Performance Score Research Articles

External Validation of Traditional and Modified Harborview Risk Scores for Ruptured Abdominal Aortic Aneurysm 30-day Mortality Prediction

To validate traditional and modified Harborview Risk Score (tHRS and mHRS) for patients with ruptured abdominal aortic aneurysm (rAAA) in an external population. Consecutive patients undergoing rAAA repair from January 2012 to January 2024 at a tertiary Vascular Surgery Center were retrospectively reviewed. The scores were calculated for each patient; receiver operating characteristic curves (ROC), area under the curve (AUC) with 95% confidence intervals (CIs) and calibration plots were built to evaluate discrimination and calibration. Furthermore, the relationship of mortality with score variables was updated running a multivariate logistic model, then applied to one thousand bootstrap samples. One hundred and five patients treated for rAAA (97 males, 92.4%) were included in the study (77±8.5 years). An endovascular repair (rEVAR) was performed in 35 patients (3 women, 80±9.0 years) while an open repair (rOAR) in 70 patients (5 women, 75±8.0 years). The 30-day mortality rate was 31.4%. (33/105), 25.7% (9/35) and 34.3% (24/70) for rEVAR and rOAR respectively (p 0.5). Eight patients (7.6%) were on therapy with warfarin at the time of admission. AUC for tHRS was 0.56 while AUC for mHRS was 0.68 (DeLong test = 0.29). The tHRS' calibration showed underestimation for patients with predicted mortality < 25% and overestimation for the remaining; for mHRS, the predictions were well calibrated for patients with estimated mortality < 40% with overprediction afterward. The model update demonstrated that the wider effects are due to the interaction between the HRS factors. THRS and mHRS showed limited prediction capability with 30-day mortality overestimation in an external validation, raising many concerns about their extended and systematic application. Interaction between factors should be taken into account to enhance the score's performance, especially in high risk patients.

Plasma Brain-Derived Tau in Prognosis of Large Vessel Occlusion Ischemic Stroke.

Large vessel occlusion acute ischemic stroke prognosis improved following the 2015 endovascular therapy (EVT) trials. Blood-based biomarkers may improve outcome prediction. We aimed to assess plasma brain-derived tau (BD-Tau) performance in predicting post-EVT large vessel occlusion acute ischemic stroke outcomes. We included 2 temporally independent prospective cohorts of anterior circulation in patients with large vessel occlusion acute ischemic stroke who successfully recanalized post-EVT. We measured plasma BD-Tau, GFAP (glial-fibrillary-acidic-protein), NfL (neurofilament-light-chain), and total-Tau upon admission, immediately, 24 hours, and 72 hours post-EVT. Twenty-four-hour neuroimaging and 90-day functional outcomes were independently assessed using the Alberta Stroke Program Early Computed Tomography Score (good outcome: >7 or unchanged) and the modified Rankin Scale (favorable outcome <3 or unchanged), respectively. Based on the first cohort (derivation), we built a multivariable logistic regression model to predict a 90-day functional outcome. Model results were evaluated using the second cohort (evaluation). In the derivation cohort (n=78, mean age=72.9 years, 50% women), 62% of patients had a good 24-hour neuroimaging outcome, and 45% had a favorable 90-day functional outcome. GFAP admission-to-EVT rate-of-change was the best predictor for early neuroimaging outcome but not for 90-day functional outcome. At admission, BD-Tau levels presented the highest discriminative performance for 90-day functional outcomes (area under the curve, 0.76 [95% CI, 0.65-0.87]; P<0.001). The model incorporating age, admission BD-Tau, and 24-hour Alberta Stroke Program Early Computed Tomography Score achieved excellent discrimination of 90-day functional outcome (area under the curve, 0.89 [95% CI, 0.82-0.97]; P<0.001). The score's predictive performance was maintained in the evaluation cohort (n=66; area under the curve, 0.82 [95% CI, 0.71-0.92]; P<0.001). Admission plasma BD-Tau accurately predicted 90-day functional outcomes in patients with large vessel occlusion acute ischemic stroke after successful EVT. The proposed model may predict functional outcomes using objective measures, minimizing human-related biases and serving as a simplified prognostic tool for AIS.

