Optimal Critical Value Research Articles

The establishment of PD-1 inhibitor treatment prognosis model based on dynamic changes of peripheral blood indexes in patients with advanced lung squamous cell carcinoma

BackgroundUnlike patients with lung adenocarcinoma, patients with lung squamous cell carcinoma (LUSC) do not derive significant benefits from targeted therapy. In recent years, immunotherapy has revolutionized the treatment approach for LUSC. However, not all patients with this type of cancer respond to immunotherapy, necessitating the identification of effective biomarkers to predict survival prognosis and evaluate the efficacy of PD-1 inhibitors.Materials and methodsWe retrospectively collected case and hematologic data from 212 patients with advanced squamous lung cancer who received PD-1 combination therapy. Hematological indices mainly contained SCC, CEA, NSE, Hb, LDH, WBC and RBC at baseline, 6 and 12 weeks of treatment. All patients underwent imaging examinations and efficacy was evaluated according to RECIST1.1 criteria. Univariate tests were used to assess the relationship between changes in serum biomarkers, clinical characteristics and treatment outcome. The survival prognosis of patients was investigated by telephone follow-up. The optimal critical values of all hematological indicators were calculated by ROC curves, and then logistic regression and Cox regression were used to analyze multiple serum markers in relation to efficacy and survival prognosis, respectively. Finally, column line plots were constructed and validated to predict the probability of patient survival.ResultsPost-treatment RBC12w<3.81 × 10 12/L (p < 0.034) was associated with lower ORR, and WBC6w<9.34 × 109/L (p=0.041) was associated with higher DCR.SCC12w≥2.25 ng/mL (p = 0.015), NSE6w≥13.54 ng/mL(p = 0.044)and RBC0w≥4.2 × 10 9/L (p = 0.003) were independent predictors of PFS. SCC12w≥2.25 ng/mL (p < 0.001) and NSE6w≥13.54ng/mL(p = 0.042) were independent predictor of OS. Patients in the SCC12w≥2.25 ng/mL (HR = 1.943,95% CI:1.218-3.079 vs. HR = 2.161,95%CI:1.087-3.241) and NSE6w≥13.54 ng/mL (HR = 1.657,95% CI:1.118-2.535 vs. HR = 2.064,95% CI:1.569-4.169) groups had shorter PFS and OS. In subgroup analysis, patients with stage III advanced squamous lung cancer had a better pro-gnosis than those with stage IV. PD-L1-positive, and SCC12w ≥2.25 ng/mL had a worse prognosis. The results of constructing column-line plots for predicting the survival probability of 1-, 3-, and 5-year PFS and OS: The C-index and 95% CI for PFS and OS of column-line plots were 0.725 (95% CI: 0.478-1.928) and 0.755 (95% CI: 0.642-0.868), respectively, and the bootstrap correction showed a good consistency of the column-line plots.ConclusionChanges in RBC12w ≥3.81×1012/L, WBC6w ≥9.34×10 9/L, SCC12w ≥2.25 ng/mL, and NSE6w ≥13.54 ng/mL after treatment are prognostic indicators of immunotherapy in patients with advanced squamous lung cancer.

The correlation between rapid eye movement sleep and nocturnal hypertension in patients with obstructive sleep apnea: A retrospective study.

Obstructive sleep apnea (OSA) is a respiratory disease closely associated with hypertension and heart disease. This study aimed to evaluate the diagnostic value of rapid eye movement (REM) sleep during nocturnal hypertension in OSA patients. We selected 194 patients who underwent polysomnography (PSG) at the Respiratory and Critical Care Medicine Department of Jiading District Central Hospital in Shanghai between January 2021 and August 2023. All patients were assigned to the hypertension and normal blood pressure groups, and the differences between the 2 groups were compared. This study included 194 patients (137 with nocturnal hypertension and 57 with normal nocturnal blood pressure). The proportion of male sex, body mass index, apnea-hypopnea index (AHI), REM sleep duration, percentage of REM sleep duration to total sleep duration, REM-AHI, nonrapid eye movement-AHI, oxygen desaturation index (ODI), REM-ODI, nonrapid eye movement-ODI, and average nighttime heart rate during sleep were higher in the hypertension group than in the normal blood pressure group, and the lowest oxygen saturation was lower than that in the normal blood pressure group (P < .05). Logistic regression analysis showed that REM-AHI was an independent risk factor for nocturnal hypertension (adjusted odds ratio, 1.048; 95% confidence interval, 1.011-1.086; P = .01). Receiver operating characteristic curve analysis showed that the REM-AHI had an area under the curve of 0.721 (95% confidence interval, 0.641-0.801; P < .001) for diagnosing nocturnal hypertension in patients with OSA, with a maximum Youden index of 0.379. The optimal critical value of the REM-AHI was 23.6 times/h, with a sensitivity of 64.2% and specificity of 73.7%. REM sleep is closely related to nocturnal hypertension, and patients with OSA are more prone to cardiovascular events.

Preoperative D‑dimer level and prognosis in patients diagnosed with gastric cancer and undergoing gastric cancer radical surgery: A retrospective cohort study.

