Kaplan-Meier Survival Analysis Research Articles

SUGT1 is a prognostic biomarker and is associated with immune infiltrates in ovarian cancer

BackgroundOvarian cancer (OC) is a prevalent gynecological malignancy with a relatively dismal prognosis. The SGT1 homolog (SUGT1) protein, which interacts with heat shock protein 90 and is essential for the G1/S and G2/M transitions, was formerly thought to be a cancer promoter, but its precise role in OC remains unknown.MethodsWe conducted a comprehensive bioinformatics analysis of SUGT1 expression in patients with OC compared with their normal controls, including the data from the cancer genome atlas (TCGA), genotype–tissue expression (GTEx) databases, gene ontology (GO) analysis, Kyoto Encylopedia of Genes and Genomes (KEGG) analysis, gene set enrichment analysis (GSEA), single sample gene set enrichment analysis (ssGSEA). In addition, Kaplan–Meier (KM) analysis, univariate and multivariate Cox analyses were applied to investigate the prognostic role of SUGT1 in ovarian cancer. Furthermore, we validated the expression of SUGT1 in OC and normal tissues through immunohistochemistry.ResultsSUGT1 was significantly overexpressed in OC than in normal tissues. In addition, the GO, KEGG and GSEA analysis revealed that SUGT1 was associated with the functions related to immunoglobulin complex, antigen binding, immunoglobulin receptor binding, among others. Besides, ssGSEA demonstrated a positive correlation between SUGT1 expression and the abundance of T central memory cells, natural killer cells, and T gamma delta cells, although it showed a negative association with activated dendritic cells, cytotoxic cells, T cells, and T helper 1 cells. Subsequently, KM survival analysis revealed that high SUGT1 expression indicated a shorter overall survival, disease specific survival and progression free interval in OC patients. Univariate and multivariate Cox regression revealed that SUGT1 could serve as an independent risk factor for prognosis of patients with OC.ConclusionsAll these results of this study show that SUGT1 is an important molecular component in immune infiltration in OC and may have a new significant prognostic role in OC.

CYP24A1 DNA Methylation in Colorectal Cancer as Potential Prognostic and Predictive Markers.

The DNA methylation of CYP24A1 can regulate its gene expression and may play a role in the occurrence and progression of colorectal cancer (CRC). However, the association between CYP24A1 DNA methylation and the prognosis of CRC patients has not yet been reported. In this study, differential methylation analysis was conducted in both blood and tissue cohorts, and differential expression analysis was performed in the tissue cohort with in vitro validation. GO and KEGG enrichment analyses were performed on CYP24A1-related genes. A correlation between CYP24A1 promoter methylation and its gene expression was explored. Kaplan-Meier survival and Cox regression analyses were performed to investigate the impact of CYP24A1 DNA methylation on the prognosis of CRC patients. Prognostic risk scores were constructed for survival prediction. Immune infiltration analysis was also conducted. Our results showed that the hypermethylation of cg02712555 in tumor tissues (hazard ratio, 0.48; 95% confidence interval, 0.24-0.94; p = 0.032) and CpG site 41 in peripheral leukocytes (HR, 0.35; 95%CI, 0.14-0.84; p = 0.019) were both associated with decreased overall mortality in CRC patients. Prognostic risk scores showed robust predictive capabilities of these two CpG loci for the prognosis of CRC patients. CYP24A1 hypermethylation was positively correlated with infiltration levels of activated CD4 + T cells, activated CD8 + T cells, activated B cells, activated dendritic cells, and macrophages. Taken together, our findings indicate that the methylation levels of specific CpG sites within the CYP24A1 promoter region in blood leukocytes and tumors are potential prognostic and predictive markers for overall survival in CRC patients.

Influence of core material and occlusal contact pattern on fatigue behavior of different monolithic ceramic crowns.

