95th Percentile Values Research Articles

Water-Fat Separation in MR Fingerprinting for Quantitative Monitoring of the Skeletal Muscle in Neuromuscular Disorders.

Background Quantitative MRI is increasingly proposed in clinical trials related to neuromuscular disorders (NMDs). Purpose To investigate the potential of an MR fingerprinting sequence for water and fat fraction (FF) quantification (MRF T1-FF) for providing markers of fatty replacement and disease activity in patients with NMDs and to establish the sensitivity of water T1 as a marker of disease activity compared with water T2 mapping. Materials and Methods Data acquired between March 2018 and March 2020 from the legs of patients with NMDs were retrospectively analyzed. The MRI examination comprised fat-suppressed T2-weighted imaging, mapping of the FF measured with the three-point Dixon technique (FFDixon), water T2 mapping, and MRF T1-FF, from which the FF measured with MRF T1-FF (FFMRF) and water T1 were derived. Data from the legs of healthy volunteers were prospectively acquired between January and July 2020 to derive abnormality thresholds for FF, water T2, and water T1 values. Kruskal-Wallis tests and receiver operating characteristic curve analysis were performed, and linear models were used. Results A total of 73 patients (mean age ± standard deviation, 47 years ± 12; 45 women) and 15 healthy volunteers (mean age, 33 years ± 8; three women) were evaluated. A linear correlation was observed between FFMRF and FFDixon (R2 = 0.97, P < .001). Water T1 values were higher in muscles with high signal intensity at fat-suppressed T2-weighted imaging than in muscles with low signal intensity (mean value, 1281 msec [95% CI: 1165, 1604] vs 1198 msec [95% CI: 1099, 1312], respectively; P < .001), and a correlation was found between water T1 and water T2 distribution metrics (R2 = 0.66 and 0.79 for the median and 90th percentile values, respectively; P < .001). Water T1 classified the patients' muscles as abnormal based on quantitative water T2, with high sensitivity (93%; 68 of 73 patients) and specificity (80%; 53 of 73 patients) (area under the receiver operating characteristic curve, 0.92 [95% CI: 0.83, 0.97]; P < .001). Conclusion Water-fat separation in MR fingerprinting is robust for deriving quantitative imaging markers of intramuscular fatty replacement and disease activity in patients with neuromuscular disorders. © RSNA, 2021 Online supplemental material is available for this article.

Analytical characterization and clinical performance evaluation of a new point-of-care testing system for high-sensitivity cardiac troponin I assay

Background We aimed to evaluate the analytical performance and clinical diagnostic accuracy of the SuperFlex point-of-care testing (POCT) high-sensitivity cardiac troponin I (hs-cTnI) assay system. Method The imprecision, the limit of blank, the limit of detection, the limit of quantitation, linearity and comparability were assessed as per the Clinical and Laboratory Standards Institute guidelines. Also, the 99th-percentile reference value and diagnostic accuracy were evaluated. Results The reproducibility and total imprecision were 1.52–1.92% and 2.69–2.92%, respectively. Limit of blank and limit of detection were 1 ng/L and 1.8 ng/L, respectively, and limit of quantitation was 12 ng/L at 10% coefficient of variation (CV). The results met the requirements of linearity, and the correlation coefficient was 0.996. The SuperFlex POCT results had good agreement with those obtained by the Siemens Advia 2400. The CV% was 7.24% at the 99th percentile concentration (p99th) of 25.6 ng/L (95% confidence interval: 22.0–33.3 ng/L) from 620 healthy subjects. The sex-partitioned CV% and p99th were 7.15% at 27 ng/L (males; n = 308) and 7.35% at 24 ng/L (females; n = 312), respectively ( P &lt; 0.0001). The hs-cTnI detection rate of all observed healthy individuals from limit of detection to 99th was 82.57% by the SuperFlex POCT assay, 89.90% for the males and 75.48% for the females. The sensitivity, specificity, positive predictive value and negative predictive value of diagnostic performance for acute myocardial infarction were 100%, 81.25%, 57% and 100%, respectively. Conclusions The SuperFlex POCT system showed the analytical performance characteristics required for enabling the clinical use of a hs-cTnI assay.

What Is The Best Time Sampling For The Two Direct Oral Anticoagulants, Dabigatran and Rivaroxaban?

