Changes In Clinical Characteristics Research Articles

Changes of clinical characteristics, distribution of red flags and prognosis in contemporary patients with wild-type transthyretin amyloidosis cardiomyopathy

Aim Increased diagnostic awareness and specific disease treatments have changed the landscape of transthyretin cardiac amyloidosis (ATTR). Patients with wild-type ATTR (ATTRwt) are increasingly being diagnosed, potentially changing the clinical profile and prognosis compared with existing retrospective data. We aimed to study the clinical characteristics, distribution of red flags and prognosis of contemporary ATTRwt patients. Methods From January 1st 2017, to December 31st 2022, 213 consecutive patients were diagnosed with ATTRwt and prospectively followed up. Data on clinical characteristics, biomarkers, echocardiography findings, hospitalization due to worsening heart failure (WHF) and all-cause mortality were collected. Results A 37% increase in newly diagnosed patients from 2017–2019 (n = 90) vs. 2020–2022 (n = 123) was observed. The majority of patients presented with NAC disease stage I in the latter period (49% in 2017–2019 vs. 58% in 2020–2022, p = .16). Red flags were primarily cardiac-related, including elevated NT-proBNP, impaired left ventricular longitudinal systolic strain with an apical sparing pattern, heart failure with increased left ventricular wall thickness and elevated troponins. NAC disease stage I as well as low NT-proBNP levels (<1000 ng/L) were significantly associated with better survival (both p < .001). When compared with NAC disease stage II + III combined, patients with NAC disease stage I had a significantly lower risk of WHF hospitalization or death (log rank test: p = .0001). Independent predictors of the combined endpoint WHF hospitalization or death were NT-proBNP (HR 1.03 [95% CI 1.00–1.07], p < .049) and prior implantation of permanent pacemaker (HR 2.01 [1.30–3.11], p = .002). Conclusion Increased diagnostic awareness resulted in a 37% increase in newly diagnosed patients in 2020–2022 vs. 2017–2019. As expected all-cause mortality but also the morbidity in terms of risk of hospitalization with WHF were significantly lower in patients with NAC disease stage I, as well as in those with low NT-proBNP levels <1000 ng/L. These findings underline the importance of continuous attention to diagnostic awareness, as early diagnosis is critical for initiating both general and specific ATTR treatment, thus improving prognosis.

Uterine cancer incidence trends and 5-year relative survival by race/ethnicity and histology among women under 50 years

BackgroundUterine cancers diagnosed before age 50 years are increasing in the U.S., but changes in clinical characteristics and survival over time across racial/ethnic groups have not been previously described. ObjectivesTo investigate age-adjusted, hysterectomy corrected incidence rates and trends, and five-year relative survival rates of uterine cancer in women aged <50 years, overall and stratified by race/ethnicity and histology. Study DesignWe included microscopically confirmed uterine cancer cases (diagnosed 2000-2019) in women aged 20-49 years from the Surveillance, Epidemiology, and End Results Program (SEER 22). Age-adjusted incidence and 5-year relative survival rates, and 95% confidence intervals were computed using SEER*Stat and compared across time periods (2000-2009 and 2010-2019). Incidence rates were adjusted for hysterectomy prevalence using Behavioral Risk Factor Surveillance System data, and trends were computed using the Joinpoint regression program. ResultsWe included 57,128 uterine cancer cases. The incidence of uterine cancer increased from 10.1 per 100,000 in 2000-2009 to 12.0 per 100,000 in 2010-2019, increasing at an annual rate of 1.7%/year for the entire period. Rising trends were more pronounced among women <40 years (3.0%/year and 3.3%/year in 20-29 and 30-39 years, respectively) than in those 40-49 years (1.3%/year), and among underrepresented racial/ethnic groups (Hispanic 2.8%/year, Non-Hispanic, [NH]-Black 2.7%, NH-Asian/Pacific Islander [PI] 2.1%) than in NH-White (0.9%/ year). Recent (2010-2019) incidence rates were highest for endometrioid (9.6 per 100,000), followed by sarcomas (1.2), and non-endometrioid subtypes (0.9). Rates increased significantly for endometrioid subtypes at 1.9%/year from 2000-2019. Recent endometrioid and non-endometrioid rates were highest in NH-Native American/Alaska Native [NA/AN] (15.2 and 1.4 per 100,000), followed by Hispanic (10.9 and 1.0), NH-Asian/PI (10.2 and 0.9), NH-White (9.4 and 0.8), and lowest in NH-Black women (6.4 and 0.8). Sarcoma rates were highest in NH-Black women (1.8 per 100,000). The five-year relative survival remained unchanged over time for women with endometrioid (from 93.4% in 2000-2009 to 93.9% in 2010-2019, p≥0.05) and non-endometrioid subtypes (from 73.2% to 73.2%, p≥0.05) but decreased for women with sarcoma from 69.8% (2000-2009) to 66.4% (2010-2019, p<0.05). ConclusionsUterine cancer incidence rates in women <50 years have increased from 2000 to 2019 while survival has remained relatively unchanged. Incidence trends can be primarily attributed to increasing rates of cancers with endometrioid histology, with the greatest increases observed among NH-Black, Hispanic, and NH-Asian/PI. Sarcomas, while much rarer, were the second most common type of uterine cancer among women <50 years and have poor prognosis and apparent decreasing survival over time. Rising rates of uterine cancer and the distinct epidemiologic patterns among women <50 years highlight the need for effective prevention and early detection strategies for uterine cancer in this age group.

