Dead Patients Research Articles

Expression of lncRNA DLX6-AS1 in patients with hepatic carcinoma and its prognostic value

ABSTRACT Hepatic carcinoma (HCC) is one of the most common malignant tumors worldwide, and the prognosis of HCC patients is often poor. Long-chain non-coding RNA (lncRNA) distal-less homeobox 6 antisense 1 (DLX6-AS1) has been shown to be involved in the pathogenesis of various cancers. This study aims to investigate the expression of DLX6-AS1 in HCC patients and its prognostic value. The serum DLX6-AS1 was quantified using a reverse transcription-polymerase chain reaction (RT-PCR) assay in both HCC patients and healthy individuals, and the correlation of DLX6-AS1 with clinicopathological features of HCC patients, as well as the diagnostic and prognostic value of DLX6-AS1 for HCC patients, were analyzed. The results showed that the expression of serum DLX6-AS1 in HCC patients was significantly higher than that of healthy individuals (P < 0.05), and DLX6-AS1 was related to tumor differentiation, pathological staging, and lymph node metastasis (all P < 0.05). Patients with high DLX6-AS1 expression showed significantly higher mortality than those with low DLX6-AS1 expression, and the DLX6-AS1 expression in dead patients was significantly higher than that in living patients. Furthermore, the AUC of DLX6-AS1 for poor prognosis of HCC patients was larger than 0.8. The univariate analysis revealed that the poor prognosis of HCC patients was related to pathological staging, lymph node metastasis, differentiation, and DLX6-AS1 expression (all P < 0.05), and the Cox multivariate analysis revealed that pathological staging, lymph node metastasis, differentiation, and DLX6-AS1 expression were independent risk factors for poor prognosis of HCC patients (all P < 0.05). These findings suggest that DLX6-AS1 may be a promising target for diagnosis, treatment, and prognosis prediction of HCC patients.

Analysis of disease burden of occupational pneumoconiosis in Gansu Province from 2010 to 2020

Objective: Through comparative analysis of the disease burden of occupational pneumoconiosis in Gansu Province from 2010 to 2020, the main influencing factors are screened, and scientific basis is provided for rational allocation of limited health resources, precise management and policy implementation. Methods: In August 2021, survey and collect information on surviving occupational pneumoconiosis patients and dead occupational pneumoconiosis patients diagnosed in Gansu Province from 2010 to 2020, and analyze and calculate indicators such as morbidity, mortality, and disability adjusted of life years (DALY). Analyzing the influencing factors of disease burden usirrg multiple linear regression. Results: From 2010 to 2020, the average annual incidence of occupational pneumoconiosis in Gansu Province was 0.9992/100000, the average annual mortality was 0.897/100000, the cumulative case fatality rate was 25.75%, and the cumulative DALY was 28932.96 person-years. The first stage of occupational pneumoconiosis was the highest among DALY loss (19920.14 person-years), and the DALY loss was positively correlated with the stage of occupational pneumoconiosis. Among occupational pneumoconiosis in Gansu Province, silicosis (13753.66 person-years) and coal worker's pneumoconiosis (13414.73 person-years) caused the highest disease burden, followed by cement pneumoconiosis and asbestos lung. Period, length of service, type of disease, and region are all influencing factors of DALY loss (P<0.05). Conclusion: From 2010 to 2020, the DALY losses caused by occupational pneumoconiosis in Gansu Province showed a fluctuating decrease, with the composition of DALY mainly changing from the loss of life years due to premature death to the loss of years due to injury and disability.

Deaths by COVID-19 in a hospital from a city from Legal Amazon region: what lessons could be learned?

Objectives: Describe the epidemiology of COVID-19 deaths within a hospital in the Amazon region in a period of 64 days, which corresponds to the growth curve of the COVID-19 first-wave pandemic in 2020. Methods: The data were obtained from medical records of 152 deaths registered for adults and elderly hospitalized. The data were also compared with the number of deaths in previous years during the same period studied to assess the impact of the pandemic on this hospital. The study also assesses the impact of intra-hospital transfers, accounting for the number of times patients who died performed transfers between sectors of the hospital. Results: During the period analyzed, there was an increase in deaths compared to the previous years. The majority of dead patients were male, aged between 34 and 96 years. The deaths were associated comorbidities such as arterial hypertension, diabetes mellitus, and kidney disease. The SARS-CoV-2 infection was confirmed in 91 cases. Among them, 15 individuals were admitted without conditions related to SARS-CoV-2 infection; they had a three-fold higher number of hospital transfers than those admitted with SARS-CoV-2 infection symptoms. Sixteen patients with SARS-CoV-2 infection developed respiratory symptoms just after hospitalization. The diagnostic exam for SARS-CoV-2 infection was performed on average 4 (± 6) days after the onset of symptoms and 6 (± 6) days after admission, and the average time from the onset of respiratory symptoms to death was 4 (± 6) days. Conclusions: These data suggest the high presence of hospital infection by SARS-CoV-2 in the Brazilian Amazon region, which may be related to the number of sectorial transfers, delay in confirming the diagnosis, and lack of management. We report a serious public health problem, as it demonstrates the fragility of healthcare institutions in the hospital environment.

