Kaplan-Meier Survival Estimates Research Articles

A study of impulsivity and adverse childhood experiences in a population health setting.

As complex mental health traits and life histories are often poorly captured in hospital systems, the utility of using the Barratt Impulsivity Scale (BIS) and Adverse Childhood Experiences (ACEs) for assessing adult disease risks is unknown. Here, we use participants from the Healthy Nevada Project (HNP) to determine if two standard self-assessments could predict the incidence and onset of disease. We conducted a retrospective cohort study involving adult participants who completed the Behavioral and Mental Health Self-Assessment (HDSA) between September 2018 and March 2024. Impulsivity levels were measured using the BIS-15, and retrospective self-reports of ACEs were collected through a standardized questionnaire. In total, 17,482 HNP participants completed the HDSA. Our findings indicate that ACEs were significantly associated with impulsivity. Disease associations with impulsivity and ACEs were evaluated using a phenome-wide association study, identifying 230 significant associations with impulsivity. Among these, 44 were related to mental health diagnoses, including major depressive disorder (MDD). Kaplan-Meier survival estimates characterized the differences in the lifetime predicted probability between high and low impulsivity for major depressive disorder and essential hypertension. This analysis showed that having both high ACEs and high impulsivity confer substantial risk of MDD diagnosis (hazard ratios 2.81, 2.17, respectively). Additionally, lifetime predicted probability of MDD was approximately 40% higher for high ACEs and high impulsivity compared to no ACEs and low impulsivity. Essential hypertension demonstrated similar trends, with an approximate 20% increase in predicted lifetime probability of diagnosis. These results demonstrate that high ACES and elevated impulsivity scores are associated with a range of negative health outcomes and a simple self-assessment of complex traits and life history may significantly impact clinical risk assessments.

Red cell distribution width-to-platelet ratio (RPR) as a predictor of prolonged stay at hospital for COVID-19 inpatients.

We looked at novel hematological composites like the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, red cell distribution width-to-lymphocyte ratio, red cell distribution width-to-platelet ratio, leukocyte-to-C reactive protein ratio, and lymphocyte-to-C reactive protein ratio as explanatory variables for COVID-19 patients´ hospital length of stay (LoS). The association of hematological indices with LoS was analyzed on 2930 COVID-19 patients using the univariate and multivariable Cox proportional hazards regression models with enter method. The Kaplan-Meier survival estimates were applied to LoS. The survivors´ mean LoS was 7.8 ± 24.0 days, but the deaths´ mean LoS was 38.6 ± 41.9 days (W = 31338, p < 0.01). Every hematological scores representative of the inflammatory status was significantly correlated in the univariate analysis with a prolonged LoS (p < 0.001). In the multivariate analysis, it was discovered that just the monocyte-to-lymphocyte and lymphocyte-to-C reactive protein ratios had not achieved statistical significance. However, most systemic inflammation measures showed hazards ratios close to one. One exemption was the red cell distribution width-to-platelet ratio (RPR) index, which can increase the probability of a longer hospital stay by up to ten times (HR(IC95%) = 0.092(0.03-0.29); p < 0.001). The most effective biomarker to identify COVID-19 patients at high risk for extended hospital stay was RPR. IntroductionDetermining hospital Length of Stay (LoS) is vital for resource management, especially for future COVID-19 outbreaks.Previous studies have primarily focused on sociodemographic and clinical attributes, along with resource availability, but have not accounted for other factors like routine laboratory tests, which can significantly impact LoS predictions.This study examines novel hematology scores as predictors of LoS, emphasizing their importance in resource-limited settings like Ecuador.MethodsThis retrospective cohort study analyzed 2,930 COVID-19 patients admitted to Hospital IESS Quito Sur in Ecuador focusing on confirmed cases with complete blood count (CBC) values to assess LoS.The study explored various hematological ratios, such as the neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width-to-lymphocyte ratio (RLR), as potential predictors of LoS and in-hospital outcomes for COVID-19 patients, using a combination of univariate and multivariable Cox proportional hazards regression models.Kaplan-Meier survival estimates and log-rank tests were used to analyze survival and discharge probabilities over time, highlighting sex-dependent effects and the significant association between selected hematological indices and patient outcomes.ResultsThe mean LoS for survivors was significantly shorter compared to those who died (p < 0.001), indicating that longer hospitalization was associated with higher mortality risk.Women had a shorter average LoS (with lower mortality risk (p < 0.001), suggesting an asymmetrical hospitalization pattern based on sex.While most hematological markers had minimal clinical relevance for LoS, the red cell distribution width-to-platelet ratio (RPR) stood out, increasing the likelihood of a longer hospital stay by up to tenfold, making it a critical factor in predicting prolonged hospitalization.DiscussionMen had longer hospital stays and higher mortality rates than women, likely due to differing inflammatory responses, though hyperinflammation markers like NLR, PLR, and Leu-CPR had minimal clinical impact.RPR had the strongest link to longer hospital stays, indicating a higher risk of extended hospitalization in severe COVID-19 cases.Elevated RPR is tied to oxidative stress and coagulation issues, suggesting early identification could help reduce prolonged stays and complications.ConclusionResearch generally points to clinical complications from COVID-19 as the main factor behind prolonged hospitalizations, underlining the importance of early identification and management of these issues.

