Increased Survival Rate Research Articles

A large-scale proteomics resource of circulating extracellular vesicles for biomarker discovery in pancreatic cancer

Pancreatic cancer has the worst prognosis of all common tumors. Earlier cancer diagnosis could increase survival rates and better assessment of metastatic disease could improve patient care. As such, there is an urgent need to develop biomarkers to diagnose this deadly malignancy. Analyzing circulating extracellular vesicles (cEVs) using ‘liquid biopsies’ offers an attractive approach to diagnose and monitor disease status. However, it is important to differentiate EV-associated proteins enriched in patients with pancreatic ductal adenocarcinoma (PDAC) from those with benign pancreatic diseases such as chronic pancreatitis and intraductal papillary mucinous neoplasm (IPMN). To meet this need, we combined the novel EVtrap method for highly efficient isolation of EVs from plasma and conducted proteomics analysis of samples from 124 individuals, including patients with PDAC, benign pancreatic diseases and controls. On average, 912 EV proteins were identified per 100 µL of plasma. EVs containing high levels of PDCD6IP, SERPINA12, and RUVBL2 were associated with PDAC compared to the benign diseases in both discovery and validation cohorts. EVs with PSMB4, RUVBL2, and ANKAR were associated with metastasis, and those with CRP, RALB, and CD55 correlated with poor clinical prognosis. Finally, we validated a seven EV protein PDAC signature against a background of benign pancreatic diseases that yielded an 89% prediction accuracy for the diagnosis of PDAC. To our knowledge, our study represents the largest proteomics profiling of circulating EVs ever conducted in pancreatic cancer and provides a valuable open-source atlas to the scientific community with a comprehensive catalogue of novel cEVs that may assist in the development of biomarkers and improve the outcomes of patients with PDAC.

A large-scale proteomics resource of circulating extracellular vesicles for biomarker discovery in pancreatic cancer.

Pancreatic cancer has the worst prognosis of all common tumors. Earlier cancer diagnosis could increase survival rates and better assessment of metastatic disease could improve patient care. As such, there is an urgent need to develop biomarkers to diagnose this deadly malignancy. Analyzing circulating extracellular vesicles (cEVs) using 'liquid biopsies' offers an attractive approach to diagnose and monitor disease status. However, it is important to differentiate EV-associated proteins enriched in patients with pancreatic ductal adenocarcinoma (PDAC) from those with benign pancreatic diseases such as chronic pancreatitis and intraductal papillary mucinous neoplasm (IPMN). To meet this need, we combined the novel EVtrap method for highly efficient isolation of EVs from plasma and conducted proteomics analysis of samples from 124 individuals, including patients with PDAC, benign pancreatic diseases and controls. On average, 912 EV proteins were identified per 100 µL of plasma. EVs containing high levels of PDCD6IP, SERPINA12, and RUVBL2 were associated with PDAC compared to the benign diseases in both discovery and validation cohorts. EVs with PSMB4, RUVBL2, and ANKAR were associated with metastasis, and those with CRP, RALB, and CD55 correlated with poor clinical prognosis. Finally, we validated a seven EV protein PDAC signature against a background of benign pancreatic diseases that yielded an 89% prediction accuracy for the diagnosis of PDAC. To our knowledge, our study represents the largest proteomics profiling of circulating EVs ever conducted in pancreatic cancer and provides a valuable open-source atlas to the scientific community with a comprehensive catalogue of novel cEVs that may assist in the development of biomarkers and improve the outcomes of patients with PDAC.

Diversity in Naturally Acquired Immunity to Group B Streptococcus: A Comparative Study of Women from Bangladesh, Malawi, and the United Kingdom.

