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- Landolfo, C., et al.
(author)
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Benign descriptors and ADNEX in two-step strategy to estimate risk of malignancy in ovarian tumors : retrospective validation on IOTA 5 multicenter cohort
- 2023
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In: Ultrasound in Obstetrics and Gynecology. - : Wiley. - 0960-7692 .- 1469-0705. ; 61:2, s. 231-242
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Journal article (peer-reviewed)abstract
- Objective: Previous work suggested that the ultrasound-based benign Simple Descriptors can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. We aim to validate a modified version of the Benign Simple Descriptors (BD), and we introduce a two-step strategy to estimate the risk of malignancy: if the BDs do not apply, the ADNEX model is used to estimate the risk of malignancy. Methods: This is a retrospective analysis using the data from the 2-year interim analysis of the IOTA5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during one year of follow-up. Multiple imputation was used when outcome based on follow-up was uncertain according to predefined criteria. Results: 8519 patients were recruited at 36 centers between 2012 and 2015. We included all masses that were not already in follow-up at recruitment from 17 centers with good quality surgical and follow-up data, leaving 4905 patients for statistical analysis. 3441 (70%) tumors were benign, 978 (20%) malignant, and 486 (10%) uncertain. The BDs were applicable in 1798/4905 (37%) tumors, and 1786 (99.3%) of these were benign. The two-step strategy based on ADNEX without CA125 had an area under the receiver operating characteristic curve (AUC) of 0.94 (95% CI, 0.91-0.95). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two-step strategy without CA125 of 0.93 (95% CI, 0.91-0.95). Conclusion: A large proportion of adnexal masses can be classified as benign by the BDs. For the remaining masses the ADNEX model can be used to estimate the risk of malignancy. This two-step strategy is convenient for clinical use.
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- Muser, Daniele, et al.
(author)
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Prognostic Value of Nonischemic Ringlike Left Ventricular Scar in Patients With Apparently Idiopathic Nonsustained Ventricular Arrhythmias
- 2021
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In: Circulation. - : LIPPINCOTT WILLIAMS & WILKINS. - 0009-7322 .- 1524-4539. ; 143:14, s. 1359-1373
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Journal article (peer-reviewed)abstract
- Background: Left ventricular (LV) scar on late gadolinium enhancement (LGE) cardiac magnetic resonance has been correlated with life-threatening arrhythmic events in patients with apparently idiopathic ventricular arrhythmias (VAs). We investigated the prognostic significance of a specific LV-LGE phenotype characterized by a ringlike pattern of fibrosis. Methods: A total of 686 patients with apparently idiopathic nonsustained VA underwent contrast-enhanced cardiac magnetic resonance. A ringlike pattern of LV scar was defined as LV subepicardial/midmyocardial LGE involving at least 3 contiguous segments in the same short-axis slice. The end point of the study was time to the composite outcome of all-cause death, resuscitated cardiac arrest because of ventricular fibrillation or hemodynamically unstable ventricular tachycardia and appropriate implantable cardioverter defibrillator therapy. Results: A total of 28 patients (4%) had a ringlike pattern of scar (group A), 78 (11%) had a non-ringlike pattern (group B), and 580 (85%) had normal cardiac magnetic resonance with no LGE (group C). Group A patients were younger compared with groups B and C (median age, 40 vs 52 vs 45 years; P<0.01), more frequently men (96% vs 82% vs 55%; P<0.01), with a higher prevalence of family history of sudden cardiac death or cardiomyopathy (39% vs 14% vs 6%; P<0.01) and more frequent history of unexplained syncope (18% vs 9% vs 3%; P<0.01). All patients in group A showed VA with a right bundle-branch block morphology versus 69% in group B and 21% in group C (P<0.01). Multifocal VAs were observed in 46% of group A patients compared with 26% of group B and 4% of group C (P<0.01). After a median follow-up of 61 months (range, 34-84 months), the composite outcome occurred in 14 patients (50.0%) in group A versus 15 (19.0%) in group B and 2 (0.3%) in group C (P<0.01). After multivariable adjustment, the presence of LGE with ringlike pattern remained independently associated with increased risk of the composite end point (hazard ratio, 68.98 [95% CI, 14.67-324.39], P<0.01). Conclusions: In patients with apparently idiopathic nonsustained VA, nonischemic LV scar with a ringlike pattern is associated with malignant arrhythmic events.
