Unadjusted OR Research Articles

Effect of postoperative utilization of somatostatin on clinical outcome after definitive surgery for duodenal fistula

PurposeTo evaluate the effect of postoperative utilization of somatostatin after definitive surgery for duodenal fistula (DF) in preventing a recurrence.MethodsPatients with definitive surgery for DF between January 2010 and December 2021 were categorized based on the utilization of somatostatin or not after the surgery. Patients in the Somatostatin group were matched to those in the Non-somatostatin group using propensity scores matching (PSM), so as to evaluate the effect of postoperative use of somatostatin by comparing the two groups.ResultsA total of 154 patients were divided into the in the Somatostatin group (84) and the Non-somatostatin group (70). Forty-three patients (27.9%) exhibited a recurrent fistula, with which the postoperative use of somatostatin was not associated (19 [22.6%] in the Somatostatin group and 24 (34.3%) in the Non-somatostatin group; unadjusted OR 0.56; 95% CI 0.28–1.14; P = 0.11). However, the postoperative usage of somatostatin served as a protective factor for developing into high-output recurrent fistula (eight (13.3%) in the Somatostatin group and 15 (25%) in the Non-somatostatin group; adjusted OR 0.39; 95% CI 0.15–0.93; P = 0.04). After PSM, the recurrent fistula occurred in 29.2% subjects (35/120). The postoperative usage of somatostatin was not associated with recurrent fistula (13 in PSM Somatostatin group vs. 22 in PSM Non-somatostatin group; unadjusted OR 0.48; 95% CI 0.21–1.07; P = 0.07), while its postoperative usage decreased the incidence of recurrent high-output fistula (5/60 in the PSM Somatostatin group, compared with 13/60 in the PSM Non-somatostatin group; adjusted OR 0.30; 95% CI 0.09–0.95).ConclusionPostoperative use of somatostatin could effectively reduce the incidence of recurrent high-output fistula, without association with overall incidence of postoperative recurrent fistula.

Evaluating associations between level of trauma care and outcomes of patients with specific severe injuries: A systematic review and meta-analysis.

Trauma networks have multiple designated levels of trauma care. This classification parallels concentration of major trauma care, creating innovations and improving outcome measures. The objective of this study is to assess associations of level of trauma care with patient outcomes for populations with specific severe injuries. A systematic literature search was conducted using six electronic databases up to April 19, 2022 (PROSPERO CRD42022327576). Studies comparing fatal, nonfatal clinical, or functional outcomes across different levels of trauma care for trauma populations with specific severe injuries or injured body region (Abbreviated Injury Scale score ≥3) were included. Two independent reviewers included studies, extracted data, and assessed quality. Unadjusted and adjusted pooled effect sizes were calculated with random-effects meta-analysis comparing Level I and Level II trauma centers. Thirty-five studies (1,100,888 patients) were included, of which 25 studies (n = 443,095) used for meta-analysis, suggesting a survival benefit for the severely injured admitted to a Level I trauma center compared with a Level II trauma center (adjusted odds ratio [OR], 1.15; 95% confidence interval [CI], 1.06-1.25). Adjusted subgroup analysis on in-hospital mortality was done for patients with traumatic brain injuries (OR, 1.23; 95% CI, 1.01-1.50) and hemodynamically unstable patients (OR, 1.09; 95% CI, 0.98-1.22). Hospital and intensive care unit length of stay resulted in an unadjusted mean difference of -1.63 (95% CI, -2.89 to -0.36) and -0.21 (95% CI, -1.04 to 0.61), respectively, discharged home resulted in an unadjusted OR of 0.92 (95% CI, 0.78-1.09). Severely injured patients admitted to a Level I trauma center have a survival benefit. Nonfatal outcomes were indicative for a longer stay, more intensive care, and more frequently posthospital recovery trajectories after being admitted to top levels of trauma care. Trauma networks with designated levels of trauma care are beneficial to the multidisciplinary character of trauma care. Systematic review and meta-analysis; Level III.

Association between artificial intelligence (AI) -assisted tumor AREG and EREG immunohistochemistry (IHC) and outcomes from anti-EGFR therapy during the routine management of metastatic colorectal cancer (mCRC): An observational cohort study.

