Stratification System Research Articles

Patients undergoing endocrine consultation and first diagnosis of nodular disease: Indications of thyroid ultrasound and completeness of ultrasound reports.

To evaluate reasons for performing ultrasonography (US) and completeness of US reports in patients undergoing endocrine consultation with the first diagnosis of nodular disease. Since January 1 to June 30, 2021, we prospectively collected patient data (age and thyroid-stimulating hormone concentrations), reasons for performing thyroid US, and completeness of reports regarding the description of the thyroid gland and nodules. In the case of multiple nodules, we considered the nodule suspected of malignancy and the largest one. To evaluate the accuracy of thyroid nodule description, we referred to the five characteristics suggested by the ACR TI-RADS system. A total of 341 patients with thyroid nodules received endocrine consultation (female, 78%). The most frequent reasons for performing thyroid US were unrelated to a suspected thyroid disease (31.7%), followed by incidentaloma (23.5%), dysfunction or positivity for thyroid antibodies (19.1%), symptomatic or visible nodules (17.6%), and family history of any thyroid disease (8.2%). Gland texture was not reported in 41.9%. The depth of the lobes was the dimension reported most frequently (42.2%), but any diameter was not reported in 57.8% of the cases. As regards the description of the most relevant nodule, length was reported more frequently (75.9%). Margins and echogenicity were more frequently described (54.5% and 44.3%, respectively) than other characteristics (composition: 27%; shape: 8.8%; echogenic foci: 6.7%). No reports had indicated the malignancy risk stratification. The results of the study demonstrate that in patients undergoing endocrine consultation with first detected thyroid nodules, US was mostly performed in asymptomatic cases, US reports were incomplete, and no risk stratification system was reported.

An effective tool for predicting survival in breast cancer patients with de novo lung metastasis: Nomograms constructed based on SEER.

An effective tool for forecasting the survival of BCLM is lacking. This study aims to construct nomograms to predict overall survival (OS) and breast cancer-specific survival (BCSS) in breast cancer patients with de novo lung metastasis, and to help clinicians develop appropriate treatment regimens for breast cancer lung metastasis (BCLM) individuals. We gathered clinical data of 2,537 patients with BCLM between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. Cox regression analysis was employed to identify independent prognostic parameters for BCLM, which were integrated to establish nomograms by R software. The discriminative ability and predictive accuracy of the nomograms were assessed using the concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration plots. Kaplan-Meier analyses were applied to evaluate the clinical utility of the risk stratification system and investigate the survival benefit of primary site surgery, chemotherapy, and radiotherapy for BCLM patients. Two nomograms shared common prognostic indicators including age, marital status, race, laterality, grade, AJCC T stage, subtype, bone metastasis, brain metastasis, liver metastasis, surgery, and chemotherapy. The results of the C-index, ROC curves, and calibration curves demonstrated that the nomograms exhibited an outstanding performance in predicting the prognosis of BCLM patients. Significant differences in the Kaplan-Meier curves of various risk groups corroborated the nomograms' excellent stratification. Primary site surgery and chemotherapy remarkably improved OS and BCSS of BCLM patients whether the patients were at low-risk or high-risk, but radiotherapy did not. We successfully developed prognostic stratification nomograms to forecast prognosis in BCLM patients, which provide important information for indicating prognosis and facilitating individualized treatment regimens for BCLM patients.

Development of a machine learning-based fine-grained risk stratification system for thyroid nodules using predefined clinicoradiological features.

We constructed and validated a machine learning-based malignancy risk estimation model using predefined clinicoradiological features, and evaluated its clinical utility for the management of thyroid nodules. In total, 5708 benign (n = 4597) and malignant (n = 1111) thyroid nodules were collected from 5081 consecutive patients treated in 26 institutions. Seventeen experienced radiologists evaluated nodule characteristics on ultrasonographic images. Eight predictive models were used to stratify the thyroid nodules according to malignancy risk; model performance was assessed via nested 10-fold cross-validation. The best-performing algorithm was externally validated using data for 454 thyroid nodules from a tertiary hospital, then compared to the Thyroid Imaging Reporting and Data System (TIRADS)-based interpretations of radiologists (American College of Radiology, European and Korean TIRADS, and AACE/ACE/AME guidelines). The area under the receiver operating characteristic (AUROC) curves of the algorithms ranged from 0.773 to 0.862. The sensitivities, specificities, positive predictive values, and negative predictive values of the best-performing models were 74.1-76.6%, 80.9-83.4%, 49.2-51.9%, and 93.0-93.5%, respectively. For the external validation set, the ElasticNet values were 83.2%, 89.2%, 81.8%, and 90.1%, respectively. The corresponding TIRADS values were 66.5-85.0%, 61.3-80.8%, 45.9-72.1%, and 81.5-90.3%, respectively. The new model exhibited a significantly higher AUROC and specificity than did the TIRADS risk stratification, although its sensitivity was similar. We developed a reliable machine learning-based predictive model that demonstrated enhanced specificity when stratifying thyroid nodules according to malignancy risk. This system will contribute to improved personalized management of thyroid nodules. • The area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity of our model were 0.914, 83.2%, and 89.2%, respectively (derived using the validation dataset). • Compared to the TIRADS values, the AUROC and specificity are significantly higher, while the sensitivity is similar. • An interactive version of our AI algorithm is at http://tirads.cdss.co.kr .

