Scoring System Research Articles

Imaging in clinical trials of axial spondyloarthritis: what type of imaging should be used.

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition predominantly affecting the sacroiliac joints and spine. Early and accurate diagnosis is crucial to prevent structural damage and improve patient outcomes. Imaging plays a pivotal role in axSpA diagnosis, monitoring, and clinical trials, offering insights into both inflammatory activity and structural progression. Conventional radiography has been foundational for detecting structural changes, such as syndesmophytes and erosions, but it is limited by poor sensitivity for early disease detection and significant interobserver variability. Advanced imaging modalities, such as magnetic resonance imaging (MRI) and low-dose computed tomography (ld-CT), have emerged as more sensitive tools. MRI excels in identifying active inflammation, particularly bone marrow edema, and is integral to early diagnosis and disease monitoring. ld-CT provides superior spatial resolution for detecting structural lesions while minimizing radiation exposure. However, challenges remain in achieving standardized imaging protocols and consistent scoring systems across clinical trials. Scoring systems like the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS), Spondyloarthritis Research Consortium of Canada (SPARCC) scores, and Berlin methods require rigorous calibration to ensure reliability. The purpose of this review is to explore the strengths and limitations as well as the use in clinical trials of the different imaging modalities and to offer guidance on selecting the most suitable imaging techniques for assessing both disease activity and structural progression in clinical trials.

CryoAlign2: efficient global and local Cryo-EM map retrieval based on parallel-accelerated local spatial structural features

Abstract Background With the rapid advancements in Cryo-Electron Microscopy (Cryo-EM), an increasing number of high-resolution 3D density maps are being made publicly available, highlighting the urgent need for efficient structure similarity retrieval. Exploring map similarity at various levels is critical for fully utilizing these valuable resources. Our previously proposed CryoAlign can provide more accurate density map alignment while maintaining a low failure rate. However, CryoAlign only offers a method for aligning density maps, with low efficiency in local alignment, and has not yet been applied to the retrieval of Cryo-EM density maps. Results We have developed an alignment-based retrieval tool to perform both global and local retrieval. Our approach adopts parallel-accelerated CryoAlign for high-precision 3D alignment and transforms density maps into point clouds for efficient retrieval and storage. Additionally, a multi-dimension scoring function is introduced to accurately assess structural similarities between superimposed density maps. To demonstrate its applicability, we conducted thorough testing across different retrieval tasks, such as global, local or hybrid similarity retrieval. Conclusions Our tool achieves up to a 7-fold speedup while supporting precise local alignments. Comprehensive experiments demonstrate that even when one density map is entirely contained within another, our tool performs exceptionally well in high-resolution density map retrieval. It provides researchers with an efficient and accurate solution for density map similarity search. Availability and implementation The source code, documentation, and sample data can be downloaded at https://github.com/JokerL2/CryoAlign2. Supplementary information Supplementary data are available at Bioinformatics online.

Integrating Machine Learning-Based Pose Sampling with Established Scoring Functions for Virtual Screening.

Physics-based docking methods have long been the cornerstone of structure-based virtual screening (VS). However, the emergence of machine learning (ML)-based docking approaches has opened new possibilities for enhancing VS technologies. In this study, we explore the integration of DiffDock-L, a leading ML-based pose sampling method, into VS workflows by combining it with the Vina, Gnina, and RTMScore scoring functions. We assess this integrated approach in terms of its VS effectiveness, pose sampling quality, and complementarity to traditional physics-based docking methods, such as AutoDock Vina. Our findings from the DUDE-Z benchmark dataset show that DiffDock-L performs competitively in both VS performance and pose sampling in cross-docking settings. In most cases, it generates physically plausible and biologically relevant poses, establishing itself as a viable alternative to physics-based docking algorithms. Additionally, we found that the choice of scoring function significantly influences VS success.

