Cohort Analysis Research Articles

Dexmedetomidine improves clinical outcomes in sepsis-induced myocardial injury: a retrospective cohort study

BackgroundThe efficacy of dexmedetomidine (DEX) in treating sepsis-induced myocardial injury (SIMI) remains unclear. In this study, we explored the relationship between DEX use and clinical outcomes of patients with SIMI, focusing on the dosage and treatment duration.MethodsIn this retrospective cohort analysis, we identified patients with SIMI from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database and categorized them into the DEX and non-DEX groups based on intensive care unit treatment. The baseline bias was reduced through propensity score matching (PSM). The primary outcome was 28-day mortality, whereas the secondary outcomes were in-hospital mortality and mortality rates at 7 days, 90 days, and 1 year. The association between DEX use and in-hospital mortality was assessed using Kaplan–Meier analysis and Cox proportional hazards models.ResultsAfter PSM, 373 patients in the DEX group were matched with 579 patients in the non-DEX group to achieve a balanced distribution of the covariates. The Cox regression model demonstrated a significant reduction in the 28-day mortality associated with DEX use, yielding a hazard ratio (HR) of 0.61 (95% confidence interval [CI]: 0.47–0.78, P < 0.001). In-hospital mortality also significantly decreased (HR = 0.43, 95% CI: 0.33–0.57, P < 0.001). Lower mortality rates were observed at 7 days, 90 days, and 1 year. DEX doses >0.4 μg/kg/h, particularly in the range of 0.400–0.612 μg/kg/h, total doses >3.113 mg during hospitalization, and treatment durations exceeding 72 h were associated with improved mortality risk at all intervals. Regarding DEX efficacy at 28 days, our subgroup analyses indicated a significant interaction between the Sequential Organ Failure Assessment score and invasive mechanical ventilation.ConclusionDEX administration was associated with improved in-hospital mortality and reduced mortality rates at 7 days, 28 days, 90 days, and 1 year in patients with SIMI. These findings require validation in future studies.

Personalised estimation of exposure to ambient air pollution and application in a longitudinal cohort analysis of cognitive function in London-dwelling older adults.

Accurate estimates of personal exposure to ambient air pollution are difficult to obtain and epidemiological studies generally rely on residence-based estimates, averaged spatially and temporally, derived from monitoring networks or models. Few epidemiological studies have compared the associated health effects of personal exposure and residence-based estimates. To evaluate the association between exposure to air pollution and cognitive function using exposure estimates taking mobility and location into account. Residence-based dispersion model estimates of ambient NO2, PM10 and PM2.5 were assigned to 768 London-dwelling participants of the English Longitudinal Study of Ageing. The London Hybrid Exposure Model was implemented to adjust estimates per pollutant to reflect the estimated time-activity patterns of each participant based on age and residential location. Single pollutant linear mixed-effects models were fit for both exposure assessment methods to investigate the associations between assigned pollutant concentrations and cognitive function over a follow-up period of up to 15 years. Increased long-term exposures to residence-based ambient NO2 (IQR: 11.10 µg/m3), PM10 (2.35 µg/m3), and PM2.5 (2.50 µg/m3) were associated with decreases of -0.10 [95% CI: -0.20, 0.00], -0.07 [-0.11, -0.02] and -0.14 [-0.21, -0.06], respectively, in composite memory score. Similar decreases were observed for executive function scores (-0.38 [-0.58, -0.18], -0.11 [-0.20, -0.02] and -0.14 [-0.29, 0.01], respectively). When applying personalised exposure estimates, which were substantially lower, similar decreases were observed for composite memory score per IQR, but a consistent pattern of slightly more adverse effects with executive function score was evident. The present study constructed a framework through which time-activity information derived from a representative sample could be applied to estimates of ambient air pollution concentrations assigned to individuals in epidemiological cohort studies, with the intention of adjusting commonly used residence-based estimates to reflect population mobility and time spent in various microenvironments. Estimates of exposure were markedly lower when incorporating time-activity, likely because people in European populations spend a large proportion of their time indoors, where their exposure to ambient air pollution may be reduced through infiltration, which is not taken into account in residence-based ambient estimates. Further work into such methods could provide insights into the efficacy of personalising exposure estimates.

Identifying depression subtypes and investigating their consistency and transitions in a 1-year cohort analysis.

