To evaluate the association between non-steroidal anti-inflammatory drugs (NSAIDs) and miscarriage, which remains elusive in the actual literature, using modelling approaches to mitigate time-related bias.

Nationwide, population-based retrospective cohort study.

The study used data from the French National Mother-Child Register (EPI-MERES), developed from the French National Health Data System containing the health information (hospital admissions, drug dispensing, comorbidities, etc.) of about 99% French population.

4 857 907 pregnancies ended in a live birth, a stillbirth or a miscarriage from 2013 to 2019.

Exposure to NSAIDs from 2 weeks before conception to the 20th week of pregnancy.

Miscarriage (ie, spontaneous abortion before the 20th week of pregnancy) from the sixth week of pregnancy. The Cox regression with a time-dependent exposure that incorporated a 3-day lag was used to estimate HRs and their 95% CIs adjusted for maternal characteristics. The 3-day lag period allows for addressing protopathic bias.

In total, there were 163 666 (3,37%) miscarriage cases, and 349 294 (7.19%) pregnancies were exposed to NSAIDs. Unexposed pregnancies were used as the reference category in all analyses. In the main analysis, exposure to NSAIDs increased the risk of miscarriage (HR, 1.83; 95% CI 1.81 to 1.86). The effect of individual drugs was heterogeneous, with 7 of the 19 drugs evaluated shown to increase the risk (flurbiprofen had the highest risk (HR, 3.28; 95% CI 3.15 to 3.41) and naproxen the lowest (HR, 1.09; 95% CI 1.01 to 1.18)). In the sensitivity analyses, increasing the lag time decreased the estimated HR (from HR, 2.25; 95% CI 2.21 to 2.28 with no lag to HR, 1.56; 95% CI 1.54 to 1.59 with a 7-day lag). Overall, the risk of miscarriage remained statistically significant in all the analyses.

Our study found that early exposure to NSAIDs could increase the risk of miscarriage. This finding contributes to the body of evidence on their safety profile and may help inform future recommendations for their use in pregnant women.

The predictive value of carotid-femoral pulse wave velocity (cfPWV) for cardiovascular (CV) events in individuals with blood pressure (BP) 120–159/80–99 mm Hg, where more accurate risk stratification has the greatest clinical effect, is unknown. This study aims to determine whether cfPWV improves the prediction of CV events beyond traditional risk factors in individuals with moderate BP.

A systematic review and meta-analysis.

PubMed and EMBASE were searched through April 2023.

We included prospective, population-based cohort studies with ≥1 year follow-up that directly measured cfPWV as an index of arterial stiffness and reported incident CV disease (CVD), atherosclerotic CVD (ASCVD), coronary heart disease, stroke or all-cause mortality outcomes.

Individual participant data from 11 cohorts (n=15 987) were harmonised and analysed using two-stage random-effects meta-analysis. Incremental predictive and clinical utility analyses compared 10-year risk models with and without cfPWV.

There were 1279 first atherosclerotic CV events over a median follow-up of 9.9 years. A 1-SD increase in log_e(cfPWV) was associated with a 1.21-fold (95% CI 1.08 to 1.36) increase in risk of ASCVD. Adding cfPWV to traditional risk factors improved ASCVD prediction: change in discrimination (C-index): 0.0048 (95% CI 0.0002 to 0.0094), p=0.041. In hypothetical populations of 100 000 individuals with moderate BP, cfPWV-guided treatment could reduce event rates by 2.7% and 3.1% under European and US guidelines, respectively.

Adding cfPWV to traditional CV risk factors may improve the prediction and classification of first CV events in individuals with moderate BP. Additional screening with cfPWV could enhance risk stratification for antihypertensive treatment initiations.

The Omicron variant of SARS-CoV-2 has emerged as the predominant strain of COVID-19 since 2022. Its association with prior vaccines remained under investigation.

Retrospective cohort study.

Clinical data for patients, from 1 May 2022 to 31 January 2023, were extracted from the Chi-Mei Medical Center, Chiali electronic medical record databases.

Hospitalised COVID-19 patients in dedicated wards were enrolled in the study. Cases of COVID-19 reinfection and relapse were also included. Patients who did not have COVID-19, those with PCR repositivity, or those with incomplete laboratory data were excluded.

