Outcomes In Young Patients Research Articles

Evaluating a Tailored 12-Week Post-Operative Rehabilitation Program for Younger Patients Following Total Knee Arthroplasty: Addressing a Growing Need

Background: The prevalence of total knee arthroplasties (TKA) is rising, especially among younger patients due to sports-related injuries and early osteoarthritis onset. Post-operative outcomes in younger patients show promise, but current rehabilitation approaches lack specificity for this group. This study aims to evaluate a post-operative rehabilitation program tailored for younger TKA recipients.; Methods: Patients from a single arthroplasty center who underwent TKA were age and sex-matched into two groups: Group A with an advanced 12-week rehabilitation program and Group B with a standard rehabilitation program. Eligibility required participants to be under 60 and ready for a specific TKA type, with assessments at baseline and 12 weeks post-operative using the KSS, KOOS, and the SF-36 scales. Results: At the 12-week follow-up, Group A, having received the advanced rehabilitation protocol, showed significantly higher KOOS (A: 85.1 ± 8.7 vs. B: 83.7 ± 11.1; p=0.042) and KSS (A: 82.9 ± 8.4 vs. B: 78.7 ± 9.2; p=0.020) scores than Group B. Both groups demonstrated marked improvements with an attendance rate of 88% (A) compared to 82% (B), although we found no significant difference in overall mean tolerability scores between the groups. Conclusions: Patients undergoing advanced rehabilitation after total knee arthroplasty showed significant improvements compared to standard protocols. Despite minor variations influenced by social determinants, the advanced protocol was more effective in post-operative recovery.

Study of 109 Patients Who Required Bipap Therapy During Corona Virus Epidemic

Background :Bipap support is essential for the management of the respiratory failure for the corona virus epidemic. Thestudy focus on the details of the patients, who required bipap support and analyzed characteristics of those patients.Materials and methods: A total of 109 patients were studied for their details including their number of comorbid conditions, age and outcomes. Results: Out of total patients who were discharged after utilizing the bipap support were 58.7% and those who expired were 41.3%. Hence the study shows that the patients who were kept on bipapsupport had shown improvement even after onset of respiratory failure during corona epidemic. The recovery may still depend upon the patients'characteristics including age and number of comorbidities.Conclusion:The patients with higher age and higher number of comorbid conditions like diabetes and hypertension etcmay have higher mortality as compared to the patients having younger age and nil comorbidities. Higher age group patients may carry more chances of poor prognosis. Increased age with higher number of comorbid conditions may lead to higher mortality. However since the ventilated patients have significant high mortality, the bipap therapy still stand a chance to save the patients from being ventilated and may show better outcomes in young patients with less comorbid conditions. The patients presented with worsened respiratory failure at the time of admission and required bipap support immediately, had higher mortality than those who had presented early and then subsequently required further use of bipap after few days of admission. Key words:Respiratory failure, bipap support, age, comorbidities.

High Body Mass Index Is Associated with Favorable Outcome in Younger Patients Receiving CD19 CAR T-Cell Therapy for B-Cell Lymphoma: A Retrospective Study from the EBMT Transplant Complications Working Party

Introduction: Obesity is a major health care burden and has been linked to numerous adverse outcomes including alterations of antitumor immunologic responses. Patients with high body mass index (BMI) undergoing autologous or allogeneic hematopoietic stem cell transplantation (HSCT) for hematological malignancies were repeatedly shown to have higher rates of non-relapse mortality (NRM) and relapse, translating into a reduced overall survival (OS). However, the impact of obesity on outcomes after CAR T-cell therapy has not been studied at large scale. The present study aims to investigate whether high BMI is associated with outcomes in patients receiving anti-CD19 CAR T-cell therapy. Methods: This is a retrospective analysis using EBMT registry data of adult patients after first therapy with commercial CD19 CAR T-cell products for relapsed/refractory B-Non-Hodgkin lymphoma (B-NHL) between 1/1/2016 and 30/6/2022. Only patients with available information on height and weight at CAR T-cell therapy were included. Patients with a history of allogeneic stem cell transplantation were excluded. As we exclusively focused on the impact of increased BMI we excluded all patients with a BMI below 18.5 from the analysis. The primary outcome was the impact of BMI on OS. Multivariate analyses were performed with cause-specific Cox models, employing as risk factors patient age, sex, ECOG status and year of CAR T-cell therapy besides BMI categories (18.5-25, 25-30, >30). Results: A total of 4576 CAR T-cell therapy patients were registered during the study period, with 3125 patients meeting inclusion criteria. Selection of patients with available height and weight including BMI of 18.5 and above resulted in a final study cohort of 1653 patients. Median follow-up was 21.2 months [95% CI: 19.6-22.6]. Patients' characteristics are summarized in Table 1. Half of the cohort had a normal range BMI, while one third was overweight (BMI 25-30) and about 18% met criteria for obesity. A significant interaction was found between age and BMI. Therefore, we divided the cohort in two groups by the median age of 62.5 years. OS was significantly reduced in younger patients with normal range BMI compared to higher BMI patients. However, this effect was not significant in the older patients (Figure 1). Upon multivariate analysis, younger patients with BMI 25-30 had a survival advantage with a hazard ratio (HR) of 0.74 (0.57-0.95, P=0.02) and patients with BMI >30 a HR of 0.68 (0.51-0.91, P=0.01) compared to normal range BMI. Progression free survival was significantly improved for younger BMI 25-30 (HR 0.79, 0.64-0.99, P=0.04) but not BMI >30 (HR 0.82, 0.64-1.05, P=0.11), and NRM was reduced only in the younger BMI 25-30 subgroup (HR 0.52, 0.31-0.9, P=0.02) but not in the obese patients (HR 0.7, 0.42-1.18, P=0.19). Multivariate analysis of BMI subgroups in patients above the age of 62.5 years did not show significant differences with regard to OS (BMI 25-30 HR 0.94, 0.74-1.18; BMI >30 HR 1.04, 0.77-1.41), PFS (BMI 25-30 HR 1.06, 0.86-1.31; BMI >30 HR 1.1, 0.83-1.47), or NRM (BMI 25-30 HR 1.35, 0.89-2.06; BMI >30 HR 1.11, 0.6-2.06). Conclusion: Our European real world data on the impact of increased BMI on anti-CD19 CAR T-cell therapy for relapsed/refractory B-NHL shows that half of these patients are overweight or obese and that this seems to confer a survival benefit to younger (<62.5 years) patients. As this finding is rather surprising, future studies are required to fine tune the risk analysis, including in-depth analysis of patients' characteristics to identify protective factors linked to an elevated BMI as well as a possible selection bias. Our findings could in part be explained by the body weight-dependent dose of infused CAR T-cells for B-cell lymphoma. Therefore, for the same tumor burden, obese patients might receive more CAR T-cells than normal weight ones. A future study should test this hypothesis also in B-ALL or multiple myeloma patients, as they typically receive a fixed dose of CAR T-cells regardless of their body weight. Ultimately, our study might contribute to identify underlying mechanisms for improved outcome of CAR T-cell patients.

