Prognostic nomograms for predicting long-term overall survival in spindle cell melanoma: a population-based study.

Background: There are few research findings on the survival prognosis of spindle cell melanoma (SCM), which is an unusual kind of melanoma. The purpose of this study was to develop a thorough nomogram for predicting the overall survival (OS) of patients with SCM and to assess its validity by comparing it with the conventional American Joint Committee on Cancer (AJCC) staging system. Methods: The Surveillance, Epidemiology, and End Results database was searched, and 2,015 patients with SCM were selected for the analysis. The patients were randomly divided into training (n = 1,410) and validation (n = 605) cohorts by using R software. Multivariate Cox regression was performed to identify predictive factors. A nomogram was established based on these characteristics to predict OS in SCM. The calibration curve, concordance index (C-index), area under the receiver operating characteristic curve, and decision-curve analysis were utilized to assess the accuracy and reliability of the model. The net reclassification improvement and integrated discrimination improvement were also applied in this model to evaluate its differences with the AJCC model. Results: The developed nomogram suggests that race, AJCC stage, chemotherapy status, regional node examination status, marital status, and sex have the greatest effects on OS in SCM. The nomogram had a higher C-index than the AJCC staging system (0.751 versus 0.633 in the training cohort and 0.747 versus 0.650 in the validation cohort). Calibration plots illustrated that the model was capable of being calibrated. These criteria demonstrated that the nomogram outperforms the AJCC staging system alone. Conclusion: The nomogram developed in this study is sufficiently reliable for forecasting the risk and prognosis of SCM, which may facilitate personalized treatment recommendations in upcoming clinical trials.

Angiotensin 1-7 Protects against Angiotensin II-Induced Endoplasmic Reticulum Stress and Endothelial Dysfunction via Mas Receptor.

Angiotensin 1-7 (Ang 1-7) counter-regulates the cardiovascular actions of angiotensin II (Ang II). The present study investigated the protective effect of Ang 1-7 against Ang II-induced endoplasmic reticulum (ER) stress and endothelial dysfunction. Ex vivo treatment with Ang II (0.5 µM, 24 hours) impaired endothelium-dependent relaxation in mouse aortas; this harmful effect of Ang II was reversed by co-treatment with ER stress inhibitors, l4-phenylbutyric acid (PBA) and tauroursodeoxycholic acid (TUDCA) as well as Ang 1-7. The Mas receptor antagonist, A779, antagonized the effect of Ang 1-7. The elevated mRNA expression of CHOP, Grp78 and ATF4 or protein expression of p-eIF2α and ATF6 (ER stress markers) in Ang II-treated human umbilical vein endothelial cells (HUVECs) and mouse aortas were blunted by co-treatment with Ang 1-7 and the latter effect was reversed by A779. Furthermore, Ang II-induced reduction in both eNOS phosphorylation and NO production was inhibited by Ang 1-7. In addition, Ang 1-7 decreased the levels of ER stress markers and augmented NO production in HUVECs treated with ER stress inducer, tunicamycin. The present study provides new evidence for functional antagonism between the two arms of the renin-angiotensin system in endothelial cells by demonstrating that Ang 1-7 ameliorates Ang II-stimulated ER stress to raise NO bioavailability, and subsequently preserves endothelial function.

A virtual psychiatric ward for orientating patients admitted for the first time.

Misconceptions about psychiatric wards frequently cause newly admitted mental patients to stay away from these wards despite their need for treatment. Although ward orientation is typically conducted by nurses in an attempt to help patients to adapt to the new environment, it is considered time-consuming, and the method of orientation and the explanations given may vary among different nurses. This situation calls for a more effective and standardized approach to orientating mental patients on their first admission. To this end, a computer-based interactive virtual environment was developed based on a real psychiatric ward by using virtual reality (VR) technologies. It enables the patient to navigate around to gain understanding about the ward through a virtual guided tour. The effectiveness of this VR orientation approach was investigated by a randomized controlled trial with consecutive sampling. Fifty-four Chinese participants were randomly assigned to undergo ward orientation by either using the VR-based approach or reading text-based electronic information sheets about the ward with a computer. Subjective and objective measures were obtained respectively using the Chinese version of the State-Trait Anxiety Inventory questionnaire and the heart-rate variability measurement before and after the intervention. In addition, a test on the level of understanding about the ward was administered at the end of the session. The results showed that the VR orientation approach is helpful in reducing patients' anxiety while also improving their level of understanding about the ward.