Median Survival Time Research Articles

Surgically managed incarcerated umbilical hernias in calves hold favorable prognosis: a retrospective analysis of 19 cases (2004-2021).

To describe the clinical signs, surgical management, postoperative complications, and outcomes following herniorrhaphy in calves with incarcerated umbilical hernias. This was a retrospective case series. The electronic medical record databases of 2 veterinary teaching hospitals were searched to identify the records of calves that underwent herniorrhaphy for correction of irreducible umbilical hernias between January 1, 2004, and December 31, 2021. Data collected included signalment, medical history, results of clinical examination and laboratory testing, ultrasonographic and surgical findings (incarceration vs strangulation), postoperative complications, and outcome. 19 calves with incarcerated umbilical hernias underwent surgical correction. The incarcerated gastrointestinal tract was identified as the abomasum in 11 calves and jejunum in 8 calves. In 9 calves, the intraoperative identification of strangulation led to 4 intestinal resections and 4 partial abomasectomies, with 1 calf being euthanized intraoperatively. Postoperative complications were reported in 3 calves that underwent intestinal resection. Sixteen calves (84%) survived to discharge and had a median survival time of 1,995 days after surgery. No statistically significant differences were observed between calves with or without gastrointestinal tract strangulation in the short-term survival rate, survival time, or number of lactations after surgery. This study demonstrated that herniorrhaphy for incarcerated umbilical hernias in calves is associated with a favorable prognosis. Postoperative complications are, however, more frequent in calves with strangulated gastrointestinal tract. Surgical intervention for incarcerated umbilical hernias in calves generally yields a positive prognosis, particularly in the absence of gastrointestinal tract strangulation, highlighting the importance of timely diagnosis and treatment.

Association between serum IgM and all-cause mortality risk in Chinese centenarians: a prospective cohort study

BackgroundWe investigated the associations between IgM, IgG, IgA, and IgE levels and all-cause mortality risk in Chinese centenarians.MethodsAll participants were from the China Hainan Centenarian Cohort Study. Eligible participants were divided into quartiles based on their IgM, IgG, IgA, and IgE levels. We used restricted cubic spline analyses, Cox regression analyses, and Kaplan–Meier survival curves to analyze associations between IgM, IgG, IgA, and IgE and all-cause mortality risk.ResultsA total of 906 centenarian participants were included in this study (81.2% female; median age, 102 years). During a median follow-up of 30.1 months, 838 (92.5%) participants died. Restricted cubic spline analysis revealed a nonlinear relationship (“L” type) between serum IgM level and all-cause mortality. Compared with the higher three quartiles of serum IgM level, the lowest quartile was associated with a higher risk of death (Q1 versus Q2-Q4: HR, 1.365; 95% CI, 1.166–1.598; P < 0.001). Among individuals for whom IgM < 0.708 g/L (Q1), the risk of all-cause mortality was 36.5% higher. Kaplan–Meier analyses showed that centenarians with lower serum IgM levels had significantly shorter median survival time (Q1 versus Q2-Q4: 26 months versus 32 months, log-rank P = 0.001).ConclusionSerum IgM levels in centenarians significantly correlated with the risk of death, suggesting that they are suitable for predicting the overall risk of death in centenarians and can be used as an independent predictor of death.

Revisiting the role of MicroRNAs in the pathogenesis of idiopathic pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF) is a prevalent chronic pulmonary fibrosis disease characterized by alveolar epithelial cell damage, fibroblast proliferation and activation, excessive extracellular matrix deposition, and abnormal epithelial-mesenchymal transition (EMT), resulting in tissue remodeling and irreversible structural distortion. The mortality rate of IPF is very high, with a median survival time of 2-3years after diagnosis. The exact cause of IPF remains unknown, but increasing evidence supports the central role of epigenetic changes, particularly microRNA (miRNA), in IPF. Approximately 10% of miRNAs in IPF lung tissue exhibit differential expression compared to normal lung tissue. Diverse miRNA phenotypes exert either a pro-fibrotic or anti-fibrotic influence on the progression of IPF. In the context of IPF, epigenetic factors such as DNA methylation and long non-coding RNAs (lncRNAs) regulate differentially expressed miRNAs, which in turn modulate various signaling pathways implicated in this process, including transforming growth factor-β1 (TGF-β1)/Smad, mitogen-activated protein kinase (MAPK), and phosphatidylinositol-3-kinase/protein kinase B (PI3K/AKT) pathways. Therefore, this review presents the epidemiology of IPF, discusses the multifaceted regulatory roles of miRNAs in IPF, and explores the impact of miRNAs on IPF through various pathways, particularly the TGF-β1/Smad pathway and its constituent structures. Consequently, we investigate the potential for targeting miRNAs as a treatment for IPF, thereby contributing to advancements in IPF research.

