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Corwin DJ, Mandel F, McDonald CC, Barnett I, Arbogast KB, Master CL. Optimizing the Combination of Common Clinical Concussion Batteries to Predict Persistent Postconcussion Symptoms in a Prospective Cohort of Concussed Youth. Am J Sports Med 2024; 52:811-821. [PMID: 38305042 PMCID: PMC11033620 DOI: 10.1177/03635465231222936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
BACKGROUND Studies have evaluated individual factors associated with persistent postconcussion symptoms (PPCS) in youth concussion, but no study has combined individual elements of common concussion batteries with patient characteristics, comorbidities, and visio-vestibular deficits in assessing an optimal model to predict PPCS. PURPOSE To determine the combination of elements from 4 commonly used clinical concussion batteries and known patient characteristics and comorbid risk factors that maximize the ability to predict PPCS. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS We enrolled 198 concussed participants-87 developed PPCS and 111 did not-aged 8 to 19 years assessed within 14 days of injury from a suburban high school and the concussion program of a tertiary care academic medical center. We defined PPCS as a Post-Concussion Symptom Inventory (PCSI) score at 28 days from injury of ≥3 points compared with the preinjury PCSI score-scaled for younger children. Predictors included the individual elements of the visio-vestibular examination (VVE), Sport Concussion Assessment Tool, 5th Edition (SCAT-5), King-Devick test, and PCSI, in addition to age, sex, concussion history, and migraine headache history. The individual elements of these tests were grouped into interpretable factors using sparse principal component analysis. The 12 resultant factors were combined into a logistic regression and ranked by frequency of inclusion into the combined optimal model, whose predictive performance was compared with the VVE, initial PCSI, and the current existing predictive model (the Predicting and Prevention Postconcussive Problems in Pediatrics (5P) prediction rule) using the area under the receiver operating characteristic curve (AUC). RESULTS A cluster of 2 factors (SCAT-5/PCSI symptoms and VVE near point of convergence/accommodation) emerged. A model fit with these factors had an AUC of 0.805 (95% CI, 0.661-0.929). This was a higher AUC point estimate, with overlapping 95% CIs, compared with the PCSI (AUC, 0.773 [95% CI, 0.617-0.912]), VVE (AUC, 0.736 [95% CI, 0.569-0.878]), and 5P Prediction Rule (AUC, 0.728 [95% CI, 0.554-0.870]). CONCLUSION Among commonly used clinical assessments for youth concussion, a combination of symptom burden and the vision component of the VVE has the potential to augment predictive power for PPCS over either current risk models or individual batteries.
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Affiliation(s)
- Daniel J. Corwin
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Francesca Mandel
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Catherine C. McDonald
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ian Barnett
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kristy B. Arbogast
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Emergency Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Christina L. Master
- Center for Injury Research and Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Sports Medicine and Performance Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Xu J, He Q, Wang M, Liu M, Li Q, Ren Y, Yao M, Li G, Lu K, Zou K, Wang W, Sun X. Handling time-varying treatments in observational studies: A scoping review and recommendations. J Evid Based Med 2024; 17:95-105. [PMID: 38502877 DOI: 10.1111/jebm.12600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Time-varying treatments are common in observational studies. However, when assessing treatment effects, the methodological framework has not been systematically established for handling time-varying treatments. This study aimed to examine the current methods for dealing with time-varying treatments in observational studies and developed practical recommendations. METHODS We searched PubMed from 2000 to 2021 for methodological articles about time-varying treatments, and qualitatively summarized the current methods for handling time-varying treatments. Subsequently, we developed practical recommendations through interactive internal group discussions and consensus by a panel of external experts. RESULTS Of the 36 eligible reports (22 methodological reviews, 10 original studies, 2 tutorials and 2 commentaries), most examined statistical methods for time-varying treatments, and only a few discussed the overarching methodological process. Generally, there were three methodological components to handle time-varying treatments. These included the specification of treatment which may be categorized as three scenarios (i.e., time-independent treatment, static treatment regime, or dynamic treatment regime); definition of treatment status which could involve three approaches (i.e., intention-to-treat, per-protocol, or as-treated approach); and selection of analytic methods. Based on the review results, a methodological workflow and a set of practical recommendations were proposed through two consensus meetings. CONCLUSIONS There is no consensus process for assessing treatment effects in observational studies with time-varying treatments. Previous efforts were dedicated to developing statistical methods. Our study proposed a stepwise workflow with practical recommendations to assist the practice.
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Affiliation(s)
- Jiayue Xu
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Qiao He
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Mingqi Wang
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Mei Liu
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Qianrui Li
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Yan Ren
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Minghong Yao
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Guowei Li
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
- Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
- Biostatistics Unit, Research Institute at St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Kevin Lu
- South Carolina College of Pharmacy, University of South Carolina, Columbia, Columbia, South Carolina, USA
| | - Kang Zou
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Wen Wang
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
| | - Xin Sun
- Chinese Evidence-Based Medicine and Cochrane China Center, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, China
- National Medical Products Administration Key Laboratory for Real World Data Research and Evaluation in Hainan, Chengdu, China
- Sichuan Center of Technology Innovation for Real World Data, Chengdu, China
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Hartl WH, Kopper P, Xu L, Heller L, Mironov M, Wang R, Day AG, Elke G, Küchenhoff H, Bender A. Relevance of Protein Intake for Weaning in the Mechanically Ventilated Critically Ill: Analysis of a Large International Database. Crit Care Med 2024; 52:e121-e131. [PMID: 38156913 PMCID: PMC10876180 DOI: 10.1097/ccm.0000000000006155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
OBJECTIVES The association between protein intake and the need for mechanical ventilation (MV) is controversial. We aimed to investigate the associations between protein intake and outcomes in ventilated critically ill patients. DESIGN Analysis of a subset of a large international point prevalence survey of nutritional practice in ICUs. SETTING A total of 785 international ICUs. PATIENTS A total of 12,930 patients had been in the ICU for at least 96 hours and required MV by the fourth day after ICU admission at the latest. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We modeled associations between the adjusted hazard rate (aHR) of death in patients requiring MV and successful weaning (competing risks), and three categories of protein intake (low: < 0.8 g/kg/d, standard: 0.8-1.2 g/kg/d, high: > 1.2 g/kg/d). We compared five different hypothetical protein diets (an exclusively low protein intake, a standard protein intake given early (days 1-4) or late (days 5-11) after ICU admission, and an early or late high protein intake). There was no evidence that the level of protein intake was associated with time to weaning. However, compared with an exclusively low protein intake, a standard protein intake was associated with a lower hazard of death in MV: minimum aHR 0.60 (95% CI, 0.45-0.80). With an early high intake, there was a trend to a higher risk of death in patients requiring MV: maximum aHR 1.35 (95% CI, 0.99-1.85) compared with a standard diet. CONCLUSIONS The duration of MV does not appear to depend on protein intake, whereas mortality in patients requiring MV may be improved by a standard protein intake. Adverse effects of a high protein intake cannot be excluded.
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Affiliation(s)
- Wolfgang H Hartl
- Department of General, Visceral, and Transplantation Surgery, University Medical Center, Campus Grosshadern, LMU Munich, Munich, Germany
| | - Philipp Kopper
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
- Munich Center for Machine Learning, LMU Munich, Munich, Germany
| | - Lisa Xu
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Luca Heller
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Maxim Mironov
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Ruiyi Wang
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Andrew G Day
- Clinical Evaluation Research Unit, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Gunnar Elke
- Department of Anaesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Helmut Küchenhoff
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
| | - Andreas Bender
- Statistical Consulting Unit, StaBLab, Department of Statistics, LMU Munich, Munich, Germany
- Munich Center for Machine Learning, LMU Munich, Munich, Germany
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154
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González-Castro A, Medina Villanueva A, Escudero-Acha P, Fajardo Campoverdi A, Gordo Vidal F, Martin-Loeches I, Rocha AR, Romero MC, Hernández López M, Ferrando C, Protti A, Modesto I Alapont V. Comprehensive study of mechanical power in controlled mechanical ventilation: Prevalence of elevated mechanical power and component analysis. Med Intensiva 2024; 48:155-164. [PMID: 37996266 DOI: 10.1016/j.medine.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/17/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To determine the prevalence of elevated mechanical power (MP) values (>17J/min) used in routine clinical practice. DESIGN Observational, descriptive, cross-sectional, analytical, multicenter, international study conducted on November 21, 2019, from 8:00 AM to 3:00 PM. NCT03936231. SETTING One hundred thirty-three Critical Care Units. PATIENTS Patients receiving invasive mechanical ventilation for any cause. INTERVENTIONS None. MAIN VARIABLES OF INTEREST Mechanical power. RESULTS A population of 372 patients was analyzed. PM was significantly higher in patients under pressure-controlled ventilation (PC) compared to volume-controlled ventilation (VC) (19.20±8.44J/min vs. 16.01±6.88J/min; p<0.001), but the percentage of patients with PM>17J/min was not different (41% vs. 35%, respectively; p=0.382). The best models according to AICcw expressing PM for patients in VC are described as follows: Surrogate Strain (Driving Pressure) + PEEP+Surrogate Strain Rate (PEEP/Flow Ratio) + Respiratory Rate. For patients in PC, it is defined as: Surrogate Strain (Expiratory Tidal Volume/PEEP) + PEEP+Surrogate Strain Rate (Surrogate Strain/Ti) + Respiratory Rate+Expiratory Tidal Volume+Ti. CONCLUSIONS A substantial proportion of mechanically ventilated patients may be at risk of experiencing elevated levels of mechanical power. Despite observed differences in mechanical power values between VC and PC ventilation, they did not result in a significant disparity in the prevalence of high mechanical power values.
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Affiliation(s)
| | | | - Patricia Escudero-Acha
- Department of Intensive Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Federico Gordo Vidal
- Department of Intensive Medicine, Hospital Universitario del Henares, Coslada-Madrid, Research Group for Critical Pathology, Universidad Francisco de Vitoria, Madrid, Spain
| | - Ignacio Martin-Loeches
- JFICMI, Consultant in Intensive Care Medicine, St James's University Hospital, Dublin, Ireland
| | - Angelo Roncalli Rocha
- Rehabilitation Division, Hélvio Auto Hospital, Alagoas, Brazil; University Center Cesmac, Alagoas, Brazil
| | - Marta Costa Romero
- Neonatology Department, Hospital Universitario de Cabueñes, Gijón, Spain
| | | | - Carlos Ferrando
- Anesthesiology and Resuscitation Service, Clinic University Hospital of Barcelona, Spain; CIBER Respiratory Diseases, ISCIII, Madrid, Spain
| | - Alessandro Protti
- IRCCS Humanitas Research Hospital, Rozzano, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milano, Italy
| | - Vicent Modesto I Alapont
- Department of Anesthesiology and Pediatric Critical Care, Hospital Universitari i Politecnic La Fe de Valencia, Spain
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155
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Schuurmans J, Veelo DP, Vlaar APJ, Schenk J. Heterogeneity in a meta-analysis: randomized controlled trials versus observational studies. Author's reply. Intensive Care Med 2024; 50:483-484. [PMID: 38421386 DOI: 10.1007/s00134-024-07367-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Jaap Schuurmans
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
| | - Denise P Veelo
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.
| | - Alexander P J Vlaar
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, Amsterdam, Netherlands
| | - Jimmy Schenk
- Amsterdam UMC location University of Amsterdam, Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Intensive Care, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam Public Health, Meibergdreef 9, Amsterdam, The Netherlands
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156
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Rosario BH, Quah JL, Chang TY, Barrera VC, Lim A, Sim LE, Conroy S, Dhaliwal TK. Validation of the Hospital Frailty Risk Score in older adults hospitalized with community-acquired pneumonia. Geriatr Gerontol Int 2024; 24 Suppl 1:135-141. [PMID: 37846810 DOI: 10.1111/ggi.14697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/03/2023] [Accepted: 09/24/2023] [Indexed: 10/18/2023]
Abstract
AIM Frailty results from age-associated declines in physiological reserve and function and is prevalent in older people. Our aim is to examine the association of the Hospital Frailty Risk Score (HFRS) with adverse events in older patients hospitalized with community-acquired pneumonia (CAP) and hypothesise that frailty is a comparable predictor of outcomes in CAP versus traditional severity indices such as CURB-65. METHODS Retrospective review of electronic medical records in patients ≥65 years with CAP admitted to a tertiary hospital from 1 January to 30 April 2021. Patients were identified using ICD codes for CAP and categorized as high risk (>15), intermediate risk (5-15) and low risk (<5) of frailty using the HFRS. RESULTS Of 429 patients with CAP, 53.8% male, mean age of 82.9 years, older patients (85 vs. 79.7 years, P < 0.001) were at higher risk of frailty. Using the HFRS, 47.6% were deemed at high risk, 35.9% at intermediate risk, and 16.6% at low risk of frailty. Multivariate logistic regression shows that HFRS was more strongly associated (≥7 days, OR 1.042, CI 1.017-1.069) than CURB-65 (OR 0.995, CI 0.810-1.222) with long hospital length of stay (LOS), while CURB-65 (Confusion, Urea >7mmol/L, Respiratory rate >30, Blood pressure, age => 65 years old) was more strongly associated with mortality at 30, 90 and 365 days, compared with the HFRS. Comparing the values for the area under the receiver operator characteristic curve, the HFRS was found to be a better predictor of long LOS, while CURB-65 remains a better predictor of mortality. CONCLUSIONS Patients with high risk of frailty have higher healthcare utilization and HFRS is a better predictor of long LOS than CURB-65 but CURB-65 was a better predictor of mortality. Geriatr Gerontol Int 2024; 24: 135-141.
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Affiliation(s)
- Barbara H Rosario
- Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Jessica Lishan Quah
- Department of Respiratory Medicine, Changi General Hospital, Singapore, Singapore
| | - Ting Yu Chang
- National University of Singapore, Singapore, Singapore
| | | | - Aileen Lim
- Health Systems Intelligence, Changi General Hospital, Singapore, Singapore
| | - Lydia Euphemia Sim
- Health Systems Intelligence, Changi General Hospital, Singapore, Singapore
| | - Simon Conroy
- University College London, London, United Kingdom
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Ye Y, Chang Y, Wu W, Liao T, Yu T, Chen C, Yu Z, Chen J, Liang G. Deep Learning-Enhanced Hand Grip and Release Test for Degenerative Cervical Myelopathy: Shortening Assessment Duration to 6 Seconds. Neurospine 2024; 21:46-56. [PMID: 38569631 PMCID: PMC10992652 DOI: 10.14245/ns.2347326.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/19/2024] [Accepted: 01/31/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE Hand clumsiness and reduced hand dexterity can signal early signs of degenerative cervical myelopathy (DCM). While the 10-second grip and release (10-s G&R) test is a common clinical tool for evaluating hand function, a more accessible method is warranted. This study explores the use of deep learning-enhanced hand grip and release test (DL-HGRT) for predicting DCM and evaluates its capability to reduce the duration of the 10-s G&R test. METHODS The retrospective study included 508 DCM patients and 1,194 control subjects. Propensity score matching (PSM) was utilized to minimize the confounding effects related to age and sex. Videos of the 10-s G&R test were captured using a smartphone application. The 3D-MobileNetV2 was utilized for analysis, generating a series of parameters. Additionally, receiver operating characteristic curves were employed to assess the performance of the 10-s G&R test in predicting DCM and to evaluate the effectiveness of a shortened testing duration. RESULTS Patients with DCM exhibited impairments in most 10-s G&R test parameters. Before PSM, the number of cycles achieved the best diagnostic performance (area under the curve [AUC], 0.85; sensitivity, 80.12%; specificity, 74.29% at 20 cycles), followed by average grip time. Following PSM for age and gender, the AUC remained above 0.80. The average grip time achieved the highest AUC of 0.83 after 6 seconds, plateauing with no significant improvement in extending the duration to 10 seconds, indicating that 6 seconds is an adequate timeframe to efficiently evaluate hand motor dysfunction in DCM based on DL-HGRT. CONCLUSION DL-HGRT demonstrates potential as a promising supplementary tool for predicting DCM. Notably, a testing duration of 6 seconds appears to be sufficient for accurate assessment, enhancing the test more feasible and practical without compromising diagnostic performance.
