Predictors Of Outcome Research Articles

Exploring the impact of physiotherapy on health outcomes in older adults with chronic diseases: a cross-sectional analysis.

This study evaluates the impact of physiotherapy interventions on health outcomes and explores the correlation between physiotherapy session characteristics and improvements in health among older individuals. In a cross-sectional design, 384 older adults with chronic conditions such as arthritis, osteoporosis, Chronic Obstructive Pulmonary Disease (COPD), diabetes, and hypertension were recruited. The proportion of arthritis (39.1%) and hypertension (45.8%) was notably high. Participants receiving physiotherapy showed significant improvements in pain levels (mean reduction from 5.09 to 2.95), mobility scores (improvement from 3.0 to 3.96), and functional independence. A positive correlation was identified between the frequency of physiotherapy sessions and pain reduction (r = 0.26, p = 0.035), and a stronger correlation between session duration and both pain reduction (r = 0.38, p = 0.002) and mobility improvement (r = 0.43, p = 0.001). High satisfaction rates with physiotherapy were reported, and age was found to be a significant negative predictor of health outcomes (Coef. = -0.3402, p = 0.0009). Physiotherapy interventions significantly improve health outcomes in older adults with chronic diseases.

The role of HGH1 in breast cancer prognosis: a study on immune response and cell cycle

BackgroundBreast cancer (BRCA) remains to be among the main causes of cancer-associated mortality in women globally. HGH1 homolog (HGH1) has been reported to be associated with tumor immunity. However, the function of HGH1 in BRCA remains unclear. Therefore, the present study examined the potential role of HGH1 in BRCA.MethodsThe Cancer Genome Atlas (TCGA) databases and Gene Expression Omnibus (GEO) were used to obtain RNA-seq data for BRCA. A protein localization of HGH1 was determined by using the Human Protein Atlas (HPA), and immunohistochemistry (IHC) staining revealed an upregulation in the expression of HGH1 in clinical BRCA tissues. Xenograft mice were used to test tumor growth and HGH1 expression in breast cancer cells. The protein interaction information of HGH1 was analyzed using the GeneMANIA website. Based on univariate Cox regression and Kaplan-Meier methods, we evaluated the role of HGH1 in BRCA prognosis. HGH1-related differentially expressed genes were analyzed using GO, KEGG, and GSEA. We also examined the relationship between HGH1 expression, immune checkpoints, and immune infiltration. CCK-8, EdU, and colony formation assays were used to measure cell proliferation, and western blot analysis was used to evaluate HGH1’s role in BRCA.ResultsIHC results showed that the expression of HGH1 was significantly upregulated in BRCA tissues compared to normal tissues. High levels of HGH1 expression was associated with worse clinical features and a worse prognosis. HGH1 expression was an independent predictor of BRCA outcomes in both univariate and multivariate analyses. Functionally, western blot analysis showed that HGH1 is implicated in cell cycle. As well, knocking down HGH1 significantly reduced BRCA cells’ proliferative abilities. Crucially, HGH1 expression levels were positively correlated with Th2 cell infiltration and negatively correlated with Tcm cell infiltration.ConclusionBiomarkers such as HGH1 can reliably predict prognosis in BRCA patients.

Magnetic resonance imaging patterns and perfusion changes of posterior reversible encephalopathy syndrome in children with clinical outcome correlation.

