Similar Rates Research Articles

Unclear relationships between mean survival rate and its environmental variance in vertebrates.

Current environmental changes may increase temporal variability of life history traits of species thus affecting their long-term population growth rate and extinction risk. If there is a general relationship between environmental variances (EVs) and mean annual survival rates of species, that relationship could be used as a guideline for analyses of population growth and extinction risk for populations, where data on EVs are missing. For this purpose, we present a comprehensive compilation of 252 EV estimates from 89 species belonging to five vertebrate taxa (birds, mammals, reptiles, amphibians and fish) covering mean annual survival rates from 0.01 to 0.98. Since variances of survival rates are constrained by their means, particularly for low and high mean survival rates, we assessed whether any observed relationship persisted after applying two types of commonly used variance stabilizing transformations: relativized EVs (observed/mathematical maximum) and logit-scaled EVs. With raw EVs at the arithmetic scale, mean-variance relationships of annual survival rates were hump-shaped with small EVs at low and high mean survival rates and higher (and widely variable) EVs at intermediate mean survival rates. When mean annual survival rates were related to relativized EVs the hump-shaped pattern was less distinct than for raw EVs. When transforming EVs to logit scale the relationship between mean annual survival rates and EVs largely disappeared. The within-species juvenile-adult slopes were mainly positive at low (<0.5) and negative at high (>0.5) mean survival rates for raw and relativized variances while these patterns disappeared when EVs were logit transformed. Uncertainties in how to interpret the results of relativized and logit-scaled EVs, and the observed high variation in EV's for similar mean annual survival rates illustrates that extrapolations of observed EVs and tests of life history drivers of survival-EV relationships need to also acknowledge the large variation in these parameters.

Characteristics of nausea and its impact on health-related quality of life in cisplatin-treated patients receiving dexamethasone-sparing prophylaxis: an analysis of the LUNG-NEPA study.

We investigated the intensity and duration of nausea as well as its impact on health-related quality of life among cisplatin-treated patients who participated in a study of dexamethasone (DEX)-sparing regimens based on NEPA (netupitant/palonosetron). This retrospective analysis included chemo-naive patients from a trial evaluating non-inferiority of DEX on day 1 (DEX1 arm) combined with NEPA, compared with the same regimen with DEX administered on days 1-4 (DEX4; reference arm) following cisplatin (≥ 70mg/m2) administration. Nausea intensity was self-rated using a four-point Likert scale. Extended nausea duration was considered ≥ 3days within the 5days post-chemotherapy. Patients completed the Functional Living Index-Emesis (FLIE) questionnaire on day 6. In the DEX1 arm, more patients (20/76) experienced acute nausea, influencing the outcome of delayed nausea (38/76). During days 1 to 5, 51.3% (39/76) and 39.5% (30/76) of patients experienced nausea in the DEX1 and DEX4 arms, respectively (P = 0.192). Of these, 43.6% and 60% reported moderate-to-severe nausea, respectively, in the DEX1 and DEX4 arms (P = 0.200), while 74.4% and 56.7% of patients experienced extended nausea duration (P = 0.122). Similar between-arm rates of nauseated patients reported an impact on daily life (79.5% vs. 70%; P = 0.408). In analyses stratified for antiemetic regimen, moderate-to-severe nausea or extended nausea duration was associated with an impact on daily life (P ≤ 0.001). Despite the higher incidence, there was no suggestion of any strong adverse effect of NEPA plus single-dose DEX on the characteristics of nausea as well as its impact on daily life in patients with cisplatin-induced nausea. Further prospective controlled study is warranted. ClinicalTrials.gov identifier: NCT04201769. Registration date: 17/12/2019.

Cemented is not superior to cementless total knee arthroplasty for complications: a propensity score matched analysis.

