Univariate Analysis Research Articles

Characteristics of regional lymph node metastasis in breast cancer and construction of a nomogram model based on ultrasonographic analysis: a retrospective study.

The ultrasonographic characteristics of lymph node metastasis in breast cancer patients were retrospectively analyzed, and a predictive nomogram model was constructed to provide an imaging basis for better clinical evaluation. B-mode ultrasound was used to retrospectively analyze the imaging characteristics of regional lymph nodes and tumors. Pathological examination confirmed the presence of lymph node metastasis in breast cancer patients. Univariable and multivariable logistic regression analyses were performed to analyze the risk factors for lymph node metastasis. LASSO regression analysis was performed to screen noninvasive indicators, and a nomogram prediction model was constructed for breast cancer patients with lymph node metastasis. A total of 187 breast cancer patients were enrolled, including 74 patients with lymph node metastasis in the positive group and 113 patients without lymph node metastasis in the negative group. Multivariate analysis revealed that pathological type (OR = 4.58, 95% CI: 1.44-14.6, p = 0.01), tumor diameter (OR = 1.37, 95% CI: 1.07-1.74, p = 0.012), spiculated margins (OR = 7.92, 95% CI: 3.03-20.67, p < 0.001), mixed echo of the breast tumor (OR = 37.09, 95% CI: 3.49-394.1, p = 0.003), and unclear lymphatic hilum structure (OR = 16.07, 95% CI: 2.41-107.02, p = 0.004) were independent risk factors for lymph node metastasis. A nomogram model was constructed for predicting breast cancer with lymph node metastasis, incorporating three significantly correlated indicators identified through LASSO regression analysis, namely, tumor spiculated margins, cortical thickness of lymph nodes, and unclear lymphatic hilum structure. The receiver operating characteristic (ROC) curve revealed that the area under the curve (AUC) was 0.717 (95% CI, 0.614-0.820) for the training set and 0.817 (95% CI, 0.738-0.890) for the validation set. The Hosmer-Lemeshow test results for the training set and the validation set were p = 0.9148 and p = 0.1648, respectively. The prediction nomogram has good diagnostic performance. B-mode ultrasound is helpful in the preoperative assessment of breast cancer patients with lymph node metastasis. The predictive nomogram model, which is based on logistic regression and LASSO regression analysis, is clinically safe, reliable, and highly practical.

Molecular characteristics of NPM1 mutations in AML patients using targeted NGS

ABSTRACT Background Acute myeloid leukemia (AML) is a clonal hematopoietic stem cell malignancy characterized by the accumulation of myeloid progenitor cells with arrested differentiation, leading to the suppression of normal hematopoiesis. The disease exhibits significant heterogeneity, with less than 30% five-year overall survival. Nucleophosmin 1 (NPM1) is the most commonly mutated gene in adult AML, found in approximately 25–35% of patients, and is recognized as a distinct subtype by the WHO. Methods The mutational status of NPM1 was assessed using the Oncomine Myeloid research panel on the Ion5S NGS platform (Thermo Fisher Scientific, USA). Results In our AML cohort, NPM1 was the most frequently mutated gene (75%). Indel mutations in the NPM1 gene, frequently resulting in frameshift consequences, show a statistically significant difference in variant allele frequency (VAF) compared to other mutation types. Specifically, NPM1-mutated cases exhibit a VAF that is positively correlated with initial bone marrow (BM) blast counts. Univariate logistic regression analysis reveals that a high VAF is significantly associated with non-complete remission (Non-CR), while a low VAF is significantly associated with complete remission (CR), indicating a statistically significant difference in outcomes (p = 0.012). Conclusion Targeted NGS technology enables the simultaneous analysis of multiple AML-relevant genes, offering a comprehensive mutational profile that supports risk stratification, diagnosis, and personalized treatment. Our findings highlight the significant impact of NPM1 mutations on patient outcomes, revealing their molecular characteristics and their correlation with different clinical parameters.

A novel cervical vertebral bone quality score can independently predict cage subsidence after anterior cervical corpectomy and fusion.

