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The Association Between Psychological Distress, Emergency Room Visits, and All-Cause Mortality Among Colorectal Cancer Survivors
No full textOBJECTIVE: We examined the prevalence of psychological distress and its association with emergency room (ER) usage and all-cause mortality among colorectal cancer (CRC) survivors.
METHODS: We utilized data from the 2000-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files. The main exposure was psychological distress, assessed with the six-item Kessler Psychological Distress Scale (K6) and classified as (no/low, moderate, severe). The outcomes were ER usage during the past 12 months and all-cause mortality. Multivariable logistic and Cox proportional hazards models were used to examine the associations between psychological distress and ER usage and all-cause mortality, respectively.
RESULTS: A total of 3198 CRC survivors were included in the study, of whom 4.1% and 19.6% reported severe and moderate psychological distress, respectively. Approximately 30% of CRC survivors had ER use, and 41.5% of deaths occurred with a median follow-up of 84 months. In the adjusted model, compared to CRC survivors with low/no psychological distress, those with severe (aOR = 1.83; 95% CI, 1.10-3.04) or moderate (aOR = 1.60; 95% CI, 1.21-2.10) psychological distress had higher odds of reporting ER use. However, there was no statistically significant association between psychological distress and all-cause mortality.
CONCLUSION: CRC survivors with severe or moderate psychological distress have higher ER usage. This finding emphasizes the significance of timely identifying and addressing psychological distress to improve the quality of life and clinical outcomes of patients diagnosed with CRC. Integrating mental health support into routine cancer care may reduce distress levels, potentially leading to fewer ER usages among CRC survivors
The Effects of Varicocele Repair on Testicular Sperm Retrieval, Sperm Recovery in the Ejaculate and Clinical Pregnancy Rates in Non-Obstructive Azoospermic Men with Clinical Varicocele: A Systematic Review and Meta-analysis
No full textPURPOSE: The role of varicocele repair (VR) in infertile men with non-obstructive azoospermia (NOA) and varicocele is controversial in the current guidelines, despite available studies. This study aims to assess the impact of VR on testicular sperm retrieval, sperm recovery from the ejaculate, and clinical pregnancy rates in infertile men with NOA and clinical varicocele through a systematic review and meta-analysis (SRMA) of controlled studies.
MATERIALS AND METHODS: A systematic literature search was conducted using the Scopus and PubMed databases up to November 2023. Among the 1,847 articles retrieved, five observational controlled studies comparing reproductive outcomes between infertile men with NOA and clinical varicocele who underwent VR, and a control group that received no treatment, met the inclusion criteria for this SRMA.
RESULTS: The selected studies included 269 men with NOA who underwent VR before the testicular sperm extraction (TESE) procedure and 364 men who did not undergo VR. The pooled estimate demonstrated a significantly higher odds ratio (OR) of 2.17 (95% confidence interval [95% CI]: 1.17-4.01, p=0.01) for surgical sperm retrieval in the VR group. VR significantly increased the likelihood of sperm appearance in the ejaculate, with an OR of 7.8 (95% CI: 3.59-16.94, p\u3c 0.001). Besides, VR provided a significantly greater clinical pregnancy rate with intracytoplasmic sperm injection (ICSI) compared to non-operated men (OR: 2.18, 95% CI: 1.03-4.60; p=0.04).
CONCLUSIONS: This is the first SRMA, consisting of only controlled studies, to demonstrate that VR performed prior to TESE in men with NOA significantly improves sperm production as reflected in the spontaneous appearance of sperm in the semen and higher odds of surgical sperm retrieval and clinical pregnancy compared with non-operated men. Thus, these findings highlight the potentially beneficial impact of VR in men with NOA and clinical varicocele
Assessing minimum two-year follow-up PROMIS scores after total shoulder arthroplasty: Is there a difference between 1- and 2-year outcomes?
No full textBACKGROUND: Historically 2-year outcomes have served as a standard to evaluate functional improvement after shoulder arthroplasty. However, recent studies suggest that legacy patient-reported outcomes often plateau at 1 year. Evaluation of newer patient-reported outcomes, such as Patient-Reported Outcomes Measurement Information System scores, has yet to be performed. This study aimed to assess differences in PROMIS Upper Extremity function and PROMIS Pain Interference between 1 and 2 years after primary shoulder arthroplasty.
