Predictive Factors Research Articles

Clinical outcomes and synergistic effect between radiotherapy and immunotherapy in patients with extensive-stage small cell lung cancer: a real-world study

BackgroundPatients with extensive-stage small cell lung cancer (ES-SCLC) experience significant therapeutic challenges and limited survival rates. This study aimed to investigate the efficacy of combining immunotherapy (IT) with chemotherapy (CT) for treating ES-SCLC and to explore the synergistic effect between radiotherapy (RT) and IT.MethodsThis retrospective analysis examined patients with ES-SCLC who received treatment at three centers. Furthermore, propensity score-matched (PSM) analysis was conducted. The Kaplan‒Meier method and Cox proportional hazards regression were used to compare the survival outcomes.ResultsA total of 257 eligible patients with ES-SCLC were included in the analysis. Among all patients, the median overall survival (mOS) was 18.0 m in the chemoimmunotherapy (CT + IT) group and 15.7 m in the CT group (p = 0.208). The median real-world progression-free survival (mrwPFS) was 7.7 m and 6.8 m (p = 0.043) in the CT + IT and CT group, respectively. Moreover, the mOS was 22.0 m in the chemoradiotherapy (CT + RT) group and 13.6 m in the CT group (p < 0.001). The mrwPFS was 7.4 m and 6.0 m (p = 0.175) in the CT + RT group and CT group, respectively. The multivariate analyses revealed that sex, liver metastasis and RT were independent prognostic factors for OS (p < 0.05), while liver metastasis and IT were found to be independent predictive factors of real-world progression-free survival (rwPFS) (p < 0.05). After PSM, the mOS was 23.2 m in the CT + IT group and 13.0 m in the CT group (p = 0.008). The mrwPFS was 7.3 m and 6.2 m (p = 0.096) in the CT + IT group and the CT group, respectively. Moreover, the mOS was 21.4 m in the CT + RT group and 12.5 m in the CT group (p < 0.001). The mrwPFS was 7.3 m and 5.2 m (p = 0.220) in the CT + RT group and the CT group, respectively. Additionally, our study revealed that in the PD-1 group, RT significantly improved patient survival (36.0 m vs. 15.8 m, p = 0.041).ConclusionAn increasing number of treatment options are being explored for ES-SCLC, and CT is the cornerstone of treatment for this disease. Combining CT with IT and RT has demonstrated remarkable efficacy and excellent safety profiles, and such treatments are worthy of further exploration.

Longitudinal Evaluation Using the Forgotten Joint Score-12 for Double-Bundle Primary Anterior Cruciate Ligament Reconstruction: A Retrospective Observational Study.

