Factor Of Poor Prognosis Research Articles

Risk factors for early liver recurrence after pancreatic cancer resection.

Liver recurrence after resection is one of the most common types of recurrence and is a risk factor for poor prognosis. The aim of this study was to identify risk factors for initial liver recurrence. Total of 109 patients with resectable pancreatic ductal adenocarcinoma who underwent resection between 2015 and 2022 were included. The influence of clinicopathologic variables on liver recurrence was analyzed to create a novel scoring system to predict liver recurrence. The liver recurrence rate was 24%, with 17% recurrence within one year. Patients with liver recurrence had an extremely poor prognosis within 1 year [MST 12.4 (95% CI 5.7-19.1)]. In multivariate analysis, R-PV, large tumor diameter ≥ 45 mm and venous invasion were independent risk factors for early liver recurrence. When each of these risk factors was scored as 1 point, the 1-year liver recurrence rates by score were 0 (0%), 1 (9%), 2 (30%), and 3 (84%). The risk factors for postoperative early liver recurrence were R-PV, a tumor diameter ≥ 45 mm and pathological venous invasion. Surgery for pancreatic cancer with these factors may require special treatment, such as hepatic arterial injection.

National trends in surgical treatment and clinical outcomes among patients with aneurysmal subarachnoid hemorrhage in the Republic of Korea.

In this study, changes in treatment methods and patient prognosis were analyzed using a Korean nationwide medical insurance information database. Patients with subarachnoid hemorrhage who received surgical treatment for cerebral aneurysm from 2005 to 2020 were included. The specific surgery type was classified using the surgical code and according to whether stents were used. Yearly trends in mortality rates and poor prognosis, using tracheostomy as proxy, were analyzed by a simple regression analysis. A multistep logistic regression analysis was performed to evaluate the risk factors of mortality and poor prognosis. Overall, 83,587 patients were included. Females were predominant (64.5%). Microsurgical clip usage rate decreased by approximately two-thirds from 78.8% in 2005 to 24.4% in 2020. Contrarily, endovascular treatment proportion gradually increased, and stent-assisted coil embolization rate surpassed microsurgical clip usage rate in 2020 (24.6% vs. 24.4%). In the multivariate analysis, endovascular treatment correlated positively with 3-month mortality (hazard ratio [HR]: 1.13, 95% confidence interval [CI]: 1.07-1.19, P<0.0001), although correlated negatively with poor prognosis (tracheostomy) (HR: 0.93, 95% CI: 0.89-0.98, P=0.0050). According to the treatment trend analysis, during the 16 years studied, for patients with subarachnoid hemorrhage due to ruptured cerebral aneurysm, the endovascular treatment rate increased rapidly and stent-assisted coil embolization rate surpassed that of microsurgical clip ligation. Diversification of treatment methods has led to a decrease in mortality and improved prognosis.

Ferritin at admission as a prognostic marker in older adults hospitalized for COVID-19: A retrospective cohort study

Background: Older adults remain vulnerable to COVID-19 waves, particularly in low-income countries with health disparities, so the discovery and validation of accessible clinical tools are required. Despite the expected changes associated with aging, little has been studied on ferritinemia as a prognostic marker, specifically in this population. Objective: Evaluate the use of serum ferritin levels at hospital admission as a prognostic marker in older adults hospitalized for COVID-19. Material and methods: This monocentric study included people over 60 hospitalized for COVID-19 between 2021 and 2022. Disease presence was assessed with polymerase chain reaction and ferritin with spectrophotometry. Multiple logistic regression models, as well as ROC and Kaplan-Meier curves, were used. Results: In 239 older adults, the association between serum ferritin and mortality was modified by the presence of clinical severity data at admission, being a poor prognosis factor only for those with severe COVID-19 (OR=2.82, p = 0.028, controlling for age and immunization doses). The best cut-off point was 355 ng/dl (Sensitivity: 88.3 %; Specificity: 27.4 %). However, there were no differences in survival curves. Conclusions: Serum ferritin levels could help guide therapeutic decisions in older adults with severe COVID-19 but do not predict mortality independently.

Perineural invasion for risk stratification in cutaneous squamous cell carcinoma: a scoping review.

