Cox Proportional Hazards Regression Research Articles

Triglyceride-Glucose Index Predicts Instability in the Natural History of Intracranial Aneurysms: Insights From a Large-Scale Chinese Multicenter Cohort.

The triglyceride-glucose (TyG) index is associated with various cerebrovascular diseases. However, the association between the TyG index and the instability (growth or rupture) of unruptured intracranial aneurysms (UIAs) remains underexplored. This multicenter retrospective analysis used data from 2 prospective Chinese cohorts with UIAs. Participants with UIAs were categorized on the basis of TyG (calculated by the Ln (triglycerides [mg/dL]×fasting blood glucose [mg/dL]/2) quartiles. Kaplan-Meier survival analysis was used to estimate survival disparities among the TyG subgroups. Multivariable-adjusted Cox proportional hazards regression models and restricted cubic spline analyses were applied to assess the relationship between the TyG index and the onset of UIA instability. This study included 5484 participants with UIAs with a median TyG index of 8.6 (interquartile range [IQR], 7.6-9.6). During a median follow-up of 57.3 (interquartile range, 50.1-67.1) months, 778 (14.2%) patients developed UIA instability. Restricted cubic spline analysis revealed a linear dose-response relationship between the TyG index and UIA instability risk. The TyG index was positively associated with risk of incident UIA instability after adjusting for potential confounding factors with adjusted hazard ratios of 1.0 (reference), 2.33 (95% CI, 1.72-3.17), 2.01 (95% CI, 2.23-4.05), and 4.39 (95% CI, 3.28-5.88) for TyG index quartiles 2, 3, and 4, respectively. Similar and consistent results were obtained in sensitivity analyses (P<0.001). The TyG index is independently associated with a higher risk of incident UIA growth or rupture, indicating the importance of applying the index in stratifying the instability risk of UIAs.

PO08 | Efficacy and safety of thromboprophylaxis in hospitalized hematological patients: a monocenter retrospective study

Background: Venous thromboembolism (VTE) is a frequent and clinically relevant complication in patients (pts.) with haematological diseases (HDs), with incidence varying according to disease and setting. However, no current risk-assessment models (RAMs) have been developed or validated for hospitalized haematological pts, leaving thromboprophylaxis decisions to clinical judgment, balancing thrombotic and hemorrhagic risks. Aims and Methods: The aims of this study were to evaluate the efficacy and safety of thromboprophylaxis in hospitalized hematological pts. affected by HDs and to assess the predictive performance for VTE of Padua Prediction Score (PPS), one of the most common RAM, in this setting. We used Improve Bleeding Score (IBS) to assess hemorrhagic risk. We retrospectively identified pts. who were admitted for the first time to our Hematology Department between January 1, 2016, and December 31, 2024. Patients with ongoing anticoagulant therapy at any dosage higher than prophylactic ones at admission were excluded. To minimise confounding, we performed a case-control matching to balance baseline characteristic between pts. who received prophylaxis and those who did not. Survival analyses were performed using Kaplan-Meier estimates, Cox proportional hazards regression, and Random Forest Survival modeling. Results: A total of 683 pts. were included. At admission, 206 pts. (30%) were at high thrombotic risk (PPS ≥ 4), and 149 (22%) were at high bleeding risk (IBS ≥ 7). Prophylaxis was administered to 199 pts. (29%): 107 (54%) were PPS-high-risk and 92 (46%) PPS-low-risk. VTE occurred in 21 pts. (3.1%), mostly pulmonary embolism (33%) and catheter-related thrombosis (29%). Notably, 95% of VTE events (20/21) occurred in pts. not receiving prophylaxis. Acute leukemia was the most common diagnosis among VTE cases (16/21, 76%), with a 5.7% incidence in this subgroup. Of 15 haemorrhagic events (HEs), 14 occurred in pts. without prophylaxis. In the IBS-high-risk group, HE incidence was comparable between those receiving and not receiving prophylaxis (5% vs. 8%). PPS showed poor performance in predicting VTE, with area under the ROC curve (AUC) values of 0.56 at day 5 and &lt;0.50 thereafter. Matched analysis based on PPS, IBS, and diagnosis showed that prophylaxis was associated with lower VTE risk, without an increase in bleeding. In pts. not receiving prophylaxis, univariable Cox regression revealed a weak association between length of hospitalization and VTE (HR=1.02, 95% CI 1.02–1.04). No significant associations were found for diagnosis (including acute leukemia), age, or platelet count at admission. To explore the complex interactions, we applied a Random Forest Survival model including the same variables. Feature importance values were as follows: acute leukemia (0.037), age (0.028), multiple myeloma (0.019), platelet count (-0.004), lymphoma (-0.016), and hospitalization length (-0.11). The out-of-bag (OOB) concordance index was 0.435. While the model’s predictive performance was limited, it provided exploratory insight into the relative contribution of covariates to VTE risk. Conclusions: In hospitalized patients affected by HDs, anticoagulant prophylaxis had significantly reduced the incidence of VTE without increasing major or CNS bleeding, even in high bleeding risk subgroups. PPS demonstrated poor predictive accuracy in this setting. These findings support the need to develop a dedicated RAM for haematology inpatients.