Modelling of the time to death of breast cancer patients at Hiwot Fana Specialized University Hospital

Breast cancer is the most common cause of cancer death and is a frequently diagnosed cancer among women worldwide. It is becoming a challenging health condition in Ethiopia with a high rate of morbidity and mortality. The main aim of this study was to model the time to death in breast cancer patients at Hiwot Fana Specialized University Hospital. A retrospective cohort study was carried out from April 1st, 2020, to April 1st, 2023, and 296 women were included in the study. We used nonparametric methods and Bayesian accelerated failure time models (with Laplace approximation) to identify risk factors and choose a model fitting breast cancer patient data. Model comparison was performed using the marginal likelihood, deviance information criterion and Watanabe Akaike information criterion. From the total of 296 patients in the study, 56 (18.9%) died. The estimated median survival time was 33 months. The log-rank test showed that age group, stage, alcohol consumption, smoking habit, and comorbidity were potential risk factors associated with the time to death in breast cancer patients at the 5% level of significance. The Bayesian Weibull accelerated failure time model was found to be the best fitted model for predicting the survival time of patients with minimum DIC (520.39) and WAIC (521.59) values. The final Bayesian Weibull AFT model with the integrated nested Laplace approximation estimation technique revealed that age group, stage, alcohol consumption, smoking habit, and comorbidity were significantly associated with the time to death in breast cancer patients. Individuals older than 65 years, with stage IV disease, drinking alcohol, smoking cigarettes and having comorbidities had shortened survival times in patients with breast cancer. Hence, Hiwot Fana Specialized University Hospital and related bodies should work on awareness creation to reduce smoking habits and alcohol use as well as give due attention to elderly and stage IV breast cancer patients during intervention.

Targeted Microglial Membrane-Coated MicroRNA Nanosponge Mediates Inhibition of Glioblastoma.

Glioblastoma (GBM) is the most prevalent primary brain tumor. Recent research emphasizes the crucial role of microRNAs (miRs) in GBM pathogenesis, and targeting miRs offers an effective approach for precise GBM therapy. However, inhibiting a single miR may not be sufficient due to the compensatory mechanisms of GBM. Herein, we developed a miR-nanosponge capable of specifically capturing multiple miRs involved in tumor growth, migration, invasion, angiogenesis, and the creation of an immunosuppressive microenvironment, thereby offering a comprehensive treatment for GBM. Coated with BV2 cell membrane (BM) for enhanced blood-brain barrier (BBB) crossing and GBM targeting, the BM@miR-nanosponge targets miR-9, miR-21, miR-215, and miR-221, significantly inhibiting GBM progression and modulating the immune system for a thorough GBM eradication. The BM@miR-nanosponge notably extended the median survival time of GBM-bearing mice and outperformed the standard treatment drug temozolomide (TMZ). This study introduces a comprehensive miR-based strategy for GBM treatment and highlights the importance of targeting multiple miRs associated with tumor survival for effective therapy.

The Use of Anaplastic Lymphoma Kinase Inhibitors in Non-Small-Cell Lung Cancer Treatment-Literature Review.

Lung cancer is the leading cause of cancer-related morbidity and mortality. The median survival time for patients with advanced non-small-cell lung cancer before the era of molecular-based personalized treatment was 7.9 months. The discovery of predictive factors and the introduction of molecular diagnostics into daily practice made a breakthrough, enabling several years of survival in patients with advanced disease. The discovery of rearrangements in the ALK gene and ALK tyrosine kinase inhibitors has resulted in a dramatic improvement in the prognosis of patients with this subtype of cancer. Currently, three generations of ALK inhibitors differing in activity, toxicity and degree of penetration into the central nervous system are available in clinical practice. The current state of knowledge on ALK inhibitors used in clinical practice is summarised in this research paper. Methods of diagnosis of abnormalities in ALK have been shown, and the review of research that contributed to the development of the next generation of ALK inhibitors has been presented.

