Receiver Operating Characteristic Analysis Research Articles

Novel ultrasound scoring system to guide cognitive fusion-targeted biopsy: a prospective study.

To develop and validate a novel ultrasound scoring system (USS) for assisting cognitive fusion-targeted biopsy (cTB). We prospectively collected a study cohort consisting of 452 patients with biopsy-naïve, PSA ≤ 20 ng/ml and their 531 Prostate Imaging Reporting and Data System (PI-RADS) v2.1 ≥ 3 lesions. All MRI regions of interest were scored as USS 0, 1, 2, and 3 for the corresponding lesion or region on TRUS. The cumulative cancer detection rate of the biopsy cores was assessed according to USS. Subgroup analysis was conducted to assess the csPCa detection rate following the re-stratification of PI-RADS using USS. Receiver operating characteristics (ROC) analysis was performed for USS, PI-RADS and USS + PI-RADS. The area under the curve (AUC), sensitivity, and specificity were calculated at the cut-off selected by the Youden index. The overall cancer detection rates for USS scores of 0 to 3 were 0% (0/67), 66% (111/166), 83% (176/210), and 100% (59/59), respectively. For USS 2 and USS 3 lesions, the detection rates in targeting the 3rd core (79%, P = 0.774) and 2nd core (93%, P = 0.125) did not significantly increase with subsequent biopsy cores. In the subgroup analysis, the csPCa positive rate for USS 0 was zero across all PI-RADS categories. In contrast, USS 1, 2, and 3 enhanced the csPCa positive rate within each PI-RADS strata. In ROC analysis, the AUC (95% CI) for the combined USS + PI-RADS 0.85 (0.82-0.89) outperformed PI-RADS 0.77 (0.73-0.81) alone (P < 0.001). USS + PI-RADS sensitivity (95% CI) was 80.7% (75.6-84.9) compared to PI-RADS 72.5% (67.6-77.0). In cTB, USS has good performance in cancer risk re-stratification, with higher USS scores correlating with an increased likelihood of cancer and improved diagnostic accuracy. No. 2023-272-002, July 14, 2023.

The pretransplant neutrophil–lymphocyte ratio is associated with postreperfusion syndrome and short-term outcomes after paediatric living-donor liver transplantation

Objective The aim of this study was to evaluate whether the pretransplant neutrophil–lymphocyte ratio (NLR) is associated with postreperfusion syndrome (PRS) after paediatric living-donor liver transplantation (LDLT) and the impact of different pretransplant NLR values on short-term outcomes. Methods Clinical data from paediatric patients who underwent LDLT for biliary atresia were retrospectively analysed. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of the pretransplant NLR for PRS. The paediatric patients were stratified into two cohorts according to the optimal cut-off value, and their perioperative clinical indices were subsequently compared. Results This retrospective study included 313 paediatric patients who had been diagnosed with biliary atresia. Based on ROC analysis, the area under the curve (AUC) of the NLR was 0.738, with a sensitivity of 73.1% and a specificity of 68.2% when predicting PRS. Paediatric patients were split into two groups according to the optimal NLR cut-off: NLR-Low (n = 158) and NLR-High (n = 155). Compared with the NLR-Low group, the NLR-High group had significantly more postoperative intensive care unit and hospitalisation days (p < 0.05). Furthermore, patients in the NLR-High group demonstrated a notably lower 1-year survival rate than their counterparts in the NLR-Low group did. An elevated NLR, a prolonged graft cold ischaemic time, and the occurrence of hypothermia before reperfusion are independent risk factors for PRS. Conclusion The pretransplant NLR is associated with postreperfusion syndrome in paediatric LDLT patients, and an elevated NLR is correlated with unfavourable short-term postoperative outcomes in paediatric patients after LDLT.

