Burden Index Research Articles

Weak Correlations and Strong Implications: Patient Age, Functional Status, and Caregiver Burden

Background: Family caregivers often face significant physical, emotional, and financial challenges when caring for surgical patients. Caregiver burden, a critical aspect of healthcare, is influenced by various patient-related factors, including age, functional capacity, and illness severity. This study examines the relationships between caregiver burden, assessed using the Zarit Burden Index (ZBI), and patient characteristics among surgical patients in Delta State, Nigeria, with a focus on practical implications for caregiving strategies. Methodology: The study utilized a cross-sectional design involving caregivers of surgical patients at two hospitals in Delta State, Nigeria. Data were collected through interviewer-administered questionnaires. Caregiver burden was evaluated using the ZBI, functional status was measured with the Palliative Performance Scale (PPS), and illness severity was categorized as mild, moderate, or severe. Results: Weak correlations were observed between caregiver burden and patient age (r = 0.218, p = 0.01) as well as functional status (r = -0.347, p = 0.01). However, illness severity showed a strong association with caregiver burden (p < 0.0001), with caregivers of patients with severe conditions or low functional capacity experiencing the greatest burden. Conclusion: Although some correlations are modest, the findings emphasize the need for targeted caregiving strategies. Interventions such as caregiver education, emotional support, and financial assistance are essential to mitigate the burdens faced by those caring for elderly or severely ill patients.

Inflammatory burden index as a prognostic marker in patients with advanced gastric cancer treated with neoadjuvant chemotherapy and immunotherapy

Inflammatory burden index as a prognostic marker in patients with advanced gastric cancer treated with neoadjuvant chemotherapy and immunotherapy

Global disease burden of cervical cancer and the association of screening coverage with quality of disease management.

To analyze the global disease burden of cervical cancer and the association between screening coverage and the quality of disease management. The data of global burden of cervical cancer 2021 and the data of cervical cancer screening 2019 were obtained from IHME Global Burden of Disease (GBD) and the WHO Global Health Observatory (GHO), respectively. The age-standardized disease burden index was calculated, the Quality of Disease Management Index (QCI) was determined with principal component analysis, the correlation between QCI and cervical cancer screening coverage was examined with linear regression analysis by regions and populations. The burden of cervical cancer and the quality of its management exhibited significant variability across countries with differing levels of social development. The indicators of cervical cancer burden in China were close to the average level of countries with higher socia-demographic index (SDI). The global QCI was 22.22 (10.50, 35.43), and that of China was 26.30. The global screening coverage rate for cervical cancer was 42% (12%, 86%) and that in China was 31%. After adjusting for the social development level of countries, the coverage level of cervical cancer screening was associated with QCI (β=0.27, P<0.01), no matter in countries with low or high SDI (P>0.05). The association was significantly stronger among younger women (β=1.48, P<0.05). There are discrepancies in both the disease burden of cervical cancer and the quality of disease management among countries with different socioeconomic levels, and there is still considerable room for improvement in China. Expanding coverage of cervical cancer screening may be an effective strategy to enhance the management quality of cervical cancer, particularly among younger women where the screening benefits are most pronounced.

Role of Bailout Gene-Silencing Therapy in Plaque Lipid Reduction: Intravascular Imaging Study.

