Worse Survival Rate Research Articles

Identification and construction of a novel NET-related gene signature for predicting prognosis in multiple myeloma

Neutrophil extracellular traps are essential in the development and advancement of multiple myeloma (MM). However, research investigating the prognostic value with NET-related genes (NRGs) in MM has been limited. Patient transcriptomic and clinical information was sourced from the gene expression omnibus database. Cox regression analysis with a univariate approach was employed to explore the link between NRGs and overall survival (OS). Kaplan–Meier methods were applied to assess variations in survival rates. A nomogram integrating clinical data and predictive risk metrics was crafted using multivariate logistic and Cox proportional risk model regression analyses. Additionally, we investigated the disparities in biological pathways, drug sensitivity, and immune cell involvement, and validated differential levels of two key genes through qPCR. We identified 148 differentially expressed NRGs through published articles, of which 14 were associated with prognosis in MM. Least absolute shrinkage and selection operator Cox regression model established a nine-gene NRG signature—comprising ANXA1, ANXA2, ENO1, HIF1A, HSPE1, LYZ, MCOLN3, THBD, and FN1—that demonstrated strong predictive power for patient survival. The Cox regression model with multiple variables demonstrated that the risk score independently predicted OS, showing that those with a high score had worse survival rates. Furthermore, a nomogram incorporating patient age, LDH levels, the International Staging System, and NRGs was developed, demonstrating strong prognostic prediction capabilities. Drug sensitivity correlation analysis also offered valuable guidance for future immuno-oncological therapies and drug selection in MM patients. The NRGs signature was a reliable biomarker for MM, effectively identifying high-risk patients and forecasting clinical outcomes.

Association Between High Sensitivity Cardiac Troponin and All-Cause and Cardiovascular Mortality in Adults at Risk of Non-Alcoholic Fatty Liver Disease: A Cohort Study.

Cardiovascular disease (CVD) is the leading cause of death among patients with non-alcoholic fatty liver disease (NAFLD). This study investigates the association between high-sensitivity cardiac troponin (hs-cTn) levels and mortality in adults at risk of NAFLD in a representative U.S. population sample. Among participants aged 18 years and older in the 1999-2004 National Health and Nutrition Examination Survey, we measured high-sensitivity troponin T using a single assay (Roche) and high-sensitivity troponin I using three assays (Abbott, Siemens, and Ortho). Myocardial injury was identified by elevated levels of hs-cTn. Mortality outcomes were determined through linkage with the National Death Index database, with follow-up until December 31, 2019. A multivariable Cox proportional hazards model was used to evaluate the associations between myocardial injury and mortality in the NAFLD population. Sensitivity analyses were conducted to assess the robustness of the main findings. A total of 2581 at risk of NAFLD were included in this observational study, with myocardial injury identified in 7.01%. Over a median follow-up of 16.7 years, 937 all-cause deaths occurred, including 319 cardiovascular disease-related deaths. NAFLD individuals with myocardial injury had worse survival rates at 5, 10, and 15 years compared to those without myocardial injury. After adjusting for baseline characteristics, myocardial injury was associated with an increased risk of all-cause mortality (adjusted Hazard Ratio [aHR] 1.785, 95% CI 1.494-2.134, P < 0.001) and cardiovascular mortality (aHR 2.155, 95% CI 1.606-2.893, P < 0.001). This large, nationally representative study demonstrates that myocardial injury, defined by elevated hs-cTn levels, is independently associated with increased all-cause and cardiovascular mortality risks in the adult population at risk of NAFLD in the United States. This association persisted after adjusting for various factors and in patients without pre-existing cardiovascular disease. The Siemens hs-cTn I assay demonstrated the strongest association with all-cause mortality. These findings highlight the potential of hs-cTn as a valuable prognostic marker in NAFLD patients, even in those without clinically apparent cardiovascular disease. Routine hs-cTn assessment may aid in risk stratification and guide targeted interventions to reduce mortality risk in this population.

The type of pathogen is associated with organ failure and legacy dysfunction in patients with sepsis.