Significant disparities in Group B Streptococcus (GBS) colonisation and neonatal disease rates have been documented across different geographical regions. For example, Bangladesh reports notably lower rates compared to the United Kingdom (UK) and Malawi. This study investigates whether this epidemiological variability correlates with the immune response to GBS in these regions. Qualitative and quantitative analyses of naturally acquired immunoglobulin G (IgG) antibodies against GBS capsular polysaccharides (CPS) and the Alp protein family were conducted in serum samples from women of childbearing age in the UK, Bangladesh, and Malawi. The efficacy of these antibodies in clearing vaginal colonisation or protecting newborns from GBS infection was assessed using humanised mouse models. Bangladeshi women displayed the highest diversity in serotype distribution, with elevated immunoglobulin G (IgG) levels in the serum against GBS capsular polysaccharides (CPS)- Ia, Ib, II, III, IV, and V, as well as Alp family proteins. In contrast, Malawian sera demonstrated the weakest antibody response. Bangladeshi sera also showed heightened IgG-mediated complement deposition, opsonophagocytic killing and neonatal Fc receptor (FcRn)-binding while tested against CPS Ib. In a humanised FcRn mouse model, Bangladeshi sera led to faster clearance of GBS virulent serotype Ib vaginal colonisation. Additionally, offspring from dams passively immunised with Bangladeshi sera demonstrated notably increased survival rates. This study demonstrates significant variability in the immune response to GBS across different geographical regions. These findings underscore the importance of understanding GBS-induced immune response in diverse populations, which may significantly impact vaccine efficacy in these regions.

Cost Utility of Various Biologic Versus Endoprosthetic Reconstruction for Primary Bone Sarcoma of the Knee

Background: Currently, the treatment of primary bone sarcoma has been developed to increase survival rate and enable patients to undergo limp sparing surgery. The cost-utility study of reconstructive surgery methods could also benefit developing treatment plans as well as national policies. Materials and Methods: The present research was conducted among 27 patients with primary bone sarcoma of the knee undergoing limp sparing surgery by analyzing the cost-utility of various biologic versus endoprosthesis reconstruction. The result reported in the quality-adjusted-life years (QALY), cost per year of well-being (Cost/QALY), ratio of additional sanitary years (QALY gain), and creating alternatives to adjust costs to an acceptable range with one-way sensitivity analysis. Results: The QALY of endoprosthesis was the highest at 5.316 years, while the lowest number was recycled bone autograft at 3.712 years. Compared with the Cost/QALY, the recycled bone autograft indicated the most breakeven method, while endoprosthesis showed the lowest. For analyzing by QALY gain, the additional investment totaled 171,314.27 THB. Conclusion: Prosthesis as a good option, have side effects and the highest number of QALY but did not breakeven. However, reducing the cost by 27.004% was almost the same as the most breakeven method. For this method, an additional investment, equivalent to the minimum wage in Thai law averaging within 1 year, was not needed because this extra investment cost only about the minimum Thai civil servant salary for 1 year. Keywords: Primary bone sarcoma of the knee; Bone reconstruction around the knee; Cost-utility analysis; Various biologic versus endoprosthesis reconstruction

Unravelling turbot (Scophthalmus maximus) resistance to Aeromonas salmonicida: transcriptomic insights from two full-sibling families with divergent susceptibility

IntroductionFurunculosis, caused by the gram-negative bacterium Aeromonas salmonicida subsp. salmonicida, remains a significant threat to turbot (Scophthalmus maximus) aquaculture. Identifying genetic backgrounds with enhanced disease resistance is critical for improving aquaculture health management, reducing antibiotic dependency, and mitigating economic losses. MethodsIn this study, five full-sibling turbot families were challenged with A. salmonicida, which revealed one family with significantly greater resistance. Transcriptomic analyses (RNA-Seq) were performed on resistant and susceptible families, examining both naïve and 24-h postinfection (hpi) samples from head kidney and liver tissues. ResultsIn the absence of infection, differentially expressed genes (DEGs) were identified predominantly in the liver. Following infection, a marked increase in DEGs was observed in the head kidney, with many genes linked to immune functions. Interestingly, the resistant family displayed a more controlled inflammatory response and upregulation of genes related to antigen presentation and T-cell activity in the head kidney at early infection stages, which may have contributed to its increased survival rate. In the liver, transcriptomic differences between the families were associated mainly with cytoskeletal organization, cell cycle regulation, and metabolic processes, including insulin signalling and lipid metabolism, regardless of infection status. Additionally, many DEGs overlapped with previously identified quantitative trait loci (QTLs) associated with resistance to A. salmonicida, providing further insights into the genetic basis of disease resistance. DiscussionThis study represents the first RNA-Seq analysis comparing resistant and susceptible turbot families and contributes valuable knowledge for the development of selective breeding programs targeting disease resistance in turbot and other aquaculture species susceptible to A. salmonicida.