Characterisation of the octogenarians presenting to the diagnostic heart failure clinic: SHEAF registry

IntroductionHeart failure (HF) incidence is increasing in older adults with high hospitalisation and mortality rates. Treatment is complicated by side effects and comorbidities. We investigated the clinical characteristics of octogenarians...

Shared comorbidity of depression, migraine, insomnia, and fibromyalgia in a population-based sample

BackgroundDepression, migraine, insomnia, and fibromyalgia are reportedly comorbidities. Nevertheless, no study has evaluated the comorbidity of all four of these disorders. This study aimed to investigate the comorbidity of these four disorders. MethodsCross-sectional analyses were performed using data of the Circannual Change in Headache and Sleep study, an online nationwide population-based survey. Validated questionnaires were used to diagnose the disorders and measure quality of life. The change of clinical characteristics by addition of any comorbidity was analyzed using the Jonckheere–Terpstra trend test. ResultsThe prevalence rates of depression, migraine, insomnia, and fibromyalgia were 7.2 %, 5.6 %, 13.3 %, and 5.8 %, respectively. Among the 3030 included participants, 494 (16.3 %), 164 (5.4 %), 40 (1.3 %), and 6 (0.2 %) had one, two, three, and four of these conditions, respectively. The number of headache days per 30 days (Jonckheere–Terpstra trend test, p = 0.011) and migraine-related disability (migraine disability assessment score, p = 0.021) increased with an increase in the number of comorbidities but not with the intensity of headache (visual analog scale, p = 0.225) among participants with migraine. The severity of insomnia (Insomnia Severity Index, p < 0.001) and fibromyalgia (fibromyalgia severity score, p = 0.002) increased with additional comorbidities; however, depression (Patient Health Questionnaire-9, p = 0.384) did not show such an increase. LimitationsThe diagnoses of conditions were based on self-reported questionnaires. ConclusionsThe findings confirmed significant comorbidity between depression, migraine, insomnia, and fibromyalgia. Health professionals should be aware of the probable comorbidity of depression, migraine, insomnia, and fibromyalgia when caring for individuals with any of these four disorders.

Integrated Network Analysis of Symptom Clusters Across Monkeypox Epidemics From 1970 to 2023: Systematic Review and Meta-Analysis.

The worldwide spread of monkeypox (mpox) has witnessed a significant increase, particularly in nonendemic countries. We aimed to investigate the changing clinical symptoms associated with mpox from 1970 to 2023 and explore their interrelations. In this systematic review and meta-analysis, 3 electronic databases were searched for English peer-reviewed studies conducted from January 1970 to April 2023 that reported any symptoms among confirmed mpox cases. We categorized the mpox epidemics into 3 periods: 1970-2002 (period 1, within the African region), 2003-2021(period 2, epidemics outside Africa), and 2022-2023 (period 3, worldwide outbreak). Following PRISMA guidelines, a meta-analysis was performed to estimate the pooled prevalence for each symptom. The correlation among symptoms was analyzed and visualized using network analysis. The meta-analysis included 61 studies that reported 21 symptoms in 720 patients from period 1, 39 symptoms in 1756 patients from period 2, and 37 symptoms in 12,277 patients from period 3. The most common symptom among patients from all 3 periods was rash (period 1: 92.6%, 95% CI 78.2%-100%; period 2: 100%, 95% CI 99.9%-100%; and period 3: 94.8%, 95% CI 90.9%-98.8%), followed by lymphadenopathy (period 1: 59.8%, 95% CI 50.3%-69.2%; period 2: 74.1%, 95% CI 64.2%-84.1%; and period 3: 61.1%, 95% CI 54.2%-68.1%). Fever (99%, 95% CI 97%-100%), enlarged lymph nodes (80.5%, 95% CI 75.4%-85.0%), and headache (69.1%, 95% CI 4%-100%) were the main symptoms in period 1, with a significant decrease in period 3: 37.9%, 31.2%, and 28.7%, respectively. Chills/rigors (73.3%, 95% CI 60.9%-85.7%), fatigue (68.2%, 95% CI 51.6%-84.8%), and dysphagia/swallowing difficulty (61.2%, 95% CI 10.5%-100%) emerged as primary new symptoms in period 2 and decreased significantly in period 3. Most other symptoms remained unchanged or decreased in period 3 compared to the former 2 periods. Nausea/vomiting had the highest degree of correlation (with 13 symptoms) and was highly positively correlated with lymphadenopathy (r=0.908) and conjunctivitis (r=0.900) in period 2. In contrast, rash and headache were 2 symptoms with the highest degree of correlation (with 21 and 21 symptoms, respectively) in period 3 and were highly positively correlated with fever (r=0.918 and 0.789, respectively). The manifestation of symptoms in patients with mpox has become more diverse, leading to an increase in their correlation. Although the prevalence of rash remains steady, other symptoms have decreased. It is necessary to surveil the evolving nature of mpox and the consequential changes in clinical characteristics. Epidemic countries may shift their focus on the potential association among symptoms and the high synergy risk. PROSPERO Registration: CRD42023403282; http://tinyurl.com/yruuas5n.

Target engagement of the subgenual anterior cingulate cortex with transcranial temporal interference stimulation in major depressive disorder: a protocol for a randomized sham-controlled trial.

