Clinical Status Of Patients Research Articles

Risk factors for mortality and financial burdens in patients with colon cancer.

300 Background: Colon cancer remains one of the most common cancers of the digestive system and continues to rank high among the leading causes of cancer-related deaths, despite the increased prevalence of screening. In this study, we aimed to investigate risk factors for mortality and health care costs in hospitalized patients diagnosed with colon cancer. Methods: Patients admitted to the hospital in 2019 and 2020 were identified using the Nationwide Inpatient Sample database and categorized into two groups based on the presence of colon cancer (with relevant ICD-10 codes). To account for confounding factors, multivariate regression analysis was applied to calculate mortality. Statistical analyses were conducted to assess mortality rates, length of stay, and hospital charges. Results: A total of 169,805 patients were admitted with a primary diagnosis of colon cancer, with a mean age of 67.6 years. The majority were White (69.9%), and 50.2% were male. Age over 60 (OR: 1.67, p < 0.001) and sepsis (OR: 16.01, p < 0.001) were associated with increased in-hospital mortality among colon cancer patients, while higher household income (76th to 100th percentile, OR: 0.71, p = 0.011) and treatment at an urban teaching facility (OR: 0.54, p < 0.001) were linked to a lower risk of in-hospital mortality. Female gender (OR: 0.88, p = 0.080) and having inflammatory bowel disease (OR: 0.67, p = 0.055) did not significantly affect in-hospital mortality, nor did Black race (OR: 1.1, p = 0.348) or Hispanic race (OR: 1.15, p = 0.287) compared to White patients. Sepsis (+11.8 days, p<0.001; +$192,699, p< 0.001), age over 60 (+0.99 days, p<0.001; +$6,134, p<0.001), and care at urban teaching hospitals (+0.54 days, p< 0.001; +$32,230, p< 0.001) were associated with longer hospital stays and higher total charges. Conversely, female gender (-0.21 days, p=0.001; -$5,529, p<0.001) and higher income (-0.69 days, p<0.001; -$1,565, p=0.466) were linked to shorter hospital stays and lower total charges. Conclusions: Early recognition of sepsis in colon cancer patients could potentially reduce in-hospital mortality rates, as well as significantly decrease costs and length of stay. The higher mortality rates observed in patients with sepsis may be attributed to the immunocompromised state associated with cancer. Implementing targeted interventions to address the higher risks in older patients and those with sepsis could improve outcomes and reduce the overall burden of colon cancer-related hospitalizations. Impact of patient demographics, socioeconomic factors, and clinical conditions on mortality, length of hospital stay, and total hospital charges. Data Mortality Length of Hospital stay Total Charge Age>60 1.67 (p< 0.001) 0.99 days, p<0.001 $6428, p< 0.001 Race (Hispanic compared to White race) 1.15 (p=0.287) 0.38 days, p= 0.004 $14,127, p<0.001 Race (Black compared to White race) 1.1 (p=0.348) 1.4 days, p< 0.001 $5370, p=0.002 Female gender 0.88 (p=0.08) -0.21 days, p= 0.001 -$5529, p< 0.001 High house hold income 0.71 (p= 0.011) -0.69 days, p<0.001 -$1565, p= 0.466 Treatment at urban teaching facility 0.54 (p<0.001 0.54 days, p<0.001 $32230, p< 0.001 Sepsis 16.01 (p<0.001) 11.8 days, p<0.001 $192699, p< 0.001 IBD 1.05 (p=0.888) 0.67 days, p=0.055 $5348, p=0.293

As interfaces da epilepsia idiopática em felino

Epilepsy consists of a neurological pathology that affects the central nervous system (CNS), characterized by clinical manifestations of convulsive crises and recurrent temporal paroxysmal episodes, and is idiopathic when its cause cannot be determined. This study aims to describe the association between the clinical signs of idiopathic epilepsy in a feline and the results of complementary exams. The animal received immediate post-crisis treatment, with supportive therapy being instituted. The administration of phenobarbital (40 mg/ml, 1-4 mg/kg every 12 hours) demonstrated efficacy in controlling seizures, with an absence of new generalized tonic-clonic seizures. The results suggest the importance of supportive care, and that the use of phenobarbital is effective in controlling seizures and stabilizing the patient's clinical condition.

Clinical Outcomes and Safety Profiles of Generic Versus Brand-Name Clopidogrel in Patients Following Coronary Artery Stent Placement.