METHODS: We retrospectively identified 199 patients from a single-center, multi-surgeon database who underwent primary anatomic and reverse total shoulder arthroplasty from 2017 to 2022 and had 1-year and 2-year PROMIS scores. Forty-six of these patients had 1- and 2-year follow-up where clinical outcomes were measured. Patients undergoing revision surgeries, hemiarthroplasty, and those lacking both 1-year and 2-year PROMIS scores were excluded. Statistical analysis was done using non-parametric analysis tests such as the Mann-Whitney U Test.
RESULTS: In the overall cohort of 199 patients, no statistically significant difference was observed in PROMIS Upper Extremity scores between the 1-year (mean: 39.06 ± 8.5) and 2-year (mean: 38.26 ± 8.3) postoperative time points (p = 0.22). PROMIS Pain Interference scores showed a statistically significant increase from 55.25 ± 6.7 at 1 year to 56.74 ± 7.1 at 2 years (p = 0.01), but this change did not meet the minimal clinically important difference threshold. An analysis of patients with clinical follow-up revealed no significant differences in PROMIS Upper Extremity or PROMIS Pain Interference scores (p \u3e 0.05). Additionally, no statistically significant differences were found in other clinical outcomes, including visual analog scale pain scores (1-year: 1.15 ± 0.9, 2-year: 1.48 ± 1.1, p = 0.51), range of motion, and strength measurements between the 1- and 2-year follow-ups (p \u3e 0.05).
CONCLUSION: Patients undergoing total shoulder arthroplasty demonstrate no significant differences in PROMIS scores between 1-year and 2-year follow-up, suggesting that patients likely reach their maximal benefit of PROMIS scores at the 1-year follow-up timepoint
Cultivating expertise in MRI physics in Mongolia through international collaboration
No full textINTRODUCTION: Mongolia\u27s expanding MRI infrastructure faces challenges due to limited local MRI physics expertise, critical for optimizing scanner performance and ensuring diagnostic quality. In response, Intermed Hospital in Ulaanbaatar partnered with RAD-AID International to build MRI capacity and enhance imaging access across urban and rural areas.
METHODS: This project included comprehensive MRI physics education, clinical protocol optimization, QA implementation, and the installation of two new MRI scanners. A didactic course covered MRI fundamentals, helping technologists, radiologists, and engineers understand how MRI parameters impact image quality. Practical sessions allowed staff to refine protocols to reduce artifacts, and an ACR-adapted QA program was established for consistent scanner monitoring.
RESULTS: Participants demonstrated improved knowledge and practical skills, enabling them to independently adjust protocols and conduct QA. Two 1.5 T MRI scanners were successfully installed in Ulaanbaatar and Darkhan, with local staff applying new expertise to maintain consistent imaging quality.
DISCUSSION: This collaborative model shows that partnerships with international experts can empower local teams in resource-limited settings to sustain high imaging standards, reduce reliance on external support, and enhance patient care through improved diagnostic quality.
CONCLUSION: The successful integration of MRI physics education, protocol optimization, and QA provides a replicable roadmap for similar low-resource settings, bridging healthcare gaps and expanding access to advanced imaging in underserved regions
The role of advanced technologies in improving diabetes outcomes
No full textOBJECTIVES: To discuss the current state of diabetes care in America, the value and utility of innovative diabetes technologies, barriers to access to quality diabetes care and technologies, and how a value-based model of diabetes care can improve outcomes and reduce costs.
STUDY DESIGN: Narrative review of the current state of diabetes care in America and use of diabetes technologies such as continuous glucose monitoring (CGM) and automated insulin delivery (AID) systems.
METHODS: An internet search of relevant studies and government reports was conducted.
RESULTS: Numerous studies have shown that use of CGM and AID improves glycemia, diabetes-related events, and health care resource utilization and lowers overall health care costs. Despite these demonstrated benefits, the majority of individuals with diabetes are not achieving their glycemic goals. Although many of these individuals have limited access to these technologies due to restrictive coverage eligibility criteria, significant disparities exist in technology use within racial/ethnic minority populations and communities of lower socioeconomic status. Transitioning to a value-based approach to diabetes care supports the Quintuple Aim framework.
CONCLUSIONS: Shifting our current health care delivery paradigm from the traditional volume-based, fee-for-service model to a value-based model that takes a proactive approach could improve patient outcomes and overall quality of life while helping to reduce the long-term costs of diabetes care
Lung Carcinoid Tumors With Potentially Actionable Genomic Alterations and Responses to Targeted Therapies
No full textBACKGROUND: Effective treatments for patients with advanced lung carcinoids remain limited. The prevalence of potentially actionable genomic alterations (AGAs) among lung carcinoids is not well-understood.
