[Source Apportionment of Morphine in Wastewater]

It is a new approach to identify legal or illegal use of morphine through information on municipal wastewater. However, the sources of morphine in wastewater are complex, and distinguishing the contribution of different sources has become a key issue. A total of 262 influent samples from 61 representative wastewater treatment plants in a typical city were collected from October 2022 to March 2023. The concentrations of morphine, codeine, thebaine, papaverine, noscapine, and monoacetylmorphine were analyzed in wastewater and poppy straws. Combined with the proportion of alkaloids in poppy straws, the source analysis of alkaloids in wastewater was analyzed using the ratio method and positive matrix factorization model (PMF). Only five alkaloids were detected in wastewater, and monoacetylmorphine, a metabolite of heroin, was not detected. The concentrations of morphine and codeine were significantly higher than those of noscapine, papaverine, and thebaine. By constructing the ratios of codeine/(morphine + codeine) and noscapine/(noscapine + codeine), the source of poppy straw could be qualitatively distinguished. The PMF results showed that three sources of morphine for medical use, poppy straw, and codeine contributed 44.9%, 43.7%, and 9.4%, respectively. The different sources varied in these months due to the COVID-19 and influenza A outbreaks, in which the use of drugs containing poppy straws and codeine was the main source, whereas the use of morphine analgesics remained relatively stable. Inventory analysis further demonstrated the reliability of the source contributions from the PMF model, and morphine was not abused in this city.

Quantitative Metrics in Mass-Gathering Studies: A Comprehensive Systematic Review

INTRODUCTION

Mass gatherings are events where many people come together at a specific location for a specific purpose, such as concerts, sports events, or religious gatherings, within a certain period of time. In mass-gathering studies, many rates and ratios are used to assess the demand for medical resources. Understanding such metrics is crucial for effective planning and intervention efforts. Therefore, this systematic review aims to investigate the usage of rates and ratios reported in mass-gathering studies.

METHODS

In this systematic review, the PRISMA guidelines were followed. Articles published through December 2023 were searched on Web of Science, Scopus, Cochrane, and PubMed using the specified keywords. Subsequently, articles were screened based on titles, abstracts, and full texts to determine their eligibility for inclusion in the study. Finally, the articles that were related to the study's aim were evaluated.

RESULTS

Out of 745 articles screened, 55 were deemed relevant for inclusion in the study. These included 45 original research articles, three special reports, three case presentations, two brief reports, one short paper, and one field report. A total of 15 metrics were identified, which were subsequently classified into three categories: assessment of population density, assessment of in-event health services, and assessment of out-of-event health services.

CONCLUSION

The findings of this study revealed notable inconsistencies in the reporting of rates and ratios in mass-gathering studies. To address these inconsistencies and to standardize the information reported in mass-gathering studies, a Metrics and Essential Ratios for Gathering Events (MERGE) table was proposed. Future research should promote consistency in terminology and adopt standardized methods for presenting rates and ratios. This would not only enhance comparability but would also contribute to a more nuanced understanding of the dynamics associated with mass gatherings.

Effectiveness of the sternocleidomastoid muscle contraction asymmetry and filter: cervical vestibular evoked myogenic potential

OBJECTIVE

This study aimed to determine the precautions that can be taken to increase the reliability of the vestibular evoked myogenic potentials test without being affected by the asymmetry of the sternocleidomastoid muscle and the issues that should be considered in the interpretation of vestibular evoked myogenic potential results if these precautions are not taken.

METHOD

Individuals with sternocleidomastoid muscle activity of less than 30 μV in cervical vestibular evoked myogenic potential testing and an asymmetry ratio of more than 0.35 were excluded. In our study, individuals were divided into different groups according to sternocleidomastoid muscle asymetry.

RESULTS

A total of 53 individuals were included in the study. Intergroup comparisons were made to determine the effect of electromyogram scaling and filter use on amplitude asymmetry ratio according to sternocleidomastoid muscle asymmetry.

CONCLUSION

Keeping the sternocleidomastoid muscle asymmetry not exceeding 10 μV maximises the reliability of cervical vestibular evoked myogenic potentials. As a result of our study, it can be concluded that in clinical applications the asymmetry should not exceed 20 μV.

Urea to Albumin Ratio Is an Excellent Predictor of Death in Patients With Complicated Intra-Abdominal Infections

Background: The urea to albumin ratio (UAR) has shown a prognostic value in various clinical settings, however, no study has yet investigated its ability to predict outcome in complicated intra-abdominal infections (cIAIs). Therefore, our aim was to evaluate the association between UAR and mortality in such patients. Patients and Methods: A single-center prospective study including 62 patients with cIAIs was performed at a University Hospital Stara Zagora for the period November 2018 to August 2021. Various routine laboratory and clinical parameters were recorded before surgery and on post-operative day 3. We used serum levels of urea and albumin to calculate the UAR. Results: The observed in-hospital mortality was 14.5%. Non-survivors had higher pre- and post-operative median of UAR than survivors (88.39 vs. 30.99, p < 0.0001 and 106.18 vs. 26.58, p < 0.0001, respectively). Lethal outcome was predicted successfully both by UAR before surgery (area under receiver operating characteristics [AUROC] curves = 0.889; p < 0.0001) at a threshold of 61.42 and on third post-operative day (AUROC = 0.943; p < 0.0001) at a threshold = 55.89. Conclusions: Peri-operative UAR showed an excellent ability for prognostication of fatal outcome in patients with cIAIs.

The effect of SARS-CoV-2 infection and vaccination on Th17 and regulatory T cells in a pregnancy cohort in NYC

Disturbances in T-cells, specifically the Th17/Treg balance, have been implicated in adverse pregnancy outcomes. We investigated these two T-cell populations following pre-pregnancy and pregnancy SARS-CoV-2 infection and COVID-19 vaccination in 351 participants from a pregnancy cohort in New York City (Generation C; 2020-2022). SARS-CoV-2 infection status was determined via laboratory or medical diagnosis and COVID-19 vaccination status via survey and electronic medical records data. Peripheral blood mononuclear cells (PBMCs) were collected at routine prenatal visits throughout gestation (median 108 days; IQR 67-191 days) with repeated measures for 104 participants (29.6%). T-cell populations CD4+/CD3+, Th17/CD4+, Treg/CD4+ and the Th17/Treg ratio were quantified using flow cytometry. Results showed that inter-individual differences are a main influencing factor in Th17 and Treg variance, however total variance explained remained small (R2 = 15-39%). Overall, Th17 and Treg populations were not significantly affected by SARS-CoV-2 infection during pregnancy in adjusted linear mixed models (p>0.05), however comparison of repeated measures among SARS-CoV-2 infected participants and non-infected controls suggests a relative increase of the Th17/Treg ratio following infection. In addition, the Th17/Treg ratio was significantly higher after SARS-CoV-2 infection prior to pregnancy (10-138 weeks) compared to controls (β=0.48, p=0.003). COVID-19 vaccination was not associated with Th17 and Treg cells. Our findings suggest an impact of SARS-CoV-2 infection on the Th17/Treg ratio, likely depending on severity of infection, yet the observed trends and their potential consequences for pregnancy outcomes require further investigation. Our study contributes to growing evidence that COVID-19 vaccination during pregnancy does not lead to an exacerbated immune response.

Prognostic Significance of NLR, LMR, PLR, and CRP-Albumin Ratio in Lower Extremity Cellulitis: A Hospitalization and Recurrence Analysis

Cellulitis, an inflammatory disease of the skin and subcutaneous tissue caused by bacterial agents, frequently causes lower-extremity wounds. Many new biomarkers have been introduced to aid the diagnosis of inflammatory diseases. In this study, we aimed to evaluate the risk of recurrence of lower-extremity cellulitis wounds and the factors determining the need for hospitalization. Demographic characteristics and underlying diseases of the patients, white blood cell count, neutrophil, lymphocyte, monocyte, neutrophil, lymphocyte, lymphocyte and monocyte counts at admission, white blood cell count at admission, platelet count, total protein, albumin, erythrocyte sedimentation rate, C-reactive protein (CRP), procalcitonin level, neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and CRP/albumin ratio were evaluated. Of the 132 patients with lower extremity cellulitis wounds, the median age was 56 years (range, 20-96 years), and 88 (66.7%) were male. Diabetes mellitus was the most commonly associated systemic disease. The most common symptom (97%) was a rash. Of the patients, 80 (60.6%) were hospitalized and 52 (39.4%) were treated as outpatients. Seventeen (12.9%) patients had recurrent cellulitis. While comorbidities and increased lesion size increased the risk in patients with recurrent cellulitis, median platelet count (P = .010), D-dimer level (P = .036), and CRP-Alb ratio (P = .019) were higher. Particularly increased lesion size, platelet count, total protein, and CRP levels should be a warning to clinicians in terms of the need for hospitalization and the risk of recurrence in patients with cellulite. In our study, PLR and CRP/albumin ratios were found to be high in these patient groups, and determining the usefulness of new biomarkers through new studies will give us a new perspective in clinical practice.

Bi-based bracelet-like monolayer with negative in-plane Poisson's ratio and enhanced photocatalytic performance: a first-principles study

Auxetic materials are in high demand for advanced applications due to their relatively rare negative Poisson's ratio in two-dimensional materials. This study investigates the structural, mechanical, electronic, optical and photocatalytic properties of the AsBiTe3monolayer(ML) using first-principles calculations. Through analysis of phonon dispersion curves,ab-initiomolecular dynamics simulations, and Born conditions, we have confirmed the thermal, dynamic, and mechanical stability of the AsBiTe3monolayer. The study of the mechanical properties of this material revealed significant anisotropy and a bidirectional in-plane negative Poisson's ratio (NPR). In addition, electronic band structures calculated, with and without spin-orbit coupling (SOC) using the HSE functional, indicate that this monolayer exhibits the characteristics of an indirect-gap semiconductor around 1.17 and 1.32 eV, respectively. Notably, by assessing the optical properties of AsBiTe3monolayer, it has been found that this monolayer has a strong light-harvesting capability with an absorption coefficient higher than 105 cm-1in the visible region. Fascinatingly, under a biaxial 1%and 4%tensile and -2% compressive strain, the band edge of the AsBiTe3monolayer extends across the redox potential of water at pH = 0, 7 and 14, respectively. This suggests that this monolayer holds promise as a potential material for catalytic water splitting. These results should inspire further experimental and theoretical research, aimed at fully exploring the potential applications of this new class of 2D materials.

