Predictive nomogram for in-hospital mortality among older patients with intra-abdominal sepsis incorporating skeletal muscle mass.

BACKGROUND: Studies on prognostic factors for older patients with intra-abdominal sepsis are scarce, and the association between skeletal muscle mass and prognosis among such patients remains unclear. AIMS: To develop a nomogram to predict in-hospital mortality among older patients with intra-abdominal sepsis. METHODS: Older patients with intra-abdominal sepsis were prospectively recruited. Their demographics, clinical features, laboratory results, abdominal computed tomography-derived muscle mass, and in-hospital mortality were recorded. The predictors of mortality were selected via least absolute shrinkage and selection operator and multivariable logistic regression analyses, and a nomogram was developed. The nomogram was assessed and compared with Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, and Simplified Acute Physiology Score II. RESULTS: In total, 464 patients were included, of whom 104 (22.4%) died. Six independent risk factors (skeletal muscle index, cognitive impairment, frailty, heart rate, red blood cell distribution width, and blood urea nitrogen) were incorporated into the nomogram. The Hosmer-Lemeshow goodness-of-fit test and calibration plot revealed a good consistency between the predicted and observed probabilities. The area under the receiver operating characteristic curve was 0.875 (95% confidence interval = 0.838-0.912), which was significantly higher than those of commonly used scoring systems. The decision curve analysis indicated the nomogram had good predictive performance. DISCUSSION: Our nomogram, which is predictive of in-hospital mortality among older patients with intra-abdominal sepsis, incorporates muscle mass, a factor that warrants consideration by clinicians. The model has a high prognostic ability and might be applied in clinical practice after external validation.

Effects of "audience effects"on animal mate choice: A review.

The information tranfered among individual animals can be shared by a network, which is consisted of the sender, the receiver, and the extra bystander of the communication signals. The bystanders can read and use the signal that is not sent directly to them and make use of it to interfere with the sender and the receiver, which is known as "audience effects" in the research area of animal behaviors. The processes of mate choice and mating of animals occur mainly in the network that is composed of the particular species. Increasing evidence show that the audience effects play an important role in regulating mating preference and mating strategy, resulting in changes in species evolution. Here, we review the role of audience effects on animal mate choice and evolution by clarifying the definition and functional explanations of audience effects, the factors contributing to audience effects, as well as the different impacts of audience effects on males and females. It would provide novel ideas to study the impacts of audience effects on mate choice and species evolution in the future.

Development programming: Stress during gestation alters offspring development in sheep.

Inappropriate management practices of domestic animals during pregnancy can be potential stressors, resulting in complex behavioural, physiological and neurological consequences in the developing offspring. Some of these consequences can last into adulthood or propagate to subsequent generations. We systematically summarized the results of different experimental patterns using artificially increased maternal glucocorticoid levels or prenatal maternal physiological stress paradigms, mediators between prenatal maternal stress (PMS) and programming effects in the offspring and the effects of PMS on offspring phenotypes in sheep. PMS can impair birthweight, regulate the development of the hypothalamic-pituitary-adrenal axis, modify behavioural patterns and cognitive abilities and alter gene expression and brain morphology in offspring. Further research should focus on the effects of programming on gene expression, immune function, gut microbiome, sex-specific effects and maternal behaviour of offspring, especially comparative studies of gestational periods when PMS is applied, continual studies of programming effects on offspring and treatment strategies that effectively reverse the detrimental programming effects of prenatal stress.

Translation and validation of the Chinese version of the maternal postpartum stress scale.

OBJECTIVE: To translate the Maternal Postpartum Stress Scale (MPSS) into Chinese and validate its psychometric properties in postpartum women. METHODS: A total of 406 postpartum women were recruited from six hospitals in Nantong, Jiangsu Province, China. Cronbach's α co-efficient, split-half reliability, and test-retest reliability were used to evaluate the reliability of the translated scale. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The Edinburgh Postnatal Depression Scale, Depression Anxiety Stress Scale-21 anxiety dimension, and Perceived Stress Scale were used as calibration scales to measure the correlation of MPSS. All data were analyzed using SPSS 25.0 and Amos 24.0. RESULTS: The Cronbach's α co-efficient of the Chinese version of MPSS and its three dimensions were 0.940 and 0.882-0.911, respectively. The split-half reliability was 0.825, and the test-retest reliability was 0.912. The scale's content validity index was 0.926. Three common factors were extracted from the EFA. The CFA validated the explored 3-factor structure, and the indicators were fitted well (χ2/Df = 2.167, comparative fit index = 0.918, Tucker-Lewis index = 0.907, incremental fit index = 0.919, and root mean square error of approximation = 0.075). CONCLUSION: The translated Chinese version of MPSS had suitable reliability and validity in assessing postpartum stress in Chinese women. The translated scale can also help with the early identification of postpartum stress and provide a scientific basis for the formulation of early personalized intervention measures. Overall, the scale has certain clinical value and practical significance for enhancing the physical and mental health of postpartum women. However, future studies including large, diverse populations are warranted.

