This commentary critically appraises the study by Li et al which pioneered the exploration of the triglyceride-glucose(TyG)index as a prognostic marker in hepatitis B virus-related advanced hepatocellular carcinoma pa...This commentary critically appraises the study by Li et al which pioneered the exploration of the triglyceride-glucose(TyG)index as a prognostic marker in hepatitis B virus-related advanced hepatocellular carcinoma patients undergoing combined camrelizumab and lenvatinib therapy.While we acknowledge the study’s clinical relevance in proposing an easily accessible metabolic biomarker,we delve into the mechanistic plausibility linking insulin resistance to immunotherapy response and angiogenic inhibition.We further critically examine the methodological limitations,including the retrospective design,the populationspecific TyG cut-off value,and unaddressed metabolic confounders.We highlight the imperative for future research to validate its utility across diverse etiologies and treatment settings,and to unravel the underlying immunometabolic pathways.展开更多
Precise risk stratification is crucial for selecting the optimal risk-adapted treatment for newly diagnosed multiple myeloma (NDMM) patients. Various prognostic factors and staging systems have been developed to predi...Precise risk stratification is crucial for selecting the optimal risk-adapted treatment for newly diagnosed multiple myeloma (NDMM) patients. Various prognostic factors and staging systems have been developed to predict NDMM patient outcomes. The Durie-Salmon (D-S) staging system reflects tumor burden and clinical progression staging with prognostic value.展开更多
BACKGROUND Hepatocellular carcinoma(HCC),the sixth most common cancer and fourthleading cause of cancer-related mortality globally,imposes a significant burden in Vietnam due to endemic hepatitis B virus(HBV)and hepat...BACKGROUND Hepatocellular carcinoma(HCC),the sixth most common cancer and fourthleading cause of cancer-related mortality globally,imposes a significant burden in Vietnam due to endemic hepatitis B virus(HBV)and hepatitis C virus(HCV)infections.Accurate prognostication is crucial for optimizing treatment and outcomes.Numerous staging systems exist,including the Barcelona Clinic Liver Cancer(BCLC),Hong Kong Liver Cancer(HKLC),cancer of the liver Italian Program(CLIP),Italian Liver Cancer(ITA.LI.CA),Japan Integrated Staging(JIS),Tokyo Score,and model to estimate survival in ambulatory HCC patients(MESIAH).However,their comparative performance in Vietnamese patients remains underexplored.AIM To compare the prognostic accuracy of seven HCC staging systems in predicting survival and identify the optimal model.METHODS This retrospective cohort study included 987 patients with HCC diagnosed at Nhan dan Gia Dinh Hospital,Vietnam,from January 2016 to December 2023.Patients were staged using BCLC,HKLC,CLIP,ITA.LI.CA,JIS,Tokyo score,and MESIAH.Overall survival was analyzed using Kaplan-Meier methods,and prognostic performance was evaluated via the area under the receiver operating characteristic(ROC)curve,Harrell’s concordance index,and calibration plots.RESULTS The HKLC and BCLC systems demonstrated the highest discriminatory ability,with area under the ROC curves of 0.834 and 0.830,respectively,at 12 months and 0.859 for both systems at 36 months.CLIP and ITA.LI.CA exhibited superior calibration,particularly at 36 months.The JIS system consistently showed the poorest discriminatory performance.Subgroup analyses revealed that HKLC maintained strong performance across different viral etiologies(HBV,HCV,non-B-non-C)and treatment modalities(transarterial chemoembolization,surgery,ablation).CONCLUSION The HKLC and BCLC systems showed superior prognostic performance for Vietnamese patients with HCC,supporting HKLC adoption in clinical practice.展开更多
This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechani...This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechanism,the syndrome shows a large heterogeneity across presentation,cause,and disease trajectory,compli-cating diagnosis and management.Based on established prognostic scoring systems,the New Clichy Score,the BCS-transjugular intrahepatic portosystemic shunt Index,the Zeitoun Score,and the Pediatric End-stage Liver Disease score were examined.These scoring systems are used for risk stratification and thera-peutic decision-making.Although these models deliver suitability information,their static parameters,narrow validation,and limited generalizability reduce their usefulness in diverse populations.Specific challenges are highlighted in pediatric patients,pregnant females,and individuals with myeloproliferative neoplasms for whom current tools often fall short.Moreover,there remains uncertainty regarding the durability of Pediatric End-stage Liver Disease score response and longer-term risks,such as hepatocellular carcinoma.There is a need to have a dynamic prognostic model that uses imaging and genetic factors in future studies.The article discussed enhancing recruitment to improve research.Overall,this article provided a contemporary,evidence-based approach for cli-nicians to aid in the evaluation and treatment of BCS.展开更多
BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lack...BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lacking.AIM To evaluate the performance and accuracy of various proposed dengue clinical prognostic scores.METHODS Three databases,PubMed,EMBASE and Cochrane,were searched for peer-reviewed studies published from inception to 4 September 2023.Studies either developing or validating a prognostic model relevant to dengue fever were included.A total of 29 studies(n=17910)were included.RESULTS Most commonly studied outcomes were severe dengue(15 models)and mortality(8 models).For the paediatric population,Bedside Dengue Severity Score by Gayathri et al(specificity=0.98)and the nomogram model by Nguyen et al(sensitivity=0.87)performed better.For the adult population,the most specific model was reported by Leo et al(specificity=0.98).The most sensitive score is shared between Warning Signs for Severe Dengue as reported by Leo et al and Model 2 by Lee et al(sensitivity=1.00).CONCLUSION While several models demonstrated precision and reliability in predicting severe dengue and mortality,broader application across diverse geographic settings is needed to assess their external validity.展开更多
BACKGROUND Gastric cancer,a globally prevalent malignant tumor,continues to exhibit high incidence and mortality rates.Although radical gastrectomy remains the primary treatment for this disease,postoperative complica...BACKGROUND Gastric cancer,a globally prevalent malignant tumor,continues to exhibit high incidence and mortality rates.Although radical gastrectomy remains the primary treatment for this disease,postoperative complications frequently arise,negatively impacting short-term recovery and significantly reducing patients’quality of life.In this context,accurately predicting the risk of postoperative recurrence and metastasis,coupled with targeted interventions,could substantially improve patient outcomes.The C-reactive protein-triglyceride-glucose index(CTI),a composite biomarker that integrates metabolic disturbances and systemic inflammation,has garnered increasing attention in oncology.The prognostic nutritional index(PNI),a composite measure based on serum albumin and peripheral blood lymphocyte count,is used to evaluate both the nutritional status and systemic immune function of patients.In recent years,both the CTI and PNI have demonstrated significant prognostic value in predicting tumor outcomes,assessing treatment responses,and formulating personalized treatment strategies.AIM To investigate whether the combined inflammation and insulin resistance marker,the CTI,can serve as a prognostic indicator for patients undergoing radical gastrectomy for gastric