Significant Difference In Survival Research Articles

Prolonged time from cross clamp until normothermic machine perfusion start is associated with increased risk of early allograft dysfunction following DCD liver transplant.

There is a paucity of data on the impact of cold ischemia time prior to the initiation of normothermic machine perfusion (NMP), particularly in more susceptible organs such livers from DCD donors. The present analysis aimed to investigate the impact of prolonged time from cross clamp until NMP start on early allograft dysfunction (EAD) and other peri-liver transplant (LT) outcomes. All DCD LT performed and placed on NMP at Mayo Clinic Arizona, Florida and Rochester from January 2022-March 2024 were included. The decision was made a priori to divide the population into 2 groups based on terciles: Typical Cross-clamp to On-pump time (lower 2 terciles) versus Prolonged Cross-clamp to On-pump Time (upper tercile; >2h 45.6min). 384 DCD LT undergoing NMP met the inclusion criteria. The rate of EAD was significantly higher in the Prolonged Cross-clamp to On-pump group (51.2%) compared to the Typical Cross-clamp to On-pump group (37.6%) (P=0.01). The Prolonged Cross-clamp to On-pump group also had higher rates of AKI and number of pRBCs transfused during LT. No significant difference in IC (2.0% vs. 1.5%;P=0.77) or graft survival at 12 months was seen between the Prolonged Cross-clamp to On-pump and Typical Cross-clamp to On-pump group, respectively. Following cross clamp, DCD liver grafts should be placed on the NMP pump as quickly as is safely and logistically possible. In cases where delays are unavoidable such as waiting for biopsy results or liver reallocation with another center, acceptable results can still be achieved and therefore livers with prolonged times should still be utilized.

Efficacy and safety of hypomethylating agents in the treatment of AML/MDS patients relapsed post allogenetic hematopoietic stem cell transplantation

IntroductionAcute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) constitute myeloid malignancies, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered as a potentially optimal approach for achieving a long term cure. However, post-allo-HSCT relapse remains a leading cause of mortality and therapeutic failure.MethodsTo evaluate the efficacy and safety of combining hypomethylating agents (HMAs) with Bcl-2 inhibitors in the treatment of AML/MDS relapse following allo-HSCT, we retrospectively collected data from 42 patients who experienced relapse between April 2012 and March 2022 at Peking University First Hospital. Among these patients, 21 underwent intensive chemotherapy (IC) alone, while the other 21 received treatment with HMAs after IC treatment, either alone or in combination with the Bcl-2 inhibitor venetoclax (VEN).ResultsThe median overall survival (OS) was 9 ± 2.153 months, and the one-year OS rate was 41.5%. The overall response rate (ORR) in the chemotherapy group and the IC+HMAs ± VEN group was 52.38% (11/21) and 76.19% (16/21), respectively, with no significant difference found (P=0.107). Kaplan-Meier analysis revealed a significant difference in OS between the chemotherapy group and the IC+HMAs ± VEN group in our retrospective cohort study (P=0.041, χ2= 4.016). Additionally, a significant difference in overall survival (OS) rates was observed between the two groups for patients categorized as intermediate/high risk (P=0.008). The secondary relapse rate was 45.45% (5/11) in the IC cohort and 25% (4/16) in the IC+HMAs ± VEN group, respectively, with no significant difference identified between the two cohorts (P=0.268). Furthermore, upon assessing the risk of graft-versus-host disease (GvHD), infection, and agranulocytosis, no notable differences were observed with the use of HMAs, suggesting that HMAs did not increase the risk. In the IC+HMAs ± VEN group, 7 patients received VEN in addition to HMAs, and no significant statistical difference was found in OS when comparing patients who received HMAs alone and those who received HMA+VEN (P=0.183), also, a statistically significant difference in OS was noted between the two groups whenaccounting for competing risks (P=0.028).ConclusionsThis retrospective study highlights the efficacy of IC+HMAs ± VEN in treating AML/MDS patients experiencing relapse post allo-HSCT, improving survival rates, especially for those classified as intermediate/high risk, with favorable tolerability.

Surgical outcomes of single-port vs multi-port laparoscopic hysterectomy for endometrial cancer: A systematic review and meta-analysis.

