ROC Curve Area Research Articles

Diagnostic value of albumin-bilirubin grade combined with serum ammonia in cirrhosis with hepatic encephalopathy

Objective: To explore the value of albumin-bilirubin (ALBI) grade combined with serum ammonia in the diagnosis of cirrhosis with hepatic encephalopathy (HE). Methods: The serum level of total bilirubin(TBIL), albumin( ALB )and blood ammonia were detected in 139 patients including 73 cirrhosis patients without HE and 66 cirrhosis patients with HE from January 2015 to January 2017 in Beijing You'an Hospital, and the relationship between ALBI and blood ammonia value and Child grade and hepatic encephalopathy was analyzed. Results: The level of ALBI and blood ammonia were more and more higher with the increase of Child grade, the level of ALBI in Child A, B and C were -2.3±0.6, -1.7±0.5, -0.9±0.4, and there was a statistically significant(F=125.100, P<0.001). The blood ammonia concentration in Child A, B and C were(42.6±16.0), (56.1±31.2), (69.8±34.7) μmol/L, and there was a statistically significant(F=7.400, P<0.001). The level of ALBI was higher with the increase of model for end-stage liver disease (MELD) grade, and there was a positive correlation(r=0.547, P<0.001). The ALBI value in the HE group was higher than the cirrhosis patients without HE((-1.1±0.5)vs(-1.6±0.7)), and the difference was statistically significant (t=5.244, P<0.001). Level of blood ammonia in the HE group was(83.6±39.5)μmol/L, which was higher than the level of cirrhosis patients without HE(42.9±17.0)μmol/L, and the difference was statistically significant (t=8.130, P<0.001) . When ALBI and blood ammonia were combined, the ROC curve area was 0.911, the sensitivity was 93.9%, the specificity was 93.2%. Conclusion: There is a significant diagnosis value and high clinical application when ALBI is combined with blood ammonia to diagnose HE .

Determination of the predictive clinical parameters to diagnose chronic exertional compartment syndrome

Chronic exertional compartment syndrome (CECS) is characterized by pain occurring during physical activity. As clinical examination is not sufficient to diagnose it, intracompartmental pressure (ICP) measure is used for CECS confirmation. Numerous clinical signs are reported but their diagnosis predictive ability has never been studied. We aimed to determine if the 12 classically reported clinical signs are predictive of CECS. We performed a single-centre retrospective cohort study on patients referred for CECS suspicion. Patients were asked to run on a treadmill. When pain occurred, post-exercise ICP was performed. We diagnosed CECS if the ICP was ≥30 mmHg and used a logistic regression to calculate the predictive value of clinical signs. One hundred twenty-five patients were evaluated. Ninety-six had CECS and 29 did not, according to the ICP 30 mmHg cut-off. Anterior and lateral compartments were the most frequently affected. After exercise, mean ICP was 58.6 mmHg ± 20.5 in the group with CECS versus 20.9 mmHg ± 4 in the group without (p < .001). Muscle hardness, muscle hernia after exercise, absence of pain at rest and pain recidivism for the same exercise were predictive of CECS. The predictive model associated muscle hardness (Odds Ratio (OR) = 2.18; p < .001) and muscle hernia after exercise (OR = 1.44; p < .001). This model identified 88.6% of CECS subjects. The ROC curve area was 0.808 [95% CI: 0.71–0.90]. This study confirmed the importance of clinical parameters to diagnose CECS. A better knowledge of the relevant parameters could help physicians to indicate invasive examinations.

Value of histogram analysis of susceptible signal intensity in differentiating papillary from chromophobe renal cell carcinoma

