Elderly Female Patients Research Articles

Motor synchronization and impulsivity in pediatric borderline personality disorder with and without attention-deficit hyperactivity disorder: an eye-tracking study of saccade, blink and pupil behavior.

Shifting motor actions from reflexively reacting to an environmental stimulus to predicting it allows for smooth synchronization of behavior with the outside world. This shift relies on the identification of patterns within the stimulus - knowing when a stimulus is predictable and when it is not - and launching motor actions accordingly. Failure to identify predictable stimuli results in movement delays whereas failure to recognize unpredictable stimuli results in early movements with incomplete information that can result in errors. Here we used a metronome task, combined with video-based eye-tracking, to quantify temporal predictive learning and performance to regularly paced visual targets at 5 different interstimulus intervals (ISIs). We compared these results to the random task where the timing of the target was randomized at each target step. We completed these tasks in female pediatric psychiatry patients (age range: 11-18 years) with borderline personality disorder (BPD) symptoms, with (n = 22) and without (n = 23) a comorbid attention-deficit hyperactivity disorder (ADHD) diagnosis, against controls (n = 35). Compared to controls, BPD and ADHD/BPD cohorts showed no differences in their predictive saccade performance to metronome targets, however, when targets were random ADHD/BPD participants made significantly more anticipatory saccades (i.e., guesses of target arrival). The ADHD/BPD group also significantly increased their blink rate and pupil size when initiating movements to predictable versus unpredictable targets, likely a reflection of increased neural effort for motor synchronization. BPD and ADHD/BPD groups showed increased sympathetic tone evidenced by larger pupil sizes than controls. Together, these results support normal temporal motor prediction in BPD with and without ADHD, reduced response inhibition in BPD with comorbid ADHD, and increased pupil sizes in BPD patients. Further these results emphasize the importance of controlling for comorbid ADHD when querying BPD pathology.

O-300 Human sperm selection using cumulus oophorus complexes compared with conventional sperm preparation method on sperm quality and ICSI outcomes: A pilot study

Abstract Study question We compared a sperm selection protocol using cumulus oophorus complexes with a swim up preparation, evaluating the effects on sperm parameters and ICSI outcomes Summary answer Spermatozoa selected using cumulus oophorus complexes showed higher rates of normal morphology, good motility compared with basal semen and the traditional pellet swim up protocol. What is known already It is known that the head of a mature spermatozoa has a hyaluronan receptor that allows them to bind with hyaluronan acid. Cumulus oophorus complexs (COCs) extracellular matrix is made mainly by hyaluronic acid (HA). Various studies have confirmed the importance of COCs in fertilization, demonstrating that spermatozoa that are able penetrate through a layer of COCs are more likely to have a normal morphology and be more effective in producing acrosome reactions than spermatozoa that are not able to do. Moreover, these spermatozoa have been shown to have higher chromatin integrity and zona-binding capacity, resulting in increased fertilization competence. Study design, size, duration A prospective study was conducted between July and December 2022. A total of 50 participants were recruited for the study, randomly selected between patients attending ICSI. The patients were classified as group A when the sperms were selected using pellet swim up and COC selection and as group B when it was used pellet swim up treatment alone. Patients older than 39 years, with endometriosis or repeated IVF failure or severe male factor were excluded. Participants/materials, setting, methods 3 drops of 30 mlt aligned and connected each other were prepared, covered with mineral oil. In group A, in the middle drop, was transferred COC fragments, while the central drop was empty in group B. In the left drop were added 20 mlt of sperm suspension after swim up, and from the right drops were recovered the sperms after passing the middle drop with or without COC, that were used for ICSI treatment. Main results and the role of chance The aim of the study was to verify the effectiveness of COCs, collected after ovarian stimulation, in selecting the best sperms to be used in ICSI procedure. No statistical difference was found between group A and B in the median age of female patients, FSH/LH units administred, E2 and endometrium thickness at triggering using hCG, in the sperm concentration, motility and normal morphology in the baseline seminal samples. We found a statistical difference in the traditional seminal parameters comparing the two different treatments. In particular, we found an higher rates of sperms with rapid and progressive motility and normal morphology in group A between basal semen sample and after sperm selection using COC filter (86.7 vs 31.3%; 8.2 vs 4.4 %). We found a lower sperm concentration in group A vs group B after sperm treatment (2.3 vs 4.7 M/ml), and an higher rates of rapid progressive motility and normal morphology in group A vs group B (86.7 vs 38.6 %; 8.2 vs 4.6%). We found an higher but not statistically significative pregnancy and implantation rates in group A compared with group B probably because of the limited number of patients analyzed (25 vs 19.2 %; 25 vs 20.6%) Limitations, reasons for caution The study was conducted on a small participant cohort. We analyzed the traditional sperm parameters, but it is necessary to evaluate the chromatine integrity of the sperms after COC selection to confirm that the higher sperm competence in fertilization and embryo development could be based on a better genetic pattern Wider implications of the findings Data seem to demonstrate that the use of COC allows to select higher competent sperms if compared with traditional pellet swim up treatment. The clinical and biological ICSI outcomes seem to be improved by COC treatment but it is necessary to increase the sample size in future experimental trial Trial registration number not applicable