Coronary artery disease remains a significant global health issue and is a leading cause of mortality. Dual antiplatelet therapy, including clopidogrel, is essential for preventing stent thrombosis after coronary artery stenting. This study assessed the comparative efficacy and safety of generic versus brand-name clopidogrel in a large Taiwanese cohort. A retrospective cohort study was conducted using the National Health Insurance database, identifying patients who underwent coronary stenting and received either generic or brand-name clopidogrel between January 1, 2008, and December 31, 2021. Propensity score matching was employed to balance baseline characteristics. The primary efficacy outcome was a composite of myocardial infarction, ischemic stroke, or cardiovascular death over a two-year follow-up. The primary safety outcome was major bleeding requiring hospitalization. A total of 211,509 patients were included, of which 2686 received generic clopidogrel and 208,823 received brand-name clopidogrel. After matching, 2686 patients from each group were analyzed. The hazard ratio for the primary efficacy outcome was 0.92 (95% confidence interval: 0.78-1.10), indicating no significant difference between the two groups. The subdistribution hazard ratio for the primary safety outcome was 1.06 (95% confidence interval: 0.84-1.33), suggesting no significant difference in bleeding risk. Subgroup analyses showed consistent results across various patient demographics and clinical conditions. In conclusion, among patients undergoing coronary stenting, the risks of ischemic and bleeding events were comparable between those receiving generic and brand-name clopidogrel.

DOP103 Optimization of Ustekinumab Treatment Induction Using a Pharmacokinetic Model in Inflammatory Bowel Disease Patients

Abstract Background Therapeutic drug monitoring and pharmacokinetic modeling, implemented in the treatment of patients with inflammatory bowel disease (IBD), improve drug efficacy and reduce side effects. Recently, Ustekinumab (UST) levels associated with therapeutic targets have been established, principally during induction, highlighting the need for appropriate optimization of this phase to improve response to UST treatment. Objectives To evaluate the effectiveness of proactive dose optimization of UST using pharmacokinetic modeling during induction (target concentration at week 8) in the treatment of IBD with UST. Methods A prospective comparative study was conducted on IBD patients initiating UST treatment, divided into two groups: standard induction protocol (initial intravenous UST dose adjusted to weight) or optimized induction protocol (following the initial weight-adjusted intravenous UST dose, UST levels were measured at 4 weeks and, using a pharmacokinetic model—including weight, height, and serum albumin levels—induction dosing was adjusted). UST plasma concentration was measured by FIA at 4 weeks in the optimized group and at 8 weeks from treatment initiation in all patients. Data on IBD and the clinical status of patients at UST treatment initiation were reviewed. Results A total of 88 patients were included: 72 in the standard protocol group (male 52.8%; Crohn's disease 59.2%; prior biologic use 95.8%; fecal calprotectin >150 g/kg 61.5%) and 16 in the optimized group (male 56.3%; Crohn's disease 68.8%; prior biologic use 93.88%; fecal calprotectin >150 g/kg 68.8%), with no significant differences in baseline characteristics between groups. The mean UST concentration at the end of induction (8 weeks) was significantly higher in patients with optimization via pharmacokinetic model compared to the standard protocol (15.4 [10.4-20.3] µg/ml vs 9.2 [7.7-10.7] µg/ml; p>0.0018) (Fig. A). In the optimized group, 6 patients (37.5%) received additional intravenous UST doses (3 patients received 1 dose and 3 patients received 2 doses before week 8). The percentage of patients achieving a UST concentration ≥ 6.6 µg/ml (linked to biochemical remission at weeks 12 and 24) and ≥ 9 µg/ml (associated with treatment durability ≥ 12 months) was significantly higher in the optimized group compared to those on the standard protocol (Figs. B and C). Conclusion Optimized UST treatment, through proactive dose adjustment based on pharmacokinetic modeling, achieves a target UST concentration during induction that should ensure treatment efficacy.

Multidisciplinary treatment is necessary in glioblastoma with extracerebral metastases.

