High-risk Group Research Articles

Construction of the bromodomain-containing protein-associated prognostic model in triple-negative breast cancer

BackgroundBromodomain-containing protein (BRD) play a pivotal role in the development and progression of malignant tumours. This study aims to identify prognostic genes linked to BRD-related genes (BRDRGs) in patients with triple-negative breast cancer (TNBC) and to construct a novel prognostic model.MethodsData from TCGA-TNBC, GSE135565, and GSE161529 were retrieved from public databases. GSE161529 was used to identify key cell types. The BRDRGs score in TCGA-TNBC was calculated using single-sample Gene Set Enrichment Analysis (ssGSEA). Differential expression analysis was performed to identify differentially expressed genes (DEGs): DEGs1 in key cells, DEGs2 between tumours and controls and DEGs3 in high and low BRDRGs score subgroups in TCGA-TNBC. Differentially expressed BRDRGs (DE-BRDRGs) were determined by overlapping DEGs1, DEGs2 and DEGs3. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis, and protein-protein interaction (PPI) network analysis were conducted to investigate active pathways and molecular interactions. Prognostic genes were selected through univariate Cox regression and least absolute shrinkage and selection operator (LASSO) regression analyses to construct a risk model and calculate risk scores. TNBC samples from TCGA-TNBC were classified into high and low-risk groups based on the median risk score. Additionally, correlations with clinical characteristics, Gene Set Enrichment Analysis (GSEA), immune analysis, and pseudotime analysis were performed.ResultsA total of 120 DE-BRDRGs were identified by overlapping 605 DEGs1 from four key cell types, 10,776 DEGs2, and 4,497 DEGs3. GO analysis revealed enriched terms such as ‘apoptotic process,’ ‘immune response,’ and ‘regulation of the cell cycle,’ while 56 KEGG pathways, including the ‘MAPK signaling pathway,’ were associated with DE-BRDRGs. A risk model comprising six prognostic genes (KRT6A, PGF, ABCA1, EDNRB, CTSD and GJA4) was constructed. A nomogram based on independent prognostic factors was also developed. Immune cell abundance was significantly higher in high-risk group. In both risk groups, TP53 exhibited the highest mutation frequency. The expression of KRT6A, ABCA1, EDNRB, and CTSD went decreased progressively in pseudotime.ConclusionA novel prognostic model for TNBC associated with BRDRGs was developed and validated, providing fresh insights into the relationship between BRD and TNBC.

Parental psychosocial factors and children’s oral health-related quality of life: Data from a caries prevention study with phone-based support

BackgroundCaries burden in children disproportionately affects minority and socioeconomically disadvantaged populations. Severe early childhood caries requiring general anesthesia (GA) is a significant concern, with high caries relapse rates in subsequent years.AimTo examine associations between parental psychosocial factors, children’s caries burden, and oral health-related quality of life (OHRQoL), including group differences, following a phone-based parental support intervention for children treated under GA for severe Early Childhood Caries (ECC).MethodsData were collected during a randomized controlled trial examining a phone-based parental support program. Parental stress was assessed using the Swedish Parenthood Stress Questionnaire (SPSQ), dental fear was measured with the Corah Dental Anxiety Scale (CDAS), and dental attitudes were evaluated using the Dental Beliefs Survey (DBS-R). Children’s OHRQoL was assessed using the Parental-Caregivers Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS). The Total Observed Caries Experience index was used to calculate the child’s cumulative caries burden. Unadjusted analyses were performed using t-tests, with effect sizes calculated as Cohen’s d. A two-step path analysis examined how parental factors, intervention, and baseline caries influenced caries burden at a one-year follow-up, while also assessing caries burdens impact on children's well-being.ResultsAt the one-year follow-up, the intervention group demonstrated significantly improved OHRQoL with lower mean scores on the P-CPQ and FIS compared to the control group, indicating fewer oral health issues and less impact on family life. No statistical differences were found in parental stress, dental fears, or dental beliefs between groups. Path analysis identified baseline caries and treatment group as significant predictors of caries burden, while intervention group predicted better OHRQoL outcomes. The model explained 86.2% of caries burden variance and 12.9% of OHRQoL variance.ConclusionA phone-based parental support program significantly improved children’s OHRQoL, even with a higher caries burden in the intervention group at the one-year follow-up. Parental stress, dental fears, and attitudes showed no differences and did not predict caries burden. Preventing early childhood caries in high-risk groups remains challenging, highlighting the importance of preventive initiatives that empower parents and foster collaboration with key stakeholders to reduce severe ECC.Registered at https://clinicaltrials.gov/ Identifier: NCT02487043.