Improved survival among elderly patients with aggressive adult T-cell leukemia/lymphoma: Impact of mogamulizumab-containing chemotherapy.

Due to the poor prognosis of adult T-cell leukemia/lymphoma (ATL), new treatments are urgently needed, especially for elderly patients with aggressive ATL. The anti-CCR4 antibody drug mogamulizumab (MOG) has been approved for the treatment of untreated ATL. To analyze the impact of MOG on elderly patients, we conducted a retrospective analysis of patients aged 70years and older with aggressive ATL diagnosed at our institution between 2015 and 2021. Among 32 patients, including those who received best supportive care, the median survival time (MST) and 2-year overall survival (OS) rate were 14.6months (range, 0.0-83.7), and 34.7% [95% confidence interval (CI), 18.2-51.9], respectively, which were better than outcomes in our previous study. The MST and 2-year OS for patients treated with MOG-containing chemotherapy were 18.1months (range, 4.0-83.7) and 45.0% (95%CI, 23.1-64.7), respectively, demonstrating clear improvement. Adverse events observed with MOG-containing treatment, such as myelosuppression and skin rash, were similar to those reported previously. Univariate analysis identified comorbidity as a predictor of poor outcomes, but not intensity of MOG-containing treatment, suggesting a different mechanism of action than that of classical chemotherapy. Our study suggests that MOG-containing treatments are an option for elderly patients with ATL.

The effect of midline shift on survival time in dogs with structural brain disease diagnosed on MRI.

The effect of midline shift identified on brain MRI on survival time in dogs with structural brain disease is relatively unknown. This retrospective single-centered cohort study reviewed medical and imaging data of 77 dogs with structural brain lesions evident on MRI. Images were reviewed for the presence of midline shift, brain edema, foramen magnum herniation, and ventriculomegaly. Kaplan-Meier method and Cox regression analysis were undertaken to compare survival between dogs with and without midline shift. Midline shift was present in 40 of 77 (52%) dogs and absent in 37 of 77 (48%). Univariate analysis revealed that dogs with midline shift had a median survival time of 34.5 days (95% CI, 4-108 days) compared with 241 days (95% CI, 133,- days) in dogs without midline shift (hazard ratio=2.67, 95% CI, 1.5-4.49). Multivariate Cox regression analysis revealed a hazard ratio of 3.6 (95% CI, 1.7-7.6; P-value<.001) for dogs with midline shift. Shorter median survival times remained significant in all groups after segregation based on etiological diagnosis. The significantly shorter survival times observed herein for dogs with midline shifts, regardless of etiologic cause, provide further evidence that midline shift holds value as a negative prognostic factor in diagnostic imaging.

Clinical outcomes of patients undergoing reoperation with solitary fibrous tumors/hemangiopericytomas and malignant progression of tumors.

The purpose of this study was to analyze the clinical outcomes and malignant progression of tumors in patients who underwent reoperation for recurrent solitary fibrous tumors (SFTs) and hemangiopericytomas (HPCs). We identified 48 patients who underwent reoperation because of tumor recurrence at Tangdu Hospital between January 2010 and December 2021 and analyzed the clinical outcomes, namely, the rate of gross total resection (GTR), progression-free survival (PFS), overall survival (OS), malignant progression of tumors and radiotherapy. The survival curves for each group were plotted using the Kaplan‒Meier method and compared using log-rank tests. Of the 48 patients (25 men and 23 women, mean age 49.5 ± 14.3 years), 25 experienced a second recurrence or metastasis, 15 of whom underwent a third surgery, and the remaining 10 patients who did not undergo surgery ultimately died after tumor progression. The median time (95% CI) to tumor recurrence was 40.0 (32.3-47.7) months after reoperation, with 3-, 5- and 10-year PFS rates of 54.6%, 29.5% and 14.8%, respectively. The median (95% CI) survival time was 70.0 (46.6-93.4) months, with 3-, 5- and 10-year survival rates of 67.9%, 55.1% and 36.7%, respectively. Among the 48 patients who underwent reoperation, 27 (56.3%) achieved GTR, and 21 (43.8%) achieved STR. Twelve patients in the GTR group (12/27, 44.4%) received radiotherapy after surgery, and 18 patients in the STR group (18/21, 85.7%) received radiotherapy. Of the 48 recurrent SFTs, 24 were classified as WHO grade 1, 14 were classified as WHO grade 2, and 10 were classified as WHO grade 3 based on 2021 WHO classification after the primary operation. After reoperation, 9 tumors developed malignant progression, including 4 WHO grade 1 tumors progressing to WHO grade 2 tumors, 1 WHO grade 1 tumor progressing to a WHO grade 3 tumor and 4 WHO grade 2 tumors progressing to WHO grade 3 tumors. GTR after reoperation was associated with better PFS and OS compared to STR. However, the PFS after the third surgery was significantly shorter than that after the second surgery, and the rate of GTR also decreased. Malignant progression may occur after second or third tumor recurrence. Furthermore, compared with WHO grade 1 SFTs, WHO grade 2 and grade 3 SFTs significantly decreased PFS, but OS did not differ among the three groups. Radiotherapy did not prolong PFS or OS in patients who underwent reoperation.

