Independent Positive Predictors Research Articles

Sociodemographic landscape of suspected prostate cancer referrals and diagnoses across North East London

AbstractObjectivesThe objective of this study is to identify healthcare inequities in referrals and diagnoses of suspected prostate cancer (PCa) in an ethnically diverse and socially deprived large urban region.MethodsRetrospective cohort study of 2‐Week Wait (2WW) suspected PCa patients (n = 12 947) referred to two acute NHS Trusts in North East London (NEL) from February 2019 to August 2023. Sociodemographics, diagnosis and pretreatment staging data were collected from patient records. We examined referral and diagnosis statistics, age at referral, radiological T‐stage at diagnosis, levels of deprivation by ethnicity and the impact of COVID‐19 pandemic lockdowns on proportion of referrals and diagnoses by ethnicity and T‐stage at diagnosis. Uni‐ and multivariable logistic regression was performed to identify predictors of locally advanced (T‐stage ≥T3) disease.ResultsOf all referrals, 22% were diagnosed with PCa. There were no statistically significant differences in referrals, diagnoses or T‐stage of PCa by ethnicity during COVID lockdown versus non‐lockdown periods (p > 0.05). Compared to men from any other ethnicity, Black men (from Black British, Black African and Black Caribbean ethnic groups) were diagnosed at a younger age (mean = 65 years), had the highest age‐adjusted PCa incidence rate of 149 per 100 000 person‐years, were from the most deprived backgrounds, and were diagnosed with the highest proportion of localised PCa (74%). Multivariable analysis of a patient subgroup revealed age bands 71–80 years (OR 2.01, 95% CI 1.31–3.07) and >80 (OR 4.27, 95% CI 2.25–8.08) as independent positive predictors of locally advanced PCa, and Black ethnicity as an independent predictor of localised disease (OR 0.66, 95% CI 0.43–1.00). Limitations of this study include the exclusion of PCa cases diagnosed outside the 2WW pathway, as well as missing data on Prostate‐Specific Antigen (PSA) levels, distant radiological staging and histopathological findings.ConclusionWe identify disparities in PCa incidence, stage and age at presentation, as well as socio‐economic deprivation among Black men in NEL. Targeted efforts are needed to mitigate these healthcare inequities.

Mitral regurgitation evolution after transcatheter tricuspid valve interventions; a sub-analysis of the TriValve registry.

Abstract Background Transcatheter tricuspid valve interventions(TTVI) are increasingly used to treat patients with significant tricuspid regurgitation(TR).[1] The evolution of concurrent mitral regurgitation(MR) severity after TTVI is currently unknown. Increasing severity of TR is associated with declining cardiac output, while a significant increase in left ventricular preload and cardiac index have been observed in patients undergoing successful tricuspid valve surgery with functional improvement.[2,3] Physiological studies, instead, have demonstrated MR worsening in response to preload augmentation especially in the setting of left ventricular systolic disfunction; however, it is unknown whether increased left ventricular preload might translate into clinically relevant MR worsening after successful TTVI.[2,4] Gaining insights regarding the trajectories of MR severity after TTVI may significantly contribute to clinical decision-making. Indeed, it would help to define whether patients undergoing TTVI may benefit from a concurrent transcatheter procedure on the mitral valve. Purpose The aim of this study was to assess the evolution of MR after TTVI and to identify predictors of MR worsening and improvement. Methods This analysis is a substudy of the Trivalve Registry, an international registry designed to collect data on TTVI.[5] This substudy included all patients with echocardiographic data on MR evolution and excluded those with a concomitant tricuspid and mitral transcatheter valve intervention or with a history of mitral valve intervention. The co-primary outcomes were MR improvement and worsening at two timepoints: pre-discharge and 2-month follow-up. Results The graphical abstract is presented in Figure 1. This analysis included 359 patients with severe TR, mostly(80%) treated with tricuspid transcatheter edge-to-edge repair(T-TEER). MR improvement was found in 106(29.5%) and 99(27%) patients, while MR worsening in 34(9.5%) and 33(9%) patients at pre-discharge and 2-month follow-up, respectively. The type of transcatheter procedure has a significant impact on MR worsening and improvement. Annuloplasty and heterotopic replacement were associated with MR worsening. Independent positive predictors of MR improvement were T-TEER, acute procedural success, TR reduction, LVEDD>60 mm and beta-blocker therapy while atrial fibrillation was a negative predictor. Patients with moderate-to-severe/severe MR following TTVI showed significantly higher death rates while the stratification according to MR evolution was not prognostically relevant(Figure 2). Conclusions MR degree variation is common after TTVI, with most cases showing improvement. Clinical and procedural characteristics may predict the MR evolution, in particular procedural success and T-TEER play key roles in MR outcomes. An effective TTVI with significant TR reduction may prevent MR worsening and possibly trigger an improvement, differently from the common belief. Figure 1. Graphical abstract. Figure 2. Death rates.

