Accuracy Of Day Research Articles

P209 Prospective validation of faecal calprotectin as a predictor of steroid failure in patients with acute severe colitis

Abstract Background Optimal outcomes in acute severe colitis (ASC) are related to time-bound management based upon an early prediction of response to intravenous (IV) corticosteroids. We have demonstrated good diagnostic accuracy of day 3 faecal calprotectin (FCP) in this setting. The present study intended to validate these findings in a different cohort. Methods This prospective cohort study included IV steroid naïve (for this episode) patients with ASC, satisfying Truelove and Witts’ criteria, hospitalised from September 2018 to August 2019. Patients were subjected to baseline sigmoidoscopy, day 1 and day 3 faecal calprotectin, baseline hemogram and biochemistry, and day 3 CRP. All patients received IV steroids after hospitalisation, and the primary outcome measure was steroid-failure defined as colectomy and/or rescue therapy with ciclosporin or infliximab during admission. Results Of 47 patients with ASC, eight were excluded (four received steroids outside, 2-directly taken for surgery/infliximab therapy, 1-toxic megacolon on day 1, 1-infectious colitis), 39 were finally included [mean age−36.08 ± 12.58 years, male (30.7%)]. Fifteen patients (38.5%) failed IV steroids and required rescue therapy (10 infliximab, 2 cyclosporine, four surgery). On univariate analysis, the factors significantly different between steroid responders and steroid failure included UCEIS >6 at baseline, Day 1 and Day 3 FCP, day 5 stool frequency, day 5 ESR and CRP, and oxford criteria (Figure 1). On multivariate analysis, only D3 FCP, UCEIS at baseline and Oxford criteria were significant predictors of steroid failure. Like the previous study, on ROC curve analysis, the day 3 FCP had similar diagnostic accuracy [AUC-0.86(0.75–0.98), and 1120.61 μg/g as a cut-off could predict steroid failure with 87% sensitivity and 79% specificity. Similarly, a combination of baseline UCEIS>6 and day 3 FCP>1120.61 μg/g had 100% specificity and positive predictive value for steroid failure. Conclusion FCP retained its value as an objective predictor of steroid failure in ASC.

Why Day 3 biopsy mosaicism is blamed for the lack of success of PGD-A?

Introduction Preimplantation Genetic Diagnosis- Aneuploidy Screening (PGD-A) is a technique commonly used in conjunction with IVF treatments. PGD-A is intended to identify those embryos with greater likelihood to implant. It is offered to patients at increased risk of producing chromosomally abnormal embryos (increased maternal age, Recurrent miscarriage, IVF failure and severe male factor). Technical related Error rates of PGD-A have fallen from 7% when using FISH to less than 1% when using modern techniques such as Next Generation Sequencing (NGS). Another source of error that is related to the physiology of the embryos is mosaicism described as the presence of two or more cells lines within an embryo. The advantage of NGS made the detection of mosaicism easier due to the i) higher sensitivity in aneuploidy detection and ii) the reliability of the technique making non-mosaicism related error minimal. The objective of our study is to assess the mosaicism rate and the misdiagnosis rate due to euploid/aneuploid mosaic embryos on day 3 biopsy. Material and Methods Embryos from patients undergoing PGD-A were biopsied on day 3 and sent to our laboratory for Aneuploidy Screening by NGS. Blind Reanalysis ofembryonic cells from embryos diagnosed as aneuploid but with good morphology and development was performed. Rebiopsy was carried out either on day 4, day 5 or day 6. Both, original analysis and reanalysis were performed by NGS (MySeq, Illumina platform). Result(s) PGD-A was performed in our laboratory on 29309 embryos at cleavage stage from 2016 to date. Rebiopsy for 173 embryos, originally diagnosed as aneuploidy, were blindly reanalyzed. There was 118 out of 173 showed aneuploidy (91.3%) while 15 out of 173 were found euploids (8.7%). The aneuploid embryos were divided into 3 categories: first where 118 embryos out of 173 (68.2%) showed the same initial result; second, 37 of the 173 (21.4%) showed at least one aneuploidy that was present in the initial result and third 3 out 173 (1.7%) showed a different an inverted figure of deletion/duplication for the same chromosome. Conclusions This study shows a very high confirmation rate (more than 90%) for day 3 biopsies. Our misdiagnosis rate after day 3 biopsy is 8.7%, due to mosaicism. Our data support the usefulness of day 3 biopsy PGD-A by NGS in places where day 5 biopsy is not possible. The mosaic rate on a relatively high number of embryos observed in this study is in line with other similar reported data. Our reanalysis was based on rebiopsies on embryos showing a good division after the first biopsy which might explain the low mosaic rate. Despite the high accuracy in day 3 biopsy diagnosis, implantation/pregnancy rate is still in the range of 50-60% implicating the necessity of finding more embryonic viability markers allowing a better outcome after IVF/PGD-A.

