Kaplan-Meier Survival Estimates Research Articles

Single-cell RNA sequencing integrated with bulk RNA sequencing analysis of clock circadian regulator with prognostic and immune microenvironment in thyroid cancer.

Disruption of circadian rhythm was found to be associated with immune infiltration and thyroid cancer. However, the role of clock circadian regulator (CLOCK) in the progression of thyroid cancer and its immune microenvironment remains largely unexplored. Therefore, our aim was to explore the role and potential mechanism of CLOCK in thyroid cancer. Single cell sequencing analysis and bulk RNA sequencing analysis was used for LASSO regression and Kaplan-Meier survival estimates. Potential mechanism analysis were gained through KEGG/GO analysis, GSEA analysis and PPI network. In vivo and in vitro experiment was used for further validation. The result showed CLOCK protein was overexpressed in thyroid cancer compared with normal tissue in both thyroid specific mouse model and human sample. A prognostic model incorporating CLOCK and other related genes (FAT4, OR6K2, STK40, TMEM63A, HRCT1, SUPT5H, and OR2C3) was developed using LASSO regression. Functional assay and bioinformatics analysis indicated that CLOCK knockdown hindered tumor growth and the activity of MAPK signaling. Besides, analyses of gene enrichment, signaling pathways, and immune checkpoints suggested that CLOCK might inhibit immune infiltration within the tumor microenvironment. Confirmatory in vitro experiments and immunohistochemical assays in human samples further linked high CLOCK expression to reduced T cell cytotoxicity and infiltration. These findings underscore the pivotal role of CLOCK in thyroid cancer prognosis and immune suppression, highlighting its potential as a target for therapeutic intervention and prognostic assessment in thyroid cancer management.

The effect of pre-release treatment with injectable naltrexone on criminal justice and substance use outcomes: Results from a randomized controlled trial

Abstract Objectives Evaluate the impact of extended-release naltrexone (XR-NTX) on postrelease criminal justice contact and substance use among individuals with opioid use disorder in correctional settings. Methods A randomized waitlist-controlled trial was conducted. The treatment group (n = 47) received XR-NTX shortly before release, and the comparison group (n = 47) was put on a waitlist for treatment at six months post-release. Outcomes were measured at 3 and 6 months post-release and included new arrests, parole revocations, reincarceration, and positive drug tests. Data were analyzed using t-tests and Kaplan–Meier survival estimates. Results At 3 months post-release, the treatment group had marginally fewer parole revocations. At 6 months, there were no significant differences in criminal justice or substance use outcomes, though the treatment group had fewer positive drug tests and a longer time to first positive drug test. Conclusions There is limited evidence that XR-NTX reduces poor criminal justice and substance use outcomes.

Real-world treatment patterns and health outcomes for patients with myelofibrosis treated with fedratinib.

Assess real-world fedratinib (FEDR) treatment patterns and clinical outcomes in patients with primary or secondary myelofibrosis following discontinuation of ruxolitinib (RUX). This study was a retrospective, noninterventional medical record review of patients in Canada, Germany, and the United Kingdom (UK). A total of 70 physicians (primarily hematologist-oncologists [78.6%]) provided data for 196 eligible patients. Patients were mostly male (62.8%) with primary myelofibrosis (76.5%) and initiated FEDR at a mean age of 67.7 years. Median treatment duration was 11.5 months (median follow-up, 13.8 months), and nearly half (49.5%) of patients initiated FEDR at the label-indicated dose of 400 mg daily. Six months post-initiation, 77.7% and 66.8% of patients experienced symptom and spleen response, respectively. Kaplan-Meier estimates of median progression-free and overall survival from initiation were 23.8 months (95% CI, 21.1-27.6) and 29.8 months (95% CI, 23.9-NE), respectively. These findings demonstrate real-world FEDR effectiveness among patients with myelofibrosis who discontinued RUX.

The effect of neoadjuvant chemotherapy on survival outcomes in patients with variant histologies who underwent radical cystectomy with precystectomy diagnostic accuracy: A multicenter study of the Turkish Urooncology Association.

