Accuracy and Consistency of 3D Magnetic Resonance Imaging Is Comparable to 3D Computed Tomography in Assessing Glenohumeral Instability: A Systematic Review.

PURPOSE: The purpose of this study is to compare the accuracy of 3D magnetic resonance imaging (MRI) with that of 3D CT in evaluating glenoid bone loss (GBL). METHODS: This review aligned with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, the Cochrane Library, Embase, and Web of Science were obtained from data inception to Aug 28, 2023. The search term "glenoid bone loss" was extracted and analyzed via stringent inclusion and exclusion criteria. The Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) combined with the Quality Assessment of Diagnostic Accuracy Studies-Comparative (QUADAS-C) to assess the heterogeneity of included studies. RESULTS: A total of 1589 related studies were retrieved, and 10 studies were finally included, of which a total of 143 shoulders were evaluated. The index test in QUADAS-C was low risk in 9 studies. 3D MRI measurements of GBL were primarily best-fit circles (n = 9). In both clinical and cadaveric studies, the mean percentages of GBL measured by 3D MRI were 0.38% to 2.19% and 0.25% to 6.1% when compared with 3D CT and standard reference values, respectively. ICC agreement greater than 0.9 between GBL percentages measured by 3D CT and 3D MRI. 3D MRI can also accurately measure glenoid width, glenoid height, humeral head width and height, etc. 3D MRI reconstruction time was similar to that of 3D CT, which was mainly 10-15 min. CONCLUSIONS: In both clinical and cadaveric studies, compared to 3D CT, 3D MRI is accurate and consistent in assessing glenohumeral bone, especially in measuring GBL, and the reconstruction time of 3D MRI is similar to 3D CT.

Phylogenomics of Afrotherian mammals and improved resolution of extant Paenungulata.

Molecular investigations have gathered a diverse set of mammals-predominantly African natives like elephants, hyraxes, and aardvarks-into a clade known as Afrotheria. Nevertheless, the precise phylogenetic relationships among these species remain contentious. Here, we sourced orthologous markers and ultraconserved elements to discern the interordinal connections among Afrotherian mammals. Our phylogenetic analyses bolster the common origin of Afroinsectiphilia and Paenungulata, and propose Afrosoricida as the closer relative to Macroscelidea rather than Tubulidentata, while also challenging the notion of Sirenia and Hyracoidea as sister taxa. The approximately unbiased test and the gene concordance factor uniformly recognized the alliance of Proboscidea with Hyracoidea as the dominant topology within Paenungulata. Investigation into sites with extremly high phylogenetic signal unveiled their potential to intensify conflicts in the Paenungulata topology. Subsequent exploration suggested that incomplete lineage sorting was predominantly responsible for the observed contentious relationships, whereas introgression exerted a subsidiary influence. The divergence times estimated in our study hint at the Cretaceous-Paleogene (K-Pg) extinction event as a catalyst for Afrotherian diversification. Overall, our findings deliver a tentative but insightful overview of Afrotheria phylogeny and divergence, elucidating these relationships through the lens of phylogenomics.

A Mobile Instant Messaging-Delivered Psychoeducational Intervention for Cancer Caregivers: A Randomized Clinical Trial.

