Features and frequency of use of electronic health records in primary care across 20 countries: a cross-sectional study

OBJECTIVES

Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability.

STUDY DESIGN

Cross-sectional study.

METHODS

PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V.

RESULTS

Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for 'interactive patient education' (37·3%) or 'home monitoring and self-testing of chronic conditions' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity.

CONCLUSIONS

EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.

Data acquisition system for a newly-built hard x-ray/soft gamma-ray spectrometer imaging system on experimental advanced superconducting tokamak

A portable hard X-ray and soft gamma-ray spectrometer imaging system (HXS) has been constructed to gather physical information about fast electrons confined in the Experimental Advanced Superconducting Tokamak (EAST). The system is installed on the low field side of the mid-plane and provides a viewing field tangential to the toroidal field. The system utilizes a two-dimensional Cadmium Zinc Telluride (CdZnTe) semiconductor detector with 128 channels, and a data acquisition (DAQ) system has been designed for it. The DAQ system features a highly integrated signal processing system with the capability of high-speed processing and digital transmission of signals from 128 channels. In addition, a related DAQ software has been developed using a modular design approach, facilitating tasks such as data reception, storage, and preliminary processing. HXS, which has been applied during the recent EAST campaign, directly obtains the digital energy spectrum of incident photons. The DAQ system is described in detail in this paper. The hardware components and energy calibration have also been described. Experimental data have been successfully obtained and briefly discussed. More physical research will be reported in future publications.

Component separation repair of incisional hernia: evolution of practice and review of long-term outcomes in a single center

PURPOSE

To review the long-term outcomes of complex abdominal wall reconstruction using anterior and posterior component separation (CS) techniques in our center.

METHODS

This was a descriptive analytical study. Analysis of data from a prospectively collected database of patients who had undergone Component Separation (CS) repair of incisional hernias was performed. Two techniques were used. Anterior component separation (ACS) and posterior component separation with transversus abdominis release (PCS/TAR). Follow-up was clinical review at 6 weeks, 6 months, and 12 months with direct access telephone review thereafter. Long-term outcome data was obtained from electronic records and based on either clinical or CT assessment. Minimum physical follow-up was 6 months for all patients.

RESULTS

89 patients with large incisional hernias underwent CS repair. 29 patients had ACS while 60 underwent PCS/TAR. Mean follow-up was 60 months (range 6-140 months) in the ACS group and 20 months (range 6-72 months) in the PCS group. Twenty-five patients (28%) had simultaneous major procedures including 21 intestinal anastomoses. Twenty-six (29%) of patients had associated stomas. Twenty-seven (30.3%) of the patients had undergone previous hernia repairs. Seromas occurred in 24 (26.97%) patients. Wound infections were more common after ACS. There have been 10 (11.2%) recurrences to date.

CONCLUSION

Component separation repair techniques result in good long-term outcomes with acceptable complication rates. They can be performed simultaneously with gastrointestinal procedures with low morbidity. Appropriate patient selection and use of appropriate mesh are important.

Mettl3‑mediated m6A RNA methylation regulates osteolysis induced by titanium particles

Peri‑prosthetic osteolysis (PPO) induced by wear particles is considered the primary cause of titanium prosthesis failure and revision surgery. The specific molecular mechanisms involve titanium particles inducing multiple intracellular pathways, which impact disease prevention and the targeted therapy of PPO. Notably, N6‑methyladenosine (m6A) serves critical roles in epigenetic regulation, particularly in bone metabolism and inflammatory responses. Thus, the present study aimed to determine the role of RNA methylation in titanium particle‑induced osteolysis. Results of reverse transcription‑quantitative PCR (RT‑qPCR), western blotting, ELISA and RNA dot blot assays revealed that titanium particles induced osteogenic inhibition and proinflammatory responses, accompanied by the reduced expression of methyltransferase‑like (Mettl) 3, a key component of m6A methyltransferase. Specific lentiviruses vectors were employed for Mettl3 knockdown and overexpression experiments. RT‑qPCR, western blotting and ELISA revealed that the knockdown of Mettl3 induced osteogenic inhibition and proinflammatory responses comparable with that induced by titanium particle, while Mettl3 overexpression attenuated titanium particle‑induced cellular reactions. Methylated RNA immunoprecipitation‑qPCR results revealed that titanium particles mediated the methylation of two inhibitory molecules, namely Smad7 and SMAD specific E3 ubiquitin protein ligase 1, via Mettl3 in bone morphogenetic protein signaling, leading to osteogenic inhibition. Furthermore, titanium particles induced activation of the nucleotide binding oligomerization domain 1 signaling pathway through methylation regulation, and the subsequent activation of the MAPK and NF‑κB pathways. Collectively, the results of the present study indicated that titanium particles utilized Mettl3 as an upstream regulatory molecule to induce osteogenic inhibition and inflammatory responses. Thus, the present study may provide novel insights into potential therapeutic targets for aseptic loosening in titanium prostheses.

