Index Score Research Articles

Comparison of growth hormone therapy response according to the presence of growth hormone deficiency in children born small for gestational age with short stature in Korea: a retrospective cohort study

BackgroundThis study aimed to compare the response to growth hormone (GH) therapy according to the presence of GH deficiency (GHD) in short-stature children born small for gestational age (SGA) in Korea and to present appropriate GH dose criteria.MethodsWe evaluated 27 children born SGA with short stature and GHD (GHD group) and 23 without GHD (non-GHD group) registered in the LG Growth Study. Growth responses and changes in GH dose over a 2-year GH therapy period were compared, and the factors affecting growth response were investigated.ResultsThe standard deviation scores (SDSs) for baseline weight and body mass index (BMI) were significantly lower in boys without GHD than in boys with GHD. The SDS for insulin-like growth factor-1 (IGF-1) was lower among boys without GHD than among boys with GHD, while the SDS for insulin-like growth factor-binding protein-3 (IGFBP-3) was higher among girls without GHD than among girls with GHD; however, there was no significant difference when comparing all children with GHD to those without GHD. Regardless of the presence of GHD, the difference between chronological age and bone age decreased annually. Notably, there was significantly rapid bone age progression among patients without GHD. The findings showed differences in GH dose according to GHD starting from the 2nd year of therapy, with the non-GHD group receiving a significantly higher dose. Regarding the factors affecting growth response, younger age and bone age, higher height SDS, BMI SDS and MPH SDS were related to higher growth response (Δheight SDS and Δgrowth velocity), but there was no statistically significant correlation.ConclusionGHD is rare among children born SGA. Nonetheless, if there are any signs of decreased growth velocity or hypopituitarism, the presence of GHD should be assessed before GH therapy, and personalized therapy based on the results is required.

Huanglian Ganjiang Decoction alleviates DSS-induced colitis through suppressing inflammation and protecting intestinal barrier: From the perspective of disassembling prescriptions.

Huanglian Ganjiang decoction (HGD), which is composed of Chinese medicines with cold, warm, and astringent properties, has demonstrated significant therapeutic efficacy in ulcerative colitis (UC). However, the underlying mechanisms remain unclear, highlighting the need for a multi-faceted investigation. Disassembling prescriptions is a crucial approach for investigating compatibility mechanisms. Analyzing the interactions among Chinese herbs through this method can refine treatment focus and provide novel insights into TCM prescription compatibility research. Therefore, HGD was disassembled into three groups: Cold Medicine Removed (C-R), which warm medicine and astringent medicine are combined; Warm Medicine Removed (W-R), which cold medicine and astringent medicine are combined; and Astringent Medicine Removed (A-R), which cold medicine and warm medicine are combined. To elucidate the therapeutic effects of HGD and its three disassembled prescriptions against UC and to uncover their compatibility mechanisms. The chemical composition of HGD and its disassembled prescriptions (HGDADPs) was qualitatively analyzed using UPLC-MS/MS. 3% dextran sulfate sodium (DSS) was used to induce a UC mouse model. The efficacy in treating UC was evaluated by body weight loss, disease activity index (DAI), colon length, spleen index, thymus index, and histopathological score. A compound-UC target network was established utilizing the network pharmacology. The underlying mechanisms were then investigated by assessing intestinal barrier function and inflammatory responses, as well as the APOC1/P38 MAPK and TLR4/NF-κB signaling pathways through qRT-PCR, Western blotting, and immunofluorescence. Subsequently, anisomycin, a P38 MAPK agonist, was used to confirm whether C-R protects the gut barrier via the APOC1/P38 MAPK pathway. Monophosphoryl lipid A (MPLA), a TLR4 agonist, was employed to investigate whether W-R mediates its anti-inflammatory effects via the TLR4/NF-κB signaling pathway. HGDADPs improved colitis symptoms, increasing ZO-1, Occludin, Claudin-1, and E-cadherin levels while reducing blood cell counts and IL-6 and IL-1β levels. HGD was the most effective in reducing inflammation and repairing the intestinal barrier, with A-R showing similar effects. C-R excelled in repairing the barrier, while W-R was better at reducing inflammation. Network pharmacology indicated C-R inhibits the APOC1/P38 MAPK pathway, and W-R suppresses the TLR4/NF-κB pathway, aligning with Western blotting results. ANI and MPLA reversed the effects of C-R and W-R, respectively. The mechanism by which HGDADPs treat colitis is demonstrated for the first time in our study. In HGD, cold medicine serves as the "Jun", primarily exerting anti-inflammatory effects; Warm medicine acts as the "Chen", mainly protecting the intestinal mucosal barrier; And astringent medicine functions as the "Zuo", playing a synergistic role in the treatment of colitis. In addition, the combination of cold and warm medicines (A-R) was the most crucial for HGD' s compatibility. The pairing of warm and astringent medicines (C-R) significantly contributed to the restoration of the gut barrier and the inhibition of the APOC1/P38 MAPK signaling pathway. Meanwhile, the combination of cold and astringent medicines (W-R) primarily contributed to alleviating inflammation and inhibiting the TLR4/NF-κB pathway.

The usefulness of Charlson Comorbidity Index (CCI) scoring in predicting all-cause mortality in Outpatients with Clinical Diagnoses of COPD.

