BACKGROUND:The blood Urea-to-Creatinine Ratio (UCR) is one of the most readily available markers for differentiating the etiology of acute kidney injury and has long been emphasized in textbooks and review articles. Nevertheless, its diagnostic accuracy has not yet been systematically evaluated. METHODS:We searched PubMed, Embase, and the Cochrane Library through May 2025. The diagnostic performance of the UCR for (1) Pre-renal azotemia/transient AKI and (2) Non-dialysis-requiring AKI was extracted and evaluated. A diagnostic accuracy meta-analysis was conducted using a bivariate model. We also compared the diagnostic accuracy of fractional excretion of sodium with UCR to predict pre-renal azotemia/transient AKI. RESULTS:We identified 9 studies comprising 10 independent cohorts with a total of 16,412 participants. For pre-renal azotemia/transient AKI, the UCR demonstrated a pooled sensitivity of 0.74 (95% CI 0.43-0.91) and specificity of 0.52 (95% CI 0.21-0.82), with an AUC of 0.69. For non-dialysis-requiring AKI, the UCR showed a pooled sensitivity of 0.49 (95% CI 0.44-0.55) and specificity of 0.71 (95% CI 0.64-0.77), with an AUC of 0.63. Substantial heterogeneity was observed, and the certainty of evidence was rated low to very low. CONCLUSIONS:Based on currently available evidence, despite its long-standing role in textbooks and review articles, UCR demonstrates limited diagnostic accuracy for differentiating AKI etiologies and identifying non-dialysis-requiring AKI. Its clinical utility should be interpreted with caution given the substantial heterogeneity and low certainty of evidence, and it may be more appropriate to use UCR in combination with, or in place of, other traditional indices or novel biomarkers.
Background The Enriched Enrolment Randomized Withdrawal (EERW) design has been widely employed under various names across multiple disease areas. The methodology underlying these trials remains subject to ongoing discussion. A review of the literature identified key criticisms associated with the EERW design, notably the Open-Label Effect (OLE) resulting from the initial Open-Label (OL) phase and the Selection Effect (SLE) arising from selecting responders at the conclusion of the OL period. The aim of this study was to quantify these effects using historical data and to propose a straightforward approach to mitigate their impact. Methods Based on proposals to estimate SLE and OLE effects, we conducted a retrospective analysis on a sample of 42 EERWs studies in various disorders and pathologies. Results The OLE effect was confirmed with a highly significant additional increase of the main final endpoint (Standardized effect βstd = 0.567, p < 0.001). Likewise, the SLE was observed with a smaller but significant effect (βstd = 0.263, p = 0.028). Adding OLE and SLE effects in the covariance model assessing the significance of the studied treatment effect provided a highly significant increase of the determination coefficient ΔR2 = 0.380 (p < 0.001) reducing the residual variability of the model. The treatment effect was not significantly affected by these effects (p > 0.150). Conclusion While EERW designs are widely utilized, the impact of the Open-Label (OL) phase on statistical outcomes remains under-addressed. This study quantifies two distinct and specific OLE and SLE effects increasing the residual variability and reducing the precision of the studied treatment estimate. By incorporating these effects as adjustments within the primary inferential model, researchers can mitigate extraneous noise and improve the precision and robustness of EERW trial results.