Prognostic Value of B7-H3 and a Novel Scoring System in Localized Renal Cell Carcinoma

Background and Objectives: Renal cell carcinoma (RCC) is a biologically heterogeneous malignancy, and traditional prognostic models often fail to provide accurate risk stratification. B7-H3 (CD276), an immune checkpoint molecule, has been implicated in RCC progression but remains underexplored as a prognostic biomarker. Materials and Methods: This retrospective study analyzed 52 patients with localized RCC who underwent nephrectomy. Immunohistochemical staining was used to assess B7-H3 expression. A novel prognostic scoring system, the Renal Immune Prognostic Index (RIPI), incorporating B7-H3 expression, tumor necrosis, tumor grade, and pathological staging, was developed and validated. Kaplan–Meier survival analysis and Cox proportional hazard models were employed to evaluate disease-free survival (DFS) and overall survival (OS). Results: High B7-H3 expression was significantly associated with shorter DFS (12 vs. 54 months; p = 0.001) and OS (70 vs. 123 months; p = 0.002). The RIPI demonstrated strong prognostic performance, stratifying the patients into distinct risk groups with a C-index of 0.82. The high-risk patients had a median DFS of 14 months, compared with 125 months in the low-risk group (p < 0.001). Conclusions: B7-H3 expression serves as a significant prognostic biomarker in localized RCC, correlating with poorer survival outcomes. The integration of B7-H3 into the RIPI enhances risk stratification by incorporating both molecular and pathological features. These findings support the incorporation of immune biomarkers into clinical practice and highlight B7-H3 as a potential target for novel therapeutic strategies in RCC.

B.T.C.H. nephrolithometry score: a novel scoring system to predict stone-free rate and complexity for ultrasound-guided percutaneous nephrolithotomy

BackgroundThe existing scoring systems for percutaneous nephrolithotomy fail to adequately consider the influence of renal anatomy, leading to limited predictive accuracy. This study introduces and validates a novel B.T.C.H. nephrolithometry score, designed to better predict stone-free rates and complexity for ultrasound-guided percutaneous nephrolithotomy.MethodsB.T.C.H. nephrolithometry score evaluates four variables including stone burden, type of renal pelvis, calyces involved, and hydronephrosis. 134 patients who underwent ultrasound-guided percutaneous nephrolithotomy at Beijing Tsinghua Changgung Hospital were retrospectively analyzed. The inter-observer agreement was assessed using the linearly weighted kappa coefficient. The accuracy in predicting the stone-free rate was evaluated using receiver operating characteristic curve analysis. Spearman’s correlation analysis and Kendall’s W test were employed to examine the correlation between the scores of each scoring system and operative time, the number of tracts and CDC scores.ResultsThe overall stone-free rate was 52.99%. The stone-free rates in low (4–8 points), medium (9–12 points), and high (13–15 points) B.T.C.H. scores were 91.9, 24.6, and 0%, respectively. The B.T.C.H. nephrolithometry score had an AUC of 0.909 for predicting stone-free rate, outperforming both the GSS (AUC = 0.761) and the S.T.O.N.E. nephrolithometry score (AUC = 0.763). The B.T.C.H. nephrolithometry score were positively correlated with operative time, the number of tracts and CDC scores.ConclusionB.T.C.H. nephrolithometry score is a suggested novel scoring system for ultrasound-guided percutaneous nephrolithotomy, which had superior prediction of stone-free rate and positive correlation with operative time, the number of tracts, and postoperative CDC scores.

Perception of MBBS Students About Pharmacology Teaching in New Competency-based Medical Education (CBME) Curriculum at a Tertiary Care Medical Institute of Haryana

Background Competency-based medical education (CBME) is an approach that ensures that the focus of teaching, learning, and assessment is on real-life medical practice. There is a radical shift in the teaching, learning, and assessment methods from the traditional curriculum. Purpose: The current study aimed to assess the perception of students regarding the recently implemented undergraduate pharmacology curriculum. Methods This was a cross-sectional study conducted among MBBS students with the help of a semi-structured questionnaire. The questionnaire consisted of various domains, namely, general perception about CBME, perception about pharmacology teaching and assessment patterns using a 5-point Likert scale, and the scoring system based on the responses. Based on the scoring system, positive, neutral, or negative perceptions of the students toward the CBME curriculum were analyzed. Results Out of the 175 participants, 165 (94.4%) of the students scored more than 60%, and hence, they had a positive perception of the newly implemented CBME curriculum in pharmacology. 159 (91%) students favored the incorporation of competencies like intravenous (I/V) drip setting. Most students opined that conceptual teaching like the personal drug (P-drug) concept, drug promotion literature (DPL), and prescription writing in the new curriculum will be helpful in better understanding the subject and will set a firm foundation for becoming a good practitioner. The majority of the students agreed with the inclusion of periodic and formative assessments in the new curriculum. Conclusion The majority of participants preferred the new curriculum over the previous one, which is a welcome sign for the successful outcome of the revised CBME curriculum in pharmacology.

