Current Scoring Systems Research Articles

Explainable Machine Learning Model for Predicting GI Bleed Mortality in the Intensive Care Unit.

Acute gastrointestinal (GI) bleed is a common reason for hospitalization with 2%-10% risk of mortality. In this study, we developed a machine learning (ML) model to calculate the risk of mortality in intensive care unit patients admitted for GI bleed and compared it with APACHE IVa risk score. We used explainable ML methods to provide insight into the model's prediction and outcome. We analyzed the patient data in the Electronic Intensive Care Unit Collaborative Research Database and extracted data for 5,691 patients (mean age = 67.4 years; 61% men) admitted with GI bleed. The data were used in training a ML model to identify patients who died in the intensive care unit. We compared the predictive performance of the ML model with the APACHE IVa risk score. Performance was measured by area under receiver operating characteristic curve (AUC) analysis. This study also used explainable ML methods to provide insights into the model's outcome or prediction using the SHAP (SHapley Additive exPlanations) method. The ML model performed better than the APACHE IVa risk score in correctly classifying the low-risk patients. The ML model had a specificity of 27% (95% confidence interval [CI]: 25-36) at a sensitivity of 100% compared with the APACHE IVa score, which had a specificity of 4% (95% CI: 3-31) at a sensitivity of 100%. The model identified patients who died with an AUC of 0.85 (95% CI: 0.80-0.90) in the internal validation set, whereas the APACHE IVa clinical scoring systems identified patients who died with AUC values of 0.80 (95% CI: 0.73-0.86) with P value <0.001. We developed a ML model that predicts the mortality in patients with GI bleed with a greater accuracy than the current scoring system. By making the ML model explainable, clinicians would be able to better understand the reasoning behind the outcome.

Evaluation of relationships between the final Gleason score, PI-RADS v2 score, ADC value, PSA level, and tumor diameter in patients that underwent radical prostatectomy due to prostate cancer.

This study aimed to investigate the relationship between the serum PSA level, Gleason score (GS), PI-RADS v2 score, tumor ADCmin value, and the largest tumor diameter in patients that underwent radical prostatectomy (RP) due to prostate cancer (PCa) and to comparatively evaluate the variables of these parameters in clinically significant and insignificant PCa groups. The mpMRI examinations of the patients who underwent RP due to PCa were retrospectively evaluated. According to the final GS, the lesions were divided into two groups as clinically significant (GS ≥ 7) and insignificant (GS ≤ 6). The PSA value, tumor ADCmin value, tumor diameter, and PI-RADS score were compared between the clinically significant and nonsignificant PCa groups using Student's t-test. The correlations between the serum PSA level, GS, PI-RADS v2 score, tumor ADCmin value, and tumor diameter were evaluated separately (Pearson's correlation analysis was used for peripheral gland tumors, and Spearman's correlation analysis for central gland tumors). A ROC analysis was undertaken to evaluate the efficacy of the tumor ADCmin, diameter and PSA values in differentiating clinically significant and nonsignificant tumors. In both central and peripheral gland tumors, there was a correlation between the PSA level, tumor diameter, PI-RADS score, ADCmin value, and GS at various levels (poor, moderate, and high). In central gland tumors, there was no significant difference between the two groups in terms of the PSA value and PI-RADS scores (p > 0.05), but the ADCmin value and diameter of the tumor significantly differed (p < 0.05). For peripheral gland tumors, significant differences were observed in all parameters (p < 0.05). The cut-off values for the peripheral and central gland tumors are as follows: lesion diameter, 13.5mm and 19mm; tumor ADCmin, 0.709 × 10-3mm2/s and 0.874 × 10-3mm2/s; and PSA level, 8.47ng/ml and 11.10ng/ml, respectively. The current PI-RADS v2 scoring system can be inadequate in distinguishing clinically significant and insignificant groups in central gland tumors. A separate cut-off value of the tumor diameter should be determined for central and peripheral gland tumors. Tumor ADCmin values can be used as a predictive parameter. The PSA cut-off value should be kept lower in peripheral gland tumors.

Primate Version of Modified Rankin Scale for Classifying Dysfunction in Rhesus Monkeys.