This study evaluated the effect of substrate core materials and occlusal contact patterns on the fatigue mechanical behavior and stress distribution of single-unit ceramic crowns. One hundred and twenty monolithic crowns were fabricated from zirconia (YZ - IPS e.max ZirCAD, Ivoclar), lithium disilicate (LD - IPS e.max CAD, Ivoclar) and polymer infiltrated ceramic network (PICN - Enamic, Vita Zahnfabrik). The crowns were allocated considering two factors: 'substrate' (epoxy resin or cast Ni-Cr metal core) and 'occlusal contact pattern' (contact at the cusp ridges or cusp tips). The substrate models were design, milled and scanned to plan the restorations in a digital workflow. The crowns were milled, bonded to the substrates, and subjected to an accelerated fatigue test (100N; 10,000 cycles/step; 20Hz step-size: 100N up to 1600N, and after, 200N until failure or survival at 2,800N; immersed in water). Statistical analyses were performed using two-way ANOVA, Tukey's post-hoc test, and Kaplan-Meier survival analysis (α=0.05) considering fatigue failure load and cycles for fatigue failure (FFL/CFF). Fractographic and finite element analysis (FEA) were carried out. The results indicate that the 'substrate' factor did not influence the mechanical behavior of YZ and LD monolithic crowns (p>0.05). However, PICN crowns bonded to epoxy resin exhibited statistically superior results for FFL and CFF (p<0.05) compared to Ni-Cr cores. Regarding the 'occlusal contact pattern' factor, YZ and LD exhibited higher mean FFL and CFF when associated with cusp tip contact compared to cusp ridge contact (p<0.05), except for YZ bonded to the epoxy resin substrate (p>0.05). No differences were detected for the 'occlusal contact' factor in PICN crowns (p>0.05). The predominant failure was Hertzian cone cracks, regardless of the restorative material. Stress measurements showed higher stress peaks at the cusp ridges. The core material did not alter the fatigue mechanical behavior of YZ or LD crowns. However, the incidence of cusp ridge contacts in YZ or LD crown increases the risk of failure. Conversely, when using PICN crowns, a core with a more similar elastic modulus enhances mechanical behavior compared to a stiffer core, and no influence on the occlusal pattern was observed.

A novel mitochondrial-related risk model for predicting prognosis and immune checkpoint blockade therapy response in uterine corpus endometrial carcinoma

Uterine Corpus Endometrial Carcinoma (UCEC) represents a common malignant neoplasm in women, with its prognosis being intricately associated with available therapeutic interventions. In the past few decades, there has been a burgeoning interest in the role of mitochondria within the context of UCEC. Nevertheless, the development and application of prognostic models predicated on mitochondrial-related genes (MRGs) in UCEC remains in the exploratory stages. This study utilized RNA sequencing data and clinical information from the TCGA database to identify differentially expressed MRGs (DEMRGs) between UCEC and normal groups that are associated with overall survival (OS). Patients were randomly assigned to training and testing cohorts in a 1:1 ratio. In the training cohort, a risk model based on DEMRGs was developed using Lasso Cox regression analysis. Subsequently, patients in both cohorts were stratified into high-risk and low-risk groups based on their median risk scores. The prognostic performance of the model was validated through Kaplan-Meier survival analysis, ROC curves, and nomograms. Additionally, further analyses including functional enrichment, immune landscape assessment, prediction of response to ICB therapy, mutation profiling, and drug sensitivity analysis elucidated biological distinctions between the identified risk groups. We established a risk model incorporating eight MRGs. Patients classified within he high-risk group exhibited significantly poorer prognoses relative to those in the low-risk group. Functional enrichment analysis identified substantial differences in biological processes and signaling pathways between the high-risk and low-risk cohorts. Immune landscape analysis showed that patients with elevated risk scores exhibited significant immunosuppressive and immune evasion mechanisms. Conversely, low-risk patients exhibited higher expression of human leukocyte antigen (HLA) family members and immune checkpoint genes (ICGs) compared to their high-risk counterparts.Consequently, low-risk patients showed greater responsiveness to immunotherapy and potential small molecule drugs, whereas high-risk patients were more susceptible to chemotherapy. The mitochondrial-related risk model formulated in this study demonstrates efficacy in predicting both prognosis and response to immunotherapy in patients with UCEC, thereby providing a scientific basis for personalized treatment strategies. Future research endeavors should focus on further validating the clinical utility of this model and investigate the specific mechanisms of the identified MRGs in UCEC.

Negative-pressure wound therapy compared with advanced moist wound therapy: A comparative study on healing efficacy in diabetic foot ulcers.