Effects of Mycoplasma ovipneumoniae, abundance, and climate conditions on bighorn sheep lamb:ewe ratios in New Mexico

AbstractMycoplasma ovipneumoniae is a primary causative agent responsible for initiating polymicrobial pneumonia in bighorn sheep (Ovis canadensis). Infections of bighorn sheep populations are typically characterized by initial all‐age epizootics followed by long‐term periods of repressed juvenile (lamb) survival. Populations of bighorn sheep in New Mexico, USA, were thought to be free of this pathogen prior to 2017 but recent infection of multiple herds raised concerns regarding impacts on population size and juvenile:female ratios. Using aerial survey, survival, and disease sampling data in an exploratory framework, we (1) characterize age‐related differences in M. ovipneumoniae prevalence and seroprevalence, (2) quantify differences in lamb:ewe ratios pre‐ and post‐M. ovipneumoniae detection, and (3) investigate differences in survival between previously exposed and naïve individuals. From 2007 to 2022, we sampled 466 bighorn sheep across 19 populations in New Mexico for M. ovipneumoniae exposure. While the timing of initial herd infections varied across populations, one population sustained active infections for over 15 years. We found reduced juvenile:female ratios post M. ovipneumoniae exposure for both desert (O. c. mexicana) and Rocky Mountain (O. c. canadensis) bighorn sheep populations. Post‐exposure ratio declines ranged from 20% to 69%. Evaluation of population size and environmental condition effects on juvenile:female ratios indicated varying impacts for each subspecies. Notably, population size was negatively related to Rocky Mountain juvenile:female ratios only after populations were exposed to M. ovipneumoniae. Additionally, climatic conditions in the previous lambing season and pre‐parturition time frame were associated with juvenile:female ratios for Rocky Mountain populations, while juvenile:female ratios of desert bighorn appeared to only be affected by pre‐parturition climatic conditions. Kaplan–Meier survival estimation of previously exposed, but putatively recovered, individuals (n = 31) and naïve individuals (n = 70) revealed lower (75%; 95% CI: 62%–93%) but not statistically significant (p = 0.2) 1‐year survival rates for individuals that were seropositive but not actively infected, when compared to seronegative individuals (88%; 95% CI: 81%–97%). These results collectively suggest that following M. ovipneumoniae introduction, bighorn sheep populations in New Mexico could be limited by lamb survival.

ER + HER2- early-stage breast cancer: association of HER2 expression, tumor characteristics, and outcomes.

To evaluate the association between the HER2 score as provided by the Oncotype DX Recurrence Score (RS) assay, tumor characteristics, and outcomes in early-stage, ER + HER2-negative breast cancer (BC). All women insured by the Clalit Health Services, with early-stage, ER + HER2-negative BC who underwent RS testing between 2008 and 2011 were included. Patient/tumor characteristics and Kaplan-Meier estimates for distant recurrence-free survival (DRFS) and overall survival (OS) were compared by HER2 category, based on the HER2 score provided by the RS assay: lower HER2 score group representing the lower third of the HER2 score range (≤ 8.5); higher HER2 score group representing the upper 2 thirds of the HER2 score range (8.6-10.7). 1535 patients were included (948 node negative, 587 node positive); 330 (21.5%) were categorized as lower HER2 score and 1205 (78.5%) as higher HER2 score. Compared to the higher HER2 score group, the lower score group included a significantly higher proportion of patients with RS ≥ 26 in both node-negative (41% vs. 13.6%, P < .001) and node-positive diseases (36% vs. 19.4%, P < .001). Compared to the higher HER2 score group, the lower score group had significantly lower Oncotype ER and PR scores and lower proportion of lobular disease. Age and tumor size were comparable between the HER2 score groups. Within each RS category, DRFS and OS were not associated with the HER2 score. Lower HER2 score was associated with higher RS results. Further study is desired to elucidate the role and significance of HER2 expression in early-stage, ER + HER2-negative.

Management of Tricuspid Atresia With Normally Related Great Arteries and Left-Sided Obstruction.

