Clinical Factors Research Articles

Engagement With Daily Symptom Reporting, Passive Smartphone Sensing, and Wearable Device Data Collection During Chemotherapy: Longitudinal Observational Study.

Chemotherapy can cause symptoms that impair quality of life and functioning. Remote monitoring of daily symptoms and activity during outpatient treatment may enable earlier detection and management of emerging toxicities but requires patients, including older and acutely ill patients, to engage with technology to report symptoms through smartphones and to charge and wear mobile devices. This study aimed to identify factors associated with participant engagement with collecting 3 data streams (ie, daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device [Google]) during chemotherapy. We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to install apps on their smartphones to rate daily symptoms and to collect passive sensor data and to wear a Fitbit device for the duration of the study. Participants completed baseline demographic and quality of life questionnaires, and clinical information was extracted from the electronic medical record. We fit a series of logistic generalized estimating equations to evaluate the association between demographic and clinical factors and daily engagement with each data stream. Participants completed daily surveys on 61% (SD 27%) of days and collected sufficient smartphone data and wearable sensor data on 73% (SD 35%) and 70% (SD 33%) of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both symptom surveys (odds ratio [OR] 0.49, 95% CI 0.29-0.81; P=.006) and wearable data collection (OR 0.35, 95% CI 0.17-0.73; P=.005). Patients with stage 4 cancer also exhibited lower odds of engagement with symptom reporting than those with earlier stage disease (OR 0.69, 95% CI 0.48-1.00; P=.048), and patients were less likely to complete symptom ratings on the weekend (OR 0.90, 95% CI 0.83-0.97; P=.008). Older patients (OR 1.03, 95% CI 1.01-1.06; P=.01) and those who reported better cognitive functioning at study entry (OR 1.18, 95% CI 1.03-1.34; P=.02) were more likely to engage with Fitbit data collection, and patients who reported higher levels of depressive symptoms were less likely to engage with smartphone data collection (OR 1.18, 95% CI 1.03-1.36; P=.02). Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with these systems. Our results suggest significant associations between demographic and clinical factors and long-term engagement with smartphone and wearable device assessments during chemotherapy. Non-White participants, those with metastatic cancer, or those with existing cognitive impairment may benefit from additional resources to optimize engagement. Contrary to hypotheses, older adults were more likely than younger adults to engage consistently with wearable device assessments.

Comparing the utility of lung function parameters and fractional exhaled nitric oxide in predicting lung cancer.

This study aimed to investigate the potential clinical factors that may be associated with the incidence of lung cancer. A total of 150 individuals were enrolled in this cohort study, of which 78 were diagnosed with lung cancer. The results of this study revealed some interesting findings. Specifically, male sex, older age, and lower BMI were found to be significantly associated with an increased risk of developing lung cancer. In contrast, several pulmonary function measures, including FEV1/FVC ratio, FVC, and FEV1, were significantly associated with a decreased risk of lung cancer. Additionally, higher levels of Feno were found to be significantly associated with an increased risk of lung cancer. These findings may be useful in developing strategies for the prevention and management of lung cancer, particularly for individuals with these risk factors. Further research is needed to validate these findings and explore the underlying mechanisms behind these associations. Overall, this study provides valuable insights into the potential clinical factors that may be associated with lung cancer incidence, and it highlights the importance of early detection and prevention strategies.

Receipt of guideline-concordant care and survival among young adult women with non-metastatic breast cancer.

Adolescent and young adults (AYA) with breast cancer, compared to older adults, are diagnosed with more aggressive cancers, at more advanced stages and may undergo more aggressive treatment but have worse survival. Despite this, no research has studied the effects of the receipt of National Comprehensive Cancer Network (NCCN) defined guideline-concordant care (GCC) for breast cancer on AYA survival. We examined the association of GCC with survival among young adult (20-39 years old) breast cancer survivors. We used the Patterns of Care Study; a stratified random sample of 952 young adult women diagnosed with Stage I-III breast cancer in 2013. NCCN guidelines were used to categorize treatment as GCC or non-GCC. We used Kaplan-Meier curves, log-rank tests, and Cox-proportional hazards models to evaluate the effect of GCC on breast cancer-specific survival, stratifying by triple-negative breast cancer (TNBC) and non-TNBC, and adjusting for sociodemographic and clinical factors. All univariate analyses showed that non-GCC was associated with worse survival than GCC. The association was statistically significant for non-TNBC (Hazard ratio: 3.45, CI 1.64-7.29) and TNBC (Hazard ratio: 3.70, CI 1.02-13.43) in multivariable Cox models adjusted for sociodemographic variables and for non-TNBC (Hazard ratio: 3.13, CI 1.13-8.72) when the model was adjusted for sociodemographic and clinical variables. Among young adult women with non-metastatic breast cancer, while receipt of NCCN GCC is univariately associated with better survival for both TNBC and non-TNBC, the effect of sociodemographic and clinical factors on the association differs by TNBC status. Further investigation with larger TNBC samples is needed.

