Strong Predictor Of Outcome Research Articles

Anthropometric and Sociodemographic Correlates of Dental Caries and Gingival Health in Children With Special Healthcare Needs at a Saudi Tertiary Care Hospital.

To evaluate the impact of anthropometric and sociodemographic factors on dental caries and gingival health among children with special healthcare needs (SHCN). This cross-sectional study involved 108 children, aged 4-14 years, with congenital heart disease, childhood cancer, bleeding disorders, various syndromes, and multiple conditions. Caregivers completed a sociodemographic questionnaire, and children underwent dental examinations to assess caries, gingival health, and oral hygiene. Anthropometric measures-weight, height, and body mass index (BMI)-were obtained and categorized into percentiles (<10, 10-90, >90) using age- and gender-specific growth charts. Dental caries was highly prevalent (93.5%), with a mean dmft/DMFT value of 7.70 (SD ± 5.22). The mean gingival index was 0.43 (SD ± 0.52). Total dmft/DMFT values were significantly higher in children ≤6 years and those with fathers of lower educational levels. Poor oral hygiene was a strong predictor of adverse outcomes for both caries and gingival health. Higher gingival indices correlated with children in the >90th weight percentile. The findings highlight the need for comprehensive oral health interventions that integrate meticulous oral hygiene, paternal education, and holistic growth monitoring beyond BMI. The results support implementing a 3-month recall program for professional dental care, combined with individualized oral hygiene instruction for caregivers. This approach is particularly crucial for the younger age group (≤6 years) where targeted early intervention could significantly reduce caries risk.

Waist Circumference Is a Strong Predictor of a Positive Outcome Evaluated One Year After Sleeve Gastrectomy.

Bariatric surgeries, such as laparoscopic sleeve gastrectomy (LSG), not only result in significant weight loss but also improve the inflammatory state in obese patients. This study aimed to investigate the effects of LSG on weight loss and inflammation status in bariatric patients 1-year post-procedure. This prospective cohort study was conducted from September 2022 to May 2024. Fifty obese adults were enrolled for LSG. All patients underwent assessments of body measurements, as well as levels of interleukin-6 (IL-6) and interleukin-10 (IL-10) at baseline, and then at 3 and 12months post-surgery. Twelve months post-surgery, body measurements showed a significant reduction, with a median excess weight loss (%EWL) of 56.8%, indicating the clinical success of the bariatric procedure. %EWL showed a strong correlation with waist circumference (R = - 0.738, p < 0.00001). A logistic regression model indicated that a reduction of just 1cm in initial waist circumference increases the likelihood of a positive outcome in laparoscopic sleeve gastrectomy by 12%. Moreover, a significant increase was observed for IL-10 (p < 0.0001), simultaneously with a significant decrease in IL-6 (p < 0.0001). This study provides valuable evidence supporting the benefits of laparoscopic sleeve gastrectomy for both weight loss and reducing inflammation. Waist circumference emerged as a strong predictor of metabolic success 1-year post-surgery, while increased IL-10 levels signaled positive immunological changes.

PROMISE: Prognostic Radiomic Outcome Measurement in Acute Subdural Hematoma Evacuation Post-Craniotomy.

Background/Objectives: Traumatic acute subdural hematoma (aSDH) often requires surgical intervention, such as craniotomy, to relieve mass lesions and pressure. The extent of hematoma evacuation significantly impacts patient outcomes. This study utilizes 3D Slicer software to analyse post-craniotomy hematoma volume changes and evaluate their prognostic significance in aSDH patients. Methods: Among 178 adult patients diagnosed with aSDH from January 2015 to December 2022, 64 underwent hematoma evacuation via craniotomy. Initial scans were performed within 24 h of trauma, followed by routine postoperative scans to assess residual hematoma. We conducted radiomic analysis of preoperative and postoperative volumes, surface area, Feret diameter, sphericity, flatness, and elongation. Clinical parameters, including SOFA score, APACHE score, pupillary response, comorbidities, age, anticoagulation status, and preoperative haematocrit and haemoglobin levels, were also evaluated. Results: Changes in Δ surface area significantly correlated with 30-day outcomes (p = 0.03) and showed moderate predictive accuracy (AUC = 0.65). Patients with a Δ surface area > 30,090 mm2 experienced poorer outcomes (OR = 6.66, p = 0.02). Significant features included preoperative surface area (p = 0.009), Feret diameter (p = 0.0012). In multivariate analysis, only the Feret diameter remained significant (p = 0.01). Conclusions: Postoperative Δ surface area is, among other variables, a strong predictor of 30-day outcomes, while in multivariate analysis, preoperative Feret diameter remains the only independent predictor. Radiomic analysis with 3D Slicer may enhance prognostic accuracy and inform tailored therapeutic strategies.

