Intraoperative hand strength as an indicator of consciousness during awake craniotomy: a prospective, observational study

AbstractAwake craniotomy enables mapping and monitoring of brain functions. For successful procedures, rapid awakening and the precise evaluation of consciousness are required. A prospective, observational study conducted to test whether intraoperative hand strength could be a sensitive indicator of consciousness during the awake phase of awake craniotomy. Twenty-three patients who underwent awake craniotomy were included. Subtle changes of the level of consciousness were assessed by the Japan Coma Scale (JCS). The associations of hand strength on the unaffected side with the predicted plasma concentration (Cp) of propofol, the bispectral index (BIS), and the JCS were analyzed. Hand strength relative to the preoperative maximum hand strength on the unaffected side showed significant correlations with the Cp of propofol (ρ = − 0.219, p = 0.007), the BIS (ρ = 0.259, p = 0.002), and the JCS (τ = − 0.508, p = 0.001). Receiver operating characteristic curve analysis for discriminating JCS 0–1 and JCS ≥ 2 demonstrated that the area under the curve was 0.76 for hand strength, 0.78 for Cp of propofol, and 0.66 for BIS. With a cutoff value of 75% for hand strength, the sensitivity was 0.76, and the specificity was 0.67. These data demonstrated that hand strength is a useful indicator for assessing the intraoperative level of consciousness during awake craniotomy.

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Upper lip bite test compared to modified Mallampati test in predicting difficult airway in obstetrics: A prospective observational study

Journal of Perioperative Practice ◽

10.1177/17504589211045231 ◽

2021 ◽

pp. 175045892110452

Author(s):

Farnaz Moslemi ◽

Zahid Hussain Khan ◽

Elham Alizadeh ◽

Zhila Khamnian ◽

Negar Eftekhar ◽

...

Keyword(s):

Observational Study ◽

Difficult Airway ◽

Difficult Intubation ◽

Prospective Observational Study ◽

Operating Characteristic ◽

Characteristic Curve ◽

Upper Lip ◽

Lehane Grade ◽

Difficult Airways ◽

Obstetric Population

Difficult airway and intubation can have dangerous sequela for patients if not managed promptly. This issue is even more challenging among obstetric patients. Several studies have aimed to determine whether the test to predict a difficult airway or difficult intubation, is higher in accuracy. This study aims to compare the upper lip bite test with the modified Mallampati test in predicting difficult airway among obstetric patients. During this prospective observational study, 184 adult pregnant women, with ASA physical status of II, were enrolled. Difficult intubations of Cormack-Lehane grade III and IV were defined as difficult airways and difficult intubation in this study. Upper lip bite test, modified Mallampati test, thyromental distance and sternomental distance were noted for all patients. Modified Mallampati test, upper lip bite test and sternomental distance had highest specificity. Based on regression analysis, body mass index and Cormack-Lehane grade have a significant association. Modified Mallampati test was the most accurate test for predicting difficult airway. The best cut-off points of thyromental distance and sternomental distance in our study were 5cm and 15cm, respectively, by receiver operating characteristic curve analysis. Based on the results of the present study, it can be concluded that in the obstetric population, modified Mallampati test is practically the best test for predicting difficult airway. However, combining this test with upper lip bite test, thyromental distance and sternomental distance might result in better diagnostic accuracy.

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Decision-making criteria for damage control surgery in Japan

Scientific Reports ◽

10.1038/s41598-019-51436-x ◽

2019 ◽

Vol 9 (1) ◽

Author(s):

Nao Urushibata ◽

Kiyoshi Murata ◽

Yasuhiro Otomo

Keyword(s):

Operating Characteristic ◽

Damage Control ◽

Characteristic Curve ◽

Area Under The Curve ◽

Damage Control Surgery ◽

Data Bank ◽

Emergency Laparotomy ◽

Level Of Consciousness ◽

Type Of Injury ◽

Japan Trauma Data Bank

Abstract Controversy still remains regarding the optimal criteria for selecting damage control surgery (DCS). Our objective was to propose an indication for implementing DCS for abdominal trauma requiring emergency laparotomy. This was a multicenter, retrospective, observational study that used data from the Japan Trauma Data Bank. Patients who underwent emergency laparotomy were included. We compared the patients regarding the performance of DCS. Of the 4447 patients included in the study, 532 patients were in the DCS group and 3915 patients were in the non-DCS group. Logistic regression analysis revealed that body temperature, level of consciousness (Glasgow Coma Scale), and type of injury (blunt or penetrating) were independent predictors of DCS. Using these predictors, we created the Damage Control Indication Detecting score. The score showed a positive correlation with mortality. The score was obtained as 5 of 9 points in total, revealing mortality of 30.8%, sensitivity of 64.8%, and specificity of 70.0%. The area under the curve for the receiver operating characteristic curve was 0.715. This score can help surgeons determine when to perform DCS. However, more than 95% of trauma cases in Japan involve blunt injuries, suggesting that the results of our study may not be applicable internationally.