Triglyceride glucose index: a significant prognostic marker of heart failure in patients with chronic kidney disease

Background Triglycerides and glucose (TyG) index, a relatively convenient method for assessing insulin resistance, has been confirmed as an independent predictor both for chronic kidney disease (CKD) and cardiovascular disease (CVD) in previous studies. However, a few studies focus on the prognostic value of TyG index for CVD in patients diagnosed with CKD, especially in advanced CKD patients. In this study, we aim to investigate the prognostic value of TyG index for heart failure (HF) in patients with non-dialysis CKD stage 3–5. Methods and results This retrospective study was conducted at The First Affiliated Hospital of Dalian Medical University. Patients with non-dialysis CKD stage 3–5 between 1 January 2016 and 1 January 2023 were included in our study. The endpoints included cardiovascular death and HF-related rehospitalization. Finally, a total of 284 subjects were enrolled in our cohort. Multivariate Cox regression analysis revealed that TyG index was one of the independent risk factors both for HF-related rehospitalization and cardiovascular death in non-dialysis CKD stage 3–5 patients. Furthermore, Cox regression model showed a favorable predictive efficiency of TyG index for adverse clinical events. Multivariate logistic regression analysis revealed that TyG index was one of the positive independent predictors of HF. Conclusions Non-dialysis CKD stage 3–5 patients with higher TyG index level experience worsening cardiovascular outcomes, and TyG index is associated with the occurrence of HF. Highlighting that TyG index may be a significant marker for assessing cardiovascular prognosis in CKD patients.

Skeletal Muscle Measurements Based on Abdominal Computerized Tomography (CT) Predict Risk of Osteoporosis in Incident Hemodialysis Patients.

Objective: Osteoporosis is prevalent in patients with chronic kidney disease (CKD), with risk increasing as CKD progresses, subsequently elevating fracture risk. While previous studies have shown a link between low skeletal muscle mass and osteoporosis in the general population, there is limited research exploring this relationship in patients with advanced CKD (stages 3-5D). This study aimed to evaluate whether skeletal muscle area (SMA), as measured by abdominal CT, is correlated with bone mineral density (BMD) in advanced CKD patients beginning hemodialysis. Methods: This single-center, retrospective cohort study included patients who started maintenance hemodialysis at Daejeon St. Mary's Hospital from January 2018 to September 2021. Patients who underwent abdominal CT and BMD assessments within three months of dialysis initiation were enrolled, resulting in a sample of 87 individuals. Baseline characteristics were analyzed, with patients stratified by sex and SMA quartiles. Pearson's correlation and multivariate regression analyses were conducted to the relationship between SMA and BMD T-scores. Results: The study cohort had an average age of 65.4 years, with 52.9% of participants being male. Male patients exhibited significantly higher SMA and BMD T-scores in both the lumbar spine and femur compared to female patients. SMA showed the strongest positive correlation with BMD at both sites (lumbar spine, r = 0.424; femur, r = 0.514; p < 0.001). Multivariate analysis identified SMA as an independent positive predictor of BMD, while alkaline phosphatase (ALP) was independently associated with lower femur BMD. In the SMA-based subgroup analysis, patients with lower SMA had significantly lower BMD T-scores and a higher risk of osteoporosis. Logistic regression indicated that patients in the lowest SMA quartile had substantially increased odds of osteoporosis compared to those in the highest quartile, with an adjusted odds ratio of 30.59 (p = 0.008). Conclusions: Lower skeletal muscle mass is significantly associated with lower bone density and a higher risk of osteoporosis in advanced CKD patients initiating hemodialysis. SMA, as measured by abdominal CT, may serve as a useful marker for identifying patients at elevated osteoporosis risk in this population.

Prognostic value of inflammatory and nutritional indexes among patients with unresectable advanced gastric cancer receiving immune checkpoint inhibitors combined with chemotherapy-a retrospective study.