Introduction Insufficient statin/ezetimibe effectiveness for low-density lipoprotein cholesterol (LDL-C) reduction is not uncommon. A novel gene-silencing medication inclisiran has been introduced. Near-infrared spectroscopy (NIRS) allows to assess the dynamics of plaque lipid content in the context of optimal lipid-lowering pharmacotherapy. The aim of this study was to evaluate the impact of optimal hypolipidaemic pharmacotherapy, including add-on inclisiran, on the plasma lipid profile and plaque lipid content. Methods This study enrolled patients with stable coronary artery disease, admitted for elective percutaneous coronary intervention (PCI). NIRS of the segment of interest was performed during index PCI and 15 months later. Patients having LDL-C >1.8 mmol/l after 4-6 weeks of maximum tolerated statin/ezetimibe therapy received add-on inclisiran. Lipid profile changes within 15 months were also evaluated. Results Among 42 included patients, 24 drug resistant hypercholesterolemia participants were assigned to inclisiran therapy. After 15 months, a significant LDL-C decrease of 26.42% was established (p=0.006), with 12 participants reaching the LDL-C goal of <1.8 mmol/l. Average 15-month LDL-C reduction was 36.03%. NIRS data demonstrated a significant reduction in maximum lipid-core burden index within 4 mm (maxLCBI4 mm) in the inclisiran group (-117.64, p=0.004) and statin/ezetimibe group (-141.88, p=0.004), with no significant difference between the groups (p=0.213). Conclusion Results demonstrate an association between better LDL-C control and coronary plaque lipid burden reduction. Addition of inclisiran leads to remarkable LDL-C reduction in patients who have run out of statin and ezetimibe treatment options.

Impact of the Inflammatory Burden Index on Prognosis After Hepatectomy for Colorectal Liver Metastasis.

The aim of this study was to investigate the prognostic impact of the inflammatory burden index (IBI), a novel inflammation-based biomarker, in patients with colorectal liver metastases (CRLM) after hepatic resection. One hundred fifty patients with CRLM who underwent hepatectomy were retrospectively analyzed. The IBI was defined as C-reactive protein × neutrophil count/lymphocyte count. The relationship of the IBI with overall survival was investigated by univariate and multivariate analyses. Seventy-three (49%) patients had a high IBI (>3.45). In univariate analysis, overall survival was significantly worse in patients with lymph node metastases (P = 0.048), high NLR (P = 0.03), and high IBI (P < 0.01). In multivariate analysis, high IBI (P = 0.048) was an independent and significant predictor of overall survival. Patients with a high IBI had more postoperative complications compared with those with a low IBI (P < 0.01). The IBI was a strong predictor for both short- and long-term outcomes in patients who underwent hepatic resection for CRLM.

ZP3 Expression in Pancreatic Adenocarcinoma: Its Implications for the Prognosis and Therapy.

The role of Zona pellucida glycoprotein 3 (ZP3) is unclear in pancreatic adenocarcinoma (PAAD). This study aimed to explore the role of ZP3 in PAAD. A comparative analysis of ZP3 gene expression was performed to discern differences between various types of cancer and PAAD, leveraging data sourced from The Cancer Genome Atlas (TCGA). This study aimed to assess the role of ZP3 as a potential diagnostic marker for PAAD. The relationship between ZP3 levels and clinical characteristics, as well as patient outcomes, was scrutinized. Additionally, genomic enrichment analysis was carried out to uncover the underlying regulatory mechanisms associated with ZP3. The study further delved into the association of ZP3 with immune system interactions, checkpoint gene expression, Tumor Mutational Burden (TMB), microsatellite instability (MSI), and tumor stemness index (mRNAsi). The aberrant expression patterns of ZP3 in PAAD cell cultures were confirmed through the application of quantitative reverse transcription PCR (qRT-PCR) techniques. ZP3 exhibited aberrant expression in both pan-cancer and PAAD. A significant correlation was observed between increased levels of ZP3 expression in PAAD patients and histologic grade (p = 0.026). Elevated ZP3 expression in PAAD was found to be significantly associated with poorer overall survival (p = 0.003), progression-free survival (p = 0.012), and disease-specific survival (p = 0.002). In PAAD, the level of ZP3 gene expression was statistically significant (p < 0.001) and recognized as a key determinant of patient prognosis. ZP3 exhibited associations with various biological pathways, including primary immunodeficiency, oxidative phosphorylation, and other pathways. ZP3 expression demonstrated correlations with immune infiltration, immune checkpoint genes, TMB, MSI, and mRNAsi in PAAD. Moreover, a pronounced negative correlation was detected between ZP3 expression levels and the therapeutic effectiveness of various medications, including selumetinib, bleomycin, FH535, docetaxel, and tanespimycin, within the context of PAAD. Elevated levels of ZP3 were consistently observed in cell line models of PAAD. ZP3 has the potential to serve as a prognostic biomarker and therapeutic target for patients with PAAD.