This study aimed to compare the surgical outcomes in patients with endometrial cancer who underwent either single-port laparoscopic hysterectomy (SPLH) or multi-port laparoscopic hysterectomy (MPLH). We conducted a systematic literature search from the earliest records available up to May 2023. The databases searched included PubMed, Embase, ClinicalTrials.gov, and the Cochrane Library. A total of 12 studies were included in the analysis. Both the SPLH and MPLH groups had similar operative times (MD = -4.27, 95% CI [-35.75, 27.22], p = 0.98), conversion rates (odds ratio [OR] = 1.43, 95% CI [0.57, 3.59], p = 0.44), blood transfusion rates, intraoperative complications (bladder injury, bowel injury, and vascular injury), and postoperative complications (umbilical hernia, fever, fistula, lymphocyst, and wound-related issues). However, the SPLH group showed significant advantages in certain areas. There was a notable reduction in estimated intraoperative blood loss (EBL) compared to the MPLH group (mean difference [MD] = -23.80, 95% CI [-42.99, -4.62], p = 0.02) and a shorter hospital stay duration (MD = -0.33, 95% CI [-0.46, -0.20], p < 0.00001). Although there was some debate about postoperative pain, SPLH tended to have more favorable outcomes. Despite these advantages, the SPLH group was less efficient in para-aortic lymph node clearance compared to the MPLH group (MD = -0.96, 95% CI [-1.57, -0.35], p = 0.002). No significant differences were observed in overall lymph node dissection (MD = -0.91, 95% CI [-2.52, 0.70], p = 0.27) and pelvic lymph node dissection (MD = -1.22, 95% CI [-3.82, 1.27], p = 0.36) between the two groups. Additionally, both groups showed similar therapeutic results, with no significant differences in overall survival (OS) and progression-free survival (PFS). SPLH and MPLH techniques are equally effective in treating endometrial cancer, with both showing low rates of surgical complications with similar rates of surgical complications and therapeutic outcomes. However, SPLH offers additional benefits, including smaller incisions, reduced estimated intraoperative blood loss, and shorter hospital stays, making it an increasingly popular option for treating endometrial cancer.

Characteristics and prognosis of small bowel tumors: A retrospective study.

Small bowel tumors (SBTs) are a heterogeneous group of difficult-to-diagnose tumors that account for 2%-5% of all gastrointestinal tumors. Single-balloon enteroscopy greatly enhances the diagnosis and treatment of SBTs. However, few epidemiological studies have been conducted in Taiwan to determine the clinical profile of SBTs. To investigate the clinical characteristics, managements and prognosis of SBTs in a medical center in Taiwan. The study enrolled 51 patients aged 58.9 ± 8.8 years (range, 22-93) diagnosed with SBTs from November 2009 to July 2021. We retrospectively recorded clinical characteristics, indications, endoscopic findings, pathological results, management, and outcomes for further analysis. A male preponderance was observed (56.8%). The most common indications were suspected small intestinal tumors (52.9%) and obscure gastrointestinal bleeding (39.2%). The most common tumor location was the ileum (41.2%). The performance of imaging studies (P = 0.004) and the types of findings (P = 0.005) differed significantly between malignant and benign SBTs. The most frequent imaging finding was a small intestinal mass (43.1%). The top three malignant tumor types were gastrointestinal stromal tumors (GISTs), adenocarcinomas, and lymphomas. Moreover, the proportions of benign and malignant tumors were 27.5% and 72.5%, respectively. The survival rates of patients with malignant tumors in the GIST and non-GIST groups differed significantly (P = 0.015). Kaplan-Meier survival analysis showed a significant difference in survival between patients in the malignant and benign groups (P = 0.04). All patients with lymphoma underwent chemotherapy (n = 7/8, 87.5%), whereas most patients with GISTs underwent surgery (n = 13/14, 92.8%). Patients with GISTs have a significantly higher survival rate than those with other malignant SBTs. Therefore, a large-scale nationwide study is warranted to evaluate the population-based epidemiology of SBTs.

Surgical approach to pulmonary metastases and its impact on prognosis.