203 Background: AREG and EREG are ligands of EGFR. AI assisted IHC evaluation of tumor AREG/EREG expression predicted benefit from anti-EGFR therapy in a retrospective analysis of the PICCOLO trial of second-line irinotecan ± panitumumab. Here, we sought to validate those findings through an analysis of patients who received anti-EGFR therapy during routine care for mCRC. Methods: Patients (pts) with available archival FFPE tumor tissue who received panitumumab or cetuximab ± chemotherapy at any time for treatment of mCRC at 8 UK cancer centers were eligible. Central RAS testing by next generation sequencing (NGS) was performed for pts where extended RAS testing had not been previously undertaken. RAS-mutant (mut) and RAS-unknown pts were excluded from the primary analysis population. AREG and EREG positive tumor cells were identified by IHC, performed locally at 6 of 8 sites. Pathologists annotated tumor areas on digital images of glass slides. AI algorithms calculated the percentage of tumor cells staining positive for AREG and EREG within tumor areas. More than 20% AREG and/or EREG tumor cell positivity was regarded as high biomarker expression, the optimal cut-point identified in PICCOLO. Study endpoints were progression-free survival (PFS), overall survival (OS), and locally reported response rate (RR) and disease control rate (DCR). Results: Of 541 pts recruited, 494 (91.3%) had adequate archival tissue for analysis. Central RAS testing was successfully performed in 255 of 393 (64.9%) pts without existing extended RAS results, leading to 45 exclusions, leaving 449 pts in the primary analysis population. 26 (5.8%) pts were BRAF-mut. 110 (24.5%) received concomitant FOLFOX and 304 (67.7%) FOLFIRI. After adjustment for additional prognostic factors, high AREG/EREG expression (n = 360; 80.2%) was associated with significantly prolonged PFS (HR 0.73; 95% CI, 0.56-0.95; p = 0.02), OS (HR 0.66 [0.50-0.86]; p = 0.002), and DCR (OR 1.92 [1.05-3.54]; p = 0.04), but not RR (unadjusted OR 1.39 [0.83-2.33]; p = 0.21). Median PFS in the high vs low biomarker groups was 8.5 vs 4.4 months; median OS 16.4 vs 8.9 months. The significant difference in OS (high vs low) was maintained in the subgroup with right-sided primary tumor location (n = 107; 23.8%) (HR 0.56 [0.37-0.86]; p = 0.007). Conclusions: High tumor AREG/EREG expression was associated with significantly prolonged PFS, OS and DCR among a cohort of pts treated with anti-EGFR therapy during routine care of mCRC. The prognostic effect observed validates the predictive effect of AREG/EREG seen in the PICCOLO trial, where AREG/EREG had no prognostic effect in patients receiving chemotherapy alone. A prospective biomarker-led trial is in set-up to support the use of AREG/EREG IHC in clinical practice.

Abstract WP203: Stroke Occurrence Is Associated With Abnormal Sleep Duration In The United States

Background and Purpose: Inappropriate sleep duration (<7 or >8 hours/night) is associated with cardiovascular events. Given its importance, the new American Heart Association Life’s Essential 8 construct of ideal cardiovascular health includes sleep duration. Yet, studies of sleep duration in relation to stroke are scarce. Our objective was to compare sleep duration among individuals with and without prior stroke in a nationally representative U.S. sample. Methods: Using the National Health and Nutrition Examination Surveys database (2005-2018), individuals >=18 years were identified (n=37,987 without self-reported stroke; n=1,572 with self-reported stroke). Prevalence of normal sleep duration (7-8 hours/night) was compared between persons with and without self-reported history of stroke using the Rao-Scott χ; 2 test. Multinomial logistic regression analysis was used to evaluate the relationship between prior stroke and abnormal sleep before and after adjusting for demographic and clinical variables. Results: Compared to individuals without prior stroke, prevalence of normal sleep duration was lower in individuals with prior stroke (18-44 years: 32% vs 54%; 45-64 years: 47% vs 55%; >=65 years: 45% vs 54%). Factors associated with >8 hours/night sleep included female sex, older age, non-White race, lower education, poverty, and obesity. Factors associated with <7 hours/night sleep were male sex, younger age, Black race, lower education, poverty, and obesity. Compared to individuals without stroke, those with prior stroke were more likely to report >8 hours/night (unadjusted OR 2.03, 95% CI 1.64-2.51) and <7 hours/night (1.29, 1.08-1.53). These associations were respectively attenuated after adjustment for demographic and clinical variables (adjusted OR 1.54, 95% CI 1.22-1.94 and 1.15, 0.96-1.38). Conclusion: Stroke survivors in the United States are more likely to have abnormal sleep duration compared to those without a prior stroke. Future research should explore the causal links between stroke by type and duration of sleep.

