Low Risk Research Articles

Modeling of Tank Vehicle Rollover Risk Assessment on Curved–Slope Combination Sections for Sustainable Transportation Safety

Tank vehicles are highly prone to rollover accidents, especially on curved–slope combination sections, which can cause hazardous chemical spills, endangering the environment, public safety, and human health. Therefore, it is crucial to conduct research aimed at reducing the risk of such incidents. Method: The rollover risk of tank vehicles under various loading conditions while traveling on curved–slope combination sections was investigated using driver–vehicle–road dynamics simulation. A multiple linear regression model was then developed to further quantify the impact of key factors on the rollover risk. Results: The results revealed that the road curve radius, vehicle operating speed, and liquid cargo fill level have the greatest impact on a tank vehicle’s rollover risk, and higher fill levels, higher speeds, and steeper downhill slopes all amplify the impact of curve radius on the rollover risk. In some cases, adhering to the road’s speed limit alone was insufficient to ensure the safe passage of the tank vehicle through curves. Conclusions: This study introduced, for the first time, a rollover risk assessment model for tank vehicles operating on curved–slope combination sections. The findings reveal effective methods to improve the transportation safety of tank vehicles. Practical Applications: The findings of this study can assist transportation agencies in selecting routes with lower rollover risks for tank vehicles with different configurations, as well as guide the development of loading standards and curve speed limits. This will effectively reduce rollover accidents of tank vehicles and support sustainable, safer transportation practices.

Organic Farming Is an Important Way to Achieve Low Accumulation of Heavy Metals in Soil

In this study, the accumulation characteristics of As, Hg, Cd, Cr, and Pb in 63 soil samples from 28 organic farms in Beijing, China, were analyzed to investigate the risk of heavy metal pollution in organic agriculture, and the key related factors were evaluated. The results revealed that the As, Hg, Cd, Cr, and Pb concentrations in the soil samples were below the risk screening values and substantially lower than those in the soil under conventional agriculture. However, the coefficients of variation for Hg and Cd were 112.45% and 38.34%, respectively, indicating a notable anthropogenic impact. Notably, 35.92% of the sampling sites had medium to high potential ecological risk values for Cd, and the Cd concentration increased considerably as the number of planting years increased. Different crop types impacted the soil heavy metal concentrations. The concentrations of Cd and As in the soil of Brassica crops were 0.265 and 12.915 mg/kg, respectively, which were substantially higher than those in the soil of other crop types. The Random Forest model indicated that soil nutrients had the most significant impact on soil heavy metal accumulation, particularly phosphorus. In conclusion, compared with conventional agriculture, organic agricultural soils have lower heavy metal concentrations and exhibit lower ecological risks, with no significant heavy metal pollution detected. However, there is a risk of Cd accumulation, and preventive measures should be implemented, especially for soils under prolonged cultivation and with potential sources of heavy Cd inputs.

Personalized Dosing of Linezolid to Reduce the Risk of Thrombocytopenia: A Systematic Review and Meta-Analysis.

Linezolid-induced thrombocytopenia (LIT) occurs in a dose-dependent manner. There is no consensus regarding personalized dosing of linezolid in the real world. This study investigated the usefulness of personalized dosing for the potential mitigation of LIT compared with standard dosing. A systematic review and meta-analysis were performed using 4 medical electronic databases. Inclusion criteria were original research articles published up to October 23, 2023, whereas nonoriginal articles were excluded. Eligible participants included adults who were administered linezolid. A random-effects model was used to synthesize the results. Four studies were eligible for inclusion. There were 208 patients in the personalized dosing (intervention) group and 195 patients in the standard dosing (comparison) group. The odds ratio for the intervention was 0.648 (95% confidence interval: 0.150-2.797), although significant heterogeneity was observed (I2 = 83.3%). An ad hoc analysis was performed by excluding one study with a significant bias risk in the treatment duration. The odds ratio for the intervention in the ad hoc analysis was 0.356 (95% confidence interval: 0.179-0.708) with little heterogeneity, showing a lower incidence risk of LIT. Personalized dosing in linezolid therapy may mitigate the risk of LIT.

Treatment of both bone forearm fractures with 2.7mm plates: a non-inferiority study.