To optimize cervical vertebral bone quality (C-VBQ) score and explore its effectiveness in predicting cage subsidence in Anterior Cervical Corpectomy and Fusion (ACCF) and identify a new method for evaluating subsidence without different equipment and image scale interference. Collecting demographic, imaging, and surgical related information. Measuring Cage Subsidence with a new method. Multifactorial logistic regression was used to identify risk factors associated with subsidence. Pearson's correlation was used to determine the relationship between C-VBQ and computed tomography (CT) Hounsfield units (HU). The receiver operating characteristic (ROC) curve was used to assess C-VBQ predictive ability. Correlations between demographics and C-VBQ scores were analyzed using linear regression models. 92 patients were included in this study, 36 (39.1%) showed subsidence with a C-VBQ value of 2.05 ± 0.45, in the no-subsidence group C-VBQ Value was 3.25 ± 0.76. The multifactorial logistic regression showed that C-VBQ is an independent predictor of cage subsidence with a predictive accuracy of 93.4%. Pearson's correlation analysis showed a negative correlation between C-VBQ and HU values. Linear regression analysis showed a positive correlation between C-VBQ and cage subsidence. Univariate analyses showed that only age was associated with C-VBQ. The C-VBQ values obtained using the new measurements independently predicted postoperative cage subsidence after ACCF and showed a negative correlation with HU values. By adding the measurement of non-operated vertebral heights as a control standard, the results of cage subsidence measured by the ratio method are likely to be more robust, perhaps can exclude unavoidable errors caused by different equipment and proportional.

Simalungun Batak Family Support for Elderly Independence

Aging is an event that will be experienced by everyone who is blessed with a long life. Biologically, elderly people experience a continuous aging process characterized by decreased physical resistance to disease. These various changes often cause elderly people to experience problems in facing life, so family support is needed. This study aims to analyze the influence of Simalungun Batak family support on the independence of the elderly in the working area of the Haranggaol Community Health Center. Type of quantitative research with a cross-sectional approach. The subjects were 149 elderly people who lived at home with family members in Harangaol who were selected using purposive sampling. The instrument was adopted and modified from existing family support, and elderly independence questionnaires and validity and reliability tests were carried out on 30 subjects with r-table &gt;.361, with Cronbach's alpha reliability of .761. The results of the univariate analysis show that the majority of emotional family support is in the excellent category 68 (46%), the appreciation family support is good 63 (43%), the informational family support is sufficient 100 (67%) the instrumental family support is good 75 (50%), the total independence of the elderly is 96 (65%). The Pearson product-moment analysis results show a significant relationship between emotional, appreciative, informational, and instrumental family support and the independence of the elderly. There is a significant relationship between emotional family support, appreciation family support, informational family support, and instrumental family support for the independence of the elderly at the Haranggaol Health Center. It is recommended that the family support the elderly in participating in integrated services, elderly activities, and customary activities to maintain the elderly's level of independence in fulfilling daily living activities.

Risk Factors for Postoperative Delirium in Thoracic Surgery Patients – A Prospective Cross-sectional Study

Background: Postoperative delirium (POD) is a common complication that affects the prognosis and outcome. The risk factors of different surgical types have significance in preventing POD. Still, there are few studies on the risk factors for this complication of thoracic surgery, and further research and exploration are necessary. Method: This study intends to conduct a prospective cross-sectional study, including patients undergoing elective thoracic surgery. The primary outcome is the incidence of POD 1-7 days after surgery or before discharge. The essential information on patients, surgery, anesthesia, and postoperative details are gathered for statistical analysis. We are exploring the potential relationship between anesthesia-related factors and POD. Result: One hundred seventy-five patients were included in this study, and 17 (9.7%) patients developed POD. Univariate analysis showed that age-adjusted Charlson Comorbidity Index (aCCI), educational attainment, blood transfusion, artificial blood vessel replacement, and indwelling urinary catheter were statistically different. Logistic regression results showed that the aCCI index (OR 1.811, 95% CI 1.058-3.103; P=0.030), the ambulation time (OR 12.303, 95% CI 2.670-56.686; P=0.001) increased POD risk. In patients undergoing thoracotomy, blood transfusion (RR 16.875, 95% CI 2.149-132.508; P=0.012) was statistically different between POD and non-POD groups. Conclusion: The results of this study showed that the higher the aCCI index, the later the ambulation time is the risk factor for POD in thoracic surgery patients. The risk of POD may be heightened in thoracic surgery patients who require a blood transfusion. However, additional research is warranted to confirm these findings.