Salivary chemokines and growth factors in patients with ischemic stroke

Stroke is a serious health problem that affects an increasing number of people. As a result of the blockage of blood flow, tissue necrosis occurs in areas of the brain supplied by the damaged vessel, and leads to the development of inflammation. Changes that occur in the brain allow molecules to enter the blood, and it has been suggested that some can also penetrate the saliva. This study is the first to assess the profile of 25 chemokines and growth factors in the saliva of stroke survivors compared to a control group. 22 stroke survivors and 22 individuals matched by age and gender were enrolled in the study. Salivary chemokines and growth factors were assessed using the multiplex ELISA method. In the unstimulated saliva of stroke patients, we demonstrated significantly higher levels of chemotactic factors (CTACK/CCL27, IL-8/CXCL8, MIG/CXCL9, MIF) and growth factors (basic FGF, G-CSF, HGF, LIF, VEGF) compared to controls. The levels of MCP-3/CCL7, eotaxin/CCL11, IP-10/CXCL10, IL-3/MCGF, and PDGF-BB were lower in the saliva of the study group. The concentration of basic FGF negatively correlated with cognitive function as measured by the Addenbrooke’s Cognitive Examination (ACE) scale (p = 0.007 r = − 0.56), while salivary IL-3 and LIF levels positively correlated with scores on the Functional Independence Measure (FIM) scale (p = 0.019 r = 0.53; p = 0.033 r = 0.47, respectively). Receiver Operating Characteristic (ROC) analysis showed that salivary basic FGF, HGF, IL-3 and LIF can distinguish ischemic stroke patients from the control group with high sensitivity and specificity. In conclusion, disruptions in chemokine and growth factor levels in saliva may suggest an inflammatory etiology of ischemic stroke. Salivary basic FGF, HGF, IL-3 and LIF could serve as potential biomarkers for stroke. Further research is needed to illuminate the differences in salivary inflammatory mediator profiles in stroke and to evaluate the diagnostic utility of chemokines and growth factors in clinical practice.

Development of a reliable risk prognostic model for lung adenocarcinoma based on the genes related to endotheliocyte senescence

Cellular senescence is a hallmark for cancers, particularly in lung adenocarcinoma (LUAD). This study developed a risk model using senescence signature genes for LUAD patients. Based on the RNA-seq, clinical information and mutation data of LUAD patients collected from the TCGA and GEO database, we obtained 102 endotheliocyte senescence-related genes. The “ConsensusClusterPlus” R package was employed for unsupervised cluster analysis, and the “limma” was used for the differentially expressed gene (DEG) analysis. A prognosis model was created by univariate and multivariate Cox regression analysis combined with Lasso regression utilizing the “survival” and “glmnet” packages. KM survival and receiver operator characteristic curve analyses were conducted applying the “survival” and “timeROC” packages. “MCPcounter” package was used for immune infiltration analysis. Immunotherapy response analysis was performed based on the IMvigor210 and GSE78220 cohort, and drug sensitivity was predicted by the “pRRophetic” package. Cell invasion and migration were tested by carrying out Transwell and wound healing assays. According to the results, a total of 32 genes related to endotheliocyte senescence were screened to assign patients into C1 and C2 subtypes. The C2 subtype showed a significantly worse prognosis and an overall higher somatic mutation frequency, which was associated with increased activation of cancer pathways, including Myc_targets2 and angiogenesis. Then, based on the DEGs between the two subtypes, we constructed a five-gene RiskScore model with a strong classification effectiveness for short- and long-term OS prediction. High- and low-risk groups of LUAD patients were classified by the RiskScore. High-risk patients, characterized by lower immune infiltration, had poorer outcomes in both training and validation datasets. The RiskScore was associated with the immunotherapy response in LUAD. Finally, we found that potential drugs such as Cisplatin can benefit high-risk LUAD patients. In-vitro experiments demonstrated that silencing of Angiopoietin-like 4 (ANGPTL4), Gap Junction Protein Beta 3 (GJB3), Family with sequence similarity 83-member A (FAM83A), and Anillin (ANLN) reduced the number of invasive cells and the wound healing rate, while silencing of solute carrier family 34 member 2 (SLC34A2) had the opposite effect. This study, collectively speaking, developed a prognosis model with senescence signature genes to facilitate the diagnosis and treatment of LUAD.

Identification of Key Nucleotide Metabolism Genes in Diabetic Retinopathy Based on Bioinformatics Analysis and Experimental Verification.

A dysregulated nucleotide metabolism has been implicated in the pathogenesis of diabetic retinopathy (DR). RNA sequencing datasets, GSE102485, GSE60436, and GSE165784, were downloaded from the GEO database. The differentially expressed genes (DEGs) between the DR and controls overlapped with nucleotide metabolism-related genes (NM-RGs), resulting in the differentially expressed NM-RGs (DE-NMRGs). Next, the core genes were identified by the five algorithms of the CytoHubba plugin. Receiver Operating Characteristic (ROC) curves and gene expression analysis were utilized to confirm the biomarkers. Then, the correlations between biomarker expression and the immune-related module were analyzed. The miRNA and transcription factor (TF) predictions, biomarker-targeting drugs, and molecular docking were implemented separately. The interaction between each subcluster of DR was elucidated through single-cell RNA (scRNA) analysis. Moreover, RT-PCR was applied to verify the expression of the biomarkers. In GSE102485, 48 DE-NMRGs were identified via the intersection of 1359 DEGs and 882 NM-RGs. Using the CytoHubba plugin, HMOX1, TLR4, and ACE were selected as core genes. As per the GSVA result, the interferon alpha response, IL6_JAK_STAT3 signaling, and apoptosis were activated in the DR group. The TF prediction identified TLR4 and HMOX1 as potential target genes of USF2. In conclusion, ACE and HMOX1 were possible diagnostic biomarkers related to nucleotide metabolism in DR.