To determine the effectiveness of 2.7mm plates in treating both bone forearm fractures (BBFFs) compared to the current gold standard of 3.5mm fixation. More specifically, to determine if 2.7mm plates are non-inferior to the current standard of 3.5mm plates. Retrospective including patients from 2016-2021. Single institution, level-1 trauma academic medical center. 77 patients met inclusion criteria, 58 patients underwent fixation with 3.5mm plates and 19 underwent fixation with 2.7mm plates. Plate osteosynthesis with either 2.7mm or 3.5mm plate instrumentation. Maintenance of reduction and achievement of fracture union. Among 77 total patients, 19 received 2.7mm plates and 58 received 3.5mm plates. There was no difference in age and BMI between groups, but the 2.7mm group had fewer males (47% vs 79%, p = 0.02). Primary end points of achievement of union (89.5% vs. 79.3%, p = 0.39) and maintenance of reduction (100% vs. 94.8%, p = 0.99), and secondary end points of implant removal (15.8% vs. 13.8%, p = 0.79), return to the operating room (OR) (5.3% vs. 5.2%, p = 0.63), and minor complications (0% vs. 6.9%, p = 0.99) were similar between the 2.7mm and 3.5mm groups. This study challenges the current standard of ORIF using 3.5mm plates for diaphyseal forearm fractures. 2.7mm plating resulted in at least equivocal achievement of fracture union and thus may be more efficacious given previous studies showing lower refracture risks after implant removal. Level III, retrospective cohort study.

Residual C-peptide secretion is associated with better CGM-metrics in adults with short-lasting type 1 diabetes.

To investigate whether the risk of hypoglycemia is associated with residual β-cell function in adults with type 1 diabetes (T1D). This cross-sectional study included 61 subjects with T1D of <15 years' duration using continuous glucose monitoring (CGM). Random C-peptide levels were compared between participants with time below range (TBR) ≥3 % (n = 15) and TBR <3 % (n = 45). The associations of C-peptide levels with other CGM metrics and clinical characteristics of the study participants were also tested. Analyses were adjusted for disease duration. Median [25th - 75th percentiles] C-peptide levels were generally low: 49.3 [15.7-152] pmol/l. Participants in the low-TBR group had significantly higher C-peptide levels compared to those in the high-TBR group (52.9 [19.5-176.3] vs. 21.0 [9.4-106.6] pmol/L, p = 0.036), independently from disease duration. Higher C-peptide levels were associated with better CGM-metrics (p < 0.05). A C-peptide threshold of 15.1 pmol/l was the best cut-off to distinguish people at high risk of hypoglycemia. C-peptide microsecretion is associated with a low risk of hypoglycemia and improved CGM metrics. Therapeutic approaches aimed at preserving minimal C-peptide secretion could potentially enhance glycemic outcomes and reduce hypoglycemic risk in individual with T1D.

Comparison of continuous non-invasive blood pressure measurement using Vitalstream™ to invasive Intraarterial pressure in pediatric surgery.

Accurate blood pressure monitoring is essential in many clinical scenarios for adults and children and, when continuous measurement is critical, necessitates the insertion of an arterial line. A novel continuous non-invasive arterial pressure monitoring device using a pulse contour algorithm (Pulse Decomposition Analysis), Vitalstream™, is approved by the United States Food and Drug Administration for use in adults. In this study the performance and accuracy of the device compared to intraarterial blood pressure monitoring were assessed in children ages 2-17 undergoing major surgeries. We report the results using comparison to aspects of the recently published ISO 81060-3:2022 standard for continuous automated blood pressure measurement. 31 children ages 2-17years scheduled for major surgery requiring invasive arterial blood pressure monitoring were consented to participate. Systolic, diastolic, and mean arterial blood pressure readings were obtained from both systems during at least thirty minutes of simultaneous monitoring during hemodynamically stable periods of the surgical procedure and statistically compared. The correlations of systolic and, diastolic, and mean arterial pressures were, respectively, 0.77, 0.68 and 0.7. The Bland-Altman comparisons yielded bias of -3.79 (9.74) mmHg, 1.72 (8.45) mmHg and 2.41 (8.75) mmHg respectively, for systolic, diastolic, and mean arterial pressures, (p<0.001 for all comparisons). Concordances for systole, diastole and MAP were, respectively, 0.82, 0.85 and 0.83. Most values fell within +/-20mmhg of the corresponding arterial line values. While this meets the basic requirement for such devices published by professional societies, clinicians will need to be aware of the potential variances and make clinical decisions accordingly. The Vitalstream™ may offer low risk, accurate continuous pressure monitoring in children ages 2-17. gov: NCT04817137 The trial was registered at clinicaltrials.gov (NCT048I7173).