Background Percutaneous Transhepatic Gallbladder Drainage (PTGBD) serves as a bridge therapy for moderate-to-severe cholecystitis. However, Laparoscopic Cholecystectomy (LC) after PTGBD is frequently complicated by chronic inflammation and fibrosis. Currently, predictive tools for difficult surgery in this population are limited, and none have integrated multidimensional parameters including novel imaging metrics and psychological assessments. Methods We retrospectively analyzed 150 patients who underwent LC after PTGBD between September 2018 and May 2025. After excluding 43 patients (22 with missing data, 21 with combined procedures), 107 were included. Using univariate and multivariate logistic regression, we developed a nomogram incorporating five-dimensional preoperative parameters: 1) Baseline clinical characteristics, 2) CT imaging features, 3) PTGBD-related surgical parameters, 4) Laboratory indicators, and 5) Psychological assessments. Difficult surgery was defined by Tokyo Guidelines (TG18) criteria: operative time > 110 min, blood loss > 150 mL, or conversion to open surgery (including subtotal cholecystectomy or fundus-first technique). Results Multivariate analysis identified four independent predictors: elevated C-reactive protein (CRP > 8.2 mg/L; OR = 4.21, p = 0.011), pericholecystic fluid (OR = 60.93, p < 0.001), gallbladder-duodenal adhesion index (GDAI > 0.7; OR = 4.00, p = 0.015), and increased Calot's triangle CT attenuation (HU > 30; OR = 5.82, p < 0.001). The nomogram demonstrated excellent discrimination (AUC = 0.903), significantly outperforming individual predictors (p < 0.001). Conclusions The model enables precise risk stratification, which could potentially guide clinical decisions and improve surgical outcomes.
Purpose To investigate whether the survival benefits of Leisure-Time Physical Activity (LTPA) among cancer survivors depend on total weekly volume, frequency of sessions, or proportion of vigorous-intensity activity. Methods We analysed data from 3362 cancer survivors aged ≥ 20-years in the National Health and Nutrition Examination Survey (NHANES) 2007–2018, linked to mortality data through December 2019. LTPA was self-reported via the Global Physical Activity Questionnaire and categorized as inactive (< 150 min/week) or active (≥ 150 min/week). The active group was further stratified by session frequency (1‒2, 3‒4, ≥ 5 week) and vigorous-intensity proportion, defined as doubled vigorous minutes divided by total equivalent LTPA minutes (< 50%, ≥ 50%). Weighted Cox proportional hazards models estimated Hazard Ratios (HRs) for all-cause mortality, adjusting for sociodemographic, lifestyle, and clinical covariates. Results Over a mean follow-up of 6.0-years, 856 deaths occurred. Meeting activity guidelines was associated with a 45% lower risk of all-cause mortality (HR = 0.55; 95% CI 0.43‒0.71). Among active participants, exploratory analyses suggested similar inverse associations across activity frequency categories and proportions of vigorous-intensity activity. Associations did not differ by age, sex, or marital status. Conclusion Adherence to physical activity guidelines was associated with lower all-cause mortality among cancer survivors. Exploratory findings suggest that survival benefits may be achieved through a range of activity frequency and intensity patterns, supporting flexible approaches to physical activity promotion in survivorship care.
Introduction Tinnitus is any perception of sound that occurs in the absence of an external auditory stimulus. Donepezil, commonly prescribed for dementia, has not yet been evaluated in individuals with tinnitus. By increasing synaptic availability of acetylcholine, a neurotransmitter widely distributed in the central nervous system and potentially neuroprotective against glutamate induced excitotoxicity, donepezil may offer a pharmacological approach for the management of this condition. Methodology We conducted a double-blind, prospective, randomized controlled trial with a sample of 35 each in a chronic subjective, non-somatosensory tinnitus group and an age- and gender-matched control group. Participants received either donepezil or a placebo for 3-months. Treatment effects were monitored using scales and questionnaires: THI, VAS, CDR, MMSE; and psychoacoustic measurements of tinnitus. Results No statistically significant difference in symptom improvement was observed between the donepezil and placebo groups as assessed by the evaluation instruments. Notably, analysis of confidence intervals for patients achieving a minimum improvement of ≥ 7 and ≥ 11-points in THI scores suggested a potential clinically meaningful trend favoring donepezil. Additionally, complete remission of tinnitus was observed in a single patient, occurring only in the donepezil group. Conclusion In the present double-blind, randomized, placebo-controlled clinical trial, no statistically significant difference was identified between the groups regarding the primary outcome. However, the donepezil-treated group demonstrated better performance than the placebo group, and a possible indication of greater clinical benefit was observed in the treatment group in those using amplification, suggesting a potential therapeutic relevance, but larger, more in-depth studies are needed to confirm our findings.