Clinicopathological, immunohistochemical and therapeutic approaches on survival in patients with epithelioid glioblastoma: Institutional experience in the management of 58 patients

Epithelioid glioblastoma (Ep-GBM) is a rare variant of glioblastoma characterized by a high recurrence rate and poor prognosis. Currently, there is no established standard treatment for Ep-GBM. Therefore, we identified 58 Ep-GBM cases to investigate these characteristics and identify the possible prognostic factors of survival. There were 30 male and 28 female patients with a median age of 39 years. Headaches and dizziness were the most common clinical symptom. The tumor is most frequently located in the temporal lobe (36.2%). The positivity rate for BRAF-V600E is 56.9% (33/58), for MGMT is 56.9% (33/58), and for INI-1 is 75% (30/40). Tumor recurrence was observed in 39 patients. The median progression-free survival (PFS) of all patients was 12.7 months, while the median overall survival (OS) was 29.1 months. Additionally, the median survival time after recurrence was 14.3 months. Both univariate and multivariate COX regression analyses revealed that individuals who received more than six cycles of adjuvant oral temozolomide experienced a longer median PFS compared to those who received fewer cycles. Characteristics associated with poorer PFS included tumor dissemination prior to initial surgery. Additionally, both analyses identified tumor dissemination, radiotherapy and adjuvant oral temozolomide as predictors of OS. Notably, for patients with recurrent Ep-GBM, reoperation was shown to significantly increase survival time after recurrence. In conclusion, the standard Stupp regimen is also applicable to patients with Ep-GBM, extending adjuvant oral temozolomide could further improve survival for Ep-GBM patients, reoperation may also prolong survival for recurrent Ep-GBM.

Brain targeted biomimetic siRNA nanoparticles for drug resistance glioblastoma treatment

Glioblastoma multiforme (GBM), the most aggressive intracranial neoplasm, remains incurable at present, primarily due to drug resistance, which significantly contributes to elevated recurrence rates and dismal prognosis. Signal transducer and activator of transcription 3 (STAT3) is a critical gene closely associated with GBM drug resistance and the progression of GBM stem cells (GSCs), making it a promising therapeutic target. In this study, we developed cancer cell membrane-cloaked biomimetic nanoparticles to deliver STAT3 siRNA to reverse drug resistance in homologous GBM. These biomimetic nanoparticles leverage homotypic targeting, rapid endosome escape, and fast siRNA release, leading to efficient in vitro STAT3 knockdown in both temozolomide-resistant U251-TR cells and X01 GSCs. Moreover, benefited from the membrane functionalization, significant prolonged blood circulation, improved blood brain barrier (BBB) penetration and GBM tumor accumulation are achieved by these siRNA biomimetic nanoparticles. Importantly, these nanoparticles effectively inhibit tumor proliferation, significantly extending median survival time in orthotopic U251-TR (43.5 d versus 20 d for PBS control) and X01 GSC-bearing mouse xenografts (52 d versus 19.5 d for PBS control). Altogether, this biomimetic siRNA platform offers a promising strategy for gene therapy targeting drug-resistant GBM.

Survival of Ischaemic and Haemorrhagic Stroke: Analysis of the Malaysian National Stroke Registry Data from 2009 to 2013.