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Soluble SIGLEC5: A New Prognosis Marker in Colorectal Cancer Patients

Cancers ◽

10.3390/cancers13153896 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3896

Author(s):

Karla Montalbán-Hernández ◽

Ramón Cantero-Cid ◽

Roberto Lozano-Rodríguez ◽

Alejandro Pascual-Iglesias ◽

José Avendaño-Ortiz ◽

...

Keyword(s):

Colorectal Cancer ◽

Operating Characteristic ◽

Prognostic Markers ◽

Characteristic Curve ◽

Area Under The Curve ◽

Significant Heterogeneity ◽

Kaplan Meier ◽

Prognosis Marker ◽

Colorectal Cancer Patients ◽

Healthy Participants

Colorectal cancer (CRC) is the second most deadly and third most commonly diagnosed cancer worldwide. There is significant heterogeneity among patients with CRC, which hinders the search for a standard approach for the detection of this disease. Therefore, the identification of robust prognostic markers for patients with CRC represents an urgent clinical need. In search of such biomarkers, a total of 114 patients with colorectal cancer and 67 healthy participants were studied. Soluble SIGLEC5 (sSIGLEC5) levels were higher in plasma from patients with CRC compared with healthy volunteers. Additionally, sSIGLEC5 levels were higher in exitus than in survivors, and the receiver operating characteristic curve analysis revealed sSIGLEC5 to be an exitus predictor (area under the curve 0.853; cut-off > 412.6 ng/mL) in these patients. A Kaplan–Meier analysis showed that patients with high levels of sSIGLEC5 had significantly shorter overall survival (hazard ratio 15.68; 95% CI 4.571–53.81; p ≤ 0.0001) than those with lower sSIGLEC5 levels. Our study suggests that sSIGLEC5 is a soluble prognosis marker and exitus predictor in CRC.

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Prediction of anemia at delivery

Scientific Reports ◽

10.1038/s41598-021-85622-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Enav Yefet ◽

Avishag Yossef ◽

Zohar Nachum

Keyword(s):

Risk Factors ◽

Operating Characteristic ◽

Complete Blood Count ◽

Characteristic Curve ◽

Secondary Analysis ◽

Area Under The Curve ◽

Iron Supplement ◽

Independent Risk Factors ◽

Operating Characteristic Curve ◽

Study Database

AbstractWe aimed to assess risk factors for anemia at delivery by conducting a secondary analysis of a prospective cohort study database including 1527 women who delivered vaginally ≥ 36 gestational weeks. Anemia (Hemoglobin (Hb) < 10.5 g/dL) was assessed at delivery. A complete blood count results during pregnancy as well as maternal and obstetrical characteristics were collected. The primary endpoint was to determine the Hb cutoff between 24 and 30 gestational weeks that is predictive of anemia at delivery by using the area under the curve (AUC) of the receiver operating characteristic curve. Independent risk factors for anemia at delivery were assessed using stepwise multivariable logistic regression. Hb and infrequent iron supplement treatment were independent risk factors for anemia at delivery (OR 0.3 95%CI [0.2–0.4] and OR 2.4 95%CI [1.2–4.8], respectively; C statistics 83%). Hb 10.6 g/dL was an accurate cutoff to predict anemia at delivery (AUC 80% 95%CI 75–84%; sensitivity 75% and specificity 74%). Iron supplement was beneficial to prevent anemia regardless of Hb value. Altogether, Hb should be routinely tested between 24 and 30 gestational weeks to screen for anemia. A flow chart for anemia screening and treatment during pregnancy is proposed in the manuscript.Trial registration: ClinicalTrials.gov Identifier: NCT02434653.

