Predictive Factors Research Articles

Development of a nomogram for deep vein thrombosis in patients with tibial plateau fractures based on systemic Immune-inflammation index

In recent years, the incidence of tibial plateau fractures (TPF) has been on the rise. Deep vein thrombosis (DVT) may lead to poor prognosis in patients. The systemic immune-inflammation index(SII) are novel biomarkers of inflammation, and this study aims to verify their predictive effect and construct the nomogram model. This study used binary logistic regression analysis to predict the predictive effect of SII on the occurrence of DVT in tibial plateau fracture patients. And use R studio to construct nomogram model. The results showed that Age (1.03 [1, 1.06], p = 0.032), SII (3.57 [1.68, 7.61], p = 0.04), and NC (7.22 [3.21, 16.26], p < 0.001) were independent predictive factors for DVT. The nomogram demonstrated good predictive performance with small errors in both the training and validation groups, and most clinical patients could benefit from them. The nomogram constructed based on SII can assist clinicians in early assessment of the probability of DVT occurrence.

Predictors of Abnormal MRI Findings in Patients with Asymmetrical Sensorineural Hearing Loss.

This study aimed to determine the predictive factors of abnormal MRI findings in patients with asymmetrical sensorineural hearing loss (ASNHL). A retrospective review of medical records. A tertiary care hospital. Patients with asymmetries of ≥10 dB in at least 1 frequency, who underwent an MRI study of the temporal bone or brain during 2019-2021, were included. Age, sex, clinical symptoms, past medical history, and audiometric parameters, including pure tone thresholds, speech reception thresholds, and speech discrimination scores, were retrieved from the electronic database. The MRI findings reported by radiologists were reviewed and extracted. Of 390 patients, 50 (12.8%) patients had relevant abnormal MRI findings that could explain ASNHL. The most prevalent abnormal MRI finding was an internal acoustic canal (IAC) or cerebellopontine angle (CPA) tumor (n = 38; 76.0%), with other notable abnormalities including labyrinthitis, stroke, mucocele, and epidermoid. Multiple logistic regression analysis highlighted that hearing asymmetry of 15 dB at 1000 Hz (OR = 4.8; 95% CI 2.2-10.5) was a significant variable. The proposed predictor demonstrated 84% sensitivity and 48% specificity in detecting abnormal MRI findings. A hearing asymmetry of 15 dB at 1000 Hz was an important clinical predictor of abnormal MRI findings in patients with ASNHL. This finding has the potential to serve as a referral guide for further MRI investigations. Level 3 Laryngoscope, 2024.

Predictive Factors of Mortality in Methanol Poisoning Outbreaks: A Cross-sectional Study During the COVID-19 Pandemic

Background: Methanol poisoning has increased in some countries after the recent coronavirus pandemic. This study aimed to investigate the clinical and paraclinical findings of patients with methanol poisoning during the COVID-19 pandemic.Methods: This cross-sectional study was conducted on patients diagnosed with methanol poisoning in Imam Reza and Hasheminezhad hospitals who were hospitalized from the beginning of March 2019 to the end of April 2020. Clinical and paraclinical data were extracted from patients’ files and subsequently categorized into three groups: deceased patients, living patients without complications, and living patients with complications. Results: Out of 107 patients included in the study, 20(18.69%) died, 50(46.7%) were discharged without complications, and 37(34.6%) with complications. The most frequent clinical symptoms in the patients were blurred vision (62.6%), lethargy (62.6%), nausea (43%), vomiting (41.1%), abdominal pain (15.9%), dizziness (11.2%), and dyspnea (6.5%). According to the multivariate logistic regression analysis, reduced pH (OR=0.007, P=0.009) and blurred vision symptoms (OR=5.096, P=0.007) significantly predicted complications. Based on univariate logistic regression, hypoxemia (OR=35.90, P=0.002), coma (OR=22.34, P&lt;0.001), high creatinine (OR=62.39, P&lt;0.001), and low pH (OR=0.001, P&lt;0.001) had the greatest impact in predicting mortality. Conclusion: This study shows the clinical and paraclinical characteristics of methanol poisoning during the COVID-19 pandemic, identifying critical predictors of complications and mortality, including low pH, blurred vision, hypoxemia, coma, and high creatinine levels.