Effects of therapeutic alliance on patients with major depressive disorder: a literature review.

Therapeutic alliance refers to the collaborative relationship between a therapist and a patient, a concept widely explored in clinical research. It has emerged as a crucial component of effective psychotherapeutic interventions, particularly in the treatment of major depressive disorder (MDD), where its role appears to be multifaceted. In this context, we reviewed the main literature on the role of therapeutic alliance in MDD. The record search was conducted across three databases: PubMed, Web of Science, and PsychInfo. Seven of the reviewed studies highlighted that therapeutic alliance is a strong predictor of clinical outcomes, contributing to symptom improvement, relapse prevention, and more adaptive functioning in patients with MDD. However, three studies supported the hypothesis that clinical improvement itself might influence the therapeutic alliance between a therapist and a patient at different stages of treatment. Overall, the results suggest a bidirectional relationship between therapeutic alliance and symptom improvement, indicating that a stronger alliance often predicts better outcomes and symptom reduction can further enhance the alliance. However, the interpretation of these results must consider certain methodological limitations. These include the use of different approaches, measurements, and clinical outcomes to assess therapeutic alliance, as well as insufficient exploration of the temporal precedence between therapeutic alliance and clinical outcomes. In conclusion, future studies are warranted to address these limitations and further clarify the role of therapeutic alliance in MDD, along with its potential implications for clinical practice.

Acute DWI volume is a strong imaging predictor of favorable outcomes in patients with acute stroke and treated with mechanical thrombectomy

BackgroundInfarct volume on diffusion-weighted imaging (DWI) is a promising imaging marker for clinical outcomes in patients with acute stroke treated with mechanical thrombectomy (MT), but its predictive value has not been well evaluated, especially in consecutive patients. The present study aimed to elucidate the relationship between infarct volume and its change and favorable functional outcomes in consecutive patients with acute stroke who underwent MT. MethodOf patients with consecutive acute stroke who underwent MT from September 2014 through December 2019, those who were pre-morbidly independent were enrolled. Infarct volume on DWI was measured at admission (DWIinitial) and 24 h after admission (DWI24h) with semi-automated imaging software. Infarct growth (IG) was calculated as the difference between DWI24h and DWIinitial. Factors associated with a favorable outcome (mRS score 0–2) 3 months after stroke onset were assessed by multivariable analyses. Model performance was evaluated with the C-statistic. ResultsA total of 251 patients (165 male [66 %], median age 75 [IQR 67–81] years, median NIHSS score 15 [7–21]) were enrolled in the present study. Multivariable logistic regression analysis showed that DWI24h (OR 0.74, 95 % CI 0.62–0.87 for every 10-mL increment) and IG (0.74, 0.62–0.88 for every 10-mL increment) were independently and negatively associated with a favorable outcome. These associations were observed in patients with diverse vessel occlusions. Adding DWI24h or IG to the conventional predictors of favorable outcomes improved predictive accuracy (p < 0.05). ConclusionDWI infarct volume 24 h after admission and IG can be strong imaging predictors of favorable outcomes after MT.

Long term outcome of childhood traumatic brain injury A study of the psychomotor and neurocognitive wellbeing of the adolescent survivors

For children traumatic brain injury can lead to persistent cognitive, neurobehavioral, intellectual academic and personality problems Injury severity is a strong predictor of long term outcomes with environmental factors playing a less consistent role

Intra-abdominal Hypertension Is a Strong Predictor of Mortality and Poor Clinical Outcome in Severe Acute Pancreatitis.