Explore How Transformational Leadership Styles Impact Educational Environments and Student

This study investigates the impact of transformational leadership on school climate and student outcomes using both correlational and regression analyses to assess the relationships between leadership behaviors and educational variables. The findings reveal that transformational leadership significantly enhances teacher collaboration (r = 0.65), inclusivity (r = 0.71), and innovation (r = 0.58), with leadership explaining up to 51% of the variance in inclusivity. Additionally, transformational leadership is positively correlated with student outcomes, including academic performance (r = 0.62) and student engagement (r = 0.62). Schools led by transformational leaders had higher mean scores in student academic performance, with an average test score of 85.50 compared to 78.00 in schools with other leadership styles. Statistical analyses such as ANOVA confirmed that these differences are statistically significant, showing that transformational leadership fosters a more collaborative, inclusive, and innovative school environment, which directly enhances student engagement and academic achievement. These results highlight the importance of transformational leadership in educational settings, particularly in shaping both teacher effectiveness and student success. The study concludes by recommending leadership development programs, collaboration initiatives, and regular leadership evaluations to ensure continuous improvement in school environments.

Machine Learning with Clinical and Intraoperative Biosignal Data for Predicting Cardiac Surgery-Associated Acute Kidney Injury.

Early identification of patients at high risk of cardiac surgery-associated acute kidney injury (CSA-AKI) is crucial for its prevention. We aimed to leverage perioperative clinical and intraoperative biosignal data to develop machine learning models that predict CSA-AKI. We introduced a novel approach for extracting relevant features from high-resolution intraoperative biosignals to reflect the patient's baseline status, the extent of unfavorable conditions encountered intraoperatively, and data variability. We developed XGBoost models from 2,003 patients across three consecutive perioperative phases using: 1) only preoperative, 2) pre- and intraoperative, and 3) pre-, intra-, and postoperative variables. The predictive performance progressively improved throughout the three consecutive perioperative phases (e.g., AUROC of 0.767 to 0.797 and 0.840), all surpassing the Thakar Score's performance. According to the SHAP method, intraoperative perfusion pressure was most important in the prediction, highlighting the importance of intraoperative patient management and the use of high-resolution biosignal data in predictive modeling to analyze hemodynamic fluctuations during surgery. Early postoperative biomarkers were also important predictors, highlighting the importance of intensified monitoring early after surgery.

Difference in medical student performance in a standardized patient encounter between telemedicine and in-person environments

ABSTRACT Introduction Telemedicine is an increasingly common form of healthcare delivery in the United States. It is unclear how there are differences in clinical performance in early learners between in-person and telemedicine encounters. Materials & Methods The authors conducted a single-site retrospective cohort study of 241 second-year medical students to compare performance between in-person and telemedicine standardized patient (SP) encounters. One hundred and twenty medical students in the 2020 academic year participated in a telemedicine encounter, and 121 medical students in the 2022 academic year participated in an in-person encounter. SPs completed a multi-domain performance checklist following the encounter, and the authors performed statistical analyses to compare student performance between groups. Results Students who completed in-person encounters had higher mean scores in overall performance (75.2 vs. 69.7, p < 0.001). They had higher scores in physical exam (83.3 vs. 50, p < 0.001) and interpersonal communication domains (95 vs. 85, p < 0.001) and lower scores in obtaining a history (73.3 vs. 80, p = 0.0025). There was no significant difference in assessment and plan scores (50 vs. 50, p = 0.96) or likelihood of appropriately promoting antibiotic stewardship (41.3% vs. 45.8%, p = 0.48). Conclusion The authors identified significant differences in clinical performance between in-person and telemedicine SP encounters, indicating that educational needs may differ between clinical environments.