Single-cell and bulk transcriptome sequencing identifies circadian rhythm disruption and cluster-specific clinical insights in colorectal tumorigenesis.

Colorectal cancer (CRC) is one of the most common malignant tumors in the digestive system worldwide, with its mortality ranking second among all cancers. Studies have indicated that disruptions in circadian rhythm (CR) are associated with the occurrence of various cancers; however, the relationship between CR and CRC requires further evidence, and research on the application of CR in CRC is still limited. In this study, we employed both bulk and single-cell RNA sequencing to explore the dysregulation of CR in patients with CRC. By constructing a CR subtype classifier, we conducted an in-depth analysis of the prognostic significance, the status of the tumor microenvironment, and response to immune checkpoint blockade (ICB) therapy between different CR clusters. Furthermore, we developed a CR scoring system (CRS) using machine learning to predict overall survival and identified several genes as potential targets affecting CRC prognosis. Our findings revealed significant alterations in CR genes and status between CRC and normal tissues using bulk and single-cell transcriptome sequencing. Patients with CRC could be categorized into two distinct CR clusters (CR cluster 1 and 2). The prognosis of CR cluster 2, with higher epithelial-mesenchymal transition (EMT) and angiogenesis scores, was significantly worser than that of CR cluster 1. These clusters exhibited distinct levels of tumor-infiltrating lymphocytes. CR cluster 2 with a notably higher proportion of patients with microsatellite-instability-high (MSI-H), potentially benefit from ICB therapy. The proportion of patients belonging to consensus molecular subtype 4 (CMS4) in CR cluster 2 was also notably higher than in CR cluster 1. Additionally, the CRS combined with tumor stage demonstrated superior overall survival prediction efficacy compared to traditional tumor stage. We revealed a potential link between model genes (LSAMP, MS4A2, NAV3, RAB3B, SIX4) and the disruption of CR and patient prognosis. This study not only provide new insights into the assessment of CR status in CRC patients but also develop a prognosis model based on CR-related genes, offering a new tool for personalized risk assessment in CRC.

A sleep-based risk model for predicting dementia: Development and validation in a Korean cohort.

BackgroundDementia is a major public health challenge, yet existing prediction models often overlook sleep-related symptoms, despite their known links to cognitive decline.ObjectiveTo develop and validate a four-year Dementia Risk Score (DRS) incorporating self-reported sleep-related symptoms with demographic and clinical factors to predict all-cause dementia, including Alzheimer's disease.MethodsData from 3082 Korean adults aged 60-79 years were analyzed. Predictors were selected using LASSO regression and included in a multivariate logistic regression model. A point-based scoring system, the DRS, was constructed from the model coefficients. Internal validation was conducted using bootstrapping and a separate dataset.ResultsThe DRS achieved robust predictive performance, with AUC values of 0.824 in the training set and 0.826 in the validation set. Key predictors included sleep disturbance, use of sleep medications, daytime dysfunction, leg discomfort, and urge to move legs.ConclusionsThe DRS provides a practical, scalable tool for predicting dementia risk, supporting community-based screening and early intervention. External validation is needed to confirm its broader applicability.

Matrix metalloproteinase-7 is dispensable in a mouse model of sepsis-induced acute lung injury.