Microscopic perineural invasion (mPNI) is a histopathological characteristic that can be found in cutaneous squamous cell carcinoma (cSCC). In the eight edition of the American Joint Committee on Cancer (AJCC), mPNI defined as the involvement of nerves ≥0.1mm and nerves deeper than the dermis is included in risk stratification of cSCC. The question remains whether other mPNI features are important for optimal cSCC staging. We aim to summarize the evidence from published studies on the independent association between various mPNI features and the risk of recurrence, metastasis and disease-specific death in patients with cSCC. Embase, PubMed, and Web of Science were searched from January 2023 to February 2024 to identify studies that reported the prognostic impact of mPNI features in patients ≥18 years with histopathologically verified cSCC. Data on study and tumour characteristics were extracted. Nineteen studies met the inclusion criteria and evaluated one or more mPNI features in cSCC including nerve diameter, the extent of mPNI, the number of affected nerves, and depth of mPNI. Two studies provided evidence that 'mPNI ≥0.1mm' and 'mPNI deeper than the dermis' are significantly and independently associated with poor prognosis after correction for other mPNI features and high-risk factors. One of these studies additionally identified 'involvement of ≥3 nerves' as an independent and significant predictor of higher risk of local recurrence (HR, 2.17; 95% CI, 1.03-4.56; p=0.04). Besides 'nerve diameter of ≥0.1mm' and 'depth of mPNI involvement', 'involvement of multiple nerves' was found to be an independent risk factor for poor prognosis and should also be considered for appropriate risk stratification.

GNA14 may be a potential prognostic biomarker in nasopharyngeal carcinoma

BackgroundNasopharyngeal carcinoma (NPC) is a highly invasive malignant tumor. Recurrence and distant metastasis represent the primary causes of treatment failure. This study aimed to identify biomarkers highly associated with NPC and investigate its roles in tumor progression.MethodsTranscriptome sequencing (RNA-seq) data of NPC and normal tissues were downloaded from the Gene Expression Omnibus (GEO) database. By analyzing the RNA-seq data, we found that G Protein Subunit Alpha 14 (GNA14) is closely associated with the diagnosis and prognosis of NPC. Immunohistochemistry (IHC) was used to detect the expression of GNA14 in tumor tissues of 165 NPC patients, and we analyzed the relationship between GNA14 expression and patient prognosis. The potential mechanisms by which GNA14 affects tumor prognosis were preliminarily analyzed using bioinformatics analysis.ResultsAnalysis of RNA-seq data and IHC showed that GNA14 expression was downregulated in NPC (p &amp;lt; 0.001, p &amp;lt; 0.01, respectively), and low expression of GNA14 was closely associated with poor prognosis. IHC analysis showed that patients with low GNA14 expression had significantly shorter progression-free survival (PFS) and distant metastasis-free survival (DMFS) than those with high GNA14 expression (p = 0.023, p = 0.008, respectively). Multivariate analysis indicated that the GNA14 expression was an independent risk factor for DMFS (p = 0.030). The DMFS nomogram included GNA14 expression, EBV DNA, and N stage as prognostic factors and the concordance index (C-index) of the nomogram was 0.73. Bioinformatics analysis indicated that NPC patients with low GNA14 expression might represent lower levels of immune cell infiltration and poorer drug sensitivity.ConclusionLow GNA14 expression may be a risk factor for poor prognosis in NPC.

Long-term prognosis and related factors of neonatal and small infants meningitis caused by streptococcus agalactiae

Objective: To explore the long-term prognosis and related factors of neonates and infants meningitis caused by Streptococcus agalactiae. Methods: The Clinical data of neonates and small infants with Streptococcus agalactiae meningitis admitted to the Children's Hospital of Zhengzhou University from January 2015 to May 2022 were retrospectively collected, and long-term follow-up of neurological development was conducted for the patients, with a follow-up period of ≥18 months. According to long-term neurological prognosis indicators, the patients were divided into good prognosis group and poor prognosis group, and the multivariate logistic regression model was used to analyze the factors affecting the long-term prognosis of the patients. Results: A total of 86 children were included, with 50 males and 36 females, and their age ranged from 3 to 85 (29.7±18.5) days. The follow-up duration was 20 to 78(47.2±17.0) months, and the age at the end of follow-up was 1.8 to 6.6(4.2±1.3) years. Among them, there were 54 cases in good long-term prognosis group and 32 cases in poor prognosis guoup. Infectious shock [56.3%(18/32) vs 13.0%(7/54), P<0.001], hypoproteinemia [46.9%(15/32) vs 22.2%(12/54), P=0.017], surgical intervention for neurological complications [31.0%(13/32) vs 7.4%(4/54), P=0.003], abnormal neurological examination at discharge [37.5%(12/32) vs 7.4%(4/54), P<0.001], and abnormal cranial imaging at discharge [53.1%(13/32) vs 7.4%(4/54), P<0.001] were higher in the poor prognosis group than those in the good prognosis group. The peripheral blood WBC count [M(Q1, Q3)] [4.7(3.4, 7.6)]×109/L at the onset of the disease was lower in the poor prognosis group than that in the good prognosis group [10.1(3.8, 14.1)]×109/L, and the cerebrospinal fluid protein concentration [3.0(2.1, 3.8)] g/L was higher in the poor prognosis group than that in the good prognosis group [2.5(1.9, 2.8)] g/L (both P<0.05). The multivariate logistic regression model found that peripheral blood WBC<4.0×109/L (OR=5.501,95%CI:1.430-21.170,P=0.013), infectious shock (OR=4.600,95%CI:1.008-21.004,P=0.047), neurological complications undergoing surgical intervention (OR=8.961,95%CI:1.792-44.812,P=0.008), and abnormal head imaging at discharge (OR=12.636,95%CI:2.502-63.829,P=0.002) were related factors for poor long-term prognosis in neonatal and infants meningitis caused by Streptococcus agalactiae. Conclusions: Neonates and infants meningitis caused by Streptococcus agalactiae have a high incidence of long-term adverse prognosis. Peripheral blood WBC<4.0×109/L, infectious shock, neurological complications undergoing surgical intervention, and abnormal cranial imaging at discharge are related factors for poor long-term prognosis.

