Pilot Investigation of Blood Pressure Control Using a Mobile App (Cardi.Health): Retrospective Chart Review Study.

BACKGROUND: The high prevalence of hypertension necessitates effective, scalable interventions for blood pressure (BP) control. Self-monitoring has shown improved adherence to medication and better BP management. Mobile apps offer a promising approach with their increasing popularity and potential for large-scale implementation. Studies have demonstrated associations between mobile app interventions and lowered BP, yet real-world data on app effectiveness and engagement remain limited. OBJECTIVE: In this study, we analyzed real-world user data from the Cardi.Health mobile app, which is aimed at helping its users monitor and control their BP. Our goal was to find out whether there is an association between the use of the mobile app and a decrease in BP. Additionally, the study explored how engagement with the app may influence this outcome. METHODS: This was a retrospective chart review study. The initial study population comprised 4407 Cardi.Health users who began using the app between January 2022 and April 2022. After applying inclusion criteria, the final study cohort comprised 339 users with elevated BP at the baseline. The sample consisted of 108 (31.9%) men and 231 (68.1%) women (P=.04). This retrospective chart review study obtained permission from the Biomedical Research Alliance of New York Institutional Review Board (June 2022, registration ID 22-08-503-939). RESULTS: The study's main findings were that there is a possible relationship between use of the Cardi.Health mobile app and a decrease in systolic BP. Additionally, there was a significant association between active use of the app and systolic BP decrease (χ21=5.311; P=.02). Finally, active users had an almost 2 times greater chance of reducing systolic BP by 5 mm Hg or more over 4 weeks (odds ratio 1.932, 95% CI 1.074-3.528; P=.03). CONCLUSIONS: This study shows a possible relationship between Cardi.Health mobile app use and decreased BP. Additionally, engagement with the app may be related to better results-active use was associated with an almost 2-fold increase in the odds of reducing BP by 5 or more mm Hg.

Efficacy of focal high-dose-rate brachytherapy in the treatment of patients diagnosed with low or favourable: intermediate-risk prostate cancer-a protocol for a randomised controlled trial.

INTRODUCTION: Prostate cancer (PCa) is men's second most predominant cancer worldwide. Because the prostate-specific antigen test is used in diagnostics, PCa is more often diagnosed in the early stages, making radical treatment of the disease possible. However, it is estimated that over a million men worldwide suffer from radical treatment-related complications. Thus, focal treatment has been proposed as a solution, which aims to destroy the predominant lesson that determines the progression of the disease. The main objective of our study is to compare the quality of life and efficacy of patients diagnosed with PCa before and after the treatment with focal high-dose-rate brachytherapy and to compare results with focal low-dose-rate brachytherapy and active surveillance. METHODS AND ANALYSIS: 150 patients diagnosed with low-risk or favourable intermediate-risk PCa who meet the inclusion criteria will be enrolled in the study. Patients are going to be randomly assigned to the study groups: focal high-dose-rate brachytherapy (group 1), focal low-dose-rate brachytherapy (group 2) and active surveillance (group 3). The study's primary outcomes are quality of life after the procedure and time without biochemical disease recurrence. The secondary outcomes are early and late genitourinary and gastrointestinal reactions after the focal high-dose and low-dose-rate brachytherapies and evaluation of the importance and significance of in vivo dosimetry used for high-dose-rate brachytherapy. ETHICS AND DISSEMINATION: Bioethics committee approval was obtained before this study. The trial results will be published in peer-reviewed journals and at conferences. TRIAL REGISTRATION NUMBER: Vilnius regional bioethics committee; approval ID 2022/6-1438-911.

Incidence, mortality and survival trends of penile cancer in Lithuania 1998-2017.

Background and objectives: The aim of this study was to analyse trends in penile cancer incidence, mortality, and relative survival in Lithuania during the period of 1998-2017. Materials and methods: The study was based on all cases of penile cancer reported to the Lithuanian Cancer Registry between 1998 and 2017. Age-specific rates standardized rates were calculated, using the direct method (World standard population). The Joinpoint regression model was used to provide estimated average annual percentage change (AAPC). One-year and five-year relative survival estimates were calculated using period analysis. Relative survival was calculated as the ratio of the observed survival of cancer patients and the expected survival of the underlying general population. Results: During the study period, the age-standardized incidence rate of penile cancer varied between 0.72 and 1.64 per 100 000, with AAPC 0.9% (95% CI -0.8-2.7). The mortality rate of penile cancer in Lithuania during this period varied from 0.18 to 0.69 per 100 000, with AAPC of -2.6% (95% CI -5.3-0.3). Relative one-year survival of patients, diagnosed with penile cancer improved over the time from 75.84% in period 1998-2001 to 89.33% in period 2014-2017. Relative five-year survival rate of patients, diagnosed with penile cancer changed from 55.44% in period 1998-2001 to 72.90% in period 2014-2017. Conclusions: The incidence rates of penile cancer showed an increasing trend, while mortality rates were decreasing in Lithuania during 1998-2017. One-year and five-year relative survival increased, however, it does not reach the highest scores of Northern European countries.

