Significant Predictive Value Research Articles

The association between lipid parameters and erectile dysfunction: a two-sample Mendelian randomization and case-control study.

Lipid parameters have been shown to have significant predictive value for cardiovascular disease, but few studies have evaluated their correlation with erectile dysfunction (ED) in young men. The case-control study encompassed 186 young ED patients (ages 20-40) and 186 healthy controls. Lipid parameters, including total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), TC/HDL ratio, TG/HDL ratio, and LDL-C/HDL-C ratio, were assessed in all participants. The International Index of Erectile Function (IIEF-5) scores were collected for all participants to evaluate erectile status. Multivariate logistic regression analysis was utilized to appraise the association of lipid-related parameters with ED. Single-nucleotide polymorphisms (SNPs) significantly correlated with lipid parameters (TC, TG, LDL-C, HDL-C) were selected from genome-wide association studies (GWAS) as instrumental variables (IV) (P < 5.0 × 10-8). Summary data for ED was gathered from a GWAS with a sample size of (n = 17,353 cases/28,210 controls). The inverse variance weighted (IVW) method was employed as the primary mendelian randomization (MR) analysis method to assess causal effects. Causal estimates were represented as odds ratios (OR) with 95% confidence intervals (CI). Results from the case-control study revealed that, when compared with the control group, levels of LDL-C, TG, UA, LDL-C/HDL-C, TG/HDL-C, and TC/HDL-C in the ED group were significantly elevated (P < 0.01), while HDL-C was significantly decreased (P < 0.01) in the ED group. Multivariate logistic regression analysis indicated LDL-C/HDL-C as a risk factor for both the incidence and severity of ED (P < 0.001). Two-sample MR analysis demonstrated no significant causal correlation between lipid parameters-LDL-C (OR, 0.98, 95% CI, 0.88-1.08, P = 0.616), HDL-C (OR, 1.07, 95% CI: 0.96-1.19, P = 0.249), TC (OR, 1.07, 95% CI, 0.96-1.18, P = 0.208), TG (OR, 0.98, 95% CI, 0.80-1.13, P = 0.579) -and an increased risk of ED (all P > 0.05). The case-control analysis ascertained a significant association between LDL-C, HDL-C, LDL-C/HDL-C, and ED and its severity. However, results from the MR study do not support a causal role of lipid parameters in ED.

An electroencephalographic signature predicts craving for methamphetamine

Craving is central to methamphetamine use disorder (MUD) and both characterizes the disease and predicts relapse. However, there is currently a lack of robust and reliable biomarkers for monitoring craving and diagnosing MUD. Here, we seek to identify a neurobiological signature of craving based on individual-level functional connectivity pattern differences between healthy control and MUD subjects. We train high-density electroencephalography (EEG)-based models using data recorded during the resting state and then calculate imaginary coherence features between the band-limited time series across different brain regions of interest. Our prediction model demonstrates that eyes-open beta functional connectivity networks have significant predictive value for craving at the individual level and can also identify individuals with MUD. These findings advance the neurobiological understanding of craving through an EEG-tailored computational model of the brain connectome. Dissecting neurophysiological features provides a clinical avenue for personalized treatment of MUD.

The modified Polsby-Popper score, a novel quantitative histomorphological biomarker and its potential to predict lymph node positivity and cancer-specific survival in oral tongue squamous cell carcinoma.

The significance of different histological spreading patterns of tumor tissue in oral tongue squamous cell carcinoma (TSCC) is well known. Our aim was to construct a numeric parameter on a continuous scale, that is, the modified Polsby-Popper (MPP) score, to describe the aggressiveness of tumor growth and infiltration, with the potential to analyze hematoxylin and eosin-stained whole slide images (WSIs) in an automated manner. We investigated the application of the MPP score in predicting survival and cervical lymph node metastases as well as in determining patients at risk in the context of different surgical margin scenarios. We developed a semiautomated image analysis pipeline to detect areas belonging to the tumor tissue compartment. Perimeter and area measurements of all detected tissue regions were derived, and a specific mathematical formula was applied to reflect the perimeter/area ratio in a comparable, observer-independent manner across digitized WSIs. We demonstrated the plausibility of the MPP score by correlating it with well-established clinicopathologic parameters. We then performed survival analysis to assess the relevance of the MPP score, with an emphasis on different surgical margin scenarios. Machine learning models were developed to assess the relevance of the MPP score in predicting survival and occult cervical nodal metastases. The MPP score was associated with unfavorable tumor growth and infiltration patterns, the presence of lymph node metastases, the extracapsular spread of tumor cells, and higher tumor thickness. Higher MPP scores were associated with worse overall survival (OS) and tongue carcinoma-specific survival (TCSS), both when assessing all pT-categories and pT1-pT2 categories only; moreover, higher MPP scores were associated with a significantly worse TCSS in cases where a cancer-free surgical margin of <5 mm could be achieved on the main surgical specimen. This discriminatory capacity remained constant when examining pT1-pT2 categories only. Importantly, the MPP score could successfully define cases at risk in terms of metastatic disease in pT1-pT2 cancer where tumor thickness failed to exhibit a significant predictive value. Machine learning (ML) models incorporating the MPP score could predict the 5-year TCSS efficiently. Furthermore, we demonstrated that machine learning models that predict occult cervical lymph node involvement can benefit from including the MPP score. We introduced an objective, quantifiable, and observer-independent parameter, the MPP score, representing the aggressiveness of tumor growth and infiltration in TSCC. We showed its prognostic relevance especially in pT1-pT2 category TSCC, and its possible use in ML models predicting TCSS and occult lymph node metastases.