Acute respiratory distress syndrome (ARDS) is a life-threatening form of acute lung injury whose pathogenesis is characterized by excessive lung inflammation and alveolar-capillary barrier permeability. Matrix metalloproteinase 7 (MMP7) can regulate leukocyte recruitment and the production of pro-inflammatory cytokines, but whether it plays a role in acute lung injury (ALI) is an unanswered question. We hypothesized that global loss of MMP7 would attenuate sepsis-induced ALI and systemic inflammation. To test this, male and female MMP7 knockout (MMP7KO) mice and wild-type (WT) littermates were exposed to a two-hit model of ALI (sepsis+hyperoxia). Sepsis was induced through intraperitoneal injection of cecal slurry (CS; 1.6mg/g) or 5% dextrose (control) followed by exposure to hyperoxia (HO; FiO2=0.95) or room air (control, FiO2=0.21). At 24-hours post-CS+HO, we measured weight loss, illness severity, and body temperature. The mice were then sacrificed, and samples from the lungs, kidneys, spleen, blood, peritoneal wash, and bronchoalveolar lavage (BAL) fluid were collected for analysis. Bacterial burden was assessed in the peritoneum, lung, and spleen. Lung inflammation was assessed by BAL inflammatory cell recruitment and pro-inflammatory cytokine concentrations as well as lung tissue mRNA expression of pro-inflammatory cytokines. Alveolar-capillary barrier disruption was quantified by BAL total protein, BAL immunoglobulin M, and lung wet-to-dry weight ratios. Histologic evidence of lung injury was evaluated using a histological scoring system. Systemic inflammation was measured through plasma pro-inflammatory cytokines and peritoneal inflammatory cells. Kidney function, inflammation, and injury were assessed through plasma urea nitrogen concentrations, as well as tissue levels of pro-inflammatory cytokines, neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule 1 (KIM-1). Relative mRNA expression of MMP-7, MMP-9, and MMP-2 was also quantified in both lung and kidney tissue through qPCR. At 24-hours post-CS+HO all mice developed ALI. Septic mice also had increased systemic inflammation, kidney inflammation, kidney injury, and kidney dysfunction compared to controls. Loss of MMP7 did not affect markers of inflammation, organ injury, or organ dysfunction. Interestingly, septic male mice exhibited more severe illness, systemic and lung inflammation, lung injury, and lung expression of matrix metalloproteinases, while septic female mice exhibited more kidney inflammation, kidney injury, and kidney expression of matrix metalloproteinases. In conclusion, MMP7 is not essential for the development or resolution of sepsis-induced ALI in this model and likely plays a limited role in the condition.

Does the addition of radiation to adjuvant chemotherapy improve the survival for early-stage (tumor size ≤4 cm) small cell neuroendocrine carcinoma of the cervix after surgery? A population-based study.

Does the addition of radiation to adjuvant chemotherapy improve the survival for early-stage (tumor size ≤4 cm) small cell neuroendocrine carcinoma of the cervix after surgery? A population-based study.

Predictive value of the RENAL nephrometry score on oncological and functional outcomes in cT1 renal cell carcinoma treated with cone-beam CT-guided percutaneous cryoablation

Abstract Stage 1 (cT1) renal cell carcinoma (RCC) can be treated by cone-beam CT-guided percutaneous cryoablation (CBCT-guided PCA). The RENAL nephrometry scoring system provides a structured method for evaluating the complexity of renal tumours by classifying them based on specific anatomical features. The aim was to evaluate the clinical utility of this scoring system in predicting postoperative oncological and functional outcomes in patients undergoing CBCT-guided PCA as their primary treatment for biopsy proven cT1 RCC. 91 patients were retrospectively analyzed. A statistically significant association was found between the RENAL nephrometry score classification and local treatment failure (p = 0.005). The RENAL score was not found to correlate with local tumour recurrence, postoperative complications, or change in renal function. These findings suggest that the RENAL nephrometry score can be utilized for risk stratification and more precise patient counseling.

BLAST: A Globally Applicable and Molecularly Versatile Survival Model for Chronic Myelomonocytic Leukemia.

BLAST: A Globally Applicable and Molecularly Versatile Survival Model for Chronic Myelomonocytic Leukemia.

Significance of Naples prognostic score for postoperative complications after colorectal cancer surgery.