Background and Purpose- Nonhuman primates are increasingly used in translational studies of ischemic stroke. However, current scoring systems in monkeys (eg, Nonhuman Primate Stroke Scale) do not focus on impairments in activities of daily living, so clinically relevant data are scarce for evaluating functional deficits in this model. Methods- Here, we referenced the modified Rankin Scale to provide a primate version of Rankin Scale (pRS) for ranking neurological dysfunction in monkeys following stroke. We selected hand function and strength, level of activity, and general mobility as the main components of pRS. We also analyzed interobserver variability. Results- pRS is a simple scale with only 6 levels. Functional deficit can be easily classified into none (category 0), slight (categories 1-2), moderate (category 3-4), and severe disabilities (category 5) based on pRS. We validated this scoring system on 11 monkeys, all with varying levels of neurological dysfunction following stroke, assessed by blinded testers. After a short training period, both technicians and neurology residents were able to achieve a high level of consistency using this scoring system. Conclusions- pRS is a simple and reliable functional scale, similar to the widely used modified Rankin Scale, for evaluating long-term neurological dysfunction in nonhuman primates. We recommend further validation studies and analyses.

Percutaneous Nephrolithotomy Outcomes Based on S.T.O.N.E., GUY, CROES, and S-ReSC Scoring Systems: The First Prospective Study.

Objective: To evaluate predictive capability and clinical applicability of the current nephrolithometric scoring systems of S.T.O.N.E. score, Guy's scoring system (GSS), CROES (Clinical Research Office of the Endourological Society) nomogram, and S-ReSC (Seoul National University Renal Stone Complexity) score for percutaneous nephrolithotomy (PCNL) outcomes in the same cohort in a prospective study. Methods: Consecutive patients undergoing PCNL between 2015 and 2018 were included calculating the four scores in the same cohort. Stone-free status (SFS), complications, operative time (OT), estimated blood loss (EBL), fluoroscopy time, and length of hospital stay were investigated. Receiver operator characteristic (ROC) curves for predictive accuracy and regression analysis for predictors of SFS were performed. Results: In all, 162 PCNLs were accomplished and analyzed. Overall, SFS was 75.9% and complication rate was 30.9%. The mean acquisition time of scores was 52.9 ± 0.5 seconds for GSS, 05.1 ± 0.3 seconds for S.T.O.N.E. score, 224 ± 3.1 seconds for CROES, and 102.6 ± 3.5 seconds for S-ReSC score. SFS had the best association with CROES grade. Clavien grade was associated with S.T.O.N.E. score. Moreover, EBL and OT had best association with S-ReSC score. All scores had comparable predictive accuracy on ROC curves regarding SFS. Stone essence and tract length are not different in cases with residual stones. Number of involved calyces, single vs multiple stones and renal pelvic obstruction were significant predictors of SFS in regression analysis. Conclusion: The four scoring systems had comparable predictive accuracy for SFS. However, S.T.O.N.E. and S-ReSC scores were easily applicable and provided better association with EBL and OT compared with the GSS score. Number of involved calyces, stone multiplicity, and renal pelvic obstruction were significant predictors of SFS; hence, further studies are needed to invent a universally agreeable scoring system covering reported shortcomings in the currently used scores.

Changes in Duration and Intensity of the World's Top-Level Badminton Matches: A Consideration of the Increased Acute Injuries among Elite Women's Singles Players.

The purpose of this study was to clarify whether there have been any specific changes in the characteristics of the world’s top-level women’s singles badminton matches compared to men’s singles matches after the current badminton scoring system was implemented in 2006. We compared the characteristics of the matches between the Super Series tournaments in 2007 and 2017. Match duration increased as the rally and rest times increased in both men’s and women’s singles matches. Specifically, in women’s singles, it was suggested that a further increase in physical demands because of the increased number of shots per second may have resulted in longer rest time in proportion to rally time. Moreover, increases in match duration (final eight, 53.3 ± 6.6 min; early rounds, 42.1 ± 3.6 min; P < 0.05) and number of shots per rally (final eight, 10.4 ± 1.2; early rounds, 8.7 ± 1.1; P < 0.05) in women’s singles were more prominent in the final eight rounds (quarterfinals, semifinals, and finals) than in the early rounds (rounds 1 and 2). The recent changes in characteristics of the world’s top-level badminton matches may account for the increased acute injuries that are frequently observed in elite women’s singles players. Thus, appropriate training programs are crucial to effectively improve performance and prevent injuries among elite badminton players.

