Modeling early phonetic acquisition from child-centered audio data

Infants learn their native language(s) at an amazing speed. Before they even talk, their perception adapts to the language(s) they hear. However, the mechanisms responsible for this perceptual attunement and the circumstances in which it takes place remain unclear. This paper presents the first attempt to study perceptual attunement using ecological child-centered audio data. We show that a simple prediction algorithm exhibits perceptual attunement when applied on unrealistic clean audio-book data, but fails to do so when applied on ecologically-valid child-centered data. In the latter scenario, perceptual attunement only emerges when the prediction mechanism is supplemented with inductive biases that force the algorithm to focus exclusively on speech segments while learning speaker-, pitch-, and room-invariant representations. We argue these biases are plausible given previous research on infants and non-human animals. More generally, we show that what our model learns and how it develops through exposure to speech depends exquisitely on the details of the input signal. By doing so, we illustrate the importance of considering ecologically valid input data when modeling language acquisition.

Survival difference among adult and pediatric mediastinal yolk sac tumors cases: A meta-analysis of case reports

BACKGROUND

Mediastinal Yolk sac tumors (YST) are rare and highly malignant extragonadal germ cell tumors with rapid growth and early metastases. We sought to conduct a meta-analysis of published case reports/case series to compare differences in survival, demographics, and treatment modalities between adult and pediatric patients with YST.

METHODS

Ovid Embase, Cochrane, and Ovid Medline databases were searched for primary mediastinal pure YST cases. The primary outcome was overall survival (OS). Log-rank and Cox regression were used. This study is registered on PROSPERO (CRD42022367586).

RESULTS

Among 846 studies, 87 met our inclusion criteria including 130 patients (Adults: 90 and Pediatrics: 40). About 41.5% of the patients were from the United States. The median age was 23.0 (Q1-Q3: 17.0-30.0), 88.5% were males, and (32.3%) were Asian. Stage II represented almost 40%. AFP was elevated in 96.9%. Respiratory distress was the presenting symptom in 65.4%. Chemotherapy, radiotherapy, and surgery were utilized in 84.6, 23.1, and 64.7% respectively. Median OS was 24 months (Adults: 23 months, Pediatrics: 25 months, P = 0.89). 3- and 5-year OS were 34.4% and 22.9% in adults and 41.5% and 41.5% in pediatrics, respectively. On multivariate analysis, anterior location of tumors, receipt of chemotherapy, and undergoing surgery were associated with better OS.

CONCLUSION

Primary mediastinal YSTs are rare, but lethal neoplasms. Our meta-analysis showed that mediastinal YSTs mimic other non-seminomatous mediastinal GCTs in terms of clinical characteristics and available treatment options. Early diagnosis, neoadjuvant chemotherapy, and surgical resection are the key points for effective management and improved outcomes.

Management of Neuroendocrine Breast Carcinoma (NEBC): Review of Literature

Extra pulmonary high-grade poorly differentiated neuroendocrine carcinomas (EP-NECs) are rare tumors that usually arise in the gastrointestinal and genitourinary tracts. Primary neuroendocrine carcinoma of the breast (NEBC) is extremely rare, representing less than 0.1% of all breast cancers and less than 1% of neuroendocrine neoplasms. Consequently, they can be misdiagnosed as other types of breast cancer, however, proper immunohistochemical (IHC) studies can assist with making the correct diagnosis. Management of NEBC can be challenging given the paucity of evidence-based literature and should not routinely follow the therapeutic guidelines of other breast cancers. In this article, we review the current literature regarding the management of NEBC.

A Comparative Study on Antimicrobial Resistance in Escherichia coli Isolated from Channel Catfish and Related Freshwater Fish Species

Antimicrobial resistance (AMR) trends in 114 generic Escherichia coli isolated from channel catfish and related fish species were investigated in this study. Of these, 45 isolates were from commercial-sized channel catfish harvested from fishponds in Alabama, while 69 isolates were from Siluriformes products, accessed from the U.S. Department of Agriculture Food Safety and Inspection Service' (FSIS) National Antimicrobial Resistance Monitoring System (NARMS) program. Antibiotic susceptibility testing and whole genome sequencing were performed using the GenomeTrakr protocol. Upon analysis, the fishpond isolates showed resistance to ampicillin (44%), meropenem (7%) and azithromycin (4%). The FSIS NARMS isolates showed resistance to tetracycline (31.9%), chloramphenicol (20.3%), sulfisoxazole (17.4%), ampicillin (5.8%) and trimethoprim-sulfamethoxazole, nalidixic acid, amoxicillin-clavulanic acid, azithromycin and cefoxitin below 5% each. There was no correlation between genotypic and phenotypic resistance in the fishpond isolates, however, there was in NARMS isolates for folate pathway antagonists: Sulfisoxazole vs. sul1 and sul2 (p = 0.0042 and p < 0.0001, respectively) and trimethoprim-sulfamethoxazole vs. dfrA16 and sul1 (p = 0.0290 and p = 0.013, respectively). Furthermore, correlations were found for tetracyclines: Tetracycline vs. tet(A) and tet(B) (p < 0.0001 each), macrolides: Azithromycin vs. mph(E) and msr(E) (p = 0.0145 each), phenicols: Chloramphenicol vs. mdtM (p < 0.0001), quinolones: Nalidixic acid vs. gyrA_S83L=POINT (p = 0.0004), and β-lactams: Ampicillin vs. blaTEM-1 (p < 0.0001). Overall, we recorded differences in antimicrobial susceptibility testing profiles, phenotypic-genotypic concordance, and resistance to critically important antimicrobials, which may be a public health concern.