The Influence of Health Education Using Brainstorming Method About Exclusive Breastfeeding on Breastfeeding Mother's Knowledge in PMB D Bogor District in 2023

Health education is expected to increase the knowledge of breastfeeding mothers in exclusive breastfeeding. West Java Health Profile in 2017 the coverage of exclusive breastfeeding in Bogor Regency was 22.84%. Mother's knowledge can influence exclusive breastfeeding. To determine the effect of health education using the brainstorming method about exclusive breastfeeding on the knowledge of breastfeeding mothers at PMB D Bogor Regency in 2023. This study used a one group pre-test post-test pre-experimental research design. Analytical research method with cross sectional design. Total population of 35 people with a sample of 32 people. The sampling technique used was purposive sampling, and bivariate data analysis used the assisted t-test. The results of the univariate analysis showed that the respondents were aged 20-35 years (84.4%), high school (78.1%), housewife (90.6%), the knowledge of breastfeeding mothers before being given health education using the brainstorming method was mostly lacking (43.8%), the knowledge of breastfeeding mothers after being given health education using the brainstorming method was mostly good (65.6%). The results of the bivariate analysis showed that there was an effect of health education using the brainstorming method about exclusive breastfeeding on increasing the knowledge of breastfeeding mothers with a p-value of 0.000 &lt;0.05. There is an effect of health education using the brainstorming method about exclusive breastfeeding on increasing the knowledge of breastfeeding mothers.

Risk factors analysis and prediction model construction of major adverse cardiovascular events in pregnant women with valvular heart disease

Objective: To analysis the risk factors for major adverse cardiovascular event (MACE) in pregnant women with valvular heart disease (VHD) and to construct a risk prediction model. Methods: The clinical data of 245 pregnant women with VHD who were hospitalized in Beijing Anzhen Hospital from January 1, 2012, to June 1, 2023 were retrospectively analyzed, including general information, pre-pregnancy and pregnancy-associated cardiac conditions, and MACE. Univariate analysis and logistic regression models were employed to identify risk factors for MACE during pregnancy among pregnant women with VHD. Furthermore, a predictive model was constructed and internal validation was conducted using bootstrap techniques. Results: (1) Among 245 pregnant women with VHD, the incidence of MACE was 18.0% (44/245), and the most common MACE was heart failure (61.4%, 27/44). The mitral valve was the most frequently affected valve (64.9%, 159/245). Prior to pregnancy, the most common type of valve surgery undertaken was mechanical valve replacement, representing 31.4% (77/245) of surgeries. In contrast, among those pregnant women who did not undergo valve surgery before pregnancy, the most common lesion type was mitral regurgitation (17.6%, 43/245). (2) Comparing the maternal and infant outcomes of warfarin, low molecular weight heparin (LMWH) and LMWH sequential with warfarin, the fetal loss rate (36%, 15/42) and malformation rate (7%, 3/42) were the highest, but the MACE rate (12%, 5/42) was the lowest in warfarin group. The fetal loss rate (1/19), malformation rate (1/19) and artificial valve thrombosis rate (0) of LMWH sequential with warfarin were the lowest, and the fetal loss rate and artificial valve thrombosis rate of the three anticoagulation methods were statistically significant (all P<0.05). (3) There were no significant differences in gestational age, age of diagnosis of heart disease, weight at delivery, pre-pregnancy body mass index, proportion of multiparous women and chronic medical history between women with MACE and those without MACE (all P>0.05). (4) Binary logistic regression analysis identified the following as risk factors for MACE during the second trimester of pregnancy among pregnant women with VHD: pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade Ⅴ, anticoagulation with LMWH during pregnancy, and arrhythmia (all P<0.05). Based on the results of multivariate analysis, a receiver operating characteristic curve was constructed, with an area under the curve of 0.837, indicating good discriminative ability. The calibration plot demonstrated a close alignment between the standard curve and the calibration prediction curve, suggesting excellent calibration of the model. Conclusions: Pregnant women with VHD are at a high risk of experiencing MACE during gestation. Five risk factors, including pre-pregnancy cardiac symptoms, history of corrective surgery for congenital heart disease, pregnancy risk grade Ⅴ, anticoagulation with LMWH, and arrhythmia, could aid in identifying high-risk pregnant women.

Age and sex-specific risk in fractures with Down syndrome in a retrospective case-control study from Germany.