SG-APSIC1035: Prospective safety surveillance study of ACAM2000 smallpox vaccine in deployed military personnel

Objectives: We compared rates of myopericarditis adverse events and evaluated potential risk factors of development. We compared rates of dermatological–neurological adverse events (severe and serious) with other adverse events in a specific population of deployed US military personnel who received or did not receive ACAM2000 vaccine (ie, Vaccinia smallpox live vaccine). Methods: Up to 20,000 military personnel recipients were enrolled in a prospective observational cohort study: up to 15,000 ACAM2000 recipients in cohort 1 and up to 5,000 military personnel who were eligible for ACAM2000 vaccination but were not vaccinated due to recent vaccination or characteristics of their contacts in cohort 2. Enrollment was at a 3:1 ratio, respectively. Serum specimens and data were collected at the initial visit and 10 days later (cf, window of 6–17 days). Study participants with evidence, either clinical or laboratory, of possible myopericarditis were referred to a blinded independent review committee for further evaluation and adjudication. The primary analysis was logistic regression with adjudicated myopericarditis as the dependent variable and age, sex, race, and exercise regimen as the independent variables. Results: Initial data and serum specimens were obtained from 14,667 participants (cohort 1, N = 10,825; cohort 2, N = 3,842). According to protocol, 2 visits were completed by 12,110 participants (cohort 1, N = 8,945; cohort 2, N = 3,165), and 125 participants (cohort 1, N = 111; cohort 2, N = 14) were referred for myopericarditis adjudication, of whom 1 had confirmed myocarditis, 5 had suspected myocarditis, 1 had suspected pericarditis, and 54 (cohort 1, N = 44; cohort 2, N = 10) had subclinical myopericarditis. The unadjusted myopericarditis rates were 5.7 per 1,000 (95% CI, 4.3–7.5) for cohort 1 and 3.2 per 1,000 (95% CI, 1.7–5.8) for cohort 2. The unadjusted and adjusted odds ratios for myopericarditis for cohort 1 and cohort 2 were 1.8 (95% CI, 0.9–3.6) and 1.3 (95% CI, 0.6–2.6), respectively. At least 1 serious adverse event was experienced by 117 participants (1.1%) in cohort 1 and 13 (0.3%) in cohort 2. No serious and severe neurological or dermatological adverse events were reported. Conclusions: ACAM2000 vaccination was associated with a modest but nonsignificant increase in the risk of myopericarditis in this prudently screened, young and healthy service-member population. The adjusted OR was 1.3 and the unadjusted OR was 1.8. Overall, all but 7 cases were subclinical. Citation: Faix DJ, Gordon DM, Perry LN, et al. Prospective safety surveillance study of ACAM2000 smallpox vaccine in deploying military personnel. Vaccine 2020;38:7323–7330.

Association of delirium with increased short-term mortality among older emergency department patients: A cohort study

Study objectiveTo evaluate the association between delirium and subsequent short-term mortality in geriatric patients presenting to the emergency department (ED). MethodsThis was an observational cohort study of adults age ≥75 years who presented to an academic ED and were screened for delirium during their ED visit. The Delirium Triage Screen followed by the Brief Confusion Assessment Method were used to ascertain the presence of delirium. In-hospital, 7-day, and 30-day mortality were compared between patients with and without ED delirium. Odds ratios with 95% confidence intervals (CIs) were calculated through logistic regression after adjusting for confounders including age, sex, history of dementia, ED disposition, and acuity. ResultsA total of 967 ED visits were included for analysis among which delirium was detected in 107 (11.1%). The median age of the cohort was 83 years (IQR 79, 88), 526 (54.4%) were female, 285 (29.5%) had documented dementia, and 171 (17.7%) had a high acuity Emergency Severity Index triage level 1 or 2. During the hospitalization, 5/107 (4.7%) of those with delirium and 4/860 (0.5%) of those without delirium died. Within 7 days of ED departure, 6/107 (5.6%) of those with delirium and 6/860 (0.7%) of those without delirium died (unadjusted OR 8.46, 95% CI 2.68–26.71). Within 30 days, 18/107 (16.8%) of those with delirium and 37/860 (4.3%) of those without delirium died (unadjusted OR 4.50, 95% CI 2.46–8.23). ED delirium remained associated with higher 7-day (adjusted OR 5.23, 95% CI 1.44–19.05, p = 0.008) and 30-day mortality (adjusted OR 2.82, 95% CI 1.45–5.46, p = 0.002). ConclusionDelirium is an important prognostic factor that ED clinicians and nurses must be aware of to optimize delirium prevention, management, disposition, and communication with patients and families.

Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria

Aims: Factors that influence the personal choice of a health care facility among health care consumers vary. Currently, what influences the choice of health facilities among enrollees under the National Health Insurance Scheme (NHIS) is not known. This study aimed to as-sess what influences the choice of facilities in the NHIS of Nigeria. Methods: This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in the 11 Local Government Areas (LGAs) of Ibadan, Nigeria. A total of 432 enrollees were selected and were interviewed. A WHO-USAID semi-structured interviewer-administered questionnaire was used to obtain relevant data. Data collection was between Oc-tober and December 2019. Data were analyzed using STATA version 12.0 (α =0.05).Results: At unadjusted OR, older respondents (OR 3.24, CI = 2.52-4.18, p = <0.0001), and those who had attained the tertiary level of education (OR 3.30, CI 2.57-4.23, p <0.0001) were more likely to make a personal choice of health care facilities. A similar pattern was ob-served among respondents who were in the high socioeconomic group (OR 4.10, CI 3.01-5.59, p = <0.0001). However, at Adjusted OR, only high socio-economic status was a predic-tor of personal choice of health care facility (OR 1.92, CI 1.21-3.05, p = 0.005). Conclusion: This study is suggestive that a need for and the ability to afford the cost of care influence the choice of health facilities. Policies that promote health literacy in the general populace will enhance the capability of individuals to make a personal choice of health facili-ties. Stakeholders should prioritize this for policy.Recommended citation: David A. Adewole, Temitope Ilori. Factors influencing the choice of facilities among enrolees of a prepayment scheme in Ibadan, Southwest Nigeria Acknowledgments: The authors wish to acknowledge study participants for permission to interview them in the course of the data collection of this study.Authors' contributions: David Adewole conceived and designed the study. Temitope Ilori did data collection and analysis. Both authors contributed equally to the manuscript write-up. The two authors also read through the manuscript draft the second time and agreed to the final manuscript. Conflict of interests: None declared.

Substance abuse and sexual frequency among youths: implications for sexually-transmitted infections in Nigeria

Substance use is one of the key factors that predispose young people to sexually frequent behaviors. This study therefore investigates the implications of substance abuse and sexual frequency for sexually transmitted infections among Nigerian youths. The study used quantitative data from the National HIV/AIDS and Reproductive Health Survey (NARHS Plus II, 2012). The data for the study were analyzed using three levels of statistical analysis while, two statistical techniques were used and five models were constructed to test the formulated hypotheses The study reveals that the estimate incidence of relative risk (IRR) of substance abuse on sexual frequency confirmed a positive significant effects for both adjusted and unadjusted data (Smoking cigarette, unadjusted OR=.19 P-value=.000, adjusted OR=.33 P-value=.000; consuming alcohol everyday unadjusted OR=1.07 P-value=.000, adjusted OR=1.40 P-value=.000). While a significant relationship between substance abuse, sexual frequency, and likelihood of contracting STIs was established in the study (Pvalue<. 005). The study concludes that there is need for education on substance abuse among young people.

Association between Hospital Carotid Endarterectomy Procedure Volumes and In-Hospital Mortality in São Paulo State.

Previous studies indicate an inverse relationship between hospital volume and mortality after carotid endarterectomy. However, data at the level of Brazil are lacking. To assess the relationship between hospital carotid endarterectomy procedure volumes and mortality in the state of São Paulo. Data from the São Paulo State Hospital Information System on all carotid endarterectomies performed between 2015 and 2019 were analyzed. Hospitals were categorized into clusters by annual volume of surgeries (1-10, 11-25, and ≥26). Multiple logistic regression models were used to determine whether the volume of carotid endarterectomy procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure. Crude in-hospital mortality was nearly 60 percent lower in patients who underwent carotid endarterectomy at the highest volume hospitals than among those who underwent endarterectomy at the lowest volume hospitals (unadjusted OR of survival to hospital discharge, 2.41; 95% CI, 1.11-5.23; p = 0.027). Although this lower rate represents 1.5 fewer deaths per 100 patients treated, high-volume centers are more likely than low-volume centers to perform elective procedures, thus the analysis did not retain statistical significance when adjusted for admission character (OR, 1.69; 95% CI, 0.74-3.87; p = 0.215). In a contemporary Brazilian registry, higher volume carotid endarterectomy centers were associated with lower in-hospital mortality than lower volume centers. Further studies are needed to verify this relationship considering the presence of symptoms in patients.

Endovascular Treatment for Minor Acute Ischemic Strokes With Large Vessel Occlusion.

Background It remains uncertain whether patients with minor acute ischemic stroke with large vessel occlusion benefit from endovascular treatment (EVT). We aim to evaluate the outcomes of EVT in minor acute ischemic stroke with anterior circulation large vessel occlusion. Methods and Results Based on a nationwide prospective stroke registry, patients with minor acute ischemic stroke with anterior circulation large vessel occlusion within 24 hours of onset were divided into groups receiving standard medical treatment plus EVT or standard medical treatment alone. Primary outcome was excellent functional outcome defined as modified Rankin Scale score 0 to 1 at 90 days. In addition, a multivariable logistic regression model was used to analyze the effect of EVT guided by perfusion imaging. A total of 572 patients with median age 68 years (interquartile range=60-77) and median National Institutes of Health Stroke score 3 (interquartile range =2-4) were identified and 123 patients were treated with standard medical treatment plus EVT. EVT was not associated with excellent functional outcome (unadjusted odds ratio [OR], 0.771 [95% CI, 0.516-1.151]; adjusted OR, 0.793 [95% CI, 0.515-1.219]; P=0.290). However, therapy selection guided by perfusion imaging was a modifier of EVT effect on outcomes, as EVT was significantly associated with excellent functional outcome (60.0% versus 50.8%, unadjusted OR, 1.451 [95% CI, 0.643-3.272]; adjusted OR, 2.849 [95% CI, 1.006-8.067]; P=0.049) but not with symptomatic intracerebral hemorrhage in the imaging-guided group. Conclusions Although functional outcomes in minor acute ischemic stroke caused by anterior circulation large vessel occlusion were not improved from the routine use of EVT, our results suggested that EVT guided by perfusion imaging could be beneficial for those patients. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04487340.