Factors influencing final year radiography students' intention to pursue postgraduate education in medical imaging

INTRODUCTION

Postgraduate education in medical imaging is an important platform that can support in preparing radiographers for the role extension and advancement in radiography. Thus, this study aims to identify the factors influencing final year radiography students' intention to pursue postgraduate education in medical imaging.

METHODS

An online cross-sectional survey was conducted among final year students in medical imaging programs from six institutions in Malaysia. Purposive convenience sampling has been employed. Data collection was related to students' interest in postgraduate study and possible factors that may affect students' intention to pursue postgraduate education after study degree completion. The questionnaire was a combination of a Likert Scale and open-ended question.

RESULTS

A total of 148 (female, n = 132 and male, n = 16) responses were included in the analysis. Among the participants, n = 93 (62.8 %) of students intended to pursue study. The highest choice of study was mixed mode (41.9 %) and cardiac imaging was the field of choice by the students (22.3 %). Five factors have been found to significantly correlate with the students' intention to pursue postgraduate study in medical imaging which were student attributes, being an academician, remuneration, finance, and social influences (p < 0.05). Two factors that did not significantly correlate with the students' intention were being an expert in the field and Covid-19 (p > 0.05).

CONCLUSION

Five out of seven factors tested were found to significantly influence students' decision to pursue postgraduate education in medical imaging. Effective strategies based on the influencing factors should be strategized to encourage more students to pursue postgraduate education in medical imaging.

IMPLICATIONS FOR PRACTICE

Implementation of effective strategies based on the influencing factors will improve access to education among radiography students, ultimately enhancing future radiographers' capability and competency.

Advanced Equilibrium Studies for the Synergetic Impact of Polyaniline on the Adsorption of Rhodamine B Dye by Polyaniline/Coal Composite

The synergetic improvement effect of the polyaniline (PANI) hybridization process on the adsorption of rhodamine B dye (RB) by PANI/coal hybrid material (PANI/C) has been evaluated using both traditional equilibrium modeling and advanced isotherm investigations. The composite was prepared by polymerizing polyaniline in the presence of coal fractions with a surface area of 27.7 m2/g. The PANI/C hybrid has an improved capacity to adsorb RB dye (423.5 mg/g) in comparison to coal particles (254.3 mg/g). The maintained increase in the elimination properties of PANI/C has been illustrated using the steric characteristics of active site density (Nm) as well as the total number of adsorbed RB on a single active site (n). However, the incorporation of PANI did not yield any substantial impact on the existing active sites' quantity, but the hybridization processes greatly influenced the selectivity and affinity of each active site, in addition to the aggregation characteristics of the dye as it interacts with the composite's surface. Whereas raw coal can only adsorb three molecules of RB, each active site throughout the PANI/C surface can adsorb approximately eight RB molecules. This is also evidence of RB dye adsorption in a vertical arrangement, which involves multimolecular processes. The Gaussian energy (4.01-5.59 kJ/mol) and adsorption energy (-4.34-4.68 kJ/mol) revealed the controllable impact of physical mechanisms. These mechanisms may include van der Waals forces, dipole-dipole interactions, and hydrogen bonds (<30 kJ/mol). The thermodynamic functions, such as enthalpy, internal energy, and entropy, that have been assessed provide evidence supporting the exothermic and spontaneous nature of the RB uptake processes by PANI/C.

Dissecting neural computations in the human auditory pathway using deep neural networks for speech

The human auditory system extracts rich linguistic abstractions from speech signals. Traditional approaches to understanding this complex process have used linear feature-encoding models, with limited success. Artificial neural networks excel in speech recognition tasks and offer promising computational models of speech processing. We used speech representations in state-of-the-art deep neural network (DNN) models to investigate neural coding from the auditory nerve to the speech cortex. Representations in hierarchical layers of the DNN correlated well with the neural activity throughout the ascending auditory system. Unsupervised speech models performed at least as well as other purely supervised or fine-tuned models. Deeper DNN layers were better correlated with the neural activity in the higher-order auditory cortex, with computations aligned with phonemic and syllabic structures in speech. Accordingly, DNN models trained on either English or Mandarin predicted cortical responses in native speakers of each language. These results reveal convergence between DNN model representations and the biological auditory pathway, offering new approaches for modeling neural coding in the auditory cortex.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

A New Cu/Fe Layer Double Hydroxide Nanocomposite Exerts Anticancer Effects against PC-3 Cells by Inducing Cell Cycle Arrest and Apoptosis

Prostate cancer treatment poses significant challenges due to its varying aggressiveness, potential for metastasis, and the complexity of treatment options. Balancing the effectiveness of therapies, minimizing side effects, and personalizing treatment strategies are ongoing challenges in managing this disease. Significant advances in the use of nanotechnology for the treatment of prostate cancer with high specificity, sensitivity, and efficacy have recently been made. This study aimed to synthesize and characterize a novel Cu/Fe layer double hydroxide (LDH) nanocomposite for use as an anticancer agent to treat prostate cancer. Cu/Fe LDH nanocomposites with a molar ratio of 5:1 were developed using a simple co-precipitation approach. FT-IR, XRD, SEM, TEM, TGA, and zeta potential analyses confirmed the nanocomposite. Moreover, the MTT cell viability assay, scratch assay, and flow cytometry were utilized to examine the prospective anticancer potential of Cu/Fe LDH on a prostate cancer (PC-3) cell line. We found that Cu/Fe LDH reduced cell viability, inhibited cell migration, induced G1/S phase cell cycle arrest, and triggered apoptotic effect in prostate cancer cells. The findings also indicated that generating reactive oxygen species (ROS) formation could improve the biological activity of Cu/Fe LDH. Additionally, Cu/Fe LDH showed a good safety impact on the normal lung fibroblast cell line (WI-38). Collectively, these findings demonstrate that the Cu/Fe LDH nanocomposite exhibited significant anticancer activities against PC-3 cells and, hence, could be used as a promising strategy in prostate cancer treatment.

