Higher Age Research Articles

Heart failure with preserved ejection fraction: from echocardiographic characteristics to a cardiovascular damage score in a high-risk hypertensive population.

Heart failure with preserved ejection fraction (HFpEF) is a high prevalence condition, with high rates of hospitalization and mortality. Arterial hypertension is the main risk factor for HFpEF. Among hypertensive patients, alterations in cardiac and vascular morphology identify hypertension-mediated organ damage (HMOD). Cardiac HMOD in terms of ventricular hypertrophy and diastolic dysfunction is a continuum between the preclinical condition (arterial hypertension) and HFpEF. In hypertensive patients, it is currently unknown what is the prevalence of individuals classifiable as being at high risk of developing HFpEF and whether aortic morphofunctional vascular changes are present. This study seeks to retrospectively assess the prevalence of echocardiographic alterations consistent with the diagnosis of HFpEF in a cohort of patients with essential arterial hypertension, and the prevalence of vascular HMOD (V-HMOD) in different risk categories of patients. Hypertensive outpatients referred at the Hypertension Center of Turin from 2003 to 2021 were retrospectively evaluated. Patients with a previous diagnosis of heart failure and known cardiovascular events were excluded. A predictive model associated with the risk of HFpEF development was calculated using echocardiographic variables. V-HMOD morphological and functional parameters were assessed by ascending aorta diameter and arterial stiffness (carotid-femoral pulse wave velocity, cfPWV). Eight hundred and four patients (34.8% women) were analyzed, age 53.1 ± 14 years; left ventricular mass index (LVMi) and E/e' ratio were impaired in 15.9 and 29.1% of cases, respectively. Dividing them into tertiles according to score: score 1 or less (30.2%); score 2-3 (47.4%); score at least 3 (22.7%). Patients identified at high risk of HFpEF (score ≥3) had higher age, BMI and blood pressure than the other two groups (P < 0.05); they showed a significantly higher prevalence of female patients (42.3%), treatment with at least two antihypertensive drugs (40.1%), diabetes (7.1%), and dyslipidemia (28%; P < 0.05), with a larger ascending aorta diameter (35.5 ± 5.5 mm, P < 0.05) and higher cfPWV (8.8 ± 2.4 m/s, P < 0.05). At least one in five hypertensive patients, referred to an outpatient echocardiographic examination, has C-HMOD compatible with a high-risk category of HFpEF and have a significant increase in V-HMOD. This reinforces the notion that arterial hypertension and HFpEF are not two distinctly separate conditions but a continuum of pathophysiologic alterations.

Metabolic Syndrome as a Risk Factor Among Lebanese Patients with Substance Use Disorder Undergoing Treatment for Recovery Through Rehabilitation or Opioid Substitution Treatment.

Background/Objectives: Data about metabolic syndrome (MS) in people who use drugs (PWUD) undergoing treatment for recovery are limited. We aimed to explore the extent of the MS and its predominant components and determinants in a sample of PWUD undergoing treatment for recovery through rehabilitation or opioid substitution treatment (OST) in Lebanon. Furthermore, we investigated the effect of each treatment modality on the MS; Methods: This was a cross-sectional study, in which demographics and treatment-related, nutritional, and biochemical data of the participants were collected. MS was defined according to the American Heart Association and the National Heart, Lung, and Blood Institute (AHA/NHLBI) criteria. Descriptive statistics were presented, and bivariate and multivariate analyses were conducted; Results: A total of 155 male subjects with the following characteristics were included: OST: n = 80; rehabilitation: n = 75; mean age: 32.53 ± 8.39 years; mean body mass index (BMI): 27.41 ± 4.99 Kg/m2; mean duration of treatment: 18 months. More than half of the sample had low HDL-C (56.8%) and/or elevated blood pressure (51.6%), 42.9% had elevated WC, 21.9% had elevated TG, and 12.3% had elevated FBS. Furthermore, 7.2% of the sample had no components of the MS, 29.2% had one component, 40.9% had two components, 16.9% had three components, and 5.8% had four components. MS was identified in 22.7% of the sample. Higher age was associated with higher odds of being diagnosed with MS (OR = 1.072; 95% CI: 1.021-1.126), whereas higher duration of current treatment was associated with lower odds (OR = 0.969; 95% CI: 0.944-0.995); Conclusions: MS and its components are prevalent in PWUD undergoing treatment for recovery. Routine screening and preventive measures are essential to prevent metabolic syndrome, particularly among older people and treatment newcomers.

Semiquantitative muscle parameters derived from FAPI and FDG PET/CT in evaluating sarcopenia among patients with malignant tumors.

