Significant Predictors Of Outcome Research Articles

Predictive Modeling for Functional Outcomes After All-Inside Arthroscopic Anterior Talofibular Ligament Repair of Chronic Ankle Instability.

Arthroscopic anterior talofibular ligament repair (AATFLR) is a surgical strategy to treat chronic ankle instability (CAI) patients. This study identified risk factors that influenced the functional outcomes of AATFLR for CAI and developed prognostic nomogram for predicting functional outcomes in future AATFLR cases. Patients undergoing AATFLR from January 2016 to June 2022 with at least 10 months of follow-up were included in the study. The Karlsson Ankle Functional Score (KAFS) was evaluated preoperatively and at last follow-up visit. A total of 15 potential predictors including age, sex, body mass index, side affected, time from injury to surgery, sports-related injury, osteophyte, loose bodies, distal tibiofibular syndesmosis, ATFL avulsion fracture, Outerbridge classification of osteochondral lesions, postoperative immobilization method, ambulation time, walking time, and follow-up time, were recorded. We first used univariate binary logistic regression analysis to select the potential significant prognostic features, which were then subjected to the least absolute shrinkage and selection operator (LASSO) regression algorithm for final feature selection. A nomogram based on the regression model was developed to estimate the functional outcomes of patients. Models were validated internally using bootstrapping and externally by calculating their performance on a validation cohort. Overall, 200 ankles fit inclusion criteria. Of these 200, a total of 185 (92.5%) ankles were eligible and divided into development (n = 121) and validation (n = 64) cohorts. Four predictors were ultimately included in the prognostic nomogram model: age, sex, sports-related injury, and postoperative immobilization method. We found in our cohort that the significant predictors of poorer functional outcomes of AATFLR were postoperative immobilization with lower-leg cast, female sex, non-sports-related ankle sprain, and increasing age. Prognostic nomograms were created. Level III, retrospective cohort study.

#3007 Association between sarcopenia and clinical outcomes in patients on maintenance hemodialysis

Abstract Background and Aims Sarcopenia is a generalized skeletal muscle disorder characterized by the progressive loss of skeletal muscle mass, strength, and function, resulting in worse quality of life and increased mortality. Chronic kidney disease and hemodialysis (HD) favor the development of sarcopenia; however, factors associated with sarcopenia in HD patients have not been well-studied. This study aimed to determine the prevalence and risk factors for sarcopenia in HD patients and to analyze the relationship between sarcopenia and overall morbidity and mortality. Method We conducted short-term follow-up prospective cohort study among maintenance HD patients. Hand Grip Strength was measured by a resisted hand-held dynamometer to identify muscle strength and Bioimpedance Spectroscopy to calculate appendicular skeletal muscle mass (ASM). Finally, appendicular skeletal muscle index (ASMI) was calculated as ASM (kg) divided by weight squared (m2). Patients were categorized as sarcopenic or non-sarcopenic using Revised European Working Group criteria (EWGSOP2). Low muscle mass was defined as an ASMI value of<7.00 kg/m2 for men and<5.40 kg/m2 for women; low muscle strength was defined as a hand grip strength of<28 kg for men and<18 kg for women. Results Our study enrolled 176 adult HD patients (60% male, 56.1 ± 14.8 years of age). Median follow-up was 15.9 (interquartile range [IQR] 8.6–21) months. Sarcopenia was present in 32.5 % of males and 28% of female patients and associated with older age (55.2 ± 13.4 vs. 64.0 ± 7.3, p<0.001), lower body mass index (25.3 ± 1.3 vs. 22.8 ± 3.1 kg/m2, p<0.05), longer dialysis vintage (9.2 ± 1.1 vs. 6.2 ± 1.9 years, p<0.001) lower Kt/V and lower serum phosphorus and albumin levels (p = 0.037, p = 0.042 and p = 0.048, respectively). In the multivariate analysis, the sarcopenic group had a significantly higher risk for all causes hospitalization than the non-sarcopenic group after adjusting for age and gender (OR 3.92, (95%CI 1.21–12.53, p = 0.031)). Sarcopenia was significantly associated with higher mortality risk (adjusted OR 1.76 (95% CI 1.32 to 2.67)), cardiovascular (adjusted OR 3.31 (95% CI 1.55 to 9.22)) and cerebrovascular events (adjusted OR 2.67 (95% CI 1.52 to 6.03)). Kaplan–Meier survival analysis showed a twelve-month survival rate of 82.1% in sarcopenic patients, which was significantly lower than the non-sarcopenic group (p = 0.034). Finally, both ASM and low muscle strength were independently related to increased mortality risk in dialysis patients (OR 1.86; 95% CI 1.31 to 2.62 and OR 2.31 95% CI 1.49 to 3.93, respectively). Conclusion Our study demonstrated that sarcopenia was highly prevalent among HD patients and was shown to be a significant predictor of poor patients outcomes. Future research should address whether the early diagnosis and treatment of sarcopenia improve outcomes.

