Status Classification Research Articles

EGS SO11 - A Retrospective Review of Perioperative Outcomes after Laparoscopic Cholecystectomy in Older Patients

Abstract Background Laparoscopic cholecystectomy is the definitive treatment for gallstone-related disease. With an increasingly aging population, a growing number of elderly patients are presenting acutely with gallstone pathology. However, rates of perioperative mortality and complications are significantly higher in elderly patients undergoing laparoscopic cholecystectomy (Kamarajah et al). We aim to evaluate peri-operative outcomes in elderly patients presenting with acute gallstone disease who have been clinically evaluated to be appropriate for emergency cholecystectomy, and explore the impact of frailty on these outcomes. Method A retrospective study was performed on patients over the age of 75 presenting acutely with gallstone disease over a 3-year period. Data on perioperative complications, mortality at 1 year, post-operative length of stay (LOS) and 90-day readmissions were collected and analysed. The patient’s pre-operative fitness was categorized using the ASA classification of physical status and the Clinical frailty score (CFS); a 9-point scale quantifying frailty based on function. Statistical significance was assessed to determine differences between the age or frailty score groups. Results 592 patients attended hospital with gallstone-related pathology; 99 patients underwent emergency laparoscopic cholecystectomy, 486 patients were managed conservatively, and 25 patients had cholecystostomies. The post-operative mortality rate was 4%, post-operative complication 19.2% and readmission rate 11.1%. Post-operative LOS was significantly longer in frailer patients (p=0.02299). There were no statistically significant differences in mortality or post-operative complications between the CFS3 or less and CFS4 or more groups, although a general trend towards higher rates of complications and mortality was noted with increasing frailty. Conclusion Patients over 75 years of age should be carefully considered before proceeding with surgical management. Although older and frailer patients exhibited increased rates of complications and mortality post-operatively, these didn't reach statistical significance, reflecting the role of clinical decision-making regarding surgical fitness. Even for a pre-selected patient group, there is statistically significant prolonged post-operative LOS in frailer patients. This suggests a need for comprehensive preoperative assessment in this population, and a combination of CFS and ASA may be key determinants. Further studies assessing frailty and non-operative outcomes are required to substantiate these findings and guide clinical management in this population.

Frequency of physical activity during leisure time and variables related to pain and pain medication use in Spanish adults: A cross-sectional study

Background Physical inactivity has been identified as a risk factor for pain. Objective The main objective was to analyze the relationships between leisure time physical activity frequency (PAF) and pain prevalence, pain level, pain impairment, daily life pain impairment, and analgesic use in Spanish adults. In addition, risk factors such as sex, body mass index, marital status and social class were assessed for these pain variables in addition to PAF. Method Cross-sectional study based on data from the 2014 and 2020 European Health Surveys in Spain residents. The Chi-square test was used to analyze the relationship of dependence between the variables of interest. A correlation study calculating Spearman’s rho and a multiple logistic regression were performed to assess risk factors for pain variables. Results 20,113 and 19,196 subjects with a median age of 49 and 52 years old in 2014 and 2020 European Health Surveys, respectively, were analyzed. Dependence relationships were found between PAF and pain variables (p<0.001). The prevalence of: pain, high levels of pain, pain impairment, high level of pain impairment and use analgesic were higher in the inactive population than in the rest of the PAF levels (36.7–53%) vs (18.6–44.3%), p<0.05. Weak correlations were found between PAF and pain variables (-0.177 ≤ Rho ≤ -0.107) (p<0.001). Logistics regression show that being active or very active reduces the odds of pain, the intensity of pain and being affected in daily activities due to pain by 0.524 to 0.776 times. Likewise, being active or very active reduces the odds of taking pain medication by 0.661 to 0.755 times. Also age, low social class, being a woman, and being obese increase of odds of pain, pain affectation and use of analgesics in both surveys by 1.008 to 2.202 times. Conclusions Physical inactivity was related to a higher prevalence of: pain, higher levels of pain, higher pain involvement and higher analgesic use. In addition, lower social class, being female, older age, and obesity were factors for higher odds of pain, pain involvement, and analgesic use in both surveys.

