The mortality associated with high-risk pulmonary embolism (PE) is remarkably high, and reperfusion to unload right ventricle should be a priority. However, several registries report reperfusion underuse. In Portugal, epidemiological data about the incidence, rate of reperfusion and mortality of high-risk PE are not known.

Nationwide population-based temporal trend study in the incidence and outcome of high-risk PE, who were admitted to hospitals of the National Health Service in Portugal between 2010 and 2018. High-risk PE was defined as patients with PE who developed cardiogenic shock or cardiac arrest. International Classification of Diseases (ICD), 9th and 10th revision, Clinical Modification codes, were used for data from the period between 2010 and 2016 (ICD-9-CM) and 2017-2018 (ICD-10-CM), respectively. The assessment focused on trends in the use of reperfusion treatment, which was defined by application of thrombolysis or pulmonary embolectomy. A comparison was made between the use or non-use of reperfusion therapy in order to examine trends in in-hospital mortality among high-risk PE cases.

From 2010 and 2018, there were 40.311 hospitalization episodes for PE in adult patients at hospitals of the National Health Service in mainland Portugal. There was a significant increase in the annual incidence of PE (41/100.000 inhabitants in 2010 to 46/100.000 in 2018; R2=0.582, p = 0.010). The average annual incidence was 45/100.000 inhabitants/year, with 2,7% of the PE episodes (1104) categorized as high-risk. The mortality rate associated with high-risk PE was high, although it has decreased over the years (74.2% in 2010 to 63.6% in 2018; R2=0.484; p = 0.022). Thrombolytic therapy was underused in high-risk PE, and its usage has not increased in recent years (17.3% in 2010 to 21.1% in 2018, R2=-0.127; p = 0.763). Surgical pulmonary embolectomy was used in 0.27% of cases, and there was no registry of catheter-directed thrombolysis. Patients with high-risk PE undergoing reperfusion therapy had lower in-hospital mortality compared to non-reperfused patients (OR=0.52; IC95% 0.38-0.70).

In Portugal, between 2010 and 2018, very few patients with PE developed high-risk forms of the disease, but the mortality rate among those patients was high. The low reperfusion rate could be associated with high in-hospital mortality and highlights the need to implement advanced therapies, as an alternative to systemic thrombolysis.

Nasal high flow (NHF) therapy is an established form of non invasive respiratory support used in acute and chronic care. Recently, a new high flow nasal cannula with asymmetric prongs was approved for clinical use. The clinical benefits of the new cannula have not yet been defined and no evidence are available on the use of asymmetric NHF support in patient with Chronic Obstructive Pulmonary Disease (COPD). We conducted a single-centre, prospective, physiologic, crossover, randomised study to investigate the effects on partial pressure of carbon dioxide (PaCO2) levels of two different nasal cannula ("asymmetric" vs "standard" nasal interface) in 20 COPD hypercapnic patients. All patients were recovering from an acute exacerbation that required hospitalisation and had persistent hypercapnia, despite having attained a stable pH. After enrolment, two 90-min trials with the asymmetric nasal high flow interface (Optiflow + Duet, Fisher & Paykel Healthcare Ltd., New Zealand) or the standard interface (Optiflow, Fisher & Paykel Healthcare Ltd., New Zealand) were randomly applied and a washout period of 60 min between the two treatments was performed for minimising the carryover effect. Study results suggested that the asymmetrical cannula did not significantly decrease PaCO2 compared with the standard cannula. Similar performances were also observed in terms of diaphragm activity, dyspnoea and patient's comfort. Interestingly, asymmetric NHF cannula performed significantly better in reducing the dead space ventilation and increasing the ventilatory efficiency in more advanced COPD patients with more severe hypercapnia higher baseline PaCO2 values (PaCO2 ≥ 65 mmHg at baseline).   .

Patients with chronic kidney disease (CKD) are considered the primary population at risk for post-contrast acute kidney injury (PC-AKI), yet there are few predictive tools specifically designed for this vulnerable population.

Adult CKD patients undergoing coronary angiography or percutaneous coronary intervention at the Second Xiangya Hospital (2015-2021) were enrolled. The patients were divided into a derivation cohort and a validation cohort based on their admission dates. The primary outcome was the development of PC-AKI. The random forest algorithm was used to identify the most influential predictors of PC-AKI. Six machine learning algorithms were used to construct predictive models for PC-AKI. Model 1 included only preoperative variables, whereas Model 2 included both preoperative and intraoperative variables. The Mehran score was included in the comparison as a classic postoperative predictive model for PC-AKI.

Among the 989 CKD patients enrolled, 125 (12.6%) developed PC-AKI. In the validation cohort, deep neural network (DNN) outperformed other machine learning models with the area under the receiver operating characteristic curve (AUROC) of 0.733 (95% CI 0.654-0.812) for Model 1 and 0.770 (95% CI 0.695-0.845) for Model 2. Furthermore, Model 2 showed better performance compared to the Mehran score (AUROC 0.631, 95% CI 0.538-0.724). The SHapley Additive exPlanations method provided interpretability for the DNN models. A web-based tool was established to help clinicians stratify the risk of PC-AKI (https://xydsbakigroup.streamlit.app/).

The explainable DNN models serve as promising tools for predicting PC-AKI in CKD patients undergoing coronary angiography and intervention, which is crucial for risk stratification and clinical descion-making.

The primary objective of this study is to determine whether an active cancer diagnosis results in an increased risk of perioperative TJA complications and postoperative mortality. The secondary objective is to analyze the effects of demographic factors on perioperative complication rates in cancer patients undergoing TJA.

Patients with active cancer diagnoses undergoing total joint arthroplasty from 2014 to 2020 were included in this retrospective analysis. Patient data was obtained through ReachNet, which consisted of data from the University Medical Center, Tulane University Medical Center, Ochsner Health System, and Baylor Scott & White Health. ICD-9/10 codes were tagged for active cancer diagnoses within 365 days before surgery or 30 days after surgery to establish our active cancer population. Acute surgical complications within 30 days were identified by ICD codes.

Patient demographics included predominantly male (51.5 %), white (83 %), and non-Hispanic (96.5 %) patients followed by black individuals (15.9 %) with 47.5 % of patients being smokers. Cancer patients did have a higher acute complication rate (2.6 % vs 1.7 %), but this difference was not significant (p = .139). This difference was higher but also not significant after adjustment (aOR = 1.32, 95 % CI = 0.71-2.43, p = .377). After adjustment, increased Charlson Comorbidity Index (CCI), white race and non-elective surgery were significant contributors to complication risk. Complication rates decreased significantly with year. Nonelective surgeries were also associated with higher complication rates (8.2 % vs. 1.8 %, p = .014).

Patients with active cancer diagnoses demonstrated higher unadjusted rates of TJA acute surgical complications and increased adjusted CCI when compared to non-cancer patients. Identifying risk factors and demographics correlated with increased perioperative complications may provide physicians with necessary information to avoid negative TJA outcomes in cancer patients.

Many adults with heart failure (HF) are physically frail and have worse outcomes. While the biological profile of physical frailty in HF has been examined, the behavioral profile remains unstudied. Physical frailty may impact self-care behaviors, particularly symptom monitoring and management (SMM), which in turn results in adverse outcomes. This paper describes the background and design of a study that addresses this knowledge gap, entitled "Physical Frailty and Symptom Monitoring and Management Behaviors in Heart Failure" (PRISM-HF).

