Diagonal Line Research Articles

A prediction nomogram for residual after negative pressure aspiration for endogenic cesarean scar ectopic pregnancy: a retrospective study

BackgroundWe aimed to establish a predictive nomogram to evaluate the incidence of residual tissue in patients with endogenic cesarean scar ectopic pregnancy after negative pressure aspiration.MethodsThis retrospective study included patients treated in the gynecology department of our institution from May 2017 to August 2023 who underwent negative pressure suction treatment, ultrasound examinations before and after treatment, and received telephone follow-up for at least 6 months. A total of 899 patients met the inclusion criteria and were divided into a training cohort (629 patients, 70%) and a validation cohort (270 patients, 30%). Independent predictive factors were established using multivariate logistic regression. The resulting nomogram was validated using 1,000 bootstrap resampling, and calibration curves were plotted. Receiver operating characteristic (ROC) analysis was performed to calculate the area under the curve, sensitivity, specificity, and other metrics to assess its discriminative performance. Clinical decision curves were constructed to evaluate clinical applicability and quantify the net benefit within a range of threshold probabilities. The model was externally validated in the validation cohort.ResultsPredictive factors included in the nomogram included age (hazard ratio [HR]: 1.220, 95% confidence interval [CI]: 1.135—1.316), BMI (HR: 0.890, 95% CI: 0.796—0.986), intraoperative major hemorrhage (HR: 4.457, 95% CI: 1.610—12.292), maximum diameter of the gestational sac (HR: 1.572, 95% CI: 1.295, 1.914), and thickness of the remaining muscle layer of the lower uterine segment (HR: 1.572, 95% CI: 0.014, 0.430). The ROC curve of the resulting nomogram showed similar area under the curve values for the training (0.809, 95% CI: 0.751—0.867) and validation cohorts (0.814, 95% CI: 0.739, 0.888). The Hosmer–Lemeshow test indicated good model fit (P = 0.861), and the calibration curve was close to the ideal diagonal line. Decision curve analysis demonstrated good net benefit, and external validation confirmed its reliability.ConclusionsThe model may aid in individual clinical decision-making, allowing clinicians to perform immediate postoperative assessments for patients with endogenous ectopic pregnancy in cesarean section scars treated with negative pressure suction, identify high-risk subpopulations, and select appropriate supplementary treatment in advance, making it particularly suitable for low-income areas and resource-limited primary hospitals.

Response to music on the nonlinear dynamics of human fetal heart rate fluctuations: A recurrence plot analysis.

Music has been shown to influence physiological functions in humans, but its effects on fetal heart rate variability (fHRV) are not well understood. This study aimed to assess the response of classical music exposure on the nonlinear behavior of fetal heart rate fluctuations in fetuses between 32 and 40 weeks of gestation using recurrence quantification analysis (RQA). We collected R-R time series from 37 fetuses in the third trimester following a study into four stages: PRE (baseline), STIM1 (first musical piece), STIM2 (second musical piece), and POST (post-exposure). The fetal R-R time series from each stage were evaluated using RQA indices such as determinism (DET), average diagonal line length (L), maximum line length (LMAX), entropy (ENTR), and trapping time (TT), as well as conventional linear indices like SDRR (standard deviation of R-R intervals). Results revealed three main points. First, there was an increase in DET, L, LMAX, and TT, with a decrease in ENTR in the POST stage compared to PRE, indicating more regular and predictable patterns. Second, the STIM2 stage enhanced the predictability and stability of cardiac dynamics compared to PRE, as indicated by L, LMAX, and TT. Third, no significant changes were observed in conventional indices, except for an increase in SDRR in the POST stage compared to STIM1. These findings suggest a reduction in complexity and nonlinear behavior of fHRV patterns after musical stimulus. The increase in SDRR during the POST stage appears to coincide with fetal movements, as indicated by the number of fetal accelerations found.

