18F-FDG PET/CT combined with CT three-dimensional reconstruction in the differentiation of benign and malignant pulmonary nodules: A retrospective cohort study / 中国胸心血管外科临床杂志

@#Objective     To investigate the accuracy of 18F-FDG positron emission tomography/computed tomography (PET/CT) combined with CT three-dimensional reconstruction (CT-3D) in the differential diagnosis of benign and malignant pulmonary nodules. Methods     The clinical data of patients who underwent pulmonary nodule surgery in the Department of Thoracic Surgery, Northern Jiangsu People's Hospital from July 2020 to August 2021 were retrospectively analyzed. The preoperative 18F-FDG PET/CT and chest enhanced CT-3D and other imaging data were extracted. The parameters with diagnostic significance were screened by the area under the receiver operating characteristic (ROC) curve (AUC). Three prediction models, including PET/CT prediction model (MOD PET), CT-3D prediction model (MOD CT-3D), and PET/CT combined CT-3D prediction model (MOD combination), were established through binary logistic regression, and the diagnostic performance of the models were validated by ROC curve. Results     A total of 125 patients were enrolled, including 57 males and 68 females, with an average age of 61.16±8.57 years. There were 46 patients with benign nodules, and 79 patients with malignant nodules. A total of 2 PET/CT parameters and 5 CT-3D parameters were extracted. Two PET/CT parameters, SUVmax≥1.5 (AUC=0.688) and abnormal uptake of hilar/mediastinal lymph node metabolism (AUC=0.671), were included in the regression model. Among the CT-3D parameters, CT value histogram peaks (AUC=0.694) and CT-3D morphology (AUC=0.652) were included in the regression model. Finally, the AUC of the MOD PET was verified to be 0.738 [95%CI (0.651, 0.824)], the sensitivity was 74.7%, and the specificity was 60.9%; the AUC of the MOD CT-3D was 0.762 [95%CI (0.677, 0.848)], the sensitivity was 51.9%, and the specificity was 87.0%; the AUC of the MOD combination was 0.857 [95%CI (0.789, 0.925)], the sensitivity was 77.2%, the specificity was 82.6%, and the differences were statistically significant (P<0.001). Conclusion     18F-FDG PET/CT combined with CT-3D can improve the diagnostic performance of pulmonary nodules, and its specificity and sensitivity are better than those of single imaging diagnosis method. The combined prediction model is of great significance for the selection of surgical timing and surgical methods for pulmonary nodules, and provides a theoretical basis for the application of artificial intelligence in the pulmonary nodule diagnosis.

Establishment of a Predictive Model for the Diagnosis of Benign and Malignant Thyroid Nodules via Multimodal Ultrasound Combined with Thyroid Hormone / 中国医学影像学杂志

Purpose To construct a benign and malignant prediction model of thyroid nodules based on ultrasound image features and clinical features,and to evaluate its diagnostic efficacy.Materials and Methods The data of 121 patients diagnosed with thyroid nodules admitted to the General Hospital of Northern Theater Command from September 2020 to March 2022 were retrospectively analyzed.Taken surgical pathology as the gold standard,there were 70 benign nodules and 51 malignant nodules.Logistic regression was used to analyze the ultrasound image characteristics and clinical data of thyroid nodules,and the characteristic indexes with statistical differences were obtained and a comprehensive prediction model was established.Results There were significant differences in the maximum diameter,morphology,calcification,capsule continuity,blood flow grade,elastography score and contrast-enhanced ultrasound characteristics between benign and malignant thyroid nodules(χ2=11.709,17.707,6.901,12.785,16.984,57.095,98.854,all P<0.05).There were significant differences in age,free thyroxine/free thyroxine ratio,and free thyroxine between the two groups(χ2/t=5.944,2.519,-2.468,all P<0.05).The sensitivity,specificity and accuracy of the clinical model,ultrasonic characteristic model and ultrasonic-clinical combined model were 55.7%,98.6%and 97.0%;72.5%,94.1%and 96.1%;and 61.9%,95.1%and 95.9%,respectively.The area under the curve of the three models were 0.619,0.991 and 0.994,respectively.The diagnostic efficiency of the ultrasonic characteristic model and the combined model was superior to the clinical model,and the difference was statistically significant(Z=-1.75,-2.25,P=0.039,0.012).The area under the curve of the combined model was greater than that of the multi-modal ultrasound model,however,the difference was not statistically significant(Z=-1.60,P=0.054).Conclusion Both the multimodal ultrasound model and the clinical model have certain diagnostic value in predicting benign and malignant thyroid nodules.The diagnostic efficiency of the multimodal ultrasound model is higher than that of the clinical model,and the combined prediction model of the two can improve the diagnostic value.