Leadership, cohesion, and stress in primary care facilities and retention in chronic care in rural northeast South Africa before and during the COVID-19 pandemic: A longitudinal study.

Human immunodeficiency virus (HIV) and hypertension are major contributors to morbidity and mortality in South Africa. Effective management of these conditions is critical to population health, yet patient management and retention varies by facility for reasons that are not fully understood. We assessed whether measures of clinic leadership, cohesion, and stress were associated with retention for HIV and hypertension in a cohort of patients in northeast South Africa before and during the Coronavirus disease 2019 pandemic. We quantified nursing capacity and service readiness within primary health care facilities in the Bushbuckridge sub-district in Mpumalanga province South Africa. We administered brief scales on facility leadership, cohesion, and stress from January to March 2019, and tested scales for individual and facility-level agreement. We extracted clinical records for patients with HIV and/or hypertension from 2019 to 2021 and quantified treatment retention by quarter. We used generalised estimating equations to assess individual and clinic factors associated with retention in each treatment programme prior to (2019-first quarter 2020) and during (second quarter 2020-2021) the pandemic. The nine facilities had a median of 12 nurses on staff and scored 0.83 out of 1.0 on basic service readiness. We collected responses to leadership, cohesion, and stress scales from 54 nurses and counsellors. Scales showed high inter-item agreement and moderate within-facility agreement. From 2019 to 2021, 19 445 individuals were treated for HIV and/or hypertension across seven participating facilities. Two-year retention was 91% for those with both conditions, 82% for those in treatment for HIV alone and 77% for those in treatment for hypertension alone, with 10-15% differences between facilities and high retention during the pandemic period. In addition to those with both conditions, women and adults aged 60-69 were more likely to be retained. Clinic factors were inconsistently associated with patient retention. While measures of clinic leadership, cohesion, and stress were generally reliable at individual and facility levels, we found limited evidence supporting a link between these factors and better retention in care. Retention was stable during the Coronavirus disease 2019 pandemic. Men, the youngest and oldest adults, and those without known multimorbidity should be prioritised for retention interventions.

Predicting lymph node metastasis of clinical T1 non-small cell lung cancer: a brief review of possible methodologies and controversies

Non-small cell lung cancer (NSCLC) is a major subtype of lung cancer and poses a serious threat to human health. Due to the advances in lung cancer screening, more and more clinical T1 NSCLC defined as a tumor with a maximum diameter of 3cm surrounded by lung tissue or visceral pleura have been detected and have achieved favorable treatment outcomes, greatly improving the prognosis of NSCLC patients. However, the preoperative lymph node staging and intraoperative lymph node dissection patterns of operable clinical T1 NSCLC are still subject to much disagreement, as well as the heterogeneity between primary tumors and metastatic lymph nodes poses a challenge in designing effective treatment strategies. This article comprehensively describes the clinical risk factors of clinical T1 NSCLC lymph node metastasis, and its invasive and non-invasive prediction, focusing on the genetic heterogeneity between the primary tumor and the metastatic lymph nodes, which is significant for a thoroughly understanding of the biological behavior of early-stage NSCLC.