cancer.Additionally,it seeks to develop a predictive model by incorporating the PNI alongside CTI.METHODS This retrospective study included a total of 300 patients who underwent radical gastrectomy.The patients were classified into high and low CTI groups based on their CTI index.Cox proportional hazards regression analysis was performed to identify independent prognostic factors influencing overall survival(OS)and disease-free survival(DFS),and two nomogram models were developed.RESULTS Of the included patients,131 had a high CTI and 169 had a low CTI.The DFS period of the low CTI group was significantly longer than that of the high CTI group.The number of postoperative adjuvant treatments,T stage,N stage,CTI,and PNI were identified as independent prognostic factors for DFS.The hazard ratio for CTI was 2.07(95%confidence interval:1.36-3.17,P<0.001).In terms of OS,the OS period of the low CTI group was significantly longer than that of the high CTI group.Whether adjuvant treatment was administered,T stage,CTI,and PNI were independent prognostic factors for OS.The hazard ratio for CTI was 2.47(95%confidence interval:1.44-4.23,P=0.001).The nomogram models for OS and DFS further emphasized the importance of CTI as a key predictor of patient prognosis.CONCLUSION CTI is a long-term prognostic indicator for the outcome of radical gastrectomy for gastric cancer.Patients with lower CTI values have a better prognosis.The prediction models constructed by combining CTI with PNI has good predictive ability for DFS and OS after radical gastrectomy.展开更多
The reliable,rapid,and accurate Remaining Useful Life(RUL)prognostics of aircraft power supply and distribution system are essential for enhancing the reliability and stability of system and reducing the life-cycle co...The reliable,rapid,and accurate Remaining Useful Life(RUL)prognostics of aircraft power supply and distribution system are essential for enhancing the reliability and stability of system and reducing the life-cycle costs.To achieve the reliable,rapid,and accurate RUL prognostics,the balance between accuracy and computational burden deserves more attention.In addition,the uncertainty is intrinsically present in RUL prognostic process.Due to the limitation of the uncertainty quantification,the point-wise prognostics strategy is not trustworthy.A Dual Adaptive Sliding-window Hybrid(DASH)RUL probabilistic prognostics strategy is proposed to tackle these deficiencies.The DASH strategy contains two adaptive mechanisms,the adaptive Long Short-Term Memory-Polynomial Regression(LSTM-PR)hybrid prognostics mechanism and the adaptive sliding-window Kernel Density Estimation(KDE)probabilistic prognostics mechanism.Owing to the dual adaptive mechanisms,the DASH strategy can achieve the balance between accuracy and computational burden and obtain the trustworthy probabilistic prognostics.Based on the degradation dataset of aircraft electromagnetic contactors,the superiority of DASH strategy is validated.In terms of probabilistic,point-wise and integrated prognostics performance,the proposed strategy increases by 66.89%,81.73% and 25.84%on average compared with the baseline methods and their variants.展开更多
BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized p...BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.展开更多
BACKGROUND Emerging evidence implicates Candida albicans(C.albicans)in human oncogenesis.Notably,studies have supported its involvement in regulating outcomes in colorectal cancer(CRC).This study investigated the para...BACKGROUND Emerging evidence implicates Candida albicans(C.albicans)in human oncogenesis.Notably,studies have supported its involvement in regulating outcomes in colorectal cancer(CRC).This study investigated the paradoxical role of C.albicans in CRC,aiming to determine whether it promotes or suppresses tumor development,with a focus on the mechanistic basis linked to its metabolic profile.AIM To investigate the dual role of C.albicans in the development and progression of CRC through metabolite profiling and to establish a prognostic model that integrates the microbial and metabolic interactions in CRC,providing insights into potential therapeutic strategies and clinical outcomes.METHODSA prognostic model integrating C. albicans with CRC was developed, incorporating enrichment analysis, immuneinfiltration profiling, survival analysis, Mendelian randomization, single-cell sequencing, and spatial transcriptomics.The effects of the C. albicans metabolite mixture on CRC cells were subsequently validated in vitro. Theprimary metabolite composition was characterized using liquid chromatography-mass spectrometry.RESULTSA prognostic model based on five specific mRNA markers, EHD4, LIME1, GADD45B, TIMP1, and FDFT1, wasestablished. The C. albicans metabolite mixture significantly reduced CRC cell viability. Post-treatment analysisrevealed a significant decrease in gene expression in HT29 cells, while the expression levels of TIMP1, EHD4, andGADD45B were significantly elevated in HCT116 cells. Conversely, LIME1 expression and that of other CRC celllines showed reductions. In normal colonic epithelial cells (NCM460), GADD45B, TIMP1, and FDFT1 expressionlevels were significantly increased, while LIME1 and EHD4 levels were markedly reduced. Following metabolitetreatment, the invasive and migratory capabilities of NCM460, HT29, and HCT116 cells were reduced. Quantitativeanalysis of extracellular ATP post-treatment showed a significant elevation (P < 0.01). The C. albicans metabolitemixture had no effect on reactive oxygen species accumulation in CRC cells but led to a reduction in mitochondrialmembrane potential, increased intracellular lipid peroxidation, and induced apoptosis. Metabolomic profilingrevealed significant alterations, with 516 metabolites upregulated and 531 downregulated.CONCLUSIONThis study introduced a novel prognostic model for CRC risk assessment. The findings suggested that the C.albicans metabolite mixture exerted an inhibitory effect on CRC initiation.展开更多
BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple...BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.展开更多
BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic...BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.展开更多
BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse outcomes.Understanding the prognostic role of hematological parameters and derive...BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse outcomes.Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events(MACE)in NSTEMI patients,potentially improving clinical outcomes.METHODS A prospective,observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla,Bosnia and Herzegovina.The study included 170 patients with NSTEMI,who were divided into a group with MACE and a control group without MACE.Furthermore,the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis.Alongside hematological parameters,an additional 13 hematological-derived ratios(HDRs)were monitored,and their prognostic role was investigated.RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction(NSTEMI)patients with MACE and a control group at T1 and T2.However,significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE.Notably,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were elevated in lethal outcomes.Furthermore,C-reactive protein-to-lymphocyte ratio(CRP/Ly)at T1(>4.737)demonstrated predictive value[odds ratio(OR):3.690,P=0.024].Both NLR at T1(>4.076)and T2(>4.667)emerged as significant predictors,with NLR at T2 exhibiting the highest diagnostic performance,as indicated by an area under the curve of 0.811(95%CI:0.727-0.859)and OR of 4.915(95%CI:1.917-12.602,P=0.001),emphasizing its important role as a prognostic marker.CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients.During follow-up,NLR,PLR,and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.展开更多