Multimarker Approach to Improve Risk Stratification of Patients Undergoing Transcatheter Aortic Valve Implantation

BackgroundA blood multimarker approach may be useful to enhance risk stratification in patients undergoing TAVI. ObjectivesThe objective of this study was to determine the prognostic value of multiple blood biomarkers in transcatheter aortic valve implantation (TAVI) patients. MethodsIn this prospective study, several blood biomarkers of cardiovascular function, inflammation, and renal function were measured in 362 patients who underwent TAVI. The cohort was divided into 3 groups according to the number of elevated blood biomarkers (ie, ≥ median value for the whole cohort) for each patient before the procedure. Survival analyses were conducted to evaluate the association between blood biomarkers and risk of adverse event following TAVI. ResultsDuring a median follow-up of 2.5 (IQR: 1.9-3.2) years, 34 (9.4%) patients were rehospitalized for heart failure, 99 (27%) patients died, and 113 (31.2%) met the composite endpoint of all-cause mortality or heart failure rehospitalization. Compared to patients with 0 to 3 elevated biomarkers (referent group), those with 4 to 7 and 8 to 9 elevated biomarkers had a higher risk of all-cause mortality (HR: 1.54 [95% CI: 0.84-2.80], P = 0.16, and HR: 2.81 [95% CI: 1.53-5.15], P < 0.001, respectively) and of the composite endpoint (HR: 1.65 [95% CI: 0.95-2.84], P = 0.07, and HR: 2.67 [95% CI: 1.52-4.70] P < 0.001, respectively). Moreover, adding the number of elevated blood biomarkers into the clinical multivariable model provided significant incremental predictive value for all-cause mortality (Net Reclassification Index = 0.71, P < 0.001). ConclusionsAn increasing number of elevated blood biomarkers is associated with higher risks of adverse clinical outcomes following TAVI. The blood multimarker approach may be helpful to enhance risk stratification in TAVI patients.

Do Chosen Learning Strategies Predict Academic Performance in First-Year DPT Anatomy Students?

The purpose of this study was to identify predictors of anatomy final course grades from first-year physical therapist students' characteristics and chosen learning strategies, as indicated on the Motivated Strategies for Learning Questionnaire (MSLQ). Identifying factors that contribute to success in content intensive classes may aid in coaching successful learning strategies as students transition from undergraduate coursework to Doctor of Physical Therapy (DPT) programs. Previous studies show that first-year graduate students use ineffective learning strategies that are insufficient for graduate-level study. The MSLQ correlates with academic performance at several educational levels. To date, only one study has examined the correlation of MSLQ with physical therapist students' academic performance for an anatomy course. Thirty-nine first-year physical therapist students participated in the study (27 from a hybrid program, 12 from a traditional program). This study analyzed MSLQ scores for the total instrument, each domain, and each subscale using regression analyses to determine predictors of final anatomy grades. The subscales of Self-Efficacy and Test Anxiety had significant predictive value for anatomy grades (R2 = 0.455, F = 5.203, P = .029). Test Anxiety had an inverse relationship to anatomy grades, meaning lower test anxiety scores correlated with higher anatomy grades. The combination of Self-Efficacy, Test Anxiety, and Critical Thinking subscales resulted in a significant prediction of anatomy grades (R2 = 0.603, F = 6.659, P = .014). This study found moderate correlations between MSLQ Motivation subscales and final grades in DPT anatomy classes. Self-Efficacy and Test Anxiety subscales had the strongest correlations and were significantly predictive of anatomy grades. Faculty may benefit from using inventories like the MSLQ for first-year physical therapist students to identify motivational characteristics associated with success and to remediate students' learning strategies to prevent academic failure.

The Influence of Personality Functioning and Pathological Traits on the Mental Well-being of Older Persons with Personality Disorders

Background:Why should you pay attention to personality pathology in geriatric psychiatry? To what extent is mental well-being determined by this? How does that relate to the influence of mental disorders? Does the Alternative Dimensional Model of Personality pathology (AMPD) as proposed by the DSM-5 provide more insight into this than the DSM-IV and DSM-5 categorical diagnoses of personality disorders?Method:These questions were examined in baseline data of 145 patients included in our randomized controlled trial (RCT) into group Schema therapy enriched with psychomotor therapy in older patients with a personality disorder (see Oude Voshaar in this symposium). Mental well-being was measured by a combination of psychological distress (53-item Brief Symptom Inventory), positive mental health (Warwick-Edinburgh Mental Well-being Scale), assessment of own health (RAND-36), and satisfaction with life (Cantrill’s ladder). Personality pathology was assessed according to the categorical personality model using the Structured Clincal Interview for Personality Disorder (SCID-II) as well as the AMDP DSM-5 model using the Severity Indices of Personality Problems (SIPP-short form) and the Personality Iventory for DSM-5 (PID-25). The relationship between personality pathology and mental well-being was investigated using multivariate regression analysis.Results:Three quarters of the included people with a personality disorder also had another psychiatric disorder (beyond personality pathology). However, personality pathology was found to be responsible for the bulk of the mental health burden and outweighed the influence of these psychiatric disorders. Personality dimensions were highly predictive of mental well-being. This contrasted with the absence of any influence from categorical personality disorders. Although dimensions of personality functioning – and in particular Identity Integration – were the primary predictors of mental well-being, pathological traits added significant predictive value (particularly Disinhibition and Negative Affectivity).Conclusions:Personality pathology seriously affects the mental well-being of patients and exceeds the impact of comorbid psychiatric disorders. Contrary to the assumption in the alternative DSM-5 and ICD-10 model, both personality functioning and pathological traits contribute to this impact on mental well-being. Screening and systematic assessment of personality pathology in geriatric psychiatry seems warranted.

