5-year Intervals Research Articles

Construction of a PANoptosis-related Prognostic Signature for Predicting Prognosis, Tumor Microenvironment, and Immune Response in Ovarian Cancer.

The PANoptosis pathway is a recently identified mechanism of cellular death that involves the interaction and synchronization among cellular pyroptosis, apoptosis, and necrosis. More and more evidence suggests that PANoptosis is involved in the development and treatment of cancer. However, a comprehensive understanding of the influence of PANoptosis genes on prognostic value, tumor microenvironment characteristics, and therapeutic outcomes in patients with ovarian cancer (OC) remains incomplete. The present work was designed to devise a PANoptosis signature for OC prognosis and explore its potential molecular function. For this study, we obtained RNA sequencing and clinical data for ovarian cancer from the Cancer Genome Atlas (TCGA) and the GSE32062 cohort. Somatic variants of PANoptosis-related genes (PRGs) in OC were analyzed using GSCA. TCGA-OC and GSE32062 were used to construct training and validation cohorts for the model. Differential expression and correlation analyses were performed following the screening of genes with prognostic ability using univariate Cox analysis. Least Absolute Shrinkage and Selection Operator (LASSO) regression was performed to construct PRG signature based on genes that were differentially expressed and correlated with prognosis. CIBERSORT and ESTIMATE were used to analyze the relationship between the PRGs signature and immune infiltration. TIDE was used to analyze the relationship between the PRG signature and immune checkpoint genes. OncoPredict was used to analyze the relationship between the PRG signature and the drug sensitivity. Quantitative real-time PCR (qRT-PCR) was used to validate the expression of PRGs in OC. The PRG signature was constructed using three prognostic genes (AIM2, APAF1, and ZBP1) in both TCGA-OC. The results showed that the PRGs signature had an AUC of 0.521, 0.546, and 0.598 in TCGA-OC and 0.620, 0.586, and 0.579 in GSE32062 to predict to predict OS at 1-, 3-, and 5-year intervals. Furthermore, a higher PRG signature risk score was significantly associated with shorter OS (HR = 1.693, 95% CI: 1.303 - 2.202, p = 8.34 × 10^-5 in TCGA-OC and HR = 1.63, 95% CI: 1.13 - 2.35, p = 0.009 in GSE32062). The risk score was identified as the independent prognostic factor for OC. Patients categorized according to their risk score exhibited notable variations in immune status, response to immunotherapy, and sensitivity to drugs. AIM2, APAF1, and ZBP1 were significantly aberrantly expressed in OC cell lines. The PRG signature has the potential to serve as a prognostic predictor for OC and to provide new insights into OC treatment.

The burden of liver cancer in Mongolia from 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

Liver cancer remains the leading cause of death and public health threat among the Mongolian population. So far, there has been no in-depth analysis to describe the burden of common attributable factors to liver cancer in Mongolia. Therefore, we aimed to explore the most prevalent causes of liver cancer and its trends from 1990 to 2019. We extracted the primary liver cancer data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to examine the mortality and morbidity of liver cancer by its etiological types, which included alcohol, viral hepatitis B and C, and non-alcoholic steatohepatitis (NASH). The data was extracted by sex and 5-year age intervals from 1990 to 2019. Data included mortality, incidence, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of liver cancer among the Mongolian population. Mongolia had the world's highest age-standardized DALYs for liver cancer (2558.1) in 2019. Alcohol-attributable DALYs (786.6) were 29 times higher than the global average (26.1), and liver cancer due to hepatitis C (752.6) and B (763.2) were 21.5 (35.0) and 10.9 (69.1) times higher, respectively. Over the past 30 years, there has been a steady increase in the incidence and number of deaths caused by liver cancer in Mongolia. In 2019, liver cancer incidence due to alcohol consumption was 3.1 times higher for males than females, and hepatitis B was 2.7 times higher for males than females. However, the incidence of hepatitis C and NASH were slightly higher for females. Deaths from liver cancer accounted for 9.51% (2365) of total deaths in Mongolia in 2019, with a continuously increasing trend in the fraction of death compared to 1990, which was 11 times higher than the global average (0.86%), particularly in females with a 319.6% (95% UI 234.9-435.7) increase observed during the study period. Liver cancer due to hepatitis B, C, and alcohol each shared about one-third of liver cancer deaths. A comprehensive analysis of the burden of liver cancer in Mongolia reveals alcohol use as a primary cause of liver cancer mortality, particularly affecting men and significantly impacting the disease burden. Viral hepatitis continues to pose a major public health concern in the country. Although significant milestones have progressed, addressing the unique demographic and geographical challenges requires tailored approaches for specific target populations. The evidence generated from this analysis is crucial to support policy guidance, contribute to evidence-based decisions, guide public health prevention measures, and amplify population health promotion and disease prevention throughout Mongolia.

