Long-term Benefits Research Articles

Respiratory and Postoperative Outcomes in Early-onset Scoliosis Patients Treated With Vertical Expandable Prosthetic Titanium Rib: Single-center Experience of 20 Years.

This study examines the long-term effectiveness and safety of the vertical expandable prosthetic titanium rib (VEPTR) device, developed in 1989 to treat early-onset scoliosis (EOS) and thoracic insufficiency syndrome (TIS). Specifically, it assesses VEPTR outcomes over 20 years in a single center, focusing on spine deformity correction, pulmonary function, weight percentile changes, and complication rates. A retrospective analysis was conducted on 36 patients from the EOS clinic who underwent VEPTR implantation without prior spine surgery, with at least 2 years of follow-up. Data collected included age, sex, weight, height, BMI, weight percentiles, comorbidities, radiographic parameters, pulmonary function tests, and complications. Weight percentile (WP) was calculated as preoperative WP and last follow-up WP. Coronal and sagittal deformities were measured preoperatively, immediately postimplantation, and at the last follow-up. Pulmonary function tests included forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) and were correlated with weight percentile changes. Complications were classified using established criteria. The mean age at VEPTR implantation was 86±34 months, with most cases attributed to neuromuscular scoliosis (56%). The initial coronal Cobb angle improved from 59±18 to 32±14 degrees postimplantation but increased to 60±25 at the final follow-up. Sagittal angles showed similar trends. Pulmonary function tests indicated a decline in FVC and FEV1 over time. There was no correlation between weight percentile changes and pulmonary function changes. Complication rates were high, affecting 63% of patients, which included hardware prominence, device migration, and infections as the most common. Although VEPTR devices initially corrected spinal deformities, their long-term benefits are limited as the correction becomes less pronounced over time. Expected improvement in pulmonary function is not observed. A different approach to treating EOS and TIS is necessary, as the significant complication rates challenge the implants' effectiveness. Level III.

Investment Decisions and Financial Performance of Insurance Companies in Kenya.

The financial performance of insurance firms in Kenya has been fluctuating, influenced by investment decisions, regulatory frameworks, and economic conditions. This study examines the relationship between investment decisions and financial performance among insurance companies in Kenya, focusing on government securities, corporate bonds, stocks, and real estate. A cross-sectional research design was adopted, targeting all 56 insurance and reinsurance firms registered with the Insurance Regulatory Authority of Kenya. The study utilized secondary data, analyzed through descriptive and inferential statistics, including ANOVA, multiple regression analysis, and Pearson correlation. Findings indicate that investment in government securities exhibits a strong positive correlation with return on assets (ROA), providing stable but limited capital growth. Corporate bonds demonstrate a moderate positive correlation with ROA, suggesting that firms benefit from long-term bond investments. Stock investments contribute to improved financial performance, albeit with a weaker correlation than government securities. Real estate investments show a weak relationship with ROA, implying limited direct impact on profitability despite long-term financial security benefits. The study concludes that strategic investment diversification can enhance financial performance, but insurance firms must carefully balance risk and return. It is recommended that insurers adopt a mixed investment strategy prioritizing government securities and corporate bonds for stability, while selectively investing in stocks and real estate for growth. Future research should explore the impact of macroeconomic factors and emerging investment instruments, such as digital assets and green bonds, on the financial performance of insurance firms.

Penile rehabilitation after radical prostatectomy using low-intensity shockwave therapy for erectile function: late results findings from a randomized clinical trial.