Acute pancreatitis is one of the leading causes of mortality and morbidity. Most acute pancreatitis scoring systems have no pathophysiologic basis when evaluating severity. Such a limitation led to an interest in measuring intra-abdominal pressure (IAP) as a method to predict outcomes in patients with acute pancreatitis. Investigate the predictive impact of intra-abdominal hypertension (IAH) on mortality and clinical outcomes in a patient hospitalized with severe acute pancreatitis. We conducted a systematic search of the PubMed, Embase, and Cochrane databases from inception through November 2021 for studies evaluating the effect of IAH on acute pancreatitis. Relevant data were extracted and analyzed using STATA 17 software. A random-effects model was used for all variables. Publication bias was assessed using Egger's test. Fourteen studies investigating 1197 patients were included. Mortality, multiorgan dysfunction syndrome, pancreatic necrosis, renal, respiratory, and cardiovascular failure were more likely in the IAH group. However, infected necrosis and surgical intervention were not statistically significant between the two groups. After excluding abdominal compartment syndrome patients, mortality and respiratory failure were the only outcomes, which remained statistically significant. Patients admitted to the hospital with severe acute pancreatitis have higher odds for mortality, multiorgan dysfunction syndrome, renal, respiratory, and cardiovascular failure if they developed IAH. IAH remained a strong predictor of mortality and respiratory failure even in the absence of abdominal compartment syndrome. Therefore, the development of IAH is a strong predictor of mortality and poor clinical outcome in such a population.

Prognostic value of neutrophil-to-lymphocyte ratios pre- and post-surgery in stage III CRC: a study of 2,742 patients

PurposeStage III colorectal cancer (CRC) is typically treated with surgery; however, it has a high recurrence rate and inconsistent benefits from postoperative chemotherapy. Inflammatory markers like the neutrophil-to-lymphocyte ratio (NLR) have shown prognostic value in various cancers. However, the prognostic significance of NLR measured before and after CRC surgery is not clear. This study aims to clarify the prognostic value of the combination of pre- and post-surgery NLR in stage III CRC patients.MethodsPatients with stage III CRC treated between 2001 and 2022 were retrospectively analyzed using data from the Chang Gung Medical Research Database. Patients were categorized into 4 groups based on their pre- and post-operative NLR levels. Kaplan–Meier survival analysis and Cox proportional hazard models were used to assess the associations between NLR levels and overall survival (OS), disease-free survival (DFS), and cancer-specific survival (CSS).ResultsData from 2,742 patients, median age of 62 years and 54% male, were analyzed. After adjustment, patients in Group IV, with high NLR values both before and after surgery, had greater risks of worse DFS (adjusted hazard ratio [aHR] = 1.30, 95% confidence interval [CI]: 1.13–1.50), OS (aHR = 1.36, 95% CI: 1.14–1.63), and CSS (aHR = 1.27, 95% CI: 1.04–1.55) compared to Group I.ConclusionsHigh NLR levels before and after surgery is a strong predictor of poor outcomes in stage III CRC patients. The findings suggest that monitoring NLR at both time points can be a valuable prognostic tool, guiding postoperative care and treatment strategies to improve patient outcomes.

Changes in Parental Involvement and Parental Expectations During High School for Students With Emotional and Behavioral Difficulties

Home-based parental involvement and parental expectations in school are strong predictors of academic outcomes for high school students. Given this, we explored whether changes in parental involvement and parental expectations during high school were correlated with academic functioning for students with emotional or behavioral difficulties ( N = 888) compared with their peers ( N = 4,148). We found that home-based parental involvement was stable during high school for both groups of students. There was a decrease in parental educational expectations during high school that was equivalent between both groups. Students with elevated emotional and behavioral difficulties had significant correlations between increases in home-based involvement and increases in both parental expectations and grade point average, whereas the peer group had significant, yet trivial correlations among the constructs.

Demographics, Prognostic Factors, and Survival Outcomes in Hepatic Angiosarcoma: A Retrospective Analysis.

