CS Score Research Articles

An Explainable Artificial Intelligence Model to Predict Malignant Cerebral Edema after Acute Anterior Circulating Large-Hemisphere Infarction

Introduction: Malignant cerebral edema (MCE) is a serious complication and the main cause of poor prognosis in patients with large-hemisphere infarction (LHI). Therefore, the rapid and accurate identification of potential patients with MCE is essential for timely therapy. This study utilized an artificial intelligence-based machine learning approach to establish an interpretable model for predicting MCE in patients with LHI. Methods: This study included 314 patients with LHI not undergoing recanalization therapy. The patients were divided into MCE and non-MCE groups, and the eXtreme Gradient Boosting (XGBoost) model was developed. A confusion matrix was used to measure the prediction performance of the XGBoost model. We also utilized the SHapley Additive exPlanations (SHAP) method to explain the XGBoost model. Decision curve and receiver operating characteristic curve analyses were performed to evaluate the net benefits of the model. Results: MCE was observed in 121 (38.5%) of the 314 patients with LHI. The model showed excellent predictive performance, with an area under the curve of 0.916. The SHAP method revealed the top 10 predictive variables of the MCE such as ASPECTS score, NIHSS score, CS score, APACHE II score, HbA1c, AF, NLR, PLT, GCS, and age based on their importance ranking. Conclusion: An interpretable predictive model can increase transparency and help doctors accurately predict the occurrence of MCE in LHI patients not undergoing recanalization therapy within 48 h of onset, providing patients with better treatment strategies and enabling optimal resource allocation.

Relationship between ocular surface pain and corneal nerve loss in dry eye diabetics: a cross-sectional study in Shenyang, China

BackgroundDiabetes mellitus has been associated with increased dry eye disease (DED) and exacerbates DED pathology.ObjectiveTo investigate the potential relationship between corneal nerve loss and ocular pain among diabetic patients with...

Radiological changes in shoulder osteoarthritis and pain sensation correlate with patients’ age

PurposeOsteoarthritis (OA) is one of the most common musculoskeletal disorders in the aging population. The correlation of radiographic OA severity, disability and pain is variable and inconsistent for the different joints. This study aims to elucidate the relationship between histological and radiological signs of shoulder OA with pain sensation and functional impairment to potentially adapt the recommendation for surgical treatment for primary total shoulder arthroplasty (TSA).MethodsForty-four patients with shoulder OA undergoing TSA using an anatomic stemless implant were included in this study. The radiological OA severity was scored pre-operatively on true ap X-rays according to the Kellgren–Lawrence score (KL-Score). Acromial types according to Bigliani were defined by pre-operative radiological images. The histological OA severity was determined according to the OARSI-Score using bone–cartilage sections from loaded areas of the humeral head. Pain was quantified using the visual analog scale (VAS). The functional status was assessed by the items “mobility” and “strength” out of the Constant–Murley score (CS Score). Demographic data including BMI, age, gender, diabetes mellitus and smoking were recorded.ResultsThere was no correlation between radiographic and histological severity in shoulder OA. However, a correlation of age and the severity of radiological changes was observed. Further, pain did not correlate with histological or radiological scores, whereas it correlated with age and the presence of diabetes mellitus. The functional shoulder status (mobility, strength) correlated with the severity of radiological changes, but not with the histologic scoring, which correlated with nicotine abuse.ConclusionThis study shows that increased age is the main determinant of radiological changes in shoulder OA, as well as pain. Therefore, age and pain sensation should be considered as important parameters for the recommendation for TSA.