House cricket males reared at different perceived acoustic population densities differ in adult behaviour but not physiology

Abstract If environments stay relatively constant over an individual's lifetime, a juvenile that accurately perceives environmental conditions, like population density, may adjust adult traits to better match their environment, thereby increasing success. While previous studies have explored how adult exposure to population density affects physiological and behavioural plasticity, the influence of juvenile density experience on adult traits is less studied. Using the common house cricket, Acheta domesticus, we explored whether perceived acoustic population density during development affected adult physiology and behaviour. We simulated high‐ and low‐densities using live ambient male song. Upon maturation, we measured metabolic (resting respiration) rate, reproductive investment (testes and accessory gland masses), calling song characteristics and aggressive behaviours from pairwise contests between males from different densities. Male rearing density did not affect resting metabolic rates or reproductive organ masses. However, high‐density males had significantly faster, longer chirps, with more pulses—known to be preferred by females—and higher dominant frequency. Low‐density males won more aggressive contests and sang the aggressive song more. Initiation of aggressive behaviours or song and singing more aggressive song were the only other significant predictors of contest outcome. These results suggest that males may plastically adjust calling song characteristics and aggressive behaviour, but not physiology, based on perceived density during development. We hypothesize that alternative mating tactics—that is, territory guarding versus attractive song production—may underlie these observed patterns. Overall, our study highlights the significant influence of early‐life biotic environments on adult behavioural decisions to enhance success in diverse environments.

#896 Long-term renal outcome in childhood-onset lupus nephritis

Abstract Background and Aims Lupus nephritis (LN) is a common and severe complication of childhood-onset SLE. Little is known about the long-term renal outcome of childhood-onset LN. We investigated predictive factors of end-stage kidney disease (ESKD) and chronic kidney disease (CKD) in a paediatric cohort of patients with LN. Method This is a retrospective multicentre study including patients with childhood-onset (<18 years) biopsy-proven LN. Clinical features were analysed at disease onset, time of kidney biopsy, 12 and 24 months after biopsy, and last follow-up. We investigated the prognostic significance of clinical, laboratory and histologic characteristics on the incidence of ESKD and CKD stage 3-5. Results We included 73 patients with a median age of 14 years (IQR 11.5-17) . At the time of kidney biopsy, most subjects displayed an aggressive disease: 2 (3%) children required haemodialysis, 27 (38%) had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. The overall median eGFR was 70 mL/min/1.73 m2 (IQR 43-96) . Moreover, the median proteinuria was 4 g/24 h (IQR 1.35-7.41) , with 41 (59%) children displaying a nephrotic range proteinuria (i.e., >3 g/24 h) . The median follow-up was 13.3 years (IQR 4.7-25.4) . A total of 10 patients (13.7%) reached ESKD, the majority of whom (12%) within 10 years from kidney biopsy; during the subsequent follow-up the incidence of ESKD stabilised (Fig. 1). At last follow-up, around 50% of patients displayed an eGFR <90 mL/min/1.73 m2. A younger age at LN onset, a lower eGFR and central nervous system involvement at the time of kidney biopsy were identified as predictors of ESKD by a univariable Cox regression model (Table 1). The same features were significantly associated with the occurrence of CKD stage 3-5 at last follow-up at a univariable logistic regression analysis. Conclusion LN often presents with severe kidney function impairment and aggressive systemic involvement in children. In our cohort, whose follow-up was among the longest reported in the literature, 12% of patients reached ESKD within 10 years from kidney biopsy. Significant predictors of poor kidney outcome in the long term were a younger age at LN onset, a lower eGFR and the presence of neurological manifestations at the time of kidney biopsy.

A Biomimetic Osteochondral Scaffold Augmented With Filtered Bone Marrow Aspirate for the Treatment of Joint Surface Lesions in the Knee.