Development of predictive models for pathological response status in breast cancer after neoadjuvant therapy based on peripheral blood inflammatory indexes

BackgroundAchieving a pathological complete response (pCR) after neoadjuvant therapy (NAT) is considered to be a critical factor for a favourable prognosis in breast cancer. However, discordant pathological complete response (DpCR), characterised by isolated responses in the breast or axillary, represents an intermediate pathological response category between no response and complete response. This study aims to investigate predictive factors and develop models based on peripheral blood inflammatory indexes to more accurately predict NAT outcomes.MethodA total of 789 eligible patients were enrolled in this retrospective study. The patients were randomized into training and validation cohort according to a 7:3 ratio. Lasso and uni/multivariable logistic regression analysis were applied to identify the predictor variables. Two Nomograms combining clinico-pathologic features and peripheral blood inflammatory indexes were developed.ResultMolecular Subtype, HALP, P53, and FAR were used to construct the predictive models for traditional non pCR (T-NpCR) and total-pCR (TpCR). The T-NpCR group was divided into DpCR and non pCR (NpCR) subgroups to construct a new model to more accurately predict NAT outcomes. cN, HALP, FAR, Molecular Subtype, and RMC were used to construct the predictive models for NpCR and DpCR. The receiver operating characteristic (ROC) curves indicate that the model exhibits robust predictive capacity. Clinical Impact Curves (CIC) and Decision Curve Analysis (DCA) indicate that the models present a superior clinical utility.ConclusionHALP and FAR were identified as peripheral blood inflammatory index predictors for accurately predicting NAT outcomes.

General practice trainee, supervisor and educator perspectives on the transitions in postgraduate training: a scoping review

Transitions are a period and a process, through which there is a longitudinal adaptation in response to changing circumstances in clinical practice and responsibilities. While the experience of the transition...

Sleep Disturbances in Amyotrophic Lateral Sclerosis and Prognostic Impact—A Retrospective Study

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease associated with sleep disturbance, namely insomnia and sleep-disordered breathing. This study aims to evaluate the overall sleep characteristics of ALS patients, their association with lung function tests, and possible predictive survival factors. We conducted a retrospective observation study among ALS patients monitored during a pulmonology consultation. Type one polysomnography (PSG) and lung function tests were performed once the patients presented with sleep-related symptoms, and the relationship between their parameters was assessed, as well as a survival analysis. We included 35 patients, with an overall diminished sleep efficiency, a partially conserved forced vital capacity (FVC), and low maximal inspiratory pressure (MIP). A positive correlation between FVC and REM sleep percentage was observed. A survival analysis showed that a normal rapid eye movement (REM) sleep percentage and respiratory disturbance index (RDI) ≥ 15/h were independent predictors of survival. We observed a trend for higher sleep quality in patients with conserved lung function. A better sleep quality was associated with a higher survival. Obstructive events (reduced or absence of airflow associated with continued or increased inspiratory effort) did not seem to impact survival.

Artificial Intelligence-Enhanced OCT Biomarkers Analysis in Macula-off Rhegmatogenous Retinal Detachment Patients.

To identify optical coherence tomography (OCT) biomarkers for macula-off rhegmatogenous retinal detachment (RRD) with artificial intelligence (AI) and to correlate these biomarkers with functional outcomes. Patients with macula-off RRD treated with single vitrectomy and gas tamponade were included. OCT volumes, taken at 4 to 6 weeks and 1 year postoperative, were uploaded on an AI-derived platform (Discovery OCT Biomarker Detector; RetinAI AG, Bern, Switzerland), measuring different retinal layer thicknesses, including outer nuclear layer (ONL), photoreceptor and retinal pigmented epithelium (PR + RPE), intraretinal fluid (IRF), subretinal fluid, and biomarker probability detection, including hyperreflective foci (HF). A random forest model assessed the predictive factors for final best-corrected visual acuity (BCVA). Fifty-nine patients (42 male, 17 female) were enrolled. Baseline BCVA was 0.5 logarithmic minimum angle of resolution (logMAR) ± 0.1, significantly improving to 0.3 ± 0.1 logMAR at the final visit (P < 0.001). Average thickness analysis indicated a significant increase after the last follow-up visit for ONL (from 95.16 ± 5.47µm to 100.8 ± 5.27µm, P = 0.0007) and PR + RPE thicknesses (60.9 ± 2.6µm to 66.2 ± 1.8µm, P=0.0001). Average occurrence rate of HF was 0.12 ± 0.06 at initial visit and 0.08 ± 0.05 at last follow-up visit (P=0.0093). Random forest model revealed baseline BCVA as the most critical predictor for final BCVA, followed by ONL thickness, HF, and IRF presence at the initial visit. Increased ONL and PR-RPE thickness associate with better outcomes, while HF presence indicates poorer results, with initial BCVA remaining a primary visual predictor. The study underscores the role of novel biomarkers like HF in understanding visual function in macula-off RRD.