Major depressive disorder (MDD) is defined by an array of symptoms that make it challenging to understand the condition at a population level. Subtyping offers a way to unpick this phenotypic diversity for improved disorder characterisation. We aimed to identify depression subtypes longitudinally using the Inventory of Depressive Symptomatology: Self-Report (IDS-SR). A secondary analysis of a two-year cohort study called Remote Assessment of Disease and Relapse in Major Depressive Disorder (RADAR-MDD), which collected data every three months from patients with a history of recurrent MDD in the United Kingdom, the Netherlands, and Spain (N = 619). We used latent class and latent transition analysis to identify subtypes at baseline, determined their consistency at 6- and 12-month follow-ups, and examined transitions over time. We identified a 4-class solution: (1) severe with appetite decrease, (2) severe with appetite increase, (3) moderate severity and (4) low severity. These same classes were identified at 6- and 12-month follow-ups, and participants tended to remain in the same class over time. We found no statistically significant differences between the two severe subtypes regarding baseline clinical and sociodemographic characteristics. Our findings emphasize severity differences over symptom types, suggesting that current subtyping methods provide insights akin to existing severity measures. When examining transitions, participants were most likely to remain in their respective classes over 1-year, indicating chronicity rather than oscillations in depression severity. Future work recommendations are made.

Evaluating the utility of the HAS‐BLED bleeding‐estimator tool for transurethral resection of prostate

AbstractObjectivesTo evaluate the utility of the HAS‐BLED bleeding risk‐estimation tool to predict for clinically significant postoperative haematuria in patients receiving transurethral resection of prostate (TURP).Patients and MethodsA single‐centre, retrospective cohort analysis of patients underwent TURP from April 2019 to December 2023 for treatment of symptomatic benign prostate hyperplasia. The primary objective was to evaluate reliability of HAS‐BLED score in predicting postoperative bleeding event. A focus sub‐analysis was performed on anticoagulated patient cohort. Each patient was categorised in to HASBLED low‐, moderate‐ and high‐risk group according to the preestablished estimator tool. Patients' demographics, clinical, pathological and operative details were collected. Events of clinically significant haematuria within 3 months postoperatively were captured. Cohort characteristics and outcome were analysed with two‐sided t test and ANOVA test. Further weight‐adjusted multivariable analysis and ROC curve was performed to evaluate the predictive value of HAS‐BLED score.ResultsOur analysis showed that patients assigned as high‐risk by HAS‐BLED were at 2.17‐times higher chance of developing clinically significant haematuria compared to the low‐risk patients. The risk for high‐risk patient was 18.5% (95%CI 11.7–25.3%) and 8.5% (95%CI 4.6–12.4%) for low‐risk patients. Moderate‐risk did not demonstrate any significant difference relative to the low‐risk group. Sub‐analysis of 113 patients receiving long‐term anticoagulation accentuates the utility of the tool. The risk of haematuria for high‐risk patient was 32.7% (95%CI 20.7–44.7%), moderate‐risk patient was 28.7% (95%CI 17.0–40.3%), and low‐risk patient was 9.7% (95%CI 4.2–15.2%). In this cohort, the risk of haematuria was 3.37 and 2.96 times higher in the high and moderate‐risk compared to the low‐risk group, respectively.ConclusionThis is the first study to validate a bleeding estimator tool for TURP patients. High HAS‐BLED score positively predicts clinically significant post‐TURP haematuria, particularly for patients receiving anticoagulation therapy.

Metabolomic Profiling Reveals Potential Biomarkers and Prominent Features in HIV/AIDS Patients Co-Infected with SARS-CoV-2.

The underlying mechanisms and diagnostic biomarkers for the progress of COVID-19 in HIV patients have not been fully elucidated. In this study, the aim is to analyze the metabolomic profiles of HIV/AIDS patients co-infected with SARS-CoV-2 and to identify biomarkers indicative of co-infection. In this study, we conducted a retrospective cohort analysis of peripheral blood samples collected from 30 HIV/AIDS patients co-infected with SARS-CoV-2 (pc group) and 30 patients without SARS-CoV-2 (nc group). In this study, through non-targeted metabolomics and lipidomics analysis, 77 differential metabolites were identified in the plasma of patients co-infected with HIV and SARS-CoV-2 compared to the nc group, with vitamin K1 emerging as a significant feature. Moreover, the plasma of the pc group showed disturbances in lipid metabolism, with elevated triglycerides (TG) and phosphatidylcholine (PC) and decreased phosphatidylglycerol (PG) compared to the control group. Vitamin K1 may be a biomarker for SARS-CoV-2 in HIV/AIDS patients, and changes in the levels of TG, PC, and PG molecules appear to be the main features following HIV co-infection with COVID-19. The emphasis in our study is on the power of using comprehensive metabolomics (lipidomics) approaches to identify metabolic biomarkers and potential mechanisms of COVID-19 in HIV/AIDS patients.