Introduction There are several postoperative evaluation methods for anterior cruciate ligament reconstruction (ACLR), and patient-reported outcome measurement (PROM) is one of the most important for evaluating postoperative clinical results. However, conventional PROMs have a high risk ofa ceiling effect at one and two years postoperatively and do not accurately reflect functional improvement over time. Therefore, a longitudinal evaluation using PROM with a low risk of ceiling effect is necessary. The forgotten joint score-12 (FJS) was developedfor clinical evaluation after arthroplasty. It is considered an evaluation method after arthroplasty with a low risk of demonstrating a ceiling effect. However, few studies have used the FJS as an evaluation method after ACLR, particularly those tracking changes over time. This study aimed to longitudinally evaluate FJS at one and two years after ACLR. Methods This is a retrospective observational study of postoperative patients using existing data and a questionnaire-based survey.This studyincluded patients who underwent primary double-bundle ACLRbetween August 2017 and August 2021. We compared the FJS, knee injury and osteoarthritis outcome score (KOOS), and Lysholm knee scale (LKS) scores at one and two years post-surgery using the Wilcoxon signed-rank test. The ceiling effect for each PROM was calculated at one and two years post-surgery.A ceiling was defined as obtaining a perfect score in PROMs, and the risk of demonstrating a ceiling effect was the percentage of perfect scores among all cases. The risk of demonstrating a ceiling effect for each PROM was compared using the McNemar test. To identify factors influencing FJS one-year post-ACLR across all cases, multivariate linear regression analysis was conducted for the FJS. Results Finally, 87 patients were included in this study.Fifty-six participants were women, and 31 were men, with an average age of 28.5 ± 11.8 years at the time of surgery and a BMI of 23.2 ± 3.7 kg/m2. Fifty-eight patients with meniscus injuries requiring treatment were observed. A total of 54 patients were used to compare the results at one and two years, while 87 patients were included in the multivariate analysis for FJS at one year.The median of FJS at one and two years post-surgery were 90.6 and 95.8, respectively. The FJS showed a statistically significant improvement from one to two years (p = 0.033). Question #12 in FJS showed a significant improvement from the first to the second year postoperatively (1.74 ± 1.46 vs 1.15 ± 1.25 at one year vs two years, respectively; p = 0.0016). FJS had a lower risk of demonstrating a ceiling effect than KOOS ADL at one and two years (FJS vs KOOS ADL; at first year: 20.4% and 48.1%, p < 0.001; at second year: 33.3% and 63.0%, p = 0.0013). There was no difference compared to the other PROMs. According to the multivariate linear regression analysis,predictive factors for higher FJS scoresat one year post-surgery were younger age and limb symmetry index of single-leg hop test(SLH-LSI) on the affected side that was close to that of the healthy side (SLH-LSI > 0.9). Conclusions The FJS continued to improve over two years after ACLR. The FJS post-ACLR was higher in younger individuals and those with SLH-LSI of 0.9 or higher.

Insomnia Catastrophizing and Affective Temperaments in Major Depressive Disorder

Background and Objective We aim to assess the role of affective temperaments, insomnia severity, sleep quality, and depressive anxiety symptoms in predicting catastrophizing insomnia in patients with major depressive disorder (MDD).Methods Our study employed a case-control design, involving 90 drug-free MDD patients and 90 healthy controls (HCs) with identical sociodemographic characteristics. Participants completed a comprehensive set of assessments, including the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), Insomnia Catastrophizing Scale (ICS), and Temperament Evaluation of Memphis, Pisa, Paris, San Diego Autoquestionnaire (TEMPS-A).Results Among the 90 MDD patients, 80% were female (n = 72), with a mean age of 32.2 ± 13.6 years. The MDD group exhibited significantly higher scores on the BDI, BAI, ISI, PSQI, ICS night, ICS daytime, and ICS total scores, along with depressive, cyclothymic, irritable, and anxious temperament scores, compared to the HCs (p &lt; 0.001). Notably, the hyperthymic temperament showed no correlation with insomnia catastrophizing in either group. Our findings revealed that the ISI score was a predictive factor for the ICS night; age and ISI were predictive factors for the ICS daytime; and age, anxious temperament, and ISI were predictive factors for the ICS total in the MDD group.Conclusions The severity of insomnia, young age, and an anxious temperament were identified as positive predictors of insomnia catastrophizing.

머신러닝을 활용한 해운기업 파산 예측에 관한 연구

Purpose: This study aims to enhance bankruptcy prediction accuracy in the shipping industry by using advanced machine learning models, specifically XGBoost and LSTM, comparing the predictive factors between large enterprises and SMEs. Research design, data, and methodology: Utilizing financial data from 2001 to 2023 for the Korean shipping industry, the study analyzes key financial ratios and macroeconomic indicators. XGBoost and LSTM models are employed to develop customized bankruptcy prediction models for large enterprises and SMEs. Results: The XGBoost model outperforms others, effectively handling complex financial and macroeconomic variables. Large enterprises are more influenced by internal financial factors, while SMEs are sensitive to external economic conditions like a shipping index. Conclusions: The study highlights the need for tailored prediction models to improve bankruptcy risk management in the shipping industry, especially focusing on the size of the company. Future research should explore model applicability across different regions, and should consider integrating real-time data for enhanced accuracy.