Importance: Psychoeducational interventions (PEIs), which provide both information and emotional and psychosocial support, may address the unmet needs of the caregivers of adolescent and young adult patients with cancer. Objective: To explore the effects of an instant messaging-delivered PEI on anxiety, depression, quality of life (QOL), and coping and determine whether the intervention reduces caregivers' unmet needs. Design, Setting, and Participants: This randomized clinical trial using an intention-to-treat protocol was conducted from April 1 to September 14, 2022, in a tertiary cancer hospital in China and included caregivers of patients diagnosed with cancer at age 15 to 39 years recruited using convenience sampling. Intervention: Caregivers were allocated 1:1 using a randomized block scheme to the intervention or control group. The intervention group received a 5-week PEI and usual care, whereas the control group received only usual care. The PEI was delivered through articles and calls through an instant messaging application. Main Outcomes and Measures: The primary outcomes were changes in the levels of caregivers' anxiety and depression, measured using the 7-Item Generalized Anxiety Disorder Scale and the Patient Health Questionnaire 9, respectively. The secondary outcomes were changes in the levels of caregivers' QOL, coping, and unmet needs. Results: Of the 160 participants, 92 (57.5%) were male; mean (SD) age was 40.27 (8.33) years. Compared with the control group, the intervention group had significantly greater reduction in severity of anxiety (B = -3.231; 95% CI, -4.746 to -1.716; P < .001) and depression (B = -3.253; 95% CI, -5.052 to -1.454; P < .001), smaller reduction in QOL (B = 13.574; 95% CI, 0.488-26.661; P = .04), and greater reduction in unmet needs (B = -12.136; 95% CI, -18.307 to -5.965; P < .001) after the intervention. Twelve weeks after baseline, the intervention group demonstrated a significantly greater reduction only in severity of anxiety (B = -1.890; 95% CI, -3.382 to -0.397; P = .01). Conclusions and Relevance: In this randomized clinical trial of a mobile instant messaging-delivered PEI, caregivers' unmet needs, anxiety, and depression decreased significantly and QOL declined at a significantly slower rate immediately after the intervention in the intervention group compared with the control group. A sustained effect on anxiety was observed 12 weeks after baseline. Trial Registration: Chinese Clinical Trial Registry identifier: ChiCTR2200055951.

Application of Complete Decongestive Therapy in Patients with Secondary Bilateral Lower Limb Lymphedema after Comprehensive Treatment of Gynecological Malignant Tumor.

Objective: The purpose of this study is to investigate the effect of complete decongestive therapy (CDT), based on fluoroscopy-guided manual lymph drainage (FG-MLD), combined with intermittent pneumatic compression (IPC) on patients with secondary bilateral lower limb lymphedema after comprehensive treatment for gynecological malignant tumors. Methods: After comprehensive treatment for gynecological malignant tumors, 18 patients suffering from bilateral lower limb lymphedema were evaluated and treated by specialist nurses (with the qualification of lymphedema therapists). The treatment course included manual drainage, IPC, bandaging, functional exercise, and skincare etc., which are performed once a day for a total of 18 times. Results: After performing the treatment 18 times, a significant reduction is observed in the patient's bilateral lower limb circumference, extracellular water (ECW) content, and lower limb segment ECW ratio. Moreover, the 50-kHz bioelectrical impedance and quality of life (QoL) scores are found to be significantly higher than before treatment (all p < 0.05). Subjective symptoms also improve significantly (p < 0.05), except for local swelling (p = 0.289 > 0.05). Conclusions: CDT based on FG-MLD, combined with IPC, effectively relieves secondary bilateral lower limb lymphedema after comprehensive treatment of gynecological malignant tumors. It also improves subjective symptoms and patients' QoL, thus deserving clinical reference and promotion.

Improved mammalian family phylogeny using gap-rare multiple sequence alignment: A timetree of extant placentals and marsupials.

The timing of mammalian diversification in relation to the Cretaceous-Paleogene (KPg) mass extinction continues to be a subject of substantial debate. Previous studies have either focused on limited taxonomic samples with available whole-genome data or relied on short sequence alignments coupled with extensive species samples. In the present study, we improved an existing dataset from the landmark study of Meredith et al. (2011) by filling in missing fragments and further generated another dataset containing 120 taxa and 98 exonic markers. Using these two datasets, we then constructed phylogenies for extant mammalian families, providing improved resolution of many conflicting relationships. Moreover, the timetrees generated, which were calibrated using appropriate molecular clock models and multiple fossil records, indicated that the interordinal diversification of placental mammals initiated before the Late Cretaceous period. Additionally, intraordinal diversification of both extant placental and marsupial lineages accelerated after the KPg boundary, supporting the hypothesis that the availability of numerous vacant ecological niches subsequent to the mass extinction event facilitated rapid diversification. Thus, our results support a scenario of placental radiation characterized by both basal cladogenesis and active interordinal divergences spanning from the Late Cretaceous into the Paleogene.

Insights into the Notch signaling pathway in degenerative musculoskeletal disorders: Mechanisms and perspectives.