Precision in Stroke Care: A Novel Model for Predicting Functional Independence in Urgent Carotid Intervention Patients.

Stroke requires timely intervention, with carotid endarterectomy (CEA) and carotid artery stenting (CAS) increasingly used in select acute carotid-related stroke patients. We aimed to build a model to predict neurologic functional independence (modified Rankin scale, mRS ≤ 2) in this high-risk group. We analyzed data from 302 stroke patients undergoing urgent CEA or CAS between 2015 and 2023 at a tertiary Comprehensive Stroke Center. Predictors included: (1) stroke severity (NIH Stroke Scale, NIHSS), (2) time to intervention (≤48 hours), (3) thrombolysis use, and (4) frailty risk score. Two-way interactions were included to enhance generalizability without overfitting. Multiple models were constructed and selected based on the area under the ROC curve (AUC). The primary endpoint was discharge neurological functional independence (mRS ≤2). Presenting clinical factors and neurological outcomes data from 302 patients undergoing urgent CEA and CAS during the index hospitalization from 2015 to 2023 at a tertiary Comprehensive Stroke Center formed the model's foundation. Most patients (72.8%, 220/302) were discharged functionally independent (mRS ≤ 2). The combined 30-day rate of stroke, death, and MI was 8.3% (25/302); 6.5% (14/214) for CEA alone, and 12.5% (11/88) for CAS. The model, incorporating thrombolysis, time to intervention, stroke severity (NIHSS), and frailty risk, correctly predicted 93% of functional independence outcomes (AUC 0.808). We present a novel model using four clinical factors-stroke severity, time to intervention, thrombolysis use, and frailty risk-to predict functional neurologic independence with 93% accuracy in patients undergoing urgent carotid interventions for acute stroke. This high predictive capability can enhance clinical decision-making and improve patient outcomes by identifying those most likely to benefit from timely carotid revascularization.

Whole lung radiomic features are associated with overall survival in patients with locally advanced non-small cell lung cancer treated with definitive radiotherapy

BackgroundSeveral studies have suggested that lung tissue heterogeneity is associated with overall survival (OS) in lung cancer. However, the quantitative relationship between the two remains unknown. The purpose of this study is to investigate the prognostic value of whole lung-based and tumor-based radiomics for OS in LA-NSCLC treated with definitive radiotherapy.MethodsA total of 661 patients with LA-NSCLC treated with definitive radiotherapy in combination with chemotherapy were enrolled in this study, with 292 patients in the training set, 57 patients from the same hospital from January to December 2017 as an independent test set (test-set-1), 83 patients from a multi-institutional prospective clinical trial data set (RTOG0617) as test-set-2, and 229 patients from a Dutch radiotherapy center as test-set-3. Tumor-based radiomic features and whole lung-based radiomic features were extracted from primary tumor and whole lungs (excluding the primary tumor) delineations in planning CT images. Feature selection of radiomic features was done by the least absolute shrinkage (LASSO) method embedded with a Cox proportional hazards (CPH) model with 5-fold cross-internal validation, with 1000 bootstrap samples. Radiomics prognostic scores (RS) were calculated by CPH regression based on selected features. Three models based on a tumor RS, and a lung RS separately and their combinations were constructed. The Harrell concordance index (C-index) and calibration curves were used to evaluate the discrimination and calibration performance. Patients were stratified into high and low risk groups based on median RS, and a log-rank test was performed.ResultsThe discrimination ability of lung- and tumor-based radiomics model was similar in terms of C-index, 0.69 vs. 0.68 in training set, 0.68 vs. 0.66 in test-set-1, 0.61 vs. 0.62 in test-set-2, 0.65 vs. 0.64 in test-set-3. The combination of tumor- and lung-based radiomics model performed best, with C-index of 0.71 in training set, 0.70 in test-set-1, 0.69 in test-set-2, and 0.68 in test-set-3. The calibration curve showed good agreement between predicted values and actual values. Patients were well stratified in training set, test-set-1 and test-set-3. In test-set-2, it was only whole lung-based RS that could stratify patients well and tumor-based RS performed bad.ConclusionLung- and tumor-based radiomic features have the power to predict OS in LA-NSCLC. The combination of tumor- and lung-based radiomic features can achieve optimal performance.