Ketogenic diet with oxyresveratrol and zinc inhibits glioblastoma and restores memory function and motor coordination.

To date, there is no effective cure for the highly malignant brain tumor glioblastoma (GBM). GBM is the most common, aggressive central nervous system tumor (CNS). It commonly originates in glial cells such as microglia, oligodendroglia, astrocytes, or subpopulations of cancer stem cells (CSCs). Glucose plays an important role in the, which energy metabolism of normal and cancer cells, but cancer cells exhibit an increased demand for glucose is required for their differentiation and proliferation. The main aim of this study is to explore the anti-cancer efficacy of the ketogenic diet against GBM. Also, this research focuses on the identification of the catalytic action of zinc in epigenetic modulators such as oxyresveratrol and ensures the combinatorial effect in the treatment of GBM. In this study, we have evaluated various parameters to understand the therapeutic efficacy of the treatment groups through in vivo experiments against aggressive brain tumors. Intracerebroventricular experiments were performed to induce the tumor in the animals and estimate the tumor burden and proliferative index. Followed by the Morris water maze, an open field test, and rota rod was performed to evaluate the memory and motor coordination. To understand the glucose, and ketone level modification before and after treatment, the level of glucose and ketone was analyzed. Moreover, the zinc level is assessed using flame atomic absorption spectroscopy. The results suggested that the ketogenic diet has an anti-cancer efficacy against C6-induced GBM cell lines. Also, it exerts a synergistic effect with the epigenetic modulator, oxyresveratrol, and zinc against GBM cell lines. Moreover, the treatment groups improved memory and motor coordination and modified the glucose and ketone levels to reduce the tumor burden and Ki-67 proliferative index. This study revealed the therapeutic effect of the ketogenic diet along with its combination such as oxyresveratrol and zinc against the C6-induced GBM in the Wistar rats. Also, it improved memory and motor coordination and reduced tumor growth. It also modified the glucose and ketone levels in the tumor-induced animal and supported to diminish the tumor burden.

Prevalence of delirium in German nursing homes: protocol for a cross-sectional study

IntroductionDelirium is a neuropathological syndrome that is associated with several negative outcomes. Nursing home residents are vulnerable to developing delirium. Valid prevalence data and associated factors are not yet available...

CAREGIVING OUTCOMES AMONG INFORMAL CAREGIVERS OF PERSONS WITH MULTIMORBIDITY AND DEMENTIA: A SCOPING REVIEW

Abstract An emerging field of research involves caregiving among older adults with Alzheimer’s disease and related dementia (ADRD) and co-occurring chronic conditions (ADRD-multimorbidity). This scoping review aims to assess, synthesize, and identify gaps in the body of literature on caregiving outcomes among informal caregivers of individuals with ADRD-multimorbidity. We adhered to the scoping review framework by Arksey and O’Malley (2005) and Levac and colleagues (2010), which encompassed five steps: 1) identify the research question(s), delineate the inclusion and exclusion criteria, 2) search for relevant studies, 3) select studies, 4) chart the data, and 5) collate, summarize, and report results. Electronic databases including Ovid Medline, CINAHL, Embase, and PsycINFO were searched to identify relevant studies. A total of 1856 articles were identified and 29 were included in the final review. The majority of studies were quantitative, cross-sectional studies. The two most commonly examined caregiving outcomes were caregiver burden and psychological wellbeing. Most research on caregiver outcomes treated care recipients’ cognitive impairment and chronic conditions separately, rather than exploring their interaction. Most studies examining caregiver burden utilized Zarit Burden Index and its variants. Specific psychological wellbeing outcomes displayed great variability across studies. Despite challenges in synthesizing the extensive variability in the way cognitive status, ADRD-multimorbidity, and caregiving outcomes were measured, included, and reported, this review underscores the intricate challenges of caregiving, especially when dealing with both cognitive impairments and co-occurring chronic conditions. This complexity underscores the need for a deeper understanding of the diverse needs facing caregivers of people with ADRD-multimorbidity.

