Individual Patient Risk Assessment Research Articles

The risk analysis index is an independent predictor of outcomes after lung cancer resection.

The Risk Analysis Index (RAI) is a frailty assessment tool based on an accumulation of deficits model. We mapped RAI to data from the Society of Thoracic Surgeons (STS) Database to determine whether RAI correlates with postoperative outcomes following lung cancer resection. This was a national database retrospective observational study based on data from the STS Database. Study patients underwent surgery 2018 to 2020. RAI was divided into four increasing risk categories. The associations between RAI and each of postoperative complications and administrative outcomes were examined using logistic regression models. We also compared the performance of RAI to established risk indices (American Society of Anesthesiology (ASA) and Charlson Comorbidity Index (CCI)) using areas under the Receiver Operating Characteristic (ROC) curves (AUC). Results: Of 29,420 candidate patients identified in the STS Database, RAI could be calculated for 22,848 (78%). Almost all outcome categories exhibited a progressive increase in marginal probability as RAI increased. On multivariable analyses, RAI was significantly associated with an incremental pattern with almost all outcomes. ROC analyses for RAI demonstrated "good" AUC values for mortality (0.785; 0.748) and discharge location (0.791), but only "fair" values for all other outcome categories (0.618 to 0.690). RAI performed similarly to ASA and CCI in terms of AUC score categories. RAI is associated with clinical and administrative outcomes following lung cancer resection. However, its overall accuracy as a surgical risk predictor is only moderate and similar to ASA and CCI. We do not recommend routine use of RAI for assessment of individual patient risk for major lung resection.

A novel gene signature related to fatty acid metabolism predicts prognosis, immune landscape, and drug sensitivity in early-stage lung squamous cell carcinoma.

Dysregulation of fatty acid metabolism (FAM) represents a significant metabolic alteration in tumorigenesis. However, the role of FAM-related genes (FAMRGs) in early-stage lung squamous cell carcinoma (LUSC) remains incompletely understood. A series of bioinformatic analyses and machine learning strategies were performed to construct a FAMRGs-based signature to predict prognosis and guide personalized treatment for early-stage LUSC patients. FAMRGs were screened through the Kyoto Encyclopedia of Genes and Genomes (KEGG) database and the Molecular Signature Database (MSigDB). Prognosis FAMRGs were identified using univariate Cox regression, and unsupervised clustering analysis facilitated the division of the cohort into different clusters. The least absolute shrinkage and selection operator (LASSO)-Cox regression and multivariate regression analysis were employed to develop a FAMRGs-based signature for predicting overall survival (OS). A nomogram was subsequently constructed to facilitate risk assessment for individual patients. Comprehensive analyses of metabolic pathways, immune infiltration, immunomodulators, and potentially applicable drugs were conducted across different FAMRGs-related risk groups. The FAMRGs-based signature, comprising nine genes (ACOT11, APOH, BMX, CYP2R1, DPEP3, FABP6, FADS2, GLYATL2, and THRSP), demonstrated robust predictive capabilities for prognosis in The Cancer Genome Atlas (TCGA)-LUSC dataset and validated across six independent Gene Expression Omnibus (GEO)-LUSC datasets. Notably, the FAMRGs-base signature exhibited superior prognostic capacity and accurate survival prediction compared to conventional clinicopathological features. Furthermore, the signature was closely associated with immune cell infiltration, human leukocyte antigen (HLA) genes, and immune checkpoint genes expression. Additionally, the signature demonstrated potential sensitivity to chemo-/target-therapy. The FAMRGs-based signature demonstrated superior sensitivity in predicting the prognosis of early-stage LUSC. Detecting FAMRGs may provide predictive targets for the development of clinical treatment strategies.