Hepatic angiosarcoma (HA) is a rare malignant vascular neoplasm. Currently, there are no standardized protocols for treating HA. This study aims to understand clinicopathologic analysis, prognostic factors, and treatment outcomes comprehensively. The data retrieved from the SEER database was reviewed for hepatic angiosarcoma cases between 2000 and 2021. A total of 389 patients with hepatic angiosarcoma were identified with a mean age of 63.9years (SD ± 16). Most patients were male (64%), and per US census data, non-Hispanic Asians or Pacific Islanders were the most common race (17%). In known cases of tumor stage (61%), the most common tumor stage was distant (22%), and most were grade III (18%) tumors. Overall, the 3-year survival rate was 6.7% with a 95% confidence interval (95% CI 0.044-0.100), disease-specific survival at a 1-year survival rate was 4.43% (95% CI 0.023-0.083), and no patients survived by 3years. The best overall survival rate was the 1-year rate for surgical resection, 18.20% (95% CI 0.075-0.441). Chemotherapy had a 1-year survival rate of 11% (95% CI 0.057-0.211), and radiation therapy had no survival significance (p = 0.2). Multivariate analysis shows age above 70years (H.R. 1.67 (95% CI 1.181-2.381), p < 0.05), no surgical intervention (H.R. 2.29 (95% CI 1.585-3.336) p < 0.001), and distant stage (H.R. 2.54 (95% CI 1.696-3.805) p < 0.001) are negative prognostic factors, whereas female sex (H.R. 0.68 (95% CI 0.536-0.875) p < 0.05) is a positive prognostic factor. Increasing age (> 70years), male sex, and distant stage were found to be strong predictors of poor survival outcomes. Patients had better outcomes when surgical resection and chemotherapy were included in their treatment. These results can provide continued evidence in the future management of patients with hepatic angiosarcoma.

Chimeric antigen receptor copies in cell-free DNA predict relapse in aggressive B-cell lymphoma patients treated with CAR T-cell therapy.

Chimeric antigen receptor (CAR) T-cell therapy has emerged as a transformative treatment for aggressive B-cell lymphomas (ABCL), However, about half of patients relapse, most of them early. This study investigates the detection of CAR copies in circulating cell-free DNA (cfDNA) as a potential predictive biomarker of early relapse (<6 months) to improve patient management. In this research, we have consecutively selected 73 ABCL patients treated with anti-CD19 CAR T-cells, analysing CAR levels in peripheral blood and other clinical variables. Our results indicate that no correlation is present between genomic DNA and cfDNA; moreover, higher levels of CAR-cfDNA on day +14 after infusion (0.44 vs. 0.07; p = 0.019) are associated with improved 6-month progression-free survival rates (74.2% vs. 26%. p < 0.01), suggesting that CAR-cfDNA could be a strong predictor of CAR T-cell therapy short-term outcomes. These findings underscore the potential of integrating CAR-cfDNA analysis into routine clinical practice to enhance the prognostic accuracy and therapeutic strategies for ABCL patients undergoing CAR T-cell therapy.

Impact of Neglect on the Relationship Between Upper Limb Motor Function and Upper Limb Performance in the (Hyper)acute Poststroke Phase.

Visuospatial neglect (VSN) is a negative, strong, and independent predictor of poor outcome after stroke, and is associated with poorer upper limb (UL) motor recovery in terms of function or capacity (ie, in standardized, lab-based testing). Although the main aim of stroke rehabilitation is to re-establish optimal functioning in daily life, the impact of VSN on UL performance (ie, in unstructured, everyday environments) is largely unknown. In this proof of principle study, the impact of VSN on the strength of the association between UL motor function (Jamar Hand Dynamometer) and UL performance (Upper Limb Lucerne ICF-based Multidisciplinary Observation Scale) was investigated in 65 (hyper)acute first-ever stroke patients. In a moderator analysis, the interaction term was negative and significant, showing that VSN suppresses the use of UL motor function in daily life (ie, performance). This finding suggests that, when considering UL performance in the (hyper)acute phase after stroke, interventions aimed to reduce deficits in both UL motor function and visuospatial function should already be started in the acute stroke unit setting.

