Intermediate Category Research Articles

Assessing quality of life in pulmonary arterial hypertension: An independent prognostic marker.

Pulmonary arterial hypertension (PAH, or PH Group 1), a disease of aberrant pulmonary vascular remodeling, causing progressive right heart failure (RHF) due to elevation of pulmonary vascular resistance (PVR). Patient mortality risk stratification guides choice and intensity of pharmacological intervention and is assessed by haemodynamics (especially PVR) as well as noninvasive tools including WHO functional class (FC), 6-min walk distance (6MWD), and NT-proBNP levels. Quality of life (QOL) assessment is acknowledged as a central aspect of patient-centered care, but our study sought to extend QOL's role as an additional noninvasive risk marker that could further refine risk stratification and hence therapeutic choices within a "treatment to target" paradigm (aiming to achieve low-risk status). This study found that QOL assessment using the PAH-SYMPACT© physical activity tool provided enhanced, independent mortality risk information, with one unit rise in this score associated with a 41% increase in likelihood risk (odds ratio 1.41, 95% confidence interval: 1.01-1.98 (p < 0.05)) of falling within intermediate versus low-group category. We therefore found further support for additional prognostic value being conferred by measurement of QOL as part of routine PAH evaluation, reinforcing its critical role.

A Case Report of Superficial Solitary Fibrous Tumor in the Right Parotideomasseteric Region.

Solitary fibrous tumors (SFTs) are rare mesenchymal tumors that occur in various soft tissues and organs throughout the body. Superficial SFTs in the head and neck region are uncommon and reports of such cases are limited. An elderly Japanese woman in her 80s presented to our clinic with a smooth mass in the right parotideomasseteric region. Ultrasonography and magnetic resonance imaging revealed a well-defined subcutaneous mass measuring 20 mm. For a definitive diagnosis and treatment, surgical resection was performed under local anesthesia. Intraoperatively, a brown-colored tumor was identified beneath the skin, without surrounding tissue adhesion, and was completely excised. Immunohistochemistry, revealing the expression of STAT6, confirmed the diagnosis of SFT. Based on the SFT risk classification, this case was classified into the low-risk group, and no recurrence occurred during the 4 year postoperative period. According to the 2020 World Health Organization Classification of Soft Tissue Tumors, SFTs belong to the intermediate category with recurrence potential. In previous studies, cases of positive margins and recurrence have been reported in superficial SFTs, and SFTs may show benign features on clinical presentation but require precise surgical manipulation. Therefore, it is crucial for otolaryngologists to gain a comprehensive understanding of this tumor for appropriate treatment.

Abstract 5829: Elucidating the significance of amphiregulin and its implications for EGFR inhibition strategies in LKB1-mutant NSCLC