There is still few evidence to support the use of low-intensity extracorporeal shockwave therapy (LiESWT) in rehabilitation of erectile function after radical prostatectomy (RP). The aim of this study is to assess the long-term results of LiWEST as a penile rehabilitation method in patients who underwent RP. This is an assessment of the late results outcomes of our previous clinical trial registered in ReBEC (ensaiosclinicos.gov.br) RBR-85HGCG. Patients were randomized in two groups with two parallel arms and an allocation ratio of 1:1. The control group received tadalafil 5mg/day, while the experimental group received tadalafil 5mg/day and were submitted to 2400 shocks/session-week distributed on four different penile regions across 8weeks of treatment. Both groups started the penile rehabilitation after the removal of the transurethral catheter. Sexual function was assessed by International Index of Erectile Function (IIEF-5) score. A difference in IIEF-5 without statistical significance between the experimental and control groups. Among 77 patients included in our previous analysis, 35 patients were reassessed after a median follow-up of 45months (95% CI, 42-50months). Seventeen of them had to be excluded from the analysis for biochemical recurrence and/or new interventions. Remaining 7 and 11 patients in the experimental and control group, respectively. The final mean IIEF-5 score between experimental and control groups showed a difference in favor of the LiWEST group, not statistically significant (18.85, SD 5.66, 95% CI, 13.61-24.1 x 16.63, SD 5.48, 95%CI, 12.9- 20.31; respectively; P = 0.42). Subgroup analysis in patients still using IPDE5 there is a higher difference between mean IIEF5, however not statistically significantly (18.5, SD 6.12, 95%CI 12.07-24.92 x 15.85, SD 3.62, 95% CI, 12.50-19.20, P = 0.35). This study highlights that LiESWT may offer limited long-term benefit for erectile function recovery after RP. This study provides valuable long-term data on the use of LiESWT as a penile rehabilitation method after RP. The randomized design and parallel group structure strengthen the reliability Journal of Sexual Medicine Journal of Sexual Medicine For Peer Review of findings, with clear intervention protocols. However, limitations include a small final sample size due to patient exclusions, which likely impacted statistical power and the generalizability of results. Additionally, while differences in IIEF-5 scores favored the LiESWT group, the lack of statistical significance limits the ability to draw definitive conclusions about its effectiveness. The LiESWT showed no impact on long-term results of penile rehabilitation in patients submitted to RP.

A 12-months randomized clinical trial comparing fluoride-based remineralising protocols on post-orthodontic initial caries lesions.

To compare the long-term remineralization of initial caries lesion (ICL) treated with different remineralizing agents during orthodontic retention using optical coherence tomography (OCT). This randomised clinical trial recruited 30 patients on fixed appliances with at least one ICL labially on any maxillary incisor. At debond (baseline), they were allocated to three groups, where twice daily fluoride toothpaste was given: (1) as control; (2) supplemented with daily casein phosphopeptide amorphous calcium phosphate with fluoride (CPP-ACPF); or (3) supplemented with three-monthly professional applied fluoride varnish (FV). Primary outcome was the OCT backscatter reflectance changes of the ICL, measured as integrated reflectivity (IR). Follow-ups were at three-month intervals up to 12months. The trial was registered with Clinicaltrials.gov (NCT04788550). Analyses included 26 participants (nine control; nine CPP-ACPF; eight FV). There were significant reduction in integrated reflectivity over time. Post hoc comparisons showed reductions were significant up to 150-micron depth at 6-months, and up to 250-micron depth at both 9- and 12-months follow-up compared to baseline. At 12-months, FV had the lowest IR values, followed by CPP-ACPF and control, but the differences between groups were not significant. After 12-months observation, use of fluoridated toothpaste alone or supplemented with either fluoride varnish or CPP-ACPF promotes enamel remineralization up to 250-micron depth. Daily fluoridated toothpaste with regular 3-monthly recall visits from the start of orthodontic retention is recommended for effective control of initial caries lesions. FV and CPP-ACPF supplementation can be considered but their long-term benefits remain inconclusive.

Effects of perioperative treatment of resectable adenocarcinoma of esophagogastric junction by immunotherapy (Adebrelimab) combined with chemotherapy (XELOX): protocol for a single-center, open-labeled study (AEGIS trial, neoadjuvant immunochemotherapy).

