Study Group Research Articles

PENGARUH LITERASI PASAR MODAL DAN PERSEPSI RISIKO TERHADAP KEPUTUSAN BERINVESTASI MAHASISWA

Capital market literacy is very important, because it makes it easier for students to make investment decisions. Risk perception is also a student factor in determining investment decisions, because the lower the risk, the higher it is in determining investment decisions and vice versa. The observation aims to determine the influence of capital market literacy and risk perception on students' investment decisions. This type of research is a quantitative approach. The data analysis method uses multiple linear regression analysis. The population and sample used were all members and administrators of the Mataram State Islamic University Capital Markets Study Group for 2022-2023, a total of 125 people using a saturated sampling technique. The research results show that capital market literacy influences investment decisions with the results of the hypothesis test (t test) (2,657 > 1,979) with a significance value (0.009 < 0.05). Risk perception influences investment decisions with the t test results (5,238 > 1,979) with a significance value (0.000 < 0.05). Meanwhile, capital market literacy and risk perception influence investment decisions simultaneously with the R2 test result (coefficient of determination) obtained at 0.263. This shows that investment decisions are influenced by Capital Market Literacy.

Loneliness and social isolation in people with HIV aged ≥50 years. The No One Alone (NOA)-GeSIDA study conducted by the GeSIDA 12021 study group.

There is a growing number of people with HIV who are aged 50 years or older, and the prevalence of loneliness and social isolation remains unknown. A multicentre study was conducted across 22 GeSIDA centres. A survey was carried out to assess loneliness [UCLA 3-item Loneliness Scale-3 (UCLA-3)] and social isolation [Lubben Social Network Scale-Revised (LSNS-R)], along with sociodemographic aspects, HIV-related factors, comorbidities, tobacco, alcohol and drug consumption, quality of life, anxiety and depression, and stigma. The prevalence of loneliness (UCLA-3 ≥ 6) and evident social isolation (LSNS-R ≤ 20) was calculated, and multivariable multinominal logistic regression models were used to identify associated factors. A total of 399 people with HIV were included; 77.4% were men, of average age 59.9 years (SD 6.5); 45.1% were aged ≥60 years; 86% were born in Spain; 86.7% in urban areas; 56.4% with secondary or higher education; 4.5% living alone against their wishes. A total of 66.9% were infected through sexual transmission, with a median of 22.9 years since diagnosis [interquartile range (IQR): 12.6-29.5] and a median nadir CD4 count of 245 cells/μL (IQR: 89-440). Overall, 90.7% had viral load <50 copies/mL, 93.5% had adherence >95%, and 26.3% had a prior AIDS diagnosis. In all, 29.1% and 21% reported significant symptoms of anxiety and depression, respectively, 24.3% had mobility issues, and 40.8% reported pain. Overall, 77.7% of participants reported neither loneliness nor social isolation, 10.0% loneliness only, 5.8% social isolation only and 6.5% both. Multivariable analyses identified that being aged 50-59, unemployed or retired, living alone unwillingly, single, poor quality of life, anxiety, and HIV-related stigma were associated with loneliness. Meanwhile, lower education, living alone unwillingly, and depressive symptoms were associated with social isolation. Individuals living alone unwillingly, with depressive symptoms and experiencing HIV-related stigma were at higher risk for both loneliness and social isolation. There is a relatively high prevalence of loneliness and social isolation in our population. Living alone against one's wishes, being unmarried, and experiencing mobility issues could predispose individuals to feel lonely and socially isolated. Those with anxiety and stigma are more prone to loneliness, while individuals with depression are more predisposed to social isolation. It is necessary to develop strategies for the detection and management of loneliness and social isolation in people with HIV aged >50 years.

Effect of Cranial Cruciate Ligament Transection during TPLO on Patellar Desmitis in Dogs with Partial Cranial Cruciate Ligament Rupture.