The end game – A quantitative assessment tool for anastomosis in simulated microsurgery

With the move towards simulation based microsurgical training and emphasis on the declining usage of animal models, there is a need for an objective method to evaluate microvascular anastomosis in a non-living, simulated microsurgical training environment. Our aim was to create a validated assessment tool to evaluate the intimal surface of the end product to measure skills acquisition. The intimal surface of 200 anastomoses from 23 candidates and 2 experts were assessed using ImageJ to measure 4 parameters: 1) distance between the distal insertion points, 2) distance between the proximal insertion points, 3) length of sutures placed, 4) number of axes. Using these parameters, a 9-component scoring system was produced based on the hypothesis of the ideal anastomosis having equidistance between the above parameters. The scoring system was devised based on population performance to give a maximum score of 100. The EPIA tool demonstrated its ability to differentiate between seniority from undergraduate to expert. Furthermore, predictive validity was shown by demonstrating skill acquisition between day 3 and 5 of the microsurgery course. The EPIA tool is a valid and feasible method to assess and provide feedback regarding the end product as an adjunct to current scoring systems in simulated microsurgery.

Can the C-reactive protein-to-plasma albumin ratio be an alternative scoring to show mortality and morbidity in patients with colorectal cancer?

This study aims to demonstrate the sensitivity and specificity of C-reactive protein to plasma albumin (CRP/ALB) ratio in predicting morbidity and mortality in patients operated for colorectal cancer followed up in the intensive care unit by comparing it with current scoring systems. The data of patients who underwent surgery for colorectal cancer and hospitalized in the intensive care unit between 2015-2018 with available data were retrospectively analyzed in this study. The CRP/ALB ratio, the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) prepared for both gastrointestinal and colorectal surgery, and the Association of Coloproctology of Great Britain and Ireland (ACPGBI-CRC) scoring system prepared for colorectal patients, were compared to determine their success in predicting mortality and morbidity. A total of 119 patients were included in this study. Mortality was observed in nine patients and morbidity was observed in 38 patients. When compared with P-POSSUM, which is the only scoring system showing morbidity, the CRP/ALB ratio was found to have a high prediction accuracy. The C reactive protein to plasma albumin ratio values was found to have lower power than P-POSSUM, CR-POSSUM and ACPGBI-CRC. Although scoring systems are useful in predicting morbidity and mortality in colorectal patients, they are difficult to use in practice since they include many parameters. that the findings obtained in this study suggest that the CRP/ALB ratio, which can be calculated without any additional cost, may help the clinician predict mortality and especially morbidity.

Clinical Fingerprinting: A Way to Address the Complexity and Heterogeneity of Bronchiectasis in Practice.

The term bronchiectasis describes a complex and heterogeneous clinical syndrome which can be characterized by chronic respiratory symptoms and permanent dilation of the airways due to multiple causes. Understanding what "complex" and "heterogeneous" precisely means in the context of bronchiectasis disease is challenging. Complexity means that bronchiectasis has several components with "nonlinear dynamic interactions", whereas Heterogeneity indicates that not all the potential components that define bronchiectasis are present in all patients (or in any given patient) during various time points in the clinical course of the disease. The current multidimensional scoring systems developed in bronchiectasis are useful to assess the clinical severity and prognosis of the disease, but they do not include other important dimensions such us the biological activity or the impact of bronchiectasis upon the patient. With this Pulmonary Perspective, we develop and propose the use of two tools: the "control panel" (which include three dimensions: severity, activity and impact of bronchiectasis), and the "clinical fingerprint" as a way to graphically depict a snapshot of the three modules of the control panel for a given patient at a given time point. These tools may help to address the complexity and heterogeneity of bronchiectasis in clinical practice and improve the patient care by moving the field towards a "precision medicine" approach, defined as "treatments targeted to the needs of individual patients on the basis of genetic, biomarker, phenotypic, or psychosocial characteristics that distinguish a given patient from other patients with similar clinical presentations".