The Naples prognostic score (NPS) is a sensitive scoring system that reflects both inflammatory and nutritional status. This study examined the significance of NPS in predicting postoperative complications following colorectal cancer surgery. The present study included data from 443 patients who underwent curative resection for colorectal cancer. The patients were classified into low NPS (score 0-2) and high NPS (score 3-4) groups. We retrospectively investigated the relationship between NPS and postoperative complications (Clavien-Dindo classification ≥ II). Among all patients, 57 (13%) developed postoperative complications. A total of 340 patients (77%) were categorized into the low NPS group and 103 (23%) were categorized into the high NPS group. A multivariate analysis identified that high NPS (P < 0.001), tumor location in the rectum (P = 0.025), longer operation time (P = 0.027), and greater blood loss (P = 0.004) were independent risk factors for postoperative complications. Furthermore, high NPS was significantly associated with older age (P < 0.001), higher American Society of Anesthesiologists physical status score (P = 0.029), advanced T stage (P < 0.001), N stage (P = 0.036), and longer length of hospital stay (P < 0.010). NPS is a strong predictor of poor outcomes in patients undergoing curative resection for colorectal cancer, suggesting the importance of systemic inflammation and the nutritional status.

Differential Expression of TLE1 in Small Round Cell Tumors: A Proposed Solution for Challenging Differentials Impacting Treatment Strategies.

Introduction. Small round cell tumors (SRCTs) represent a heterogeneous group of neoplasms with overlapping histological features but varying origins, prognoses, and treatments. TLE1 is a well-established marker for synovial sarcoma (SS). However, TLE1's diagnostic utility is limited by its expression in a broad range of tumor types, reducing its specificity for SS. This study explores TLE1 expression across SRCTs and proposes an immunohistochemical algorithm to enhance diagnostic accuracy. Methods. This retrospective, single-center observational study, conducted from 2019 to 2024, reviewed pathology records for SRCTs. TLE1 staining was evaluated using the immunoreactive score system, categorized as follows: 0 (negative), 1+ (weak), 2+ (moderate), and 3+ (strong). Results. A total of 301 SRCTs were evaluated with diverse distribution: neuroendocrine neoplasms (21%, n = 63), extraskeletal Ewing sarcoma (15%, n = 45), lymphoblastic lymphoma (11%, n = 34), and poorly differentiated synovial sarcoma (PDSS) (8%, n = 24). TLE1 expression of 3 + was most frequently observed in PDSS (75%, 18/24). Other tumors with TLE1 3 + included extraskeletal Ewing sarcoma, extracutaneous malignant melanoma, neuroendocrine neoplasms, rhabdomyosarcoma, and endometrial stromal sarcoma. TLE1 2 + was noted in lymphoblastic lymphoma and desmoplastic SRCT, while TLE1 1 + was seen in some gastrointestinal stromal tumors. The remaining specimens were negative for TLE1. These findings led to a diagnostic framework for SRCTs based on TLE1 expression patterns. Conclusions. Although TLE1 is a key marker for SS, its expression in other tumors can present diagnostic challenges. Integrating clinical features, histological assessment, and a panel of immunohistochemistry markers is essential for accurate diagnosis and effective management of SRCTs.

The Quality of Methodological Reporting of Randomised Controlled Trial (RCT) Articles Published in Iranian and Top Nursing and Midwifery Journals Indexed in the Scopus Database using the CONSORT Checklist: A Cross-sectional Study.

The quality of methodological reporting of randomised controlled trials (RCTs) is an important consideration in the use of RCTs for guiding healthcare decisions; however, in recent years, the quality of reporting has been examined from a more methodological perspective. The current study seeks to compare the methodological reporting of randomized controlled trial (RCT) articles published in Iranian nursing and midwifery journals indexed in Scopus with that of RCT articles published in nursing and midwifery journals indexed in the Scopus database, utilizing the CONSORT checklist as a framework for evaluation. The current study is a comparative cross-sectional study. RCT articles from eight Iranian Scopus-indexed journals (381 articles) and three of the journals with the highest CiteScore index (204 articles) were reviewed. The study was conducted during 2017-2021. The data collection utilized the methodology section of the CONSORT checklist, which comprises 17 items and incorporates a two-dimensional scoring system with a score range of 0 to 17. SPSS 19 software was used for data analysis. The average percentages of the methodological reports published in the top three Iranian journals, indexed in the Scopus, were 76.4% and 84.4%, respectively. Also, the mean quality score of methodological reporting of RCT articles published in Iranian nursing and midwifery journals was significantly lower than the mean score of methodological reporting of RCT articles in international nursing and midwifery journals indexed in the Scopus published from 2017-2021 (P <0.001). In some cases, such as items related to randomisation and blinding, there was under-reporting in both groups of journals. The results of the research showed that the average quality of the methodological report in most cases of CONSORT statements in Iranian journals is lower than that of the top three Scopus journals. Journals with lower reporting quality scores, such as Iranian journals, can improve the quality of their articles by following reporting guidelines for all types of articles, including RCT articles.