The aim of this study was to assess the protective effect of transecting a partially ruptured cranial cruciate ligament (CCL) during tibial plateau levelling osteotomy (TPLO) surgery on postoperative patellar ligament thickness (PLT) and shortening. Dogs with partial CCL rupture that underwent a unilateral TPLO were included. The population was divided into two groups: remnant CCL transected (study group) and left in situ (control group). Preoperative and 6-week postoperative measurements of PLT, in three specific locations, and patellar ligament length (PLL) were collected. Risk factors for PLT and shortening were also included. Fifty-two dogs (56 stifles) with partial CCL rupture were retrospectively included. Twenty-nine stifles (51.8%) had the remnant CCL transected (study group) and 27 stifles (48.2%) had the remnant CCL left in situ (control group). Significant differences were found on PLT measurements between pre- and 6-week post-surgery for all three ligament locations with greatest difference at the middle region. Median PLL was significantly shorter 6-week post-surgery for both groups. No significant differences in PLT nor PLL were identified between procedures where the remnant was transected or not. This study did not identify a protective effect of transecting the CCL remnant on PLT or patellar ligament shortening, contrary to other reports within the literature. Further investigation is needed in the form of prospective studies with higher number of cases to understand the clinical implications of patellar ligament thickening and shortening in dogs.

Androgen receptor CAG repeat polymorphism might be a possible cause of familial constitutional delay of growth and puberty.

Induction of puberty in boys with constitutional delay of growth and puberty (CDGP) through a short course of low-dose testosterone therapy indicates the critical interaction between testosterone and the androgen receptor (AR) during the activation and maturation of the hypothalamic-pituitary-gonadal axis at puberty onset. Previous studies have shown an inverse relationship between the CAG repeat length and the transactivation function or expression level of the AR gene. We aimed to investigate whether the AR CAG repeat polymorphism has any implications on pubertal delay. Thirty-three male patients with CDGP were enrolled in the study group, while 53 age-matched healthy individuals who had entered puberty on time were included in the control group. The CAG repeat length was determined through direct DNA sequencing analysis. The median chronological age of boys with CDGP was 14.2 (14.1-14.6) years, compared to 14.2 (13.65-14.8) years for healthy subjects (p = 0.5). In the CDGP group, 22 (66.7%) children had a family history of the condition. There was no significant difference between the groups in terms of AR CAG repeat length (median AR CAG repeat length: 21 (20-24.5) and 20 (20-24), respectively, p = 0.1). However, in boys with CDGP with a similar family history (n = 22), a significantly longer AR CAG repeat length was found compared to the control group (n = 53) (median AR CAG repeat length: 22 (20-25) and 20 (20-24), respectively, p = 0.03). The median AR CAG repeat length in boys without a family history was 21 (20-22) triplets. Although boys with a family history had a slightly longer AR CAG repeat length than those without, the difference was not statistically significant (p = 0.07). Additionally, no significant differences were observed between boys with non-familial CDGP and control subjects (p = 0.8). Furthermore, no significant differences in anthropometric characteristics or hormonal parameters were found when patients with CDGP were categorized by AR CAG repeat length quartiles. This is the first study to investigate the role of AR CAG polymorphism in the etiopathogenesis of CDGP. Our findings suggest that the AR CAG repeat length may be associated with familial CDGP.

Can leisure education effect on screen time and perceived leisure benefits for college students?

BackgroundSince children and adolescents usually spend their theoretical course time at schools, they experience many negative effects of inactivity and physical inactivity. They are disadvantaged in terms of facing many health and social problems due to lack of physical activity. This sedentary life increases their exposure to screens and the time they spend sitting.Aim of the studyThe first aim of this research is to conduct an experimental study to reduce the excessive screen time of college students with an exercise intervention. The second aim of the study is to examine the perceived benefits of leisure activities of students with an exercise intervention.MethodsIn this direction, the study group of the research, which was conducted as an experimental study, consisted of 176 [74 female (42.0%), 102 male (58.0%)] students studying in the department of mathematics at college. In the study, the screen exposure time of students was measured with the “Screen time scale for youth and adolescents” along with a personal information form. In addition, the “Perceived Leisure Benefit Scale” scale was used to evaluate the participants’ awareness of the benefits obtained from leisure activities.Results and conclusionAccording to the findings of the research, it was determined that there was a positive and significant decrease in the screen time of the experimental group participants of students who participated in the research before and after the exercise intervention. In the Leisure Benefit Scale, it was observed that there were significant positive differences in favor of the experimental group.