Enhancing large-diameter timber production: Evaluating poplars by genotype and spacing

To meet the increased demand for construction timber, selecting large-diameter hybrid poplar genotypes and optimizing spacing are essential for enhancing stand productivity in Northeast China. In the Daling River Plain, a trial with 12 clones (G1∼G12) of Populus × euramericana at four spacings (2 m×5 m, 3 m×8 m, 4 m×8 m, 4 m×10 m) was conducted. Over a 14-year rotation, tree height, diameter at breast height, survival rate, individual tree volume, growing stock, and timber yield were measured and analyzed. Results showed that while tree height was minimally affected, diameter at breast height, survival rate, and growing stock were significantly influenced by genotype and spacing. Higher spacings inhibited growth but increased variability within the stand. Diameter at breast height in the 2 m×5 m spacing reached the large-diameter standard (24 cm) and provided a higher growing stock. The minimum density required for larger-diameter wood (diameter at breast height over 35 cm) was the 4 m×8 m spacing. GGE-Biplots identified the top five genotypes as G2, G4, G11, G1, and G10. Genotypes G4, G10, and G1 were suitable for low-density plantations, with G4 performing best, achieving a 95 % improvement in survival rate and a 105 % increase in growing stock. Genotypes G2 and G11 were ideal for high-density plantations, with G2 showing the best results, increasing survival rate by 36 % and growing stock by 56 %. The optimal period for early selection in P. × euramericana is the 4th to 5th year after afforestation. The best design, D1×G2, yielded 513 m³·ha⁻¹ of timber and 288.52 m³·ha⁻¹ of large-diameter wood. These findings support the establishment of large-diameter poplar plantations, aiding future breeding efforts and increasing stand productivity.

Deletion of the phd3 in zebrafish results in increased resistance to Aeromonas hydrophila infection

Aeromonas hydrophila, a gram-negative pathogen prevalent in aquatic environments, is a known inducer of septicemia in aquatic animals, causing considerable losses in aquaculture. The limited effectiveness of conventional drug therapies underscores the need for exploring innovative treatment strategies. Gene knockout technology presents a promising approach for exploring the immune response in zebrafish and developing therapeutic interventions for aquatic organisms diseases. This study focuses on elucidating the mechanism of action of phd3 in zebrafish against Aeromonas hydrophila through the creation of a phd3 knockout model. Our findings reveal a high degree of conservation of phd3 sequences between zebrafish and commercially important fish species, making it a suitable model organism for studying fish inflammation. Knocking out phd3 significantly improved the resistance of zebrafish to Aeromonas hydrophila, reduced tissue damage, increased survival rates, and decreased bacterial burden. Furthermore, the downregulation of phd3 enhanced immune responses, antioxidant levels, endoplasmic reticulum stress, autophagy reactions and apoptosis. This research underscores the crucial role of phd3 in zebrafish innate immunity, offering novel insights into the prevention and management of diseases in aquatic organisms, and potential immunotherapeutic strategies. Our findings have significant implications for the future development of targeted therapeutic strategies against Aeromonas hydrophila and other aquatic pathogens.

Reactivation of mTOR signaling slows neurodegeneration in a lysosomal sphingolipid storage disease.

