A Novel Nomogram for Predicting the Risk of Premature Delivery Based on the Thyroid Function in Pregnant Women

BackgroundMaternal thyroid dysfunction and autoantibodies were associated with preterm delivery. However, recommendations for cutoff values of thyroperoxidase antibody (TPOAb) positivity and thyroid-stimulating homone (TSH) associated with premature delivery are lacking.ObjectiveTo identify the pregnancy-specific cutoff values for TPOAb positivity and TSH associated with preterm delivery. To develop a nomogram for the risk prediction of premature delivery based on maternal thyroid function in singleton pregnant women without pre-pregnancy complications.MethodsThis study included data from the International Peace Maternity and Child Care Health Hospital (IPMCH) in Shanghai, China, between January 2013 and December 2016. Added data between September 2019 and November 2019 as the test cohort. Youden’s index calculated the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration. Univariate and multivariable logistic regression analysis were used to screen the risk factors of premature delivery. The nomogram was developed according to the regression coefficient of relevant variables. Discrimination and calibration of the model were assessed using the C-index, Hosmer-Lemeshow test, calibration curve and decision curve analysis.Results45,467 pregnant women were divided into the training and validation cohorts according to the ratio of 7: 3. The testing cohort included 727 participants. The pregnancy-specific cutoff values associated with the risk of premature delivery during the first trimester were 5.14 IU/mL for TPOAb positivity and 1.33 mU/L for TSH concentration. Multivariable logistic regression analysis showed that maternal age, history of premature delivery, elevated TSH concentration and TPOAb positivity in the early pregnancy, preeclampsia and gestational diabetes mellitus were risk factors of premature delivery. The C-index was 0.62 of the nomogram. Hosmer-Lemeshow test showed that the Chi-square value was 2.64 (P = 0.955 > 0.05). Decision curve analysis showed a positive net benefit. The calibration curves of three cohorts were shown to be in good agreement.ConclusionsWe identified the pregnancy-specific cutoff values for TPOAb positivity and TSH concentration associated with preterm delivery in singleton pregnant women without pre-pregnancy complications. We developed a nomogram to predict the occurrence of premature delivery based on thyroid function and other risk factors as a clinical decision-making tool.

External Validation of Models to Predict Unsuccessful Endometrial Ablation: a Retrospective Study

Study Objective: External validation of our previously presented and locally established prediction models to help counsel patients for failure of endometrial ablation (EA) or surgical re-intervention within 2 years after EA, called ‘Failure model’ and ‘Re-intervention model’ respectively. Design: Retrospective external validation study, minimal follow-up time of 2 years.Setting: Two non-academic teaching hospitals in the Netherlands.Patients: Pre-menopausal women (18+) who had undergone EA for abnormal uterine bleeding problems between January 2010 and November 2012. A total of 329 patients were eligible for analysis.Interventions: Interventions used for EA were Novasure (Hologic, Marlborough, Massachusetts, US) and ThermaChoice III (Ethicon, Sommerville, US). Measurements and Main Results: The Area Under the Receiver Operating characteristics Curve (AUROC) for the outcome parameter of failure within 2 years after EA was 0.59 (95% CI 0.53 – 0.65). Variables in this model were dysmenorrhea, age, parity ≥5 and preoperative menorrhagia. The Hosmer-Lemeshow test showed no significant difference between the observed and predicted outcome. (Chi-square: 4.62, P-value: .80) The AUROC for the outcome parameter surgical re-intervention within 2 years was 0.62 (95% CI 0.53 – 0.70) Variables in this model were dysmenorrhea, age, menstrual duration> 7 days, parity ≥5 and a previous caesarean section. The Hosmer-Lemeshow test showed no significant difference between the observed and predicted outcome (Chi-square 11.34, P-value .18).Conclusion: Both the failure model and the re-intervention model can be used to predict unsuccessful endometrial ablation in the general population within two years after the procedure. It can be used prior to surgery to facilitate tailor-made shared decision-making, and help counsel patients with regards to the potential outcome of their treatment with the use of a personally calculated percentage.