Effect of Oral Inflammatory Burden on Size and Stage of Oral Tongue Cancer.

Oral tongue squamous cell carcinoma is an aggressive life-threatening disease, the prognosis of which is affected by tumor stage and size. We retrospectively studied whether oral inflammatory burden and established tongue carcinoma etiological factors exert an impact on tumor size and stage. Medical records of 183 subjects diagnosed with tongue carcinoma at Helsinki University Hospital were investigated. Data on sex, smoking habits, alcohol consumption, and oral inflammatory burden were assessed by the Periodontal Burden Index, Total Dental Index, and Panorama Tomography Index. In addition, Candida hyphae in histological samples, and tumor size and stage were recorded and analyzed. History of oral potentially malignant disorders was also investigated. Increased oral inflammatory burden, male sex, and smoking were associated significantly with larger size and advanced stage of cancer, whereas oral Candida hyphae were not associated with size of tongue carcinoma but were associated with female sex. Male sex, oral inflammatory burden, and smoking were more common in patients with a large and advanced stage of tongue carcinoma. Thus, oral and periodontal infections and their pro-inflammatory effects may eventually promote carcinoma growth and advance the stage, especially in males.

Preoperative inflammatory burden index for prognostication in esophageal squamous cell carcinoma undergoing radical resection

BackgroundThe Inflammatory burden Index (IBI) is an effective predictor for a range of malignancies. However, the significance of IBI in esophageal squamous cell carcinoma (ESCC) needs to be further verified. The aim of this study was to verify the predictive power of IBI in ESCC undergoing radical resection.MethodsThe current retrospective study, which comprised 408 ESCC patients randomized into either the primary or validation cohort, evaluated the relationships between IBI, clinical characteristics, and cancer-specific survival (CSS). Additionally, the nomogram model was also constructed and verified.ResultsThe IBI is significantly related to tumor length, vessel invasion, perineural invasion, and TNM stage. Compared to other hematological indices, the decision curve analyses (DCA) and receiver operating characteristic curve (ROC) confirmed the higher prognostic value of IBI, indicating the better clinical applicability. In patients with high IBI compared to the low IBI cohort, the 5-year CSS was considerably worse (total: 27.0% vs. 59.1%, P < 0.001; primary: 25.0% vs. 58.9%, P < 0.001; validation: 31.7% vs. 59.7%, P = 0.002). The IBI was shown to be an independent parameter by multivariate analyses (primary: HR = 2.352, P < 0.001; validation: HR = 1.683, P = 0.045). Finally, with the C-index of 0.675 (0.656–0.695) in the primary set and 0.662 (0.630–0.694) in the validation set for CSS in ESCC, an IBI-based nomogram was created and validated.ConclusionThe predictive significance of IBI in ESCC patients undergoing radical resection was validated by this investigation. IBI may be utilized for preoperative evaluation of ESCC as it was found to be substantially correlated with prognosis.

Anticholinergic burden and frailty in older inpatients: insights from analysis of admission and discharge medicines using four anticholinergic scales