No Association Between Fencing Response After Concussion and Recovery Time, Concussion Severity, or Clinical Outcomes in Professional American Football Players.

The relationship between tonic posturing (also known as the "fencing response") after concussion and clinical outcomes is unclear. The objective of this study was to compare clinical outcomes between professional American football players with a documented fencing response after concussion to players without documented fencing response after concussion. Players with a fencing response after concussion were matched 1:2 to players without documented fencing response after in-game concussion by age, position, and concussion history from the 2018 to 2023 seasons. The primary outcome measure was number of days until return to full participation. Secondary outcome measures included screening of neurocognitive function with the Standardized Assessment of Concussion (SAC) and modified Balance Error Scoring System (mBESS), and subjective symptom reporting with the Sport Concussion Assessment Tool-5. An independent-samples median test compared game-day SAC and mBESS outcomes between groups. A Kaplan-Meier curve evaluated fencing response after concussion on days until return to full participation. A linear mixed-effects model for 11 Sport Concussion Assessment Tool-5 total symptom scores (ie, day of injury up to postinjury day 10) compared symptom recovery over time between fencing groups. Fifty-seven fencing responses were documented over 6 seasons. Nearly 2-in-3 players with a fencing response played defensive back or wide receiver. There was no difference between players with a fencing response (median = 10 days) and those without fencing response (median = 9 days) in days until return to full participation (P = .16). Fencing response was not associated with a change in hazard for days until return to full participation (χ2 = 0.91; P = .34). There was no difference between groups in SAC scores (P = .18-.99) or mBESS score (fencing: 4, nonfencing: 4; P = .87). There was no difference between groups in symptom scores over time (β: -0.02; P = .92). Fencing response after concussion was not associated with symptom recovery, concussion severity, or short-term recovery in professional American football.

A new tool to predict mortality in Fournier's Gangrene: Controlling Nutritional Status (CONUT) score.

The aim of our study was to demonstrate the role of The Controlling Nutritional Status (CONUT) score in predicting mortality after Fournier's Gangrene (FG) debridement by comparing it with other scoring systems. Data of 193 patients who underwent debridement for FG between January 2013 and December 2024 were retrospectively analyzed. Survivor 156 patients (Group S) and 37 non-survivor patients (Group NS) were divided into two groups. Four scoring systems commonly used to predict mortality in FG and the CONUT score were compared by regression analyses. Cut-off values were determined for each scoring system and ROC curves were constructed. Mortality rate was 19.2%. Total CONUT and other scoring systems were higher in Group NS (p < 0.001). In multivariate analyses, an increase in Total CONUT score predicted mortality (OR = 99.26; 95% CI 8.19-120.30: p < 0.001). The sensitivity, specificity, PPV, NPV and AUC values at the CONUT score ≥ 2.5 cut-off were 86%, 87%, 87%, 87%, 96% and 0.935 (95% CI: 0.88-0.98; p < 0.001), respectively. The CONUT score predicts mortality in FG with high sensitivity and specificity. It is also easy and practical to calculate.

Validation of Drum Tower Severity Scoring (DTSS) System for Pyrrolizidine Alkaloid-Induced Hepatic Sinusoidal Obstruction Syndrome.