Multilayered osteochondral scaffolds are becoming increasingly utilized for the repair of knee joint surface lesions (KJSLs). However, the literature on predictive factors is rather limited. To (1) evaluate the clinical outcomes and safety of a combined single-step approach using a biomimetic collagen-hydroxyapatite scaffold (CHAS) and filtered bone marrow aspirate (fBMA) for the treatment of KJSLs and (2) identify significant predictors of the treatment outcomes. Case series; Level of evidence, 4. All patients who underwent surgery because of a KJSL (size ≥1.5 cm2; International Cartilage Regeneration & Joint Preservation Society grades 3-4) using the combination above were selected from a hospital registry database (100 patients; minimum 2-year follow-up). Patient characteristics, medical history, knee joint and lesion status, intraoperative details, and cellular parameters of the injected fBMA were collected. The arthroscopic evaluation of chondral and meniscal tissue quality in all knee compartments was performed using the Chondropenia Severity Score. Treatment outcomes were determined clinically using patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, EuroQol-5 Dimensions-3 Levels, EuroQol-Visual Analog Scale, and Tegner Activity Scale) and by assessing the occurrence of serious adverse events and graft failure. Multivariable regression analysis was performed to identify significant predictors of the treatment outcomes. At a mean follow-up of 54.2 ± 19.4 months, 78 (87%) patients completed the questionnaires with significant improvements toward the baseline (P < .00625): KOOS Pain subscale from 62 ± 17 to 79 ± 18, KOOS Total score from 57 ± 16 to 70 ± 20, EuroQol-Visual Analog Scale from 61 ± 21 to 76 ± 16, EuroQol-5 Dimensions-3 Levels from 0.57 ± 0.20 to 0.80 ± 0.21, and Tegner Activity Scale from 2.8 ± 1.5 to 3.9 ± 1.9. The graft failure rate was 4%. A longer duration of preoperative symptoms, previous surgery, larger lesions, older age, and female sex were the main negative predictors for the treatment outcomes. The Chondropenia Severity Score and the number of fibroblast colony-forming units in fBMA positively influenced some of the clinical results and safety. A CHAS augmented with fBMA proved to be an adequate and safe approach for the treatment of KJSLs up to midterm follow-up. Based on the subanalysis of predictive factors, the surgical intervention should be performed in a timely and precise manner to prevent lesion enlargement, deterioration of the general knee cartilage status, and recurrent surgical procedures, especially in older and female patients. When a CHAS is used, the quantity of MSCs seems to play a role in augmentation. NCT06078072 (ClinicalTrials.gov identifier).

Oocyte retrieval in social fertility preservation: challenging traditional beliefs on gonadotropin dosing and follicular size.

To investigate treatment approaches for fertility preservation patients, with a focus on timing of oocyte retrieval, and to determine whether their characteristics differ from those of other IVF patients. Additionally, to evaluate the significance of follicle size on triggering day in the context of fertility preservation. This retrospective cohort study was conducted in a tertiary, university-affiliated medical center. It compared 140 matched patients undergoing social fertility preservation to 140 patients undergoing IVF treatment due to male factor infertility. Patients undergoing fertility preservation received a higher initial gonadotropin dose and had more oocytes retrieved than the control group. Within the fertility preservation cohort, a negative correlation was observed between the rate of large follicles and the number of retrieved oocytes. While there was no significant association between rate of large follicles and oocyte maturation rate in the entire group, age-stratified analysis revealed a negative relationship. Analysis revealed that although traditional treatment determinants such as follicular size and gonadotropin dosing were considered, peak estradiol levels were consistently identified as significant predictors of treatment outcomes. Physicians may modify treatments for fertility preservation, emphasizing a higher gonadotropin dosage to maximize oocyte retrieval. Elevated estradiol levels can serve as a real-time predictive marker for the number of mature oocytes. While treatment strategies can influence outcomes, intrinsic patient factors, particularly baseline ovarian function, remain crucial. These results challenge beliefs regarding the importance of larger follicles and suggest the need for a tailored approach, considering patient age and specific fertility preservation objectives.

Survival Prognostication in Patients with Differentiated Thyroid Cancer and Distant Metastases: A SEER Population-Based Study.

Background: For patients with thyroid cancer, distant metastasis is a significant predictor of poor outcome. Since distant metastasis occur in less than 10% of patients with differentiated thyroid cancer, correlates of survival in this vulnerable patient population remain understudied. This study aimed to identify prognostic groups among patients with differentiated thyroid cancer and distant metastases; and to determine the role of, and interactions between, patient and tumor characteristics in determining survival. Methods: We identified adult patients diagnosed with differentiated thyroid cancer with distant metastases from the U.S. SEER-17 cancer registry (2010-2019). Analyses were performed using Cox proportional hazards regression, survival trees, and random survival forest. Relative importance of patient and tumor factors important for disease-specific and overall survival was assessed based on the random survival forest analyses. Results: Cohort consisted of 2,411 patients with differentiated thyroid cancer with distant metastases followed for a median of 62 months. Most common histopathologic subtype (86.0%) was papillary thyroid cancer, and the most common sites of distant metastasis were the lungs (33.7%) and bone (18.9%). Cox proportional hazards model illustrated significant associations between survival and: patient age (P<0.001), tumor size (P<0.01), and site of distant metastasis (P<0.05). Survival tree analyses identified three distinct prognostic groups based on disease-specific survival (DSS) (5-year survival of the prognostic groups was 92%, 64%, and 41%; P<0.001) and four distinct prognostic groups based on overall survival (OS) (5-year survival of the prognostic groups was 96%, 84%, 57%, and 31%; P<0.001). The first split in the survival trees for DSS and OS was by age at diagnosis (<57 years vs >58 years) with subsequent splits based on presence/absence of lung metastases, tumor size (<4 cm vs >4 cm), and patient age. A total of 558 patients (23.1%) died from thyroid cancer, and 757 patients (31.4%) died from all causes during the study period. Conclusions: This study identifies distinct prognostic groups for patients with differentiated thyroid cancer with distant metastases and highlights the importance of patient age, lung metastases, and tumor size to determining both disease-specific and overall survival. These findings inform risk stratification and treatment decision-making in this understudied patient population.