Development and validation of a risk model for intracardiac thrombosis in patients with dilated cardiomyopathy: a retrospective study

Intracardiac thrombosis is a severe complication in patients with non-ischemic dilated cardiomyopathy. This study aims to develop and validate an individualized nomogram to evaluate the risk of intracardiac thrombosis in patients with non-ischemic dilated cardiomyopathy. This retrospective study included patients diagnosed with dilated cardiomyopathy at first admission. Clinical baseline characteristics were acquired from electronic medical record systems. Multiple methods were applied to screen the key variables and generate multiple different variable combinations. Multivariable logistic regression was used to build the models, and the optimal model was chosen by comparing the discrimination. Then we checked the performance of the model in different thrombus subgroups. Finally, the model was presented using a nomogram and evaluated from the perspectives of discrimination, calibration, and clinical usefulness. Internal validation was performed by extracting different proportions of data for Bootstrapping. Ultimately, 564 eligible patients were enrolled, 67 of whom developed an intracardiac thrombosis. Risk factors included d-dimer, white blood cell count, high-sensitivity C-reactive protein, pulse pressure, history of stroke, hematocrit, and NT-proBNP in the optimal model. The model had good discrimination and calibration, and the area under the curve (AUC) was 0.833 (0.782–0.884), and the model’s performance in each subgroup was stable. Clinical decision curve analysis showed that the model had clinical application value when the high-risk threshold was between 2% and 78%. The AUC of interval validation (30% and 70% data resampling) was 0.844 (0.765–0.924) and 0.833 (0.775–0.891), respectively. This novel intracardiac thrombosis nomogram could be conveniently applied to facilitate the individual intracardiac thrombosis risk assessment in patients with non-ischemic dilated cardiomyopathy.

When the ward is the patient: Using the PRISM protocol to understand and reduce violence in an inpatient intellectual disability setting.

Violence in inpatient settings is recognised as a worldwide issue, with inpatient intellectual disability services having higher rates than other mental health settings. Violence results in injury and illness, lack of confidence in the organisation and staff burnout. These combined effects have a negative impact on the ability of services to provide therapeutic environments. Attempts to manage violence tend to focus on the individual. This is only one part of the solution. Situational risk factors for violence within secure settings can be identified and modified to reduce violence rates. The role of situational risk factors in rates of institutional violence requires consideration in addition to individual patient risk assessment and management. To discuss an illustrative case study of a ward experiencing high levels of violence, resulting in staff burnout and low morale. To describe how assessing and addressing the relevant situational risk factors led to demonstrable reductions in violence and improvements in the service provided. This case study demonstrates the practical application of assessing and managing situational risk factors for violence in a locked intellectual disability ward in order to effectively reduce levels of violent incidents. A description of the violence and critical issues faced by the ward is provided, noting key elements of the timeline of events and the application of the Promoting Risk Intervention by Situational Management (PRISM) process to address these. The PRISM protocol enabled a comprehensive assessment and understanding of situational factors relevant to the violence rates in the ward. The recommendations following the analysis enabled the management team to identify areas for immediate and long-term action. Practical steps to address issues such as improving soundproofing were implemented quickly whilst other issues required changes over the longer term. Significantly, reduced levels of violence were observed within a 2-month period of immediate steps being taken, with further gains achieved over the longer term. This paper provides the only example of the use of the PRISM protocol in an intellectual disability inpatient setting. The reduction in violence seen in this unit provides 'real world' evidence that addressing situational factors for institutional violence can be effective in intellectual disability inpatient settings, with beneficial outcomes for patients and staff. Whilst individual patient risk assessment and risk management are key components of forensic mental health care, situational risk factors for violence are highly relevant to rates of violence within secure care settings. Structured assessment of situational risk factors should be considered when inpatient settings experience persistent high levels of violence. Further research on the impact of assessing situational risk factors in forensic mental health settings (including intellectual disability services) would help to develop the existing evidence base.

Coinfections and antimicrobial treatment in a cohort of falciparum malaria in a non-endemic country: a 10-year experience