Is there a difference in pathogen infection among sepsis patients with different organ dysfunction and Post-sepsis persistent organ dysfunction? Is this related to survival? It is currently unclear. This study reviewed 1982 sepsis patients between December 2019 and September 2023, and included 619 patients after removing patients with missing data. Of these, 332 were tested for metagenomic next-generation sequencing (mNGS). First, the pathogens distribution was assessed in all NGS-positive patients, followed by patients with different organ dysfunction (excluding those who died during hospitalization). Lastly, the survival analysis was conducted on patients infected with different pathogens. The results showed that the mortality rate in our cohort was 27.63% in patients with sepsis, and patients with Respiratory, Liver, Circulatory, Hematologic, Neurological, and Renal dysfunction had poor survival. And patients with post-sepsis persistent organ dysfunction after sepsis have worse survival rates. In addition, we found the infection rates of Legionella and Betapapillomavirus were higher in patients with liver dysfunction. The infection rates of Mastadenovirus, Enterococcus, and Candida were higher in patients with neurological dysfunction. The infection rates of Candida were higher in patients with renal dysfunction and hematologic dysfunction. The infection rates of Moraxella were higher in patients with circulatory dysfunction. The infection rates of Enterococcus, Pneumocystis, and Acinetobacter were higher in patients with Post-sepsis cardiac dysfunction.The infection rates of Enterococcus, Acinetobacter, and Morganella were higher in patients with Post-sepsis liver dysfunction. The infection rates of Enterococcus, Acinetobacter, and Staphylococcus were higher in patients with Post-sepsis respiratory dysfunction. The infection rates of Enterococcus, Candida, Pneumocystis, Staphylococcus, and Listeria were higher in patients with Post-sepsis renal dysfunction. In addition, we found that patients with Escherichia infection in sepsis had the lowest survival rate. The survival rate of patients with Enterococcus infection combined with post-sepsis persistent respiratory dysfunction is also worse. In conclusion, there are differences in the types and proportions of pathogens infected in patients with different organ dysfunction and Post-sepsis persistent organ dysfunction. The combination of Escherichia infection and Enterococcus infection with post-sepsis persistent respiratory dysfunction can affect the survival of patients. We should strengthen the management of sepsis patients, especially those with Post-sepsis persistent organ dysfunction.

Clinical impact of combined assessment of myocardial inflammation and fibrosis using myocardial biopsy in patients with dilated cardiomyopathy: a multicentre, retrospective cohort study

BackgroundAmong patients with dilated cardiomyopathy (DCM), myocardial inflammation and fibrosis are risk factors for poor clinical outcomes. Here, we investigated the combined prognostic value of these two factors, as evaluated...

Ventricular opening in High-Grade Glioma surgery. Impact on surgical, functional outcomes, and survival rates. Experience in a Latin-American center.

Ventricular opening in High-Grade Glioma surgery. Impact on surgical, functional outcomes, and survival rates. Experience in a Latin-American center.

16 Open abdomen: analysis of indications, relation with peritonitis, outcomes and prognostic factors for mortality in non-traumatic patients