Hobby engagement and mental wellbeing among people aged 65 years and older in 16 countries.

Growing aging populations pose a threat to global health because of the social and psychological challenges they experience. To mitigate this, many countries promote hobby engagement to support and improve mental health. Yet, it remains unclear whether there is consistency in benefits across different national settings. We harmonized measures of hobby engagement and multiple aspects of mental wellbeing across 16 nations represented in five longitudinal studies (N = 93,263). Prevalence of hobby engagement varied substantially across countries, from 51.0% of Spanish respondents to 96.0% of Danish respondents. Fixed effects models and multinational meta-analyses were applied to compare the longitudinal associations between hobbies and mental wellbeing. Independent of confounders, having a hobby was associated with fewer depressive symptoms (pooled coefficient = -0.10; 95% confidence intervals (CI) = -0.13, -0.07), and higher levels of self-reported health (pooled coefficient = 0.06; 95% CI = 0.03, 0.08), happiness (pooled coefficient = 0.09; 95% CI = 0.06, 0.13) and life satisfaction (pooled coefficient = 0.10; 95% CI = 0.08, 0.12). Further analyses suggested a temporal relationship. The strength of these associations, and prevalence of hobby engagement, were correlated with macrolevel factors such as life expectancy and national happiness levels but overall, little variance in findings was explained by country-level factors (<9%). Given the relative universality of findings, ensuring equality in hobby engagement within and between countries should be a priority for promoting healthy aging.

Lentinan-functionalized graphene oxide hydrogel as a sustained antigen delivery system for vaccines.

Hydrogel has been proven to have the ability to deliver antigens continuously to achieve slow vaccine delivery, which makes it a promising candidate for an adjuvant delivery platform. Meanwhile, graphene oxide (GO) has garnered significant attention due to its good biosafety, excellent surface area and easy modification. However, GO exists as weak colloidal particles and poses challenges in self-assembling into a hydrogel structure. Here, we propose an innovative strategy involving self-assembling lentinan-functionalized graphene oxide hydrogel ((LNT-GO Gel) by simply mixing lentinan (LNT)-functionalized GO with polyethylene imide (PEI), which can simultaneously encapsulate antigens, achieve long-lasting release of antigens and generate excellent adjuvant activity. The results indicated that the LNT-GO Gel can control the release of OVA at the injection site and confer targeted delivering capacity to lymph nodes. And the date demonstrates that LNT-GO Gel displays favorable safety and biodegradability in vivo. Moreover, LNT-GO Gel can enhance the activation and maturation of dendritic cells (DCs) in lymph node, induce stronger OVA-specific antibody response, and promote spleen T lymphocyte differentiation, which underscores that LNT-GO Gel has ability to generate stronger antigen-specific humoral and cellular immune responses. Collectively, these results demonstrate the adjuvant potential of the lentinan-functionalized graphene oxide hydrogel (LNT-GO Gel) for subunit vaccine.

Brief mindfulness meditation intervention improves attentional control of athletes in virtual reality shooting competition: Evidence from fNIRS and eye tracking.

