COH outcomes in breast cancer patients for fertility preservation: a comparison with the expected response by age

PurposeBreast cancer is the most common cancer diagnosed during childbearing age, and fertility preservation is becoming increasingly more essential. However, recent studies indicate a possible poorer response to controlled ovarian hyperstimulation (COH) in cancer patients than in non-cancer controls and a negative impact of BRCA mutations on female fertility. This study aims to evaluate ovarian response and the number of mature oocytes (MII) vitrified in women with breast cancer, with or without BRCA mutation, comparing them to the expected response according to an age-related nomogram.MethodsThis is a retrospective observational study involving sixty-one breast cancer patients who underwent COH for oocyte cryopreservation. The age-specific nomogram was built using 3871 patients who underwent COH due to oocyte donation, fertility preservation for non-medical reasons, or FIVET for male factor exclusively.ResultsThe mean number of oocytes retrieved was 13.03, whereas the mean number of MII oocytes was 10.00. After the application of the z-score, no statistically significant differences were found compared with the expected response in the general population, neither by dividing patients according to the presence or absence of BRCA mutation nor according to the phase in which they initiated stimulation.ConclusionThe results obtained do not support the notion of a negative impact of the BRCA mutation on the ovarian response of women with breast cancer. Women with breast cancer undergoing COH for fertility preservation can expect the ovarian response predicted for their age.     

Individual prediction of lateral neck metastasis risk in patients with unifocal papillary thyroid carcinoma

IntroductionMuch controversy exists over whether to perform lateral neck dissection (LND) on patients with papillary thyroid carcinoma (PTC). This study aimed to build predictive nomograms that could individually estimate lateral neck metastasis (LNM) risk and help determine follow up intensity.Patients and methodsUnifocal PTC patients who underwent LND between April 2012 and August 2014 were identified. Clinical and pathological variables were retrospectively evaluated using univariate and stepwise multivariate logistic regression analysis. Variables that had statistical significance in final multivariate logistic models were chosen to build nomograms, which were further corrected using the bootstrap resampling method.ResultsIn all, 505 PTC patients were eligible for analysis. Among these, 178 patients (35.2%) had lateral neck metastasis. Two nomograms were generated: nomogram (c) and nomogram (c + p). Nomogram (c) incorporated four clinical variables: age, tumor size, tumor site, and extrathyroidal extension (ETE). It had a good discriminative ability, with a C-index of 0.79 (bootstrap-corrected, 0.78). Nomogram (c + p) incorporated two clinical variables and two pathological variables: tumor size, tumor site, extranodal extension (ENE), and number of positive nodes in the central compartment. Nomogram (c + p) showed an excellent discriminative ability, with a C-index of 0.86 (bootstrap-corrected, 0.85).ConclusionTwo predictive nomograms were generated. Nomogram (c) is a clinical model, whereas nomogram (c + p) is a clinicopathological model. Each nomogram incorporates only four variables and can give an accurate estimate of LNM risk in unifocal PTC patients, which may assist clinicians in patient counseling and decision making regarding LND.     

A Novel Nomogram to Identify Candidates for Extended Pelvic Lymph Node Dissection Among Patients with Clinically Localized Prostate Cancer Diagnosed with Magnetic Resonance Imaging-targeted and Systematic Biopsies

Background

Available models for predicting lymph node invasion (LNI) in prostate cancer (PCa) patients undergoing radical prostatectomy (RP) might not be applicable to men diagnosed via magnetic resonance imaging (MRI)-targeted biopsies.

Learning,habituation, and training

Summary The apparent efficiency of sub-maximum exercise tends to be lower in subjects with a large aerobic power. This is probably an artefact arising from neglect of the oxygen debt in the calculation of mechanical efficiency. Changes in the extent of oxygen debt can obscure an increased skill of performance with training. Efficiency is improved by repetition of a given mode of exercise, but not by other forms of training. Habituation is greater during work than at rest, but even during work the change in pulse rate of young men does not exceed 2–5 beats/min over 5 experimental days. Habituation is lost if the test procedure is not repeated during training; this can complicate assessments of training from the response to sub-maximum exercise.     