To evaluate the role of neoadjuvant chemotherapy in the final treatment plan and its impact on survival in bladder cancer patients who were diagnosed with variant histology in the radical cystectomy specimen and whose diagnostic accuracy was achieved with the previous transurethral resection of the bladder specimen. In this retrospective multicenter study, data from 221 patients across 9 centers were analyzed between January 2012 and January 2022. The primary endpoint was overall, cancer-specific, recurrence-free, and metastasis-free survival rates among patients with and without neoadjuvant chemotherapy, and the secondary endpoint was to identify independent predictors of survival. The Kaplan-Meier method was used to estimate overall survival, cancer-specific survival, recurrence-free survival, and metastasis-free survival, and multivariate analyses were performed using the Cox-regression model. Kaplan-Meier estimates of overall, cancer-specific, recurrence-free, and metastasis-free survival demonstrated no significant difference between two groups. Cox multifactorial analysis revealed that the age (HR 1.030, 95% CI 1.003-1.057, p = 0.027), presence of pT4 tumor stage (HR 3.861, 95% CI 1.303-11.494, p = 0.015), and pN+ (HR 2.288, 95% CI 1.475-3.550, p < 0.001) at radical cystectomy histopathology were independent predictors of overall survival; presence of pT4 tumor stage and pN+ at radical cystectomy histopathology were independent predictors of cancer-specific survival (HR 8.245, 95% CI 1.873-36.292, p = 0.005 and HR 1.792, 95% CI 1.049-3.061, p = 0.033) and metastasis-free survival (HR 9.957, 95% CI 1.286-77.073, p = 0.028 and HR 2.949, 95% CI 1.674-5.197, p < 0.001); and the age (HR 1.047, 95% CI 1.006-1.090, p = 0.025) and pN+ at radical cystectomy histopathology (HR 4.150, 95% CI 1.917-8.981, p < 0.001) were independent predictors of recurrence-free survival. Neoadjuvant chemotherapy does not provide any survival advantage in variant histology; therefore, considering the disadvantages, such as delaying radical cystectomy, which can lead to inadvertent disease progression and chemotherapy-related toxicities, cautious should be exercised when administering neoadjuvant chemotherapy.

Incidence of Acute Kidney Injury in Relapsed and Refractory Multiple Myeloma treated with Teclistamab versus CAR T-cells.

Teclistamab, a novel bispecific monoclonal antibody targeting CD3 and B-cell maturation antigen (BCMA), and chimeric antigen receptor T-cell (CAR-T) therapy are promising options for treating relapsed/refractory multiple myeloma (MM). However, the rates of acute kidney injury (AKI) associated with teclistamab remain inadequately characterized. This study aims to compare the incidence, severity, and outcomes of AKI between patients receiving teclistamab and CAR-T therapy. This was a retrospective study involving 64 patients with relapsed/refractory MM treated with either teclistamab or CAR-T therapy. All patients had previously received at least four lines of chemotherapy before being treated with either teclistamab or CAR-T. The primary outcome was the incidence of AKI, and secondary outcomes included AKI severity, kidney recovery rates, and mortality. Kaplan-Meier estimates for AKI-free survival were calculated, and hazard ratios (HRs) for AKI risk were determined using Cox proportional hazards models. Sixty-four patients met inclusion criteria for this study (30 received CAR-T and 34 received teclistamab therapy). Among these patients, 14 AKI events occurred in total (22%), with 10 events (29%) in the teclistamab group and 4 events (13%) in the CAR-T group. AKI-free survival estimates at 180 days after treatment initiation were 68% (95% confidence interval [CI]: 53%-87%) for teclistamab patients and 90% (95% CI: 79%-100%) for CAR-T patients. While patients receiving teclistamab were found to have an increased risk of an AKI event compared to those receiving CAR-T therapy, the results were not statistically significant (HR [95% CI]: 3.38 [0.93-12.31], P=0.065). This study suggests that patients treated with teclistamab may experience a higher incidence of AKI compared to those receiving CAR-T therapy. However, further research is required to determine whether this increased risk is attributable to disease progression or teclistamab itself. These results highlight the need for close kidney function monitoring in patients receiving teclistamab.

Adjuvant radiation therapy is not associated with a survival benefit after R0 resection in non-metastatic adrenocortical carcinoma.