Gastric cancer, one of the most aggressive tumors affecting the digestive tract, has seen a rise in both incidence and mortality rates in recent years, with a lack of clear prognostic indicators. D-dimer, a byproduct of fibrin degradation, is a conventional coagulation biomarker that has been investigated as a potential adverse prognostic factor for postoperative cancer patients. However, conflicting results exist, with some studies suggesting that D-dimer is an independent risk factor for the postoperative prognosis of gastric cancer, and others suggesting that there is no significant association between D-dimer level and gastric cancer prognosis. This controversy underscores the need for further research to determine the true influence of D-dimer level on the prognosis of postoperative cancer patients, including exploring the linear and non-linear associations, and identifying optimal critical values before surgery. The present study aimed to assess the association between preoperative D-dimer levels and 5-year overall survival (OS) rate in patients undergoing radical surgery for gastric cancer. Data was analyzed from patients diagnosed with gastric cancer who underwent a radical gastrectomy at Shanxi Cancer Hospital (Taiyuan, China) in 2017 and were followed up for 5 years until December 2022. Preoperative D-dimer levels and tumor-related indicators were collected as covariates from hospital records, with patient follow-up information obtained from the hospital's tracking system. Utilizing multivariate Cox regression, curve fitting and inflection point analysis, the present study sought to investigate the link between preoperative D-dimer levels and 5-year OS rate following radical surgery for gastric cancer. After strict admission and exclusion procedures, a total of 133 patients were included in the study and were then classified based on D-dimer level. Based on the mean value, the D-dimer levels were segregated into two distinct cohorts: The D-dimer_high group (n=66) and the D-dimer_low group (n=67). Cox multiple regression analysis was conducted using both continuous and binary variables. The results showed no effect in terms of the continuous variables, but higher preoperative D-dimer levels were significantly associated with a higher 5-year overall survival compared with lower preoperative D-dimer levels in the categorical variables. Therefore, curve fitting was performed, which indicated that the association between D-dimer level and 5-year survival rate after radical gastrectomy for cancer showed a U-shaped curve, with P<0.001, high and low D-dimer levels both indicated poorer prognosis. A curvilinear correlation was demonstrated between preoperative D-dimer levels and the 5-year survival rate following radical gastrectomy for cancer. Subsequently, an inflection point analysis found that the inflection point was located at 100-200 ng/ml. In conclusion, in patients undergoing radical gastrectomy for gastric cancer, preoperative D-dimer can be used to indicate the current state of the tumor to some extent through blood coagulation status. Notably, a U-shaped association exists between D-dimer levels and 5-year postoperative survival rate in gastric cancer. This association demonstrates varying effects across different intervals. Specifically, D-dimer levels <100 ng/ml are associated with a worse prognosis, whereas levels >200 ng/ml are associated with a better prognosis.

Development and validation of a risk prediction model for feeding intolerance in neurocritical patients with enteral nutrition.

This study collects and analyzes clinical data on enteral nutrition therapy in neurocritical patients, develops and validates a feeding intolerance (FI) risk prediction model, and provides a theoretical basis for screening patients with high risk of feeding intolerance (FI) and delivering personalized care. A convenience sampling method was employed to select 300 patients who were admitted to a tertiary hospital in China for early enteral nutrition therapy in the neurointensive care unit between April 2022 and December 2022. Independent risk factors for FI were identified using univariate and logistic regression analyses. A prediction model was established, and the goodness of fit and discriminant validity of the model were evaluated. The incidence of FI in neurocritical patients receiving enteral nutrition was 71%. Logistic regression analysis identified age, Glasgow Coma Scale (GCS) scores, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, mechanical ventilation, feeding via the nasogastric tube route, hyperglycemia, and low serum albumin as independent risk factors for the development of FI (p < 0.05). The predictive formula for FI risk was established as follows: Logit p = -14.737 + 1.184 × mechanical ventilation +2.309 × feeding route +1.650 × age + 1.336 × GCS tertile (6-8 points) + 1.696 × GCS tertile (3-5 points) + 1.753 × APACHE II score + 1.683 × blood glucose value +1.954 × serum albumin concentration. The Hosmer-Lemeshow test showed χ2 = 9.622, p = 0.293, and the area under the ROC curve was 0.941 (95% confidence interval: 0.912-0.970, p < 0.001). The optimal critical value was 0.767, with a sensitivity of 85.9%, a specificity of 90.8%, and a Youden index of 0.715. The early enteral nutrition FI risk prediction model developed in this study demonstrated good predictive ability. This model can serve as a valuable reference for effectively assessing the risk of FI in neurocritical patients, thereby enhancing clinical outcomes.