Measures of left atrial function and risk of incident atrial fibrillation in patients with heart failure with reduced ejection fraction.

Measures of left atrial (LA) function have demonstrated prognostic value in relation to incident atrial fibrillation. This study aimed to investigate the relationship between measures of LA function and the risk of incident atrial fibrillation (AF) in outpatients with HFrEF. Subjects were retrospectively included from a HF clinic and followed using the Danish National Patient Registry. Measures included LA emptying fraction (LAEF), peak atrial longitudinal strain (PALS), and peak atrial contractile strain (PACS). Prognostic value was assessed with Cox proportional hazards regressions. Effect modification by sex, valve disease, and LA enlargement was assessed using interaction terms. The final study population consisted of 452 subjects (mean age 65.5±11.8 years, male sex 70.1%) free from AF at baseline. During a median follow-up of 9.4 years [IQR: 5.2, 12.7], 118 (26.1%) developed AF. These subjects exhibited higher LAVi, while LAEF, PALS, and PACS were all significantly lower. All three measures of LA function were significantly associated with incident AF in univariable and adjusted Cox regression analysis (Adjusted analysis: LAEF: HR 1.03 per 1% decrease, 95% CI 1.02-1.04, p=0.009, PALS: HR 1.06 per 1% decrease, 95% CI 1.04-1.09, p=0.037, PACS: HR 1.07 per 1% decrease, 95% CI 1.03-1.10, p=0.021). The prognostic value of LAEF was modified by sex and valve disease (p for interaction=0.007 and 0.041, respectively), while the value of PACS was modified by valve disease (p for interaction=0.011). Impaired PALS, LAEF, and PACS were all associated with an increased risk of incident AF in outpatients with HFrEF.

The prognostic importance of features of myometrial invasion in endometrial endometrioid carcinoma

Abstract Purpose The depth of myometrial invasion (MI) is known to have a prognostic value in endometrial carcinoma (EC), and the FIGO 50% cutoff is widely accepted; however, recent studies have suggested other measurements such as the absolute depth of invasion and tumor-free distance (TFD) from the serosal surface to also be predictive. The aim of this study was to assess the association between the FIGO cutoff and other measures with overall survival and disease-free survival of patients. Methods This is a retrospective analysis of a cohort of 248 women diagnosed with stage I endometrioid endometrial carcinoma, treated at Soroka University Medical Center between 2006 and 2020. Clinical and pathological data were collected and analyzed. ROC analysis was used to define the best cutoffs in all three categories (MI, absolute depth and TDF). Survival analyses were then conducted using Kaplan–Meier curves, log-rank tests, and Cox proportional hazards regression. Results Absolute myometrial invasion (MI) to the depth of 1 cm significantly predicted overall survival (log-rank, p = 0.009) in univariate analysis; however, this significance was not maintained in multivariate analysis. Additionally, a 33% MI cutoff demonstrated potential for better outcome prediction as compared to the commonly used 50% MI threshold, though it did not reach statistical significance. Tumor-free distance (TFD) from the serosal surface was not significantly associated with outcome. Conclusions MI depth of more than 1 cm may serve as a meaningful prognostic indicator. Additionally, a cutoff of 33% MI probably has a better prognostic value than the current 50% cutoff. These findings show a promising direction for future research, emphasizing the need for larger cohorts and multicenter studies to confirm our findings.

Metabolic syndrome as a prognostic factor in advanced pancreatic cancer: a predictive model and chemotherapy evaluation.

