Strong Predictive Factor Research Articles

Determinants of Success in Revision Cochlear Implant Surgeries: A Comprehensive Evaluation of Patient, Surgical, and Radiological Factors

Background/Objectives: This study aims to evaluate factors influencing revision cochlear implant surgeries, including patient demographics, surgical techniques, and radiological findings. The main aim was to identify factors influencing surgical success to inform clinical treatment and enhance patient outcomes. Methods: This cross-sectional study included adult patients over the age of 18 who underwent revision cochlear implant surgery due to implant-related complications. Data were collected from systematic chart reviews of electronic medical records, including demographics, surgical techniques, radiological output from standard high-resolution CT and MRI, and intraoperative data. The primary outcome was surgical success, defined by improved auditory function, stable device positioning, and absence of postoperative complications. Statistical analyses, including multivariate logistic regression, were conducted to identify independent predictors of surgical success. Results: A total of 188 patients were included, with a mean age of 45.67 years. Younger age, shorter duration of implant use, modified surgical techniques, and absence of co-morbidities are key factors contributing to surgical success. Modified surgical techniques were associated with better outcomes (39.29% vs. 68.75%, OR: 2.78, 95% CI: 1.25–6.14, p = 0.012). Radiological patterns significantly affected outcomes, with normal findings associated with higher success rates. In contrast, abnormalities such as electrode migration (OR: 2.14, 95% CI: 1.12–4.09, p = 0.021) and ossification (r = −0.51, β = −0.44, adjusted R2 = 0.25, p < 0.01) were correlated with poorer results. Smoking status, when comparing smokers to non-smokers, was associated with unfavorable outcomes (20.00% vs. 45.83%, OR: 2.01, 95% CI: 1.01–4.01, p = 0.048), and a history of previous surgeries (21.43% vs. 37.50%, OR: 1.95, 95% CI: 1.03–3.71, p = 0.033) was significantly associated with unfavorable outcomes. Conclusions: Statistically, significantly better outcomes are positively correlated with the duration of the first cochlear implant experience and negatively with prior otologic pathology and nonauditory environmental influences on surgical success. Younger age, modified surgical techniques, and normal radiological findings were related to better outcomes; complications such as electrode migration and ectopic ossification were strong predictive factors for surgical failure. These findings underscore the need for tailored surgical approaches and early intervention to enhance outcomes in revision cochlear implant surgeries.

Uncontrolled hypertension is associated with higher perioperative mortality, prolonged ICU stay, and increased cardiac complications versus controlled hypertension after Endovascular Aneurysm Repair

Hypertension (HTN) has been well documented as a strong predictive factor for worse outcomes in patients undergoing various cardiovascular procedures. However, limited research has investigated the effect of controlled versus uncontrolled hypertension preoperatively in patients undergoing elective Endovascular Aneurysm Repair. Using a national database, we aimed to determine whether there are significant differences in outcomes between these two groups to improve quality of care and preoperative management. We studied patients undergoing Endovascular Aneurysm Repair in the Vascular Quality Initiative from 2020 to 2023. Patients were categorized into three groups: no history of hypertension, controlled hypertension, and uncontrolled hypertension. The definition of HTN in this study was based on documented history of HTN or recorded blood pressures on three or more occasions before the procedure. Patients with controlled hypertension included patients treated with medication and having a blood pressure <130/80. Patients with uncontrolled hypertension had a blood pressure >130/80. Our primary outcome was perioperative death. Secondary outcomes included myocardial infarction and other cardiac complications, pulmonary complications, bowel and leg ischemia, acute kidney injury and prolonged ICU length of stay (>1 day). We used logistic regression models for a multivariate analysis, controlling for confounding variables. A total of 11,938 (34.6%) no hypertension patients, 17,926 (52.0%) controlled hypertension patients, and 4,598 (13.3%) uncontrolled hypertension patients were analyzed. Patients with controlled hypertension and uncontrolled hypertension had higher rates of comorbidities including prior coronary artery disease, diabetes, and congestive heart failure and were more likely receiving aspirin and statin compared to patients with no HTN. In the multivariate analysis, uncontrolled hypertension patients had higher risk of perioperative death (aOR:2.64;95%CI[1.44-4.88];p=0.002), and prolonged ICU length of stay (aOR:1.52;95%CI[1.25-1.83];p<0.001) compared to no hypertension patients. Patients with controlled hypertension patients had a significantly lower rate of perioperative death (aOR:0.60;95%CI[0.38 - 0.96];p=0.029), cardiac complications (aOR:0.60;95%CI[0.38 - 0.99];p=0.036), and prolonged ICU length of stay (aOR=0.55;95%CI[0.46-0.66];p<0.001) compared with uncontrolled hypertension patients. Notably, there was no significant difference in perioperative mortality or in-hospital complications between patients with controlled hypertension and those with no history of hypertension. Patients with uncontrolled hypertension are more likely to experience worse outcomes-including perioperative death, cardiac complications, and prolonged ICU stay-compared to patients with no hypertension and those with controlled hypertension. Patients with controlled hypertension had similar outcomes to patients with no hypertension. These results highlight the importance of regulating blood pressures prior to undergoing elective Endovascular Aneurysm Repair to improve patients' overall outcomes. Further studies may add more insight into the optimal duration of blood pressure control prior to Endovascular Aneurysm Repair.

