RESUMO
Background: The increase in the diagnosis of papillary thyroid carcinoma (PTC) has prompted researchers to establish a diagnostic model and identify functional subclusters. The Human Phenotype Ontology (HPO) platform is widely available for differential diagnostics and phenotype-driven investigations based on next-generation sequence-variation data. However, a systematic and comprehensive study to identify and validate PTC subclusters based on HPO is lacking. Methods: We first used the HPO platform to identify the PTC subclusters. An enrichment analysis was then conducted to examine the key biological processes and pathways associated with the subclusters, and a gene mutation analysis of the subclusters was conducted. For each subcluster, the differentially expressed genes (DEGs) were selected and validated. Finally, a single-cell RNA-sequencing data set was used to verify the DEGs. Results: In our study, 489 PTC patients from The Cancer Genome Atlas (TCGA) were included. Our analysis demonstrated that distinct subclusters of PTC are associated with different survival times and have different functional enrichment, and that C-C motif chemokine ligand 21 (CCL21) and zinc finger CCHC-type containing 12 (ZCCHC12) were the common down- and upregulated genes, respectively, in the 4 subclusters. Additionally, 20 characteristic genes were identified in the 4 subclusters, some of which have previously been reported to have roles in PTC. Further, we found that these characteristic genes were mainly expressed in thyrocytes, endothelial cells, and fibroblasts, and were rarely expressed in immune cells. Conclusions: We first identified subclusters in PTC based on HPO and found that patients with distinct subclusters have different prognoses. We then identified and validated the characteristic genes in the 4 subclusters. These findings are expected to serve as a crucial reference that will improve our understanding of PTC heterogeneity and the use of novel targets.
RESUMO
BACKGROUND: Pancreatic encephalopathy is the most serious complication of severe acute pancreatitis (SAP) and substantially increases mortality. Delirium is a common clinical manifestation of pancreatic encephalopathy. This study aimed to assess the clinical effects of an improved version of the Hospital Elderly Life Program (HELP) on preventing delirium in elderly patients with SAP. METHODS: A total of 106 patients with SAP aged 70 years or older were randomly divided into an experimental group (53 cases) and a control group (53 cases). The experimental group was given 2 weeks of conventional nursing combined with the HELP regimen, while the control group was given 2 weeks of conventional nursing. Conventional nursing included disease care, geriatric syndrome care and observation of critically ill patients. The incidence of delirium, severity of delirium, self-care ability, cognitive function, length of hospital stay, and patient satisfaction were compared between the 2 groups before and after the intervention. RESULTS: The incidence of delirium was 4.00% in the experimental group and 16.98% in the control group; the difference was statistically significant (P=0.033). After 2 weeks of intervention, the experimental group showed significantly better self-care ability and cognitive function, shorter hospital stay, and greater patient satisfaction than the control group (all P<0.05). CONCLUSIONS: The improved HELP protocol for elderly patients with SAP can reduce the incidence and severity of delirium, improve self-care ability and cognitive function, shorten hospital stay, and increase patient satisfaction.