Introduction Thanks to their predictable pharmacokinetic profile, frequent monitoring of direct oral anticoagulants (DOACs) effects or levels is not recommended in the majority of patients, but it is anticipated that a non-negligible proportion of patients will achieve either insufficient or supra-therapeutic levels of the drug. Moreover, in pharmacokinetic studies with dabigatran etexilate (DE) and rivaroxaban marked interindividual variation in drug levels has been observed. The question about the most appropriate test to assess the treatment response has already been addressed and it was additionally stated that the interval between the drug intake and the blood sampling is mandatory. However, no information regarding the most appropriate delay for monitoring is currently provided. Therefore, the objective of this work is to evaluate the interindividual response at different time points in order to identify which interval between the drug intake and the blood sampling should be preferred for the assessment of the individual response. Methods Series of patients treated with rivaroxaban (AF n=25; VTE n=8) or DE (AF n=18) were included in the study. For each patient, blood was taken at 3 different intervals: - At Ctrough o 22 to 26 hours after the last intake of rivaroxaban o 11 to 13 hours after the last intake of DE - Two hours and three hours after drug administration For rivaroxaban samples, prothrombin time was performed with Triniclot PT Excel S®, RecombiPlasTin 2G® and Innovin®. Rivaroxaban plasma concentration was estimated with the Biophen Direct Factor Xa Inhibitor®. For DE samples, activated Partial Thromboplastin Time (aPTT) was perfomed with STA®-C.K.Prest and SynthasIL®. Plasma dabigatran concentration was estimated with the Hemoclot Thrombin Inhibitor®. Wilcoxon analyses were performed between the different blood sampling intervals. Test for effective pairing was computed with the Spearman non-parametric correlation coefficient with a one-tailed P value. Results Table 1 shows the minimum, the median and the maximum obtained with each tests at each time sampling. [Figure 1][1] provides the box-plot and whiskers (min to max) of the different assays performed on rivaroxaban samples at the different time sampling. [Figure 2][1] provides the box-plot and whiskers (min to max) of the different assays performed on dabigatran samples at the different time sampling. ![Figure 1][2] Figure 1 ![Figure 2][2] Figure 2 Discussion Our results confirm that there is a non-negligible interindividual variation in drug levels at same time points. When comparing intervals, whatever the test used in our study, we can see that results at Ctrough clearly differ from results obtained 2 or 3 hours after the intake of the drug ([Table 1][3]). Interestingly, for rivaroxaban, the median after 2 or 3 hours are closely the same with similar 25th – 75th percentile values whatever the test. Based on our results, we can affirm that for the majority of patients in our study, the Cmax is reached within 2 to 3 hours after the intake. For dabigatran, the plasma concentration is higher at 3h than at 2 hours ([Table 1][3]). However, the power of the study is not sufficient to show a statistically significant effect. Interestingly, this phenomenon is not encountered with the aPTT. This may be due to the well-known flattening curve effect at these higher concentrations. View this table: Table 1 Conclusion Based on our results, we can assert that it seems preferable to take the blood 3 hours after the last intake of DE to avoid missing the Cmax. For rivaroxaban, whatever the blood is taken 2 or 3 hours after the intake, results are similar. Therefore, we recommend to systematically performing blood sampling 3 hours after the intake of the drug to assess the maximal response at these treatments. Sampling at Ctrough is also required to evaluate the clearance. As a limitation, our results should be confirmed in larger cohort studies. Disclosures: No relevant conflicts of interest to declare. [1]: #F1 [2]: pending:yes [3]: #T1

Polycyclic aromatic hydrocarbons in 30 river ecosystems, Taiwan: Sources, and ecological and human health risks

Polycyclic aromatic hydrocarbons (PAHs) are diverse contaminants of global concern because of their ubiquity, toxicity, and carcinogenicity to many organisms, including humans. This study determines the distribution and sources of PAHs in sediments and fish from 30 major rivers in Taiwan, and the risks these PAHs pose to river ecosystems and human health. The total concentrations of 26 PAHs in sediments and fish were 0.016–7.44 mg/kg dw and 0.096–5.51 mg/kg ww, respectively. The PAH composition in sediments differed from that in fish, indicating that sediments may not be the major contributor of PAHs to fish. The accumulation of different PAH compounds in fish was species-specific, depending on the lipid content, living pattern, and trophic level of each fish species, and on the level of environmental contamination. The diagnostic ratios revealed that PAHs in the sediment primarily originated from pyrogenic sources, with some contribution from petrogenic sources. The contribution of each source varied with the sampling site and season. Several water and air quality variables were found to significantly correlate with PAH concentration in sediments and fish, suggesting that PAHs were mainly derived from wastewater discharge and combustion emissions. The 95th percentile risk quotient values suggested that PAHs in sediment from six rivers pose high ecotoxicological risks. The toxic equivalents of benzo[a]pyrene for 16 PAHs in fish were 12–108 μg/kg dw. A human risk assessment using the 95th percentile values of hazard quotient, hazard index, and margin of exposure revealed that the consumption of contaminated fish muscle poses no remarkable risk to human health. However, the 95th percentile carcinogenic risk values indicated that benzo[a]pyrene concentrations in some fish muscles may pose a carcinogenic risk. Benzo[a]pyrene risk management measures are, therefore, necessary.