Prognosis and risk factors of IgA vasculitis nephritis in children

Objective: To investigate the prognosis and risk factors of IgA vasculitis nephritis (IgAVN) in children. Methods: A retrospective cohort study was conducted. Clinical data were collected from 264 children who were pathologically diagnosed with IgAVN at Department of Pediatric nephrology, Tongji Hospital, affiliated with Tongji Medical College, Huazhong University of Science and Technology, between January 2011 and December 2017. All patients had a follow-up period of more than 3 years. Clinical characteristics, renal pathology, 3-year and 5-year prognosis were analyzed. The patients were grouped based on gender, age of onset (≤6 years,>6-9 years, and >9 years), pathological classification (≤Ⅲ and>Ⅲ),whether the prognosis was complete remission at 3 and 5 years. Independent sample t-tests, ANOVA or chi-squared test were used for intergroup comparisons. Spearman correlation analysis was applied for ordinal data, and multivariate Logistic regression was used to analyze factors affecting the prognosis. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of these factors. Results: Of the 264 children with IgAVN, 153 were male and 111 were female, the age of onset was 8.3 (6.7, 10.3) years, 118 patients (45%) with onset age >6-9 years accounted for the highest proportion. All patients presented with skin purpura and renal involvement, primarily manifesting as hematuria and/or proteinuria. Microscopic hematuria was observed in 253 patients (95.8%), while 246 patients (93.2%) showed proteinuria. In 256 patients (97.0%), hematuria or porteinuria urinalysis was detected within 6 months of skin purpura onset, and 243 patiauts (92.0%) underwent renal biopsy within 6 months of renal involvement. The most common clinical subtype in 264 IgAVN children was hematuria and proteinuria (204 cases, 77.3%), with grade Ⅲ being the predominant pathological classification (181 cases, 68.6%). Among children ≤6 years old, the 3-year complete remission rate was higher in males than in females (83.9% (26/31) vs. 7/16, χ²=8.12, P=0.012). Factors independently associated with poor 5-year prognosis included time from hematuria or porteinuria urinalysis to renal biopsy>6 months, elevated serum cholesterol levels, and incomplete remission 3 years post-biopsy (OR=5.41, 1.39, 6.02, 95%CI 1.40-20.86, 1.04-1.84, 2.61-13.88, all P<0.05). The serum cholesterol has a predictive value for 5-year prognosis (P=0.020, AUC=0.62, 95%CI 0.52-0.71, Youden index=0.27, cutoff=4.37). Conclusions: For children with IgAVN aged≤6 years, the 3-year prognosis is better in males than in females. Time from hematuria or porteinuria urinalysis to renal biopsy>6 months, elevated serum cholesterol levels, and incomplete remission at 3 years post-biopsy may be independent risk factors for poor 5-year prognosis in children with IgAVN.

Prognostic significance of serum inflammatory markers in patients with acute ischemic stroke undergoing revascularization therapy.

