Functional Status Research Articles

Predictive Factors for Onset of Moderate-to-Severe Disability Following Hospital Discharge Due to Rib Fractures.

According to previous studies, a prolonged hospital stay, along with the patient's clinical features, can lead to the onset of disability. This study aimed to identify predictive factors of moderate-to-severe disability following hospital discharge in rib fracture patients. We conducted a retrospective study with hospitalized adult patients with rib fractures who received conservative treatment. Patients' clinical profiles and characteristics were collected from their clinical histories and healthcare professional records. Overall, patients exhibited a 44% rate of moderate-to-severe disability after a six-day hospital stay. The incidence of patients with a prolonged hospital stay who showed disabilities was associated with male sex (HR 0.73, p < 0.001), presence of first rib fracture (HR 1.78, p = 0.047), presence of flail chest (HR 1.29, p = 0.046), severity of lung injury (HR 1.65, p < 0.001), and functional status (HR 1.37, p < 0.001). Moderate-to-severe disability in patients with rib fractures may depend on factors such as sex, functionality, severity of lung injury, and presence of first rib fracture and flail chest during a prolonged hospital stay.

Clustering Based on Laboratory Data in Patients With Heart Failure Admitted to the Intensive Care Unit.

Heart failure (HF) is a common condition that imposes a significant burden on healthcare systems. We aimed to identify subgroups of patients with heart failure admitted to the ICU using routinely measured laboratory biomarkers. A large dataset (N = 1176) of patients with heart failure admitted to the ICU at the Beth Israel Deaconess Medical Center in Boston, USA, between June 1, 2001, and October 31, 2012, was analyzed. We clustered patients to identify laboratory phenotypes. Cluster profiling was then performed to characterize each cluster, using a binary logistic model. Two distinct clusters of patients were identified (N = 679 and 497). There was a significant difference in the mortality rate between Clusters 1 and 2 (50 [7.4%] vs. 109 [21.9%], respectively, p < 0.001). Patients in the Cluster 2 were significantly older (mean [SD] age = 72.35 [14.40] and 76.37 [11.61] years, p < 0.001) with a higher percentage of chronic kidney disease (167 [24.6%] vs. 262 [52.7%], respectively, p < 0.001). The logistic model was significant (Log-likelihood ratio p < 0.001, pseudo R2 = 0.746) with an area under the curve of 0.905. The odds ratio for leucocyte count, mean corpuscular volume (MCV), red blood cell (RBC) distribution width, hematocrit (HcT), lactic acid, blood urea nitrogen (BUN), serum potassium, magnesium, and sodium were significant (all p < 0.05). Laboratory data revealed two phenotypes of ICU-admitted patients with heart failure. The two phenotypes are of prognostic importance in terms of mortality rate. They can be differentiated using blood cell count, kidney function status, and serum electrolyte concentrations.

Role of aminophylline in prevention of acute kidney injury in term neonates with severe perinatal asphyxia: a randomized open-label controlled trial.

Acute kidney injury (AKI) is one of the frequently observed complications in neonates with severe perinatal asphyxia. The efficacy of aminophylline in preventing or alleviating renal dysfunction in these neonates remains controversial. The current study aimed to explore whether treatment with aminophylline as adjunctive therapy is superior to standard care alone in preventing AKI in severely asphyxiated term neonates and to delineate the changes in other renal parameters. In this open-label randomized clinical trial, term neonates with severe asphyxia (n = 41) received a 5 mg/kg intravenous dose of aminophylline within the first hour after birth, in addition to standard care for birth asphyxia. The control group (n = 40) received standard care alone. Their daily urine output, weight, serum creatinine, renal functional status, and complications during the first 5 days of life were monitored and compared. The statistical package for social sciences version 25 was used for analysis. Approximately 24.39% of neonates in the aminophylline group developed AKI, compared to 35.0% in the control group (P = .088). Although urine output was generally higher in aminophylline-treated newborns than in the control group, this increase was not statistically significant (P > .05), with the most notable differences observed on the second and third postnatal days. Also, the changes in plasma creatinine levels between the two groups during this time were not statistically significant. Administering a single dose of aminophylline (5 mg/kg) within the first hour of life to severely asphyxiated term neonates might temporarily enhance urine output, but does not reduce the overall incidence of AKI.

