Baseline Factors Research Articles

A correlational study to assess the relationship between body mass index and selected life style practices among high school students in selected schools at Dakshina Kannada district, Karnataka, India

People in the 18.5-22.4 BMI range with high scores on the alternate healthy eating index and high levels of physical activity have the lowest risk of early mortality, while those with higher BMIs can still have a lower risk if they also have at least one low risk lifestyle component. To assess the body mass index of high school students in a selected school, lifestyle practice, find the association between selected lifestyle practices with demographic variables in high school students and association between Body Mass Index with demographic variables in high school students. Prior to starting the data gathering process, approval from BEO and the headmistresses of the chosen high schools was obtained. Canara High School and St. Aloysius High School in Mangalore hosted the primary study. The data gathering period ran from October 121, 2017, to January 1, 2018. All participants were told of the study's goal and gave their informed permission. The respondents received guarantees on the privacy and confidentiality of the data they submitted. Data from the samples were gathered by the researcher herself. In order to gather data, questionnaires about baseline data were used, along with a self-made rating scale to evaluate lifestyle behaviours and measures of height and weight to determine BMI. Karl Pearson ‘s correlation coefficient and Chi square test.The majority of samples, or 70%, had normal BMIs. Merely 20% of those surveyed were overweight. The least number of respondents (10%) were underweighted. Eighty-two percent of the respondents followed moderate lifestyles. Good living habits are present in 15% of the samples. The fewest responders (3%) led unhealthy lifestyles. Level of lifestyle habits broken down by area: The average lifestyle practice of students was 60.657.68, indicating that the majority of students follow a moderate lifestyle.A noteworthy correlation was observed between the mother's work and certain baseline factors, such as the body mass index score. Consequently, the null hypothesis was disproved. The score of a few chosen lifestyle activities and a few chosen baseline characteristics, such gender, were significantly correlated. They rejected the null hypothesis.Teenagers are the future citizens of this country, and their future depends on them. It is crucial to regularly assess students' body mass index and lifestyle choices so that those who lead unhealthy lifestyles can be quickly identified and treated appropriately to reduce their chance of developing health issues later on. Nurses will be able to teach parents and pupils about healthy lifestyle practices since they are aware of the relationship. The present study's findings have been taken into consideration for drawing the following conclusions.

A preliminary study of optimal treatment response rates in patients undergoing hepatic arterial infusion chemotherapy combined with molecular targeting and immunotherapy

ObjectivesThis study aimed to examine the effectiveness of the best response rate (BRR) as a surrogate for overall survival (OS), using the modified Response Evaluation Criteria in Solid Tumors (mRECIST), in patients with unresectable hepatocellular carcinoma (HCC) undergoing hepatic arterial infusion chemotherapy (HAIC) with fluorouracil, leucovorin, and oxaliplatin (FOLFOX) combined with molecular targeting and immunotherapy.MethodsThis study enrolled 111 consecutive patients who had complete imaging data. The median age of patients was 58 years (IQR 50.5-65.0). Among the patients, those with Barcelona Clinic Liver Cancer (BCLC) stage A, BCLC stage B, and BCLC stage C comprised 6.4%, 19.1%, and 73.6%, respectively. The optimal threshold of BRR can be determined using restricted cubic splines (RCS) and the rank sum statistics of maximum selection. Survival curves of patients in the high rating and low rating groups were plotted. We then used the change-in-estimate (CIE) method to filter out confounders and the inverse probability of treatment weighting (IPTW) to balance confounders between the two groups to assess the robustness of the results.ResultsThe median frequency of the combination treatment regimens administered in the overall population was 3 times (IQR 2.0-3.0). The optimal BRR truncation value calculated was −0.2. Based on this value, 77 patients were categorized as the low rating group and 34 as the high rating group. The differences in the OS between the high and low rating groups were statistically significant (7 months [95%CI 6.0-14.0] vs. 30 months [95%CI 30.0-]; p< 0.001). Using the absolute 10% cut-off value, the CIE method was used to screen out the following confounding factors affecting prognosis: successful conversion surgery, baseline tumor size, BCLC stage, serum total bilirubin level, number of interventional treatments, alpha-fetoprotein level, presence of inferior vena cava tumor thrombus, and partial thrombin activation time. The survival curve was then plotted again using IPTW for confounding factors, and it was found that the low rating group continued to have better OS than the high rating group. Finally, the relationship between BRR and baseline factors was analyzed, and inferior vena cava tumor thrombus and baseline tumor size correlated significantly with BRR.ConclusionsBRR can be used as a surrogate endpoint for OS in unresectable HCC patients undergoing FOLFOX-HAIC in combination with molecular targeting and immunotherapy. Thus, by calculating the BRR, the prognosis of HCC patients after combination therapy can be predicted. Inferior vena cava tumor thrombus and baseline tumor size were closely associated with the BRR.