MATERIALS AND METHODS: Lung carcinoids submitted for next-generation sequencing (NGS) at a Clinical Laboratory Improvement Amendments (CLIA)-certified genomics laboratory from September 2013 to March 2024 were retrospectively investigated to determine prevalence of AGAs. We evaluated outcomes with genotype-matched targeted therapies in patients with advanced lung carcinoids with AGAs identified across 3 institutions and comprehensive literature search.
RESULTS: Among 321 cases of lung carcinoids profiled by NGS, 8 (2.5%) harbored potential AGAs (4 [1.2%] with commercially available targeted therapies), including KRAS mutations (n = 4, 1.2%: G12C, G12D, G12R, G12V), ALK fusions (n = 2, 0.6%), BRAF D594N (n = 1, 0.3%), and RET fusion (n = 1, 0.3%). None of the 24 typical carcinoids harbored an AGA. Collectively across these database-identified patients, our multi-institutional cohort, and literature review, we identified 36 cases of lung carcinoids with potential AGAs (24 with commercially available targeted therapies), predominantly comprising fusions of ALK (n = 14), RET (n = 5), and NTRK (n = 2). Of 27 with known disease stage, 19 had stage 4 disease, and 13 (68.4%) had outcomes reported following targeted therapies. Median treatment duration was 12.0 months (95% CI: 6.7-16.0). Median progression-free survival (PFS) was 10.6 months (95% CI: 6.7-16.0) across all targeted therapy lines and 14.0 months (95% CI: 1.3-NA) with first-line targeted therapies. Objective response rate with at least one targeted therapy was 61.5%.
CONCLUSIONS: Patients with advanced lung carcinoids harboring AGAs can derive meaningful benefit from genotype-matched targeted therapies, highlighting potential role for NGS in patients with advanced carcinoids
Patient- and Community-Level Characteristics Associated With Respiratory Syncytial Virus Vaccination
No full textIMPORTANCE: In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts.
OBJECTIVE: To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines.
DESIGN, SETTING, AND PARTICIPANTS: During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines.
EXPOSURES: Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level.
MAIN OUTCOMES AND MEASURES: The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions.
RESULTS: Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P \u3c .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P \u3c .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P \u3c .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P \u3c .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P \u3c .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P \u3c .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P \u3c .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-term care facilities, patients with Medicaid coverage, and uninsured patients.
CONCLUSIONS AND RELEVANCE: In this cross-sectional study of hospitalized adults, knowledge of RSV disease and RSV vaccine eligibility was low. Older adults and those with certain medical conditions were more likely to have received vaccine, suggesting appropriate prioritization, but sociodemographic differences in vaccine uptake occurred
Vaccine Effectiveness Against Influenza A(H1N1), A(H3N2), and B-Associated Hospitalizations-United States, September 1, 2023-May 31, 2024
No full textBACKGROUND: The 2023-2024 influenza season included sustained elevated activity from December 2023-February 2024 and continued activity through May 2024. Influenza A(H1N1), A(H3N2), and B viruses circulated during the season.
METHODS: During September 1, 2023-May 31, 2024, a multistate sentinel surveillance network of 24 medical centers in 20 U.S. states enrolled adults aged ≥18 years hospitalized with acute respiratory illness (ARI). Consistent with a test-negative design, cases tested positive for influenza viruses by molecular or antigen test, and controls tested negative for influenza viruses and SARS-CoV-2. Vaccine effectiveness (VE) against influenza-associated hospitalization was calculated as (1 - adjusted odds ratio for vaccination) × 100%.
RESULTS: Among 7690 patients, including 1170 influenza cases (33% vaccinated) and 6520 controls, VE was 40% (95% CI: 31%-48%) with varying estimates by age (18-49 years: 53% [34%-67%]; 50-64 years: 47% [31%-60%]; ≥65 years: 31% [16%-43%]). Protection was similar among immunocompetent patients (40% [30%-49%]) and immunocompromised patients (32% [7-50%]). VE was statistically significant against influenza B (67% [35%-84%]) and A(H1N1) (36% [21%-48%]) and crossed the null against A(H3N2) (19% [-8%-39%]). VE was higher for patients 14-60 days from vaccination (54% [40%-65%]) than \u3e120 days (18% [-1%-33%]).
