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Abstract Background: Evaluating inflammatory severity using imaging is essential for Crohn’s disease (CD), but it is limited by potential interobserver variation and subjectivity. We compared the efficiency of magnetic resonance index of activity (MaRIA) collected by radiologists and a radiomics model in assessing the inflammatory severity of terminal ileum (TI).Methods: 121 patients were collected from two centers. Patients were divided into ulcerative group and mucosal remission group based on the TI Crohn's disease Endoscopic Severity Index (tCDEIS). The consistency of bowel wall thickness (BWT), relative contrast enhancement (RCE), edema, ulcer, MaRIA and features of the region of interest (ROI) between radiologists were described by weighted k coefficient and intraclass correlation coefficient (ICC), and developed receiver operating curve (ROC) of MaRIA. The radiomics model was established using reproducible features of logistic regression based on arterial staging of T1WI sequences. Delong test was used to compare radiomics with MaRIA.Results: The consistency between radiologists were moderate in BWT (ICC=0.638), fair in edema (k=0.541), RCE (ICC=0.461), MaRIA (ICC=0.579) and poor in ulcer (k=0.271). Radiomics model was developed by 6 reproducible features (ICC=0.93-0.96) and equivalent to MaRIA which evaluated by the senior radiologist(0.872 vs 0.883 in training group, 0.824 vs 0.783 in testing group, P=0.847, 0.471), both of which were significant higher than MaRIA evaluated by junior radiologist(AUC: 0.621 in training group, 0.557 in testing group, all, PB0.05).

Background: Patients with suspected genetic ataxia are often tested for Friedreich's ataxia (FRDA) and/or a variety of spinocerebellar ataxias (SCAs). FRDA can present with atypical, late-onset forms and so may be missed in the diagnostic process. We aimed to determine FRDA-positive subjects among two cohorts of patients referred to a specialist ataxia centre either for FRDA or SCA testing to determine the proportion of FRDA cases missed in the diagnostic screening process.Methods: 2000 SCA-negative ataxia patients, not previously referred for FRDA testing (group A), were tested for FRDA expansions and mutations. This group was compared with 1768 ataxia patients who had been previously referred for FRDA testing (group B) and were therefore more likely to have a typical presentation. The phenotypes of positive cases were assessed through review of the clinical case notes.Results: Three patients (0.2%) in group A had the FRDA expansion on both alleles, compared with 207 patients (11.7%) in group B. The heterozygous carrier rate across both cohorts was of 41 out of 3,768 cases (1.1%). The size of the expansions in the three FRDA-positive cases in group A was small, and their presentation atypical with late-onset.Conclusions: This study demonstrates that FRDA is very rare among patients who were referred purely for SCA testing without the clinical suspicion of FRDA. Such cases should be referred to specialist ataxia centres for more extensive testing to improve patient management and outcomes.

Abstract Background More and more studies have confirmed that TAAbs could be used as potential biomarkers for tumor patients. The aim of this study is to identify novel TAAbs through proteomic chips and construct a diagnostic model to discriminate esophageal squamous cell carcinoma (ESCC) cases from benign esophageal diseases cases and normal controls (NCs). Methods The human proteomic chips were used to screen TAAbs. Enzyme-linked immunosorbent assay (ELISA) was adopted to verify and validate the candidate TAAbs which were screened by the chips in verification phase (90 ESCC cases and 90 NCs) and validation phase (126 ESCC cases, 237 benign esophageal diseases cases and 126 NCs). Based on the candidate TAAbs, then the diagnostic model for ESCC was constructed by logistic regression analysis in the training group and validated in the testing group. Results Firstly, thirteen potential candidate TAAbs were identified by proteomic chips. In verification phase, the titers of six TAAbs (anti-MAGEA1, anti-VCL, anti-PRKCZ, anti-TP53, anti-NFKB1 and anti- MAGEA4) in ESCC cases were higher than those in NCs while other seven TAAbs showed no difference. Subsequently, six candidate TAAbs were validated further in validation phase. Finally, the logistic regression model with 3 TAAbs (anti-MAGEA1, anti-VCL, anti-TP53) could discriminate ESCC cases from NCs with area under curve(AUC)of 0.80 in the training group and 0.73 in the testing group, respectively. Meanwhile, the model could discriminate ESCC cases from benign esophageal diseases cases with AUC of 0.74. Conclusion The study has identified six novel TAAbs through protein chips and constructed a diagnostic model. The panel showed great performance to distinguish ESCC cases from benign esophageal diseases cases and NCs.