Systemic AL Amyloidosis in Patients Younger Than 40 Years of Age: Clinical Presentation and Outcomes

Background: The median age at diagnosis for systemic AL amyloidosis is reported to be 64 years. A small number of patients are diagnosed at a much younger age, i.e., before 40 years. The characteristics and prognosis of these patients are not well known, and perhaps they require unique considerations due to the earlier onset of disease. A closer understanding of this patient population could help guide management approach and improve long term outcomes. Aim: In this study, we aimed to describe the presenting clinical features, hematologic profiles and outcomes of young patients with AL amyloidosis. Methods: Patients with systemic AL amyloidosis and age ≤ 40 years at diagnosis who presented to the Boston University Amyloidosis Center between 2000 and 2023 were identified from our prospectively maintained database of consented patients (ClinicalTrials.gov Identifier: NCT00898235). All patients had clinicopathological evidence of systemic AL amyloidosis, with positive Congo red staining of a biopsy specimen and evidence of a plasma cell dyscrasia. We collected clinical data both from the database and medical records of these patients. Overall survival (OS) rates were estimated using the Kaplan-Meier method, and hazard ratios (HR) computed from multivariable Cox proportional hazard models for OS. Results: Of 1,722 patients with AL amyloidosis evaluated during the study period, we identified 45 (2.6%) patients who were diagnosed at ≤ 40 years of age. The median age was 37 years (range 21-40) and only 4 patients were ≤ 30 years of age. Presenting characteristics are shown in Table 1. Notably, this cohort had a median B-type natriuretic peptide of 87 pg/mL (range 0-2,346), troponin-I of 0.012 ng/mL (range 0-3.192), interventricular septum of 11 mm (range 5-18), and 6-minute walking distance (6MWD) of 396 meters (range 183-731). The median time from symptom onset to diagnosis was 8 months (range 1-72). The majority (n = 32, 71%) were treated with high-dose melphalan and stem cell transplantation (HDM/SCT) as frontline therapy. Meanwhile, 11 patients received non-SCT treatments, including melphalan/dexamethasone (7%), daratumumab-CyBorD (4%), CyBorD (2%), bortezomib/dexamethasone (2%), and dexamethasone alone (2%). Of the evaluable patients (n = 31), 39% achieved hematologic complete response to any regimen at 6-12 months following treatment. With a medianfollow-up of surviving patients of 9.0 years, the median OS was 16.7 years (95% CI 11.6-16.9). Of the cohort, a total of 20 patients (44%) died. Patients treated with HDM/SCT had median OS of 16.9 years; meanwhile, those treated with non-SCT therapies had a median OS of 1.3 years. On multivariate analysis, time from symptom onset to diagnosis of >6 months (HR 2.21, p = 0.21) and 6MWD < 400 meters (HR 1.37, p = 0.66) were independently associated with increased risk of mortality. Conclusions: Young patients with AL amyloidosis who are diagnosed before 40 years of age have a prolonged survival if treated with intensive treatment with HDM/SCT if eligible. Longer time to diagnosis from symptom onset and 6-minute walk distance are important prognostic factors in this patient population.