Distribution of natural radionuclides in NORM samples from North Abu Rusheid area, Egypt

The North Abu Rusheid area in Egypt is a well-known high background natural radiation area (HBNRA) due to the existence of naturally occurring radioactive materials (NORMs) in mylonitic rocks. In this study, 27 rock samples were selected for dose estimation studies. ²³⁸U and ²³²Th were measured using inductively coupled plasma mass spectrometry (ICP-MS) and ⁴⁰K was measured using sodium iodide (thallium) gamma-ray spectroscopy. The ranges of activity concentrations (Bq/kg) of ²³⁸U, ²³²Th and ⁴⁰K in the samples varied from 270 ± 2 to 2120 ± 29, 350 ± 2 to 1840 ± 27 and 20 ± 2 to 1390 ± 35 with mean values of 980 ± 349, 770 ± 351, and 640 ± 402 Bq/kg, respectively. The radiological hazard parameters were estimated from activity concentrations of ²³⁸U, ²³²Th and ⁴⁰K and compared to United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR) values. The present study revealed that the hazard parameters were several times higher than the worldwide averages. The U/Th concentration ratio ranged from 0.7 to 3 and could be attributed to the presence of kasolite, uranothorite, zircon, and columbite in mylonitic rocks. From the radiological protection viewpoint, it is necessary to monitor natural radionuclides in these rocks prior to their use in residential and commercial construction materials.

Novel Mediastinoscope-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-analysis

BACKGROUND

Minimally invasive surgery is an expanding field of surgery that has replaced many open surgical techniques. Surgery remains a cornerstone in the treatment of esophageal cancer, yet it is still associated with significant morbidity and technical difficulties. Mediastinoscope-assisted esophagectomy is a promising technique that aims to decrease the surgical burden and enhance recovery.

METHODS

PubMed, MEDLINE, and EMBASE databases were searched for publications on mediastinoscope-assisted esophagectomies for esophageal cancer. The primary endpoint was a postoperative anastomotic leak, while secondary endpoints were assessment of harvested lymph nodes (LNs), blood loss, chyle leak, hospital length of stay (LOS), operative (OR) time, pneumonia, wound infection, mortality, and microscopic positive margin (R1). The pooled event rate (PER) and pooled mean were calculated for binary and continuous outcomes respectively.

RESULTS

Twenty-six out of the 2274 searched studies were included. The pooled event rate (PER) for anastomotic leak was 0.145 (0.1144; 0.1828). The PERs for chyle leak, recurrent laryngeal nerve injury/hoarseness, postoperative pneumonia, wound infection, early mortality, postoperative morbidity, and microscopically positive (R1) resection margins were 0.027, 0.185, 0.09, 0.083, 0.020, 0.378, and 0.037 respectively. The pooled means for blood loss, hospital stay, operative time, number of total harvested LNs, and number of harvested thoracic LNs were 159.209, 15.187, 311.116, 23.379, and 15.458 respectively.

CONCLUSIONS

Mediastinoscopic esophagectomy is a promising minimally invasive technique, avoiding thoracotomy, patient repositioning, and lung manipulation; thus allowing for shorter surgery, decreased blood loss, and decreased postoperative morbidity. It can also be reliable in terms of oncological safety and LN dissection.

Prevalence and correlates of occupational noise-induced hearing loss among workers in the steel industry

BACKGROUND

The steel industry is one of the noisiest industries, which can predispose workers to hearing loss. In Egypt, the demand for steel is increasing due to the construction of new infrastructures as bridges, flyover roads, buildings, and towers; however, little is known about the prevalence of occupational noise-induced hearing loss (NIHL) among steel workers. Understanding the distribution of the affected workers is crucial for planning prevention strategies. This study aimed to estimate the prevalence of occupational NIHL among Egyptian steel workers and identify its correlates.

METHODS

This study was conducted at two steel factories in Egypt in November 2021. It involved an initial retrospective review of the factory medical records of the latest periodic medical examination conducted on workers from July to September in the year 2021 representing workers' health status in that year. Then, a case-control approach analysis was carried out. Eligible workers (n = 606) were enrolled and divided into two groups: noise-exposed workers (n = 396) and unexposed workers (n = 210). Univariate and multivariate regression analyses were performed.

RESULTS

Occupational exposure to hazardous A-weighted equivalent noise level (> 85 dB) was associated with higher hearing thresholds at all frequencies (highest at 4 kHz followed by 6 kHz), particularly in younger workers below the age of 40 years. Nearly 71% of noise-exposed workers had hearing impairment, and 47% had NIHL compared with unexposed workers (45.7% and 11.9%, respectively). The probability of NIHL in noise-exposed workers was 6.55 times higher than that in unexposed workers (OR = 6.55, 95%CI = 4.13, 10.40; p < 0.001). In noise-exposed workers, age and tinnitus were independent predictors of hearing thresholds, while tinnitus was found to be an independent predictor of NIHL after adjusting for age and job duration (OR = 2.06, 95%CI = 1.01, 4.20; p = 0.045).

