Monitoring Of Patients Research Articles

Efficacy of an Internet of Things-based system for cardiac rehabilitation monitoring: insights from the IntellIoT pivotal trial in heart failure patients

Abstract Aims Digital health solutions targeted to remote clinical monitoring are constantly gaining ground in cardiovascular care. However, evidence regarding their impact on cardiac rehabilitation efficiency in heart failure (HF) patients is relatively limited. In this study, conducted in the context of the IntellIoT project, we evaluated the effect of a purpose-designed Internet of Things (IoT)-based patient monitoring system on cardiac rehabilitation outcomes in a cohort of HF patients. Methods and results Nineteen clinically stable HF patients were enrolled in the study, which consisted of a 12-month standard-of-care run-in phase and a remote follow-up phase of equal duration, whereby an IoT-based e-health system was provided to study subjects. Device-derived data transmission was facilitated by a mobile phone application, coupled with a web-based platform accessible to study physicians. Study endpoints were (i) patient adherence rates to e-health system use and their associations to key clinical parameters, (ii) the degree of change in physical activity, and (iii) total time dedicated by physicians to enrolled patients’ care with and without the aid of the e-health system. Baseline-to-peak increase in daily step count was calculated at 23.34%. System use was associated with a decrease in time dedicated by physicians to enrolled patients’ care. A significant negative correlation was observed between age and progressive drop-in adherence rate to system use (r = −0.5722, P = 0.02). Conclusion Internet of Things-based healthcare constitutes a promising approach in HF patients’ rehabilitation, whereas elderly patients might constitute the population most likely to benefit. However, larger, randomized studies are required to confirm our findings.

Visual Detection of Methylglyoxal in Multiple Scenarios via NIR-Excitable Reversible Ratiometric Fluorescent Hydrogel Sensor.

Methylglyoxal is considered a key indicator in evaluating wine flavor and quality, as well as an important marker for diabetic pathological syndromes. Rapid and accurate quantitative detection of methylglyoxal is essential in scenarios of wine production standards and human health monitoring. Herein, we report a visual method for detecting methylglyoxal via an NIR-excitable reversible ratiometric fluorescent hydrogel sensor, where NIR-excited upconversion nanoparticles serve as energy donors and eosin B acts as the energy acceptor, together forming an integrated ratiometric nanophotonic probe that ensures the accuracy of detection without being affected by various background fluorescence interference in different scenarios. The integrated optical probe is combined with a 3D network hydrogel to design a sensing patch that can be easily regenerated through simple treatment, exhibiting a distinct optical color response. Upon the addition of methylglyoxal, the G/R value of the sensing patch changes, enabling the real-time quantitative detection of methylglyoxal. Additionally, we combined the hydrogel sensing patch with a smartphone to create a portable sensing platform for the convenient visual detection of methylglyoxal. The probe and hydrogel sensing patch have detection limits for methylglyoxal as low as 59 and 75.4 nM, respectively. The portable sensing patch designed here provides an effective strategy for standardizing the wine production process and monitoring patient health.

Improving Participant Recruitment in Clinical Trials: Comparative Analysis of Innovative Digital Platforms.

