National Study Research Articles

Outcomes after anti-tumour necrosis factor originator to biosimilar switching in children and young people with juvenile idiopathic arthritis in the UK: a national cohort study.

For cost-saving purposes, children and young people with juvenile idiopathic arthritis (JIA) are being switched (for non-medical reasons) from biological originators to biosimilars. Here, we aimed to investigate those who switched from an anti-tumour necrosis factor (TNF) originator to a biosimilar, regarding drug survival and disease activity, compared with a matched cohort who continued the originator. This analysis included all patients in the UK JIA Biologics Register switching directly from an anti-TNF originator to a biosimilar of the same product. All patients were matched (age, sex, disease duration, calendar year of when patients started originator therapy, line of therapy, and International League of Associations for Rheumatology [ILAR] category) to patients continuing the originator. For those matched successfully, a Cox proportional hazard model assessed whether drug persistence differed between those who switched compared with those who continued the originator. Overall change in the 71-joint juvenile arthritis disease activity score and the proportion of patients with a clinically important worsening score (by ≥1·7 units) after 6 months was compared between cohorts. This analysis was designed to address a priority research area set by our patient partners. There were 224 children and young people with non-systemic JIA (139 [62%] were female, and 85 [38%] were male) identified as switching from a biological originator to a biosimilar of the same product from Jan 1, 2017, to July 7, 2023. 143 (64%) patients were originally on adalimumab, 56 (25%) on etanercept, and 25 (11%) on infliximab. Of these, 164 patients were matched successfully to those continuing the originator. There was no evidence that patients switching were more likely to stop treatment compared with those continuing the originator, with a hazard ratio of 1·46 (95% CI 0·93-2·30). Of the 51 patients in the biosimilar group who stopped treatment, 18 (35%) switched back to the originator (14 in the first year), 28 (55%) started a different biological drug, and five (10%) discontinued all treatment by the last follow-up. Of the 87 matched patients with available disease activity, there was no evidence that JADAS-71 worsened more after 6 months, with an odds ratio of 0·71 (95% CI 0·34-1·51; p=0·38). In this matched comparative effectiveness analysis, children and young people with JIA switched from originators to biosimilars. Disease activity was similar between patients switching compared with those continuing the originator. Three quarters of patients were still receiving their biosimilar after 1 year, with switching back to originator uncommon, at only 9% after 1 year, suggesting good tolerability of non-medical switching in this patient population. This information is reassuring to clinicians and patients regarding the effect of non-medical biological switching. British Society for Rheumatology, Versus Arthritis, and National Institutes for Health Research Manchester Biomedical Research Centre.

Reducing radicality in fertility-sparing surgery is associated with improved in vitro fertilization outcome in early-stage cervical cancer: A national retrospective study

ObjectiveFertility-sparing surgery (FSS) aims to achieve oncological outcomes that are non-inferior to radical treatment while preserving fertility and optimizing reproductive results. This study assesses in vitro fertilization (IVF) outcomes in early-stage cervical cancer survivors following FSS, comparing radical and non-radical approaches. MethodsThis retrospective analysis used data from Hungary's National Health Insurance Fund (2004–2022) on patients who underwent IVF treatment following FSS for early-stage cervical cancer at ten Hungarian fertility clinics. Patients were classified into radical and non-radical surgical groups, with the uterine arteries being spared in the non-radical procedures. RStudio (R software version: 4.2.2) was used for statistical analysis. Student's t-test was used to compare group means, and Fisher's exact test was applied to assess independence and distributions between categorical variables, and to estimate odds. ResultsThe study analyzed data from 122 IVF treatment cycles involving 36 patients. The non-radical group had a significantly higher live birth rate (83%, 5/6 compared to the radical group (17%, 5/30). Additionally, the non-radical group had a significantly higher implantation rate and cumulative live birth rate per oocyte retrieval (37%, 7/19 and 55%, 6/11 respectively) compared to the radical group (8%, 12/148 and 6%, 5/80 respectively). ConclusionThis is the largest study to evaluate IVF outcomes in young cervical cancer survivors who have undergone FSS. The findings suggest that less radical procedures are associated with significantly better IVF outcomes. These results emphasize the importance of considering oncological safety and reproductive outcomes together when choosing FSS for early-stage cervical cancer patients. It also highlights the reproductive benefits of performing less radical surgery.