CONCLUSION

Almost half of noise-exposed workers had NIHL. Tinnitus was found to be an independent predictor of NIHL. Decreasing noise exposure levels in steel plants is recommended to reduce hearing loss. Future research is required to study the effect of tinnitus on audiometry measurements among workers with NIHL.

Green synthesis and characterization of iron oxide nanoparticles for the removal of heavy metals (Cd2+ and Ni2+) from aqueous solutions with Antimicrobial Investigation

Clove and green Coffee (g-Coffee) extracts were used to synthesize green iron oxide nanoparticles, which were then used to sorb Cd²⁺ and Ni²⁺ ions out of an aqueous solution. Investigations with x-ray diffraction, Fourier-transform infrared spectroscopy, transmission electron microscopy, X-ray photoelectron spectroscopy, nitrogen adsorption and desorption (BET), Zeta potential, and scanning electron microscopy were performed to know and understand more about the chemical structure and surface morphology of the produced iron oxide nanoparticles. The characterization revealed that the main component of iron nanoparticles was magnetite when the Clove extract was used as a reducing agent for Fe³⁺, but both magnetite and hematite were included when the g-Coffee extract was used. Sorption capacity for metal ions was studied as a function of sorbent dosage, metal ion concentration, and sorption period. The maximum Cd²⁺ adsorption capacity was 78 and 74 mg/g, while that of Ni²⁺ was 64.8 and 80 mg/g for iron nanoparticles prepared using Clove and g-Coffee, respectively. Different isotherm and kinetic adsorption models were used to fit experimental adsorption data. Adsorption of Cd²⁺ and Ni²⁺ on the iron oxide surface was found to be heterogeneous, and the mechanism of chemisorption is involved in the stage of determining the rate. The correlation coefficient R² and error functions like RMSE, MES and MAE were used to evaluate the best fit models to the experimental adsorption data. The adsorption mechanism was explored using FTIR analysis. Antimicrobial study showed broad spectrum antibacterial activity of the tested nanomaterials against both Gram positive (S. aureus) (25923) and Gram negative (E. coli) (25913) bacteria with increased activity against Gram positive bacteria than Gram negative one and more activity for Green iron oxide nanoparticles prepared from Clove than g-Coffee one.

Gaming behavior disorder and its association with social phobia during COVID-19 pandemic: A cross-sectional study among the young Arabs

Background

Gaming addiction is a compulsive mental health condition that can have severe negative consequences on a person's life. As online gaming has increased during the COVID-19 pandemic, studies have shown a heightened risk of mental health issues. This study aims to assess the prevalence of severe phobia and addiction to online gaming among Arab adolescents and identify risk factors associated with these disorders.

Methods

This cross-sectional study was conducted across 11 Arab nations. Participants were recruited using convenience sampling through an online survey distributed on social media platforms in 11 Arab countries. The survey included demographic questions, the Nine-item Internet Gaming Disorder Scale-Short Form (IGDS-SF9) to measure participants' online gaming addiction, the Social Phobia Scale (SPS), and questions assessing the impact of the COVID-19 pandemic on the prevalence of internet gaming addiction. The data were analyzed using SPSS win statistical package version 26.

Results

Out of 2,458 participants, 2,237 were included in the sample due to non-response and missing data. The average age of the participants was 19.9 ± 4.8 years, and the majority were Egyptian and unmarried. 69% of the participants reported playing more than usual since the COVID-19 pandemic, as they were confined to their homes. Higher social phobia scores were associated with being single, male, and Egyptian. Participants from Egypt and those who felt that the pandemic significantly increased their gaming time had higher scores for online gaming addiction. Several major criteria, such as playing hours per day and beginning gaming at an early age, were associated with a higher level of online gaming addiction with social phobia.

Conclusion

The study's findings suggest that there is a high prevalence of internet gaming addiction among Arab adolescents and young adults who play online games. The results also indicate a significant association between social phobia and several sociodemographic factors, which may inform future interventions and treatments for individuals with gaming addiction and social phobia.

Relationship Between Rotating Night Shift Work and Anthropometric Markers of Overall and Central Adiposity

Purpose

This study aimed to investigate possible association between rotating night shift (RNS) work and anthropometric markers of overall and central adiposity among male workers.

Methods

Medical records of workers who underwent medical examination at the Occupational Medicine Unit affiliated with Alexandria Faculty of Medicine were reviewed in December 2021 to extract data about RNS, overall adiposity [body mass index (BMI) from 25 to 29.9 kg/m² indicated overweight, while BMI ≥30 kg/m² indicated obesity], central adiposity (waist circumference ≥94 cm). Univariate and multivariate logistic regression were done to model adiposity as a function of potential demographic, lifestyle, and occupational factors.

Results

Data of 647 male workers, including daytime workers (26.9%) and RNS workers (73.1%) who spent 1-5 years, 6-9 years, or ≥10 years working RNS, were analyzed. No association was found between RNS work and overall adiposity (BMI ≥30 kg/m²). In multivariate regression, age, residence, and smoking status were predictors of an increased BMI. Compared with young workers (<30 years old), the odds of an increased BMI (BMI ≥25 kg/m²) were 2.6 and 3.01 times higher among workers who were 30-<40, and 40-<50 years old, respectively [95% CI=(1.35, 5.05) and (1.19, 7.56), respectively]. Workers who lived in urban areas were less likely to have had an increased BMI (OR=0.34, 95% CI=0.16, 0.74). The odds of an increased BMI were 2.14 times higher in workers who never smoked compared with current smokers (95% CI=1.12, 4.11). No association was found between RNS and central adiposity. In multivariate regression, age was the sole predictor of central adiposity.

