Survival Period Research Articles

Defection Analysis of Post-Paid Telephone Customers in Nepal Using the Weibull Model

This study examines the defection patterns of post-paid telephone customers based on migrant status and season-wise acquisition using the Weibull model. Data from 48,666 post-paid customers were extracted from the data warehouse of a telephone company in Nepal. After pre-processing, the migrant status and season of acquisition for 48,583 customers were identified. Survival analysis was then conducted using the Kaplan–Meier (K-M) method to estimate the hazard of defection. Finally, the Weibull model was applied to analyse defection patterns concerning migrant status, default status, and season-wise acquisition in relation to survival periods. The results indicate that migrant customers have a significantly higher probability of defection compared to non-migrant customers. Additionally, the season of acquisition has a notable impact on customer survival duration. The study also highlights a higher risk of involuntary defection among migrant customers. These findings can inform the development of marketing strategies aimed at improving customer retention and acquisition in the telecommunications sector. Moreover, the model and methodology employed in this research can be extended to other marketing contexts.

The impact of digital inequities on salivary gland cancer disparities in the United States.

Technology and internet access have become increasingly integrated into healthcare as the primary platform for health-related information and provider-patient communication. Disparities in access to digital resources exist in the United States and have been shown to impact health outcomes in various head and neck malignancies. Our objective is to evaluate the associations of digital inequity on health outcomes in patients with salivary gland cancer (SGC). The Digital Inequity Index (DII) was developed using 17 census-tract level variables obtained from the American Community Survey and Federal Communications Commission. Variables were categorized as digital infrastructure or sociodemographic (e.g., non-digital) and scored based on relative rankings across all US counties. Scores were assigned to patients from the Surveillance-Epidemiology-End Results (SEER) database diagnosed with SGC between 2013 and 2017 based on county-of-residence. Regressions were performed between DII score and outcomes of surveillance time, survival time, tumor stage at time of diagnosis, and treatment modality. Among 9306 SGC-patients, increased digital inequity was associated with advanced-staging at presentation (OR: 1.04, 95% CI: 1.01-1.07, p = 0.033), increased odds of chemotherapy receipt (OR: 1.05, CI: 1.01-1.10, p = 0.010), and decreased odds of surgical intervention (OR: 0.94, 95% CI: 0.91-0.98, p = 0.003) after accounting for traditional sociodemographic factors. Increased digital inequity was also associated with decreased surveillance time and survival periods. Digital inequity significantly and independently associates with negative health and treatment outcomes in SGC patients, highlighting the importance of directed efforts to address these seldom-investigated drivers of health disparities.

Incidence and Survival of Patients With Prostate Cancer in North-Rhine Westphalia, Germany.

There is no organized prostate cancer screening in Germany. The aim of this study was to investigate the development of incidence and survival in patients with primary malignant tumors of the prostate in relation to changing recommendations of prostate-specific antigen (PSA) screening in guidelines. Age-standardized incidence rates and 5-year relative survival (RS) (period approach) were calculated using data from the cancer registry North Rhine-Westphalia with the subset of the administrative district Münster respectively for the years 1992-2019. Analyses were stratified according to TNM classification. Until 2008 overall prostate cancer incidence increased, followed by a decrease up to 2017 and another increase thereafter. The same trend was observed in nonmetastatic but not in metastatic prostate cancer. Overall 5-year RS showed an increase of 10 percentage points up to period 2005-2009, followed by a constant RS. 5-year RS of patients with distant metastases remained constant from period 2000-2004 to 2015-2019, while 5-year RS with nonmetastatic prostate cancer and lymph node metastases increased slightly. Overall and nonmetastatic incidence rates reflect changes of recommendation in PSA screening guidelines from the United States. Accordingly, the increase in 5-year RS might be influenced by lead time bias. Incidence and survival of metastatic prostate cancer barely suggest any association with changing PSA screening recommendations. Structured early detection of metastases with additionally applied diagnostic methods might improve 5-year RS rates of metastatic prostate cancer patients.