Value of Maternal Renal Function Indicators in Predicting Small for Gestational Age Infants in Patient with Severe Preeclampsia

Background: Severe preeclampsia poses significant health risks to both pregnant patients and their newborns. Our goal was to explore the association between serum renal function related indicators in pregnant patients with severe preeclampsia and the occurrence of small for gestational age (SGA) infants, as well as to further identify independent risk factors for SGA based on these indicators. Methods: This was a retrospective case-control study. We evaluated the renal function indicators of 127 severe preeclampsia pregnant patients and 127 normal pregnant patients antenatally who delivered in Shijiazhuang Fourth Hospital from January 2022 to December 2022. Mann-Whitney U test and Chi-square test were used to compare the differences in clinical data between two groups. Spearman correlation analysis was used to determine the correlation between renal function indicators and newborn weight in severe preeclampsia pregnant patients. Receiver operating characteristic (ROC) curve was used to determine the optimal critical values of the above indicators, and multivariate logistic regression analysis was used to determine the independent risk factors for severe preeclampsia combined with SGA. Results: Blood urea nitrogen (BUN), serum creatinine (SCr) and serum uric acid (SUA) in severe preeclampsia patients with SGA were higher than severe preeclampsia without SGA (p &lt; 0.05 vs. all groups). In the severe preeclampsia group, these indicators were significantly negatively correlated with birth weight (p &lt; 0.001 vs. all groups), whereas no correlation was observed in the control group. In the severe preeclampsia group, a ROC analysis was performed based on whether the infants were small for gestational age, and the indicators were divided into two groups according to the optimal cut-off value. After adjusting for confounding factors, elevated BUN (≥4.9 mmol/L) served as an independent risk factor for severe preeclampsia patients with SGA (odds ratio (OR) = 4.336, 95% confidence interval (95% CI): 1.781–10.552, p = 0.001), and the corresponding area under the curve was 0.661 (0.572, 0.743). Conclusions: Serum renal function indicators in pregnant patients with severe preeclampsia were significantly associated with the occurrence of small for gestational age (SGA) infants. Moreover, elevated maternal BUN levels (≥4.9 mmol/L) prior to delivery may indicate the occurrence of SGA. However, we also acknowledge that the predictive power of this single marker is limited.

Prognostic Role of Hemoglobin Combined With Geriatric Nutritional Risk Index in Patients With Vater Ampulla Carcinoma Undergoing Pancreaticoduodenectomy.

The purpose of this investigation was to assess the prognostic importance of the combination of preoperative hemoglobin (Hb) levels and Geriatric Nutritional Risk Index (GNRI) in forecasting postoperative survival outcomes for patients undergoing pancreaticoduodenectomy (PD) due to Vater ampulla carcinoma (VPC). The GNRI nutritional screening was conducted for all patients, and patient outcomes, including overall survival (OS), were subsequently monitored. An H- GNRI scoring system was established using the optimal critical values of 125.5 g/L for Hb and 91.72 for GNRI, as determined by X-tile software. According to the H-GNRI score, the patients were categorized into three groups, namely low H-GNRI group (H-GNRI score = 0, n = 47) with Hb < 125.5 g/L and GNRI < 91.72; medium H-GNRI group (H-GNRI score = 1, n = 77) with Hb < 125.5 g/L and GNRI ≥ 91.72, or Hb ≥ 125.5 g/L and GNR < 91.72; and high H-GNRI group (H-GNRI score = 2, n = 51) with Hb ≥ 125.5 g/L and GNRI ≥ 91.72. The Kaplan-Meier analysis and log-rank tests were employed to evaluate the OS rate and compare survival disparities among various groups. Additionally, both univariate and multivariate analyses were conducted utilizing the Cox regression model, with p < 0.05 considered statistically significant. Finally, to evaluate the predictive effectiveness of Hb, GNRI, and H-GNRI, a receiver operating characteristic (ROC) curve was constructed to compare the area under curve (AUC) values. The OS rate was higher in patients with high Hb levels (≥ 125.5 g/L) compared to those with low Hb levels (< 125.5 g/L). Likewise, patients in the high GNRI group (≥ 91.72) exhibited significantly superior OS compared to those in the low GNRI group (< 91.72). Compared with both the medium and low H-GNRI groups, the high H-GNRI group demonstrated a notably higher OS rate. The T stage (HR = 2.523, 95% CI: 1.694-3.757, p < 0.001), N stage (HR = 2.018, 95% CI: 1.255-3.246, p = 0.004), and the H-GNRI score (H-GNRI score of 2 used as the baseline; H-GNRI score of 0: HR = 2.569, 95% CI: 1.499-4.402, p < 0.001; H-GNRI score of 1: HR = 1.835, 95% CI: 1.118-3.014, p = 0.016), after adjusting for gender, were determined to be independent significant predictors affecting the OS of patients with VPC. The AUC of H-GNRI was 0.677, exceeding that of Hb levels (0.631) and GNRI (0.615). The combination of preoperative Hb levels and GNRI demonstrates superior predictive efficacy for VPC patients undergoing PD, compared with either Hb levels or GNRI score alone. Therefore, the H-GNRI score can be utilized to promptly identify high-risk patients, establish comprehensive nutritional pre-rehabilitation plans through interdisciplinary collaboration, and inform decisions regarding additional adjunctive therapies.

