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PubMed1993

Cytoplasmic islet cell antibodies recognize distinct islet antigens in IDDM but not in stiff man syndrome.

Cytoplasmic islet cell antibodies are well-established predictive markers of IDDM. Although target molecules of ICA have been suggested to be gangliosides, human monoclonal ICA of the immunoglobulin G class (MICA 1-6) produced from a patient with newly diagnosed IDDM recognized glutamate decarboxylase as a target antigen. Here we analyzed the possible heterogeneity of target antigens of ICA by subtracting the GAD-specific ICA staining from total ICA staining of sera. This was achieved 1) by preabsorption of ICA+ sera with recombinant GAD65 and/or GAD67 expressed in a baculovirus system and 2) by ICA analysis of sera on mouse pancreas, as GAD antibodies do not stain mouse islets in the immunofluorescence test. We show that 24 of 25 sera from newly diagnosed patients with IDDM recognize islet antigens besides GAD. In contrast, GAD was the only islet antigen recognized by ICA from 7 sera from patients with stiff man syndrome. Two of these sera, however, recognized antigens besides GAD in Purkinje cells. In patients with IDDM, non-GAD ICA were diverse. One group, found in 64% of the sera, stained human and mouse islets, whereas the other group of non-GAD ICA was human specific. Therefore, mouse islets distinguish two groups of non-GAD ICA and lack additional target epitopes of ICA besides GAD. Longitudinal analysis of 6 sera from nondiabetic ICA+ individuals revealed that mouse-reactive ICA may appear closer to clinical onset of IDDM in some individuals. Mouse-reactive ICAs, however, remained absent in 36% of the patients at diagnosis of IDDM.

Adolescent↗
PubMedDate not supplied

A randomized clinical trial of a care recommendation letter intervention for somatization in primary care.

PURPOSE: This paper describes the impact of a care recommendation (CR) letter intervention on patients with multisomatoform disorder (MSD) and analysis of patient factors that affect the response to the intervention. METHODS: One hundred eighty-eight patients from 3 family practices, identified through screening of 2,902 consecutive patients, were classified using somatization diagnoses based on the number of unexplained physical symptoms from a standardized mental health interview. In a controlled, single-crossover trial, patients were randomized to have their primary care physician receive the CR letter either immediately following enrollment or 12 months after enrollment. The CR letter notified the physician of the patient's somatization status and provided recommendations for the patient's care. Patients were followed for 24 months with assessments of functional status at baseline, 12, and 24 months. RESULTS: Longitudinal analysis revealed a 12-month intervention effect for patients with multisomatoform disorder (MSD) of 5.5 points (P < .001) on the physical functioning (PCS) scale of the SF-36. Analysis of scores on the MCS scale of the SF-36 found no significant effect on mental functioning. The intervention was more effective for patients with 1 or more comorbid chronic physical diseases (P = .01). CONCLUSIONS: The CR letter has a favorable impact on physical impairment of primary care patients with MSD, especially for patients with comorbid chronic physical disease. Multisomatoform disorder appears to be a useful diagnostic classification for managing and studying somatization in primary care patients.

Alabama↗
PubMed2003

Factors affecting reconstitution of the T cell compartment in allogeneic haematopoietic cell transplant recipients.

The factors affecting T cell reconstitution post haematopoietic cell transplantation (HCT) are not well characterised. We carried out a longitudinal analysis of T cell reconstitution in 32 HCT recipients during the first 12 months post transplant. We analysed reconstitution of naïve, memory and effector T cells, their diversity and monitored thymic output using TCR rearrangement excision circles (TRECs). Thymic-independent pathways were responsible for the rapid reconstitution of memory and effector T cells less than 6 months post HCT. Thymic-dependent pathways were activated between 6 and 12 months in the majority of patients with naïve T cell numbers increasing in parallel with TREC levels. Increasing patient age, chronic GVHD and T cell depletion (with or without pretransplant Campath-1H) predicted low TREC levels and slow naïve T cell recovery. Furthermore, increasing patient age also predicted high memory and effector T cell numbers. The effects of post HCT immunosuppression, total body irradiation, donor leucocyte infusions, T cell dose and post HCT infections on T cell recovery were also analysed. However, no effects of these single variables across a variety of different age, GVHD and T cell depletion groups were apparent. This study suggests that future analysis of the factors affecting T cell reconstitution and studies aimed at reactivating the thymus through therapeutic intervention should be analysed in age-, GVHD- and TCD-matched patient groups.