CONCLUSIONS: During 2023-2024, influenza vaccination reduced the risk of influenza A(H1N1)- and influenza B-associated hospitalizations among adults; effectiveness was lower in patients vaccinated \u3e120 days prior to illness onset compared with those vaccinated 14-60 days prior
Cardiovascular Hazards of Abacavir- Versus Tenofovir-Containing Antiretroviral Therapies: Insights From an Analysis of the REPRIEVE Trial Cohort
No full textBACKGROUND: Prior analyses suggest that the nucleoside reverse transcriptase inhibitor (NRTI) abacavir (ABC), but not tenofovir (TFV), is associated with a 2-fold increase in the hazard of myocardial infarction. the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE) is ideally suited to evaluate the role of ABC and the TFV backbones, tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF), in major adverse cardiovascular events (MACE).
METHODS: We compared hazard of first MACE among people living with human immunodeficiency virus (HIV) at low-to-moderate cardiovascular risk using ABC (n = 883), TAF (n = 957), and TDF (n = 4274) at entry. Overlap weights balanced biasing factors, including age, sex at birth, atherosclerotic cardiovascular disease risk, CD4 count, estimated glomerular filtration rate, and anchor antiretroviral therapy. Associations between entry NRTI and MACEs were estimated using a marginal Cox proportional hazards model. Change of NRTI, or switching, was common during follow-up. Additional associations were estimated by further censoring at first switch and applying time-updated inverse probability of censoring weighting (IPCW).
RESULTS: Baseline-adjusted associations suggest clinically relevant increases in hazard of first MACE for ABC versus TAF (hazard ratio [HR], 1.5 [95% confidence interval {CI}, .9-2.3]) and ABC versus TDF (HR, 1.4 [95% CI, .9-2.1]), but not TAF versus TDF (HR, 0.9 [95% CI, .6-1.5]). With censoring at switch, HRs increased to 1.6 (95% CI, .9-2.7) for ABC versus TAF, 2.0 (95% CI, 1.2-3.4) for ABC versus TDF, and 1.2 (95% CI, .7-2.2) for TAF versus TDF. The largest HR observed was for ABC versus TDF and myocardial infarction (IPCW HR, 3.5 [95% CI, 1.3-9.4]).
CONCLUSIONS: Antiretroviral therapies with ABC backbones are associated with an increase in MACE compared to TFV backbones among people living with HIV at low-to-moderate cardiovascular risk.
CLINICAL TRIALS REGISTRATION: NCT02344290
A cross-sectional study of the role of epithelial cell injury in kidney transplant outcomes
No full textBACKGROUND: Expression of acute kidney injury-associated (AKI-associated) transcripts in kidney transplants may reflect recent injury and accumulation of epithelial cells in failed repair states. We hypothesized that the phenomenon of failed repair could be associated with deterioration and failure in kidney transplants.
METHODS: We defined injury-induced transcriptome states in 4,502 kidney transplant biopsies injury-induced gene sets and classifiers previously developed in transplants.
RESULTS: In principal component analysis (PCA), PC1 correlated with both acute and chronic kidney injury and related inflammation and PC2 with time posttransplant. Positive PC3 was a dimension that correlated with epithelial remodeling pathways and anticorrelated with inflammation. Both PC1 and PC3 correlated with reduced survival, with PC1 effects strongly increasing over time whereas PC3 effects were independent of time. In this model, we studied the expression of 12 new gene sets annotated in single-nucleus RNA-sequencing studies of epithelial cells with failed repair in native kidneys. The new gene sets reflecting epithelial-mesenchymal transition correlated with injury PC1 and PC3, lower estimated glomerular filtration rate, higher donor age, and future failure as strongly as any gene sets previously derived in transplants and were independent of nephron segment of origin and graft rejection.
CONCLUSION: These results suggest 2 dimensions in the kidney transplant response to injury: PC1, AKI-induced changes, failed repair, and inflammation; and PC3, a response involving epithelial remodeling without inflammation. Increasing kidney age amplifies PC1 and PC3.
TRIAL REGISTRATION: INTERCOMEX (ClinicalTrials.gov NCT01299168); Trifecta-Kidney (ClinicalTrials.gov NCT04239703).
FUNDING: Genome Canada; Natera, Inc.; and Thermo Fisher Scientific