Association between gestational diabetes mellitus diagnostic criteria and adverse pregnancy outcomes—a systematic review and meta-analysis of adjusted effect sizes from studies using current diagnostic criteria

ObjectivesTo quantify the association between Gestational Diabetes Mellitus (GDM) and adverse pregnancy outcomes and primarily compare the associations between diagnostic criteria following the International Association of Diabetes and Pregnancy Study...

Cognitive frailty as a predictor of hospitalisation among older adults: a systematic review and meta-analysis.

To examine whether cognitive frailty serves as a predictor of hospitalisation in older adults. PubMed, Web of Science, Embase, Scopus and Cochrane Library databases were systematically searched from inception to February 6, 2024. The reviewers independently selected studies, extracted data and evaluated the quality of studies. Stata 15.1 Software was used to perform the meta-analysis. A total of 13 articles were included in this study, including 34 230 participants. The results suggested that cognitive frailty was associated with hospitalisation in older adults (odds ratio (OR) = 1.79, 95% CI: 1.33-2.42, P < 0.001). The risk of hospitalisation for patients with cognitive frailty was 1.76 times higher than that for patients without cognitive frailty (relative risk = 1.76, 95% CI: 1.48-2.08, P < 0.001). According to different models of cognitive frailty, the results of subgroup analysis showed that the frail + cognitive impairment group had the highest risk of hospitalisation (OR = 2.22, 95% CI: 1.51-3.26, P < 0.001). Subgroup analysis based on study design showed that the incidence of hospitalisation was lowest in the cohort study group (OR = 1.51, 95% CI: 1.14-2.00, P = 0.004). This study suggested that cognitive frailty was an important predictor of hospitalisation in older adults. Future studies are needed to investigate the impact of cognitive frailty on hospitalisation in older adults, as this may help reduce hospitalisation rates and improve patients' quality of life.

Current evidence on gender-related risk factors for type 1 diabetes, type 2 diabetes and prediabetes: a reappraisal of the Italian study group on gender difference in endocrine diseases.

Diabetes is a chronic disease with a significant socio-economic burden. Recognizing its risk factors and gender differences within its physio-pathological mechanisms may allow early diagnosis. This review aims to summarize the current evidence on gender differences in terms of prevalence, risk factors and pathogenesis for Type 1 Diabetes (T1D), Type 2 Diabetes (T2D) and prediabetes. A comprehensive search of English-language articles was conducted in PubMed, EMBASE and Cochrane Library until July 2024. We selected all studies that assessed gender differences on risk factors for diabetes and prediabetes. T1D is an autoimmune disease, with a multifactorial pathogenesis. Contrary to most autoimmune diseases, it has a male gender bias, with a male predominance incidence after puberty, for which the involvement of hormones has been hypothesized in addition to genetic predisposition. In T2D, the accumulation of visceral adipose tissue is recognized as the main predisposing factor for insulin resistance and consequent β-cells loss and dysfunction. Sex hormones influence fat disposition resulting in different body composition between males and females and different metabolic impact. Gender differences in dietary patterns and socio-cultural determinants also influence the risk of T2D. Also, a gender-related risk factor has been detected in prediabetes; indeed, females are at greater risk of impaired glucose tolerance than males. Evidence shows the existence of gender differences in risk factors for T1D, T2D and prediabetes. This suggests that gender should be considered in prevention and screening programs, with the goal of reducing incidence or making an early diagnosis.