Analysis of prognostic and predictive factors in neovascular age-related macular degeneration Kuopio cohort.

The aim of the study was to explore factors affecting the progression of neovascular age-related macular degeneration (nAMD) and identify predictive factors that can estimate the duration of intravitreal treatments. This retrospective real-world study included 421 nAMD patients treated at the Kuopio University Hospital during years 2007-2021. The collected data included background demographics, treatment history, visual acuity and retinal biomarker analysis. Impact of baseline factors on age at diagnosis, treatment duration, received treatment intensity and visual acuity gains were analysed. Heavy smoking and high body mass index (BMI) were associated with an earlier onset, while the use of anticoagulation and anti-aggregation medication were associated with a later onset of nAMD. A low number of injections during the first year of treatment and the presence of intraretinal fluid (IRF) at baseline were associated with shorter treatment duration. Interestingly, when IRF only patients were compared to subretinal fluid (SRF) only patients, IRF patients showed higher occurrences of subretinal drusenoid deposits (43.5% vs. 15%, p = 0.04). In addition, when all patients with IRF were compared to SRF only patients, more hyperreflective foci (HRF) and complete RPE and outer retinal atrophy (cRORA; 20.7% vs. 5%, p = 0.02) were observed in patients with IRF. Our results reveal that heavy smoking and high BMI are accelerating factors for earlier emergence of nAMD, while the presence of IRF results in a fast-progressing disease. More intriguingly, the link between IRF and appearance of subretinal drusenoid deposits, HRF, and increased retinal atrophy was observed.

Dural Sac Cross-sectional area change from preoperatively and up to 2 years after decompressive surgery for central lumbar spinal stenosis: investigation of operated levels, data from the NORDSTEN study.

The aim of the present study was to investigate how canal area size changed from before surgery and up to 2 years after decompressive lumbar surgery lumbar spinal stenosis. Further, to investigate if an area change postoperatively (between 3 months to 2 years) was associated with any preoperative demographic, clinical or MRI variables or surgical method used. The present study is analysis of data from the NORDSTEN- SST trial where 437 patients were randomized to one of three mini-invasive surgical methods for lumbar spinal stenosis. The patients underwent MRI examination of the lumbar spine before surgery, and 3 and 24 months after surgery. For all operated segments the dural sac cross-sectional area (DSCA) was measured in mm2. Baseline factors collected included age, gender, BMI and smoking habits. Furthermore, surgical method, index level, number of levels operated, all levels operated on and baseline Schizas grade were also included in the analysis. 437 patients were enrolled in the NORDSTEN-SST trial, whereof 310 (71%) had MRI at 3 months and 2 years. Mean DSCA at index level was 52.0mm2 (SD 21.2) at baseline, at 3 months it increased to 117.2mm2 (SD 43.0) and after 2 years the area was 127.7mm2 (SD 52.5). Surgical method, level operated on or Schizas did not influence change in DSCA from 3 to 24 months follow-up. The spinal canal area after lumbar decompressive surgery for lumbar spinal stenosis increased from baseline to 3 months after surgery and remained thereafter unchanged 2 years postoperatively.

Cognitive outcome after acute spontaneous intracerebral hemorrhage: analysis of the iDEF randomized trial.

Introduction The impact of intracerebral hemorrhage (ICH) on cognition and the determinants of cognitive recovery early after ICH remain elusive. In this post-hoc analysis of the Intracerebral Hemorrhage Deferoxamine (iDEF) trial, we examined the trajectories of cognitive impairment and the determinants of early cognitive recovery after ICH. Methods We examined baseline factors associated with 90-day cognitive outcome and constructed generalized linear mixed models to examine the trajectory of cognitive function over time among iDEF participants. Cognition was measured by the Montreal Cognitive Assessment (MoCA) scores at days 7, 30 and 90. Results 291 were available for analysis under the trial's modified intention-to-treat definition (38% female, mean age 60.3±12.0 years, median NIHSS 13, IQR 8-18). The median baseline ICH volume was12.9 IQR (6.4-26.0) ml; 59 (20%) of the ICH cases were lobar, 120 (41%) had intraventricular extension. There was an overall significant increase in total MOCA score with time (p<0.0001). Total MOCA score increased by an estimated 3.9 points (95% CI 3.1, 4.7) between the Day 7 and Day 30 assessments and by an additional 2.9 points (95% CI 2.2, 3.6) between the Day 30 and Day 90 assessments. Despite the overall improvement, 134 of 205 (65%) patients with patients with available 90-day MoCA score remained cognitively impaired with a score <26 at 90 days. Older age, higher NIHSS score, baseline ICH volume, intraventricular hemorrhage and perihematoma edema had an adjusted negative impact on cognitive recovery. Conclusions Although ICH survivors exhibit significant improvement of cognitive status over the first 3 months, cognitive performance remains impaired in the majority of patients. Among factors independently associated with worse cognitive recovery, higher baseline ICH, intraventricular blood and perihematomal edema volumes, are potential therapeutic targets that merit further exploration.