Investigation of Subcarinal Angle and Tracheobronchial Morphology in Patients with COVID 19: A Retrospective Computed Tomography Study

Objective: Morphological features of the trachea are very important in choosing the correct endotracheal tube size for intubation. In this study, it was proposed to reveal the effect of SARS-CoV-2 on tracheobronchial morphology and subcarinal angle. 
 Method: 56 (26 female, 30 male) COVID-19 and 48 (24 female, 24 male) healthy individuals aged 40 and over were included in the study. The mean age of female patients with COVID-19 was 51.30±12.78 years, while the women in the control group were 45.00±11.89 years. The mean age of male patients with COVID-19 was 48.73±13.99 years, while the mean age of men in the control group was 43.76±8.45 years. The trachea length (TL), proximal, middle and distal levels anteroposterior (AP) and transverse (TR) trachea diameters (TD), subcarinal angle (SA), proximal right main bronchus (RMB) and left main bronchus (LMB) diameters were also measured on computed tomography (CT) images. 
 Results: The RMB angle was higher in men with COVID-19 than in the control group (p=0.005). TL was lower in women with COVID-19 than in the control group (p=0.030). Proximal AP-TD was higher in men with COVID-19 than in the control group (p=0.006). Proximal TR-TD was lower in men with COVID-19 than in the control group (p=0.029). TL, proximal, middle, and distal levels of AP and TR-TD,SA, RMB, and LMB angles, and proximal RMB and LMB diameters were found to be lower in women with COVID-19 than in men with COVID-19 (p=0.001). 
 Conclusion: It was deduced that tracheobronchial morphology might change in patients infected with SARS-CoV-2.It is clinically important that this situation should not be overlooked, especially in the indication of endotracheal intubation.

P-233 Novel, non-invasive imaging techniques in quality assessment of mammalian eggs

Abstract Study question Can Optical Coherence Microscopy (OCM) imaging and Cytoplasmic Movement Velocity (CMV) analysis be useful in quality assessment of mature mammalian oocytes? Summary answer OCM allows for assessment of oocytes’ metaphase spindles, and CMV – the actomyosin cytoskeleton functionality, therefore they are potentially useful in oocyte selection for IVF. What is known already The success rate of IVF has significantly improved over the recent years, yet its efficiency plummets with the increasing age of female patients. Therefore, novel approaches to oocyte/embryo quality assessment are in high demand. Among the most promising new methods are OCM, a label-free, 3D tool for subcellular structure visualization, such as the meiotic spindle in mature oocytes or nuclear structure in immature oocytes, and the analysis of CMV, a time-lapse imaging-based method for studying properties of the actomyosin cytoskeleton, crucial for a plethora of cellular process. Both these methods provide unique insights into oocyte competence. Study design, size, duration MII spindle dimensions were measured in OCM-imaged freshly ovulated oocytes collected from young mice (FO-MII, n = 108) and correlated with the outcome of preimplantation development achieved after the oocytes’ activation. Spindles of FO-MII (n = 45) were also compared to spindles of oocytes collected from mice in advanced maternal age (AMA-MII, n = 44). CMV was compared in time-lapse imaged FO-MII (n = 24), postovulatory aged oocytes collected from young mice (PA-MII, n = 16), and AMA-MII (n = 19). Participants/materials, setting, methods Oocytes were collected from hormonally primed mice and imaged using a customized OCM protocol. They were then activated parthenogenetically and cultured for 5 days, followed by immunofluorescence staining to assess the total number of cells and number of cells in the first embryonic cell lineages. FO-MII, PA-MII, and AMA-MII were time-lapse imaged (6 frames per minute; 15 min). The images were subjected to particle image velocimetry analysis and the mean CMV was calculated. Main results and the role of chance Oocytes that achieved the blastocyst stage had smaller spindle volume (p < 0.001) and width (p < 0.05) as compared to those failing to do so. Univariate logistic regression analysis indicated that a 1 μm rise in the spindle width decreases the odds of blastocyst formation by 28% and the number of cells on average by 8, whereas a 100 μm3 rise in the volume – by almost 10% and 2.7 cells respectively. Moreover, the spindle volume is also related to the number of trophectodermal cells, and the spindle length - to the number of primitive endoderm cells in the blastocysts. Noteworthily, young oocytes’ spindles had significantly smaller volume (p < 0.0001), as well as were narrower (p < 0.0001) compared to their counterparts from aged females. A multivariate linear regression model combining spindle length with three morphokinetic parameters (t3, cc2b, tSB) explained 60% of the variability in the total number of cells in 5-day-old embryos (R2 = 0.604) while models based solely on a single morphokinetic parameters explained only up to approx. 54% (R2 = 0.537, for tSB). On the other hand, CMV analysis revealed that freshly ovulated eggs display faster cytoplasmic movements than those postovulatory-aged (p < 0.0001). Reduced cytoplasmic speed was also observed in oocytes collected from aged mice (p < 0.0001). Limitations, reasons for caution All studies presented here were performed on a mouse model, so the obtained data needs to be verified in the target species for validation of these methods as novel tools in oocyte selection protocols. Wider implications of the findings Our results suggest that OCM-based assessment of the MII spindle and short, 15-minute CMV imaging allow for the selection of higher quality oocytes and could potentially find application in assisted reproductive technologies, as they are non-invasive and may enhance the universally acclaimed oocyte/embryo quality assessment protocols. Trial registration number not applicable