Impact of Day 14 Bone Marrow Biopsy on Re-Induction Decisions and Prediction of a Complete Response in Acute Myeloid Leukemia Cases

Background:With acute myeloid leukemia (AML), there are limited data about the accuracy of day 14 bone marrow (BM) biopsies for predicting complete remission as compared to day 28 BM biopsy results. We here aimed to estimate the correlation between, and the diagnostic accuracy of, both approaches.Materials and Methods:We reviewed 84 patients with AML treated with standard induction chemotherapy to evaluate the remission rate and treatment decisions based on day 14 BM biopsy from 2000-2012.Results:Sixty five patients (77%) demonstrated remission (CR) with less than 5% blasts on their day 14 BM. Thirteen patients (16%) had residual disease (RD), and 6 (7%) were classified as indeterminate response (IR) i.e., blasts 5-20%. Two patients with RD on day 14 underwent re-induction. Out of the 17 remaining cases with RD+IR, 14 (all 6 with IR and 8 out of 11 with residual disease with no re-induction) demonstrated a morphologic complete remission (CR) on day 28 BM. The percentages for complete remissions on days 28 and 14 were significantly different [94% versus 79.3%, respectively; p=0.004, (OR= 0.143, 95% CI: 0.032-0.63)]. Day 14 BM had 82% sensitivity in predicting CR on Day 28; however, it had insufficient specificity (60%) in predicting failure of CR.Conclusions:Induction treatment response assessment based on day 14 BM does not accurately predict the response rate on day 28 and the use of day 14 BM as a sole marker of response to therapy might expose patients to unnecessary interventions.

Prognosis in Relation to Blood Pressure Variability

Prognosis in Relation to Blood Pressure Variability

지능형 CCTV를 이용한 수위감지 경보시스템에 대한 실험 및 해석적 연구

본 연구에서는 지능형 CCTV를 이용하여 자동 수위감지 알고리즘과 사전 경보시스템을 개발하고 Test-Bed에 적용하여 실용화 가능성을 검증하고자 한다. 이를 위하여 현장여건에 적합한 지능형 CCTV 기반의 자동 수위감지 알고리즘을 개발하고 자동인식률 가변 요소에 대한 성능저하 방지대책을 수립하여 CCTV 카메라 기종별 수위감지 성능과 적합성을 평가하고 실용화에 따른 최적 적용방안을 도출한다. 그 결과, CCTV 카메라 기종별 수위감지 성능이 90%으로 도출되었다. CCTV 카메라 기종에 따른 적합성 평가 결과, 자동 수위감지용으로 NIR카메라가 정밀도에서 주 야간 95%이상의 성능을, 떨림 안개 저조도 등 자연환경에서 가장 우수한 성능을, 설치용이성에서는 일반카메라와 대등한 성능을, 가격측면에서 일반카메라 대비 15% 최소 상승분으로 가장 우수했다. 따라서 본 연구개발의 성과물인 지능형 CCTV를 이용한 수위감지 경보시스템의 실용화 가능성을 확인하였으며 향후 실용화가 예상된다. In this research, we developed video analytic algorithms to detect water-level automatically and a system for proactive alarming using intelligent CCTV cameras. We applied these algorithms and a system to test-beds and verified for practical use. We made camera-selection policies and operation plans to keep the detection accuracy high and to optimize the suitability for the ever-changing weather condition, while the environmental factors such as camera shaking and weather condition can affect to detection accuracy. The estimation result of algorithms showed 90% detection accuracy for all CCTV camera types. For water level detection, NIR camera performed great. NIR camera performed over 95% accuracy in day or night, suitable in natural weather condition such as shaking condition, fog, and low light, needs similar installment skills with common cameras, and spends only 15% high cost. As a result, we practically tested water level detection algorithms and operation system based on intelligent CCTV camera. Furthermore, we expect the positive evidences when it is applied for public use.

