Houston Community College System

The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory marker predicting cardiovascular mortality (CVM) and all-cause mortality (ACM). To investigate the association between the NLR and CVM and ACM in patients with peritoneal dialysis (PD). We reviewed articles from PubMed, Google Scholar, and Scopus until May 2024 for the association of ACM and CVM in patients with NLR following PD. We used a fixed effects model and I 2 statistics to pool hazard ratio (HR) and measure heterogeneity. Leave-one-out sensitivity analysis assessed the robustness of our study. Multivariate meta-regression (MMR) was utilized to identify influencing confounding factors. Joanna Briggs Institute (JBI) tool was used for quality assessment. Out of 160 articles screened, seven studies from 2011 to 2024 with 4350 patients, a mean age of 49.9 years ± 15 years, and a median follow-up of 4 years were included. We found that higher NLR (> 3) was significantly associated with ACM [adjusted HR (aHR): 1.18, 95%CI: 1.03-1.36, P = 0.016]. However, there was no significant association of NLR (> 3) with CVM (aHR: 1.16, 95%CI: 0.68-1.98, P = 0.59) in patients following PD. Sensitivity analysis showed no variations. JBI tool revealed low bias among the studies. MMR revealed a significant relationship between age and ACM (coefficient: 0.14, P = 0.04). Our meta-analysis identifies a significant association between NLR (> 3) and ACM outcome, which can help prevent deaths in the elderly and optimize resource use. Caution is needed when predicting mortality in this group as age significantly confounds ACM in patients undergoing PD.

Background: Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, increasingly prevalent worldwide. Type 2 diabetes mellitus (T2DM) is a major chronic disorder and a significant risk factor for AF, contributing to high morbidity and mortality. Metformin monotherapy can contribute to the reduced occurrence of adverse cardiovascular outcomes in patients with T2DM, but its effects on AF are understudied. This meta-analysis evaluates the association of metformin with the risk of incident AF among patients with T2DM on metformin. Methods: Databases, including PubMed, Google Scholar, and EMBASE, were screened through November 2024 for studies evaluating the association between metformin and new-onset AF in patients with T2DM. Comprehensive Meta-Analysis (CMA) version 4, by Biostat, Inc., utilizing a random effects model, was used to pool hazard ratios (HR) and 95% confidence intervals (CI). A meta-regression analysis was also performed to identify factors that may have influenced the results. A p-value < 0.05 was considered statistically significant. Results: A total of seven studies, comprising 4,017,929 patients with T2DM, having a mean age of 62.82 years and 52.5% males, were included. Metformin was associated with a statistically significantly lower risk of new-onset AF among patients with T2DM compared to other hypoglycemic agents (aHR: 0.85; 95% CI 0.76–0.94; p = 0.002). Meta-regression analysis identified age as a significant moderator of the treatment effect (β = −3.15, p = 0.001). Conclusions: Metformin is associated with a lower risk of new-onset AF among patients with T2DM compared to other hypoglycemic agents. Furthermore, age-related attenuation of this association was observed, with older patients with T2DM showing a weaker association.

Purpose Artificial intelligence (AI) has seen considerable growth recently and is denoted as an emerging technology, particularly in educational settings. This study aims to explain the students’ perceptions and behavioral factors in adopting AI. This paper utilized gender and country differences to explore the adoption patterns influenced by perceptual and behavioral factors, including AI literacy, AI anxiety, AI self-efficacy, relevance, and perceived enjoyment. Design/methodology/approach A survey was conducted on Malaysian students using purposive sampling. The finalized sample of 391 respondents was tested using MS Excel, SPSS and SmartPLS to obtain the results. Moreover, to observe the differences, this paper used multigroup analysis based on gender and country. Findings This paper found that the theoretical factors strongly influence the intention of students to adopt AI in higher education. AI anxiety, AI self-efficacy and perceived enjoyment affect ease of use (PEOU). AI literacy, PEOU, relevance and subjective norms influence perceived usefulness (PU). In addition, both PU and PEOU shape students’ attitudes and intentions to adopt AI in their learning. Originality/value The use of AI has garnered significant attention from both consumers and organizations. This study specifically focuses on students, shedding light on the perceptual, behavioral and social factors influencing AI adoption in higher education.