Predictive Feasibility of the Graz Malnutrition Screening, Controlling Nutritional Status Score, Geriatric Nutritional Risk Index, and Prognostic Nutritional Index for Postoperative Long-Term Mortality After Surgically Treated Proximal Femur Fracture.

Hip fractures are a prevalent and serious health issue, particularly among the elderly population aged >65 years. These injuries are associated with elevated rates of postoperative complications and mortality, significantly diminishing patients' quality of life in both the short- and long-term. The prognosis for recovery is further exacerbated in individuals with signs of malnutrition. The primary objective of this study was to evaluate the predictive value of four distinct nutritional assessment scores in relation to postoperative mortality in patients undergoing surgical intervention for hip fractures at 1, 3, 6, 12, and 24 months. This observational study included patients admitted to the Department of Traumatology at the Medical University for the surgical management of hip fractures between January 2019 and November 2021. Nutritional assessment scores were derived from a retrospective analysis of clinical data. The statistical correlation between nutritional scores and postoperative mortality outcomes was rigorously evaluated. Logistic regression analysis revealed a statistically significant correlation (p < 0.01) between all four nutritional scores and postoperative mortality risk. The malnourished cohorts demonstrated a markedly higher risk of mortality compared to those with adequate nutritional status, as indicated by the following risk ratios: Graz Malnutrition Screening (risk ratio = 2.53-1.68), Prognostic Nutritional Index (risk ratio = 2.44-1.74), Geriatric Nutritional Risk Index (risk ratio = 2.05-1.58), and Controlling Nutritional Status (risk ratio = 2.34-1.46). Despite these findings, the receiver operating characteristic analysis yielded area under the curve (AUC) values ranging from 0.64 to 0.68, indicating limited predictive power. Although a significant correlation existed between the evaluated nutritional scores and postoperative mortality, the predictive value of these scores was quantitatively low. No single nutritional assessment tool has emerged as a strong predictor of postoperative outcomes in this patient population. Consequently, implementation of any specific nutritional screening tool for standard assessment in patients with hip fractures is not recommended at this time. Nevertheless, given the established association between malnutrition and postoperative mortality, a comprehensive evaluation of nutritional status is advisable and further research is needed.

Ambulatory autonomic nervous system activity in relation to hearing impairment.

Previous research has demonstrated that hearing impairment is associated with heightened subjective experiences of listening effort, fatigue, and stress, impacting daily functioning. This study aimed to evaluate whether hearing impairment alters physiological stress systems and whether different aspects of hearing impairment could vary in predicting dysregulation in these systems. Hallmark measures of parasympathetic and sympathetic nervous system activity were derived from electrocardiography, impedance cardiography, and electrodermal activity recordings taken from 133 individuals, aged 37 to 73, over two 24-hr periods, including sleep. Using ecological momentary assessment (EMA), participants reported mood, listening effort, and fatigue seven times daily. Hearing impairment was quantified through pure tone thresholds, speech perception in noise testing, and the Amsterdam Inventory for Auditory Disability questionnaire (Amsterdam Inventory). Using mixed models, we compared average daytime and sleep values of physiological measures across the 2 days, and their daytime-to-sleep contrast, based on each hearing impairment assessment. Results indicated that all three hearing impairment assessments were strong predictors of EMA outcomes of listening effort and fatigue. Contrary to expectations, hearing impairment did not have a significant impact on parasympathetic activity in daily life or on skin sympathetic activity. However, individuals with higher impairment exhibited a larger change in a cardiac sympathetic measure, the pre-ejection period, during wakefulness compared to sleep. Overall, hearing impairment had a small impact on autonomic nervous system functioning in daily life, but the effects were potentially attenuated by reduced exposure to listening demand in those with hearing impairment.

Lactate Is a Strong Predictor of Poor Outcomes in Patients with Severe Traumatic Brain Injury.