963: PREHOSPITAL INHALED CORTICOSTEROIDS MAY BE PROTECTIVE IN CHILDREN WITH DIRECT LUNG INJURY

Introduction: Trials looking at systemic corticosteroid use in acute respiratory failure demonstrate unclear mortality benefit, in part due to side effects. Inhaled corticosteroids (ICS) confer local anti-inflammatory benefit in adults with direct lung injury, with minimal systemic absorption. However, this has not been studied in children. We hypothesized that ICS protect against progression to respiratory failure in children with direct lung injury. Methods: We performed a retrospective, single center cohort study at the Children’s Hospital of Philadelphia. Using ICD10, we identified children (6 months to 21 years old) who presented to the emergency department with direct lung injury with reliable pre-presentation medication records. We excluded subjects with care limitations and transfers. The primary outcome was intubation; secondary outcomes were non-invasive ventilatory (NIV) support, hospital and ICU admission, length of stay, and mortality. Logistic regression was performed, with age, sex, race, ethnicity, socioeconomic status, and medical complexity chosen as confounders. We a priori planned stratified analyses based on prior history of asthma given the relationship between ICS and asthma. Results: Of 35,220 eligible patients, 17,649 (50%) were prescribed ICS. Intubation occurred in 169 patients (73 on ICS, 96 not on ICS; unadjusted OR 0.76, 95% CI 0.56-1.03) and NIV was required in 3,582 patients (1,336 on ICS, 2,245 not on ICS; unadjusted OR 0.56, 95% CI 0.52-0.60). After adjusting for confounders, ICS was associated with lower intubation (adjusted OR 0.46, 95% CI 0.31-0.67) and lower NIV use (aOR 0.45, 95% CI 0.40-0.49). When stratified on history of asthma, the aOR remained significant for intubation (aOR 0.49,95% CI 0.33-0.72) and NIV (aOR 0.41, 95% CI 0.37-0.46) in patients with a history of asthma, but no longer for patients without a history of asthma (intubation aOR 0.38, 95% CI 0.05-2.8; NIV aOR 0.89, 95% CI 0.61-1.30). Hospital and ICU admission, length of stay, and mortality were similar between groups. Conclusions: ICS may reduce escalation to intubation and NIV for children with direct lung injury, with an effect strongest in those with a history of asthma. Future studies should test whether there is a role for early prophylactic ICS, stratified by history of asthma.

251: ASSOCIATION OF EARLY HEPARIN USE AMONG PATIENTS WITH COVID-19 AND SEPSIS AND HOSPITAL OUTCOMES

Introduction: There is published literature about COVID-19 disease associated coagulopathy in hospitalized patients. We aim to study association of early heparin use among adult patients with COVID-19 and sepsis and hospital outcomes. Methods: Retrospective study utilizing the EMR (electronic medical record) data at a large tertiary care academic center with ICU patients admitted for COVID-19 and sepsis and received therapeutic heparin for anticoagulation. We reported nominal variables in (gender, exposure - yes/no, etc) as number and percentage. And reported continuous (age, length of stay, etc) as median (IQR). We used Chi Square test and t-test as appropriate for nominal and continuous data analysis. This study was IRB approved. Results: A total of 230 patients with age ≥18 years were included in final analysis. Out of these, 183 (79.6%) patients received heparin within 48 hours of ICU admission and 47 (20.4%) after 48 hours. The median (IQR) age was 67.5 years (58-77) with majority being caucasian (73.9%) male (68%) patients. Overall, 59 (26%) patients had died, 86 (37%) had been discharged home without assistance, 12 (5%) discharged home, with home health from the hospitals. In univariable analysis, early (< 48 hours) administration of heparin was associated reduced utilization of invasive mechanical ventilation (IMV) (OR 0.23, p=< 0.01) and non-IMV (NIMV) (OR 0.49, p=0.03) and reduced ICU (MD -1.64, SE 0.58, p=< 0.01 and hospital length of stay (LOS) (MD-4.15, SE 0.93, p=< 0.01. This association remained significant when model was adjusted for age, gender, BMI, race, ethnicity, SOFA score on day 1, APACHE-III score on ICU admission: IMV utilization (aOR 0.12, p=< 0.01), NIMV utilization (aOR 0.47, p=0.35), ICU LOS (MD -1.65, SE 0.57, p=< 0.01) and hospital length of stay (MD -4.43, SE 0.95, p=< 0.01). The hospital mortality was observed to be not statistically significant (unadjusted OR 0.68, p=0.28 and adjusted OR 0.67, p=0.32) due to small sample size. Conclusions: Early administration of heparin in patients with moderate to severe COVID-19 sepsis was associated with reduced utilization of IMV and NIMV and reduced hospital LOS. Association with reduced hospital mortality did not reach the statistical significance.