Posterior reversible encephalopathy syndrome (PRES) in children has a propensity towards atypical features on magnetic resonance (MR) imaging, with limited literature on perfusion changes and clinicoradiological correlation. We aimed to comprehensively study MR imaging patterns of pediatric PRES, including cerebral blood flow variations on arterial spin labeling, and looked for any MR biomarkers of poor clinical outcome. In this retrospective observational study conducted in a tertiary hospital setting, MR records over a 4-year period (May 2019 to May 2023) were systematically searched along with their clinical details. Patients with an age less than 18years and a clinicoradiological constellation consistent with PRES were included. MR scans were analyzed by two neuroradiologists with 8years' and 10years' experience. Association was sought with poor clinical outcome (defined as modified Rankin Scale score at discharge of > 2). A total of 45 patients (29 boys) were included in the study, with a mean age (± standard deviation) of 11.19 (± 4.53) years. On MR imaging, 95.6% of patients (n = 43) showed atypical features and/or atypical areas of involvement. The superior frontal sulcus (n = 18) was the most predominant MR pattern, and cerebellar involvement was not uncommon (n = 15). Unilateral involvement (n = 3), isolated central pattern (n = 1), and spinal cord involvement (PRES-SCI: n = 1) were also encountered. Brainstem involvement (n = 4) showed a characteristic "V-sign" of anterior medullary hyperintensity. Patchy restricted diffusion (46.6%), punctate hemorrhages (37.7%), and leptomeningeal contrast enhancement (36%) were not uncommon. Arterial spin labeling sequence (available in 24 patients) showed increased cerebral blood flow in the involved areas in 79.2% of patients. Univariate analysis showed a significant association of the presence of hemorrhage (P = 0.003), involvement of brainstem (P = 0.007), deep white matter (P = 0.008), and thalamus (P = 0.026) with poor clinical outcome. Multivariate regression analysis found that hemorrhage on MRI (P = 0.011, odds ratio 8) was an independent factor associated with poor clinical outcome. The conventionally described atypical features in PRES are common in children and therefore may no longer be considered exceptions. Raised perfusion on arterial spin labeling sequence was seen in the majority of cases. Hemorrhage on MRI was an independent predictor of poor clinical outcome in pediatric PRES.

WP3.10 - Variability of frailty scoring during unplanned surgical admissions in older persons - why accuracy matters

Abstract Introduction The Clinical Frailty Score (CFS) is a reliable predictor of outcomes for older patients in the acute hospital setting and is used to guide management decisions. Our hospital routinely calculates the CFS for older adults on admission to the Emergency Department (ED). Patients admitted under general surgery will then be referred for a Comprehensive Geriatric Assessment (CGA) by our Perioperative Medicine for the Older Patients undergoing Surgery (POPS) team who also calculate CFS. This study aimed to compare the CFS calculated in ED and CGA for these patients. Methods We performed a single centre prospective study of emergency general surgical admissions who were reviewed as an inpatient by our POPS team between August 2022 and September 2023. CFS from ED documentation was compared to that after CGA. A two tailed, paired t test was performed to compare the CFS on admission and after CGA using GraphPad Prism version 10.0. Results A total of 293 patients were identified with a mean age of 79 years(65-102). There was a difference between the admission CFS [4.2 (3.9-4.4 95%CI)] and the CFS following POPS review [4.5 (4.3-4.7 95%CI)] which was statistically significant (p<0.0001). Univariate analysis showed that CFS was predictive of length of hospital stay. Conclusion CFS calculated in the ED can both over and underestimate the degree of frailty when compared to the CFS calculated during the CGA. As evidence suggests that CFS is predictive of outcomes in this cohort, we suggest staff are adequately trained in undertaking an accurate assessment of this score.

Molecular Profile as an Outcome Predictor in Glioblastoma along with MRI Features and Surgical Resection: A Scoping Review.

Glioblastoma (GBM) is one of the most aggressive malignant tumors of the brain. We queried PubMed for articles about molecular predictor markers in GBM. This scoping review aims to analyze the most important outcome predictors in patients with GBM and to compare these factors in terms of absolute months of survival benefit and percentages. Performing a gross total resection for patients with GBM undergoing optimal chemo- and radiotherapy provides a significant benefit in overall survival compared to those patients who received a subtotal or partial resection. However, compared to IDH-Wildtype GBMs, patients with IDH-Mutant 1/2 GBMs have an increased survival. MGMT promoter methylation status is another strong outcome predictor for patients with GBM. In the reviewed literature, patients with methylated MGMT promoter lived approximately 50% to 90% longer than those with an unmethylated MGMT gene promoter. Moreover, KPS is an important predictor of survival and quality of life, demonstrating that we should refrain from aggressive surgery in important brain areas. As new therapies (such as TTFs) emerge, we are optimistic that the overall median survival will increase, even for IDH-Wildtype GBMs. In conclusion, molecular profiles are stronger outcome predictors than the extent of neurosurgical resection for GBM.

The Role of Global Longitudinal Strain in the Follow-Up of Asymptomatic Patients with Chronic Primary Mitral Regurgitation.