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The Incidence, Risk Factors, Predictors, and Prognoses of Cytomegalovirus Reactivation in Immunocompetent Mechanical Ventilation Patients: A Prospective Observational Study

10.21203/rs.3.rs-247841/v1 ◽

2021 ◽

Author(s):

Zhihui Zhang ◽

Xuesong Liu ◽

Ling Sang ◽

Sibei Chen ◽

Zhan Wu ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Observational Study ◽

Prospective Observational Study ◽

Area Under The Curve ◽

University Hospital ◽

Laboratory Findings ◽

Cytomegalovirus Reactivation ◽

Cmv Reactivation ◽

Immunocompetent Patients

Abstract Background: Cytomegalovirus (CMV) reactivation can seriously affect the clinical prognoses of critically ill patients. However, the epidemiology and predictors of CMV in immunocompetent patients with mechanical ventilation are not very clear. Methods: A single-center, prospective observational study (conducted from June 30, 2017 to July 01, 2018) with a follow-up of 90 days (September 29, 2018) that included 71 CMV-seropositive immunocompetent patients with mechanical ventilation at a 37-bed university hospital general intensive care unit (ICU) in China. Routine detection of CMV DNAemia was performed once a week until 28 days (Day1, 7, 14, 21, 28) and serology, laboratory findings, and clinical data were obtained at admission.Results: Among 71 patients, 13 (18.3%) showed CMV reactivation within ICU 28-day admission. The median time to reactivation was 7 days. CMV reactivation was related to various factors, including body weight, body mass index (BMI), sepsis, NT-proBNP, BUN, and Hb levels (P< 0.05). In the multivariate regression model, BMI, Hb level, and sepsis were associated with CMV reactivation patients (P< 0.05). Moreover, the area under the curve (AUC) of BMI, Hb and BMI combined Hb was 0.69, 0.70, 0.76, respectively. The rate of complications, duration of mechanical ventilation, hospitalization expense, length of ICU stay, and 90-day all-cause mortality rate in patients with CMV reactivation was significantly higher than in those without CMV reactivation (P< 0.05).Conclusions: Among immunocompetent patients with mechanical ventilation, the incidence of CMV reactivation was high. CMV reactivation can lead to various adverse prognoses. BMI, Hb, and sepsis were independent risk factors for CMV reactivation. BMI and Hb may predict CMV reactivation.

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The Optimal Cutoff Value of D-dimer Levels to Predict in Hospital Mortality in Severe Cases of Coronavirus Disease 2019

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.7600 ◽

2021 ◽

Vol 9 (B) ◽

pp. 1561-1564

Author(s):

Ngakan Ketut Wira Suastika ◽

Ketut Suega

Keyword(s):

Hospital Mortality ◽

Receiver Operating Characteristic Curve ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Optimal Cutoff ◽

Cutoff Value ◽

Operating Characteristic Curve ◽

D Dimer

Introduction: Coronavirus disease 2019 (Covid-19) can cause coagulation parameters abnormalities such as an increase of D-dimer levels especially in severe cases. The purpose of this study is to determine the differences of D-dimer levels in severe cases of Covid-19 who survived and non-survived and determine the optimal cut-off value of D-dimer levels to predict in-hospital mortality. Method: Data were obtained from confirmed Covid-19 patients who were treated from June to September 2020. The Mann-Whitney U test was used to determine differences of D-dimer levels in surviving and non-surviving patients. The optimal cut-off value and area under the curve (AUC) of the D-dimer level in predicting mortality were obtained by the receiver operating characteristic curve (ROC) method. Results: A total of 80 patients were recruited in this study. Levels of D-dimer were significantly higher in non-surviving patients (median 3.346 mg/ml; minimum – maximum: 0.939 – 50.000 mg/ml) compared to surviving patients (median 1.201 mg/ml; minimum – maximum: 0.302 – 29.425 mg/ml), p = 0.012. D-dimer levels higher than 1.500 mg/ml are the optimal cut-off value for predicting mortality in severe cases of Covid-19 with a sensitivity of 80.0%; specificity of 64.3%; and area under the curve of 0.754 (95% CI 0.586 - 0.921; p = 0.010). Conclusions: D-dimer levels can be used as a predictor of mortality in severe cases of Covid-19.