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.

Apakah Empati Mempengaruhi Kepatuhan Pajak?

Research on the impact of empathy as a non-economic factor on taxpayer compliance has not been studied in Indonesia. Most research still focuses on economic factors that affect tax compliance. To find out whether empathy affects tax compliance, this study uses binary logistic regression analysis because the dependent variable is nominal and categorical. The significance of the regression equation parameters was tested by the Ratio Likelihood Test and the Wald Test. Then, the goodness of fit model was tested using the Hosmer-Lemeshow Test. The likelihood ratio test shows that there is at least one coefficient from the regression model that has an effect on the 5% significance level. Based on the Wald test, there is no independent variable that has a significant effect on tax compliance with a 5% significance level. The Hosmer-Lemeshow test states that the binary logistic regression model in this study is feasible to use. Binary logistic regression analysis shows that only one predictor has a significant effect on the tax compliance variable, namely empathic concern items. The odds ratio value of 1.054 on the empathic concern items variable shows that taxpayers who have empathy will be 1.054 times more tax compliant than respondents who do not have empathy. In other words, respondents who have empathy will tend to be more obedient in paying taxes than those who do not have this trait. Therefore, the government can formulate regulations that support the emergence of empathic concern items in the community so that tax compliance increases.

Integrative parameter of platelet aggregation in intensive care of COVID-19 patients

Objective. To conduct a comparative analysis of changes in platelet aggregation parameters in COVID-19 patients which are related to anticoagulant therapy and to determine the effectiveness of the integrative parameter of platelet aggregation.Materials and methods. 34 patients with confirmed COVID-19 (group 1) were included into the study. To compare the obtained results, healthy females were included into group 2 (n = 30). The following parameters of aggregation were determined: degree, time, rate and area of aggregation (until its maximum degree).Results. The area of aggregation is the best among all the parameters of platelet aggregation to diagnose COVID-19 in patients according to the Hosmer-Lemeshow test: with an ADP inducer — 0.3 μg/ml (Chi-square = 9.481, p = 0.303); ADP — 1.25 μg/ml (Chi square = 12.577, p = 0.127); ADP — 2.5 μg/ml (Chi-square = 6.226, p = 0.622); adrenaline — 2.5 μM (Chi-square = 7.367, p = 0.498); adrenaline — 5 μM (Chi-square = 6.824, p = 0.556).Conclusion. The area of aggregation is an informative integrative parameter that allows to quantify the degree of aggregation in the treatment of hypercoagulation syndrome in COVID-19 patients.

Diagnostic Value of Radiomics Analysis in Contrast-Enhanced Spectral Mammography for Identifying Triple-Negative Breast Cancer

PurposeTo evaluate the value of radiomics analysis in contrast-enhanced spectral mammography (CESM) for the identification of triple-negative breast cancer (TNBC).MethodCESM images of 367 pathologically confirmed breast cancer patients (training set: 218, testing set: 149) were retrospectively analyzed. Cranial caudal (CC), mediolateral oblique (MLO), and combined models were built on the basis of the features extracted from subtracted images on CC, MLO, and the combination of CC and MLO, respectively, in the tumour region. The performance of the models was evaluated through receiver operating characteristic (ROC) curve analysis, the Hosmer-Lemeshow test, and decision curve analysis (DCA). The areas under ROC curves (AUCs) were compared through the DeLong test.ResultsThe combined CC and MLO model had the best AUC and sensitivity of 0.90 (95% confidence interval: 0.85–0.96) and 0.97, respectively. The Hosmer–Lemeshow test yielded a non-significant statistic with p-value of 0.59. The clinical usefulness of the combined CC and MLO model was confirmed if the threshold was between 0.02 and 0.81 in the DCA.ConclusionsMachine learning models based on subtracted images in CESM images were valuable for distinguishing TNBC and NTNBC. The model with the combined CC and MLO features had the best performance compared with models that used CC or MLO features alone.