IntroductionFalciparum malaria remains one of the deadliest infectious diseases worldwide. In Germany, it is mainly an imported infection among travellers. Rates of coinfection are often unknown, and a clinical rationale for the beneficial use of calculated antibiotic therapy in patients with malaria and suspected coinfection is lacking.MethodsWe conducted an analysis of all in-patients treated with falciparum malaria at a German infectious diseases centre in vicinity to one of Europe’s major airports for 2010–2019. Logistic regression and time-to-event analysis were used to evaluate predictors for bacterial coinfection, the use of antibacterial substances, as well as their influence on clinical course.ResultsIn total, 264 patients were included. Of those, 64% received an additional antibacterial therapy (n = 169). Twenty-nine patients (11.0%) were found to have suffered from a relevant bacterial coinfection, while only a small fraction had relevant bacteremia (n = 3, 1.4%). However, patients with severe malaria did not suffer from coinfections more frequently (p = 0.283). CRP levels were not a reliable predictor for a bacterial coinfection (OR 0.99, 95% CI 0.94–1.06, p = 0.850), while another clinical focus of infection was positively associated (OR 3.86, 95% CI 1.45–11.55, p = 0.010).ConclusionAlthough bacterial coinfections were rare in patients with malaria at our centre, the risk does not seem negligible. These data point rather towards individual risk assessment in respective patients than to general empiric antibiotic use.

Risk assessment and clinical prediction model of planned transfer to the ICU after hip arthroplasty in elderly individuals

BackgroundWith the development of hip arthroplasty technology and rapid rehabilitation theory, the number of hip arthroplasties in elderly individuals is gradually increasing, and their satisfaction with surgery is also gradually improving. However, for elderly individuals, many basic diseases, poor nutritional status, the probability of surgery, anaesthesia and postoperative complications cannot be ignored. How to reduce the incidence of postoperative complications, optimize medical examination for elderly patients, and reasonably allocate medical resources. This study focuses on the construction of a clinical prediction model for planned transfer to the ICU after hip arthroplasty in elderly individuals.MethodsWe retrospectively analysed 325 elderly patients who underwent hip arthroplasty. The general data and preoperative laboratory test results of the patients were collected. Univariate and multivariate logistic regression analyses were performed to screen independent influencing factors. The backwards LR method was used to establish the prediction model. Then, we assessed and verified the degree of discrimination, calibration and clinical usefulness of the model. Finally, the prediction model was rendered in the form of a nomogram.ResultsAge, blood glucose, direct bilirubin, glutamic-pyruvic transaminase, serum albumin, prothrombin time and haemoglobin were independent influencing factors of planned transfer to the ICU after hip arthroplasty. The area under the curve (AUC) of discrimination and the 500 bootstrap internal validation AUC of this prediction model was 0.793. The calibration curve fluctuated around the ideal curve and had no obvious deviation from the ideal curve. When the prediction probability was 12%-80%, the clinical decision curve was above two extreme lines. The discrimination, calibration and clinical applicability of this prediction model were good. The clinical prediction model was compared with the seven factors in the model for discrimination and clinical use. The discrimination and clinical practicability of this prediction model were superior to those of the internal factors.ConclusionThe prediction model has good clinical prediction ability and clinical practicability. The model is presented in the form of a linear graph, which provides an effective reference for the individual risk assessment of patients.

Evaluating the Supporting Evidence of Medical Cannabis Claims Made on Clinic Websites: Cross-Sectional Study.

Since the legalization of medical cannabis in Canada in 2013, prescription of cannabis for medical purposes has become commonplace and a multibillion dollar industry has formed. Much of the media coverage surrounding medical cannabis has been positive in nature, leading to Canadians potentially underestimating the adverse effects of medical cannabis use. In recent years, there has been a large increase in clinic websites advertising the use of medical cannabis for health indications. However, little is known about the quality of the evidence used by these clinic websites to describe the effectiveness of cannabis used for medical purposes. We aimed to identify the indications for medical cannabis reported by cannabis clinics in Ontario, Canada, and the evidence these clinics cited to support cannabis prescription. We conducted a cross-sectional web search to identify all cannabis clinic websites within Ontario, Canada, that had physician involvement and identified their primary purpose as cannabis prescription. Two reviewers independently searched these websites to identify all medical indications for which cannabis was promoted and reviewed and critically appraised all studies cited using the Oxford Centre for Evidence-Based Medicine Levels of Evidence rubric. A total of 29 clinics were identified, promoting cannabis for 20 different medical indications including migraines, insomnia, and fibromyalgia. There were 235 unique studies cited on these websites to support the effectiveness of cannabis for these indications. A high proportion (36/235, 15.3%) of the studies were identified to be at the lowest level of evidence (level 5). Only 4 clinic websites included any mention of harms associated with cannabis. Cannabis clinic websites generally promote cannabis use as medically effective but cite low-quality evidence to support these claims and rarely discuss harms. The recommendation of cannabis as a general therapeutic for many indications unsupported by high-quality evidence is potentially misleading for medical practitioners and patients. This disparity should be carefully evaluated in context of the specific medical indication and an individualized patient risk assessment. Our work illustrates the need to increase the quality of research performed on the medical effects of cannabis.

