Probability Of Outcome Research Articles

Maternal and foetal risks associated with teenage pregnancy - a comparative retrospective study in Turkey

Background Adolescent pregnancy is defined as pregnancy occurring in young women between the ages of 10 and 19 years. Adolescent pregnancies, which are among the social healthcare concerns in developed and developing countries, have negative effects on maternal and infant health. Pregnancy in adolescence puts the health of both the mother and child at risk, as adolescent pregnancies have higher rates of eclampsia, systemic infection, low birth weight, and preterm delivery compared to other pregnancies. In this study, the effects of education level, smoking, and marital status on maternal and foetal outcomes in adolescent pregnancies were evaluated. Methods The records of a total of 960 pregnant women (480 pregnant adolescents aged 15–19 years and 480 pregnant adult women aged 20–26 years) were examined retrospectively. The demographic data of the groups and maternal and foetal outcomes of the pregnancies were compared. A logistic regression model was established as a statistical method for reducing confounding effects. Results Unmarried women were statistically significantly more prevalent in the adolescent group (38.3% vs. 7.3%). Among the considered risk factors, preeclampsia (2.9% vs. 0.8%) and smoking (29.8% vs. 9.8%) were statistically significantly more common in the adolescent group. When the groups were compared in terms of risk factors in pregnancy, it was found that pregnancy in adolescence was associated with a 3.04-fold higher risk of smoking, 5.25-fold higher risk of being unmarried, 3.50-fold higher risk of preeclampsia, and 1.70-fold higher risk of intrauterine growth retardation (IUGR). Conclusions This study demonstrates an increased risk of preeclampsia, IUGR, and smoking during pregnancy in adolescent pregnant women. These findings can be used to identify adolescent pregnancies requiring specific assistance and to take measures to reduce the probability of adverse outcomes.

Door-to-Needle Time for Extracorporeal Cardiopulmonary Resuscitation and Neurological Outcomes in Out-of-Hospital Cardiac Arrest: A Nationwide Study.

Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for refractory cardiac arrest, and immediate initiation after indication is recommended. However, the practical goals of ECPR preparation (such as the door-to-needle time) remain unclear. This study aimed to elucidate the association between the door-to-needle time and neurological outcomes of out-of-hospital cardiac arrest. This is a post hoc analysis of a nationwide multicenter study on out-of-hospital cardiac arrest treated with ECPR at 36 institutions between 2013 and 2018 (SAVE-J [Study of Advanced Cardiac Life Support for Ventricular Fibrillation with Extracorporeal Circulation in Japan] II study). Adult patients without hypothermia (≥32 °C) in whom circulation was not returned at ECPR initiation were included. The probability of favorable neurological function at 30 days (defined as Cerebral Performance Category ≤2) was estimated using a generalized estimating equations model, in which institutional, patient, and treatment characteristics were adjusted. Estimated probabilities were then calculated according to the door-to-needle time with 3-minute increments, and a clinical threshold was assumed. Among 1298 patients eligible for this study, 136 (10.6%) had favorable neurological function. The estimated probability of favorable outcomes was highest in patients with 1 to 3 minutes of door-to-needle time (12.9% [11.4%-14.3%]) and remained at 9% to 10% until 27 to 30 minutes. Then, the probability dropped gradually with each 3-minute delay. A 30-minute threshold was assumed, and shorter door-to-extracorporeal membrane oxygenation/low-flow time and fewer adverse events related to cannulation were observed in patients with door-to-needle time <30 minutes. The probability of favorable functions after out-of-hospital cardiac arrest decreased as the door-to-needle time for ECPR was prolonged, with a rapid decline after 27 to 30 minutes. URL: https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041577; Unique identifier: UMIN000036490.

Neural Representation of Valenced and Generic Probability and Uncertainty.