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Affiliation(s)
- Yongyu Ye
- Department of Orthopedic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Yunbing Chang
- Department of Orthopedic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Weihao Wu
- School of Software Engineering, South China University of Technology, Guangzhou, China
- Key Laboratory of Big Data and Intelligent Robot (South China University of Technology), Ministry of Education, Guangzhou, China
| | - Tianying Liao
- Department of Orthopedic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Tao Yu
- Department of Orthopedic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chong Chen
- Department of Orthopedic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Zhengran Yu
- Department of Orthopedic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Junying Chen
- School of Software Engineering, South China University of Technology, Guangzhou, China
- Key Laboratory of Big Data and Intelligent Robot (South China University of Technology), Ministry of Education, Guangzhou, China
| | - Guoyan Liang
- Department of Orthopedic Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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158
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Mollura M, Chicco D, Paglialonga A, Barbieri R. Identifying prognostic factors for survival in intensive care unit patients with SIRS or sepsis by machine learning analysis on electronic health records. PLOS Digit Health 2024; 3:e0000459. [PMID: 38489347 PMCID: PMC10942078 DOI: 10.1371/journal.pdig.0000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 02/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Systemic inflammatory response syndrome (SIRS) and sepsis are the most common causes of in-hospital death. However, the characteristics associated with the improvement in the patient conditions during the ICU stay were not fully elucidated for each population as well as the possible differences between the two. GOAL The aim of this study is to highlight the differences between the prognostic clinical features for the survival of patients diagnosed with SIRS and those of patients diagnosed with sepsis by using a multi-variable predictive modeling approach with a reduced set of easily available measurements collected at the admission to the intensive care unit (ICU). METHODS Data were collected from 1,257 patients (816 non-sepsis SIRS and 441 sepsis) admitted to the ICU. We compared the performance of five machine learning models in predicting patient survival. Matthews correlation coefficient (MCC) was used to evaluate model performances and feature importance, and by applying Monte Carlo stratified Cross-Validation. RESULTS Extreme Gradient Boosting (MCC = 0.489) and Logistic Regression (MCC = 0.533) achieved the highest results for SIRS and sepsis cohorts, respectively. In order of importance, APACHE II, mean platelet volume (MPV), eosinophil counts (EoC), and C-reactive protein (CRP) showed higher importance for predicting sepsis patient survival, whereas, SOFA, APACHE II, platelet counts (PLTC), and CRP obtained higher importance in the SIRS cohort. CONCLUSION By using complete blood count parameters as predictors of ICU patient survival, machine learning models can accurately predict the survival of SIRS and sepsis ICU patients. Interestingly, feature importance highlights the role of CRP and APACHE II in both SIRS and sepsis populations. In addition, MPV and EoC are shown to be important features for the sepsis population only, whereas SOFA and PLTC have higher importance for SIRS patients.
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Affiliation(s)
- Maximiliano Mollura
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Davide Chicco
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Dipartimento di Informatica Sistemistica e Comunicazione, Università di Milano-Bicocca, Milan, Italy
| | - Alessia Paglialonga
- CNR-Istituto di Elettronica e di Ingegneria dell’Informazione e delle Telecomunicazioni (CNR-IEIIT), Milan, Italy
| | - Riccardo Barbieri
- Dipartimento di Elettronica Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
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Demirbuğa A, Akgün Karapınar DB, Yaşa B, Çoban A, Öngen B, Dede E, Mete Atasever N, Somer A, Hançerli Törün S. Emerging importance of multidrug-resistant Stenotrophomonas maltophilia infections in neonatal intensive care unit in a tertiary center in Turkey. Pediatr Neonatol 2024; 65:183-187. [PMID: 37919104 DOI: 10.1016/j.pedneo.2023.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 04/10/2023] [Accepted: 04/21/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE Stenotrophomonas maltophilia is an emerging multi-drug resistant, opportunistic pathogen in the neonatal intensive care unit (NICU). In this study, we aimed to assess the incidence, clinical features, antibiotic susceptibility, and treatment options of S. maltophilia infection among the healthcare-associated infections (HAIs) in the neonatal unit. METHODS In this study, the patients who were hospitalized in the NICU between January 2020 and December 2021 with S. maltophilia isolated from clinical samples were included. Demographic, clinic features, and microbiological findings of the patients were retrospectively evaluated by using the medical records. The samples (lower respiratory tract, urine, peritoneal fluid) were first examined microscopically by gram preparation and cultured. Antibiotic susceptibility tests were performed according to the recommendations of The European Committee on Antimicrobial Susceptibility Testing (EUCAST) for TMP-SMX. RESULTS S. maltophilia was isolated in 38 clinical samples of the 20 patients who were hospitalized at the NICU between January 2020 and December 2021. A total of 40 % (n = 8) of samples from different patients were accepted as colonization. Ventilator-associated pneumonia was determined in 55 % (n = 11), and urinary tract infection in 5 % (n = 1). S. maltophilia-associated bacteremia was not detected in any of the cases. The TMP-SMX susceptibilities of the strains were as it follows: 3 (15 %) were resistant (R), 7 (28 %) were susceptible (S), and 10 (47 %) were susceptible-increased exposure (I). Three of these patients were given dual antibiotics therapy (levofloxacin plus TMP-SMX) and nine of them were given only TMP-SMX. The most common hospital-acquired infectious agents are Gram negative microorganisms (51 %), followed by coagulase negative staphylococci (CNS), Staphylococcus aureus (24 %) and S. maltophilia (24 %). CONCLUSION Increasing TMP-SMX resistance and specific drug and dosage-related problems in the neonatal unit are important problems in treatment management.
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Affiliation(s)
- Asuman Demirbuğa
- Istanbul University, Istanbul Faculty of Medicine, Departmenf of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul, Turkey.
| | | | - Beril Yaşa
- Istanbul University, Istanbul Faculty of Medicine, Department of Neonatology, Istanbul, Turkey
| | - Asuman Çoban
- Istanbul University, Istanbul Faculty of Medicine, Department of Neonatology, Istanbul, Turkey
| | - Betigül Öngen
- Istanbul University, Istanbul Faculty of Medicine, Departmant of Medical Microbiology, Istanbul, Turkey
| | - Elif Dede
- Istanbul University, Istanbul Faculty of Medicine, Departmenf of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Neslihan Mete Atasever
- Istanbul University, Istanbul Faculty of Medicine, Departmenf of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Ayper Somer
- Istanbul University, Istanbul Faculty of Medicine, Departmenf of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul, Turkey
| | - Selda Hançerli Törün
- Istanbul University, Istanbul Faculty of Medicine, Departmenf of Pediatrics, Division of Pediatric Infectious Diseases, Istanbul, Turkey
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160
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Duignan M, Drennan J, Mc Carthy VJC. Relationship between work-related psychosocial factors and self-leadership in advanced nurse practitioners: A cross-sectional study. J Adv Nurs 2024; 80:1120-1131. [PMID: 37837195 DOI: 10.1111/jan.15855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/14/2023] [Accepted: 08/28/2023] [Indexed: 10/15/2023]
Abstract
AIM The aim of this study was to investigate the relationship between advanced nurse practitioners' self-leadership and commitment to the workplace, work engagement and influence at work. BACKGROUND The concept of self-leadership is particularly suited to ANPs, who are required to take responsibility for their work roles. An optimum balance between the ANPs' psychosocial work environment and self-leadership may positively impact work ability in this group and can be compromised by interactions between and among these variables. DESIGN A cross-sectional correlational study was conducted from July 2020 to August 2020 on 153 ANPs across a national health service. METHODS The survey was distributed to respondents online. The revised self-leadership questionnaire was used to measure self-leadership, and three scales from the Copenhagen Psychosocial Questionnaire were used to measure commitment to the workplace, work engagement and influence at work. Multiple linear regression was used to examine the association between self-leadership and the psychosocial variables. RESULTS ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. No relationship was found between self-leadership and influence at work. CONCLUSION Improving self-leadership among ANPs by involving them in strategic leadership activities at an organizational level could be an effective strategy for optimizing the role and facilitating ANPs to contribute at an organizational level beyond the clinical interface. However, organizational support is required to ensure that ANPs practise to the full potential of their training and capability. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT This study provided new evidence of a relationship between ANPs' self-leadership and psychosocial factors. This study found that ANPs with high levels of self-leadership reported high levels of work engagement and commitment to the workplace. Policymakers and organizational leaders can optimize the ANP role and facilitate ANPs to contribute strategically to improve care systems. This study identifies a relationship between ANPs' self-leadership and specific psychosocial variables.
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Affiliation(s)
- Martin Duignan
- Our Lady's Hospital, Navan, Co. Meath, Dublin, Ireland
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Terzi N, Fournier A, Lesieur O, Chappé J, Annane D, Chagnon JL, Thévenin D, Misset B, Diehl JL, Touati S, Outin H, Dauger S, Sement A, Drault JN, Rigaud JP, Laurent A. Perceived Quality of Life in Intensive Care Medicine Physicians: A French National Survey. J Intensive Care Med 2024; 39:230-239. [PMID: 37709265 DOI: 10.1177/08850666231199937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Purpose: There is a growing interest in the quality of work life (QWL) of healthcare professionals and staff well-being. We decided to measure the perceived QWL of ICU physicians and the factors that could influence their perception. Methods: We performed a survey coordinated and executed by the French Trade Union of Intensive Care Physicians (SMR). QWL was assessed using the French version of the Work-Related Quality of Life (WRQoL) scale, perceived stress using the French version of 10 item-Perceived Stress Scale (PSS-10) and group functioning using the French version of the Reflexivity Scale, the Social Support at Work Questionnaire (QSSP-P). Results: 308 French-speaking ICU physicians participated. 40% perceived low WRQoL, mainly due to low general well-being, low satisfaction with working conditions and low possibility of managing the articulation between their private and professional lives. Decreased QWL was associated with being a woman (p = .002), having children (p = .022) and enduring many monthly shifts (p = .022). Conclusions: This work highlights the fact that ICU physicians feel a significant imbalance between the demands of their profession and the resources at their disposal. Communication and exchanges within a team and quality of social support appear to be positive elements to maintain and/or develop within our structures.
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Affiliation(s)
| | - Alicia Fournier
- Laboratoire de Psychologie : Dynamiques Relationnelles et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
| | - Olivier Lesieur
- Intensive Care Unit, Saint Louis Hospital, La Rochelle, France
| | - Julien Chappé
- Laboratoire de Psychologie : Dynamiques Relationnelles et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
| | - Djillali Annane
- General Intensive Care Unit, Hôpital Raymond Poincaré (APHP), Université de Versailles SQY and Université Paris Saclay, Garches, France
| | - Jean-Luc Chagnon
- General Intensive Care Unit, Centre hospitalier de Valenciennes, Valenciennes, France
| | - Didier Thévenin
- Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France
| | - Benoit Misset
- Intensive Care Department and Burn Center, University Hospital, Liège, Belgium
| | - Jean-Luc Diehl
- Service de médecine intensive Réanimation, Hôpital Européen Georges Pompidou, Université de Paris, Paris, France
| | - Samia Touati
- Réanimation médico-chirurgicale, Groupement hospitalier public du sud de l'Oise, Creil, France
| | - Hervé Outin
- Médecine Intensive Réanimation, Centre Hospitalier Intercommunal de Poissy - Saint-Germain-en-Laye 10 rue du Champ Gaillard, Poissy Cedex, France
| | - Stéphane Dauger
- Paediatric Intensive Care Unit, Robert-Debré University Hospital, Paris, France
| | - Arnaud Sement
- Réanimation Polyvalente, Centre Hospitalier Mont de Marsan, Urrugne, Nouvelle-Aquitaine, France
| | | | | | - Alexandra Laurent
- Laboratoire de Psychologie : Dynamiques Relationnelles et Processus Identitaires (PsyDREPI), Université de Bourgogne Franche-Comté, Dijon, France
- Department of Anaesthesiology and Critical Care Medicine, Dijon University Medical Centre, Dijon, France
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Choi JW, Yang M, Kim JW, Shin YM, Shin YG, Park S. Prognostic prediction of sepsis patient using transformer with skip connected token for tabular data. Artif Intell Med 2024; 149:102804. [PMID: 38462275 DOI: 10.1016/j.artmed.2024.102804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 09/25/2023] [Accepted: 02/08/2024] [Indexed: 03/12/2024]
Abstract
Sepsis is known as a common syndrome in intensive care units (ICU), and severe sepsis and septic shock are among the leading causes of death worldwide. The purpose of this study is to develop a deep learning model that supports clinicians in efficiently managing sepsis patients in the ICU by predicting mortality, ICU length of stay (>14 days), and hospital length of stay (>30 days). The proposed model was developed using 591 retrospective data with 16 tabular data related to a sequential organ failure assessment (SOFA) score. To analyze tabular data, we designed the modified architecture of the transformer that has achieved extraordinary success in the field of languages and computer vision tasks in recent years. The main idea of the proposed model is to use a skip-connected token, which combines both local (feature-wise token) and global (classification token) information as the output of a transformer encoder. The proposed model was compared with four machine learning models (ElasticNet, Extreme Gradient Boosting [XGBoost]), and Random Forest) and three deep learning models (Multi-Layer Perceptron [MLP], transformer, and Feature-Tokenizer transformer [FT-Transformer]) and achieved the best performance (mortality, area under the receiver operating characteristic (AUROC) 0.8047; ICU length of stay, AUROC 0.8314; hospital length of stay, AUROC 0.7342). We anticipate that the proposed model architecture will provide a promising approach to predict the various clinical endpoints using tabular data such as electronic health and medical records.
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Affiliation(s)
- Jee-Woo Choi
- Mediv Corporation, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Minuk Yang
- Mediv Corporation, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Jae-Woo Kim
- AI Research Center, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Yoon Mi Shin
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Yong-Goo Shin
- Department of Electronics and Information Engineering, Korea University, Sejong-si, Republic of Korea.
| | - Seung Park
- Department of Biomedical Engineering, Chungbuk National University Hospital, Cheongju-si, Chungcheongbuk-do, Republic of Korea; Chungbuk National University College of Medicine, Cheongju-si, Chungcheongbuk-do, Republic of Korea.
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Sanz-Reig J, Mas-Martinez J, Ojeda-Thies C, Saez-Lopez MP, Alonso-García N, Gonzalez-Montalvo JI. Emergency department prediction model for 30-day mortality after hip fracture: the Spanish National Hip Fracture Registry (RNFC) cohort. Hip Int 2024; 34:290-297. [PMID: 37670497 DOI: 10.1177/11207000231197818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The aim of this study was to design and validate a predictive model for 30-day mortality in a cohort of patients from the Spanish National Hip Fracture Registry (RNFC) with variables collected at the Emergency Department. METHODS Retrospective study of a prospective database of hip fracture patients ⩾75 years old between 1 January 2017 and 30 September 2019. Patient characteristics, type of fracture and osteoprotective medication were collected at the Emergency Department. Univariate analysis compared the results between patients alive and deceased 30 days after hospital discharge. The variables associated with 30-day mortality in the regression analysis were age >85 years, male sex, indoors pre-fracture mobility, dementia, ASA score >3, pathological fracture, and vitamin D intake. A score scale was created with these variables. Discriminative performance was assessed using the area under the curve (AUC), calibration was assessed by applying Hosmer-Lemeshow goodness-of-fit test and predicted-to-observed mortality was compared. RESULTS A total of 29,875 hip fracture cases were included in the study. The 30-day mortality of the overall cohort was 7.7%. A scale of 0-9 points was created, with a cut-off point of 4 points for the determination of patients at high risk of mortality. The AUC was 0.886. RNFC score presented good level of calibration (p = 0.139). The predicted-to-observed ratio was 1.09. CONCLUSIONS The RNFC predictive model with variables collected at the Emergency Department showed an excellent predictive capacity for 30-day mortality in patients after hip fracture.