Non-alcoholic fatty liver disease related health outcomes and influencing factors among community inhabitants / 上海预防医学

ObjectiveTo describe different non-alcoholic fatty liver disease （NAFLD） outcomes among community inhabitants， and further to explore the correlation between bio-indicator level variance and the outcomes. MethodsPhysical indicators （height， weight， waist circumstances， hip circumstances， blood pressure， etc）， biochemical indicators ［fasting plasma glucose， HbA1c， serum triglycerides（TG）， serum total cholesterol（TC）， low-density lipoprotein cholesterol（LDL-C）， high-density lipoprotein cholesterol（HDL-C）， liver related transaminase， etc］ and clinical imaging （B-scan ultrasonography） were collected during the follow-up from the Songjiang Natural Population Sub-cohort. The identification of NAFLD was supported by the definition criteria from Guidelines for the diagnosis and treatment of non⁃alcoholic fatty liver disease. Paired t-test and multifactorial logistic regression model were used to compare the difference between the indicator level of the subjects from different outcome subgroups and to further analyze the correlation between these indicator variance and different NAFLD outcomes. ResultsDuring a median follow-up time of 2.94 years， 12 076 subjects were involved. The cumulative NAFLD incidence and remission rate were 21.57% and 31.15%， respectively. The proportion of subjects who still had NAFLD was 27.96%. Among subjects with newly-developed NAFLD， indicators including blood pressure， BMI， fasting plasma glucose， and plasma lipid level increased， while in the remission subgroup， blood pressure， BMI（WHR）， waist-hip ratio（WHR）， and TG level were significantly decreased. Increased level of systolic pressure， WHR， BMI， HbA1c， and LDL-C might be the risk factors to the occurrence of NAFLD. While decreased level of WHR， BMI， TC and LDL-C level and elevated HDL-C level were likely to be the influencing factors of NAFLD remission process. ConclusionThe NAFLD morbidity in the community inhabitants is relatively high. BMI， WHR， fasting plasma sugar and plama lipid level variance may act as the influencing factors towards different NAFLD outcomes.

Reflexión desde la Entropía: un análisis de la realidad según la violencia en la sociedad / Reflection from Entropy and Chaos: an analysis of reality according to violence in society / Reflexão da Entropia e Caos: uma análise da realidade de acordo com a violência na sociedade

Resumen Introducción: la teoría del caos se usa para explicación de fenómenos complejos, cuya naturaleza no responde a comportamientos lineales y que a su vez no permite determinar con exactitud medidas y cálculos, pero que a pesar de ello se han logrado avances significativos en la ciencia, pudiéndose expandir además hasta las explicaciones de fenómenos sociales, siendo en este caso la violencia. Materiales y Métodos: se emplearon expresiones matemáticas para validar un modelo de realidad que describa aproximadamente índices de violencia a partir de datos reales. Resultados: se obtuvieron relaciones matemáticas que describen el comportamiento caótico, las cuales dependiendo de la tasa de violencia define si el valor tiende a cero, a un valor constante o un comportamiento caótico. Conclusiones: se obtuvo una relación matemática que describe el comportamiento entrópico de la violencia en sociedad, cuya tendencia caótica describe aproximadamente índices de violencia reales.