Pulmonary metastasectomy (PM) is an important procedure for the treatment of metastatic nodules in the lung. The choice of surgical approach, whether thoracotomy or video-assisted thoracoscopic surgery (VATS), remains controversial in terms of the impact on patient prognosis. This study aimed to evaluate the outcomes and impact on survival of patients undergoing PM with VATS compared to thoracotomy. A retrospective evaluation of 136 patients who underwent PM between September 2012 and July 2020 was performed. Data on the demographics, primary tumor histopathology, metastatic features, surgical approach, surgical outcomes, and survival status were analyzed. Statistical analyses included descriptive statistics, survival analysis and Cox regression models. Of the participants, 84 underwent thoracotomy and 52 underwent VATS. The median survival time of thoracotomized patients was 86.6 months, while it was 99.6 months for VATS patients. A gender-specific analysis revealed a significantly longer survival time for female VATS patients compared to thoracotomy. Multivariate analysis showed significant independent effects of specific tumor types and the number of nodes removed on survival. Overall, no significant difference in survival was found between the 2 surgical methods. Both VATS and thoracotomy are effective and safe options for PM. Video-assisted thoracoscopic surgery may offer advantages, particularly in certain patient groups and tumor types, potentially prolonging survival. Gender-specific analyses suggest a survival benefit of VATS, particularly in women. Further studies are needed to validate these results and optimize surgical decision-making in PM.

The last generation: F3 of Echinometra sea urchins under experimental climate change

Ocean warming and acidification are a threat to calcifying marine invertebrates such as Echinoderms. Transgenerational plasticity may allow animals to respond to these conditions, but few studies exposing marine invertebrates to climate stressors over multiple generations exist. Here, data from the final (F2 post-settlement, F3 larvae and juveniles) generations in a long-term (> 6 yrs) experiment on the tropical sea urchin Echinometra sp. A. This commenced with exposing wild collected animals (F0 generation) and subsequent generations (larvae and adults both for F1 and F2) to control (present-day ambient) and climate change (CC) conditions (2 °C above ambient temperatures, 940 ppm pCO2). Survivorship in all F2 treatments (ranging from all generations being held at ambient conditions to all at elevated conditions) was high (> 50%). Some significant differences in survivorship existed among treatments, although there was no apparent relationship to CC conditions exposure time. There was also no difference in size among treatment groups in the F2 sea urchins up to 720d post-settlement. As in previous generations, the largest effect on adults was that males exposed to CC conditions have reduced reproductive potential, and there was a significant negative relationship with the number of generations exposed to future ocean conditions and spawning performance. Effects were extreme, in that we could only raise larvae from the control treatment, or those individuals kept for 0.5 generations (only F2 adults under climate change conditions). Larvae from both parental groups only reached settlement when raised under control conditions. Larval morphology also responded to treatment (reduced arm length under CC conditions) and exhibited negative parental effects (smaller arm and body lengths from parents under CC conditions). Thus, negative parental effects observed in earlier publications did not diminish over the following generations but, in some traits, increased. We therefore detected no evidence of transgenerational acclimation to future ocean conditions.

Does Adjuvant Radiotherapy Enhance Survival in Intracranial Solitary Fibrous Tumor Patients?

Intracranial solitary fibrous tumor (SFT) is a rare central nervous system (CNS) tumor that lacks a reliable prognostic clinical model. Uncertainty persists regarding the treatment outcomes of surgery and adjuvant radiotherapy (ART). To address this, we investigated the efficacy of ART and applied machine learning (ML) to develop accurate prognostic models. The SEER database was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five ML algorithms to predict 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of the models. We investigated the role of ART and surgery using Kaplan Meier survival analysis, competing risk analysis and BRACE method. The study population comprised 747 patients. Among them are 316 patients with "surgery" and 431 patients with "surgery + ART." The therapeutic groups showed significant differences in overall survival (OS). Multivariate Cox regression analysis revealed that older age and surgery alone were poor prognostic factors. The most significant prognostic factors were the local tumor excision, followed by lobectomy and age. Although ART did not lead to a substantial decrease in cancer-specific deaths, it did improve OS. This underscores the broader health benefits of ART, including effective management of comorbid conditions. Caution is advised when interpreting these survival benefits because of potential confounding factors in patient health and treatment management. Our web tool and ML models aid in clinical decision-making.

A predictive model for endometrial cancer recurrence based on molecular markers and clinicopathologic parameters: A double-center retrospective study.