BackgroundExposure to high anticholinergic burden is associated with adverse outcomes in older adults. Older adults with frailty have greater vulnerability to adverse anticholinergic effects. There is limited data on anticholinergic burden in hospitalised older adults with frailty particularly, in New Zealand. This study aimed to (i) examine exposure to anticholinergic medicines in older inpatients using multiple scales, and (ii) describe the association of patient factors such as frailty with anticholinergic exposure.MethodsWe reviewed admission and discharge medicines of 222 older patients (≥ 65 years) in a New Zealand hospital. Sociodemographic, diagnostic and medication data were collected from electronic health records. Anticholinergic burden was quantified using the Anticholinergic Burden Classification (ABC), Anticholinergic Cognitive Burden Scale (ACB), Anticholinergic Risk Scale (ARS), and Drug Burden Index (DBI). Frailty was assessed using frailty index (FI) and the Hospital Frailty Risk score (HFRS); higher scores indicate higher frailty. Multivariable logistic regression analysis was used to determine patient factors associated with anticholinergic burden.ResultsDepending on the scale used, the mean anticholinergic burden ranged from 0.65 to 1.83 on admission and 0.59 to 1.40 at discharge, with 32–74% of the patients on admission and 25–65% at discharge prescribed at least one anticholinergic medicine. About 1 in 3 patients had high anticholinergic burden on admission and discharge. On admission, being frail (adjusted odds ratio [AOR] 5.16, 95% confidence interval [95% CI] 1.57, 16.97), having history of readmission (AOR 4.96, CI 1.58, 15.59), and higher number of medicines [AOR range 1.18 CI 1.10, 1.26 (ARS scale) to 1.25 CI 1.15, 1.36 (DBI scale)] were associated with higher odds of anticholinergic exposure. At discharge, pre-frail (DBI scale: AOR = 6.58, CI 1.71–25.32) and frail patients (ACB scale: AOR = 5.73, CI 1.66, 19.70) and those with higher number of medicines [AOR range 1.18 CI 1.09, 1.29 (ARS scale) to 1.33 CI 1.20, 1.49 (DBI scale)] had higher odds of anticholinergic exposure.ConclusionA reduction in the anticholinergic burden from admission to discharge was observed in the study population yet, one-third of the study cohort were discharged with high anticholinergic medicines. Enhancing hospital prescribers’ and pharmacists’ awareness about anticholinergic burden and targeted interventions such as in-hospital deprescribing are needed to reduce high anticholinergic exposure in acute setting.

Genomic landscape of circulating tumor DNA in HER2-low metastatic breast cancer

The large population of HER2-low breast cancer patients necessitates further research to provide enhanced clinical guidance. In this study, we retrospectively analyzed 1071 metastatic breast cancer (MBC) patients and the circulating tumor DNA (ctDNA) to investigate clinicopathological and genetic alterations of HER2-low MBC patients. The effect of HER2-low status on different treatment modalities was explored in two prospective clinical trials (NCT03412383, NCT01917279) and a retrospective study. Our findings suggest TP53, PIK3CA, and ESR1 are frequently mutated genes in HER2-low MBC. Compared to the HER2-0 group, mutations observed in the HER2-low group are more closely associated with metabolic pathway alterations. Additionally, among patients with ERBB2 mutations and treated with pyrotinib, the HER2-low group may experience superior prognosis when compared to the HER2-0 group. Notably, we did not find any statistically significant disparity in the response to chemotherapy, endocrine therapy, or CDK4/6 inhibitor therapy between HER2-0 and HER2-low breast cancer patients. Interestingly, within the subgroup of individuals with metabolic pathway-related gene mutations, we found that HER2-low group exhibited a more favorable response to these treatments compared to HER2-0 group. Additionally, dynamic analysis showed the HER2-low MBC patients whose molecular tumor burden index decreased or achieved early clearance of ctDNA after the initial two treatment cycles, exhibited prolonged survival. Moreover, we classified HER2-low MBC into three clusters, providing a reference for subsequent treatment with enhanced precision. Our study offers valuable insights into the biology of HER2-low MBC and may provide reference for personalized treatment strategies.