Various doses of vaccines included primary series, additional dose and booster. The types of vaccines included ChAdOx1-S, mRNA-based vaccines and recombinant protein vaccine. The interval between the last vaccination date and the diagnosis date of COVID-19 was assessed.

The primary outcome was all-cause mortality by day 30. The secondary outcomes were severe disease of COVID-19 and 90-day survival.

Among 469 cases, the adjusted HR for 30-day mortality in vaccinated compared with unvaccinated patients was 0.831 (95% CI 0.541 to 1.277; p=0.398), indicating no statistically significant association. Age, Charlson Comorbidity Index (CCI), quick Sequential Organ Failure Assessment score and administration of dexamethasone were recognised as powerful predictors for survival in multivariable analysis. In subgroup analysis, a statistically significant association with better 30-day survival was observed among patients aged

Vaccination was associated with lower mortality in younger or low-CCI patients, but not in older or highly comorbid patients.

The financial impact on trauma patients can be devastating. Although Taiwan has universal health insurance coverage, medical bill reimbursement cannot compensate for the damage to a person’s ability to work. The aim of this study was to investigate personal financial outcomes after major trauma.

A retrospective cohort study.

Nationwide data from Taiwan’s National Health Insurance Research Database.

This study included all patients with major trauma (injury severity score ≥16) in Taiwan from 2003 to 2007, and a 10-year follow-up was conducted. Patients aged 18–70 were enrolled. Patients who returned to work after trauma (RTW) and those who did not return to work (non-RTW) were compared. Basic demographics and short-term outcomes were analysed, and the 10-year trend of income variation was calculated.

The primary outcomes are the ratio of non-RTW after major trauma, and the independent risk factors for non-RTW. The secondary outcome is the 10-year trend of income variation of major trauma patients.

5965 patients were included, with 4741 (79.5%) in the RTW group and 1224 (20.5%) in the non-RTW group. Hospital-acquired pneumonia, urinary tract infection, prolonged intensive care unit length of stay (LOS) and prolonged hospital LOS were identified as independent risk factors for future non-RTW. The mean monthly income of all patients declined in the three consecutive years postinjury and slowly returned to the preinjury level 9 years after the injury.

Loss of working ability was noted in 20.5% of major trauma patients, and the income level for all patients did not recover to the preinjury level until 9 years after the injury. Further welfare planning beyond the extent of the National Health Insurance programme should be made to protect the financial shortcomings experienced by these patients.

ISRCTN18269986.

In addition to hypertension, the constellation of metabolic abnormalities (diabetes mellitus, dyslipidaemia and/or obesity) independently increases the incidence and severity of cardiovascular diseases, and this is compounded by the modern lifestyle and ageing society. The prevalence of metabolic syndrome is high and non-hypertensive heart failure is common in Asians. Adverse cardiac remodelling is an important substrate for cardiac dysfunction in the onset and progression of heart failure and its amelioration improves outcomes and prognosis. A better understanding of metabolic-driven cardiac remodelling is warranted due to the rising prevalence and complexity of metabolic syndrome and strong interests in targeted therapy.

Response of the myocardium to hypertrophic conditions in the adult population is a prospective observational cohort study with an aim to establish the significance of cardiac remodelling by cardiovascular magnetic resonance (CMR). The current recruitment target is 2000 participants. Expanding from the initial population with hypertension, the study examines adults with cardiometabolic conditions, including diabetes, dyslipidaemia, obesity and fatty liver disease. Eligible patients are identified at National Heart Centre Singapore, primary care clinics and through public outreach. Physical, clinical, imaging and biochemical data are collected. Cardiac remodelling features pertaining to hypertrophy, fibrosis and functional changes are assessed on CMR. Body adiposity is mapped by MRI across the heart, liver and abdomen. Outcome data are adjudicated and follow-up assessment will be available in a subset of participants. Blood biomarkers will be investigated in relation to imaging findings. Cross-sectional analysis will establish the implication of cardiometabolic disease towards cardiac remodelling, while follow-up and outcome analysis will infer on disease progression and prognosis.

The study was approved by the SingHealth Centralised Institutional Review Board (2015/2603). Written informed consent is obtained from all participants. Study findings will be reported in peer-reviewed journals and at scientific conferences.

ClinicalTrials.gov, NCT02670031.