Examining whether the impact of different types of interpersonal violence and mental disorders on attempted suicide is greater for bisexual women.

This national study examined whether different types of interpersonal violence and mental disorders were associated with greater risk for attempted suicide among bisexual women than heterosexual women. Data were used from participants in Wave II of the National Epidemiologic Survey on Alcohol and Related Conditions in the United States of America who identified as female and either heterosexual or bisexual (N = 19,261; 71% White). Logistic regression models tested the main and interactive effects of three types of interpersonal violence (i.e., childhood abuse, childhood neglect, or intimate partner violence [IPV]), four types of mental disorders (i.e., mood, anxiety, substance use, and posttraumatic stress) and sexual orientation (i.e., bisexual vs. heterosexual) on attempted suicide. A post hoc logistic regression also tested the main and interactive effects of four types of anxiety disorders (i.e., panic disorder, social phobia, specific phobia, and generalized anxiety disorder [GAD]) and sexual orientation on attempted suicide. Sexual orientation moderated the impact of childhood neglect, IPV, and anxiety disorders on attempted suicide. Bisexual women who experienced childhood neglect, IPV, or an anxiety disorder had 3.75, 1.43, and 6.24 greater odds, respectively, of attempted suicide, compared to heterosexual women who reported these problems. Additionally, bisexual women who had GAD had 1.66 greater odds of attempting suicide compared to heterosexual women who had GAD. Findings elucidate factors that may increase suicide risk in vulnerable populations as called for by the Centers for Disease Control and Prevention's suicide prevention strategic plan. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Preliminary results of Polish national multicenter LILEO study on ileostomy reversal

Introduction: Ileostomy reversal is a common surgical procedure and currently standardized perioperative and surgical protocols are lacking. Aim: LILEO study was designed to perform a multicenter analysis on numerous perioperative parameters and estimation of the incidence of postoperative complications.Materials and methods: The study is an open multicenter prospective cohort study. Preliminary results of the LILEO study after 3 months were available from 18 Polish surgical centers comprising full data of 59 patients who underwent ileostomy reversal.Results: Parameters such as preoperative care, surgical technique, postoperative course and complications were analyzed. Preoperative fasting was used in 49,1% of patients. Fifty nine percent of anastomosis were handsewn and in 72,9% of patients had primary single suture wound closure. Mean length of hospital stay was 7,9 days (min 2 days, max 26 days). Complications occurred overall in 20 patients (33,9%). In 11,9% of patient’s complications had grade 3 A/B in Clavien-Dindo classification. Discussion: The perioperative care in the group of patients undergoing ileostomy reversal still lacks standardized and optimized treatment.Conclusions: Ileostomy removal is a procedure with high risk of postoperative complications. Standardization of perioperative care based on further multicenter national study could result in a decrease of complications rate.

Harm-to-self from gambling: A national study of Australian adults.

Understanding how gambling harm is distributed is essential to inform effective harm reduction measures. This first national Australian study of gambling harm-to-self examined the extent, distribution, risk factors, and health related quality of life (HRQoL) impacts of this harm. ARandom Digit Dialling sample of 15,000 Australian adults was weighted to key population variables. Key measures included the Gambling Harms Scale-10 (GHS-10), PGSI, SF-6D, gambling behaviours, and demographics. Analyses included ordinal logistic regression. Amongst gamblers, 14.7% reported harm on the GHS-10, including 1.9% reporting high-level harm. While high-level harm occurred mainly in the problem gambling group (77.3%), other PGSI groups accounted for most of the more prevalent low (98.5%) and moderate (87.2%) harms reported. Proximal predictors of greater harm were use of online gambling and more frequent gambling on electronic gaming machines (EGMs), race betting sports betting, poker, skin gambling, scratchies, and loot box purchasing. Distal predictors were being younger, male, single, Aboriginal or Torres Strait Islander, and speaking a non-English language at home. At the population level, the greatest aggregate HRQoL impacts were amongst lower-risk gamblers, confirming the results of other studies regarding the 'prevention paradox'. The distribution of harm across gambler risk groups indicates the need for preventive measures, not just interventions for problem gambling. Reducing harm requires modifying product features that amplify their risk, especially for EGMs, race betting and sports betting that are both inherently risky and widely used. Gambling harm exacerbates health disparities for disadvantaged and vulnerable groups, requiring targeted resources and support.

