Weight Categories Research Articles

Racial and Ethnic Differences in Acuity and Cumulative Frontline Organ Toxicity at the Time of Relapse in Pediatric Acute Myeloid Leukemia

Introduction: Racial and ethnic disparities in survival outcomes exist in pediatric acute myeloid leukemia (AML), but the role of relapse and its potential contribution to outcome disparities is unknown. We sought to examine differences in relapse-free survival (RFS) and clinical characteristics at the time of relapse by race and ethnicity using a real-world multi-institution cohort of pediatric AML patients. Methods: A retrospective cohort including all pediatric (age <19 years) patients treated for AML from 2011-2019 at 13 institutions in the United States was established and is being actively expanded to include diagnoses through 2023. Data collection was accomplished by detailed chart abstraction performed by trained study personnel. We additionally merged resource utilization data from the Pediatric Health Information System to ascertain patient acuity and cumulative organ toxicity. Analyses were restricted to patients identified in the medical record as Hispanic, non-Hispanic Black (NHB), and non-Hispanic White (NHW) to specifically assess historically marginalized patient populations. Other racial/ethnic groups including multi-racial were excluded due to small numbers. Kaplan-Meier survival curves were generated for RFS by race/ethnicity. Adjusted Cox models compared the hazard of relapse by race/ethnicity. Models adjusted for age at diagnosis, sex, initial risk classification, weight category at diagnosis, and acuity at initial presentation. To assess misspecification of outcome, we performed sensitivity analyses restricted to relapses occurring within 1 year of diagnosis (early RFS). Among the patients who relapsed, descriptive frequencies for clinical and treatment characteristics were reported by race/ethnicity. Results: A total of 437 pediatric patients with AML (28% Hispanic, 18% NHB, median follow-up time 3.0 years) were included in the analytic cohort. There were no statistically significant differences in RFS or early RFS by race/ethnicity (Figure 1). However, among relapsed patients, important qualitative differences were noted at the time of relapse (Table 1). Hispanic and NHB patients were older at relapse than NHW patients. Greater proportions of Hispanic and NHB patients (compared to NHW) experienced cardiovascular, respiratory, and renal failure during frontline therapy. Cumulative prevalence of organ failure in 2 or more systems since initial diagnosis was higher for both Hispanic (50%) and NHB (50%) patients compared to NHW patients (29%). Overweight/obesity at relapse was more prevalent among Hispanic (41%) and NHB (50%) compared to NHW (21%) patients. NHB patients were also more likely to present at relapse with higher acuity, defined as requiring ICU-level resources for 2 or more organ systems within 72 hours of admission, compared to NHW patients (75% vs. 57%). Conclusions: Our data suggest a similar risk of relapse by race and ethnicity. However, differences in cumulative frontline organ toxicity and acuity of presentation may lead to differential treatment at the time of relapse and drive subsequent overall survival disparities for Hispanic and NHB patients with pediatric AML. Future Directions: This was a planned interim analysis, and chart abstraction is ongoing to expand this cohort (anticipated N ~1000). We intend to pursue a series of formal mediation analyses regarding the role of relapse, cumulative organ toxicity during frontline treatment, and selection of salvage regimen on disparities in survival outcomes with the expanded cohort.

Establishing Real-World Data-Driven Response Criteria in Pediatric Acute Myeloid Leukemia

Introduction: Disease response criteria in pediatric acute myeloid leukemia (pAML) include complete remission (CR), complete remission without platelet count recovery (CRp), and complete remission with incomplete count recovery (CRi). Although clinicians use CR, CRp, and CRi as valid endpoints, the FDA only accepts CR as a valid response endpoint with the Cheson/European Leukemia Network (ELN) response criteria of absolute neutrophil count (ANC) >1,000 and platelets >100,000. Recent adult data show improved survival in patients achieving CR relative to CRp or CRi. Pediatric data from the Children's Oncology Group (COG) demonstrate similar survival regardless of achieving an ANC >500 or platelets >50,000. However, actual ANC and platelet data were not known, and COG data may not reflect outcomes of patients treated off study. Exclusion of CRp and CRi as valid efficacy endpoints limits clinical trials by potentially excluding patients who achieve remission but proceed to subsequent chemotherapy prior to meeting ELN recovery criteria. To address this data gap, we defined the ANC and platelet count trajectories in a 13-day window at end of course bone marrow (BM) after Induction I/II and Reinduction I/II of relapse therapy. We compared disease-free (DFS) and overall survival (OS) among CR categories and hypothesized that CR, CRp, and CRi after Induction I and Reinduction I would be associated with similar DFS and OS. Methods: Newly diagnosed pAML patients from 2011-2022 with at least one frontline chemotherapy course at one of six pediatric centers (Children's Hospital of Philadelphia, Children's Healthcare of Atlanta, Children's Hospital of Michigan, C.S. Mott Children's Hospital, Lurie Children's Hospital, and Texas Children's Hospital) underwent manual chart abstraction to capture demographic, therapy, toxicity, and BM response data: morphologic and minimal residual disease (MRD). The highest daily ANC and platelet counts were abstracted ±13 days around the last BM aspirate after Induction I/II and reinduction I/II post relapse. ELN and COG recovery criteria for ANC (>1,000 and >500, respectively) and platelet (>100,000 and >50,000, respectively) defined CR, CRp and CRi; CRi was further divided into CRnoANC and CRnoANCnoPlatelet. Standard descriptive statistics and Kaplan-Meier (KM) methods were used for analyses. Course-specific evaluations were restricted to subjects with an end of course BM documenting morphological response and ANC/platelet values on the day of course ending BM or 1 day prior. Results: The source population contained 486 patients with the analysis cohort restricted as described above to include 313 patients in Induction I, 290 patients in Induction II, 70 patients in Reinduction I, and 34 patients in Reinduction II. This represents 707 total courses and 8933 ANC/platelet observation days, restricted from 1166 courses (371 without morphologic response and 88 lacked ANC/platelet at course end BM). Demographic covariates included age, sex, race, ethnicity, risk group, MRD, extramedullary disease, weight category, and insurance. At Induction I, MRD differed significantly by CR category for ELN and COG criteria; risk group approached but did not reach significance; and Hispanic ethnicity differed by CR category only in COG criteria. No covariates differed significantly at Reinduction I in either ELN or COG criteria. At Induction I, CR proportion differed between ELN and COG criteria: 40.9% (95% CI 35.5-46.6%) vs 69.6% (95% CI 64.2%-74.7%). At Reinduction I, CR proportion differed between ELN and COG criteria: 18.6% (95% CI 10.3-29.7%) vs 47.1% (95% CI 35.1-59.4%). Panel 1a shows median ANC at Induction I BM is <1000 (ELN) but >500 (COG) in >75% of individuals. KM analyses showed no significant differences in CR strata in ELN or COG criteria in DFS or OS at Induction I. At Reinduction I, ELN CR strata did not differ, but COG CR strata were significantly different in DFS (p = 0.0007) and OS (p = 0.0019) with CRp and CRnoANC with higher DFS than CR or CRnoANCnoPlatelet (Panel 1b). Conclusion: These real-world data suggest that ELN/COG response criteria may lead to markedly different CR rates that may impact reported response rates in clinical trials. These analyses also support COG CR response criteria in de novo pAML and CR, CRp, and CRnoANC in relapsed pAML, recognizing that the modest relapsed pAML sample size requires additional data to determine optimal response criteria.