While glioblastoma is the most common malignant brain tumor in adults, extracerebral manifestations are very rare in this highly aggressive disease with poor prognosis. We conducted asystematic literature review in the PubMed database and complemented the data by inclusion of acase treated in our clinic. In this context, we report on a60-year-old woman with aright frontal glioblastoma, IDH wildtype, MGMT methylated. Six months after initial diagnosis and primary treatment, there was extensive local intracranial progression with additional extension into the subcutaneous and frontotemporal cranial bones. Despite continuation of multimodal treatment, further extracerebral manifestations occurred 11months after the initial diagnosis, both in the cranial bone as well as metastases in the right parotid gland, cervical lymph nodes, and lungs. While local radiotherapy enabled the cerebral lesions to be controlled, the patient's clinical condition deteriorated rapidly despite simultaneous systemic therapy. The treatment had to be discontinued, and the patient died 5weeks after confirmation of the multilocal extracerebral manifestations and atotal of 12months after initial diagnosis. Extracerebral manifestations of glioblastoma require close collaboration and joint decision-making with the patient, with an emphasis on palliative strategies.

Overview of selected completed prospective studies on PSMA-targeted radioligand therapy with [177Lu]Lu-PSMA-617 in metastatic castration-resistant prostate cancer.

Theranostics in nuclear oncology combines diagnostic and therapeutic procedures using radiotracers to target tumor cells. Prostate-specific membrane antigen (PSMA) is a key target in metastatic prostate cancer, and the radioligand [177Lu]Lu-PSMA-617, which binds to PSMA, has shown promising results in treating metastatic castration-resistant prostate cancer (mCRPC), leading to its approval by the European Medicines Agency in 2022.In this narrative review, the current evidence of [177Lu]Lu-PSMA-617 in mCRPC was discussed in the context of selected studies and the joint EANM/SNMMI guidelines for Lutetium-177-labeled PSMA-targeted radioligand therapy.The use of [177Lu]Lu-PSMA-617 for post-chemotherapy mCRPC is supported by substantial evidence from the phase II TheraP and the phase III VISION trials, demonstrating its safety and efficacy. The theranostic approach identifies patients likely to benefit from [177Lu]Lu-PSMA-617, which is effective only in tumors with sufficient PSMA expression, as detected by PSMA-ligand PET/CT, which is also used for response assessment.The success of [177Lu]Lu-PSMA-617 in post-chemotherapy mCRPC patients has led to further ongoing studies evaluating its use earlier in the treatment sequence, prior to chemotherapy. To ensure beneficial treatment outcome, adequate patient selection and evaluation of imaging-based response through PSMA-ligand PET/CT is necessary. · Indications for [177Lu]Lu-PSMA-617 are based on the TheraP and VISION clinical trials.. · Adequate patient selection using PSMA-ligand PET/CT is essential for beneficial outcomes.. · Response evaluation is based on imaging, PSA levels, and the patient's clinical condition.. · Karimzadeh A, Lehnert W, Koehler D et al. Overview of selected completed prospective studies on PSMA-targeted radioligand therapy with [177Lu]Lu-PSMA-617 in metastatic castration-resistant prostate cancer. Rofo 2025; DOI 10.1055/a-2514-4523.

Effect of cardiac rehabilitation on progression to long-term care: A clinical and economic longitudinal study in Japan.

The social burden of nursing care is increasing with age, particularly for patients with heart failure who often require intensive care. This study aimed to clarify the relationship between nursing care needs and the clinical status of patients with a history of cardiovascular disease, focusing on the benefits of cardiac rehabilitation (CR) in reducing these needs. This single-gate, multicenter, retrospective observational study included patients of all ages with a history of hospitalization for cardiovascular diseases using government-administered insurance claims and health examination data. Data spanning a four-year period (April 2014 to March 2018) were analyzed, and the effects of CR on nursing care needs and associated factors were examined. Multivariate analysis and propensity score matching were used to adjust for confounding factors, ensuring a robust comparison between CR and nonCR groups. A total of 48,456 patients were enrolled, with an average follow-up of 36.1 months. After propensity score matching, patients who participated in CR demonstrated significantly lower mortality rates and reduced nursing care needs compared to those who did not (0.02 ± 0.13 vs. 0.04 ± 0.20, p < 0.01, 0.94 ± 0.27 vs. base: 1, p = 0.05). CR was associated with improved adherence to medications and increased generic drug prescriptions, contributing to better long-term health outcomes. The adjusted odds ratio for CR in reducing nursing care needs was 0.574 (95 % CI, 0.347-0.948, p < 0.05). This study confirms the potential critical role of CR in reducing mortality and nursing care needs in patients with cardiovascular disease. Although CR did not directly reduce nursing care costs, it contributed to improved health outcomes and reduced dependency on long-term care services. These findings highlight the benefits of CR as a preventive intervention, especially in aging populations. Further research is needed regarding its long-term economic benefits.