The benefit of adjuvant radiation therapy (RT) in adrenocortical carcinoma (ACC) is not well characterized for those who undergo initial R0 surgical resection. Patients in the NCDB who underwent R0 resection were placed into two cohorts - those who underwent adjuvant RT and those who did not. 388 patients were identified with 51 receiving RT. No difference was observed between Kaplan-Meier survival estimates of the two cohorts (p​=​0.54). After adjusting for age, sex, co-morbidity index, race, receipt of chemotherapy, tumor size, grade, stage, and nodal stage, RT was not associated with improved OS. However, tumor size ≥6​cm (HR 1.54, [1.03-2.32], p​=​0.04), high tumor-grade (HR 3.46, [1.83-6.55], p​<​0.001), and N1-stage (HR 2.30, [1.06-4.94], p​=​0.03) were associated with worse OS, without benefit of RT on subgroup analysis of these factors. Treatment with adjuvant RT in patients with ACC who underwent R0 resection was not associated with an OS benefit.

A "1.5-Stage" Spacer Construct Using Revision Components for the Management of Periprosthetic Joint Infection of the Knee.

The two-stage surgical protocols used for the treatment of periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) are associated with marked patient morbidity. As such, alternatives such as durable "1.5-stage" spacer constructs have gained popularity. We sought to describe the outcomes of a novel "1.5-stage" spacer construct utilizing revision stemmed-tibia implants. Patients who underwent a "1.5-stage" for the management of a knee PJI at our institution were screened for inclusion. A "1.5-stage" was defined as a spacer placed with the intent of not performing a second stage, without the use of press-fit stems or cemented intramedullary fixation as is often done during a single-stage protocol. Procedures were categorized into two groups based on construct type: (1) hand-made constructs utilizing all-polyethylene tibial components or (2) constructs utilizing stemmed-revision components pre-coated with cement before insertion. Patient demographics, comorbidities, and surgical details were collected and reported. The two-year Kaplan-Meier survival estimates for all-cause revision, revision for spacer loosening, and revision due to infection recurrence were reported. In total, 46 "1.5-stage" procedures were identified, including 12 hand-made and 34 stemmed-revision constructs. The stemmed-revision cohort was less likely to undergo reoperation for any reason (17.6 versus 50.0%, P = 0.028) or a revision for spacer loosening (0.0 versus 25.0%, P = 0.003) compared to the hand-made cohort. There were no differences with respect to infection recurrence or time to revision. The 2-year survival from revision for loosening was higher in the stemmed cohort compared to the hand-made cohort, though not statistically different (100%, 95% CI [confidence interval]: 2.5 to 100.0% versus 72.9%, 95% CI: 26.3 to 96.6%, P = 0.330). A "1.5-stage" spacer construct using stemmed-revision components was associated with promising short-term results. Durable spacer constructs may be a viable option for select patients, however; longer-term follow-up is needed to identify patients that stand to benefit the most from this technique.

Outcomes and molecular profiles in sarcomatoid carcinoma of unknown primary: the Mayo Clinic experience.

Sarcomatoid carcinomas (SC) are rare tumors with both epithelial and mesenchymal characteristics, linked to aggressive behavior and poor prognosis. Sarcomatoid carcinoma of unknown primary (SCUP) is an exceedingly rare subset with limited literature and no standardized management guidelines. This study aims to characterize the clinical presentations, treatment patterns, and genomic landscape of SCUP. Data were retrospectively collected from the Mayo Clinic Rochester Cancer of Unknown Primary Registry. Patients included had biopsy-proven SC with no identifiable primary tumor despite comprehensive diagnostic evaluations. Baseline characteristics, immunohistochemistry (IHC) results, next-generation sequencing (NGS) data, and treatment outcomes were analyzed. Statistical analyses included descriptive statistics, Kaplan-Meier survival estimates, and Cox proportional hazards regression. Fifty-two SCUP patients were identified, with a median age of 60 years. Most patients presented with widely metastatic disease, particularly lytic bone lesions. Elevated alkaline phosphatase (ALP) was noted in nearly half of the patients. IHC showed high positivity for AE1/AE3 and OSCAR antibodies. Tumor NGS revealed 247 alterations, with TP53 being the most common mutation. Patients receiving definitive therapy had a median overall survival (OS) of 72 months, significantly longer than those receiving systemic therapy (14 months). Immunotherapy was a significant prognostic factor, reducing the risk of death by 90%. This study provides essential insights into the clinical and genomic characteristics of SCUP, advocating for the integration of definitive therapy and immunotherapy in treatment protocols. Further prospective studies are needed to validate these findings and improve patient outcomes.

