Development and Validation of a Multivariable Predictive Model for the Risk of Histologic Chorioamnionitis in Patients with Premature Rupture of Membranes in the Late Preterm and Term.

Background: This study aimed to develop and validate a model to predict histologic chorioamnionitis (HCA) risk in late preterm and term premature rupture of membranes (PROM) patients using clinical and laboratory parameters. Methods: We conducted a retrospective study on 116 late preterm and term PROM cases, divided into a training (n=81) and a validation set (n=35). A multivariable logistic regression model was developed using the training set. Performance was assessed via the area under the receiver operating characteristic curve (AUC) and net reclassification index (NRI). Decision curve analysis (DCA) evaluated the model's clinical utility. Additionally, nomograms and a web version of the model were developed. Results: In the training set, the combined model constructed using maternal BMI, gravidity, amniotic fluid characteristics, and prenatal white blood cell (WBC) count showed significantly higher AUC than WBC alone (0.859 vs 0.710, P=0.010), with improved accuracy and sensitivity. In the validation set, the AUC of the combined model remained higher than that of WBC, but the difference was not statistically significant (0.728 vs 0.584, P=0.173). NRI analysis indicated that the combined model improved the correct classification of HCA by 25.0% (P=0.012) compared to that of WBC alone. DCA demonstrated that the combined model had a higher net benefit than WBC in most cases. The nomograms and web version of the model provided convenient tools for clinicians to predict the risk of HCA. Conclusion: This study successfully developed and validated a clinically feasible multivariable model to predict the risk of HCA in women with late preterm and term PROM.

Effect of thyrotropin suppressive therapy on lumbar bone mineral density in patients with differentiated thyroid cancer: a retrospective cohort study.

Background: To investigate the effect of thyrotropin (TSH) suppressive therapy on lumbar bone mineral density (BMD) in patients with differentiated thyroid cancer (DTC) after operation. Methods: We retrospectively analyzed 70 DTC patients at intermediate or high risk of recurrence, including 17 males, 30 premenopausal females, and 23 postmenopausal females. All patients were treated with oral 131I to clear any residual thyroid and L-thyroxine tablets to suppress TSH after surgery. The baseline and follow-up lumbar BMD were measured. The anthropometric and biochemical parameters, the doses of calcium supplement, and levothyroxine were collected. Results: Lumbar BMD in the postmenopausal female group was markedly decreased (regression coefficient: -0.201; P<0.001) compared to the male group and premenopausal female group (both: P>0.05). Further comparisons between groups found that premenopausal women had a monthly lumbar BMD reduction of 0.001 g/cm2 more than men, but the difference was not statistically significant (P=0.515). In contrast, postmenopausal women had a monthly lumbar BMD reduction of 0.004 g/cm2 more than men and 0.003 g/cm2 more than postmenopausal controls (P=0.017 and P<0.001, respectively). Lumbar BMD decreased significantly with the increasing duration of TSH suppression in both the calcium supplement group and the non-calcium supplement group (both: P<0.05), but there was no statistical difference between the two groups (P=0.534). Conclusions: The longer the duration of TSH suppression in DTC patients after operation, the more significant the decrease of BMD, especially in postmenopausal women. Furthermore, calcium supplementation did not significantly improve lumbar BMD.

Association Analysis of Insulin Resistance and Osteoporosis Risk in Chinese Patients with T2DM.

BACKGROUND: To explore the relationship between insulin resistance and osteoporosis risk in Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 234 T2DM patients were retrospectively analyzed, and their lumbar bone mineral density (BMD) and insulin resistance using C-peptide-based homeostasis model of insulin resistance [HOMA-IR (CP)] were assessed. Univariate and multivariable logistic regression methods were used to evaluate the association between HOMA-IR (CP) and osteoporosis, and subgroup analysis was performed on female and male patients. RESULTS: After fully adjusting the covariates, the association between HOMA-IR (CP) and osteoporosis was only significant in female patients (P = 0.022); the interaction effect with gender was significant (P for interaction <0.05). Curve fitting showed that the relationship between HOMA-IR (CP) and osteoporosis in women was nonlinear. When HOMA-IR (CP) is <4.00, its effect on osteoporosis was not significant (P = 0.474); when HOMA-IR (CP) is >4.00, the risk of osteoporosis increased significantly, with OR = 26.88 (95% CI: 2.75-262.69, P = 0.005). The relationship between insulin resistance and osteoporosis risk in T2DM patients is significantly affected by gender. CONCLUSION: The higher the degree of insulin resistance in female patients, the greater the risk of osteoporosis, but the two are not linearly associated.