The objective of this study is to explore and compare the potential utility of fibroblast activation protein inhibitor (FAPI) and fluorodeoxyglucose PET/computed tomography (CT) in assessing sarcopenia among patients with malignant tumors. A retrospective analysis was conducted on 127 patients with histologically confirmed malignant tumors who underwent both 18F/68Ga-FAPI and fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT scans. Clinical characteristics and PET/CT parameters of maximum and mean standard uptake value (SUVmax and SUVmean) of muscle at the 3rd lumbar (L3) level were reviewed. Skeletal muscle area at the L3 level was measured, and skeletal muscle index was calculated to determine sarcopenia. The association between sarcopenia and PET/CT parameters was analyzed. The incidence of sarcopenia was 41.7% among these 127 patients. Higher age, male, lower BMI, lower SUVmax and SUVmean of muscle from 18F/68Ga-FAPI PET/CT, and lower SUVmax of muscle from 18F-FDG PET/CT were correlated with a higher prevalence of sarcopenia (P < 0.05). Besides, no significant differences in SUVmax and SUVmean of muscle were noted between 18F-FAPI and 68Ga-FAPI groups. The best cutoff value of SUVmax of muscle from 18F/68Ga-FAPI PET/CT was 1.17, yielding the area under the curve (AUC) of 0.764 and sensitivity and specificity of 74.3% and 71.7%, while the optimal cutoff value of SUVmax of muscle from 18F-FDG PET/CT was 0.76, with an AUC of 0.642 and sensitivity and specificity of 36.5% and 86.8%, respectively. Patients with sarcopenia exhibit decreased muscle uptake of FAPI and fluorodeoxyglucose. FAPI PET/CT emerges as a more valuable tool for sarcopenia assessment in patients with malignant tumors compared to fluorodeoxyglucose PET/CT.

Predictors of coronary atherosclerosis in middle-aged and older athletes: the MARC-2 study.

Exercise improves cardiovascular health, but high-volume high-intensity exercise is associated with increased coronary artery atherosclerosis and calcification (CAC). We aimed to identify predictors of CAC in athletes. We assessed the association of traditional and non-traditional cardiovascular risk factors with CAC using linear and logistic regression. 289 male athletes from the MARC-2 study were included, with a median age of 60 [Q1-3 56-66] years, lifelong weekly training load of 26 [17-35] MET-hours, BMI of 24.5 [22.9-26.6] kg/m2, systolic blood pressure of 139±18 mmHg, and reported 0.0 [0.0-8.0] smoking pack years. Thirty-one percent had a CAC score >100 and 13% >400. Among traditional cardiovascular risk factors, higher age, systolic blood pressure, smoking pack years, and family history of coronary artery disease independently predicted greater CAC scores, while body mass index, LDL cholesterol, and diabetes mellitus did not. Among non-traditional risk factors, higher training loads, serum phosphate, and lower adjusted energy intake and fat percentage of energy intake independently predicted greater CAC scores. The full model with all traditional and non-traditional risk factors had higher accuracy in predicting CAC>100 (ROC-AUC 0.76, 95%CI [0.70-0.82]) and CAC>400 (0.85 [0.77-0.92]) than traditional cardiovascular risk factors alone (0.72 [0.65-0.78], p=0.012, and 0.81 [0.74-0.90], p=0.038, respectively). Non-traditional risk factors, including training load, dietary patterns, and serum phosphate, were independently associated with CAC in aging male athletes. Prediction accuracy for CAC increased when including these variables in a prediction model with traditional risk factors.

Diagnostic accuracy of cancer ratio and other new parameters in differentiating malignant from benign pleural effusions.

Differentiation of malignant from benign pleural effusions is challenging in clinical practice due to limitations in the cytologic analysis. The combination of pleural fluid biomarkers has previously been used to predict malignant pleural effusion (MPE). We have conducted a prospective observational study to assess the diagnostic potential of cancer ratio [(CR) serum lactate dehydrogenase (sLDH): pleural fluid adenosine deaminase (pADA)], CR plus (CR: pleural lymphocyte count), sLDH: pleural lymphocyte count, and age: pADA in differentiating malignant effusions from benign ones. Prospective data from patients evaluated for exudative pleural effusions in the pulmonary medicine department at our institute over 12 months were collected. All subjects underwent thoracentesis, and if the results were inconclusive, they underwent invasive diagnostic testing for confirmation. They were divided into MPE and non-MPE groups for analysis. Pleural fluid biomarker ratios were calculated and compared between both groups, and receiver operating characteristic curves were generated. We included 120 subjects: 59 were diagnosed with MPE, and 61 had benign effusion (46 tubercular and 15 parapneumonic). The mean (standard deviation) age of the study population [64 (53.3%) males] was 52.4 (14.5) years. CR, CR plus, and age: pADA were significantly higher in the MPE group compared to the benign group. The sLDH: lymphocyte count was similar between both groups. Age: pADA ratio and CR performed best, with areas under the curve of 0.99 [95% confidence interval (CI), 0.97-1.0] and 0.97 (95% CI, 0.94-1.0) respectively. A higher age: pADA level was associated with a malignant etiology of effusion (adjusted odds ratio 12.27, 95% CI 2.37-63.54) on multivariate analysis. At a cut-off of 2, age: pADA ratio provided 96.6% sensitivity, 93.4% specificity, with a positive likelihood ratio of 14.7. Age: pADA and CR are promising diagnostic indices for differentiating MPE and non-MPE with high sensitivity and specificity. The diagnostic accuracy of CR plus and sLDH: lymphocyte ratio is inferior to that of CR and age: pADA.