Factors associated with DPP4i or SGLT2i utilisation: a retrospective cohort study among people with type 2 diabetes mellitus

AbstractBackgroundDipeptidyl peptidase‐4 inhibitors (DPP4i) and sodium‐glucose co‐transporter 2 inhibitors (SGLT2i) are increasingly used as glucose‐lowering therapies in Malaysia.AimTo examine factors associated with the initiation of DPP4i or SGLT2i among people with type 2 diabetes mellitus (T2DM) in Malaysia.MethodA retrospective cohort study was conducted from 1 January 2012–30 December 2020 in two tertiary Malaysian hospitals. Multivariate logistic regression was used to assess the factors associated with DPP4i or SGLT2i initiation. The impact of treatment initiation on glycaemic control, anthropometric and lipid levels at 6 and 12 months were also measured. Ethical approval was granted by the Malaysian National Medical Research Register (Reference no: NMRR‐20‐662‐52570), the Monash University Human Research Ethics Committee (Reference no: 2020‐24900‐45575), the Ministry of Health Malaysia Medical Research and Ethics Committee, and the study conforms with the Declaration of Helsinki.ResultsThis study included 1628 patients. Patients with co‐existing dyslipidaemia (odds ratio [OR] 1.34, 95% confidence interval [CI] 1.04–1.73), cardiovascular disease (OR 1.43, 95% CI 1.1–1.87), and microalbuminuria (OR 2.47, 95% CI 1.42–4.3), with ≥5‐year history of T2DM (years of T2DM 5–14 OR 1.67, 95% CI1.18–2.38; years of T2DM ≥15 OR 2.07, 95% CI 1.39–3.07), who had a body weight of ≥100 kg (OR 1.75, 95% CI 1.26–2.45), and baseline use of three or more glucose‐lowering medicines (OR 2.92, 95% CI 1.74–4.91) had higher odds of being prescribed with SGLT2i. Patients aged ≥65 years old (OR 0.68, 95% CI 0.50–0.93), presented with a family history of diabetes (OR 0.64, 95% CI 0.47–0.89), an estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m2 (eGFR 60–89 mL/min/1.73 m2 OR 0.60, 95% CI 0.39–0.90; eGFR ≥90 mL/min/1.73 m2 OR 0.55, 95% CI 0.34–0.87), with serum creatinine ≥120 μmol/L (OR 0.31, 95% CI 0.17–0.58), and had baseline usage of sulfonylureas (OR 0.28, 95% CI 0.19–0.4) and insulin (OR 0.5, 95% CI 0.35–0.72) were more likely to receive DPP4i. Glycated haemoglobin of patients receiving these medicines reduced significantly at 6 months (DPP4i: −0.61%, p < 0.001; SGLT2i: −0.66%, p < 0.001) and 12 months (DPP4i: −0.62%, p < 0.001; SGLT2i: −0.74%, p < 0.001).ConclusionTreatment choice with pharmacotherapy was associated with many clinical risk factors presented by patients.

Characteristics of HCC patients with portal vein thrombosis: albumin and survival.

Presence of macroscopic portal vein thrombosis (PVT) in patients with hepatocellular carcinoma (HCC) has been found to be a major poor prognosis characteristic. To examine patients with PVT for their clinical characteristics and factors related to both PVT and to survival. A large HCC database containing 1094 patients with PVT and 2513 patients without PVT was examined. Patients had routine baseline serum liver parameters and alpha-fetoprotein (AFP) levels measured; radiological assessment of maximum tumor diameter (MTD), tumor number, presence of macroscopic portal vein thrombosis, plus survival. The percent of patients with PVT increased with increase in both MTD and serum AFP levels and liver parameter levels were worse in patients with PVT than without it. A logistic regression model showed that the combination of MTD>5cm plus AFP >100 IU/mL plus albumin <3.5 g/dL had an odds ratio of 10.988 for the presence of PVT. Normal serum albumin levels significantly reduced the hazard ratio for death in a Cox proportional hazard model and were associated with decreased liver failure. Logistic regression showed the significance of MTD, AFP and albumin on presence of PVT and the Cox model highlighted the importance of albumin levels in decreasing death.

Ethnicity as a Risk Factor for Early Neurological Deterioration: A Post Hoc Analysis of the Secondary Prevention of Small Subcortical Strokes Trial.