Sandhoff disease, a lysosomal storage disorder, is caused by pathogenic variants in the HEXB gene, resulting in the loss of β-hexosaminidase activity and accumulation of sphingolipids including GM2 ganglioside. This accumulation occurs primarily in neurons, and leads to progressive neurodegeneration through a largely unknown process. Lysosomal storage diseases often exhibit dysfunctional mTOR signaling, a pathway crucial for proper neuronal development and function. In this study, Sandhoff disease model mice exhibited reduced mTOR signaling in the brain. To test if restoring mTOR signaling could improve the disease phenotype, we genetically reduced expression of the mTOR inhibitor Tsc2 in these mice. Sandhoff disease mice with reactivated mTOR signaling displayed increased survival rates and motor function, especially in females, increased dendritic-spine density, and reduced neurodegeneration. Tsc2 reduction also partially rescued aberrant synaptic function-related gene expression. These findings imply that enhancing mTOR signaling could be a potential therapeutic strategy for lysosomal-based neurodegenerative diseases.

A qualitative study of attitudes and perceptions of smoking cessation medication among patients with cancer.

Among patients with cancer, tobacco use remains high. Nearly half who report smoking at diagnosis continue to smoke following diagnosis, and use of smoking cessation medication remains low. This studyexplores attitudes, barriers, and preferences for smoking cessation medication among patients enrolled in a tobacco treatment trial in the context of cancer care. This is a secondary qualitative analysis of the Smokefree Support Study. Of 221 participants who completed the 6-month follow-up survey, n = 72 participants were randomly selected for an exit interview. Interviews were conducted using a semi-structured interview guide, recorded, transcribed, and individually coded using NVivo 11 until high interrater reliability was reached (Kappa > 0.86). Participants (55.6% female) were predominantly White (83.3%) and on average 60years old. Many participants held negative beliefs about smoking cessation medications, primarily concerns about safety and side effects in the context of cancer treatment. Lack of understanding interactions with ongoing chemotherapy and access were the most common barriers reported by those who did not use cessation medication during the study. For those who did use medication during the study, positive outcomes included craving reduction, ease of use and access, and psychological benefits. The findings suggest a knowledge gap in the safety and effectiveness of smoking cessation medications, specifically in relation to cancer care. Addressing this knowledge gap may increase medication uptake, adherence, and quit rates. Cancer care providers are seen as instrumental in emphasizing the importance and safety of smoking cessation medications as well as patient access concerns. Tobacco use among patients with cancer remains high and has serious clinical implications. Tobacco cessation is associated with decreased treatment-related toxicity, decreased risk of second primary cancers, and increased survival rates. Smoking cessation medications are effective, yet patients with cancer have low usage rates. Elucidating reasons associated with smoking cessation medication nonadherence will assist cancer care providers in better addressing factors that increase adherence rates.

Recombinant Saccharomyces cerevisiae EBY100/pYD1-FaeG: a candidate for an oral subunit vaccine against F4+ ETEC infection.

Diarrheal diseases attributable to multidrug-resistant F4+ enterotoxigenic Escherichia coli (ETEC) are escalating in severity, posing significant risks to the health and safety of both humans and animals. This study used Saccharomyces cerevisiae EBY100 to display the FaeG subunit of F4 colonizing factor as an oral vaccine against F4+ ETEC infection. Mice were orally immunized twice with 108 CFU of EBY100/pYD1-FaeG, followed by a challenge with F4+ ETEC EC6 on day 7 post-immunization. The results showed that the recombinant strain EBY100/pYD1-FaeG orally enhanced the growth of the small intestine villi, significantly boosted the expression of tight junction proteins (ZO-1, Occludin, MUC2, and Claudin) (P < 0.05), and modulated the gut microbiota composition. Additionally, immunization with EBY100/pYD1-FaeG also upregulated the levels of IL-2, IL-4, and IFN-γ in the intestines of mice (P < 0.01), while serum IgG and fecal sIgA titer significantly increased (P < 0.05). These immune responses enhanced the capacity to fight against ETEC, leading to an increased survival rate of mice and relieved damage to tissues and organs of mice infection. In summary, the study suggested that the recombinant Saccharomyces cerevisiae EBY100/pYD1-FaeG could effectively stimulate the immune response and generate specific antibodies against F4+ ETEC, showing its potential to serve as a subunit oral vaccine candidate for preventing F4+ ETEC infection.IMPORTANCEThe multidrug-resistant F4+ enterotoxigenic Escherichia coli (ETEC) strains are the primary clinical pathogens responsible for post-weaning diarrhea in piglets, resulting in substantial economic losses in the pig farming industry. In the study, we developed an oral vaccine candidate, Saccharomyces cerevisiae EBY100/pYD1-FaeG, to prevent diarrhea caused by multidrug-resistant F4+ ETEC. Oral administration of EBY100/pYD1-FaeG significantly enhanced immune responses, improved intestinal health, and provided protection against F4+ ETEC infection in mice. This approach offers a potential application prospect for preventing F4+ ETEC infections that lead to post-weaning diarrhea in clinical settings and provides a promising solution for addressing the growing threat of antibiotic resistance in bacterial pathogens.