Potential interactions between antimicrobials and direct oral anticoagulants: population-based cohort and case-crossover study.

Although drug interactions between clarithromycin/erythromycin/fluconazole and direct oral anticoagulants (DOACs) are mechanistically plausible, it is uncertain whether they are clinically relevant. To investigate the association between co-prescribed DOACs and antimicrobials and bleeding, cardiovascular disease and mortality. We identified DOAC users in the Clinical Practice Research Datalink Aurum from 1/1/2011-29/3/2021. We used a cohort design to estimate hazard ratios for bleeding outcomes (intracranial bleeding, gastrointestinal bleeding, other bleeding), comparing DOACs+clarithromycin/erythromycin/fluconazole users with DOACs users not receiving these antimicrobials. Cardiovascular outcomes were ischaemic stroke, myocardial infarction, venous thromboembolism, cardiovascular mortality and all-cause mortality. A 6-parameter case-crossover design comparing odds of exposure to different drug initiation patterns for all outcomes in hazard window versus referent window within an individual was also conducted. Of 483,815 DOAC users, we identified 21,701 co-prescribed clarithromycin, 4,532 co-prescribed erythromycin and 4,840 co-prescribed fluconazole. We observed an increased risk of gastrointestinal bleeding over 7-days following co-prescription of DOAC+erythromycin versus DOAC alone (HR:3.66; 99%CI:1.27-10.51), with wide CIs in case-crossover analysis. No evidence of increased risk of bleeding outcomes was seen for DOAC+clarithromycin/fluconazole in cohort and case-crossover analyses. For cardiovascular outcomes, compared with DOAC alone, an increased risk of cardiovascular mortality with DOAC+clarithromycin(HR:3.36; 99%CI:1.73-6.52) and increased risk of all-cause mortality with DOAC+clarithromycin/erythromycin/fluconazole were observed in cohort analysis. However, similar risks were found when initiating erythromycin/fluconazole with and without DOAC. We found no strong evidence of increased risks of bleeding and cardiovascular outcomes in DOACs+clarithromycin/fluconazole/erythromycin users except a possible short-term increased risk of gastrointestinal bleeding in DOACs+erythromycin users.

Long-term epidemiological trends in (primary) pediatric central nervous system tumors: a 25-year cohort analysis in Western Mexico.

Central nervous system tumors (CNSTs) represent a significant oncological challenge in pediatric populations, particularly in developing regions where access to diagnostic and therapeutic resources is limited. This research investigates the epidemiology, histological classifications, and survival outcomes of CNST in a cohort of pediatric patients aged 0 to 19years within a 25-year retrospective study at the Civil Hospital of Guadalajara, Mexico, from 1999 to 2024. Data was analyzed from 273 patients who met inclusion criteria, revealing a higher incidence in males (51.6%) with a mean age at diagnosis of 8.2years. Histological analysis revealed gliomas as the most common type (52.7%), followed by embryonal tumors (28.6%). High-grade tumors (WHO grade 4) comprised 49.8% of cases, demonstrating significantly poorer survival outcomes (median overall survival of 13.5months) compared to lower-grade tumors (up to 57months). The predominance of tumors in the supratentorial region and the notable differences in survival outcomes by tumor type underscore the varied impact of geographical and socioeconomic factors on pediatric oncology in Mexico. This study highlights the critical need for improved healthcare infrastructure and early diagnosis initiatives, as well as the importance of targeted research to address disparities in treatment and outcomes for pediatric CNST in this region.

Impact of 5-Aminosalicylic Acid on Ustekinumab in Inflammatory Bowel Disease: A Retrospective Medical Claims Analysis.

The efficacy of 5-aminosalicylic acid (5-ASA) in combination with advanced therapies (ADTs), particularly ustekinumab (UST), for the treatment of inflammatory bowel disease (IBD) remains unclear. This retrospective cohort analysis used data from the Medical Data Vision database, including patients with ulcerative colitis (UC) and Crohn's disease (CD) who had initiated UST therapy. Cumulative UST continuation rates and factors associated with UST failure were analyzed, and post hoc subgroup analyses based on prior ADT use were conducted. A total of 1971 patients with CD and 1284 patients with UC were included. Overall, the concomitant use of 5-ASA did not significantly affect UST failure in either CD or UC. Post hoc subgroup analysis suggested a protective effect of 5-ASA in ADT-naïve patients with CD or UC who had been previously exposed to ADT. 5-ASA did not provide a significant overall benefit when used in combination with UST for CD or UC. However, post hoc subgroup analyses indicated a potential role for 5-ASA in specific subgroups. Further studies are necessary to confirm these findings and explore personalized treatment strategies.