Validation of a French Version of the Visual Function and Corneal Health Status Instrument and Correlation With Vision and Glare Measurements in Fuchs Endothelial Corneal Dystrophy.

To validate a French version of the Visual Function and Corneal Health Status (V-FUCHS) instrument in Fuchs endothelial corneal dystrophy (FECD) and to correlate questionnaire scores with objective measurements of best-corrected visual acuity (BCVA) and intraocular straylight. The original V-FUCHS 15-item instrument was designed to assess VA and glare in patients with FECD. It was translated from English to French and back translated to English by independent translators. The questionnaire was administered on 2 occasions (4 weeks apart), and BCVA, modified Krachmer grade, and straylight were measured. Construct validity, internal consistency, test-retest reliability, and predictive validity were assessed. A total of 159 subjects, aged 41 to 86 years, were prospectively recruited from July 2019 to October 2020 and classified into 6 groups: mild, moderate, or advanced FECD; unilateral or bilateral Descemet membrane endothelial keratoplasty for FECD; and healthy controls (n = 35). Construct validity was confirmed by item response theory model. Cronbach alpha demonstrated excellent internal consistency (VA: 0.91, glare: 0.88), and intraclass correlations showed good test-retest reliability (VA: 0.75 and glare: 0.82). Significant correlations were observed between both VA and glare factors and the modified Krachmer grade, BCVA, and straylight. The proposed French version of the V-FUCHS instrument provides a valid and reliable tool for the assessment of visual disability in patients with FECD. This questionnaire bridges the gap between self-reported FECD symptoms and objective clinical measurements, which may prove useful to optimize the timing of surgery and to assess postoperative improvement in symptoms.

Perceived Health Status Predicts Resilience after Hip Fracture in Older People.

Background and Objectives: Perceived health status (PHS) is associated with various health outcomes in older adults, but its relationship with resilience in the context of events with a major impact on functional status (FS), such as hip fracture, has not been explored. Our objective was to evaluate whether older adults who report good PHS before a hip fracture have a higher probability of returning to their baseline physical performance (PP) and personal independence. Materials and Methods: We analyzed data from waves 1 and 2 of the Survey of Health, Ageing and Retirement in Europe (SHARE) study, enrolling patients ≥ 65 years who experienced a hip fracture between these two waves. As study outcomes, we analyzed changes in PP and functional abilities (FAs). Results: We included 149 participants with a mean age of 75.7 years (SD: 6.5); women comprised 66%. The incidence of loss of PP was 51.7% among participants with good PHS and 59.6% among those with poor PHS. FA worsened in 40% of participants with good PHS and 58.4% in those with poor PHS. Relative risk (RR) for loss of FA in people with good PHS was 0.68 (95% CI: 0.48-0.98), which did not change after an adjustment for age, gender, baseline FA, depression, number of comorbidities, education, income, and social support, despite it not reaching statistical significance. After adjustment, the risk of worsening PP in participants with good PHS was reduced by 34% (95% CI: 0.41-1.06). Conclusions: A simple question on PHS may predict the resilience of older adults after an acute stressor. A systematic evaluation of PHS can help identify patients with a higher probability of regaining function after a hip fracture and thus provide useful information for resource allocation.

Exploring the Dual Benefits of Fermented and Non-Fermented Garlic Powder on Growth, Antioxidative Capacity, Immune Responses, and Histology in Gray Mullet (Liza ramada)

This study investigated the effects of dietary garlic powder and fermented garlic powder supplementation at 1% and 2% levels on growth performance, digestive tract efficacy, blood biochemistry, immunity, and antioxidant status of Liza ramada (n = 225 fish; 86.00 ± 0.42 g) over a 60-day period. Fish fed diets supplemented with both forms of garlic at both levels exhibited significantly improved final body weight, weight gain, specific growth rate, and feed conversion ratio compared to the control group. Digestive enzyme activities (amylase, lipase, and protease) were significantly enhanced in all supplemented groups. Blood biochemical analysis revealed reduced glucose levels and increased total protein in garlic-supplemented groups, with no adverse effects on liver or kidney function markers. Immune parameters, including lysozyme activity, bactericidal activity against Streptococcus agalactiae, alternative complement pathway (ACP), and respiratory burst (NBT), were significantly enhanced in garlic-supplemented groups, with fermented garlic showing more pronounced effects. Antioxidant enzyme activities (SOD, CAT, and GPx) were also significantly increased in all supplemented groups, particularly in those fed fermented garlic. No significant differences in survival rates were observed among treatments. The results suggest that both garlic powder and fermented garlic powder supplementation, especially at the 2% level, can effectively improve growth, feed utilization, immune function, and antioxidant status in L. ramada. Fermented garlic generally demonstrated superior effects, indicating its potential as a beneficial feed additive in aquaculture. Based on these findings, it is recommended to incorporate fermented garlic powder at a 2% level in L. ramada diets to optimize growth performance and health status. Further research is warranted to investigate the long-term effects and cost-effectiveness of this supplementation strategy in commercial aquaculture settings.