Uncertainties and opportunities in delivering environmentally sustainable surgery: the surgeons' view

Surgery is a carbon-heavy activity and creates a high volume of waste. Surgical teams around the world want to deliver more environmentally sustainable surgery but are unsure what to do and how to create change. There are many interventions available, but resources and time are limited. Capital investment into healthcare and engagement of senior management are challenging. However, frontline teams can change behaviours and drive wider change. Patients have a voice here too, as they would like to ensure their surgery does not harm their local community but are concerned about the effects on them when changes are made. Environmentally sustainable surgery is at the start of its journey. Surgeons need to rapidly upskill their generic knowledge base, identify which measures they can implement locally and take part in national research programmes. Surgical teams in the NHS have the chance to create a world-leading programme that can bring change to hospitals around the world. This article provides an overview of how surgeons see the surgical team being involved in environmentally sustainable surgery.

Prognostic model of ER-positive, HER2-negative breast cancer predicted by clinically relevant indicators

PURPOSE

To study the clinicopathological variables connected with disease-free survival (DFS) as well as overall survival (OS) in patients who are ER-positive or HER2-negative and to propose nomograms for predicting individual risk.

METHODS

In this investigation, we examined 585 (development cohort) and 291 (external validation) ER-positive, HER2-negative breast cancer patients from January 2010 to January 2014. From January 2010 to December 2014, we retrospectively reviewed and analyzed 291 (external validation) and 585 (development cohort) HER2-negative, ER-positive breast cancer patients. Cox regression analysis, both multivariate and univariate, confirmed the independence indicators for OS and DFS.

RESULTS

Using cox regression analysis, both multivariate and univariate, the following variables were combined to predict the DFS of development cohort: pathological stage (HR = 1.391; 95% CI = 1.043-1.855; P value = 0.025), luminal parting (HR = 1.836; 95% CI = 1.142-2.952; P value = .012), and clinical stage (HR = 1.879; 95% CI = 1.102-3.203; P value = 0.021). Endocrine therapy (HR = 3.655; 95% CI = 1.084-12.324; P value = 0.037) and clinical stage (HR = 6.792; 95% CI = 1.672-28.345; P value = 0.009) were chosen as predictors of OS. Furthermore, we generated RS-OS and RS-DFS. According to the findings of Kaplan-Meier curves, patients who are classified as having a low risk have considerably longer DFS and OS durations than patients who are classified as having a high risk.

CONCLUSION

To generate nomograms that predicted DFS and OS, independent predictors of DFS in ER-positive/HER2-negative breast cancer patients were chosen. The nomograms successfully stratified patients into prognostic categories and worked well in both internal validation and external validation.

Comprehensive Need as a Mediator Between Psychological Stress and Quality of Life Among Caregivers of Patients With Cancer

BACKGROUND

Caregivers of patients with cancer are susceptible to profound psychological distress and low quality of life owing to the substantial demands of caregiving. The comprehensive needs of caregivers are closely linked to their quality of life. However, little is known about the relationship between these factors.

OBJECTIVE

This study aimed to determine whether comprehensive needs mediate the relationships between psychological stress and quality of life in caregivers of patients with cancer.

METHODS

A cross-sectional design was used to recruit 382 participants through convenience sampling. Psychological stress, comprehensive needs, and quality of life were measured using a questionnaire.

RESULTS

Psychological stress was associated with higher comprehensive needs (r = 0.30, P < .01) and lower quality of life (r = -0.20, P < .01). Comprehensive needs were negatively associated with quality of life (r = -0.28, P < .01). Mediation analysis findings revealed that both the indirect effect of psychological stress on quality of life via comprehensive needs (β = -0.10; P < .001) and its direct effect on quality of life (β = -0.16; P < .01) were statistically significant, suggesting a partial mediatory effect of comprehensive needs between psychological stress and quality of life.