Identifying Distinct Developmental Patterns of Brain Complexity in Autism: A Cross-Sectional Cohort Analysis Using the Autism Brain Imaging Data Exchange.

Autistic traits exhibit neurodiversity with varying behaviors across developmental stages. Brain complexity theory, illustrating the dynamics of neural activity, may elucidate the evolution of autistic traits over time. Our study explored the patterns of brain complexity in autistic individuals from childhood to adulthood. We analyzed functional magnetic resonance imaging data from 1087 autistic participants and neurotypical controls aged 6 to 30 years within the ABIDE I (Autism Brain Imaging Data Exchange) data set. Sample entropy was calculated to measure brain complexity among 90 brain regions, utilizing an automated anatomical labeling template for voxel parcellation. Participants were grouped using sliding age windows with partial overlaps. We assessed the average brain complexity of the entire brain and brain regions for both groups across age categories. Cluster analysis was conducted using generalized association plots to identify brain regions with similar developmental complexity trajectories. Finally, the relationship between brain region complexity and autistic traits was examined. Autistic individuals may tend toward higher whole-brain complexity during adolescence and lower complexity during childhood and adulthood, indicating possible distinct developmental trajectories. However, these results do not remain after Bonferroni correction. Two clusters of brain regions were identified, each with unique patterns of complexity changes over time. Correlations between brain region complexity, age, and autistic traits were also identified. The study revealed brain complexity trajectories in autistic individuals, providing insight into the neurodiversity of autism and suggesting that age-related changes in brain complexity could be a potential neurodevelopmental marker for the dynamic nature of autism.

Intracranial dural arteriovenous fistulas with deep venous drainage: a single-center retrospective cohort study.

Dural arteriovenous fistulas (DAVFs) with deep venous drainage (DVD) (DAVFs-DVD) are characteristically associated with non-hemorrhagic neurological deficits, most notably cognitive impairment. Large studies have yet to thoroughly characterize these DAVFs. We conducted an analysis of the largest cohort of DAVFs-DVD to provide a comprehensive characterization of this specific subset. This study was a retrospective cohort analysis of 207 patients with DAVFs-DVD who were hospitalized at a single medical center between 2001 and 2022. Logistic regression was employed to identify angiographic features specific to DAVFs associated with cognitive impairment. Additionally, post-treatment outcomes were evaluated. DAVFs-DVDs can be classified into two categories: the Galenic group, where arterial feeders drain directly into the vein of Galen (VoG), and the non-Galenic group, where arterial feeders drain into other veins or venous sinuses and indirectly flow into the VoG. Cognitive impairment accounting for 15.9% of all clinical presentations. We found that the overall rate of complete occlusion was 86.6%, while the overall rate of complications was 16.4%. Moreover, patients with DAVFs-DVD presenting with cognitive impairment were more likely to have straight sinus stenosis or occlusion, as well as DAVFs located at the midline. DAVFs-DVDs can be classified into two categories: the Galenic group and the non-Galenic group. Patients with DAVFs-DVD presenting with cognitive impairment were more likely to have straight sinus stenosis or occlusion, as well as DAVFs located at the midline. Venous hypertension of the deep venous system is a key angiographic feature of DAVFs associated with thalamic cognitive impairment.

Tenofovir vs. Entecavir on the prognosis of hepatitis B virus-related hepatocellular carcinoma patients after liver resection: the role of HBsAg levels.