Representing the probability and uncertainty of outcomes facilitates adaptive behavior by allowing organisms to prepare in advance and devote attention to relevant events. Probability and uncertainty are often studied only for valenced (appetitive or aversive) outcomes, raising the question of whether the identified neural machinery also processes the probability and uncertainty of motivationally neutral outcomes. Here, we aimed to dissociate valenced from valence-independent (i.e., generic) probability (p; maximum at p = 1) and uncertainty (maximum at p = 0.5) signals using human neuroimaging. In a Pavlovian task (n = 41; 19 females), different cues predicted appetitive, aversive, or neutral liquids with different probabilities (p = 0, p = 0.5, p = 1). Cue-elicited motor responses accelerated, and pupil sizes increased primarily for cues that predicted valenced liquids with higher probability. For neutral liquids, uncertainty rather than probability tended to accelerate cue-induced responding and decrease pupil size. At the neural level, generic uncertainty signals were limited to the occipital cortex, while generic probability also activated the anterior ventromedial prefrontal cortex. These generic probability and uncertainty signals contrasted with cue-induced responses that only encoded the probability and uncertainty of valenced liquids in medial prefrontal, insular, and occipital cortices. Our findings show a behavioral and neural dissociation of generic and valenced signals. Thus, some parts of the brain keep track of motivational charge while others do not, highlighting the need and usefulness of characterizing the exact nature of learned representations.

Can quantum theory be underpinned by a non-local hidden variable theory?

In this paper we consider the description by a general Bell-type non-local hidden variable theory of bipartite quantum states with two observables per sub-system. We derive Bell inequalities of the Collins-Gisin.-Liden-Massar-Popescu type which involve combinations of the probabilities of related outcomes for measurements for the four pairs of sub-system observables. It is shown that the corresponding quantum theory expressions violate the Bell inequalities in the case of the maximally entangled state of the bipartitite system. The CHSH Bell inequality is also derived from this general CGLMP Bell-type non-local hidden variable theory. This shows that quantum theory can not be underpinned by a Bell-type non-local hidden variable theory. So as a general Bell-type local hidden variable theory has already been shown to conflict with quantum theory, it follows that quantum theory can not be understood in terms of any CGLMP Bell-type hidden variable theory—local or non-local.

Sociodemographic Factors Associated with Suicide Outcomes in Transgender and Gender Diverse Young Adults

Objective Transgender and gender diverse (TGD) populations have a higher prevalence of suicide outcomes compared to cisgender peers. Further, among TGD groups, young adults frequently demonstrate a higher risk compared to other age cohorts. While evidence supports sociodemographic differences in suicide risk, these relationships are not well-established for TGD young adults. Method A secondary data analysis of the young adult (18–24 years) subpopulation of the 2015 U.S. Transgender Survey was conducted. Predicted probabilities of 12-month and lifetime suicide outcomes by gender identity, sexual orientation, race/ethnicity, homelessness, and poverty were estimated comparing fully adjusted models. Results Gender identity, race/ethnicity, and homelessness were significantly associated with all suicide outcomes. Comparisons of gender identities were significant for all outcomes and varied based on the outcome. American Indian/Alaska Native TGD young adults had the highest predicted probabilities compared to other race/ethnicity groups. Further, having a heterosexual/straight sexual identity was among the lowest predicted probabilities for suicide outcomes and significantly differed from several of the other sexual identities. Conclusions Findings underscore the importance of heterogeneity among TGD young adults and the need for intersectional research within this population. Elucidating sociodemographic characteristics that contribute to differential suicide risk is necessary for effective intervention strategies and policy advocacy.

Outcome-based analytical performance specifications: current status and future challenges.