Gastric cancer(GC)has remained one of the leading causes of cancer-related deaths globally.The development of noninvasive biomarkers in cancer diagnosis and treatment has gained substantial traction in recent years.Re...Gastric cancer(GC)has remained one of the leading causes of cancer-related deaths globally.The development of noninvasive biomarkers in cancer diagnosis and treatment has gained substantial traction in recent years.Recent evidence highlights hypercoagulation as a promising prognostic biomarker,particularly in locally advanced GC(LAGC)who underwent radical resection after neoadjuvant immunochemotherapy(NICT).A recent study by Li et al showed that hypercoagulation is a valuable prognostic indicator for patients with LAGC who have undergone radical resection following NICT.While the study addresses an important clinical issue and provides insightful findings,the present study offered valuable insights;the applicability of these findings was constrained by the retrospective design,the focus on a single center,and the small sample size of the existing studies.Additionally,vital confounders,such as preoperative comorbidities and systemic inflammation,are inadequately addressed.Future studies should focus on prospective multicenter trials,incorporating advanced predictive models such as machine learning algorithms to integrate coagulation markers with other clinical variables for personalized risk stratification.In addition,we are required to validate findings to examine the biological mechanisms correlating hypercoagulation to tumor progression.Integrating machine learning,comprehensive biomarker panels,and real-world data would allow the researchers to have personalized risk stratification,improve predictive accuracy,and optimize clinical decision-making.Finally,A multidisciplinary approach,including lifestyle interventions and imaging modalities,is essential to improve outcomes among patients with GC.展开更多
BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(H...BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(HCC)treated with Lenvatinib has not been fully elucidated.AIM To compare different inflammation scores'prognostic values,and establish novel nomogram for predicting overall survival(OS)in HCC patients on Lenvatinib.METHODS In total,144 patients with HCC treated with Lenvatinib were enrolled in this study.The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed,including the platelet-to-lymphocyte ratio,neutrophil-to-lymphocyte ratio,lymphocyteto-C-reactive protein ratio,lymphocyte-to-monocyte ratio,systemic immune-inflammation index,C-reactive protein-to-albumin ratio,and prognostic nutritional index(PNI).Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.RESULTS All the inflammation-based scores demonstrated good discrimination in terms of OS(all P<0.05),and the PNI emerged as an independent predictor of OS in multivariate analysis(hazard ratio=4.097;95%confidence interval:1.405-11.944;P=0.01).We selected three independent prognostic factors(macrovascular invasion,metastasis,and PNI)to generate a nomogram for OS.CONCLUSION The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.展开更多
Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The ...Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The present study aimed to identify clinical and biological factors at admission associated with 30-day mortality in acute cholangitis,to build an efficient prognostic score based on these parameters and to study the performances of this new score.Methods:We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021.We developed a score system named ProChol using variables significantly asso-ciated with 30-day mortality in multivariate logistic analysis and simplified this system(named sProChol)based on a simple points-based approach.Results:In total,528 patients were included,with an average age of 77±13 years,a male predominance(54.2%)and a majority of lithiasis etiology(66.5%).Mortality in 30 days was 11.9%.In multivariate logis-tic analysis,tumor etiology[adjusted odds ratio(aOR)=15.43,95%confidence interval(CI):5.90-40.40],stent obstruction(aOR=5.12,95%CI:2.02-12.99),hypoalbuminemia(aOR=3.50,95%CI:1.25-9.81),renal failure(aOR=6.51,95%CI:2.62-16.18),oxygen therapy(aOR=4.63,95%CI:1.02-20.92)and cu-rative anticoagulation(aOR=2.60,95%CI:1.23-5.52)were independently associated with the 30-day mortality while fever was a protective factor(aOR=0.37,95%CI:0.16-0.84).ProChol score using these 7 parameters and sProChol using the 3 robust factors(etiology,renal failure and anticoagulation)presented respectively an area under receiver operating characteristic(ROC)curves(AUC)of 0.81 and 0.77,higher than Tokyo(AUC=0.72)and Gravito-Soares et al.score(AUC=0.71).Patients with sProChol≥4 had a significantly higher risk of transfer to intensive care unit(13.3%vs.5.1%;P<0.001)and longer length of stay(P=0.0006).Conclusions:ProChol and sProChol constructed from simple clinico-biological parameters at admission,present interesting performances in predicting the 30-day mortality in acute cholangitis.展开更多
Objective:A highly aggressive and lethal malignancy,characterized by its heterogeneity,lung adenocarcinoma(LUAD)presents significant challenges in prognosis and treatment.Disulfidptosis,a newly identified form of regu...Objective:A highly aggressive and lethal malignancy,characterized by its heterogeneity,lung adenocarcinoma(LUAD)presents significant challenges in prognosis and treatment.Disulfidptosis,a newly identified form of regulated cell death,offers novel insights into cancer progression,yet its role in LUAD remains poorly understood.Methods:We identified disulfidptosis-related genes(DRGs)from prior studies and analyzed their interactions and functional enrichment.Molecular subtypes were identified through consensus clustering based on DRG expression,and a prognostic DRG signature was developed using multivariate Cox regression analysis.A nomogram integrating clinical variables was developed to predict survival.Comprehensive analyses,including single-cell RNA sequencing,immune infiltration,and drug sensitivity,were validated using clinical specimens,LUAD cell lines,Western blotting(WB)and immunohistochemistry(IHC).Results:A total of 16 DRGs were identified,classifying LUAD patients into three distinct subtypes with differential survival and immune profiles.A 4-gene signature(GYS1,NDUFA11,NDUFB10,SLC7A11)was used to build a risk score model,demonstrating robust prognostic accuracy.A nomogram combining this signature with clinical features reliably predicted 1-,3-,and 5-year survival.The signature correlated with immune cell infiltration,with single-cell analysis revealing DRG enrichment in myeloid cells.Notably,SLC7A11 and GYS1 were positively associated with chemotherapeutic drug sensitivity.Validation through reverse transcription quantitative polymerase chain reaction(RT-qPCR),WB and IHC confirmed upregulated DRG expression in LUAD tissues and cell lines.Conclusions:This research highlights the essential role of DRGs in modulating the tumor microenvironment,influencing therapeutic response,and determining the prognosis of LUAD.The risk model and nomogram,derived from DRG expression,offer robust tools for survival prediction and personalized treatment stratification,facilitating the development of disulfidptosis-targeted therapeutic strategies.展开更多
