0.05). The area under the receiver operating characteristics curve (AUC) was 0.922 [95% confidence interval (CI) 0.89–0.95]. In external validation, the discrimination was good, with an AUC value of 0.833 (95% CI 0.70–0.92) for this model. Nomogram calibration plots indicated good agreement between the predicted and observed outcomes, exhibiting close approximation between the predicted and observed probability.CONCLUSION: We constructed a scoring model for predicting massive transfusion during cesarean section in women with placenta previa. This model may help in determining the need to prepare an appropriate amount of blood products and the optimal timing of blood transfusion.]]>
Area Under Curve ; Blood Transfusion ; Calibration ; Cesarean Section ; Cohort Studies ; Discrimination (Psychology) ; Early Intervention (Education) ; Erythrocytes ; Female ; Humans ; Logistic Models ; Maternal Age ; Nomograms ; Placenta Previa ; Placenta ; Placentation ; Postpartum Hemorrhage ; Pregnancy ; ROC Curve ; Ultrasonography

Neuroinflammation is an important process underlying a wide variety of neurodegenerative diseases. Carvacrol (CAR) is a phenolic monoterpene commonly used as a food additive due to its antibacterial properties, but it has also been shown to exhibit strong antioxidative, anti-inflammatory, and neuroprotective effects. Here, we sought to investigate the effects of CAR on inflammation in the hippocampus and prefrontal cortex, as well as the molecular mechanisms underlying these effects. In our study, lipopolysaccharide was injected into the lateral ventricle of rats to induce memory impairment and neuroinflammation. Daily administration of CAR (25, 50, and 100 mg/kg) for 21 days improved recognition, discrimination, and memory impairments relative to untreated controls. CAR administration significantly attenuated expression of several inflammatory factors in the brain, including interleukin-1β, tumor necrosis factor-α, and cyclooxygenase-2. In addition, CAR significantly increased expression of brain-derived neurotrophic factor (BDNF) mRNA, and decreased expression of Toll-like receptor 4 (TLR4) mRNA. Taken together, these results show that CAR can improve memory impairment caused by neuroinflammation. This cognitive enhancement is due to the anti-inflammatory effects of CAR medicated by its regulation of BDNF and TLR4. Thus, CAR has significant potential as an inhibitor of memory degeneration in neurodegenerative diseases.
Animals ; Brain ; Brain-Derived Neurotrophic Factor ; Cyclooxygenase 2 ; Cytokines ; Discrimination (Psychology) ; Food Additives ; Hippocampus ; Inflammation ; Lateral Ventricles ; Lipopolysaccharides ; Memory ; Necrosis ; Neurodegenerative Diseases ; Neuroprotective Agents ; Phenol ; Prefrontal Cortex ; Rats ; RNA, Messenger ; Toll-Like Receptor 4

PURPOSE: Hepatocellular carcinoma (HCC) is an aggressive disease with high recurrence rate. However, current staging systems were lack of predictive capacity for HCC recurrence. We aimed to develop prognostic nomograms based on inflammation-related markers for HCC patients underwent hepatectomy. MATERIALS AND METHODS: We recruited 889 surgically treated patients from two medical centers. Independent prognostic factors were identified by cox regression analyses. Nomograms for recurrence-free survival (RFS) and overall survival (OS) were established, and validated internally and externally. The performance, discrimination, and calibration of nomograms were assessed, and compared with existed staging systems. RESULTS: Neutrophil to lymphocyte ratio (NLR) and gamma-glutamyl transpeptidase to platelet ratio (GPR) were the two inflammation-related factor that independently correlated with survival. NLR, GPR, international normalized ratio (INR), microvascular invasion, satellite lesions, tumour number, tumour diameter, and macrovascular invasion were used to construct nomogram for RFS while GPR, total bilirubin, INR, α-fetoprotein, microvascular invasion, satellite lesions, tumour diameter, and macrovascular invasion were for OS. In the training cohort, the C-index of nomogram was 0.701 (95% confidence interval [CI], 0.669 to 0.732) for RFS and 0.761 (95% CI, 0.728 to 0.795) for OS. These results received both internal and external validation with C-index of 0.701 (95% CI, 0.647 to 0.755) and 0.707 (95% CI, 0.657 to 0.756) for RFS, and 0.706 (95% CI, 0.640 to 0.772) and 0.708 (95% CI, 0.646 to 0.771) for OS, respectively. The nomograms showed superior accuracy to conventional staging systems (p<0.001). CONCLUSION: The nomograms based on inflammation-related markers are of high efficacy in predicting survival of HCC patients after hepatectomy, which will be valuable in guiding postoperative interventions and follow-ups.
Bilirubin ; Blood Platelets ; Calibration ; Carcinoma, Hepatocellular ; Cohort Studies ; Discrimination (Psychology) ; Follow-Up Studies ; gamma-Glutamyltransferase ; Hepatectomy ; Humans ; Inflammation ; International Normalized Ratio ; Lymphocytes ; Neutrophils ; Nomograms ; Recurrence