Correlation analysis between myopia growth and physical development parameters of school-age children in Shihezi area, Xinjiang Uyghur Autonomous Region

Objective: To study the correlation between myopia growth and physical development of primary school student in Shihezi area of Xinjiang Uyghur Autonomous Region by measuring the ocular biometry and physical parameters of the eye, and to provide an objective basis for the development of myopia prevention and control. Methods: A cross-sectional study design was used. The Grade 1-6 students from 33 schools in Shihezi area were randomly selected in October 2023. The children were classified according to age into the low age group (6-9 years) and the high age group (10-13 years).The children's height, weight, axial length (AL), maximum keratometry (steepest keratometry, K1), and minimum keratometry (flattest keratometry, K1) were measured. The body mass index (BMI), keratometric astigmatism (ΔK), mean keratometry (K), corneal radius (CR) and AL/CR were calculated. Correlation analyses were performed between ocular biometry and physical parameters. LASSO regression analysis was used to screen the best variables, and linear regression models were constructed after adjusting for confounding factors of age and sex. Results: A total of 3 986 children aged 6-13 years were included in this study, including 2 094 boys (52.53%) and 1 892 girls (47.47%); 2 162 in the lower age group and 1 824 in the upper age group. Girls had higher K, ΔK and AL/CR values than boys (43.38 D vs 42.7 D, t=-7.84,P<0.01; 1.1 D vs 1.01 D, t=-2.14,P=0.03; 2.97 vs 2.96, t=3.32,P=0.02). Boys had higher AL, height, weight and BMI than girls (23.47 mm vs 23.02 mm, t=13.77,P<0.01; 1.34 m vs 1.33 m, t=3.02,P=0.03; 32 kg vs 29.5 kg, t=7.82,P<0.01; 17.4 vs 16.52, t=10.36, P<0.01). LASSO regression was used to screen the 3 physical parameter variables (height, weight, and BMI) to determine that height was the best physical parameter variable for AL/CR. After adjusting for confounders, it was shown that in the low age group (6-9 years), there was a significant positive correlation between children's height and AL/CR (b=0.174, 95%CI: 0.106 to 0.241, P<0.001), whereas in the high age group (10-13 years), there was no correlation between children's height and AL/CR (b=0.086, 95%CI:-0.038 to 0.21, P=0.174). Conclusion: There was a positive correlation between height and myopia growth in the lower age group of children in Shihezi area, Xinjiang Uyghur Autonomous Region; there was no correlation between height and myopia growth in the higher age group.

An international study of clinical, demographic, and competence-related determinants of communication with professionals.

This study aims to identify a combination of clinical, demographic, and patient competence determinants of patients' communication with doctors and nurses in an international sample of cancer patients. For our cross-sectional study, cancer patients assessed their communication with their doctors or nurses at the start of their treatment. Patients completed EORTC communication questionnaire QLQ-COMU26 to assess ten areas of communication with their doctor or nurses plus another item to assess how competent they felt when communicating with professionals. Bivariable analyses and multivariable linear regression models were performed separately for each QLQ-COMU26 area. Included in the study were 988 patients from 15 centres in 13 countries (five cultural areas). Higher age was related to higher level of communication in eight QLQ-COMU26 areas. Males reported higher level of communication in three areas. Lower levels of studies and higher level of perceived competence when communicating with professionals were related to higher level of communication in the ten QLQ-COMU26 areas. Communication was of a higher level with nurses than with doctors in four areas. Having received previous treatment with the same doctor or group of nurses was related to higher communication levels in seven areas. Lack of comorbidity was related to higher communication levels in two areas. Various differences in determinants were found among tumour sites. Our regression model has shown several relationships between communication and the demographic and clinical variables that may help identify patients at risk of poor communication. Future studies could focus on communication at diagnosis and in follow-up, and on areas such as assessing the particularities of communication between patient and professionals in relation to cancer type.