Objective To evaluate the feasibility of histogram analysis of susceptible signal intensity in differentiating papillary (pRCC) from chromophobe renal cell carcinoma(ChRCC). Methods Thirteen cases with pRCC and 9 cases with ChRCC, who underwent susceptible-weighted imaging(SWI), MR common scanning and enhancement, were assessed retrospectively. The histogram parameters of susceptible signal intensity were measured, including maximum, minimum, mean, median, skewness and kurtosis. The independent samples t test(normal distribution) and Mann-Whitney rank sum test(skewed distribution) were used to compare the differences in SWI parameters between pRCCs and ChRCCs. Receiver operating characteristic curve was used to evaluate the efficiency of the whole-tumor SWI parameters in differentiating pRCCs from ChRCCs. Results The significant differences of the minimum, mean, median and skewness between pRCCs and ChRCCs were present(P<0.05), and there was no significant differences in maximum and kurtosis between between pRCCs and ChRCCs(P<0.05). In all the histogram parameters, the area of ROC curve of mean value was largest(0.80). The sensitivity of minimum value (84.62%) was the highest and and the specificity of skewness(100.00%) was the highest. Conclusion Histogram analysis of susceptible signal intensity can help differentiate pRCCs from ChRCCs. Key words: Kidney neoplasms; Magnetic resonance imaging; Histogram

The value of presepsin(sCD-14) combined with NEWS for predicting the prognosis of patients with sepsis

Objective To investigate the value of serum soluble leukocyte differentiation antigen 14 subtype (sCD14-ST, presepsin) combined with national early warning score (NEWS) for predicting the prognosis of emergency patients with sepsis. Methods To select 119 patients who came to the emergency department of Beijing Hospital with sepsis from September 2009 to July 2015 as the objects of the study. The serum samples were collected immediately as they came, the presepsin was measured, and the NEWS scorescalculated. Patients were divided into survival group (81 cases) and death group (38 cases) according to the 30-day prognosis, and the value of the presepsin, NEWS score and presepsin + NEWS score in the assessment of prognosis were compared. Results Presepsin and NEWS scores both were higher in the death group than the survival group.Presepsin and NEWS were the independent risk factors of the 30-day mortality of patients with sepsis.Under the ROC curve area (AUC) of presepsin and NEWS were 0.842 and 0.823; the combination of Presepsin and NEWS was 0.906. When presepsin> 927.5 pg / mL and NEWS> 6.5 points, it can significantly improve the efficacy of predicting prognosis. Conclusions Serum presepsin is a good indicator to judge the prognosis of patients with sepsis, and the combination with NEWS can improve the ability to predict the risk of septic death. Key words: Sepsis; Presepsin; NEWS; Prognosis

Assessment of cognitive function in patients with metastatic cancer: Are we using the right tools?

This study aimed at analyzing the validity and reliability of the continuous reaction time (CRT) test, the finger-tapping test (FTT), the Digit Span Test (DST), the Trail Making Test - part B (TMTB), and the Mini-Mental State Examination (MMSE) in patients with metastatic cancer. Eighty adult patients and 81 healthy controls were assessed between July of 2010 and November of 2015. The neuropsychological tests were analyzed regarding construct/discriminant/criterion validity and reliability. In terms of construct validity, it was not possible to estimate a model for the MMSE because of a skewed response distribution. For discriminant validity, patients were slower on two measures of the CRT (p = 0.00483, p = 0.00030) and FTT dominant hand (p = 0.00306). Regarding sensitivity and specificity, only the DST and TMTB seemed to predict cognitive deficit; however, the ROC curve areas were ≤ 0.73. In terms of criterion validity, there were few significant correlations between the tests and the sociodemographic and clinical variables, and for the most part were very weak. Reliability was deemed to be adequate for the TMTB, DST, and FTT. The findings of the full validation analyses were not clear-cut. However, CRT test, DST, FTT, and TMTB demonstrated partial positive results, indicating that these tests have good potential for use in clinical settings and require further study.

The breast cancer diagnosis accuracy of the digital breast tomosynthesis technique

Objective: To explore the Digital breast tomosynthesis technique (DBT) in breast cancer diagnosis accuracy. Methods: Choose 263 cases of patients with breast lesions, using DBT combined FFDM (Full field digital mammography) independent FFDM, evaluate the diagnostic accuracy of breast cancer. Results: The ROC curve area (AUC) of two kinds of breast cancer diagnosis methods (DBT combined FFDM and independent FFDM) were 0.954±0.014 and 0.907±0.019, with significant difference (P=0.000 3). In premenopausal patients and breast density ACR3-4 cases, DBT combined FFDM diagnosis accuracy is higher than FFDM alone group, with significant difference (P<0.05). Conclusion: DBT combined FFDM compared with independent FFDM, in a certain extent, improves the accuracy of the diagnosis of breast cancer.