Pharmaceutical product development relies on thorough and costly clinical trials. Participant recruitment and monitoring can be challenging. The incorporation of cutting-edge technologies such as blockchain and artificial intelligence has revolutionized clinical research (particularly in the recruitment stage), enhanced secure data storage and analysis, and facilitated participant monitoring while protecting their personal information. This study aims to investigate the use of novel digital platforms and their features, such as e-recruitment, e-consent, and matching, aiming to optimize and expedite clinical research. A review with a systematic approach was conducted encompassing literature from January 2000 to October 2024. The MEDLINE, ScienceDirect, Scopus, and Google Scholar databases were examined thoroughly using a customized search string. Inclusion criteria focused on digital platforms involving clinical trial recruitment phases that were in English and had international presence, scientific validation, regulatory approval, and no geographic limitations. Literature reviews and unvalidated digital platforms were excluded. The selected studies underwent meticulous screening by the research team, ensuring a thorough analysis of novel digital platforms and their use and features for clinical trials. A total of 24 digital platforms were identified that supported clinical trial recruitment phases. In general, most of them (n=22, 80%) are headquartered and operating in the United States, providing a range of functionalities including electronic consent (n=14, 60% of the platforms), participant matching, and monitoring of patients' health status. These supplementary features enhance the overall effectiveness of the platforms in facilitating the recruitment process for clinical trials. The analysis and digital platform findings refer to a specific time frame when the investigation took place, and a notable surge was observed in the adoption of these novel digital tools, particularly following the COVID-19 outbreak. This study underscores the vital role of the identified digital platforms in clinical trials, aiding in recruitment, enhancing patient engagement, accelerating procedures, and personalizing vital sign monitoring. Despite their impact, challenges in accessibility, compatibility, and transparency require careful consideration. Addressing these challenges is crucial for optimizing digital tool integration into clinical research, allowing researchers to harness the benefits while managing the associated risks effectively.

Validity and reliability study of the Turkish version of KOOS-ACL questionnaire

BackgroundThis study aimed to adapt the Knee injury and Osteoarthritis Outcome Score- Anterior Cruciate Ligament (KOOS-ACL) into Turkish and to assess its validity and reliability.MethodsThe adaptation process involved translation, back-translation, and cultural adaptation of the questionnaire. Totally 133 patients who had a diagnosis of anterior cruciate ligament tear was recruited. The reliability of the Turkish version of the KOOS-ACL was assessed using Cronbach’s alpha, item-total correlations, and ICC. EFA and CFA were performed to evaluate construct validity, supported by KMO and Bartlett’s test results. Criterion validity was examined through correlations with IKDC scores, and discriminative power was assessed using an independent samples t-test.ResultsIKDC score for evaluating knee function was 59.84 ± 21.74. The composite KOOS-ACL-Tr score was 61.95 ± 25.19. Cronbach’s Alpha value was found to be 0.952 demonstrating high reliability. KOOS-ACL-Tr scores showed a linear positive correlation with the time elapsed since injury and IKDC scores (p < 0.001) establishing concurrent validity.ConclusionsThe adapted Turkish version of the KOOS-ACL is a valid and reliable scale intended for use in monitoring patients with ACL injuries.

Association between psychiatric disorders and the risk of stroke: a meta-analysis of cohort studies

BackgroundPsychiatric disorders may be associated with an elevated risk of stroke; however, the existence of variations in this association between different populations remains controversial. Consequently, we conducted a comprehensive systematic review and meta-analysis to examine the magnitude of the relationship between psychiatric disorders and the risk of stroke.MethodsThe PubMed, Embase, and Cochrane Library databases were systematically searched to identify eligible studies from inception to April 2024. The aggregated findings were expressed as relative risks (RRs) with 95% confidence intervals (CIs), and the combined analysis was performed using a random-effects modeling approach. Further exploratory analyses were also performed using sensitivity and subgroup analyses.ResultsA total of 36 cohort studies, involving 25,519,635 individuals, were selected for analysis. We noted that depression (RR: 1.50; 95% CI: 1.34–1.68; p &amp;lt; 0.001), schizophrenia (RR: 1.74; 95% CI: 1.36–2.24; p &amp;lt; 0.001), and bipolar disorder (RR: 1.65; 95% CI: 1.27–2.14; p &amp;lt; 0.001) were associated with an elevated risk of stroke. Further exploratory analyses found that the association between depression and the risk of stroke differed according to the adjusted level (RR ratio: 0.77; 95% CI: 0.61–0.98; p = 0.034), and the association between schizophrenia and the risk of stroke differed according to the outcome definition (RR ratio: 0.68; 95% CI: 0.52–0.90; p = 0.006). Moreover, the association between bipolar disorder and the risk of stroke differed according to the study design (RR ratio: 0.68; 95% CI: 0.55–0.84; p &amp;lt; 0.001).ConclusionThe significant association between psychiatric disorders and an elevated risk of stroke highlights the importance of enhanced monitoring and stroke prevention in patients with psychiatric disorders.Systematic review registrationOur study was registered on the INPLASY platform (number: INPLASY202450049).