ObjectivesOveruse of antibiotics and antibiotic resistance are global healthcare problems. In pediatric patients with respiratory infections, viral and bacterial etiologies are challenging to distinguish, leading to irrational antibiotic use. Rapid and accurate molecular diagnostic testing methods for respiratory pathogens has been shown to facilitate effective clinical decision-making and guide antibiotic stewardship interventions in the developed regions, but its impacts on pediatric patient care in the developing countries remain unclear.MethodsIn this single-center, retrospective case-control study, we compared demographics, clinical characteristics, especially microbiological findings, and antibiotic usage between pediatric patients with respiratory infection receiving FilmArray Respiratory Panel (FilmArray RP) testing and a matched routine testing control group. Our primary outcome was the duration of intravenous antibiotics treatment (DOT) during hospitalization.ResultsEach group consisted of 346 children with a respiratory infection. In the FilmArray RP testing group, the DOT was shorter than that in the routine testing group (6.41 ± 3.67 days versus 7.23 ± 4.27 days; p = 0.006). More patients in the FilmArray RP testing group de-escalated antibiotic treatments within 72 hours of hospitalization (7.80%, 27/346 versus 2.60%, 9/346; p = 0.002). By contrast, fewer patients in the FilmArray RP testing group had escalated antibiotic treatments between 72 hours and seven days (7.80% versus 14.16%; p = 0.007). The cost of hospitalization was significantly lower in the FilmArray RP testing group ($ 1413.51 ± 1438.01 versus $ 1759.37 ± 1929.22; p = 0.008). Notably, the subgroup analyses revealed that the FilmArray RP test could shorten the DOT, improve early de-escalation of intravenous antibiotics within 72 hours of hospitalization, decline the escalation of intravenous antibiotics between 72 hours and seven days, and reduce the cost of hospitalization for both patient populations with or without underlying diseases.ConclusionsMolecular point-of-care testing for respiratory pathogens could help to reduce intravenous antibiotic use and health care costs of pediatric patients with respiratory infections in developing countries.

The axiological approach to the education impacts future professional musician’s values and ability to solve professional problems and challenges. This research is aimed at studying the principles of the axiological approach and its possible application in the pedagogical process. Theoretical and practical research on the use of axiological approach in the theory and practice of music pedagogical education was conducted. Pedagogical methods such as questionnaire, observation, testing, group and individual interviews were used. The definition of the axiological approach was given. Effective means of its developing were presented. It was found that integration of axiological, systemic, culturological approaches allows to deepen and diversify the structural and semantic characteristics of the axiology sphere of higher institutions of music and music-pedagogical education. The prospects for further research were found including the necessity to identify the specifics of the development of axiological competence in students of higher art educational institutions.

Abstract Background Analysis of cytologically indeterminate thyroid nodules with Afirma Gene Expression Classifier (GEC) and Genomic Sequencing Classifier (GSC) can reduce surgical rate and increase malignancy rate of surgically resected indeterminate nodules. Methods Retrospective cohort analysis of all adults with cytologically indeterminate thyroid nodules from January 2013 through December 2019. We compared surgical and malignancy rates of those without molecular testing to those with GEC or GSC, analyzed test performance between GEC and GSC, and identified variables associated with molecular testing. Results 468 indeterminate thyroid nodules were included. No molecular testing was performed in 273, 71 had GEC, and 124 had GSC testing. Surgical rate was 68% in the group without molecular testing, 59% in GEC, and 40% in GSC. Malignancy rate was 20% with no molecular testing, 22% in GEC, and 39% in GSC (p = 0.022). GEC benign call rate (BCR) was 46%, sensitivity 100%, specificity 61% and PPV 28%. GSC BCR was 60%, sensitivity 94%, specificity 76%, and PPV 41%. Those with no molecular testing had larger nodule size, pre-operative growth of nodules, and constrictive symptoms, and those who underwent surgery in the no molecular testing group had higher BMI, constrictive symptoms, higher TIRADS and Bethesda classification. Type of provider was also associated with the decision to undergo surgery. Conclusion Implementation of GEC showed no effect on surgical or malignancy rate, but GSC resulted in significantly lower surgical and higher malignancy rates. This study provides insight into the factors that affect the real- world use of these molecular markers preoperatively in indeterminate thyroid nodules.

Objective. The study was to develop and externally validate a prognostic nomogram to effectively predict the overall survival of patients with stomach cancer. Methods. Demographic and clinical variables of patients with stomach cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2007–2016 were retrospectively collected. Patients were then divided into the Training Group (n = 4,456) for model development and the Testing Group (n = 4,541) for external validation. Univariate and multivariate Cox regressions were used to explore prognostic factors. The concordance index (C-index) and the Kolmogorov–Smirnov (KS) value were used to measure the discrimination, and the calibration curve was used to assess the calibration of the nomogram. Results. Prognostic factors including age, race, marital status, TNM stage, surgery, chemotherapy, grade, and the number of regional nodes positive were used to construct a nomogram. The C-index was 0.790 and the KS value was 0.45 for the Training Group, and the C-index was 0.789 for the Testing Group, all suggesting the good performance of the nomogram. Conclusion. We have developed an effective nomogram with ten easily acquired prognostic factors. The nomogram could accurately predict the overall survival of patients with stomach cancer and performed well on external validation, which would help improve the individualized survival prediction and decision-making, thereby improving the outcome and survival of stomach cancer.

