Scoring System to Evaluate Risk of Nonoperative Management Failure in Children With Intussusception.

INTRODUCTION: Typical first-line management of children with intussusception is enema reduction; however, failure necessitates surgical intervention. The number of attempts varies by clinician, and predictors of failed nonoperative management are not routinely considered in practice. The purpose of this study is to create a scoring system that predicts risk of nonoperative failure and need for surgical intervention. METHODS: Children diagnosed with intussusception upon presentation to the emergency department of a tertiary children's hospital between 2019 and 2022 were retrospectively identified. Univariable logistic regression identified predictors of nonoperative failure used as starting covariates for multivariable logistic regression with final model determined by backwards elimination. Regression coefficients for final predictors were used to create the scoring system and optimal cut-points were delineated. RESULTS: We identified 143 instances of ultrasound-documented intussusception of which 28 (19.6%) required operative intervention. Predictors of failed nonoperative management included age ≥4 y (odds ratio [OR] 32.83, 95% confidence interval [CI]: 1.91-564.23), ≥1 failed enema reduction attempts (OR 189.53, 95% CI: 19.07-1884.11), presenting heart rate ≥128 (OR 3.38, 95% CI: 0.74-15.36), presenting systolic blood pressure ≥115 mmHg (OR 6.59, 95% CI: 0.93-46.66), and trapped fluid between intussuscepted loops on ultrasound (OR 17.54, 95% CI: 0.77-397.51). Employing these factors, a novel risk scoring system was developed (area under the curve 0.96, 95% CI: 0.93-0.99). Scores range from 0 to 8; ≤2 have low (1.1%), 3-4 moderate (50.0%), and ≥5 high (100%) failure risk. CONCLUSIONS: Using known risk factors for enema failure, we produced a risk scoring system with outstanding discriminate ability for children with intussusception necessitating surgical intervention. Prospective validation is warranted prior to clinical integration.

Evaluating diagnostic significance: The utilization of elastography and contrast-enhanced ultrasound for differential diagnosis in breast lesions.

OBJECTIVE: The primary aim of this study is to assess the diagnostic efficacy of elastography and contrast-enhanced ultrasound (CEUS) in the identification of breast lesions subsequent to the optimization and correction of the BI-RADS category 4 classification obtained through conventional ultrasound. The objective is to augment both the specificity and accuracy of breast lesion diagnosis, thereby establishing a reliable framework for reducing unnecessary biopsies in clinical settings. METHODS: A cohort comprising 50 cases of breast lesions classified under BI-RADS category 4 was collected during the period from November 2022 and November 2023. These cases were examined utilizing strain elastography (SE), shear wave elastography (SWE), and CEUS. Novel scoring methodologies for ultrasonic elastography (UE) and CEUS were formulated for this investigation. Subsequently, the developed UE and CEUS scoring systems were used to refine and optimize the conventional BI-RADS classification, either in isolation or in conjunction. Based on the revised classification, the benign group was classified as category 3 and the suspected malignant group was classified as category 4a and above, with pathological results serving as the definitive reference standard. The diagnostic efficacy of the optimized UE and CEUS, both independently and in combination, was meticulously scrutinized and compared using receiver operating characteristic (ROC) curve analysis, with pathological findings as the reference standard. RESULTS: Within the study group, malignancy manifested in 11 cases. Prior to the implementation of the optimization criteria, 78% (39 out of 50) of patients underwent biopsies deemed unnecessary. Following the application of optimization criteria, specifically a threshold of≥8.5 points for the UE scoring method and≥6.5 points for the CEUS scoring method, the incidence of unnecessary biopsies diminished significantly. Reduction rates were observed at 53.8% (21 out of 39) with the UE protocol, 56.4% (22 out of 39) with the CEUS protocol, and 89.7% (35 out of 39) with the combined UE and CEUS optimization protocols. CONCLUSION: The diagnostic efficacy of conventional ultrasound BI-RADS category 4 classification for breast lesions is enhanced following optimized correction using UE and CEUS, either independently or in conjunction. The application of the combined protocol demonstrates a notable reduction in the incidence of unnecessary biopsies.

GSScore: a novel Graphormer-based shell-like scoring method for protein-ligand docking.

