Image_1_The association between graded prognostic assessment and the prognosis of brain metastases after whole brain radiotherapy: a meta-analysis.tiff

IntroductionThis meta-analysis aims to provide evidence-based medical evidence for formulating rational treatment strategies and evaluating the prognosis of brain metastasis (BM) patients by assessing the effectiveness of the graded prognostic assessment (GPA) model in predicting the survival prognosis of patients with BM after whole-brain radiotherapy (WBRT).MethodsA comprehensive search was conducted in multiple databases, including the China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Wanfang database, Cochrane Library, Web of Science, and Embase. Cohort studies that met the inclusion and exclusion criteria were selected. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale, and all statistical analyses were performed with R version 4.2.2. The effect size (ES) was measured by the hazard ratio (HR) of overall survival (OS). The OS rates at 3, 6, 12, and 24 months of patients with BM were compared between those with GPAs of 1.5–2.5, 3.0, and 3.5–4.0 and those with GPAs of 0–1 after WBRT.ResultsA total of 1,797 participants who underwent WBRT were included in this study. The meta-analysis revealed a significant association between GPA and OS rates after WBRT: compared with BM patients with GPA of 0–1, 3-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.48; 95% CI: 0.40–0.59), GPA of 3 (HR = 0.38; 95% CI: 0.25–0.57), and GPA of 3.5–4 (HR = 0.28; 95% CI: 0.15–0.52); 6-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.48; 95% CI: 0.41–0.56), GPA of 3 (HR = 0.33; 95% CI: 0.24–0.45), and GPA of 3.5–4 (HR = 0.24; 95% CI: 0.16–0.35); 12-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.49; 95% CI: 0.41–0.58), GPA of 3 (HR = 0.48; 95% CI: 0.32–0.73), and GPA of 3.5–4 (HR = 0.31; 95% CI: 0.12–0.79); and 24-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.49; 95% CI: 0.42–0.58), GPA of 3 (HR = 0.49; 95% CI: 0.32–0.74), and GPA of 3.5–4 (HR = 0.38; 95% CI: 0.15–0.94).ConclusionBM patients with higher GPAs generally exhibited better prognoses and survival outcomes after WBRT compared to those with lower GPAs.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023422914.</p

Image_2_The association between graded prognostic assessment and the prognosis of brain metastases after whole brain radiotherapy: a meta-analysis.tiff

IntroductionThis meta-analysis aims to provide evidence-based medical evidence for formulating rational treatment strategies and evaluating the prognosis of brain metastasis (BM) patients by assessing the effectiveness of the graded prognostic assessment (GPA) model in predicting the survival prognosis of patients with BM after whole-brain radiotherapy (WBRT).MethodsA comprehensive search was conducted in multiple databases, including the China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), PubMed, Wanfang database, Cochrane Library, Web of Science, and Embase. Cohort studies that met the inclusion and exclusion criteria were selected. The quality of the included literature was evaluated using the Newcastle-Ottawa Scale, and all statistical analyses were performed with R version 4.2.2. The effect size (ES) was measured by the hazard ratio (HR) of overall survival (OS). The OS rates at 3, 6, 12, and 24 months of patients with BM were compared between those with GPAs of 1.5–2.5, 3.0, and 3.5–4.0 and those with GPAs of 0–1 after WBRT.ResultsA total of 1,797 participants who underwent WBRT were included in this study. The meta-analysis revealed a significant association between GPA and OS rates after WBRT: compared with BM patients with GPA of 0–1, 3-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.48; 95% CI: 0.40–0.59), GPA of 3 (HR = 0.38; 95% CI: 0.25–0.57), and GPA of 3.5–4 (HR = 0.28; 95% CI: 0.15–0.52); 6-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.48; 95% CI: 0.41–0.56), GPA of 3 (HR = 0.33; 95% CI: 0.24–0.45), and GPA of 3.5–4 (HR = 0.24; 95% CI: 0.16–0.35); 12-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.49; 95% CI: 0.41–0.58), GPA of 3 (HR = 0.48; 95% CI: 0.32–0.73), and GPA of 3.5–4 (HR = 0.31; 95% CI: 0.12–0.79); and 24-month OS rates after WBRT were significantly higher in BM patients with GPA of 1.5–2.5 (HR = 0.49; 95% CI: 0.42–0.58), GPA of 3 (HR = 0.49; 95% CI: 0.32–0.74), and GPA of 3.5–4 (HR = 0.38; 95% CI: 0.15–0.94).ConclusionBM patients with higher GPAs generally exhibited better prognoses and survival outcomes after WBRT compared to those with lower GPAs.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023422914.</p

Data_Sheet_1_Association of depression and sleep quality with frailty: a cross-sectional study in China.docx

BackgroundWith the rapid growth of global aging, frailty has become a serious public health burden, affecting the life quality of older adults. Depressive symptoms (depression hereafter) and sleep quality are associated with frailty, but the pathways in which sleep quality and depression affect frailty remain unclear.MethodThis cross-sectional study included 1866 community-dwelling older adults. Demographic characteristics and health-related data of them was collected, and we also assessed frailty, depression, and sleep quality. Descriptive statistics were carried out and ordinal logistic regression analysis was used to identify the factors correlated with frailty. Spearman correlation analysis and mediation analysis were employed to assess associations between sleep quality, depression and frailty. Two-sided p ResultsThe results showed that 4.1% older adults were frail and 31.0% were pre-frail. Ordinal logistic regression showed that age, consumptions of vegetables, exercise, sleep quality, depression, number of chronic diseases, chronic pain, and self-rated health were correlated with frailty. Spearman correlation analysis revealed that frailty was associated with depression and sleep quality. There was a mediation effect that sleep quality was a significant and positive predictor of frailty (total effect = 0.0545, 95% boot CI = 0.0449–0.0641), and depression was a mediator between sleep quality and frailty (mediation effect = 60.4%).ConclusionDepression and poor sleep quality may be early indicators of frailty in older adults. Improving the sleep quality and psychological state of older adults can improve frailty, which is beneficial for healthy aging.</p