Tricuspid atresia (TA) is the second most common form of functionally univentricular heart. For patients with TA and normally related great arteries (Type I), left ventricular outflow tract obstruction (LVOTO) is rare. From the Congenital Heart Surgeons' Society multi-institutional cohort of 445 patients with Type I TA enrolled from 1999 to 2024 from 42 sites, 14 infants (3%) had interventions for associated LVOTO, either at presentation or after their first TA-related intervention. Of seven infants initially undergoing Norwood/Damus-Kaye-Stansel (DKS), six survived to Stage II, of whom five survived with one developing pulmonary hypertension and four achieving Fontan. An additional seven infants who were first managed with pulmonary artery band placement subsequently had bidirectional superior cavopulmonary anastomosis (BCPA) and a DKS procedure; there were six survivors, all achieving Fontan. All ten survivors who underwent the Fontan procedure had normal left ventricular and mitral valve function at the latest follow-up. The overall Kaplan-Meier survival estimate at 20 years for these 14 patients was 79% (70% CI, 66%-88%), and the median follow-up was 8.3 years (0.24-21.5). While infants with TA and transposition of the great arteries are more likely to have LVOTO, this can also occur in the setting of normally related great arteries. Infants with Type I TA and LVOTO can be managed in the neonatal period with the Norwood procedure ensuring complete arch relief with acceptable outcomes. If LVOTO becomes evident after initial pulmonary artery band placement, a subsequent DKS procedure facilitates satisfactory success to Fontan.

Combination of grade and spread through air spaces (STAS) predicts recurrence in early stage lung adenocarcinoma: a retrospective cohort study.

Adenocarcinomas, a common subtype of lung cancer, exhibit diverse histological patterns. In 2020, The International Association for the Study of Lung Cancer (IASLC) introduced a grading system emphasizing high-grade components, which has shown prognostic value. Spread through air spaces (STAS) is recognized as a prognostic feature increasing the risk of recurrence in lung cancer. This study evaluates the combination of STAS status and the IASLC-grading system in surgically resected Stage I lung adenocarcinomas. This study is a retrospective analysis of 123 patients with Stage I lung adenocarcinoma who underwent lobectomy between 2011 and 2019. Histological patterns were assessed according to the IASLC criteria, and STAS status was documented. Patients were categorized based on their IASLC Grade and STAS status. Statistical analyses included Kaplan-Meier survival estimates, Cox proportional hazards models, and comparisons using Chi-square and t-tests. The cohort comprised 43 females and 80 males with a mean age of 61.8 ± 7.6years. STAS positivity was noted in 52.8% of patients. STAS positivity correlated significantly with Grade 3 tumors (p < 0.001). The 5-year recurrence-free survival was significantly lower in STAS-positive patients (70.7% vs. 88.7%, p = 0.026). Patients with Grade 3 and STAS positivity had significantly lower recurrence-free survival compared to other groups (p = 0.002). Grade 3 and STAS positivity were independent predictors of poor recurrence-free survival in multivariate analysis. IASLC Grade 3 tumors and STAS positivity are independent prognostic factors for poor recurrence-free survival in Stage I lung adenocarcinomas. Adjuvant treatment strategies should be considered for patients with these characteristics to improve outcomes.

The Modified History of Juvenile Rheumatic Mitral Stenosis Following Percutaneous Transmitral Commissurotomy: Intermediate-Term Outcomes From a Decadal Follow-Up Study

There are few studies that have looked at the long-term outcomes of juvenile mitral stenosis (JMS) following percutaneous transmitral commissurotomy (PTMC). This study sought to analyse the modified history of JMS in children following PTMC. We describe a longitudinal, observational follow-up study of all children and young adults aged <20 years who underwent PTMC at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India from 2012 to 2021. Children were followed up for progression of mitral stenosis (MS), development of mitral regurgitation (MR), need for repeat interventions (percutaneous or surgical), and mortality. A total of 114 children and adolescents underwent the procedure. The mean age of children in the study was 15.1±2.5 years. After immediate procedural success, there was a tendency towards restenosis with respect to valve areas and transmitral gradients at follow-up. Severe MR after the procedure was noted in 2.6%. Compliance with penicillin prophylaxis was noted in 42.5%. The Kaplan-Meier survival estimate over 10 years showed a mortality rate of 1.98/100 patient-years and a re-intervention rate (re-do PTMC or surgery) of 5.50/100 patient-years. Additional valvular lesions were noted in 13.1% of children during follow-up. Severe symptomatic status at presentation (New York Heart Association class 4) was predictive of mortality, and children aged <15 years often needed re-intervention. With a mortality rate of 6.1% and re-do intervention rate of 15.8% during extended follow-up, JMS has considerable healthcare implications in terms of morbidity and mortality in children and young adults.

Dynamic Anthropometrics in Pancreatic Cancer: Associations Between Body Composition Changes During Neoadjuvant Therapy and Survival Outcomes After Resection.

