Risk factors and the utility of three different kinds of prediction models for postoperative fatigue after gastrointestinal tumor surgery.

BACKGROUND: Postoperative fatigue (POF) is a common complication after gastrointestinal tumor surgery, and it also brings negative effect on prognosis and life quality. However, there are no prediction models for POF, and studies of risk factors are not comprehensive. Therefore, the aim of this study is to investigate the risk factors and pick out the best prediction model for POF and to validate it. METHODS: A prospective study was conducted for patients undergoing elective gastrointestinal tumor surgery. Physiological, psychological, and socioeconomic factors were collected. Logistic regression, back-propagation artificial neural networks (BP-ANNs), and classification and regression tree (CART) were constructed and compared. RESULTS: A total of 598 patients consisting of 463 derivation sample and 135 validation sample were included. The incidence of POF in derivation sample, validation sample, and total were 58.3%, 57.0%, and 58.7%, respectively. Logistic regression results showed age, higher degree of education, lower personal monthly income, advanced cancer, hypoproteinemia, preoperative anxiety or depression, and limited social support were risk factors for POF. Receiver operating characteristic curve (ROC) and performance indices were used to test three models. BP-ANN was the best by the comparison of models, and its strong predictive performance was also validated. CONCLUSIONS: More attention should be paid on specific patients after gastrointestinal tumor surgery. BP-ANN is a powerful mathematical tool that could predict POF exactly. It may be used as a noninvasive screening tool to guide clinicians for early identification of high-risk patients and grading interventions.

Altered Static and Dynamic Brain Functional Topological Organization in Patients with Dysthyroid Optic Neuropathy.

CONTEXT: Dysthyroid optic neuropathy (DON) is a serious vision-threatening complication of thyroid-associated ophthalmopathy (TAO). Exploration of the underlying mechanisms of DON is critical for its timely clinical diagnosis. OBJECTIVE: We hypothesized that TAO patients with DON may have altered brain functional networks. We aimed to explore the alterations of static and dynamic functional connectomes in patients with and without DON using resting-state functional MRI with graph theory method. DESIGN: A cross-sectional study. SETTING: Grade A tertiary hospital. PARTICIPANTS: Sixty-six TAO patients (28 DON and 38 non-DON) and 30 healthy controls (HCs). MAIN OUTCOME MEASURES: Topological properties of functional networks. RESULTS: For static properties, DON patients exhibited lower global efficiency (Eg), local efficiency, normalized clustering coefficient, small-worldness (σ), and higher characteristic path length (Lp) than HCs. Both DON and non-DON patients exhibited varying degrees of abnormalities in nodal properties. Meanwhile, compared with non-DON, DON patients exhibited abnormalities in nodal properties in orbitofrontal cortex and visual network (VN). For dynamic properties, DON group exhibited higher variance in Eg and Lp than non-DON and HC groups. A strengthened subnetwork with VN as the core was identified in DON cohort. Significant correlations were found between network properties and clinical variables. For distinguishing DON, the combination of static and dynamic network properties exhibited optimal diagnostic performance. CONCLUSION: Functional network alterations were observed in both DON and non-DON patients, providing novel insights into the underlying neural mechanisms of disease. Functional network properties may be potential biomarkers for reflecting the progression of TAO from non-DON to DON.

Dixon MRI-based quantitative parameters of extraocular muscles, intraorbital fat, and lacrimal glands for staging thyroid-associated ophthalmopathy.