This study aimed to identify independent prognostic factors for advanced unresectable pancreatic ductal adenocarcinoma (PDAC) and construct a nomogram-based prediction model. The efficacy of different chemotherapy regimens was evaluated based on metabolic risk levels. Clinical data from 276 patients with unresectable PDAC treated between 2020 and 2022 were retrospectively analyzed. Cox proportional hazards regression identified prognostic factors, and survival analysis was performed using Kaplan-Meier methods. A nomogram was developed, and ROC analysis assessed its predictive performance. Two-way ANOVA evaluated chemotherapy efficacy, and TCGA transcriptomic data explored metabolic correlations. Metabolic syndrome (MetS) and distant metastasis were independent prognostic factors. Patients with MetS had significantly shorter survival. The nomogram showed good discrimination (AUC: 0.815 training, 0.793 validation). Patients without MetS had better outcomes with FOLFIRINOX or GS regimens. Transcriptomic analysis revealed metabolic pathways linked to PDAC progression. MetS and distant metastasis significantly impact PDAC prognosis. Patients without MetS benefit more from specific chemotherapy regimens. Our predictive model may aid personalized treatment strategies.

Survival outcomes and prognostic impact of adjuvant chemotherapy in stage IB lung adenocarcinoma with cribriform component.

Cribriform morphology is a distinct high-grade pattern associated with aggressive tumor biology and poor survival outcomes in lung adenocarcinoma (LUAD). The potential survival benefits of adjuvant chemotherapy (ACT) for stage IB LUAD containing cribriform components remain undefined. This study aims to investigate the prognostic significance of ACT in patients with stage IB LUAD containing cribriform components. This retrospective study enrolled 235 surgically resected LUAD patients with pathologically confirmed stage IB disease from Qilu Hospital of Shandong University. To mitigate selection bias, propensity score matching (PSM) was implemented with 1:1 nearest-neighbor matching. Survival outcomes were compared using Kaplan-Meier methodology with log-rank testing for intergroup comparisons. Univariate and Multivariate Cox proportional hazards models were constructed to identify independent prognostic factors. Patients were stratified into cribriform-positive and cribriform-negative cohorts based on histologically confirmed cribriform component status, resulting in 67 patients with cribriform components and 168 patients without this histopathological feature. After PSM, 59 pairs of patients were finally included for analysis. The results showed that both the 5-year overall survival (OS) rates (63.5% vs. 84.5%, P = 0.013) and 5-year recurrence-free survival (RFS) rates (58.7% vs. 77.7%, P = 0.033) for cribriform-positive patients were lower than those for cribriform-negative patients. In addition, we further explored whether patients with cribriform components could derive a survival benefit from postoperative ACT. The results indicated that patients receiving ACT demonstrated a significant improvement in 5-year rates of RFS compared to observation-only management (70.2% vs. 38.6%, P = 0.0096). Univariate and multivariate Cox proportional hazards regression analyses identified the resection range (HR = 0.197; 95% CI: 0.061-0.632; P = 0.006), STAS (HR = 2.653; 95% CI: 1.131-6.221; P = 0.025), and ACT (HR = 0.334; 95% CI: 0.151-0.742; P = 0.007) as independent prognostic factors for RFS. The presence of cribriform components in stage IB LUAD was associated with diminished survival prognosis. Patients with stage IB LUAD containing cribriform components could derive survival benefit from postoperative ACT.

Carbohydrate consumption and cirrhosis-related mortality: a prospective cohort study.

Liver cirrhosis is a chronic liver disease that is often associated with poor prognosis. An important part of the treatment of patients with cirrhosis is related to nutrition. Although carbohydrates constitute the main component of the diet, limited data is available regarding the association of carbohydrate intake with cirrhosis. This study aimed to investigate the relationship between different types of carbohydrates and the risk of mortality in patients with cirrhosis. The current study was conducted as a prospective cohort with a follow-up length of 4 years, on 166 newly diagnosed outpatient cirrhosis patients. Evaluation of dietary intake was conducted using a valid 168-item food frequency questionnaire. Carbohydrate intake was classified into total, sugar, glucose, galactose, fructose, sucrose, lactose and maltose. Cox proportional hazards regression models were used to calculate multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). The comparison of dietary intakes indicated a higher intake of calories and protein and a lower intake of fat and carbohydrates in the survivors. After fully adjustment for confounders, significant associations were observed between different types of carbohydrates and cirrhosis-related mortality: sugar (HR = 4.9, CI 95%: 1.5-11.2, P = 0.014), glucose (HR = 3.4, CI 95%: 1.2-10, P = 0.030), fructose (HR = 1.6, CI 95%: 1.02-3, P = 0.043), sucrose (HR = 2.2, CI 95%: 1.2-4, P = 0.024) and lactose (HR = 0.65, CI 95%: 0.3-0.92, P = 0.044). No significant association was found for galactose and maltose. Mortality in cirrhosis is positively associated with total dietary intake of carbohydrates in addition to sugar, glucose, fructose, sucrose, and negatively associated with dietary intake of lactose. A low carbohydrate diet may help the prognosis of cirrhotic patients.