This randomized controlled trial aimed to compare the efficacy of negative-pressure wound therapy with advanced moist wound therapy in managing diabetic foot ulcers. A total of 450 participants with diabetic foot ulcers were randomized to receive either negative-pressure wound therapy (n= 204) or advanced moist wound therapy (n= 246) over 18months. The primary outcome was complete ulcer closure, with secondary outcomes including time to closure, wound size reduction, infection rates, recurrence, and amputation rates. Wound dimensions were measured using digital planimetry, and Kaplan-Meier survival analysis was applied to assess time to closure. Analysis revealed statistically significant differences in clinical outcomes between treatment modalities. In the negative-pressure wound therapy group (n= 204), complete ulcer closure was achieved in 177 patients (87%), which was significantly greater than the advanced moist wound therapy group (n= 246) with 72 patients (29%) (P<.001). Although the mean time to wound closure was marginally extended in the negative-pressure wound therapy group (73±45days vs 64±49days; P=.045), this cohort demonstrated substantially more significant wound area reduction (48%±15 vs 25%±30; P<.001). Secondary outcome analysis revealed that negative-pressure wound therapy was associated with markedly reduced adverse events: wound infection (40 patients [20%] vs 95 patients [39%]; P<.001), ulcer recurrence (40 patients [20%] vs 113 patients [46%]; P<.001), and amputation rates (30 patients [15%] vs 132 patients [54%]; P<.001). Longitudinal assessment through Kaplan-Meier survival analysis demonstrated significantly greater wound closure probability and reduced complication risk in the negative-pressure wound therapy group throughout the follow-up period (log-rank P<.001). Negative-pressure wound therapy is significantly more effective than advanced moist wound therapy in treating diabetic foot ulcers, demonstrating superior outcomes in wound closure, infection control, and amputation prevention. This study highlights negative-pressure wound therapy as the preferred treatment option for complex diabetic foot ulcers, warranting further research into its long-term benefits and cost-effectiveness.

The Five-years Overall Survival and Recurrence Free Survival of Neoadjuvant Systemic Therapy in Breast Cancer Sudanese Patients: A Retrospective Comparative study

Background Breast cancer (BC) is a leading cause of cancer-related mortality among women worldwide. The role of neoadjuvant chemotherapy (NAC) in improving clinical outcomes for breast cancer patients has gained significant attention; however, its impact on long-term survival and recurrence rates remains under investigation. Thus, we evaluated the effectiveness of NAC on metastasis, recurrence rates, and overall survival in BC patients. Statistical analyses, including Chi-square tests and Kaplan-Meier survival analysis, were employed to assess differences between groups. Methods In this retrospective study, 46 Sudanese patients with locally advanced BC were consecutively collected attending Alsharif Specialized Hospital during the period from 2015 to 2016, comprising 28 patients who received NAC (case group) and 18 patients who underwent upfront surgery (control group). Data regarding demographics, histological types, treatment regimens, prognostic markers, survival, recurrence and metastasis were collected Results Most of patients in both groups were &gt; 40 years old. Invasive ductal carcinoma (IDC) was the predominant histological type observed. Notably, the metastasis rate was lower in the case group than in the control group (n=6; 21.4% vs. n=9; 50%, P = 0.043). However, the recurrence rates and overall survival did not differ significantly between the two groups (P = 0.353 and P = 0.454, respectively). The estimated mean survival time was 74.1 months for the case group compared to 82.0 months for the control group, but without significant difference (log-rank P = 0.973). Conclusion While NAC appears to reduce metastasis rates in breast cancer patients, it does not significantly impact recurrence rates or overall survival. These results underscore the need for further research to explore additional factors that influence long-term outcomes of breast cancer management.

Soluble CD72 concurrently impairs T cell functions while enhances inflammatory response in sepsis.

Sepsis is defined as multi-organ dysfunction caused by dysregulated host response to infection. This dysregulated host response includes enhanced inflammatory responses and suppressed adaptive immunity, but the molecular mechanisms behind it have not yet been elucidated. CD72, a type II transmembrane protein that is primarily expressed in B cells, was found to play an immunomodulatory role in the immune system and was associated with mortality in patients with sepsis. However, whether CD72 affects the pathogenesis of sepsis by influencing the immune response remains unclear. We first collected peripheral blood from 40 healthy volunteers and 57 septic patients and analyzed the mRNA levels of CD72 and the expression of its soluble form sCD72 using Realtime-PCR and ELISA. We then employed the CRISPR/Cas9 system to generate CD72 knockout mice (CD72-KO) and established a cecal ligation and puncture (CLP) model to analyze the effects of CD72 gene deletion on the survival, organ injury and immune response of septic mice by Kaplan-Meier survival analysis, pathological sections and flow cytometry. We also observe the effects of excess sCD72 on survival and immune response in sepsis by injecting recombinant CD72 protein into mice. Finally, the mechanism of sCD72 affecting sepsis immunity was analyzed by fluorescence staining, confocal microscopy and flow cytometry. We found that when sepsis occurs, the levels of CD72 mRNA and cell surface CD72 in immune cells decrease, while the level of soluble sCD72 in the blood increases significantly. Excessive sCD72 increased sepsis mortality in a dose-dependent manner, which can bind to CD100 on the surface of T cells and enter the cytoplasm, leading to impaired T cell functions, including a decrease in CD4+IFN-γ+, CD8+Perforin+, CD8+GZMB+, and CD8+FASL+ population and an increase in inflammatory CD4+TNF-α+ population, thereby suppressing adaptive immunity while enhancing inflammatory response. The immunosuppression of sepsis has been recognized, but the underlying mechanism has not been fully elucidated. Our study identified for the first time that sCD72 is an important mediator that cause adaptive immunosuppression during sepsis, which leads to T cell suppression by competitively binding to CD100 on the surface of T cells. Our study provides novel insights in our understanding of sepsis-related immunosuppression and may provide translational opportunities for the design of new diagnostic biomarkers and therapeutic targets for sepsis.