Histogram analysis of arterial spin labeling perfusion data to determine the human papillomavirus status of oropharyngeal squamous cell carcinomas.

To evaluate the correlation between histogram parameters derived from pseudo-continuous arterial spin labeling (PCASL) and human papillomavirus (HPV) status in patients with oropharyngeal squamous cell carcinoma (OPSCC). This study included a total of 58 patients (HPV-positive: n = 45; -negative: n = 13) from a prospective cohort of consecutive patients aged ≥ 18years, who were newly diagnosed with oropharyngeal squamous cell carcinoma. All patients were required to have undergone pre-treatment MRI with PCASL to measure regional perfusion. The region of interest was drawn by two radiologists, encompassing the entire tumor volume on all corresponding slices. Differences in the histogram parameters derived from tumor blood flow (TBF) in ASL were assessed for HPV-positive and -negative patients. Receiver operating characteristic curve analysis was performed to determine the best differentiating parameters, and a leave-one-out cross-validation was used. Patients with HPV-positive OPSCC showed a significantly lower overall standard deviation and 95th percentile value of tumor blood flow (P < .007). The standard deviation of TBF was the single best predictive parameter. Leave-one-out cross-validation tests revealed that the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were 0.745, 75.9%, 75.6%, and 76.9%, respectively. PCASL revealed differences in perfusion parameters according to HPV status in patients with OPSCC, reflecting their distinct histopathology.

Anthropometry of Female Agricultural Workers of Madhya Pradesh

Most of the agricultural operations in India are performed manually with hand tools and equipment by female agricultural workers. This prompted designers to use female anthropometric data in designing of farm equipment and workplaces in order to reduce drudgery, to enhance safety, to improve performance, productivity and efficiency. A study was conducted to collect the anthropometric data of selected 30 female agricultural workers in the age group of 22-54 years from Madhya Pradesh state. For design of agricultural tools, equipment and workplaces the important, thirty eight body dimensions including weight were identified and measured. The values of mean, standard deviation (SD), minimum, maximum, coefficient of variation (CV) and 1st, 5th, 50th, 95th and 99th percentile values were calculated of selected body dimensions. The mean weight and stature of female agricultural workers were found to be 53 kg and 1536 mm, respectively. A large variation in anthropometric dimensions in the anthropometric data of female farm workers of different states of India and other countries was observed. Pearson correlation coefficients (PCC) were calculated among selected anthropometric dimensions of subjects. The correlation coefficients of measured data varied from 0.65-0.98.

Mathematical model for histogram analysis of dynamic contrast-enhanced MRI: A method to evaluate the drug treatment response in rheumatoid arthritis

PurposeTo evaluate the effectiveness of a mathematical model for histogram analysis of DCE-MRI in distinguishing responders from non-responders during RA drug treatment. MethodTwenty-three consecutive RA patients with clinically active inflammation prospectively underwent DCE-MRI at baseline and after treatment. Manual segmentation of the enhanced synovium was performed on the last phase of DCE-MRI. The voxel-based contrast enhancement was calculated in each phase to obtain 75th percentile values. Kinetic curves made from the 75th percentile values were fitted to mathematical model as follows, ΔS(t) = A(1 – e−αt)e-βt, where A is the upper limit of signal intensity (%), α (sec−1) is the rate of signal increase, and β (sec−1) is the rate of signal decrease during washout. AUC30 was calculated by integration of 30 s. SER was calculated as the signal intensity at the initial time point (t = 60) relative to the delayed time point (t = 300). The volumes of enhanced synovium (sum of the number of voxels) were also calculated. ResultsAfter treatment, α, Aα, AUC30 and SER were significantly lower in the responder group than in the non-responder group (p = 0.033, 0.024, 0.015, and 0.007). The p value of SER was lowest. Aα, AUC30, and the volume of enhanced synovium had significantly larger changes from baseline to after treatment in the responder group than in the non-responder group (p = 0.045, 0.017, and 0.008). The volume of enhanced synovium had the lowest p value. ConclusionsSER after treatment and change in the volume of enhanced synovium might be effective for distinguishing responders from non-responders.