Doxapram for apnoea of prematurity and neurodevelopmental outcomes at age 5–6 years

ObjectiveTo assess the long-term neurodevelopmental impact of doxapram for treating apnoea of prematurity.DesignSecondary analysis of the French national cohort study EPIPAGE-2. Recruitment took place in 2011. A standardised neurodevelopmental assessment...

Comprehensive analysis of environmental exposure to hazardous trace elements and lung function: a national cross-sectional study

BackgroundThere is growing interest in the joint effects of hazardous trace elements (HTEs) on lung function deficits, but the data are limited. This is a critical research gap given increased...

Development and validation of the Telepsychology Facilitators Scale: A national study.

This study developed and validated the Telepsychology Facilitators Scale (TFS), a novel measure that uses the theory of reasoned action and technology acceptance model as frameworks to assess factors that influence psychologists' openness to using telepsychology. At the beginning of the COVID-19 pandemic, an online sample of 2,619 psychologists completed initial items considered for the TFS, along with a measure assessing their actual use of telepsychology. The sample was split in half, with a preliminary exploratory factor analysis ultimately revealing a 13-item general scale with four distinct subscales (Positive Attitudes, Facilitating Infrastructure, Organizational Support, and External Policies). Higher scores on each subscale positively correlated with psychologists' percentage of patient treatment conducted with telepsychology. The exploratory factor analysis subscale structure was subsequently supported via confirmatory factory analyses of a four-factor structure and bifactor structure (tested separately) with the other half of the sample, revealing adequate model fit for both models and similar convergent validity. The TFS may help the field assess the potential barriers and drivers of telepsychology use among psychologists and be used to inform future organizational and policy efforts to increase telepsychology implementation and use across health service settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Qualitative research during the COVID19 pandemic: the impact of remote research on the collaborative production of methodological knowledge

ABSTRACT During the COVID19 crisis, school closure was a frequent feature of Government responses. The Children’s School Lives (CSL) national cohort study of primary schooling in Ireland had to be adapted and transferred online as an interim response to the unprecedented impact that the pandemic had on the research environment. Adapting longitudinal qualitative research in response to a global pandemic brought specific challenges. In addition to moving data collection to remote methods, longitudinal studies also needed to maintain a focus on retention of research participants and sustain an analysis that informs the longitudinal design of the study. Based on reflective research practice during the COVID19 pandemic and through the collaborative production of methodological knowledge, this paper contributes to the literature on remote research during times of crisis. However, it also extends this literature as the methodological learning can be applied beyond the very particular circumstances of a pandemic.

Body Roundness Index and All-Cause Mortality Among US Adults

Obesity, especially visceral obesity, is an established risk factor associated with all-cause mortality. However, the inadequacy of conventional anthropometric measures in assessing fat distribution necessitates a more comprehensive indicator, body roundness index (BRI), to decipher its population-based characteristics and potential association with mortality risk. To evaluate the temporal trends of BRI among US noninstitutionalized civilian residents and explore its association with all-cause mortality. For this cohort study, information on a nationally representative cohort of 32 995 US adults (age ≥20 years) was extracted from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018 and NHANES Linked Mortality File, with mortality ascertained through December 31, 2019. Data were analyzed between April 1 and September 30, 2023. Biennial weighted percentage changes in BRI were calculated. Restricted cubic spline curve was used to determine optimal cutoff points for BRI. The survival outcome was all-cause mortality. Mortality data were obtained from the Centers for Disease Control and Prevention website and linked to the NHANES database using the unique subject identifier. Weibull regression model was adopted to quantify the association between BRI and all-cause mortality. Among 32 995 US adults, the mean (SD) age was 46.74 (16.92) years, and 16 529 (50.10%) were women. Mean BRI increased gradually from 4.80 (95% CI, 4.62-4.97) to 5.62 (95% CI, 5.37-5.86) from 1999 through 2018, with a biennial change of 0.95% (95% CI, 0.80%-1.09%; P < .001), and this increasing trend was more obvious among women, elderly individuals, and individuals who identified as Mexican American. After a median (IQR) follow-up of 9.98 (5.33-14.33) years, 3452 deaths (10.46% of participants) from all causes occurred. There was a U-shaped association between BRI and all-cause mortality, with the risk increased by 25% (hazard ratio, 1.25; 95% CI, 1.05-1.47) for adults with BRI less than 3.4 and by 49% (hazard ratio, 1.49; 95% CI, 1.31-1.70) for those with BRI of 6.9 or greater compared with the middle quintile of BRI of 4.5 to 5.5 after full adjustment. This national cohort study found an increasing trend of BRI during nearly 20-year period among US adults, and importantly, a U-shaped association between BRI and all-cause mortality. These findings provide evidence for proposing BRI as a noninvasive screening tool for mortality risk estimation, an innovative concept that could be incorporated into public health practice pending consistent validation in other independent cohorts.