There is continued debate regarding the survivorship and revision rate of cementless versus cemented total knee arthroplasty (TKA) prostheses. This includes the assessment of early revision surgery due to aseptic loosenings and periprosthetic joint infections (PJIs). Studies have not always taken into account the impact of comorbidities, such as diabetes, obesity, and tobacco. Therefore, we compared revisions in a large population of patients undergoing cemented or cementless TKAs at 90days, 1year, and 2years. A review of an administrative claims database was used to identify patients undergoing primary TKA, either cementless (n = 8,890) or cemented (n = 215,460), from October 1, 2015 to October 31, 2020. Revision surgery for PJI and aseptic loosening were identified with diagnosis and associated procedural codes at 90days, 1year, and 2years and then compared between groups. A propensity matched-analysis was performed for age, sex, Charles Comorbidity Index (CCI) > 3, alcohol abuse, tobacco use, obesity, and diabetes. Chi square tests assessed statistical significance of differences in the matched cohorts using odds ratios (ORs) with 95% confidence intervals (CIs). A P < 0.05 was defined as statistically significant. Cementless TKA was associated with similar revisions rates due to PJIs at 90days (OR, 1.04, 95% CI 0.79-1.38, p = 0.83), 1year (OR, 0.93, 95% CI 0.75-1.14, p = 0.53, and 2years (OR, 0.87, 95% CI 0.73-1.05, p = 0.17) in comparison to the cemented TKA cohort. The odds ratio of revision due to aseptic loosening was similar as well at 90days (OR, 0.67, 95% CI 0.34-1.31, 0.31), 1year (OR, 1.09, 95% CI 0.73-1.61, p = 0.76), and 2years (OR, 1.00, 95% CI 0.73-1.61, p = 0.99). This study found a comparable risk of PJI and aseptic loosening in cementless and cemented TKA when controlling for several comorbidities, such as tobacco, diabetes, and alcohol. Therefore, with proper patient selection, cementless TKAs can be performed with expectation of low risks of infections and aseptic loosenings.

ALMA-LEGUS. II. The Influence of Subgalactic Environments on Molecular Cloud Properties

We compare the molecular cloud properties in subgalactic regions of two galaxies, barred spiral NGC 1313, which is forming many massive clusters, and flocculent spiral NGC 7793, which is forming significantly fewer massive clusters despite having a similar star formation rate to NGC 1313. We find that there are larger variations in cloud properties between different regions within each galaxy than there are between the galaxies on a global scale, especially for NGC 1313. There are higher masses, line widths, pressures, and virial parameters in the arms of NGC 1313 and the center of NGC 7793 than in the interarm and outer regions of the galaxies. The massive cluster formation of NGC 1313 may be driven by its greater variation in environment, allowing more clouds with the necessary conditions to emerge, although no one parameter seems primarily responsible for the difference in star formation. Meanwhile NGC 7793 has clouds that are as massive and have as much kinetic energy as the clouds in the arms of NGC 1313, but have densities and pressures more similar to those in the interarm regions and so are less inclined to collapse and form stars. The cloud properties in NGC 1313 and NGC 7793 suggest that spiral arms, bars, interarm regions, and flocculent spirals each represent distinct environments with regard to molecular cloud populations. We see surprisingly little difference in surface density between the regions, suggesting that the differences in surface densities frequently seen between arm and interarm regions in lower-resolution studies are indicative of the sparsity of molecular clouds, rather than differences in their true surface density.

Stereotactic radiosurgery with versus without embolization for intracranial dural arteriovenous fistulas: a systematic review and meta-analysis.

Stereotactic radiosurgery (SRS) has been established as a safe and alternative treatment for dural arteriovenous fistulas (dAVFs). While embolization alone is the most commonly used modality for the treatment of dAVFs, the adjunctive use of embolization with SRS, with the growing use of SRS, has gained increasing interest in the past few years. However, the relative efficacy and safety of SRS combined with embolization versus SRS alone for dAVFs remains uncertain. Hence, this systematic review aimed to evaluate the efficacy of SRS with adjunctive embolization for intracranial dAVFs. A systematic review and meta-analysis was conducted by searching electronic databases, including PubMed, Embase, and the Cochrane Library, up to August 2023. All studies evaluating the utilization of adjunctive embolization and SRS for dAVFs were included. Risk of bias was assessed using the Newcastle-Ottawa Scale. A meta-analysis was conducted on the suitable outcomes. Eighteen studies involving 715 patients were included. The mean age of the participants in the study was 64.30 years in the adjunctive embolization group and 60.51 years in the SRS-alone group. In the adjunctive embolization group 41.3% of patients were female, compared with 47.1% in the SRS-only group. The dAVF obliteration rates were 64.7% and 65.7% in the adjunctive embolization and SRS-alone groups, respectively. These obliteration rates were comparable between the two groups (p = 0.96), as were the symptom improvement rates (p = 0.35). Adverse events were rare, and were more commonly associated with the adjunctive embolization procedure, although further causal analysis was not possible. This study provides evidence that adjunctive embolization plus SRS provides similar obliteration and symptom improvement rates compared with SRS alone, with both having very limited SRS-related adverse events. Considering the added burden and adverse events of additional endovascular treatment, the authors recommend embolization be reserved for more complex dAVFs or when embolization can potentially be curative alone or provide more rapid symptomatic relief or protection during the radiosurgical latency period.