Correlation of serum homocysteine and cystatin C levels with prognosis in heart failure with preserved ejection fraction patients

ObjectiveThis study investigated the relationship of serum homocysteine (Hcy) and cystatin C (Cys C) levels with the prognosis of patients with heart failure with preserved ejection fraction (HFpEF).MethodsA total of 178 patients with HFpEF who were admitted to our hospital between December 2019 and November 2020 were included. Patients were grouped based on their serum Hcy and Cys C levels: high Hcy level, normal Hcy level, high Cys C level, and normal Cys C level. Cardiac function, ventricular remodeling indices, and prognosis were compared among patients in these groups. Additionally, the predictive value of serum Hcy and Cys C levels for adverse cardiovascular events in HFpEF patients was analyzed.ResultsPatients’ mean age in the high Hcy level, normal Hcy level, high Cys C level, and normal Cys C level groups was 69.21 ± 4.17,67.74 ± 4.28,69.95 ± 4.98, and 67.06 ± 4.13 years old, respectively. The high Hcy level group exhibited a lower proportion of class II cardiac function according to the New York Heart Association (NYHA) classification and a higher proportion of class IV cardiac function than the normal Hcy level group, with statistically significant differences. Similarly, the high Cys C level group had a lower proportion of class II cardiac function and a higher proportion of class IV cardiac function compared with the normal Cys C level group, with statistically significant differences. Left ventricular end-diastolic internal diameter (LVEDD), left ventricular end-systolic internal diameter (LVESD), and left ventricular mass index (LVMI) were significantly higher in both the high Hcy level and high Cys C level groups compared with the normal group, with statistically significant differences. The rates of all-cause mortality and class I endpoint events were significantly higher in the high Hcy level and high Cys C level groups than in the normal group. Multifactorial logistic regression analysis demonstrated that adverse cardiovascular events were significantly associated with cardiac function class, LVEDD, LVESD, LVMI, Hcy, and Cys C in patients with HFpEF. The area under the curve (AUC) values for Hcy and Cys C, determined using receiver operating characteristic (ROC) curve analysis, were 0.778 (optimal critical value, 25.38) and 0.681 (optimal critical value, 1.56), respectively, for predicting adverse cardiovascular events. Both Hcy and Cys C serum levels were positively correlated with LVEDD, LVESD, LVMI, and NYHA classification.ConclusionSerum levels of Hcy and Cys C were closely associated with cardiac function, ventricular remodeling indices, and prognosis in patients with HFpEF. These levels may serve as valuable indices for assessing HFpEF patients’ health status and prognosis, providing important insights into their potential role as biomarkers for HFpEF management and prognosis.

Quantitative Assessment of Polarization and Elastic Properties of Endometrial Tissue for Precancer/Cancer Diagnostics Using Multimodal Optical Coherence Tomography

Objectives: The most important phase in the endometrial pathologies diagnostics is the histological examination of tissue biopsies obtained under visual hysteroscopic control. However, the unclear visual diagnostics characteristics of subtle focal endometrial pathologies often lead to selection errors regarding suspicious endometrial lesions and to a subsequent false pathological diagnosis/underestimation of precancer or early-stage cancer. Methods: In this study, we investigate the potential of Multimodal Optical Coherence Tomography (MM OCT) to verify suspicious endometrial lesion regions before biopsy collection. We study the polarization (by cross-polarization OCT, CP OCT) and elastic (by compression OCT-elastography, C-OCE) properties of ex vivo endometrial tissue samples in normal conditions (proliferative and secretory phases to the menstrual cycle, atrophic endometrium) with endometrial hyperplasia (non-atypical and endometrial intraepithelial neoplasia) and endometrial cancer subtypes (low-grade, high-grade, clear cell and serous). Results: To the best of our knowledge, this is the first quantitative assessment of relevant OCT parameters (depth-resolved attenuation coefficient in co-[Att(co) values] and cross-[(Att(cross) values] polarizations and Young’s elastic modulus [stiffness values]) for the selection of the most objective criteria to identify the clinically significant endometrial pathologies: endometrial intraepithelial neoplasia and endometrial cancer. The study demonstrates the possibility of detecting endometrial pathologies and establishing optimal threshold values of MM OCT criteria for the identification of endometrial cancer using CP OCT (by Att(co) values = 3.69 mm−1, Sensitivity (Se) = 86.1%, Specificity (Sp) = 92.6%; by Att(cross) values = 2.27 mm−1, Se = 86.8%, Sp = 87.0%) and C-OCE (by stiffness values = 122 kPa, Se = 93.2%, Sp = 91.1%). The study also differentiates endometrial intraepithelial neoplasia from non-atypical endometrial hyperplasia and normal endometrium using C-OCE (by stiffness values = 95 kPa, Se = 87.2%, Sp = 90.1%). Conclusions: The results are indicative of the efficacy and potential of clinical implementation of in vivo hysteroscopic-like MM OCT in the diagnosis of endometrial pathologies.

Correlation and consistency between resting full-cycle ratio and fractional flow reserve in assessing coronary artery function in a Chinese real-world cohort with non-ST-segment elevation acute coronary syndrome: a retrospective observational study

ObjectiveThe study aimed to investigate the correlation and consistency between resting full-cycle ratio (RFR) and fractional flow reserve (FFR) in functional assessment of coronary arteries in a Chinese real-world cohort...

Critical values for body mass index related to morbidity in high-volume low-complexity general surgery: a systematic review and meta-analysis.