Biphenotypic Sinonasal Sarcoma with Orbital and Skull Base Involvement Report of 3 Cases and Systematic Review of the Literature

Biphenotypic sinonasal sarcoma (BSNS) is a rare malignant tumour of the upper nasal cavity and ethmoid sinuses that presents predominantly in middle aged female patients and show a characteristic infiltrative and hypercellular proliferation of spindle cells that demonstrate a specific immunoreactivity. We present three cases with BSNS that had different presenting complaints, either sinonasal or orbital problems, underwent endoscopic surgical treatment and/or radiotherapy and have been disease free on long follow up. A systematic review of all published cases was performed to identify all BSNS cases known at present. BSNS requires prompt and correct diagnosis with accurate surgical resection as well as consideration of radiotherapy. Our three cases confirm the findings of the literature and support that BSNS is an aggressive but treatable malignant disease of the sinonasal tract.

Comparison of HRCT Chest Findings of COVID-19 Patients Having Clinical Co-morbid to Those Without Co-morbid Disease

Objective: To determine the severity of High-Resolution Computed Tomography Chest findings of COVID-19 patients having co-morbid in comparison to those without co-morbid.
 
 Study Design: Comparative cross sectional study.
 Place and Duration of the Study: Radiology Department Combined Military Hospital, Multan Pakistan, from Mar to Sep 2020.
 Methodology: Data was collected through the medical record system of positive COVID-19 tests. Patients were divided into patients with no co-morbidities and others having co-morbidities. Two radiologists interpreted High-Resolution Computed Tomography chests independently to assess the disease severity in these two Groups. Co-morbidities included diabetes mellitus, hypertension, chronic renal disease, heart disease, Chronic Obstructive Pulmonary Disease and liver diseases.
 Results: A total of 200 patients were included. Out of 121 male patients, 85 had co-morbidities (71 had moderate to severe lung involvement; 14 had mild lung involvement); while 36 had no co-morbidities (5 had moderate to severe lung involvement; 31 had mild lung involvement). Out of 79 female patients, 47 had co-morbidities (15 had moderate to severe lung involvement; 32 had mild lung involvement); while 32 had no co-morbidities (3 had moderate to severe lung involvement; 29 had mild lung involvement).
 Conclusion: The severity of lung involvement was remarkably higher in patients with associated co-morbidities compared to no co-morbidities. Older age male patients having co-morbidities pose a risk factor for the severity of disease progression as compared to younger age female patients having no co-morbidities

Development of Anatomic Risk Factors for ACL Injuries: A Comparison Between ACL-Injured Knees and Matched Controls

Background: Several tibiofemoral anatomic features have been repeatedly associated with increased anterior cruciate ligament (ACL) injury risk. Previous studies have highlighted age and sex differences among these anatomic risk factors, but little is known about the normal and pathologic development of these differences during skeletal maturation. Purpose: To investigate differences in anatomic risk factors at various stages of skeletal maturation between ACL-injured knees and matched controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: After institutional review board approval, magnetic resonance imaging scans from 213 unique ACL-injured knees (age, 7-18 years, 48% female) and 239 unique asymptomatic ACL-intact knees (age, 7-18 years, 50% female) were used to measure femoral notch width, posterior slope of the lateral and medial tibial plateau, medial and lateral tibial spinal height (MTSH, LTSH), medial tibial depth, and posterior lateral meniscus-bone angle. Linear regression was performed to assess change in quantified anatomic indices with age for male and female patients in the ACL-injured cohort. Two-way analysis of variance with Holm-Sidak post hoc testing was performed to compare anatomic indices between ACL-injured knees and ACL-intact controls in each age group. Results: In the ACL-injured cohort, notch width, notch width index and medial tibial depth increased with age (R2 > 0.1; P < .001) in both sexes. MTSH and LTSH increased with age only in boys (R2≥ 0.09; P≤ .001), whereas meniscus-bone angle decreased with age only in girls (R2 = 0.13; P < .001). There were no other age differences in quantified anatomic indices. Patients with ACL injury consistently had a significantly higher lateral tibial slope (P < .01) and smaller LTSH (P < .001) as compared with ACL-intact controls across all age groups and sexes. When compared with age- and sex-matched ACL-intact controls, ACL-injured knees had a smaller notch width (boys, 7-18 years; girls, 7-14 years; P < .05), larger medial tibial slope (boys and girls, 15-18 years; P < .01), smaller MTSH (boys, 7-14 years; girls, 11-14 years; P < .05), and larger meniscus-bone angle (girls, 7-10 years; P = .050). Conclusion: The consistent morphologic differences throughout skeletal growth and maturation suggest a developmental role in high-risk knee morphology. The observed high-risk knee morphology at an earlier age preliminarily suggests the potential of knee anatomy measurements in identifying those with a predisposition toward ACL injury.