Background The etiology of Bilateral Vestibulopathy (BVP) is complex. Given the close association between vitamin D and various vestibular disorders, including benign paroxysmal positional vertigo and vestibular neuritis, this study aims to investigate the relationship between serum vitamin D levels and BVP. Methods This single-center retrospective case-control study included 35 patients with BVP and 70 age- and sex-matched healthy controls (HC). Demographic information, clinical data, including 25-Hydroxyvitamin D (25(OH)D) levels, and vestibular assessment results were collected. Results Serum 25(OH)D levels were significantly lower in the BVP group than in the HC group (18.58±5.80 vs. 24.25±5.91 ng/mL, p < 0.001). Insufficient or deficient vitamin D levels were observed in 97.14% of patients in the BVP group (deficiency, 60.00%; insufficiency, 37.14%). No significant association was found between vitamin D insufficiency or deficiency and the disease duration, season of visit, residential latitude, or underlying medical conditions in patients with BVP. Binary logistic regression analysis showed that serum 25(OH)D levels were associated with BVP, with an odds ratio of 0.846 (95% CI 0.765–0.935; p = 0.001). Conclusion Serum 25(OH)D levels were significantly lower in patients with BVP than in HC, suggesting an association between vitamin D insufficiency/deficiency and BVP.
Background The Glucose-to-Lymphocyte Ratio (GLR) reflects metabolic-immune status, but its association with mortality in the general population remains unclear. Methods We analyzed 22,120 adults from NHANES (1999–2016) with complete data on glucose, lymphocytes and mortality. Associations between log₂-transformed GLR and all-cause or Cardiovascular Disease (CVD) mortality were evaluated using multivariable Cox models. Nonlinear dose–response relationships were assessed with restricted cubic splines, and survival differences visualized with Kaplan-Meier curves. Model performance was compared using ROC curves and DCA for inflammatory markers, while NRI and IDI were calculated based on the Framingham risk model. Results Higher GLR was associated with older age, comorbidities, and increased mortality over a median follow-up of 122-months. Fully adjusted models showed associations with all-cause (HR = 1.33, 95% CI 1.25–1.42) and CVD mortality (HR = 1.51, 95% CI 1.36–1.66). Dose–response analyses indicated J-shaped curves with exploratory, cohort-specific inflection points at GLR ≈46 (all-cause) and ≈49 (CVD). GLR showed comparable or slightly better discrimination (AUC 67.5%‒67.7%) than individual inflammatory markers. When added to the Framingham model, GLR provided modest improvements in reclassification indices (NRI and IDI). E-values, subgroup and sensitivity analyses, and competing risks models showed the model was robust. Conclusion In this study, elevated GLR was associated with higher all-cause and CVD mortality in a J-shaped manner. While these findings suggest GLR may be a composite metabolic-immune marker worthy of further investigation, its clinical utility remains uncertain and requires external validation.
Objective To synthesize forensic autopsy findings reported in femicide and to evaluate their contribution, limitations, and appropriate use in medico-legal classification. Methods A structured narrative review was conducted in PubMed/MEDLINE, SciELO, and ScienceDirect for publications from January 2000 to March 2026. Search terms addressed femicide, gender-related homicide, forensic pathology, autopsy, injury patterns, and forensic evidence. Sources providing forensic, autopsy, injury-pattern, or analytical medico-legal data were included in the main synthesis. Epidemiological and public health studies were retained only for contextual interpretation. Results Ten forensic or analytical sources were retained for the main narrative synthesis, and ten epidemiological or public health sources were retained for contextual framing. Recurrent findings included overkill, craniofacial and cervical injuries, asphyxial mechanisms, defensive wounds, and weapon-specific patterns. However, these findings were non-specific and did not reliably distinguish intimate partner femicide from non-intimate partner femicide. The Belgrade autopsy series reinforced the importance of domestic setting and firearm use while showing substantial overlap in injury morphology between femicide subtypes. Conclusion Femicide is associated with a recognizable but non-specific forensic profile. Morphology alone cannot establish gender-related motivation or legal classification. Expert interpretation should integrate autopsy findings with crime-scene reconstruction, victim-perpetrator relationship, prior violence, weapon access, and sociobehavioral context. Standardized documentation and integrated medico-legal frameworks may improve forensic consistency, judicial communication, and public health surveillance.