The purpose of this study was to establish a predictive model for endometrial cancer (EC) recurrence based on commonly used molecular markers and clinicopathologic parameters. This was a double-center retrospective study. The data of patients were retrospectively collected from two tertiary hospitals in Chongqing, China. The patients were divided into training and validation cohorts according to the ratio of 7:3. In the training cohort, the factors related to the recurrence were screened through uni- and multivariate Cox regression analysis, and a nomogram was constructed based on this. Internal and external validation of the model was performed in two cohorts, respectively. In the training cohort, the optimal risk threshold of the model was determined by using the receiver operating characteristic (ROC) curve and the maximum value of the Youden index. A total of 1348 patients were included, including 944 in the training cohort and 404 in the validation cohort. Multivariate analysis suggested that ER expression, P53 expression and other clinicopathologic parameters, were significantly related to recurrence. On this basis, a nomogram was constructed to predict 1-, 3-, and 5-year recurrence-free survival (RFS) rate. The model had good predictive accuracy in both cohorts through the validation. The ROC curve and Youden index suggested that the optimal risk threshold of 3-year RFS rate predicted by the model was 0.83, and there was a significant survival difference between the high- and low-risk groups. Compared to traditional prediction models, the model proposed in this study that combined molecular indicators and clinicopathologic parameters can better predict the prognosis of EC patients.

Does Method of Field Preparation Affect Survival and Growth of Juvenile Chinook Salmon in Agricultural Floodplains?

ABSTRACTThere is growing interest to integrate conservation initiatives into agricultural practices using a reconciliation ecology framework. In California's Central Valley, one approach to improving crucial nursery habitat for threatened and endangered fish species is by re‐creating floodplain habitats through the inundation of agricultural fields during the non‐growing season. We conducted a series of field experiments in agricultural floodplains (winter‐flooded rice fields that historically were natural floodplains) to examine whether different field preparation methods enhanced growth and survival of floodplain‐dependent fish species. Approximately 8000 juvenile fall‐run Chinook Salmon (Oncorhynchus tshawytscha) were reared for at least 28 days on eight, 0.2 hectares (ha) experimental fields. Each experimental field represented one of four treatments (two replicates per treatment): addition of large wood, addition of in‐field canals, addition of both large wood and in‐field canals, and control. Controls fields received no additional field preparations beyond standard post‐growing practices: that is chopping rice into stubble, baling, and removing excess rice straw, and discing the field with a single pass by plowing rice straw into the ground to promote decomposition. We found no significant difference in water temperature, fish growth or fish survival among habitat treatments. Across treatments, survival ranged from 50.1% to 78.3% and averaged 65.75% (+/− 7.89% SE). These findings suggest agricultural floodplains require no additional modifications to promote fish growth and survival. Results illustrate the benefits of integrating working landscapes with conservation initiatives, as this approach creates more accessible and beneficial habitat for native fish species.

Clinical and prognostic effects of microvascular density and FOXP3 positive T cells in breast cancer

There are conflicting data regarding the prognostic effect of microvascular density (MVD) in breast cancer and its molecular subtypes. It is thought that high levels of FOXP3 + T cells in breast cancer are associated with poor prognosis. However, data regarding FOXP3 show significant variability in the literature. In our study, we aim to measure MVD and FOXP3 + T cells in breast cancer cases and investigate their relationship with each other and their effects on breast cancer patients’ clinical and prognostic features. In our study, the results of 207 female breast cancer patients whose excisional tumoral tissue was obtained are presented. The study evaluated the findings under a light microscope using antibodies against CD34 for measuring MVD and FOXP3 for measuring FOXP3-positive T cells. CD34 ≥ 17 was categorized as high MVD, and CD34 < 17 was classified as low MVD. FOXP3 + cell count ≥ 20/mm2 was categorized as high FOXP3 positivity and < 20/mm2 as low FOXP3 positivity. The SPSS program (version 22) was used to evaluate the results statistically, and p < 0.05 was considered significant. The median age was 54.0 (27–86) years, and the median follow-up period was 60.0 (IQR: 42.6–86.5) months. In the high MVD group, a higher progesterone receptor (PR) positivity rate was detected (p = 0.035). High FOXP3 positivity was significantly associated with high nuclear grade (p = 0.003). High FOXP3 positivity was significantly associated with PR negativity and high Ki67 values ​​(p = 0.009, p = 0.012, respectively). No statistically significant correlation was found between MVD elevation and FOXP3 positivity (r = 0.063, p = 0.36). A weakly significant positive correlation was detected between high Ki67 and FOXP3 positivity (r = 0.0146, p = 0.04). A weak inverse correlation was detected between high FOXP3 positivity and PR percentage values ​​(r=-0.182, p = 0.01). While there was no significant difference in disease-free survival in cases with high MVD and high FOXP3 + T cells compared to groups with low levels, the results were not mature enough because the median values ​​in overall survival could not be reached. A significant correlation was found between high FOXP3 positivity and some aggressive tumor features; no effect on survival was detected. In contrast to literature data on luminal A breast cancer, high MVD in the luminal B (HER2-) subgroup was associated with a lower risk of recurrence. Our study is the first in the literature to evaluate the relationship between MVD measured using CD34 and FOXP3 positive T cells in breast cancer. Our study found no correlation between MVD and FOXP3 positivity, while literature data show significant correlations in some other cancers.

