Prognostic Marker In Patients Research Articles

The utility of ultrafast MRI and conventional DCE-MRI for predicting histologic aggressiveness in patients with breast cancer.

Prediction of histologic prognostic markers is important for determining management strategy and predicting prognosis. To identify important features of ultrafast and conventional dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) that can predict histopathologic prognostic markers in patients with breast cancer. Preoperative MRI scans of 158 consecutive women (mean age = 54.0 years; age range = 29-86 years) with 163 breast cancers between February 2021 and August 2022 were retrospectively reviewed. Inter-observer agreements for ultrafast MRI parameters were analyzed by two radiologists. The qualitative and quantitative MRI parameters were correlated with histopathologic prognostic markers including molecular subtypes and histologic invasiveness. Inter-observer agreements for ultrafast MRI parameters were excellent (intraclass correlation coefficients of area under the kinetic curve [AUC], maximum slope [MS], maximum enhancement [ME], and slope = 0.987, 0.844, 0.822, and 0.760, respectively). Triple-negative breast cancers (TNBC) were significantly associated with rim enhancement (odds ratio [OR] = 9.4, P = 0.003) and peritumoral edema (OR = 17.9, P = 0.002), compared to luminal cancers. Invasive cancers were associated with lesion type-mass, increased delayed washout, angiovolume, ME, slope, MS, and AUC, compared to in situ cancers. In regression analysis, the combination of MS (>46.2%/s) (OR = 5.7, P = 0.046) and delayed washout (>17.5%) (OR = 17.6, P = 0.01), and that of AUC (>27,410.3) (OR = 9.6, P = 0.04), delayed washout (>17.5%) (OR = 8.9, P = 0.009), and lesion-type mass (OR = 4.6, P = 0.04) were predictive of histologic invasiveness. Conventional DCE-MRI with ultrafast imaging can provide useful information for predicting histologic underestimation and aggressive molecular subtype. MS and AUC on ultrafast MRI can be potential imaging markers for predicting histologic upgrade from DCIS to invasive cancer with high reliability.

The HALP score as a prognostic factor in metastatic biliary cancer.

Biliary tract cancers are serious diseases and new biomarkers may be useful for the optimal management and prediction of these cases. This study aimed to evaluate the prognostic significance of the hemoglobin, albumin, lymphocyte, and platelet (HALP) score, a novel composite marker, in patients with metastatic biliary tract cancer. Patients with biliary tract cancers were analyzed retrospectively. Laboratory values, patient and disease characteristics, and survival rates were evaluated. The diagnostic impact of the HALP score was assessed with regression analyses. The study included 106 individuals with metastatic biliary tract cancer. Based on the median HALP score, ≥ 2.22 was considered a high score and < 2.22 was considered low. The overall average survival time was found to be 11.4months. Patients with low HALP scores had median overall survival of 9.5months, while those with high HALP scores had median overall survival of 15.9months. In multivariate analysis, Eastern Cooperative Oncology Group performance status, CA19-9 level, and HALP score remained significant predictors of overall survival. The HALP score appears to be a useful prognostic marker in patients with metastatic biliary tract cancer.

Circulating Polyploid Giant Cancer Cells, a Potential Prognostic Marker in Patients with Carcinoma

Polyploid Giant Cancer Cells (PGCCs) have been recognized as tumor cells that are resistant to anticancer therapies. However, it remains unclear whether their presence in the bloodstream can be consistently detected and utilized as a clinical marker to guide therapeutic anticancer regimens. To address these questions, we conducted a retrospective study involving 228 patients diagnosed with six different types of carcinomas (colon, gastric, NSCLC, breast, anal canal, kidney), with the majority of them (70%) being non-metastatic. Employing a highly sensitive liquid biopsy approach, ISET®, and cytopathological readout, we isolated and detected circulating PGCCs in the patients’ blood samples. PGCCs were identified in 46 (20.18%) out of 228 patients, including in 14.47% of 152 non-metastatic and 29.85% of 67 metastatic cases. Patients were subsequently monitored for a mean follow up period of 44.74 months (95%CI: 33.39–55.79 months). Remarkably, the presence of circulating PGCCs emerged as a statistically significant indicator of poor overall survival. Our findings suggest that circulating PGCCs hold promise as a reliable prognostic indicator. They underscore the importance of further extensive investigations into the role of circulating PGCCs as a prognostic marker and the development of anti-PGCC therapeutic strategies to improve cancer management and patient survival.