Abstract 4112652: Impact of metabolic overweight/obesity phenotypes on clinical outcomes of patients with resectable non-small cell lung cancer in an Asian population

Background: Metabolic syndrome and obesity are known to increase the incidence of lung cancer. We investigated the association between metabolic health and overweight/obesity phenotypes and clinical outcomes in patients with resectable non-small cell lung cancer (NSCLC). Methods: This large retrospective cohort study included adult patients who underwent curative upfront surgery for their stage IA-IIIB NSCLC at a tertiary university hospital from January 2010 to December 2020. They were classified into four phenotypes based on the combination of metabolic health status and body mass index categories: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obesity (MHO), metabolically unhealthy overweight/obesity (MUO). The primary outcomes were disease recurrence and death. Results: Of the 1,513 patients (342 with MHNW, 585 with MUNW, 122 with MHO, and 464 with MUO), patients with the phenotype of MHO were less likely to experience recurrence (MHO [13.1%] vs. MHNW [16.1%] vs. MUNW [22.9%] vs. MUO [19.2%], p = 0.018) and death (MHO [15.6%] vs. MHNW [24.6%] vs. MHUW [31.3%] vs. MUO [24.8%], p < 0.001) compared to those with other 3 phenotypes. Similar results were observed in Kaplan-Meier curves for the primary outcomes according to the four phenotypes (all log-rank P < 0.05). In multivariate Cox regression analyses, both MHO and MUO phenotypes did not increase the risk of recurrence compared to the MHNW phenotype and were associated with improved survival (MHO: adjusted hazard ratio [HR] 0.60, 95% confidence interval [CI] 0.36-0.98, p = 0.040; MUO: adjusted HR 0.76, 95% CI 0.60-0.96, p = 0.022). Conclusions: After curative resection for NSCLC, regardless of metabolic health, patients with overweight/obesity were not at an increased risk of recurrence and paradoxically, had favorable overall survival.

PATH-62. CORRELATES OF NEURAL SIGNALING ELUCIDATE SURVIVAL BENEFIT IN GLIOMAS

Abstract Recent literature has highlighted neural signaling markers (SM) as drivers for synaptogenesis, invasion, and proliferation in gliomas. Further work on elucidating key mutations can provide improved prognostication and potential treatment targets. Our objective is to identify correlates of neural signaling in relation to glioma histopathology and patient outcomes. We used a combination of bulk RNA sequencing (RNA-seq) and a DNA gene panel (DPG) by Tempus next-generation sequencing. Differential gene expression (DGE) was performed using DESeq2 after subsetting genes for neural SM. Dimensionality reduction was applied through t-SNE projections. Variant calls were analyzed using EnsemblVEP and maftools. Survival analysis was determined through log-rank tests. All analyses were conducted with R. 176 and 184 patient samples were analyzed for RNA-seq and DPG, respectively. t-SNE of DGE highlights two distinct functional clusters with no correlation to WHO classification status (Chi-squared p = 0.39) The median survival for the big cluster was observed at 957 days, while no median survival was reached even after 4,420 days of follow-up in the small cluster (p = 0.01). This contrast remains consistent when examining subsets of gliomas with unmethylated MGMT promoter (p = 0.02) and glioblastomas (p = 0.02), but not others such as IDH mutation status and low-grade gliomas (p > 0.1). Genes upregulated in the small cluster had equal representation of synaptic and paracrine SM (45% and 55%), while the big cluster had a greater representation of paracrine SM (69% and 31%). DPG of low-grade gliomas highlighted 3 somatic signaling mutations (FGFR1, PTPRD, and SLIT2) that are more prevalent in the big cluster. Functional classification based on neural signaling markers can elucidate a novel set of biomarkers that may impact survival in glioma patients. Further studies are required to validate such findings and develop therapeutic targets.

DISP-05. SUPERVISED MACHINE LEARNING PREDICTION OF THERAPEUTIC CLINICAL TRIAL ENROLLMENT FOR MINORITY PATIENTS AND WOMEN IN NEURO-ONCOLOGY

Abstract BACKGROUND Despite changes in national policy, women and minority patients remain under-accrued in glioma clinical trials. Supervised machine learning may serve as a novel approach to understanding which variables and their complex interplay most influence enrollment for underrepresented patients. We aimed to design and externally validate machine learning models to predict therapeutic clinical trial enrollment for a) all patients, b) women, and c) NIH-designated minority patients with low- and high-grade glioma. METHODS In a 20-year retrospective cohort of 1042 adult patients with low- and high-grade glioma, boosted neural network (BNN) models for the whole, women, and minority cohorts were used to analyze the combined effects of demographic, socioeconomic, and oncologic variables on clinical trial enrollment. These models were validated using an external cohort (n=103). RESULTS In the development cohort (445 [42.7%] women; 151 [14.5%] minorities; median age, 51.5 [interquartile range: 39.4-62.5] years), 350 patients (33.6%) enrolled in a therapeutic clinical trial. The whole cohort BNN (AUC: 0.827, misclassification rate (MR): 0.175), the women cohort BNN (AUC: 0.895, MR: 0.125), and the minority cohort BNN (AUC: 0.983, MR: 0.053) models accurately predicted trial enrollment on external validation. For the whole cohort and women models, several demographic (race, ethnicity, minority status, sex), socioeconomic (insurance, employment status), and oncologic variables (seizure, chemotherapy, KPS, WHO grade, tumor lobe) were equally influential (Main effect (ME): 1.000, Total effect (TE): 1.000) on enrollment. For the minority model, socioeconomic variables including insurance status (ME: 0.089, TE: 0.417) and occupation classification (ME: 0.087, TE: 0.381) drove enrollment. CONCLUSION We designed and externally validated the first machine learning model for predicting therapeutic clinical trial enrollment for patients with diffuse glioma. Model features driving trial enrollment varied for underrepresented patients. These results may help prioritize personalized patient-specific initiatives to address barriers to equitable patient accrual.