Comparing Refrigeration to Immediate Room Temperature Testing for Uric Acid Monitoring in Rasburicase-Treated Patients.

Rasburicase retains activity at room temperature (RT), so specimens collected for uric acid-level monitoring require cooling protocols. Our objective was to determine if we could ease these preanalytical requirements to improve compliance while maintaining accuracy. Fifty pairs of specimens were transported and stored either on ice or at RT. All were tested at 3 time points postcollection: immediately upon arrival to the laboratory (approximately 45 min), 90, and 135 min. Uric acid concentrations are not clinically significantly different in RT or iced specimens, as long as specimens are tested within approximately 45 min postcollection. There was a negative bias in uric acid levels in a subset of specimens if they were held at RT and tested at 90 min (-9.1%) and 135 min (-17.5%). Specimens tested within 2 rasburicase half-lives postinfusion have an additional 24% decrease in uric acid levels if kept at RT for 90 min. Specimens from patients given a 6 mg dose had an 18% decrease in uric acid concentration compared to a 3 mg dose. Laboratories that can test uric acid levels rapidly after specimen collection may be able to validate alternative preanalytical methods to transporting and testing on ice.

Integration of personalised ultrasensitive ctDNA monitoring of patients with metastatic breast cancer to reduce imaging requirements.

Circulating tumour DNA (ctDNA) is an emerging biomarker for monitoring cancers. The personalised disease monitoring in metastatic breast cancer (PDM-MBC) study is an ongoing study instigated to evaluate ctDNA as a biomarker to individualise imaging requirements in patients with MBC. Patients receiving first-line endocrine therapy (aromatase inhibitor + cyclin-dependent kinase 4/6 inhibitor) had plasma samples collected pre-treatment, weeks 2 and 4, and concurrently with imaging until progressive disease (PD). Here, we apply an experimental analytical workflow for ultrasensitive ctDNA analysis, utilising personalised ctDNA panels designed from mutations identified in tumour tissue, and present results for 24 patients. Twenty patients (83%) had detectable ctDNA pre-treatment. The median progression-free survival was 25.6 months, and 13 patients experienced PD, with rising ctDNA detected at or prior to PD in 12 patients (92%). If imaging had been omitted until the detection of rising ctDNA for at least one mutation, 68% (n = 71) of the scans performed amongst ctDNA-positive patients would have been avoided. Our results demonstrate that integration of personalised ctDNA monitoring of patients with MBC has potential to substantially reduce the imaging needs in patients showing ctDNA response to treatment.

Simultaneous bilateral avascular necrosis of the humerus and femur in long COVID-19: a case report

Background. The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted the widespread use of corticosteroids as a treatment strategy, particularly in cases of severe pneumonia and cytokine storm. While this therapy has saved countless lives, its side effects have also been well-documented, including the development of avascular necrosis. Case presentation. This case report presents a rare instance of simultaneous bilateral avascular necrosis (AVN) affecting both the humeral and femoral heads in a 49-year-old male patient recovering from severe COVID-19. The patient was treated with high-dose corticosteroids, receiving 1250 mg of prednisolone over five days during hospitalization for COVID-19 pneumonia. Six months after discharge, he developed persistent hip pain, which was later diagnosed as AVN in both femoral heads. During hyperbaric oxygen therapy, the patient reported new shoulder pain, and MRI confirmed stage III AVN in both humeral heads. The patient’s pain was managed with bilateral suprascapular nerve radiofrequency ablation and bilateral Pericapsular Nerve Group (PENG) blocks, which provided significant relief. Conclusions. This case emphasizes the potential for corticosteroid-induced AVN, even months after treatment, and underscores the need for long-term monitoring of patients receiving corticosteroids for COVID-19. The involvement of four major joints highlights the severe musculoskeletal complications that can arise, supporting the importance of early diagnosis and timely intervention for pain relief.

