Primary Variable Research Articles

Pooled analysis of NeoCARH and NeoCART trials: patient-reported outcomes in patients with early-stage breast cancer receiving platinum-based or anthracycline-based neoadjuvant chemotherapy.

Anthracycline-based or platinum-based neoadjuvant chemotherapy belongs to the standard treatment for early-stage breast cancer (EBC) that is either triple-negative or human epidermal growth factor receptor 2 positive (HER2 +). Currently, there is a paucity of data comparing their impact on health-related quality of life (HRQoL). Triple-negative or HER2 + EBC from our two prospective randomized controlled trials, neoCARH and neoCART, were divided into two groups based on the neoadjuvant chemotherapy regimens they received: anthracycline-based or platinum-based group. HRQoL was the exploratory endpoint in these two trials, which was assessed using the European Organization for Research and Treatment of Cancer Quality of Life-Core30 and Breast23 questionnaires. The primary variable of interest was the C30 summary score (C30-SumSc). Assessments were carried out at baseline, after neoadjuvant chemotherapy, and 1year and 2years after diagnosis. The mean questionnaires' compliance rate was 95.0%. After neoadjuvant chemotherapy, 210 patients had evaluable HRQoL data, the mean least square change from baseline for the platinum-based group was - 15.997 (95% confidence interval (CI): - 17.877 to - 14.117), and it was - 20.156 (95% CI: - 22.053 to - 18.258) for the anthracycline-based group (difference: 4.159, 95% CI: 1.462 to 6.855, P = 0.003, minimal important difference = 3). For the majority of the domains of interest assessed by the C30 and BR23 questionnaires, the platinum-based group demonstrated superior outcomes in comparison to the anthracycline-based group. Patients receiving platinum-based or anthracycline-based regimens both experienced worsened HRQoL after neoadjuvant chemotherapy; however, the former provided relatively better HRQoL compared with the latter. ClinicalTrials.gov: NCT03140553. Registered 4 May 2017 (neoCARH). NCT03154749. Registered 16 May 2017 (neoCART).

Evaluating inflammatory outcomes: A systematic review and meta-analysis of aerobic versus resistance exercise interventions

Chronic inflammation is widely recognized as a crucial contributor to the onset and progression of various diseases. Physical activity serves as a nonmedicinal intervention known to influence inflammatory dynamics. The specific effects of distinct exercise types, namely aerobic and resistance training, on inflammatory indices have not been fully delineated. This systematic review with meta-analysis seeks to clarify the relative impacts of these 2 forms of exercise on markers of inflammation. An exhaustive literature review was performed across several databases, including MEDLINE, EMBASE, and the Cochrane Library, to identify randomized controlled trials that assess the impact of aerobic versus resistance training on inflammatory markers. The primary variables of interest were alterations in inflammatory indicators such as C-reactive protein, interleukin-6, and tumor necrosis factor–alpha. We synthesized the data employing a random-effect meta-analytical approach and evaluated heterogeneity using the I² statistic. The literature search culminated in 36 randomized controlled trial with a collective participant count of 3616. Data analyses revealed that aerobic training is associated with a notable decrease in levels of interleukin-6 [standardized mean difference (SMD): −0.13, 95% CI: −0.31 to −0.05] and C-reactive protein (SMD: −0.28, 95% CI: −0.47 to −0.09), whereas resistance training is linked to a significant reduction in tumor necrosis factor–alpha levels (SMD: −0.61, 95% CI: −0.87 to −0.34). The investigation indicates that both aerobic and resistance training modalities play roles in diminishing inflammatory markers, likely through different biological processes. These insights highlight the critical nature of selecting appropriate exercise modalities to manage inflammatory health issues effectively. It is imperative to conduct further studies to unravel the precise mechanisms at play and to refine exercise recommendations for tailored management of inflammation.

Examining Changes in Shoulder Strength, Lower Body Power, and Body Composition among Collegiate Baseball Players after Completion of a Summer Baseball League Season.