Protein-ligand interactions (PLIs) are essential for cellular activities and drug discovery. But due to the complexity and high cost of experimental methods, there is a great demand for computational approaches to recognize PLI patterns, such as protein-ligand docking. In recent years, more and more models based on machine learning have been developed to directly predict the root mean square deviation (RMSD) of a ligand docking pose with reference to its native binding pose. However, new scoring methods are pressingly needed in methodology for more accurate RMSD prediction. We present a new deep learning-based scoring method for RMSD prediction of protein-ligand docking poses based on a Graphormer method and Shell-like graph architecture, named GSScore. To recognize near-native conformations from a set of poses, GSScore takes atoms as nodes and then establishes the docking interface of protein-ligand into multiple bipartite graphs within different shell ranges. Benefiting from the Graphormer and Shell-like graph architecture, GSScore can effectively capture the subtle differences between energetically favorable near-native conformations and unfavorable non-native poses without extra information. GSScore was extensively evaluated on diverse test sets including a subset of PDBBind version 2019, CASF2016 as well as DUD-E, and obtained significant improvements over existing methods in terms of RMSE, $R$ (Pearson correlation coefficient), Spearman correlation coefficient and Docking power.

Pharmacy Workload in Clinical Trial Management: A Preliminary Complexity Assessment Tool for Sponsored Oncology and Haematology Trials.

Investigational drug services need to be organised in a structured approach, especially for sites with a large number of ongoing clinical trials. The aim of this study was to develop a tool to assess the complexity of pharmacy involvement in a sponsored oncology clinical trial. Categorisation into ordinal complexity categories was used to assess the complexity of the clinical trials for consistent pharmacy grant applications. The 15 items of the tool were divided into three sections, and individual item scores were agreed upon among four pharmacists with experience in the conduct of clinical trials at two different centres. A final version of the tool, named Pharm-CAT, was approved. The pharmacists were instructed to use Pharm-CAT to assign a score to each new sponsored trial. To determine the cut-offs for the complexity categories, the scores were sorted in ascending order and the cut-offs corresponding to the first and third tertiles of the score distribution were selected. To verify the reproducibility of the results, Pharm-CAT was applied by two pharmacists independently for each trial. Pharm-CAT proved to be user-friendly. Sixty clinical trials were evaluated and a total of 120 scores were recorded. Low-complexity scores ranged from 0 to 19, medium-complexity scores ranged from 20 to 25, and high-complexity scores were 26 or higher. The average score recorded was 22.88 points. Prospective multicentre validation of Pharm-CAT is needed to confirm its applicability.

Establishing a river health evaluation index system for seven rivers in Jiamusi City of China.

The Jiamusi section of the Songhua River is one of the first 17 model river construction sections in China. The implementation of river health assessments can determine the health dynamics of rivers and test the management's effectiveness. Targeting seven rivers, this study conducted river zoning and monitoring point deployment to conduct sufficient field research and monitoring. The authors selected hydrological and water resources, physical structure, water quality, aquatic life, social service functions, and management as guideline layers and 15 indicator layers. Subsequently, the authors established an evaluation index system to evaluate and analyze the ecological status and social service status of each river. The results showed that the Yindamu, Alingda, and Gejie rivers scored well as healthy rivers, with health evaluation scores of 78.98, 76.06, and 75.83, respectively. The Wangsanwu, Lujiagang, and Lingdangmai rivers are generally sub-healthy rivers with scores of 71.55, 67.97, and 60.7, respectively. The Yinggetu River has a score of 54.52 and is therefore assessed as unhealthy. Based on the scientific evaluation index method, this study analyses the current river health state in Jiamusi City to provide the basis for the evaluation of the river chief's work and future river management.

Predictors for emergency readmission in patients with ureteral calculi: a focus on pain management and stone location.