Development and validation of a nomogram for predicting perioperative transfusion in children undergoing cardiac surgery with CPB

BackgroundTimely recognition of perioperative red blood cell transfusion (PRT) risk is crucial for developing personalized blood management strategies in pediatric patients. In this study, we sought to construct a prediction model for PRT risk in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass (CPB).MethodsFrom September 2014 to December 2021, 23,884 pediatric patients under the age of 14 were randomly divided into training and testing cohorts at a 7:3 ratio. Variable selection was performed using univariate logistic regression and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then used to identify predictors, and a nomogram was developed to predict PRT risk. The model’s performance was evaluated based on discrimination, calibration, and clinical utility in both cohorts.ResultsAfter multiple rounds of variable selection, eight predictors of PRT risk were identified: age, weight, preoperative hemoglobin levels, presence of cyanotic congenital heart disease, CPB duration, minimum rectal temperature during CPB, CPB priming volume, and the use of a small incision. The predictive model incorporating these variables demonstrated strong performance, with an area under the curve (AUC) of 0.886 (95% CI: 0.880–0.891) in the training cohort and 0.883 (95% CI: 0.875–0.892) in the testing cohort. The calibration plot closely aligned with the ideal diagonal line, and decision curve analysis indicated that the model provided a net clinical benefit.ConclusionsOur predictive model exhibits good performance in assessing PRT risk in pediatric patients undergoing cardiac surgery with CPB, providing clinicians a practical tool to optimize individualized perioperative blood management strategies for this vulnerable population.

Recurrence Quantification Analysis (RQA) of Toroidal End Tool Milling Process

One type of milling process is the face milling of flat surfaces using a toroidal face cutter. A key feature of this process is that changes in the depth of the cut alter the entering angle, impacting milling dynamics by shifting cutting force proportions. To investigate this phenomenon, an experimental study was conducted on the face milling process using different sets of cutting parameters. Cutting force components were recorded, as these signals provide essential information about the milling process. Statistical indicators were then calculated and analyzed based on the recorded data. Following this, a recursive force analysis was performed, and Recurrence Quantification Analysis (RQA) indicators were computed. Relationships between the RQA indicators and the cutting parameters, specifically the feed per tooth (fz) and axial depth of the cut (ap), were established using response surface methodology. Empirical relationships between these parameters were derived. The results indicate that the RQA indicators like the determinism DET, the entropy ENT, and the length of longest vertical line VMAX are correlated with the cutting parameters for both the feed force (Ff) and the component normal to the feed (FfN). In the axial direction, the RQA indicators DET, ENT, and VMAX and also the percentage of recurrence points in a recurrence plot RR and the longest diagonal line length LMAX are shown to be relevant for analyzing the dynamics of the face milling process.

Nomogram for Predicting Suboptimal Weight Loss at Three Years after Roux-en-Y Gastric Bypass Surgery in Chinese Patients with Obesity and Type 2 Diabetes.

Strategies to address suboptimal weight loss after Roux-en-Y gastric bypass (RYGB) can be developed if at-risk patients are identified in advance. This study aimed to build a pre-surgery prediction nomogram for early prediction of insufficient weight loss (IWL) or weight regain (WR) after bariatric surgery in Chinese patients. In this retrospective study, 187 patients with obesity and type 2 diabetes who underwent laparoscopic RYGB were followed yearly for 3 years. Suboptimal weight loss included IWL and WR. IWL was defined as a total weight loss percentage of <25% at 1 year postoperatively, and WR was defined as a maximum weight loss percentage of >20% at 3 years postoperatively. Multivariate logistic regression was performed to identify independent predictors and to establish a nomogram to predict the occurrence of suboptimal weight loss. Multivariate logistic regression revealed that male sex (OR 4.268, 95% CI: 1.413-12.890), body mass index (OR 0.816, 95% CI: 0.705-0.946), and glycated hemoglobin (OR 1.493, 95% CI: 1.049-2.126) were independent predictors of IWL/WR. The AUC value of the nomogram constructed from the above three factors was 0.781. The Hosmer-Lemeshow test showed that the model had a good fit (p = 0.143). The calibration curve of the nomogram is close to an ideal diagonal line. Furthermore, the decision curve analysis demonstrated the good net benefits of the model. A nomogram based on pre-surgery factors was developed to predict postoperative IWL/WR. This provides a convenient and useful tool for predicting suboptimal weight loss before surgery.

The Labiomandibular Fold Anatomy for Comprehensive Lower Facial Rejuvenation: A Micro-Computed Tomography Investigation.

