Predictors associated with poor outcomes

This study aimed to determine predictive factors associated with poor outcomes among older adult inpatients in the convalescent rehabilitation ward. We also examined the validity of factors that were identified as predictive of poor outcomes. Study subjects were 104 older adult inpatients in the convalescent rehabilitation ward, divided into two groups based on outcome at discharge. Group I included the outcomes of death or transfer to an acute care hospital and Group II included all other outcomes. Data were retrospectively collected from older adults’ medical records, including: activities of daily living, swallowing grade, nutritional index, and blood biochemistry data. Logistic regression analysis was used to extract predictive factors associated with poor outcomes. Next, we calculated the Stratum-specific likelihood ratio (SSLR) for each extracted factor. Two items were extracted as predictive factors with AUCs ≥ 0.7 : N-terminal pro-brain natriuretic peptide (NT-proBNP) and days from onset to hospitalization. The SSLRs showed the risk for a poor outcome increased when NT-proBNP was ≥ 2500 pg / ml, and when there were ≥ 35 days from onset to hospitalization. Our findings suggest these predictive factors provide a valid index to predict poor outcomes among older adults from the early stage of admission

長期療養病棟入院の摂食嚥下障害患者における嚥下反射と誤嚥性肺炎の発症率との関連性 : 60日間の前向きコホート研究

Objective: To investigate the association between the Simple Swallowing Provocation Test (SSPT) and the incidence of aspiration pneumonia in patients with dysphagia in long-term care (LTC) wards. Design: The study design was a prospective cohort study. Participants were followed for 60 days from admission. Setting: LTC wards. Participants: Study participants were patients with dysphagia aged ≥65 years who were admitted to LTC wards between August 2018 and August 2019. In total, 39 participants were included in the analysis (N=39; 20 male, 19 female; mean age, 83.8±8.5y). Participants were divided into 2 groups based on SSPT results: normal swallowing reflex (SSPT normal group) and abnormal swallowing reflex (SSPT abnormal group). The covariates were age and sex, primary disease, history of cerebrovascular disease, Glasgow Coma Scale, body mass index, Geriatric Nutritional Risk Index, the Mann Assessment of Swallowing Ability, Food Intake Level Scale, FIM, and Oral Health Assessment Tool. Interventions: Not applicable. Main Outcome Measures: The outcome was the incidence of aspiration pneumonia during the first 60 days of hospitalization, and the predictive factor was SSPT: 0.4 mL. Results: The incidence of aspiration pneumonia was 33.3% in the SSPT normal group and 76.2% in the SSPT abnormal group. The φ coefficient (a measure of association for 2 binary variables) was 0.43, the risk ratio (the ratio of the probability of an outcome in an exposed group to the probability of an outcome in an unexposed group) was 2.29, and the 95% confidence interval was 1.14-4.58 for the SSPT abnormal group. Conclusions: Our findings suggest that the SSPT provides a valid index for the development of aspiration pneumonia in older patients with dysphagia admitted to LTC wards

Magnetar Broadband X-ray Spectra Correlated with Magnetic Fields: Suzaku Archive of SGRs and AXPs Combined with NuSTAR, Swift, and RXTE

The 1–70 keV persistent spectra of 15 magnetars, observed with Suzaku from 2006 to 2013, were studied as a complete sample. Combined with early NuSTAR observations of four hard X-ray emitters, nine objects showed a hard power-law emission dominating at ≳ 10 keV with the 15–60 keV flux of ~1–11 x 10^(-11) erg s^(−1) cm^(−2). The hard X-ray luminosity L_h, relative to that of a soft-thermal surface radiation L_s, tends to become higher toward younger and strongly magnetized objects. Their hardness ratio, updated from a previous study and defined as ξ = L_h/L_s, is correlated with the measured spin-down rate P as ξ = 0.62 x (P/10^(-11)s s^(-1))^(0.72), corresponding to positive and negative correlations with the dipole field strength B_d (ξ ∝ B^(1.41)_d) and the characteristic age τ_c (ξ ∝ τ_c^(-0.68)), respectively. Among our sample, five transients were observed during X-ray outbursts, and the results are compared with their long-term 1–10 keV flux decays monitored with Swift/XRT and RXTE/PCA. Fading curves of three bright outbursts are approximated by an empirical formula used in the seismology, showing a ~10–40 day plateau phase. Transients show the maximum luminosities of L_s ~ 10^(35) erg s^(−1), which are comparable to those of persistently bright ones, and fade back to ≾10^(32) erg s^(−1). Spectral properties are discussed in the framework of the magnetar hypothesis

Assessing the validity of two-dimensional video analysis for measuring lower limb joint angles during fencing lunge

IntroductionThe fencing lunge (lunge), characterized by minimal body rotation, offers a movement well-suited for 2D video analysis. However, to the best of our knowledge, the validity of 2D video analysis for fencing has not been verified. This study aimed to validate 2D video analysis by comparing lower limb joints (hip, knee, and ankle joints) angles during lunge using both 2D video analysis and 3D motion analysis methods.MethodsTwenty-two male fencers performed lunge trials that were simultaneously recorded using eight motion capture cameras (Qualisys Miqus M1) and two digital video cameras (Sony AX-450 and AX450a).ResultsThe 2D video analysis results exhibited an extremely large correlation in knee joint angles of the front and rear legs in the sagittal with those from 3D motion analysis (r = 0.93–0.99). However, while a robust correlation was found between the ankle joint angles of the front and rear legs (r = 0.82–0.84), a large bias was also observed (−5.23° to −21.31°). Conversely, for the hip joints of the rear leg, a moderate correlation (r = 0.31) and a large bias (−10.89°) were identified.ConclusionsThe results of this study will contribute to the development of coaching using 2D video analysis in competition settings because such analysis can be a useful alternative to 3D motion analysis when measuring the knee joint angle of the front leg and rear leg in the sagittal plane. However, for the ankle joint angle, further research on the optimal shooting position and height of the digital video camera is needed, whereas for the hip joint angle, 3D motion analysis is recommended at this time