Associations Between Metabolic Age, Sociodemographic Variables, and Lifestyle Factors in Spanish Workers.

Metabolic age is defined as an estimation of a person's age based on their basal metabolic rate (BMR) and other physiological health indicators. Unlike chronological age, which simply measures the number of years lived since birth, metabolic age is based on various health and fitness markers that estimate the body's "true" biological age and can be assessed using various methodologies, including bioimpedance. The aim of this study was to evaluate how age, sex, social class, smoking habits, physical activity, and adherence to the Mediterranean diet influence metabolic age. A cross-sectional, descriptive study was conducted on 8590 Spanish workers in the Balearic Islands. A series of sociodemographic variables and health-related habits were assessed, while metabolic age was measured using bioimpedance. A metabolic age exceeding chronological age by 12 years or more was considered high. A descriptive analysis of categorical variables was performed by calculating their frequency and distribution. By applying multivariate models, specifically multinomial logistic regression, we observe that all independent variables (sex, age, social class, physical activity, mediterranean diet, and smoking) show varying levels of association with the occurrence of high metabolic age values. Among these independent variables, those showing the highest degree of association, represented by odds ratios, are physical activity, adherence to the Mediterranean diet, and social class. In all cases, the observed differences demonstrate a high level of statistical significance (p < 0.001). The factors with the greatest influence were physical inactivity, with an OR of 5.07; and low adherence to the Mediterranean diet, with an OR of 2.8; followed by social class, with an OR of 2.51. Metabolic age increased with chronological age and was higher in males, with an OR of 1.38. Smoking also had a negative impact on metabolic age, with an OR of 1.19. Mediterranean diet is associated with a higher metabolic age. The most influential factors on metabolic age are physical activity and adherence to the Mediterranean diet, followed by the individual's socioeconomic class. Smoking also contributes to increased metabolic age, albeit to a lesser extent.

Clinicopathologic Features of Breast Tumors in Germline TP53 Variant-Associated Li-Fraumeni Syndrome.

We present one of the largest cohorts of TP53-pathogenic germline variants (PGVs) associated with patients with Li-Fraumeni syndrome (n = 82) with breast tumors (19 to 76y; median age: 35). Most had missense variants (77%), followed by large gene rearrangements (LGRs; 12%), truncating (6%), and splice-site (5%) variants. Twenty-one unique germline missense variants were found, with hotspots at codons 175, 181, 245, 248, 273, 334, and 337. Of 100 total breast tumors, 63% were invasive (mostly ductal), 30% pure ductal carcinoma in situ, 4% fibroepithelial lesions, and 3% with unknown histology. Unlike BRCA-associated tumors, approximately half of the breast cancers exhibited HER2-positivity, of which ~50% showed estrogen receptor coexpression. Pathology slides were available for review for 61 tumors (44 patients), and no significant correlation between the type of TP53 PGVs and histologic features was noted. High p53 immunohistochemistry expression (>50%) was seen in 67% of tumors tested (mostly missense variant). Null pattern (<1% cells) was seen in 2 (LGR and splicing variants carriers). Surprisingly, 2 tumors from patients with an LGR and 1 tumor from a patient with a truncating variant showed p53 overexpression (>50%). The subset of patients with the Brazilian p.R337H variant presented at a higher age than those with non-p.R337H variant (46 vs 35y) though statistically insignificant (P = 0.071) due to an imbalance in the sample size, and were uniquely negative for HER2-overexpressing tumors. To conclude, breast cancer in carriers of TP53 PGVs has some unique clinicopathological features that suggest differential mechanisms of tumor formation. p53 immunohistochemistry cannot be used as a surrogate marker to identify germline TP53-mutated breast cancers.

Understanding preoperative health-related quality of life in rotator cuff tear patients: role of patients’ characteristics