BACKGROUND: The management of patients with ureteral calculi in the emergency department (ED) remains challenging due to high revisit rates. PURPOSE: To identify predictors of revisits among patients with ureteral calculi in the ED. DESIGN, SETTING, AND PARTICIPANTS: Data from patients who presented at a tertiary academic hospital in Seoul, Republic of Korea, between February 2018 and December 2019, were analyzed retrospectively. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Variables, including the respiratory rate (RR), estimated glomerular filtration rate (eGFR), duration of pain, number of analgesic doses, location of ureteral calculi, and ED length of stay (LOS) were examined using logistic regression. We also examined some additional variables included in the STONE and CHOKAI scoring systems to examine their association with revisit. RESULTS: Significant predictors of revisits included the number of analgesic doses and the location of ureteral calculi. Patients who required multiple analgesic doses or those with proximal or mid-ureteral calculi were more likely to revisit the ED. Although the STONE and CHOKAI scores could predict uncomplicated ureteral calculi, we found that the CHOKAI score is a valuable tool for predicting the likelihood of patient revisits (p = 0.021). CONCLUSIONS: Effective pain management and consideration of calculi location are important for predicting patient revisits. More research is required to validate findings, develop precise predictive models, and empower tailored care for high-risk patients. In patients with ureteral calculi in the ED, the number of analgesics given and stone location predict return visits. Proximal ureteral calculi on CT may require early urologic intervention to prevent pain-related revisits.

Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas / Design of a predictive score table for peritonsillar infection based on signs and symptoms

Introducción La infección periamigdalina (IPA) supone un motivo de consulta urgente entre las molestias de garganta. Un diagnóstico diferido o incorrecto puede comprometer la vía aerodigestiva alta y resultar mortal en su evolución. Nuestro objetivo fue desarrollar un modelo predictivo de presencia de IPA que ayude en su rápida detección. Pacientes y métodos Un estudio observacional retrospectivo de 66 meses desde 2017 fue desarrollado en un hospital comarcal y su centro terciario de referencia, recogiendo datos de todos los pacientes diagnosticados de IPA y un volumen proporcional de sujetos con sintomatología faríngea sin IPA. Recopilación de datos clínicos, exploratorios y demográficos entre participantes. Su mayor riesgo relativo de presencia de IPA los etiquetó como variables a testar. Elaboración de una escala de puntuación de probabilidad de padecerla y análisis de regresión logística, con obtención de la curva ROC que ofreciera mejor correlación diagnóstica. Validación interna y cálculo de los valores predictivos de este modelo. Resultados Sobre 348 casos de IPA, la escala de valoración puntuó la presencia de 6 variables: trismus (3), disfagia-odinofagia unilateral (2), abombamiento velar (2), otalgia refleja (1), faringolalia (1) y edad de 16-46 años (1). Con un rango de 0 a 10, un cut-off≥6 ofreció una sensibilidad del 96,1%, una especificidad del 93,9% y una eficienca del 94,9%. El área bajo la curva ROC fue de 0,979. Conclusiones La validación interna de este modelo basado en signos y síntomas la faculta como herramienta muy útil para detectar precozmente IPA en otorrinolaringología y atención primaria (AU)

Background Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. Patients and methods A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. Results On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. Conclusions The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care (AU)

A comparative study of the predictive value of four models for death in patients with severe burns.

OBJECTIVE: To assess the prognostic value of the Ryan score, Belgian Outcome of Burn Injury (BOBI) score,revised Baux (rBaux) score, and a new model (a Logit(P)-based scoring method created in 2020) for predicting mortality risk in patients with extremely severe burns and to conduct a comparative analysis. METHODS: A retrospective analysis was conducted on 599 burn patients who met the inclusion criteria and were admitted to the burn unit of the First Affiliated Hospital of Nanchang University from 2017 to 2022. Relevant information was collected, and receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were plotted for each of the four models in assessing mortality in these burn patients using both age-stratified and unstratified forms. The ROC curve section was further compared with the area under the curve (AUC), optimal cutoff value, as well as its sensitivity and specificity. Additionally, the quality of the AUC was assessed using the Delong test. RESULT: Among the patients who met the inclusion criteria, 532 were in the survival group and 67 in the death group. Irrespective of age stratification, the novel model exhibited superior performance with an AUC of 0.868 (95% CI: 0.838-0.894) among all four models predicting mortality risk in included patients, and also demonstrated better AUC quality than other models; the calibration curves showed that the accuracy of all four models was good; the DCA curves showed that the clinical utility of the novel model and rBuax score were better. In the comparison of four scoring models across different age groups, the new model demonstrated the largest AUC in both 0-19 years (0.954, 95% CI 0.914-0.979) and 20-59 years groups (0.838, 95% CI 0.793-0.877), while rBuax score exhibited the highest AUC in ≥ 60 years group (0.708, 95% CI of 0.602-0.800). The calibration curves showed that the four models exhibited greater accuracy within the age range of 20-59 years, while the DCA curves indicated that both the novel model and rBuax score scale displayed better prediction in both the 20-59 and ≥ 60 years groups. CONCLUSIONS: All four models demonstrate accurate and effective prognostication for patients with severe burns. Both the novel model and rBaux score exhibit enhanced prediction utility. In terms of the model itself alone, the new model is not simpler than, for example, the rBaux score, and whether it can be applied clinicallyinvolves further study.