Development of Internet of Things (IoT) and its Impact on the Healthcare Industry

The Internet of Things (IoT) has the potential to modernize healthcare through remote patient monitoring, disease management, and improved health outcomes. IoT devices, such as wearables and sensors, can collect and transmit data in real time, enabling healthcare providers to make informed and timely decisions. This paper examines the current state of the Internet of Things in healthcare, the opportunities presented by the Internet of Things, and the challenges faced during implementation. This paper first describes the benefits of IoT in healthcare, including improving patient outcomes, reducing healthcare costs, and increasing access to care. We look at a variety of IoT devices used in healthcare, including wearables, smart implants, and medical sensors. This paper also outlines the challenges facing the use of IoT in healthcare, including data security, privacy issues, and regulatory issues. The paper concludes with a discussion of the future of IoT in healthcare and its potential impact on the healthcare industry.

A Rare Case Report on Jaundice, Alcoholic Liver Disease with a History of Herbal Medicine Induced Liver Injury

Background: Alcoholic liver disease (ALD) is a complex condition caused by excessive alcohol consumption, affecting fatty liver, alcoholic hepatitis, and cirrhosis. Risk factors include alcohol intake, genetic predisposition, and co-existing liver conditions. Alcoholic fatty liver disease (AFLD) accumulates excessive fat in the liver, leading to steatosis and fibrosis. ALD complications include portal hypertension, liver failure, and hepatocellular carcinoma. The use of herbal medicines, such as tamarind and neem extracts, is also concerning due to potential liver damage. Increased awareness and caution are needed from patients and healthcare providers. Case report: A 33-year-old male patient presented with symptoms including right hypochondrium pain, yellowish discoloration of the sclera, fever, decreased urine output, light yellow tongue, and generalized weakness. He was a chronic alcoholic, consuming various alcoholic beverages for 15 years. His dietary routine was mixed, but he preferred non-vegetarian foods. His family suggested he consume traditional herbal medicine to treat jaundice. After collecting his history, lab tests were conducted to confirm his diagnosis of alcoholic liver disease (ALD) with herbal medicine-induced liver (DILI). LFT tests were alarming, and he was diagnosed with alcoholic liver disease with jaundice and DILI due to herbal medicine. To improve his symptoms and prevent liver failure complications, he was prescribed a list of medications to improve his symptoms and to prevent complications of liver failure. Discussion: A holistic treatment approach is needed for patients with alcoholic liver disease and herbal medicine-induced liver injury, focusing on symptom relief, liver function enhancement, and complication prevention. This includes lifestyle changes, nutritional support, and managing potential issues. Regular monitoring is crucial for adjustments. Conclusion: This case report highlights the complex relationship between alcoholic liver disease and herbal medicine-induced liver injury, especially in jaundice cases. It emphasizes the need for thorough patient histories, increased awareness of hepatotoxic potential, and educating patients about alcohol and herbal supplement risks. It calls for multidisciplinary collaboration, enhanced regulation, and safety evaluations of herbal medicines to protect public health. It also underscores the importance of continuous monitoring and monitoring patients with liver injury histories. Keywords: ALD, Herbal medicine, DILI, Liver failure, Patient care

Association of Anti-Smith, Anti-Ro, and Anti-ribonucleoprotein Combination With Accelerated Development of Lupus Nephritis in Systemic Lupus Erythematosus Patients in Saudi Arabia.