Recommendations for individual comorbidity risk assessment in adult patients with psoriasis

It has long been known that chronic inflammatory systemic diseases, such as psoriasis, pose ahigh risk of developing comorbidities. In everyday clinical practice, it is therefore of particular importance to identify patients who have an individually increased risk profile. In patients with psoriasis, the comorbidity patterns "metabolic syndrome", "cardiovascular comorbidity" and "mental illness" were identified as particularly relevant in epidemiological studies depending on the duration and severity of the disease. In the everyday care of patients with psoriasis in dermatological practice, the use of an interdisciplinary checklist for risk analysis and the initiation of professional follow-up care has proven valuable. On the basis of an existing checklist, the contents were critically evaluated by an interdisciplinary group of experts and aguideline-oriented update was prepared. In the opinion of the authors, the new analysis sheet represents apracticable, factually focused and updated tool for comorbidity risk assessment in patients with moderate and severe psoriasis.

Proteome-Wide Analysis Reveals TFEB Targets for Establishment of a Prognostic Signature to Predict Clinical Outcomes of Colorectal Cancer.

Dephosphorylation of transcription factor EB (TFEB) at Ser142 and Ser138 determines its nuclear localization and transcriptional activity. The link between TFEB-associated genes and colorectal cancer (CRC) progression and prognosis remains unclear. To systematically identify the targets of TFEB, we performed data-independent acquisition (DIA)-based quantitative proteomics to compare global protein changes in wild-type (WT) DLD1 cells and TFEBWT- or TFEBS142A/S138A (activated status)-expressing DLD1 cells. A total of 6048 proteins were identified and quantified in three independent experiments. The differentially expressed proteins in TFEBS142A/S138A versus TFEBWT and TFEBWT versus control groups were compared, and 60 proteins were identified as products of TFEB transcriptional regulation. These proteins were significantly associated with vesicular endocytic trafficking, the HIF-1 signaling pathway, and metabolic processes. Furthermore, we generated a TFEB-associated gene signature using a univariate and LASSO Cox regression model to screen robust prognostic markers. An eight-gene signature (PLSCR3, SERPINA1, ATP6V1C2, TIMP1, SORT1, MAP2, KDM4B, and DDAH2) was identified. According to the signature, patients were assigned to high-risk and low-risk groups. Higher risk scores meant worse overall survival and higher epithelial-mesenchymal transition (EMT) scores. Additionally, as per the clinicopathological parameters and gene signature, a nomogram was constructed that was utilized to enhance the quantification capacity in risk assessment for individual patients. This research shows that TFEB directly mediates network effects in CRC, and the identified TFEB gene signature-based model may provide important information for the clinical judgment of prognosis.

S-31-6: CURRENT STATUS AND FUTURE PERSPECTIVES OF ELDERLY HYPERTENSION IN ASIA

Because of rapid aging and unhealthy life style in most of Asian countries, non-communicable diseases are increasing gradually and become significant disease burden and socioeconomic burden in Asia. However, the level of hypertension management is not good especially in the young adults. Clinical decision-making for hypertension in the elderly should not depend on chronological age alone. Global risk assessment for individual patients, including comorbidities, frailty, functional status, polypharmacy, cognitive impairment, and variable life expectancy and the risk of orthostatic hypotension should be done for better management of hypertension and outcome. There are many conflicting results and discrepancies on the optimal target BP in elderly hypertensive patients. Asians are different from Caucasians in genetic background, pathophysiology, clinical phenotypes, respond to medication, prognosis and etc. Although there are several hypertension guidelines in Asia, development of hypertension management guidelines for Asians is needed through pooled national cohort data, big health data analysis for precision medicine of hypertension. Hypertension is also good candidate for the digital smart healthcare in the near future.