M Score Performance Measure for Islamic Banks in Malaysia and Indonesia

Performance measurement is vital to examine the performance of any institution. Due to the different nature of business operations, processes, and activities in Islamic banks, they have to be measured by a more focused instrument to reflect the Shariah compliance parts and their business nature compared to the conventional banks. Hence, M Score which has been developed by Abdul Rahim, Abdul Rahman and Syed AlHabshi (2016) has been adopted in this study. The findings from the computation will indicate which country gains the higher M Score in performance, and this can be used as a benchmarking exercise. This research aims to analyse and compare the M Score performance of Islamic banks in Malaysia and Indonesia. The content analysis via Annual Reports of Islamic banks has been used for this study. The sampling technique used is purposive sampling. The research was conducted on Islamic banks in Malaysia and Indonesia over a period of two years, from 2020-2021. This comparative research is expected to be an evaluation tool for Malaysian Islamic banks, helping them improve their performance to catch up with their counterparts in Indonesia. Thus, the purpose of this research proposal is to analyse and compare the effect of the soundness of Islamic banks based on the M Score performance of Islamic banks in Malaysia and Indonesia. The results of this study indicate that Islamic banks in Indonesia have a higher M Score ranking than those in Malaysia. There are significant differences in the performance of Islamic banks based on the Need Fulfilment and Equitable Distribution (NFED), Economic Growth (EG), and Economic Stability (ES) in Malaysia and Indonesia.

Resting State Electrophysiological Profiles and Their Relationship with Cognitive Performance in Cognitively Unimpaired Older Adults: A Systematic Review.

Aging is a complex and natural process. The physiological decline related to aging is accompanied by a slowdown in cognitive processes, which begins shortly after individuals reach maturity. These changes have been sometimes interpreted as a compensatory sign and others as a fingerprint of deterioration. In this context, our aim is to uncover the mechanisms that underlie and support normal cognitive functioning in the brain during the later stages of life. With this purpose, a systematic literature search was conducted using PubMed, Scopus, and Web of Science databases, which identified 781 potential articles. After applying inclusion and exclusion criteria, we selected 12 studies that examined the brain oscillations patterns in resting-state conditions associated with cognitive performance in cognitively unimpaired older adults. Although cognitive healthy aging was characterized differently across studies, and various approaches to analyzing brain activity were employed, our review indicates a relationship between alpha peak frequency (APF) and improved performance in neuropsychological scores among cognitively unimpaired older adults. A higher APF is linked with a higher score in intelligence, executive function, and general cognitive performance, and could be considered an optimal, and easy-to-assess, electrophysiological marker of cognitive health in older adults.

Cognitive impairment in major depressive disorder with non-suicidal self-injury: Association with the functional connectivity of frontotemporal cortex

BackgroundNon-suicidal self-injury (NSSI) may be related to serious cognitive impairment in patients with major depressive disorder (MDD), but the specific mechanism is still unclear. This study attempts to identify the neurobiological process alterations of cognitive impairment in MDD patients with NSSI by examining the functional connectivity of the frontotemporal cortex in MDD patients with or without NSSI. MethodThirty MDD patients with NSSI, 36 MDD patients without NSSI, and 35 healthy controls (HC) were included in the study. The MATRICS Consensus Cognitive Battery (MCCB) was used to comprehensively assess the cognitive function of the subjects and functional near-infrared spectroscopy (fNIRS) was used to detect the functional connectivity of the frontotemporal cortex and its brain regions of interest. ResultsMDD patients with or without NSSI had multi-domain cognitive impairments. MDD patients with NSSI showed the lowest score in performance of attention/alertness and the weakest functional connectivity of frontotemporal when compared with the MDD patients without NSSI and the HC. In addition, the functional connectivity of the bilateral frontotemporal cortex was positively correlated with verbal learning and working memory in MDD patients with NSSI. ConclusionIn MDD patients, the appearance of NSSI is often accompanied by further impairment of attention/alertness and a decline in functional connectivity of the frontotemporal cortex. The impairment of verbal learning and working memory was associated with decreased functional connectivity of the frontotemporal cortex in MDD patients with NSSI.

MDC-RHT: Multi-Modal Medical Image Fusion via Multi-Dimensional Dynamic Convolution and Residual Hybrid Transformer.

The fusion of multi-modal medical images has great significance for comprehensive diagnosis and treatment. However, the large differences between the various modalities of medical images make multi-modal medical image fusion a great challenge. This paper proposes a novel multi-scale fusion network based on multi-dimensional dynamic convolution and residual hybrid transformer, which has better capability for feature extraction and context modeling and improves the fusion performance. Specifically, the proposed network exploits multi-dimensional dynamic convolution that introduces four attention mechanisms corresponding to four different dimensions of the convolutional kernel to extract more detailed information. Meanwhile, a residual hybrid transformer is designed, which activates more pixels to participate in the fusion process by channel attention, window attention, and overlapping cross attention, thereby strengthening the long-range dependence between different modes and enhancing the connection of global context information. A loss function, including perceptual loss and structural similarity loss, is designed, where the former enhances the visual reality and perceptual details of the fused image, and the latter enables the model to learn structural textures. The whole network adopts a multi-scale architecture and uses an unsupervised end-to-end method to realize multi-modal image fusion. Finally, our method is tested qualitatively and quantitatively on mainstream datasets. The fusion results indicate that our method achieves high scores in most quantitative indicators and satisfactory performance in visual qualitative analysis.