Low Skeletal Muscle Mass: A Strong Predictive Factor for Surgical Complications After Free Forearm Flap Reconstruction in Oral Cancer Patients.

Low skeletal muscle mass (SMM) is a predictive factor for complications in patients undergoing major head and neck cancer surgery. This study aims to identify the predictive value of low SMM for postoperative complications in patients who underwent free forearm flap (FAFF) reconstructions after oral cancer resections. A retrospective study was performed with all patients who underwent FFAF between 2003 and 2020 for an oral cavity reconstruction after cancer ablation. Free flap related, any postoperative complications and hospital stay were investigated. Low SMM was associated with an increased risk of free flap associated complications (OR 2.14; 95% CI 1.02-4.39, p = 0.029). Low SMM was associated with severe complications (Clavien-Dindo ≥ III) (OR 1.46; 95% CI 1.20-2.09, p = 0.02). Low SMM is a strong predictive factor for free flap related surgical complications in patients undergoing FAFF reconstruction after resection of oral cancer.

Association of ABO blood group with blood pressure in healthy adults of districts Hyderabad Pakistan

BackgroundIncreased blood pressure is called a “silent killer” as it is often asymptomatic and can persist without the knowledge of the sufferer. It is one of the most prevalent and strong predictive factors for cardiovascular diseases.MethodologyThis cross-sectional study was conducted to find out any association of the ABO blood group with blood pressure and includes 581 randomly selected subjects from the different organizations of district Hyderabad including Universities, colleges, Hospitals, their students, faculty members, and their employees. This study was conducted from February 2021 to January 2022. Informed consent was obtained from volunteers. A detailed history was taken followed by a thorough clinical examination. Blood pressure was recorded with a mercury sphygmomanometer in sitting position. Blood grouping was done by ABO typing. Data obtained were analyzed by SPSS version 23.0.ResultsIn this study, the B blood group participants were 205 (34.22%) was found more prevalent in district Hyderabad, the mean systolic blood pressure was 119.10 ± 16.57, and the mean diastolic blood pressure was 78.89 ± 29.85. and in blood group B participants systolic blood pressure was found 46.82% and diastolic blood pressure was found 43.90% also in B blood group participants followed by A, O, and AB.ConclusionThe incidence of hypertension is high in Pakistan as found in other developing countries. In this study, the evidence is suggestive of the association of the B blood group with increased blood pressure in young healthy adults of district Hyderabad Pakistan.

Dysphagia is a strong predictor of revision supraglottoplasty in pediatric laryngomalacia

