Predictors of Out-of-Hospital Cardiac Arrest in Patients Hospitalized With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

Out-of-hospital cardiac arrest (OHCA) refers to the abrupt stoppage of the heart's mechanical activity, primarily triggered by coronary artery disease. OHCA represents a significant global cause of death. The aim of this study was to assess the predictors of OHCA in patients admitted with acute coronary syndrome (ACS). This meta-analysis was conducted following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two investigators performed a comprehensive search of online databases, including PubMed, EMBASE, and Web of Science, from their inception to October 15, 2023. Keywords such as "predictors," "out-of-hospital cardiac arrest," and "acute coronary syndrome" were used to identify relevant articles. To enhance the search, synonyms and their corresponding Medical Subject Heading terms were included. A total of six studies were included in this meta-analysis. The pooled incidence of out-of-hospital cardiac arrest was 4% (95% confidence interval, 3%-5%). The current meta-analysis reports that age, gender, having multivessel disease, hypertension, dyslipidemia, and having ST-elevation myocardial infarction were some of the significant factors associated with OHCA in patients hospitalized with ACS.

Meta-Analysis on the Impact of Inflammatory Rheumatological Conditions on Outcomes Following Acute Coronary Syndrome.

Inflammatory rheumatological conditions, also known as inflammatory rheumatic conditions (IRC), constitute a category of autoimmune and inflammatory ailments primarily affecting the musculoskeletal system, encompassing the joints, muscles, and connective tissues. The objective of this meta-analysis is to evaluate the impact of inflammatory rheumatological conditions (IRC) on post-acute coronary syndrome (ACS) outcomes. This study was performed as per the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. The PubMed, Web of Science, and Scopus databases were searched by two authors without any language constraints from January 1, 2015, to October 15, 2023. The primary outcome assessed in this meta-analysis was all-cause mortality. Other outcomes included myocardial infarction and revascularization. A total of 11 studies were included in this meta-analysis. The risk of all-cause mortality was significantly higher in patients with IRC compared to non-IRC patients (RR: 1.12, 95% CI: 1.00 to 1.26, p-value: 0.04). There is a significantly higher risk of myocardial infarction and revascularization in patients with IRC as opposed to those without IRC. Furthermore, while there was a higher risk of stroke in the IRC group compared to the non-IRC group, this disparity did not reach statistical significance. Future research should focus on specific inflammatory rheumatoid conditions, a comprehensive evaluation of cardiovascular events, and targeted interventions to enhance patient outcomes in this vulnerable population.

Child drowning and associated risk factors: Findings from a qualitative study in Bangladesh.

Background: World Health Organization (WHO) has classified drowning as a major public health problem. The most vulnerable victims of drowning are children from low and middle-income countries. Previously, it was the primary cause of death among children aged between 1 and 17 years in Bangladesh. Aims: This study explored the surrounding circumstances and associated factors of child drownings in Bangladesh. Methods: A qualitative phenomenological approach has been used to conduct the study. Bangladesh was chosen as the study area, and data were gathered using a semi-structured, open-ended questionnaire. Using convenience and snowball sampling methods, we have collected data from Dhaka and seven additional districts in Bangladesh. We reached a total of 44 individuals, where 22 agreed to participate in an interview (face-to-face and online interviews). The remaining 22 participants were selected in two focus group discussions via the web platform "ZOOM cloud meeting." Results: Our investigation revealed several factors associated with child drowning, including a lack of adequate parental supervision and monitoring, geographic locations and environment, seasonal factors, low living standards, peer pressure and risky behaviors, social stigma and prejudices, and natural disasters and calamities. According to our findings, a lower socioeconomic position is linked to a higher risk of nonfatal drowning. Moreover, this research also indicates a substantial nexus between child drowning fatalities and the socioeconomic conditions of the families of the victims. Conclusion: The study adds to the existing body of knowledge by underlining the associated factors of child drowning fatalities in Bangladesh, which will aid in developing preventive policies. An essential aspect of any drowning prevention program for Bangladesh should be enhanced for community awareness of safe water rescue and resuscitation practices.