PURPOSE: Predicting lymph node metastasis (LNM) risk is crucial in determining further treatment strategies following endoscopic resection of T1 colorectal cancer (CRC). This study aimed to establish a new prediction model for the risk of LNM in T1 CRC patients. MATERIALS AND METHODS: The development set included 833 patients with T1 CRC who had undergone endoscopic (n=154) or surgical (n=679) resection at the National Cancer Center. The validation set included 722 T1 CRC patients who had undergone endoscopic (n=249) or surgical (n=473) resection at Daehang Hospital. A logistic regression model was used to construct the prediction model. To assess the performance of prediction model, discrimination was evaluated using the receiver operating characteristic (ROC) curves with area under the ROC curve (AUC), and calibration was assessed using the Hosmer-Lemeshow (HL) goodness-of-fit test. RESULTS: Five independent risk factors were determined in the multivariable model, including vascular invasion, high-grade histology, submucosal invasion, budding, and background adenoma. In final prediction model, the performance of the model was good that the AUC was 0.812 (95% confidence interval [CI], 0.770 to 0.855) and the HL chi-squared test statistic was 1.266 (p=0.737). In external validation, the performance was still good that the AUC was 0.771 (95% CI, 0.708 to 0.834) and the p-value of the HL chi-squared test was 0.040. We constructed the nomogram with the final prediction model. CONCLUSION: We presented an externally validated new prediction model for LNM risk in T1 CRC patients, guiding decision making in determining whether additional surgery is required after endoscopic resection of T1 CRC.
Adenoma ; Area Under Curve ; Calibration ; Colorectal Neoplasms ; Decision Making ; Discrimination (Psychology) ; Humans ; Logistic Models ; Lymph Nodes ; Neoplasm Metastasis ; Nomograms ; Risk Factors ; ROC Curve

Corollary discharge mechanism refers to the suppression of sensory consequences of self-generated actions; a process that serves to distinguish between self and non-self based on discrimination of origination of action. It explains, say for example, why we cannot tickle ourselves. This review discusses how corollary discharge model is an essential neural integration mechanism central to the motor functioning of animal kingdom. In this article, research conducted in the field of corollary discharge has been reviewed to understand the neuroanatomical and neurophysiological basis of corollary discharge and gain insight into the biochemical basis of its dysfunction. This review article also explores the role of corollary discharge and its dysfunction in the presentation of symptoms of schizophrenia, discussing the findings from corollary discharge studies on schizophrenia population. Lastly, the link between schizophrenia psychopathology and corollary discharge dysfunction has been highlighted, and an attempt has been made to establish a case for correction of corollary discharge deficit in schizophrenia through neuromodulation.
Animals ; Discrimination (Psychology) ; Hallucinations ; Motor Activity ; Psychopathology ; Schizophrenia ; Transcranial Direct Current Stimulation

BACKGROUND: It is difficult for surgeons to reconstruct soft tissue defects of the great toe. This report aims to evaluate the utility and efficacy of innervated distally based first dorsal metatarsal artery (FDMA) flap with a wide pedicle for reconstruction of soft tissue defects of the great toe. METHODS: This is a retrospective report. Between January 2015 and December 2017, six cases of skin defect of the great toe were reconstructed with an innervated distally based FDMA flap with a wide pedicle. One case was excluded in this report because of chronic pain on the metatarsophalangeal joint due to osteoarthritis before the injury. A total of five cases were evaluated for flap survival and sensory recovery. The sensory recovery was investigated by two-point discrimination and Semmes-Weinstein monofilament tests. The average age of the selected patients was 40 years (range, 36 to 56 years), and the average size of the defect in the toe was 8.3 cm2 (range, 4 to 13.8 cm2). The average follow-up period was 29.4 months (range, 18 to 38 months). RESULTS: All patients survived without any complications. The average two-point discrimination test value was 8.0 ± 0.89 mm (range, 7 to 9 mm), and the average value obtained from the Semmes-Weinstein monofilament test was 4.53 ± 0.33 (range, 4.17 to 4.93). The average residual pain score evaluated with a visual analog scale was 1 (range, 0 to 2). Two patients complained of stiffness in the great toe below 30° of total range of motion during the early stages after surgery, but this stiffness gradually improved after rehabilitation. The average range of motion of three patients with a remaining metatarsophalangeal joint after surgery was 80° (range, 70° to 90°). All five cases could walk regularly without any unique footwear at the final follow-up. CONCLUSIONS: The innervated distally based FDMA flap with a wide pedicle could be a good alternative method for repair of soft tissue defects of the great toe.
Arteries ; Chronic Pain ; Discrimination (Psychology) ; Follow-Up Studies ; Humans ; Metatarsal Bones ; Metatarsophalangeal Joint ; Methods ; Osteoarthritis ; Perforator Flap ; Range of Motion, Articular ; Rehabilitation ; Retrospective Studies ; Skin ; Surgeons ; Toes ; Visual Analog Scale