PRISM-HF is a sequential mixed methods study where in Phase 1, we collect quantitative data from a sex-balanced sample of 120 adults with HF, and in Phase 2, we collect qualitative data from ∼32-40 adults from this sample, aiming to: (1) quantify associations among physical frailty, SMM behaviors, and outcomes; (2) describe the experience of SMM behaviors for physically frail and non-physically frail adults with HF; and (3) identify the SMM behavioral needs of physically frail and non-physically frail adults with HF. At baseline, we measure symptoms, SMM behaviors, and physical frailty and collect clinical events at 6-months. We will use generalized linear modeling and survival analysis in Aim 1, directed content analysis in Aim 2, and triangulation analyses using an informational matrix in Aim 3.

This innovative study will investigate the behavioral underpinnings of physical frailty in HF, incorporate the patient's perspective of SMM behaviors in the context of physical frailty, and identify possible explanations for the effect of physical frailty on outcomes.

COVID-19 is no longer a global health emergency, but it remains challenging to predict its prognosis.

To develop and validate an instrument to predict COVID-19 progression for critically ill hospitalized patients in a Brazilian population.

Observational study with retrospective follow-up. Participants were consecutively enrolled for treatment in non-critical units between January 1, 2021, to February 28, 2022. They were included if they were adults, with a positive RT-PCR result, history of exposure, or clinical or radiological image findings compatible with COVID-19. The outcome was characterized as either transfer to critical care or death. Predictors such as demographic, clinical, comorbidities, laboratory, and imaging data were collected at hospitalization. A logistic model with lasso or elastic net regularization, a random forest classification model, and a random forest regression model were developed and validated to estimate the risk of disease progression.

Out of 301 individuals, the outcome was 41.8 %. The majority of the patients in the study lacked a COVID-19 vaccination. Diabetes mellitus and systemic arterial hypertension were the most common comorbidities. After model development and cross-validation, the Random Forest regression was considered the best approach, and the following eight predictors were retained: D-dimer, Urea, Charlson comorbidity index, pulse oximetry, respiratory frequency, Lactic Dehydrogenase, RDW, and Radiologic RALE score. The model's bias-corrected intercept and slope were - 0.0004 and 1.079 respectively, the average prediction error was 0.028. The ROC AUC curve was 0.795, and the variance explained was 0.289.

The prognostic model was considered good enough to be recommended for clinical use in patients during hospitalization (https://pedrobrasil.shinyapps.io/INDWELL/). The clinical benefit and the performance in different scenarios are yet to be known.

Subjective cognitive decline (SCD) is a common concern among older adults in the South Korean population. Thus, non-pharmacological interventions are needed to reduce cognition, communication, and mood complaints.

This study evaluated the effects of a Roadmap Time-Traveling Intervention program (RMTI), a digital reminiscence therapy intervention, on cognitive measurements, communication, and mood in older adults with SCD.

Fifty participants were randomly assigned to the experimental or control group. Cognitive function, communication difficulties, quality of life (QoL), depression, and anxiety were assessed at baseline (T0), immediately after the intervention (T1), and four weeks post-intervention (T2). Generalized estimation equations were utilized to analyze the program's effectiveness over time (T0-T1) between groups. A repeated measures ANOVA and the Friedman/Wilcoxon signed-rank tests examined changes across the three time points (T0-T1-T2) within the experimental group. The study followed the Consolidated Standards of Reporting Trials guidelines.

The experimental group exhibited significant improvements in the Korean version of the Mini-Mental State Examination (MMSE-K) scores (p < .001) and QoL (p < .001) compared with the control group: MMSE-K scores (Ⲭ² = 9.55, p = .008), communication difficulties (Ⲭ² = 8.57, p = .014), and QoL (Ⲭ² = 3.35, p = .046) improved significantly across the three time points (T0-T1-T2).

The RMTI effectively enhanced MMSE-K scores, reduced communication difficulties, and enhanced the QoL in older adults with SCD. This program shows promise for broader implementation in community settings for older adults with SCD.

The Lewy Body Composite Risk Score (LBCRS) has been developed to increase the sensitivity and specificity of the diagnosis attributable to Lewy body pathology outside of specialty centers. We aimed to assess the validity and reliability of the Turkish version of the LBCRS in patients with dementia with Lewy Bodies (DLB) and investigate the discriminative power of the test in Turkish patients with Alzheimer's disease (AD) and DLB, and control group. The sample population (n = 512) comprised DLB (n = 113), DLB-Mild Cognitive Impairment (MCI)(n = 12), AD (n = 42), AD-MCI (n = 21), and control group (n = 324). A significant group difference was observed in the Turkish version of the LBCRS scores of the five groups (p < .001). The Cronbach's α value was 0.82 (95% CI: 0.799-0.868). The test-retest reliability score of the scale was r = 0.94 and p < .001. The subscales of the LBCRS (motor and nonmotor subdomains of the disease) were determined to explain 65.961% of the total variance with an eigenvalue >1. In patients with DLB, the cutoff score of ≥3 showed sensitivity (92%) and specificity (81%) (area under the curve [AUC] = 0.883, 95% CI: 0.815-0.951), p < .001) compared with the AD. Compared to the control group, the cutoff score of ≥3 showed a sensitivity of 98% and specificity of 97% (AUC = 0.994, 95% CI: 0.989-0.999, p < .001). The Turkish version of LBCRS permits accurate diagnosis of DLB with high sensitivity and specificity. Also, it can be useful to inform the caregivers regarding the course of the disease during the follow-up.

Although sleep duration and sleep-related breathing disorders were associated with dementia previously, few studies examined the association between circadian rhythm association and cognitive status.

We aimed to investigate the association of rest and activity rhythm with cognitive performance in older people with cognitive complaints and less education.

Activity rhythm was evaluated with wrist actigraphy in 109 community-dwelling older people with cognitive complaints without diagnosed dementia. Each participant completed a neuropsychological battery and was classified as having cognitive impairment (MCI), dementia, or normal cognition. We used adjusted multinomial logistic regression and linear regression models to compare sleep and circadian non-parametric measures with cognitive groups and cognitive z-scores, respectively.

The mean age of the 109 participants was 79.3 ± 6.3 years old, 74% were women, 68% were white, and the mean education was 5.6 ± 5.2 years. Daytime activity intensity was associated with better language (β = 0.178; 95% CI = 0.022, 0.334; p = 0.03) and visuospatial performance (β = 0.158; 95%CI = 0.008, 0.308; p = 0.04). Also, less fragmented rhythm was associated with better visuospatial (β = 0.172; 95%CI = 0.025, 0.320; p = 0.02) and global cognitive scores (β = 0.134; 95%CI = 0.005, 0.263; p = 0.04). More interdaily stability was associated with a lower risk of MCI and dementia (RR = 0.54; 95%CI = 0.29-0.99; p = 0.04, and RR = 0.44; 95%CI = 0.21-0.94; p = 0.03, respectively). Moreover, more daytime activity (RR = 0.40; 95%CI = 0.18-0.89; p = 0.02) and less rhythm fragmentation (RR = 0.31; 95%CI = 0.14-0.73; p = 0.007) were associated with lower risk for dementia.

Daytime activity intensity and fragmented rhythm during the day and night may play an important role as markers for cognitive impairment in less educated populations. Future studies with larger samples should confirm these findings.

Patients with triple-negative breast cancer (TNBC) who have residual disease after neoadjuvant chemotherapy (NACT) benefit from adjuvant capecitabine. Older patients are not always treated according to guidelines, likely due to concerns regarding tolerance. We examined the use of adjuvant capecitabine, its association with outcomes, and subsequent emergency room visits (ER) and hospitalizations (HSP) among older patients with early-stage TNBC.

Retrospective, observational study using data in the SEER-Medicare database. Older patients (≥ 66 years) with early-stage TNBC, diagnosed in 2010-2019, who received NACT, underwent surgery, and were prescribed adjuvant capecitabine were included. We analyzed capecitabine use, its association with overall survival and breast-cancer specific survival, and time to first ER/HSP. Logistic regression, Kaplan-Meier estimates, and Cox regression models with propensity score adjustments were used.