Preterm Labour Pain & Its Outcome in 50 pts attending at a Tertiary Care Hospital-ICMH

Introduction: Preterm labor is the leading cause of neonatal morbidity all over the world. Over the past two decades despite major preventive efforts, the incidence of preterm birth has remained constant at about 5-10% of live births. The etiology is often multifactorial and poorly understood. Currently preterm labour is one of the most challenging problems confronting the obstetricians and perinatologists. With this background the present study was done to find out perinatal outcome in women presenting with preterm labour. Aims To study the fetal and maternal outcome in preterm labor cases. Materials and Methods: It was Prospective, single centered, observational study. A total of 50 women with preterm labor in the study period i.e. from June 2019 to May 2020 were included for the study sample. This study carried out at the department of Obstetrics and Gynecology, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, Bangladesh. The data were collected personally through a structural questionnaire. Results: Out of 50 subjects, majority of mothers 32(64%) were in age group of 21-30 years followed by 12(24%) in age group of 20 years. Majority 26(52%) of study subjects were primigravida followed by 24(48%) multigravida. Majority 32(64%) of study subjects were in lower class followed by 15 (30%) cases in middle class, 3(6.0%) cases in affluent class. Maximum 31 (62%) cases were unbooked cases and rest 19 (38%) cases were booked. Out of 50 babies who were <2500 grams, maximum 29 (58.0%) were low birth weight followed by 11(22%) being VLBW babies. 5 cases were >2.5 kgs, which are not LBW babies according to WHO Classification of low birth weight. Majority 17 (47.2%) stayed for 1-10 days followed by 9 (25.0%) babies for 11-20 days. Also 7 (19.4%) babies stayed for 21-30 days. Conclusions: Preterm infants are at high risk of overall morbidity and mortality. Clinical suspicion, early detection and correction of risk factors, institutional delivery and good neonatal care back up facilities can improve the outcome of preterm labour and decrease the maternal complications as well. Medicine Today 2023 Vol.35 (2): 73-77

Direct oral anticoagulants and the risk of adverse clinical outcomes among patients with different body weight categories: a large hospital-based study

ObjectiveThrough predictable pharmacokinetics—including a convenient fixed-dose regimen, direct oral anticoagulants (DOACs) are preferred over previous treatments in anticoagulation for various indications. However, the association between higher body weight and the risk of adverse consequences is not well studied among DOAC users. We aim to explore the association of body weight and adverse clinical outcomes in DOAC users.MethodsA total of 97,413 anonymised DOAC users in a tertiary care setting were identified following structured queries on the electronic health records (EHRs) to extract the feature-rich anonymised dataset. The prepared dataset was analysed, and the features identified with machine learning (ML) informed the adjustments of covariates in the multivariate regression analysis to examine the association. Kaplan–Meier analysis was performed to evaluate the mortality benefits of DOACs.ResultsAmong DOAC users, the odds of adverse clinical outcomes, such as clinically relevant non-major bleeding (CRNMB), ischaemic stroke, all-cause mortality, and prolonged hospital stay, were lower in patients with overweight, obesity, or morbid obesity than in patients with normal body weight. The odds of ischaemic stroke (OR 0.42, 95% CI: 0.36–0.88, p = 0.001) and all-cause mortality (OR 0.87, 95% CI: 0.81–0.95, p = 0.001) were lower in patients with morbid obesity than in patients with normal body weight. In the Kaplan–Meier analysis, apixaban was associated with a significantly lower rate of mortality overall and in obesity and overweight subgroups than other DOACs (p < 0.001). However, rivaroxaban performed better than apixaban in the morbid obesity subgroup (p < 0.001).ConclusionThis study shows the positive effects of DOAC therapy on clinical outcomes, particularly in patients with high body weight. However, this still needs validation by further studies particularly among patients with morbid obesity.