Transition in Quality Of Life Among Older Patients With Bladder Cancer and Its Association With Treatment: A Clustering Approach

Purpose: To classify older patients with bladder cancer (BC) based on quality-of-life (QoL) measures and explore the clusters transitions over a 2-year period and patient characteristics, BC stages, and treatment. Patients with BC report a significant decline in functional status and QoL. The association of this transition and patient characteristics and treatment over time is not known. We aim to explore this association. Methods: Data were obtained from patients with BC in the SEER-MHOS database (1998-2021). Unsupervised cluster analysis was employed to identify homogeneous clusters of patients with similar functionality based on age, physical and mental component score, and ability to perform activities of daily living. Univariate and multivariable analyses were performed to assess the association of patient characteristics and treatment on cluster transitions over a 2-year interval. Results: The final cohort consisted of 2934 (age 65 or older) older patients with BC. We identified 3 distinct clusters: 67.9% in Cluster 1; 25.4% in Cluster 2; and 6.7% in Cluster 3. After 2 years, 11.7% patients showed improvement and 14% experienced a decline. Cancer/treatment characteristics were not associated with cluster transition. Younger age and being married were identified as factors associated with improvement. Older age, non–homeownership, and last-year fall were associated with transition to less healthy cluster. Conclusions: Over a 2-year interval after BC diagnosis, a quarter of patients will have substantial changes in QoL. No significant association was observed between cluster transition and BC characteristics. Age as well as marital, fall, and homeowner status do impact this transition.

Risk of Biochemical Recurrence and Metastasis in Prostate Cancer Patients Treated with Radical Prostatectomy After a 10-year Disease-free Interval

Background and objectiveProstate-specific antigen (PSA) testing is used to follow up prostate cancer (PCa) patients treated with radical prostatectomy (RP). Research on PSA thresholds for identifying PCa patients with biochemical recurrence (BCR) who are at a higher risk of progression yielded inconclusive results. This study aims to investigate the risk of late BCR in PCa patients treated with RP and long postoperative (120 mo) undetectable PSA follow-up, and to identify prognostic factors for late BCR within this patient cohort. MethodsPCa patients treated with curative RP (1992–2012) and free of BCR during the first 120 mo following RP were retrospectively identified within five European tertiary centers; BCR was defined as two consecutive PSA values of ≥0.2 ng/ml. Kaplan-Meier and Cox regression models tested for an association between BCR and patient or tumor characteristics. Key findings and limitationsThe study cohort consisted of 4639 patients, of whom 243 (5.2%) developed BCR at a medium follow-up of 147 mo. Of those with BCR, 23 (9.5%) subsequently developed metastatic progression. In Kaplan-Meier models, BCR-free survival differed according to advanced tumor status. In multivariable Cox regression models, pT stage (pT3a: hazard ratio [HR]: 1.46; pT3b: HR: 2.42), pathological Gleason score (pGS 3 + 4: HR: 1.71; pGS ≥4 + 3: HR: 2.47), surgical margin (R1/Rx: HR: 1.72), and pNx stage (pNx: HR: 0.72) represented independent predictors for BCR (all p < 0.05). Conversely, age, PSA at diagnosis, and year of surgery failed to achieve independent predictor status for BCR. Conclusions and clinical implicationsAmong PCa patients with an uneventful follow-up of at least 10 yr after RP, still one in 20 patients subsequently develop late BCR. Nevertheless, late BCR and subsequent progression to metastasis (0.3%) rates in patients with pT2 stage and pGS ≤3 + 4 were strikingly low, implicating that abandoning follow-up beyond an uneventful period of 10 yr is justifiable within this cohort of patients. Patient summaryIn this study, prostate cancer patients treated with a radical prostatectomy and at least 10 yr of uneventful prostate-specific antigen testing were identified within five European centers. Relying on these patients, the rate of subsequent late biochemical recurrence was calculated and risk factors were identified for biochemical recurrence following 10 yr of uneventful prostate-specific antigen testing.