Nearly 25% of those with a small vessel stroke will develop early neurological deterioration (END). The objectives of this study were to identify clinical risk factors for small vessel stroke-related END and its associated impact on functional outcomes in an ethnically diverse data set. We performed a post hoc analysis of the "Secondary Prevention of Small Subcortical Strokes" trial. The primary outcome was END defined as progressive or stuttering stroke-related neurological symptoms. Standard descriptive and inferential statistical methods were used for analysis. Functional outcomes are reported by modified Rankin Scale score and analyzed by the Wilcoxon signed-rank test. In all, 69 participants met the inclusion criteria; 21 (30%) had END. Of the cohort, Spanish, Hispanic, or Latino ethnicity (grouping per trial definition) most frequently developed END [11 (52.4%) vs 4 (8.3%), P < 0.001] with a higher adjusted likelihood of END (odds ratio: 14.1, 95% CI: 2.57-76.7, P = 0.002). Black or African-American race less commonly had END [3 (14.3%) vs 21 (43.8%), P = 0.03] but lost significance after adjustment (odds ratio: 1.46, 95% CI: 0.26-8.17, P = 0.67) due to powering. END was associated with a higher mean modified Rankin Scale (2.06 ± 0.94 vs 1.17 ± 0.79, P = 0.006) but did not differ in the shift analysis. We found that Spanish, Hispanic, or Latino ethnicity was the most consistent risk factor for END though it was without meaningful functional outcome differences.

The Impact of Tumor Stage and Histopathology on Survival Outcomes in Esophageal Cancer Patients over the Past Decade

Background: Esophageal cancer (EC) is the sixth leading cause of cancer-related mortality worldwide, continuing to be a significant public health concern. The purpose of this study is to assess the impact of staging and histopathology of EC on associated mortality. The study also aims to further investigate clinical characteristics, prognostic factors, and survival outcomes in patients diagnosed with EC between 2010 and 2017. Furthermore, we analyzed the interaction between tumor histology and staging and the risk of mortality. Methods: A total of 24,011 patients diagnosed with EC between 2010 and 2017 in the United States were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Demographic parameters, tumor stage, and histologic subtypes were analyzed and associated overall mortality (OM) and cancer-specific mortality (CSM) were measured across all subgroups. Covariates reaching the level of statistical significance, demonstrable by a p-value equal to or less than 0.01, were incorporated into a multivariate Cox proportional hazards model. A hazard ratio greater than 1 was indicative of an increased risk of mortality in the presence of the variable under discussion. Additionally, the study explores the interaction between histology and tumor stage on outcomes. Results: The majority of patients were male (80.13%) and non-Hispanic white (77.87%), with a predominant age at diagnosis of between 60 and 79 years (59.86%). Adenocarcinoma was the most common tumor subtype (68.17%), and most patients were diagnosed at a distant stage (41.29%). Multivariate analysis revealed higher mortality risks for males, older patients, unmarried individuals, and those with advanced-stage tumors. Higher income, receiving radiation or chemotherapy, and undergoing surgery were associated with lower mortality. Tumor subtype significantly influenced mortality, with squamous cell carcinoma and neuroendocrine tumors showing higher hazard ratios compared to adenocarcinoma. Adenocarcinoma is linked to a poorer prognosis at advanced stages, whereas the opposite trend is observed for SCC. Conclusions: The study identifies significant demographic and clinicopathologic factors influencing mortality in esophageal cancer patients, highlighting the importance of early diagnosis and treatment intervention. Future research should focus on tailored treatment strategies to improve survival outcomes in high-risk groups and to understand the interaction between tumor histology and tumor stage.

Health service access and quality of care provided by the Western NSW Local Health District Virtual Rural Generalist Service: a retrospective analysis of linked administrative data.

To evaluate the quantity and quality of medical care provided by the Western NSW Local Health District Virtual Rural Generalist Service (VRGS). Retrospective cohort study; analysis of emergency department and administrative hospital data. Twenty-nine rural or remote hospitals in the Western NSW Local Health District at which the VRGS was providing medical care in the emergency department (ED) and/or inpatient setting. The VRGS was providing predominantly virtual medical support when local doctors needed relief or were unavailable, typically for lower acuity ED presentations and scheduled inpatient ward rounds. All patients who presented or were admitted to a Western NSW Local Health District hospital serviced by the VRGS between 1 July 2021 and 30 June 2022. Treatment completions, transfers, ED departure within 4 hours, length of stay, and hospital mortality. During 2021-22, 34% of ED presentations (13 660/39 701) and 40% of admissions (2531/6328) involved VRGS care. For ED presentations, after adjusting for socio-demographic and clinical factors, patients attended by VRGS doctors had higher odds of not waiting (adjusted odds ratio [aOR], 3.69; 95% CI, 2.79-4.89), lower odds of transfer to another hospital (aOR, 0.66; 95% CI, 0.60-0.72) and slightly lower odds of ED departure within 4 hours (aOR, 0.92; 95% CI, 0.86-0.98) when compared with patients not attended by VRGS doctors (ie, those provided usual care). For admissions, after adjusting for socio-demographic and clinical factors, inpatients attended exclusively by VRGS doctors had higher odds of discharging at their own risk (3.33; 95% CI, 1.98-5.61) and lower odds of being a long stay outlier (aOR, 0.51; 95% CI, 0.35-0.74) when compared with inpatients not attended by VRGS doctors. The odds of inpatient mortality were equivalent when comparing VRGS and non-VRGS care (aOR, 0.78; 95% CI, 0.48-1.28) and when comparing combined (VRGS and non-VRGS) and non-VRGS care (aOR 1.21; 95% CI, 0.91-1.61). In the current environment of rural medical workforce shortages, the VRGS achieved similar outcomes on routinely collected measures of quality of care. It is demonstrably an option for complementing and enhancing the delivery of medical care in rural and remote communities with limited or no local medical services.