Degenerative musculoskeletal disorders are a group of age-related diseases of the locomotive system that severely affects the patient's ability to work and cause adverse sequalae such as fractures and even death. The incidence and prevalence of degenerative musculoskeletal disorders is rising owing to the aging of the world's population. The Notch signaling pathway, which is expressed in almost all organ systems, extensively regulates cell proliferation and differentiation as well as cellular fate. Notch signaling shows increased activity in degenerative musculoskeletal disorders and retards the progression of degeneration to some extent. The review focuses on four major degenerative musculoskeletal disorders (osteoarthritis, intervertebral disc degeneration, osteoporosis, and sarcopenia) and summarizes the pathophysiological functions of Notch signaling in these disorders, especially its role in stem/progenitor cells in each disorder. Finally, a conclusion will be presented to explore the research and application of the perspectives on Notch signaling in degenerative musculoskeletal disorders.

Phylogenomics Reveals High Levels of Incomplete Lineage Sorting at the Ancestral Nodes of the Macaque Radiation.

The genus Macaca includes 23 species assigned into 4 to 7 groups. It exhibits the largest geographic range and represents the most successful example of adaptive radiation of nonhuman primates. However, intrageneric phylogenetic relationships among species remain controversial and have not been resolved so far. In this study, we conducted a phylogenomic analysis on 16 newly generated and 8 published macaque genomes. We found strong evidence supporting the division of this genus into 7 species groups. Incomplete lineage sorting (ILS) was the primary factor contributing to the discordance observed among gene trees; however, we also found evidence of hybridization events, specifically between the ancestral arctoides/sinica and silenus/nigra lineages that resulted in the hybrid formation of the fascicularis/mulatta group. Combined with fossil data, our phylogenomic data were used to establish a scenario for macaque radiation. These findings provide insights into ILS and potential ancient introgression events that were involved in the radiation of macaques, which will lead to a better understanding of the rapid speciation occurring in nonhuman primates.

Online training to improve evidence-based leadership competencies among nurse leaders in Finland and China: study protocols for two randomised feasibility trials.

INTRODUCTION: This study protocol describes two randomised feasibility trials that will evaluate the feasibility and preliminary effectiveness of an online training course to improve evidence-based leadership competences among nurse leaders working in hospitals in Finland and China. METHODS AND ANALYSIS: Two randomised, parallel-group studies will be conducted separately: one in Finland (n=140) and one in China (n=160). Nurse leaders who fulfil the eligibility criteria will be randomly allocated (1:1) to participate in either the online evidence-based leadership training or conventional online training (reading material only). The primary outcomes will be acceptance of the online course (logging into the platform) and adherence in the online course (returned course tasks and drop-out rate of the participants). The secondary outcomes will be acceptance of the study regarding recruitment, feasibility of the eligibility criteria and outcome measures and potential effectiveness of the online course on leadership skills, evidence-based knowledge, attitudes, practice, self-efficacy, self-esteem and intention to leave. In addition, the feedback will be asked after the course. ETHICS AND DISSEMINATION: Two separate trials have received ethical clearance from local ethics committees (12/2022 in Finland, E2021167 in China). Permission to conduct the study will be granted by hospital authorities. All participants will provide electronic informed consent before baseline data are collected. The trial results will be published locally, nationally and internationally in professional and peer-reviewed journals, and shared at national and international meetings and conferences. TRIAL REGISTRATION NUMBERS: NCT05244512; NCT05244499.

Chromosome-level Asian elephant genome assembly and comparative genomics of long-lived mammals reveal the common substitutions for cancer resistance.

The naked mole rat (Heterocephalus glaber), bats (e.g., genus Myotis), and elephants (family Elephantidae) are known as long-lived mammals and are assumed to be excellent cancer antagonists. However, whether there are common genetic changes underpinning cancer resistance in these long-lived species is yet to be fully established. Here, we newly generated a high-quality chromosome-level Asian elephant (Elephas maximus) genome and identified that the expanded gene families in elephants are involved in Ras-associated and base excision repair pathways. Moreover, we performed comparative genomic analyses of 12 mammals and examined genes with signatures of positive selection in elephants, naked mole rat, and greater horseshoe bat. Residues at positively selected sites of CDR2L and ALDH6A1 in these long-lived mammals enhanced the inhibition of tumor cell migration compared to those in short-lived relatives. Overall, our study provides a new genome resource and a preliminary survey of common genetic changes in long-lived mammals.

Large-scale across species transcriptomic analysis identifies genetic selection signatures associated with longevity in mammals.