Abstract Aim The open abdomen (OA) is a surgical technique originally employed in critically traumatic patients, and later extended to other non-traumatic aetiologies, mostly peritonitis, vascular emergencies, or acute pancreatitis. Indications and results of OA in non-traumatic patients have not been rigorously described. The study aimed to analyse and report indications, prognostic factors of mortality, and the outcomes of OA in non-traumatic patients, with emphasis on peritonitis. Methods Single-center retrospective study of 94 OA patients from 2008 to 2021. The decision to perform OA relied either on the surgeon's judgment or mainly on the presence of at least one trauma OA criterion: hypotension (systolic blood pressure ≤70 mmHg), massive transfusion, coagulopathy (INR ≥ 1.7), acidosis (pH &amp;lt; 7.25), and hypothermia (&amp;lt;35°C). Statistical tests were performed to analyse survival and identify morbidity and mortality prognostic factors. Observed outcomes were compared to those predicted by preoperative using the Age-adjusted Charlson Comorbidity Index (ACCI) and postoperative using the Sequential Organ Failure Assessment score (SOFA score). Results OA was performed for peritonitis (n = 54), vascular emergencies (n = 23), pancreatitis (n = 11), abdominal compartmental syndrome (n = 2), and intestinal fistulas (n = 4). The overall 90-day mortality was 55.3% (n = 52), 55.5% (n = 29) were from the peritonitis group. The multivariate analysis emphasizes the major role of altered physiology in mortality. Although 71.05% of peritoneal fluid cultures were positive, being E. faecium (n = 13, 14.3%), P. aeruginosa (n = 12, 13.2%) the most common germs. mortality did not seem to be associated with positive peritoneal cultures or to a particular group of germs. Even though there were not statistically significant differences in the distribution of mortality peritonitis and acute pancreatitis may benefit most from the damage control and OA. approach. Conclusions OA can be a reliable treatment for critically ill patients with non-traumatic abdominal emergencies, especially in peritonitis and pancreatitis. Age, comorbidities, multi-organ failure and altered physiology are parameters whose effects seem to be associated with a worse survival rate. High mortality does not appear to be associated neither to positive peritoneal cultures nor to any particular group of germs.

The potential impact of ACOG guideline changes on genital melanoma detection rates in females: a retrospective cross-sectional analysis and implications for clinical practice.

Genital melanoma (GM) is a rare but aggressive cancer that accounts for less than 5% of vaginal cancers and 0.2-0.8% of all melanomas in the United States. The 2018 American College of Obstetricians and Gynecologists (ACOG) guidelines reduced routine pelvic exams for women aged 65 and older, raising concerns about later-stage GM diagnosis, worse survival rates, and potential underreporting. This study investigated the impact of these guideline changes on female GM detection rates through a cross-sectional analysis of female patients aged 18 and older in the All of Us database from 2012 to 2023. The analysis focused on melanoma in-situ (MIS) of the vulva using ICD-10-CM code D03.8 to calculate prevalence and incidence. The study identified 16 cases of vulvar MIS (0.006%, 95% CI [0.004-0.010%]) with a mean age of 64.6 ± 12.4 years at diagnosis. Prevalence peaked in the 61-70 age group (0.014%, 95% CI [0.000-0.029%]), with white patients showing the highest prevalence (0.009%, 95% CI [0.004-0.015%]). The overall incidence was 5.37 cases per million women per year. However, a decreasing trend was observed, with no cases reported between 2021 and 2023. This decline in reported cases may be linked to the 2018 ACOG guideline changes, potentially leading to later-stage diagnoses and poor outcomes. The study's limitations include the inability to calculate yearly incidence due to lack of annual enrollment data and the absence of staging information. The findings suggest a potential connection between the ACOG guideline modifications and GM detection rates. While current incidence rates are similar to or higher than those before the 2018 changes, the decline in routine pelvic exams may contribute to later-stage diagnoses and poor outcomes. The absence of diagnosed GM cases in the past three years is particularly concerning and may reflect delayed effects of infrequent screening. Increased awareness, improved screening practices, and additional research are necessary to fully understand the impact of the 2018 ACOG guideline changes on GM diagnosis and treatment. Healthcare providers should consider performing yearly pelvic examinations, especially for patients over 65, while educating patients on early self-detection of GM.

Extracorporeal Membranous Oxygenation Associated With Tracheal Procedures: An Extracorporeal Life Support Organization (ELSO) Registry Analysis.

Extracorporeal membrane oxygenation (ECMO) has been primarily used for respiratory and circulatory failure, but its airway-related use has not been investigated well. Tracheal procedures are a situation when ECMO could be used to support patients during anticipated difficult airway management. The Extracorporeal Life Support Organization registry was queried for adult patients treated with ECMO in 2010-2022 during the same admission with types of tracheal procedures. Tracheal procedures were divided into surgical procedure and bronchoscopic procedure groups, and the survival rate was analyzed for each procedural type. Two-hundred sixty-nine patients met the inclusion criteria (64 surgical procedures and 205 bronchoscopic procedures), and 173 (64.3%) patients survived to discharge. Among the surgical procedures, tracheal resection was most performed (30 patients; 46.9%) and was associated with a high survival rate to discharge (86.7%; p = 0.003) compared with airway reconstruction (57.1%) and airway injury repair (46.2%). In bronchoscopic procedure, tracheal stent had favorable survival (76.1%; p = 0.004), whereas tumor debulking was associated with poor prognosis (48.3%; p = 0.006). Hemorrhagic complications were seen in 70 (26.0%) patients and were associated with a worse survival rate (58.6%; p < 0.001). Among them, surgical site bleeding was seen in 35 (13.0%) patients and was also associated with worse survival (42.9%; p = 0.007).