Head-to-head comparisons of enhanced CT, 68Ga-PSMA-11 PET/CT and 18F-FDG PET/CT in identifying adverse pathology of clear-cell renal cell carcinoma: a prospective study.

Accurate preoperative prediction of adverse pathology is crucial for treatment planning of renal cell carcinoma (RCC). Previous studies have emphasized the potential of prostate-specific membrane antigen positron emission tomography / computed tomography (PSMA PET/CT) in differentiating between benign and malignant localized renal tumors. However, there is a scarcity of case reports elucidating the identification of aggressive pathological features using PET/CT. Our study was designed to prospectively compare the diagnostic value of enhanced CT, 68Ga-PSMA-11 and 18F-fluorodeoxyglucose (18F-FDG) PET/CT in clear-cell renal cell carcinoma (ccRCC) with necrosis or sarcomatoid or rhabdoid differentiation. A prospective case series of patients with a newly diagnosed renal mass who underwent enhanced CT, 68Ga-PSMA-11 and 18F-FDG PET/CT within 30 days prior to nephrectomy was included. Complete preoperative and postoperative clinicopathological data were recorded. Patients who received neoadjuvant targeted therapy, declined enhanced CT or PET/CT scanning, refused surgical treatment or had non-ccRCC pathological indications were excluded. Radiological parameters were compared within subgroups of pathological characteristics. Bonferroni corrections were used to adjust for multiple testing and statistical significance was set at a p-value less than 0.017. Seventy-two patients were available for the final analysis. Enhanced CT demonstrated poor performance in identifying necrosis, sarcomatoid or rhabdoid differentiation and adverse pathology (all P > 0.05). The maximum standardized uptake value (SUVmax) of 68Ga-PSMA-11 PET/CT was more effective than 18F-FDG PET/CT in identifying tumor necrosis and adverse pathology, with an area under the curve (AUC) of 0.85 (cutoff value=25.26, p<0.001; Delong test z=2.709, p=0.007) for tumor necrosis and AUC of 0.90 (cutoff value=25.26, p<0.001; Delong test z=3.433, p<0.001) for adverse pathology. However, no significant statistical difference was found between 68Ga-PSMA-11 and 18F-FDG PET/CT in predicting sarcomatoid or rhabdoid feature (AUC of 0.91 vs.0.75, Delong test z=1.998, p=0.046). Subgroup analyses based on age, sex, tumor location, maximal diameter, stage and WHO/ISUP grade demonstrated that 68Ga-PSMA-11 PET/CT SUVmax had a significant predictive value for adverse pathology. Enhanced CT value and SUVmax demonstrated strong reliability [intraclass correlation coefficient (ICC) > 0.80], indicating a robust correlation. 68Ga-PSMA-11 PET/CT demonstrates distinct advantages in identifying aggressive pathological features of primary ccRCC when compared to enhanced CT and 18F-FDG PET/CT. Further research and assessment are warranted to fully establish the clinical utility of 68Ga-PSMA-11 PET/CT in ccRCC.

Probability Assessment of Pulmonary Embolism (PE) Using Laboratory Values in Hospitalized Patients: A Single Center, Retrospective Observational Study and a Review of the Literature