The aim of this study was to investigate the effect of body mass index (BMI, kg/m2) on outcomes of high-volume low-complexity (HVLC) general surgery procedures and to determine critical values for BMI when selecting patients into HVLC programmes. A systematic review was conducted of studies looking at patients in different BMI categories undergoing HVLC general surgery procedures (laparoscopic cholecystectomy, inguinal hernia repair and umbilical or paraumbilical hernia repair), in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. A comparison meta-analysis model was constructed to compare the outcomes using random-effects modelling. The QUIPS (Quality In Prognosis Studies) tool and GRADE (Grading of Recommendations Assessment, Development and Evaluation) system were used to assess bias. A total of 26 studies including 486,392 patients were examined. In laparoscopic cholecystectomy, BMI ≥40 was associated with higher conversion to open surgery (odds ratio [OR]: 1.33, p=0.040) but did not affect complications (OR: 0.69, p=0.400) or length of hospital stay (mean difference [MD]: -0.01 days, p=0.900). In inguinal hernia repair, BMI ≥35 was associated with longer operative time (MD: 18.00 minutes, p<0.00001), and higher risk of wound complications (OR: 3.01, p<0.00001) and hospital readmission (OR: 1.46, p=0.0008). In umbilical or paraumbilical hernia repair, BMI ≥30 was associated with higher risk of wound complications (OR: 6.45, p<0.0001) and hospital readmission (OR: 5.56, p<0.00001), and longer operative time (MD: 4.01 minutes, p=0.030). Obesity was associated with longer operative time (up to 23 minutes) and higher risk of postoperative morbidity (up to 4-fold) in HVLC procedures. BMI <40 (moderate GRADE certainty - laparoscopic cholecystectomy) and BMI <35 (moderate GRADE certainty - inguinal hernia) appear to represent optimal critical values for perioperative safety metrics.

Analysis of preoperative nutrition, immunity and inflammation correlation index on the prognosis of upper tract urothelial carcinoma surgical patients: a retrospective single center study

BackgroundSII, PNI, SIRI, AAPR, and LIPI are prognostic scores based on inflammation, nutrition, and immunity. The purpose of this study was to examine the prognostic value of the SII, PNI, SIRI, AAPR, and LIPI in patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision.Materials and methodsData of UTUC patients in Sichuan Provincial People's Hospital from January 2017 to December 2021 were collected. The optimal critical values of SII, PNI, SIRI, and AAPR were determined by ROC curve, and LIPI was stratified according to the dNLR and LDH. The Kaplan–Meier method was used to draw the survival curve, and Cox proportional hazard model was used to analyze the factors affecting the prognosis of UTUC patients.ResultsA total of 81 patients with UTUC were included in this study. The optimal truncation value of PNI, SII, SIRI and AAPR were determined to be 48.15, 596.4, 1.45 and 0.50, respectively. Univariate Cox proportional hazard regression showed that low PNI, high SII, high SIRI, low AAPR and poor LIPI group were effective predictors of postoperative prognosis of UTUC patients. Multivariate Cox proportional hazard regression showed that high SII was an independent risk factor for postoperative prognosis of UTUC patients. According to ROC curve, the prediction efficiency of fitting indexes of PNI, SII, SIRI, AAPR and LIPI is better than that of using them alone.ConclusionsThe SII, PNI, SIRI, AAPR, and LIPI was a potential prognostic predictor in UTUC patients who underwent radical nephroureterectomy with bladder cuff excision.

Predictive value of leukocyte derived markers for postoperative delirium after cardiac valve surgery

To explore the predictive value of leukocyte derived markers for postoperative delirium (POD) in patients undergoing cardiac valve surgery. A prospective cohort study was conducted. The patients who underwent cardiac valve surgery admitted to Beijing Anzhen Hospital of Capital Medical University from October 2021 to March 2023 were enrolled. The demographic, baseline and perioperative data were collected, and the neutrophil to lymphocyte ratio (NLR) and platelet to white blood cell ratio (PWR) were calculated before operation and within 24 hours after operation. Delirium assessment was conducted twice a day for patients within 1-5 days after surgery or discharged within 5 days. According to the evaluation results, the patients were divided into delirium group and non-delirium group. The clinical indexes between the two groups were compared. Multivariate Logistic regression analysis was used to screen the independent risk factors of POD, and the POD predictive model was constructed. The predictive value of POD predictive model was evaluated by receiver operator characteristic curve (ROC curve). A total of 235 patients were enrolled in the analysis, of which 83 patients had POD (35.32%) and 152 patients did not have POD (64.68%). Compared with the non-delirious group, the patients in the delirious group had higher Charlson comorbidity index (CCI) score and lower mini-mental state examination (MMSE) score. In terms of perioperative data, compared with the non-delirium group, the patients in the delirium group had longer operative time, duration of cardiopulmonary bypass, length of intensive care unit (ICU) stay, duration of mechanical ventilation, and postoperative hospital stay, higher incidence of perioperative atrial fibrillation, and lower discharge life score. In terms of leukocyte derived markers, NLR within 24 hours after surgery in both groups were significantly higher than those before surgery, and PWR were significantly lower than those before surgery. The NLR within 24 hours after surgery, PWR difference and NLR difference in the delirium group were significantly higher than those in the non-delirium group. Multivariate Logistic regression analysis showed that CCI score [odds ratio (OR) = 1.394, 95% confidence interval (95%CI) was 1.038-1.872, P = 0.027], perioperative atrial fibrillation (OR = 3.697, 95%CI was 1.711-7.990, P < 0.001), duration of cardiopulmonary bypass (OR = 1.008, 95%CI was 1.002-1.015, P = 0.016), length of ICU stay (OR = 1.006, 95%CI was 1.002-1.010, P = 0.002), NLR difference (OR = 1.029, 95%CI was 1.009-1.050, P = 0.005) and PWR difference (OR = 1.044, 95%CI was 1.009-1.080, P = 0.013) were independently correlated with POD. POD predictive model was constructed by multivariate Logistic regression analysis result: POD predictive model index = -4.970+0.336×CCI score+1.317×perioperative atrial fibrillation+0.009×duration of cardiopulmonary bypass+0.006×length of ICU stay+0.030×NLR difference+0.044×PWR difference. ROC curve analysis showed that the area under the ROC curve (AUC) of NLR difference for predicting POD was 0.659 (95%CI was 0.583-0.735), the optimal critical value was 16.62, the sensitivity was 60.2%, and the specificity was 70.4% (P < 0.05). The AUC of PWR difference for predicting POD was 0.608 (95%CI was 0.528-0.688), the optimal critical value was 25.68, the sensitivity was 51.8%, and the specificity was 75.7% (P < 0.05). The AUC of POD predictive model for predicting POD was 0.805 (95%CI was 0.745-0.865), the optimal critical value was 0.39, the sensitivity was 74.7%, and the specificity was 79.6% (P < 0.05). The differences of NLR and PWR are independently related to POD, which has potential value in predicting POD after cardiac valve surgery.