Discovery and Validation of Plasma-Protein Biomarker Panels for the Detection of Colorectal Cancer and Advanced Adenoma in a Danish Collection of Samples from Patients Referred for Diagnostic Colonoscopy.

Well-collected and well-documented sample repositories are necessary for disease biomarker development. The availability of significant numbers of samples with the associated patient information enables biomarker validation to proceed with maximum efficacy and minimum bias. The creation and utilization of such a resource is an important step in the development of blood-based biomarker tests for colorectal cancer. We have created a subject data and biological sample resource, Endoscopy II, which is based on 4698 individuals referred for diagnostic colonoscopy in Denmark between May 2010 and November 2012. Of the patients referred based on 1 or more clinical symptoms of colorectal neoplasia, 512 were confirmed by pathology to have colorectal cancer and 399 were confirmed to have advanced adenoma. Using subsets of these sample groups in case-control study designs (300 patients for colorectal cancer, 302 patients for advanced adenoma), 2 panels of plasma-based proteins for colorectal cancer and 1 panel for advanced adenoma were identified and validated based on ELISA data obtained for 28 proteins from the samples. One of the validated colorectal cancer panels was comprised of 8 proteins (CATD, CEA, CO3, CO9, SEPR, AACT, MIF, and PSGL) and had a validation ROC curve area under the curve (AUC) of 0.82 (CI 0.75-0.88). There was no significant difference in the performance between early- and late-stage cancer. The advanced adenoma panel was comprised of 4 proteins (CATD, CLUS, GDF15, SAA1) and had a validation ROC curve AUC of 0.65 (CI 0.56-0.74). These results suggest that the development of blood-based aids to colorectal cancer detection and diagnosis is feasible.

A Preoperative Measurement of Serum MicroRNA-125b May Predict the Presence of Microvascular Invasion in Hepatocellular Carcinomas Patients

The high recurrence rate remains a major problem that strongly influenced the prognosis of hepatocellular carcinoma (HCC) patients who received hepatectomy. The presence of microvascular invasion (MVI) is regarded as the most important risk factor that contributes to the postoperative recurrence. Our previous study has hinted that serum microRNA-125b (miR-125b) was associated with MVI. The aim of the present study was to identify whether serum miR-125b can serve as a biomarker to reliably predict microvascular invasion (MVI) preoperatively. MiR-125b was quantified in 108 HCC patients’ serum before they received surgery by quantitative real-time PCR (qRT-PCR). Our results revealed that MVI was associated with relapse free survival (RFS) of postoperative HCC patients; surgical margin width was associated with postoperative RFS in MVI present patients, but not in the patients without MVI. Multivariate analysis revealed that miR-125b, tumor size and AFP were the independent predictive factors associated with MVI in this cohort (P = .001, .001, .003, respectively). The probability of the predictive accuracy of miR-125b was 76.95% (51.32% specificity and 87.50% sensitivity), which was almost equal to the classifier established by combination of AFP and tumor size (78.82% probability, 65.63% specificity and 84.21% sensitivity). Furthermore, the combination of tumor size, AFP and miR-125b yielded a ROC curve area of 86.68% (72.37% specificity and 84.38% sensitivity). Our study indicated that serum miR-125b can be used to predict MVI of HCC patients before they received hepatic resection. Therefore, miR-125b can potentially guide individualized treatment, which helps HCC patients, with or without MVI, to benefit from different surgical approach.

Entropy of cardiac repolarization predicts ventricular arrhythmias and mortality in patients receiving an implantable cardioverter-defibrillator for primary prevention of sudden death.