Outcome of treatment with nebulized 3% hypertonic saline solution in infants hospitalized with moderate bronchiolitis

Bronchiolitis is the most common lower respiratory infectious disease in infants presenting with cough and/or wheeze and occurs most frequently in the winter months. Treatment of bronchiolitis by means of nebulization with inhaled corticosteroids and bronchodilator such as salbutamol or ipratropium bromide considered an effective method. Usually, 0.9% normal saline used together with the medications mentioned above. However, there are studies showing that 3% hypertonic saline might be a better choice compared with the normal saline. Objective: Our main aim of this study is to determine the improvement of patient’s condition by comparing the length of hospital stay and improvement in clinical severity score (CS score) in infants with moderate bronchiolitis nebulized with 3% hypertonic saline or 0.9% saline. Methods: 124 patients were arranged randomly to nebulize either 3% hypertonic saline with salbutamol plus budesonide (Group 1) or 0.9% saline with salbutamol plus budesonide (Group 2) three times per day until conditions were stable enough for discharge (with a CS score below 3). We recorded the SC scores of each patient before and after the first nebulization every day. Outcomes, considered mainly as ①differences in the length of hospital stay from admission to time taken to reach CS score < 3; ②the change in CS score after the first nebulization every day. A P value <0.05 was considered statistically significant. Results: 124 patients of them completed the study. Their mean age was 6.92±0.24 months (range, 3 to 12 months). The cases were diagnosed as moderate bronchiolitis with CS scores varying from 6 to 9. The mean length of hospital stay from admission to time taken to reach CS score <3 was 4.83 ±0.077 days for the whole subjects investigated, and it differed significantly between the two groups: 4.27±0.90 days in Group 1 and 5.39±0.610 days in Group 2. On the first day of treatment, the mean CS scores at baseline were 7.34±0.1 and 7.39±0.99 for Group 1 and Group 2, respectively. After the first nebulization, the CS scores decreased to 5.94±0.89 (SD-0.698) and 6.50±0.094 (SD 0.741) of Group 1 and Group 2, respectively. The P value in both groups were less than 0.001, indicating statistically differences between CS scores before and after nebulization by both groups of solutions in the treatment of moderate bronchiolitis. However, the differences of the mean values and standard deviation (SD) results after nebulization in the two groups suggested a better treatment outcome of 3% hypertonic saline with salbutamol plus budesonide than 0.9% normal saline. There were no significant differences between the respiratory rate, heart rate, saturation and add-on therapy in the two groups. No adverse events noted in both groups. Conclusion: The curative effect of 3% hypertonic saline group was significant better in comparison with the 0.9% normal saline group in terms of the improvement of CS score and length of hospital stay. In conclusion, 3% hypertonic saline is safe and effective in infants with moderate bronchiolitis.

Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease.

A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3, and mean BMI was 26 ± 5.5. Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2, 2 grade of incontinence and the CS score showed an average of 10 ± 3, 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients' great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure (47 ± 13 mmHg) and an increased volume to stimulate desire to defecate (197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value (37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.

Clinical Comparison of Laparoendoscopic Single-site Surgery and Multiport Laparoscopic Surgery for the Removal of Ovarian Endometrioid Cyst

Background: Endometriosis is a common, chronic gynecological disease. Laparoscopy is currently the preferred method of ovarian endometriosis. However, the safety and feasibility of laparoendoscopic single-site surgery for ovarian endometrioid cyst removal still need to be discussed. Objective: To explore the safety and feasibility of laparoendoscopic single-site (LESS) surgery versus conventional multiport laparoscopic (CMPL) surgery for the ovarian endometrioid cystectomy. Methods: We retrospectively analyzed the data of 47 patients who had undergone LESS and LESS ovarian cystectomy due to ovarian endometrioid cyst in our hospital from March 2018 to April 2019. The patients were classified into single-port group (14) and multiport group (33) based on surgical paths. The patients’ general characteristics and perioperative outcomes compared. Results: There were no significant statistical differences between the two groups (P>0.05) in the operation time and the maximum body temperature in 24 h after operation. There were significant statistical differences (all P<0.05) in postoperative decrease of Hb, intraoperative bleeding volume, total hospital stay and CS score. Conclusion: LESS for ovarian endometrioid cyst removal is safe and feasible, and it better than CMPL in relieving postoperative pain and inproving cosmetic effects and so on.