New compartment model for COVID-19

The SIR or susceptible-infected-recovered model is the standard compartment model for understanding epidemics and has been used all over the world for COVID-19. While the SIR model assumes that infected patients are identical to symptomatic and infectious patients, it is now known that in COVID-19 pre-symptomatic patients are infectious and there are significant number of asymptomatic patients who are infectious. In this paper, population is separated into five compartments for COVID-19; susceptible individuals (S), pre-symptomatic patients (P), asymptomatic patients (A), quarantined patients (Q) and recovered and/or dead patients (R). The time evolution of population in each compartment is described by a set of ordinary differential equations. Numerical solution to the set of differential equations shows that quarantining pre-symptomatic and asymptomatic patients is effective in controlling the pandemic.

The sCD14-ST predictive value in the development of adverse outcomes in operated colorectal cancer patients (diagnostic study).

For the period 2020-2021, 90 operated CRC patients were examined. Patients were divided into two groups: 1 - 50 patients operated on for CRC without acute bowel obstruction (ABO); 2 - 40 patients operated on for tumor ABO caused by CRC. To determine sCD14-ST by the ELISA (enzyme-linked immunosorbent assay) method, venous blood was taken 1h before surgery and 72h after it (third day). sCD14-ST levels were higher in CRC patients with ABO, organ dysfunction, and dead patients. If the sCD14-ST level on the third day after surgery is greater than 520pg/ml, the risk of a fatal outcome is 12.3 times higher than at its lower level [odds ratio (OR): 12.3, 95% CI: 2.34-64.20]. With the increase in the sCD14-ST level on the third day after surgery from baseline or its decrease by no more than 8.8pg/ml, the risk of organ dysfunctions is 6.5 times higher than with its greater decline (OR: 6.5, 95% CI: 1.66-25.83). This study has demonstrated that in CRC patients, sCD14-ST can be used as a predictive criterion for the development of organ dysfunction and death. Significantly worse results and prognosis were observed in the patients with higher levels of sCD14-ST on the third day after surgery.

The association between vitamin D intake with inflammatory and biochemical indices and mortality in critically ill patients with COVID-19: A case-control study.

The coronavirus disease-2019 (COVID-19) has become a worldwide health issue with widespread hospitalization and dependence on the intensive care unit (ICU). Vitamin D has a key role in modulating immune cells and modulating the inflammatory responses. This study aimed to investigate the association of vitamin D supplementation with inflammatory, biochemical, and mortality indices in critically ill patients with COVID-19. This case-control study was conducted on critically ill COVID-19 patients hospitalized in the ICU including the survived >30 day patients as the case group and dead patients as the control group. The status of vitamin D supplementation and inflammatory and biochemical indices of the patients were retrieved from the medical records. Logistic regression method was used to assess the association between 30 days survival and vitamin D supplement intake. Compared to the group of COVID-19 patients who died in <30 day, the survived patients had a lower eosinophile level (2.2 ± 0.5 vs. 6 ± 0.0, p < .001) and higher vitamin D supplementation duration (9 ± 4.4 vs. 3.3 ± 1.9 day, p = .001). Vitamin D supplementation had a positive association with survival in COVID-19 patients (OR: 1.98, 95%CI:1.15-3.40, p < .05). The association remained significant after adjustments fot age, sex, underlying diseases,and smoking. Vitamin D supplementation in critically ill patients with COVID-19 has the potential to increase survivability within the first 30 days of hospitalization.