Impact of temporal beach grain size variability on aeolian sediment transport and topographic evolution in a microtidal environment

While the impact of the spatio/temporal variability of grain size on morphological beach state is reasonably well understood, relatively little is known on its impact at a scale of days/months on aeolian sediment transport. This study focuses on five short intensive wind events during which aeolian sediment transport measurements, beach surface sampling and elevation change surveys were carried out for 1 to 3 days, over a 16-month period on a microtidal beach dominated by offshore winds. Monthly observations show a high temporal variability in beach grain size in relation to the decoupling between hydrodynamic and aeolian processes, from medium sand after a marine storm and inundation of the beach, to very coarse sand after several weeks of storm-force winds. During each wind event, topographic change on the beach ranged from zero, to 0.55 m. The time scale of coarsening depended on the initial beach grain size and could be very fast when the beach was composed of medium sand (e.g. 388 μm sand changed to coarse sand of 547 μm in 40 h). In contrast, it took one month to transition from a coarse median beach grain size of 883 μm to a very coarse one of 1323 μm. This variability in grain size results in dramatically different rates of sediment flux. For example, during average wind speeds of 10 to 14 m/s the sediment flux when the beach was composed of medium sized sand ranged between 21 and 154 kg/m/h compared to 0.4 to 50 kg/m/h when the beach was composed of coarse and very coarse sized grains. Overall, this study highlights the importance of beach grain size variability on aeolian sediment transport and shows that for similar incident wind and climatic conditions aeolian sediment transport rates vary dramatically. The study demonstrates the importance of taking care when using a constant median grain size in the calculation of long-term aeolian sand transport on beaches with heterogeneous spatial and temporal beach grain size variability.

Healthy dietary patterns and risk of prostate cancer in men at high genetic risk.

Prostate cancer has high heritability. Healthy lifestyle has been associated with lower lethal prostate cancer risk among men at increased genetic susceptibility, but the role of healthy dietary patterns remains unknown. We prospectively followed 10,269 genotyped men in the Health Professionals Follow-up Study (1993-2019). Genetic risk was quantified using an established polygenic risk score (PRS). Five dietary patterns were investigated: healthy eating index, Mediterranean, diabetes risk-reducing, hyperinsulinemic and inflammatory diet. Overall and lethal prostate cancer rates (metastatic disease/prostate cancer-specific death) were analyzed using multivariable Cox proportional hazards models. During 26 years of follow-up, 2133 overall and 253 lethal prostate cancer events were documented. In the highest PRS quartile, higher adherence to a diabetes risk-reducing diet was associated with lower rates of overall (top vs. bottom quintile HR [95% CI], 0.74 [0.58-0.94]) and lethal prostate cancer (0.43 [0.21-0.88]). A low insulinemic diet was associated with similar lower rates (overall, 0.76 [0.60-0.95]; lethal, 0.46 [0.23-0.94]). Other dietary patterns showed weaker, but similar associations. In the highest PRS quartile, men with healthy lifestyles based on body weight, physical activity, and low insulinemic diet had a substantially lower rate (0.26 [0.13-0.49]) of lethal prostate cancer compared with men with unhealthy lifestyles, translating to a lifetime risk of 3.4% (95% CI, 2.3%-5.0%) among those with healthy lifestyles and 9.5% (5.3%-16.7%) among those with unhealthy lifestyles. Our findings indicate that lifestyle modifications lowering insulin resistance and chronic hyperinsulinemia could be relevant in preventing aggressive prostate cancer among men genetically predisposed to prostate cancer.

Regional emissions of soil greenhouse gases across Tibetan alpine grasslands

Soil greenhouse gas (GHG) emissions play an important role in regional climate feedback on the Qinghai-Tibetan Plateau (QTP). Previous studies have focused on soil GHGs based on observations within a limited space on the QTP, however, the regional GHG emissions remain unclear. Analyzing soil samples from 25 sites along a 2,700 km transect across QTP, we showed significantly higher soil CO2 and N2O emission rates in alpine meadows than other upland grassland types, but similar soil CH4 uptake rates across all grassland types. The spatial variations of total soil GHG balance were dominated by CO2 emission. We found that CO2 emission was primarily constrained by high soil pH, low soil moisture and nutrient availability, and fungal abundance, N2O emission was inhibited by high soil pH, while CH4 uptake was dominated by methanotrophic abundance. Furthermore, we estimated a current regional total soil GHG balance of 144.4 Tg CO2-eq yr−1 for surface soil across Tibetan alpine grasslands, which increased by 17.6%, 24.8%, and 38.9% under warming scenarios of 1.5℃, 2℃ and 3℃, respectively. Our results provide a baseline for regional soil GHG emissions responding to climate warming on the QTP.