Background Antineutrophil Cytoplasmic Antibody (ANCA) – Associated Vasculitis (AAV) is a rare systemic small-vessel vasculitis in which renal involvement is a major determinant of morbidity and survival. Despite therapeutic advances, many patients still present with advanced kidney disease. Data from Southeast Europe remain limited. Methods We conducted an 11-year retrospective observational study of adult patients with AAV and renal involvement treated at national nephrology center in North Macedonia. Demographic, clinical, laboratory, treatment, and outcome data were analyzed. Predictors of mortality were evaluated using Cox proportional hazards models, while renal outcomes were assessed using Fine-Gray competing risk regression with death treated as a competing event. Results Forty-two patients were included (57.1% male; mean age 56.5 ± 14.9 years). Renal involvement was severe at presentation, with a mean eGFR of 26.2 ± 16.4 mL/min/1.73 m2 corresponding to CKD stage G4. Pulmonary involvement was observed in 71.4%, whereas 21.4% had renal-limited disease. During follow-up, 27 patients (64.3%) progressed to RRT and 17 (40.5%) died. Median overall survival was 84.0-months (95% CI 57.4–110.6). In multivariable Cox regression, older age independently predicted mortality (HR = 1.05, 95% CI 1.01–1.10). In multivariable Fine-Gray competing risk analysis, lower baseline eGFR independently predicted progression to ESRD (sHR 0.96 per/mL/min/1.73 m2 increase, 95% CI 0.93–0.99), whereas pulmonary involvement was not independently associated with either outcome. Conclusion This first national cohort from North Macedonia confirms that AAV with renal involvement presents with advanced kidney dysfunction, a compressed time to RRT, and substantial early mortality. Baseline renal function remains the dominant determinant of renal outcome, underscoring the need for earlier diagnosis and structured referral pathways.
Objective The American Society of Anesthesiologists (ASA) physical status classification system is a preoperative evaluation regarding the risk of anesthesia during surgery. We investigated associations of ASA scores with postoperative Patient-Reported Outcome Measures (PROMs) and long-term survival rate in patients undergoing vertebroplasty. Methods We retrospectively identified patients undergoing vertebroplasty for vertebral compression fractures from 2018 to 2020. PROMs were assessed using the Oswestry Disability Index (ODI) and EuroQol-5D (EQ-5D) prior to surgery and at postoperative follow-up. Patients were categorized by preoperative ASA scores (≤ 2 vs. ≥ 3). Between-group differences in postoperative changes of PROMs were compared. All-cause mortality was confirmed through March 2022. The association of ASA classification with all-cause mortality was examined using Cox-proportional hazard models. Results A total of 199 patients were analyzed (ASA ≤ 2, n = 95; ASA ≥ 3, n = 104). Patients with an ASA ≤ 2 experienced a greater improvement in ODI (mean [SD] -35.8 [18.7] vs. -25.5 [17.4], p = 0.001) and EQ-5D (mean [SD] 0.42 [0.22] vs. 0.33 [0.26], p = 0.042) at 12-month follow-up than those having an ASA ≥ 3. After a median follow-up of 2.2-years, patients having a higher ASA score (≥ 3 vs. ≤ 2) experienced a greater risk of all-cause mortality (HR = 3.315, 95% CI 1.330 to 8.258, p = 0.010). Conclusion A lower ASA score (≤ 2 vs. ≥ 3) was associated with a greater improvement in PROMs and better long-term survival after vertebroplasty for compression fractures. ASA classification may help identify high-risk patients, even in less invasive surgeries.