Clinical prognostic factors in patients with diffuse gliomas of the brain

BACKGROUND: Diffuse gliomas of the brain represent a heterogeneous group, which differs in age of the disease onset, histologic characteristics, tumor grade, molecular genetic markers and prognosis. AIM: of the present study is to identify the factors, which affect the duration of the relapse-free period and life expectancy in patients with diffuse brain gliomas, based on a comprehensive analysis of clinical syndromes and symptoms. MATERIALS AND METHODS: The study was carried out at the Departments of Neurosurgery and Nerve Diseases of the S.M. Kirov Military Medical Academy (Saint Petersburg, Russia). It included 390 in-patients with diffuse brain gliomas who underwent treatment over the periods of 2014–2022 and 2004–2006. Age at time of diagnosis was 45.26 ± 15.72 years old. The study included 218 (55.9%) male and 172 (44.1%) female patients. It was a single-centre prospective study. RESULTS: of the author’s research. Favourable demographic factors include the age range of 18–39 (relapse-free period duration p 0.01, life expectancy p 0.001) and female sex (relapse-free period p = 0.02, life expectancy p = 0.03). Prognostically favourable clinical manifestations include epileptic seizures before surgery (relapse-free period p 0.01, life expectancy p 0.02); unfavourable clinical manifestations are pyramidal syndrome (relapse-free period p 0.01, life expectancy p 0.001), sensitive disorders (relapse-free period p = 0.045–0.12, life expectancy p = 0.09–0.17), speech pathology (relapse-free period p 0.02, life expectancy p = 0.02–0.12) and cerebellar syndrome (relapse-free period p 0.02, life expectancy p 0.001). Clinical signs such as headache, nausea and vomiting, asthenia, diffuse neurological symptoms, craniocerebral nerve involvement and visual impairment do not affect (p 0.05) the outcomes of the patients with diffuse brain gliomas. CONCLUSION: Thus, favourable demographic prognostic factors include female sex and age range of 18–39, favourable clinical prognostic factors include epileptic seizures before surgery. Unfavourable clinical prognostic factors include presence of motor, sensory disorders, speech impairment and cerebellar syndrome.

Integration of Longitudinal and Transverse Radiomics from Ultrasound Images with Clinical Factors for HER-2 Status Prediction in Invasive Breast Cancer Patients

Objective This study developed a nomogram combining longitudinal and transverse ultrasound radiomics with clinical factors to identify human epidermal growth factor receptor 2 (HER2) status in invasive breast cancer (BC). Materials and methods We analyzed 537 invasive BC patients from two hospitals: 436 in the training cohort (Hospital A) and 101 in the test cohort (Hospital B). From longitudinal and transverse ultrasound planes, 788 radiomics features were extracted, with dimensionality reduced using least absolute shrinkage and selection operator regression. A radiomics nomogram integrating clinical predictors and radiomics scores (Rad-scores) was constructed. Results Fifteen and sixteen features from longitudinal and transverse ultrasound planes, respectively, were selected to generate Rad-scores, which differed significantly between HER2-positive and HER2-negative groups in both cohorts (p < 0.05). The combined radiomics model outperformed individual models with AUCs of 0.783 and 0.762 in the training and external test cohorts, respectively. Tumor size was an independent clinical predictor. The nomogram, incorporating Rad-scores and tumor size, achieved AUCs of 0.790 (training cohort) and 0.774 (test cohort). Decision curve analysis demonstrated its potential clinical utility. Conclusion A biplanar ultrasound radiomics nomogram effectively predicts HER2 status in invasive BC, potentially reducing the need for biopsies and supporting personalized treatment strategies.