Heterogeneity analysis and prognostic model construction of HPV negative oral squamous cell carcinoma T cells using ScRNA-seq and bulk-RNA analysis

BackgroundT cells are involved in every stage of tumor development and significantly influence the tumor microenvironment (TME). Our objective was to assess T-cell marker gene expression profiles, develop a predictive risk model for human papilloma virus (HPV)-negative oral squamous cell carcinoma (OSCC) utilizing these genes, and examine the correlation between the risk score and the immunotherapy response.MethodsWe acquired scRNA-seq data for HPV-negative OSCC from the GEO datasets. We performed cell‒cell communication, trajectory, and pathway enrichment analyses of T-cell-associated genes. In addition, we constructed and validated a T-cell-associated gene prognostic model for HPV-negative OSCC patients using TCGA and GEO data and assessed the immune infiltration status of HPV-negative OSCC patients .qRT-PCR was used to detect the expression level of prognosis-related genes in different risk groups.ResultsScRNA-seq was conducted on 28,000 cells derived from 14 HPV-negative OSCC samples and 6 normal samples. We identified 4,635 T cells from these cells and identified 774 differentially expressed genes(DEGs) associated with T cells across five distinct T-cell subtypes. Through the integration of bulk-RNAseq data, we established a prognostic model based on DEGs related to T cells. By separating patients into high-risk and low-risk groups according to these prognostic related genes, we can accurately predict their survival rates and the immune infiltration status of the TME.qRT-PCR results showed that compared with the patients of low risk group, the expression of PMEPA1, SH2D2A, SMS and PRDX4 were significantly up-regulated in high risk group.ConclusionThis study provides a resource for understanding the heterogeneity of T cells in HPV-negative OSCC patients and associated prognostic risk models. It provides new insights for predicting survival and level of immune infiltration in patients with HPV-negative OSCC.

Outcomes in stage IIA versus stage IIB/III in the PALLAS trial [ABCSG-42/AFT-05/PrE0109/BIG-14-13])

BackgroundThe PALLAS trial investigated the addition of palbociclib to standard adjuvant endocrine therapy to reduce breast cancer recurrence. This pre-specified analysis was conducted to determine whether adjuvant palbociclib benefited patients diagnosed with lower risk stage IIA disease compared to those with higher stage disease.MethodsPALLAS was an international, multicenter, randomized, open-label, phase III trial, representing a public–private partnership between Pfizer, the Austrian Breast Cancer Study Group, and the U.S. ALLIANCE Foundation. Patients diagnosed with stage II–III, hormone-receptor-positive, HER2/neu negative breast cancer within 12 months of diagnosis had completed all definitive therapy aside from endocrine therapy (started within 6 months prior to study entry) were eligible. All patients were required to submit a formalin-fixed paraffin-embedded (FFPE) tumor block. Patients were randomly assigned 1:1 to receive standard adjuvant endocrine therapy (of physicians’ choice) for at least 5 years with or without 2 years of palbociclib, administered orally at a starting dose of 125 mg daily, given for 21 days followed by a 7-day break.ResultsA total of 5,796 patients with HR + /HER2- early breast cancer (including 1,010 with stage IIA) were enrolled. Median follow-up was 50 months for stage IIA patients and 43.1 months overall. In the stage IIA cohort, 4-year iDFS in the palbociclib arm was 92.9% versus 92.1% for ET alone (HR 0.75, 95%CI 0.48–1.19, p = 0.23). There was no differential benefit by histologic grade, chemotherapy receipt, age, or anatomic/clinical risk. Additionally, no benefit to palbociclib was seen in this cohort in invasive breast cancer-free survival (iBCFS), locoregional relapse-free survival (LRFS), distant relapse-free survival (DRFS), or overall survival (OS). For the stage IIB/III patients, 4-year iDFS was 85.3% for palbociclib + ET versus 83.6% for ET alone (HR 0.91, 95% CI 0.77–1.07, p = 0.24).Conclusions and relevanceWhile there were substantial differences in outcome for stage IIA versus IIB/III patients at 4 years of follow-up, the addition of 2 years of palbociclib did not improve outcomes for patients, regardless of stage.Trial Registration ClinicalTrials.gov number NCT02513394 Registered 30 Jul 2015.