Analytical performance specifications (APS) based on outcomes refer to how 'good' the analytical performance of a test needs to be to do more good than harm to the patient. Analytical performance of a measurand affects its clinical performance. Without first setting clinical performance requirements, it is difficult to define how good analytically the test needs to be to meet medical needs. As testing is indirectly linked to health outcomes through clinical decisions on patient management, often simulation-based studies are used to assess the impact of analytical performance on the probability of clinical outcomes which is then translated to Model 1b APS according to the Milan consensus. This paper discusses the related key definitions, concepts and considerations that should assist in finding the most appropriate methods for deriving Model 1b APS. We review the advantages and limitations of published methods and discuss the criteria for transferability of Model 1b APS to different settings. We consider that the definition of the clinically acceptable misclassification rate is central to Model 1b APS. We provide some examples and guidance on a more systematic approach for first defining the clinical performance requirements for tests and we also highlight a few ideas to tackle the future challenges associated with providing outcome-based APS for laboratory testing.

Photonic implementation of the quantum Morra game

The Morra game, an age-old noncooperative game, traditionally played on one's hand, has proved to be a rich setting to study game-theoretic strategies, both classically and within the quantum realm. In this paper, we study a faithful translation of a two-player quantum Morra game, which builds on previous study by including the classical game as a special case. We propose a natural deformation of the game in the quantum regime in which Alice has a winning advantage, breaking the balance of the classical game. A Nash equilibrium can be found in some cases by employing a pure strategy, which is impossible in the classical game where a mixed strategy is always required. We prepared our states using photonic qubits on a linear optics setup, with an average deviation ≤2% with respect to the measured outcome probabilities. Finally, we discuss potential applications of the quantum Morra game to the study of quantum information and communication. Published by the American Physical Society 2024

Ascertainment of Aboriginal and Torres Strait Islander status for assessment of perinatal health outcomes: Reported versus derived maternal ethnicity in Western Australian pregnancy data.

Under-identification of Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) people can result in inaccurate estimation of health outcomes. Data linkage has improved identification of Aboriginal people in administrative datasets. To compare three methods of ascertainment of Aboriginal status using only pregnancy data from the Western Australian Midwives Notification System (MNS), to the linked Indigenous Status Flag (ISF) derived by the Department of Health. This retrospective population-based cohort study utilised logistic regression to determine which demographic characteristics were associated with under-identification, and the effect of ascertainment method on perinatal adverse outcomes. All methods identified a core group of 19 017 (83.0%) Aboriginal women and the ISF identified 2298 (10.0%) women who were not identified using any other method. Under-ascertainment was lowest when a woman's Aboriginal status was determined by ever being recorded as Aboriginal in the MNS data, and highest when taken as it had been recorded for the birth in question. Maternal age <20 years, smoking during pregnancy, pre-existing diabetes, a history of singleton preterm birth and being in the lowest 20% of Socio-Economic Indexes for Areas score were all associated with a higher chance of being identified by the methods using only the MNS. These methods were less likely to identify nulliparous women, and those with maternal age ≥35 years. The method of ascertainment of Aboriginality did not make a significant difference to the adjusted predicted marginal probabilities of adverse perinatal outcomes. Unlinked pregnancy data can be used for epidemiological research in Aboriginal obstetric populations.

Baseline systolic blood pressure, hypertension history, and efficacy of remote ischemic conditioning.

We performed a post hoc exploratory analysis of Remote Ischemic Conditioning for Acute Moderate Ischemic Stroke (RICAMIS) to determine whether hypertension history and baseline systolic blood pressure (SBP) affect the efficacy of remote ischemic conditioning (RIC). Based on the full analysis set of RICAMIS, patients were divided into hypertension versus non-hypertension group, or <140 mmHg versus ≥140 mmHg group. Each group was further subdivided into RIC and control subgroups. The primary outcome was modified Rankin Scale (mRS) 0-1 at 90 days. Efficacy of RIC was compared among patients with hypertension versus nonhypertension history and SBP of <140 mmHg versus ≥140 mmHg. Furthermore, the interaction effect of treatment with hypertension and SBP was assessed. Compared with control group, RIC produced a significantly higher proportion of patients with excellent functional outcome in the nonhypertension group (RIC vs. control: 65.7% vs. 57.0%, OR 1.45, 95% CI 1.06-1.98; p = 0.02), but no significant difference was observed in the hypertension group (RIC vs. control: 69.1% vs. 65.2%, p = 0.17). Similar results were observed in SBP ≥140 mmHg group (RIC vs. control: 68.0% vs. 61.2%, p = 0.009) and SBP <140 mmHg group (RIC vs. control: 65.6% vs. 64.7%, p = 0.77). No interaction effect of RIC on primary outcome was identified. Hypertension and baseline SBP did not affect the neuroprotective effect of RIC, but they were associated with higher probability of excellent functional outcome in patients with acute moderate ischemic stroke who received RIC treatment.