Preoperative collateralization depending on posterior components in the prediction of transient neurological events in moyamoya disease.

Changes in local cerebral blood flow (CBF) are a major cause of transient neurological events (TNEs) after revascularization for moyamoya disease (MMD); however, the influence of preoperative collateral pathway development on TNEs has not yet been investigated. This study included 28 hemispheres from 28 consecutive patients with MMD who underwent surgical revascularization, including a superficial temporal artery (STA) to middle cerebral artery (MCA) bypass, between January 2014 and March 2022. The collateralization pathways included the anterior communicating artery (AcomA) collaterals, posterior communicating artery (PcomA) collaterals, transdural collaterals, posterior pericallosal anastomosis, lenticulostriate anastomosis, thalamic anastomosis, and choroidal anastomosis. These collateral pathways were analyzed to identify predictive factors significantly associated with TNEs. TNEs were observed in 11 (39.3%) hemispheres. The development of posterior pericallosal anastomosis and choroidal anastomosis was a significant independent predictor of the occurrence of TNEs after bypass surgery for MMD (P = 0.01, OR 26.9, 95% CI 1.50-480.0; P = 0.002, OR 47.6, 95% CI 2.65-856.6). The development of choroidal and posterior pericallosal anastomosis could be reliable preoperative predictors of TNEs after bypass surgery for MMD. Our results provide useful information for future studies aimed at clarifying the mechanisms underlying TNEs.

Prognostic value of soluble programmed death-1 and soluble programmed death ligand-1 in severe traumatic brain injury patients

Patients with traumatic brain injury (TBI) frequently exhibit concomitant immunosuppression. In this study, we evaluated the predictive values of soluble programmed death-1 (sPD-1) and soluble programmed death ligand-1 (sPD-L1) in patients with severe TBI. Peripheral blood sPD-1 and sPD-L1 levels were measured within 48 h of patient admission. A total of 20 healthy volunteers and 82 patients were enrolled in this study. The levels of sPD-1 and sPD-L1 were upregulated in patients with severe TBI (P < 0.001). They were significantly increased in the post-TBI severe pneumonia group and among non-survivors (P < 0.001). The area under the curves (AUCs) for sPD-1 and sPD-L1 levels to predict severe pneumonia were 0.714 and 0.696, respectively, and the AUCs to predict mortality were 0.758 and 0.735. The levels of sPD-1 and sPD-L1 are correlated with the GCS scores at admission, APACHE II scores, length of MV, and time elapsed to mortality. The levels of sPD-1 and sPD-L1 emerged as independent predictive factors for severe pneumonia and mortality. This study demonstrates that upregulation of sPD-1 and sPD-L1 in severe TBI patients is significantly associated with severe pneumonia and mortality, suggesting their potential as predictive biomarkers for these outcomes.

Covid-19 mortality risk factors: Survival analysis of the hospitalized cohort in Sahloul university hospital in Tunisia

Background Tunisia was one of the most affected nations with COVID-19 disease. The clinical features of this illness range from asymptomatic illness to death. Aim To analyse the survival of patients admitted to a Tunisian tertiary care center (Sahloul University Hospital) and identify independent predictive factors for hospital COVID-19 mortality. Methods A longitudinal study was conducted among confirmed COVID-19 patients hospitalized in Sahloul University Hospital between September 2020 and September 2022. Cox univariate regression was used to calculate the Hazard Ratio (HR) of death for patient characteristics regarding the time at risk. Risk factors with a p value of 0.2 or less in the univariate analysis were initially included in the multivariate Cox regression models. Results During the study at Sahloul Hospital, 1978 patients were hospitalized, averaging 55.65 years in age (± 21.39). Among them, 417 deaths occurred, with a median survival of 30 days (± 3.11) [23.904-36.096]. Factors significantly affecting the survival curve were: Age, male gender, comorbidities, diabetes, hypertension, endocrine diseases, obesity, intubation, and ICU admission Multilevel survival analyses revealed that hypertension (aHR 1.24; CI [1.02-1.52]; p=0.028), ICU admission (aHR 12.20- CI [9.56-15.57]; p&lt;10-3), and male gender (HR 1.19; CI [0.98-1.46]; p=0.076) were independent factors associated with COVID-19 mortality. Conclusion Our study concluded the importance of the early identification of high-risk COVID-19 patients to decrease this virus mortality. A good understanding of the possible clinical factors associated with COVID-19 severity is helpful for clinicians in identifying patients who are at high risk and require prioritized treatment to minimize death.