BackgroundAssessing health-related quality of life (HRQoL) is a widely employed method in orthopedics to evaluate patient well-being and measure the effectiveness of surgical interventions. Understanding the relationship between specific baseline factors and preoperative HRQoL can help clinicians identify patients at risk for low quality of life and thus, develop preventive strategies that adequately address individual patient needs. The objective was to assess associations between baseline factors and preoperative HRQoL in patients undergoing arthroscopic rotator cuff repair (ARCR).MethodsThis study is part of a multicenter prospective Swiss cohort study that included patients undergoing ARCR between June 2020 and November 2021. Data were derived from baseline and surgery forms. HRQoL was assessed using the European Quality of Life 5-Dimension 5-Level (EQ-5D-5L) questionnaire to calculate EQ-5D index and EQ VAS scores. Univariable and multivariable linear regression models examined associations between the 21 factors and preoperative HRQoL. Final models were determined using stepwise backward regression.ResultsA total of 973 included patients (mean age [SD], 57.3 [9.4] years; 611 men [63%]) had a mean [SD] EQ-5D index and EQ VAS of 0.70 [0.23] and 68.7 [19.8], respectively. Being male (regression coefficient (β), 0.05; 95% CI [0.02–0.08]), having a higher age (β, 0.02; 95% CI [0.01–0.03]) and higher education levels (e.g., university, college: β, 0.11; 95% CI [0.06–0.16]) were associated with a higher EQ-5D index. Increased body mass index (β, -0.02; 95% CI [-0.04 to -0.01]) and worse sleep quality (β, -0.03; 95% CI [-0.04 to -0.03]) were associated with a lower EQ-5D index. Factors negatively associated with overall EQ VAS health were depression (e.g., moderate: β, -12.70; 95% CI [-16.18 to -9.21]), presence of at least one comorbidity (β, -3.71; 95% CI [-5.91 to -1.52]), and pain (β, -1.81; 95% CI [-2.36 to -1.26]).ConclusionOur results suggest that preoperative HRQoL is highly associated with sociodemographic and patient-related factors. Specifically addressing these factors may improve orthopedic care.

Lung function in adult patients with osteogenesis imperfecta: a cohort study

BackgroundOsteogenesis imperfecta (OI) is a rare hereditary bone disease resulting from a defect in collagen synthesis or processing, leading to bone fragility, frequent fractures and skeletal deformities. OI is associated with increased respiratory morbidity and mortality, but the mechanisms of lung involvement are poorly understood, and there are no data on the natural history of lung function. We studied lung function over time in a cohort of adult OI patients at one center.MethodsWe used data from OI patients aged 15 and above followed up at the Lausanne university hospital between 2012 and 2023 with available pre-bronchodilator spirometry. Associations between spirometric measurements at first visit and clinical characteristics were studied through linear regression. Changes of spirometric variables over time were analysed through mixed linear regression. Models were adjusted for age, sex, height and OI type (Sillence classification).ResultsAmong 46 subjects, 24% had impaired spirometry at baseline, with similar distribution between restrictive (8.7%), obstructive (8.7%) and mixed (6.5%) ventilatory patterns. At first visit, higher age was associated with lower FEV1 (β = −0.019 l, p = 0.014) and lower FEV1/FVC (β = −0.175%, p = 0.012). A history of asthma was associated with higher FEV1 (β = 0.636 l, p = 0.028) and FVC (β = 0.834 l, p = 0.010). At first visit, FEV1 (β = −0.750 l, p = 0.006) and FVC (β = −0.859 l, p = 0.004) was lower in individuals with OI Sillence types 3, 4 or 5 compared to type 1. Over a mean follow-up of 3.4 years, smokers had a greater decline of FEV1/FVC compared to non-smokers (β = −6.592%, p = 0.007). Individuals with a mutation in the gene COL1A2 had 740 ml lower FVC compared to those with a mutation in COL1A1 (p = 0.037). After adjustment for sex, age, height and OI type, FEV1 increased by 26 ml (95% CI 8; 45) or 1.28%pred (0.51; 2.05) and FVC increased by 25 ml (95% CI 8; 43) or 0.93%pred (0.31; 1.55) per year of follow-up.ConclusionsAn increase of FEV1 and FVC over time was observed in OI patients after adjustment for other variables, suggesting that the defective collagen synthesis may impact the pulmonary interstitium and lead to increased lung compliance and hyperinflation, in contrast to skeletal deformities, which reduce the thoracic volume. Lung function changes in OI thus result from the interplay of several mechanisms.

Germanic Rampart or Roman Encampment?—New Geoarchaeological Evidence at the Roman Conflict Site at Kalkriese (NW‐Germany)

ABSTRACTKalkriese, near Osnabrueck (NW Germany), is considered the location of the ‘Battle of Varus’, where a coalition of Germanic tribes, under the leadership of Arminius, defeated three Legions under the command of Varus in 9 ad. Roman coinage and remains of military equipment prove that the Oberesch site at Kalkriese saw military operations between Germanic tribes and the Roman legions during Early Imperial times, but the sequence and magnitude of the military operations still remain unclear. In this study, we present for the first time absolute dates from the Oberesch site to decipher the general sequence of the Holocene landscape development at Kalkriese, identify the antique surface, and evaluate the ‘Germanic Rampart Theory’ and the ‘Roman Encampment Theory’. The geoprofile encompasses the entire stratigraphic sequence from the Pleistocene base, indicating intensive agricultural use of the area since the Early Neolithic. A fossil topsoil of late Pre‐Roman Iron Age to Roman Imperial Age was identified, which probably represents the antique surface of the Roman conflict site. Our results do not support either the ‘Germanic Rampart Theory’ or the ‘Roman Encampment Theory’, as both linear structures seem to be of High Middle Age origin.