Introduction: Venous thromboembolism, including pulmonary embolism (PE) and deep venous thrombosis (DVT), is a common and potentially life-threatening condition in hospitals. Currently, the assessment of PE probability relies on subjective scoring systems, such as Well's and Geneva's scores, which have limitations in certain patient populations (demented, sedated, or intubated patients). This study aims to investigate the use of laboratory values for PE probability assessment, which has not been explored before. Methods: This retrospective observational study included 855 patients meeting the inclusion criteria for suspected PE (age 18 or older and the presence of signs and symptoms of suspected PE such as shortness of breath, chest pain, hemoptysis, tachypnea, tachycardia, and signs of DVT). Sixteen variables were examined, including laboratory values and clinical factors (Table 1). Logistic regression analysis, adjusting for confounding factors, was performed, and significant variables were used to develop a scoring method. Continuous variables that showed statistical significance were transformed into categorical variables using their respective maximum Youden index as the cut-off score. The receiver operating characteristic (ROC) curve was used to detect PE using the developed scoring system and determine the optimal cut-off value. A p-value of less than 0.05 was considered statistically significant. Results: The logistic regression model, incorporating several variables, achieved an 84.6% accuracy in predicting PE after accounting for confounding factors. Among the variables, hypocapnia, fever, alkaline phosphatase (ALP), D-dimer, and lactate had significant predictive values for PE (Table 1). ALP, D-dimer, and lactate were continuous variables with respective maximum Youden indices of 83.89, 952.50, and 1.614. Hypocapnia, ALP, and lactate showed negative slopes (B values), while fever and D-dimer had positive slopes in the logistic regression model. A scoring method was developed based on these variables. Fever, with an adjusted odds ratio (OR) of 1.995, received a score of 2 for values above the cut-off, while other variables with adjusted OR values at or below 1 were assigned a score of 1 above the cut-off. The mean ± SD score among all study participants was 1.84 ± 1.10, with a median (IQR) 2.0 (1.0 - 2.0). Patients without PE had a mean ± SD score of 1.80 ± 1.13, with a median (IQR) of 2 (1 - 2), while patients with PE had a mean ± SD score of 2.07 ± 0.91, with a median (IQR) of 2 (1 - 3). Patients with PE exhibited significantly higher mean ± SD scores than those without PE (P = 0.001; t = -5.813) (Table 2). The area under the ROC curve was 0.585 (95% CI: 0.563 - 0.606), indicating a statistically significant ability to detect PE (p-value = 0.001). Using a cut-off score of 1.5 based on the maximum Youden index, the scoring system achieved a sensitivity of 73.1% and specificity of 43.4% in detecting PE among the study participants. The Well's score, calculated for the study participants, demonstrated a sensitivity of 51.13% and specificity of 75.10% in detecting PE. Conclusion: This study presents a novel approach using laboratory values for PE probability assessment. The developed scoring method showed promising results, providing an alternative to the current accepted scoring systems. Further research and validation are needed to confirm the utility of laboratory-based assessment in clinical practice.

Predictive value of the anterior communicating artery (ACoA) complex variations for the incidence and rupture of ACoA aneurysms

BackgroundIncrease pressure on arteries branching points and curves (hyperdynamic theory) is the most popular theory to explain the aneurysms formation that augmented by the observation of high incidence of anomalies (either A1 aplasia or hypoplasia) and the anterior communicating artery (ACoA) aneurysms. It still underestimated the correlation between these anatomical anomalies and aneurysm occurrence and its rupture. We aim to estimate the incidence and type of anatomical anomalies of the anterior cerebral circulation, including the A2 segment in patients with ACoA aneurysms and their predictive value for aneurysm occurrence and rupture parallel to the risk of hypertension. Also, we study the impact of these anomalies on the configuration of the aneurysm, including the neck and size.ResultsA1 hypoplasia and aplasia were significantly higher in AcoA aneurysms group than in the control group (P < 0.001 and 0.002, respectively). These anomalies have no significant statistical difference between rupture and unruptured ACoA aneurysms. A2 anomalies were insignificantly different between both groups.ConclusionCongenital anomalies in the A1 segment (hypoplasia and aplasia) have a significant predictive value for AcoA aneurysms formation, with no predictive value for the aneurysm rupture. Concomitantly, A2 anomalies have no significant risk for AcoA aneurysms formation and rupture.

Jewish and Arab teachers' views on school communications, innovation and commitment after COVID-19: sector of education as a moderator

PurposeThe study investigated the correlation between school communication and teachers' perceptions of the school's innovative climate in the Israeli education system during the coronavirus disease 2019 (COVID-19) crisis. Furthermore, this study examined the role of affective commitment and the role of sector (Arab or Jewish) in these correlations.Design/methodology/approachFirst, Arab and Jewish teachers studying toward their MA degree were randomly selected from 2 higher education institutes in Israel, and then other teachers were selected using the snowball method through teacher groups on the Facebook social network and WhatsApp groups (N = 383).FindingsThe findings revealed major differences between Arab and Jewish teachers. Among Arab teachers, the correlation between school communications and an innovative climate was found to be mediated through affective commitment, whereas among Jewish teachers, a direct correlation was found between the first two variables. The correlation between school communications and affective commitment was found to be stronger among Arab teachers than among Jewish teachers.Originality/valueThe study results confirmed that school communication and affective commitment hold a significant predictive value in school innovation and highlight the importance of affective commitment in supporting innovation. The study adds to the body of research directed at identifying antecedents to innovative climate as well as studies examining the effects of school communications on affective commitment and innovative climate in a multicultural society, both in regular and emergency situations. The findings can also provide valuable insights for culturally sensitive and relevant education policy design and management in the post-COVID-19 period.