Enhancing staging in multiple myeloma using an m6A regulatory gene-pairing model

Multiple myeloma (MM) is characterized by clonal plasma cell proliferation in the bone marrow, challenging prognosis prediction. We developed a gene-pairing prognostic risk model using m6A regulatory genes and a nested LASSO method. A cutoff of − 0.133 categorized MM samples into high-risk and low-risk groups. The model showed strong prognostic performance in 2088 newly diagnosed MM samples and predicted response to combination therapy (daratumumab, carfilzomib, lenalidomide, and dexamethasone) in patients who failed or relapsed from bortezomib-containing regimens, with an AUC of 0.9. It distinguished between smoldering MM and MM (cutoff: − 0.45) and between MM and plasma cell leukemia (cutoff: 0.0857). Single-cell analysis revealed higher risk scores at relapse. Combining MM cell lines and sample data, we identified potential drugs and targets (ADAT2 and NUP153) effective against high-risk MM. Integrating the m6A risk model with the International Staging System (ISS) enhanced stratification accuracy. These insights support precision treatment of MM.Graphical

The expression landscape and clinical significance of methyltransferase-like 17 in human cancer and hepatocellular carcinoma: a pan-cancer analysis using multiple databases

BackgroundMethyltransferase-like (METTL) family protein plays a crucial role in the progression of malignancies. However, the function of METTL17 across pan-cancers, especially in hepatocellular carcinoma (HCC) is still poorly understood.MethodsAll original data were downloaded from TCGA, GTEx, HPA, UCSC databases and various data portals. First, we comprehensively analyzed RNA-seq data from the HPA database of 25 human tissues. An array of bioinformatics methods was employed to explore the potential oncogenic roles of METTL17, including analyzing its related prognosis, mutation, landscapes, tumor stemness index, immune cell infiltration, and other factors among different tumors. Additionally, gene set enrichment analysis (GSEA) was used to analyze pathways associated with METTL17 in HCC. Immunohistochemistry (IHC) was performed on clinical samples to validate the differential expression of METTL17 in HCC and normal tissues. Ultimately, we constructed a METTL17-related risk-score model of HCC and validated its prognostic classification efficiency. Survival rates were calculated using the Kaplan-Meier method. Statistical significance was defined as P < 0.05.ResultsMETTL17 was differentially expressed in various cancers. METTL17 maintained strong correlations with the cancer patient’s prognosis, genetic alterations, tumor stemness index, and immune-infiltrated cells, etc. In addition, IHC experiments verified that METTL expression was significantly decreased in liver tissues of HCC patients compared to normal liver tissue. GESA analysis indicated METTL17 mainly involves oncogenic and immune-related pathways among HCC. MRPS5, CHCHD2, NCBP1, LRPPRC, DAP3, and BMS1 were included in a prognostic model based on METTL17’s interaction networks. Kaplan–Meier survival analysis of the prognostic model showed that the overall survival (OS) of the low-risk group was significantly better than that of the high-risk group (P < 0.001). The area under the receiver operating characteristic (ROC) curve (AUC) of the 1-year, 3-year, and 5-year OS were 0.747, 0.671, and 0.631, respectively.ConclusionsMETTL17 may serve as a novel prognostic marker and therapeutic target for human tumors, offering a theoretical foundation for formulating more effective and tailored clinical treatment options for cancers, particularly HCC.

A decision-analytic method to evaluate the cost-effectiveness of remote monitoring technology for chronic depression.

Advances in mobile apps, remote sensing, and big data have enabled remote monitoring of mental health conditions, but the cost-effectiveness is unknown. This study proposed a systematic framework integrating computational tools and decision-analytic modeling to assess cost-effectiveness and guide emerging monitoring technologies development. Using a novel decision-analytic Markov-cohort model, we simulated chronic depression patients' disease progression over 2 years, allowing treatment modifications at follow-up visits. The cost-effectiveness, from a payer's viewpoint, of five monitoring strategies was evaluated for patients in low-, medium-, and high-risk groups: (i) remote monitoring technology scheduling follow-up visits upon detecting treatment change necessity; (ii) rule-based follow-up strategy assigning the next follow-up based on the patient's current health state; and (iii-v) fixed frequency follow-up at two-month, four-month, and six-month intervals. Health outcomes (effects) were measured in quality-adjusted life-years (QALYs). Base case results showed that remote monitoring technology is cost-effective in the three risk groups under a willingness-to-pay (WTP) threshold of U.S. GDP per capita in year 2023. Full scenario analyses showed that, compared to rule-based follow-up, remote technology is 74 percent, 67 percent, and 74 percent cost-effective in the high-risk, medium-risk, and low-risk groups, respectively, and it is cost-effective especially if the treatment is effective and if remote monitoring is highly sensitive and specific. Remote monitoring for chronic depression proves cost-effective and potentially cost-saving in the majority of simulated scenarios. This framework can assess emerging remote monitoring technologies and identify requirements for the technologies to be cost-effective in psychiatric and chronic care delivery.