Prognostic significance of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in uterine carcinosarcoma.

Uterine carcinosarcoma (UCS) and uterine sarcomas (US) are rare but aggressive cancer with poor prognoses. The prognostic value of systemic inflammatory response (SIR) indicators, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR), in predicting outcomes of UCS and US remains unclear. This study investigated the prognostic significance of SIR indicators for UCS and US. Clinicopathological data from 237 patients diagnosed with UCS or US across 14 hospitals from January 2008 to December 2017 were retrospectively analyzed. NLR, PLR, and MLR values were calculated from preoperative blood counts. Prognostic impact was evaluated using Kaplan-Meier survival analysis, Cox regression models, and receiver operating characteristic (ROC) curve analysis. Elevated NLR, PLR, and MLR were associated with poorer progression-free survival (PFS) in UCS. Additionally, a high NLR also indicated worse overall survival (OS) in UCS. In patients with US, only PLR was significantly associated with poorer PFS. Combining SIR indicators provided a stronger prognostic prediction for UCS compared to individual indicators. Multivariate analysis revealed that high levels of SIR indicators were an independent poor prognostic factor for both PFS and OS in UCS. SIR indicators, particularly when combined, are valuable prognostic markers in UCS, reflecting the inflammatory status and aiding in stratifying patients for tailored therapeutic strategies. These findings support the incorporation of SIR indicators into clinical practice for better management of patients with UCS.

Early postoperative bevacizumab for preventing neovascular glaucoma in phacovitrectomy for proliferative diabetic retinopathy

To evaluate the effectiveness of postoperative intravitreal bevacizumab (IVB) in preventing neovascular glaucoma (NVG) and identify associated risk factors in patients with proliferative diabetic retinopathy (PDR) undergoing phacovitrectomy. Patients with PDR who underwent phacovitrectomy were enrolled and categorized into two subgroups based on their postoperative treatment regimen: one group received IVB within 2 months following phacovitrectomy (Group 1); the other did not receive IVB during this period (Group 2). A comparative analysis evaluated the distinguishing characteristics of the two groups after 1:1 propensity score matching. Kaplan–Meier survival analysis was utilized to determine the incidence of NVG after phacovitrectomy. Multivariate analysis with the Cox proportional hazards model identified risk factors associated with NVG postphacovitrectomy. A total of 206 eyes of 206 patients were investigated in this study. NVG developed in 15 eyes (7.28%). The probabilities of NVG occurrence at 6, and 12 months following phacovitrectomy were 4.85%, and 7.28%, respectively. When comparing Groups 1 (n = 57) and 2 (n = 57), a significant difference was observed in the occurrence of NVG (P < 0.001). In Group 1, only one case of NVG (1.75%) were noted, whereas all other NVG cases occurred in Group 2 (9.39%). Male sex and high preoperative intraocular pressure (IOP) were associated with NVG occurrence following phacovitrectomy, and the administration of IVB within 2 months postphacovitrectomy demonstrated efficacy in preventing the development of NVG. Male sex and high preoperative IOP were associated with a higher incidence of NVG, and postoperative IVB had a protective effect against NVG occurrence.

Return to work in young and middle-aged colorectal cancer survivors: Factors influencing self-efficacy, fear, resilience, and financial toxicity

BACKGROUND Return to work (RTW) serves as an indication for young and middle-aged colorectal cancer (CRC) survivors to resume their normal social lives. However, these survivors encounter significant challenges during their RTW process. Hence, scientific research is necessary to explore the barriers and facilitating factors of returning to work for young and middle-aged CRC survivors. AIM To examine the current RTW status among young and middle-aged CRC survivors and to analyze the impact of RTW self-efficacy (RTW-SE), fear of progression (FoP), eHealth literacy (eHL), family resilience (FR), and financial toxicity (FT) on their RTW outcomes. METHODS A cross-sectional investigation was adopted in this study. From September 2022 to February 2023, a total of 209 participants were recruited through a convenience sampling method from the gastrointestinal surgery department of a class A tertiary hospital in Chongqing. The investigation utilized a general information questionnaire alongside scales assessing RTW-SE, FoP, eHL, FR, and FT. To analyze the factors that influence RTW outcomes among young and middle-aged CRC survivors, Cox regression modeling and Kaplan-Meier survival analysis were used. RESULTS A total of 43.54% of the participants successfully returned to work, with an average RTW time of 100 days. Cox regression univariate analysis revealed that RTW-SE, FoP, eHL, FR, and FT were significantly different between the non-RTW and RTW groups (P &lt; 0.05). Furthermore, Cox regression multivariate analysis identified per capita family monthly income, job type, RTW-SE, and FR as independent influencing factors for RTW (P &lt; 0.05). CONCLUSION The RTW rate requires further improvement. Elevated levels of RTW-SE and FR were found to significantly increase RTW among young and middle-aged CRC survivors. Health professionals should focus on modifiable factors, such as RTW-SE and FR, to design targeted RTW support programs, thereby facilitating their timely reintegration into mainstream society.