Adolescent↗
PubMed1990

Cross-sectional versus longitudinal investigations of the diet-cancer relation.

Within a prospective cohort study on diet and cancer, information was collected on cancer prevalence and baseline meat consumption. A nested case-control study on meat and cancer was conducted with 656 prevalent colorectal cases, 1,894 breast cancer cases, and 4,701 controls. When analyzed cross-sectionally, prevalence odds ratios for eating meat rarely versus regularly were 2.08 for female colorectal and 1.75 for breast cancer. In the longitudinal analysis, cases who started consuming meat rarely after diagnosis were excluded, resulting in odds ratios of 0.51 for female colorectal and 1.17 for breast cancer. These opposite findings highlight the problem of cross-sectional designs.

Aged↗
PubMed2000

Surgery versus conservative management in adult isthmic spondylolisthesis--a prospective randomized study: part 1.

STUDY DESIGN: A prospective randomized study was performed. OBJECTIVE: To determine whether posterolateral fusion in patients with adult isthmic spondylolisthesis results in an improved outcome compared with an exercise program. SUMMARY OF BACKGROUND DATA: In spondylolisthesis, satisfactory results have been reported with both surgical and conservative management. The evidence for treatment efficacy, however, is weak because prospective randomized studies are lacking. METHODS: In this study, 111 patients were randomly allocated to an exercise program (n = 34) or posterolateral fusion with or without transpedicular fixation (n = 77). The inclusion criteria were lumbar isthmic spondylolisthesis of any grade, at least 1 year of low back pain or sciatica, and a severely restricted functional ability in individuals 18 to 55 years of age. Pain and functional disability were quantified before treatment and at 1- and 2-year follow-up assessments by visual analog scales (VAS). RESULTS: The 2-year follow-up rate was 93%. The functional outcome, as assessed by the Disability Rating Index and the pain reduction, was better in the surgically treated group than in the exercise group at both the 1- and 2-year follow-up assessments (P < 0.01). In the longitudinal analysis, the mean Disability Rating Index and pain improved in the surgical group (P < 0.0001). In the exercise group, the Disability Rating Index did not change at all, whereas the pain decreased slightly (P < 0.02). CONCLUSIONS: Surgical management of adult isthmic spondylolisthesis improves function and relieves pain more efficiently than an exercise program.

Adult↗
PubMed1986

Timing and magnitude of adolescent growth in height and weight in Cape coloured children after kwashiorkor.

One hundred sixteen patients who had had kwashiorkor between the ages of 5 months and 4 4/12 years and 89 controls were the subjects of a 15-year follow-up study of their growth and development. We report the findings of a longitudinal analysis of 53 (30 females) of the ex-patients and 30 (15 females) of the controls, selected because at the end of 15 years of study they conformed to the criteria of adult secondary sexual characteristics, height velocity less than 2 cm/yr, and completeness of data. Nonlinear curve-fitting techniques were applied to the height and weight data for these subjects using the Preece-Baines model 1 growth function to determine the timing and magnitude of adolescent growth spurts and the associated biologic changes. Both ex-patients and controls grew below the 25th percentile of British longitudinal standards, but the male ex-patients were heavier, and perhaps taller, than the controls for most of their childhood and adolescence. Velocity curves indicated that the ex-patients had higher pre-adolescent peak increments than the controls and a generally longer growth spurt of reduced magnitude. Two possible explanations are discussed: Garrow and Pike's theory that children with kwashiorkor have a genetic potential for greater physical growth, and a socioeconomic crisis occurring within a family affects the youngest child, who subsequently requires a longer time to recover than do siblings within an improving socioeconomic situation.

Black People↗
PubMed1991

12-year clinical course of schizophrenia in hospital and night clinic patients over the period from 1971/1973 to 1983. Longitudinal study from 1971/1973 to 1983.