Abstract LKB1-mutant non-small cell lung cancer (NSCLC) is aggressive and treatment-refractory, underscoring the need for new therapeutic strategies. Our comparative study involving mouse lung tumors driven by oncogenic KrasG12D and LKB1 loss as well as tumors driven solely by KrasG12D, revealed that LKB1 loss upregulated amphiregulin (Areg), a pro-growth EGFR ligand. Therefore, this study investigates how the inactivation of LKB1 enhances AREG expression, the significance of elevated AREG in sustaining lung cancer growth, and the responses of AREG-high lung cancer to EGFR inhibitors. We first evaluated the potential clinical significance of AREG using The Cancer Genome Atlas (TCGA) lung adenocarcinoma dataset and the Cancer Cell Line Encyclopedia (CCLE) database. We observed that LKB1-null tumors with high AREG levels were associated with shorter patient survival and exhibited transcriptional signatures similar to EGFR-mutant tumors. High AREG expression also correlated positively in NSCLC cell lines with LKB1 mutations and Western blot analysis confirmed that elevated AREG levels in lung cancer cells were associated with constitutive EGFR signaling. We next explored the impact of LKB1 loss on AREG expression in lung cancer. Our prior RNA-seq and ChIP-seq investigations demonstrated CRTC2 and CREB enrichment on the AREG promoter in LKB1-null lung cancer cells. Upon LKB1 reintroduction, the enrichment diminished, indicating that CRTC-CREB transcriptionally induces AREG in LKB1-null lung cancer. To corroborate, reintroducing LKB1 or expressing a dominant-negative construct (dnCRTC), disrupting CREB/CRTC interaction, decreased AREG levels, as confirmed by RT-qPCR in LKB1-null lung cancer cells. This supports that AREG is a direct target of CRTC-CREB activation induced by LKB1 loss. To assess the impact of elevated AREG in LKB1-mutant lung cancer growth, we used RNA interference and antibodies to inhibit AREG. Both interventions decreased cell growth and colony formation, underscoring AREG is critical for LKB1-mutant lung cancer growth. Moreover, we investigated the potential correlation between AREG and the response to the EGFR tyrosine-kinase inhibitor Erlotinib in NSCLC cell lines, utilizing AREG expression data from CCLE and Erlotinib response data from the Genomics of Drug Sensitivity in Cancer (CDSC) databases. Stratifying NSCLC cell lines into sensitive, intermediate, and resistant categories revealed a potential positive association between AREG expression and Erlotinib sensitivity. Notably, LKB1-null lung cell lines with high AREG expression demonstrated heightened sensitivity compared to those with low AREG expression. Our study revealed that LKB1 loss increases AREG, triggering aberrant EGFR signaling critical for lung cancer growth, and AREG expression might impact the Erlotinib response in LKB1-inactive cells. Citation Format: Xzaviar Kaymar Solone, Xin Zhou, Mu Yu, Jennifer W. Li, Finn Rimay, Frederic Kaye, Lizi Wu. Elucidating the significance of amphiregulin and its implications for EGFR inhibition strategies in LKB1-mutant NSCLC [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5829.

Abstract 61: Differential Associations of Cardiovascular Health Factors With Vascular Health in Adults Free of Cardiovascular Disease

Background: There is limited understanding of the association of the AHA's Life's Essential 8 (LE8), reflecting cardiovascular health (CVH) behaviors and factors, with vascular stiffness and hemodynamics in adults without cardiovascular diseases (CVD). Methods: In 2330 Framingham Heart Study Offspring participants (Exam 7, 1998-2002) with applanation tonometry and LE8 data (diet, physical activity, smoking, sleep health, BMI, lipids, glucose, blood pressure), we calculated CVH scores per AHA guidelines. In multivariable linear regression analyses adjusting for CV risk factors, we analyzed LE8 as a predictor of vascular health, assessed by carotid femoral pulse wave velocity (PWV) and central pulse pressure (CPP). We examined for effect modification by age (dichotomized at median) and sex in the associations between LE8 and arterial stiffness. We set p=0.05 and p=0.10 as thresholds for significance in primary and secondary analyses, respectively. Mediation analysis was utilized to discern the indirect effects of PWV and CPP on the relationship between LE8 and both all-cause and CVD mortality. Results: In our sample (60±9 years; 57% women; LE8 = 69±12), higher LE8 indicating better CVH, was associated with lower PWV and CPP (Table). Age and sex interactions were noted for PWV (p=0.01 and 0.07, respectively). Higher LE8 was associated with lower PWV in adults ≥59 years and women but not in &lt;59 years or men (Table). With low CVH category as referent, intermediate CVH category had no significant association with PWV and high CVH category had lower PWV. CPP was lower in the intermediate and high CVH categories compared to low CVH category (Table). PWV mediated 19% and CPP 10% of the association between LE8 and CVD mortality and 17% and 15%, respectively, for all-cause mortality. Conclusion: In our community cohort, we observed age and sex differences in the relationship between CVH and vascular health. Mediation analyses revealed indirect effects on mortality, warranting further study. Table

Is the National Early Warning Score able to identify nursing activity load? A prospective observational study