10: PROFOUND INCREASES IN NEUROINTACT PATIENT SURVIVAL FOR NONSHOCKABLE (ASYSTOLE/PEA) CARDIAC ARRESTS

Introduction: The neuroprotective approach to basic CPR (NPCPR) using adjuncts to lower ICP and enhance cardiac venous return (including gradual head/torso-up positioning [HTup]), has significantly improved overall neuro-intact survival (SURVni) for out-of-hospital cardiac arrest (OHCA) patients (Resuscitation 2022). However, as ~80% of OHCA cases have non-shockable (asystole/PEA) presentations (N-Sh) and attendant grim prognoses, the specific aim was to confirm if (and by how much) NPCPR-improved SURVni applies to N-Sh OHCA cases. Methods: Five U.S. EMS agencies using NPCPR prospectively tracked SURVni and all known SURVni related factors: age; sex; witnessed arrest; bystander CPR; T-CPR (time from 9-1-1 call to EMS crews starting CPR); initial ECG; and T-htup (9-1-1 call to HTup start). An automated HTup device (occiput raised to 22cm over several mins) was combined with active compression-decompression and impedance threshold devices (all FDA-cleared). For rigorous comparisons, conventional CPR (C-CPR) controls were derived from 2 large (n=10,053) published NIH trials involving (criteria-compliant) high-performance EMS systems (eg, recorded /monitored /reported CPR quality). Using propensity scoring for the pivotal SURVni factors, 353 N-Sh NPCPR patients were well-matched with 353 N-Sh C-CPR patients and compared for SURVni (mRS < or =3 or CPC 1 or 2). Results: For both 353 NPCPR patients and 353 controls: 2/3 were in asystole; mean ages 66; 8 min median T-CPR (IQR 6-10). Median T-htup = 11 min (IQR 9-15). Before propensity matching, the overall unadjusted OR [95%CI] for NPCPR SURVni (vs C-CPR) was 3.09 [1.64-5.81] and 3.87 [1.27-11.78] after matching (incl. responses >20 min). Analogous to AEDs in shockable OHCA, the earlier NPCPR was applied, SURVni improved: NPCPR SURVni was >10-fold higher, 6.1% v 0.6% (10/165 v 1/165) when T-htup < 11 mins [OR 10.59;1.34-83.63] or (cumulatively) 4.6% v 0.4% (13/281 v 1/281) if < 16 mins [OR 13.58;1.76-104.54]. Conclusions: Even compared to top-performing EMS systems, NPCPR, especially applied early, was associated with markedly-improved SURVni odds for asystole/PEA patients, with or without propensity score matching. As most EMS systems can initiate CPR for the majority of patients in < 12 min, NPCPR may potentially salvage many more lives than previously projected.

Gender-specific factors associated with hypertension among women of childbearing age: Findings from a nationwide survey in India.

The association of conventional (modifiable and non-modifiable) risk factors for hypertension has already been established in the literature. However, there are other putative risk factors specific to women (early menarche, age at first childbirth, women empowerment, number of children born, hysterectomy, etc.) in the development of hypertension. This study is the first study to highlight the potential association of gender-specific factors along with other conventional risk factors and hypertension, using a nationwide sample. The study is a secondary analysis of the data collected from the National Family Health Survey-4 (NFHS-4), a nationally representative sample of 699,686 women of reproductive age in India. The interview schedule included data on general background characteristics, marriage, reproductive history, hysterectomy, knowledge, and utilization of family planning services, maternal and child care, women empowerment, non-communicable diseases, and domestic violence. The blood pressure was measured by direct observation by the study investigators using a digital blood pressure monitor. To account for disproportionate sampling and non-response, a weighted statistical analysis was performed. Logistic regression analysis was done to study the strength of the association between the risk factors and hypertension (computation of unadjusted and adjusted odds ratio). The prevalence of hypertension was 11.8% among women. Among the conventional factors, older age, higher body mass index (BMI), tobacco use, and alcohol use had higher odds for hypertension, while higher education, higher socio-economic position, and living in urban areas had lower odds. Among the gender-specific factors, younger age at first childbirth, early menarche, oral contraceptive pill use [adjusted OR: 1.23; (1.18-1.28)], and hysterectomy [adjusted OR: 1.10; (1.05-1.69)] were found to be risk factors for hypertension. Domestic violence was significantly associated with hypertension [unadjusted OR: 1.11; (1.02-1.20)]. Empowered women had lower odds of hypertension [adjusted OR: 0.93; (0.95-1.03)]. Significant association of these gender-specific factors among women necessitates the need for taking into account these factors while screening for hypertension among women and thus, designing a tailored model better suited to them for risk assessment.