A sample of 46 schizophrenic patients (26 men and 20 women) from a night clinic (N subjects) with an average age of 21.7 years at the time of first manifestation of the illness and a sample of hospital inpatients (H subjects) matched for diagnosis, sex, and age were followed up from 1971/1973 to 1983. The average age of the patients in 1983 was 40 years. The course of the illness and the pattern of hospitalization were investigated by personally questioning each patient and by scrutinizing all the case history records and other relevant documents; for each clinical cycle of illness, consisting of an overt phase followed by a quiescent interval, a case control sheet was filled out. The duration of illness was 18 years for the N subjects and 15 years for the H subjects. Longitudinal analysis of these years of illness in both patient samples showed a marked decrease in the number and duration of overt phases and stays in hospital, but a progressive aggravation of residual symptomatology during quiescent intervals and a progressively decreasing ability to work and earn a living.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗
PubMed2001

The midgrowth spurt in healthy children is not caused by adrenarche.

A small transient increase in growth, the midgrowth spurt, has been observed in several growth studies in healthy children around the age of 7 yr. During this time adrenarche (the physiological increase in adrenal androgen secretion) also occurs. Although it is now well established that estrogen, not androgen, has a critical role in the male (and female) pubertal growth spurt, a direct effect of androgens on growth cannot be excluded. In accordance with published observations that growth is frequently accelerated in infants and young children with late-diagnosed 21-hydroxylase deficiency (before adequate androgen suppression), it has been speculated that the adrenarchal increase in adrenal androgen secretion in healthy children could be responsible for the midgrowth spurt. To test this hypothesis we studied long-term serial changes in urinary 24-h excretion rates of dehydroepiandrosterone sulfate and total 17-ketosteroid sulfates in a group of healthy children (n = 12) in which yearly auxological measurements allowed the identification of a midgrowth spurt. Annual measurements of standing height were performed over periods of 6-9 yr before the onset of puberty. All children collected five to seven serial 24-h urine samples (1-yr intervals) each at the time of anthropometric examination. The peak of the midgrowth spurt was found to occur at a mean age of 6.8 +/- 1.0 yr. The average height of the midgrowth peak, i.e. average maximum gain in height velocity, was 0.9 cm/yr. In a peak-centered examination of individual 24-h excretion rates of dehydroepiandrosterone sulfate and 17-ketosteroid sulfates, primarily weak 1-yr changes in adrenal androgens were observed until the peak was attained. Only after the peak did increments in urinary adrenal androgen output become more pronounced. ANOVA performed on the peak-centered dehydroepiandrosterone sulfate and 17-ketosteroid sulfate excretion rates revealed a highly significant overall increase in adrenal androgen secretion from 2 yr before to 2 yr after the midgrowth spurt. After multiple testing, however, significant increments, when compared with the respective preceding androgen excretion levels, were for the first time seen 1 yr after the midgrowth spurt (dehydroepiandrosterone sulfate) or 2 yr later (17-ketosteroid sulfates). In conclusion, our longitudinal analysis of prepubertal growth and urinary adrenal androgen excretion in healthy children disproves the speculation that the midgrowth spurt is primarily caused by the adrenarchal increase in adrenal androgen secretion. However, the present results do not rule out a growth-accelerating effect of clearly higher androgen levels, as in premature adrenarche.

17-Ketosteroids↗
PubMed2002

Effects of chronic epilepsy on declarative memory systems.

Memory is systematically affected by temporal lobe epilepsy. Since surgery is a promising alternative to pharmacological treatment the questions which memory system is affected and what the long-term prognosis of memory is are more relevant than ever. We address these issues by cross-sectional and longitudinal analysis of memory performance in large series of patients with temporal lobe epilepsy (TLE). The findings indicate that episodic memory rather than semantic memory is impaired in TLE, in particular in TLE with mesial temporal pathology. With the exception that mesial functions appear increasingly affected by chronic non-mesial TLE, memory decline in TLE is not different from that observed in healthy control subjects. However, since patients perform poorer than controls at any age, normal senescence brings patients to mnesic disability at a younger age. Semantic memory seems unaffected by this process but early cortical lesions appear to interfere with knowledge acquisition. Longitudinal data come to a different conclusion regarding the contribution of epilepsy/seizures to memory decline. Conservative treatment is associated with significant decline in figural memory and 37% of the patients experience some memory decline in the long run. Surgery partly anticipates the decline observed with conservative treatment, but losses are most marked after left temporal lobe surgery. After surgery, quite stable memory or even late recovery from surgery is indicated. Leaving aside the surgical intervention, the data provide evidence that the longitudinal memory outcome in TLE is determined by seizure control, seizure severity, mental reserve capacities, and the retest interval. Thus early and efficient seizure control and the prevention of any cerebral damage from the beginning of epilepsy are demanded.