239 of 1,799 older patients with TNBC received adjuvant capecitabine. Capecitabine use increased from 1.3% in 2010 to 29.6% in 2019. Older age, ≥ 71 years, (OR = 0.54, 95%CI 0.32-0.92) and ≥ 2 comorbidities (OR = 0.42, 95%CI 0.2-0.9) were associated with decreased odds of receiving ≥ 6 cycles of capecitabine. Increasing number of cycles of capecitabine was associated with decreased risks of death (HR = 0.74, 95%CI 0.66-0.83) and breast cancer-specific death (HR = 0.73, 95%CI 0.61-0.89). 55 patients (23%) treated with capecitabine experienced ER/HSP.

In recent years, adjuvant capecitabine is increasingly used for patients with early-stage TNBC. Patients with older age and more comorbidities received fewer cycles of capecitabine. While one-fourth of patients had ER/HSP, receipt of more cycles was associated with better survival.

Although multiple emerging studies have suggested the relationship between greenness and mental health, evidence regarding associations among green space, suicide attempts, and depression is still limited. In this study, we aimed to estimate the association of greenness with suicide attempts in patients with depression.

This study used the National Health Insurance Service database in South Korea to construct a cohort of patients diagnosed with depression during 2012-2013 (n = 677,498) with an 8-year follow-up period. Residential greenness was measured as the district-level annual average of the Enhanced Vegetation Index. The primary outcome was the suicide attempt, and categorized suicide attempts (non-violent and violent methods) were also examined. A Cox regression with time-varying variables was performed to assess the association between greenness and suicide attempts, and stratified analyses were conducted by sex, age, insurance premium, and disability status.

A higher level of greenness was associated with lower suicide attempts among patients with depression (HR: 0.789; 95% CI: 0.677, 0.918). The protective association was higher for suicide attempts by violent methods (HR: 0.733; 0.545, 0.987) than non-violent methods (HR: 0.812; 0.680, 0.970), based on point estimates. Among patients with depression, males, individuals aged 35-64 years, and Medical Aid beneficiaries showed a more prominent association with greenness.

This nationwide cohort study provides epidemiological evidence for the benefits of residential greenness in reducing suicide among patients with depression and suggests the appropriateness of public health policies for increasing green spaces.

The dominant treatment paradigm for locoregionally advanced head and neck squamous cell carcinoma (HNSCC) involves postoperative or definitive radiotherapy with concurrent cisplatin chemotherapy. Despite years of research investigating de-intensified treatment, cisplatin-based chemoradiotherapy remains the standard, yet it is associated with significant acute and chronic toxicity. However, due to shared risk factors, such as advanced age, and tobacco and alcohol use, patients with HNSCC frequently have comorbid illnesses that impact treatment tolerability, adding complexity to treatment-related decision-making. In addition, many patients have medical contraindications to cisplatin, requiring alternative treatment strategies. It is thus important to consider how well patients are likely to tolerate treatment, and how to adapt treatment in response to a patient's condition, when weighing treatment options. In this review, we aim to offer readers guidance in managing the elderly or comorbid patient with HNSCC, with particular attention to (i) approaching comorbidity and fragility assessment to make determinations on intensity of treatment, (ii) considering primary treatment modality (eg, surgery vs radiotherapy, chemo-radiotherapy vs radiotherapy alone) and (iii) choice of concurrent systemic therapy agent.

HIV infection is linked to persistent inflammation despite effective antiretroviral therapy (ART). The Systemic Immune-Inflammation Index (SII) is a marker of inflammation in various conditions.

We compared SII values between PWH and PWoH. Clinical blood laboratory data were used to calculate the SII for each participant using the formula [(Platelet count × Neutrophil count)/Lymphocyte count]. Differences in SII values between the groups were analyzed using the Wilcoxon test, and the impact of potential confounders was assessed with multivariable regression models.

The study included 343 PWH and 199 PWoH. Age and race did not significantly differ, but sex distribution did (83.1% male in PWH vs. 55.8% in PWoH, P  < 0.0001). Among PWH, median [IQR] nadir and current CD4 + cell counts were 199 cells/μl [50, 350] and 650 [461,858], respectively. Nearly all PWH were on ART, with 97.2% achieving viral suppression. PWH had lower SII values than PWoH (327 [224, 444] vs. 484 [335,657], P  = 1.35e-14). PWH also had lower neutrophils and platelets ( P s < 0.001) and higher lymphocyte counts ( P  = 0.001). These differences remained significant after adjusting for age, sex, and other potential confounders.

Contrary to expectations, PWH had lower SII levels, likely due to altered hematologic parameters influenced by HIV and ART. These findings suggest that SII interpretation in PWH requires consideration of unique hematologic profiles and underscore the need for further research to understand the mechanisms and clinical implications of SII in HIV management.

This study evaluated the prevalence and incidence of systemic lupus erythematosus (SLE) in Germany and explored real-world data on sequence of therapy (SOT; sequence of drugs as prescribed in clinical practice).

This retrospective, observational, longitudinal cohort study using German claims data from the WIG2 GmbH Scientific Institute for Health Economics and Health System Research database (January 2011-December 2019), extrapolated to the statutory health insurance (SHI)-insured population, evaluated prevalence and incidence in an epidemiological analysis group and SLE treatment patterns in an incident cohort (subgroup ≥ 18 years of age with incident disease and ≥ 24-month follow-up post index date). Analyses were descriptive.

Based on the epidemiological analysis (N = 3017), annual SLE prevalence per 100,000 gradually increased from 40.47 in 2012 to 59.87 in 2019 in the SHI population. In contrast, annual SLE incidence was relatively stable, ranging from 8.83 in 2012 to 8.86 in 2019. In the incident cohort (n = 941), based on SOT analysis (n = 681), treatment gaps of > 60 days were common: 67.1%, 51.2% and 54.9% in SOT1, SOT2 and SOT3, respectively. Corticosteroids were the most frequent monotherapy in SOT1 (31.0% vs 0% in SOT2/SOT3); 30.0-70.0% of patients received a corticosteroid combination therapy across SOTs. Over 50% of patients in each SOT received an antimalarial therapy (combination or monotherapies). The use of biologic disease-modifying drugs was low, ranging from 0.4% in SOT1 to 9.7% in SOT3.

Our data demonstrate an increased prevalence of SLE with stable incidence in Germany, suggesting improved survival of affected patients. Nevertheless, suboptimal treatment patterns, including limited use of biologics, reflect a high unmet need for optimised and personalised therapies in patients with SLE.

Proton pump inhibitors (PPIs) decrease pancreatic exocrine secretions. There has been interest in the impact of their short-term in-hospital administration on acute pancreatitis (AP) outcomes. It is unknown whether long-term use affects AP outcomes. We investigated the association between chronic PPI use and short-term AP outcomes. We included all (2308) patients admitted with a primary diagnosis of AP (625 on chronic PPI use) between January 2008 and June 2021 and evaluated any association between chronic PPI use and 30-day all-cause mortality by univariate logistic regression. Compared to non-users, patients on chronic PPIs were older (p < 0.001) and had a higher Charlson Comorbidity Index score (p < 0.001). Mortality rates at 30 days were 1.6% in chronic PPI users and 4.4% in non-users (OR 0.35; 95% CI, 0.17-0.66; p < 0.002). [Correction added on 18 February 2025, after first online publication: Mortality rates at 30 days in chronic PPI users and non-users were updated in this version.].

Periprosthetic joint infections (PJIs) are one of the most devastating complications of total knee arthroplasty (TKA). Patients who have chronic kidney disease (CKD) are more vulnerable to PJI. We aimed to answer the following questions: 1) What are the commonly observed pathogens in PJI after TKA in CKD patients, and do they differ from those in non-CKD patients? and 2) What are the risk factors for PJI after TKA in CKD patients?