Factors associated with pathologic myopia onset and progression: A systematic review and meta-analysis.

To synthesise evidence across studies on factors associated with pathologic myopia (PM) onset and progression based on the META-analysis for Pathologic Myopia (META-PM) classification framework. Findings from six longitudinal studies (5-18 years) were narratively synthesised and meta-analysed, using odds ratio (OR) as the common measure of association. All studies adjusted for baseline myopia, age and sex at a minimum. The quality of evidence was rated using the Grades of Recommendation, Assessment, Development and Evaluation framework. Five out of six studies were conducted in Asia. There was inconclusive evidence of an independent effect (or lack thereof) of ethnicity and sex on PM onset/progression. The odds of PM onset increased with greater axial length (pooled OR: 2.03; 95% CI: 1.71-2.40; p < 0.001), older age (pooled OR: 1.07; 1.05-1.09; p < 0.001) and more negative spherical equivalent refraction, SER (OR: 0.77; 0.68-0.87; p < 0.001), all of which were supported by an acceptable level of evidence. Fundus tessellation was found to independently increase the odds of PM onset in a population-based study (OR: 3.02; 2.58-3.53; p < 0.001), although this was only supported by weak evidence. There was acceptable evidence that greater axial length (pooled OR: 1.23; 1.09-1.39; p < 0.001), more negative SER (pooled OR: 0.87; 0.83-0.92; p < 0.001) and higher education level (pooled OR: 3.17; 1.36-7.35; p < 0.01) increased the odds of PM progression. Other baseline factors found to be associated with PM progression but currently supported by weak evidence included age (pooled OR: 1.01), severity of myopic maculopathy (OR: 3.61), intraocular pressure (OR: 1.62) and hypertension (OR: 0.21). Most PM risk/prognostic factors are not supported by an adequate evidence base at present (an indication that PM remains understudied). Current factors for which an acceptable level of evidence exists (limited in number) are unmodifiable in adults and lack personalised information. More longitudinal studies focusing on uncovering modifiable factors and imaging biomarkers are warranted.

Outcome of Darunavir-Cobicistat-Based Regimens in HIV-Infected People Who Have Experienced Virological Failure.

To evaluate the virological outcome of darunavir-cobicistat (DRVc)-based regimens in adults living with HIV who had experienced virological failure (VF) on any previous drug combination. This was a retrospective cohort study (CSLHIV Cohort) of adults living with HIV who started a DRVc-based regimen with HIV-RNA >50 copies/mL after VF on any previous drug combination. Data on demographics, antiretroviral treatment since HIV diagnosis, and immunological and metabolic parameters from baseline (start of DRVc) to 48 weeks were analyzed in order to assess the cumulative proportion of those who achieved virological success (VS), defined as at least one instance of HIV-RNA <50 copies/mL within 12 months from baseline. Follow-up lasted from the start of the DRVc-based regimen (baseline) to the first instance of HIV-RNA <50 copies/mL, last available visit, or lossto follow-up or death, whichever occurred first. Univariate and multivariate Cox proportional-hazard regression models were used to identify baseline factors associated with VS. A total of 176 individuals were included, and 120 (68.2%) achieved <50 HIV-RNA copies/mL within 12 months since baseline. On multivariate analysis, baseline HDL cholesterol was independently associated with the occurrence of VS (adjusted HR 1.021, 95% CI 1.004-1.038; p=0.014). Among the 120 subjects with VS, 27 (22.5%) had had VF during a median follow-up of 20.8 months since the first undetectable HIV-RNA. Resistance testing after VF was available in two cases, which harboured the HIV variant-bearing protease inhibitor-resistance mutations D30N, I50V, and N88D. During a median follow-up of 38.4 months, 65 of 176 (36.9%) individuals discontinued DRVc for any reason (37 of 120, 30.8%) and achieved VS vs. 28 of 56 (50%) without VS (p=0.019). Time to discontinuation was longer in people with VS (41.5 vs. 23.0 months, p=0.0007). No statistically significant changes were observed in immunological or lipid profiles during follow-up. Most individuals in this study achieved VS within 12 months from the beginning of a DRVc-based regimen; therefore, this treatment represent a viable option for people who have experienced VF on other regimens.

Heart Rate Variability, Deceleration Capacity of Heart Rate, and Death: A Veteran Twins Study.