Predictive role of early treatment dynamics of HBV RNA and HBcrAg for HBeAg seroconversion in children with chronic hepatitis B.

This study aimed to assess the predictive capacity of emerging serological markers, serum HBV RNA and HBcrAg, for HBeAg seroconversion in children with HBeAg-positive chronic hepatitis B (CHB). Treatment-naïve HBeAg-positive CHB children who admitted to the Liver Disease Center of Hunan Children's Hospital between April 2021 and September 2022 and received treatment with the combined entecavir and interferon-alpha treatment were recruited. Serum HBV RNA and HBcrAg were measured at baseline and Weeks 12, 24, and 48 of treatment. Our study showed that serum HBV RNA (HR = 0.71, 95% CI: 0.56-0.91, p = 0.006), HBcrAg (HR = 0.60, 95% CI: 0.43-0.84, p = 0.003), and HBsAg (HR = 0.49, 95%CI: 0.36-0.69, p < 0.001) at Week 12 were independent predictors of HBeAg seroconversion. ROC curve analysis presented that serum HBV RNA decline value (ΔHBV RNA) at Week 36 and HBcrAg decline value (ΔHBcrAg) at Week 12 (AUC = 0.871, p = 0.003 and AUC = 0.810, p = 0.003, respectively) could effectively predict HBeAg seroconversion. Furthermore, the optimal critical values were determined and the children with ΔHBV RNA > 3.759 log10 copies/mL at Week 36 or ΔHBcrAg >0.350 log10 U/mL at Week 12 more likely to achieve HBeAg seroconversion. The serum HBV RNA and HBcrAg provide new insights into the treatment of CHB in children. Early assessment of serum HBV RNA and HBcrAg during treatment can assist clinical decision-making and optimize individualized therapeutic approaches.

Comparison of the relative diagnostic performance of 68Ga-DOTA-IBA and 18F-NaF for the detection of bone metastasis.

We aimed to compare the relative diagnostic efficacy of 68Ga-Labeled DOTA-ibandronic acid (68Ga-DOTA-IBA) to that of18F-NaF PET/CT as a mean of detecting bone metastases in patients with a range of cancer types. This study retrospectively enrolled patients with bone metastases associated with various underlying malignancies. All patients underwent both 68Ga-DOTA-IBA and 18F-NaF PET/CT scans. Histopathology and follow-up CT or MRI imaging results were used as reference criteria, with a minimum follow-up period of 3 months. The maximum Standardized Uptake Value (SUVmax) and number of bone metastases were recorded. The Target-Background Ratio (TBR) was calculated along with the detection rate, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 68Ga-DOTA-IBA and 18F-NaF PET/CT imaging for overall and partial primary solid tumor bone metastases. Pearson chi-square test, McNemar test, and Kappa test was conducted to assess the correlation and consistency of diagnostic efficiency between the two imaging agents. Receiver Operating Characteristic curve (ROC curve) was performed to compare diagnostic performance and the area under the curve of the two imaging agents, determining optimal critical values for SUVmax and TBR in diagnosing bone metastasis. Differences in SUVmax and TBR values between the two imaging agents for detecting bone metastases were analyzed using the Wilcoxon signed rank test. The difference was statistically significant when P < 0.05. A total of 24 patients (13 women and 11 men) were included in this study, with a mean age of 52 (interquartile range, 49-64 years). The detection rate, sensitivity, specificity, PPV, NPV, accuracy, and AUC of 68Ga-DOTA-IBA and 18F-NaF PET/CT for bone metastases were 81%, 90%, 62%, 95%, 43%, 88%, 0.763, and 89%, 99%, 59%, 95%, 89%, 95%, 0.789, respectively. There was no significant difference between the two imaging methods (P < 0.01), and there was a significant correlation (X2=168.43, P < 0.001) and a strong consistency (Kappa=0.774,P < 0.001) between the diagnostic results of the two imaging agents. The SUVmax values of lesions measured by 68Ga-DOTA-IBA and 18F-NaF imaging in 22 patients with bone metastasis were 5.1 ± 5.4 and 19.6 ± 15.1, respectively, with statistically significant differences (P<0.05). The TBR values of the two imaging methods were 5.0 ± 5.0 and 6.7 ± 6.4, respectively, with statistically significant differences (P<0.05). The AUC of the SUVmax of 68Ga-DOTA-IBA and 18F-NaF curves were 0.824 and 0.862, respectively, with no statistically significant difference (P=0.490). No significant difference was found in the AUC of the TBR of 68Ga-DOTA-IBA and 18F-NaF (0.832 vs 0.890; P=0.248). Subgroup analysis showed significant correlation between the two imaging agents in the diagnosis of bone metastases in lung cancer and breast cancer, with consistent diagnostic results. However, in the diagnosis of bone metastases in prostate cancer, there was a significant difference (P<0.001) and lack of consistency (P=0.109). The diagnostic efficacy of 68Ga-DOTA-IBA for bone metastasis lesions is comparable to that of 18F-NaF. This finding holds significant clinical importance in terms of diagnosis of bone metastasis and selecting treatment plans for patients with malignant tumors.