A Study on How Age Sensitivity Moderates the Learning of New Health Behaviors via Social Media Platforms

The objective of this study was to analyze the moderation effect of Age Sensitivity on the relationship between Cognitive Factors and Self-Regulation of social media users in learning new health behaviors via social media platforms in Sub-Sahara Africa.The study adopted a cross-sectional research design where data were collected and analyzed at one point in time. In line with the requirements of cross-sectional design, quantitative research methods were used to collect, analyze and present the findings. Data were analyzed using descriptive statistics, regressions, modegraphs, and confirmatory analysis in structural equation modelling.Results reveal that the moderation effect of Age Sensitivity is high. Inversely, the moderation effect is low when Age Sensitivity is low. Therefore, high Age Sensitivity will influence Cognitive Factors to create high Self-Regulation of social media users in learning new health behaviors via social media platforms in Sub-Sahara Africa. We learn that individuals with strong beliefs become more self-regulated once they become age-sensitive.Given that Self-Regulation positively influences health behavior, we are confident that the moderation effect of Age Sensitivity in the relationship between Cognitive Factors and Self-Regulation results in positive learning. Therefore, it is important for social media developers to enhance the knowledge of their users. At the same time, they should be mindful of users’ beliefs and ages when packaging health-related content. This will promote information acceptance and consumption, thereby helping to change the Health Behaviors of social media users positively.

Medieval Foundations for the Development of the Modern Slovenian Nation and National Identity

Although the Slovenian nation did not exist in the Middle Ages, it was this nearly thousand-year-long period that witnessed the gradual formation of certain foundations for its subsequent development. Among these was, first and foremost, the geographical area of the Slovenian linguistic community which was formed once the state border was settled between the Holy Roman Empire and the Kingdom of Hungary and once the systematic medieval colonization came to an end. These two processes were also closely linked to the genesis of the Slovenian language, which dates back to the High Middle Ages. However, still older roots pertain to Christianity, the adoption of which brought about profound religious and social changes, coupled with political and cultural affiliation of Slovenian territory to the European West. The article focuses on presenting the above-mentioned three foundations and their part in the formation of the modern Slovenian nation and national identity.

Is Whole-Brain Radiotherapy for Brain Metastases an Overestimated Therapy? A Retrospective Study of Real-World Data Using Landmark Analyses.

The role of whole-brain radiotherapy for patients with brain metastases is changing as immunotherapy and molecularly targeted therapies advance. However, whole-brain radiotherapy continues to be part of the multimodal concept. This retrospective study included 285 patients who received whole-brain radiotherapy for brain metastases, using a median dose of 30 Gy. The study analyzed prognostic factors for survival using Cox regression analyses, while two landmark analyses, reflecting a minimum survival of 60 and 90 days, accounted for early deaths. Neurological symptoms were compared before and after treatment using the McNemar test. The median patient age was 62 years. Non-small cell lung cancer (n = 95), breast cancer (n = 53), and small cell lung cancer (n = 48) were the most frequent cancer types. Median survival was 4.3 months (interquartile range 1.8-11.1). In the multivariable Cox regression model, patients who received additional immunotherapy/molecularly targeted therapy had a higher chance of survival than others. Overall survival was influenced by control of primary cancer, extracranial metastases, age, Karnofsky performance status, and number of brain metastases. The 90-day landmark analysis included 181 patients who survived at least 90 days, reflecting that 104 patients (36.5%) died within the first 90 days. The 90-day landmark analysis confirmed all predictive variables for survival. Patients who died before the 90-day landmark endpoint had more brain metastases, lower Karnofsky performance status, higher age, and were less frequently treated with immunotherapy/molecularly targeted therapy than those surviving at least 90 days. The treatment significantly improved neurological symptoms. These results indicate an insufficient patient selection, as one-third of patients treated with whole-brain radiotherapy died within 90 days. However, neurological symptoms improved, and the addition of immunotherapy and/or molecularly targeted therapy to whole-brain radiotherapy was associated with better survival. Patients receiving whole-brain irradiation should be more carefully selected. ClinicalTrials: 24-3626-104.