Gestational diabetes mellitus in pregnancies conceived after infertility treatment: a population-based study in the United States, 2015–2020

To evaluate the risk of gestational diabetes mellitus (GDM) in singleton pregnancies conceived using infertility treatment and examine the influence of race and ethnicity as well as prepregnancy body mass index (BMI). Cross-sectional study using the US vital records data of women that delivered singleton births. United States, 2015-2020. Any infertility treatment was divided into two groups: those that used fertility-enhancing drugs, artificial insemination, or intrauterine insemination, and those that used assisted reproductive technology (ART). Gestational diabetes mellitus, defined as a diagnosis of diabetes mellitus during pregnancy, includes both diet-controlled GDM and medication-controlled GDM in singleton pregnancies conceived with infertility treatment or spontaneously and delivered between 20- and 44-weeks' gestation. We also examined whether the infertility treatment-GDM association was modified by maternal race and ethnicity as well as prepregnancy BMI. Associations were expressed as a rate ratio (RR) and 95% confidence interval (CI), derived from log-linear models after adjustment for potential confounders. A total of 21,943,384 singleton births were included, with 1.5% (n = 318,086) undergoing infertility treatment. Rates of GDM among women undergoing infertility treatment and those who conceived spontaneously were 11.0% (n = 34,946) and 6.5% (n = 1,398,613), respectively (adjusted RR 1.24, 95% CI 1.23, 1.26). The RRs were adjusted for maternal age, parity, education, race and ethnicity, smoking, BMI, chronic hypertension, and year of delivery. The risk of GDM was modestly increased for those using fertility-enhancing drugs (adjusted RR 1.28, 95% CI 1.27, 1.30) compared with ART (adjusted RR 1.18, 95% CI 1.17, 1.20), and this risk was especially apparent for non-Hispanic White women (adjusted RR 1.29, 95% CI 1.26, 1.31) and Hispanic women (adjusted RR 1.35, 95% CI 1.29, 1.41). The number of women who needed to be exposed to infertility treatment to diagnose one case of GDM was 46. Prepregnancy BMI did not modify the infertility treatment-GDM association overall and within strata of race and ethnicity. These general patterns were stronger after potential corrections for misclassification of infertility treatment and unmeasured confounding. Infertility treatment, among those who received fertility-enhancing drugs, is associated with an increased GDM risk. The persistently higher risk of GDM among women who seek infertility treatment, irrespective of prepregnancy weight classification, deserves attention. Infertility specialists must be vigilant with preconception counseling and ensure that all patients, regardless ofrace and ethnicity or BMI, are adequately tested for GDM early in pregnancy using a fasting blood glucose level or a traditional 50-g oral glucose tolerance test. Testing may be completed by the infertility specialist or deferred to the primary prenatal care provider at the first prenatal visit.

Changes in weight status during the COVID-19 pandemic: impact of educational level and mental health.

The COVID-19 pandemic has resulted in a disruption of daily routines and changes in health behaviors leading to widespread concerns about unfavorable changes in weight status and a potential increase in the prevalence of obesity. This study examined the long-term impact of the COVID-19 pandemic on changes in weight status and its possible dependency on educational level and mental health. The study utilizes the Danish Health and Well-being Survey with repeated self-reported information on weight status collected before the COVID-19 pandemic (autumn of 2019) and twice during the pandemic (autumns of 2020 and 2021). Information on educational level was derived from registers, whereas mental health was measured using validated scales. Generalized estimating equations were performed to investigate changes in mean weight and body mass index (BMI) category (BMI < 30 to BMI ≥ 30) between 2019 and 2021 and to investigate potential differences in changes in weight status by pre-pandemic educational level and mental health. Mean weight significantly increased by 0.34 kg [95% confidence interval (CI): 0.16-0.51] in 2020 and by 0.46 kg (95% CI: 0.26-0.66) in 2021 compared with pre-pandemic weight status. The increase was greater among individuals with lower educational levels and poorer mental health. There were no significant changes in BMI category during the pandemic. The results showed a significant increase in mean weight among the Danish population, particularly among individuals with lower educational levels and poorer mental health, but without detectable differences in obesity, supporting a long-term but minor impact of the COVID-19 pandemic on weight status.

Body Mass Index, Quality of Life and Activity Limitation Trajectories over 2 Years in Patients with Knee or Hip Osteoarthritis: A Dual Trajectory Approach Based on 4265 Patients Included in the AktivA Quality Register.

(1) Background: Recent studies claim that weight-neutral approaches emphasizing physical activity might be as effective as weight-loss-centered approaches for improving pain and physical function in patients with knee and hip osteoarthritis. The objectives were to identify distinctive groups of individuals with similar BMI, quality of life and activity limitation trajectories over two years, to compare the overall differences between BMI trajectory groups for baseline variables and to explore the probabilities of the quality of life and activity limitation trajectory groups conditional on the BMI group. (2) Methods: Baseline data for age, gender, BMI, quality of life, activity limitations, pain, general health, knee or hip osteoarthritis and follow-up data on BMI, quality of life and activity limitations at 3, 12 and 24 months were retrieved from the "Active with osteoarthritis" (AktivA) electronic quality register. Group-based trajectory modeling was used to identify distinct trajectories for BMI, quality of life and activity limitations. (3) Results: 4265 patients were included in the study. Four distinct BMI trajectories were identified, normal weight (31%), slightly overweight (43%), overweight (20%) and obese (6%). At baseline, there were highly significant differences between all BMI groups, pain increased and age and general health decreased with higher BMI. Irrespective of weight category, minimal changes in BMI were found over the two-year follow-up period. Over 80% of the participants showed moderate-to-considerable improvements both in quality of life and activity limitations. (4) Conclusions: Almost 70% of the participants belonged to the overweight trajectories. Despite no significant weight reduction over the two years, eight in every 10 participants improved their quality of life and reduced their activity limitations after participating in the AktivA program.