OGC P42 Presentation, Management and Outcomes in Young Patients Diagnosed with Gastric Cancer

Abstract Background Gastric cancer poses a significant global health challenge, mainly affecting older individuals with well-established risk factors. However, outcomes in young patients have been perceived as poorer due to late diagnosis and more aggressive disease subtype. There are also a small sub-set of younger patients in which gastric cancer is genetically inherited. This comprehensive retrospective cohort study aimed to evaluate the patient characteristics, treatment modalities, and survival outcomes of young patients diagnosed with gastric cancer, to provide valuable insights into optimal therapeutic strategies. Methods A retrospective analysis was conducted using electronic medical records from a regional oesophago-gastric cancer service serving 3.5 million people across the North West of England, encompassing a 5-year period between January 2018 and December 2022 inclusive. Young patients were defined as being 50 or younger (eligible for genetic testing) at the time of diagnosis of gastric cancer. Clinical and pathological data, including tumour characteristics, treatment approaches, and survival outcomes, were collected. Survival analysis was performed utilising Kaplan-Meier estimates, and survival rates following gastrectomy were compared to publicly available outcomes. Results 60/956 (6.3%) patients were aged 50 or below at the time of diagnosis. Mean age was 42.1 (range = 28-50); 48% were male. Stages III and IV of disease were observed in 27% and 57% of patients respectively. Poorly differentiated disease was observed in 53%, with HER-2 positivity in 13%. Distal gastric cancer represented 56% of cases and proximal cancer 27%. Initial treatment intent was curative in 43%. 1-year and 3-year overall survival was 51% and 33. 3-year overall survival was 92% for 20 patients who received gastrectomy versus 60% in all patients reported by NOGCA. Conclusions This study suggests that young patients with gastric cancer present with significantly advanced disease. Despite this, young patients show similar medium- and long-term survival rates. Well selected young patients can be offered treatment with curative intent with good medium- to long-term outcomes. Future research should focus on understanding the underlying mechanisms in this group, exploring novel therapeutic strategies, including the role of genetic testing, as well as validating these finding in larger and more diverse patient populations.

OGC P41 Presentation, Management and Outcomes in Young Patients Diagnosed with Oesophageal Cancer

Abstract Background Oesophageal cancer is a devastating malignancy associated with poor prognosis, primarily affecting older individuals with multiple co-morbidities. However, outcomes of younger patients have been perceived as poor due to late diagnosis and more aggressive disease subtype. This subset of patients poses unique clinical challenges and requires a better understanding of their outcomes. This comprehensive retrospective cohort study aimed to evaluate the patient characteristics, treatment modalities, and survival outcomes of young patients diagnosed with oesophageal cancer, to provide further insights into this understudied population. Methods A retrospective analysis was conducted using electronic medical records from a regional oesophago-gastric cancer service serving 3.5 million people across the North West of England, encompassing a 5-year period between January 2018 and December 2022 inclusive. Young patients were defined as being 50 or younger at the time of diagnosis of oesophageal cancer. Clinical and pathological data, including tumour characteristics, treatment approaches, and survival outcomes, were collected. Survival analysis was performed utilising Kaplan-Meier estimates, and survival rates following oesophagectomy were compared to publicly available outcomes. Results 87/2485 (3.5%) of patients studied were aged 50 or below at the time of diagnosis. Mean age at diagnosis was 44.3 (range = 24-50); 71% were male. Adenocarcinoma and SCC accounted for 73% (33% poorly differentiated, 40% moderately differentiated) and 25% of cases respectively. The majority presented with c-stage III (24%), c-stage IVa (17%) and c-stage IVb (46%) disease. Initial treatment intent was curative in 43%. 1-and 3-year overall survival rates were 49% and 21% respectively - similar to the wider population. 1- and 3-year survival rates after oesophagectomy were 80% and 44.5% (versus 82.5% and 59.5% for wider population). Conclusions Our findings underscore the concerns about the proportion of advanced-stage diagnosis in young patients with oesophageal cancer, and poorer longer-term outcomes after curative resection. This highlights the importance of timely detection and appropriate treatment strategies in this patient group. Future research should focus on understanding the underlying mechanisms in this group, exploring novel therapeutic strategies as well as validating these finding in larger and more diverse patient populations.

The prevalence of young ST-elevation myocardial infarction, the risk factors, and the pattern of coronary artery involvement in the Serdang PPCI Registry over 7 years

Abstract Background Acute coronary syndrome has remained Malaysia's leading cause of death for the past 15 years, with a more than 50% increase in the last ten years. There is limited published literature focusing on this population. Hence, we aim to assess the clinical risk factors, angiographic profile, and outcome of young patients (aged ≤ 40 years) with acute STEMI from the Serdang Primary PCI STEMI Network over a period of 7 years. Methods We evaluated all patients ≤40 years of age admitted with acute ST-segment elevation acute myocardial infarction (STEMI) who were studied between May 2015 and December 2022 at Serdang Heart Center Hospital. Risk factors were determined by review of electronic medical records. The primary outcomes of interest were all-cause mortality. Results Out of 1374 patients, 184 were very young STEMI patients, accounting for 13.4% of all patients in our study, with the majority being male (92.9%). The average age was 34.61±4.71. The mean pain score was 5.7±2.4. Anterior wall MI was present in 90 patients (48.9%), inferior wall MI in 84 patients (45.7%), lateral wall MI in 9 patients (4.9%), and left main stem MI in 1 patient (0.5%). The prevalence of diabetes mellitus was 27.7%, with a mean HbA1c of 6.9±2.4. With a mean TC of 5.68±1.61 mmol/L and a mean LDL of 3.70±1.48 mmol/L, the prevalence of dyslipidaemia was 49.5%. The mean creatinine was 83.04±21.04. The majority presented a Killip I score, which accounted for 91.3%. The radial vascular access was 84.8%. Single-vessel disease was the most common finding, at 77.7%. At 1 month, 98.4% of patients survived. Conclusion STEMI in people under the age of 40 is almost entirely seen in men. Around 15% of patients have no significant stenosis of the coronary arteries. Anterior-wall MI is more common, and more than three-quarters of patients have single-vessel disease. The 1-month survival rate is high.

