Mathematical Modelling For assessing the Impact of Intervention Strategies On HIV/AIDS High Risk Group Population Dynamics

Background: Despite steady improvements in cardiac surgery-related outcomes, our understanding of the physiologic mechanisms leading to perioperative mortality remains incomplete. Intraoperative hypotension is an important risk factor for mortality after noncardiac surgery but remains relatively unexplored in the context of cardiac surgery. We examined whether the association between intraoperative hypotension and in-hospital mortality varied by patient and procedure characteristics, as defined by the validated Cardiac Anesthesia Risk Evaluation (CARE) mortality risk score. Methods: We conducted a retrospective cohort study of consecutive adult patients who underwent cardiac surgery requiring cardiopulmonary bypass (CPB) from November 2009–March 2015. Those who underwent off-pump, thoracic aorta, transplant and ventricular assist device procedures were excluded. The primary outcome was in-hospital mortality. Hypotension was categorized by mean arterial pressure (MAP) of <55 and between 55–64 mmHg before, during and after CPB. The relationship between hypotension and death was modeled using multivariable logistic regression in the intermediate and high-risk groups. Results: Among 6627 included patients, 131 (2%) died in-hospital. In-hospital mortality in patients with CARE scores of 1, 2, 3, 4 and 5 was 0 (0%), 7 (0.3%), 35 (1.3%), 41 (4.6%) and 48 (13.6%), respectively. In the intermediate-risk group (CARE = 3–4), MAP < 65 mmHg post-CPB was associated with increased odds of death in a dose-dependent fashion (adjusted OR 1.30, 95% CI 1.13–1.49, per 10 min exposure to MAP < 55 mmHg, p = 0.002; adjusted OR 1.18 [1.07–1.30] per 10 min exposure to MAP 55–64 mmHg, p = 0.001). We did not observe an association between hypotension and mortality in the high-risk group (CARE = 5). Conclusions: Post-CPB hypotension is a potentially modifiable risk factor for mortality in intermediate-risk patients. Our findings provide impetus for clinical trials to determine if hemodynamic goal-directed therapies could improve survival in these patients.

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Identification of Novel Tumor Microenvironment-Related Long Non-coding RNAs to Predict the Prognosis for Hepatocellular Carcinoma

10.21203/rs.3.rs-877901/v1 ◽

2021 ◽

Author(s):

Shenglan Huang ◽

Jian Zhang ◽

Dan Li ◽

Xiaolan Lai ◽

Lingling Zhuang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

High Risk ◽

Tumor Microenvironment ◽

Cox Regression ◽

Risk Group ◽

High Risk Group ◽

Low Risk ◽

Clinicopathological Parameters ◽

Kaplan Meier ◽

The Impact

Abstract Introduction: Hepatocellular carcinoma (HCC) is one of the most common malignant tumors with poor prognosis. Tumor microenvironment (TME) plays a vital role in the tumor progression of HCC. Thus, we aimed to analyze the association of TME with HCC prognosis, and construct an TME-related lncRNAs signature for predicting the prognosis of HCC patients.Methods: We firstly assessed the stromal/immune /Estimate scores within the HCC microenvironment using the ESTIMATE algorithm based on TCGA database, and its associations with survival and clinicopathological parameters were also analyzed. Then, different expression lncRNAs were filtered out according to immune/stromal scores. Cox regression was performed to built an TME-related lncRNAs risk signature. Kaplan–Meier analysis was carried out to explored the prognostic values of the risk signature. Furthermore, we explored the biological functions and immune microenvironment feathers in high- and low risk groups. Lastly, we probed the association of the risk signature with the treatment responses to immune checkpoint inhibitors (ICIs) in HCC by comparing the immunophenoscore (IPS).Results: Stromal/immune /Estimate scores of HCC patients were obtained based on the ESTIMATE algorithm. The Kaplan-Meier curve analysis showed the high stromal/immune/ Estimate scores were significantly associated with better prognosis of the HCC patients. Then, six TME-related lncRNAs were screened for constructing the prognosis model. Kaplan-Meier survival curves suggested that HCC patients in high-risk group had worse prognosis than those with low-risk. ROC curve and Cox regression analyses demonstrated the signature could predict HCC survival exactly and independently. Function enrichment analysis revealed that some tumor- and immune-related pathways associated with HCC tumorigenesis and progression might be activated in high-risk group. We also discovered that some immune cells, which were beneficial to enhance immune responses towards cancer, were remarkably upregulated in low-risk group. Besides, there was closely correlation of immune checkmate inhibitors (ICIs) with the risk signature and the signature can be used to predict treatment response of ICIs.Conclusions: We analyzed the impact of the tumor microenvironment scores on the prognosis of patients with HCC. A novel TME-related prognostic risk signature was established, which may improve prognostic predictive accuracy and guide individualized immunotherapy for HCC patients.

