Median Interquartile Range Research Articles

Tumour size is associated with growth rates of >0.5 cm/year and delayed intervention in small renal masses in patients on active surveillance.

To evaluate the association between tumour size and the growth rate (GR) of small renal masses (SRMs) in patients managed by active surveillance (AS). We queried the prospective, multi-institutional Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry for patients on AS with an imaging interval of ≥6 months, identifying 456 patients. We tracked tumour size over time; a GR >0.5 cm/year was defined as a GR event. We used multivariable recurrent events and time-to-event Cox regression modelling to evaluate the association between tumour size and GR events (primary outcome) and tumour size and delayed intervention (DI; secondary outcome). We tested tumour size as a continuous variable and dichotomised tumour size by predefined (2-cm) and calculated (2.9-cm) cutoffs. We calculated the cutoff using maximally selected rank statistics and time to progression, defined according to the DISSRM registry. The median (interquartile range) follow-up of patients on AS was 40.1 (26.4-71.2) months, during which 128 patients (28%) had ≥1 GR event, and 80 (18%) underwent DI. Larger tumour size was an independent predictor for GR events and DI when tested as a continuous and a dichotomous variable in multivariable analyses (all P < 0.05). The association was strongest when accounting for the change in tumour size over time and when applying the 2.9-cm cutoff. The study is limited by the mixed tumour pathology inert to SRMs. Larger tumour size was independently associated with GR events and DI for patients with SRMs on AS. A 2.9-cm cutoff may provide valuable information for patient counselling.

Association between enteral carboxymethyllysine intake and daily glycemic variability in critically ill adults: A retrospective cohort study.

Advanced glycation end-products (AGEs) can enter patients' circulation through exogenous sources, such as enteral nutrition formulae. Circulating AGEs, specifically carboxymethyllysine, can promote insulin resistance and activation of pro-inflammatory pathways leading to oxidative stress, cell death, and organ failure. Suboptimal kidney function increases the risk of elevated circulating AGEs because levels are controlled through urinary excretion. Our aim was to determine associations between carboxymethyllysine intake and glycemic control as well as clinical outcomes in critically ill patients and explore these in the subset of patients with an acute kidney injury (AKI). This was a retrospective cohort study. Data were extracted from electronic medical records. Patients were eligible if they were ≥18 years and received enteral nutrition, with known carboxymethyllysine content, for ≥3 days. AKI was defined using the Kidney Disease: Improving Global Outcomes guidelines. Linear and logistic regression models were used to determine adjusted associations. Between 2015 and 2021, 2636 patients met the eligibility criteria, with 848 (32%) patients having an AKI. Most were male (n = 1752, 67%) with a median (interquartile range) Acute Physiology And Chronic Health Evaluation III score of 59 (45-77). For every 10-μmol increase in carboxymethyllysine provision, mean blood glucose increased by 0.05 mmol (95% CI, 0.03-0.07), and the odds of dying increased by 16% (odds ratio = 1.16; 95% CI, 1.06-1.27). A subgroup analysis indicated these associations persisted in patients with AKI but not in those without. Carboxymethyllysine intake was associated with increased mean blood glucose and odds of dying in our study cohort.

Tumor-Infiltrating Lymphocytes Assessed Using the International TILs Working Group System Are Not Prognostic in Medullary Thyroid Cancer.

Background: Tumor-infiltrating lymphocytes (TILs) are a protective prognostic factor in several solid tumors and predict response to immune checkpoint inhibitor therapy. The prognostic impact of TILs in medullary thyroid cancer (MTC) is poorly understood. Materials and Methods: In this retrospective cohort study, we assessed the TILs profile of primary MTC tumors using the International TILs Working Group system and correlated this with clinicopathological prognostic variables, including the International Medullary Thyroid Cancer Grading System (IMTCGS) grade and survival outcomes. Results: We identified 71 patients with primary MTC tumors who were treated surgically between 1995 and 2016 at the Royal North Shore Hospital in Sydney, Australia. The median (interquartile range) duration of follow-up was 69 (90) months. Using the ITWG system, all patients with MTC had low TILs, with a median (range) of 3% (0-10%). This group was further subdivided into "very low" (0-4%) and "low" (5-10%), and on Cox regression analysis, increasing TILs were associated with increased local recurrence (log-rank p = 0.022, odds ratio [OR] 1.94 [confidence interval or CI 0.61-6.16], p = 0.26), reduced disease-specific survival (log-rank p = 0.015, OR 5.11 [CI 1.01-26.0], p = 0.049), and a trend to decreased distant metastasis-free survival (log-rank p = 0.14). When examining the association between TILs and other prognostic factors, only "high IMTCGS grade" was significantly associated with increased TILs (OR 7.29 [CI 1.21-43.90], p = 0.015). In the multivariable logistic regression analysis, there was no significant association between TILs and local recurrence or disease-specific survival. Conclusions: In our study, the prognostic value of TILs in MTC was limited. Even high-grade MTC can be considered an immune quiescent tumor, and the adverse prognostic factors associated with higher grade tumors outweigh the marginal increase in immune recognition associated with a slight increase in TILs. The low level of TILs in MTC and their lack of correlation with survival suggest that immune checkpoint inhibitor therapy may not be effective.