Our study aimed to explore whether hepatitis B surface antigen (HBsAg) levels affected the role of nucleot(s)ide analog treatment (entecavir (ETV) and tenofovir (TDF)) in improving the prognosis of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) patients after liver resection. A total of 865 HBV-related HCC patients after hepatectomy treated with TDF or ETV were included in our study. Patients were divided into the high HBsAg cohort (n=681) and the low HBsAg cohort (n=184). Propensity score matching (PSM) analysis was used to reduce the impact of potential confounding factors. Kaplan-Meier method and competing risk analysis were used to compare the survival outcomes. In the High HBsAg cohort, patients in the TDF group had better recurrence-free survival (RFS) and overall survival (OS) compared with patients in the ETV group both before (RFS: p<0.001; OS: p<0.001) and after (RFS: p=0.005; OS: p=0.035) PSM. TDF treatment was a favorable factor independently associated with RFS (HR: 0.58, 95%CI: 0.45-0.75, p<0.001) and OS (HR: 0.43, 95%CI: 0.28-0.66, p<0.001). In the low HBsAg cohort, no difference was observed in RFS and OS between the TDF group and the ETV group both before (RFS: p=0.140; OS: p=0.640) and after (RFS: p=0.480; OS: p=0.920) PSM. TDF treatment remained superiority after controlling for competing events by competing risk analysis in the high HBsAg cohort. TDF treatment was superior to ETV treatment in improving RFS and OS of HBV-related HCC patients with high HBsAg level after liver resection. Even after controlling for survival competing events, the advantage of TDF treatment remained. Our findings may better help clinicians to assign individualized antiviral regimens to HBV-related HCC patients after liver resection.

Laryngeal Carcinoma Characteristics Associated with Positive Margins and Endoscopic Understaging.

Background/Objectives: The study aims to analyse the factors associated with positive margins and endoscopic understaging in laryngeal carcinoma. It also aims to assess the diagnostic accuracy of Narrow Band Imaging (NBI) in comparison to White Light Endoscopy (WLE) and other diagnostic methods. Methods: In this retrospective comparative cohort analysis, 206 patients who underwent endoscopic laser surgery for T1 and T2a glottic squamous cell carcinoma between 1 January 2016 and 30 April 2023 were included. The data were collected from endoscopy, CT, histopathology, and NBI images. Statistical analysis was performed and associations between variables were analysed using binary logistic regression and receiver operating characteristic analysis. Results: The types of cordectomy performed included type III (51 patients), type IV (40 patients), and type VI (23 patients). Positive margins were found in 14.01% of patients, with significant correlations observed between positive margins and bilateral laryngeal carcinoma, right-sided laryngeal carcinoma, higher clinical and histopathologic T categories, and higher NBI grade. Endoscopic understaging versus histopathologic T category correlated with various factors, including cordectomy type, tumour size, and clinical T category. The NBI findings correlated with positive margins but did not correlate with endoscopic understaging. Conclusions: The study highlights several clinical and pathological factors associated with positive margins and endoscopic understaging in laryngeal carcinoma. NBI demonstrated high diagnostic accuracy, correlating with histopathological results and serving as an independent predictive factor for positive margins. Recognizing these factors is crucial for improving preoperative assessments, refining treatment strategies, and enhancing patient care.

Intravenous lidocaine for the treatment of sepsis-associated encephalopathy: a retrospective cohort study

ABSTRACT Objective This study aimed to evaluate the efficacy of intraoperative intravenous lidocaine administration in the management of sepsis-associated encephalopathy (SAE). Methods This retrospective cohort analysis included 165 patients diagnosed with SAE, who were categorized into two groups: the lidocaine group (n = 55) and the control group (n = 110). The lidocaine group received an intravenous injection of lidocaine at 1.5 mg/kg following anesthesia induction, and then received a continuous infusion at 1.5 mg/kg/h until the completion of surgery. The control group did not receive lidocaine during surgery. Data collected included patient demographics, medical history, infection site, Acute Physiology and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, Glasgow Coma Scale (GCS) score, laboratory results, anesthetic agents used, surgery duration, and length of stay in the intensive care unit (ICU). The primary outcome was the in-hospital prognosis of SAE. Results Patients in the lidocaine group had a significantly shorter ICU stay and a significantly higher rate of favorable prognosis compared with the control group (p < 0.05). Multivariate logistic regression analysis identified age and surgery duration as risk factors for SAE prognosis, whereas intraoperative intravenous lidocaine, GCS score, and intravenous dexmedetomidine emerged as protective factors. Conclusion Intraoperative intravenous administration of lidocaine significantly enhanced the prognosis of SAE patients.

VTE incidence shortens survival in IDH-WT glioblastoma.