Perspective: The Application of A Priori Diet Quality Scores to Cardiovascular Disease Risk—A Critical Evaluation of Current Scoring Systems

ABSTRACTHealthy dietary habits are the cornerstone of cardiovascular disease (CVD) prevention. Numerous researchers have developed diet quality indices to help evaluate and compare diet quality across and within various populations. The availability of these new indices raises questions regarding the best selection relevant to a given population. In this perspective, we critically evaluate a priori–defined dietary indices commonly applied in epidemiological studies of CVD risk and mortality. A systematic literature search identified 59 observational studies that applied a priori–defined diet quality indices to CVD risk factors and/or CVD incidence and/or CVD mortality. Among 31 different indices, these scores were categorized as follows: 1) those based on country-specific dietary patterns, 2) those adapted from distinct dietary guidelines, and 3) novel scores specific to key diet-related factors associated with CVD risk.The strengths and limitations of these indices are described according to index components, calculation methods, and the application of these indices to different population groups. Also, the importance of identifying methodological challenges faced by researchers when applying an index are considered, such as selection and weighting of food groups within a score, since food groups are not necessarily equivalent in their associations with CVD. The lack of absolute cutoff values, emphasis on increasing healthy food without limiting unhealthy food intake, and absence of validation of scores with biomarkers or other objective diet assessment methods further complicate decisions regarding the best indices to use. Future research should address these limitations, consider cross-cultural and other differences between population groups, and identify translational challenges inherent in attempting to apply a relevant diet quality index for use in CVD prevention at a population level.

THE IMPACT OF MILITARY-SPORTS-ROUND ON THE LEVEL OF PHYSICAL STRENGTH OF CADETS OF HIGHER MILITARY EDUCATIONAL INSTITUTIONS

The article is dedicated to the topical issue of improving the preparation level of cadets of higher military educational institutions. The article purpose is to investigate the influence of the military pentathlon on the Level of physical abilities development and the general level of physical preparation of cadets of higher military educational institutions. The study involved 95 cadets of the control group who studied under the current system of physical training and 36 cadets of the experimental group who were engaged in the section of military pentathlon. The age of the subjects is from 17 to 26 years. During the experiment pedagogical testing of the level of development of physical abilities (speed, strength, stamina) and the level of physical preparation was determined according to the current scoring system of physical preparation. The study results show a statistically significant improvement in the marks of physical abilities of experimental group cadets as regards to control group cadets: speed 2,3% (p &lt;0.001) and strength 9,4% (p &lt;0.05); which eventually led to a statistically significant improvement of 8,6% (p &lt;0.001) of the overall level of physical preparation of experimental group cadets as regards to the representatives of the control group. During the last year sin the conditions of the battle operating on East of Ukraine an urgent requirement trod in drastic alternations in the educational programs higher soldiery educational establishments, so as the real practice of conduct of battle actions changes constantly, tactics of actions of subdivisions, armament and military technique improve reckless rates. Change of military political situation in the world, appearance of new standards of armament, newest going near the conduct of battle actions, permanent race of armaments is requires from us the permanent change of approaches and improvement of preparation of soldiery professionals, increase of requirements to their physical and psychical readiness to implementation of tasks on purpose. Realization of row of reforms in preparation of soldiery specialists of Armed Forces of Ukraine requires from us to analyse and radically change the programs of studies of the combat training taking into account the newest approaches, and methods of application of troops. Conclusion: military pentathlon can improve the level of physical preparation of university cadets.

Applied anatomy, pathophysiology and a revised scoring system of bull sheaths.

The sheath and prepuce are anatomically simple yet vital parts of the mating apparatus of the bull. They are also susceptible to a range of insults, and pathology of these structures is a common cause of infertility in both Bos taurus and Bos indicus bulls. Significant individual and breed-based variation occurs in the looseness of the skin, the presence and development of preputial muscles, the relative position of the opening to the cranial preputial muscles, the length of the prepuce, and the prominence of the umbilicus. Individual and breed-based susceptibility to different conditions is associated with these anatomical variations. Regardless of the cause, pathology of the prepuce generally results in sepsis, prolapse, stenosis or adhesions or a combination. Clinical examination should be aimed at determining the extent of these processes and the amount of healthy prepuce which would remain following successful treatment. The inclusion of evaluation of sheath conformation in the form of a sheath score is recommended. Current scoring systems do not reflect the diversity of predisposing factors to morbidity and may therefore fail to accurately reflect the risk of morbidity. A more detailed scoring system has been proposed. Further refinement of this system is outlined, consisting of a composite of scores for depth, umbilical skin fold, prepuce eversion, and distance from cranial muscle to opening (the 'Y' factor). Validation against actual bull performance is indicated to develop a valid and useful risk-management tool for use in evaluating sheath conformation.