BackgroundThe National Early Warning Score scale correlates well with the intensity of the patient's acute condition. It could also correlate with the nursing activity load and prove useful in defining and redistributing nursing resources based on the acuity of patients. AimTo assess whether patients' National Early Warning Score at hospital admission correlates with objective nursing demands and can be used to optimize the distribution of available care resources. MethodsThis single-center prospective study included patients admitted to the Department of Internal Medicine at the Civil Hospital in Altovicentino (Italy) between September 1 and December 31, 2022. Nursing activities were recorded for the first three days after admission and standardized to the daily mean as performance/5 min/patient/day. Linear regression was used to assess the correlation between nursing demands for different National Early Warning Scores. ResultsThis study included 333 patients. Their mean National Early Warning Score was 3.9 (standard deviation: 2.9), with 61 % (203/333) in the National Early Warning Score <5 category, 19.5 % (65/333) in the National Early Warning Score 5–6 category, and 19.5 % (65/333) in the National Early Warning Score >6 category. Their average daily care requirements increased from 22 (16–30) activities/5 min/patient/day in the low National Early Warning Score category to 30 (20–39) activities/5 min/patient/day in the intermediate National Early Warning Score category (p < 0.001) and 35 (23–45) activities/5 min/patient/day in the high National Early Warning Score category (p < 0.001). ConclusionThe National Early Warning Score correlates with nursing care activities for patients with an acute condition and can be used to optimize the distribution of available care resources.

Comparison of body mass index and fat mass index to classify body composition in adolescents—The EVA4YOU study

The objectives of this study were to develop age- and sex-specific reference percentiles for fat mass index (FMI) and fat-free mass index (FFMI) in adolescents aged 14 to 19 years and to determine differences in overweight/obesity classification by FMI and body mass index (BMI). The EVA4YOU study is a single-center cross-sectional study conducted in western Austria. Cardiovascular risks including anthropometric measurements and bioelectrical impedance analysis were assessed in adolescents (mean age 17 years). FMI and FFMI were calculated as the ratio of fat mass (FM) and fat-free mass (FFM) to the square of height and compared to study population–specific BMI percentiles. One thousand four hundred twenty-two adolescents were included in the analysis. Girls had a significantly higher mean FM and FMI and a significantly lower mean FFM, FFMI (p < 0.001, each), and mean BMI (p = 0.020) than boys. Body composition classification by FMI and BMI percentiles shows a concordance for the < 75th and > 97th percentile, but a significant difference in percentile rank classifications between these two cut-off values (all p < 0.05). Based on FMI, 15.5% (221/1422) of the whole population and 29.4% (92/313) of those between the 75th and 97th percentiles are classified one category higher or lower than those assigned by BMI. Conclusion: Classification of normal or pathologic body composition based on BMI and FMI shows good accordance in the clearly normal or pathologic range. In an intermediate range, FMI reclassifies categories based on BMI in more than a quarter of adolescents. Cut-off values to differentiate normal from pathologic FMI values on a biological basis are needed.Trial registration: The study is registered at www.clinicaltrials.gov (Identifier: NCT04598685; Date of registration: October 22, 2020).What is Known:• Chronic non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with major risk factors including unhealthy diets, harmful behaviors, and obesity. Obesity in children and adolescents is a key risk factor for later NCDs, which is commonly measured by Body Mass Index (BMI).• BMI can be misleading as it doesn't distinguish between fat mass (FM) and fat-free mass (FFM), leading to potential misclassification of obesity in children. Previous studies have already suggested the use of the Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI) as a more accurate measures of body composition.What is New:• This study adds the first age- and sex-specific reference values for FMI and FFMI in Austrian adolescents using bioelectrical impedance analysis (BIA) as a safe and secure measurement method of a large representative cohort.• We found percentile misclassification between BMI and FMI when categorizing for obesity, especially in intermediate categories of body composition. Furthermore, when comparing the new reference values for FMI and FFMI to existing ones from the US, UK, and Germany we could show a good alignment within the European cohorts and major differences with American values, indicating and confirming the difference of FMI and FFMI for different populations of different ethnical background, living on different continents.

Impact of fine-needle aspiration cytology in thyroidectomy extent and associated surgical morbidity in thyroid cancer