The increasing life expectancy of individuals with Down syndrome has led to a growing awareness of mid- and late-life conditions. Based on the Disease Analyser database (IQVIA), this retrospective cohort study compared adults ≥18years of age with Down syndrome (ICD-10: Q90) in general practices in Germany with a propensity score-matched cohort without Down syndrome. The outcome was the first diagnosis of a fracture within 5years of the index date. The cumulative incidence of fractures over a 5-year period was presented using Kaplan-Meier curves. Univariable Cox regression analyses by age group and sex were performed to assess the association between Down syndrome and fractures. A total of 2547 individuals with Down syndrome and 12735 individuals without Down syndrome were included in the study. A significantly higher cumulative fracture incidence within 5years was observed in the age group 51-60years (9.3% Down syndrome vs. 4.8% without Down syndrome, P=0.003) as well as in the age group >60years (20.3% Down syndrome vs. 8.6% without Down syndrome, P<0.001) compared with the cohort without Down syndrome. Regression analysis showed a significant association between Down syndrome and fracture risk in women with Down syndrome aged 51-60years (hazard ratio [HR]=1.60; 95% confidence interval [CI]: 1.13-2.26), and in those aged 51-60years (HR=2.08; 95% CI: 1.27-3.41) and >60years (HR=2.98; 95% CI: 1.87-4.73)), but not in men. When comparing fractures in individuals with and without Down syndrome, shoulder and arm fractures were most common in the Down syndrome cohort. The results of our study indicate a positive association between individuals with Down syndrome and subsequent fractures in women and those aged >50years. Prevention of falls appears to be particularly important in these populations. However, future studies should clarify the extent to which socio-economic factors, such as housing, play a role in this context.

Nutrition Education and Nutritional Status of Chronic Lack of Energy Pregnant Women in PUSKESMAS Work Areas Throughout Kupang City

One of the indirect causes of preventable maternal and child mortality is the health status of pregnant women. Pregnant women with SEZ conditions are at risk of experiencing decreased muscle strength, which is needed in the process of labor so that it can result in fetal death, premature birth, birth defects, low birth weight babies, short birth babies and even infant death. The design used is quantitative with a cross sectional approach with univariate and bivariate analysis using the Chi-Square test. The population of this study were all pregnant women who did pregnancy checks at the Puskesmas in Kupang City in 2022. Sample technique using purposive sampling technique. This study was conducted from January to December 2022. The results showed that of all pregnant women who were given nutrition education in the form of counseling and provision of additional food, most experienced weight gain. In contrast to the increase in LiLA, although there is a change in the size of LiLA after being given education, there are still pregnant women who do not experience changes in LiLA. The statistical test results obtained a p-value &lt;0.005, which means that there is a relationship between the provision of nutrition education and the improvement of the nutritional status of pregnant women with SEZ. It is expected for health workers to carry out special monitoring of pregnant women at risk of SEZ in conducting health checks and consuming additional nutritionally balanced foods.

Drug sensitivity tumor cell clusters in malignant peritoneal mesothelioma.

To explore the most effective adjuvant chemotherapy regimen for malignant peritoneal mesothelioma (MPM) through patient derived tumor-like cell clusters (PTC) drug sensitivity test. PTC were cultured in vitro with intraoperative specimens, and drug sensitivity test was performed to calculate the most effective chemotherapy regimen for MPM. The patients were divided into conventional and individualized chemotherapy group according to whether they received PTC drug testing. Univariate and multivariate analyses were conducted to identify independent prognostic factors. Among 186 MPM patients included, 63 underwent PTC culture and drug sensitivity test. The results showed that the most effective chemotherapy regimen was oxaliplatin + gemcitabine. After propensity score matching, a total of 64 patients were enrolled in the following study, including 32 patients receiving individualized chemotherapy guided by PTC drug results as group 1 and 32 patients receiving conventional chemotherapy as group 2. Survival analysis showed that the median OS of group 1 was not reached, significantly longer than that of group 2 (23.5 months) (p < 0.05). Compared with conventional chemotherapy, individualized chemotherapy guided by PTC drug sensitivity tests can prolong patient survival, and oxaliplatin + gemcitabine + apatinib could be the optimal adjuvant treatment regimen for MPM.