For resectable adenocarcinoma of the esophagogastric junction (AEG), current treatment exploration primarily focuses on perioperative chemotherapy regimens combined with PD-1/PD-L1 inhibitors, but the long-term survival benefits of still require further investigation, and the use of upfront immunotherapy is typically restricted to patients with metastatic MSI-H (M1 MSI-H) disease due to their potential responsiveness to immunological agents. Adebrelimab, as a novel PD-L1 antibody, has not yet been proven for its efficacy and safety in adenocarcinoma of the esophagogastric junction. The AEGIS study is a prospective, open-labeled, single-arm, phase II clinical trial. A total of 26 patients with AEG will be enrolled. The primary endpoint is the pathologic complete response (pCR) rate after perioperative neoadjuvant immunochemotherapy. Secondary outcomes of the study include the objective response rate (ORR), R0 resection rate, major pathological response (MPR) rate, and pCR rate in combined positive score(CPS) ≥ 5 and MSI-H populations, event-free survival (EFS), and overall survival (OS). The exploratory outcomes are the biomarkers related to therapeutic efficacy, such as PD-L1 expression, microsatellite instability (MSI), tumor mutational burden(TMB), Epstein-Barr virus(EBV) infection, and circulating tumor DNA(ctDNA). This trail aims to verify the efficacy and safety of the perioperative treatment regimen of anti-PD-L1 (Adebrelimab) combined with chemotherapy (capecitabine plus oxaliplatin, XELOX) for patients with resectable AEG. Considering the differences in chemotherapy regimen tolerance between Asian and Western populations, this study intends to evaluate the suitability of Adebrelimab combined with XELOX chemotherapy for the Asian population. ClinicalTrials.gov: NCT06482788. The trial was prospectively registered on 22 May 2024, https://clinicaltrials.gov/study/NCT06482788 .

Effectiveness of a Developed Video Lesson On Kitchen Tools, Equipment, and Paraphernalia for TLE 8 Cookery Students

This study aimed to determine the effectiveness of a developed video lesson compared to traditional teaching methods in conveying TLE8-Cookery concepts to Grade 8 students at Gacub Atad S. Iligan Tribal National High School and Esperanza Integrated School. Using a quasi-experimental design, students were divided into two groups – one taught using a traditional approach, the other using a crafted video lesson. The video was developed following ADDIE Model and evaluated on content, instructional, and technical quality using the DepEd Learning Resource Management Department Section (LRMDS) tool. Results showed high ratings for the video’s content alignment, instructional clarity, and technical quality, especially its clear audio-visual elements. Moreover, students taught through the video lesson demonstrated significantly greater improvement in post-test scores compared to those taught traditionally, underscoring the video’s potential to enhance comprehension and retention in cookery concepts. The study recommends that the Department of Education and school leaders incorporate video lessons as effective tools to support technical subjects and consider training teachers in creating instructional videos. Future studies could extend this research to analyze the long-term impact and engagement benefits of video lessons.

Determinants of 5-year survival in patients with advanced NSCLC with PD-L1≥50% treated with first-line pembrolizumab outside of clinical trials: results from the Pembro-real 5Y global registry

BackgroundPembrolizumab monotherapy is an established front-line treatment for advanced non-small cell lung cancer (NSCLC) with programmed cell death-ligand 1 (PD-L1) tumor proportion score (TPS)≥50%. However, real-world data on its long-term...

Terapi Radiasi Eksternal dengan Metode Hypofractionated pada Kanker payudara Post Breast Conserving Surgery di Instalasi Onkologi Radiasi Rumah Sakit Indriati Solo Baru: Studi Kasus

Background: Radiotherapy is one method of cancer treatment that uses radiation to destroy cancer cells. Radiation dose delivery is done gradually through a process called fractionation, which is divided into conventional and hypofractionated fractions. In the radiation oncology installation of the new Indriati Solo Hospital, some breast cancer patients have received treatment with the hypofractionated method, while the majority still use the conventional fraction method. The hypofractionated method aims to reduce the number of treatment sessions by increasing the dose in each fraction with outcomes comparable to conventional fractions.Methods: This research method is descriptive qualitative with a case study approach. The study involves breast cancer patients post-Breast Conserving Surgery (BCS), Data were gathered through interviews with radiation oncologists, radiotherapists, and medical physicists, along with direct observations and patient record analysis The collected data were analyzed descriptively to evaluate the application and effectiveness of the hypofractionated method.Results: The results showed that the use of hypofractionated can shorten OTT (Overall Treatment Time), as well as better side effects than conventional fractions, and effectively reduce the number of queues of radiotherapy patients. In conclusion, the use of the hypofractionated method is very effective and recommended for radiotherapy treatment in breast cancer.Conclusions: Hypofractionated radiotherapy for breast cancer patients at Indriati Solo Baru has proven effective in reducing OTT and patient queues, with outcomes comparable to conventional fractionation. Further research is needed to assess long-term benefits, including quality of life, recurrence rates, cost-effectiveness, and dose distribution, particularly in high-volume healthcare settings. Hypofractionated radiotherapy is a promising alternative.