Recent studies have revealed that inflammatory factors and nutritional status of patients with advanced gastric cancer (AGC) are related to the efficacy of drug therapy and patient prognosis. This study seeks to evaluate the correlation between inflammatory markers, nutritional status, and clinical outcomes of immune checkpoint inhibitor (ICI)-based therapies among inoperable AGC patients. This retrospective study included 88 AGC patients who received ICIs combined with chemotherapy. Inflammatory and nutritional indicators from patients before and after two cycles of treatment were collected. Finally, the correlations between these indicators and the clinical response and survival of AGC patients with ICI treatment were examined. The results revealed that an Eastern Cooperative Oncology Group performance status (ECOG PS) score of 0, neutrophil count to lymphocyte count ratio (NLR) < 2.84, platelet count to lymphocyte count ratio (PLR) < 82.23, lymphocyte count to monocyte count ratio ≥ 2.35, the hemoglobin, albumin, lymphocyte and platelet score (HALP) ≥ 31.17, prognostic nutritional index (PNI) ≥ 46.53, albumin ≥ 41.65, the decreased HALP group and the decreased PNI group were significantly correlated with improved objective response rate. Additionally, an ECOG PS score of 0, NLR < 2.84 and the decreased HALP group was associated with a superior disease control rate. Meanwhile, an ECOG PS score of 0 (progression-free survival (PFS): P = 0.003; overall survival (OS): P = 0.001) and decreased PLR following treatment (PFS: P = 0.011; OS: P = 0.008) were significant independent predictors of PFS and OS. Lastly, a systemic immune inflammation index ≥ 814.8 was also a positive independent predictor of OS among AGC patients. Our study supports the potential of inflammatory and nutritional factors to serve as predictors of the efficacy and prognosis in patients undergoing ICI-based therapies for AGC. However, further investigations are necessary to validate these findings.

Prednisolone impairs trabecular bone score changes in adolescents with 21-hydroxylase deficiency.

Individuals with 21-hydroxylase deficiency (21OHD) require lifelong glucocorticoid (GC) therapy, which increases their risk of fragility fractures. However, fractures in GC-treated individuals can occur at normal bone mineral density (BMD) levels, suggesting an alteration in the bone microarchitecture. To evaluate trabecular bone microarchitecture and its changes in adolescents with 21OHD. We enrolled 38 adolescents with 21OHD for whom complete clinical data and baseline and follow-up lumbar spine bone mineral density (LSBMD) measurements were available. The mean duration was 1.5 ± 0.6 years. Trabecular bone score (TBS), an indirect measurement of bone microarchitecture, was analyzed using iNsight™ software version 3.0. Impaired BMD and TBS were defined at Z-scores ≤ -1.5. At baseline, participants (55% female; 68% salt-wasting type; mean age, 15.2 ± 3.8 years; bone age, 17.5 ± 2.8 years; mean GC dose, 18.5 ± 6.5 mg/m2/day) had the prevalence of impaired BMD and TBS of 5% and 18%, respectively. During follow-up, adolescents with 21OHD receiving prednisolone showed a lower annual percentage change in TBS than those who received hydrocortisone (p = 0.028). A stepwise regression analysis showed that body mass index percentile (p < 0.001) and testosterone concentration (p = 0.002) were independent positive predictors of the baseline TBS Z-score, whereas prednisolone use was the only negative predictor of the annual percentage change in TBS (p = 0.002). Adolescents with 21OHD have a high prevalence of impaired bone microarchitecture. Furthermore, prednisolone therapy is associated with impaired bone microarchitecture development, suggesting that hydrocortisone may better preserve bone microarchitecture and should be considered the first-line treatment for this population.

IMMU-44. EXTRINSIC ELECTRICAL MODULATION OF THE GLIOBLASTOMA TUMOR MICROENVIRONMENT

Abstract BACKGROUND Approximately 30 to 50% of patients with glioblastoma (GBM) present with glioma-related epilepsy (GRE). Despite morbidity associated with seizures, GRE constitutes an independent positive predictive predictor for survival in GBM. Our prior results showed that repeated seizure induction through extrinsic electrical modulation (EEM, a technique in which an electrical stimulus sufficient to produce a therapeutic seizure is applied) slows intracranial tumor growth and prolongs overall survival in immunocompetent CT-2A glioma-bearing mice. However, the overall survival advantage following EEM treatment was diminished in immunocompromised mice bearing human patient derived xenografts. We hypothesized that EEM induces immune-related tumor microenvironment (TME) changes that prolong survival in mice. METHODS C57BL/6J mice were orthotopically implanted with CT-2A xenografts and subjected to EEM of 2.0 millicoulombs or sham treatment. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) was performed at 3 and 24 hours to determine mRNA level of inflammatory cytokines. Immunohistochemistry (IHC) and bulk RNA sequencing analysis were utilized to assess CD3+ T-cell infiltration and identify immune-related secreted genes, respectively. Flow cytometry at 3 and 96 hours was utilized to characterize tumor-infiltrating immune cell populations. Samples were subjected to Percoll gradient enrichment of immune cell populations and stained for extracellular (CD45, CD4, CD8, CD11b, F4/80, CD80, Ly6G, Ly6C, and CX3CR1) and intracellular (TNF-a, Il-1b, CCL2, and Arg1) antigens. RESULTS RT-qPCR showed an increase in pro-inflammatory cytokines TNF-α (P = 0.0087) and IL-1β (P = 0.000349). IHC analysis demonstrated an increase in intratumoral CD3+ T-cells in EEM-treated samples (P = 0.0171). From 1855 upregulated genes, 3 immune-related secreted genes (C1QTNF4, FAM19A4, and GREM2) were identified. Flow cytometric analysis showed a significant increase in CD11b+, CX3RC1+ microglia (P = 0.0306) and CD45+, CD11b+ tumor-associated myeloid cells (TAMCs) (P = 0.0192) at 3 hours post-EEM. CONCLUSIONS EEM treatment promotes an inflammatory TME with increased intratumoral microglia, TAMCs and T-cell infiltration. These inflammatory changes may prolong survival of CT-2A glioma-bearing mice.