PurposeTo assess the impact of fine-needle aspiration cytology (FNAC) in the extent of surgery in patients with thyroid cancer (TC) and the associated surgical morbidity in primary and completion setting.MethodsA Swedish nationwide cohort of patients having surgery for TC (n = 2519) from the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal surgery between 2004 and 2013 was obtained. Data was validated through scrutinizing FNAC and histology reports.ResultsAmong the 2519 cases operated for TC, the diagnosis was substantiated and validated through the histology report in 2332 cases (92.6%). Among these, 1679 patients (72%) were female, and the median age at TC diagnosis was 52.3 years (range 18–94.6). Less than total thyroidectomy (LTT) was undertaken in 944 whereas total thyroidectomy (TT) in 1388 cases. The intermediate FNAC categories of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/ FLUS), as well as suspicion for follicular neoplasm (SFN) lesions were more often encountered in LTT (n = 314, 33.3%) than TT (n = 63, 4.6%), whereas FNACs suspicion for malignancy and/or malignancy were overrepresented in TT (n = 963, 69.4%). Completion thyroidectomies were undertaken in 553 patients out of 944 that initially had LTT. In 201 cases with cancer lesions > 1 cm, other than FTC (Follicular TC)/ HTC (Hürthle cell TC) subjected to primary LTT, inadequate procedures were undertaken in 81 due to absent, Bethesda I or II FNAC categories, preoperatively. Complications at completion of surgery in this particular setting were 0.5% for RLN palsy (n = 1) and 1% (n = 2) for hypoparathyroidism 6 months postoperatively. The overall postoperative complication rate was higher in primary TT vs. LTT for RLN palsy (4.8% [n = 67] vs. 2.4% [n = 23]; p = 0.003) and permanent hypoparathyroidism (6.8% [n = 95] vs. 0.8% [n = 8]; p < 0.0001).ConclusionsFNAC results appear to affect surgical planning in TC as intermediate FNAC categories lead more often to LTT. Overall, inadequate procedures necessitating completion surgery are encountered in up to 15% of TC patients subjected to LTT due to absent, inconclusive, or misleading FNAC, preoperatively. However, completion of thyroidectomy in this setting did not yield significant surgical morbidity. Primary LTT is a safer primary approach compared to TT in respect of RLN palsy and permanent hypoparathyroidism complication rates; therefore, primary TT should probably be reserved for lesions > 1 cm or even larger with suspicion for malignancy or malignant FNAC.

Lumbar clear cell meningioma mimicking schwannoma 7 years after resection of the same type of intracranial tumor: a case report

BackgroundMeningioma is the second most common intradural extramedullary tumor, following schwannoma. Meningioma is primarily categorized as benign World Health Organization grade 1, but clear cell meningioma is grade 2 of the intermediate malignant category. Clear cell meningiomas are rare, accounting for less than 1% of all meningioma tumors. There is no previous report of multiple intraspinal clear cell meningiomas without dural attachment.Case presentationA 27-year-old Asian male patient presented with lower right extremity pain, and had undergone tumor resection for intracranial clear cell meningioma 7 years previously, with re-resection and radiotherapy for local tumor recurrence at our hospital’s department of neurosurgery being carried out 4 years previously. No recurrence was observed since then. Preoperative lumbar magnetic resonance imaging showed two tumors at the L1 and L4 levels, both mimicking schwannoma with well-defined margins, no dural tail sign and homogeneous internal contrast. Intraoperative findings on tumor resection showed two tumors contiguous with the right L2 and L5 roots, which were not attached to the dura mater, similar to a schwannoma. After gross total resection, the postoperative pathology revealed no nuclear SMARCE1 antibody staining. The patient was diagnosed with clear cell meningioma. The patient’s postoperative course went well, with no symptoms of nerve dropout and no recurrence 2 years after surgery. In this case, both lumbar lesions were well demarcated and spherical in shape, occurring with single roots. Tumor characteristics suggested a primary rather than a metastatic lesion. Clear cell meningioma is characterized by a SMARCE1 mutation and is different from other types of meningiomas.ConclusionTo the best of our knowledge, this is the first report of multiple intraspinal clear cell meningiomas without dural attachment at the lumbar spine after resection of intracranial clear cell meningioma. We speculate that the two tumors were de novo lesions on the basis of the features of the tumors, although they were detected 7 years after the resection of intracranial clear cell meningioma.

Association of ideal cardiovascular health metrics with incident low estimated glomerular filtration rate: More than a decade follow-up in the Tehran Lipid and Glucose Study (TLGS).