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Obesity and menopause modify the epigenomic profile of breast cancer

Endocrine Related Cancer ◽

10.1530/erc-16-0565 ◽

2017 ◽

pp. 351-363 ◽

Cited By ~ 16

Author(s):

Ana B Crujeiras ◽

Angel Diaz-Lagares ◽

Olafur A Stefansson ◽

Manuel Macias-Gonzalez ◽

Juan Sandoval ◽

...

Keyword(s):

Breast Cancer ◽

Dna Methylation ◽

High Risk ◽

Risk Group ◽

Menopausal Status ◽

Breast Tumors ◽

Methylation Pattern ◽

High Risk Group ◽

Cpg Sites ◽

The Impact

Obesity is a high risk factor for breast cancer. This relationship could be marked by a specific methylome. The current work was aimed to explore the impact of obesity and menopausal status on variation in breast cancer methylomes. Data from Infinium 450K array-based methylomes of 64 breast tumors were coupled with information on BMI and menopausal status. Additionally, DNA methylation results were validated in 18 non-tumor and 81 tumor breast samples. Breast tumors arising in either pre- or postmenopausal women stratified by BMI or menopausal status alone were not associated with a specific DNA methylation pattern. Intriguingly, the DNA methylation pattern identified in association with the high-risk group (postmenopausal women with high BMI (>25) and premenopausal women with normal or low BMI < 25) exclusively characterized by hypermethylation of 1287 CpG sites as compared with the low-risk group. These CpG sites included the promoter region of fourteen protein-coding genes of which CpG methylation over the ZNF577 promoter region represents the top scoring associated event. In an independent cohort, the ZNF577 promoter methylation remained statistically significant in association with the high-risk group. Additionally, the impact of ZNF577 promoter methylation on mRNA expression levels was demonstrated in breast cancer cell lines after treatment with a demethylating agent (5-azacytidine). In conclusion, the epigenome of breast tumors is affected by a complex interaction between BMI and menopausal status. The ZNF577 methylation quantification is clearly relevant for the development of novel biomarkers of precision therapy in breast cancer.

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Layanan Informasi melalui Voluntary Counseling and Testing pada Kelompok Resiko Tinggi (Analisis Bimbingan Konseling Islam)

KONSELING EDUKASI Journal of Guidance and Counseling ◽

10.21043/konseling.v5i1.9758 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Anis Lud Fiana ◽

Amrizarois Ismail ◽

Sri Maullasari ◽

Isa Aulia Rohman

Keyword(s):

High Risk ◽

Risk Group ◽

Information Service ◽

Risk Groups ◽

High Risk Group ◽

Information Services ◽

Voluntary Counseling ◽

Voluntary Counseling And Testing ◽

Counseling And Testing ◽

Hiv Aids

Information Services through Voluntary Counseling and Testingfor High-Risk Groups (Islamic Counseling Guidance Analysis). Information services allow clients to receive and understand various information in various fields such as education, social, health, and others. The counseling program in the information service Voluntary Counseling and Testing (VCT) aims to provide knowledge about maintaining health to reduce the spread of HIV/AIDS. Anyone can experience cases of contracting the HIV/AIDS virus, one of which is the high-risk group for sex men (MSM), transgender (TG), and people who inject drugs (PWID). This study aims to provide an analysis of the implementation of information services through VCT in the prevention of HIV/AIDS transmission in high-risk groups. The design of this study used a descriptive qualitative method by taking samples from assisted groups in PKBI Semarang City. Information services in VCT contain the knowledge of HIV/AIDS transmission and prevention. This study shows the effectiveness of information services provided by officers in the VCT process in preventing transmission of HIV/AIDS in the high-risk group to be analyzed using the Islamic counseling guidance model.Keywords: Information Services, Voluntary Counseling, and Testing, HIV AIDS, High-Risk Groups