Influence of demographic, socioeconomic and geographical variability on children under-five mortality in The Gambia: an application of survival analysis

BackgroundThere has been a notable decline in child mortality globally, yet Gambia continues to face a high mortality rate among children under five, which poses a serious public health challenge....

A study of impulsivity and adverse childhood experiences in a population health setting.

As complex mental health traits and life histories are often poorly captured in hospital systems, the utility of using the Barratt Impulsivity Scale (BIS) and Adverse Childhood Experiences (ACEs) for assessing adult disease risks is unknown. Here, we use participants from the Healthy Nevada Project (HNP) to determine if two standard self-assessments could predict the incidence and onset of disease. We conducted a retrospective cohort study involving adult participants who completed the Behavioral and Mental Health Self-Assessment (HDSA) between September 2018 and March 2024. Impulsivity levels were measured using the BIS-15, and retrospective self-reports of ACEs were collected through a standardized questionnaire. In total, 17,482 HNP participants completed the HDSA. Our findings indicate that ACEs were significantly associated with impulsivity. Disease associations with impulsivity and ACEs were evaluated using a phenome-wide association study, identifying 230 significant associations with impulsivity. Among these, 44 were related to mental health diagnoses, including major depressive disorder (MDD). Kaplan-Meier survival estimates characterized the differences in the lifetime predicted probability between high and low impulsivity for major depressive disorder and essential hypertension. This analysis showed that having both high ACEs and high impulsivity confer substantial risk of MDD diagnosis (hazard ratios 2.81, 2.17, respectively). Additionally, lifetime predicted probability of MDD was approximately 40% higher for high ACEs and high impulsivity compared to no ACEs and low impulsivity. Essential hypertension demonstrated similar trends, with an approximate 20% increase in predicted lifetime probability of diagnosis. These results demonstrate that high ACES and elevated impulsivity scores are associated with a range of negative health outcomes and a simple self-assessment of complex traits and life history may significantly impact clinical risk assessments.

Real-world Effectiveness of Single-Agent Enfortumab Vedotin in Patients With Advanced Urothelial Carcinoma.

Enfortumab vedotin (EV) is a nectin-4-directed antibody and microtubule inhibitor conjugate indicated for patients with metastatic urothelial carcinoma (mUC) who have received prior platinum-based chemotherapy and PD-1/L1 inhibitors or are ineligible for cisplatin-containing regimens and have undergone at least 1 prior line of therapy. EV is also indicated in combination with pembrolizumab in the first-line setting. However, real-world effectiveness of EV based on treatment line and impact of prior therapy remains unclear. This retrospective study utilized the nationwide Flatiron Health electronic health record (EHR)-derived de-identified database. Patients with advanced, recurrent, or mUC of upper or lower urinary tract who received single-agent EV in the second-line or beyond after December 18, 2019 (FDA accelerated approval date), were included. Patients without documentation of first-line therapy or without evidence of contact for 90 days from mUC diagnosis were excluded. Time to next therapy (TTNT) and overall survival (OS) were analyzed based on treatment line and prior platinum-based chemotherapy and PD-1/L1 inhibitors using Kaplan-Meier survival estimates and its 95% confidence interval. Between January 17, 2020, and September 30, 2022, 6566 patients with mUC received systemic treatment, with 431 receiving EV. EV monotherapy was administered across various lines (N = 371): second (157), third (132), fourth (62), and fifth (20). Approximately 22% of patients had prior platinum-based therapy, and 48% had prior PD-1/L1 inhibitors. Median TTNT and OS varied across treatment lines, with patients with prior platinum exposure generally showing longer TTNT and OS, notably in those receiving EV in the fourth-line setting. EV demonstrates efficacy in patients with mUC regardless of prior receipt of platinum-based chemotherapy and PD-1/L1 inhibitors or treatment line. While only hypothesis-generating, these findings provide valuable insights for patient counseling, prognostication, and therapeutic decision-making in clinical practice.