Increasing Rate of Fatal Streptococcus pyogenes Bacteriemia—A Challenge for Prompt Diagnosis and Appropriate Therapy in Real Praxis

Streptococcus pyogenes, group A streptococci (GAS) bacteriaemia, is a life-threatening infection with high mortality, requiring fast diagnosis together with the use of appropriate antibiotic therapy as soon as possible. Our study analysed data from 93 patients with GAS bacteraemia at the General University Hospital in Prague between January 2006 and March 2024. In the years 2016–2019 there was an increase in GAS bacteraemia. Mortality in the period 2006–2019 was 21.9%; in the period 2020–2024, the mortality increased to 41.4%, p = 0.08. At the same time, in the post-2020 period, the time from hospital admission to death was reduced from 9.5 days to 3 days. A significant predictor of worse outcome in this period was high levels of procalcitonin, &gt;35.1 µg/L (100% sensitivity and 82.35% specificity), and lactate, &gt;5 mmol/L (90.91% sensitivity and 91.67% specificity). Myoglobin was a significant predictor in both compared periods, the AUC was 0.771, p = 0.044, and the AUC was an even 0.889, p ≤ 0.001, respectively. All isolates of S. pyogenes were susceptible to penicillin, and resistance to clindamycin was 20.3% from 2006–2019 and 10.3% in 2020–2024. Appropriate therapy was initiated in 89.1%. and 96.6%, respectively. We hypothesise that the increase in mortality after 2020 might be due to a decrease in the immune status of the population.

Employing machine learning for enhanced abdominal fat prediction in cavitation post-treatment

This study investigates the application of cavitation in non-invasive abdominal fat reduction and body contouring, a topic of considerable interest in the medical and aesthetic fields. We explore the potential of cavitation to alter abdominal fat composition and delve into the optimization of fat prediction models using advanced hyperparameter optimization techniques, Hyperopt and Optuna. Our objective is to enhance the predictive accuracy of abdominal fat dynamics post-cavitation treatment. Employing a robust dataset with abdominal fat measurements and cavitation treatment parameters, we evaluate the efficacy of our approach through regression analysis. The performance of Hyperopt and Optuna regression models is assessed using metrics such as mean squared error, mean absolute error, and R-squared score. Our results reveal that both models exhibit strong predictive capabilities, with R-squared scores reaching 94.12% and 94.11% for post-treatment visceral fat, and 71.15% and 70.48% for post-treatment subcutaneous fat predictions, respectively. Additionally, we investigate feature selection techniques to pinpoint critical predictors within the fat prediction models. Techniques including F-value selection, mutual information, recursive feature elimination with logistic regression and random forests, variance thresholding, and feature importance evaluation are utilized. The analysis identifies key features such as BMI, waist circumference, and pretreatment fat levels as significant predictors of post-treatment fat outcomes. Our findings underscore the effectiveness of hyperparameter optimization in refining fat prediction models and offer valuable insights for the advancement of non-invasive fat reduction methods. This research holds important implications for both the scientific community and clinical practitioners, paving the way for improved treatment strategies in the realm of body contouring.

Relationship between imitation skills and maternal responsiveness for children with autism spectrum disorder: a longitudinal study

Background Imitation is an important developmental skill in terms of social communication with which children with autism spectrum disorder (ASD) have difficulty. Furthermore, responsiveness is suggested to play an essential role in the development of social communication skills in this population. This necessitates understanding the impact of responsiveness on the development of imitation skills. This observational study examines the longitudinal effect of maternal responsiveness on the development of imitation skills among minimally verbal preschool children with ASD. Methods This observational study used a longitudinal correlational design, which is in the correlational dimension of the quantitative research method. The study involved 31 children aged between 28 and 79 months and their mothers. The children with ASD were assessed for elicited and spontaneous imitation skills using observation-based structured tasks. Additionally, the frequency of maternal responsiveness was measured during an unstructured play session with the mother and child. Results The study found a correlation between verbal and nonverbal maternal responses following the child’s focus of attention and elicited and spontaneous imitation skills. Additionally, after controlling for the severity of autism symptoms, object engagement, or initial imitation performances, it was determined that follow-in directives for behavior and nonverbal responses predicted only spontaneous imitation at Time II, together with the severity of autism symptoms. Conclusions The findings show that maternal responsiveness, particularly in response to the child’s focus of attention, including follow-in directives for behavior and nonverbal responses, is a significant predictor of spontaneous imitation outcomes. Therefore, interventions should target maternal responsiveness, emphasizing the development of spontaneous imitation skills.

