Development of a risk assessment scale for perinatal venous thromboembolism in Chinese women using a Delphi-AHP approach.

BACKGROUND: The treatment and prevention of perinatal venous thromboembolism (VTE) are challenging because of the potential for both fetal and maternal complications. METHODS: This study developed a rapid assessment scale for VTE and evaluate its validity based on Delphi-AHP (Analytic Hierarchy Process) method in China. The research was conducted by literature retrieval and two rounds of Delphi expert consultation. The item pools of the scale were developed and a questionnaire was designed according to literature retrieval published between 2010 and 2020. A survey was conducted among experts from 25 level A hospitals in China, and data of experts' opinions were collected and analyzed by the Delphi method. RESULTS: A perinatal VTE risk assessment scale was formed, including 5 first-level items, 20 s-level items and 40 third-level items. The response rates in the two rounds of expert consultation were 97.4% and 98.0%, and the authoritative coefficients were 0.89 and 0.92. The coefficients of variation ranged from 0.04 to 0.28. CONCLUSIONS: The scale is significantly valid and reliable with a high authority and coordination degree, and it can be used to assess the risk of perinatal VTE and initiate appropriate thrombophylactic interventions in China.

Adaptation responses in C4 photosynthesis of sweet maize (Zea mays L.) exposed to nicosulfuron.

Nicosulfuron is an ingredient in photosynthesis-inhibiting herbicides and has been widely used in corn post-emergence weed control. In the current study, a pair of sister lines, HK301 (nicosulfuron-tolerence, NT) and HK320 (nicosulfuron-sensitive, NS), was used to study the effect of nicosulfuron in sweet maize seedlings on C4 photosynthetic enzymes and non-enzymatic substances, expression levels of key enzymes, and chloroplast structure. Nicosulfuron was sprayed at the four-leaf stage, and water was sprayed as a control. After nicosulfuron treatment, phosphoenolpyruvate carboxylase (PEPC), NADP-malic dehydrogenase (NADP-MDH), NADP-malic enzyme (NADP-ME), pyruvate orthophosphate dikinase (PPDK), and ribulose-1,5-bisphosphate carboxylase/oxygenase (Rubisco) activities of NT were significantly higher than those of NS. Compared to NT, malate, oxaloacetic acid, and pyruvic acid significantly decreased as exposure time increased in NS. Compared to NS, nicosulfuron treatment significantly increased the expression levels of PEPC, NADP-MDH, NADP-ME, PPDK, and Rubisco genes in NT. Under nicosulfuron treatment, chloroplast ultrastructure of NS, compared to that of NT, nicosulfuron induced swelling of the chloroplast volume and reduced starch granules in NS. In general, our results indicate that in different resistant sweet maize, C4 photosynthetic enzymes activity and key genes expression play a critical role in enhancing the adaptability of plants to nicosulfuron stress at a photosynthetic physiological level.

Comparison of 2013 and 2009 versions of Caprini risk assessment models for predicting VTE in Chinese cancer patients: a retrospective study.

This study aimed to compare the predictive value of 2009 and 2013 version of Caprini risk assessment models (RAM) for venous thromboembolism (VTE) in cancer patients by receiver operating characteristic (ROC) analysis. This retrospective study reviewed a total of 1439 VTE and 1439 non-VTE Chinese cancer inpatients. The baseline demographic data of these patients were recorded. 2009 and 2013 versions Caprini RAMs were applied, and cumulative risk scores were obtained by adding the scores of each risk factor. The specificity, sensitivity, positive predictive value and negative predictive value of these two models were analyzed. ROC curve was drawn to calculate the area under the curve (AUC) and the Youden index. Significant differences were observed in the risk factors between VTE and non-VTE Group. The specificity and negative predictive value of 2013 version were higher than those of 2009 version (P < 0.05). No significant differences were found in the sensitivity or positive predictive value between 2009 and 2013 versions of the Caprini RAM (P > 0.05). The AUC and Youden index of 2013 Caprini RAM were significantly higher than those of 2009 Caprini RAM (P < 0.001), whereas the Youden index of the 2009 Caprini RAM at critical point 4 was higher than that at critical point 3 (0.362 vs 0.067, P < 0.05). Compared with 2009 version, 2013 version of the Caprini RAM provides a more accurate and efficacious method for the risk assessment of VTE in Chinese cancer patients.