Predictors of postoperative persistent low back pain following lumbar fusion in patients older than 75 years: An analysis of a minimum 2-year follow-up

PurposeThis study aimed to evaluate pre- and perioperative predictors associated with persistent low back pain (LBP) following lumbar fusion in patients aged > 75 years. MethodsThis single-center retrospective study examined 310 patients aged > 75 years who underwent lumbar fusion for lumbar degenerative disease (104 males, 206 females; mean age, 79 [75–90] years). The visual analog scale (VAS) score for LBP was examined preoperatively and 2-year postoperatively. The persistent LBP group comprised patients with a 2-year postoperative LBP-VAS score ≥ 3. The demographic and preoperative radiographic parameters were also reviewed. A multivariate stepwise logistic regression analysis was performed of variables with values of P < 0.2 on the univariate analysis. ResultsNinety-nine patients (32%) experienced persistent postoperative LBP. Multivariate logistic regression analysis revealed that age < 82 years, history of previous lumbar decompression, and greater preoperative VAS score for LBP were associated with greater postoperative persistent LBP after lumbar fusion, whereas other factors, such as gender, body mass index, osteoporosis, diabetes mellitus, depression, symptom duration, operative time, estimated blood loss, and spinopelvic sagittal parameters, were not. ConclusionsThis study showed that a relatively younger age, history of preoperative lumbar decompression, and greater preoperative VAS score for LBP were preoperative predictors of postoperative persistent LBP following lumbar fusion in elderly patients. In contrast, preoperative spinopelvic sagittal parameters were not associated with persistent postoperative LBP. Although lumbar fusion is expected to improve LBP, surgeons should pay attention to age, surgical history, and preoperative back pain intensity.

Predicting a successful match among applicants to reproductive endocrinology and infertility fellowship

To identify independent predictors of a successful match to reproductive endocrinology and infertility (REI) fellowships, and to develop and internally validate a prediction model for REI match results. Retrospective cohort study. REI fellowship applications sent to the University of Pennsylvania from 2019 to 2023 (excluding 2020), which represented nearly all REI applicants nationally according to National Resident Matching Program (NRMP) data. Demographics, education, training, and academic achievements. Match result, confirmed through online search and communication with program administrators. Univariate analyses identified variables associated with match, which were then included in multivariable models to identify independent predictors. Bootstrapping was used to assess model discrimination and calibration. The final model was integrated into a web-based tool. Of 286 applications (99.0% of REI applications to the NRMP), 199 (69.6%) resulted in a successful match. In univariate analyses, variables associated with match were younger age, attendance at an allopathic U.S. medical school, USMLE and CREOG scores, residency rank, residency affiliation with a fellowship, research experiences, first-author publications, abstracts/articles in progress, and poster presentations. In the adjusted model, independent predictors of match included residency affiliation with an REI fellowship (aOR 5.43, 2.02-14.64), residency rank (aOR 1.77, 1.25-2.50), USMLE score (aOR 1.05, 1.02-1.08), at least one first-author publication (aOR 2.32, 1.08-4.96), projects in progress (aOR 1.26 (1.02-1.55), and poster presentations (aOR 1.07, 1.00-1.15). Attendance at an international medical school was a negative predictor (aOR 0.32, 0.11-0.88). The model achieved an area under the curve (AUC) of 0.883, with 88.5% sensitivity and 65.8% specificity. A refined model without USMLE scores maintained strong performance (C-statistic 0.85, 0.81-0.91; calibration slope 0.91, 0.72-1.24). Affiliation with an REI fellowship, residency reputation, and research output strongly predicted match success. Gender, race, and ethnicity were not major predictors, yet underrepresentation of certain racial and ethnic groups limited the power to detect potential differences. Our prediction model correctly classified >75% of candidates' match results. These findings may help candidates optimize applications and estimate chances of a successful match into REI fellowship, as well as assist programs in critically reviewing their selection criteria for fellowship match.

Dietary practices of type 2 diabetes mellitus patients concerning Pender's health Promotion Model in Lalitpur district, Nepal