Attentional control is a crucial cognitive ability for sports performance. The current research aimed to investigate whether a brief (20-min) pre-competition mindfulness meditation (MM) intervention enhances athletes' attentional control during competitions and alters the activity of brain regions related to attentional control. We created a virtual reality shooting competition to compare the eye-gaze indicators and functional near-infrared spectroscopy (fNIRS) parameters of 78 university athletes after 20 min of MM or 20 min of mind wandering (MW). Participants' average fixation durations (AFDs) on task-relevant information (targets) were significantly longer in the MM group. In contrast, both average fixation counts (AFCs) and AFDs on task-irrelevant information (the ranking screen) were significantly lower in the MM group than in the MW group. Additionally, the MM group exhibited significantly stronger activation of the left and right dorsolateral prefrontal cortex (dlPFC) as well as higher levels of oxygenated haemoglobin [HbO] and greater functional connectivity (FC) of the right dlPFC, which was considered evidence of recruitment for attentional control. Moreover, the MM group achieved significantly better shooting performance than the MW group. Overall, the findings suggest that one session 20-min MM practice pre-competition facilitates focus during competition and improves athletic performance. We recommend the application of brief mindfulness practice in sports, especially in closed-skill sports that require high attention participation (e.g., shooting, archery, darts, golf, gymnastics, skating etc.).

Efficacy and safety of laser-related therapy for melasma: A systematic review and network meta-analysis.

BACKGROUND: Melasma is a prevalent, persistent hyperpigmentation disorder that negatively affects the psychological health of patients. However, the treatment outcome remains unsatisfactory due to the complexity of pathogenesis, recurrence characteristics, and relatively high morbidity. OBJECTIVES: To compare the performance of laser-related therapies in improving the melasma area severity index (MASI) score of melasma and the occurrence of adverse effects by network meta-analysis (NMA). METHODS: From the inception to November 2022, eligible randomized controlled trials were identified. Two investigators independently searched relevant studies from PUBMED, EMBASE, and the Cochrane Library database. RESULTS: A total of 39 clinical studies with 1394 participants were eligible for enrollment. For efficacy, the NMA demonstrated that Q-switched Nd: YAG laser + topical medications (QSND+TM) was superior to Q-switched Nd:YAG laser (QSND) [MD = -4.21 (-6.80, -1.63)], Er: YAG laser + topical medications (ERYL+TM) [MD = -3.52 (-6.84, -0.19)], and picosecond laser + topical medications (PICO+TM) [MD = -4.80 (-9.33, -0.27)]. The microneedling + topical medications (MN+TM) was superior to picosecond laser (PICO) [MD = -5.26 (-10.44, -0.08)] and topical medications (TM) [MD = -5.22 (-9.20, -1.23)]. The top five of the surface under the cumulative ranking curve value (SUCRA) are Q-switched Nd:YAG laser + topical medications (QSND+TM 85.9%), oral tranexamic acid (oTA 80.1%), microneedling + topical medications (MN+TM 79.7%), Q-switched Nd:YAG laser + intense pulse light (QSND+IPL 78.9%), and fractional carbon dioxide laser + topical medications (FCDL+TM 70.5%). CONCLUSIONS: In conclusion, the Qs-Nd:YAG laser with topical medications is the first choice for treating melasma according to the SUCRA value. Among the three treatment modalities, namely MN + TM, PICO, and TM, our recommendation favors MN+TM as the superior choice for enhancing the curative efficacy in melasma. However, the actual clinical choice should also take into account the adverse effects, the skin type of the patient, the duration of the disease, and other relevant factors.

Puerarin alleviates sleep disorders in aged mice related to repairing intestinal mucosal barrier.

More and more evidence suggests that puerarin, a potential remedy for gut inflammation, may have an ameliorative effect on sleep disturbances. However, the relationship between puerarin and sleep disruption has not been extensively researched. This study aims to explore the role and mechanisms of puerarin in improving sleep disorders. We established a light-induced sleep disorder model in mice and assessed the effects of puerarin on cognitive behavior using open field and water maze tests. Pathological detection demonstrated that sleep disturbances resulted in observable damage to the liver, lung, and kidney. Puerarin reversed multi-organ damage and inflammation. Further, puerarin activated paneth cells, resulting in increased lysozyme and TGF-ß production, and stimulating intestinal stem cell proliferation. Puerarin also effectively inhibited the expression of F4/80, iNOS, TNF-α, and IL-1ß in the small intestine, while it increased Chil3, CD206, and Arg-1 levels. Moreover, puerarin treatment significantly decreased P-P65, TLR4, Bcl-xl, and cleaved caspase-3 protein levels while increasing barrier protein levels, including ZO-1, Occludin, Claudin 1 and E-cadherin suggesting a reduction in inflammation and apoptosis in the gut. Overall, puerarin diminished systemic inflammation, particularly intestinal inflammation, and enhanced intestinal barrier integrity in mice with sleep disorders. Our findings suggest a potential new therapeutic pathway for sleep disorders.