Effectiveness of liver transplant mortality scales in a Mexican population.

Liver transplantation is the treatment of choice in patients with chronic liver disease and acute liver failure of any etiology. Scales such as the Survival Outcome Following Transplantation (SOFT) score and the Balance of Risk (BAR) score can be used to predict survival. In this study, we compared these scales in the Mexican population. A cross-sectional analytical study was carried out in a Mexican third-level transplant center. The MELD, SOFT, and BAR scales were adopted. The ROC curves of the three predictive scores were constructed, and the areas under the curve were obtained and compared. A bivariate analysis and Cox regression were performed. Finally, a survival analysis was performed using Kaplan-Meier curves. We analyzed 123 liver transplant (LT) recipients. The bivariate analysis and Cox regression indicated that portal thrombosis, with an HR of 3.36 (IC 1.069-10.59, p = 0.038), and the number of red blood cells transfused, with an HR of 1.084 (CI 1.039-1.130, p < 0.000), were significantly associated with mortality. The receiver height was a protective factor, with an HR of 0.001 (CI 0.000-0.761, p = 0.041). Regarding the Pearson correlation analysis, the BAR scale had a coefficient of 0.199 (p = 0.032) for transfusion, while the SOFT scale's correlation coefficients for cold ischemia and transfusion were 0.236 (p = 0.011) and 0.274 (p = 0.003), respectively, all indicating weak correlations. The areas under the curve (AUCs) of MELD, SOFT, and BAR in predicting 3-month mortality were 0.495 (P = 0.94), 0.608 (p = 0.129), and 0.502 (p = 0.97), respectively. Finally, in the survival analysis using Kaplan-Meier curves, an estimated mean survival period of 71.52 months was obtained, with a survival rate of 89.3 % at 30 days and 81.1 % at five years. In this study, it was found that all three scales were deficient in discriminating among the outcomes obtained in the Mexican population.

ANKRD22 participates in the proinflammatory activities of macrophages in the colon cancer tumor microenvironment

Tumor-associated macrophages (TAMs) are among the most common types of immune cells in the colon cancer microenvironment. Reprogramming M2-type TAMs with immunosuppressive functions into M1-type TAMs with proinflammatory functions is a novel strategy for reshaping the tumor microenvironment (TME) and enhancing the efficacy of immunotherapy in colon cancer. However, the key molecules and mechanisms underlying TAM polarization require further clarification. Our previous study suggested that ANKRD22 may play a role in regulating the functional state transition of macrophages. However, the expression levels of ANKRD22 in colon TAMs and its specific effects on tumor proliferation remain unclear. In the present study, we observed elevated ANKRD22 expression in M1-type TAMs. The expression level of ANKRD22 was positively correlated with the survival period of patients with colon cancer and with the infiltration abundance of M1-type TAMs, and ANKRD22 expression was negatively correlated with the infiltration abundance of M2-type TAMs. A significant decrease in ANKRD22 expression in macrophages cocultured with colon cancer cell culture supernatant as well as in macrophages directly derived from colorectal cancer tissues was observed. Single-cell RNA sequencing, spatial transcriptomic studies, and subcutaneous xenograft experiments in mice revealed that Ankrd22 silencing altered the subtype distribution of macrophages, attenuated their proinflammatory activity, and enhanced their protumor activity. Additionally, we identified a small-molecule ANKRD22 upregulator that could aid in the development of novel therapeutics targeting TAM remodeling.