Machine learning approach identifies inflammatory gene signature for predicting survival outcomes in hepatocellular carcinoma

BackgroundHepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide, often linked to chronic inflammation. Our study aimed to probe inflammation pathways at the genetic level and pinpoint biomarkers linked to HCC patient survival.MethodsWe analyzed gene transcriptome data from 246 resectable stage I and II HCC patients from The Cancer Genome Atlas (TCGA). After selecting 917 inflammation-related genes (IRGs), we identified 104 differentially expressed genes (DEGs) through differential expression analysis. Two significant prognostic DEGs, S100A9 and PBK, were identified using LASSO and Cox regression, forming the basis of a risk score model. We conducted functional enrichment and immune landscape analyses, validated our findings on 170 patients from the GSE14520 dataset, and performed mutational analysis using TCGA somatic mutation data.ResultsWe analyzed 296 samples (246 HCC, 50 normal liver), showing significant survival differences between high and low-risk groups based on our risk score model. Functional enrichment analysis unveiled inflammation-associated pathways. Validation using the GSE14520 dataset confirmed our risk score’s predictive ability, and we explored clinical correlations.ConclusionOur study delineates inflammation-related genomic changes in HCC, unveiling prognostic biomarkers with potential therapeutic implications. These findings deepen our understanding of HCC molecular mechanisms and may guide personalized therapeutic approaches, ultimately improving patient outcomes.

Comparative analysis of the safety and feasibility of laparoscopic and open approaches for right anterior sectionectomy

Laparoscopic hepatectomy has minimally invasive advantages, but reports on laparoscopic right anterior sectionectomy (LRAS) are rare. Herein, we try to explore the benefits and drawbacks of LRAS by comparing it with open right anterior sectionectomy (ORAS). Between January 2015 and September 2023, 39 patients who underwent LRAS (n = 18) or ORAS (n = 21) were enrolled in the study. The patients’ characteristics, intraoperative details, and postoperative outcomes were compared between the two groups. No significant differences in the preoperative data were observed between the two groups. The LRAS group had significantly lesser blood loss (P = 0.019), a shorter hospital stay (P = 0.045), and a higher rate of bile leak (P = 0.039) than the ORAS group. There was no significant difference in the operative time (P = 0.156), transfusion rate (P = 0.385), hospital expenses (P = 0.511), rate of other complications, postoperative white blood cell count, and alanine aminotransferase and aspartate aminotransferase levels between the two groups (P > 0.05). Beside, there was no significant difference in disease-free survival (P = 0.351) or overall survival (P = 0.613) in patients with hepatocellular carcinoma between the two groups. LRAS is a safe and feasible surgical procedure. It may be preferred for lesions in the right anterior lobe of the liver.

Open window mapping with extended early meets late algorithm vs. conventional mapping for accessory pathway ablation.