Comparative analysis of methyl–donor nutrient intakes and RCPM cognitive performance among school-aged children

Evidence shows a link between methyl-donor nutrient intakes and a child's cognitive ability. However, this is less known among Ghanaian children who might be at higher risk of methyl-donor nutrient deficiencies. This study showed comparative analysis of methyl-donor nutrient intakes and Raven's Coloured Progressive Matrices (RCPM) test performance among 2073 Ghanaian school children aged 9-13 years across four regions of Ghana. Data for the present study were obtained from the Child Nutrition, Fitness, and Cognition project; a cross-sectional survey conducted in four regions of Ghana. Dietary methyl-donor nutrient values were based on repeated 24h recall data collected during the study periods. Cognitive tests were performed on the 2073 children using Raven's Coloured Progressive Matrices (RCPM) test. We found dietary zinc (adjusted: β=0.21, p=0.003) and methionine (adjusted: β=0.60, p=0.044) intakes to be associated with RCPM scores in the linear regression model. School children living in Northern Region (adjusted OR=0.6, p<0.001, 95% CI=0.4-0.7) and Volta Region (adjusted OR=0.7, p=0.006, 95% CI=0.5-0.9) had lower odds of scoring above the 50th percentile on the RCPM test compared with those living in Greater Accra Region. Children who consumed below the RDA for dietary folate (unadjusted OR=0.8, p=0.055, 95% CI=0.7-1.0) and zinc (unadjusted OR=0.8, p=0.049, 95%CI=0.7-1.0) had lower odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the RDA for dietary folate and zinc respectively. Children who consumed below the EAR for dietary vitamin B12 (unadjusted OR=0.7, p=0.004, 95% CI=0.6-0.9) had reduced odds of scoring above the 50th percentile on the RCPM test compared with those who consumed above the EAR for dietary vitamin B12. Higher dietary methionine intake was strongly associated with higher RCPM scores. Regional differences, and children's dietary consumption below the EAR/RDA for dietary folate, vitamin B12, and zinc were associated with poor RCPM test performance. School children's nutrient intake should be prioritized for improved cognition.

Woven EndoBridge versus stent-assisted coil embolization of cerebral bifurcation aneurysms.

Stent-assisted coil (SAC) embolization has been the mainstay endovascular treatment for bifurcation aneurysms. The recent introduction of the Woven EndoBridge (WEB) device has presented an alternative endovascular treatment modality for these aneurysms. Direct comparisons of outcomes between these two modalities are limited in the literature. Here, the authors compared the outcomes of bifurcation aneurysms treated with SAC and WEB devices. This retrospective single-center study comprised 148 bifurcation aneurysms that were treated endovascularly with SAC or WEB devices between 2011 and 2019. The primary outcome was complete occlusion of the aneurysm at 6 months on catheter angiography. The SAC and WEB cohorts comprised 85 and 63 aneurysms, respectively. The baseline characteristics were well balanced after inverse probability weight (IPW) adjustment, except for smoking status. The 6-month complete occlusion rate was higher in the WEB cohort than the SAC cohort (67.4% vs 40.6%; unadjusted OR [95% CI] 3.014 [1.385-6.563], p = 0.005). However, this difference in complete occlusion rates did not remain significant after IPW adjustment and multiple imputations. The neck remnant rate was lower in the WEB cohort than the SAC cohort (20% vs 50%; OR [95% CI] 0.250 [0.107-0.584], p = 0.001), and this difference remained significant after IPW adjustment (OR [95% CI] 0.304 [0.116-0.795], p = 0.015) and multiple imputations. Use of SAC and WEB demonstrated comparable 6-month complete occlusion rates for bifurcation aneurysms. WEB appeared to be associated with a lower rate of neck remnant at 6 and 12 months compared with SAC. WEB was also associated with fewer complications and decreased retreatment rates compared with SAC.

Fibromyalgia among University Students: A Vulnerable Population.