Background/Objectives: In patients with chronic primary mitral regurgitation (MR), postoperative persistent left ventricular (LV) dysfunction underlines the lack of a sensitive parameter that can identify subclinical LV dysfunction and optimize the timing of intervention. Left ventricular global longitudinal strain (LV-GLS) is a measure of the longitudinal left ventricular systolic function, with prognostic significance. Its role in the follow-up of asymptomatic patients with MR is, however, poorly defined. The aim of this study was to assess the relative changes in LV-GLS in a cohort of MR patients and to correlate these changes with the need for intervention during a follow-up period. Methods: We conducted a prospective study on a cohort of 218 patients, divided into three subgroups according to MR severity (mild, moderate, severe). LV-GLS was measured at baseline and every six months during a median follow-up period of 30 months. The composite endpoint was the occurrence of heart failure symptoms, hospitalization for heart failure, LVEF < 60%, LVEDD > 45 mm, new onset atrial fibrillation, or cardiovascular death. Results: Patients with moderate and severe MR had a significantly lower GLS at baseline than those with mild MR (19.5% and 19.1% versus 22.3%, p < 0.01) despite a normal LVEF in all subgroups. The relative decrease in LV-GLS occurred earlier (at 12 months vs. 24 months) and was more evident in patients with moderate and severe MR (13.6% and 14.5%, respectively) versus patients with mild MR (6.72%). The baseline LV-GLS being under 18% and a relative decrease of over 10% in GLS were independent predictors of a composite outcome (HR = 1.59, CI 95% 1.17-2.86; HR = 1.74, CI 95% 1.2-2.91, p < 0.01). Conclusions: LV-GLS is a valuable monitoring tool for asymptomatic MR patients, a relative decrease > 10% in GLS may be predictive for the need for valve intervention.

Predictors of outcomes in conservative management of high-grade renal trauma

BackgroundManagement of high-grade renal trauma is debatable, with the recent evidence embracing a conservative approach in the management of even grade 5 renal injuries. The study aimed to analyze the clinical profile of patients with high-grade renal trauma, assessing their management strategies, outcomes, complications, and need for ancillary procedures.MethodsA retrospective analysis of prospectively maintained data was performed involving blunt abdominal trauma patients with high-grade renal injuries (Grade 4 and 5) presenting to our hospital from January 2018 to December 2022. Patient data analyzed included demographics, clinical presentation, injury characteristics, complications, ancillary procedures, and mortality rates. All patients underwent renal functional assessment using an isotope renogram scan at the 3-month follow-up. Data collected were entered into a database and subjected to descriptive analysis using Jamovi version 2.3.28.ResultsThe study included 45 patients with a mean age of 29 years and a male-to-female ratio of 41:4. Most patients (n = 42) were managed conservatively. Thirty-eight patients had grade 4 injuries, and seven had grade 5 injuries. Twenty-six patients suffered renal parenchymal injuries alone, three patients had renal vascular injuries alone, and 16 patients had both parenchymal and vascular injuries. Grade 5 renal injury (p < 0.001), vascular high-grade injury (p < 0.001), angioembolization (p < 0.001), and blood transfusions (p = 0.021) were significantly associated with the incidence of poorly functioning kidney in high-grade renal trauma patients managed conservatively. Multinomial logistic regression analysis revealed angioembolization (p < 0.001), poorly functioning kidney post-trauma (p < 0.001), and blood transfusions (p < 0.001) were significantly associated with high-grade renal vascular injuries compared to high-grade renal parenchymal injuries.ConclusionConservative management is advisable for high-grade renal trauma in hemodynamically stable patients. High-grade vascular injuries are more severe than parenchymal injuries and correlate with poorer renal functional outcomes. Grade 5 renal injury, predominantly vascular high-grade injury, and the requirement for angioembolization and blood transfusions serve as significant predictors of poorly functioning kidneys post-trauma. Urologists should consider these predictors when counseling patients regarding potential outcomes following conservative management of high-grade renal trauma.