Parental singing during kangaroo care: parents' experiences of singing to their preterm infant in the NICU

IntroductionSinging fosters emotional connections, attachment, bonding, and language development in infants. Prematurely born infants, however, are at risk of missing this vital communication, impacting neurodevelopment and family wellbeing, especially during prolonged hospital stays. Kangaroo care provides physiological and emotional support, while Creative Music Therapy (CMT) has demonstrated positive effects on neurodevelopment, parental wellbeing, and attachment. The Singing Kangaroo project, a Swedish-Finnish multi-center randomized controlled trial (RCT), investigated the impact of parental singing during kangaroo care. This qualitative follow-up study explores these findings through the lens of Antonovsky's Sense of Coherence (SOC) model.MethodSemi-structured interviews were conducted with 28 families (20 intervention group, eight control group) at their infant's 5-month corrected age. The intervention group received CMT twice weekly during kangaroo care for 4 weeks in the NICU, while the control group received standard care. Data were analyzed inductively, followed by deductive categorization within the SOC framework, focusing on its three core components: Manageability, Comprehensibility, and Meaningfulness.ResultsParents in the intervention group reported enhanced understanding of how singing fosters attachment and boosts their self-esteem, aligning with increased manageability and comprehensibility. Control group parents also experienced joy in singing, which positively influenced family wellbeing, albeit less extensively. Across both groups, singing was described as a meaningful activity that strengthened parent-infant bonding and promoted emotional connection within the family.ConclusionParental singing during kangaroo care, particularly when supported by a trained music therapist, enhances parents' sense of coherence by fostering comprehensibility, manageability, and meaningfulness. This study highlights the long-term benefits of integrating CMT into family-centered NICU care to support both infants' neurodevelopment and family wellbeing.

Investigating the Impact of Sustainable Rice Cultivation Processes (Alternative Wetting and Drying and Direct Seeded Rice) on the Indian Agrarian Economy and its Contribution to the UN’s Sustainable Development Goals

Sustainability has become an integral part of the United Nations’ development goals to ensure that the usage of resources in the present does not deplete the quality or quantity of resources available for future generations. The importance of sustainable agricultural practices has increased by manifolds when combating environmental and food security challenges. Rice cultivation in India alone comprises 26% of global rice production hence alternative rice farming methods are being explored for their potential contribution to fulfilling the Sustainable Development Goals (SDGs) and ensuring that the agrarian economy in India is growing at a sustainable rate.i This study aims to analyse the extent to which alternative sustainable rice cultivation methods (Alternative Wetting and Drying [AWD] and Direct Seeded Rice [DSR]) align with Social Development goals and impact the Indian economy. The research employs a qualitative analysis of secondary data from academic journals, government reports, and industry publications to evaluate the environmental and economic impacts of sustainable rice farming methods. The findings indicate that practices such as DSR and AWD significantly reduce water usage, lower greenhouse gas emissions, and improve soil health aligning with the SDGs (specifically SDG 12 [Responsible Consumption and Production] SDG 13 [Climate Change] and SDG 15 [Life on Earth]). Additionally, these practices are shown to offer long-term economic benefits for farmers through increased yields and reduced input costs and provide an external benefit to society by reducing the harmful impact of the wastage of water and greenhouse gas emissions on the environment. This study also discusses various government policies and private-sector projects that have incentivised farmers to adopt these sustainable rice cultivation practices. This research contributes to a deeper understanding of how sustainable agricultural practices can be leveraged to achieve global sustainability goals, offering a model for integrating environmental and economic objectives in agricultural policy.

Inpatient Metformin Utilization and Post-hospitalization Clinical Outcomes: An Observational Cohort Study.