Fibromyalgia (FM), a complex musculoskeletal disorder, can affect individuals from different genders having different genetic and psychosocial backgrounds. The prevalence of FM depends specifically on the age, gender, and level of stress of the individual. Since the university student body tackles high levels of academic and non-academic stress, we aimed to assess the prevalence and characteristics of FM among such a vulnerable population. A survey was sent to participants from two major English-speaking private universities in Lebanon; the American University of Beirut (AUB) and the Lebanese American University (LAU). The survey included the modified American College of Rheumatology (ACR) 2016 criteria, the widespread pain index (WPI), the symptoms severity score (SSS), and the duration of presence of such FM symptoms. In addition, the survey evaluated the presence of other specific musculoskeletal disorders among participants. Nevertheless, a 12-item general healthy questionnaire (GHQ-12) was used to assess the presence of anxiety, depression, social dysfunction, and loss of confidence among participants. The survey was sent to a total of 2178 students with 184 complete responses (8.45% response rate). The prevalence of FM among the respondents was 13.6%. Students with FM had a significant personal history of a musculoskeletal disorder other than FM and a significant family history of musculoskeletal disorders. The mean SSS score of the target population, including those with FM and those without FM, was 4.5. Patients with FM were significantly in distress and highly symptomatic as measured by GHQ-12 (Unadjusted OR 3.23 [95% CI 1.32-7.95]). Fibromyalgia seems to be prevalent among university students; in particular, those with other musculoskeletal disorders, those with a family history of musculoskeletal disorders, and those with severe depression and anxiety.

The Attitude of Chinese Parents Towards The ‘Double Reduction’ Policy and The Factors Influencing Their Attitude

Since China's Ministry of Education announced the ‘Double Reduction’ policy in July 2022, its impact on China's education system has been a heated topic. Using an online survey (n=381), this dissertation, investigated the attitudes and views of Chinese parents towards the ‘Double Reduction’ policy. Descriptive statistical analysis was used to quantify the proportions of positive and negative perceptions; logistic regression was used to examine factors associated with positive or negative perceptions. The results of this study show that most Chinese parents support the ‘Double Reduction’ policy and hope that it will continue (87.6%). The higher the stage of compulsory education of the children, the more likely parents are to support the ‘Double Reduction’ policy (high school unadjusted OR =2.033, 95% CI=1.119-3,695). Overall, most Chinese parents support the ‘Double Reduction’ policy, but the existence of exam-oriented education and Chinese parents' lack of confidence in their support ability and their children's own learning ability still affect their attitude towards the ‘Double Reduction’ policy. Future research and policy formulation should focus on the guidance of family education.

A systematic review and meta-analysis on alcohol consumption and risk of endometriosis: an update from 2012

Endometriosis is a complex and chronic disease, whose multifactorial nature has encouraged a deep investigation on the role of lifestyle factors. A strong association between alcohol intake and endometriosis risk has already been shown. We aimed to confirm this association, considering the updated literature. 23 eligible studies were identified through comprehensive literature search of PubMed and EMBASE (May 2012–October 2021). A borderline statistical significance was found comparing any alcohol consumption with no consumption (unadjusted OR 1.14; 95% CI: 0.99–1.31, p = 0.06), in contrast with a previous meta-analysis. However, we confirmed the significant association between moderate alcohol intake and endometriosis (unadjusted OR 1.22, 95% CI: 1.03–1.45, p = 0.02), also performing a sensitivity analysis (unadjusted OR 1.27, 95% CI: 1.04–1.54). Our partly divergent evidence reflects the tough challenge of isolating the impact of specific factors on the natural history of multifactorial diseases. Indeed, on one hand alcohol could be adopted by patients as a self-management therapy and on the other, it could favor the disease, promoting positive feedback with inflammatory mediators and oxidative stress. Our study encourages further investigation on the role of modifiable lifestyle factors and highlights the opportunity to adopt them to prevent or at least limit endometriosis progression.

Significantly increased risk of chronic obstructive pulmonary disease amongst adults with predominantly mild congenital heart disease

Adults with congenital heart disease (CHD) face increased risk of various comorbid diseases. Previous work on lung dysfunction in this population has mainly focused on restrictive lung disease, in patients with severe CHD phenotypes. We examined the association of mild CHD with chronic obstructive pulmonary disease (COPD) in the UK Biobank (UKB). Electronic health records (EHR) were used to identify 3385 CHD cases and 479,765 healthy controls in UKB, before performing a case–control analysis over a 20-year study period for a total of > 9.5 M person-years of follow-up. Our analysis showed that UKB participants with CHD are at substantially greater risk of developing COPD than healthy controls (8.7% vs 3.1% prevalence, unadjusted OR 2.98, 95% CI 2.63, 3.36, P = 1.40e−53). Slightly increased rates of smoking were observed amongst CHD cases, however the association with COPD was shown to be robust to adjustment for smoking and other factors known to modulate COPD risk within a multivariable-adjusted Cox regression framework (fully adjusted HR 2.21, 95% CI 1.97, 2.48, P = 5.5e−41). Care for adults with CHD should aim to mitigate their increased risk of COPD, possibly via increased smoking cessation support.