Clinicogenomic predictors of outcomes in patients with hepatocellular carcinoma treated with immunotherapy.

Immune checkpoint inhibitor (ICI) combinations extend overall survival (OS) while anti-PD-1/L1 monotherapy is non-inferior to sorafenib in treatment-naïve, patients with advanced hepatocellular carcinoma (HCC). Clinicogenomic features are posited to influence patient outcomes. The primary objective of this retrospective study was to define the clinical, pathologic, and genomic factors associated with outcomes to ICI therapy in patients with HCC. Patients with histologically confirmed advanced HCC treated with ICI at Memorial Sloan Kettering Cancer Center from 2012 to 2022 were included. Association between clinical, pathological, and genomic characteristics were assessed with univariable and multivariable Cox regression model for progression-free survival (PFS) and OS. Two-hundred and forty-two patients were treated with ICI-based therapy. Patients were predominantly male (82%) with virally mediated HCC (53%) and Child Pugh A score (70%). Median follow-up was 28 months (0.5-78.4). Median PFS for those treated in 1st line, 2nd line and ≥ 3rd line was 4.9 (range: 2.9-6.2), 3.1 (2.3-4.0), and 2.5 (2.1-4.0) months, respectively. Median OS for those treated in 1st line, 2nd line, and ≥ 3rd line was 16 (11-22), 7.5 (6.4-11), and 6.4 (4.6-26) months, respectively. Poor liver function and performance status associated with worse PFS and OS, while viral hepatitis C was associated with favorable outcome. Genetic alterations were not associated with outcomes. Clinicopathologic factors were the major determinates of outcomes for patients with advanced HCC treated with ICI. Molecular profiling did not aid in stratification of ICI outcomes. Future studies should explore alternative biomarkers such as the level of immune activation or the pretreatment composition of the immune tumor microenvironment.

Impacts of dietary Ajwain (Trachyspermum ammi L.) on growth, antioxidative capacity, immune responses, and intestinal histology of grey mullet (Liza ramada)

This study investigated the impacts of dietary supplements with ajwain seed extract (ASE) on the growth, biochemical parameters, digestive enzymes, antioxidant activity, immunity, and intestine histology of Liza ramada. Juveniles (N = 450) with an initial weight of 40.12 ± 0.14 g were fed six experimental diets enriched with ASE at 0 (control), 0.2, 0.4, 0.6, 0.8, and 1.0 g/kg diet for 60 days. Results revealed that fish-fed diets containing ASE at levels of 0.6 g/kg or higher exhibited significantly improved growth parameters including final weight, weight gain percentage, and specific growth rate, along with enhanced feed conversion efficiency compared to lower ASE levels and the control diet. Survival rates remained similar across all experimental groups. Digestive enzyme activity, particularly lipase, was highest in groups fed higher ASE levels (≥ 0.4 g/kg diet). Histomorphological analysis of the intestine showed improved villi structures with increasing ASE supplementation, reaching an optimal appearance at 0.8 g/kg. Blood biochemical analysis indicated higher total protein and globulin concentrations, and lower total cholesterol levels in groups with higher ASE intake (≥ 0.4 g/kg diet). Immune parameters increased with increasing ASE concentrations, including lysozyme activity, bactericidal percentage, and nitroblue tetrazolium levels. Antioxidant status, measured through superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and malondialdehyde (MDA) levels, showed significant improvements with ASE supplementation, with optimal dietary ASE levels for maximizing SOD (0.73 g/kg), CAT (0.74 g/kg), GPx (0.83 g/kg), and minimizing MDA (0.73 g/kg) identified through polynomial regression analysis. These findings suggest that ASE supplementation (0.6–0.8 g/kg) positively influences the growth performance, digestive function, gut health, immunity, and antioxidant status of L. ramada, highlighting its potential as a beneficial dietary additive in aquaculture.