Development and validation of a novel death risk stratification scale in patients with hemorrhagic fever with renal syndrome: a 14-year ambispective cohort study

ObjectivesTo develop and validate a simple and effective death risk stratification scale for hemorrhagic fever with renal syndrome (HFRS). MethodsIn this ambispective cohort study, we investigated the epidemiological and clinical data of 2245 patients with HFRS (1873 enrolled retrospectively and constituting the training cohort, 372 prospectively recruited as the validation cohort) from September 2008 to December 2021, and identified independent risk factors for 30-day death of HFRS. Using logistic regression analysis, a nomogram prediction model was established and was further simplified into a novel scoring scale. Calibration plot, receiver operating characteristic curve, net reclassification index, integrated discrimination index, and decision curve analysis were used to assess the calibration, discrimination, precision, and clinical utility in both training and validation cohorts. ResultsOf 2245 patients with HFRS, 132 (5.9%) died during hospitalization. The nomogram prediction model and scoring scale were developed using six predictors: comorbid hypertension, hypotensive shock, hypoxemia, neutrophils, aspartate aminotransferase, and activated partial thromboplastin time. Both the scale and nomogram were well calibrated (near-diagonal calibration curves) and demonstrated significant predictive values (areas under receiver operating characteristic curves >0.9, sensitivity and specificity >90% in the training cohort and >84% in the validation cohort). The simplified scoring scale demonstrated equivalent discriminative ability to the nomogram, with net reclassification index and integrated discrimination index of 0.022 and 0.007 in the training cohort, 0.126 and 0.022 in the validation cohort. Decision curve analysis graphically represented significant clinical utility and comparable net benefits of the nomogram and scoring scale across a range of threshold probabilities. DiscussionThis evidence-based, factor-weighted, accurate score could help clinicians swiftly stratify HFRS mortality risk and facilitate the implementation of patient triage and tiered medical services during epidemic peaks.

The Clinical Relevance of Selected Cytokines in Newly Diagnosed Multiple Myeloma Patients.

Multiple myeloma (MM) is the second most common hematological neoplasm. Cytokines, chemokines, and their receptors, induced by the microenvironment of MM, participate in tumor growth, the attraction of leukocytes, cell homing, and bone destruction. This study aimed to assess the correlation between the pretreatment serum concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), angiogenic chemokine monocyte chemoattractant protein-1 (MCP-1), and vascular endothelial growth factor (VEGF) and the clinical outcomes and survival of patients newly diagnosed with MM. The study group consisted of 82 individuals. The IL-8 concentration was significantly positively correlated with the age of onset (p = 0.007), the International Staging System (ISS) stage (p = 0.03), the Eastern Cooperative Oncology Group (ECOG) performance status (p < 0.001), the degree of anemia before treatment (p < 0.0001), the degree of kidney disease (p < 0.001), and VEGF (p = 0.0364). Chemotherapy responders had significantly lower concentrations of IL-8 (p < 0.001), IL-6 (p < 0.001), and VEGF (p = 0.04) compared with non-responders. Patients with treatment-induced polyneuropathy had significantly higher levels of IL-8 (p = 0.033). Patients with a high level of IL-6 had a 2-fold higher risk of progression-free survival (PFS) reduction (17 vs. 35 months; HR = 1.89; p = 0.0078), and a more than 2.5-fold higher risk of overall survival (OS) reduction (28 vs. 78 months; HR = 2.62; p < 0.001). High levels of IL-6, IL-8, and VEGF demonstrated significant predictive values for some clinical conditions or outcomes of newly diagnosed MM patients. Patients with an early response to chemotherapy had a significantly lower concentration of these cytokines. A high pretreatment IL-6 concentration was an independent negative prognostic marker for newly diagnosed MM patients.

Abstract 12496: Prognostic Value of Glasgow Prognostic Score and Its Modified Scores on 5-Year Outcome in Patients With Percutaneous Coronary Intervention

Background: Glasgow Prognostic Score (GPS) is an inflammatory score commonly used in clinical practice. In recent years, its modified scores have emerged, including modified GPS (mGPS) and hs-CRP-modified GPS (hs-mGPS). However, the long-term predictive values of these three scores (GPS, mGPS, and hs-mGPS) in coronary heart disease (CHD) remains unclear. Aim: To assess the predictive values of GPS, mGPS, and hs-mGPS on long-term survival in patients following percutaneous coronary intervention (PCI). Methods: Consecutive 10,724 patients with PCI were enrolled in the year of 2013. The primary endpoint was 5-year all-cause death. Results: Finally, 8909 patients with complete clinical data and no loss of follow-up were included. According to the original scores, the risk of all-cause death in patients with a high score of GPS, mGPS, and hs-mGPS was significantly higher than that in patients with a low score. All GPS, mGPS, and hs-mGPS had predictive values for all-cause death with relatively lower AUC of 0.534, 0.522, and 0.545, respectively. In further analysis, we improved hs-mGPS by using hs-CRP 2 mg/L and albumin 40 g/L, and established the CHD-hs-mGPS. The AUC of CHD-hs-mGPS was 0.554 which was significantly higher than mGPS (P = 0.017) and was numerically higher than GPS and hs-mGPS in the total population. Of these four scores (GPS, mGPS, hs-mGPS, and CHD-hs-mGPS), only the CHD-hs-mGPS had a predictive value for both ACS and non-ACS subgroups. Conclusion: For CHD patients, GPS, mGPS, and hs-mGPS had significant long-term predictive value for all-cause death. The score we modified, CHD-hs-mGPS, simultaneously had a predictive value in the total population, ACS and non-ACS subgroups. These inflammatory scores can help early identification of high-risk patients in the patients with established CHD following PCI.