U.S. Social Work Students and Social Media: A Descriptive Analysis of Survey Items across Four Time-Points.

Between fall 2018 and spring 2023, the author conducted four survey studies on social work students' use, attitudes, and knowledge regarding social media: (1) a pilot study in fall 2018 (N = 57), (2) a comparative study in spring 2019 (N = 42), (3) a national survey study in fall 2019 (N = 430), and (4) a national replication survey study in spring 2023 (N = 287). The purpose of this article is to describe general observed trends across these four studies. Findings included persistent and pervasive use of social media, decreased knowledge of the impact of social media in undermining democratic processes, students' inverted concern for others' use of social media when compared with concern over their own use, diminished agreement with the importance of protecting personal data and treating data protection as a civil/human right, overall agreement that law enforcement should be able to use social media in the apprehension of people accused of committing a crime, decreased agreement that disinformation is a problem on social media, ambivalence toward social media's positive impact on society, and increased strong disagreement that students wish to delete their accounts but feel unable to do so. Recommendations are shared.

Care partners' engagement in preventing falls for community-dwelling older people with dementia.

Little is known about how to prevent falls in community-dwelling older people with dementia. Although their care partners adopt various behaviors to prevent their falls, it is unclear if these behaviors reduce falls for those with different levels of fall risk. Linking the 2015 and 2016 National Health and Aging Trends Study (NHATS) and the 2015 National Study of Caregiving (NSOC), we identified 390 community-dwelling older people with dementia with 607 care partners. We selected 26 NSOC items representing fall risk management (FRM) behaviors. We examined the prevalence and dimensionality of these behaviors and investigated associations between care partners' behaviors in 2015 (T1) and older people's falls in 2016 (T2) stratified by their fall incidence at T1, adjusting for covariates. Five domains of FRM were identified: mobility and safety assistance, medical service coordination, health management, social service coordination, and accommodation. For those who did not fall at T1, mobility and safety assistance and social service coordination were each associated with an increased risk of falling at T2 (adjusted incidence rate ratio [aIRR]=1.39, 95% confidence interval [CI]=1.06-1.83, p=0.019, aIRR=1.25, 95% CI=1.01-1.55, p=0.043). For those who had fallen at T1, social service coordination was associated with a decreased risk of falling at T2 (aIRR=0.83, 95% CI=0.73-0.94, p=0.004). The different impacts of dementia care partners' FRM behaviors emphasize the need to address specific behaviors when involving care partners in preventing falls for older people with dementia at varying levels of fall risk.

Suicide after colorectal cancer-a national population-based study.