Impact of social determinants of health on follow-up adherence, testing completion, and outcomes among pediatric glaucoma patients at a tertiary care center

PurposeTo identify patient characteristics associated with visit attendance, treatment outcomes, and optical coherence tomography (OCT) testing in pediatric glaucoma patients at an urban tertiary care center. MethodsThe records of patients with childhood glaucoma seen from 2015 to 2021 were reviewed. Primary outcomes were the proportion of scheduled visits completed, visual acuity and intraocular pressure (IOP) at most recent follow-up, and rates of OCT testing. Social determinants of health evaluated included race and ethnicity, distance of residence from clinic, insurance carrier type and residence within Baltimore City County, the latter two serving as proxies for socioeconomic status. ResultsA total of 99 patients met inclusion criteria: 61% were male; 47%, white (non-Hispanic); 25%, black (non-Hispanic); 11%, Hispanic/Latino; and 7% Asian/Pacific Islander. Mean distance from clinic was 45.3 miles. Mean visit completion rate was 90.4%; there was no statistically significant variation in visit completion rates by patient characteristics. IOP outcomes did not vary across patient groups, but visual acuity outcomes in affected eyes were significantly worse among Baltimore City County residents compared with non-residents. Only 22% of the cohort received ≥1 OCT per year, and patients living 0-29.9 miles from clinic had significantly lower odds of reaching the threshold than more distant patients. Patients with state-based insurance had significantly lower odds of being ≥50th percentile for rate of OCTs received compared to patients with commercial insurance. ConclusionsIn children with glaucoma, residence within Baltimore City County was associated with significantly worse visual acuity outcomes, and close proximity to clinic was an independent predictor of lower rates of OCT testing, despite similar visit attendance rates and IOP outcomes across all groups.

ALMA-LEGUS. I. The Influence of Galaxy Morphology on Molecular Cloud Properties

We present a comparative study of the molecular gas in two galaxies from the Legacy ExtraGalactic UV Survey (LEGUS) sample: barred spiral NGC 1313 and flocculent spiral NGC 7793. These two galaxies have similar masses, metallicities, and star formation rates, but NGC 1313 is forming significantly more massive star clusters than NGC 7793, especially young massive clusters (<10 Myr, >104 M ⊙). Using Atacama Large Millimeter/submillimeter Array (ALMA) CO(2–1) observations of the two galaxies with the same sensitivity and resolution (13 pc), we directly compare the molecular gas in these two similar galaxies to determine the physical conditions responsible for their large disparity in cluster formation. By fitting size–line width relations for the clouds in each galaxy, we find that NGC 1313 has a higher intercept than NGC 7793, implying that its clouds have higher kinetic energies at a given size scale. NGC 1313 also has more clouds near virial equilibrium than NGC 7793, which may be connected to its higher rate of massive cluster formation. However, these virially bound clouds do not show a stronger correlation with young clusters than with the general cloud population. We find surprisingly small differences between the distributions of molecular cloud populations in the two galaxies, though the largest of those differences is that NGC 1313 has higher surface densities and lower freefall times.

Diuretic use and outcomes in patients with heart failure with reduced ejection fraction: Insights from the VICTORIA trial.

In VICTORIA, vericiguat compared with placebo reduced the risk of cardiovascular death (CVD) and heart failure hospitalization (HFH) in patients enrolled after a worsening heart failure (WHF) event. We examined clinical outcomes and efficacy of vericiguat as it relates to background use of loop diuretics in patients with WHF. We calculated the total daily loop diuretic dose equivalent to furosemide dosing at randomization and categorized these as: no loop diuretic, 1-39, 41-80, 40, and >80 mg total daily dose (TDD). The primary composite outcome of CVD/HFH and its components were evaluated based on TDD loop diuretic and expressed as adjusted hazard ratios with 95% confidence intervals. Post-randomization rates of change in TDD were also examined. Of 4974 patients (98% of the trial) with diuretic dose information available at randomization, 540 (10.8%) were on no loop diuretic, 647 (13.0%) were on 1-39, 1633 (32.8%) were on 40, 1185 (23.8%) were on 41-80, and 969 (19.4%) were on >80 mg TDD. Patients with higher TDD had a higher rate of primary and secondary clinical outcomes. There were no significant interactions with TDD at randomization and efficacy of vericiguat versus placebo for any outcome (all pinteraction > 0.5). Post-randomization diuretic dose changes for vericiguat and placebo showed similar rates of up-titration (19.6 and 20.2/100 person-years), down-titration (16.8 and 18.1/100 person-years), and stopping diuretics (22.9 and 24.2/100 person-years). Loop diuretic TDD at randomization was independently associated with worse outcomes in this high-risk population. The efficacy of vericiguat was consistent across the range of diuretic doses.