Objective:To explore the application value of a machine learning-based prediction model in assessing the prognosis of septic children in the pediatric intensive care unit(PICU)and provide data support for clinical dec...Objective:To explore the application value of a machine learning-based prediction model in assessing the prognosis of septic children in the pediatric intensive care unit(PICU)and provide data support for clinical decision-making.Methods:A total of 180 septic children admitted to the PICU of a tertiary hospital from January 2020 to December 2024 were selected.They were divided into a control group(90 cases,using traditional scoring methods to predict prognosis)and an observation group(90 cases,using a multivariable model based on machine learning algorithms to predict prognosis)according to the random number table method.General information,laboratory indicators,and clinical interventions were collected.Various models such as Random Forest(RF),Support Vector Machine(SVM),and Logistic Regression(LR)were established.The model performance was evaluated using ROC curve,AUC value,accuracy,sensitivity,and specificity.Results:The machine learning models performed better than traditional scoring methods in predicting the 28-day mortality rate of septic children.Among them,the RF model achieved an AUC value of 0.921,a sensitivity of 85.6%,and a specificity of 88.1%,which were significantly higher than the PIM3 score(AUC 0.762).The prediction accuracy and timeliness of clinical intervention in the observation group were significantly improved,leading to a shortened hospital stay and reduced mortality rate(p<0.05).Conclusion:The prediction model based on machine learning can more accurately assess the prognostic risk of septic children in PICU,showing good clinical application prospects and providing references for individualized treatment and optimal resource allocation.展开更多
Gastric cancer(GC)remains a leading cause of cancer-related mortality worldwide,necessitating the identification of reliable prognostic indicators to enhance treatment outcomes.Recent research has highlighted the trig...Gastric cancer(GC)remains a leading cause of cancer-related mortality worldwide,necessitating the identification of reliable prognostic indicators to enhance treatment outcomes.Recent research has highlighted the triglyceride-glucose(TyG)index as a potential surrogate marker for insulin resistance,which may significantly influence the prognosis of patients undergoing immunotherapy combined with chemotherapy.In this context,the study by Yao et al demonstrates that a high TyG index correlates with improved overall survival and progressionfree survival in advanced GC patients receiving sintilimab and chemotherapy.Specifically,patients in the high TyG group had a significantly longer median progression-free survival of 9.8 months[95%confidence interval(CI):9.2-10.9]compared to 8.0 months(95%CI:7.5-8.5)in the low TyG group(hazard ratio=0.58,95%CI:0.43-0.79,P<0.001).Similarly,the median overall survival was significantly longer in the high TyG group at 23.1 months(95%CI:21.2-NA)vs 16.5 months(95%CI:13.9-18.3)in the low TyG group(hazard ratio=0.30,95%CI:0.21-0.42,P<0.001).These findings underscore the strong prognostic potential of the TyG index in guiding treatment strategies for advanced GC.These findings underscore the need for further investigation into the TyG index’s role as a prognostic tool and its underlying mechanisms in influencing treatment efficacy.We advocate for additional multicenter studies to validate these results and explore the TyG index’s applicability across diverse patient populations,ultimately aiming to refine treatment strategies and improve patient outcomes in advanced GC.展开更多
BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM T...BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.展开更多
Skin cutaneous melanoma(SKCM),a highly invasive malignant tumor originating from skin melanocytes,poses a significant threat to public health[1,2].Its development is closely associated with multiple factors,such as ul...Skin cutaneous melanoma(SKCM),a highly invasive malignant tumor originating from skin melanocytes,poses a significant threat to public health[1,2].Its development is closely associated with multiple factors,such as ultraviolet radiation,gene mutations,and immune escape.Among these,imbalance in the immune surveillance and clearance of tumor cells is a crucial link to disease progression[3,4].Tripartite motif-containing 27,which belongs to the TRIM protein family and is encoded by the TRIM27 gene,contains the RING,B-box,and coiled-coil domains.It participates in biological processes such as cell-cycle regulation,signal transduction,and immune response mainly by modifying target proteins through ubiquitination.Notably,increasing evidence indicates that TRIM27 is closely associated with the tumor immune microenvironment and contributes to cancer immune escape via multiple mechanisms,thereby promoting tumor development[5].However,the role of TRIM27 in SKCM remains unclear,thus prompting our investigation to elucidate this.展开更多
文摘This commentary critically appraises the study by Li et al which pioneered the exploration of the triglyceride-glucose(TyG)index as a prognostic marker in hepatitis B virus-related advanced hepatocellular carcinoma patients undergoing combined camrelizumab and lenvatinib therapy.While we acknowledge the study’s clinical relevance in proposing an easily accessible metabolic biomarker,we delve into the mechanistic plausibility linking insulin resistance to immunotherapy response and angiogenic inhibition.We further critically examine the methodological limitations,including the retrospective design,the populationspecific TyG cut-off value,and unaddressed metabolic confounders.We highlight the imperative for future research to validate its utility across diverse etiologies and treatment settings,and to unravel the underlying immunometabolic pathways.
基金supported by the National Natural Science Foundation of China (Grant nos. 82470209 and 82170141)the Jiaxing Key Discipiline of Medcine-Nephrology (Grant no. 2023-ZC-011)。
文摘Precise risk stratification is crucial for selecting the optimal risk-adapted treatment for newly diagnosed multiple myeloma (NDMM) patients. Various prognostic factors and staging systems have been developed to predict NDMM patient outcomes. The Durie-Salmon (D-S) staging system reflects tumor burden and clinical progression staging with prognostic value.
文摘BACKGROUND Hepatocellular carcinoma(HCC),the sixth most common cancer and fourthleading cause of cancer-related mortality globally,imposes a significant burden in Vietnam due to endemic hepatitis B virus(HBV)and hepatitis C virus(HCV)infections.Accurate prognostication is crucial for optimizing treatment and outcomes.Numerous staging systems exist,including the Barcelona Clinic Liver Cancer(BCLC),Hong Kong Liver Cancer(HKLC),cancer of the liver Italian Program(CLIP),Italian Liver Cancer(ITA.LI.CA),Japan Integrated Staging(JIS),Tokyo Score,and model to estimate survival in ambulatory HCC patients(MESIAH).However,their comparative performance in Vietnamese patients remains underexplored.AIM To compare the prognostic accuracy of seven HCC staging systems in predicting survival and identify the optimal model.METHODS This retrospective cohort study included 987 patients with HCC diagnosed at Nhan dan Gia Dinh Hospital,Vietnam,from January 2016 to December 2023.Patients were staged using BCLC,HKLC,CLIP,ITA.LI.CA,JIS,Tokyo score,and MESIAH.Overall survival was analyzed using Kaplan-Meier methods,and prognostic performance was evaluated via the area under the receiver operating characteristic(ROC)curve,Harrell’s concordance index,and calibration plots.RESULTS The HKLC and BCLC systems demonstrated the highest discriminatory ability,with area under the ROC curves of 0.834 and 0.830,respectively,at 12 months and 0.859 for both systems at 36 months.CLIP and ITA.LI.CA exhibited superior calibration,particularly at 36 months.The JIS system consistently showed the poorest discriminatory performance.Subgroup analyses revealed that HKLC maintained strong performance across different viral etiologies(HBV,HCV,non-B-non-C)and treatment modalities(transarterial chemoembolization,surgery,ablation).CONCLUSION The HKLC and BCLC systems showed superior prognostic performance for Vietnamese patients with HCC,supporting HKLC adoption in clinical practice.