Assessing the Likelihood of Procedural Intubation During Percutaneous Coronary Intervention.

Preprocedural fasting is widely used before percutaneous coronary intervention (PCI). However, the incidence of procedural intubation during PCI is unknown. This study aims to identify the incidence and predictors for procedural intubation during PCI. A retrospective cohort study was performed on patients undergoing PCI between 2014 and 2021 within the Victorian Cardiac Outcomes Registry. Patients were classified into urgent, semiurgent, or elective PCI on the basis of recorded PCI indication. Those undergoing semiurgent or elective PCI were presumed to be fasted preprocedurally. The incidence of procedural intubation was reported for each PCI group. Inverse probability treatment weighting was used to determine the association between 30-day death and procedural intubation. Logistic regression was performed to determine clinical, procedural, and lesion characteristics associated with procedural intubation among fasted patients. Among 83 929 patients, the incidence of procedural intubation was 0.5%. Patients undergoing urgent PCI (odds ratio [OR], 19.68 [95% CI, 13.91-27.86]; P<0.01) had the highest risk of procedural intubation. Procedural intubation was associated with increased 30-day death (OR, 4.79 [95% CI, 3.29-6.96]; P<0.01). Among fasted patients, estimated glomerular filtration rate (OR, 0.99 [95% CI, 0.98-0.99]; P<0.01), cardiogenic shock (OR, 96.24 [95% CI, 56.01-165.35]; P<0.01), out-of-hospital cardiac arrest (OR, 3.42 [95% CI, 1.30-8.97]; P=0.01), femoral access (OR, 2.09 [95% CI, 1.38-3.19]; P<0.01), left main disease (OR, 5.77 [95% CI, 3.16-10.54]; P<0.01), type C lesions (OR, 3.86 [95% CI, 1.19-12.56]; P=0.03), and rotational atherectomy (OR, 2.20 [95% CI, 1.03-4.69]; P=0.04) were associated with procedural intubation. Despite an association with a worse 30-day mortality rate, the incidence of procedural intubation during PCI was low. Universal preprocedural fasting may be unnecessary and could be targeted at higher-risk groups.

Early Dynamics of Portal Pressure Gradient After TIPS Insertion Predict Mortality.

Transjugular intrahepatic portosystemic shunt (TIPS) placement leads to a reduction in portal pressure and an improvement in survival in patients with recurrent and refractory ascites and variceal haemorrhage. Prediction of post-TIPS survival is primarily determined by factors identified before the TIPS procedure, as data collected during or after TIPS implantation are limited. The aim of the study was to evaluate the influence of early hemodynamic changes after TIPS placement on survival, in order to refine post TIPS management. In this prospective bicentric study, consecutive patients (n = 105) undergoing TIPS placement for ascites or variceal haemorrhage underwent measurement of portal pressure gradient (PPG) immediately at TIPS insertion (PPG0) and 24 h later (PPG24h) and the ΔPPG was calculated from PPG24h and PPG0 (ΔPPG = PPG24h-PPG0). Kaplan-Meier survival analysis and uni- and multivariable regression analyses were conducted to identify survival predictors. Patients with lack of increased ΔPPG exhibited poorer 90-day and 1-year survival compared to patients with increased ΔPPG. This worse survival was independent of The Model for End-Stage Liver Disease (MELD) score, Child-Pugh score, bilirubin levels, creatinine and the Freiburg index of post-TIPS survival (FIPS) > 0.92. Among these patients with poorer outcome, elevated bilirubin (> 25 μmol/L) further distinguished survivors from non-survivors. Lack of increased ΔPPG post-TIPS insertion identifies a high-risk patient group with worse survival. We propose incorporating this second PPG measurement and determining ΔPPG into clinical practice to identify these patients early and tailor post-TIPS patient care.

Biomarker Panels for Discriminating Risk of CKD Progression in Children.