The strength of the shoulder musculature involved with internal rotation and arm extension plays an important role in the overhead throwing motion for baseball athletes, both for throwing-related performance and injury risk. The maintenance of shoulder strength is a high priority for baseball athletes throughout a season; however, little is known in regards to the expected changes in strength throughout a season. To examine pre-post changes in shoulder strength, lower body power, and body composition among collegiate baseball players after the completion of a summer baseball league season. Amateur baseball players (n = 12; age: 20.9 ± 1.0 years.; height: 181.6 ± 5.6 cm; body mass: 86.4 ± 11.1 kg; BMI: 26.0 ± 2.6 kg/m2) participated in the current study. Pre- and post-competitive season, the participants completed shoulder strength assessments and body composition and countermovement vertical jump (CMJ) tests. An upper-body isometric test (athletic shoulder [ASH] test) was used to evaluate shoulder strength for each arm. Each subject completed maximal isometric contractions for both the throwing and non-throwing arms at four separate angles of abduction (180°, 'I'; 135°, 'Y'; 90°, 'T'; and -180°, 'A') while lying in a prone position. For shoulder strength, the primary dependent variable of interest was a composite measure that represented the average of the forces produced across all four positions of the ASH test (I, Y, T, A). For the ASH test composite measure, there was a trend toward a significant arm-by-time interaction effect (p = 0.08), as shoulder strength decreased by 9.03% for the throwing arm (ES = 0.72; 95% CI = [-0.27, -0.01]), compared to only 2.03% for the non-throwing arm (ES = 0.15; 95% CI = [-0.16, 0.09]), over the course of the season. The main effects of time (p = 0.16) and arm (p = 0.58) were not significant for the ASH test composite measure. There was no relationship between lower body power and throwing arm strength at baseline (r = 0.20, p = 0.56), and only a non-significant weak relationship at post-test (r = 0.28, p = 0.41). Throughout a season, baseball players may experience reductions in shoulder strength of the throwing arm with minimal changes in shoulder strength in the non-throwing arm.

BRAND PERFORMANCE AND IMPACT OF SOCIAL MEDIA ENGAGEMENT ACTIVITIES

This research examines the correlation between users’ engagement with social media, their feedback mechanisms, and their overall satisfaction regarding the social media efficacy of three prominent brands: Myntra, Zomato, and BigBasket. A survey was administered to 44 participants, predominantly from urban locales, concentrating on their social media utilization patterns, brand interaction, and feedback mechanisms. The primary variables assessed encompassed the duration of social media usage, the platforms engaged, satisfaction with brand interaction, and the characteristics of feedback provided.The findings revealed that individuals categorized as moderate social media users (2-3 hours per day) demonstrated elevated levels of satisfaction with brand performance, with 61% indicating either satisfaction or neutral perspectives, whereas heavy users (4+ hours) tended to express neutrality or dissatisfaction more frequently. Zomato and Myntra emerged as the most engaged brands, with 64% of participants interacting with Zomato and 54% with Myntra, in stark contrast to a mere 2% engagement for BigBasket. Cross-tabulation analysis illustrated that positive feedback exhibited a robust correlation with increased satisfaction levels, as 58% of respondents providing feedback reported being either satisfied or very satisfied. Notably, neutral feedback or the absence of feedback was more prevalent among individuals with diminished satisfaction levels, thereby underscoring the significance of proactive consumer-brand interactions. This investigation concludes that moderate engagement with social media and constructive feedback play a crucial role in fostering a positive perception of brands, while excessive exposure does not necessarily enhance satisfaction. Hence, brands ought to prioritize responsiveness, tailor content to individual preferences, and capitalize on promotional strategies to sustain and elevate consumer satisfaction on social media platforms.

Dose-response and efficacy of 904nm photobiomodulation on diabetic foot ulcers healing: a randomized controlled trial.

This study aimed to examine the impact of a 904nm photobiomodulation (PBM) on diabetic ulcers using varying dosages. The study was a randomized, double-blind, placebo-controlled clinical trial that compared treatments using PBM (GaAs 904nm 30w) with three different energy densities (4J/cm2; 8J/cm2; 10J/cm2) in the healing process of non-infected diabetic foot ulcers. Eighty volunteers (48.75% female; 58.5 ± 11.1 years) were randomized into three intervention groups treated with PBM and one control group (PBM placebo). Volunteers performed up 20 interventions with PBM, either placebo or actual, in conjunction with conventional therapy, which involved dressing the wound with Helianthus annuus vegetable oil. The primary variable was the ulcer size reduction rate. GaAs 904nm PBM yielded a clinically and significant ulcer size rate reduction of diabetic foot ulcers, independently of energy density range (p < 0.05). However, 10J/cm² had 60% of completely healed ulcers and the highest proportion of patients reaching 50% of ulcer reduction rate after 5 weeks of treatment. In addition, only 10J/cm² showed a significant difference between control group after a 10-week follow-up (p < 0.05). GaAs 904nm PBM was effective in treating diabetic foot ulcers in this study and a dosage of 10J/cm², after a 10-week follow-up, proved to be the most effective compared to the other groups. NCT04246814.