To evaluate the association between ideal cardiovascular health metrics (ICVHM) and incident low estimated glomerular filtration rate (eGFR) among the Iranian population. The study population included 6927 Iranian adults aged 20-65 years (2942 male) without prevalent low eGFR [i.e., eGFR < 60 ml/min/1.73 m2] and free of cardiovascular disease. The ICVHM was defined according to the 2010 American Heart Association. The multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratios (HRs) of ICVHM both as continuous and categorical variables. Over the median of 12.1 years of follow-up, we found 1259 incident cases of low eGFR among the study population. In this population, ideal and intermediate categories of body mass index (BMI) and blood pressure (BP) and only the ideal category of fasting plasma glucose (FPG) significantly decreased the risk of developing low eGFR; the corresponding HRs and (95% confidence intervals) were (0.87, 0.77-0.99), (0.84, 0.76-0.99), (0.79, 0.68-0.93), (0.70, 0.60-0.83) and (0.76, 0.64-0.91). Also, one additional ICVHM was associated with a reduced risk of low eGFR for the global (0.92, 0.88-0.97) and biological cardiovascular health (0.88, 0.82-0.93) in these participants. A sensitivity analysis using the interval-censoring approach demonstrated that our method is robust, and results remained essentially unchanged. In a subgroup population with dietary data (n = 2285), we did not find the beneficial impact of having intermediate/ideal categories of nutrition status compared to its poor one on incident low eGFR. We found a strong inverse association between having higher global ICVHM with incident low eGFR among the non-elderly Iranian population; the issue is mainly attributable to normal BP, BMI, and FPG levels.

PENINGKATAN PERSEPSI RESIKO MELALUI PENYULUHAN KESELAMATAN BERKENDARA PADA SISWA SMA MATER DEI PAMULANG TANGERANG SELATAN

Traffic accidents are one of the causes of death in adolescence and the cause of most pain in the world, especially in developing countries such as Indonesia. Risk perception is one of the important factors in developing safety behaviour. These sessions aimed to improve the perception of safety risk remains low drive that was originally to be better. Risk perception is assessed by the psychometric paradigm. The study was conducted on 150 students in September 2023 using a cross-sectional design, the primary data in the form of a questionnaire and supporting data in the form of interviews. The parameters used are Likert scale numbers 1-4. The results showed that before the activity, the perception of the students had been quite good (intermediate category) but there is still a need for improvement. Dimensions voluntariness is perceived as high compared with 8 other dimensions, meaning that students are willing to accept all the risks that exist while driving. Having conducted outreach activities increased scores on each dimension, and there are changes in the highest score on the dimensions of knowledge. Creating safety cultured behaviour then takes a strong commitment from students related to road safety, training, and dissemination of information about the applicable safety and participation of the whole society to always prioritize safety.

Tingkat Kebugaran Jasmani Adaptif Anak Berkebutuhan Khusus

Adaptive physical fitness is a specialized method aimed at addressing challenges in the psychomotor domain specifically for children with exceptional needs. Special schools (SLB) are the designated locations for providing adapted physical education, alongside inclusive schools. This research was carried out in a specialized school (SLB) in West Lombok. The observations revealed that the school had never administered an adaptive physical fitness test for children with special needs. In addition, the participants in this study consisted of 20 children with special needs (ABK) who had hearing impairments, physical disabilities, and mental disabilities. Specifically, there were 17 males and 13 girls. This study will employ the Euro fit exam, encompassing the Bent arm hang test, the sit and reach test, the 50-meter running test, the Flamingo balance test, and the Harvard step test. The majority of children with special needs at SLB Negeri 1 Lombok Barat had a low level of adaptive physical fitness, with 40% (12 children) falling into the "less" group. 60% (18 children) fall into the "moderate" category, while none of the children fall into the "good" category. These findings indicate that 60% of the children with special needs in the school fall into the intermediate category of physical fitness, which corresponds to a total of 18 children.

Toefl Preparation Class in Non EFL Classroom: How is it Impactful on The Non-EFL Learners’ Achievement?