Return to work in young and middle-aged colorectal cancer survivors: Factors influencing self-efficacy, fear, resilience, and financial toxicity.

Return to work (RTW) serves as an indication for young and middle-aged colorectal cancer (CRC) survivors to resume their normal social lives. However, these survivors encounter significant challenges during their RTW process. Hence, scientific research is necessary to explore the barriers and facilitating factors of returning to work for young and middle-aged CRC survivors. To examine the current RTW status among young and middle-aged CRC survivors and to analyze the impact of RTW self-efficacy (RTW-SE), fear of progression (FoP), eHealth literacy (eHL), family resilience (FR), and financial toxicity (FT) on their RTW outcomes. A cross-sectional investigation was adopted in this study. From September 2022 to February 2023, a total of 209 participants were recruited through a convenience sampling method from the gastrointestinal surgery department of a class A tertiary hospital in Chongqing. The investigation utilized a general information questionnaire alongside scales assessing RTW-SE, FoP, eHL, FR, and FT. To analyze the factors that influence RTW outcomes among young and middle-aged CRC survivors, Cox regression modeling and Kaplan-Meier survival analysis were used. A total of 43.54% of the participants successfully returned to work, with an average RTW time of 100 days. Cox regression univariate analysis revealed that RTW-SE, FoP, eHL, FR, and FT were significantly different between the non-RTW and RTW groups (P < 0.05). Furthermore, Cox regression multivariate analysis identified per capita family monthly income, job type, RTW-SE, and FR as independent influencing factors for RTW (P < 0.05). The RTW rate requires further improvement. Elevated levels of RTW-SE and FR were found to significantly increase RTW among young and middle-aged CRC survivors. Health professionals should focus on modifiable factors, such as RTW-SE and FR, to design targeted RTW support programs, thereby facilitating their timely reintegration into mainstream society.

A Novel Prognostic Risk Model Based on Oxidative Stress to Predict Survival and Improve Treatment Strategies in Stomach Adenocarcinoma.

Stomach adenocarcinoma (STAD) is the fifth most common tumor worldwide, imposing a significant disease burden on populations, particularly in Asia. Oxidative stress is well-known to play an essential role in the occurrence and progression of malignancies. Our study aimed to construct a prediction model by exploring the correlation between oxidative stress-related genes and the prognosis of patients with STAD. STAD data from TCGA were used to identify the differentially expressed oxidative stress-related genes (OSGs), with data from GEO serving as the validation cohort. Univariate Cox and LASSO regression analyses were performed to select prognosis-related genes for the risk model, which was then integrated with clinical features into a nomogram. The physiological functions and pathways of these identified genes were explored using GO and KEGG analyses. After evaluating the prediction value of the prognostic model in the GEO cohort, drug sensitivity and immune infiltration were comprehensively analyzed using R. Expression levels of the prognostic genes were verified by quantitative real-time PCR in gastric cancer and paired normal tissues. Cox regression and LASSO regression analysis identified SERPINE1, VHL, CD36, NOS3, ANXA5, ADCYAP1, POLRMT and GPX3 as the signature genes from 160 differentially expressed OSGs. Both Kaplan-Meier survival analysis and ROC curve at 5 years in the TCGA and the GEO cohort exhibited great predictive ability of the prognostic model, with the AUC >0.7 in TCGA. Validated as an independent risk factor, the model was integrated with clinicopathological variables (including age, stage, and gender) to build a nomogram for more accurate risk stratification. Moreover, therapy sensitivity analysis between the low- and high-risk categories showed that those who scored higher would benefit more from BEZ235, Dasatinib, Pazopanib, and Saracatinib. Meanwhile, differences in the tumor environment, immune infiltration and response to immunotherapy between the two groups were noted. Finally, qRT-PCR validated the differential expression of these genes in STAD and paired normal tissues. Our study has effectively established an oxidative stress-related prognostic model, providing a promising tool for personalized clinical strategies and improved STAD patient outcomes.