The effects of the prognostic biomarker SAAL1 on cancer growth and its association with the immune microenvironment in lung adenocarcinoma

BackgroundInhibition of Serum Amyloid A-like 1 (SAAL1) expression could inhibit cancer progression and improve the prognosis of cancer patients. At present, the correlation between SAAL1 and lung adenocarcinoma (LAC) remains unclear. Therefore, this study surveyed the worth and pathway of SAAL1 in LAC progression and immunity.MethodsBioinformatics and immunohistochemistry were used to identify the SAAL1 expression in LAC. The roles of SAAL1 expression in the existence values of LAC patients were explored, and the nomograms were constructed. Clinical values of SAAL1 co-expressed genes were evaluated by COX regression, survival, and Receiver operating characteristic (ROC) analysis. EDU and western blotting methods were used to inquiry the functions and pathways of the SAAL1 in cell growths. The correlation between the SAAL1 level and immune microenvironment was visualized using correlation research.ResultsSAAL1 level was elevated in LAC tissues, and was observed in cancer tissues of dead patients. SAAL1 overexpression had something to do with shorter overall survival, progression-free interval, and disease-specific survival in LAC. The area under the curve of SAAL1 was 0.902 in normal tissues and cancer tissues. Inhibition of SAAL1 expression could inhibit cancer cell proliferation, which may be related to the decreased expression of cyclin D1 and Bcl-2 proteins. In LAC, SAAL1 level had something to do with stromal, immune, and estimate scores, and correlated with macrophages, T cells, Th2 cells, CD8 T cells, NK CD56dim cells, DC, eosinophils, NK CD56bright cells, pDC, iDC, cytotoxic cells, Tgd, aDC cells, B cells, Tcm, and TFH levels. SAAL1 overexpression had something to do with existence values and the immunity in LAC.ConclusionsInhibition of SAAL1 expression could regulate cancer growth via cyclin D1 and Bcl-2. SAAL1 is a promising prognostic biomarker in LAC patients.

Mortality across the spectrum of hemoglobin level in patients undergoing surgical coronary revascularization

Preoperative hemoglobin (Hb) level is a predictor of in-hospital and midterm mortality in patients undergoing coronary artery bypass grafting surgery (CABG). However, the debate about the different hazards across Hb levels and sex differences in outcome occurrence is still on the table. This is a registry-based serial cross-sectional study at Tehran Heart Center. Nonanemic patients who underwent CABG with complete follow-up data were included. The Restricted Cubic Splines (RCS) in the Cox model was used to calculate the sex-specific correlation between in-hospital, 6-month, and 1-year mortalities and normal Hb levels using odds ratio for the in-hospital and hazard ratios for 6-month and 1-year mortality, adjusted for all possible confounders. From 2005 to 2016, a total of 13,557 patients were included, of which 134 had in-hospital mortality as our primary outcome. Preoperative Hb levels were significantly lower in the deceased. Moreover, dead patients had significantly higher rates of diabetes and hypertension, while lower ejection fraction. Cut-offs for reference Hb level were higher for males compared with females. The correlation between Hb level and in-hospital mortality was nearly U-shaped. Quantitatively, Hb of ≥15.62 and ≤13.25 g/dL for men and that of ≥14.92 and ≤13.4 g/dL for women tended to be associated with higher in-hospital mortality. The association between preoperative Hb level and in-hospital mortality differs in men and women and does not follow a linear correlation among nonanemic patients. Both low and high numbers in the Hb level spectrum are at greater risk.

Prediction of In-Hospital Outcomes in Patients with Traumatic Brain Injury Using Computed Tomographic Scoring Systems: A Comparison Between Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems

This study aimed to compare the prognostic value of Marshall, Rotterdam, and Neuroimaging Radiological Interpretation Systems (NIRIS) in predicting the in-hospital outcomes of patients with traumatic brain injury. We identified 250 patients with traumatic brain injury in a retrospective single-center cohort from 2019 to 2020. Computed tomography (CT) scans were reviewed by two radiologists and scored according to three CT scoring systems. One-month outcomes were evaluated, including hospitalization, intensive care unit admission, neurosurgical procedure, and mortality. Logistic regression analysis was performed to identify scoring systems and outcome relationships. The best cutoff value was calculated using the receiver operating characteristic curve model. Eighteen patients (7.2%) died in the 1-month follow-up. The mean age and Glasgow Coma Scale of survivors differed significantly from nonsurvivors. Subarachnoid hemorrhage and compressed/absent cisterns were dead patients' most frequent CT findings. All three scoring systems had good discrimination power in mortality prediction (area under the receiver operating characteristic curve of the Marshall, Rotterdam, and NIRIS was 0.78, 0.86, and 0.84, respectively). Regarding outcome, three systems directly correlated with unfavorable outcome prediction. The Marshall, Rotterdam, and NIRIS are good predictive models for mortality and outcome prediction, with slight superiority of the Rotterdam in mortality prediction and the Marshall in intensive care unit admission and neurosurgical procedures.

