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Background The environment plays a large role in the health of individuals; however, more research is needed to better understand aspects of the environment that most influence health. Specifically, our study examines how the social environment influences cardiovascular health (CVH). Methods and Results The social environment was characterized using measures of belonging and life and work stress in individuals, as well as nationally derived measures of marginalization, deprivation, economic status, and community well‐being in neighborhoods. CVH was defined by the American Heart Association's Cardiovascular Health Index—a summed score of 7 clinical and behavioral components known to have the greatest impact on CVH. Data were obtained from the Canadian Community Health Survey 2015 to 2016 and multiple national data sources. Multilevel regression models were used to analyze the associations between CVH and the social environment. Overall, 27% of Canadians reported ideal CVH (6–7 score points), 68% reported intermediate CVH (3–5 score points), and 5% reported poor CVH (0–2 score points). The neighborhood environment contributed up to 7% of the differences in CVH between individuals. Findings indicated that residing in a neighborhood with greater community well‐being (odds ratio [OR], 1.33 [95% CI, 1.26–1.41]) was associated with achieving higher odds of ideal CVH, while weaker community belonging (OR, 0.67 [95% CI, 0.62–0.72]) and residing in a neighborhood with greater marginalization (OR, 0.87 [95% CI, 0.82–0.91]) and deprivation (OR, 0.67 [95% CI, 0.64–0.69]) were associated with achieving lower odds of ideal CVH. Conclusions Aspects of individual‐level social environment and residing in a neighborhood with a more favorable social environment were both independently and significantly associated with achieving ideal CVH.

Stereotactic radiosurgery (SRS) can effectively control brain metastasis (BRM) from non-small-cell lung cancer (NSCLC), although intracranial recurrence from untreated micrometastatic tumor deposits is common without whole-brain radiotherapy. Our goal was to determine if immunotherapy improves distant intracranial progression-free survival (DI-PFS) compared with other systemic therapies in patients treated with SRS.All patients from 2011 to 2019 treated with SRS without previous whole-brain radiotherapy for NSCLC BRM were reviewed. DI-PFS for the entire cohort, and subgroups of patients, was estimated and compared using the Kaplan-Meier/log-rank method.One hundred and thirty-six SRS sessions used to treat 99 patients were reviewed; 98 (72%) for previously untreated BRM and 38 (28%) for recurrent BRM. 35% received immunotherapy (77% concurrent with SRS), 46% received chemotherapy (75% concurrent), and 18% received epidermal growth factor receptor/anaplastic lymphoma kinase (ALK) targeted therapy (85% concurrent). At median follow-up of 13.7 months, 49% developed distant intracranial recurrence. One-year DI-PFS was improved with any use of immunotherapy (58% vs. 39%; P = 0.03) and concurrent immunotherapy versus chemotherapy or targeted therapy (67% vs. 37% vs. 39%, respectively; P = 0.01). In the immunotherapy cohort, 1-year DI-PFS was improved for programmed death-ligand 1 expression ≥50% versus 1%-49% versus 0% (80% vs. 49% vs. 19%, respectively; P0.01), and Lung Immune Prognostic Index 0-1 versus 2 (63% vs. 34%; P = 0.03).Immunotherapy concurrent with SRS, particularly in patients with high programmed death-ligand 1 expression or low Lung Immune Prognostic Index, is associated with improved DI-PFS and no increased risk of radiation necrosis compared with other systemic therapies for NSCLC.

Purpose/objectives Induction chemotherapy followed by chemoradiation and surgical resection in rectal cancer, known as total neoadjuvant therapy (TNT), is associated with improved pathologic complete response (pCR) rates. The National Cancer Database was utilized to identify factors associated with pCR and survival following treatment with TNT compared to standard neoadjuvant chemoradiation (nCRT). Materials/methods The National Cancer Database was queried from 2004 to 2015 for patients with locally advanced, non-metastatic rectal cancer. We identified 16,299 patients receiving neoadjuvant chemotherapy and radiation followed by definitive surgical resection. Patients were stratified by treatment received, either TNT (n=350) or nCRT (n=15,949). Multivariate binomial regression analysis and propensity matching were used to evaluate predictors of pCR. Kaplan-Meier and Cox multivariate analysis of survival were performed. Results Median follow-up was 38 months vs 53 months in the TNT vs nCRT groups, respectively. There were more patients with T4 or node-positive disease in the TNT group. There was a trend towards improved pCR in the TNT group (p=0.053). Patients achieving pCR had improved 5-year overall survival (OS) of 85.1%. The 5-year OS was not improved for TNT (76.2%) over nCRT (69.9%) (p=0.19). Pelvic nodal pCR was significantly higher in the TNT group (72%). When stratified by clinical stage, patients with cT3 (p=0.038) or cN1 (p=0.049) disease had improved OS with TNT. Conclusions Compared to nCRT, TNT is correlated with higher rates of complete pelvic nodal clearance in patients with locally advanced rectal adenocarcinoma. The use of TNT showed improved survival in patients with cT3 and cN1 disease, indicating a potential benefit for patients with less advanced disease.