529P Evaluating metastatic disease sites as a prognostic marker in patients receiving sequential treatment with regorafenib and trifluridine/tipiracil for refractory colorectal cancer: Survival outcomes from the multicenter retrospective “ReTrITA” study

529P Evaluating metastatic disease sites as a prognostic marker in patients receiving sequential treatment with regorafenib and trifluridine/tipiracil for refractory colorectal cancer: Survival outcomes from the multicenter retrospective “ReTrITA” study

628. GUSTAVE ROUSSY IMMUNE SCORE IS A PROGNOSTIC MARKER IN PATIENTS WITH ESOPHAGEAL CANCER AFTER NEOADJUVANT THERAPY: A MULTICENTER RETROSPECTIVE STUDY

Abstract Background GRIm-Score (Gustave Roussy Immune Score), a novel nutritional and inflammatory-based prognostic score, is an unfavorable prognostic factor in patients with esophageal carcinoma (EC). However, the prognostic importance of GRIm-Scores after neoadjuvant chemo-radiotherapy in these patients remains unclear. Methods A retrospective study including 432 EC patients undergoing surgical resection was performed. The GRIm-Score was calculated by lactate dehydrogenase (LDH), neutrophil-lymphocyte ratio (NLR), and albumin (ALB). The over survival (OS) and disease-free survival (DFS) were analyzed for the current study with Cox regression analyses, Kaplan-Meier methods, and propensity score matching (PSM). Results There were 374 (86.6%) men and 58 (13.4%) women with a mean age of 62.1 ± 7.7 years (range: 39-80 years). After PSM, cohorts consisted of 55 patients in the high GRIm-Score group and 55 in the low GRIm-Score group. Patient with a high GRIm-Score had poor OS (Cohort: p = 0.001; PSM: p = 0.007) and DFS (Cohort: p = 0.001; PSM: p = 0.008). The GRIm-Score, instead of NLR, LDH, or ALB in multivariate analyses, was an independent prognostic factor for OS (p = 0.019) before PSM. However, after PSM, it was a powerful independent prognostic factor for both OS (p = 0.028) and DFS (p = 0.039). Subgroup analyses showed that GRIm-Score could identify cases with worse OS or DFS among pT3-4 patients, indicating the complementary role of GRIm-Score in the decision-making of adjuvant therapy. Conclusion The GRIm-Score was an independent prognostic marker in patients with EC undergoing surgical resection after neoadjuvant therapy. Our study is also the first to discuss the prognostic value of GRIm-Score in patients with EC after neoadjuvant treatment.

A real-world study of active vitamin D as a prognostic marker in patients with sarcoma

PurposeThe assessment of sarcoma during clinical practice is primarily based on imaging examination, with no effective biomarkers available. Although it has been established that 1,25(OH)2D3 is abnormally expressed in patients with sarcoma, it remains unclear whether 1,25(OH)2D3 level could be used as an evaluation marker in these patient population.MethodsThis real-world study investigated 1,25(OH)2D3 level and its association with clinical features in sarcoma patients. Data on 1,25(OH)2D3, parathyroid hormone, calcium, and calcitonin were collected from 331 patients with sarcoma, while the imaging results and the variation in 1,25(OH)2D3 among 213 patients with sarcoma before and after treatment was further analyzed.ResultsWe found that the serum 1,25(OH)2D3 level was predominantly decreased in patients with sarcoma, with a mean of 45.68 nmol/L. 1,25(OH)2D3 was significantly correlated with the gender and age of sarcoma patients, with more substantial reductions in women and younger patients. Among sarcoma patients, those with progressive disease exhibited a 7.08 nmol/L (−13.73%) decrease in serum 1,25(OH)2D3 levels compared to baseline, while patients with non-progressive disease showed a 1.11 nmol/L (+ 7.0%) increase.ConclusionThe variation of serum 1,25(OH)2D3 can predict the disease status of patients with sarcoma. Decreased serum 1,25(OH)2D3 levels are indicative of disease progression in sarcoma patients, suggesting its potential for application as a prognostic marker for disease assessment in this patient population.