Metformin is the first-line treatment for diabetes, with multiple long-term benefits. However, there is limited evidence for its use in the inpatient setting, and clinical guidelines have historically recommended holding oral diabetes medications during acute hospitalization. While studies have not found evidence of harm from continuing metformin during hospitalization, withholding may lead to unnecessary insulin prescriptions, which in turn may lead to hypoglycemia events after discharge and other associated complications. To investigate the association between metformin use during hospitalization and post-hospitalization outcomes. Observational cohort study from January 2016 to January 2022, emulating a target trial. Adults with type 2 diabetes admitted to a Veterans Health Administration hospital for common medical conditions. Continuation of an outpatient metformin prescription during hospitalization. Hypoglycemia within 90 days of discharge. Secondary outcomes included insulin prescriptions at discharge, 90-day readmissions, and 90-day mortality. The propensity-matched cohort included 67,162 hospitalizations, equally split between those who did and did not have metformin continued during hospitalization. Within 90 days of hospital discharge, those that received metformin had lower risk of hypoglycemia (1.5% vs 1.8%; OR 0.83, 95% CI 0.73-0.93; p = 0.003), readmissions (29.4% vs 30.6%; OR 0.96, 95% CI 0.92-1.00; p= 0.03), and mortality (6.4% vs 7.4%; OR 0.86, 95% CI 0.80-0.92; p <0.001). Patients receiving metformin also had lower risk of insulin prescriptions at discharge (18.5% vs 20.3%; OR 0.89, 95% CI 0.84-0.95; p<0.001). Continuation of metformin during hospitalization for patients with type 2 diabetes was associated with decreased risk of post-hospitalization insulin prescriptions and 90-day hypoglycemia, readmissions, and mortality. These findings question clinical guideline recommendations to hold metformin during hospitalization.

Menumbuhkan Self-Love pada Remaja di MAN 2 Surakarta

Adolescence is a transition period from childhood to adulthood that is vulnerable to various psychological problems, such as searching for identity, social problems, academic pressure, and low self-confidence. Self-love or self-love is an important element in building mental health that is often overlooked, especially among adolescents. Based on the author's observations at MAN 2 Surakarta, it was found that students tend not to fully understand the concept of self-love, so they are vulnerable to social pressure, adakemik, and negative emotions. For this reason, this community service activity was carried out with the aim of instilling an understanding of the importance of self-love, recognizing oneself, and improving students' mental health. The implementation method used in this community service activity has three stages, namely: 1). Planning stage, 2). Implementation stage and 3). Evaluation stage. The results of this community service activity show that students begin to understand the importance of self-love as a basis for mental health. In conclusion, cultivating self-love is very important for adolescents to face psychological and social challenges. The application of this concept is expected to provide long-term benefits for students' mental and emotional well-being, as well as encourage their positive contributions in the social environment.

Navigating challenges and adherence in time-restricted eating: A qualitative study.

Adherence to any dietary approach is crucial for achieving long-term benefits. This qualitative study aims to explore the facilitators and barriers to adherence, and how individuals in community settings navigate time-restricted eating in their daily lives. Semi-structured, in-depth interviews were conducted with 21 participants who had practised time-restricted eating (confining the daily eating window to <10h a day; and excluding periodic fasting methods like the 5:2 approach or alternate day fasting) for periods ranging from 3 months to more than 5 years. A qualitative content analysis, underpinned by the Capability-Opportunity-Motivation-Behaviour Model, identified multiple facilitators, barriers, and strategies that evolved over the practice. Key facilitators included the simplicity and versatility of time-restricted eating, maintaining a non-obsessive and non-dieting mindset, and having a supportive environment. Barriers included hunger and food cravings, an obsessive mindset during the initial stages, and conflicting schedules with social eating occasions, including holidays. Participants employed several coping strategies to successfully navigate adherence and reported confidence in maintaining time-restricted eating as a lifestyle that contributes to better health and weight management. Our findings suggest that successful implementation of time-restricted eating in community settings requires flexibility and viewing it as more than a short-term weight loss tool. Guidelines are needed to help individuals and practitioners implement better practices and promote healthier behaviours.