Assessment of individual tumor biology and response to systemic therapy in pancreatic ductal adenocarcinoma (PDAC) remains a clinical challenge. The significance of anthropometric (body composition) changes during chemotherapy as a surrogate for tumor biology in the setting of localized PDAC is unknown. A retrospective, single-institution analysis of patients with PDAC who received neoadjuvant therapy (NAT) and pancreatectomy from 2017 to 2021 was performed. Radiologic anthropometric analysis used artificial intelligence-driven software to segment and compute total and sub-compartment muscle area, adipose tissue area, and attenuation values at the level of the L3 vertebra. Kaplan-Meier survival estimates, log-rank tests, and multivariable Cox regression models were used in survival analyses. The inclusion criteria were met by 138 patients. Although decreases in muscle and adipose tissue areas during NAT were predominant, a subset of patients experienced an increase in these compartments. Increases in muscle greater than 5% (hazard ratio [HR], 0.352; 95% confidence interval [CI] 0.135-0.918; p=0.033) and increases in adipose tissue greater than 15% (HR, 0.375; 95% CI 0.144-0.978; p=0.045), were significantly associated with improved survival, whereas loss of visceral fat greater than 15% was detrimental (HR 1.853; CI 1.099-3.124; p=0.021). No significant associations with single time-point anthropometrics were observed. Gains in total muscle and adipose mass were associated with improved pathologic response to systemic therapy and less advanced pathologic tumor stage. Dynamic anthropometric analysis during NAT for PDAC is a stronger prognostic indicator than measurements taken at a single point in time. Repeated anthropometric analysis during preoperative chemotherapy may serve as a biomarker for individual tumor biology and response to therapy.

Intraoperative neurophysiologic monitoring during cardiac surgery: an observational cohort study

ObjectiveTo evaluate the impact of intraoperative neuromonitoring (IONM) on stroke and operative mortality after coronary and/or valvular operations.MethodsThis was an observational study of coronary and/or valvular heart operations from 2010...

Predicting 30-Day Outcomes in Primary Intracerebral Hemorrhage Using the Intracerebral Hemorrhage Score: A Study in Bangladesh.

Introduction Intracerebral hemorrhage (ICH) is a severe subtype of stroke associated with high rates of mortality and morbidity. Accurate early prognostication is essential for optimizing treatment strategies and improving patient outcomes. The ICH score, which includes clinical and imaging variables, is widely used to predict mortality and functional outcomes in ICH patients. However, limited data on the applicability of this scoring system are available from low-income countries. This study aims to evaluate the ICH score as a predictor of 30-day mortality and functional outcome, as measured by the modified Rankin Scale (mRS), in ICH patients at a tertiary care hospital in Bangladesh. Methods We conducted a prospective cohort study over one year at the National Institute of Neurosciences and Hospital in Dhaka, Bangladesh. One hundred patients aged over 18 years with confirmed primary ICH were enrolled. We collected data on demographics, clinical presentation, risk factors, and imaging findings, including the Glasgow Coma Scale (GCS), ICH score components, and hematoma volume. Patients were followed up for 30 days, and outcomes were assessed using the mRS. Statistical analyses included univariate and multivariate logistic regression and Kaplan-Meier survival estimates. Results A total of 100 participants were enrolled for the study. The mean age of participants was 59.2 ± 14.5 years, and 57 were men, and 43 were women. The overall 30-day mortality rate was 44%. Mortality rates increased significantly with higher ICH scores (p < 0.001), with all patients scoring 4 or 5 on the ICH score dying within 30 days. Lower GCS scores, larger hematoma volumes, the presence of intraventricular hemorrhage (IVH), and increasing age were associated with higher mortality. Multivariate analysis identified increasing age (p = 0.023), lower GCS score (p = 0.003), and higher ICH score (p = 0.025) as independent predictors of 30-day mortality. Higher ICH scores were also significantly associated with poor functional outcomes (mRS ≥ 4) at both discharge and 30 days (p < 0.001). GCS score emerged as an independent predictor of poor functional outcomes at 30 days (p = 0.012). Conclusions The ICH score is an effective tool for predicting 30-day mortality and functional outcomes in patients with primary ICH. Incorporating the ICH score and GCS assessment into routine clinical practice can aid healthcare providers in early risk stratification, optimizing treatment plans, and improving resource allocation.

Military expenditure and income inequality in European NATO Member States

The purpose of this investigation was to empirically assess the association between military expenditure and income inequality in the 19 European member states of NATO between 2011 and 2022. To achieve this, the authors carried out multivariate statistical analysis using Kaplan-Meier life tables and survival estimation techniques. The results highlighted a trend in the countries analysed that income inequality tended to decrease when investment in the military increased during the period under consideration. The association manifested itself in the shortest time in the group of countries with the lowest military spending per capita, while emerging in the longer term in the countries with the highest. Furthermore, under high threat of war, the association tends to be shortest in relative terms in countries with the lowest military expenditure per capita. The results also revealed that the association between military spending and income inequality is more pronounced in the smallest countries by population and those with the lowest military expenditure per capita. The authors believe that this investigation will enrich scientific knowledge with new insights.

