Significant Worsening Research Articles

QOL-01. VARIABILITY IN ANXIETY AND DEPRESSION SYMPTOMS AFTER ELOQUENT GLIOMA RESECTION IS ASSOCIATED WITH CHANGES IN FUNCTIONAL CONNECTOMIC PROPERTIES

Abstract Little is known regarding how treatment-related changes in cerebral networks relate to symptoms of anxiety and depression in patients with glioma. Fifteen patients with left perisylvian glioma underwent resting-state fMRI and neuropsychological evaluation before and 1 month after resection. Symptoms of depression and anxiety were characterized with Beck Depression Inventory-II (BDI) and Beck Anxiety Inventory (BAI) Total scores and rates of clinically significant symptom burden. Change scores and reliable change classifications were also examined. Graph theoretical analysis was applied to fMRI connectivity matrices to calculate brain network properties. Comparison of pre- and postoperative measures were performed with Wilcoxon tests. Correlations between changes in anxiety and depression symptom measures and network properties were examined. Pre- and postoperative Total scores did not significantly differ though postoperative symptom burden trended toward reduction [Change: BDI=-1.93(5.73), BAI=-5.80(8.19)] with considerable interindividual variability noted [Change: BDI range=-12 to +6; BAI range=-18 to +6]. Preoperatively, at least mild symptoms were found in 27% of patients on BDI and 60% on BAI. Postoperatively, rates were the same for BDI while BAI was 33%. Using reliable change criteria, improvement was found in 13% of patients on BDI and 33% on BAI without any significant worsening. Significant postoperative connectivity decreases were observed in betweenness centrality [Change = -5.56(12.07), p = .031] and assortativity [Change=-.062(.096), p = .027]. Strong associations were found between pre- to postoperative differences in betweenness centrality and assortativity and changes in BDI [ρ(13)=.58 and .67, p< .02] and BAI Total scores [ρ(13)=.62 and .68, p< .01]. Anxiety and depression symptoms vary considerably postoperatively, though most patients do not show significant worsening. Variability in symptom change appears related to alterations in functional connectomics, with those showing increases in certain connectomic properties exhibiting worse postoperative anxiety and depression symptoms. Surgically-induced connectomic changes may coincide with or potentially contribute to psychological symptom differences in the postoperative setting.

QOL-05. EXPLORATORY ANALYSIS OF COGNITIVE BEHAVIORAL THERAPY FOR INSOMNIA (CBT-I) AMONG PATIENTS WITH PRIMARY BRAIN TUMOR: EFFECTS ON DEPRESSION, ANXIETY, AND LIFE QUALITY

Abstract BACKGROUND Sleep disturbance is among the most common complaints endorsed by patients with a brain tumor diagnosis, yet the delivery of behavioral insomnia treatment is not standard practice in neuro-oncology. Our pilot trial of a 6-session group-based telehealth CBT-I program among primary brain tumor patients demonstrated clinically significant improvements in self-reported insomnia, fatigue, and sleep quality. In other cancer patient samples, CBT-I is also associated with improvements in psychosocial outcomes beyond sleep; thus, the aim of this exploratory analysis was to examine change in depression, anxiety, and life quality among primary brain tumor patients enrolled in CBT-I. METHODS This was a single-arm ORBIT Model Phase IIa proof-of-concept trial. N = 40 cognitively-intact participants (Mage = 52.4 + 12 years; 50.0% female) with a primary brain tumor and insomnia enrolled in a 6-week group-based telehealth CBT-I intervention with weekly 90-minute sessions led by graduate students in clinical psychology. Questionnaires (PHQ-9, GAD-7, EORTC-QLQ-30) were completed at baseline and 6 weeks. Within-person clinically significant improvement was calculated for intervention completers (n = 34) based on established cutoffs. RESULTS Approximately one-third of participants experienced clinically significant improvements in symptoms of depression (n = 12, 35.3%) and generalized anxiety (n = 11, 32.3%) following CBT-I, with 0 participants experiencing a clinically significant worsening of symptoms. Thirty-two of thirty-four participants (94.1%) reported clinically significant improvement in at least 1 domain of life quality spanning physical, role, emotional, and/or social functioning. CONCLUSIONS Findings suggest that a brief behavioral intervention for insomnia, CBT-I, may improve depression, anxiety, and life quality in addition to sleep among primary brain tumor patients. RESULTS from this proof-of-concept trial suggest proceeding to a test of CBT-I in comparison to a control group in order to bolster internal validity. In addition, future studies will examine sleep and related psychosocial outcomes over a longer follow-up period to assess maintenance of intervention effects.