RNAseq Analysis of Livers from Pigs Treated with Testosterone and Nandrolone Esters: Selection and Field Validation of Transcriptional Biomarkers.

The use of anabolic-androgenic steroids (AASs) as growth promoters in farm animals is banned in the European Union, representing both an illicit practice and a risk for consumer health. However, these compounds are still illegally administered, often in the form of synthetic esters. This work aimed to characterize significant coding RNA perturbations related to the illicit administration of testosterone and nandrolone esters in fattening pigs. A total of 27 clinically healthy 90-day-old pigs were randomly assigned to test and control groups. Nine animals were treated with testosterone esters (Sustanon®) and other nine with nandrolone esters (Myodine®). At the end of the trial, liver samples were collected and analyzed using RNAseq, allowing the identification of 491 differentially expressed genes (DEGs). The transcriptional signature was further characterized by a smaller sub-cluster of 143 DEGs, from which a selection of 16 genes was made. The qPCR analysis confirmed that the identified cluster could still give good discrimination between untreated gilt and barrows compared to the relative testosterone-treated counterparts. A conclusive field survey on 67 liver samples collected from pigs of different breeds and weight categories confirmed, in agreement with testosterone residue profiles, the specificity of selected transcriptional biomarkers, showing their potential applications for screening purposes when AAS treatment is suspected, allowing to focus further investigations of competent authorities and confirmatory analysis where needed.

FEMALE BROODSTOCK SIZE AND MATERNAL EFFECTS ON PROGENY OF Clarias gariepinus (BURCHELL 1822)

Catfish farmers have been enduring having to spawn with very big females at high cost avoiding medium and small sizes. The relationship between female broodstock weight and the growth rate of progeny has been a major concern among catfish producers. To examine the impact of different female broodstock sizes on the reaction to growth of the fish seed, induced breeding of the study fish was done. The experiment was designed a completely randomized design (CRD) made of three treatments replicated three times. The treatment were three categories of weight of broodstocks as Treatment I (1000g (Treatment I or Small size), Treatment II (1500g or Medium size) and Treatment III (2500g or Large size). There was no significant fluctuation in the physico-chemical parameters of the water. There was no significant difference in the fry survival among Treatments (P&gt;0.05). The maternal effect on growth of the study fish was 10.5 weeks of culture as Treatment 11 fingerlings then grew fastest. At the end of 40 weeks culture period there was significant difference (P&lt;0.05) in the final weight of the table fish (1231.67 g, 1156.67g, and 1006.67g, for Treatment 11, Treatment 111, and Treatment 1, respectively). Overall, the results of these growth evaluations showed that the selected group had improved growth performance. Medium sized female broodstock can therefore deliver substantial genetic improvements in induced breeding of the study fish.&#x0D;

An annotated grain kernel image database for visual quality inspection

We present a machine vision-based database named GrainSet for the purpose of visual quality inspection of grain kernels. The database contains more than 350K single-kernel images with experts’ annotations. The grain kernels used in the study consist of four types of cereal grains including wheat, maize, sorghum and rice, and were collected from over 20 regions in 5 countries. The surface information of each kernel is captured by our custom-built device equipped with high-resolution optic sensor units, and corresponding sampling information and annotations include collection location and time, morphology, physical size, weight, and Damage & Unsound grain categories provided by senior inspectors. In addition, we employed a commonly used deep learning model to provide classification results as a benchmark. We believe that our GrainSet will facilitate future research in fields such as assisting inspectors in grain quality inspections, providing guidance for grain storage and trade, and contributing to applications of smart agriculture.

Association between nutritional status, body composition, and fitness level of adolescents in physical education in Casablanca, Morocco.

This study aims to analyze and compare dietary intake, as well as to examine the associations between energy intake in terms of macronutrients, body composition, and physical fitness (PF) specifically cardiorespiratory endurance (CE) among a sample of young adolescents aged 15 to 18 years, who participate in physical education and sports sessions in public schools in Casablanca, Morocco. A total of 311 participants, including 156 girls and 154 boys, were included in the study. Each participant maintained a food diary for 3 days during the same study week. Additionally, body composition measurements were taken using bioelectrical impedance analysis (BIA). The PF was assessed using the validated mini-Cooper test (6 min). The results show that the participants had an average total energy intake of 2386.7 ± 492.7 kcal. A significant difference was observed between boys and girls, with average energy intakes of 2468.8 ± 531.1 kcal and 2304.0 ± 437.0 kcal, respectively. These dietary intakes were significantly lower than their needs and nutritional recommendations. The associations of nutritional status, sex, body mass index (BMI) and physical fitness (PF) were tested and a positive correlation was observed following an adequate intake of carbohydrates (CHO) and proteins on Vo2max, while a negative association was observed with regard to Body fat for both sexes. Boys exhibit significantly better PF than girls (p < 0.01). Obese participants had the lowest PF and an unbalanced nutritional status, the adolescents with a normal weight p < 0.01 displayed a high level of PF compared to individuals in other weight categories. The PF is significantly associated with macronutrient intake status and body composition, especially BMI and BF. The Underweight, overweight, and obese students demonstrated poorer performance in physical fitness indices compared to normal-weight. Adolescents adhering to recommended CHO and protein intake levels tend to exhibit enhanced physical fitness. Implementing strategies to encourage students to maintain a balanced diet and engage in regular physical exercise is essential.

