Determination of cut-off value by receiver operating characteristic curve of norquetiapine and 9-hydroxyrisperidone concentrations in urine measured by LC-MS/MS

Fetal blood lactate concentration

To determine the clinical indicators of early death (within 72 hours) in patients with acute paraquat poisoning. The data of 93 acute paraquat poisoning patients admitted to emergency intensive care unit (EICU) of the First Hospital of China Medical University were retrospectively analyzed. The patients were divided into two groups according to whether they died within 72 hours or not. The gender, age, poison dose, paraquat concentration in urine, reduction of paraquat amount in urine after each hemoperfusion, and the worst value of white blood cell (WBC) count, lymphocytes count, arterial blood gas analysis, blood K⁺, Na⁺, Cl⁻, and serum amylase, serum lipase, serum total bilirubin, troponin I, creatine kinase (CK), blood urea nitrogen, serum creatinine within 24 hours after poisoning were compared. Spearman correlation analysis was used to analyze the correlation between paraquat concentration in urine and the dose of paraquat. The predictive value of each indicator at death in early stage of poisoning was analyzed with receiver operating characteristic curve (ROC curve). Nineteen patients in the group of those died in early stage of poisoning (within 72 hours) resulted in a mortality rate of 20.4%. Compared with non-early death group, in early death group, the value of poison dose (133.4 ± 108.8 mL vs. 58.6 ± 40.0 mL, t=3.145, P=0.002), paraquat concentration in urine [16.34 (11.87, 96.76) mg/L vs. 4.46 (1.21, 12.78) mg/L, Z=-3.422, P=0.001], WBC (22.63 ± 9.72 × 10⁹/L vs. 14.95 ± 8.39 × 10⁹/L, t=3.446, P=0.001), blood lactate [Lac: 6.7 (2.2, 12.1) mmol/L vs. 1.9 (1.1, 3.4) mmol/L, Z=-3.294, P=0.001] were significantly higher, and the reduction rate of paraquat concentration in urine after first perfusion [(38.4 ± 15.63)% vs. (67.59 ± 27.87)%, t=2.945, P=0.004] and arterial partial pressure of carbon dioxide (PaCO₂: 28.7 ± 9.3 mmHg vs. 34.8 ± 6.7 mmHg, t=-3.245, P=0.002) were significantly lowered. There was no significant difference between two groups in other indexes. Poison dose and paraquat concentration in urine showed significantly positive correlation (r=0.450, P<0.001). ROC curve showed that the predictive value of paraquat concentration in urine, WBC, and Lac in early death were significant [area under the ROC curve (AUC) of paraquat concentrations in urine was 0.806, 95% confidence interval (95%CI) 0.699-0.913, the cut-off value was 11.64 mg/L, with sensitivity 84.6%, specificity 71.4%; AUC of WBC was 0.734, 95%CI 0.569-0.899, the cut-off value was 15.94×10(9)/L with sensitivity 69.2%, specificity 76.8%; AUC of Lac was 0.729, 95%CI 0.568-0.891, the cut-off value was 1.95 mmol/L with sensitivity 84.6%, specificity 42.9%]. Paraquat concentrations in urine, WBC, Lac, poison dose and PaCO2 were the risk factors of the early death of the acute paraquat poisoning. The research suggests that paraquat concentration in urine, WBC and Lac are valuable in predicting early death of the patients.

To assess whether angiotensin-II receptor blockers (ARBs) offer any additional advantage in confirming the diagnosis of primary aldosteronism (PA) and their use in the differentiation of PA subtypes. A prospective, cohort, head-to-head study was conducted between July 2003 and July 2006. A total of 135 patients received captopril and losartan tests to confirm the diagnosis of PA in the TAIPAI (Taiwan Primary Aldosteronism Investigation) intervention. In total, 71 patients were diagnosed with PA. The area under the receiver-operating characteristic (ROC) curve of the postcaptopril plasma aldosterone concentration (PAC) was significantly less than that of the postlosartan PAC (0.744 vs. 0.829, P = 0.038). Using an aldosterone-renin ratio (ARR, ng/dl per ng/ml/h) >35 with a PAC >10 ng/dl, the specificity was 89.1% vs. 93.8% and the sensitivity was 66.2% vs. 84.5 % for the captopril test vs. the losartan test, respectively. With respect to the losartan test, the accuracy was 88.9%, the agreement was good (k = 0.778), and there was no disagreement with the McNemar test (P = 0.118). Losartan had the advantage of a better negative predictive value to exclude PA when patients were referred with a serum potassium (SK) level <3.8 mmol/l. When a postlosartan ARR >60 was the cutoff value, the positive predictive value was 82% with a negative predictive value of 57% in distinguishing aldosterone-producing adenomas (APAs) from idiopathic hyperaldosteronism (IHA). The postlosartan ARR and PAC were shown to have better accuracy for the diagnosis of PA than the captopril test. With a postlosartan ARR >60, APAs can be adequately differentiated from IHA.