Gender-specific inflammatory burden and headache risk in youth: a NHANES analysis

BackgroundHeadaches are a common and often debilitating condition among youth. The Inflammatory Burden Index (IBI), a simple surrogate marker of systemic inflammation, has been linked to various diseases. However, evidence for its relationship with headaches, particularly in youth, is lacking. This study aimed to investigate the association between IBI and persistent headache in youth, with a focus on evaluating gender-specific responses to IBI exposure.MethodsWe analyzed data from 2,210 young people in the 2001–2004 National Health and Nutrition Examination Survey (NHANES). The association between IBI and frequent or severe headaches in the past year was investigated using weighted logistic regression models. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated, and threshold effect analyses were performed.ResultsYouths in the highest IBI quartile (Q4) had a 46% higher risk of severe headaches compared to the lowest quartile (Q1) (OR: 1.46, 95% CI: 1.12–1.91, P = 0.0051). Gender-stratified analysis revealed a significant association between high IBI and headache risk in females (OR: 1.48; 95% CI: 1.03–2.11, P = 0.0324), but not in males. Threshold effect analysis identified an IBI breakpoint of 3.78, below which the headache risk increased significantly in females under 18 years (OR: 1.12, 95% CI: 1.01–1.25, P = 0.0385).ConclusionsOur findings demonstrate a significant association between elevated IBI and increased headache risk in youth, particularly in females. This gender-specific effect suggests that inflammatory processes may play a more prominent role in headache pathophysiology among female youth. These results underscore the importance of considering inflammatory markers in the early identification and prevention of youth headaches, especially in females.

Global, Regional, and National Burden of Stroke, 1990-2021: A Systematic Analysis for Global Burden of Disease 2021.

This study aims to perform a comprehensive analysis of stroke burden from the Global Burden of Disease 2021. We conducted a comprehensive analysis of the burden, including prevalence, incidence, mortality, and disability-adjusted life year rates, for stroke across 204 countries and regions from 1990 to 2021 using data from the Global Burden of Disease 2021. We calculated the estimated annual percentage change (EAPC) and performed a joinpoint regression analysis to identify the trends. We also explored the association between the stroke burden and sociodemographic index. The age-standardized prevalence, incidence, mortality, and disability-adjusted life year rates for stroke were 1099.310, 141.553, 87.454, and 1886.196 per 100 000 persons in 2021, respectively. The general stroke burden trends declined in EAPC analysis (age-standardized prevalence: EAPC, -0.37; age-standardized incidence: EAPC, -0.99; age-standardized mortality: EAPC, -1.81; and disability-adjusted life year: EAPC, -1.76). However, we found an increasing burden of stroke in East Asia and Southern Sub-Saharan Africa (EAPC >0). The global burdens of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke showed a similar trend. The stroke, intracerebral hemorrhage, and ischemic stroke burdens were heavier in men than in women, except for that of subarachnoid hemorrhage in women. Our joinpoint regression analysis revealed that the age-standardized burden rates of stroke decreased from 1990 to 2021 (average annual percent change <0), whereas an upward trend was observed between 2019 and 2021 (average annual percent change >0). The burden of stroke was inversely proportional to the sociodemographic index (P<0.05), except in the case of subarachnoid hemorrhage. The actual stroke burden showed an increasing trend for stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in 2021 (during the coronavirus pandemic). We found age-standardized rates of stroke burden declining over time, but some areas exhibited a notable increase in the prevalence, incidence, mortality, and disability-adjusted life year rates.

Association of the Inflammatory Burden Index With Increased Mortality Among Cancer Patients: Insights From the NHANES Study.

