To assess the long-term economic and welfare burden of Ménière’s disease, focusing on healthcare costs, income, and reliance on social benefits before and after the first hospital-recorded diagnosis. We conducted a nationwide matched cohort study in Denmark, involving 5,434 patients with a hospital-recorded Ménière’s disease diagnosis later confirmed by an otorhinolaryngologist and 16,302 matched controls based on age, sex, civil status, municipality, and index year defined by the first hospital registration of Ménière’s disease. The mean age was 59 years, and 56
Accurate blood pressure reference values are crucial for detecting hypertension in children. However, international guidelines, with reference values based on multiethnic US cohorts, may not be fully applicable in other populations. This study primarily aimed to develop percentile-based population-specific oscillometric blood pressure reference values for Danish children and, secondly, to compare these to existing percentile-based international reference values. A cross-sectional study was conducted using data from the Lolland–Falster Health Study (2016–2020), including 1771 children aged 4–15 years. A reference model was developed based on 1512 children of normal weight, excluding those with chronic conditions, blood pressure-altering medications, or a country of origin other than Denmark. Quantile regression models estimated sex- and age-specific 5th to 95th percentile for systolic and diastolic blood pressure. Reference values were compared in reclassification tables. The novel Danish reference model provides percentile-based age- and sex-specific oscillometric office blood pressure reference values. Excluding height from the model had minimal impact on explanatory power. Applying international reference values identified 27
Loop diuretics relieve congestion in chronic heart failure (CHF). We systematically reviewed randomised clinical trials (RCTs) evaluating their effects. A systematic search was conducted across major databases. We included RCTs that compared a loop diuretic to another loop diuretic, placebo, or “no intervention”. The primary outcome was all-cause mortality, and secondary outcomes were all-cause hospitalisation, serious adverse events (SAEs), and change in body weight (kg). This review included 23 RCTs that enrolled 4,902 patients. Treatment with alternative loop diuretics (torsemide, azosemide and piretanide) compared with furosemide did not reduce all-cause mortality (risk ratio 1.00, 95
BACKGROUND AND OBJECTIVES:Acute postoperative pain is typically managed with titration of opioids, balancing pain intensity and opioid-related adverse events (ORADEs). Often, the dosing strategy is individualised based on the clinician's intuition or expertise. The influence of broader patient-related predictors remains insufficiently synthesised. This systematic review aimed to synthesise evidence on associations between patient-related predictors and opioid use, pain intensity and ORADEs within 24 h after surgery. DATABASES AND DATA TREATMENT:In this systematic review, we searched MEDLINE, Embase and CENTRAL for studies examining associations between patient-related predictors and opioid use, pain, or ORADEs within 0-24 h postoperatively. We used Quality in Prognosis Studies (QUIPS) for risk of bias and conducted meta-analyses. RESULTS:We included 39 studies (294,221 patients) investigating 31 patient-related predictors. Meta-analyses showed that young age and chronic pain were associated with moderate-severe pain risk and large opioid consumption. Smoking, non-normal BMI, anxiety and preoperatively opioid use or pain were associated with moderate-severe pain. Female sex and lower ASA-scores were associated with postoperative nausea and vomiting. No other ORADEs were assessed. All but two studies were high risk of bias. CONCLUSION:The certainty of evidence was low due to high risk of bias and substantial heterogeneity in designs, populations and exposure/outcome definitions. Within 24 h after surgery, younger age, female sex, lower ASA score, smoking, abnormal BMI, anxiety, chronic pain and chronic opioid use were associated with greater postoperative complexity in terms of increased pain intensity, opioid use, or risk of nausea and vomiting. SIGNIFICANCE STATEMENT:This comprehensive review provides important understanding of patient-related predictors, which can contribute to a more individualised perioperative pain management, including dosing of preventive analgesia at the end of surgery and in adjusting as-needed opioid doses postoperatively. PROSPERO-IDENTIFIER:CRD42024559821.
Recurrence after curative-intent surgery for colorectal cancer is a major cause of cancer-related death. Circulating cell-free tumor DNA (ctDNA) is increasingly used in the perioperative setting to detect residual disease. However, the association between preoperative ctDNA, the tumor microenvironment, including tumor-infiltrating lymphocytes, and recurrence is unknown. We explored the association between ctDNA and the tumor microenvironment in patients with non-metastatic CRC undergoing curative-intent surgery. ctDNA was assessed using a tumor-agnostic hypermethylated cfDNA test. Among 140 patients, ctDNA tested positive in 102 (72.9%) before surgery, with 38 (27.1%) tumors classified as immune infiltration high. ctDNA was associated with expression of cancer-metastasis pathways, while immune active phenotypes were associated with immune infiltration high tumors. ctDNA status could identify deficient mismatch repair tumors with an active immune phenotype. The results suggest that a positive ctDNA analysis before surgery is associated with a metastatic tumor microenvironment.