Düşük riskli kadınlarda enfekte epizyotomi riskini öngören bir model

Purpose: Infected episiotomy (IE) is a rare complication of vaginal delivery. However, the practical use of the risk factors involved in the development of IE is unclear. The aim of this study is to create a risk scoring model to be applied in clinical practice with the risk factors we will determine so as to predict the development of IE. 
 Materials and Methods: All women who were delivered vaginally with mediolateral episiotomy within a 1-year period were included in this retrospective study. While 42 women (cases) with the diagnosis of IE were eligible for inclusion in the study and formed the case group, randomly selected 168 women in whom IE was not detected formed the control group. Possible risk factors for the development of IE were evaluated by multivariate regression analysis.
 Results: The analysis revealed 5 significant independent factors related to IE. Among these factors, 5 points were given to current smoking presence, 4 points to weight gain during pregnancy ≥11.5 kg, 3 points to postpartum neutrophil to lymphocyte ratio ≥10.4, 2 points to presence of diabetes mellitus, and 1 point to presence of hospitalization before active phase of labor. And a cut-off value of 5.5 was found to be moderately effective in predicting IE.
 Conclusion: Consequently, this five-variable model can predict the presence of IE with significant efficiency. In the presence of these variables, the clinician can identificate the patients at risk of IE. In this way, individualized patient risk assessment and situation-specific counseling can be made.

Resumption of Antiplatelet Therapy after Major Bleeding.

Major bleeding is a common threat in patients requiring antiplatelet therapy. Timing and intensity with regard to resumption of antiplatelet therapy represent a major challenge in clinical practice. Knowledge of the patient's bleeding risk, defining transient/treatable and permanent/untreatable risk factors for bleeding, and weighing these against thrombotic risk are key to successful prevention of major adverse events. Shared decision-making involving various disciplines is essential to determine the optimal strategy. The present article addresses clinically relevant questions focusing on the most life-threatening or frequently occurring bleeding events, such as intracranial hemorrhage and gastrointestinal bleeding, and discusses the evidence for antiplatelet therapy resumption using individual risk assessment in high-risk cardiovascular disease patients.

Interdental Aids – A review

People brush their teeth for a variety of reasons: to feel revitalised and confident, to maintain a healthy smile, and to avoid bad breath and disease. Oral hygiene is critical for oral health preservation because it eliminates microbial plaque and prevents it from accumulating on teeth and gingivae. Control of the plaque is crucial for the management of periodontal diseases, but not all patients are at the same risk of disease development, and the difficulties depend on clinical findings. The clinical presentations and risk assessment for individual patients are to be adapted to the oral hygiene techniques and recommendations.Interdental aids are available in a variety of forms, including dental floss, interdental brushes, rubber tips, wooden tooth picks, water jets, and oral irrigators. Each of these options has distinct advantages and disadvantages. The appropriate interproximal cleaning aid is determined by the ease of use, the size of the interproximal space, the individual's acceptability, dexterity, and motivation. Thus, the dentist can make a recommendation based on the unique characteristics of each patient.

An Individualized EMT-Related Gene Signature to Predict Recurrence-Free Survival in Stage II/III Colorectal Cancer Patients.

Approximately 30% of stage II and 50-60% of stage III colorectal cancer (CRC) patients who have undergone surgery will develop recurrence within 5years. Thus, more reliable prognostic biomarkers are urgently needed to identify the high-risk subset of patients who will benefit from postoperative adjuvant therapy. We retrospectively analyzed 911 stage II/III CRC patients in multiple cohorts. Using a series of bioinformatic and statistical approaches, an individualized prognostic signature was established in the training cohort and validated in four other independent cohorts. An integrated decision tree was generated to improve risk stratification, and a nomogram was built to quantify risk assessment for individual patients. Epithelial-mesenchymal transition (EMT) was identified as a dominant risk factor for recurrence-free survival (RFS) in stage II/III CRC patients. The EMT-related gene signature could discriminate high-risk subsets in a training cohort and four independent validation cohorts (with 473, 89, 130, 74 and 145 patients, respectively). Survival analyses demonstrated that the EMT-related gene signature served as an independent risk factor for RFS in different subgroups. The decision tree could optimize the risk stratification, and the nomogram could predict the 5-year RFS probability accurately. The proposed EMT-related prognostic signature is a useful biomarker to predict RFS and identify the high-risk subset in stage II/III CRC patients.