Vitamin D3 Exerts a Neuroprotective Effect in Metabolic Syndrome Rats: Role of BDNF/TRKB/Akt/GS3Kβ Pathway.

Metabolic syndrome (MetS) is usually associated with cognitive impairment, neuropathic pain, and reduced brain-derived neurotrophic factor (BDNF) levels. BDNF via tropomyosin receptor kinase B (TrkB) exerts neuroprotection by activating protein kinase B (Akt) to inhibit glycogen synthase kinase-3β (GSK3β). Although Vitamin D3 (VitD3) has demonstrated favorable metabolic and neuronal outcomes in MetS, the precise molecular mechanisms underlying its neuroprotective effects remain poorly elucidated. We aimed to test the hypothesis that VitD3 mitigates MetS-induced cognition deficits and neuropathic pain via modulating the BDNF/TRKB/Akt/GS3Kβ signaling pathway. MetS was induced in male rats by 10% fructose-supplemented water and 3% salt-enriched diet. After 6 weeks, normal and MetS rats received either vehicle or VitD3 (10 µg/kg/day) for an additional 6 weeks. Glycemic status, lipid profile, and behavioral changes were assessed. The advanced glycation end products (AGEs), and markers of inflammation (TNF-α and NF-κB), oxidative stress (malondialdehyde), and apoptosis (caspase3), as well as BDNF, TrkB, PI3K, Akt, GSK3β, phosphorylated tau, and amyloid beta (Aβ) were assessed in the cerebral cortex. MetS rats had deteriorated glycemic and lipid profiles, higher AGEs, reduced levels of BDNF, TrkB, PI3K, and active Akt, along with increased GSK3β levels, inflammation, oxidative stress, and apoptosis. These changes were associated with higher levels of cognitive impairment markers phosphorylated tau and Aβ, as well as behavioral changes indicative of cognitive impairment and neuropathic pain. VitD3 improved the cognitive and behavioral alterations, while mitigating the associated molecular derangements. Our results indicate that VitD3 may exert neuroprotective effects by modulating the BDNF/TrkB/PI3K/Akt/GSK3β signaling pathway.

Preoperative Ultrasonographic Assessment of the Gastric Antrum in Diabetic Patients Before Elective Surgery: A Prospective Observational Comparative Cohort Study.

Diabetic patients may have neuropathy-induced gastroparesis predisposing them to aspiration. Point-of-care gastric ultrasonography (GUSG) is useful in the qualitative assessment of the antrum and quantitative prediction of gastric volume (GV) in diabetic patients. In this study, we compared the GUSG findings between fasting diabetic and non-diabetic patients in the elective preoperative setting. A total of 220 patients were included in the study with 110 diabetic patients in the diabetes mellitus (DM) group and 110 non-diabetic patients in the non-diabetes mellitus (NDM) group. GUSG was performed in supine and right lateral decubitus (RLD) positions and qualitative grading was done. An empty antrum in both supine and RLD positions was graded 0. Fluid present in the RLD position but empty in the supine position was graded 1. The presence of solids or fluid in both supine and RLD positions was graded 2. Quantitative assessment was done by calculating the estimated GV using the measured cross-sectional area (CSA). The presence of grade 2 antrum or solids or GV >0.8 mL/kg was considered as criteria for a 'high-risk' antrum. Grade 2 antrum was found in 18% of patients in the diabetic group compared to 3% in the non-diabetic group. Mean CSA (5.65 cm2)and mean GV (34.52 mL) were significantly higher in diabetic patients. Forty-one (37.2%) patients among the diabetic patients had a high-riskantrum and a potentially higher risk of aspiration when compared to non-diabetic patients. Higher age and female gender were found to be associated with the incidence of 'high-risk' antrum in the univariate logistic regression model. Diabetic patients have a higher incidence of grade 2 antrum, and higher CSAand GV, when compared to non-diabetic patients. Risk factors such as female gender and increasing age are associated with thehigh-riskantrum incidence.Further studies where objective tests are done to identify the presence of diabetic autonomic neuropathy might help determine the relationship between GUSG and aspiration risk.