Progeny Transfer Effects of Chitosan-Coated Cobalt Ferrite Nanoparticles.

Cobalt ferrite nanoparticles (CFNs) are promising materials for their enticing properties for different biomedical applications, including magnetic resonance imaging (MRI) contrast, drug carriers, biosensors, and many more. In our previous study, a chitosan-coated CFN (CCN) nanocomplex demonstrated potential as an MRI contrast dye by improving the biocompatibility of CFN. In this study, we report the progeny transfer effects of CCN following a single intravenous injection of CCN (20, 40, or 60 mg/kg) in pregnant albino Wistar rats. Biochemical and histological observation reveals that CCN is tolerated with respect to maternal organ functions (e.g., liver, kidney). Atomic absorption spectroscopy results showed that CCN or CCN-leached iron could cross the placental barrier and deposit in the fetus. Furthermore, this deposition accelerated lipid peroxidation in the placenta and fetus.

The trend in exclusive breastfeeding practice and its association with maternal employment in Bangladesh: A multilevel analysis.

Exclusive breastfeeding (EBF) is essential for infant and child health. This study aimed to explore the trend in the EBF over the last decade in Bangladesh and investigated if there was a significant association with maternal employment by analyzing the data extracted from three consecutive nationally representative surveys: Bangladesh Demographic and Health Surveys (BDHS) of 2011, 2014, and 2017-2018. Prevalence of EBF (95% confidence interval) with the Cochran-Armitage test was reported to see the trend in EBF. A chi-square (χ2) test was applied to find the potential factors associated with EBF. Finally, a three-level logistic regression was utilized to find the significant association between maternal employment and EBF while adjusting other covariates. We observed no increase in the practice of EBF over the last decade (P = 0.632). The prevalence of EBF was 64.9% (95% CI: 61.41, 68.18) in 2011, followed by 60.1% (95% CI: 56.25, 64) in 2014, and 64.9% (95% CI: 61.82, 67.91) in 2017. Regression results showed that employed mothers had 24% (p < 0.05) lower odds of EBF than unemployed mothers. Early initiation of breastfeeding was also found to be significantly associated [Adjusted odds ratio (AOR): 1.22, P < 0.05] with EBF. Government and policymakers must come forward with new interventions to increase the practice of EBF, providing basic education and campaigns on the topic of EBF. Maternity leave should be extended up to 6 months of the child's age to achieve an optimal level of EBF.

Paradigm shifting of education system during COVID-19 pandemic: A qualitative study on education components.

The COVID-19 pandemic has had a far-reaching effect on the education system, leading to some changes in the conventional education system. Educational institutions are adopting alternative methods to adapt to the changed situation. The purpose of this study is to explore the changes that have taken place in the education system due to the pandemic situation. A qualitative phenomenological approach has been used to conduct the study. To get a complete picture of the shifting paradigm of the education system, two interview methods such as In-depth Interviews (IDI), Key Informant Interviews (KII) have been adopted. Interviews were taken from 15 respondents. A purposive sampling technique has been used to reach the target sample. A semi-structured questionnaire has been developed to collect necessary data. The findings of this study showed that COVID-19 pandemic has led to changes in various components of the education system. Curriculum, syllabus, assessment method, teaching method, learning method, etc., have changed in the education system. The elements of education are shifting from offline to online. The use of online-based learning materials is increasing. The curriculum has been made more flexible with a more compressed and shortened syllabus to suit the students learning under such unforeseen circumstances. Faculty should promote online study groups so that those groups can assist in providing additional support throughout specific courses. The education policy should be changed by the Bangladesh government to adapt to the changed situation.

Semantic Web in Healthcare: A Systematic Literature Review of Application, Research Gap, and Future Research Avenues.