Immunotherapy as a neoadjuvant preoperative treatment for locally advanced pulmonary sarcomatoid carcinoma: a case report of clinical efficacy

BackgroundPulmonary sarcomatoid carcinoma (PSC) is a rare subtype of non-small cell lung cancer (NSCLC) with a generally poor prognosis. Studies have shown that the survival rate for advanced-stage patients is less than 5%, with a median overall survival (OS) of less than 6.5 months.Case reportHerein, we report a case of locally advanced PSC in a 56-year-old male patient who received platinum-based double-drug therapy combined with anti-angiogenic drugs, followed by immunotherapy as the first-line systemic treatment. After undergoing eight cycles of neoadjuvant therapy, the opportunity for surgery arose. Postoperative pathology confirmed that the neoadjuvant chemotherapy in this regimen achieved pathological complete remission (pCR). At present, the patient maintains a good quality of life, continues with immunotherapy for consolidation and prevention of recurrence, and has reached a survival period of 10 months.ConclusionFor patients with locally advanced PSC who do not have significant genetic mutations, the use of immunotherapy as a first-line neoadjuvant and adjuvant therapy may hold promise for achieving a pCR. Further research into this treatment protocol is warranted.

Effect of ramucirumab on progression free survival and quality of life in conventional drug resistant or metastatic non-squamous variant of non-small cell lung cancers: a pilot study

Background: Lung cancer is the leading cause of cancer-related death in India overall with the lowest five-year survival rate. Early detection of lung cancer is challenging due to the absence of usual clinical signs. Methods: This non-randomised, single-arm, retrospective and prospective, pilot observational study enrolled 20 adult patients who have histologically or cytologically confirmed metastatic/drug-resistant/relapsed non-squamous NSCLC, having measurable disease at the time of study entry as defined by the response evaluation criteria in solid tumours (RECIST) with an Eastern cooperative oncology group (ECOG) performance status score of 0 to 2 and adequate organ function are eligible to participate in the study. Results: The survival rate is exceedingly poor in the case of metastatic non-small cell lung cancer. The primary mass shrunk in size as the sum of the largest diameters (SLD) fell by a modest 12.22% up to the third chemotherapy cycle and a further 9.78% up to the sixth chemotherapy cycle. The progression-free survival duration was found 250.82 days, or roughly 8.33 months, and the overall survival (OS) period was 459 days, or approximately 15.3 months. Overall, the mean trial outcome index increased by 9.31% with additional chemotherapy cycles, while FACT-L increased by a comparable 24.25 percent. Conclusions: Angiogenesis inhibitors, due to their novel mechanism of action, provide new therapeutic options for metastatic NSCLC. Despite our inability to draw statistically significant conclusions from these encouraging data, our experience with ramucirumab has been truly pleasant thus far.

Edaravone is a Therapeutic Candidate for Doxorubicin-Induced Cardiomyopathy by Activating the Nrf2 Pathway.

Doxorubicin (DOXO) has long been used clinically and remains a key drug in cancer therapy. DOXO-induced cardiomyopathy (DICM) is a chronic and fatal complication that severely limits the use of DOXO. However, there are very few therapeutic agents for DICM, and there is an urgent need to identify those that can be used for a larger number of patients. The most likely pathogenic mechanism of DICM is the involvement of reactive oxygen species (ROS) and promotion of cell death. In this study, we investigated the efficacy and mechanism of action of edaravone (EDA), a known radical scavenger in DICM. Two methods of EDA administration were employed: daily and weekly. Our results showed that the daily administration group had prolonged survival periods and preserved the left ventricular ejection fraction in DICM mice. In contrast, in the weekly treatment group, slight improvements were observed in these indicators compared with those in DICM mice; however, none of them were statistically significant. These results show that the daily administration group had a higher efficacy than the weekly administration group. Gene-expression results showed that Nrf2 and its related genes were upregulated in the daily group but not in the weekly group. Based on these results, we hypothesized that the Sirt1/Nrf2/HO-1 and ABCB4 pathways were involved in EDA. However, there is limited evidence that EDA is effective against DICM. The findings obtained herein bolster the evidence in DICM by demonstrating prolonged survival and continued preservation of cardiac function and proposing a possible mechanism.

Characterization of Microbubble Cavitation in Theranostic Ultrasound-mediated Blood-Brain Barrier Opening and Gene Delivery.