BackgroundThere is growing research on the association between swallowing dysfunction and laryngomalacia. Supraglottoplasty is the surgical intervention used to treat laryngomalacia, however a portion of patients who undergo this procedure will require a revision surgery. Predictive risk factors for revision supraglottoplasty in patients with laryngomalacia are not well understood, and previous studies failed to evaluate swallowing systematically. HypothesisWe predict a significant association between swallowing dysfunction and revision supraglottoplasty for patients with laryngomalacia. MethodsThis was a retrospective cohort study of consecutive patients between 2013 and 2023 at a tertiary pediatric care centre (Stollery Children's Hospital). All patients had an endoscopic diagnosis of laryngomalacia by a staff otolaryngologist and at minimum a systematic clinical swallowing assessment by a speech language pathologist, with an instrumental assessment as needed. Patients with genetic or neurological comorbidities, lack of follow up information, or age of >3 years were excluded. Clinical and instrumental swallow data, demographic information, surgical outcomes and revision surgeries were documented and collected. Univariate analysis was done to determine associations between variables and revision supraglottoplasty. Binary logistic regression was done to determine independent predictors of revision supraglottoplasty. Results214 patients met the inclusion criteria and were analyzed in the study. 24 patients (11 %) required revision supraglottoplasty. 118 out of the 214 patients (55 %) had an instrumental assessment completed (FEES or VFSS). Of those, 92 (78 %) had abnormal findings on instrumental assessments. Univariate analysis showed Type 2 laryngomalacia (P = 0.017), presence of aspiration (P=<0.001), presence of cyanosis (P = 0.002) and abnormal findings on an instrumental assessment (P = 0.013) to be significantly associated with the need for revision supraglottoplasty. Binary regression analysis showed aspiration (OR = 5.6 {2.087–14.889}, P=<0.001) and cyanosis (OR = 5.3 {1.852–15.181}, P = 0.002) to be the only independent predictors of revision supraglottoplasty. ConclusionPresence of aspiration is a strong predictive factor for revision supraglottoplasty in patients with laryngomalacia, when swallowing is evaluated systematically. More prospective research is needed to understand the relationship between swallowing dysfunction, laryngomalacia and surgery.

Serum soluble interleukin-2 receptor alpha may predict tubulointerstitial inflammatory cell infiltration and short-term disease progression in immunoglobin A nephropathy

This study aims to explore the relationship between serum soluble interleukin-2 receptor alpha (sIL-2Rα) levels and histologic features in immunoglobin A nephropathy (IgAN), and evaluate its predicting values on disease progression and remission status. IgAN patients were included retrospectively. Lee classification, Oxford classification and histological scoring were evaluated. Patients’ estimated filtration rate (eGFR) and proteinuria remission status were collected during 6-month follow-up. Logistic regression was used to determine the risk factors and predicting value. Receiver operating characteristic (ROC) curve were used to determine the predicting value for outcome. One hundred seventy-two subjects were included in this study. Individuals in moderate-to-severe tubulointerstitial inflammatory cell infiltration group manifested with significantly elevated serum sIL-2Rα levels than those in non-to-mild group. Serum sIL-2Rα levels were positively correlated with infiltration scores. Serum sIL-2Rα was an independent risk factor for moderate-to-severe inflammatory cell infiltration [sIL-2Rα: OR 1.29 (1.015–1.640, p = 0.038)]. ROC curve analysis regarding predictive value for moderate-to-severe inflammatory cell infiltration of sIL-2Rα suggested area under curve was 0.859 (0.801–0.918, p = 0.000) when sIL-2Rα combined with eGFR < 60 mL/(min·1.73 m2), 24-h proteinuria excretion > 1.0 g, and hemoglobin. It showed good sensitivity (71.6%) and specificity (87.6%). Additionally, sIL-2Rα levels at kidney biopsy were strong predictive factor for kidney function loss 6 months after kidney biopsy [OR 4.161 (1.013–17.088, p = 0.048)]. High serum sIL-2Rα was significantly associated with serious inflammatory cell infiltration in IgAN, and it showed strong predictive value for disease prognosis. Serum sIL-2Rα could be a useful noninvasive biomarker to evaluate the extent of histological injury and disease prognosis in IgAN.

Systemic Therapy for Metastatic Pancreatic Cancer-Current Landscape and Future Directions.

Pancreatic ductal adenocarcinoma (PDAC) is a significant cause of cancer-associated mortality, with a rising global incidence. A paucity of strong predictive risk factors mean screening programmes are difficult to implement. Historically, a lack of identifiable and actionable driver mutations, coupled with a relatively immunosuppressed tumour microenvironment, has led to a reliance on cytotoxic chemotherapy. The NAPOLI-3 trial has reported data supporting consideration of NALIRIFOX as a new first-line standard of care. Kirsten Rat Sarcoma Virus (KRAS) G12D mutations are present in >90% of all PDAC's; exciting breakthroughs in small molecule inhibitors targeting KRAS G12D may open new modalities of treatment, and therapies targeting multiple KRAS mutations are also in early clinical trials. Although immunotherapy strategies to date have been disappointing, combination with chemotherapy and/or small molecule inhibitors hold promise and warrant further exploration.