Appropriate Blood Usage and Adherence to Guidelines in Orthopaedic Patients Managed at Moi Teaching and Referral Hospital, Eldoret, Kenya

Blood transfusion is required in the management of life threatening orthopaedic trauma hemorrhage. However, this practice is faced with erratic supply, increasing demand for safe blood and inappropriate transfusions which may expose patients to transfusion associated risks. Appropriate use of blood and related products as well as adherence to transfusion guidelines has been shown to ameliorate these challenges. This study set out to determine the appropriate blood and blood components usage and adherence to guidelines in orthopaedic patients managed at Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Descriptive cross-sectional study design was and involved 132 transfused orthopedic trauma patients, recruited by consecutive sampling, between March 2019 and January 2020. Data was collected using interviewer administered structured questionnaire. Continuous data were summarized as median (inter-quartile range) and categorical data as frequency tables and proportions. Fisher’s Exact Test was used to assess associations between categorical variables and non-parametric Kruskal-Wallis Test was used for continuous independent variables. A p value &lt; 0.05 was considered statistically significant. The results: Males were 101 (76.5%), median age was 36 (IQR 28, 47) years, majority of the patients, 95 (72%) were referrals, 64 (48.5%) were unskilled workers and 64 (48.5%) had primary school level of education. Most of the patients, 105 (79.5%) were injured in road traffic accidents. Most patients, 105 (79.5%) and 115 (87.1%) had normal pulse rate and systolic blood pressure respectively while 77 (58.3%) had increased respiratory rate. The median pre-transfusion haemoglobin was 8.90 (IQR 7.98, 10.35) g/dl and the commonest blood group was O positive. Patients with isolated femur fractures were 62 (47.0%). Patients who underwent primary open reduction and internal fixation were 61(46.2%). Majority of the patients, 127 (96.2%) received packed red blood cells. The proportion adherent to transfusion guidelines was 16.7% [95% CI: (10.75, 24.14)]. The factors associated with adherence were pre-transfusion haemoglobin and haematocrit levels, Fisher’s Exact and Kruskal-Wallis p value being &lt; 0.001. Mild transfusion reactions were noted in 15 (11.4%) patients. Conclusions made were that most patients were males, transfused with packed red blood cells and majority of injuries sustained were due to road traffic accidents. The level of adherence to the institutional transfusion guidelines was low at 16.7%. Factors associated with transfusion guidelines adherence were pre-transfusion haemoglobin and haematocrit levels. The recommendation was that Moi Teaching and Referral Hospital Transfusion Committee should increase transfusion guidelines awareness among clinicians in orthopaedic trauma.

Impact of a new image enhancement technology on the nuchal translucency thickness.

To examine the impact of a new image enhancement technique on the distribution of NT measurements. In this retrospective study, nuchal translucency (NT) images that were taken with the GE Voluson E22 ultrasound machine between May and September 2024 were collected. One operator took manual and automated NT measurements in an NT image without radiant enhancement mode followed by automated measurements in NT images with minimum, medium and maximum radiant mode. The automated measurement in the NT images without radiant mode were considered gold standard. The relative bias of the gold standard, the manual measurement and the automated measurements with the radiant enhancement technology were compared using median and 25-75th interquartile range as well as by the Wilcoxon test. The database search yielded 352 NT images from 101 pregnant women. Average maternal age of the study population was 34.0 years and average crown-rump length was 68.3. The median NT thickness was 1.7 mm for both the manual and automated measurements done without the use of radiant mode. The median automated measurement with minimum, medium and maximum radiant mode was 2.00, 2.05 and 2.10 mm, respectively. All automated measurements were significantly higher than the gold standard. The use of the radiant mode results in an increase in the NT thickness. This effect should be taken into account when calculating the risk for chromosomal abnormalities.