Assistance time and peripheral oxygen saturation in prehospital emergency data as predictors of COVID19 hospital outcomes

To verify if data obtained in the prehospital evaluation of patients with severe acute respiratory syndrome (SARS) during the initial response to the COVID-19 pandemic is associated with clinical outcomes: mechanical ventilation, hospital discharge, and death. This is a retrospective analysis involving secondary data from the Emergency Medical Service (EMS) records and the Health Surveillance Information System of patients assisted by the EMS in Manaus, from January to June 2020, the period of the first peak of COVID-19 cases. The combination of the two databases yielded a total of 1.190 patients, who received a first EMS response and were later admitted to hospital with SARS and had data on clinical outcomes of interest available. Patients were predominantly male (754, 63.4%), with a median age of 66 (IQR: 54.0–78.0) years. SARS illness before medical assistance was associated to need for invasive mechanical ventilation (IMV, p < 0.001). Lower pre-hospital SpO2 was associated to death (p = 0.025). Death was more common among patients with respiratory support needs, especially in the invasive ventilation group (262/287; 91.3%) (p < 0.001). In addition, IMV was more common among elderly individuals (p < 0.001). Patients admitted to ICU had a greater chance of dying when compared to non-ICU admitted patients (p < 0.001), and closely related to IMV (p < 0.001). Patients in ICU were also older (p = 0.003) and had longer hospital stay (p < 0.001). Mortality was associated with mechanical ventilation (p < 0.001), ICU admission (p < 0.001), and older age (p < 0.001). Patients who died had a shorter length of both ICU and total hospital stay (p < 0.001). Prehospital EMS may provide feasible and early recognition of critical patients with SARS in strained healthcare systems, such as in low-resource settings and pandemics.

Unveiling the role of PSMA5 in glioma progression and prognosis

Glioma is the most aggressive intracranial malignancy and is associated with poor survival rates and limited quality of life, impairing neuropsychological function and cognitive competence in survivors. The Proteasome Subunit Alpha Type-5 (PSMA5) is a multicatalytic proteinase complex that has been linked with tumor progression but is rarely reported in glioma. This study investigates the expression pattern, prognostic characteristics, and potential biological functions of PSMA5 in glioma. PSMA5 was significantly overexpressed in 28 types of cancer when compared to normal tissue. Furthermore, elevated levels of PSMA5 were observed in patients with wild-type isocitrate dehydrogenase 1 and exhibited a positive correlation with tumor grade. It was also found to be a standalone predictor of outcomes in glioma patients. Additionally, inhibiting PSMA5-induced cell cycle arrest may provide a therapeutic option for glioma.

Female sex as a negative predictor of outcomes of ankle arthrodesis: a retrospective comparative monocentric study

BackgroundEnd-stage post-traumatic osteoarthritis of the ankle joint may require arthrodesis if conservative treatment fails and a decision against total ankle replacement is made. We aimed to compare the sex-specific differences in outcomes and objectify them using validated specific scores.MethodsBetween 2010 and 2021, 221 patients underwent ankle arthrodesis at our institution, including 143 men (MAA) and 78 women (FAA). In addition to demographic data, the aetiology of osteoarthritis, the Foot Function Index (FFI-D), the Olerud-Molander Score (OMAS), and the Short Form-12 questionnaire (SF-12) were collected in this monocentric study. The mean follow-up time was 5.8 years. End-stage osteoarthritis was mostly due to ankle fractures as a result of sprains, falls, and road traffic accidents.ResultsPost-operatively, the mean FFI-D for pain was 17.3 (MAA: 14.7; FAA 22.2) and 43.9 for function (MAA: 41.1; FAA 49.5); the mean OMAS was 58.2; and the mean SF-12 physical component score was 42.5. Women achieved significantly worse results in all scores; only the mental component summary of the SF-12 did not differ between the sexes (p > 0.05). Approximately 34% of women stated that the result in terms of gait pattern was worse than expected (MAA 16.1%; p < 0.05). Again, significantly more men stated that the result was better than expected (MAA: 48.3%; FAA: 31.5%, p < 0.05).ConclusionsThe fact that the clinical results were significantly worse in women after ankle arthrodesis should be considered when determining the indication. However, the expectations of men and women also need to be individually adjusted.

The Role of P Wave Parameters in Predicting Pulmonary Vein Isolation Outcomes for Paroxysmal Atrial Fibrillation: An Observational Cohort Study.