ASSESSMENT OF LEFT VENTRICULAR FUNCTION AFTER CORONARY ARTERY BYPASS GRAFTING

Coronary artery bypass grafting (CABG) is a commonly performed surgical intervention for coronary artery disease (CAD), aiming to restore blood flow to the myocardium and improve cardiac function. Left ventricular (LV) systolic function is a crucial determinant of postoperative outcomes in CABG patients, yet the predictors of adverse outcomes remain incompletely understood. Objective: This study aimed to evaluate left ventricular function outcomes following CABG and identify predictors of mortality among CABG patients. Methods: A prospective cohort study was conducted at, Ch. Pervaiz Elahi Institute Of Cardiology (CPEIC), Multan, Pakistan, from December 2022 to December 2023. The study included 96 patients undergoing CABG surgery. Preoperative data collection encompassed demographic information, medical history, and baseline clinical characteristics. Left ventricular function was assessed using echocardiography preoperatively and postoperatively. Statistical analysis involved descriptive statistics, univariate analysis, and univariate regression. Results: The study cohort comprised 96 participants, with a mean age of 56.1 years (±12.2) and a male predominance (67.7%). Prevalent comorbidities included diabetes mellitus (78.1%) and hypertension (79.2%). LV systolic dysfunction (30.2%) and old ischemic heart disease (72.9%) were common preexisting conditions. Intraoperative variables included perioperative inotropes (5.2%) and emergent surgeries (3.1%). Postoperative complications included reoperation for bleeding (5.2%) and deterioration of LV ejection fraction (34.4%). The mortality rate was 5.2%. Postoperatively, the mean LVEF increased significantly from 32.00% (±5.219) to 37.00% (±9.801) in isolated CABG patients. Conclusion: This study confirms the significant improvement in LV systolic function following CABG and underscores the high benefit of CABG in patients with reduced EF. However, diabetes mellitus, advanced diastolic dysfunction, and the insertion of IABP were identified as significant predictors of adverse outcomes. Identifying patients with these risk predictors could provide complementary prognostic information and help optimise care, monitoring, and follow-up to improve their expected poor outcomes.

A retrospective study of clinical outcomes for patients with esophageal cancer who were treated with radiotherapy alone

Introduction: Patients with esophageal cancer who are in a poor general condition receive radiotherapy alone, but outcomes are often unsatisfactory. The aim of this study was to clarify recent outcomes of radiotherapy alone for esophageal cancer. Methods: Patients who underwent 50 Gy or more of radiotherapy without chemotherapy were retrospectively reviewed. Endpoints were overall survival (OS), disease-specific survival (DSS), local control (LC), and progression-free survival (PFS). Survival curves were drawn using the Kaplan-Meier method and predictors were analyzed using the Cox proportional hazards model. Results: Sixty-nine patients were included. The median follow-up period was 17.9 months. The 5-year OS, DSS, LC, and PFS rates were 33.2%, 49.8%, 46.2%, and 16.8%, respectively. In the multivariate Cox proportional hazard model, clinical stage was a significant predictor for OS (hazard ratio [HR]: 4.42, 95% confidence interval [CI]: 1.80 – 11.17, p = 0.001), DSS (HR: 2.08, 95% CI: 1.43 – 3.12, p = 0.0001), LC (HR: 1.86, 95% CI: 1.28 – 2.74, p = 0.001), and PFS (HR: 1.65, 95% CI: 1.25 – 2.18, p = 0.0004). Radiation dose was a significant predictor for LC (HR: 0.87, 95% CI: 0.78 – 0.97, p = 0.018) and tumor location was a significant predictor for PFS (HR: 1.55, 95% CI: 1.10 – 2.19, p = 0.018). In subgroup analysis, the 5-year OS, DSS, LC, and PFS rates for stage I were 60.0%, 80.0%, 71.9%, and 46.1%, respectively. Conclusions: Stage, radiation dose and tumor location are significant predictors for outcomes. Patients with stage I esophageal cancer can be cured by radiotherapy alone.

Impact of Vaccination Status on Outcome of Patients With COVID-19 and Acute Ischemic Stroke Undergoing Mechanical Thrombectomy.

Data on impact of COVID-19 vaccination and outcomes of patients with COVID-19 and acute ischemic stroke undergoing mechanical thrombectomy are scarce. Addressing this subject, we report our multicenter experience. This was a retrospective analysis of patients with COVID-19 and known vaccination status treated with mechanical thrombectomy for acute ischemic stroke at 20 tertiary care centers between January 2020 and January 2023. Baseline demographics, angiographic outcome, and clinical outcome evaluated by the modified Rankin Scale score at discharge were noted. A multivariate analysis was conducted to test whether these variables were associated with an unfavorable outcome, defined as modified Rankin Scale score >3. A total of 137 patients with acute ischemic stroke (48 vaccinated and 89 unvaccinated) with acute or subsided COVID-19 infection who underwent mechanical thrombectomy attributable to vessel occlusion were included in the study. Angiographic outcomes between vaccinated and unvaccinated patients were similar (modified Thrombolysis in Cerebral Infarction ≥2b: 85.4% in vaccinated patients versus 86.5% in unvaccinated patients; P=0.859). The rate of functional independence (modified Rankin Scale score, ≤2) was 23.3% in the vaccinated group and 20.9% in the unvaccinated group (P=0.763). The mortality rate was 30% in both groups. In the multivariable analysis, vaccination status was not a significant predictor for an unfavorable outcome (P=0.957). However, acute COVID-19 infection remained significant (odds ratio, 1.197 [95% CI, 1.007-1.417]; P=0.041). Our study demonstrated no impact of COVID-19 vaccination on angiographic or clinical outcome of COVID-19-positive patients with acute ischemic stroke undergoing mechanical thrombectomy, whereas worsening attributable to COVID-19 was confirmed.