BACKGROUND:Accurate estimation of Low-Density Lipoprotein Cholesterol (LDL-C) is critical for cardiovascular risk assessment. Traditional equations like Friedewald often underperform, especially in patients with high triglyceride levels. This study compares the performance of Machine Learning (ML) algorithms with conventional equations for LDL-C estimation. METHODS:A retrospective analysis was conducted using 96,492 lipid profiles from Dubai Health. LDL-C was directly measured for triglycerides > 400 mg/dL and estimated using Friedewald, Martin-Hopkins, and Sampson equations for TG < 400 mg/dL. ML models, Random Forest, XGBoost, Neural Network, k-Nearest Neighbors (k-NN), and Bayesian Ridge, were trained using total cholesterol, HDL-C, and triglycerides as predictors. RESULTS:Machine learning models demonstrated higher statistical agreement with directly measured LDL-C than conventional equations in patients with triglyceride levels < 400 mg/dL. Model performance declined substantially in hypertriglyceridemia subgroups (> 400 mg/dL), with increased prediction error across all approaches. CONCLUSION:Machine learning-based LDL-C estimation shows improved agreement with routinely reported direct LDL-C values under specific triglyceride conditions. However, performance limitations in hypertriglyceridemia and the absence of external validation indicate that ML approaches should be considered complementary rather than replacement methods.
Background Olfactory Dysfunction (OD) is a prevalent neurological sequela of Coronavirus Disease 2019 (COVID-19) and substantially impairs quality of life. Although multiple pharmaceutical and non-pharmaceutical interventions have been proposed, their relative efficacy remains controversial. This study aimed to compare the efficacy of existing interventions for post-COVID-19 OD. Methods PubMed, Embase, the Cochrane Library, and Web of Science databases were systematically searched up to July 31, 2025. Randomized Controlled Trials (RCTs), cohort studies, and non-RCT studies evaluating interventions for post-COVID-19 OD were included. Study quality was assessed using the National Institutes of Health (NIH) scale and the Newcastle-Ottawa Scale (NOS). Data were analyzed using RStudio and Stata. The interventions were ranked by Surface Under the Cumulative Ranking (SUCRA) values. Results A total of 44 studies involving 3,516 patients and 26 interventions were included, with overall moderate to high quality. Chelators (Standardized Mean Difference [SMD = 3.61], 95% Credible Interval [CrI]: 2.77, 4.55) significantly improved total olfactory scores and their subdomains (with SUCRA values of 98.2%). Platelet-rich plasma (SMD = 1.33, 95% CrI: 0.92, 1.74) markedly improved the results of the University of Pennsylvania Smell Identification Test (UPSIT). Corticosteroids substantially improved olfactory function, as revealed by the Visual Analogue Scale (VAS) (SMD = 1.99, 95% CrI: 0.52, 3.48). Functional Septorhinoplasty (FSPR) demonstrated superior improvement in sinonasal-related quality of life, as measured by the 22-item Sino-nasal Outcome Test (SNOT-22) (SMD = -1.06, 95% CrI: -1.91, -0.21). Conclusion Chelators and chelators combined with other interventions demonstrated benefit in improving post-COVID-19 olfactory function, offering new directions for multi-target therapies. Further high-quality RCTs are required to confirm these findings.
Background Cardiac Arrest (CA) often leads to Acute Kidney Injury (AKI), presenting a major health issue. This study aims to develop and validate machine learning models predicting 30-day mortality in CA patients with AKI. Methods A retrospective study was conducted on 1,121 adult ICU patients diagnosed with CA and AKI using data from the MIMIC-IV database. Data from 2008‒2016 (n = 900) formed the training cohort, while 2017‒2019 data (n = 221) served as the temporal validation cohort. Feature selection utilized LASSO regression, followed by the application of six machine learning algorithms. Model performance was evaluated using ROC curves, calibration curves, and decision curve analysis, with comparisons made against the APACHE II and SOFA scores. Results Seven key features were identified, namely, APACHE II score, lactate, anion gap, RDW, oliguria, norepinephrine, and temporary pacemaker implantation. The LASSO-Logistic Regression (LASSO-LR) model demonstrated the most stable performance in validation (AUROC = 0.751), significantly outperforming APACHE II (0.583, p < 0.001) and SOFA (0.660, p = 0.009), with a Brier score of 0.209. SHAP analysis revealed oliguria and RDW as the most significant predictors. Conclusions The LASSO-LR model offers a modest but statistically significant improvement over conventional scoring systems for predicting 30-day mortality in patients with CA and AKI, with acceptable calibration and interpretability. However, the clinical meaningfulness of this incremental benefit requires prospective validation before clinical implementation.