CONCLUSIONS

Our findings suggest that reducing psychological stress can improve quality of life by promoting satisfaction with comprehensive needs.

IMPLICATIONS FOR PRACTICE

Interventions that help reduce psychological stress and meet the comprehensive needs of caregivers of patients with cancer can improve their quality of life.

Mindfulness-based stress reduction combined with early cardiac rehabilitation improves negative mood states and cardiac function in patients with acute myocardial infarction assisted with an intra-aortic balloon pump: a randomized controlled trial

Objective

To investigate the clinical effects of mindfulness-based stress reduction (MBSR) intervention combined with early cardiac rehabilitation (CR) on patients with acute myocardial infarction (AMI) assisted with an intra-aortic balloon pump (IABP).

Methods

A total of 100 AMI patients with IABP assistance due to hemodynamic instability at Wuhan Asia Heart Hospital were enrolled in the study. The participants were divided into two groups using the random number table method (n = 50 each group). Patients receiving routine CR were assigned to the CR control group, while patients receiving MBSR plus CR were assigned to the MBSR intervention group. The intervention was performed twice a day until the removal of the IABP (5-7 days). Each patient's level of anxiety/depression and negative mood state were evaluated before and after intervention using the self-rating anxiety scale (SAS), self-rating depression scale (SDS), and profiles of mood state scale (POMS). The results of the control and intervention groups were compared. IABP-related complications and left ventricular ejection fraction (LVEF), measured with echocardiography, were also assessed and compared between the two groups.

Results

The SAS, SDS, and POMS scores were lower in the MBSR intervention group than in the CR control group (P < 0.05). There were also less IABP-related complications in the MBSR intervention group. LVEF was significantly improved in both groups, but the degree of LVEF improvement was more significant in the MBSR intervention group than in the CR control group (P < 0.05).

Conclusions

MBSR combined with early CR intervention can assist in alleviating anxiety, depression, and other negative mood states, reduce IABP-related complications, and further improve cardiac function in AMI patients with IABP assistance.

Spatial-temporal patterns of high-temperature and drought during the maize growing season under current and future climate changes in Northeast China

BACKGROUND

Under the background of global warming, the intensity and frequency of extreme meteorological events in the maize growing season in Northeast China are increasing. In order to clarify the occurrence characteristics of extreme meteorological events in Northeast China, this study focused on three extreme agrometeorological events, i.e., high temperatures, drought, and the compound events of high-temperature and drought during the maize growing season (May to September), impacting maize production in Northeast China.

RESULTS

Based on historical (1981-2017) and future (2021-2060) climate data, we analyzed the spatial-temporal patterns of these three events with different intensities in Northeast China. The results indicated that slight high temperatures and moderate and severe droughts occurred more frequently in the study area during the historical period. The frequency of the different grades of the compound events of high-temperature and drought will exhibit an increasing trend in the future, as will the frequency of the compound events of high-temperature and drought. This is particularly evident in the northwest of the study area.

CONCLUSION

The compound events of high-temperature and drought mainly occurred in late July and early August, encompassing the flowering stage of early-, middle-, and late-maturing maize varieties. It is important to identify the area and time of major extreme weather events to implement the necessary preventive measures. This article is protected by copyright. All rights reserved.

Pan-Cancer Analysis of Prognostic and Immune Infiltrates for the TMEM65, Especially for the Breast Cancer

Introduction

Transmembrane protein 65 (TMEM65) is an inner mitochondrial membrane protein, which played important role in mediating autophagy, smooth muscle contraction, protein glycosylation, and immune response. In recent years, the interest had risen for exploring the function of the TMEM genes in the cancer fields. As a consequence, in our pan-cancer research of the TMEM65, we explored the function of the gene in kinds of database and tried to apply the finding in the clinical practice.

Methods

In this research, we provide a comprehensive investigation of TMEM65 expression in a pan-cancer manner containing 33 cancer types. We evaluated the association of TMEM65 with the prognosis, immune infiltration, drug sensitivity analysis, GSVA enrichment analysis, TMB, MSI, NEO, and hotspot mechanisms.