Since comorbid conditions are frequently present in chronic obstructive pulmonary disease (COPD) and affect outcome, a composite scoring system to quantify comorbidity might be helpful in assessing mortality risk. We tested the hypothesis that the Charlson Comorbidity Index (CCI) score at the time of an outpatient medical clinic encounter for COPD predicts all-cause mortality. Cox Proportional Hazards analyses were used in 200 randomly selected patients to relate CCI scores to all-cause mortality out to 5 years. Mean age was 62 ± 10 years, 56% were female, FEV1 was 62%, CCI was 3.08 ± 2.30, and 30% had a CCI ≥ 4, indicating 3 or more comorbid conditions. All-cause mortality was 8.5% and 20% at 3 and 5 years, respectively. In univariate testing, the CCI score and hospitalizations predicted mortality, but FEV1 did not. In multivariable testing, which included covariates of age, sex, socioeconomic status, race, FEV1 percent-predicted, and all-cause hospitalizations in the preceding year, CCI expressed as a continuous variable strongly predicted mortality: hazard ratio (HR) 1.38 for each unit increase in the score (p < 0.0001). While 1 or 2 comorbid conditions were not significantly related to mortality, 3 or more comorbid conditions (compared to none) strongly predicted mortality: HR 9.80, 95% CI 3.80 to 25.00. Comorbidity, assessed with the CCI, is strongly predictive of mortality in outpatients with a clinical diagnosis of COPD, and this relationship appears to be non-linear. This instrument may be useful in determining prognosis in this population.

A double-blind randomized crossover trial comparing the esthetic outcomes of CAD-CAM provisional restorations fabricated using CBCT and IOS acquisition methods.

This double-blind randomised crossover trial aimed to compare the aesthetic outcomes of CAD-CAM manufactured provisional restorations created using cone beam computed tomography (CBCT) and intraoral scanners (IOS) acquisition methods. Twelve participants (mean-age: 38 ± 5 years) requiring full mouth rehabilitation were included in this crossover trial. Two sets of identical CAD-CAM provisional restorations, differing only in the method of data acquisition (A: CBCT, B: IOS), were fabricated. Restorations were cemented for two weeks, with washout period between interventions. Esthetic evaluations were conducted using clinician and patient-reported outcome questionnaires. Both parametric and non-parametric tests were used to account for data variability: Mann-Whitney U test compared pink esthetic score (PES), white esthetic score (WES), and modified US Public Health Service (USPHS) score. An unpaired t-test compared Oral Health Impact Profile- Aesthetic Questionnaire (OHIP-Aes) scores and Orofacial Esthetic scores. Clinician-reported outcomes showed significantly better esthetic scores for provisional restorations fabricated using CBCT compared to IOS. CBCT scored higher in Pink Esthetic Score (PES) [Mean rank: CBCT = 16.00, IOS = 9.00; P = 0.012] and White Esthetic Score (WES) [Mean rank: CBCT = 17.25, IOS = 7.75; P < 0.001]. No significant differences were observed for Modified USPHS scores across groups [Mean rank: CBCT = 11.38, IOS = 13.63; P = 0.221]. Patient-reported outcomes indicated no significant differences between groups in OHIP-Aes scores [CBCT = 1.25 ± 1.76, IOS = 1.58 ± 1.62; P = 0.635] or Orofacial Esthetic Index (OFEI) scores [CBCT = 65.75 ± 1.54, IOS = 65.50 ± 1.62; P = 0.703]. Both CBCT and IOS acquisition techniques provide aesthetically satisfactory CAD-CAM provisional restorations. CBCT demonstrated significantly higher clinician-reported esthetic outcomes for both pink and white esthetic scores. While patient satisfaction was similar for both methods, CBCT offers practical advantages, including the elimination of separate diagnostic appointments, making it a preferred choice for enhanced esthetic outcomes in CAD-CAM provisional restorations. CBCT acquisition methods yield significantly better clinician-reported esthetic outcomes for CAD-CAM provisional restorations compared to IOS. Additionally, CBCT eliminates the need for separate diagnostic appointments, reducing treatment time and number of visits, while both methods provide similar satisfactory patient-reported outcomes. Approval number: CTRI/2023/03/050410.

Receipt of respiratory vaccines among patients with heart failure in a multicenter health system registry.

Heart failure affects people of all ages and is a leading cause of death for both men and women in most racial and ethnic groups in the United States. Infections are common causes of hospitalizations in heart failure, with respiratory infections as the most frequent diagnosis. Vaccinations provide significant protection against preventable respiratory infections. Despite being an easily accessible intervention, prior studies suggest vaccines are underused in patients with heart failure. An observational study of 5089 adults with heart failure was conducted using data from an integrated, multicenter, academic health system in Southern California from 2019 to 2022. Logistic regression models were used to determine the rates of influenza, pneumococcal, and COVID-19 vaccination among a population of patients with heart failure (heart failure preserved ejection fraction [HFpEF], heart failure mildly reduced ejection fraction [HFmrEF], and heart failure reduced ejection fraction [HFrEF], and identify whether heart failure phenotype is associated with vaccination status. Vaccination rates varied between influenza, pneumococcal, and COVID-19 vaccines. Of the three respiratory vaccines, 58.0% of patients had received an influenza vaccine, 76.2% had received a pneumococcal vaccine, and 83.3% had received a COVID-19 vaccine. There were no sex-based differences by vaccination status. Differences were seen within age, race/ethnicity, insurance type, whether the patient was a member of an Accountable Care Organization (ACO), primary language, Social Vulnerability Index (SVI) score, clinician type, and number of comorbidities. Patients with HFpEF and HFmrEF had higher vaccination rates than HFrEF. In adjusted models, patients with HFrEF had lower odds of being vaccinated for influenza (aOR=0.75, 95% CI=0.66-0.86), pneumococcal (aOR=0.65, 95% CI=0.55-0.75), and COVID (aOR=0.74, 95% CI=0.62-0.89) compared to patients with HFpEF. Patients with HFrEF had the lowest levels of respiratory vaccination compared to other specified heart failure categories. Interventions are needed to increase vaccination education and offerings, especially to patients with HFrEF.