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Affiliation(s)
- Javier Sanz-Reig
- Traumatology Vistahermosa, HLA Vistahermosa Clinic, Alicante, Spain
| | | | - Cristina Ojeda-Thies
- Department of Orthopaedic Surgery and Traumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - Maria P Saez-Lopez
- La Paz University Hospital, La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Geriatrics Department, Fundación Alcorcón University Hospital, Alcorcón, Spain
| | - Noelia Alonso-García
- Orthopaedic Surgery and Traumatology Department, Segovia Health Care Complex, Segovia, Spain
| | - Juan I Gonzalez-Montalvo
- Geriatrics Department, La Paz University Hospital, La Paz Hospital Research Institute (IdiPAZ), Madrid, Spain
- Department of Medicine, Autonomous University of Madrid, Spain
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McEvoy AM, Hippe DS, Lachance K, Park S, Cahill K, Redman M, Gooley T, Kattan MW, Nghiem P. Merkel cell carcinoma recurrence risk estimation is improved by integrating factors beyond cancer stage: A multivariable model and web-based calculator. J Am Acad Dermatol 2024; 90:569-576. [PMID: 37984720 PMCID: PMC10922724 DOI: 10.1016/j.jaad.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 10/19/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) recurs in 40% of patients. In addition to stage, factors known to affect recurrence risk include: sex, immunosuppression, unknown primary status, age, site of primary tumor, and time since diagnosis. PURPOSE Create a multivariable model and web-based calculator to predict MCC recurrence risk more accurately than stage alone. METHODS Data from 618 patients in a prospective cohort were used in a competing risk regression model to estimate recurrence risk using stage and other factors. RESULTS In this multivariable model, the most impactful recurrence risk factors were: American Joint Committee on Cancer stage (P < .001), immunosuppression (hazard ratio 2.05; P < .001), male sex (1.59; P = .003) and unknown primary (0.65; P = .064). Compared to stage alone, the model improved prognostic accuracy (concordance index for 2-year risk, 0.66 vs 0.70; P < .001), and modified estimated recurrence risk by up to 4-fold (18% for low-risk stage IIIA vs 78% for high-risk IIIA over 5 years). LIMITATIONS Lack of an external data set for model validation. CONCLUSION/RELEVANCE As demonstrated by this multivariable model, accurate recurrence risk prediction requires integration of factors beyond stage. An online calculator based on this model (at merkelcell.org/recur) integrates time since diagnosis and provides new data for optimizing surveillance for MCC patients.
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Affiliation(s)
- Aubriana M McEvoy
- Department of Dermatology, University of Washington, Seattle, Washington; Division of Dermatology, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Daniel S Hippe
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Kristina Lachance
- Department of Dermatology, University of Washington, Seattle, Washington
| | - Song Park
- Department of Dermatology, University of Washington, Seattle, Washington
| | - Kelsey Cahill
- Department of Dermatology, University of Washington, Seattle, Washington
| | - Mary Redman
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Ted Gooley
- Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Michael W Kattan
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Paul Nghiem
- Department of Dermatology, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Center, Seattle, Washington.
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165
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Raab G, Yu Y, Sherman E, Wong R, Mell LK, Lee NY, Zakeri K. Nomogram to predict risk of early mortality following definitive or adjuvant radiation and systemic therapy for head and neck cancer. Clin Transl Radiat Oncol 2024; 45:100725. [PMID: 38304239 PMCID: PMC10832379 DOI: 10.1016/j.ctro.2024.100725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 01/07/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose/Objectives We sought to create nomograms to predict individual risk of early mortality, which can identify patients who require interventions to prevent early death. Methods We included patients in the National Cancer Database with non-metastatic squamous cell carcinoma of the head and neck who received radiation and systemic therapy between 2004 and 2017 in the definitive or adjuvant setting. Early mortality was defined as any death less than 90 days after starting radiation. Multivariable logistic regression was used to assess the relationship between covariates and early mortality. Nomograms to predict the risk of early death were created for both the definitive and adjuvant settings. Results Among 84,563 patients in the definitive group and 18,514 patients in the adjuvant group, rates of early mortality were 3.5 % (95 % CI 3.4-3.7 %) and 2.2 %, (95 % CI 1.9-2.4 %), respectively. Patients above the age of 70 had an early mortality rate of 7.8 % (95 % CI 7.3-8.2 %) in the definitive group and 4.4 % (95 % CI 3.6-5.4 %) in the adjuvant group. In the multivariable analysis, age, comorbidity, T and N category, and tumor site were associated with early mortality in both cohorts (p < 0.05 for all). Nomograms including age, comorbidity, T and N category and tumor site performed better than age alone at predicting early mortality (AUC for definitive group: 0.70 vs 0.66; AUC for adjuvant group: 0.71 vs 0.61). Conclusion Nomograms including age, comorbidity, T and N category and tumor site were developed to predict the risk of early death following definitive or adjuvant chemoradiation.
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Affiliation(s)
- Gabriel Raab
- Weill Cornell Medical College, New York, NY, USA
| | - Yao Yu
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Sherman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Richard Wong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Loren K. Mell
- Department of Radiation Medicine and Applied Sciences, UC San Diego, La Jolla, CA, USA
| | - Nancy Y. Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kaveh Zakeri
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sungurlu S, Balk RA. The Role of Biomarkers in the Diagnosis and Management of Pneumonia. Infect Dis Clin North Am 2024; 38:35-49. [PMID: 38280766 DOI: 10.1016/j.idc.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Biomarkers are used in the diagnosis, severity determination, and prognosis for patients with community-acquired pneumonia (CAP). Selected biomarkers may indicate a bacterial infection and need for antibiotic therapy (C-reactive protein, procalcitonin, soluble triggering receptor expressed on myeloid cells). Biomarkers can differentiate CAP patients who require hospital admission and severe CAP requiring intensive care unit admission. Biomarker-guided antibiotic therapy may limit antibiotic exposure without compromising outcome and thus improve antibiotic stewardship. The authors discuss the role of biomarkers in diagnosing, determining severity, defining the prognosis, and limiting antibiotic exposure in CAP and ventilator-associated pneumonia patients.
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Affiliation(s)
- Sarah Sungurlu
- Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Rush Medical College, 1725 West Harrison Street Suite 054, Chicago, IL 60612, USA
| | - Robert A Balk
- Division of Pulmonary, Critical Care, and Sleep Medicine, Rush University Medical Center, Rush Medical College, 1725 West Harrison Street Suite 054, Chicago, IL 60612, USA.
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Castro Villamor MA, Alonso-Sanz M, López-Izquierdo R, Delgado Benito JF, Del Pozo Vegas C, López Torres S, Soriano JB, Martín-Conty JL, Sanz-García A, Martín-Rodríguez F. Comparison of eight prehospital early warning scores in life-threatening acute respiratory distress: a prospective, observational, multicentre, ambulance-based, external validation study. Lancet Digit Health 2024; 6:e166-e175. [PMID: 38395538 DOI: 10.1016/s2589-7500(23)00243-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 09/26/2023] [Accepted: 11/22/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND A myriad of early warning scores (EWSs) exist, yet there is a need to identify the most clinically valid score to be used in prehospital respiratory assessments to estimate short-term and midterm mortality, intensive-care unit admission, and airway management in life-threatening acute respiratory distress. METHODS This is a prospective, observational, multicentre, ambulance-based, external validation study performed in 44 ambulance services and four hospitals across three Spanish provinces (ie, Salamanca, Segovia, and Valladolid). We identified adults (ie, those aged 18 years and older) discharged to the emergency department with suspected acute respiratory distress. The primary outcome was 2-day all-cause in-hospital mortality, for all the patients or according to prehospital respiratory conditions, including dyspnoea, chronic obstructive pulmonary disease (COPD), COVID-19, other infections, and other conditions (asthma exacerbation, haemoptysis, and bronchoaspirations). 30-day mortality, intensive-care unit admission, and invasive and non-invasive mechanical ventilation were secondary outcomes. Eight EWSs, namely, the National Early Warning Score 2, the Modified Rapid Emergency Medicine Score, the Rapid Acute Physiology Score, the Quick Sequential Organ Failure Assessment Score, the CURB-65 Severity Score for Community-Acquired Pneumonia, the BAP-65 Score for Acute Exacerbation of COPD, the Quick COVID-19 Severity Index, and the Modified Sequential Organ Failure Assessment (mSOFA), were explored to determine their predictive validity through calibration, clinical net benefit as determined through decision curve analysis, and discrimination analysis (area under the curve of the receiver operating characteristic [AUROC], compared with Delong's test). FINDINGS Between Jan 1, 2020, and Nov 31, 2022, 902 patients were enrolled. The global 2-day mortality rate was 87 (10%); in proportion to various respiratory conditions, the rates were 35 (40%) for dyspnoea, nine (10%) for COPD, 13 (15%) for COVID-19, 28 (32%) for other infections, and two (2%) for others conditions. mSOFA showed the best calibration, a higher net benefit, and the best discrimination (AUROC 0·911, 95% CI 0·86-0·95) for predicting 2-day mortality, and its discrimination was statistically significantly more accurate (p<0·0001) compared with the other scores. The performance of mSOFA for predicting 2-day mortality was higher than the other scores when considering the prehospital respiratory conditions, and was also higher for the secondary outcomes, except for non-invasive mechanical ventilation. INTERPRETATION Our results showed that mSOFA outperformed other EWSs. The inclusion of mSOFA in prehospital decision making will entail a quick identification of patients in acute respiratory distress at high risk of deterioration, allowing prioritisation of resources and patient care. FUNDING Gerencia Regional de Salud, Public Health System of Castilla y León (GRS Spain). TRANSLATION For the Spanish translation of the abstract see Supplementary Materials section.
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Affiliation(s)
| | | | - Raúl López-Izquierdo
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain; Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | | | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Santiago López Torres
- Servicio de Asistencia Municipal de Urgencia y Rescate (SAMUR-Protección Civil), Ayuntamiento de Madrid, Madrid, Spain
| | - Joan B Soriano
- Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III (ISCIII), Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Servicio de Neumología, Hospital Universitario de La Princesa, Madrid, Spain
| | - José L Martín-Conty
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain.
| | - Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Zhang W. Critical roles of S100A12, MMP9, and PRTN3 in sepsis diagnosis: Insights from multiple microarray data analyses. Comput Biol Med 2024; 171:108222. [PMID: 38447501 DOI: 10.1016/j.compbiomed.2024.108222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/16/2024] [Accepted: 02/25/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Sepsis, characterized by systemic inflammatory response syndrome and life-threatening organ dysfunction, remains a significant global cause of disability and death. Despite its impact, reliable biomarkers for sepsis diagnosis are yet to be identified. OBJECTIVE This study aims to investigate and identify key genes and pathways in sepsis through the analysis of multiple microarray datasets, providing potential treatment targets for future clinical trials. METHODS Two independent gene expression profiles (GSE54514 and GSE69528) were downloaded from the Gene Expression Omnibus (GEO) database. After merging and batch normalization, differentially expressed genes (DEGs) were obtained using the "limma" package. Gene Ontology (GO) and Gene Set Enrichment Analysis (GSEA) were performed using "R" software. A Protein-Protein Interaction (PPI) network was constructed using the Search Tool for the Retrieval of Interacting Genes (STRING). The top 10 hub genes were identified using Cytoscape. A Nomogram model for predicting sepsis occurrence was constructed and evaluated. RESULTS Bioinformatic analysis of 210 sepsis and 91 control blood samples identified 72 DEGs. GO analyses revealed associations with immune response processes. GSEA indicated involvement in key signaling pathways. S100A12, MMP9, and PRTN3 were identified as independent risk factors for sepsis. CONCLUSION This study unveils critical genes and pathways in sepsis through bioinformatic methods. S100A12, MMP9, and PRTN3 may play essential roles in the immune response to infection, influencing sepsis prognosis.
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Affiliation(s)
- Wenyuan Zhang
- The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
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Natsui H, Watanabe M, Yokota T, Tsuneta S, Fumoto Y, Handa H, Shouji M, Koya J, Nishino K, Tatsuta D, Koizumi T, Kadosaka T, Nakao M, Koya T, Temma T, Ito YM, Kanako HC, Hatanaka Y, Yasushige S, Wakasa S, Miura S, Masuda T, Nishioka N, Naraoka S, Ochi K, Kudo T, Ishikawa T, Anzai T. Influence of epicardial adipose tissue inflammation and adipocyte size on postoperative atrial fibrillation in patients after cardiovascular surgery. Physiol Rep 2024; 12:e15957. [PMID: 38546216 PMCID: PMC10976808 DOI: 10.14814/phy2.15957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/05/2024] [Accepted: 02/09/2024] [Indexed: 04/28/2024] Open
Abstract
Epicardial adipose tissue (EAT) is an active endocrine organ that is closely associated with occurrence of atrial fibrillation (AF). However, the role of EAT in the development of postoperative AF (POAF) remains unclear. We aimed to investigate the association between EAT profile and POAF occurrence in patients who underwent cardiovascular surgery. We obtained EAT samples from 53 patients to evaluate gene expression, histological changes, mitochondrial oxidative phosphorylation (OXPHOS) capacity in the EAT, and protein secretion in EAT-conditioned medium. EAT volume was measured using computed tomography scan. Eighteen patients (34%) experienced POAF within 7 days after surgery. Although no significant difference was observed in EAT profile between patients with and without POAF, logistic regression analysis identified that the mRNA expression levels of tumor necrosis factor-alpha (TNF-α) were positively correlated and adipocyte size in the EAT was inversely correlated with onset of POAF, respectively. Mitochondrial OXPHOS capacity in the EAT was not associated with POAF occurrence; however, it showed an inverse correlation with adipocyte size and a positive correlation with adiponectin secretion. In conclusion, changes in the secretory profile and adipocyte morphology of the EAT, which represent qualitative aspects of the adipose tissue, were present before the onset of AF.