Perioral rejuvenation is challenging due to the lack of spatial anatomical understanding of the labiomandibular fold (LMF). The LMF's formation mechanism remains underexplored due to intricate relationships between musculature and subcutaneous structures. This study aimed to clarify the three-dimensional structures of the LMF using micro-computed tomography and histology. Twenty-two rectangular specimens, following the LMF as the diagonal line, were retrieved bilaterally from eleven fresh frozen cadavers (mean age, 69.3 years). Eleven specimens were imaged with phosphotungstic acid contrast staining for micro-computed tomography, and the rest were histologically examined using Masson and Verhoeff-van Gieson staining. The LMF was divided into three equal-width regions for analysis. The LMF serves as a border between the lateral fat-abundant zone and the medial fat-scant zone statically. Dynamically, the LMF is accentuated with age by the downward pull of depressor muscles via a compact slanted collagen-elastin-muscle (CEM) network composed of the depressor anguli oris, platysma, and buccinator muscle fibers. The LMF formation is governed by subcutaneous composition differences between the lower lip and cheek region and vertical dermal insertions of mimetic muscles. Perioral muscle contractions transmit directly at the skin via the CEM network, governing regional wrinkle severity and appearance. The micro-CT findings provide crucial three-dimensional insights into the layered architecture and intricate musculature correlation of the LMF region, providing regional-specific evidence for holistic rejuvenation practices. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Optimization of parallel coiled cavities of different depths in microperforated panel sound absorbers

This paper presents a microperforated panel (MPP) sound absorber with parallel coiled-up-cavities of different-depths (PCD) and the corresponding optimization on their cavities. In this study, an analytical model is initially proposed for estimating the cavity depths of the PCD-MPP absorber upon normal incidence absorption coefficient evaluation at given resonance frequencies. Cavity effective depths and normal incidence absorption coefficient are evaluated after coiling up cavities for a compact structure. Numerical simulations with the finite element method and experiments are conducted for validations. Subsequently, a design process is suggested on the basis of the proposed model for sound absorption optimization. Results show that, absorption coefficient from the proposed analytical model agrees well with finite element simulations and experiments. It is also shown that, for the effective depth evaluation of the coiled-up cavities of PCD-MPP absorbers, the diagonal lines of subchannels of coiled-up cavities with a coiled-up angle of 180° can accurately represent the effective depths, while the combination of centerlines of subchannels and quarter arc inside the coiled-up area is more suitable for those with a coiled-up angle of 90°. Optimization investigation shows that, PCD-MPP absorbers can have high absorption performance with the averaged and maximum absorption coefficient of 0.91 and 0.98 within the target bandwidth of 400–1600 Hz, where the absorber thickness can stay below 65 mm. This work can provide valuable guidelines for the design of sound absorbers for broadband absorption.

Optimization of Sports Event Operations Through Algorithmic Scheduling and Management

The operation of sports events requires a highly systematic and refined approach, involving comprehensive planning, scheduling, and resource allocation to meet the needs of participants and spectators while achieving economic and social benefits. For large-scale sports games, the method of diagonal line pass distribution is employed to ensure fairness by preventing athletes from the same unit or with similar performance levels from competing in the same group. This paper proposes an automated arrangement management system that combines the diagonal line pass method with Genetic Algorithms (GA) to optimize the scheduling of track and field events. The algorithm is designed to efficiently manage resources such as tracks, rounds, and competition formats, and it transforms the objective function into a fitness function for optimization. Experimental results demonstrate the improved algorithm's superior performance compared to traditional GA in solving complex scheduling problems, making it a valuable tool for enhancing the efficiency and fairness of sports event management.

Mean Platelet Volume as Potential Predictor of Intradialytic Hypertension

Abnormalities in platelets can lead to severe consequences renal and systemic blood flow. The aim of this study is to determine the predictive ability of platelet indices (mean platelet volume, platelet-lymphocyte ratio, and platelet count) in relation to changes in blood pressure before and immediately after hemodialysis. This study included 98 patients undergoing hemodialysis at the RSU UMM Malang, aged ≥18 years, hemodialysis duration &gt; 1 month, and signing informed consent. The predictor variable were MPV, PLR, and platelet count and the outcome was the incidence of IDHT. There was a significant difference in the blood pressure of patients undergoing hemodialysis before compared to immediately after hemodialysis, for both systolic and diastolic blood pressure (p &lt; 0.001). To assess the sensitivity and specificity of the accuracy of the platelet count, MPV, and PLR markers in predicting IDHT, ROC curve was created based on the difference in systolic blood pressure before-after hemodialysis. From the receiver operating characteristic (ROC) curve, it was found that the MPV value was the highest above the diagonal line compared to PLR and platelet count with an MPV cut-off value was 9.15. This indicates that MPV is the best predictive marker compared to the other models.