Mediation of race/ethnicity (R/E) disparities in mental health patient reported outcomes (PROS) among elderly female patients with breast cancer (BC) in the Surveillance, Epidemiology, and end results-medicare health outcomes survey (SEER-MHOS) database.

e22527 Background: Variations in mental health PROs between Non-Hispanic Black (NHB) and Hispanic compared to Non-Hispanic White (NHW) elderly women with BC may be attributable to differences in socioeconomic position (SEP), comorbid disease (CD), tumor biology (TB), social support (SS), and treatment factors (TF). We examine the extent to which the R/E disparity in patient reported mental health summary scores (MCS) is transmitted through these domains. Methods: Data is from SEER-MHOS and the analytic sample (n = 17,465) included 12,493 NHW, 2,503 NHB, and 2,019 Hispanic women with newly diagnosed BC between 2010-2017. MCS were calculated using the SF-36/V linear transformation of 0-100 versions of the scale that yield a population mean of 50 and standard deviation of 10 based on 1990 population means. We estimated average controlled direct associations (ACDA) using regression models with predictive margins (risk difference %) to evaluate crude and age/body mass index (BMI)-adjusted MCS by R/E and performed a series of ACDA [with comparison of rescaled coefficients (RC)] controlling for the domains of (1) SEP [household income (&lt; 30K, 30K-80K, &gt; 80K) and education attainment [ &lt; High School (HS), HS, &gt; HS)]; (2) CD [smoking status (current smoker/current non-smoker), diabetes (yes/no), and hypertension (yes/no)]; (3) TB [stages (1-3), grade (well/moderate/poor), and subtype (luminal A/ triple negative)]; (4) SS [domestic partner (yes/no); and (5) TF [systemic therapy (yes/no)]. Results: Overall, NHB and Hispanic women were younger and had higher BMI than NHW women and crude models showed MCS disparity for NHBs (-4.13%; 95% CI: -4.63, -3.63) and Hispanics (-5.91%, 95%CI: -6.49, -5.34) compared with NHWs. In baseline age/BMI adjusted models, NHBs and Hispanics had worse MCS, -3.78% (95% CI: -3.2, -4.35) and -5.7% (95% CI: -5.04, -6.36) respectively, compared with NHWs. Control for TF had minimal effect on the observed disparity [NHB (-3.85%; 95% CI: -4.56, -3.15) and Hispanics (-4.79%; 95% CI: -5.6, -3.97) compared with NHW], but control for SEP largely reduced the disparity [NHB (-1.56%; 95% CI: -0.89, -2.23) and Hispanics (-2.8%; 95% CI: -1.99, -3.6)]. Inclusion of all 5 domains also attenuated the magnitude of the disparity to a degree such that it was still considered a minimally important difference for Hispanics (-2.34%, 95% CI: -3.75, -0.94), but not for NHBs (0.12%; 95% CI: -1.08, 1.32). However, low acculturation in Hispanics appeared to modify (worsen) the disparity. Based on the method of RC, we determined that SEP accounted for the largest fraction of mediated effects. Conclusions: Our findings suggest that observed R/E differences in mental health PROs in elderly BC patients are largely mediated by differences in SEP rather than treatment.

Breast cancer staging for patients with “low risk” disease: Are they all the same?

6584 Background: Studies have shown that a low (&lt;11) Oncotype DX recurrence score (RS) is associated with better survival outcomes. RS is currently included in the AJCC prognostic staging criteria. Not all patients with a low RS are downstaged. It has been suggested that a low RS should further downstage patients regardless of other disease factors. We explored survival outcomes for patients with a low RS to assess if additional patients should be downstaged. Methods: Using the National Cancer Database, female patients ages 18-75 with invasive unilateral pT1-3, pN0-1, M0 hormone receptor positive (ER+ and/or PR+), HER2- breast cancer and a RS &lt;11, diagnosed 2010-2018 were identified. Patients who received neoadjuvant treatment were excluded. Patients were grouped based on the AJCC 8th edition prognostic stage (IA, IB, IIA, IIB, IIIA). Variables were summarized, and unadjusted overall survival (OS) was estimated using the Kaplan-Meier method. Cox proportional hazards models were used to estimate the association of stage with OS after adjustment for available covariates. Results: Of the 54,961 patients with a RS &lt;11, median follow-up was 57.7 months (95% CI 57.3-58.1), and median age was 61yo (IQR 52-67). Most tumors were grade 1 (37.6%) or 2 (56.9%) with ductal histology (75.3%). The median tumor size was 1.5 cm (IQR 1-2), and most were pN0 (83.3%). Although most patients with a RS &lt;11 were stage IA (94.2%), some had a higher stage assignment (5.1% stage IB, 0.6% IIA, 0.1% IIB, &lt;0.01% IIIA). Most patients (93.4%) received endocrine therapy (ET), and few (3%) received chemotherapy. Patients treated with chemotherapy more often had younger age, lobular histology, higher grade, larger tumor size, and/or pN+ disease (all p&lt;0.001). Unadjusted OS was reduced with higher stage (log-rank p&lt;0.001), and this remained true when limited to only those who received ET without chemotherapy (log-rank p&lt;0.001). After adjustment for relevant covariates including treatment, higher stage remained associated with worse OS [stage IA: ref; IB: HR 1.66 (95% CI 1.34-2.05); IIA: HR 2.29 (95% CI 1.44-3.65); IIB: HR 2.48 (95% CI 1.03-5.95); overall p&lt;0.001]. Conclusions: For patients with a low RS, survival outcomes vary with current AJCC prognostic disease stage, suggesting that not all patients with a RS &lt;11 should be downstaged based on RS alone. Anatomic and other non-genomic factors remain relevant when assessing prognosis. [Table: see text]

Demographic stratification, evaluation of symptoms burden on basis of gender, and implications of G8 questionnaires in elderly patients with cancer in Bangladesh.