Is pancreatic adenosquamous carcinoma (PASC) a surgical disease? A large healthcare system review

IntroductionPancreatic cancer represents an increasing cause of cancer-related deaths. Pancreatic adenosquamous carcinoma (PASC) is a rare subtype of pancreas cancer. Optimal treatment is not well-defined. This review aims to provide a detailed analysis of the natural history, management, and outcomes of the patients with PASC within a single large healthcare system. Materials and methodsA large healthcare database was used to retrospectively identify all patients with histological diagnosis of PASC from 2010 to 2020. The cohort was evaluated as a whole and according to the following management modalities: operative, non-metastatic non-operative, and patients with metastatic disease. Abstracted data included patient characteristics, oncologic characteristics at presentation, and details of surgical and non-surgical treatment. ResultsIn total, 60 patients with PASC were identified. All patients had confirmed histopathological diagnosis of PASC. Mean age at the time of diagnosis was 70.9 years, and 28 patients were male (46.7 %). Most patients presented with pancreas head tumors (60 %). Thirty-four patients presented with non-metastatic disease (56.6 %). The operative group consisted of 17 patients (28.3 %). Most patients received adjuvant systemic therapy (70.6 %). Majority of patients experienced recurrence (76.5 %), with median time to recurrence at 6.5 months. Median overall survival in the operative group was 19.1 months. Seventeen patients with non-metastatic disease (28.3 %) did not undergo resection. Median overall survival of this cohort was 3.3 months. Systemic chemotherapy was used in 8 patients. Approximately half of patients with non-metastatic disease (9/17) did not receive any treatment due to rapid physical deterioration or poor functional status at baseline. Median survival for the non-treatment group was 1.7 months. At presentation, 26 patients (43.3 %) had metastatic disease. Most common site of metastasis was the liver. Median survival for patients with metastatic disease was 3.1 months. DiscussionPASC is a distinct entity from glandular PDAC, and it appears to be a more aggressive disease process. Complete resection confers survival benefit but is not curative. Furthermore, few patients undergo surgery, even with seemingly resectable disease. Systemic therapy administration is limited in many patients due to physiologic decline. Dismal clinical course and poor survival is universal among all patients who do not undergo any treatment modality, regardless of metastatic status. Globally grim prognosis appears to be due early systemic effects, disease progression and lack of effective systemic therapy. ConclusionsPASC remains a poorly understood cancer and portends particularly poor prognosis. It is associated with a rapid clinical decline, poor response to systemic therapy, early recurrence, and poor overall survival. However, ability to treat with surgery and chemotherapy may best prolong survival. SynopsisPancreatic adenosquamous carcinoma (PASC) is a rare subtype of pancreatic cancer. In this study, we evaluated 60 patients with PASC. PASC is a systemic disease characterized by rapid clinical decline, poor response to systemic therapy, early recurrence, and poor survival. Despite resection or systemic therapy, patients succumb rapidly.

Reliability of self-measured objective functional impairment using the timed up and go test in patients with diseases of the spine.