Predictive Factors and Nomogram for Spontaneous Bacterial Peritonitis in Decompensated Cirrhosis Among the Elderly.

Spontaneous bacterial peritonitis (SBP) represents a significant complication in the decompensated phase of cirrhosis. The challenges in treating SBP and the associated mortality rates are markedly elevated in elderly individuals. Timely detection and intervention for SBP are imperative. We aimed to develop a predictive tool for the occurrence of SBP in elderly individuals with decompensated cirrhosis (DC). Elderly patients diagnosed with DC were enrolled from Chengdu Fifth People's Hospital in China, spanning from January 1, 2015, to September 31, 2023. Among the patients, 337 were assigned to the training cohort, while 145 were designated to the validation cohort. A multivariate logistic regression analysis was performed to identify significant predictors and to develop a nomogram for predicting the occurrence of SBP. To evaluate the model's discrimination and calibration, a bootstrap method with 1000 resamples was utilized. Findings from the multivariate logistic regression analysis indicated that constipation (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.25-3.49, P=0.005), ascites (OR 2.84, 95% CI 1.64-4.92, P<0.001), Child-Pugh-Turcotte (CPT) score (OR 4.80, 95% CI 1.69-13.60, P=0.003), and high sensitivity C-reactive protein (hs-CRP) (OR 2.96, 95% CI 1.54-5.45, P=0.001) were significant independent predictors for the occurrence of SBP in elderly individuals with DC. The generated nomogram showed an area under the curve of 0.779 for the training cohort and 0.817 for the validation cohort. The nomogram's calibration curve nearly matched the perfect diagonal line, and decision curve analysis showed an improved net benefit for the model. Subsequent validation further corroborated the reliability of the predictive nomogram. In conclusion, the nomogram, incorporating variables such as constipation, ascites, CPT score, and hs-CRP, effectively predicted the occurrence of SBP in elderly patients with DC, underscoring its substantial clinical applicability.

Bioinformatics analysis reveals VEGFC's prognostic significance in head and neck squamous cell carcinoma and its association with immune cell infiltration.

Head and neck squamous cell carcinoma (HNSCC) has a poor prognosis due to late diagnosis and complex molecular mechanisms. Vascular endothelial growth factor C (VEGFC) is associated with angiogenesis and lymphangiogenesis. This study aimed to investigate VEGFC's prognostic value in HNSCC and its correlation with immune cell infiltration. VEGFC gene expression was analyzed in HNSCC patients using Tumor Immune Estimation Resource 2.0 (TIMER2.0), Gene Expression Profiling Interactive Analysis (GEPIA), and University of ALabama at Birmingham CANcer data analysis Portal (UALCAN) databases, focusing on differential expression and clinical-pathological correlations. The impact of VEGFC on overall survival (OS) and disease-free survival (DFS) was assessed using GEPIA. RNA-seq profiles and clinical information from 503 HNSCC tumor tissues and 44 normal control tissues obtained from The Cancer Genome Atlas (TCGA) database were subjected to univariate and multivariate Cox regression analyses to develop a prognostic nomogram. The Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database was used for a protein-protein interaction (PPI) network, while the Tumor-Immune System Interaction Database (TISIDB) for immune-related associations. Expression was further validated with the Gene Expression Omnibus dataset (GSE6631) and reverse transcription quantitative polymerase chain reaction (RT-qPCR). VEGFC was significantly upregulated in HNSCC and closely correlated with age, gender, race, and tumor stage (P<0.05). PPI and co-expression gene analysis identified ITGA3, NT5E, and PXN as highly associated with VEGFC (R>0.6, P<0.05), which are mainly enriched in PI3K/Akt, MAPK signaling pathway, and cancer-associated glycoproteins. High VEGFC expression predicted poor OS (P=0.003) and DFS (P=0.03). Univariate and multivariate Cox regression analyses confirmed VEGFC as an independent prognostic factor for HNSCC. The prognostic nomogram accurately predicted 1-, 3-, and 5-year survival and calibration curve was very close to ideal 45-degree diagonal line. VEGFC also correlated with immune cells infiltration, including B cells, CD4+ T cells, CD8+ T cells, as well as immune-related markers such as tumor-infiltrating lymphocytes (TILs) markers, immune modulators, and inflammatory chemokines (P<0.05). VEGFC may serve as an independent prognostic factor and potential immunotherapeutic target in HNSCC, offering insights into patient risk stratification and personalized treatment strategies.