Results

TMEM65 was abnormally expressed in 24 types of cancers and showed correlation with the OS for 6 cancers and PFI for 9 cancers and kpI for 3 types. Moreover, the TME score, CD8 T effector, and immune checkpoint scoring systems showed a close correlation with the TMEM65. Moreover, TMEM65 was strongly correlated with some of the most common tumor-related genes and certain pathways (TGF beta signaling, TNFA signaling, hypoxia, pyroptosis, DNA repairing, autophagy, ferroptosis, and other related genes). Additionally, the TMEM65 showed correlations with the tumor mutational burden (TMB), microsatellite instability (MSI), NEO, and drug sensitivity. Finally, we confirmed several pathways by the GSEA and GSVA for the TMEM65 at the breast cancer aspects. Nomogram prediction model was also established for the breast tumors based on the TMEM65 level and other variables.

Conclusion

Above all, the TMEM65 played important roles in predicting the prognosis of the cancers and correlated with the tumor immunity in the pan-cancer analysis.

Characteristics of sludge-based pyrolysis biochar and its application of enhancing denitrification

A modified biochar for enhanced denitrification was developed through a facile pyrolysis method using sewage sludge as raw material and melamine as nitrogen source. Through electrochemical analysis, sludge-based pyrolysis biochar (SPBC) has superior electrical conductivity and poor redox activity. SPBC can increase the electron transfer through the geoconductor mechanism. The effect and the mechanism of SPBC on denitrification were studied. The nitrate treatment efficiency increased with the increase of SPBC dosage. From the perspective of molecular biology, the activities of NAR and NIR enzymes, the degradation efficiency of glucose and the ETSA of bacteria were all promoted with the increase of SPBC, thereby promoting the removal of NO₃^-. In addition, SPBC had a certain screening effect on microbial communities, and biodiversity decreased with the increase of SPBC dosage. Although the biodiversity decreased, the relative abundance of microorganisms conducive to denitrification increased with the increase of SPBC dosage. The transformation strategy of SPBC proposed in this paper provides a technical solution for sludge recycling and application for strengthening denitrification.

Diffusion Tensor Imaging Analysis Along the Perivascular Space Index in Primary Parkinson's Disease Patients With and Without Freezing of Gait

Parkinson's disease (PD) is a common neurodegeneration disease associated with the abnormal deposition and spread of misfolded proteins (α-synuclein and Tau protein), which progressively damages the glymphatic system. This research intended to investigate the activity of the glymphatic system in PD individuals with freezing of gait (PD-FOG) and PD patients without it (PD-nFOG), as well as their relationship to the clinical neural scale. Diffusion tensor imaging (DTI) was performed in 28 PD-FOG individuals, 31 PD-nFOG individuals, and 34 healthy controls (HC). The DTI analysis along the perivascular space (DTI-ALPS) index was computed after post-processing of DTI images, representing brain glymphatic functions. The DTI-ALPS index was assessed for the association with the clinical variables. Compared to the HC group, the DTI-ALPS index of both PD-FOG and PD-nFOG patients was significantly decreased; however, no notable difference was found between the PD-FOG and PD-nFOG group. In addition, the DTI-ALPS index of PD-nFOG patients were positively correlated with disease duration, Unified Parkinson's Disease Rating-III Right (UPDRS-III R), UPDRS-III TOTAL, UPDRS-IV. Taken together, these findings highlighted the weakening of function of the glymphatic system in PD individuals, which is associated with motor symptoms and treatment complications. We speculate that treatment aimed at enhancing the flow and clearance of the glymphatic system may alleviate clinical symptoms of PD.

Phospholipid peroxidation inhibits autophagy via stimulating the delipidation of oxidized LC3-PE

Phospholipid peroxidation of polyunsaturated fatty acids at the bis-allylic position drives ferroptosis. Here we identify a novel role for phospholipid peroxidation in the inhibition of autophagy. Using in vitro and in vivo models, we report that phospholipid peroxidation induced by glutathione peroxidase-4 inhibition and arachidonate 15-lipoxygenase overexpression leads to overload of peroxidized phospholipids and culminate in inhibition of autophagy. Functional and lipidomics analysis further demonstrated that inhibition of autophagy was associated with an increase of peroxidized phosphatidylethanolamine (PE) conjugated LC3. We further demonstrate that autophagy inhibition occurred due to preferential cleavage of peroxidized LC3-PE by ATG4B to yield delipidated LC3. Mouse models of phospholipid peroxidation and autophagy additionally supported a role for peroxidized PE in autophagy inhibition. Our results agree with the recognized role of endoplasmic reticulum as the primary source for autophagosomal membranes. In summary, our studies demonstrated that phospholipid peroxidation inhibited autophagy via stimulating the ATG4B-mediated delipidation of peroxidized LC3-PE.