The predictive value of LGR for distant metastasis-free survival in locally advanced rectal cancer patients

Studies show that inflammation induced by cancer is a key factor in carcinogenesis. Here, we sought to assess the relationship between patients with locally advanced rectal cancer (LARC) and the lymphocyte to neutrophil granulocyte ratio (LGR) prior to neoadjuvant chemoradiotherapy (nCRT) and distant metastasis-free survival (DMFS). Using a receiver operating characteristic (ROC) analysis of 326 LARC patients who underwent total mesorectal excision (TME) surgery and neoadjuvant chemoradiotherapy, we were able to determine the ideal LGR cutoff value. We used the Kaplan-Meier method and univariate and multivariate Cox regression to study the clinical characteristics of LARC patients in comparison between the low LGR group and the high LGR group. DMFS analysis was one of the primary clinical variables examined. We discovered that the low LGR group of LARC patients had a longer DMFS than the high LGR group. The median duration of follow-up for LARC patients was 89.4 months, with a significantly lower DMFS observed in the high LGR group compared to the low LGR group. Multivariate Cox regression analysis revealed that LARC patients with low LGR levels, early ypTNM stages, and BRAF wild had longer DMFS. LGR prior to nCRT was a critical prognostic indicator that contributed extra predictive value beyond conventional clinicopathological characteristics to predict the outcome of LARC patients receiving neoadjuvant chemoradiotherapy followed by TME surgery.

Early-Life Circumstances and Racial Disparities in Cognition Among Older Adults in the US

ImportanceGiven the critical role of neurocognitive development in early life, understanding the association between early-life circumstances and racial disparities in cognition has important implications.ObjectiveTo assess whether racial differences in early-life circumstances are collectively and individually associated with racial disparities in late-life cognition among older adults in the US.Design, Setting, and ParticipantsThis cross-sectional study used comprehensive life history data from the Health and Retirement Study, a nationally representative survey of US adults 50 years or older. Data analyses were performed from August 9, 2022, to January 20, 2024.Main Outcomes and MeasuresRacial differences in early-life circumstances and racial disparities in late-life cognition were investigated using a Blinder-Oaxaca decomposition regression model. Cognitive outcomes, including cognitive score and cognitive impairment, were evaluated using the Telephone Interview for Cognitive Status. Early-life educational experiences were primary explanatory variables; early-life cohort, regional, financial, health, trauma, family relationship factors, and educational attainment were additional explanatory variables; demographic and genetic factors were covariates.ResultsThe study sample comprised 9015 participants; 1634 non-Hispanic Black (hereafter, Black) individuals (18.1%) and 7381 non-Hispanic White (hereafter, White) individuals (81.9%). Among Black participants, the mean (SD) age was 69.2 (9.2) years and 1094 (67.0%) were women. Among White participants, the mean (SD) age was 73.2 (10.1) years and 4410 (59.7%) were women. Cognitive scores (scale, 0-27) were significantly lower among Black participants (13.5 [95% CI, 13.3-13.7] points) than among White participants (15.8 [95% CI, 15.7-15.9] points), while the prevalence of cognitive impairment (cognitive score <12) was significantly higher among Black participants (33.6 [95% CI, 31.3-35.9] percentage points [ppt]) than among White participants (16.4 [95% CI, 15.6-17.2] ppt). Substantial racial differences were observed in early-life circumstances. Overall, differences in early-life circumstances were associated with 61.5% of the racial disparities in cognitive score (1.4 [95% CI, 0.88-2.0] points), and 82.3% of the racial disparities in cognitive impairment (14.2 [95% CI, 8.8-19.5] ppt), respectively. In multivariable analyses, early-life educational experiences were associated with 35.2% of the disparities in cognitive score and 48.6% in cognitive impairment. Notably, school racial segregation (all segregated schooling before college) was associated with 28.8% to 39.7% of the racial disparities in cognition. These findings were consistent in a series of sensitivity analyses.Conclusions and RelevanceThe findings of this cross-sectional study suggest that less favorable early-life circumstances are associated with clinically meaningful racial disparities in late-life cognition. Policies that improve educational equity have the potential to reduce racial disparities in cognition in older ages. Clinicians may leverage early-life circumstances to promote the screening, prevention, and interventions of cognitive impairment more efficiently, thereby promoting health equity.