BackgroundType 2 Diabetes Mellitus (T2DM) is one of the most prevalent Non Communicable Diseases (NCD) in Nepal. Nutrition plays a significant role in creating barriers to the development of NCDs like diabetes. The main objective of this study is to identify the factors that influence the dietary behaviors and practices among T2DM patients. MethodsThe study used quantitative method and a cross-sectional research design. The study was carried out in two centers: one in diabetes and another in thyroid care centers at the Lalitpur district, Nepal. A survey questionnaire based on Pender Health Promotion Model (PHPM) was developed, piloted, and administrated directly to 450 T2DM patients aged 40–65. Validity and reliability of the tools was ensured through reviewing panel of experts and using the coefficient and Cronbach's alpha test, respectively. Three sorts of statistical analysis; univariate, bivariate, and multivariate analysis were done using SPSS version 25. ResultsRespondents belonged to a joint family, no alcohol consumption, positive attitude towards a healthy diet (P < 0.05), no smoking habit, reminders for healthy food, and engaging in physical activity (P < 0.001) were significantly associated with good dietary practice. Higher odds of sufficient dietary practice were found in respondents who were from joint families (adjusted Odds Ratio (aOR = 2.332; 95 % Confidence Level (CI): 1.958–2.989, p < 0.01), literate (aOR = 1.783; 95 % CI: 1.256–2.531, p < 0.01), no smoking history (aOR = 0.935; 95 % CI: 0.609–1.434, p < 0.05), alcohol consumption history (aOR = 0.615, 95 % CI: 0.412–2.346, p < 0.05), had family support (aOR = 1.824, 95 % CI: 1.265–2.630, p < 0.01), availability of healthy foods (aOR = 2.26; 95 % CI: 1.453–3.517, p < 0.001), and those who preferred daily physical activities (aOR = 1.982, 95 % CI: 1.369–2.364, p < 0.001). ConclusionNuclear family, illiteracy, lower income, smoking and consumption of alcohol, poor family support, poor access in healthy food, and low engagement in physical activities influenced dietary behavior among T2DM patients. Thus, PHPM based educational intervention needs essential to the T2DM patients and family members to ensure better life.

Myocardial scar area predicts major adverse cardiovascular events after coronary artery bypass grafting in patients with ischemic cardiomyopathy

Objective: To investigate the value of myocardium scar area in predicting adverse cardiovascular events (MACEs) after coronary artery bypass grafting (CABG) in patients with ischemic cardiomyopathy (ICM). Methods: The first part of this study was a retrospective study. Patients diagnosed with ICM and undergoing CABG surgery at Beijing Anzhen Hospital, Capital Medical University from January 2017 to December 2022 were enrolled as the discovery cohort. All patients underwent cardiac magnetic resonance-late gadolinium enhancement (CMR-LGE) before surgery. According to the occurrence of postoperative MACEs, the patients were divided into MACEs group and MACEs-free group. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. The primary endpoint was postoperative MACEs. Univariate and multifactor regression analyses were used to analyze the risk factors for MACEs. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive efficacy and optimal cut-off value of myocardial scar area for endpoint events. The second part of this study was a prospective study. Patients with ICM who received CABG at Beijing Anzhen Hospital, Capital Medical University from January 2023 to June 2023 were enrolled as a validation cohort, and were divided into MACEs group and MACEs-free group according to whether MACEs occurred after surgery. Preoperative clinical and imaging data, intraoperative and postoperative data were collected and compared between the two groups. Verify the reliability of the cut-off value obtained by ROC curve in the validation cohort. Results: A total of 120 patients with ICM (30 patients in MACEs group and 90 patients in MACEs-free group), aged (61.6±8.7) years, including 93 males, were included in the discovery cohort. A total of 22 ICM patients (5 patients in MACEs group and 17 patients in MACEs-free group), aged (59.5±8.2) years, including 18 males, were included in the validation cohort. Multivariate Cox regression showed that myocardial scar area (HR=1.258, 95%CI 1.096-1.444, P=0.001) was an independent risk factor for the primary endpoint event. The area under ROC curve of myocardial scar area for predicting postoperative MACEs was 0.90 (95%CI 0.83-0.95), and myocardial scar area≥36.0% was the optimal cut-off value for predicting postoperative MACEs, and its sensitivity, specificity and accuracy were 96.7%, 72.2% and 78.3%, respectively. In the validation cohort, the sensitivity, specificity and accuracy of myocardial scar area in predicting postoperative MACEs in patients with ICM after CABG were 80.0%, 82.4% and 81.8%, respectively. Conclusion: Myocardial scar area is an independent risk factor for MACEs after CABG in patients with ICM, and myocardial scar area≥36.0% is the optimal cut-off value for predicting MACEs after CABG. Myocardial scar area can help to identify patients at high risk of surgery and provide a basis for risk stratification of patients.

High Glycolytic Activity Signature Reveals CCNB2 as a Key Therapeutic Target in Triple-Negative Breast Cancer.