Accurate assessment of a patient's functional status is crucial for determining the need for treatment and evaluating outcomes. Objective functional impairment (OFI) measures, alongside patient-reported outcome measures (PROMs), have been proposed for spine diseases. The Timed-Up and Go (TUG) test, typically administered by healthcare professionals, is a well-studied OFI measure. This study investigates whether patient self-measurement of TUG is similarly reliable. In a prospective, observational study, patients with spinal diseases underwent two TUG assessments: one measured by a healthcare professional and one self-measured by the patient. Interrater reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random-effects model, considered excellent between 0.75 - 1.00. Paired t-tests directly compared both measurements. The impact of variables such as age, sex, disease type, symptom severity (via PROMs), comorbidities, and frailty on reliability was also analysed. Seventy-four patients were included, with a mean age of 62.9years (SD 17.8); 29 (39.2%) were female. The majority (64.9%) were treated for degenerative disc disease. The lumbo-sacral region was most affected (71.6%), and 47.3% had previous surgeries. Patient self-measurement reliability was excellent (ICC 0.8740, p < 0.001), and the difference between healthcare professional (19.3 ± 9.4s) and patient measurements (18.4 ± 9.7s) was insignificant (p = 0.116). Interrater reliability remained high in patients > 65years (ICC 0.8584, p < 0.001), patients with ASA grades 3&4 (ICC 0.7066, p < 0.001), patients considered frail (ICC 0.8799, p < 0.001), and in patients not using any walking aid (ICC 0.8012, p < 0.001). High symptom severity still showed strong reliability (ICC 0.8279, p < 0.001 for Oswestry Disability Index > 40; ICC 0.8607, p = 0.011 for Neck Disability Index > 40). Patients with spine diseases can reliably self-measure OFI using the TUG test. The interrater reliability between self-measurements and those by healthcare professionals was excellent across all conditions. These findings could optimize patient assessments, especially in resource-limited settings.

Gait speed in older adults: exploring the impact of functional, physical and social factors

Purpose: With age there is a neuromuscular and cognitive decline that impacts on functional ability. One of the most characteristic and easily recognisable signs of this decline is a decrease in usual gait speed. For older adults, gait speed is a non-invasive indicator of health and functional status and is regarded as a vital sign. As it predicts various conditions later in life, measuring usual walking speed is crucial in the clinical setting. Therefore, analysing and determining the association between walking speed and the impact of functional and socio-economic variables may facilitate the prevention of associated health problems and the maintenance of physical function in older adults. This study aims to identify the key factors that influence walking speed in older adults, as well as to examine the influence of socio-economic status on walking speed. Methods: A total of 1253 older adults (89.5% women) with a mean age of 78.1 ± 5.8 voluntarily participated in this descriptive cross-sectional study, which examines the results of functional capacity tests and socioeconomic data in older adults. To assess physical function, SPPB tests (chair stand test, balance tests, gait speed test), manual grip strength, muscle quality index, and power were conducted, in addition to measuring body composition and socioeconomic status. Results: The final regression model showed that gait speed was significantly partially explained (R2=0.35; p&lt;0.01) by the socioeconomic environment, age, balance, and relative power. At the same time, belonging to a higher socio-economic environment is linked to lower relative power (p&lt;0.01; η2=0.07). Conclusions: Exploring the factors that affect walking speed in older adults, this study highlights that age, relative power and balance are significant determinants. These clinical markers provide crucial information for designing personalized and effective interventions to promote healthy aging. Keywords: Frailty, gait speed, elderly, relative power, socioeconomic status.

Lower adaptive immunity in invasive Egyptian geese compared to sympatric native waterfowls

Successful invasive species increase their spreading success by trading-off nutritional and metabolic resources allocated to reproduction and range expansion with other costly body functions. One proposed mechanism for the reallocation of resources is a trade-off with the immune function and the regulation of oxidative status. Relying on a panel of blood-based markers of immune function and oxidative status quantified in an invasive species (Egyptian goose) and two native competing species (mallard and mute swan) in Germany, we tested the hypothesis that the invasive species would have (i) lower investment in immune function, (ii) lower levels of oxidative damage, and (iii) no higher antioxidant defences compared to the native species. We found lower levels of adaptive immune markers (lymphocytes and immunoglobulin Y), in the invasive species compared to the two native species. Innate immune profile was generally similar between Egyptian geese and mallards. By contrast, mute swans showed higher levels of heterophils and lysozymes, and lower levels of bacteria killing ability compared to both Egyptian geese and mallards. Mute swans also showed higher levels of haemolysis and haemagglutination, but lower levels of monocytes and haematocrit compared to Egyptian geese. Reactive oxygen metabolites, a marker of oxidative damage, were higher in mallards and lower in Egyptian geese compared to the other waterfowl species, while levels of antioxidants were generally similar among the three species. Our results point to a reduced investment in adaptive immune function in the invasive species as a possible resources-saving immunological strategy due to the loss of co-evolved parasites in the new colonised habitats, as observed in a previous study. A lower investment in immune function may benefit other energy-demanding activities, such as reproduction, dispersal, and territoriality, while maintaining relatively higher innate immunity is beneficial since invasive species mainly encounter novel pathogens. Results pointed out also other important species-specific differences in baseline immune status, supporting previous findings on the relationship between species' body mass and immune profile.