Autonomic function can be measured noninvasively using heart rate variability (HRV), which indexes overall sympathovagal balance. Deceleration capacity (DC) of heart rate is a more specific metric of vagal modulation. Higher values of these measures have been associated with reduced mortality risk primarily in patients with cardiovascular disease, but their significance in community samples is less clear. This prospective twin study followed 501 members from the VET (Vietnam Era Twin) registry. At baseline, frequency domain HRV and DC were measured from 24-hour Holter ECGs. During an average 12-year follow-up, all-cause death was assessed via the National Death Index. Multivariable Cox frailty models with random effect for twin pair were used to examine the hazard ratios of death per 1-SD increase in log-transformed autonomic metrics. Both in the overall sample and comparing twins within pairs, higher values of low-frequency HRV and DC were significantly associated with lower hazards of all-cause death. In within-pair analysis, after adjusting for baseline factors, there was a 22% and 27% lower hazard of death per 1-SD increment in low-frequency HRV and DC, respectively. Higher low-frequency HRV and DC, measured during both daytime and nighttime, were associated with decreased hazard of death, but daytime measures showed numerically stronger associations. Results did not substantially vary by zygosity. Autonomic inflexibility, and especially vagal withdrawal, are important mechanistic pathways of general mortality risk, independent of familial and genetic factors.

Real-world clinical remission of severe asthma with benralizumab in Spanish adults with severe asthma

Objective Patients with severe eosinophilic asthma experience high risk of exacerbations and reduced quality of life. Benralizumab, a monoclonal antibody binding to IL-5 receptor α subunit, is an approved drug for its treatment. The objective was to describe clinical remission after benralizumab prescription in routine clinical practice. Methods Retrospective multicenter study with data from four hospitals in Valencian Community (Spain) with asthma units between 2019 and 2020. Data was gathered at baseline and after 12 months. We considered clinical remission after 1 year if the patient remained without exacerbations and use of systemic corticosteroids and with good clinical control and normal lung function. Results Data from 139 patients was gathered. At the 12-month follow-up, 44.1% were in clinical remission, since 84.0%, 77.5%, 51.0% and 95.5% of patients did not experience exacerbations, had total asthma control test score of ≥20, prebronchodilator FEV1 of ≥80% and did not use systemic corticosteroids. A significant reduction of long-acting muscarinic antagonists (p = 0.0001), leukotriene receptor antagonists (p = 0.0326), oral corticosteroids (p < 0.0001) and short-acting beta agonists (p = 0.0499) was observed. Baseline factors with greatest individual influence on clinical remission were employment situation, tobacco use, comorbidity number, eosinophil value, number of exacerbations, FEV1, emergency visit number, and ACT, MiniAQLQ and TAI scores. Final analysis of multiple logistic regression indicated that having baseline FEV1 value below 80% increases remission chance 9.7 times a year compared to FEV1 >80%. Conclusion Clinical remission after treatment with benralizumab is achievable in a high percentage of patients with severe asthma eosinophilia not controlled in real life.

Improved patient reported outcomes with the direct anterior approach versus the posterior approach for total hip arthroplasty in the early post-operative period.

Patients undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA) may experience faster recovery but may also have better baseline health than those who undergo THA with the posterior approach (PA). This study aimed to compare patient-reported outcome measures (PROMs) between the DAA and PA while controlling for baseline factors. This is a secondary data analysis from a prospective cohort study of patients utilizing a smartphone-based care management platform following THA. The primary outcomes were HOOS JR and EQ-5D-5L through 1 year and change from baseline. Longitudinal regression models were created to control for baseline characteristics and investigate the impact of surgical approach on PROMs. Of 1364 THAs evaluated, 731 (53.6%) were female, and 840 (61.6%) used the PA. Patients in the PA group were of similar age but had higher body mass index and comorbidity scores. Pre-operative HOOS JR and EQ-5D-5L were comparable, but higher post-operatively in the DAA group through 6months (p = 0.03 and p = 0.005). At 1 year post-operatively, HOOS JR and EQ-5D-5L did not vary between groups (p = 0.48 and p = 0.56), nor did changes from baseline (p = 0.47 and p = 0.11). After controlling baseline characteristics, DAA was significantly associated with higher average HOOS JR through 6months (p = 0.03) and EQ-5D-5L through 3months (p  = 0.005), but not at 12months (p = 0.89 and p = 0.56). THA patients undergoing DAA demonstrate earlier improvements in HOOS JR and EQ-5D-5L. However, these differences may not be clinically significant and are not evident at 1-year post-operative. Patient selection and surgeon training may continue to affect outcomes by surgical approach.

Association of comorbidities with postoperative walking independence in patients with hip fractures: a single-center, retrospective, observational study.