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ANALISIS KADAR KREATININ PADA ANAK DENGAN LEUKEMIA LIMFOBLASTIK AKUT DI PUSAT KANKER ANAK ESTELLA BLU RSUP PROF DR RD KANDOU

e-CliniC ◽

10.35790/ecl.2.1.2014.3662 ◽

2014 ◽

Vol 2 (1) ◽

Author(s):

Fajrul Falakh Tamsil

Keyword(s):

Acute Lymphoblastic Leukemia ◽

High Risk ◽

Risk Group ◽

Lymphoblastic Leukemia ◽

High Risk Group ◽

Good Effect ◽

Result Show ◽

The Impact ◽

Standard Risk ◽

Common Malignancy

Abstract: Malignant disease in children is one cause of death in the age group of children. Characteristic of the spread and prognosis of malignancy in children is very different with malignancy in adult. Acute Lymphoblastic Leukemia is the most common malignancy in children. Treatment with chemotherapy gifts a good effect in recent years, characterized by a decrease in mortality. How ever, as a vital organ that has function to stabilizer and organ disposal of substances that are not useful and toxic, surely chemotherapy effect on the health of kidney function. The impact of chemotherapy on renal function can be determined by examination of creatinne levels in children undergoing chemotherapy. The purpose of this study is to determine the levels of creatinine in children with acute lymphoblastic leukemia undergoing therapy in Estella Room BLU RSUP Prof Dr RD Kandou Manado. Characteristic of this study is descriptive analytic with retrospectional approach, this case done by taking patient’s medical record data from September 2012-2013. Samples were 30. Conclusion:The result obtained from 30 samples contain as many as 16 samples had normal creatinine levels, and 14 samples had not normal creatinine levels, which consisted of 15 samples with a high risk group, an 15 sample with standard risk group. Bivariat analysis result show the value of P=0.642. From this result, it can be concluded that there is no differences between creatinine levels in children with high risk group and children with standard risk group. Keywords: Acute Lymphoblastic Leukemia, Creatinine, Child Abstrak:Penyakit keganasan pada anak merupakan salah satu penyebab utama kematian pada kelompok umur anak.Kanker pada anak sangat berbeda dengan keganasan pada orang dewasa dalam sifat, penyebaran dan prognosis.Leukimia Limfoblastik Akut merupakan keganasan yang paling sering terjadi pada anak.Penanganan dengan kemoterapi memberikan efek yang baik dalam beberapa tahun terakhir, ditandai dengan penurunan angka mortalitas.Namun sebagai organ vital yang memiliki fungsi sebagai pengatur keseimbangan dan organ pembuangan zat-zat yang tidak berguna serta bersifat toksik, tentunya kemoterapi memberikan efek terhadap kesehatan fungsi ginjal. Dampak kemoterapi terhadap fungsi ginjal dapat diketahui dengan pemeriksaan kadar kreatinin pada anak yang menjalani kemoterapi. Tujuan penelitian ini untuk mengetahui kadar kreatinin pada anak dengan leukemia limfoblastik akut yang menjalani terapi di Ruang Estella BLU RSUP Prof. DR. R.D Kandou.Penelitian ini bersifat deskriptif analitik dengan pendekatan retrospektional, dalam hal ini dilakukan dengan pengambilan data rekam medik pasien sejak September 2012-2013. Sampel berjumlah 30 orang. Simpulan : Hasilyang didapatkan dari 30 orang sampel, terdapat sebanyak 16 sampel yang memiliki kadar kreatinin yang normal, dan 14 sampel yang memiliki kadar kreatinin yang tidak normal, yang terdiri dari 15 sampel dengan kelompok resiko tinggi(High Risk), dan 15 sampel dengan kelompok resiko standar (Standard Risk). Hasil analisis bivariat menunjukkan nilai p=0,642. Dari hasil penelitian ini dapat disimpulkan bahwa tidak adaperbedaan kadar kreatinin pada anak kelompok resiko tinggi (High Risk) LLA, dengan resiko standard (Standard Risk) LLA Kata Kunci: Leukemia Limfoblastik Akut, Kadar Kreatinin, Anak.