NAFLD Histology: a Critical Review and Comparison of Scoring Systems

Despite the emergence of non-invasive tests, liver biopsy remains the gold standard for the diagnosis of non-alcoholic fatty liver disease (NAFLD). This review will provide an overview of the histology of adult NAFLD with a focus on current scoring systems, histologic features that predict clinical outcomes, and areas in need of improvement. Studies during the last two decades have established the histologic features used to categorize NAFLD into non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH), described histologic scoring systems that measure disease activity and fibrosis, and correlated histologic features with fibrosis progression and liver-related outcomes. Hepatocellular ballooning degeneration with associated lobular inflammation is the key feature that distinguishes NAFL from NASH. Fibrosis remains the most important feature in predicting relevant clinical outcomes; however, fibrosis and ballooning degeneration are tightly linked. Despite these advances, deficiencies remain in the histologic evaluation of NAFLD. While histologic scoring systems have been developed and used in both clinical trials and clinical practice, areas of uncertainty exist, and refinement of current histologic indices is needed. Standardized assessment of these features is essential in clinical trials.

The "MICE" scoring system in differentiating the identical twins leptospirosis and hantavirus infection.

To develop a practical scoring system to assist clinicians in differentiating leptospirosis and hantavirus infections, whose epidemiological, clinical, and laboratory characteristics are literally like identical twins. The study population consisted of 162 patients admitted to hospital with a confirmed diagnosis of leptospirosis (LG group, n = 92) and hantavirus infections (HG, group = 70) between January 2000 and January 2019. The two groups were compared in terms of demographic, clinical and laboratory features. Sensitivity, specificity, and positive and negative predictive values were determined from ROC analysis for findings of significance in the diagnosis of leptospirosis, and a scoring system for diagnosis was developed ("MICE" score). During the development of this scoring system, we were careful to employ parameters that would not affect one another statistically, to reflect the involvement of very different systems (such as the hematological, hepatic, renal, and musculoskeletal systems) due to the multisystemic effect of the disease in the organism, and to ensure that the system should be simple to apply and understand. Accordingly, five parameters, serum WBC, creatinine, creatine kinase, total bilirubin, and C-reactive protein, were employed in the "MICE" scoring system. Three cut-off values were determined using ROC analysis for the five parameters included in the MICE system. Accordingly, scores of 0, 1, or 2 were given based on the values WBC (/μL): ≤ 7500, 7500-15,000, and > 15,000; total bilirubin (mg/dL): ≤ 3, 3-10, and > 10; CRP (mg/dL): ≤ 5, 5-15, and > 15; creatinine (mg/dL): ≤ 1.5, 1.5-3, and > 3; CK (U/L): ≤ 500, 500-1000, > 1000. AUC was calculated as 0.964 at ROC analysis, while the most noteworthy cut-off point was obtained when MICE score was ≥ 3, exhibiting 93.5% sensitivity, 92.9% specificity, PPV 94.5% and NPV 91.5%. A test score ≥ 3 was regarded as positive. In addition, our patients were evaluated using other current scoring systems in addition to "MICE," and our scoring system exhibited a greater diagnostic power in our subjects. Leptospirosis and hantavirus infections can be accurately predicted by the MICE scoring system. Early diagnosis and rational treatment will also help to lower the mortality rates in these diseases.