BackgroundThe aim of this study was to test if Procalcitonin PCT value at the time of admission is a predictor of mortality and/or a diagnostic marker of concomitant infection in...

Work function variation versus alloy concentration for dispenser cathodes

NOx and SO2 emissions from municipal solid waste (MSW) combustion in CO2/O2 atmosphere

Accurate characterization of features of the melatonin production curve is important for research in chronobiology. Local polynomial regression is used to model the plasma melatonin concentration curve and obtain consistent and asymptotically normally distributed estimates of synthesis onset and offset times, duration, peak concentration, and area under the curve. A simple production-clearance model for melatonin kinetics provides the connection between plasma concentrations and the melatonin production curve. This model identifies onset and offset times with critical points of derivatives of the concentration curve. The method proposed has the advantage of flexibility and ease of implementation. Local polynomial regression can be shown to produce consistent estimates of the regression curve and parameters of interest. Furthermore, the method can be implemented in any software package with weighted least squares routines.

Objective To evaluate the significance of detecting plasma methylated Septin9 (SEPT9) alone and combined with fecal immunochemical test (FIT) in screening colorectal cancer (CRC) and adenoma. Methods From October 2014 to April 2015, outpatients received CRC and adenoma screening were enrolled. Colonscopy examination and pathological diagnosis were taken as gold standard. The sensitivity and specificity of plasma methylated SEPT9 and FIT in CRC and adenoma were calculated. The diagnostic value of combined examination was evaluated.Receiver operating characteristic (ROC) curve of SEPT9 in CRC diagnosis was drawn. Results A total of 300 outpatients were enrolled. Among them, CRC was detected in 45 patients (15.0%) and adenoma was detected in 68(22.7%) patients, including 37(12.3%) cases of advanced adenomas.The sensitivity of SEPT9 and FIT for CRC diagnosis was 80.0% and 88.9%, and the specificity was 95.3 % and 54.1%, respectively.The area under concentration curve (AUC) of methylated SEPT9 in CRC diagnosis was 0.923. The sensitivity of SEPT9 and FIT in advanced adenoma diagnosis were 10.8% and 62.2%, and the specificity were 83.3% and 49.0%, respectively. The sensitivity of combined examination in CRC diagnosis was 97.8% and the specificity was 52.9%; the sensitivity in advanced adenoma diagnosis was 67.6% and the specificity was 47.4%. Conclusions Plasma methylated SEPT9 is helpful in CRC screening, moreover, when combined with FIT, it can increase detection rate of colorectal adenoma. Key words: Colorectal neoplasms; Colorectal adenoma; Advanced adenoma; SEPT9 DNA methylation; Immunochemical fecal occult blood tests

DCE and DSC MR perfusion imaging in the differentiation of recurrent tumour from treatment-related changes in patients with glioma

Correlation of C0 and C2 Levels With Cyclosporine Side Effects in Kidney Transplantation

Acute heart failure (AHF) is a severe complication after cardiac surgery with cardiopulmonary bypass (CPB). Although some AHF biomarkers have been used in clinic, they have limitations when applied in the prediction and diagnosis of AHF after cardiac surgery with CPB, and there are still no effective and specific biomarkers. We and other researchers have shown that circulating microparticles (MPs) increased in a variety of cardiovascular diseases. However, whether the concentration of circulating MPs could be a new biomarker for AHF after cardiac surgery remains unknown. Here, 90 patients undergoing cardiac surgery with CPB and 45 healthy subjects were enrolled. Patients were assigned into AHF (n=14) or non-AHF (n=76) group according to the diagnosis criteria of AHF. The concentrations of circulating MPs were determined before, as well as 12 h and 3 days after operation with nanoparticle tracking analysis technique. MPs concentrations in patients before surgery were significantly higher than those of healthy subjects. Plasma levels of MPs were significantly elevated at 12 h after surgery in patients with AHF, but not in those without AHF, and the circulating MPs concentrations at 12 h after surgery were higher in AHF group compared with non-AHF group. Logistic regression analysis indicated that MPs concentration at postoperative 12 h was an independent risk factor for AHF. The area under receiver operating characteristic curve for MPs concentration at postoperative 12 h was 0.81 and the best cut-off value is 5.20×108 particles mL-1 with a sensitivity of 93% and a specificity of 10%. These data suggested that the concentration of circulating MPs might be a new biomarker for the occurrence of AHF after cardiac surgery with CPB.