We have previously studied biomarkers of tubular health (EGF), injury (KIM-1), dysfunction (alpha-1 microglobulin), and inflammation (TNFR-1, TNFR-2, MCP-1, YKL-40, suPAR), and demonstrated that plasma KIM-1, TNFR-1, TNFR-2 and urine KIM-1, EGF, MCP-1, urine alpha-1 microglobulin are each independently associated with CKD progression in children. In this study, we used bootstrapped survival trees to identify a combination of biomarkers to predict CKD progression in children. The CKiD Cohort Study prospectively enrolled children 6 months to 16 years old with an eGFR of 30-90 ml/min/1.73m2. We measured biomarkers in stored plasma and urine collected 5 months after study enrollment. The primary outcome of CKD progression was a composite of 50% eGFR decline or kidney failure. We constructed a regression tree-based model for predicting the time to the composite event, using a panel of clinically relevant biomarkers with empirically derived thresholds, in addition to conventional risk factors. Of the 599 children included, the median age was 12 years [IQR, 8 - 15], 371 (62%) were male, baseline urine protein to creatinine ratio was 0.33 [IQR: 0.12 - 0.95] mg/mg, and baseline eGFR was 53 [IQR, 40 - 66] ml/min/1.73m2. Overall, 205 (34%) children reached the primary outcome of CKD. A single regression tree-based model using the most informative predictors with data driven biomarker thresholds suggested a final set of 4 prognosis groups. In the final model, urine albumin/creatinine was the variable with the highest importance, and along with urine EGF/creatinine identified the highest risk group of 24 children, 100% of whom developed CKD progression at a median time of 1.3 years [95% CI: 1.0, 1.7]. When the regression tree-derived risk group classifications were added to prediction models including the clinical risk factors, the C-statistic increased from 0.76 [95%CI: 0.71 - 0.80] to 0.85 [95%CI: 0.81 - 0.88]. Using regression tree-based methods, we identified a biomarker panel of urine albumin/creatinine, urine EGF/creatinine, plasma KIM-1, and eGFR which significantly improved discrimination for CKD progression.

Early menarche is associated with disordered eating-results from a National Youth Survey.

Disordered eating (DE) is highly prevalent among adolescents, though its definition varies. The association between DE and early pubertal maturation (EPM) remains underexplored in Israel, and has not been sufficiently examined using the widely-used SCOFF questionnaire. This study examines these associations in adolescents. Participants (n = 2415 girls, 2095 boys; ages 12-18 years) in a nationally-representative, cross-sectional Youth Health and Nutrition Survey (2015-2016) completed self-administered questionnaires, including the SCOFF questionnaire, and underwent anthropometric measurements. EPM was determined by menarcheal age <11.5 years in girls, and facial hair appearance <12.5 years in boys. Respondents affirming ≥2 SCOFF items were classified as DE cases. Multivariable logistic regression analyses examined the associations between EPM and DE. Among the participants, 12.7% of the girls and 20.4% of the boys met EPM criteria; 55.5% and 33.7%, respectively, were categorized as having DE. Following adjustment for age, socioeconomic status, ethnic background, and weight status, EPM was significantly associated with DE in girls (OR 1.47, 95%CI: 1.12-1.93) and with 3/5 SCOFF items. No such association was found in boys (OR 1.00, 95%CI: 0.77-1.28). EPM in girls was associated with DE. Identifying high risk groups for DE in adolescents is crucial for early intervention and prevention. This study included a large, nationally representative sample of Israeli adolescents and utilized the SCOFF questionnaire, a widely used screening measure for disordered eating (DE). Following comprehensive analyses, a significant association between early pubertal maturation (EPM), defined as early menarche, and DE was documented in Israeli adolescent girls. Identifying girls with EPM and screening for disordered eating will allow for early interventions, potentially improving physical and mental health, and preventing progression to eating disorders.