Optimal duration of neoadjuvant chemotherapy prior to CRS±HIPEC for colorectal cancer: An assessment of survival and postoperative outcomes.

188 Background: Cytoreductive surgery (CRS) with or without heated intraperitoneal chemotherapy (HIPEC) represents a viable treatment option for select patients with colorectal cancer peritoneal metastases. Given high recurrence rates after surgery, it is common practice to administer neoadjuvant chemotherapy (NAC). The optimal duration, however, when considering oncologic value and postoperative outcomes, is not known. Methods: A single institution database (2009-2024) of colorectal cancer patients that underwent CRS±HIPEC was reviewed. Patients with colorectal cancer undergoing CRS±HIPEC for curative intent (completeness of cytoreduction 0 or 1) with known NAC duration were included. Analysis was stratified by NAC duration of 0-3 months or greater than 3 months. Co-primary outcomes were recurrence free survival (RFS) and overall survival (OS). Secondary outcomes included clinically significant complications, defined as Grade 3 or greater adverse events based on Common Terminology Criteria for Adverse Events Version 5.0. Results: From 2009-2024, 108 patients underwent CRS±HIPEC for colorectal cancer. Final analysis included 84 patients that underwent curative intent surgery and had a known duration of NAC ( &gt; 3 months NAC: 55 patients, 0-3 months NAC: 29 patients). Median peritoneal cancer index (PCI) score was similar between the two cohorts ( &gt; 3 months: median PCI 11 versus (vs) 0-3 months: median PCI 12; p = 0.42). Recurrence-free survival was 9 months for the entire cohort and not significantly different based on duration of NAC ( &gt; 3 months: 8 months vs 0-3 months: 15 months, p = 0.14). Overall survival was also similar between both cohorts ( &gt; 3 months: 26 months vs 0-3 months: 37 months; p = 0.11). On univariate analysis, &gt; 3 months of NAC was associated with an increased rate of complications of any severity ( &gt; 3 months: 83.6% vs 0-3 months: 55.2%; p = 0.01), clinically significant complications ( &gt; 3 months: 54.5% vs 0-3 months: 31.0%; p = 0.07), and increased median length of stay ( &gt; 3 months: 10 days vs 0-3 months: 8 days; p = 0.01). When controlling for other perioperative variables on multivariable analysis, &gt; 3 months of NAC trended towards an increased risk of clinically significant complications (HR 1.76, 95% CI 0.59-5.30; p = 0.32). Conclusions: Even with a similar disease burden, as measured by PCI, an extended duration of neoadjuvant chemotherapy prior to CRS±HIPEC does not appear to be associated with any improved recurrence-free or overall survival. Conversely, postoperative outcomes are worse with higher complication rates and increased length of stay. Thus, despite high recurrence rates after CRS±HIPEC for this disease, it still appears that in well selected patients, an extended duration of neoadjuvant chemotherapy may not be the best treatment strategy.

Assessing cognitive functions in non-neuropsychiatric childhood systemic lupus erythematosus: Cross-sectional study.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multisystem, including neuropsychiatric, involvement. The nervous system is affected in 20-27% of patients within approximately two years after diagnosis. This study aimed to examine neurocognitive impairment in childhood-onset SLE (cSLE) patients before the development of any neurological, psychiatric, or cognitive manifestations. The study included 98 children and adolescents. Of these, 34 (35%) were cSLE groups, and the remaining formed two control groups: 31 (31%) oligoarticular Juvenile Idiopathic Arthritis (oJIA) patients served as a "patient control" group, and 33 (34%) healthy participants socio-demographically matched to the cSLE and oJIA patients formed the healthy control (HC) group. None of the subjects in the study exhibited neurological or psychiatric symptoms. The Wechsler Intelligence Scale for Children-IV (WISC-IV) was applied to all groups. Test results showed that the Perceptual Reasoning Index Score (PRIS) was significantly lower in cSLE than in HC (F(2, 95)=3.365, p=0.042, Tukey HSD: p=0.01). 'Comprehension' subtest scores were significantly lower in the cSLE group compared to the HC group (H(2)=8.133, p=0.017; U=352.5, p=0.009). Similarly, 'symbol search' subtest scores were significantly lower in the cSLE group compared to the HC group (F(2, 95)=3.545, p=0.036, Tukey HSD: p=0.014). Our results revealed that cSLE may have neurocognitive impairment without presenting any symptoms. Early detection is possible with the neurocognitive test WISC-IV. These results support the inclusion of objective neurocognitive assessment methods into the routine clinical follow-up of childhood-onset SLE.

Racial Disparities in Total Knee and Hip Arthroplasty in a Medically Underserved Community with a Diverse Population.