Double vitrification and warming of blastocysts does not affect IVF implantation rates, or birth outcomes

Research questionDoes double blastocyst vitrification and warming affect pregnancy rates from embryos subjected to PGT-A testing? DesignThis is a retrospective observational analysis of embryo transfers performed at a single Centre between January 2017 and August 2022. The double vitrification (DV) group included frozen blastocysts that were vitrified after 5-7 days of culture, warmed, biopsied (either once or twice) and re-vitrified. The single vitrification (SV) group included fresh blastocysts that were biopsied at 5-7 days, and then vitrified. ResultsComparison of the 84 DV blastocysts and 729 control SV blastocysts indicated that the DV embryos were frozen later in development and had expanded more than the SV embryos. Of the 813 embryo transfer procedures reported in this study, 452 resulted in the successful delivery of healthy infants (56%). There were however no significant differences between DV and SV embryos in the pregnancy rates achieved after single embryo transfer (55% vs 56%). Logistic regression indicated that while reduced pregnancy rates were associated with increasing maternal age at oocyte collection and at embryo transfer, and with longer culture prior to freezing, DV was not a significant predictor of outcome. ConclusionsBlastocyst DV was not shown to impact pregnancy rates. While caution is necessary due to the study size, no effects of DV on miscarriage rates, birth weight or gestation period were noted. These data offer reassurance given the absence of influence of DV on pregnancy rates after PGT-A.

Decisional and prognostic impact of diagnostic ureteroscopy in high-risk upper tract urothelial carcinoma: A multi-institutional collaborative analysis (ROBUUST collaborative group)

BackgroundDiagnostic ureteroscopy (URS) with or without biopsy remains a subject of contention in the management of upper tract urothelial carcinoma (UTUC), with varying recommendations across different guidelines. The study aims to analyse the decision-making and prognostic role of diagnostic ureteroscopy (URS) in high-risk UTUC patients undergoing curative surgery. Materials and methodsIn this retrospective multi-institutional analysis of high-risk UTUC patients from the ROBUUST dataset, a comparison between patients who received or not preoperative URS and biopsy before curative surgery was carried out. Logistic regression analysis evaluated differences between patients receiving URS and its impact on treatment strategy. Survival analysis included 5-year recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS) and overall survival (OS). After adjusting for high-risk prognostic group features, Cox proportional hazard model estimated significant predictors of time-to-event outcomes. ResultsOverall, 1,912 patients were included, 1,035 with preoperative URS and biopsy and 877 without. Median follow-up: 24 months. Robot-assisted radical nephroureterectomy was the most common procedure (55.1%), in both subgroups. The 5-year OS (P = 0.04) and CSS (P < 0.001) were significantly higher for patients undergoing URS. The 5-year RFS (P = 0.6), and MFS (P = 0.3) were comparable between the 2 groups. Preoperative URS and biopsy were neither a significant predictor of worse oncological outcomes nor of a specific treatment modality. ConclusionsThe advantage in terms of OS and CSS in patients undergoing preoperative URS could derive from a better selection of candidates for curative treatment. The treatment strategy is likely more influenced by tumor features than by URS findings.

A Study on Teaching Factors Affecting Learning Outcomes in General Education: University A’s Case-based

The purpose of this study is to provide implications for general education by analyzing the factors influencing learning outcomes in general education courses. To achieve this, a survey was conducted with 2,042 enrolled students at A National University located in Chungnam. For this study, correlation analysis and descriptive statistics, analysis of differences in learning performance according to students’ background characteristics, and multiple regression analysis of factors affecting learning performance in general education courses were conducted. The findings are as follows: Firstly, from the results of analyzing the difference in learning outcomes based on students’ background characteristics, we can see that the first-year students were statistically significantly lower in satisfaction than their second and third-year counterparts. Additionally, students from the College of Arts showed statistically significant differences in satisfaction compared to those from the College of Education, College of Humanities and Social Science, and College of Engineering. Secondly, the analysis of factors influencing learning outcomes showed that in the “Course Syllabus Area”, the clarity of learning objectives, in the “Course Content Area” the organization of course content for achieving learning objectives, and in the “Course Operation Area,” factors such as instructors’ adequate preparation, active communication with instructors during lectures, adherence to the weekly course schedule outlines in the syllabus, and appropriate supplementary sessions significantly predicted learning outcomes in general education courses. Additionally, in the “Student Evaluation Area,” the use of appropriate assessment for teaching methods, as well as providing suitable feedback on assignments and evaluation results, were significant predictors of learning outcomes. Furthermore, we found that the clarity of learning objectives in the “Course Syllabus Area” only moderately predicted the understanding of course content. Additionally, factors in the “Course Operation Area” such as active communication with instructors during lectures, adherence to the weekly course schedule, and appropriate supplementary sessions only moderate predicted knowledge and skill improvement. However, we also found the appropriateness of notifying the students of any changes in course content in the “Course Operation Area” not to be statistically significant in predicting knowledge and skill improvement. Based on the above research findings, it is recommended that instructors emphasize the importance of their role in influencing learning outcomes in general education courses. Additionally, it is crucial that instructors carefully structure course content during the planning phase to align with the achievement of learning objectives. Adequate preparation by instructors, active engagement with students during lectures, and the implementation of strategies to enhance interaction should be prioritized. Furthermore, the effective utilization of appropriate assessment methods for teaching and providing constructive feedback on assignments and evaluations is essential. This study also suggested deriving recommendations for assignment criteria, evaluation methods, and feedback mechanisms.