The Use of Anaplastic Lymphoma Kinase Inhibitors in Non-Small-Cell Lung Cancer Treatment—Literature Review

Lung cancer is the leading cause of cancer-related morbidity and mortality. The median survival time for patients with advanced non-small-cell lung cancer before the era of molecular-based personalized treatment was 7.9 months. The discovery of predictive factors and the introduction of molecular diagnostics into daily practice made a breakthrough, enabling several years of survival in patients with advanced disease. The discovery of rearrangements in the ALK gene and ALK tyrosine kinase inhibitors has resulted in a dramatic improvement in the prognosis of patients with this subtype of cancer. Currently, three generations of ALK inhibitors differing in activity, toxicity and degree of penetration into the central nervous system are available in clinical practice. The current state of knowledge on ALK inhibitors used in clinical practice is summarised in this research paper. Methods of diagnosis of abnormalities in ALK have been shown, and the review of research that contributed to the development of the next generation of ALK inhibitors has been presented.

Prediction of allograft function in pre-transplant kidneys using sound touch elastography (STE): an ex vivo study

BackgroundThe purpose of the study was to evaluate renal quality and predict posttransplant graft function using ex vivo sound touch elastography (STE).MethodsIn this prospective study, 106 donor kidneys underwent ex vivo STE examination and biopsy from March 2022 to August 2023. The mean stiffness of the superficial cortex (STEsc), deep cortex (STEdc), and medulla (STEme) was obtained and synthesized into one index (STE) through the factor analysis method. Additionally, 100 recipients were followed up for 6 months. A random forest algorithm was employed to explore significant predictive factors associated with the Remuzzi score and allograft function. The performance of parameters was evaluated by using the area under the receiver operating characteristic curve (AUC).ResultsSTE had AUC values of 0.803 for diagnosing low Remuzzi and 0.943 for diagnosing high Remuzzi. Meanwhile, STE had an AUC of 0.723 for diagnosing moderate to severe ATI. Random forest algorithm identified STE and Remuzzi score as significant predictors for 6-month renal function. The AUC for STE in predicting postoperative allograft function was 0.717, which was comparable with that of the Remuzzi score (AUC = 0.756). Nevertheless, the specificity of STE was significantly higher than that of Remuzzi (0.913 vs 0.652, p < 0.001). Given these promising results, donor kidneys can be transplanted directly without the need for biopsy when STE ≤ 11.741.ConclusionsThe assessment of kidney quality using ex vivo STE demonstrated significant predictive value for the Remuzzi score and allograft function, which could help avoid unnecessary biopsy.Critical relevance statementPre-transplant kidney quality measured with ex vivo STE can be used to assess donor kidney quality and avoid unnecessary biopsy.Key PointsSTE has significant value for diagnosing low Remuzzi and high Remuzzi scores.STE achieved good performance in predicting posttransplant allograft function.Assessment of kidney quality using ex vivo STE could avoid unnecessary biopsies.Graphical

Biliary drainage in palliative and curative intent European patients with hilar cholangiocarcinoma and malignant hilar obstruction: a retrospective single center analysis