Medical student perception of force application: An accuracy assessment and pilot training program.

It is unclear how accurately students can reproduce specific forces that are often required for physical examination maneuvers. This study aimed to determine the baseline accuracy of force application for preclinical medical students, evaluate the effectiveness of a quantitative visual feedback intervention, and investigate whether certain demographics influence accuracy. First- and second-year medical students were enrolled and demographic data were collected. Students blindly applied their estimation of 15 lbs (6.8 kg), 3 lbs (1.4 kg), 10 lbs (4.5 kg), 1.5 lbs (0.7 kg), and 6 lbs (2.7 kg) of force on a scale. Visual feedback training was then performed wherein students applied a series of additional forces unblinded five times, and then blindly administered the same five initial forces 12 minutes and one week later. Accuracy was compared at each time point and a regression analysis was evaluated for predictors of accuracy. Thirty-three students participated. The mean baseline accuracy was 38.3%, 41.1% immediately following intervention, and 35.6% one week later (P = 0.66). Accuracy was significantly higher at higher intended forces compared to lower forces (P < 0.05). The number of prior occupations was a positive independent predictor (P = 0.04), and the number of sports played was noted to be a negative predictor (P = 0.01), of baseline accuracy. Medical students' ability to accurately reproduce clinically relevant forces is poor. There is a clear need to implement a robust training program in medical education, and students may need multiple training sessions to refine this skill.

Dietary Calcium Intake and Association with Serum Calcium in Healthy Urban North Indian Adults: The Calcium-Chandigarh Urban Bone Epidemiological Study.

Data on dietary calcium intake (DCI) from healthy North Indian adults are limited. Hence, the present study aims to assess DCI in healthy community-dwelling adults residing in an affluent North Indian city and correlate with serum biochemical parameters. Healthy men and women were recruited from the community by door-to-door surveys. Serum total calcium, phosphate, 25-hydroxyvitamin D, and iPTH were estimated. DCI was assessed by recalling the diet consumed in the previous 7 days. A total of 291 participants were included (mean age = 39.4 ± 12.9 years). The mean (± standard deviation) and median (inter-quartile range) DCI were 392.6 ± 169.1 mg/day and 391 (274-518) mg/day, respectively. DCI was higher in men compared with women. Only 21.3% of participants had DCI more than RDA (600 mg/day). Serum calcium was found to be significantly higher across each quartile of DCI. On multiple linear regression analysis, DCI emerged as an independent positive predictor of serum total calcium. DCI is low in urban Indians. Promotion of consumption of dairy products and fortification of commonly consumed foods with calcium is needed.

The prevalence and related factors of compassion fatigue among nursing interns: a cross-sectional study

BackgroundCompassion fatigue is common among nurses and can lead to decreased motivation, impaired physical and mental health, and turnover. Nursing interns often face environments the same as professional nurses, yet their compassion fatigue has received less attention. Therefore, this study aims to assess the prevalence and related factors of compassion fatigue among nursing interns.MethodsThis was a cross-sectional study involving 221 nursing interns in 2 tertiary-level hospitals in Shanghai, China. A general information questionnaire was formulated to investigate the demographic characteristics and internship-related factors of nursing interns. Compassion fatigue was assessed using the Professional Quality of Life Scale [compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS)]. Psychological resilience, empathy, and perceived stress were evaluated by the Connor-Davidson Resilience Scale, Jefferson Scales of Empathy, and Perceived Stress Scale, respectively. Personality traits were assessed using the extroversion/introversion subscale of the Eysenck Personality Inventory. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson’s correlation analysis, and multiple linear regressions were used to determine the predictors of the main research variables.ResultsThe prevalence of mild, moderate, and severe compassion fatigue in 221 nursing interns (mean age 21 years, 202 [91.4%] females) was 10.4%, 46.6%, and 43.0%, respectively, and their mean scores for CS, BO, and STS were 29.75 ± 6.39, 28.72 ± 4.78, and 28.51 ± 7.51, respectively. Psychological resilience and empathy were the strongest protective factors for CS and BO, respectively (p < 0.001), and the number of night shifts monthly was the most significant positive independent predictor of STS (p = 0.001). Additionally, male gender negatively predicted CS (p = 0.009). Younger age and extended daily working hours were associated with elevated levels of both BO and STS (p < 0.05). Clinical nursing teachers with intermediate or senior titles, as well as departments of pediatrics and obstetrics had a positive effect on STS (p < 0.05), while internship time had a negative effect on STS (p = 0.005). Furthermore, the variables of perceived stress, personality traits, and choice of nursing profession did not exhibit statistical significance in the multivariate analysis. Related factors predicted 14.2%, 26.2%, and 23.9% of the variance in the model of CS, BO and STS, respectively (all P < 0.001).ConclusionThe compassion fatigue of nursing interns was more serious, especially for nursing interns who were male and younger, and who had shorter internship time, departments of pediatrics and obstetrics, and clinical nursing teachers with intermediate or senior titles. Nursing educators can improve the psychological resilience and empathy of nursing interns by offering relevant psychological courses according to the different stages of internship, as well as rationalizing their daily working hours and the frequency of night shifts to improve the compassion fatigue of nursing interns.Registration NumberChiCTR2400081968.