Previous studies have demonstrated lower total joint arthroplasty utilization rates and worse postoperative outcomes among non-White patients. Our study examined whether these disparities exist in the setting of a diverse population. This retrospective study included patients with a self-reported race who underwent total knee (TKA) or hip (THA) arthroplasty procedures in a racially diverse county. Patients who did not identify as White or Hispanic/Latino were excluded from the study due to small sample sizes. Demographic, intra and postoperative outcome differences were calculated.A multivariate logistic regression was developed to examine the association between patients' race and undesired postoperative outcomes. Five hundred fifty-five patients were included in our study with 490 identifying as non-Hispanic/Latino White (88.8%) and 65 as Hispanic/Latino (11.2%). Hispanic/Latino-identifying patients were significantly younger (61.9 ± 12.79 versus 68.58 ± 9.00years), had lower Charlson Comorbidity Index scores, and were more likely to use non-Medicare/Medicaid insurance. We observed no differences between our cohorts in postoperative adverse events, emergency department visits, and hospital readmissions.Patients' self-identified race was not correlated with undesired postoperative outcomes. Although Hispanic/Latino-identifying patients constitute 50.2% of the county population of our study cohort, they accounted for only 11.2% of the patients in our study. This is noteworthy considering the lack of evidence suggesting a decreased prevalence of osteoarthritis among individuals of different races and ethnicities. Further, the demographic differences we observed suggest an exclusive Hispanic/Latino patient population utilizing TKA or THA procedures. Future studies controlling for risk factors and less invasive treatment options may explain these disparities.

Investigating Postoperative Urinary Retention: Risk Factors and Postsurgical Outcomes in Total Joint Arthroplasty.

Postoperative urinary retention (POUR), a known complication following total joint arthroplasty (TJA), remains inconsistent in its diagnostic criteria, prevalence, and risk factors. This study aims to quantify POUR rates, identify risk factors, and assess complications associated with catheterization in TJA. A single-center cohort undergoing TJA between January 2015 and December 2022 was retrospectively reviewed. POUR rates were quantified using 3 different diagnostic criteria. Variables analyzed included age, sex, alpha-blocker prescription, operative joint, body mass index, American Society of Anesthesiologists score, Charlson Comorbidity Index classification, and anesthesia type. Complication rates between POUR and non-POUR patients were compared. Among POUR patients, 90-day postoperative renal and infectious complications were evaluated based on catheterization type and frequency. Among the 17,220 TJA patients identified, POUR incidence rates varied from 20% (catheterization), 25% (postoperative bladder scan > 500 mL), to 29% (catheterization and/or bladder scan). Advanced age, male gender, lower body mass index, moderate Charlson Comorbidity Index scores, total knee arthroplasty, spinal anesthesia, and alpha-blocker use were significantly more prevalent among POUR patients. The development of postoperative complications, including renal/infectious complications, was not significant between POUR and non-POUR patients. Among POUR patients, there was a significant increase in renal/infectious complications among patients who received 4+ catheters (odds ratio= 10.17, 2.75, 37.59). Diagnostic variability in POUR after TJA persists. For POUR management, patients receiving 4+ catheters were at a 10-fold risk for renal/infectious complications compared to those without catheterization. Reducing catheterization frequency and employing risk stratification for susceptible patients may help mitigate these risks effectively.

Abstract TP144: Telemedicine Appointments early after Acute Ischemic Stroke may Reduce 30-day Emergency Department Visits

Introduction: Limiting the rate of unplanned emergency department (ED) revisits for patients with acute ischemic stroke is an important aspect of secondary stroke prevention. This is influenced by patients’ demographics, comorbidities, stroke severity, disposition destination, and may be impacted by early outpatient follow-up where stroke risk factors and etiology continue to be evaluated. Methods: We retrospectively identified all acute ischemic stroke patients discharged from an 11-hospital network, the largest healthcare system in the state of Georgia, from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with ED visits within 30- and 90-days after discharge. Results: Of 2,191 patients, 143 (6.5%) had ED visits within 30 days and 296 (13.5%) within 90 days. The median age was 68 [IQR 57, 77]. History of heart failure (HF), atrial fibrillation (AF), chronic kidney disease and end stage renal disease each increased the likelihood of an ED re-visit within 30 and 90 days whereas diabetes mellitus increased the likelihood of an ED re-visit at 90 days only. In multiple logistic regression analyses, factors independently associated with 30-day ED visit was a history of HF (OR 1.57, 95% CI 1.07-2.28; p=0.02) and AF (OR 1.49, 95% CI 1.00-2.19; p=0.04); at 90 days, only an increased Charlson Comorbidity Index score was associated with ED visit (OR 1.09, 95% CI 1.02-1.16; p=0.01). There were 501 (23%) patients who completed an outpatient neurology clinic follow-up within 30 days of discharge, including 81 patients (4%) who completed a telemedicine outpatient visit; patients completing a telemedicine visit were less likely to have a 30-day ED visit than those who had an in-person visit (OR= 0.13, 95% CI 0.01-0.62; p=0.05). Conclusion: ED revisits after hospitalization for acute ischemic stroke are relatively common and associated with patients who have comorbid conditions including HF and AF. Our study suggests that telemedicine-based follow-ups were associated with lower rates of unplanned ED revisits within 30 days. Efforts to increase outpatient neurology clinic access through telemedicine may reduce ED visits after discharge for acute ischemic stroke patients.