Culturally modified olfactory test adapted to East-Turkey: A comparison with Sniffin' Sticks.

Although the "Sniffin' Sticks" test (SST) is a widely used odor test, aplicability of odor tests is limited because of the high cost of the test and the regional-cultural differentiation of odor recognition. We aimed to evaluate our regional odor norms by applying the SST with a Modified odor test (MOT) we created for this study, and to develop a test similar to the SST, which was less expensive and probably had a higher odor definition for our region. This study includes 201 healthy volunteers: 91 men and 110 women over the age of 18 were included in the study. Tests were compared by applying the SST and MOT to all volunteers. In all subjects, for the SST: the mean Threshold score (TS), Discrimination score (DS), and Identification score (IS) were, respectively, 10.73±2.35, 11.11±11.94 and 11.32±2.15. TheTDI mean score was found to be 33.11±5.9. In the TDI score, the 10th percentile value was found to be 26. For the MOT, the mean TS(mTS), DS(mDS), and IS(mIS) were 10.88±2.31, 12±2.06, and 11.95±2.07, respectively, the modified test TDI(mTDI) mean was 34.68±6.47. The mTDI 10th percentile value was found to be 26. In all volunteers, there was no statistically significant difference between the two tests for the mean threshold score, while the difference in the mean discrimination score, the average identification score, and the average TDI (thresold, discrimination, sum of identification scores) score was statistically significant (P<.01). This study is the first study to compare the SST and the MOT in our region. Making low-cost modifications by adding more probable smells to the smell tests and using them in studies involving more participants will be more meaningful in evaluating normative odor scores and will result in more widespread use.

Potential health risk associated with consumption of local food containing pesticide residues for the rural population

Objective. Hygienic assessment of the potential health risks to the rural population associated with the use of local food products produced in areas containing residual amounts of pesticides in the soil. Material and methods. The quantification of chloro- and organophosphorus pesticides in local foods was analyzed by thin-layer and gas-liquid chromatography. Health risks to the rural population from exposure to pesticides in foods were assessed according to the Risk Assessment Guidelines (P 2.1.10. 1920-04). To calculate exposure and hazard ratio (HQ), summary hazard indices (HIs), individual (CR), and population (PCR) carcinogenic hazards, the median and 90th percentile of pesticide content in topical foods were used. Results. Dairy and vegetable products were found to contribute mainly to the median level of pollution with organochlorine toxic chemicals for most studied areas. Potatoes and vegetable products contributed to pollution with organophosphorus compounds. The HQ values calculated at the median level of pesticide content in food products in all agricultural areas under study in the region indicated an acceptable level of exposure. It is also good, but above 1.0, were the total HI due to pesticide contamination at the level of the 90th percentile value in local food products of four districts of the Saratov region. The total non-carcinogenic risk at the level of the 90th percentile was assessed for pesticides that have a unidirectional effect on the damage to the endocrine system - due to the action of DDT, HCHCG, and malathion; damage to the liver, kidneys, and the reproductive system - due to the action of DDT, HCHCG, chlorpyrifos and glyphosate. Conclusion. Thus, the study established a high level of the CR value for the health of all surveyed environmentally disadvantaged areas of the Saratov region associated with contamination of HCHCG food products calculated at the median and 90th percentile level. An average of 84.2% of PCR was due to contamination of local HCHCG foodstuffs and 15.8 % to DDT.

Compliance Testing and Homogenous Exposure Group Assessment in the South African Coal Mining Industry.