The salvage role of allogeneic hematopoietic stem-cell transplantation in relapsed/refractory diffuse large B cell lymphoma

To clarify the role of allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in the chimeric antigen receptor T-cell therapy era, we analyzed the clinical characteristics and outcomes of 52 patients treated with allo-HSCT with relapsed/refractory diffuse large B cell lymphoma. Most enrolled patients had previously undergone intensive treatments, the median number of chemotherapy lines was 4, and the median time from diagnosis to allo-HSCT was 27.1 months. Patients were divided into remission-achieved (n = 30) and active-disease (n = 22) groups before allo-HSCT. Over a median follow-up period of 38.3 months, overall survival (OS) and event-free survival (EFS) rates were 38.4% and 30.6%, respectively. The cumulative incidence of relapse (CIR) and the non-relapsed mortality (NRM) were 36.7% and 32.7%, respectively. OS, EFS, and graft-versus-host disease-free, relapse-free survival (GRFS) outcomes were significantly superior in the remission-achieved group with lower CIR. In a multivariate analysis, a shorter interval from diagnosis to allo-HSCT reflected relatively rapid disease progression and showed significantly poor OS and EFS with higher CIR. Patients with active disease had significantly lower EFS, GRFS, and higher CIR. Previous autologous stem-cell transplantation was associated with better GRFS. Allo-HSCT is an established modality with a prominent group of cured patients and still has a role in the CAR T-cell era, particularly given its acceptable clinical outcomes in young patients with chemo-susceptible disease.

Prediabetes is Associated with Worse Long-Term Outcomes in Young Patients with Acute Coronary Syndrome.

The incidence of prediabetes mellitus (pre-DM) is increasing among young individuals. Whether pre-DM can predict adverse cardiovascular events in acute coronary syndrome (ACS) patients remains controversial. This study aimed to investigate the impact of pre-DM on the long-term clinical outcomes of patients aged≤ 45 years with new-onset ACS. A total of 1113 patients with new-onset ACS (aged≤ 45 years) who underwent percutaneous coronary intervention (PCI) were enrolled in this study. Patients were divided into three groups according to their glycemic status or history: normal glucose metabolism (NGM), prediabetes (pre-DM), and diabetes mellitus (DM). The primary endpoint was defined as a composite of major adverse cardiovascular events (MACE) including all-cause death, myocardial infarction (MI), stroke, or unplanned repeat revascularization. Multivariate Cox regression analysis was performed to explore the association between abnormal glycemic status and MACE. The prevalence of NGM, pre-DM, and DM were 45.9% (n=511), 27.0% (n=301), and 27.0% (n=301), respectively. During a median follow-up of 65 months, MACE occurred in 23.5% (n=120) of NGM, 29.2% (n=88) of pre-DM, and 34.6% (n=104) of DM (P=0.003). After multivariate adjustment, both pre-DM and DM significantly increased the risk of MACE compared with the NGM group (pre-DM: HR1.38, CI95% 1.05-1.83, P=0.023; DM: HR1.65, CI95% 1.27-2.16, P<0.001). Moreover, pre-DM had a similar impact on MACE as DM in young patients with ACS (P=0.162). Pre-DM was common among patients aged≤ 45 years with new-onset ACS. Pre-DM was associated with an increased risk of future MACE compared to NGM.

Clinical outcome and outcome prediction of octogenarians with acute basilar artery occlusion and endovascular stroke treatment compared to younger patients.