Lifespan varies significantly among mammals, with more than 100-fold difference between the shortest and longest living species. This natural difference may uncover the evolutionary forces and molecular features that define longevity. To understand the relationship between gene expression variation and longevity, we conducted a comparative transcriptomics analysis of liver, kidney, and brain tissues of 103 mammalian species. We found that few genes exhibit common expression patterns with longevity in the three organs analyzed. However, pathways related to translation fidelity, such as nonsense-mediated decay and eukaryotic translation elongation, correlated with longevity across mammals. Analyses of selection pressure found that selection intensity related to the direction of longevity-correlated genes is inconsistent across organs. Furthermore, expression of methionine restriction-related genes correlated with longevity and was under strong selection in long-lived mammals, suggesting that a common strategy is utilized by natural selection and artificial intervention to control lifespan. Our results indicate that lifespan regulation via gene expression is driven through polygenic and indirect natural selection.

The Feasibility and Acceptability of a Needs-Oriented Psychoeducational Intervention Among Caregivers of Adolescent and Young Adult Cancer Patients: A Pilot Randomized Controlled Trial.

BACKGROUND: Little is known about the psychoeducational interventions for caregivers of adolescent and young adult (AYA) cancer patients. OBJECTIVE: To evaluate the feasibility and acceptability of a needs-oriented psychoeducational intervention among caregivers of AYA cancer patients. METHODS: In this 2-arm (parallel-group), pilot randomized controlled trial, participants were randomized to the intervention or control group. Participants in the control group received usual care, whereas those in the intervention group received a needs-oriented psychoeducational intervention via WeChat as well as the usual care. Feasibility was evaluated on recruitment, attrition, and adherence rates and the data collection process. Acceptability was assessed based on participants' satisfaction with and perceived usefulness of the intervention, collected using a questionnaire. In addition, a semistructured interview was conducted to explore their experiences. RESULTS: Twenty-four caregivers of AYA cancer patients were recruited, with a consent rate of 61.5%. The attrition and response rates 5 weeks after baseline were 8.3% and 91.7%. Among the 12 participants in the intervention group, 10 (83.3%) completed all of the 5 weekly sessions. Most of the participants were satisfied with the program and perceived its usefulness. The semistructured interviews revealed 3 major categories: facilitators of participation, perception of the intervention, and perceived benefits. CONCLUSIONS: The needs-oriented psychoeducational intervention delivered through WeChat is feasible for and acceptable to caregivers of AYA cancer patients. A full-scale study is warranted to examine the effects of this intervention on caregivers' health outcomes. IMPLICATIONS FOR PRACTICE: The WeChat-based, needs-oriented psychoeducational intervention may be beneficial to improve caregivers' health outcomes.

Comparative susceptibility of SARS-CoV-2, SARS-CoV, and MERS-CoV across mammals.

Exploring wild reservoirs of pathogenic viruses is critical for their long-term control and for predicting future pandemic scenarios. Here, a comparative in vitro infection analysis was first performed on 83 cell cultures derived from 55 mammalian species using pseudotyped viruses bearing S proteins from SARS-CoV-2, SARS-CoV, and MERS-CoV. Cell cultures from Thomas's horseshoe bats, king horseshoe bats, green monkeys, and ferrets were found to be highly susceptible to SARS-CoV-2, SARS-CoV, and MERS-CoV pseudotyped viruses. Moreover, five variants (del69-70, D80Y, S98F, T572I, and Q675H), that beside spike receptor-binding domain can significantly alter the host tropism of SARS-CoV-2. An examination of phylogenetic signals of transduction rates revealed that closely related taxa generally have similar susceptibility to MERS-CoV but not to SARS-CoV and SARS-CoV-2 pseudotyped viruses. Additionally, we discovered that the expression of 95 genes, e.g., PZDK1 and APOBEC3, were commonly associated with the transduction rates of SARS-CoV, MERS-CoV, and SARS-CoV-2 pseudotyped viruses. This study provides basic documentation of the susceptibility, variants, and molecules that underlie the cross-species transmission of these coronaviruses.

Correlated evolution of social organization and lifespan in mammals.