Temporal Validation of a Predictive Score for Death in Children with Visceral Leishmaniasis

Objectives. To perform a temporal validation of a predictive model for death in children with visceral leishmaniasis (VL). Methods. A temporal validation of a children-exclusive predictive model of death due to VL (Sampaio et al. 2010 model), using a retrospective cohort, hereby called validation cohort. The validation cohort convenience sample was made of 156 patients less than 15 years old hospitalized between 2008 and 2018 with VL. Patients included in the Sampaio et al. 2010 study are here denominated derivation cohort, which was composed of 546 patients hospitalized in the same hospital setting in the period from 1996 to 2006. The calibration and discriminative capacity of the model to predict death by VL in the validation cohort were then assessed through the procedure of logistic recalibration that readjusted its coefficients. The calibration of the updated model was tested using Hosmer–Lemeshow test and Spiegelhalter test. A ROC curve was built and the value of the area under this curve represented the model’s discrimination. Results. The validation cohort found a lethality of 6.4%. The Sampaio et al. 2010 model demonstrated inadequate calibration in the validation cohort (Spiegelhalter test: p = 0.007 ). It also presented unsatisfactory discriminative capacity, evaluated by the area under the ROC curve = 0.618. After the coefficient readjustment, the model showed adequate calibration (Spiegelhalter test, p = 0.988 ) and better discrimination, becoming satisfactory (AUROC = 0.762). The score developed by Sampaio et al. 2010 attributed 1 point to the variables dyspnea, associated infections, and neutrophil count <500/mm3; 2 points to jaundice and mucosal bleeding; and 3 points to platelet count <50,000/mm3. In the recalibrated model, each one of the variables had a scoring of 1 point for each. Conclusion. The temporally validated model, after coefficient readjustment, presented adequate calibration and discrimination to predict death in children hospitalized with VL.

Diplopia Is Frequent and Associated with Motor and Non-Motor Severity in Parkinson’s Disease: Results from the COPPADIS Cohort at 2-Year Follow-Up

Background and objective: Diplopia is relatively common in Parkinson’s disease (PD) but is still understudied. Our aim was to analyze the frequency of diplopia in PD patients from a multicenter Spanish cohort, to compare the frequency with a control group, and to identify factors associated with it. Patients and Methods: PD patients who were recruited from January 2016 to November 2017 (baseline visit; V0) and evaluated again at a 2-year ± 30 days follow-up (V2) from 35 centers of Spain from the COPPADIS cohort were included in this longitudinal prospective study. The patients and controls were classified as “with diplopia” or “without diplopia” according to item 15 of the Non-Motor Symptoms Scale (NMSS) at V0, V1 (1-year ± 15 days), and V2 for the patients and at V0 and V2 for the controls. Results: The frequency of diplopia in the PD patients was 13.6% (94/691) at V0 (1.9% in controls [4/206]; p < 0.0001), 14.2% (86/604) at V1, and 17.1% (86/502) at V2 (0.8% in controls [1/124]; p < 0.0001), with a period prevalence of 24.9% (120/481). Visual hallucinations at any visit from V0 to V2 (OR = 2.264; 95%CI, 1.269–4.039; p = 0.006), a higher score on the NMSS at V0 (OR = 1.009; 95%CI, 1.012–1.024; p = 0.015), and a greater increase from V0 to V2 on the Unified Parkinson’s Disease Rating Scale–III (OR = 1.039; 95%CI, 1.023–1.083; p < 0.0001) and Neuropsychiatric Inventory (OR = 1.028; 95%CI, 1.001–1.057; p = 0.049) scores were independent factors associated with diplopia (R2 = 0.25; Hosmer and Lemeshow test, p = 0.716). Conclusions: Diplopia represents a frequent symptom in PD patients and is associated with motor and non-motor severity.