Retrospective cohort study based on the MIMIC-IV database: analysis of factors influencing all-cause mortality at 30 days, 90 days, 1 year, and 3 years in patients with different types of stroke.

This study aims to evaluate key factors influencing the short-term and long-term prognosis of stroke patients, with a particular focus on variables such as body weight, hemoglobin, electrolytes, kidney function, organ function scores, and comorbidities. Stroke poses a significant global health burden, and understanding its prognostic factors is crucial for clinical management. This is a retrospective cohort study based on data from the MIMIC-IV database, including stroke patients from 2010 to 2020. A total of 5,110 patients aged 18 and older were included in the study. The exposure variables included body weight and hemoglobin levels, while the outcome variables were the 30-day, 90-day, 1-year, and 3-year mortality risks. Covariates included electrolyte levels, kidney function, organ function scores, and comorbidities. Random forest and gradient boosting tree models were employed for data analysis to assess mortality risk. Kaplan-Meier survival analysis showed that ischemic stroke patients had the highest 30-day mortality rate at 8.5%, with only 20% 1-year survival. Traumatic subarachnoid hemorrhage patients had the best prognosis, with a 1-year survival rate of 60%. Multivariable Cox regression analysis revealed that each 1-point increase in the Charlson Comorbidity Index raised the 1-year and 3-year mortality risks by 1.39 times (95% CI: 1.10-1.56) and 1.44 times, respectively. Each 1-point increase in the SOFA score increased the 30-day, 90-day, 1-year, and 3-year mortality risks by 2.11 times, 2.03 times, and 1.84 times, respectively. Additionally, lower hemoglobin levels were significantly associated with increased mortality, with 30-day, 90-day, and 1-year mortality risks increasing by 3.33 times, 3.34 times, and 4.16 times, respectively (p < 0.005). Age ≥ 71 years, longer hospital stays, and organ dysfunction were also significant factors affecting mortality. This study highlights the critical role of stroke type, comorbidity index, SOFA score, hemoglobin levels, and length of hospital stay in stroke prognosis. These findings provide valuable insights for clinical risk assessment and the development of individualized treatment strategies, which may improve the management and outcomes of stroke patients. The predictive model constructed effectively assesses mortality risks in stroke patients, offering support for future clinical practice.

Antiphospholipid antibodies positivity as a potential risk factor for restenosis following arteriovenous fistula stenting in hemodialysis patients: a pilot study.

The arteriovenous fistula (AVF) is the preferred vascular access for hemodialysis. AVF stenosis is a common complication, often requiring balloon angioplasty. For recurrent stenosis, AVF stenting may be an option. Persistent antiphospholipid antibody (aPL) positivity is frequently observed in hemodialysis (HD) patients and is associated with AVF thrombosis and stenosis. This study aimed to evaluate AVF stent survival without stenosis in aPL-positive hemodialysis patients. A monocentric retrospective observational study was conducted on 35 patients who underwent AVF stenting between 1st January 2014 and 31st December 2023. The patients were divided into two groups: the aPL+ group [defined by a score of 3 or more based on the laboratory criteria of the 2023 ACR/EULAR for antiphospholipid syndrome (APS)] and the control group. Intrastent restenosis was defined as a chronic change in the AVFphysical examination or blood flow, confirmed by ultrasound (US) or angiography. Kaplan-Meier survival analysis was used to estimate the probability of stent survival without restenosis. The prevalence of intrastent restenosis was significantly higher in the aPL+ group at 24 months. The Kaplan-Meier survival analysis showed a significantly lower probability of AVF stent survival without restenosis in the aPL+ group (age-adjusted Hazard Ratio, 2.13 [IC95%, 1.70-2.69]). To the best of our knowledge, we describe for the first time a statistically significant association between aPL+ and AVF intrastent restenosis. Intimal hyperplasia is a non-thrombotic lesion associated with aPL+ and is linked to the mammalian target of rapamycin (mTOR) signaling pathway. We hypothesize that aPL may contribute to intrastent restenosis by inducing intimal hyperplasia. Whether this phenomenon is mTOR-mediated and whether sirolimus-eluting stents or balloons could be a better option for aPL+ patients requires further study.