The characterization of microbubble activity has proven critical in assessing the safety and efficacy of ultrasound-mediated blood-brain barrier (BBB) opening and drug and gene delivery. In this study, we build upon our previous work on theranostic ultrasound (ThUS)-mediated BBB opening (ThUS-BBBO) and conduct for the first time a comprehensive characterization of the role of microbubble cavitation in ThUS-BBBO, as well as its impact on gene delivery with adeno-associated viruses (AAV). A repurposed imaging phased array was used throughout the study to generate focused transmits and record microbubble activity through high-resolution power cavitation imaging (PCI). The cavitation of microbubbles under ThUS pulses was first characterized in flow phantom using pulse lengths ranging from 1.5 to 20 cycles and under varying microbubble flow rates using a separate single-element transducer a passive cavitation detector (PCD). A comprehensive in vivo study in mice was then conducted to characterize the in vivo microbubble activity under ThUS and correlate the resulting cavitation with AAV-mediated transgene delivery and expression. The transcranial microbubble activity was first detected in two mice using a PCD, to confirm the findings of the flow phantom study. Next, three mouse studies were conducted to evaluate the relationship between cavitation and AAV delivery; one with three different microbubble size distributions using polydisperse and size-isolated microbubbles, one with variable burst length and burst repetition frequency, and one with different AAV serotypes and injection doses. Electronic beam steering was used to induce bilateral BBB opening with 1.5 cycle on the left and 10 cycles on the right hemisphere. Cavitation dose was correlated with BBB opening volume, AAV transgene expression was evaluated with immunofluorescence staining and histological safety was assessed with T2* imaging and Hematoxylin and Eosin staining. Frequency domain analysis in the phantoms revealed a broadband-cavitation dominance at the shorter pulse lengths, while harmonic cavitation components are significantly increased for longer pulses. The PCD was better at detecting higher frequency harmonics, while the signal received by the theranostic array was more broadband dominated. Analysis of signals in the time domain showed that the longer pulses induce higher microbubble collapse compared to short pulses. In the transcranial in vivo experiments, the PCD was able to detect increased harmonic cavitation for 10-cycle pulses. The microbubble study showed that 3-5 μm microbubbles resulted in the largest cavitation doses, BBBO volumes and AAV transgene expression compared to the smaller microbubble sizes. The burst sequence study revealed that the sequences with shorter bursts and faster burst repetition frequencies induce larger BBBO volumes and AAV transduction due to faster microbubble replenishment in the focal volume. Increased erythrocyte extravasation was observed on the hemisphere sonicated with 10-cycle pulses. Transgene expression was also increased with injection dose, without notable side effects during the three-week survival period. Finally, AAV9 was shown to be the serotype with the highest transduction efficiency compared to AAV2 and AAV5 at the same injected dose. This is the first comprehensive study into the microbubble cavitation under theranostic ultrasound. The phantom and in vivo studies show that the mechanism of ThUS-BBBO is mainly transient cavitation dominant, as microbubble collapse increases with pulse length despite the increased harmonic frequency response. Increased cavitation dose resulted in larger BBBO volumes and transgene expression in vivo . While ThUS induced microhemorrhage for most of the studied conditions, it did not have an impact on the survival and behavior of the mice.

Extensive small cell lung cancer treated by integrated traditional Chinese and Western medicine: A case report.