Neural Stem/Progenitor Cell Therapy in Patients and Animals with Amyotrophic Lateral Sclerosis: A Systematic Review and Meta-analysis.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative malady that causes progressive degeneration and loss of motor neuron function in the brain and spinal cord, eventually resulting in muscular atrophy, paralysis, and death. Neural stem/progenitor cell (NSPC) transplantation can improve bodily function in animals and delay disease progression in patients with ALS. This paper summarizes and analyzes the efficacy and safety of neural stem/progenitor cell (NSPC) transplantation as a treatment for ALS, aiming to improve function and delay disease progression in patients. We present a summary of the pathogenic mechanism and causative genes associated with ALS and describe the mechanism and efficacy of NSPC treatment for ALS. We comprehensively searched for relevant English-language articles published between January 1, 2000 and October 1, 2023, across the following five medical databases: PubMed, EMBASE, OVID, Web of Science, and the Cochrane Library. We examined experimental indices of physical function in animals and patients who underwent stem cell transplantation. All statistical analyses were performed via Review Manager 5.4. The study comprised a total of 16 investigations, including 5 clinical studies and 11 animal studies and involving 66 patients and 203 animals. The meta-analysis revealed that the administration of NSPCs appeared to yield positive outcomes in clinical patients, as assessed by the ALS functional rating scale and forced vital capacity. Furthermore, improvements following cell injection were observed in the rotarod test results, the Basso-Beattie-Bresnahan Locomotor Rating Scale score, weight, and survival time. Our meta-analysis, which was grounded in randomized controlled trials, revealed that the transplantation of neural stem/progenitor cells (NSPCs), has potential effects on ALS patients, enhancing the physical function of animals and mitigating degenerative effects in individuals. These underscored the promise of NSPC therapy as a viable treatment option. We report that the transplantation of neural stem/progenitor cells (NSPCs) is promising for enhancing bodily function and slowing the progression of ALS in affected patients. In this review, we summarize the treatment of ALS with NSPCs, evaluating both its efficacy and safety. Through database searches, we identified 16 studies involving 66 patients and 203 animals and analyzed the experimental indices of physical function following stem cell transplantation. The meta-analysis results indicated a positive impact of NSPCs on the clinical conditions of patients and the behavior of animals. A meta-analysis of randomized controlled trials further supported the conclusion that NSPC transplantation has a beneficial effect on improving physical function and mitigating degeneration in ALS patients.

Nurses' Perceptions of Patients With Co-Occurring Psychiatric and Substance Use Disorders in Psychiatric Settings: A Grounded Theory Study.

To explore psychiatric and mental health nurses' perceptions of patients with co-occurring psychiatric and substance use disorders in psychiatric settings. An exploratory qualitative study design based on grounded theory, employing Straussian analytic procedures. Semi-structured interviews were conducted with 11 psychiatric and mental health nurses. Participants were recruited at a public psychiatric hospital located in the Paris metropolitan area of France. Face-to-face interviews took place between February 2024 and May 2024. Field notes and interview data were continuously analysed during open, axial and selective coding phases. The core category identified was 'waiting for a patient's will to change to emerge' when caring for patients with co-occurring substance use disorders. This active waiting period involved a balancing strategy between two discrete care objectives: stabilising the patient's clinical status and keeping the nurse-patient relationship intact. Identifying a patient's will to change provided an opportunity to reconcile these two aspects of psychiatric nursing through the addition of a collaborative component to the relationship. The substantive theory generated by our findings contributes to understanding the interactional and relational processes that occur between nurses and patients presenting with co-occurring substance use disorders in the context of psychiatric care. Implications of our study include the need for further emphasis on collaborative approaches that can be applied even in early or pre-contemplative stages of recovery. Organisational policies should systematically include training in the field of addiction care, given the high prevalence of co-occurring substance use disorders in psychiatric settings. Our findings can assist nurses in critically examining the challenges they experience when engaging with patients with co-occurring substance use disorders. This research adheres to the COREQ (COnsolidated criteria for REporting Qualitative research) Checklist. No patient or public contribution.