Impact of leadless pacemaker therapy on tricuspid regurgitation

Abstract Background The association between conventional transvenous pacemaker leads and tricuspid regurgitation (TR) has been well described. Leadless pacemakers (LP) have risen as an alternative to conventional transvenous pacemakers in order to avoid lead associated complications. Prior studies have included a mix of leadless pacemaker types including: Nanostim, Micra, etc. This is the first study exploring only one model of LP. Purpose The purpose of the study was to investigate the impact of leadless pacemaker therapy on tricuspid regurgitation. Methods Adult patients who underwent Micra leadless pacemaker implantation at a single center from 2016 to 2022 were identified retrospectively. Patients who had an echocardiogram prior to the procedure and within 24 months after the procedure were included. Echocardiograms were reviewed to assess for change in presence or in severity of tricuspid regurgitation. Results There were 310 patients in total who received LP at our hospital. Of these, 104 met inclusion criteria. 189 patients were excluded because they did not have an echocardiogram before or after the procedure. 17 more were excluded because their post procedure echo was done more than 2 years later. The average age of our patient population was 78. Of the 104 total patients, 97 had some TR before LP implantation (Trace 41%, Trace-Mild 4%, Mild 31%, Mild-Moderate 7%, Moderate 13%, Moderate-Severe 1%, Severe 2%). After implantation, 34 patients had worsening TR (33%), 23 patients had improved TR (22%), and 47 patients had no change in TR severity (45%) p=0.053. Conclusion Overall, the results did not show a statistically significant improvement or worsening in TR severity after LP implantation. Further studies should be done to validate these findings, to evaluate the effect of a larger sample size, and to examine whether controlling for additional confounders maintains or contradicts this finding.

Usefulness of low-dose direct oral anticoagulants for peripheral deep vein thrombosis of the lower extremities in cancer patients with cancer bleeding lesions

Abstract Background Venous thromboembolism (VTE) is a frequent complication in cancer patients. VTE is often detected as asymptomatic peripheral deep vein thrombosis (DVT). Standard doses of anticoagulants are generally considered difficult to administer in cancer patients due to the high risk of bleeding. However, it has been reported that peripheral DVT worsening to proximal DVT in cancer patients due to increased coagulation tendency, and some strategy for peripheral DVT is required. And the adverse bleeding effects of DOACs have been reported to be dose-dependent. Purpose The aim of this study was to determine the optimal treatment strategy of peripheral DVT in patients with bleeding cancer lesions. In order to do this we compared no anticoagulation, low-dose direct oral anticoagulants (DOACs) and standard-dose DOACs in patients with and without bleeding cancer lesions. Methods A total of 224 consecutive patients with peripheral DVT of the lower extremities (excluding pulmonary thromboembolism or proximal DVT) were included from April 2019 to March 2020. Of these, 172 patients could be followed up by repeated ultrasound examinations for up to 2 years. We investigated retrospectively the change in ultrasound findings between first and second examinations (median interval 44 days). 163 patients were studied, excluding 9 patients who used warfarin or heparin. In 119 of these DOACs were applied, and 44 were without anticoagulation. If the treatment procedure had changed between the first and second ultrasound examinations main treatment procedure was selected and categorized. Results All the patients of low-dose and standard-dose DOACs groups had no major bleeding during follow up period. In the group with cancer bleeding lesion (n=45) there were 12 patients (70.1%) worsening DVT in the group without anticoagulation, 1 patient (4.3%) in the low-dose DOACs and 0 (0%) in the standard-dose DOACs group. There was significant worsening of DVT in the no anticoagulant group compared with low-dose DOACs (P<0.0001), but no significant difference between low-dose DOACs and standard-dose DOACs (P=0.63) in the group with bleeding (see Figure 1). In the group without cancer bleeding (n=118), worsening of DVT occurred in 16 patients (59.3%) without anticoagulation, in 6 patients (16.7%) with low-dose DOACs and in 4 patients (7.3%) with standard-dose DOACs. There was significant worsening of DVT in the no anticoagulant group compared with low-dose DOACs (P<0.0001), but no significant difference between the low-dose and standard-dose DOACs (P=0.16) in the group without bleeding (see Figure 2). Conclusion Low-dose DOACs were found to be as effective as standard-dose DOACs in treating peripheral DVT in cancer patients, with or without bleeding of the cancer lesion. Peripheral DVT treatment with low-dose DOACs can reduce worsening of DVT and should be one of the supportive treatments for the completion of cancer management.DVT in 3 groups with cancer bleedingDVT in 3 groups without cancer bleeding

Serial global and longitudinal RV functional assessment in symptomatic, severe aortic stenosis undergoing AVR