Stroke ranks as the second leading cause of death globally, contributing to 15.2 million deaths in 2016. In Malaysia, stroke has emerged as a significant cause of mortality and disability. This study aims to evaluate the survival time and rate of stroke patients in Malaysia. In this retrospective cohort study, we reviewed secondary data from the National Stroke Registry (NSR) of Malaysia. The study included all Malaysian residents over the age of 12 years old diagnosed with either ischaemic or haemorrhagic stroke between 1 January 2009 and 31 December 2013. Patients with a transient ischaemic attack were excluded. We updated the death status up to 31 December 2018 using mortality data from the Malaysian National Registry Department. We used Kaplan-Meier Survival Analysis to determine the overall median survival time and log-rank test to compare the median time by ethnicity, sex and stroke type. The survival rates at 1 year, 3 years and 5 years were obtained using the life-table method. The analysis included a total of 5,777 stroke patients. The mean age at diagnosis was 63.15 years old (with a standard deviation of 12.46 years old). The overall median survival time was 51 months (95% CI: 47.4, 54.6). Non-Malay patients and those with ischaemic strokes experienced a longer median survival time (65.2 months [95% CI: 56.6, 73.7] and 56.3 months [95% CI: 52.2, 60.3]), respectively. The survival rates at 1 year, 3 years and 5 years were 66.7% (95% CI: 65.5%, 68.0%), 55.6% (95% CI: 54.3%, 56.9%) and 46.9% (95% CI: 45.6%, 48.2%), respectively. There are significant differences in median survival time in relation to ethnicity and stroke types. Compared to other developed countries, Malaysia's 5-year survival rate is notably lower.

Mobilizing STING Pathway via a Cationic Liposome to Enhance Doxorubicin‐Induced Antitumor Immunity

AbstractThe efficacy of anthracycline, such as doxorubicin (DOX), is facilitated by cancer cell‐intrinsic type I interferon (IFN‐I) signaling through the induction of immune responses. However, weak and chronic IFN‐I responses from rounds of chemotherapy lead to resistance against DNA damage and acquired resistance to the therapy. An exogenous supply of IFN‐I can improve the chemotherapeutic responses. Herein, a library of cationic liposomes is developed for the optimization of 1, 2‐dioleoyl‐3‐trimethylammonium‐propane (DOTAP) proportions to enhance the lysosome escape and tumor distribution of the stimulator of interferon genes (STING) agonist 2′,3′‐cyclic guanosine monophosphate‐adenosine monophosphate (cGAMP) and DOX. The cationic liposomes with 8% DOTAP release cGAMP into the cytoplasm and increase the concentration of DOX in the tumor by 1.5 times compared with the free drug. Upon accumulation at the tumor site, the optimized liposomes induce immunogenic cell death (ICD) and stimulate the STING signaling, thereby improving the production of endogenous IFN‐I and promoting dendritic cell maturation to mobilize T cell immunity. The tumor growth inhibition rate is 86%, and the median survival time is 1.6‐fold prolonged. This study offers a strategy to enhance the DOX‐induced immune response by activating the STING pathway to supply IFN‐I.

Clinical presentation, management and outcome of maxillofacial fractures in pet rabbits: 27 cases (2008-2022).

To report clinical findings, management strategies and outcomes in pet rabbits with maxillofacial fractures. Medical records of pet rabbits with confirmed maxillofacial fractures from three exotic animal veterinary services between 2008 and 2022 were reviewed. Forty-five fractured maxillofacial bones were reported in 27 rabbits, including mandibular symphyseal separation in 13 rabbits. Median age was 18 months (interquartile range, 7 to 38 months), and median bodyweight was 1.70 kg (interquartile range, 1.36 to 2.33 kg). The most common aetiology was anthropogenic accidents (16/27). Hyporexia/anorexia was the most frequent presenting complaint (17/27). Common clinical findings included dental malocclusion (12/27), craniofacial pain (9/27), crepitus (9/27) and swelling (7/27). Three (3/27) rabbits were euthanised after diagnosis. Mandibular symphyseal separation in 11 of 12 treated rabbits were addressed using circummandibular cerclage wiring. All remaining fractures were conservatively managed. Twenty-three of 27 rabbits survived to hospital discharge. Median time of return to normal or near-normal eating was 1 day (interquartile range, <1 to 3 days). Median survival time was 859 days (interquartile range, 567 to 1092 days). Dental malocclusion was a reported complication in 12 of 16 rabbits with follow-up data. However, only five of 12 rabbits developed associated clinical signs requiring corrective dentistry. Maxillofacial fracture in rabbits may present with similar clinical signs and findings to other conditions such as odontogenic disease. Successful outcomes with infrequent long-term clinical complications are associated with management strategies that emphasise early functional recovery.