Oxidative damage and mitochondrial dysfunction in cystathionine beta-synthase deficiency

Cystathionine beta-synthase deficiency (CBSD) is the most prevalent inherited disorder of homocysteine metabolism in the transsulphuration pathway. Research have suggested oxidative stress and inflammation as candidate pathogenic mechanisms in CBSD. This study aims to evaluate mitochondrial dysfunction and oxidative stress biomarkers in cystathionine beta-synthase deficiency (CBSD) patients, which may aid in understanding the pathogenesis of CBSD and improving treatment. The study group comprised 23 patients with a diagnosis of CBSD and healthy controls. We analysed serum levels of NAD+ and NADH by fluorometric assay, FGF-21 and GDF-15 by ELISA, mitochondrial DAMPs by real time qRT-PCR, total homocysteine levels in plasma by enzymatic test and compared the results in CBSD group with healthy controls. In patient group, a positive correlation was found between the total homocysteine level and both GDF-15 and NAD+/NADH levels. Furthermore, there was a negative correlation between total homocysteine levels and both total NAD++NADH and NADH levels. The alterations in NAD+, FGF-21, GDF-15 levels, and NAD+/NADH ratio in patients suggest that oxidative damage coexists with mitochondrial dysfunction in CBSD. Assessment of oxidative damage and addition of anti-oxidant therapy together with mitochondrial support may have additional benefits in reducing long-term morbidity in CBSD patients.

Efficacy and Safety of Vuong Hoat Natural Health Supplement in Managing Low Back Pain: A Randomized Clinical Trial.

This clinical study aimed to assess the effectiveness and safety of Vuong Hoat (VH) natural health supplement for reducing the negative impact of low back pain, improving the quality of life, and enhancing functional activities in patients with lumbar degenerative disc disease (LDD). The open-label, randomized, controlled clinical trial involved 60 patients suffering from low back pain caused by LDD. The participants were randomly assigned to either a study group (SG) comprising 30 subjects or a control group (CG) comprising 30 subjects. Patients in the CG received treatment with electro-acupuncture, while those in the SG were administered VH in conjunction with the same electro-acupuncture protocol for 28 days. The clinical progression and tolerability of both groups were compared based on seven objective measurements: visual analog scale index, Schober test, fingertip-to-floor distance, spinal flexion, spinal extension, spinal tilt, and spinal rotation. After 14 days of treatment, the SG showed a significant improvement in overall outcomes compared to the CG. Specifically, 43.3% of SG patients achieved very good results, 53.3% had good results, and 3.4% had moderate results, whereas corresponding figures for the CG were 6.7%, 76.7%, and 16.6%, respectively (P < .05). After 28 days of treatment, both groups demonstrated a shift toward very good results, with the SG continuing to show better outcomes than the CG (P < .05). In the SG, the very good results increased to 76.7%, good results decreased to 20%, and moderate results were 3.3%. On the other hand, the CG had 46.7% very good results, 43.3% good results, and 10% moderate results. Notably, no side effects were reported from the VH treatments during the study. The findings of this study indicate that VH health supplement is a safe and effective approach for managing low back pain and limited spinal movement in patients with LDD.

Concentration, motivation, activity, and subjective fatigue in patients with single-sided deafness.

To evaluate four dimensions of fatigue, including subjective fatigue severity, concentration problems, reduced motivation, and activity in patients with single-sided deafness. Following audiological assessment, the Checklist Individual Strength scale and Montreal Cognitive Assessment were performed on 41 adults with single-sided deafness and 41 sex-matched adults with normal bilateral hearing in the study group and control group, respectively. Subjective fatigue severity, concentration, motivation, activity level and cognitive performance were analysed between and within groups. Individuals with single-sided deafness exhibited reduced concentration and motivation; however, their activity level was average. Subjective fatigue symptoms were more prevalent in individuals with single-sided deafness than in control participants. The concentration problem was related to decreased cognitive performance. This study revealed negative somatic consequences of single-sided deafness. Self-perceived fatigue is likely underestimated in this population due to the limited studies reported in the literature. Further studies should focus on counselling, follow up and hearing rehabilitation concerning ameliorating fatigue.