Endovascular Ablation of the Greater Splanchnic Nerve in Heart Failure With Preserved Ejection Fraction

Greater splanchnic nerve ablation may improve hemodynamics in patients with heart failure and preserved ejection fraction (HFpEF). To explore the feasibility and safety of endovascular right-sided splanchnic nerve ablation for volume management (SAVM). This was a phase 2, double-blind, 1:1, sham-controlled, multicenter, randomized clinical trial conducted at 14 centers in the US and 1 center in the Republic of Georgia. Patients with HFpEF, left ventricular ejection fraction of 40% or greater, and invasively measured peak exercise pulmonary capillary wedge pressure (PCWP) of 25 mm Hg or greater were included. Study data were analyzed from May 2023 to June 2024. SAVM vs sham control procedure. The primary efficacy end point was a reduction in legs-up and exercise PCWP at 1 month. The primary safety end point was serious device- or procedure-related adverse events at 1 month. Secondary efficacy end points included HF hospitalizations, changes in exercise function and health status through 12 months, and baseline to 1-month change in resting, legs-up, and 20-W exercise PCWP. A total of 90 patients (median [range] age, 71 [47-90] years; 58 female [64.4%]) were randomized at 15 centers (44 SAVM vs 46 sham). There were no differences in adverse events between groups. The primary efficacy end point did not differ between SAVM or sham (mean between-group difference in PCWP, -0.03 mm Hg; 95% CI, -2.5 to 2.5 mm Hg; P = .95). There were also no differences in the secondary efficacy end points. There was no difference in the primary safety end point between the treatment (6.8% [3 of 44]) and sham (2.2% [1 of 46]) groups (difference, 4.6%; 95% CI, -6.1% to 15.4%; P = .36). There was no difference in the incidence of orthostatic hypotension between the treatment (11.4% [5 of 44]) and sham (6.5% [3 of 46]) groups (difference, 4.9%; 95% CI, -9.2% to 18.8%; P = .48). Results show that SAVM was safe and technically feasible, but it did not reduce exercise PCWP at 1 month or improve clinical outcomes at 12 months in a broad population of patients with HFpEF. ClinicalTrials.gov Identifier: NCT04592445.

Fluoxetine promotes the recovery of dysphagia and improves nutritional status and neurotrophic status in dysphagia patients after acute ischemic stroke.

This study aimed to investigate the effects of fluoxetine on swallowing function, neurotrophic factors, and psychological status in patients with dysphagia after acute ischemic stroke (AIS). A total of 118 patients with dysphagia after AIS who were diagnosed and treated in our hospital from July 2020 to March 2022 were selected as the study objects with 59 cases in each group. Patients in the control group underwent routine treatment and swallowing rehabilitation without fluoxetine. Patients in the study group received routine treatment, swallowing rehabilitation, and fluoxetine treatment. The quality of life was compared according to the Generic Quality of Life Inventory-74 (CQOLI-74). Patients were followed for 90 days, and the grades were compared with the Modified Rankin Scale (mRS). The total effective rate of the study group was 84.75%, which was higher than that of the control group with 62.71% (χ2 = 7.394, P < 0.05). The life quality scores of the two groups were both dramatically elevated compared to those before the treatment, and the study group had a sensibly higher life quality score than the control group (P < 0.05). The proportion of grade 4~5 in the study group was significantly lower than that in the control group (χ2 = 492, P < 0.05). The total incidence of adverse reactions in the control group was 5.08% (3/59), which was significantly lower than that in the study group with 11.86% (7/59) (χ2 = 1.748, P = 0.186). Fluoxetine has a significant effect on the treatment of dysphagia after AIS by enhancing the recovery of dysphagia and promoting the recovery of neurological function.

Targeting the CSF1/CSF1R signaling pathway: an innovative strategy for ultrasound combined with macrophage exhaustion in pancreatic cancer therapy.