Temporal Trends in Takotsubo Syndrome: Results From the International Takotsubo Registry

BackgroundThe perception of takotsubo syndrome (TTS) has evolved significantly over the years, primarily driven by increased recognition of acute complications and mortality. ObjectivesThis study aimed to explore temporal trends in demographic patterns, risk factors, clinical presentations, and outcomes in patients with TTS. MethodsPatients diagnosed with TTS between 2004 and 2021 were enrolled from the InterTAK (International Takotsubo) registry. To assess temporal trends, patients were divided into 6 groups, each corresponding to a 3-year interval within the study period. ResultsOverall, 3,957 patients were included in the study. There was a significant demographic transition, with the proportion of male patients rising from 10% to 15% (P = 0.003). Although apical TTS remained the most common form, the diagnosis of midventricular TTS increased from 18% to 28% (P = 0.018). The prevalence of physical triggers increased from 39% to 58% over the years (P < 0.001). There was a significant increase in 60-day mortality over the years (P < 0.001). However, a landmark analysis excluding patients who died within the first 60 days showed no differences in 1-year mortality (P = 0.150). ConclusionsThis study of temporal trends in TTS highlights a transition in patients demographic with a growing prevalence among men, increasing recognition of midventricular TTS type, and increased short-term mortality and rates of cardiogenic shock in recent years. This transition aligns with the rising prevalence of physical triggers, as expression of increased recognition of TTS in association with acute comorbidities.

Greenhouse gas emissions during the rice season are reduced by a low soil C:N ratio using different upland-paddy rotation systems

ContextUpland-paddy rotation can improve multiple-cropping index and crop yields; however, the mechanisms underlying the effects of dry-season crop diversification on rice yields and greenhouse gas (GHG) emissions under multiple rotation systems remain unclear. ObjectiveHere, we aimed to clarify the intrinsic mechanisms whereby rice yields and GHG emissions respond to the diversification of dry-season crops and lay a theoretical foundation for developing agronomic measures that can stabilize yields and reduce GHG emissions. MethodsUsing a positioning experimental site for upland-paddy rotation, we measured rice-season CH4 and N2O emissions, crop yields, GHG-emission intensity (GHGI) levels, soil physical and chemical properties in garlic–rice (GR), wheat–rice (WR) systems for 3 years (2019–2020, and 2022), and in a rapeseed–rice (RR) system for 1 year (2022). The soil microbial dynamics of the three systems were only tested in 2022. ResultsThe WR system had the highest CO2 emission equivalent (CO2-eq), with a 3-year interval value of 1898.24–16794.30 kg·ha−1, the lowest yield (8490.10–9773.46 kg·ha−1), and the highest GHGI (0.22–1.83). The GR system had the highest rice yield (9718.91–10769.75 kg ha−1), a lower CO2-eq (1588.55–12567.51 kg·ha−1), and therefore a lower GHGI (0.16–1.24). The RR system had the lowest GHGI in 2022 (benefiting from the lowest CO2-eq) and a slightly higher yield than that of the WR system. CH4 contributed to >88 % of the CO2-eq under the three systems in 2020 and 2022. The higher soil C:N ratio of the WR system stimulated methanogenic microorganisms, coupled with higher microbial biomass C levels, and ultimately increased CH4 emissions substantially. The soil C:N ratios of the GR and RR systems were significantly lower than that of the WR system because the soil total nitrogen (TN) of both systems was higher and increased CH4 emissions were avoided. The higher levels of N nutrients (TN, NO3--N, and NH4+-N) in the GR and RR systems also enhanced rice yields, with respective increases of 10.37 % and 1.22 %, compared with that of the WR system. ConclusionsThe diversified cultivation of dry-season crops in upland-paddy rotation systems affected rice yields and GHG emissions by changing the ratios of C and N. ImplicationsOur findings highlight the importance of future research involving comprehensive agronomic measures to help reduce emissions, including fertilizer management, straw management, and tillage methods.

Effects and Thresholds of Young to Midlife Vascular Risks on Brain Health.