Correlation between hs-CRP-triglyceride glucose index and NAFLD and liver fibrosis

BackgroundThe novel serum high-sensitivity C-reactive protein-triglyceride glucose index (CTI) has been recognized as an optimal parameter encompassing both insulin resistance (IR) and inflammation, which are potential mechanisms contributing to non-alcoholic fatty liver disease (NAFLD). This study aims to examine the correlation between CTI and NAFLD/liver fibrosis in American adults.MethodsThis is a cross-sectional study utilizing data from NHANES during the period from 2017 to 2020. The composite CTI was calculated through the formula: 0.412×Ln [(high-sensitivity C-reactive protein(hs-CRP)] + Ln(triglycerides × fasting plasma glucose/2). To explore the correlation between CTI and NAFLD/liver fibrosis, multivariate logistic regression analyses, subgroup analyses, restricted cubic spline (RCS) regression, and receiver operating characteristic (ROC) analysis were employed.ResultsAmong 3,488 participants, 42.7% (n = 1,488) were diagnosed as NAFLD, while 9.4% (n = 329) exhibited liver fibrosis. Logistic regression and RCS regression analyses demonstrated a significant positive linear correlation between CTI and the prevalence of NAFLD (OR = 1.94, 95% CI: 1.70, 2.22) as well as liver fibrosis (OR = 1.38, 95% CI: 1.14, 1.67), even after being adjusted for potential confounding variables. Furthermore, a significant correlation between CTI and the prevalence of NAFLD/liver fibrosis was observed across various subgroups. ROC analysis revealed that CTI can serve as a more robust identify for the prevalence of NAFLD (AUC = 0.756) and liver fibrosis (AUC = 0.702) compared to triglyceride glucose index (TyG) and hs-CRP alone.ConclusionElevated levels of CTI are directly associated with significant liver fibrosis and the presence of NAFLD, indicating its potential utility as a biomarker for liver fibrosis and NAFLD.

Multi-sequence MRI based radiomics nomogram for prediction expression of programmed death ligand 1 in thymic epithelial tumor.

High expression levels of programmed death receptor 1 (PD-1) and its ligand 1 (PD-L1) have been observed in thymic epithelial tumors (TET), suggesting their potential as prognostic indicators for disease progression and the effectiveness of immunotherapy in TET. The conventional method obtaining PD-L1 was challenging due to invasive sampling and tumor heterogeneity. A total of 124 patients with pathologically confirmed TET (57 PD-L1 positive, 67 PD-L1 negative) were retrospectively enrolled and allocated into training and validation cohorts in a ratio of 7:3. Radiomics features were extracted from T1-weighted, T2-weighted fat suppression, and apparent diffusion coefficient (ADC) map images to establish a radiomics signature in the training cohort. Multivariate logistic regression analysis was conducted to develop a combined radiomics nomogram that incorporated clinical, conventional MR features, or ADC model for evaluation purposes. The performance of each model was compared using receiver operating characteristics analysis, while discrimination, calibration, and clinical efficiency of the combined radiomics nomogram were assessed. The radiomics signature, consisting of four features, demonstrated a favorable ability to predict and differentiate between PD-L1 positive and negative TET patients. The combined radiomics nomogram, which incorporates the peri-cardial invasion sign, ADC value, WHO classification, and radiomics signature, showed excellent performance (training cohort: area under the curve [AUC] = 0.903; validation cohorts: AUC = 0.894). The calibration curve and decision curve analysis further confirmed the clinical usefulness of this combined model. The decision curve analysis demonstrated the clinical utility of the integrated radiomics nomogram. The radiomics signature serves as a valuable tool for predicting the PD-L1 status of TET patients. Furthermore, the integration of radiomics nomogram enhances the personalized prediction capability.

Correlation of N-telopeptide of type 1 collagen and C-telopeptide of type 1 collagen in Iraqi women with breast cancer

Among the most common cancers worldwide is breast cancer. It is a varied sickness that is the leading cause of cancer-related mortality in females. Prognostic biomarkers—N-telopeptide of type 1 collagen and C-telopeptide of type 1 collagen—are being researched more and more to help with management, even though more research is needed to improve specificity and determine the actual therapeutic use of particular indications. The ELISA method was utilized to measure the levels of both CTX-1 and NTX-1. At the Oncology Teaching Hospital in the Medical City of Baghdad, these markers were examined in the serum of ninety women, forty of whom were healths and fifty of whom had the disease. The women's ages ranged from 40 to 60 years old, statistical research was significantly increased NTX-1 levels were found. CTX-1 did not reveal any discernible variation in the patient's group. The best marker for breast cancer diagnosis, according to a Receiver Operating Characteristic curve analysis, is NTX-1. Our results indicate that serum NTx has potential applications as a prognostic biomarker for bone metastases of several cancers, including breast cancer in Iraqi women.