Identification of Ovarian High-Grade Serous Carcinoma with Mitochondrial Gene Variation.

Women diagnosed with advanced-stage ovarian cancer have a much worse survival rate than women diagnosed with early-stage ovarian cancer, but the early detection of this disease remains a clinical challenge. Some recent reports indicate that genetic variations could be useful for the early detection of several malignancies. In this pilot observational retrospective study, we aimed to assess whether mitochondrial DNA (mtDNA) variations could discriminate the most frequent type of ovarian cancer, high-grade serous carcinoma (HGSC), from normal tissue. We identified mtDNA variations from 20 whole-exome sequenced (WES) HGSC samples and 14 controls (normal tubes) using the best practices of genome sequencing. We built prediction models of cancer with these variants, with good performance measured by the area under the curve (AUC) of 0.88 (CI: 0.74-1.00). The variants included in the best model were correlated with gene expression to assess the potentially affected processes. These analyses were validated with the Cancer Genome Atlas (TCGA) dataset, (including over 420 samples), with a fair performance in AUC terms (0.63-0.71). In summary, we identified a set of mtDNA variations that can discriminate HGSC with good performance. Specifically, variations in the MT-CYB gene increased the risk for HGSC by over 30%, and MT-CYB expression was significantly decreased in HGSC patients. Robust models of ovarian cancer detection with mtDNA variations could be applied to liquid biopsy technology, like those which have been applied to other cancers, with a special focus on the early detection of this lethal disease.

Gender Disparities in Melanoma: Advances in Diagnosis, Treatment, and the Role of Artificial Intelligence

ABSTRACTBackgroundMelanoma, a highly aggressive skin cancer, demonstrates significant gender disparities, with men facing later‐stage diagnoses, more aggressive tumor characteristics, and worse survival rates. This review examines the biological, behavioral, and environmental factors driving these disparities, alongside recent advancements in diagnosis and treatment. Additionally, it explores how artificial intelligence (AI) can address gender‐specific differences in melanoma incidence and outcomes.ResultsGender disparities in melanoma stem from biological factors, such as hormonal and genetic differences, and behavioral patterns like delayed health‐seeking among men. AI‐driven diagnostic tools, including convolutional neural networks (CNNs), show promise but often reflect biases in training data sets, underrepresenting darker skin tones and gender‐specific patterns. Ensuring diverse data sets, integrating “super‐prompts” or region‐specific demographic prompts, and utilizing bias‐aware algorithms can help mitigate these biases, thereby improving diagnostic accuracy and equity.ConclusionReducing gender disparities in melanoma requires integrating innovative technologies with equitable healthcare policies and education. Early detection using inclusive AI models tailored to diverse skin tones and genders, alongside targeted therapeutic strategies, is critical to improving outcomes for high‐risk groups, particularly men and underserved populations.

Literature-Guided 6-Gene Signature for the Stratification of High-Risk Acute Myeloid Leukemia.