The Treatment of Diffuse Large B-Cell Lymphoma (Triple Expression) Involving the Breast, Spleen, and Bone in a Male Patient with Viral Hepatitis B: A Rare Case Report.

Background: Diffuse large B-cell lymphoma (DLBCL) involving the breast, spleen, and bone in a male patient with hepatitis B virus (HBV) infection is extremely rare in clinical practice. Case Presentation: We report a case of DLBCL involving the breast, spleen, and bone (triple expression of Bcl-2+, Bcl-6+, and 70% positive C-mcy) in a male patient with HBV admitted to our hospital. The patient was treated with EPOCH×4, lenalidomide+EPOCH×2 chemotherapy, intermittent methotrexate intrathecal injections to prevent central invasion, and autologous stem cell transplantation (ASCT). The patient is currently in complete remission, and the follow-up time was 43 months. Conclusion: A patient with DLBCL involving the breast, spleen, and bone can be treated with a combination of multiple regimens. If the patient's economic conditions permit it, ASCT can be considered.

Nickel-Catalyzed Asymmetric Decarboxyarylation with NHP Esters of α-Amino Acid to Chiral Benzylamines.

A nickel-catalyzed asymmetric decarboxyarylation of NHP esters via reductive cross-coupling has been established. Utilizing the NHP of amino acid esters as radical precursors furnishes a new protocol in which structurally diverse chiral benzylamines could be accessible. This method has demonstrated excellent catalytic efficiency, high enantioselective control, mild conditions, and good functional group tolerance, thus enabling the late-stage modification of bioactive molecules and pharmaceuticals.

High-throughput creation of Nicotiana tabacum gene-targeted mutants based on CRISPR/Cas9.

KEY MESSAGE: 4382 available sgRNAs targeting 1060 tobacco genes were obtained, and 10,682 targeted mutants were created using high-throughput methods. Four optimization experiments were established to solve problems encountered during genetic transformation.

Non-Traditional Blood Lipid Indices for Metabolism Dysfunction-Associated Fatty Liver Disease Prediction in Non-Obese Type 2 Diabetes Mellitus.

Objective: This study aims to investigate the predictive value of non-traditional blood lipid indices for metabolism dysfunction-associated fatty liver disease (MAFLD) in non-overweight/obese patients with type 2 diabetes mellitus (T2DM). Methods: A retrospective observational study was conducted, including non-overweight/obese patients with T2DM who visited the Fourth Hospital of Hebei Medical University between August 2018 and August 2022. The low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, the triacylglycerol-glucose index (TyG) multiplied by body mass index (BMI), and TyG/HDL-C ratio were calculated. Results: The study involved 190 participants, of whom 34 were diagnosed with MAFLD (24 males and 10 females), while 156 did not have MAFLD (64 males and 92 females). Multivariable analysis revealed that aspartate transaminase (AST) (OR=1.216, 95% CI: 1.059-1.374, P=0.006), blood uric acid (BUA) (OR=1.017, 95% CI: 1.002-1.032, P=0.022), TyG*BMI (OR=1.231, 95% CI: 1.051-1.442, P=0.010), and TyG/HDL-C (OR=3.162, 95% CI: 1.228-8.141, P=0.017) were independently associated with MAFLD. The TyG*BMI index exhibited an area under the ROC curve (AUC) of 0.812, with 91.2% sensitivity and 69.2% specificity for MAFLD. The TyG/HDL-C index had an AUC of 0.929, with 85.3% sensitivity and 88.5% specificity for MAFLD. Conclusion: The results indicate that TyG*BMI and TyG/HDL-C are independently associated with MAFLD in non-overweight/obese patients with T2DM.

Large-Scale Preparation for Multicolour Stimulus-Responsive Room-Temperature Phosphorescence Paper Via Cellulose Heterogeneous Reaction.