The attrition, physical and insecticidal durability of two dual active ingredient nets (Interceptor® G2 and Royal Guard®) in Benin, West Africa: results from a durability study embedded in a cluster randomised controlled trial.

Studies evaluating the attrition, physical and insecticidal durability of dual active ingredient (AI) insecticide-treated nets (ITNs) are essential for makingprogrammatic decisions regarding their deployment. We performed a prospective study embedded in a cluster randomised controlled trial (cRCT) to evaluate the attrition, fabric integrity and insecticidal durability of Interceptor® G2 (alpha-cypermethrin-chlorfenapyr) and Royal Guard® (alpha-cypermethrin-pyriproxyfen), compared to Interceptor® (alpha-cypermethrin) in Benin. A total of 2428 study nets in 1093 randomly selected households in five clusters per arm of the cRCT were monitored for ITN attrition and fabric integrity every 6-12months post-distribution. Householders were further surveyed to investigate non-study net use and their preference for ITN fabric types used in the study nets. A second cohort of 120 nets per ITN type were withdrawn every 12months and assessed for chemical content and insecticidal activity in laboratory bioassays. Alpha-cypermethrin bioefficacy was investigated using the susceptible Anopheles gambiae Kisumu strain, and chlorfenapyr and pyriproxyfen bioefficacy were investigated using the pyrethroid-resistant Anopheles coluzzii Akron strain. Net pieces were tested in WHO cone bioassays and tunnel tests for alpha-cypermethrin and in tunnel tests for chlorfenapyr; pyriproxyfen activity was assessed in cone bioassays as the reduction in fertility of blood-fed survivors using ovary dissection. Bioefficacy was expressed as the proportion of ITNs passing predetermined WHO criteria, namely knock-down ≥ 95% or 24/72h mortality ≥ 80% or reduction in fertility ≥ 50%. Overall ITN survivorship was 52% at 24months and fell to 15% at 36months. Median ITN survival time was lower with Royal Guard® relative to Interceptor® [1.6 vs 2.3years; hazard ratio (HR) 1.49, 95% confidence interval (CI) 1.36-1.66; p < 0.001] and Interceptor® G2 (1.6 vs 2.1years; HR 1.33, 95% CI 1.20-1.47; p < 0.001). Householders overwhelmingly preferred polyester nets over polyethylene nets (96%), and more Royal Guard® nets were replaced with spare polyester nets from previous campaigns. All Royal Guard® nets passed efficacy criteria for alpha-cypermethrin at all time points (100%) while ITN pass rates after 24months had fallen to < 40% for pyriproxyfen and chlorfenapyr. The chemical content analysis showed a higher loss rate of the non-pyrethroid insecticides relative to the pyrethroids in each dual ingredient AI ITN; 74% vs 47% for Royal Guard® and 85% vs 63% for Interceptor® G2 at 36months. The median ITN survival time for Interceptor® G2 (2.1years) and Royal Guard® (1.6years) in Benin is substantially lower than 3years. Royal Guard® nets were discarded more quickly by householders, partly due to their low preference for polyethylene nets. The insecticidal activity of the non-pyrethroid insecticides in both dual AI ITNs was short-lived compared to alpha-cypermethrin. The results corroborate the findings from the cRCT conducted in Benin.

A mattress suture with pledgets can partially occlude intrahepatic shunts in 23 dogs: evaluation of long-term survival.

To explore the differences in outcomes between dogs with intrahepatic portosystemic shunts (IHPSSs) partially occluded with a mattress suture with pledgets or attenuated with cellophane banding. 74 dogs with IHPSSs were included in this retrospective study. Medical records between January 2000 and February 2020 were evaluated for information on dogs undergoing laparotomy with cellophane banding (group C) or mattress suture with pledgets (group P) for treatment of IHPSSs, including specific outcomes of survival time, persistence of clinical signs, and necessity of continued medical management. Primary veterinarians and owners were contacted for long-term follow-up. 51 dogs were entered in group C and 23 in group P. The duration of surgery was 154.6 minutes (136.3 to 170 minutes) for group C and 154.9 minutes (128.9 to 180.9 minutes) for group P. The short-term mortality rate was 2% for group C and 4% for group P. Dogs in group C had a median survival time of 3,537 days, while dogs in group P had a median survival time of 2,141 days. In the long term, dogs in group P received more medications than dogs in group C, but the distribution of the quality-of-life score was not different. Mattress suture with pledgets can be used as an alternative to cellophane banding. For dogs with IHPSSs where full surgical dissection for placement of cellophane band is not possible, partial occlusion of the shunt with a mattress suture with pledgets is a viable option with acceptable long-term outcomes.