Abstract Background Right ventricular (RV) dysfunction is currently regarded as an end-stage marker of of cardiac damage in patients with severe aortic stenosis (AS). However, global RV assessment prior to and after aortic valve replacement (AVR) has largely been neglected and little is known about RV response after AVR. Aims to describe the prevalence of RV dysfunction in a group of patients with severe AS referred to surgical AVR, and to evaluate post-operative evolution, as assessed by both CMR and echocardiography. Methodology Single-center prospective cohort study of patients with isolated severe symptomatic high-gradient AS submitted to surgical AVR. Those with previous known cardiomyopathy were excluded. All patients performed same day transthoracic echocardiogram (TTE) and CMR both before surgery and at the 3rd to 6th post-operative month. Global RV dysfunction was defined by an RVEF <45% at CMR. Echocardiographic evidence of RV dysfunction was defined by: tricuspid annular plane excursion (TAPSE) <17mm, free wall longitudinal strain (FWLS) >- 21% or RV S’ wave by tissue Doppler imaging <12 cm/s. Results A total of 112 patients were included (mean age 71 ± 8 years; mean valvular transaortic gradient 61 ± 18 mmHg; mean indexed aortic valve area 0.4 ± 0.1 cm2/m2; mean indexed systolic volume 48 ± 11mL/m2,mean LV ejection fraction by CMR pre and post-AVR: 60 ± 10% and 59 ± 8%; mean pulmonary artery systolic pressure pre-AVR: 35 ± 10mmHg). Only four of the patients (3.4%) had pre-operative stage 4 cardiac damage (RV dysfunction) as assessed by CMR. Moreover, only FWLS at TTE was significantly related to CMR RVEF at both pre-operative (Spearmen R= -0.337, p<0.001) and post-operative evaluation (Spearmen R = -0.217, p=0.026). Contrary to CMR RVEF (58 ± 15% vs. 57 ± 8%, p=0.461), there was a significant worsening of all TTE parameters at post-operative evaluation – overall, 32%, 20% and 25% of patients met one, two or three echocardiographic parameters of RV dysfunction - Figure 1. Conclusion RV dysfunction is common after AVR is patients with severe AS as assessed by common TTE parameters, but this is not accompanied by significant impairment of RVEF. Overall, only FWLS showed a consistent, albeit only moderate, correlation with RVEF at pre and post-AVR. These results highlight the limitations of longitudinal function indexes in evaluating post-surgical global RV function.

Cognitive decline in older adults in the UK during and after the COVID-19 pandemic: a longitudinal analysis of PROTECT study data

Although the long-term health effects of COVID-19 are increasingly recognised, the societal restrictions during the COVID-19 pandemic hold the potential for considerable detriment to cognitive and mental health, particularly because major dementia risk factors-such as those related to exercise and dietary habits-were affected during this period. We used longitudinal data from the PROTECT study to evaluate the effect of the pandemic on cognition in older adults in the UK. For this longitudinal analysis, we used computerised neuropsychology data from individuals aged 50 years and older participating in the PROTECT study in the UK. Data were collected from the same participants before the COVID-19 pandemic (March 1, 2019-Feb 29, 2020) and during its first (March 1, 2020-Feb 28, 2021) and second (March 1, 2021-Feb 28, 2022) years. We compared cognition across the three time periods using a linear mixed-effects model. Subgroup analyses were conducted in people with mild cognitive impairment and in people who reported a history of COVID-19, and an exploratory regression analysis identified factors associated with changes in cognitive trajectory. Pre-pandemic data were included for 3142 participants, of whom 1696 (54·0%) were women and 1446 (46·0%) were men, with a mean age of 67·5 years (SD 9·6, range 50-96). Significant worsening of executive function and working memory was observed in the first year of the pandemic across the whole cohort (effect size 0·15 [95% CI 0·12-0·17] for executive function and 0·51 [0·49-0·53] for working memory), in people with mild cognitive impairment (0·13 [0·07-0·20] and 0·40 [0·36-0·47]), and in people with a history of COVID-19 (0·24 [0·16-0·31] and 0·46 [0·39-0·53]). Worsening of working memory was sustained across the whole cohort in the second year of the pandemic (0·47; 0·44-0·49). Regression analysis indicated that cognitive decline was significantly associated with reduced exercise (p=0·0049; executive function) and increased alcohol use (p=0·049; working memory) across the whole cohort, as well as depression (p=0·011; working memory) in those with a history of COVID-19 and loneliness (p=0·0038; working memory) in those with mild cognitive impairment. In the second year of the pandemic, reduced exercise continued to affect executive function across the whole cohort, and associations were sustained between worsening working memory and increased alcohol use (p=0·0040), loneliness (p=0·042), and depression (p=0·014) in those with mild cognitive impairment, and reduced exercise (p=0·0029), loneliness (p=0·031) and depression (p=0·036) in those with a history of COVID-19. The COVID-19 pandemic resulted in a significant worsening of cognition in older adults, associated with changes in known dementia risk factors. The sustained decline in cognition highlights the need for public health interventions to mitigate the risk of dementia-particularly in people with mild cognitive impairment, in whom conversion to dementia within 5 years is a substantial risk. Long-term intervention for people with a history of COVID-19 should be considered to support cognitive health. National Institute for Health and Care Research.

Telomere Length Associates With Symptom Severity After Mild Traumatic Brain Injury in Older Adults.