Predictors of child restraint usage among Chinese parents

Objective: To investigate psychological predictors of the use of child restraints among Chinese parents following passage of national law requiring their use. Methods: Grounded in the Prototype Willingness Model (PWM) and guidance from previous research, we developed and administered a questionnaire to assess child restraint usage and understand psychological factors that predict usage. 413 parents with child(ren) aged 0–8 years completed the questionnaire through the WenJuanXing online survey platform. Results: Among the 413 parents, 321 (77.7%) used child restraints regularly when taking their children on car trips, with the highest use reported among parents with children under 1 year (83.8%). Among the psychological predictors, willingness to use a restraint was the strongest predictor of intention and self-reported behavior to use restraints, but the predictive effect of intention on behavior was not significant. Descriptive norms – a belief that trusted friends and family use restraints – was the strongest predictor of behavior to use child restraints, and prototype favorability – the belief that prototypical parents of similar age and gender use restraints – also showed significant effects in predicting behavior. Conclusions: Following the passage of national laws requiring child restraints in China, it is becoming more common for parents to use restraints when their children travel by car. Parents’ use of child restraints for children follows a socially reactive (through willingness) decision-making path rather than a reasoned (through intention) decision-making pattern. The influence of the behavior of others, both trusted friends and family (descriptive norms) and prototypical similar parents (prototype favorability) are strong predictive factors for use of child restraints, suggesting prevention programs might leverage behavior of others to impact parents and encourage use of child restraints.

Ultrasound-based comparative analysis and nomogram development for predicting triple-negative and non-triple-negative breast cancer: a 4-year institutional study in Quanzhou First Hospital

ObjectiveThe objective of this study was to compare ultrasound features and establish a predictive nomogram for distinguishing between triple-negative breast cancer (TNBC) and non-TNBC.DesignA retrospective cohort study.SettingThis study was conducted...

Flow Cytometry-Based Detection of Minimal/Measurable Residual Disease Predicts Survival Outcomes in Pediatrics, Adolescents, and Young Adults With T-acute Lymphoblastic Leukemia.

Measurable/minimal residual disease (MRD) is considered the single most powerful high-risk factor in acute leukemia, including T-cell acute lymphoblastic leukemia (T-ALL). In this study, we evaluated the impact of flow cytometry (FC)-based detection of MRD on survival outcomes in pediatrics, adolescents, and young adults (AYA) with T-ALL. We included 139 patients, 88 pediatric patients between the ages of one and 14 years, and 51 AYA patients between 15 and 39 years of age, over a period of three years and were treated with the Indian Collaborative Childhood Leukemia Group (ICiCLe) protocol. MRD assessment was performed on post-induction (PI) bone marrow aspirate samples using a 10-color 11-antibody MRD panel on a Gallios instrument (Beckman Coulter, Miami, FL, USA). MRD value > 0.01% was considered positive. PI-MRD status was available in 131 patients. The five-year event-free survival (5-year EFS) in PI-MRD positive patients was inferior to those of negative patients (13.56% vs 79.06%), which was statistically significant (P < 0.001). However, the five-year overall survival (5-year OS) did not show any statistically significant difference between PI-MRD positive and negative T-ALL patients (92.93% vs 94.28%). The hazard ratio (HR) for 5-year EFS and MRD positivity was 8.03 (p-value < 0.0001). HR for 5-year EFS and early T-cell precursor ALL (ETP-ALL) was 2.63 (p = -0.02). PI-MRD detected using FC is a strong predictive factor of inferior survival outcomes in pediatrics, AYA patients with T-ALL. PI-MRD positivity can be used to modify the treatment of T-ALL patients, especially in resource-constrained developing countries where molecular tests are not widely available.