Time to Progression to Proliferative Diabetic Retinopathy in Patients With Type 2 Diabetes.

Risk stratification of patients at risk of progression to proliferative diabetic retinopathy (PDR) enables earlier detection and more efficient allocation of health care resources. To develop survival models to predict progression to PDR in patients with type 2 diabetes. This prognostic study used deidentified electronic health record data from the University of California (UC) Health Data Warehouse (UCHDW) from March 1, 2012, to July 3, 2024. The UCHDW consists of data on 10 million patients receiving care from the UC Health system. Patients aged 18 years or older with nonproliferative diabetic retinopathy (NPDR) or diabetic macular edema (DME) and type 2 diabetes were included. Patients who had a diagnosis of PDR before the index date or failed to meet the look-back criterion (≥1 outpatient visit at least 1 year before index date) were excluded. The cohort was divided into a development set and an external test set by UC Health site. The development set was split into an internal training set (75%) and test set (25%). The 3 survival models used (Cox proportional hazards regression, Cox with least absolute shrinkage and selection operator [LASSO] regression, and random survival forest [RSF]) were trained on the internal training set and validated on the internal and external test sets. Risk factors included demographics, eye-related diagnoses, systemic comorbidities, laboratory data, vital signs, medications, and procedures. The primary outcome was time from the index date (first diagnosis of diabetic retinopathy recorded in the UCHDW) to the first PDR diagnosis or the last in-person visit. Harrell concordance index (C index) was used to assess the model's predictive performance. Among 7739 participants (mean [SD] age, 66.7 [11.4] years; 4116 males [53.2%]; 1548 Asian [20.0%], 744 Black or African American [9.6%], 1665 Hispanic or Latino [21.5%]; 3278 White [42.4%], 1286 other [16.6%] individuals) were included. Of these patients, 723 (9.3%) had PDR progression with a mean (SD) progression time of 1.89 (2.09) years. All survival models had good predictive discrimination (C index, 0.73-0.75) for the internal and external test sets. The Cox proportional hazards regression and RSF models had good calibration for up to 2 years. Key independent risk factors summarized across all models were baseline age, race, ethnicity, DME, NPDR severity, mean hemoglobin A1c level, and diabetic nephropathy. The survival models developed and validated in this study demonstrated good discrimination across internal and external test sets and good calibration up to 2 years. These models have the potential to enable earlier identification, personalized follow-up, and targeted resource allocation for high-risk patients.

A prospective cohort study on the association of sleep duration and fasting plasma glucose with risk of stroke

Objective: To investigate the association of sleep duration and fasting plasma glucose with the risk of stroke. Methods: A Prospective cohort study. Two towns in Xin'an County, Henan Province were selected as study sites. Using natural villages as the sampling unit, cluster random sampling was used to recruit 20 194 participants in 2007-2008 for the baseline study, and two follow-up studies were completed in 2013-2014 and 2018-2020, respectively. A total of 13 741 eligible participants were included in the analysis. Multivariate Cox proportional hazards regression model was used to assess the association of sleep duration and fasting plasma glucose with stroke risk and the restricted cubic spline was applied to fit the dose-response relationships. Results: The age [M (Q1, Q3)] of 13 741 participants was 51.0 (41.0, 60.0) years, and 5 308 (38.63%) participants were male. Over a median follow-up of 10.18 years, 1 612 incident stroke events were observed. Compared with participants sleeping 7 to<8 h/d, the risk of stroke increased for those sleeping<6 and≥10 h/d, with HR (95%CI) of 1.44 (1.04-2.00) and 1.37 (1.13-1.66), respectively. A U-shaped relationship between sleep duration and stroke risk was observed (Pnonlinear<0.001). Compared to people with normal fasting glucose, the HR (95%CI) of stroke risk was 1.58 (1.36-1.84) for diabetes patients. A nonlinear association between fasting plasma glucose level and stroke risk was observed (Pnonlinear=0.036). Compared to individuals with sleep duration of 7 to<9 h/d and normal fasting glucose, the HR (95%CI) of stroke risk was 1.60 (1.18-2.16) for those with sleep duration<7 h/d and prediabetes, and 2.07 (1.27-3.39) for those with sleep duration<7 h/d and diabetes; the HR (95%CI) of stroke risk was 1.18 (1.01-1.39) for those with sleep duration≥9 h/d and prediabetes, and 1.84 (1.50-2.26) for those with sleep duration≥9 h/d and diabetes. But no significant interaction between sleep duration and fasting plasma glucose was found on stroke risk (P>0.05). Conclusions: Inadequate sleep duration, prolonged sleep duration and elevated fasting plasma glucose level were associated with increased risk of stroke, and the stroke risk was further increased when sleep duration<7 or≥9 h/d coexisted with abnormal fasting plasma glucose states.