Sensa Mobile App for Managing Stress, Anxiety, and Depression Symptoms: Pilot Cohort Study.

BACKGROUND: An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)-based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule. OBJECTIVE: This study aims to analyze Sensa users' retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results. METHODS: The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score. RESULTS: The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. CONCLUSIONS: Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms.

User Engagement and Weight Loss Facilitated by a Mobile App: Retrospective Review of Medical Records.

BACKGROUND: Intermittent fasting (IF) has gained popularity in recent years for its effect on weight loss and supposed additional health benefits, such as a positive effect on body composition and metabolic markers. Mobile apps can act as platforms that help deliver dietary interventions by improving adherence and motivation. Although the effect of IF on weight loss has been demonstrated in earlier trials, there is not much research about the engagement and weight loss results with IF apps. OBJECTIVE: Our main objective was to compare how a nudging platform (including smart scales) influences engagement (the extent to which users interact with the app measured by the number of active days) with the app among users who had obesity at the beginning of use. The secondary objectives were to evaluate the body weight changes among active and nonactive users and, finally, to evaluate the body composition changes of users possessing smart scales during app usage. Through this study, we hope to provide (1) more insight into how nudging (using smart scales as a nudging platform) is associated with engagement with the mobile app, (2) how engagement with the mobile app is associated with weight loss, and (3) how IF is associated with body composition. METHODS: We performed a retrospective analysis of data from 665 users with obesity (BMI≥30) who started using the IF app DoFasting. Of them, 244 used body composition scales that estimated body fat and body muscle values. Users were stratified into engagement groups in accordance with their activity ratio (number of active days divided by the total time of use). Baseline and final users' weight (in kg), body fat (in %), and body muscle (in %) were compared. RESULTS: Our findings suggest an association between the nudging platform (smart scales) and better engagement with the app. Smart scale users had a significantly higher activity ratio than regular users. Additionally, active DoFasting users lost significantly more weight. Further, body composition analysis showed that app usage might be related to body fat loss and an increase in muscle mass. CONCLUSIONS: We found a possible association between the nudging and gamified elements and higher app engagement. Additionally, increased app engagement is associated with increased weight loss. Thus, nudging and gamified elements of mobile health apps, such as interactive tools, goals, challenges, and progress tracking, are suggested to affect engagement positively and should be investigated further in future research. Finally, the IF regime delivered through the DoFasting app might be related to the body muscle mass gain and reduced fat mass.

Fasting and weight loss: mobile application-based approach.

BACKGROUND: The purpose of this study was to investigate the efficacy of intermittent fasting (IF) guidance, delivered through a smartphone application, in terms of engagement and weight loss. METHODS: We performed a retrospective chart-review study of all consecutive users with overweight or obesity of the DoFasting mobile application, which integrates IF solutions for people looking to lose weight. Users with overweight and obesity at the beginning of application use, who met the inclusion criteria (entered their gender, height, and starting weight; had more than one weight entry; used the app for at least a month; had at least one active day per week with valid app-related activities) and used the application for weight loss were included in the study. RESULTS: The final study cohort comprised 22,022 consecutive users. The short-term cohort comprised 17,221 users (8585 females and 8636 males), while 4801 users (2983 females and 1818 males) were in the long-term cohort. Long-term active users of the application lost a statistically significant amount of weight over the study period and lost more than inactive users did (2.2 [3.5] vs 1.4 [3.2], p < 0.0001; the results are shown in kilograms as medians with the interquartile range in brackets). Active and long-term users were also more likely to reduce their BMI class (p < 0.05) in comparison to non-active short-term users. A multiple regression model showed that the total length of use and active days were the most significant predictors of weight loss. In-app activities such as total fasting hours, weight logging, completing challenges, and providing feedback were also statistically significant predictors of weight loss with varying contributions. CONCLUSION: We found that the DoFasting mobile application that implements IF is an effective tool for weight loss if used actively and sufficiently. TRIAL REGISTRATION: This retrospective chart review study was approved by BRANY IRB in January 2022 (study ID.: 22-08-034-939).