The large-scale preparation of sustainable room-temperature phosphorescence (RTP) materials, particularly those with stimulus-response properties, is attractive but remains challenging. This study developed a facile heterogeneous B-O covalent bonding strategy to anchor arylboronic acid chromophores to cellulose chains using pure water as a solvent, resulting in multicolour RTP cellulose. The rigid environment provided by the B-O covalent bonds and hydrogen bonds promote the triplet population and suppress quenching, leading to an excellent lifetime of 1.42 s for the target RTP cellulose. By increasing the degree of chromophore conjugation, the afterglow colours could be tuned from blue to green and then to red. Motivated by this finding, a papermaking production line was built to convert paper pulp reacted with an arylboronic acid additive into multicolour RTP paper on a large scale. Furthermore, the RTP paper was sensitive to water because of the destruction of hydrogen bonds and the stimuli-response could be repeated in response to water/heat stimuli. The RTP paper can be folded into 3D afterglow origami handicrafts and anti-counterfeiting packing boxes or used for stimulus-responsive information encryption. This success paves the way for the development of large-scale, eco-friendly, and practical stimuli-responsive RTP materials. This article is protected by copyright. All rights reserved.

CIRC_0085323 SILENCING INHIBITS TNF-Α-INDUCED NORMAL HUMAN COLONIC EPITHELIAL CELL INFLAMMATION AND APOPTOSIS THROUGH THE MIR-495-3P/TRAF3 AXIS.

ABSTRACT: Background: Previous data have suggested the involvement of circular RNA (circRNA) in ulcerative colitis (UC) development. However, the role and mechanism of circ_0085323 in UC occurrence have not been reported. Methods: Normal human colonic epithelial cells (NCM460) were treated with TNF-α to simulate UC-like cell inflammation and injury in vitro. The expression of circ_0085323, microRNA-495-3p (miR-495-3p), and TNF receptor-associated factor 3 (TRAF3) was detected by quantitative real-time polymerase chain reaction. Protein expression was checked by western blotting analysis. Cell viability, cell proliferation, and cell apoptosis were investigated by cell counting kit-8 assay, 5-ethynyl-29-deoxyuridine assay, and flow cytometry analysis, respectively. IL-1ß, IL-6, and IL-8 production were analyzed by enzyme-linked immunosorbent assays. Lactate dehydrogenase activity was assessed by a lactate dehydrogenase activity detection assay. The interactions among circ_0085323, miR-495-3p, and TRAF3 were identified by dual-luciferase reporter assay and RNA immunoprecipitation assay. Results: Circ_0085323 was overexpressed in the colonic mucosal tissues of UC patients and TNF-α-stimulated NCM460 cells. Circ_0085323 knockdown relieved TNF-α-induced inhibitory effect on the proliferation of NCM460 cells and promoting effects on cell apoptosis and inflammation. Circ_0085323 acted as a miR-495-3p sponge, and the effects of circ_0085323 silencing on TNF-α-induced NCM460 cell injury were attenuated by decreasing miR-495-3p expression. TRAF3 was targeted by miR-495-3p, and circ_0085323 combined with miR-495-3p to regulate TRAF3. TRAF3 depletion not only alleviated TNF-α-induced NCM460 cell damage but also partially revoked the effect of circ_0085323 silencing combined with miR-495-3p depletion on TNF-α-induced NCM460 cell injury. Conclusions: Circ_0085323 knockdown ameliorated TNF-α-induced NCM460 cell injury by regulating the miR-495-3p/TRAF3 axis, which suggested that circ_0085323 might be a therapeutic target for UC.

Kappa statistic considerations in evaluating inter-rater reliability between two raters: which, when and context matters.

BACKGROUND: In research designs that rely on observational ratings provided by two raters, assessing inter-rater reliability (IRR) is a frequently required task. However, some studies fall short in properly utilizing statistical procedures, omitting essential information necessary for interpreting their findings, or inadequately addressing the impact of IRR on subsequent analyses' statistical power for hypothesis testing. METHODS: This article delves into the recent publication by Liu et al. in BMC Cancer, analyzing the controversy surrounding the Kappa statistic and methodological issues concerning the assessment of IRR. The primary focus is on the appropriate selection of Kappa statistics, as well as the computation, interpretation, and reporting of two frequently used IRR statistics when there are two raters involved. RESULTS: The Cohen's Kappa statistic is typically utilized to assess the level of agreement between two raters when there are two categories or for unordered categorical variables with three or more categories. On the other hand, when it comes to evaluating the degree of agreement between two raters for ordered categorical variables comprising three or more categories, the weighted Kappa is a widely used measure. CONCLUSION: Despite not substantially affecting the findings of Liu et al.?s study, the statistical dispute underscores the significance of employing suitable statistical methods. Rigorous and accurate statistical results are crucial for producing trustworthy research.