Pulmonary vein isolation (PVI) is an effective management method for paroxysmal atrial fibrillation (PAF). The P wave in the 12-lead electrocardiogram (ECG) represents atrial depolarisation. This study aims to utilise the P wave to predict PVI outcomes for PAF. This single-centre retrospective study aimed to predict PVI outcomes using P wave parameters. It included 211 consecutive patients with first PVI for PAF between 2018 and 2019 and targeted the pulmonary veins (PVs). Procedure success was defined by freedom of ECG-documented AF at 12 months. Digital 12-lead ECGs with 1-50 hertz bandpass filters were monitored before the procedure. Corrected P wave duration (PWDc), P wave amplitude (PWV), P wave dispersion (PWDisp), intra-atrial block (IAB), P wave area (PWA), and P wave terminal force in V1 (PTFV1) were measured before ablation and correlated with the outcomes. Successful PVI occurred in 154 patients (73%). Demographics were similar between both arms. P wave parameters correlated with PVI failure included increased PWDc in all leads except for lead III, aVR, and V3, decreased PWV in lead I (hazard ratio [HR]: 0.7, 95% confidence interval [CI]: 0.53-0.95), lead II (HR: 0.45, 95% CI: 0.22-0.65), aVL (HR: 0.58, 95% CI: 0.22-0.98), and aVF (HR: 0.67, 95% CI: 0.58-0.87), decreased PWA in lead I (HR: 0.55, 95% CI: 0.21-0.76), lead II (HR: 0.48, 95% CI: 0.34-0.87), aVL (HR: 0.65, 95% CI: 0.45-0.96), and aVF (HR: 0.61, 95% CI: 0.32-0.89), and the presence of IAB (HR: 2, 95% CI: 1.4-4.2, p = 0.02). PWDisp and PTFV1 were not correlated with PVI outcome. PWDc, PWA, PWV, and IAB are valuable predictors for PVI outcome for PAF at 12 months.

The structure of motivation: Assessing readiness to change dimensions and their predictive value with the network validation of the Italian version of the Anorexia Nervosa Stages of Change Questionnarie.

Motivation to change is an important predictor for treatment outcomes in individuals with anorexia nervosa (AN), however, the existence and clinical relevance of distinct motivational dimensions are understudied. This study aimed to structurally validate the AN Stage of Change Questionnaire (ANSOCQ) in the Italian adult AN population to identify separate motivational dimensions and their association with clinical variables and outcomes. Inpatients and outpatients with AN (N=300) completed the ANSOCQ and measures assessing eating and depressive psychopathology. Unique Variable Analysis and Exploratory Graph Analysis were employed to identify dimensions in the network structure of ANSOCQ. Cross-sectional associations with clinical variables were assessed in the whole sample. Predictive value on weight and psychopathology was assessed in inpatients. Two dimensions were identified, one comprising items relative to weight gain, and the second items regarding attitudes towards eating, body, and emotional problems. Feelings associated with eating resulted as most central in the network. Higher scores in the first dimension and ANSOCQ total predicted weight gain during hospitalisation. No significant predictors emerged for changes in eating psychopathology. These findings confirm the robust psychometric properties of ANSOCQ and provide support for the use of its subdimensions in clinical practice.

Using MRI Texture Analysis Machine Learning Models to Assess Graft Interstitial Fibrosis and Tubular Atrophy in Patients with Transplanted Kidneys

Objective: Interstitial fibrosis/tubular atrophy (IFTA) is a common, irreversible, and progressive form of chronic kidney allograft injury, and it is considered a critical predictor of kidney allograft outcomes. The extent of IFTA is estimated through a graft biopsy, while a non-invasive test is lacking. The aim of this study was to evaluate the feasibility and accuracy of an MRI radiomic-based machine learning (ML) algorithm to estimate the degree of IFTA in a cohort of transplanted patients. Approach: Patients who underwent MRI and renal biopsy within a 6-month interval from 1 January 2012 to 1 March 2021 were included. Stable MRI sequences were selected, and renal parenchyma, renal cortex and medulla were segmented. After image filtering and pre-processing, we computed radiomic features that were subsequently selected through a LASSO algorithm for their highest correlation with the outcome and lowest intercorrelation. Selected features and relevant patients’ clinical data were used to produce ML algorithms using 70% of the study cases for feature selection, model training and validation with a 10-fold cross-validation, and 30% for model testing. Performances were evaluated using AUC with 95% confidence interval. Main results: A total of 70 coupled tests (63 patients, 35.4% females, mean age 52.2 years) were included and subdivided into a wider cohort of 50 for training and a smaller cohort of 20 for testing. For IFTA ≥ 25%, the AUCs in test cohort were 0.60, 0.59, and 0.54 for radiomic features only, clinical variables only, and a combined radiomic–clinical model, respectively. For IFTA ≥ 50%, the AUCs in training cohort were 0.89, 0.84, and 0.96, and in the test cohort, they were 0.82, 0.83, and 0.86, for radiomic features only, clinical variables only, and the combined radiomic–clinical model, respectively. Significance: An ML-based MRI radiomic algorithm showed promising discrimination capacity for IFTA &gt; 50%, especially when combined with clinical variables. These results need to be confirmed in larger cohorts.