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Affiliation(s)
- Hiroyuki Natsui
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Masaya Watanabe
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Takashi Yokota
- Institute of Health Science Innovation for Medical Care, Hokkaido University HospitalSapporoJapan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional RadiologyHokkaido University HospitalSapporoJapan
| | - Yoshizuki Fumoto
- Department of Molecular Biology, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Haruka Handa
- Department of Molecular Biology, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Matsushima Shouji
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineKyushu UniversityFukuokaJapan
| | - Jiro Koya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Kotaro Nishino
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Daishiro Tatsuta
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Takuya Koizumi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Takahide Kadosaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Motoki Nakao
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Taro Koya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Taro Temma
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Yoichi M. Ito
- Institute of Health Science Innovation for Medical Care, Hokkaido University HospitalSapporoJapan
| | - Hatanaka C. Kanako
- Center for Development of Advanced DiagnosticsHokkaido University HospitalSapporoJapan
| | - Yutaka Hatanaka
- Center for Development of Advanced DiagnosticsHokkaido University HospitalSapporoJapan
| | - Shingu Yasushige
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Satoru Wakasa
- Department of Cardiovascular Surgery, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
| | - Shuhei Miura
- Department of Cardiovascular Surgery, Teine Keijinkai HospitalSapporoJapan
| | - Takahiko Masuda
- Department of Cardiovascular Surgery, Teine Keijinkai HospitalSapporoJapan
| | - Naritomo Nishioka
- Department of Cardiovascular Surgery, Teine Keijinkai HospitalSapporoJapan
| | - Shuichi Naraoka
- Department of Cardiovascular Surgery, Teine Keijinkai HospitalSapporoJapan
| | - Kayoko Ochi
- Department of Clinical Laboratory MedicineTeine Keijinkai HospitalSapporoJapan
| | - Tomoko Kudo
- Department of Clinical Laboratory MedicineTeine Keijinkai HospitalSapporoJapan
| | - Tsugumine Ishikawa
- Department of Clinical Laboratory MedicineTeine Keijinkai HospitalSapporoJapan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of MedicineHokkaido UniversitySapporoJapan
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170
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Wang S, Xiong Z, Cui Y, Fan F, Zhang S, Jia R, Hu Y, Li L, Zhang X, Han F. Placebo and Nocebo Responses in Pharmacological Trials of Tic Disorders: A Meta-Analysis. Mov Disord 2024; 39:585-595. [PMID: 38247265 DOI: 10.1002/mds.29714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Clinical trials of new drugs for tic disorders (TD) often fail to yield positive results. Placebo and nocebo responses play a vital role in interpreting the outcomes of randomized controlled trials (RCTs), yet these responses in RCTs of TD remain unexplored. OBJECTIVE The aim was to assess the magnitude of placebo and nocebo responses in RCTs of pharmacological interventions for TD and identify influencing factors. METHODS A systematic search of the Embase, Medline, Cochrane Central Register of Controlled Trials, and PsycINFO databases was conducted. Eligible studies were RCTs that compared active pharmacological agents with placebos. Placebo response was defined as the change from baseline in TD symptom severity in the placebo group, and nocebo response as the proportion experiencing adverse events (AEs) in this group. Subgroup analysis and meta-regression were performed to explore modifying factors. RESULTS Twenty-four trials involving 2222 participants were included in this study. A substantial placebo response in TD symptom severity was identified, with a pooled effect size of -0.79 (95% confidence interval [CI] -0.99 to -0.59; I2 = 67%). Forty-four percent (95% CI 27% to 63%; I2 = 92%) of patients experienced AEs while taking inert pills. Sample size, study design, and randomization ratio were correlated with changes in placebo and nocebo responses. CONCLUSION There were considerable placebo and nocebo responses in TD clinical trials. These results are of great relevance for the design of future trials and for clinical practice in TD. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration ID CRD42023388397. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Simeng Wang
- Department of Pediatrics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhiyi Xiong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yuehua Cui
- Department of Pediatrics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fei Fan
- Department of Pediatrics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Si Zhang
- Department of Pediatrics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Ru Jia
- Department of Pediatrics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuchen Hu
- Department of Pediatrics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liang Li
- Department of Traditional Chinese Medicine, Children's Hospital of Soochow University, Soochow, China
| | - Xuan Zhang
- Chinese EQUATOR Center, Hong Kong Chinese Medicine Clinical Study Center, Chinese Clinical Trial Registry (Hong Kong), School of Chinese Medicine, Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Fei Han
- Department of Pediatrics, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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171
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Yang M, Liu S, Hao T, Ma C, Chen H, Li Y, Wu C, Xie J, Qiu H, Li J, Yang Y, Liu C. Development and validation of a deep interpretable network for continuous acute kidney injury prediction in critically ill patients. Artif Intell Med 2024; 149:102785. [PMID: 38462285 DOI: 10.1016/j.artmed.2024.102785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/05/2023] [Accepted: 01/21/2024] [Indexed: 03/12/2024]
Abstract
Early detection of acute kidney injury (AKI) may provide a crucial window of opportunity to prevent further injury, which helps improve clinical outcomes. This study aimed to develop a deep interpretable network for continuously predicting the 24-hour AKI risk in real-time and evaluate its performance internally and externally in critically ill patients. A total of 21,163 patients' electronic health records sourced from Beth Israel Deaconess Medical Center (BIDMC) were first included in building the model. Two external validation populations included 3025 patients from the Philips eICU Research Institute and 2625 patients from Zhongda Hospital Southeast University. A total of 152 intelligently engineered predictors were extracted on an hourly basis. The prediction model referred to as DeepAKI was designed with the basic framework of squeeze-and-excitation networks with dilated causal convolution embedded. The integrated gradients method was utilized to explain the prediction model. When performed on the internal validation set (3175 [15 %] patients from BIDMC) and the two external validation sets, DeepAKI obtained the area under the curve of 0.799 (95 % CI 0.791-0.806), 0.763 (95 % CI 0.755-0.771) and 0.676 (95 % CI 0.668-0.684) for continuousAKI prediction, respectively. For model interpretability, clinically relevant important variables contributing to the model prediction were informed, and individual explanations along the timeline were explored to show how AKI risk arose. The potential threats to generalisability in deep learning-based models when deployed across health systems in real-world settings were analyzed.
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Affiliation(s)
- Meicheng Yang
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Songqiao Liu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Department of Critical Care Medicine, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch, Nanjing, China
| | - Tong Hao
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Caiyun Ma
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Hui Chen
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuwen Li
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China
| | - Changde Wu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jianfeng Xie
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Haibo Qiu
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Jianqing Li
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China; School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, China.
| | - Yi Yang
- Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
| | - Chengyu Liu
- The State Key Laboratory of Digital Medical Engineering, School of Instrument Science and Engineering, Southeast University, Nanjing, China.
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172
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De Anda-Mora KL, Tavares-Carreón F, Alvarez C, Barahona S, Becerril-García MA, Treviño-Rangel RJ, García-Contreras R, Andrade A. Increased Proteolytic Activity of Serratia marcescens Clinical Isolate HU1848 Is Associated with Higher eepR Expression. Pol J Microbiol 2024; 73:11-20. [PMID: 38437469 PMCID: PMC10911700 DOI: 10.33073/pjm-2024-002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 12/14/2023] [Indexed: 03/06/2024] Open
Abstract
Serratia marcescens is a global opportunistic pathogen. In vitro cytotoxicity of this bacterium is mainly related to metalloprotease serralysin (PrtS) activity. Proteolytic capability varies among the different isolates. Here, we characterized protease production and transcriptional regulators at 37°C of two S. marcescens isolates from bronchial expectorations, HU1848 and SmUNAM836. As a reference strain the insect pathogen S. marcescens Db10 was included. Zymography of supernatant cultures revealed a single (SmUNAM836) or double proteolytic zones (HU1848 and Db10). Mass spectrometry confirmed the identity of PrtS and the serralysin-like protease SlpB from supernatant samples. Elevated proteolytic activity and prtS expression were evidenced in the HU1848 strain through azocasein degradation and qRT-PCR, respectively. Evaluation of transcriptional regulators revealed higher eepR expression in HU1848, whereas cpxR and hexS transcriptional levels were similar between studied strains. Higher eepR expression in HU1848 was further confirmed through an in vivo transcriptional assay. Moreover, two putative CpxR binding motifs were identified within the eepR regulatory region. EMSA validated the interaction of CpxR with both motifs. The evaluation of eepR transcription in a cpxR deletion strain indicated that CpxR negatively regulates eepR. Sequence conservation suggests that regulation of eepR by CpxR is common along S. marcescens species. Overall, our data incorporates CpxR to the complex regulatory mechanisms governing eepR expression and associates the increased proteolytic activity of the HU1848 strain with higher eepR transcription. Based on the global impact of EepR in secondary metabolites production, our work contributes to understanding virulence factors variances across S. marcescens isolates.
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Affiliation(s)
- Karla L. De Anda-Mora
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Faviola Tavares-Carreón
- Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | - Carlos Alvarez
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Samantha Barahona
- Facultad de Ciencias Biológicas, Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
| | - Miguel A. Becerril-García
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rogelio J. Treviño-Rangel
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rodolfo García-Contreras
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Angel Andrade
- Departamento de Microbiología, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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Haghighi Bardineh SA, Balou HA, Sedigh Ebrahim‐Saraie H, Mobayen M, Esmailzadeh M, Haghighi S, Haghighi A, Sadeghi M. Predictive value of serum albumin and calcium levels in burn patients with Pseudomonas aeruginosa infection: A comprehensive analysis of clinical outcomes. Int Wound J 2024; 21:e14786. [PMID: 38385765 PMCID: PMC10883257 DOI: 10.1111/iwj.14786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024] Open
Abstract
In the ongoing challenge to reduce burn-associated mortality rates, this study explores the predictive capacity of clinical factors in burn patients, focusing on vitamin D, calcium, and serum albumin levels during hospitalisation in cases with Pseudomonas aeruginosa infection. Our research involves a comprehensive analysis of 100 burn patients, encompassing crucial clinical parameters such as the burn severity index, serum albumin, vitamin D, and calcium levels at admission. Data were meticulously entered into IBM Statistics SPSS software version 28 and subjected to statistical analysis. The study reveals an average patient age of 39.75 years and a notable 34% mortality rate. Additionally, the average lengths of hospital and intensive care unit (ICU) stays are determined to be 11.33 and 7.79 days, respectively. Significantly, a correlation between calcium and albumin variables and treatment outcomes is established, showcasing their potential to predict variable changes in patient mortality rates. Furthermore, a noteworthy association is observed between serum calcium levels and the duration of ICU hospitalisation. In conclusion, albumin and calcium variables emerge as sensitive and specific indicators for predicting outcomes in burn patients. Importantly, the independence of these factors from the physician's experience and diagnosis reduces human error and thus increases the accuracy of mortality prediction in this patient population.
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Affiliation(s)
| | - Heydar Ali Balou
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Hadi Sedigh Ebrahim‐Saraie
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
- Department of Microbiology, School of MedicineGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Mojdeh Esmailzadeh
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Samane Haghighi
- Institute of Theoretical and Translational MedicineSemmelweis UniversityBudapestHungary
| | - Arezoo Haghighi
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmaceutical SciencesSemmelweis UniversityBudapestHungary
| | - Mahsa Sadeghi
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
- Department of Microbiology, School of MedicineGuilan University of Medical SciencesRashtIran
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174
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Jin D, Chen H, He J, Li Y, Zheng G, Yang Y, Zhao Y, Le J, Shu W, He D, Cai Z. Impact of AML1/ETO Fusion on the Efficacy of Venetoclax Plus Hypomethylating Agents in Newly Diagnosed Acute Myeloid Leukemia. Target Oncol 2024; 19:237-249. [PMID: 38466536 DOI: 10.1007/s11523-024-01039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND AML1/ETO fusion confers favorable prognosis in acute myeloid leukemia (AML) treated with intensive chemotherapy (IC). However, the impact of AML1/ETO fusion on the efficacy of venetoclax in the treatment of AML is unclear. OBJECTIVE The aim of this study was to evaluate the efficacy of venetoclax plus hypomethylating agents (VEN/HMAs) in patients with AML1/ETO-positive AML. PATIENTS AND METHODS Patients with newly diagnosed AML in two centers were reviewed and divided into three cohorts: AML1/ETO-positive AML treated with frontline VEN/HMA (Cohort A), AML1/ETO-negative AML treated with frontline VEN/HMA (Cohort B), or AML1/ETO-positive AML treated with frontline IC (Cohort C). The response and survival were compared between the cohorts. RESULTS A total of 260 patients were included in the study. Patients in Cohort A had a significantly lower overall response rate (ORR) than patients in Cohort B (40.9% vs 71.2%, p = 0.005). The median event-free survival (EFS) in Cohort A and Cohort B was 2.7 months and 7.7 months, respectively, with no significant difference. The ORR and median EFS in Cohort C were 80.8% and 14.9 months, respectively, which were significantly superior to those in Cohort A, and the advantages remained significant after propensity score matching. ORR and EFS in KIT-mutated patients with AML1/ETO-positive AML receiving VEN/HMA were much inferior to those in KIT wild-type patients (ORR 0.0% vs 81.8%, p = 0.001; EFS 1.2 months vs not reached, p < 0.001). CONCLUSIONS Newly diagnosed AML patients with AML1/ETO fusion had a poor response to frontline VEN/HMA treatment. When determining induction therapy for patients with AML1/ETO-positive AML, IC should be preferred over VEN/HM.
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Affiliation(s)
- Dian Jin
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, Ningbo, 315000, China
| | - Haoguang Chen
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China
| | - Jingsong He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China
- Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yi Li
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China
- Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Gaofeng Zheng
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China
- Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yang Yang
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China
- Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Yi Zhao
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China
- Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China
| | - Jing Le
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, Ningbo, 315000, China
| | - Wenxiu Shu
- Department of Hematology, Ningbo Medical Treatment Center Li Huili Hospital, Ningbo, 315000, China
| | - Donghua He
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China.
- Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China.
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.
| | - Zhen Cai
- Bone Marrow Transplantation Center, The First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun road, Hangzhou, 310003, China.
- Liangzhu Laboratory, Zhejiang University Medical Center, 1369 West Wenyi Road, Hangzhou, 311121, China.
- Institute of Hematology, Zhejiang University, Hangzhou, 310003, China.
- Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, China.
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175
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Guzelj D, Grubelnik A, Greif N, Povalej Bržan P, Fluher J, Kalamar Ž, Markota A. The Effect of Body Temperature Changes on the Course of Treatment in Patients With Pneumonia and Sepsis: Results of an Observational Study. Interact J Med Res 2024; 13:e52590. [PMID: 38427413 PMCID: PMC10943422 DOI: 10.2196/52590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Traditionally, patients who are critically ill with infection and fever have been treated with antipyretics or even physically cooled. Presumed benefits of the reduction of body temperature are mostly based on decreased metabolic demands. However, it has been shown that decreasing body temperature in patients who are critically ill is not associated with improvement in treatment outcomes. Additionally, there is some data to support the use of temperature modulation (therapeutic hyperthermia) as an adjuvant treatment strategy in patients with infection. OBJECTIVE This study aims to determine the effect of body temperature on the course of intensive care unit (ICU) treatment of patients who are mechanically ventilated with pneumonia, sepsis, and positive tracheal aspirates on admission. METHODS We performed a single-center retrospective study. Core body temperature was measured in all patients. We analyzed associations between average temperatures in the first 48 hours after admission to ICU and ICU treatment parameters. Additionally, patients were divided into three groups: patients with negative tracheal aspirates 1 week after ICU admission (P-N group), patients with a different pathogen in tracheal aspirates 1 week after ICU admission (P-HAP group), and patients with a persisting pathogen in tracheal aspirates 1 week after ICU admission (P-P group). Differences in body temperature and interventions aimed at temperature modulation were determined. RESULTS We observed a significantly higher average temperature in the first 48 hours after admission to ICU in patients who survived to hospital discharge compared to nonsurvivors (mean 37.2 °C, SD 1 °C vs mean 36.9 °C, SD 1.6 °C; P=.04). We observed no associations between average temperatures in the first 48 hours after ICU admission and days of mechanical ventilation in the first 7 days of treatment (ρ=-0.090; P=.30), the average maximum daily requirement for noradrenaline in the first 7 days of treatment (ρ=-0.029; P=.80), average maximum FiO2 in the first 7 days of ICU treatment (ρ=0.040; P=.70), and requirement for renal replacement therapy in the first 7 days of ICU treatment (mean 37.3 °C, SD 1.4 °C vs mean 37.0 °C, SD 1.3 °C; P=.23). In an additional analysis, we observed a significantly greater use of paracetamol in the P-N group (mean 1.0, SD 1.1 g vs mean 0.4, SD 0.7 g vs mean 0.4, SD 0.8 g; P=.009), a trend toward greater use of active cooling in the first 24 hours after ICU admission in the P-N group (n=11, 44% vs n=14, 33.3% vs n=16, 32%; P=.57), and no other significant differences in parameters of ICU treatment between patient groups. CONCLUSIONS We observed better survival in patients who developed higher body temperatures in the first 48 hours after admission to the ICU; however, we observed no changes in other treatment parameters. Similarly, we observed greater use of paracetamol in patients with negative tracheal aspirates 1 week after ICU admission. Our results support the strategy of temperature tolerance in patients who are intubated with pneumonia and sepsis.