[Design of a predictive score table for peritonsillar infection based on signs and symptoms]. / Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas.

BACKGROUND: Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. PATIENTS AND METHODS: A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. RESULTS: On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. CONCLUSIONS: The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care.

The application value of lung ultrasound scoring in assessing disease severity: Evaluation of small-scale outbreaks of COVID-19.

PURPOSE: This study explored the use of transthoracic lung ultrasound for evaluating COVID-19 patients, compared it with computed tomography (CT), and examined its effectiveness using 8 and 12 lung regions. METHODS: A total of 100 patients with COVID-19 and 40 healthy volunteers were assessed using 12 regions (bilateral upper/lower regions of the anterior/lateral/posterior chest) and simplified 8 zones (bilateral upper/lower regions of the anterior/lateral chest) transthoracic lung ultrasound. The relationships between ultrasound, CT, and clinical indicators were analyzed to evaluate the diagnostic value of ultrasound scores in COVID-19. RESULTS: Increased disease severity correlated with increased 8- and 12-zone ultrasound and CT scores (all p < 0.05). The modified 8-zone method strongly correlated with the 12-zone method (Pearson's r = 0.908, p < 0.05). The 8- and 12-zone methods correlated with CT scoring (correlation = 0.568 and 0.635, respectively; p < 0.05). The intragroup correlation coefficients of the 8-zone, 12-zone, and CT scoring methods were highly consistent (intragroup correlation coefficient = 0.718, p < 0.01). The 8-zone ultrasound score correlated negatively with oxygen saturation (rs = 0.306, p < 0.05) and Ca (rs = 0.224, p < 0.05) and positively with IL-6 (rs = 0.0.335, p < 0.05), erythrocyte sedimentation rate (rs = 0.327, p < 0.05), alanine aminotransferase (rs = 0.230, p < 0.05), and aspartate aminotransferase (rs = 0.251, p < 0.05). The 12-zone scoring method correlated negatively with oxygen saturation (rs = 0.338, p < 0.05) and Ca (rs = 0.245, p < 0.05) and positively with IL-6 (rs = 0.354, p < 0.05) and erythrocyte sedimentation rate (rs = 0.495, p < 0.05). CONCLUSION: Lung ultrasound scores represent the clinical severity and have high clinical value for diagnosing COVID-19 pneumonia. The 8-zone scoring method can improve examination efficiency and reduce secondary injuries caused by patient movement.

Prediction of pulmonary tuberculosis treatment outcome in a sub-Saharan African context.

Failure to treat many pathogens is a concern. Identifying a priori, patients with potential failure treatment outcome of a disease could allow measures to reduce the failure rate. The objectives of this study were to use the Scoring method to identify factors associated with the tuberculosis unsuccessful treatment outcome and to predict the treatment outcome. A total of 1,529 patients with pulmonary tuberculosis were randomly selected in the city of Douala, Cameroon, this sample was randomly split into two parts: one subsample of 1,200 patients (78%) used as the Development sample, and the remaining of 329 patients (22%) used as the Validation sample. Baseline characteristics associated with unsuccessful treatment outcomes were investigated using logistic regression. The optimal score was based on the Youden's index. HIV positive status, active smoker and non-belief in healing were the factors significantly associated with unsuccessful treatment outcomes (P#x003C;0.05). A model used to estimate the risk of unsuccessful treatment outcome was derived. The threshold probability which maximize the area under the ROC curve was 18%. Patients for whom the risk was greater than this threshold were classified as unsuccessful treatment outcome and the others as successful. HIV positive and active smoking status were associated with death; the non-belief in healing, youth and male gender associated with lost-to-follow-up, TB antecedent and not having TB contact associated with therapeutic treatment failure. To increase the tuberculosis treatment success rate, targeted follow-up could be taken during the treatment for TB patients with previous characteristics.