This study aimed to evaluate the prognostic significance of serum inflammatory factor levels in patients with acute ischemic stroke undergoing revascularization therapy. The study included 94 patients with acute ischemic stroke who underwent revascularization therapy at our hospital. The primary outcome was the modified Rankin scale (mRS) score assessed three months post-treatment. Patients were categorized into two groups: those with a poor prognosis (mRS score > 2) and those with a good prognosis (mRS score≤2). The patients were divided into two groups based on the type of revascularization treatment received: thrombus extraction or intravenous thrombolysis. Logistic regression analysis was used to identify independent risk factors associated with the prognosis of patients treated with recanalization for acute ischemic stroke. Among the 94 patients, 59 had a good prognosis, and 35 had a poor prognosis. At admission, the patients in the good prognosis group exhibited lower NIHSS scores, shorter hospital stays, fewer previous cardiac events, lower LDL levels, fasting glucose, IL-6, and TNF-a compared to those in the poor prognosis group (all P < 0.05). Logistic regression analysis identified TNF-a (odd ratio (OD), 1.623; 95% confidence interval (CI), 1.282-1.933; P = 0.035) and IL-6 (OD, 1.055; 95% CI, 1.024-1.088, P = 0.023) as independent risk factors for poor prognosis in patients after revascularization. Additionally, pre-hospital NIHSS scores, IL-6, and TNF-a levels were significantly lower in the good prognosis group compared to the poor prognosis group, with these differences being statistically significant. IL-6 and TNF-α may serve as prognostic markers for outcomes following revascularization therapy in patients with acute ischemic stroke, including those receiving intravenous thrombolysis.

The effective duration of systemic therapy and the neutrophil-to-lymphocyte ratio predict the surgical advantage of primary tumor resection in patients with de novo stage IV breast cancer: a retrospective study

BackgroundThe primary tumor resection (PTR) of de novo stage IV breast cancer (DnIV BC) is controversial, and previous studies have suggested that the neutrophil-to-lymphocyte ratio (NLR) could be a poor-prognosis factor for BC. We investigated PTR’s surgical advantage related to clinical outcomes, the surgery timing in responders to systemic therapy, and whether the NLR can predict the benefit of surgery for DnIV BC.Patients and methodsWe retrospectively analyzed the cases of the DnIV BC patients who received systemic therapies and/or underwent PTR at our institution between January 2004 and December 2022. Blood tests and NLR measurement were performed before and after each systematic therapy and/or surgery.ResultsSixty patients had undergone PTR local surgery (Surgery group); 81 patients had not undergone surgical treatment (Non-surgery group). In both groups, systemic treatment was performed as chemotherapy (95%) and/or endocrine therapy (92.5%) (p < 0.0001). The groups’ respective median progression-free survival (PFS) durations were 88 and 30.3 months (p = 0.004); their overall survival (OS) durations were 100.1 and 31.8 months (p = 0.0002). The Surgery-group responders to systemic therapy lasting > 8.1-months showed significantly longer OS (p = 0.044). The PFS and OS were significantly associated with the use of postoperative systemic therapy (p = 0.0012) and the NLR (p = 0.018). A low NLR (≤ 3) was associated with significantly better prognoses (PFS and OS; p < 0.0001).ConclusionsA longer effective duration of systemic therapy (> 8.1 months) and a low pre-surgery NLR (≤ 3.0) could predict PTR’s surgical advantage for DnIV BC. These variables may help guide decisions regarding the timing of surgery for DnIV BC.

Predictors of adverse outcomes in patients with chronic obstructive pulmonary disease and pulmonary embolism and the predictive value of the simplified pulmonary embolism severity index

Objective: To explore the relevant factors associated with poor prognosis in patients suffering from chronic obstructive pulmonary disease (COPD) combined with pulmonary embolism (PE), and investigate the predictive value of the simplified pulmonary embolism severity index (sPESI) score on adverse outcomes in these patients. Methods: A total of 168 patients with COPD and PE who were treated at West China Hospital of Sichuan University from January 1, 2018, to December 30, 2020 were retrospectively included. Patients were divided into adverse outcome group and control group based on the occurrence of adverse outcomes [any of the following events: in-hospital death, intensive care unit (ICU) admission, and endotracheal intubation]. Correlation factors for poor prognosis were explored using multivariate logistic regression analysis. Receiver operating characteristic (ROC) curve was employed to assess the predictive value of the sPESI score for adverse outcomes in COPD patients with PE. Results: A total of 168 patients were studied, with an age of (73.4±10.4) years and 119 male (70.8%). In the adverse outcome group, there were 18 cases (10.7%), including 12 in-hospital deaths, 6 ICU admission, and 1 endotracheal intubation. The control group comprised 150 cases (89.3%). Statistically significant differences were observed between two groups regarding the proportion of patients with diabetes, nephrotic syndrome, severe pneumonia, respiratory failure and lower extremity edema, and the pulse, diastolic blood pressure, pulse oxygen saturation, lactate dehydrogenase and cholesterol levels (all P<0.05). Multivariate logistic regression analysis revealed that severe pneumonia, respiratory failure, lower extremity edema, and diastolic blood pressure<60 mmHg (1 mmHg=0.133 kPa) are correlative factors of adverse outcomes in patients with COPD complicated by PE [OR (95%CI) were 7.363 (1.053-51.772), 4.077 (1.030-16.133), 4.490 (1.131-17.832), and 8.060 (1.209-53.918), respectively, all P<0.05]. The sPESI score in the adverse outcome group was higher than that in the control group [M (Q1, Q3), 2 (2, 2) vs 1 (1, 2) score, P=0.006]; the optimal cutoff value for sPESI score was 2 score, the sensitivity was 77.8%, the specificity was 54.0%, and the area under the curve (AUC) and 95%CI were 0.681 (0.554-0.809) based on the ROC curve analysis. Patients with sPESI≥2 score exhibited a 4.109-fold (95%CI: 1.292-13.063, P=0.017) increased risk of adverse prognosis compared to those with sPESI<2 score. Conclusions: Patients with COPD combined with PE have a higher incidence of adverse prognostic outcomes. Severe pneumonia, respiratory failure, lower limb edema, and diastolic pressure<60 mmHg are associated factors for poor prognosis. The sPESI score has some value in predicting adverse outcomes in COPD patients with PE.