Abstract Introduction: chaos theory is used to explain complex phenomena, whose nature does not respond to linear behavior and which in turn does not allow exact measurements and calculations to be determined, but despite this, significant advances have been made in science, being able to also expand to the explanations of social phenomena, in this case being violence. Materials and Methods: mathematical expressions are used to validate the reality, which describes rates of violence from real data in Colombia. Results: mathematical relationships describing chaotic behavior were obtained, which, depending on the rate of violence, define whether the value tends to zero, a constant value or chaotic behavior. Conclusions: a mathematical relationship was obtained that describes the entropic behavior of violence in society, whose chaotic trend approximately describes real violence values.

Resumo Introdução: a teoria do caos é utilizada para explicar fenômenos complexos, cuja natureza não responde ao comportamento linear e que por sua vez não permite determinar medidas e cálculos exatos, mas apesar disso, avanços significativos foram feitos na ciência, expandindo para as explicações de fenômenos sociais, neste caso a violência. Materiais e Métodos: foram utilizadas expressões matemáticas para validar um modelo de realidade que descreve aproximadamente as taxas de violência a partir de dados reais. Resultados: foram obtidas relações matemáticas que descrevem o comportamento caótico, que, dependendo da taxa de violência, definem-se o valor que tende a zero, um valor constante ou um comportamento caótico. Conclusões: obteve-se uma relação matemática que descreve o comportamento entrópico da violência na sociedade, cuja tendência caótica descreve de forma aproximada os índices reais de violência.

Cuestionario Revisado de Personalidad de Eysenck (versión reducida): análisis con la teoría de respuesta al ítem / Revised Eysenck Personality Questionnaire (Brief Version): Analysis with Item Response Theory

Resumen El objetivo de este trabajo es aportar nuevas evidencias de calidad psicométrica para la adaptación argentina de la versión reducida del Cuestionario de Personalidad de Eysenck (EPQ-RS). Participaron 1136 personas de población general (52.5% femenino, edad media = 29.6 años, DE = 11.9) residentes en Buenos Aires, Argentina. La adaptación argentina se compone de 42 ítems con formato de respuesta dicotómica. Se realizó un análisis factorial confirmatorio a partir de la matriz de correlaciones tetracóricas. Esto permitió replicar la estructura propuesta por Eysenck para el modelo PEN (Psicoticismo-Extraversión-Neuroticismo) y la escala Sinceridad. Posteriormente, se ajustó el modelo logístico de dos parámetros por separado para los ítems de cada escala. Los ítems no mostraron funcionamiento diferencial según género. La discriminación de los ítems resultó moderada-alta. Los parámetros b se localizaron en rangos acotados de cada uno de los rasgos medidos, lo que originó que la precisión de las escalas varíe en el recorrido de los continuos. La escala Neuroticismo aporta más información en niveles medios del rasgo, Psicoticismo en los medio-bajos y Extraversión en los medio-altos. La escala Sinceridad mostró una función de información relativamente plana en todo el recorrido del rasgo. Se brindan evidencias de validez basadas en la relación con otras pruebas que miden facetas del neuroticismo y sintomatología. Las evidencias de validez y confiabilidad obtenidas ofrecen garantías de calidad suficientes para la aplicación de este instrumento en el contexto local y confirman la vigencia del modelo teórico que operacionaliza el EPQ-RS.