CT-guided Percutaneous Microwave Ablation Combined with Local Radiotherapy or Chemotherapy of Malignant Pulmonary Tumors.

The study aimed to investigate the clinical efficacy of CT-guided microwave ablation (MWA) combined with 125I seed implantation or bronchial arterial infusion (BAI) chemotherapy in the treatment of malignant pulmonary tumors. A total of 56 patients who underwent MWA, MWA combined with 125I particle implantation, or MWA combined with BAI chemotherapy for advanced lung cancer or metastatic lung cancer from January 2015 to June 2021 in Guangdong Provincial People's Hospital were enrolled. Among them, 21 patients were treated with MWA (MWA), 18 with MWA combined with 125I seed implantation (MWA+125I), and 17 with MWA combined with BAI chemotherapy (MWA+BAI). The short-term outcomes, complications, Eastern Cooperative Oncology Group (ECOG) performance score (Zubrod-ECOG-WHO, ZPS), survival, and factors related to survival were compared between the three groups. The response rate of the MWA group (9.52%) was significantly lower than that of the MWA+125I group (50.00%) and MWA+BAI chemotherapy group (47.06%), and the differences were statistically significant (p < 0.05). The incidence of complications in the MWA, MWA+125I, and MWA+BAI chemotherapy groups was 47.62%, 55.56%, and 52.94%, respectively, with no significant difference (p > 0.05). Three months after the treatment, the ZPS of the MWA+125I and MWA+BAI chemotherapy groups was significantly lower than before treatment and significantly lower than that of the MWA group in the same period; the differences were statistically significant (p < 0.05). The median survival time of the MWA+125I group was 18 (9.983, 26.017) months and that of the MWA+BAI chemotherapy group was 21 (0.465, 41.535) months, both of which were higher than that of the MWA group [11 (6.686, 15.314) months]; the differences were statistically significant (p < 0.05). Cox regression analysis was performed on the factors related to survival and revealed treatment mode as a protective factor [HR = 0.433, 95% CI = (0.191, 0.984), p = 0.046]. Other factors, such as gender, age, and tumor size, did not independently affect survival. CT-guided MWA combined with 125I seed implantation and MWA combined with BAI chemotherapy are safe and effective for the treatment of advanced lung cancer and metastatic lung cancer, and can control tumor progression and prolong survival time.

The Effects of Nursing Students' Locus of Control, Motivation, and Learning Strategies on Their Academic Performance.

The academic performance of nursing students significantly impacts their ability to deliver quality patient care. This descriptive correlational study investigated the effects of nursing students' locus of control, motivation, and learning strategies on their academic performance in a sample of 515 students. External locus of control was associated with higher scores in extrinsic goal orientation, task value, elaboration, and academic performance. Locus of control, test anxiety, and organization were identified as predictors of academic performance. The study highlights the need for further research on factors affecting academic performance and effective educational interventions.

#958 Development and Validation of a Score Estimating the Probability of obtaining a genetic diagnosis in adults with CKD of uncertain origin