Octogenarians are underrepresented in recently published studies that showed the benefit of endovascular stroke treatment (EST) for patients with acute basilar artery occlusion (BAO). We aimed to compare the clinical outcome of octogenarians with BAO and EST compared to younger patients (YPs) and identify independent outcome predictors. This is a retrospective, single-center analysis of patients treated for BAO with EST from January 2013 until June 2021 in a tertiary stroke center. Octogenarians (80-89 years) were compared to YPs. A study endpoint was a favorable clinical outcome as per the modified Rankin Scale (mRS 0-3), 90 days after stroke onset. The study groups were compared using univariate analysis, and a multivariable logistic regression analysis was performed to define independent predictors for favorable and unfavorable (mRS 5-6) clinical outcomes. In this study cohort, 74/191 (38.7%) octogenarians had a higher pre-stroke mRS [median, interquartile range (IQR): 2, 1-3 octogenarians vs. 0, 0-1 YP, p < 0.001] and a comparable National Institutes of Health Stroke Scale (NIHSS) before EST (median, IQR: 21, 10-38 vs. 20, 8-35 in YP, p = 0.487). They showed a comparable rate of favorable outcome (mRS 0-3, 90 days, 23.0 vs. 25.6% in YP, p = 0.725), but were less often functionally independent (mRS 0-2: 10.8% in octogenarians vs. 23.0% in YP, p = 0.049). The rate of unfavorable clinical outcome was comparable (mRS 5-6, n = 40, 54.1% in octogenarians vs. n = 64, 54.7% in YP, p = 0.831). A baseline NIHSS was an independent predictor for clinical outcome in YPs [e.g., for unfavorable clinical outcome: odds ratio (OR) 1.061, confidence interval (CI) 1.027-1.098, p = 0.005] and for favorable clinical outcome in octogenarians. Pre-stroke mRS predicted favorable outcomes in octogenarians (OR 0.54, CI 0.30-0.90, p = 0.0291), while age predicted unfavorable outcomes in YPs (OR 1.045, CI 1.011-1.086, p = 0.0137). Octogenarians with acute BAO eligible for EST are as likely to achieve a favorable outcome as YPs, and the rate of death or severe disability is comparable. The admission NIHSS is an independent predictor for favorable and unfavorable outcomes in YP and for favorable outcomes in octogenarians. In this study cohort, pre-stroke mRS predicted favorable outcomes in octogenarians while age predicted an unfavorable outcome in YPs.

Fertility-Sparing Treatment in Gestational Choriocarcinoma: Evaluating Oncological and Obstetrical Outcomes in Young Patients.

BACKGROUND Gestational choriocarcinoma (GC) is an uncommon neoplasia that occurs in women who may not have completed a procreation plan. The aim of this study was to evaluate oncological and obstetrical outcomes in young patients with GC after fertility-sparing treatment. MATERIAL AND METHODS The eligibility criteria for the study were histopathological diagnosis of GC, age ≤40 years, and treatment with systemic chemotherapy. Patients who underwent upfront hysterectomy were excluded. The response to treatment was assessed according to beta-human chorionic gonadotropin (beta-hCG) serum measurement. Complete response and progression were considered if the beta-hCG dropped to a normal range and increased (or reached a plateau), respectively. The birth rate was calculated as the number of women who gave birth after treatment divided by the total number of patients. RESULTS A total of 18 patients fulfilled the study's eligibility criteria. A complete response and progression to first-line chemotherapy were found in 13 (72.22%) and 5 (27.78%) patients, respectively. Salvage treatment was administered to patients with progression. Overall, 16 (88.88%) patients achieved complete response after treatment and 2 (11.12%) died. GC relapse was diagnosed in 1 patient 62 months after treatment. The birth rate was 22.22%, and a total of 6 children were born. All pregnancies ended in term delivery. No congenital abnormalities were detected in the newborns. CONCLUSIONS GC is a life-threatening form of gestational trophoblastic neoplasia, mainly due to its rapid course and resistance to chemotherapy. Most patients with GC will not be able to bear children after treatment.

Lung Cancer in Young Patients is Associated With More Advanced Disease but Better Overall Survival

IntroductionIt is unclear whether nonsmall cell lung cancer (NSCLC) is associated with more aggressive disease and worse overall survival (OS) among younger patients. The aim of this study is to evaluate outcomes in young patients. We hypothesize that young age is associated with more advanced disease upon presentation, but better OS. MethodsWe identified patients with NSCLC from 2004 to 2018 in the National Cancer Database. Patients were categorized in 3 groups: age≤50, 51-84, and ≥85 y. The outcomes were OS, stage IV NSCLC and clinical nodal metastasis. OS was analyzed using multivariate cox and Kaplan–Meier analysis accounting for stage, comorbidities, and other factors. The association of age, presentation with stage IV NSCLC and node positivity was analyzed using multivariate logistic regression. ResultsIn total 1,651,744 patients were identified: 92,506 (5.57%) age ≤50, 1,477,723 (88.90%) age 51-84, and 91,964 (5.53%) age ≥85. Multivariate model showed stage IV NSCLC was associated with age ≤50 (OR 1.17 (1.15-1.20) P < 0.001) and ≥85 (odds ratio (OR) 1.03 (1.02-1.04) P < 0.001). Clinical lymph node positivity was associated with age ≤50 (OR 1.27 (1.23-1.30) P < 0.001). Relative to patients 51-84, the ≤50 group was associated with better survival in Stage I (hazard ratio (HR) 0.61 versus 1.00), stage II (HR 1.12 versus 1.50), stage III (HR 2.12 versus 2.53), and stage IV (HR 6.65 versus 7.53). ConclusionsPatients ≤50-y-old present with more advanced NSCLC, but better OS compared to patients 51-84. These findings suggest the need for increased awareness regarding NSCLC among age groups seen as low risk.