Background High-sensitivity cardiac troponins (Hs-cTns) are reliable indicators of myocardial injury, but their relationship with cardiovascular outcomes remains less understood. This study explores the association between adverse cardiac events and Hs-cTnT levels exceeding 14 ng/L in patients with stable CAD. Methods Thirteen pertinent studies were identified using specific keywords from a pool of 208 articles retrieved from PubMed, Scopus, and Google Scholar, spanning 2013 to 2023. The primary outcomes included all-cause mortality (ACM), myocardial infarction (MI), cardiovascular death (CVD), rehospitalization due to decompensated heart failure (RDHF), need for revascularization, and stroke. Comprehensive meta-analysis (CMA) was employed to analyze the data for odds ratios (OR) and 95% confidence intervals (CI). Heterogeneity was assessed using I2 statistics, and both qualitative assessment (Newcastle-Ottawa Scale) and quantitative analysis (Egger’s and Beggs test, funnel plots) were conducted. Results The analysis included 29,115 participants (74.72% male) with a mean age of 68.34 years. It revealed a significantly elevated risk of ACM among stable CAD patients with Hs-cTnT levels >14 ng/L compared to those with levels <14 ng/L (11.2% vs. 3.3%; OR = 5.46; 95% CI = 1.53–19.54; p = 0.009). Similarly, higher risks were observed for MI (10.9% vs 3.6%; OR = 3.12; 95% CI = 0.98–9.95, p = 0.053), CVD (8.1% vs. 2.1%; OR = 3.37; 95% CI = 1.74–6.50; p < 0.0001), and RDHF (6.62% vs. 0.92%; OR = 9.46; 95% CI = 4.65–19.24; p < 0.0001). Notably, major adverse cardiovascular events (MACE) exhibited a stronger association with Hs-cTnT levels (18.2% vs 7.81%; OR = 1.89; 95% CI = 0.80–4.43; I2 = 97%; p = 0.14) compared to Hs-cTnI levels (20.1% vs 21.1%; OR = 1.30; 95% CI = 1.03–1.64; I2 <0.0001%; p = 0.03). Conclusion Elevated levels of Hs-cTnT (>14 ng/L) are significantly associated with increased risks of RDHF and ACM in patients with stable CAD. Further large-scale prospective studies are warranted to refine risk assessment strategies and mitigate cardiovascular mortality in this population.

Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of death in the United States and is expected to be ranked second in the next 10 years due to poor prognosis and a rising incidence. Distant metastatic PDAC is associated with the worst prognosis among the different phases of PDAC. The diagnostic options for PDAC are convenient and available for staging, tumor response evaluation, and management of resectable or borderline resectable PDAC. However, imaging is crucial in PDAC diagnosis, monitoring, resectability appraisal, and response evaluation. The advancement of medical technologies is evolving, hence the use of imaging in PDAC treatment options has grown as well as the utilization of ctDNA as a tumor marker. Treatment options for metastatic PDAC are minimal with the primary goal of therapy limited to symptom relief or palliation, especially in patients with low functional capacity at the point of diagnosis. Molecular profiling has shown promising potential solutions that would push the treatment boundaries for patients with PDAC. In this review, we will discuss the latest updates from evidence-based guidelines regarding diagnosis, therapy response evaluation, prognosis, and surveillance, as well as illustrating novel therapies that have been recently investigated for PDAC, in addition to discussing the molecular profiling advances in PDAC.

Disparities exist in the length and quality of survival from melanoma. This study evaluated, in a Texas cohort, patient factors associated with melanoma survival and examined if newer immune-oncologic agents extend survival compared with conventional therapies. A retrospective analysis of patients diagnosed with metastatic melanoma from 2011 to 2018 in the Texas Cancer Registry database. Multivariable Cox proportional hazard regression was used to evaluate patient characteristics associated with cancer-specific survival (CSS) and overall survival (OS). The patient cohort was then grouped based on receipt of first-line immunotherapy or other therapies. The association between receipt of immunotherapy and survival was assessed with Kaplan-Meier analysis and inverse probability treatment weighted Cox regression. There were 1372 patients with metastatic melanoma. Factors associated with increased melanoma mortality risk (CSS) included being male (HR: 1.13, 95% CI: 1.02-1.26), non-Hispanic black (HR: 1.28, 95% CI: 1.13-1.45), living in poorer counties (HR: 1.40, 95%CI: 1.20-1.64), and having multimorbidity (HR: 1.35, 95% CI: 1.05-1.74). All minority races and Hispanics had poorer OS compared with non-Hispanic Whites. Patients who received first-line immunotherapy had significantly longer median (interquartile range) survival (CSS: 27.00 [21.00 to 42.00] mo vs. 16.00 [14.00 to 19.00] mo; OS: 22.00 [17.00 to 27.00] mo vs. 12.00 [11.00 to 14.00] mo). They also had reduced mortality risk (HR for CSS: 0.80; 95% CI: 0.73-0.88; P <0.0001; HR for OS: 0.76; 95% CI: 0.69-0.83; P <0.0001) compared with the nonimmunotherapy cohort. This study showed differences in risks from melanoma survival based on patient demographic and clinical characteristics. Low socioeconomic status increased mortality risk, and first-line immunotherapy use favored survival. Health policies and tailored interventions that will promote equity in patient survival and survivorship are essential for managing metastatic melanoma.