Pancreatic cancer (PC) is a highly aggressive and lethal malignancy characterized by a complex tumor microenvironment (TME) and immunosuppressive features that limit the efficacy of existing treatments. This paper reviews the potential of combining ultrasound with macrophage exhaustion in the treatment of pancreatic cancer. Macrophages, particularly tumor-associated macrophages (TAMs), are crucial in pancreatic cancer progression and immune escape. Prolonged exposure to the immunosuppressive TME leads to macrophage exhaustion, reducing their anti-tumor ability and instead promoting tumor growth. The CSF1/CSF1R signaling pathway is key in macrophage recruitment and functional regulation, making it an effective target for combating macrophage exhaustion. Ultrasound technology not only plays a significant role in diagnosis and staging but also enhances therapeutic efficacy by guiding radiofrequency ablation (RFA) and percutaneous alcohol injection (PEI) in combination with immunomodulators. Additionally, ultrasound imaging can monitor the number and functional status of TAMs in real-time, providing a basis for optimizing treatment strategies. Future studies should further investigate the combined use of ultrasound and immunomodulators to refine treatment regimens, address challenges such as individual variability and long-term effects, and offer new hope for pancreatic cancer patients.

Differential response of multiple stream ecosystem processes to basin- and reach-scale drivers

Stream ecosystems are inherently dependent on their surroundings and, thus, highly vulnerable to anthropogenic impacts, which alter both their structure and functioning. Anchored in biologically-mediated processes, the response of stream ecosystem functioning to environmental conditions exhibits intricate patterns, reflecting both natural dynamics and human-induced changes. Our study aimed at determining the natural and anthropogenic drivers influencing multiple stream ecosystems processes (nutrient uptake, biomass accrual, decomposition, and ecosystem metabolism) at a regional scale. By examining 38 natural and anthropogenic variables across 63 stream reaches in Gipuzkoa (northern Iberian Peninsula), we used structural equation modeling to unravel the cascading effect of basin- and reach-scale drivers onto ecosystem process. The results reveal significant variability in ecosystem processes, with contrasting spatial patterns, suggesting that studied processes respond differently to environmental factors. Urban land-use emerged as a primary basin-scale driver, whereas reach-scale variables reflected both natural and anthropogenic influence. Nutrient uptake rates were primarily driven by nutrient concentrations in stream water, but models for biomass accrual, decomposition, and ecosystem metabolism exhibited more complex cause-effect relationships. Our findings highlight the impact of urban areas on multiple ecosystem processes and services, disproportionate when considering their small land cover. The present study emphasizes the convenience of measuring multiple ecosystem functions simultaneously to get a comprehensive diagnosis of the functional status of rivers.

Comparative analysis of the structure of the heart and blood vessels surgeries, taking into account the clinical and functional status of patients with coronary heart disease in 2015 and 2020

Relevance. In a very short period of time, surgical treatment methods have become widespread due to the expansion of indicators for performing heart surgery in patients with severe complicated forms of coronary heart disease and the use of combined surgical operations.Aim: To study changes in the clinical and functional status of patients depending on the type of surgical intervention for coronary artery disease in different time periods in the gender aspect.Material and Methods. The study was conducted retrospectively. For comparative analysis, patients with an established diagnosis of coronary heart disease who underwent surgical treatment at the Federal Center for Cardiovascular Surgery of the of the Ministry of Healthcare of the Russian Federation (Chelyabinsk) in 2015 (n = 1017) and 2020 (n = 967) were included. Of the total number of patients in 2015, there were 771 (75.8%) men and 246 (24.2%) women, in 2020 718 (74.3%) and 249(25.7%), respectively.Results. In the structure of interventions performed, there is a decrease in the number of almost all types of surgical interventions for complications of myocardial infarction, most pronounced in relation to resection of the left ventricular aneurysm, reconstruction of the left ventricle and operations in combination with mitral valve replacement. In a large percentage of cases, patients with a history of risk factors for cardiovascular diseases are referred for coronary artery bypass surgery, regardless of gender. The majority of patients had angina pectoris of the 3rd–4th functional class. However, there is a trend towards a decrease in the proportion of people with post-infarction cardiosclerosis when referred for surgery.Conclusion. Despite the significant volume and availability of practical information, the number of patients with major cardiovascular risk factors is not decreasing.