Drawing a Long Shadow: Analyzing Spatial Segregation of Afghan Immigrants in Tehran

Although recent dramatic political changes in Afghanistan have brought that country to global attention, migration from Afghanistan to Iran has a long history. Nearly three quarters of Afghan immigrants in Iran are located in cities, particularly in Tehran’s metropolitan area. However, despite the long-term presence of Afghan immigrants in Iran, research on patterns and drivers of spatial segregation of immigrants has been very limited. The research method involves a secondary analysis of census data. Therefore, this article utilizes 2006 Iran census tract data to examine patterns of spatial segregation of Afghan immigrants in the Tehran metropolis. The required data for two-group segregation indices, Getis–Ord statistics, and Geographically Weighted Regression, were analyzed as a map using ArcMap and Geo-Segregation Analyzer. The results reveal that the spatial segregation of Afghans is high and that most live in lower-SES census tracts. Multivariable analyses indicate that the extent of segregation can be explained by education, job class, and generation status. It can be concluded that generational transition and access to human capital have reduced various indicators of spatial segregation of Afghan immigrants in Tehran.

SURG-47. SUPRAMAXIMAL RESECTION IMPROVES OVERALL SURVIVAL IN PATIENTS WITH MGMT-UNMETHYLATED GLIOBLASTOMA

Abstract INTRODUCTION Glioblastoma is highly resistant to radio- and chemotherapy and its heterogeneity is a therapeutic challenge. O6-methylguanine–DNA methyltransferase (MGMT) promotor methylation is an established biomarker for favorable effect of chemotherapy. Supramaximal resection has proven predict the best overall survival (OS), but whether this benefit applies equally to patients with different MGMT-promotor methylation status is still to be debated. MATERIAL AND METHODS Population based retrospective study that examined all adult patients in South-Eastern Norway that underwent resection for IDH wildtype glioblastoma between January 2019 and December 2021. Extent of resection (EOR) was classified according to RANO resect classification and MGMT-promotor methylation status by pyrosequencing-qPCR. RESULTS The study included 281 patients. MGMT-promotor methylated patients (MGMT+) had a median OS of 18.4 months compared to 13.1 months in MGMT-unmethylated (MGMT-) patients (p<0.0001). Patients with supramaximal resection had a median OS of 20.4 months compared to 14.9 months (p<0.01) with maximal resection. For patients with supramaximal resection we found no significant difference in median OS (25.5 vs. 18.3 months (p=0.24)) dependent on MGMT-status. Separated analysis between MGMT-status and EOR showed a median survival of 18.3, 13.4 (p<0.001), and 8.5 (p<0.001) months for MGMT-, and 25.5, 18.4 (p=.99), and 9.0 (p<0.001) months for MGMT+ in patients where supramaximal-, maximal-, and submaximal resection was achieved, respectively. CONCLUSIONS Patients with supramaximal resection and MGMT+ have a 50% 2-years survival probability. In patients where supramaximal resection was achieved, survival benefit was not dependent on MGMT-status. There was a significant improved survival in MGMT- patients between supramaximal and maximal resection, that was not present for MGMT+ patients. Intraoperative molecular diagnosis has the potential to guide the surgical strategy dependent on MGMT-promotor methylation status, especially in tumors where supramaximal resection has a higher risk of new neurological deficits.