Estimating mean air temperature using MODIS day and night land surface temperatures

Near surface air temperature (Ta) values measured by weather stations provide limited information about spatial patterns over a wide area. Remote sensing is a promising technology for providing a more accurate description of spatial variations in the Ta on both a regional and global scale. This paper presents a new approach for estimating mean Ta using a combination of MODIS day–night land surface temperatures (Ts) and enhanced vegetation index (EVI) data (called DTVX method). The advantages of the DTVX method include complete independence of ancillary data and non-contextual characteristics that circumvent the limitations inherent to the contextual temperature–vegetation index (TVX) method. Three land areas covered by the MODIS sinusoidal tile h26v04, h26v05, and h27v05 were selected as test areas because their terrain elevations vary in the range of several decameters to several kilometers. Based on the DTVX method, Terra MODIS 8-day day–night Ts and 16-day EVI products were used to obtain an 8-day average Ta from May 2010 to June 2011 (a total of 51 8-day periods). The daily average Ta values measured at 314 weather stations in the three tiles were utilized as the in-situ reference data. An RMSE value of 1.84 K with R 2 of 0.97 was observed for the Ta estimation in the h27v05 tile (plain area). In the case of the h26v05 tile (high mountain area), an RMSE of 2.45 K with R 2 of 0.96 was observed, whereas the h26v04 tile (mountain area) exhibited an RMSE of 2.34 K with an R 2 of 0.989. The RMSE of the three tiles was 2.23 K with an R 2 of 0.977. Sensitivity analysis indicates that the method developed herein is elastic with respect to the accuracy of day–night Ts and EVI data in areas with a greater EVI and day–night Ts difference, such as dense forests and high mountain areas.

Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study

Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study

Prognostic accuracy of day versus night ambulatory blood pressure: a cohort study

Few studies have formally compared the predictive value of the blood pressure at night over and beyond the daytime value. We investigated the prognostic significance of the ambulatory blood pressure during night and day and of the night-to-day blood pressure ratio. We did 24-h blood pressure monitoring in 7458 people (mean age 56.8 years [SD 13.9]) enrolled in prospective population studies in Denmark, Belgium, Japan, Sweden, Uruguay, and China. We calculated multivariate-adjusted hazard ratios for daytime and night-time blood pressure and the systolic night-to-day ratio, while adjusting for cohort and cardiovascular risk factors. Median follow-up was 9.6 years (5th to 95th percentile 2.5-13.7). Adjusted for daytime blood pressure, night-time blood pressure predicted total (n=983; p<0.0001), cardiovascular (n=387; p<0.01), and non-cardiovascular (n=560; p<0.001) mortality. Conversely, adjusted for night-time blood pressure, daytime blood pressure predicted only non-cardiovascular mortality (p<0.05), with lower blood pressure levels being associated with increased risk. Both daytime and night-time blood pressure consistently predicted all cardiovascular events (n=943; p<0.05) and stroke (n=420; p<0.01). Adjusted for night-time blood pressure, daytime blood pressure lost prognostic significance only for cardiac events (n=525; p> or =0.07). Adjusted for the 24-h blood pressure, night-to-day ratio predicted mortality, but not fatal combined with non-fatal events. Antihypertensive drug treatment removed the significant association between cardiovascular events and the daytime blood pressure. Participants with systolic night-to-day ratio value of 1 or more were older, at higher risk of death, and died at an older age than those whose night-to-day ratio was normal (> or =0.80 to <0.90). In contrast to commonly held views, daytime blood pressure adjusted for night-time blood pressure predicts fatal combined with non-fatal cardiovascular events, except in treated patients, in whom antihypertensive drugs might reduce blood pressure during the day, but not at night. The increased mortality in patients with higher night-time than daytime blood pressure probably indicates reverse causality. Our findings support recording the ambulatory blood pressure during the whole day.

Prospective evaluation of the optimal time for selecting a single embryo for transfer: day 3 versus day 5

To determine the best day for the selection and transfer of a single embryo, a prospective, randomized study was undertaken that compared the ongoing pregnancy rate (PR) after single embryo transfer (SET) on day 3 with that after single blastocyst transfer (SBT) on day 5. Our results show an overall significantly higher PR after SBT (32.8%) compared with SET (23.2%), and a PR of 40.8% after SBT versus 25.6% after excellent-quality embryos became available.

Accuracy of day 3 criteria for selecting the best embryos

Objective: To assess the accuracy of day 3 morphologic criteria in identifying the best embryos. Design: Prospective observational study. Setting: University IVF program. Patient(s): One hundred cycles in women desiring blastocyst transfer who had ≥3 eight-cell embryos on day 3. Intervention(s): On day 3, the embryologist chose the two embryos that would have been transferred that day. On day 5, embryos were examined to determine the best and second-best blastocysts. Main Outcome Measure(s): Accuracy of day 3 picks as measured in culture on day 5, outcome of nontransferred picks, and cryopreservation rate. Result(s): All cycles reached the blastocyst stage and 73% had cryopreservation. The mean number of blastocysts was 4.8 (3.2 on day 5 and 1.6 on day 6). Neither pick was chosen in 39% of cycles; one pick was transferred in 38%; and both picks were transferred in 23%. Of 116 nontransferred picks, 51 were frozen and 65 arrested, with both picks arresting in 9 cycles. The single best blastocyst was chosen from the picks in 39% of cycles. Conclusion(s): Morphologic criteria for cleavage-stage embryo selection may fall short when the transfer is limited to two embryos. Culture to blastocyst is warranted in this population to avoid high-order multiples and still be able to choose the two embryos with the highest implantation potential.

