In Real Life, Low-Level HER2 Expression May Be Associated With Better Outcome in HER2-Negative Breast Cancer: A Study of the National Cancer Center, China

BackgroundTo characterize the clinical and pathological features and survival of patients with human epidermal growth factor receptor 2 (HER2)-low breast cancer in China.MethodsThe China National Cancer Center database was used to identify 1,433 metastatic breast cancer patients with HER2-negative disease diagnosed between 2005 and 2015. Clinicopathological features, survival, and prognosis information were extracted. Overall survival (OS) was estimated using the Kaplan–Meier method and compared using the log-rank test. Prognostic factors associated with OS were analyzed using Cox regression model with 95% confidence interval (95% CI).ResultsThere were 618 (43.1%) and 815 (56.9%) HER2-low and HER2-zero tumors out of 1,433 tumors, respectively. The proportion of hormone receptor (HR)-positive tumors was significantly higher in HER2-low tumors than in those with HER2-zero tumors (77.8% vs. 69.2%, p < 0.001). Patients with HER2-low tumors survived significantly longer than those with HER2-zero tumors in the overall population (48.5 months vs. 43.0 months, p = 0.004) and HR-positive subgroup (54.9 months vs. 48.1 months, p = 0.011), but not in the HR-negative subgroup (29.5 months vs. 29.9 months, p = 0.718). Multivariate regression analysis revealed that HER2-low tumors were independently associated with increased OS in HER2-negative population (HR: 0.85, 95% CI: 0.73–0.98, p = 0.026).ConclusionOur findings demonstrate that HER2-low tumors could be identified as a more distinct clinical entity from HER2-zero tumors, especially for the HR-positive subgroup. A more complex molecular landscape of HER2-low breast cancer might exist, and more precise diagnostic algorithms for HER2 testing could be investigated, thus offering new therapeutic targets for breast cancer treatment.

Quantitative Literacy and Reasoning of Freshman Students with Different Senior High School Academic Background Pursuing STEM-Related Programs

<p style="text-align: justify;">This paper investigates the quantitative literacy and reasoning (QLR) of freshmen students pursuing a Science, Technology, Engineering, and Mathematics (STEM)–related degree but do not necessarily have a Senior High School (SHS) STEM background. QLR is described as a multi-faceted skill focused on the application of Mathematics and Statistics rather than just a mere mastery of the content domains of these fields. This article compares the QLR performance between STEM and non-STEM SHS graduates. Further, this quantitative-correlational study involves 255 freshman students, of which 115 have non-STEM academic background from the SHS. Results reveal that students with a SHS STEM background had significantly higher QLR performance. Nevertheless, this difference does not cloud the fact that their overall QLR performance marks the lowest when compared to results of similar studies. This paper also shows whether achievement in SHS courses such as General Mathematics, and Statistics and Probability are significant predictors of QLR. Multivariate regression analysis discloses that achievement in the latter significantly relates to QLR. However, the low coefficient of determination (10.30%) suggests that achievement in these courses alone does not account to the students’ QLR. As supported by a deeper investigation of the students’ answers, it is concluded that QLR indeed involves complex processes and is more than just being proficient in Mathematics and Statistics.</p>

High Fibrinogen to Albumin Ratio: A Novel Marker for Risk of Stroke-Associated Pneumonia?