Abstract 15065: A Novel Predictor of Unsustained Return of Spontaneous Circulation in Patients in Cardiac Arrest Through a Combination of Capnography and Pulse Oximetry

Introduction: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. However, no parameter so far can be used to predict the sustainability of ROSC. Research Questions: End-tidal carbon dioxide (ETCO 2 ) is regarded as an indicator of ROSC in cardiac arrest patients. Pulse oximetry photoplethysmogram (POP) parameters have been shown to be associated with peripheral perfusion in critically ill patients. We hypothesized that the combination of ETCO 2 and POP parameters might be discriminative for early recognition of patients at risk of unsustained ROSC before rearrest. Aims: This study examined whether ETCO 2 and POP parameters can be used to identify unsustained ROSC. Methods: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest managed from 2013 to 2014. Patients’ general information, ETCO 2 , and POP parameters, including area under the curve (AUCp) and amplitude (Amp) of POP waveform, were collected and statistically analyzed. Results: The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. Patients with unsustained ROSC had lower 24-hour survival rate than sustained ROSC patients (11.5% vs. 25.0%, respectively; P&lt;0.05). The logistic regression analysis showed that, ΔETCO 2 (difference in ETCO 2 between after to before ROSC) and ΔAUCp (difference in AUCp between after to before ROSC) were independently associated with sustained ROSC (OR = 0.931, P = 0.011 and OR = 0.998, P &lt; 0.001). The area under the receiver operating characteristic curve of ΔETCO 2 , ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962). Conclusion: Patients with unsustained ROSC have a poor prognosis. Combined ΔETCO 2 and ΔAUCp showed significant predictive value for unsustained ROSC.

Abstract 297: A Novel Predictor of Unsustained Return of Spontaneous Circulation in Patients in Cardiac Arrest Through a Combination of Capnography and Pulse Oximetry

Introduction: Unsustained return of spontaneous circulation (ROSC) is a critical barrier to survival in cardiac arrest patients. However, no parameter so far can be used to predict the sustainability of ROSC. Research Questions: end-tidal carbon dioxide (ETCO 2 ) is regarded as an indicator of ROSC in cardiac arrest patients. pulse oximetry photoplethysmogram (POP) parameters have been shown to be associated with peripheral perfusion in critically ill patients. We hypothesized that the combination of ETCO 2 and POP parameters might be discriminative for early recognition of patients at risk of unsustained ROSC before rearrest. Aims: This study examined whether ETCO 2 and POP parameters can be used to identify unsustained ROSC. Methods: We conducted a multicenter observational prospective cohort study of consecutive patients with cardiac arrest managed from 2013 to 2014. Patients’ general information, ETCO 2 , and POP parameters, including area under the curve (AUCp) and amplitude (Amp) of POP waveform, were collected and statistically analyzed. Results: The included 105 ROSC episodes (from 80 cardiac arrest patients) comprised 51 sustained ROSC episodes and 54 unsustained ROSC episodes. Patients with unsustained ROSC had lower 24-hour survival rate than sustained ROSC patients (11.5% vs. 25.0%, respectively; P&lt;0.05). The logistic regression analysis showed that, ΔETCO 2 (difference in ETCO 2 between after to before ROSC) and ΔAUCp (difference in AUCp between after to before ROSC) were independently associated with sustained ROSC (OR = 0.931, P = 0.011 and OR = 0.998, P &lt; 0.001). The area under the receiver operating characteristic curve of ΔETCO 2 , ΔAUCp, and the combination of both to predict unsustained ROSC were 0.752 (95% CI 0.660-0.844), 0.883 (95% CI 0.818-0.948), and 0.902 (95% CI 0.842-0.962). Conclusion: Patients with unsustained ROSC have a poor prognosis. Combined ΔETCO 2 and ΔAUCp showed significant predictive value for unsustained ROSC.

Prognostic value of coronary microvascular dysfunction in patients with aortic stenosis and nonobstructed coronary arteries.

Patients with aortic valve stenosis have been postulated to have coronary microvascular dysfunction (CMD) contributing to the clinical symptoms and adverse outcomes. The coronary angiography (CAG)-derived index of microcirculatory resistance (caIMR) is proposed as a novel, less invasive and pressure-wire-free index to assess CMD. This study aimed to quantify CMD assessed by caIMR and investigate its prognostic impact in patients with aortic valve stenosis. This study included 77 moderate or severe aortic valve stenosis patients with no obstructive coronary disease (defined as having no stenosis more than 50% in diameter) who underwent caIMR measurement. CMD was defined by caIMR at least 25. Major adverse cardiovascular events (MACE) were the clinical outcomes during the median 40 months of follow-up. The incidence of CMD was 47.7%. Seventeen MACE occurred during the follow-up duration. CMD was associated with an increased risk of MACE (log-rank P < 0.001) and an independent predictor of clinical outcomes [hazard ratio 5.467, 95% confidence interval (CI) 1.393-21.458; P = 0.015]. The receiver-operating characteristic (ROC) curve analysis demonstrated that caIMR could provide a significant predictive value for MACE in aortic valve stenosis patients (AUC 0.785, 95% CI 0.609-0.961, P < 0.001). In addition, the risk of MACE was higher in CMD patients with severe aortic valve stenosis (log-rank P < 0.001) and no aortic valve replacement (log-rank P = 0.003) than in other groups. Aortic valve stenosis patients demonstrated markedly impaired caIMR. CMD assessed by caIMR increases the risk of MACE and is an independent predictor of adverse outcomes in aortic valve stenosis patients. This finding suggests that using caIMR in the clinical assessment may help identify high-risk groups and stimulate earlier intervention.