Does medullary diameter to stem width ratio and stem length affect outcomes of revision total knee arthroplasties? A case series

OBJECTIVES

This study aimed to investigate the relationship between the ratio of stem size to intramedullary canal diameter, stem length, and functional outcome in revision total knee arthroplasty (RTKA) procedures, which remains largely unexplored in the current literature.

PATIENTS AND METHODS

A single surgeon series of RTKA procedures performed between October 2014 and November 2022 were included in this case series, and data were analyzed retrospectively. A total of 32 patients (27 females, 5 males; mean age: 73.2±8.1 years; range, 52 to 88 years) were identified, with a minimum follow-up period of five months and a maximum of eight years. Filtering the patients based on >24 month follow-up, we were left with 13 patients aged between 65 and 88 (mean 74.9±6.9) years. The latest X-rays of patients were analyzed, and the ratio of intramedullary canal diameter to stem width was calculated for both femur and tibia in both anteroposterior and lateral planes. Household income, preoperative C-reactive protein, erythrocyte sedimentation rate, comorbidities, body mass index, and implant dimensions were also recorded. Postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Short Form-12 (SF-12) scores, and range of motion (ROM) measurements were used to evaluate functional outcome.

RESULTS

A moderate negative relationship between the tibial canal fill ratio (CFR) in anteroposterior views and ROM of the patients was noted. Additionally, a significant positive correlation was found between SF-12 physical score and CFR in lateral view. A moderate level of correlation between femoral CFR in anteroposterior views was also established. Due to insufficient data, joint ROM data did not show normal distribution. Therefore, a cutoff value indicating the relationship between the stem size and knee ROM could not be calculated using receiver operating characteristic analysis. Multiple regression analysis did not yield significant results, suggesting that hypothesized predictor variables were not sufficient to predict the variation in functional scores. Otherwise, no clear statistical importance or correlation between functional scores, such as WOMAC or SF-12, and CFR was found.

CONCLUSION

In conclusion, the findings suggest that other factors, such as other patient characteristics, surgical techniques, or implant designs, may have a more substantial impact on the functional outcomes in RTKA patients.

A Cross-Sectional Comparative Study of Morbidity and Mortality of COVID-19 Disease in four Cities of Northern Khorasan Province using Ratio of Coefficient of Variation

Background

In December 2019, the spread of a new infectious disease was reported in Wuhan, caused by a new coronavirus named COVID-19 by the World Health Organization. This study aims to compare the dispersion of COVID-19 disease among four Iranian cities in North Khorasan named Bojnord, Farooj, Jajarm, and Shirvan.

Materials and Methods

This cross-sectional study includes information about the daily morbidity and mortality of COVID-19 in 1124 patients from March to May 2021. The analysis of variance method, Scheffe post hoc technique and Leven's test are used to compare the means and the variances of daily morbidity and mortality of these cities. Finally, the coefficients of variation (CVs) of the morbidity and mortality are compared.

Results

The means of daily morbidity in Bojnord, Farooj, Jajarm, and Shirvan cities are 6.387, 0.946, 1.150, and 2.193, respectively. Furthermore, the means of daily mortality in Bajnourd, Farooj, Jajarm, and Shirvan are 0.763, 0.193, 0.161, and 0.290, respectively. The means and the variances of both daily mortality and morbidity are significantly different in all four cities (P < 0.05). Furthermore, CVs of daily morbidity in the cities of Bojnord, Farooj, Jajarm, and Shirvan are 0.665, 1.026, 1.032, and 0.787, respectively. The CVs of daily mortality in these cities are 1.196, 2.052, 2.468, and 1.728, respectively. The CVs of both daily mortality and morbidity are significantly different in all four cities (P < 0.05).

Conclusion

The ratio of CVs is a good option for comparing the spread of COVID-19 in different regions with different means and variances.

Synergy of the microRNA Ratio as a Promising Diagnosis Biomarker for Mucinous Borderline and Malignant Ovarian Tumors

Epithelial ovarian cancers (EOCs) are a heterogeneous collection of malignancies, each with their own developmental origin, clinical behavior and molecular profile. With less than 5% of EOC cases, mucinous ovarian carcinoma is a rare form with a poor prognosis and a 5-year survival of 11% for advanced stages (III/IV). At the early stages, these malignant forms are clinically difficult to distinguish from borderline (15%) and benign (80%) forms with a better prognosis due to the large size and heterogeneity of mucinous tumors. Improving their diagnosis is therefore a challenge with regard to the risk of under-treating a malignant form or of unnecessarily undertaking radical surgical excision. The involvement of microRNAs (miRNAs) in tumor progression and their potential as biomarkers of diagnosis are becoming increasingly recognized. In this study, the comparison of miRNA microarray expression profiles between malignant and borderline tumor FFPE samples identified 10 down-regulated and 5 up-regulated malignant miRNAs, which were validated by individual RT-qPCR. To overcome normalization issues and to improve the accuracy of the results, a ratio analysis combining paired up-regulated and down-regulated miRNAs was performed. Although 21/50 miRNA expression ratios were significantly different between malignant and borderline tumor samples, any ratio could perfectly discriminate the two groups. However, a combination of 14 pairs of miRNA ratios (double ratio) showed high discriminatory potential, with 100% of accuracy in distinguishing malignant and borderline ovarian tumors, which suggests that miRNAs may hold significant clinical potential as a diagnostic tool. In summary, these ratio miRNA-based signatures may help to improve the precision of histological diagnosis, likely to provide a preoperative diagnosis in order to adapt surgical procedures.

Placental biomarkers and fetoplacental Dopplers in combination reliably predict preterm birth in pregnancies complicated by fetal growth restriction

OBJECTIVE

To assess the association between placental biomarkers (placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt-1)/PlGF ratio) and fetoplacental Dopplers - Umbilical Artery Pulsatility Index (UA PI) and Uterine Artery Pulsatility Index (UtA PI) in various combinations for the likelihood of preterm birth (PTB) in women with fetal growth restriction (FGR).

METHODS

A prospective cohort study of pregnancies complicated by FGR. Maternal serum PlGF levels, sFlt-1/PlGF ratio, UA PI and UtA PI were measured at 4-weekly intervals from recruitment to delivery. Harrell's concordance statistic was used to evaluate various combinations of placental biomarkers and fetoplacental Dopplers to ascertain the ideal combination to predict PTB (<37 weeks). Multivariable Cox regression was used as time-varying covariates.

RESULTS

There were 320 pregnancies in the study cohort - 179 (55.9%) were FGR and 141 (44.1%) were AGA. In the FGR cohort, both low PlGF levels and elevated sFlt-1/PlGF ratio significantly affected time to PTB. Low PlGF was a better predictor of PTB than either sFlt-1/PlGF ratio or combination of PlGF and sFlt-1/PlGF ratio (Harrell's C 0.81, 0.79, 0.75 respectively). Similarly, although both UA PI and UtA PI >95th centile for gestation significantly affected the time to PTB, in combination, they were better predictors than either measure alone (Harrell's C 0.82, 0.75, 0.76 respectively). The predictive utility was highest when PlGF <100ng/L, UA PI and UtA PI >95th centile was combined (Harrell's C 0.88) (HR 32.99 95% CI 10.74, 101.32).

CONCLUSIONS

Low maternal PlGF levels (<100ng/L) and abnormal fetoplacental Dopplers (UA PI and UtA PI >95th centile) in combination have greatest predictive utility for PTB in pregnancies complicated with FGR and may help guide clinical management of these complex pregnancies. This article is protected by copyright. All rights reserved.

Total Number of Lymph Nodes in Neck Dissection and Its Relation to Cancer-Positive Lymph Nodes as a Prognostic Indicator in Aerodigestive Tract Cancers: A Multi-Center Study

Objectives Few studies have been conducted on the total number of lymph nodes (LNs) in neck dissection and the lymph node ratio (LNR; number of positive lymph nodes divided by number of excised lymph nodes), or their potential use as a prognostic indicator for cancers of the upper aerodigestive tract (UADT) and its treatment. We aimed to measure the number of lymph nodes dissected and the LNR to assess their prognostic value for cancers of the UADT, as well as their effect on overall survival and disease-free survival. Methods We performed a retrospective study of patients diagnosed with cancer of the UADT who underwent neck dissection as the primary or secondary modality of their treatment plan at King Abdulaziz University Hospital and the National Guard Hospital, Jeddah, Saudi Arabia. Data were collected through medical records and analyzed to assess prognosis and calculate survival rates in relation to the number of lymph nodes and LNR. Results A total of 121 patients were included: 14 women (11.57%) and 107 men (88.43%). The median age was 60 years and the mean follow-up period was 2.7 years. Of the malignancies, 44.63% were of the oral tongue and 35.54% were laryngeal. A median of 38 lymph nodes were dissected during neck dissections. The distribution of the individual LNRs was characterized by mean values. A mean LNR of 0.04 was considered the cutoff value, an LNR of > 0.04 a high LNR, and an LNR of < 0.04 a low LNR. Kaplan-Meier survival estimates for the cohort showed a three-year overall survival rate of 88% (95% confidence interval [CI]: 77% to 94%) for patients with a low LNR, but 71% (95% CI: 47% to 85%) for patients with a high LNR, which was statistically significant. A similar significant decreasing trend persisted at the four-year follow-up, where the disease-free survival rate was 73% (95% CI: 61% to 82%) for patients with a low LNR compared with 56% (95% CI: 35% to 72%) for patients with a high LNR. Conclusion The number of excised lymph nodes in neck dissections and the LNR might be a good prognostic indicator for overall survival and disease-free survival in patients with cancers of the UADT and may serve as a valuable tool in deciding on different treatment plans.