Redox state of human serum albumin as a post-discharge prognostic marker in patients hospitalized for heart failure

BackgroundHeart failure (HF) is a global health concern, and oxidative stress has been implicated in its progression. The redox state of human serum albumin, a systemic oxidative biomarker, holds promise as a prognostic marker in HF. This study aimed to investigate the association between the fraction of human mercaptalbumin (fHMA), an indicator of human serum albumin's redox state, and adverse events in HF within a prospective single-hospital-based cohort. MethodsWe enrolled patients hospitalized for HF and measured fHMA using high-performance liquid chromatography at discharge. The primary endpoint was the composite of HF rehospitalization and all-cause death within one year after discharge. ResultsA total of 221 participants (median age:79 years; 35 % female) were included in the study. Over the course of one year, 26.1 % of the patients experienced HF readmission, while 13.1 % died. The low fHMA group divided by median of fHMA (<57.6 %) showed higher composite outcome rates (41.4 % for the low fHMA vs. 24.6 % for the high fHMA, p = 0.0114). Multivariate analysis, accounting for seven potential confounders, identified low fHMA (adjusted HR: 1.79 [1.03–3.11]) and lower hemoglobin as independent predictors of HF prognosis. ConclusionsThe findings in this study provide the first evidence that fHMA is a potential novel prognostic biomarker in patients with HF.

Diagnostic and prognostic utility of plasma thrombospondin-1 levels in traumatic brain injury.

Thrombospondin-1 (TSP-1), a powerful antiangiogenic agent, is increasingly expressed in mice brain tissues after traumatic brain injury (TBI). However, in the peripheral blood of TBI patients, TSP-1 concentrations have not been identified. This study aimed to determine if TSP-1 measured in the plasma of patients relates to TBI diagnosis and injury severity. Plasma TSP-1 levels were assessed in 75 patients with mild to severe TBI and 60 healthy volunteers. Glasgow Coma Scale (GCS) score was recorded to assess traumatic severity. Other relevant clinical characters and laboratory tests were collected to evaluate the diagnostic efficiency of TSP-1. Glasgow outcome scale (GOSE) 3 months after trauma was dichotomized into unfavorable (GOSE1-4) and favorable (GOSE5-8) outcomes. TSP-1 levels were significantly higher in TBI patients than in controls (median 530.4 ng/l, the upper- lower quartiles 373.2-782.1 vs. median 201.5mg/l, the upper - lower quartiles 83.1-351.4, P < 0.001). Plasma TSP-1 was able to differentiate patients with mild, moderate, and severe TBI from healthy controls with Area Under the Receiver-Operating Characteristic Curve (AUROC) of 0.8089, 0.9312, and 0.9189, respectively. TSP-1 levels were closely and negatively correlated with GCS score (r = -0.41). TSP-1 levels > 624.4 ng/ml independently predicted a 3-month unfavorable outcome with an odds ratio value of 9.666 (95% confidence interval (CI),1.393-69.072). TSP-1 levels significantly discriminated 3-month unfavorable outcome with AUROC of 0.7445 (95%CI, 0.6152-0.8739). The results of this study indicate that plasma TSP-1 should be further investigated as a diagnostic and prognostic marker for patients with TBI.

Frailty and Cardiovascular Health.

The incidence of frailty and cardiovascular disease (CVD) increases as the population ages. There is a bidirectional relationship between frailty and CVD, and both conditions share several risk factors and underlying biological mechanisms. Frailty has been established as an independent prognostic marker in patients with CVD. Moreover, its presence significantly influences both primary and secondary prevention strategies for adults with CVD while also posing a barrier to the inclusion of these patients in pivotal clinical trials and advanced cardiac interventions. This review discusses the current knowledge base on the relationship between frailty and CVD, how managing CVD risk factors can modify frailty, the influence of frailty on CVD management, and future directions for frailty detection and modification in patients with CVD.