Globally, several strategies for compliance testing and within-group exposure variability have been suggested. This study aimed to evaluate the performance of the South African Mining Industry Code of Practice (SAMI CoP) approach for grouping and compliance testing against international standards. A total of 28 homogenous exposure groups (HEGs) with 728 underground coal mine workers' eight-hour time-weighted average coal dust concentration data were obtained. Compliance testing was assessed using 10% exceedance above occupational exposure limit (OEL) for SAMI CoP, and the 95th percentile of the lognormal distribution was computed for the European Standardization Committee (CEN) and American Industrial Hygiene Association (AIHA). Comparison of the homogeneity of the HEGs was done between SAMI CoP which mandates that both the arithmetic mean (AM) and 90th percentile must fall in the same exposure band to certify homogeneity and the global geometric standard deviation (GSD) and Rappaport ratio (R-ratio) with specific acceptability criteria. To test the homogeneity of exposure within job titles, eight non-homogenous HEGs that have two or more job titles with three measurements were investigated using GSD and the SAMI CoP criteria. A total of 21 HEGs out of 28 were non-compliant to the OEL across SAMI CoP, CEN, and AIHA criteria. Compliance to the OEL was observed for seven HEGs according to the SAMI CoP approach, whereas only one HEG was compliant according to both the SAMI CoP and CEN approaches. The GSD criterion and SAMI CoP revealed that 11 and 6 HEGs were homogenous, respectively, and only on 4 occasions, the 2 approaches agreed. The job titles of the majority of non-homogenous HEGs in both SAMI CoP and GSD were actually homogenous. Five out of 10 sub-groups have their AM above that of HEG B. Other HEGs had at least one of their AM and 90th percentile values above that of their respective parent HEGs. All three approaches mainly confirmed non-compliance of HEGs. SAMI CoP tended to show compliance of HEGs more than CEN. Non-homogenous HEGs had many job titles that were homogenous according to both SAMI CoP and GSD criteria. There was no perfect agreement of homogeneity by all the indicators. For both future constitutions of HEGs as well as a retrospective assessment of high exposure groups, homogeneity can be improved by using job titles.

Raised sputum extracellular DNA confers lung function impairment and poor symptom control in an exacerbation-susceptible phenotype of neutrophilic asthma

BackgroundExtracellular DNA (e-DNA) and neutrophil extracellular traps (NETs) are linked to asthmatics airway inflammation. However, data demonstrating the characterization of airway inflammation associated with excessive e-DNA production and its impact on asthma outcomes are limited.ObjectiveTo characterize the airway inflammation associated with excessive e-DNA production and its association with asthma control, severe exacerbations and pulmonary function, particularly, air trapping and small airway dysfunction.MethodsWe measured e-DNA concentrations in induced sputum from 134 asthma patients and 28 healthy controls. We studied the correlation of e-DNA concentrations with sputum neutrophils, eosinophils and macrophages and the fractional exhaled nitric oxide (FeNO). Lung function was evaluated using spirometry, body plethysmography, impulse oscillometry and inert gas multiple breath washout. We stratified patients with asthma into low-DNA and high-DNA to compare lung function impairments and asthma outcomes.ResultsPatients with severe asthma had higher e-DNA concentration (54.2 ± 42.4 ng/µl) than patients with mild-moderate asthma (41.0 ± 44.1 ng/µl) or healthy controls (26.1 ± 16.5 ng/µl), (all p values < 0.05). E-DNA concentrations correlated directly with sputum neutrophils (R = 0.49, p < 0.0001) and negatively with sputum macrophages (R = − 0.36, p < 0.0001), but neither with sputum eosinophils (R = 0.10, p = 0.26), nor with FeNO (R = − 0.10, p = 0.22). We found that 29% of asthma patients (n = 39) had high e-DNA concentrations above the upper 95th percentile value in healthy controls (55.6 ng /μl). High-DNA was associated with broad lung function impairments including: airflow obstruction of the large (FEV1) and small airways (FEF50%, FEF25–75), increased air trapping (RV, RV/TLC), increased small airway resistance (R5-20, sReff), decreased lung elasticity (X5Hz) and increased ventilation heterogeneity (LCI), (all P values < 0.05). We also found that high e-DNA was associated with nearly three-fold greater risk of severe exacerbations (OR 2·93 [95% CI 1.2–7.5]; p = 0·012), worse asthma control test (p = 0.03), worse asthma control questionnaire scores (p = 0.01) and higher doses of inhaled corticosteroids (p = 0.026).ConclusionIncreased production of extracellular DNA in the airway characterizes a subset of neutrophilic asthma patients who have broad lung function impairments, poor symptom control and increased risk of severe exacerbations.