The application value of multimodal ultrasound imaging technology in the prediction of early-stage type 2 diabetic kidney disease

Diabetic kidney disease (DKD) is the primary cause of end-stage renal disease. This study examines the diagnostic efficacy of multi-modal ultrasound imaging technology for the early detection of DKD, offering a valuable reference for the prompt diagnosis of affected patients. The clinical data of 88 patients with early-stage type 2 diabetic kidney disease (E-T2DKD group), 82 patients with uncomplicated type 2 diabetes (T2DM group), and 82 healthy individuals (control group) who underwent physical examinations at the outpatient clinic of the Affiliated Jiangning Hospital with Nanjing Medical University, were analyzed. Multimodal ultrasound imaging technology (MUIT) was employed to detect various parameter indicators, and a prediction model was developed using the receiver operating characteristic (ROC) curve. The results indicated no significant differences in age, gender, and BMI among the three patient groups. In comparison to the patients in the T2DM group, those in the E-T2DKD group exhibited significantly higher durations of diabetes and HbA1C levels. Significant differences were observed in the renal function-related indicators assessed across the three groups, including Cystatin C, β2-microglobulin (β2-MG), serum retinol-binding protein (S-RBP), serum creatinine (Scr), plasma urea nitrogen (PUN), estimated glomerular filtration rate (eGFR), urine neutrophil gelatinase-associated lipocalin (U-NGAL), urine retinol-binding protein (U-RBP), urine N-acetyl-β-D-glucosaminidase (U-NAG) and urinary albumin excretion rates (UAER) (p < 0.05), whereas no significant differences were found in eGFR, Scr and PUN levels between the control group and the T2DM group. Notable statistical differences among the three groups were also identified in the MUIT detection parameters, including renal cortex shear wave elastography (SWE), kidney volume index (KVI), interlobar artery (IA) Vsmax, IA Vdmin, IA resistance index (RI), and IA pulsatility index (PI) (p < 0.05). The early SWE, KVI, IA RI, and IA PI in the E-T2DKD group were significantly higher than those in both the T2DM and control groups, while RCT/RMT, IA Vsmax, and IA Vdmin were significantly lower in comparison to the T2DM and control groups (p < 0.05). These indicators were incorporated into a binary logistic regression model, and the joint predictive value was fitted based on the regression coefficients. Further ROC analysis revealed that the prediction area under the curve (AUC) for MUIT and clinical characteristics reached 0.993, indicating a high predictive value for E-T2DKD.

Assessing the validity of Society of Thoracic Surgeons (STS) score in predicting stroke risk among patients undergoing cardiothoracic surgery at a tertiary hospital in Pakistan: a retrospective cohort study

BackgroundPostoperative stroke is one of the most serious consequences of cardiac surgery. Morbidity risk assessment is critical for preoperative risk assessments and resource allocation. In this article, we aim to investigate the predictive value of Society of Thoracic Surgeons (STS) score’s effectiveness in stroke risk in cardiothoracic surgery patients in our population.MethodsThis retrospective cohort study was conducted at Aga Khan University Hospital (AKUH) using a consecutive sampling technique. The study included all eligible patients aged 18 years or older who underwent cardiac surgical procedures between January 2010 and December 2016. Of the 3,898 patients initially identified, 814 records were excluded due to incomplete data or pre-existing conditions. Statistical analyses, including chi-square tests, t-tests, and logistic regression, were performed to identify significant predictors of stroke. Prediction accuracy was assessed using a Receiver Operating Characteristic (ROC) curve, with Youden’s J statistic employed to determine optimal sensitivity and specificity thresholds.ResultsOut of 3,084 patients, 52 (1.7%) experienced a postoperative stroke. Stroke patients were significantly older (mean age 62.8 years vs. 57.7 years). They also had higher white blood cell count (10.7 ± 5.1 vs. 9.3 ± 3.3) and a longer history of myocardial infarction (9.2 ± 9.3 years vs. 6.9 ± 7.6 years). Cardiovascular interventions (15.4% vs. 7.7%), postoperative congestive heart failure (21.1% vs. 7.3%), and use of inotropes (5.8% vs. 1.6%) were more prevalent in stroke patients. Emergent surgical status (19.2% vs. 13.4%) and complications such as dialysis, prolonged ventilation, and intra-aortic balloon pump use were also significantly higher. The predictive model demonstrated strong accuracy in predicting postoperative stroke (AUC: 0.841, CI: 0.794–0.888). The ROC analysis for the STS stroke model showed high sensitivity (90.4%) and negative predictive value (99.7%), with moderate specificity (64.3%) and overall accuracy (64.8%), indicating excellent performance in ruling out stroke but moderate reliability in identifying positive cases.ConclusionThe STS risk score demonstrated strong predictive accuracy for postoperative stroke risk in cardiothoracic surgery patients, effectively incorporating clinical factors already accounted for in the comprehensive set of 70 variables used in its calculation.