Several retrospective series have reported that patients with collagen vascular disease (CVD) are at increased risk of radiation (RT) toxicity. However, the evidence is mixed, and many series lack control groups. We performed a meta-analysis including only case-cohort or randomized studies that examined the risk of RT toxicity for patients with CVD compared with controls.Meta-analysis of Observational Studies in Epidemiology guidelines were used to perform a comprehensive search identifying case-control or randomized studies reporting RT toxicity outcomes for patients with CVD versus controls. Data were synthesized from studies reporting grade 2 to 3 or more (G2/3 +) acute and late RT toxicities. Results were analyzed with fixed effects meta-analysis on the random-effects model for between-study heterogeneity; otherwise, the fixed-effects model was used. Hazard ratio or odds ratio (OR) were the effect-size estimators, as appropriate.Ten studies were included, with 4028 patients (CVD: 406, control: 3622). Patients with CVD had higher rates of acute G2/3 + toxicity (26.2% vs 16.5%, OR [odds ratio] 2.01; P.001) and late G2/3 + toxicity (18.4% vs 10.1%, OR 2.37; P.001). Higher rates of late G2/3 + toxicity were observed for CVD patients with systemic lupus erythematous (21% vs 9.7%; OR 2.55, P = .03), systemic scleroderma (31.8% vs 9.7%, OR 3.85; P = .03), rheumatoid arthritis (11.7% vs 8.4%, OR = 2.56; P = .008), and those irradiated to the pelvis/abdomen (32.2% vs 11.9%, OR 3.29; P = .001), breast (14.7% vs 4.4%, OR 3.51; P = .003), thorax (12.5% vs 8.7%, OR 3.46; P.001), and skin (14.6% vs 5.2%, OR 2.59; P = .02). Late grade 5 toxicities were significantly higher for patients with CVD, although absolute rates were low (3.9% vs 0.6%, OR = 7.81; P = .01).Moderate and severe toxicities are more likely in patients with CVD, with variable risk depending on toxicity grade, CVD subtype, treatment site, and dose. Severe toxicities are uncommon. These factors should be considered when informing patients of treatment-related risks and monitoring for morbid treatment sequelae.