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Comprehensive and Integrative Analysis Reveals the Diagnostic, Clinicopathological and Prognostic Significance of Polo-Like Kinase 1 in Hepatocellular Carcinoma

Cellular Physiology and Biochemistry ◽

10.1159/000490135 ◽

2018 ◽

Vol 47 (3) ◽

pp. 925-947 ◽

Cited By ~ 4

Author(s):

Peng Lin ◽

Dong-yue Wen ◽

Yi-wu Dang ◽

Yun He ◽

Hong Yang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Cell Cycle ◽

Liver Cancer ◽

Receiver Operating Characteristic Curve ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Summary Receiver Operating Characteristic ◽

Operating Characteristic Curve ◽

Standardized Mean Difference

Background/Aims: Liver cancer has the second highest cancer-related death rate globally and has relatively few targeted therapeutics. Polo-like kinase 1 (PLK1) is a fascinating trigger of the cell cycle; however, the still-rudimentary understanding of PLK1 at present is a significant barrier to its clinical applications. Here, we comprehensively clarified the clinicopathological value and potential functions of PLK1 in hepatocellular carcinoma (HCC). Methods: HCC-related microarrays, RNA-sequencing datasets and published studies were deeply mined and integrated from The Cancer Genome Atlas, Gene Expression Omnibus, ArrayExpress, Oncomine, literature databases, and immunohistochemistry experiments. Meanwhile, the associations between PLK1 expression and its clinicopathological implications and prognostic value in HCC patients were assessed. The standardized mean difference, summary receiver operating characteristic curve and the corresponding area under the curve, hazard ratios, odds ratios (ORs), and their 95% confidence intervals (CIs) were examined by STATA 12.0. Additionally, several bioinformatics methods were used to identify the potential function of PLK1 in HCC. Results: Comprehensive analyses revealed that PLK1 was significantly increased in HCC (standardized mean difference = 1.34, 95% CI: 1.03–1.65, P < 0.001). The results of diagnostic tests specified that in the summary receiver operating characteristic curve, the area under the curve was 0.88 (95% CI: 0.85–0.90). Furthermore, an elevated PLK1 level significantly predicted unfavorable overall survival (hazard ratio = 1.78, 95% CI: 1.10–2.88, P = 0.019) and was correlated with female gender (OR = 0.73, 95% CI: 0.56–0.95, P = 0.017), tumor thrombus (OR = 3.97, 95% CI: 1.46–10.78, P < 0.001), metastasis (OR = 3.46, 95% CI: 1.33–9.01, P = 0.011), pathologic stage (OR = 1.56, 95% CI: 1.17–2.07, P = 0.002), Barcelona Clinic Liver Cancer stage (OR = 5.76, 95% CI: 2.17–15.28, P < 0.001) and histologic grade (OR = 2.33, 95% CI: 1.12–487, P = 0.024). Through bioinformatics methods, we determined that enhancing the proliferative effect of PLK1 in HCC was associated with a series of hub genes and the activation of the cell cycle pathway. Conclusions: These findings substantiated that PLK1 may be an independent prognostic biomarker in HCC and may facilitate the development of targeted precision oncology.

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miR-142-3p as a novel biomarker for predicting poor prognosis in renal cell carcinoma patients after surgery

The International Journal of Biological Markers ◽

10.1177/1724600819866456 ◽

2019 ◽

Vol 34 (3) ◽

pp. 302-308 ◽

Cited By ~ 2

Author(s):

Xiqi Peng ◽

Xiang Pan ◽

Kaihao Liu ◽

Chunduo Zhang ◽

Liwen Zhao ◽

...

Keyword(s):

Renal Cell Carcinoma ◽

Receiver Operating Characteristic ◽

Cell Carcinoma ◽

Renal Cell ◽

Poor Prognosis ◽

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

The Cancer Genome Atlas ◽

Receiver Operating

Background: miR-142-3p has proved to be involved in tumorigenesis and the development of renal cell carcinoma. The present study aimed to explore the prognostic value of miR-142-3p. Methods: Total RNA was extracted from renal cell carcinoma specimens and the expression level of miR-142-3p was measured. Pearson Chi-square test, Kaplan–Meier analysis, as well as univariate and multivariate regression analysis were performed to determine the correlation between miR-142-3p and the prognosis of renal cell carcinoma patients. Receiver operating characteristic curves were constructed to evaluate the predictive efficiency of miR-142-3p for the prognosis of renal cell carcinoma patients. Data from The Cancer Genome Atlas (TCGA) were utilized to validate our findings. Results: Our results demonstrated that upregulation of miR-142-3p was correlated with shorter overall survival (P=0.002) and was, in the meantime, an independent prognostic factor for renal cell carcinoma patients (P=0.002). The receiver operating characteristic curve combining miR-142-3p expression with tumor stage showed an area under the curve of 0.633 (95% confidence interval 0.563, 0.702). The result of TCGA data was consistent with our findings. Conclusions: Our results suggest miR-142-3p expression is correlated with poor prognosis of renal cell carcinoma patients and may serve as a prognostic biomarker in the future.