The objectives were to compare differences in telomere length (TL) among younger (21-54 years) and older adults (≥55) with mild traumatic brain injury (mTBI) to non-injured controls and to examine the association between TL and the severity of post-concussive symptoms over time. We performed a quantitative polymerase chain reaction to determine the TL (Kb/genome) of peripheral blood mononuclear cell samples (day 0, 3 months, and 6 months) from 31 subjects. The Rivermead Post-Concussion Symptoms Questionnaire was used to assess symptoms. Group-by-time comparisons of TL and symptom severity were evaluated with repeated-measures analysis of variance. Multiple linear regression examined the relationship between TL, group (mTBI and non-injured controls), and symptom severity total and subscale scores. Significant aging-related differences in TL were found within mTBI groups by time (day 0, 3 months, and 6 months; p = 0.025). Older adults with mTBI experienced significant worsening of changes in total symptom severity scores over time (day 0, 3 months, and 6 months; p = 0.016). Shorter TLs were associated with higher total symptom burden among each of the four groups at day 0 (baseline; p = 0.035) and 3 months (p = 0.038). Shorter TL was also associated with higher cognitive symptom burden among the four groups at day 0 (p = 0.008) and 3 months (p = 0.008). Shorter TL was associated with higher post-injury symptom burden to 3 months in both older and younger persons with mTBI. Large-scale, longitudinal studies of factors associated with TL may be useful to delineate the mechanistic underpinnings of higher symptom burden in adults with mTBI.

Deepening Depression in Women Balancing Work-Life Responsibilities and Caregiving during the COVID-19 Pandemic: Findings from Gender-Specific Face-to-Face Street Interviews Conducted in Italy.

This study investigated the impact of the COVID-19 pandemic on mental health, quality of life, and family functioning in a sample of the general female population, exploring difficulties encountered in managing family and work responsibilities and burden of care when taking care of a loved one. This study was, moreover, aimed at investigating factors capable of influencing severe depressive symptomatology in the context of socio-demographics, traumatic events, individual vulnerability, and family functioning. The sampling method used in this research was non-probability sampling. The survey took place during a Hospital Open Weekend (8-10 October 2021) organized by the National Gender Observatory on Women's Health "Fondazione Onda" on the occasion of the World Mental Health Day. A total of 211 women were interviewed (mean age = 35.6, 53% living alone, more than 15% with financial difficulties, 47% exposed to the 2009 L'Aquila earthquake). More than 50% of the sample reported a higher complexity in managing their lives during the COVID-19 pandemic compared to their previous routine, with no statistically significant differences between working women and non-workers, although the latter obtained higher scores for depressive symptomatology and poorer quality of life. Compared to non-caregivers, female caregivers (22.3%) in charge of the care of loved ones affected by physical (10.9%) or psychiatric disabilities (11.4%) complained of a poorer quality of life, especially in general health perception (p = 0.002), physical function (p = 0.011), role limitations related to physical problems (p = 0.017), bodily pain (p = 0.015), mental health (p = 0.004), and social functioning (p = 0.007). Women caring for people affected by mental disorders seemed to experience a more significant worsening in vitality (p = 0.003) and social functioning (p = 0.005). Approximately 20% of the total sample reported severe depressive symptomatology. Previous access to mental health services (O.R. 10.923; p = 0.000), a low level of education (O.R. 5.410; p = 0.021), and difficulties in management of everyday lives during the COVID-19 pandemic (O.R. 3.598; p = 0.045) were found to be the main variables predictive of severe depressive psychopathology. Old age, good problem-solving skills, and ability to pursue personal goals were identified as protective factors. The COVID-19 pandemic underlined the need for support amongst emotionally vulnerable women with pre-existing mental health conditions, partly reflecting the cumulative effects of traumas.

Predictors of Changes in Pelvic Rotation after Surgery with or without Femoral Derotational Osteotomy in Ambulatory Children with Cerebral Palsy.

Asymmetry of pelvic rotation affects function. However, predicting the post-operative changes in pelvic rotation is difficult as the root causes are complex and likely multifactorial. This retrospective study explored potential predictors of the changes in pelvic rotation after surgery with or without femoral derotational osteotomy (FDRO) in ambulatory children with cerebral palsy (CP). The change in the mean pelvic rotation angle during the gait cycle, pre- to post-operatively, was examined based on the type of surgery (with or without FDRO) and CP distribution (unilateral or bilateral involvement). In unilaterally involved patients, pelvic rotation changed towards normal with FDRO (p = 0.04), whereas patients who did not undergo FDRO showed a significant worsening of pelvic asymmetry (p = 0.02). In bilaterally involved patients, the changes in pelvic rotation did not differ based on FDRO (p = 0.84). Pelvic rotation corrected more with a greater pre-operative asymmetry (β = -0.21, SE = 0.10, p = 0.03). Sex, age at surgery, GMFCS level, and follow-up time did not impact the change in pelvic rotation. For children with hemiplegia, internal hip rotation might cause compensatory deviation in pelvic rotation, which could be improved with surgical correction of the hip. The predicted changes in pelvic rotation should be considered when planning surgery for children with CP.