Propafenone as potential AgoKir: exploration of long-term effects and mechanisms of propafenone on Kir2.1 channel

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Chinese Scholarship Council

Background

Inward rectifying potassium (Kir) channel expression and activity are tightly regulated within the heart. Kir channels play key roles in shaping cardiac action potentials, having a reduced conductance at depolarized potentials but contributing to the final stage of repolarization and resting membrane stability. The Kir2.1 channel protein has polyamine binding residues in both the transmembrane (D172) and the cytoplasmic domains (E224,E299), responsible for the process of inward rectification. A reduced functioning of Kir2.1 causes 1) Andersen-Tawil Syndrom and 2) is present in a subset of heart failure patients. Restoration of normal Kir2.1 function by agonists of Kir2.1 (AgoKirs) would be beneficial. The drug propafenone is identified as an AgoKir, but its long-term effects on Kir2.1 protein expression and subcellular localisation is unknown.

Purpose

To investigate propafenone's long-term effect on Kir2.1 expression and its underlying mechanisms in cell systems.

Methods

GFP, Dendra2 or non-tagged wildtype (WT) and mutant Kir2.1 expression constructs were transiently or stably (HEK-KWGF; CHO-KD cell lines) expressed in Human Embryonic Kidney and Chinese Hamster Ovary cells. Kir2.1 carried currents were measured by single cell patch clamp electrophysiology. Kir2.1 proteins expression levels were determined by Western blot analysis, whereas conventional immunofluorescence and advanced live-imaging microscopy were used to assess the subcellular localisation of Kir2.1 proteins. Propafenone was dissolved in DMSO,BaCl2 was used as Kir2.1 channel inhibitor.

Results

Acute administration of 0.1 and 0.5 µM propafenone increased Kir2.1 carried outward current confirming the drug's Agokir status. Propafenone dose-dependently increased WT Kir2.1 expression levels (2.63±0.40 fold increase at 25 µM and 2.75±0.56 fold increase at 50 µM, 24h) in a process that is independent of the E224, E299 and D172 polyamine binding sites, and the R312 residue which is adjacent to the proposed propafenone binding site. Propafenone (25, 50 µM, 24h) induced intracellular accumulation of WT and mutant Kir2.1 proteins in the late endosome/lysosome compartment (Figure). Channel inhibition by BaCl2 did not affect the propafenone responses on Kir2.1 expression levels or subcellular localisation.

Conclusion

Acute administration of propafenone at low concentrations increases Kir2.1 currents. Chronic propafenone treatment at only 25-100 times higher concentrations results in increased Kir2.1 protein expression levels and intracellular accumulation in late endosomes and/or lysosomes. Our data support the ability of propafenone at low concentrations to function as AgoKirs without disturbing Kir2.1 protein handing.

A novel strategy for optimal component formula of anti-PRRSV from natural compounds using tandem mass tag labeled proteomic analyses

BACKGROUND

Porcine Reproductive and Respiratory Syndrome (PRRS) is one of the most important porcine viral diseases which have been threatening the pig industry in China. At present, most commercial vaccines fail to provide complete protection because of highly genetic diversity of PRRSV strains. This study aimed to optimize a component formula from traditional Chinese medicine(TCM)compounds with defined chemical characteristics and clear mechanism of action against PRRSV.

METHODS

A total of 13 natural compounds were screened for the anti-PRRSV activity using porcine alveolar macrophages (PAMs). Three compounds with strong anti-PRRSV activity were selected to identify their potential protein targets by proteomic analysis. The optimal compound formula was determined by orthogonal design based on the results of proteomics. MTT assay was used to determine the maximum non-cytotoxic concentration (MNTC) of each compound using PAMs. QPCR and western blot were used to investigate the PRRSV N gene and protein expression, respectively. The Tandem Mass Tag (TMT) technique of relative quantitative proteomics was used to detect the differential protein expression of PAMs treated with PRRSV, matrine (MT), glycyrrhizic acid (GA) and tea saponin (TS), respectively. The three concentrations of these compounds with anti-PRRSV activity were used for orthogonal design. Four formulas with high safety were screened by MTT assay and their anti-PRRSV effects were evaluated.