Transcranial temporal interference stimulation (tTIS) is a new, emerging neurostimulation technology that utilizes two or more electric fields at specific frequencies to modulate the oscillations of neurons at a desired spatial location in the brain. The physics of tTIS offers the advantage of modulating deep brain structures in a non-invasive fashion and with minimal stimulation of the overlying cortex outside of a selected target. As such, tTIS can be effectively employed in the context of therapeutics for the psychiatric disease of disrupted brain connectivity, such as major depressive disorder (MDD). The subgenual anterior cingulate cortex (sgACC), a key brain center that regulates human emotions and influences negative emotional states, is a plausible target for tTIS in MDD based on reports of its successful neuromodulation with invasive deep brain stimulation. This pilot, single-site, double-blind, randomized, sham-controlled interventional clinical trial will be conducted at St. Michael's Hospital - Unity Health Toronto in Toronto, ON, Canada. The primary objective is to demonstrate target engagement of the sgACC with 130 Hz tTIS using resting-state magnetic resonance imaging (MRI) techniques. The secondary objective is to estimate the therapeutic potential of tTIS for MDD by evaluating the change in clinical characteristics of participants and electrophysiological outcomes and providing feasibility and tolerability estimates for a large-scale efficacy trial. Thirty participants (18-65 years) with unipolar, non-psychotic MDD will be recruited and randomized to receive 10 sessions of 130 Hz tTIS or sham stimulation (n = 15 per arm). The trial includes a pre- vs. post-treatment 3T MRI scan of the brain, clinical evaluation, and electroencephalography (EEG) acquisition at rest and during the auditory mismatch negativity (MMN) paradigm. This study is one of the first-ever clinical trials among patients with psychiatric disorders examining the therapeutic potential of repetitive tTIS and its neurobiological mechanisms. Data obtained from this trial will be used to optimize the tTIS approach and design a large-scale efficacy trial. Research in this area has the potential to provide a novel treatment option for individuals with MDD and circuitry-related disorders and may contribute to the process of obtaining regulatory approval for therapeutic applications of tTIS. ClinicalTrials.gov, identifier NCT05295888.

Hematopoietic Stem Cell Transplantation for DLBCL: 55,000 Cases from EBMT As a Comparator for CAR T-Cells

Introduction: Autologous (auto-HSCT) and allogeneic (allo-HSCT) stem cell transplantation represent established treatments for patients (pts) with diffuse large B-cell lymphomas (DLBCL). Transplant modalities and results substantially changed over time. Due to the favorable data reported for chimeric antigen receptor T-cell (CART) treatment and other more targeted drugs, the landscape of transplantation for DLBCL is rapidly changing. We provide long-term data for DLBCL transplants reported to the European Society for Blood and Marrow Transplantation (EBMT) over 30 years as a comparator to CAR T-cell therapies. Methods: We conducted a registry-based analysis of auto- and allo-HSCT activities in Europe and other countries reporting to EBMT in patients with DLBCL treated between 1990 and 2022. Patients meeting the following criteria were included: age≥18 years, diagnosis of DLBCL, auto-HSCT as first HSCT or allo-HSCT either as first HSCT or after auto-HSCT. For transplants reported between 1990-2019, information on modalities and outcomes were retrieved from the EBMT database. CART numbers from the first CART treatment reported to EBMT until 2022 were also collected. Results: In total, 50,776 patients received an auto-HSCT and 5,282 an allo-HSCT between 1990 and 2022. Numbers for auto-HSCT increased from 1,021 in 1990-1994 to a maximum of 2,385 in 2019; the number of allo-HSCT rose from 45 to 305 for these time periods. After 2019, transplant numbers experienced a sharp decline with only 1,548 auto- and 124 allo-HSCT performed in 2022, Conversely, the number of CART consistently increased since the first EBMT-recorded infusion in 2014, rising from 537 in 2019 to 809 in 2022. For detailed analyses, 38,979 auto-HSCT and 4,100 allo-HSCT pts (1,753 allo-HSCT as 1 st HSCT; 2,347 after auto-HSCT) between 1990 and 2019 were identified. Important trends for auto-HSCT were an increase of median age at HSCT [42.0yr (1990-1994) to 57.4yr (2015-2019), p&amp;lt;.0001] and better performance status ≥80% [91.3% (1990-1994) vs 93.0%(2015-2019), p=.006]. Peripheral blood (PB) became the dominant stem cell source for auto-HSCT in 1994; numbers of patients prepared with total body irradiation decreased [16.5% (1990-1994) to 0.4% (2015-2019), p&amp;lt;.0001]. For allo-HSCT pts, the following trends emerged: significant increase in median age [35.8yr (1990-1994) to 53.0yr (2015-2019), p&amp;lt;.0001], adoption of PB as the main stem cell source in 1998 and a substantial shift towards reduced intensity conditioning [0% (1990-1994) to 60.6% (2015-2019), p&amp;lt;.0001]. The proportion of unrelated donors and haploidentical donors significantly increased over time [0% (1990-1994) vs 51.2% (2015-2019), p&amp;lt;.0001 and 0% vs 16.2%, p&amp;lt;.0001]. With a median follow-up of 3.7yr (range 0-30.8yr) for autografted pts, 3-yr overall survival (OS) significantly improved over time [57% (1990-1994) to 71% (2015-2019), p&amp;lt;.001], the relapse rate (RI) declined [50% (1990-1994) to 36%(2015-2019), p&amp;lt;.001], but non-relapse mortality (NRM) remained at 4%. Auto-HSCT patients transplanted in first CR/PR between 2016 and 2019 showed superior outcomes compared to pts treated in second or later CR/PR [3-yr PFS: 69% vs 56%, p&amp;lt;.001; 3-yr OS: 79% vs 69%, p&amp;lt;.001]. For allo-HSCT recipients, with a median follow-up of 4.7yr (range 0-28.6yr), significant improvements were noted for 3-yr OS [35% (1990-1999) to 46% (2015-2019), p&amp;lt;.001)], 3-yr PFS ( p&amp;lt;.001) as well as 3-yr RI ( p&amp;lt;.005). However, 1-yr NRM only improved numerically [30% (1990-1994) to 20% (2015-2019), p=.21]. Conclusions: With more than 50,000 patients analyzed, we provide a comprehensive overview of changes in transplantation modalities and results over more than 30 years. We observed major changes in clinical characteristics and substantial improvements in all major outcome parameters. Patients became increasingly older and medically fit and were transplanted earlier in the course of disease. OS and PFS significantly increased, relapse incidence decreased, NRM did not show major evolution, all supposedly attributable to better patient selection and supportive care. With CART entering the clinical arena, the numbers of transplants for DLBCL sharply decreased. Auto- and allo-HSCT remain important modalities for pts failing CART or in countries where CART are not readily available. The outcomes reported here may serve as real-world benchmark data when new modalities like CART are considered.