Systemic lupus erythematosus (SLE) is an autoimmune inflammatory disorder affecting multiple organs. Lupus nephritis (LN), one of its serious complications, is characterized by proteinuria and renal dysfunction. The objective of this study was to evaluate the association between a specific antibody profile (anti-Smith [anti-Sm], anti-Ro, and anti-ribonucleoprotein [anti-RNP]) and the time to develop LN in SLE patients. A retrospective, single-center cohort study was conducted at King Fahad Medical City (KFMC) in Riyadh, Saudi Arabia, and included 128 patients with LN who visited the Rheumatology Clinic between 2014 and 2021. Patients were divided into two groups: a positive serological profile group, which included patients positive for all three antibodies (anti-Sm, anti-Ro, and anti-RNP), and a negative serological profile group (which included patients with at least one negative antibody result). Data on demographics, antibody profiles, time to proteinuria development, and LN classification were analyzed. The time to develop proteinuria from the initial diagnosis of LN to the first detection of proteinuria exceeding 500 mg was categorized into less than 1 year, 1-5 years, 6-10 years, and more than 10 years. Our findings revealed that a substantial proportion (95%) of patients positive for all three antibodies (anti-Sm, anti-Ro, and anti-RNP) had a significantly higher likelihood of developing proteinuria within the first five years of their SLE diagnosis, compared to 89.66% of patients with a negative serological profile. The findings suggest that the presence of anti-Sm, anti-Ro, and anti-RNP antibodies is associated with a higher risk of early LN development, specifically within five years after initial SLE diagnosis. Regular monitoring and proactive management of high-risk patients can reduce the burden of LN and its complications.

UPLC-MS/MS High-Risk Screening for Sphingolipidoses Using Dried Urine Spots

Background: Early detection of sphingolipidoses is crucial to prevent irreversible complications and improve patient outcomes. The use of urine samples dried on filter paper (DUS) is a non-invasive strategy that simplifies the collection, storage, and shipping of samples compared to using liquid urine specimens. Objectives: (1) Develop and validate a multiplex ultra-performance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) methodology using DUS to quantify twenty-one lysosphingolipids normalized to creatinine for eight different sphingolipidoses. (2) Establish normal reference values to evaluate the clinical utility of the methodology. Methods: Samples were eluted from a 5 cm filter paper disk (~1 mL of urine) and extracted on Oasis MCX solid-phase extraction cartridges prior to injection in the UPLC-MS/MS system. Results: Urinary lysosphingolipids were stable on DUS at −80 °C and −30 °C for 117 days, at 21.5 °C and 4 °C for at least 26 days, and at 35 °C for 3 days. Globotriaosylsphingosine, glucosylsphingosine, and their analogs were elevated in patients with Fabry disease and Gaucher disease, respectively, compared to controls (p-value &lt; 0.0001). The analysis of related analog profiles suggests a better overall reliability in detecting patients early, especially for Fabry patients. Conclusions: This approach is feasible and might be useful for the early detection, monitoring, and follow-up of patients with sphingolipidoses.

Wearable Cardioverter Defibrillator as a Treatment in Patients with Heart Failure of Various Aetiologies—A Series of Ten Cases Within the BIA-VEST Registry

Background/Objectives: Sudden cardiac death (SCD) remains a major global health concern and represents one of the most common causes of mortality due to cardiovascular diseases. The wearable cardioverter–defibrillator (WCD) is an innovative, non-invasive medical device designed to provide continuous heart monitoring and immediate defibrillation in patients at risk for SCD. The study aimed to assess the efficacy of WCD usage in patients awaiting decision on therapy with implantable cardioverter–defibrillators (ICDs). Methods: We explored the clinical applications, benefits, and limitations of WCD usage within the BIA-VEST registry in Poland over the years 2021–2023. The study included 10 patients with a mean age of 49.1 ± 12.02 years. Results: All patients demonstrated good tolerance and compliance with the LifeVest WCD, wearing it for an average of 93.1 days, about 22.8 h per day (95.7% of the time). No interventions from LifeVests were recorded, and there were no effective, ineffective, or inadequate discharges. After the first follow-up echocardiography, five patients still required ICDs. Due to improved LVEF and overall condition in six out of ten patients undergoing WCD bridge therapy, ICD implantation was finally waived. Conclusions: The WCD acts as a bridge to therapy, such as ICD implantation or cardiac surgery, and may be particularly beneficial for patients with transient or evolving conditions, such as structural heart diseases and life-threatening ventricular arrhythmias.