Effective blind bilateral superficial cervical plexus block for tracheostomy tube insertion in a geriatric patient with Ludwig angina with hypertension in resource constrained area: a case report

IntroductionLudwig angina is a rare, rapidly spreading submaxillary, submandibular, and sublingual necrotizing life-threatening widespread cellulitis of the soft tissue on the floor of the mouth that can cause fatal complications because of airway obstruction. Currently, there are few published studies assessing the efficacy of superficial cervical plexus block for airway surgery and there is no agreement in the literature about airway management. The published recommendations differ and are based on the authors’ own experiences and available resources. This report aimed to provide insight into critical patient management by performing regional anesthesia with fewer complications to the cardiovascular and respiratory systems.Case presentationWe report the case of a 70 year-old hypertensive Black Ethiopian woman with American Society of Anesthesiologist–Physical Status class III and hypertension, who was admitted to the hospital for treatment by her surgeon. The surgeon diagnosed her with Ludwig angina. After adequate physical examination and laboratory investigation, she arrived at the operation room for exploration and drainage of the abscess with a superficial cervical plexus block. She arrived safely at the adult intensive care unit for frequent suctioning. The block was effective until 6 h after the procedure with visual analogue scale (2/10), her vital signs remained stable throughout the postoperative period, and then the tracheostomy tube was removed by the surgeon after 10 days. The patient’s hemodynamic status and breathing effort were satisfactory, and she was discharged 15 days later.Clinical discussionProper airway management is critical for the survival of patients diagnosed with Ludwig angina. According to recent studies, an increasing number of patients with Ludwig angina require intensive care unit admission for tracheal intubation and mechanical breathing. However, it is uncertain whether intensive care reduces the death rate in patients with Ludwig angina. Finally, it is suggested that studies with large sample sizes and strong levels of evidence be conducted to conclude the effectiveness of superficial cervical plexus block for airway emergency surgeries.ConclusionManagement of the airway in patients with Ludwig angina is challenging. Clinicians must take precautions and make sharp decisions on the basis of a variety of circumstances, including the availability of equipment at medical facilities, such as fiberoptic intubation equipment; the anesthetist’s level of experience, such as performing superficial regional block and good mask ventilation; and the patient’s medical status at the time of presentation. As a result, intervention needs to be quick so as to avoid airway obstruction and further complications.

Attitude and Practice towards Pre-exposure Prophylaxis (PrEP) for HIV Prevention among Female Sex Workers in Kicukiro District, Rwanda

This study aimed to assess the attitude, and Practice of female sex workers towards Pre-exposure Prophylaxis for HIV prevention in the Kicukiro district, Rwanda. The study used a descriptive cross-sectional design, using a probability sampling method, and the Yamane formula was used to calculate the sample size of 300 female sex workers including a 10% non-response rate. Primary data was collected using a structured questionnaire, at 10 health centers. Analysis was conducted using IBM SPSS software, with chi-square tests and logistic regression for inferential analysis. The ethical clearance was acquired from the Mount Kenya University ethics committee and the Young Women Christian Association Rwanda. The study findings showed that (60%) of female sex workers have a positive attitude towards PrEP, and 60.4% of respondents were using PrEP. Demographic factors like age group, marital status, and Ubudehe category were significantly associated with practices. Female sex workers aged between 25 and 29 had 4 times more chance to have good practices. This study provides insights into improving PrEP education and interventions targeting female sex workers and other key populations. These findings highlighted the concerns about stigma and privacy, and the need for public health interventions that target it in the community.

Not Like Everybody Else but We're the Same: Psychosocial Variables Compared Across Diverse Sexual and Gender Identities.

Sexual and gender minority (SGM) people are underrepresented in psychological research. Part of the underrepresentation of SGM people likely stems from potential participants' unwillingness to join a study, but more concerningly, researchers exclude data from SGM participants. Furthermore, much of SGM research focuses on existing health disparities and risk factors rather than wellness-framed and personality research. To fill in this gap, the current study aims to quantify effect sizes of similarities/differences across a broad range of psychosocial measures. Applying the framework of the Gender Similarities Hypothesis, we compare means, variances, and correlations across 34 psychosocial variables between categories of SGM, gender identity, sexual orientation, relationship status, and monogamy (N = 1743). Data was collected online mainly through paid ads on Instagram. Consistently, we find largely similarities across gender identity, sexual orientation, and relationship structure categories. These results support a general expectation that similarities are more common than differences in normative psychological domains, although clear differences in means and variances exist for specific experiences and outcomes. This work informs the inclusion of diverse identities in basic psychological research and further speaks to the generalizability of past findings to populations historically underrepresented in psychological science.

The Impact of Salvage Logging on Deadwood Decomposition and Forest Regeneration: A Case Study in Tatra National Park, Slovakia