Discerning the relationship between sociality and longevity would permit a deeper understanding of how animal life history evolved. Here, we perform a phylogenetic comparative analysis of ~1000 mammalian species on three states of social organization (solitary, pair-living, and group-living) and longevity. We show that group-living species generally live longer than solitary species, and that the transition rate from a short-lived state to a long-lived state is higher in group-living than non-group-living species, altogether supporting the correlated evolution of social organization and longevity. The comparative brain transcriptomes of 94 mammalian species identify 31 genes, hormones and immunity-related pathways broadly involved in the association between social organization and longevity. Further selection features reveal twenty overlapping pathways under selection for both social organization and longevity. These results underscore a molecular basis for the influence of the social organization on longevity.

Factors Influencing Lower Limb Lymphedema After Cervical Cancer Surgery: A Case-Control Study.

Background: To analyze the factors influencing lower limb lymphedema (LLL) after cervical cancer surgery and provide a scientific reference for its effective prevention and control. Methods and Results: Patients at a tertiary tumor hospital between January 2010 and January 2020 who received surgical treatment for cervical cancer were included in this study. Patients were divided into lymphedema case group (n = 253) and control group (n = 506) according to lymphedema occurrence, and univariate and multivariate analyses were used to analyze the factors influencing the occurrence of LLL after cervical cancer surgery. Multifactor conditional logistic regression analysis revealed that risk factors for lymphedema occurrence included body mass index, level of education, the presence of preoperative radiotherapy and chemotherapy, radiotherapy within 3 months after postoperative chemoradiotherapy, emergence of coronary heart disease within 3 months, vaginal disease, occurrence of postoperative complications, cervical cancer diagnosis before the manifestation of menstrual abnormalities, and a history of previous surgery. Conclusion: Postoperative LLL after cervical cancer surgery is a chronic progressive disease, and no cure for LLL has been identified. Thus, determining the risk factors associated with LLL occurrence after uterine and cervical cancer surgery and the development of targeted prevention and early intervention strategies is urgently needed.

Inter-glacial isolation caused divergence of cold-adapted species: the case of the snow partridge.

Deciphering the role of climatic oscillations in species divergence helps us understand the mechanisms that shape global biodiversity. The cold-adapted species may have expanded their distribution with the development of glaciers during glacial period. With the retreat of glaciers, these species were discontinuously distributed in the high-altitude mountains and isolated by geographical barriers. However, the study that focuses on the speciation process of cold-adapted species is scant. To fill this gap, we combined population genetic data and ecological niche models (ENMs) to explore divergence process of snow partridge (Lerwa lerwa). Lerwa lerwa is a cold-adapted bird that is distributed from 4,000 to 5,500 m. We found 2 genetic populations within L. lerwa, and they diverged from each other at about 0.40-0.44 million years ago (inter-glacial period after Zhongliangan glaciation). The ENMs suggested that L. lerwa expanded to the low elevations of the Himalayas and Hengduan mountains during glacial period, whereas it contracted to the high elevations, southern of Himalayas, and Hengduan mountains during inter-glacial periods. Effective population size trajectory also suggested that L. lerwa expanded its population size during the glacial period. Consistent with our expectation, the results support that inter-glacial isolation contributed to the divergence of cold-adapted L. lerwa on Qinghai-Tibetan Plateau. This study deepens our understanding of how climatic oscillations have driven divergence process of cold-adapted Phasianidae species distributed on mountains.

Cervical cancer prognosis and related risk factors for patients with cervical cancer: a long-term retrospective cohort study.

This study aims to explore the recurrence rate and overall survival for patients with cervical cancer after the first treatment and the related risk factors. A retrospective cohort study was conducted on cervical cancer patients enrolled in a cancer specialist hospital in Hunan Province, China from January 1992 to December 2005 and followed up until December 2010. Kaplan-Meier survival analysis was used to estimate the cumulative recurrence rate, and Cox proportional hazards model was utilized to identify risk factors associated with prognosis. A total of 4358 patients were enrolled with a median follow-up of 7.4 years (range 5-19 years), and 372 (8.5%) patients had cancer recurrence. The cumulative recurrence rate showed a rapid increase from 3.8% in the first year after discharge to 8.0% in the fifth year, and the recurrence rate remained relatively stable afterward reaching 9.7% and 10.8% in the 10th and the 15th year, respectively. The median time to recurrence was 15.5 months with an IQR of 5.5-40.0 months. The Cox regression showed that miscarriage, clinical stage, and treatment received were significantly associated with cervical cancer recurrence after adjustment for confounders. Patients with recurrence showed a significantly higher risk for mortality than those without recurrence (HR 2.79, 95% CI 2.42-3.22). This study depicted the long-term recurrence rate and survival after recurrence for patients with cervical cancer after the first treatment, and reported time to recurrence and risk factors related to recurrence. These findings may provide important evidence for designing targeted interventions for the treatment of cervical cancer.