RESULTS

MT, GA and TS inhibited PRRSV replication in a dose-dependent manner. CCL8, IFIT3, IFIH1 and ISG15 were the top four proteins in expression level change in cells treated with MT, GA or TS. The relative expression of IFIT3, IFIH1, ISG15 and IFN-β mRNAs were consistent with the results of proteomics. The component formula (0.4 mg/mL MT + 0.25 mg/mL GA + 1.95 μg/mL TS) showed synergistic anti-PRRSV effect.

CONCLUSIONS

The component formula possessed anti-PRRSV activity in vitro, in which the optimal dosage on PAMs was 0.4 mg/mL MT + 0.25 mg/mL GA + 1.95 μg/mL TS. Compatibility of the formula was superposition of the same target with GA and TS, while different targets of MT. IFN-β may be one of the targets of the component formula possessed anti-PRRSV activity.

Posterior stabilization with polyetheretherketone (PEEK) rods and transforaminal lumbar interbody fusion (TLIF) with titanium rods for single-level lumbar spine degenerative disease in patients above 70 years of age

BACKGROUND

Given the lack of guidelines regarding the operative management of elderly patients needing lumbar spine fusion for degenerative disease, it is often difficult to balance between invasiveness respecting the fragile spine and geriatric comorbidities.

AIM

To compare reoperation rates and clinical outcome in patients above 70 years of age undergoing Transforaminal Lumbar Interbody Fusion (TLIF) with titanium rods or posterior stabilization with Polyetheretherketone (PEEK) rods for the treatment of one-level lumbar spine degenerative disease.

METHODS

Retrospective review of baseline characteristics, reoperation rates as well as the clinical and radiological outcomes of patients, older than 70 years, undergoing posterolateral fusion with PEEK rods (n = 76, PEEK group) or TLIF with titanium rods (n = 67, TLIF group) for a single-level lumbar degenerative disease from 2014 to 2020. Additional subanalysis on the patients above 80 years of age was performed.

RESULTS

Our results showed similar reoperation rates and outcomes in the TLIF and PEEK groups. However, intraoperative blood loss, administration of tranexamic acid, and operation time were significantly higher in the TLIF group. In patients older than 80 years, reoperation rates at first follow-up were significantly higher in the TLIF group, too.

CONCLUSION

According to our results, posterior stabilization with PEEK rods is less invasive and was associated with significantly lower blood loss, administration of blood products and shorter operation time. Moreover, in patients above 80 years of age reoperations rates were lower with PEEK rods, as well. Nevertheless, the benefits of PEEK rods for foraminal stenosis still have to be investigated.

Treatment-related adverse events as predictive biomarkers of efficacy in patients with advanced neuroendocrine tumors treated with surufatinib: results from two phase III studies

Background

No validated biomarkers currently exist for predicting the efficacy outcomes in patients with neuroendocrine tumors (NETs) treated with antiangiogenic therapy. We aimed to evaluate the association between treatment-related adverse events (TRAEs) and efficacy outcomes of surufatinib in patients with advanced NET.

Patients and methods

We included patients with NET treated with surufatinib in two multicenter, randomized, double-blind, placebo-controlled, phase III trials (SANET-p and SANET-ep) in this study. The main exposure was the presence of any of the TRAEs including hypertension, proteinuria, and hemorrhage in the first 4 weeks of surufatinib treatment. The primary outcome of the study was investigator-assessed progression-free survival (PFS). PFS outcomes were estimated using the Kaplan–Meier method with the log-rank test. Hazard ratios (HRs) were calculated by using univariable and multivariable Cox proportional hazard regression models. Blinded independent image review committee (BIIRC) assessments and 4-week landmark analysis were also performed as supportive evaluations.

Results

During the study period, a total of 242 patients treated with surufatinib were included in the analysis, and 164 (68%) patients had at least one of hypertension, proteinuria, and hemorrhage in the first 4 weeks of treatment. The presence of TRAEs in the first 4 weeks was associated with prolonged median PFS [11.1 versus 9.2 months; HR 0.67, 95% confidence interval (CI) 0.47-0.97; P = 0.036]. In multivariable Cox regression analysis, the presence of TRAEs was also significantly associated with longer PFS (HR 0.65, 95% CI 0.44-0.97; P = 0.035). Similar results were obtained in the BIIRC assessments and 4-week landmark analysis.