A comparative study of the effect of capsular repair in the Latarjet procedure

BackgroundLong term studies have shown the Latarjet procedure to be successful in preventing re-dislocation in primary and recurrent anterior inferior shoulder instability. It provides stability through the sling effect of the conjoint tendon and the bone block. It is unclear whether augmentation with capsular repair provides an added benefit or leads to restricted range of external rotation. The primary aim of this study is to evaluate the effect of capsular repair in the open Latarjet procedure on rotational range of active external rotation in 90 degrees abduction (RoM-ER90). The secondary aim is to evaluate the effect on clinical outcomes including post-operative apprehension, instability, proprioception and shoulder function scores.MethodsThis is a multi-national retrospective cohort study including patients with a minimum of 6-months follow-up post Latarjet procedure performed between 2016 and 2020 recruited from 3 units in Australia and France. Range of motion was measured using a Proteck goniometer. Clinical outcomes were assessed using the Western Ontario Shoulder Instability Index (WOSI), Oxford shoulder, Oxford instability, Walch-Duplay and Rowe scores. Shoulder proprioception was assessed by the active relocation test described by Glendon et al.ResultsForty-four patients were included, median age was 29.5 years and 91% male. Three groups were assessed, open latarjet with no capsular repair (OL n = 11), open latarjet with capsular repair (OLCR n = 20), and arthroscopic Latarjet without capsular repair (AL n = 13). There was no apparent effect of capsular repair on the ROM-ER 90 in the open groups with a median (interquartile range) of 78° (72°, 90°) for OL and 84° (75°, 90°; P = 0.87) for OLCR groups. Capsular repair and arthroscopic approach did not affect the proportion of patients reporting shoulder apprehension (P = 0.52 and 0.48 respectively). There was no difference in proprioception between operative and non-operative sides for the OL group (P = 0.43). Proprioception was poorer on the operative side for the OLCR group (P = 0.04) but better on the operative side for the AL group (P = 0.08). WOSI scores for the open surgical groups were similar (OL = 78, OLCR = 80, P = 0.91) and when combined (median WOSI = 79) demonstrated greater stability than the AL group (P = 0.009). There was no evidence of an effect of capsular repair or arthroscopic approach on the Walch-Duplay, Oxford Instability, or Rowe scores.ConclusionsThere is no significant difference in ROM-ER 90 or WOSI score in patients who undergo the Latarjet procedure with and without capsular repair. The arthroscopic Latarjet may preserve proprioception but did not improve shoulder stability compared to the open Latarjet.Level of evidenceIII, retrospective cohort study.

D-dimer cutoff values for predicting functional prognosis in patients with severe head trauma: a multi-centre prospective observational study.

D-dimer, a fibrinolysis indicator, may predict functional and life outcomes in traumatic brain injury (TBI) patients. We aimed to identify optimal D-dimer cutoff values for poor functional outcomes in severe TBI. We used data from a multi-centre prospective observational cohort study that included patients with TBI with a Glasgow Coma Scale (GCS) score ≤ 8 within 48h after injury or required neurosurgical procedures. We selected patients admitted ≤ 1h after injury. Neurological function at discharge was assessed using the modified Rankin Scale (mRS). The association between D-dimer levels at admission and neurological function (mRS ≥ 4 or < 4), adjusted for age, GCS, systolic blood pressure, and head abbreviated injury scale (AIS) score, was determined by logistic regression analysis. The predictive utility of D-dimer levels was assessed using the area under the receiver operating characteristic curve (AUC), with the cutoff value being determined using Youden's index. Among the 336 patients, most were male; approximately half had experienced motor vehicle accidents. The median (interquartile range) of age, GCS scores, and head AIS scores were 65 (40.25 - 78.75) years, 7 (4 - 9), and 5 (4 - 5), respectively. Overall, 214 (63.7%) patients had poor neurological function (mRS ≥ 4). D-dimer levels > 28µg/mL predicted poor functional prognosis (odds ratio = 3.84 [95% confidence interval 1.62 - 9.11]); the AUC and cutoff values were 0.73 and 27.2µg/mL, respectively. A cutoff value of 27.2µg/mL for early-stage D-dimer levels could predict the functional prognosis of patients with severe isolated TBI.

Metabolic syndrome is associated with postoperative complications after holmium laser enucleation of the prostate.

To compare postoperative complication rates of patients with metabolic syndrome (MetS) with patients without MetS after holmium laser enucleation of the prostate (HoLEP) for management of benign prostatic hyperplasia (BPH). We retrospectively reviewed patients aged >40 years who underwent HoLEP at our institution from 2007 to 2022. Criteria for MetS were diagnoses of at least three of the following: diabetes mellitus, hypertension, hyperlipidaemia, or obesity (body mass index ≥30 kg/m2). Uni- and multivariable logistic regression were used to compare the likelihood of immediate, 30-day, and 90-day complications between groups. A total of 1500 patients were included with a median (interquartile range) age of 70 (65-76) years. Patients with MetS were more likely to develop complications at both 30 and 90 days, including urinary incontinence, irritative voiding symptoms, and bleeding (P < 0.001). After adjusting for potential confounders, patients with MetS had a greater than three times odds of both 30- and 90-day complications compared to patients without MetS (30-day adjusted odds ratio [aOR] 3.32, 95% confidence interval [CI] 2.21-5.01, P < 0.001; and 90-day aOR 3.64, 95% CI 2.49-5.31, P < 0.001). Metabolic syndrome was associated with a three-fold likelihood of 30- and 90-day complications after HoLEP. This could be an important factor to consider in preoperative counselling and patient selection.