Down-regulated BNC1 promotes glioma by inhibiting ferroptosis via TCF21/PI3K signaling pathway BNC1TCF21PI3K

We elucidate the role of the BNC1 gene in glioma and its potential mechanism. The expression levels of BNC1 in patients with glioma or corresponding cell lines were down-regulated. High BNC1 expression increased survival rate in patients with glioma. BNC1 gene reduced cell proliferation, and enhanced ferroptosis of glioma cells through the induction of TCF21/PI3K signaling pathway. Meanwhile, BNC1 gene could decline tumor proliferation in mice model of glioma. The ferroptosis inhibitor alleviated the impact of BNC1 on glioma ferroptosis, while the ferroptosis agonist weakened the effect of BNC1 on glioma ferroptosis. SiTCF21 also declined the effects of BNC1 on ferroptosis of glioma. The enhanced expression of TCF21 also inhibited the effect of BNC1 on ferroptosis of glioma. BNC1 protein interlinked with TCF21 protein, and bioluminescence imaging demonstrated that BNC1 enhanced TCF21 expression in the brain tissue of the mouse model of glioma. In conclusion, BNC1 reduced cell proliferation, and increased ferroptosis of glioma cells by TCF21/PI3K signaling pathway, may be a feasible strategy to treat glioma.

Targeted anti-cancer agents and risk of venous thromboembolism.

The incidence of one-year venous thromboembolism (VTE) after cancer diagnosis is reported to be increasing for several types of cancer. The introduction of targeted anti-cancer therapies and immunotherapy into the therapeutic armamentarium of medical oncologists contributed to the significantly improved response rates and survival times of cancer patients. In recent years, a potential prothrombotic effect of several targeted anti-cancer agents and immunotherapy drugs has been suggested; however, the methodological limitations of clinical trials evaluating the possible role of these classes of drugs on the VTE risk often make the interpretation of their results difficult. It is still not clear whether the increased risk of VTE is more closely correlated to the expression of specific oncogenic profiles than to the administration of specific therapies against these mutations. Furthermore, the increased survival rates observed with these agents could influence the prevalence of VTE events in cancer patients by the competing risk mortality on the risk of VTE. To date, the available data have suggested that the risk of VTE varies among different categories of targeted therapy, being most reported for anti-vascular endothelial growth factor receptor (VEGFR), epidermal growth factor receptor (EGFR), monoclonal antibodies and immune checkpoint inhibitors, and less reported for tyrosine kinase inhibitors (TKI). The risk of VTE seems to significantly increase when targeted therapy is administered in combination with traditional anti-cancer agents. Considering the uncertainties in estimating the rate of thrombotic complications associated with targeted therapy, the need for antithrombotic prophylaxis in cancer patients receiving targeted therapies still needs to be specifically assessed. In this review, we examine available evidence of the literature and the methodological limitations of clinical trials, and we discuss the potential future perspectives.