The landscape of inpatient admissions for alcoholic hepatitis in the era of early liver transplantation

Introduction and ObjectivesLiver transplant (LT) is a recent option available in the United States (US) to treat those with severe, refractory alcoholic hepatitis (AH). We examined changes in clinical characteristics of patients admitted with AH and tracked hospital outcomes as practice changes involving LT have shifted. Materials and MethodsUsing the National Inpatient Sample, we performed a cross-sectional analysis of patients admitted with AH during the years 2016–2020 in the US. Differences in clinical characteristics over time were assessed. To compare outcomes between 2016–2017 (when LT was less common) and 2018–2020 (when LT was more common), we conducted linear and logistic regression. Propensity-score matching was used to compare outcomes between patients with and without LT. ResultsFrom 2016–2017 to 2018–2020, patients admitted with AH tended to have a higher frequency of infection (p = 0.006), hepatorenal syndrome (<0.001), and ascites (<0.001). Hospital costs and length of stay (LOS) were highest in transplant hospitals, and costs rose over time in both non-transplant (NT) teaching and non-teaching hospitals (p < 0.001). Mortality decreased in NT teaching hospitals [aOR 0.7 (95% CI: 0.6–0.8)] and slightly decreased in NT non-teaching hospitals [aOR 0.7 (95% CI: 0.5–1.0)]. In the propensity-matched cohort involving LT versus non-LT patients, there was a 10% absolute reduction in-hospital mortality, but this came at a higher cost (p < 0.001) and length of stay (p < 0.001). ConclusionsThe severity of AH has been increasing over time, yet mortality has declined after adjusting for severity of disease. Patients who underwent LT survived; however, the healthcare burden of LT is substantial.

Evaluation of Non-Compressive Transvaginal Cervical Elastography as a Quantitative Imaging Biomarker in Pregnancy: A Repeatability and Reliability Analysis.

Non-compressive strain elastography has been proposed as a novel quantitative imaging biomarker for assessing the structure and function of the cervix. The current study aims to assess the repeatability, and intra- and inter-observer reliability of transvaginal non-compressive cervical strain elastography in a clinical setting. We conducted a dual-phase single-center prospective feasibility study of singleton gestations >16-weeks gestation that required a clinically-indicated transvaginal ultrasound. Each study participant, n = 43 in phase 1 and n = 13 in phase 2, had elastography performed by two trained observers that each performed multiple image acquisitions. We performed a multivariable regression to adjust for changes in clinical characteristics between study phases and calculated the repeatability coefficients, limits of agreement, and intraclass correlations for each quantitative elastography parameter. We compared quantitative elastography parameters to cervical length measurements, acquired from the same images. The repeatability coefficients and percent limits of agreement were wide for all of the quantitative elastography parameters, demonstrating poor repeatability. Intraclass correlation coefficients were poor-moderate for both intra-observer (0.31-0.77) and inter-observer reliability (0.35-0.77) in both study phases, while cervical length showed excellent reliability with intraclass correlations consistently >0.90. Non-compressive transvaginal strain cervical elastography did not demonstrate adequate repeatability or reliability. Our results highlight the importance of rigorously assessing novel quantitative imaging biomarkers before clinical application.