Simultaneous extraction of crocin and geniposide from gardenia fruits (Gardenia jasminoides Ellis) by probe-type ultrasound-assisted natural deep eutectic solvents and their inhibition effects on low density lipoprotein oxidation.

The simultaneous extraction of crocin and geniposide from gardenia fruits (Gardenia jasminoides Ellis) was performed by integrating natural deep eutectic solvents (NADES) and ultrasound-assisted extraction (UAE). Among the eight kinds of NADES screened, choline chloride-1,2-propylene glycol was the most suitable extractant. The probe-type ultrasound-assisted NADES extraction system (pr-UAE-NADES) demonstrated higher extraction efficiency compared with plate-type ultrasound-assisted NADES extraction system (pl-UAE-NADES). Orthogonal experimental design and a modified multi-index synthetic weighted scoring method were adopted to optimize pr-UAE-NADES extraction process. The optimal extraction conditions that had a maximum synthetic weighted score of 29.46 were determined to be 25 °C for extraction temperature, 600 W for ultrasonic power, 20 min for extraction time, and 25% (w/w) for water content in NADES, leading to the maximum yields (7.39 ± 0.20 mg/g and 57.99 ± 0.91 mg/g, respectively) of crocin and geniposide. Thirty-three compounds including iridoids, carotenoids, phenolic acids, flavonoids, and triterpenes in the NADES extract were identified by LC-Q-TOF-MS2 coupled with a feature-based molecular networking workflow. The kinetics evaluation of the conjugated dienes generation on Cu2+-induced low density lipoprotein (LDL) oxidation via the four-parameter logistic regression model showed that crocin increased the lag time of LDL oxidation in a concentration-dependent manner (15 µg/mL, 30 µg/mL, 45 µg/mL) by 12.66%, 35.44%, and 73.42%, respectively. The quantitative determination for fluorescence properties alteration of the apolipoprotein B-100 exhibited that crocin effectively inhibited the fluorescence quenching of tryptophan residues and the modification of lysine residues caused by reactive aldehydes and malondialdehydes. The pr-UAE-NADES showed significant efficiency toward the simultaneous extraction of crocin and geniposide from gardenia fruits. And this study demonstrates the potential utility of gardenia fruits in developing anti-atherogenic functional food.

A novel evaluation system of green development level in the Three Gorges Reservoir Area and its spatial-temporal pattern.

Evaluating the green development level (GDL) of a region will accelerate its economic transformation and promote ecological civilization. From the perspective of complex system, this study explores the green development level (GDL) of the Three Gorges Reservoir Area (TGRA) by constructing a novel and ecology-oriented evaluation system. The system is three-dimensional including indicators of environmental protection and utilization, green economy development, social harmony and prosperity. Resource elements are highly valued; inclusive society is fully considered. Overall entropy method and expert scoring method are integrated to assess the GDL of 26 regions in the TGRA from 2000 to 2020; the temporal and spatial characteristics of the GDL are examined through exploratory spatial data analysis (ESDA). The results show that (1) the GDL of the TGRA is at a medium level with the score fluctuating from 0.3 to 0.4 and the ecological protection with weight of 0.37 contributes greatly to the GDL. (2) Despite the high degree of coupling coordination, the complex ecosystem in the TGRA remains at a low level of coordinated development. (3) The GDL in the middle part of the TGRA is the highest, followed by the upper part and the lower part, and the gap is narrowing. (4) The global spatial correlation of the GDL is not obvious. The spatial spillover effect is not significant and clusters only appear in the upper part and the lower part. Finally, some reasonable suggestions are put forward for improving the GDL.

Effect of water and nitrogen coupling regulation on the growth, physiology, yield, and quality attributes and comprehensive evaluation of wolfberry (Lycium barbarum L.).