Today, healthcare has become one of the largest and most fast-paced industries due to the rapid development of digital healthcare technologies. The fundamental thing to enhance healthcare services is communicating and linking massive volumes of available healthcare data. However, the key challenge in reaching this ambitious goal is letting the information exchange across heterogeneous sources and methods as well as establishing efficient tools and techniques. Semantic Web (SW) technology can help to tackle these problems. They can enhance knowledge exchange, information management, data interoperability, and decision support in healthcare systems. They can also be utilized to create various e-healthcare systems that aid medical practitioners in making decisions and provide patients with crucial medical information and automated hospital services. This systematic literature review (SLR) on SW in healthcare systems aims to assess and critique previous findings while adhering to appropriate research procedures. We looked at 65 papers and came up with five themes: e-service, disease, information management, frontier technology, and regulatory conditions. In each thematic research area, we presented the contributions of previous literature. We emphasized the topic by responding to five specific research questions. We have finished the SLR study by identifying research gaps and establishing future research goals that will help to minimize the difficulty of adopting SW in healthcare systems and provide new approaches for SW-based medical systems' progress.

Discrimination and social exclusion of third-gender population (Hijra) in Bangladesh: A brief review.

The Hijra community is marginalized in social, political, and economic life and especially stigmatized in society. It is their birthright to make use of society's opportunities and amenities. This overview aimed to summarize the stigma, prejudice, exclusions, and discriminatory attitudes toward third-gender populations (Hijra) in Bangladesh from the mainstream society based on a critical assessment of available data and evidence. The paper also explored the socio-economic situation of the third-gender community in Bangladesh regarding income, education, health, housing, social relations, and outcome through a critical literature review. Here, we have highlighted the magnitudes of social exclusion that the Hijra minority group in Bangladesh experiences. The Hijra in Bangladesh faces severe mistreatment due to socio-cultural norms. This minority group suffers from extreme social, cultural, political, and economic exclusion in Bangladesh. Their livelihood is different than other communities in the society. The primary source of income for hijras in Bangladesh is begging and prostitution. They have no access within civil society, even in times of recreational and marital practices. People are unreasonably afraid of their presence in public places. Apart from that, they are physically and psychologically abused and deprived of appropriate medical and civil support. Hijras are deprived of government facilities and are accustomed to miserable lifestyles in Bangladesh. They are the most vulnerable and disadvantaged minority as they lack access to quality services, health care, and employment opportunities. Social recognition and financial independence may be the first step to alleviating discrimination toward the third-gender population. Government and non-governmental organizations (NGOs) should be concerned about ensuring the rights of the Hijra community must be protected.

Benefits of global mutant huntingtin lowering diminish over time in a Huntington's disease mouse model.

We have developed an inducible Huntington's disease (HD) mouse model that allows temporal control of whole-body allele-specific mutant huntingtin (mHtt) expression. We asked whether moderate global lowering of mHtt (~50%) was sufficient for long-term amelioration of HD-related deficits and, if so, whether early mHtt lowering (before measurable deficits) was required. Both early and late mHtt lowering delayed behavioral dysfunction and mHTT protein aggregation, as measured biochemically. However, long-term follow-up revealed that the benefits, in all mHtt-lowering groups, attenuated by 12 months of age. While early mHtt lowering attenuated cortical and striatal transcriptional dysregulation evaluated at 6 months of age, the benefits diminished by 12 months of age, and late mHtt lowering did not ameliorate striatal transcriptional dysregulation at 12 months of age. Only early mHtt lowering delayed the elevation in cerebrospinal fluid neurofilament light chain that we observed in our model starting at 9 months of age. As small-molecule HTT-lowering therapeutics progress to the clinic, our findings suggest that moderate mHtt lowering allows disease progression to continue, albeit at a slower rate, and could be relevant to the degree of mHTT lowering required to sustain long-term benefits in humans.

Child drownings in Bangladesh: need for action.