Degenerative gluteal tears associated with hip arthroplasty

BackgroundUnrepaired chronic abductor tears may be a cause of residual pain and weakness after hip arthroplasty, but the current incidence is unclear.MethodsFrom 1994 to 2009, the senior surgeon performed 1628 hip resurfacing and 864 total hip arthroplasties without identifying any gluteal tears. We recognized our first case of concomitant abductor tear during a hip resurfacing procedure in April 2009. After this, we began following a protocol to identify and repair abductor tears in the next 5601 consecutive primary hip arthroplasties (5429 hip resurfacings and 172 total hips).ResultsWomen over 60 were the highest-risk group for abductor tear, with a 3.6% rate of tears identified. All tears were repaired. We found no differences in mean HHS and VAS pain score in patients with repair gluteal tears versus a control group of cases without a tear. Patients without a tear had higher postoperative UCLA activity scores at 2 years postoperative. The majority (98.1%) of hip arthroplasty patients with a gluteal tear repair at time of surgery presented with 4 or 5 abductor strength at their 2-year postoperative physical exam. Of our abductor tear cohort, 70.3% had no limp and 21.9% had a slight limp at 2 years postoperative.ConclusionsIn a large group of hip arthroplasty cases (n = 4507), we identified gluteal tears in 3.6% of women and 1.0% of men. All reported clinical outcomes (excluding mean HHS) in our cohort of hip arthroplasty patients did not differ significantly between cases without abductor tears and those that had gluteal repair at time of surgery. These results suggest abductor tears may be repaired at time of hip arthroplasty surgery without forgoing desirable functional outcomes.Level of evidenceLevel 3 Retrospective Cohort Study.

Generalised anxiety disorder and its determinants amongst patients with diabetes in primary healthcare clinics: a cross-sectional study in Kuwait City, 2024

BackgroundAnxiety disorders are the second most common mental health disorders in terms of disability-adjusted life years and years of life lost across all age groups. A bidirectional relationship between anxiety disorders and diabetes mellitus has been documented. This study aimed to determine the prevalence of anxiety and its associated factors among patients with diabetes receiving care at public primary care clinics in Kuwait during the first quarter of 2024.MethodologyA cross-sectional study was conducted in the first quarter of 2024 at three primary healthcare centres within the Capital Governate in Kuwait City. Adults with diabetes mellitus for longer than six months duration were requested to participate by the health promoters and the Generalised Anxiety Disorder questionnaire was shared via a mobile link/QR scan. Data were collected through self-or interviewer-administered surveys, cleaned and coded in Microsoft Excel, and analysed using STATA version 18. Descriptive analysis was initially conducted followed by bivariate and multivariate analysis with a p < 0.05 and a 95% confidence interval used to determine the association between demographic and clinical factors and GAD.ResultsA total of 554 patients participated, yielding an 80% response rate. Anxiety symptoms were observed in 48% of respondents, though only 4% (n = 25) had a GAD score > 10. Among participants with moderate-to-severe anxiety (n = 21), 52% were aged 50–59 years, 90% were non-native Kuwaiti citizens, and 62% had an HbA1C measurement > 7 mmol/L. Multivariate analysis indicated that non-native Kuwait citizens were significantly more likely to have moderate-to-severe anxiety (AOR: 6.99, 95% CI: 1.42–34.43) compared to Kuwaiti nationals. Conversely, participants attending clinic visits every two months were less likely (AOR: 0.30, 95% CI: 0.00–0.50) to report moderate-to-severe anxiety symptoms than those attending monthly.ConclusionWhile nearly half of patients with diabetes displayed anxiety symptoms, only a small proportion (4%) experienced moderate-to-severe anxiety. Non-native Kuwaiti residents were significantly more likely to have GAD scores > 10. Integrating anxiety screening into diabetes care may improve outcomes for this high-risk group.

Factors related to cough strength before tracheal extubation in post-cardiac surgery patients: A cross-sectional study.

Tracheal extubation failure after cardiac surgery is associated with diminished cough strength, albeit the information on cough strength in post-cardiac surgery patients is limited. To investigate the cough strength in patients after cardiac surgery before tracheal extubation and the related influencing factors. A cross-sectional study was designed, with adherence to the STROBE guidelines. The participants were 528 patients undergoing open-heart cardiac surgery who were admitted to the Cardio Surgical Centre in a tertiary hospital in Nanjing, China, from August 2022 to September 2023. Cough peak flow (CPF) ≤60 L/min set as the cut-off value for evaluating diminished cough strength before tracheal extubation. Univariate analysis and multiple linear regression analysis were used to analyse the related influencing factors. The mean CPF was 130.70 ± 50.58 L/min. A total of 76 (14.4%) patients exhibited a CPF of ≤60 L/min. Multiple linear regression analysis revealed that gender (B = 14.266, t = 2.456, p = .014), inspiratory capacity (IC) (B = 0.013, t = 3.755, p < .001), preoperative CPF (B = 0.086, t = 3.903, p < .001), muscle strength (B = 12.423, t = 4.242, p < .001), preoperative exercise regimen (B = 16.716, t = 4.236, p < .001) and pain levels (B = -8.115, t = -5.794, p < .001) significantly contributed to cough strength. Female gender, lower upper limb muscle strength, higher pain levels, lower preoperative CPF and IC, and the absence of systematic exercise were found to be associated with diminished cough strength. Cough strength provides important auxiliary data in extubation decision-making. In addition, understanding its relevant factors can help identify the high-risk group of tracheal extubation failure and can help provide a strong theoretical basis for the development of personalized interventions.