Prognostic role of ECG patterns in Anderson Fabry disease

Abstract Background Anderson Fabry disease (AFD) is an X-linked lysosomal storage disorder leading to a deficiency in α-galactosidase A and globotriasylceramide (Gb3) deposition in different organs. Cardiac involvement is extremely common. It has been shown that the ECG abnormalities are directly correlated with the progressive accumulation of glycosphingolipids in the myocardium and cardiac conduction system. However, it is still unclear whether the ECG alterations are correlated with clinical events. Purpose To evaluate the prognostic role of ECG patterns in an unselected population of patients with AFD. Methods We conducted a retrospective multicenter study enrolling 215 consecutive patients. Based on the baseline ECG the study population was divided into the following five groups: 1) normal ECG or minimal alterations; 2) left ventricular hypertrophy (LVH) without signs of overload; 3) isolated negative T waves in the inferior and/or lateral leads; 4) LVH with signs of overload with or without incomplete right bundle branch block (RBBB); 5) complete RBBB. The primary endpoint was the composite of sudden cardiac death, resuscitated cardiac arrest, sustained ventricular tachycardia, and heart failure. Results Median age of study population was 45 years (32-57), and 86 patients (40%) were men. The rate of classic phenotype was 68%. Patients with ECG patterns 3 and 4 were older at baseline, more frequently affected by arterial hypertension, mostly male and showed greater left ventricular thickening, At a median follow up of 60 months (25-83) the overall Kaplan-Meier survival free from the primary endpoint was 57%: the Kaplan-Meier survival estimates of ECG groups were 66%, 75%, 68%, 27% e 52% respectively (log Rank 0.0026). On multivariable analysis patients belonging to either 3 or 4 group showed an increased risk of primary endpoint (HR= 2.45; 95% CI 1.04-5.78, p=0.040) compared to other groups. Conclusion ECG at baseline may be a useful tool to predict the risk of cardiovascular events in Anderson-Fabry Disease. Future studies should investigate if ECG may be useful also to evaluate the clinical response to specific therapy.

One-year outcomes of patients with hypertrophic cardiomyopathy according to levels of inflammatory biomarkers

Abstract Background Hypertrophic cardiomyopathy (HCM) is a vastly heterogeneous sarcomere disorder unified by maximal left ventricular (LV) thickness increases. The lifetime relative risk of morbidity in HCM is four-fold higher than in the general population, primarily driven by arrhythmias and heart failure (HF). Numerous prognostic features have been identified, but our ability to identify high-risk patients of progression remains rudimentary. Small retrospective studies have shown that systemic inflammation is associated with adverse outcomes in patients with HF; others, small and single-center, have also shown associations between adverse outcomes and inflammation in HCM. Purpose We aimed to determine whether elevated levels of inflammatory biomarkers are associated with an increased risk of acute heart failure (AHF) and mortality at 1 year in a large cohort of patients with HCM across multiple centers in the United States (US). Methods In this retrospective study, using the US cohort of 60 healthcare organizations in the TriNetX database, we included more than 85,000 adult patients with HCM (ICD-10-CM codes I42.1 and I42.2) between 2004 and 2024. Patients were divided according to predetermined cut-offs of different inflammatory biomarkers (C-reactive protein [CRP], &amp;lt;2 mg/L vs. 2-100 mg/L; white blood cells [WBC], &amp;lt; vs. ≥ the median [8x10^3/µL]; neutrophils [Neu], &amp;lt; vs. ≥ the median [5x10^3/µL]). These cohorts were then 1:1 propensity score matched (PSM) for age, sex, and race. We used Kaplan-Meier survival curves to derive cumulative incidence curves (as 1 minus Kaplan-Meier survival estimates) for AHF (ICD-10-CM codes I50.21, I50.23, I50.31, I50.33, I50.41, I50.43) or death, and we compared them with the Log-rank (Mantel-Cox) test. We also derived Hazard Ratios (HR) with 95% Confidence Interval (CI) from Cox regression analysis to compare the outcomes within the groups at 1-year. Results After PSM, patients with HCM and CRP levels between 2-100 mg/L experienced higher rates of the composite outcome (19.6% vs. 12.2%, Log-rank p&amp;lt;0.001; HR 1.67, 95% CI [1.29-2.16]), as well as the separate outcomes of death (14.7% vs. 6.8%, Log-rank p&amp;lt;0.001; HR 2.23, 95% CI [1.68-2.98]) and AHF (10.9% vs. 7.5%, Log-rank p&amp;lt;0.001; HR 1.49, 95% CI [1.07-2.07]), compared to those with CRP &amp;lt;2 mg/L (Table 1)(Figure 1). Similarly, patients with Neu ≥5x10^3/µL reported higher incidences of the composite outcome (20.3% vs. 13.2%, Log-rank p&amp;lt;0.001; HR 1.62, 95% CI [1.55-1.68]) and the separates outcomes, compared to those with Neu &amp;lt;5x10^3/µL (Table 1) (Figure 1). Patients with WBC ≥8x10^3/µL also had increased rates of the composite outcome (19.4% vs. 14.1%, Log-rank p&amp;lt;0.001; HR 1.43, 95% CI [1.38-1.48]) and the separate outcomes, compared to those with WBC &amp;lt;8x10^3/µL (Table 1)(Figure 1). Conclusions In the first large 'real world' analysis of patients with HCM, elevated levels of inflammatory biomarkers were associated with worse outcomes of death and acute heart failure.