The Predictive Role of miRNAs in Hepatitis B Vaccine Response of Metabolic Dysfunction-Associated Steatotic Liver Disease Patients

(1) Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease. Although the changes in the expression levels of microRNAs (miRNAs) in hepatitis B virus-related diseases have been evaluated, no study has evaluated the role of miRNAs in HBV vaccine response in MASLD patients. We aimed to determine the miRNA expression profile in MASLD patients according to HBV vaccine response. (2) Methods: Overall, 100 MASLD patients and 100 controls were included, and anti-HBs levels were measured after three doses of HBV vaccine administration. After collecting blood samples, 22 different miRNA expression profiles were analyzed by RT-PCR analysis, and changes in the expression levels of potential miRNAs were further verified in all study groups. (3) Results: The miR-146a expression level considerably increased in MASLD patients compared to the control group. Furthermore, miR-99a and miR-640 expression levels significantly increased in AntiHBs (−) healthy individuals. (4): Conclusions: miR-146a could be used as the diagnostic marker in MASLD patients. Furthermore, the miR-99a and miR-640 expression levels could predict hepatitis B vaccine response. However, validation studies are required to verify the biomarker potential of miRNAs within a more significant number of patients.

Assessment of urine calprotectin and YKL-40 levels in urinary tract infection diagnosis in children under 2 years of age

Urinary tract infections (UTI) are common cause of fever in children. They often manifest with non-specific symptoms. New markers assessed in non-invasively collected urine are needed for quick and reliable diagnosis. This study evaluates the usefulness of calprotectin and YKL-40 in the diagnosis of febrile UTIs among children. 67 children aged between 1 month and 2 years took part in the study. The study group (group UTI) consisted of children with the first episode of febrile UTI (n = 20). Two control groups were created: group F - febrile children with other than UTI cause of the fever (n = 36), group H - healthy children (n = 11). Concentrations of calprotectin and YKL-40 in urine samples were determined with the use of the enzyme-linked immunosorbent assay method (ELISA). In the UTI group, the average calprotectin concentration was 1273.3 ng/ml, which was significantly higher than in group F (35.4 ng/ml) and in group H (8.0 ng/ml) (p < 0.001). The YKL-40 concentration in the UTI group was 15,542.1 pg/ml, which was also significantly higher than in group F (138.1 pg/ml) and in group H (162 pg/ml) (p < 0.01). These findings suggest that urinary YKL-40 and calprotectin could be useful markers in the differential diagnosis of febrile UTI among children.

Effect of Pelvic Control Exercises on Balance in Children with Cerebral Palsy: A Randomized Controlled Trial

Objective: The study’s goal was to find out how children with cerebral palsy’s (CP) balance was affected by exercises for pelvic control. Material and Methods: Forty-two children that participated in this single-blind trial were divided into two groups at random. Group A (n=21) received conventional intervention and pelvic control exercises, while Group B (n=21) received only conventional intervention. For a period of eight weeks, the intervention was carried out; three days a week. The time up and go scale was used for assessment before and after treatment. The paired-t test was used to analyze differences within the group, whereas the independent t-test was utilized to analyze differences between the two groups.Results: Results for pre and post-treatment timed up and go (TUG) scores are presented as means and standard deviations. The values of TUG scores in study group A showed a notable increase (p-value&lt;0.05) after treatment with conventional physiotherapy and pelvic control exercises. Conclusion: The results indicated that pelvic control training was found to be beneficial in improving the balance of children with CP.

Sarcopenia Seems to Be Common in Older Patients With Restless Legs Syndrome.