Leukemia Inhibitory Factor, Tissue Factor, Thrombomodulin, P-Selectine, D-Dimer, Thrombin Generation and Procoagulant Phospholipid Dependent Clotting Time Are Predictive for in Vitro Fertilization Outcome. the Prospective Roadmap-IVF Study

Background The link between blood hypercoagulability, endothelial cell activation and infertility or in vitro fertilization (IVF) failure is a puzzling issue. Activation of platelets, endothelial cells and blood coagulation, proinflammatory and angiogenetic potential play important role in implantation and early embryonic development. Biomarkers of cellular hypercoagulability are associated with high risk of IVF failure. Soluble Leukemia Inhibitory Factor (LIF), an interleukin 6 class cytokine expressed in the trophectoderm of the developing embryo is an important regulator in the establishment of pregnancy. Endoglin (Eng), a co-receptor for TGF-β1 and TGF-β3 is implicated in vascular complications of pregnancy and particularly in preeclampsia. Aim: The prospective longitudinal monocentric observational cohort study ROADMAP-IVF, evaluated the synergistic prognostic value of LIF and Eng with the biomarkers of cellular hypercoagulability in predicting the endometrial receptivity of fresh IVF cycles. Materials and Methods. The ROADMAP-IVF enrolled 40 women eligible for IVF with normal blood count, PT, aPTT, Fg, renal and liver function. The control group (CG) consisted of 30 healthy women with history of uncomplicated pregnancies. Exclusion criteria: Use of anticoagulant or antiplatelet agents during the last 30 days before inclusion. Known cardiovascular disease, active cancer. Active corticosteroid treatment. Primary end-point: Echographically documented pregnancy at 7 weeks from implantation. Blood was collected on day 2 (D2) from the natural cycle and 6 days after hormone treatment initiation corresponding to D8 of the cycle. Procoagulant phospholipid-dependent clotting time (PPL-ct), tissue factor (TF), thrombomodulin (TM), von Willebrand factor (vWF) and D-Dimers (DDi) were measured with assays from Diagnostica Stago (Asnieres, France). P- and E-Selectin, LIF and Eng were measured with ELISA. Thrombin generation (TG) with the TF 5 pM PPP-Reagent ® was assessed on Calibrated Automated Thrombogram (Stago, France). The cut-off values for studied biomarkers have been selected on the basis of ROC analysis. Univariate and multivariate logistic regression analysis examined the associations between the biomarkers and the study outcome. Results: 40 women were enrolled in the study. In 11 women pregnancy was confirmed with ultrasound and in 23 women no pregnancy was echographically documented. Age was not significantly different between the IVF (41 ys; range 22 - 48 ys) and the control group (40 ys; range 20 - 46 ys). At D2 and D8 the DDi and LIF were significantly higher in IVFG as compared to the CG. At D2 most of the patients had PPL-ct, DDi and MRI of TG higher than the upper normal limit (UNL). At D8 only TF was significantly increased as compared to the CG. Analytical data are presented in Table 1. Age did not correlate with the levels of the studied biomarkers. Significant correlations (p&amp;lt;0.05) were found between DDi and ETP (r=0.35); TM, TF and P-Selectin (r=0.4) at D2; TF, LIF and Eng (r=0.5) at D2 and D8; P-Selectin and PPL-ct (r=-0.4) at D2; P-Selectin and TM (r=0.4), E-Selectin (r=0.5), LIF (0.4) at D2; E-Selectin and P-Selectin (r=0.5), TF (r=0.3), and LIF (r=0.4) at D2. The ROC analysis showed that IVF failure was associate with DDi increase at D2 (AUC = 0.64); P-Selectin increase at D2(AUC = 0.57) and D8 (AUC = 0.61); TM increase at D8 (AUC = 0.61); TF increase at D8 (AUC = 0.57); LIF increase at D8 (AUC = 0.59); ETP increase at D2 (AUC = 0.67) and D8 (AUC = 0.67); Peak increase at D2 (AUC = 0.64) and D8 (AUC = 0.61). Prolongation of PPL-ct on D8 was predictive for positive pregnancy outcome(AUC 0.64). Conclusion The ROADMAP-IVF study showed that at least one out of four women eligible for IVF present biological evidence of activation of platelets, endothelial cells, blood coagulation or LIF upregulation. Hormone treatment administration does not significantly alter the proinflammatory or the hypercoagulable state. Among the studied biomarkers the levels of LIF, DDi, P-Selectine, TM and TF as well as the status of thrombin generation and PPL-ct showed a significant predictive value for the IVF outcome, particularly when measured at 6 days after hormone treatment administration. These findings will lead to the elaboration of an risk assessment model for IVF failure combining the selected biomarkers of hypercoagulability with LIF.