Trends, prospects, challenges, and security in the healthcare internet of things

The Healthcare Internet of Things (H-IoT) is a rapidly developing problem solving model with significant potential to improve patient care and healthcare outcomes. This study focuses on integrating cryptographic platforms into H-IoT systems to enable secure data access. We present insights on how to manage challenges such as cyber risks, resource constraints, latency, and energy consumption by exploring cryptographic approaches in diverse H-IoT applications. We explore important topics including big data management, blockchain, machine learning, edge computing, and software-defined networks. Additionally, we examine real-time operational challenges and emerging trends, such as remote patient monitoring and predictive analytics. Our research underscores the need for strong encryption mechanisms, access controls, device authentication, and proactive threat detection to improve the safety and efficiency of healthcare services. By combining cryptographic approaches with the architecture of the H-IoT system, this work provides the foundation for resilient healthcare infrastructures. Addressing current challenges and anticipating future opportunities contribute to strategic healthcare planning that prioritizes patient privacy and data security while anticipating future strategic healthcare planning opportunities. This article aims to provide valuable information to researchers by covering energy-efficient and resource-optimized healthcare system approaches that are integrated into the development of H-IoT systems.

MXene Nanoconfinement of SAM-Modified Molecularly Imprinted Electrochemical Biosensor for Point-of-Care Monitoring of Carcinoembryonic Antigen.

The high rate of cancer worldwide and the heavy costs imposed on governments and humanity have always motivated researchers to develop point-of-care (POC) biosensors for easy diagnosis and monitoring of cancer treatment. Herein, we report on a label-free impedimetric biosensor based on Ti3C2Tx MXene and imprinted ortho-phenylenediamine (o-PD) for the detection of carcinoembryonic antigen (CEA), a biomarker for various cancers surveillance, especially colorectal cancer (CRC). Accordingly, MXene was drop-casted on the surface of a disposable silver electrode to increase the sensitivity and create high-energy nanoareas on the surface, which are usable for protein immobilization and detection. A self-assembled monolayer (SAM) was exploited for oriented CEA immobilization on the MXene-modified electrode. The monomer-protein interaction and successful protein removal were confirmed by molecular docking and atomic force microscopy (AFM) investigations to evaluate the quality of the fabricated molecularly imprinted polymer (MIP). Also, the role of MXene in increasing the electrical field inside the nanoareas was simulated using COMSOL Multiphysics software. A suitable limit of detection (9.41 ng/mL), an appropriate linear range of detection (10 to 100 ng/mL) in human serum, and a short detection time (10 min) resulted from the use of SAM/MIP next to MXene. This biosensor presented outstanding repeatability (97.60%) and reproducibility (98.61%). Moreover, acceptable accuracy (between 93.04 and 116.04%) in clinical serum samples was obtained compared with immunoassay results, indicating the high potential of our biosensor for real sample analysis. This biomimetic and disposable sensor provides a cost-effective method for facile and POC monitoring of cancer patients during treatment.