In November 2004, a severe windstorm destroyed large portions of the spruce-dominated forests in the Tatra National Park (northern Slovakia). This study focused on the status of deadwood and its influence on post-disturbance forest regeneration 18 years after the destruction. Since some disturbed areas were salvaged and others were not, we could compare the situations between these two management approaches. Therefore, 40 research sites (20 salvaged and 20 unsalvaged) were analyzed; each contained four satellite plots, i.e., circle-like areas with a radius of 3 m. We measured the diameter of deadwood and its decay status (classes 1–5) and recorded the sizes (stem base diameter and height) as well as species of young trees. Our results showed that while salvage conditions and contact with soil stimulated deadwood decomposition, the diameter of logs was not a significant factor. The highest decay class (3.83) was found in deadwood in salvaged areas and touching the soil, while the lowest decay class (3.10) was found in deadwood in unsalvaged areas and in the case of logs not touching the soil. Although carbon content (based on the percentage of wood mass) did not change with the decay class, wood density decreased sharply with decay, and deadwood moisture increased. We also found that the different post-disturbance management strategies influenced forest regeneration. Significantly higher tree diversity was observed in salvaged sites (5.40 species per plot) compared to unsalvaged sites (3.85 species per plot). At the same time, while sites with logging were predominantly covered by broadleaved species, those without logging were typically dominated by Norway spruce (Picea abies L. Karst). Our findings suggest that although salvage logging reduced the carbon and total water content in deadwood, it can promote tree species diversity. Therefore, the currently prevailing opinion about the exclusively negative effects of salvage logging on the forest environment should be accepted with caution, and local conditions must be considered before making broad judgments.

Development and validation of prediction models for prehospital triage of military trauma patients.

The introduction of wireless sensors will enable military care providers to continuously and remotely assess/monitor vital signs. Prediction models are needed to use such data adequately and aid military care providers in their on-scene decision-making to optimise prehospital triage and improve patient outcomes. A prospective cohort comprising data from eight Emergency Medical Services and seven inclusive trauma regions was used to develop and validate prediction models that could aid military care providers in their prehospital triage decisions. Healthy (American Society of Anesthesiologists physical status classification 1 or 2) admitted adult trauma patients (aged ≥16 and ≤50 years), who suffered from a trauma mechanism that could occur to military personnel and were transported by ambulance from the scene of injury to a hospital, were included. A full model strategy was used, including prehospital predictors that are expected to be automaticly collectible by wireless sensors or to be incorporated in a personalised device that could run the models. Models were developed to predict early critical-resource use (ECRU), severe head injury (Abbreviated Injury Scale (AIS) ≥4), serious thoracic injury (AIS ≥3) and severe internal bleeding (>20% blood loss). Model performance was evaluated in terms of discrimination and calibration. Prediction models were developed with data from 4625 patients (80.0%) and validated with data from 1157 patients (20.0%). The models had good to excellent discriminative performance for the predicted outcomes in the validation cohort, with an area under the curve of 0.80 (95% CI 0.76 to 0.84) for ECRU, 0.83 (0.76 to 0.91) for severe head injury, 0.75 (0.70 to 0.80) for serious thoracic injury and 0.85 (0.78 to 0.93) for severe internal bleeding. All models showed satisfactory calibration in the validation cohort. The developed models could reliably predict outcomes in a simulated military trauma population and potentially support prehospital care providers in their triage decisions.

Comparative prognostic value of tumor volume in IOIO and IOTKI treatment for metastatic renal cancer

ObjectivesWe aimed to investigate the prognostic significance of tumor size in metastatic renal cell carcinoma (mRCC) by comparing the effectiveness of dual immune checkpoint inhibitor (IOIO) and immune checkpoint inhibitor combined with tyrosine kinase inhibitor (IOTKI) therapies. MethodsThis retrospective observational study included patients with mRCC diagnosed between October 2014 and February 2024 who received IOIO or IOTKI treatment at Kobe University Hospital and 5 affiliated hospitals. Clinical and imaging data were collected, and target lesions were measured according to RECIST v.1.1 criteria. Time-dependent ROC curve analysis was performed to evaluate the prognostic value of tumor size, nephrectomy status, and IMDC risk criteria for progression-free survival (PFS) and overall survival (OS). ResultsThe study included 180 mRCC patients, consisting of 99 receiving IOIO therapy and 81 receiving IOTKI therapy. Time-dependent AUC analysis showed that tumor size had a higher predictive ability for PFS and OS in the IOIO group than the IOTKI group. In multivariate analysis, tumor size was a significant independent prognostic factor for PFS (HR: 1.010, 95% CI: 1.004–1.016, P < 0.001) in the IOIO group. Moreover, the AUC for tumor size was consistently superior in predicting outcomes compared to nephrectomy status and IMDC risk classification in the IOIO group. Kaplan-Meier curves indicated that tumor size effectively stratified PFS in both nephrectomized and non-nephrectomized cases. ConclusionTumor size significantly impacts the prognosis of mRCC patients treated with IOIO therapy, demonstrating greater predictive ability than nephrectomy status and IMDC risk classification. These findings suggest that tumor volume should be considered a critical factor in treatment decision-making for renal cancer, particularly in patients undergoing IOIO therapy.

Approaches and processes for paediatric chest X-ray classification used in the SHINE TB treatment-shortening trial.