A cancer diagnosis is often associated with physical as well as emotional distress. Previous studies indicate a higher risk for suicide in patients diagnosed with cancer. The aim of this study was to investigate the prevalence of death by suicide in a national cohort of patients with newly diagnosed colorectal cancer compared with a matched control group to determine if patients with colorectal cancer had an increased incidence of death by suicide. This national Swedish cohort was retrieved from the register-based research database CRCBaSe, which includes all patients diagnosed with colorectal cancer between 1997-2006 (rectal) and 2008-2016 (colon) and six controls for each patient matched by age, sex, and county. Cause specific mortality due to suicide was modelled using Cox proportional hazards model and adjusted for known risk factors. The main analysis included patients operated for colorectal cancer, 55 578 patients compared with 307 888 controls. The first year after diagnosis the hazard ratio (HR) for suicide among patients operated for colorectal cancer was 1.86 (CI: 1.18-2.95) compared to controls. Suicide was more common among men than women (HR 2.08; 1.26-3.42 vs. 1.09; 0.32-3.75). A subgroup analysis of the 9198 patients who did not undergo surgery after diagnoses found a seven-fold increase of suicide (HR 7.03; 3.10-15.91). Suicide after surgery for colorectal cancer was almost twice as high as in the control group, mainly driven by excess mortality among men. Although the cases were few in the subgroup of nonoperated patients, the considerably higher risk of suicide indicates that more resources might be needed in this group. Evaluation of risk factors for suicide among patients with colorectal cancer should be performed for early identification of individuals at risk.

Associations between metabolic dysfunction-associated fatty liver disease, chronic kidney disease, and abdominal obesity: a national retrospective cohort study.

Metabolic dysfunction-associated fatty liver disease (MAFLD) and chronic kidney disease (CKD) present notable health challenges, however, abdominal obesity has received scant attention despite its potential role in exacerbating these conditions. Thus, we conducted a retrospective cohort study using the National Health and Nutrition Examination Surveys III (NHANES III) of the United States from 1988 to 1994 including 9161 participants, and mortality follow-up survey in 2019. Statistical analyze including univariable and multivariable Logistic and Cox regression models, and Mediation effect analyze were applied in study after adjustment for covariates. Our findings revealed that individuals with both abdominal obesity and MAFLD were more likely to be female, older and exhibit higher prevalence of advanced liver fibrosis (7.421% vs. 2.363%, p < 0.001), type 2 diabetes mellitus (T2DM) (21.484% vs. 8.318%, p < 0.001) and CKD(30.306% vs. 16.068%, p < 0.001) compared to those with MAFLD alone. MAFLD (adjusted OR: 1.392, 95% CI 1.013-1.913, p = 0.041), abdominal obesity (adjusted OR 1.456, 95% CI 1.127-1.880, p = 0.004), abdominal obesity with MAFLD (adjusted OR 1.839, 95% CI 1.377-2.456, p < 0.001), advanced fibrosis(adjusted OR 1.756, 95% CI 1.178-2.619, p = 0.006) and T2DM (adjusted OR 2.365, 95% CI 1.758-3.183, p < 0.001) were independent risk factors of CKD. The abdominal obese MAFLD group had the highest all-cause mortality as well as mortality categorized by disease during the 30-year follow-up period. Indices for measuring abdominal obesity, such as waist circumference (WC), waist-hip ratio (WHR), and lipid accumulation product (LAP), elucidated a greater mediation effect of MAFLD on CKD compared to BMI on CKD (proportion mediation 65.23%,70.68%, 71.98%, respectively vs. 32.63%). In conclusion, the coexistence of abdominal obesity and MAFLD increases the prevalence and mortality of CKD, and abdominal obesity serves as a mediator in the association between MAFLD and CKD.

What is the rate of definitive stoma after subtotal colectomy for inflammatory bowel disease? A nationwide study of 1860 patients.

Some patients with inflammatory bowel disease (IBD) require subtotal colectomy (STC) with ileostomy. The recent literature reports a significant number of patients who do not undergo subsequent surgery and are resigned to living with a definitive stoma. The aim of this work was to analyse the rate of definitive stoma and the cumulative incidence of secondary reconstructive surgery after STC for IBD in a large national cohort study. A national retrospective study (2013-2021) was conducted on prospectively collected data from the French Medical Information System Database (PMSI). All patients undergoing STC in France were included. The association between definitive stoma and potential risk factors was studied using univariate and multivariate analyses. A total of 1860 patients were included (age 45 ± 9 years; median follow-up 30 months). Of these, 77% (n = 1442) presented with ulcerative colitis. Mortality and morbidity at 90 days after STC were 5% (n = 100) and 47% (n = 868), respectively. Reconstructive surgery was identified in 1255 patients (67%) at a mean interval of 7 months from STC. Seveny-four per cent (n = 932) underwent a completion proctectomy with ileal pouch anal anastomosis and 26% (n = 323) an ileorectal anastomosis. Six hundred and five (33%) patients with a definitive stoma had an abdominoperineal resection (n = 114; 19%) or did not have any further surgical procedure (n = 491; 81%). Independent risk factors for definitive stoma identified in multivariate analysis were older age, Crohn's disease, colorectal neoplasia, postoperative complication after STC, laparotomy and a low-volume hospital. We found that 33% of patients undergoing STC with ileostomy for IBD had definitive stoma. Modifiable risk factors for definitive stoma were laparotomy and a low-volume hospital.