Abstract The aim of this work is to provide new evidence of psychometric quality for the Argentinean adaptation of the brief version of the Eysenck Personality Questionnaire (EPQ-RS). 1136 people from the general population (52.5% female, mean age = 29.6 years, SD = 11.9) residing in Buenos Aires, Argentina participated. The Argentinean adaptation consists of 42 items with dichotomous response format. A confirmatory factor analysis was performed from the tetrachoric correlation matrix. This allowed replicating the structure proposed by Eysenck for the PEN model (Psychoticism - Extroversion - Neuroticism) and the Lie scale. Subsequently, the two-parameter logistic model was adjusted separately for the items of each scale. The items did not show differential functioning by gender. Items discrimination was moderate-high. Parameters b were located in narrow ranges of each one of the measured traits, which caused the precision of the scales to vary along the trait continuums. The Neuroticism scale provides more information at medium levels of the trait, Psychoticism in the medium-low and Extraversion in the medium-high. The Lie scale showed a relatively flat information function throughout the trait. Evidence of validity based on the relationship with other tests that measure facets of neuroticism and symptomatology is provided. The evidence of validity and reliability obtained offers sufficient quality guarantees for the application of this instrument in the local context and confirms topicality of the theoretical model that operationalizes the EPQ-RS.

Thirty-day Outcomes of On-Pump and Off-Pump Coronary Artery Bypass Grafting: an Analysis of a Brazilian Sample by Propensity Score Matching

Abstract Introduction: Coronary artery bypass grafting (CABG) performed with and without cardiopulmonary bypass (CPB) support has been widely discussed in the literature. However, little is known about the outcomes of those techniques in Brazil. This study aims at exploring 30-day mortality and morbidity outcomes of on- and off-pump isolated CABG in a large sample from Southern Brazil. Methods: A single-center cohort with 1,767 patients undergoing isolated CABG (January 2013 - December 2018) was initially evaluated. Patients undergoing off-pump (N=397) and on-pump (N=1,370) CABG were identified. To obtain two completely homogeneous study groups, propensity score matching was used. The paired groups were compared by descriptive and univariate analyses. Then, logistic regression was used to verify the effects of on- and off-pump CABG on 30-day mortality. Results: None of the baseline characteristics showed significant difference between the groups (P>0.05). None of the analyzed morbidity outcomes showed any difference between the groups, including acute myocardial infarction (3.0% vs. 1.5%; P=0.192), stroke (2.4% vs. 4.2%; P=0.193), and major reoperation (0.6% vs. 0.3%; P=1.000), as well as the major adverse cardiovascular and cerebrovascular events composite outcome (6.3% vs. 7.5%; P=0.541). Mortality also did not differ (1.5% vs. 2.4%; P=0.401), and CPB support was not an independent predictor of risk for 30-day mortality (odds ratio: 2.052; 95% confidence interval: 0,609-6.913; P=0.246). Conclusion: After matching by propensity analyses, similar rates of on- and off-pump 30-day mortality and other major outcomes were observed. In addition, the use of CPB support was not an independent predictor of risk for the occurrence of 30-day mortality.

Establishment of the prediction models of malignant brain edema after vascular recanalization in anterior circulation acute large vascular occlusion stroke / 国际外科学杂志