Public Health Policy, Political Ideology, and Public Emotion Related to COVID-19 in the U.S.

Social networks, particularly Twitter 9.0 (known as X as of 23 July 2023), have provided an avenue for prompt interactions and sharing public health-related concerns and emotions, especially during the COVID-19 pandemic when in-person communication became less feasible due to stay-at-home policies in the United States (U.S.). The study of public emotions extracted from social network data has garnered increasing attention among scholars due to its significant predictive value for public behaviors and opinions. However, few studies have explored the associations between public health policies, local political ideology, and the spatial-temporal trends of emotions extracted from social networks. This study aims to investigate (1) the spatial-temporal clustering trends (or spillover effects) of negative emotions related to COVID-19; and (2) the association relationships between public health policies such as stay-at-home policies, political ideology, and the negative emotions related to COVID-19. This study employs multiple statistical methods (zero-inflated Poisson (ZIP) regression, random-effects model, and spatial autoregression (SAR) model) to examine relationships at the county level by using the data merged from multiple sources, mainly including Twitter 9.0, Johns Hopkins, and the U.S. Census Bureau. We find that negative emotions related to COVID-19 extracted from Twitter 9.0 exhibit spillover effects, with counties implementing stay-at-home policies or leaning predominantly Democratic showing higher levels of observed negative emotions related to COVID-19. These findings highlight the impact of public health policies and political polarization on spatial-temporal public emotions exhibited in social media. Scholars and policymakers can benefit from understanding how public policies and political ideology impact public emotions to inform and enhance their communication strategies and intervention design during public health crises such as the COVID-19 pandemic.

Adiposity, fat depots and the prediction of stroke.

Despite the progress in research, the utility of clinical assessment for the prediction of stroke is limited. The aim herein, was to evaluate the predictive values of major ultrasound indexes of carotid artery and fat depots for stroke in patients with high and very high cardiovascular (CV) risk. The study group included 364 patients (age: 61.3 ± 7.2 years old) with typical CV risk factors scheduled for elective coronary angiography (2012-2013). A comprehensive baseline assessment included the following ultrasound indexes: carotid artery intima-media thickness (IMT), extra-media thickness (EMT), epicardial (EFT) and pericardial fat thickness (PFT), abdominal subcutaneous (ASF) and visceral fat (AVF) and combined periarterial adipose tissue intima-media adventitia (PATIMA) index. Afterwards, all patients were followed for 80.9 ± 7.1 months. There were 23 strokes and 25 cases with new-onset atrial fibrillation during follow-up. Receiver operating characteristics (ROC) analysis showed, that selected clinical parameters (age, waist circumference [WC], waist-hip ratio [WHR]) and ultrasound indexes (EFT: area under curve [AUC] 0.672, p < 0.01 and PATIMA index: AUC 0.658, p < 0.01) were predictive for stroke. However, their predictive values showed no significant differences (p = NS). The baseline body mass index (BMI) was the only parameter, which showed a prediction for new-onset atrial fibrillation (BMI > 33 kg/m2: sensitivity 65%, specificity 76%). It was found that age, WC and echocardiographic EFT revealed significant predictive values for stroke. Both WC and EFT showed a very high NPV suggesting that they should be implemented into the clinical practice as a tool affirming a very low risk of stroke.

Predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality after below-knee amputation.

This retrospective cross-sectional study aimed to evaluate the predictive value of SII (Systemic Immune Inflammation Index) and PNI (Prognostic Nutritional Index) with blood ratios on mortality in diabetic foot patients who underwent below-knee amputation. A total of 231 living (n = 71; 30.7%) and exitus (n = 160; 69.3%) patients were evaluated. The mortality group was divided into 3 groups: 30-day mortality (n = 62; 38.8%), 1-year mortality (n = 62; 38.8%), and over-1-year mortality (n = 36; 22.5%). The hemogram, SII, and PNI parameters of the patients were evaluated. Age, some blood count parameters and SII were significantly higher in the exitus group (P < .05). The lymphocyte, monocyte, eosinophil, albumin, and PNI levels were significantly higher in the living group (P < .05). Mortality was significantly predicted by age (B [regression coefficient] = 0.026, P < .05), NLR (neutrophil lymphocyte ratio) (B = -0.065, P < .05), PNI (B = -0.100, P < .01), and SII (B = 0.00000024, P < .01). The predictive values of CAR (C reactive protein albumin ratio), PNI, and SII were 77.3%, 77.0%, and 76.1%, respectively. For CAR of 30.88 cutoff value, the sensitivity and specificity were 79.4% and 64.8%, respectively. For the PNI 22.0143 cutoff value, the sensitivity and specificity were 66.9% and 5.6%, respectively. For the SII 732249.2481 cutoff value, the sensitivity and specificity were 91.9% and 31.0%, respectively. The predictive value of the PNI was significant for mortality time (B = 0.058; P < .01). The predictive value of PNI for 30-day mortality was significant (AUC (area under curve):0.632; P < .01), whereas its predictive value for 1-year mortality and over-1-year mortality after below-knee amputation was statistically insignificant (P > .05). Both the SII and PNI may be evaluated and used to predict mortality after below-knee amputation. The SII had a significant predictive value for 30-day mortality after below-knee amputation.