Real-Time Elastography: A Web-Based Nomogram Improves the Preoperative Prediction of Central Lymph Node Metastasis in cN0 PTC

BackgroundGiven the difficulty of accurately determining the central lymph node metastasis (CLNM) status of patients with clinically node-negative (cN0) papillary thyroid carcinoma (PTC) before surgery, this study aims to combine real-time elastography (RTE) and conventional ultrasound (US) features with clinical features. The information is combined to construct and verify the nomogram to foresee the risk of CLNM in patients with cN0 PTC and to develop a network-based nomogram.MethodsFrom January 2018 to February 2020, 1,157 consecutive cases of cN0 PTC after thyroidectomy and central compartment neck dissection were retrospectively analyzed. The patients were indiscriminately allocated (2:1) to a training cohort (771 patients) and validation cohort (386 patients). Multivariate logistic regression analysis of US characteristics and clinical information in the training cohort was performed to screen for CLNM risk predictors. RTE data were included to construct prediction model 1 but were excluded when constructing model 2. DeLong’s test was used to select a forecast model with better receiver operator characteristic curve performance to establish a web-based nomogram. The clinical applicability, discrimination, and calibration of the preferable prediction model were assessed.ResultsMultivariate regression analysis showed that age, sex, tumor size, bilateral tumors, the number of tumor contacting surfaces, chronic lymphocytic thyroiditis, and RTE were risk predictors of CLNM in cN0 PTC patients, which constituted prediction model 1. Model 2 included the first six risk predictors. Comparison of the areas under the curves of the two models showed that model 1 had better prediction performance (training set 0.798 vs. 0.733, validation set 0.792 vs. 0.715, p < 0.001) and good discrimination and calibration. RTE contributed significantly to the performance of the prediction model. Decision curve analysis showed that patients could obtain good net benefits with the application of model 1.ConclusionA noninvasive web-based nomogram combining US characteristics and clinical risk factors was developed in the research. RTE could improve the prediction accuracy of the model. The dynamic nomogram has good performance in predicting the probability of CLNM in cN0 PTC patients.

A Nomogram for Predicting Intraoperative Hemodynamic Instability in Patients With Pheochromocytoma

PurposeSurgical removal of pheochromocytoma (PCC), including open, laparoscopic, and robot-assisted adrenalectomy, is the cornerstone of therapy, which is associated with high risk of intraoperative and postoperative life-threatening complications due to intraoperative hemodynamic instability (IHD). This study aims to develop and validate a nomogram based on clinical characteristics as well as computed tomography (CT) features for the prediction of IHD in pheochromocytoma surgery.MethodsThe data from 112 patients with pheochromocytoma were collected at a single center between January 1, 2010, and December 31, 2019. Clinical and radiological features were selected with the least absolute shrinkage and selection operator regression analysis to predict IHD then constitute a nomogram. The performance of the nomogram was assessed in terms of discrimination, calibration, and clinical utility.ResultsAge, tumor shape, Mayo Adhesive Probability score, laterality, necrosis, body mass index, and surgical technique were identified as risk predictors of the presence of IHD. The nomogram was then developed using these seven variables. The model showed good discrimination with a C-index of 0.773 (95% CI, 0.683–0.862) and an area under the receiver operating characteristic curve (AUC) of 0.739 (95% CI, 0.642–0.837). The calibration plot suggested good agreement between predicted and actual probabilities. Besides, calibration was tested with the Hosmer–Lemeshow test (P = 0.961). The decision curve showed the clinical effectiveness of the nomogram.ConclusionsOur nomogram based on clinical and CT parameters could facilitate the treatment strategy according to assessment of the risk of IHD in patients with pheochromocytoma.

A Case-Control Study on Risk Predictors Associated with Periodontitis in Systemically Healthy Patients; a Regression Analysis

Aim: This case-control study was conducted to analyze the association of periodontitis with risk predictors i.e. age, gender, education status, brushing habits and past dental visits in systemically healthy patients. Materials and Methods: The study included total of 1097 systemically healthy, non-tobacco using patients with age ≥ 18 years that reported to periodontology department from year 2018. The demographic details and dental care pattern of the patients were extracted from the records of periodontology department, and their frequencies were formulated. The association of five study variables i.e. age, gender, education status, brushing habits and past dental visits was assessed using forward step-wise logistic regression analysis. Results: Total of 471(42.9%) patients were diagnosed with periodontitis. Higher frequency of periodontitis was observed in patients who were male and ≥ 50 years of age. Regression analysis showed that the subjects with < 50 years of age, ≥ 12 years of education, regular brushing habits and regular past dental visits had greater odds of being safe from periodontitis. Conclusion: Since the population chosen for this research was systemically healthy, non-tobacco using individuals, a high prevalence (42.9%) of periodontitis was observed indicating the need to analyze the factors other than systemic conditions contributing in prevalence of periodontitis. Furthermore, a positive association between study variables and periodontitis was observed in this research, which will help the clinicians in prediction of periodontitis in systemically healthy, non-tobacco using individuals.