Vascular risk factors, particularly hypertension, are important contributors to accelerated brain aging. We sought to quantify vascular risk factor risks over adulthood and assess the empirical evidence for risk thresholds. We used SBP (systolic blood pressure) and diastolic blood pressure, total cholesterol, fasting blood glucose, and body mass index measurements collected from participants in the CARDIA study (Coronary Artery Risk Development in Young Adults) at 2- to 5-year intervals through year 30. The Montreal Cognitive Assessment and domain-specific cognitive tests were performed at year 30. White matter hyperintensity volume was measured by magnetic resonance imaging. We used a 2-step method to fit longitudinal vascular risk factor exposures to optimized spline functions with mixed-effects models, then used the participant-specific random effects that characterized individual exposures over time in cross-sectional models adjusted for sex, race, age, and education to study effects on midlife brain health. Change in SBP up to 33 years of age was negatively associated with Montreal Cognitive Assessment scores (-0.29 Montreal Cognitive Assessment Z score per mm Hg/y change [95% CI, -0.49 to -0.09]; P=0.005), with similar effects for SBP changes from 33 to 49 years of age (-0.08 [95% CI, -0.16 to 0.01]; P=0.08). We observed comparable, significant associations between SBP exposure during those ages, midlife performance on specific cognitive domains, and volume of white matter hyperintensity (all P<0.05). SBP ≤111 mm Hg was the estimated threshold below which no harmful association with midlife cognitive performance was identified. SBP in early adulthood is the vascular risk factor most strongly associated with midlife cognitive performance and white matter hyperintensity burden, with SBP 111 mm Hg suggested as a harm threshold.

A mathematical simulation model to determine the optimal endoscopic screening strategy for detection of H. pylori-naïve gastric neoplasms.

The effectiveness of esophagogastroduodenoscopy (EGD) screening in cohorts with low Helicobacter pylori prevalence is unknown. This study aimed to develop an optimally efficient EGD screening strategy for detecting H. pylori-naïve gastric neoplasms (HpNGNs). EGD data of 12 institutions from 2016 to 2022 were retrospectively analyzed. Age-related HpNGN prevalence, tumor growth rate, missing rate, and detection threshold size were calculated from the databases. Subsequently, using clinical data, a novel mathematical model that simultaneously simulated demographic changes and HpNGN detection was developed. Screening strategies using different starting ages (40/45/50years) and intervals (2/5/10years) were also compared. The detection rates of all tumors occurring within the virtual cohort and number-needed-to-test (NNT) were measured as outcomes. Data of 519,368 EGDs and 97 HpNGNs (34 pure signet ring cell carcinomas, 26 gastric adenocarcinomas of the fundic gland type, 30 foveolar gastric adenoma-Raspberry type, and seven undifferentiated-type cancer cases) were analyzed. A virtual cohort with a 70-year time horizon was used to simulate the occurrence, growth, and detection of 346,5836 people. Among the strategies with detection rate > 50%, the screening strategy with a 5-year interval starting at 45years of age had the lowest NNT. Adopting this strategy, most HpNGNs were detected at < 20mm in size, and the deep submucosal invasion rate was less than 30%. A mathematical simulation model revealed that screening every 5years starting at 45years of age could efficiently assist in identifying HpNGNs at an early stage.

Exploring the relationship between vitamin D and hepatic carcinoma in individuals diagnosed with hepatitis B virus infection

ObjectiveThe primary objective of this study is to examine the distribution and prognostic implications of serum vitamin D levels among individuals diagnosed with primary hepatic carcinoma (PHC) attributable to hepatitis B virus (HBV) infection. MethodsA total of 345 patients diagnosed with HBV infection were enrolled in our hospital between August 2014 and October 2020. Among these, 144 individuals were diagnosed with chronic hepatitis B (CHB), 66 individuals were diagnosed with HBV-related hepatic cirrhosis (HBV cirrhosis), and 135 individuals were diagnosed with HBV-related PHC (HBV-PHC). Peripheral serum levels of vitamin D were measured. Patients with cirrhosis underwent examination using the Child–Pugh grading system, and the mortality rates at 1-year and 3-year intervals for patients with HBV-PHC were analyzed. ResultsVitamin D levels in peripheral serum in the CHB group, HBV cirrhosis group, and HBV-PHC group exhibited varying degrees of reduction compared to healthy individuals. Significant differences were observed between the three groups (F = 4.02, P = 0.019). No significant difference was observed in vitamin D levels between different Child–Pugh grades within the HBV cirrhosis group (F = 0.89, P = 0.417). However, significant differences were observed in vitamin D levels between different Child–Pugh grades within the HBV-PHC group (F = 4.84, P = 0.009). There was no significant difference in 1-year and 3-year mortality rates between patients diagnosed with HBV-PHC and with varying vitamin D levels (P > 0.05). ConclusionsVitamin D levels decreased to varying degrees in patients diagnosed with CHB, HBV cirrhosis, and PHC. This decrease was well correlated with disease progression (HBV-PHC group < HBV cirrhosis group < CHB group). In cases where hepatic function was comparable, there was no discernible correlation between serum vitamin D level and mortality rates from PHC.