12060 Background: Geriatric oncology is a new concept worldwide, as well as in Bangladesh. Presently, there is a scarcity of data regarding the geriatric perspective of malignant patients in Bangladesh. Our study investigated the demographic differentiation, evaluation of symptoms burden on the basis of gender, and implications of the G8 questionaries in elderly cancer patients from a tertiary cancer care center in Bangladesh. This will help physicians to understand cancer in the elderly better, integrate their biological and epidemiological characteristics, and promote a longer life expectancy without compromising their quality of life in resource-constrained regions. Methods: This study included all the newly diagnosed and histologically confirmed primary solid tumors among age ≥60 years at the National Institute of Cancer Research &amp; Hospital (NICRH), a tertiary care center in Bangladesh, during the year 2019 and 2020. For all statistical analyses, P&lt;0.05 was considered significant. Results: Of 8057 solid tumor patients, 2823 were geriatric patients (35.04%). Male dominant patients' mean BMI was 20.23 ±SD 4.26 and 35.4% were malnourished. The low SES was 63.7%i and 68.5% of patients were illiterate. Pain was the most common symptom (37.44%), followed by GI symptoms (31.77%), whereas 33.1% suffered from more than one symptom. in the disease distribution, lung cancer was 52.4% irrespective of sex, followed by GIT 17% and HBS cancer 10%. Breast 24.58% and GIT 17.77% were the second most common malignancy in females and males, respectively. Among them, 22.1% of patients were metastatic at presentation and 25% had a comorbid condition. About 17.4% of patients were completely disabled. Low BMI with high ECOG status had more symptoms (p=.004). Gender, nutrition and socioeconomic condition strongly correlated with the patient's functional status and symptomatic presentation. Females were more comorbid with symptomatic metastases at presentation (p=0.020), and males presented with late-stage cancer (p=0.002). Compared to male elderly patients, female elderly patients suffered more from malnutrition and obesity (p=&lt;.000). Polypharmacy rates for elderly males were lower than those for elderly females (p=0.000). Food intake behavior, weight loss, mobility, and health-related perception did not differ based on gender during or after treatment. Based on G8 scoring, we found that 12.3% were in the worse group, 70.2% in the intermediate group and the good group contained 17.5%. According to the cut-off value (≤11), 71.9% of patients needed the CGA evaluation. Conclusions: A high number of elder patients with multiple symptoms makes comprehensive management more challenging. A frail elderly patient's gender, SES, education, disease type, and stage along with performance status at the time of presentation of their disease are important prognostic factors.

Moderating effect of mindfulness on the relationship between anxiety and somatization symptoms in middle-aged and elderly female patients with hypertension.

To explore the moderating effect of mindfulness on the relationship between anxiety and somatization symptoms in middle-aged and elderly female patients with hypertension and provide a foundation for the development of more effective mindfulness intervention strategies. A total of 109 middle-aged and elderly female patients with hypertension participated in this cross-sectional study from April to July 2022 and provided valid responses to the Five Facet Mindfulness Questionnaire (FFMQ), the Hospital Anxiety and Depression Scale (HADS), and the Somatization Symptom Self-rating Scale (SSS). The moderating effect of mindfulness was determined using multiple linear regression. The participants' average scores were as follows: mindfulness: 123.86±10.49; anxiety: 7.41±3.62; and somatization symptoms: 41.2±9.44. The anxiety (P=.000) and somatization symptoms (P=.001) of participants with high mindfulness were significantly reduced. Anxiety was positively correlated with somatization symptoms (r=0.606, P=.000), while mindfulness was negatively correlated with both anxiety (r=-0.468, P=.000) and somatization symptoms (r=-0.439, P=.000). Moreover, mindfulness had a significant moderating effect on the relationship between anxiety and somatization symptoms (n=109) (B=-0.166, t=-2.125, P=.036). The effect of mindfulness on anxiety and somatization symptoms was more significant in participants with low mindfulness levels (n=56) (B=0.144, t=2.805, P=.008) than in participants with high mindfulness levels (n=53) (B=-0.037, t=-0.864, P=.393). The moderating effect analysis based on regression analysis showed that mindfulness had a significant moderating effect on anxiety and somatization symptoms, especially in participants with low mindfulness levels.

Identification of Populations at Risk for "Choosing Un-Wisely": A SEER Population-Based Study.