Prognostic Value of D-Dimer in Younger Patients with Pulmonary Embolism

Abstract In patients with pulmonary embolism (PE), the D-dimer assay is commonly utilized as part of the diagnostic workup, but data on D-dimer for early risk stratification and short-term mortality prediction are limited. The purpose of this study was to determine D-dimer levels as a predictive biomarker of PE outcomes in younger (&lt;50 years of age) compared to older patients. We conducted retrospective analysis for 930 patients diagnosed with PE between 2015 and 2019 as part of the Serbian University Multicenter Pulmonary Embolism Registry (SUPER).All patients had D-dimer levels measured within 24 hours of hospital admission. The primary outcome was mortality at 30 days or during hospitalization. Patients were categorized into two groups based on age (≤ 50 and &gt;50 years of age). Younger patients constituted 20.5% of the study cohort. Regarding all-cause mortality, 5.2% (10/191)of patients died in group under the 50 years of age; the short-term all-causemortality was 12.4% (92/739) in older group.We have found that there was significant difference in plasma D-dimer level between patients ≤ 50 years of age and older group (&gt;50), p= 0.006.D-dimer plasma level had good predictive value for the primary outcome in younger patients (c-statistics 0.710; 95% CI, 0.640-0.773; p&lt;0.031). The optimal cutoff level for D-dimer to predict PE-cause death in patients aged &gt; 50 years was found to be 8.8 mg/l FEU(c-statistics 0,580; 95% CI 0.544-0.616; p=0.049). In younger PE patients, D-dimer levels have good prognostic performance for 30-day all-cause mortalityand concentrations above 6.3 mg/l FEU are associated with increased risk of death. D-dimer in patients aged over 50 years does not have predictive ability for all-caused short-term mortality. The relationship between D-dimer and age in patients with PE may need further evaluation.

The effects of a group-based intervention through physical activities and dietary changes in young patients with severe psychiatric disorders: a pilot study.

The present study aims to investigate the effect of the 4-F (Fit, Fun, Feel, and Food) group-based program on physical, clinical, and biological outcomes in young patients suffering from severe psychiatric disorders. A pilot study with a naturalistic design was conducted to investigate the effect of a group-based intervention on young patients. A descriptive analysis revealed that out of the 61 outpatients initially enrolled in the program, with a mean age of 26.9 years old (±6.1, 60% men), 71% were overweight or obese. Paired T-tests for the difference between T0 and T1 were used to evaluate the evolution of the outcomes. The 24 patients who completed the full program showed no significant decrease in weight or body composition. Despite the limitations, the main findings of this study were the significant improvement in muscular endurance and coordination (from T0 (M = 13.65, SD = ±1.93) compared to T1 (M = 12.49, SD = ±1.81), [t(20) = 3.072, p < 0.05] and the general increase in mental well-being from baseline to the end of the program according to the type of psychopathology [F(3,10) = 4.25, p < .05]. A slight modification in eating behavior, with a tendency towards a decrease in TFEQ hunger levels, was also noticed. The ANCOVA showed no difference in outcomes between the groups based on diagnosis. Despite its limitations and the small sample size, this pilot study provides valuable insights, demonstrating the feasibility of the program and its positive impact on physical well-being and improved mental health in young patients with psychiatric disorders, sedentary behavior, and unhealthy lifestyles. These encouraging results warrant further research in controlled, larger population samples to deepen our understanding of the potential effects of such interventions.

WTP7.1 Outcomes of Surgical Repair of Incisional Hernia in The Old Patients ≥70 Years

Abstract Aims Incisional hernia (IH) is a common complication after abdominal surgery. Increasing age and frailty may be associated with poor outcomes after surgical interventions. This study aims to assess the safety of surgical repair of IH in patients ≥ 70-Year-old. Methods A retrospective study of patients who had surgical repair of IH on an elective and emergency basis in a UK District Hospital. The patients were divided into two groups, Group I &amp;lt;70 and Group II ≥70 years. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes. Results 262 patients were included with a mean age of 61.8 SD± 14.2 years, and 152 (58%) were females. Group I included 173, and Group II had 89 patients. Group I had more morbidly obese patients, 46 (28.8%) compared to 12 (15.2%) in Group II; p= 0.021. Group II had more patients with at least one comorbidity and COPD than Group I; p= 0.004 and 0.003, respectively. There were no significant differences in overall or wound-related complications, p= 0.587 and 0.125, respectively. The 30-day mortality rates were 3 (1.7%) and 3 (3.4%), and the 90-day mortality rates were 4 (2.3%) and 3 (3.4%) in Groups I and II, respectively, without significant differences between both groups. There were no significant differences in the recurrence rate (with a mean follow-up of 56 months) or 90-day readmissions between the two groups. Conclusions Surgical repair of IH is safe and effective in patients ≥ 70 years, with comparable outcomes in younger patients.