The comprehensive expression and functional analysis of m6A modification "readers" in hepatocellular carcinoma.

N6-methyladenosine (m6A) modification regulators are essential for the diagnosis and treatment of various cancers. However, the comprehensive analysis about roles of m6A "readers" in hepatocellular carcinoma (HCC) remains unclear. UALCAN, GEPIA2, HPA, Kaplan Meier plotter, cBioPortal, STRING WebGestalt, Metascape and TIMER 2.0 database and Cytoscape software were used to comprehensively analyze the bioinformatic data. We found that m6A "readers" were upregulated at the mRNA level and protein level in HCC patients. Highly expressed YTHDF1, IGF2BP3 and NKAP were positively correlated with advanced HCC stage and had a poor prognosis in OS and PFS. The gene alterations of m6A "readers" happened frequently, and YTHDF3 had the highest mutation rate. The function of m6A "readers" on HCC may be closely correlated with splicing related proteins (including HNRNP family, SNRP family, and SR family), metabolic process, protein binding and RNA splicing related signaling pathways. Moreover, although the correlation of YTHDF3 and CD8+ T cell infiltration, and the correlation of IGF2BP3 and infiltration of mast cells and CAF are negative, most m6A "readers" had a positive correlation with immune cells (including CD8+ T cell, CD4+ T cell, Tregs, B cell, neutrophil, monocyte, macrophage, myeloid dendritic cell, nature killer cell, mast cell, and CAF). Macrophages, CD4+ T cell, Treg, B cell, monocyte, and myeloid dendritic cell had a positively strong correlation (Rho>0.4) with most m6A "readers" (such as YTHDC1, YTHDC2, YTHDF1, IGF2BP3, HNRNPA2B1 and HNRNPC). In conclusion, by comprehensive analysis of m6A "readers", we found that they were involved in the prognosis of HCC, and m6A "readers" might regulate the development and progression of HCC by participating in some metabolism-related and RNA splicing-related signaling pathways as well as immune cell infiltration.

The Dysregulation of SOX Family Correlates with DNA Methylation and Immune Microenvironment Characteristics to Predict Prognosis in Hepatocellular Carcinoma.

Background: Due to the molecular heterogeneity of hepatocellular carcinoma (HCC), majority of patients respond poorly among various of therapy. This study is aimed at conducting a comprehensive analysis about roles of SOX family in HCC for obtaining more therapeutic targets and biomarkers which may bring new ideas for the treatment of HCC. Methods: UALCAN, Kaplan Meier plotter, cBioPortal, STRING, WebGestalt, Metascape, TIMER 2.0, DiseaseMeth, MethSurv, HPA, CCLE database, and Cytoscape software were used to comprehensively analyze the bioinformatic data. Results: SOX2, SOX4, SOX8, SOX10, SOX11, SOX12, SOX17, and SOX18 were significantly differentially expressed in HCC and normal tissues and were valuable for the grade and survival of HCC patients. In addition, the gene alterations of SOX family happened frequently, and SOX4 and SOX17 had the highest mutation rate. The function of SOX family on HCC may be closely correlated with the regulation of angiogenesis-related signaling pathways. Moreover, SOX4, SOX8, SOX11, SOX12, SOX17, and SOX18 were correlation with 8 types of immune cells (including CD8+ T cell, CD4+ T cell, B cell, Tregs, neutrophil, macrophage, myeloid DC, and NK cell), and we found that most types of immune cells had a positive correlation with SOX family. Notably, CD4+ T cell and macrophage were positively related with all these SOX family. NK cells were negatively related with most SOX family genes. DNA methylation levels in promoter area of SOX2, SOX4, and SOX10 were lower in HCC than normal tissues, while SOX8, SOX11, SOX17, and SOX18 had higher DNA methylation levels than normal tissues. Moreover, higher DNA methylation level of SOX12 and SOX18 demonstrated worse survival rates in patients with HCC. Conclusion: SOX family genes could predict the prognosis of HCC. In addition, the regulation of angiogenesis-related signaling pathways may participate in the development of HCC. DNA methylation level and immune microenvironment characteristics (especially CD4+ T cell and macrophage immune cell infiltration) could be a novel insight for predicting prognosis in HCC.