Vitamin D can mitigate sepsis-associated neurodegeneration by inhibiting exogenous histone-induced pyroptosis and ferroptosis: Implications for brain protection and cognitive preservation

BackgroundSepsis-induced neurodegeneration and cognitive dysfunction remain critical challenges worldwide. Vitamin D was reported to reduce neuronal injury and neurotoxicity and its deficiency was associated with neurocognitive disorders. This study investigates the mechanisms by which vitamin D exerts neuroprotective potential against damage-associated molecular patterns (DAMPs), specifically extracellular histones, in sepsis-related brain dysfunction. MethodsThe cultured mouse hippocampal neuronal HT22 cells were exposed to 20 µg/ml exogenous histone for 24 h to induce pyroptosis and ferroptosis in the presence or absence of the active form of vitamin D, calcitriol (1 nM). A cecal ligation and puncture mouse sepsis model was used to evaluate histone release and pyroptosis/ferroptosis biomarkers in the brain together with neurobehavioral performance with or without calcitriol treatment (1 µg/kg, i.p. injection) at 24 h or 1 week after sepsis onset. ResultsIn vitro, histone exposure triggered both pyroptosis and ferroptosis in neuronal cells, which was significantly suppressed by calcitriol treatment with the reduced expression of caspase-1 by 38 %, GSDMD by 30 %, ACSL4 by 33 %, and the increased expression of GPX4 by 35 % (n = 6, P < 0.05). Similarly, in vivo, calcitriol treatment inhibited both neuronal pyroptosis and ferroptosis by reducing expression of pyroptosis marker, GSDMD/NeuN (11.6 ± 1.2 % vs. 19.4 ± 1.1 %) and increasing expression of ferroptosis marker, GPX4/NeuN (21.4 ± 1.7 % vs. 13.5 ± 1.1 %), in the brain of septic mice (n = 6, P < 0.01). In addition, calcitriol increased survival rate (72 % vs. 41 %) and ameliorated cognitive dysfunction of septic mice (n = 8–13, P < 0.05). ConclusionsThis study demonstrates that vitamin D exerts a neuroprotective effect against sepsis by attenuating histone-induced pyroptosis and ferroptosis. These findings highlight the potential therapeutic role of vitamin D supplementation in mitigating brain dysfunction associated with sepsis which needs for further investigation.

Optimizing Reproductive Options for Young Women with Cervical Cancer

Cervical cancer is one of the leading causes of mortality in women of reproductive age. In recent years, the development of preventive and therapeutic strategies has significantly increased survival rates. While this represents an important medical achievement, it has also raised a major social issue regarding the need to ensure an adequate quality of life for surviving patients. Many of these women are left without their reproductive capacity at an age when their desire for motherhood has not yet been fulfilled. Infertility or subfertility in cancer survivors is actually a growing problem, complicated by the current trend of increasingly delaying pregnancy. The psychological effects of this issue can be devastating, sometimes even more so than the cancer diagnosis itself. Although today fertility-sparing surgeries can ensure excellent reproductive outcomes with minimal oncological risk, obstetric sequelae remain significant, and affected women often require specialized care pathways. Additionally, adequate counselling is still not provided to all patients who cannot access fertility-sparing treatments and who find themselves without hope. Reproductive medicine is therefore facing the modern challenge of offering concrete options to help these patients realize their desire for motherhood. The aim of this article is to provide an overview of the therapeutic options available to young women facing an early- or later-stage diagnosis of cervical cancer.