Characteristics and Outcomes of COVID-19 Patients with Diabetes Mellitus at the University of Muhammadiyah Malang General Hospital

The number of confirmed cases of COVID-19 in East Java is 590,531 (9,41% of total national confirmed cases)\. The death toll in the province is 31,774. Diabetes Mellitus (DM) can cause systemic complications such that COVID-19 patients with DM have a high risk of serious illness and mortality. The characteristics and outcomes of COVID-19 patients with DM at the University of Muhammadiyah Malang General Hospital have never been reported before. Data were taken from medical records at the University of Muhammadiyah Malang General Hospital. The diagnosis of COVID-19 was obtained from a positive PCR swab. DM diagnosis was made by studying the patient history of DM or Random Blood Glucose (RBG) &gt;200 mg/dL or HbA1c &gt;7% sampling. Characteristics of the patients were age, gender, length of treatment, history of DM, and adherence to DM control. The supporting examinations were leukocytes, platelets, O2 saturation, RBG, HbA1c, CRP, and D-dimer, which were grouped into two groups: recovered and dead. Data were analyzed with the SPSS version 28. COVID-19 patients with DM from June 2020 to May 2021 were 206 (23.09%) out of 892 confirmed COVID-19. The majority of cases occurred in men (51.5%) and occurred in the age range of 51-60 years (38.3%). The number of patients who died was 38 (18.4%). The average platelet value was 286,191, the average leukocyte value was 7804, the average oxygen saturation was 90%, the average HbA1c value was 9.4%, the average CRP value was 68.99mg/L, and the average D-dimer value is 13,39ng/mL There was a significant difference in oxygen saturation and D-Dimer between recovered and dead patients. There were no significant differences in the results of other investigations.&#x0D; Keywords: COVID-19, DM, mortality, University of Muhammadiyah Malang General Hospital

The Comparative Evaluation of Hospitalized Elderly Patients with COVID-19 from the Onset of the Disease to Recovery and Death in Iran

Background &amp; Objectives: Numerous studies have shown that the risk of death is higher in elderly patients with COVID-19. In Iran, due to the growth of the elderly population and the prevalence of underlying diseases, it is necessary to pay attention to this age group of patients. In this study, clinical, radiological, PCR, and laboratory data of elderly patients with COVID-19 were collected and analyzed in two groups of recovered and dead patients.Materials &amp; Methods: This is a retrospective study of 196 consecutive elderly patients with COVID-19 hospitalized from March 21, 2020, to April 3, 2020, and their follow-up until April 23, 2021. Clinical characteristics, laboratory results, PCR, chest CT scans and Hounsfield Unit data were collected and analyzed in two groups of recovered and dead patients. Obtained Data were analyzed using SPSSv22.0 and MATLAB-R2017 software.Results: The results showed that there were no specific symptoms to distinguish the death group from the recovery group. Significant differences were observed between the two groups for red blood cell counts, hemoglobin, MCHC and MCV levels, bilirubin, aminotransferase levels, CRP, white blood cells, serum BNU, creatinine and PT coagulation index. The concentrations of VBG (HCO3) and VBG (PCO2) in the deceased patients suggest compensated respiratory alkalosis. CT sensitivity is 100% for patients in advanced and severe stages of the disease.Conclusion: The patients in the death group had more underlying diseases than the recovered group. COVID-19 patients are more likely to die when they have both diabetes and cardiovascular disease.

Comparison of the predictive value of the modified CADILLAC, GRACE and TIMI risk scores for the risk of short-term death in patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention

To establish a modified controlled abciximab and device investigation to lower late angioplasty complication (CADILLAC) score, and to compare the predictive value of modified CADILLAC score, the global registry of acute coronary event (GRACE) score and the thrombolysis in myocardial infarction (TIMI) score in predicting the risk of short-term death after percutaneous coronary intervention (PCI) in patients with acute ST segment elevation myocardial infarction (STEMI). A retrospective study was conducted. The clinical data of 169 STEMI patients under going PCI admitted to the department of cardiology of Guizhou Provincial People's Hospital from September 2019 to December 2020 through emergency chest pain fast track were enrolled. A multivariate Logistic regression analysis was used to screen the factors closely related to the mortality risk within 30 days of STEMI, and a modified CADILLAC scoring system was established by referring to CADILLAC scoring settings. The score of modified CADILLAC, GRACE and TIMI scores of patients were calculated after admission, and the number of deaths due to cardiovascular disease (CVD) within 30 days after onset was recorded. The receiver operating characteristic curve (ROC curve) was used to evaluate the predictive value of three scoring systems on the risk of death within 30 days after PCI in patients with STEMI. In 169 STEMI patients, 16 patients died of CVD within 30 days after PCI, and the actual case mortality was 9.47%. Multivariate Logistic regression analysis showed that age > 75 years old, cardiac function Killip ≥ Grade III, ventricular arrhythmia, ST segment elevation ≥ 0.2 mV, cardiac troponin I (cTnI) increase, systolic blood pressure (SBP) < 90 mmHg (1 mmHg ≈ 0.133 kPa) were all independent predictors of death after PCI in STEMI patients. The improved CADILLAC scoring system was constructed based on the above predictive factors combined with left ventricular ejection fraction (LVEF) less than 0.40. The GRACE, TIMI and modified CADILLAC scores of dead patients were significantly higher than those of survival patients (GRACE score: 197.60±31.83 vs. 149.81±36.72, TIMI score: 11.21±2.13 vs. 7.27±1.97, modified CADILLAC score: 12.60±2.52 vs. 6.96±2.17, all P < 0.05). The higher the risk stratification of the three scores, the higher the mortality of patients with CVD within 30 days after PCI [the mortality of patients with low, medium and high risk in GRACE score were 2.41% (2/83), 9.61% (5/52) and 26.47% (9/34); the mortality of patients with low, medium and high risk in TIMI score were 3.12% (3/96), 12.82% (5/39) and 23.53% (8/34); and the mortality of patients with low, medium and high risk in modified CADILLAC score were 3.19% (3/94), 7.69% (4/52) and 39.13% (9/23), respectively, all P < 0.01]. The area under the ROC curve (AUC) of the GRACE, TIMI and the modified CADILLAC scores predicting the risk of death 30 days after PCI in STEMI patients were 0.855 [95% confidence interval (95%CI) was 0.702-0.923], 0.725 (95%CI was 0.666-0.812) and 0.882 (95%CI was 0.732-0.936), respectively, all P = 0.000; the sensitivity of its prediction accuracy were 81.59%, 78.65% and 89.26%, and the specificity were 78.62%, 57.12% and 75.54%, respectively. The GRACE and the modified CADILLAC scores have predictive value for the short-term mortality risk of STEMI patients after PCI, and the modified CADILLAC score is more accurate. But the TIMI score has a poor predictive effect on the short-term mortality risk of STEMI patients after PCI.

Abstract PD4-04: PD4-04 A quantitative spatial analysis of microenvironmental biomarkers for breast cancer outcome

Abstract Background: Understanding breast cancer progression and the relationships among biomarkers in the tumor and tumor microenvironment could go beyond established prognostic markers of breast cancer. Poor response and recurrence may indeed be a consequence of the highly heterogeneous spatial distribution of biomarkers within cancers, and/or the synergistic and antagonistic relationship between co-localized biomarkers. Recently, mechanical and physical microenvironmental signatures have emerged as relevant in determining cancer aggressiveness and invasiveness. This suggests that physical structures in the tumor tissue may drive favorable immune-tumor-stroma cell patterns. However, current assessment of tumor biopsies is limited in the ability to quantify and spatially resolve several different subtypes of cells and biomarkers within tumors. Methods: We developed a 60-marker imaging mass cytometry panel to resolve high-plex spatial patterns of cells, signaling, and microenvironmental biomarkers within tumor tissues. Our panel includes 16 tumor markers, 20 immune markers and 24 microenvironmental markers. We built an innovative computational tool to identify recurring spatial patterns of these markers within the tumor microenvironment, and define the spatial scale of heterogeneity of such patterns. We correlated the results from this spatial analysis to prospectively collected long term clinical outcome variables (e.g. 10 year survival, local and distant recurrence) in primary breast cancers sampled at baseline. Our patient cohort comprised 287 samples of patients treated with surgery and a radiation, chemotherapy, endocrine therapy, or combinations of these post-surgery. Of these, 174 were from patients alive 5 years post diagnosis, and 113 from patients lost to breast cancer deaths. Living patients were evaluated for recurrence, and of these 94% were disease free at the end of the study, while 4% had local recurrence and 2% distant metastasis. Of the dead patients, 59% had local recurrence while 27% had distant metastasis. Results: We investigated first all patients independent of tumor subtype; in this analysis the presence of both endothelial (CD31+) or HLADR+ cells were consistently associated with long term survival. We further investigated the distribution of all 60 markers in Lum A, Lum B, Lum like, Her2+ and triple negative subtypes. Among the results we confirmed the prognostic role of known biomarkers such as p53+ as a biomarker for poor survival in Luminal B. We also identified complex microenvironmental patterns associated with outcome. For example, the presence of PD1+ cells in collagen rich environments were generally associated with long terms survival in Luminal B patients. With our spatial analysis tool we further investigated intra-patient and inter-patient spatial distribution and classified clusters predictive of outcome beyond heterogeneity. We found that beyond the mere positivity of each marker, the spatial distribution and co-localization of different immune, tumor and mechanical markers determines long term outcome in different subtypes. Specifically, we investigated the role of vimentin within different microenvironments and tumor subtypes. We identified the co-localization of hCa9 and vimentin as strongly associated with poor 5 year outcome, independent of tumor subtype. Moreover, in Luminal A patients while the presence of clusters exclusively positive for vimentin was associated with poor survival, vimentin co-expression with β actin and co-localization of XBP1+ cancer cells and immune cells in a collagen matrix was associated with longer survival. Conclusion: These results suggest the importance of mechanics and physics in determining spatial distribution of tumor-promoting and tumor-inhibiting immune cells, offering new avenues of physics-based therapeutic targets. Citation Format: Sara Nizzero, Maria Pelaez Soni, Yitian Xu, Licheng Zhang, Junjun Zheng, Brian A. Menegaz, Lee B Jordan, Colin A Purdie, Philip R Quinlan, Chandandeep Nagi, Karla A Sepulveda, Philipp Oertle, Tobias A Appenzeller, Marko Loparic, Zhihui Wang, Shu-Hsia Chen, Vittorio Cristini, Marija Plodinec, Alastair M. Thompson. PD4-04 A quantitative spatial analysis of microenvironmental biomarkers for breast cancer outcome [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD4-04.