Objective:Based on Logistic regression and XGBoost algorithm, the prediction model of malignant brain edema (MBE) after vascular recanalization of anterior circulation acute great vessel occlusive stroke (ALVOS) was constructed, and the prediction performance was compared.Methods:A retrospective selection of 382 patients with anterior circulation ALVOS who underwent early endovascular treatment (EVT) in our hospital from March 2014 to June 2020 and successfully recanalized the occluded blood vessel was selected. The patients were divided into the training group ( n=267) and the test group ( n=115) according to the ratio of 7∶3 by the random number table method. According to whether the patients had MBE after successful recanalization of the occluded blood vessels, the training group was divided into the MBE group ( n=41) and non-MBE group ( n=226). The baseline data, treatment and brain computed tomography perfusion(CTP) results of MBE group and non-MBE group in training group and test group were compared respectively, including age, admission score of National Institutes of Health Stroke Scale (NIHSS), grade of cerebral collateral circulation, cerebral blood volume, and so on. Logistic regression model and XGBoost algorithm model were used to screen the predictors of MBE in ALVOS patients with occluded vessels successfully recanalized, and the discrimination and calibration of the two models were compared. The measurement data conforming to the normal distribution were expressed as mean ± standard deviation ( ± s), and the independent sample t test was used for comparison between the two groups. Non-normally distributed measurement data were represented by M ( Q1, Q3), using independent sample Mann-Whitney U test. The chi-square test was used to compare the count data between groups. Results:There was no significant difference in baseline data, treatment status, and cranial computed tomography perfusion (CTP) imaging results of the training group and the test group ( P>0.05). The age, admission systolic blood pressure, admission NIHSS score, proportion of hypertension, proportion of cerebral collateral circulation 0-2, proportion of thrombus removal times> 3 times, time from onset to recanalization, and cerebral blood volume (CBV) of MBE group were (68.95±8.04) years old, (146.71±22.73) mmHg, 17(13, 21) min, 87.80%, 82.93%, 68.29%, (365.64±87.83) min, (32.56±5.73) mL/100 g, obvious higher than the non-MBE group [(60.27±7.13) years old, (137.92±19.58) mmHg, 14(10, 18) points, 73.01%, 60.62%, 2.65%, (307.59±74.05) min, (27.49±5.46) mL/100 g] ( P<0.05). The results of Logistic regression model showed that age, NIHSS on admission, grade of cerebral collateral circulation, times of thrombectomy and time from onset to recanalization were the predictors of MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS ( P<0.05). The top five important feature scores of XGBoost algorithm model were cerebral collateral circulation classification 34, embolectomy times 27, onset to vascular recanalization time 25, admission NIHSS score 22, age 16.In the training set, the area under the curve of the Logistic regression model was 0.816(95% CI: 0.749-0.883), and the Hosmer-Lemeshow test showed that χ2=1.547, P=0.438. The area under the curve of the XGBoost algorithm model was 0.856(95% CI: 0.799-0.913), and the Hosmer-Lemeshow test showed that χ2=1.021, P=0.998. Conclusion:Logistic regression model and XGBoost algorithm model had similar prediction performance for MBE after successful recanalization of occluded vessels after EVT in patients with anterior circulation ALVOS, and collateral circulation classification, number of thrombolysis, time from onset to recanalization, NIHSS score on admission, and age could be used as predictors.

Perda potencial em anos de vida decorrente da Covid-19 nas regiões brasileiras: avaliação dos seis primeiros meses da pandemia / Potential loss in years of life arising from COVID-19 in Brazilian regions: evaluation of the six first months of pandemic / Pérdida potencial en años de vida por Covid-19 en las regiones brasileñas: evaluación de los seis primeros meses de pandemia

A presente nota de pesquisa estima o impacto das mortes por Covid-19 sobre a esperança de vida no Brasil e regiões para os primeiros seis meses de 2020. Com base nos dados do Datasus e nas tábuas de vida com decremento simples, estimou-se que as mortes por Covid-19 ocorridas até 18 de agosto de 2020 tiveram impacto estatisticamente negativo na esperança de vida ao nascer, tanto masculina (-1,05 ano) quanto feminina (-0,85 ano). Em termos regionais, a maior perda em anos de vida é estimada no Norte (-1,65 ano para homens e -1,48 ano para mulheres), enquanto o Sul foi a região com menor impacto (-0,5 ano para homens e -0,36 para mulheres). Os resultados do modelo logístico para o país apontam que a mortalidade por Covid-19 tende a ser maior entre a população com mais de 65 anos, homens, pretos e de baixa instrução. As comorbidades aumentam a chance de desfecho morte, especialmente doença hepática e renal crônica. Tais análises foram ainda desagregadas por grandes regiões brasileiras.

This research note estimates the impact of deaths by Covid-19 on life expectancy in Brazil and the Regions for the first six months of 2020. Based on data from Datasus and the decreasing life tables, it was estimated that deaths by Covid-19 that occurred until August 18, 2020 had a statistically negative impact on life expectancy at birth, both male (-1.05 years) and female (-0.85 years). In regional terms, the greatest loss in years of life is estimated in the North (-1.65 years for men and -1.48 years for women), while in the South it was -0.5 year for men and -0.36 for women. The results of the logistic model for the country show that Covid-19 mortality tends to be higher among males, blacks, people with low education level and people over 65 years old. Comorbidities increase the chance of death, especially liver disease and chronic kidney disease. Such analyzes were further disaggregated by large Brazilian regions.