Comparison of Survival Outcomes in Young Patients With Breast Cancer Receiving Contralateral Prophylactic Mastectomy Versus Unilateral Mastectomy

BackgroundContralateral prophylactic mastectomy (CPM) has been performed for several decades in patients with unilateral breast cancer (BC). However, the survival benefits of CPM are controversial, particularly in young women. Materials and MethodIn this retrospective study, the clinical total of 69,000 young female patients (age ≤ 40 years) who were diagnosed to have unilateral BC and underwent unilateral mastectomy (UM) or CPM between January 1, 2000 and December 31, 2019 were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was performed to minimize selection bias and overcome differences in tumor characteristics between the CPM and UM groups. Overall survival (OS) and BC-specific survival (BCSS) were assessed using Kaplan–Meier curves and compared across groups using log-rank test. Multivariable Cox proportional hazards regression analysis was performed to estimate hazard ratios (HRs). ResultsA total of 36,528 patients (21,600 and 14,928 patients in the UM and CPM groups, respectively) were included in follow study. The CPM group showed a higher 5-year OS rate (82.1% vs. 75.8%) and a higher 5-year BCSS rate (83.5% vs. 77.7%) than the UM group. Multivariate Cox analysis after PSM (n = 13,089) showed that CPM significantly decreased 25% risk of all-cause mortality (OS, HR: 0.75, 95% confidence interval [CI]: 0.70-0.80; P < .001) and 25% risk of BC-specific mortality (BCSS, HR: 0.75, 95% CI: 0.70-0.80; P < .001) in young BC patients as compared to UM. ConclusionThis study suggests that CPM improved OS and BCSS benefits in young BC patients as compared to UM. Randomized clinical trials with a larger sample size are required in the future to confirm these results.

Clinical risk factors and outcomes of young patients with acute ST segment elevation myocardial infarction: a retrospective study

BackgroundThis study aimed to analysis the clinical characteristics and prognosis of acute STEMI in patients aged ≤ 45 years.MethodsSeven hundred and one patients with STEMI from Liaocheng People’s Hospital from January 2018 to March 2021 were included in this study. Clinical characteristics, management, and outcomes (average follow-up: 11.5 months) were compared between patients aged ≤ 45 years and those aged > 45 years.ResultsOf the patients with STEMI who underwent primary percutaneous coronary intervention, 108 (15.4%) were aged ≤ 45 years. Compared to the older group, the younger patient group included more males, current smokers, and those with alcohol use disorder (AUD) or a family history of ischaemic heart disease (IHD). The culprit vessel in young patients was the left anterior descending (LAD) artery (60% vs. 45.9%, P = 0.031), which may have been due to smoking (odds ratio, 3.5; 95% confidence interval: 1.12–10.98, P = 0.042). Additionally, young patients presented with higher low-density lipoprotein and lower high-density lipoprotein levels than older patients; uric acid levels were also significantly higher in younger patients than that in the older group. Diabetes showed a trend toward major adverse cardiovascular events (MACE) in both groups; age and sex were both independent predictors of MACE in older patients.ConclusionMore patients who were smokers, had AUD, or a family history of IHD were present in the young patient group. Hyperuricaemia (but not dyslipidaemia) was a prevalent risk factor in patients aged ≤ 45 years. Diabetes should be controlled to reduce cardiovascular events in young patients.

O-146 Oocyte donation does not increase live birth rates in young women suffering from recurrent pregnancy loss

Abstract Study question Does oocyte donation improve reproductive outcomes in recurrent pregnancy loss (RPL) patients? Summary answer Oocyte donation increases live birth and reduces miscarriage rates in RPL women older than 35, but it does not improve reproductive outcomes in younger patients. What is known already Recurrent pregnancy loss (RPL) is defined as 2 or more pregnancy losses prior to 20-24 weeks of gestation and has an incidence of approximately 1 to 2% in couples trying to conceive. Known risk factors for RPL are embryo aneuploidy, advanced maternal age (AMA), previous miscarriages, uterine abnormalities, parental chromosomal abnormalities, antiphospholipid syndrome, endocrine factors, such as thyroid function or obesity, and thrombophilia. However, 50-70% of patients suffering from RPL do not present any known risk factor, making the management of idiopathic RPL patients particularly challenging for ART clinicians. Study design, size, duration This is a cohort retrospective study involving 2 centers. Charts from 18,273 women undergoing IVF treatment between 2011 and 2020 were reviewed. A total of 912 patients (5%) met the definition of RPL and were classified into study groups based on their age and oocyte origin: ≤35 years old receiving oocyte donation (n = 39) or using their own oocytes (n = 35), and AMA women using donor eggs (n = 716) or their own (n = 122). Participants/materials, setting, methods Demographic variables analysed included known risk factors, number of transferred embryos, day of embryo transfer (3 vs 5) and sperm origin (partner/donor). Differences in biochemical, clinical, ongoing pregnancy, miscarriage and live birth rates were assessed by Pearson’s Chi-squared or Fisher’s exact test. P-values &amp;lt;0.05 were considered significant. Main results and the role of chance RPL patients had 2.77±1.27 pregnancy losses overall (2.76±1.37 in women ≤35 and 2.77±1.26 in patients &amp;gt;35). Most RPL patients (91.9%) were of AMA. Other RPL-associated risk factors, including uterine malformations, previous pregnancy losses, chromosomal abnormalities and thrombophilia were identified in 207/912 patients (22.7%). Interestingly, these were more frequent in patients &amp;lt;35 (37.8% vs 21%, p = 0.001). Young RPL women presented higher rates of karyotype abnormalities than older patients (17.6% vs 3.8%, p &amp;lt; 1x10-04), while showing a similar incidence of uterine abnormalities (14.9% vs 12.9%, p &amp;gt; 0.63) and thrombophilia (4.1% vs 4.7%, p &amp;gt; 0.81). RPL patients &amp;gt;35 preferentially underwent oocyte donation (85.4% vs 52.7%, p &amp;lt; 1x10-04), which led to significantly higher biochemical (52.5% vs 17.1%, p &amp;lt; 1x10-04), clinical (42.4% vs. 8.5% p &amp;lt; 1x10-04), ongoing pregnancy (37.9% vs 5.1%, p &amp;lt; 1x10-04), live birth (32% vs 4%, p &amp;lt; 1x10-04) and lower miscarriage rates (10.5% vs 40%, p = 0.0186) than in autologous cycles. In contrast, RPL patients &amp;lt;35 had similar reproductive outcomes: biochemical (41% vs. 52.9), clinical (28.2% vs. 37.1%), ongoing pregnancy (25.6% vs 29.4%), live birth (25.6% vs 26.4%) and miscarriage rates (9% vs 23%), regardless of oocyte origin (donated vs own, p &amp;gt; 0.05 for all cases). Importantly, this was also true for a small subgroup of idiopathic young RPL patients (n = 13). Limitations, reasons for caution The main limitation of this study is its retrospective nature, which does not allow for full elucidation of all potential confounders. The number of young RPL patients undergoing oocyte donation may be too low to draw significant conclusions. Wider implications of the findings RPL can be resolved in AMA patients by using donor oocytes, which points to key roles of oocyte quality and aneuploidy underlying RPL aetiology. However, RPL is not ameliorated by oocyte donation in young women, suggesting an endometrial/systemic origin and highlighting the need to further study mechanisms driving this disorder. Trial registration number Not applicable