The need for a readily available, inexpensive, non-invasive method for improved risk stratification of heart failure (HF) patients is paramount. Prior studies have proposed that distinct fluctuation patterns underlying the variability of physiological signals have unique prognostic value. We tested this hypothesis in an extensively phenotyped cohort of HF patients using EntropyXQT, a novel non-linear measure of cardiac repolarization dynamics. In a prospective, multicentre, observational study of 852 patients in sinus rhythm undergoing clinically indicated primary prevention implantable cardioverter-defibrillator (ICD) implantation (2003-10), exposures included demographics, history, physical examination, medications, laboratory results, serum biomarkers, ejection fraction, conventional electrocardiographic (ECG) analyses of heart rate and QT variability, and EntropyXQT. The primary outcome was first 'appropriate' ICD shock for ventricular arrhythmias. The secondary outcome was composite events (appropriate ICD shock and all-cause mortality). After exclusions, the cohort (n = 816) had a mean age of 60 ± 13 years, 28% women, 36% African Americans, 56% ischaemic cardiomyopathy, and 29 ± 16% Seattle HF risk score (SHFS) 5-year predicted mortality. Over 45 ± 24 months, there were 134 appropriate shocks and 166 deaths. After adjusting for 30 exposures, the hazard ratios (comparing the 5th to 1st quintile of EntropyXQT) for primary and secondary outcomes were 3.29 (95% CI 1.74-6.21) and 2.28 (1.53-3.41), respectively. Addition of EntropyXQT to a model comprised of the exposures or SHFS significantly increased net reclassification and the ROC curve area. EntropyXQT measured during ICD implantation strongly and independently predicts appropriate shock and all-cause mortality over follow-up. EntropyXQT complements conventional risk predictors and has the potential for broad clinical application.

Predictor measures on CT for hematoma expansion following acute intracerebral hemorrhage

To evaluate the worth of solid predictors in acute intracerebral hematoma(ICH) expansions in computer tomography images. A total of 105 patients with acute ICH in The Second Affiliated Hospital of Soochow University during January 2012 to February 2015 were enrolled. CT plain scan, CTA within 6 hours since the symptoms and CT plain scan recheck within 24 hours were executed. Hematoma location, initial volume of hematoma, shape of hematoma, "spot sign" , UHG speed were analyzed with single factor and binary Logistic regression between the patients with and without hematoma expansion. There were 30 cases with hematoma expansion and 75 cases with no hematoma expansion in 105 patients. In single factor comparisons, hematoma location(χ(2) =13.125, P<0.05), hematoma shape(χ(2) =23.987, P<0.05), spot sign(χ(2) =25.846, P<0.05), UHG speed(χ(2) =20.328, P<0.05) and the initial hematoma volume(t=-3.183, P<0.05) between the hematoma expansions and the non-hematoma expansions made significant differences. In binary Logistic regression, hematoma shape(irregular (P=0.033) and cleavage(P=0.009)), spot sign(P=0.000) and UHG speed(P=0.040) had significant differences between the two groups. ROC curve areas of hematoma shape, spot sign and UHG speed were 0.776(95%CI 0.682-0.870), 0.740(95%CI 0.625-0.855) and 0.720(95% CI 0.604-0.836). The high specificities of hematoma shape(84%), spot sign (88%)and UHG speed(84%)revealed their great reliabilities with equal sensitivity (60%). Hematoma shape, spot sign and UHG speed are solid predictors of hematoma expansion among which spot sign has promising specificity, hematoma shape and UHG speed are more convenient to be observed.

The Penn Parkinson's Daily Activities Questionnaire-15: Psychometric properties of a brief assessment of cognitive instrumental activities of daily living in Parkinson's disease

IntroductionTo describe the psychometric properties of the Penn Parkinson's Daily Activities Questionnaire-15 (PDAQ-15), a 15-item measure of cognitive instrumental activities of daily living for Parkinson's disease (PD) patients derived from the original 50-item PDAQ. MethodsPDAQ-15 items were chosen by expert consensus. Knowledgeable informants of PD participants (n = 161) completed the PDAQ-15. Knowledgeable informants were defined as an individual having regular contact with the PD participant. PD participants were assigned a diagnosis of normal cognition, mild cognitive impairment, or dementia based on expert consensus. ResultsPDAQ-15 scores correlated strongly with global cognition (Dementia Rating Scale-2, r = 0.71, p < 0.001) and a performance-based functional measure (Direct Assessment of Functional Status, r = 0.83; p < 0.001). PDAQ-15 scores accurately discriminated between non-demented PD participants (normal cognition/mild cognitive impairment) and PD with dementia (ROC curve area = 0.91), participants with and without any cognitive impairment (normal cognition versus mild cognitive impairment/dementia, ROC curve area = 0.85) and between participants with mild cognitive impairment and dementia (ROC curve area = 0.84). ConclusionsThe PDAQ-15 shows good discriminant validity across cognitive stages, correlates highly with global cognitive performance, and appears suitable to assess daily cognitive functioning in PD.