Background The accurate and timely diagnosis of Non-ST Elevation Myocardial Infarction (NSTEMI) in early presenter is important to reduce false negative cases. We aimed to discern the diagnostic cut-off of high-sensitive cardiac Troponin I (hs-cTnI) in early presenters who lack preexisting cardiac morbidity. Method This is a record-based study in which we included data from 457 patients who presented to emergency care with symptoms suggestive of suspected Acute Coronary Syndrome (ACS). We calculated sensitivity and Negative Predictive Value (NPV) for rule out and specificity and Positive Predictive Value (PPV) to rule in NSTEMI at various cut-off levels of hs-cTnI. In addition, we used binary logistic regression to identify the best predictor for NSTEMI diagnosis. Result We observed 91% sensitivity and 79% NPV at a baseline hs-cTnI level below 2 ng/L. However, this was insufficient to rule out NSTEMI. In addition, we found 1-hour delta (absolute delta) hs-cTnI to be the best predictor of NSTEMI. To rule in NSTEMI, specificity was 95%, and PPV was 77% at 4 ng/L 1-hour delta hs-cTnI. The Area Under Curve (AUC) in the Receiver Operating Characteristic (ROC) was 0.796 (p-value = 0.001) for 1-hour delta hs-cTnI. Conclusion In early presenters without prior heart disease, a single baseline hs-cTnI measurement below 3 ng/L provided 86% NPV, but this was insufficient for safe rule-out, confirming that serial sampling is necessary. Standard 99th percentile cut-offs performed poorly in this population. Incorporation of a 1-hour delta assessment improved diagnostic discrimination. Further, even a low 1-hour delta hs-cTnI (4 ng/L) can rule in NSTEMI. However, due to nature of this pilot study, our 4 ng/L rule-in criterion needs to be validated in further studies before being used in the clinics.
Introduction The optimal surgical management of Lymph Nodes (LNs) following Neoadjuvant Systemic Therapy (NACT) remains a subject of clinical debate. Targeted Axillary Dissection (TAD) aims to improve staging accuracy by identifying the initially metastatic node. The prerequisite for TAD is the identification of the initially most prominent pathological nodule in the axilla before the start of treatment. Methods This study presents a retrospective observational study of breast cancer after Neoadjuvant Systemic Therapy (NACT), from 2021 to 2024. The study primarily focused on the diagnosis of LN conditions and the surgical procedures performed. This study included n = 58 female patients with biopsy-proven cN1 breast cancer. Results The patients with initially positive axillary LNs were evaluated. Before the start of NACT, the biopsy of the pathological node was performed and also labeled with a Magseed magnetic marker. After NACT, a standard sentinel lymph node protocol was performed with preoperative lymphoscintigraphy with Technetium colloid. Significantly, there was never a case in which a labeled node was negative while metastases were in other nodes. In 4/58 (6.9%) cases, the common sentinel nodes were negative, while the labeled TAD node was positive. Conclusion The labeled node appears to represent the status of LNs more accurately after NACT than conventional ones. The metastatic nodes can be spared with axillary dissection using neoadjuvant treatment and TAD; however, the long-term oncologic outcomes of this approach are not yet reliably known.