Uncovering and quantifying the subduction zone sulfur cycle from the slab perspective.

Sulfur belongs among H2O, CO2, and Cl as one of the key volatiles in Earth's chemical cycles. High oxygen fugacity, sulfur concentration, and δ34S values in volcanic arc rocks have been attributed to significant sulfate addition by slab fluids. However, sulfur speciation, flux, and isotope composition in slab-dehydrated fluids remain unclear. Here, we use high-pressure rocks and enclosed veins to provide direct constraints on subduction zone sulfur recycling for a typical oceanic lithosphere. Textural and thermodynamic evidence indicates the predominance of reduced sulfur species in slab fluids; those derived from metasediments, altered oceanic crust, and serpentinite have δ34S values of approximately -8‰, -1‰, and +8‰, respectively. Mass-balance calculations demonstrate that 6.4% (up to 20% maximum) of total subducted sulfur is released between 30-230 km depth, and the predominant sulfur loss takes place at 70-100 km with a net δ34S composition of -2.5 ± 3‰. We conclude that modest slab-to-wedge sulfur transport occurs, but that slab-derived fluids provide negligible sulfate to oxidize the sub-arc mantle and cannot deliver 34S-enriched sulfur to produce the positive δ34S signature in arc settings. Most sulfur has negative δ34S and is subducted into the deep mantle, which could cause a long-term increase in the δ34S of Earth surface reservoirs.

Garnet U-Pb and O isotopic determinations reveal a shear-zone induced hydrothermal system.

The absolute crystallization ages of minerals from hydrothermal fluids measured in situ can unravel the timing of key events leading to the formation of, for instance, ore deposits and hydrothermally derived geological terrains. In this study, a skarn iron deposit from northwest (NW) China is shown to have U-Pb garnet and U-Pb zircon ages of 254.2 ± 1.7 Ma and 255.5 ± 1.0 Ma, respectively, which are both significantly younger than magmatism and metamorphism of the region. This skarn age instead correlates with the occurrence of strike-slip and thrust faulting in the region. The water/rock mass ratio of 0.065~0.115 suggests the δ18O garnet composition is ~1‰ at temperatures ranging from 250-450 °C. The low oxygen isotopic composition indicates the role of meteoric water in the garnet formation. These measurements can be interpreted as the shear along faults circulating meteoric water ~10 km below the hanging wall of meta-volcanic sedimentary rock. Meteoric water in this hydrothermal system would leach cations from the meta-volcano-sedimentary rocks necessary for mineralization. Silica-rich hydrothermal fluid reacts with calcic-rich materials in the meta-volcano-sedimentary rocks, depositing the garnet and magnetite. Our work suggests that the shear zone is rich in ores, rendering this deposit for NW China a prospective source for future mineral resource exploration.

Predictive value of procalcitonin for infection of patients with type-2 diabetes mellitus.

The aim of the present study was to investigate the predictive value of procalcitonin (PCT) for infection in patients with type 2 diabetes mellitus (T2DM). A retrospective analysis of 178 patients with T2DM who were divided into non-infection, local infection and sepsis groups was conducted; in conjunction with 33 healthy control patients. Clinicopathological characteristics and inflammatory indicators were compared between the four groups. Patients in the non-infection group exhibited significantly higher PCT levels compared with healthy controls (P=0.002). In addition, PCT, C-reactive protein (CRP), white blood cell count and neutrophil percent were significantly different amongst patients with T2MD across different infection groups (all P<0.001) with the following rank order: Sepsis group > local infection group > non-infection group (all P<0.05). In addition, the following observations were made: i) PCT and CRP demonstrated larger areas under the curve (AUC) for predicting local infection (0.804 and 0.741, respectively); ii) PCT displayed lower sensitivity of only 21.8% at its classical cutoff value (0.500 ng/ml) whereas CRP exhibited higher sensitivity and specificity at 64.1 and 76.1%, respectively, at its classical cutoff value (10.0 mg/l); and iii) PCT exhibited the largest AUC (0.914) for predicting sepsis with high sensitivity and specificity (86.4 and 84.5%, respectively) at its cutoff value (0.990 ng/ml). Patients with T2DM without infection demonstrated higher baseline PCT levels. The present study clarified the value of PCT in predicting infection of T2DM patients. The application of PCT to predict local infection in patients with T2DM was identified to be inferior to CRP, but its ability to predict sepsis was concluded to be the best when compared with CRP, white blood cell count and neutrophil percent.