Patients who underwent surgery due to a chronic PJI of the TKA were retrospectively enrolled. The patients were divided into two groups as follows: patients those who had and those who did not have CKD. Demographic data and comorbidities of the patients were recorded. The microorganisms responsible for PJI were identified based on the biopsy results, and comparisons were made between the two groups. There were 331 patients in the CKD group and 2,238 in the control group. Patients who had CKD were significantly older (P < 0.001) and had higher Charlson Comorbidity Index scores (P < 0.001).

Binary logistic regression identified multiple microorganisms within the CKD group. The most common microorganisms in PJI were as follows: Staphylococcus epidermidis (odds ratio [OR] 1.38; P = 0.030; 95% confidence intervals (CI) 1.03 to 1.86), Staphylococcus aureus (OR 1.88; P < 0.001; 95% CI 1.36 to 2.61), Enterococcus faecalis (OR 2.39; P < 0.001; 95% CI 1.44 to 3.94), Escherichia coli (OR 1.76; P = 0.028; 95% CI 1.06 to 2.94), methicillin-resistant Staphylococcus aureus (OR 3.04; P = 0.024; 95% CI 1.15 to 8.02), polymicrobial infections (OR 1.52; P < 0.001; 95% CI 1.12 to 2.06).

Patients who had PJI and CKD demonstrated a higher incidence of infections with specific microorganisms, including Staphylococci, enterococci, gram-negative bacteria, and methicillin-resistant Staphylococcus aureus. To mitigate the high PJI risk in CKD patients, a treatment plan based on this microbial profile and a multidisciplinary assessment of CKD comorbidities before TKA is recommended.

A public oral health screening, periodontal disease screening, has been implemented in Japan, but it remains unclear whether screening encourages subsequent regular dental visits. This study aimed to examine whether people who underwent periodontal disease screening were more likely to regularly visit dentists after undergoing the screening than before using a difference-in-differences (DID) approach.

This study used health care claims data of municipality residents who underwent periodontal disease screening in 2017 or 2018. For each screening recipient, 4 individuals were extracted from those who did not undergo screening as controls. In the DID analysis, we assessed the change in the proportion of dentist visits at least once every 180 d after undergoing screening.

A total of 4,050 participants were included in the analysis. The proportion of participants visiting dentists was consistent throughout the study period (approximately 45%) among the participants who did not undergo the screening. However, among the participants who underwent the screening, while the proportion who visited dentists was consistent before screening (approximately 60%), the proportion was higher after screening (1-180 d after, 81.2%). DID analysis indicated that the proportion increased by 12.9% after the screening. In addition, the age-subgroup DID estimates were higher in the younger population (aged 20-35 y, 13.9%; 40-55 y, 12.8%; 60 y, 12.6%).

Among people who underwent periodontal disease screening, a higher proportion visited dentists after undergoing the screening than before, suggesting that periodontal disease screening was associated with an increase in subsequent regular dental visits.Knowledge Transfer Statement:Our results provide evidence that a public oral health screening could increase regular dental visits, which has the potential to improve and maintain people's oral health, especially in the younger population.

Using a nationally representative cohort of medical claims data in Korea, this study aimed to analyze the association between the use of various anti-rheumatic agents and the risk of acute myocardial infarction (AMI) in patients with rheumatoid arthritis (RA).

This nested case-control study used the Korean Health Insurance Review and Assessment data of 35,133 patients newly diagnosed with RA between 2011 and 2020. Incident AMI patients were identified and matched at a 14 ratio with randomly selected controls. The usage of anti-rheumatic agents was measured from the date of RA diagnosis to the index date and stratified based on exposure time and duration. The risk of AMI associated with each anti-rheumatic agent was estimated using conditional logistic regression, adjusted for comorbidities and concomitant drug use.

Of the 35,133 patients with RA, 484 were diagnosed with AMI. In total, 484 AMI patients and 1,924 controls with newly diagnosed RA were included in the analysis. Current exposure and long-term exposure to glucocorticoids (adjusted odds ratio [aOR] 2.301, 95% confidence interval [CI] 1.741~3.041; aOR 1.792, 95% CI 1.378~2.330) and leflunomide (aOR 1.525, 95% CI 1.196~1.944; aOR 1.740, 95% CI 1.372~2.207) were associated with an increased risk of AMI.

The study demonstrates a significant association between the current and long-term use of glucocorticoids and leflunomide and an increased risk of AMI in patients with RA. These findings underscore the importance of careful consideration of cardiovascular risks when selecting anti-rheumatic agents for RA treatment.

To investigate the epidemiology of latent tuberculosis infection (LTBI) and associated risk factors among adults in Al-Madinah, KSA, and to identify vulnerable populations for targeted interventions.

This hospital-based cross-sectional study was conducted at Prince Mohammed Bin Abdulaziz Hospital, Al-Madinah, from January 2021 to December 2022. Participants aged >14 years were screened for LTBI using the QuantiFERON®-TB Gold In-Tube test. People with active tuberculosis were excluded. Data on demographics, comorbidities, and risk factors were analyzed using multivariate logistic regression to identify factors associated with LTBI.

In total, 773 participants were included and 291 (37.6 %) tested positive for LTBI. Multivariate analysis identified greater age, male sex, diabetes mellitus, and connective tissue disorders as significant risk factors for LTBI. Non-Saudi nationality was associated with higher odds of LTBI (adjusted odds ratio [aOR], 3.86; 95 % confidence interval (95 % CI), 1.80-8.27), whereas the risk was lower for Saudi nationals (aOR, 0.34; 95 % CI, 0.25-0.47).

This study highlights the burden of LTBI in Al-Madinah, and specific demographic and medical risk factors. These findings underscore the importance of personalized public health strategies and preventive measures for controlling LTBI progression in high-risk populations.

Background: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) and Impella, a transluminal microaxial ventricular assist device, are well-established in the management of cardiogenic shock. No randomized controlled trials (RCTs) directly compare Impella versus VA ECMO to inform their safety and efficacy in cardiogenic shock. Purpose: This study aims to conduct a systematic review and meta-analysis of propensity score-matched/adjusted studies to compare the clinical outcomes of Impella versus VA ECMO in cardiogenic shock patients. Methods: A systematic review was undertaken to identify comparative studies of Impella and VA ECMO in cardiogenic shock, which in the absence of RCTs, was limited to observational trials with propensity-matched or adjusted outcomes to account for important confounding factors between populations. In-hospital/30-day survival and bleeding events requiring transfusion were meta-analyzed using the random effects method. Results: Five propensity score-matched/adjusted studies comparing short-term survival following treatment with Impella versus VA ECMO were included. A statistically significant difference in in-hospital/30-day mortality was detected between patients treated with Impella (39.6%) versus VA ECMO (53.8%) (odds ratio [95% confidence interval]: 0.57 [0.44, 0.74]; P < 0.0001). Impella was associated with significantly fewer bleeding events requiring transfusion compared with VA ECMO (19.9% vs. 28.8%, respectively) (OR [95% confidence interval]: 0.61 [0.46, 0.80]; P = 0.0004). Conclusion: In the absence of RCTs, this meta-analysis of propensity matched/adjusted observational trials represents the highest level of evidence available to date. Impella was associated with improved short-term survival and decreased bleeding events compared to VA ECMO in patients with cardiogenic shock.

To examine patient-centred outcome following endoscopic treatment of central airway stenosis in terms of days alive and out of hospital (DAOH), need for re-intervention, and complications, with reference to aetiology of disease and applied treatment methodology.