Epilepsy↗
PubMed1997

Association between vitamin D receptor gene polymorphism and sex-dependent growth during the first two years of life.

An association between vitamin D receptor (VDR) gene polymorphisms and bone mass variance has been observed in adult populations. To analyze possible association between VDR genotype and growth, we studied 589 healthy infants who were homogeneous for age, diet, and vitamin D status. The Bsm I, TaqI, and ApaI alleles' frequencies and genotypes were similar to those reported for Caucasian populations. Variations in Bsm I polymorphism were not associated with calcium intakes nor with serum levels of calcium, 25-hydroxyvitamin D, 1, 25-dihydroxyvitamin D, or alkaline phosphatase activity. But, they were associated with differences in body size. At 2 yr, homozygote BB (BsmI site absent) girls had higher length, weight and body surface area, and inversely, BB boys had lower weight, body mass index and body surface area, than their respective bb counterparts. As a result, gender-related differences were observed in Bb and bb, but not in BB populations. This VDR genotypic effect was observed also at birth and at 10 months in the longitudinal analysis of 145 selected full-term babies homozygous for the Bsm I polymorphism. These findings provide support for the hypothesis that VDR genotype influences intrauterine and early postnatal growth, directly or via interactions with gender-related growth regulators.

Alleles↗
PubMed2002

Chronic and acute effects of "crack" cocaine on diffusing capacity, membrane diffusion, and pulmonary capillary blood volume in the lung.

STUDY OBJECTIVES: To evaluate possible alterations in the diffusing capacity of the lung for carbon monoxide (DLCO) or its components, membrane diffusing capacity of the lung for carbon monoxide (DMCO) and pulmonary capillary blood volume (Vc), in habitual smokers of "crack" cocaine (with or without tobacco) and following the short-term administration of inhaled cocaine base or IV cocaine HCl. DESIGN: Cross-sectional and longitudinal evaluation of DLCO and its components in smokers of cocaine alone, tobacco alone, and cocaine plus tobacco, and in nonsmokers and ex-smokers. Measurement of possible acute effects on DLCO and its components after experimental short-term administration of IV and smoked cocaine. SETTING: University and Veterans Affairs hospital research laboratories. PARTICIPANTS: Convenience sample of habitual smokers of crack cocaine with or without tobacco and matched control nonsmokers and ex-smokers, and smokers of tobacco only. MEASUREMENTS: DLCO, DMCO, and Vc. CONCLUSIONS: Neither habitual cocaine smoking in cross-sectional or longitudinal analysis nor the short-term administration of inhaled alkaloidal cocaine significantly affected DLCO or its component parts. In contrast, a clear cross-sectional effect of regular tobacco smoking was demonstrated.

Adult↗
PubMed1992

Summer and school-term youth employment: ecological and longitudinal analyses.

The effects of summer versus school-year employment on self-esteem, peer relationships, and family social climate were investigated in a sample of 135 adolescents. Students were assessed the summer before entrance into high school and during the second semester of high school, using a longitudinal design. Cross-sectional findings indicated that, during the summer, 52 workers possessed higher self-esteem than 79 nonworkers. Longitudinal analysis indicated that 10 girls who worked only during the school term reported increases in both stress and activity with peers. At our final assessment, the families of 49 students who did not work at either time had become more conflicted and less cohesive than families of all other students. The developmental implications of these results are discussed.

Achievement↗
PubMed2004

Longitudinal changes in cognition and behavior in asymptomatic carriers of the APOE e4 allele.

