Objective To characterize racial disparities in glaucoma management by evaluating treatment modality utilization patterns between Asian American and non-Asian American patients with primary open-angle glaucoma (POAG). Patients and Methods This retrospective cohort study utilized the TriNetX US Collaborative Network, a large-scale, multi-institutional electronic medical record database, with data from January 1, 2004, to June 16, 2025. Asian American and non-Asian American patients with POAG were identified via ICD-10 codes and stratified by disease severity (mild-to-moderate vs severe). Cohorts were balanced using 1:1 propensity score matching for demographic characteristics, systemic comorbidities, family history, and smoking status. The primary outcome was the relative utilization of topical medications, laser procedures, traditional surgery, and microinvasive glaucoma surgery. Results After propensity score matching, the study evaluated 12,526 patients with mild-to-moderate POAG (6263 per group) and 3410 patients with severe POAG (1705 per group). In the mild-to-moderate cohort, Asian Americans had a higher likelihood of receiving topical medications (odds ratio [OR], 1.041; 95% confidence interval [CI], 1.016-1.068). Conversely, Asian Americans with severe POAG were less likely to receive topical medications (OR, 0.950; 95% CI, 0.906-0.996) or laser procedures (OR, 0.769; 95% CI, 0.630-0.939). No significant differences were observed in surgical or microinvasive glaucoma surgery utilization. Conclusion Significant differences exist in POAG treatment utilization for Asian Americans, particularly a relative underutilization of adjunctive medical and laser therapies in severe disease. These findings suggest that current practice patterns may diverge from traditional treatment algorithms for this rapidly growing demographic, highlighting a need for increased awareness of potential systemic or provider-level barriers to equitable care.
Objective To determine the ultraviolet-C (UV-C) irradiation doses required to inactivate Pseudomonas aeruginosa and Aspergillus flavus contamination on polycarbonate surfaces using a triangular emitter configuration. Patients and Methods In this laboratory experiment, polycarbonate test carriers inoculated with >108 colony-forming units of P aeruginosa (MYA-15442) or A flavus (American Type Culture Collection 9643) were positioned 2.74 m from 3 linear UV-C emitters to determine minimally effective doses. Ten independent irradiation doses were evaluated for P aeruginosa (25-250 mJ/cm2) and A flavus (50-2000 mJ/cm2). Larger carriers were additionally evaluated for A flavus to model reduced cell clumping, simulating prior surface disinfection. Residual colony-forming units were quantified and compared with untreated controls to calculate log reductions. Finally, the efficacy of delivering these minimally effective doses through a triangular UV-C emitter configuration was assessed. Results For P aeruginosa, no growth was detected at any dose, including 25 mJ/cm2. For A flavus on standard carriers, inactivation occurred at 725 mJ/cm2, though no growth conditions were not achieved at any tested dose. However, on larger carriers (reduced clumping), no growth conditions for A flavus were achieved at 650 mJ/cm2. Delivery of 25 mJ/cm2 for P aeruginosa and 650 mJ/cm2 for A flavus through the triangular configuration resulted in undetectable growth. Conclusion A UV-C dose of 25 mJ/cm2 is sufficient to attenuate P aeruginosa surface contamination. Conversely, A flavus inactivation will likely require manual high-level surface disinfection augmented with 650 mJ/cm2 of UV-C irradiation.
Objective To evaluate the effectiveness of Tofersen in patients with superoxide dismutase 1 gene (SOD1-ALS) patients in France in a real-world setting, using disease progression within patient comparisons and with a historical cohort. Patients and Methods Patients with SOD1-ALS were included from across 19 French FILSLAN network centers. Baseline was defined as the treatment initiation date. Main endpoints were the ALSFRS-R progression rate and plasmatic neurofilament light chain (NfL) levels at baseline and 12 months after baseline. Results In the Tofersen Cohort (N=46), within-group comparisons showed that the mean ALS functional rating scale revised (ALSFRS-R) progression rate slowed from 0.53 ± 0.5 at baseline to 0.22 ± 0.3 point/month at 12 months (P=.006). NfL levels significantly decreased from 89.0 ± 9.0 pg/ml at baseline to 29.2 ± 19.5.5 at 12 months (P=.004). Exploratory comparisons with a propensity score (PS) matched historical cohort (39 matched pairs) using a mixed-effects model, ALSFRS-R progression rate at baseline, 6 months, and 12 months after baseline, showed no statistically significant differences between groups P=.30, whereas longitudinal ALSFRS-R scores differed significantly between groups (time-treatment interaction P=.006). The mean survival of the PS matched population was longer in the Tofersen Cohort (42.6 months) than the Historical Cohort (31.8 months) P=.004. Time-dependent adjusted cox analysis showed that Tofersen was associated with a reduction in mortality risk (adjusted HR=0.34; 95% CI, 0.12-0.91; P=.03). Conclusion Tofersen seems to be associated with slower functional decline and reduced NfL levels. While limitations of retrospective design and ALSFRS-R sensitivity must be acknowledged, these findings provide real-world evidence suggesting a clinical benefit of Tofersen.
Objective To evaluate the association of estimated cardiorespiratory fitness (eCRF) with incident cardiometabolic multimorbidity (CMM) and its potential contribution to CMM risk prediction in an older adult population. Patients and Methods The analysis included 3326 participants from the English Longitudinal Study of Aging (mean age 63 years; 1820 (54.7%) women) who were free of hypertension, cardiovascular disease, diabetes, and stroke at baseline (wave 4; 2008-2009). Estimated CRF was derived using validated nonexercise prediction equations (heart rate-based, body mass index-based, and Nord-Trøndelag Health Study-based eCRF). Incident CMM was defined at wave 10 (2021-2023) as the presence of ≥2 of the following: hypertension, cardiovascular disease, diabetes, or stroke. Multivariable-adjusted odds ratios (ORs) (95% CIs) and discrimination indices were calculated. Results During 12-15 years of follow-up, 197 (5.9%) participants developed CMM. Each eCRF measure reported an inverse linear association with CMM risk. Higher heart rate-based eCRF was associated with lower odds of CMM (per 1- metabolic equivalents (MET) increment: OR=0.78; 95% CI, 0.70-0.87; highest vs lowest tertile: OR=0.42; 95% CI, 0.25-0.69). Similar associations were observed for body mass index-based eCRF (per 1-MET increment: OR=0.78; 95% CI, 0.68-0.89; highest vs lowest tertile: OR=0.42; 95% CI, 0.25-0.70) and Nord-Trøndelag Health Study-based eCRF (per 1-MET increment: OR=0.73; 95% CI, 0.65-0.82; highest vs lowest tertile: OR=0.36; 95% CI, 0.22-0.58). Incorporation of each eCRF measure into a conventional risk prediction model modestly improved discrimination. Conclusion Estimated CRF derived from validated nonexercise equations was similarly and inversely associated with incident CMM in older adults, with all models reporting comparable modest predictive utility.