Determinants of Success and Complications in Vaginal Birth After Cesarean Section: A Systematic Literature Review

Trial of Labor After Cesarean (TOLAC) is the process of attempting a vaginal delivery after a prior cesarean section. TOLAC offers an alternative to repeat cesarean delivery but requires careful assessment of risks and benefits. This research aims to evaluate the factors affecting VBAC success and associated risks, providing guidance for clinical practice in determining VBAC eligibility. Relevant literature on VBAC was sourced from databases such as PubMed and Cochrane Library using the keywords "VBAC," "VBAC success," and "VBAC risks." Literature searches for these articles are conducted through databases of scientific journals such as PubMed and Google Scholar. Analysis was conducted to assess predictive factors for VBAC success, including previous vaginal delivery history, cervical conditions, and other parameters. VBAC success is significantly influenced by previous vaginal delivery history, cervical conditions at admission, and factors such as BMI and interpregnancy interval. The main risk associated with VBAC is uterine rupture, occurring in approximately 0.2–0.9% of cases. Proper management and careful risk assessment can minimize complications. VBAC can be a safe and effective option for women who meet specific criteria. Adequate monitoring and assessment are crucial to minimize risks and enhance success rates. Individual evaluation and thorough planning are essential for achieving optimal delivery outcomes. The decision to implement VBAC should be made with careful consideration of the benefits and risks to ensure safe and optimal outcomes for both mother and baby.

Predictors for severe persisting pain in rheumatoid arthritis are associated with pain origin and appraisal of pain

ObjectivesTo determine the proportion of patients with rheumatoid arthritis (RA) with severe persisting pain and to identify predictive factors despite treatment-controlled disease activity.MethodsThis prospective multicentre study included outpatients with RA...

Sarcopenia Predicts Postoperative Complications and Survival of Colorectal Cancer Patients Undergoing Radical Surgery.

Aims/Background Previous literature has indicated that sarcopenia is related to poor outcomes after radical resection for colorectal cancer (CRC). However, its effect on the postoperative clinical outcomes of CRC remains controversial. This study aimed to elucidate the predictive value of sarcopenia for postoperative complications and survival in CRC patients. Methods This investigation retrospectively assessed the clinical data of 226 CRC patients who underwent radical resection at the Department of Gastrointestinal Surgery, Affiliated Hospital of Zunyi Medical University from January 2018 to December 2020. Sarcopenia was diagnosed according to the recommendations of the Asian Working Group for Sarcopenia in 2019, and patients were categorized into sarcopenia and non-sarcopenia groups. Multivariate and univariate analyses were employed to assess the risk factors for postoperative complications. The Kaplan-Meier method and survival curve were used to analyze postoperative survival time. Cox proportional hazards regression models were used to evaluate risk factors affecting the prognosis of CRC patients. Results This investigation included 226 patients, of which 68 were diagnosed with sarcopenia. Furthermore, it was revealed that sarcopenia was linked with older age (p < 0.001), low body mass index (p < 0.001), high prevalence of diabetes (p = 0.002), high cystatin level (p = 0.017), and low 3rd lumbar spine (L3) planar skeletal muscle index (p < 0.001), but was not related to the tumour stage or the gender. Moreover, sarcopenia was also correlated with increased occurrence of all postoperative complications (p = 0.050). The results of the multivariate analysis indicated that sarcopenia was an independent risk factor for postoperative complications (odds ratio (OR): 7.154; 95% confidence interval (CI): 2.261-22.633; p = 0.017). The Kaplan-Meier analysis revealed that sarcopenia patients had significantly lower 5-year disease-free survival (DFS) (48.5% vs 59.5%; log-rank p = 0.033) and 5-year overall survival (OS) (57.4% vs 77.2%; log-rank p < 0.001) rates. Sarcopenia was an independent risk factor for poor DFS (hazard ratio (HR) = 1.404; p = 0.016) and OS (HR = 1.290; p = 0.021). Conclusion In CRC patients undergoing radical surgery, sarcopenia is an independent risk factor for postoperative complications. Sarcopenia may be a predictive factor for the prognosis and survival of CRC patients undergoing radical resection.