Patients with extensive small cell lung cancer (SCLC) generally have a dismal survival rate and are conventionally treated with chemotherapy. This study aimed to explore an alternative treatment approach by combining traditional Chinese medicine (TCM) with radiotherapy and chemotherapy. A 68-year-old male was diagnosed with extensive-stage SCLC. Positron emission tomography/computed tomography scans indicated a high metabolism mass in the left hilar region, along with multiple lymph node metastases and metastatic tumors in both lungs. A left lung biopsy verified small cell carcinoma. The patient was confirmed to have extensive stage SCLC based on imaging and biopsy results. The patient received a comprehensive treatment regimen. TCM herbal prescriptions such as Qianjin Weijing Decoction, Wuwei Xiaodu Decoction, Xiaoxianxiong Decoction, and Xiaochengqi Decoction were administered. In parallel, standard Western medicine therapies, including chemotherapy (intravenous cisplatin and etoposide) and radiotherapy, were carried out. Oral ondansetron was given to alleviate nausea and vomiting caused by chemotherapy and radiotherapy. After 30 months, follow-up positron emission tomography/computed tomography demonstrated the complete disappearance of all cancerous lesions. The patient regained normal daily activities and experienced a substantially enhanced quality of life. Four years after the initial treatment, there has been no recurrence, and the patient persists in taking the original TCM decoction. The combination of TCM and Western medicine in treating SCLC proves effective in managing systemic symptoms, mitigating bone marrow suppression, gastrointestinal reactions, immunosuppression, and other chemotherapy-induced adverse reactions. It also significantly prolongs the survival period, suggesting it as a preferable treatment option for SCLC.

Blocking PD-1 and Tim-3 Pathways to Overcome CD8+ T Cell Exhaustion and Enhance Cancer Immunotherapy Efficacy

Although significant progress has been made in cancer immunotherapy in recent years, its overall efficacy remains limited in a large number of patients. The interaction between the tumor microenvironment (TME) and CD8+ T cells is one of the core topics in cancer immunotherapy research. CD8+ T cells can play an anti-tumor role by recognizing and killing virus-infected or mutated cells. However, in the TME, as the tumor compresses immune cells, the function of them is impaired, and studies have found that relying on PD-1 alone is not enough to resist tumor cells. Therefore, by blocking the PD-1 and Tim-3 pathways to interfere with CD8+ T cell exhaustion (TEX), the performance of CD8+ T cells can be maximized, their survival period extended, and the efficacy of positive cancer immunotherapy improved. For patients with cancer who have failed to respond to immune checkpoint inhibitors as monotherapy, multi-targeted combination therapy may achieve better results.

Socioeconomic, Race-Ethnicity, Household, and Infrastructure Disparities of Hematologic Cancer Outcomes in the US.

Although social determinants of health (SDoH) investigations have shown limited analyses of socioeconomic and race-ethnic status on certain hematologic malignancies, the impact of factors beyond those across a fuller scope of hematologic cancers remains unknown. The Social Vulnerability Index (SVI), a tool for assessing varied US-census derived sociodemographic factors, allows the specific quantification of SDoH in dynamic, regional contexts for their associations with hematologic-malignancy inequities. To assess the summative influence of varied SDoH-factors on hematologic malignancy outcomes and discern which SDoH-factors contributed the largest associations towards disparities 796,005 adults with hematologic malignancies between 1975-2017 were identified for this retrospective cohort study. Vulnerability in 15 SDoH-factors was measured using composite and subcategory SVI scores geographically matched to patients. Regressions between SVI factors and follow-up time after diagnosis and survival period were performed. Increasing overall SVI correlated with significantly decreased surveillance period in 11/14 hematologic malignancies, with decreases upwards of 33.4% (39.0 to 26.0 months-acute lymphocytic leukemia). Increasing SVI significantly associated with decreased survival period across 11/14 hematologic malignancies, with decreases upwards of 47.2% (89.5 to 47.3 months-Hodgkins). Socioeconomic status and housing-transportation-vulnerabilities showed the largest-magnitude contributions, followed by minority-language and household composition. Significant decreases in hematologic-malignancy prognosis associate with increasing overall SDoH-vulnerability in varied sociodemographic contexts in the US. Furthermore, there are quantifiable differences in which types of SDoH contribute more to trends per malignancy-type. These findings demonstrate specific SDoH-targets for further research and policy-initiatives to combat hematologic-malignancy disparity more effectively.

EIF4A3-Mediated circ_0008126 Inhibits the Progression and Metastasis of Gastric Cancer by Modulating the APC/β-Catenin Pathway.