P-536 The comparison of luteal phase support in modified natural cycle-frozen embryo transfer in young patients with high quality embryos -vaginal versus vaginal and subcutaneous progesterone.

Abstract Study question Does adding subcutaneous progesterone to vaginal administration affect pregnancy outcomes in young patients undergoing modified natural-frozen embryo transfer (mNC-FTET) with top-good quality, single blastocyst ? Summary answer Adding subcutaneous progesterone supplementation to vaginal administration after frozen-thawed embryo transfer in modified natural cycles does not improve live birth rates. What is known already Vaginal progesterone supplementation during frozen-thawed embryo transfer in modified natural cycles during luteal phase may increase the rate of live birth rate and decrease the rate of miscarriage. Study design, size, duration 245 participants were included in this retrospective cohort study conducted at a single IVF center between November 2020and January 2022.The primary outcome was the live birth rate; secondary outcomes included pregnancy, clinical pregnancy and biochemical and clinical abortion rates. Participants/materials, setting, methods 245 women aged 20-35 years in mNC-FTET cycles with a single top-good quality blastocyst embryo transfer were included. Patients with fibroids, synechiae, recurrent implantation failure, recurrent pregnancy loss were excluded. After thawing embryos were evaluated for quality, hCG(Ovitrelle-Merck) triggered; 129 patients received 200 mg vaginal progesterone (Lutinus-Merck)(group I), while 116 received 200 mg. vaginal and 25 mg subcutaneous progesterone (Progestan-Dex-Kocak Pharma) (group II). The main outcome was live birth rate(LBR), secondary outcome was miscarriage rate. Main results and the role of chance Baseline demographics and background characteristics were similar in the study groups. The live birth rate in group I is 86 of 106 (66.6%) compared 74 of 116 (63.7%) in group II (odds ratio 1,135, 95% confidence interval [CI]: 0.670-0.922, P = 0.637). There were 106 pregnant patients out of 129 in group I (82.17%) and 93 pregnant patients out of 116 in group II (odds ratio 0.877, 95 CI: 0.462-1,666, P = 0.68). The clinical pregnancy rate is 95 out of 129 patients (73.6%) in group I and 90 out of 116 patients in group II (odds ratio of 0.807, 95% confidence interval [CI]: 0.449-1.45, P = 0.474). The rate of biochemical abortion in group II was 10 of 129 patients (7.75%) and 4 of 116 (3.45%) (odds ratio 2.35, 95 CI: 0.717–7.718, P = 0.687). The clinical abortion rate was 6 of 129 patients (4.6%) and 6 of 116 patients (5.17%) in group II (odds ratio 2.35, 95 CI: 0.717-7.718; P = 0.687). According to primary and secondary outcomes, there were no significant differences between the groups. Limitations, reasons for caution To avoid bias, patients older than 35 years were excluded. Subcutaneous progesterone may be beneficial for older patients undergoing euploid embryo transfer. To reduce confounding factors, the number of patients was limited. Wider implications of the findings For luteal phase support, both vaginal and subcutaneous progesterone supplementation did not increase live birth rates following frozen-thawed embryo transfer in modified natural cycles in young patients. Trial registration number not applicable

Systematic Review With Meta-Analysis of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm Repair in the Young.

The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients. A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models. Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4-9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: -0.01, 95% CI: -0.02 to -0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: -4.44 days, 95% CI: -4.79 to -4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low. Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy. PROSPERO, CRD42022325051. Uncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.