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Impact of Protocol-Based Guidelines on the Management and Outcome of Acute Upper Gastrointestinal Hemorrhage in a District General Hospital

Canadian Journal of Gastroenterology ◽

10.1155/2003/720313 ◽

2003 ◽

Vol 17 (2) ◽

pp. 97-100 ◽

Cited By ~ 4

Author(s):

RM Anwar ◽

A Dhanji ◽

A Fish ◽

S Singh

Keyword(s):

High Risk ◽

Risk Group ◽

District General Hospital ◽

Endoscopic Examination ◽

High Risk Group ◽

Second Phase ◽

Upper Gi ◽

Risk Scoring ◽

The Impact ◽

Upper Gastrointestinal

A prospective audit of acute upper gastrointestinal (GI) hemorrhage was conducted between January and September 2000 at Frimley Park Hospital to determine the impact of introducing an upper GI bleeding protocol based on Rockall’s initial risk scoring system. Fifty-seven patients and 52 patients were in the pre- and postprotocol phases of the study respectively. Fifty per cent (28) of the patients in the first phase and 40% (21) of the patients in the second phase belonged to the high risk group. In the preprotocol phase, endoscopy was performed in 86% (49) of cases with 60% of patients having an esophogastroduodenoscopy within 24 h. Thirty-three per cent of the high risk group failed to have an endoscopic examination within 24 h. Only two of 57 patients required surgery and the mortality was 14%. In the postprotocol phase, endoscopy was performed in 79% (42) of patients and 68% (36) patients had endoscopy within 24 h. Only four of 21 patients belonging to the high risk group had their endoscopy after 24 h of the admission. Patients were better monitored and mortality was reduced to 7.5%. Reduction of mortality from upper GI hemorrhage followed the introduction of an agreed protocol based on risk scoring.

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CARD-Associated Risk Score Features the Immune Landscape and Predicts the Responsiveness to Anti-PD-1 Therapy in IDH Wild-Type Gliomas

Frontiers in Cell and Developmental Biology ◽

10.3389/fcell.2021.653240 ◽

2021 ◽

Vol 9 ◽

Author(s):

Depei Li ◽

Wanming Hu ◽

Xiaoping Lin ◽

Ji Zhang ◽

Zhenqiang He ◽

...

Keyword(s):

High Risk ◽

Risk Score ◽

Risk Group ◽

Penalized Regression ◽

High Risk Group ◽

Low Risk ◽

Wild Type ◽

Immune Microenvironment ◽

Molecular Features ◽

The Impact

BackgroundProteins containing the caspase recruitment domain (CARD) play critical roles in cell apoptosis and immunity. However, the impact of CARD genes in tumor immune cell infiltration, responsiveness to checkpoint immunotherapy, and clinical outcomes of gliomas remains unclear. Here, we explore using CARD genes to depict the immune microenvironment and predict the responsiveness of gliomas to anti-PD-1 therapy.MethodsThe genome and transcriptome data of 231 patients with isocitrate dehydrogenase wild-type (IDH-wt) gliomas were retrieved from The Cancer Genome Atlas (TCGA) database to screen CARD genes associated with T lymphocyte infiltration in gliomas. Weighted co-expression network and LASSO penalized regression were employed to generate a CARD-associated risk score (CARS). Two independent and publicly available datasets were used to validate the effectiveness of CARS.ResultsThe CARS divided the 231 glioma patients into high- and low-risk subgroups with distinct immune microenvironment and molecular features. The high-risk group had high CARS and was characterized by enrichment of dysfunctional T lymphocytes in a profound immunosuppressive microenvironment, whereas the low-risk group had low CARS and exhibited an immune exclusion genotype. Moreover, signaling aberrations including upregulation of PI3K/Akt/mTOR, NF-κB, and TGF-β were found in the high-risk group. In contrast, the activated WNT pathway was more evident in the low-risk group. Furthermore, we found that an elevated CARS indicated a decreased overall survival for IDH-wt gliomas under standard care but a clinical benefit from checkpoint immunotherapy.ConclusionThis study developed an immune- and prognosis-relevant risk score, which could be used to enhance our understanding of the heterogeneity of immune microenvironment of gliomas and facilitate to identify patients who will benefit from checkpoint immunotherapy.