Prediction of surgical benefit in gastric cancer patients with peritoneal metastasis treated with hyperthermic intraperitoneal chemotherapy.

The objective is to evaluate whether gastric cancer patients with peritoneal metastasis can benefit from surgery through a comprehensive analysis of different clinical factors and perioperative treatment methods. A total of 135 gastric cancer patients with peritoneal metastasis were treated with Hyperthermic intraperitoneal chemotherapy (HIPEC). Patients were divided into either training group (without surgery, n = 90) or test group (with surgery, n = 45). A nomogram was constructed based on significant prognostic factors. The patients were divided into high- and low-risk groups using a nomogram. Overall survival were then compared according to whether surgery was performed in both groups. Alpha-fetoprotein (AFP), complications, conversion chemotherapy, and postoperative chemotherapy were significantly associated with overall survival (p < 0.05). A nomogram was constructed using the above four factors and validated using the test set. The area under the curve (AUC) of the model was 0.752 (95% CI 0.525-978). In the group that did not undergo surgery, the median survival times for the high-risk and low-risk groups were 7 and 11months, respectively. In the surgery group, the median survival times for the high-risk and low-risk groups were 11 and 19months, respectively. The difference was statistically significant (p < 0.0001). The four-factor nomogram can accurately predict high-risk and low-risk populations. Our findings suggest that cytoreductive surgery combined with HIPEC can improve the survival time of patients in both groups.

Effect of deep testosterone reduction on the prognosis of metastatic prostate cancer with high-volume disease

ObjectiveThis study aims to investigate the correlation between serum testosterone levels after one month of treatment and prognosis in patients with high-volume disease metastatic prostate cancer (mPCa) who are undergoing combined androgen blockade therapy (CAB).MethodsThe clinical data of 199 patients with high-volume disease mPCa, diagnosed through biopsy pathology and imaging, were retrospectively analyzed from January 2010 to October 2022 in the Department of Urology at the First Affiliated Hospital of Xinjiang Medical University. Among these patients, 111 cases had a deep reduction in serum testosterone (< 0.7 nmol/l) after one month of treatment, while 88 cases did not achieve a deep reduction (≥ 0.7 nmol/l). The study utilized the Kaplan–Meier method to plot survival curves and employed the multifactor COX regression model to analyze independent risk factors. The risk factors with a significance level of P < 0.05 in the multivariate analysis were included in the nomogram prediction model. The accuracy of the model was assessed using the ROC curve and the calibration curve, while the net benefit for patients was evaluated through the decision curve analysis (DCA).ResultsThe group that achieved deep testosterone reduction(DTR) had a higher proportion of PSA < 0.2 ng/ml and a greater PSA decline rate after six months of treatment (P < 0.05). The group that achieved DTR and the group that did not achieve DTR had a progression to castration resistant prostate cancer(CRPC) time of 17.93 ± 6.68 months and 13.43 ± 6.12 months, respectively (P < 0.001). The median progression-free survival time for the 2 groups were 18 months and 12 months, respectively (P < 0.001). The median overall survival times were 57 months and 32 months, respectively (P < 0.001). The median progression-free survival times were 18, 15, and 10 months for the group that achieved DTR within 1 month, the group that achieved DTR beyond 1 month but within 1 year, and the group that did not achieve DTR within 1 year, respectively (P < 0.001), and the median survival times were 57, 45, and 26 months, respectively (P < 0.001). COX multivariate analysis revealed that a testosterone level of ≥ 0.7 nmol/l at 1 month of treatment is an independent risk factor for the progression to CRPC and prognosis in patients with high-volume disease mPCa (P < 0.05). The risk of death in patients with a testosterone level of ≥ 0.7 nmol/l at 1 month of treatment was 2.087 times higher than that of patients with a level of < 0.7 nmol/l (P < 0.05). A nomogram prediction model was developed using independent risk factors, with the area under the ROC curve (AUC) for progression-free survival (PFS) at 12, 15, 18, and 21 months being 0.788, 0.772, 0.760, and 0.739, respectively. For 3 and 5 years, the AUCs for overall survival (OS) were 0.691 and 0.624. The calibration curve demonstrated good consistency between the model’s predicted values and the actual outcomes.ConclusionPatients with high-volume disease mPCa who receive CAB treatment may experience extended progression-free survival and overall survival if their serum testosterone levels are below 0.7 nmol/l after one month of treatment. The longer it takes to achieve DTR, the worse the patient’s prognosis may be. The nomogram prediction model developed in this study demonstrates good predictive ability in assessing the progression and prognosis of high-volume disease mPCa.