Joint and independent associations of dietary antioxidant intakes with all-cause and cardiovascular mortality among patients with hypertension: a population-based cohort study

BackgroundThe evidence regarding dietary antioxidant intake and all-cause and cardiovascular disease (CVD) mortality among patients with hypertension is scarce.Methods and resultsThis study included 16,190 adults with hypertension from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. Death outcomes were ascertained by linkage to National Death Index records through December 31, 2019. Overall dietary intake was estimated with composite dietary antioxidant index (CDAI). Cox proportional hazards models were used to estimate the risk for all-cause and CVD mortality. Kaplan–Meier curve was used to illustrate the survival probabilities among CDAI quartiles. Weighted quantile sum (WQS) regression was conducted to evaluate the joint and independent associations of antioxidants with all-cause and CVD mortality. The median (interquartile range) age of participants was 59.00 (47.00, 69.00) years. During a median of 94 months of follow-up, 3,858 deaths were documented. Compared to participants with the lowest quartile of CDAI, the multivariable adjusted HR and 95% CI for participants with the highest quartile was 0.76 (0.64, 0.91) for all-cause mortality. The highest quartile (Q4) of vitamin E (HR = 0.69; 95% CI, 0.59–0.80), selenium (HR = 0.84; 95% CI, 0.70–1.00) and total carotenoids (HR = 0.86; 95% CI, 0.75–0.98) intakes were negatively associated with all-cause mortality. Vitamin E and selenium intakes might be the major contributors to this negative relationship. The highest quartile (Q4) of vitamin E (HR = 0.72; 95% CI, 0.56–0.93) intake was negatively associated with CVD mortality.ConclusionHigher overall dietary antioxidant intake was significantly associated with decreased all-cause and CVD mortality among patients with hypertension. Further randomized controlled trials are required to confirm our findings.

Efficacy and safety of JMT103 in patients with bone metastases from solid tumors: A randomized Phase Ib clinical trial.

This study aimed to assess the efficacy and safety of three dosing regimens of JMT103 in patients with bone metastases from solid tumors. Eligible patients were randomly assigned to receive JMT103 subcutaneously, 120 mg every 4 weeks (Cohort 1), 120 mg every 8 weeks (Cohort 2), or 180 mg every 8 weeks (Cohort 3) for up to 49 weeks. The primary endpoint was change from baseline to Week 13 in creatinine-adjusted urinary N-telopeptide (uNTx/Cr). Two hundred and ninety-five patients were randomized, and 293 received at least one dose of JMT103, of whom 96 were assigned to Cohort 1, 97 were assigned to Cohort 2, and 100 were assigned to Cohort 3. The median (interquartile range) percentage reduction in uNTx/Cr at Week 13 was 80.0% (49.9%, 93.4%) in Cohort 1, 73.0% (34.5%, 94.0%) in Cohort 2, and 75.7% (40.4%, 92.0%) in Cohort 3, respectively. On-study skeletal-related events were reported by 3.1% of patients in Cohort 1, 6.2% in Cohort 2, and 7.0% in Cohort 3. Treatment-emergent adverse events occurred in 289 patients, 162 of whom were deemed treatment-related. The most common treatment-related adverse events were hypocalcemia (23.2%), hypophosphatemia (22.9%), and increased aspartate transaminase (11.9%). JMT103 demonstrated a good safety and a strong suppression of the bone turnover markers.

Association of prostate-specific antigen density with prostate cancer mortality after a benign systematic prostate biopsy result.

To assess the association between prostate-specific antigen (PSA) density (PSAD) and prostate cancer mortality after a benign result on systematic transrectal ultrasonography (TRUS)-guided prostate biopsy. This retrospective study used data from the Finnish Randomised Study of Screening for Prostate Cancer (FinRSPC) collected between 1996 and 2020. We identified men aged 55-71 years randomised to the screening arm with PSA ≥4.0 ng/mL and a benign systematic TRUS-guided biopsy result. The cumulative prostate cancer mortality of men stratified by a PSAD cutoff of 0.15 ng/mL/cm3 was modelled with competing risk functions. The ability of PSAD, PSA, and base variables (age at biopsy, DRE result, socioeconomic status, 5α-reductase inhibitor usage, family history, and Charlson Comorbidity Index (CCI)) to predict prostate cancer death was compared using c-statistics and a likelihood ratio test. After excluding 10 men without PSA data within 2 years of the biopsy and 65 without prostate volume data, 2276 men were eligible for inclusion in the study. A total of 50 men died from prostate cancer and 1028 from other causes during a median (interquartile range) follow-up of 17.4 (13.2-20.9) years. The cumulative prostate cancer mortality of men with PSAD <0.15 ng/mL/cm3 was significantly lower than that of men with PSAD ≥0.15 ng/mL/cm3: 0.5% (95% confidence interval [CI] 0.2%-1.1%) vs 2.0% (95% CI 1.2%-3.1%) at 15 years (Grey's test, P = 0.001). The model consisting of PSAD, PSA and the base variables predicted prostate cancer mortality (c-statistic 0.781) significantly better than either the base variables alone (c-statistic 0.737; likelihood-ratio test, P = 0.003) or the base variables and PSA (c-statistic 0.765; likelihood-ratio test, P = 0.039). Prostate cancer mortality after a benign systematic TRUS-guided biopsy is low. In these patients, PSAD predicts prostate cancer mortality and provides additional value to other clinical variables. PSAD-based stratification can be used to guide follow-up strategy.