The prognostic value of dynamic changes in SII for the patients with STEMI undergoing PPCI

BackgroundPredicting the prognosis of primary percutaneous coronary intervention(PPCI) in ST-segment elevation myocardial infarction (STEMI) patients in the perioperative period is of great clinical significance. The inflammatory response during the perioperative period is also an important factor. This study aimed to investigate the dynamic changes in the systemic immune inflammatory index (SII) during the perioperative period of PPCI and evaluate its predictive value for in-hospital and out-of-hospital outcomes in patients with STEMI.MethodsThis retrospective study included 324 consecutive patients with STEMI who were admitted to the cardiac care unit. Blood samples were collected before PPCI, 12 h (T1), 24 h, 48 h after PPCI, the last time before hospital discharge (T2), and 1 month after hospital discharge. The SII was calculated as (neutrophils×platelets)/lymphocytes. Based on whether the primary endpoint occurred, we divided the patients into event and non-event groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors that might influence the occurrence of the primary endpoint. Dynamic curves of SII were plotted, and receiver operating characteristic (ROC) curves were drawn for each node to calculate the optimal critical value, sensitivity, and specificity to assess their predictive ability for in-hospital and out-of-hospital courses. Kaplan-Meier curves were used to analyze the differences in survival rates at different SII inflammation levels.ResultsHigh levels of SII were individually related to the occurrence of the in-hospital period and long-term outcomes during the post-operative follow-up of STEMI patients (in-hospital SII: T1:OR 1.001,95%CI 1.001–1.001, P < 0.001; SII following hospital discharge: T1M: OR 1.008,95%CI 1.006–1.010, P < 0.001). Patients with high SII levels had lower survival rates than those with low SII levels. The analysis showed that the SII 12 h after (T1) and SII 1 month (T1M) had excellent predictive values for the occurrence of in-hospital and out-of-hospital outcomes, respectively (AUC:0.896, P < 0.001; AUC:0.892, P < 0.001).ConclusionThere is a significant relationship between the dynamic status of SII and prognosis in patients with STEMI. This study found that the 12 h and SII 1 month affected in-hospital and out-of-hospital outcomes, respectively. Consequently, we focused on the dynamic changes in the SII.

Application value of ultrasound elastography for screening of early pregnancy cervical insufficiency: a retrospective case-control study.

This study aimed to investigate changes in the cervical strain rate (SR), cervical length (CL), and uterine artery blood flow parameters during early pregnancy in women with cervical insufficiency and evaluate the clinical efficacy of these markers for screening of cervical insufficiency in early pregnancy. This retrospective study in 60 pregnant women with cervical insufficiency and 100 normal pregnant women was conducted between September 2021 and January 2023 and measured ultrasound parameters of the cervix during early pregnancy. The cervical SR, CL, and uterine artery resistance index (RI) were measured in both groups at 11-14 weeks of gestation. Strain elastography represented by the SR was used to assess the hardness of the internal and external cervical openings. During early pregnancy, the SR at the internal and external cervical openings were significantly higher in the cervical insufficiency group than those in the normal pregnancy group (SR I: 0.19 ± 0.018% vs. 0.16 ± 0.014%; SR E: 0.26 ± 0.028% vs. 0.24 ± 0.025%; p < .001). The CL was significantly shorter in the cervical insufficiency group than that measured in the normal pregnancy group (34.3 ± 2.9 mm vs. 35.2 ± 1.99 mm; p = .036), while cervical blood perfusion was also poorer in the cervical insufficiency group than that in the normal pregnancy group (uterine artery RI: 0.76 ± 0.07 vs. 0.74 ± 0.05; p = .048). Receiver operating characteristic (ROC) curve analysis showed that the optimal critical values for diagnosing cervical insufficiency were 0.17% for SR I, 0.25% for SR E, 33.8 mm for CL, and 0.78 for uterine artery RI. Of these parameters, the ROC curve for SR I had the largest area under the curve [AUC = 0.89 (p < .001)], with the highest sensitivity (78%) and specificity (82%). Multivariate logistic regression analysis demonstrated that the SR at the internal cervical opening (OR 17.47, 95% confidence interval (CI) 5.08-60.08; p < .001) and CL (OR 5.05, 95% CI 1.66-15.32; p = .004) still showed significant differences between the two groups. Cervical elastography is an effective tool for screening early pregnancy cervical insufficiency. The SR at the internal cervical opening is a valuable indicator for screening cervical insufficiency and has superior clinical efficacy for screening for this condition compared to that of CL and the uterine artery blood flow index.