Genetically encoded transcriptional plasticity underlies stress adaptation in Mycobacterium tuberculosis.

Transcriptional regulation is a critical adaptive mechanism that allows bacteria to respond to changing environments, yet the concept of transcriptional plasticity (TP) remains largely unexplored. In this study, we investigate the genome-wide TP profiles of Mycobacterium tuberculosis ( Mtb ) genes by analyzing 894 RNA sequencing samples derived from 73 different environmental conditions. Our data reveal that Mtb genes exhibit significant TP variation that correlates with gene function and gene essentiality. We also found that critical genetic features, such as gene length, GC content, and operon size independently impose constraints on TP, beyond trans-regulation. By extending our analysis to include two other Mycobacterium species -- M. smegmatis and M. abscessu s -- we demonstrate a striking conservation of the TP landscape. This study provides a comprehensive understanding of the TP exhibited by mycobacteria genes, shedding light on this significant, yet understudied, genetic feature encoded in bacterial genomes.

Comparison of Xpert MTB/RIF Ultra with Xpert MTB/RIF for the detection of Mycobacterium tuberculosis and rifampicin resistance in a primary-level clinic in rural China.

The Xpert MTB/RIF Ultra (Ultra) is not yet used for the diagnosis of tuberculosis (TB) in China. We compared the performance of the Xpert and Ultra for detecting Mycobacterium tuberculosis and rifampicin resistance in a primary-level clinic in rural China. Sputum samples from suspected pulmonary TB patients were collected and subjected to smear microscopy, liquid culture, Xpert and Ultra tests. We then compared the sensitivity and specificity of Xpert and Ultra for diagnosing TB against liquid culture. Whole-genome sequencing was performed to predict rifampicin resistance and the results were compared with the Xpert and Ultra tests. The sensitivities of Xpert and Ultra were 88.1% and 95.1%, and the specificities were 91.9% and 84.4%, respectively. Among the 61 smear-negative culture-positive patients, the sensitivities of Xpert and Ultra were 80.3% and 91.8%. All Xpert-positive patients were Ultra-positive. Among culture-negative Xpert or Ultra-positive patients, 69.6% were taking anti-TB drugs or had a previous history of TB. Of the samples that Ultra classified as trace, nearly 25% were probably false-positives. Both Xpert and Ultra accurately detected all rifampicin-resistant patients. In conclusion, Ultra was more sensitive than Xpert, especially for smear-negative patients but had decreased specificity with more false-positives, especially with Ultra trace results.

Surformer: An interpretable pattern-perceptive survival transformer for cancer survival prediction from histopathology whole slide images.

BACKGROUND AND OBJECTIVE: High-resolution histopathology whole slide images (WSIs) contain abundant valuable information for cancer prognosis. However, most computational pathology methods for survival prediction have weak interpretability and cannot explain the decision-making processes reasonably. To address this issue, we propose a highly interpretable neural network termed pattern-perceptive survival transformer (Surformer) for cancer survival prediction from WSIs. METHODS: Notably, Surformer can quantify specific histological patterns through bag-level labels without any patch/cell-level auxiliary information. Specifically, the proposed ratio-reserved cross-attention module (RRCA) generates global and local features with the learnable prototypes (pglobal, plocals) as detectors and quantifies the patches correlative to each plocal in the form of ratio factors (rfs). Afterward, multi-head self&cross-attention modules proceed with the computation for feature enhancement against noise. Eventually, the designed disentangling loss function guides multiple local features to focus on distinct patterns, thereby assisting rfs from RRCA in achieving more explicit histological feature quantification. RESULTS: Extensive experiments on five TCGA datasets illustrate that Surformer outperforms existing state-of-the-art methods. In addition, we highlight its interpretation by visualizing rfs distribution across high-risk and low-risk cohorts and retrieving and analyzing critical histological patterns contributing to the survival prediction. CONCLUSIONS: Surformer is expected to be exploited as a useful tool for performing histopathology image data-driven analysis and gaining new insights for interpreting the associations between such images and patient survival states.