AAA 18. Risk Scoring Strategy for Ruptured Abdominal Aortic Aneurysms

Ruptured abdominal aortic aneurysms (rAAAs) still have a high overall mortality of up to 75%. Risk prediction models can provide valuable information on surgical risks, guiding clinical decision-making. Clinicians and patients could benefit from a tool to predict survival after surgical intervention. We compared five different risk scores to verify the accuracy. Several models are currently available, including the Glasgow Aneurysm Score, the Hardman Index, the Vancouver Scoring System, and the Edinburgh Ruptured Aneurysm Score (ERAS). The patients from 2003 to 2018 were included. The real mortality and the expected mortality were compared to evaluate the accuracy. The hospital mortality rate was 23%. The Vascular Study Group of New England score was found to be more advantageous than other scores. Altogether, 65 patients underwent surgery or endovascular repair for rAAA. It was found that ERAS scores of 0, 1, 2, and 3 corresponded to mortality of 27%, 47%, and 69%. The Vascular Study Group of New England score was 0, 1, 2, 3, and >4, and the corresponding mortality rates were 11%, 20%, 32%, 72%, and 56%. Hardman Index and Glasgow Aneurysm Score also showed a trend of increasing mortality with increase of the score. The Hardman Index had an area under the curve of 0.653 (95% confidence interval [CI], 0.596- 0.727); the Vancouver Scoring System, 0.723 (95% CI, 0.633-0.767); the ERAS, 0.663 (95% CI, 0.643-0.709); and the Glasgow Aneurysm Score, 0.693 (95% CI, 0.618-0.762). The current scoring systems still have less accuracy in evaluating the mortality of rAAA patients, especially in patients with high risk. At present, most of the rAAA scores were established 20 years ago. With the development of surgical technique, treatment concept, and intensive care treatment, the past score will not be fully applied to the present. A more in-depth multicenter study is needed if we are to establish a more appropriate scoring system for Chinese.

978P - Algorithms derived from quantitative pathology can be a gatekeeper in patient selection for clinical trials in localised clear cell renal cell carcinoma (ccRCC)

BackgroundIdentifying low risk of disease recurrence in localised ccRCC is key for gatekeeping in the adjuvant therapy enrolment. Uncertainty increases the number of patients required for accrual to achieve statistical power. Current scoring systems are good at identifying very low and very high risk cohorts, but have not been proved to be as effective at accurately predicting disease recurrence in intermediate groups. These patients are perhaps those likely to benefit from intervention in addition to surgery, but many may be treated unnecessarily. Using digital pathology, image analysis and machine learning we sought to stratify for risk in this intermediate category. MethodsDefiniens Tissue studio and Developer XD were utilised for object thresholding to measure tumour cell nuclear morphological features on H&E digitised images from 120 ccRCC training set from UK and 217 ccRCC validation set from Singapore. Multiplexed immunofluorescence (mIF) was performed on 120 cases to co-detect neo-vasculature and pan-T cells. An algorithm was derived to measure spatial relationships between blood vessels and T cells. A statistical model was developed by generalised linear model with spatially adaptive local smoothing algorithm, having specificity prefixed (0.8-1) plus cross validation. ResultsReplacing manual nuclear grade with AI aided tumour cell nuclear morphological features improved the specificity of Leibovich score (LS) from 0.76 to 0.86 and from 0.84 to 0.94 in training and validation sets, respectively. Moreover, tumour microenvironment (TM) parameters significantly improved the specificity up to 0.93 in the training set. The negative predictive values of both LS 5 and 6 were zero, but by applying the algorithm the specificity for LS 5 and 6 cases became 0.93 and 0.40 respectively. ConclusionsBy applying image analysis it is possible to identify lower risk for recurrence patients in a conventionally identified intermediate risk group based on routine ccRCC H&E images, and multiplexed TM features. This approach to pathology should help refine selection of patients for clinical trials and form the basis of future AI-enabled prognostic and predictive algorithms in ccRCC. Legal entity responsible for the studyAuthors. FundingRenal Cancer Research Fund and NHS Lothian. DisclosureAll authors have declared no conflicts of interest.

Prediction of side branch occlusions in percutaneous coronary interventions by coronary computed tomography: the CT bifurcation score as a novel tool for predicting intraprocedural side branch occlusion.