Effect of Cannabis Usage on Thyroid Eye Disease.

The purpose of this study is to investigate the association between cannabis usage and thyroid eye disease (TED) in patients with autoimmune hyperthyroidism. While the association between cigarette smoking and TED is well established, the effect of cannabis on TED is unclear. This cohort study examined data from TriNetX, an electronic health record platform, for patients with autoimmune hyperthyroidism between December 1, 2003, and December 1, 2023. Primary outcomes were TED presentation (exophthalmos, eyelid retraction, eyelid edema, orbital edema, strabismus, and optic neuropathy) and treatment (teprotumumab, methylprednisolone, tarsorrhaphy, and orbital decompression) in cannabis users, nicotine users, and control patients. Propensity matching was performed to control for characteristics such as age, sex, race, prior thyroidectomy, and/or radio ablation. Relative risk between cohorts was calculated for each outcome in 6-month, 1-year, and 2-year intervals following diagnosis of autoimmune hyperthyroidism. Of 36,186 patients with autoimmune hyperthyroidism, 783 were cannabis users, 17,310 were nicotine users, and 18,093 were control patients without cannabis or nicotine usage. Compared with control patients, cannabis users were more likely to be younger, male, and Black/African American and have anxiety or depression. After propensity matching, cannabis users were 1.9 times more likely to develop exophthalmos (p = 0.03) and 1.6 times more likely to develop any TED presentation (p = 0.049) in the 1-year interval although these differences did not remain statistically significant in the 2-year interval. Cannabis users had a significantly increased risk for TED outcomes in the 1-year interval. Further research is needed to inform TED management.

Effect of transjugular intrahepatic portosystemic shunt insertion on waitlist mortality and access to liver transplantation in budd-chiari syndrome.

The impact of transjugular intrahepatic portosystemic shunt (TIPS) on waitlist mortality and liver transplantation (LT) urgency in Budd-Chiari Syndrome (BCS) patients remains unclear. We analyzed BCS patients listed for LT in the UNOS database(2002-2024) to assess TIPS's impact on waitlist mortality and LT access via competing-risk analysis. We compared trends across two phases:Phase1(2002-2011) and Phase2(2012-2024). Of 815 BCS patients, 263(32.3%) received TIPS at listing. TIPS group had lower MELD-Na scores(20vs22,p<0.01), milder ascites(p=0.01), and fewer Status1 patients(those at risk of imminent death while awaiting LT)(2.7%vs8.3%,p<0.01) at listing compared to those without TIPS. TIPS patients had lower LT rates(43.3%vs56.5%,p<0.01) and longer waitlist times(350vs113d,p<0.01). TIPS use increased in Phase2(64.3%vs35.7%,p<0.01). Of 426 transplanted patients, 134(31.5%) received TIPS, showing lower MELD-Na scores(24vs27,p<0.01) and better medical conditions(Intensive care unit:14.9%vs21.9%,p<0.01) at LT. Status1 patients were fewer (3.7%vs12.3%,p<0.01), with longer waiting days(97vs26d,p<0.01) in TIPS group. TIPS use at listing increased from Phase1(25.6%) to Phase2(37.7%). From Phase1 to Phase2, ascites severity improved, re-LT cases decreased(Phase1:9.8%vsPhase2:2.2%,p<0.01), and cold ischemic time slightly decreased(Phase1:7.0vsPhase2:6.4 hours,p=0.14). Median donor body mass index significantly increased. No significant differences were identified in patient/graft survival at 1-/5-/10-year intervals between phases or TIPS/non-TIPS patients. While 90-day waitlist mortality showed no significant difference(p=0.11), TIPS trended towards lower mortality(subHazard ratio[sHR]:0.70[0.45-1.08]). Multivariable analysis indicated that TIPS was a significant factor in decreasing mortality(sHR:0.45[0.27-0.77],p<0.01). TIPS group also showed significantly lower LT access(sHR:0.65[0.53-0.81],p<0.01). Multivariable analysis showed that TIPS was a significant factor in decreasing access to LT(sHR:0.60[0.46-0.77],p<0.01). Sub-group analysis excluding Status1 or HCC showed similar trends. TIPS in BCS patients listed for LT reduces waitlist mortality and LT access, supporting its bridging role.