The combination of lenvatinib and pembrolizumab in the treatment of patients with metastatic kidney cancer and factors of poor prognosis: experience of clinics in Moscow: A prospective observational study

Background. Combination therapy is the standard of care for intermediate and poor prognosis metastatic renal cell carcinoma. In the IMDC prognostic classification, tumor stage and histological type are not considered due to the lack of independent impact on overall survival. The CLEAR study demonstrated the efficacy of lenvatinib and pembrolizumab combination in long-term treatment outcomes, including overall survival in poor prognosis compared to sunitinib. The KEYNOTE-B61 study demonstrated high efficacy of this combination in patients with non-clear cell renal cell carcinoma. Aim. To evaluate the efficacy of the combination of lenvatinib and pembrolizumab in patients with high tumor burden and non-clear cell histotypes. Materials and methods. This prospective observational study included 54 patients with metastatic renal cell carcinoma who received a combination of lenvatinib and pemrolizumab in the first line between 2022 and May 2024 in oncology clinics of the Moscow Department of Health. Clear cell histotype was represented in 79.6% of cases, 14.8% had papillary cancer, and 5.6% of patients had chromophobe cancer. The primary endpoint was the objective response rate. Results. The objective response was assessed in 50 patients. The objective response rate was 38%, including 2% complete response according to RECIST 1.1, disease progression was in 8% of patients. The median depth of response was -25% (from -100% to +28). The median time to response was 12.4 weeks (1.1–38.3). Conclusion. The efficacy of the combination of lenvatinib and pembrolizumab in real-life clinical practice outside the inclusion criteria of the CLEAR study is clinically significant and allows us to expect improvement even in patients with a large volume of metastatic process and non-clear cell histotype, but the expected benefit in patients with unsatisfactory somatic status remains disputed.

Analysis of METTL14 expression in pancreatic cancer and adjacent tissues and its prognostic value for patient outcomes

This study aims to analyze the differential expression of METTL14 in pancreatic cancer (PC) tissues and adjacent normal tissues, and its correlation with clinical outcomes. According to the inclusion and exclusion criteria, a total of 80 patients diagnosed in our hospital from January 2021 to January 2023 were chosen as research subjects. RTQ-PCR has detected the mRNA level expression of METTL14 in cancer and para-cancerous tissues. Immunohistochemistry was used to detect the protein expression of METTL14 in cancer and para-cancerous tissues. To compare the relationship between METTL14 expression and clinicopathological parameters in different PC patients. Kaplan–Meier survival analysis of the relationship between METTL14 expression in PC tissues and patient survival prognosis. The Multifactor COX model evaluates factors affecting the prognosis of PC. The expression level of METTL14 mRNA in PC tissues was 5.51 ± 0.35 (kDa), and the positive rate of METTL14 protein expression in PC tissues of all patients was 73.75 (59/80). Tumor location (P = 0.012), tumor differentiation degree (P = 0.028), tumor AJCC stage (P = 0.000), and lymph node metastasis (P = 0.000) were significantly related to the positive rate of METTL14 protein expression in PC tissue. Follow-up results showed that among 80 patients, 63 died. The three-year survival rate of the METTL14 positive group was 13.56% (8/59), and the three-year survival rate of the negative group was 42.86% (9/21). The difference in the three-year survival rate between METTL14 positive and negative expression groups was statistically significant (P = 0.031). Multivariate COX regression analysis results showed that METTL14 was positive (OR 2.797, 95% CI 1.233–5.877), tumor AJCC stage II–III (OR 1.628, 95% CI 1.435–3.859) and lymph node metastasis (OR 1.733, 95% CI 1.122–2.372) were substantive risk factors for poor prognosis in patients with PC. METTL14 expression increases in PC tissue, which is related to tumor AJCC stage, tumor differentiation, and lymph node metastasis, and can be evaluated in the survival prognosis of patients with PC.