Drowning is one of the major public health concerns, and children are the most vulnerable victims of drowning death in Bangladesh, which has been a paramount threat to child survival. Based on available data, we intend to underline the prevalence and associated risk factors for child drowning deaths in Bangladesh. According to the Center for Injury Prevention and Research, Bangladesh, about 19 000 people of all ages drown per year across the country, where approximately 77% are children (<18 years), which means that over 40 Bangladeshi children drown per day. A recent survey reported that as of data collected from January 2020 to June 2021, 83% of drowning victims were children. Insufficient parental supervision, mother's illiteracy, lack of swimming ability, male gender, children under 5 years, geographical and environmental conditions, seasonality, and disasters significantly contribute to child drowning deaths in Bangladesh. We urge the governments and local administrations to address the current crisis by coordinating and integrating several effective efforts to prevent child drowning deaths.

Investigation of Antimicrobial Activity and Biocompatibility of Biogenic Silver Nanoparticles Synthesized using Syzigyum cymosum Extract.

Nanotherapeutics has emerged as the most sought after approach to tackle the menace of drug-resistant pathogenic bacteria. Among others, biogenic silver nanoparticles (bAgNPs) synthesized using medicinal plant extracts demonstrate promising antibacterial propensity with excellent biocompatibility. Herein, bAgNPs were synthesized through the green chemistry approach using Syzygium cymosum leaf extract as a reducing agent at different pH values (i.e., 5, 7, 8, and 10). The average size of bAgNPs synthesized at pH 5, 7, 8, and 10 was 23.3, 21.3, 17.2, and 35.3 nm, respectively, and all the nanoparticles were negatively charged. Their antibacterial potential was investigated against Bacillus subtilis, Escherichia coli DH5α, E. coli K12, enteropathogenic E. coli, and Salmonella typhi. The highest antibacterial activity was exhibited by bAgNPs synthesized at pH 8 against all the tested bacterial strains, which can be attributed to their small size and greater surface area to volume ratio. The bAgNPs demonstrated the highest zone of inhibition (29.5 ± 0.8 mm) against B. subtilis through oxidation of membrane fatty acids that resulted in the formation of the malondialdehyde-thiobarbituric acid (MDA-TBA) adduct. However, bAgNPs demonstrated excellent hemocompatibility with rat and human red blood cells. Biogenic AgNPs synthesized at pH 8 also exhibited biocompatibility in terms of liver and kidney function biomarkers. Furthermore, hematoxylin and eosin staining of the tissue sections of vital organs (i.e., liver, kidneys, lungs, heart, spleen, and brain) also confirmed the biocompatibility of bAgNPs.

Subchronic Toxicity Study of Alternanthera philoxeroides in Swiss Albino Mice Having Antioxidant and Anticoagulant Activities.

Alternanthera philoxeroides, a tropical herb and edible vegetable, has been popular as a medicinal plant. Applying in vitro approach, we initially attempted to assess the phytochemicals, bioactive chemicals, as well as antioxidant and anticoagulant activities of this plant. Following that, the in vivo toxicological effects of methanolic extracts of A. philoxeroides using different doses on the kidney, heart, lung, liver, stomach, brain, and blood of female Swiss Albino mice were investigated. We estimated phytochemicals content as well as antioxidant activity through DPPH, NO, CUPRAC, and reducing power assays, followed by the anticoagulant activities of PT and aPTT and bioactive compounds using HPLC. To confirm the biocompatibility of A. philoxeroides extracts, histopathological and hematological parameters were examined in a mice model. Total phenol, flavonoid, and tannin content in A. philoxeroides was 181.75 ± 2.47 mg/g, 101.5 ± 3 .53 mg/g, and 68.58 ± 0.80 mg/g, respectively. Furthermore, the HPLC study confirmed the presence of four phenolic compounds: catechin, tannic acid, gallic acid, and vanillic acid. The methanolic extract of A. philoxeroides showed considerable antioxidant activity in all four antioxidant assay methods when compared to the standard. In comparison to ascorbic acid, A. philoxeroides also demonstrated a minor concentration-dependent ferric and cupric reduction activity. In vivo evaluation indicated that A. philoxeroides extracts (doses: 250, 500, and 1000 mg/kg) had no negative effects on the relative organ or body weight, or hematological indicators. Our study concluded that A. philoxeroides had significant antioxidant and anticoagulant activities and demonstrated no negative effects on the body or relative organ weight, histopathological, and hematological indices in the mouse model.