P0324 Lower Bone Mineral Density and alterations in bone biomarkers DKK-1, Sclerostin, and Periostin in individuals with Inflammatory Bowel Disease

Abstract Background Inflammatory Bowel Disease (IBD) affects the gastrointestinal tract but often presents with extraintestinal manifestations in many patients, including the decline in bone mass. The pathogenesis of IBD is primarily attributed to disturbances in immune responses within the gastrointestinal mucosa and potential disruptions in gut microbiomes. The inflammation of gastrointestinal tract triggers various systems, including the Wnt pathway, which is associated with bone loss. This study explores the alterations in Bone Mineral Density (BMD) and the levels of dickkopf-1(DKK-1), sclerostin (SOST), periostin (POSTN) and bone metabolism markers in IBD patients. Methods We evaluated a cohort of 89 individuals diagnosed with IBD (64% male, 65% with Crohn’s disease, and 35% with ulcerative colitis) with a median (interquartile range) age of 39(28, 54) years and 73 controls of 42(29, 54) years. Bone Mineral Density (BMD) was evaluated using dual-energy x-ray absorptiometry (DXA). We also measured DKK-1, SOST, POSTN, biochemical parameters and bone metabolism markers in the plasma and serum of participants. Results Femoral neck BMD Z-score was lower -0.7(-1.65, 0.2) vs -0.3(-1.1, 0.2) SD, p=0.04, while there was a trend for lower lumbar spine BMD Z-score in patients. Increased C-terminal telopeptides (CTX) 0.49(0.28, 0.68) vs 0.34(0.24, 0.47) pg/mL, p&amp;lt;0.001 and N-terminal telopeptides (NTX) levels 17(13, 23) vs 13.5(11, 18) nMBCE, p&amp;lt;0.001 were observed in patient group, while procollagen-1 N-propeptide and osteocalcin levels had comparable levels. Phosphorus and 25(OH)D levels were comparable between groups, while calcium levels were higher in patients 9.4(9, 9.7) vs 8.9(8.7, 9.2) mg/dl, p=0.02. Parathyroid hormone (PTH) 42(33, 54) vs 51(37, 63) pg/mL, p=0.009 as well as magnesium levels 2(1.8, 2.1) vs 2.1 (2, 2.2), p=0.02 were lower in the patient group. IBD patients exhibited elevated DKK1 levels 2359 (2104, 2583) vs 1580(1419, 1733) pg/mL, p&amp;lt;0.001 and reduced sclerostin 375(313, 501) vs 724(570, 899) pg/mL, p&amp;lt;0.001 and periostin levels 150(108, 204) vs 217(181, 312) ng/mL, p&amp;lt;0.001. DKK1 levels were positively correlated with CTX rho=0.27, p&amp;lt;0.001 and NTX rho=0.26, p&amp;lt;0.001 and negatively correlated with lumbar BMD Z-score rho=-0.21, p=0.02. Conclusion IBD patients were found with an osteopenic phenotype, which can be the consequence of bone loss due to osteoblast activation and increased bone resorption as indicated by increased CTX and NTX levels and osteoblast and osteocyte suppression as indicated by higher DKK-1 and lower periostin and sclerostin levels. The inflammation itself, malabsorption of nutrients, medications (e.g. corticosteroids), and low energy intake could contribute to those pathophysiological changes.

Understanding the growing burden of Malignant Pleural Effusion - epidemiology, health care utilization and cost, a Canadian perspective.