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Affiliation(s)
- Domen Guzelj
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Anže Grubelnik
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Nina Greif
- Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Petra Povalej Bržan
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Jure Fluher
- Medical Intensive Care Unit, University Medical Centre Maribor, Maribor, Slovenia
| | - Žiga Kalamar
- Medical Intensive Care Unit, University Medical Centre Maribor, Maribor, Slovenia
| | - Andrej Markota
- Medical Intensive Care Unit, University Medical Centre Maribor, Maribor, Slovenia
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Tan J, Liu C, Yang M, Xiong Y, Huang S, Qi Y, Chen M, Thabane L, Liu X, He L, Sun X. Investigation of statistical methods used in prognostic prediction models for obstetric care: A 10 year-span cross-sectional study. Acta Obstet Gynecol Scand 2024; 103:611-620. [PMID: 38140844 PMCID: PMC10867372 DOI: 10.1111/aogs.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
INTRODUCTION Obstetric care is a highly active area in the development and application of prognostic prediction models. The development and validation of these models often require the utilization of advanced statistical techniques. However, failure to adhere to rigorous methodological standards could greatly undermine the reliability and trustworthiness of the resultant models. Consequently, the aim of our study was to examine the current statistical practices employed in obstetric care and offer recommendations to enhance the utilization of statistical methods in the development of prognostic prediction models. MATERIAL AND METHODS We conducted a cross-sectional survey using a sample of studies developing or validating prognostic prediction models for obstetric care published in a 10-year span (2011-2020). A structured questionnaire was developed to investigate the statistical issues in five domains, including model derivation (predictor selection and algorithm development), model validation (internal and external), model performance, model presentation, and risk threshold setting. On the ground of survey results and existing guidelines, a list of recommendations for statistical methods in prognostic models was developed. RESULTS A total of 112 eligible studies were included, with 107 reporting model development and five exclusively reporting external validation. During model development, 58.9% of the studies did not include any form of validation. Of these, 46.4% used stepwise regression in a crude manner for predictor selection, while two-thirds made decisions on retaining or dropping candidate predictors solely based on p-values. Additionally, 26.2% transformed continuous predictors into categorical variables, and 80.4% did not consider nonlinear relationships between predictors and outcomes. Surprisingly, 94.4% of the studies did not examine the correlation between predictors. Moreover, 47.1% of the studies did not compare population characteristics between the development and external validation datasets, and only one-fifth evaluated both discrimination and calibration. Furthermore, 53.6% of the studies did not clearly present the model, and less than half established a risk threshold to define risk categories. In light of these findings, 10 recommendations were formulated to promote the appropriate use of statistical methods. CONCLUSIONS The use of statistical methods is not yet optimal. Ten recommendations were offered to assist the statistical methods of prognostic prediction models in obstetric care.
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Affiliation(s)
- Jing Tan
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Chunrong Liu
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Min Yang
- Department of Epidemiology and Biostatistics, West China School of Public HealthSichuan UniversityChengduChina
- Faculty of Health, Design and ArtSwinburne Technology UniversityMelbourneVictoriaAustralia
| | - Yiquan Xiong
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Shiyao Huang
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Yana Qi
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
| | - Meng Chen
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
- Biostatistics UnitSt Joseph's Healthcare—HamiltonHamiltonOntarioCanada
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, and Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University HospitalSichuan UniversityChengduSichuanChina
| | - Lin He
- The Intelligence Library Center, Ministry of Science and Technology, Chinese Evidence‐Based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
| | - Xin Sun
- Chinese Evidence‐based Medicine Center, West China HospitalSichuan UniversityChengduSichuanChina
- NMPA Key Laboratory for Real World Data Research and Evaluation in HainanChengduSichuanChina
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May C, Or G, Gad S, Daniel Z, Hila H, Boris F, Pninit L, Hadar A, Galia B. Can Patients with Electrolyte Disturbances Be Safely and Effectively Treated in a Hospital-at-Home, Telemedicine-Controlled Environment? A Retrospective Analysis of 267 Patients. J Clin Med 2024; 13:1409. [PMID: 38592241 PMCID: PMC10932046 DOI: 10.3390/jcm13051409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/10/2024] [Accepted: 02/27/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Morbidities indicated for hospital-at-home (HAH) treatment include infectious diseases and exacerbations of chronic conditions. Electrolyte disturbances are not included per se. However, their rate is high. We aimed to describe our experience via the monitoring and treatment of such patients. METHODS This was a retrospective analysis of patients in the setting of telemedicine-controlled HAH treatment. We collected data from the electronic medical records of patients who presented electrolyte disturbances. RESULTS For 14 months, we treated 267 patients in total in HAH settings, with a mean age of 72.2 + 16.4, 44.2% for males. In total, 261 (97.75%) patients were flagged with electrolyte disturbances, of whom 149 had true electrolyte disturbances. Furthermore, 67 cases (44.96%) had hyponatremia, 9 (6.04%) had hypernatremia after correction for hyperglycemia, 20 (13.42%) had hypokalemia and 27 (18.12%) had hyperkalemia after the exclusion of hemolytic samples. Ten (6.09%) patients had hypocalcemia and two (1.34%) had hypercalcemia corrected to albumin levels. Thirteen (8.72%) patients had hypomagnesemia and one (0.67%) had hypermagnesemia. Patients with electrolyte disturbances suffered from more chronic kidney disease (24.2% vs. 12.2%; p = 0.03) and malignancy (6.3% vs. 0.6%; p = 0.006), and were more often treated with diuretics (12.6% vs. 4.1%; p = 0.016). No patient died or suffered from clinically significant cardiac arrhythmias. CONCLUSIONS The extent of electrolyte disturbances amongst HAH treatment patients is high. The monitoring and treatment of such patients can be conducted safely in this setting.
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Affiliation(s)
- Cohn May
- 3rd Faculty of Medicine, Charles University, 11636 Prague, Czech Republic
| | - Gueron Or
- School of Medicine, University of Nicosia, Nicosia 2417, Cyprus;
| | - Segal Gad
- Chaim Sheba Medical Center, Education Authority, 2nd Sheba Road, Ramat-Gan 5262000, Israel
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
| | - Zubli Daniel
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
- Chaim Sheba Medical Center, The Infection Prevention & Control Unit, 2nd Sheba Road, Ramat-Gan 5262000, Israel
| | - Hakim Hila
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Fizdel Boris
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Liber Pninit
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Amir Hadar
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
| | - Barkai Galia
- Chaim Sheba Medical Center, Sheba-Beyond Virtual Hospital, 2nd Sheba Road, Ramat-Gan 5262000, Israel (F.B.); (B.G.)
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
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Zainal-Abidin A, Miptah H, Ariffin F, Razali S, Badlishah-Sham S. Association of coping mechanisms with medication adherence among young People living with HIV (PLHIV) in Klang Valley. Heliyon 2024; 10:e25740. [PMID: 38380003 PMCID: PMC10877255 DOI: 10.1016/j.heliyon.2024.e25740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/09/2024] [Accepted: 02/01/2024] [Indexed: 02/22/2024] Open
Abstract
Background As young People Living with HIV (PLHIV) will need to take antiretroviral therapy (ART) for life, there is a need to understand their coping mechanisms in living with the disease. Lack of coping mechanisms leads to poor medication adherence and hospital follow-up, poor health outcomes and shortened life expectancy. Objectives This study aimed to determine the pattern of coping mechanisms in young PLHIV and its association with medication adherence. Methods This study was a cross-sectional study amongst young PLHIV patients (aged 20-39 years old) attending two HIV clinics in Klang Valley. Data was collected between February to August 2022. The pattern of coping strategies was assessed using the 28-item Brief Coping Orientation to Problems Experienced (COPE) questionnaire in English and Malay language, which was validated and found to have good internal consistency. Self-reported medication adherence was measured using the one-item Medical Outcomes Study (MOS) Specific Adherence Scale. Statistical analysis included descriptive statistics, single and multiple logistic regression. Results A total of 395 respondents were recruited for the study. The mean scores for each coping mechanism were: 1) problem-focused coping 2.98 (SD 0.62), 2) emotion-focused coping 2.40 (SD 0.48), 3) dysfunctional coping 1.84 (SD 0.44) and 4) religion/spirituality coping 3.07 (SD 0.97). The majority of the respondents (66.8%) were adherent to their ART. Respondents who had a longer duration of medication [OR:1.014 (95% CI: 1.002,1.026)] and those who adopted less religion/spirituality coping mechanisms [OR: 0.495 (95% CI:0.246, 0.997)] were found to be significantly associated with medication adherence. Conclusion This study revealed an overall medication adherence rate of 66.8%. Patients with longer ART duration and who adopted less religion or spirituality coping had better medication adherence. These study findings provide input into the design of intervention by clinicians and healthcare policy makers for young PLHIV in clinical practice.
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Affiliation(s)
- A.N.I. Zainal-Abidin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
| | - H.N. Miptah
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
| | - F. Ariffin
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
| | - S. Razali
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
| | - S.F. Badlishah-Sham
- Department of Primary Care Medicine, Faculty of Medicine, Universiti Teknologi MARA, Selangor, Malaysia
- Hospital Al-Sultan Abdullah (HASA), UiTM Puncak Alam, Selangor, Malaysia
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179
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Niczewski M, Gawęda S, Kluszczyk P, Rycerski M, Syguła D, Danel A, Szmigiel S, Mendrala K, Oraczewska A, Kijonka C, Nowicka M, Wita M, Cyzowski T, Brożek G, Dyrbuś M, Skoczyński S. The Predictive Role of Lactate in the Emergency Department in Patients with Severe Dyspnea. Emerg Med Int 2024; 2024:6624423. [PMID: 38455374 PMCID: PMC10919975 DOI: 10.1155/2024/6624423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/23/2024] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
Objective An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. Methods The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished-arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1-quartile 3) 2 (1-4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. Results The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO2 on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01-2.47), by 80% in VBG (95% CI: 1.13-2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22-2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO2, and pCO2 did not predict short-term mortality. Conclusions In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.
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Affiliation(s)
- Maciej Niczewski
- Department of Internal Medicine and Metabolic Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Szymon Gawęda
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Paulina Kluszczyk
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mikołaj Rycerski
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Daria Syguła
- Student Scientific Society, Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Anna Danel
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Szymon Szmigiel
- 1st Department of Lung Diseases and Tuberculosis, Provincial Specialist Hospital in Czerwona Góra, Chęciny, Poland
| | - Konrad Mendrala
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Aleksandra Oraczewska
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Czarosław Kijonka
- Emergency Department, Upper Silesian Medical Center, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Monika Nowicka
- Emergency Department, Upper Silesian Medical Center, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michał Wita
- First Chair and Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Cyzowski
- Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Brożek
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maciej Dyrbuś
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Szymon Skoczyński
- Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
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180
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Wei D, Zhao L, Hua XY, Zheng MX, Wu JJ, Xu JG. A bibliometric analysis of brachial plexus injury from 1980 to 2022. Heliyon 2024; 10:e26175. [PMID: 38434026 PMCID: PMC10906180 DOI: 10.1016/j.heliyon.2024.e26175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 01/14/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Brachial plexus injury is a common severe peripheral nerve injury with high disability. At present, the bibliometric analysis of brachial plexus injury is basically unknown. Methods This article analyzes the data retrieved to the web of science and uses the R language (version 4.2), Citespace (version 6.1.R3 Advanced), Vosviewer (Lei deng university) to make a scientific map. Specifically, we analyze the main publication countries, institutions, journals where the article is published, and the cooperative relationship between different institutions, the relationship between authors, main research directions in this field, and current research hotspots. Results From 1980 to 2022, the total number of publications is 1542. In terms of countries where articles were published, 551 records were published in the United States, accounting for 35% of the total. With 74 articles, Fudan University ranks first in the world in terms of the number of articles issued by the institution, followed by 72 articles from Mayo Clinic. The magazine with the largest number of articles is JOURNAL OF HAND SURGERY-AMERICAN VOLUME, which has published 87 articles in total. GU YD (Gu Yu-Dong) team (Fudan University) and spinner RJ (Robert J Spinner) team (Mayo clinic) are in a leading position in this field. Nerve transfer and nerve reconstruction have been a hot topic of brachial plexus injury. "Spinal nerve root repair and reimplantation of avulsed ventral roots into the spinal cord after brachial plexus injury" has the strongest citation bursts. Conclusion Research on brachial plexus injury shows a trend of increasing heat. At present, there is a lack of communication and cooperation between scholars from different countries. Nerve transfer and nerve reconstruction are the current and future research directions in the treatment of brachial plexus injury.
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Affiliation(s)
- Dong Wei
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Li Zhao
- Department of Prosthodontics, Stomatological Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, 400015, Chongqing, China
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Xu-Yun Hua
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, China
| | - Mou-Xiong Zheng
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, China
| | - Jia-Jia Wu
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, China
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181
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Lin S, Mao X, He W, Zhan Q. Association between red blood cell distribution width-to-platelet ratio and post-discharge readmission rate in patients with heart failure: A retrospective cohort study. Heliyon 2024; 10:e26549. [PMID: 38434056 PMCID: PMC10906436 DOI: 10.1016/j.heliyon.2024.e26549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 02/07/2024] [Accepted: 02/15/2024] [Indexed: 03/05/2024] Open
Abstract
Background To date, no studies have investigated the association between red blood cell distribution width (RDW)-to-platelet ratio (RPR) and readmission rates among patients with heart failure (HF). As such, the present study aimed to examine the relationship between RPR and readmission rates in patients with HF. Methods Data for this study were obtained from the Fourth People's Hospital (Zigong, Sichuan Province, China). Patients were diagnosed with HF in accordance with European Society of Cardiology criteria. The primary outcome was the 28-day readmission rate. Various logistic regression models were constructed to explore the association between RPR and the 28-day readmission rate. Results The study comprised 1978 patients with HF, with a 28-day readmission rate of 6.98%. RPR emerged as an independent risk factor for 28-day readmission, evidenced by consistent results across the various regression-adjusted models. The covariate-adjusted propensity score model demonstrated that every 0.1 increase in RPR was associated with an 8.2% increase in 28-day readmission rate (odds ratio [OR] 1.082 [95% confidence interval (CI) 1.012-1.158]; P = 0.0212). Similarly, each 0.1 change in RPR was associated with a 9.8% (OR 1.098 [95% CI 1.014-1.188]) and 7.3% (OR 1.073 [95% CI 0.991-1.161]) increase in 3- and 6-month readmission rates, respectively. However, RPR was not statistically associated with the 6-month readmission rate. Curve fit plots illustrated a nonlinear positive correlation between RPR and 28-day, and 3- and 6-month readmissions. Moreover, the effects of RPR on 28-day, and 3- and 6-month readmission rates remained robust across subgroup variables in stratified analysis. Finally, the effect sizes of pooled multiply imputed data were consistent with the original data, suggesting robust results. Conclusion RPR was an independent risk factor for 28-day readmission among patients with HF and also demonstrated modest predictive value for readmissions at 3 and 6 months, despite being non-significant for the 6-month readmission rate. Early identification of patients with HF with elevated RPR would facilitate management and may confer favorable effects on prognosis.