Desarrollo de un modelo predictivo para el índice de esfuerzo del cuidador

BackgroundPatient homecare with multiple morbidities is an increasingly common occurrence. The caregiver strain index is tool in the form of questionnaire that is designed to measure the perceived burden of those who care for their families. The aim of this study is to construct a diagnostic nomogram of informal caregiver burden using data from a predictive model. MethodsThe model was drawn up using binary logistic regression and the questionnaire items as dichotomous factors. The dependent variable was the final score obtained with the questionnaire but categorised in accordance with that in the literature. Scores between 0 and 6 were labelled as “no” (no caregiver stress) and at or greater than 7 as “yes”. The version 3.1.1R statistical software was used. To construct confidence intervals for the ROC curve 2000 boot strap replicates were used. ResultsA sample of 67 caregivers was obtained. A diagnosing nomogram was made up with its calibration graph (Brier scaled = 0.686, Nagelkerke R2=0.791), and the corresponding ROC curve (area under the curve=0.962). FindingsThe predictive model generated using binary logistic regression and the nomogram contain four items (1, 4, 5 and 9) of the questionnaire. R plotting functions allow a very good solution for validating a model like this. The area under the ROC curve (0.96; 95% CI: 0.994-0.941) achieves a high discriminative value. Calibration also shows high goodness of fit values, suggesting that it may be clinically useful in community nursing and geriatric establishments.

A new method to diagnose discoid lateral menisci on radiographs

The aim of this study was to prove that it is feasible to diagnose discoid lateral meniscus in radiographs. Plain radiographic findings of discoid lateral menisci with matched controls were analysed and compared in a quantitative method. Sixty consecutive patients (60 knees) who were diagnosed with discoid lateral meniscus (discoid group) by magnetic resonance imaging (MRI) were included. Another 60 age- and sex-matched controls with normal medial and lateral menisci on the basis of MRI findings were included as the control group. Each plain radiograph was evaluated from the anteroposterior view for the following variables: height of the fibular head (HFH), lateral joint space distance (LJSD), height of the lateral tibial spine (HLTS), obliquity of the lateral tibial plateau, obliquity of the lateral femoral condyle, distance from the lateral tibial spine to the lateral femoral condyle, height of the medial tibial spine, chordal distance of the femoral condyle (CDLF, CDMF), the HFH/LJSD, LJSD/HLTS and the CDLF/CDMF. A significant difference was found in the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS between the two groups. The cut-off values of the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS were 12.9mm, 6.6mm, 7.8mm, 3.0mm, 2.7mm, 2.0 and 0.9, respectively. Among the cut-off values in diagnosing discoid lateral meniscus, the sensitivity, specificity and ROC curve area of LJSD/HLTS were as high as 73.6%, 83.0% and 0.8, respectively. The corresponding values of the HFH/LJSD were as high as 66.0%, 86.8% and 0.8. For the first two indicators, the results of the HFH/LJSD and LJSD/HLTS were higher than that of most other parameters. At the same time, the ROC curve area of the HFH/LJSD and LJSD/HLTS ranked highest among all the results. There were significant differences in the HFH, LJSD, HLTS, DLC, CDLF, HFH/LJSD and LJSD/HLTS, especially the HFH/LJSD and the LJSD/HLTS, between plain radiographic findings of discoid lateral meniscus patients and normal controls. The results of the HFH/LJSD and the LJSD/HLTS showed a positive impact on the diagnosis of discoid lateral meniscus in this research. These findings enable radiographs to screen for discoid lateral meniscus. II.