Similar rates of reoperation for neuroma after transtibial amputations with and without targeted muscle reinnervation.

To compare the rates of revision surgery for symptomatic neuromas in patients undergoing primary transtibial amputations with and without targeted muscle reinnervation (TMR). Retrospective cohort study. Level I trauma hospital and tertiary military medical center. Adult patients undergoing transtibial amputations with and without TMR. Transtibial amputation with targeted muscle reinnervation. Reoperation for symptomatic neuroma. During the study period, there were 112 primary transtibial amputations performed, 29 with TMR and 83 without TMR. Over the same period, there were 51 revision transtibial amputations performed, including 23 (21%) in the patients undergoing primary transtibial amputation at the study institution. The most common indications for revision surgery were wound breakdown/dehiscence (42%, n = 25), followed by symptomatic neuroma 18% (n = 9/51) and infection/osteomyelitis (17%, n = 10) as the most common indications. However, of the patients undergoing primary amputation at the study's institution, there was no difference in reoperation rates for neuroma when comparing the TMR group (3.6%, n = 1/28) and no TMR group (4.0%, n = 3/75) (P = 0.97). Symptomatic neuroma is one of the most common reasons for revision amputation; however, this study was unable to demonstrate a difference in revision surgery rates for neuroma for patients undergoing primary transtibial amputation with or without targeted muscle reinnervation. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Is Postoperative Splinting Advantageous After Upper Extremity Fracture Surgery? Results From the Arm Splint Pain Improvement Research Experiment.

The authors report no conflict of interest.To determine if short-term immobilization with a rigid long arm plaster elbow splint after surgery of the arm, elbow, or forearm results in superior outcomes compared with a soft dressing with early motion. Prospective Randomized Control Trial. Academic Medical Center. Patients undergoing operative treatment for a mid-diaphysis or distal humerus, elbow, or forearm fracture were consented and randomized according to the study protocol for postoperative application of a rigid elbow splint (10-14 days in a plaster Sugar Tong Splint for forearm fracture or a Long Arm plaster Splint for 10-14 for all others) or soft dressing and allowing immediate free range of elbow and wrist motion (range of motion [ROM]). Self-reported pain (visual analog score or VAS), Healthscale (0-100, 100 denoting excellent health), and physical function (EuroQol 5 Dimension or EQ-5D) surveyed on postoperative days 1-5 and 14 were compared between groups. Patient-reported pain score (0-10, 10 denoting highest satisfaction) at week 6, time to fracture union, ultimate disabilities of the arm, shoulder, and hand score, and elbow ROM were also collected for analysis. Incidence of complications were assessed. Hundred patients (38 men to 62 women with a mean age of 55.7 years) were included. Over the first 5 days and again at postop day 14, the splint cohort reported a higher "Healthscale" from 0 to 100 than the nonsplint group on all study days ( P = 0.041). There was no difference in reported pain between the 2 study groups over the same interval ( P = 0.161 and 0.338 for least and worst pain, respectively), and both groups reported similar rates of treatment satisfaction ( P = 0.30). Physical function ( P = 0.67) and rates of wound problems ( P = 0.27) were similar. Additionally, the mean time to fracture healing was similar for the splint and control groups (4.6 ± 2.8 vs. 4.0 ± 2.2 months, P = 0.34). Ultimate elbow ROM was similar between the study groups ( P = 0.48, P = 0.49, P = 0.61, and P = 0.51 for elbow extension, flexion, pronation, and supination, respectively). Free range of elbow motion without splinting produced similar results compared with elbow immobilization after surgical intervention for a fracture to the humerus, elbow, and forearm. There was no difference in patient-reported pain outcomes, wound problems, or elbow ROM. Immobilized patients reported slightly higher "healthscale" ratings than nonsplinted patients and, however, reported similar rates of satisfaction. Both treatment strategies are acceptable after upper extremity fracture surgery. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