Predictors of Inpatients Mortality in Patients with Liver Cirrhosis with Hepatic Encephalopathy

Background Hepatic encephalopathy has high risk of recurrence and is associated with advanced cirrhosis of liver. It features a spectrum of reversible neuropsychiatric abnormalities. The purpose of the research was to study the inpatients mortality and its predictors among cirrhotic patients with hepatic encephalopathy. MethodsA cross-sectional, hospital-based study comprising of 182 cirrhotic patients with hepatic encephalopathy were evaluated. West Haven Classification (Grade I to IV) was used for grading of hepatic encephalopathy. The data analysis was done using SPSS version 20 and p-value of ≤0.05 was considered significant. ResultsMajority of patients (39.6%) presented with Grade II encephalopathy followed by Grade III (26.4%). Inpatient mortality was 22.5%. Mortality was seen in 95% patients with HE of grade IV. Univariate analysis showed male sex [p-value=0.01, OR-0.37, CI (0.17-0.820)], shock at presentation [p-value=0.0001, OR-42, CI (16.05 -109.9)], CTP [p-value=0.03, OR-3.8, CI (1.1-13.3)], presence of more than two precipitating factors [P=0.0001, OR-48, CI (10.3-216.3)], presence of SBP [p-value=0.0001, OR-23.4, CI (9.1-60.4)] as statistically significant predictive factors. Multivariate analysis showed shock [P=0.0001, OR-85.3, CI (12.7-571.7)], presence of more than two precipitating factors [p-value=0.0001, OR-101.8, CI (3.32-3119.32)] and SBP [p-value=0.0001, OR-44.7, CI (6.49-309.5)] as statistically significant predictive factors for mortality in patients with liver cirrhosis with hepatic encephalopathy. Conclusions Inpatient mortality was high with increasing grades of encephalopathy among cirrhotic patients. Initial presentation with shock, presence of more than two precipitating factors and SBP were independent predictors of inpatient mortality in patients with liver cirrhosis with hepatic encephalopathy.

Transition readiness assessment in Portuguese adolescents and young adults with pediatric-onset rheumatic diseases: a single-center study.

In this study, we aimed to assess the transition readiness levels amongst patients with childhood-onset rheumatic diseases. Additionally, we sought to identify and analyze predictive factors associated with better transition readiness skills in adolescent and young adult (AYAs) patients. This is a monocentric cross-sectional study that includes patients between 14 and 26 years of age who attended outpatient pediatric and young adult rheumatology appointments between October and December of 2023 and that were diagnosed with an immune-mediated rheumatic disease before reaching 18 years of age, with at least 1 year of disease duration. Patients were presented with a questionnaire that contained demographic and clinical questions, TRACS (Questionário de Preparação da Transição para a Autonomia nos Cuidados de Saúde) questionnaire - a validated Portuguese version of the Transition Readiness Assessment Questionnaire (TRAQ), and Hospital Anxiety and Depression Scale (HADS) questionnaire. Data was analyzed to assess the significant associations between the different variables and transition readiness outcome measured by the TRACS. Descriptive statistics, statistical comparisons and logistic regression analysis were performed. A total of 69 patients with a median age of 20 [17.5-22.5] were included in this study. The median TRACS score was 4.41 [4.09-4.74]. Significantly higher TRACS scores were observed in patients who were female, 18 years of age or older, had a higher level of education, were employed, had active disease or that belonged to middle-class (when compared to patients belonging to upper- middle class). The logistic regression analysis demonstrated that being a female or having an educational status equal to 12th grade or superior emerged as predictors of higher transition readiness levels. Our study identified female sex and higher level of education as predictors of increased transition readiness levels. Therefore, healthcare providers should consider these variables when assessing patients for transition readiness and focus on improving transition process, especially in male and less educated AYAs.

Factors Limiting Ostomy Reversal After Cytoreductive Surgery for Ovarian Cancer: A Retrospective Study.