Gender Differences and Postoperative Delirium in Adult Patients Undergoing Cardiac Valve Surgery

Background: Postoperative delirium (POD) is common in patients following cardiac surgery. According to studies on non-cardiac surgery, males suffered from higher incidence of POD. However, there is no report about effect of gender differences on POD occurrence in cardiac surgery patients. The aim of this study was to investigate the effect of gender differences on POD occurrence in adult patients after cardiac valve surgery.Methods: This is a retrospective case-control study. We recorded the clinical data in adult patients who underwent elective cardiac valve surgery from May 2019 to October 2020. POD was assessed by the Confusion Assessment Method for Intensive Care Unit. Univariate analysis was used to screen the potential risk factors. Collinearity analysis was conducted to detect overlapping predictor variables on the outcomes. A multivariate logistic regression with odds ratio (OR) and 95% confidence interval (CI) was used to identify the independent risk factors. The Hosmer-Lemeshow test was performed to show the good calibration of the logistic regression model.Results: In total, we recorded the perioperative data in 431 adult patients, including 212 males and 219 females. Sixty patients suffered from POD, including 39 males and 21 females. Twenty-one perioperative variables were selected, and 11 were screened by univariate analysis. We did not detect the severe collinearity among the 11 variables. Male gender was identified as a significant risk factor in POD occurrence in patients undergoing cardiac surgery (Adjusted OR: 2.213, 95% CI: 1.049–4.670, P = 0.037). The Hosmer-Lemeshow test demonstrated good calibration of the logistic regression model (χ2 = 7.238, P = 0.511). Besides, compared with females, the relationship of male and delirium subtypes was as follows: (1) hyperactive: adjusted OR: 3.384, 95% CI: 1.335–8.580, P = 0.010; (2) hypoactive: adjusted OR: 0.509, 95% CI: 0.147–1.766, P = 0.287. A Stratification analysis by age demonstrated that the males showed higher POD incidence in patients aged younger than 60 years (adjusted OR: 4.384, 95% CI: 1.318–14.586, P = 0.016).Conclusions: Male gender is an important risk factor in POD occurrence in patients following cardiac surgery. Furthermore, the incidence of hyperactive delirium is higher in males. Besides, the male patients aged younger than 60 years are at high risk of POD. We should pay more attention to the male patients to prevent their POD occurrence.

Proteinuria is independently associated with carotid atherosclerosis: a multicentric study

Background and aims Atherosclerosis is a vital cause of cardiovascular diseases. The correlation between proteinuria and atherosclerosis, however, has not been confirmed. This study aimed to assess whether there is a relationship between proteinuria and atherosclerosis. Methods From January 2016 to September 2020, 13,545 asymptomatic subjects from four centres in southern China underwent dipstick proteinuria testing and carotid atherosclerosis examination. Data on demography and past medical history were collected, and laboratory examinations were performed. The samples consisted of 7405 subjects (4875 males and 2530 females), excluding subjects failing to reach predefined standards and containing enough information. A multivariate logistic regression model was used to adjust the influence of traditional risk factors for atherosclerosis on the results. Results Compared with proteinuria-negative subjects, proteinuria-positive subjects had a higher prevalence rate of carotid atherosclerosis. The differences were statistically significant (22.6% vs. 26.7%, χ2 = 10.03, p = 0.002). After adjusting for common risk factors for atherosclerosis, age, sex, BMI, blood lipids, blood pressure, renal function, hypertensive disease, diabetes mellitus and hyperlipidaemia, proteinuria was an independent risk factor for atherosclerosis (OR = 1.191, 95% CI 1.015–1.398, p = 0.033). The Hosmer–Lemeshow test was used to test the risk prediction model of atherosclerosis, and the results showed that the model has high goodness of fit and strong independent variable prediction ability. Conclusions Proteinuria is independently related to carotid atherosclerosis. With the increase in proteinuria level, the risk of carotid atherosclerotic plaque increases. For patients with positive proteinuria, further examination of atherosclerosis should not be ignored.