Evaluating the diagnostic validity of CBCL-OCS in Chinese children and adolescents with OCD

Background and objectivesObsessive-compulsive disorder (OCD) is recognized globally as a serious mental health concern among children and adolescents. Accurate early diagnosis and intervention are crucial for effective management and improving patient outcomes. The primary objective of this study was to evaluate the diagnostic validity of the Child Behavior Checklist-Obsessive Compulsive Scale (CBCL-OCS) in Chinese children and adolescents, ensuring its cultural adaptability. The secondary objective was to explore the clinical characteristics of OCD, including prevalence, symptom severity, and comorbidities.MethodsA cross-sectional epidemiological survey was conducted among 8,595 middle school students in Liaoning Province, China. The CBCL-OCS was employed as the primary screening tool. The optimal cutoff value for OCD screening was determined through receiver operating characteristic (ROC) curve analysis.ResultsThe study found an OCD prevalence of 1.710%, which was consistent with the global estimation. ROC analysis determined a cutoff score of 2.5 for CBCL-OCS, with a sensitivity of 0.789 and a specificity of 0.899. Furthermore, adolescents exhibited significantly higher CBCL-OCS scores compared to younger children, suggesting an increase in OCD severity with age. Significant associations were also found between OCD symptoms and comorbid emotional disorders, behavioral problems, and anxiety symptoms.ConclusionsThis study confirms the utility of CBCL-OCS as an effective early screening tool for OCD in Chinese middle school students, highlighting its sensitivity and specificity, and cultural adaptability. Results contributed valuable insights to the epidemiology of OCD among children and adolescents, underscoring the need for targeted interventions during critical developmental periods, especially in adolescence.

In the eye of the beholder – validating the visual social anxiety scale (VSAS) in social anxiety disorder

ABSTRACT The Visual Social Anxiety Scale (VSAS) is a novel picture-based self-report measure of social anxiety that shown promising psychometric properties among non-selected participants. The present study aimed to validate the VSAS among individuals with clinically diagnosed social anxiety disorder (SAD) and establish clinical cutoff scores. One-hundred-and-three adults with SAD completed the VSAS with a battery of additional self-report measures of social anxiety, depression, and general anxiety. Internal consistency, convergent and discriminant validities, were assessed. Clinical cutoff scores were established via a Receiver Operating Characteristics (ROC) analysis using a control group of individuals without any past or present psychopathology (n = 34). An Exploratory Factor Analysis (EFA) was performed to explore underlying thematic factors. The VSAS exhibited high internal consistency and adequate convergent and discriminant validities. The ROC analysis showed the area under the curve to be 0.95 and yielded an optimal cutoff score of 23.40, providing high accuracy (0.90), sensitivity (0.89), and specificity (0.91) for distinguishing SAD from non-SAD individuals. The EFA revealed a 3-factor structure representing the following themes: social interpersonal situations, formal interpersonal situations, and being the center of attention. The psychometric properties of the VSAS support its utility in assessing and identifying individuals with clinical SAD.

Postmortem Temporal Changes in Liver and Spleen Stiffness: Evaluation with Shear Wave Elastography in a Rat Model.