Long-term results of treatment of amblyopia in children with impaired fixation mechanism using biofeedback

Purpose: to evaluate the long-term results (1 year) of a new method of treating amblyopia in children with unstable central and eccentric fixation using microperimetric biofeedback, as well as to develop a protocol for patients monitoring after treatment and clear criteria for prescribing repeated courses of treatment using microperimetric biofeedback.Material and methods. The study included 21 patients (21 eyes) aged from 5 to 15 years (ave 8.28 ± 3.08) who were able to perform training sessions on the MP-3 microperimeter (MP, Nidek, Japan). Treatment was carried out on the MP using visual (flickering checkerboard pattern) and sound (sound signal) biofeedback: 10–15 sessions, 10–12 minutes each. All patients were examined before treatment, immediately and 1, 3, 6 and 12 months after the treatment. Dynamic observation of patients and prescription of repeated courses of treatment were carried out in accordance with the developed protocol.Results. After 1 course of treatment, a significant increase in best-corrected visual acuity (BCVA) was detected in 90.4 % of patients, as well as an improvement in all fixation parameters: a significant increase in density by 2° and 4°, a decrease in amplitude by ≈ 50 %; a tendency to increase the functional parameters of the retina in the macular area. During follow-up (1 year), 13 patients (1 patient with central fixation and 12 patients with eccentric fixation) underwent additional courses of biofeedback therapy in accordance with the developed protocol. In 4 patients with eccentric fixation, mainly peripheral, despite improvement in fixation parameters, no additional positive dynamics in visual acuity were noted after a repeated course of biofeedback therapy. In 8 patients, after a repeated course of treatment of amblyopia using biofeedback therapy, positive dynamics were noted, namely: an increase in density and a decrease in the amplitude of fixation, and an increase in BCVA.Conclusion. The effectiveness and safety of a previously developed method of treating amblyopia with impaired fixation mechanism using biofeedback therapy has been demonstrated. A protocol for dynamic monitoring of patients with amblyopia after biofeedback therapy and criteria for prescribing additional courses of training sessions have been developed.

Wearable equipment-based telemedical management via multiparameter monitoring on cardiovascular outcomes in elderly patients with chronic coronary heart disease: an open-labelled, randomised, controlled trial

BackgroundThe prevalence of chronic coronary heart diseases (CHDs) increases with age in the elderly, which represents one of the top-ranked causes of death and disease burden.MethodsThis study aimed to investigate...

Characterization of PSA dynamics and oncological outcomes in patients with metastatic hormone-sensitive prostate cancer treated with androgen receptor signaling inhibitors.

This study investigated the characteristics of prostate-specific antigen (PSA) dynamics when androgen receptor signaling inhibitor (ARSI), or vintage agent (bicalutamide) was used for patients with metastatic hormone-sensitive prostate cancer (mHSPC). A total of 213 mHSPC patients from each of the ARSI and bicalutamide groups treated between 2015 and 2022 were selected from multiple institutions using propensity score-matched analysis to align backgrounds. PSA progression-free survival (PFS) and overall survival (OS) were assessed. PSA level at 3months, PSA nadir level, and time to PSA nadir were examined to analyze of PSA kinetics. ARSI treatment significantly improved PSA PFS compared to bicalutamide (P = 0.0063), although no significant difference in OS was seen (P = 0.3134). No significant differences were observed between treatment groups in median PSA levels at 3months (1.47 vs 0.52ng/ml, P = 0.3042) or PSA nadir levels (0.263 vs 0.1345ng/ml, P = 0.1228). Bicalutamide treatment demonstrated longer time to nadir than ARSI in progression-free cases (median: 243 vs 213.5days, P = 0.0003). Survival tree analysis found that PSA nadir ≤ 1.5ng/ml and time to nadir ≥ 145days were the optimal cut-offs for best stratifying OS with bicalutamide, while PSA nadir ≤ 0.45ng/ml and time to nadir ≥ 70days were optimal with ARSI. No significant differences in PSA response was seen between groups; however, distinct optimal cut-offs were demonstrated for PSA nadir and time to nadir. The present findings will be useful for optimal PSA monitoring for mHSPC patients and for early identification of poor-prognosis populations.