PURPOSE/OBJECTIVE(S) The standard therapeutic approach for patients with head and neck cancer (HNC) often involves multi-modality therapy including surgery, radiation therapy (RT) or chemoradiation therapy (CRT). Treatment complications include mucositis, weight loss, and feeding tube dependence (FTD) which can result in treatment delays, incomplete treatment, and decreased quality of life (QOL). Recent studies on the effects of photobiomodulation therapy (PBMLT) have demonstrated promising reductions in severity of mucositis but there is a lack of quantitative data demonstrating these effects. In addition, there are few studies evaluating the effect that PBMLT has on other parameters such as weight loss and FTD. We conducted a matched case-control study comparing treatment complications for patients with HNC receiving PBMLT to those who did not, hypothesizing that PBMLT improves mucositis severity, weight loss and FTD. MATERIALS/METHODS Medical records of 44 patients with HNC treated with CRT or RT at a single institution from 2015-2021 were retrospectively reviewed. Twenty-two patients received PBMLT and were matched 1:1 to controls based on age, RT fields, and RT dose. Outcomes included maximum mucositis grade per CTCAE v5.0, weight loss as a percentage of pre-treatment weight, and FTD 100 days after initiation RT or CRT. Outcomes were compared between groups by conducting various statistical tests, including Wilcoxon Rank Sum for weight loss, Fisher's Exact test for FTD at 100 days, and Chi Square for maximum mucositis grade. RESULTS Of 44 patients, the median age was 63.5 years (IQR 12.5). Median RT dose was 60 Gy in the PBMLT group and 66 Gy in the control group. Of patients treated with PBMLT, 11 received CRT and 11 received RT alone. Of control patients, 16 received CRT and 6 received RT alone. For patients in the PBMLT group, the median number of PBMLT treatment sessions was 22 (IQR 6.75). The median maximal mucositis grade was 2 in the PBMLT group compared to 3 in the control group, which was statistically significant (P = 0.0016). The median percent weight loss for PBM patients was 6.7% compared to 7.3% in the control group which was not statistically significant (P = 0.35). Nine patients in the control group required FT placement during RT or CRT, compared to 5 patients in the PBMLT group. The odds ratio of requiring a FT to be placed during treatment for patients receiving PBMLT was 0.385 (95% CI, 0.165 to 0.896). CONCLUSION This study demonstrates that PBMLT may have a role in decreasing complications related to RT and CRT for HNC, mainly mucositis severity. There is also likely benefit in decreasing the rate feeding tube placement during RT or CRT. We conclude that PBMLT has the potential to improve patient adherence to therapy, safety, and QOL during cancer treatment.

PURPOSE/OBJECTIVE(S) The casualties suffered during the opioid epidemic galvanized the development of guidelines intended to reduce inappropriate opioid prescribing. Although acute cancer-related pain was excluded from these recommendations, studies have demonstrated reduced opioid prescribing for cancer patients in recent years, even those hospitalized with advanced disease. It's unclear how the stigma of opioid use disorder (OUD) may further affect inpatient pain management (PM) for patients with advanced cancer. We performed a matched case-control analysis to test the hypothesis that patients with a history of OUD would receive lower quality care for acute cancer-related pain compared to those with no history of OUD. MATERIALS/METHODS Charts from 105 patients with locally advanced or metastatic cancer and a documented history of OUD admitted to a single institution from 2015-2020 were retrospectively reviewed. Hospitalizations were excluded if patients refused opioid treatment or did not have acutely worsening cancer pain on admission. Forty hospitalizations met inclusion criteria. Each hospitalization was matched in a 1:1 ratio by patient age, gender, smoking/alcohol use, and disease extent. Home milligram morphine equivalent per day (MME/day) was calculated from the patient's home medication list at the time of admission. Admission MME/day refers to the average administered MME/day over the course of hospitalization, or if PM specialty was consulted, the average MME/day prior to PM consult. Post-consult MME/day refers to the average MME/day given after PM consult. Wilcoxon signed rank test was performed for statistical comparison. RESULTS A total of 80 hospitalizations (40:40) were matched for 25 patients with a history of OUD and 31 patients with no history of OUD. The median age was 37.5 years (IQR 35-53.8). Cancer was locally advanced for 30% of admissions and metastatic or relapsed for 70% of admissions. The median overall survival was 3.2 months (95% CI 1.91-5.209, P = 0.13) and was not statistically significant between groups. Patients with OUD had a significantly lower median change from home to admission MME/day compared to controls (-3 vs. 37, P < 0.01) and were more likely to have decreased or no change in admission MME/day (OR 7.9, 95% CI 2.8-22.2, P < 0.01) regardless of whether OUD was in documented remission. Similarly, the median change from home to discharge MME/day was lower for patients with OUD (0 vs. 55, P < 0.01). For patients with PM consult, the change from home MME/day to post-consult MME/day did not differ compared to matched controls (26.7 vs 37.5 MME/day, P = .82). CONCLUSION Our results suggest that the stigma of opioid dependence impedes the delivery of compassionate care. Stigma-reduction strategies and early involvement of pain specialists are critical for improving the quality of care for patients with advanced cancer.