Evaluation of using grip strength and hand muscle cross-sectional area to predict secondary fractures post distal radius fracture

SummaryGrip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in distal radius fracture patients. This simple tool enhances clinical practice by identifying high-risk patients for targeted interventions, potentially preventing or reversing functional decline and recurrent fractures.PurposeTo evaluate grip strength and hand muscle cross-sectional area as predictors of secondary fracture risk in patients with a history of distal radius fracture (DRF), serving as surrogates of the diagnosis of sarcopenia.MethodsA retrospective cohort study of 745 DRF patients was analyzed with their grip strength data using Cox proportional hazards regression, receiver operating characteristic analysis, and Kaplan–Meier analysis to predict secondary fracture risk over an average of 12 years. Hand muscle cross-sectional area was similarly analyzed.ResultsPatients with a history of DRF were predicted to have a 4.1% higher likelihood of experiencing a secondary fracture per kilogram reduction in their grip strength (p < 0.008), independent of age and sex. Patients were categorized as high-risk (≤ 16 kg), moderate-risk (17–24 kg), or low–risk (≥ 25 kg) (p < 0.001). High-risk patients showed a 2.2-fold (95% CI = 1.55–3.17) higher recurrent fracture risk compared to low-risk patients. Cumulative secondary fracture probabilities of the high-risk group patients at 5, 10, and 15 years were estimated to be 16%, 30%, and 54%, respectively.ConclusionsGrip strength measurement, as a surrogate of sarcopenia diagnosis, effectively predicts secondary fracture risk in patients with DRF. This simple tool could improve clinical practice by identifying high-risk patients for targeted interventions to prevent recurrent fractures or even reverse functional decline.

The Prevalence and Influencing Factors of Child Sexual Abuse among School Students in Rural Central China: A Cross-Sectional Survey

Background: Child sexual abuse (CSA) is a global public health problem, which has a significant impact, and the situation is not optimistic. Objectives: The aim was to investigate the prevalence rate and influencing factors of CSA among school-aged children in rural central China. Participants and Setting: Participants were recruited from rural schools to reflect the prevalence rate of CSA in Hubei Province in China. A total of 3,940 (2,085 boys and 1,855 girls) school-aged rural children in central China participated in this study. Methods: The prevalence rate and influencing factors of CSA were tested through the utilization of anonymous and self-administered questionnaires, which collected the demographic information of the participants and the contact and non-contact types of CSA incidents. Results: The prevalence rate of CSA in the survey was 15.3%. Findings from multivariate analysis indicated that gender (OR=0.428, 95%CI: 0.355~0.517, reference: boy), study level at school (OR=1.597，95%CI: 1.414~1.805, reference: primary school) and whether the respondent was a left-behind child (OR=1.238，95%CI: 1.014~1.511, reference: non-left-behind child) were significantly associated with CSA. Conclusions: The prevalence rate of CSA among the participants was relatively high. Boys, senior high school students and left-behind children were more likely to be sexually abused. The provision of systematic sexual education to these high-risk groups will help reduce the prevalence of CSA.

Necroptosis-Related Gene Signature Predicts Prognosis in Patients with Advanced Ovarian Cancer

Background/Objectives: This study aimed to construct a risk score (RS) based on necroptosis-associated genes to predict the prognosis of patients with advanced epithelial ovarian cancer (EOC). Methods: EOC data from The Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) series 140082 (GSE140082) were used. Based on known necroptosis-associated genes, clustering was performed to identify molecular subtypes of EOC. A least absolute shrinkage and selection operator (LASSO)–Cox regression analysis identified key genes related to prognosis. The expression of one of them, RIPK3, was analyzed via immunohistochemistry in an EOC cohort. Results: An RS made from ten genes (IDH2, RIPK3, FASLG, BRAF, ITPK1, TNFSF10, ID1, PLK1, MLKL and HSPA4) was developed. Tumor samples were divided into a high-risk group (HRG) and low-risk group (LRG) using the RS. The model is able to predict the overall survival (OS) of EOC and distinguish the prognosis of different clinical subgroups. Immunohistochemical verification of the receptor-interacting serine/threonine-protein kinase (RIPK) 3 confirmed that high nuclear expression is correlated with a longer OS. In addition, the score can predict the response to a programmed death ligand 1 (PD-L1) blockade treatment in selected solid malignancies. Patients from the LRG seem to benefit more from it than patients from the HRG. Conclusions: Our RS based on necroptosis-associated genes might help to predict the prognosis of patients with advanced EOC and gives an idea on how the use of immunotherapy can potentially be guided.