Impact of Prolonged COVID-19 Lockdown on Body Mass Index, Eating Habits, and Physical Activity of University Students in Bangladesh: A Web-Based Cross-Sectional Study.

Objectives: This current study aims to assess the prevalence and factors associated with body mass index (BMI), dietary patterns, and the extent of physical activities among university students following the prolonged coronavirus disease 2019 (COVID-19) lockdown in Bangladesh. Methods: A cross-sectional web-based survey was conducted between July 10 to August 10, 2021, through a pre-designed Google Form to collect the data from Bangladeshi university students (age: ≥18 years). Informed consent was electronically obtained from each participant, and a simple snowball technique was employed during the sampling. Frequency and percentage distribution, paired t-test, chi-square [χ2] test, and multinomial and binary logistic regression analyses were consecutively applied to analyze the collected data. Results: Among the total participants (n = 1,602), 45.1% were female and 55.6% were 22-25 years' age group students. The BMI (mean ± standard deviation, SD) during the COVID-19 lockdown was 23.52 ± 7.68 kg/m2, which was 22.77 ± 4.11 kg/m2 during the pre-lockdown period (mean difference = 0.753; p < 0.001). The multinomial logistic regression analysis found a significant impact of gender [male vs. female: adjusted relative risk ratio (RRR) = 1.448; 95% confidence interval (CI) = 1.022, 2.053; p = 0.037], age (years) (<22 vs. >25: RRR =0.389, 95% CI = 0.213,0.710; p = 0.002, and 22-25 vs. >25: RRR = 0.473, 95% CI = 0.290, 0.772; p = 0.003), monthly family income (BDT) (<25,000 vs. >50,000: RRR = 0.525, 95% CI = 0.334,0.826; p = 0.005), university type (public vs. private: RRR = 0.540, 95% CI = 0.369, 0.791; p = 0.002), eating larger meals/snacks (increased vs. unchanged: RRR = 2.401, 95% CI = 1.597, 3.610; p < 0.001 and decreased vs. unchanged: RRR = 1.893, 95% CI = 1.218, 2.942; p = 0.005), and verbally or physically abuse (yes vs. no: RRR = 1.438, 95% CI = 0.977, 2.116; p = 0.066) on obesity during COVID-19 pandemic. Besides, the female students and those who have constant eating habits, were more likely to be underweight. Additionally, the binary logistic regression analysis found that the students from private universities [others vs. private: adjusted odds ratio (AOR) = 0.461, 95% CI = 0.313, 0.680; p < 0.001], urban areas (urban vs. rural: AOR = 1.451, 95% CI = 1.165, 1.806; p = 0.001), wealthier families (<25,000 BDT vs. >50,000 BDT: AOR = 0.727, 95% CI = 0.540, 0.979; p = 0.036), and who were taking larger meals/snacks (increased vs. unchanged: AOR = 2.806, 95% CI = 2.190, 3.596; p < 0.001) and had conflicts/arguments with others (no vs. yes: AOR = 0.524, 95% CI = 0.418, 0.657; p < 0.001), were significantly more physically inactive. Finally, the level of education and smoking habits significantly influenced the eating habits of university students during the extended strict lockdown in Bangladesh. Conclusion: The current findings would be helpful tools and evidence for local and international public health experts and policymakers to reverse these worsening effects on students mediated by the prolonged lockdown. Several effective plans, programs, and combined attempts must be earnestly implemented to promote a smooth academic and daily life.

Status of psychological health of students following the extended university closure in Bangladesh: Results from a web-based cross-sectional study.