The effect of controlled vs uncontrolled hypertension on outcomes of carotid revascularization procedures

BackgroundHypertension (HTN) has been implicated as a strong predictive factor for poorer outcomes in patients undergoing various vascular procedures. However, limited research is available that examines the effect of uncontrolled HTN (uHTN) on outcomes after carotid revascularization. We aimed to determine which carotid revascularization procedure yields the best outcome in this patient population. MethodsWe studied patients undergoing carotid endarterectomy (CEA), transfemoral carotid artery stenting (TFCAS), or transcarotid artery revascularization (TCAR) from April 2020 to June 2022 using data from the Vascular Quality Initiative. Patients were stratified into two groups: those with cHTN and those with uHTN. Patients with cHTN were those with HTN treated with medication and a blood pressure of <130/80 mm Hg. Patients with uHTN had a blood pressure of ≥130/80 mm Hg. Our primary outcomes were in-hospital stroke, death, myocardial infarction (MI), and 30-day mortality. Our secondary outcomes were postoperative hypotension or HTN, reperfusion syndrome, prolonged length of stay (LOS) (>1 day), stroke/death, and stroke/death/MI. We used logistic regression models for the multivariate analysis. ResultsA total of 34,653 CEA (uHTN, 11,347 [32.7%]), 8199 TFCAS (uHTN, 2307 [28.1%]), and 17,309 TCAR (uHTN, 4990 [28.8%]) patients were included in this study. There was no significant difference in age between patients with cHTN and patients with uHTN for each carotid revascularization procedure. However, compared with patients with cHTN, patients with uHTN had significantly more comorbidities. uHTN was associated with an increased risk of combined in-hospital stroke/death/MI after CEA (adjusted odds ratio [aOR], 1.56; 95% confidence interval [CI], 1.30-1.87; P < .001), TFCAS (aOR, 1.59; 95% CI, 1.21-2.08; P < .001), and TCAR (aOR, 1.39; 95% CI, 1.12-1.73; P = .003) compared with cHTN. Additionally, uHTN was associated with a prolonged LOS after all carotid revascularization methods. For the subanalysis of patients with uHTN, TFCAS was associated with an increased risk of stroke (aOR, 1.82; 95% CI, 1.39-2.37; P < .001), in-hospital death (aOR, 3.73; 95% CI, 2.25-6.19; P < .001), reperfusion syndrome (aOR, 6.24; 95% CI, 3.57-10.93; P < .001), and extended LOS (aOR, 1.87; 95% CI, 1.51-2.32; P < .001) compared with CEA. There was no statistically significant difference between the outcomes of TCAR compared with CEA. ConclusionsThe results from this study show that patients with uHTN are at a higher risk of stroke and death postoperatively compared with patients with cHTN, highlighting the importance of treating HTN before undergoing elective carotid revascularization. Additionally, in patients with uHTN, TFCAS yields the worst outcomes, whereas CEA and TCAR proved to be safer interventions. Patients with uTHN with symptomatic carotid disease treated with CEA or TCAR have better outcomes compared with those treated with TFCAS.

Frequency and characteristics of immune-related thyroid adverse events in patients with resected stage III/IV melanoma treated with adjuvant PD-1 inhibitors: a national cohort study

PurposeImmune-related thyroid adverse events (irTAEs) occur frequently following immune checkpoint inhibitor (ICI) therapy. The purpose of this study is to provide knowledge about the incidence, clinical timeline characteristics, associated factors of irTAEs, and potential impact on treatment efficacy in patients with melanoma receiving adjuvant ICI therapy.MethodsA national multicenter retrospective cohort study of patients with resected stage III/IV melanoma treated with adjuvant PD-1 inhibitors between November 2018 and December 2020. Data were extracted from the Danish Metastatic Melanoma Database. The irTAEs were defined as two consecutive abnormal TSH values and subdivided into transient or persistent.ResultsOf 454 patients, 99 developed an irTAE (21.8%), of these were 46 transient (46.5%) and 53 persistent (53.5%). Median time to transient and persistent irTAE was 55 and 44 days, respectively (p = 0.57). A hyperthyroid phase followed by hypothyroidism was seen in 73.6% of persistent irTAEs, whereas 87% of transient irTAEs developed an isolated hypo- or hyperthyroid phase. Multiple variable analysis demonstrated an association between irTAE and female sex (HR 2.45; 95% CI 1.63–3.70; p < 0.001), but no association with recurrence-free survival (HR 0.86; 95% CI 0.50–1.48; p = 0.587) or overall survival (HR 1.05; 95% CI 0.52–2.12, p = 0.891).ConclusionsIrTAE is a common side effect to PD-1 inhibitors primarily occurring within the first 3 months, with a high risk of persistency. Female sex is a strong predictive factor. IrTAE was not associated with improved clinical outcome.