Predictive value of APACHE II combined with TIMI risk score for prognosis of acute coronary syndrome

Objective To investigate the predictive value of acute physiology and chronic health score (APCHE Ⅱ) scoring system on the patients with acute coronary syndrome (ACS), and to demonstrate whether the predictive value combined with TIMI risk score impact on prognosis. Methods We calculated APACHE Ⅱ, TIMI risk score and total score of these two for 198 patients with acute coronary syndrome (ACS) in CCU, and compared the discriminative power of the three scores by the area under the receiver operating characteristic curve (AUROCC). Results The APACHE Ⅱ scores of survival group (9.42±3.38) and death group (14.77±3.27) were statistically significant (t=-8.018, P 0.05); for the total ACS, the score of APACHE Ⅱ was (10.23±3.86) and predicted mortality 11.62% (23/198) and actually mortality 15.15%(30/198) (χ2=29.892, P<0.01). The ROC curve area of 3 score methods had been compared and found out TIMI had the biggest ROC curve area and the best predicted livability and mortality. Conclusions APACHE Ⅱ score can not predict mortality satisfactorily in patients with ACS well, and the method of APACHE Ⅱ combined with TIMI risk score is not better than TIMI risk score showed in the study. The TIMI risk score is a quick, convenient and effective method to evaluate patients with ACS. Key words: Acute coronary syndrome; Acute physiology and chronic health score; TIMI risk score

Computed tomography segmental calcium score (SCS) to predict stenosis severity of calcified coronary lesions.

To estimate the probability of ≥ 50% coronary stenoses based on computed tomography (CT) segmental calcium score (SCS) and clinical factors. The Institutional Review Board approved the study. A training sample of 201 patients underwent CT calcium scoring and conventional coronary angiography (CCA). All patients consented to undergo CT before CCA after being informed of the additional radiation dose. SCS and calcification morphology were assessed in individual coronary segments. We explored the predictive value of patient's symptoms, clinical history, SCS and calcification morphology. We developed a prediction model in the training sample based on these variables then tested it in an independent test sample. The odds ratio (OR) for ≥ 50% coronary stenosis was 1.8-fold greater (p = 0.006) in patients with typical chest pain, twofold (p = 0.014) greater in patients with acute coronary syndromes, twofold greater (p < 0.001) in patients with prior myocardial infarction. Spotty calcifications had an OR for ≥ 50% stenosis 2.3-fold (p < 0.001) greater than the absence of calcifications, wide calcifications 2.7-fold (p < 0.001) greater, diffuse calcifications 4.6-fold (p < 0.001) greater. In middle segments, each unit of SCS had an OR 1.2-fold (p < 0.001) greater than in distal segments; in proximal segments the OR was 1.1-fold greater (p = 0.021). The ROC curve area of the prediction model was 0.795 (0.95 confidence interval 0.602-0.843). Validation in a test sample of 201 independent patients showed consistent diagnostic performance. In conjunction with calcification morphology, anatomical location, patient's symptoms and clinical history, SCS can be helpful to estimate the probability of ≥ 50% coronary stenosis.

Liver function, paraclinical tests, and mortality risk factors in pediatric liver transplant candidates

Liver transplantation has become a well-recognized transplant modality for children with end-stage liver disease. The first indicator to evaluate its efficiency is mortality rate. The aim of this study is to evaluate the complications and mortality of liver disease in children waiting for transplantation and understanding the risk factors that predict liver transplant waiting list death. This is a single-center prospective cohort study of all patient ≤18 years of age with chronic liver disease listed for liver transplantation. We analyzed medical records of 130 children for mortality risk factor. There were 52.3 % boys and 47.7 % girls with mean age of 8.6 ± 6.1 year (range, 3 months–18 year). The most common causes of cirrhosis were biliary atresia (21.5 %). The most common complication while awaiting transplantation was failure to thrive (76.2 %). Up to end of study, 20 patients (15.4 %) died without transplantation, 22 (16.9 %) of them transplanted, and 88 (67.7 %) of patients were alive while waiting for a liver transplantation. Mortality rate and transplantation ratio were 15.4 and 16.9 % with survival time waiting list 67.7 %. Factors which significantly associated with waiting list mortality included encephalopathy (p = 0.006), child score ≥10 (p = 0.036), model for end-stage liver disease (MELD) score ≥20 (p = 0.002), gastrointestinal bleeding (p = 0.004), Na (p = 0.046), and international normalized ratio (INR) (p = 0.018). A pediatric risk factor = (0.715 × Encephalopathy) + (0.152 × INR) − (0.022 × Na) was created. It had 90-day survival time 76.5 % for low risk group and 40.6 % for high risk group (p = 0.001) with ROC curve area 0.7 (95 % CI 0.599–0.796). The pediatric risk score such as MELD predicts the risk of liver transplantation waiting list mortality. Use of such scores in organ allocation in Iranian liver transplant unit may result in reduced waiting list mortality.