Students' severe affective mental distress has emerged as significant public health attention globally because of the disastrous effects of coronavirus disease 2019 (COVID-19). The current study aimed at exploring the prevalence of two alarming psychological distresses, depression and anxiety, among university students following a prolonged shutdown of educational institutions in Bangladesh. A cross-sectional online-based study was conducted by deploying two standard scales to assess the depression and anxiety among Bangladeshi students from various universities amid the 2nd stream of the COVID-19 pandemic. A total of 568 Bangladeshi university students participated in this questionnaire-based survey through various social media platforms. Frequency and percentage distribution as univariate, chi-square (χ2) test as bivariate, and logistic regression as multivariate analyses were applied to investigate the prevalence of depression and anxiety and their associated various sociodemographic factors. After cleaning and eliminating the partial data, we analyzed 465 responses, where 42% were female and 64.3% were from public universities. Both mental disorders were prevalent in more than 50% of Bangladeshi university students. The students from the private universities were two times and 2.7 times more depressed and anxious, respectively than the students from the public universities. In addition, the students who became incomeless had significantly more anxiety (adjusted odds ratio [AOR] = 1.711; p = 0.018) than those who did not lose income source during the COVID-19 lockdown. The present study revealed that more than 50% of Bangladeshi university students were suffering from depression and anxiety. Several effective measures must be assured by the concerted efforts of university authorities, educationalists, and the Government to alleviate these distressing mental health burdens.

Fabrication and Characterization of Chitosan-Polyethylene Glycol (Ch-Peg) Based Hydrogels and Evaluation of Their Potency in Rat Skin Wound Model.

Thermal burns are a major cause of death and suffering around the globe. They can cause debilitating, life-altering injuries as well as lead to significant psychological and financial consequences. Several research works have been conducted in attempt to find a wound healing therapy that is successful. At present, hydrogels have been widely used in cutting-edge research for this purpose because they have suitable properties. This study aimed to see how therapy with chitosan-polyethylene glycol (Ch-Peg) based hydrogels affected the healing of burn wounds in rats. With the concern of public health, xanthan gum (X), boric acid (B), gelatin (Ge), polyethylene glycol (Peg), chitosan (Ch), glutaraldehyde (G), and HPLC-grade water were prepared using X : Ge : G, X : Ge : Peg : G, X : Ge : Ch : G, X : Ge : Peg : Ch : G, X : Ge : B : Ch : G, X : Ge : B : Peg : G, and X : Ge : B : Peg : Ch : G. The produced composite hydrogels were examined for swelling ability, biodegradability, rheological characteristics, and porosity. The 3D structure of the hydrogel was revealed by scanning electron microscopy (SEM). After that, the structural characterization technique named Fourier-transform infrared spectroscopy (FTIR) was used to describe the composites (SEM). Lastly, in a rat skin wound model, the efficacy of the produced hydrogels was studied. Swelling ability, biodegradability, rheological properties, and porosity were all demonstrated in composite hydrogels that contained over 90% water. Hydrogels with good polymeric networks and porosity were observed using SEM. The existence of bound water and free, intra- and intermolecule hydrogen-linked OH and NH in the hydrogels was confirmed using FTIR. In a secondary burned rat model, all hydrogels showed significant wound healing effectiveness when compared to controls. When compared to other composite hydrogels, wounds treated with X : Ge : Peg : Ch : G, X : Ge : B : Peg : G, and X : Ge : B : Peg : Ch:G recovered faster after 28 days. In conclusion, this research suggests that X : Ge : Peg : Ch : G, X : Ge : B : Peg : G, and X : Ge : B : Peg : Ch : G could be used to treat skin injuries in the clinic.

Neurocognitive status and risk of mortality among people living with human immunodeficiency virus: an 18-year retrospective cohort study.