Primary orbital and adnexal rhabdomyosarcoma: a study of 54 Asian Indian patients

ABSTRACT Purpose To describe the clinical presentation, management, and outcomes of orbital and adnexal rhabdomyosarcoma (RMS) in an Asian-Indian cohort and analyze the factors predictive of outcomes. Methods Retrospective interventional case series of 54 patients of histopathology-proven RMS Results The mean age of presentation with RMS was 10 years (median, 7 years; range, <1–54 years). The most common tumor location was the superonasal quadrant (n = 21, 39%). Extensions beyond the orbit into the sinuses, temporal fossa, and brain were seen in 15 (28%), 3 (6%), and 8 (15%), respectively. First-line treatment modalities included a combination of surgical debulking, chemotherapy, and external beam radiotherapy in 20 (37%) patients; chemotherapy and radiation in 20 (37%); complete surgical excision and chemotherapy in 3 (6%); orbital exenteration, chemotherapy, and external beam radiotherapy in 1 (2%); chemotherapy alone in 1 (2%) patient, and 9 (17%) patients were lost to follow up. By Intergroup Rhabdomyosarcoma Study Group (IRSG) grouping, tumors belonged to groups I (n = 2,4%), II (n = 13, 29%), and III (n = 30, 67%). Kaplan-Meier survival estimates for tumor recurrence, lymph node metastasis, systemic metastasis, and death (n = 45) were 84%, 82%, 95%, and 95% at 1 year, 69%, 76%, 81%, and 77% at 5 years, 69%, 76%, 81%, and 77% at 10 years, respectively. On multivariate regression, age >18 years was found to have a significantly increased risk of locoregional LN metastasis (p = 0.005). Conclusion Despite aggressive treatment modalities, the 5–year disease-specific survival rate was 77% in Asian-Indian cohort. Age > 18 years at presentation was associated with a poorer prognosis.

Determinants of Length of Stay for Medical Inpatients Using Survival Analysis.

With the increase in insured patients and an aging population, managing the length of stay (LOS) for inpatients has become crucial for controlling medical costs. Analyzing the factors influencing LOS is necessary for effective management. Previous studies often used multiple or logistic regression analyses, which have limitations such as unmet assumptions and the inability to handle time-dependent variables. To address these issues, this study applied survival analysis to examine the factors affecting LOS using the National Health Insurance Service (NHIS) sample cohort data from 2016 to 2019, covering over 4 million records. We used Kaplan-Meier survival estimation to assess LOS probabilities based on sociodemographic, patient, health checkup, and institutional characteristics. Additionally, the Cox proportional hazards model controlled for confounding factors, providing more robust validation. Key findings include the influence of age, gender, type of insurance, and hospital type on LOS. For instance, older patients and medical aid recipients had longer LOS, while general hospitals showed shorter stays. This study is the first in Korea to use survival analysis with a large cohort database to identify LOS determinants. The results provide valuable insights for shaping healthcare policies aimed at optimizing inpatient care and managing hospital resources more efficiently.

Anatomy-guided resections for paralimbic tumors in the temporo-insular region: combining tumor and epilepsy surgery concepts.