Introduction Serum concentration of Carbohydrate Antigen 19-9 (CA19-9) has been related to survival of patients with Cholangiocarcinoma (CCA). We evaluated the cut-off value of serum CA19–9 to define predictive management strategies in patients with CCA. Method Three hundred and forty-one (341) Patients were retrospectively reviewed at a regional hepatobiliary centre in Liverpool, UK. The hospital integrated database was used to extract clinical and laboratory data. The receiver operating characteristic curve (ROC) of serum concentration of CA19–9 by location of tumour and type of treatment offered were assessed. The cut-off value of CA19–9 providing optimal prognosis was used to evaluate differences in survival of the patients using Kaplan-Meier survival log-rank test. Results One hundred and sixty-four (48%) patients had valid pre-treatment CA19–9 measurements. Among treatment groups; biliary stent was placed in 67(41%); surgical resection in 43 (26.2%); chemotherapy in 36 (22.0%); while 18 (11%) had supportive care. For site of lesion, ROC for CA19–9 was 0.74 (95% CI: 0.62–0.84; sensitivity: 80.9%; specificity: 60.0%, p = 0.0002). For prognosis of intrahepatic disease and ROC for hilar lesions was 0.62 (95% CI: 0.51–0.71; sensitivity: 90.2%; specificity: 36.1%, p = 0.05). By treatment modality, surgical resection showed significant relationship with pre-treatment CA19–9 value (ROC: 0.75; 95% CI: 0.60–0.87). Serum concentration of >34 IU/ml was defined as the cut-off predictive of prognosis for those who had surgical resection (sensitivity: 76.9% and specificity: 73.3%, p = 0.001). The median survival of patients who had surgical resection with serum CA19–9 >34 IU/ml was 18 months whereas for those with a value ≤34 IU/ml, 5 year survival was 80%. Conclusion Serum CA19–9 concentration is a useful predictor of prognosis in patients with intrahepatic lesions as well as those undergoing resection for IHBD tumours. Validation of this cut-off value requires further studies. Disclosure of interest None Declared.

High D-Dimer Concentration Is a Significant Independent Prognostic Factor in Patients with Acute Large Vessel Occlusion Undergoing Endovascular Thrombectomy

Objective: The objective was to evaluate peritoneal microdialysis in the detection of clinical anastomotic leakage after left-sided colon and rectal resection through a systematic review.Methods: A systematic review (PRISMA guidelines) based on a systematic search through PubMed, Cochrane Library, and EMBASE (1 February 2017) was performed. Methodological index of non-randomised studies score was selected to assess the methodological quality. Patient demographics and raw data for intraperitoneal microdialysis concentrations of glucose, lactate, glycerol and pyruvate for 5 d postoperative were obtained from the respective study groups.Results: Ten studies with a total of 128 patients were included. Thirty (23%) patients developed clinical anastomotic leakage. The area under the curve for intraperitoneal lactate concentration was significant higher in patients with anastomotic leakage (58.2; 95% CI 39.2, 77.2) compared with the no leakage group (41.0; 95% CI 35.2, 46.1; p = .007). Receiver operating characteristic curve analysis of the maximum measured lactate concentration demonstrated 25% sensitivity, 88% specificity and 74% accuracy for AL at a cut-off value of 9.8 mmol/L. The odds ratio for a 5 mmol/L increase in lactate in relation to the risk of AL was 2.9 (CI 1.1, 8.0).Conclusions: Increased intraperitoneal lactate concentration within the first 5 d postoperative was significantly associated with clinical anastomotic leakage, but with low predictive values. The microdialysis method is not yet ready for clinical implication before large prospective studies have defined cut off values for a biologic marker in the setting of a clear definitions of leakage.

Elevation of serum S100 protein concentration as a marker of ischemic brain damage in extremely preterm infants