The beneficial role of nano-sized Fe3O4 entrapped in ultra-stable Y zeolite for the complete mineralization of phenol by heterogeneous photo-Fenton under solar light

Highly efficient, separable, and stable magnetic iron-based-photocatalysts produced from ultra-stable Y (USY) zeolite were applied, for the first time, to the photo-Fenton removal of phenol under solar light. USY Zeolite with a Si/Al molar ratio of 385 was impregnated under vacuum with an aqueous solution of Fe2+ ions and thermally treated (500–750 °C) in a reducing atmosphere. Three catalysts, Fe-USY500°C-2h, Fe-USY600°C-2h and Fe-USY750°C-2h, containing different amounts of reduced iron species entrapped in the zeolitic matrix, were obtained. The catalysts were thoroughly characterized by absorption spectrometry, X-ray powder diffraction with synchrotron source, followed by Rietveld analysis, X-ray photoelectron spectroscopy, N2 adsorption/desorption at −196 °C, high-resolution transmission electron microscopy and magnetic measurements at room temperature.The catalytic activity was evaluated in a recirculating batch photoreactor irradiated by solar light with online analysis of evolved CO2. Photo-Fenton results showed that the catalyst obtained by thermal treatment at 500 °C for 2 h under a reducing atmosphere (FeUSY-500°C-2h) was able to completely mineralize phenol in 120 min of irradiation time at pH = 4 owing to the presence of a higher content of entrapped nano-sized magnetite particles. The latter promotes the generation of hydroxyl radicals in a more efficient way than the Fe-USY catalysts prepared at 600 and 750 °C because of the higher Fe3O4 content in ultra-stable Y zeolite treated at 500 °C. The FeUSY-500°C-2h catalyst was recovered from the treated water through magnetic separation and reused five times without any significant worsening of phenol mineralization performances. The characterization of the FeUSY-500°C-2h after the photo-Fenton process demonstrated that it was perfectly stable during the reaction. The optimized catalyst was also effective in the mineralization of phenol in tap water. Finally, a possible photo-Fenton mechanism for phenol mineralization was assessed based on experimental tests carried out in the presence of scavenger molecules, demonstrating that hydroxyl radicals play a major role.

Survival outcomes seen with neoadjuvant chemotherapy in the management of locally advanced inflammatory breast cancer (IBC) versus matched controls

Inflammatory breast cancer (IBC) poses an ongoing challenge as rates of disease recurrence and mortality remain high compared to stage-matched controls. However, frontline therapy has evolved through the years, including the widespread use of neoadjuvant chemotherapy (NAC) given the prognostic importance of pathologic complete response (pCR). Due to these sweeping changes, we need new data to assess current recurrence and survival outcomes for locally advanced IBC in the context of matched non-inflammatory controls. We conducted a retrospective analysis of institutional IBC data from 2010 to 2016 with the primary objective of comparing overall survival (OS), relapse-free survival (RFS), and distant relapse-free survival (DRFS). We matched IBC patients to non-inflammatory controls based on age, receptor status, tumor grade, clinical stage, and receipt of prior NAC. Secondary objectives included assessing pCR rates and identifying prognostic factors. Among NAC recipients, we observed similar pCR rates (47.6 % vs. 49.4 %, p = 0.88) between IBC (n = 84) and matched non-IBC (n = 81) cohorts. However, we noted a significant worsening of OS (p = 0.0001), RFS (p = 0.0001), and DRFS (p = 0.001) in the IBC group. Specifically, 5-year OS in the IBC cohort was 58.9 % vs. 86.7 % for matched controls (p = 0.0003). Older age was a weak negative predictor for OS (HR 1.03, p = 0.001) and RFS (HR 1.02, p = 0.01). For DRFS, older age was also a weak negative predictor (HR 1.02, p = 0.02), whereas the use of NAC was a positive predictor (HR 0.47, p = 0.02). Despite no clear difference in pCR, survival outcomes remain poor for IBC compared to matched non-inflammatory controls.

Market Segmentation and Haze Pollution in Yangtze River Delta Urban Agglomeration of China

Haze pollution not only has negative impact on public health and air quality, but also has restricted China’s industrial upgrading and high-quality development, and Chinese urban agglomerations are one of the areas hardest hit of haze pollution. In the process of China’s economic transformation, local governments will adopt local protectionism, leading to market segmentation. This is a phenomenon that refers to the distortion of resource allocation by local governments for the sake of vested interests and the existence of segmentation in commodity markets. This behavior is considered to be one of the important factors causing haze pollution. As Yangtze River Delta urban agglomerations are considered to be one of the earliest, fastest growing, and most mature for market integration in China, there is a lack of empirical testing on the impact of market segmentation on haze pollution in this urban agglomeration. Based on urban panel data from the period of 1998–2018 and the market segmentation index calculated by the relative price method, we use the dynamic spatial Durbin model and generalized space two-stage least squares method to explore the effect of market segmentation in urban agglomeration on haze pollution; the results are as follows: (1) Market segmentation significantly exacerbates haze pollution, in other words, haze pollution will increase by 2.14% when market segmentation increases by 1%. (2) Cities with a high degree of market segmentation and high levels of haze pollution have the potential to reduce pollution through market integration in the future. (3) Market segmentation in surrounding regions also has a significant worsening effect on haze pollution in the region. The indirect effect of market segmentation is 3.67 times that direct effect, indicating that the spatial spillover effect of market segmentation on haze pollution is greater than its own impact. (4) Mechanism analysis finds that it will aggravate haze pollution by hindering economic scale, industrial structure, and technological progress when the degree of market segmentation is high.