Tumors in the temporo-mesial region often extend into the insula and vice versa. The present study investigated the results of a surgical strategy that combines principles of tumor and epilepsy surgery. We retrospectively analyzed 157 consecutive patients with intrinsic brain tumors in the temporo-mesial region, with varying degrees of extensions into the insula (44 patients, 28.0%). The surgical strategy utilized "anatomy-guided resection," targeting specific anatomical compartments infiltrated by the tumor (e.g., temporal pole, anterior temporo-mesial region = uncus and hippocampal head, posterior temporo-mesial, insula) rather than treating the tumor as a single mass. The most frequent histologies were ganglioglioma CNS WHO grade 1 (55 patients, 35.0%) and IDH1 wildtype glioblastoma (36 patients, 22.9%). Tumor infiltration was most commonly found in the anterior temporo-mesial compartment (145 patients, 92.4%). An anterior temporal lobectomy was part of the surgical strategy in 131 cases (83.4%). Seventy-six patients (48.4%) with drug-resistant epilepsy underwent a formal presurgical epilepsy work-up, including depth electrode placement in three cases. Complete resections were achieved in 117 patients (74.5%), with supramarginal resections performed in 89 cases (56.7%). Four patients experienced non-temporary neurological complications (CTCAE grade 3-5). At 6 months, 127 of 147 assessable patients (86.4%) were free from seizures or auras (ILAE class 1), excluding early postoperative seizures (<30 days). At 24 months, 122 of 144 assessable cases (84.7%) remained seizure-free (ILAE class 1). Kaplan-Meier estimates for 5-year overall survival were 98.5% for non-recurrent glioneuronal tumors. The 2-year overall survival estimates were 96.0% for 24 primary diffuse CNS WHO grade 2 and 3 gliomas and 55.2% for 30 patients undergoing first surgeries for glioblastomas/astrocytomas CNS WHO grade 4. Combining both epilepsy and tumor surgery concepts in the surgical treatment of intrinsic brain tumors involving the mesial temporal lobe, often extending into the insula, led to more extensive resections, improved seizure outcomes, and potentially even better patient survival outcomes.

A Comparative Study of Hospitalization Mortality Rates between General and Emergency Hospitalized Patients Using Survival Analysis

Background/Objectives: In Korea’s emergency medical system, when an emergency patient arises, patients receive on-site treatment and care during transport at the pre-hospital stage, followed by inpatient treatment upon hospitalization. From the perspective of emergency patient management, it is critical to identify the high death rate of patients with certain conditions in the emergency room. Therefore, it is necessary to compare and analyze the determinants of the death rate of patients admitted via the emergency room and generally hospitalized patients. In fact, previous studies investigating determinants of survival periods or length of stay (LOS) primarily used multiple or logistic regression analyses as their main research methodology. Although medical data often exhibit censored characteristics, which are crucial for analyzing survival periods, the aforementioned methods of analysis fail to accommodate these characteristics, presenting a significant limitation. Methods:Therefore, in this study, survival analyses were performed to investigate factors affecting the dying risk of general inpatients as well as patients admitted through the emergency room. For this purpose, this study collected and analyzed the sample cohort DB for a total of four years from 2016 to 2019 provided by the Korean National Health Insurance Services (NHIS). After data preprocessing, the survival probability was estimated according to sociodemographic, patient, health checkup records, and institutional features through the Kaplan–Meier survival estimation. Then, the Cox proportional hazards models were additionally utilized for further econometric validation. Results: As a result of the analysis, in terms of the ‘city’ feature among the sociodemographic characteristics, the small and medium-sized cities exert the most influence on the death rate of general inpatients, whereas the metropolitan cities exert the most influence on the death rate of inpatients admitted through the emergency room. In terms of institution characteristics, it was found that there is a difference in determinants affecting the death rate of the two groups of study, such as the number of doctors per 100 hospital beds, the number of nurses per 100 hospital beds, the number of hospital beds, the number of surgical beds, and the number of emergency beds. Conclusions: Based on the study results, it is expected that an efficient plan for distributing limited medical resources can be established based on inpatients’ LOS.

Comparing optimum prosthesis combinations of total stemmed, stemless and reverse shoulder arthroplasty revision rates for men and women with glenohumeral osteoarthritis