The characteristics of the growing environment (arid and semi-arid regions with abundant light), wastage of water, types of fertilizers used, quality of the plants, and the decline in yield due to the need for large quantities of water and fertilizers are the most significant obstacles to wolfberry cultivation. To cope with the scarcity of water caused by the increase in the area of wolfberry cultivation and to improve the efficiency of the utilization of water and fertilizers, a two-year field experiment was conducted in a typical area of the central dry zone of Ningxia in 2021 and 2022. The effects of different water and nitrogen coupling on the physiology, growth, quality, and yield of wolfberry were investigated, and a water and nitrogen management model with better indicators was constructed based on the TOPSIS model and a comprehensive scoring method. In the experiment, three irrigation quotas of 2,160, 2,565, and 2,970 m3 ha-1 (I1, I2, and I3) and three N applications of 165, 225, and 285 kg ha-1 (N1, N2, and N3) were established; the local conventional management served as the control (CK). The results showed that the growth index of wolfberry was most significantly affected by irrigation, followed by the water and nitrogen interaction effect, and the nitrogen application had the least effect. The growth and development of wolfberry plants mainly takes place during the fruit ripening and flowering periods, and growth almost stops after entering the fruit ripening period. The chlorophyll (SPAD) values were affected by irrigation and nitrogen application to a significant level, except for during the spring tip period, but the effect of water and nitrogen interaction was not significant. The SPAD values of N2 treatment were better under different irrigation. The daily photosynthetic activity of wolfberry leaves peaked between 10:00 am and noon. The daily photosynthetic dynamics of wolfberry were affected by irrigation and nitrogen application to a significant level during the fruit ripening period, and the transpiration rate and leaf water use efficiency were affected by water and nitrogen interaction to a significant level during 8:00 am and noon, while the effect was not significant during the spring tip period. The yield, dry-to-fresh ratio, and 100 grain weight of wolfberry were significantly affected by the irrigation, nitrogen application, and their interaction effects. Specifically, the two-year yield with I2N2 treatment increased by 7.48% and 3.73%, respectively, compared to CK. The quality indices were significantly affected by irrigation and nitrogen application, except for the total sugars; other indexes were also significantly affected by water and nitrogen interaction effects. The evaluation of the TOPSIS model showed that the I3N1 treatment yielded the best quality of wolfberry, and the results of the integrated scoring method based on the growth, physiology, yield, and quality indicators and water-saving objectives showed that the I2N2 (2,565 m3 ha-1, 225 kg ha-1) treatment was the optimal water and nitrogen management mode for drip-irrigated wolfberry. Our findings provide a scientific basis for the optimal irrigation and management of fertilization of wolfberry in arid regions.

The accuracy and difference of scoring rules and methods to score respiratory event-related leg movements in obstructive sleep apnea patients.

OBJECTIVE: To compare manual scoring: 1) to the American Academy of Sleep Medicine (AASM) auto-scoring rules. 2) to the AASM and World Association of Sleep Medicine (WASM) rules, and evaluate the accuracy of the AASM and WASM for respiratory event-related limb movements (RRLM) in diagnostic and continuous positive airway pressure (CPAP) titration polysomnography (PSG). METHODS: We retrospectively, re-scored diagnostic and CPAP titration PSGs of 16 patients with obstructive sleep apnea (OSA), using manual re-scoring by the AASM (mAASM) and WASM (mWASM) criteria for RRLM, periodic limb movements during sleep (PLMS), and limb movements (LM), which were compared to auto-scoring by the AASM (aAASM). RESULTS: In diagnostic PSG, significant differences were found in LMs (p < 0.05), RRLM (p = 0.009) and the mean duration of PLMS sequences (p = 0.013). In CPAP titration PSG, there was a significant difference in RRLM (p = 0.008) and PLMS with arousal index (p = 0.036). aAASM underestimated LM and RRLM, especially in severe OSA. Changes in RRLM and PLMS with arousal index between diagnostic and titration PSG were significantly different between aAASM and mAASM, but there was no significant difference between scoring by mAASM and mWASM. The ratio of PLMS and RRLM changes between diagnostic and CPAP titration PSG was 0.257 in mAASM and 0.293 in mWASM. CONCLUSIONS: In addition to the overestimation of RRLM by mAASM compared to aAASM, mAASM may also be more sensitive than aAASM in detecting RRLM changes in the titration PSG. Despite intuitive differences in the definition of RRLM between AASM and WASM rules, RRLM results between mAASM and mWASM were not significant and about 30% of RRLMs might be scored as PLMS by both scoring rules.