The Value of Multidisciplinary Neuro-oncological Tumor Boards to Increase the Accuracy of FET PET for Identifying Brain Tumor Relapse.

Especially in Europe, amino acid PET is increasingly integrated into multidisciplinary neuro-oncological tumor boards (MNTBs) to overcome diagnostic uncertainties such as treatment-related changes. We evaluated the accuracy of MNTB decisions that included the O-(2-[18F]-fluoroethyl)-L-tyrosine (FET) PET information compared with FET PET results alone to differentiate tumor relapse from treatment-related changes. In a single academic center, we retrospectively evaluated 180 MNTB decisions of 151 patients with CNS WHO grade 3 or 4 gliomas (n = 122) or brain metastases (n = 29) presenting equivocal MRI findings following anticancer treatment. All patients underwent FET PET imaging besides MRI before MNTB discussion. Additionally, the patient's clinical status and pretreatment were considered for decision-making. The diagnostic performance was calculated for FET PET findings alone and MNTB decisions that included FET PET results using 2 × 2 contingency tables. MNTB decisions were validated using the neuropathological result in 43% (n = 78) or clinicoradiologically in 57% (n = 102). FET PET results alone yielded an accuracy of 87% (sensitivity, 90%; specificity, 65%; positive predictive value, 95%). When integrating FET PET results for decision-making in the MNTB setting, the accuracy increased to 95% (sensitivity, 99%; specificity, 70%; positive predictive value, 96%; P = 0.002). In MNTB decisions concerning glioblastoma patients, the median survival was 2.4 times longer when FET PET suggested treatment-related changes (15.6 vs 6.4 months; P = 0.009). Our results suggest that MNTB discussion further enhances the FET PET value for identifying brain tumor relapse. A prospective evaluation of FET PET results with and without integration in an MNTB is warranted.

Prevalence of neoplasms in acromegaly: a Turkish single-center retrospective study

Aims: This study aimed to investigate the prevalence of benign and malignant neoplasms and to assess associated clinical conditions in patients with acromegaly. Methods: In this single center, retrospective and observational study, data from 71 patients with acromegaly followed at an endocrinology and metabolism diseases outpatient clinic between January 2010 and December 2023 were reviewed through the hospital's electronic database. Patients' medical histories, demographic data, blood examinations, medications, pituitary MRI scans, thyroid ultrasound, mammography, colonoscopy, endoscopy, and pathology reports were evaluated. Acromegaly diagnosis was based on elevated insulin-like growth factor-1 (IGF-1) levels and unsuppressed growth hormone (GH) levels after oral glucose tolerance testing. The chi-square test and Mann-Whitney U test were used to compare patients with malignancy to other patients in terms of demographic and clinical characteristics. Results: The study included predominantly female patients (60.6%) with an average age of 55.6 years. The mean age at diagnosis was 44.3±11.3 years, and the mean disease duration was 11.3±8.4 years. Malignancies, including breast, thyroid, and colorectal cancers, were detected in 9.9% of patients. Additionally, thyroid nodules were present in 62% of patients, and colon polyps in 14.1%. No significant differences were observed in clinical features including age, gender, disease duration, GH levels, IGF-1 levels, adenoma size, or remission frequency between patients with and without malignancy (p&gt;0.05 for all). Conclusion: This study reveals an increased prevalence of breast, colon, and thyroid cancers in patients with acromegaly. Performing cancer screenings in patients with acromegaly more comprehensively and at an earlier stage compared to the normal population may be beneficial.

Late-onset CSF1R-related Disorder: A Case Report.

CSF1R-related disorder, a catastrophic neurodegenerative disease, arises from genetic mutations in the colony-stimulating CSF1R. Initial misdiagnosis is common, as demonstrated by this case involving a 52-year-old female who presented with symptoms of limb numbness and weakness. Differential diagnosis first indicated Parkinsonism, lacunar infarction, and cervical spondylosis. Subsequently, however, this patient's clinical presentation evolved to include bradykinesia, cognitive decline, and a spectrum of neurological manifestations. A Pan-V2 assay revealed a heterozygous mutation in the CSF1R gene. Craniocerebral MRI showed cerebral infarctions, lacunar infarctions, and leukoaraiosis. Despite symptomatic treatments, our patient's clinical status continued to decline until her family chose to discontinue further medical interventions. This case underscores the diagnostic complexities of early detection of CSF1R-related disorders. It emphasizes the importance of including leukodystrophy in such differential diagnoses and the need for prompt genetic screening in patients who present with progressive leukoencephalopathy, especially when cerebrospinal fluid analysis is unremarkable.