The Role of Controlled Breathing in Pain Management

Breathing is a fundamental physiological process essential for cellular respiration and energy production. Beyond its physiological necessity, controlled breathing techniques such as yogic breathing etc. pranayama, have been practiced for centuries due to their perceived spiritual and health benefits, including stress reduction and pain management. Recent studies have explored the physiological effects of deep slow breathing (DSB), particularly its impact on the autonomic nervous system (ANS) and pain perception. Evidence suggests that breathing at a low frequency, such as 6 h per minute (bpm), enhances heart rate variability (HRV), promotes parasympathetic activity, and reduces stress and pain levels.This review examines the mechanisms underlying these effects, highlighting the role of the vagus nerve in regulating relaxation and reducing inflammation. Empirical studies demonstrate that DSB positively influences chronic pain conditions, including menstrual pain and visceral pain, by modulating pain perception and emotional regulation. Additionally, the combination of DSB and vagus nerve stimulation (VNS) has shown promise in managing chronic pain and improving musculoskeletal pain thresholds. Despite promising findings in menstrual pain, visceral pain, and chronic conditions, further research is needed to elucidate the mechanisms and optimize breathing techniques for pain relief. However, while DSB and VNS have demonstrated potential in reducing pain and anxiety, current research is limited in scope and methodology. Further investigations are needed to establish their long-term benefits and optimize their use in pain management strategies. This review underscores the need for a deeper understanding of the connection between controlled breathing, vagal tone, and pain relief to support their clinical application.

Safety and efficacy of perioperative chemotherapy combined with PD-1 inhibitor versus chemotherapy with D2 gastrectomy plus PAND in gastric cancer with PALD metastasis: A single-center retrospective cohort study.

368 Background: Gastric cancer with para-aortic lymph node (PALD) metastasis is associated with a poor prognosis. When the metastasis is limited to the PALD, preoperative systemic therapy combined with D2 gastrectomy plus para-aortic lymph node dissection (PAND) may enhance survival. The benefit of perioperative chemotherapy combined with immune checkpoint inhibitors for these patients is unknown. Methods: A total of 133 patients with gastric cancer and limited No.16a2/b1 lymph node metastasis underwent perioperative systemic therapy combined with D2 gastrectomy plus PAND. Patients receiving chemotherapy combined with a PD-1 inhibitor were assigned to Group A (n=62), while those receiving chemotherapy alone were assigned to Group B (n=71). Pathological response, safety, efficacy, and survival outcomes were compared between the two groups. Results: Adverse events occurred at comparable rates between the two groups. No treatment-related deaths occurred in either group. In Group A, all patients (100%) achieved R0 resection, compared to 70 patients (98.6%) in Group B. Group A showed significantly better pathological outcomes than Group B, with higher rates of pathological complete response (pCR) (37.1% vs. 4.2%, P &lt; 0.001), and major pathological response (MPR) (58.1% vs. 22.5%, P &lt; 0.001). Group A showed a higher 2-year overall survival (OS) rate compared to Group B (90.3% vs. 62.9%, P = 0.011). The median overall survival (mOS) in Group B was 35.0 months, while follow-up data for Group A are currently insufficient to assess mOS. Conclusions: The addition of a PD-1 inhibitor to chemotherapy significantly improves the pathological response rate and prognosis in gastric cancer patients with PALD. Notably, the combination did not increase adverse events. These findings suggest that combining PD-1 inhibitor with chemotherapy could be a promising strategy for improving outcomes in this patient population, though further prospective studies are necessary to confirm long-term survival benefits. Postoperative outcomes and pathological response. Variable Group A (n=62) % Group A (n=71) % P Value Vascular tumor embolus 0.005 Negative 43 69.4% 32 45.1% Positive 19 30.6% 39 54.9% Nerve infiltration 0.004 Negative 44 71.0% 33 46.5% Positive 18 29.0% 38 53.5% No.16a2/b1 0.057 Negative 53 85.5% 51 71.8% Positive 9 14.5% 20 28.2% Tumor resection 0.970 Distal 26 41.9% 30 42.3% Total 36 58.1% 41 57.7% Serum CEA (U/mL） 0.805 Normal 56 90.3% 65 91.5% &gt;5 6 9.7% 6 8.5% Serum CA125 (U/mL) 0.280 Normal 30 48.4% 41 57.7% &gt;35 32 51.6% 30 42.3% Serum CA199 (U/mL) 0.783 Normal 56 90.3% 65 91.5% &gt;37 6 9.7% 6 8.5% pT-stage &lt;0.001 ≤T2 37 59.7% 19 26.8% ＞T2 25 40.3% 52 73.2% pN-stage 0.001 N0/1 42 67.7% 27 38.0% N2/3 20 32.3% 44 62.0% TRG ＜0.001 0 23 37.1% 3 4.2% 1 13 21.0% 13 18.3% 2 22 35.5% 47 66.2% 3 4 6.5% 8 11.3% pCR 23 37.1% 3 4.2% ＜0.001 MPR 36 58.1% 16 22.5% ＜0.001