Luxury Immigrants? An Exploration of the Practical and Symbolic Motivations of Chinese Beneficiaries of the Canadian Citizenship by Investment Programme

What were the motivations of people who chose to acquire Canadian citizenship through the Federal Immigrant Investor Programme? To answer this question, we draw on a series of nineteen semi-structured interviews conducted with people of Chinese origin who obtained Canadian nationality through this programme. Based on the concept of nationality as a system of social stratification on a global scale, this research shows that children’s education, access to spacious housing, and a good quality, health environment topped the list of reasons given by interviewees. Increased mobility, which is much discussed in the academic literature, is sought only insofar as it gives access to these goods. The desire to acquire a privileged status within the global capitalist system is also a source of motivation, with the Canadian passport representing an object of social distinction and a sign of belonging to one of the richest nations.

POEMS-syndrome

POEMS-syndrome (polyneuropathy - P, organomegaly - O, endocrinopathy - E, M-protein - M, skin changes - S) is a paraneoplastic syndrome caused by underlying dyscrasia of plasma cells. The main criteria of the syndrome are polyradiculoneuropathy, clonal proliferation of plasma cells, sclerotic bone lesions, elevated levels of vascular endothelial growth factor and the presence of Castleman disease. Additional signs include organomegaly, endocrinopathy, characteristic skin changes, edema of the optic disc, extravascular volume overload (edema) and thrombocytosis. The diagnosis is often made late, because the syndrome is rare and is often mistaken by specialists for other neurological disorders, most often for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). We present two cases of POEMS-syndrome. The description is based on the principle of differential diagnosis with a number of similar neurological disorders. The goal facing the neurologist is to carry out the most complete diagnostic measures for early diagnosis, which further determines timely therapeutic tactics. Hematologists are engaged in specific therapy of POEMS-syndrome. A brief description of possible therapeutic options is presented. On the example of these cases, we demonstrate possible variants of the therapeutic response based on the developed system of risk stratification of patients with POEMS-syndrome.

CASTE BASED CENSUS: A LEAP TOWARDS INCLUSIVE SOCIETY

Caste is a system of birth-ascribed stratification of the Indian society which places certain castes at the top and deprives certain castes in every sphere of life. India runs massive affirmative programmes to level the caste-based deprivations of the weaker sections (SC/STs and OBCs). A new policy in the form of a quota of 10 percent for the economically weaker sections (EWS) has emerged. All the affirmative programmes and a new EWS (economically weaker sections) quota are running on hazy projections and blurry extrapolations in the absence of caste-based data. The issue of caste-based census has surfaced once again in the lie of the forthcoming Census of 2021. This paper addresses the issue of the caste-based census. It advocates for the count of the castes in the census of 2021. It also advocates that the castebased census is an inevitable move for the Inclusive Society.

Risk stratification and validation of ultrasound ovarian and adnexal reporting data system: Correlation with clinical follow-up and histopathology