Clinical presentation, management, and outcome of TIAN in CNS lymphoma treated with CD19-CAR T-cell Therapy

Clinical presentation, management, and outcome of TIAN in CNS lymphoma treated with CD19-CAR T-cell Therapy

Geriatric Nutritional Risk Index and mortality in individuals with prediabetes and diabetes: a longitudinal cohort study

BackgroundThis study examines the relationship between Geriatric Nutrition Risk Index (GNRI) and all-cause and cardiovascular mortality in individuals with prediabetes and diabetes, aiming to guide clinical nutrition management and extend life expectancy.MethodsWe analyzed a weighted sample of 7,640 individuals with prediabetes and diabetes from the NHANES 2005–2018 and the NCI database. Nutritional status was assessed using the GNRI. Survival outcomes, including all-cause and cardiovascular mortality, were analyzed using Cox proportional hazards regression models and Kaplan–Meier survival curves. Subgroup analyses and restricted cubic spline (RCS) regressions were further conducted to evaluate the robustness and potential nonlinear relationships between GNRI and mortality outcomes.ResultsOver a median follow-up of 8.00 years, 1,210 participants died, including 319 from cardiovascular diseases. Kaplan–Meier curves revealed significantly lower survival rates for both mortalities in participants with low GNRI. Fully adjusted COX regression models revealed a 2.50-fold (95% CI: 2.14–2.92, p &amp;lt; 0.001) increased risk of all-cause mortality and a 2.78-fold (95% CI: 2.04–3.77, p &amp;lt; 0.001) increased risk of cardiovascular mortality in the low GNRI group. These associations remained robust across subgroup analyses. RCS analyses presented nonlinear associations between GNRI and both mortalities (both p-non-linear &amp;lt;0.05, p-overall &amp;lt;0.05).ConclusionGNRI demonstrated a significant, negative, and nonlinear association with all-cause and cardiovascular mortality in US individuals with prediabetes and diabetes, highlighting its utility in improving survival outcomes through nutritional assessment.

Association between neighborhood deprivation and type 2 diabetes risks among asthma patients: a nationwide population-based cohort study

Abstract This study aimed to investigate the potential impact of neighborhood deprivation on the incidence of type 2 diabetes mellitus (T2DM) among individuals with asthma. This nationwide, open cohort study conducted in Sweden from 1997 to 2018 included asthma patients of all ages (n = 1,051,240) to assess their subsequent risk of developing T2DM. The study compared asthma patients residing in highly deprived neighborhoods with those living in moderately or less deprived areas (reference group). Cox proportional hazards regression models were employed to analyze the association between neighborhood deprivation and T2DM incidence, with results expressed as hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses were stratified by sex and adjusted for potential confounders. A significant association between neighborhood deprivation and T2DM risk in asthma patients was shown. These associations remained statistically significant after adjusting for confounders, with adjusted HRs of 1.44 (95% CI 1.38–1.50) for men and 1.51 (95% CI 1.46–1.57) for women. Furthermore, a graded relationship was observed, with higher levels of neighborhood deprivation associated with an increased incidence of T2DM among asthma patients. These findings underscore critical clinical and public health concerns. The results of this study provide valuable insights for policymakers, highlighting the need to consider neighborhood deprivation when allocating resources in primary healthcare settings. They also offer guidance for optimizing clinical care strategies for patients in socioeconomically disadvantaged communities.