文摘This editorial narrative review discussed Budd-Chiari syndrome(BCS),which re-presents a rare but critical vascular liver disease resulting in an obstruction of he-patic venous outflow.Despite having a unifying mechanism,the syndrome shows a large heterogeneity across presentation,cause,and disease trajectory,compli-cating diagnosis and management.Based on established prognostic scoring systems,the New Clichy Score,the BCS-transjugular intrahepatic portosystemic shunt Index,the Zeitoun Score,and the Pediatric End-stage Liver Disease score were examined.These scoring systems are used for risk stratification and thera-peutic decision-making.Although these models deliver suitability information,their static parameters,narrow validation,and limited generalizability reduce their usefulness in diverse populations.Specific challenges are highlighted in pediatric patients,pregnant females,and individuals with myeloproliferative neoplasms for whom current tools often fall short.Moreover,there remains uncertainty regarding the durability of Pediatric End-stage Liver Disease score response and longer-term risks,such as hepatocellular carcinoma.There is a need to have a dynamic prognostic model that uses imaging and genetic factors in future studies.The article discussed enhancing recruitment to improve research.Overall,this article provided a contemporary,evidence-based approach for cli-nicians to aid in the evaluation and treatment of BCS.
文摘BACKGROUND Clinical predictors of dengue fever are crucial for guiding timely management and avoiding life-threatening complications.While prognostic scores are available,a systematic evaluation of these tools is lacking.AIM To evaluate the performance and accuracy of various proposed dengue clinical prognostic scores.METHODS Three databases,PubMed,EMBASE and Cochrane,were searched for peer-reviewed studies published from inception to 4 September 2023.Studies either developing or validating a prognostic model relevant to dengue fever were included.A total of 29 studies(n=17910)were included.RESULTS Most commonly studied outcomes were severe dengue(15 models)and mortality(8 models).For the paediatric population,Bedside Dengue Severity Score by Gayathri et al(specificity=0.98)and the nomogram model by Nguyen et al(sensitivity=0.87)performed better.For the adult population,the most specific model was reported by Leo et al(specificity=0.98).The most sensitive score is shared between Warning Signs for Severe Dengue as reported by Leo et al and Model 2 by Lee et al(sensitivity=1.00).CONCLUSION While several models demonstrated precision and reliability in predicting severe dengue and mortality,broader application across diverse geographic settings is needed to assess their external validity.
文摘BACKGROUND Gastric cancer,a globally prevalent malignant tumor,continues to exhibit high incidence and mortality rates.Although radical gastrectomy remains the primary treatment for this disease,postoperative complications frequently arise,negatively impacting short-term recovery and significantly reducing patients’quality of life.In this context,accurately predicting the risk of postoperative recurrence and metastasis,coupled with targeted interventions,could substantially improve patient outcomes.The C-reactive protein-triglyceride-glucose index(CTI),a composite biomarker that integrates metabolic disturbances and systemic inflammation,has garnered increasing attention in oncology.The prognostic nutritional index(PNI),a composite measure based on serum albumin and peripheral blood lymphocyte count,is used to evaluate both the nutritional status and systemic immune function of patients.In recent years,both the CTI and PNI have demonstrated significant prognostic value in predicting tumor outcomes,assessing treatment responses,and formulating personalized treatment strategies.AIM To investigate whether the combined inflammation and insulin resistance marker,the CTI,can serve as a prognostic indicator for patients undergoing radical gastrectomy for gastric cancer.Additionally,it seeks to develop a predictive model by incorporating the PNI alongside CTI.METHODS This retrospective study included a total of 300 patients who underwent radical gastrectomy.The patients were classified into high and low CTI groups based on their CTI index.Cox proportional hazards regression analysis was performed to identify independent prognostic factors influencing overall survival(OS)and disease-free survival(DFS),and two nomogram models were developed.RESULTS Of the included patients,131 had a high CTI and 169 had a low CTI.The DFS period of the low CTI group was significantly longer than that of the high CTI group.The number of postoperative adjuvant treatments,T stage,N stage,CTI,and PNI were identified as independent prognostic factors for DFS.The hazard ratio for CTI was 2.07(95%confidence interval:1.36-3.17,P<0.001).In terms of OS,the OS period of the low CTI group was significantly longer than that of the high CTI group.Whether adjuvant treatment was administered,T stage,CTI,and PNI were independent prognostic factors for OS.The hazard ratio for CTI was 2.47(95%confidence interval:1.44-4.23,P=0.001).The nomogram models for OS and DFS further emphasized the importance of CTI as a key predictor of patient prognosis.CONCLUSION CTI is a long-term prognostic indicator for the outcome of radical gastrectomy for gastric cancer.Patients with lower CTI values have a better prognosis.The prediction models constructed by combining CTI with PNI has good predictive ability for DFS and OS after radical gastrectomy.
基金co-supported by the National Natural Science Foundation of China(Nos.52272403,52402506)Natural Science Basic Research Program of Shaanxi,China(Nos.2022JC-27,2023-JC-QN-0599)。
文摘The reliable,rapid,and accurate Remaining Useful Life(RUL)prognostics of aircraft power supply and distribution system are essential for enhancing the reliability and stability of system and reducing the life-cycle costs.To achieve the reliable,rapid,and accurate RUL prognostics,the balance between accuracy and computational burden deserves more attention.In addition,the uncertainty is intrinsically present in RUL prognostic process.Due to the limitation of the uncertainty quantification,the point-wise prognostics strategy is not trustworthy.A Dual Adaptive Sliding-window Hybrid(DASH)RUL probabilistic prognostics strategy is proposed to tackle these deficiencies.The DASH strategy contains two adaptive mechanisms,the adaptive Long Short-Term Memory-Polynomial Regression(LSTM-PR)hybrid prognostics mechanism and the adaptive sliding-window Kernel Density Estimation(KDE)probabilistic prognostics mechanism.Owing to the dual adaptive mechanisms,the DASH strategy can achieve the balance between accuracy and computational burden and obtain the trustworthy probabilistic prognostics.Based on the degradation dataset of aircraft electromagnetic contactors,the superiority of DASH strategy is validated.In terms of probabilistic,point-wise and integrated prognostics performance,the proposed strategy increases by 66.89%,81.73% and 25.84%on average compared with the baseline methods and their variants.
基金Supported by National Natural Science Foundation of China,No.81874390 and No.81573948Shanghai Natural Science Foundation,No.21ZR1464100+1 种基金Science and Technology Innovation Action Plan of Shanghai Science and Technology Commission,No.22S11901700the Shanghai Key Specialty of Traditional Chinese Clinical Medicine,No.shslczdzk01201.