Analyses were based on data from consecutive adult patients treated endoscopically for benign central airway obstruction at Aarhus University Hospital from 2012 to 2022, with a minimum follow-up of one year. DAOH was calculated for 30 and 365 days. Complications were graded based on the Clavien-Dindo classification. Univariate and multivariate analyses were performed to identify predictors for DAOH, re-intervention and complications.

82 consecutive adult patients underwent endoscopic treatment during the period of inclusion, comprising a total of 175 dilatations, 42 benign tumour resections, and 67 stent insertions. Multiple interventions and short re-intervention intervals was more likely amongst patients reporting significant preoperative dyspnoea or requiring preoperative respiratory support, as well as patients treated with endoscopic insertion of silicone stents. The overall complication rate per procedure was 11.7%, and complications were more likely to occur in patients with high age, high BMI and comorbidity. Overall DAOH during the first year after intervention was 343 days, lowest amongst patients with tracheobronchomalacia or severe airway stenosis, and in those who underwent endoscopic stent insertion.

Endoscopic treatment is a safe and viable intervention in the management of benign central airway obstruction in adults with few complications and a high overall outcome.

Long-term data on the prognosis of patients who survived >5 years after gastrectomy for gastric cancer (GC) remain scarce. This study aimed to investigate sequential changes in conditional survival (CS) in patients with stage I-III GC who underwent R0 gastrectomy.

Of 1129 patients with stage I to III GC who underwent R0 gastrectomy, the causes of death were assessed, and sequential changes in conditional overall survival (cOS), conditional disease-specific survival (cDSS), and conditional non-disease-specific survival (cNDSS) were calculated and compared. In a subgroup of 709 patients who survived >5 years, the associations between cOS, cDSS, cNDSS, and clinicopathologic factors were analyzed.

Over a median follow-up of 63 months, 203 patients (18.0%) died of GC, and 132 patients (11.7%) died of non-GC causes. The 5-year cDSS consistently increased over 10 years after gastrectomy for stage II and III GC. The cDSS and cNDSS intersected at 7 years after gastrectomy for stage II GC, whereas these measures crossed at 8 years after gastrectomy for stage III GC. In the 709 5-year survivors, multivariate analysis identified disease stage as being significantly associated with cOS and cDSS. Moreover, age ≥ 80 years, male sex, and preoperative comorbidities were associated with lower cNDSS.

Surveillance for GC relapse was crucial during the first 7 and 8 years after gastrectomy for stages II and III, respectively. Conversely, surveillance for second primary cancers and benign diseases became relatively more important 0, 7, and 8 years after gastrectomy for stages I, II, and III, respectively. In 5-year survivors, age ≥ 80 years, male sex, and preoperative comorbidities were associated with mortality unrelated to GC.

Hospital experience measured by geriatric trauma proportion (GTP) is associated with in-hospital mortality among geriatric patients. Our goal was to determine the impact of GTP on long-term survival among older trauma patients.

This was a retrospective analysis of Medicare inpatient claims (2014-2015) of geriatric trauma patients admitted in Florida. GTP was calculated by dividing the number of geriatric trauma patients by the overall adult trauma volume in each hospital. Hospitals were then categorized into tertiles of GTP. Our main outcome was mortality at 30, 90, 180, and 365 days. Multivariable regression was performed to identify the association between GTP and long-term survival.

We included 65,763 geriatric trauma patients. As compared with hospitals in the lowest tertile, patients treated at the highest tertile were associated with lower mortality at 90 days (OR 0.90, 95%CI 0.82-0.98), 180 days (OR 0.90, 95%CI 0.83-0.97), and 365 days (OR 0.91, 95%CI 0.85-0.98).

Higher GTP is associated with improved long-term outcomes. However, mortality following trauma among geriatric patients continues to increase for 12 months.

Few studies have examined the prognosis of long-term survivors with gastric cancer (GC) after gastrectomy. This study aimed to identify the prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC.

A total of 721 patients with pathologic stage Ⅰ to Ⅲ GC who underwent gastrectomy between 2005 and 2018 and survived for 5 years without recurrence were enrolled. Conditional overall survival (cOS), conditional disease-specific survival (cDSS), and conditional non-disease-specific survival (cNDSS) of 5-year recurrence-free survivors were calculated. The association between cOS, cDSS, and cNDSS and clinicopathologic factors was evaluated using univariate and multivariate analyses.

The mean age of the patients was 70.5 ± 10.1 years, 68.5% of the patients were male, and 491, 128, and 102 had stage Ⅰ, Ⅱ, and Ⅲ GC, respectively. Of note, 17 patients relapsed, and 65 patients died (disease-specific, non-disease-specific, and unknown: 12, 45, and 6, respectively) during a median follow-up of 36 months. The 5-year cOS, cDSS, and cNDSS rates were 90.3%, 97.3%, and 93.3%, respectively. Multivariate analysis showed that age of ≥80 years and neutrophil-to-lymphocyte ratio (NLR) of ≥2.7 were significantly associated with poorer cOS. Stage Ⅲ GC was associated with decreased cDSS, and age of ≥80 years, NLR of ≥2.7, and mean corpuscular volume (MCV) of ≥93.4 fL were associated with lower cNDSS.

Age of ≥80 years, stage Ⅲ GC, NLR of ≥2.7, and MCV of ≥93.4 fL were unfavorable prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC. Long-term surveillance after gastrectomy could be tailored based on these factors.

This study aims to investigate the association between elderly patients with COPD with different blood eosinophil on admission and those without COPD and the prognosis of COVID-19.

A territory-wide retrospective study was conducted to investigate the association between elderly COPD patients with different blood eosinophil on admission and the prognosis of COVID-19. Elderly patients admitted to public hospitals and community treatment facility in Hong Kong for COVID-19 from January 23, 2020, to September 31, 2021, were included in the study. Severe diseases were defined as those who develop respiratory complications, systemic complications and death.

Among the 1925 patients included, 133 had COPD. Forty had admission blood eosinophil count ≥ 150 cells/μL, and 93 had blood eosinophil count < 150 cells/μL. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, had severe COVID-19 with the development of respiratory and systemic complications. They were more likely to develop respiratory failure (OR = 5.235, 95% CI = 2.088-13.122, p < 0.001) and require invasive mechanical ventilation (OR = 2.433, 95% CI = 1.022-5.791, p = 0.045) and intensive care unit admission (OR = 2.214, 95% CI = 1.004-4.881, p = 0.049).

Our study suggested that the blood eosinophil count on admission could have significant prognostic implications among elderly patients with COPD. Patients with COPD and admission blood eosinophil count ≥ 150 cells/μL, but not those with admission blood eosinophil count < 150 cells/μL, have significantly increased risks of developing respiratory and systemic complications from COVID-19, when compared with non-COPD patients.

The efficacy and safety of a sedation regimen combining dexmedetomidine and midazolam during endoscopic submucosal dissection for upper gastrointestinal tumors remains unclear. In this study, we aimed to evaluate the efficacy and safety of this sedation regimen, where non-anesthesiologists performed sedation.

Sixty-eight patients who underwent endoscopic submucosal dissection for upper gastrointestinal tumors, sedated by non-anesthesiologists, were retrospectively evaluated. The sedation was performed by non-anesthesiologists as part of on-the-job training (OJT) under anesthesiologists' supervision. Each non-anesthesiologist received OJT at least thrice. Proficiency levels were assessed during the third OJT session. The target sedation depth was a Richmond Agitation-Sedation Scale of -2 to -4, with 2 L/min of oxygen delivered via a nasal cannula at sedation initiation. The treatment completion rates, which measured efficacy and safety, were assessed by the frequencies of respiratory depression, hypotension, and bradycardia.