Conclusion

The study supports the idea that RNS work might not be associated with overall or central adiposity and highlights a possible association between central adiposity and age and association between BMI and age, residence, and smoking behavior. Longitudinal, larger studies are required to explore the relationship between RNS and adiposity.

Geographic variation in malignant cardiac tumors and their outcomes: SEER database analysis

Introduction

Primary malignant cardiac tumors (PMCTs) are rare. Geographical distribution has been demonstrated to affect cancer outcomes, making the reduction of geographical inequalities a major priority for cancer control agencies. Geographic survival disparities have not been reported previously for PMCT and the aim of this study is to compare the prevalence and the long-term survival rate with respect to the geographic location of PMCTs using the Surveillance, Epidemiology, and End Results (SEER) research plus data 17 registries between 2000 and 2019.

Methods

The SEER database was queried to identify geographic variation among PMCTs. We classified the included states into 4 geographical regions (Midwest, Northeast, South and West regions) based on the U.S. Census Bureau-designated regions and divisions. Different demographic and clinical variables were analyzed and compared between the four groups. Kaplan Meier curves and Cox regression were used for survival assessment.

Results

A total of 563 patients were included in our analysis. The median age was 53 years (inter-quartile range (IQR): 38 - 68 years) and included 26, 90, 101, and 346 patients from the Midwest, Northeast, South, and West regions respectively. Sarcoma represented 65.6% of the cases, followed by hematological tumors (26.2%), while mesothelioma accounted for 2.1%. Treatment analysis showed no significant differences between different regions. Median overall survival was 11, 21, 13, and 11 months for Midwest, Northeast, South and West regions respectively and 5-year overall survival was 22.2%, 25.4%, 14.9%, and 17.6% respectively. On multivariate Cox regression, significant independent predictors of late overall mortality among the entire cohort included age (Hazard Ratio [HR] 1.028), year of diagnosis (HR 0.967), sarcoma (HR 3.36), surgery (HR 0.63) and chemotherapy (HR 0.56).

Conclusion

Primary malignant cardiac tumors are rare and associated with poor prognosis. Sarcoma is the most common pathological type. Younger age, recent era diagnosis, surgical resection, and chemotherapy were the independent predictors of better survival. While univariate analysis revealed that patients in the South areas had a worse survival trend compared to other areas, geographic disparity in survival was nullified in multivariate analysis.

Up-to-Date Review of Meningococcal Meningitis: Global Challenges and Recommendations

The Center for Disease Control and Prevention is warning about a new outbreak of meningococcal meningitis among gay, bisexual, and other men that have sex with men (MSM) due to multiple cases reported in Florida. Meningococcal meningitis (MM) is a bacterial infection often spread by direct contact or through respiratory droplet dissemination from an infected person to a host. Meningitis can cause a wide range of complications, from thrombosis to cerebral edema or even septic shocks as the bacteria thrive on colonizing the submucosa of blood vessels adjacent to inflamed meninges. The CDC urged MSM to immediately take the MenACWY vaccine. 200 years ago, several outbreaks have been recorded of the disease throughout history, the first being in Africa in the 1840s. The world cannot afford more outbreaks and serious measures should be taken to contend with and contain such potential threats. In this review, we aim to provide an updated investigation of the bacterial infection relevant to the current global health status and a revision on what governments, policymakers, health providers, and individuals should do to prevent the further spread of this fatal disease.

Clinical Characteristics, Course, and Outcomes of Vertebral Artery Dissections in the Postpartum Period; a Pooled Analysis of Published Case Reports

Introduction

Vertebral artery dissection (VAD) is a rare, but life-threatening condition. Compared to the general population, pregnant and postpartum women are more likely to develop VAD. Spontaneous arterial dissections have an ambiguous pathophysiology and may be difficult to manage. This study aimed to pool and analyze the data of published cases in this regard.

Methods

We conducted a literature search on February 24, 2022, using MeSH terms of interest in PubMed, Google Scholar, Ovid, Web of Science, and Scopus databases to find studies on VAD following childbirth.

Results

A total of 28 studies were included in this review based on a database search. In the studies, 44 postpartum VAD (PPVAD) patients with a mean age of 34.26 ± 3.5 years were included. It took an average of 24.37± 13.7 days from delivery to dissection. 64% of the patients had developed unilateral dissection and 36% had developed bilateral dissection; 70% reported full recovery, and 9% did not achieve full recovery. The most common symptoms were headaches (89%), neck pain (64%), and hypertension (52%). The most common methods of diagnosis were magnetic resonance imaging (MRI) (64%) and computed tomography (CT) angiography (CTA) scan (66%). Only 8 (18%) cases reported the use of electrocardiography (ECG). The recorded outcomes of the patients with unilateral and bilateral postpartum VAD showed no statistical difference. Most of the included studies recommend early suspension and management for a better prognosis and prevention of complications.

Conclusion

PPVAD is a severe medical condition but most cases were fully recovered after an early and proper antithrombotic plan for each case scenario.