Having problem of reaching the tested aspects of TOEFL particularly on achieving target score of TOEFL set, participants needed to be provided an intervention with TOEFL preparation class before encountering the test. For that reason, this community service activity highlighted the impact of TOEFL preparation class on the non EFL learners’ achievement. One class was used as the sample of this activity in which it consisted of twenty students coming from different major in one of private universities in Palembang, southern region of sumatera. Descriptive analysis with experimental design was used. A test was administered to see whether or not there was a significant improvement on the non EFL learners’ TOEFL-like score achievement. The results revealed that achievement level of the participants were in the elementary and intermediate category. Besides, statistically there was a significant improvement on the EFL learners’ TOEFL-like score intervened by the provision of TOEFL preparation class. Thus, it could be further concluded that TOEFL preparation class was impactful on the non EFL undergaduates’ English achievement. Keywords: TOEFL preparation class; Non EFL Classroom; Non EFL learners’ achievement

Comparing ultrasound to fine needle aspiration in differentiating between benign and malignant thyroid masses

Introduction: Due to the possibility of malignancy of thyroid nodules, it is necessary to identify the type of thyroid nodule to choose the most accurate treatment possible. Objectives: Considering that there is no standard diagnostic method for masses with intermediate suspicion of malignancy, the present study was conducted to investigate the diagnostic value of ultrasound in differentiating between benign and malignant thyroid masses compared with fine needle aspiration (FNA). Patients and Methods: In this cross-sectional study, 150 patients who had been referred to an endocrinologist’s office in Bandar Abbas with a complaint of thyroid mass in 2019-2020 and had undergone ultrasound and FNA were included in the study by census. After obtaining their informed consent, the patient’s information was collected by reviewing their ultrasound and FNA reports and analyzed with descriptive and analytical tests in SPSS software version 26. Results: The sensitivity and specificity of ultrasound in detecting malignant and benign masses were 56.25% and 85.07%, respectively. The positive and negative predictive values of ultrasound were 60% and 98.27%, respectively. The number of malignant FNA reports was significantly higher in the intermediate suspicion category of patients than in patients with ultrasound results showing high suspicion of malignancy. Conclusion: Performing further diagnostic measures such as FNA and core needle biopsy after noticing an intermediate suspicion in a patient’s ultrasound seems necessary.

Risk Stratification of Foetuses based on Estimated Foetal Weight less than the 40th Percentile and Evaluation of Perinatal Outcomes using Third-trimester Obstetric Ultrasound: A Prospective Cohort Study

Introduction: Perinatal mortality and morbidities constitute a burden on society and healthcare system. One of the major identifiable causes of these conditions in India is Low Birth Weight (LBW) and preterm births. Small for Gestational Age (SGA) infants account for almost 46.9% of LBW infants. They are prone to the morbidities of preterm birth and are the second major contributor to perinatal mortality. Recent studies have reported that higher screening performance for SGA can be achieved through ultrasonographic foetal biometry and Doppler studies during the third trimester. Aim: To stratify foetuses with Estimated Foetal Weight (EFW) below the 40th centile, as determined by obstetric ultrasound, into three categories (low, intermediate, and high-risk), and study the perinatal outcomes in each category. Materials and Methods: The present prospective cohort study was conducted in the Department of Obstetrics and Gynaecology at Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India from November 2020 to April 2022. A total of 280 antenatal women, at a gestational period between 35 to 36+6 weeks with singleton pregnancies, were studied and based on the foetal biometry and Doppler parameters, women were classified into low (Group A), intermediate (Group B) and high risk (Group C) categories. Risk categorisation was based on EFW and Doppler indices. The low-risk group underwent an ultrasound Doppler scan after four weeks, the intermediate-risk group after two weeks, and the high-risk group was scanned weekly. The high-risk group was delivered at 39 weeks of gestation. Perinatal outcomes, neonatal weights, adverse neonatal outcomes {such as Neonatal Intensive Care Unit (NICU) admissions exceeding 48 hours}, stillbirths, and neonatal deaths were recorded. The Area under Curve (AUC) cut-off for EFW percentiles on ultrasonography was calculated as a predictor for SGA foetuses requiring NICU admissions. Concurrent admissions in the NICU of neonates delivered to unregistered pregnant mothers, who were not screened during the antenatal period, were also recorded. The Chi-square test was used to compare categorical data between groups. The receiver operating characteristic curve was used to determine the cut-off for foetal weight to predict NICU admission. A p-value of &lt;0.05 was considered statistically significant. Results: Among the study population, 231 (82.6%) were between 21-30 years of age, and 250 (88.87%) had a normal Body Mass Index (BMI) with a mean age of 25.78±3.90 years. On risk categorisation, 71 (25.1%), 82 (29%), and 127 (45.9%) women were in the high, intermediate, and low-risk categories, respectively. All the neonates in the high-risk group were classified as SGA according to the INTERGROWTH 21st growth chart. Among the neonates, 18 (6.4%) weighed below 2100 g, 35 (12.4%) weighed between 2101 to 2200 g, 62 (22.3%) weighed between 2201 to 2400 g, and 165 (59%) weighed above 2401 g. NICU admissions occurred in 25 (35.2%), 10 (12%), and 5 (3.8%) neonates in the high, intermediate, and low-risk groups, respectively (p-value &lt; 0.001). At a cut-off of EFW (g) less than or equal to 2122 g (between the 10th and 20th centile) during the first ultrasound, it predicted SGA neonates requiring NICU admissions with a sensitivity of 80% and a specificity of 70%. No stillbirths or neonatal mortality occurred in the study group. Conclusion: A single third-trimester obstetric ultrasound, along with Doppler measurements, should be performed at 35 to 36 weeks as an important adjunct for identifying and stratifying the risk of singleton foetuses. Close monitoring and timely delivery can help reduce adverse perinatal outcomes in SGA foetuses.