Runoff Control Performance of Three Typical Low-Impact Development Facilities: A Case Study of a Community in Beijing

The development of sponge cities advocates for sustainable urban rainwater management, effectively alleviating urban flood disasters, reducing non-point-source pollution, and promoting the recycling of rainwater resources. Low-Impact Development (LID) serves as a key strategy in this context, providing essential support for urban rainwater control and pollution reduction. To investigate the runoff control effects of LID measures and to reveal the relationship between facility runoff control performance and installation scale, this study focuses on a sponge community in Beijing. A SWMM model was constructed to analyze the rainwater flood control and pollutant load reduction effects of different LID facilities, including bio-retention cells, green roofs, and permeable pavements. Using evaluation indicators such as surface runoff, node overflow, and pollutant control rates, this study examined how facility performance varies with installation scale under different rainfall conditions. The combination scheme of LID equipment optimal configuration is designed by using multiple criteria decision analysis (MCDA) and cost–benefit theory. The results indicate significant differences in performance among the various LID facilities across different rainfall scenarios. Specifically, the optimal installation proportion for runoff and overflow control of permeable pavements were found to be between 30% and 70%. Green roofs demonstrate superior performance in handling extreme rainfall events, while bio-retention cells exhibit significant effectiveness in controlling Total Suspended Solids (TSSs). Through comprehensive performance evaluation, this study identified the optimal combination scale under a 3-year rainfall recurrence interval as 30% permeable pavements, 20% green roof, and 60% bio-retention cells. This combination effectively leverages the strengths of each facility, ensuring system stability and efficiency while also demonstrating optimal management efficiency in cost–benefit analyses. The findings of this research provide valuable insights for future urban water management and infrastructure development.

Hepatic Insulin Resistance Increases Risk of Gallstone Disease in Indigenous Americans in the Southwestern United States.

Animal models indicate that hepatic insulin resistance (IR) promotes cholesterol gallstone disease (GSD). We sought to determine whether hepatic and whole-body IR is associated with incident GSD. At baseline, 450 Southwestern Indigenous American adults without GSD were included. Participants had a 2-step hyperinsulinemic-euglycemic clamp with glucose tracer at submaximal and maximal insulin stimulation (240 and 2,400 pmol/m 2 /min) for whole-body IR (M-low and M-high) and hepatic glucose production (HGP) before and during submaximal insulin infusion (HGP-basal and HGP-insulin). Incident GSD was identified during follow-up visits conducted at ∼2-year intervals. The associations of HGP (basal, insulin, and % suppression), M-low, and M-high with risk of GSD were assessed by Cox regression models adjusted for age, sex, body fat (%), glucose, and insulin. Sixty participants (13%) developed GSD (median follow-up: 11.6 years). Participants who developed GSD were of similar age and whole-body IR as those who did not ( P 's > 0.07) but were more likely to be female; have higher body fat, higher HGP-basal, and HGP-insulin; and lower % suppression of HGP ( P 's < 0.02). In separate adjusted models, higher HGP-insulin and lower % suppression of HGP were associated with increased risk for GSD (hazard ratio [HR] per SD: HR 1.38, 95% CI 1.12-1.69, P = 0.002; HR 1.41, 95% CI 1.16-1.72, P = 0.0007). HGP-basal, M-low, and M-high were not associated with GSD in adjusted models ( P 's > 0.22). Resistance to insulin suppression of HGP increases risk for GSD. Hepatic IR is a link between GSD and other conditions of the metabolic syndrome.

Evidence-based radiology 5years on-a single-centre review of image referral appropriateness.