Acute myeloid leukemia (AML) shows significant heterogeneity in therapeutic responses. We aimed to develop a gene signature for the stratification of high-risk pediatric AML using publicly available AML datasets, with a focus on literature-based prognostic gene sets. We identified 300 genes from 12 well-validated studies on AML-related gene signatures. Clinical and gene expression data were obtained from three datasets: TCGA-LAML, TARGET-AML, and BeatAML. Least absolute shrinkage and selection operator (LASSO)-Cox regression analysis was used to perform the initial gene selection and to construct a prognostic model using the TCGA database (n=132). The final gene signature was validated with two independent cohorts: BeatAML (n=411) and TARGET-AML (n=187). We identified a six-gene signature (ETFB, ARL6IP5, PTP4A3, CSK, HS3ST3B1, PLA2G4A), referred to as the literature-based signature 6 (LBS6), that was significantly associated with lower overall survival rates across the TCGA (HR=4.2, 95% CI: 2.59-6.81, p<0.0001), BeatAML (HR=1.52, 95% CI: 1.17-1.96, p=0.0013), and TARGET (HR=2.05, 95% CI: 1.36-3.08, p<0.001) datasets. The high-LBS6 score group exhibited significantly poorer five-year event-free survival compared to the low-LBS6 score group (HR=2.09, 95% CI: 1.38-3.15, p<0.001). After adjusting for key risk factors, including gene mutations (WT1, FLT3, and NPM1), protocol-based risk group, WBC count, and age, the LBS6 score was independently associated with worse survival rates in validation cohorts. Our literature-driven approach identified a robust gene signature that stratifies AML patients into distinct risk groups. The LBS6 score shows promise in redefining initial risk stratification and identifying high-risk AML patients.

CRYβB2 alters cell adhesion to promote invasion in a triple-negative breast cancer cell line

ObjectiveAfrican American women with breast cancer experience disproportionately poor survival outcomes, primarily due to the high prevalence of the deadliest subtype; triple-negative breast cancer (TNBC). The CRYβB2 gene is upregulated in tumors from African American patients across all breast cancer subtypes, including TNBC, and is associated with worse survival rates. This study investigated the effect of CRYβB2 on the invasion of TNBC cells and the underlying mechanisms contributing to this phenotype.ResultsWe utilized the SUM159 cells with stable CRYβB2 overexpression in a 3D-culture tumor spheroids model in our investigation. A quantitative 3D invasion assay demonstrated that CRYβB2 overexpression significantly enhanced invasion (median invasion %; SUM159 = 0.14 and SUM159 + CRYβB2 = 0.33). RNA sequencing analysis indicated that CRYβB2 overexpression modulated cell-cell adhesion and extracellular matrix organization pathways, which are critical to invasion of cancer cells. Specifically, CRYβB2 suppressed the expression of key cell-cell adhesion genes known as clustered protocadherins and promoted the expression of PCDH7, a nonclustered protocadherin with known oncogenic roles in various cancers. Notably, the knockout of PCDH7 diminished the invasive capacity induced by CRYβB2 (median invasion %; SUM159 = 0.093, SUM159 + CRYβB2 = 0.184 and SUM159 + CRYβB2/PCDH7−/−=0.082). These findings provide a novel link between a previously identified differentially expressed gene, CRYβB2, in driving breast cancer phenotypes by modulating a class of adhesion proteins.

The role of macrophages in oral cancer: A narrative review

Abstract One of the immune cells that are most prevalent in the tumor microenvironment of tumors is the macrophage, and in most malignancies, the macrophage’s presence is correlated with a worse survival rate. Tumor-associated macrophages (TAMs) are the primary cells that generate an immunosuppressive tumor microenvironment by generating cytokines, chemokines, and growth factors, as well as activating the release of inhibitory immunological checkpoint proteins in T cells. The role of TAMs in tumor development will be discussed in this review, covering elements such protumorigenic inflammation, immune suppression, neoangiogenesis, and acceleration of tissue invasion and distant metastasis. Major research databases such as PubMed, Science Direct, Scopus, Web of Science, and Google scholar were explored from 2022 to 2023, yielding 110 papers. Based on the inclusion criteria, this review comprised 30 articles. Macrophages promote angiogenesis, cancer cell invasion, and intravasation at the initial location and are present throughout the whole course of a tumor. Macrophages and monocytes at the metastatic site encourage extravasation and survival of disseminated cancer cells by preventing immune-mediated clearance or by directly interacting with the tumor cells to activate prosurvival signaling pathways. This is done by preparing the metastatic site for the arrival of disseminated tumor cells. A supportive metastatic niche is established by macrophages, which further encourages the proliferation of disseminated cancer cells at the metastatic location. Macrophages have a critical function in tumor progression, affecting the prognosis. Treatments that decrease TAMs and limit their function have been found to be clinically effective. Many diagnostic and therapeutic medications are now available as nanoparticles owing to advancements in nanobiotechnology. TAMs can be employed as nanoparticle carriers in cell therapy to boost the therapies’ tumor-killing ability.