The 99mTc-MIP-1404 PSMA Uptake in the Isolated Paratracheal Lymph Node From the Prostate Adenocarcinoma.

ABSTRACT: The oncologist consulted a 56-year-old man after receiving prostate-specific antigen screening results. Prostate-specific antigen level during the screen time was 33 ng/mL. As a result, poorly differentiated prostate adenocarcinoma with a Gleason score of 9 (5 + 4) was diagnosed. SPECT/CT scan with 99mTc-MIP-1404 PSMA tracer was performed. The 99mTc-PSMA-positive lesions were detected in the prostate, external iliac, obturator lymph nodes of the pelvis, para-aortic, and the right lower paratracheal space. The patient was prescribed androgen deprivation therapy and early chemotherapy with docetaxel (6 fractions), after which radiation therapy to prostate and seminal vesicles was planned.

Androgen-deprivation therapy and risk of death from cardio-vascular disease in prostate cancer patients: a nationwide lithuanian population-based cohort study.

Purpose: The main purpose of this study was to evaluate the risk of CVD mortality in the national cohort of patients diagnosed with prostate cancer and treated with ADT compared with the ADT non-users.Materials and methods: We performed a retrospective cohort study of patients aged 40-79 years and diagnosed with prostate cancer between 1 January 2012 and 31 December 2016 using the Lithuanian Cancer registry data. In total, 13 343 prostate cancer patients were included in the final study cohort who exclusively used gonadotropin-releasing hormone agonists. The primary outcomes that were registered during the follow-up of this study were overall CVD death.Results: There was a higher risk of CVD death in the cohort of patients treated with ADT than in ADT non-users (HR 2.14, 95% CI [1.86-2.45], p < 0.001). Moreover, there was an increased risk of death from ischemic heart disease and stroke (HR 1.42, 95% CI [1.16-1.73] and 1.70, 95% CI [1.18-2.45], respectively) among ADT users. Finally, the risk of CVD-related mortality was highest in the 70-79 age group of ADT users (HR 4.78, 95% CI [3.79-6.04]).Conclusions: This study shows that ADT usage is associated with increased CVD-related mortality risk for patients diagnosed with prostate cancer compared with ADT non-users. The highest mortality risk was found for ischemic heart disease and stroke. CVD-related mortality was increased in the elder group of patients also.

KetoCycle mobile app for ketogenic diet: a retrospective study of weight loss and engagement.

BACKGROUND: The ketogenic diet is one of the oldest diets that has been used for more than a centennial in the clinical setting, and it is gaining popularity as a measure to fight obesity, which is a major predisposing factor for many diseases to manifest, including diabetes mellitus, chronic heart disease, cancer, and others. Thus, we designed this retrospective investigation to determine if users of the mobile application KetoCycle achieved statistically significant weight loss outcomes. METHODS: The initial study cohort comprised 12,965 consecutive users who started using KetoCycle between January 2020 and December 2020. The final cohort comprised 10,269 users. The main parameters obtained from the database containing all self-reported data were gender, number of active days (AD), total time of use (TT), height, initial weight, and last recorded weight. The primary outcome of the study was weight loss. Statistical analyses were performed using IBM SPSS Statistics, version 26 (IBM Corp., Armonk, NY, USA). In addition, a standard multiple regression model was created to predict weight loss from significant actions. RESULTS: A retrospective analysis of KetoCycle user data showed that 87.3% of KetoCycle users lost some of their initial weight. Of those, 1645 users (18.3%) lost more than 10% of their initial body weight, 3528 (39.3%) users lost between 5 and 10% of their initial body weight, and 3796 (42.3%) users lost less than 5% of their body weight. When user activity was taken into account, it was found that active users lost statistically significantly more weight than non-active users (p < 0.05). App engagement was also associated with losing > 5% of initial weight. Using water tracking, weight tracking, and creation of a meals list within KetoCycle statistically significantly predicted weight loss in a multiple regression model. CONCLUSIONS: We concluded that KetoCycle appeared as a promising mobile application suited for weight loss and weight control. TRIAL REGISTRATION: This retrospective chart review study was approved by BRANY IRB in January 2022 (registration ID.: 21-08-564-939).

A Pilot Study of Safer Radiation Dosage to the Heart and Its Subregions.