OBJECTIVES: Biosignal data captured by patient monitoring systems could provide key evidence for detecting or predicting critical clinical events; however, noise in these data hinders their use. Because deep learning algorithms can extract features without human annotation, this study hypothesized that they could be used to screen unacceptable electrocardiograms (ECGs) that include noise. To test that, a deep learning-based model for unacceptable ECG screening was developed, and its screening results were compared with the interpretations of a medical expert. METHODS: To develop and apply the screening model, we used a biosignal database comprising 165,142,920 ECG II (10-second lead II electrocardiogram) data gathered between August 31, 2016 and September 30, 2018 from a trauma intensive-care unit. Then, 2,700 and 300 ECGs (ratio of 9:1) were reviewed by a medical expert and used for 9-fold cross-validation (training and validation) and test datasets. A convolutional neural network-based model for unacceptable ECG screening was developed based on the training and validation datasets. The model exhibiting the lowest cross-validation loss was subsequently selected as the final model. Its performance was evaluated through comparison with a test dataset. RESULTS: When the screening results of the proposed model were compared to the test dataset, the area under the receiver operating characteristic curve and the F1-score of the model were 0.93 and 0.80 (sensitivity = 0.88, specificity = 0.89, positive predictive value = 0.74, and negative predictive value = 0.96). CONCLUSIONS: The deep learning-based model developed in this study is capable of detecting and screening unacceptable ECGs efficiently.
Dataset ; Electrocardiography ; Humans ; Learning ; Mass Screening ; Monitoring, Physiologic ; Noise ; ROC Curve ; Sensitivity and Specificity ; Signal Detection, Psychological

BACKGROUND: Biportal endoscopic spine surgery (BESS) is a recent addition to minimally invasive spine surgery treatments. It boasts excellent magnification and fine discrimination of neural structures. Selective decompression with preservation of facet joints for structural stability is also feasible owing to access to the spinal canal and foramen deeper inside. This study has a purpose to investigate clinical benefits of BESS for spinal stenosis in comparison to the other common surgical treatments such as microscopic decompression-only (DO) and fusion and instrumentation (FI). METHODS: From December 2013 to March 2015, 30 cases of DO, 48 cases of FI, and 66 consecutive cases of BESS for lumbar spinal stenosis (LSS) were enrolled to evaluate the relative clinical efficacy of BESS. Visual analog scale (VAS) for back pain and leg pain, postoperative hemoglobin, C-reactive protein (CRP) changes, transfusion, and postoperative complications were examined. RESULTS: All the patients were followed up until 6 months, and 98 patients (86.7%) for 2 years. At the 6-month follow-up, VAS for back pain improved from 6.8 to 2.8, 6.8 to 3.2, and 6.8 to 2.8 (p = 0.078) for BESS, DO, and FI, respectively; VAS for leg pain improved from 6.3 to 2.2, 7.0 to 2.5, and 7.2 to 2.5 (p = 0.291), respectively. Two cases in the BESS group underwent additional foraminal decompression, but no fusion surgery was performed. Postoperative hemoglobin changes for BESS, DO, and FI were −2.5, −2.4, and −1.3 mL, respectively. The BESS group had no transfusion cases, whereas 10 cases (33.3%) in DO and 41 cases (85.4%) in FI had transfusion (p = 0.000). CRP changes for BESS, DO, and FI were 0.32, 6.53, and 6.00, respectively, at day 2 postoperatively (p = 0.000); the complication rate for each group was 8.6% (two dural tears and one root injury), 6.7% (two dural tears), and 8.3% (two dural tears and two wound infections), respectively. CONCLUSIONS: BESS for LSS showed clinical results not inferior to those of the other open surgery methods in the short-term. Stable hemodynamic changes with no need for blood transfusion and minimal changes in CRP were thought to cause less injury to the back muscles with minimal bleeding. Foraminal stenosis decompression should be simultaneously conducted with central decompression to avoid an additional surgery.
Back Muscles ; Back Pain ; Blood Transfusion ; C-Reactive Protein ; Constriction, Pathologic ; Decompression ; Discrimination (Psychology) ; Endoscopy ; Follow-Up Studies ; Hemodynamics ; Hemorrhage ; Humans ; Leg ; Lumbar Vertebrae ; Minimally Invasive Surgical Procedures ; Pain, Postoperative ; Postoperative Complications ; Spinal Canal ; Spinal Stenosis ; Spine ; Tears ; Treatment Outcome ; Visual Analog Scale ; Wounds and Injuries ; Zygapophyseal Joint