Background: Lactate is a byproduct of glycolysis, often linked to oxygen deprivation. This study aimed to examine how lactate levels (LLs) affect clinical outcomes in patients with severe TBI, hypothesizing that higher LLs would correlate with worse outcomes. Methods: This is a level 1 single-center, retrospective study of patients with severe TBI between 1 January 2020 and 31 December 2023, inclusive. Results: Single-factor ANOVA indicated a significant decrease in LLs with increasing age. Linear regression models showed the same for hospital admission, Intensive Care Unit (ICU) admission LLs, and death LLs. Prognostic scores such as Injury Severity Scores (ISS) and Glasgow Coma Score (GCS) showed a strong correlation with both Hospital admission and ICU admission LLs. ANOVA indicated higher LLs with increasing ISS and increasing LLs with decreasing GCS. Linear regressions revealed a strong positive correlation between ISS and LLs. On linear regression, the LL measured at hospital admission and ICU admission was positively associated with the length of stay (LOS) in the hospital, LOS in the ICU, ventilator days, and mortality. Linear regression models showed that a decreased delta LL during ICU admission led to an increased LOS at the hospital and the ICU, as well as a higher number of days on a ventilator. Discussion: We discovered that high LLs were linked to higher AIS and GCS scores, longer stays in the hospital and ICU, more days requiring a ventilator, and higher mortality rates in patients with severe TBI. Conclusions: LLs can be considered a strong predictor of poor clinical outcomes in patients with severe TBI.

Impact of cerebral collateral recycle status on clinical outcomes in elderly patients with endovascular stroke treatment

BackgroundElderly patients are at high risk of acute ischemic stroke caused by large vessel occlusion (AIS-LVO) and usually suffer disability and fatality from stroke even after receiving endovascular treatment (EVT). Previous studies lacked the knowledge of comprehensive cerebral collateral for elderly patients. Hence, we explore the role of cerebral collateral recycle (CCR) status in clinical outcomes in a real-world setting among elderly AIS-LVO patients undergoing EVT. MethodsThis was a multicenter retrospective cohort study. Computed tomographic angiography (CTA) at admission was applied to evaluate cerebral venous outflow profiles by the Cortical Vein Opacification Score (COVES) and pial arterial collaterals by the Tan scale. According to the status of cerebral collaterals, enrolled patients were divided into the poor, moderate, and favorable CCR groups. The primary outcome was functional independence (90-day modified Rankin Scale score 0-2). ResultsAmong 860 AIS-LVO patients receiving EVT, a total of 338 elderly patients were included in the present study after strict screening. Compared with the poor CCR group, the moderate CCR group (31.1% vs. 10.2%; adjusted odds ratio[aOR] 3.80; 95% confidence interval[CI] 1.71-8.44; P=0.001) and the favorable CCR group (63.3% vs. 10.2%; aOR 8.49; 95% CI 4.02-17.92; P<0.001) both had a significantly higher rate of functional independence. In subgroup analysis, similar results were found in AIS-LVO patients with older age, large core infarction, or late time window. ConclusionThe cerebral collateral status in elderly patients with AIS-LVO treated by EVT is a strong predictor of functional outcomes and more robust CCR means better outcomes.

Post-transplant relapse in pediatric acute lymphoblastic leukemia in the era of CAR-T cell therapy. A multicenter analysis of Grupo Español de Trasplante Hematopoyetico y Terapia Celular (GETH-TC) Pediatric Committee.