Nadir Creatinine in Congenital Anomalies of the Kidney and Urinary Tract (CAKUT): A Single-Center Experience.

Congenital anomalies of the kidney and urinary tract (CAKUT) are the main cause of chronic kidney disease (CKD) requiring renal replacement therapy (RRT) in children, being the leading cause (50-70%) of end-stage renal disease (ESRD) in children and young adults. Our study aimed to assess the natural evolution of various antenatally diagnosed renal malformations and to identify potential prognostic factors to guide the therapeutic management of patients with CAKUT. We conducted a retrospective study on 205 children with CAKUT. For each patient, analyzing their medical records, we established the nadir value of serum creatinine, defined as the lowest creatinine level during the first year of life. We assessed the value of nadir creatinine as a prognostic marker in patients with CAKUT, and using an ROC curve, we also determined a threshold value of nadir creatinine that predicted progression to ESRD. The male-to-female ratio was 2.8 to 1. The mean gestational age at detection was 29.85 weeks (±6.71). A total of 36 patients (17.6%) had impaired renal function, of which 8 (3.9% of the total) progressed to ESRD. The mean nadir creatinine in patients with ESRD was 1.39 mg/dL. A nadir creatinine cut-off of 0.98 mg/dL had high sensitivity and specificity in identifying patients with progression to ESRD, with an AUC of 0.95 and a 95% confidence interval between 0.86 and 1.05 mg/dL. Our results support the value of nadir creatinine in predicting progression to ESRD, consistent with previously published data.

Identification of Oxidative Stress-Related Biomarkers for Pain-Depression Comorbidity Based on Bioinformatics.

Oxidative stress has been identified as a major factor in the development and progression of pain and psychiatric disorders, but the underlying biomarkers and molecular signaling pathways remain unclear. This study aims to identify oxidative stress-related biomarkers and signaling pathways in pain-depression comorbidity. Integrated bioinformatics analyses were applied to identify key genes by comparing pain-depression comorbidity-related genes and oxidative stress-related genes. A total of 580 differentially expressed genes and 35 differentially expressed oxidative stress-related genes (DEOSGs) were identified. By using a weighted gene co-expression network analysis and a protein-protein interaction network, 43 key genes and 5 hub genes were screened out, respectively. DEOSGs were enriched in biological processes and signaling pathways related to oxidative stress and inflammation. The five hub genes, RNF24, MGAM, FOS, and TKT, were deemed potential diagnostic and prognostic markers for patients with pain-depression comorbidity. These genes may serve as valuable targets for further research and may aid in the development of early diagnosis, prevention strategies, and pharmacotherapy tools for this particular patient population.

Association between the anion gap and mortality in critically ill patients with influenza: A cohort study

IntroductionInfluenza is an important global health concern, particularly in critically ill patients. The anion gap, a marker of metabolic acidosis, is associated with mortality in various critical illnesses. However, its association with mortality in critically ill patients with influenza remains unclear. This study investigated the association between the anion gap on admission and 28-day mortality in critically ill patients with influenza. MethodsA retrospective cohort study was conducted using data from MIMIC-IV database. Patients admitted to the intensive care unit (ICU) with influenza were included. The anion gap was measured within the first 24 h of ICU admission. The primary outcome was the 28-day mortality. The secondary outcomes were 60-day mortality and in-hospital mortality. Multivariable Cox regression was used to assess the association between the anion gap and mortality. ResultsA total of 276 critically ill patients with influenza were included in the study. The mean age was 65 years, and 60 % were male. The overall 28-day mortality was 15.5 %. A greater anion gap on admission was associated with significantly increased 28-day mortality in the unadjusted analysis (hazard ratio [HR], 1.11; 95 % confidence interval [CI], 1.03–1.2; p < 0.001). The association remained significant after adjusting for age, sex, race, and illness severity (adjusted HR, 1.09; 95 % CI, 1.02–1.17; p = 0.017). Subgroup analysis showed consistent results across the different groups. ConclusionA greater anion gap on admission was independently associated with increased 28-day mortality in critically ill patients with influenza. These findings suggest that the anion gap can be used as a prognostic marker in patients with influenza, aiding in risk stratification and guiding clinical management.