Since 2016, the Choosing Wisely campaign has recommended against routine axillary surgery in elderly patients with early stage, hormone receptor positive (ER+) breast cancer. The objective was to evaluate factors associated with axillary surgery in breast cancer patients meeting criteria for sentinel lymph node biopsy (SLNB) omission and identify potential disparities. Female patients age ≥70years with cT1-2N0M0, ER+, HER2-negative breast cancer diagnosed after publication of the Choosing Wisely recommendations, between 2016 and 2019, were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patient demographics and tumor characteristics associated with axillary surgery were analyzed. Of the 31756 patients meeting omission criteria, 25771 (81.2%) underwent axillary surgery. Hispanic ethnicity, median household income between $35,000 and $70,000, treatment in rural areas, poor differentiation, lobular and mixed lobular with ductal histology, T2 tumors, radiation therapy, and systemic therapy were factors associated with receiving axillary surgery on multivariable analysis. In the axillary surgery cohort, a median of 2 (IQR = 2) nodes were examined and 529 (2.1%) patients were found to have 1 or more positive lymph nodes. Among elderly patients meeting Choosing Wisely criteria for SLNB omission, particular racial, ethnic, socioeconomic, and geographic populations may be at increased risk for potential over treatment. Identification of these factors provides specific opportunities for education and implementation of de-escalation of unnecessary procedures.

Primary and reproductive healthcare access and use among reproductive aged women and female family planning patients in 3 states.

Public funding plays a key role in reducing cost barriers to sexual and reproductive health (SRH) care in the United States. In this analysis, we examine sociodemographic and healthcare seeking profiles of individuals in three states where public funding for health services has recently changed: Arizona, Iowa, and Wisconsin. In addition, we examine associations between individuals' health insurance status and whether they experienced delays or had trouble in obtaining their preferred contraception. This descriptive study draws on data collected between 2018 to 2021 in two distinct cross-sectional surveys in each state, one among a representative sample of female residents aged 18-44 and the other among a representative sample of female patients ages eighteen and older seeking family planning services at healthcare sites that receive public funding to deliver this care. The majority of reproductive-aged women and female family planning patients across states reported having a personal healthcare provider, had received at least one SRH service in the preceding 12 months, and were using a method of birth control. Between 49-81% across groups reported receiving recent person-centered contraceptive care. At least one-fifth of each group reported wanting healthcare in the past year but not getting it, and between 10-19% reported a delay or trouble getting birth control in the past 12 months. Common reasons for these outcomes involved cost and insurance-related issues, as well as logistical ones. Among all populations except Wisconsin family planning clinic patients, those with no health insurance had greater odds of being delayed or having trouble getting desired birth control in the past 12 months than those with health insurance. These data serve as a baseline to monitor access and use of SRH services in Arizona, Wisconsin, Iowa in the wake of drastic family planning funding shifts that changed the availability and capacity of the family planning service infrastructure across the country. Continuing to monitor these SRH metrics is critical to understand the potential effect of current political shifts.

Understanding risks and time to congestive heart failure following incident atrial fibrillation

Objectives: Evaluate how different comorbidities increase 3-year risk of incident congestive heart failure (CHF) in new atrial fibrillation (AF) patients and the time from diagnosis of AF to developing incident CHF while controlling for risk factors and treating death as a competing risk event. Methods: We utilized CMS Medicare 100% inpatient and outpatient claims data between 2013 and 2017. Patients with new AF diagnosis (without concurrent CHF at AF diagnosis) in 2014 who had 1-year continuous enrollment prior to their AF diagnosis (baseline period) and no prior diagnosis of AF or CHF in the baseline period were identified. Results: With every 1-year increase in age of incident AF patients, 3-year risk of CHF increases by 2.6%, presence of coronary artery disease, COPD, diabetes mellitus, peripheral artery disease, and cardiomyopathy increases 3-year risk of CHF by 22.1%, 30.2%, 31.9%, 15.2%, 44.8%, and 6.3% respectively. Blacks with incident AF had 6.9% higher 3-year risk CHF than Whites. For the average aged female patient in our cohort (78.5years) with no comorbidities and death as a competing risk, we found the probability of CHF within the first 3 years after AF diagnosis to be 23.5%, 17.5% within the first 2 years, and 10% within the first year. Conclusion: Various comorbidities affect the risk of CHF differently in incident AF patients. Cumulative risk of incident CHF appears to increase fastest within the first few years following incident AF diagnosis.

Correlation between delayed carpal tunnel syndrome and carpal malalignment after distal radial fracture

BackgroundDelayed carpal tunnel syndrome after Colles’ fracture is a common complication particularly following conservative treatment. The aim of the study was to verify the correlation of different radiological parameters of carpal alignment and the development as well as the severity of DCTS in elderly female patients within 6 months of distal radial fracture (DRF).MethodsThis is a retrospective case–control study that included 60 female patients with DRF within 6 months treated conservatively (30 patients with signs and symptoms suggestive of DCTS and 30 asymptomatic patients as a control group). Electrophysiological evaluation was done for all the participants, as well as radiological assessment to measure parameters of carpal alignment mainly radiocapitate distance (RCD), volar prominence height (VPH) and volar tilt (VT).ResultsThere was a statistical significant difference between both groups regarding the radiological parameters of carpal alignment (The mean values of RCD, VT and VPH were − 11.48 mm, − 20.68° angle, and 2.24 mm respectively in the symptomatic group). A strong correlation was found between decrease in the parameters of carpal alignment and the severity of DCTS. Logistic regression analysis showed that VT is strongly involved in the development of DCTS. The threshold value of the VT was − 20.2° angle (sensitivity 0.83; specificity 0.9; odds ratio 45; 95% CI 0.894–0.999; p < 0.001).ConclusionsAnatomical alteration of the carpal tunnel after DRF with dorsal displacement of the carpal bones contribute to the development of DCTS. Decreasing VT and VPH and RCD are the most significant independent predictors for the development of DCTS in conservatively managed DRF.Protocol ID: 0306060.