Clinical prognostic factors in progressive supranuclear palsy: Implications for clinical trials

Background Progressive supranuclear palsy (PSP) is a rare neurodegenerative disease with diverse clinical phenotypes, prompting the development of new diagnostic criteria known as the MDS-PSP classification. However, little is known about the prognostic value of this classification in order to better stratify patients for the clinical trials. Objective To assess the impact of the different clinical phenotypes according to the MDS-PSP classification on prognosis using the clinical milestones of death, severe dysphagia, institutionalization, and need for walking aid. Methods A prospective cohort of 205 PSP patients from Lille University Hospital was analyzed retrospectively. Patients were classified into different MSD-PSP phenotypes according to their clinical presentation after 3 years of follow-up. The milestones of death, severe dysphagia, institutionalization, and need for walking aid were recorded, and a survival analysis was performed to describe the prognosis of each disease presentation. Results Median survival time was 6.4 (interquartile range (IQR): 4.8–8.6) years and mean diagnostic delay from symptom onset was 38.1 ± 22.5 months. PSP Richardson Syndrome (PSP-RS) had a poorer survival rate and a higher occurrence of severe dysphagia and need for walking aid compared to PSP variants such as PSP Parkinsonism (PSP-P), PSP postural instability without ocular motor dysfunction (PSP-PI), and other rare phenotypes. Conclusions PSP-RS has a less favorable prognosis compared to PSP variants stratified according to the MDS-PSP classification. This classification could assist in selecting patients for clinical trials and help design outcomes that account for the disease heterogeneity.

Sero-prevalence of Hepatitis C infection among the Municipal Waste collectors in Aden, Yemen

Objectives: Hepatitis C virus infection is major global health problem. The present study was aimed to determine the prevalence of Hepatitis C infection among municipal waste collectors and to identify clinical findings and risk factors associated with HCV infection among those collectors in Aden, Yemen. Methods: A cross-sectional study was conducted on 100 municipal waste collectors. The blood samples were collected from all MWCs, then the clotted blood was separated by centrifuge and the sera were tested for presence of HCV antibodies (Anti-HCV) by Cobas technique that based on ECLIA. Results: Out of 100 municipal waste collectors, majority was males 89(89/100). The total mean age of those members was 36.74±10.98years. The range of ages was 16 and 60 years. Only 1(1/100) had HCV infection. This case was male, married and within age group ≥ 45years which comprised; 1.1%, 1.2% and 4.5%, respectively. The positive case was illiterate and had low economic status and had duration of work as municipal waste collector from 10-20years and alone accommodation which comprised 1.1%, 1.6% 2.4% and 9.1%, respectively. This 1(7.8%) HCV infected patient infection lives in Al-Muallhe. Significant associations found between HCV infection and exposing to blood transfusion, catheterization and needles stick as risk factors (p=0.002,0.0001 and 0.080), respectively and liver cirrhosis as complicated clinical finding (p=.0001),but the association was not significant between HCV infection and sources of waste (0.620). Conclusion: It can be concluded from this study that the municipal waste collectors in Aden, Yemen had lower rate of HCV infection than most studies globally. The males, married and MWCs in age group≥ 45years, and those had illiterate education and live alone had highest percentages of HCV infection. Blood transfusion, needles stick and catheterization may increase the risk of HCV infection.

Identification of Key Risk Factors for Rupture in Small Intracranial Aneurysms: A Multicenter Study.

Predicting rupture risk in small intracranial aneurysms (IAs) < 5 mm is crucial for guiding clinical decisions. This study aims to identify key clinical and morphological risk factors associated with rupture in small IAs, providing better insight for decision-making. A retrospective analysis was performed on patients with small IAs from one center, with external validation data from another center. Logistic regression identified significant risk factors for aneurysm rupture, which were incorporated into a predictive model. The model's performance was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC), calibration plots, and the Hosmer-Lemeshow (H-L) goodness-of-fit test. Clinical utility was assessed via decision curve analysis (DCA). The training cohort consisted of 226 patients (ruptured, n = 181; unruptured, n = 92), while 136 patients (ruptured, n = 100; unruptured, n = 59) were used for external validation. Significant risk factors included hypertension, smoking, anterior communicating artery aneurysms (AcomA), daughter sacs, aspect ratio (AR), and size ratio (SR). The model demonstrated strong predictive ability with AUCs of 0.969 and 0.967 in the training and validation cohorts, respectively. Calibration plots indicated a good agreement between predicted and observed rupture risks, while DCA highlighted the model's clinical relevance. This study identifies and validates critical risk factors associated with small IA rupture and presents a clinically useful, high-accuracy predictive model to aid in individualized patient management.

