Vertebral body collapse after spine stereotactic body radiation therapy: a single-center institutional experience.

BACKGROUND: Spine stereotactic body radiation therapy (SBRT) for the treatment of metastatic disease is increasingly utilized owing to improved pain and local control over conventional regimens. Vertebral body collapse (VBC) is an important toxicity following spine SBRT. We investigated our institutional experience with spine SBRT as it relates to VBC and spinal instability neoplastic score (SINS). PATIENTS AND METHODS: Records of 83 patients with 100 spinal lesions treated with SBRT between 2007 and 2022 were reviewed. Clinical information was abstracted from the medical record. The primary endpoint was post-treatment VBC. Logistic univariate analysis was performed to identify clinical factors associated with VBC. RESULTS: Median dose and number of fractions used was 24 Gy and 3 fractions, respectively. There were 10 spine segments that developed VBC (10%) after spine SBRT. Median time to VBC was 2.4 months. Of the 11 spine segments that underwent kyphoplasty prior to SBRT, none developed subsequent VBC. No factors were associated with VBC on univariate analysis. CONCLUSIONS: The rate of vertebral body collapse following spine SBRT is low. Prophylactic kyphoplasty may provide protection against VBC and should be considered for patients at high risk for fracture.

Reciprocal Associations Between Maternal Smoking Cessation and Breastfeeding.

Background: Pregnancy is a motivating factor to quit smoking, but many women relapse postpartum. The underlying mechanisms and the necessary duration of breastfeeding that provide long-term protection against postpartum smoking relapse are unknown. Aims: We aimed to examine (1) associations of smoking cessation with breastfeeding initiation and duration; (2) necessary breastfeeding duration to reduce or prevent risk of postpartum smoking relapse. Methods: In this cohort study, we recruited 55 mothers, either smoking or have quit smoking, who recently delivered their baby from the Greater Buffalo area, NY, USA. Results: Quitters had a higher breastfeeding initiation rate (73.7% versus 30.8%; p = 0.029) and breastfed longer (p < 0.024) than nonquitters. Mothers who never breastfed relapsed quicker than mothers who did (p = 0.039). There was a 28% reduction in smoking relapse at 12 months postpartum for every month longer of breastfeeding duration (confounder-adjusted hazard ratio, 0.72 [95% confidence interval, 0.55-0.94]; p = 0.014). The estimated smoking relapse risk was 60.0% for nonbreastfeeding, 22.4% for 3 months of breastfeeding, 8.4% for 6 months of breastfeeding, and 1.2% for 12 months of breastfeeding. Conclusion: Smoking cessation was associated with increased breastfeeding initiation and duration. Smoking relapse risk decreased with longer breastfeeding duration, and 12 months of breastfeeding may help to prevent smoking relapse. An integrated intervention of maternal smoking cessation and breastfeeding promotion is promising to enhance both behaviors.

Sleep quality and health among pregnant smokers.

STUDY OBJECTIVES: We aimed to examine (1) sleep quality trends of pregnant smokers and (2) their associations with health outcomes. METHODS: A secondary analysis of 88 participants from the University at Buffalo Pregnancy and Smoking Cessation Study (nonrandomized clinical study) was performed. Sleep quality was measured with the Pittsburgh Sleep Quality Index (higher scores, worse quality) and sleep duration was self-reported repeatedly during pregnancy at preintervention, postintervention, and end-of-pregnancy visits. Participants were divided into 3 groups (until preintervention, until postintervention, until end-of-pregnancy). Maternal outcomes included gestational weight gain and smoking cessation. Infant outcomes included birth weight, gestational age, and Apgar score. RESULTS: There was a significant increase (P = .046) in Pittsburgh Sleep Quality Index score from postintervention (mean, 5.5 [standard deviation (SD), 2.6]) to end of pregnancy (6.6 [SD, 2.8]). Mean gestational weight gain was significantly lower for participants with poor sleep quality than those with good sleep quality (19.0 kg [SD, 21.3] vs 36.1 kg [SD, 22.8]; P = .008). Newborns with poor maternal sleep quality had a significantly lower mean 5-minute Apgar score (8.1 [SD, 1.3] vs 9.0 [SD, 0.0]; P = .021) than newborns with good maternal sleep quality. Preintervention sleep quality was not associated with smoking cessation, birth weight, or gestational age. Smoking cessation was almost half as prevalent in participants with insufficient sleep (< 7 hours/night) vs sufficient sleep duration (47.4% vs 92.3%, P = .011). CONCLUSIONS: Sleep quality worsened toward the end of pregnancy among smokers. Poor sleep might negatively influence gestational weight gain and Apgar score. Insufficient preintervention sleep might negatively influence smoking cessation. CITATION: Danilov M, Issany A, Mercado P, Haghdel A, Muzayad JK, Wen X. Sleep quality and health among pregnant smokers. J Clin Sleep Med. 2022;18(5):1343-1353.