<sec><title>INTRODUCTION</title>SHINE (Shorter Treatment for Minimal Tuberculosis in Children) was the first Phase 3 paediatric TB treatment-shortening trial. Robust chest X-ray (CXR) classification methods were integral to excluding severe disease for trial eligibility and to retrospectively adjudicating TB status at baseline. We describe and critically evaluate the CXR classification approaches and processes used in the SHINE trial.</sec><sec><title>METHODS</title>Children with non-severe TB were randomised to 4- vs 6-months anti-TB treatment. Radiologically non-severe TB was defined on CXR. CXRs were systematically interpreted by on-site clinicians prospectively for eligibility determination and retrospectively by experts to inform adjudication of baseline TB status and disease severity.</sec><sec><title>RESULTS</title>A screening CXR was successfully obtained from all 1,204 enrolled children; 1,134 CXRs from children with intra-thoracic TB were reviewed by expert readers. Compared with the expert panel, enrolling clinicians classified more CXRs as abnormal and 'typical TB' and all as radiologically non-severe. The expert panel retrospectively classified 71/1,134 (6%) CXRs as severe. Of these, 4 (5.6%) had unfavourable outcomes compared with 34 (3.0%) in the trial overall.</sec><sec><title>DISCUSSION</title>Using CXRs to classify radiological disease severity and inform eligibility decisions in real-time by local enrolling clinicians was feasible and safe in this large paediatric TB trial. Retrospective central expert CXR review was successful. Refinement of the CXR methods for the classification of both disease severity and TB status could support standardised implementation in routine care and research.</sec>.

Unlocking Insights: Using Machine Learning to Identify Wasting and Risk Factors in Egyptian Children Under 5

Introduction: Malnutrition, particularly wasting, continues to be a significant public health issue among children under five years in Egypt. Despite global advancements in child health, the prevalence of wasting remains a critical concern. This study employs machine learning techniques to identify and analyze the determinants of wasting in this population. Aim: To evaluate the prevalence of wasting among children under five years in Egypt and identify key factors associated with wasting using machine learning models.Methods: This study is based on secondary data sourced from the Demographic and Health Surveys (DHS), conducted in 2005, 2008, and 2014. Six machine learning classifiers (XGBoost, Logistic Regression, Random Forest, Gradient Boosting, K-Nearest Neighbor, and Decision Tree) were applied to the dataset. The study included children under five years of age, focusing on nutritional status, maternal health, and socio-economic factors. The dataset was cleaned, preprocessed, encoded using one-hot encoding, and split into training (70%) and test (30%) sets. Additionally, k-fold cross-validation and the StandardScaler function from Scikit-learn were used. Performance metrics such as accuracy, precision, recall, F1 score, and ROC-AUC were used to evaluate and compare the algorithms.Results: It was observed that 76.2% of the children in the dataset have normal nutritional status. Furthermore, 5.2% were found to be suffering from wasting (1.7% experiencing severe wasting and 3.5% moderate wasting), with notable regional disparities. The XGBoost model outperformed other models. Its efficiency metrics include an accuracy of 94.8%, precision of 94.7%, recall of 94.7%, F1 score of 94.7%, and an ROC-AUC of 99.4%. These results indicate that XGBoost was highly effective in predicting wasting.Conclusion: Machine learning techniques, particularly XGBoost, show significant potential for improving the classification of nutritional status and addressing wasting among children in Egypt. However, the limitations in simpler models highlight the need for further research to refine predictive tools and develop targeted interventions. Addressing the identified determinants of wasting can contribute to more effective public health strategies.

Lessons learned from implementing laparoscopic common bile duct exploration at a safety net hospital