Analysing trunk and arm motion in volleyball jump serve: a comparison of straight line and diagonal line techniques

ABSTRACT This study aimed to clarify the disparities in trunk rotation and attack arm movement and their effect on hand kinematics adjustments between straight-line (SL) and diagonal-line (DL) volleyball jump serves. Thirteen male professional volleyball players (age 21.53 ± 5.39 years, height 1.95 ± 0.06 m, body mass 86.48 ± 11.63 kg, experience 8.61 ± 3.47 years) performed SL and DL jump serve, with three-dimensional coordinate data captured using a motion capture system (200 hz). Paired t-test and statistical parametric mapping examined kinematic differences between the two serving directions. At ball contact (BC), the speed of the attack arm hand was significantly faster in DL (16.99 ± 1.36 m/s) compared to SL (16.37 ± 1.53 m/s), whereas the face angle was significantly smaller in DL (1.98 ± 11.75°) than in SL (17.60 ± 17.98°). Forward rotation angles of the pelvic and upper torso at BC were significantly greater in DL (28.47 ± 10.89°; 21.30 ± 10.25°) than in SL (18.27 ± 12.46°; 9.09 ± 14.41°). During the arm swing phase, the pelvic’s forward rotation angles in DL were significantly greater than in SL at 42–72% spiking motion, and the upper torso’s angles were significantly greater at 49–58% spiking motion. These findings underscore the importance of adjusting pelvic and upper torso rotations to control the hand’s face angle when serving in the diagonal line.

A prediction model of echocardiographic variables to screen for potentially correctable shunts in adult atrial septal defect-pulmonary hypertension patients.

Atrial septal defect (ASD) is a prevalent congenital heart condition in adults that leads to pulmonary hypertension (PAH) and right heart failure if left untreated. During a routine follow-up of adult ASD-PAH patients, the suitability of shunt closure depends on the invasive right heart catheterization (RHC). Nevertheless, performing RHC at every follow-up is impractical and may be harmful. The present retrospective cross-sectional study was designed to investigate which echocardiographic variables were associated with pulmonary vascular resistance (PVR) in adult ASD-PAH patients and propose a model using these variables to screen for patients with a correctable shunt. A total of 530 adult ASD-PAH patients with pulmonary arterial systolic pressure (PASP) of ≥60 mmHg measured using transthoracic echocardiogram (TTE) were included in the study. All RHCs were performed within 3 months after TTE. The correctable shunt was defined as PVR ≤3 Wood units (WU). Multivariable regressions were performed utilizing echocardiographic variables. A scoring system was constructed based on the predictors of PVR ≤3 WU using multivariable logistic regression analysis. The scoring system was then examined using a receiver operating characteristic (ROC) analysis. In addition, clinical utility of the model was determined based on decision curve analysis, and a calibration curve was used to evaluate model conformity. Estimated PASP, velocity through the pulmonary valve, tricuspid annulus early diastolic velocity, and maximum defect dimension were identified as independent predictors. The area under the ROC curve of the predictive value in the model was 0.905 (95% CI, 0.878-0.931, sensitivity: 84.3%, specificity: 83.6%). The net benefit of the model was notable in terms of a wide-range probability threshold in decision curve analysis, indicating that the prediction model had good clinical applicability. The model's calibration curve was close to an ideal diagonal line, showing good predictive accuracy between the actual and predictive probabilities. The study provided a valuable model in predicting adult ASD-PAH patients with a correctable shunt, which may help clinicians to make appropriate treatment decision for follow-up patients.

EXPRESSO: a multi-omics database to explore multi-layered 3D genomic organization.

The three-dimensional (3D) organization of the human genome plays a crucial role in gene regulation. EXPloration of Regulatory Epigenome with Spatial and Sequence Observations (EXPRESSO) is a novel multi-omics database for exploration and visualization of multi-layered 3D genomic features across 46 different human tissues. Integrating 1360 3D genomic datasets (Hi-C, HiChIP, ChIA-PET) and 842 1D genomic and transcriptomic datasets (ChIP-seq, ATAC-seq, RNA-seq) from the same biosample, EXPRESSO provides a comprehensive resource for studying the interplay between 3D genome architecture and transcription regulation. This database offers diverse 3D genomic feature types (compartments, contact matrix, contact domains, stripes as diagonal lines extending from a genomic locus in contact matrix, chromatin loops, etc.) and user-friendly interface for both data exploration and download. Other key features include REpresentational State Transfer application programming interfaces for programmatic access, advanced visualization tools for 3D genomic features and web-based applications that correlate 3D genomic features with gene expression and epigenomic modifications. By providing extensive datasets and tools, EXPRESSO aims to deepen our understanding of 3D genomic architecture and its implications for human health and disease, serving as a vital resource for the research community. EXPRESSO is freely available at https://expresso.sustech.edu.cn.