Depression as a risk factor for osteoporosis independent of sarcopenia in hemodialysis patients: findings from a multicenter cross-sectional study

BackgroundOsteoporosis and sarcopenia frequently occur in patients with end-stage renal disease undergoing hemodialysis (HD), and depression is also a common mental health issue in this population. Despite the prevalence of these conditions, the interrelationships among them remain poorly understood in HD patients.MethodsIn this multicenter cross-sectional study, 858 HD patients from 7 dialysis centers were recruited. Bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry. Skeletal muscle mass index (SMI) was calculated from body composition data obtained through multifrequency bioimpedance analysis (BIA), while handgrip strength (HGS) was measured with a dynamometer. Gait speed was evaluated with a 4-meter walk test, and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9).ResultsAmong the 858 participants (524 men, 334 women), 39.2% had osteoporosis. The prevalence of sarcopenia and depression was 18.9% and 42.1%, respectively. Logistic regression analysis showed that SMI was significantly associated with a decreased risk of osteoporosis (OR = 0.638, 95% CI = 0.494–0.823, P = 0.001), while HGS was not(OR = 0.990, 95% CI = 0.963–1.017, P = 0.449). HD patients with sarcopenia were 1.92 times more likely to have osteoporosis than those without sarcopenia. Most notably, after adjusting for both sarcopenia and SMI, the risk of osteoporosis in HD patients with depression was 1.45 times higher than in those without depression (OR = 1.452, 95% CI = 1.060–1.989, P = 0.020).ConclusionsIn HD patients, increased muscle mass, rather than muscle strength, is linked to a lower risk of osteoporosis. Notably, depression emerges as a significant risk factor for osteoporosis in this population, highlighting the need for mental health considerations in managing bone health.

Early Neurologic Deterioration and Efficacy of Dual Antiplatelet in Anterior Versus Posterior Circulation Stroke.

Anterior circulation stroke (ACS) differs from posterior circulation stroke (PCS) in several aspects. We hypothesize that the risk of early neurologic deterioration (END) and its responses to clopidogrel plus aspirin versus aspirin alone may be different between stroke territories. This was a prespecified post hoc analysis of ATAMIS (Antiplatelet Therapy in Acute Mild to Moderate Ischemic Stroke) trial and included patients with definite infarct location who were classified into ACS and PCS according to stroke territory. Primary outcome was occurrence of END at 7 days, defined as ≥2-point increase in National Institutes of Health Stroke Scale score compared with baseline. We compared the treatment effects of clopidogrel plus aspirin versus aspirin alone in each stroke territory. From 3000 patients, 2431 eligible patients (1780 with ACS [910 assigned into clopidogrel plus aspirin and 870 assigned into aspirin alone] and 651 with PCS [371 assigned into clopidogrel plus aspirin and 280 assigned into aspirin alone]) were included. Median age was 66 years and 35.1% were women. The occurrence of END was higher in ACS than PCS (6.8% versus 3.8%, P=0.007). clopidogrel plus aspirin was associated with lower risk of END in ACS (risk difference [95% CI]: -2.4% [-4.1% to -0.8%], P=0.004), but not in PCS (risk difference [95% CI]: -0.6% [-2.7% to 1.5%], P=0.57). No significant interaction was found (P=0.69). Our study demonstrated END was higher in acute mild-to-moderate ischemic stroke with anterior circulation, who derived more benefit from clopidogrel plus aspirin than aspirin alone. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02869009.

Effects of surgical approach and downstaging in esophageal adenocarcinoma patients treated with neoadjuvant chemotherapy: a 2010-2020 National Cancer Database (NCDB) study.