Chapter 7: Radioactive Iodine Treatment in Differentiated Thyroid Cancer

ABSTRACT Radioactive iodine (RAI) has been used in the treatment of differentiated thyroid cancer (DTC) since many decades. However, there is growing evidence to suggest that RAI may be avoided in low-risk group and is recommended in intermediate and high risk categories of DTC. This article incorporates literature review followed by a consensus of experts to conclude the role of RAI in DTC. The goals of RAI treatment, patient preparation, selection, and doses of RAI treatment in various risk categories are discussed. The follow-up after RAI treatment, side effects, and contraindications to RAI treatment are explained.

AHP 분석기법을 활용한 산지 태양광 발전시설 점검기준 개발

Recently, mountain photovoltaic power stations have caused sediment-related disasters, such as soil erosion and landslides. Efforts to mitigate these issues include strengthening installation slope standards and restructuring systems through mandatory inspections. In response to these challenges, this study aimed to select inspection items for the ongoing management of mountain photovoltaic power stations, and to establish standards for their inspection and overall management. Initially, inspection items for mountain photovoltaic power stations were categorized into three major groups, eight intermediate categories, 17 minor categories, and 58 detailed categories based on spatial criteria. Using the Analytic Hierarchy Process(AHP) analysis method to calculate the weight for each item, 'slope' was found to directly influence mountain landslide disasters, and items related to 'erosion' and 'drainage facilities' carried a high weight. Subsequently, a checklist was developed based on the weight of each item, carrying out on-site inspections. A clear variation in scores depending on the management status was confirmed.

Application of a 21-Gene Recurrence Score in a Swiss Single-Center Breast Cancer Population: A Comparative Analysis of Treatment Administration before and after TAILORx.

In patients with hormone receptor positive, human epidermal receptor 2 negative (HR+/HER2-) negative breast cancer (BC), the TAILORx study showed the benefit of adding chemotherapy (CHT) to endocrine therapy (ET) in a subgroup of patients under 50 years with an intermediate Oncotype DX recurrence score (RS 11-25). The aim of the present study was to determine if the TAILORx findings, including the changes in the RS categories, impacted CHT use in the intermediate RS (11-25) group in daily practice, as well as to identify the main factors for CHT decisions. We conducted a retrospective study on 326 BC patients (59% node-negative), of which 165 had a BC diagnosis before TAILORx (Cohort A) and 161 after TAILORx publication (Cohort B). Changes in the RS categories led to shifts in patient population distribution, thereby leading to a 40% drop in the low RS (from 60% to 20%), which represented a doubling in the intermediate RS (from 30% to 60%) and an increase of 5% in the high RS (from 8-10% to 15%). The overall CHT recommendation and application did not differ significantly between cohort B when compared with A (19% vs. 22%, resp., p = 0.763). In the intermediate RS (11-25), CHT use decreased by 5%, while in the high-risk RS category (>25), there was an increase of 13%. The tumor board recommended CHT for 90% of the patients according to the new RS guidelines in cohort A and for 85% in cohort B. The decision for CHT recommendation was based on age (OR 0.93, 95% CI 0.08-0.97, p = 0.001), nodal stage (OR 4.77, 95% CI 2.03-11.22, p < 0.001), and RS categories (RS 11-25 vs. RS 0-10: OR 0.06 (95% CI 0.02-0.17), p < 0.001; RS > 26 vs. RS 11-25: OR 618.18 95% CI 91.64-4169.91, p < 0.001), but did not depend on the cohort. In conclusion, while the tumor board recommendation for CHT decreased in the intermediate RS category, there was an increase being reported in the high RS category, thus leading to overall minor changes in CHT application. As expected, among the younger women with intermediate RS and unfavorable histopathological factors, CHT use increased.