Malignant Pleural Effusion (MPE) is common in advanced malignancy. Data are needed on health care utilization and costs. This population-based retrospective cohort study included patients aged ≥18 years with an MPE diagnosed between January 1, 2004 and December 31, 2018. We described the incidence and prevalence of MPE from 2004 to 2018, and trends in hospital admissions, emergency department (ED) visits, and pleural-based procedures. In patients diagnosed with MPE from 2006 to 2016 we estimated 2-year health care costs (2018 US dollars) from the public payer perspective. The annual incidence and prevalence of MPE increased from 5,090 and 14,579 in 2004 to 6,977 and 23,204 in 2018, respectively. Annual mortality among prevalent patients decreased from 32% to 28%. In 2004, 57% of patients were hospitalized, decreasing to 50% in 2018. ED visits increased (59% to 61%). From 2004 to 2018, the number of patients who had insertions of thoracostomy tube (2,211 to 3,664) and tunnelled pleural catheter (383 to 1,164) increased. The number of patients receiving pleurodesis declined (565 to 284). No change occurred in the number of patients receiving video-assisted thoracoscopy (range 140 - 208/year). Between 2004 and 2016, 76,190 patients were diagnosed with MPE (mean age 71.2; 52% female). The median (interquartile range) health care cost during follow-up was $45,641 ($23,237-$86,700), with $19,753 ($9,590-$38,746) for inpatient hospitalization. Hospitalization and temporizing MPE procedures are associated with high costs. This population-based study may guide clinicians and policy makers to improve MPE management and reduce health care costs.

Granulocyte and Monocyte Adsorption Therapy in Patients With Sepsis: A Feasibility Study.

The pathogenesis of sepsis is thought to be linked to a dysregulated immune response, particularly that involving neutrophils. We have developed a granulocyte adsorption column as a "decoy organ," which relocates the massive inflammation in organs in the body to a blood purification column. This study was conducted to assess the safety and experimental effectiveness of granulocyte monocyte adsorption apheresis-direct hemoperfusion (G1-DHP) in the treatment of patients with sepsis, using a prospective, multicenter design. The study included patients diagnosed with sepsis and with an APACHE II score ranging from 17 to 34. A total of five G1-DHP were performed within 3 days of patient enrollment. The primary endpoint was the change in sequential organ failure assessment (SOFA) score from enrollment to 7 days, and the safety endpoints were adverse events and mortality at 28 days. G1-DHP was performed on 82 patients. The median (interquartile range) SOFA score decreased from 10 (8-11) to 4 (3-7) after 7 days (n = 70; p < 0.01). Granulocytes, mainly neutrophils, were adsorbed, and the neutrophil-to-lymphocyte ratio significantly improved (p < 0.01). Notable improvements were observed in the SOFA scores for circulation and renal function. The acute physiology and chronic health evaluation II score of the 77 patients evaluated for mortality was 27, and the 28-day mortality rate was 7.8%. This study confirmed that G1-DHP can be safely used as an adjunct to standard sepsis treatment regimens. Although further investigations are required, G1-DHP is a promising supplemental therapy for sepsis. jRCT1080225183 (Japan Registry of Clinical Trials identifier).

Dietary Sources of Sodium in Nigerian Adults From 3 Geographic Regions: A Population-Based Cross-Sectional Study.

Background To address the growing burden of hypertension and related diseases, Nigeria seeks to reduce excess dietary sodium through policymaking. The current study aims to describe the levels and sources of dietary sodium intake among Nigerian adults to inform targeted policies for reducing sodium intake. Methods From June 2023 to July 2023, adults aged 18 to 70 years old were recruited from the Federal Capital Territory, Kano States, and Ogun States to participate in a population-based, cross-sectional non-communicable diseases survey. Data were also collected to assess levels and dietary sources of sodium through four 24-hour dietary recalls by trained study personnel with 90.7% response rate. Concurrent 24-hour urine sodium data were collected. The primary analyses included the distribution of sodium intake and sources of sodium, overall and by sex and state. Results were adjusted to the Nigerian population. Multivariate regression models evaluated associations between baseline sociodemographic factors and sodium intake. Results Among 537 participants, 365 (68.0%) were female, and median (Interquartile range) age was 38 (27, 48) years. Adjusted median (IQR) daily sodium intake according to 24-hour dietary recalls was 3,803 (2,663, 5,085) mg per day with higher intake reported among males (males: 3,878 [2,663, 5,032] mg/dl; females: 3,415 [2,373, 4,689], p<.0001). Two-thirds (67.0%) of the sodium intake was from home-cooked meals. Nearly half (48.7%) of sodium came from discretionary sources, including 21.4% from bouillon. Salt and yaji spice added at the table accounted for 9.1% of sodium intake and was highest among females (18.8%) and males (13.7%) in Kano. On the other hand, sodium from street food was highest in males (35.9%) and females (34.2%) in Ogun. After adjustment, older participants and those with higher education had lower daily sodium intake compared to younger participants and those with less education, respectively. Results were similar when excluding individuals with cardiovascular disease or hypertension. Conclusions Adults in the Federal Capital Territory, Kano, and Ogun consume nearly twice the recommended level of dietary sodium. Most dietary sodium intake came from home cooked foods, nearly half of which came from discretionary sources, which has important policy implications for SHAKE package implementation. Registration number: NCT04765865.