Class III Obesity Is Associated with Worse Overall Survival in Previously Untreated Younger Patients with Acute Myeloid Leukemia Enrolled on SWOG 1203

Mohamed Sorror and Mary-Elizabeth Percival contributed equally to this project. Introduction: There has been inconsistent evidence supporting the association between obesity and outcomes in patients with newly diagnosed acute myeloid leukemia (AML). Prior studies have studied obesity as defined by body mass index (BMI) ≥ 30. However, this general definition of obesity can be further subdivided into class I obesity (BMI 30 to &amp;lt;35), class II obesity (BMI 35 to &amp;lt;40) and class 3 obesity (BMI ≥40). Given the high prevalence of obesity in the United States (41.9%; with class III obesity 9.2%), distinctions in degree of obesity may be associated with outcomes for patients with AML (Stierman et al, 2021). We were interested in studying outcomes in patients with AML stratified by class I, class II and class III obesity after induction chemotherapy and allogeneic hematopoietic cell transplant (HCT). Identification of at-risk patient populations could aid in design of future interventions. Methods: We retrospectively reviewed a group of 738 previously untreated subjects with AML randomized to daunorubicin and cytarabine (DA), idarubicin and cytarabine (IA), and IA with vorinostat as part of clinical trial SWOG 1203, conducted by the SWOG Cancer Research Network between 2012 and 2015. Subjects with adverse risk cytogenetics were recommended to receive HCT in their first complete remission (CR1); subjects with intermediate risk cytogenetics were selected for HCT in CR1 per local institutional standards. Nine patients who did not receive protocol therapy or had missing BMI were excluded (final cohort 729 patients). Early death was defined as death within 56 days of induction chemotherapy. Multivariable time-dependent Cox regression model and Fisher's exact test were used for analysis of overall survival (OS). HCT in first complete remission (CR1) was included as a time-dependent covariate. Results: The median age was 49 years (range, 18 to 60), 51% were male, 90% had de novo disease, and 88% had a performance status (PS) of 0-1 (Table 1). Among these patients, 1% (n=9) were underweight, 25% (n=182) were normal weight, 31% (n=225) were overweight, 20% (n=145) had class I obesity, 11% (n= 82) had class II obesity and 12% (n= 86) had class III obesity. There was no difference in the rate of achieving composite CR (CR with or without count recovery) between different weight categories (p=0.17). There was no clear trend in early death rate by weight (underweight: 11%; normal weight: 4%; overweight: 6%;class I obesity: 7%; class II obesity: 4%; class III obesity: 17%), though class III obesity had a significantly higher early death rate as compared to all the other groups combined (p=0.004). In multivariable Cox regression analyses, class III obesity was significantly associated with worse OS when compared to normal weight (hazard ratio (HR) 2.56, 95% confidence interval (CI) 1.68-3.90; p&amp;lt;0.001); though not statistically significant, we identified a trend towards worse OS for patients with class I (HR 1.40, 95% CI 0.95-2.06; p=0.09) and class II obesity (HR 1.48, 95% CI 0.95-2.31; p=0.09) (Figure 1). Other co-variates with a significant association with OS included age (HR 1.03, 95% CI 1.01-1.04; p&amp;lt;0.001), intermediate cytogenetic risk (HR 2.45, 95% CI 1.33-4.51; p=0.004), and adverse cytogenetic risk (HR 5.86, CI 3.10-11.06; p&amp;lt;0.001). HCT during CR1 was not found to be significantly associated with OS (HR 0.88, CI 0.67-1.15; p=0.3). No significant difference was identified in time to HCT based on BMI category. In patients who underwent HCT during CR1, class III obesity (HR 2.32, 95% CI 1.22-4.43; p=0.01) and older age (HR 1.02, 95% CI 1.00-1.04; p=0.01) were significantly associated with worse OS; in contrast no significant association was identified between OS and class I obesity (HR 1.30, 95% CI 0.77-2.20;p=0.32), while a higher HR and a trend existed for class II obesity (HR 1.76, 95% CI 0.97-3.17; p=0.06). Conclusions: Our retrospective analysis suggests that among newly diagnosed younger patients with AML, those with class III obesity are at increased risk of early death and shorter overall survival. Future directions include assessing lean body mass in addition to BMI in patients with newly diagnosed AML, as sarcopenic obesity is known to portend poor outcomes. Identifying this at-risk patient population may help guide future investigation of early weight management interventions in patients with newly diagnosed AML.