Unveiling Tim-3 immune checkpoint expression in hepatocellular carcinoma through abdominal contrast-enhanced CT habitat radiomics.

Immune checkpoint inhibitors (ICIs) are important systemic therapeutic agents for hepatocellular carcinoma (HCC), among which T-cell immunoglobulin and mucin-domain containing protein 3 (Tim-3) is considered an emerging target for ICI therapy. This study aims to evaluate the prognostic value of Tim-3 expression and develop a predictive model for Tim-3 infiltration in HCC. We collected data from 424 HCC patients in The Cancer Genome Atlas (TCGA) and data from 102 pathologically confirmed HCC patients from our center for prognostic analysis. Multivariate Cox regression analyses were performed on both datasets to determine the prognostic significance of Tim-3 expression. In radiomics analysis, we used the K-means algorithm to cluster regions of interest in arterial phase enhancement and venous phase enhancement images from patients at our center. Radiomic features were extracted from three subregions as well as the entire tumor using pyradiomics. Five machine learning methods were employed to construct Habitat models based on habitat features and Rad models based on traditional radiomic features. The predictive performance of the models was compared using ROC curves, DCA curves, and calibration curves. Multivariate Cox analyses from both our center and the TCGA database indicated that high Tim-3 expression is an independent risk factor for poor prognosis in HCC patients. Higher levels of Tim-3 expression were significantly associated with worse prognosis. Among the ten models evaluated, the Habitat model constructed using the LightGBM algorithm showed the best performance in predicting Tim-3 expression status (training set vs. test set AUC 0.866 vs. 0.824). This study confirmed the importance of Tim-3 as a prognostic marker in HCC. The habitat radiomics model we developed effectively predicted intratumoral Tim-3 infiltration, providing valuable insights for the evaluation of ICI therapy in HCC patients.

Construction and validation of a prognostic signature based on microvascular invasion and immune-related genes in hepatocellular carcinoma

Background: Microvascular invasion (MVI) is an independent risk factor of poor prognosis in hepatocellular carcinoma (HCC) and can be used to guide the diagnosis and treatment of HCC. The immune system serves as an integral role in the incidence and progression of HCC. However, the molecular biology correlation between MVI and tumor immunity and the value of combining the two parameters to predict patient prognosis and HCC response to treatment remain to be evaluated. Results: In this study, we used univariate Cox regression analysis and least absolute shrinkage and selection operator (LASSO) Cox analysis to establish the MVI and immune-related gene index (MIRGPI) including eight genes. We demonstrated that the MIRGPI was an independent risk factor in predicting the prognosis of HCC. Subsequently, our research established a nomogram model combining pathologic characteristics and verified its good clinical application value. In addition, our study found that the TP53 gene had a higher mutation frequency and a lower degree of immune infiltration in the high-risk group. The low-risk group had higher sensitivity to immunotherapy, sorafenib, and TACE treatment, and the high-risk group had higher sensitivity to common chemotherapeutic agents. Finally, SEMA3C was found to facilitate the proliferation, migration and invasive ability of HCC by in vitro and in vivo experiments, and its mechanism may be associated with the activation of the NF-Κb/EMT signaling pathway. Conclusions: In summary, the MIRGPI signature we developed is a reliable marker for the prediction of prognosis and treatment response, and is important for the prognostic assessment and individualized treatment of HCC.

CT-based radiomics model for predicting perineural invasion status in gastric cancer.

Perineural invasion (PNI) is an independent risk factor for poor prognosis in gastric cancer (GC) patients. This study aimed to develop and validate predictive models based on CT imaging and clinical features to predict PNI status in GC patients. This retrospective study included 291 GC patients (229 in the training cohort and 62 in the validation cohort) who underwent gastrectomy between January 2020 and August 2022. The clinical data and preoperative abdominal contrast-enhanced computed tomography (CECT) images were collected. Radiomics features were extracted from the venous phase of CECT images. The intraclass correlation coefficient (ICC), Pearson correlation coefficient, and t-test were applied for radiomics feature selection. The random forest algorithm was used to construct a radiomics signature and calculate the radiomics feature score (Rad-score). A hybrid model was built by aggregating the Rad-score and clinical predictors. The area under the receiver operating characteristic curve (ROC) and decision curve analysis (DCA) were used to evaluate the prediction performance of the radiomics, clinical, and hybrid models. A total of 994 radiomics features were extracted from the venous phase images of each patient. Finally, 5 radiomics features were selected and used to construct a radiomics signature. The hybrid model demonstrated strong predictive ability for PNI, with AUCs of 0.833 (95% CI: 0.779-0.887) and 0.806 (95% CI: 0.628-0.983) in the training and validation cohorts, respectively. The DCA showed that the hybrid model had good clinical utility. We established three models, and the hybrid model that combined the Rad-score and clinical predictors had a high potential for predicting PNI in GC patients.