No need to use both Disabilities of the Arm, Shoulder and Hand and Constant–Murley score in studies of midshaft clavicular fractures

Background and purpose — Most newer randomized studies examining plate fixation and nonoperative treatment of midshaft clavicular fractures utilize both Disabilities of the Arm, Shoulder and Hand (DASH) and Constant–Murley score (CS) in the evaluation of patient outcomes. Compared with DASH, the use of CS requires on-site trained personnel and patient visits to obtain the score. The use of both DASH and CS should provide extra value compared with the use of a single functional outcome score; if this value is not provided, the combined use is not necessary. We evaluated the agreement between DASH and CS in patients with displaced midshaft clavicular fractures. Patients and methods — We used prospectively collected data from 146 patients enrolled in a randomized study comparing operative and nonoperative treatment of midshaft clavicular fractures. We determined correlation between DASH and CS at all follow-up points and calculated mean bias in the Bland–Altman plot. Results — We found moderate to high correlation (from 0.82 at 6 weeks’ follow-up to 0.58 at 1-year follow-up) between DASH and CS score, and a small bias (2.21 [95% CI 0.22–4.20]) in the Bland–Altman plot. Interpretation — In patients with displaced midshaft clavicular fractures DASH and CS measures the same degree of disability. Unless specifically studying strength and range of motion, we recommend the sole use of DASH as it would eliminate potential observer-induced bias along with removing the economic and logistic burden of obtaining CS without compromising the value of the collected data.

The relationship between morningness-eveningness and resilience in mood disorder patients

BackgroundThere is some evidence that resilience is related to mental illness. Patients with a mood disorder have a tendency to show eveningness, and they tend to be less resilient. However, no study has investigated the association between resilience and morningness-eveningness in patients with a mood disorder. The aim of this study was to explore whether morningness-eveningness is related to resilience in patients with a mood disorder. MethodsWe recruited 224 patients with major depressive disorder (MDD), 77 with bipolar disorder (BD), and 958 control participants. Morningness-eveningness and resilience were evaluated using the Composite Scale of Morningness (CS) and the Connor-Davidson Resilience Scale (CD-RISC), respectively. ResultsThe CD-RISC scores were significantly lower in patients with MDD, followed by those with BD, than those of the control group. The CD-RISC score was positively correlated with the CS score in patients with MDD and BD. Multiple linear regression analyses revealed that the CS score was significantly associated with the CD-RISC score after controlling for the possible influence of age, gender, length of education, economic status, onset age, and suicide attempt history in the MDD group. However, the association did not reach statistical significance in patients with BD. ConclusionsHigher resilience was positively correlated with morningness in patients with MDD or BD. In multiple regression analysis, a significant linear relationship was observed between resilience and morningness only in patients with MDD. The biological mechanism underlying the relationship between morningness-eveningness and resilience should be explored.

Two-staged application of PRP in arthroscopic rotator cuff repair: a matched-pair analysis.

Failure rates after arthroscopic rotator cuff repair remain high. Platelet-rich plasma has gained interest as a potential biological augmentation to enhance bone-tendon healing. The purpose of this study is to evaluate the clinical and structural outcomes of repeated PRP application on rotator cuff repair. Thirty-six patients underwent arthroscopic reconstruction, using knotless anchor double-row repair. Eighteen patients [10 female, 8 male; 61.2 (±9.2) years] received two applications of PRP-directly subsequent to the repair and 7days postoperatively. Eighteen patients [11 male, 7 female; 61.4 (±6.5) years] who solely received the same technique of rotator cuff repair were matched for age. The subjective shoulder value, WORC, and the Constant-Murley score were used for clinical evaluation. MRI was performed for tendon integrity, and cuff appearances were graded according to the Sugaya classification. We prospectively evaluated the PRP group with a minimum follow-up of 24 months. Clinical results did not show significantly differences in comparison to patients with isolated rotator cuff repair concerning CS (79±13 vs. 77±13; P=0.6), SSV (90±14 vs. 88±16; P=0.5) or WORC Score (90±18 vs. 86±20; P=0.2). At the final follow-up, MRI showed retears in 11% of the PRP and in 28% of the control group (P=0.4). Knotless-anchor double-row repair shows good to excellent clinical results with an acceptable retear rate. Additional two-staged PRP application failed to significantly improve clinical parameters. Even though there was a trend for lower retear rates in the PRP group, it did not achieve statistical difference. Level III, Retrospective comparative study.