OBJECTIVE: To determine whether memory loss is detectable before the symptomatic presentation of mild cognitive impairment (MCI) in those at greater genetic risk for Alzheimer disease (AD) based upon presence or absence of the e4 allele of APOE. METHODS: Participants were age 50 years or older who responded to newspaper advertisements. A total of 212 cognitively normal individuals of known APOE genotype were initially enrolled in a match paradigm that included e4 homozygotes, e3/4 heterozygotes, and e4 noncarriers in a 1:1:2 ratio (53 sets). Of the original 212 individually matched participants, 180 completed at least two epochs of testing including 45 APOE e4/4 homozygotes, 42 APOE e3/4 heterozygotes, and 93 APOE e4 noncarriers, mean age 60 (+/-6.2) years. Of these, four developed MCI or AD during the follow-up period and were excluded from analysis. Longitudinal neuropsychological study included two verbal (Auditory Verbal Learning Test [AVLT], Selective Reminding Test [SRT]) and two visual (Complex Figure Test [CFT], Visual Retention Test) memory tests. RESULTS: Multiple measures on both verbal memory tests showed poorer performance over a mean interval of 33 months in e4 carriers than noncarriers: AVLT total learning, long term delayed recall; SRT free and cued recall. Among those age 50 to 59 years, AVLT long term delayed recall, SRT free and cued recall, and CFT recall declined more in APOE e4 carriers. No differences were found in the domains of language, spatial skills, or executive function. CONCLUSIONS: Memory declined in APOE e4 carriers before the symptomatic presentation of MCI in a cohort whose mean age was 60 years over a median period of 33 months. The decline began prior to age 60.

Aged↗
PubMed2005

Effects of New Zealand's health reengineering on nursing and patient outcomes.

BACKGROUND: In 1993, New Zealand (NZ) implemented policies aimed at controlling costs in the country's public health care system through market competition, generic management, and managerialism. The cost control focus was similar to reengineering efforts implemented by other countries struggling with escalating health care costs, particularly the United States. OBJECTIVE: The study's purpose was to examine the effects hospital reengineering may have on adverse patient outcomes and the nursing workforce. RESEARCH DESIGN: The study was a retrospective, longitudinal analysis of administrative data. Relationships between adverse outcome rates and nursing workforce characteristics were examined using autoregression analysis. SUBJECTS: All medical and surgical discharges from NZ's public hospitals (n = 3.3 million inpatient discharges) from 1989 through 2000 and survey data from the corresponding nursing workforce (n = 65,221 nurse responses) from 1993 through 2000 were examined. MEASURES: Measures included the frequency of 11 nurse sensitive patient outcomes, average length of stay, and mortality along with the number of nursing full time equivalents (FTEs), hours worked, and skill mix. RESULTS: After 1993, nursing FTEs and hours decreased 36% and skill mix increased 18%. Average length of stay decreased approximately 20%. Adverse clinical outcome rates increased substantially. Mortality decreased among medical patients and remained stable among surgical patients. The relationship between changes in nursing and adverse outcomes rates over time were consistently statistically significant. CONCLUSIONS: In the chaotic environment created in NZ by reengineering policy, patient care quality declined as nursing FTEs and hours decreased. The study provides insight into the role organizational change plays in patient outcomes, the unintended consequences of health care reengineering and market approaches in health care, and nursing's unique contribution to quality of care.

Adult↗
PubMed2001

Does parental disapproval of smoking prevent adolescents from becoming established smokers?

OBJECTIVE: To evaluate the hypothesis that adolescents are less likely to smoke if their parents voice strong disapproval of smoking. DESIGN AND SETTING: Three-wave school-based cohort study of rural Vermont adolescents attending 3 K-12 schools. We evaluate cross-sectional and longitudinal associations between perceived parental disapproval of smoking and the adoption of smoking behavior. OUTCOME MEASURES: Students' perceptions of their parents' reaction to their own smoking was ascertained by asking the following question for mothers and fathers: "How do you think your mother (father) would react if you were smoking cigarettes and she (he) knew about it?" A response of "S/he would tell me to stop and be very upset" was considered to indicate strong parental disapproval. Outcome measures include a 6-level smoking index for cross-sectional analyses and, for a longitudinal analysis of 372 never smokers at baseline, being an established smoker (smoked > or =100 cigarettes lifetime and within the past 30 days) by survey 3. RESULTS: The study samples for the cross-sectional analyses were 662 (baseline), 758 (year 2), and 730 (year 3). Students were equally distributed across grade (4th-11th grades) and gender. At baseline, most (65.9%) adolescents perceived both parents as disapproving of smoking, with 110 (16.6) perceiving 1 parent as disapproving, and 116 (17.5%) perceiving neither parent as disapproving. Perceived disapproval of smoking was inversely associated with adolescent smoking, grade in school, parental and sibling smoking, friend smoking, and ownership of tobacco promotional items. After controlling for confounding influences, adolescents who perceived strong parental disapproval of their smoking were less than half as likely to have higher smoking index levels compared with those who did not perceive strong parental disapproval. In the longitudinal sample of baseline never smokers, those who perceived strong disapproval in both parents at baseline were less than half as likely to become established smokers (adjusted odds ratio 0.4 [0.1, 1.0]). Those who perceived their parents becoming more lenient over time were significantly more likely to progress to established smokers. In all analyses, the effect of parental disapproval of smoking was stronger and more robust than the effect of parent smoking. In addition, the effect of parent disapproval was as strong for parents who smoked as it was for nonsmoking parents. An interaction analysis suggests that the peer smoking effect is attenuated when both parents strongly disapprove of smoking, suggesting that parent disapproval makes adolescents more resistant to the influence of peer smoking. CONCLUSIONS: These findings contrast with the widespread notion that there is little parents can do to prevent their adolescents from becoming smokers. Instead, adolescents who perceive that both parents would respond negatively and be upset by their smoking are less likely to smoke. Interventions that enhance parental self-efficacy in conveying and enforcing no-smoking policies for their children could reduce adolescent smoking.