Case report: Multidrug-resistant Streptococcus pseudoporcinus isolated from an infected surgical wound of a 9-year-old spayed female Great Dane dog

Streptococcus pseudoporcinus (S. pseudoporcinus) is a β-hemolytic, Gram-positive novel bacterium first identified in 2006. It is a catalase-negative, non-motile coccus arranged in short chains. Furthermore, it has a broad beta-hemolytic reaction on sheep blood agar and cross-reacts with Lancefield group B antigen agglutination reagent. In this study, we report a case of S. pseudoporcinus infection of a surgical wound on the left metatarsus of a dog. The patient is a 9-year-old spayed female Great Dane dog with a brief history of multiple cutaneous masses being removed. Post-surgery, the post-surgical site on the left metatarsus became infected and discharged purulent material with a fetid odor. Upon preliminary diagnostic testing, we detected catalase-negative Gram-positive cocci exhibiting beta-hemolytic growth on sheep blood agar. A VITEK^® 2 Compact machine from bioMérieux identified the bacterium as S. pseudoporcinus. Furthermore, antibiotic testing revealed multidrug resistance. Therefore, we document a multidrug-resistant S. pseudoporcinus isolate as a cause of canine post-surgical wound infection. Furthermore, it was the only isolate detected from the sample; hence, it is the cause of the infection. To our knowledge, this case is the first report of S. pseudoporcinus in a dog.

Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry

AIMS

The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation.

METHODS AND RESULTS

Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin.

CONCLUSION

The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.

Measurements of the associated production of a W boson and a charm quark in proton-proton collisions at s = 8 TeV

Measurements of the associated production of a W boson and a charm ( c ) quark in proton-proton collisions at a centre-of-mass energy of 8 TeV are reported. The analysis uses a data sample corresponding to a total integrated luminosity of 19.7 fb - 1 collected by the CMS detector at the LHC. The W bosons are identified through their leptonic decays to an electron or a muon, and a neutrino. Charm quark jets are selected using distinctive signatures of charm hadron decays. The product of the cross section and branching fraction σ ( pp → W + c + X ) B ( W → ℓ ν ) , where ℓ = e or μ , and the cross section ratio σ ( pp → W + + c ¯ + X ) / σ ( pp → W - + c + X ) are measured in a fiducial volume and differentially as functions of the pseudorapidity and of the transverse momentum of the lepton from the W boson decay. The results are compared with theoretical predictions. The impact of these measurements on the determination of the strange quark distribution is assessed.

Opportunistic soaring by birds suggests new opportunities for atmospheric energy harvesting by flying robots

The use of flying robots (drones) is increasing rapidly, but their utility is limited by high power demand, low specific energy storage and poor gust tolerance. By contrast, birds demonstrate long endurance, harvesting atmospheric energy in environments ranging from cluttered cityscapes to open landscapes, coasts and oceans. Here, we identify new opportunities for flying robots, drawing upon the soaring flight of birds. We evaluate mechanical energy transfer in soaring from first principles and review soaring strategies encompassing the use of updrafts (thermal or orographic) and wind gradients (spatial or temporal). We examine the extent to which state-of-the-art flying robots currently use each strategy and identify several untapped opportunities including slope soaring over built environments, thermal soaring over oceans and opportunistic gust soaring. In principle, the energetic benefits of soaring are accessible to flying robots of all kinds, given atmospherically aware sensor systems, guidance strategies and gust tolerance. Hence, while there is clear scope for specialist robots that soar like albatrosses, or which use persistent thermals like vultures, the greatest untapped potential may lie in non-specialist vehicles that make flexible use of atmospheric energy through path planning and flight control, as demonstrated by generalist flyers such as gulls, kites and crows.

353 FACTORS ASSOCIATED WITH ADVERSE OUTCOMES IN OLDER ADULTS DIRECTLY DISCHARGED FROM THE EMERGENCY DEPARTMENT

Background

Older adults attend the Emergency Department (ED) frequently. Over 40% are directly discharged from the ED. The risk of adverse outcomes is high following discharge including unplanned ED return, institutionalisation, and mortality. The purpose of this study was to highlight factors that predict these adverse outcomes.

Methods

A secondary analysis was completed of SOAED (a prospective cohort study examining screening instruments to predict adverse outcomes for undifferentiated older adults attending the ED) and OPTIMEND (randomised control trial examining the effectiveness of an intervention by a team of Health and Social Care Professionals along with usual care and compared this to standard ED care alone). Inclusion criteria were adults aged 65 years and over presenting to ED at a University Teaching Hospital with medical complaints and a Manchester Triage System category 2–5.

Results

Three-hundred and nine patients were discharged directly from ED (mean age 80 years; 58% female). 96 patients re-attended ED within 6 months. 66 patients were re-hospitalised within 6 months. 16 patients died within six months of discharge. 63% of the discharged patients screened positive for frailty measured by PRISMA-7 (3 or more). Relative risk ratio analysis confirmed that the risk of revisiting a hospital was 1.241 times for patients that scored frail compared to those who scored not frail. The risk of mortality was 1.075 times for patients that scored frail compared to those who scored not frail. The risk of being admitted to a nursing home was 1.146 times for patients that scored frail compared to those who scored not frail.

Conclusion

Older people have a high ED re-attendance rate of 31% after an index visit. Frailty (scored on PRISMA-7) is a significant predictor of adverse outcomes. Focused screening and intervention for frail patients who attend the ED should be a priority.

Immunotherapy in head and neck squamous cell carcinoma: An updated review

Squamous cell cancer of the head and neck (HNSCC) is the sixth most common cancer and is associated with significant morbidity and mortality. The tumor microenvironment for HNSCC is a complex interplay of immune cells, stromal cells, and cytokines amongst others. Immunotherapy acts as an effective antineoplastic agent by influencing this complex environment and includes immune checkpoint inhibitors (ICI). ICI have been approved in the frontline setting for recurrent and metastatic (R/M) HNSCC as well as platinum-refractory (second line) R/M HNSCC. However, recent clinical studies highlight that the response to immunotherapy varies, and different ICI, as well as different combination strategies play a crucial role in augmenting the efficacy of immunotherapy. An in-depth analysis and focused study of the immune contexture in patients with HNSCC receiving ICI remains critical. Many novel immunotherapies including CAR-T cell therapy, oncolytic virus therapy, and vaccines are underway. Ongoing trials are testing ICI in the neoadjuvant and adjuvant settings. Furthermore, identifying better biomarkers to target population that benefits from immunotherapy is of paramount importance. Pioneering the optimal combination regimen utilizing new novel immunotherapy has recently become a paradigm shift in the HNSCC treatment landscape. Herein, we summarize the clinical development with all ongoing clinical trials of immunotherapy in HNSCC.