High-grade liver injuries with contrast extravasation managed initially with interventional radiology versus observation: A secondary analysis of a WTA multicenter study

BackgroundHigh-grade liver injuries with extravasation (HGLI ​+ ​Extrav) are associated with morbidity/mortality. For low-grade injuries, an observation (OBS) first-strategy is beneficial over initial angiography (IR), however, it is unclear if OBS is safe for HGLI ​+ ​Extrav. Therefore, we evaluated the management of HGLI ​+ ​Extrav patients, hypothesizing IR patients will have decreased rates of operation and mortality. MethodsHGLI ​+ ​Extrav patients managed with initial OBS or IR were included. The primary outcome was need for operation. Secondary outcomes included liver-related complications (LRCs) and mortality. ResultsFrom 59 patients, 23 (39.0%) were managed with OBS and 36 (61.0%) with IR. 75% of IR patients underwent angioembolization, whereas 13% of OBS patients underwent any IR, all undergoing angioembolization. IR patients had an increased rate of operation (13.9% vs. 0%, p ​= ​0.049), but no difference in LRCs (44.4% vs. 43.5%) or mortality (5.6% vs. 8.7%) versus OBS patients (both p ​> ​0.05). ConclusionOver 60% of patients were managed with IR initially. IR patients had an increased rate of operation yet similar rates of LRCs and mortality, suggesting initial OBS reasonable in appropriately selected HGLI ​+ ​Extrav patients.

Temperature-Dependent Kinetics of the Reactions of the Criegee Intermediate CH2OO with Hydroxyketones.

Though there is a growing body of literature on the kinetics of CIs with simple carbonyls, CI reactions with functionalized carbonyls such as hydroxyketones remain unexplored. In this work, the temperature-dependent kinetics of the reactions of CH2OO with two hydroxyketones, hydroxyacetone (AcOH) and 4-hydroxy-2-butanone (4H2B), have been studied using a laser flash photolysis transient absorption spectroscopy technique and complementary quantum chemistry calculations. Bimolecular rate constants were determined from CH2OO loss rates observed under pseudo-first-order conditions across the temperature range 275-335 K. Arrhenius plots were linear and yielded T-dependent bimolecular rate constants: kAcOH(T) = (4.3 ± 1.7) × 10-15 exp[(1630 ± 120)/T] and k4H2B(T) = (3.5 ± 2.6) × 10-15 exp[(1700 ± 200)/T]. Both reactions show negative temperature dependences and overall very similar rate constants. Stationary points on the reaction energy surfaces were characterized using the composite CBS-QB3 method. Transition states were identified for both 1,3-dipolar cycloaddition reactions across the carbonyl and 1,2-insertion/addition at the hydroxyl group. The free-energy barriers for the latter reaction pathways are higher by ∼4-5 kcal mol-1, and their contributions are presumed to be negligible for both AcOH and 4H2B. The cycloaddition reactions are highly exothermic and form cyclic secondary ozonides that are the typical primary products of Criegee intermediate reactions with carbonyl compounds. The reactivity of the hydroxyketones toward CH2OO appears to be similar to that of acetaldehyde, which can be rationalized by consideration of the energies of the frontier molecular orbitals involved in the cycloaddition. The CH2OO + hydroxyketone reactions are likely too slow to be of significance in the atmosphere, except at very low temperatures.

Effectiveness and safety of adalimumab compared with leflunomide in patients with Takayasu arteritis: a retrospective cohort study

ObjectiveThis study aims to evaluate the effectiveness and safety of adalimumab (ADA) compared with leflunomide (LEF) in patients with Takayasu arteritis (TAK).MethodA retrospective cohort study was performed with the following...

Abstract A001: Tracking the Relationship between Accrual and Comorbidities in Clinical TRrial Enrollment (TRACE)