Characteristics of arterial hypertension in patients after being in a combat zone in the Kharkiv region of Ukraine

Objective — to study the characteristics of arterial hypertension (AH) in patients (representatives of the civilian population) after their stay in the combat zone in the Kharkiv region of Ukraine.
 Materials and methods. The study involved 62 patients with 2—3 degree AH (29 men and 33 women), who were examined in the Department of Arterial Hypertension and Kidney Disease at L. T. Mala NIT NAMSU before the war and 4—5 months after its start. The interval between the baseline and re‑examination was 8—9 months. All examined patients during the war were in the combat zone in Kharkiv region of Ukraine. The mean patients’ age was 52.4±4.3 years. All patients underwent general clinical, laboratory and instrumental examinations. The degree, stage of hypertension and the presence of risk factors for cardiovascular disease (CVD), established CVD and kidney disease were assessed in accordance with recent recommendations. At baseline, before the war start, all patients were administered two‑ or three‑component antihypertensive and (in the presence of elevated levels of low‑density lipoprotein cholesterol (LDL‑C) lipid‑lowering therapy in accordance with the latest guidelines. All 62 patients (100%) during their dynamic observation before the war, reached target levels of «office» blood pressure (BP). The frequency of achieving target levels of LDL‑C was significantly lower and amounted to 57%.
 Results. In patients with hypertension (representatives of the civilian population), who were in the combat zone in the Kharkiv region of Ukraine and experienced chronic wartime stress, a significant increase in the frequency of severe and uncontrolled hypertension, its crisis course and resistant form was found. Prognostically unfavorable consequences of staying in the combat zone in patients with hypertension is a significant increase in the incidence of such risk factors for CVD as increased LDL‑C blood levels, prediabetes and insulin resistance, smoking and regular alcohol consumption. Staying in the combat zone leads to a significant increase in the incidence of coronary heart disease, heart rhythm disturbances and heart failure in patients with hypertension and contributes to the accelerated development of type 2 diabetes mellitus, as well as such severe cardiovascular and cerebrovascular complications as atrial fibrillation, acute myocardial infarction, transient ischemic attack and ischemic stroke
 Conclusions. The stay of patients with hypertension in the combat zone and the related chronic stress of wartime leads to a significant worsening of hypertension course and to the development of adverse metabolic disorders and cardiovascular and cerebrovascular complications. This justifies the need to establish dynamic monitoring for this category of patients and conduct long‑term combined therapy, taking into account the characteristics of the clinical course and the presence and severity of the disease complications.

The Effect of Age on Health-Related Quality of Life in Patients Treated for Early Stage, Estrogen Receptor Positive Breast Cancer

Prospective studies on Health-related quality of life (HRQoL) evaluating the effect of age on outcomes in breast cancer (BC) is not well studied. This study aims to examine the physical and mental health perceptions in BC patients enrolled in an international, multi-center REQUITE study. This study includes 2,057 patients with ER+ early-stage BC treated with breast conservation surgery, radiation (RT), and endocrine therapy (ET) across Europe and North America between April 2014 and March 2017. The prospectively collected HRQoL dataset includes EORTC30 and Multidimensional Fatigue Inventory (MFI-20) at baseline, post-RT, 1, 2, and 3 years of follow up. Patients were stratified by age: 851 aged <70 (younger) and 201 aged ≥ 70 (older). The median age (range) for the younger and older cohort is 57 years (30-69 years) and 75 years (70-86 years), respectively. Analysis includes descriptive statistics and univariable logistic regression. Older patients had a greater burden of comorbid conditions including increased BMI (27.3 vs 26.5; P = 0.006), history of diabetes (10.9% vs 6.6%; P = 0.0336), heart disease (15.4% vs 6.1%; P<0.0001), rheumatoid arthritis (6.5% vs 3.2%; P = 0.0280), hypertension (54.2% vs 25.0%; P<0.0001), and polypharmacy (37.8% vs 16.7%; P<0.0001) compared to younger patients. Higher utilization of aromatase inhibitor (67.7% vs 42.4%; P<0.0001) in older patients, and tamoxifen (63.7% vs 36.5%; P<0.0001) in younger patients. The T-stage distribution in younger and older patients is T1 = 82.4% vs 68.7%, T2 = 9.8% vs 26.4%, T3 = 0.1% vs 1%, respectively. The 3-year relapse-free survival was similar in both groups (P = 0.183). Significant worsening in fatigue (P<0.0001, P<0.0001), pain (P = 0.0274, P<0.0001), cognitive functioning (P = 0.0291, P<0.0001), and global health status (P = 0.0064, P<0.0001) was observed during follow up from baseline in both groups (older patients, younger patients). Compared to older patients where significant deterioration persisted, younger patients showed improvement in most HRQoL measures over the duration of follow up years. Older patients had poorer global health status (OR = 1.19 vs 0.8, P = 0.0214) than younger patients from baseline at 2 years. On the MFI-20 measure, both age groups showed worsening fatigue from baseline at post-RT, but eventual recovery noted in the 1-to-3-year follow up period. Older patients, present with greater comorbidities, polypharmacy, and later stages in BC, reported worsening fatigue, pain, cognitive functioning, and global health status during 3 years follow up. One limitation of this study is that patients were predominately White, potentially limiting the generalizability of these observations. Further studies supplementing biomarkers and prognostic signatures with functional measures such as HRQoL may provide a useful tool to guide risk-tailored treatment in older patients with breast cancer.