Prevalence of depressive symptoms, suicidal ideation and behaviours in young people presenting with a first episode of psychosis.

Suicide accounts for a proportion of the early mortality in people affected by psychotic disorders. The early phase of illness can represent a particularly high-risk time for suicide. Therefore, in a cohort of young people presenting with first-episode psychosis, this study aimed to determine: (i) the prevalence of suicidal ideation, intent with plan and self-harm and any associated demographic or clinical factors and (ii) the prevalence of depressive symptoms and any associated demographic or clinical factors. Young people with a first episode of psychosis attending the Early Psychosis Prevention and Intervention Centre in Melbourne were included. Suicidal behaviours were recorded using a structured risk assessment - 'Clinical Risk Assessment and Management in the Community', and depressive symptoms were measured using the PHQ-9. A total of 355 young people were included in the study. 57.2% were male, 95.4% were single and over one quarter were migrants. At the time of presentation, 34.6% had suicidal ideation, 6.2% had suicidal intent with a plan, and 21.4% had engaged in self-harm before their presentation. Combined, 39.7% (n = 141) presented with suicidal ideation, intent with plan or self-harm. A total of 71.5% (n = 118) had moderately severe or severe depressive symptoms, which was strongly associated with suicidal ideation or behaviours at the time of presentation (OR = 4.21, 95% C.I. 2.10-8.44). Depressive symptoms, self-harm and suicidal behaviours are commonly present in the early phases of a psychotic disorder, which has important clinical implications for assessment and management.

Clinical manifestations and misdiagnosis factors of pulmonary embolism patients seeking treatment in cardiology.

To explore the clinical manifestations and factors leading to misdiagnosis in pulmonary embolism (PE) patients in a cardiology department. We retrospectively analyzed 74 patients diagnosed with PE at our hospital from March 2018 to March 2022, comparing them to 136 patients suspected of PE but excluded by computed tomography pulmonary angiography during the same period. Both groups received the same basic care, including disease counseling, nutritional planning, and monitoring. We compared general information, clinical manifestations, risk factors, and auxiliary examinations to identify correlations between specific manifestations and misdiagnosis factors. The male-to-female ratio in the PE group was approximately 3:4, which was statistically significant compared to the control group (P < .05), though its impact on PE incidence was low. Common symptoms in the PE group included chest tightness, shortness of breath, sweating, and chest pain, with no significant difference from the control group (P > .05). Notable risk factors included deep vein thrombosis (DVT) (43.24%), prolonged bed rest (32.43%), lower limb varicose veins (18.92%), trauma (21.62%), pulmonary infections (62.16%), coronary heart disease (37.84%), respiratory failure (32.43%), and chronic obstructive pulmonary disease (13.51%). DVT was significantly associated with PE (P < .05). Multivariate logistic regression identified DVT (OR = 118.528, 95% CI: 6.959-2018.906, P = .001) and lower limb varicose veins (OR = 212.766, 95% CI: 6.584-6875.950, P = .003) as independent predictive factors for suspected PE. Clinical manifestations strongly correlated with PE included pulmonary rales, cyanosis, tachycardia, hypotension, elevated D-dimer, positive N-terminal pro-brain natriuretic peptide, and sinus tachycardia on echocardiogram. PE in cardiology patients may present with pulmonary rales, hypotension, shortness of breath, and abdominal symptoms, warranting reexamination for PE. Misdiagnosis factors typically involve chest pain, tightness, and shortness of breath. Lower limb varicose veins and DVT are reliable predictors of suspected PE.

Exploring the value and optimizing strategies of CA125, CA199, CEA, AFP, and PT in predicting adenomatous gastrointestinal polyps in elderly male patients.