Evaluation of body weight–based dosing, alternative dosing regimens, and treatment interruptions for α1-proteinase inhibitors and implications on biochemical efficacy in patients with α1-antitrypsin deficiency

IntroductionThe recommended standard dose for α1-proteinase inhibitor (A1PI) augmentation therapy is 60 mg/kg once-weekly (QW) intravenous (IV) infusions that aim to maintain systemic A1PI levels >11 μM, the biochemical efficacy threshold, in patients with α1-antitrypsin deficiency (AATD). However, this standard dose may not be optimal for all patients. Body weight–based dosing, alternative dosing regimens, and treatment interruption periods were evaluated using population pharmacokinetic (PopPK) modeling and simulations. MethodsA nonlinear mixed-effects PopPK model with covariate effects was developed using data from 3 clinical studies investigating 60 mg/kg QW IV A1PI infusions in patients with AATD (n = 65) to evaluate A1PI pharmacokinetic (PK) characteristics. Model-based simulations were conducted for predefined body weight categories, alternative dosing regimens (60–180 mg/kg QW or once every 2 weeks [Q2W]), and treatment interruption periods ranging from 3 to 14 days. ResultsA1PI PK characteristics were well described by a 2-compartment turnover model with zero-order input and linear elimination. Body weight was a statistically significant determinant of variability in central volume of distribution. Model-based simulations suggested that patients with a higher body weight may attain the 11 μM threshold quicker than patients with a lower body weight and that QW dosing was better at maintaining A1PI levels >11 μM, even when higher Q2W doses were administered. Missing a dose for as few as 3 days could result in A1PI levels <11 μM. DiscussionFindings suggest that doses higher than 60 mg/kg administered QW might be more clinically beneficial in some patients with AATD, and that body weight should be considered in dose optimization.

Increased body weight and central adiposity markers are positively associated with the 20-year incidence of cardiovascular disease: The ATTICA epidemiological study (2002–2022)

Increased adiposity predisposes to cardiovascular disease (CVD). We hypothesized that the presence of obesity would be positively associated with CVD risk, and that the co-presence of central obesity would modify/enhance this association. This was a prospective study (2002–2022) among 1845 Greek adults (mean age, 44.8 ± 13.5 years; men, 49.8%). At baseline, the presence of overweight/obesity was assessed via body mass index (BMI), whereas central obesity was defined as waist circumference ≥102/88 cm, waist-to-hip-ratio ≥0.95/0.80, or waist-to-height-ratio ≥0.50 in men/women. BMI was reevaluated at 10 years and longitudinal BMI trajectories (2002–2012) were identified. CVD incidence was recorded at 20 years (ratio of new cases to the number of participants assessed). Compared with participants with normal weight at baseline, those with obesity exhibited a 27% higher 20-year CVD risk after adjustment for age, sex, lifestyle habits, and medical status (hazard ratio, 1.271; 95% confidence interval, 1.012–1.597). In similar multiadjusted models, compared with participants who were always non-overweight/obese, those who were always overweight/obese exhibited a 40% higher 20-year CVD risk (hazard ratio, 1.403; 95% confidence interval, 1.018–1.936). Additional control for high-sensitivity C-reactive protein attenuated the associations. In the combined baseline body weight classification analysis, CVD incidence was the lowest in participants with normal weight without central obesity, moderate in those with overweight/obesity without central obesity, and highest in those with normal weight and central obesity and overweight/obesity and central obesity (P < .001). Obesity leads to increased CVD risk, partly mediated by inflammation. The combination of BMI with simple measures of abdominal adiposity is superior for CVD risk screening.

Показники змагальної діяльності висококваліфікованих дзюдоїстів вагових категорій 90 та 100 кг на World judo Championships-Doha 2023

Purpose: to analyse the indicators of competitive activity of highly skilled judokas of weight categories 90 and 100 kg at the World Judo Championships-Doha 2023. Material and methods. Research methods were used during the work: analysis and generalization of scientific and methodical literature; timing; analysis of protocols and video recordings of fights of highly qualified judokas of weight categories up to 90 and 100 kg; methods of mathematical statistics. We analysed 61 bouts of judokas in the weight category up to 90 kg and 47 meetings of athletes up to 100 kg. Results: the time analysis of the bouts of highly skilled judokas showed that almost half of the bouts ended early. Thus, for athletes under 90 kg, this figure is 45 %, for judokas under 100 kg – 47 %. Accordingly, the number of matches that ended within the allotted time is the smallest: 22 % for athletes under 90 kg and 19 % for judokas under 100 kg. The percentage of bouts that ended in extra time is 33 % in the category up to 90 kg and 28 % up to 100 kg. An analysis of the types of comments received by the competitors showed that the largest number of them in both categories were received for three types of penalties: not fighting (up to 90 kg – 43 % of all comments; up to 100 kg – 40 %), avoiding a grab (up to 90 kg 23 %; up to 100 kg – 10 %) and using false attacks (up to 60 kg – 9 %; up to 100 kg – 24 %). The analysis of the disqualifications of highly qualified judokas showed that out of 61 fights of athletes in the weight category up to 90 kg, 12 (19 %) ended in disqualification. It is interesting to note that 11 fights (92 %) were disqualified for punishment and 1 fight (8 %) for traumatic prohibited actions (head dipping)). In the weight category up to 100 kg, 87 fights were analysed, of which 13 (27 %) ended in disqualification. More than half of them were for penalties - 7 fights (54 %), and 2 fights (15 %) for traumatic prohibited actions (head dipping). There were also disqualifications for doctor's call - 1 fight (8 %) and no-show - 3 fights (23 %). The main effective technical actions, which are most often used by athletes of each weight category separately in the stand, floor position and lying down, were revealed. Thus, in sportsmen of a weight category up to 90 kg these are: a group of throws through a back (13 %), pick-ups (13 %), hooks (13 %), a throw through a head with a planting of a shin (12 %) and different types of holdings (a lower back - 60 %; from the side of a head - 20 %; from the side with a grip from under a hand - 20 %). In judokas of the weight category up to 100 kg these are: grabs (39 %), hooks (16 %), throws by unbalancing (9 %) and hold across the back (37,5 %). Conclusions. It was established that judokas of weight categories up to 90 and 100 kg finish most of the fights early, during the fight they receive a rather large number of remarks connected with a cautious waiting struggle for which they receive punishment for not conducting a struggle, avoiding a grip. It was found that the struggle of athletes up to 90 and 100 kg mainly takes place in the stance. It has been established that athletes in the weight category up to 90 kg are more technical and use a greater volume of technical actions in competitions. But this applies only to the stance position. If we analyze the position of the floor, lying down, then athletes of the weight category up to 100 kg, on the contrary, have a greater arsenal of technical actions in comparison with the category up to 90 kg.

