BackgroundThe geriatric nutritional risk index (GNRI) is a commonly used method to assess nutritional risk for predicting potential surgical site infections (SSI) in cancer patients. This study aims to create and verify a simple nomogram and a dynamic web-based calculator for predicting the risk of SSI among gynecologic oncology patients.MethodsA retrospective evaluation was conducted on patients who were admitted into a tertiary hospital in China with confirmed diagnosis of gynecologic cancer between 01 August 2017 and 30 November 2021. A two-piecewise linear regression model with a smoothing function was used to investigate the non-linear association between GNRI and SSI to determine the ideal cut-off point. Three models were developed on the basis of different variables to predict SSI in gynecologic oncology patients. Through a nomogram the concordance index (C-index), the Akaike information criterion (AIC), and the integrated discrimination index (IDI) were used to determine the final model. Finally, the performance of the nomogram was validated using the 1,000-bootstrap resamples method and analyzed using C-index, GiViTI calibration belts, and decision curve. Also, a user-friendly dynamic web-based calculator was developed.ResultsA total of 1,221 patients were included in the analysis. A non-linear association could be observed between GNRI and SSI risk with a GNRI cut-off value of 101.7. After adding GNRI to Model 2 (which comprised Morse Fall Scale score, preoperative length of stay, operation time, and estimated blood loss), the AIC value decreased, the C-index value increased and IDI increased significantly. The nomogram C-index in the development cohort and internal validation cohort demonstrates a moderate-high degree of discrimination. The GiViTI calibrated belt showed a good agreement between the observed and predicted probabilities of SSI. The decision curve validates the clinical feasibility of the nomogram with a threshold value between 0 and 49%.ConclusionThe GNRI cut-off value of 101.7 allowed for appropriate stratification of patients into distinct SSI risk groups. This study found that including GNRI in the above nomogram (Model 2) would enhance its potential to predict SSI in gynecologic oncology patients.

Background: Abortion was defined as loss at a gestational age less than 28 weeks. Vitamin D is reported to be associated with reproductive functions, whereas its casual effects on abortion remains unclear. In this study, a two-sample Mendelian randomization (MR) analysis was performed to systematically assess the causal relationships between serum 25 hydroxyvitamin D concentration and the risk of abortion. Results: GWAS summary data of vitamin D was used as exposure, and data of missed abortion and spontaneous abortion was considered as outcome. A retrospective study was also conducted to verify the associations identified from MR study. MR estimates showed that a higher Vitamin D level was associated with decreased risk of both missed abortion and spontaneous abortion. However, the P value was not significant. We then conducted a retrospective study, and observed the consistent result of Vitamin D’s protective role to abortion. The value was very close to statistical significance (P=0.0527). Conclusions: This study reports the potential protective role of serum 25 hydroxyvitamin D concentration to abortion, that is, higher Vitamin D levels can decrease risk of abortion. Further larger retrospective study is needed to confirm this association.