Predictors of adherence to follow-up and treatment success in childhood obesity

IntroductionManagement of childhood obesity, based upon behavioural, physical activity and dietary guidance, usually achieves limited success and is hindered by a high attrition rate. The identification of potential predictors of either weight loss or early weight management attrition could help develop personalised management plans in order to improve patient outcomes. Patients and methodsWe conducted a retrospective study in a cohort of 1300 patients with obesity managed in speciality clinics for up to 5 years with outpatient conservative treatment. We studied the family background and personal characteristics (demographic, behavioural, psychosocial, anthropometric and metabolic) of patients who dropped out before completing the first year of the programme and patients who achieved significant weight loss, with a separate analysis of patients who achieved substantial reductions in weight compared to the rest of the cohort. ResultsThe mean age of the patients in the cohort was 10.46 years (SD, 3.48) the mean BMI z-score 4.01 (SD, 1.49); 52.8% of the patients were male, 53.3% were prepubertal, 75.8% were Caucasian and 19% Latin. We found a higher proportion of Latinla ethnicity and compulsive eating in the group of patients with early attrition from the weight management follow-up. In the group of patients with substantial weight loss, a greater proportion were male, there was a higher frequency of dietary intake control at home and obesity was more severe, and the latter factor was consistently observed in patients who achieved substantial weight loss at any point of the follow-up. ConclusionsSome family and personal characteristics in childhood obesity are associated with an increased risk of early withdrawal from follow-up or a greater probability of successful outcomes; however, the predictive value of these variables is limited.

Confidence Calibration of a Medical Imaging Classification System That is Robust to Label Noise.

A classification model is calibrated if its predicted probabilities of outcomes reflect their accuracy. Calibrating neural networks is critical in medical analysis applications where clinical decisions rely upon the predicted probabilities. Most calibration procedures, such as temperature scaling, operate as a post processing step by using holdout validation data. In practice, it is difficult to collect medical image data with correct labels due to the complexity of the medical data and the considerable variability across experts. This study presents a network calibration procedure that is robust to label noise. We draw on the fact that the confusion matrix of the noisy labels can be expressed as the matrix product between the confusion matrix of the clean labels and the label noises. The method is based on estimating the noise level as part of a noise-robust training method. The noise level is then used to estimate the network accuracy required by the calibration procedure. We show that despite the unreliable labels, we can still achieve calibration results that are on a par with the results of a calibration procedure using data with reliable labels.

Safety outcomes in patients with acute myeloid leukemia receiving gemtuzumab ozogamicin and proceeding to allogeneic hematopoietic stem cell transplantation.