Background: Stroke-associated pneumonia (SAP) is associated with poor prognosis after acute ischemic stroke (AIS).Purpose: This study aimed to describe the parameters of coagulation function and evaluate the association between the fibrinogen-to-albumin ratio (FAR) and SAP in patients with AIS.Patients and methods: A total of 932 consecutive patients with AIS were included. Coagulation parameters were measured at admission. All patients were classified into two groups according to the optimal cutoff FAR point at which the sum of the specificity and sensitivity was highest. Propensity score matching (PSM) was performed to balance potential confounding factors. Univariate and multivariate logistic regression analyses were applied to identify predictors of SAP.Results: A total of 100 (10.7%) patients were diagnosed with SAP. The data showed that fibrinogen, FAR, and D-dimer, prothrombin time (PT), activated partial thromboplastin time (aPTT) were higher in patients with SAP, while albumin was much lower. Patients with SAP showed a significantly increased FAR when compared with non-SAP (P &lt; 0.001). Patients were assigned to groups of high FAR (≥0.0977) and low FAR (&lt;0.0977) based on the optimal cut-off value. Propensity score matching analysis further confirmed the association between FAR and SAP. After adjusting for confounding and risk factors, multivariate regression analysis showed that the high FAR (≥0.0977) was an independent variable predicting the occurrence of SAP (odds ratio =2.830, 95% CI = 1.654–4.840, P &lt; 0.001). In addition, the FAR was higher in the severe pneumonia group when it was assessed by pneumonia severity index (P = 0.008).Conclusions: High FAR is an independent potential risk factor of SAP, which can help clinicians identify high-risk patients with SAP after AIS.

Study on the Clinical Implications of NLR and PLR for Diagnosing Frailty in Maintenance Hemodialysis Patients and Their Correlations with Patient Prognosis

Objective. To explore the clinical implications of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) for diagnosing frailty in patients with maintenance hemodialysis (MHD) and their correlations with patient prognosis. Methods. A total of 185 patients with MHD admitted to the hemodialysis center of our hospital were selected, 72 of whom were diagnosed with frailty according to the Chinese version of Tilburg Frailty Indicator (TFI). The relevant data were collected, and the influencing factors of frailty in MHD patients were analyzed by one-way analysis of variance (ANOVA) and multivariate logistic regression. The value of NLR and PLR in diagnosing frailty in MHD patients was observed, and patients’ all-cause mortality was compared during the 3-year follow-up. The influences of different levels of NLR and PLR on the survival of MHD patients were investigated. Results. Multivariate regression analysis identified that serum albumin, dialysis adequacy, NLR, and PLR are independent risk factors for frailty in MHD patients ( P < 0.05 ). The area under the receiver operating characteristic (ROC) curve of NLR and PLR in diagnosing frailty in MHD patients was 0.859 and 0.799, respectively. Compared with the nonfrailty group, the 3-year mortality was higher, and the 3-year survival rate assessed by survival analysis was lower in the frailty group ( P < 0.05 ). Patients with high NLR and PLR levels showed a lower 3-year survival rate. Conclusions. Dialysis adequacy, serum albumin, NLR, and PLR are independently associated with frailty in MHD patients. NLR and PLR are of a certain diagnostic value for frailty in MHD patients. MHD patients with frailty have an unfavorable prognosis, as of those with high NLR and PLR levels.

Reactions to problems in marriage

Purpose: Violence within the family is a common problem that can be seen in almost most socio-economic groups, societies, all ages and all educational levels. This study was planned to investigate the behavior and attitudes and marital satisfaction levels of the spouses in the family life process.Methods: All citizens 18 years and older that are living in households in the Republic of Turkey have been included. Considering the existing population records, a stratified two-stage systematic cluster sampling method was applied. . Comparisons by the sex, educational level, and marital status satisfied were performed with the use of chi-square and multivariate regression analysis, correlation analysis. A p-value <0.05 was considered to be statistically significant.Result: Violent behaviors such as doing harm, breaking and hitting things were more intense in men. Aply physical violence was more common among males. Only maintaining silence, getting angry or sulking was statistically significant in women (p <0.000). Yelling, scolding, humiliating, separating the bedroom and decreasing spending money was statistically significant in males (p <0.000).Conclusion: All concepts related to marriage should be well defined because spouse satisfaction and conflicts can have different meanings. It suggests that raising awareness about domestic violence against women, knowing solution methods, informing about their rights and increasing social support may be beneficial in solving the problem.