Purpose: Diseases pertaining to the reproductive system of the women are becoming increasing common. The first and foremost system in a female body to show systemic dysfunction is the Endocrine system, which in turn affects the menstrual cycle. Thus menstrual abnormalities are becoming increasingly common. Most common gynaecological problems include ovarian cysts, adnexal masses, fibroids, polycystic ovarian disease. Ovarian cancer is the second most common malignancy in women, accounting for 4% of all cancers in the female population.Adnexal masses (mass of the ovary, fallopian tube, or surrounding connective tissues) are a common gynaecological problem. They account for 80% of all gynaecological problems.These masses may be found in females of all ages.Aim: To stratify and assess the risk stratification of adnexal masses on the basis of ORADS and to calculate statistical measures of performance of ORADS with the help of clinical follow up and histopathology.Materials and Methods: Suspected patients with ovarian/adnexal lesions were referred to Radiology department for Ultrasonography. Transabdominal and/ or transvaginal sonography was performed. The lesions were assessed based on ORADS grading system. Subsequently, the lesions were correlated with the HPE reports. Results: This is a prospective observational study conducted in 166 patients. There was a significant positive correlation between the distribution of benign and malignant tumours across ORADS grades and p value of 0.000 was derived indicating extremely significant statistical difference. Conclusions: Ovarian-Adnexal Reporting and Data System US risk stratification and management system had higher sensitivity and specificity for detection of adnexal malignancy in our study. Higher ORADS Grades were had loculated tumours, irregular margins, septations, solid component, and higher echogenicity. In the ORADS Grade 1, 2 and 3, did not have any malignancy. ORADS grade 4 and 5 had higher prevalence of malignancy.

Legend of Watu Umpak and the Structure Construction (Study of Folklore as an Effort to Maintain Social Position in Social Stratification of Village Communities)

This study follows up several previous studies in same location. This study aims to examine how the efforts of elite groups members of local rural to maintain their social position in social stratification system of rural communities. This study uses a qualitative approach. Research is based on reality in the field, namely the existence of folklore or oral history about boulders which are called “ watu umpak". The boulder was placed inside the mosque and functioned as a seat for preacher. The results showed that presence of “ watu umpak” in the mosque contributed to maintain the social position of local elite members in social stratification system of village community. Keywords : legend, watu umpak , social stratification DOI: 10.7176/RHSS/13-2-06 Publication date: January 31 st 2023

Data, Anomalies; a Call to Cease and Desist.

Data, Anomalies; a Call to Cease and Desist.

Transformation of primary myelofibrosis into acute myeloblastic leukemia: clinical case

Primary myelofibrosis (PMF) is a disease from the group of Ph–negative myeloproliferative tumors, which is characterized by bone marrow fibrosis, splenomegaly and extramedullary hematopoiesis. The mean life in PMF ranges from 7.6 to 10 years and varies widely depending on the appearance of additional mutations and a higher degree of malignancy. Most patients have an indolent flow, and in some patients with PMF, the disease progresses rapidly with the development of acute myeloblastic leukemia. The international stratification system DIPSS-plus allows predicting the occurrence time of the PMF blast transformation phase. The article presents a case of early PMF transformation into acute myeloblastic leukemia in a patient with a heterozygous mutation in the JAK2 gene and an intermediate risk-2 established according to the International Prognostic Scoring DIPSS-plus. The patient received standard cytoreductive therapy.

Acute management of pneumonia in adult patients.

Acute management of pneumonia in adult patients.

Comparison of diagnostic performance of the current score-based ultrasound risk stratification systems according to thyroid nodule size

Comparison of diagnostic performance of the current score-based ultrasound risk stratification systems according to thyroid nodule size

Clinical Application of the 2021 Korean Thyroid Imaging Reporting and Data System (K-TIRADS)

In patients with thyroid nodules, ultrasonography (US) has been established as a primary diagnostic imaging method and is essential for treatment decision. The Korean Thyroid Imaging Reporting and Data System (K-TIRADS) is a pattern-based, US malignancy risk stratification system that can easily diagnose nodules during real-time ultrasound examinations. The 2021 K-TIRADS clarified the US criteria for nodule classification and revised the size thresholds for nodule biopsy, thereby reducing unnecessary biopsies for benign nodules while maintaining the appropriate sensitivity to detect malignant tumors in patients without feature of high risk thyroid cancer. Thyroid radiology practice has an important clinical role in the diagnosis and non-surgical treatment of patients with thyroid nodules, and should be performed according to standard practice guidelines for proper and effective clinical care.

Validation of CT-Based Risk Stratification System for Lymph Node Metastasis in Patients With Thyroid Cancer.