The study included 14, 52, and two patients with superficial esophageal cancer, early gastric cancer, and gastric adenoma, respectively. The median treatment time was 68 and 84 min for superficial esophageal cancer, early gastric cancer, and adenoma, respectively. Endoscopic submucosal dissection was completed in all patients. No severe sedation-related adverse events were reported; however, peripheral arterial oxygen saturation <90%, hypotension, and bradycardia occurred in 1 (1.5%), 30 (44.1%), and 30 patients (44.1%), respectively. All 22 non-anesthesiologists who underwent the proficiency evaluation passed the test.

A sedation regimen combining dexmedetomidine and midazolam can be feasibly administered by non-anesthesiologists. Further studies are needed to verify the effectiveness of OJT.

While active surveillance (AS) is an alternative to surgical interventions in patients with small renal masses (SRMs), evidence regarding its oncological efficacy is still debated. We aimed to evaluate oncological outcomes for patients with SRMs who underwent AS in comparison to surgical interventions.

In April 2024, PubMed, Scopus, and Web of Science were queried for comparative studies evaluating AS in patients with SRMs (PROSPERO: CRD42024530299). The primary outcomes were overall (OS) and cancer-specific survival (CSS). A random-effects model was used for quantitative analysis.

We identified eight eligible studies (three prospective, four retrospective, and one study based on Surveillance, Epidemiology and End Results [SEER] data) involving 4947 patients. Pooling of data with the SEER data set revealed significantly higher OS rates for patients receiving surgical interventions (hazard ratio [HR] 0.73; p = 0.007), especially partial nephrectomy (PN; HR 0.62; p < 0.001). However, in a sensitivity analysis excluding the SEER data set there was no significant difference in OS between AS and surgical interventions overall (HR 0.84; p = 0.3), but the PN subgroup had longer OS than the AS group (HR 0.6; p = 0.002). Only the study based on the SEER data set showed a significant difference in CSS. The main limitations include selection bias in retrospective studies, and classification of interventions in the SEER database study.

Patients treated with AS had similar OS to those who underwent surgery or ablation, although caution is needed in interpreting the data owing to the potential for selection bias and variability in AS protocols. Our review reinforces the need for personalized shared decision-making to identify patients with SRMs who are most likely to benefit from AS.

For well-selected patients with a small kidney mass suspicious for cancer, active surveillance seems to be a safe alternative to surgery, with similar overall survival. However, the evidence is still limited and more studies are needed to help in identifying the best candidates for active surveillance.

Renal Tumor biopsy (RTB) can assist clinicians in determining the most suitable approach for treatment of renal cancer. However, RTB's limitations in accurately determining histology and grading have hindered its broader adoption and data on the concordance rate between RTB results and final pathology after surgery are unavailable. Therefore, we aimed to develop a machine learning algorithm to optimize RTB technique and to investigate the degree of concordance between RTB and surgical pathology reports.

Within a prospectively maintained database, patients with indeterminate renal masses who underwent RTB at a single tertiary center were identified. We recorded and analyzed the approach (US vs. CT), the number of biopsy cores (NoC), and total core tissue length (LoC) to evaluate their impact on diagnostic outcomes. The K-Nearest Neighbors (KNN), a non-parametric supervised machine learning model, predicted the probability of obtaining pathological characterization and grading. In surgical patients, final pathology reports were compared with RTB results.

Overall, 197 patients underwent RTB. Overall, 89.8% (n=177) and 44.7% (n=88) of biopsies were informative in terms of histology and grading, respectively. The discrepancy rate between the pathology results from renal tissue biopsy (RTB) and the final pathology report following surgery was 3.6% (n=7) for histology and 5.0% (n=10) for grading. According to the machine learning model, a minimum of 2 cores providing at least 0.8 cm of total tissue should be obtained to achieve the best accuracy in characterizing the cancer. Alternatively, in cases of RTB with more than two cores, no specific minimum tissue threshold is required.

The discordance rates between RTB pathology and final surgical pathology are notably minimal. We defined an optimal renal biopsy strategy based on at least 2 cores and at least 0.8 cm of tissue or at least 3 cores and no minimum tissue threshold.

RTB is a useful test for kidney cancer, but it's not always perfect. Our study shows that it usually matches up well with what doctors find during surgery. Using machine learning can make RTB even better by helping doctors know how many samples to take. This helps doctors treat kidney cancer more accurately.

Dysphagia is significantly correlated with prognostic outcomes in patients with stroke; however, the intrinsic mechanism of action between the two remains unclear. This study aimed to model the intrinsic mechanism of action between dysphagia and prognostic outcomes in patients with stroke based on structural equation modeling.

A retrospective analysis of 900 inpatients with stroke from three large hospitals was performed. AMOS software (version 23.0) was used to construct the structural equation modeling.

The overall model showed a good fit (chi-square = 27.3, root mean square error of approximation = 0.01, standardized root mean square residual = 0.032, comparative fit index = 0.98, and adjusted goodness of fit = 0.94). Structural equation modeling showed that the total effect of dysphagia on the prognosis of patients with stroke was 0.694, with a direct effect of 0.599, accounting for 86.31 % of the total effect. The total indirect effect was 0.095, with the mediating effects of serum albumin level and pneumonia accounting for 6.48 % and 7.35 % of the total effect, respectively. The moderating effects of sex on dysphagia and the relationship between activities of daily living, modified Rankin scale score, and length of hospital stay were insignificant (ΔR2 = 0.063, P = 0.145; ΔR2 = 0.002, P = 0.620; ΔR2 = 0.001, P = 0.307).

Dysphagia can directly affect the prognostic outcomes of patients with stroke and indirectly affect prognosis by triggering pneumonia and lowering albumin levels. Sex was not found to play a moderating role in the relationship between dysphagia and prognosis.

Venous thromboembolism after colorectal cancer resection is common and highly morbid. Extended pharmacologic venous thromboembolism prophylaxis after cancer surgery lowers venous thromboembolism risk and is recommended by major professional societies. Adherence is low in contemporary local and regional studies.

Assess patient and hospital factors associated with receipt of prophylaxis after colorectal cancer surgery in a national data set.

Retrospective cohort study.

Surveillance, epidemiology, and end results in a Medicare data set.

Patients older than 64 years undergoing resection for colorectal cancer between 2016 and 2017.

The primary outcome was the receipt of prophylaxis within 7 days of discharge. Patient and hospital factors associated with receiving prophylaxis were identified using multivariable logistic regression. Secondary outcomes included 30- and 90-day venous thromboembolism.

Of 23,527 patients, 4.7% received prophylaxis. Utilization increased from 2016 to 2017 (3.9% vs 5.5%; p < 0.001). Patients treated at National Cancer Institute-designated hospitals received prophylaxis more frequently than teaching, non-National Cancer Institute hospitals and nonteaching, non-National Cancer Institute hospitals (10.2% vs 5.6% vs 1.7%; p < 0.001). Patients receiving care at larger hospitals by bed size quartile were more likely to receive prophylaxis compared to those at smaller hospitals (9.0% vs 4.0% vs 3.4% vs 2.2%; p < 0.01). On multivariable regression, National Cancer Institute status, larger bed size, White race (compared to others), rectal tumor location, and more recent year of treatment were independently associated with prophylaxis utilization. Venous thromboembolism events at 30 and 90 days were 1.87% and 2.63%, respectively. Prophylaxis was associated with decreased 30-day venous thromboembolism (1.26% vs 1.9%; p = 0.1211).

Retrospective, large database study.

Utilization of prophylaxis after colorectal cancer surgery remains limited even in large, specialized hospitals. Further work is needed to understand this departure from guideline-concordant care. See Video Abstract .