"Evaluation of quality of life in patients with gastric adenocarcinoma receiving chemoradiotherapy: a cross-sectional study".

The aim of this study was to evaluate quality of life (QoL) in patients with gastric adenocarcinoma receiving adjuvant chemoradiotherapy (CRT). The European Organization for Cancer Research and Treatment Quality of Life Questionnaire-Core 30 (QLQ-C30) and site-specific module for gastric cancer (QLQ-STO22) were administered at four time points to 156 patients admitted to Cumhuriyet University Oncology Center between 2011 and 2018. The patient group comprised 76% men and 24% women with a median age of 61years (range, 18-88). During CRT, 12 patients (8%) discontinued treatment, 25 (16%) lost weight, and 42 (27%) had reduced performance. There was significant worsening in QLQ-C30 global health status and all functional and symptom scale scores at CRT completion. These changes were also clinically significant except for physical functioning scores and were supported by minimal clinically important difference measurements. In the QLQ-STO22, all symptoms except dry mouth and hair loss were negatively affected at CRT completion. In general, scores were improved at 1month after CRT and almost all scores reached baseline level by 6months. Certain scores were more adversely affected in women (global health status, physical functioning, role functioning, fatigue, pain, and insomnia), those who lost weight during CRT (emotional functioning), and those with CRT interruption (emotional functioning and anxiety). Although CRT reduces QoL in patients with gastric cancer, the effects tend to resolve within 6months after completing treatment. Female sex, weight loss, and CRT interruption negatively affected some QoL scores.

Comparison of Sinonasal Outcomes in Patients Undergoing Uni-nostril and Bi-nostril Endoscopic Trans-sphenoidal Excision of Pituitary Adenomas: A Prospective Study.

Background Prospective studies comparing quality-of-life and olfaction in patients undergoing endoscopic uni-nostril versus bi-nostril trans-sphenoidal pituitary surgery have not been published. Methods We prospectively compared olfaction and quality-of-life at baseline and at 3 to 6 months follow-up using the Anterior Skull Base Nasal Inventory-12 (ASK-12) questionnaire, composite olfaction score, and Lund-Kennedy Endoscopic Score (LKES) in 43 patients who underwent endoscopic excision of pituitary adenoma with either a uni-nostril (24 patients) or a bi-nostril (19 patients) approach. Results Baseline data for both groups were comparable. In the uni-nostril group, ASK-12 and LKES scores were not significantly different at follow-up when compared with the preoperative scores. In the bi-nostril group, there was a significant postoperative worsening of ASK-12 scores (mean: 3.2 vs. 5.3; p = 0.04) and the LKES (mean: 2.9 vs. 6.6; p = 0.01). Composite olfaction score was not significantly affected postoperatively with either approach. Nasal complications were also more in the bi-nostril group (5/18, 27.8% vs. 1/23, 4.3%) but this was not statistically significant ( p = 0.07). Conclusion Both approaches preserve olfactory function but the uni-nostril approach is associated with better postoperative quality-of-life and endoscopic scores and subjective olfaction outcomes. At least in short term, the postoperative morbidity is higher in the bi-nostril approach compared with the uni-nostril approach. Although preference for a particular approach is related to a surgeon's preference, preoperative counselling of the patients regarding sinonasal morbidity is important.

Burden of Medication Overuse in Migraine: A Cross-sectional, Population-Based Study in Five European Countries Using the 2020 National Health and Wellness Survey (NHWS).