The iRefer guidelines provide evidence-based recommendations on imaging and are designed to facilitate appropriate referrals and limit unnecessary radiation exposure. In 2017, a review at this institution assessed the appropriateness of imaging referrals. This study provides an update 5years later on the referral appropriateness and aims to assess what impact the previous review has had on referral appropriateness. A retrospective study of 945 referrals across GPs, ED, and inpatients was audited against the iRefer guidelines with costs and cumulative dose estimates calculated for inappropriate referrals considering salaries of those involved, the average time spent performing and reporting radiographs, and the median effective dose values. Results show a decrease in the volume of requests overall with the relative proportion of inappropriate requests rising significantly. Inappropriate requests for abdominal X-rays from GPs decreased from 72 to 37.5%, whereas inappropriate ED referrals increased from 38 to 46% and inappropriate inpatient requests remained static at 30%. The proportion of inappropriate GP requests for spinal radiographs significantly increased for cervical, thoracic, and lumbar spine radiographs, respectively (18 to 66%; 47 to 72%; 53 to 80%; p-value < 0.001). Inappropriate radiographs represent an increased financial and dose-based burden. The volume of radiograph requests reduced after over a 5-year interval; however, the relative proportion of inappropriate requests rose significantly. The iRefer guidelines provide a useful resource to ensure that imaging is used appropriately, effectively, and safely; however, more work is needed to ensure that requests are adhering to these guidelines.

Detecting cell types and densities in the tumor microenvironment improves prognostic risk assessment for breast cancer.

A comprehensive evaluation of the relationship between the densities of various cell types in the breast cancer tumor microenvironment and patient prognosis is currently lacking. Additionally, the absence of a large patch-level whole slide imaging (WSI) dataset of breast cancer with annotated cell types hinders the ability of artificial intelligence to evaluate cell density in breast cancer WSI. We first employed Lasso-Cox regression to build a breast cancer prognosis assessment model based on cell density in a population study. Pathology experts manually annotated a dataset containing over 70,000 patches and used transfer learning based on ResNet152 to develop an artificial intelligence model for identifying different cell types in these patches. The results showed that significant prognostic differences were observed among breast cancer patients stratified by cell density score (P = 0.0018), with the cell density score identified as an independent prognostic factor for breast cancer patients (P < 0.05). In the validation cohort, the predictive performance for overall survival (OS) was satisfactory, with area under the curve (AUC) values of 0.893 (OS) at 1-year, 0.823 (OS) at 3-year, and 0.861 (OS) at 5-year intervals. We trained a robust model based on ResNet152, achieving over 99% classification accuracy for different cell types in patches. These achievements offer new public resources and tools for personalized treatment and prognosis assessment.

Comparison of human hair cortisol concentration stability for 1-year and 2-year test-retest intervals.

Human hair cortisol concentration (HCC) has previously been found to be highly stable for a 1-year interval (r=0.73) in terms of a product-moment correlation. The present study aimed to replicate this finding and compare HCC stability regarding 1-year and 2-year test-retest intervals. Female university students (N=39) provided hair strands twice (t1 and t2) at intervals of 1 (n=21) or 2years (n=18). Multiple regression analysis predicting HCC at t2 revealed a significant interaction term (HCC at t1 × time interval condition). It was determined that HCCs were substantially related for the 1-year interval but unrelated for the 2-year interval. The findings were not attributable to potential influences, such as hair treatment. The product-moment correlation showed nearly identical consistency with previous research regarding the 1-year test-retest interval. There was no significant product-moment correlation for the 2-year interval. Overall, these findings indicate that within a temporal framework of 1year, HCCs may be stable predictors in correlational studies where the focus is on the rank orders of measured values.

Histopathological Grading based on Tumor Margin according to BI-RADS Mammography in Breast Cancer