Abstract Background and Aims We aim to derive and validate a score estimating the probability of identifying a variant explicative of the renal phenotype using Exome Sequencing (ES) in adults with CKD of uncertain origin. Method Participants: prospective cohort study including all consecutive index patients with a CKD from uncertain origin in three French nephrology units (metropolitan: Sorbonne University Hospitals, Paris, and Conception Hospital, Marseille; overseas: La Réunion University Hospital, Réunion island) who underwent ES between October 11th, 2017 and May 31st, 2023. Outcome measure: identification of a causal variant using ES data, according to the American College of Medical Genetics and Genomics diagnostic criteria. Candiate variables and feature engineering: raw data regarding patients’ phenotypes was prospectively entered in a collection form at the time of ES by the prescribing physician. Structured data (yes/no questions and lists) was mapped to Human Phenotype Ontology (HPO) terms. Unstructured data (free text) was manually translated into HPO terms by the same investigator (nephrologist), which was blinded to ES results. First, second and third-order ancestor HPO terms were included in the analysis. Score's derivation: an optimal weighted average of multiple models (“ensemble model”) was specified, following guidelines provided in a recently published article (PMID:36905602). Score's validation: internal validation using 10-fold cross validation, followed by internal-external validation (data from 2/3 centers was used to develop a model which was then tested using data from the remaining center; this process was repeated in each center). Results We included 2,490 patients, 560/2,490 (22.5%) of whom had a causal variant identified by ES. We collected 1,028 distinct HPO terms describing the patients’ phenotypes. The most common term was “Hypertension”, occurring in 2,079/2,490 (83.5%) patients. In internal validation, the score showed accurate calibration and discrimination (area under the receiver operating characteristics curve (AUC): 0.71, 95% CI 0.68 to 0.73; index of precision accuracy (IPA): 0.11, 95% CI 0.09 to 0.13). Performances were moderately diminished in internal-external validation but remained satisfactory (Tenon: AUC 0.64, IPA 0.04; Marseille: AUC 0.67, IPA 0.04; La Réunion: 0.68, IPA 0.09). Conclusion We derived, internally and internally-externally validated a clinical score which accurately predicts the probability of obtaining a genetic diagnosis using Exome Sequencing. Feature engineering could further increase the score's performances. Automatic computation by clinicians using an interactive tool is achievable and could be of clinical utility, especially to guide resource allocation in case of a low pretest probability.

The role of ESG scores in ESG fund performance and institutional investor selection

This paper conducts a study on ESG funds between 2012 and 2022 to analyze the impact of ESG fund performance indicators on their institutional ownership ratios. The findings show that the performance of ESG funds is positively correlated with the proportion of institutional holdings. External institutional investors tend to be more inclined to hold funds with excellent historical performance, while fund management companies are more inclined to hold funds with poorer historical performance. In addition, fund management companies are more inclined to hold funds with high ESG scores.

Caffeine Does Not Alter Performance, Perceptual Responses, and Oxidative Stress After Short Sprint Interval Training.

Despite the abundance of research investigating the efficacy of caffeine supplementation on exercise performance, the physiological and biochemical responses to caffeine supplementation during intermittent activities are less evident. This study investigated the acute effects of caffeine supplementation on measures of exercise performance, ratings of perceived exertion, and biomarkers of oxidative stress induced by an acute bout of sprint interval training. In a randomized crossover design, 12 healthy males (age: 26 ± 4years, height: 177.5 ± 6cm, body mass: 80.7 ± 7.6kg) ingested 6mg/kg of caffeine or placebo 60min prior to performing sprint interval training (12 × 6s "all-out sprints" interspersed by 60s of rest). Performance scores and ratings of perceived exertion were assessed after every sprint. Blood samples were collected before supplementation, prior to and following each sprint, and 5 and 60min after the last sprint. Caffeine had no effect on any performance measures, ratings of perceived exertion, or biomarkers of oxidative stress (p > .05). In conclusion, caffeine supplementation does not improve performance or decrease oxidative stress after an acute bout of sprint interval training.

Clinical Characteristics Associated With Posttransplant Survival Among Adults 70 Years Old or Older Undergoing Liver Transplantation.

We sought to identify pre-liver transplantation (LT) characteristics among older adults associated with post-LT survival. The proportion of older patients undergoing deceased-donor liver transplantation (DDLT) has increased over time. We analyzed adult DDLT recipients in the United Network for Organ Sharing registry from 2016 through 2020, excluding patients listed as status 1 or with a model of end-stage liver disease exceptions for hepatocellular carcinoma. Kaplan-Meier methods were used to estimate post-LT survival probabilities among older recipients (age ≥70 y). Associations between clinical covariates and post-LT mortality were assessed using Cox regressions. Of 22,862 DDLT recipients, 897 (4%) were 70 years old or older. Compared with younger recipients, older recipients had worse overall survival ( P < 0.01) (1 y: 88% vs 92%, 3 y: 77% vs 86%, and 5 y: 67% vs 78%). Among older adults, in univariate Cox regressions, dialysis [hazards ratio (HR): 1.96, 95% CI: 1.38-2.77] and poor functional status [defined as Karnofsky Performance Score (KPS) <40] (HR: 1.82, 95% CI: 1.31-2.53) were each associated with mortality, remaining significant on multivariable Cox regressions. The effect of dialysis and KPS <40 at LT on post-LT survival (HR: 2.67, 95% CI: 1.77-4.01) was worse than the effects of either KPS <40 (HR: 1.52, 95% CI: 1.03-2.23) or dialysis alone (HR: 1.44, 95% CI: 0.62-3.36). Older recipients with KPS >40 without dialysis had comparable survival rates compared with younger recipients ( P = 0.30). While older DDLT recipients had worse overall post-LT survival compared with younger recipients, favorable survival rates were observed among older adults who did not require dialysis and had poor functional status. Poor functional status and dialysis at LT may be useful to stratify older adults at higher risk for poor post-LT outcomes.