Characterization of adrenal glands on computed tomography with a 3D V-Net-based model

ObjectivesTo evaluate the performance of a 3D V-Net-based segmentation model of adrenal lesions in characterizing adrenal glands as normal or abnormal.MethodsA total of 1086 CT image series with focal adrenal lesions were retrospectively collected, annotated, and used for the training of the adrenal lesion segmentation model. The dice similarity coefficient (DSC) of the test set was used to evaluate the segmentation performance. The other cohort, consisting of 959 patients with pathologically confirmed adrenal lesions (external validation dataset 1), was included for validation of the classification performance of this model. Then, another consecutive cohort of patients with a history of malignancy (N = 479) was used for validation in the screening population (external validation dataset 2). Parameters of sensitivity, accuracy, etc., were used, and the performance of the model was compared to the radiology report in these validation scenes.ResultsThe DSC of the test set of the segmentation model was 0.900 (0.810–0.965) (median (interquartile range)). The model showed sensitivities and accuracies of 99.7%, 98.3% and 87.2%, 62.2% in external validation datasets 1 and 2, respectively. It showed no significant difference comparing to radiology reports in external validation datasets 1 and lesion-containing groups of external validation datasets 2 (p = 1.000 and p > 0.05, respectively).ConclusionThe 3D V-Net-based segmentation model of adrenal lesions can be used for the binary classification of adrenal glands.Critical relevance statementA 3D V-Net-based segmentation model of adrenal lesions can be used for the detection of abnormalities of adrenal glands, with a high accuracy in the pre-surgical scene as well as a high sensitivity in the screening scene.Key PointsAdrenal lesions may be prone to inter-observer variability in routine diagnostic workflow.The study developed a 3D V-Net-based segmentation model of adrenal lesions with DSC 0.900 in the test set.The model showed high sensitivity and accuracy of abnormalities detection in different scenes.Graphical

A randomized, crossover trial of one night of oxygen therapy for obstructive sleep apnea in patients with fibrotic interstitial lung disease.

There is no satisfactory treatment for obstructive sleep apnea (OSA) in patients with interstitial lung disease (ILD) because of poor tolerance of positive airway pressure (PAP) therapy. Supplemental oxygen therapy has been shown to reduce hypoxemia and is well tolerated in patients with ILD. However, little is known about the effect of nocturnal oxygen supplementation (NOS) on OSA in patients with ILD. In this study, we evaluated one night of oxygen therapy in ILD patients with OSA. Forty-one patients with fibrotic ILD and OSA were randomized to receive supplemental oxygen or air for one night each in a crossover design separated by a washout period of one week. Polysomnography was performed, and sleep-disordered breathing, nocturnal desaturation, sleep architecture, and cardiovascular reactions were monitored. During nights with sham oxygen, the median (interquartile range) apnea-hypopnea index (AHI) was 14.1/h (10.4/h-24.1/h). The percentage of patients in the N3 sleep stage (N3%) was 19.5% (14.0-31.2%). NOS significantly decreased the AHI by a median of 9.3/h (95% CI, 7.6/h-14.4/h; P < 0.001), increased N3% by 4.4% (95% CI, 0.3-10.1%; P = 0.049), and lowered the sleep stage change index by 1.6/h (95% CI, 0.0/h-4.8/h; P = 0.036). NOS improved the oxygen desaturation index (ODI) by -8.8/h (95% CI, -13.4/h to -5.9/h; P < 0.001) and the mean SpO2 by 3.0% (95% CI, 2.6-4.5%; P < 0.001). The mean heart rate during sleep was reduced with the NOS; however, total sleep time and nocturnal blood pressure did not change. In patients with OSA and ILD, one night of oxygen therapy significantly improved sleep-disordered breathing, sleep architecture, nocturnal oxygenation, and heart rate. NOS may be a therapeutic option for ILD patients with OSA.

Gemcitabine and docetaxel for high-risk non-muscle-invasive bladder cancer: EuroGemDoce group results.