Efficacy in Predicting Negative Appendectomy Rates in Operated Acute Appendicitis Patients Using the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) Score Versus Modified Alvarado Score.

Introduction Acute appendicitis is the commonest abdominal surgical emergency globally. The most accepted management of acute appendicitis is surgical, either open or laparoscopic appendectomy. Overlapping clinical presentations with many genitourinary and gynecological conditions lead to difficulty in accurate diagnosis, making negative appendectomies an unwanted reality. With the advancement in technology, there have been constant efforts to minimize negative appendectomy rates (NAR) using imaging modalities like USG of the abdomen and the gold-standard imaging test, the contrast-enhanced computed tomography of the abdomen. Due to the cost incurred and the lesser availability of such imaging modalities and needed expertise in resource-poor settings, various clinical scoring systems were devised to accurately diagnose acute appendicitis and thereby decrease NAR. We conducted our study to determine the NAR between the Raja Isteri Pengiran Anak Saleha Appendicitis score (RIPASA) and the modified Alvarado (MA) scoring methods. Methods A prospective observational analytical study was conducted, including 50 patients presenting to our hospital with acute appendicitis and who underwent emergency open appendectomy. The need to operate was decided by the treating surgeon. Patients were stratified by both scores; the pre-operative scores were noted and were later compared with the histopathological diagnosis. Results A total of 50 clinically diagnosed patients with acute appendicitis were evaluated utilizing the RIPASA and the MA scores. The NAR was 2% using the RIPASA score vs 10% with the MA score. The sensitivity was 94.11% vs 70.58% (p<0.0001), the specificity was 93.75% vs 68.75% (p<0.0001), the positive predictive value (PPV) of 96.96% vs 82.75% (p<0.001), the negative predictive value (NPV) of 88.23% vs 52.38% (p<0.001), and NAR of 2% vs 10% (p<0.0001) in the RIPASA vs MA scoring method, respectively. Conclusions RIPASA score is highly efficacious and statistically significant in diagnosing acute appendicitis with higher PPV at higher scores and higher NPV with lower scores leading to decreased NAR compared with MA score.

A revised version of the Seirei Swallowing Questionnaire for people with cognitive decline (Swallow-10).

The Seirei dysphagia screening questionnaire (namely, Seirei dsq) has been used to screen for oropharyngeal dysphagia (OD). Some of the questions in the questionnaire are difficult for people with cognitive decline to answer. We selected 10 items from the Seirei dsq that could be assessed by others, such as care workers (named Swallow-10). This study aims to verify the validity of the scoring method used in Swallow-10. The dataset used in this study was the one used in the development of Seirei dsq : 50 patients with cerebrovascular disease who were diagnosed with OD, 145 patients with cerebrovascular disease who did not have OD, and 170 healthy subjects. Among the answer choices, "A" for severe symptom, "B" for mild symptom and "C" for no symptom were scored with 4, 1 and 0 points respectively. Factor analysis extracted two factors : one related to pharyngeal function and another related to oral function. In addition, the Cronbach's alpha coefficient was 0.84. ROC analysis indicated that optimal cutoff value was 5 points, with a sensitivity of 90.0% and a specificity of 88.5%. These results suggest that Swallow-10 may be useful as an OD screening tool for subjects with cognitive decline J. Med. Invest. 70 : 231-235, February, 2023.

Tumor Area Positivity (TAP) score of programmed death-ligand 1 (PD-L1): a novel visual estimation method for combined tumor cell and immune cell scoring.

BACKGROUND: Determination of programmed death-ligand 1 (PD-L1) protein expression level in tumor cells and tumor-associated immune cells is critical for identifying patients eligible for immunotherapy. PD-L1 manual scoring algorithms can generally be divided into two categories: cell counting and visual estimation. Cell counting can be time-consuming and is not in sync with pathology practice, which classically uses a Gestalt approach based on pattern recognition and visual estimation. In this study, we introduce the Tumor Area Positivity (TAP) score, which is a novel, straightforward method for scoring tumor cells and immune cells together using visual estimation. METHODS: To demonstrate the reproducibility of TAP scoring among pathologists, between- and within-reader precision studies were performed both within (internal) and outside of (external) our organization. We also compared the TAP score to the Combined Positive Score (CPS), which is based on cell counting, for concordance and time efficacy. RESULTS: The average positive agreement, average negative agreement, and overall percent agreement between and within readers were all above 85% for both internal and combined external reader precision studies. TAP score had high concordance rate at 5% cutoff compared with CPS at cutoff 1: positive percent agreement, negative percent agreement, and overall percent agreement were all above 85%. CONCLUSIONS: Our study showed the TAP scoring method to be straightforward, significantly less time-consuming, and highly reproducible with a high concordance rate between TAP score and CPS.