Sociodemographic Heterogeneity in the Associations of Social Isolation With Mortality

There are limited data on whether the vulnerabilities and impacts of social isolation vary across populations. To explore the association between social isolation and mortality due to all causes, cardiovascular diseases (CVD), and malignant neoplasms focusing on heterogeneity by sociodemographic factors. This cohort study used a moderator-wide approach to examine the heterogeneity in the association of social isolation with all-cause, CVD, and malignant neoplasm mortality using baseline data from the Japan Gerontological Evaluation Study in 2010 and 2011. Eligible participants were adults aged 65 years or older without heart disease, stroke, cancer, or impaired activity of daily living across 12 Japanese municipalities. Follow-up continued until December 31, 2017, identifying 6-year all-cause, cardiovascular disease (CVD), and malignant neoplasm mortality. Logistic regression assessed effect modification by age, gender, education, income, population density, marital status, and employment on mortality associations. Data analysis was performed from September 13, 2023, to March 17, 2024. Social isolation, determined by a 3-item scale (scores of 2 or 3 indicating isolation) was the primary exposure variable. Six-year all-cause, CVD, and malignant neoplasms mortality. This study included 37 604 older adults, with a mean (SD) age of 73.5 (5.9) years (21 073 women [56.0%]). A total of 10 094 participants (26.8%) were classified as experiencing social isolation. Social isolation was associated with increased all-cause (odds ratio [OR], 1.20 [95% CI, 1.09-1.32]), CVD (OR, 1.22 [95% CI, 0.98-1.52]), and malignant neoplasm mortality (OR, 1.14 [95% CI, 1.01-1.28]). Stratified analysis showed associations of social isolation with all-cause and malignant neoplasm mortality among people with high income (highest tertile all cause: OR, 1.27 [95% CI, 1.06-1.53]; malignant neoplasm: OR, 1.27 [95% CI, 1.02-1.60]), living in areas with high population density (highest tertile all cause: OR, 1.47 [95% CI, 1.26-1.72]; malignant neoplasm: OR, 1.38 [95% CI, 1.11-1.70]), not married (all cause: OR, 1.33 [95% CI, 1.15-1.53]; malignant neoplasm: OR, 1.25 [95% CI, 1.02-1.52]), and retirees (all cause: OR, 1.27 [95% CI, 1.14-1.43]; malignant neoplasm: OR, 1.27 [95% CI, 1.10-1.48]). Formal testing for effect modification indicated modification by population density and employment for all-cause mortality and by household income and employment for neoplasm mortality. Social isolation was associated with increased risks of all-cause, CVD, and malignant neoplasm mortality, with associations varying across populations. This study fills an important gap in research on social isolation, emphasizing its varied associations across demographic and socioeconomic groups.

Assessment of genotoxicity of air pollution in urban areas using an integrated model of passive biomonitoring

Atmospheric pollution is a major public health issue and has become increasingly critical for human health. Urban atmospheric pollution is typically assessed through physicochemical indicators aligned with environmental legislation parameters, providing data on air quality levels. While the effects of pollution on sensitive organisms serve as a warning for public health decision-makers, there remains a need to explore the interpretation of environmental data on pollutants. The use of species adapted to urban environments as sentinels enables continuous and integrated monitoring of environmental pollution implications on biological systems. In this study, we investigated the use of the plant species Tradescantia pallida as a biomonitor to evaluate the genotoxic effects of atmospheric pollution under diverse vehicular traffic conditions. T. pallida was strategically planted at the leading urban intersections in Uberlândia, Brazil. During COVID-19 pandemic lockdowns, we compared indicators such as physical, biological, and traffic data at different intersections in residential and commercial zones. The reduction in vehicular traffic highlighted the sensitivity of plant species to changes in air and soil pollutants. T. pallida showed bioaccumulation of heavy metals Cd and Cr in monitored areas with higher traffic levels. Additionally, we established a multiple linear regression model to estimate genotoxicity using the micronucleus test, with chromium concentration in the soil (X1) and particulate matter (PM) in the atmosphere (X2) identified as the primary independent variables. Our findings provide a comprehensive portrait of the impact of vehicular traffic changes on PM and offer valuable insights for refining parameters and models of Environmental Health Surveillance.