An evaluation of 20-year survival of radiofrequency ablation for hepatocellular carcinoma as first-line treatment

ObjectivesTo evaluate the changes in clinical characteristics, overall survival (OS), and progression-free survival (PFS) by investigating a 20-year cohort of patients with HCC who underwent RFA treatment. MethodsFrom 2000 to 2020, 505 consecutive patients with HCC underwent ultrasound-guided percutaneous RFA as first-line therapy at a tertiary cancer hospital. We divided the cohort according to the time when hepatitis-B antiviral therapy was covered by national medical insurance coverage (early 2011), including the first decade (2000–2010) and second decade (2011–2020). The prognostic factors for OS were analyzed by the Cox proportional hazard model. OS and PFS in different groups were compared using the Kaplan-Meier method. To reduce selection bias, matched groups of patients were selected using the propensity score matching (PSM) method. ResultsIn total, 726 RFA sessions were performed to treat 867 HCC lesions. Patients treated in the second decade were younger (p =.047), had smaller tumors (p <.001), had lower Child-Pugh scores (p <.001), and had a higher proportion of antiviral treatment (p <.001). A total of 96.0% of patients achieved technical efficacy from the initial RFA. After PSM analysis, improved PFS was found for the second decade (median, 68 vs. 49 months, p =.003), but no significant difference in OS was observed between the two groups (median, 71 vs. 65 months, p =.20). ConclusionsThis study demonstrated that improved PFS was achieved in patients with HCC receiving RFA as first-line treatment in the second decade. However, long-term OS was not significantly increased compared to the first decade suggesting that while RFA treatment has improved, it still might not substantially affect OS results.

Ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China: a CR-HepB-based real-world study

Objective: To understand ten-year changes in clinical characteristics and antiviral treatment patterns of chronic hepatitis B in China. Methods: Patients with chronic HBV infection:demographic, virologic, hematologic, blood biochemistry, and antiviral treatment data were extracted from the China Registry of Hepatitis B (CR-HepB) database between 2012 and 2022 for descriptive statistics and change trend analysis. Multiple group comparisons were conducted using the Kruskal Wallis H test, while counting data was compared between groups using χ (2) test. Results: A total of 180 012 patients with chronic HBV infection were included, with a median age of 40 years old, and a male proportion accounting for 60.2%. The HBeAg positive rate was 43.3%. Over time, the median age of new patients each year increased from 39 to 47 years, while the HBeAg positive rate decreased from 51.3% to 32.8%. The initial diagnosis of patients was mainly CHB (71.4%), followed by hepatitis B cirrhosis (11.8%), inactive HBsAg carrier status (10.6%), and chronic HBV carrier status (6.2%). Among the newly registered patients every year from 2012 to 2022, the proportion of hepatitis B cirrhosis remained stable, but after 2019, the proportion of CHB increased and the proportion of other diagnoses decreased. The proportion of patients with cirrhosis increased with age in different age groups, with 3.5%, 19.3%, and 30.4% in the < 40, 40-69, and≥70 age groups, respectively. The proportion of women in patients with cirrhosis also increased with age, from 16.1% in those < 30 years old to 44.3% in those≥80 years old. From 2012 to 2022, the proportion of patients receiving first-line nucleos(t)ide analog antiviral treatment increased year by year, from 51.0% in 2012-2013 to 99.8% in 2022. Conclusion: The CR-HepB registration data reflect the changes in clinical characteristics and antiviral treatment patterns in patients with chronic HBV infection in China over the past ten years and can thus provide a reference to promote hepatitis B diagnosis and treatment practice, as well as scientific research.

Characteristic Features of Hospitalized Covid-19 Patients in Al-Dejail Hospital Region

Background: Covid-19 has been one of the affected countries during the pandemic from February 2020. The majority of published research have shown the demographic and clinical features of Covid-19 patients in various parts of Iraq, but not in Al-Dejail district, Salah AldenGovernorate. The baseline and clinical features of hospitalized COVID-19 patients hospitalized are described below.Methods: This is a cross-sectional study in ِ Al-Dejail Emergency and Maternity Hospital from February 2020 until July 2020. Review of 100 admitted patients to the emergency unit was done and, the demographic and clinical manifestations was reported in patients with COVID-19 infection. The patients in this study were split into two groups: mild to moderate cases (percent) and severe to critically sick cases (78 percent). In accordance, a comparative analysis of all reported characteristics is performed.Results: The patients' mean age was 52.25±13.9 years, with 46-55 years being the most frequent age group. In terms of gender, smoking, or job, there was no statistically significant difference between the mild-moderate and seriously to critically ill groups (p &gt; 0.05). Fever (84 percent), cough (82 percent), dyspnea (88 percent), and GIT symptoms were the most prevalent symptoms among the hospitalized patients. Except for obesity, diabetes, and CT results, there were no significant changes in clinical characteristics, co morbidities, or clinical outcomes between moderate and severe patients.Conclusions: The majority of COVID-19 patients were symptomatic and were older than previous reports ranges between 46 and 55 years. Obesity and diabetes mellitus were discovered to be strongly associated to the progression and severity of illness

Temporal Changes in Clinical Characteristics and Outcomes of Adults With Congenital Heart Disease

The purpose of this study was to assess differences in the clinical characteristics (defined by congenital heart disease [CHD] anatomic and physiologic classification scheme) of adults with CHD across different eras, and how these differences influence outcomes (heart failure hospitalization and all-cause mortality). Patients were divided into depending on year of baseline encounter: cohort #1 (1991-2000, n=1,984 [27%]), cohort #2 (2001-2010, n=2,448 [34%]), and cohort #3 (2011-2020, n=2,847 [39%]). Patients were classified into 3 anatomic groups (simple, moderate, and complex CHD) and 4 physiologic stages (stage A-D). There was a temporal increase in the proportion of patients in physiologic stage C (17% vs 21% vs 24%, P < .001), and stage D (7% vs 8% vs 10%, P=.09), with a corresponding decrease in physiologic stage A (39% vs 35% vs 28%, P < .001). No temporal change in anatomic groups. There was a temporal decrease in the incidence of all-cause mortality (12.7 vs 10.6 vs 9.5 per 1,000 patient-years, P < .001). However, there was a temporal increase in the incidence of heart failure hospitalization (6.8 vs 8.4 vs 11.2 per 1,000 patient-years, P < .001). CHD physiologic stage (but not anatomic groups) was associated with heart failure hospitalization and all-cause mortality. There is a need for better strategies to identify and treat heart failure, and to modify the risk factors associated with heart failure and all-cause mortality.