Background and Objectives: The real impact of ionizing radiation on the heart and poorer overall survival for patients with non small cell lung cancer (NSCLC) remains unclear. This study aims to determine the safe dose constraints to the heart's subregions that could prevent patients' early non-cancerous death and improve their quality of life. Methods and Materials: A retrospective cohort study was performed containing 51 consecutive patients diagnosed with stage III NSCLC and treated using 3D, Intensity-modulated radiation therapy (IMRT), and Volumetric modulated arc therapy (VMAT) radiotherapy. For a dosimetric analysis, these structures were chosen: heart, heart base (HB), and region of great blood vessels (GBV). Dose-volume histograms (DVH) were recorded for all mentioned structures. Maximum and mean doses to the heart, HB, the muscle mass of the HB, and GBV were obtained. V10-V60 (%) parameters were calculated from the DVH. After performed statistical analysis, logistic regression models were created, and critical doses calculated. Results: The critical dose for developing a fatal endpoint for HB was 30.5 Gy, while for GBV, it was 46.3 Gy. Increasing the average dose to the HB or GBV by 1 Gy from the critical dose further increases the possibility of early death by 22.0% and 15.8%, respectively. Conclusions: We suggest that the non-canonical sub-regions of the heart (HB and GBV) should be considered during the planning stage. Additional constraints of the heart subregions should be chosen accordingly, and we propose that the mean doses to these regions be 30.5 Gy and 46.3 Gy, respectively, or less. Extrapolated DVH curves for both regions may be used during the planning stage with care.

Effect of Biological Environment on Polyester Surgical Suture's Physical Properties: An Experimental Study in Rats.

Objective The following study aims to analyze the alteration of nonabsorbable polyester surgical suture physical properties after in vivo incubation. Methods A comparative study of braided nonabsorbable polyester 2/0 (U.S.P) sutures was performed. The control in vitro group and three experimental in vivo subgroups, composed of ten sutures in each, were created. All 30 experimental sutures were implanted into a total of 15 laboratory rats subcutaneous tissue (two sutures in each rat) and removed after seven, eight and nine weeks, respectively. Further, they were attached to the mechanical testing device and affected with a mechanical force, increasing the load by 0,1 N/s until complete breakage. Tensile strength (TS), failure displacement (FD), failure strain (FS) and failure stress (FST) were measured at the point of failure and compared to the same parameters of the control group. Results No statistically significant difference was found in the physical parameters of the samples between the experimental and control groups (TS [p = 0.358], FD [p = 0.258], FS [p = 0.258] FST [p = 0.358]). A statistically significant difference was found in the failure load between sutures that break on the knot site (KS) and the rest of the samples: significantly less force was needed to break the suture on the KS. Moreover, most of the breaks on the KS occurred in sutures that were incubated for the longest period of nine weeks (n = 4). An anomaly of partial failure (PF) was noticed. Sutures with PF elongated significantly more compared to the sutures that did not undergo PF in the control and in experimental groups (p = 0,044; p = 0,017; p = 0,016; p = 0,013). Conclusion The biological environment had no radical aftereffects to the suture's physical properties. In vivo exposure may cause the suture to break on the KS more frequently and may lead to PF, when a few sutures composed of fiber fail. Sutures that undergo PF tend to elongate further.

Clinical and radiological outcomes after reverse shoulder arthroplasty with less medialized endoprosthesis after mean follow-up time of 45 months.

INTRODUCTION: The purpose of this study was to evaluate outcomes after reverse shoulder arthroplasty for the treatment of complex three- and four-fragment proximal humeral fractures after mean follow-up time of 45 months and to compare our results with the results published by other authors. MATERIALS AND METHODS: Retrospectively we have analyzed 27 consecutive patients after total arthroplasty with less medialized reverse shoulder prosthesis used for the treatment of complex proximal humeral fracture. The median age and standard deviation was 67.5 ± 7.3 years (range 55-85). The average follow-up time was 45 months. Shoulder function was evaluated using Simple Shoulder Test and Constant scale. Patient satisfaction about the treatment was evaluated using Likert-type questionnaire. All patients were investigated radiologically for possible complications using standard lateral and anterior views. RESULTS: All patients were satisfied (74%) or highly satisfied (26%). The mean total Constant-Murley score was 57.6 pts. (range 37.4-80.2). Mean total Simple Shoulder Test score was 73.5 pts. (range 49.8-100). There were two cases with heterotopic ossification and one with greater tubercle malposition. We found no signs of scapular notching, implant failure or loosening. CONCLUSIONS: Results after reverse arthroplasty for complex proximal humeral fractures yield good clinical, functional, and radiological outcomes after mean follow-up time of 45 months. Results are comparable to other studies published in the recent literature.