Abstract Background: Clinical trial accrual disparities are pervasive and multifactorial. Prior research shows differential racial enrollment patterns of cancer patients due to comorbidity-based exclusion criteria (CEC). Uterine cancer (UC) has one of the largest racial disparities in incidence and mortality, yet the impact of CEC on accrual of racial minorities into UC trials is unknown. Objective/Hypothesis: To 1) characterize the presenting comorbidity profile of UC patients, by race and 2) use real-world data to quantify expected effects of common CEC on UC trial accrual. We hypothesize that racial minorities with UC have more comorbidities resulting in higher exclusion from trials than Whites. Method: In this observational, cross-sectional study, we used the Vizient ® Clinical Data Base [permission of Vizient Inc. (all rights reserved)] with 8.5 million inpatient and 130 million outpatient encounter level claims annually. We identified individuals ≥18yo with a UC diagnosis, 2002–2021. Demographic variables and comorbidity diagnoses were identified by ICD9/10 codes and used to construct Charlson, Elixhauser, and National Cancer Institute (NCI) comorbidity indices (CI). Individual comorbidity-based and summary theoretical ineligibility rates were calculated, by race, based on a modified set of CEC (Riner et al, JCO 2022). Ineligibility rates were compared between groups and differences assessed with logistic regression using STATA v.18. Result: We identified 384,093 UC patients. 73% were White, 14% Black, 11% unknown race, and 3% Asian. The majority (61%) were of non-Hispanic ethnicity. On average, Blacks had more comorbidities than Whites, Asians, or those of unknown race [1.3 (SD 2), 0.7 (SD 1.6), 0.6 (SD 1.3), 0.9 (SD 1.6), respectively]. For NCI CI, Blacks had the highest CI score (0.8, SD 1.4) while Asians the lowest (0.4, SD 0.9). Whites and those of unknown race had similar scores (0.5, SD 1.1) (all p-values &amp;lt; 0.001). Individual comorbidity prevalence varied significantly by race. Blacks (12%) with UC were more likely to have renal failure compared to Whites (5%). Asians (14%) and Whites (15%) had similar rates of diabetes while Blacks had the highest (24%). Hypertension was higher in Blacks (50%), followed by Whites (33%) then Asians (28%). In simulation analyses, odds of trial exclusion based on comorbidity status were two times higher in Blacks compared to Whites (OR 2.09, 95% CI 2.05-2.13). Those of unknown race had slightly higher odds (OR 1.04, 95% CI 1.02-1.07) and Asians lower odds (OR 0.89, 95% CI 0.86-0.93) of being ineligible relative to Whites. Conclusion: For UC patients, comorbidity prevalence and CI scores varied by race. This results in significant differences in trial eligibility at baseline before any patient engagement. Quantifying the distribution of comorbidities is critical because it allows us to anticipate, statistically, how the accrual of minorities may be hampered by individual CEC. This in turn can support equity efforts of targeted oversampling and strategic site selection to ensure diverse participants. Citation Format: Ann Oluloro, Mindy Pike, Adrienne Moore, Tiffany Luu, Soledad Jorge, Kemi M. Doll. Tracking the Relationship between Accrual and Comorbidities in Clinical TRrial Enrollment (TRACE) [abstract]. In: Proceedings of the AACR Special Conference on Endometrial Cancer: Transforming Care through Science; 2023 Nov 16-18; Boston, Massachusetts. Philadelphia (PA): AACR; Clin Cancer Res 2024;30(5_Suppl):Abstract nr A001.

A Time-Saving Alternative to "Peak-Picking" Algorithms: A Gaussian Mixture Model Feature Extraction Technique for the Neurodiagnostic Auditory Brainstem Response.

The accurate and efficient analysis of neurodiagnostic auditory brainstem responses (ABR) plays a critical role in assessing auditory pathway function in human and animal research and in clinical diagnosis. Traditional analysis of the neurodiagnostic ABR analysis involves visual inspection of the waveform and manually marking peaks and troughs. Visual inspection is a tedious and time-consuming task, especially in research where there may be hundreds or thousands of waveforms to analyze. "Peak-picking" algorithms have made this task faster; however, they are prone to the same errors as visual inspection. A Gaussian mixture model-based feature extraction technique (GMM-FET) is a descriptive model of ABR morphology and an alternative to peak-picking algorithms. The GMM-FET is capable of modeling multiple waves and accounting for wave interactions, compared with other template-matching approaches that fit single waves. The present study is a secondary analysis applying the GMM-FET to 321 ABRs from adult humans from 2 datasets using different stimuli and recording parameters. Goodness-of-fit of the GMM-FET to waves I and V and surrounding waves, that is, the summating potential and waves IV and VI, was assessed, and latency and amplitude estimations by the GMM-FET were compared with estimations from visual inspection. The GMM-FET had a similar success rate to visual inspection in extracting peak latency and amplitude, and there was low RMS error and high intraclass correlation between the model and response waveform. Mean peak latency differences between the GMM-FET and visual inspection were small, suggesting the two methods chose the same peak in the majority of waveforms. The GMM-FET estimated wave I amplitudes within 0.12 µV of visual inspection, but estimated larger wave V amplitudes than visual inspection. The results suggest the GMM-FET is an appropriate method for extracting peak latencies and amplitudes for neurodiagnostic analysis of ABR waves I and V.