To investigate the factors related to non-reversal of ostomy after cytoreductive surgery in ovarian cancer. In many women with ovarian cancer, transitory ostomies are performed to limit the consequences of anastomotic leak. Although intended to be temporary, a proportion of these ostomies might never be reversed. This was a retrospective study of patients with 2014 International Federation of Obstetrics and Gynecology stage IIB-IVB ovarian cancer requiring a transitory ostomy during primary or secondary cytoreductive surgery at the Bergonie Institute, France, and the University Hospital of Las Palmas, Spain, between January 2012 and December 2022. Rate of ostomy reversal, its timing (weeks) and postoperative complications were assessed. Multivariate logistic regression analysis was performed to identify limiting factors for ostomy reversal. During the study period, we reviewed data on 181 consecutive patients with ovarian cancer with transitory ostomy creation; 89 (49.2%) patients were not candidates for an ostomy reversal surgery because of disease progression (n=65), death (n=16), and patient's refusal of surgery (n=8). A total of 92 patients were candidates for reversal surgery and were therefore included in the final analysis. In total, 57 (62%) patients had their ostomy reversed. The mean time from ostomy creation to ostomy closure was 47.7 (standard deviation=33.1) weeks. Hartmann's procedure (leaving a rectal stump of 5-6 cm) was identified as an independent predictive factor for non-reversal of ostomy (odds ratio=6.42, 95% confidence interval=1.61-25.53; p=0.008). Complications after ostomy reversal occurred in 32 patients (34.8%). Hartmann's procedure is a limiting factor for ostomy reversal in patients with ovarian cancer. We recommend avoiding Hartmann's procedure during cytoreductive surgery, even after colorectal anastomotic leak.

Predictors of Attitudes toward Aging in Middle-Aged Individuals: A Cross-Sectional Study

Objective: Attitudes toward aging (ATA) are among the most important determinants of well-being in old age. However, little research has examined factors contributing to their formation in middle-aged individuals. This study aimed to investigate predictors of attitudes toward aging among Iranian middle-aged individuals in 2022. Method: This study recruited 330 people with a mean age of 56.5 ± 5.6 using multistage cluster sampling. Data were collected using a three-part questionnaire, including demographic factors, an attitude toward aging questionnaire (AAQ), and a multidimensional scale of perceived social support (MSPSS). The obtained data were analyzed using SPSS (v.22) statistical software to conduct t-tests, ANOVA, Pearson correlation, and linear regression. Results: According to bivariate analysis, perceived social support (PSS), age, level of education, and perceived income adequacy (PIA) had a significant relation with the total ATA score (P &lt; 0.05). According to regression analysis, family support (β = 0.288, P &lt; 0.001), friend support (β = 0.188, P &lt; 0.001), significant others support (β = 0.130, P = 0.04), age (β = 0.118, P = 0.002), and PIA (β = 0.290, P &lt; 0.001) were the predictor factors of ATA and explained 41% of the variance. PSS and PIA were the predictors of all dimensions of ATA. Conclusion: The results highlight the role of potentially modifiable factors, such as PSS, PIA, and level of education, in shaping ATA. This requires interventions and policies that effectively promote social and financial support in middle-aged individuals.

BRAF V600E mutation in thyroid carcinoma: a large-scale study in Han Chinese population

BackgroundThe prevalence of genetic mutations in thyroid cancer varies significantly among different ethnic backgrounds. The present study aimed to investigate the clinical potential of BRAF V600E in a large group of homogenous Han Chinese patients.MethodsFrom 2018 to 2021, 6232 thyroid disease patients who underwent thyroidectomy at our hospital were enrolled. We measured the diagnostic value of BRAF and plotted ROC curves. Patients with full clinical-pathological data were selected and divided into the BRAF mutation and wild type groups. We conducted univariate and multivariate analyses to quantify the differences in potential predictive factors of papillary thyroid carcinoma (PTC) patients between the groups. Kaplan–Meier survival analysis was used to estimate overall recurrence and recurrence rate.ResultsThe prevalence of BRAF V600E mutation was 86.0% in PTCs. The sensitivity and specificity of BRAF mutation for diagnosing PTC from suspicious lesions were 85.5% and 100%, respectively. The sensitivity and specificity of BRAF analysis in the indeterminate cytology group were 72.5% and 100%, respectively. BRAF mutation showed an independent association with older age, negative HT, larger tumor size, extrathyroidal extension, and multifocality in PTCs. In micro-PTCs (tumor size ≤ 1), the mutation was also positively correlated with progressive phenotypes of extrathyroidal extension and multifocality. BRAF mutation was associated with poorer recurrence-free probability in Kaplan–Meier survival analysis.ConclusionsThis large single-center study reveals that BRAF V600E is highly prevalent in the Han Chinese population and demonstrates BRAF V600E mutation testing has high diagnostic accuracy and its strong association with the progress of aggressiveness in PTCs and a higher probability of recurrence. BRAF mutation can serve as an accurate marker for diagnosis and decision-making with great value.