Association of Anatomical Features of the Petrotympanic Fissure and Presence of Foramen of Huschke With Temporomandibular Disorders.

The foramen of Huschke (FH) and the petrotympanic fissure (PTF) are anatomical structures that can influence temporomandibular joint disorders (TMD) by potentially affecting the movement and function of the mandibular condyle. This study investigates the relationship between patients with TMD and the presence of FH and PTF to enhance diagnostic and therapeutic approaches. This retrospective study analyzed cone beam computed tomography (CBCT) images from 212 patients. Patients were categorised into TMD and control groups based on standardized DC/TMD protocols. An observer, blinded to the patient's clinical status, then analyzed the CBCT images. The CBCT images were evaluated for the presence and characteristics of FH, PTF, and condyle shape and position. A higher incidence of FH and PTF was observed in patients with TMD than in the control group. FH was present on the right side in 33.3% of patients with TMD and 18% of controls and on the left side in 23.8% of patients with TMD and 10.9% of controls. Open and semi-open FPT statistically differed between the TMD and control groups (p < 0.05). The length of FH in patients with TMD was significantly larger (2.11 ± 0.44 mm) than in the controls (1.67 ± 0.56 mm). The position of the condyle showed a statistically significant difference between the groups (p < 0.05). FH and PTF subtypes are significantly associated with TMD, underscoring their importance in clinical practice.

Whole blood concentrations of fingolimod and its pharmacologically active metabolite fingolimod phosphate obtained during routine health care of patients with multiple sclerosis.

Fingolimod is a first-in-class, orally administered drug indicated for the treatment of relapsing-remitting multiple sclerosis. It acts as an immunomodulator, is classified as a "disease-modifying therapy", and its main mechanism of action is the modulation of sphingosine-1-phosphate receptors. In this prospective pilot study, whole blood concentrations of fingolimod and fingolimod phosphate obtained during routine health care were measured. In this study, we aimed to determine whether therapeutic monitoring of fingolimod and fingolimod phosphate concentrations can help personalise pharmacotherapy for patients with multiple sclerosis. The study group consisted of 73 patients treated with oral fingolimod (0.5 mg) once daily. Blood samples were collected between July 2021 and January 2022. The whole blood concentrations of fingolimod and fingolimod phosphate were analysed using ultra-high-performance liquid chromatography-tandem mass spectrometry. The relationship between the measured concentrations and the absolute peripheral blood lymphocyte count was evaluated. Fingolimod concentrations ranged from 0.61 to 6.21 µg/L, and fingolimod phosphate concentrations from 0.48 to 4.28 µg/L. Significantly higher concentrations of the active metabolite, fingolimod phosphate, and a significantly higher fingolimod phosphate/fingolimod concentration ratio were observed in women. The sum of fingolimod and fingolimod phosphate concentrations was significantly higher in the subgroup of patients with a lower absolute peripheral blood lymphocyte count. Although all patients were treated with the same dose of fingolimod (0.5 mg orally daily), a 10-fold difference was observed in the achieved whole blood concentrations of fingolimod and fingolimod phosphate. This wide inter-individual variability may lead to potential toxicity or suboptimal concentrations, with the risk of further deterioration in the clinical condition of patients with multiple sclerosis. Therefore, fingolimod is a suitable candidate for therapeutic drug monitoring, including monitoring patient adherence to treatment.

The Practice of Percutaneous EVAR under Local Anesthesia.

Objectives: Endovascular aortic repair (EVAR) should be performed using a less invasive procedure based on the patient's clinical condition, as many patients who undergo this procedure are elderly and have poor surgical tolerance. We report our experience and results of percutaneous EVAR under local anesthesia in order to practice minimally invasive EVAR at our hospital. Methods: In August 2019, we started percutaneous EVAR using Perclose ProGlide under local anesthesia. We compared the backgrounds and surgical outcomes of patients who underwent EVAR at our hospital before and after the introduction of percutaneous EVAR under local anesthesia. Results: We included 148 patients in this study. The age at surgery and prevalence of severe renal dysfunction were significantly higher in percutaneous EVAR under local anesthesia group. The operative time and postoperative hospital stay were significantly shorter in the percutaneous EVAR group under local anesthesia. Conclusions: The introduction of percutaneous EVAR under local anesthesia enabled minimally invasive EVAR to be performed safely even in high-risk patients. (This is a translation of J Jpn Coll Angiol 2022; 62: 1-5.).