Background and aimsRelief of cholestasis in hilar cholangiocarcinoma is commonly undertaken in both curative and palliative treatment plans. There are numerous open questions with regard to the ideal biliary drainage strategy – including what constitutes clinical success (CS). In the existing data, curative patients and patients from the Western world are underrepresented.Patients and methodsWe performed a retrospective analysis of patients with complex malignant hilar obstruction (Bismuth-Corlette II and higher) due to cholangiocarcinoma who underwent biliary drainage at a German referral center between 2010 and 2020. We aimed to define CS and complication rates and directly compare outcomes in curative and palliative patients.Results56 curative and 72 palliative patients underwent biliary drainage. In patients with curative intent, CS was achieved significantly more often regardless of what definition of CS was applied (e.g., total serum bilirubin (TSB) < 2 mg/dl: 66.1% vs. 27.8%, p = < 0.001, > 75% reduction of TSB: 57.1% vs. 29.2%, p = 0.003). This observation held true only when subgroups with the same Bismuth-Corlette stage were compared. Moreover, palliative patients experienced a significantly greater percentage of adverse events (33.3% vs. 12.5%, p = 0.01). Curative intent treatment and TSB at presentation were predictive factors of CS regardless of what definition of CS was applied. The observed CS rates are comparable to published studies involving curative patients, but inferior to reported CS rates in palliative series mostly from Asia.ConclusionsBiliary drainage in complex malignant hilar obstruction due to cholangiocarcinoma is more likely to be successful and less likely to cause adverse events in curative patients compared to palliative patients.

Prognostic and predictive factors in advanced upper gastrointestinal cancer treated with immune checkpoint inhibitors: a systematic review and meta-analysis of the current evidence

BackgroundImmune checkpoint inhibitors (ICIs) have shown encouraging treatment efficacy for upper gastrointestinal cancers (UGICs). However, durable clinical responses only existed in a minority of patients. We evaluated evidence predicting survival benefits to identify the optimal population followed by ICI-based therapy.MethodsA comprehensive search was performed using PubMed, Embase, Cochrane Library, and Web of Science to identify clinical trials for UGICs with ICI-based therapy. The outcomes were objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation System (GRADE).ResultsThirty-six studies comprising 12,440 patients were included for quantitative synthesis. Patients with PD-L1-positive (OR = 2.08, p < 0.00001), EBV+ (OR = 8.47, p = 0.003) tumors were more likely to respond to ICI treatment. Moreover, OS was significantly improved with the statistical subgroup difference concerning sex (p = 0.02) and region (p = 0.02). An exploratory subgroup analysis showed significantly improved OS with ICI plus chemotherapy in patients with CPS ≥ 10 (HR = 0.66, p = 0.001) and CPS ≥ 1 (HR = 0.75, p < 0.00001).ConclusionUGIC patients with PD-L1-positive, EBV + status are associated with a better therapeutic response to ICI-based therapy. The male patients and Asian patients could derive more survival benefits following ICI treatment than female and non-Asian ones. A combination of prognostic and predictive factors was suggested to help guide immunotherapy decision-making in UGIC patients.

The vasculogenic mimicry, CD146+ and CD105+ microvessel density in the prognosis of endometrioid endometrial adenocarcinoma: a single-center immunohistochemical study

The microvessel compartment is crucial in the tumor microenvironment of endometrioid adenocarcinoma (EA). This study investigated the role of vasculogenic mimicry (VM), CD146, and CD105 microvessel density in the clinical prognosis of EA. A total of 188 EA cases were analyzed, with VM channels and microvessels detected using PAS/CD31, CD146, and CD105 staining. Mann-Whitney and Fisher exact tests were used to compare the study groups according to the evaluated criteria. ROC analysis included determination of the confidence interval (CI) and area under the ROC curve. The Mantel-Cox test was used to analyze progression-free survival. Multivariate Cox proportional hazard analysis was performed using stepwise regression. Results showed that VM channels and CD146 and CD105 microvessels were significantly higher (p < 0.0001) in cases with unfavorable prognosis. Univariate survival analysis highlighted the significant role of these factors in progression-free survival, while multivariate Cox analysis identified VM and CD146+ vessels as predictive factors. This study demonstrates, for the first time, that VM, CD146, and CD105-positive vessels are involved in EA prognosis, suggesting their potential as independent prognostic indicators and targets for antiangiogenic therapy. However, these findings require further validation through large-scale studies.

Inferior vena cava collapsibility index for predicting hypotension after spinal anesthesia in patients undergoing total knee arthroplasty.