Assessment of pain relief after four botulinum toxin A injection cycles in patients with post-stroke lower limb spasticity: A prospective, observational study

IntroductionSpasticity is common after a stroke and is an independent risk factor for developing pain. BotulinumtoxinA injection is the treatment of choice for focal spasticity. We examined the effect of intramuscular botulinumtoxinA on pain relief in patients in routine clinical practice who were experiencing pain as a primary complaint associated with post-stroke lower limb spasticity. MethodsProspective, multicentre, post-marketing observational study. The study period was 16 months. The primary effectiveness variable was the mean change from baseline on the pain 0–10 Numerical Rating Scale after four botulinumtoxinA injection cycles. Secondary endpoints included changes from baseline on the pain 0–100 Visual Analogue Scale, Goal Attainment Scale, modified Ashworth Scale, 10-Meter Walk Test, Penn Spasm Frequency Scale, and 36-item Short-Form Health Survey. ResultsOf 186 enrolled patients, 180 (96.8%) received botulinumtoxinA at least once. The mean (standard deviation) pain 0–10 Numerical Rating Scale score decreased significantly (p<0.0001) from 4.9 (2.2) at baseline to 2.5 (2.1) at study end, representing a 50% decrease in pain severity. Relief of pain due to spasticity was supported by improvement from baseline in all secondary variables except the 10-Meter Walk Test. Two adverse events (erysipelas and phlebitis) in one patient were considered likely to be related to botulinumtoxinA injection. ConclusionBotulinumtoxinA appears to provide pain relief as an additional benefit of local treatment in patients with post-stroke lower limb spasticity for whom pain relief is a primary therapeutic goal (a Lay Abstract has been provided as Appendix A).

P.150 Effect of postoperative pain control and other perioperative risk factors on length of stay after elective spine surgery

Background: Prolonged length of stay (LOS) after elective spine surgery increases patients’ risk for in-hospital complications and contributes significantly to healthcare costs. Here we explored the role of pain control and other perioperative factors on LOS. Methods: Consecutive adult patients undergoing elective spine surgery were enrolled. The primary outcome was in-hospital LOS following surgery. The primary independent variable was poor pain control on postoperative day 1 (POD1). Univariable analyses followed by multivariable regression analysis were used to investigate the relationship between poor pain control and LOS. Results: 1305 patients were enrolled. Mean LOS was 4.38 days. Incidence of poor pain control was 56.9%. Multivariable analysis revealed poor POD1 pain control was significantly associated with increased LOS (p=0.03), after adjusting for other significant predictors of increased LOS including perioperative hemodynamic instability (p=0.001), perioperative blood transfusion (p=0.000), delirium (p=0.000), POD1 morphine equivalent dose (p=0.000), urinary tract infection (p=0.000), urinary retention (p=0.003), surgical site infection (p=0.000), wound complication (p=0.000), neurologic deterioration (p=0.000), surgical levels (p=0.016), operative time (p=0.007), ASA score (p=0.000), preoperative disability score (p=0.001). Conclusions: Poor pain control on POD1 was an independent predictor of increased LOS after elective spine surgery, highlighting the importance of a proactive approach to addressing pain in the immediate postoperative period.

Enhancing the Theory of Planned Behavior with Perceived Consumer Effectiveness and Environmental Concern towards Pro-Environmental Purchase Intentions for Eco-Friendly Apparel: A Review Article

The textile sector has become a significant source of pollution due to increasing carbon emissions, heightened greenhouse gas emissions, and growing landfill contributions. In response, the industry is turning towards sustainable fashion, which is gaining popularity as an eco-friendly practice. This study utilized the theory of planned behavior (TPB) alongside variables such as environmental concern, personal moral norms, and perceived consumer effectiveness to predict eco-friendly apparel purchasing intentions among educated Indian youth. The research applied variance-based partial least squares structural equation modeling (PLS-SEM) to assess the proposed model. Results revealed that perceived behavioral control significantly and positively impacts purchasing intentions, followed by personal moral norms, general attitude, and perceived consumer effectiveness. Environmental concern was shown to indirectly influence purchasing intentions via the primary TPB variables and personal moral norms. Additionally, multi-group analysis (MGA) was used to investigate the moderating effects of perceived consumer effectiveness on the attitude-intention relationship, finding that individuals with higher perceived effectiveness displayed a more consistent attitude-intention correlation compared to those with lower perceived effectiveness. This study offers valuable insights for professionals and policymakers, suggesting the development of tailored sustainable marketing strategies and policies to address local market conditions.

A low-frequency piezoelectric wave energy harvester based on segmental beam and double magnetic excitation

Wave energy is a source of clean energy with huge reserves, but its application is limited owing to the low frequency of the waves. This paper proposes a low-frequency piezoelectric wave energy harvester (L-PWEH) based on segmental beam and double magnetic excitation. The L-PWEH uses a combination of mechanical and magnetic frequency tuning to achieve an improved output performance in low-frequency wave environments. The natural frequency of the segmental beam is effectively reduced by using the mechanical tuning method of the segmental beam structure. With the introduction of the tuning magnet, a double magnetic excitation of the segmental beam is formed to make it more susceptible to deformation. Multiple magnets on the rotor for excitation can obtain a better broadband effect. Through theoretical and simulation analysis, the primary variables influencing the output performance of the L-PWEH are discovered. Under ideal testing conditions, the L-PWEH can produce a peak power of 31.21 mW when the external resistance is 30 kΩ. The thermohygrometer can function effectively and be illuminated by 142 light-emitting diodes (LEDs) thanks to the L-PWEH. These findings confirm that the L-PWEH can supply low-power electronic devices with electricity.