Mounting evidence exhibits circRNAs as critical regulators in the progression of many tumors. The regulatory function and potential mechanism by which circ_0008126 in gastric cancer (GC) is unknown. To validate and analyze the expression levels and clinical values of circ_0008126 in GC patients, the biological phenotypes of circ_0008126 in GC were investigated in vitro and in vivo. The roles and effects of circ_0008126 on miR-502-5p, EIF4A3, and APC in GC cells were explored using rescue experiment, RNA stability assay, RNA pull-down, dual-luciferase reporter, RNA immunoprecipitation (RIP), RNA FISH, immunofluorescence (IF), and TOP/Flash and FOP/Flash assays. Circ_0008126 expression levels were prominently down-regulated in GC tissues and cells. Importantly, low expression of circ_0008126 was relevant to the more lymphatic metastasis, advanced TNM stage, and poor survival period in patients with GC. Functionally, circ_0008126 inhibited GC cell proliferative activity, metastatic ability, and epithelial-mesenchymal transition (EMT) in vitro and vivo. Mechanistically, we verified that EIF4A3 can mediate the formation of circ_0008126, and circ_0008126 could competitively bind miR-502-5p and alleviate its role and effect on APC, thus inactivating the β-catenin pathway in GC. Additionally, circ_0008126 was determined to increase the stability of APC mRNA by interacting with cytoplasmic EIF4A3 protein and then enhancing the APC expression. These data demonstrate that EIF4A3-mediated circ_0008126 could regulate the APC expression and inactivate the β-catenin pathway partly by binding to miR-502-5p and EIF4A3, thus inhibiting the tumorigenesis and development of GC.

Orbital ameloblastoma: research and challenges of a rare benign tumor

Abstract There are numerous types of orbital tumors, among which orbital ameloblastoma is a rare metastatic benign tumor that often originates in the jaw and later metastasizes to the orbit. The mystery of it lies in that, although it is classified as a benign tumor, it exhibits high recurrence and malignant potential with high invasiveness, posing a serious threat to ocular health and the quality of life of patients. The prognosis of orbital ameloblastoma is relatively poor, but there is still hope. With aggressive treatment and close follow-up observation, patients may still have the possibility of achieving a longer survival period and a better quality of life. The global incidence of ameloblastoma is 0.92 cases per million people per year. According to world literature reports, there are 32 cases of maxillary bone metastasis to the orbit and 4 cases of mandibular bone metastasis to the orbit. With more and more cases and related research being reported, it is necessary to comprehensively review the etiology, clinical manifestations, diagnosis, treatment, and prognosis of orbital ameloblastoma, in order to enhance ophthalmologists' understanding and diagnostic and treatment skills of this disease, and ultimately improve patients' prognosis and quality of life.

AL16431.1 is identified as a biomarker for bladder cancer progression and immunotherapy response

LncRNA AL161431.1 is currently known as a factor that can promote epithelial-mesenchymal transition. However, its role in the prognosis, immune infiltration and progression of bladder cancer (BLCA)patients is still unclear. The expression of AL161431.1 is elevated in BLCA tissues compared to normal tissues according to the TCGA database. By combining this data with clinical information, patients with high AL161431.1 expression have more advanced clinicopathological stages and shorter survival periods. Furthermore, AL161431.1 was identified as an independent prognostic factor for bladder cancer. We further analyzed the differences in immune infiltration, tumor mutation burden (TMB), immune checkpoints, and sensitivity to immunotherapy between groups with different levels of AL161431.1 expression. Enrichment analysis demonstrated that AL161431.1 is associated with numerous immune signaling pathways. High expression of AL161431.1 in cancer tissues was confirmed by qRT-PCR. CCK8, transwell, and wound healing demonstrated the oncogenic effects of AL161431.1. In conclusion, AL161431.1 is associated with immune infiltration in bladder cancer and has the potential to become a biomarker for predicting the prognosis of BLCA.