Neural network analysis of tumor and germline profiling to predict survival of muscle-invasive bladder cancer following radical cystectomy: An analysis of the Cancer Genome Atlas (TCGA).

546 Background: Following radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC), recurrence is suboptimally associated with pathologic stage. A prognostic model that incorporates information from comprehensive genomic and transcriptomic data from germline and tumor tissues will improve the selection of high-risk patients (pts) for adjuvant therapy and tailored surveillance. Methods: Pts with MIBC in TCGA who underwent RC (without neoadjuvant chemotherapy) and with whole exome sequencing (WES) of tumor + normal, and tumor RNA-Seq were eligible. Germline variants were called and annotated using GATK4 and Variant Effect Predictor (VEP). Only high and moderate VEP-Impact variants contributed to burdens. Given that recurrence is associated with 5-year survival, pts were required to have data for survival at a landmark of 5 years post-RC or may have died within 5 years of RC. Patients who died &lt;4 months of diagnosis were excluded since they may have died from post-operative complications. Dead patients were propensity-matched against alive patients by pathologic stage, adjuvant chemotherapy, gender, race, age and smoking. A linear artificial neural network was trained to predict 5-year survival using Artificial Intelligence Quality Control (AIQC)-a deep learning experience tracker. The samples were divided into 3 equally distributed subsets of alive and dead pts. The algorithm was trained on 50% of the dataset, evaluated on 40% and tested on 10%. The remaining 39 dead pts were used for additional holdout validation. The accuracy (percentage of correct prediction of death or survival) was reported. Results: A cohort of 117 pts were evaluable for 5 year survival. The cohort included 39 survivors that satisfied inclusion criteria, and 78 dead pts that were propensity matched against them (one set of 39 dead pts for training &amp; evaluation, and a second set of 39 dead pts as an additional holdout). The binary classification neural network was trained on 38 samples to predict survival based on their most differentiated: germline alteration burdens + tumor alteration burdens + tumor gene expression. The differentially mutated genes most important to the algorithm were: PTPRN(n-m), TECTA(t-m), BPIFB1(n-m), SORL1(n-m), SLC39A5(n-m), and RBBP6(n-h) [t=tumor/ n=normal tissue origin | m=moderate/ h=high VEP impact]. The algorithm was 97% accurate on the 38 training samples, and 94% accurate across the 79 evaluation (validation, test and holdout) samples. Conclusions: Neural network analysis of germline and tumor profiling was validated to optimally differentiate between dead and surviving pts at 5 years following RC for MIBC. Further validation and application of this promising algorithm may advance precision medicine by permitting the selection of the most appropriate pts with high-risk MIBC for adjuvant therapy.

Liver Injury in Favipiravir-Treated COVID-19 Patients: Retrospective Single-Center Cohort Study.

