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Background: The occurrence of systemic inflammatory response syndrome (SIRS) is an early alert for sepsis after flexible ureteroscopy (fURS). Once sepsis occurs, it often leads to severe or fatal consequences. We aimed to identify SIRS patients preoperatively by developing and validating a feasible prognostic nomogram model based on retrospective cohort analysis. Methods: A total of 311 patients who underwent fURS in Dongguan Kanghua Hospital (Dongguan, China) between 2016 and 2020 were included and randomly divided into a primary cohort (n=219) and validation cohort (n=92). Single factor regression analysis was used to identify the primary cohort's meaningful characters between SIRS and non-SIRS groups. Factors of the primary cohort were then identified by least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram was built to execute the subsequent analysis using these factors. Finally, we analyzed and drew the calibration curve, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) curve to validate the prognostic value of the nomogram in calibration and discrimination. Results: Review of the single regression analysis of characters in the primary cohort showed gender, stone burden, diabetes, neutrophil (N), lymphocyte (L), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocytes ratio (LMR), urine-WBC, nitrite (Nit), urine culture, and surgery time as significant factors between the SIRS and non-SIRS groups (P<0.05). The LASSO regression analysis suggested NLR, PLR, and urine culture were substantial factors in predicting SIRS postoperatively, lambda.min and lambda.1se (standard error, SE) were 0.01491 and 0.0796. A nomogram built with the three factors showed good calibration and discrimination, with the Brier values 0.064 and 0.034 and the area under curve (AUC) values 0.897 (95% CI: 0.837-0.957) and 0.976 (95% CI: 0.947-1.000) in the primary and validation cohort, respectively. DCA demonstrated the nomogram was clinically useful, and the predict probability of SIRS's occurrence was very close to the actual rate as the risk threshold increased by higher than 60% in clinical impact curve analysis. Conclusions: NLR, PLR, and urine culture were significantly related to the occurrence of SIRS's after fURS. The nomogram with these three factors showed excellent calibration, discrimination, and clinical usefulness.
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BACKGROUND: Abiraterone acetate, a CYP17 enzyme inhibitor, can block the synthesis of androgens in the adrenal gland, prostate, and testis. The purpose of this study was to investigate the efficacy and safety of abiraterone acetate in high-risk prostate cancer patients, including metastatic castration-resistant prostate cancer (mCRPC) and metastatic castration-sensitive prostate cancer (mCSPC). METHODS: A meta-analysis based on 6 randomized controlled trials (RCTs) was undertaken in compliance with the guidelines of systematic reviews and meta-analyses. Databases including PubMed, EMBASE, and Cochrane library were searched for relevant literature through to September 2019. RESULTS: The pooled analysis reported abiraterone acetate showed significant efficacy in high-risk prostate cancer patients, including overall survival (OS) [HR 0.66, 95% confidence interval (CI), 0.61-0.73, P<0.001], the time to prostate-specific antigen (PSA) progression (HR 0.45, 95% CI, 0.34-0.59, P<0.001), progression-free survival (PFS) (according to radiographic evidence) (HR 0.55, 95% CI, 0.45-0.68, P<0.001) and PSA response rate (RR 2.49, 95% CI, 1.47-4.22, P<0.001). A subgroup analysis was carried out due to the significant heterogeneity between the studies. The incidence of arthralgia (RR 1.19), hypokalemia (RR 2.47), cardiac disorder (RR 1.48), and hypertension (RR 1.57) in the abiraterone acetate group was moderately higher than the control group. CONCLUSIONS: The efficacy and safety of abiraterone acetate as an androgen receptor (AR) pathway targeted drug in high-risk prostate cancer patients was confirmed.
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BACKGROUND: The BAP1 mutation is commonly found kidney renal clear cell carcinoma (KIRC) and a potential biomarker of individualized therapy. We evaluated the clinical significance of BAP1 mutation in the prognosis and treatment therapies for KIRC. Potential key pathways and related genes associated with these mechanisms were also identified in this investigation. METHODS: We identified the relevant data of patients BAP1 mutated on the cBioPortal and the compounds with significant selectivity to BAP1 mutations on the Genomics of Drug Sensitivity in Cancer (GDSC). And then, we identified the differences in mRNA expression levels of biological function annotation and pathways between mutated and wild type BAP1 patients by GSEA analysis. Furthermore, we screened the differentially expressed genes (DEGs) between BAP1 mutated and wild typed in KIRC patients and performed the GO and KEGG analysis. Finally, we conducted a protein-protein interaction (PPI) network to investigate the interaction between proteins encoded by candidate DEGs. RESULTS: Review of the TCGA data revealed 41 patients (10%) with KIRC displayed the BAP1 mutation. Further analysis led to the identification of 730 DEGs, while 617 genes were shown to be down-regulated, with 113 genes displaying upregulation. GO and KEGG pathway analysis indicated DEGs as enriched in metabolism, drug metabolism-cytochrome P450, and Drug-metabolizing enzymes. Subsequently, the top 10 hub genes, ranked by the degree in the PPI network were identified. Furthermore, our findings verify that the BAP1 mutation was associated with the deterioration of prognosis in patients with KIRC. Additionally, analysis of the GDSC database revealed that KIRC patients with BPP1 mutation are more prone to responding to Linsitinib. CONCLUSIONS: Our investigation identified the main pathways and relevant genes related to the BAP1 mutation in KIRC, which can contribute to the development of targeted treatment strategies for enhanced prognostic predictions of KIRC.