Abstract Background: Owing to lack of predictive models for Hepatocellular carcinoma (HCC) metastasis based on the expression of miRNAs, we aimed to develop a simple model for identification of HCC patients at high risk of metastasis. Results: HCC datasets with metastasis information were acquired from the Gene Expression Omnibus (GEO), and samples were randomly divided into training group (n=169) and testing group (n=72). Based on expression of miRNAs in the training group, we developed a predictive nomogram for HCC metastasis and evaluated its performance using area under the receiver operating characteristic curve (AUC), calibration curve, decision curve and clinical impact curve analysis. We found that the expression of miR-30c, miR-185 and miR-323 in HCC correlated with metastasis by the least absolute shrinkage and selection operator regression (LASSO) method and multivariate logistic regression. Based on these three miRNAs, we generated the nomogram for predicting metastasis in the training group (AUC 0.869 [95% CI .813-0.925], sensitivity 80.5%, specificity 78.9%); in testing group (0.821 [0.770-0.872], 48.5%, 92.3%). The calibration curve showed a good agreement between actual observation and prediction by nomogram. The nomogram represented high clinical net benefits using decision curve. Moreover, total scores calculated by nomogram were higher in dead patients than that in alive patients. In addition, the predicted target genes of these 3 miRNAs correlated with tumor metastasis by functional enrichment analysis, such as filopodium and we identified their related hub genes. Conclusions: Our easy-to-use nomogram could assist in identifying HCC patients at high risk of metastasis, which offer valuable information for clinical treatment.

AbstractPatient-specific and lesion-specific computational simulation of bifurcation stenting is an attractive approach to achieve individualized pre-procedural planning that could improve outcomes. The objectives of this work were to describe and validate a novel platform for fully computational patient-specific coronary bifurcation stenting. Our computational stent simulation platform was trained using n = 4 patient-specific bench bifurcation models (n = 17 simulations), and n = 5 clinical bifurcation cases (training group, n = 23 simulations). The platform was blindly tested in n = 5 clinical bifurcation cases (testing group, n = 29 simulations). A variety of stent platforms and stent techniques with 1- or 2-stents was used. Post-stenting imaging with micro-computed tomography (μCT) for bench group and optical coherence tomography (OCT) for clinical groups were used as reference for the training and testing of computational coronary bifurcation stenting. There was a very high agreement for mean lumen diameter (MLD) between stent simulations and post-stenting μCT in bench cases yielding an overall bias of 0.03 (− 0.28 to 0.34) mm. Similarly, there was a high agreement for MLD between stent simulation and OCT in clinical training group [bias 0.08 (− 0.24 to 0.41) mm], and clinical testing group [bias 0.08 (− 0.29 to 0.46) mm]. Quantitatively and qualitatively stent size and shape in computational stenting was in high agreement with clinical cases, yielding an overall bias of < 0.15 mm. Patient-specific computational stenting of coronary bifurcations is a feasible and accurate approach. Future clinical studies are warranted to investigate the ability of computational stenting simulations to guide decision-making in the cardiac catheterization laboratory and improve clinical outcomes.

(1) Background: The current study leveraged social media to connect with teens with EDs to identify population specific characteristics and to gather feedback on an mHealth intervention. (2) Methods: We recruited teens with EDs from social media in two phases: (1) Discovery Group, (2) Testing Group. The Discovery Group (n = 14) participants were recruited from Facebook/Instagram and were asked to review the app for up to one week and provide qualitative feedback. After incorporating feedback from the Discovery Group, we refined our social media outreach methods to connect with 30 teens with EDs to pilot this mobile app. Recruitment from a variety of platforms on social media was successful, with the majority of enrolled participants in the Testing Group coming from Snapchat (60%) and a large percentage of participants belonging to gender and sexual minority groups (63%). (3) Results: Participants from both groups experienced extremely high rates of depression (100% Discovery, 90% Testing) and/or anxiety symptoms (100% Discovery, 93% Testing) in addition to ED symptoms, and noted this as a possible barrier to app engagement. (4) Conclusion: Use of social media for recruitment of teens with EDs is feasible and may connect with groups who may be more difficult to reach using traditional recruitment methods. Among the Discovery Group there was high acceptability of and interest in an app to support ED recovery, and characteristics of both groups demonstrated need for support in other mental health domains. Future studies should evaluate the preliminary efficacy of such tools among teens to determine the effects of such interventions on ED symptoms and other mental health outcomes.