Side branch (SB) occlusion is one of the major technical hurdles in the percutaneous coronary intervention (PCI) of bifurcation lesions. Our aim was to investigate whether preprocedural coronary computed tomography angiography (CCTA) could predict intraprocedural SB occlusion. A total of 260 bifurcation lesions were enrolled from 246 patients who underwent CCTA before elective bifurcation PCI. Quantitative plaque analysis was performed in the main vessel (MV) and SB. Intraprocedural SB occlusion occurred in 42 lesions (16%). These lesions were characterised by SB plaque, calcified plaque in the MV, low attenuation plaque in the main proximal segment or SB, and a ratio of MV to SB ostium area >4.3, which constituted a point-based CT bifurcation score. The CT bifurcation score was cross-validated, outperforming any angiographic Medina classification or RESOLVE score (c-statistics=0.749 versus 0.631 to 0.551; p<0.05 for all). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the CT bifurcation score ≥1 were 90%, 42%, 23%, 96%, and 50%, respectively. Comprehensive CCTA assessment was able to predict intraprocedural SB occlusion better than the current angiographic classification or scoring system. The CT bifurcation score may thus be a helpful guide for selecting the optimal bifurcation PCI strategy.

The change in age distribution of CAP population in Korea with an estimation of clinical implications of increasing age threshold of current CURB65 and CRB65 scoring system.

BackgroundCURB65 and CRB65 score are simple and popular methods to estimate the mortality in patients with community-acquired pneumonia (CAP). Although there has been a global increase in life expectancy and population ageing, we are still using the same age threshold derived from patients in late 1990s to calculate the scores. We sought to assess the implication of using higher age threshold using Korean population data and a single center hospital records.MethodsUsing Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC), we analyzed annual age distribution of CAP patients in Korea from 2005 to 2013 and report how patients aged >65 years increased over time. We also assessed annual change in test characteristics of various age threshold in Korean CAP population. Using a single center hospital registry of CAP patients (2008–2017), we analyzed test characteristics of CURB65 and CRB65 scores with various age thresholds.Results116,481 CAP cases were identified from NHIS-NSC dataset. The proportion of patients aged >65 increased by 1.01% (95% CI, 0.70%-1.33%, P<0.001) every year. In the sample Korean population dataset, age threshold showed its peak AUROC (0.829) at 70. In the hospital dataset, 7,197 cases were included for analysis. The AUROC of both CRB65 and CURB65 was maximized at 71. When CRB71 was applied instead of CRB65 for hospital referral using score <1 to define a low-risk case, the potential hospital referral was significantly decreased (72.9% to 64.6%, P<0.001) without any significant increase in 1-month mortality in the low risk group (0.6% to 0.7%, P = 0.690).ConclusionThere was a significant age shift in CAP population in Korea. Increasing the current age threshold of CURB65 (or CRB65) could be a viable option to reduce ever-increasing hospital referrals and admissions of CAP patients.

The Quantitative ER Immunohistochemical Analysis in Breast Cancer: Detecting the 3 + 0, 4 + 0, and 5 + 0 Allred Score Cases.

Background and objectives: The currently used immunohistochemical approach in determining the estrogen receptor (ER) positivity of breast cancers (BCs) is inherently subjective and additionally limited by its semi-quantitative nature. The application of software in the analysis of digitized slide images may overcome some of these limitations. However, the utilization of such an approach requires that the entire staining procedure is standardized. Background and objectives: We aimed to establish a procedure for the photometric and morphometric analysis of BC immunohistochemical parameters that can possibly be used for a diagnostic purpose that is in line with the current semi-quantitative scoring system. Materials and Methods: Semi-quantitative analysis of ER-stained tissue sections was performed following the Allred scoring system guidelines. The quantitative analysis was performed in ImageJ software after color deconvolution. The quantitative analysis of 66 cases of invasive lobular BC included: Percent of ER-positive cells, average nuclear coloration intensity, and the quantitative ER score. The percent of ER-positive tumor cells was counted using a standard grid overlay, while optical density (0.0–1.0) was measured within each nucleus at the grid points. Results: A statistical analysis revealed a significant positive correlation (r = 0.886, p < 0.001) between the subjective semi-quantitative and quantitative ER scores, with a large effect size (d = 3.8215). We observed strong statistically significant correlations between individual parameters of the total ER score, percentage of ER-positive nuclei, and color intensity, obtained by the two independent methods. Conclusions: Additionally, besides excluding subjectivity, the up to now unreported cases of 3 + 0, 4 + 0, and 5 + 0 Allred scores were detected only by the application of the proposed quantitative approach.