Venous thromboembolisms (VTE's) are the second leading cause of death in cancer patients. While previous analyses have demonstrated VTE rates are greater in GBM patients using smaller patient cohorts in high-grade glioma, since the release of the update 5 th edition of the World Health Organization (WHO) classification a systematic analysis in a large-scale cohort of patients with IDH-wildtype GBM with clinical outcomes is lacking. This study utilizes the online database, TriNetx, to build patient cohorts for outcomes analysis. TriNetX is a database comprised of over 50 healthcare organization patient information that is quarriable by CPT, ICD, RxNorm, and other proprietary codes. Patient cohort demographics were used for propensity score matching. Risk ratios, odds ratios, hazard ratios, and Kaplan Meier curves were utilized for primary outcomes including survival and time-to-event analyses. 24% of patients with GBM experienced at least 1 VTE or PE after their diagnosis. Compared to a population of patients with no cancer history with an index event of an inpatient visit, patients with GBM were at 20.4 (12.23-34.17) and 5.96 (3.85-9.23) times higher risk of experiencing a VTE/PE at 1- and 5-year follow-up, respectively. Sex differences were not seen between VTE/PE rates and survival after VTE/PE at 1- and 5-year follow-up (p>0.05). Lastly, patients with GBM and a VTE/PE after diagnosis experienced worse survival at 1- and 5-year follow-up compared to those without a VTE/PE (p<0.0001 and p = 0.0014, respectively). Patients with GBM experience increased risks of thrombotic events after diagnosis. These risks are not sex-dependent but do affect overall survival.

Characterization and dosimetric predictors for absolute lymphocyte count changes during neoadjuvant chemoradiotherapy with or without pembrolizumab for esophageal squamous cell carcinoma: an analysis of a prospective cohort

AimTo characterize the differences of dynamic changes for absolute lymphocyte count (ALC) among esophageal squamous cell carcinoma (ESCC) patients treated with neoadjuvant chemoradiotherapy (nCRT) with or without pembrolizumab, as well as to investigate the clinical and lymphocyte-related organs dosimetric parameters that would impact ALC nadir during nCRT.Materials and methodsA total of 216 ESCC patients who received nCRT (with pembrolizumab 144; without pembrolizumab: 72) were identified from a prospective cohort. Weekly and 1-month post-nCRT ALC were identified. lymphocyte-related organs at risk (LOARs) were delineated. linear and logistic regression analysis was used to analyze the association between G4 lymphopenia/lymphopenia nadir and clinical/DVHs factors. Receiver-operating characteristic curves were used to derive optimal dosimetric planning constraints. Grade 4 (G4) lymphopenia was defined as ALC < 0.2 × 109/L during nCRT.ResultsG4 lymphopenia was observed in 35 ESCC patients (16.2%) during neoadjuvant treatment. Compared to nCRT alone, the addition of pembrolizumab to nCRT significantly improve lymphopenia recovery in the 1-months after nCRT (p = 0.0003), but the ALC at other time point during nCRT and ALC nadir was comparable between the two groups. A total of 198 patients finally received surgery. Of them, 98 patients archived pCR (49.5%), with 50.4% (68/135 patients) in nCRT with pembrolizumab and 47.6% (30/63) in nCRT alone(p = 0.94), respectively. The mean ALC nadir in the pCR group was significantly higher than those without (p = 0.0003). Multivariable linear and logistic regression analysis indicated that TVB mean dose, TVB V5, TVB V10, TVB V20, mean cardiopulmonary dose, mean ribs dose, mean whole body dose, mean spleen dose, V5, V10, and V20 of spleen dose were significantly associated with developing grade 4 lymphopenia. Dosimetric analysis showed that lymphocyte-sparing photon or proton irradiation was feasible while did not compromise clinically acceptable objectives.ConclusionThe addition of pembrolizumab to nCRT improved lymphopenia recovery for ESCC after trimodality therapy. ALC nadir was significantly associated with pCR and RFS after nCRT. Sparing of LOARs using advanced radiation techniques might reduce the risk of developing lymphopenia and improve treatment response in the era of immunotherapy.

Artificial Intelligence in Pancreatic Intraductal Papillary Mucinous Neoplasm Imaging: A Systematic Review.