Adding Vision to Concussion Testing: A Prospective Study of Sideline Testing in Youth and Collegiate Athletes.

Sports-related concussion commonly affects the visual pathways. Current sideline protocols test cognition and balance but do not include assessments of visual performance. We investigated how adding a vision-based test of rapid number naming could increase our ability to identify concussed athletes on the sideline at youth and collegiate levels. Participants in this prospective study included members of a youth ice hockey and lacrosse league and collegiate athletes from New York University and Long Island University. Athletes underwent preseason baseline assessments using: 1) the King-Devick (K-D) test, a <2-minute visual performance measure of rapid number naming, 2) the Standardized Assessment of Concussion (SAC), a test of cognition, and 3) a timed tandem gait test of balance. The SAC and timed tandem gait are components of the currently used Sport Concussion Assessment Tool, 3rd Edition (SCAT3 and Child-SCAT3). In the event of a concussion during the athletic season, injured athletes were retested on the sideline/rink-side. Nonconcussed athletes were also assessed as control participants under the same testing conditions. Among 243 youth (mean age 11 ± 3 years, range 5-17) and 89 collegiate athletes (age 20 ± 1 years, range 18-23), baseline time scores for the K-D test were lower (better) with increasing participant age (P < 0.001, linear regression models). Among 12 athletes who sustained concussions during their athletic season, K-D scores worsened from baseline by an average of 5.2 seconds; improvement by 6.4 seconds was noted for the nonconcussed controls (n = 14). The vision-based K-D test showed the greatest capacity to distinguish concussed vs control athletes based on changes from preseason baseline to postinjury (receiver operating characteristic [ROC] curve areas from logistic regression models, accounting for age = 0.92 for K-D, 0.87 for timed tandem gait, and 0.68 for SAC; P = 0.0004 for comparison of ROC curve areas). Adding a vision-based performance measure to cognitive and balance testing enhances the detection capabilities of current sideline concussion assessment. This observation in patients with mild traumatic brain injury reflects the common involvement and widespread distribution of brain pathways dedicated to vision.

Value of plasma D-dimer, high-density lipoprotein, carcino embryonic antigen and carbohydrate antigen 724 on diagnosis of gastric cancer

Objective To evaluate the diagnostic value of the level of plasma D-dimer, high-density lipoprotein (HDL), carcino embryonic antigen (CEA) and carbohydrate antigen 724 (CA724) in gastric cancer. Methods The plasma and clinicopathological data of 103 gastric cancer patients and 111 normal controls were collected. The levels of D-dimer, HDL, CEA and CA724 were detected. SPSS 13.0 statistical software was applied to analysis the sensitivity and specificity of each examination method and to find out the appropriate combination. Results The levels of D-dimer, CEA and CA724 in patients with gastric carcinoma were 0.87 (2.69) μg/ml, 2.66 (4.38) ng/ml, 5.10 (7.79) U/ml, respectively, they were distinctly higher than those in normal controls [0.22 (0.21) μg/ml, 1.28 (1.60) ng/ml, 1.81 (1.60) U/ml, all P= 0.000]. HDL level was significantly lower in patients than that in normal controls [0.86 (0.35) mmol/L vs 1.29 (0.44) mmol/L, P= 0.000]. The area of ROC curve of D-dimer, HDL, CEA, CA724 were 0.799, 0.859, 0.739, 0.743, respectively. The cut-off of D-dimer was 0.46 μg/ml, the sensitivity was 68.0 %, the specificity was 86.5 %. The cut-off of HDL was 0.995 mmol/L, the sensitivity was 73.8 %, the specificity was 84.7 %. The cut-off of CEA was 3.585 ng/ml, the sensitivity was 44.7 %, the specificity was 92.0 %. The cut-off of CA724 was 3.765 U/ml, the sensitivity was 57.3 %, the specificity was 89.2 %. The sensitivity of D-dimer+HDL+CA724 was 83.5 %, the specificity was 89.2 %. The sensitivity and specificity of D-dimer+HDL+CEA+CA724 were 84.5 % and 89.2 %, respectively. Conclusions The D-dimer+ HDL+ CEA+ CA724 may provide the evidence for diagnosis of gastric cancer. Combined detection has higher sensitivity and specificity. Key words: Stomach neoplasms; D-dimer; High-density lipoprotein; Carcino embryonic antigen; Carbohydrate antigen 724