To evaluate the computed tomography (CT) features for diagnosing metastatic cervical lymph nodes (LNs) in patients with differentiated thyroid cancer (DTC) and validate the CT-based risk stratification system suggested by the Korean Thyroid Imaging Reporting and Data System (K-TIRADS) guidelines. A total of 463 LNs from 399 patients with DTC who underwent preoperative CT staging and ultrasound-guided fine-needle aspiration were included. The following CT features for each LN were evaluated: absence of hilum, cystic changes, calcification, strong enhancement, and heterogeneous enhancement. Multivariable logistic regression analysis was performed to identify independent CT features associated with metastatic LNs, and their diagnostic performances were evaluated. LNs were classified into probably benign, indeterminate, and suspicious categories according to the K-TIRADS and the modified LN classification proposed in our study. The diagnostic performance of both classification systems was compared using the exact McNemar and Kosinski tests. The absence of hilum (odds ratio [OR], 4.859; 95% confidence interval [CI], 1.593-14.823; P = 0.005), strong enhancement (OR, 28.755; 95% CI, 12.719-65.007; P < 0.001), and cystic changes (OR, 46.157; 95% CI, 5.07-420.234; P = 0.001) were independently associated with metastatic LNs. All LNs showing calcification were diagnosed as metastases. Heterogeneous enhancement did not show a significant independent association with metastatic LNs. Strong enhancement, calcification, and cystic changes showed moderate to high specificity (70.1%-100%) and positive predictive value (PPV) (91.8%-100%). The absence of the hilum showed high sensitivity (97.8%) but low specificity (34.0%). The modified LN classification, which excluded heterogeneous enhancement from the K-TIRADS, demonstrated higher specificity (70.1% vs. 62.9%, P = 0.016) and PPV (92.5% vs. 90.9%, P = 0.011) than the K-TIRADS. Excluding heterogeneous enhancement as a suspicious feature resulted in a higher specificity and PPV for diagnosing metastatic LNs than the K-TIRADS. Our research results may provide a basis for revising the LN classification in future guidelines.

Retracted: The Diagnostic Efficacy of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI‐RADS) and the American Thyroid Association (ATA) Risk Stratification Systems for Thyroid Nodules

Retracted: The Diagnostic Efficacy of the American College of Radiology (ACR) Thyroid Imaging Report and Data System (TI‐RADS) and the American Thyroid Association (ATA) Risk Stratification Systems for Thyroid Nodules

What are the current diabetic foot assessment methods in private podiatry practices in Flanders, Belgium: an exploratory mixed method study

BackgroundDiabetic foot assessments detect patients at risk for developing a diabetes-related foot ulceration and can significantly reduce the risk of amputation. In order to organize this assessment effectively, diabetic foot assessment guidelines are required according to the International Working Group of the Diabetic Foot. However, these international guidelines have not been adapted into a national guideline for podiatrists in Flanders, Belgium. This study aims to identify the methods and guidelines currently used to assess the diabetic foot in private podiatry practices in Flanders, Belgium and to explore the podiatrists’ opinions on developing a national diabetic foot assessment guideline.MethodsThis exploratory mixed method study was composed of an anonymous online survey comprising of open- and closed-ended questions followed by 1:1 online semi-structured interviews. Participants were recruited via e-mail and a closed private Facebook group of podiatry alumni. Data was analyzed using SPSS statistics and thematic analysis described by Braun and Clarke.ResultsThis study showed that the vascular assessment of the diabetic foot exists solely of a medical history and palpation of the pedal pulses. Non-invasive tests such as doppler, toe brachial pressure index or ankle brachial pressure index are seldom used. Only 66% reported to use a guideline for the diabetic foot assessment. There was a variety of reported guidelines and risk stratification systems in use in private podiatry practices in Flanders, Belgium.ConclusionNon-invasive tests such as the doppler, ankle brachial pressure index or toe brachial pressure index are rarely used for the vascular assessment of the diabetic foot. Diabetic foot assessment guidelines and risk stratification systems to identify patients at risk for developing a diabetic foot ulcer were not frequently used. International guidelines of the International Working Group of the Diabetic Foot have not yet been implemented in private podiatry practices in Flanders, Belgium. This exploratory research has provided useful information for future research studies.

Validation of Ultrasound and Computed Tomography-Based Risk Stratification System and Biopsy Criteria for Cervical Lymph Nodes in Preoperative Patients With Thyroid Cancer.