A novel score to estimate thrombus burden and predict intracranial hypertension in cerebral venous sinus thrombosis.

BACKGROUND: Current methods to evaluate the severity of cerebral venous sinus thrombosis (CVST) lack patient-specific indexes. Herein, a novel scoring method was investigated to estimate the thrombus burden and the intracranial pressure (ICP) of CVST. METHODS: In this retrospective study from January 2019 through December 2021, we consecutively enrolled patients with a first-time confirmed diagnosis of CVST by contrast-enhanced magnetic resonance venography (CE-MRV) or computed tomography venography (CTV). In these patients, a comprehensive CVST-Score was established using magnetic resonance black-blood thrombus imaging (MRBTI) to estimate the thrombus burden semi-quantitatively. The relationship between CVST-Score and ICP was explored to assess the potential of using the CVST-score to evaluate ICP noninvasively and dynamically. RESULTS: A total of 87 patients were included in the final analysis. The CVST-Scores in different ICP subgroups were as follows: 4.29±2.87 in ICP<250mmH2O subgroup, 11.36±3.86 in ICP =250-330mmH2O subgroup and 14.99±3.15 in ICP>330mmH2O subgroup, respectively (p<0.001). For patients with ICP ≤330mmH2O, the CVST-Score was linearly and positively correlated with ICP (R2=0.53). The receiver operating characteristic (ROC) curves showed the optimal CVST-Score cut-off values to predict ICP ≥250mmH2O and >330mmH2O were 7.15 and 11.62, respectively (P<0.001). Multivariate analysis indicated CVST-Score as an independent predictor of ICP ≥250mmH2O (odds ratio, 2.15; 95% confidence interval, 1.49-3.10; p<0.001). CONCLUSIONS: A simple and noninvasive CVST-Score can rapidly estimate the thrombus burden and predict the severity of intracranial hypertension in patients with CVST. The CVST-Score can aid in evaluating therapeutic responses and avoiding unnecessary invasive procedures at long-term follow-up.

A new practical method of estimating tumoral microenvironment parameters of possible prognostic significance in patients with invasive breast carcinoma: Combined microenvironment score.

BACKGROUND AND OBJECTIVE: In recent years, the tumor microenvironment has become increasingly recognized as an influential factor in breast cancer development and growth. The parameters that form the microenvironment are the tumor stroma ratio and tumor infiltrating lymphocytes. In addition, tumor budding, which shows the ability of the tumor to metastasize, gives information about the progression of the tumor. In this study, the combined microenvironment score (CMS) was determined with these parameters, and the relationship between CMS and prognostic parameters and survival was evaluated. MATERIALS AND METHODS: In our study, tumor stroma ratio, tumor infiltrating lymphocytes, and tumor budding were evaluated in hematoxylin-eosin sections of 419 patients with invasive ductal carcinoma. Patients were scored separately for each of these parameters, and these scores were summed to determine the CMS. The patients were divided into 3 groups according to CMS and the relationship between CMS and prognostic parameters and the survival of the patients was studied. RESULTS: The patients with CMS 3 had higher histological grade and Ki67 proliferation index compared to CMS 1 and 2. Additionally, lymphovascular invasion, axillary lymph node and distant metastasis were more common. Disease-free, and overall survival were significantly shortened in the CMS 3 group. CMS was found as an independent risk factor for DFS (HR: 2.144 (95 % CI: 1.219-3.77) p: 0.008), but not an independent risk factor for OS. CONCLUSION: CMS is a prognostic parameter that can be easily evaluated and does not require extra time and cost. Evaluating the morphological parameters of the microenvironment with a single scoring system will contribute to routine pathology practice and predict patient prognosis.