Hip fractures (HFs) are common in the elderly and lead to decreased walking independence. Although comorbidities may be associated with gaining walking independence, few studies have comprehensively examined baseline and preoperative clinical factors. We aimed to evaluate the effects of comorbidities on the postoperative walking independence of patients with HFs. This single-center, retrospective, observational study included patients with HFs admitted to an acute care hospital between 1 May 2022 and 1 March 2023, who before the incident were able to walk independently [functional independence measure (FIM) walk score ≥6 points]. Postoperative walking independence was evaluated using the walk item of the FIM. The Charlson comorbidity index (CCI) was used to evaluate comorbidities at admission, and the patients were divided into two categories with CCI scores of 0 points and ≥1 point. The effect of comorbidities, assessed using the CCI, on postoperative walking independence was evaluated using Cox proportional hazards analysis. Ninety-four participants were included in the analysis. The Cox proportional hazards model adjusted for potential confounders (age, operative delay and nutritional status) revealed that the CCI was significantly associated with postoperative walking independence (P < 0.05). The hazard ratio and 95% confidence interval (CI) for the CCI for postoperative walking independence were 0.40 (95% CI, 0.189-0.865). Preoperative assessment of comorbidities using the CCI may aid in predicting the postoperative walking independence of patients with HFs.

Abstract 2256: Guideline-based physical activity and physical quality of life among individuals with nonmetastatic prostate cancer: A target trial emulation in the Health Professionals Follow-up Study

Abstract Introduction: Randomized trials have shown that physical activity can improve quality of life (QOL) among individuals with cancer. In the absence of a randomized trial of adequate size and follow-up to comprehensively evaluate this relationship for prostate cancer, we aim to emulate a target trial of guideline-based physical activity strategies and 6-year physical QOL. Methods: We will use observational data on individuals in the Health Professionals Follow-up Study diagnosed with nonmetastatic prostate cancer between 2010-2016 and free of conditions that could preclude following current physical activity recommendations at baseline (first post-diagnostic questionnaire). The physical activity strategies of interest are (1) engage in ≥150 minutes of moderate activity, or ≥75 minutes of vigorous activity per week, or an equivalent combination (i.e., ≥7.5 metabolic equivalent of task [MET]-hours/week of vigorous or moderate activity) and (2) no physical activity intervention. The outcomes of interest are 6-year mean physical QOL scores (based on EPIC-CP measures of bowel function, urinary incontinence, urinary irritation/obstruction, sexual function, and vitality/hormonal function). We will adjust for baseline and time-varying risk factors using the parametric g-formula. Conclusion: These findings may help to inform clinical recommendations to improve QOL among individuals with nonmetastatic prostate cancer. Further, the proposed approach will provide a framework for future studies designed to evaluate the effectiveness of any intervention strategies to improve patient-reported outcome measures in cancer survivorship research. Table 1. Specification and emulation of a target trial using observational data from HPFS Protocol component Target trial specification Target trial emulation Eligibility criteria (1) Individuals diagnosed with non-metastatic prostate cancer between 2010 and 2016; (2) No history of other cancers (Except nonmelanoma skin cancer); (3) No history of conditions that could preclude high levels of physical activity: myocardial infarction, stroke, congestive heart failure, amyotrophic lateral sclerosis, or functional impairment (defined as difficulty climbing a flight of stairs or walking eight blocks due to physical impairment) Same as for the target trial, except: We required complete data on physical activity, birth date, and other risk factors on the pre-diagnostic questionnaire and the first post-diagnostic (baseline) questionnaire. Physical activity strategies Each individual is assigned to one of the following strategies at baseline: (1) No intervention (usual physical activity) (2) Engage in ≥1.25 hours/week of vigorous activity or ≥2.5 hours/week of moderate activity or ≥7.5 MET-hours/week of vigorous or moderate activity (an equivalent combination). Strategies are initiated at baseline and continued over follow-up. Individuals are excused from following the physical activity intervention upon the development of myocardial infarction, stroke, congestive heart failure, amyotrophic lateral sclerosis, cancer metastasis, or functional impairment. Individuals must respond to surveys at every follow-up period to assess time-varying variables. Same as for the target trial, except: (1) Follow-up periods correspond to the questionnaire cycles in the cohort study. (2) We assumed that each 2-year physical activity questionnaire accurately reflects the individual's (1) average physical activity over the previous 2-year period and (2) intended physical activity that the individual would have reported at the start of the current period under no intervention. Strategy assignment Individuals are randomly assigned to a strategy at baseline and are aware of their assigned strategy. We assumed randomization conditional on the following baseline covariates: age; employment status; primary treatment; stage; Gleason score, and prostate-specifc antigen level at diagnosis; pre-baseline values of body-mass index and physical activity. Outcomes 6-year mean quality of life scores in the following physical domains: (1) Bowel function, (2) Urinary incontinence, (3) Urinary irritation/obstruction, (4) Sexual function, (5) Vitality/hormonal function. Individuals self-report their physical quality of life on EPIC (The Explanded Prostate Cancer Index Composite) questionnaires at every follow-up period. Same as for the target trial. Follow-up periods correspond to the questionnaire cycles in the cohort study. Follow-up For each eligible individual, follow-up starts at strategy assignment (baseline) and ends upon death, loss to follow-up, or the end of follow up in December 2018, whichever happens first. Same as for the target trial. Loss to follow-up was defined as questionnaire non-response. Causal contrasts Intention-to-treat and per-protocol effect. Observational analogue of per-protocol effect. Statistical analysis Intention-to-treat analysis. Per protocol analysis: Parametric g-formula to compare 6-year physical quality of life under each strategy via mean differences, with adjustment for pre- and post-baseline prognostic factors associated with adherence and loss to follow-up. Same as for the per-protocol analysis of the target trial. Citation Format: Naiyu Chen, Rachel C. Nethery, Lorelei A. Mucci, Barbra A. Dickerman. Guideline-based physical activity and physical quality of life among individuals with nonmetastatic prostate cancer: A target trial emulation in the Health Professionals Follow-up Study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2256.