Effects of Mycoplasma ovipneumoniae, abundance, and climate conditions on bighorn sheep lamb:ewe ratios in New Mexico

AbstractMycoplasma ovipneumoniae is a primary causative agent responsible for initiating polymicrobial pneumonia in bighorn sheep (Ovis canadensis). Infections of bighorn sheep populations are typically characterized by initial all‐age epizootics followed by long‐term periods of repressed juvenile (lamb) survival. Populations of bighorn sheep in New Mexico, USA, were thought to be free of this pathogen prior to 2017 but recent infection of multiple herds raised concerns regarding impacts on population size and juvenile:female ratios. Using aerial survey, survival, and disease sampling data in an exploratory framework, we (1) characterize age‐related differences in M. ovipneumoniae prevalence and seroprevalence, (2) quantify differences in lamb:ewe ratios pre‐ and post‐M. ovipneumoniae detection, and (3) investigate differences in survival between previously exposed and naïve individuals. From 2007 to 2022, we sampled 466 bighorn sheep across 19 populations in New Mexico for M. ovipneumoniae exposure. While the timing of initial herd infections varied across populations, one population sustained active infections for over 15 years. We found reduced juvenile:female ratios post M. ovipneumoniae exposure for both desert (O. c. mexicana) and Rocky Mountain (O. c. canadensis) bighorn sheep populations. Post‐exposure ratio declines ranged from 20% to 69%. Evaluation of population size and environmental condition effects on juvenile:female ratios indicated varying impacts for each subspecies. Notably, population size was negatively related to Rocky Mountain juvenile:female ratios only after populations were exposed to M. ovipneumoniae. Additionally, climatic conditions in the previous lambing season and pre‐parturition time frame were associated with juvenile:female ratios for Rocky Mountain populations, while juvenile:female ratios of desert bighorn appeared to only be affected by pre‐parturition climatic conditions. Kaplan–Meier survival estimation of previously exposed, but putatively recovered, individuals (n = 31) and naïve individuals (n = 70) revealed lower (75%; 95% CI: 62%–93%) but not statistically significant (p = 0.2) 1‐year survival rates for individuals that were seropositive but not actively infected, when compared to seronegative individuals (88%; 95% CI: 81%–97%). These results collectively suggest that following M. ovipneumoniae introduction, bighorn sheep populations in New Mexico could be limited by lamb survival.

Initial surgery for spontaneous intestinal perforation in extremely low birth weight infants is not associated with mortality or in-hospital morbidities.

Determine short-term outcomes following peritoneal drain (PD), laparotomy (LAP) after PD (PD-LAP), and LAP in extremely low birth weight (ELBW) infants with spontaneous intestinal perforation (SIP). ELBW infants with SIP were identified using the Children's Hospitals Neonatal Database. Mortality and length of stay (LOS) were compared among groups. Of 729 SIP infants from 6/2010-12/2016, 383(53%) received PD, 61(8%) PD-LAP, and 285(39%) LAP. PD infants had lower GA at birth, at SIP diagnosis and upon admission than PD-LAP or LAP; and higher sepsis rates than LAP. Bivariate analysis and Kaplan-Meier survival estimates suggested PD had increased mortality vs. PD-LAP and LAP (27%, 11.5%, and 15.8% respectively, p < 0.001). However, surgical approach was not significantly associated with mortality in multivariable analysis accounting for GA and illness severity. LOS did not differ by surgical approach. In ELBW infants with SIP, mortality, and LOS are independent of the initial surgical approach.

Time to antenatal care booking and its predictors among pregnant women in East Africa: a Weibull gamma shared frailty model using a recent demographic and health survey.

Antenatal care (ANC) is an important component of maternal and child healthcare. The World Health Organization (WHO) recommends that pregnant women book their ANC contact at or before 12 weeks of gestational age. However, in East Africa, evidence on whether the WHO recommendations have been followed is limited. Therefore, this study aimed to determine the time to ANC booking and its predictors among pregnant women in East Africa. This study was conducted among 86,662 pregnant women in East Africa. The time to ANC booking was estimated using the Kaplan-Meier (K-M) survival estimate. A Weibull gamma shared frailty model was used to determine the predictors of time to the first ANC visit. An adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported. The median time to ANC booking among pregnant women in East Africa was 4 ± 2 months. Maternal education at the primary (AHR = 1.01, 95% CI: 1.02-1.25), secondary (AHR = 1.03, 95% CI: 1.02-1.05), and higher level (AHR = 1.40, 95% CI: 1.30-1.50); husband's education level at the primary (AHR = 1.08, 95% CI: 1.06-1.09), secondary (AHR = 1.12, 95% CI: 1.10-1.13), and higher (AHR = 1.08, 95% CI: 1.07-1.10) levels as compared to with no education; a middle-class wealth status (AHR = 1.66, 95% CI: 1.60-1.70), being rich (AHR: 1.60, 95% CI: 1.56-1.73), high community-level maternal literacy (AHR = 1.05, 95% CI: 1.04-1.06), high community-level poverty (AHR = 0.99, 95% CI: 0.98-0.99), previous Cesarean section (CS) (AHR = 1.35, 95% CI: 1.33-1.39), and unwanted pregnancy (AHR = 0.74, 95% CI: 0.72-0.77) were predictors of the time to ANC booking. The median time to ANC booking among pregnant women in East Africa is longer than the new WHO recommendation. Maternal and husband education, high community-level maternal literacy, a better household, community-level wealth index, and previous CS increase the likelihood of an early ANC booking. However, unwanted pregnancy lowers the likelihood of an early ANC booking. Therefore, strengthening systematic efforts to improve women's and their husbands' educational status, encouraging women's education in the community, providing economic support for women with low wealth status and poor communities, encouraging wanted pregnancy, and providing accessible counseling services for women with unwanted pregnancies will help to encourage early ANC booking among pregnant women in East Africa.