Association of Obesity Based on Different Metabolic Status with Risk of Gout Occurrence in Patients: A National Study.

Obesity often co-exists with metabolic abnormalities, but the results of studies on the relationship between obesity, metabolic abnormalities and the risk of gout are inconsistent. We aimed to study whether there was a mutual regulation between obesity, metabolic abnormalities and the risk of gout. We conducted a cross-sectional study to expound the association between obesity based on different metabolic statuses and the risk of gout. Patients were derived from Nationwide Readmission Database (2018 sample). A total of 9,668,330 records were recruited for analysis from January to December. The risk of gout in the obesity group, metabolic abnormalities group and obesity combined with metabolic abnormalities group was 1.67 times (OR=1.67, 95%CI 1.64-1.70), 3.12 times (OR=3.12, 95%CI 3.09-3.15) and 4.27 times (OR=4.27, 95%CI 4.22-4.32) higher than that in the normal control group. For different metabolic components, OR value was highest in hypertension group (OR=2.65, 95%CI 2.60-2.70 and OR=4.85, 95%CI 4.73-4.97), followed by dyslipidemia group (OR=2.23, 95%CI 2.16-2.30 and OR=3.74, 95%CI 3.55-3.95) and in hyperglycemia group (OR=1.73, 95%CI 1.66-1.80 and OR=2.94, 95%CI 2.78-3.11). Fewer components of metabolic syndrome were associated with a lower risk of gout in both nonobese and obese patients. When metabolic abnormalities were present, obesity induced a higher risk of gout. Different components of metabolic abnormalities had different effects on the risk of gout occurrence, and the number of metabolic abnormalities was closely related to the risk of gout occurrence. Follow-up and intervention methods targeting obesity and metabolic abnormalities should be considered for patients with gout.

Probiotics for managing patients after bowel preparation for colonoscopy: an interventional, double-arm, open, randomized, multi-center, and national study (COLONSTUDY).

Bowel preparation (BP) for colonoscopy induces significant changes in gut microbiota, causing dysbiosis that, in turn, elicits intestinal symptoms. Consequently, probiotics may counterbalance the disturbed microbiota after BP. So, probiotics may restore microbiota homeostasis. The current study evaluated the efficacy and safety of Abincol®, an oral nutraceutical containing a probiotic mixture with Lactobacillus plantarum LP01 (1 billion living cells), Lactobacillus lactis subspecies cremoris LLC02 (800 millions living cells), and Lactobacillus delbrueckii LDD01 (200 millions living cells), Patients were randomized in two groups (2:1). Group A took one stick/daily for four weeks after colonoscopy. Group B was considered as control. Patients were evaluated at baseline (T0) and after one (T1), two (T2), and four (T3) weeks. The severity of symptoms was measured by patients using a Visual Analog Scale. Abincol® significantly diminished the presence and the severity of intestinal symptoms at T2 and even more at T3. All patients well tolerated the probiotic mixture. The present study suggests that Abincol® may be considered an effective and safe therapeutic option in managing patients undergoing BP. The course should last one month.

