across patients with renal impairment and obesity, highlighting C/T as a component within treatment guidelines for resistant Gram-negative infections. Full article

Background/Objectives: The fundamental classification based on white, brown, pink, and beige adipose tissue morphology together with fat vacuole content released into the tumor microenvironment incompletely defines breast cancer-associated adipose tissue (BCAAT) heterogeneity and does not sufficiently explain its controversial impact on invasion, recurrence, or survival in breast cancer (BC). We aim to expand BCAAT characterization by systematically evaluating stromal cellular elements within peritumoral adipose tissue, including CD34-positive fibroblasts, smooth muscle actin (SMA)-positive myofibroblasts, inflammatory cells, and microvascular structures to define distinct BCAAT subgroups. Methods: CD34 and smooth muscle actin (SMA) double immunohistochemistry was performed on 109 BC tissue specimens from patients aged 35 to 79 years old, followed by microscopic evaluation of cellular and vascular components inside peritumor adipose tissue. Microscopic findings were then correlated to age, body mass index (BMI), lymphovascular (LVI) and perineural invasion (PnI), recurrence (R), and tertiary lymphoid structures (TLSs). Results: Four BCAAT subtypes have been identified as fibroblast-rich (F^Rich_BCAAT), myofibroblast-rich (MyoF^Rich_BCAAT), vascular-rich (V^Rich_BCAAT), and mixed-vascular and inflammatory-rich (VI^Rich_BCAAT). The F^Rich_BCAAT subtype predominates for the age subgroup 35 to 49 years old and is a significantly worse prognostic factor for survival (p = 0.022). For the age subgroup of 50 to 69 years old, the VI^Rich_BCAAT subtype significantly influences PnI (p = 0.05) but not survival (Log-rank test, z = 0.57, p = 0.57). V^Rich_BCAAT was significantly impactful for BC patient survival aged 70 to 75 years old (p = 0.043). BMI did not correlate with any of the BCAAT subtypes but was strongly correlated with prognostic markers for each BCAAT subtype. Conclusions: Based on immunohistochemically detected cellular and vascular components, four microscopic BCAAT subtypes were identified. Three of four BCCAT subtypes specifically affect BC patient prognosis and survival depending on age. Full article

Background/Objectives: Early detection of cardiometabolic irregularities is crucial for averting cardiovascular illness; however, demographic cohorts that consistently engage with healthcare systems like habitual blood donors are inadequately leveraged for metabolic monitoring. Methods: This study performed lipid profiling and cardiovascular risk assessment among blood donors identified with visually lipemic plasma during routine screening, in order to explore metabolic variability within this selected donor subgroup. Of 13,818 screened donors, 160 with lipemic plasma were included, and multivariable and machine-learning analyses were restricted to 90 donors with complete clinical data. Results: We observed substantial variability in triglyceride levels, with males displaying higher and more dispersed values. Correlation analysis indicated that triglycerides were associated with BMI and composite cardiovascular risk metrics, while age was the strongest contributor to the calculated 10-year cardiovascular risk score. Using a Random Forest classifier, elevated triglyceride levels were predicted with an AUC of 0.86; however, given the limited sample size, this analysis should be interpreted as exploratory and proof-of-concept in nature. Conclusions: In this selected subgroup of donors with lipemic plasma, clinically relevant hypertriglyceridemia was frequently observed. These findings suggest that routine donor data may provide opportunities for targeted metabolic monitoring, although the results cannot be generalized to the broader blood donor population. Further studies in larger and more representative cohorts are warranted. Full article

Understanding how anthropometric characteristics influence internal load during boxing remains limited, despite heart rate (HR) being a key indicator of exercise intensity. This study examined the relationship between anthropometry and HR responses during three boxing-specific exercises—shadowboxing, pad work, and heavy bag work—in 39 male practitioners (29.0 ± 2.3 years). Body height (BH), body mass (BM), and body mass index (BMI) were assessed. HR_peak and HR_mean were recorded using a validated chest-strap monitor (Polar H10). Significant positive correlations were observed between BH, BM, BMI, and HR responses across all modalities, with the strongest associations during heavy bag work (e.g., HR_peak: BH r = 0.658, BM r = 0.681, BMI r = 0.677; all p < 0.001). Regression analyses indicated that BH explained 23–36% of HR variance during shadowboxing and pad work, whereas BM and BMI showed greater predictive capacity during heavy bag work, explaining up to 46% of HR_peak variance. Repeated-measures ANOVA revealed significant differences between modalities, with heavy bag work eliciting the highest intensities (p < 0.001). These findings demonstrate that greater anthropometric dimensions are associated with higher cardiovascular responses, supporting individualized training prescriptions based on morphological characteristics. Full article

Introduction/Objectives: Body composition changes and diet quality may contribute to metabolic complications and graft outcomes after kidney transplantation. We evaluated the relationships between diet quality and CT-derived body composition components (skeletal muscle mass, muscle quality/myosteatosis, and visceral adiposity) and explored their associations with metabolic markers and graft function. Materials and Methods: In this single-center retrospective cross-sectional study, we included 161 adult first kidney transplant recipients (KTRs) with a functioning graft and ≥12 months of follow-up. Body composition was quantified on routine abdominal CT at the L3 level using skeletal muscle index (SMI), mean muscle attenuation (Hounsfield units) for myosteatosis, and visceral adipose tissue area (VAT). Diet quality was scored using the Revised Diet Quality Index (DQI-R). Graft function was followed with creatinine-based estimated glomerular filtration rate (eGFR) calculated by the CKD-EPI equation. Results: Mean age was 45.7 ± 13.2 years and 58% were men. The prevalence of low muscle mass was 26.0%, myosteatosis 73.5%, and visceral obesity (VAT ≥ 100 cm²) 45.6%. No participant had “good” diet quality; 48.4% had poor diet quality. DQI-R showed a weak positive correlation with SMI (r = 0.157; p = 0.047) but was not significantly related to VAT, subcutaneous adipose tissue (SAT), Kidney transplant recipient (VSR) or myosteatosis. In multivariable models, age and VAT were associated with HbA1c, whereas body composition and diet quality variables were not independent predictors of eGFR. Myosteatosis was independently associated with older age. Conclusions: Visceral adiposity and impaired muscle quality frequently clustered and were linked to metabolic status. These findings support post-transplant follow-up strategies that go beyond BMI and integrate body composition and nutritional assessment within a multidisciplinary care model. Full article