Based on the Fukuoka and Kyoto international consensus guidelines, the current clinical management of intraductal papillary mucinous neoplasm (IPMN) largely depends on imaging features. While these criteria are highly sensitive in detecting high-risk IPMN, they lack specificity, resulting in surgical overtreatment. Artificial Intelligence (AI)-based medical image analysis has the potential to augment the clinical management of IPMNs by improving diagnostic accuracy. Based on a systematic review of the academic literature on AI in IPMN imaging, 1041 publications were identified of which 25 published studies were included in the analysis. The studies were stratified based on prediction target, underlying data type and imaging modality, patient cohort size, and stage of clinical translation and were subsequently analyzed to identify trends and gaps in the field. Research on AI in IPMN imaging has been increasing in recent years. The majority of studies utilized CT imaging to train computational models. Most studies presented computational models developed on single-center datasets (n=11,44%) and included less than 250 patients (n=18,72%). Methodologically, convolutional neural network (CNN)-based algorithms were most commonly used. Thematically, most studies reported models augmenting differential diagnosis (n=9,36%) or risk stratification (n=10,40%) rather than IPMN detection (n=5,20%) or IPMN segmentation (n=2,8%). This systematic review provides a comprehensive overview of the research landscape of AI in IPMN imaging. Computational models have potential to enhance the accurate and precise stratification of patients with IPMN. Multicenter collaboration and datasets comprising various modalities are necessary to fully utilize this potential, alongside concerted efforts towards clinical translation. Artificial Intelligence holds promise in the field of IPMN by augmenting IPMN detection, differentiation of different types of pancreatic cysts, stratifying malignant progression risk, and automating the analysis of IPMN imaging through computational cyst segmentation.The majority of studies related to AI-based analysis of IPMN imaging use single-center patient cohorts of less than 250 patients to develop and validate computational models and consider imaging as the only data modality.Reporting transparency of existing studies on AI in IPMN imaging is limited and there remains a scarcity of comprehensive, multimodal approaches as well as clinical translation.

Stuck in Transition: Clinical and Patient Factors Behind Prolonged Paramedic to Emergency Department Transfer of Care

ABSTRACT Objectives Paramedic services face increasing challenges due to delays in patient transfer of care (TOC) at emergency departments (EDs). Prolonged TOC times directly impact paramedic services’ ability to provide emergency response, though the patient and clinical factors contributing to these delays remain unclear. We examined TOC times for all transports to the ED and analyzed factors associated with prolonged TOC. Methods We conducted a retrospective cohort study using paramedic call data from Toronto Paramedic Services from September 1, 2022, to July 31, 2024. We included all paramedic-transported patient records to EDs following a 9-1-1 call, excluding inter-facility transfers and records with missing TOC timestamps. The TOC times were categorized into four intervals: 0-29, 30-59, 60-89, and ≥ 90 minutes. We conducted a cohort and subgroup analysis of patients aged 60 years or older using multivariable binary logistic regression models to identify factors independently associated with TOC times exceeding 60 minutes, using odds ratios (OR) with 95% confidence intervals (CI). Results A total of 418,196 patients were transported to EDs, of which 214,612 were 60 years or older. Overall, mean TOC was 39.9 minutes (SD 54.2). Patients aged 0-17 years had the lowest proportion in longer TOC intervals (5% for 60-89 mins; 2% for ≥ 90 mins), while patients 75 years or older had the highest (9%; 9% respectively). A TOC of at least 60 minutes was independently associated with older age (60 to 74 years OR 1.19, 1.15 – 1.22; 75 years or greater OR 1.27, 1.23 – 1.30), medical complexity (seven to eight diagnoses OR 1.15, 1.10 – 1.20; nine or greater diagnoses OR 1.29, 1.23 – 1.36), polypharmacy and specific presenting complaints (altered level of consciousness, respiratory distress, general weakness, head trauma). Medical acuity and receiving a paramedic intervention were not associated with prolonged TOC. Similar findings were determined in the subgroup analysis of older adults. Conclusions Prolonged TOC times disproportionately affect older or clinically complex patients, regardless of their acuity or need for paramedic intervention. Our findings highlight the importance for paramedic services, hospitals, and stakeholders to develop targeted care models and collaborations to reduce prolonged TOC.

Substance use and psychiatric outcomes following substance use disorder treatment: An 18-month prospective cohort study in Chile.