Dietary yeast culture can protect against chronic heat stress by improving the survival, antioxidant capacity, immune response, and gut health of juvenile Chinese mitten crab (Eriocheir sinensis)

As global warming intensifies, aquatic species are increasingly threatened by heat stress, urging the aquaculture industry to explore innovative strategies to mitigate the adverse impact of thermal stress on animals. Supplementing diets with yeast culture (YC) has shown promising results in coping with heat stress. This study evaluated the effects of YC on the survival, biochemical responses, transcriptome, and intestinal microbiota of the Chinese mitten crab (Eriocheir sinensis) under chronic heat stress. Juvenile crabs were subjected to four conditions over 42 days: a control temperature of 24 °C and a high temperature of 30 °C supplemented with three YC doses: 0, 3.2, and 6.4 g/kg. Each group had six replicates of 30 crabs each. Chronic heat stress substantially reduced survival rates and increased molting frequency. However, YC supplementation significantly improved survival and antioxidant enzyme activities (SOD and GSH-Px) while reducing MDA levels, indicating a reduction in oxidative stress. The immune response metrics (PO and AKP activities) were comparable to those of the control group when YC was included in the diet. A significant correlation existed between the crab survival rate, antioxidant performance and gut health. Histological assessment revealed that YC maintained the integrity of the intestinal lining under heat stress. 16S rRNA sequencing revealed that YC ameliorated disruptions in the diversity and structure of the intestinal microbiota caused by high temperature. Transcriptomic analysis identified DEGs linked to serine-type peptidases and ascorbate and aldarate metabolism pathways. Significant correlations were detected between Candidatus_Hepatoplasma, Rhodobacter, Aeromonas, and genes related to antioxidant and immune responses. In conclusion, dietary YC at 3.2 g/kg effectively enhanced the resilience of E. sinensis to chronic heat stress by increasing survival rates and antioxidant capacity, restoring immune function, and maintaining gut health.

Medicaid Expansion and Overall Survival of Lower Gastrointestinal Cancer Patients After Cytoreductive Surgery and Heated Intraperitoneal Chemotherapy.

In the United States, often only tertiary centers offer cytoreductive surgery and heated intraperitoneal chemotherapy (CRS+HIPEC) for peritoneal metastases in advanced lower gastrointestinal malignancies. Growing evidence shows that Medicaid expansion under the Affordable Care Act (ACA) of 2010 enhanced healthcare access and outcomes. We sought to determine whether Medicaid expansion was associated with decreased all-cause mortality of lower gastrointestinal cancer patients following CRS+HIPEC. We analyzed data from the National Cancer Database (2010-2019) on lower gastrointestinal cancer patients who underwent CRS+HIPEC. Medicaid expansion, introduced under the ACA in 2010, extends health insurance to low-income adults. We categorized states by expansion timing: early (2010-2013), immediate (January 2014), late (after January 2014), or no expansion to assess the impact of Medicaid expansion on mortality using a multivariable Cox regression model. Of the 1001 study patients, 671 (67%) were diagnosed in Medicaid expansion states. Grade and Medicaid expansion status were the only factors independently associated with overall survival on multivariable analysis. On average, patients in Medicaid expansion states experienced a 4% increase in annual survival compared with those in non-expansion states who had a 1% decrease in annual survival over the study period. Patients from states that had an early expansion of Medicaid and patients with lower-grade tumors had significantly better overall survival. Our study findings suggest that improved access to healthcare through Medicaid expansion was associated with increased survival rates of lower gastrointestinal cancer patients who undergo CRS+HIPEC for the treatment of peritoneal metastases.

Early Palliative Care in Advanced Non-Small Cell Lung Cancer Patients: A Meta-Analysis.

This study aims to assess the efficacy of Early Palliative Care (EPC) in non-small cell lung cancer (NSCLC) through a meta-analysis approach. A computerized search was conducted in databases such as PubMed, Cochrane Library, Scopus, Embase, and Web of Science for prospective randomized controlled trials (RCTs) investigating the application of EPC in advanced NSCLC. Outcome measures including Overall Survival (OS), quality of life, and psychological status were extracted and subjected to pooled analysis. After the computerized search, a total of 7 studies comprising 1185 participants were included, with 597 patients receiving EPC intervention and 588 patients receiving Standard Care (SC) intervention. Three studies reported OS after the intervention, demonstrating a significant improvement in OS for patients receiving EPC (pooled HR = 1.60, 95% CI: 1.22, 1.98). Five studies analyzed the Functional Assessment of Cancer Therapy (FACT) scores after the intervention, revealing a significant improvement in FACT scores for patients receiving EPC (pooled SMD = 1.18, 95% CI: 1.04, 1.31). No significant differences were found in anxiety and depression scores between the 2 interventions in the 5 studies. In advanced NSCLC, EPC provides benefits in terms of increased survival rates and improved quality of life. EPC should be considered as part of multidisciplinary treatment for patients with advanced NSCLC.