Pacemaker-detected atrial fibrillation burden and risk of ischemic stroke or thromboembolic events—A cohort study

BackgroundAtrial fibrillation (AF) burden might link to increased risk of systemic embolism. Current scoring systems for evaluating stroke risks such as CHA2DS2-VASc do not incorporate AF burden partly because of the difficulty to assess these data. Patients with dual-chamber pacemakers implanted have opportunities to acquire incidence and duration of AF. ObjectivesWe aimed to evaluate the AF burden and its association with thromboembolism in patients with dual-chamber pacemakers. MethodsThis retrospective cohort study enrolled patients who underwent dual-chamber pacemaker implantation at our center between October 2003 and May 2017. We excluded patients with prior thromboembolism or receiving anticoagulants. The incidence and duration of pacemaker-detected AF were compared between patients with and without thromboembolic outcomes. Propensity score matching (1:1) was conducted based on clinical characteristics. Multivariate regressions were performed to determine the predictors of thromboembolic outcomes. Survival free from stroke and thromboembolism was assessed using Kaplan–Meier analysis in groups with different AF burden. ResultsAmong the 152 patients enrolled (43.4% women; age 73.2 ± 13.3 years), ten experienced thromboembolic events within a median follow-up of 67 months. Patients with thromboembolisms had higher CHA2DS2-VASc scores but not higher AF burden. Higher CHA2DS2-VASc score was associated with increased risk for systemic thromboembolism [hazard ratio (HR), 1.87; 95% confidence interval (CI), 1.07–3.24; P = 0.027). In the propensity score-matched cohort with comparable CHA2DS2-VASc score, patients with thromboembolism had higher AF burden. Pacemaker-detected AF was associated with increased risk for thromboembolism (propensity-adjusted HR, 9.33; 95% CI, 1.19–72.99; P = 0.033). Experiencing AF episodes lasting >6 min was a predictor of significantly higher risk of future stroke or thromboembolism (propensity-adjusted HR, 6.75; 95% CI, 1.30–35.11; P = 0.023). ConclusionIn patients with dual-chamber pacemakers and comparable CHA2DS2-VASc score, pacemaker-detected AF burden is associated with elevated risk for thromboembolism. Further research is needed to clarify how pacemaker-detected AF burden could incorporate with CHA2DS2-VASc score variables and help to guide anticoagulation.

Predictors of behaviour in solitary fibrous tumours of the pleura surgically resected: Analysis of 107 patients

Gold standard therapy for solitary fibrous tumour of the pleura is complete surgical resection. Aims of this retrospective study are to evaluate oncological and surgical outcomes and to verify the clinical reliability of prognostic scores presented in literature. Study population: 107 patients surgically treated between 1972 and 2018. Male/female ratio: 1/2.45; median age at surgery: 60 years (range, 19-80); peduncle lesions 69.8%; visceral pleura origin 72.9%; benign histology 73.8%; median diameter 8 cm (range 1 to 35, 27 cases giant [≥15 cm]). After a median follow up of 7 years, 12 patients had recurrence. By multivariate analysis, malignant histology (P = .03; HR, 4.17; 95% CI, 1.15-15.06), origin from parietal pleura (P = .03; HR, 3.90; 95% CI, 1.08-14.09), England (P = .002; HR, 1.98; 95% CI, 1.28-3.07), Diebold(P = .008; HR, 1.96; 95% CI, 1.20-3.22) and Tapias (P = .003; HR, 1.75; 95% CI, 1.20-2.53) scores were found independent significant predictors of relapse. Giant tumours were associated with open surgery (P = .003), origin from parietal pleura (P = .011) and intraoperative bleeding (P > .001). Overall 10-year disease-free survival (DFS) rate was 81%. Predictors of worst DFS were parietal pleura origin (P = .002), malignant histology (P = .006) and all the prognostic scores. Malignant histology and origin from parietal pleura were significant predictors of tumour recurrence and worst DFS. The use of current scoring systems can help to predict clinical behaviour. Patients with higher risk of relapse can benefit from closer follow up, prolonged over 10 years.