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Affiliation(s)
- Shan Lin
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Xueyan Mao
- Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Wanmei He
- Department of Medical Intensive Care Unit, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, 510080, China
| | - Qingyuan Zhan
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
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Song D, Yang Z, Cai L, Huang H, Gu Z. Conditional survival analysis and dynamic survival prediction for intracranial solitary-fibrous tumor/hemangiopericytoma. J Cancer Res Clin Oncol 2024; 150:107. [PMID: 38418608 PMCID: PMC10902043 DOI: 10.1007/s00432-024-05629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/19/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND As the form of World Health Organization Central Nervous System (WHO CNS) tumor classifications is updated, there is a lack of research on outcomes for intracranial combined solitary-fibrous tumor and hemangiopericytoma (SFT/HPC). This study aimed to explore conditional survival (CS) pattern and develop a survival prediction tool for intracranial SFT/HPC patients. METHODS Data of intracranial SFT/HPC patients was gathered from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute. The patients were split into training and validation groups at a 7:3 ratio for our analysis. CS is defined as the likelihood of surviving for a specified period of time (y years), given that the patient has survived x years after initial diagnosis. Then, we used this definition of CS to analyze the intracranial SFT/HPC patients. The least absolute shrinkage and selection operator (LASSO) regression and best subset regression (BSR) were employed to identify predictive factors. The Multivariate Cox regression analysis was applied to establish a novel CS-based nomogram, and a risk stratification system was developed using this model. RESULTS From the SEER database, 401 patients who were diagnosed with intracranial SFT/HPC between 2000 and 2019 were identified. Among them, 280 were included in the training group and 121 were included in the internal validation group for analysis. Our study revealed that in intracranial SFT/HPC, 5-year survival rates saw significant improvement ranging from 78% at initial diagnosis to rates of 83%, 87%, 90%, and 95% with each successive year after surviving for 1-4 years. The LASSO regression and BSR identified patient age, tumor behavior, surgery and radiotherapy as predictors of CS-based nomogram development. A risk stratification system was also successfully constructed to facilitate the identification of high-risk patients. CONCLUSION The CS pattern of intracranial SFT/HPC patients was outlined, revealing a notable improvement in 5-year survival rates after an added period of survival. Our newly-established CS-based nomogram and risk stratification system can provide a real-time dynamic survival estimation and facilitate the identification of high-risk patients, allowing clinicians to better guide treatment decision for these patients.
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Affiliation(s)
- Dagang Song
- Department of Neurosurgery, Shaoxing Central Hospital, The Central Hospital of Shaoxing University, Shaoxing, Zhejiang, China
| | - Zhihao Yang
- Department of Neurosurgery, Shaoxing Central Hospital, The Central Hospital of Shaoxing University, Shaoxing, Zhejiang, China
| | - Linqiang Cai
- Department of Neurosurgery, Shaoxing Central Hospital, The Central Hospital of Shaoxing University, Shaoxing, Zhejiang, China
| | - Hua Huang
- Department of Neurosurgery, Shaoxing Central Hospital, The Central Hospital of Shaoxing University, Shaoxing, Zhejiang, China
| | - Zhiwei Gu
- Department of Neurosurgery, Shaoxing Central Hospital, The Central Hospital of Shaoxing University, Shaoxing, Zhejiang, China.
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183
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Liu J, Ashuach T, Inoue F, Ahituv N, Yosef N, Kreimer A. Optimizing sequence design strategies for perturbation MPRAs: a computational evaluation framework. Nucleic Acids Res 2024; 52:1613-1627. [PMID: 38296821 PMCID: PMC10939410 DOI: 10.1093/nar/gkae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/26/2023] [Accepted: 01/12/2024] [Indexed: 02/02/2024] Open
Abstract
The advent of perturbation-based massively parallel reporter assays (MPRAs) technique has facilitated the delineation of the roles of non-coding regulatory elements in orchestrating gene expression. However, computational efforts remain scant to evaluate and establish guidelines for sequence design strategies for perturbation MPRAs. In this study, we propose a framework for evaluating and comparing various perturbation strategies for MPRA experiments. Within this framework, we benchmark three different perturbation approaches from the perspectives of alteration in motif-based profiles, consistency of MPRA outputs, and robustness of models that predict the activities of putative regulatory motifs. While our analyses show very similar results across multiple benchmarking metrics, the predictive modeling for the approach involving random nucleotide shuffling shows significant robustness compared with the other two approaches. Thus, we recommend designing sequences by randomly shuffling the nucleotides of the perturbed site in perturbation-MPRA, followed by a coherence check to prevent the introduction of other variations of the target motifs. In summary, our evaluation framework and the benchmarking findings create a resource of computational pipelines and highlight the potential of perturbation-MPRA in predicting non-coding regulatory activities.
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Affiliation(s)
- Jiayi Liu
- Graduate Program in Cell & Developmental Biology, Rutgers, The State University of New Jersey, 604 Allison Rd, Piscataway, NJ 08854, USA
- Department of Biochemistry and Molecular Biology, Rutgers, The State University of New Jersey, 604 Allison Road, Piscataway, NJ 08854, USA
- Center for Advanced Biotechnology and Medicine, Rutgers, The State University of New Jersey, 679 Hoes Lane West, Piscataway, Piscataway, NJ 08854, USA
| | - Tal Ashuach
- Department of Electrical Engineering and Computer Sciences and Center for Computational Biology, University of California, Berkeley, 387 Soda Hall, Berkeley, CA 94720, USA
| | - Fumitaka Inoue
- Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Faculty of Medicine Building B, Yoshidatachibanacho, Sakyo Ward, Kyoto 606-8303, Japan
| | - Nadav Ahituv
- Department of Bioengineering and Therapeutic Sciences, University of California, 1700 4th Street, San Francisco, CA 94158, USA
- Institute for Human Genetics, University of California, 513 Parnassus Ave, San Francisco, CA 94143, USA
| | - Nir Yosef
- Department of Systems Immunology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 7610001, Israel
- Chan-Zuckerberg Biohub, 499 Illinois St, San Francisco, CA 94158, USA
- Department of Systems Immunology, Ragon Institute of MGH, MIT, and Harvard Institute of Science, 400 Technology Square, Cambridge, MA 02139, USA
| | - Anat Kreimer
- Department of Biochemistry and Molecular Biology, Rutgers, The State University of New Jersey, 604 Allison Road, Piscataway, NJ 08854, USA
- Center for Advanced Biotechnology and Medicine, Rutgers, The State University of New Jersey, 679 Hoes Lane West, Piscataway, Piscataway, NJ 08854, USA
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Brockhus L, Hofmann E, Keitel K, Bärtsch M, Müller M, Klukowska-Rötzler J. Emergency department utilisation and treatment for trauma-related presentations of adolescents aged 16-18: a retrospective cross-sectional study. BMC Emerg Med 2024; 24:33. [PMID: 38413869 PMCID: PMC10900568 DOI: 10.1186/s12873-024-00945-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/01/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND A recent study conducted at our tertiary hospital emergency department (ED) reviewed ED consultations and found that adolescents aged 16-18 years present significantly more often for trauma and psychiatric problems than adults over 18 years. Accidental injuries are one of the greatest health risks for children and adolescents. In view of the increased vulnerability of the adolescent population, this study aimed to further analyse trauma-related presentations in adolescents. METHODS We conducted a single-centre, retrospective, cross-sectional study of all adolescent trauma patients aged 16 to 18 years presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from January 2013 to July 2017. We analysed presentation data as well as inpatient treatment and cost-related data. Data of female and male patients were compared by univariable analysis. A comparison group was formed consisting of 200 randomly chosen patients aged 19-25 years old with the same presentation characteristics. Predictive factors for surgical treatment were obtained by multivariable analysis. RESULTS The study population included a total of 1,626 adolescent patients aged 16-18 years. The predominant causes for ED presentation were consistent within case and comparison groups for sex and age and were sports accidents, falls and violence. Male patients were more likely to need surgical treatment (OR 1.8 [95% CI: 1.2-2.5], p = 0.001) and consequently inpatient treatment (OR 1.5 [95% CI: 1.1-2.1], p = 0.01), associated with higher costs (median 792 Swiss francs [IQR: 491-1,598]). Other independent risk factors for surgical treatment were violence-related visits (OR 2.1 [95% CI: 1.3-3.5, p = 0.004]) and trauma to the upper extremities (OR 2.02 [95% CI: 1.5-2.8], p < 0.001). Night shift (OR 0.56 [95% CI: 0.37-0.86], 0.008) and walk-in consultations (OR 0.3 [95% CI: 0.2; 0.4, < 0.001] were preventive factors for surgical treatment. CONCLUSIONS Male adolescents account for the majority of emergency visits and appear to be at higher risk for accidents as well as for surgical treatment and/or inpatient admission due to sports accidents or injuries from violence. We suggest that further preventive measures and recommendations should be implemented and that these should focus on sport activities and injuries from violence.
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Affiliation(s)
- Lara Brockhus
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Elias Hofmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Kristina Keitel
- Department of Paediatric Emergency Medicine, Inselspital, University Children's Hospital, Bern University, 3010, Bern, Switzerland
- Department of Paediatrics, Inselspital, University Children's Hospital, Bern University, 3010, Bern, Switzerland
| | - Martina Bärtsch
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland
| | - Martin Müller
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland.
| | - Jolanta Klukowska-Rötzler
- Department of Emergency Medicine, Inselspital, Bern University Hospital, Bern University, Bern, Switzerland.
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185
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Zhou J, Dong J, Hou H, Huang L, Li J. High-throughput microfluidic systems accelerated by artificial intelligence for biomedical applications. Lab Chip 2024; 24:1307-1326. [PMID: 38247405 DOI: 10.1039/d3lc01012k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
High-throughput microfluidic systems are widely used in biomedical fields for tasks like disease detection, drug testing, and material discovery. Despite the great advances in automation and throughput, the large amounts of data generated by the high-throughput microfluidic systems generally outpace the abilities of manual analysis. Recently, the convergence of microfluidic systems and artificial intelligence (AI) has been promising in solving the issue by significantly accelerating the process of data analysis as well as improving the capability of intelligent decision. This review offers a comprehensive introduction on AI methods and outlines the current advances of high-throughput microfluidic systems accelerated by AI, covering biomedical detection, drug screening, and automated system control and design. Furthermore, the challenges and opportunities in this field are critically discussed as well.
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Affiliation(s)
- Jianhua Zhou
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China.
- Key Laboratory of Sensing Technology and Biomedical Instruments of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China
| | - Jianpei Dong
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China.
- Key Laboratory of Sensing Technology and Biomedical Instruments of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China
| | - Hongwei Hou
- Beijing Life Science Academy, Beijing 102209, China
| | - Lu Huang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen 518107, China.
- Key Laboratory of Sensing Technology and Biomedical Instruments of Guangdong Province, School of Biomedical Engineering, Sun Yat-sen University, Shenzhen 518107, China
| | - Jinghong Li
- Department of Chemistry, Center for BioAnalytical Chemistry, Key Laboratory of Bioorganic Phosphorus Chemistry & Chemical Biology, Tsinghua University, Beijing 100084, China.
- New Cornerstone Science Laboratory, Shenzhen 518054, China
- Beijing Life Science Academy, Beijing 102209, China
- Center for BioAnalytical Chemistry, Hefei National Laboratory of Physical Science at Microscale, University of Science and Technology of China, Hefei 230026, China
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186
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Olivera MJ, Muñoz L. Exploring the latency period in Chagas disease: duration and determinants in a cohort from Colombia. Trans R Soc Trop Med Hyg 2024:trae004. [PMID: 38411919 DOI: 10.1093/trstmh/trae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/26/2023] [Accepted: 02/01/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Chagas disease has a varying latency period, the time between infection and onset of cardiac symptoms, due to multiple factors. This study seeks to identify and understand these factors to enhance our knowledge of the disease. METHODS A retrospective follow-up study was conducted in Colombia on patients with indeterminate chronic Chagas disease. Medical files were examined to evaluate the disease latency time using time ratios (TRs) and the AFT Weibull model. RESULTS The study followed 578 patients, of whom 309 (53.5%) developed cardiac disease, with a median latency period of 18.5 (95% CI 16 to 20) y for the cohort. Those with the TcISyl genotype (TR 0.72; 95% CI 0.61 to 0.80), individuals who lived 5-15 y (TR 0.80; 95% CI 0.67 to 0.95), 15-30 y (TR 0.63; 95% CI 0.53 to 0.74) or >30 y (vs 5 y) in areas with high disease prevalence had shorter latency periods. On the other hand, undergoing treatment increased the latency period (TR: 1.74; 95% CI 1.52 to 1.87). CONCLUSIONS The latency period of Chagas disease was found to be independently related to male gender, receipt of etiological treatment, length of time spent in an endemic area and the TcISyl genotype. The implications of these findings are discussed.
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Affiliation(s)
- Mario Javier Olivera
- Departamento de investigación en salud pública, Grupo de Parasitología, Instituto Nacional de Salud, Bogotá 111321, D.C., Colombia
| | - Lyda Muñoz
- Departamento de investigación en salud pública, Grupo de Parasitología, Instituto Nacional de Salud, Bogotá 111321, D.C., Colombia
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187
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Xu J, Ye X, Lv Z, Chen YH, Wang XS. The Role of Base in Reaction Performance of Photochemical Synthesis of Thiazoles: An Integrated Theoretical and Experimental Study. Chemistry 2024:e202304279. [PMID: 38409580 DOI: 10.1002/chem.202304279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 02/28/2024]
Abstract
Artificial intelligence (AI)/machine learning (ML) is emerging as pivotal in synthetic chemistry, offering revolutionary potential in retrosynthetic analysis, reaction conditions and reaction prediction. We have combined chemical descriptors, primarily based on Density Functional Theory (DFT) calculations, with various AI/ML tools such as Multi-Layer Perceptron (MLP) and Random Forest (RF), to predict the synthesis of 2-arylbenzothiazole in photoredox reactions. Significantly, our models underscore the critical role of the molecular structure and physicochemical characteristics of the base, especially the total atomic polarizabilities, in the rate-determining steps involving cyclohexyl and phenethyl moieties of the substrate. Moreover, we validated our findings in articles through experimental studies. It showcases the power of AI/ML and quantum chemistry in shaping the future of organic chemistry.
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Affiliation(s)
- Jiaxin Xu
- The Institute for Advanced Studies (IAS), Wuhan University, Wuhan, 430072, China
| | - Xiaoyu Ye
- The Institute for Advanced Studies (IAS), Wuhan University, Wuhan, 430072, China
| | - Zongchao Lv
- The Institute for Advanced Studies (IAS), Wuhan University, Wuhan, 430072, China
- CMC Pharmaceutical Research Center, Wuhan RS Pharmaceutical Co., Ltd., Wuhan, 430073, China
| | - Yi-Hung Chen
- The Institute for Advanced Studies (IAS), Wuhan University, Wuhan, 430072, China
| | - Xiang Simon Wang
- Howard University College of Pharmacy, 2300 Fourth Street NW, Washington, DC 20059, United States
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188
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Daisley H, George D, Daisley J. Acute dissection of a syphilitic saccular aneurysm of the ascending aorta and arch in a hypertensive patient - a rare phenomenon. Autops Case Rep 2024; 14:e2024475. [PMID: 38487034 PMCID: PMC10939182 DOI: 10.4322/acr.2024.475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
We report the case of a 77-year-old male who suffered from hypertension and died suddenly. At autopsy, he was found to have hypertensive cardiomegaly and a dissecting syphilitic saccular aneurysm of the ascending aorta and arch with tamponade. Chronic aortic regurgitation, which is often seen in syphilitic aortitis, produces an additive effect to the concentric left ventricular hypertrophy seen in hypertension.