The past, present, and future of opioid prescribing: Perioperative opioid use in gynecologic oncology patients after laparotomy at a single institution from 2012 to 2021

ObjectiveTo describe the evolution of perioperative opioid management in gynecologic oncology patients after open surgeries and determine current opioid over-prescription rates. MethodsPart one of this two-part study was a retrospective chart review of adult patients who underwent laparotomy by a gynecologic oncologist from July 1, 2012 to June 30, 2021, comparing changes in clinical characteristics, pain management and discharge opioid prescription sizes between fiscal year 2012 (FY2012) and 2020 (FY2020). In part two, we prospectively surveyed patients after laparotomy in 2021 to determine opioid use after hospital discharge. Results1187 patients were included in the chart review. Demographic and surgical characteristics remained stable from FY2012 to FY2020 with differences notable for increased rates of interval cytoreductive surgeries for advanced ovarian cancer and decreased rates of full lymph node dissection. Median inpatient opioid use decreased by 62 % from FY2012 to FY2020. Median discharge opioid prescription size was 675 oral morphine equivalents (OME) per patient in FY2012 and decreased by 77.7 % to 150 OME in FY2020. Of 95 surveyed patients in 2021, median self-reported opioid use after discharge was 22.5 OME. Patients had an excess of opioids equivalent to 1331 doses of 5-milligram oxycodone tablets per 100 patients. ConclusionInpatient opioid use in our gynecologic oncology open surgical patients and post-discharge opioid prescription size significantly decreased over the last decade. Despite this progress, our current prescribing patterns continue to significantly overestimate patients’ actual opioid use after hospital discharge. Individualized point of care tools are needed to determine an appropriate opioid prescription size.

Associations of striatal dopamine transporter binding with motor and non-motor symptoms in early Parkinson's disease.

Dopamine transporter (DAT) imaging is an in vivo tool to assess presynaptic dopaminergic function in the clinical practices of Parkinson's disease (PD). Current clinical practices focused on qualitatively visual interpretation of DAT imaging, whereas quantitative analyses are potentially more helpful when monitoring the progression of PD. Previous cross-sectional studies indicated certain motor and non-motor features were associated with striatal DAT binding, whereas limited data were reported in terms of the longitudinal correlation between clinical features of PD with striatal DAT binding. The purpose of our study is to clarify current and longitudinal correlations between striatal DAT binding and clinical measures. A total of 352 untreated PD individuals and 167 healthy controls with complete baseline clinical measures and neuroimaging data were identified from the Parkinson's Progression and Markers Initiative (PPMI) database. Patients with PD underwent DAT imaging at the screening visit and following months 12, 24, and 48. Multiple linear regression models and linear mixed-effect models were respectively conducted to investigate the cross-sectional and longitudinal correlation between clinical characteristics and DAT binding. Associations between changes in clinical characteristics and changes in DAT binding were further evaluated and the Spearman rank correlation coefficients were reported. In the cross-sectional analysis, baseline striatal DAT binding was significantly associated with the Hoehn and Yahr scale, the Movement Disorder Society-Sponsored Revision of the Unified Parkinson Disease Rating Scale (MDS-UPDRS) scores, the rigidity scores, and the axial scores in PD individuals (false discovery rate [FDR]-adjusted p=0.0017 for all above). Patients who developed freezing of gait had lower striatal DAT binding (FDR-adjusted p=0.0161). Healthy controls who had higher tremor scores and suffered more severe olfactory dysfunction had lower striatal DAT binding (FDR-adjusted p=0.0257 for all above). Longitudinal analysis indicated that baseline severity of rapid-eye-movement sleep behavior disorder was significantly associated with longitudinal striatal DAT binding in patients with PD (FDR-adjusted p=0.0120). Furthermore, changes in MDS-UPDRS scores and the State-Trait Anxiety Inventory (STAI) scores demonstrated significant correlations with changes in striatal DAT binding over 4 years (p=0.005 and p=0.032, respectively). Our findings clarified quantitative associations between certain motor and non-motor features with current and future striatal dopamine binding, suggesting the feasibility of using DAT images as a progression predictive marker for PD. Further studies are needed to investigate correlations between different regional dopamine binding with specific clinical features.