POTENTIAL OF CITRUS LEAF EXTRACT (Cymbopogon citratus (DC.) Stapf) AS AN ANTIBACTERIAL INHIBITORY of Staphylococcus epidermidis

The concerns of antibiotic resistance have increased in recently years, this issue caused by long-term repeated use of antibiotics to treat bacterial illnesses. Lemongrass leaf (Cymbopogon citratus (DC.) Stapf) is one of the natural ingredients that can be used as an alternative antibacterial. The study objective is to determine the antibacterial activity of the ethanol extract of 70% cooking leaves against Staphylococcus epidermidis using diffusion methods. In addition, the Minimum inhibitory concentration (MIC) and Minimum bactericidal concentration (MBC) of extracts were determined using liquid dilution methods. The results of this study show that extract concentrations of 1,000,000 ppm have a barrier zone in the intermediate category when compared with the positive control, that is, clindamycin. Meanwhile, the MIC value obtained is 1250 ppm, while the MBC value is 5000 ppm. The results of statistical analysis showed that there were no significant differences in the inhibition zone diameter formed between the test concentrations.

Assessment of diabetes risk among adult population using Indian diabetes risk score and to correlate with actual capillary blood sugar level: a cross sectional study

Background: Diabetes is one of the fastest growing health challenges of the 21st century, with the number of adults living with diabetes having more than tripled over the past 20 years. IDRS is pre-screening tool for assessing diabetes mellitus. It is also a non-invasive procedure and less time consuming. Aim were to assess diabetes risk among adult urban population of district Etawah by using Indian Diabetes Risk Score and to correlate it with actual capillary blood sugar status. Methods: The present study was a cross sectional study carried out among 200 adult urban non diabetic population the age group of 30 years and above. The data was collected using predesigned questionnaire followed by capillary blood sugar estimation. The data was collected under following broad heading: socio-demographic profile, Behavioural factor, Indian diabetes risk score and capillary blood sugar estimation. Results: Majority of the participants were in the age group of 35-49 years and Hindu by religion. 62.5% gave history of fast food consumption, nearly half of the participants gave the history of moderate to heavy physical exercise. It was found that 89% of the participants fall under the category of intermediate and high risk category. On application of test of association between IDRS score and actual capillary blood sugar level, strong association exist between the two variables. Conclusions: The present study concludes that IDRS is a powerful tool for screening of high risk group of diabetes. There is a strong association between capillary blood sugar and IDRS score.

Comparison of finger flexion strength and muscular recovery of male lead sport climbers across climbing classes

Background/objectiveThe purpose of this study was to compare finger flexor strength (FS), finger flexor muscle recovery (FR), and forearm circumference (FC) across three different climbing classes in male lead sport climbers. MethodsA total of 37 male lead sport climbers were classified into low (LC), intermediate (IC), and advanced classes (AC) categories according to the International Rock Climbing Research Association (IRCRA) Scale. All participants measured FS three times for both open grip (OG) and crimp grip (CG). Following FS measurement, the FR was observed immediately after the all-out training. The FC was measured twice using an inelastic tape. ResultsThe FS differed significantly across climbing classes for both grip styles and hands, regardless of dominant hand, with the higher classes showing greater FS (all, p ≤ 0.001). FR was significantly higher in AC compared to IC and LC at 5 min (all, p ≤ 0.001), 10 min (all, p ≤ 0.005) and 15 min (all, p ≤ 0.005). The FC showed significant differences with climbing classes for both forearms. ConclusionClimbing classes are associated with differences in FS, with higher class corresponding to greater FS. Similarly, climbing classes are linked to FR and FC, with higher classes being associated with faster recovery and larger FC.