Restless legs syndrome (RLS) is a disorder characterized by nocturnally exacerbating pain that leads to significant sleep disturbances. The hormonal and metabolic changes caused by sleep disruption may increase the incidence of muscle-related diseases like sarcopenia in older adults, which is defined by a progressive loss of muscle strength and mass. This study aimed to investigate the relationship between RLS and sarcopenia, which may affect each other through common pathophysiological pathways in older adults. This was a cross-sectional study including 109 patients with RLS and 220 without RLS who applied to the geriatric clinic. RLS was assessed using the Turkish version of the International Restless Legs Syndrome Study Group (IRLSSG). Sarcopenia was diagnosed according to the European Working Group on Sarcopenia in Older People-2 criteria. All the demographics, comorbid conditions, medications and findings of comprehensive geriatric assessments were recorded. The association between RLS and sarcopenia was examined by logistic regression. The mean age was 75 ± 7.4 and 73.8 ± 7 years for the RLS and the control groups, respectively (p > 0.05) and the ratio of females was higher in the RLS group (69.7% vs. 57.9%) (p = 0.035). The frequencies of coronary artery disease (CAD), hypertension (HT) and peripheral artery disease (PAD) were significantly higher in RLS patients (p = 0.020, p = 0.047, p = 0.010, respectively), while the prevalence of anaemia was 41% and 25-OH Vitamin D levels (25[OH]D) were higher than in the control group (p < 0.001). The frequency of probable sarcopenia and sarcopenia was higher in patients with RLS than in controls (20% vs. 11%, p = 0.037 and 8% vs. 2.3%, p = 0.047, respectively). A significant association between RLS and an increased likelihood of probable sarcopenia, sarcopenia and slow gait speed (odds ratio [OR]: 2.621, 95% confidence interval [CI] [1.265, 5.431]; OR: 4.542, 95% CI [1.284, 16.071]; OR: 2.663, 95% CI [1.432, 4.951], respectively) was found after adjusting for factors such as gender, HT, CAD, PAD, serum 25(OH)D levels, anaemia, chronic kidney disease (CKD) and nutritional status. However, the significance of low muscle mass disappeared (p > 0.05). This study demonstrated that sarcopenia is prevalent among older patients with RLS, which seems to be associated with low muscle strength and slow gait speed. Given the negative health outcomes related to sarcopenia, interventions aimed at preventing its development could be significantly beneficial for patients with RLS in older adults as well.

Bilateral Versus Unilateral Repair of Nasal Septal Perforation: A Two-Center Retrospective Study.

There are two main approaches for nasal septal perforation (NSP) surgery-bilateral and unilateral repair. There are advantages and disadvantages to each of these techniques. At the same time, there is a lack of comparative studies on the effectiveness of these approaches. The study aims to compare the effectiveness of unilateral and bilateral closure of NSP. A total of 99 patients with symptomatic NSP underwent surgery between 2021 and 2022 and were followed up at two large tertiary centers. The "unilateral closure" group (Group 1, N = 47) utilized an anterior ethmoidal artery (AEA) flap to close the perforations. Group 2 (N = 52) consisted of patients, who underwent bilateral closure of NSP. Complete closure of the NSP was achieved in 39 of 47 (83%) patients in Group 1 and in 48 of 52 (92.3%) patients in Group 2. There was a trend toward a higher incidence of incomplete defect closure among Group 1 patients when analyzing the subgroups of large (>2 cm) NSP (RR = 2.75 [95% CI: 0.96; 7.87], p = 0.072). There was a statistically significant decrease in SNOT-25 score after surgery in each of the study groups (p < 0.001) with no significant differences between groups (p = 0.51). The relative advantages of the thin flap are outweighed by the obtained data of higher efficacy of the bilateral technique in large NSP cases. Therefore, in cases of surgical repair of small and medium-sized NSP, the closure rates after single-layer and double-layer closure are comparable. III Laryngoscope, 2024.