Neoadjuvant Chemoradiation (nCRT) has been shown to improve survival in patients with Esophageal Adenocarcinoma (EAC). The objective of this study is to assess the patient characteristics associated with tumor downstaging in a large national database. Additionally, we evaluated surgical approach and change in clinical versus pathological staging as predictors of patient survival. Using the 2010-2020 National Cancer Database, we identified 6,400 patients with clinical stage 1B to 4A EAC who received nCRT and underwent esophagectomy. Multivariable logistic models were estimated to evaluate odds of downstaging, and complete downstaging. Multivariable marginal Cox proportional-hazard models were estimated to evaluate all-cause mortality hazard. 3285 (51%) patients downstaged (of which 292 [5% of total] completely downstaged), 2430 (38%) had no change in stage, and 685 (11%) progressed. Generally, higher covariate values such as Clinical T, Clinical N, age, and Charlson-Deyo score were associated with higher odds of downstaging and lower odds of complete downstaging. Downstaging was associated with 31% lower risk of death compared to progression (p < .001) and 17% lower risk of death compared to no change (p < .001). Regarding surgical approach, when compared with open esophagectomy (OE), robotic-assisted minimally invasive esophagectomy (RAMIE) was associated with 17% lower adjusted risk of death (p = .002) while minimally invasive esophagectomy (MIE) was associated with a 10% decrease in adjusted risk of death (p = .009). In patients with EAC who underwent nCRT, pathological downstaging was associated with increased survival compared to no change or progression. Additionally, RAMIE and MIE were associated with lower risk of death compared to OE.

Long-term exposure to air pollution and greenness in association with respiratory emergency room visits and hospitalizations: The Life-GAP project.

Air pollution has been linked to respiratory diseases, while the effects of greenness remain inconclusive. We investigated the associations between exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3), and greenness (normalized difference vegetation index, NDVI) with respiratory emergency room visits and hospitalizations across seven Northern European centers in the European Community Respiratory Health Survey (ECRHS) study. We used modified mixed-effects Poisson regression to analyze associations of exposure in 1990, 2000 and mean exposure 1990-2000 with respiratory outcomes recorded duing ECRHS phases II and III. We assessed interactions of air pollution and greenness, and of atopic status (defined by nasal allergies and hay fever status) and greenness, on these outcomes. The analysis included 1,675 participants, resulting in 119 emergency visits and 48 hospitalizations. Increased PM2.5 by 5 μg/m³ was associated with higher relative risk (RR) of emergency visits (1990: RR 1.16, 95% CI: 1.00-1.35; 2000: RR 1.24, 95% CI: 0.98-1.57; 1990-2000: RR 1.17, 95% CI: 0.97-1.41) and hospitalizations (1990: RR 1.42, 95% CI: 1.00-2.01; 2000: RR 2.20, 95% CI: 1.43-3.38; 1990-2000: RR 1.44, 95% CI: 1.04-2.00). Similar trends were observed for PM10, BC, and NO2, with only PM10 showing significant associations with hospitalizations across all periods. No associations were found for O3. Greenness exposure was linked to more emergency visits in 2000 but to fewer hospitalizations in 1990. Significant interactions were observed between greenness and atopic status for emergency visits, and between NDVI with O3 and BC for some time windows. Long-term exposure to particulate matter was associated with increased emergency room visits and hospitalizations. Significant associations were observed for BC and NO2 with hospitalizations. No link was found with O3. Greenness indicated a lower risk of hospitalizations, but increased risks for emergency visits for those with atopic status.

Associations of the serum 25-hydroxyvitamin D with mortality among patients in osteopenia or osteoporosis.

The correlation between serum vitamin D and mortality in patients with osteopenia or osteoporosis remains unclear. Therefore, this study examined the relationship between serum 25-hydroxy vitamin D [(25(OH)D] and mortality in patients with osteopenia or osteoporosis. This prospective cohort study included patients with osteopenia or osteoporosis from the National Health and Nutrition Examination Survey from 2001 to 2018. Multivariate Cox regression models examined the correlation between serum 25(OH) D and all-cause mortality, cardiovascular mortality (CVD), and cancer mortality. The cohort included 9282 adult participants with a median follow-up period of 97.01 months, including 1394 all-cause deaths, 413 CVD-related deaths, and 322 cancer deaths. In fully adjusted models, higher serum 25(OH) D levels (≥75.0 nmol/L) were associated with a lower risk of all-cause mortality (hazard ratio 0.54, 95 % confidence interval 0.41 to 0.73) and cardiovascular death (0.47, 0.29 to 0.76), using participants with low 25(OH) D levels (<25 nmol/L) as the reference. In addition, we found an L-shaped non-linear dose-response relationship between serum 25(OH) D and all-cause and cardiovascular mortality, with inflection points of 38.8 nmol/L and 53.6 nmol/L, respectively. Higher serum 25(OH) D concentrations are strongly associated with a diminished risk of all-cause and CVD mortality in patients with osteopenia or osteoporosis, this association has a threshold effect. More in-depth intervention studies are needed to clarify underlying mechanisms.