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Affiliation(s)
- Hubert Daisley
- Scarborough General Hospital, Scarborough, Trinidad and Tobago
| | - Dennecia George
- Scarborough General Hospital, Scarborough, Trinidad and Tobago
| | - Johann Daisley
- Scarborough General Hospital, Scarborough, Trinidad and Tobago
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189
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Kimura T, Washida N, Ohtsuki S, Sugita K, Hosoya K, Uchiyama K. A multi-center randomized controlled trial to investigate potential effects of exercise therapy on renal function stratified by renal disorders and renal pathology: beneficial or harmful effect in immunoglobulin a nephropathy. Clin Exp Nephrol 2024:10.1007/s10157-024-02461-2. [PMID: 38402501 DOI: 10.1007/s10157-024-02461-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND The effects of exercise therapy (ET) on renal function in chronic kidney disease (CKD) remain unclear. METHODS In a randomized controlled trial (UMIN-CTR number: UMIN000038415), we investigated whether ET affects renal function in CKD; eligible patients had undergone renal biopsy in the past 3 months. We stratified patients by disease (immunoglobulin A [IgA] nephropathy, n = 16; diabetic nephropathy, n = 4; benign nephrosclerosis, n = 13; and other CKD types, n = 13) and randomized them to 12 weeks' observation and 24 weeks' ET comprising home-based aerobic exercise 3×/week and resistance training 2×/week (intervention group) or usual care (non-intervention group). Primary endpoint was creatinine-based estimated glomerular filtration rate (eGFR) or serum cystatin C-based eGFR (eGFRcys). Secondary endpoints included urinary protein and exercise tolerance. RESULTS Seventy patients were enrolled, 50 fulfilled the inclusion criteria, but 4 discontinued before randomization. No items significantly differed between week 0 to 24 in either group (intervention group, n = 23; non-intervention group, n = 23) or between groups at week 24 (intention-to-treat population) in the total study population. The eGFRcys slope showed no significant intergroup difference in the observation period, but eGFRcys improved significantly in IgA nephropathy patients (n = 16) in the intervention group (stratified comparison; week 0, 48.3 ± 18.2; week 24, 51.6 ± 17.6; p = 0.043). In these patients, urinary protein was significantly worse at week 24 in the non-intervention group (p = 0.046) and worsened significantly less in the intervention group (p = 0.039). CONCLUSION ET did not improve renal function overall in CKD patients but might help maintain renal function in patients with IgA nephropathy.
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Affiliation(s)
- Takahide Kimura
- Department of Nephrology, Mishima General Hospital, Mishima, Shizuoka, Japan
| | - Naoki Washida
- Department of Nephrology, International University of Health and Welfare, Narita Hospital, 852, Hatakeda, Narita, Chiba, 286-8520, Japan.
| | - Shigeaki Ohtsuki
- Japan Institute of Statistical Technology, Niiza, Saitama, Japan
| | - Kazuya Sugita
- Department of Nephrology, International University of Health and Welfare, Narita Hospital, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Kozi Hosoya
- Department of Nephrology, International University of Health and Welfare, Narita Hospital, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
| | - Kiyotaka Uchiyama
- Department of Nephrology, International University of Health and Welfare, Narita Hospital, 852, Hatakeda, Narita, Chiba, 286-8520, Japan
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190
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Wang H, Hao X, He Y, Fan L. AbImmPred: An immunogenicity prediction method for therapeutic antibodies using AntiBERTy-based sequence features. PLoS One 2024; 19:e0296737. [PMID: 38394128 PMCID: PMC10889861 DOI: 10.1371/journal.pone.0296737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/18/2023] [Indexed: 02/25/2024] Open
Abstract
Due to the unnecessary immune responses induced by therapeutic antibodies in clinical applications, immunogenicity is an important factor to be considered in the development of antibody therapeutics. To a certain extent, there is a lag in using wet-lab experiments to test the immunogenicity in the development process of antibody therapeutics. Developing a computational method to predict the immunogenicity at once the antibody sequence is designed, is of great significance for the screening in the early stage and reducing the risk of antibody therapeutics development. In this study, a computational immunogenicity prediction method was proposed on the basis of AntiBERTy-based features of amino sequences in the antibody variable region. The AntiBERTy-based sequence features were first calculated using the AntiBERTy pre-trained model. Principal component analysis (PCA) was then applied to reduce the extracted feature to two dimensions to obtain the final features. AutoGluon was then used to train multiple machine learning models and the best one, the weighted ensemble model, was obtained through 5-fold cross-validation on the collected data. The data contains 199 commercial therapeutic antibodies, of which 177 samples were used for model training and 5-fold cross-validation, and the remaining 22 samples were used as an independent test dataset to evaluate the performance of the constructed model and compare it with other prediction methods. Test results show that the proposed method outperforms the comparison method with 0.7273 accuracy on the independent test dataset, which is 9.09% higher than the comparison method. The corresponding web server is available through the official website of GenScript Co., Ltd., https://www.genscript.com/tools/antibody-immunogenicity.
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Affiliation(s)
- Hong Wang
- Production and R&D Center I of Life Science Services, GenScript Biotech Corporation, Nanjing, China
| | - Xiaohu Hao
- Production and R&D Center I of Life Science Services, GenScript Biotech Corporation, Nanjing, China
| | - Yuzhuo He
- Production and R&D Center I of Life Science Services, GenScript Biotech Corporation, Nanjing, China
| | - Long Fan
- Production and R&D Center I of Life Science Services, GenScript Biotech Corporation, Nanjing, China
- Production and R&D Center I of Life Science Services, GenScript (Shanghai) Biotech Co., Ltd., Shanghai, China
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191
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Li X, Cui L, Xu H. Association between systemic inflammation response index and chronic kidney disease: a population-based study. Front Endocrinol (Lausanne) 2024; 15:1329256. [PMID: 38455650 PMCID: PMC10917959 DOI: 10.3389/fendo.2024.1329256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Our objective was to explore the potential link between systemic inflammation response index (SIRI) and chronic kidney disease (CKD). Methods The data used in this study came from the National Health and Nutrition Examination Survey (NHANES), which gathers data between 1999 and 2020. CKD was diagnosed based on the low estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 or albuminuria (urinary albumin-to-creatinine ratio (ACR) of more than 30 mg/g). Using generalized additive models and weighted multivariable logistic regression, the independent relationships between SIRI and other inflammatory biomarkers (systemic immune-inflammation index (SII), monocyte/high-density lipoprotein ratio (MHR), neutrophil/high-density lipoprotein ratio (NHR), platelet/high-density lipoprotein ratio (PHR), and lymphocyte/high-density lipoprotein ratio (LHR)) with CKD, albuminuria, and low-eGFR were examined. Results Among the recruited 41,089 participants, males accounted for 49.77% of the total. Low-eGFR, albuminuria, and CKD were prevalent in 8.30%, 12.16%, and 17.68% of people, respectively. SIRI and CKD were shown to be positively correlated in the study (OR = 1.24; 95% CI: 1.19, 1.30). Furthermore, a nonlinear correlation was discovered between SIRI and CKD. SIRI and CKD are both positively correlated on the two sides of the breakpoint (SIRI = 2.04). Moreover, increased SIRI levels were associated with greater prevalences of low-eGFR and albuminuria (albuminuria: OR = 1.27; 95% CI: 1.21, 1.32; low-eGFR: OR = 1.11; 95% CI: 1.05, 1.18). ROC analysis demonstrated that, compared to other inflammatory indices (SII, NHR, LHR, MHR, and PHR), SIRI exhibited superior discriminative ability and accuracy in predicting CKD, albuminuria, and low-eGFR. Discussion When predicting CKD, albuminuria, and low-eGFR, SIRI may show up as a superior inflammatory biomarker when compared to other inflammatory biomarkers (SII, NHR, LHR, MHR, and PHR). American adults with elevated levels of SIRI, SII, NHR, MHR, and PHR should be attentive to the potential risks to their kidney health.
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Affiliation(s)
| | | | - Hongyang Xu
- Department of Critical Care Medicine, The Affiliated Wuxi People’s Hospital of Nanjing Medical University, Wuxi, China
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192
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Wijesurendra RS, Sardell R, Jayaram R, Samuel N, Chen Z, Staplin N, Collins R, Zheng Z, Haynes R, Hill M, Emberson J, Casadei B. Mechanisms of rosuvastatin-related acute kidney injury following cardiac surgery: the STICS trial. Eur Heart J 2024; 45:629-631. [PMID: 37793132 PMCID: PMC10881091 DOI: 10.1093/eurheartj/ehad640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/01/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Rohan S Wijesurendra
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, UK
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rebecca Sardell
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Raja Jayaram
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, UK
| | - Nathan Samuel
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhengming Chen
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Natalie Staplin
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rory Collins
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Zhe Zheng
- Department of Cardiovascular Surgery, State Key Laboratory of Cardiovascular Disease, National Clinical Research Center of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Richard Haynes
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Michael Hill
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jonathan Emberson
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Medical Research Council Population Health Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Barbara Casadei
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, UK
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Gomatam A, Hirlekar BU, Singh KD, Murty US, Dixit VA. Improved QSAR models for PARP-1 inhibition using data balancing, interpretable machine learning, and matched molecular pair analysis. Mol Divers 2024:10.1007/s11030-024-10809-9. [PMID: 38374474 DOI: 10.1007/s11030-024-10809-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/07/2024] [Indexed: 02/21/2024]
Abstract
The poly (ADP-ribose) polymerase-1 (PARP-1) enzyme is an important target in the treatment of breast cancer. Currently, treatment options include the drugs Olaparib, Niraparib, Rucaparib, and Talazoparib; however, these drugs can cause severe side effects including hematological toxicity and cardiotoxicity. Although in silico models for the prediction of PARP-1 activity have been developed, the drawbacks of these models include low specificity, a narrow applicability domain, and a lack of interpretability. To address these issues, a comprehensive machine learning (ML)-based quantitative structure-activity relationship (QSAR) approach for the informed prediction of PARP-1 activity is presented. Classification models built using the Synthetic Minority Oversampling Technique (SMOTE) for data balancing gave robust and predictive models based on the K-nearest neighbor algorithm (accuracy 0.86, sensitivity 0.88, specificity 0.80). Regression models were built on structurally congeneric datasets, with the models for the phthalazinone class and fused cyclic compounds giving the best performance. In accordance with the Organization for Economic Cooperation and Development (OECD) guidelines, a mechanistic interpretation is proposed using the Shapley Additive Explanations (SHAP) to identify the important topological features to differentiate between PARP-1 actives and inactives. Moreover, an analysis of the PARP-1 dataset revealed the prevalence of activity cliffs, which possibly negatively impacts the model's predictive performance. Finally, a set of chemical transformation rules were extracted using the matched molecular pair analysis (MMPA) which provided mechanistic insights and can guide medicinal chemists in the design of novel PARP-1 inhibitors.
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Affiliation(s)
- Anish Gomatam
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, (NIPER Guwahati), Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Govt. of India, Sila Katamur (Halugurisuk), Dist: Kamrup, P.O.: Changsari, Guwahati, Assam, 781101, India
| | - Bhakti Umesh Hirlekar
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, (NIPER Guwahati), Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Govt. of India, Sila Katamur (Halugurisuk), Dist: Kamrup, P.O.: Changsari, Guwahati, Assam, 781101, India
| | - Krishan Dev Singh
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, (NIPER Guwahati), Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Govt. of India, Sila Katamur (Halugurisuk), Dist: Kamrup, P.O.: Changsari, Guwahati, Assam, 781101, India
| | - Upadhyayula Suryanarayana Murty
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, (NIPER Guwahati), Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Govt. of India, Sila Katamur (Halugurisuk), Dist: Kamrup, P.O.: Changsari, Guwahati, Assam, 781101, India
| | - Vaibhav A Dixit
- Department of Medicinal Chemistry, National Institute of Pharmaceutical Education and Research, (NIPER Guwahati), Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Govt. of India, Sila Katamur (Halugurisuk), Dist: Kamrup, P.O.: Changsari, Guwahati, Assam, 781101, India.
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Eichinger M, Shah K, Palt N, Eichlseder M, Pichler A, Zoidl P, Zajic P, Rief M. Association of prehospital lactate levels with base excess in various emergencies - a retrospective study. Clin Chem Lab Med 2024; 0:cclm-2024-0060. [PMID: 38373063 DOI: 10.1515/cclm-2024-0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Blood gas analysis, including parameters like lactate and base excess (BE), is crucial in emergency medicine but less commonly utilized prehospital. This study aims to elucidate the relationship between lactate and BE in various emergencies in a prehospital setting and their prognostic implications. METHODS We conducted a retrospective analysis of prehospital emergency patients in Graz, Austria, from October 2015 to November 2020. Our primary aim was to assess the association between BE and lactate. This was assessed using Spearman's rank correlation and fitting a multiple linear regression model with lactate as the outcome, BE as the primary covariate of interest and age, sex, and medical emergency type as confounders. RESULTS In our analysis population (n=312), lactate and BE levels were inversely correlated (Spearman's ρ, -0.75; p<0.001). From the adjusted multiple linear regression model (n=302), we estimated that a 1 mEq/L increase in BE levels was associated with an average change of -0.35 (95 % CI: -0.39, -0.30; p<0.001) mmol/L in lactate levels. Lactate levels were moderately useful for predicting mortality with notable variations across different emergency types. CONCLUSIONS Our study highlights a significant inverse association between lactate levels and BE in the prehospital setting, underscoring their importance in early assessment and prognosis in emergency care. Additionally, the findings from our secondary aims emphasize the value of lactate in diagnosing acid-base disorders and predicting patient outcomes. Recognizing the nuances in lactate physiology is essential for effective prehospital care in various emergency scenarios.
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Affiliation(s)
- Michael Eichinger
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Karan Shah
- Section of Biostatistics, Quantitative Health Sciences, 2569 Cleveland Clinic , Cleveland, OH, USA
| | - Niklas Palt
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Michael Eichlseder
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Alexander Pichler
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Philipp Zoidl
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Paul Zajic
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Martin Rief
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
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195
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Balk R, Esper AM, Martin GS, Miller RR, Lopansri BK, Burke JP, Levy M, Opal S, Rothman RE, D’Alessio FR, Sidhaye VK, Aggarwal NR, Greenberg JA, Yoder M, Patel G, Gilbert E, Parada JP, Afshar M, Kempker JA, van der Poll T, Schultz MJ, Scicluna BP, Klein Klouwenberg PMC, Liebler J, Blodget E, Kumar S, Navalkar K, Yager TD, Sampson D, Kirk JT, Cermelli S, Davis RF, Brandon RB. Validation of SeptiCyte RAPID to Discriminate Sepsis from Non-Infectious Systemic Inflammation. J Clin Med 2024; 13:1194. [PMID: 38592057 PMCID: PMC10931699 DOI: 10.3390/jcm13051194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/08/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: SeptiCyte RAPID is a molecular test for discriminating sepsis from non-infectious systemic inflammation, and for estimating sepsis probabilities. The objective of this study was the clinical validation of SeptiCyte RAPID, based on testing retrospectively banked and prospectively collected patient samples. (2) Methods: The cartridge-based SeptiCyte RAPID test accepts a PAXgene blood RNA sample and provides sample-to-answer processing in ~1 h. The test output (SeptiScore, range 0-15) falls into four interpretation bands, with higher scores indicating higher probabilities of sepsis. Retrospective (N = 356) and prospective (N = 63) samples were tested from adult patients in ICU who either had the systemic inflammatory response syndrome (SIRS), or were suspected of having/diagnosed with sepsis. Patients were clinically evaluated by a panel of three expert physicians blinded to the SeptiCyte test results. Results were interpreted under either the Sepsis-2 or Sepsis-3 framework. (3) Results: Under the Sepsis-2 framework, SeptiCyte RAPID performance for the combined retrospective and prospective cohorts had Areas Under the ROC Curve (AUCs) ranging from 0.82 to 0.85, a negative predictive value of 0.91 (sensitivity 0.94) for SeptiScore Band 1 (score range 0.1-5.0; lowest risk of sepsis), and a positive predictive value of 0.81 (specificity 0.90) for SeptiScore Band 4 (score range 7.4-15; highest risk of sepsis). Performance estimates for the prospective cohort ranged from AUC 0.86-0.95. For physician-adjudicated sepsis cases that were blood culture (+) or blood, urine culture (+)(+), 43/48 (90%) of SeptiCyte scores fell in Bands 3 or 4. In multivariable analysis with up to 14 additional clinical variables, SeptiScore was the most important variable for sepsis diagnosis. A comparable performance was obtained for the majority of patients reanalyzed under the Sepsis-3 definition, although a subgroup of 16 patients was identified that was called septic under Sepsis-2 but not under Sepsis-3. (4) Conclusions: This study validates SeptiCyte RAPID for estimating sepsis probability, under both the Sepsis-2 and Sepsis-3 frameworks, for hospitalized patients on their first day of ICU admission.