LeAf Trauma- an intersectoral prospective multicenter study assessing quality of life and return to work after majortrauma-study protocol.

With increasing survival rates, the functional outcome and quality of life of trauma patients are gaining more importance. Survivors suffer from chronic pain, psychosomatic disorders, and unemployment as well as increased post-traumatic morbidity, which can lead to an impaired quality of life. So far, the TraumaRegister DGU® records patient data during in-hospital treatment. In this study severely injured patients after major trauma are assessed when discharged from hospital, as well as 6, 12 and 18 months after trauma. The aim is to document cross-sector patient pathways and to identify and quantify the factors influencing the health-related quality of life (hrQoL) and the return to work (RTW), using patient-reported experience measures (PREM) and patient reported outcome measures (PROM). Patients are recruited in certified trauma centers of the German Society for Trauma Surgery (DGU). This study protocol describes the methodology of the prospective multicentre study of LeAf Trauma. Translation of the results will be implemented by using the network structures of the German Society for Trauma Surgery (DGU) for the treatment of patients with major trauma.

Abstract 4134692: In-Hospital Mortality Rate and Predictors of 30-Day Readmission in Cancer Patients with MI Undergoing PCI -A Cross Sectional Study From Nationwide Readmission Database

Background and objectives: Data regarding readmission rates and predictors of readmission in cancer patients undergoing PCI are sparce. With the increasing survival rates and prevalence of cardiovascular complications in cancer patients, understanding the patterns and predictors of readmission in this population is paramount for optimizing their outcomes. Cancer patients pose unique clinical challenges due to their combined prothrombotic state and propensity for bleeding. We attempted to identify factors associated with readmission in cancer patients. Methods: We utilized the Nationwide Readmission Database from 2016 to 2020 and included patients more than 18 years of age with primary diagnosis of myocardial infarction(MI) who underwent percutaneous coronary intervention(PCI) and have a preexisting diagnosis of cancer. We used International Classification of Disease, Tenth Revision, Clinical Modification (ICD10 CM) codes to define MI, PCI, and cancer. The primary outcome was the 30-day readmission rate, and secondary outcomes were mortality rates, predictors of readmission, and common causes of readmission. The independent predictors of readmission were analyzed using cox regression analysis. Results: Of the 52,307 cancer patients who underwent PCI, 7,767 were readmitted within a 30-day period. The readmission rate for these patients was 15.70%. The mortality rate was 6.05% for index admission and 6.80% for readmitted cases. Among the readmitted patients in the strongest independent predictor for readmission were leaving against medical advice(AMA), anemia, congestive heart failure, and discharge to a skilled nursing facility or home health. Common causes of readmission within this time included hypertensive heart disease with concomitant CKD stage I-IV and heart failure (6.21%), sepsis (6.12%), NSTEMI (5.60%), hypertensive heart disease with concomitant heart failure (4.62%) and acute kidney injury (1.98%). Conclusions: Thirty-day readmission rate was 15.70%. Independent predictors of readmission were anemia, diabetes mellitus, congestive heart failure, malnutrition, peripheral artery disease, leaving against medical advice, and discharge to facility. Most common cause of readmission was hypertensive heart and kidney disease with heart failure, which comprised 6.21%.

Bystander Response and Out-of-Hospital Cardiac Arrest Outcomes (Bro. Study) in 3 Gulf Countries: Protocol for a Prospective, Observational, International Collaboration Study.

: Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri-cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. DERR1-10.2196/58780.