MO174FIBROSCAN DETECTION OF FATTY LIVER AND LIVER FIBROSIS IN SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract Background and Aims Systemic Lupus Erythematosus (SLE) is a chronic, multi-organ, systemic autoimmune disease that is more common in women than men and is typically diagnosed during the reproductive age. Although liver dysfunction is not considered the main organ pathology in SLE, the frequency of liver dysfunction or abnormal liver enzyme values may be observed in 50-60% of patients. Liver-related complications may present as asymptomatic hepatomegaly, subclinical steatosis and abnormal liver enzymes. The most common causes are drug-associated liver injury, lupus-associated hepatitis, and fatty liver disease. The aim of this study was to assess fatty liver and liver fibrosis in SLE patients using the FibroScan method as well as associated factors such as immunosuppressive medications. Method Sixty SLE patients and 30 healthy controls were included. Patients with HBV, HCV or cirrhosis, malignancy, cardiac disease, or patients on dialysis were excluded. All participants underwent FibroScan measurements. Demographic data and cumulative doses of immunosuppressive medications were extracted from patient charts. Fasting blood was collected for analysis Results Demographic and clinical characteristics of the study groups are shown in Tables 1. The prevalence of fatty liver disease was similar between SLE patients and healthy controls (21.7% vs 26.7%, p= 0.597) and was associated with body mass index (BMI) (p= 0.026) and C-reactive protein (CRP) (p= 0.046) in multivariate analysis. Liver fibrosis was also similar between the two groups (26.7% vs 10.0%, p= 0.069). There was no relationship between cumulative drug doses including glucocorticoids with either fatty liver disease or liver fibrosis. Since the majority of SLE patients were female, we performed a subgroup analysis in female patients (n=51) and healthy controls (n=25). Fatty liver disease was similar between female SLE patients and healthy controls (23.5% vs 24.0%, p= 0.964). However, liver fibrosis in female patients with SLE was increased compared to the female healthy population (29.4% vs 4.0%, p= 0.011) and was associated with age (p= 0.034) and low-dose cumulative glucocorticoid use (p = 0.034). Low-dose cumulative glucocorticoid use was defined as less than 17.45 g, which was the 75th percentile value. Only 1 out of 15 female patients with fibrosis had high-dose cumulative glucocorticoid use (&amp;gt;17.45 g), while the remaining 14 patients had used lower doses (&amp;lt;17.45 g). Conclusion The prevalence of fatty liver was similar between SLE patients and healthy controls, while liver fibrosis was increased in the female patient group as compared to controls. Furthermore, liver fibrosis was associated with age and low dose cumulative glucocorticoid use. Interestingly, fatty liver did not precede liver fibrosis in the majority of cases, contrary to what is observed in the general population. We hypothesized that liver fibrosis may be the result of subclinical inflammation and autoimmunity associated with SLE itself and the use of steroids may prevent or prolong fibrosis formation in the liver.

Association between parental education level and left ventricular hypertrophy in childhood

Objective: To examine the relationship between parental education level and left ventricular hypertrophy (LVH) in children. Methods: The data comes from the baseline survey of the Huantai Childhood Cardiovascular Health Cohort Study (HCCH) conducted in Huantai County, Zibo City, Shandong Province. A convenient cluster sampling method was used to select a primary school in Huantai County, Zibo City, Shandong Province as a survey point. A cross-sectional survey was conducted from November 2017 to January 2018. A total of 1 316 children aged 6-11 years with complete data were included. LVH was defined as left ventricular mass index ≥ sex-and age-specific 90th percentile values of this population. Education levels of both parents were divided into junior high school or lower, high school, university or higher, respectively. Logistic regression models were used to analyze the association between parental education level and LVH in children. Results: The age of 1 316 participants was (8.9±1.5) years old. Among them, there were 703 boys (53.4%).After adjusting for gender, age, intake of vegetables and fruits, intake of carbonated drinks, physical activity, sleep time, screen time, overweight or obesity, and occasional hypertension, the logistic regression model results show that compared with those children whose parents' education level is junior high school or below, paternal or maternal education level of college or higher was associated with odds of LVH (father: OR=0.53, 95%CI: 0.33-0.87; mother: OR=0.52, 95%CI: 0.32-0.87; father/mother: OR=0.54,95%CI: 0.32-0.91). Conclusion: Parental education level is inversely associated with LVH in childhood. The probability of LVH in childhood decreases with the increase of parental education levels.

Floating particles with high copper concentration in the sea-surface microlayer.

This study sought to clarify whether suspended particles containing high Cu concentrations are present in the sea-surface microlayer (S-SML). For this reason, suspended particles (10-2000 μm) in the S-SML were collected periodically from a ship mooring pond during 2018-2020, and the acid-soluble Cu concentration in the suspended particles was measured as particulate Cu (P-Cu). The highest concentration of P-Cu in the S-SML of the pond was 75 μg L-1 with a 90th percentile value of 2.5 μg L-1. This is below P-Cu values reported for the S-SML in North American ports, but 140 times higher than this found in bulk seawater in the Atlantic Ocean. The highest P-Cu concentration in the S-SML of non-organism (abiotic) origin was 17 μg L-1, and the abiotic P-Cu to P-Cu ratio varied from 0.2 to 100%, likely depending on the quality and quantity of biogenic material in the S-SML samples. It is assumed that the S-SML particles examined here contain high Cu concentrations originating from ship antifouling paints.