Background/Objectives: Postmortem changes in tissue stiffness and organ morphology are critical for forensic medicine and pathology. Shear wave elastography (SWE) has emerged as a non-invasive tool to assess tissue stiffness, yet its potential for postmortem interval estimation remains underexplored. While previous studies have demonstrated early postmortem alterations in tissue elasticity, the temporal progression of these changes in different organs is not fully understood. This study aims to investigate the temporal changes in liver and spleen stiffness during the postmortem period using SWE and to evaluate the predictive potential of elastographic parameters for postmortem interval estimation. Methods: Twelve male Sprague-Dawley rats were sacrificed via cervical dislocation following deep anesthesia. Postmortem liver and spleen measurements, including longitudinal and short diameters and SWE values (kPa), were recorded at 0, 2, 4, 6, 9, 12, 18, 24, and 36 h. All elastographic measurements were obtained using a 5 mm circular region of interest (ROI) for the liver and a 3 mm ROI for the spleen. Changes over time were analyzed using repeated measures ANOVA, with post hoc Bonferroni corrections applied where necessary. Additionally, Receiver Operating Characteristic (ROC) curve analysis and binary logistic regression analysis were performed to assess the predictive accuracy of SWE parameters in estimating postmortem time. Results: Postmortem liver and spleen stiffness exhibited a significant declining trend over time (p < 0.001, η2 = 0.749 and η2 = 0.810, respectively). Liver and spleen dimensions initially increased, reaching peak values around 6 h, followed by a gradual reduction. ROC analysis demonstrated that spleen SWE (AUC = 0.917) and liver SWE (AUC = 0.845) were the strongest predictors of early postmortem time. Binary logistic regression further confirmed that liver and spleen SWE were statistically significant predictors of postmortem time (p = 0.006 and p = 0.020, respectively). Conclusions: This study provides evidence that postmortem liver and spleen stiffness decline progressively over time, while organ dimensions exhibit a biphasic pattern. Elastographic parameters, particularly SWE values, demonstrated strong predictive accuracy in estimating early postmortem intervals. These findings suggest that SWE may serve as a valuable imaging modality for forensic applications, providing objective insights into postmortem biomechanical changes and time-of-death estimation. Further research should explore the applicability of SWE in different tissue types and under varying environmental conditions.

The impact of KRAS mutations on risk of venous thromboembolism recurrence in patients with metastatic colorectal cancer

BackgroundThe relationship between KRAS mutations and the risk of venous thromboembolism (VTE) recurrence in metastatic colorectal cancer (mCRC) patients with established cancer-associated thrombosis (CAT) remains uncertain. This study aims to (1) evaluate the predictive value of seven KRAS mutation subtypes for VTE recurrence and (2) assess the impact of incorporating these mutations into two existing VTE risk scores: the Khorana score and the Ottawa score.MethodsBetween 2019 and 2023, we identified patients with histologically confirmed mCRC who had symptomatic or incidental index VTE and received anticoagulation therapy. Regression analyses were conducted to calculate hazard ratios (HRs) for recurrent VTE associated with the seven KRAS mutation subtypes. We used receiver operating characteristic (ROC) curves to assess the performance of both the original scores and the modified scores that included KRAS mutations. To quantify the improvements of the modified scores, we calculated the net reclassification improvement (NRI).ResultsA total of 2,195 patients were enrolled. KRAS G12C, KRAS G12A, and KRAS G13D mutations were significantly associated with a higher risk of recurrent VTE compared to other subtypes, with HRs of 1.84 (95% CI: 1.09–2.97), 2.02 (95% CI: 1.07–3.79), and 1.55 (95% CI: 1.02–2.27), respectively. The original Khorana and Ottawa scores demonstrated moderate predictive ability for VTE recurrence, each with an area under the ROC curve (ROC-AUC) of 0.56 (95% CI: 0.52–0.60). Incorporating the KRAS G12C, KRAS G12A, and KRAS G13D mutations improved the AUCs to 0.70 (95% CI: 0.67–0.74) for the modified Khorana score and 0.71 (95% CI: 0.67–0.74) for the modified Ottawa score. After dichotomizing risk using thresholds from ROC analysis, the NRI values were 0.54 (95% CI: 0.43–0.65) for the modified Khorana score and 0.48 (95% CI: 0.37–0.60) for the modified Ottawa score.ConclusionsThe KRAS G12C, KRAS G12A, and KRAS G13D mutations are significantly associated with an increased risk of recurrent VTE. Incorporating these specific KRAS mutations into existing risk scores may enhance their predictive accuracy for recurrent VTE in patients with mCRC.

Hs-CRP/HDL-C can predict the risk of all cause mortality in cardiovascular-kidney-metabolic syndrome stage 1-4 patients.