Development of a modified nutritional index model based on nutritional status and sarcopenia to predict long-term survival and chemotherapy benefits in elderly patients with advanced gastric cancer

BackgroundElderly patients with advanced gastric cancer have poor prognoses. This study aims to develop a prediction model for long-term survival after radical surgery and to identify patients who may benefit from chemotherapy. MethodsData from 555 elderly patients with advanced gastric cancer admitted to two medical centers from 2009 to 2018 were retrospectively analyzed. Sarcopenia was combined with the Controlling Nutritional Status (CONUT) score to create a modified nutritional index (mCONUT). Cox regression analyses were used to develop a novel nomogram prediction model (mCNS) that combined mCONUT, pN, and tumor size, and its performance was further verified both internally and externally. ResultsMultivariate Cox analysis revealed that tumor size, pN, and mCONUT were independent prognostic risk factors for overall survival (OS). The mCNS model showed good fit and high predictive value (AUC: training set 0.711; validation set 0.707), outperforming the pTNM model (p<0.05). To further investigate the association between the model and adjuvant chemotherapy, we categorized the model into two risk groups : a high-risk group and a low-risk group. Further analysis revealed that, in the low-risk group, the OS and recurrence-free survival(RFS) for patients receiving adjuvant chemotherapy was significantly better than that of those who did not receive chemotherapy (p=0.047,p=0.019). In the high-risk group, this result was not observed (p=0.120, p=0.053). ConclusionThe mCNS model has high predictive value in predicting long-term survival of elderly patients with advanced gastric cancer. Patients with mCNS-L were able to benefit from chemotherapy after laparoscopic radical gastrectomy.

Phenomapping the Response of Patients With Ischemic Cardiomyopathy With Reduced Ejection Fraction to Surgical Revascularization.

Coronary artery bypass grafting (CABG) has demonstrated long-term mortality benefits in patients with HFREF and obstructive coronary artery disease (CAD), but whether phenotypic heterogeneity influences the benefits of CABG is unknown. We applied clustering analysis to STICHES (Surgical Treatment for Ischemic Heart Failure Extension Study) to identify phenogroups with different long-term risk profiles and investigate differences in CABG benefits between phenogroups. STICHES was a randomized controlled trial evaluating the effect of CABG in addition to medical therapy versus medical therapy alone. We split the STICHES participants into derivation (n = 753) and validation (n = 459) cohorts. We phenomapped the derivation cohort using penalized model-based clustering. We fit multivariable Cox models to investigate long-term differences in all-cause mortality, cardiovascular (CV) mortality, and a composite of all-cause mortality/CV hospitalization between phenogroups and whether phenogroup assignment modified the effects of CABG on these outcomes. Findings were internally validated on the validation cohort. Four phenogroups were identified in the derivation cohort. The highest-risk group was at a twofold greater risk of death (HR: 2.0, 95% CI: 1.4-2.9, p < 0.001) and CV death (HR: 2.0, 95% CI: 1.3-3.1, p = 0.002), and a 1.5-fold greater risk for death/CV hospitalization (HR: 1.5, 95% CI: 1.1-2.1, p = 0.016). Phenogroup assignment did not modify the effects of CABG on the outcomes (p > 0.05 for all). Similar results were obtained in the validation cohort. The beneficial effects of CABG on all-cause mortality, CV mortality, and a composite of all-cause mortality and CV hospitalization persist despite phenotypic heterogeneity in HFREF and CAD.

Childhood adversity, early school leaving and long-term social benefit use: a longitudinal mediation analysis of a population-wide study

Childhood adversity, early school leaving and long-term social benefit use: a longitudinal mediation analysis of a population-wide study

Updated survival results of ZL-IRIAN: Irinotecan plus anlotinib or in combination with penpulimab as second-line treatment of metastatic colorectal cancer.