Minimal Invasive Dentistry: An Emerging Trend

When first introduced, the term Minimal Intervention Dentistry (MID) referred to use of smaller and more conservative cavity preparations. Today, concept is much broader, being a philosophy of care related to risk assessment of individual patients, early detection of oral disease, targeted preventively orientated strategies and limited surgical intervention appropriate to level of disease1-3. “Extension for prevention” which was previously taught has been changed to “Prevention of extension”.
 Though concept of MID has been stressed upon for more than a decade, but its uptake has not been global. MID should be the standard of care in modern dentistry, as it avoids over-zealous restorative interventions as well as supervised neglect. As dental profession worldwide grapples with challenges of dealing with high rates of dental diseases in socially disadvantaged and medically compromised patients, it is even more important to incorporate these concepts into practice to deal with challenge of management of oral diseases. This review focuses on the concept and techniques of minimal invasive dentistry as an emerging trend in paediatric dentistry.
 Keywords: paediatric dentistry, MID

Imaging and circulating biomarkers: a united approach for secondary tricuspid regurgitation

Abstract Background Secondary tricuspid regurgitation (STR) is frequent among patients with heart failure with reduced ejection fraction (HFrEF), however inheres considerable diagnostic challenges. The assessment of circulating biomarkers reflecting neurohumoral activation may constitute a valuable supplement to the currently imaging-based diagnostic process. This study therefore sought to investigate (i) the expression of a set of complementary biomarkers in STR, (ii) to evaluate their association with STR severity, and (iii) to analyse whether the combination of neurohormone measurement and echocardiographic grading improves the individual patient risk assessment. Methods We included 576 HFrEF patients under guideline-directed therapy recording functional, echocardiographic, invasive hemodynamic and biochemical measurements, i.e. N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin, C-terminal pro-endothelin-1 (CT-pro-ET1) and copeptin. Results Plasma levels of aforementioned neurohormones were significantly rising with increasing STR severity (for all P<0.001). Among all measured biomarkers, CT-pro-ET1 and MR-proANP were closest related to severe STR, even after multivariate adjustment for established clinical confounders (adj. OR 1.46; 95% CI 1.11–1.91, P=0.006 and adj. OR 1.45, 95% CI 1.13–1.87, P=0.004, respectively). By means of individual outcome in patients with moderate to severe STR, adding the selected biomarkers (i.e. CT-pro-ET1 and MR-proANP) resulted in a substantial improvement in the discriminatory power regarding long-term mortality (C-statistic: 0.54 vs. 0.65, P<0.001; continuous NRI 57%, P<0.001). Conclusions Circulating biomarkers closely relate to STR severity and correlate with hemodynamic and morphologic mechanisms of STR. Specifically, MR-proANP and CT-pro-ET1 are closely linked to the presence of severe STR and a combined assessment with the guideline recommended echocardiographic grading leads to a significant improvement of individual risk stratification. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): FWF - Austrian Science Fund Graphical AbstractNeurohumoral profiles of STR

A pragmatic approach to risk assessment in pulmonary arterial hypertension using the 2015 European Society of Cardiology/European Respiratory Society guidelines

ObjectiveTo optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk...