Development and Validation of a Risk Prediction Model for NAFLD: A Study Based on a Physical Examination Population.

To construct and validate a precise and personalized predictive model for non-alcoholic fatty liver disease (NAFLD) to enhance NAFLD screening and healthcare administration. A total of 730 participants' clinical information and outcome measurements were gathered and randomly divided into training and validation sets in a ratio of 3:7. Using the least absolute shrinkage and selection operator (LASSO) regression and multiple logistic regression, a nomogram was established to select risk predictor variables. The NAFLD prediction model was validated through the receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis (DCA). After random grouping, the cohort comprised 517 in the training set and 213 in the validation set. The prediction model employed nine of the 20 selected variables, namely gender, hypertension, waist circumference, body mass index, blood platelet, triglycerides, high-density lipoprotein cholesterol, plasma glucose, and alanine aminotransferase. ROC curve analysis yielded an area under the curve values of 0.877 (95% Confidence Interval [CI]: 0.848-0.907) for the training set and 0.871 (95% CI: 0.825-0.917) for the validation set. Optimal critical values were determined as 0.472 (0.786, 0.825) in the training set and 0.457 (0.743, 0.839) in the validation set. Calibration curves for both sets showed proximity to the ideal diagonal, with P-values of 0.972 and 0.370 for the training and validation sets, respectively (P > 0.05). DCA indicated favorable clinical applicability of the model. We constructed a nomogram model that could complement traditional NAFLD detection methods, aiding in individualized risk assessment for NAFLD.

The coexistence of myosteatosis and the creatinine/cystatin C ratio are determinants of outcomes in cholangiocarcinoma patients undergoing curative surgery.

Myosteatosis is a well-established predictor of poor prognosis in many types of cancer, and a decreased Creatinine/Cystatin C ratio (CCR) is a known indicator of unfavorable outcomes in patients with metabolic disorders and cancer. Despite this knowledge, the significance of concurrent CCR and myosteatosis in predicting the prognosis of patients with cholangiocarcinoma (CCA) who undergo radical surgery remains uncertain. Data from 757 patients with cholangiocarcinoma who underwent the first radical resection in the Affiliated Hospital of Qingdao University from January 2017 to March 2022 were collected. According to the inclusion and exclusion criteria, 149 patients were finally included in the retrospective study cohort. Various clinicopathological, serological, and radiological data were collected at admission. Myosteatosis was evaluated using sliceOmatic software on computed tomography (CT) images. The study used receiver operating characteristic (ROC) curve analysis to determine the critical value of CCR, which predicts overall survival (OS) based on the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were employed to identify the risk factors associated with OS and RFS confidently. The group identified as the myosteatosis cohort consisted of 79 patients with an average age of 64.3 ± 7.8 years. The ROC curve analysis revealed an optimal critical CCR value of 10.834.A low CCR ≤ 10.834 and myosteatosis were found to be associated with poor OS and RFS outcomes (P = 0.022; P = 0.017; P = 0.038; P = 0.030 respectively). Moreover, patients with myosteatosis and a CCR ≤ 10.834 had the worst OS and RFS outcomes (P = 0.035; P = 0.027). After radical excision in CCA patients, the presence of myosteatosis and CCR had a negative correlation with prognosis. A more accurate prediction of OS and RFS was possible by combining CCR and myosteatosis, compared to CCR alone.

The method for solving the multi-criteria linear-fractional optimization problem in integers

In the papers we propose a method for solving the linear-fractional multi-criteria optimization model with identical denominators in whole numbers. Such models are in increasing demand, especially from an application point of view. The solving procedure of these models initially involves assigning utilities (weights) to each criterion [15] and building the optimization model with a single criterion, which is a synthetic function of all criteria weighted. It was found that the optimal solution of the model does not depend on the values optimum of the criteria obtained in R+ or in Z+. So, the decision maker can combinatorially select the types of optimal values of criteria, a fact that represents the essential priority of the algorithm. By changing the utility values, at the decision maker's discretion, we will obtain a new optimal compromise solution of the model. Theoretical justification of the algorithm as well as a solved example are brought to work.

The method for solving the multi-criteria linear-fractional optimization problem in integers

In the papers we propose a method for solving the linear-fractional multi-criteria optimization model with identical denominators in whole numbers. Such models are in increasing demand, especially from an application point of view. The solving procedure of these models initially involves assigning utilities (weights) to each criterion [15] and building the optimization model with a single criterion, which is a synthetic function of all criteria weighted. It was found that the optimal solution of the model does not depend on the values optimum of the criteria obtained in R+ or in Z+. So, the decision maker can combinatorially select the types of optimal values of criteria, a fact that represents the essential priority of the algorithm. By changing the utility values, at the decision maker's discretion, we will obtain a new optimal compromise solution of the model. Theoretical justification of the algorithm as well as a solved example are brought to work.