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- Rahmati, Omid, et al.
(author)
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Capability and robustness of novel hybridized models used for drought hazard modeling in southeast Queensland, Australia
- 2020
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In: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 718
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Journal article (peer-reviewed)abstract
- Widespread detrimental and long-lasting droughts are having catastrophic impacts around the globe. Researchers, organizations, and policy makers need to work together to obtain precise information, enabling timely and accurate decision making to mitigate drought impacts. In this study, a spatial modeling approach based on an adaptive neuro-fuzzy inference system (ANFIS) and several metaheuristic optimizations (ANFIS-BA, ANFIS-GA, ANFIS-ICA, ANFIS-PSO) was developed to predict the spatial occurrence of drought in a region in southeastern Queensland, Australia. In this approach, data describing the distribution of eight drought-contributing factors were prepared for input into the models to serve as independent variables. Relative departures of rainfall (RDR) and relative departures of soil moisture (RDSM) were analyzed to identify locations where drought conditions have occurred. The set of locations in the study area identified as having experienced drought conditions was randomly divided into two groups, 70% were used for training and 30% for validation. The models employed these data to generate maps that predict the locations that would be expected to experience drought. The prediction accuracy of the model-produced drought maps was scrutinized with two evaluation metrics: area under the receiver operating characteristic curve (AUC) and root mean square error (RMSE). The results demonstrate that the hybridized models (ANFIS-BA (AUC(mean) = 83.7%, RMSEmean = 0.236), ANFIS-GA (AUC(mean) = 81.62%, RMSEmean = 0.247), ANFIS-ICA (AUC(mean) = 82.12%, RMSEmean = 0.247), and ANFIS-PSO (AUC(mean) = 81.42%, RMSEmean = 0.255)) yield better predictive performance than the standalone ANFIS model (AUC(mean) = 71.8%, RMSEmean = 0.344). Furthermore, sensitivity analyses indicated that plantavailable water capacity, the percentage of soil comprised of sand, and mean annual precipitation were the most important predictors of drought hazard. The versatility of the new approach for spatial drought modeling and the capacity of ANFIS model hybridization to improve model performance suggests great potential to assist decision makers in their formulations of drought risk, recovery, and response management, and in the development of contingency plans.
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- Thekkinkattil, D., et al.
(author)
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Assessing variability in breast cancer management across the world: results of a questionnaire survey amongst global international experts in breast cancer management
- 2022
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In: Ecancermedicalscience. - : Ecancer Global Foundation. - 1754-6605. ; 16
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Journal article (peer-reviewed)abstract
- Background: Breast cancer is the most common cancer in women worldwide with an estimated 2.3 million breast cancer cases diagnosed annually. The outcome of breast cancer management varies widely across the globe which could be due to a multitude of factors. Hence, a blanket approach in standardisation of care across the world is neither practical nor feasible.Aim: To assess the extent and type of variability in breast cancer management across the globe and to do a gap analysis of patient care pathway.Method: An online questionnaire survey and virtual consensus meeting was carried out amongst 31 experts from 25 countries in the field of breast cancer surgical management. The questionnaire was designed to understand the variability in diagnosis and treatment of breast cancer, and potential factors contributing to this heterogeneity.Result: The questionnaire survey shows a wide variation in breast surgical training, diagnosis and treatment pathways for breast cancer patients. There are several factors such as socioeconomic status, patient culture and preferences, lack of national screening programmes and training, and paucity of resources, which are barriers to the consistent delivery of high-quality care in different parts of the world.Conclusion: On-line survey platforms distributed to global experts in breast cancer care can assess gaps in the diagnosis and treatment of breast cancer patients. This survey confirms the need for an in-depth gap analysis of patient care pathways and treatments to enable the development of personalised plans and policies to standardise high quality care.
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