Circulating resistin levels and mutation burden of the RETN gene variants predict long-term mortality in a Taiwanese population

Human resistin is a proinflammatory cytokine involving the development and progression of cancer and cardiovascular diseases. However, prediction of long-term outcome using circulating resistin level and its genetic determinants in a population-based study remain to be explored. After genome-wide association study (GWAS), DNA methylation (DNAm) analysis and functional assays of a RETN rs370006313 variant, we tested whether resistin level and its genetic determinants can be used to determine the long-term outcomes of 5678 Taiwan Biobank (TWB) participants. GWAS and DNAm analysis revealed RETN variants, rs3219175, rs370006313, and rs3745368, and DNAm sites, cg21271423 and cg09909011, independently associated with circulating resistin levels. Functional assays showed rs370006313 variant played a key role in affecting RETN promoter activity, whereas genotypes of rs3219175 and rs3745368, but not rs370006313, exhibited genome-wide significant associations with RETN promoter DNAm levels. Using Kaplan-Meier survival and Cox regression analyses, participants with progressively increasing resistin levels had a higher hazard ratio for all-cause mortality and cancer mortality compared to those with lower resistin levels. Participants with all three RETN variants (high mutation burden) also exhibited significantly higher hazard ratios for all-cause mortality and cancer mortality, at 3.99 and 5.55, respectively, compared to those without a high mutation burden. In conclusion, RETN rs370006313 is a functional variant affecting RETN promoter activity. Elevated circulating resistin levels and a high RETN mutation burden predict all-cause and cancer mortality in TWB participants. Both resistin levels and RETN variants may serve as biomarkers of long-term outcomes in the general Taiwanese populations.

DDX21 Is a Potential Biomarker for Predicting Recurrence and Prognosis in Hepatocellular Carcinoma

DEAD‐box helicase 21 (DDX21) is a conserved Asp‐Glu‐Ala‐Asp (DEAD) box RNA helicase with multiple functions that is involved in various cellular processes and diseases. However, the role of DDX21 in the recurrence and prognosis of hepatocellular carcinoma (HCC) patients remains unknown. In the current study, we examined the protein expression of DDX21 in HCC tissues through immunohistochemical staining and analyzed the correlation between DDX21 protein expression and clinical outcome via Kaplan–Meier survival analysis. The Cox proportional hazards regression model was used to assess the interrelationships between the outcome and variable over time. Our results showed that increased expression of DDX21 protein was observed in HCC tissues compared with paracancerous tissues and was associated with advanced BCLC stage. Recurrent HCC patients had higher levels of DDX21 protein than nonrecurrent cases. Notably, DDX21 was an independent risk factor for predicting worse overall survival and recurrence‐free survival in HCC patients. Furthermore, lack of DDX21 abated the growth and mobility of Hep3B cells. Taken together, our data highlight the clinical significance of DDX21 in the recurrence and prognosis of HCC patients and indicate that targeting DDX21 may represent an effective therapeutic strategy for the treatment of HCC.

Impact of being lateral and sitting position for spinal anesthesia administration on maternal hemodynamic variability and the timing of hypotension among cesarean section patients in a resource-constrained area: a prospective observational cohort study

Background: Type of anesthesia used for cesarean section can be general, spinal, or epidural. However, peripheral nerve blocks, such as the lower and upper extremity nerve blocks, can be referred to as other types of anesthesia. Spinal anesthesia is the most frequently used method because of its ease, dependability, and rapidity in attaining proper anesthesia. The purpose of this study was to determine the effects of spinal anesthesia induction position on maternal hemodynamics and the timing of hypotension. Method: A prospective observational cohort study design was employed. A simple random sampling technique was used. A total of 190 patients received spinal anesthesia, with 95 in the lateral and 95 in the sitting position in each group. The data were entered into Epi Data version 4.6 and then exported to SPSS version 26 for analysis. Independent sample t-tests and chi-square (χ 2) tests were performed. Kaplan–Meier survival analysis and log-rank test were used and P value ≤0.05 considered significant. Results: The overall incidence rates of hypotension in the lateral and sitting groups were 54.6% [95% CI, 52.3–72.1] and 73.8% [95% CI, 69.8–87.2], respectively (P = 0.025). The timing of first hypotension was 8.86 minute [95% CI, 8.690–13.272] and 15.75 minute [95% CI, 14.569–19.372] (P = 0.001) for sitting and lateral, respectively. Conclusion and recommendation: In this study, we found a significant difference between the lateral and sitting groups with different measurement parameters, such as blood pressure, intraoperative adverse events, and onset of hypotension. The incidence of hypotension, intraoperative adverse effects of spinal anesthesia, and fluid consumption were lower in the lateral groups. Nonetheless, instead of being technically challenging during spinal anesthesia induction, the lateral position results in better hemodynamics and onset of hypotension than in the sitting posture.

Prognostic value and clinical significance of IL-33 expression in patients with uterine corpus endometrial carcinoma.