The precise function of the hs-CRP/HDL-C ratio in forecasting the long-term mortality risk of patients with stages 1-4 of Cardiovascular-Kidney-Metabolic (CKM) syndrome remains inadequately delineated. This study investigates the potential correlation between the hs-CRP/HDL-C ratio and long-term mortality risk in individuals with CKM syndrome stages 1-4. This prospective cohort study utilises data from the China Health and Retirement Longitudinal Study (CHARLS) project, encompassing 6,719 people who satisfied stringent criteria. We developed three Cox proportional hazards regression models to investigate the potential relationship between the hs-CRP/HDL-C ratio and long-term mortality risk in patients with CKM stages 1-4. We employed Restricted Cubic Spline (RCS) curves for analysis to identify any potential nonlinear correlations. Furthermore, we performed Receiver Operating Characteristic (ROC) curve analysis to evaluate predictive performance and identify the appropriate cut-off value. To enhance the research findings, we conducted a stratified analysis to investigate the influence of various sociodemographic factors on this association. In individuals with CKM syndrome stages 1-4, the 10-year incidence of all-cause mortality was 14.1%. Upon controlling for additional potential confounding variables, the outcomes of the Cox proportional hazards regression model distinctly demonstrated a statistically significant linear positive association between the hs-CRP/HDL-C ratio and the long-term mortality risk in patients. For each quartile increase in the hs-CRP/HDL-C ratio, the probability of poor outcomes (i.e., mortality) escalated by 15% (Hazard Ratio, HR = 1.15, 95% Confidence Interval, CI: 1.09-1.22, p-value < 0.001). Moreover, the integration of the hs-CRP/HDL-C ratio into the baseline risk prediction model, with all pertinent factors thoroughly adjusted, markedly enhanced the model's predictive capacity, facilitating a more precise assessment of long-term mortality risk in patients with CKM syndrome stages 1-4. This study identified a positive linear association between the hs-CRP/HDL-C ratio and long-term mortality risk in patients with stages 1 to 4 of CKM syndrome. This remarkable discovery not only offers a crucial reference for enhancing early individualised treatment options but also greatly aids in the early identification of patients with poor prognoses, hence presenting a novel perspective for improving clinical management pathways for these individuals.

A Spatially-Informed Healthy Location Index for Assessing Urban Living Environment

Urban health outcomes are shaped by the complex interplay of environmental, social, and spatial factors. This study develops a Healthy Location Index (HLI) to assess spatial health risks by integrating health-promoting (HPSVs) and health-restraining (HRSVs) spatial variables using geospatial analysis and the Analytic Hierarchy Process (AHP). Taking Kolkata, India, as a case study, the HLI incorporates factors such as green and blue spaces, built-up density, air quality, and the distribution of alcohol and fast-food outlets to create a spatial model of urban health. The study utilizes remotely sensed and administrative datasets (e.g., Landsat-derived NDVI, NDBI, NDWI, Point-of-Interest data) and validates the HLI against COVID-19 containment zones (June 2020–January 2021) using Receiver Operating Characteristic (ROC) analysis. Results indicate that areas with high HLI scores—characterized by greater access to green spaces and lower exposure to environmental stressors—were less likely to be containment zones, suggesting a meaningful relationship between spatial health factors and urban resilience. However, the study acknowledges potential confounding variables, such as socioeconomic disparities, population density, and healthcare accessibility, which may influence health outcomes. The findings underscore the global applicability of the HLI framework in urban planning, public health policy, and epidemiological risk assessment, offering a scalable model for cities facing rapid urbanization and environmental challenges.

Superiority of ROC curves among four powers and eight predictive powers with historical and interim data

The Receiver Operating Characteristic (ROC) analyses of powers and predictive powers play a crucial role in clinical trials, providing valuable insights. We derive analytical expressions for the ROC curves of four powers (Classical Power (CP), Classical Conditional Power (CCP), Bayesian Power (BP), and Bayesian Conditional Power (BCP)) as well as their associated eight predictive powers for both hypotheses and reversed hypotheses. Furthermore, we thoroughly investigate the comparative superiority of these ROC curves across the four powers and eight predictive powers in five distinct aspects. Our findings reveal that among all the considered powers, the second and eighth predictive powers exhibit exceptional performance. Finally, extensive numerical experiments are conducted along with a real data example to comprehensively evaluate the relative merits of these ROC curves.

Predictive value of miR-24-3p and miR-1277-5p in hemodialysis patients with vascular access thrombosis.