Analyze the clinical characteristics of mild and severe SARS-CoV-2 infected patients based on the local Omicron variant epidemic

To analyze the epidemic characteristics and clinical key indicators of the patients infected with SARS-CoV-2 of the local Omicron variant epidemic, to understand the clinical characteristics of mild and severe patients, and to provide a scientific basis for the effective treatment and prevention of severe disease. From January 2020 to March 2022, the clinical and laboratory data of COVID-19 patients admitted to the Fifth People's Hospital of Wuxi were retrospective analyzed, including virus gene subtypes, demographic information, clinical classification, main clinical symptoms, and key indicators of clinical testing, and the changes of clinical characteristics of the patients infected with SARS-CoV-2. A total of 150 patients with SARS-CoV-2 infection were admitted, 78, 52 and 20 in 2020, 2021 and 2022, including 10, 1 and 1 severe patient, and the main infected virus strains were L, Delta, and Omicron variants. The relapse rate of patients infected with the Omicron variant was as high as 15.0% (3/20), the incidence of diarrhea decreased to 10.0% (2/20), the incidence of severe disease decreased to 5.0% (1/20), and the number of hospitalization days of mild patients increased compared with 2020 (days: 20.43±1.78 vs. 15.84±1.12); respiratory symptoms were reduced, and the proportion of pulmonary lesions decreased to 10.5%; the virus titer of severely ill patients with SARS-CoV-2 Omicron variant infection (day 3) was higher than that of L-type strain (Ct value: 23.92±1.16 vs. 28.19±1.54). The acute plasma cytokines interleukin (IL-6, IL-10) and tumor necrosis factor-α (TNF-α) were significantly lower in patients with severe Omicron variant new coronavirus infection than those with mild disease [IL-6 (ng/L): 3.92±0.24 vs. 6.02±0.41, IL-10 (ng/L): 0.58±0.01 vs. 4.43±0.32, TNF-α (ng/L): 1.73±0.02 vs. 6.91±1.25, all P < 0.05], while γ-interferon (IFN-γ) and IL-17A were significantly higher than patients with mild disease [IFN-γ (ng/L): 23.07±0.17 vs. 13.52±2.34, IL-17A (ng/L): 35.58±0.08 vs. 26.39±1.37, both P < 0.05]. Compared with previous epidemics (2020 and 2021), the proportion of CD4/CD8 ratio, lymphocyte count, eosinophil and serum creatinine decreased in patients with mild Omicron infection in 2022 (36.8% vs. 22.1%, 9.8%; 36.8% vs. 23.5%, 7.8%; 42.1% vs. 41.2%, 15.7%; 42.1% vs. 19.1%, 9.8%), the proportion of patients with elevated monocyte count and procalcitonin was large (42.1% vs. 50.0%, 23.5%; 21.1% vs. 5.9%, 0). The incidences of severe disease in patients with SARS-CoV-2 Omicron variant infection was significantly lower than that of previous epidemics, and the occurrence of severe diseases was still related to the underlying diseases.

Real-World Clinical Practice Among Patients With Bipolar Disorder and Chronic Kidney Disease on Long-term Lithium Therapy.

Long-term lithium therapy (LTLT) has been associated with chronic kidney disease (CKD). We investigated changes in clinical characteristics, pharmacotherapeutic treatments for medical/psychiatric disorders, and outcomes among patients with bipolar disorder (BD) and CKD on LTLT in a 2-year mirror-image study design. Adult BD patients on LTLT for ≥1 year who enrolled in the Mayo Clinic Bipolar Disorder Biobank and developed CKD (stage 3) were included, and our study was approved by the Mayo Clinic Institutional Review Board. The primary outcome was the time to the first mood episode after CKD diagnosis among the lithium (Li) continuers and discontinuers. Cox proportional hazards models were used to estimate the time to the first mood episode. We tested for differences in other medication changes between the Li continuers and discontinuers group using Mantel-Haenszel χ2 tests (linear associations). Of 38 BD patients who developed CKD, 18 (47%) discontinued Li, and the remainder continued (n = 20). The median age of the cohort was 56 years (interquartile range [IQR], 48-67 years), 63.2% were female, and 97.4% were White. As compared with continuers, discontinuers had more psychotropic medication trials (6 [IQR, 4-6] vs 3 [IQR, 2-5], P = 0.02), a higher rate of 1 or more mood episodes (61% vs 10%, P = 0.002), and a higher risk of a mood episode after CKD diagnoses (Hazard Ratio, 8.38; 95% confidence interval, 1.85-38.0 [log-rank P = 0.001]]. Bipolar disorder patients on LTLT who discontinued Li had a higher risk for relapse and a shorter time to the first mood episode, suggesting a need for more thorough discussion before Li discontinuation after the CKD diagnosis.

Clinical and biochemical indices of people with high-altitude experience linked to acute mountain sickness

BackgroundAcute mountain sickness (AMS) is a major health issue for people travelling to high altitudes. This study was designed to comprehensively evaluate the changes in clinical characteristics and biochemical indices of high-altitude travelers and determine whether these changes were associated with AMS. MethodsA total of 14 clinical indices and 52 biochemical indices were determined in 22 subjects before and during acute high-altitude exposure. Six hours after passive ascent to 3648 m (Lhasa, China), the Lake Louise Scoring (LLS) system 2018 was used to assess AMS, which was defined as headache with a total LLS ≥3. ResultsBefore travelling to high altitudes, uric acid (UA), platelet distribution width (PDW), mitral peak E velocity (MVE), and ejection fraction (EF) were significantly higher in AMS-resistant individuals than in AMS-susceptible ones (all p < 0.05). A good predictive value of UA (0.817, 95% CI: 0.607–1.000) and PDW (0.844, 95% CI: 0.646–1.000) for AMS-susceptible subjects was found. With high-altitude experience, 14 subjects were diagnosed as having AMS. Compared with non-AMS, the changes in UA and number of neutrophils in AMS presented a significant difference (all p < 0.05). The high-altitude-induced changes in UA, area under the curve, specificity, and sensitivity for identifying AMS were 0.883 (95% CI: 0.738–1.000), 83.30%, and 90.00%, respectively. ConclusionHuman presents a compensatory physiological and biochemical response to high-altitude travel at early phase. The UA concentration before travel and its trend with high-altitude experience exhibited good performance for identifying AMS.