Engagement With Daily Symptom Reporting, Passive Smartphone Sensing, and Wearable Device Data Collection During Chemotherapy: Longitudinal Observational Study.

Chemotherapy can cause symptoms that impair quality of life and functioning. Remote monitoring of daily symptoms and activity during outpatient treatment may enable earlier detection and management of emerging toxicities but requires patients, including older and acutely ill patients, to engage with technology to report symptoms through smartphones and to charge and wear mobile devices. This study aimed to identify factors associated with participant engagement with collecting 3 data streams (ie, daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device [Google]) during chemotherapy. We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to install apps on their smartphones to rate daily symptoms and to collect passive sensor data and to wear a Fitbit device for the duration of the study. Participants completed baseline demographic and quality of life questionnaires, and clinical information was extracted from the electronic medical record. We fit a series of logistic generalized estimating equations to evaluate the association between demographic and clinical factors and daily engagement with each data stream. Participants completed daily surveys on 61% (SD 27%) of days and collected sufficient smartphone data and wearable sensor data on 73% (SD 35%) and 70% (SD 33%) of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both symptom surveys (odds ratio [OR] 0.49, 95% CI 0.29-0.81; P=.006) and wearable data collection (OR 0.35, 95% CI 0.17-0.73; P=.005). Patients with stage 4 cancer also exhibited lower odds of engagement with symptom reporting than those with earlier stage disease (OR 0.69, 95% CI 0.48-1.00; P=.048), and patients were less likely to complete symptom ratings on the weekend (OR 0.90, 95% CI 0.83-0.97; P=.008). Older patients (OR 1.03, 95% CI 1.01-1.06; P=.01) and those who reported better cognitive functioning at study entry (OR 1.18, 95% CI 1.03-1.34; P=.02) were more likely to engage with Fitbit data collection, and patients who reported higher levels of depressive symptoms were less likely to engage with smartphone data collection (OR 1.18, 95% CI 1.03-1.36; P=.02). Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with these systems. Our results suggest significant associations between demographic and clinical factors and long-term engagement with smartphone and wearable device assessments during chemotherapy. Non-White participants, those with metastatic cancer, or those with existing cognitive impairment may benefit from additional resources to optimize engagement. Contrary to hypotheses, older adults were more likely than younger adults to engage consistently with wearable device assessments.

Bone Health Determinants in Ambulant Prepubertal Boys With Duchenne Muscular Dystrophy Treated With Deflazacort: Findings From a 3-Year Study.

Duchenne muscular dystrophy (DMD) is complicated by bone fragility. This study aimed to elucidate changes in bone mineral density (BMD) and body composition over time and to explore associations with adiposity measures in DMD. A three-year follow-up analysis was performed of total body (TB) and lumbar spine (LS) dual-energy x-ray absorptiometry (DXA) measurements, anthropometric measures, Tanner stage and bone turnover biomarkers assessments, and the incidence of fragility fractures in 26 ambulant prepubertal DMD patients treated with deflazacort (DFZ). Age at baseline was 7.7 years (interquartile range: 6-9.2). The TB BMD Z-score declined over time and was negatively related to the TB fat mass percentage and fat mass index (p < 0.05), but not to body mass index (BMI) standard deviation score (SDS). In contrast LS bone mineral apparent density (BMAD) Z-score remained stable and normal. The cumulative incidence of fragility fractures was 19.2%; DMD boys with fractures displayed a 1.5-fold higher decline of TB BMD Z-score/year (p < 0.05) and a worse adiposity profile compared to fracture-free patients. No difference was found in DFZ dose or duration between the two groups. We observed a high incidence of fragility fractures, and identified fat tissue as a potential detrimental factor for bone health, suggesting a need for monitoring in DMD patients with excessive adiposity. Fat mass measures assessed by DXA could help to identify those at risk, enabling targeted interventions for better bone health. The co-occurrence of multiple glucocorticoid side effects might characterize patients at higher risk of fractures.