This study explores the application of serum biomarkers in the diagnosis of adenomatous polyps and evaluates the effectiveness of different markers and their combined diagnosis in adenomatous polyp detection. Using receiver operating characteristic curve analysis, this study assessed the efficacy of serum biomarkers such as carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), alpha-fetoprotein (AFP), carbohydrate antigen 199 (CA199), and prothrombin time (PT) in diagnosing adenomatous polyps in 90 patients. The study also compared the diagnostic accuracy of individual tests versus combined diagnostic approaches and analyzed the impact of polyp size and number on the levels of these markers. Among the individual tests, CA125 showed relatively high diagnostic efficacy. However, combined diagnostic approaches, such as the combination of CEA and CA125, the trio of CEA, CA125, and AFP, and the quartet of CEA, CA125, AFP, and PT, significantly improved diagnostic sensitivity and specificity. Additionally, the study found that the size and number of adenomatous polyps significantly influenced the levels of CEA, CA125, CA199, and PT, with larger and more numerous polyps associated with higher marker levels. This study demonstrates that combined diagnostic strategies have significant advantages in diagnosing adenomatous polyps, providing more accurate and comprehensive diagnostic information. Furthermore, the impact of polyp size and number on serum biomarker levels suggests that these clinical factors should be considered in clinical assessments. These findings offer new perspectives and approaches for the diagnosis of adenomatous polyps.

Understanding canine oral neoplasia: intrinsic rather than extrinsic features represent key risk factors in a 39-year analysis.

Canine oral neoplasia is often detected late in the course of the disease, necessitating radical surgeries frequently combined with adjuvant chemotherapy or radiotherapy for positive outcomes. Although there has been extensive analytical and epidemiologic work on human oral cancer, research in veterinary medicine has been lacking. This study aimed to evaluate the prevalence and risk factors associated with canine oral neoplasia to enhance early detection by improving screening. Patient data from 1985 to 2024 from the University of California-Davis Veterinary Teaching Hospital were bulk extracted to determine prevalence as well as the effect of clinical and environmental risk factors, including sex, breed, oral location, air quality, and periodontal disease status. The median air quality index (AQI) data were extrapolated from the Environmental Protection Agency's database. Periodontal disease status was evaluated on patient CT scans. The incidence of oral tumors was 4.59/1,000 patients. The median age upon diagnosis was 9.66 years, and 3 breeds were identified as significantly at risk compared to the general patient population. Air quality index, geographical location, and periodontal disease were not associated with oral neoplasia. Different tumor histologies had distinct oral predilection sites. Overall, there was a significant correlation between age/breed and oral neoplasms. Tumor locations were significantly different for each pathology. Other risk factors did not play a substantial role in disease. These findings can aid veterinarians and researchers in targeting screening and treatment strategies in high-risk dogs.

Clinical and Genomic Prediction of Coronary Artery Disease Subtypes.

Coronary artery disease (CAD) is a complex, heterogeneous disease with distinct etiological mechanisms. These different etiologies may give rise to multiple subtypes of CAD that could benefit from alternative preventions and treatments. However, so far, there have been no systematic efforts to predict CAD subtypes using clinical and genetic factors. Here, we trained and applied statistical models incorporating clinical and genetic factors to predict CAD subtypes in 26 036 patients with CAD in the UK Biobank. We performed external validation of the UK Biobank models in the US-based All of Us cohort (8598 patients with CAD). Subtypes were defined as high versus normal LDL (low-density lipoprotein) levels, high versus normal Lpa (lipoprotein A) levels, ST-segment-elevation myocardial infarction versus non-ST-segment-elevation myocardial infarction, occlusive versus nonocclusive CAD, and stable versus unstable CAD. Clinical predictors included levels of ApoA, ApoB, HDL (high-density lipoprotein), triglycerides, and CRP (C-reactive protein). Genetic predictors were genome-wide and pathway-based polygenic risk scores (PRSs). Results showed that both clinical-only and genetic-only models can predict CAD subtypes, while combining clinical and genetic factors leads to greater predictive accuracy. Pathway-based PRSs had higher discriminatory power than genome-wide PRSs for the Lpa and LDL subtypes and provided insights into their etiologies. The 10-pathway PRS most predictive of the LDL subtype involved cholesterol metabolism. Pathway PRS models had poor generalizability to the All of Us cohort. In summary, we present the first systematic demonstration that CAD subtypes can be distinguished by clinical and genomic risk factors, which could have important implications for stratified cardiovascular medicine.