Uterine corpus endometrial carcinoma (UCEC) is one of the most common malignant tumours of the female genital tract. In the occurrence, progression and prognosis of UCEC, chronic inflammation plays an important role, making it pivotal to identify inflammatory response-related endometrial diseases. The cytokine interleukin-33 (IL-33) plays significant roles in immune responses, and has been associated with inappropriate allergic reactions, autoimmune diseases, and cancer pathology. In the past decade, studies have begun to uncover the pivotal roles of IL-33 in shaping tumour microenvironment (TME), where it may promote or inhibit tumorigenesis and development depending on the specific tumour types. However, the association between IL-33 expression and UCEC remains unclear. Here we investigated the expression profiles of IL-33 in pan-cancer based on TCGA database. Then, differential gene expression analysis and correlation analysis of IL-33 was investigated in UCEC. In addition, functional enrichment analysis and Kaplan-Meier survival analysis were performed to predict the potential function of IL-33 and its role in the prognosis of UCEC patients. Also, a nomogram model was constructed to predict the prognosis of UCEC. The expression of the inflammatory factor NF-κB p65 and the IL-33, along with its receptor ST2, was analyzed in UCEC tumour tissues and normal tissues of clinical specimens through immunohistochemical staining. Meanwhile, we used toluidine blue staining and methanol Congo red staining to observe the infiltration of mast cells and eosinophils in the endometrial tissue. The results of Kaplan-Meier plotter data indicated that patients with lower IL-33 expression had poorer progression-free interval than those with higher expression. Based on the results of multifactor Cox regression, a nomogram was generated to predict UCEC occurrence risk and prognosis. Clinical specimen characteristics also confirmed a negative correlation between IL-33 expression and UCEC staging and grading. This comprehensive analysis of IL-33, based on bioinformatics and immunohistochemistry, revealed that IL-33 has the function of inhibiting UCEC occurrence and progression and can be served as a beneficial prognostic marker in the clinic.

Predicting Time to First Rejection Episode in Lung Transplant Patients Using a Comprehensive Multi-Indicator Model.

Rejection hinders long-term survival in lung transplantation, and no widely accepted biomarkers exist to predict rejection risk. This study aimed to develop and validate a prognostic model using laboratory data to predict the time to first rejection episode in lung transplant recipients. Data from 160 lung transplant recipients were retrospectively collected. Univariate Cox analysis assessed the impact of patient characteristics on time to first rejection episode. Kaplan-Meier survival analysis, LASSO regression, and multivariate Cox analysis were used to select prognostic indicators and develop a riskScore model. Model performance was evaluated using Kaplan-Meier analysis, time-dependent ROC curves, and multivariate Cox regression. Patient characteristics were not significantly associated with the time to the first rejection episode. Six laboratory indicators-Activated Partial Thromboplastin Time, IL-10, estimated intrapulmonary shunt, 50% Hemolytic Complement, IgA, and Complement Component 3-were identified as significant predictors and integrated into the riskScore. The riskScore demonstrated good predictive performance. It outperformed individual indicators, was an independent risk factor for rejection, and was validated in the validation dataset. The riskScore model effectively predicts time to first rejection episode in lung transplant recipients.

A Novel Electrocardiographic Marker for Predicting Total Mortality in Ischemic Stroke: Frontal QRS-T Angle.

This study aimed to investigate the relationship between mortality and the frontal QRS-T angle (FQRS-TA), obtained by calculating the absolute difference between the QRS and T waves electrocardiographically (ECG), in patients diagnosed with ischemic stroke (IS). This research is a retrospective and cross-sectional study. The diagnosis of IS was confirmed through brain imaging and physical examination. Patients with sinus rhythm were included in the study. The FQRS-TA was measured by calculating the absolute difference between the QRS-axis and the T-axis, as automatically measured on the ECG. Patients were divided into two groups: those who died within five years and those who survived, and the groups were compared. A total of 322 patients with IS were included in the study, of whom 290 survived, and 32 died. Age, creatinine level, PR interval, QRS duration, corrected QT (cQT) value, and FQRS-TA value were found to be higher in the deceased group. Cox regression analyses were performed to examine the association between predictors of stroke-related mortality. Age [hazard ratio (HR): 1.091, 95% (1.045-1.140), P < 0.001], high-density lipoprotein (HDL) [HR: 0.914, 95% (0.875-0.955), P < 0.001], and FQRS-TA [odds ratio (OR): 1.011, 95% (1.003-1.019), P = 0.007] were associated with mortality. A FQRS-TA of 68 degrees or higher was associated with cumulative mortality in the Kaplan-Meier survival analysis (log rank [Mantel-Cox] test: P = 0.001). In this study, increased FQRS-TA was found to be associated with mortality in patients with IS. ECG parameters are simple and time-efficient measurements that can provide important prognostic information. To the best of our knowledge, this research is the first study to examine the relationship between FQRS-TA and mortality in patients with IS.