中学生抑郁症状的影响因素分析

目的 探讨中学生出现抑郁症状的影响因素,建立风险预测的列线图模型,为防控中学生抑郁提供理论依据。方法 采用分层整群抽样的方法,抽取大连市城市和农村中学生共3 470名,使用学生健康行为调查表及抑郁量表进行问卷调查;采用多因素logistic回归分析抑郁症状的影响因素,并建立列线图,预测中学生出现抑郁症状的风险。 结果 中学生的抑郁症状检出率为24.12%,肯定有抑郁症状的检出率为16.22%。遭受校园欺凌（OR = 2.748,95%CI:2.257～3.346）、被家长打骂（OR = 2.025,95%CI:1.679～2.433）、学段（职高:OR = 1.883,95%CI:1.286～2.758;高中:OR = 1.242,95%CI:1.001～1.541）、上网时间越长（≥3 h:OR = 1.773,95%CI:1.366～2.302;2～＜3 h:OR = 1.525,95%CI:1.190～1.954）、女生（OR = 1.352,95%CI:1.141～1.603）、农村地区（OR = 1.351,95%CI:1.126～1.622）均是中学生抑郁症状检出的危险因素;体育课时数多（2 节:OR = 0.685,95%CI:0.504～0.931;≥3 节:OR = 0.583,95%CI:0.425～0.799）、睡眠时间充足（OR = 0.676,95%CI:0.562～0.812）都是中学生抑郁症状检出的保护因素;基于以上影响因素建立的列线图模型具有较好的区分度（一致性指数C - index = 0.700,95%CI:0.680～0.721）和准确度（Hosmer - Lemeshow检验χ2 = 2.885,P = 0.941）。 结论 遭受校园欺凌、被家长打骂、职高或高中、上网时间越长、女生、来自农村地区、体育课时数少、睡眠时间不足的中学生更容易出现抑郁症状,可以利用列线图直观、有效地预测中学生出现抑郁症状的风险,从而有针对性地对高危群体及时采取干预措施。     

新型冠状病毒肺炎患者死亡风险列线图模型的构建与验证

目的构建列线图模型以预测新型冠状病毒病2019(COVID-19)的死亡风险,以早期筛选死亡高危患者。 方法收集2020年1月至2020年4月武汉大学人民医院(东院)和2022年4月至2022年5月上海市第九人民医院(北院)收治COVID-19患者的临床资料。以武汉大学人民医院患者(166例)作为训练集,上海市第九人民医院患者(52例)作为验证集。采用先单因素后多因素Logistic回归分析确定死亡的独立危险因素,应用R语言构建列线图模型。采用受试者工作特征曲线(ROC)、C指数及校准曲线评估列线图模型的预测准确性及判断能力,决策曲线分析评估模型的临床应用价值。通过验证集对模型进行外部验证。 结果本研究共纳入重型/危重型COVID-19患者218例,其中67例(30.73%)死亡,多因素Logistic回归分析显示,≥3种基础疾病、APACHE Ⅱ评分(5~40分)、中性粒细胞/淋巴细胞(0~90)、乳酸(0~16mmol/L)均是死亡的独立危险因素。ROC曲线分析显示,训练集的曲线下面积(AUC)为0.869(95%CI：0.811~0.927),验证集AUC为0.797(95%CI：0.671~0.924),训练集与验证集校准曲线经Hosmer-Lemeshow拟合优度检验(P＝0.473,P＝0.421)。临床决策曲线分析表明,该列线图预测模型的临床应用价值高。 结论本研究构建COVID-19患者死亡风险列线图模型预测效能良好,可个体化、可视化、图形化预测,有助于医师早期做出合适临床决策及诊疗。     

Explorations on risk profiles for overweight and obesity in 9501 preschool-aged children

BackgroundChildhood obesity places a major burden on global public health. We aimed to identify and characterize potential factors, both individually and jointly, in association with overweight and obesity in Chinese preschool-aged children.MethodsWe cross-sectionally recruited 9501 preschool-aged children from 30 kindergartens in Beijing and Tangshan. Overweight and obesity are defined according to the World Health Organization (WHO), International Obesity Task Force (IOTF), and China criteria.ResultsAfter multivariable adjustment, eating speed, sleep duration, birthweight, and paternal body mass index (BMI) were consistently and significantly associated with childhood overweight and obesity under three growth criteria at a significance level of 5%. Additional fast food intake frequency, maternal BMI, gestational weight gain (GWG) and maternal pre-pregnancy BMI were significant factors for overweight (WHO criteria) and obesity (both IOTF and China criteria). Importantly, there were significant interactions between parental obesity and eating speed for childhood obesity. Finally, for practical reasons, risk nomogram models were constructed for childhood overweight and obesity based on significant factors under each criterion, with good prediction accuracy.ConclusionOur findings indicated a synergistic association of lifestyle, fetal and neonatal, and family-related factors with the risk of experiencing overweight and obesity among preschool-aged children.     