Аналіз змагальної діяльності висококваліфікованих таеквондистів на Чемпіонаті Європи 2023

Purpose: to analyze the competitive activity of highly skilled taekwondo athletes at the European Championships 2023. Material and methods. The following methods were used in the research: analysis of scientific and methodical information and sources of the Internet; video computer analysis of competitive activity of highly skilled taekwondoists; methods of mathematical statistics. To analyze the fights, a specialized computer program «Martial Arts Video Analysis» was used. The research analyzed 56 rounds (28 competitive fights) of highly qualified taekwondo fighters in weight categories in the range of 58-92 kg of the European Taekwon-Do ITF Championship. Results: the analysis of scientific and methodical publications and sources of the Internet determined that scientific and methodical support of training of highly skilled taekwondo fighters requires the increase of efficiency of technical and tactical training and its further improvement. On the basis of the analysis of the competitive activity of highly qualified taekwondo fighters, it was found that some winners performed significantly more technical actions than those who lost (by 72,2 %); fight winners achieved higher scores (on average by 7 points) and had higher efficiency of actions compared to those who lost, but the level of variability in these indicators in winners (V=28,5 %) and losers (V=22,0 %) is quite significant, and it is important to take into account the abnormal distribution of results; the efficiency of technical and tactical actions of the winners during the fight increases (76,7±12,64, V=16,5 %), and of the losers - decreases (26,7±21,73, V=81,4 %); time intervals between technical actions in winners amounted to 32,7±6,26 (V=19,1 %), in losers - 35,4±6,33 (V=17,8 %); the number of various effective actions in winners amounted to 4,2±0,82 (V=19,5 %), in losers - 3±0,61 (V=20,3 %); most often athletes perform a blow with the hand closer to the opponent (5,8 times), the effectiveness of this action is 11,2 % and brings 1.4 points; the blow «Yop chagi (upper level, the leg is closer to the opponent)» is performed less often, only 1,6 times, but has a much higher efficiency – 17,5 % and brings 2 points. Conclusions. The analysis of fights of highly skilled taekwondoists of weight categories in the range of 58-92 kg at the European Taekwon-Do ITF Championships allows to optimize the training process and is a prerequisite for the development of new approaches of training. It is established which technical and tactical actions of highly qualified taekwondo athletes of different weight categories contributed to the achievement of maximum results: for weight categories 58-71 kg - a punch «Dollo chagi (medium level, the leg is closer to the opponent)» and a punch in a jump; for weight categories 78-92 kg - a punch with a hand closer to the opponent and «Dollo chagi (medium level, the leg is far from the opponent)».

Сучасні технології для визначення ланок тіла борців

Purpose: to determine the effectiveness of using modern computer vision technologies to determine the body parts of wrestlers in competitive activities. Material and methods. The following methods were used in the research: analysis of scientific and methodical literature and Internet sources, analysis of video and images with the help of computer vision (Computer Vision, Machine Learning), methods of mathematical statistics. The final bout in the 65 kg weight category at the 2021 Tokyo Olympics in freestyle wrestling was chosen for analysis. The total number of video fragments was 1763 images. The Yolo machine learning model was used to detect faces, and Google's MediaPipe model was used to detect body parts. For each athlete, 21 body parts were identified. Results: the accuracy of identifying athletes' body parts was obtained: all indicators were above 78 %. The results of the analysis showed that the lower limbs are better identified: hip, knee, ankle, etc. The identification accuracy is above 90%. At the same time, the identification accuracy of the upper limbs is lower. In our opinion, this is due to the fact that athletes spend a sufficient amount of time in the grip and preparing for an attack during the fight. During this time, certain parts of the upper limbs are closed for identification. Analysis of the results of the number of unidentified images showed a similar trend to the identification accuracy. Most of the unidentified body parts were associated with the upper limbs (more than 25 %). At the same time, 10 to 12 % of the body parts associated with the delicate limbs were not identified. Conclusions. The analysis of results of the use of modern technologies of computer vision for determination of links of a body of wrestlers in competitive activity is carried out. The algorithm for studying the body parts of athletes had two stages: the first stage is to determine the area of the image fragment (video) where the athletes are located and the second is to determine the body parts of each wrestler. At the first stage of the study, it was possible to identify both athletes in 79,5 % of the images. The analysis of the accuracy of the athletes' body parts identification showed that the body parts of the lower limbs are better identified than those of te right limbs. This is due to the peculiarity of competitive activity. The visual analysis of the images showed that a certain part of the identified links do not coincide with the actual location of the athletes' body links.