Predictive significance of hypertension in the incidence of complications in critically ill patients with COVID‑19: A retrospective cohort study.

The association between hypertension as a pre-existing comorbidity and the severe form of coronavirus disease 2019 (COVID-19) remains unclear due to the contradictory results of previously published studies. The present study evaluated the predictive significance of hypertension in the incidence of complications among critically ill patients with COVID-19. The present study included 372 critically ill adults with COVID-19 pneumonia, hospitalized between January 1 and December 31, 2021. The study cohort was divided into the hypertension group (HTA group), which included 245 patients with a history of hypertension, or a non-HTA group (control group), which included 127 patients without hypertension. The incidence of complications was retrospectively extracted from medical records and compared between groups. Multivariate regression analysis (adjusted for potential confounders) and receiver operating characteristic (ROC) curve analysis determined the predictive significance of hypertension on the incidence of complications. The patients in the HTA group were more likely to receive invasive mechanical ventilation [odds ratio (OR), 1.696; P<0.02], develop sepsis (OR, 1.807; P<0.01) and develop complications (OR, 3.101; P<0.001). Hypertension was an independent positive predictor for invasive mechanical ventilation [area under the curve (AUC), 0.67; positive predictive value (PPV), 71.7%; P<0.05], sepsis (AUC, 0.69; PPV, 77.5%; P<0.026) and total complications per patient (AUC, 0.71; PPV, 81.4%; P<0.001). On the whole, the data of the present study indicate that a history of hypertension should be considered as an independent clinical predictor of a higher incidence of complications in critically ill patients with COVID-19. Patients with pre-existing hypertension and a diagnosis of COVID-19 require timely identification, additional attention and treatment to avoid a critical course and help improve outcomes.

Different effects of migraine associated features on headache impact, pain intensity, and psychiatric conditions in patients with migraine

Migraine is a multifactorial brain disorder characterized by recurrent disabling headaches and their associated features. Several studies have suggested that these features are related to headache impact, pain intensity, and psychiatric conditions. However, differences in the relationship between each associated feature and headache impact, pain intensity, or psychiatric conditions remain unclear. This study aimed to assess the impact of migraine-associated features on headache impact, pain intensity, and psychiatric conditions in patients with migraine. In this two-centered study, patients with migraine without aura (MwoA) were enrolled to exclude those without headaches and avoid the influence of medication overuse, which is commonly associated with chronic migraine. We used multiple logistic regression to analyze the headache impact, pain intensity, and psychiatric conditions measured using the Headache Impact Test (HIT-6), Visual Analog Scale (VAS), Generalized Anxiety Disorder 7-item scale (GAD-7), and Patient Health Questionnaire-9 (PHQ-9). Patients’ likelihood of experiencing symptoms such as nausea, vomiting, photophobia, phonophobia, osmophobia, and allodynia were also recorded. A total of 1103 patients with MwoA were enrolled in this study, and 164 patients were excluded from the study because of missing data. Finally, 939 patients with MwoAs were included. On multiple logistic regression analyses, nausea (odd ratios [OR] 1.87, confidence interval [CI]: 1.37–2.54), vomiting (OR 1.57, CI: 1.11–2.23), photophobia (OR 1.67, CI: 1.18–2.35), and allodynia (OR 1.56, CI: 1.06–2.28) were independent positive predictors of higher HIT-6 scores, and nausea (OR 1.72, CI: 1.22–2.43), vomiting (OR 1.84, CI: 1.29–2.63), phonophobia (OR 1.58, CI: 1.10–2.25), photophobia (OR 1.49, CI: 1.07–2.08), and allodynia (OR 1.81, CI: 1.24–2.66) were independent positive predictors of higher VAS score. Nausea (OR 1.49, CI: 1.09–2.02), phonophobia (OR 2.00, CI: 1.42–2.82), and allodynia (OR 1.81, CI: 1.24–2.63) were independent positive predictors of GAD-7 score. Nausea (OR 1.66, CI: 1.21–2.28), phonophobia (OR 1.49, CI: 1.05–2.11), and allodynia (OR 1.68, CI: 1.16–2.45) were independent positive predictors and vomiting (OR 0.54, CI: 0.37–0.78) was an independent negative predictor of PHQ-9 score. Our results suggest that nausea, vomiting, photophobia, phonophobia, and osmophobia have distinct effects on headache impact, pain intensity, and psychiatric conditions. Understanding these differences can aid in the personalized management of patients with MwoA.