文摘BACKGROUND Rebleeding after recovery from esophagogastric variceal bleeding(EGVB)is a severe complication that is associated with high rates of both incidence and mortality.Despite its clinical importance,recognized prognostic models that can effectively predict esophagogastric variceal rebleeding in patients with liver cirrhosis are lacking.AIM To construct and externally validate a reliable prognostic model for predicting the occurrence of esophagogastric variceal rebleeding.METHODS This study included 477 EGVB patients across 2 cohorts:The derivation cohort(n=322)and the validation cohort(n=155).The primary outcome was rebleeding events within 1 year.The least absolute shrinkage and selection operator was applied for predictor selection,and multivariate Cox regression analysis was used to construct the prognostic model.Internal validation was performed with bootstrap resampling.We assessed the discrimination,calibration and accuracy of the model,and performed patient risk stratification.RESULTS Six predictors,including albumin and aspartate aminotransferase concentrations,white blood cell count,and the presence of ascites,portal vein thrombosis,and bleeding signs,were selected for the rebleeding event prediction following endoscopic treatment(REPET)model.In predicting rebleeding within 1 year,the REPET model ex-hibited a concordance index of 0.775 and a Brier score of 0.143 in the derivation cohort,alongside 0.862 and 0.127 in the validation cohort.Furthermore,the REPET model revealed a significant difference in rebleeding rates(P<0.01)between low-risk patients and intermediate-to high-risk patients in both cohorts.CONCLUSION We constructed and validated a new prognostic model for variceal rebleeding with excellent predictive per-formance,which will improve the clinical management of rebleeding in EGVB patients.
基金Supported by Gansu Province Joint Fund General Program,No.24JRRA878Gansu Provincial Science and Technology Program Project,No.24JRRA1020+2 种基金Gansu Province Key Talent Program,No.2025RCXM006Teaching Research and Reform Program for Postgraduate Education at Gansu University of Traditional Chinese Medicine(GUSTCM),No.YBXM-202406Special Fund for Mentors of“Qihuang Talents”in the First-Level Discipline of Chinese Medicine,No.ZYXKBD-202415。
文摘BACKGROUND Emerging evidence implicates Candida albicans(C.albicans)in human oncogenesis.Notably,studies have supported its involvement in regulating outcomes in colorectal cancer(CRC).This study investigated the paradoxical role of C.albicans in CRC,aiming to determine whether it promotes or suppresses tumor development,with a focus on the mechanistic basis linked to its metabolic profile.AIM To investigate the dual role of C.albicans in the development and progression of CRC through metabolite profiling and to establish a prognostic model that integrates the microbial and metabolic interactions in CRC,providing insights into potential therapeutic strategies and clinical outcomes.METHODSA prognostic model integrating C. albicans with CRC was developed, incorporating enrichment analysis, immuneinfiltration profiling, survival analysis, Mendelian randomization, single-cell sequencing, and spatial transcriptomics.The effects of the C. albicans metabolite mixture on CRC cells were subsequently validated in vitro. Theprimary metabolite composition was characterized using liquid chromatography-mass spectrometry.RESULTSA prognostic model based on five specific mRNA markers, EHD4, LIME1, GADD45B, TIMP1, and FDFT1, wasestablished. The C. albicans metabolite mixture significantly reduced CRC cell viability. Post-treatment analysisrevealed a significant decrease in gene expression in HT29 cells, while the expression levels of TIMP1, EHD4, andGADD45B were significantly elevated in HCT116 cells. Conversely, LIME1 expression and that of other CRC celllines showed reductions. In normal colonic epithelial cells (NCM460), GADD45B, TIMP1, and FDFT1 expressionlevels were significantly increased, while LIME1 and EHD4 levels were markedly reduced. Following metabolitetreatment, the invasive and migratory capabilities of NCM460, HT29, and HCT116 cells were reduced. Quantitativeanalysis of extracellular ATP post-treatment showed a significant elevation (P < 0.01). The C. albicans metabolitemixture had no effect on reactive oxygen species accumulation in CRC cells but led to a reduction in mitochondrialmembrane potential, increased intracellular lipid peroxidation, and induced apoptosis. Metabolomic profilingrevealed significant alterations, with 516 metabolites upregulated and 531 downregulated.CONCLUSIONThis study introduced a novel prognostic model for CRC risk assessment. The findings suggested that the C.albicans metabolite mixture exerted an inhibitory effect on CRC initiation.
文摘BACKGROUND Acute-on-chronic liver failure(ACLF)is a liver disease based on chronic liver disease,which is significantly influenced by clinical treatment regimen and disease status,and despite the existence of multiple prognostic assessment indicators for ACLF,the overall sensitivity and accuracy are relatively low.AIM To investigate the prognostic value of the combined detection of alpha-fetoprotein(AFP),plasma prothrombin activity(PTA),and serum prealbumin(PA)in ACLF.METHODS This retrospective study included 87 patients with ACLF admitted from February 2021 to February 2023 and categorized them into the survival(n=47)and death(n=40)groups according to their clinical outcomes 3 months posttreatment.All the participants underwent AFP,PTA,and PA level measurements upon admission.Baseline data,as well as AFP,PTA,and PA levels,were comparatively analyzed.Pearson correlation coefficients were utilized to analyze the correlations of AFP,PTA,and PA with different survival outcomes in patients with ACLF.Receiver operating characteristic(ROC)curves and areas under the curves were used to evaluate the predictive value of AFP,PTA,and PA for ACLF prognosis.RESULTS AFP,PTA,and PA levels were markedly decreased in the death group than in the survival group(P<0.05).Pearson analysis indicated a positive association of the AFP,PTA,and PA levels with the survival of patients with ACLF(P<0.05).ROC curve analysis determined the sensitivity and specificity of the combined diagnosis at 91.24%and 100.00%,respectively,both of which were notably increased compared to the single-index diagnosis.The ROC of their combined diagnosis was 0.989,significantly surpassing 0.907,0.849,and 0.853 of AFP,PTA,and PA,respectively.No statistically significant variance was determined in the sensitivity and specificity of the combined diagnosis vs the single detection(P>0.05).CONCLUSION The combined detection of AFP,PTA,and PA levels demonstrates favorable diagnostic value for the short-term prognosis of patients with ACLF,featuring high sensitivity and specificity.
基金Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01C297.
文摘BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.