167 Background: The irinotecan based chemotherapy in combination with bevacizumab had become the standard second-line treatment for metastatic colorectal cancer (mCRC), but the efficacy was limited. Anlotinib, an oral anti-angiogenic tyrosine kinase inhibitor, had initially shown promising clinical effects when combined with chemotherapy in the first-line treatment of mCRC. Whether anlotinib could bring clinical benefit in the second line treatment warrants further exploration. The PD-1 antibody might have partial effects when combined with anti-angiogenic agents with or without chemotherapy in first- and third-line treatment for proficient mismatch repair (pMMR)/microsatellite stable (MSS) mCRC. Our study was to explore the rationality of anlotinib plus chemotherapy or further combined with a novel anti-PD-1 IgG1 antibody—penpulimab in the second line treatment of mCRC. Methods: This study was an open label, non-randomized, multi-cohorts, phase II prospective clinical trial that included pts with pMMR/MSS mCRC who were eligible for the second-line systemic treatment. Two cohorts were established as follows: Cohort A consisted of anlotinib(10mg daily, d1-10, q2w) + irinotecan (180mg/m d6, q2w) (n = 23); Cohort B consisted of anlotinib (8mg daily, d1-10, q2w)+irinotecan (180mg/m d6, q2w) + penpulimab (200mg, d6, q2w) (n = 23). The primary endpoint was ORR. Secondary endpoints included progress free survival (PFS), overall survival (OS), duration of response (DoR), disease control rate (DCR) and safety. The ORR was reported at 2024 ASCO, and PFS and OS have been updated in this report. Results: At the cutoff date on August 2024, a total of 23 Pts were enrolled in A cohort, and 23 pts were enrolled B cohort but 21 pts received at least one dose of treatment. The median PFS was 7.87 months (95% CI 5.52-10.22) in A cohort, compared to 7.4 months (95% CI 3.17-11.63) in B cohort, p=0.141. The 6-month, 12-month and 18-month PFS rates in A cohort and B cohort were 69.3% vs 80.7%, 27.5% vs 40.3% and 5.5% vs 22.4%, respectively. The median OS of A cohort was 21.73 months (95% CI 9.43-34.03), compared to 19.17 months (95% CI 11.44-26.90 months) in B cohort, p=0.987. The 12-month and 24-month OS rates in A cohort and B cohort were 64.7% vs 73.1% and 20.2% vs 54.8%, respectively. Safety profile indicated that 65.2% (15/23) and 66.7% (14/21) experienced grade≥3 adverse events in A cohort and B cohort, respectively. Common grade ≥ 3 adverse reactions (≥ 20%) mainly include hypertension (4.35% vs 14.29%), diarrhea (13.04% vs 9.52%), neutrophilopenia (39.13% vs 33.33%), and leukopenia (26.09% vs 9.52%). Conclusions: There was no statistically significant difference in overall efficacy between the two cohorts, but the long-term PFS and OS rates were higher in group B cohort, indicating that immunotherapy may bring long-term survival benefits to certain patients. Clinical trial information: NCT05229003 .

Transitioning From a Pilot Program of Home Care for Acute Symptoms to Long-Term Care Services Planning

The Ministry of Health and Welfare's "Pilot Program of Home Care for Acute Symptoms", launched in 2024, and complementary measures for long-term care services are introduced in this article. The goal of the pilot program is to provide appropriate home medical care to specific emergency patients as an alternative to hospitalization, allowing the extension of emergency care from hospitals to home and residential institutions and connecting long-term care resources during and after acute care. Given that many of those targeted by the pilot program are individuals with mobility issues or who require long-term care, and thus subject to higher levels of treatment difficulty and care service demand, the Ministry has relaxed the rules initially set for this program. Now, cases that meet the conditions for long-term care benefits under the "Regulations on Application and Payment for Long-Term Care Services" are eligible to access long-term care services during the home care period within the scope of care provided by the home care team without adjusting payment limits or co-payment terms. For institutional residents, additional incentive indicators for the pilot program have been incorporated into the "Plan for Minimizing Outpatient Visits by Institutional Residents". In summary, these measures are designed to improve the efficiency and quality of home care provided to address acute symptoms while optimizing the use of long-term care resources to address future medical and caregiving challenges in Taiwan's future super-aged society.