6516 Background: Gemtuzumab ozogamicin (GO) is a CD33-directed antibody-drug conjugate approved by the FDA in 2017 for the treatment of newly diagnosed and relapsed/refractory (R/R) CD33-positive acute myeloid leukemia (AML) in adults and pediatric patients of 1 month and older and 2 years and older, respectively. Previous data have associated GO with adverse events (AEs) including hepatotoxicity and hepatic veno-occlusive disease (VOD). Patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) may be at greater risk of VOD with GO. This study aimed to characterize AEs after HSCT in adult patients with AML who were treated with GO. Methods: This non-interventional post-authorization safety study used de-identified healthcare data from the Center for International Blood and Marrow Transplant Research (CIBMTR) database. Data were collected from 01 September 2017. Safety outcomes post-HSCT were evaluated in adult patients with newly diagnosed or R/R AML who received GO prior to first HSCT. Data cutoff was 04 July 2023. Results: We present the interim data of 157 patients from 24 centers with a median follow-up of 12.9 months (range, 3.0-49.7). At the time of HSCT, 84 patients were in first complete remission (CR1), 48 patients were in second CR (CR2) and 25 patients were in third or greater CR, relapse or primary induction failure (CR3, n=5; Rel, n=12; PIF, n=8). Most patients (n=105; 67%) received GO as first line therapy. Median lines of therapy prior to HSCT were 2, 3.5 and 5 in CR1, CR2 and CR3/Rel/PIF groups, respectively. Median age was 52.5 y (range, 18.7-74.9); 53% male. Time from diagnosis to first GO dose was &lt;3 months for most patients (n=120; 76%). Total cumulative GO dose was 1-3 mg/m2 in 25 (16%), 4-6 mg/m2 in 28 (18%), 7-9 mg/m2 in 45 (29%) and ≥10 mg/m2 in 14 (9%) patients. The most common HSCT donor type was unrelated (n=93; 59%), and 55% of patients received myeloablative conditioning regimens. Non-fatal VOD was reported in 7 (4%) patients. Median time from HSCT to VOD was 0.9 months (range, 0.4-2.2). No VOD-related deaths occurred. Outcome probabilities for 6-month transplant-related mortality (TRM) were 8% (95% CI, 4-13) and 5% (95% CI, 2-8) for 100-day VOD. Conclusions: The use of GO appears to be safe prior to HSCT in adults with AML. Rates for 100-day VOD and TRM were comparable to those previously reported for patients with AML who received HSCT with or without prior GO. Clinical trial information: B1767034.

How Do Quantitative Tissue Imaging Outcomes in Acute Ischemic Stroke Relate to Clinical Outcomes?

Infarct volume and other imaging markers are increasingly used as surrogate measures for clinical outcome in acute ischemic stroke research, but how improvements in these imaging surrogates translate into better clinical outcomes is currently unclear. We investigated how changes in infarct volume at 24 hours alter the probability of achieving good clinical outcome (modified Rankin Scale [mRS] 0-2). Data are from endovascular thrombectomy patients from the randomized controlled ESCAPE-NA1 (Efficacy and Safety of Nerinetide for the Treatment of Acute Ischaemic Stroke) trial. Infarct volume at 24 hours was manually segmented on non-contrast computed tomography or diffusion-weighted magnetic resonance imaging. Probabilities of achieving good outcome based on infarct volume were obtained from a multivariable logistic regression model. The probability of good outcome was plotted against infarct volume using linear spline regression. A total of 1,099 patients were included in the analysis (median final infarct volume 24.9 mL [interquartile range: 6.6-92.2]). The relationship between total infarct volume and good outcome probability was nearly linear for infarct volumes between 0 mL and 250 mL. In this range, a 10% increase in the probability of achieving mRS 0-2 required a decrease in infarct volume of approximately 34.0 mL (95% confidence interval: -32.5 to -35.6). At infarct volumes above 250 mL, the probability of achieving mRS 0-2 probability was near zero. The relationships of tissue-specific infarct volumes and parenchymal hemorrhage volume generally showed similar patterns, although variability was high. There seems to be a near-linear association between total infarct volume and probability of achieving good outcome for infarcts up to 250 mL, whereas patients with infarct volumes greater than 250 mL are highly unlikely to have a favorable outcome.