Deep learning-based quantification of osteonecrosis using magnetic resonance images in Gaucher disease

Gaucher disease is one of the most common lysosomal storage disorders. Osteonecrosis is a principal clinical manifestation of Gaucher disease and often leads to joint collapse and fractures. T1-weighted (T1w) modality in MRI is widely used to monitor bone involvement in Gaucher disease and to diagnose osteonecrosis. However, objective and quantitative methods for characterizing osteonecrosis are still limited. In this work, we present a deep learning-based quantification approach for the segmentation of osteonecrosis and the extraction of characteristic parameters. We first constructed two independent U-net models to segment the osteonecrosis and bone marrow unaffected by osteonecrosis (UBM) in spine and femur respectively, based on T1w images from patients in the UK national Gaucherite study database. We manually delineated parcellation maps including osteonecrosis and UBM from 364 T1w images (176 for spine, 188 for femur) as the training datasets, and the trained models were subsequently applied to all the 917 T1w images in the database. To quantify the segmentation, we calculated morphological parameters including the volume of osteonecrosis, the volume of UBM, and the fraction of total marrow occupied by osteonecrosis. Then, we examined the correlation between calculated features and the bone marrow burden score for marrow infiltration of the corresponding image, and no strong correlation was found. In addition, we analyzed the influence of splenectomy and the interval between the age at first symptom and the age of onset of treatment on the quantitative measurements of osteonecrosis. The results are consistent with previous studies, showing that prior splenectomy is closely associated with the fractional volume of osteonecrosis, and there is a positive relationship between the duration of untreated disease and the quantifications of osteonecrosis. We propose this technique as an efficient and reliable tool for assessing the extent of osteonecrosis in MR images of patients and improving prediction of clinically important adverse events.

Clinical features and outcomes of mpox in people with and without HIV: a national comparative study.

People who live with HIV (PWLH) have been one of the most affected groups during the current mpox outbreak. They are hypothesized to have a more severe clinical course than people without HIV but comparative data is scarce. We aimed to compare clinical features and outcomes of mpox in people with and without HIV in Mexico. Country-wide study in Mexico. We performed an observational study using nation-wide epidemiological data. We included all people with confirmed mpox diagnosed between May and November 2022 in Mexico. Clinical and sociodemographic characteristics were compared between people with and without HIV. Multivariable logistic regression models were preformed to determine the association between HIV, clinical features, and outcomes and reported with odds ratios (ORs) and 95% confidence intervals (95% CI). ORs for rare outcomes were interpreted as risk ratios. Among 3291 people with mpox, 59% were PWLH. PWLH had an increased risk of severe mpox (OR 2.6, 2.4-2.9) and death (OR 10.8, 9.7-11.9). They also had a higher risk of otalgia, proctitis, and urethritis. Eleven individuals died, of whom ten were PWLH. All deaths were directly attributed to mpox. People with HIV have a higher risk of severe mpox and death due to mpox.

Gender disparities in incidence of psychological disorder among patients with breast cancer: A national cohort study.

e23285 Background: Male breast cancer (MBC) is rare. The features of MBC shares similar characteristics with female breast cancer, often resembling postmenopausal breast cancer. However, there are notable differences between male and female breast cancer, especially regarding gender and age, which can have distinct psychological impacts on male patients. In this study, we investigated whether the psychological distress experienced upon a diagnosis of breast cancer differs according to gender. Methods: Data were obtained from the National Health Insurance claims database of the Health Insurance Review and Assessment Service in South Korea. This study focused on the three most common psychological disorders: sleep disorders, anxiety disorders, and depression. Diagnosis confirmation relied on diagnostic codes based on the International Code of Disease, 10th revision, alongside breast cancer diagnoses. Propensity score matching was used in a 1:5 ratio, and adjustment variables included age, endocrine therapy, chemotherapy, HER2-targeted treatment, and Charlson Comorbidity Index score. Results: After excluding patients with previous psychological disorder, there were a total of 75,936 patients, and 281 (0.4%) male patients. Male patients were diagnosed at an older age, had a higher prevalence of hormone receptor-positive status, higher comorbidities, and lower rates of anxiety disorders, while sleep disorders and depressive disorders showed similar incidences. The Cox proportional hazard regression model exhibited that being female was a risk factor for anxiety disorder (after matching, multivariable, HR 1.498, 95% CI 1.057-2.123, p = 0.023). However, gender did not significantly influence the development of sleep or depressive disorders, despite these conditions typically having a higher incidence in females. During the acute phase shortly after diagnosis, women tend to have more distress, as seen on the cumulative incidence curves. Conclusions: MBC patients experienced similar levels of psychological distress related to sleep and depression disorders as female patients. These results suggested that both genders require an equal support system and psychological care to maintain mental well-being after a breast cancer diagnosis.