Prognostic impact of clinical factors for immune checkpoint inhibitor with or without chemotherapy in older patients with non-small cell lung cancer and PD-L1 TPS ≥ 50%

IntroductionThe proportion of older patients diagnosed with advanced-stage non-small cell lung cancer (NSCLC) has been increasing. Immune checkpoint inhibitor (ICI) monotherapy (MONO) and combination therapy of ICI and chemotherapy (COMBO) are standard treatments for patients with NSCLC and programmed cell death ligand-1 (PD-L1) tumor proportion scores (TPS) ≥ 50%. However, evidence from the clinical trials specifically for older patients is limited. Thus, it is unclear which older patients benefit more from COMBO than MONO.MethodsWe retrospectively analyzed 199 older NSCLC patients of Eastern Cooperative Oncology Group performance status (ECOG PS) 0-1 and PD-L1 TPS ≥ 50% who were treated with MONO or COMBO. We analyzed the association between treatment outcomes and baseline patient characteristics in each group, using propensity score matching.ResultsOf the 199 patients, 131 received MONO, and 68 received COMBO. The median overall survival (OS; MONO: 25.2 vs. COMBO: 42.2 months, P = 0.116) and median progression-free survival (PFS; 10.9 vs. 11.8 months, P = 0.231) did not significantly differ between MONO and COMBO group. In the MONO group, OS was significantly shorter in patients without smoking history compared to those with smoking history [HR for smoking history against non-smoking history: 0.36 (95% CI: 0.16-0.78), P = 0.010]. In the COMBO group, OS was significantly shorter in patients with PS 1 than those with PS 0 [HR for PS 0 against PS 1: 3.84 (95% CI: 1.44-10.20), P = 0.007] and for patients with squamous cell carcinoma (SQ) compared to non-squamous cell carcinoma (non-SQ) [HR for SQ against non-SQ: 0.17 (95% CI: 0.06-0.44), P < 0.001]. For patients with ECOG PS 0 (OS: 26.1 months vs. not reached, P = 0.0031, PFS: 6.5 vs. 21.7 months, P = 0.0436) or non-SQ (OS: 23.8 months vs. not reached, P = 0.0038, PFS: 10.9 vs. 17.3 months, P = 0.0383), PFS and OS were significantly longer in the COMBO group.ConclusionsECOG PS and histological type should be considered when choosing MONO or COMBO treatment in older patients with NSCLC and PD-L1 TPS ≥ 50%

Predictors of in-hospital mortality in elderly unvaccinated patients during SARS-CoV-2 Alpha variants epidemic

Summary: Background: COVID-19, caused by SARS-CoV-2, has caused a global pandemic. This study aimed to identify predictors of in-hospital mortality in unvaccinated elderly patients with COVID-19 by comparing various predictive factors between the survivors and non-survivors. Methods: We retrospectively selected 132 unvaccinated patients aged over 65 years with COVID-19 at a hospital in Kanagawa, Japan, during SARS-CoV-2 Alpha variants epidemic. We compared the clinical characteristics, laboratory and radiological findings, treatment, and complications of the survivors and non-survivors. In logistic regression analysis, variables that were significant in the univariate analysis were subjected to multivariate analysis using the variable increase method. Results: There were 119 and 13 patients in the survivor and non-survivor groups, respectively. Multivariate regression revealed increasing odds with the presence of ARDS and DIC (odd ratio (OR) = 16.35, 34.36; P=0.002, 0.001, respectively) and prolonged hospital stay (OR = 1.17; P=0.004). Conclusions: We found the complications of ARDS and DIC and hospital length of stay to be independent predictors of in-hospital mortality in elderly unvaccinated patients with COVID-19. Establishing treatments and prevention methods for ARDS and DIC could result in lower mortality rates

Clinical impact of tumour burden on the efficacy of PD‐1/PD‐L1 inhibitors plus chemotherapy in non‐small‐cell lung cancer

Abstract Background Programmed cell death 1 (PD‐1)/programmed cell death ligand (PD‐L1) inhibitors plus chemotherapy (ICI + Chemo) is the standard treatment for advanced non‐small‐cell lung cancer (NSCLC). However, the impact of tumour burden on the efficacy of ICI + Chemo remains unknown. Methods We retrospectively evaluated 92 patients with advanced NSCLC treated with ICI + Chemo. Tumour burden was assessed as the sum of the longest diameter of the target lesion (BSLD) and number of metastatic lesions (BNMLs). We categorised the patients into three groups based on the combined BSLD and BNML values. Results Sixty‐eight patients (74%) had progressive disease or died. Forty‐four patients (48%) in the low‐BSLD group had a median progression‐free survival (PFS) of 9.5 months, whereas patients in the high‐BSLD group had a median PFS of 4.6 months (hazard ratio [HR] = 0.54, p = 0012). Twenty‐five patients (27%) in the low‐BNML group had a median PFS of 9.6 months, whereas patients in the high‐BNML group had a median PFS of 6.5 months (HR = 0.51, p = 0.029). Low‐BSLD and low‐BNML were associated independently with improved PFS in multivariate analysis. Analysis of the tumour burden combined with BSLD and BNML revealed a trend towards improved PFS as the tumour burden decreased, with median PFS of 22.3, 8.7, and 3.9 months in the low‐ (N = 13), medium‐ (N = 42) and high‐burden (N = 37) groups respectively. Conclusions Our findings demonstrated that a high tumour burden negatively impacts the efficacy of ICI + Chemo in patients with advanced NSCLC