Embracing Survivalist Entrepreneurship: How African American Men Leverage Business Ownership out of Economic Necessity

There has been extensive research and examination dedicated to the advantages and disadvantages of entrepreneurship, both in general and specifically for African Americans. Significant research has been devoted to understanding the economic outcomes of African American men, and there is an area of opportunity to study how African American men, specifically, can leverage entrepreneurship to increase the probability of successful economic outcomes for themselves and their families. Entrepreneurial research has the potential to be leveraged to combat waning labor force participation rates and heightened unemployment rates among African American men. Leveraging the theories of Trust, Goal-Orientation, Logotherapy, and Social Identity Theory, a study was conducted among United States-based business owners. The sample size was forty-one African American male business owners. The results demonstrate how these African American men have leveraged entrepreneurship to build social capital and wealth, while improving their standard of living, as well as highlight the hurdles and barriers they have endured during the process of business ownership. The majority of African American owned business are owned by African American men, and this study provides insights into the phenomenology of African American male entrepreneurs.

Disability level’s impact on blood pressure-mortality association in older long-term care adults: evidence from a large Chinese cohort study

BackgroundEvidence of the optimal blood pressure (BP) target for older adults with disability in long-term care is limited. We aim to analyze the associations of BP with mortality in older adults in long-term care setting with different levels of disability.MethodsThis prospective cohort study was based on the government-led long-term care programme in Chengdu, China, including 41,004 consecutive disabled adults aged ≥ 60 years. BP was measured during the baseline survey by trained medical personnel using electronic sphygmomanometers. Disability profile was assessed using the Barthel index. The association between blood pressure and mortality was analyzed with doubly robust estimation, which combined exposure model by inverse probability weighting and outcome model fitted with Cox regression. The non-linearity was examined by restricted cubic spline. The primary endpoint was all-cause mortality, and the secondary endpoints were cardiovascular and non-cardiovascular mortality.ResultsThe associations between systolic blood pressure (SBP) and all-cause mortality were close to a U-shaped curve in mild-moderate disability group (Barthel index ≥ 40), and a reversed J-shaped in severe disability group (Barthel index < 40). In mild-moderate disability group, SBP < 135 mmHg was associated with elevated all-cause mortality risks (HR 1.21, 95% CI, 1.10–1.33), compared to SBP between 135 and 150 mmHg. In severe disability group, SBP < 150 mmHg increased all-cause mortality risks (HR 1.21, 95% CI, 1.16–1.27), compared to SBP between 150 and 170 mmHg. The associations were robust in subgroup analyses in terms of age, gender, cardiovascular comorbidity and antihypertensive treatment. Diastolic blood pressure (DBP) < 67 mmHg (HR 1.29, 95% CI, 1.18–1.42) in mild-moderate disability group and < 79 mmHg (HR 1.15, 95% CI, 1.11–1.20) in severe disability group both demonstrated an increased all-cause mortality risk.ConclusionThe optimal SBP range was found to be higher in older individuals in long-term care with severe disability (150-170mmHg) compared to those with mild to moderate disability (135-150mmHg). This study provides new evidence that antihypertensive treatment should be administered cautiously in severe disability group in long-term care setting. Additionally, assessment of disability using the Barthel index can serve as a valuable tool in customizing the optimal BP management strategy.Trial registrationChinese Clinical Trial Registry (Registration Number: ChiCTR2100049973).

P.052 Utility of amyotrophic lateral sclerosis functional rating scale (ALSFRS) bulbar subscores for predicting need for gastrostomy tube