Catheter ablation of accessory pathway is the treatment of choice for patients with symptomatic Wolff-Parkinson-White (WPW) syndrome. Accessory pathway (AP) identification relies on point-by-point mapping, raising the need for more precise and efficient methods. High-density open window mapping (OWM) combined with the extended early meets late (EEML) algorithm, utilizing 3D electroanatomic mapping systems, is a promising alternative. However, its role in clinical practice lacks comprehensive investigation, necessitating a comparison with conventional mapping. A prospective cohort study of patients referred for AP ablation evaluated the OWM strategy, comparing it with a retrospective cohort using conventional mapping. Procedure variables, including radiofrequency (RF), fluoroscopy, mapping and procedure times along with total mapping points were compared. Long-term recurrence rates were assessed. 42 patients in the OWM group and 34 in the conventional group were included. The OWM strategy exhibited a significantly lower total mapping time (p = 0.030) despite acquiring more points (p < 0.001) than the conventional group. OWM was associated with reduced fluoroscopy time (12.0 (9.0-16) vs. 19 (11-30) minutes, p = 0.009) and RF time (p = 0.021). Long-term recurrence rates were comparable between groups (7.1% OWM vs. 17.7% conventional mapping, p = 0.284). At a median follow-up of 16.2 (4.6-39.4) months there were not significant differences in recurrence-free survival (p = 0.509). OWM with the EEML algorithm is a feasible tool for precise AP location and ablation, associated with less fluoroscopy time, RF time, and total mapping time. Long-term recurrence rates were similar to conventional mapping. Prospective studies are warranted for further validation.

Unraveling molecular signatures and prognostic biomarkers in glioblastoma: a comprehensive study on treatment resistance and personalized strategies

BackgroundGlioblastoma (GBM) is a highly aggressive primary brain tumor with limited treatment success and poor prognosis. Despite surgical resection and adjuvant therapies, GBM often recurs, and resistance to radiotherapy and temozolomide presents significant challenges. This study aimed to elucidate molecular signatures associated with treatment responses, identify potential biomarkers, and enhance personalized treatment strategies for GBM.MethodsWe conducted a comprehensive analysis using the Gene Expression Omnibus (GEO) and The Cancer Genome Atlas (TCGA) databases. The GEO dataset (GSE206225) was used to identify differentially expressed genes (DEGs) between radiation-sensitive/resistant and temozolomide-sensitive/resistant GBM samples. TCGA data were utilized for subsequent analyses, including Lasso-Cox regression, risk score model construction, Kaplan–Meier survival analysis, and gene set enrichment analysis (GSEA). Hub genes were identified through survival analysis, and a gene prognostic nomogram was developed. Additionally, validation of the three-gene risk signature through multiple external cohorts and validation of protein expression levels were performed.ResultsDEG analysis identified 111 genes associated with chemoradiotherapy resistance, providing insights into the complex landscape of GBM treatment response. The risk score model effectively stratified patients, showing significant differences in overall survival and progression-free survival. GSEA offered a deeper understanding of pathway activities, emphasizing the intricate molecular mechanisms involved. NNAT, IGFBP6, and CYGB were identified as hub genes, and a gene prognostic nomogram demonstrated predictive accuracy.ConclusionThis study sheds light on the molecular intricacies governing GBM treatment response. The identified hub genes and the gene prognostic nomogram offer valuable tools for predicting patient outcomes and guiding personalized treatment strategies. These findings contribute to advancing our understanding of GBM biology and may pave the way for improved clinical management.

Clinical features of vulvar and vaginal malignant melanomas and the effects of immune checkpoint inhibitors in Japanese patients: a single-center, retrospective cohort study.

Vulvar and vaginal melanomas (VVMs) are rare malignancies, but they are relatively more common among Asian women. This makes the collection of data on VVMs in this population crucial. Moreover, no cohort studies have examined and compared the effects of immune checkpoint inhibitors (ICIs) on VVM in Asian women. Therefore, we aimed to investigate the clinical characteristics of VVMs in Japanese women and the effects of ICI treatment. This single-center, retrospective cohort study included patients who were histologically diagnosed with VVM at our hospital between March 2005 and December 2023. The Kaplan-Meier analysis was used to compare the prognosis of vulvar melanoma (VuM) and vaginal melanoma (VaM) throughout entire treatments and compare the efficacies of ICIs and conventional chemotherapies in VVM. In total, 28 women with VuM (n = 14) and VaM (n = 14) were included. There were no significant differences in overall survival (OS) [median OS: not reached (95% confidence interval (CI), 13.2-NA) vs. 30.2 months (95% CI, 23.2-NA), log-rank test, P = 0.456] between the VuM and VaM groups. The progression-free survival (median progression-free survival: 14.7 vs. 5.2 months, P = 0.002) and OS (median OS: 33.8 vs. 7.2 months, P < 0.001) were significantly better for the ICI-treated group than for the conventional chemotherapy-treated group in VVM. The prognosis of patients with VVM improved significantly with the advent of ICI, demonstrating the importance of ICI in the treatment of VVM.