A Customizable Digital Cognitive Aid for Neonatal Resuscitation: A Simulation-Based Randomized Controlled Trial.

Adherence to the International Liaison Committee on Resuscitation (ILCOR) algorithm optimizes the initial management of critically ill neonates. In this randomized controlled trial, we assessed the impact of a customizable sequential digital cognitive aid (DCA), adapted from the 2020 ILCOR recommendations, compared with a poster cognitive aid (standard of care [SOC]), on technical and nontechnical performance of junior trainees during a simulated critical neonatal event at birth. For this prospective, bicentric video-recorded study, students were recruited on a voluntary basis, and randomized into groups of 3 composed of a pediatric resident and two midwife students. They encountered a simulated cardiac arrest at birth either (1) with DCA use and ILCOR algorithm poster displayed on the wall (intervention group) or (2) with sole ILCOR algorithm poster (poster cognitive aid [SOC]). Technical and nontechnical skills (NTS) between the two groups were assessed using a standardized scoring of videotaped performances. A neonate specific NTS score was created from the adult Team score. 108 students (36 groups of three) attended the study, 20 groups of 3 in the intervention group and 16 groups of 3 in the poster cognitive aid (SOC) group. The intervention group showed a significant improvement in the technical score ( P < 0.001) with an average of 24/27 points (24.0 [23.5-25.0]) versus 20.8/27 (20.8 [19.9-22.5]) in poster cognitive aid (SOC) group. No nontechnical score difference was observed. Feedback on the application was positive. During a simulated critical neonatal event, use of a DCA was associated with higher technical scores in junior trainees, compared with the sole use of ILCOR poster algorithm.

Methodological examination of the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score.

The objective of this study was to examine the impact of methodological changes to the 2018 World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) Score on associations with risk for all-cause mortality, cancer mortality, and cancer risk jointly among older adults in the National Institutes of Health (NIH)-AARP Diet and Health Study. Weights were incorporated for each score component; a continuous point scale was developed in place of the score's fully discrete cut points; and cut-point values were changed for physical activity and red meat based on evidence-based recommendations. Exploratory aims also examined the impact of separating components with more than one subcomponent and whether all components were necessary to retain within this population utilizing a penalized scoring approach. Findings suggested weighting the original 2018 WCRF/AICR Score improved its predictive performance in association with all-cause mortality and provided more precise estimates in relation to cancer risk and mortality outcomes. The importance of healthy weight, physical activity, and plant-based foods in relation to cancer and overall mortality risk were highlighted in this population of older adults. Further studies are needed to better understand the consistency and generalizability of these findings across other populations.

Relative performance evaluation of four bleeding risk scores in atrial fibrillation patients. What does the new DOAC score provide?