Red cell distribution width-to-platelet ratio (RPR) as a predictor of prolonged stay at hospital for COVID-19 inpatients.

We looked at novel hematological composites like the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, red cell distribution width-to-lymphocyte ratio, red cell distribution width-to-platelet ratio, leukocyte-to-C reactive protein ratio, and lymphocyte-to-C reactive protein ratio as explanatory variables for COVID-19 patients´ hospital length of stay (LoS). The association of hematological indices with LoS was analyzed on 2930 COVID-19 patients using the univariate and multivariable Cox proportional hazards regression models with enter method. The Kaplan-Meier survival estimates were applied to LoS. The survivors´ mean LoS was 7.8 ± 24.0 days, but the deaths´ mean LoS was 38.6 ± 41.9 days (W = 31338, p < 0.01). Every hematological scores representative of the inflammatory status was significantly correlated in the univariate analysis with a prolonged LoS (p < 0.001). In the multivariate analysis, it was discovered that just the monocyte-to-lymphocyte and lymphocyte-to-C reactive protein ratios had not achieved statistical significance. However, most systemic inflammation measures showed hazards ratios close to one. One exemption was the red cell distribution width-to-platelet ratio (RPR) index, which can increase the probability of a longer hospital stay by up to ten times (HR(IC95%) = 0.092(0.03-0.29); p < 0.001). The most effective biomarker to identify COVID-19 patients at high risk for extended hospital stay was RPR. IntroductionDetermining hospital Length of Stay (LoS) is vital for resource management, especially for future COVID-19 outbreaks.Previous studies have primarily focused on sociodemographic and clinical attributes, along with resource availability, but have not accounted for other factors like routine laboratory tests, which can significantly impact LoS predictions.This study examines novel hematology scores as predictors of LoS, emphasizing their importance in resource-limited settings like Ecuador.MethodsThis retrospective cohort study analyzed 2,930 COVID-19 patients admitted to Hospital IESS Quito Sur in Ecuador focusing on confirmed cases with complete blood count (CBC) values to assess LoS.The study explored various hematological ratios, such as the neutrophil-to-lymphocyte ratio (NLR) and red cell distribution width-to-lymphocyte ratio (RLR), as potential predictors of LoS and in-hospital outcomes for COVID-19 patients, using a combination of univariate and multivariable Cox proportional hazards regression models.Kaplan-Meier survival estimates and log-rank tests were used to analyze survival and discharge probabilities over time, highlighting sex-dependent effects and the significant association between selected hematological indices and patient outcomes.ResultsThe mean LoS for survivors was significantly shorter compared to those who died (p < 0.001), indicating that longer hospitalization was associated with higher mortality risk.Women had a shorter average LoS (with lower mortality risk (p < 0.001), suggesting an asymmetrical hospitalization pattern based on sex.While most hematological markers had minimal clinical relevance for LoS, the red cell distribution width-to-platelet ratio (RPR) stood out, increasing the likelihood of a longer hospital stay by up to tenfold, making it a critical factor in predicting prolonged hospitalization.DiscussionMen had longer hospital stays and higher mortality rates than women, likely due to differing inflammatory responses, though hyperinflammation markers like NLR, PLR, and Leu-CPR had minimal clinical impact.RPR had the strongest link to longer hospital stays, indicating a higher risk of extended hospitalization in severe COVID-19 cases.Elevated RPR is tied to oxidative stress and coagulation issues, suggesting early identification could help reduce prolonged stays and complications.ConclusionResearch generally points to clinical complications from COVID-19 as the main factor behind prolonged hospitalizations, underlining the importance of early identification and management of these issues.