Granulosa cell tumors (GCTs) of the ovary are rare, comprising less than 5% of all malignant ovarian neoplasms. While generally considered indolent, GCTs have a tendency for metastasis and delayed relapse, with recurrence developing in 20%-50%. Recurrent or metastatic disease is associated with aggressive behavior and a poor prognosis, as nearly 70% of patients developing recurrence will eventually succumb to their disease. The optimal management of relapsed disease is controversial. Initial salvage therapy typically involves surgical debulking followed by cisplatin-based chemotherapy. Unfortunately, tumor responses are durable for less than half of patients treated with this regimen. Radiation therapy is an attractive option for providing rapid palliation and improving local control without the morbidity of additional surgery or chemotherapy. Here we describe a case of multiply recurrent, rapidly growing intraperitoneal GCT refractory to repeated surgical debulking and several lines of systemic therapy. The patient was treated with two courses of palliative radiotherapy and achieved rapid symptomatic relief, achieving over a 90% reduction in tumor volume. Serum concentration of inhibin B, often inappropriately elevated in patients with GCT, decreased by 98% following irradiation with no interim systemic therapy. At one-year follow-up, the patient has no evidence of radiographic or biochemical recurrence.

Purpose The guinea pig is widely used in studies of refractive error development and myopia which often involve experimental optical manipulations. The study described here investigated the optical quality of the guinea pig eye, for which there are limited data, despite its fundamental importance to understanding visually guided eye growth. Methods The ocular aberrations of eight adolescent New Zealand pigmented guinea pigs (6-11 weeks old) were measured after cycloplegia using a custom-built Shack-Hartmann aberrometer and fit with a Zernike polynomial function to the 10th order (65 terms). The optical quality of their eyes was assessed in terms of individual Zernike coefficients, and data were further analyzed to derive root-mean-square (RMS) wavefront errors, modulation transfer functions (MTFs), point spread functions (PSFs), Strehl ratios, and depth of focus. A 4-mm pupil was used in all computations. The derived data are compared with equivalent data from normal young adult human eyes. Results The guinea pigs exhibited low hyperopia and a small amount of positive spherical aberration, with other aberration terms decreasing with increasing order. Their average depth of focus, estimated from through-focus modulation, was 3.75 diopters. The RMS wavefront error of the guinea pig eye was found to be larger than that of the human eye for the same pupil size, reflecting a higher degree of aberrations, although the PSF (area) on the retina was smaller and sharper due to its shorter focal length. The radial average best-focus MTF derived for the guinea pig eye showed good performance at very low spatial frequencies, with a steeper decline with increasing frequency than for the human eye, dropping below 0.3 at 9 cpd. When converted to linear units (cycles/mm), the guinea pig eye had a higher spatial frequency cutoff and a slight contrast advantage for low spatial frequencies compared to the human eye. Conclusions The optical quality of the guinea pig eye is far superior to their reported behavioral visual acuity. This implies a neuroanatomical limit to their vision, which contrasts with the close match of optical and neural limits to spatial resolution in human eyes. The significance for eye growth regulation of the relative optical advantages exhibited by guinea pig eyes, when optical quality is expressed in linear rather than angular retinal units, warrants further consideration.

Background: Prevalence of gastro-esophageal reflux disease (GERD) in all ages has shown an upward trend over the past decades. The reasons for this increase are ill-understood. The data in the pediatric population is limited. Recent studies have linked childhood GERD to adult GERD. This study was conducted to assess the symptoms, risk factors of GERD among the schoolchildren residing in a rural area. Aims: The aim of this study was to find out the prevalence of GERD risk factors among the school children aged 8-17 years and to find any association between body mass indexes , meal pattern and sleep disturbances related to GERD. Materials and Methods: We did a cross-sectional study on 380 school children of 4 th -10 th standard from 4 schools of Veleru, the Rural Health Center attached to Dr. Pinnamaneni Siddhartha Institute of Medical Sciences. The questionnaire consisted of questions for reflux symptoms, meal pattern and sleep disturbances. Results: The symptoms of reflux like abdominal pain was reported in 7%, heartburn in 1.3%, regurgitation in 2.4%, vomiting in 2.9%, difficulty in swallowing in 2.1%, sore taste in mouth in 0.8% of the children. The risk-factors for reflux like caffeinated drinks were found in 45.3%, very spicy food in 12.1%, heavy meals in 2.4% of the children. Sleep disturbance was seen in 33.4% of the children. Obesity was present in 0.6% of the children. Conclusion: School children should be informed about the symptoms and risk factors of GERD so that healthy dietary habits can be developed at a young age and GERD can be prevented.