BackgroundThis study investigated prostheses from a large national arthroplasty registry with the lowest rates of revision, defined as optimum. We compared optimum shoulder arthroplasty revision rates for osteoarthritis (OA) to determine the most suitable/effective procedure for men and women. MethodsThere were three cohort groups of optimum primary shoulder arthroplasties for OA undertaken between 1st January 2008 and 31 December 2022: stemless shoulder arthroplasty with cemented polyethylene glenoids (slTSA), stemmed shoulder arthroplasty with modified central peg polyethylene glenoids (stTSA), and cementless reverse shoulder arthroplasty (rTSA). The cumulative percent revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for age, gender, humeral head/glenosphere size, polyethylene type, and surgeon volume. Possible interactions were examined. A sub-analysis from 1 January 2017 captured additional patient demographics, ASA score, BMI and glenoid morphology. ResultsThe CPR at 7 years was 4.0%(95% confidence interval (CI) 3.1, 5.1) for slTSA (n=3,041), 3.8%(95%CI 2.7, 5.5) for stTSA (n=1,259) and 4.1%(95%CI 3.7, 4.6) for rTSA (n=12,341). slTSA had a higher rate of revision compared to rTSA after the first 9 months (p<0.001). rTSA had a lower revision rate compared to stTSA from 3 months on (p=0.004). After adjusting for other confounders, prosthesis type and gender were associated with revision rates (p<0.001) whereas surgeon volume was not. Additionally, gender and prosthesis type strongly interacted (p=0.013) and the combined model exhibited greater predictive performance when including this interaction. Women had lower rates of revision than men for both stTSA and rTSA, but not slTSA. Most revisions were for infection in men, especially rTSA. After 3 months, the rate of revision for slTSA vs rTSA for women was increased (p<0.001) and revision rates for men did not significantly differ. However, in a sub-analysis of procedures in males since 2017 with additional adjustments, slTSA had a lower revision rate than stTSA (p=0.010). ConclusionsThe optimum shoulder arthroplasty revision rates vary for both the gender and implant type for the diagnosis of OA. A model combining optimum prostheses and gender predicted revision better than optimum implants alone. After 3 months, rTSA was associated with lower revision rates compared to slTSA in women, whereas there were no significant differences between optimum prostheses in men. However, surgeons may also consider lower revision risk of optimum slTSA at sub analysis and increased cumulative incidence of infection for rTSA requiring revision to resolve decision making for male patients.

Long-term outcomes of mitral valve repair in children.

Mitral Valve Disease in children presents unique challenges due to the wide range of associated pathologies and the complexities of pediatric cardiac anatomy. Mitral valve repair in this demographic is preferred over replacement due to the drawbacks associated with prosthetic valves in young patients, such as the need for long-term anticoagulation and issues with prosthetic size and growth. This retrospective study reviewed pediatric patients under 18 years who underwent mitral valve repair between January 2002 and December 2023. Exclusion criteria included patients with atrioventricular septal defects or single-ventricle physiology. Surgical outcomes were assessed using preoperative and postoperative transthoracic echocardiography, with follow-up data analyzed via Kaplan-Meier survival estimates. The study included 47 patients with a median age of 4 years. Surgical techniques varied based on the specific mitral valve pathology. The overall early mortality was 6.3%, and the one and ten-year survival rates were 93.6 ± 3.6% and 91.4 ± 4.1%, respectively. Most patients showed improved or stable postoperative cardiac function during a median follow-up of 105 months. Notably, the rate of freedom from re-operation at ten years was 85.1 ± 6.9%, highlighting the durability of the surgical interventions. Mitral valve repair in children demonstrates favorable long-term outcomes with low mortality and reoperation rates, particularly when performed at an older age to accommodate growth and avoid the complexities of smaller, more delicate cardiac structures. These findings suggest that mitral valve repair should be considered a viable and effective option for managing pediatric MVD, with a personalized approach essential for optimizing outcomes.

Distal Endovascular Extension After FET: Short and Mid-Term Outcome in a High-Volume Single-Center Experience

ObjectivesThis study aims to investigate results and outcomes of distal endovascular extensions after FET procedure. MethodsBetween September 2018 and December 2022, all consecutive patients who underwent thoracic endovascular aortic repair (TEVAR) or complex thoraco-abdominal repair (TAA-EVAR) after FET were included in the study. Patients were assigned to “Aneurysm” group or to “Dissection” group according to underlying patology before FET repair. The primary endpoints were overall technical success and early re-intervention rate. Secondary endpoints included 30-day and mid-term overall survival. ResultsA total of 29 patients were included in the study and divided as follows, n=12 in the aneurysm group and n=17 in the dissection group. The mean age of the population was 64.6±10.2 years, 69% were male. All patients received TEVAR as primary extension while 9 of them underwent further extension to a subsequent TAA-EVAR in a second stage. Among the dissection group, 7 patients experienced a distal stent-graft induced new entries (dSINE) caused by the stent-graft portion of the FET. Technical success of the first stage (TEVAR) was fully achieved as well as for the second stage (TAA-EVAR). Within the first 30 days, no patient expired or required early reinterventions. Freedom-from-reintervention at 36 months was 72% and 64% in the aneurysm and dissection group, respectively. Overall, 1 major adverse event (MAE) (3,4%) and 3 access-related complication (10.3%) occurred among the entire cohort. The Kaplan-Meier survival estimation showed a non-significant log-rank value (p=.248) with a survival rate of 91.7% and 100% at 12, 24 and 36 months each for aneurysm and dissection group, respectively. ConclusionDistal endovascular extensions after FET repair is feasible with low perioperative morbidity and mortality regardless of the underlying pathology. Technical success rate of endovascular extension is high but aortic-related re-intervention rate remains quite consistent over time. Thus, a close surveillance is advocated for such patients.