Modeling of Supercritical Co2 Shell-and-Tube Heat Exchangers Under Extreme Conditions. Part 1: Correlation Development

High-temperature supercritical CO2 Brayton cycles are promising possibilities for future stationary power generation and hybrid electric propulsion applications. Heat exchangers are critical components in supercritical CO2 thermal cycles and require accurate correlations and comprehensive performance modeling under extreme temperatures and pressures. In this paper (part I), new Colburn and friction factor correlations are developed to quantify shell-side heat transfer and friction characteristics of flow within heat exchangers in the shell-and-tube configuration. Using experimental and CFD data sets from existing literature, multivariate regression analysis is conducted to achieve correlations that capture the effect of multiple critical geometric parameters. These correlations offer superior accuracy and versatility as compared to previous studies and predict the thermohydraulic performance of about 90% of the existing experimental and CFD data within ±15%. Supplementary thermohydraulic performance data is acquired from CFD simulations with sCO2 as working fluid to validate the developed correlations and demonstrate its capability to be applied to sCO2 heat exchangers.

Cervical Myelopathy Caused by Non-Rheumatic Retro-Odontoid Pseudotumor: An Investigation of Underlying Mechanisms and Optimal Surgical Strategy

Study Design Retrospective case-control study. Objective This study aimed to identify the underlying pathologies of non-rheumatic retro-odontoid pseudotumors (NRPs), which would help establish an appropriate surgical strategy for myelopathy caused by NRP. Methods We identified 35 patients with myelopathy caused by NRP who underwent surgery between 2006 and 2017. An age- and sex-matched control group of 70 subjects was selected from patients with degenerative cervical myelopathy. Radiographic risk factors for NRP were compared between cases and controls. We also assessed surgical outcomes following occipital-cervical (O-C) fusion, atlantoaxial (C1-2) fusion, or C1 laminectomy. Results Patients with NRP had significantly lower C1 sagittal inner diameter, C2-7 range of motion (ROM), C2-7 Cobb angle, and C7 tilt, as well as significantly higher C1-2 ROM, atlantodental interval (ADI), and C1-2 to O-C7 ROM ratio. Multivariate regression analysis revealed that ADI, C2-7 ROM, and C7 tilt were independent risk factors for NRP. Neurological recovery and pseudotumor size reduction were comparable among surgical procedures, whereas post-operative cervical spine function was significantly lower in the O-C fusion group than in the other groups. Conclusion Non-rheumatic retro-odontoid pseudotumor was associated with an increase in ADI, suggesting that spinal arthrodesis surgery is a reasonable strategy for NRP. C1-2 fusion is preferable over O-C fusion because of the high prevalence of ankylosis in the subaxial cervical spine. Given that 29% of patients with NRP have C1 hypoplasia, such cases can be treated by posterior decompression alone. Our study highlights the need to select appropriate surgical procedures based on the underlying pathology in each case.

Can open-defecation free (ODF) communities be sustained? A cross-sectional study in rural Ghana

Community-led total sanitation (CLTS) is a widely used approach to reduce open defecation in rural areas of low-income countries. Following CLTS programs, communities are designated as open defecation free (ODF) when household-level toilet coverage reaches the threshold specified by national guidelines (e.g., 80% in Ghana). However, because sanitation conditions are rarely monitored after communities are declared ODF, the ability of CLTS to generate lasting reductions in open defecation is poorly understood. In this study, we examined the extent to which levels of toilet ownership and use were sustained in 109 communities in rural Northern Ghana up to two and a half years after they had obtained ODF status. We found that the majority of communities (75%) did not meet Ghana’s ODF requirements. Over a third of households had either never owned (16%) or no longer owned (24%) a functional toilet, and 25% reported practicing open defecation regularly. Toilet pit and superstructure collapse were the primary causes of reversion to open defecation. Multivariate regression analysis indicated that communities had higher toilet coverage when they were located further from major roads, were not located on rocky soil, reported having a system of fines to punish open defecation, and when less time had elapsed since ODF status achievement. Households were more likely to own a functional toilet if they were larger, wealthier, had a male household head who had not completed primary education, had no children under the age of five, and benefitted from the national Livelihood Empowerment Against Poverty (LEAP) program. Wealthier households were also more likely to use a toilet for defecation and to rebuild their toilet when it collapsed. Our findings suggest that interventions that address toilet collapse and the difficulty of rebuilding, particularly among the poorest and most vulnerable households, will improve the longevity of CLTS-driven sanitation improvements in rural Ghana.