Real World Data in Stage III Melanoma in Latino Low Middle Income Country: Prognostic Factors and Outcomes.

Malignant melanoma is a heterogeneous disease, with varying outcomes depending on the patient's race and ethnicity. Advanced stages can be tackled by novel targeted therapies and immunotherapy. We aimed to investigate the real-world data in Latino-Hispanic patients diagnosed with Stage III melanoma residing in Peru, a region marked by limited resources and healthcare infrastructure. Patients diagnosed with Stage III melanoma at the Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru were included from the years 2010 to 2020. Cox regression analysis was used to assess prognostic factors. Four hundred twelve patients were included, the median age of diagnosis was 63 years, with a male predominance (55.6%). Most of the patients presented with a lesion in the lower extremities (77.4%), acral lentiginous melanoma (35.4%), and ulcerated tumors (72.3%). 64.1% were diagnosed with Stage IIIC, and 27.2% received interferon-alpha therapy. With a median follow-up of 36 months, the relapse-free survival and overall survival rates were 26% and 78% at 3 years follow-up, respectively. Prognostic factors of event-free survival (EFS) were greater age (HR = 1.015, 95% CI: 1.005-1.025), ulcerated lesions (HR = 1.855, 95% CI: 1.221-2.820), N category, and the administration of interferon therapy (HR = 0.680, 95% CI: 0.488-0.947). While worse overall survival (OS) was associated with greater ages (HR = 1.032, 95% CI: 1.011-1.053) and the presence of ulceration (HR = 2.992, 95% CI:1.142-7.835). Stage III melanoma in the Hispanic-Latino population from Peru has worse survival rates than other races and populations despite similar prognostic factors of worse EFS and OS. In resource-limited settings, reducing barriers to receiving healthcare and broadening access to contemporary immunotherapy and targeted therapy are crucial measures to improve outcomes in patients with advanced melanoma.

Survival Outcomes Following Chemotherapy for High-Grade Central Nervous System Tumors in Adolescents and Young Adults: An Exploration of Variations According to Ethnicity and Deprivation.

Introduction: Adolescents and young adults (AYA) are a unique subgroup of patients who experience cancer at the interface between pediatric and adult oncology services. Central nervous system (CNS) tumors are the leading cause of cancer-related morbidity and mortality in this group. Socioeconomic status and ethnicity are known to impact CNS tumor survival in patients of all ages. Studies reporting AYA CNS survival outcomes by ethnicity and area-based deprivation, however, are lacking in the United Kingdom (UK). Methods: Using cancer registration data for 351 patients (12-29 years) who received systemic chemotherapy for a high-grade malignant CNS tumor in England between April 2014 and December 2018, we quantified differences in survival at 1, 2, and 3 years post-diagnosis by ethnicity and area-based socioeconomic status. Results: Lower survival estimates were seen for non-White ethnicity and lower socioeconomic groups. Three-year survival was 64.4% (95% CI 58.3-69.9) for White patients but 46.6% (95% CI 29.9-61.7) for non-Whites and 64.0% (95% confidence interval [CI]49.0-75.7) and 62.9% (95% CI 50.7-72.8) in those from the two least deprived fifths compared to 50.2% (95% CI 36.1-62.7) and 56.1% (95% CI 42.4-67.7) in the two most deprived groups. Conclusion: Our study is the first to show the existence of health disparities in AYA treated with chemotherapy for a primary CNS tumor in England, where patients from ethnic minorities and deprived areas had worse survival rates than their White and socioeconomically advantaged counterparts. These findings call for further research into the underlying reasons behind survival differences between sociodemographic groups to improve survivorship outcomes.

Hepcidin Is a Valuable Therapeutic Target for Colorectal Cancer.