Predictive factors associated with health-related quality of life in patients with colorectal cancer in Iran: a cross-sectional study

ObjectivesThis study aims to identify the primary factors influencing health-related quality of life (HRQoL) in patients with colorectal cancer (CRC), hypothesising that specific patient characteristics and clinical factors significantly impact...

Predictive factors for deep medial collateral ligament release in adjusted mechanical alignment total knee arthroplasty

BackgroundTotal knee arthroplasty (TKA) demands precision in achieving optimal alignment and soft tissue balance, especially in cases of medial compartment osteoarthritis where the need for medial soft tissue release is critical yet challenging to ascertain.ObjectiveThis study aims to systematically investigate the relationship between preoperative data, initial knee conditions and the necessity for deep collateral ligament (MCL) release in adjusted mechanical alignment total knee arthroplasty.MethodsWe conducted a retrospective study involving 61 TKA patients who underwent adjusted mechanical alignment robotic-assisted procedures. Soft tissue release was carried out when clinically indicated. We collected and statistically analyzed patient demographics, initial knee conditions, and surgical details.ResultsAmong the patients, 52% required deep MCL release. Notably, patients without soft tissue release exhibited lower initial hip-knee-ankle (HKA) angles, reduced varus-valgus stress test angles, and a greater range of flexion. We identified a predictive threshold HKA angle of 6.250 degrees, demonstrating high sensitivity and specificity for determining the need for deep MCL release.ConclusionThis study underscores the significance of the initial HKA angle and varus-valgus stress tests in predicting deep MCL release during TKA. The established HKA angle threshold simplifies surgical decision-making, reducing the likelihood of unnecessary soft tissue release.

Investigating the Relationship between Moral Intelligence and Attitude towards Patient Safety in Nurses Working at Shahid Sadoughi Teaching Hospital in Yazd in 2023

Background: Moral intelligence in nurses is of particular importance due to the human and moral nature of their job and profession. Moral intelligence can provide a rule for the correct functioning of humans and is considered a predictive factor of behavior. The moral intelligence of nurses refers to their ability to distinguish right from wrong and adhere to ethical principles. Nurses with higher moral intelligence show more commitment to patient safety and adherence to professional protocols and have a more positive attitude toward patient safety. The purpose of this study was to investigate the relationship between moral intelligence and attitude towards patient safety in nurses working at Shahid Sadoughi Teaching Hospital in Yazd in 2023. Methods: The present study was a descriptive-analytical one conducted cross-sectionally in 2023. The statistical population included 237 nurses working in Shahid Sadoughi Teaching Hospital, Yazd, who were selected by stratified random sampling. Two standard questionnaires with a 5-point Likert scale were used to collect data. Data were analyzed by SPSS24 using descriptive statistics, one-way analysis of variance and Pearson's correlation coefficient. Results: The average moral intelligence of the studied nurses was 135.22 ± 22.30, and the average attitude of the nurses towards patient safety was 72.65 ± 17.32, indicating high moral intelligence and an average attitude towards patients safety in nurses in Shahid Sadoughi University. The results of Pearson's correlation coefficient showed that there is a positive and significant correlation between moral intelligence and nurses' attitude towards patient safety (r = 0.19, p = 0.003). Conclusion: Moral intelligence plays a role in predicting nurses' attitude towards patient safety; therefore, it seems that by strengthening the moral intelligence of nurses, their attitude towards patient safety can be influenced. To strengthen the moral intelligence of nurses and improve their attitude towards patient safety, professional ethics training, development of critical thinking skills and creation of ethical organizational culture can be used. Also, holding workshops to discuss ethical issues and support from ethical management can strengthen nurses in making ethical decisions and more responsible behavior in the field of patient safety.