Hepatic stearoyl-CoA desaturase-1 deficiency induces fibrosis and hepatocellular carcinoma-related gene activation under a high carbohydrate low fat diet

Stearoyl-CoA desaturase-1 (SCD1) is a pivotal enzyme in lipogenesis, which catalyzes the synthesis of monounsaturated fatty acids (MUFA) from saturated fatty acids, whose ablation downregulates lipid synthesis, preventing steatosis and obesity. Yet deletion of SCD1 promotes hepatic inflammation and endoplasmic reticulum stress, raising the question of whether hepatic SCD1 deficiency promotes further liver damage, including fibrosis. To delineate whether SCD1 deficiency predisposes the liver to fibrosis, cirrhosis, and hepatocellular carcinoma (HCC), we employed in vivo SCD1 deficient global and liver-specific mouse models fed a high carbohydrate low-fat diet and in vitro established AML12 mouse cells. The absence of liver SCD1 remarkably increased the saturation of liver lipid species, as indicated by lipidomic analysis, and led to hepatic fibrosis. Consistently, SCD1 deficiency promoted hepatic gene expression related to fibrosis, cirrhosis, and HCC. Deletion of SCD1 increased the circulating levels of Osteopontin, known to be increased in fibrosis, and alpha-fetoprotein, often used as an early marker and a prognostic marker for patients with HCC. De novo lipogenesis or dietary supplementation of oleate, an SCD1-generated MUFA, restored the gene expression related to fibrosis, cirrhosis, and HCC. Although SCD1 deficient mice are protected against obesity and fatty liver, our results show that MUFA deprivation results in liver injury, including fibrosis, thus providing novel insights between MUFA insufficiency and pathways leading to fibrosis, cirrhosis, and HCC under lean non-steatotic conditions.

Serum Cytokeratin-18 levels as a prognostic biomarker in advanced liver disease: a comprehensive meta-analysis

Cytokeratin-18 (CK-18) is a marker of hepatic cell death. Serum CK-18 could serve as a prognostic marker for patients with advanced liver disease (ALD). This meta-analysis aims to explore the association between total CK-18 (M65) and caspase-cleaved CK-18 (M30) levels with the prognosis of ALD patients. Relevant longitudinal observational studies were identified through comprehensive searches of the Medline, Web of Science, and Embase databases. A random-effects model was utilized to synthesize the findings, accommodating heterogeneity among studies. The analysis included 14 datasets from 11 studies. Elevated serum CK-18 levels at admission were linked to a higher risk of death or liver transplantation during follow-up. This association was consistent for both M65 (risk ratio [RR] 1.99, 95% confidence interval [CI] 1.65 to 2.40, p < 0.001; I2 = 43%) and M30 (RR 1.94, 95% CI 1.57 to 2.40, p < 0.001; I2 = 46%). Subgroup analysis revealed that the relationship between serum M65 levels and adverse outcomes was attenuated in studies using multivariate analysis compared to those using univariate analysis (RR 1.78 vs. 2.80, p for subgroup difference = 0.03). Further subgroup analyses indicated that the prognostic significance of CK-18 for ALD patients was not significantly influenced by study design, methods of determining CK-18 cutoff values, or follow-up durations. Elevated serum CK-18 levels at admission indicate a poor prognosis in patients with ALD. This finding holds for both M65 and M30.

A Review of Paradeniya Organophosphorus Poisoning Scale as a Severity and Prognostic Marker in Patients with Acute Organophosphorus Poisoning

Abstract not available CME J 2024; 3(2); 43-46

AI-based Fully-Automated Stress Left Ventricular Ejection Fraction as a Prognostic Marker in Patients Undergoing Stress-CMR.