Covered Stent Graft for Treatment of Carotid Blowout Syndrome in Patients With Head and Neck Cancer

Carotid blowout syndrome (CBS) is a rare life-threatening complication of head and neck cancer that requires either surgical or endovascular treatment such as a carotid occlusion procedure or stent-graft placement. CBS outcomes and complications of its management using endovascular stent-graft placement remain unclear due to limited published data. Given that this treatment approach is increasingly used, understanding its efficacy and associated risks is paramount. To evaluate the periprocedural and postprocedural complications and outcomes associated with stent-graft treatment for CBS in patients with head and neck cancer. This case series study conducted at the Institut Gustave Roussy (Villejuif, France) between January 2006 and December 2021 included all eligible patients with head and neck cancer who experienced CBS and were referred for endovascular treatment. Risk factors and periprocedural and postprocedural data were collected retrospectively from medical records. Data analyses were performed from July 2022 to July 2024. Endovascular stent-graft placement for the treatment of CBS in patients with head and neck cancer. Periprocedural and postprocedural complications of stent-graft placement. Secondary outcomes were technical success, defined as immediate control of hemorrhage; 30-day and overall survival rates; and risk factors for mortality and rebleeding. Risk factors considered were body mass index (BMI), CBS presentation, hemodynamic status, tumor stage, and radiation dose. In all, 67 CBS-related stent-graft procedures were performed in 62 patients (mean [SD] age, 55.4 [10.1] years; 10 [16.1%] females and 52 [83.9%] males), most with advanced-stage head and neck cancer, over 15 years. The most frequently observed clinical complications were rebleeding (16 patients [38.8%]) and stroke (9 patients [13.4%]). Immediate hemostasis was achieved in 100% of cases. The survival rate was 77.3% (51 participants) at 30 days postprocedure, with a median (IQR) overall survival time of 59 (32-141.5) days. Acute CBS presentation (risk ratio, 4.30; 95% CI, 1.11-28.23) and BMI (risk ratio, 0.88; 95% CI, 0.77-0.99) showed a statistically significant association with 30-day mortality in univariate analysis. The findings of the case-series study indicate that CBS can be safely managed with endovascular stent-graft placement that preserves carotid patency; however, it carries significant risks of ischemia and rebleeding. These findings suggest that stent grafts should be used only in specific clinical scenarios. Despite achieving a high rate of technical success in controlling hemorrhage, the overall and 30-day survival outcomes underscore the critical implications of CBS in patients with cancer and its associated therapeutic challenges.

Analysis of Therapeutic Efficacy and Adverse Prognostic Factors of Secondary Central Nervous System Lymphoma

To explore the therapeutic efficacy and prognostic factors of induction therapy for secondary central nervous system lymphoma (SCNSL). Clinical data of patients diagnosed with SCNSL from 2010 to 2021 at Guangdong Provincial People's Hospital were retrospectively collected. A retrospective cohort study was performed on all and grouped patients to analyze the efficacy and survival. Multivariate logistic regression analysis was used to explore the adverse prognostic factors. Thirty-seven diffuse large B-cell lymphoma patients with secondary central involvement were included in the research. Their 2-year overall survival (OS) rate was 46.01% and median survival time was 18.1 months. The 2-year OS rates of HD-MTX group and TMZ group were 34.3% and 61%, median survival time were 8.7 and 38.3 months, and median progression-free survival time were 8.1 and 47 months, respectively. Multivariate logistic regression analysis showed that age, sex, IPI, Ann Arbor stage were correlated with patient survival time. The median survival time of patients with CD79B, KMT2D, CXCR4, ERBB2, TBL1XR1, BTG2, MYC, MYD88, and PIM1 mutations was 8.2 months, which was lower than the overall level. HD-MTX combined with TMZ as the first-line strategy may improve patient prognosis, and early application of gene sequencing is beneficial for evaluating prognosis.