Abstract TP118: Early Outpatient Follow-up After Acute Ischemic Stroke Reduces 30-day and 90-day Inpatient Readmissions

Introduction: Despite advancements in the management of acute ischemic strokes, readmissions continue to impact both healthcare costs and patient outcomes. The objective of our study was to evaluate factors associated with 30- and 90-day readmissions after acute ischemic stroke including the impact of early transitional care outpatient follow-up by a centralized specialty stroke clinic. Methods: We retrospectively identified all acute ischemic stroke patients discharged from the largest healthcare system in the state of Georgia from October 1, 2022 to March 31, 2024; we excluded patients who were discharged to a long-term acute care or hospice facility. Baseline characteristics, inpatient metrics and post-discharge outpatient follow-up were assessed to identify factors associated with 30- and 90-day inpatient readmission. Results: Of 2191 acute ischemic stroke patients discharged during the study period, 177 (8.1%) and 304 (13.9%) had 30- and 90-day all cause readmissions to the healthcare system, respectively. Increasing age, Charlson Comorbidity Index score, and history of diabetes were independently associated with 30- and 90-day readmission; history of heart failure, obesity, and discharge to inpatient rehabilitation or skilled nursing facility (versus home) were also independently associated with 90-day readmission. Completion of a subspecialty stroke clinic follow-up within 30 days of discharge was associated with a lower likelihood of 30-day (OR 0.64, 95% CI 0.41-0.96; p=0.04) and 90-day readmission (OR 0.69, 95% CI 0.49-0.94; p=0.02). Conclusion: While acute ischemic stroke patients who are older, have comorbid conditions and disability are at an increased likelihood of 30- and 90-day readmission after acute ischemic stroke, our study found that early (&lt;30 day) outpatient follow-up in a subspecialty stroke clinic was associated with a significant reduction in 30- and 90-day readmission. Efforts should be made to ensure early outpatient specialty stroke clinic follow-up for acute ischemic stroke patients after discharge.

A Nationwide Analysis of Complications, Reoperations, and Cost of Wide-Awake Flexor Tendon Repairs.

Some articles suggest that wide-awake flexor tendon repair (FTR) may reduce rates of postoperative tendon gapping and rupture because of improved intraoperative testing of the repair. The current study is a nationwide cohort study comparing FTRs performed wide-awake and with traditional anesthesia. Patients undergoing zone II FTR between 2010 and 2022 were identified in PearlDiver. Exclusion criteria were other tendon repairs, concomitant treatment for vascular injury, fracture, dislocation or amputation, inpatient or office surgery, age younger than 18 years, and less than 1 year of follow-up. Patients were stratified by anesthesia technique: traditional anesthesia (general anesthesia, monitored anesthesia care, regional blocks) or wide-awake anesthesia. Patients were matched based on age, sex, Elixhauser Comorbidity Index score, geographic region, insurance coverage, number of tendon repairs, and presence of concomitant nerve repair. Thirty-day wound complications, emergency department visits and readmissions, and 1-year reoperations were identified. Total reimbursement for surgery was determined. Each matched cohort included 2563 patients. Wide-awake patients had fewer 30-day emergency department visits (2.7% versus 4.8%). There were no differences in 30-day wound complications or readmissions. There was no difference in 1-year reoperations for rupture or stiffness. Multivariable linear regression identified wide-awake surgery to be significantly associated with lower total reimbursement. Performing digital FTR using wide-awake techniques can reduce costs, but the hypothesis that wide-awake repairs may reduce rates of tendon rupture was not supported by the current study. Therapeutic, III.

Comparative effectiveness of delirium recognition with and without a clinical decision assessment system on outcomes of hospitalized older adults: Cluster randomized controlled trial.

Early recognition of delirium is essential for effective management, but it often goes unrecognized, resulting in adverse outcomes. Clinical decision support systems can enhance adherence to guidelines and improve patient outcomes. We developed a mobile-based clinical decision assessment tool (3D-DST) based on the 3-minute diagnostic interview for confusion assessment method-defined delirium (3D-CAM). Implementing the 3D-DST may enhance delirium recognition and adherence to interventions among healthcare professionals, potentially improving outcomes in older adults. To test whether improved recognition of delirium could lead to better clinical outcomes in older adults. A cluster randomized controlled trial with pair-matching. A tertiary geriatric hospital. Patients aged ≥65years. Four general wards were paired and randomly assigned to the intervention group (two wards) or the control group (two wards). The intervention included routine delirium assessments by nurses using either the 3D-DST or the 3D-CAM, along with delirium prevention and intervention measures carried out by a multidisciplinary team. Outcomes measured included delirium incidence, duration, severity, length of stay, and adherence to the delirium assessment, prevention, and treatment protocol. A trained nursing researcher collected data on demographics, clinical characteristics, and primary and secondary outcomes. 211 eligible patients participated (106 in the intervention group and 105 in the control group), with 21 identified as delirium-positive using the 3D-DST. The median Charlson comorbidity index score among older adults in the intervention group was 1 (1-2), compared to 2 (1-3) in the control group (P=0.032). Nurses' adherence to delirium assessment was significantly higher in the intervention group than in the control group (73% vs. 31%). The recognition rate of delirium among nurses was 89% in the intervention group and 42% in the control group. There were no statistically significant differences in delirium duration (6 [3-9] vs. 7 [2-14], P=0.967), incidence (8.5% vs. 11.4%, P=0.500), severity (2 [1-3] vs. 2 [1-4], P=0.891) or length of hospital stay (15 [14-18] vs. 18 [13-22], P=0.568) between the intervention and control groups. The 3D-DST enhanced adherence to routine delirium recognition by nurses. However, effective strategies are urgently needed to strengthen multidisciplinary collaboration and enhance adherence to delirium management among healthcare professionals. Chinese Clinical Trial Registry, Identifier: ChiCTR1900028402.