One of the complications of chronic kidney disease (CKD) is venous thromboembolism (VTE). Currently, the D-dimer test is used for the diagnosis of VTE. This test has low diagnostic value and specificity. Circulating microRNAs are present in plasma, serum, and other body fluids and have recently been shown to be valuable biomarkers in numerous illnesses. Therefore, this study aimed to evaluate the diagnostic potential of serum microRNAs as noninvasive biomarkers for VTE diagnosis in hemodialysis patients. Serum samples were collected from 42 hemodialysis patients with thrombosis, 42 hemodialysis patients without thrombosis, and 42 healthy individuals. After the synthesis of cDNA from serum, the expression of miR-24-3P and miR-1277-5P was measured by qRT-PCR. The data were analyzed using SPSS 20 and GraphPad Prism7 software. The expression level of miR-24-3P in the thrombotic and nonthrombotic hemodialysis groups was significantly greater than that in the healthy groups after adjustment for hyperglycemia (P = 0.003, P = 0.04). Receiver-operating characteristic (ROC) analysis revealed that the area under the curve (AUC) values were 0.769 and 0.649, respectively. However, in the thrombotic group compared with the nonthrombotic group after adjustment for hyperglycemia, no significant difference was detected (P = 0.063), and the AUC was 0.62. After adjustment for age, sex, and BMI, there was a significant difference between the thrombotic group and the nonthrombotic group (P = 0.002), and the AUC was 0.71. Compared with that in the control group, the odds ratio (OR) of increased miR-1277-5P expression was greater in the thrombotic group (P = 0.05, OR = 1.618). There was no significant difference between the nonthrombotic group and the control group (P = 0.73, OR = 0.914). Our results indicated that miR-24-3P is not a reliable marker for examining thrombosis in the studied samples, while miR-1277-5P has a positive association with VAT and could be considered a diagnostic and therapeutic marker.

Impacts of Average Real Variability Parameters of Blood Pressure on Recovery Following Posterior Fixation Surgery for Thoracolumbar Vertebral Fractures.

This study aimed to investigate the influence of average real variability (ARV) parameters of blood pressure on the recovery following posterior fixation surgery for thoracolumbar vertebral fractures. A retrospective analysis was conducted on 190 patients who underwent posterior fixation surgery for thoracolumbar vertebral fractures at Ningbo Medical Center Lihuili Hospital between January 2021 and December 2023. Patients were divided into two groups based on their postoperative recovery: the good recovery group (n = 140) and the poor recovery group (n = 50). Univariate and binary logistic regression analyses were performed to identify factors influencing postoperative recovery. Pearson correlation analysis was used to assess the relationships between ARV and other variables, while receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive value of ARV in postoperative recovery. No statistically significant differences were observed between the two groups in terms of age, body mass index (BMI), gender, place of residence, monthly family income, occupation, education level, surgery duration, intraoperative blood loss, fracture type, fracture location, or fracture stage (p > 0.05). However, significant differences were noted in complication rates, ARV levels, and self-efficacy scores (p < 0.05). Pearson linear correlation analysis revealed that ARV was positively correlated with the presence of complications (r = 0.151, p < 0.05). Binary logistic regression analysis identified complications, ARV, and self-efficacy as significant factors influencing postoperative recovery (p < 0.05). Patients were divided into four groups based on ARV quartiles: Group 1 (ARV < 0.79), Group 2 (0.79 ≤ ARV < 0.89), Group 3 (0.89 ≤ ARV < 0.98), and Group 4 (ARV ≥ 0.98). A statistically significant difference in complication rates was observed across the groups (p < 0.05). ROC analysis showed that the area under the curve (AUC) for ARV in predicting postoperative recovery was 0.724 (95% confidence interval (CI): 0.612-0.836, p < 0.001). ARV is a significant factor influencing recovery following posterior fixation surgery for thoracolumbar vertebral fractures. Higher ARV levels are associated with increased postoperative complications, leading to poorer recovery outcomes.

Imaging-based biomarkers in acute pancreatitis: the predictive value of adrenal contrast ratios for intensive care unit admission.

Early risk stratification is crucial in acute biliary pancreatitis (ABP) to optimize patient management and guide intensive care unit (ICU) admission decisions. Traditional biomarkers and scoring systems have limitations in early severity assessment. This study aimed to evaluate the predictive value of adrenal contrast ratios on contrast-enhanced CT (CECT) as imaging-based biomarkers for ICU admission and prolonged hospitalization in ABP patients. This retrospective study included 288 ABP patients who underwent CECT within 24h of admission. Adrenal-to-inferior vena cava (IVC) and adrenal-to-spleen contrast ratios were measured from portal venous phase images. The predictive performance of these ratios for ICU admission was assessed using receiver operating characteristic (ROC) analysis, and their correlation with clinical outcomes was evaluated through regression analysis. ICU-admitted patients had significantly higher adrenal contrast ratios compared to non-ICU patients (adrenal-to-IVC ratio: 1.15 vs. 0.99, p < 0.001; adrenal-to-spleen ratio: 0.97 vs. 0.75, p < 0.001). ROC analysis demonstrated strong predictive accuracy (AUC = 0.74 for adrenal-to-IVC, AUC = 0.81 for adrenal-to-spleen). Additionally, adrenal contrast ratios correlated significantly with prolonged hospital stay (r = 0.49-0.55, p < 0.001). Adrenal contrast ratios serve as promising imaging-based biomarkers for early ICU admission prediction and risk stratification in ABP patients. Their integration into clinical decision-making may enhance early management strategies. Further prospective validation is warranted.