Western corn rootworm resistance in maize persists in the absence of jasmonic acid.

Larva growth, survival, and development speed were not affected by the absence of jasmonic acid (JA) indicating that JA does not have a direct role in maize resistance to western corn rootworm. Jasmonic acid (JA) is a plant hormone that regulates multiple physiological processes including defense against herbivory by chewing insects. Previous research showed its importance for resistance to aboveground herbivory. While few studies have investigated the role of JA in resistance to belowground root-feeding herbivores, none has directly tested the role of JA in such resistance. In this study, we used an opr7opr8 double mutant to directly test the role of JA in resistance to western corn rootworm (Diabrotica virgifera virgifera, WCR), a devastating and specialist pest of maize. The opr7opr8 double mutant is deficient in JA accumulation as we found that it does not accumulate JA nor JA-Ile independently of exposure to WCR. We found no significant difference in growth (body mass), survival, and development of WCR larvae in response to JA deficiency, suggesting that disruption of JA biosynthesis does not impact resistance in maize roots to WCR. Additionally, we observed no significant effect on loss of root tissue caused by WCR associated with JA deficiency, while we found a reduction in shoot growth (mass) associated with WCR herbivory in the opr7opr8 mutant that was not observed in the wildtype. This suggested a role for JA in aboveground growth response to WCR herbivory rather than resistance to WCR.

Deep Multiple Instance Learning Model to Predict Outcome of Pancreatic Cancer Following Surgery

Background/Objectives: Pancreatic ductal adenocarcinoma (PDAC) is a cancer with very poor prognosis despite early surgical management. To date, only clinical variables are used to predict outcome for decision-making about adjuvant therapy. We sought to generate a deep learning approach based on hematoxylin and eosin (H&amp;E) or hematoxylin, eosin and saffron (HES) whole slides to predict patients’ outcome, compare these new entities with known molecular subtypes and question their biological significance; Methods: We used as a training set a retrospective private cohort of 206 patients treated by surgery for PDAC cancer and a validation cohort of 166 non-metastatic patients from The Cancer Genome Atlas (TCGA) PDAC project. We estimated a multi-instance learning survival model to predict relapse in the training set and evaluated its performance in the validation set. RNAseq and exome data from the TCGA PDAC database were used to describe the transcriptomic and genomic features associated with deep learning classification; Results: Based on the estimation of an attention-based multi-instance learning survival model, we identified two groups of patients with a distinct prognosis. There was a significant difference in progression-free survival (PFS) between these two groups in the training set (hazard ratio HR = 0.72 [0.54;0.96]; p = 0.03) and in the validation set (HR = 0.63 [0.42;0.94]; p = 0.01). Transcriptomic and genomic features revealed that the poor prognosis group was associated with a squamous phenotype. Conclusions: Our study demonstrates that deep learning could be used to predict PDAC prognosis and offer assistance in better choosing adjuvant treatment.

Unicompartmental knee arthroplasty implant survival in patients with borderline indications.

In the literature, 80% to 92% of patients are satisfied with their medial femorotibial unicompartmental knee arthroplasties (UKAs). These results are associated with a 10-year implant survival rates ranging from 94% to 98% in various studies. Such outcomes are generally reported after excluding patients with obesity, chronic anterior instability, frontal deformities, or preoperative knee flexion deformities exceeding 10 °. These contraindications remain controversial in the literature. The primary objective of this study was to compare the survival rates of implants used for medial femorotibial UKA performed under borderline indications with those of procedures performed under conventional indications and to identify the prognostic factors for revision surgery. We hypothesized that the survival of medial femorotibial UKAs is not impacted by these contraindications. This was a retrospective, single-center, observational, epidemiological study. All consenting patients who underwent medial femorotibial UKA between 2009 and 2015 were included. Patients who underwent other types of arthroplasties concurrently were excluded. The primary evaluation criterion was implant survival, which was characterized by no need for revision surgery. The borderline indications were defined as follows: obesity (Body Mass index BMI > 30), anterior cruciate ligament (ACL) deficiency, preoperative lower limb frontal deviation ≥10 °, or preoperative flexion deformity ≥10 °. A total of 468 patients were included, and the average follow-up duration was 8.5 years [7.1; 10.3]. Among them, 270 (57.7%) underwent UKA under at least one borderline indication, whereas 198 (42.3%) underwent UKA under conventional indications. Forty revision surgeries were recorded, and the average time to revision surgery was 26 months. No statistically significant difference in survival was observed between patients with borderline indications and those with conventional indications. Multivariate analysis revealed that obesity (HR = 3.0 [1.5-5.7]) and ACL deficiency (HR = 3.5 [1.4-8.8]) significantly increased the risk of revision surgery. This study revealed no significant difference in survival between UKAs performed under borderline versus conventional indications. Larger studies are needed to confirm these findings. IV; retrospective observational study. Mots clés: genou, arthroplastie, obésité, ostéoarthrite, survie.