Predictors Of Loneliness In Older Irish Adults And Its Relationship To Depression

Abstract Background Loneliness can affect up to 30% of older adults and is associated with increased morbidity and all cause mortality. Loneliness is also a major risk factor for depression. We aimed to explore the predictors of loneliness in older Irish adults and its relationship to depression. Methods Study participants were Irish adults aged &amp;gt;60 years in the Trinity Ulster University Department of Agriculture (TUDA) study. Participants with an MMSE &amp;lt;24 were excluded, to prevent the inclusion of individuals with dementia. Loneliness in the last week was identified from the 'loneliness' question in the Center for Epidemiological Studies Depression Scale (CES-D) and considered present when experienced ≥1-2 days in the last week and absent when experienced rarely or none of the time. Depression was defined as a CES-D ≥16. Predictors of loneliness were explored in multinomial regression models as well as its association with depression. Results There were 4561 participants, 70% female, mean age 70.1 years and 21.6% experienced loneliness. Positive independent predictors of loneliness were living alone (OR 5.2, CI 4.41-6.14, p&amp;lt;0.001), female sex (OR 1.29, CI 1.07-1.56, p=0.009), timed up and go &amp;gt;12 seconds (OR 1.46-2.32, p&amp;lt;0.001) non-driving status (OR 1.37, CI 1.13-1.67, P=0.001) and lower MMSE (OR 0.57, CI 0.41-0.79, p=0.0006). Those who reported loneliness had a higher prevalence of depression (32.1 vs 3.3%, p&amp;lt;0.0001). Conclusion Living alone was, as expected, the greatest predictor of loneliness followed by physical frailty, non-driving status, female sex, and lower cognition. A high proportion (one third) who felt lonely had depression, though low mood may increase the perception of loneliness independent of social engagement. A limitation is that we did not have a specific validated tool to assess loneliness or to distinguish between `emotional' or `social' loneliness.

Predictors for the Occurrence of Seizures in Meningioma.

Seizure is a common symptom of meningioma that has a major impact on patients' quality of life. The purpose of this study was to identify predictive factors for the occurrence of preoperative and postoperative seizures. The data of patients with resection of histologically confirmed meningioma at University Hospital Leipzig from 2009 to 2018 were retrospectively examined. Univariate and multivariate logistic regression analyses of different factors influencing seizure outcome were performed. The male gender was identified as an independent positive predictor for preoperative seizures (odds ratio [OR] 1.917 [95% confidence interval {CI} 1.044-3.521], p = 0.036), whereas headache (OR 0.230 [95% CI 0.091-0.582], p = 0.002) and neurological deficits (OR 0.223; [95% CI 0.121-0.410], p < 0.001) were demonstrated to be negative predictive factors. Sensorimotor deficit after surgery (OR 4.490 [95% CI 2.231-9.037], p < 0.001) was found to be a positive predictor for the occurrence of postoperative seizures. The identified predictors for the occurrence of seizures in meningioma can contribute to improving seizure treatment and patients' quality of life.

Urinary continence outcomes, surgical margin status, and complications after radical prostatectomy in 2,141 German patients treated in one high-volume inpatient rehabilitation clinic in 2022

PurposeTo identify independent predictors of urinary continence and report early complications after radical prostatectomy (RP) in a large, contemporary German cohort.MethodsUrinary incontinence data of patients undergoing 3-week inpatient rehabilitation (IR) after RP were prospectively assessed by 24-hr pad test and uroflowmetry at the beginning and the end of IR, respectively. Lymphoceles were assessed prospectively by ultrasound. Tumor and patient characteristics, and information on urinary leakage on initial cystography were retrospectively extracted from discharge letters and surgical reports. Regression analyses were performed to identify predictors of urinary continence at the beginning of IR.ResultsOverall, 2,141 patients were included in the final analyses. Anastomotic leakage on the initial cystography and lymphoceles were found in 11.4% and 30.8% of patients, respectively. Intervention for a symptomatic lymphocele was required in 4.2% of patients. At the end of IR, 54.2% of patients were continent, while the median urine loss decreased to 73 g (interquartile range 15–321). Multivariable logistic regression analysis identified age and diabetes mellitus as independent negative predictors, but nerve-sparing surgery as an independent positive predictor of urinary continence (each p < 0.001). Multivariable linear regression analysis showed that 24-hr urine loss increased by 7 g with each year of life (p < 0.001), was 79 g higher in patients with diabetes mellitus (p = 0.007), and 175 g lower in patients with NS (p < 0.001).ConclusionAge, diabetes mellitus, and NS are significantly associated with continence outcomes in the early period after RP. Our analyses may help clinicians to pre-operatively counsel patients on potential surgical outcomes.