Association of immune-related adverse events with durvalumab efficacy after chemoradiotherapy in patients with unresectable Stage III non-small cell lung cancer.

Immune-related adverse events (irAEs) have been found to predict PD-L1 inhibitor efficacy in metastatic NSCLC. However, the relation of irAEs to clinical outcome for nonmetastatic NSCLC has remained unknown. In this multicenter prospective study of Stage III NSCLC treated with PACIFIC regimen, the relation of irAEs to PFS was evaluated by 8-week landmark analysis to minimise lead-time bias as well as by multivariable analysis adjusted for baseline factors. irAEs were categorised as mild or nonmild according to whether they were treated with systemic steroid. Median PFS was 16.0 months, not reached, and 9.7 months for patients without (85 cases) or with mild (21 cases) or nonmild (21 cases) irAEs, respectively. Multivariable analysis indicated that nonmild irAEs were associated with poor PFS, with HRs of 3.86 (95% CI, 1.31-11.38) compared with no irAEs and 11.58 (95% CI, 2.11-63.63) compared with mild irAEs. This pattern was consistent after irAE grade, the number of durvalumab doses and immune profiles (PD-L1 score, CD8+ tumour-infiltrating lymphocyte density, and tumour mutation burden) were taken into consideration. The development of mild irAEs might predict a better survival outcome, whereas immunosuppressive steroid-treated irAEs were associated with a worse outcome, regardless of baseline clinical and immune profiles.

Initiation of belimumab with higher daily prednisolone is effective for rapid glucocorticoid reduction: A 96-week retrospective study.

For appropriate glucocorticoid (GC) reduction, we investigated the optimal strategy including baseline factors that could reduce GC more than 50% with 96weeks of belimumab. This is a retrospective cohort study of Kakogawa Central City hospital from 2019 to 2023. We identified SLE patients who were receiving 200mg of belimumab weekly by subcutaneous injection for 96 weeks. The background at baseline, trends in clinical indicators, and factors involved in GC reduction were statistically analyzed. Finally, univariate and multivariate logistic analyses were carried out to identify baseline factors associated ≥50% GC reduction at 96weeks. Forty-seven patients were enrolled, with a median daily prednisolone of 5mg. Almost 90% of them received concomitant immunosuppressants and/or hydroxychloroquine. Serological indices, daily GC dose, and SLEDAI-2K scores showed significant improvement in 96weeks. At baseline, a significant negative correlation has been shown between the daily dose of GC and the duration from onset or last flare, as well as C4 levels. At 96weeks, GC reduction rate and SLEDAI-2K scores were negatively correlated with duration from onset or last flare to initiation of belimumab. Mycophenolate mofetil use was significantly frequent in patients with lupus nephritis (LN), which also correlated with the frequency of past flares. In addition, LN presence was associated with higher SLEDAI-2K scores at 96weeks, and baseline SLEDAI-2K ≥10 was associated with significantly higher GC dose at 96weeks. Univariate analysis of the factor contributing to achieving ≥50% GC reduction at 96weeks has pointed shorter disease duration and higher daily GC dose at baseline as significant variables. Finally, we performed a multivariate analysis by combining above two items with age, which extracted the higher daily GC dose at baseline as a significant variable (OR (95% CI) 1.25 (1.00 to 1.56), p = .047). Our study showed that a delay in belimumab initiation led to higher SLEDAI-2K score and difficulty in achieving a 50% GC reduction at 96weeks. Since GC-related adverse events increase with long-term administration of GC though with small daily doses, we proposed here that belimumab should be started in combination with higher daily prednisolone.