Influencing factors and risk prediction model for cervical cancer recurrence. / å®«é¢ˆç™Œå¤å‘çš„å½±å“å› ç´ åŠé£Žé™©é¢„æµ‹æ¨¡åž‹.

OBJECTIVES: Cervical cancer is the most common malignant tumor in the female reproductive system worldwide. The recurrence rate for the treated cervical cancer patients is high, which seriously threatens women's lives and health. At present, the risk prediction study of cervical cancer has not been reported. Based on the influencing factors of cervical cancer recurrence, we aim to establish a risk prediction model of cervical cancer recurrence to provide a scientific basis for the prevention and treatment of cervical cancer recurrence. METHODS: A total of 4 358 cervical cancer patients admitted to the Hunan Cancer Hospital from January 1992 to December 2005 were selected as research subjects, and the recurrence of cervical cancer patients after treatment was followed up. Univariate analysis was used to analyze the possible influencing factors. Variables that were significant in univariate analysis or those that were not significant in univariate analysis but may be considered significant were included in multivariate Cox regression analysis to establish a cervical cancer recurrence risk prediction model. Line graphs was used to show the model and it was evaluated by using receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis. RESULTS: Univariate analysis showed that the recurrence rates of cervical cancer patients with different age, age of menarche, parity, miscarriage, clinical stage, and treatment method were significantly different (all P<0.05). Multivariate Cox regression analysis showed that RR=-0.489×(age≥55 years old)+0.481×(age at menarche >15 years old)+0.459×(number of miscarriages≥3)+0.416×(clinical stage II)+0.613×(clinical stage III/IV)+0.366×(the treatment method was surgery + chemotherapy) + 0.015×(the treatment method was chemotherapy alone). The area under the ROC curve (AUC) of the Cox risk prediction model for cervical cancer recurrence constructed was 0.736 (95% CI 0.684 to 0.789), the best prediction threshold was 0.857, the sensitivity was 0.576, and the specificity was 0.810. The accuracy of the Cox risk model constructed by this model was good. From the clinical decision curve, the net benefit value was high and the validity was good. CONCLUSIONS: Patient age, age at menarche, miscarriages, clinical stages, and treatment methods are independent factors affecting cervical cancer recurrence. The Cox proportional hazards prediction model for cervical cancer recurrence constructed in this study can be better used for predicting the risk of cervical cancer recurrence.

Measured and perceived impacts of evidence-based leadership in nursing: a mixed-methods systematic review protocol.

INTRODUCTION: Despite the abundance of existing literature on evidence-based nursing practice, knowledge regarding evidence-based leadership, that is, leadership supported by an evidence-based approach, is lacking. Our aim is to conduct a mixed-methods systematic review with qualitative and quantitative studies to examine how evidence is used to solve leadership problems and to describe the measured and perceived effects of evidence-based leadership on nurses and nurse leaders and their performance as well as on organisational and clinical outcomes. METHODS AND ANALYSIS: We will search the following databases with no year limit or language restrictions: CINAHL (EBSCO), Cochrane Library, Embase (Elsevier), PsycINFO (EBSCO), PubMed (MEDLINE), Scopus (Elsevier) and Web of Science. In addition, the databases for prospectively registered trials and other systematic reviews will be screened. We will include articles using any type of research design as long as the study includes a component of an evidence-based leadership approach. Three reviewers will independently screen all titles, abstracts and full-text articles and two reviewers will extract the data according to the appropriate checklists. The quality of each study will be appraised using specific appraisal tool fitting in study design used in each study. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) grid, PRISMA Protocols, Synthesis Without Meta-analysis and ENTREQ will guide the study process and reporting. Outcomes related to individual or group performance of nurses or nurse managers regarding leadership skills (e.g., communication skills), organisational outcomes (e.g., work environment, costs) and clinical outcomes (e.g., patient quality of life, treatment satisfaction) will be extracted and synthesised. ETHICS AND DISSEMINATION: This systematic review will not include empirical data, and therefore, ethics approval will not be sought. The results of the review will be disseminated in a peer-reviewed scientific journal and in a conference presentation. PROSPERO REGISTRATION NUMBER: CRD42021259624.