Post-transplant cyclophosphamide versus anti-thymocyte globulin in haploidentical stem cell transplantation: a systematic review and meta-analysis.

Post-transplant cyclophosphamide (PTCy) and anti-thymocyte globulin (ATG) are mainstay prophylactic treatment options for graft-versus-host disease (GVHD), widely used in haploidentical stem cell transplantation. Due to a lack of prospective studies, a number of retrospective comparisons have yielded different conclusions as to which prophylaxis regimen is superior. We performed a meta-analysis of these studies to get more informed and comprehensive decisions from clinicians. Nine studies were eligible, and a total of 1674 patients were included. The combined hazard ratio (HR), relative risk (RR), and weighted mean difference (WMD) results demonstrated that, compared with ATG, PTCy demonstrated better overall survival (OS) (HR 0.7, 95% CI 0.51-0.97), leukemia-free survival (LFS) (HR 0.66, 95% CI 0.53-0.81), and GVHD-free/relapse-free survival (GRFS) (HR 0.79, 95% CI 0.65-0.97); faster lymphocyte reconstitution, lower risk of relapse (HR 0.69, 95% CI 0.53-0.9) and fungal infection (RR 0.23, 95% CI 0.07-0.79). However, neutrophil engraftment was delayed in the PTCy regimen group (WMD 3.29, 95% CI 2.49-4.10). No statistically significant differences were observed in the time to platelet engraftment, bacterial infection, or viral infection, including cytomegalovirus, polyomaviruses BK/JC and Epstein-Barr virus. Nor was any statistically significant difference observed in the incidences of II-IV acute-GVHD (aGVHD) (HR 0.81, 95% CI 0.62-1.05), III-IV aGVHD (HR 0.67, 95% CI 0.22-2.19) or severe chronic-GVHD (cGVHD) (RR 1.22, 95% CI 0.51-2.88), or non-relapse mortality (NRM) outcomes (HR 0.67, 95% CI 0.4-1.11). Therefore, in haploidentical transplantation, PTCy accelerates lymphocyte reconstitution, significantly reduces the risk of recurrence and fungal infection, and improves the OS, LFS and GRFS, compared with ATG, with no significant difference in the efficacy of preventing acute or severe cGVHD, or the risk of bacterial or viral infection.

Risk of Lymph Node Metastasis in T2 Colon Cancer: A Nationwide Population-Based Cohort Study.

Similar to T1 colon cancer (CC), risk stratification may guide T2 CC treatment and reduce unnecessary major surgery. In this study, prediction models were developed that could identify T2 CC patients with a lower risk of lymph node metastasis (LNM) for whom (intensive) follow-up after local treatment could be considered. A nationwide cohort study was performed involving pT2 CC patients who underwent surgery between 2012 and 2020, using data from the Dutch ColoRectal Audit, which were linked to the Nationwide Pathology Databank. Four machine learning models were evaluated to predict LNM. LNMs were found in 1877/9803 patients (19.1%). Independent risk factors included (younger) age (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.979-0.990), left-sided CC (OR 1.5, 95% CI 1.4-1.7), poor differentiation (OR 1.7, 95% CI 1.4-2.2), and lymphovascular invasion (LVI; OR 4.1, 95% CI 3.6-4.7). A deficient mismatch repair (MMR) status significantly lowered the risk of LNM (OR 0.3, 95% CI 0.2-0.5). The general linear model demonstrated the highest prediction accuracy, achieving area under the receiver operating characteristic curves of 0.67 and 0.68, with good calibration. In the absence of risk factors, elderly patients (≥74years of age) had a predicted risk of LNM of 10.7%, yet up to 30% experienced postoperative complications, with mortality rates reaching up to 3.5%. Patients with a deficient MMR status had a predicted risk of LNM of 6.1% if LVI was absent and the tumor was well-differentiated. The risk of LNM should be weighed against surgical risks. The findings of this study will enable clinicians to make more deliberate considerations about these competing risks before making a shared decision.