CT-Based Lung Size Matching in Delayed Chest Closure for Systemic Sclerosis Lung Transplantation.

Delayed chest closure (DCC) during lung transplantation (LTx) is a controversial surgical approach that lacks research in systemic sclerosis (SSc) patients. We investigated outcomes, clinical risk factors, and CT-based lung size-matching parameters associated with DCC in SSc recipients. This retrospective study included 92 SSc recipients (age 51 years ± 10, 56/92 (61.0%) females) who underwent bilateral LTx between 2007 and 2020. Of the recipients, 34.8% (32/92) underwent DCC. Recipient lung and chest cavity volumes were automatically computed from CT imaging using deep learning algorithms. Survival between groups was compared using Kaplan-Meier analysis. Multivariate logistic regression was used to identify risk factors and predict DCC occurrence using preoperative variables. Recipients who underwent DCC had longer total vent duration (p=0.001), more use of postoperative mechanical support (p=0.001), longer ICU length of stay (p=0.008), and lower incidence of pneumonia post-operation (p=0.031). No significant difference in survival was observed between DCC and PCC recipients at 30 days (p = 0.713), 90 days (p = 0.267), 1 year (p = 0.941), and 5 years (p = 0.651). Clinical risk factors for DCC included BMI >30kg/m2 (p = 0.009), tracheostomy (p = 0.002), atrial fibrillation (p = 0.012), decreased preoperative FEV1/FVC (p=0.013), and previous chest operation (p = 0.020). Two CT-based measurements of lung matching were significantly associated with DCC occurrence (p = 0.021 and 0.050). The regression model achieved a mean AUC of 0.82 (0.70, 0.94) in retrospectively predicting DCC occurrence. SSc recipients undergoing DCC have similar survival rates but experience more complications than PCC recipients. Clinical risk factors and CT-based size matching can be leveraged to predict DCC pre-transplant.

Vitamin D supplementation can improve the 28-day mortality rate in patients with sepsis-associated acute kidney injury.

Vitamin D levels are generally lower in septic patients and are associated with poor prognosis. Observational studies suggest improved renal recovery in acute kidney injury (AKI) patients with increased vitamin D levels. Still, large RCTs did not show significant clinical benefits, possibly due to the limited number of sepsis or AKI patients included. This study aimed to examine the impact of vitamin D supplementation on 28-day all-cause mortality in patients with sepsis-associated acute kidney injury (S-AKI). A retrospective cohort study was conducted using data from the MIMIC-IV (v2.0) database, which included 18,713 ICU patients with S-AKI. Propensity score matching (PSM) was used to adjust for confounding factors, and multivariate Cox regression was employed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Patient survival and clinical characteristics will be assessed utilizing Kaplan-Meier curves, with comparisons conducted using the log-rank test. Kaplan-Meier survival analysis revealed significant differences in survival between the groups. Multivariate Cox regression indicated a reduced risk of 28-day mortality associated with vitamin D supplementation (HR: 0.73, 95% CI: 0.67-0.80, p < 0.001). The results after PSM were consistent with those of the original cohort. Similar results were observed for in-hospital mortality and 90-day mortality. The Restricted Cubic Spline curve (RCS) indicated an increasing trend in the therapeutic effect of vitamin D with increasing SOFA score. Vitamin D supplementation is associated with decreased all-cause mortality in patients with S-AKI, and those with more severe conditions may benefit even more.