Construction and Validation of a Predictive Model for Mortality Risk in Patients with Acinetobacter baumannii Bloodstream Infection.

To develop and validate a predictive model for the risk of death in patients with Acinetobacter baumannii (A. baumannii) bloodstream infection (BSI) for clinical decision-making and patient management. In this study, we included demographic and clinical data from 206 patients with Acinetobacter baumannii BSI in China between January 2013 and December 2023. Variables were screened by least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression, and prognostic models and nomograms were constructed. The models were evaluated using the area under curve (AUC) of Receiver Operating Characteristic (ROC), decision curve analysis (DCA), and standard curves to evaluate the model. Comorbid septic shock, an elevated neutrophil/lymphocyte ratio (NLR), low hemoglobin (HGB) levels, and low platelet counts (PLT) were found to be independent risk factors for death in patients with A. baumannii BSI. With the models constructed from these four variables, the AUCs of the ROC curves of the test and validation cohorts for the prognostic scenarios at 7, 14, and 28 days were not less than 0.850, and the AUCs of the ROC curves of the risk-of-death prediction model were the highest for both groups at 7 days, at 0.907 and 0.886, respectively. The two sets of calibration curves show that the calibration curves oscillate around a 45° diagonal line at 7, 14, and 28 days, and there is a good correlation between the actual risk and the predicted risk, with a high degree of calibration.The clinical decision curve shows that the model has a strong discriminatory ability when the probability is between 10% and 70%. Septic shock status, NLR, HGB and PLT are independent risk factors for 28-day mortality in patients with A. baumannii BSI. These variables are conveniently and readily available, and in patients with A. baumannii BSI these indicators can be closely monitored in clinical practice and timely interventions can be made to improve prognosis.

Assessing diagnostic accuracy: 18F-FDG PET-CT scans in low-grade infection detection among post-traumatic long bone non-unions; a literature review and clinical data

IntroductionThe diagnosis of low-grade infection in post-traumatic long bone non-unions poses challenges due to the absence of clinical signs. This study aimed to review the available literature on the diagnostic accuracy of imaging techniques for low-grade infections and assess the diagnostic accuracy of 18F-FDG PET-CT scans for low-grade infection in post-traumatic long bone non-unions. MethodsA mini-review was conducted using Pubmed in March 2024. A retrospective study was conducted including adult patients with a long bone non-union, suspected of infection. All patients underwent 18F-FDG PET-CT scans as the index test before surgical intervention, with peri‑operative cultures obtained during surgery serving as the reference standard. Quantitative analyses were performed on the standardized uptake value (SUV) measurements obtained from the 18F-FDG PET-CT scans. Diagnostic accuracy measures including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the discriminatory ability of SUV measurements. ResultsLiterature suggests that 18F-FDG PET-CT is the most accurate imaging technique to detect low-grade infections. The study included a total of 51 18F-FDG PET-CT scans and cultures from 50 patients with long bone non-unions. The diagnostic accuracy was found to be 0.67 (95 % CI 0.44–0.87). The PPV and NPV were calculated as 0.79 (95 % CI 0.53–1.00) and 0.52 (95 % CI 0.30–0.73), respectively. Quantitative analyses of SUV measurements demonstrated a low level of accuracy, with all area under the curve (AUC) values < 0.75 and ROC curves showing a trajectory fairly parallel to the diagonal line. Conclusion and discussionThe findings of this study indicate that in post-traumatic long bone non-unions, where a low-grade fracture-related infection (FRI) is suspected, the 18F-FDG PET-CT has a performance that is advantageous over other imaging techniques. A careful interpretation of the scan results is warranted, possibly including the quantitative analysis on tracer uptake as an adjunct. Nevertheless, the diagnostic accuracy in this condition is not as good as in early-onset FRI cases, and this should be taken into account when treating these challenging cases.