PURPOSE: Many patients with cytology proven node-positive breast cancer receive a neoadjuvant chemotherapy (NAC) treatment. We developed a nomogram to predict the breast and axillary pathologic complete responses (pCR) in patients with a cytologically proven axillary node positive breast cancer with NAC. METHODS: We selected 995 patients who were diagnosed with an invasive breast cancer and axillary lymph nodes metastasis, and who were treated with NAC followed by a curative surgery at the Samsung Medical Center between January 2007 and December 2014. The baseline patient and tumor characteristics, chemotherapy regimen, and tumor and nodal responses were thoroughly analyzed and reviewed. A nomogram was developed using a binary logistic regression model with a cross validation. RESULTS: Axillary pCR was achieved in 47.3% and breast pCR was achieved in 24.3% of the patients after NAC. In this case, the both pCR was associated with an initial clinical tumor stage, negative progesterone receptor status, positive human epidermal growth factor receptor 2 status, and clinical radiologic nodal responses. A nomogram was developed based on the clinical and statistically significant predictors. It had good discrimination performance (area under the curve [AUC], 0.868; 95% confidence interval, 0.84–0.89) and calibration fit as noted in that case. The cross validation had an average AUC 0.853 (0.837–0.869). CONCLUSION: Our nomogram might help to predict breast and axillary pCRs after NAC in patients with an initially node-positive breast cancer. Minimal surgery might be acceptable in patients for whom the nomogram indicates a high probability of achieving pCRs.
Area Under Curve ; Breast Neoplasms ; Breast ; Calibration ; Discrimination (Psychology) ; Drug Therapy ; Humans ; Logistic Models ; Lymph Nodes ; Neoadjuvant Therapy ; Neoplasm Metastasis ; Nomograms ; Polymerase Chain Reaction ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone

PURPOSE: The Maternal Role Attainment Scale Form B (MRAS-Form B) was developed based on Mercer's theory and widely used to assess maternal role attainment among Thai mothers in hospitals. To assess the maternal identity among primiparous adolescent mothers in communities, MRAS-Form B remains indistinguishable due to differences in both mothers' ages and circumstances andwas modified to the Maternal Identity Scale (MIS). Therefore, the aim of this study was to examine the validity and reliability of the MIS. METHODS: A cross-sectional study was conducted among 397 primiparous Thai teenagers residing with their infants aged 4−12 months. Data were collected using self-administered questionnaires. Confirmatory factor analysis was performed to confirm the construct validity using Mplus Software. RESULTS: The overall model provided fit well to the empirical data (χ²/df = 2.23, comparative fit index = .93, TuckereLewis index = .92, root mean square error of approximation = .06, standardized root mean square residual = .05). About 33−66% of the variance among MIS items could be explained by three constructs of maternal identity. Convergent validity showed item loadings ranging from .58 to .81; in addition, average variance extracted and composite reliability ranged from .44 to .54 and .82 to .92, respectively. Discriminant validity correlations between constructs were ranging from .74 to .87. The MIS exhibited very good item discrimination values (.52 ≤ corrected item-total correlation ≤.70) and an excellent reliability (Cronbach's α = .95). CONCLUSION: Appropriately for community health nursing, the MIS was a valid and reliable tool, assessing maternal identity among primiparous teenage mothers one year after delivery.
Adolescent ; Asian Continental Ancestry Group ; Community Health Nursing ; Cross-Sectional Studies ; Discrimination (Psychology) ; Factor Analysis, Statistical ; Humans ; Infant ; Mothers ; Postpartum Period ; Reproducibility of Results