BackgroundThe management of relapsed acute lymphoblastic leukemia (ALL) after hematopoietic stem cell transplantation (HSCT) has evolved significantly. Initially, treatment options were limited to palliative care, salvage chemotherapy, and second HSCT. Currently, the focus has shifted to innovative immunotherapies, particularly CAR T-cell therapy. ObjectivesThis study aims to: 1. Analyze outcomes after relapse following HSCT and identify prognostic factors associated with prolonged survival. 2. To evaluate and compare treatment strategies, including immunotherapy (e.g., CAR T-cell therapy) and second HSCT after achieving a new remission, or both treatments in high-risk cases. Study designThis retrospective, multicenter study will evaluate the outcomes of HSCT relapse in pediatric ALL patients. Key endpoints include disease-free survival (DFS), relapse rate, and NRM. We enrolled 73 children with ALL who relapsed after HSCT in 10 hospitals of the Pediatric Committee of the Spanish Group of Transplantation (GETH-TC) between 2013 and 2021. Among them, 56 patients (77%) had B-cell ALL and 17 (23%) had T-cell ALL. ResultsThe median time to relapse was 6 months after the first HSCT. CAR-T cell therapy was administered to 31 patients, all of whom achieved complete remission with negative MRD. However, two patients died prematurely due to cytokine release syndrome (CRS), resulting in a NRM of 7±4%. Sixteen patients relapsed after CAR-T therapy with a cumulative incidence (CI) of 65±11%. Seven of these patients subsequently underwent a second HSCT. The only significant prognostic factor for DFS was the MRD level prior to CAR-T therapy: DFS was 20±8% with MRD ≥3% compared to 100% with MRD <3% (p=0.002). At a median follow-up of 17 months after CAR-T therapy, DFS was 28±10% and overall survival (OS) was 40±10%. Second allogeneic HSCT was performed in 23 patients, including 7 who had previously received CAR-T therapy. Three patients died from NRM (CI: 19±10%). Eight patients relapsed after the second HSCT (CI: 52±13%), of which 2 were successfully treated with CAR-T therapy. At a median follow-up of 33 months after the second HSCT, DFS was 29±11% and OS was 32±10%. Of 17 patients with T-cell ALL, only 2 survived after a second HSCT with a DFS of 12±9%. Of the 73 patients, 20 are alive with a median follow-up of 4 years (DFS: 20±5%). Time to relapse after HSCT was the strongest predictor of outcome; no patient who relapsed within 6 months after the first HSCT survived. There was a trend towards worse DFS in patients who developed chronic GVHD during the first transplant, with 8 out of 9 relapsing despite rescue therapy (p<0.07). ConclusionsChildren with relapsed ALL after HSCT have a substantial chance of long-term survival if relapse occurs more than 6 months after the first transplant and if chronic GVHD was not present. The treatment paradigm has shifted to immunotherapy, including monoclonal antibodies and CAR-T therapy. The role of bridging to a second allogeneic HSCT after CAR-T therapy to improve long-term survival remains a subject of ongoing debate.

Factors associated with self-rated health in Black Canadians: A cross-sectional study.

Self-rated health (SRH) has shown to be a strong predictor of morbidity, functional decline, and mortality outcomes. This paper investigates the association between sociodemographic variables (e.g., employment, education, sex) and SRH among Black Canadians. We used cross-sectional survey data (n = 1380) from the A/C (African Caribbean)Study of first- and second-generation Black Canadians in Toronto and Ottawa. Participants were invited to complete an electronic survey questionnaire in English or French in 2018-2019. Generalized linear model analyses were used to evaluate the associations among sociodemographic factors and self-rated quality of health. A total of 1380 self-identified Black individuals completed the survey and were included in the analysis. The majority of participants were under the age of 60 (89.7%), female (63.4%), born outside of Canada (75.1%), and residing in Toronto, Ontario (61.9%). The strongest association with poor SRH was found for difficulties accessing health care, sexual orientation, and substance misuse/disorder, while accessing/meeting basic needs was associated with better SRH, following adjustment for other socioeconomic conditions and lifestyle factors. Our findings underscore the importance of improving the social determinants of health as a conduit to improving the general health status and the quality of life of Black Canadians. Results revealed that Black Canadians may be demonstrating high levels of resilience in circumventing their current social circumstances and structural disadvantages to live the best quality of life. Understanding sociodemographic and socio-structural barriers that Black people face is essential to reducing vulnerabilities to poor outcomes and improving their health and well-being.

Abstract A006: Development of a syngeneic transplant rat model for the identification of an mRNA signature associated with metastatic hepatocellular carcinoma