Could the New BA.2.75 Sub-Variant Cause the Emergence of a Global Epidemic of COVID-19? A Scoping Review

With over 58 million cases and 6 million deaths by August 2022, the Coronavirus disease 2019 (COVID-19), causing severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2), has had an insurmountable impact on the world’s population. This is one of the worst health crises since 1918’s influenza pandemic. There are four subvariants of Omicron; BA.1, BA.1.1, BA.2 and BA.3. As a result of new mutations in its spike protein, most of which occur in its receptor binding site, the Omicron variant appears to be more transmissible and less resistant to vaccination and antibody response. Understanding Omicron’s virology and mutations is essential to developing diagnostic and therapeutic methods. A thorough assessment of control measures, as well as timely adjustment of control measures, requires addressing such issues as re-infection risk, vaccine response, booster vaccine doses, and the increased rate of Omicron infections. This review article aims to look at the current information about the different types of SARs-CoV-2, focusing on the new subtype BA.2.75.

Effects of Group-I Elements on Output Voltage Generation of ZnO Nanowires Based Nanogenerator; Degradation of Screening Effects by Oxidation of Nanowires

Here, we report the successful incorporation of group I elements (K, Na, Li) to ZnO nanowires. Three distinct (2, 4, and 6 wt.%) doping concentrations of group I elements have been used to generate high piezoelectric voltage by employing a vertically integrated nanowire generator (VING) structure. X-ray photoelectron spectra (XPS) indicated the seepage of dopants in ZnO nanowires by substitution of Zn. Shallow acceptor levels (Li_Zn, Na_Zn, K_Zn) worked as electron trapping centers for intrinsically n-type ZnO nanowires. Free moving electrons caused a leakage current through the nanowires and depleted their piezoelectric potential. Reverse leakage current is a negative factor for piezoelectric nanogenerators. A reduction in reverse leakage current signifies the rise in output voltage. A gradual rise in output voltage has been witnessed which was in accordance with various doping concentrations. K-doped ZnO nanowires have generated voltages of 0.85 V, 1.48 V, and 1.95 V. For Na-doped ZnO nanowires, the voltages were 1.23 V, 1.73 V, and 2.34 V and the voltages yeilded for Li-doped ZnO nanowires were 1.87 V, 2.63 V, and 3.54 V, respectively. Maximum voltage range has been further enhanced by the surface enrichment (oxidized with O₂ molecules) of ZnO nanowires. Technique has been opted to mitigate the screening effect during an external stress. After 5 h of oxidation in a sealed chamber at 100 ppm, maximum voltage peaks were pronounced to 2.48 V, 3.19 V, and 4.57 V for K, Na, and Li, respectively. A low-cost, high performance mechanical transducer is proposed for self-powered devices.

Dual Targeting of Steroid Sulfatase and 17β-Hydroxysteroid Dehydrogenase Type 1 by a Novel Drug-Prodrug Approach: A Potential Therapeutic Option for the Treatment of Endometriosis

A novel approach for the dual inhibition of steroid sulfatase (STS) and 17β-hydroxysteroid dehydrogenase type 1(17β HSD1) by a single drug was explored, starting from in-house 17β HSD1 inhibitors via masking their phenolic OH group with a sulfamate ester. The sulfamates were intentionally designed as drugs for the inhibition of STS and, at the same time, prodrugs for 17β-HSD1 inhibition ("drug-prodrug approach"). The most promising sulfamates 13, 16, 18-20, 22-24, 36, and 37 showed nanomolar IC₅₀ values for STS inhibition in a cellular assay and their corresponding phenols displayed potent 17β-HSD1 inhibition in cell-free and cellular assays, high selectivity over 17β-HSD2, reasonable metabolic stability, and low estrogen receptor α affinity. A close relationship was found between the liberation of the phenolic compound by sulfamate hydrolysis and 17β-HSD1 inactivation. These results showed that the envisaged drug-prodrug concept was successfully implemented. The novel compounds constitute a promising class of therapeutics for the treatment of endometriosis and other estrogen-dependent diseases.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Learning curve and volume outcome relationship of endoscopic trans-oral versus trans-axillary thyroidectomy; A systematic review and meta-analysis

BACKGROUND

In the modern era, minimally invasive surgery is rapidly evolving and even replacing conventional open techniques in many surgical fields. Thyroidectomy was not an exception, with the introduction of multiple endoscopic thyroidectomy techniques. Trans-oral endoscopic trans-vestibular thyroidectomy (TOT) is a novel technique with promising outcomes. We conducted this meta-analysis to compare surgical outcomes and learning curves for TOT and other endoscopic thyroidectomy techniques.

METHODS

A systematic review in PubMed, MEDLINE, and EMBASE databases was conducted searching for publications on TOT versus trans-axillary thyroidectomy (TAT). The primary endpoint was operative (OR) time. Secondary endpoints were number of harvested lymph nodes (LNs), estimated blood loss (EBL), recurrent laryngeal nerve (RLN) injury, hoarseness, seroma, infection, chyle leak, hypocalcemia, hospital length of stay (LOS), and Cost. We also investigated the learning curve for each technique. Leave-out-out analysis, meta-regression, and subgroup analysis were used. Random effect inverse variance method was utilized.