Esta nota de investigación estima el impacto de las muertes por Covid-19 en la esperanza de vida en Brasil y sus regiones durante los primeros seis meses de 2020. Con base en los datos de Datasus y de las tablas de vida decrecientes, se estimó que las muertes por Covid-19 que ocurrieron hasta el 18 de agosto de 2020 tuvieron un impacto estadísticamente negativo en la esperanza de vida al nacer, tanto en hombres (−1,05 años) como en mujeres (−0,85 año). En términos regionales, la mayor pérdida en años de vida se estima en el Norte (−1,65 año para los hombres y −1,48 años para las mujeres), mientras que en el Sur fue de −0,5 años para los hombres y −0,36 para las mujeres. Los resultados del modelo logístico para el país muestran que la mortalidad por Covid-19 tiende a ser mayor entre la población mayor de 65 años, hombres, afrobrasileros y de bajo nivel educativo. Las comorbilidades aumentan la probabilidad de muerte, especialmente la enfermedad hepática y la enfermedad renal crónica. Dichos análisis se desglosaron aun más por grandes regiones brasileñas.

The Gudermannian Growth Model: Theory, Application and Statistical Analysis

Abstract: Processes producing sigmoid curves are common in many areas such as biology, agrarian sciences, demography and engineering. Several mathematical functions have been proposed for modeling sigmoid curves. Some models such as the logistic, Gompertz, Richards and Weibull are widely used. This work introduces the Gudermannian function as an option for modeling sigmoid growth curves. The original function was transformed and the resulting equation was called the "Gudermannian growth model." This model was applied to four sets of experimental growth data to illustrate its practical application. The results were compared with those obtained by the logistic and Gompertz models. Since all these models are nonlinear in the parameters, the statistical properties of the least squares estimators were evaluated using measures of nonlinearity. For each experimental data set, the Akaike's corrected information criterion was utilized to discriminate among the models. In general, the Gudermannian model fitted better to the experimental data than the logistic and Gompertz models. The results showed that the Gudermannian model can be a good alternative to the classical sigmoid models.

Predictors of in-hospital mortality by logistic regression analysis among melioidosis patients in Northern Malaysia: A retrospective study

Objective: To identify the predictors of mortality among in-hospital melioidosis patients. Methods: A total of 453 patients in Hospital Sultanah Bahiyah, Kedah, and Hospital Tuanku Fauziah, Perlis with culture-confirmed melioidosis were retrospectively included in the study. Advanced multiple logistic regression was used to obtain the final model of predictors of mortality from melioidosis. The analysis was performed using STATA/SE 14.0. Results: A total of 50.11% (227/453) of the patients died at the hospital, and a majority (86.75%, 393/453) of cases were bacteremic. The logistic regression estimated that the bacteremic type of melioidosis, low platelet count, abnormal white blood cell counts, and increased urea value were predictors of mortality. The results showed that bacteremic melioidosis increased the risk of death by 4.39 times (OR 4.39, 95% CI 1.83-10.55, P=0.001) compared to non-bacteremic melioidosis. Based on laboratory test, the adjusted ORs from the final model showed that all three blood investigations were included as the associated factors of mortality for the disease [high white blood cell (>10×109/L): OR 2.43, 95% CI 1.41-4.17, P7 800 μmol/L): OR 5.53, 95% CI 2.50-12.30, P<0.001; and low level of urea (<2 500 μmol/L): OR 3.52, 95% CI 1.71-7.23, P=0.001). Conclusions: Routine blood investigations during a hospital admission can early identify predictors of mortality in melioidosis patients.