Efeitos de 15 minutos de exercícios físicos na aptidão física de adolescentes: Estudo de protocolo

Overweight, obesity, and low physical fitness (PF) are conditions associated with physical and mental health problems in children and adolescents. Schools and physical education (PE) classes provide ideal environments for promoting physical exercise, improving levels of PF, and preventing obesity in this population. This article outlines the protocol of an experimental study whose primary objective is to assess the effects of a 15-minute physical exercise program implemented during elementary school physical education classes on PF and anthropometric markers of overweight and obesity (AMOO). Enrolled students in 6th to 9th-grade classes within rural elementary schools located in a Southern city in Brazil will participate of the study. The participants will be randomized into the intervention group and control group. The intervention will last for 12 weeks with two sessions per week. Various components of PF and AMOO will be the primary dependent variables. Physical activity level, recreational screen time, sleep duration, physical self-concept, motivation for participating in PE classes, symptoms of anxiety, depression, and stress will be secondary dependent variables. Sociodemographic information and somatic maturation will serve as covariates. All variables will be measured pre and post-intervention. The study’s findings will contribute to a better understanding of the potential of school PE classes to improve PF, AMOO, and, secondarily, health-related behaviors, motivation for participating in PE classes, and the mental health of students.

Association between the utilization of senior centers and participation in health check-ups

The global older adult population is increasing. Early detection and intervention through health check-ups are crucial for successful aging, as they play a significant role in identifying and addressing diseases. This study explored the relationship between the utilization of senior centers and the promotion of health check-ups. It utilized data from 10,097 individuals aged 65 years and above, sourced from the 2020 Elderly Survey in South Korea. The primary variable of interest was classified into two groups: those who utilized senior centers and those who did not. Subgroups were further categorized based on the frequency of usage and the presence of family members among senior centers users. Logistic regression analyses were conducted to assess the association between the utilization of senior centers and participation in health check-ups. Both men and women utilizing senior centers demonstrated a higher likelihood of participating in health check-ups compared with those who did not use senior centers. Participants visiting senior centers in a week exhibited a progressively higher likelihood of engaging in health check-ups compared with those who visited such senior centers zero times a week. Senior centers can serve as effective intervention methods to enhance health check-ups among older adults. Furthermore, this can contribute to fostering successful aging among older adults.

Does Timing of Radiation Therapy Impact Wound Healing in Patients Undergoing Metastatic Spine Surgery?

The impact of radiation on wound healing after metastatic spine surgery remains an active area of research. In patients undergoing metastatic spine surgery, we sought to (1) assess the relationship between preoperative and/or postoperative radiation on wound complications, and (2) evaluate the relationship between the timing of postoperative radiation and wound complications. A single-center, retrospective, cohort study of patients undergoing metastatic spine surgery was conducted from 2010 to 2021. The primary exposure variable was the use/timing of radiation. Radiation included both external beam radiotherapy (EBRT) and stereotactic body radiotherapy (SBRT). Patients were trichotomized into the following groups: (1) preoperative radiation only, (2) postoperative radiation only, and (3) no radiation. The primary outcome variable was wound complications, which was defined as dehiscence requiring reoperation, infection requiring antibiotics, or infection requiring surgical debridement. Multivariable logistic/linear regression controlled for age, tumor size, primary organ of origin, and the presence of other organ metastases. A total of 207 patients underwent surgery for extradural spinal metastasis. Participants were divided into three groups: preoperative RT only (N = 29), postoperative RT only (N = 91), and no RT (N = 178). Patients who received postoperative RT only and no RT were significantly older than patients who received preoperative RT only (p = 0.009) and were less likely to be white (p < 0.001). No other significant differences were found in basic demographics, tumor characteristics, or intraoperative variables. Wound-related complications occurred in two (6.9%) patients with preoperative RT only, four patients (4.4%) in postoperative RT only, and 11 (6.2%) patients with no RT, with no significant difference among the three groups (p = 0.802). No significant difference was found in wound-related complications, reoperation, and time to wound complications between patients with preoperative RT only and no RT, and between postoperative RT only and no RT (p > 0.05). Among the postoperative-RT-only group, no difference in wound complications was seen between those receiving SBRT (5.6%) and EBRT (4.1%) (p > 0.999). However, patients who received preoperative RT only had a longer time to wound complications in comparison to those who received postoperative RT only (43.5 ± 6.3 vs. 19.7 ± 3.8, p = 0.004). Regarding timing of postoperative RT, the mean (SD) time to RT was 28.7 ± 10.0 days, with a median of 28.7 (21-38) days. No significant difference was found in time to postoperative RT between patients with and without wound complications (32.9 ± 12.3 vs. 29.0 ± 9.7 days, p = 0.391). In patients undergoing metastatic spine surgery, a history of previous RT or postoperative RT did not significantly affect wound complications. However, those with previous RT prior to surgery had a longer time to wound complications than patients undergoing postoperative RT only. Moreover, timing of RT had no impact on wound complications, indicating that earlier radiation may be safely employed to optimize tumor control without fear of compromising wound healing.