Prognostic performance of microscopic size measurements in small invasive carcinomas arising in intraductal papillary mucinous neoplasms of the pancreas.

Small invasive carcinomas arising in intraductal papillary mucinous neoplasms (IPMNs) of the pancreas can present as multiple, small foci. In such cases, there is no clear optimal measurement method for determining the invasive size for tumour staging and prognostication. In all, 117 small invasive IPMNs (size of largest invasive component ≤2 cm) from seven institutions (2000-2016) were reviewed, and all individual foci of invasive carcinoma were measured. T stages (AJCC 8th edition) based on the largest single focus size (LS), average size of all foci (AS), and total sum of all foci (TS) were examined in association with clinicopathologic parameters and patient outcomes. The cohort comprised IPMNs with invasive tubular-type (n = 82, 70%) and colloid-type (n = 35, 30%) carcinomas. The mean LS, AS, and TS were 0.86, 0.71, and 1.32 cm, respectively. Based on the LS, AS, and TS, respectively, 48, 65, and 39 cases were classified as pT1a; 22, 18, and 11 cases as pT1b; and 47, 34, and 50 cases as pT1c. Higher pT stages based on all measurements were significantly associated with small vessel, large vessel, and perineural invasion (P < 0.05). LS-, AS-, and TS-based pT stages were not significantly associated with recurrence-free survival (RFS) or overall survival (OS) by univariate or multivariate analyses. However, among tubular-type carcinomas, higher LS-, AS-, and TS-based pT stages trended with lower RFS (based on 1-, 3-, and 5-year survival rates). All microscopic measurement methods were most predictive of RFS and OS using a 1.5-cm cutoff, with LS significantly associated with both RFS and OS by univariate and multivariate analysis. For invasive tubular-type carcinomas arising in IPMN, microscopic size-based AJCC pT stages were not significant predictors of patient outcomes. However, for LS, a size threshold of 1.5 cm was optimal for stratifying both RFS and OS. The AJCC 8th ed. may not be applicable for stratifying small invasive IPMNs with colloid-type histology that generally portend a more favourable prognosis.

Prognostic Utility of Left Atrial Strain From MRI Feature Tracking in Ischemic and Nonischemic Dilated Cardiomyopathy: A Multicenter Study.

BACKGROUND. MRI-based prognostic evaluation in patients with dilated cardiomyopathy (DCM) has historically used markers of late gadolinium enhancement (LGE) and feature tracking (FT)-derived left ventricular global longitudinal strain (LVGLS). Early data indicate that FT-derived left atrial strain (LAS) parameters, including reservoir, conduit, and booster, may also have prognostic roles in such patients. OBJECTIVE. The purpose of our study was to evaluate the prognostic utility of LAS parameters, derived from MRI FT, in patients with ischemic or nonischemic DCM, including in comparison with the traditional parameters of LGE and LVGLS. METHODS. This retrospective study included 811 patients with ischemic or nonischemic DCM (median age, 60 years; 640 men, 171 women) who underwent cardiac MRI at any of five centers. FT-derived LAS parameters and LVGLS were measured using two- and four-chamber cine images. LGE percentage was quantified. Patients were assessed for a composite outcome of all-cause mortality or heart failure hospitalization. Multivariable Cox regression analyses including demographic characteristics, cardiovascular risk factors, medications used, and a wide range of cardiac MRI parameters were performed. Kaplan-Meier analyses with log-rank tests were also performed. RESULTS. A total of 419 patients experienced the composite outcome. Patients who did, versus those who did not, experience the composite outcome had larger LVGLS (-6.7% vs -8.3%, respectively; p < .001) as well as a smaller LAS reservoir (13.3% vs 19.3%, p < .001), LAS conduit (4.7% vs 8.0%, p < .001), and LAS booster (8.1% vs 10.3%, p < .001) but no significant difference in LGE (10.1% vs 11.3%, p = .51). In multivariable Cox regression analyses, significant independent predictors of the composite outcome included LAS reservoir (HR = 0.96, p < .001) and LAS conduit (HR = 0.91, p < .001). LAS booster and LGE were not significant independent predictors in the models. LVGLS was a significant independent predictor only in a model that initially included LAS booster but not the other LAS parameters. In Kaplan-Meier analysis, all three LAS parameters were significantly associated with the composite outcome (p < .001). CONCLUSION. In this multicenter study, LAS reservoir and LAS conduit were significant independent prognostic markers in patients with ischemic or nonischemic DCM, showing greater prognostic utility than the currently applied markers of LVGLS and LGE. CLINICAL IMPACT. FT-derived LAS analysis provides incremental prognostic information in patients with DCM.