Obstetric and neonatal outcomes in the management of twin pregnancies with gestational diabetes using the IADPSG criteria for singleton pregnancies

BackgroundThis study evaluates the effectiveness of the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria, typically applied to singleton pregnancies, in managing gestational diabetes mellitus (GDM) in twin pregnancies. Focusing on a Chinese cohort, it contrasts the clinical outcomes and complications in twin pregnancies with and without GDM.MethodsWe conducted a retrospective cohort study at our hospital from January 2019 to December 2021, including all twin deliveries except those before 28 weeks of gestation, with prior diabetes, or unknown GDM status. GDM was diagnosed using a 75 g oral glucose tolerance test based on the IADPSG criteria, and management involved dietary or insulin interventions. We assessed outcomes such as hypertensive disorders (gestational hypertension, preeclampsia, and eclampsia), membrane rupture, preterm birth, small for gestational age (SGA), large for gestational age (LGA), and neonatal intensive care unit (NICU) admissions.ResultsAmong 1003 twin pregnancies, 21.7% had GDM, with 11.5% receiving insulin. GDM was associated with older maternal age, higher BMI, and a family history of diabetes. Pregnant women with GDM had lower weekly weight gain (0.44 kg/week vs. 0.58 kg/week, p < 0.001) and experienced a higher risk of SGA neonates (aOR = 1.68, 95% CI: 1.06–2.67) and increased NICU admissions (aOR = 1.30, 95% CI: 1.00-1.69) compared to those without GDM. Additionally, dichorionic twins with GDM showed higher risks of SGA and NICU admissions, while monochorionic twins had no significant differences. A U-shaped relationship was identified between weekly weight gain and the rates of SGA and NICU admissions, with the lowest risk observed at a weekly weight gain of 0.75 kg for SGA and 0.57 kg for NICU admissions.ConclusionsApplying singleton-derived IADPSG criteria to twin pregnancies may mitigate some maternal risks but elevates the risk for SGA neonates, suggesting a need for tailored diagnostic and management strategies for twin pregnancies.Trial registrationRetrospectively registered.

Implications of Implementing Children's Oncology Group Risk Stratification to Patients With Rhabdomyosarcoma Treated on European Paediatric Soft Tissue Sarcoma Study Group Clinical Trial.

Prognostic factors are crucial in tailoring treatments for patients with rhabdomyosarcoma (RMS). The European paediatric Soft tissue sarcoma Study Group (EpSSG) and the Children's Oncology Group (COG) employ similar prognostic factors, but utilize them differently resulting in diverse stratification systems. This diversity may result in dissimilar treatment approaches for comparable patients and hinder the comparison of clinical trial results. We reclassified 1993 patients enrolled in the EpSSG RMS 2005 and MTS 2008 studies based on the risk stratification used in current EpSSG and COG trials, and compared the type and cumulative doses of chemotherapy recommended to the different risk groups. Alkylating agents were compared using the cyclophosphamide equivalent dose formula. Metastatic RMS with high-risk features were excluded because no standard recommended treatment exists. Patients were variably distributed across EpSSG and COG risk stratifications. Notably, 34.2% of EpSSG standard-risk patients fell into three different COG risk groups (very low, low, and intermediate), and 66.8% of the total population, classified as standard, high, and very high risk by EpSSG, would all be considered intermediate risk by COG. Consequently, only 57.3% of the study population would receive comparable intensive chemotherapy under both EpSSG and COG protocols. Disparities emerged, with 16.5% undergoing more intensive and 17.2% receiving less intensive treatment in COG protocols compared to EpSSG studies. Our study shows the complexities of the current RMS risk stratification systems, emphasizing the need for a global consensus. A unified approach would reduce the risk of disparate treatments for similar patients and facilitate more straightforward cross-study comparisons.

Making wrong site surgery a "never event" in spinal deformity surgery by use of a "landmark vertebra" to eliminate variability in identifying a target vertebral level.