Abstract Approximately 70% of patients with hepatocellular carcinoma (HCC) die of metastasis, mainly in the lung, due in part to late diagnosis. Therefore, in vivo models that are representative of metastatic HCC biology in patients must include factors that are essential for metastasis development, such as an immunocompetent system and a tumor microenvironment with homotypic interactions. This will allow the identification of new prognostic biomarkers for patients with metastatic HCC that are efficient and accessible. We developed two hepatocellular carcinoma cell lines for syngeneic transplant models in immunocompetent rats: Samy (nonmetastatic) and Samy Met (metastatic). These cell lines allow the development of cancer and metastasis in a homotypic environment with a complete immune system; therefore, they are expected to be representative of what happens in patients with metastatic HCC. Both cell lines were biologically characterized, and the primary tumors they produced were used in a comparative transcriptomic study to identify a metastatic HCC molecular signature that may function as a prognostic biomarker. The differentially expressed genes (DEGs) were related to relevant biological processes, such as metastasis, cancer stem cells (CSCs), and tumor growth, and all of these processes are essential for cancer progression. Among the top 50 DEGs, an mRNA firm was assembled, including 3 upregulated genes (ITGB6, SEMA3F, and NDC80) and 7 downregulated genes (COL15A1, ATP13A4, C18ORF26, PRKG2, ITM2A, IGSF9B, and CNTN1). The firm was related to poor survival in patients with HCC and had good accuracy in predicting macrovascular invasion, which is a strong predictor of poor HCC outcome, both after surgical resection and after liver transplantation. Citation Format: Theresa G Azcárraga Acosta, Carolina Piña Vazquéz, Hury V Hernández Galdámez, Karla M Rubio Nava, Josué Guzmán Linares, Ivonne Ramírez Díaz, Guillermo Barreto, Mario A Aguilar Chaparro, Stefan Günther, Saul Villa Treviño, Mireya De la Garza, Teresita del niño Jesús Flores Téllez, Veronica R Vásquez Garzón. Development of a syngeneic transplant rat model for the identification of an mRNA signature associated with metastatic hepatocellular carcinoma [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: RNAs as Drivers, Targets, and Therapeutics in Cancer; 2024 Nov 14-17; Bellevue, Washington. Philadelphia (PA): AACR; Mol Cancer Ther 2024;23(11_Suppl):Abstract nr A006.

Effect of Patient Resilience on Functional Outcomes After Anterior Cruciate Ligament Reconstruction.

Previous studies have examined the relationship between patient resilience and functional outcome scores after anterior cruciate ligament reconstruction (ACLR). However, past studies have failed to explore the longitudinal relationship between preoperative resilience and functional outcomes 2 years after ACLR. To evaluate the relationship between preoperative patient resilience and functional outcomes 2 years after ACLR. Cohort study; Level of evidence, 3. Patients were identified who underwent ACLR for anterior cruciate ligament tears between January and June 2020 at a single institution. Those who completed the Brief Resilience Scale preoperatively as part of routine patient questionnaires were considered for inclusion. Patients were contacted a minimum of 2 years after ACLR to complete the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-JR), Single Assessment Numeric Evaluation (SANE), International Knee Documentation Committee (IKDC) Subjective Knee Form, and visual analog scale (VAS). Outcomes were compared among patients with low resilience (LR), normal resilience (NR), and high resilience (HR), as defined in a previous study.23. A total of 81 patients were included in the final analysis, with 14 patients in the low preoperative resilience group, 54 in normal, and 13 in high. The mean age of the cohort was 32.0 years, and there were no significant differences in age, sex, race, graft type, or psychiatric comorbidities among the resilience groups. Significantly increased postoperative KOOS-JR scores were observed in patients in the HR group as compared with those in the NR and LR groups (94.8, 86.7, and 79.6, respectively; P = .031). There were also significantly increased postoperative SANE scores in patients in the HR group versus those in the NR and LR groups (92.3, 83.5, and 69.2; P = .012). Patients with high preoperative resilience achieved the IKDC Patient Acceptable Symptom State at significantly higher rates (P = .003). No significant differences were observed in postoperative VAS (P = .364), IKDC (P = .072), or change in IKDC (P = .448) over time among resilience groups. Postoperatively, 30 patients (37.0%) changed resilience groups, with 13 moving down and 17 moving up in category (low, n = 12; normal, n = 55; high, n = 14). Preoperative resilience correlated with KOOS-JR and SANE scores 2 years after ACLR but did not correlate with VAS, IKDC, or change in IKDC over the same period. Resilience was not static, with changes in resilience observed from initial to final evaluations. Resilience is not a strong predictor of postoperative patient-reported outcomes after ACLR.