Colorectal cancer (CRC) is one of the most frequent neoplasms and a major cause of cancer death worldwide. Despite recent advances in treatment approaches, the prognosis of advanced CRC remains poor, thus indicating the necessity of more effective treatments for CRC patients. CRC cells produce high levels of hepcidin, a peptide hormone that binds to the membrane-bound ferroportin and promotes its internalization and degradation, thus sequestering iron into the cancer cells with the downstream effect of enhancing tumor growth. Additionally, CRC cell-expressed hepcidin prolongs cell survival and, by targeting both CD8+ T cells and myeloid cells, restrains the induction of an efficient immune response against tumor antigens. The greatest expression of hepcidin is found in patients with metastatic CRC, and CRC patients with high hepcidin content have a worse survival rate than those with low hepcidin content. In the present article, we review the data supporting the prominent role of hepcidin in colon tumorigenesis and discuss how hepcidin inhibitors can help treat CRC patients in the metastatic setting with particular regard to the impact of hepcidin modulation on immunotherapeutic outcomes.

Short-term and long-term outcomes of lung transplantation from marginal donors: a single-center retrospective study.

To expand the donor pool, medical centers worldwide are applying marginal donor lungs in clinical settings. We carried out this research to reveal the short-term and long-term outcomes of marginal lung donor transplantation. We performed retrospective research using data from patients who underwent lung transplantation (LT) in The Affiliated Wuxi People's Hospital of Nanjing Medical University, Jiangsu Province, China, between 2018 and 2022 to compare the short-term and long-term outcomes of standard donors and marginal donors. A total of 553 cases were incorporated in this study. The perioperative mortality of recipients who received marginal donor lungs was around 20.8%, compared with 13.4% in the standard donor recipients (P=0.03). There were no significant differences between the two groups in terms of mechanical ventilation or extracorporeal membrane oxygenation (ECMO), length of intensive care unit and hospital stay, occurrence of primary graft dysfunction, and prevalence of acute rejection. The 1-year survival rate for recipients in the standard group and marginal group was 71.7% and 54.2% (P<0.001), respectively. There was a worse survival rate in the subgroups of age >55 years, smoking ≥20 pack-years, and abnormal chest radiographs; however, the 1-year survival rate in the subgroup analysis of donors with ratio of arterial oxygen partial pressure to fraction of inspired oxygen (PaO2/FiO2) <300 mmHg and purulent secretions on bronchoscopy was not significantly different. Our findings suggest that marginal donor recipients can expect to have a lower survival rate than standard donor recipients. However, marginal lung transplant recipients could also gain benefit equivalent to that provided by standard donor LTs in both the short- and long-term when proper assessment and management strategies are implemented.

Navigating Treatment-Induced Head and Neck Malignancies in Cancer Survivors.

Cancer presents a significant global health burden. Traditional treatment modalities, especially radiotherapy and chemotherapy, have improved survival, but they have long-term consequences. Treatment-induced malignancies, a growing concern, pose risks to survivors. Often with limited treatment options, these tumors tend to have a worse survival rate. A thorough understanding of the main risk groups is critical for lifelong follow-up and personalized care strategies. This review provides an update on the knowledge of treatment-induced malignancies of the head and neck in cancer survivors; specifically, it discusses the risks, histological considerations, diagnosis and treatment strategies, follow-up recommendations, and future perspectives.

Abstract 4143176: Association Between Frailty Testing through Gait Speed and Mortality in CRT Patients: Report for a Multidisciplinary CRT Clinic