Aerobic glycolysis and the cell cycle are well-established tumor hallmarks. Understanding their relationship could help to unravel the pathogenic mechanisms of breast cancer (BC) and suggest potential new strategies for treatment. Glycolysis-related genes (GRGs) were downloaded from the Reactome database and screened using univariate Cox analysis. The consensus clustering method was employed to identify a glycolytic activity signature (GAS) using the Gene Expression Omnibus (GEO) dataset. A nomogram risk prediction model was constructed using coefficients from univariate Cox analysis. Immune cell infiltration was evaluated using single-sample gene set enrichment analysis (ssGSEA) and the ESTIMATE algorithm. Gene co-expression modules were created using weighted correlation network analysis (WGCNA) to identify hub genes. Gene expression in three BC cell lines was quantified using Quantitative Reverse Transcriptase Polymera (qRT-PCR). Single-cell RNA sequencing (scRNA-seq) data was used to examine the relationship between GAS and hub genes. The sensitivity of different groups to cell cycle-related clinical drugs was also examined. BC with high GAS (HGAS) showed high tumor grade and recurrence rate. HGAS was a prognostic indicator of worse overall survival (OS) in BC patients. HGAS BC showed more abundant immune cells and significantly higher expression of immunomodulators compared to BC with low GAS (LGAS). HGAS BC also showed enhanced cell cycle pathway, with high mRNA and protein expression levels of Cyclin B2 (CCNB2), a key component of the cell cycle pathway. Importantly, scRNA-seq analysis revealed that elevated CCNB2 expression was positively correlated with HGAS in triple-negative BC (TNBC). This was validated in clinical samples from TNBC patients. High expression of CCNB2 was found in three BC cell lines, and was also an indicator of poor prognosis. HGAS BC showed high sensitivity to several cell cycle-related clinical drugs, with 9 of these also showing activity in BC with high CCNB2 expression. HGAS was associated with enhanced cell cycle pathway and immune activity in BC. These results suggest that CCNB2 is a potential key therapeutic target in BC patients.

Development and validation of optical coherence tomography (OCT) and OCT angiography prediction model for short-term vitreous haemorrhage secondary to polypoidal choroidal vasculopathy

AimsTo construct and validate an optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) image model for predicting the occurrence of short-term vitreous haemorrhage (VH) in polypoidal choroidal vasculopathy...

Antibodies to PfEMP1 and Variant Surface Antigens: Protection after Controlled Human Malaria Infection in Semi-immune Kenyan Adults

ObjectivesAcquisition of antibodies to Plasmodium falciparum variant surface antigens (VSA) expressed on infected red blood cells (iRBCs) is associated with naturally acquired immunity to malaria. We have previously shown that antibodies to VSA on iRBCs are associated with protection against parasite growth in the context of controlled human malaria infection (CHMI). This study explored whether antibodies to recombinant antigens derived from PfEMP1 domains were independently associated with protection during CHMI in semi-immune Kenyan adults. MethodsWe used a multiplex bead assay to measure levels of IgG antibody against a panel of 27 recombinant PfEMP1 antigens derived from the PfEMP1 repertoire of the 3D7 parasite clone. We measured IgG levels in plasma samples collected from the CHMI participants before inoculation with Sanaria® PfSPZ Challenge, on the day of diagnosis, and 35 days post-inoculation. Univariable and multivariable Cox regression analysis was used to evaluate the relationship between the levels of antibodies to the antigens and CHMI outcome. We also adjusted for previous data including antibodies to VSA on iRBCs, and we assessed the kinetics of antibody acquisition to the different PfEMP1 recombinant antigens over time. ResultsAll study participants had detectable antibodies to multiple PfEMP1 proteins before inoculation. All PfEMP1 antigens were associated with protection against parasite growth to the threshold criteria for treatment in CHMI albeit with substantial collinearity. However, individual PfEMP1 antigens were not independently associated with protection following adjustment for breadth of reactivity to VSA on iRBCs and schizont extract. In addition, antibodies to PfEMP1 antigens derived from group B PfEMP1 were induced and sustained in the participants who could not control parasite growth. ConclusionThis study shows that the breadth of antibody response to VSA on iRBCs, and not to specific PfEMP1 antigens, is predictive of protection against malaria in CHMI.