Development and Validation of a Novel Classification System and Prognostic Model for Open Traumatic Brain Injury: A Multicenter Retrospective Study.

Open traumatic brain injury (OTBI) is associated with high mortality and morbidity; however, the classification of these injuries and the determination of patient prognosis remain uncertain, hindering the selection of optimal treatment strategies. This study aimed to develop and validate a novel OTBI classification system and a prognostic model for poor prognosis. This retrospective study included patients with isolated OTBI who received treatment at three large medical centersin China between January 2020 and June 2022 as the training set. Data on patients with OTBI collected at the Fuzong Clinical Medical College of Fujian Medical University between July 2022 and June 2023 were used as the validation set. Clinical parameters, including clinical data at admission, radiological and laboratory findings, details of surgical methods, and prognosis were collected. Prognosis was assessed through a dichotomized Glasgow Outcome Scale (GOS). A novel OTBI classification was proposed, categorizing patients based on a combination of intracranial hematoma and midline shift observed on imaging, and logistic regression analyses were performed to identify risk factors associated with poor prognosis and to investigate the association between the novel OTBI classification and prognosis. Finally, a nomogram suitable for clinical application was established and validated. Multivariable logistic regression analysis identified OTBI classification type C (p<0.001), a Glasgow Coma Scale score (GCS)≤8 (p<0.001), subarachnoid hemorrhage (SAH) (p=0.004), subdural hematoma (SDH) (p=0.011), and coagulopathy (p=0.020) as independent risk factors for poor prognosis. The addition of the OTBI classification to a model containing all the other identified prognostic factors improved the predictive ability of the model (Z=1.983; p=0.047). In the validation set, the model achieved an area under the curve (AUC) of 0.917 [95% confidence interval (CI)=0.864-0.970]. The calibration curve closely approximated the ideal curve, indicating strong predictive performance of the model. The implementation of our proposed OTBI classification system and its use alongside the other prognostic factors identified here may improve the prediction of patient prognosis and aid in the selection of the most suitable treatment strategies.

Mechanical Thrombectomy for Treatment of Acute Cerebral Infarction due to Distal Medium Vessel Occlusions: A Retrospective Cohort Study.

Mechanical thrombectomy (MT) is standard of care for acute cerebral infarction (ACI) due to large vessel occlusions. However, its clinical efficacy in patients with ACI due to distal medium vessel occlusions (DMVOs) remains unclear. This study evaluates the efficacy and safety of MT in patients with ACI due to DMVOs. Totally, 306 patients with ACI at a very early stage were assigned into DMVOs-MT, M1-MT, and DMVOs-intravenous thrombolysis (IVT) groups. These groups were compared regarding baseline data, recanalization rate, location of vessel occlusions, number of thrombectomy, first-pass recanalization, mRS scores, NIHSS scores, 90-day mRS scores, incidence of adverse events, and mortality. Risk factors for poor prognosis of patients with DMVOs following MT were analyzed. DMVOs-MT and M1-MT groups showed comparable first-pass recanalization rates, recanalization rates, and NIHSS score reduction ratios, with marked differences in location of vessel occlusions. Versus DMVOs-IVT, DMVOs-MT had increased differences between pre- and post-treatment NIHSS scores and between pre-treatment NIHSS scores and NIHSS scores at discharge and elevated NIHSS reduction ratios. The poor prognosis rate of DMVOs-MT group was insignificantly different from that of M1-MT group but lower than that of DMVOs-IVT group. Adverse events and mortality incidences were comparable among the three groups. Diabetes, first-pass recanalization, and pre-treatment NIHSS scores were independent risk factors for poor prognosis in DMVO patients after MT. MT is as effective and safe in patients with DMVOs as in patients with M1 occlusions. In patients with DMVOs, MT has higher efficacy and safety than IVT.

T Lymphocyte Mitochondrial Markers as Independent Risk Factors for Poor Prognosis of COVID-19.