文摘BACKGROUND Non-ST segment elevation myocardial infarction(NSTEMI)poses significant challenges in clinical management due to its diverse outcomes.Understanding the prognostic role of hematological parameters and derived ratios in NSTEMI patients could aid in risk stratification and improve patient care.AIM To evaluate the predictive value of hemogram-derived ratios for major adverse cardiovascular events(MACE)in NSTEMI patients,potentially improving clinical outcomes.METHODS A prospective,observational cohort study was conducted in 2021 at the Internal Medicine Clinic of the University Hospital in Tuzla,Bosnia and Herzegovina.The study included 170 patients with NSTEMI,who were divided into a group with MACE and a control group without MACE.Furthermore,the MACE group was subdivided into lethal and non-lethal groups for prognostic analysis.Alongside hematological parameters,an additional 13 hematological-derived ratios(HDRs)were monitored,and their prognostic role was investigated.RESULTS Hematological parameters did not significantly differ between non-ST segment elevation myocardial infarction(NSTEMI)patients with MACE and a control group at T1 and T2.However,significant disparities emerged in HDRs among NSTEMI patients with lethal and non-lethal outcomes post-MACE.Notably,neutrophil-to-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR)were elevated in lethal outcomes.Furthermore,C-reactive protein-to-lymphocyte ratio(CRP/Ly)at T1(>4.737)demonstrated predictive value[odds ratio(OR):3.690,P=0.024].Both NLR at T1(>4.076)and T2(>4.667)emerged as significant predictors,with NLR at T2 exhibiting the highest diagnostic performance,as indicated by an area under the curve of 0.811(95%CI:0.727-0.859)and OR of 4.915(95%CI:1.917-12.602,P=0.001),emphasizing its important role as a prognostic marker.CONCLUSION This study highlights the significant prognostic value of hemogram-derived indexes in predicting MACE among NSTEMI patients.During follow-up,NLR,PLR,and CRP/Ly offer important insights into the inflammatory processes underlying cardiovascular events.
文摘Gastric cancer(GC)has remained one of the leading causes of cancer-related deaths globally.The development of noninvasive biomarkers in cancer diagnosis and treatment has gained substantial traction in recent years.Recent evidence highlights hypercoagulation as a promising prognostic biomarker,particularly in locally advanced GC(LAGC)who underwent radical resection after neoadjuvant immunochemotherapy(NICT).A recent study by Li et al showed that hypercoagulation is a valuable prognostic indicator for patients with LAGC who have undergone radical resection following NICT.While the study addresses an important clinical issue and provides insightful findings,the present study offered valuable insights;the applicability of these findings was constrained by the retrospective design,the focus on a single center,and the small sample size of the existing studies.Additionally,vital confounders,such as preoperative comorbidities and systemic inflammation,are inadequately addressed.Future studies should focus on prospective multicenter trials,incorporating advanced predictive models such as machine learning algorithms to integrate coagulation markers with other clinical variables for personalized risk stratification.In addition,we are required to validate findings to examine the biological mechanisms correlating hypercoagulation to tumor progression.Integrating machine learning,comprehensive biomarker panels,and real-world data would allow the researchers to have personalized risk stratification,improve predictive accuracy,and optimize clinical decision-making.Finally,A multidisciplinary approach,including lifestyle interventions and imaging modalities,is essential to improve outcomes among patients with GC.
基金Supported by Natural Science Foundation of China,No.82103566。
文摘BACKGROUND Inflammation is closely related to survival and disease progression in patients with cancer.However,the predictive value of inflammation-based scores for survival in patients with hepatocellular carcinoma(HCC)treated with Lenvatinib has not been fully elucidated.AIM To compare different inflammation scores'prognostic values,and establish novel nomogram for predicting overall survival(OS)in HCC patients on Lenvatinib.METHODS In total,144 patients with HCC treated with Lenvatinib were enrolled in this study.The prognostic value of pre-treatment inflammation-based scores was retrospectively analyzed,including the platelet-to-lymphocyte ratio,neutrophil-to-lymphocyte ratio,lymphocyteto-C-reactive protein ratio,lymphocyte-to-monocyte ratio,systemic immune-inflammation index,C-reactive protein-to-albumin ratio,and prognostic nutritional index(PNI).Kaplan-Meier survival curves and time-dependent receiver operating characteristic analysis were used to assess predictive accuracy.Univariate and multivariate Cox regression analyses were conducted to identify prognostic factors predicting OS and construct a prognostic nomogram.RESULTS All the inflammation-based scores demonstrated good discrimination in terms of OS(all P<0.05),and the PNI emerged as an independent predictor of OS in multivariate analysis(hazard ratio=4.097;95%confidence interval:1.405-11.944;P=0.01).We selected three independent prognostic factors(macrovascular invasion,metastasis,and PNI)to generate a nomogram for OS.CONCLUSION The PNI is a prognostic indicator for assessing OS in patients with HCC treated with Lenvatinib and is superior to other inflammation-based scores in predicting OS.
文摘Background:Acute cholangitis is an infection due to the bile duct obstruction.Despite progress in treat-ment,acute cholangitis remains potentially fatal.Early diagnosis and treatment improve the patient out-comes.The present study aimed to identify clinical and biological factors at admission associated with 30-day mortality in acute cholangitis,to build an efficient prognostic score based on these parameters and to study the performances of this new score.Methods:We enrolled all adult patients consecutively hospitalized for acute cholangitis between January 2017 and December 2021.We developed a score system named ProChol using variables significantly asso-ciated with 30-day mortality in multivariate logistic analysis and simplified this system(named sProChol)based on a simple points-based approach.Results:In total,528 patients were included,with an average age of 77±13 years,a male predominance(54.2%)and a majority of lithiasis etiology(66.5%).Mortality in 30 days was 11.9%.In multivariate logis-tic analysis,tumor etiology[adjusted odds ratio(aOR)=15.43,95%confidence interval(CI):5.90-40.40],stent obstruction(aOR=5.12,95%CI:2.02-12.99),hypoalbuminemia(aOR=3.50,95%CI:1.25-9.81),renal failure(aOR=6.51,95%CI:2.62-16.18),oxygen therapy(aOR=4.63,95%CI:1.02-20.92)and cu-rative anticoagulation(aOR=2.60,95%CI:1.23-5.52)were independently associated with the 30-day mortality while fever was a protective factor(aOR=0.37,95%CI:0.16-0.84).ProChol score using these 7 parameters and sProChol using the 3 robust factors(etiology,renal failure and anticoagulation)presented respectively an area under receiver operating characteristic(ROC)curves(AUC)of 0.81 and 0.77,higher than Tokyo(AUC=0.72)and Gravito-Soares et al.score(AUC=0.71).Patients with sProChol≥4 had a significantly higher risk of transfer to intensive care unit(13.3%vs.5.1%;P<0.001)and longer length of stay(P=0.0006).Conclusions:ProChol and sProChol constructed from simple clinico-biological parameters at admission,present interesting performances in predicting the 30-day mortality in acute cholangitis.