Adolescent↗
PubMed2005

Influence of cognitive functioning on functional status in an older population: 3- and 6-year follow-up of the Maastricht Aging Study.

BACKGROUND: To date, it remains unclear to what extent cognitive competence is related to a change in general functional status in older adults. OBJECTIVES: To evaluate both the cross-sectional and the longitudinal relation between cognitive functioning and functional status. METHODS: Sensorimotor speed, memory, and executive functioning were assessed in a large population of healthy adults aged 60 years and older (n = 485) who participated in the Maastricht Aging Study. Data from the baseline (1993-1995), three-year follow-up, and six-year follow-up were used. Functional status was measured using the SF-36, which was coded into a physical and a mental component summary measure. RESULTS: After adjustment for age, sex, and educational level, a high level of cognitive functioning appeared to be associated with better functional status in the cross-sectional analysis. Longitudinal analyses demonstrated, that cognitive functioning was not a predictor of functional status three or six years later. CONCLUSIONS: Thus while cognitive functioning is useful clinically for predicting the short-term functional status of an older person, it is not useful for predicting that person's long-term (>3 years) functional status and thus the period of validity of the results of these tests in answering such questions is limited.

Aged↗
PubMed1996

Factors associated with paranoid symptoms in a community sample of older adults.

Symptoms of paranoia were found in 9.5% of a community sample of older adults in North Carolina. In cross-sectional analyses, these symptoms were associated most strongly with black race, lower income and education, less exercise, and more depressive symptoms. In longitudinal analysis, paranoid symptoms three years following initial interview were predicted by baseline paranoid symptoms, education and depressive symptoms at the initial interview. In blacks, paranoid symptoms may represent an appropriate response to a hostile environment rather than a psychopathic trait.

Activities of Daily Living↗
PubMed2006

Longitudinal study of the relationship between chemoradiation therapy for non-small-cell lung cancer and patient symptoms.

PURPOSE: Cancer patients undergoing aggressive therapy suffer from multiple nonspecific treatment-related symptoms. The goal of this prospective study was to establish a profile of the development of different symptoms over the time of therapy and to examine symptom-related functional interference in patients with non-small-cell lung cancer (NSCLC) undergoing concurrent chemoradiation therapy (CXRT). PATIENTS AND METHODS: Patients with locally advanced unresectable (stage II-IIIB) NSCLC were recruited for the study (N = 64). The M.D. Anderson Symptom Inventory (MDASI) was used to measure multiple symptoms before and weekly for 12 weeks after the start of CXRT. Mixed-effect growth curve models were used to estimate symptom development during CXRT. RESULTS: Approximately 63% of patients suffered from moderate to severe levels of multiple symptoms by the end of CXRT. Symptom clusters with four development patterns appeared over the time of CXRT. With some variation between patients, all symptoms had a significant impact on the level of interference (all P < .001). Fatigue, distress, and sadness were the single strongest predictors of total symptom interference (each R2 > or = 0.49). Physical symptoms had greater impact on interference with function when they were moderate to severe, whereas affective symptoms had the largest effect on interference when they were mild to moderate. CONCLUSION: Longitudinal analysis identified symptom clusters that have different development patterns in NSCLC patients receiving CXRT, providing a base for more accurate symptom management and suggesting the need for further study to identify potential mechanisms that might lead to better symptom control or prevention.

Adult↗