ANTECEDENTES:La tromboembolia venosa tras la resección del cáncer colorrectal es común y presenta una alta morbilidad. La profilaxis farmacológica prolongada indicada para la tromboembolia venosa después de la cirugía del cáncer reduce el riesgo de tromboembolia venosa y es recomendada por las principales sociedades profesionales. La adherencia es baja en estudios locales y regionales contemporáneos.OBJETIVO:Evaluar los factores relacionados al paciente y al hospital asociados con la indicacion de profilaxis después de la cirugía del cáncer colorrectal en un conjunto de datos nacionales.DISEÑO:Estudio de cohorte retrospectivo.ESCENARIO:Conjunto de datos de vigilancia, epidemiología y resultados finales de Medicare.PACIENTES:Pacientes mayores de 64 años sometidos a resección por cáncer colorrectal entre 2016 y 2017.PRINCIPALES MEDIDAS DE RESULTADOS:El resultado primario fue la recepcion de profilaxis dentro de los 7 días posteriores al alta. Los factores asociados al paciente y al hospital asociados con la recepción de profilaxis se identificaron mediante regresión logística multivariable. Los resultados secundarios incluyeron la tromboembolia venosa a los 30 y 90 días.RESULTADOS:De 23.527 pacientes, el 4,7 % recibió profilaxis. La utilización aumentó de 2016 a 2017 (3,9 % frente a 5,5 %; p < 0,001). Los pacientes tratados en hospitales designados por el Instituto Nacional del Cáncer recibieron profilaxis con mayor frecuencia que los hospitales docentes no pertenecientes al Instituto Nacional del Cáncer y los hospitales no docentes no pertenecientes al Instituto Nacional del Cáncer (10,2 % frente a 5,6 % frente a 1,7 %; p < 0,001). Los pacientes que recibieron atención en hospitales más grandes por cuartil de tamaño de cama tenían más probabilidades de recibir profilaxis en comparación con los de hospitales más pequeños (9,0 % frente a 4,0 % frente a 3,4 % frente a 2,2 %; p < 0,01). En la regresión multivariable, el status relacionado al Instituto Nacional del Cáncer, el mayor tamaño de cama, la raza blanca (en comparación con otras), la ubicación del tumor rectal y año más reciente de tratamiento se asociaron de forma independiente con la utilización de profilaxis. Los eventos de tromboembolia venosa a los 30 y 90 días fueron de 1,87% y 2,63% respectivamente. La profilaxis se asoció con una disminución de la tromboembolia venosa a los 30 días (1,26% frente a 1,9%; p = 0,1211).LIMITACIONES:Estudio retrospectivo de una gran base de datos.CONCLUSIONES:La utilización de la profilaxis después de la cirugía de cáncer colorrectal sigue siendo limitada incluso en hospitales grandes y especializados. Se necesitan más estudios para comprender esta desviación de la atención concordante con las directrices. (Traducción-Dr Osvaldo Gauto ).

Quality benchmarking has recently evolved from a historical focus on short-term morbidity and mortality as the key metrics to assessing long-term outcomes. Long-term quality metrics have been shown to provide a more complete assessment of geriatric trauma care. Among these metrics, patients' average number of healthy days at home (HDAH) proports to be a useful administrative claims-based marker of patient functional status. Our goal was to determine the predictors of HDAH among injured older adults.

Medicare inpatient claims (2014-2015) were used to identify all geriatric trauma patients. Patients' number of HDAH was measured from the date of discharge and calculated as the total sum of patients' time during that period less any time spent in the hospital or emergency department, step-down/rehabilitation/nursing care, home health, or after death within a 365-period after index admission. Controlling for demographic, injury severity, and hospital-level characteristics, multivariable regression analyses were performed to identify the factors associated with increased HDAH.

We included 772,109 geriatric trauma patients. The mean age was 82.15 years (SD, 8.49 years), 68.3% were female, and 91.6% were White. The median HDAH was 351 days (interquartile range, 351-355 days). After adjusted analysis, age, Black race, Charlson Comorbidity Index (CCI), and care at a level 3/nontrauma center were associated with fewer HDAH within 365 days after discharge.

This study suggests that higher level trauma centers provide more HDAH after index admission for injured older adults. Future studies should focus on correlating HDAH with more granular but less readily accessible quality of life metrics.

Prognostic and Epidemiological; Level III.

To test the efficacy of Problem Adaptation Therapy for Pain (PATH-Pain) versus Usual Care (UC) in reducing pain-related disability, pain intensity, and depression among older adults with chronic pain and negative emotions.

RCT assessing the between-group differences during the acute (0-10 weeks) and follow-up (weeks 11-24) phase of treatment.

A geriatrics primary care site.

100 participants (80 % females, Mean Age = 75.5) with chronic pain, negative emotions, and varying cognition (56 % had cognitive impairment) were randomly assigned to PATH-Pain (N = 49) or UC (N = 51).

PATH-Pain is a collaborative program which includes a psychosocial intervention designed to improve emotion regulation. UC participants received a booklet that described evidence-based self-management pain strategies.

Primary outcomes: Pain-related disability (Modified Roland-Morris Disability Questionnaire), and pain intensity.

Depression (Montgomery-Asberg Depression Rating Scale), emotion regulation (Emotion Regulation Questionnaire), and treatment satisfaction (Client Satisfaction Questionnaire).

During acute treatment (by Week 10), PATH-Pain vs. UC participants showed a significant decrease in pain-related disability [contrast mean difference (CMD) = -1.96, P = 0.02), CI [-0.47, -3.44]] and in depression severity (CMD = -2.50, P = 0.03, CI [-.0.23, -4.76]), but not in pain intensity. PATH-Pain (vs. UC) participants also demonstrated a significant improvement in expressive suppression, an aspect of emotion regulation (CMD = 2.120, P = 0.010, CI [.085, 4.155]). During follow-up (Week 11 to 24), there were no significant between-group differences in pain-related disability, pain intensity, or depression severity.

This primarycarebased study demonstrates the short-term efficacy of PATH-Pain versus UC in reducing pain-related disability and depression in older adults with comorbid chronic pain and negative emotions, as well as varying degrees of cognitive functioning.

Maternal hepatitis B virus (HBV) infection influence both maternal and fetal health. Recent studies reported increased congenital anomalies in offspring of HBV-infected mothers. This study investigated whether maternal HBV infection was associated with higher risk of congenital heart disease (CHD) in children. With the Korean National Health Insurance Service (K-NHIS) database, this retrospective cohort study included live births from 2005 to 2019, born to women under 40. Propensity score matching with a 1:3 ratio was conducted to compare HBV-infected mother's children with HBV-uninfected mother's children while adjusting for various maternal and pregnancy-related factors. Logistic regression models were used to estimate the risk. Of 2,673,059 eligible participants, 263,904 children were born to HBV-infected mothers. Risk estimation in this group showed a modestly increased risk of CHD (OR = 1.05, 95% CI = 1.02, 1.09). Notably, when pregnant mothers were treated with antiviral medication, there was an indication of reduced CHD risk, although this result was not statistically significant. The highest risk of CHD was observed in children who were themselves infected with HBV. The study indicates an association between maternal HBV infection and an increased CHD risk in offspring. The findings suggest the need to re-evaluate the timing of antiviral treatment during pregnancy to align more closely with early stages of fetal cardiac development. Further research is needed to understand the biological mechanisms of this association and to redefine clinical guidelines for managing HBV infection in pregnancy.

The study aimed to explore a definition for complicated coagulase-negative staphylococci bloodstream infections (CoNS BSIs) and to identify predictors for mortality.

A prospective cohort study was conducted from October 2016 to March 2017 in 26 Spanish hospitals. Complicated CoNS BSI criteria included lack of early catheter removal in catheter-related cases, foreign indwelling implant, persistent bacteraemia, fever ≥72 hours on active therapy, metastatic infection or deep-seated focus, and infective endocarditis. Independent predictors for 30-day mortality were evaluated by Cox regression, and the impact of the definition of complicated bacteraemia was assessed.