Use of Dichlorodimethylsilane to Produce Polydimethylsiloxane as a Substitute for Vitreous Humour: Characteristics and In Vitro Toxicity

Polydimethylsiloxane (PDMS) is a substitute for vitreous humour in vitreoretinal surgery and is usually produced from octamethylcyclotetrasiloxane (D4). In Indonesia, both commercial PDMS and D4 are limited and expensive. Dichlorodimethylsilane (DCMS) can be an alternative to produce PDMS. DCMS is cheaper and easier to obtain than D4. However, more extra effort is needed in order to produce PDMS from DCMS. Therefore, this study aimed to produce PDMS from DCMS by varying the ratio of DCMS precursor to dichloromethane (DCM) solvent at ratios of 1:1 and 1:4 through the hydrolysis-condensation method under neutral conditions. The PDMS produced had medium- (2.06 Pa·s) and high viscosity (3.59 Pa·s), with densities ranging from 0.96 to 0.99 g/mL. The refractive index was 1.4034-1.4036 and surface tension was 21 × 10-3 N/m, while they were able to transmit ~100% visible light, which were similar values to the commercial PDMS characteristics. PDMS samples were characterized using IR and NMR spectroscopy, which confirmed they were of PDMS type. The most optimum DCMS:DCM ratio was 1:1 due to the medium-viscosity PDMS type that could be produced. The in vitro HET-CAM toxicity test showed that samples were non-irritant, similar to PDMS produced from D4. PDMS from DCMS was non-toxic and ready to be used as a vitreous humuor substitution.

Developing a Culturally and Linguistically Congruent Digital Storytelling Intervention in Vietnamese and Korean American Mothers of Human Papillomavirus-Vaccinated Children: Feasibility and Acceptability Study

BACKGROUND

The high morbidity, mortality, and economic burden attributed to cancer-causing human papillomavirus (HPV) call for researchers to address this public health concern through HPV vaccination. Disparities of HPV-associated cancers in Vietnamese and Korean Americans exist, yet their vaccination rates remain low. Evidence points to the importance of developing culturally and linguistically congruent interventions to improve their HPV vaccination rates. We adopted digital storytelling (DST) that combines oral storytelling with computer-based technology (digital images, audio recording, and music) as a promising approach for facilitating the communication of culturally relevant health messages.

OBJECTIVE

This study aimed to (1) assess the feasibility and acceptability of intervention development through DST workshops, (2) conduct an in-depth analysis of the cultural experience that shapes HPV attitudes, and (3) explore aspects of the DST workshop experience that could inform future formative and intervention work.

METHODS

Through community partners, social media, and snowball sampling, we recruited 2 Vietnamese American and 6 Korean American mothers (mean age 41.4, SD 5.8 years) who had children vaccinated against HPV. Three virtual DST workshops were conducted between July 2021 and January 2022. Our team supported mothers to develop their own stories. Mothers completed web-based surveys before and after the workshop and provided feedback on each other's story ideas and the workshop experience. We used descriptive statistics to summarize quantitative data and constant comparative analysis to analyze qualitative data collected in the workshop and field notes.

RESULTS

Eight digital stories were developed in the DST workshops. They were well accepted, and the mothers showed overall satisfaction and relevant indicators (eg, would recommend it to others, would attend a similar workshop, it was worth their time; mean 4.2-5, range 1-5). Mothers found the process rewarding and appreciated the opportunity to share their stories in group settings and learn from each other. The 6 major themes that emerged from the data reflect the mothers' rich personal experiences, attitudes, and perceptions about their child's HPV vaccination, which included (1) showing parents' love and responsibility; (2) HPV and related knowledge, awareness, and attitudes; (3) factors influencing vaccine decision-making; (4) source of information and information sharing; (5) response to children's being vaccinated; and (6) cultural perspectives on health care and HPV vaccination.

CONCLUSIONS

Our findings suggest that a virtual DST workshop is a highly feasible and acceptable approach to engaging Vietnamese American and Korean American immigrant mothers in developing culturally and linguistically congruent DST interventions. Further research is needed to test the efficacy and effectiveness of digital stories as an intervention for Vietnamese American and Korean American mothers of unvaccinated children. This process of developing an easy-to-deliver, culturally and linguistically aligned, and holistic web-based DST intervention can be implemented with other populations in other languages.

Increased acylcarnitine ratio indices in newborn screening for carnitine-acylcarnitine translocase deficiency shows increased sensitivity and reduced false-positivity

Background

Carnitine-acylcarnitine translocase (CACT) deficiency is a rare autosomal recessive metabolic disorder of mitochondrial long-chain fatty acid oxidation. Newborn screening via tandem mass spectrometry (MS/MS) technology enables early diagnosis. However, previous analyses of MS/MS data of patients showed that some results were misdiagnosed because they did not show typical acylcarnitine profiles of CACT deficiency. This study aimed to identify additional indices to assist the diagnosis of CACT deficiency.

Methods

To evaluate the acylcarnitine profile and the acylcarnitine ratios of individuals with CACT deficiency, the MS/MS data of 15 patients diagnosed via genetic testing were retrospectively analysed. The sensitivity and false-positive rates of primary acylcarnitine markers and ratio indices were validated using the data from 28,261 newborns and 53 false-positive cases. Additionally, the MS/MS data of 20 newborns carrying the c.199-10T>G mutation in SLC25A20 and 40 normal controls were compared to verify whether the carriers had abnormal acylcarnitine concentrations.

Results

The acylcarnitine profiles from 15 patients were classified into three categories using C12, C14, C16, C18, C16:1, C18:1, and C18:2 as the primary diagnostic markers. The first category represented a typical profile (P1-P6). The second category for patients P7 and P8 showed a significant decrease in the C0 level and a normal concentration of long-chain acylcarnitines. The third category for patients P9-P15 showed the presence of interfering acylcarnitines. The second and third categories may have been misdiagnosed. An acylcarnitine ratio analysis showed that C14/C3, C16/C2, C16/C3, C18/C3, C16:1/C3, and C16:1-OH/C3 were significantly increased in all 15 patients. The verification of 28,261 newborn screening results showed that the false-positive rate of ratios, except for (C16 + C18)/C0, was lower than that of acylcarnitine indices (0.02-0.08% vs. 0.16-0.88%). None of the single long-chain acylcarnitines could separate patients from the false-positive cases; however, all ratios produced good discrimination between the two groups.

Conclusions

Based on the primary acylcarnitine markers alone, CACT deficiency can be misdiagnosed in newborn screening. The ratios of the primary markers (C16 + C18:1)/C2, C16/C2, C16:1/C3, and C16:1-OH/C3 can facilitate the diagnosis of CACT deficiency, thereby increasing sensitivity and reducing false-positivity.

Using progesterone to follicular index ratio is better correlated with intracytoplasmic sperm injection outcome than using serum progesterone level alone

OBJECTIVES

to investigate the possibility of using the ratio of serum progesterone level to the number of follicles, according to ovarian response in the day of human chorionic gonadotrophin trigger, as a predictor of cycle outcome.

MATERIAL AND METHODS

A prospective intervensional study was conducted at Kamal Al-Samarai Hospital for Infertility Treatment and IVF during the period from December 2020 to September 2021. Ninety infertile women underwent intracytoplasmic sperm injection (ICSI) cycles using antagonist protocol. Moreover, once the patient reached triggering criteria, meticulous recording of follicular index together with serum estrogen level and serum progesterone level are measured. Fresh embryo transfer of cleavage stage embryo is done once serum progesterone level was less than 1.5 ng/mL. A follow-up to confirm pregnancy rate and cycle outcome was done.

RESULTS

The study showed a positive pregnancy rate of 28.9%. The relationship between progesterone follicular index (Prog/FI) ratio and (ICSI) outcome was highly significant with a p value of 0.001. Additionally, an inverse relationship, as the ratio was lower the pregnancy rate was improved, was documented. The receiver operating characteristic (ROC) curve for progesterone follicular index ratio was 0.711 with a cut off value of 0.0354 ng/mL in addition to a sensitivity of 65.6 and a specificity of 65.4.

CONCLUSIONS

The serum progesterone level is an independent factor for the prediction of intracytoplasmic sperm injection (ICSI) outcome, whereas the progesterone follicular index ratio can be used as a potential marker for predicting ICSI outcome in fresh embryo transfer.

The Effect of Lameness on Milk Production of Dairy Goats

Lameness on dairy goat farms is a welfare concern and could negatively affect milk production. This study's objective was to evaluate the effects of clinical lameness on the daily milk production of dairy goats. Between July 2019 and June 2020, 11,847 test-day records were collected from 3145 goats on three farms in New Zealand. Locomotion scoring of goats used a five-point scoring system (0 to 4). The dataset was split into two groups by lactation type, where goats were classified as being in seasonal lactation (≤305 days in milk) or extended lactation (>305 days in milk). A linear mixed model was used to analyze datasets using milk characteristics as the dependent variables. Severely lame goats (score 4) in seasonal and extended lactation produced 7.05% and 8.67% less milk than goats not lame, respectively. When the prevalence of severe lameness is between 5 and 20% of the herd, the estimated average daily milk income lost was between NZD 19.5 and 104 per day. This study established the negative impact of lameness on milk production and annual income in dairy goats on three farms.

A Novel Approach to Staging and Detection of Colorectal Cancer in Early Stages

Colorectal cancer (CRC) is a significant problem affecting patients all over the world. Since it is the fourth most common cause of cancer-related deaths, many scientists aim to expand their knowledge on the detection in early stages and treatment of this disease. Chemokines, as protein parameters involved in many processes accompanying the development of cancer, constitute a group of potential biomarkers that could also be useful in the detection of CRC. For this purpose, our research team used the results of thirteen parameters (nine chemokines, one chemokine receptor and three comparative markers, i.e., CEA, CA19-9 and CRP) to calculate one hundred and fifty indexes. Moreover, for the first time, the relationship between these parameters during the ongoing cancer process and in comparison to a control group are presented. As a result of statistical analyses using patients' clinical data and the obtained indexes, it was established that several of the indexes have a diagnostic utility that is much higher than the tumor marker that is currently the most commonly used (CEA) currently. Furthermore, two of the indexes (CXCL14/CEA and CXCL16/CEA) showed not only extremely high usefulness in the detection of CRC in its early stages, but also the ability to determine whether the stage is low (stage I and II) or high (stage III and IV).

Neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and platelet-lymphocyte ratio in stroke-associated pneumonia: a systematic review and meta-analysis

BACKGROUND

Predicting stroke-associated pneumonia (SAP) is crucial for intensifying preventive measures and decreasing morbidity and mortality. This meta-analysis aims to evaluate the association between baseline neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) with SAP and to determine the strength of the association.

METHODS

The Web of Science, SCOPUS, and PUBMED databases were searched to find eligible studies. The standardized mean difference (SMD) and 95% confidence interval (CI) were used to evaluate the differences in NLR, MLR, and PLR levels between SAP and non-SAP patients. The meta-analysis was conducted using the software "Review Manager" (RevMan, version 5.4.1, September 2020). The random-effect model was used for the pooling analysis if there was substantial heterogeneity. Otherwise, the fixed-effect model was adopted.

RESULTS

Twelve studies comprising 6302 stroke patients were included. The pooled analyses revealed that patients with SAP had significantly higher levels of NLR, MLR, and PLR than the non-SAP group. The SMD, 95% CI, p-value, and I² for them were respectively reported as (0.88, 0.70-1.07, .00001, 77%); (0.94, 0.43-1.46, .0003, 93%); and (0.61, 0.47-0.75, .001, 0%). Subgroup analysis of NLR studies showed no significant differences in the effect size index between the severity of the stroke, the sample size, and the period between the stroke onset and the blood sampling.

CONCLUSION

This systematic review and meta-analysis suggest that an elevated NLR, MLR, and PLR were associated with SAP, indicating that they could be promising blood-based biomarkers for predicting SAP. Large-scale prospective studies from various ethnicities are recommended to validate this association before they can be applied in clinical practice.

The acute impact of baseline renal function and contrast medium volume/estimated glomerular filtration rate ratio on reduced renal function following endovascular abdominal aortic aneurysm repair

OBJECTIVE

The aim of this study was to determine the acute impact of baseline serum creatinine, estimated glomerular filtration rate (eGFR), and contrast medium volume (CMV) on the incidence of reduced renal function (RRF) after endovascular abdominal aortic aneurysm repair (EVAR). We aimed to determine if the CMV/eGFR ratio was a predictor of RRF.

METHODS

This study is a retrospective review of EVAR patients in the Society for Vascular Surgery/Vascular Quality Initiative (SVS/VQI) from January 2015 to August 2020. Reduced renal function was defined as > 0.3 mg/dl (26.5 μmol/L), 50% increase from baseline, and temporary or permanent dialysis. Receiver operator characteristic (ROC) curve analyses were conducted for serum creatinine, eGFR, contrast volume, fluid volume, and CMV/eGFR ratio. Two data sets (training and test) were developed followed by multivariate analyses.

RESULTS

SVS/VQI data for EVAR contained 38,701 records, of which 30,539 were divided into training (n = 18,283; 60%) and test (n = 12,256; 40%) data sets. RRF rate for the training set was 3.6% (n = 667) and 3.4% (n = 420) for the test data. RRF patients included more females (29.4 vs 19.0%, p < 0.001), were older in age (75.6 + 8.4 vs 73.3 + 8.7 years), had more congestive heart failure (22.3 vs 12.2%, p < 0.001), and more COPD (42.0 vs 34.2%, p < 0.001). An ROC analysis revealed that eGRF, creatinine, contrast, intravenous fluid, and contrast medium volume (CMV)/eGFR ratio were all significantly (p < 0.05) correlated with RRF. The eGFR and CMV/eGFR ratio had the largest area under the curve, (0.26) and (0.65), respectively, while fluid had the lowest (0.54). Negative predictive values were 93.7 (CMV/eGFR), 93.9 (creatinine), 94.2 (eGFR), 92.8 (contrast), and 92.6 (intravenous fluid). Multivariate analysis of the training data set resulted in the CMV/eGFR ratio as an independent predictor of RRF (odds ratio, OR: 1.9 with 95% CI: 1.6, 2.2, p < 0.015). For the test data, the CMV/eGFR ratio was an independent predictor of RRF (OR: 1.8, CI: 1.4 to 2.2, p < 0.001) as well as several other variables.

CONCLUSION

RRF after EVAR is a dreaded and potentially devastating complication. Baseline serum creatinine, eGFR, contrast medium volume, and the ratio (CMV/eGFR) were all significantly associated with RRF. The optimal cut-off value for the CMV/eGFR ratio, ≤ 2, provides an easy-to-use equation to provide a suggested contrast target based on initial renal function with caution applied for high-risk patients.

Effect of Suture Length on the Incidence of Incisional Hernia and Surgical Site Infection in Patients Undergoing Midline Laparotomy: A Systematic Review and Meta-Analysis

The development of an incisional hernia is a common complication of midline laparotomy. Improper fascial closure techniques have a significant role in its development. It can also lead to poor wound healing and increase the risk of developing surgical site infections (SSI). Upon conducting a thorough literature review, various studies have been conducted on closing abdominal wounds. However, there is a dearth of studies portraying the role of suture length in the prevention of incisional hernia and SSI. The effect of using a greater suture-to-wound length ratio on postoperative outcomes was not clearly analyzed or described. The objective of this study is to assess the effectiveness of using a suture length to wound length ratio ≥4:1 versus a ratio <4:1 in preventing postoperative complications such as incisional hernia and SSI. This study is a systematic review of randomized controlled trials on abdominal wound closure using a suture length to wound length ratio of ≥4:1 and <4:1. published in PubMed, Google Scholar, and Cochrane library. The inclusion and exclusion criteria were defined. The relevant studies identified from 1991 to 2017, were included in the analysis. The primary endpoint was the incidence of incisional hernia, and the secondary outcome was the incidence of SSI. This meta-analysis considered five randomized controlled trials that compared the effects of using different suture length to wound length ratios during abdominal closure on incisional hernia and SSI. Participants ranged in size from 100 to 363. The trial follow-up period ranged from a minimum of 10 months to five years. The outcomes studied in the two groups were incisional hernia and SSI. The relative risk of the occurrence of incisional hernia if the suture length to wound length ratio was ≥4:1 was 0.42 with a p-value of <0.001 which was considered significant. This implied that using a suture length of more than four times that of the wound i.e., 4:1, significantly decreases the risk of developing an incisional hernia by more than half. The relative risk of developing a SSI was 0.98 with a p-value of 0.966. Thus, this method of abdominal closure uing a longer suture length to wound length ratio does not contribute to an increased incidence or significant change in the risk of developing SSI.

Decision-making from temporally accumulated conflicting evidence: The more the merrier

How do humans evaluate temporally accumulated discrete pieces of evidence and arrive at a decision despite the presence of conflicting evidence? In the present study, we showed human participants a sequential presentation of objects drawn from two novel object categories and asked them to decide whether a given presentation contained more objects from one or the other category. We found that both a more disparate ratio and greater numerosity of objects improved both reaction time (RT) and accuracy. The effect of numerosity was separate from ratio, where with a fixed object ratio, sequences with more total objects had lower RT and lower error rates than those with fewer total objects. We replicated these results across three experiments. Additionally, even with the total presentation duration equated and with the motor response assignment varied from trial to trial, an effect of numerosity was still found in RT. The same RT benefit was also present when objects were shown simultaneously, rather than sequentially. Together, these results showed that, for comparative numerosity judgment involving sequential displays, there was a benefit of numerosity, such that showing more objects independent of the object ratio and the total presentation time led to faster decision performance.

Assessment of carnitine excretion and its ratio to plasma free carnitine as a biomarker for primary carnitine deficiency in newborns

In the Netherlands, newborns are referred by the newborn screening (NBS) Program when a low free carnitine (C0) concentration (<5 μmol/l) is detected in their NBS dried blood spot. This leads to ~85% false positive referrals who all need an invasive, expensive and lengthy evaluation. We investigated whether a ratio of urine C0 / plasma C0 (RatioU:P) can improve the follow-up protocol for primary carnitine deficiency (PCD). A retrospective study was performed in all Dutch metabolic centres, using samples from newborns and mothers referred by NBS due to low C0 concentration. Samples were included when C0 excretion and plasma C0 concentration were sampled on the same day. RatioU:P was calculated as (urine C0 [μmol/mmol creatinine])/(plasma C0 [μmol/l]). Data were available for 59 patients with genetically confirmed PCD and 68 individuals without PCD. The RatioU:P in PCD patients was significantly higher (p value < 0.001) than in those without PCD, median [IQR], respectively: 3.4 [1.2-9.5], 0.4 [0.3-0.8], area under the curve (AUC) 0.837. Classified for age (up to 1 month) and without carnitine suppletion (PCD; N = 12, Non-PCD; N = 40), medians were 6.20 [4.4-8.8] and 0.37 [0.24-0.56], respectively. The AUC for RatioU:P was 0.996 with a cut-off required for 100% sensitivity at 1.7 (yielding one false positive case). RatioU:P accurately discriminates between positive and false positive newborn referrals for PCD by NBS. RatioU:P is less effective as a discriminative tool for PCD in adults and for individuals that receive carnitine suppletion.

Age-related changes in the ratio of Type I/III collagen and fibril diameter in mouse skin

The content of type I collagen (COL-I) and type III collagen (COL-III) and the ratio between them not only affect the skin elasticity and mechanical strength, but also determine the fibril diameter. In this research, we investigated the age-related changes in COL-I/COL-III ratio with their formed fibril diameter. The experimental result was obtained from high performance liquid chromatography-mass spectrometer, hydroxyproline determination, picrosirius red staining and transmission electron microscopes (TEM), respectively. The result indicated that the COL-I/COL-III ratio in mouse skin increased with aging. From the 0th to 9th week, the COL-I/COLIII ratio increased from 1.3:1 to 4.5:1. From the 9th to the 18th week, it remained between 4.5:1 and 4.9:1. The total content of COL-I and COL-III firstly increased and then decreased with aging. The TEM result showed that the fibril diameter increased with aging. From the 0th to 9th week, the average fibril diameter increased from 40 to 112 nm; From the 9th to 18th weeks, it increased from 112 to 140 nm. After the 9th week. The fibril diameter showed obvious uneven distribution. Thus, the COL-I/COLIII ratio was proportional to the fibril diameter, but inversely proportional to the uniformity of fibril diameter.

Cerebrospinal fluid white cell count to red cell count ratio as a predictor of ventriculitis in patients with external ventricular drains

INTRODUCTION

External ventricular drain (EVD) associated ventriculitis is a complication of EVD placement associated with significant morbidity and mortality. Gold-standard for EVD associated bacterial ventriculitis diagnosis involves cerebrospinal fluid (CSF) sampling from the EVD with microscopy, culture and sensitivity testing. The ratio of white blood cells to red blood cells has anecdotally been considered a predictive factor in diagnosing EVD associated ventriculitis, however no study has been done demonstrating this.

METHODS

A retrospective cross-sectional study was designed to assess whether the ratio of CSF white blood cells to red blood cells could be used to diagnose EVD associated ventriculitis. Data was collected for all patients undergoing EVD insertion at a major neurosurgical unit in Sydney, Australia. A receiver operator characteristics (ROC) curve was used to determine if this ratio was useful, and Youden's index was calculated to determine the appropriate cut-off point.

RESULTS

This sample of n = 157 consecutive patients a total of 29 patients were diagnosed with ventriculitis. The area under the ROC curve was significant (0.706, P <0.001), and Youden's index demonstrated an appropriate cut-off point was a ratio of 1:106.

DISCUSSION

CSF parameters have long been considered predictive of EVD associated ventriculitis. We demonstrated that using a component of routine testing it is possible to accurately predict a ventriculitis diagnosis. As the ratio is used, it enables discrimination in a raised white blood cell count due to local trauma with interventricular bleeding.

CONCLUSION

CSF white blood cell to red blood cell ratio is an appropriate diagnostic test for ventriculitis.

Density of nurses and midwives in sub-Saharan Africa: Trends analysis over the period 2004-2016

AIM

To analyse the trends of density rates of nurses and midwives per population in sub-Saharan Africa over the period from 2004 to 2016.

BACKGROUND

Nursing, the largest health care workforce, is actively contributing to the achievement of the Sustainable Development Goals. The African continent is one of the most affected areas by the differences in the density of nurses and midwives indicator.

METHODS

Joinpoint regression analysis was applied to identify significant changes in trends of the density of nurses and midwives from the 50 countries of sub-Saharan Africa.

RESULTS

From 2004 to 2013, the density of nurses and midwives in sub-Saharan Africa increased significantly from 5.6 to 12.44 per 10,000 population, although it exhibited a increasing trend of a magnitude of 8.3% until 2013 that does not continue from that year.

CONCLUSIONS

Only seven countries show an increasing trend, although in the case of the rest, they do not present any trend that suggests a change in this indicator in the short term.

IMPLICATIONS FOR NURSING MANAGEMENT

From a macrolevel nursing management point of view, our study shows the importance of implementing actions that contribute to the increase of the nursing workforce in Africa, essential to achieve the Sustainable Development Goals.

Peripheral Blood Cell Ratios as Prognostic Indicators in a Neoadjuvant Chemotherapy-Treated Breast Cancer Cohort

Breast cancer represents a heterogeneous condition in which the interaction between host immune response and primary oncogenic events can impact disease progression. Ratios of systemic blood-based immunocytes have emerged as clinically-relevant prognostic biomarkers in cancer patients. The NLR (neutrophil-to-lymphocyte ratio) has been shown to be prognostic in a variety of cancers, including breast cancer. However, evaluation of the prognostic value for overall survival (OS) and disease-free survival (DFS) of other key immunocyte ratios-neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-white cell count ratio (NWR), lymphocyte-to-white cell count ratio (LWR), monocyte-to-white cell count ratio (MWR), platelet-to-lymphocyte (PLR)-by breast cancer subtypes in a neoadjuvant chemotherapy (NAC) cohort remains to be fully explored. An NAC-treated breast cancer cohort, comprised of Luminal A, Luminal B, HER2-positive, and triple negative/basal breast cancers, treated at a tertiary referral center (minimum 3-year follow-up), was used to calculate immunocyte ratios and immunocyte cut-off values, calculated with >80% specificity (using decision tree modeling). The association with subtype-specific OS, DFS, and tumor grade was analyzed using cut offs calculated using both receiver operating characteristic curves and decision tree modelling. Decision tree calculated ratios showed that LMR (5.29) and MWR (0.06) were significantly associated with Luminal A OS (p = 0.004 and p = 0.022) and DFS (p = 0.004 and p = 0.022), and Luminal B OS (p = 0.027 and p = 0.008) and DFS (p = 0.005 and p = 0.007). NLR (1.79) and LWR (0.30) were significantly associated with HER2-positive OS (p = 0.013 and p = 0.043). NLR (1.79) and NWR (0.62) were significantly associated with DFS (p = 0.035 and p = 0.021). No significant association we observed between any immunocyte ratio in the triple negative cohort. Our results demonstrate the subtype-specific prognostic value of immunocyte ratios in NAC-treated breast cancer patients. Further validation of immunocyte ratios will provide clinicians with a new prognostic aid for disease management and monitoring.

The Prediction of Surgery Outcomes in Abdominal Tumor Patients with Sepsis by Pcv-aCO2/Ca-cvO2

Background

To determine whether Pcv-aCO2/Ca-cvO2 combined with Pcv-aCO2 could predict the outcomes in patients complicated with abdominal infection and sepsis after abdominal tumor operation.

Methods

Total 92 patients admitted to our hospital from January 2017 to December 2020 who underwent abdominal tumor operation were enrolled. Blood gas analysis of artery and central vein, various laboratory indexes, SOFA score, hemodynamic parameters at different time points and treatment outcome were recorded.

Results

ROC curve analysis showed that hemodynamic parameter alone could not predict ICU treatment outcome and mortality of patients, but 72-hour SOFA score could predict treatment outcome of patients (AUC = 0.930, 95% CI: 0.803–1.000, p = 0.019). The significant hemodynamic parameter for evaluating treatment outcome and prognosis of patients was Pcv-aCO2 + Ratio of T3. Kaplan–Meier univariate survival curve and Log-rank suggested that patients who had higher combined predictive parameter of T3 Ratio + T3 Pcv-aCO2 still had ischemia and hypoxia of tissues and organs after standard fluid resuscitation, and treatment outcome was not good. In subgroup analysis, patients with higher Ratio had higher lactate, higher T72 SOFA score, and poor treatment outcome.

Conclusion

The combination of Ratio and Pcv-aCO2 could evaluate clinical treatment outcome of patients complicated with abdominal infection and sepsis after abdominal tumor operation.

The Role of the Pediatric Yorkhill Malnutrition Score (PYMS), Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in Malnutrition Prediction of Hospitalized Children

Malnutrition in hospitalized children represents a significant burden with occasionally detrimental consequences. In this retrospective analysis of pediatric patients aged one to 16 years old, who were hospitalized in the children’s cantonal hospital of Aarau, Switzerland, we investigated the utilization of PYMS (Pediatric Yorkhill Malnutrition Score) as a routine screening tool for malnutrition in pediatric inpatients. Additionally, we explored the correlation between PYMS and NLR (neutrophil−lymphocyte ratio) and PLR (platelet−lymphocyte ratio), which are two novel biomarkers. Various parameters were analyzed from the medical records of the patients. Most of the sample (n = 211, 77.3%) was characterized by a low PYMS of 0−1 point. Greater NLR and PLR values were significantly associated with greater PYMS (p = 0.030 and p = 0.004, respectively). ROC (receiver operating characteristic curves) analysis revealed that PLR had a significant predictive ability for having PYMS > 1 (AUC = 0.59; 95% CI: 0.51−0.68; p = 0.024). The optimal cut-off was 151 with sensitivity of 51.6% (95% CI: 38.6−64.5%) and specificity of 67.3% (95% CI: 60.5−73.6%). Furthermore, 37% of the children (n = 101) yielded a PLR over 151. Our results support a promising value of PLR as a predictive marker for moderate to severe malnutrition in hospitalized children.

Optimization and field evaluation of sex-pheromone of potato tuber moth, Phthorimaea operculella Zeller (Lepidoptera: Gelechiidae)

BACKGROUND

The potato tuber moth, Phthorimaea operculella is a key pest of potato and tobacco in China. We compared the sex pheromone titers released by P. operculella female, and the electroantennogram (EAG) responses of male antennae to pheromone compounds under laboratory conditions. Then, the optimal sex pheromone ratio was screened in the field.

RESULTS

The P. operculella sex pheromone feeding on potato or tobacco was extracted by solvent-extraction method. Main sex pheromone compounds including E4, Z7-13: AC (PTM1) and E4, Z7, Z10-13: AC (PTM2) were found in gland. The titer and relative ratio of P. operculella sex pheromone compounds secreted by female adult moths differ between host populations, while the relative EAG responses trend of P. operculella males to the pheromone components were the same when directly stimulated. In field trials, PTM1:PTM2 = 8:1-4:1 and PTM1:PTM2 = 1:4-1:7 was the most attractive ratio to P. operculella males in tobacco and potato fields, respectively. During 2019-2020, after 8 weeks of mass trapping for each year, the sex pheromone could reduce the population of P. operculella in the potato and tobacco fields.

CONCLUSIONS

In this study, fixed property and quantity analyzing methods were adopted to compare sex pheromones from feeding on potato versus tobacco. EAG tests then were carried out on P. operculella males. Finally, we optimized the ratio of two sex pheromone compounds in potato and examined how this influenced field trapping. By further improving the parameters of sex pheromone application in the field, we demonstrate that deployment of sex pheromones can provide effective control of P. operculella. © 2021 Society of Chemical Industry.

Glucose to Platelet Ratio: A Potential Predictor of Hemorrhagic Transformation in Patients with Acute Ischemic Stroke

Glucose and platelet are two easily obtained clinical indicators; the present research aimed to demonstrate their association with hemorrhagic transformation (HT) in acute ischemic stroke (AIS) patients without thrombolytic or thrombectomy therapy. This was a single-center retrospective study. Patients who were diagnosed with HT after AIS were included in the HT group. Meanwhile, using the propensity score matching (PSM) approach, with a ratio of 1:2, matched patients without HT were included in the non-HT group. Serum G/P levels were measured on the first morning after admission (at least eight hours after the last meal). Characteristics were compared between the two groups. Multivariate logistic regression was used to determine the independent relationship between G/P and HT after AIS, with G/P being divided into quartiles. From January 2013 to March 2022, we consecutively included 643 AIS patients with HT (426/643 [66.25%] with HI and 217/643 [33.75%] with PH), and 1282 AIS patients without HT, at the First Affiliated Hospital of Wenzhou Medical University. The HT group had higher G/P levels than the non-HT group (0.04 ± 0.02 vs. 0.03 ± 0.02, p < 0.001). However, there was no difference in G/P levels between HI and PH subgroups (0.04 ± 0.02 vs. 0.04 ± 0.02, p > 0.05). Moreover, the G/P levels were divided into quartiles (Q1 ≤ 0.022; Q2 = 0.023−0.028; Q3 = 0.029−0.039; Q4 ≥ 0.040), with Q1 being settled as the reference layer. After controlling the confounders, multivariate regression analyses showed that the Q4 layer (Q4: G/P ≥ 0.040) was independently associated with elevated HT risk (odds ratio [OR] = 1.85, 95% CI = 1.31−2.63, p < 0.001). G/P levels on admission were independently associated with HT risk in AIS patients. In clinical practice, adequate attention should be paid to AIS patients with elevated G/P levels (G/P ≥ 0.040).

Relation of Dietary n-3 and n-6 Fatty Acid Intakes to Metabolic Syndrome in Middle-Aged People Depending on the Level of HbA1c: A Review of National Health and Nutrition Survey Data from 2014 to 2016

Background and Objectives: The relation of dietary n-6 fatty acid to metabolic syndrome has not been examined and clearly defined. To improve health in the general population, this study was to investigate the role of n-3 and n-6 fatty acids in the reduction in metabolic syndrome and to observe changes in the effects of these fatty acids depending on the level of insulin resistance. Materials and Methods: This cross-sectional study utilized national health and nutrition survey data from 2014 to 2016. From the data, a relation of n-3 and n-6 fatty acid intakes to metabolic syndrome and Hemoglobin A1c (HbA1c)’s role in the relation was evaluated and analyzed for 4852 patients between 40 and 64 years old. Intake frequency of 112 nutrition and daily consumption amounts were identified, and intakes of n-3 and n-4 fatty acids were calculated from this data. Metabolic syndrome was determined for each participant using diagnostic standards for the Asian population published by the National Cholesterol Education Program. Results: Among the total 4852 subjects, 1583 (32.6%) had metabolic syndrome; 736 of 1875 (39.3%) males and 847 of 2977 (28.5%) females had the syndrome. In males, when their HbA1c was low (<5.4%), intakes of both n-3 and n-6 fatty acids were related to a 43−63% decreased prevalence of metabolic syndrome with significance, and a similar negative tendency was also observed in females. On the contrary, for both males and females, no statistically significant correlation was present when HbA1c was high. Conclusion: It was considered that consistent and regular dietary intakes of n-3 and n-6 fatty acids may contribute greatly to prevent or treat metabolic syndrome in healthy males with normal insulin sensitivity, but the effect of their dietary intakes was found to be limited in a group with strong insulin resistance. The conclusion of this study presents a valuable reference and knowledge to provide nutritional education to the general population.

Long-tailed macaques: an unfairness model for humans

The current study was designed to predict why human primates often behave unfairly (equity aversion) by not exhibiting equity preference (the ability to equally distribute outcomes 1:1 among participants). Parallel to humans, besides inequity aversion, lab monkeys such as kin of long-tailed macaques (Macaca fascicularis) also demonstrate equity aversion depending on their preference for the outcome (food) type. During the pre-experiment phase, a food-preference test was conducted to determine the most preferred income per individual monkey. Red grapes were the most preferred outcome (100%) when compared to vanilla wafers (0%). The first set of experiments used a 1:1 ratio (equity condition) of grape distribution among six kin-pairs of female long-tailed macaques, and we compared their aversion (Av) versus acceptance (Ac). In the second experiment, we assessed the response to the 0:2 and 1:3 ratio distribution of grapes (inequity condition). A total of 60 trials were conducted for each condition with N = 6 pairs. Our results show aversion to the inequity conditions (1:3 ratios) in long-tailed macaques was not significantly different from aversion to the equity conditions (1:1 ratios). We suggest that the aversion observed in this species was associated with the degree of preference for the outcome (food type) offered rather than the distribution ratio. The subjective preferences for outcome types could bring this species into irrationality; they failed to share foods with an equal ratio of 1:1.

"Transsexuality" and gender ratio in Poland: A case study on the East/West dichotomy

The article investigates scientific and journalistic discourses around differences in gender ratio among trans persons. The disparity between Poland and many other countries that was first noted in the 1980s was repeatedly associated with the different gender politics in the capitalist West and the (post) state-socialist East. Using Foucauldian methodology, the article claims that this discourse was constructed such that Poland's ratio-and consequently Poland's gender order-would always appear problematic, while Western countries were considered an invisible standard. Discourses around this ratio elucidate the role of heteronormativity and biological essentialism in the construction of the category of "transsexuality" in state-socialist Poland. The analysis also reveals that chronologies of LGBT and feminist movements had direct consequences for the theoretical and cultural spaces of trans identities.

Hair Cortisol and DHEA-S in Foals and Mares as a Retrospective Picture of Feto-Maternal Relationship under Physiological and Pathological Conditions

Equine fetal hair starts to grow at around 270 days of pregnancy, and hair collected at birth reflects hormones of the last third of pregnancy. The study aimed to evaluate cortisol (CORT) and dehydroepiandrosterone-sulfate (DHEA-S) concentrations and their ratio in the trichological matrix of foals and mares in relation to their clinical parameters; the clinical condition of the neonate (study 1); the housing place at parturition (study 2). In study 1, 107 mare-foal pairs were divided into healthy (group H; n = 56) and sick (group S; n = 51) foals, whereas in study 2, group H was divided into hospital (n = 30) and breeding farm (n = 26) parturition. Steroids from hair were measured using a solid-phase microtiter radioimmunoassay. In study 1, hair CORT concentrations measured in foals did not differ between groups and did not appear to be influenced by clinical parameters. A correlation between foal and mare hair CORT concentrations (p = 0.019; r = 0.312, group H; p = 0.006; r = 0.349, group S) and between CORT and DHEA-S concentrations in foals (p = 0.018; r = 0.282, group H; p < 0.001; r = 0.44, group S) and mares (p = 0.006; r = 0.361, group H; p = 0.027; r = 0.271, group S) exists in both groups. Increased hair DHEA-S concentrations (p = 0.033) and decreased CORT/DHEA-S ratio (p < 0.001) appear to be potential biomarkers of chronic stress in the final third of pregnancy, as well as a potential sign of resilience and allostatic load in sick foals, and deserve further attention in the evaluation of prenatal hypothalamus-pituitary-adrenal (HPA) axis activity in the equine species. In study 2, hormone concentrations in the hair of mares hospitalized for attended parturition did not differ from those that were foaled at the breeding farm. This result could be related to a too brief period of hospitalization to cause significant changes in steroid deposition in the mare’s hair.

Total protein concentration as a predictor of in neoplastic peritoneal and pleural effusions of dogs

BACKGROUND

The diagnosis of neoplastic cavitary effusions requires the identification of neoplastic cells in effusions, yet the cytologic appearance of neoplastic effusions can be highly variable due to the varied mechanisms of formation. Additional parameters might aid in the interpretation of equivocal cytologic results.

OBJECTIVES

Our goal was to evaluate whether total protein concentrations can be used to support the diagnosis of neoplasia in the peritoneal and pleural effusions of dogs with lower cellularities (≤5000 nucleated cells/μL).

METHODS

Pleural and peritoneal fluid analyses from dogs presented to the University of Illinois Veterinary Teaching Hospital between 2014 and 2019 were evaluated retrospectively. Effusions were categorized as neoplastic or non-neoplastic based on histology or cytology. Non-neoplastic effusions were subcategorized according to mechanism: decreased oncotic pressure, increased hydrostatic pressure, increased vascular permeability, leakage of urine, and leakage of lymph. The TP and blood albumin to fluid TP ratio (Alb_blood :TP_fluid ) were compared among groups.

RESULTS

Twenty-seven neoplastic and 65 non-neoplastic cases were evaluated. TP was higher in the neoplastic group (P = .001) than in the non-neoplastic group. Neoplastic effusions had a lower Alb_blood :TP_fluid than non-neoplastic (P = .001), and effusions with Alb_blood :TP_fluid of ≤0.6 were 5.6 times more likely to be neoplastic (95% CI 1.69-17.36; P = .003).

CONCLUSIONS

Fluid TP concentrations were significantly greater in neoplastic than non-neoplastic effusions; however, given the considerable overlap between groups, the diagnostic utility of this difference is low. A neoplastic etiology might be more likely in cases with an Alb_blood :TP_fluid ≤0.6.

Biopsy Ratio of Suspected to Confirmed Sarcoma Diagnosis

Simple Summary

Determining the biology of mesenchymal tumor, imaging alone is usually not enough, and the final diagnosis is established through tissue analysis If the indication to perform a biopsy is not established frequently enough, an undesired unplanned resection of a sarcoma may result, and conversely, a patient’s discomfort as well as costs may increase. In here, using a real-world data registry of quality, we included the absolute number of a consecutive series of patients, to determine the prevalence of biopsies and its related diagnosis, to establish a reference, which may allow for the definition of a quality indicator for the work-up within a multidisciplinary team.

Abstract

The ratio of malignancy in suspicious soft tissue and bone neoplasms (RMST) has not been often addressed in the literature. However, this value is important to understand whether biopsies are performed too often, or not often enough, and may therefore serve as a quality indicator of work-up for a multidisciplinary team (MDT). A prerequisite for the RMST of an MDT is the assessment of absolute real-world data to avoid bias and to allow comparison among other MDTs. Analyzing 950 consecutive biopsies for sarcoma-suspected lesions over a 3.2-year period, 55% sarcomas were confirmed; 28% turned out to be benign mesenchymal tumors, and 17% non-mesenchymal tumors, respectively. Of these, 3.5% were metastases from other solid malignancies, 1.5% hematologic tumors and 13% sarcoma simulators, which most often were degenerative or inflammatory processes. The RMST for biopsied lipomatous lesions was 39%. The ratio of unplanned resections was 10% in this series. Reorganizing sarcoma work-up into integrating practice units (IPU) allows the assessment of real-world data with absolute values over the geography, thereby enabling the definition of quality indicators and addressing cost efficiency aspects of sarcoma care.

9: Evaluation of the neck circumference to thyromental distance ratio as a predictor of difficult intubation-A prospective observational study

Background and Aims:

Preoperative identification of difficult airway and subsequent planning is of utmost importance for patient safety. Previous studies have identified neck circumference to thyromental distance ratio (NC/TMD) as a reliable predictor of difficult intubation in obese patients.[1] But, there is lack of a reported study evaluating NC/TMD in the non-obese patients. The aim of our study was to evaluate the NC/TMD as a predictor of difficult intubation in both obese and non-obese patients.

Methods::

A prospective observational study was conducted after obtaining Institutional Ethics Committee clearance and written informed consent from each patient. Hundred adult patients undergoing elective surgeries under general anaesthesia with orotracheal intubation were included in this study. Difficulty in intubation was assessed using Intubation Difficulty Scale (IDS>5).[2] The NC/TMD was calculated and was compared with other established parameters in predicting difficult intubation in both obese and non-obese patients. Statistical Package for the Social Sciences (SPSS) software (version 22.0) was used for statistical analysis.

Results:

Univariate logistic regression analysis showed that sex, weight, body mass index, inter-incisor gap, Mallampati classification, neck circumference, thyromental distance, sternomental distance and NC/TMD had a significant association with difficult intubation. NC/TMD has a higher sensitivity, specificity, PPV and NPV with a large area under curve (AUC) (P = 0.000) in comparison to other parameters.

Conclusion:

The NC/TMD is a reliable and better predictor of difficult intubation in both obese and non-obese patients in comparison to neck circumference, thyromental distance, sternomental distance alone

Improvements in Endovascular Treatment for Acute Ischemic Stroke: A Longitudinal Study in the MR CLEAN Registry

We evaluated data from all patients in the Netherlands who underwent endovascular treatment for acute ischemic stroke in the past 3.5 years, to identify nationwide trends in time to treatment and procedural success, and assess their effect on clinical outcomes.

Comparison among low intensity bridge exercises using suspension devices based on muscle activity and subjective difficulty

BACKGROUND

Recent clinical studies have revealed the advantages of using suspension devices. Although the supine, lateral, and forward leaning bridge exercises are low-intensity exercises with suspension devices, there is a lack of studies directly comparing exercise progression by measuring muscular activity and subjective difficulty.

OBJECTIVE

To identify how the variations in the bridge exercise affects trunk muscle activity, the present study investigated changes in neuromuscular activation during low-intensity bridge exercises. We furthermore explored whether the height of the suspension point affects muscle activation and subjective difficulty.

METHODS

Nineteen asymptomatic male participants were included. Three bridge exercise positions, supine bridge (SB), lateral bridge (LB), forward leaning (FL), and two exercise angles (15 and 30 degrees) were administered, thereby comparing six bridge exercise conditions with suspension devices. Surface electromyography and subjective difficulty data were collected.

RESULTS

The rectus abdominis activity was significantly higher with the LB and FL exercises compared with the SB exercise (p< 0.05). The erector spinae muscle activity was significantly higher with the SB and LB exercises, compared with the FL exercise (p< 0.05). The LB exercise significantly increased the internal oblique muscle activity, compared with other exercise variations (p< 0.05). The inclination angle of the exercise only affected the internal oblique muscle and subjective difficulty, which were significantly higher at 30 degrees compared with 15 degrees (p< 0.05).

CONCLUSIONS

Relatively higher inclination angle was not effective in overall activation of the trunk muscles; however, different bridge-type exercises could selectively activate the trunk muscles. The LB and SB exercises could be good options for stimulating the internal oblique abdominis, and the erector spinae muscle, while the FL exercise could minimize the erector spinae activity and activate the abdominal muscles.

Angle specific analysis of hamstrings and quadriceps isokinetic torque identify residual deficits in soccer players following ACL reconstruction: a longitudinal investigation

 Analysing the isokinetic curve is important following ACL reconstruction as there may be deficits in torque production at specific points throughout the range of motion. We examined isokinetic (60°.s-1) torque-angle characteristics in 27 male soccer players (24.5 ± 3.9 years) at 3 time-points (17 ± 5; 25 ± 6; and 34 ± 7 weeks post-surgery). Extracted data included knee flexor and extensor peak torque, conventional hamstrings: quadriceps (H/Q) ratio, and angle-specific torque using Statistical Parametric Mapping (SPM). There were significant involved limb increases in extension peak torque at each assessment (p<0.001); however, asymmetry favouring the un-involved limb was observed (p<0.01). Flexion peak torque was greater on the un-involved limb at assessments 1 and 2 only (p<0.05). The angle of peak torque was not significantly different at individual time-points or within-limbs across the 3 assessments. SPM revealed involved limb angle-specific reductions in extension torque across the full range of motion at time-points 1 and 2 (p<0.001) but only in angles [51-80°] at assessment 3 (p<0.05). Between limb H/Q angle differences [33-45°] were shown at assessments 2 and 3. The ratio ranged from 1.60-0.74 depending on the angle tested. Angle-specific moment curves are useful for monitoring patterns of strength development during rehabilitation.

Characteristics of the length of the radius and ulna in children

OBJECTIVES

Congenital malformation, trauma, tumor, or metabolic disease can cause length deformity of the radius or ulna, affecting the appearance and function of the forearm. Osteotomy and lengthening with external fixation can obviously improve the length of the radius and ulna (LRU). However, the extent of lengthening required is still unclear. This study analyzed the LRU in children, to provide suggested standards for various orthopedic treatments.

METHODS

Normal LRUs were measured on X-ray images in children who came to hospital for emergency treatment, with measurements including anterior-posterior (AP) radiographs, lateral (LAT) radiographs, full LRU (total length), and LRU without the epiphysis (short length). Any cases of fracture or deformity affecting measurement were excluded. Three hundred twenty-six cases were divided into 16 groups according to age from 1 year old to 16 years old.

RESULTS

The earliest epiphyseal plate and ossification center were observed in the distal part of the radius at 1 year old, and in the proximal part at 3 years old in both boys and girls. In the ulna, at the distal end it was 6 years old in girls and 7 years old in boys, while in the proximal part ossification was observed at 9 years old in both boys and girls. The proximal epiphyseal plate of the ulna began to close on X-ray images at 12 years old in girls and 13 years in boys. LRU increased with age, and there was a strong positive correlation and consistent ratio between radius, ulna and age. In short length, the ratio of the length of radius to ulna (RLRU) ranged from 0.8941 to 0.9251 AP, from 0.8936 to 0.9375 LAT. In total length, RLRU ranged from 0.9286 to 0.9508 AP, and 0.9579 to 0.9698 LAT.

CONCLUSIONS

The length and epiphyseal ossification of the radius and ulna are associated with age. RLRU is also limited to a certain range and tends to remain stable with age. These characteristics have clinical significance for deformity correction of the forearm.

Procalcitonin to C-reactive protein ratio is associated with short-term mortality in ischemic stroke patients: preliminary report

INTRODUCTION

Inflammation is associated with the development and progression of ischemic stroke. In this study, we tested the diagnostic ability of procalcitonin (PCT) to C-reactive protein (CRP) ratio (PC ratio; ×10^-6) to predict 90-day mortality in ischemic stroke patients.

MATERIAL AND METHODS

We retrospectively collected the medical records of patients with a diagnosis of ischemic stroke from February 2008 to January 2018. We analyzed the data of study patients with both PCT and CRP results, and evaluated the relationship between PC ratio and 90-day mortality. Logistic regression was adjusted for confounders and survival analysis was conducted using the Kaplan-Meier estimation.

RESULTS

A total of 333 patients were analyzed in this study. As compared with the lowest PC ratio quartile (0-2.1), the odds ratios for 90-day mortality were; 1.47 (95% CI: 0.62-4.20) for the 2^nd quartile (2.2-6.3, p = 0.440), 2.54 (95% CI: 0.95-5.91) for the 3^rd quartile (6.4-19.6, p = 0.048), and 4.10 (95% CI: 1.73-9.80) for the 4^th quartile (≥ 19.7, p = 0.002), after adjusting for age, sex, medical history, and laboratory results. A higher PC ratio (≥ 2.2) was associated with higher mortality (p < 0.05) in ischemic stroke patients in Kaplan-Meier estimation, and this was confirmed by the log-rank test (p < 0.001).

CONCLUSIONS

Procalcitonin to C-reactive protein ratio was found to be positively associated with 90-day mortality in ischemic stroke patients. Our findings indicate that PC ratio may be a useful marker for predicting mortality after ischemic stroke. Further prospective studies are required to investigate and validate the use of PC ratio in clinical practice.

Relationships Between Circulating Tenascin-C Levels and Gonadal Hormones in Male Patients with Depressive Disorder: A Retrospective, Cross-Sectional Study

OBJECTIVE

Tenascin-C (TNC) is an extracellular matrix glycoprotein closely associated with the progression of psychiatric disorders. The present study was performed to investigate the possible association between serum gonadal hormones and TNC levels in male patients with depressive disorder.

MATERIALS AND METHODS

We measured serum TNC levels by enzyme-linked immunosorbent assay. In addition, we investigated the influence of testosterone (T) and estradiol (E2) on TNC levels in primary neuronal cultures.

RESULTS

Patients with depression had lower levels of T, free tri-iodothyronine (FT3), thyroid-stimulating hormone (TSH), and the T/E2 ratio than healthy control patients. Levels of TNC and high-sensitivity C-reactive protein were significantly higher in patients than in healthy volunteers. Serum TNC concentrations were negatively associated with levels of E2 and T and with the T/E2 ratio. Levels of TNC, TSH, and FT3 and the T/E2 ratio were predictors of depression. Among men with depression, TNC was negatively associated with T levels and with the T/E2 ratio. Incubating pheochromocytoma 12 cells with the combination of T and E2 greatly decreased TNC levels in the culture medium.

CONCLUSION

Increased TNC levels may predict imbalance between T and E2 in patients with depression, and gonadal hormones may modulate TNC expression in vivo.

The Prognostic Significance of Preoperative Platelet-to-Lymphocyte and Neutrophil-to-Lymphocyte Ratios in Patients Operated for Non-Small Cell Lung Cancer

Introduction

The aim of the study was to determine the prognostic significance of PLR and NLR ratios in patients operated due to non-small cell lung cancer.

Material

The study group consisted of 532 (174 women, 358 men) patients with non-small cell lung cancer (NSCLC) staged IA-IIIA. The mean age was 63.6 years (range 36 to 84 years). Together with platelet/lymphocyte ratio (PLR) and neutrophil/lymphocyte ratio (NLR), the following factors were included in the statistical analysis: age, sex, smoking history, the number of leukocytes, neutrophils, and platelets, histopathology, T-stage, N-stage, concomitant diseases according to the Charlson Comorbidity Index (CCI), type of operation, adjuvant chemotherapy, and overall survival.

Results

Univariate analysis showed an association between the value of PLR and NLR and the length of survival. Multivariate analysis found that the stage of advancement of the neoplastic disease (p=0.00003), adjuvant chemotherapy (p=0.009), CCI > 4 (0.00008), and PLR > 144 (p=0.001) were negative prognostic factors for survival > 2 years; however, this effect diminishes in patients surviving more than 5 years.

Conclusion

PLR might serve as a prognostic factor in patients affected by NSCLC with expected two-year overall survival.

Lactic Dehydrogenase to Albumin Ratio Is Associated With the Risk of Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke

Background: Stroke-associated pneumonia (SAP) is one of the common complications of stroke patients. Higher lactic dehydrogenase (LDH) and lower albumin levels were associated with SAP, but the contribution of the LDH to albumin ratio (LAR) to the risk of SAP in acute ischemic stroke (AIS) patients remained unclear. Methods: A total of 3173 AIS patients were included in this study, divided into SAP (n = 417) and non-SAP groups (n = 2756). Characteristics were compared between these two groups. The receiver operating characteristic curves (ROC) were used to evaluate the discrimination ability of the LAR, LDH, and albumin levels in predicting SAP. Logistic regression analysis was furtherly adopted to estimate the association between LAR and SAP. We also used the restricted cubic spline (RCS) to clarify the relationship between LAR and the risk of SAP. Results: LAR in the SAP group was significantly higher than that of the non-SAP group (8.75 ± 4.58 vs. 6.10 ± 2.55, P < 0.001). According to the results of ROC, LAR had the highest prognostic accuracy compared to LDH and albumin (P < 0.05). Besides, the logistic regression model showed that higher LAR (LAR > 6.75) were more vulnerable to SAP (OR, 2.80; 95% CI, 2.18-3.59, P < 0.001), controlling the confounders. The RCS model showed that there was a non-linear relationship between LAR and the risk of SAP. Conclusion: High LAR was associated with an increased risk of SAP in patients with AIS. LAR may be a potential predictor for the incidence of SAP. Appropriate prevention measures were needed in patients with high LAR (LAR > 6.75).

Neutrophil to apolipoprotein A-I ratio as an independent indicator of locally advanced nasopharyngeal carcinoma

PURPOSE

To explore the peripheral blood cells (neutrophil/monocyte/lymphocyte/platelet) to apolipoprotein AI or high-density lipoprotein-cholesterol ratio (NAR, MAR, LAR, PAR, NHR, MHR, LHR, and PHR) as independent prognostic indicators for stage III nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS

Between 2009 and 2014, 562 patients diagnosed with stage III NPC who were treated with a concomitant chemotherapy and intensity-modulated radiotherapy with cumulative cisplatin dose ≥200 mg/m2 were included in this retrospective study. Routine blood and biochemical variables and baseline clinical characteristics (T and N stage, age, sex, and induction chemotherapy) were collected. After inserting 19 hematological parameters into a set, we applied the least absolute shrinkage and selection operator (LASSO) algorithm and restricted cubic splines regression to select valuable parameters for predicting 5-year overall survival (OS). Subsequently, univariate and multivariate survival analyses were used to assess independent indicators of 5-year OS, distant metastasis survival, regional recurrence-free survival (RRFS), and disease-free survival.

RESULTS

NAR, MAR, serum lactated dehydrogenase (LDH), and Epstein-Barr virus (EBV)-DNA were selected using LASSO regression, and the optimal cut-off values for NAR, MAR, EBV-DNA, and, LDH were 4.39, 0.3, 1590 copies/mL, and 218.4 IU/L, respectively. In multivariate survival analysis, higher NAR was associated with both poor 5-year OS and RRFS (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.09-3.25, P = .024; HR, 3.13; 95% CI, 1.42-6.91, P = .005, respectively).

CONCLUSION

NAR could be an attractive indicator for evaluating the 5-year OS in patients with stage III NPC, which is closely related to inflammation and circulating lipid metabolism.Level of Evidence: 4.

The impact of lymph node ratio on overall survival in patients with colorectal cancer

Background

Lymph node metastasis is a predominant prognostic indicator in colorectal cancer. Number of lymph nodes removed surgically was demonstrated to correlate with staging accuracy and oncological outcomes. However, number of lymph nodes removed depends on uncontrolled variables. Therefore, a more reliable prognostic indicator is needed. Calculation of ratio of positive lymph nodes to total number of removed lymph nodes may be an appealing solution.

Materials and Methods

We retrospectively analyzed data of 156 Stage III colorectal cancer patients whom underwent surgery between 2008 and 2015. Patients' demographic characteristics, tumor grade, location, vascular-perineural invasion status, number of removed lymph nodes, and ratio of positive lymph nodes to number of removed lymph nodes were recorded. Spearman correlation analysis was used to determine the correlation coefficient while Kaplan-Meier method and Cox proportional hazard regression model were performed for the prediction of survival and multivariate analysis, respectively.

Results

Number of removed lymph nodes did not correlate with survival, but it was inversely correlated with number of positive lymph nodes. Multivariate analysis showed that ratio of removed positive lymph nodes to the total number of lymph nodes was a significant prognostic factor for survival for a ratio equal or above 0.31 was a poor prognostic indicator (108 months vs. 34 months, hazard ratio: 4.24 [95% confidence interval: 2.15-8.34]; P < 0.019). Tumor characteristics failed to demonstrate any prognostic value.

Conclusions

This study showed that positive lymph node ratio (PLNR) is an important prognostic factor for Stage III colorectal cancer. Although 0.31 can be taken as threshold for "PLNR," prospective trials including larger patient groups are needed to validate its role as a prognostic indicator.

The Ratio of CD86+/CD163+ Macrophages Predicts Postoperative Recurrence in Stage II-III Colorectal Cancer

Tumor-associated macrophages (TAMs) are pivotal for tumor progression and metastasis. We investigated the stromal CD86+TAM/CD163+TAM (CD86/CD163) ratio as a novel prognostic biomarker for stage II-III colorectal cancer (CRC). Two independently clinical cohorts of stage II-III CRC were retrospectively enrolled in this study. TAMs were detected using immunohistochemical staining for CD86 and CD163. The stromal CD86/CD163 ratio was calculated as a prognostic biomarker for recurrence-free survival (RFS) and overall survival (OS). Patients with a low CD86/CD163 ratio had shorter RFS (HR=0.193, p<0.001) and OS (HR=0.180, p<0.001) than patients with a high CD86/CD163 ratio in the training cohort. CD86/CD163 ratio may be an independent predictor for RFS (HR=0.233, p<0.001) and OS (HR=0.224, p<0.001) in the training cohort. We obtained equivalent results in the validation cohort. The CD86/CD163 ratio tends to have better predictive values than tumor stage in the training (AUC: 0.682 vs 0.654, p=0.538) and validation (AUC: 0.697 vs 0.659, p=0.586) cohorts. CD86/CD163 ratio effectively predicts RFS for stage II (HR=0.203, p<0.001) and stage III CRC (HR=0.302, p<0.001). CD86/CD163 ratio also effectively predicts RFS in CRC patients with adjutant chemotherapy (HR=0.258, p<0.001) and without adjutant chemotherapy (HR=0.205, p<0.001). The stromal CD86/CD163 ratio could be used for individual risk assessment of recurrence and mortality for stage II-III CRC. Together with tumor stage, this ratio will aid in the personal treatment.

Low Preoperative Mean Platelet Volume/Platelet Count Ratio Indicates Worse Prognosis in Non-Metastatic Renal Cell Carcinoma

Objectives: Multiple blood parameters are used to determine the prognosis of renal cell carcinoma (RCC). Mean platelet volume/platelet count (MPV/PC) ratio is related to disease progression in various cancers. Our study tried to evaluate the prognostic value of the MPV/PC ratio in RCC patients who underwent surgery. Methods: We retrospectively reviewed 89 patients who underwent radical or partial nephrectomy for RCC in a single institution. Baseline characteristics and MPV/PC ratios were analyzed. The optimal cut-off value of the MPV/PC ratio was determined by a receiver operating characteristic (ROC) curve, and our patients were divided into low and high MPV/PC ratio groups. The Kaplan–Meier survival curve and Cox proportional hazards model were applied for progression-free survival (PFS) and overall survival (OS) analyses. Harell’s C-index was used to compare the prognostic values of the MPV/PC ratio, MPV and PC. Results: Lower MPV/PC ratios were correlated with more advanced tumor stages and worse outcomes. The optimal cut-off value of the preoperative MPV/PC ratio was 0.034 (sensitivity 84.6%, specificity 56.6%). The Kaplan–Meier survival curve revealed that low MPV/PC ratios were associated with worse PFS (p = 0.007) and OS (p = 0.017). Multivariate analysis showed that low MPV/PC ratios were an independent unfavorable factor for PFS (p = 0.044) and OS (p = 0.015). Harell’s C-indexes showed that the prognostic value of the MPV/PC ratio was significantly better than MPV and PC (p < 0.001). Conclusion: Low MPV/PC ratios are an independent, unfavorable risk factor for disease progression and overall survival in patients undergoing surgery for RCC.