Multivariate ocean waves dynamics in North Sea and Norwegian Sea by Gaidai reliability method

Current study presents state-of-the-art approach for evaluating spatiotemporal multivariate environmental risks, especially suitable for complex environmental systems that have been either numerically simulated or physically observed. Advocated methodology provides accurate hazard risk forecasts, based on real-time in situ environmental data. Design of offshore structures requires multivariate risk assessment – offshore and naval operations require both short- and long-term risk and reliability analyses. Contemporary risk evaluation techniques often struggle with raw timeseries multivariate data due to intrinsic multidimensionality and nonlinear interconnections among critical system’s dimensions/components. In the current study effectiveness of the Gaidai multivariate risk evaluation method is illustrated by utilizing significant wave heights dataset, measured within two offshore zones: Heidrun and Troll Norwegian oil fields. Analyzing offshore waves being particularly challenging due to their complexity, high nonlinearity, multidimensionality, yet dynamic inter-correlations. Global warming being among several significant factors, affecting ocean and sea wave heights. For naval, offshore and marine structures operating in harsh weather conditions, robust multivariate environmental risk evaluation methods being crucial for both design and safe operations. Current study aims to validate and benchmark state-of-the-art methodology, enabling extraction. Advocated approach allows for efficient yet accurate assessment of global damages, failures or hazard risks for a wide range of complex nonlinear multivariate environmental and energy systems. Primary advantage of presented multivariate reliability methodology lies within its ability to treat complex systems with practically unlimited number of dimensions, while existing reliability methods being mostly limited to univariate and bivariate analyses.

Prognostic nutritional index predicts lateral lymph node metastasis and recurrence free survival in papillary thyroid carcinoma.

Preoperative hematological parameters are predictors of pathological features and recurrence-free survival (RFS) in various malignancies. However, comprehensive studies of preoperative indicators associated with papillary thyroid carcinoma (PTC) are scarce. The present study investigated the association between preoperative indicators and RFS in patients with PTC. Accordingly, we explored the clinical impact of the prognostic nutritional index (PNI) on lymph node metastasis and RFS in patients with PTC. A total of 619 PTC patients were retrospectively reviewed between Jan 2013 and Dec 2017. Laboratory values were measured and calculated. Receiver operating characteristic curves were generated to calculate the cutoff value. Univariate and multivariate analyses using the COX proportional hazard model were performed for RFS. The effects of PNI and age on RFS were investigated by the Kaplan-Meier method. Clinical characteristics and PNI were tested with the chi-square test. Univariate and multivariate logistic analyses were conducted to evaluate the predictive value of PNI for lymph node metastasis. In the multivariate Cox analysis, age, PNI and lymph node metastasis were independent prognostic indicators for RFS. The Kaplan-Meier method showed that the lower PNI group and age older than 55 years group displayed poor RFS. A low preoperative PNI was remarkably correlated with age, sex, extrathyroidal invasion, T stage, N stage and TNM stage. PNI was the only preoperative hematological indicator for lateral lymph node metastasis. Among the preoperative hematological indicators, PNI may serve as a promising and effective predictor for RFS and lateral lymph node metastasis in PTC patients.

Skin Microvascular Dysfunction in Type 2 Diabetes Mellitus Using Laser Speckle Contrast Analysis and Association with Carotid Intima-Media Thickness.

Background: It is established that diabetes mellitus (DM) is characterized by increased cardiovascular risk associated with subclinical atherosclerosis as well as microvascular alterations. Laser speckle contrast analysis (LASCA) is an innovative, non-invasive method for assessing skin microvascular function. Objectives: We sought to assess skin microvascular function in patients with type 2 DM and matched controls. Methods: Consecutive patients with DM and individuals matched for age, sex and BMI were included in the study. Skin microvascular perfusion was assessed, using LASCA, during baseline, a 5 min occlusion period and a 5 min reperfusion period. Carotid intima-media thickness (cIMT) was measured as a surrogate marker of macrocirculation. Results: In total, 18 patients with DM and 22 in the control group were enrolled. No statistically significant differences were observed in baseline flux, peak flux and percentage decrease during arterial occlusion. During reperfusion, individuals with DM exhibited a smaller peak magnitude compared to controls (147.0 ± 64.7% vs. 189.4 ± 46.0%, respectively; p < 0.05). Moreover, cIMT was higher in patients with DM compared to controls (0.68 ± 0.09 mm vs. 0.60 ± 0.08 mm, respectively, p < 0.01) and was negatively correlated with skin microvascular reactivity in the univariate analysis. In the multivariate analysis, glucose and office systolic blood pressure levels remained significant predictors of microvascular reactivity. Conclusions: Our study shows that patients with type 2 DM exhibit impaired skin microvascular function compared to controls. Furthermore, glucose levels and blood pressure play a key role in microvascular dysfunction. However, additional studies are needed to address the clinical significance of early microvascular changes in DM.