BackgroundMounting evidence favors one-stage laparoscopic cholecystectomy with common bile duct exploration over endoscopic retrograde cholangiopancreatography with cholecystectomy for choledocholithiasis. However, laparoscopic cholecystectomy with common bile duct exploration remains underused. In 2020, our center initiated a laparoscopic cholecystectomy with common bile duct exploration program for choledocholithiasis. This study compares the experience and outcomes of laparoscopic cholecystectomy with common bile duct exploration compared with endoscopic retrograde cholangiopancreatography with cholecystectomy at a safety net hospital. MethodsThis single-center, retrospective study analyzed data from 179 patients admitted with choledocholithiasis from 2019 to 2023. Demographics, preoperative investigations, intraoperative details, and postoperative outcomes were evaluated. ResultsThe study included 179 patients (55.6 ± 21.0 years, 66% female) with American Society of Anesthesiologists Physical Status Classification System score III (II–III) and body mass index 29 kg/m2 (25.8–35.5 kg/m2). Of these, 148 underwent endoscopic retrograde cholangiopancreatography with cholecystectomy and 31 underwent laparoscopic cholecystectomy with common bile duct exploration. Demographic and preoperative data were similar between groups. Laparoscopic cholecystectomy with common bile duct exploration achieved a 74.2% success rate. Laparoscopic cholecystectomy with common bile duct exploration’s average operative time was 180 (139–213) minutes, with a 3.2% postoperative bile leak and 35.4% requiring postoperative ERCP. Median lengths of stay were 3 (1–4) for laparoscopic cholecystectomy with common bile duct exploration and 4 days (3–7) for endoscopic retrograde cholangiopancreatography with cholecystectomy (Z = –3.16, P = .002). The number of readmissions were 1.2 ± 0.4 for laparoscopic cholecystectomy with common bile duct exploration and 1.9 ± 1.3 for endoscopic retrograde cholangiopancreatography with cholecystectomy (t = 1.43, P = .08). Additional procedures for choledocholithiasis were performed in 36% of laparoscopic cholecystectomy with common bile duct exploration and 79% of ERCP + LC cases (χ2 = 21.7, P < .0001). ConclusionThe study highlights challenges in implementing laparoscopic cholecystectomy with common bile duct exploration at a safety net hospital. Results support laparoscopic cholecystectomy with common bile duct exploration over endoscopic retrograde cholangiopancreatography, with cholecystectomy, with shorter stays, fewer readmissions, and fewer additional procedures reported. Laparoscopic cholecystectomy with common bile duct exploration remains underused, with only 17.3% of patients who underwent one-stage laparoscopic cholecystectomy with common bile duct exploration. Further research is needed for laparoscopic cholecystectomy with common bile duct exploration’s expansion as the superior choledocholithiasis treatment.

Antibiotics Prophylaxis for Elective Pediatric Laparoscopic Cholecystectomies

BackgroundThe Surgical Infection Society (SIS) guidelines recommend against the use of surgical antibiotic prophylaxis (SAP) for low-risk patients undergoing elective laparoscopic cholecystectomies. MethodsUsing National Surgical Quality Improvement Program (NSQIP) data, 5,440 pediatric patients were identified who underwent laparoscopic cholecystectomy from 2021-2022. Patients who had immunodeficiency, active malignancy, American Society of Anesthesiologists (ASA) physical status classification 3-5, procedure indicated for infection, emergent procedure, received intravenous antibiotics before the prophylaxis window, or missing SAP data were excluded. Results3,959 patients were included in the analysis. Among these patients, 3,570 (90.2%) received SAP. Overall incidence of 30-day superficial incisional surgical site infection (SSI), deep incisional SSI, and organ space SSI were 0.9%, 0.0%, and 0.1%, respectively. The incidence of superficial incisional SSI was significantly higher in the patients who did not receive SAP (SAP 0.8%, no SAP 2.1%; p=0.024). The incidence of organ space SSI was also significantly higher in the patients who did not receive SAP (SAP 0.1%, no SAP 0.8%; p=0.008). There was no difference in the incidence of C. diff colitis (SAP 0.1%, no SAP 0.0%; p=1.000). Multivariable modeling, controlling for Hispanic ethnicity, age, and gender, demonstrated patients that received SAP were significantly less likely to have any postoperative SSI compared to patients who did not receive SAP (OR=0.35). ConclusionHospitals are not currently compliant with SIS guidelines regarding omission of antibiotic prophylaxis for low-risk patients undergoing elective laparoscopic cholecystectomies. The authors advocate for additional studies and reassessment of current guidelines for pediatric patients given the above findings. Type of StudyRetrospective comparative study Level of EvidenceIII

Association between sarcopenic obesity and osteoarthritis: The potential mediating role of insulin resistance