Trends in sex differences of functional outcome after intravenous thrombolysis in patients with acute ischemic stroke.

Intravenous thrombolysis (IVT) is an approved treatment for patients with acute ischemic stroke irrespective of sex. However, the current literature on sex differences in functional outcomes following IVT is inconsistent. So far, a number of studies-including a previous analysis based on data from the Austrian Stroke Unit Registry (ASUR)-detected significant sex-related differences in functional outcome, while others did not report any differences between women and men. In addition, currently there is a lack of data on how sex-related differences evolve over time. To assess time trends of sex-related differences in functional outcome of ischemic stroke in a large nationwide cohort and to investigate associations of patient characteristics with functional outcome post thrombolysis in women and men. These data will offer crucial insights into whether sex differences in functional outcome persist despite the large advances in acute stroke treatment. We analyzed retrospective data of consecutive patients with acute ischemic stroke treated with IVT in 39 stroke centers contributing to the ASUR between 2006 and 2021. We included patients over 18 years of age diagnosed with an acute ischemic stroke who received IVT and with available data on functional outcome at 3 months after treatment. The primary outcome parameter was favorable functional outcome (modified Rankin Scale (mRS) of 0-2) at 3 months. Multivariable logistic regression analysis was performed in the overall population and stratified by sex to assess associations of baseline characteristics with functional outcome. Among 11,840 patients receiving IVT, 2489 of 5503 (45.4%) women achieved favorable functional outcome compared to 3787 of 6337 (59.8%) men. Overall, female sex was a statistically significant predictor of functional outcome after thrombolysis, but additional predictors of outcome differed between women and men. Female sex was independently associated with decreased chances of achieving functional independency (adjusted odds ratio (adjOR) = 0.87, 95% confidence interval (CI) = 0.79-0.96, p = 0.005) and we detected a statistically significant improvement in functional outcome over time only in men (year of treatment, adjOR (per year) = 1.04, 95% CI = 1.02-1.06, p < 0.001) but not in women (adjOR (per year) = 1.01, 95% CI = 0.99-1.03, p = 0.280). Hypertension, smoking, and longer or unknown onset-to-door times were statistically significant predictors of outcome only in male patients, whereas atrial fibrillation, prior myocardial infarction, and longer door-to-needle times were significantly associated with outcome only in women. Sex differences in functional outcome after IVT for acute ischemic stroke are persisting over the past years. Results of our analysis can increase awareness and a resulting focus on sex differences in predictors of outcome could be helpful in mitigating these differences in the future by supporting a more individualized patient care in clinical routine. Follow-up analyses are needed to assess this potential impact and its effect in the future. Data from the Austrian Stroke Unit Registry can only be accessed by the employed statistician (D.M.), access inquiries have to be addressed to the registry's academic review board.

Predictors of language and reading outcomes in 12-year-old children born very preterm.

To investigate predictors of language and reading outcomes in 12-year-old Swedish children born very preterm (<32 gestational weeks) in 2004-2007. Children born very preterm (n = 78, 43 girls), and term-born controls (n = 50, 32 girls), were examined on verbal IQ, semantic and phonemic fluency, sentence recall, reading fluency, word and phonological decoding at 12 years of age. The results were related to neonatal characteristics, language development, measured with Bayley-III, at 2.5 years corrected age, and concurrent non-verbal IQ. Preterm children showed language and reading difficulties that were not completely accounted for by level of concurrent non-verbal IQ. Extremely preterm born children (<28 gestational weeks) demonstrated specific linguistic weaknesses. Administration of antenatal steroids, retinopathy of prematurity and persistent ductus arteriosus explained unique variance in language and reading outcomes. Language assessments at 2.5 years had low predictive value for language and reading outcomes at age 12. Language and reading difficulties in 12-year-old children born preterm were not fully explained by concurrent non-verbal IQ, and were not reliably predicted by language assessments at 2.5 years. Renewed language assessments at school age are warranted for identifying children with persisting linguistic difficulties.