MISSING DEMENTIA DIAGNOSIS INFORMATION DURING HOME HEALTH: PREVALENCE AND IMPACTS

Abstract Medicare-funded Home Health Care (HHC) delivers skilled health care services through visits to patients’ homes. Poor information transfer between HHC and other care settings is a perennial issue; HHC providers rarely have reliable and complete information regarding patients’ clinical history or needs. One-third of HHC patients have dementia, but lack of visibility into a patient’s dementia status could negatively impact HHC providers’ ability to appropriately tailor care to these individuals. We examined a national sample of 426,606 older adults (65+) who received Medicare HHC in 2018 and had diagnosed dementia, as reported in the Medicare Beneficiary Summary File. The majority (68.3%) did not have their dementia diagnosis captured in the HHC claims or assessment files. We fit multilevel logistic models clustering at the HH agency-level and adjusting for patient sociodemographic characteristics and clinical status and HHC agency characteristics. Patients whose dementia diagnosis was not captured during HHC were less likely to receive Speech-Language Pathology (aOR: 0.63; 95% CI: 0.61-0.64), social work (aOR: 0.70; 0.69-.72), or aide visits (aOR: 0.81, 95% CI: 0.80-0.82). Patients whose dementia diagnosis was not captured were also more likely to be hospitalized (aOR: 1.69; 1.65-1.73) or to visit the Emergency Department (aOR: 1.47; 95% CI: 1.44-1.50) during HHC, and less likely to have their Activities of Daily Living (ADL) limitations stabilize or improve by HHC discharge (aOR: 0.70; 95% CI: 0.68-0.72). Results suggest HHC providers often lack pertinent information regarding patients’ dementia status, contributing to reduced access to relevant services and increased risk for negative outcomes.

Pansitopenia as a Marker of Advanced Human Immunodeficiency Virus (HIV) infection: How Often? A Case Study Accompanied by Literature

Pansitopenia is a condition characterized by anemia, thrombocytopenia, and leukopenia. One of the common etiologies of Pansitopenia is HIV infection. In advanced HIV, Pansitopenia may present even without other clinical findings leading to a diagnosis of HIV. This study was conducted as a case study of a 34-year-old man who presented with chief complaints of chronic diarrhea and fever that lasted for one month. Laboratory examination showed Pansitopenia, HIV-rapid reactive and peripheral blood picture indicating Pansitopenia/ aplastic anemia. Data were collected through history taking, physical examination, and a series of laboratory tests. The patient was diagnosed with Pansitopenia suspected to be caused by HIV infection. The chief complaints of chronic diarrhea and fever suggested a chronic disease process due to immune compromise, as seen in the patient's clinical status indicating advanced HIV. The literature suggests that the severity of pansitopenia depends on the severity of HIV disease. Pansitopenia can be an indicator of the advanced stage of HIV infection. Appropriate management and regular monitoring are essential to prevent further complications. Pansitopenia in HIV patients can be considered as an important indicator to assess the severity of the infection. Prompt treatment and antiretroviral therapy are highly recommended to improve the prognosis of patients.

How I Treat AML relapse after allogeneic HCT

Allogeneic hematopoietic stem-cell transplantation (HCT) is one of the principal curative approaches in the treatment of acute myeloid leukemia (AML); however, relapse post-transplantation remains a catastrophic event with poor prognosis. The incidence of relapse has remained unchanged over the last three decades despite an evolving understanding of the immunobiology of the graft-versus leukemia effect and the immune escape mechanisms that lead to post-HCT relapse. The approach to post-transplant relapse is highly individualized and is dictated both by disease biology and genomics as well as the patient's clinical status at the time of relapse and the interval between relapse and transplantation. With the help of three illustrative cases, we discuss our approach to early, late, and incipient relapse. Current therapeutic strategies incorporate immunosuppression taper when feasible, a variety of targeted and non-targeted chemotherapeutic agents and consolidative cellular therapies including donor lymphocyte infusions or a second allogeneic transplant. We then summarize evolving frontiers in the treatment and prognostication of relapse including the critical role of measurable residual disease. Finally, we emphasize enrollment on clinical trials and thoughtful discussions regarding goals of care and supporting frail patients as universal principles that should be incorporated in approaches to treatment of AML relapse post-transplantation.