Prognostic impact of combination therapy with gemcitabine and cisplatin plus S-1 and subsequent conversion surgery for initially unresectable upper biliary tract cancers.

For the past decade, there have been few chemotherapy options for unresectable biliary tract cancer (BTC). Recently, however, combination therapy with gemcitabine and cisplatin plus S-1 (GCS) has been identified as a promising strategy. This retrospective study analyzes the clinical results of GCS therapy and subsequent conversion surgery (CS). We analyzed the clinical data of 60 consecutive patients who received GCS therapy for unresectable upper BTC at our university hospital during the 5 years between September, 2018 and December, 2022. All patients received GCS therapy as first-line chemotherapy. The response rate was 33.9% and subsequent CS was performed in 35.0%. Of the patients who underwent CS, 81% required more than bisectionectomy of the liver with extrahepatic bile duct resection. The median overall survival of the patients who received GCS therapy and underwent subsequent CS was significantly longer than that of the patients who received GCS therapy alone (28.0 months vs. 12.4 months, respectively; p < 0.001). A decrease in the CA19-9 level 1 month after chemotherapy and RECIST PR were independent positive predictors of CS, whereas unresectable gallbladder cancer and pretreatment ALBI grade 3 were negative predictors of CS. GCS therapy and subsequent CS may contribute to the longer term survival of patients with unresectable upper BTC.

Prognostic factors for non‑metastatic castration‑resistant prostate cancer treated with androgen receptor signaling inhibitors.

The treatment paradigm for non-metastatic castration-resistant prostate cancer (nmCRPC) has changed in recent years. An observational multicenter study was conducted to evaluate the effectiveness of androgen receptor signaling inhibitors (ARSIs) as a first-line treatment for patients with nmCRPC. The present study included native Japanese patients from four hospitals who received ARSIs as a first-line treatment for nmCRPC. The primary endpoint of the study was to evaluate the efficacy and safety of ARSI in patients with nmCRPC. The secondary endpoint was to develop a novel system to stratify the prognoses of these patients. In total, 160 patients were included in the present study. Within a median follow-up period of 23 months, the median overall survival (OS) was not reached, whereas the median progression-free survival was 26 months. Multivariate Cox regression analyses showed that the time to CRPC, prostate-specific antigen (PSA) level at the initiation of nmCRPC treatment and Geriatric Nutritional Risk Index (GNRI) were independent predictors of OS. The patients for whom information about all three independent OS predictors was available were subsequently divided into three groups as follows: Group 1, 57 patients with negative or one positive independent OS predictor; group 2, 38 patients with two positive independent OS predictors; and group 3, 10 patients with three independent OS predictors. The OS differed significantly among the three groups (P<0.0001). In conclusion, ARSIs as a first-line treatment may be associated with favorable outcomes in Japanese patients with nmCRPC. Time to CRPC, PSA level at the initiation of nmCRPC treatment and GNRI are potential predictors of OS in Japanese patients with nmCRPC who received ARSIs as a first-line treatment.

Role of myocardial microRNAs in the long-term ventricular remodelling of patients with aortic stenosis.

We hypothesize that miRs are key players in the dynamics of the hypertrophy phenotype in aortic stenosis (AS) patients. In our study, we aimed to identify the transcriptional patterns (protein-coding transcripts and miRs) from myocardial sample biopsies that could be associated with the absence of left ventricular (LV) mass regression after aortic valve replacement (AVR) in patients with severe AS and LV hypertrophy. We prospectively included 40 patients with severe AS, LV hypertrophy, and preserved ejection fraction undergoing AVR. Myocardial biopsies obtained during surgery were analysed for transcriptomic analysis performed by next-generation sequencing. At a 1-year follow-up, no hypertrophy reversal was observed in about half of the patients in the absence of patient-prosthesis mismatch and prosthesis dysfunction of uncontrolled hypertension. Predictors of mass regression were assessed from clinical, echocardiographic, and biochemical variables as well as from 300 miRs obtained from myocardial specimens, allowing the identification 29 differentially expressed. miR-4709-3p was found as a positive independent predictor of hypertrophy regression together with high-sensitivity troponin T (cTNT-hs) as a negative predictor. Gene transcripts RFX1, SIX5, MAPK8IF3, and PKD1 were predicted as simultaneous targets of five upregulated miRs suggesting its importance in LV hypertrophy. In our cohort, tissue miR-4709-3p and cTNT-hs were independent predictors of hypertrophy regression. The hypertrophy reversal process will likely depend from a complex network where miRNAs may have an important role, allowing a potential opportunity for therapy.

