BACKGROUND: Spontaneous intracerebral hemorrhage (ICH) is associated with high case fatality and significant healthcare costs. Recent studies emphasize the critical role of nutritional status in affecting outcomes in neurological disorders. This study investigates the relationship between the Prognostic Nutrition Index (PNI) and in-hospital complications and case fatality among patients with ICH.
METHODS: A retrospective analysis was performed using data from the Changhua Christian Hospital Clinical Research Database between January 2015 and December 2022. Patients under 20 or over 100 years of age or with incomplete medical data were excluded. We utilized restricted cubic spline models, Kaplan-Meier survival analysis, and ROC analysis to assess the association between PNI and clinical outcomes. Propensity score matching analysis was performed to balance these clinical variables between groups.
RESULTS: In this study, 2402 patients with spontaneous ICH were assessed using the median PNI value of 42.77. The cohort was evenly divided between low and high PNI groups, predominantly male (59.1%), with an average age of 64 years. Patients with lower PNI scores at admission had higher in-hospital complications and increased 28- and 90-day case fatality rates.
CONCLUSIONS: Our study suggests that PNI could serve as a valuable marker for predicting medical complications and case fatality in patients with spontaneous ICH.

UNASSIGNED: External beam radiotherapy (EBRT), an adjuvant to breast-conserving surgery (BCS), requires a long treatment period, is costly, and is associated with numerous complications. Large sample studies with long follow-up periods are lacking regarding whether intraoperative radiotherapy (IORT), an emerging radiotherapy modality, can replace EBRT for patients with T1-2 early stage breast cancer without lymph node metastasis treated with BCS.
UNASSIGNED: We identified 270,842 patients with T1-2N0M0 breast cancer from 2000 to 2018 in the Surveillance, Epidemiology, and End Results (SEER) database. A total of 10,992 patients were matched by propensity score matching (PSM). According to the radiotherapy method, the patients were divided into the IORT and EBRT groups. Overall survival (OS) and breast cancer-specific survival (BCSS) rates were analyzed and compared between the IORT and EBRT groups by Kaplan-Meier analysis. Bilateral P < 0.05 was considered to indicate significance.
UNASSIGNED: After PSM, the survival analysis showed no significant differences in OS or BCSS rates between the IORT and EBRT groups. In the subgroup analysis, the IORT population diagnosed from 2010 to 2013 (HRs = 0.675, 95% CI 0.467-0.976, P = 0.037) or with T2 stage (HRs = 0.449, 95% CI 0.261-0.772, P = 0.004) had better OS rates, but in the overall population, the OS and BCSS rates were better in patients with T1 stage than in patients with T2 stage (P < 0.0001), and the proportion of chemotherapy was significantly higher in T2 stage than in T1 stage. Patients who had EBRT with unknown estrogen receptor had better OS rates (HRs = 3.392, 95% CI 1.368-8.407, P = 0.008). In addition, the IORT group had better BCSS rates for married (HRs = 0.403, 95% CI 0.184-0.881, P = 0.023), grade III (HRs = 0.405, 95% CI 0.173-0.952, P = 0.038), and chemotherapy-receiving (HRs = 0.327, 95% CI 0.116-0.917, P = 0.034) patients with breast cancer compared to the EBRT group.
UNASSIGNED: Intraoperative radiotherapy results of non-inferior OS and BCSS rates, compared to those of EBRT, in patients with early stage breast cancer without lymph node metastasis treated with BCS, and IORT may provide substantial benefits to patients as an effective alternative to standard treatment. This finding provides new insights into radiotherapy strategies for early stage breast cancer.

As an important endocrine hormone regulating glucose metabolism, fibroblast growth factor 21 (FGF21) is increased in individuals with gestational diabetes mellitus (GDM) after 24 gestational weeks. However, it is unknown whether the increase in FGF21 precedes the diagnosis of GDM.
In this nested case-control study, 133 pregnant women with GDM and 133 pregnant women with normal glucose tolerance (NGT) were identified through propensity score matching, and serum FGF21 levels were measured at 14 to 21 gestational weeks, before GDM is routinely identified. The differences in FGF21 levels were compared. The association between FGF21 and the occurrence of GDM was evaluated using logistic regression models with adjustment for confounders.
The serum FGF21 levels of the GDM group at 14 to 21 gestational weeks were significantly higher than those of the NGT group overall (P < 0.001), with similar results observed between the corresponding BMI subgroups (P < 0.05). The 2nd (OR 1.224, 95% CI 0.603-2.485), 3rd (OR 2.478, 1.229-5.000), and 4th (OR 3.419, 95% CI 1.626-7.188) FGF21 quartiles were associated with greater odds of GDM occurrence than the 1st quartile after multivariable adjustments.
The serum FGF21 levels in GDM groups increased in the early second trimester, regardless of whether participants were stratified according to BMI. After adjusting for confounding factors, the FGF21 levels in the highest quartile were associated with more than three times higher probability of the diagnosis of GDM in the pregnancy as compared to levels in the first quartile.