The Predictive Value of Virtue: Many Virtues Predict Lower Depression and Anxiety Symptom Scores Among College Students…But Gratitude Dominates

Depression and anxiety symptoms have risen in the last decade, especially among college students. Virtues are potentially strong predictive factors of mental health symptoms, but a minimal amount of research has explored which virtues are the strongest predictors. We examined the relative predictive strength of gratitude, forgiveness, patience, intellectual humility, and self-control using dominance analyses. Results suggested that gratitude had the strongest predictive value for lower anxiety and depressive symptom scores compared to forgiveness, intellectual humility, patience, and self-control. An implication of these findings is that when considering intervention work with young emerging adults, researchers may do well to start with gratitude, then promote other virtues such as forgiveness and self-control.

326 Factors Associated With the Maintenance of Cost-Effectiveness at 5 Years in Adult Spinal Deformity Corrective Surgery

INTRODUCTION: Substantial increase of costs in the surgical treatment of adult spinal deformity has given precedence to scrutinize the value it can provide hence cost-effectiveness (CE) is a vital analytical constituent. The analysis of factors associated with the durability of cost-effectiveness at 5 years has not been previously evaluated. METHODS: Adult spinal deformity (ASD) patients with baseline (BL) to 5-year (5Y) data were included. Cost calculation using PearlDiver database and CMS.gov definitions was used. Cost analysis was based on average DRG reimbursement rates. ODI was converted to SF-6D, with a 3% discount applied for residual decline in life expectancy. Cost per QALY gained at 2Y and 5Y was calculated. Threshold value for cost per QALY was $100,000. Patients that met 2Y (CE2+) were grouped based on meeting CE at 5Y(CE5+) or not(CE5-). Analysis based on meeting cost-effectiveness (CE) at 2Y and 5Y was conducted. Conditional-inference-tree (CIT) established cutoffs values for HRQLs. RESULTS: 299 patients with 5Y data were included. Major and minor complication rates were 11% and 47% respectively, while 26% underwent reoperation by 5Y. The mean cost of surgery was $91,095 ± $47,003, utility-gain of 0.091 ± 0.086, and QALY of 0.171 ± 0.183, CE of $118,976 ± $208,323. 85.5% of the cohort met CE at 2Y, 79.2% at 5Y, whereas 59.6% met both. Frailty was comparable at baseline but was worse in CE5- at 2Y. CIT depicted 2Y ODI &lt; 18 and SRS-22r &gt; 3.3 (both p &lt; 0.03) being associated with higher rates of C5+. Multivariable-regression depicted higher baseline CCI and pelvic tilt (PT) to be the strongest baseline predictors of not maintaining CE at 5Y (CCI OR: 1.821, p = 0.009) (PT OR: 1.079, p = .030). CONCLUSIONS: The majority that met cost-effectiveness at the 2 year went on to maintain it at 5 years. Lower baseline CCI and PT were strong predictive factors.

Exploring the associations of demographics and scale measures with cognitive driving behavior among older drivers in China

Age-related changes and frailty are reasons for the high proportion of older drivers in certain types of crashes, such as giving right of way at intersections and turning left. The identified crash causes include the driver’s demographics, driving style, cognitive function, and mental workload. This study aimed to explore the associations of demographics and scale measures with cognitive driving behavior. Thirty-nine drivers, consisting of twenty younger drivers (18–60 years old) and nineteen older drivers (above 60 years old), participated in driving simulation experiments after completing scale tests. The selected scale measures included the demographic questionnaire, Multidimensional Driving Style Inventory (MDSI-C), Mini-Mental State Examination (MMSE), Trail Making Test Part A (TMT-A) and Part B (TMT-B), and the National Aeronautics and Space Administration Task Load Index (NASA-TLX) for obtaining subjective information from drivers. Driving scenarios were developed based on the driving characteristics of older adults to investigate age-related driving ability. The driving behavior parameters included reaction time, lateral stability, and driving speed, corresponding to reaction, perception, and execution. Three stepwise regression models showed that NASA-TLX, the interaction between age and driving experience, and the interaction between age and TMT-A significantly explained 53.3 % of reaction time variance; TMT-A, risk driving style, anxiety driving style, and gender significantly explained 53.5 % of lateral stability variance; TMT-A, NASA-TLX, and MMSE significantly explained 60.6 % of driving speed variance. Subsequently, the impact of four age-related predictor variables on driving behavior was further discussed. It is worth noting that a rich driving experience may compensate for driving performance. However cognitive impairment impairs this compensation. Driving behavior is influenced by a combination of various factors. Age, as a physiological indicator, is not sufficient to be a strong predictive factor for lateral stability and driving speed. The results provide a reference for traffic safety management departments to streamline driving suitability test procedures and propose targeted training methods for older drivers.