结直肠间质瘤临床病理特征及预后分析

目的 探究结直肠间质瘤预后相关因素,并通过列线图预测该肿瘤生存概率,为指导临床评估预后提供依据.方法: 通过监测流行病学和最终结果(surveillance, epidemiology, and end results, SEER)数据库获取1992年1月至2015年12月结直肠间质瘤临床病理及预后相关资料,对入组患者进行生存分析,将分析得到的独立预后因素绘制成列线图,之后采用校准曲线评估列线图预测生存准确性.结果: 546例结直肠间质瘤患者被纳入研究.中位发病年龄64岁,区域淋巴结转移率9.4%.546例患者多因素生存分析显示发病年龄 > 64岁,未婚/离婚,结肠间质瘤(与直肠间质瘤相比),非手术治疗,组织分化级别高,区域淋巴结转移及远处转移具有更差的肿瘤特异性生存和总生存(P均<0.05), 美国东部地区诊治患者比西部地区患者具有更长的总生存时间(P = 0.027),以上独立预后因素预测肿瘤特异性生存率和总生存率的C指数分别为0.76(95%CI: 0.72-0.80)和0.75(95%CI: 0.72-0.78).在174例组织分化级别和肿瘤部位明确的患者中,影响肿瘤特异性生存和总生存的独立预后因素为年龄,组织分化级别和是否行手术治疗(P均<0.05),而肿瘤部位仅与肿瘤特异性生存显著相关(P = 0.041),未证实与总生存显著相关(P = 0.057),采用这4个预后影响因素预测546例患者肿瘤特异性生存率和总生存率的C指数分别是0.71(95%CI: 0.66-0.75)和0.73(95%CI: 0.70-0.77), 能较准确预测结直肠间质瘤患者总生存率.结论: 结直肠间质瘤预后受多个临床病理因素影响,列线图能为预测结直肠间质瘤患者生存率提供依据.     

Experiences with a compound method for estimating the time since death.

The temperature-based nomogram method for estimation of the time period since death was used at the scene of death as the primary method within a compound method in 72 consecutive cases. The situation and cooling conditions inspected and evaluated by the forensic pathologist at the scene are described as far as necessary to enable handling of the method. A comparison of the estimated period since death with the period determined by the police investigations demonstrates the reliability of the method. There were no contradictions in any of the 60 cases between the period of death estimated by this method and that determined by the police investigations. The criminal investigations were effectively supported in the earliest stages in 11 cases despite the fact that the period estimated was of considerable duration.     

Survival prediction and conditional survival of primary central nervous system lymphoma: A population-based study

BackgroundPrimary central nervous system lymphoma is a rare and highly aggressive type of non-Hodgkin lymphoma. This study used population-based data to evaluate the clinical characteristics and prognostic factors of primary central nervous system lymphoma and develop a prediction model to estimate survival.MethodsPatients’ data were extracted from the Surveillance, Epidemiology, and End Results database. Significant prognostic factors were identified using univariate and multivariate Cox regression analyses. Conditional survival estimates were calculated as CS(x y) = S(x + y)/S(X), and a nomogram was built to predict patient prognosis.ResultsIn total, 2563 patients with primary central nervous system lymphoma were included. Multivariate Cox analysis showed that age at diagnosis, sex, histology, tumor site, surgery, chemotherapy, and marital status were independent prognostic factors of overall survival. The 1-year conditional survival increased with time, and our nomogram model showed favorable discriminative ability.ConclusionAt the population level, our study found that gross total resection and chemotherapy improved the prognosis of patients with primary central nervous system lymphoma. However, the prognosis of black patients was poor. Conditional survival provided a more accurate and dynamic survival estimate. Moreover, our nomogram had a good performance and could help predict the overall survival of these patients.