Sensitivity and Specificity of Modified Early Obstetric Warning Score (MEOWS) and Maternal Early Warning Criteria (MEWC) for Maternal Morbidity: A Retrospective Cohort Study in Pregnant Women with COVID-19

Objective: To measure the comparative sensitivity, specificity, and predictive value of MEOWS and MEWC in predicting morbidity in pregnant patients infected with COVID-19. This research can be one of the screenings used to determine the level of care for pregnant patients with COVID-19. Methods: The retrospective cohort technique was used to examine the 89 pregnant women with COVID-19 who were admitted to the Bantul Regional General Hospital between January and December 2021. Data analysis used the ROC curve to compare sensitivity, specificity, and predictive value. Results: MEWC is better than MEOWS in predicting the morbidity of pregnant patients with COVID-19 infection. This is because MEWC has a better sensitivity (78,3%) and PPV value (78%) than MEOWS, even though it has a lower specificity value (81,8%) and NPV value (82%). The specificity value of MEWC (81.8%), when compared to MEOWS (97.1%), does have a lower specificity value. The results of MEOWS and MEWC data analysis using ROC produce an area under the curve for MEOWS of 74,9% while for MEWC of 80%. Discussion: MEWC has a better sensitivity indicating that patients who do not trigger MEWC criteria will have a low risk of experiencing maternal morbidity. Screening tools will prioritize the sensitivity value compared to the specificity value of the instrument used. A screening tool will have a lower positive predictive value if the study population has a lower prevalence of morbidity. Based on the comparison of the predictive value, sensitivity, and specificity of the MEWC and MEOWS instruments, it can be concluded that MEWC is associated with maternal morbidity with a higher sensitivity than MEOWS, although it has a lower specificity. High sensitivity values will result in screening tools with consistent results. The ROC curve can also show that MEWC has a higher sensitivity value by looking at the Y-coordinate, which is higher than the Y-coordinate of MEOWS. MEWC has a better Receiver Operator Curve (ROC) intersection point than MEOWS, where the MEWC intersection point has the furthest point on the upper left of the ROC diagonal line. Conclusion: MEWC has a higher sensitivity compared to MEOWS, even though it has a lower specificity. High sensitivity values will produce screening tools with consistent results. Keywords: MEWC, maternal early warning system, maternal morbidity, MEOWS

Clinical prediction model of main adverse cardiovascular and cerebrovascular events for elderly patients with acute coronary syndrome

Abstract Background Age is an independent factor for adverse outcomes in acute coronary syndrome (ACS). With the accelerated aging process, there is an increasing incidence of ACS in the elderly; however, research on this population is underrepresented. Due to the unique presence of multiple diseases and organ changes in the elderly, specialized risk assessment tools are required. Purpose To explore the risk factors for poor prognosis of elderly patients with ACS and establishing a risk stratification tool. Methods The derivation cohort consisted of 1674 elderly ACS patients consecutively enrolled in a single center from January 2013 to December 2013. The validation cohort included 2333 elderly ACS patients consecutively enrolled in nine medical centers from January 2015 to May 2019. All patients were followed up for 2 years, and the study endpoint was defined as major adverse cardiovascular and cerebrovascular events (MACCE). Model selection was performed using Cox regression and the Akaike Information Criterion (AIC) to construct the final risk assessment model. The performance of the predictive model was evaluated in the derivation and validation cohorts using the c-index, receiver operating characteristic (ROC) curves, and calibration curves. Results A total of 1,674 elderly ACS patients (70.97±4.68 years, 23.24% female) were included in the derivation cohort, and 210 cases (12.54%) of MACCE were recorded during the 2-year follow-up period. In the validation cohort, there were 2,333 elderly ACS patients (72.13±5.82 years, 35.83% female), with 364 cases (15.60%) of MACCE documented during the 2-year follow-up. Initially, 25 variables were preliminarily selected based on the results of univariate Cox regression and the clinical importance of these variables. Subsequently, these variables were included in a multivariable Cox model, and model selection was performed based on the AIC, resulting in the final selection of 10 variables (including age, cardiac insufficiency, current smoker, DAPT use, history of PCI or CABG, IABP use, number of lesions, residual SYNTAX score, preoperative HGB, and preoperative PLT). Then we developed and validated a nomogram to predict the 2-year MACCE in elderly ACS patients based on the assessment of 10 clinically easily obtainable variables during hospitalization. In both the derivation and validation cohorts, the nomogram demonstrated good discriminative ability (AUC of 0.723 and 0.699, c-index of 0.727 and 0.661, respectively) and calibration (calibration curves closely approximating the 45-degree diagonal line). The Kaplan-Meier analysis reveals significant differences in MACCE incidence rates between groups stratified by the median predicted probability (p&amp;lt;0.001). Conclusion Our study developed and validated a practical nomogram for predicting the 2-year risk of MACCE in elderly patients with ACS.