The importance of high total body water/fat free mass ratio and serial changes in body composition for predicting hospital mortality in patients with severe pneumonia: a prospective cohort study

PurposeThis study aimed to investigate the impact of body composition variables on hospital mortality compared to other predictive factors among patients with severe pneumonia. Additionally, we aimed to monitor the dynamic changes in body composition variables over the course on days 1, 3, and 8 after intensive care unit (ICU) admission for each patient.MethodsWe conducted a prospective study, enrolling patients with severe pneumonia admitted to the medical intensive care unit at Kaohsiung Chang Gung Memorial Hospital from February 2020 to April 2022. We collected clinical data from all patients and assessed their body composition at 1, 3, and 8 days post-ICU admission. On day 1, we analyzed clinical and body composition variables to predict in-hospital mortality.ResultsMultivariate analysis identified the Modified Nutrition Risk in the Critically Ill (mNUTRIC) score and the ratio of total body water to fat-free mass (TBW/FFM) as independent factors associated with in-hospital mortality in severe pneumonia patients. Receiver operating characteristic analysis determined that the TBW/FFM ratio was the most reliable predictive parameter of in-hospital mortality, with a cutoff value of 0.74. General linear regression with repeated measures analysis showed that hospital non-survivors displayed notable fluctuations in body water, fat, and muscle variables over the course of days 1, 3, and 8 after ICU admission.ConclusionsThe mNUTRIC score and TBW/FFM ratio emerged as independent factors for predicting hospital mortality, with the TBW/FFM ratio demonstrating the highest reliability as a predictive parameter.

Development and validation of a risk prediction model for older adults with social isolation in China

BackgroundOlder adults are vulnerable to social isolation due to declining physical and cognitive function, decreased interpersonal interactions, and reduced outdoor activities after retirement. This study aimed to develop and validate a predictive model to assess the risk of social isolation among older adults in China.MethodsUsing data from the 2011 China Health and Retirement Longitudinal Study (CHARLS). The study cohort was randomly divided into training and validation groups in a 70:30 ratio. We used least absolute shrinkage and selection operator (LASSO) regression analysis with tenfold cross-validation to identify optimal predictive factors and examined the correlates of social isolation using logistic regression. A nomogram was constructed for the predictive model, and its accuracy was assessed using calibration curves. The predictive performance of the model was assessed using area under the receiver operating characteristic (ROC) curve and decision curve analysis (DCA).ResultsFrom the 2011 CHARLS database, 4,747 older adults were included in the final analysis, of whom 1,654 (34.8%) experienced social isolation. Multifactorial logistic regression identified educational level, marital status, gender, physical activity, physical self -maintenance ability, and number of children as predictive factors for social isolation. The predictive model achieved an AUC of 0.739 (95%CI = 0.722–0.756) in the training set and 0.708 (95%CI = 0.681–0.735) in the validation set. The Hosmer-Lemeshow test yielded P values of 0.111 and 0.324, respectively (both P > 0.05), indicating significant agreement between the nomogram and observed outcomes. The nomogram showed excellent predictive ability according to ROC and DCA.ConclusionsThe predictive model developed to assess the risk of social isolation in the Chinese older adults shows promising utility for early screening and intervention by clinical healthcare professionals.

Comparative study of machine learning and statistical survival models for enhancing cervical cancer prognosis and risk factor assessment using SEER data.