Ефективність змагальної діяльності в хортингу

Purpose: to investigate the efficiency of the competitive activity of skilled sledders in the competitive section «duel». Material and methods. The following methods were used in the research: the analysis and generalization of data of the special scientific literature; the analysis of protocols and video recordings of the competitive activity of the qualified greyhounds; methods of mathematical statistics. The competitive activity (47 fights) at the championships and cups of Ukraine in 2021-2023 in the section «duel» in all weight categories of male athletes among adults (18 years and older) was studied. Results: the study of competitive activity showed that 67 % of the time of fights in the competitions in the field of hornting is held in the stand, and 33 % in the floor. Scoring points in the ground can be obtained by holding (1 and 2 points) and strikes that hit the opponent (1 point). From the stand-up position, the athletes scored 54 points (65 %), and 29 points (35 %) in the ground. In 31 % of the fights, the victory was achieved by scoring points, 31 % by painful techniques, 23 % by choking techniques and 15 % by knockout blows. An early victory in the sport of horting is possible by executing an effective painful or choke hold, a knockout punch, and one of the athletes scoring 6 points. The distribution of early wins by competition round shows that in the first round, 67 % of athletes won. In the second round, athletes achieved early victories in 33% of the matches. In 45 % of the fights, the athletes achieved an early victory through painful techniques. Of these, 75 % were arm holds and 25 % were leg holds. In 33 % of the fights, the athletes achieved victory through choke holds. The winner was determined by knockout in 22 % of fights. Conclusions. Adult male athletes use striking and wrestling techniques in the fights of the «duel» competitive section. The most effective technique for achievement of victory by points and early victory is a wrestling technique. In competitive fights in a stance, the most effective throws are those with a leg grab. Insufficient mastery of wrestling technique leads to the defeat of an athlete in the first round by a suffocating or painful hold. It is determined that transfers to the ground are not evaluated by judges, but create conditions for the further implementation of holds, painful and suffocating techniques. In the ground, the most effective are painful arm holds and chokes. Striking techniques are used mainly as a preparatory technique for throws and painful and suffocating holds. In the second round, the importance of performing holds increases.

SEDENTARY PHYSICAL ACTIVITY WITH BODY MASS INDEX AMONG PRECLINICAL STUDENTS AT THE FACULTY OF MEDICINE OF WIDYA MANDALA CATHOLIC UNIVERSITY OF SURABAYA

Background: The percentage of individuals with a body mass index (BMI) above normal continues to increase every year. Sedentary physical activity is one of the factors that may cause an increase in BMI. IMT is a statistical indicator that applies an individual's weight and height to determine weight categories at all age groups. Sedentary physical activity refers to an activity in a conscious state that only expends energy of ≤1.5 Metabolic Equivalent of Task (MET). Objective: To determine the correlation between sedentary physical activity and BMI among preclinical students at the Faculty of Medicine, Widya Mandala Catholic University of Surabaya. Methods: This was an observational analytical study with cross-sectional design. The samples were selected through simple random sampling. The data source for this study were derived from primary data in the form of interviews using the International Physical Activity Questionnaire (IPAQ) and direct measurement towards 159 students. Results: 41.5% of students had normal BMI and 33.3% of students had sedentary physical activities. Based on the results of Spearman correlation test, it was found that there was a strong and significant relationship between sedentary physical activity and body mass index (p value=0.000 with r=0.641). Conclusions: There was a significant positive correlation between sedentary physical activity and BMI, which indicated that the higher the sedentary physical activity, the higher the BMI. Such relationship suggested that sedentary physical activity had a positive role in the incidence of overweight and obesity.

Perinatal Outcome in Overweight Women: An Audit.

Obesity in pregnancy is associated with a myriad of well-documented complications. However, the outcomes of pregnancy in overweight females, who are not classified as obese, have not been studied. The aim of the study was to assess foeto-maternal outcomes in primigravida who are overweight and compare them to normal-weight patients. This was a prospective observational cohort study and included primigravida with full-term gestation (between 38 and 42 weeks), with a single live foetus in vertex presentation, who were admitted for labour induction. Based on pre-pregnancy weight, patients were divided into normal weight (body mass index, BMI<23kg/m2) and overweight (BMI≥23kg/m2 and<25kg/m2) categories labelled as groups A and B, respectively. Data was collected for gestational age, demographics (age, education, occupation), and obstetric and labour-related parameters per pre-designed proforma. Parameters included were the reason for induction, number of doses of prostaglandin E2 (PGE2) gelused, duration of labour, induction to delivery interval, and mode of birth- operative/ non-operative. Data was also collected for peri-partum maternal complications, neonatal Apgar score, and need for Neonatal Intensive Care Unit (NICU) admissions. One hundred and fifty patients were recruited in the study and divided based on weight into two groups- 115 in Group A (normal weight) and 35 in Group B (overweight). Compared to Group A, a higher proportion ofpatients in Group B needed a third dose of PGE2 gel (n=24, 20.8%vs n=18, 51.4%). Also, more patients in Group B had an induction to delivery time of longer than 30 hours (n=7, 20% vs n=5, 4.3%)and had a higher incidence of failed induction needing caesarean section (n=9, 25.7% vs n=13, 11.3%).Neonates born to overweight mothers had a poor Apgar score at 1 min. However, on reassessment, Apgar improved at 5 minutes, and no statistically significant difference was seen for admission to NICU- 5.7% (n=2) in Group B vs 1.7% (n=2) in Group A Conclusion: Pregnancy in overweight females is associated with prolonged labour, higher instances of failed induction, and poor neonatal outcomes at initial assessment. Thus, perinatal counselling and management should focus on weight control while also planning appropriate strategies for monitoring and treating pregnancy-related complications if weight control measures fail. Although obesity is the main focus of research, we suggest including overweight but non-obese females in such studies as they have similar adverse outcomes and complications.