Effectiveness of 3% hypertonic saline nebulization in acute bronchiolitis among Indian children: A quasi-experimental study.

Objective:To compare the effects of 3% hypertonic saline (HS) and 0.9% normal saline with nebulized 0.9% normal saline with salbutamol in patients of acute viral bronchiolitis.Materials and Methods:Participants were divided into three groups, that is, 3% HS group, 0.9% normal saline group and 0.9% saline with salbutamol group. Four doses at interval of 6 h were given daily until discharge. Average CS score and length of hospital stay were compared. One-way analysis of variance paired t-test and Chi-square test were utilized for statistical analysis.Results:The mean ages of the patients in three groups were 6.03 ± 3.71, 5.69 ± 3.34 and 5.48 ± 3.35 respectively. The 3rd day CS scores for all the groups were 1.0 ± 1.1, 1.9 ± 1.1 and 3.3 ± 0.5 respectively (P = 0.000). The average length of hospital stay was 3.4 ± 1.7, 3.7 ± 1.9 and 4.9 ± 1.4 days respectively (P = 0.001).Conclusion:The present study concludes that 3% HS nebulization (without additional bronchodilators) is an effective and safe treatment for nonasthmatic, moderately ill patients of acute bronchiolitis. The economic benefit of this comparably priced modality of treatment can be enormous in terms of hospital costs with parents returning to work sooner.

Nailfold videocapillaroscopy micro-haemorrhage and giant capillary counting as an accurate approach for a steady state definition of disease activity in systemic sclerosis.

IntroductionNailfold videocapillaroscopy (NVC) in systemic sclerosis (SSc) is a procedure commonly used for patient classification and subsetting, but not to define disease activity (DA). This study aimed to evaluate whether the number of micro-haemorrhages (MHE), micro-thrombosis (MT), giant capillaries (GC), and normal/dilated capillaries (Cs) in NVC could predict DA in SSc.MethodsEight-finger NVC was performed in 107 patients with SSc, and the total number of MHE/MT, GC, and the mean number of Cs were counted and defined as number of micro-haemorrhages (NEMO), GC and Cs scores, respectively. The European Scleroderma Study Group (ESSG) index constituted the gold standard for DA assessment, and scores ≥3.5 and =3 were considered indicative of high and moderate activity, respectively.ResultsNEMO and GC scores were positively correlated with ESSG index (R = 0.65, P <0.0001, and R = 0.47, P <0.0001, respectively), whilst Cs score showed a negative correlation with that DA index (R = −0.30, P <0.001). The area under the curve (AUC) of receiver operating characteristic plots, obtained by NEMO score sensitivity and specificity values in classifying patients with ESSG index ≥3.5, was significantly higher than the corresponding AUC derived from either GC or Cs scores (P <0.03 and P <0.0006, respectively). A modified score, defined by the presence of a given number of MHE/MT and GC, had a good performance in classifying active patients (ESSG index ≥3, sensitivity 95.1%, specificity 84.8%, accuracy 88.7%).ConclusionsMHE/MT and GC appear to be good indicators of DA in SSc, and enhances the role of NVC as an easy technique to identify active patients.