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Affiliation(s)
- Robert Balk
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Annette M. Esper
- Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA 30322, USA; (A.M.E.); (G.S.M.); (J.A.K.)
| | - Greg S. Martin
- Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA 30322, USA; (A.M.E.); (G.S.M.); (J.A.K.)
| | | | - Bert K. Lopansri
- Intermountain Medical Center, Murray, UT 84107, USA; (B.K.L.); (J.P.B.)
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - John P. Burke
- Intermountain Medical Center, Murray, UT 84107, USA; (B.K.L.); (J.P.B.)
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA
| | - Mitchell Levy
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA; (M.L.); (S.O.)
| | - Steven Opal
- Warren Alpert Medical School, Brown University, Providence, RI 02912, USA; (M.L.); (S.O.)
| | - Richard E. Rothman
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (R.E.R.); (F.R.D.); (V.K.S.)
| | - Franco R. D’Alessio
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (R.E.R.); (F.R.D.); (V.K.S.)
| | - Venkataramana K. Sidhaye
- School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA; (R.E.R.); (F.R.D.); (V.K.S.)
| | - Neil R. Aggarwal
- Anschutz Medical Campus, University of Colorado, Denver, CO 80045, USA;
| | - Jared A. Greenberg
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Mark Yoder
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Gourang Patel
- Rush Medical College and Rush University Medical Center, Chicago, IL 60612, USA; (J.A.G.); (M.Y.); (G.P.)
| | - Emily Gilbert
- Loyola University Medical Center, Maywood, IL 60153, USA; (E.G.); (J.P.P.)
| | - Jorge P. Parada
- Loyola University Medical Center, Maywood, IL 60153, USA; (E.G.); (J.P.P.)
| | - Majid Afshar
- School of Medicine and Public Health, University of Wisconsin, Madison, WI 53705, USA;
| | - Jordan A. Kempker
- Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA 30322, USA; (A.M.E.); (G.S.M.); (J.A.K.)
| | - Tom van der Poll
- Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (T.v.d.P.); (M.J.S.)
| | - Marcus J. Schultz
- Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (T.v.d.P.); (M.J.S.)
| | - Brendon P. Scicluna
- Centre for Molecular Medicine and Biobanking, University of Malta, Msida MSD 2080, Malta;
- Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Hospital, University of Malta, Msida MSD 2080, Malta
| | | | - Janice Liebler
- Keck Hospital of University of Southern California (USC), Los Angeles, CA 90033, USA; (J.L.); (S.K.)
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
| | - Emily Blodget
- Keck Hospital of University of Southern California (USC), Los Angeles, CA 90033, USA; (J.L.); (S.K.)
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
| | - Santhi Kumar
- Keck Hospital of University of Southern California (USC), Los Angeles, CA 90033, USA; (J.L.); (S.K.)
- Los Angeles General Medical Center, Los Angeles, CA 90033, USA
| | - Krupa Navalkar
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Thomas D. Yager
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Dayle Sampson
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - James T. Kirk
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Silvia Cermelli
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Roy F. Davis
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
| | - Richard B. Brandon
- Immunexpress Inc., Seattle, DC 98109, USA; (K.N.); (J.T.K.); (S.C.); (R.F.D.)
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Mani K, Deng D, Lin C, Wang M, Hsu ML, Zaorsky NG. Causes of death among people living with metastatic cancer. Nat Commun 2024; 15:1519. [PMID: 38374318 PMCID: PMC10876661 DOI: 10.1038/s41467-024-45307-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Studying survivorship and causes of death in patients with advanced or metastatic cancer remains an important task. We characterize the causes of death among patients with metastatic cancer, across 13 cancer types and 25 non-cancer causes and predict the risk of death after diagnosis from the diagnosed cancer versus other causes (e.g., stroke, heart disease, etc.). Among 1,030,937 US (1992-2019) metastatic cancer survivors, 82.6% of patients (n = 688,529) died due to the diagnosed cancer, while 17.4% (n = 145,006) died of competing causes. Patients with lung, pancreas, esophagus, and stomach tumors are the most likely to die of their metastatic cancer, while those with prostate and breast cancer have the lowest likelihood. The median survival time among patients living with metastases is 10 months; our Fine and Gray competing risk model predicts 1 year survival with area under the receiver operating characteristic curve of 0.754 (95% CI [0.754, 0.754]). Leading non-cancer deaths are heart disease (32.4%), chronic obstructive and pulmonary disease (7.9%), cerebrovascular disease (6.1%), and infection (4.1%).
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Affiliation(s)
- Kyle Mani
- Albert Einstein School of Medicine, Bronx, NY, USA
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Daxuan Deng
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Christine Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ming Wang
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Melinda L Hsu
- Division of Hematology and Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Nicholas G Zaorsky
- Department of Radiation Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA.
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Newson JJ, Bala J, Giedd JN, Maxwell B, Thiagarajan TC. Leveraging big data for causal understanding in mental health: a research framework. Front Psychiatry 2024; 15:1337740. [PMID: 38439791 PMCID: PMC10910083 DOI: 10.3389/fpsyt.2024.1337740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Over the past 30 years there have been numerous large-scale and longitudinal psychiatric research efforts to improve our understanding and treatment of mental health conditions. However, despite the huge effort by the research community and considerable funding, we still lack a causal understanding of most mental health disorders. Consequently, the majority of psychiatric diagnosis and treatment still operates at the level of symptomatic experience, rather than measuring or addressing root causes. This results in a trial-and-error approach that is a poor fit to underlying causality with poor clinical outcomes. Here we discuss how a research framework that originates from exploration of causal factors, rather than symptom groupings, applied to large scale multi-dimensional data can help address some of the current challenges facing mental health research and, in turn, clinical outcomes. Firstly, we describe some of the challenges and complexities underpinning the search for causal drivers of mental health conditions, focusing on current approaches to the assessment and diagnosis of psychiatric disorders, the many-to-many mappings between symptoms and causes, the search for biomarkers of heterogeneous symptom groups, and the multiple, dynamically interacting variables that influence our psychology. Secondly, we put forward a causal-orientated framework in the context of two large-scale datasets arising from the Adolescent Brain Cognitive Development (ABCD) study, the largest long-term study of brain development and child health in the United States, and the Global Mind Project which is the largest database in the world of mental health profiles along with life context information from 1.4 million people across the globe. Finally, we describe how analytical and machine learning approaches such as clustering and causal inference can be used on datasets such as these to help elucidate a more causal understanding of mental health conditions to enable diagnostic approaches and preventative solutions that tackle mental health challenges at their root cause.
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Affiliation(s)
| | - Jerzy Bala
- Sapien Labs, Arlington, VA, United States
| | - Jay N. Giedd
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
| | - Benjamin Maxwell
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, United States
- Rady Children’s Hospital – San Diego, San Diego, CA, United States
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Chen H, Atenafu EG, Zeng KL, Chan A, Detsky J, Myrehaug S, Soliman H, Tseng CL, Sahgal A, Maralani PJ. Magnetic Resonance Imaging Frequency After Stereotactic Body Radiation Therapy for Spine Metastases. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00319-5. [PMID: 38373656 DOI: 10.1016/j.ijrobp.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/03/2024] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE Stereotactic body radiation therapy (SBRT) is increasingly being used to treat spine metastases. Current post-SBRT imaging surveillance strategies in this patient population may benefit from a more data-driven and personalized approach. The objective of this study was to develop risk-stratified post-SBRT magnetic resonance imaging (MRI) surveillance strategies using quantitative methods. METHODS AND MATERIALS Adult patients with bony spine metastases treated with SBRT between 2008 and 2021 and who had at least 2 follow-up spine MRIs were reviewed retrospectively. A recursive partitioning analysis model was developed to separate patients into different risk categories for post-SBRT progression anywhere within the spine. Imaging intervals were derived for each risk category using parametric survival regression based on multiple expected spine progression rates per scan. RESULTS A total of 446 patients and 1039 vertebral segments were included. Cumulative incidence of spine progression was 19.2% at 1 year, 26.7% at 2 years, and 35.3% at 4 years. The internally validated risk stratification model was able to divide patients into 3 risk categories based on epidural disease, paraspinal disease, and Spinal Instability Neoplastic Score category. The 4-year risk of spine progression was 23.4%, 39.0%, and 51.8%, respectively, for the low-, intermediate-, and high-risk groups. Using an expected per-scan spine progression rate of 3.75%, the low-risk group would require follow-up scans every 6.0 months (95% CI, 4.9-7.6) and the intermediate-risk group would require surveillance every 3.1 months (95% CI, 2.6-3.7). At an expected spine progression rate of 5%, the high-risk group would require surveillance every 1.3 months (95% CI, 1.1-1.6) during the first 13.2 months after SBRT and every 5.9 months thereafter (95% CI, 2.8-12.3). CONCLUSIONS Data-driven follow-up MRI surveillance intervals at a range of expected spine progression rates have been determined for patients at different risks of spine progression based on an internally validated, single-institution risk stratification model.
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Affiliation(s)
- Hanbo Chen
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada.
| | - Eshetu G Atenafu
- Department of Biostatistics, University Health Network, University of Toronto, Toronto, Ontario Canada
| | - K Liang Zeng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Aimee Chan
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | - Pejman J Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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199
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Liu WD, Wang JT, Shih MC, Chen KH, Huang ST, Huang CF, Chang TH, Tsai MJ, Kuo PH, Yeh YC, Tsai WC, Pan MY, Li GC, Chen YJ, Lin KY, Huang YS, Cheng A, Chen PY, Pan SC, Sun HY, Ku SC, Chang SY, Sheng WH, Fang CT, Hung CC, Chen YC, Ho YL, Wu MS, Chang SC. Effect of early dexamethasone on outcomes of COVID-19: A quasi-experimental study using propensity score matching. J Microbiol Immunol Infect 2024:S1684-1182(24)00039-2. [PMID: 38402071 DOI: 10.1016/j.jmii.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/15/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND The RECOVERY trial demonstrated that the use of dexamethasone is associated with a 36% lower 28-day mortality in hospitalized patients with COVID-19 on invasive mechanical ventilation. Nevertheless, the optimal timing to start dexamethasone remains uncertain. METHODS We conducted a quasi-experimental study at National Taiwan University Hospital (Taipei, Taiwan) using propensity score matching to simulate a randomized controlled trial to receive or not to receive early dexamethasone (6 mg/day) during the first 7 days following the onset of symptoms. Treatment was standard protocol-based, except for the timing to start dexamethasone, which was left to physicians' decision. The primary outcome is 28-day mortality. Secondary outcomes include secondary infection within 60 days and fulfilling the criteria of de-isolation within 20 days. RESULTS A total of 377 patients with COVID-19 were enrolled. Early dexamethasone did not decrease 28-day mortality in all patients (adjusted odds ratio [aOR], 1.03; 95% confidence interval [CI], 0.97-1.10) or in patients who required O2 for severe/critical disease at admission (aOR, 1.05; 95%CI, 0.94-1.18); but is associated with a 24% increase in superinfection in all patients (aOR, 1.24; 95% CI, 1.12-1.37) and a 23% increase in superinfection in patients of O2 for several/critical disease at admission (aOR, 1.23; 95% CI, 1.02-1.47). Moreover, early dexamethasone is associated with a 42% increase in likelihood of delayed clearance of SARS-CoV-2 virus (adjusted hazard ratio, 1.42; 95% CI, 1.01-1.98). CONCLUSION An early start of dexamethasone (within 7 days after the onset of symptoms) could be harmful to hospitalized patients with COVID-19.
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Affiliation(s)
- Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
| | - Ming-Chieh Shih
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
| | - Kai-Hsiang Chen
- Department of Internal Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan.
| | - Szu-Ting Huang
- Department of Internal Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan.
| | - Chun-Fu Huang
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
| | | | - Ming-Jui Tsai
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan.
| | - Po-Hsien Kuo
- Department of Internal Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan.
| | - Yi-Chen Yeh
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wan-Chen Tsai
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Mei-Yan Pan
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.
| | - Guei-Chi Li
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Yi-Jie Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Kuan-Yin Lin
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Yu-Shan Huang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Aristine Cheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Pao-Yu Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Sung-Ching Pan
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Shih-Chi Ku
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Sui-Yuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan; Department of Tropical Medicine and Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Yee-Chun Chen
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; School of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
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Xia B, Wang J, Zhang D, Hu X. Integration of basement membrane-related genes in a risk signature for prognosis in clear cell renal cell carcinoma. Sci Rep 2024; 14:3893. [PMID: 38365923 PMCID: PMC10873511 DOI: 10.1038/s41598-024-54073-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/08/2024] [Indexed: 02/18/2024] Open
Abstract
Clear cell renal cell carcinoma (ccRCC) is characterized by high heterogeneity and recurrence rates, posing significant challenges for stratification and treatment. Basement membrane-related genes (BMGs) play a crucial role in tumor initiation and progression. Clinical and transcriptomic data of ccRCC patients were extracted from TCGA and GEO databases. We employed univariate regression and LASSO-Cox stepwise regression analysis to construct a BMscore model based on BMGs expression level. A nomogram combining clinical features and BMscore was constructed to predict individual survival probabilities. Further enrichment analysis and immune-related analysis were conducted to explore the enriched pathways and immune features associated with BMGs. High-risk individuals predicted by BMscore exhibited poorer overall survival, which was consistent with the validation dataset. BMscore was identified as an independent risk factor for ccRCC. Functional analysis revealed that BMGs were related to cell-matrix and tumor-associated signaling pathways. Immune profiling suggests that BMGs play a key role in immune interactions and the tumor microenvironment. BMGs serve as a novel prognostic predictor for ccRCC and play a role in the immune microenvironment and treatment response. Targeting the BM may represent an alternative therapeutic approach for ccRCC.
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Affiliation(s)
- Bowen Xia
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Worker's Stadium, Chaoyang District, Beijing, 100020, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Jingwei Wang
- Department of Occupational Medicine and Toxicology, Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China
| | - Dongxu Zhang
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Worker's Stadium, Chaoyang District, Beijing, 100020, China
- Institute of Urology, Capital Medical University, Beijing, China
| | - Xiaopeng Hu
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Worker's Stadium, Chaoyang District, Beijing, 100020, China.
- Institute of Urology, Capital Medical University, Beijing, China.
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