Background: Identifying predictors of mortality in CRT patients remains an active area of investigation. Objective: To establish a relationship between gait speed (GS) and mortality in heart failure patients with CRT. Hypothesis: Patients with slower gait speeds have worse survival rates after CRT implantation. Methods: This retrospective study included 504 patients who underwent CRT implantation at our institution between 2017-2022. All patients were followed up with a multidisciplinary team, including electrophysiology and heart failure physicians about 6 months after CRT implantation, where frailty was assessed. We used GS as a measure of frailty and divided patients into 2 groups: GS: &lt;1 m/s (n=177) and ≥ 1 m/s (n=327). The primary endpoint was a composite of left ventricular assist device implantation, transplant, or death at 2 years post-CRT. Data was collected retrospectively from electronic medical records. Results: The study population was 65.7% male, with a mean age of 69.1 years, with majority of the devices being CRT-D (79.6%). Response was defined as an improvement in LVEF &gt;5% with reduction in LVESV&gt;10%; anybody not meeting this definition was classified as a non-responder. Responder and non-responder rates among GS&lt; 1 m/s and GS &gt; 1 m/s were 53.8% vs 66.4%; and 35.1% vs 26.2%, respectively. The median (IQR) GS was 1.15 m/s (0.91-1.37 m/s). 52 (10.3%) patients had a composite outcome within 2 years follow up. Non-parametric univariate analysis revealed that lower GS was significantly associated higher composite outcome rates (median GS 0.8 vs 1.18 m/s; p&lt;0.001). Multivariate cox regression also revealed GS&lt;1 m/s to be an independent predictor of our composite outcome [HR- 4.33 (2.20-8.86); p&lt;0.001] (Table 1), with survival graphs showing patients with GS&lt;1m/s having worse 2-year survival (Figure 1). Conclusion: Frailty testing using GS post-CRT implantation is a strong predictor of mortality in CRT patients.

The association between changes in muscle mass and function and mortality in individuals receiving peritoneal dialysis.

Data in terms of how dynamic changes of muscle mass and function affect mortality in end-stage kidney disease (ESKD) patients undergoing dialysis have led to inconclusive results. The main goal of this research was to determine the association between dynamic deterioration of muscle mass and function and all-cause mortality in ESKD patient on continuous ambulatory peritoneal dialysis (CAPD). Eligible ESKD patients on CAPD were prospectively included, and followed up at 3-month intervals in the tertiary care center for 2 years. Dynamic deterioration of muscle mass and function during a 12-month follow-up period before patients enrolled was the exposure of interest. The deterioration of muscle mass and function was identified utilizing the criteria set by the Asian Working Group on Sarcopenia in 2019 (AWGS 2019). Primary outcome was defined as the all-cause mortality during the next 2-year follow-up period. Kaplan-Meier analysis with log-rank test was used to compare overall survival between groups. Association of dynamic deterioration of muscle mass and function with all-cause mortality was examined by employing Cox proportional hazards models. A sensitivity analysis was also conducted to examine whether the potential association was modified. A total of 217 eligible patients on CAPD were included. The prevalence of dynamic deterioration of muscle mass and function was 42.9% (93/217), of which that evolving to sarcopenia (nonsevere sarcopenia or severe sarcopenia) from nonsarcopenia was 24.9% (54/217) and that evolving to severe sarcopenia from nonsevere sarcopenia was 18.0% (39/217). A total of 35.0% (76/217) participants died during the 2-year follow-up period, of which the group with deterioration of muscle mass and function was 50.5% (47/93), and the group without deterioration was 23.4% (29/124), with an absolute difference of 27.1% (95%CI 14.5%-39.7%). Kaplan-Meier survival curve revealed that the participants with dynamic deterioration of muscle mass and function had a worse survival rate than those without deterioration (log-rank test, χ2 = 17.46, p < 0.001). After adjustment for potential confounding factors, the dynamic deterioration of muscle mass and function was still significantly associated with increased risk of all-cause mortality (hazard ratio [HR] = 2.40, 95%CI 1.44-4.00, p = 0.001). In sensitivity analysis, the relationship between dynamic deterioration of muscle mass and function (nonsarcopenia to sarcopenia vs without deterioration) and all-cause mortality was consistent (HR = 4.01, 95%CI 2.22-7.22, p < 0.001). Nevertheless, no significant relationship was found in participants who evolved to severe sarcopenia from nonsevere sarcopenia (HR = 1.41, 95%CI 0.72-2.74, p = 0.313). This research demonstrated a significant association between dynamic deterioration of muscle mass and function and higher risk of mortality in ESKD patients on CAPD, and we recommend individualized lifestyle intervention that may be implemented to intervene in the progression of their muscle mass and function across the health care spectrum.