Investigating the association between social participation and all-cause mortality risk among Chinese middle-aged and older adults

ObjectiveWhile the association between social participation and all-cause mortality has been investigated to some extent, the link remains inconclusive, especially in China. This study aimed to investigate the association between social participation and all-cause mortality among middle-aged and older adult people in China.MethodsUsing data from the China Health and Retirement Longitudinal Study, and altogether 15,883 participants were included. The Cox proportional hazards regression model was used to assess the relationship between social participation and all-cause mortality, and subgroup analyses were conducted by age (&amp;lt; 60 years, ≥ 60 years) and sex.ResultsWith a median follow-up of 9.01 years, 2,175 participants developed deaths. Results from multivariable Cox regression modeling showed participants who participated in social activities had an all-cause risk of death of 0.88 (HR = 0.88, 95% CI: 0.78, 0.99) compared with those who did not. Further analyses showed that compared with participants with no social participation, those with 1 item of social participation had an all-cause mortality risk of 0.93 (HR = 0.93, 95% CI: 0.81, 1.06), and those with ≥ 2 items were 0.77 (HR = 0.77, 95% CI: 0.64, 0.94). In addition, subgroup analyses showed no age (Pinteraction = 0.571) or sex (Pinteraction = 0.440) differences in the relationship between the both.ConclusionOur results suggest social participation is an independent protective factor for all-cause death among middle-aged and older adult people in China. Active social participation helps to reduce the risk of death.

Napsin A-specific T-cell clonotypes are associated with improved clinical outcomes in patients receiving checkpoint immunotherapy for metastatic non-small cell lung cancer.

Napsin A is normally expressed in human lung pneumocytes and is a highly expressed cancer antigen in lung adenocarcinoma. We examined whether T cells specific for Napsin A may play a role in immune checkpoint inhibitor (ICI)-mediated responses. We used bulk T-cell receptor (TCR) repertoire data to assess whether the presence of Napsin A-specific clonotypes in the peripheral blood was associated with improved clinical responses to ICI. Patients with metastatic non-small cell lung cancer (NSCLC) receiving anti-programmed cell death protein 1 (PD-1) and/or programmed death-ligand 1 (PD-L1) were enrolled at Fred Hutchinson Cancer Center and Stanford University Medical Center (n=62; histology of adenocarcinoma n=48, squamous n=9, NSCLC/other n=5). Peripheral blood mononuclear cells were collected for genomic DNA isolation at one pretreatment and one post-treatment time point (range 3 weeks to 3 months). TCRβ was bulk sequenced via the immunoSEQ platform (Adaptive Biotechnologies). Napsin A-specific TCRβ sequences were identified from publicly available data and their frequencies were quantified in each patient sample. We examined whether overall survival (OS) and progression-free survival (PFS) outcomes differed in patients with or without detectable Napsin A-specific TCRs (herein Napsin TCRs). We used Cox proportional hazards regression to assess the association between detectable Napsin TCRs and PFS or OS in univariable and multivariable analyses. Napsin TCRs were detectable in the blood in a large fraction of our cohort (n=25/62 (40%) pretreatment; n=21/42 (50%) post-treatment). Patients with detectable Napsin TCRs had a significant improvement in OS compared with patients without these TCRs (median OS 45.4 vs 14.8 months, p=0.0043 pretreatment; median OS 55.4 vs 18.9 months, p=0.0066 post-treatment). Among 27 HLA-A*02 carriers of 55 human leukocyte antigen-typed patients (49%), patients with detectable pretreatment Napsin TCRs had a significant improvement in OS (median 60.2 vs 16.5 months, p=0.0054) and PFS (median 21.5 vs 7.2 months, p=0.031) compared with patients without these TCRs. In univariate and multivariate analysis, the presence of Napsin TCRs pretreatment was associated with improved OS (p=0.0057, HR 0.40, 95% CI 0.21 to 0.76 univariate; p=0.033, HR 0.45, 95% CI 0.23 to 0.91 multivariate). Napsin TCRs are frequently detected in patients with NSCLC and are associated with improved OS in patients with NSCLC receiving ICI.

Associations of residential green space and natural environment with heart failure: the mediating effect of air pollution and physical activity.