Retinal Nerve Fibre Layer Thickness and Contrast Sensitivity in HIV-Infected Individuals in South Africa: A Case-Control Study

BackgroundAntiretroviral treatment (ART) has altered the spectrum of HIV-related eye disease, resulting in a lower prevalence of retinal opportunistic infections (OIs). However, abnormalities in visual function have been reported in HIV-infected individuals despite effective viral suppression and the absence of retinal OIs. These changes may be mediated by an HIV-associated ‘neuroretinal disorder’, characterized by changes in the retinal nerve fibre layer (RNFL). HIV infection may also be associated with accelerated biological aging. The aim of this study was to investigate the relationships between contrast sensitivity, RNFL thickness, HIV infection and frailty in South African adults.MethodsCase-control study of 225 HIV-infected individuals without retinal OIs and 203 gender/age-matched HIV-seronegative individuals. Peri-papillary RNFL thickness was determined with spectral domain optical coherence tomography in four quadrants. CS was measured using a Pelli-Robson chart. Frailty was assessed using standard criteria. Multivariable linear and logistic regression were used to assess associations between HIV status and RNFL/CS and frailty.ResultsThe median age of both groups was similar (41.2 vs. 41.9 years, p = 0.37). 88% of HIV-infected individuals were receiving ART and their median CD4 count was 468 cells/μl. Adjusted CS score was lower in HIV-infected participants compared to HIV-seronegative individuals (1.76 vs. 1.82, p = 0.002). Independent predictors of poor CS in the HIV-infected group were positive frailty status and current HIV viral load >2 log copies/ml. Lower CS score was also associated with thin temporal RNFL in HIV-infected individuals (p = 0.04). Superior quadrant RNFL thickness was greatest in ART-naïve participants relative to the HIV-uninfected group (p-trend = 0.04). Longer ART duration was associated with thinning of inferior and nasal RNFL quadrants (p-trend = 0.03 and 0.04, respectively).ConclusionsContrast sensitivity is reduced in HIV-infected individuals and functionally associated with frailty and unsuppressed viraemia. This may reflect structural changes in the RNFL that are evident despite the absence of OIs.

Su1301 Impact of Infection Type, Acute Kidney Injury, and Systemic Inflammatory Response Syndrome on Survival of Cirrhotic Patients With Bacterial Infections: A Population-Based Cohort Study

G A A b st ra ct s patients has not been examined. The objective of this analysis was to assess the efficacy and tolerability of rifaximin in maintaining remission from HE in cirrhotic patients with HCV. Methods: Breakthrough HE events and tolerability were assessed from a 6-month, randomized, double-blind, placebo-controlled trial of RFX 550 mg BID in cirrhotic patients (n= 299) with a recent history of recurrent HE but in remission at enrollment (Conn Score [CS], 0 or 1). Breakthrough overt HE was defined as an increase in CS to ≥2, or an increase in both CS and asterixis score of 1 grade each for patients entering with a CS of 0. Lactulose was permitted throughout the study. The incidence of adverse events (AEs) was reported. Results: HCV was the etiology of advanced liver disease in 42.8% (128 of 299) of patients. Demographic and baseline characteristics were generally similar between HCV and nonHCV patients. In HCV patients, breakthrough HE events occurred in 26.2% (16 of 61) of RFX patients vs. 47.8% (32 of 67) of PBO patients, corresponding to relative reduction in risk of a breakthrough HE episode of 52.2% (Figure, P=0.014). In cirrhotic patients with other etiologies (eg, alcohol-related, NAFLD/NASH), there were also significant treatmentrelated differences, with 19.0% (15 of 79) of RFX patients experiencing a breakthrough HE event vs. 44.6% (41 of 92) of PBO patients (P,0.001). In HCV patients, the most commonly reported AEs were nausea (RFX:18.0% of patients, PBO:19.4% of patients), fatigue (RFX:14.8%, PBO:13.4%), and peripheral edema (RFX:14.8%, PBO:7.5%). Conclusions: In patients with HCV and recurrent HE, RFX was efficacious and well-tolerated, with a clinical profile similar to that observed for cirrhotic patients with other etiologies of advanced liver disease.