This study aimed to identify risk factors associated with hypotension in patients undergoing total knee arthroplasty (TKA) under spinal anesthesia. Atotal of 200 patients (50-75years of age) who underwent elective TKA under spinal anesthesia between October 2023 and January 2024 were enrolled. Patients were divided into two groups (hypotensive and nonhypotensive) depending on the occurrence of postspinal anesthesia hypotension (PSAH). Patient characteristics (age, sex, body mass index, and medical history), blood pressure, heart rate, and ultrasound data before anesthesia were documented. Multivariate logistic regression models were used to determine risk factors for hypotension after spinal anesthesia. Furthermore, anomogram was constructed according to independent predictive factors. The area under the curve (AUC) and calibration curves were employed to assess the performance of the nomogram. In total, 175 patients were analyzed and 79(45.1%) developed PSAH. Logistic regression analysis revealed that variability of the inferior vena cava (odds ratio, OR, 1.147; 95% confidence interval, CI: 1.090-1.207; p < 0.001) and systolic arterial blood pressure (SABP, OR 1.078; 95% CI: 1.043-1.115; p < 0.001) were independent risk factors for PSAH. Receiver operating characteristic (ROC) curve analysis showed that the AUC of the inferior vena cava collapsibility index (IVCCI) and SABP alone were 0.806 and 0.701, respectively, while the AUC of both combined was 0.841. Specifically, an IVCCI of > 37.5% and systolic arterial blood pressure of > 157 mm Hg were considered threshold values. Furthermore, we found that the combination had abetter predictive value with higher AUC value, sensitivity, and specificity than the index alone. The nomogram model and calibration curves demonstrated the satisfactory predictive performance of the model. Elevated preoperative systolic arterial blood pressure and ahigher IVCCI were identified as independent risk factors for hypotension in patients receiving spinal anesthesia, which may help guide personalized treatment.

Predictive Factors of Canine Malignant Hepatic Diseases with Multifocal Hepatic Lesions Using Clinicopathology, Ultrasonography, and Hepatobiliary Ultrasound Scores

Multifocal hepatic lesions in dogs arise from various benign and malignant liver diseases. Diagnosing these lesions is challenging because clinical signs, hematological data, and serum biochemistry are not definitive indicators. Ultrasound is utilized as a diagnostic imaging tool to evaluate liver parenchyma and detect hepatic lesions. This study aims to investigate the predictive factors that differentiate between benign and malignant multifocal hepatic lesions by examining ultrasound characteristics, blood tests, and serum biochemistry. In total, 43 dogs with multifocal hepatic lesions were included in this study. All dogs were classified into benign hepatic diseases (n = 32) and malignant haptic diseases (n = 11). For all dogs, their liver characteristics, lesion characteristics, and hepatobiliary ultrasound score by ultrasound were evaluated and we collected individual clinicopathological data for analysis. The findings of the univariate analysis revealed significant differences in four hematological and blood chemical parameters (hematocrit, white blood cell count, aspartate transaminase (AST), and alkaline phosphatase (ALP)) and six ultrasonographic parameters (liver parenchymal echogenicity, lesion homogeneity, lesion echogenicity, maximum lesion dimension, average lesion dimension, and hepatobiliary ultrasound score). Using multivariate analysis, only two parameters, hepatobiliary ultrasound score and lesion homogeneity, showed significant differences (p-value &lt; 0.001 and p-value = 0.011, respectively). Additionally, these parameters demonstrated high accuracy in predicting malignant multifocal liver lesions, with accuracy rates of 97.67% and 93.02%, respectively. Therefore, the hepatobiliary ultrasound score and lesion homogeneity are considered effective parameters for screening malignant multifocal liver lesions in dogs.

Construction and validation of a diagnostic model for high-risk papillary thyroid microcarcinoma