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Accuracy of apparent diffusion coefficients and enhancement ratios on magnetic resonance imaging in differentiating primary cerebral lymphomas from glioblastoma

The Neuroradiology Journal ◽

10.1177/1971400919857556 ◽

2019 ◽

Vol 32 (5) ◽

pp. 328-334 ◽

Cited By ~ 1

Author(s):

Shayan Sirat Maheen Anwar ◽

Mirza Zain Baig ◽

Altaf Ali Laghari ◽

Fatima Mubarak ◽

Muhammad Shahzad Shamim ◽

...

Keyword(s):

Operating Characteristic ◽

Characteristic Curve ◽

Area Under The Curve ◽

Regions Of Interest ◽

Post Contrast ◽

Apparent Diffusion Coefficients ◽

Normal Appearing White Matter ◽

Apparent Diffusion ◽

Adc Values ◽

Patient Subgroups

Background and purposeThis study aimed to determine the accuracy of apparent diffusion coefficient (ADC) and enhancement ratio (ER) in discriminating primary cerebral lymphomas (PCL) and glioblastomas.Materials and methodsCircular regions of interest were randomly placed centrally within the largest solid-enhancing area of all lymphomas and glioblastomas on both post-contrast T1-weighted images and corresponding ADC maps. Regions of interest were also drawn in the contralateral hemisphere to obtain enhancement and ADC values of normal-appearing white matter. This helped us to calculate the ER and ADC ratio.ResultsMean enhancement and ADC (mm2/s) values for PCL were 2220.56 ± 2948.30 and 712.00 ± 137.87, respectively. Mean enhancement and ADC values for glioblastoma were 1537.07 ± 1668.33 and 1037.93 ± 280.52, respectively. Differences in ADC values, ratios and ERs were all statistically significant between the two groups ( p < 0.05). ADC values correctly predicted 71.4% of the lesions as glioblastoma and 83.3% as PCL (area under the curve (AUC) = 0.86 on receiver operating characteristic curve analysis). ADC ratios correctly predicted 85.7% of the lesions as glioblastoma and 100% as PCL (AUC = 0.93). ERs correctly predicted 71.4% of the lesions as glioblastoma and 88.9% as PCL (AUC = 0.92). The combination of ADC ratio and ER correctly predicted 100% tumour type in both patient subgroups.ConclusionsADC values, ADC ratios and ERs may serve as useful variables to distinguish PCL from glioblastoma. The combination of ADC ratio and ER yielded the best results in identification of both patient subgroups.

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A novel collagen area fraction index to quantitatively assess bowel fibrosis in patients with Crohn’s disease

BMC Gastroenterology ◽

10.1186/s12876-019-1100-3 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Xue-hua Li ◽

Zhuang-nian Fang ◽

Tian-ming Guan ◽

Jin-jiang Lin ◽

Can-hui Sun ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Operating Characteristic ◽

Characteristic Curve ◽

Intraclass Correlation ◽

Area Under The Curve ◽

Area Fraction ◽

Strongly Correlated ◽

Fibrosis Score ◽

High Repeatability

Abstract Background A validated histopathological tool to precisely evaluate bowel fibrosis in patients with Crohn’s disease is lacking. We attempted to establish a new index to quantify the severity of bowel fibrosis in patients with Crohn’s disease-associated fibrostenosis. Methods We analyzed the histopathological data of 31 patients with Crohn’s disease strictures undergoing surgical resection. The most representative sections of resected strictured segments were stained with Masson trichrome to manifest bowel fibrosis. The collagen area fraction and histological fibrosis score were simultaneously calculated for the same section to evaluate the severity of bowel fibrosis. Results Collagen area fraction strongly correlated with histological fibrosis scores (r = 0.733, P < 0.001). It showed a stronger correlation (r = 0.561, P < 0.001) with the degree of bowel strictures than the histological fibrosis score did (r = 0.468, P < 0.001). It was also shown to be more accurate for diagnosing Crohn’s disease strictures (area under the receiver operating characteristic curve = 0.815, P < 0.001) compared with the histological fibrosis score (area under the curve = 0.771, P < 0.001). High repeatability was observed for the collagen area fraction, with an intraclass correlation coefficient of 0.915 (P < 0.001). Conclusions Collagen area fraction is a simple and reliable index to quantify the severity of bowel fibrosis in patients with Crohn’s disease-associated fibrostenosis.

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