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A nomogram for predicting post-operative cancer specific survival in AJCC 8th edition stage I NSCLC patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.8540 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 8540-8540

Author(s):

Wenhua Liang ◽

Yuan Zeng ◽

Jianxing He

Keyword(s):

High Risk ◽

Risk Group ◽

Staging System ◽

High Risk Group ◽

Stage I ◽

Cancer Specific Survival ◽

Stage Ib ◽

Resected Nsclc ◽

The Impact ◽

Current Stage

8540 Background: The AJCC 8th edition staging system has moved 4-5 cm 7th edition stage Ib NSCLC to current stage IIa, thus theoretically all current stage I patients are not considered candidates for adjuvant therapy (ad-Tx). This study was to develop a clinical nomogram for predicting cancer specific survival (CSS) of the current stage I resected NSCLC to identify those with higher risk for cancer-related deaths and potentially benefiting from ad-Tx. Methods: NSCLC cases between 1998 and 2013 was extracted from the SEER database and were randomly divided into training (n = 23,496) and validation (n = 7,915) cohorts. We identified and integrated the recurrence-associated factors to build a nomogram. The model was subjected to bootstrap internal validation and independent validation. The predictive accuracy and discriminative ability were illustrated by calibration plots and concordance index (C-index). We determined the cut-off for high-risk group by matching the nomogram-predicted 5-year CSS with that of the current 4-5 cm stage IIa cases. Results: In multivariate analysis, independent factors for CSS were examined lymph node count ( < 16 vs. > = 16), tumor size, resection scope (lobectomy/segmentectomy/wedge resection), differentiation grade, histology (squamous vs. non-squamous vs. former BAC with majority being AIS/MIA) and visceral pleural invasion, which were then integrated into the model (sex and age were not included due to lack of direction to ad-Tx selection). The calibration curves showed excellent agreement between nomogram prediction and actual observation. The C-index of the nomogram was higher than that of staging system (Ia1, Ia2, Ia3, Ib) (training set, 0.60 vs. 0.56, P < 0.01; validation set, 0.60 vs. 0.57, P < 0.01). Specifically, 21.5% stage Ib patients (8.8% of all stage I) were categorized into high risk group (score > 29.5) and had inferior CSS compared with 4-5 cm stage IIa patients. Conclusions: We established a nomogram that can individually predict CSS for 8th edition stage I NSCLC. By this model, we identified a subset of patients with relatively high risk for recurrence. Further study to determine the impact of postoperative ad-Tx on these high risk patients is undergoing.

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The impact of acetylsalicylic acid dosed at bedtime on circadian rhythms of blood pressure in the high-risk group of cardiovascular patients—a randomized, controlled trial

European Journal of Clinical Pharmacology ◽

10.1007/s00228-020-02997-8 ◽

2020 ◽

Vol 77 (1) ◽

pp. 35-43

Author(s):

Beata Krasińska ◽

Lech Paluszkiewicz ◽

Ewa Miciak-Ławicka ◽

Maciej Krasinski ◽

Piotr Rzymski ◽

...