Impact of preoperative persistent or permanent atrial fibrillation on inhospital mortality after coronary artery bypass graft surgery

Introduction: Atrial fibrillation (AF) is an arrhythmia that has a well-established impact on cardiovascular and cerebrovascular morbidity and mortality. However, the role of this arrhythmia plays on surgical risk remains uncertain. Objective: to evaluate the impact of preoperative persistent or permanent AF on in-hospital mortality after isolated coronary artery bypass graft surgery (CABG). Methods: prospective cohort with 2,377 patients submitted to isolated CABG between January 2014 and December 2021. Sixty-two variables, including baseline factors, operative characteristics, and outcomes, were analyzed. Patients were divided into two study groups: No preoperative AF (n=2,287) and preoperative persistent or permanent AF (N=90). The comparison between the groups was performed initially by descriptive and univariate analysis. Subsequently, the analysis of mortality predictors was performed using binary logistic regression - multivariate adjusted analysis. Results: patients with preoperative AF were older, had a higher prevalence of pulmonary hypertension and anemia, had lower ejection fraction and had higher surgical risk scores when compared with patients with no history of atrial fibrillation. The in-hospital death was more frequent in patients with a history of AF (3.2% vs 8.9%, P=0.010). Through the multivariate analysis, it was possible to verify that preoperative AF is independently associated with the occurrence of in-hospital mortality after CABG (OR 2.68; 95% CI 1.21-5.94, P=0.015). Conclusion: Preoperative persistent or permanent AF has been shown to have a significant impact on in-hospital mortality rates after CABG even after adjusted multivariate analysis, being an independent risk predictor for the occurrence of postoperative death.

What really matters for returning to work after breast cancer? A 6-month exploratory study

ABSTRACT Return to work (RTW) after breast cancer (BC) may significantly impact on women recovery and quality of life. Literature hightlighed several factors associated to RTW after BC but there is still some concern about prognostic factors influencing work resumption after BC treatments. The present study aims to explore which baseline factors are associated with RTW at 6-month after BC surgery. The participants in this 6-month prospective study were 149 patients who underwent breast cancer-related surgery and accessed an Oncology Clinic for cancer therapy from March 2017 to December 2019 in Northern Italy. Participants filled in a battery of questionnaires at baseline, and they were asked whether they had returned to work at 6-month follow-up. Psychological measurements included job stress (Job Content Questionnaire), work engagement (Utrecht Work Engagement Scale), quality of life (World Health Organization Quality of Life- BREF), anxiety and depression (Hospital Anxiety and Depression Scale), resilience (Connor – Davidson Resilience Scale − 10 item) and personal expectations about RTW (ad-hoc single item). Moreover, sociodemographic, clinical, and work-related data were collected. Independent t-test and Chi-square test were used for comparisons among variables; logistic regression model was used to explore predictors of RTW. A total of 73.9 percent returned to work at6-month after surgery. In the multivariate model, chemiotherapy (B = −1.428; SE = 0.520) and baseline women’s expectations about their RTW (B = −0.340; DS = 0.156) were significant predictors of RTW. These results suggest that careful individual clinical and psychological screening of risk factors at baseline can prevent from occupational disability and long sickness absence.

Predictive factors for dose reduction and discontinuation of nintedanib in fibrotic interstitial lung diseases: Real life data

Nintedanib, an intracellular inhibitor targeting multiple tyrosine kinases, has emerged as a standard treatment for various fibrotic lung diseases. Despite its efficacy, side effects such as nausea, diarrhea, and hepatotoxicity often lead to dose reduction or discontinuation. In this retrospective analysis at an university hospital's interstitial lung disease clinic, we aimed to identify baseline characteristics associated with dose adjustment or treatment discontinuation. Of the 58 patients included, 41.4% maintained the full nintedanib dose, while 31.0% required dosage reduction, and 27.6% discontinued treatment due to adverse events, predominantly gastrointestinal and hepatotoxic effects. Multivariate analysis revealed body surface area (BSA) as an independent and significant baseline risk factor (adjusted Odds Ratio [aOR] 0.22), suggesting a 78% decreased chance of requiring dose modification for every decimal point increase in BSA. A BSA cutoff of ≤1.73 m [2] exhibited a sensitivity of 73% and specificity of 91.7%, with significant impact on one-year survival under full-dose treatment (p < 0.001). Lower BSA was associated with early onset adverse effects, particularly gastrointestinal, supporting the need for regular clinical monitoring. The study emphasizes the importance of recognizing baseline factors to ensure the safety and tolerability of nintedanib, thereby preventing the progression of pulmonary fibrosis. These findings contribute to the evolving understanding of nintedanib management in fibrotic interstitial lung diseases, guiding clinicians in personalized treatment approaches.

The relation between usage of an eHealth intervention for stress urinary incontinence and treatment outcomes: an observational study