Clinical significance of controlling nutritional status score (CONUT) in evaluating outcome of postoperative patients with gastric cancer

The stomach is the main digestive organ in humans. Patients with gastric cancer often develop digestive problems, which result in poor nutrition. Nutritional status is closely related to postoperative complications and quality of life (QoL) in patients with gastric cancer. The controlling nutritional status (CONUT) score is a novel tool to evaluate the nutritional status of patients. However, the relationship of the CONUT score with postoperative complications, QoL, and psychological status in patients with gastric cancer has not been investigated. The present follow-up study was conducted in 106 patients who underwent radical gastrectomy in our hospital between 2014 and 2019. The CONUT score, postoperative complications, psychological status, postoperative QoL scores, and overall survival (OS) of patients with gastric cancer were collected, and the relationship between them was analyzed. A significant correlation was observed between the CONUT score and postoperative complications of gastric cancer (P < 0.001), especially anastomotic leakage (P = 0.037). The multivariate regression analysis exhibited that the CONUT score (P = 0.002) is an independent risk factor for postoperative complications. The CONUT score was correlated with the state anxiety questionnaire (S-AI) for evaluating psychological status (P = 0.032). However, further regression analysis exhibited that the CONUT score was not an independent risk factor for psychological status. Additionally, the CONUT score was associated with postoperative QoL. The multivariate regression analysis exhibited that the CONUT score was an independent risk factor for the global QoL (P = 0.048). Moreover, the efficiency of CONUT score, prognostic nutrition index, and serum albumin in evaluating complications, psychological status, and QoL was compared, and CONUT score was found to outperform the other measures (Area Under Curve, AUC = 0.7368). Furthermore, patients with high CONUT scores exhibited shorter OS than patients with low CONUT scores (P = 0.005). Additionally, the postoperative complications (HR 0.43, 95% CI 0.21–0.92, P = 0.028), pathological stage (HR 2.26, 95% CI 1.26–4.06, P = 0.006), and global QoL (HR 15.24, 95% CI 3.22–72.06, P = 0.001) were associated with OS. The CONUT score can be used to assess the nutritional status of patients undergoing gastric cancer surgery and is associated with the incidence of postoperative complications and QoL.

Reactions to problems in marriage

Purpose: Violence within the family is a common problem that can be seen in almost most socio-economic groups, societies, all ages and all educational levels. This study was planned to investigate the behavior and attitudes and marital satisfaction levels of the spouses in the family life process.Methods: All citizens 18 years and older that are living in households in the Republic of Turkey have been included. Considering the existing population records, a stratified two-stage systematic cluster sampling method was applied. . Comparisons by the sex, educational level, and marital status satisfied were performed with the use of chi-square and multivariate regression analysis, correlation analysis. A p-value <0.05 was considered to be statistically significant.Result: Violent behaviors such as doing harm, breaking and hitting things were more intense in men. Physical violence was more common among males. Only maintaining silence, getting angry or sulking was statistically significant in women (p <0.000). Yelling, scolding, humiliating, separating the bedroom and decreasing spending money was statistically significant in males (p <0.000).Conclusion: All concepts related to marriage should be well defined because spouse satisfaction and conflicts can have different meanings. It suggests that raising awareness about domestic violence against women, knowing solution methods, informing about their rights and increasing social support may be beneficial in solving the problem.