Plasma fibronectin is a prognostic biomarker of disability in Parkinson’s disease: a prospective, multicenter cohort study

In a prospective longitudinal study with 218 Parkinson’s disease (PD) patients in the discovery cohort and 84 in the validation cohort, we aimed to identify novel blood biomarkers predicting disability milestones in PD. Through Least Absolute Shrinkage and Selection Operator-Cox (Lasso-Cox) regression, developed nomogram predictive model and Linear mixed-effects models, we identified low level of plasma fibronectin (pFN) as one of the best-performing risk markers in predicting disability milestones. A low level of pFN was associated with a short milestone-free survival period in PD. Longitudinal analysis showed an annual decline in the rate of pFN was significantly associated with the annual elevation rate in the Hoehn-Yahr stage. Moreover, pFN level was negatively correlated with phosphorylated α-synuclein, and a low level of pFN was associated with BBB disruption in the striatum on neuroimaging, providing evidence for pFN’s role in PD progression. We finally identified pFN as a novel blood biomarker that predicted first-milestone disability in PD.

Metabolism of cancer cells and immune cells in the initiation, progression, and metastasis of cancer.

The metabolism of cancer and immune cells plays a crucial role in the initiation, progression, and metastasis of cancer. Cancer cells often undergo metabolic reprogramming to sustain their rapid growth and proliferation, along with meeting their energy demands and biosynthetic needs. Nevertheless, immune cells execute their immune response functions through the specific metabolic pathways, either to recognize, attack, and eliminate cancer cells or to promote the growth or metastasis of cancer cells. The alteration of cancer niches will impact the metabolism of both cancer and immune cells, modulating the survival and proliferation of cancer cells, and the activation and efficacy of immune cells. This review systematically describes the key characteristics of cancer cell metabolism and elucidates how such metabolic traits influence the metabolic behavior of immune cells. Moreover, this article also highlights the crucial role of immune cell metabolism in anti-tumor immune responses, particularly in priming T cell activation and function. By comprehensively exploring the metabolic crosstalk between cancer and immune cells in cancer niche, the aim is to discover novel strategies of cancer immunotherapy and provide effective guidance for clinical research in cancer treatment. In addition, the review also discusses current challenges such as the inadequacy of relevant diagnostic technologies and the issue of multidrug resistance, and proposes potential solutions including bolstering foundational cancer research, fostering technological innovation, and implementing precision medicine approaches. In-depth research into the metabolic effects of cancer niches can improve cancer treatment outcomes, prolong patients' survival period and enhance their quality of life.

Long-term drought and risk of infant mortality in Africa: A cross-sectional study.

As extreme events such as drought and flood are projected to increase in frequency and intensity under climate change, there is still large missing evidence on how drought exposure potentially impacts mortality among young children. This study aimed to investigate the association between drought and risk of infant mortality in Africa, a region highly vulnerable to climate change that bears the heaviest share of the global burden. In this cross-sectional study, we obtained data on infant mortality in 34 African countries during 1992-2019 from the Demographic and Health Surveys program. We measured drought by the standardized precipitation evapotranspiration index at a timescale of 24 months and a spatial resolution of 10 × 10 km, which was further dichotomized into mild and severe drought. The association between drought exposure and infant mortality risk was estimated using Cox regression models allowing time-dependent covariates. We further examined whether the association varied for neonatal and post-neonatal mortality and whether there was a delayed association with drought exposure during pregnancy or infancy. The mean (standard deviation) number of months in which children experienced any drought during pregnancy and survival period (from birth through death before 1 year of age) was 4.6 (5.2) and 7.3 (7.4) among cases and non-cases, respectively. Compared to children who did not experience drought, we did not find evidence that any drought exposure was associated with an increased risk of infant mortality (hazard ratio [HR]: 1.02, 95% confidence interval [CI] [1.00, 1.04], p = 0.072). When stratified by drought severity, we found a statistically significant association with severe drought (HR: 1.04; 95% CI [1.01, 1.07], p = 0.015), but no significant association with mild drought (HR: 1.01; 95% CI [0.99, 1.03], p = 0.353), compared to non-exposure to any drought. However, when excluding drought exposure during pregnancy, the association with severe drought was found to be non-significant. In addition, an increased risk of neonatal mortality was associated with severe drought (HR: 1.05; 95% CI [1.01, 1.10], p = 0.019), but not with mild drought (HR: 0.99; 95% CI [0.96, 1.02], p = 0.657). Exposure to long-term severe drought was associated with increased infant mortality risk in Africa. Our findings urge more effective adaptation measures and alleviation strategies against the adverse impact of drought on child health.