Development and validation of a multivariable nomogram predictive of hepatitis B e antigen seroconversion after pregnancy in hepatitis B virus-infected mothers.

Current guidelines are controversial regarding the continuation of nucleos(t)ide analogues (NAs) therapy after delivery in Hepatitis B virus (HBV)-infected pregnant women. The postpartum period may be an opportune moment for achieving hepatitis B e antigen (HBeAg) seroconversion earlier with constant NAs therapy due to the restoration of immune function after delivery. We investigated prenatal and pregnant factors associated with HBeAg seroconversion after pregnancy and developed a nomogram to predict HBeAg seroconversion rates, aiding decision-making for optimal management in women. We retrospectively included 489 HBeAg-positive mothers as the training cohort from January 2014 to December 2018 and prospectively enrolled 94 patients as the external validation cohort from January 2019 to December 2021 at the First Affiliated Hospital of Xi'an Jiaotong University. In the training cohort, independent predictors were identified using the least absolute shrinkage and selection operator (LASSO) regression algorithm. Subsequently, multivariate logistic regression was employed to establish the nomogram. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). Both discrimination and calibration were evaluated through bootstrapping with 1,000 resamples. The external validation cohort was subsequently used to validate the nomogram. Factors such as pregnancy hepatitis flare (OR: 5.122, 95% CI: 2.725-9.928, p < 0.001), NAs therapy after delivery (OR: 15.051, 95% CI: 6.954-37.895, p: <0.001), hepatitis B surface antigen (HBsAg) (OR: 0.549, 95% CI: 0.366-0.812, p: 0.003) and HBV DNA level at delivery (OR: 0.785, 95% CI: 0.619-0.986, p: 0.041) were included in the final risk model. The AUC in the training set was 0.873 (95% CI: 0.839-0.904). The calibration curve of the nomogram closely resembled the ideal diagonal line. DCA showed a significantly better net benefit in the model. External validation also confirmed the reliability of the prediction nomogram. The AUC in the external validation set was 0.889 (95% CI: 0.801-0.953). The calibration curve for the external validation set was in close proximity to the ideal diagonal line. DCA also demonstrated a significant net benefit associated with the predictive model, consistent with the findings in the training set. Finally, the nomogram has been translated into an online risk calculator that is freely available to the public (https://wendyzhong.shinyapps.io/DynNomapp/). We developed a nomogram based on prenatal and pregnant factors to estimate HBeAg seroconversion after delivery in women. This tool provides clinicians with a precise and effective way to identify individuals likely to undergo HBeAg seroconversion postpartum, aiding in decision-making for optimal management.

Elasto-inertial focusing and rotating characteristics of ellipsoidal particles in a square channel flow of Oldroyd-B viscoelastic fluids

The elasto-inertial focusing and rotating characteristics of spheroids in a square channel flow of Oldroyd-B viscoelastic fluids are studied by the direct forcing/fictitious domain method. The rotational behaviours, changes in the equilibrium positions and travel distances are explored to analyse the mechanisms of spheroid migration in viscoelastic fluids. Within the present simulated parameters (1 ≤ Re ≤ 100, 0 ≤ Wi ≤ 2, 0.4 ≤ α ≤3), the results show that there are four kinds of equilibrium positions and six (five) kinds of rotational behaviours for the elasto-inertial migration of prolate (oblate) spheroids. We are the first to identify a new rotational mode for the migration of prolate spheroids. Only when the particles are initially located at a corner and wall bisector, some special initial orientations of the spheroids have an impact on the final equilibrium position and rotational mode. In other general initial positions, the initial orientation of the spheroid has a negligible effect. A higher Weissenberg number means the faster the particles migrate to the equilibrium position. The spheroid gradually changes from the corner (CO), channel centreline (CC), diagonal line (DL) and cross-section midline (CSM) equilibrium positions as the elastic number decreases, depending on the aspect ratio, initial orientation and rotational behaviour of the particles and the elastic number of the fluid. When the elastic number is less than the critical value, the types of rotational modes of the spheroids are reduced. By controlling the elastic number near the critical value, spheroids with different aspect ratios can be efficiently separated.