Cervical cancer is a common malignant tumor of the female reproductive system and the leading cause of death among women worldwide. The survival prediction method can be used to effectively analyze the time to event, which is essential in any clinical study. This study aims to bridge the gap between traditional statistical methods and machine learning in survival analysis by revealing which techniques are most effective in predicting survival, with a particular emphasis on improving prediction accuracy and identifying key risk factors for cervical cancer. Women with cervical cancer diagnosed between 2013 and 2015 were included in our study using data from the Surveillance, Epidemiology, and End Results (SEER) database. Using this dataset, the study assesses the performance of Weibull, Cox proportional hazards models, and Random Survival Forests in terms of predictive accuracy and risk factor identification. The findings reveal that machine learning models, particularly Random Survival Forests (RSF), outperform traditional statistical methods in both predictive accuracy and the discernment of crucial prognostic factors, underscoring the advantages of machine learning in handling complex survival data. However, for a survival dataset with a small number of predictors, statistical models should be used first. The study finds that RSF models enhance survival analysis with more accurate predictions and insights into survival risk factors but highlights the need for larger datasets and further research on model interpretability and clinical applicability.

Adipogenesis biomarkers as the independent predictive factors for breast cancer recurrence: a systematic review and meta-analysis

BackgroundComprehensive analysis of clinical evidence for breast cancer adipogenesis with prognosis is lacking. This study aims to consolidate the latest evidence on the relationship between adipogenesis and breast cancer outcomes.Data sources: Medline, Web of Science, Embase, Scopus, Clinicaltrials.gov, Cochrane library.MethodsA systematic review was conducted according to the PRISMA guidelines. Studies that reported the correlation between tumor adipogenesis and cancer recurrence or empirical pathological markers were included for meta-analysis. The standard reference for pathological markers determination was set as histopathological examination. The PROSPERO ID was CRD489135.ResultsEleven studies were included in this systematic review and meta-analysis. Several adipogenesis biomarkers involved in the synthesis, elongation, and catabolism of fatty acids, such as FASN, Spot 14, pS6K1, lipin-1, PLIN2, Elovl6, and PPARγ, were identified as the potential biomarkers for predicting outcomes. Through meta-analysis, the predictive value of adipogenesis biomarkers for 5-year recurrence rate was calculated, with a pooled predictive risk ratio of 2.19 (95% CI: 1.11–4.34). In terms of empirical pathological markers, a negative correlation between adipogenesis biomarkers and ki-67 was observed (RR: 0.69, 95% CI: 0.61–0.79). However, no significant correlation was found between the adipogenesis and ER, PR, HER2, or p53 positivity.ConclusionsBiomarker of adipogenesis in breast cancer is a significant predictor of long-term recurrence, and this prediction is independent of HR, HER2, and ki-67. The diverse roles of adipogenesis in different breast cancer subtypes highlight the need for further research to uncover specific biomarkers that can used for diagnosis and prediction.Protocol registrationPROSPERO ID: CRD489135.

A classification model for resectability in hepatocellular carcinoma patients.

Some patients undergoing liver resection for hepatocellular carcinoma (HCC) have poor outcomes. Therefore, we aimed to propose a new resectability classification for patients with HCC. We classified patients into three categories: resectable (R), borderline resectable (BR), and unresectable (UR). Patients (n=409) who underwent hepatectomy for HCC were assigned to the non-UR (R and BR classes combined; n=285) and UR-HCC classes (n=68; training cohort). Patient characteristics in the BR-HCC and R-HCC groups were compared. The new criteria were tested in a validation cohort (n=295). Of the 285 patients, 229 and 56 were classified into the R- and BR-HCC classes, respectively, using macrovascular invasion, tumor size, and future liver remnant/modified albumin-bilirubin scores. Patients with BR-HCC demonstrated significantly worse progression-free and overall survival (p<0.0001 and p<0.0001, respectively) than patients with R-HCC in the training cohort. Similar results were observed in the validation cohort. Multivariate analysis of the non-UR-HCC group in the training cohort revealed that the tumor number and BR-HCC were independent predictive factors for poor overall survival. This classification can help select patients with BR-HCC for preoperative treatment before considering surgery.