This study aimed to explore the associations of exposure to residential green space and natural environment with incident heart failure (HF) risk and to investigate the role of PM2.5 and physical activity in these associations. We conducted a prospective study using data from the UK Biobank cohort, which included 437 656 participants. Cox proportional hazards regression models were employed to assess the association between residential exposure and HF risk, adjusting for multiple potential confounding factors. Casual mediation analysis was used to determine the mediation effect of PM2.5 and physical activity. Over a median follow-up of 13.5 years, 16209 cases with HF were recorded. In the fully adjusted models, participants with green space coverage and natural environment coverage at the 300m buffer in the highest tertiles had 13% [hazard ratio (HR) = 0.87, 95% confidence interval (CI): 0.84-0.91] and 12% (HR = 0.88, 95% CI: 0.84-0.91) lower risks of incident HF, respectively. Similar protective associations were observed for green space (HR = 0.87, 95% CI: 0.84-0.91) and the natural environment (HR = 0.85, 95% CI: 0.81-0.88) at the 1000m buffer. PM2.5 and physical activity partially mediated these relationships between residential exposure and HF risk. Increased residential green space and natural environment levels were associated with decreased risk of incident HF, and these associations may be partially mediated by PM2.5 and physical activity.

Impact of body mass index on clinical presentation and prognosis in myasthenia gravis.

The literature lacks consistent information on the correlation between baseline body mass index (BMI), clinical presentation, and prognosis in patients with myasthenia gravis (MG). This observational multicenter prospective cohort study included patients with MG from February 2017 to June 2023, categorizing them by baseline BMI. The primary outcome was the time to generalization of ocular MG. Secondary outcomes included the time to Activities of Daily Living (ADL) response and Minimal Symptom Expression (MSE). Kaplan-Meier curves and multivariable Cox proportional hazards regression models were used to assess the impact of BMI on these outcomes. Out of 940 MG patients (510 women) included, 524 had a low BMI and 416 had a high BMI, with a median age of 50.00 years. Patients in the high BMI group were significantly older (p < 0.001), had a lower percentage of females (p < 0.001), and had a shorter disease duration (p = 0.014) compared to those with a low BMI. They also had higher rates of ocular onset (p < 0.001), ocular MG classification (p = 0.001), and acetylcholine receptor antibody seropositivity (p = 0.007), but a lower incidence of thymectomy (p = 0.027). During a median follow-up of 33.00 months, the adjusted Cox models revealed that a higher baseline BMI was associated with an increased risk of ocular MG generalization (HR 1.06; 95% CI 1.01-1.11; p = 0.026), but not with ADL response (HR 0.99; 95% CI 0.95-1.04; p = 0.779) or MSE (HR 0.97; 95% CI 0.92-1.02; p = 0.240). A higher baseline BMI was associated with an increased risk of ocular MG generalization but not with ADL response or MSE.

The Role of Multiparametric MRI Radiomics for Preoperative Prediction of Axillary Lymph Node Metastasis in Patients With Invasive Breast Cancer: A Comparative Study

ABSTRACTBackgroundThe predictive value of different MRI sequences for axillary lymph node metastasis (ALNM) in patients with invasive breast cancer remains unclear. This study compared the performance of radiomics models based on individual and combined MRI sequences for the preoperative prediction of ALNM and evaluated the clinical application value of the optimal model.MethodsThis retrospective study included 454 patients (mean ± SD age 50.9 ± 10.7 years) diagnosed with invasive breast cancer from two centers, with 382 patients from Center 1 (training cohort) and 72 patients from Center 2 (external test cohort). Tumor segmentation and radiomics feature extraction were performed on T2‐weighted imaging (T2WI), diffusion‐weighted imaging (DWI), and dynamic contrast‐enhanced (DCE) images. The least absolute shrinkage and selection operator with 10‐fold cross‐validation was used for feature selection and radiomics score construction. Three single‐sequence models and one multi‐sequence radiomics model were developed, and the optimal model was combined with conventional MRI features to create a combined MRI model. The combined model's performance was compared to radiologists' diagnoses. A nomogram was developed based on the optimal model and correlated with prognosis using the Kaplan–Meier curve and Cox proportional hazard regression. Model performance was evaluated using area under the curve (AUC); DeLong's test was used for comparison.ResultsIn the external test cohort, the DCE model showed the highest performance (AUC = 0.76) but was not significantly different from T2WI (AUC = 0.72) and DWI (AUC = 0.70) (all p > 0.05). The combined radiomics model achieved an AUC of 0.82, outperforming DWI and T2WI (p < 0.05), but was not significantly different from the DCE model (p > 0.05). The combined MRI model demonstrated the highest AUC of 0.84 and notably improved radiologist diagnostic accuracy. A nomogram based on the combined MRI model was developed to assist clinical decision‐making by providing individualized risk predictions. The higher‐risk group based on the model's predictive probability showed a significantly worse prognosis (p < 0.001).ConclusionThe combined radiomics model outperformed single‐sequence models in predicting ALNM. The combined MRI model demonstrated the highest performance, improving diagnostic accuracy and showing potential for prognostic prediction.