This study aimed to validate the risk stratification system (RSS) and biopsy criteria for cervical lymph nodes (LNs) proposed by the Korean Society of Thyroid Radiology (KSThR). This retrospective study included a consecutive series of preoperative patients with thyroid cancer who underwent LN biopsy, ultrasound (US), and computed tomography (CT) between December 2006 and June 2015. LNs were categorized as probably benign, indeterminate, or suspicious according to the current US- and CT-based RSS and the size thresholds for cervical LN biopsy as suggested by the KSThR. The diagnostic performance and unnecessary biopsy rates were calculated. A total of 277 LNs (53.1% metastatic) in 228 patients (mean age ± standard deviation, 47.4 years ± 14) were analyzed. In US, the malignancy risks were significantly different among the three categories (all P < 0.001); however, CT-detected probably benign and indeterminate LNs showed similarly low malignancy risks (P = 0.468). The combined US + CT criteria stratified the malignancy risks among the three categories (all P < 0.001) and reduced the proportion of indeterminate LNs (from 20.6% to 14.4%) and the malignancy risk in the indeterminate LNs (from 31.6% to 12.5%) compared with US alone. In all image-based classifications, nodal size did not affect the malignancy risks (short diameter [SD] ≤ 5 mm LNs vs. SD > 5 mm LNs, P ≥ 0.177). The criteria covering only suspicious LNs showed higher specificity and lower unnecessary biopsy rates than the current criteria, while maintaining sensitivity in all imaging modalities. Integrative evaluation of US and CT helps in reducing the proportion of indeterminate LNs and the malignancy risk among them. Nodal size did not affect the malignancy risk of LNs, and the addition of indeterminate LNs to biopsy candidates did not have an advantage in detecting LN metastases in all imaging modalities.

The correlation between biomechanical parameters of lower limb and overall risk for diabetic foot ulcer

Background/Aim: Preventing lower limb diabetic complications begins with identifying those at risk for diabetic foot ulceration (DFU). DFU development is related to abnormal pattern of plantar pressure distribution caused by alterations in foot rollover process due to loss of foot-ankle muscular strength, impaired range of motion (ROM) and nervous function, as their integrity is needed to enable proper load absorption on plantar surface. Objective of study was to determine correlation between biomechanical parameters of lower limb: ankle and foot muscle strength, ROM at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP) and overall risk for DFU assessed by IWGDF 2019 Guidance risk stratification system. Methods: A cross-sectional study included 100 diabetic patients, both types. Patients were classified into 4 DFU risk categories applying IWGDF Guidelines 2019 stratification risk system. Function of ten foot and ankle muscles was evaluated by manual muscle testing applying Michigan Diabetic Neuropathy Score system and was expressed by muscle score (MS) on dominant leg. ROM at AJ, SJ and I MTP was measured with a goniometer on dominant leg and was expressed by degree (°). Results: Average MS in specified categories were as follows: Category 0: 9.2; Category 1: 13.9; Category 2: 13.3; Category 3: 15.2 and they were significantly different. Average ROM at AJ in specified categories were as follows: Category 0: 49.3°; Category 1: 48.8°; Category 2: 45.5°; Category 3: 44.6° and they were not significantly different. Average ROM at SJ in specified categories were as follows: Category 0: 37.8°; Category 1: 31.3°; Category 2: 35.0°; Category 3: 28.7° and they were significantly different. Average ROM at I MTP in specified categories were as follows: Category 0: 78.60 ; Category 1: 74.4°; Category 2: 65.5°; Category 3: 57.9° and they were significantly different. Conclusions: Risk for DFU ulcer significantly correlates with decreased ankle and foot muscle strength and ROM at SJ and I MTP but does not correlate with ROM at AJ.

Thyroid nodules: need for a universal risk stratification system.

Thyroid nodules: need for a universal risk stratification system.

Nomogram to Predict Long-Term Overall Survival and Cancer-Specific Survival of Radiotherapy Patients with Nasopharyngeal Carcinoma.

To establish and validate a nomogram to predict the overall survival (OS) and cancer-specific survival (CSS) in patients with nasopharyngeal carcinoma (NPC) receiving radiotherapy by integrating multiple independent prognostic factors. Data from 5663 patients with NPC who received definite radiotherapy between 2004 and 2018 were included and divided into training and validation cohorts. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors of patients with NPC after radiotherapy. Thereafter, the predictive accuracy of the nomogram model was evaluated. Age, race, marital status, pathological type, tumor size, T stage, N stage, M stage, American Joint Committee on Cancer stage, and chemotherapy were independent factors affecting the prognosis of patients with NPC receiving radiotherapy. Nomograms with a concordance index of 0.726 (95% confidence interval (CI): 0.675-0.777) and 0.732 (95% CI: 0.680-0.785) were able to predict OS and CSS, respectively. The area under the curve showed excellent predictive performance. Additionally, the calibration curve indicated that the predicted survival rate was consistent with the actual survival rate, and the decision curve indicated its clinical value. The established risk stratification system was able to accurately stratify patients receiving radiotherapy for NPC into three risk subgroups with significant differences in prognosis (P < 0.05). The constructed nomogram had good prognostic performance and could be used as an effective tool to evaluate the prognosis of patients with NPC after radiotherapy. This nomogram could be further used to guide clinical decisions and personalized treatment plans.