Background: We evaluated the utility of the Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS) in predicting risk of gastrostomy tube (G-tube) insertion in patients with ALS. Methods: We conducted a retrospective study using the Pooled Resource Open-Access ALS Clinical Trials Database. People with ALS, at least two ALSFRS scores, and baseline swallowing subscore &gt;1 were included. G-tube outcome was defined as reaching a swallowing subscore ≤1. Predictors were ALSFRS bulbar subscores (swallowing, speech, salivation). Survival analyses estimated median time to outcome and cumulative probability of outcome within 91 days. Individuals were censored at last ALSFRS score. Results: We included 6,943 participants. Median [95% CI] time to G-tube insertion was 245 [228, 285], 562 [547, 621], and 1,268 [980, 1,926] for baseline swallowing subscores of 2, 3, and 4, respectively. Probability of G-tube insertion was associated with baseline swallowing, speech, and salivation subscores (log-rank test p &lt; 0.0001). For patients who transitioned to a swallowing subscore of 2 or 3, 18.1% [95% CI 16.1, 20.3] and 1.9% [95% CI 1.3, 2.7] required G-tube insertion within 91 days of score transition. Conclusions: ALSFRS bulbar subscores may identify patients at risk of G-tube insertion. Probability of G-tube insertion within 91 days is low if swallowing subscore ≥3.

Tight Bounds from Multiple‐Observable Entropic Uncertainty Relations

AbstractThe additivity properties for both bipartite and multipartite systems are investigated by using entropic uncertainty relations (EUR) defined in terms of the joint Shannon entropy of probabilities of local measurement outcomes. In particular, state‐independent and state‐dependent entropic inequalities are introduced. Interestingly, the violation of these inequalities is strictly connected with the presence of quantum correlations. It is shown that the additivity of EUR holds only for EUR that involve two observables, while this is not the case for inequalities that consider more than two observables or the addition of the von Neumann entropy of a subsystem. They are applied to bipartite systems and to several classes of states of a three‐qubit system.

Cisternal and intraventricular irrigation in subarachnoid and intraventricular haemorrhage

BackgroundSubarachnoid haemorrhage (SAH) and intraventricular haemorrhage (IVH) are associated with poor patient outcomes. Intraventricular fibrinolysis is effective in clearing IVH and improving patient survival and neurological outcome. By similar rationale,...

TMErisk score: A tumor microenvironment-based model for predicting prognosis and immunotherapy in patients with head and neck squamous cell carcinoma

Tumor microenvironment (TME) is closely associated with the progression and prognosis of head and neck squamous cell carcinoma (HNSCC). To investigate potential biomarkers for predicting therapeutic outcomes in HNSCC, we analyzed the immune and stromal status of HNSCC based on the genes associated with TME using the ESTIMATE algorithm. Immune and stromal genes were identified with differential gene expression and weighted gene co-expression network analysis (WGCNA). From these genes, 118 were initially selected through Cox univariate regression and then further input into least absolute shrinkage and selection operator (LASSO) regression analysis. As a result, 11 genes were screened out for the TME-related risk (TMErisk) score model which presented promising overall survival predictive potential. The TMErisk score was negatively associated with immune and stromal scores but positively associated with tumor purity. Individuals with high TMErisk scores exhibited decreased expression of most immune checkpoints and all human leukocyte antigen family genes, and reduced abundance of infiltrating immune cells. Divergent genes were mutated in HNSCC. In both high and low TMErisk score groups, the tumor protein P53 exhibited the highest mutation frequency. A higher TMErisk score was found to be associated with reduced overall survival probability and worse outcomes of immunotherapy. Therefore, the TMErisk score could serve as a valuable model for the outcome prediction of HNSCC in clinic.

Pemphigus and Pregnancy.

Pemphigus in pregnancy is a special clinical scenario that has potential consequences on both maternal and fetal outcomes. Being an autoimmune disease with Th2 preponderance, pemphigus is expected to flare in pregnancy, especially in the first two trimesters. Fetal outcomes like stillbirth and neonatal pemphigus have been reported, the latter being a consequence of a transient transplacental transfer of autoantibodies. Management needs to be individualized keeping the risk/benefit ratios of therapies in mind while optimizing maternal and fetal health. It is crucial to have appropriate counseling regarding conception for women with pemphigus in the child-bearing period because the probability of adverse materno-fetal outcomes is higher if the disease is severe.