Clinical Characteristics and Outcome Predictors in Drug-Resistant Tuberculosis: A Comprehensive Analysis

Background: Drug-resistant tuberculosis (DR-TB) poses significant challenges to public health, with poor outcomes frequently observed in affected patients. This study aims to evaluate the characteristics and factors associated with poor outcomes in patients with drug-resistant pulmonary tuberculosis at Liwa Hospital from January 2018 to May 2023. Methods: A retrospective, cross-sectional single-center analysis was conducted on 408 patients admitted to Liwa Hospital. Among these, 28 patients diagnosed with drug-resistant tuberculosis (DR-TB) were selected for detailed analysis based on their treatment outcomes and clinical data. Inclusion criteria encompassed patients aged 18 years or older with confirmed drug-resistant TB, while patients younger than 18, those with latent tuberculosis, and those with extra-pulmonary tuberculosis were excluded. Results: The majority of patients were between 18-40 years old (60.7%), predominantly male (85.7%), and Asian (96.4%). Comorbidities included diabetes (46.4%) and hypertension (21.4%). Clinical characteristics revealed cough (28.6%) and fever with cough (7.1%) as common symptoms. Primary resistance was observed in 92.9% of cases, with 96.4% being newly diagnosed TB cases. Adverse drug events were minimal, with 7.1% experiencing nausea and vomiting. Radiological findings showed unilateral TB in 53.6% and cavitary TB in 57.1% of cases. Laboratory analysis indicated elevated HbA1c (9.83 ± 3.25), CRP (25.94 ± 5.16 mg/L), and white blood cell count (9.94 ± 4.59 x 10^9 cells/L). Rifampicin resistance was the most prevalent (42.9%), followed by isoniazid resistance (25.0%). Regarding treatment outcomes, age, hypertension, and diabetes mellitus were found to be significantly associated with poor outcomes in patients (p=0.05). Conclusion: The study identified significant associations between treatment outcomes and age, hypertension, and diabetes status, with higher proportions of poor outcomes observed in patients. Comprehensive management strategies targeting these factors are essential to improve outcomes in patients with drug-resistant TB. Further research is warranted to develop tailored interventions for this population.

Influence of Postoperative Insulin Resistance on Short-Term Outcomes of Radical Gastrectomy for Gastric Cancer: A Microbiome and Metabolome-Based Prospective Cohort Study.

Gastrectomy is one of the main treatment modalities for gastric cancer (GC) and induces pathophysiological changes that significantly affect patients' postoperative recovery. In this study, we investigated the relationships between altered insulin resistance (IR), inflammation, and gut microbiota associated with gastrectomy. This study was a single-center prospective cohort investigation involving 60 patients with GC who underwent gastrectomy between May 2023 and April 2024. Monitoring encompassed IR, inflammation, and nutrition-related markers via blood assays, while gut microbiota analysis employed high-throughput sequencing, and short-chain fatty acids (SCFAs) were examined through targeted metabolomics. The study is registered under the number ChiCTR2300075653. The patients exhibited a significant increase in post-gastrectomy IR markers (P < 0.001), accompanied by elevated inflammation markers (P < 0.001), and also showeddecreased nutrition-related indicators (P < 0.001). Notable alterations were observed in the gut microbiota, including reductions in Bifidobacterium and Faecalibacterium, an increase in Streptococcus, and a noteworthy decrease in fecal butyrate. Patients with postoperative IR exhibited poorer inflammation markers (P < 0.05), nutritional indicators (P < 0.05), and postoperative recovery parameters (P < 0.05). Furthermore, significant negative correlations were observed between IR and Bifidobacterium,Faecalibacterium,as well as butyrate. Patients with GC post-gastrectomy displayed heightened IR, exacerbated inflammation, and compromised nutritional status. Disturbed gut microbiota and reduced fecal butyrate were observed. Gut microbiota and metabolite butyrate production may be predictors of postoperative IR and short-term outcomes in patients with GC.