Unraveling the dynamic slowdown in supercooled water: The role of dynamic disorder in jump motions.

When a liquid is rapidly cooled below its melting point without inducing crystallization, its dynamics slow down significantly without noticeable structural changes. Elucidating the origin of this slowdown has been a long-standing challenge. Here, we report a theoretical investigation into the mechanism of the dynamic slowdown in supercooled water, a ubiquitous yet extraordinary substance characterized by various anomalous properties arising from local density fluctuations. Using molecular dynamics simulations, we found that the jump dynamics, which are elementary structural change processes, deviate from Poisson statistics with decreasing temperature. This deviation is attributed to slow variables competing with the jump motions, i.e., dynamic disorder. The present analysis of the dynamic disorder showed that the primary slow variable is the displacement of the fourth nearest oxygen atom of a jumping molecule, which occurs in an environment created by the fluctuations of molecules outside the first hydration shell. As the temperature decreases, the jump dynamics become slow and intermittent. These intermittent dynamics are attributed to the prolonged trapping of jumping molecules within extended and stable low-density domains. As the temperature continues to decrease, the number of slow variables increases due to the increased cooperative motions. Consequently, the jump dynamics proceed in a higher-dimensional space consisting of multiple slow variables, becoming slower and more intermittent. It is then conceivable that with further decreasing temperature, the slowing and intermittency of the jump dynamics intensify, eventually culminating in a glass transition.

Impact of COVID-19 on women living with HIV who are survivors of intimate partner violence

BackgroundWomen living with HIV (WLWH) experience higher rates of intimate partner violence (IPV) compared to women without HIV, but there has been minimal research to date on the impact of the COVID-19 pandemic on the lived experiences of WLWH who are IPV survivors.MethodsThis is a secondary analysis of COVID-19 impact using baseline data from an ongoing, prospective, micro-longitudinal cohort study of HIV care engagement among WLWH who have experienced lifetime IPV. We measured the impact of COVID-19 along key domains (i.e., physical health, day-to-day life, sexual/relationship behavior, substance use, HIV care, mental health, financial status, and having conflict with partners). Using independent t-tests or Fisher’s exact tests, and Pearson’s chi-squared tests, we compared women with and without ongoing IPV across sociodemographic characteristics, psychiatric disorders, substance use, and COVID-19 impact domains. We then built separate multivariate linear regression models for each of the different COVID-19 impact domains; ongoing IPV exposure was the primary explanatory variable of interest.ResultsEnrolled participants (n = 84) comprised a group of women (mean age 53.6y; SD = 9.9) who were living with HIV for a mean 23.3 years (SD = 10), all of whom had experienced lifetime IPV. Among 49 women who were currently partnered, 79.6% (n = 39) reported ongoing IPV. There were no statistically significant differences between those experiencing ongoing IPV and those who were not (or not partnered) in terms of demographic characteristics, substance use, or mental health. In multivariate models, ongoing IPV exposure was not associated with any COVID-19 impact domain. Anxiety and depression, however, were associated with COVID-19-related physical health, HIV care, and relationship conflict. Hispanic ethnicity was significantly associated with COVID-19-related physical health. More severe cocaine and opioid use were also significantly associated with COVID-19-related impact on day-to-day life.ConclusionsAmong this sample of WLWH who are all lifetime IPV-survivors, nearly half had ongoing IPV exposure. The COVID-19 public health emergency period affected WLWH in varied ways, but impacts were most profound for women experiencing concurrent mental health and substance use problems. Findings have important implications for future interventions to improve women’s health and social outcomes.