B-222 Receptor-donor CYP3A5 and CYP3A4 genotype testing in liver transplant patients and its influence in tacrolimus blood levels: a retrospective study

Abstract Background Optimal immunosupression is crucial for transplant success. In orthohepatic transplants, blood target levels of tacrolimus, when coadministred with corticoids and mycophenolic acid, are between 6 and 10 ng/mL during the first three months post-transplant. Notwithstanding, achieving tacrolimus concentrations into this range may be tough because of factors such as liver function status, age, sex, drug-drug interactions, etc. In this way, pharmacogenetic testing of CYP3A5 and CYP3A4 genes have demonstrated to be useful in tacrolimus dosing optimization. Nonetheless, there is no evidence enough for pharmacogenetic based adjusting in liver transplant, specially if receptor and graft’s genotypes differ in these loci. The aim of the present study is to find out how the receptor and donor genotypes in CYP3A5 and CYP3A4 genes affect tacrolimus pharmacokinetics. Methods Genotypic profiling of 108 receptor-donor's pairs biopsies gathered from patients who were underwent hepatic transplant from 2012 to 2019 were carried out using Taqman® OpenArray™ PGx Express 120 panel (ThermoFisher™). We focused on CYP3A5*3, *6 and *7; and CYP3A4*1B, *3 and *22 alleles. Next to pharmacogenetic testing, each patient was classified as very poor, poor, intermediate, rapid or ultrarapid metabolizer according to their own genotype, graft’s genotype or both of them. Patient’s initial dose, at seven days after treatment start and after discharge of tacrolimus and their trough concentrations (C0) were collected from their electronic health records. Tacrolimus levels were measured by affinity chrome-mediated immunoassay. C0 was normalized by weight-adjusted dosage (C/D ratio); then, median C/D ratios between different metabolic profiles were compared through Kruskal-Wallis test. Results When patients were classified based on donor’s genotype isolated or combined with receptor’s genotype, lower C/D ratios were found as metabolizer ability increases (p=0.045 for donors and p=0.027 for combined genotypes, respectively). No statistically differences were found for C/D ratios at seven days and discharge, though that differences were almost significant for donor’s genotypes (p=0.06 in both cases). Conclusions These results show that previous information about both patient’s and specially donor’s CYP genes genotype may improve initial immunosupression and avoid tacrolimus induced toxicity. Pharmacogenetics has been currently proposed as a guide for tacrolimus treatment of some solid organ transplants as kidney transplanted patients. Better understanding of how receptor and donor’s CYP genotype affects its pharmacokinetics, along with liver’s damage markers and other genetic polymorphisms will allow clinicians, in the era of personalized medicine, to improve immunosupressive management.

Comparison of Connective Tissue Massage and Classic Massage in Women With Primary Dysmenorrhea: A Randomized Clinical Trial

ObjectiveThe purpose of this study was to compare the short-term effects of connective tissue massage (CTM) and classic massage (CM) on pain, functional and emotional status, and menstrual complaints in women with primary dysmenorrhea (PD). MethodsWomen with PD were randomly assigned to 2 groups: CTM (n = 19) and CM (n = 19). CTM or CM was applied 5 days a week from the estimated date of ovulation to the onset of the next menstruation. The pain intensity with the Visual Analog Scale and functional and emotional status with the Functional and Emotional Dysmenorrhea Scale (FEDS) were assessed before and after the applications. Pain duration and the presence of menstrual complaints were recorded. ResultsIn the postintervention period, both groups had decreased menstrual pain intensity and duration, drug use, and FEDS scores (P < .001). Pain duration and FEDS-functional scores decreased more in the CTM group than in the CM group (P < .05). Moreover, in the postintervention period, fewer women were nervous in the CM group, whereas low back pain, constipation, and sleeplessness were less frequent in the CTM group, compared with their preintervention period (P < .05). A difference was observed between groups only in terms of the changes in sleeplessness between before and after intervention (P = .016). ConclusionCTM and CM improved menstrual pain and functional and emotional status, and decreased drug use. Moreover, CTM was superior in improving pain duration, functional status, and sleeplessness compared with CM in PD. CTM and CM might be useful treatment methods for PD.

Predictors of death without prior appropriate therapy in ICD recipients: the comorbidities, frailty and functional status (COMFFORT study)

ObjectiveMost patients who have an implantable cardioverter-defibrillator (ICD) implant do not receive life-prolonging therapy from it. Little research has been undertaken to determine which patients benefit the least from ICD...