ER + HER2- early-stage breast cancer: association of HER2 expression, tumor characteristics, and outcomes.

To evaluate the association between the HER2 score as provided by the Oncotype DX Recurrence Score (RS) assay, tumor characteristics, and outcomes in early-stage, ER + HER2-negative breast cancer (BC). All women insured by the Clalit Health Services, with early-stage, ER + HER2-negative BC who underwent RS testing between 2008 and 2011 were included. Patient/tumor characteristics and Kaplan-Meier estimates for distant recurrence-free survival (DRFS) and overall survival (OS) were compared by HER2 category, based on the HER2 score provided by the RS assay: lower HER2 score group representing the lower third of the HER2 score range (≤ 8.5); higher HER2 score group representing the upper 2 thirds of the HER2 score range (8.6-10.7). 1535 patients were included (948 node negative, 587 node positive); 330 (21.5%) were categorized as lower HER2 score and 1205 (78.5%) as higher HER2 score. Compared to the higher HER2 score group, the lower score group included a significantly higher proportion of patients with RS ≥ 26 in both node-negative (41% vs. 13.6%, P < .001) and node-positive diseases (36% vs. 19.4%, P < .001). Compared to the higher HER2 score group, the lower score group had significantly lower Oncotype ER and PR scores and lower proportion of lobular disease. Age and tumor size were comparable between the HER2 score groups. Within each RS category, DRFS and OS were not associated with the HER2 score. Lower HER2 score was associated with higher RS results. Further study is desired to elucidate the role and significance of HER2 expression in early-stage, ER + HER2-negative.

Management of Tricuspid Atresia With Normally Related Great Arteries and Left-Sided Obstruction.

Tricuspid atresia (TA) is the second most common form of functionally univentricular heart. For patients with TA and normally related great arteries (Type I), left ventricular outflow tract obstruction (LVOTO) is rare. From the Congenital Heart Surgeons' Society multi-institutional cohort of 445 patients with Type I TA enrolled from 1999 to 2024 from 42 sites, 14 infants (3%) had interventions for associated LVOTO, either at presentation or after their first TA-related intervention. Of seven infants initially undergoing Norwood/Damus-Kaye-Stansel (DKS), six survived to Stage II, of whom five survived with one developing pulmonary hypertension and four achieving Fontan. An additional seven infants who were first managed with pulmonary artery band placement subsequently had bidirectional superior cavopulmonary anastomosis (BCPA) and a DKS procedure; there were six survivors, all achieving Fontan. All ten survivors who underwent the Fontan procedure had normal left ventricular and mitral valve function at the latest follow-up. The overall Kaplan-Meier survival estimate at 20 years for these 14 patients was 79% (70% CI, 66%-88%), and the median follow-up was 8.3 years (0.24-21.5). While infants with TA and transposition of the great arteries are more likely to have LVOTO, this can also occur in the setting of normally related great arteries. Infants with Type I TA and LVOTO can be managed in the neonatal period with the Norwood procedure ensuring complete arch relief with acceptable outcomes. If LVOTO becomes evident after initial pulmonary artery band placement, a subsequent DKS procedure facilitates satisfactory success to Fontan.

Combination of grade and spread through air spaces (STAS) predicts recurrence in early stage lung adenocarcinoma: a retrospective cohort study.