RESULTS

Among 3820 retrieved studies, 15 studies (10 unmatched and 5 matched), with 2173 (TOT: 1024(47.12%) and TAT:1149(52.87%)) patients, met the inclusion criteria. The operative time and harvested L. Ns number were higher in TOT versus TAT (standard mean difference (SMD) = 0.72 [95%CI 0.07; 1.37], P = 0.029 and SMD = 0.32 [95%CI 0.02; 0.62], P = 0.036 respectively) while less EBL in TOT versus TAT (SMD = -0.26 [-0.43; -0.09], P = 0.0018). All other outcomes showed no significant difference between both groups. Weighted mean values for TOT and TAT were 158.03 vs 144.97 min for OR time, 6.33 vs 5.16 for harvested LNs, and $5,919.05 vs $6,253.79 for the cost. Statistical significance in learning curve development was noticed ranging between 6 and 15 annual cases.

CONCLUSION

Trans-oral thyroidectomy is a safe and reliable technique with outcomes comparable to other endoscopic techniques. It provides better access to the central compartment with a more feasible LN dissection. Improvement in surgical outcomes is expected with growing learning curve and technique mastery.

Sex differences in primary malignant cardiac tumors: A multi-institutional cohort study from National Cancer Database

INTRODUCTION

Despite the significant clinical importance of sex among factors affecting cancer progression and survival, it remains one of the least studied factors. Therefore, we sought to examine these differences in relation to primary malignant cardiac tumors (PMCTs) using a national data set.

METHODS

The 2004-2017 National Cancer Database was queried for patients with PMCTs. Annual trend of females' percent was assessed. Overall survival predictors were evaluated with Kaplan-Meier and Cox-regression. Subgroup analysis was done based on histology, comorbidity index, race, insurance, and surgical treatment.

RESULTS

PMCTs were identified in 736 patients (median age 52, female [47.8%]). Most of them were high-grade (49.2%). About 60% underwent surgery. Angiosarcoma (43%), fibrosarcoma (5.2%), and leiomyosarcoma (5.2%) were the most common pathologies. Based on multivariate Cox-regression, higher income, higher comorbidity index, angiosarcoma, and Stage III/IV were associated with higher late mortality, while year of diagnosis and use of surgery or chemotherapy were associated with lower mortality. Among the surgical group, age, higher income, higher comorbidity index, angiosarcoma, and Stage III/IV were independent predictors of higher late mortality, while private insurance and year of diagnosis were associated with lower late mortality. No difference was seen between males and females in 30-day and late mortality (p = .71). Subgroup analysis based on Cox-regression showed no differences in late mortality between males and females.

CONCLUSION

PMCTs have poor overall survival. Surgery and chemotherapy were associated with longer survival benefits. On the contrary, the associated risk factors for mortality were advanced age, higher comorbidity index, angiosarcoma histology, and Stage III/IV.

Echocardiographic characteristics of patients admitted with acute heart failure with a previous history of cancer: a single-centre observational study

Funding Acknowledgements

Type of funding sources: None.

Background

Cancer and heart failure frequently co-exist, with cancer and chemotherapy exerting a number of pathological effects on the myocardium. Despite this, our understanding of the clinical impact of previous history of cancer in acute heart failure remains unclear.  We therefore performed a retrospective cohort study to identify the echocardiographic characteristics in patients admitted with acute heart failure with and without a diagnosis of solid organ cancer.

Methods

Consecutive patients with signs and/or symptoms of acute heart failure admitted over a period of 33 weeks (7th January – 28th August 2020) were identified. Discharge summaries, electronic notes and shared care networks were manually searched to determine baseline demographics, admission bloods, comorbidities, cancer diagnoses, imaging and echocardiography. Univariate and multivariate Cox regression analysis was performed to identify clinical and biochemical predictors of mortality.

Results

In total, 478 patients were admitted with acute heart failure over the study period (mean age 80 ± 11 years, 53.6% were male and mean NT pro-BNP was 9106). 386 had echocardiography available for review. Of these, 64 (16.6%) had a past or current history of solid organ cancer.

Patients with a past or current history of solid organ cancer had a significantly higher ejection fraction (48% (±9%) vs 44% (±11%), p = 0.003), higher incidence of heart failure with preserved ejection fraction (57.8% vs 33.5%, p &lt; 0.001) and lower incidence of right ventricular impairment (defined using both visual inspection and TAPSE measurements) (25.0% vs 47.8%, p &lt; 0.001).

There were no significant differences in any valvular pathologies between groups (overall prevalence 71.9% vs 71.7%, p = 0.982) No difference was observed between the rate of prior myocardial infarction (28.1% vs 26.0%, p = 0.727) or lung disease (34.4% vs 37.0%, p = 0.692).

Overall, mortality at six months follow up was significantly higher in the group with a current or previous cancer diagnosis (43.4% vs 32.0%, p = 0.046) compared to the group without.

Conclusion

Patients admitted with acute heart failure and a past or current history of cancer have a significantly higher ejection fraction and lower prevalence of right ventricular impairment. Despite the higher ejection fraction their prognosis is worse. Further work is needed to determine potential mechanisms for this, as well as its clinical implications. Abstract Figure. Six Month Survival Kaplan Meier Graph  Abstract Figure. Echocardiogrpahic Features