(1) Background: Favipiravir (FVP) is a new antiviral drug used to treat COVID-19. It has been authorized to be used in the kingdom of Saudi Arabia in the treatment of COVID-19. The mechanism of action of FVP is working as a specific inhibitor for the RNA-dependent RNA polymerase of the RNA chain virus. FVP has the potential to be hepatotoxic because of the structure similarity with pyrazinamide. This retrospective study aimed to determine the prevalence of liver injury in FVP-treated COVID-19 patients in General East Jeddah Hospital, Saudi Arabia, during the COVID-19 pandemic. (2) Methods: A total of 6000 patients infected with COVID-19 and treated at the East Jeddah Hospital were included, with a sample size of 362 patients. The participants ranged from 18 to 70 years of age, both males and females, with normal hepatic and renal function and had a confirmed diagnosis of COVID-19 infection. Patients who had gouty arthritis, hepatic and renal dysfunction, dead patients, pregnant women, and breastfeeding mothers were all excluded from this study. A retrospective cohort study compared two groups of patients treated with and without FVP and who followed the Saudi Ministry of Health protocol to manage COVID-19 infection. (3) Results: An adverse effect of FVP on the liver was found that ranged from mild to severe. Stopping treatment with FVP was associated with an observed important increase in the levels of liver enzymes AST (p < 0.001), ALT (p < 0.001), alkaline phosphatase (p < 0.03), total bilirubin (p < 0.001), and direct bilirubin (p < 0.001) in the treated compared with the untreated group. (4) Conclusion: This study showed a significant difference between the treated and the untreated groups with FVP in liver injury. FVP influences the liver, increasing the blood levels of the liver function parameters.

Glycemic disorders in acute pancreatitis: significance of microstructural changes of pancreatic parenchyma

Objective. To study the character and peculiarities of pathohistological changes of pancreatic tissues on the autopsy material, including its endocrine apparatus in acute necrotic pancreatitis and to determine connection between established changes and occurrence of glycemia.&#x0D; Materials and methods. Pathohistological investigation of 48 preparation of pancreatic gland was performed on the autopsy material in 11 dead patients with an acute necrotic pancreatitis, using method of the light microscopy.&#x0D; Results. There was established the presence of microstructural disorder of pancreatic acinar apparatus with various degree of spread and depth of the organ parenchyma necrosis, as well as parapancreatic cellular tissue. With beginning of the false pancreatic cysts formation there was demonstrated occurrence of the connective tissue elements, as well as focal and diffuse sclerosing, while the structure of islets of Langerhans remained unchanged.&#x0D; Conclusion. The signs of hyperglycemia in the disease course may be do not connected with destruction of the organ endocrine apparatus.

Evaluation of altered miRNA expression pattern to predict COVID-19 severity

Outbreak of COVID-19 pandemic in December 2019 affected millions of people globally. After substantial research, several biomarkers for COVID-19 have been validated however no specific and reliable biomarker for the prognosis of patients with COVID-19 infection exists. Present study was designed to identify specific biomarkers to predict COVID-19 severity and tool for formulating treatment. A small cohort of subjects (n = 43) were enrolled and categorized in four study groups; Dead (n = 16), Severe (n = 10) and Moderate (n = 7) patients and healthy controls (n = 10). Small RNA sequencing was done on Illumina platform after isolation of microRNA from peripheral blood. Differential expression (DE) of miRNA (patients groups compared to control) revealed 118 down-regulated and 103 up-regulated known miRNAs with fold change (FC) expression ≥2 folds and p ≤ 0.05. DE miRNAs were then subjected to functional enrichment and network analysis. Bioinformatic analysis resulted in 31 miRNAs (24 Down-regulated; 7 up-regulated) significantly associated with COVID-19 having AUC>0.8 obtained from ROC curve. Seventeen out of 31 DE miRNAs have been linked to COVID-19 in previous studies. Three miRNAs, hsa-miR-147b-5p and hsa-miR-107 (down-regulated) and hsa-miR-1299 (up-regulated) showed significant unique DE in Dead patients. Another set of 4 miRNAs, hsa-miR-224-5p (down-regulated) and hsa-miR-4659b-3p, hsa-miR-495-3p and hsa-miR-335-3p were differentially up-regulated uniquely in Severe patients. Members of three miRNA families, hsa-miR-20, hsa-miR-32 and hsa-miR-548 were significantly down-regulated in all patients group in comparison to healthy controls. Thus a distinct miRNA expression profile was observed in Dead, Severe and Moderate COVID-19 patients. Present study suggests a panel of miRNAs which identified in COVID-19 patients and could be utilized as potential diagnostic biomarkers for predicting COVID-19 severity.