Expression of Trop2, Nectin-4, and FOLR1 cell surface markers in biliary tract cancers: Is it time to repurpose drugs?

637 Background: Biliary tract cancers (BTC), including gall bladder cancer, intrahepatic and extrahepatic cholangiocarcinoma are aggressive malignancies, with poor prognosis. Despite advances in frontline setting, and in biomarker selected population (IDH1, FGFR2, Her2, BRAF, HRD), there is a dire need to advance therapy in subsequent lines. Methods: We identified BTC patients (pts) at Roswell Park Cancer Center who underwent curative intent surgery between 01/2006-01/2020. After excluding duplicate samples and those with insufficient tissue, we found 78 pts with adequate follow up for analysis. Expression of trophoblast cell surface antigen 2 (Trop2), nectin4, folate receptor alpha (FOLR1) was assessed by immunohistochemistry and correlated with clinical outcomes. H score, a weighted index score that factor in, the % of cells across different intensity was calculated. H scores were classified as negative (0) and positive (&gt;1). Positive H scores were grouped as weak (1-100), intermediate (101-200) and strong (201-300). Descriptive statistics were conducted, and multivariate analyses performed (R studio) to study any correlation between expression of markers and survival outcomes. Results: The median age of our cohort was 67.5 years (range 40-87) with 58% male; 24.4%, 30.8%, 20.5%, 7.7% had stages I, II, III, IV disease. Staging information was missing in 16.7% of pts. Of 73 analyzable samples for Trop2, all were positive for Trop2, with a mean H score of 86, SD of 68.9. 56.4% of patients had a weak H score, 30.8% had an intermediate H score and 6.4% had a strong H score for Trop2. Median overall survival (mOS) among low, intermediate and high expressing group of pts with Trop2 was 48.9 months (m), 23.9 m, and 41.9 m with median Progression Free Survival (mPFS) of 37.8m, 15.3 m, and 37.4 m, respectively. Of 75 analyzable samples for FOLR1 and Nectin4, FOLR1 was expressed in 51.3% with a mean H score of 6.97 (SD 21.9). Nectin4 was expressed in 78.2%, with a mean H score of 13.7 (SD 26.3). Pts with Trop2 expression had a mOS of 39.5 m and a mPFS of 28.7 m. There were no significant differences in mOS (48.9 m vs 33.3 m, p =0.14) and mPFS (37.8 m vs 26.2 m, p =0.35) among patients with positive vs negative FOLR1 respectively. There was no difference in mOS (41.6 m vs 38.3 m, p=0.92) and mPFS (32.8 vs 26.4 m, p-value=0.5) in patients with positive vs negative Nectin4. Multivariate analyses showed that pts with intermediate Trop2 (H score=101-200) had a high risk of death (HR 21.44, CI 2.81-163.4, p= 0.003). Conclusions: Though no difference was seen in clinical outcomes in pts with strong Trop2 expression, FOLR1, and Nectin4 expression, this could be explained by the small sample size. Trop2 is frequently expressed in BTCs and patients with Intermediate Trop2 H score had lower mOS and mPFS, with a higher risk of mortality. This warrants further investigation into potential use of Antibody Drug conjugates against Trop2 in BTC.

Abstract 25: Discovery of Serum Biomarkers to Inform Early Rehabilitation after Acute Ischemic Stroke

Background: Rehabilitation therapy is an important component of acute ischemic stroke (AIS) recovery. A major hinderance is the inability to predict which patients benefit from mobilization during the first 24 hours (ERehab). We hypothesize serum biomarker analyses during the hyperacute phase can bridge the gap. Methods: This is a single center study of 20 AIS patients&amp;14 age/sex matched controls enrolled from 3/2022-6/2023. Serum samples were collected at 4 time points – angiography suite before cerebral reperfusion or Neuro ICU at hospital admission, 12, 24&amp;72 hours. Biomarker candidates were identified using a DisGeNET search for AIS associated proteins; 70% achieved an Evidence Index cutoff score of 1, indicating all publications support human gene-disease or variant-disease associations. Time course of serum proteome changes was evaluated using aptamer-based SomaScan assay, measuring 1500 proteins. NIH Database for Annotation, Visualization&amp;Integrated Discovery (DAVID) Gene Functional Classification Tool compared shared genes and biomarkers for stroke (vs healthy controls)&amp;unfavorable (vs favorable) outcome, characterized by modified Rankin Scale (mRS) score of 3-6 (vs 0-2), at hospital discharge&amp;90 days (90d). Results: The mean age of AIS patients was 59 years, 65% were male. Median NIHSS score was 11, Charlson Comorbidity Index score was 5.5 and the median last known well to hospital admission was 6.6 hrs. The average time to first mobilization was 39 hrs, 25% received ERehab. The mean rehab duration during AIS hospitalization was 438 min; median length of stay was 8.4 days, 40% received post-acute rehabilitation. Median AIS volume was 36mL, 65% of patients had ICA or M1/MCA involvement. Approximately 65% received IV thrombolysis, 80% underwent cerebral reperfusion therapy, 94% achieved modified thrombolysis in Cerebral Infarction score ≥ 2b. The median mRS was 4 at hospital discharge, 3 at 90d. Mortality rate was 10%. DAVID analyses resulted in 22 biomarkers at hospital discharge&amp;35 biomarkers at 90d associated with favorable outcome. Gene expression differences were present at each time point (Figure). Conclusions: We identified multiple serum biomarkers and gene clusters associated with favorable outcomes at hospital discharge and 90d in AIS patients, indicating a need for several biologic targets to predict ERehab response during the hyperacute phase. These findings provide an early framework for tailored stroke recovery interventions.