BackgroundSarcopenic obesity (SO) and osteoarthritis (OA) are highly prevalent musculoskeletal conditions that significantly impair health-related quality of life. AimThis study investigated the association between SO and OA, and explored the potential mediating role of insulin resistance in this relationship. We utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. MethodsThis cross-sectional analysis employs NHANES data collected from 1999 to 2018, including participants aged 18 years and older. SO was assessed using dual-energy X-ray absorptiometry (DXA) measurements. Insulin resistance was estimated using the triglyceride-glucose (TyG) index. OA status was based on self-reported physician diagnosis. Statistical analyses included weighted logistic regression, restricted cubic spline (RCS) interaction analysis, mediation analysis using structural equation modeling (SEM), and receiver operating characteristic (ROC) curve analysis. Subgroup analyses were conducted based on age, sex, and diabetes status. ResultsThe sarcopenic obese group demonstrated the highest prevalence of OA (23.4 %), hypertension (47.8 %), and diabetes (12.0 %). Additionally, they exhibited elevated levels of triglycerides, cholesterol, glucose, blood urea nitrogen (BUN), creatinine, and uric acid. Logistic regression revealed significant positive associations between sarcopenic obesity, the TyG index, and OA risk. RCS analysis identified significant non-linear relationships and interactions of the TyG index with age, sex, and diabetes status on OA risk. Mediation analysis indicated that the TyG index mediated approximately 4.9 % of the effect of sarcopenic obesity on OA risk. ROC curve analysis demonstrated moderate diagnostic accuracy for the TyG index (AUC = 0.65), which improved when incorporated into the multivariate model (AUC = 0.78). Subgroup analyses confirmed significant associations between the TyG index and sarcopenic obesity with OA risk across different age, sex, and diabetes status categories. ConclusionOur findings suggest a significant correlation between insulin resistance, as measured by the TyG index, and elevated OA risk in individuals with sarcopenic obesity. Targeting insulin resistance through future research may be a promising avenue to lower OA risk in this population.

SEPSIGN: early identification of sepsis signs in emergency department.

Because 20-30% of patients with sepsis deteriorate to critical illness, biomarkers that provide accurate early prognosis may identify which patients need more intensive treatment versus safe early discharge. The objective was to test the performance of sVEGFR2, suPAR and PCT, alone or combined with clinical signs and symptoms, for the prediction of clinical deterioration. This prospective observational study enrolled patients with suspected infection who met SIRS criteria without organ dysfunction (delta SOFA <2 from baseline) from 16 emergency departments. The primary endpoint was clinical deterioration (increased SOFA score ≥2 points, new or increased organ support, or death) within 72 hours of enrollment. Diagnosis and classification of infection status were adjudicated. 724 patients were enrolled, (54% men, median age 55 [38-70] y-o). Infection origin was abdominopelvic (21%), skin and soft tissues (17%), urinary (16%) and pulmonary (15%). 176 (24%) patients deteriorated, with a 28-day mortality of 1.4%. They had lower sVEGFR2 level (6.17 [5.00-7.40] vs 6.52 [5.40-7.84], p=0.024), higher circulating suPAR (5.25 [3.86-7.50] vs 4.18 [3.16-5.68], p<0.001) and higher PCT level (0.32 [0.08-1.80] vs 0.18 [0.05-0.98], p=0.004). suPAR demonstrated superior performance (AUC=0.65 [0.60-0.70]), compared to other biomarkers (PCT, AUC=0.57 [0.52-0.62] and sVEGFR2, AUC=0.58 [0.53-0.64]). Maximum accuracy was achieved from the combination of clinical information, sVEGFR2 and suPAR, yielding an AUC of 0.74 [0.69-0.78] and NPV 0.90 [0.88-0.94]. sVEGFR2 and suPAR were insufficiently accurate to rule out clinical deterioration. Panels of biomarkers will likely be needed to capture the heterogeneous mechanistic pathways involved in sepsis-related organ failure.

Exploring Serum Ferritin's Connection to the Acute Phase Response in Zoo-Managed African Rhinoceroses.

Despite serum ferritin's potential as an iron status indicator, its concentrations vary significantly throughout a black rhinoceros's (Diceros bicornis) life, sometimes irrespective of iron load. We explored acute phase response-related biomarkers, serum amyloid A (SAA) and ceruloplasmin (Cp), to better understand the mechanisms influencing serum ferritin changes in managed black rhinoceroses. The objective was to evaluate the relationships between circulating levels of ferritin, SAA, and Cp in black and white rhinoceroses (Ceratotherium simum). We analyzed banked serum samples collected serially from 11 black (n = 222) and 7 white (n = 134), rhinoceroses (rhinos) and classified samples based on SAA values: clinically healthy (< 1 mg/L), subclinical (1-7 mg/L), or clinically abnormal (> 7 mg/L). In black rhinos, serum ferritin was not different between health status categories (p = 0.5292), nor was it correlated with SAA (p = 0.4164). However, Cp activity was significantly lower in clinically healthy sera (p < 0.0001) and had a moderate positive association with SAA (r = 0.477, p < 0.0001). Among the white rhino samples, only five had SAA values greater than 1 mg/L, limiting the assessment of ferritin and Cp activity in the health context. Minor, yet significant, relationships were observed between serum ferritin and Cp activity, negative in black rhinos (r = -0.206; p = 0.0022) and positive in white rhinos (r = 0.289, p = 0.0008). Cp activity may aid in diagnosing illness in black and white rhinos, based on values observed in sera collected near the time of death. However, acute inflammatory processes do not appear to be one of the primary drivers of the high ferritin concentrations detected in some black rhinos.