Accuracy of day three criteria for selecting the best embryos.

Objective: Recently there is a heightened awareness of the need to control the risk of multiple gestations with IVF. Ideally, programs should not transfer more than two embryos to avoid the potential complications seen with higher-order multiples. The main obstacle to such an approach is the difficulty in choosing which two embryos to replace. To aid in the selection process, we perform blastocyst transfer (BT) in patients with more than three 8-cell embryos. However, the effort needed for blastocyst culture, compounded by concerns about the occasional sub-optimal performance of extended media, have led many programs to maintain their day 3 ET practice. In order to evaluate whether culture to day 5 is warranted for better embryo selection, we started a prospective study to assess the accuracy of day 3 criteria in identifying the best embryos. Design: Prospective study. Materials/Methods: This is an ongoing study of BT since September 2000. On day 3, the embryologist chose the 2 embryos that would have been selected for transfer that day and cultured them separately. On day 5, all embryos were examined to determine the best and second best blastocysts. Typically, two blastocysts were chosen for transfer with additional ones frozen on day 5 or 6. All embryos were cultured under oil in P1 with 10% SSS and moved on day 3 to Blastocyst medium with 10% SSS. Results: 65 patients had BT in this study to date. The mean age was 34.6 (27-41). The mean number of ≥8-cell embryos was 6.3. Picks were ≥8-cells and typically grade I (87%). All cycles made blastocysts and 74% had cryopreservation. The mean number of blastocysts was 2.9 on day 5 and 1.7 on day 6. Neither pick was chosen in 27 cycles. In 24 cycles, one pick was transferred, while both picks were transferred in only 14 cycles (22%). Of 78 non-transferred picks, 39 were frozen and 39 arrested, with both picks arresting in 6 cycles. The single best blastocyst was chosen from the picks in 27/65 cycles (42%). Conclusions: The value of morphologic criteria for cleavage-stage embryo selection may fall short when the transfer is limited to only two embryos. Although a reasonable number of day 3 picks did end up forming blastocysts by day 6, surprisingly, in 42% of our cycles, the chosen blastocysts were not from the day 3 picks selected by experienced embryologists. In the remaining 58% of the cycles at least one of the transferred blastocysts was from the picks. However, the single best blastocyst did not come from either pick in 38 out of 65 cycles. This could suggest that the majority of patients who conceived a singleton would not have achieved a pregnancy if they had a day 3 transfer of only the 2 picks. Therefore, we believe that blastocyst culture is the method of choice in this population.

Accuracy of day 4 bone scans and efficacy of clinical findings in the assessment of patients with clinical scaphoid fractures

Accuracy of day 4 bone scans and efficacy of clinical findings in the assessment of patients with clinical scaphoid fractures

Can a Day 4 Bone Scan Accurately Determine the Presence or Absence of Scaphoid Fracture?

Study objective: To evaluate the accuracy of day 4 bone scans in predicting the presence or absence of fracture in patients with "clinical scaphoid fracture." Design: Prospective sensitivity study of ED patients with clinical scaphoid fractures. Each patient was immobilized in a thumb spica cast and had day 4 bone scans of both wrists and hands. Blinded day 4 bone scan results were ultimately compared with the diagnosis on day 14 when patients returned for repeat clinical examination and radiographs. In cases of equivocal radiographic or clinical examination results, a day 14 bone scan was performed. Setting: Two tertiary care teaching hospital emergency departments. Participants: All ED patients older than 16 years with the diagnosis of clinical scaphoid fracture were eligible. Results: Ninety-nine patients were enrolled and successfully completed the study protocol from October 1990 through November 1992. One patient had bilateral injury, for a total of 100 completed studies. Day 4 bone scans were 100% sensitive and 92% specific, for a positive predictive value of 65%, a negative predictive value of 100%, and accuracy of 93% (95% confidence interval, 88% to 98%). Many other types of fractures were identified on the day 4 scans, including those of the triquetra, distal radius, capitate, hamate, trapezoid, trapezium, and metacarpals. Conclusion: Day 4 bone scans are an accurate means of ruling out scaphoid fracture. However, because of a significant number of false-positive scans at day 4, they do not reliably confirm the diagnosis of scaphoid fracture. The bone scans also permitted identification of several other wrist fractures that had not been radiographically apparent. [Murphy DG, Eisenhauer MA, Powe J, Pavlofsky W: Can a day 4 bone scan accurately determine the presence or absence of scaphoid fracture? Ann Emerg Med October 1995;26:434-438.]