The systemic inflammatory response significantly influences the progression and prognosis of various cancers. The novel Inflammatory Burden Index (IBI) was recently introduced as a biomarker to gauge systemic inflammation and evaluate cancer patient prognosis. However, studies investigating the relationship between IBI and mortality rates in cancer patients remain limited. This study analyzed data from 2748 cancer patients enrolled in the National Health and Nutrition Examination Surveys between 1999 and 2018. We used weighted Cox regression analysis and restricted cubic spline models to examine the relationship between the IBI and mortality due to all causes, cardiovascular disease (CVD), and cancer. Furthermore, we employed Kaplan-Meier survival curves, subgroup analyses, and receiver operating characteristic curves to elaborate on these associations. Over a median follow-up period of 112 months, the cohort experienced 1067 deaths, including 320 from cancer, 239 attributable to heart disease, and 508 from various other causes. The Kaplan-Meier curve indicated that individuals in the higher quartiles of the IBI faced significantly increased mortality risks compared to those in lower quartiles. Analyses using weighted Cox proportional hazards models demonstrated that subjects in the top IBI quartile were at a substantially higher risk for all-cause mortality (Hazard Ratio [HR] 2.09, 95% Confidence Interval [CI] 1.67-2.62, p < 0.001), CVD mortality (HR = 1.95, 95% CI= 1.18-3.23, p = 0.010), and cancer mortality (HR = 2.06, 95% CI = 1.31-3.26, p = 0.002). Furthermore, stratification and interaction analyses affirmed the uniformity of these initial findings. The areas under the curve for the 3-, 5-, and 10-year survival predictions for all-cause mortality were 0.62, 0.62, and 0.67, respectively; for cardiovascular mortality, they were 0.64, 0.64, and 0.70; and for cancer mortality, they were 0.62, 0.77, and 0.70. In cancer patients, higher IBI levels significantly correlate with increased mortality from all causes, CVD, and cancer-specific deaths. This index could possess considerable diagnostic and prognostic importance, possibly acting as a new biomarker for evaluating outcomes in cancer patients.

Preoperative Albumin to Alkaline Phosphatase Ratio and Inflammatory Burden Index for Rectal Cancer Prognostic Nomogram-Construction: Based on Multiple Machine Learning.

Preoperative albumin to alkaline phosphatase ratio (AAPR) and inflammatory burden index (IBI) are prognostic indicators for a multitude of cancers, and our study focuses on evaluating the prognostic significance of the AAPR and the IBI on rectal cancer (RC) patients to provide a more accurate guideline for patient prognosis. This study enrolled patients who underwent laparoscopic rectal cancer surgery from January 2016 to January 2021. We utilized three machine learning approaches to select variables most relevant to prognosis in the training cohort. Finally, based on the screened variables, a nomogram was established to predict RC patients' overall survival (OS). The improvement in predictive ability and clinical benefit was assessed through the concordance index (C-index), receiver operating characteristic (ROC), calibration curve, and decision curve analysis (DCA). A total of 356 patients were enrolled and they were randomly divided into a training cohort (60%, n=214) and a validation cohort (40%, n=143). Overall survival (OS) was worse for patients in either the low AAPR or the high AAPR group, whereas patients in the low AAPR with both high IBI group had the lowest OS (P<0.001). Finally, five variables were obtained after screening the best variables by three machine learning, and the nomogram was constructed. In both the development and validation cohorts, the C-index values exceeded 0.85, indicating that the predictive model has a strong predictive performance in terms of overall survival. The calibration curves and the decision curve analysis (DCA) showed that the nomogram demonstrated a superior benefit. Preoperative AAPR and IBI can serve as effective indicators for predicting the OS of RC patients. We have developed a nomogram for predicting the OS of patients who underwent laparoscopic rectal cancer surgery.

Computed tomography versus near-infrared spectroscopy for the assessment of coronary atherosclerosis.

Coronary computed tomography angiography (CCTA) has been proposed as an alternative to intravascular imaging for assessing plaque pathology. We aimed to assess the efficacy of CCTA against near-infrared spectroscopy-intravascular ultrasound (NIRS-IVUS) in evaluating atheroma burden and composition and for guiding coronary interventions. Seventy patients with a chronic coronary syndrome were recruited and underwent CCTA and NIRS-IVUS. The imaging data were matched, and the estimations of lumen, vessel wall and plaque dimensions and composition of the two modalities were compared. The primary endpoint of the study was the efficacy of CCTA in detecting lipid-rich plaques identified by NIRS-IVUS. Secondary endpoints included the performance of CCTA in evaluating coronary artery pathology in the studied segments and its value in stent sizing, using NIRS-IVUS as the reference standard. In total, 186 vessels were analysed. The attenuated plaque volume on CCTA had weak accuracy in detecting lipid-rich plaques (58%; p=0.029). Compared to NIRS-IVUS, CCTA underestimated the lumen volume (309.2 mm3 vs 420.4 mm3; p=0.001) and plaque dimensions (total atheroma volume 116.1 mm3 vs 292.8 mm3; p<0.001 and percentage atheroma volume 27.67% vs 41.06%; p<0.001) and overestimated the lipid component (lipid core burden index 48.6 vs 33.8; p=0.007). In the 86 lesions considered for revascularisation, CCTA underestimated the reference vessel area (8.16 mm2 vs 12.30 mm2; p<0.001) and overestimated the lesion length (23.5 mm vs 19.0 mm; p=0.029) compared to NIRS-IVUS. CCTA has limited efficacy in assessing plaque composition and quantifying lumen and plaque dimensions and tissue types, which may potentially impact revascularisation planning.