Overall, 445 CoNS BSI cases were included; catheter-related infections were predominant (336/445, 75.5%). Complicated bacteraemia was identified in 240 of 445 patients (53.9%); 30-day mortality in complicated and uncomplicated cases was 53 of 240 (22.1%) and 24/205 (11.7%), respectively (p 0.004). Predictors of 30-day mortality identified in the multivariate analysis included age (hazard ratio [HR]: 1.03, 95% CI: 1.01-1.05), cerebrovascular disease (HR: 2.58, 95% CI: 1.45-4.58), immunosuppressive therapy (HR: 2.16, 95% CI: 1.22-3.84), SOFA score (HR: 1.09, 95% CI: 1.03-1.16), and complicated bacteraemia (HR: 2.14, 95% CI: 1.29-3.53). A catheter-related source of bacteraemia was found to be protective (HR: 0.49, 95% CI: 0.30-0.80). When specific criteria to define complicated bacteraemia were included, fever ≥72 hours was associated with an increased risk of death (HR: 2.52, 95% CI: 1.52-4.17) and early catheter removal was protective (HR: 0.47, 95% CI: 0.26-0.83).

A high proportion of patients presented complicated bacteraemia according to the proposed criteria; these patients had higher hazards for mortality. Other mortality predictors were identified. Further studies would be needed to validate the proposed criteria.

Neoadjuvant chemoimmunotherapy (NCIO) is a new and effective treatment for cancer, but its efficacy in treating certain patients is unclear. We previously found that comorbidity was an independent factor associated with the pathological complete response (pCR) of non-small cell lung cancer (NSCLC) to NCIO. However, we did not address which comorbidities or comorbidity indices were associated with pCR. The present study retrospectively collected the data for NSCLC patients who underwent NCIO after surgery at The Second Xiangya Hospital of Central South University (Hunan, China) between January 2019 and July 2022. The associations between comorbidities/comorbidity indices and pCR rates/clinicopathological factors were analyzed. In total, 101 eligible patients with stage IIB-IIIC NSCLC were enrolled. Comorbid hypertension [odds ratio (OR)=0.321(0.110-0.937)], vascular disease [OR=0.275 (0.111-0.677)] and cardiovascular disease [OR=0.272 (0.114-0.646)] were all significantly associated with pCR (all P<0.05). The comorbidity indices Cumulative Illness Rating Scale-Geriatric (CIRS-G) ≥2 [OR=0.360 (0.154-0.840)], CIRS-G ≥3 [OR=0.404 (0.179-0.912)], CIRS-G ≥4 [OR=0.293 (0.105-0.817)] and Adult Comorbidity Evaluation-27 (ACE-27) ≥2 [OR=0.427 (0.192-0.950)] were all significantly associated with pCR (all P<0.05). Cardiovascular disease was the only independent risk factor for pCR [adjusted OR=0.272 (0.114-0.646); P=0.003] according to multivariate logistic analysis. In conclusion, cardiovascular comorbidities and the CIRS-G and ACE-27 indices were associated with the effectiveness of NCIO and clinicopathological factors. These results could help to screen for the most suitable NSCLC patients for NCIO.

There is no consensus on de-escalation of monitoring during active surveillance (AS) for prostate cancer (PCa). Our objective was to determine clinical criteria that can be used in decisions to reduce the intensity of AS monitoring.

The global prospective AS cohort from the Global Action Plan prostate cancer AS consortium was retrospectively analyzed. The 24656 patients with complete outcome data were considered. The primary goal was to develop a model identifying a subgroup with a high ratio of other-cause mortality (OCM) to PCa-specific mortality (PCSM). Nonparametric competing-risks models were used to estimate cause-specific mortality. We hypothesized that the subgroup with the highest OCM/PCSM ratio would be good candidates for de-escalation of AS monitoring.

Cumulative mortality at 15 yr, accounting for censoring, was 1.3% for PCSM, 11.5% for OCM, and 18.7% for death from unknown causes. We identified body mass index (BMI) >25 kg/m2 and <11% positive cores at initial biopsy as an optimal set of criteria for discriminating OCM from PCSM. The 15-yr OCM/PCSM ratio was 34.2 times higher for patients meeting these criteria than for those not meeting the criteria. According to these criteria, 37% of the cohort would be eligible for de-escalation of monitoring. Limitations include the retrospective nature of the study and the lack of external validation.

Our study identified BMI >25 kg/m2 and <11% positive cores at initial biopsy as clinical criteria for de-escalation of AS monitoring in PCa.

We investigated factors that could help in deciding on when to reduce the intensity of monitoring for patients on active surveillance for prostate cancer. We found that patients with higher BMI (body mass index) and lower prostate cancer volume may be good candidates for less intensive monitoring. This model could help doctors and patients in making decisions on active surveillance for prostate cancer.

Balance impairment and falls are common among patients after cancer treatment. This study aimed to compare static and dynamic balance functions in lung cancer survivors (LCS) and healthy controls and to investigate the factors related to balance in LCS.

Cross-sectional data were collected from lung cancer patients whose treatment had been completed within the previous 3 months (n = 60) and age and gender-matched healthy controls (n = 60). Clinical characteristics and history of falls were recorded. Pulmonary function tests and measurements of respiratory muscle strength were performed. Dynamic and static balance, fear of falling, knee-extension strength, physical activity level, dyspnea, comorbidity, and quality of life (QoL) were assessed using the Time Up and Go Test, Single Leg Standing Test, the Fall Efficacy Scale-International, hand-held dynamometer, the International Physical Activity Questionnaire, the Modified Medical Research Dyspnea Scale, the Charlson Comorbidity Index, and the European Organization for Research and Treatment of Cancer QoL Scale.

LCS reported a higher fall rate and exhibited lower dynamic balance compared to controls (p < 0.05). The number of chemotherapy cycles, number of falls in the past year, fear of falling, perceived dyspnea, forced expiratory volume in 1 s (%), maximal inspiratory pressure (%), knee-extension strength, physical activity score, and QoL score related to physical function were correlated with balance function in LCS (p < 0.05).

LCS had a higher risk of falls and lower dynamic balance function which might be related to various clinical and physical parameters.

Identifying factors related to balance should be considered within the scope of fall prevention approaches for these patients.

Acute myeloid leukemias (AMLs) are the hematological malignancies with the highest need for intensive care unit (ICU) admission due to their association with various life-threatening situations. Limited data exist regarding the outcomes of elderly individuals with AML admitted to the ICU. However, current therapeutic protocols offer the potential for extended survival in this population. This retrospective, monocentric study focused on the outcomes of individuals aged ≥ 60 years admitted to the ICU for newly diagnosed AML. It included 139 patients admitted to the ICU at the Paoli-Calmettes Institute between April 2010 and October 2020, during the initial phase of AML management. Patients were categorized into three groups based on the presence of biological criteria indicating "high risk" for complications (thrombocytopenia < 50 000/mm3 and leukocytosis > 50 000/mm3) and organ failure. Multiple logistic regression models were employed to identify predictive factors for in-hospital and day 90 mortality, while Cox regression was used for 1-year mortality. The rates of in-hospital, day 90, and 1-year mortality were 37%, 42%, and 60%, respectively. Variables associated with in-hospital mortality included the Charlson Comorbidity Index, the need for invasive mechanical ventilation (MV), and multi-organ failure. ELN17 risk was significantly associated with 1-year mortality rates. This study demonstrates the benefits of ICU management for individuals aged ≥ 60 years during the initial phase of AML. It illustrates the effects of age, comorbidities, and the severity of organ failures on short-term mortality and highlights the impact of classical prognostic markers on long-term mortality.