Highlights: The highest distribution of breast cancer patients’ age based on the 5-year age interval was 45- 49 years old. There was no significant difference between tumor margin and age of breast cancer patients. There was no significant difference between tumor margin and histopathological grade. Abstract Introduction: Mammography is an X-ray technique used to take images of the breast. It is the primary diagnostic method for breast tumors. Breast imaging reporting and data system (BI-RADS) classification is needed to determine benign or malignant masses by accessing the mass's shape, margin, density, and other features. However, the tumor margin is the most helpful one. This study aimed to know the difference in the distribution of tumor margin types in each histopathological grading in breast cancer patients. Methods: This was an observational analytic study with a comparative approach using secondary data from medical records of patients with breast cancer at the radio diagnostic and anatomical pathology installation of Dr. Soetomo General Acadamic Hospital, Surabaya, from January 2017 to December 2021. All statistical data were performed using the International Business Machines Corporation (IBM) Statistical Package for Social Sciences (SPSS) version 27. Results: Out of 235 cases, the highest distribution of breast cancer patients’ age interval was 45-49 years old (20.9%), the primary tumor margin type was spiculated (64.3%), and the highest distribution of histopathological grading was grade 3 (53.2%). There was no significant difference between tumor margin and age of breast cancer patients (p = 0.815), with spiculated tumor margin as the most common type in all age intervals. There was no significant difference (p = 0.163) in the distribution of tumor margin types in each histopathological grading, with spiculated tumor margin as the most common type in every grade. Conclusion: There was no significant difference between tumor margin and age of breast cancer patients, and there was no significant difference between tumor margin and histopathological grading.

Cost-effective endoscopic screening for gastric cancer in a cohort with low Helicobacter pylori prevalence.

Periodic endoscopic screening for gastric cancer (GC) is widely performed in East Asia; however, the optimal screening strategy remains unclear. This study aimed to determine the most cost-effective endoscopic screening strategy for the detection and treatment of GC in a cohort with a low Helicobacter pylori prevalence. The following data were retrospectively extracted from participants who received screening endoscopy between April 2019 and March 2023: age, H. pylori infection status, presence of intestinal metaplasia, pathological diagnosis of GC, and the interval between the most recent endoscopies. A Markov state transition model was constructed based on the cohort data. The cost-effectiveness of 15 strategies with different starting ages (40/50/60years) and screening intervals (1/2/3/4/5years) was compared. The net monetary benefit (NMB) and incremental cost-effectiveness ratio (ICER) of quality-adjusted life-years gained by treatment were used as outcomes. A simulation model was constructed based on the cohort data of 94 137 participants (mean age 54.5years, males 57.9%; 74.4% H. pylori-naïve, 94.2% intestinal metaplasia-negative). The results of the base-case analysis showed that the screening strategy of 4-year intervals starting at the age of 40years had the highest NMB (97 401 578 yen). In both the Monte Carlo simulation and one-way sensitivity analysis with a varying probability of H. pylori infection status transition, the ICER was superior in the screening strategy every 4years, starting at age 40years. Our simulation showed that endoscopic screening at 4-year intervals starting at the age of 40years was the most cost-effective method.

The road to a world-unified approach to the management of patients with gastric intestinal metaplasia: a review of current guidelines

ObjectiveDuring the last decade, the management of gastric intestinal metaplasia (GIM) has been addressed by several distinct international evidence-based guidelines. In this review, we aimed to synthesise these guidelines and...

Global, regional, and national burden of early-onset gastric cancer.

The burden of gastric cancer (GC) across different age groups needs updating. We determined the GC global, regional, and national burden profiles and changes in incidence for 3 sequential 5-year intervals from 2003 to 2017. The latest incidence and mortality estimates of GC from 185 countries and regions were extracted from the GLOBOCAN 2022 database. The 5-year interval age-standardised incidence rates (ASIRs) were evaluated using cancer registry data from volumes X-XII of the Cancer Incidence in Five Continents (CI5). Correlation analysis was used to evaluate the relationship between ASIR or the age-standardised mortality rate (ASMR) and the Human Development Index (HDI). There was an estimated global 968,000 new GC cases and 660,000 deaths in 2022, with male predominance. GC ASIRs and ASMRs were 9.2 and 6.1 per 100,000 persons, respectively. East Asia had the highest burden, with 53.8% of cases and 48.2% of deaths among all geographic regions. There was a significant correlation between ASIR and HDI. Over three 5-year intervals from 2003 to 2017, the incidence of GC notably decreased in most countries but peaked at 2008-2012 in New Zealand, Turkey, and South Africa. Several countries in Europe, Oceania, and America suggest an increasingly concerning trend among younger individuals, especially females. GC is a significant health issue, especially among males and in geographic regions with an HDI, such as eastern Asia. While the incidence of GC is decreasing in many countries due to prevention efforts and improved treatments, a rising trend persists among younger individuals. Comprehensive prevention strategies tailored to different age patterns are clearly needed.