Childhood maltreatment as predictor and moderator for treatment outcome in patients with major depressive disorders treated with metacognitive therapy or behavioral activation

BackgroundChildhood maltreatment (CM) is a risk factor for developing and maintaining depression. It is unclear whether CM influences the effect of treatments for depression. This study examined CM's predictor and moderator effect in Behavioral Activation (BA) and Metacognitive Therapy (MCT). MethodCM was analyzed in a trial comparing a six months treatment program of either BA or MCT for 122 outpatients with major depressive disorder (MDD). Depression was assessed by the Hamilton Rating Scale for Depression (HRSD-24). CM was assessed using the Childhood Trauma Questionnaire (CTQ). ResultsLinear mixed models showed no predictor or moderator effects for the CTQ total score (all p > .58) but revealed a moderator effect for ‘sexual abuse’ on the reduction of depressive symptoms (β = 10.98, SE = 4.48, p = .015) indicating that patients with experiences of childhood sexual abuse benefited more from BA. There also was a predictor effect for ‘physical neglect’ (β = −3.35, SE = 1.70, p = .049): patients without the experience of physical neglect benefited more from treatment regardless of condition. Exploratory analyses indicated no predictor or moderator effects for the onset or persistence of depression, comorbid anxiety disorders or Cluster-C PDs (all p > .28). LimitationsLimitations include small sample sizes for some of the subsamples. ConclusionChildhood sexual abuse seems to moderate treatment effectiveness in a sample of severely affected outpatients with MDD treated with MCT or BA. If confirmed in further trials, a history of sexual abuse might guide the choice between MCT and BA. Trial registrationGerman Clinical Trials Register DRKS-ID: DRKS00011536 (retrospectively registered on February 13, 2017, without changes to the study protocol).

A Systematic Review of the Relationship Between Traumatic Brain Injury and Disruptions in Heart Rate Variability.

Autonomic nervous system dysfunction is increasingly recognized as a common sequela of traumatic brain injury (TBI). Heart rate variability (HRV) is a specific measure of autonomic nervous system functioning that can be used to measure beat-to-beat changes in heart rate following TBI. The objective of this systematic review was to determine the state of the literature on HRV dysfunction following TBI, assess the level of support for HRV dysfunction following TBI, and determine if HRV dysfunction predicts mortality and the severity and subsequent recovery of TBI symptoms. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two raters coded each article and provided quality ratings with discrepancies resolved by consensus. Eighty-nine papers met the inclusion criteria. Findings indicated that TBI of any severity is associated with decreased (i.e., worse) HRV; the severity of TBI appears to moderate the relationship between HRV and recovery; decreased HRV following TBI predicts mortality beyond age; HRV disturbances may persist beyond return-to-play and symptom resolution following mild TBI. Overall, current literature suggests HRV is decreased following TBI and may be a good indicator of physiological change and predictor of important outcomes including mortality and symptom improvement following TBI.

First Years Away From Home: Predictors of Engagement in a Self-Directed Prevention Handbook for Caregivers of Transitioning College Students

Caregiver and teen engagement in prevention programs is critical for positive outcomes, but barriers may reduce participation for those who may benefit most. Self-directed programs can reduce some barriers, but little research exists on predictors of engagement in these programs, especially those aimed at college-age youth and their caregivers. This paper describes engagement in a self-administered, paper handbook-based preventive intervention for students leaving home for their first year of college. Data are from the First Years Away from Home randomized controlled trial study. We measured four engagement outcomes: caregiver-reported initiation, caregiver- and student-reported dose, and caregiver-reported student engagement. Aim 1 was to describe caregiver and student engagement in the intervention; Aim 2 was to examine four categories of engagement predictors measured at baseline: sociodemographic, student, and caregiver factors, and caregiver–student relationship quality. Caregivers and students reported engaging with intervention materials, with 80% of caregivers and 77% of students reporting some handbook use. Most caregivers reported students as moderately to highly engaged. Some positive predictors of engagement outcomes included a positive caregiver–student relationship, greater student well-being, and caregiver disapproval of substance use. However, some were less engaged: risk factors for lower engagement included minoritized ethnicity status, student substance use, first-generation college student status, and students with poorer well-being and less positive relationships with their caregiver. Future work should examine ways to better engage families of students who may be entering college with higher levels of risk when creating and implementing interventions aimed at this developmental period.