Severe Acute Respiratory Syndrome Virus 2 (SARS-CoV-2) primarily targets mitochondria. However, the description of mitochondrial signaling in immune cells remains limited in COVID-19. This study aimed to elucidate the pivotal roles played by immune cells and mitochondria in the pathogenesis of COVID-19 and the resulting clinical outcomes. We obtained epidemiological characteristics, laboratory parameters and T cell mitochondrial damage indicators in 296 COVID-19 patients. And we further evaluated the predictive value of novel T lymphocyte mitochondrial markers and conventional immune inflammatory markers as clinical outcomes in COVID-19 patients. Finally, Binary logistic regression analysis was conducted to identify the independent risk factors associated with the prognosis of patients with COVID-19. The severe group exhibited lower counts of Mito+CD3+, Mito+CD4+, and Mito+CD8+ cells compared to the non-severe group. Significantly higher positive rates of CD3+, CD3+CD4+, and CD3+CD8+T cell mitochondrial damage were observed in the severe group compared to the non-severe group. The CD3+CD8+T cells MMP-low% had the highest AUC value of 0.864 (95% CI =0.794-0.934) to evaluate COVID-19 outcome. Binary logistic regression analysis showed that CD3+T cells MMP-low%, CD3+CD4+T cells MMP-low% and CD3+CD8+T cells MMP-low% were independent risk factors for adverse outcomes in COVID-19 patients. Our research suggests that a substantial proportion of COVID-19 patients exhibited mitochondrial impairment with T-lymphocyte. T cells mitochondrial markers can serve as predictive factors and independent risk factors for predicting adverse outcomes in COVID-19 patients.

Low transthyretin concentration linked to adverse prognosis in elderly inpatients

BackgroundTo investigate the association between low transthyretin (prealbumin) concentration and mortality or readmission for all causes in elderly inpatients.MethodsThis analysis is based on a prospective cohort study conducted from September 2018 to April 2019 in ten wards of three tertiary referral hospitals in Beijing. Patients aged 65 years or older were enrolled, and their clinical data, laboratory test results, and auxiliary test results for patients were collected. A three-year follow-up was conducted with patients. Based on the 5th and 95th percentiles of transthyretin concentration, patients were split into three groups. The correlation between transthyretin concentration and the outcome of elderly hospitalized patients was investigated. The primary outcome of the research was death or readmission from all causes within three years.ResultsAmong the 636 individuals in the study, 335 (52.7%) were males, with a median age of 74.7 years (interquartile range [IQR]: 69.3–80.1). During a median follow-up period of 1,099.0 days (IQR: 1,016.3-1,135.0), 363 individuals (57.0%) experienced all-cause mortality or readmission events. Patients with transthyretin concentrations at or below the 5th percentile had a significantly increased risk of all-cause mortality or readmission compared to those with concentrations between the 5th and 95th percentiles (hazard ratio [HR]: 2.25; 95% confidence interval [CI]: 1.55–3.26). Even after adjusting for potential confounders, low transthyretin concentration remained an independent risk factor for poor prognosis in elderly inpatients (HR: 1.84; 95% CI: 1.03–3.28). Since women have consistently lower baseline transthyretin levels than men, we performed gender-specific analysis. We found that low transthyretin concentration is an independent risk factor for adverse prognosis in elderly male inpatients (HR: 2.99; 95% CI: 1.35–6.62) but not in females.ConclusionsLow transthyretin concentrations are associated with increased all-cause mortality or readmission in elderly inpatients, particularly among male patients.Graphical

Clinical evaluation of serum miR-513a-3p combined with arterial blood gas analysis parameters and lung ultrasound score in neonatal respiratory distress syndrome

BackgroundNeonatal respiratory distress syndrome (NRDS) is harmful to neonates and the prognosis is variable, ranging from mild to severe forms. This study aims to evaluate the clinical utility of miR-513a-3p in conjunction with arterial blood gas analysis parameters and lung ultrasound (LUS) score in the context of NRDS.MethodsThe study included 169 preterm infants, including 106 newborns with NRDS and 63 newborns without NRDS. The relative expression level of miR-513a-3p was detected by quantitative real time polymerase chain reaction (qRT-PCR). Umbilical artery blood gas parameter values and LUS score were recorded, and the clinical significance of miR-513a-3p, umbilical artery blood gas parameter and LUS score in NRDS were evaluated by Receiver Operating Characteristic (ROC) analysis.ResultsElevated levels of miR-513a-3p were detected in the serum of NRDS, and higher expression of miR-513a-3p was observed in individuals with poor prognosis. Notably, miR-513a-3p exhibited a significant correlation with the parameters of arterial blood gas analysis and LUS score in NRDS patients. Furthermore, miR-513a-3p was one of the risk factors for poor prognosis in NRDS patients. miR-513a-3p levels combined with umbilical artery blood gas parameters and LUS score has diagnostic value for NRDS and is reliable for its prognosis.ConclusionsElevated levels of miR-513a-3p in neonatal serum served as a useful tool in the combined assessment with umbilical artery blood gas analysis and LUS score to diagnosis and prognosis of NRDS. Consequently, miR-513a-3p may be served as a biomarker for diagnosis and prognosis of NRDS.