OBJECTIVE: To investigate the value of Dixon magnetic resonance imaging (MRI)-based quantitative parameters of extraocular muscles (EOMs), intraorbital fat (IF), and lacrimal glands (LGs) in staging patients with thyroid-associated ophthalmopathy (TAO). METHODS: Two hundred patients with TAO (211 active and 189 inactive eyes) who underwent Dixon MRI for pretreatment evaluation were retrospectively enrolled and divided into training (169 active and 151 inactive eyes) and validation (42 active and 38 inactive eyes) cohorts. The maximum, mean, and minimum values of the signal intensity ratio (SIR), fat fraction (FF), and water fraction (WF) of EOMs, IF, and LGs were measured and compared between the active and inactive groups in the training cohort. Binary logistic regression analysis, receiver operating characteristic curve analysis, and the Delong test were used for further statistical analyses, as appropriate. RESULTS: Compared with inactive TAOs, active TAOs demonstrated significantly greater EOM-SIRmax, EOM-SIRmean, EOM-SIRmin, IF-SIRmax, IF-SIRmean, LG-SIRmax, LG-SIRmean, EOM-WFmean, EOM-WFmin, IF-WFmax, IF-WFmean, and LG-WFmean and lower EOM-FFmax, EOM-FFmean, IF-FFmean, IF-FFmin, and LG-FFmean values (all p < 0.05). The EOM-SIRmean, LG-SIRmean, and LG-FFmean values were independently associated with active TAO (all p < 0.05). The combination of the EOM-SIRmean, LG-SIRmean, and LG-FFmean values showed better performance than the EOM-SIRmean value alone in staging TAO in both the training (AUC, 0.820 vs 0.793; p = 0.016) and validation (AUC, 0.751 vs 0.733, p = 0.341) cohorts. CONCLUSION: Dixon MRI-based parameters of EOMs, LGs, and IF are useful for differentiating active from inactive TAO. The integration of multiple parameters can further improve staging performance. CRITICAL RELEVANCE STATEMENT: In this study, the authors explored the combined value of quantitative parameters of EOMs, IF, and LGs derived from Dixon MRI in staging TAO patients, which can support the establishment of a proper therapeutic plan. KEY POINTS: The quantitative parameters of EOMs, LGs, and IF are useful for staging TAO. The EOM-SIRmean, LG-SIRmean, and LG-FFmean values were found to independently correlate with active TAO. Joint evaluation of orbital tissue improved the ability to assess TAO activity.

Comparison of five sarcopenia screening tools in preoperative patients with gastric cancer using the diagnostic criteria of the European Working Group on Sarcopenia in Older People 2.

OBJECTIVES: The aim of this study was to compare the performance of five sarcopenia screening tools in preoperative patients with gastric cancer, including strength, assistance with walking, rise from a chair, climb stairs, and falls; strength, assistance with walking, rise from a chair, climb stairs, falls, and calf circumference (SARC-CalF); Ishii score chart; short version of the mini sarcopenia risk assessment; and full version of the mini sarcopenia risk assessment. METHODS: We conducted a cross-sectional study of consecutive patients undergoing a gastrectomy between May 2020 and October 2020. Sarcopenia was diagnosed per the diagnostic criteria proposed by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Data on the five sarcopenia screening tools, patient characteristics, nutrition risk screening 2002, and diagnostic indicators of sarcopenia were collected preoperatively, and pathological characteristics of the tumor were collected postoperatively. Based on the EWGSOP2 criteria, the clinical validity of the sarcopenia tools was measured using sensitivity, specificity, and predictive value. A receiver operator characteristic curve and area under curve were applied to compare the overall screening accuracy, and a Youden index was calculated to determine the optimal cutoff value of each tool. RESULTS: We included 260 participants age 62.38 ± 11.21 y. Based on the EWGSOP2 criteria, the prevalence of sarcopenia and severe sarcopenia were 8.46% and 4.62%, respectively. Moreover, the prevalence of sarcopenia risk ranged from 3.46% to 73.85% based on the five screening tools. Of these tools, SARC-CalF had the largest area under the curve (0.896) with moderate-to-high sensitivity (86.36%) and high specificity (92.86%). For SARC-CalF, the cutoff value of 10 reached the highest Youden index, and the corresponding sensitivity and specificity were 81.82% and 93.44%, respectively. CONCLUSION: Among the above five screening tools, SARC-CalF appeared to be the optimal choice to screen sarcopenia in preoperative patients with gastric cancer.