To determine in patients undergoing stress CMR whether fully automated stress artificial intelligence (AI)-based left ventricular ejection fraction (LVEFAI) can provide incremental prognostic value to predict death above traditional prognosticators. Between 2016 and 2018, we conducted a longitudinal study that included all consecutive patients referred for vasodilator stress CMR. LVEFAI was assessed using AI-algorithm combines multiple deep learning networks for LV segmentation. The primary outcome was all-cause death assessed using the French National Registry of Death. Cox regression was used to evaluate the association of stress LVEFAI with death after adjustment for traditional risk factors and CMR findings.In 9,712 patients (66±15 years, 67% men), there was an excellent correlation between stress LVEFAI and LVEF measured by expert (LVEFexpert) (r=0.94, p<0.001). Stress LVEFAI was associated with death (median [IQR] follow-up 4.5 [3.7-5.2] years) before and after adjustment for risk factors (adjusted hazard ratio [HR], 0.84 [95% CI, 0.82-0.87] per 5% increment, p<0.001). Stress LVEFAI had similar significant association with death occurrence compared with LVEFexpert. After adjustment, stress LVEFAI value showed the greatest improvement in model discrimination and reclassification over and above traditional risk factors and stress CMR findings (C-statistic improvement: 0.11; NRI=0.250; IDI=0.049, all p<0.001; LR-test p<0.001), with an incremental prognostic value over LVEFAI determined at rest. AI-based fully automated LVEF measured at stress is independently associated with the occurrence of death in patients undergoing stress CMR, with an additional prognostic value above traditional risk factors, inducible ischemia and LGE.

Value of Zonulin as a Diagnostic and Prognostic Marker in Patients with Nonalcoholic Fatty Liver Disease

Abstract Background Nonalcoholic fatty liver disease (NAFLD) is a spectrum of liver disorders ranging from simple fat accumulation in the hepatocytes (hepatic steatosis), to liver inflammation and hepatocytes injury (nonalcoholic steatohepatitis, NASH) with increasing levels of fibrosis to cirrhosis and hepatocellular carcinoma (HCC). The gut microbiota is involved in the occurrence and development of chronic liver diseases. Zonulin is considered a marker of intestinal permeability. Aim and Objectives to study the value of zonulin as a diagnostic and prognostic marker in different degrees of Non-alcoholic fatty liver disease (Steatosis, Steatohepatitis, Cirrhosis) in patients with and without Diabetes Mellitus. Subjects and Methods This was Case control study, was conducted in Ain-Shams University Hospitals Internal medicine&amp; Gastroenterology department and bariatric surgery unit over 60 subjects divided into 3 groups:(Group A): 20 Patients have mild NASH, (Group B): 20 Patients have moderate to severe NASH, (Group C): 20 Healthy controls, during a period 1 year. Result There was high statistically significant difference between the studied groups as regard Zonulin concentration. Conclusion serum zonulin concentration is increased in patients with NAFLD and correlates with the severity of steatosis. However, the cross-sectional design of our study precludes the establishment of causal or temporal relationships between increased zonulin concentrations and severity of steatosis and the presence of NASH. Follow up studies may be helpful in elucidating the cause-and effect relations and the underlying mechanisms.

Changes in Health-Related Quality of Life of Patients Treated for Esophageal Cancer in Eldoret, Kenya

Purpose: The study objectives were: to determine the demographic and clinical characteristics of patients treated for EC in Eldoret and to determine the change in health-related quality of life of patients treated for EC. Methodology: A longitudinal study was conducted at three cancer centers in Eldoret, Kenya. Participants were interviewed at enrollment (pre-treatment) and three months post-treatment. The study included patients aged 18 and above with histologically confirmed esophageal cancer. Consecutive sampling method was used to enroll study participants until a predetermined sample size of 59 was achieved. Independent variables considered were patient characteristics (demographic and clinical), and baseline HRQoL while the dependent variable was 3 months post-treatment HRQoL. Patients' characteristic data was analyzed using descriptive statistics (frequencies and percentages); change in HRQoL was calculated using the analysis of variance (ANOVA) test and the results were presented using tables. Findings: At baseline, 59 patients (68% female, mean age 56.3 years) were enrolled. The most common complaints were dysphagia (100%) and weight loss (74.6%). The baseline mean HRQoL score was 107.1, indicating a compromised quality of life at the start of treatment. After treatment, patients receiving chemotherapy plus surgery showed improved HRQoL, while radiotherapy alone was associated with deterioration. The differences were statistically significant (p-values: 0.04 and 0.0092, respectively). Multivariate regression revealed that only baseline HRQoL was significantly associated with post-treatment HRQoL (p=0.0065).This study sheds light on the underexplored aspect of HRQoL in Kenyan esophageal cancer patients. The findings emphasize the impact of treatment modalities on HRQoL, with chemotherapy plus surgery showing better outcomes. The study underscores the importance of considering patients' baseline HRQoL in assessing post-treatment outcomes. Addressing these factors can inform targeted interventions to improve the overall well-being of esophageal cancer patients in Kenya. Further research with larger, more diverse samples is warranted to enhance the generalizability of these findings. Unique Contribution to Theory Practice and Policy: This study highly recommends community sensitization and awareness of esophageal cancer to the at-risk population groups, further research on HRQoL as a prognostic marker for patients with esophageal cancer and more high-quality studies on HRQoL with large sample sizes are needed to determine the association between characteristics of the patients and health-related quality of life.