Keyword(s):

Blood Pressure ◽

Coronary Heart Disease ◽

Heart Disease ◽

High Risk ◽

Arterial Hypertension ◽

Risk Group ◽

High Risk Group ◽

Control Group ◽

Cardiovascular Patients ◽

The Impact

Abstract Purpose Time of drug administration may significantly influence its effect. The aim of the present study was to investigate the effect of ASA (administrated in the morning or in the evening) on the anti-hypertensive effect and diurnal blood pressure profile in the high-risk group of cardiovascular patients. Methods All patients (n = 114) had been diagnosed with coronary heart disease and arterial hypertension prior to the enrolment and had been treated with 75 mg per day of ASA in the morning. The patients were randomly assigned to one of the two study groups receiving 75 mg of ASA per day in a single antiplatelet therapy for 3 months in the morning (n = 58) or in the evening (n = 56). The control group (n = 61) consisted of patients with arterial hypertension but without coronary heart disease, not receiving ASA. In all the patients, during each visit, clinical blood pressure (BP) and ambulatory blood pressure measurements (ABPM) were performed. Results There was a significant reduction in 24-h BP and blood pressure at night in the ASA group evening group compared with the ASA morning group and the control group. Conclusions The present study demonstrated that compared with the use of ASA in the morning, its administration in the evening may lead to favourable drop in the ABPM and an improvement of the diurnal profile in the high-risk group of cardiovascular patients who are not naïve to ASA.

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Knowledge of Pregnant Women regarding HIV/AIDS

Journal of Chitwan Medical College ◽

10.3126/jcmc.v3i3.8632 ◽

2013 ◽

Vol 3 (3) ◽

pp. 18-21 ◽

Cited By ~ 1

Author(s):

N Pandey

Keyword(s):

High Risk ◽

Pregnant Women ◽

Risk Group ◽

Antenatal Clinic ◽

Structured Interview ◽

High Risk Group ◽

People Living With Hiv ◽

Sources Of Information ◽

The Relationship ◽

Hiv Aids

A descriptive study was conducted with the purpose of assessing the knowledge of HIV/AIDS among the pregnant women in antenatal clinic of Bir Hospital, Kathmandu. Sixty pregnant women were selected using non- probability purposive sampling technique. A pretested Nepali version semi-structured interview schedule was used to collect the data from them. Ethical consideration was maintained throughout the study. The obtained data was analyzed using descriptive statistics. The data are presented in different tables. Findings related to socio-demographic characteristics revealed that half (50%) percent of the respondents belonged to the age of 20-24years. Majority (88.3%) of the respondents were literate and (85%) of them belonged to Hindu religion. Findings showed that (90%) of respondents have heard about HIV/AIDS. The most common sources of information of HIV/AIDS were Television (77.8%), Radio (75%) and newspapers (66.7%). Regarding transmission of HIV/AIDS, majority (88.9%) knew that HIV/AIDS is transmitted from sexual contact with infected person (81.5%) knew from infected blood transfusion and (70.4%) said from infected mother to child. More than (80%) of respondents said that commercial sex worker and having multiple sex workers were the high risk group for HIV/AIDS. Majority (77.8%) said by avoiding multiple sex partners and (72.2%) being faithful to the partner was the preventive measures of HIV/AIDS. Majority (61%) of respondents did not know the relationship between STI and HIV/AIDS. Majority (68.5%) of respondents did not know that there is available of drugs which lengthen the living years of life of people living with HIV/AIDS. Majority 51(98.1%) knew the use of condom is to prevent pregnancy, 44(84.6%) said prevent HIV/AIDS, 29(55.8%) said control STI. Although majority of the respondents had knowledge regarding the high risk group, mode of transmission and prevention of HIV/AIDS, some lacking areas has been identified that majority of the respondents were not aware about the the relationship between STI and HIV/AIDS. They also lacked awareness that use of condom controls STI and about availability of drug which prevents progression of HIV infection. On the basis of finding, it is concluded that health education and awareness programme should be planned to women attending the antenatal clinic to enhance their knowledge on HIV/AIDS prevention and management. DOI: http://dx.doi.org/10.3126/jcmc.v3i3.8632 Journal of Chitwan Medical College 2013; 3(3): 18-21

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