Combination Therapy with Korean Medicine and Filgrastim on Neutropenia: A Retrospective Study

Objectives: Neutropenia is a complication due to chemotherapy or radiotherapy that can limit clinical outcomes. Previous systematic reviews and meta-analysis have suggested that traditional Asian medicine may relieve neutropenia. This study investigated the effect of the combination therapy of Korean Medicine (KM) and filgrastim on neutropenia.Methods: A total of 336 subjects were included, with 167 in the only filgrastim treatment group and 169 in the filgrastim with KM treatment group. Absolute neutrophil count (ANC) was calculated by multiplying the white blood cell count by the total percentage of neutrophils. ANC was observed on the day of filgrastim and up to 6 days with hospital medical records.Results: The clinical characteristics of the participants in the filgrastim with KM treatment group tended to have higher age. Comparing the two groups, by the linear mixed-effects model, ANC mean was significantly different on the 3rd day. A linear mixed effect model was performed to estimate difference in slope of ANC over time after treatment between the two groups. The slope difference was significant in neutropenia grade 3 patients. The mean of ANC increment after initial treatment tends to increase with the number of days of KM treatment but not statistically significant. During the follow-up period, the average blood levels of patients in the filgrastim with KM treatment group were within the normal range.Conclusions: The combination treatment with filgrastim and KM can be effective for patients with neutropenia.

Pengaruh Senam Ergonomis terhadap Tingkat Kemandirian Activity of Daily Living pada Lansia

Background: Aging is a natural process in the elderly which causes changes in health, physical, mental and social. This will have an impact on the independence of the elderly in their Activities of Daily Living (ADL). Activity of Daily Living (ADL) is a form of measuring a person's ability to carry out daily activities independently. One important measure of morbidity (unwell condition) is a person's ability to perform ADLs. Ergonomic exercise is an effort to address the problem of elderly independence in carrying out daily activities independently. Objectives: The purpose of this study was to determine the effect of ergonomic gymnastics on the level of independence in the Activity of Daily Living in the elderly in Balak Village, Cawas District, Klaten Regency. Methods: This research is a quantitative research with a one group pre- test post-test design. Ergonomic gymnastics was carried out as many as 12 sessions in 8 weeks. This research sampling method uses a purposive sampling technique of 30 samples. The research instrument used is Functional Independence Measurement (FIM). Data analysis using SPSS version 25 with statistical Wilcoxon test technique. Results: Based on the results of data analysis, the sample is dominated by men (60%). The education level of respondents is mostly elementary school (66.7%). The highest age is at 60 – 74 years (83.3%). The majority of respondents lived with their families (86.7%). The status of couples is dominated by those who have a partner (76.7%). BMI is dominated by those with normal weight (46.7%). The results of the study averaged the level of independence of the elderly before the intervention was 105.1 and after the intervention of ergonomic gymnastics became 114.4 which means there was an increase. Wilcoxon test results obtained a p-value of 0.000. Conclusion: Ergonomic gymnastics affect the level of independence in the Activity of Daily Living for the erderly in Balak Village, Cawas District, Klaten Regency. Keywords: Ergonomic Gymnastics, level of independence, Elderly.

A multi-frequency, multi-epoch radio continuum study of the Arches cluster with the Very Large Array

Context. The Arches cluster, one of the most massive clusters in the Milky Way, is located about 30 pc in projection from the central massive black hole Sagittarius A* at a distance of ≈8 kpc from Earth. With its high mass, young age, and location in the Galaxy’s most extreme star forming environment, the Arches is an extraordinary laboratory for studying massive stars and clusters. Aims. Our objective is to improve our knowledge of the properties of massive stars and the Arches cluster through high-angular-resolution radio continuum studies. Methods. We observed the Arches cluster with the Karl G. Jansky Very Large Array in the C- and X-bands (central frequencies of 6 and 10 GHz respectively) in two epochs at C-band and five epochs at X-band throughout 2016, 2018, and 2022, covering time spans ranging from 22 days to 6 years. We used the A-configuration to achieve the highest possible angular resolution and cross-matched the detected point-sources with stars detected in the infrared, using proper motion catalogues to ensure cluster membership. Results. We report the most extensive radio point-source catalogue of the cluster to date, with a total of 25 radio detections (7 more than the most recent study). We also created the deepest (2.5 μJy in X-band) images of the cluster so far in the 4 to 12 GHz frequency range. Most of our stellar radio sources (12 out of 18) show a positive spectral index, indicating that the dominant emission process is free-free thermal radiation, which probably originates from stellar winds. We find that radio variability is more frequent than what was inferred from previous observations, and affects up to 60% of the sources associated with bright stellar counterparts, with two of them, F18 and F26, showing extreme flux variability. We propose four of our detections (F6, F18, F19, and F26) as primary candidates for colliding-wind binaries (CWBs) based on their consistent flat-to-negative spectral index. We classify F7, F9, F12, F14, and F55 as CWB binary candidates based on their high flux and/or spectral index variability, and X-ray counterparts. Thus, we infer a 14/23 ≈ 61% multiplicity fraction for the radio stars of the Arches cluster when combining our findings with recent infrared radial velocity studies.