基金funded by the Top Talent Support Program for Young and Middle-aged People of Wuxi Health Commission(No.BJ2023014)the General Program of Wuxi Medical Center of Nanjing Medical University(No.WMCG202406)the Quality Talent Program of Wuxi Medical Center of Nanjing Medical University(No.WMCQ202401)。
文摘Objective:A highly aggressive and lethal malignancy,characterized by its heterogeneity,lung adenocarcinoma(LUAD)presents significant challenges in prognosis and treatment.Disulfidptosis,a newly identified form of regulated cell death,offers novel insights into cancer progression,yet its role in LUAD remains poorly understood.Methods:We identified disulfidptosis-related genes(DRGs)from prior studies and analyzed their interactions and functional enrichment.Molecular subtypes were identified through consensus clustering based on DRG expression,and a prognostic DRG signature was developed using multivariate Cox regression analysis.A nomogram integrating clinical variables was developed to predict survival.Comprehensive analyses,including single-cell RNA sequencing,immune infiltration,and drug sensitivity,were validated using clinical specimens,LUAD cell lines,Western blotting(WB)and immunohistochemistry(IHC).Results:A total of 16 DRGs were identified,classifying LUAD patients into three distinct subtypes with differential survival and immune profiles.A 4-gene signature(GYS1,NDUFA11,NDUFB10,SLC7A11)was used to build a risk score model,demonstrating robust prognostic accuracy.A nomogram combining this signature with clinical features reliably predicted 1-,3-,and 5-year survival.The signature correlated with immune cell infiltration,with single-cell analysis revealing DRG enrichment in myeloid cells.Notably,SLC7A11 and GYS1 were positively associated with chemotherapeutic drug sensitivity.Validation through reverse transcription quantitative polymerase chain reaction(RT-qPCR),WB and IHC confirmed upregulated DRG expression in LUAD tissues and cell lines.Conclusions:This research highlights the essential role of DRGs in modulating the tumor microenvironment,influencing therapeutic response,and determining the prognosis of LUAD.The risk model and nomogram,derived from DRG expression,offer robust tools for survival prediction and personalized treatment stratification,facilitating the development of disulfidptosis-targeted therapeutic strategies.
文摘Objective:To explore the application value of a machine learning-based prediction model in assessing the prognosis of septic children in the pediatric intensive care unit(PICU)and provide data support for clinical decision-making.Methods:A total of 180 septic children admitted to the PICU of a tertiary hospital from January 2020 to December 2024 were selected.They were divided into a control group(90 cases,using traditional scoring methods to predict prognosis)and an observation group(90 cases,using a multivariable model based on machine learning algorithms to predict prognosis)according to the random number table method.General information,laboratory indicators,and clinical interventions were collected.Various models such as Random Forest(RF),Support Vector Machine(SVM),and Logistic Regression(LR)were established.The model performance was evaluated using ROC curve,AUC value,accuracy,sensitivity,and specificity.Results:The machine learning models performed better than traditional scoring methods in predicting the 28-day mortality rate of septic children.Among them,the RF model achieved an AUC value of 0.921,a sensitivity of 85.6%,and a specificity of 88.1%,which were significantly higher than the PIM3 score(AUC 0.762).The prediction accuracy and timeliness of clinical intervention in the observation group were significantly improved,leading to a shortened hospital stay and reduced mortality rate(p<0.05).Conclusion:The prediction model based on machine learning can more accurately assess the prognostic risk of septic children in PICU,showing good clinical application prospects and providing references for individualized treatment and optimal resource allocation.
文摘Gastric cancer(GC)remains a leading cause of cancer-related mortality worldwide,necessitating the identification of reliable prognostic indicators to enhance treatment outcomes.Recent research has highlighted the triglyceride-glucose(TyG)index as a potential surrogate marker for insulin resistance,which may significantly influence the prognosis of patients undergoing immunotherapy combined with chemotherapy.In this context,the study by Yao et al demonstrates that a high TyG index correlates with improved overall survival and progressionfree survival in advanced GC patients receiving sintilimab and chemotherapy.Specifically,patients in the high TyG group had a significantly longer median progression-free survival of 9.8 months[95%confidence interval(CI):9.2-10.9]compared to 8.0 months(95%CI:7.5-8.5)in the low TyG group(hazard ratio=0.58,95%CI:0.43-0.79,P<0.001).Similarly,the median overall survival was significantly longer in the high TyG group at 23.1 months(95%CI:21.2-NA)vs 16.5 months(95%CI:13.9-18.3)in the low TyG group(hazard ratio=0.30,95%CI:0.21-0.42,P<0.001).These findings underscore the strong prognostic potential of the TyG index in guiding treatment strategies for advanced GC.These findings underscore the need for further investigation into the TyG index’s role as a prognostic tool and its underlying mechanisms in influencing treatment efficacy.We advocate for additional multicenter studies to validate these results and explore the TyG index’s applicability across diverse patient populations,ultimately aiming to refine treatment strategies and improve patient outcomes in advanced GC.
文摘BACKGROUND Peritoneal lavage cytology-positive(CY1)gastric cancer(stage IV)has a poor prognosis,though some cases fare better.Therefore,identifying prognostic factors and an optimal treatment strategy is crucial.AIM To investigate prognostic factors in patients with gastric cancer who underwent gastrectomy with CY1,and to evaluate the optimal postoperative chemotherapy regimen.METHODS This multicenter retrospective cohort study analyzed prognostic factors and postoperative chemotherapy in patients with CY1 gastric cancer who underwent gastrectomy,excluding those with macroscopic peritoneal dissemination.Data from 13 institutions(2015-2019)were reviewed.RESULTS Overall,82 patients met the inclusion criteria.The median overall survival was 22.8 months,and diffuse-type histology and the absence of postoperative chemotherapy were identified as independent poor prognostic factors.The 5-year survival rate was 82.4%for those receiving fluoropyrimidine plus docetaxel/oxaliplatin vs 21.8%for those with S-1 monotherapy or a cisplatin-based regimen.Median overall survival was not reached in the fluoropyrimidine+docetaxel/oxaliplatin group but was 22.9 months in the S-1/cisplatin group.Chemotherapy regimen was an independent prognostic factor(hazard ratio=5.47,P=0.004).The fluoropyrimidine plus docetaxel/oxaliplatin group had an average relative dose intensity of 82.1%,with significantly more patients achieving a relative dose intensity≥80%than in the S-1 monotherapy or cisplatin-based group(P=0.001).CONCLUSION Diffuse-type histology and the absence of postoperative chemotherapy influence the prognosis of patients with CY1 gastric cancer.Combination therapy with oxaliplatin or docetaxel may enhance the treatment intensity and improve survival outcomes after gastrectomy.
基金supported by the Natural Science Foundation of Hebei Province(Grant number:C2025405060).
文摘Skin cutaneous melanoma(SKCM),a highly invasive malignant tumor originating from skin melanocytes,poses a significant threat to public health[1,2].Its development is closely associated with multiple factors,such as ultraviolet radiation,gene mutations,and immune escape.Among these,imbalance in the immune surveillance and clearance of tumor cells is a crucial link to disease progression[3,4].Tripartite motif-containing 27,which belongs to the TRIM protein family and is encoded by the TRIM27 gene,contains the RING,B-box,and coiled-coil domains.It participates in biological processes such as cell-cycle regulation,signal transduction,and immune response mainly by modifying target proteins through ubiquitination.Notably,increasing evidence indicates that TRIM27 is closely associated with the tumor immune microenvironment and contributes to cancer immune escape via multiple mechanisms,thereby promoting tumor development[5].However,the role of TRIM27 in SKCM remains unclear,thus prompting our investigation to elucidate this.