Genome-wide identification of AAAP gene family and expression analysis in response to saline-alkali stress in foxtail millet (Setaria italica L.).

Amino acid/auxin permease (AAAP) genes encode a large family of protein transporters that play important roles in various aspects of plant growth and development. Here, we performed genome-wide identification of members in the foxtail millet (Setaria italica L.) AAAP family (SiAAAP) and their saline-alkali stress-induced expression patterns, resulting in the identification of 65 SiAAAP genes, which could be divided into eight subfamilies. Except for SiAAAP65, the remaining 64 genes were located on nine chromosomes of foxtail millet. Gene structure and conserved motif analyses indicated that the members in the same subfamily are highly conserved. Gene duplication event analysis suggested that tandem duplication may be the main factor driving the expansion of this gene family, and Ka/Ks analysis indicated that all the duplicated genes have undergone purifying selection. Transcriptome analysis showed differential expression of SiAAAPs in roots, stems, leaves, and tassel inflorescence. Analysis of cis-acting elements in the promoter indicated that SiAAAPs contain stress-responsive cis-acting elements. Under saline-alkali stress, qRT-PCR analysis showed that SiAAP3, SiLHT2, and SiAAP16 were differentially expressed between salt-alkali tolerant millet variety JK3 and salt-alkali sensitive millet variety B175. These results suggest that these genes may be involved in or regulate the response to saline-alkali stress, providing a theoretical basis for further studying the function of SiAAAPs.

In Patients With Low- to Intermediate-Risk Thyroid Cancer, a Preablative Thyrotropin Level of 30 µIU/mL Is Not Adequate to Achieve Better Response to 131I Therapy.

PURPOSE: The optimal preablative level of thyrotropin (TSH) for patients with differentiated thyroid cancer (DTC) to achieve better response after I ablation remains unknown. The objective of this study was to assess whether a higher preablative TSH level above 30 µIU/mL is associated with better response to I therapy in low- to intermediate-risk DTC and to explore the potential factors that may impact their responses. PATIENTS AND METHODS: A total of 204 consecutive non-high-risk patients were retrospectively reviewed. Serum TSH and thyroglobulin (Tg) levels were measured right before I treatment after thyroxine hormone withdrawal (THW). Patients were categorized by their preablative TSH level grouping of 30 to less than 60 (n = 11), 60 to less than 90 (n = 61), 90 to less than 120 (n = 56), 120 to less than 150 (n = 33), and 150 µIU/mL or greater (n = 43). Responses to I therapy were evaluated as excellent, indeterminate, biochemical incomplete, or structural incomplete response (ER, IDR, BIR, or SIR) after a mean follow-up of 20.3 months. Initial risk factors (age, sex, T and N status by AJCC/UICC TNM staging system, and thyroid remnant), the administered dose of I and response to I therapy were compared among different preablative TSH groups. Multivariate analysis was further performed to identify factors associated with incomplete response (IR, including BIR and SIR). RESULTS: Except the significant correlation between younger age and higher preablative TSH level (P = 0.001), the 5 TSH groups did not differ in other related prognostic factors or dose of I (all P > 0.05). Among each ascending TSH group, ER was observed in 54.5%, 68.9%, 73.2%, 69.7%, and 60.5%, respectively, whereas IR was observed in 18.2%, 18.0%, 7.1%, 9.1%, and 20.9%, respectively. Group 90 to less than 120 µIU/mL presented the highest rate of ER and lowest rate of IR. In the multivariate analysis, preablative TSH level, in addition to preablative Tg, was also an associated factor for response to I therapy (P = 0.048). CONCLUSIONS: A preablative TSH level of 90 to less than 120 µIU/mL might be more appropriate for patients with low- to intermediate-risk DTC to achieve better response to I therapy.

Value of serial preablative thyroglobulin measurements: can we address the impact of thyroid remnants?