Pre- and intra-operative risk factors predict postoperative respiratory failure after minimally invasive oesophagectomy.

Severe pulmonary complications such as postoperative respiratory failure can occur after minimally invasive oesophagectomy. However, the risk factors have not been well identified. The goal of this study was to develop a predictive model for the occurrence of postoperative respiratory failure with a large sample. We collected data from patients with oesophageal cancer who had a minimally invasive oesophagectomy at Shanghai Chest Hospital from 2019 to 2022. Univariable and backward stepwise logistic regression analysis of 19 pre- and intra-operative factors was used before model fitting, and its performance was evaluated with the receiver operating characteristic curve. Internal validation was assessed with a calibration plot, decision curve analysis and area under the curve with 95% confidence intervals, obtained from 1000 resamples set by the bootstrap method. This study enrolled 2,386 patients, 57 (2.4%) of whom developed postoperative respiratory failure. Backward stepwise logistic regression analysis revealed that age, body mass index, cardiovascular disease, diabetes, diffusion capacity of the lungs for carbon monoxide, tumour location and duration of chest surgery ≥101.5 min were predictive factors. A predictive model was constructed and showed acceptable performance (area under the curve: 0.755). The internal validation with the bootstrap method proves the good agreement for prediction and reality. Obesity, severe diffusion dysfunction and upper segment oesophageal cancer were strong predictive factors. The established predictive model has acceptable predictive validity for postoperative respiratory failure after minimally invasive oesophagectomy, which may improve the identification of high-risk patients and enable health-care professionals to perform risk assessment for postoperative respiratory failure at the initial consultation.

An Italian real-world multicenter study of patients with advanced mixed neuroendocrine non-neuroendocrine neoplasms (MiNENs) of the gastro-entero-pancreatic system treated with chemotherapy.

The aim of this study is to describe the clinical management of an Italian series of patients with advanced gastro-entero-pancreatic (GEP) MiNENs treated in clinical practice. Clinical records of patients from four Italian referral Centers were retrospectively analyzed to correlate clinical/biological data with clinical outcomes. All the surgical specimens were centrally reviewed. Clinical data and surgical samples of 51 patients during 1995-2015 were analyzed. Sites of origin were: 32 colorectal, 14 gastro-esophageal, and 5 pancreatobiliary. Twenty-one out of fifty-one (42.2%) developed metachronous distant metastases. Only 5/51 (9.8%) patients received peri-operative therapy, and 23/51 (45.1%) first-line chemotherapy, mostly fluoropyrimidines/oxaliplatin. The NEN component was poorly differentiated in the whole population. Patients with Ki67 index < 55% in the NEC component had a significantly longer median overall survival (OS) (35.3months; 95% CI 27.1-41.0) than those with Ki67 ≥ 55% (11.9months; 95% CI 9.1-14.0) P = 0.0005. The median OS was 14months (95% CI 10.1-19.1) in the whole cohort, with 11.4months (95% CI 6.2-20.2) in patients who received a first-line therapy. This study confirms that GEP-MiNENs represent a complex disease and that over the past years the clinical management has been predominantly guided by the subjective judgment of the clinicians. Although, in this series, the NEC component appeared mostly responsible for the systemic spread and prognosis on the whole neoplasm, the lack of strong prognostic and predictive factors universally recognized seems to condition their management so far. Future prospective clinical and biomolecular studies could help clinicians to improve clinical management of GEP-MiNENs.

Predicting residual pressure gradients after balloon angioplasty in patients with femoropopliteal artery lesions.