Personalised Approach to Atherosclerotic Cardiovascular Disease: The Future is Here

This plenary session began with a focus on cutting edge research into the role of the immune system in atherosclerotic cardiovascular disease (ASCVD). Firstly, Chiara Giannerelli, New York University (NYU) Langone Health and NYU Grossman School of Medicine, New York, USA, emphasised the value of deep phenotyping of atherosclerotic disease to understand the immune mechanisms involved in cardiovascular (CV) risk. She presented data demonstrating an enrichment of phenotypically distinct cluster of differentiation (CD) 4+ and CD8+ T cells in advanced atherosclerotic plaque compared with paired blood and explained how this data can be used to identify drugs with the potential to be repurposed to reduce CV risk. Secondly, Eicke Latz, Institute of Innate Immunity, University of Bonn, Germany, presented data from his research team that begins to explain how the Western diet might lead to chronic inflammation and atherogenesis, implicating cholesterol crystals and short-chain sphingomyelins in the reprogramming of granulocyte-monocyte precursor cells (GMP) in this process. The arguments for greater use of imaging and molecular biomarkers in clinical practice were presented by Wolfgang Koenig, German Heart Center Munich, Technical University of Munich, Germany, who speculated that the assessment of CV risk in the future is likely to harness big data and machine learning to achieve accurate risk assessment in individual patients. Finally, Amit Khera, Massachusetts General Hospital, Boston, USA, covered the role of genetic factors in the prediction of CV disease (CVD), explaining that a combination of traditional risk factors and polygenic scoring techniques provides the most accurate estimation of CVD risk.

Construction and Validation of an Immune Infiltration-Related Gene Signature for the Prediction of Prognosis and Therapeutic Response in Breast Cancer.

Breast cancer patients show significant heterogeneity in overall survival. Current assessment models are insufficient to accurately predict patient prognosis, and models for predicting treatment response are lacking. We evaluated the relationship between various immune cells and breast cancer and confirmed the association between immune infiltration and breast cancer progression. Different bioinformatics and statistical approaches were combined to construct a robust immune infiltration-related gene signature for predicting patient prognosis and responses to immunotherapy and chemotherapy. Our research found that a higher immune infiltration-related risk score (IRS) indicates that the patient has a worse prognosis and is not very sensitive to immunotherapy. In addition, a new nomogram was constructed based on the gene signature and clinicopathological features to improve the risk stratification and quantify the risk assessment of individual patients. Our study might contribute to the optimization of the risk stratification for survival and the personalized management of breast cancer.

The application of thromboelastography in risk stratification for selective thromboembolism prophylaxis after total joint arthroplasty in Chinese: a randomized controlled trial.

As Asian populations, Chinese have a lower rate of high-risk gene mutations in venous thrombosis. Therefore, individual patient risk assessment, rather than a "blanket policy", is considered the best thromboembolism prophylaxis for Chinese. The purpose of this study was to evaluate the effectiveness and safety of selective thromboembolism prophylaxis compared with conventional thromboembolism prophylaxis by risk stratification with thromboelastography (TEG) after joint arthroplasty in Chinese. Between August 2016 to August 2017, Chinese patients who underwent hip or knee arthroplasty were randomly divided into a selective anticoagulation group (SAG) and a conventional anticoagulation group (CAG). Participants and outcome assessors were blinded. In the SAG, an anticoagulant was used when TEG indicated hypercoagulability; while in the CAG, an anticoagulant was regularly used until one month after surgery. Outcome evaluation included effectiveness (defined as the incidence of VTE), and safety (defined as the incidence of bleeding events, poor wound healing, blood loss, and infection). A total of 197 patients (79 in the SAG and 118 in the CAG) were included in the study. There was 1 case of deep vein thrombosis (DVT) in the SAG and 2 cases of DVT in the CAG, but there was no significant difference between the two groups. Hidden blood loss in the SAG was 707.4±539.8 mL and hidden blood loss in the CAG was 617±565.0 mL, respectively (P>0.05). No significant difference was observed in perioperative blood loss between the SAG and the CAG (1,024.9±597.9 and 1,139.3±620.9 mL, respectively). Volume of blood transfusion was 92.4±270.2 mL in the SAG and 224.6±416.3 mL in the CAG, respectively, while rate of transfusion was 13.9% in the SAG and 33.9% in the CAG, respectively, which were significantly different between the two groups (P<0.05). In Chinese patients who underwent hip or knee arthroplasty, the efficacy of selective anticoagulation using TEG in risk stratification was comparable to that of conventional anticoagulation. Furthermore, the safety of selective anticoagulant prophylaxis was superior to that of conventional anticoagulant prophylaxis.