BackgroundRecently, the direct oral anticoagulant (DOAC) score was developed and better predicted major bleeding in DOAC-treated patients with atrial fibrillation (AF) than HASBLED did. Little is known on the new score's performance regarding other bleeding risk in AF. MethodsWe studied 14,672 patients diagnosed with AF between 2014 and 2018. During follow-up, we assessed the performance of DOAC score compared with the HASBLED, ORBIT and SWISS scores at predicting major bleeding in DOACs and non-DOACs users. Discrimination, calibration and decision curve analysis (DCA) were used to assess the risk scorer's performance. ResultsThere were 1484 (10.1%) patients on DOACs, 9730 on vitamin K antagonist (VKA), and 3458 on non-oral anticoagulants. Over a median of 3.5 years of follow-up, 79 major bleedings occurred in the DOAC patients, and 486 in the VKA patients (cumulative incidences = 7.4 and 13.9 per 100 patient-years, respectively).Amongst the DOAC patients, the DOAC score discrimination was moderate (C-statistic = 0.711), but significantly higher than HASBLED (C = 0.640; p = 0.03), ORBIT (C = 0.660; p = 0.04), and SWISS scores (C = 0.637; p = 0.002). The DCA showed higher net benefit using DOAC score compared with the remaining scores.In the VKA patients, DOAC score showed the highest discrimination (c-statistic = 0.709), followed by ORBIT (C = 0.692; p = 0.07), HASBLED and SWISS (C = 0.635 and 0.624, respectively; p < 0.01). All risk scores calibrated well, although HASBLED showed relatively poor calibration. ConclusionsThe new DOAC bleeding risk score is a valid and reasonable predictor of major bleeding over a median of 3.5 years of follow-up. Physicians can be reassured about the applicability of DOAC score for bleeding risk stratification in AF patients. RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT04364516

Influence of Surgical Resection on Survival in Glioblastoma with Multiple Localizations—a Multi-Center Retrospective Analysis

INTRODUCTION: The presence of multiple localizations in glioblastoma is rare and associated with poor prognosis. The presence of a visible junction between enhancing lesions on magnetic resonance imaging (MRI) is defined as multifocal (MF), the absence of a dissemination pathway as multicentric (MC). METHODS: Data collection was performed as a multicenter retrospective analysis. From Jan 1, 2008, to Dec 31, 2020 patients presenting with IDH wild-type glioblastoma (CNS WHO grade 4) with multiple localizations were included. Demographic data, tumor size, Karnofsky Performance Score (KPS) before and after surgery were analyzed. EOR was measured by FLAIR and contrast-enhanced MRI. Gross total resection (GTR, residual tumor (RTM) &lt; 5%), subtotal resection (STR, RTM &lt; 30%), partial resection (PR, RTM &gt; 30%), and biopsy (RTM &gt; 75%). RESULTS: This study included 117 patients with a median age of 62 years. 45 (38.5%) patients had MC lesions, 72 (61.5%) MF. Median KPS on admission was similar in both subtypes. Median OS did not differ among MC and MF glioblastomas. In MF glioblastoma, GTR (p = 0.0001) and STR (p = 0.0001) significantly increased the median OS compared to PR and biopsy. Likewise, OS was increased after GTR (p = 0.0272) and STR (p = 0.0272) in MC glioblastoma, as well. Overall, resection significantly increased OS in patients with glioblastoma with multiple localizations compared to biopsy alone. In multivariate logistic regression analysis EOR and chemotherapy were significant and independent predictors of OS in MC and MF glioblastomas. CONCLUSIONS: These data indicate that GTR and STR positively affects OS in patients with MC and MF glioblastoma. These results argue for a more aggressive stance towards surgical treatment of these tumors with particularly poor prognosis, even when GTR is not within reach before resection.

Classifying alkaliphilic proteins using embeddings from protein language model

Alkaliphilic proteins have great potential as biocatalysts in biotechnology, especially for enzyme engineering. Extensive research has focused on exploring the enzymatic potential of alkaliphiles and characterizing alkaliphilic proteins. However, the current method employed for identifying these proteins that requires web lab experiment is time-consuming, labor-intensive, and expensive. Therefore, the development of a computational method for alkaliphilic protein identification would be invaluable for protein engineering and design. In this study, we present a novel approach that uses embeddings from a protein language model called ESM-2(3B) in a deep learning framework to classify alkaliphilic and non-alkaliphilic proteins. To our knowledge, this is the first attempt to employ embeddings from a pre-trained protein language model to classify alkaliphilic protein. A reliable dataset comprising 1,002 alkaliphilic and 1,866 non-alkaliphilic proteins was constructed for training and testing the proposed model. The proposed model, dubbed ALPACA, achieves performance scores of 0.88, 0.84, and 0.75 for accuracy, f1-score, and Matthew correlation coefficient respectively on independent dataset. ALPACA is likely to serve as a valuable resource for exploring protein alkalinity and its role in protein design and engineering.