Integrating Navigation-Assisted Ablation in the Locoregional Treatment of Hepatocellular Carcinoma

With the increasing prevalence of hepatocellular carcinoma (HCC), ablative therapy is a critical treatment option to achieve a cancer-free state. The anatomic location of the tumor can be a challenge, and select hepatic locations of a tumor require laparoscopic-assisted strategies to safely reach and treat the lesion. To assess the association of real-time ultrasonography-augmented navigation for HCC ablation with patient survival, operative time, and rate of incomplete ablations. This retrospective case-control study was conducted among a prospectively collected database of more than 750 patients with HCC who were treated with ablation therapy with and without the use of navigation at a single quaternary medical center from June 2011 to January 2021. Data were analyzed from October 2022 through June 2023. Real-time ultrasonography-augmented navigation. The primary outcome was rate of incomplete ablations in patients undergoing HCC ablation with vs without navigation. Secondary outcomes included overall survival (OS), progression-free survival (PFS), and operative time. The analytic cohort included 467 patients (mean [SD] age, 62.4 [7.8] years; 355 male [76.0%]; 21 Hispanic [4.5%], 67 non-Hispanic Black [14.5%], and 347 Non-Hispanic White [75.0%] among 463 patients with race and ethnicity data). The most common etiology of liver disease was hepatitis C infection (187 patients with etiology data [40.0%]), and 348 of 458 patients with TMN staging data (76.0%) had TNM stage 1 disease. There were 187 individuals treated with navigation and 280 individuals treated without navigation. Patients who underwent navigation-assisted ablation were more likely to have stage 2 disease based on TNM staging (62 of 183 patients [33.9%] vs 47 of 275 patients [17.1%] with TMN data; P < .002) and had a higher mean (SD) number of lesions (1.3 [0.5] vs 1.2 [0.5] lesions; P = .002) and a longer mean (SD) operation time (113.2 [29.4] vs 109.6 [32.3] minutes; P = .04). Patients who underwent navigation were also more likely to have tumors in segment 8 (59 patients [32.1%] vs 53 of 275 patients with segment data [19.3%] with segment data; P = .005) and less likely to have tumors in segment 4 (20 patients [10.9%] vs 54 patients with segment data [19.6%]; P = .005). Overall mean (SD) time to recurrence after treatment was 10.0 (12.5) months, with similar rates for patients with navigation vs no navigation. There were no differences in incomplete ablation rate (10 patients [9.2%] vs 10 patients [10.5%]; P = .32), OS, or PFS between patients undergoing ablation with and without navigation. In this study, use of navigation was associated with comparable outcomes to undergoing ablation without navigation, although patients with navigation had more locally advanced disease. These findings suggest that use of real-time navigation in laparoscopic-assisted ablation of liver cancer should be considered as a useful tool for treating challenging tumors.

Patients With and Without Double Crush Syndrome Achieve Similar Rates of Clinical Improvement Following Carpal Tunnel Release.

The purpose of this study is to compare outcomes of carpal tunnel release (CTR) in patients with and without double crush syndrome (DCS), defined as concurrent carpal tunnel syndrome (CTS) and cervical radiculopathy at C5-T1 on preoperative nerve conduction studies. Patients with preoperative nerve conduction studies who underwent unilateral, isolated CTR were retrospectively identified. All patients completed preoperative and 3-month postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) and pain interference (PI), and Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires, and responded to the anchor question: "Since your treatment, how would you rate your overall function?" (much worse, worse, slightly worse, no change, slightly improved, improved, much improved). Preoperative, postoperative, and changes in scores for UE, PI, and QuickDASH were compared, as were the anchor question responses and rates of achieving the minimal clinically important difference (MCID). Sixty-three patients with DCS and 115 patients with CTS only were included. At 3- to 4-month follow-up, absolute and change in UE, PI, and QuickDASH scores were not statistically different between patients with DCS and CTS. Rates of anchor question response and MCID achievement were comparable for patients with CTS only and DCS on each questionnaire. The MCID achievement ranged from 48.4% to 68.8% in the unmatched cohort and 48.4% to 60% in the matched group. At 3 to 4 months, patients with DCS experience similar patient-reported symptomatic and functional improvement, and achieve MCID of outcome measures at comparable rates to patients with CTS only. For patients with nerve compression at the carpal tunnel and cervical spine, CTR is a reasonable first step prior to proceeding with cervical spine decompression.