The Clinical Outcomes of Ventricular Septal Rupture Secondary to Acute Myocardial Infarction: A Retrospective, Observational Trial

Background. Ventricular septal rupture (VSR) is a severe mechanical complication secondary to acute myocardial infarction (AMI) with a dreadful prognosis. The goal of our study was to evaluate the mortality and to identify the predictors of mortality for this population. Methods. From June 2012 to July 2021, patients with VSR secondary to AMI were initially screened for eligibility in this study. The potential risk predictors were determined using appropriate logistic regression models. Results. In this retrospective study, a total of 50 cases were included, and 14 patients survived and got discharged successfully. Univariable analyses indicated that the heart rate (HR), white blood cell (WBC) count, neutrophils count, serum glucose, serum creatinine, serum lactic acid, and the closure of rupture were significantly associated with mortality among these special populations. Conclusion. This study found that such high mortality in patients with VSR after AMI was significantly correlated with these risk factors representing sympathetic excitation and large infarct size. Coronary revascularization combined with the closure of rupture might be helpful in improving their prognosis.

Comparison of Scoring Systems for Mortality Prediction in Pediatric Multitrauma Patients

The aim of this study was to compare scoring systems for mortality prediction and determine the threshold values of this scoring systems in pediatric multitrauma patients. A total of 57 multitrauma patients referred to the pediatric intensive care unit from January 2020 to August 2021 were included. The pediatric trauma score (PTS), injury severity score (ISS), base deficit (B), international normalized ratio (I), Glasgow coma scale (G) (BIG) score, and pediatric risk of mortality 3 (PRISM 3) score were analyzed for all patients. Of the study group, 35% were females and 65% were males with a mean age of 72 months (interquartile range: 140). All groups' mortality ratio was 12.2%. All risk scores based on mortality prediction were statistically significant. Cutoff value for PTS was 3.5 with 96% sensitivity and 62% specificity; for the ISS, it was 20.5 with 92% sensitivity and 43% specificity; threshold of the BIG score was 17.75 with 85.7% sensitivity and 34% specificity; and 12.5 for PRISM 3 score with 87.6% sensitivity and 28% specificity. PTS, ISS, BIG score, and PRISM 3 score were accurate risk predictors for mortality in pediatric multitrauma patients. ISS was superior to PTS, PRISM 3 score, and BIG score for discrimination between survivors and nonsurvivors.

Atrial Fibrillation Ablation Using Robotic Magnetic Navigation Reduces the Incidence of Silent Cerebral Embolism

Background: The incidence of silent cerebral embolisms (SCEs) has been documented after pulmonary vein isolation using different ablation technologies; however, it is unreported in patients undergoing with atrial fibrillation (AF) ablation using Robotic Magnetic Navigation (RMN). The purpose of this prospective study was to investigate the incidence, risk predictors and probable mechanisms of SCEs in patients with AF ablation and the potential impact of RMN on SCE rates.Methods and Results: We performed a prospective study of 166 patients with paroxysmal or persistent AF who underwent pulmonary vein isolation. Patients were divided into RMN group (n = 104) and manual control (MC) group (n = 62), and analyzed for their demographic, medical, echocardiographic, and risk predictors of SCEs. All patients underwent cerebral magnetic resonance imaging within 48 h before and after the ablation procedure to assess cerebral embolism. The incidence and potential risk factors of SCEs were compared between the two groups. There were 26 total cases of SCEs in this study, including 6 cases in the RMN group and 20 cases in the MC group. The incidences of SCEs in the RMN group and the MC group were 5.77 and 32.26%, respectively (X2 = 20.63 P &lt; 0.05). Univariate logistic regression analysis demonstrated that ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction were significantly associated with SCEs, and multivariate logistic regression analysis showed that MC ablation was the only independent risk factor of SCEs after an AF ablation procedure.Conclusions: Ablation technology, CHA2DS2-VASc score, history of cerebrovascular accident/transient ischemic attack, and low ejection fraction are associated with SCEs. However, ablation technology is the only independent risk factor of SCEs and RMN can significantly reduce the incidence of SCEs resulting from AF ablation.Clinical Trial Registration: ChiCTR2100046505.