Pulmonary radiologic findings based on Warrick score as a predictor of COVID-19 patients’ outcomes

Introduction: Predicting factors related to the severity and mortality of coronavirus disease 2019 (COVID-19) patients can significantly help in better management of their treatment. Objectives: This study aimed to investigate the correlation between pulmonary radiologic findings based on the Warrick score and COVID-19 patients’ outcomes. Patients and Methods: This descriptive-analytical study was conducted on 436 COVID-19 patients hospitalized at Shahid Mohammadi hospital in Bandar Abbas. Pulmonary radiologic findings were scored based on the Warrick score. Outcomes of COVID-19 patients, including disease severity and mortality, were followed. Independent T-test and binary logistic regression were conducted to explore the correlation between the pulmonary radiologic findings and patients’ outcomes. Results: Results showed that the correlation between pulmonary radiologic findings with both disease severity and mortality was significant, since higher pulmonary involvement caused greater severity and mortality. The Warrick score difference between dead and recovered patients and low and high disease severity were significant, therefore greater Warrick score caused more disease severity and mortality. Conclusion: Pulmonary radiologic findings based on the Warrick score can use as a predictor of COVID-19 patients’ outcomes.

Prognostic predictors in patients with cardiopulmonary arrest: A novel equation for evaluating the 30-day mortality

BackgroundEarly prediction of outcomes after cardiopulmonary arrest (CPA) is important for considering the best support. Our purpose was to evaluate predictors of the 30-day mortality in patients with CPA after return of spontaneous circulation (ROSC) and to assess an equation for calculating the 30-day mortality using clinical parameters. MethodsWe retrospectively analyzed the data of 194 consecutive patients with CPA and ROSC in a derivation study (2015–2022). We compared clinical parameters between the survived (n = 78) and dead (n = 116) patients. We derived an equation for estimated probability of death based on clinical parameters, using multivariate logistic regression analysis. The reliability of the equation was validated in 80 additional patients with CPA. ResultsThe 30-day mortality was associated with sex, witnessed cardiac arrest, bystander cardiopulmonary resuscitation (CPR), CPA due to acute myocardial infarction, pupil diameter, Glasgow Coma Scale score (GCS), presence of light reflex, arterial or venous pH, lactate levels, initial ventricular fibrillation (VF), CPA time, and age. The derived logistic regression equation was as follows: Estimated probability of death = 1 / (1 + e-x), x = (0.25 × bystander CPR) + (0.44 × pupil diameter) – (0.14 × GCS) + (0.09 × lactate) – (1.87 × initial VF) + (0.07 × CPA time) + (0.05 × age) - 7.03. The cut-off value for estimated probability of death calculated by this equation was 54.5 %, yielding a sensitivity, specificity, and accuracy of 86.2 %, 80.8 %, and 84.5 %, respectively. In the validation model, these values were 81.8 %, 85.7 %, and 82.5 %, respectively. ConclusionsThe 30-day mortality may be calculated after ROSC in patients with CPA using simple clinical parameters. This equation may facilitate further best support for patients with CPA.

Impact of immunosuppression regimen on COVID-19 mortality in kidney transplant recipients: Analysis from a Colombian transplantation centers registry

BackgroundThe impact of immunosuppression in solid organ transplant recipients with SARS-CoV-2 infection is unknown. The knowledge about the behavior of different immunosuppression schemes in clinical outcomes is scarce. This study aimed to determine the risk of death in kidney transplant recipients with COVID-19 under two different schemes of immunosuppression. MethodsWe describe our experience in kidney transplant recipients with SARS-CoV-2 infection in seven transplant centers during the first year of the pandemic before starting the vaccination programs in the city of Bogotá. Demographic characteristics, clinical presentation, immunosuppression schemes at presentation, and global treatment strategies were compared between recovered and dead patients; survival analysis was carried out between calcineurin inhibitors based regimen and free calcineurin inhibitors regimen. ResultsAmong 165 confirmed cases, 28 died (17%); the risk factors for mortality identified in univariate analysis were age older than 60 years (p=.003) diabetes (p=.001), immunosuppression based on calcineurin inhibitors (CNI) (p=.025) and patients receiving steroids (p=.041). In multivariable analysis, hypoxemia (p=.000) and calcineurin inhibitors regimen (p=.002) were predictors of death. Survival analysis showed increased mortality risk in patients receiving CNI based immunosuppression regimen vs. CNI free regimens mortality rates were, respectively, 21.7% and 8.5% (p=.036). ConclusionsOur results suggest that the calcineurin inhibitors probably do not provide greater protection compared to calcineurin inhibitor free schemes being necessary to carry out analyzes that allow us to evaluate the outcomes with different immunosuppression schemes in solid organ transplant recipients with SARS-CoV-2 infection.