The frequency of detected pathogen genomes in children with acute respiratory infections

Due to the high prevalence of acute respiratory infections in children, it was of interest to determine the composition of bacterial and viral-bacterial associations for respiratory tract inhabiting microorganisms. To identify respiratory tract pathogens, especially viruses and unculturable bacteria, it is advisable to use molecular genetic research methods particularly PCR. The work was aimed at comparatively analyzing rate of genome detection for respiratory tract pathogens in children with acute respiratory infections and apparently healthy controls. Materials and methods. Children (97 people) were examined, of which 35 people — with acute respiratory infections of the upper respiratory tract (nasopharyngitis, pharyngitis, laryngitis) (ARI URT), 32 people — with acute respiratory infections of the lower respiratory tract (acute bronchitis, acute obstructive bronchitis) (ARI NDP) and 30 people — apparently healthy control at the time of examination. RNA and DNA of viral and bacterial pathogens were assessed in the oropharyngeal smears using PCR. Test systems produced by the Federal Budgetary Institution Central Research Institute of Epidemiology of Rospotrebnadzor and JSC Vector-Best were used. Results. An analysis of detection rate for DNA and RNA of bacterial and viral pathogens showed the presence of a wide range of them (20 different species/strains out of 27 identified) in oropharyngeal biomaterial from all examined children. The peak diversity and detection rate of pathogen genomes were found in apparently healthy subjects and children with ARI UDP (DNA of members from Herpesviridae family, S. pneumoniae, H. influaenzae, MSSA, MRCoNS). Associations of 4–6 pathogens prevailed in the microflora, and the “core” of both bacterial and viral-bacterial associations was the combination of S. pneumoniae and H. influenzae (in 93.3% and 60.0% of cases, respectively). In bacterial associations, staphylococci (MRSA and MRCoNS) and P. aeruginosa were also detected in healthy children, MSSA and other very rarely bacterial types were detected in children with ARI UDP. In children with NPD infections, the majority of whom (75.0±7.7%) were classified as long-term ill and had a complicated disease course, a noticeable depletion (decrease in taxonomic diversity) of the nasopharyngeal microbiota was found. Conclusion. The presented data indicate the presence in the biomaterial of the examined children of molecular genetic markers of a wide range of pathogens presented as viral-bacterial and bacterial associations, with varying composition being related to patient clinical status. Detection of pathogen genomes is important for choosing proper etiotropic therapy at early disease stages as well as prescribing probiotic drugs that can restore a balance in respiratory tract microflora.

OSTEOPONTIN-REGULATED CHANGES IN THE MAST CELL POPULATION ASSOCIATED WITH BREAST CANCER.

The development of breast cancer (BCa) is largely determined by the characteristics of the tumor microenvironment (ТМЕ), which undergoes significant changes during the progression of the disease. Mast cells (MCs) are among the least studied components of the TME. The aim of the work was to investigate the relationship between the density of infiltration and the functional activity of MCs with indicators of osteopontin (OP) expression in BCa tissue. The study was conducted on the postoperative material of 15 patients with fibroadenoma and 78 patients with stage I-II BCa. MCs in the tissue of benign and malignant breast tumors were detected by a histochemical method using toluidine blue. The functional activity of MCs was calculated by the degranulation index. The OP expression in tumor tissue was assessed by the immunohistochemical method. The density of MCs infiltration and their functional activity are associated with such indicators of BCa malignancy as tumor size, lymph node involvement, tumor grade, molecular subtype, proliferative activity, and PR- and HER2/neu-expression status. A high expression of OP in the stromal component of BCa is associated with the growth of the tumoral MCs population, metastatic lesions in regional lymph nodes, and a low differentiation grade of the tumors. In addition, OP is involved in the regulation of MCs in the tissue of the luminal B and basal molecular BCa subtypes. The level of OP expression in the parenchymal component of BCa is associated with the number of infiltrated MCs in the presence of metastatic lesions of regional lymph nodes. The identified relationship of OP expression level with the topology and functional activity of MCs in BCa tissue, depending on the clinical status of patients, indicates the prospects for their use in predicting the aggressiveness of the tumor process.