BackgroundStress urinary incontinence (SUI), though a prevalent condition among women, is undertreated in primary care. EHealth with pelvic floor muscle training is an evidence-based alternative to care-as-usual. It is unknown, however, how eHealth usage is related to treatment outcome, and this knowledge is required for general practitioners to implement eHealth in their practice. This study examines the relation between usage of eHealth for SUI and treatment outcomes by examining log data. Baseline factors were also explored for associations with treatment success.MethodIn this pre-post study, women with SUI participated in “Baasoverjeblaas.nl”, a web-based intervention translated from the Swedish internet intervention "Tät®-treatment of stress urinary incontinence". Usage was based on log data and divided into three user groups (low, intermediate and high). Online questionnaires were sent before, after treatment and at six-months follow-up. The relation between usage and the primary outcome − treatment success (PGI-) − was studied with a binomial logistic regression analysis. Changes in the secondary outcomes − symptom severity (ICIQ-UI SF) and quality of life (ICIQ-LUTSqol) − were studied per user group with linear mixed model analysis.ResultsIncluded were 515 users with a mean age of 50.5 years (12.0 SD). The majority were low users (n = 295, 57.3%). Treatment success (PGI-I) was reached by one in four women and was more likely in high and intermediate users than in low users (OR 13.2, 95% CI 6.1–28.5, p < 0.001 and OR 2.92, 95% CI 1.35–6.34, p = 0.007, respectively). Symptom severity decreased and quality of life improved significantly over time, especially among high users. The women’s expected ability to train their pelvic floor muscles and the frequency of pelvic floor muscle exercises at baseline were associated with treatment success.ConclusionThis study shows that usage of eHealth for SUI is related to all treatment outcomes. High users are more likely to have treatment success. Treatment success is more likely in women with higher expectations and pelvic floor muscle training at baseline. These findings indicate that general practitioners can select patients that would be more likely to benefit from eHealth treatment, and they can enhance treatment effect by stimulating eHealth usage.Trial registrationLandelijk Trial Register NL6570; https://onderzoekmetmensen.nl/nl/trial/25463.

Red Yeast Rice and Statin Therapy in Patients with Hypercholesterolemia and the Comorbidities: A Retrospective Cohort Study on Lipid-Lowering Effects and Cardiovascular Outcomes.

Red yeast rice (RYR) is known for its lipid-lowering effects in patients with hypercholesterolemia; however, its comparative efficacy with statins and risk reduction remains uncertain. This retrospective study analyzed data from 337,104 patients with hyperlipidemia in the Chang Gung Research Database cohort, spanning from January 2016 to December 2021. Exclusion criteria were applied to ensure data completeness and compliance, including an age limit of [Formula: see text] years, absence of RYR or statin treatment, and a treatment duration of [Formula: see text] days. Propensity score matching was employed to minimize bias based on baseline factors, with one patient matching with four patients in the comparison group. The study encompassed a total of 5,984 adult hyperlipidemic patients, with 1,197 in the RYR group and 4,787 in the statin group. The patients were also stratified into statin ([Formula: see text]) or combined use ([Formula: see text]) groups for further comparison. Following one year of treatment, both the RYR and statin groups exhibited reductions in total cholesterol and triglyceride levels. Most biochemical parameters showed no significant differences, except for elevated glutamic oxaloacetic transaminase levels in the RYR group ([Formula: see text]) and increased glycohemoglobin levels in the statin group at the three-month mark ([Formula: see text]). In patients with comorbid diabetes, hypertension, kidney, or liver diseases, RYR and statins demonstrated comparable risks for emergency room (ER) visits, stroke, and myocardial infarction (MI). However, the combination of RYR and statins was associated with reduced stroke-related hospitalizations in patients with diabetes, hypertension, and kidney disease, as well as decreased MI-related hospitalizations in patients with hypertension and kidney disease (all [Formula: see text]). In conclusion, both RYR and statins effectively lower blood lipid levels and mitigate related complications. Combining these therapies may lead to fewer ER visits, reduced stroke frequency, and fewer MI hospitalizations in hypertensive and kidney disease patients, and they decreased all-cause mortality in the kidney disease population. Further research on combined therapy is warranted.

Improving lifestyle behaviors during chemotherapy for breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis (LEANer) Trial.

Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes. Newly diagnosed patients with breast cancer (N=173) undergoing chemotherapy were randomized to a year-long nutrition and exercise intervention (n=87) or usual care (UC, n=86). Mixed models compared 1-year changes in PA and diet quality via the Healthy Eating Index (HEI)-2015 by study arm. Among the intervention group, baseline factors associated with change in PA and diet were assessed with multivariable linear and logistic regression. At 1 year, compared with UC, the intervention arm increased PA more (mean difference=136.1 minutes/week; 95% CI,90.2-182.0), participated in more strength training (56% vs. 15%; p<.001), and had suggestive improvements in HEI-2015 (mean difference=2.5; 95% CI, -0.3 to 5.3; p=.08). In the intervention arm, lower fatigue was associated with improved PA (p=.04) and higher education was associated with improved HEI-2015 (p=.001) at 1 year. Higher HEI-2015 (p=.04) and married/living with someone (p=.05) were associated with higher odds of participating in strength training at 1 year. This year-long lifestyle intervention for patients with breast cancer undergoing chemotherapy resulted in increases in PA and suggestive improvements in diet quality. Behavior change was associated with baseline fatigue, diet quality, education, and married/living with someone. Addressing these factors in interventions may improve uptake of lifestyle behaviors in trials during and after chemotherapy.