Risk of fragility fracture of pelvis in endometrial cancer survivors : A national claim database study.

This study aimed to evaluate the incidence of fragility fracture of pelvis (FFP) in endometrial cancer survivors and identify associated risk factors using data from the Korean National Claims Database. A total of 6923 endometrial cancer patients were identified between 2007 and 2016 using data from the linkage between the Korea National Health Insurance Service and Korea Central Cancer Registry. The incidence of FFP was estimated and risk factors, such as age, radiation therapy (RT) status, medical institution type, residential area, income level, insurance type, and comorbidities, were assessed using a Cox proportional hazards regression. The overall incidence of FFP was 0.6%, with a higher incidence in patients who underwent RT (0.8%) compared to those who did not (0.5%). However, the difference was not statistically significant (P = 0.355). Older age was significantly associated with an increased risk of FFPs (adjusted HR = 1.101, 95% CI 1.066-1.138; P < 0.001). The incidence of FFP in endometrial cancer survivors was 0.6%, with a slightly higher rate in those who received RT. Older age was a significant risk factor of FFP. These findings emphasize the need for careful detection and management of FFP, particularly in older patients, to improve long-term outcomes in endometrial cancer survivors.

Joint modeling of predictors of adverse drug reactions and viral load changes over time among adult patients on ART at Nigist Eleni Mohammed Memorial comprehensive specialized hospital, central Ethiopia

BackgroundAdverse drug reactions (ADRs) represent a significant global public health concern, contributing substantially to patient morbidity and mortality. While viral load dynamics are known to influence ADRs incidence, this relationship has been insufficiently explored in clinical research. Current evidence is limited by methodological constraints, as most prior studies have analyzed these factors separately rather than employing integrated approaches that account for the endogenous nature of time-varying biomarkers like viral load. Joint modelling techniques offer a robust solution by simultaneously analyzing longitudinal and time-to-event data, providing more efficient and precise estimates of this critical association. This study aimed to determine the incidence and predictors of ADRs and its association with changes in viral load among adult patients on antiretroviral therapy (ART) at Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital (NEMMCSH) of central Ethiopia.MethodsA retrospective follow-up study at NEMMCSH from March 1, 2018 to April 30, 2022 among 376 randomly selected age above 15 years patients who initiated first-line ART and had two or more viral load measurements during follow-up. Data were extracted from medical records and analyzed using joint modeling techniques combining Cox proportional hazards regression with linear mixed effects models. Results are presented as adjusted hazard ratios (aHR) with 95% confidence intervals. Model adequacy was assessed through residual diagnostics, and statistical significance was determined at α = 0.05.ResultA total of 376 adult patients on ART were followed for a combined 45,752 person-months of observation (median follow-up = 23 months; range: 1–50 months), accounting for variability in enrollment dates and censoring events. Overall, 93 patients (26.70%) developed ADRs with an incidence rate of 14.2 per 1000 person-months observation (95% CI: 13.20–15.40). The ART regimen (AZT/3TC/NVP) (AHR = 2.15: 95% CI: 1.01–4.57), TB co-infection (AHR = 0.79: 95% CI: 0.68–0.87) and ART duration (AHR = 0.96: 95% CI: 0.95–0.97) were significant predictors of ADRs. The time-dependent true value of the viral load log was significantly associated with the risk of adverse drug reaction (α = 1.67: AHR = 5.31: 95% CI: 1.64–7.23).ConclusionADRs among HIV patients continue to be a public health concern. Viral load changes were significant associations with the risk of adverse reactions. To reduce ART adverse reactions, we recommend health professionals closely monitor and follow those patients on ART regimens (AZT/3TC/NVP).

Predictive factors for bladder function recovery following cervical OPLL surgery: a comprehensive analysis.

Predictive factors for bladder function recovery following cervical OPLL surgery: a comprehensive analysis.