Optimal portfolio choice under kinked power utility

We extend the kinked power utility function by allowing a different risk aversion level in the two parts contained in the utility function. We maximize the expected utility of the replacement ratio at retirement that is wealth at retirement to a stochastic benchmark, for plan members in a defined contribution pension plan in a complete market. We derive closed-form optimal solutions under risk aversion and loss aversion implied by the kinked power utility. We find that plan members under kinked power utility tend to de-risk around the reference level, which could lead to a great proportion of the replacement ratio at retirement being on the reference level, while a small variation in the proportion of the replacement ratio at retirement ending up in the left tail. When the reference level is set at 100%, and the market price for future pension premiums (the value of initial capital) is lower than that for the benchmark, a lower risk aversion level when the replacement ratio falls below the reference level, could lead to a significant increase in the proportion of the replacement ratio at retirement being not below the reference level.

Associations of objectively measured physical activity and sedentary time with all-cause mortality in Japanese older adults: a 10-year prospective study

ObjectiveTo examine the associations of accelerometer-measured physical activity and sedentary time with all-cause mortality in older Japanese adults.MethodsA total of 1723 independent Japanese adults aged ≥65 years were followed from...

P1103 Thromboembolic and cardiovascular risk profiles in ulcerative colitis patients initiating advanced therapies: a single-center study

Abstract Background IBD, especially during flare periods, seems to be associated with an increased risk of thromboembolic and cardiovascular(CV) events[1]. After the results of the ORAL Surveillance study[2] enrolling patients with rheumatoid arthritis, several concerns have also been raised on the intrinsic risk of Janus kinase inhibitors (JAK-i), though the population enrolled was predominantly &amp;gt;50 years old and had several CV risk factors (CVRF). Accordingly, regulatory agencies recommend that JAK-i should be used only if no suitable treatment alternatives are available in patients at increased CV risk for all indications [3]. However, the real prevalence of CVRF and the risk related to JAK-i seem to be lower for patients with UC. The aim of our study is to explore the prevalence of thromboembolic and CV risks factors in a large cohort of UC patients suitable for advanced therapies. Methods We conducted a single-centre study including all consecutive adult patients with UC who initiated advanced therapies between Jun-20 and Dec-23. To assess thrombosis and CV risk, we collected all anamnestic, clinical and laboratory data from the medical records. In addition, we used an online questionnaire to collect all other information that were not available in routine clinical records. To assess CV risk, we calculated the 10-year CV risk score using the American College of Cardiology ASCVD Risk Estimator[4]. Results Out of 305 patients surveyed, we had a 100% response rate: 53.5% male, with a median age of 44 years. Overall, 39.0% were biologic-naïve, and 21.6% started a Janus kinase inhibitor (JAK-i). Baseline patients’ characteristics and variables collected are shown in Table 1 and Table 2, respectively. Cumulatively, 184 patients (60.3%) had 0-1 thromboembolic risk factors, 73 patients (23.93%) had 2 risk factors, 34 patients (11.2%) had 3 risk factors, 8 patients(2.6%) had 4, and 6 patients(1.9%) had 5 or 6 thromboembolic risk factors. Complete cholesterol data were available for 171 patients, but ASCVD score has been calculated only for 153 patients(median age 49 years) with LDL-C levels &amp;gt;70 mg/dL. Among them, 67.3% were classified as low risk, 6.5% as borderline risk, 20.9% as intermediate risk, and 5.2% as high risk. When CV risk was stratified by age, 66.7% of elderly patients (aged 65 years or older) were classified as intermediate risk, while 20.8% were high risk. In contrast, 79.1% of non-elderly were categorized as low risk, 12.4% at intermediate risk and 2.3% at high risk. Conclusion Our study confirms the prevalence of thrombotic and CVRF among patients affected by UC is quite low and mostly related to age. Accordingly, the concerns regarding the use of JAK-i observed in rheumatological cohorts may not be fully applicable for patients with UC.