Distribution and prognostic value of high-sensitive troponin T measurement in patients with type 2 diabetes without cardiovascular disease

AimThe objective of this work was to define a value for the 99th percentile of high-sensitive troponin T and to evaluate the prognostic value of this biomarker in a population of patients with type 2 diabetes without a history of cardiovascular disease. MethodsIn this prospective, observational and analytic study, 482 patients with type 2 diabetes were enrolled. The patients were asymptomatic, with no history of cardiovascular events, renal insufficiency, or inflammatory or systemic disease. As events we considered a combined end point of major adverse cardiovascular events (MACE). Results94.9% of the patients had detectable troponin values, 20.7% of the patients had troponin values above the healthy population reference upper threshold (14pg/mL). The 99th percentile value for this patient population was 48pg/mL. Age, sex, the glomerular filtration rate and hypertension were associated with troponin values>14pg/mL. The incidence of MACE was 3.96 per 100 patients/year (p/y) between those with hs-TnT>14pg/mL and 1.07 per 100 p/y between those with hs-TnT≤14pg/mL (HR=3.78 CI95 1.49–9.58; p=0.005). ConclusionsThe 99th percentile value of troponin T in a population of patients with type 2 diabetes is 3-fold higher than the value proposed by the manufacturer for a healthy population. We also observed a significant difference in the distribution of troponin T values between men and women. This biomarker may be a valuable prognostic factor, since troponin T values above the reference upper threshold were associated with an increase in the risk of cardiovascular events in these patients.

Impact of Future Land-Use/Cover Change on Streamflow and Sediment Load in the Be River Basin, Vietnam

Evaluation of the influence of land-use/cover (LUC) change on water and sediment fluxes from river basins is essential for proposing adaptation and mitigation strategies, but as of yet little information is available, especially in the tropics. For this motivation, the objective of this study was to assess the impact of scenarios of LUC change on streamflow and sediment load in the Be River Basin using the Dynamic Conversion of Land-Use and its Effects (Dyna-CLUE) model and the Soil and Water Assessment Tool (SWAT) model. The Dyna-CLUE and SWAT models were calibrated and validated against observed data in the period of 1980–2010. Three future LUC scenarios in 2030, 2050, and 2070 were generated utilizing the calibrated Dyna-CLUE model based on the historical conversion of forest land to agricultural land and urban area in the study region. Subsequently, the calibrated SWAT model was used to simulate the changes in streamflow and sediment load under these three future LUC scenarios. Results indicated that the annual streamflow and sediment load were estimated to be approximately 287.35 m3/s and 101.23 × 103 ton/month for the baseline period. Under the influence of future LUC scenarios, the annual streamflow and sediment load would experience increases of 0.19% to 0.45% and 0.22% to 0.68%, respectively. In addition, the 5th and 95th percentile values of streamflow and sediment load are predicted to rise in the context of future LUC change. The results achieved from the present study will support the managers and policy makers proposing appropriate solutions for sustainable water resources management and sediment control in the context of LUC change.

Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration?

The first-choice therapy for adults with moderate/severe obstructive sleep apnea is continuous positive airway pressure (CPAP). However, studies evaluating whether the therapeutic CPAP level obtained from a titration is affected by sex are surprisingly scarce. Our main objective was to verify if sex influenced the optimal CPAP measurement obtained during a titration. This cross-sectional study was conducted in adults diagnosed with moderate/severe obstructive sleep apnea [baseline apnea-hypopnea index (AHI) ≥ 15.0 events/h] who underwent auto-adjusting CPAP titration (S9 or S10 AutoSet ResMed) in a sleep laboratory setting. All participants used a nasal mask during the titration. The optimal pressure, leak, and residual AHI values were registered. Multiple linear regression was used to evaluate if clinical and polysomnographic data influenced the therapeutic CPAP level setting (95th percentile pressure). A total of 1,006 adults were enrolled: 354 women and 652 men. There were no statistically significant sex-related differences in the CPAP requirements and leak values delineated during the titration; all P-values > .005. However, the median residual AHI was significantly higher in males vs females: 2.7 events/h vs 2.2 events/h (P = .008). Body mass index (β: 0.292, P < .001), baseline AHI (β: 0.167, P < .001), and age (β: 0.065, P = .035) were independent predictors of the therapeutic CPAP level settings. Sex does not significantly influence the therapeutic CPAP settings. However, age, BMI, and baseline AHI emerge as independent predictors of the 95thpercentile CPAP requirement during an auto-adjusting CPAP titration. Duarte RLM, Magalhães-da-Silveira FJ, Gozal D. Are there sex-related differences in therapeutic CPAP levels in adults undergoing in-laboratory titration? JClin Sleep Med. 2021;17(9):1815-1820.