Patterns of oxytocin use for induction and augmentation of labour among healthcare providers in Nigeria

BackgroundThe practice of intrapartum use of oxytocin for induction and augmentation of labour is increasing worldwide with documented wide variations in clinical use, especially dose administrations. There is also evidence of intrapartum use by unauthorized cadre of staff.AimThis study assessed the patterns – frequency of intrapartum use of oxytocin, the doses and routes of administration for induction and augmentation of labour, and identified the predictors of oxytocin use for induction and augmentation of labour by healthcare providers in Nigeria.MethodsThis was a cross-sectional study conducted among healthcare providers – doctors, nurses/midwives and community health workers (CHWs) in public and private healthcare facilities across the country’s six geopolitical zones. A multistage sampling technique was used to select 6,299 eligible healthcare providers who use oxytocin for pregnant women during labour and delivery. A self-administered questionnaire was used to collect relevant data and analysed using STATA 17 statistical software. Summary and inferential statistics were done and further analyses using multivariable regression models were performed to ascertain independent predictor variables of correct patterns of intrapartum oxytocin usage. The p-value was set at < 0.05.ResultsOf the 6299 respondents who participated in the study, 1179 (18.7%), 3362 (53.4%), and 1758 (27.9%) were doctors, nurses/midwives and CHWs, respectively. Among the respondents, 4200 (66.7%) use oxytocin for augmentation of labour while 3314 (52.6%) use it for induction of labour. Of the 1758 CHWs, 37.8% and 49% use oxytocin for induction and augmentation of labour, respectively. About 10% of the respondents who use oxytocin for the induction or augmentation of labour incorrectly use the intramuscular route of administration and about 8% incorrectly use intravenous push. Being a doctor, and a healthcare provider from government health facilities were independent positive predictors of the administration of correct dose oxytocin for induction and augmentation of labour. The CHWs were most likely to use the wrong route and dose administration of oxytocin for the induction and augmentation of labour.ConclusionOur study unveiled a concerning clinical practice of intrapartum oxytocin use by healthcare providers in Nigeria – prevalence of intrapartum use of oxytocin, inappropriate routes of administration for induction and augmentation of labour, varied and inappropriately high start dose of administration including unauthorized and high intrapartum use of oxytocin among CHWs.

Aspartate Aminotransferase to Platelet Ratio Index (APRI) as a Predictor of Metabolic Syndrome (MetS) Development in Individuals With Type 2 Diabetes Mellitus.

Despite ongoing findings on the relationship between liver fibrosis in nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome (MetS), this association in diabetic patients remains unclear. Early diagnosis of liver fibrosis is important due to the easily available diagnostic tools, such as noninvasive indices that combine clinical and laboratory variables, and the possibility of preventing its complications in type 2 diabetes mellitus (T2DM) patients with MetS. This study examines the potential predictive values of non-invasive liver fibrosis indices for MetS in T2DM patients. Over the course of a two-year prospective, observational, clinical study, 80 individuals with T2DMrandomly selected from the Diabetes Counseling Centers of the Public Institution Health Center of Sarajevo Canton were divided into two groups: T2DM-MetS and T2DM-non-MetS, based on the development of MetS. The studyincludedindividuals with T2DM aged30 to 60who were clinically diagnosed without MetS, voluntarily agreed to participate, and provided complete data in the collection forms. Serum samples from the patients were assessed for levels of liver enzymes, platelet counts, total cholesterol, high-density lipoprotein cholesterol, fasting glucose, and triglycerides. Various equations were utilized to calculate liver fibrosis indices, including the Aspartate Aminotransferase to Platelet Ratio Index (APRI), Aspartate Aminotransferase to Gamma-Glutamyl Transferase to Platelet Ratio (AGPR), Aspartate Aminotransferase to Alanine Aminotransferase Ratio to Platelet Ratio Index (AARPRI), Fibrosis-4 (FIB-4) Index, Forns Index, and Gamma-Glutamyl Transpeptidase to Platelet Ratio (GPR). Receiver operating characteristic (ROC) analysis was utilized to determine the usefulness of noninvasive liver fibrosis indices for diagnosing MetS in individuals with T2DM. Logistic regression analysis was used to predict the onset of MetS in T2DM patients. Significant differences in the values of APRI (p<0.001), AGPR (p<0.05), AARPRI (p<0.001), and the FIB-4 index (p=0.001) were observed in T2DM-MetS individuals compared to T2DM-non-MetS. According to ROC analysis, the area under the curve (AUC) was found to be highest for APRI (0.84), followed by FIB-4 (0.783) and AARPRI (0.747). Logistic regression analysis identified APRI as an independent positive predictor of MetS (OR 18.179, 95% CI 6.035-24.58, p=0.015). This research highlights the effectiveness of the APRI index as a reliable predictor of MetS development in individuals with T2DM.