A Profile Study of Japanese Encephalitis in an Industrial Hospital in Eastern India.

Introduction Japanese encephalitis (JE), caused by a Flavivirus, is one of the common causes of mosquito-borne encephalitis the world over including India. The disease is endemic in many states of India, including Jharkhand. Mortality ranges from 30 to 40% in different studies and a large number of patients survive with permanent neuropsychiatric sequelae. Aim The study aimed to evaluate the clinical spectrum, laboratory (including radiological) features and outcomes of cases of JE admitted in our hospital. Methods and materials This is a retrospective observational study consisting of confirmed cases of JE admitted to the medical wards and critical care unitof Tata Main Hospital (TMH) from January to December 2022. The case records of patients were retrieved from Hospital Management System (HMS) and analysed for demographic characteristics, clinical presentationsand treatment details along with outcome measures, which included length of stay (LOS), complications, and mortality. Observation Of the 14 confirmed cases, six (43.9%) were males and eight (57.1%) were females. The average age of male and female patients was 41.8 ± 23.1 and 35.1 ± 20.5 years respectively. A total of 35.7% of the patients were in the age group of 21 to 30 years. The clinical manifestations in the decreasing frequency were altered sensorium in 11 (78.6%) patients, headache in six (42.8%) patients, generalised convulsions in four (28.6%) cases, vomiting in three (21.4%) cases and weakness in all limbs and of the right half of the body in one (7.1%) case each. Objective neurological findings noted were neck stiffness (3, 21.4%), cog-wheel rigidity (3, 21.4%), tremors (2, 14.3%), delirium (2,14.3%), quadriparesis, facio-brachial dystonia and hemiparesis (1, 7.14%) patient each. Neutrophilic leucocytosis was observed in five (35.7%) patients and mild thrombocytopenia in two (14.3%) patients. The average C-reactive protein (CRP) level was 7.3 ± 6.6 mg/dL. Three (21.4%) patients had mild transaminitis. Cerebrospinal fluid analysis was abnormal in all patients with varying degrees of elevated protein and cell count, while adenosine deaminase (ADA) levels and sugar were normal in all patients. Magnetic resonance imaging (MRI) brain revealed bilateral thalamic T2FLAIR (fluid-attenuated inversion recovery) hyperintensities in 11 patients (78.6%). The average length of hospital stay was 9.6 ± 4.7 days. Ten patients (71.4%) needed treatment in the critical care unit. Complications seen were acute respiratory distress syndrome (2, 14.3%), sepsis with multiorgan failure (2, 14.3%) and ventilator-associated pneumonia (1, 7.1%). The case fatality rate was one (7.1%). Six patients (42.9%) had residual neuropsychiatric sequelae. Conclusion JE continues to be a major health-related problem. Most cases are concentrated during the post-monsoon period, coinciding with a higher vector density. Patients from rural backgrounds were seen to be more susceptible. JE may present with varying severities of acute encephalitic syndrome. As there is no specific treatment, timely diagnosis is important to reduce the morbidity and mortality associated with this disease. Clinicians must be aware of the wide spectrum of presentation of this disease. A high degree of suspicion along with thorough clinical examination and appropriate investigations are needed to diagnose this condition early and prevent complications.

The prevalence of anemia in patients with malignant tumors: a hospital based cross sectional study

Cancer is a worldwide health problem, and anemia is one of its manifestations. There are no published data on anemia among patients with cancer in Sudan. The current study aimed to investigate the prevalence of anemia among patients with malignant tumors in central Sudan. The medical records of patients with malignant tumors admitted to the National Cancer Institute, University of Gezira, Sudan, from March to December 2020 were reviewed. Among the 471 patients enrolled in the study, 292 (62.0%) were female. The median (interquartile range, IQR) age was 55 (45-66) years. Breast cancer (109, 23.1%), colorectal/anorectal (88, 18.7%), head and neck (83, 17.6%), female genital tract (70, 14.9%), and prostate (35, 7.4%) cancer were the main cancers observed in this study. The median (IQR) hemoglobin was 11.9 (10.5-13.0) g/dl and 237 (50.3%) patients had anemia. The prevalence of anemia ranged from 31.2% in breast cancer patients to 82.9% in those with prostate cancer. Compared with males (120/292, 41.1%), females (117/179, 65.4%) had a significantly higher prevalence of anemia (P&lt;0.001). The median (IQR) age of the patients with anemia was significantly higher than that of those without anemia (57.0 years vs. 51.5 years, respectively; P=0.003). Half the patients with malignant tumors had anemia. Anemia was more common among female patients and elderly patients.