Tendencias temporales en las características, tratamiento y resultados de la insuficiencia cardiaca en octogenarios durante dos décadas

Introduction and objectivesOctogenarians represent the most rapidly expanding population segment in Europe. The prevalence of heart failure (HF) in this group exceeds 10%. We assessed changes in clinical characteristics, therapy, and 1-year outcomes over 2 decades in chronic HF outpatients aged ≥ 80 years enrolled in a nationwide cardiology registry. MethodsWe included 2520 octogenarians with baseline echocardiographic ejection fraction measurements and available 1-year follow-up, who were recruited at 138 HF outpatient clinics (21% of national hospitals with cardiology units), across 3 enrolment periods (1999-2005, 2006-2011, 2012-2018). ResultsAt recruitment, over the 3 study periods, there was an increase in age, body mass index, ejection fraction, the prevalence of obesity, diabetes, dyslipidemia, pre-existing hypertension, and atrial fibrillation history. The proportion of patients with preserved ejection fraction rose from 19.4% to 32.7% (P for trend <.0001). Markers of advanced disease became less prevalent. Prescription of beta-blockers and mineralocorticoid receptor antagonists increased over time. During the 1-year follow-up, 308 patients died (12.2%) and 360 (14.3%) were admitted for cardiovascular causes; overall, 591 (23.5%) met the combined primary endpoint of all-cause mortality or cardiovascular hospitalization. On adjusted multivariable analysis, enrolment in 2006 to 2011 (HR, 0.70; 95%CI, 0.55-0.90; P=.004) and 2012 to 2018 (HR, 0.61; 95%CI, 0.47-0.79; P=.0002) carried a lower risk of the primary outcome than recruitment in 1999 to 2005. ConclusionsAmong octogenarians, over 2 decades, risk factor prevalence increased, management strategies improved, and survival remained stable, but the proportion hospitalized for cardiovascular causes declined. Despite increasing clinical complexity, in cardiology settings the burden of hospitalizations in the oldest old with chronic HF is declining.

Retrospective observation and analysis of autoimmune-related indicators in 317 patients with acute Omicron variant infection

To compare the changes of clinical characteristics and immune-related indicators of patients with mild and moderate acute Omicron variant infection, and to evaluate the protective effect of coronavirus disease 2019 (COVID-19) vaccination. The study retrospectively analyzed the clinical characteristics of 317 adult patients diagnosed with COVID-19 Omicron variant (B1.1.529) infection admitted to Tianjin First Central Hospital (Shuixi District) from January 22, 2022 to February 24, 2022. Demographic characteristics, vaccination status, underlying diseases, epidemiological characteristics, baseline data, and relevant laboratory test results on admission were collected, and the differences in clinical characteristics, especially the changes in immune-related indicators, between mild and moderate patients were compared and analyzed. Among the 317 adult patients with acute Omicron variant infection, the proportion of elderly, hypertension, diabetes, and cardiovascular or cerebrovascular diseases were significantly higher in moderate group (203 cases) than those of mild group (114 cases) [age ≥ 60 years old: 27.58% (56/203) vs. 9.65% (11/114), hypertension: 31.03% (63/203) vs. 19.30% (22/114), diabetes: 15.76% (32/203) vs. 7.89% (9/114), cardiovascular and cerebrovascular diseases: 11.33% (23/203) vs 0.88% (1/114), all P < 0.05]. The route of transmission was mainly through gatherings and the first symptoms were fever, dry cough, fatigue, sore throat, nasal congestion, runny nose and other flu symptoms; 19.30% (22/114) and 24.63% (50/203) of patients in mild and moderate groups were positive for the new coronavirus nucleic acid test, respectively, but the difference was not significant difference (P > 0.05). Inflammatory indicators in most mild and moderate patients were within normal range, such as white blood cell count (WBC), neutrophil ratio (NEU%), lymphocyte count (LYM), C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6), etc., suggesting that the acute phase of Omicron variant infection had not yet caused severe inflammatory storm, which might be related to the weakening of pathogenicity after vaccination and virus mutation. The proportion of patients with IL-6 > 7 ng/L in the mild group was significantly lower than that in the normal group [1.75% (2/114) vs. 6.40% (13/203), P < 0.05], suggesting that elevated IL-6 might be an important factor in evaluating indicators of disease severity. There was no significant difference in lymphocyte subsets between the two groups, but there were 12.90% (12/93) and 11.04% (17/154) of the patients in two groups, respectively, decreased in the proportion of helper T cells, and 18.28% (17/93) and 14.28% (22/154) of the patients had elevated CD4+/CD8+ ratio, suggesting that patients with Omicron variant infection had autoimmune system dysfunction, which might be related to disease progression and the occurrence of long-term autoimmune disease. Serum IL-6 level may be used as a predictor for evaluating the severity of disease in patients with Omicron variant infection; after vaccination, inflammatory indicators in patients with acute Omicron variant infection were significantly reduced, but the long-term effects still require long-term follow-up observation.