Identification of recurrence-related serum microRNAs in hepatocellular carcinoma following hepatectomy

Hepatocellular carcinoma (HCC) is one of the most deadly tumors. Prognosis of patients with HCC is generally poor due to the high recurrence rate. In the present study, TaqMan Real-time PCR microRNA Array was used to identify differentially expressed miRNAs from 10 tumor tissue samples (5 from recurrence group vs. 5 from non-recurrence group) and the matched serum samples. Four differentially expressed miRNAs (miR-486–5p, miR-422a, miR-125b and miR-139–5p) were further quantified in 20 tumor tissues and 116 HCC patients' serum before they received hepatectomy. Univariate analysis revealed that miR-486–5p, miR-422a and miR-125b were significantly associated with patients' relapse free survival (RFS). Multivariate analysis demonstrated that miR-486–5p, AFP and microvascular invasion (MVI) were the independent prognostic factors associated with RFS in this cohort (p = 0.000, 0.043, 0.000, respectively). Besides, the expression levels of miR-486–5p were positively correlated in tumor tissues and the paired serum samples, so was miR-422a. The probability of the prognostic accuracy of miR-486–5p in predicting postoperative recurrence of HCC within the first year was 76.79% (65.38% specificity and 81.58% sensitivity), which was almost equal to the classifier established by combination of AFP and MVI (75.98% probability, 63.13% specificity and 85.90% sensitivity). Furthermore, the combination of AFP, MVI and miR-486–5p yielded a ROC curve area of 88.02% (69.20% specificity and 92.10% sensitivity). Our study was the first to identify that serum miR-486–5p could be used to stratify the patients with higher recurrence risk before hepatic resection and potentially guide more effective surveillance strategies for them.

Is height the best predictor for adequacy of semitendinosus-alone anterior cruciate ligament reconstruction? A study of hamstring graft dimensions and anthropometric measurements.

To predict adequacy of semitendinosus (ST) graft dimension for ACLR from anthropometric measures. Single tendon harvest for autograft hamstring ACLR could be beneficial to limit donor site morbidity; however, concerns for reconstruction failure based upon inadequate graft size may limit this surgical technique. To predict adequacy, prospectively, 108 patients who underwent ACLR by hamstring graft (STG graft) were enrolled for the study. Mean age was 33.028years±9.539 SD (14-59) with 88 males and 20 females. Anthropometric measurements (height, weight, BMI, thigh and total limb length) and intraoperative data (graft dimensions and bone tunnel measurements) were collected for analysis. Semitendinosus graft can be used as 3-strand (ST3) or 4-strand (ST4) graft. Adequacy criteria for ST3 and ST4 graft dimensions were determined from data analysis. SPSS (v.17) Pearson's correlation coefficient and ROC curves were used for statistical analyses. A total of 74 out of 108 patients (68.52%) had adequate graft dimensions for ST3 reconstruction. Height equal or greater than 158cm was predictive of adequate graft for ST3 reconstruction. Only 23 patients (21.3%) had adequate graft dimensions for ST4 reconstruction. Height equal or greater than 170cm was predictive of adequate graft for ST4 reconstruction. Height variable had the highest ROC curve area of 0.840 and 0.910 for both ST3 graft and ST4 graft, respectively. Hence, height was used as best predictor to determine adequacy of the graft. Height can be predictive of adequate graft for single tendon ACL reconstruction.