Adenocarcinomas, a common subtype of lung cancer, exhibit diverse histological patterns. In 2020, The International Association for the Study of Lung Cancer (IASLC) introduced a grading system emphasizing high-grade components, which has shown prognostic value. Spread through air spaces (STAS) is recognized as a prognostic feature increasing the risk of recurrence in lung cancer. This study evaluates the combination of STAS status and the IASLC-grading system in surgically resected Stage I lung adenocarcinomas. This study is a retrospective analysis of 123 patients with Stage I lung adenocarcinoma who underwent lobectomy between 2011 and 2019. Histological patterns were assessed according to the IASLC criteria, and STAS status was documented. Patients were categorized based on their IASLC Grade and STAS status. Statistical analyses included Kaplan-Meier survival estimates, Cox proportional hazards models, and comparisons using Chi-square and t-tests. The cohort comprised 43 females and 80 males with a mean age of 61.8 ± 7.6years. STAS positivity was noted in 52.8% of patients. STAS positivity correlated significantly with Grade 3 tumors (p < 0.001). The 5-year recurrence-free survival was significantly lower in STAS-positive patients (70.7% vs. 88.7%, p = 0.026). Patients with Grade 3 and STAS positivity had significantly lower recurrence-free survival compared to other groups (p = 0.002). Grade 3 and STAS positivity were independent predictors of poor recurrence-free survival in multivariate analysis. IASLC Grade 3 tumors and STAS positivity are independent prognostic factors for poor recurrence-free survival in Stage I lung adenocarcinomas. Adjuvant treatment strategies should be considered for patients with these characteristics to improve outcomes.

The Modified History of Juvenile Rheumatic Mitral Stenosis Following Percutaneous Transmitral Commissurotomy: Intermediate-Term Outcomes From a Decadal Follow-Up Study

There are few studies that have looked at the long-term outcomes of juvenile mitral stenosis (JMS) following percutaneous transmitral commissurotomy (PTMC). This study sought to analyse the modified history of JMS in children following PTMC. We describe a longitudinal, observational follow-up study of all children and young adults aged <20 years who underwent PTMC at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India from 2012 to 2021. Children were followed up for progression of mitral stenosis (MS), development of mitral regurgitation (MR), need for repeat interventions (percutaneous or surgical), and mortality. A total of 114 children and adolescents underwent the procedure. The mean age of children in the study was 15.1±2.5 years. After immediate procedural success, there was a tendency towards restenosis with respect to valve areas and transmitral gradients at follow-up. Severe MR after the procedure was noted in 2.6%. Compliance with penicillin prophylaxis was noted in 42.5%. The Kaplan-Meier survival estimate over 10 years showed a mortality rate of 1.98/100 patient-years and a re-intervention rate (re-do PTMC or surgery) of 5.50/100 patient-years. Additional valvular lesions were noted in 13.1% of children during follow-up. Severe symptomatic status at presentation (New York Heart Association class 4) was predictive of mortality, and children aged <15 years often needed re-intervention. With a mortality rate of 6.1% and re-do intervention rate of 15.8% during extended follow-up, JMS has considerable healthcare implications in terms of morbidity and mortality in children and young adults.

Dynamic Anthropometrics in Pancreatic Cancer: Associations Between Body Composition Changes During Neoadjuvant Therapy and Survival Outcomes After Resection.

Assessment of individual tumor biology and response to systemic therapy in pancreatic ductal adenocarcinoma (PDAC) remains a clinical challenge. The significance of anthropometric (body composition) changes during chemotherapy as a surrogate for tumor biology in the setting of localized PDAC is unknown. A retrospective, single-institution analysis of patients with PDAC who received neoadjuvant therapy (NAT) and pancreatectomy from 2017 to 2021 was performed. Radiologic anthropometric analysis used artificial intelligence-driven software to segment and compute total and sub-compartment muscle area, adipose tissue area, and attenuation values at the level of the L3 vertebra. Kaplan-Meier survival estimates, log-rank tests, and multivariable Cox regression models were used in survival analyses. The inclusion criteria were met by 138 patients. Although decreases in muscle and adipose tissue areas during NAT were predominant, a subset of patients experienced an increase in these compartments. Increases in muscle greater than 5% (hazard ratio [HR], 0.352; 95% confidence interval [CI] 0.135-0.918; p=0.033) and increases in adipose tissue greater than 15% (HR, 0.375; 95% CI 0.144-0.978; p=0.045), were significantly associated with improved survival, whereas loss of visceral fat greater than 15% was detrimental (HR 1.853; CI 1.099-3.124; p=0.021). No significant associations with single time-point anthropometrics were observed. Gains in total muscle and adipose mass were associated with improved pathologic response to systemic therapy and less advanced pathologic tumor stage. Dynamic anthropometric analysis during NAT for PDAC is a stronger prognostic indicator than measurements taken at a single point in time. Repeated anthropometric analysis during preoperative chemotherapy may serve as a biomarker for individual tumor biology and response to therapy.