The Drum Tower Severity Scoring (DTSS) system is a novel tool designed for assessing the outcome of anticoagulation therapy and disease severity in patients with pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS). The aim of this study was to validate the predictive performance of the DTSS system in PA-HSOS patient outcome. We conducted a retrospective analysis of 111 PA-HSOS patients who received standard anticoagulation-transjugular intrahepatic portosystemic shunt (TIPS) stepwise therapy from six hospitals in China. Patients were categorized into two groups based on whether they responded to anticoagulation therapy. The predictive performance of the DTSS system was evaluated through the efficacy of anticoagulation therapy, the area under the receiver operating characteristic curve (AUROC), calibration curve, decision curve analysis (DCA), and clinical impact curve (CIC) analysis. The response rates to anticoagulation therapy varied among patients with DTSS of different severity, being 94.12% for mild, 57.81% for moderate, and 13.33% for severe cases. The DTSS system demonstrated a robust predictive performance, with an AUROC of 0.864. The calibration curve indicated a close match between the predicted and observed effects of the DTSS system. Good calibration was confirmed by the Hosmer-Lemeshow test (p = 0.704), and both the DCA and CIC analysis indicated high clinical utility of the DTSS system. The DTSS system is a practical tool that uses easily accessible data to predict the initial response to anticoagulation therapy in PA-HSOS patients, showing robust predictive performance and significant clinical benefit in guiding personalized management strategies.

External Validation of the Clinical Obstetric Comorbidity Index across a Diverse Health System.

The clinically-modified obstetric comorbidity index (OB-CMI) is a comorbidity-based scoring system that has been validated to predict severe maternal morbidity (SMM) in a single tertiary, academic hospital using an internal SMM definition. We aimed to validate the OB-CMI for the prediction of SMM as defined by the CDC during delivery admissions across a diverse health system.This is a retrospective cohort study evaluating all deliveries in a large health system encompassing academic and community hospitals. Data from 2019 to 2021 were extracted from the electronic health record (EHR) and validated with chart review. An OB-CMI score was calculated for each patient using established diagnosis codes and EHR data. The primary outcome was nontransfusion SMM (defined by the CDC) during the delivery admission. Patient characteristics were evaluated by the hospital, and hospital-specific receiver-operator characteristic (ROC) curves were constructed and compared.In total, 42,130 deliveries were included with significant differences in all demographic, clinical, and obstetric characteristics across the hospitals including age, BMI, race/ethnicity, insurance type, preterm birth, and preeclampsia rates. Median OB-CMI score and rate of elevated OB-CMI score (≥6) were also significantly different. ROC curves for OB-CMI and SMM for each hospital are noted in the figure with an area under the curve range from 0.77 to 0.83, and no significant differences across hospitals (p = 0.32).In a large cohort of patients delivering across a diverse hospital system, the clinical OB-CMI score similarly predicted SMM despite differences in demographic and clinical characteristics among the hospitals. This validation of the OB-CMI supports the use of this scoring system in variegated clinical settings, which can inform widescale uptake and clinical integration of OB-CMI scoring to improve obstetric risk stratification. · The clinically-modified OB-CMI consistently predicted nontransfusion SMM across multiple hospitals.. · This OB-CMI can be used for obstetric risk stratification across different clinical settings.. · Future research should explore the impact of using the OB-CMI to mitigate risk in clinical practice..

Microbiota-friendly diet ameliorates hypoalbuminemia in chronic kidney disease: evidence from NHANES

Chronic kidney disease (CKD) is a global health issue, affecting approximately 10% of the population. Hypoalbuminemia, a common complication in advanced CKD, is associated with poor prognosis. This study aimed to investigate the association between a microbiota-friendly dietary scoring system (Dietary Index for Gut Microbiota, DI-GM) and serum albumin levels in patients with CKD. We utilized a cross-sectional cohort from the NHANES 2007–2018, which included 2,947 CKD patients. Multivariable logistic regression and restricted cubic spline models were applied to analyze the relationship between DI-GM scores and serum albumin. Higher DI-GM scores were significantly associated with increased serum albumin levels (β = 0.18 g/L, 95% CI: 0.07–0.28, p = 0.002). Furthermore, each 1-point increase in DI-GM score was linked to a 15% reduction in the odds of hypoalbuminemia (OR: 0.85, 95% CI: 0.74–0.97, p = 0.014). The findings suggest that a high DI-GM diet may have beneficial effects in managing hypoalbuminemia in CKD patients by modulating gut microbiota composition and reducing inflammation. This diet pattern could be a promising dietary intervention for improving clinical outcomes in CKD patients, especially those at risk for malnutrition and inflammation.