Conclusions

Treatment-related hypertension, proteinuria, and hemorrhage could be potential biomarkers to predict antitumor efficacy of surufatinib in patients with advanced NET. Future prospective studies are needed to validate the findings.

Trial registration

ClinicalTrials.govNCT02589821; https://clinicaltrials.gov/ct2/show/NCT02589821 and ClinicalTrials.gov NCT02588170; https://clinicaltrials.gov/ct2/show/NCT02588170

•

Treatment-related hypertension, proteinuria, or hemorrhage is associated with longer survival in NETs.

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The association is confirmed by the BIIRC assessments and 4-week landmark analysis.

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TRAEs can be biomarkers to predict antitumor efficacy in patients with NET.

The compound effects of drought and high temperature stresses will be the main constraints on maize yield in Northeast China

Compound climate extremes such as drought and high temperature have a greater impact on agricultural production than the individual extremes. An increasing frequency and intensity of the compound climate extremes has been observed and projected under climate change, yet partitioning the total impacts to individual ones on crop yield has not been well assessed. In this study, we assessed the compound and separate effects of drought and high temperature on maize yield under 9 climate-year types (CYTs) with different combinations of precipitation and temperature in Northeast China (NEC). The well-validated Agricultural Production Systems Simulator (APSIM) model was used to simulate the maize yield, driven by historical (1981-2017) and future climate data (2021-2060). The results show that CYTs of warm (warm-dry, warm-wet, warm) are prominent in the future under both Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios. However, CYT of warm-wet increased mostly (11.5%) under RCP8.5, while warm-dry increased most (12.3%) under RCP4.5. The magnitude of maize yield loss caused by the compound of high temperature and drought (18.75%) is higher than the individual ones (drought 17.32% and high temperature 1.27%). There are variations in the effects of stresses on maize yield among CYTs and the yield reductions by the compound effects of drought and high temperature were warm-dry > warm > rainless > warm-wet > normal > cold-dry > cold > rainy > cold-wet. In addition, the yield loss was negatively correlated with T_max and VPD_max but positively correlated with Prec. These findings imply the importance of fully considering the selection of heat and drought-resistant varieties and implementing supplementary irrigation for future climate mitigation strategies during maize production in NEC.

Machine learning analysis including social determinants of health for predication of mortality following transcatheter aortic valve implantation: a single center experience

Funding Acknowledgements

Type of funding sources: None.

Introduction

Social determinants of health (SDOH) are increasingly being recognized as critical, independent prognosticators in cardiovascular disease. Despite this, little is known about the role of SDOH in predicting outcomes following transcatheter aortic valve implantation (TAVI).

Purpose

To assess the value of adding census-derived SDOH in developing machine learning (ML) models for prediction of all-cause mortality in patients following TAVI.

Methods

A total of 398 patients, who underwent TAVI in 2019, were studied. Clinical, demographic, echocardiographic (echo) and census-derived SDOH data were collected. All-cause mortality at 1 year was the endpoint. A general linear ML model was fit with 100 iterations and a 70:30 training-test split. We compared the predictive performance of the model with and without adding SDOH. The SDOH included in the ML model were race (white vs. non-white), % zip code population as female, and zip code average yearly income less than $45,000.

Results

Baseline SDOH, demographic, clinical, and echo data are shown in Table 1. Following univariate and multivariate predictor analysis, the following input data were used for the ML model without the SDOH: post TAVI all-cause hospitalizations, history of outpatient hemodialysis, atrial fibrillation, heart failure with reduced ejection fraction, myocardial infarction, coronary artery disease and beta-blockers. The ML model with SDOH used the same input as well as the SDOH variables. The model with vs. without SDOH had a median AUC of 0.75 vs. 0.73 (p = 0.9957).

Conclusions

Despite not reaching statistical significance, our ML model provides a holistic picture of mortality predictors. Larger studies are needed to more assess the predictive value of SDOH post TAVI. Abstract Figure. Baseline patient characteristics  Abstract Figure. ML Model: Area Under Curve