HIV-related neurocognitive impairment (NCI) may increase the risk of death. However, a survival disadvantage for patients with NCI has not been well studied in the post-combination antiretroviral therapy (cART) era. Specifically, limited research has been conducted considering the reversible nature and variable progression of the impairment and this area demands further evaluation. We performed multivariable Cox proportional hazards modeling to assess the association between baseline NCI (global T scores) and mortality. A joint modeling approach was then used to model the trajectory of global neurocognitive functioning over time and the association between neurocognitive trajectory and mortality. Among the National NeuroAIDS Tissue Consortium's (NNTC) HIV-infected participants, we found a strong negative association between NCI and mortality in the older age groups (e.g., at age = 55, HR = 0.79; 95% CI 0.64-0.99). Three neurocognitive sub-domains (abstraction and executive functioning, speed of information processing, and motor) had the strongest negative association with mortality. Joint modelling indicated a 33% lower hazard for every 10-unit increase in global T scores (HR = 0.67; 95% CI 0.56-0.80). The study identified older HIV-infected individuals with NCI as a group needing special attention for the longevity of life. The study has considerable prognostic utility by not only predicting mortality hazard, but also future cognitive status.

The impact of stereotactic body radiation therapy on the overall survival of patients diagnosed with early-stage non-small cell lung cancer.

BACKGROUND AND PURPOSE: Stereotactic Body Radiotherapy (SBRT) has emerged as a standard treatment for inoperable early-stage non-small cell lung cancer (NSCLC) with remarkable local control. However, it is not clear if this local control translates to overall survival (OS). The objective of this study is to investigate the impact of SBRT on the OS of early-stage NSCLC patients and examine if the extent of this impact changes with the era of diagnosis, T stage, age, and comorbidity status. MATERIALS AND METHODS: Using the National Cancer Database, we compared the OS of cT1-3 cN0 cM0 NSCLC patients with SBRT or observation. Multivariable analyses were adjusted for age, race, sex, income, education, place of living, hospital type, insurance status, comorbidity score, histology types, and diagnosis year. RESULTS: Among 50,819 patients, 27,027 (53.18%) received SBRT and 23,792 (46.82%) were observed. Multivariable Cox Proportional-Hazards analysis demonstrated SBRT was associated with an improved OS compared to observation (HR:0.56, p < 0.001). Subset multivariable Cox Proportional-Hazards analyses stratified by T stage, year of diagnosis, age, or Charlson Score revealed that HRs of SBRT vs. observation decrease from cT1 to cT3 (0.73-0.68), from 2004 to 2015 (0.65-0.51), from <50 to ≥80 years old (1.04-0.58) and from a Charlson Score 0 to 2 (0.69-0.58). CONCLUSION: SBRT was associated with improved OS compared to no treatment in early-stage NSCLC. The magnitude of the impact of SBRT on OS increases in patients with advanced age, higher T stages, higher comorbidity scores and more recent treatment eras.

Stereotactic body radiation therapy mitigates radiation induced lymphopenia in early stage non-small cell lung cancer.

INTRODUCTION: Radiation-induced lymphopenia (RIL) occurs during treatment with conventional radiation in multiple organ sites. Development of RIL portends poor prognosis. Stereotactic body radiation therapy (SBRT) spares RIL in pancreatic cancer, but has not been examined in other sites commonly treated with SBRT. This work examines if SBRT similarly spares RIL in patients with non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Retrospective analysis was done at a single institution on 40 distinct cases of SBRT for early stage NSCLC from 2006-2017. Incidentally collected lymphocyte counts collected within 6 months of SBRT treatment were analyzed to determine if RIL occurred. The presence of RIL was correlated with location of initial failure and survival endpoints. Kaplan-Meier curves were constructed with significance defined at the level p < 0.05. RESULTS: RIL was observed in 35% of the analyzed patients. Patterns of failure and survival data were comparable to prior SBRT literature. There was no observed association in two year local, nodal, or distant failure, progression free survival, or overall survival based on the presence of RIL. DISCUSSION: SBRT spares RIL in NSCLC compared to historical rates observed with conventionally fractionated radiation. As understanding of the role of the immune system in cancer control continues to evolve, the importance of RIL sparing techniques take on increasing importance. This study represents further analysis of RIL sparing in SBRT in an early stage NSCLC cohort without the confounding influence of chemotherapy.