TAILORED CARE FOR TERMINALLY-ILL OLDER ADULTS: INTEGRATED COMMUNITY-BASED END-OF-LIFE SUPPORT TEAM MODEL (ICEST)

Abstract Background The integrated community-based end-of-life support team (ICEST) tailored the physical-psychosocial-practical care for community-dwelling terminally ill patients and enhanced the capacity of family caregiving through ongoing assessments and seamless interdisciplinary cooperation. The study evaluated the deceased patients’ first three-month care profiles and outcomes. Methods An intervention study with three-time-point repeated measures. Public hospitals identified and referred eligible older adults (age ≥ 60, life expectancy ≤12 months) to receive ICEST services. Patients’ clinical symptoms were measured at baseline, one month, and three months after, and the care they received was recorded. Deceased cases (n=756) were extracted for analysis. Repeated ANOVA was used to analyze the changes in care profiles and clinical outcomes using SPSS 27.0. Results The ICEST could significantly reduce patients’ physical and psycho-social-spiritual symptoms. Except for patients with a short survival period (≤3 months), they experienced a sharp worsening of pain (F (3,188)=2.82,p&amp;lt;.05) and weakness (F (3,188)=5.32,p&amp;lt;.01) and drowsiness remained consistently high (F (3,190)=6.29,p&amp;lt;.001). Depression levels of patients with a longer survival period (&amp;gt;12 months) decreased more after 1st month (F(3,168)=2.68,p&amp;lt;.05). The highest input was in psychosocial care. No significant change was found in its input or physical care, and practical support increased after the 1st month. Psychosocial care for patients with shorter survival periods (≤3 months) was higher initially and decreased later, whereas others showed the opposite trend. Conclusion Various care profiles indicated the moment-by-moment changes in care demands among community-dwelling terminally ill patients. Timely assessments and corresponding adjustments of interventions to address real-time needs are essential.

A clinical analysis and literature review of eleven cases with primary pulmonary angiosarcoma

ObjectiveThe aim of this study is to explore the clinicopathological features, radiographic manifestations, treatment options, and prognosis of primary pulmonary angiosarcoma (PPAS).MethodWe summarized and analyzed the clinical data of 11 patients with primary pulmonary angiosarcoma treated at the First Affiliated Hospital of Guangzhou Medical University between January 2018 and January 2024. A retrospective analysis was conducted in conjunction with a review of the relevant literature.ResultsAmong the 11 cases, the primary symptoms were nonspecific respiratory issues, with chest pain, cough, and shortness of breath being the most common. Initial diagnosis was correct in only 2 cases, while the remaining 9 cases were misdiagnosed as other conditions, such as lung nodules, infections, or pulmonary embolism. All patients were ultimately diagnosed via pathology, with CD31 and CD34 showing a high positivity rate of 60%. Of the 11 patients, 9 have died, and 2 remain alive. The average survival period was 13.2 months.Based on the number of lesions, PPAS was categorized into three types: solitary, multiple, and invasive pulmonary artery. The average survival period for the solitary type (2 cases) was 15.5 months, for the multiple type (5 cases) was 6.6 months, and for the pulmonary artery type (4 cases) was 20.5 months. Among the 3 patients who underwent surgery, the median overall survival (OS) was 23.0 months, whereas for the 8 non-surgical patients, the median OS was 9.7 months.ConclusionPrimary pulmonary angiosarcoma is a rare, highly aggressive vascular malignancy characterized by nonspecific clinical symptoms and a tendency for metastasis and pulmonary artery embolism. Currently, no effective treatment exists, and the overall prognosis is poor.