Does Elective Admission vs. Emergency Department Presentation Affect Surgical Outcomes in Metastatic Spine Surgery?

Approximately 20% of patients with metastatic spine disease develop symptomatic spinal cord compression, and these patients can present urgently to the emergency department (ED) or, in a more organized fashion, to a clinic. In a cohort of patients undergoing metastatic spine surgery, we sought to (1) determine the rate of ED presentation, (2) identify preoperative and perioperative risk factors associated with ED presentation, and (3) evaluate whether ED vs. clinic presentation impacts long-term outcomes. A single-institution, multi-surgeon, retrospective cohort study was undertaken of patients undergoing metastatic spinal tumor surgery between 02/2010 and 01/2021. The primary exposure variable was presentation setting, dichotomized to the ED vs. clinic. The primary outcomes were postoperative functional status, measured with the Karnofsky Performance Scale (KPS) and McCormick Scale (MMS), local recurrence (LR), and overall survival (OS). Secondary outcomes included complications and readmissions. A total of 311 patients underwent metastatic spine surgery (51.7% ED vs. 48.3% clinic). Those presenting to the ED had higher rates of smoking (21.7% vs. 16.0%, p = 0.02), were more likely to have 2+ comorbidities (47.2% vs. 32.7%, p = 0.011), and were more likely to have public insurance (43.5% vs. 32.0%, p = 0.043). Preoperative KPS was lower in ED patients (p < 0.001), while the Bilsky score was higher (p = 0.049). ED patients had higher rates of oligometastatic disease (p = 0.049), higher total decompressed levels (p = 0.041), and higher rates of costotransversectomy (p = 0.031) compared to clinic patients. Length of stay was significantly longer for ED patients (7.7 ± 6.1 vs. 6.1 ± 5.8 days, p = 0.020), and they were less likely to be discharged home (52.2% vs. 69.3%, p = 0.025). ED presentation was significantly associated with shorter overall survival (HR =1.53 95% CI = 1.13-2.08, p = 0.006). Of patients undergoing metastatic spine disease, approximately half presented through the ED vs. clinic. ED patients had higher rates of smoking, public insurance, and higher Bilsky score. ED patients also underwent more extensive surgery, had longer LOS, were less likely discharged home, and most importantly, had a shorter overall survival. These results suggest that initial presentation for patients undergoing surgery for metastatic spine disease significantly impacts outcomes, and signs/symptoms of metastatic spine disease should be recognized as soon as possible to prevent ED presentation.

Hypofractionated Radiotherapy-Related Lymphopenia Is Associated With Worse Survival in Unresectable Intrahepatic Cholangiocarcinoma.

The aim of this study was to evaluate the incidence of radiotherapy (RT)-related lymphopenia, its predictors, and association with survival in unresectable intrahepatic cholangiocarcinoma (ICC) treated with hypofractionated-RT (HF-RT). Retrospective analysis of 96 patients with unresectable ICC who underwent HF-RT (median 58.05 Gy in 15 fractions) between 2009 and 2022 was performed. Absolute lymphocyte count (ALC) nadir within 12 weeks of RT was analyzed. Primary variable of interest was severe lymphopenia, defined as Grade 3+ (ALC <0.5 k/μL) per CTCAE v5.0. Primary outcome of interest was overall survival (OS) from RT. Median follow-up was 16 months. Fifty-two percent of patients had chemotherapy pre-RT, 23% during RT, and 40% post-RT. Pre-RT, median ALC was 1.1 k/μL and 5% had severe lymphopenia. Post-RT, 68% developed RT-related severe lymphopenia. Patients who developed severe lymphopenia had a significantly lower pre-RT ALC (median 1.1 vs. 1.5k/μL, P =0.01) and larger target tumor volume (median 125 vs. 62 cm 3 , P =0.02). In our multivariable Cox model, severe lymphopenia was associated with a 1.7-fold increased risk of death ( P =0.04); 1-year OS rates were 63% vs 77% ( P =0.03). Receipt of photon versus proton-based RT (OR=3.50, P =0.02), higher mean liver dose (OR=1.19, P <0.01), and longer RT duration (OR=1.49, P =0.02) predicted severe lymphopenia. HF-RT-related lymphopenia is an independent prognostic factor for survival in patients with unresectable ICC. Patients with lower baseline ALC and larger tumor volume may be at increased risk, and use of proton therapy, minimizing mean liver dose, and avoiding treatment breaks may reduce RT-related lymphopenia.