In endovascular therapy (EVT) for femoropopliteal artery (FPA) lesions, studies examining the relationship between lesion morphology and hemodynamic status are limited. The purpose of this study was to investigate FPA lesion characteristics, including imaging findings and their cutoff values that can predict hemodynamic significance after balloon angioplasty. This single-center retrospective study enrolled 50 de novo FPA lesions from 43 patients treated under intravascular ultrasound (IVUS) usage between June 2022 and March 2023. As a physiological parameter, the pressure gradient was measured, and the cutoff value of the residual pressure gradient (RPG) was defined as a systolic pressure > 10mmHg through the lesions after balloon angioplasty. The pressure gradients were measured using a 0.014-inch wire-guided, rapid exchange-type microcatheter, Navvus II (Acist, Eden Prairie, Minnesota, USA). Predictive risk factors for RPG were analyzed using the random forest (RF) method. The relationship between the variables, RPG, and the cutoff points of each predictor was assessed using the partial dependence plot (PDP) method. RPG was observed in 20% of the lesions after balloon angioplasty. The RF model revealed that the percent diameter stenosis (%DS) and minimum lumen area (MLA) on IVUS assessment were strong predictive factors for RPG after balloon angioplasty. The PDP model revealed that a higher %DS (cutoff 30%) and smaller MLA (cutoff 10 mm2) could predict RPG after balloon angioplasty. Conventional lesion parameters such as %DS and MLA can predict hemodynamic significance during EVT for FPA lesions.

Disseminated intravascular coagulation score evolution in 48 h predicts early death in acute promyelocytic leukemia patients.

Early death (ED) is the unsolved issue of acute promyelocytic leukemia (APL). The disseminated intravascular coagulation (DIC) score has been proposed as a marker of bleeding and death in APL; whether its temporal evolution predicts outcomes in APL is unknown. We evaluated whether an increasing score 48 h after diagnosis associates with ED. Retrospective, single-center study, including patients with newly diagnosed APL between 2000 and 2023, treated with all-transretinoic acid (ATRA) plus anthracycline or arsenic trioxide (ATO). "DIC score worsening" was defined as ≥1 point increase in the score after 48 h, and ED as death within 30 days of diagnosis. Eighty-six patients were included, with median age of 46 years (17-82). ED patients (26.7%) more frequently had age >60 years and worsening DIC score after 48 h. These were also the only predictors of ED identified in both univariate and multivariate (OR 4.18, p = .011; OR 7.8, p = .005, respectively) logistic regression analysis. This is the first study on DIC score evolution in APL-a worsening DIC score 48 h after diagnosis is a strong independent predictive factor of ED. We propose a reduction of the DIC score from diagnosis as a new treatment goal in APL care.

P694 Age is a strong of predictive risk factor for anti-TNF therapy related adverse events in IBD patients

Abstract Background Anti-TNFα is the first class of biologics approved for treatment of moderate-to-severely active Inflammatory Bowel Disease (IBD). More than two decades on, anti-TNFs remain one of the most commonly used biologics for both Ulcerative Colitis (UC) and Crohn’s Disease (CD), and often as first-line therapy. Although effective, they cause several adverse events (AEs), sometimes requiring withdrawal of therapy. We aimed to record AEs and understand factors that could predict risk of AEs. Methods All IBD patients exposed to anti-TNF therapy were identified from EMR at two centres of a large tertiary hospital between January 2009 and June 2022. All relevant demographic and clinical data were collected for those patients with well recorded AEs and follow-up. Data on cumulative AEs directly attributed to anti-TNFs that ranged from mild reactions to serious AEs (defined as those requiring review/withdrawal of anti-TNF), were collected. Adverse events (AEs) were recorded as per relevant systems involved e.g.- haematological, cardiac etc., including infections and malignancies as separate categories. All analysis (normalization, hypothesis testing, and visual reports were performed using R software package Version: R 4.2.1. Results A total of 844 IBD patients (Male =408) were included with an age range of 18-75yrs. Majority were Caucasian in ethnicity (514) and more patients with CD [605(71%)] were exposed to anti-TNF than UC. The age profiling analysis was performed across ethnic groups (Asian, Caucasian and Others). Age associated AE was reported across all the groups (data not shown). It must be mentioned that though not significant, Caucasian patients were more susceptible towards AE as compared to Asian. Conclusion · Patient age above 50yrs has a strong predictive risk factor for AEs related to anti-TNF therapy for IBD. · In our cohort, more than half of patients &amp;gt;50yrs reported at least one AE in UC, and the age was lower in CD. · Although Caucasians were more vulnerable to AEs, this was not statistically significant. · Clinicians should consider and discuss this risk before selecting patients for anti-TNF therapy. · With multiple biologic choices currently available, another class could be considered where possible, for the &amp;gt;50yr patient cohort.