To evaluate the oncological efficacy and safety of sequential intravesical gemcitabine/docetaxel (Gem/Doce) therapy in a European cohort of patients with high-risk and very-high-risk non-muscle-invasive bladder cancer (NMIBC) after previous Bacillus Calmette-Guérin (BCG) treatment. Data were retrospectively collected from 95 patients with NMIBC, treated with Gem/Doce at 12 European centres between 2021 and 2024. Patients previously treated with BCG who had completed a full induction course and received at least one follow-up evaluation were included. One-year disease-free survival (DFS), high-grade DFS and progression-free survival (PFS) were estimated using Kaplan-Meier curves. Adverse events (AEs) were recorded through medical interviews. Of 75 patients, 63 (84%) were classified as having high-risk and 12 (16%) as having very-high-risk NMIBC. Over a median (interquartile range) follow-up of 9 (5-14) months, 20 patients (27%) relapsed and five (6.7%) underwent radical cystectomy. The 1-year DFS was 73% (95% confidence interval [CI] 62-86%), 1-year high-grade DFS was 79% (95% CI 68-91%) and 1-year PFS was 95% (95% CI 90-100%). AEs occurred in 34 patients (45%), with six (8.7%) experiencing severe AEs. Limitations of the study include the short follow-up and variability in both treatment dwelling times and dosage across centres. The intravesical Gem/Doce regimen demonstrated promising short-term oncological outcomes and was well tolerated in this cohort of patients with high- and very-high-risk NMIBC previously treated with BCG. Prospective studies and randomised trials are awaited to define the ideal candidates for Gem/Doce therapy and to standardise treatment protocols.

Obese Hypertensive Men Have Fasting Serum Concentrations of Leptin Similar to Those of Obese Normotensive Men.

Leptin is a hormone which is secreted by the adipocytes. In the circulation, leptin levels are directly proportional to the body fat percentage. Studies have shown that higher leptin levels are associated with an increased risk of hypertension after adjusting for body mass index (BMI). Therefore, leptin has been proposed as a mediator of obesity-related hypertension. Whether leptin is associated with hypertension when controlling for body fat percentage remains unclear. We studied 103 obese men (BMI ≥30.0kg/m2). All men were healthy and were medication-free. We measured blood pressure using 24-hour ambulatory blood pressure (ABP) recordings. Hypertension was defined as 24-hour systolic ABP ≥130mm Hg and/or 24-hour diastolic ABP ≥80mm Hg, and normotension was defined as 24-hour ABP <130/80mm Hg. We measured fasting serum leptin concentrations and used dual-energy X-ray absorptiometry scanning to determine body fat percentage. Of the 103 obese men, 64 were hypertensive (24-hour systolic ABP (mean ± standard deviation) 137±11mg Hg and 24-hour diastolic ABP 83±6mm Hg) and 40 were normotensive (24-hour systolic ABP 117±6mg Hg and 24-hour diastolic ABP 73±4mm Hg). The 2 groups had similar fasting serum leptin concentrations (median (interquartile range)) 13.4 (5.7-36.1) µg/L versus 13.4 (5.4-27.1) µg/L, P=0.88) and total fat mass percentage (34.8±4.5% versus 34.0±4.7%, P=0.90). Obese hypertensive men have serum leptin concentrations similar to those of obese normotensive men with comparable body fat percentage measurements. This finding does not support leptin's candidacy as a mediator of obesity-related hypertension.

A Comparison of Glucose and Additional Signals for Three Different Exercise Types in Adolescents with Type 1 Diabetes Using a Hybrid Closed-Loop System.

Objective: To compare glycemic outcomes during and following moderate-intensity exercise (MIE), high-intensity interval exercise (HIE), and resistance exercise (RE) in adolescents with type 1 diabetes (T1D) using a hybrid closed-loop (HCL) insulin pump while measuring additional physiological signals associated with activity. Methods: Twenty-eight adolescents (average age 16.3 ± 2.1 years, 50% females, average duration of T1D 9.4 ± 4 years) using HCL (Medtronic MiniMed 670G) undertook 40 min of MIE, HIE, and RE. A temporary glucose target (8.3 mmol/L, 150 mg/dL) was set for 2 h prior and during exercise. Heart rate, accelerometer, venous glucose, lactate, ketones, and counter-regulatory hormones were measured for 280 min postexercise commencement. The primary outcome was glucose percentage time in range (TIR): 3.9-10 mmol/L (70-180 mg/dL) for 14 h from exercise onset. Results: Median (interquartile range) TIR for HIE was 88 (78, 96)%, MIE 79 (63, 88)%, and RE 86 (72, 95)% for 14 h from exercise onset. For MIE compared with HIE, TIR was lower (P = 0.012) and time above range (TAR) was greater (18 [2.4, 28] vs. 6.9 [0.0, 14]%, P = 0.041). Hypoglycemia occurred in 13 (46%), 11 (39%), and 14 (50%) of participants for HIE, MIE, and RE, respectively, the majority following the meal after exercise. There were higher levels of lactate (P = 0.001), growth hormone (P = 0.001), noradrenaline (P = 0.001), and heart rate (P = 0.01) during HIE and RE compared with MIE. Conclusions: HCL use in adolescents with T1D results in excellent TIR during different forms of exercise when a temporary target is set 2 h before. Extending the temporary target after exercise may also be needed to help minimize postexercise hypoglycemia.