Periodontal Disease and Metabolic Syndrome in Women at Prior High Risk for Gestational Diabetes.

This study aimed to assess the association between periodontal disease and metabolic syndrome (MetS) among women at prior high risk for gestational diabetes with the hypothesis that women with MetS show more signs of periodontal disease than women without MetS. A total of 112 women from an original study cohort of 348 women at high risk of gestational diabetes were examined 4-6 years postpartum. Diagnosis of MetS was based on the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria. Insulin resistance was approximated by the homeostatic model assessment for insulin resistance. Full-mouth examinations and panoramic radiographs provided the total dental index, number of teeth, and decayed, missing, and filled teeth index. Clinical examination assessed bleeding on probing, probing depth, visible plaque index, signs of infection, and clinical attachment levels. The periodontal inflammatory burden index (PIBI) was also calculated. Information on oral health habits, symptoms, and individual opinions on oral health was collected through questionnaires. Five years after delivery, 21% of the women had MetS, and they had more gingivitis compared to those without MetS (bleeding on probing: 52% and 44%, p = 0.011). Women with MetS tended to have more periodontitis than those without (39% and 25%, p = 0.13). A high PIBI correlated with insulin resistance (partial correlation of PIBI and homeostatic model assessment for insulin resistance: 0.25 p < 0.05). Periodontal disease was associated with insulin resistance and MetS in women at prior high risk of developing gestational diabetes.

Anticholinergic Exposure, Drug Dose and Postoperative Delirium: Comparison of Dose-Related and Non-Dose-Related Anticholinergic Burden Scores in a Retrospective Cohort Study of Older Orthopaedic and Trauma Surgery Patients.

Postoperative delirium (POD) is a common complication in older adult patients after surgery. A patient's preoperative anticholinergic (AC) burden is a potentially modifiable risk factor for POD. As the influence of the drug dose remains unknown, we aimed to compare three AC burden scores in relation to POD, two of which were dose-related. This retrospective cohort study (03/22-10/22) included orthopaedic and trauma surgery patients > 65 years. POD was assessed using the four A's test (4AT), delirium diagnosis, and chart review. The AC burden was determined using the non-dose-related German Anticholinergic Burden score (GerACB), an extension of the dose-related Muscarinic Acetylcholinergic Receptor ANTagonist Exposure scale (extMARANTE), and the dose-related German Drug Burden Index (GerDBI). Multivariable logistic regression analysis determined the association between the preoperative AC burden and POD. Scores were compared using kappa statistics, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). POD was observed in 71 of 385 patients (18.4%). For all three scores, a high AC burden was significantly associated with POD after adjusting for age, sex, dementia, preoperative physical status, and number of prescribed drugs (p < 0.001). The overall agreement among the burden classifications was substantial (no POD: κ = 0.645, POD: κ = 0.632). The GerACB had the lowest sensitivity with 23.9% (extMARANTE: 42.3%, GerDBI: 40.8%), but the highest PPV with 48.6% (extMARANTE: 38.5%, GerDBI: 43.3%). Both dose-related and non-dose-related AC burden scores have limited sensitivity and modest PPV for screening a patient's medication for POD. However, given the additional effort required for dose consideration, the non-dose-related GerACB remains sufficient in clinical practice, with the lowest sensitivity but highest PPV.