Evidence from high-income countries has linked duration and compliance with treatment for substance use disorders (SUDs) with reductions in substance use and improvements in mental health. Generalizing these findings to other regions like South America, where opioid and injection drug use is uncommon, is not straightforward. We examined if length of time in treatment and compliance with treatment reduced subsequent substance use and presence of psychiatric comorbidities. Prospective cohort analysis (3 assessments, 18 months) using inverse probability weighting to account for confounding and loss to follow-up. Outpatient/inpatient programs in Región Metropolitana, Chile. Individuals initiating publicly funded treatment (n = 399). Exposures included length of time in (0-3, 4-7, 8 + months, currently in) and compliance with treatment (not completed, completed, currently in) measured in the intermediate assessment (12 months). Primary outcomes were past-month use of primary substance (most problematic) and current psychiatric comorbidities (major depressive episode, panic, anxiety or post-traumatic stress disorders) measured 6months later (18 months). Secondary outcomes included past month use of alcohol, cannabis, cocaine powder and cocaine paste. 18.3% [95% confidence interval (CI) = 14.7%-22.6%] of individuals participated for 3 or fewer months in treatment and 50.1% (95% CI = 45.2%-55.1%) did not complete their treatment plan at 12 months. Participating for 8 + months in treatment was associated with lower risk of past month use of primary substance at 18 months [vs. 0-3 months, risk ratio (RR) = 0.62, 95% CI = 0.38-1.00] and completion of treatment (vs. not completed, RR = 0.49, 95% CI = 0.30-0.80). Neither participating 8 + months (vs. 0-3 months, RR = 0.83, 95% CI = 0.57-1.22) nor treatment completion (vs. not completed, RR = 1.02, 95% CI = 0.72-1.46) were associated with lower risk of psychiatric comorbidity at 18 months. Longer time in treatment and compliance with treatment for substance use disorders in Chile appears to be associated with lower risk of substance use but not current comorbid psychiatric conditions 18 months after treatment initiation.

Relationship between VEGF to PEDF ratio and in-hospital mortality in acute respiratory distress syndrome patients

Acute respiratory distress syndrome (ARDS) has a high mortality rate worldwide; thus, identifying death risk factors related to ARDS is critical for risk stratification in patients with ARDS. In the present study, we conducted a single-center retrospective cohort analysis. Out of 278 patients with ARDS admitted from January 2016 to June 2022, 226 were included in this study. The patients were classified based on whether they were alive or dead during hospitalization. Their demographic and laboratory data and results were analyzed by performing a standard statistical analysis. Patients in the death group were older, with worse respiratory functions and blood biochemistry than those in the non-death group. Moreover, statistically significant differences were observed in the levels of vascular endothelial growth factor (VEGF) and pigment epithelium-derived factor (PEDF) between the two groups. Multivariate stepwise logistic regression analysis showed that the VEGF/PEDF ratio was strongly associated with the risk of death. The area under the curve of the VEGF/PEDF ratio was 0.829 (95% confidence interval: 0.772–0.885; P < 0.001), sensitivity was 86.3%, and specificity was 68.0%. Therefore, a VEGF/PEDF ratio is positively correlated with the risk of death in patients with ARDS.

KRAS, NRAS, and BRAF Hot-Spot Mutations in Relation to Sidedness of Primary Colorectal Cancer: A Retrospective Cohort Study.

Background/Objective: Studies have shown an association between colorectal cancer (CRC) sidedness and gene mutations that may affect CRC clinical behavior. This study examined the association between specific KRAS, NRAS, and BRAF hot-spot mutations and primary CRC sidedness. Methods: We performed a retrospective cohort analysis of 722 patients diagnosed with primary CRC and tested for KRAS, NRAS, and BRAF hot-spot mutations at the University of Texas Medical Branch (UTMB) from January 2016 through July 2023. Multivariable logistic regressions analyses were conducted. Results:KRAS, NRAS, and BRAF hot-spot mutations rates were 37.8%, 4.6%, and 6.1%, respectively. Right-sided primary CRC had the highest prevalence of mutated tumors (64%). KRAS and BRAF hot-spot mutations were significantly different according to tumor sidedness. KRAS p.Gly12Asp, p.Gly12Val, and p.Gly13Asp showed a significantly increased likelihood of right-sided primary CRC compared to KRAS wildtype, 128%, 134%, and 221% higher, respectively. Conversely, KRAS p.Gly12Val and p.Gly13Asp mutations were associated with decreased likelihood of rectal cancer (53% lower) and left-sided tumors (56% lower), respectively. BRAF p.Val600Glu mutation, as opposed to BRAF wildtype, was associated with a 278% higher likelihood of right-sided CRC. No significant associations were observed between NRAS mutations and primary CRC sidedness. Conclusions: In primary CRC, specific mutations in KRAS (p.Gly12Asp, p.Gly12Val, and p.Gly13Asp) and BRAF p.Val600Glu were associated with increased likelihood of right-sided tumors. KRAS p.Gly12Val and p.Gly13Asp mutations were associated with decreased likelihood of rectal cancer and left-sided tumors, respectively. These findings suggest that tumorigenesis and mutational processes differ based on tumor sidedness. Further studies are needed to substantiate these findings.