Derivation and validation of a simple prognostic risk score to predict short-term mortality in acute cardiogenic pulmonary edema: SABIHA Score.

In the context of acute cardiogenic pulmonary edema (ACPE), a frequently encountered medical emergency associated with high early mortality rates, there is a need to predict short-term outcomes for risk stratification.Our aim was to derive and validate a model, a simple clinical scoring system using baseline vital signs, clinical and presenting characteristics, and readily available laboratory tests, that allows accurate prediction of short-term mortality in individuals experiencing ACPE. This retrospective cohort study included 1088 patients with ACPE from six health centers. Subjects were randomly allocated into derivation and validation cohorts at a 4:3 ratio, facilitating comprehensive examination and validation of prognostic model. Independent predictors of mortality (p<0.05) from the multivariable model were included in the risk score. The discriminant ability of the score was tested by ROC analysis. In the derivation cohort (n=623), age, blood urea nitrogen, heart rate, intubation, anemia, and systolic blood pressure were identified as independent predictors of mortality in multivariable analysis. These variables were used to develop a risk score ranging from 0 to 6 by scoring 0 and 1. The SABIHA score provided a good calibration with a concordance index of 0.879 (95% CI: 0.821-0.937). While the probability of short-term mortality was 80.0% in the high risk group, this rate was only 3.3% in the low risk group. This score also performed well on the validation set. A simple clinical score consisting of routinely obtained variables can be used in risk stratification to predict short-term outcomes in patients with ACPE.

ANESTHETIC CONSIDERATIONS FOR CRITICALLY ILL PATIENTS WITH SEPSIS

Objective: Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Critically ill patients with sepsis often require surgical interventions, presenting significant anesthetic challenges due to profound physiological alterations and multiple organ dysfunctions. Methods: This systematic review aims to synthesize current evidence on anesthetic management strategies for critically ill patients with sepsis. A comprehensive literature search was conducted in PubMed, Embase, and Cochrane Library databases for studies published up to October 2023. Inclusion criteria encompassed clinical trials, observational studies, reviews, and guidelines focusing on anesthetic considerations in septic patients. Results: Key findings indicate that thorough preoperative assessment, vigilant hemodynamic monitoring, careful selection of anesthetic agents, and tailored ventilatory strategies are crucial for improving perioperative outcomes. Hemodynamic instability necessitates the use of invasive monitoring and vasoactive medications like norepinephrine. Etomidate and ketamine are preferred induction agents due to their hemodynamic stability, with considerations for their side effects. Maintenance anesthesia often favors total intravenous techniques to minimize cardiovascular depression. Protective lung ventilation strategies are essential due to the high risk of acute respiratory distress syndrome (ARDS). Postoperative care requires multidisciplinary collaboration to manage ongoing sepsis and prevent complications. Conclusion: This review highlights the importance of individualized anesthetic plans and suggests that adherence to evidence-based practices can enhance patient outcomes in this high-risk group.

Quantitative Analysis of Free 3-Methoxytyramine by LC-MS/MS in Pediatric Patients with Neuroblastoma

Neuroblastomas are the most common solid tumours in early childhood. Currently, the prognosis of patients is evaluated almost exclusively on the basis of molecular-genetic markers from a biopsy sample of tumour tissue. This study is focused on evaluating the potential use of 3‑methoxytyramine as an alternative non-invasive prognostic marker for patients with neuroblastoma. For this purpose, a method was developed to determine free 3‑methoxytyramine in urine using liquid chromatography coupled with tandem mass spectrometric detection. The method was fully validated and subsequently tested on 25 pediatric urine samples. In the group of patients with a poor prognosis, the median value of free 3-methoxy­tyramine was 666.7 nmol mmol−1Krea, while in the group with a favourable prognosis, it was 168.4 nmol mmol−1Krea. The analysis of pediatric urine samples from neuroblastoma patients revealed statistically significant differences in the concentration of free 3‑methoxytyramine (P &lt; 0,05) between the low/medium-risk group and the high-risk group.