Background The home exercise programme is a treatment method that ensures the continuity of rehabilitation after discharge. Although it is known that home exercise programmes improve recovery in patients compared to those who do not exercise at all in different diseases, it is not known which home exercise programme is more effective in donors after organ transplantation. Methods A total of 117 donors were included in the study. The participants were randomly divided into three groups: control, home exercise, and video-based exercise groups. While no intervention was made to the control group, the individuals in the other groups were asked to perform the exercises twice a week for 8-weeks, for a total of 16 sessions. The evaluations were performed twice in the hospital environment, before and after the exercise. Results The initial test results showed that the data for the groups were similar. In all measurements, a significant difference occurred between the first and second test scores in all three groups (p < 0.05). When comparing the changes in the groups, the brochure-based home exercise group showed a greater increase in the 6-minute walk test score compared to the control group, while the improvement rates in the video-based exercise group were superior to the other two groups in all data except for the non-dominant quadriceps femoris muscle strength (p < 0.05). Conclusion Home exercise enhances recovery in donor rehabilitation after liver transplantation. When different home-based exercise programs were compared, the video-based exercise program was more effective than the standard brochure-based exercise program.
BACKGROUND:This study aimed to develop and validate prognostic models for Lymph Node (LN)-negative pancreatic cancer patients. METHODS:Data were extracted from the SEER database (2004‒2015). The included participants were randomly divided into training (70%) and validation (30%) sets. Independent prognostic factors for Overall Survival (OS) and Cancer-Specific Survival (CSS) were identified using Cox and Fine-Gray models to construct predictive nomograms for 1-, 3-, and 5-year outcomes. RESULTS:Among 5970 included patients, 4270 deaths occurred. The nomogram for OS included 11 variables and the nomogram for CSS included 10. For OS, the C-indices in the training and validation cohorts were 0.740 (95% CI 0.722-0.758) and 0.740 (95% CI 0.712-0.768), respectively. Similarly, the C-indices for CSS were 0.737 (95% CI 0.719-0.756) and 0.736 (95% CI 0.708-0.764), respectively. The AUCs for 1-, 3-, and 5-year OS were 0.794 (95% CI 0.770-0.818), 0.819 (95% CI 0.800-0.839), and 0.836 (95% CI: 0.816-0.855). Meanwhile, the AUCs for 1-, 3-, and 5-year CSS were 0.796 (95% CI: 0.781-0.812), 0.829 (95% CI: 0.816-0.841), and 0.850 (95% CI: 0.838-0.862), indicating strong predictive performance. Calibration curves confirmed good accuracy. Competing risk analysis showed conventional methods overestimated CSS, supporting the accuracy of the Fine-Gray model. CONCLUSION:We developed and internally validated two clinically practical nomograms for OS and CSS for patients with LN-negative pancreatic cancer. These models show favorable discrimination and calibration, enabling clinical risk stratification and prognosis assessment. Future external validation using independent cohorts is needed to confirm the generalizability of these models.
Chronic Kidney Disease (CKD) has a global impact on morbidity and mortality, affecting disproportionately Afro-descendants with a risk of 4 to5 times higher compared to non-Afro-descendants. The increased risk is driven by both socioeconomic and biological factors, highlighting the role of APOL1 as a pragmatic example of this scenario. Carriers of the high-risk genotype (two risk alleles) are approximately three times more likely to develop CKD and experience more severe disease progression. Despite the high impact on Afro-descendant health, few studies of APOL1 kidney disease investigated the impact in admixed populations. In this integrative review, we evaluate APOL1 kidney disease globally, with a focus on the Brazilian population. We conducted a comprehensive search on PubMed, Lilacs, and Scielo databases. Publications in English, Spanish, and Portuguese were included, covering the period from the identification of APOL1 G1 and G2 variants in 2010 through October 2025. The initial search found 831 articles, after screening and full-text assessment based on predefined inclusion criteria which only includes original research on African or Afro-descendant populations, 306 articles were included and analyzed. In total, ten Brazilian articles were identified. Brazilian studies highlighted the prevalence of APOL1 risk variants, revealing the presence of G1 and G2 alleles in Afro-Brazilians and their significant role in the onset of CKD, lupus nephritis, and early kidney replacement therapy. The limited number of studies conducted within the Brazilian population underscores an urgent need for further research to tailor strategies in public health policies of APOL1 kidney disease on Afro-Brazilian and admixture populations.