Progression of the first stage of labour, in low risk nulliparas in a South Asian population: a prospective observational study

We compared the labour pattern in the active phase of labour, defined at 4 cm versus 6 cm cervical dilatation, in a South Asian population. This was a prospective observational study where 500 low risk nulliparous women were recruited. Our aim was to study, the average labour pattern curve of all parturients. Mean duration of the active phase from 4 to 10 cm was 5.12 ± 2.10 hours and from 6 to 10 cm was 2.79 ± 1.72 hours. The 95th percentile values suggests that it takes 5–6 hours to progress from 4 to 6 cm and again 5–6 hours from 6 to 10 cm. The minimum labour progression rate can be as low as 0.5 cm/hour with vaginal delivery (VD) still being achieved. The slope of labour curve steepens after 6 cm, suggesting 6 cm as the onset of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum intervention and caesarean section (CS) for labour dystocia. Impact Statement What is already known on this subject ? Friedman’s definitions of normal labour and abnormal labour are widely accepted in current obstetric practises. Friedman’s normal dilatation rate of 1 cm/h that is universally accepted is becoming questionable in our current obstetric population because of escalating rates of unnecessary labour interventions like oxytocin augmentation and CS. What the results of this study add ? The rule of 1 cm/hour of labour progression cannot be applied to every woman and inappropriate interventions should be withheld until labour progression does falls below 0.5 cm/hour. What the implications are of these findings for clinical practice and/or further research? Six centimetres rather than 4 cm of cervical dilatation is a more appropriate landmark for the start of the active phase. Allowing labour to continue for a longer period before 6 cm of cervical dilation may reduce the rate of unnecessary intrapartum interventions and CS for labour dystocia.

Comparisons of PNEC derivation logic flows under example regulatory schemes and implications for ecoTTC

Derivation of Predicted No Effect Concentrations (PNECs) for aquatic systems is the primary deterministic form of hazard extrapolation used in environmental risk assessment. Depending on the data availability, different regulatory jurisdictions apply application factors (AFs) to the most sensitive measured endpoint to derive the PNEC for a chemical. To assess differences in estimated PNEC values, two PNEC determination methodologies were applied to a curated public database using the EnviroTox Platform (www.EnviroToxdatabase.org). PNECs were derived for 3647 compounds using derivation procedures based on example US EPA and a modified European Union chemical registration procedure to allow for comparisons. Ranked probability distributions of PNEC values were developed and 5th percentile values were calculated for the entire dataset and scenarios where full acute or full chronic data sets were available. The lowest PNEC values indicated categorization based on chemical attributes and modes of action would lead to improved extrapolations. Full acute or chronic datasets gave measurably higher 5th percentile PNEC values. Algae were under-represented in available ecotoxicity data but drove PNECs disproportionately. Including algal inhibition studies will be important in understanding chemical hazards. The PNEC derivation logic flows are embedded in the EnviroTox Platform providing transparent and consistent PNEC derivations and PNEC distribution calculations.

ESTABLISHING LOCAL DIAGNOSTIC REFERENCE LEVELS FOR ROUTINE COMPUTED TOMOGRAPHY EXAMINATIONS IN JIMMA UNIVERSITY MEDICAL CENTER SOUTH WEST ETHIOPIA.

The main purpose of this study was to determine local diagnostic reference level (LDRL) for Routine Computed Tomography (CT) examination in, Jimma University Medical Center (JUMC) South West Ethiopia. Retrospective study was conducted to determine LDRL for routine CT examination in JUMC. We have considered CTDIvol and DLP as dosimetric quantity based on the recommended guidelines to determine LDRLs by different international legal Authorities. The 75th percentile values of the calculated CTDIvol and DLP were proposed as LDRL. LDRL was obtained as CTDIvol, 42.97mGy, 7.76mGy, 14.32mGy, and 10.86mGy for routine brain CT, routine chest CT, routine thoraco-lumbar CT and routine abdomen CT examination respectively. Similarly the determined LDRL from DLP was 1364.15mGycm, 368.96mGycm, 853.18mGycm, and 1568.96mGycm for brain, chest, thoraco-lumbar and abdomen examination respectively. The LDRL obtained for DLP was higher compared with international DRLs; it can be reduced by coordinating effort between radiologists, technologists and medical physicist.