P1227 Predictors of biologics/JAKi use, surgeries, and hospitalisations in a newly diagnosed cohort of IBD patients: Long-term outcomes from the nationwide EpidemIBD study of GETECCU

Abstract Background Factors influencing the exposure to targeted therapies (biologics/JAKi), intestinal resections and hospitalisations in newly diagnosed IBD patients have been scarcely studied. Aim: To identify predictive factors of exposure to biologics/JAKi, surgeries, and hospitalisations within the first five years in IBD patients. Methods Prospective, population-based nationwide registry. Adult patients diagnosed with IBD [Crohn’s disease (CD), ulcerative colitis (UC) or IBD unclassified (IBD-U)] during 2017 in the 17 Spanish regions were included. Patients who consented were followed-up for 5 years after diagnosis. Multivariate analyses were performed to identify the predictive factors for biologics/JAKi use, surgeries, and hospitalisations. To this end, only abdominal surgeries were analysed, and early treatment with immunomodulators or biologics/JAKi drugs were considered if these had been prescribed within the first six months of diagnosis. Results A total of 1,526 patients diagnosed with CD and 1,633 with UC were included (figure 1). The cumulative incidence of exposure to biologics/JAKi drugs, surgeries, and hospitalisations were analysed, and predictive factors were identified. Regarding the predictors of exposure to biologics/JAKi treatments, we observed that younger age, more aggressive phenotype of CD and greater extent of UC were associated with a higher risk of exposure (table 1). Furthermore, smoking was associated with a higher likelihood of exposure to biologics/JAKi drugs in patients with CD (HR=1.33, 95%CI=1.11-1.60) while in UC patients it was associated with a lower risk (HR=0.56, 95%CI=0.35-0.89). Concerning surgeries (table 1), early treatment with immunomodulators was associated with a lower risk in patients with CD (HR=0.33, 95%CI=0.22-0.49), whereas early use of biologics/JAKi drugs was associated with a higher likelihood of surgery in patients with UC (HR=11.86, 95%CI=4.62-30.42). Finally, the exposure to biologics/JAKi drugs was associated with a lower risk of hospital admissions both in patients with CD (HR=0.37, 95%CI=0.24-0.56) and UC (HR=0.45, 95%CI=0.22-0.91) (table 1). Conclusion The exposure to biologics/JAKi drugs is mediated by the more aggressive phenotype of CD, greater extent of UC, and younger patient age. The use of biologics/JAKi drugs, as currently practiced, is associated with a lower risk of hospitalisations but does not reduce the need for surgery, even when administered early. There is an unmet need for more accurate identification of patients who require these treatments to modify the natural course of the disease.

Managing Pregnancies of Unknown Location With the M4 Prediction Model or the NICE Algorithm: A Randomised Controlled Trial With Cross-Sectional Diagnostic Accuracy Data.

To determine the diagnostic performance and clinical utility of the M4 prediction model and the NICE algorithm managing women with pregnancy of unknown location (PUL). The study has a superiority design regarding specificity for non-ectopic pregnancy for M4, given that the primary outcome of sensitivity for ectopic pregnancy (EP) is non-inferior in comparison with the NICE algorithm. Emergency gynaecology units in Sweden. 595 women with PUL. Participants were randomised (1:1) to M4 or the NICE algorithm after two serum human chorionic (hCG) levels and were categorised as high or low risk of having an EP. The diagnostic performance was evaluated on cross-sectional data and utility by parallel groups. The proportion of EP categorised as high risk (sensitivity) and non-ectopic pregnancies categorised as low risk (specificity). Clinical outcomes were assessed. The sensitivity for EP was 79% (115 of 146) for M4 versus 85% (124 of 146) for the NICE algorithm, p = 0.1496 and the specificity for non-ectopic pregnancies was 67% (300 of 449) for M4 and 74% (334 of 449) for the NICE algorithm, p = 0.0003. Clinical outcomes were similar between groups. The sensitivity for EP by M4 was non-inferior to NICE, but specificity was better for the NICE algorithm. No between group differences were observed for clinical outcomes. NCT03461835, https://www. gov.