Despite the introduction of "standardized counting" methods, errors in counting spinal levels and subsequent wrong-level surgery (WLS)remain critically important patient safety concerns. Previous work by our group has documented inconsistency in the identification of T12 despite the use of these systems including the Spinal Deformity Study Group (SDSG)conventions. To assist with consistent and repeatable identification of proposed preoperative surgical levels, the current study investigates a new strategy: utilization of a "landmark vertebra". It was hypothesized that individuals using a "landmark vertebra" strategy will achieve high concordance with target level identification between distinct time points as compared to conventional methods defining T12. Survey participants analyzed 99 pre-op radiographs, identifying and naming a "landmark vertebra" with concise descriptions like "last bilaterally ribbed vertebra." They then noted the proposed lowest instrumented vertebra's (LIV) distance relative to landmark (i.e., one below landmark). After a waiting period, participants used their written descriptions of the landmark and distance to LIV to reidentify these vertebrae. Cohen's Kappa (k) was used to measure intra-rater agreeability. The landmark strategy was compared to our previous work evaluating consistency in defining T12 based on the SDSG system. All raters showed perfect to near-perfect agreement when re-identifying the landmark and target vertebrae (k = 0.819-1.00; Table1A). Raters at all training levels had higher agreeability in naming the landmark vertebra and target when compared to raters at similar training levels defining T12 (k = 0.34-0.91; Table1B). This high agreement across training demonstrates the strategy's versatility and generalizability. Utilization of a landmark strategy proved to be highly effective in reducing intra-rater variability, with perfect to near-perfect agreement among all raters and consistently higher agreeability when compared to defining T12. Level II-prospective survey.

Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis

Patients with painful chronic pancreatitis and a dilated pancreatic duct can be treated by early surgery or an endoscopy-first approach. To compare long-term clinical outcomes of early surgery vs an endoscopy-first approach using follow-up data from the ESCAPE randomized clinical trial. Between April 2011 and September 2018, 88 patients with painful chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach in 30 hospitals in the Netherlands collaborating in the Dutch Pancreatitis Study Group as part of the ESCAPE randomized clinical trial. For the present cohort study, long-term clinical data were collected after the initial 18-month follow-up. Follow-up was completed in June 2022, and data analysis was performed in June 2023. Patients with chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach. The primary end point was pain, assessed by the Izbicki pain score; secondary end points included patient-reported complete pain relief and satisfaction. Predefined subgroups included patients who progressed from endoscopy to surgery and those with ductal clearance obtained by endoscopy. Analysis was performed according to the intention-to-treat principle. In this cohort study, 86 of 88 overall patients could be evaluated, with a mean (SD) follow-up period of 98 (16) months. Of 88 initial patients, 21 patients (24%) were female, and mean (SD) patient age was 61 (10) years. At the end of long-term follow-up, the mean (SD) Izbicki pain score was significant lower (33 [31] vs 51 [31]) in the early surgery group, as was the rate of patient-reported complete pain relief (14 of 31 patients [45%] vs 6 of 30 patients [20%]), compared to the endoscopy-first group. After the initial 18-month follow-up, 11 of 43 patients in the early surgery group (26%) underwent reinterventions vs 19 of 43 patients in the endoscopy-first group (44%). At the end of follow-up, more patients in the early surgery group were "very satisfied" with their treatment (22 of 31 patients [71%] vs 10 of 30 patients [33%]). Patients who progressed from endoscopy to surgery (22 of 43 patients [51%]) had significantly worse mean (SD) Izbicki pain scores (33 [31] vs 52 [24]) compared to the early surgery group and had a lower rate of complete pain relief (55% for early surgery vs 12% for endoscopy first). In the endoscopy-first group, patients with endoscopic ductal clearance had similar mean (SD) Izbicki pain scores as the remaining patients (49 [34] vs 53 [28]). In this cohort study evaluating long-term outcomes of the ESCAPE randomized clinical trial, after approximately 8 years of follow-up, early surgery was superior to an endoscopy-first approach in patients with painful chronic pancreatitis and a dilated main pancreatic duct in pain scores and patient satisfaction. Notably, patients who progressed from endoscopy to surgery had worse outcomes compared to patients undergoing early surgery, and obtaining endoscopic ductal clearance did not improve outcomes.