Identifying immune biomarkers associated with human trauma as potential therapeutic targets

Abstract Severe trauma can induce systemic immunosuppression, which makes understanding the biomarker profiles of trauma patients critical for therapeutic development and for predicting potential immune responses to treatments such as biomedical implants. Our goal was to establish a data set containing levels of a large array of biomarkers measured in blood from human trauma patients. Multiplex electrochemiluminescence assays were conducted to measure the levels of 59 biomarkers in 1000 blood samples collected from patients at the time of admission to trauma centers. Injury types were categorized as motor vehicle crashes (n=448), falls (n=221), gun wounds (n=78), stabbings (n=117), or other traumatic injuries. Patients ranged in age from 18 to 101, with a mean age of 42.7 for male patients (n= 725) and 49.8 for female patients (n= 272). There were no significant differences in biomarker expression levels between the different injury types. Differences in age distributions of male and female patients for each injury type were not found to be statistically significant, except in the case of falls, which had a higher average age for female patients compared to male patients. MIF, MIP-5, and YKL-40 had the highest expression, with concentrations of 554148 ± 62938 pg/mL, 17409 ± 919 pg/mL, and 98793 ± 10015 pg/mL (mean ± 95 % CI) respectively, at 1:100 dilution. Further experiments are currently being conducted to establish biomarker profiles for control uninjured human samples, and data comparing the profiles of trauma patients and uninjured controls will be presented. Overall, this work provides a resource for understanding immune responses to injury and potentially developing new therapeutics with these biomarker profiles in mind. This work was supported by the National Institute of Biomedical Imaging and Bioengineering

Adjuvant Therapy for Elderly Breast Cancer Patients after Breast-Conserving Surgery: Outcomes in Real World Practice.

We aimed to evaluate the standard of care of adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) in elderly female patients (≥65 years) treated outside of clinical trials and to identify potential factors related to the omission of RT and the interaction with endocrine therapy (ET). All women treated with BCS at two major breast centers between 1998 and 2014 were evaluated. Data were provided by the Tumor Registry Munich. Survival analyses were conducted using the Kaplan-Meier method. Prognostic factors were identified using multivariate Cox regression analysis. The median follow-up was 88.4 months. Adjuvant RT was performed in 82% (2599/3171) of patients. Irradiated patients were younger (70.9 vs. 76.5 years, p < 0.001) and were more likely to receive additional chemotherapy (p < 0.001) and ET (p = 0.014). Non-irradiated patients more often had non-invasive DCIS tumors (pTis: 20.3% vs. 6.8%, p < 0.001) and did not undergo axillary surgery (no axillary surgery: 50.5% vs. 9.5%, p < 0.001). Adjuvant RT was associated with improved locoregional tumor control after BCS in invasive tumors (10-year local recurrence-free survival (LRFS): 94.0% vs. 75.1%, p < 0.001, 10-year lymph node recurrence-free survival (LNRFS): 98.1% vs. 93.1%, p < 0.001). Multivariate analysis confirmed significant benefits for local control with postoperative RT. Furthermore, RT led to increased locoregional control even in patients who received ET (10-year LRFS 94.8% with ET + RT vs. 78.1% with ET alone, p < 0.001 and 10-year LNRFS: 98.2% vs. 95.0%, p = 0.003). Similarly, RT alone had significantly better locoregional control rates compared to ET alone (10-year LRFS 92.6% with RT alone vs. 78.1% with ET alone, p < 0.001 and 10-year LNRFS: 98.0% vs. 95.0%, p = 0.014). The present work confirms the efficacy of postoperative RT for breast carcinoma in elderly patients (≥65 years) treated in a modern clinical setting outside of clinical trials, even in patients who receive ET.

Non-alcoholic fatty liver disease is associated with an increased risk of type 2 diabetes.

Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease worldwide and represents the leading cause of liver-related morbidity and mortality. Its all-cause mortality is often driven by co-existing metabolic diseases such as type 2 diabetes (T2DM), which share many pathophysiological characteristics. The risk of developing T2DM among NAFLD patients in Germany is only poorly described. A cohort of 17 245 NAFLD patients and a propensity score-matched cohort of equal size were identified from the Disease Analyzer database (IQVIA) between 2005 and 2020. The incidence of T2DM was evaluated as a function of NAFLD during a 5-year study period using Cox-regression models. Within 5 years of the index date, 18.8% and 11.7% of individuals with and without NAFLD were diagnosed with T2DM (P < 0.001). Regression analysis revealed a hazard ratio of 1.77 [95% confidence interval (CI), 1.68-1.88] for the development of T2DM among NAFLD patients. Subgroup analyses confirmed this association for all age groups (18-50, 51-60, 61-70 and >70 years), male and female patients, as well as normal weight (BMI < 25 kg/m2), overweighted (BMI 25-30 kg/m2) and obese (BMI > 30 kg/m2) patients. Our data revealed a significantly increased incidence of T2DM among NAFLD patients in Germany. Given the dramatically increasing global relevance of NAFLD, we believe that prevention and regular screening programs for T2DM in NAFLD patients could help to reduce its high mortality and morbidity in the future.