Prognostic value of exercise longitudinal right ventricular free wall strain in patients with sickle cell disease.

Longitudinal right ventricular free wall strain (RVFWS) has been identified as an independent prognostic marker in patients with pulmonary hypertension. Little is known however about the prognostic value of RVFWS in patients with sickle cell (SC) disease, particularly during exercise. We therefore examined the prognostic significance of RVFWS both at rest and with exercise in patients with SC disease and normal resting systolic pulmonary artery pressure (SPAP). Consecutive patients with SC disease referred for bicycle ergometer stress echocardiography (SE) were enrolled ftom July 2019 to January 2021. All patients had measurable tricuspid regurgitation velocity (TRV). Conventional echocardiography parameters, left ventricular global longitudinal strain (LVGLS), RVFWS, and ventriculoarterial coupling indices (TAPSE/SPAP and RVFWS/SPAP) were assessed at rest and peak exercise. Repeat SE was performed at a median follow-up of 2years. The cohort consisted of 87 patients (mean age was 31 ± 11years, 66% females). All patients had normal resting TRV < 2.8m/s, RVFWS and LVGLS at baseline. There were 23 (26%) patients who had peak stress RVFWS < 20%. They had higher resting and peak stressTRV andSPAP, but lower resting and peak stressTAPSE/SPAP, RVFWS/SPAP, and LVGLS as well as lower peak stresscardiac output when compared to patients with peak stressRVFWS ≥ 20% (p < 0.05). Patients with baseline peak stressRVFWS < 20% had a significant decrease in exercise performance at follow-up (7.5 ± 2.7min at baseline vs. 5.5 ± 2.8min at follow-up, p < 0.001). In the multivariate analysis, baseline peak stressRVFWS was the only independent predictor of poorer exercise performance at follow-up [odds ratio 8.2 (1.2, 56.0), p = 0.033]. Among patients with SC disease who underwent bicycle ergometer SE, a decreased baseline value of RVFWS at peak stress predicted poorer exercise time at follow-up.

BMP Signaling Is a Prognostic Marker in Patients With Colorectal Cancer and Associates With Frailty.

Bone morphogenetic proteins (BMPs) are members of the transforming growth factor-β superfamily of ligands and have been shown to promote or suppress colorectal cancer (CRC) growth. Developing treatments that target BMPs is challenging due to their multiple roles, including involvement in the inflammatory response and nutritional status. The present study evaluated the prognostic value of BMP-4, which is believed to be highly expressed in CRC, and its correlation with inflammatory and nutrition statuses in patients with CRC. We analyzed BMP-4 expression in tumor tissues from 144 patients who underwent CRC surgery using immunohistochemistry and evaluated the relationship between BMP-4 levels and clinical outcomes. Kaplan-Meier analysis revealed that patients with high expression levels of BMP-4 exhibited a shorter overall survival rate than those with low levels of expression. Multivariate analysis revealed that BMP-4 expression was an independent prognostic factor for overall survival and death from other diseases in CRC patients. Furthermore, high BMP-4 expression was significantly correlated with high C-reactive protein/Albumin ratio, sarcopenia, and osteopenia. BMP-4 is a significant prognostic factor in CRC, particularly in predicting death from other diseases, while also showing associations with inflammatory and nutritional statuses.