Correlation of the Geriatric Nutritional Risk Index (GNRI) With Other Indicators of Nutrition in Chronic Hemodialysis Patients.

The GNRI (Geriatric Nutritional Risk Index1) is an index used in geriatrics to predict the risk of complications and mortality associated with malnutrition. It considers serum albumin levels and the ratio of current weight or BMI to the ideal theoretical weight/BMI. The aim of this study was to evaluate this index in a population of metabolically stable chronic hemodialysis patients aged > 60 years and associate it with other nutritional markers. The studied patient cohort was divided into two groups based on their Geriatric Nutritional Risk Index (GNRI) scores: Gr 1 with GNRI score < 97 and Gr 2 with GNRI ≥ 97. We registered the anthropometric, clinical, and biological data of the study population. One hundred seventy-seven patients (102 M-75F) undergoing chronic hemodialysis were included. There were no differences in age, muscle mass estimated by bioimpedance analysis, potassium levels, phosphorus levels, and nPCR between the groups. However, there were significant differences between the two groups concerning the primary disease. Gr 1 presented with a higher prevalence of diabetes and cardiovascular comorbidities. Additionally, Gr 1 presented with lower handgrip strength (Mean ± standard deviation in kg, 19.79 ± 9.37 vs. 26.83 ± 11.63, p = 0.05), lower fat mass index estimated by bioimpedance analysis (Mean ± standard deviation in kg/m2, 7.31 ± 4.55 vs. 15.24 ± 6.47, p < 0.001), and higher CRP levels (Mean ± standard deviation in mg/l, 22.27 ± 23.49 vs. 8.13 ± 10.14, p < 0.001). In conclusion, the GNRI, an easy calculation tool for nutrition assessment, is associated with important nutritional status parameters in chronic hemodialysis patients.

The effect of plaster applied to the umbilical area (Shenque-CV8 point) on nausea and vomiting during pregnancy.

Hormonal and physical changes, especially in the first trimester of pregnancy, can cause nausea and vomiting. This study aims to investigate the effect of plaster applied to the umbilical area (Shenque-CV8 point) on nausea and vomiting during pregnancy. It is a randomized-controlled study (Clinical trial number: NCT05788796). A total of 60 pregnant women, 30 in the CV8 group and 30 in the control group constituted the sampling of the study. Pregnant women in the CV8 group were regularly asked to fix a hazelnut-sized cotton ball to the umbilicus with plaster before going to bed at night for five days. Pregnant women in the control group were not asked to make any changes in their lives. The nausea-vomiting levels of pregnant women before and five days after the treatment were compared using the Rhodes Nausea Index and PUQE nausea scoring. The data was analyzed by the independent sample t-test, chi-square test, and paired sample t-test. The statistical significance value was accepted as P < 0.05. There was no statistically significant difference between the experiment and control groups in terms of sociodemographic and obstetric characteristics. The degree of nausea decreased in the experiment group compared to the pre-intervention period (p < 0.001), while no statistically significant change was found in the control group. In addition, while there was no difference between the two groups in terms of nausea scores before the application, there was a statistically significant difference between the two groups after the application, the nausea score of the experimental group was lower compared to the control group (p < 0.05). The results show that the application of plaster to the Shenque-CV8 point reduces nausea and vomiting in pregnant women and has no side effects. This application is practical, non-invasive, and easy to apply.

Clinical outcomes and patient-reported outcome measures among patients undergoing posterior lumbar fusion procedures with varying insurance payor status: a propensity score-matching study.

Posterior lumbar fusion (PLF) is a routinely used procedure for treatment of spinal pathology. Several studies have highlighted disparities in reoperation and postoperative complications and demonstrated associations between differing insurance providers, complication rates, and hospital resource utilization in spine surgery. Previous studies have examined broad spinal procedures but have not extended to uninsured patients, or adjusted for sociodemographic factors or comorbidity history. Understanding relationships between payor status and outcomes following fusion procedures is vital to promoting healthcare equity. The objective of this study was to assess whether patients' insurance impacts postoperative outcomes and patient satisfaction following PLF procedures. The Stanford University Medical Center inpatient registry was used to retrospectively analyze patients who underwent PLF procedures between 2016 and 2022. Propensity score matching was used to compare privately insured with Medicaid patients, as well as comparing uninsured patients with Medicaid patients based on age, sex, and comorbidities. Outcomes data, including 90-day postoperative complications, reoperation, and patient-reported outcome measures scores (Oswestry Disability Index and Patient Health Questionnaire) were collected. A total of 1904 patients fulfilled the inclusion criteria. In unmatched comparisons, statistically significant differences existed within specific types of complications including altered mental status, delirium, neurological complications, and pulmonary complications. A total of 292 privately insured patients were matched to 292 Medicaid patients. Within matched patient groups, the Medicaid group had higher rates of altered mental status (6.2% vs 2.7%, p = 0.042); delirium (9.9% vs 5.1%, p = 0.035); renal dysfunction (6.9% vs 4.1%, p = 0.020); and pulmonary complications (8.9% vs 3.8%, p = 0.049) compared to privately insured patients. Privately insured patients had lower postoperative Oswestry Disability Index scores (30.2 vs 34.4, p = 0.018) compared to Medicaid patients. Following propensity score matching of 88 Medicaid patients to 88 uninsured patients, large but not statistically significant differences existed for neurological complications (12.5% vs 5.7%, p = 0.165) and 5-year revision rates (3.4% vs 1.1%, p = 0.353). The findings indicate that the treatment outcomes, care quality, and patient satisfaction following PLF procedures differ between Medicaid and privately insured patients. Further investigation is warranted to explore relationships between insurance payor status and clinical outcomes in multicenter populations.