ObjectiveThe purpose of this study was to construct a diagnostic model by exploring the potential predictors of high-risk Papillary Thyroid Microcarcinoma (PTMC) and verifying its reliability.MethodsA retrospective analysis of PTMC patients who underwent surgical treatment from 2004 to 2015 in the SEER database (training set) and the clinical pathological ultrasound information of PTMC patients at the Sichuan Provincial People's Hospital from 2020 to 2022 (external validation set) was conducted. In the training set, univariate and multivariate logistic regression analyses were used to screen independent predictive factors for high-risk PTMC patients in pathology. A nomogram diagnostic model was further constructed. Additionally, ROC curves and calibration curves were drawn to evaluate the efficiency of the model. In the external validation set, the diagnostic model was indirectly evaluated based on preoperative ultrasound imaging features to explore the feasibility and reliability of diagnosing high-risk PTMC through preoperative ultrasound imaging features.ResultsA total of 1628 patients were included in the training set, and 530 patients were included in the test set. The independent risk factors for pathological high-risk PTMC were sex, age, tumor maximum diameter, tumor invasive, and cervical lymph nodes (P&amp;lt;0.05). The C-index of the nomogram constructed based on these five factors was 0.947, with an optimal sensitivity of 96.7% and a specificity of 86.0%. The calibration curve showed that the model had high consistency. The area under the curve (AUC) value of the ROC curve for high-risk PTMC predicted by the risk score based on ultrasound features was 0.824 [95% CI (0.789, 0.860)], which was highly consistent with the risk score based on pathological features (κ= 0.758, P&amp;lt;0.05).ConclusionIndirect evaluation of a high-risk PTMC diagnostic model based on preoperative ultrasound imaging features had high predictive efficiency and potential value for clinical application.

Prevalence and predictive parameters of external root resorption caused by retained wisdom teeth

ObjectivesThe aim of this study was to estimate the prevalence and severity of external root resorption (RR) caused by retained third molars (M3), to compare the sensitivity of panoramic radiography (PAN) and cone beam computed tomography (CBCT) and to determine predictive factors for root resorption.Materials and methodsIn a retrospective cross-sectional analysis, we included patients (N = 367) who underwent PAN and CBCT imaging between December 2017 and July 2019. Previous orthodontic treatment, age, gender, superimposition of second molars (M2) and M3 on PAN, retention depth, inclination angle and vertical level of contact with the M2 were used as predictor variables. The outcome variable was RR of the M2, graded according to Ericson et al. [1]. Subgroup analyses compared patients with and without suspected resorption in the PAN.ResultsWhile less than 5% of PANs suggested RR associated with M3, CBCT showed RR in 20% of all M2 with adjacent retained M3. The angle of inclination of M3, patient age and vertical level of molar contact emerged as predictive parameters, with mesial inclination, older age and deeper retention associated with increased severity of M2.ConclusionWithin the limitations of our study, these data confirm the poor performance of PAN in the diagnosis of RR. CBCT may be helpful in detecting RR in mesioangulated and deeply retained M3 in elderly patients, even when PAN did not suggest pathology.Clinical relevanceOur study may help to decide whether CBCT should be considered prior to M3 surgery.

Course and Predictors of Adult Spinal Sagittal Disorders

Study Design. Prospective case series Objective. To study the natural course of adult spinal deformity (ASD) over a10-year period and the determinants associated with postural malalignments. Summary of Background Data. ASD comprises a heterogeneous spectrum of abnormalities of the thoracolumbar spine throughout adulthood. Radiographic deterioration of sagittal alignment is a combination of decreased lumbar lordosis (LL), PI-related retroversion of the pelvic tilt (PT), anteriorizing sagittal vertical axis (SVA) and increased T1 pelvic angle (TPA). Methods. The full spine radiographs were taken to measure the SRS-Schwab sagittal modifiers PI-LL, PT and SVA to measure the possible change in severity of deformity from the 204 volunteer participants (mean age 62.7 years, 61% female), which were 32% of the 637 consecutive patients with prolonged back pain who originally joined the study in 2012–2013. Each participant completed the Scoliosis Research Society 22r (SRS-22r) questionnaire. Results. The mean change in the SRS-Schwab score was 0.4 units (baseline 1.1 vs. follow-up 1.5, P &lt; 0.001) implying deterioration of the spinal deformity. The SRS-Schwab score decreased (n=76, 37%), remained the same (n=102, 50%) or improved (n=26, 13%). Four predictive factors for a change of sagittal alignment were found, of which the poor score in the SRS-22r function domain (P=0.049) and severe pelvic tilt (PT greater than 30°, P=0.006) predicted the change. Conclusion. This study showed the variability in how sagittal alignment of the spine change during the 10-year follow-up period. The ASD patients with poor self-assessed functional ability and disturbed pelvic position were associated with the risk of deterioration in spinopelvic alignment. The diversity in the natural course of ASD and the known risk factors highlights the need for tailored advice when planning preventive treatment procedures for ASD patients. Level of evidence. 3