OBJECTIVE: Preablative stimulated thyroglobulin (ps-Tg) is somewhat nonspecific when used as a predictive marker for distant metastases (DM) from differentiated thyroid carcinoma because of the impact of residual tissue postsurgery. The aim of this study was to explore the potential value of serial ps-Tg measurements and assess the clinical value of these measurements in the context of thyroid remnants. MATERIALS AND METHODS: A total of 370 consecutive differentiated thyroid carcinoma patients with serial measurements of ps-Tg, thyrotropin (TSH), and anti-Tg antibody before radioactive iodine ablation were included in the study. Patients were divided into those with DM (n=76) and non-DM with no remnant thyroid (NRT, n=53), moderate remnant thyroid (MRT, n=206), and overt remnant thyroid (ORT, n=35) on the basis of uptake in the thyroid bed on the whole-body I scan. The initial ps-Tg and the last one collected immediately before radioactive iodine ablation were marked as Tg1 and Tg2, respectively, with a median interval of 8 days. The change was marked as ΔTg. The same was applied for serum TSH values. Both single parameters (Tg1, Tg2) and ΔTg were compared among different groups. The velocity of ps-Tg change as well as ΔTg/ΔTSH was also used to alleviate the impact of time and TSH levels on ps-Tg. RESULTS: Patients with ORT presented with significantly higher single ps-Tg values than those with MRT and NRT (both P<0.01), with the highest initial Tg value of 194.4 ng/ml, which was higher than most patients with DM (median: 104.3 ng/ml). However, no differences were observed among ORT, MRT, and NRT when ΔTg, velocity of ps-Tg change, or ΔTg/ΔTSH was used as an index (both P>0.05), which implies that the change parameters can be used as predictors of DM involvement even in the context of significant residual thyroid tissue. CONCLUSION: In comparison with a single ps-Tg measurement, changes in ps-Tg values even over as short an interval as 8 days can provide clinical guidance for possible metastatic involvement even in the context of significant thyroid remnant tissue.

Serum thyrotropin level of 30 µIU/mL is inadequate for preablative thyroglobulin to serve as a prognostic marker for differentiated thyroid cancer.

PURPOSE: Preablative-stimulated thyroglobulin (ps-Tg) has manifested its potential for predicting prognosis in patients with differentiated thyroid carcinoma (DTC), but its level can be affected by thyrotropin (TSH). The objective of this study was to evaluate the utility of ps-Tg in predicting individual response after radioactive iodine (RAI) therapy, and further explore the appropriate TSH level for ps-Tg to serve as a prognostic marker in DTC without initial distant metastasis (DM). METHODS: A total of 208 consecutive non-DM DTC patients with serial ps-Tg, TSH, and anti-Tg antibody (TgAb) measured simultaneously were enrolled. The initial and last measurements of ps-Tg were marked as Tg1 and Tg2, respectively, with a median interval of 8 days, so does TSH. Clinical response was retrospectively evaluated as excellent, indeterminate, biochemical incomplete, or structural incomplete response (ER, IDR, BIR, or SIR) after a mean follow-up of 21.5 months. Tg1 and Tg2 were tested and compared for their performances in predicting ER and incomplete response (IR, including BIR and SIR) by receiver operating characteristic (ROC) curve analysis. The 416 ps-Tg levels (Tg1 and Tg2) were then categorized by their corresponding TSH grouping of 30-<60 (n = 100), 60-<90 (n = 131), 90-<120 (n = 99), and ≥120 µIU/mL (n = 86), and the predictive performances were further compared among TSH groups. RESULTS: Tg2, with a higher corresponding TSH level than Tg1 (median: 104.763 vs. 65.046 µIU/mL), presented higher area under the ROC curve (AUC) in predicting both ER and IR (ER: 0.889 vs. 0.836, P = 0.003; IR: 0.925 vs. 0.869, P = 0.046). The performances of ps-Tg in predicting ER and IR were both improved significantly as TSH rose from 30-<60 to 60-<90 µIU/mL, with an increase in AUC from 0.810 to 0.888 in predicting ER (P = 0.006) and from 0811 to 0.937 in predicting IR (P = 0.014), respectively. However, this kind of benefit was not further enlarged as TSH rose from 60-<90 to 90-<120 µIU/mL (both P > 0.05). CONCLUSION: In comparison with the TSH context of 30 µIU/mL, a higher preablative TSH level of 60-<90 µIU/mL might be more appropriate for ps-Tg to serve as a prognostic marker for DTC.