Tooth vitality and periapical healing: is Biodentine at par with MTA in regenerative endodontics?

The study is a prospective, double-blinded randomised control trial that compares the mineral trioxide aggregate (MTA) and Biodentine as the pulp space barrier material after induction of a periapical blood clot by over-instrumentation for endodontic regeneration in single-rooted mature permanent anterior tooth (closed apex) with apical periodontitis (periapical pathology of more than 3 mm) and having necrosed pulp. A total of 36 patients were included in the study and after randomisation were allocated equally to both the groups out of which 31 patients returned for follow-up over an 18-month period. The treatment protocol consisted of two separate appointments. At the first appointment, a standardised and custom-made radiographic guide was prepared for each patient to ensure uniformity and repeatability of the radiographs at subsequent follow-up visits. This was followed by access to the pulp chamber and biomechanical preparation of the single canal up to master apical file size. The irrigant used in each case was 1.5% sodium hypochlorite and also calcium hydroxide intracanal medicament was placed during this visit. The interval between the two appointments was not fixed and depended on the patient's symptoms following the first visit; however, the maximum allowable time frame was set at 3 weeks. During the second visit after irrigation with 17% ethylenediaminetetraacetic acid (EDTA) over instrumentation was done to induce bleeding that was allowed to fill the canal. The clot was stabilised by collagen plug and the pulp space sealer (either MTA or Biodentine) was placed below the cementoenamel junction following which composite restoration was done. The radiographs were taken before the treatment, after both the appointments and at 6, 9, 12 and 18 months subsequently by a single experienced examiner. Pre-operatively, a periapical index score (PAI) was given to each case and the sensibility test was performed at 6, 12, 18 months postoperatively using an electric pulp tester (EPT). Participants were recruited from the Department of Endodontics outpatient clinic. The patients were aged between 10-35 years and had no systemic conditions. For inclusion in the study, participants were required to have mature anterior tooth (single root canal) with closed apex associated with apical periodontitis and necrotic pulp having periapical radiolucency of more than 3 mm on the radiograph. Patients suffering from periodontitis (ensured by periodontal probing) and those having developmental anomalies of the teeth were excluded from the study. The normalcy of the data was assessed by Shapiro-Wilk test. Continuous data was analysed by Mann Whitney U test and the categorical data was analysed by Chi-square test and Fisher's exact test. With the level of significance set at 0.05. Firstly, the author presented the overall healing of the periapical lesion from Fisher's exact test, which showed that after 18 months, out of 31 patients, 21 cases (67.7%) had completely healed and 10 cases (32.3%) showed signs of healing and no case remained unhealed. The difference between the Biodentine and MTA was non-significant as derived from the Chi-square test for comparison of postoperative lesion sizes score at 18 months postoperatively. Secondly, based on EPT, the author presented the regain of tooth sensibility from Fisher's exact test which shows that out of 31 cases, 22 (71%) showed a positive response to EPT and 9 cases (29%) showed no response. Again, the difference between Biodentine and MTA was non-significant. Both Biodentine and MTA when used as pulp space barrier in regenerative endodontic procedures showed promising results. In both groups significant reduction in the size of periapical radiolucency was noted along with resolution of patient's symptoms. There was also significant regain in the tooth sensibility postoperatively. As there was no significant difference between the two in the treatment outcomes, both of these biomaterials can be used to treat apical periodontitis in mature permanent tooth as an alternative to conventional endodontic treatment in which the vitality of tooth is lost.

Chronic Use of Proton Pump Inhibitors Is Associated With Reduced 30-Day Mortality From Acute Pancreatitis.

Proton pump inhibitors (PPIs) decrease pancreatic exocrine secretions. There has been interest in the impact of their short-term in-hospital administration on acute pancreatitis (AP) outcomes. It is unknown whether long-term use affects AP outcomes. We investigated the association between chronic PPI use and short-term AP outcomes. We included all (2308) patients admitted with a primary diagnosis of AP (625 on chronic PPI use) between January 2008 and June 2021 and evaluated any association between chronic PPI use and 30-day all-cause mortality by univariate logistic regression. Compared to non-users, patients on chronic PPIs were older (p < 0.001) and had a higher Charlson Comorbidity Index score (p < 0.001). Mortality rates at 30 days were 1.5% in chronic PPI users and 4.6% in non-users (OR 0.33; 95% CI, 0.16-0.6; p < 0.001).