Overuse of medication to treat migraine attacks can lead to development of a new type of headache or significant worsening of pre-existing headache, known as medication overuse headache. However, data concerning the burden of medication overuse (MO) in migraine are limited. This study aimed to assess the humanistic burden of MO in individuals with migraine from five European countries. Data are from the 2020 National Health and Wellness Survey-a cross-sectional, population-based survey conducted in France, Germany, Italy, Spain, and the UK. Data were included from adults (≥ 18years) with a self-reported diagnosis of migraine and at least one migraine attack and one headache in the past 30days. MO was defined as (i) use of simple analgesics/over-the-counter medications on ≥ 15days/month; or (ii) use of migraine medication, including combination analgesics, on ≥ 10days/month. Humanistic burden of MO was assessed using the 12-Item Short-Form Health Survey (SF-12v2), EuroQol 5-Dimensions 5-Levels (EQ-5D), Short-Form 6-Dimensions (SF-6D), and Migraine Disability Assessment (MIDAS). The association of MO with humanistic burden was evaluated using generalized linear models adjusted for potential confounders in the full migraine population and in subgroups defined by headache frequency (monthly headache days [MHDs] 1-3, 4-7, 8-14, or ≥ 15). Among individuals with migraine, humanistic burden (SF-12v2, SF-6D, EQ-5D, and MIDAS) was higher in individuals who reported MO (n = 431) versus no MO (n = 3554), even after adjustment for confounding variables (p < 0.001 for all measures). MIDAS and EQ-5D scores were higher in individuals with MO than without, at all levels of headache frequency. For SF-12v2 and SF-6D, differences between groups with/without MO were seen only at lower levels of headache frequency (MHD 1-3 and 4-7). Among people with migraine, those who report MO face a greater humanistic burden than those without MO, irrespective of headache frequency.

Effects of elexacaftor/tezacaftor/ivacaftor on liver fibrosis markers in adults with cystic fibrosis

BackgroundThere are limited studies to date on the effects of elexacaftor/tezacaftor/ivacaftor (E/T/I) on markers of liver fibrosis in adults with cystic fibrosis (CF). This study aims to analyse changes in makers of liver fibrosis before and after initiation of E/T/I in CF adults. MethodsOutcome measures of liver fibrosis, including liver stiffness measurement (LSM) using FibroScan, AST-to-platelet-ratio index (APRI) and gamma-GT-to-platelet-ratio (GPR) were available in 74 CF adults following initiation of E/T/I. This was compared to historical data collected in 2018 prior to UK availability of E/T/I. ResultsThe median duration of E/T/I therapy at the time liver fibrosis markers were repeated was 21 (IQR: 17–25) months. There was an increase in APRI from historical measurement to follow-up but no change in LSM or GPR. There were no differences in change in fibrosis markers according to CF liver disease (CFLD) status, although those with a raised LSM at baseline (>6.8 kPa) (n = 14) had a significant reduction in LSM from historical measurement to follow-up versus those with a normal historical value (-3.3 kPa vs 0.25 kPa, p < 0.01). ConclusionsApart from APRI, we found no changes in liver fibrosis outcomes after initiation of E/T/I in adults with CF. Those with a historical diagnosis of CFLD had no significant worsening or improvement of liver fibrosis markers. We did observe a reduction in LSM in those with liver nodularity, with an initial highest result suggesting a potential positive treatment effect of E/T/I in this category of those with severe CFLD.

COVID-19 in patients with metabolic disorders: focus on management

obesity, diabetes mellitus, cardiovascular pathologies, male gender and old age contribute to a significant worsening of the COVID-19 course and were associated with an increased risk of acute kidney injury. The study aims to define the main streams of improvement of health care of COVID-19 in patients with metabolic disorders, focusing on the risk factors, and analysing doctoral attitudes to the problems of obesity with an accent on health promotion. Research methods: systemic approach, medical-statistical, questioning, structural-logical analysis, clinical, laboratory and instrumental methods. We conducted a retrospective analysis of the medical documents of COVID-19 in-patients treated at the National Military Medical Clinical Centre “Main Military Clinical Hospital” (n=146). There were 2 groups according to the severity of COVID-19 (severe course, n= 37, non-severe – n=109). We also proposed to participate in questioning a group of doctors who were involved in the treatment of patients with COVID-19. Results. A high prevalence of diabetes and hyperglycemia in patients with a severe course of the coronavirus disease was revealed, which requires risk management both at the individual and population levels. According to the received results, majority of doctors concern on the problems of obesity and propose to take care on the preventive strategies to the patients with non-communicable diseases. Initial assessments of the clinical and laboratory data are extremely important as it could be necessary to achieve compensation of diabetes before onset of COVID-19. Health promotion of decreasing weight, giving up smoking, regular physical activity could be helpful in improvement of individual health. We propose identifying obesity as an important independent risk factor which helps in decision-making on hospitalisation of COVID-19 patients before severe respiratory insufficiency starts. Baseline creatinine should be analysed, as rapid increase serum creatinine could be associated with acute kidney injury and may need urgent renal replacement therapy while in the case of not enough resources could be challengeable and causing poor outcomes.

Mental health, stress, and well-being measured before (2019) and during (2020) COVID-19: a Swedish socioeconomic population-based study

Objectives Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic. Methods Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy–General Population]) and self-rated health (SRH) was assessed with a single-item question. Results When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M̂ = 9.15 vs. 8.48, p < 0.01) and depression (M̂ = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M̂ = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M̂ = 76.40 vs. 77.92, p < 0.01) and SRH (M̂ = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income. Conclusions The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect.