Detection of metastasis of central lymph nodes in papillary thyroid cancer is difficult before surgery. The role of routine or preventive central lymph node dissection in the management of papillary ...thyroid cancer remains inconclusive. Moreover, glucose metabolism and systemic inflammation are related to the aggressiveness of several malignant tumors and the prognoses of these patients. This study aimed to construct a nomogram based on the readily available preoperative clinical features for predicting the occurrence of preoperative central lymph node metastasis in patients with papillary thyroid cancer and type 2 diabetes mellitus. The findings may underlie clinical implications for determining the appropriate treatment strategies for these patients.
A total of 419 patients were enrolled. We used the receiver operating characteristic curves to determine the best cut-off value and converted the continuous into categorical variables. Next, a single-factor logistic analysis for the independent variables was performed, following which a multivariate regression analysis was conducted for the selected significant risk factors. Finally, the nomogram was constructed and verified using external data; the existing data were compared with the original model.
According to the receiver operating characteristic curves, the best cut-off values for glucose-to-lymphocyte ratio and tumor size were 4.23 cm and 0.95 cm, respectively. Findings from the multivariate logistic regression analysis suggested that age, bilateral tumors, maximum tumor size, and the ratio of glucose-to-lymphocytes were independent risk factors for preoperative central lymph node metastasis. The C-indexes in the training and the external validation data sets were 0.733 and 0.664, respectively. Both calibration curves and the Hosmer-Lemeshow tests indicated that the model was well-calibrated. Through decision curve analysis, the predictive model was estimated to have strong clinical applicability and greater benefits. To compare the performance of the new with that of the original model, we performed a net reclassification index and the integrated discrimination improvement analyses, both of which indicated that the new model had a better predictive ability.
In patients with type 2 diabetes mellitus and papillary thyroid cancer, a high preoperative glucose-to-lymphocyte ratio was an independent predictor of the preoperative central lymph node metastasis. The nomogram so constructed could better predict the preoperative central lymph node metastasis in these patients.
Maladaptive personality traits have been implicated in romantic relationship dissatisfaction, but the etiology of those links and the degree to which they extend to other types of relationships are ...unclear. The purpose of this study was to examine associations between maladaptive personality traits and satisfaction in various relationships using a co-twin control design to identify potential environmental contributions.
The sample consisted of 1340 older adult twin participants from the Minnesota Twin Registry (M
= 70.3) that completed the Personality Inventory for DSM-5 Faceted Brief Form and Network of Relationships Inventory (Revised for Older Adults).
Several maladaptive personality traits were phenotypically associated with relationship dissatisfaction, with detachment and negative affect having the largest effects. Further, within twin pair differences in detachment and negative affect were associated with greater relationship dissatisfaction, suggesting that observed associations were mediated partly by the unique environment, not solely the result of genetic and familial confounding. Both phenotypic and co-twin associations were strongest overall in the romantic partner relationship.
These findings support the notion that maladaptive personality traits are implicated in interpersonal dysfunction across multiple domains.
Permasalahan yang melatarbelakangi dari penelitian ini adalah bagaimana upaya meningkatkan keaktifan belajar peserta didik kelas VII A dengan model Rroblem Based Learning (PBL) di MTS Muhammadiyah ...Trucuk Klaten Tahun Pelajaran 2021/2022. Metode dalam penelitian ini menggunakan penelitian tindakan kelas (classroom action research). Penelitian tindakan kelas ini dilaksanakan di MTS Muhammadiyah Trucuk Klaten. Adapun waktu penelitian ini direncanakan selama 6 bulan. Waktu penelitian dimulai dari Maret hingga Oktober 2021 Sebagai subjek dalam penelitian ini adalah siswa kelas VIA yang berjumlah 30 orang. Adapun Langkah – langkah dari penelitian tindakan : perencanaan, pelaksanaan, pengumpulan data, dan refleksi pada masing – masing langkah menggunakan dua siklus. Hasil penelitian pada pra siklus dapat menunjukkan tingkat keaktifan peserta didik rata rata 62%. Sedangkan pada siklus I rata-rata keaktifan peserta didik dari indikator 1 sampai dengan 12 mencapai 74 % Pada siklus II keaktifan peserta didik dengan rata-rata 73%. Dengan demikian disimpulkan bahwa adanya peningkatan terhadap keaktifan peserta didik dalam pembelajaran pada materi perumusan dan pengesahan UUD NRI 1945 di MTS Muhammadiyah Trucuk Klaten.
A wide range of relatively short-term disruptive events such as partial flooding, visibility reductions, traction hazards due to weather, and pavement deterioration occur on transportation networks ...on a daily basis. Despite being relatively minor when compared to catastrophes, these events still have profound impacts on traffic flow. To date there has been very little distinction drawn between different types of network-disruption studies and how the methodological approaches used in those studies differ depending on the specific research objectives and on the disruption scenarios being modeled.
In this paper, we advance a methodological approach that employs different link-based capacity-disruption values for identifying and ranking the most critical links and quantifying network robustness in a transportation network. We demonstrate how an ideal capacity-disruption range can be objectively determined for a particular network and introduce a scalable system-wide performance measure, called the Network Trip Robustness (NTR) that can be used to directly compare networks of different sizes, topologies, and connectivity levels.
Our approach yields results that are independent of the degree of connectivity and can be used to evaluate robustness on networks with isolating links. We show that system-wide travel-times and the rank-ordering of the most critical links in a network can vary dramatically based on both the capacity-disruption level and on the overall connectivity of the network. We further show that the relationships between network robustness, the capacity-disruption level used for modeling, and network connectivity are non-linear and not necessarily intuitive. We discuss our findings with respect to Braess’ Paradox.
The Patient-Generated Subjective Global Assessment (PG-SGA) is currently the standard nutritional assessment tool for patients with cancer. In a retrospective assessment of a prospective cohort, we ...showed that the Nutritional Risk Index (NRI) seemed to be associated with treatment toxicity and survival in patients with metastatic colorectal cancer (mCRC).
The objective of this study was to compare these two nutritional tools (PG-SGA and NRI) on their correlation with chemotherapy-related toxicity and survival in non–pre-treated patients with mCRC.
This prospective multicentre observational study enrolled non–pre-treated patients with mCRC. PG-SGA and NRI were performed at the onset of first-line chemotherapy. Treatment-related toxicities were registered according to National Cancer Institute Common Toxicity Criteria Adverse Event version 4.0. Progression-free survival (PFS) and overall survival (OS) were calculated from the start of treatment.
A total of 168 patients were included from eight French centres. Patients were considered malnourished in 41% of cases according to PG-SGA and 56% of cases according to the NRI. In multivariate analysis, malnutrition according to PG-SGA was significantly associated with chemotherapy-related grade ≥2 clinical toxicities (odds ratio: 3.7; 95% confidence interval CI: 1.7–8.4; p = 0.001) and OS (hazard ratio HR: 2.6; 95% CI: 1.3–5.3; p = 0.006), but not with PFS (HR: 1.5; 95% CI: 0.8–2.6; p = 0.2). Conversely, malnutrition according to the NRI was not significantly associated with these tolerance and efficacy parameters.
Although more complex to perform in daily oncology practice, the PG-SGA score appears to be the best nutritional assessment tool because of its strong association with clinically relevant oncological outcomes such as OS and treatment-related toxicities in patients with mCRC.
•In colorectal cancer (CRC), malnutrition is associated with chemotherapy-related toxicities.•In CRC, malnutrition is associated with decreased overall survival.•Patient-Generated Subjective Global Assessment should now be the standard nutritional assessment for patients with metastatic CRC.
The antimicrobial susceptibilities of Turkish F. psychrophilum isolates were investigated using a Clinical and Laboratory Standards Institute (CLSI) standard microdilution testing protocol. The ...significance of the minimum inhibitory concentrations was determined by applying empirically and statistically determined epidemiological cut-off values calculated by normalized resistance analysis. Twenty-five F. psychrophilum isolates made over four years from three different trout species in five different regions were examined. All isolates were fully susceptible to amoxicillin and florfenicol, but 88% of our isolates were categorized as having reduced susceptibility to the two quinolones, oxolinic acid, and enrofloxacin. Eighty percent of the isolates were categorized as showing reduced susceptibility to oxytetracycline.
Sequence analysis demonstrated that the reduced susceptibility to the quinolones was associated with chromosomal mutations in the gyrA and parE genes. PCR analysis demonstrated that the genes tetA, tetB, tetC, tetE, tetH, tetL, and tetM were not associated with the reduced susceptibility to oxytetracycline and the significance of this observation is discussed. PCR analysis also showed the presence of sul2 in six isolates and floR in one isolate. This study is the first report of these genes in F. psychrophilum. It was noted, however, that the floR was detected in an isolate categorized as fully susceptible to florfenicol, but the reasons for its lack of expression in the phenotype was not investigated.
It is argued that the Turkish trout industry, in common with those of many countries world-wide, is critically dependent on the continued susceptibility of F. psychrophilum to florfenicol.
•The first data on the antimicrobial susceptibility of Turkish isolates of Flavobacterium psychrophilum using a standard CLSI testing protocol•The first data produced for statistically and empirically based set of epidemiological cut-off values on F. psychrophilum for Turkish isolates•This study is the first comprehensive research about antimicrobial resistance phenotype and resistance genes in F. psychrophilum•Genotypic antimicrobial resistance were assessed by the presence of genes, in which floR and sul2 were detected firstly in F. psychrophilum
Study Design.
A prospective, multicenter study.
Objective.
This study clarified the uses and limitations of transcranial motor-evoked potentials (Tc-MEPs) for nerve root monitoring during adult ...spinal deformity (ASD) surgeries.
Summary of Background Data.
Whether Tc-MEPs can detect nerve root injuries (NRIs) in ASD surgeries remains controversial.
Materials and Methods.
We prospectively analyzed neuromonitoring data from 14 institutions between 2017 and 2020. The subjects were ASD patients surgically treated with posterior corrective fusion using multichannel Tc-MEPs. An alert was defined as a decrease of ≥70% in the Tc-MEP’s waveform amplitude from baseline, and NRI was considered as meeting the focal Tc-MEP alerts shortly following surgical procedures with postoperative nerve root symptoms in the selected muscles.
Results.
A total of 311 patients with ASD (262 women and 49 men) and a mean age of 65.5 years were analyzed. Tc-MEP results revealed 47 cases (15.1%) of alerts, including 25 alerts after 10 deformity corrections, six three-column osteotomies, four interbody fusions, three pedicle screw placements or two decompressions, and 22 alerts regardless of surgical maneuvers. Postoperatively, 14 patients (4.5%) had neurological deterioration considered to be all NRI, 11 true positives, and three false negatives (FN). Two FN did not reach a 70% loss of baseline (46% and 65% loss of baseline) and one was not monitored at target muscles. Multivariate logistic regression analysis revealed that risk factors of NRI were preexisting motor weakness (
P
<0.001, odds ratio=10.41) and three-column osteotomies (
P
=0.008, odds ratio=7.397).
Conclusions.
Nerve root injuries in our ASD cohort were partially predictable using multichannel Tc-MEPs with a 70% decrease in amplitude as an alarm threshold. We propose that future research should evaluate the efficacy of an idealized warning threshold (e.g., 50%) and a more detailed evoked muscle selection, in reducing false negatives.
Francisellosis is an emerging disease caused by Francisella orientalis and is responsible for major economic losses in tilapia farms worldwide. The method of choice for francisellosis outbreak ...control is oral antibiotic administration, as no commercial vaccines or autogenous effective vaccines are available. Although there is a standard method recommended by the Clinical and Laboratory Standards Institute (CLSI) for susceptibility testing of fish pathogenic Francisella spp., basic information on culture and growth conditions for this pathogen is scarce. In this study, the antibiotic susceptibility profile of Francisella orientalis was determined using the disk diffusion test. For that, 89 Francisella orientalis samples obtained from disease outbreaks in tilapia farms in 2012–2019 in various Brazilian states were selected for testing against different antibiotics. Because F. orientalis cannot grow on the standard Mueller-Hinton (MH) agar medium, two different culture media were selected for testing: modified heart cystine agar (CHAH) and modified cation-adjusted Mueller-Hinton agar (MMHA). Different incubation periods were also tested for more appropriate and accurate measurement data. CHAH was more suitable for performing the diffusion disk tests because MMHA required longer incubation periods and formed overestimated inhibition zones. Incubation time affected the antibiogram results mainly for β-lactam antibiotics, with 48 h being the ideal period for measuring inhibition zones. Epidemiological cutoff values of Francisella orientalis isolates using the normalized resistance interpretation (NRI) methodology were successfully calculated. All 89 isolates (100%) were considered wild type (WT) for florfenicol, oxytetracycline, erythromycin, and doxycycline, whereas 86 isolates (96.6%) were considered WT for amoxicillin, ampicillin, enrofloxacin, and norfloxacin. Three isolates (3.4%) were considered non-wild type (NWT) for enrofloxacin, norfloxacin, amoxicillin, and ampicillin. This is the first report of Francisella orientalis isolates resistant to amoxicillin and fluoroquinolones. This study provided important data on Francisella orientalis antibiotic susceptibility. Moreover, it showed that Brazil is already suffering the effects of the inadvertent use of licensed drugs and of off-label drugs, as the aforementioned drug classes are illegally used for farmed fish in the country.
•The modified heart cystine agar (CHAH) medium and 48-h incubation were suitable for diffusion disk testing of Francisella orientalis.•Epidemiological cutoff values were determined using normalized resistance interpretation (NRI) for eight antibiotics.•All isolates were wild type (WT) for florfenicol, oxytetracycline, erythromycin, and doxycycline.•Francisella orientalis resistant to norfloxacin and enrofloxacin is herein firstly described.
The molecular structure of mercurated azo compound (A1), (E)-(2-((8-hydroxyquinolin-5-yl)diazenyl)-5-sulfamoylphenyl)mercury(II) chloride, is investigated theoretically by the DFT with the GGA ...approximation, PEB level and DNP as basis set. The nonlinear optical (NLO) properties of the synthesized azo compound are investigated using a continuous wave (cw), low power, with TEM00 mode laser beam using the methods diffraction ring patterns (DRPs) and Z-scan. The nonlinear refraction index (NRI) is calculated based on both methods where as high as 5.28 × 10−7 cm2/W of the NRI is determined via the DRPs. The optical limiting (OLg) property of the A1 compound is examined with limiting threshold of 10 mW is determined. The experimentally determined DRPs are simulated via Fresnel-Kirchhoff integral with good accord of experimental and theoretical results.
•The azo compound was synthesized and investigated theoretically by the DFT, PEB level and DNP as basis set.•We studied the nonlinear optical properties of azo compound.•The nonlinear refractive index of this sample is determined using diffraction ring patterns and Z-scan techniques.•Optical limiting threshold of azo compound is found to be 10 mW.
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