Game on for learning: a holistic exploration of Gamification’s impact on student engagement and academic performance in educational environments

PurposeThe research paper examines the complex relationship between gamification, student engagement and academic performance in educational environments. The study employed a structural equation model that highlights important connections among key constructs within the educational setting.Design/methodology/approachThis research aims to explore the connection between gamification, student engagement and academic performance in educational settings. The study employs various statistical techniques such as factor analysis, Kaiser–Meyer–Olkin (KMO), Bartlett’s test, component transformation matrix, correlation and regression analysis, descriptive statistics, ANOVA, coefficients and coefficient correlations, residual statistics and confirmatory factor analysis (CFA) to analyze the data.FindingsIt was found that active participation by the instructor and good time management skills have a positive impact on student engagement levels (β = 0.380, p &lt; 0.001; β = 0.433 and p &lt; 0.001). However, peer interaction does not significantly predict student engagement (β = −0.068 and p = 0.352). Additionally, there is a positive correlation between student engagement and performance (β = 0.280 and p &lt; 0.001).Research limitations/implicationsThe study highlights the importance of innovative design to fully utilize gamification. Future research should consider design, user characteristics and educational context. The findings can guide informed decisions about gamification in education, fostering motivation and learning objectives.Practical implicationsThe study presents a reliable tool for assessing student engagement and performance in educational settings, demonstrating high Cronbach’s alpha and robust reliability. It identifies student engagement and time management as significant predictors of Global Learning Outcome. The findings can inform decisions on implementing gamification in educational settings, promoting intrinsic motivation and aligning with learning objectives.Social implicationsThe research highlights the transformative impact of gamification on educational practices, highlighting its potential to enhance student experiences, motivate, promote diversity and improve long-term academic performance, highlighting the trend of integrating technology into education.Originality/valueIn today’s ever-changing education landscape, it is essential to incorporate innovative techniques to keep students engaged and enthusiastic about learning. Gamification is one such approach that has become increasingly popular. It is a concept that takes inspiration from the immersive world of games to enhance the overall learning experience.

Relationship between lymphocytes and idiopathic macular hole

BackgroundAn idiopathic macular hole (IMH) is a full-thickness anatomic defect extending from the internal limiting membrane to the photoreceptor layer of the macula without any known cause. Recently, clinical laboratory markers of systemic inflammatory status derived from complete blood counts have been evaluated in ocular diseases. This study aimed to explore whether they could predict the development and progression of IMHs.MethodsA retrospective review of 36 patients with IMH and 36 sex-and-age-matched patients with cataracts was conducted. We collected complete blood counts of all participating individuals and calculated systemic immunoinflammatory indicators. The maximum base diameter of the IMH (BD), minimum diameter of the IMH (MIN), height of the IMH (H), area of the intraretinal cyst (IRC), and curve lengths of the detached photoreceptor arms were measured on optical coherence tomography (OCT) images. We used these values to calculate the macular hole index (MHI), tractional hole index (THI), diameter hole index (DHI), hole form factor (HFF), and macular hole closure index (MHCI). We performed a receiver operating characteristic (ROC) curve analysis of 30 patients with IMH who were followed up 1 month after surgery.ResultsLymphocyte counts were significantly higher in the IMH group. No other significant differences were observed between the IMH and control groups. Lymphocyte counts in the IMH group were significantly negatively correlated with MIN and BD and were significantly positively correlated with MHI, THI, and MHCI. However, lymphocyte counts were not significantly correlated with H, IRC, DHI, and HFF. In the ROC analysis, BD, MIN, MHI, THI, and MHCI were significant predictors of anatomical outcomes. According to the cut-off points of the ROC analysis, lymphocyte counts were compared between the above-cut-off and below-cut-off groups. Lymphocyte counts were significantly higher in the MIN ≤ 499.61 μm, MHI ≥ 0.47, THI ≥ 1.2, and MHCI ≥ 0.81 groups. There were no significant differences between the above-cut-off and below-cut-off BD groups.ConclusionsAlthough inflammation may not be an initiating factor, it may be involved in IMH formation. Lymphocytes may play a relatively important role in tissue repair during the developmental and postoperative recovery phases of IMH.