Good Predictor Of Risk Research Articles

Autistic-like social communication disorders and sensory profile in visually impaired children: Similarity and divergence with autism spectrum disorders

This study examined the sensory profile of three groups of children (those with visual impairment, typical development or autism spectrum disorder) aged 3 to 12. The principal aim was to find out whether the Sensory Profile (SP) of children with visual impairment was a good predictor of behaviors typical of ASD. The data was collected through a sensory profile filled out by parents of 37 visually impaired children, 30 with autism spectrum disorder (ASD) and 42 with typical development (TD). To assess the risk of ASD, the Social Communication Questionnaire (SCQ) was also administered. The results indicate that children with visual impairment are at increased risk of exhibiting signs of ASD, and that the sensory profile is a good predictor of risk of autistic signs in children with visual impairment. This study provides for the first time strong evidence for the need to systematically assess the sensory profile in children with visual impairment.

Retrospective study of role of neoadjuvant rectal scores in evaluating the 10-year disease-free survival of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy followed by surgery

Objective: To investigate the correlation between the neoadjuvant rectal (NAR) score and long-term survival in patients with locally advanced rectal cancer who have undergone neoadjuvant chemoradiotherapy. Methods: Clinical and pathological data of 487 patients diagnosed with rectal adenocarcinoma from October 2004 to April 2014 at Sun Yat-sen University Cancer Center who had received neoadjuvant chemoradiotherapy were retrospectively analyzed and the impact of NAR score on prognosis studied. Disease-free-survival (DFS) was calculated by the Kaplan-Meier method and survivals compared using the log-rank test. Cox models were used for univariate and multivariate analyses. Receiver operating characteristic curves were utilized to evaluate the predictive capability of NAR and tumor regression grade scores for the risk of 10-year postoperative recurrence and metastasis. The Delong test was employed to compare the diagnostic performance of the two scores. Results: Of the 487 patients included in the study, 166 were men (34.1%). The median age was 56 years (interquartile range [IQR]: 46-63). All patients completed adequate preoperative chemoradiotherapy and underwent R0 resection.The median interval between the end of chemoradiotherapy and surgery was 51 days (IQR: 44-58). Post-chemoradiotherapy downstaging occurred in 329 patients (67.6%). Tumor regression grades (TRGs) were 1-2 in 246 patients (50.5%) and 3-4 in 241 patients (49.5%). A total of 394 patients (80.9%) received postoperative chemotherapy. NAR scores were <8 in 182 patients (37.4%), 8-16 in 180 (37.0%), and >16 in 125 (25.6%). The median follow-up time was 111.5 months (IQR: 70.7-133.7 months). One hundred and thirteen patients died of rectal cancer, among whom 13 patients developed local recurrence, 88 patients developed distant metastasis, and 12 patients had unknown recurrence patterns. The 10-year DFS and overall survival rate of f the whole group were 68.9% and 71.5% respectively. The 10-year DFS rates for patients with NAR scores <8, 8-16, and >16 were 85.1%, 80.5%, and 66.4%, respectively (P<0.001). Multivariate analyses revealed that the Dixon operation (HR=0.606, 95%CI: 0.408-0.902, P=0.014), and >16 (HR=2.569, 95%CI: 1.559-4.233, P<0.001) were independent predictors of the 10-year DFS of patients with locally advanced rectal cancer (P<0.05 for all). In the entire patient cohort, the AUC of the receiver operating characteristic curve for NAR score predicting 10-year recurrence and metastasis was 0.67 (95%CI: 0.62-0.72), whereas the AUC for TRG score was 0.54 (95%CI: 0.49-0.60). The two scores differed significantly in accuracy (Z=-4.06, P<0.001), the NAR score being a significantly better predictor of risk of 10-year recurrence and metastasis than the TRG score. Conclusion: The NAR score is a reliable predictor of 10-year DFS in patients with locally advanced rectal cancer who have undergone neoadjuvant chemoradiotherapy followed by curative surgery.

Undiagnosed and Untreated Peripheral Complications of Diabetes: Findings from a Pilot Study on Diabetes-Related Foot Diseases (DFD) in Patients with Glycemic Disorders.

BACKGROUND Diabetes-related foot disease (DFD) is a serious complication of diabetes, increasing the risk of amputation. Coimplications are preventable, but most diabetics do not receive proper screening and treatment, despite indications. This study was a pilot screening of diabetes-related foot disease in a group of people with glycemic disorders. MATERIAL AND METHODS We recruited 143 volunteers over 40 years of age. In the final analysis, we included 85 people diagnosed with glycemic disorders (diabetes or prediabetes), for whom we performed a total of 170 foot measurements. We screened for peripheral artery disease using: foot pulse, ankle-brachial index (manual and automatic), toe-brachial index, and transcutaneous oxygen pressure (TcPO2). To screen for diabetic peripheral neuropathy, we used indicators of loss of protective sensation: pressure perception and temperature perception, and plantar pressure distribution. RESULTS A history of diabetes was reported by 26 (30.6%) of the subjects. Disorders of at least 1 foot occurred in 20 (66.7%) subjects with diagnosed diabetes and in 10 (17%) subjects declaring no diabetes. Higher risk and DFD category were correlated with duration of diabetes (r=0.68, p=0.007), glycemic levels (r=0.56, p=0.001), age (r=0.57, p=0.007), and the presence of other diabetes complications. The best predictor of risk in DFD was manual ABI, p=0.001; followed by automatic ABI, p=0.006. CONCLUSIONS Our results showed that peripheral complications of diabetes, such as DFD, often remain undiagnosed and untreated despite the high risk of developing ulcers. There is a need for multi-center screening studies.

Thoracic Aortic Aneurysm Risk Assessment: A Machine Learning Approach

BackgroundTraditional methods of risk assessment for thoracic aortic aneurysm (TAA) based on aneurysm size alone have been called into question as being unreliable in predicting complications. Biomechanical function of aortic tissue may be a better predictor of risk, but it is difficult to determine in vivo. ObjectivesThis study investigates using a machine learning (ML) model as a correlative measure of energy loss, a measure of TAA biomechanical function. MethodsBiaxial tensile testing was performed on resected TAA tissue collected from patients undergoing surgery. The energy loss of the tissue was calculated and used as the representative output. Input parameters were collected from clinical assessments including observations from medical scans and genetic paneling. Four ML algorithms including Gaussian process regression were trained in Matlab. ResultsA total of 158 patients were considered (mean age 62 years, range 22-89 years, 78% male), including 11 healthy controls. The mean ascending aortic diameter was 47 ± 10 mm, with 46% having a bicuspid aortic valve. The best-performing model was found to give a greater correlative measure to energy loss (R2 = 0.63) than the surprisingly poor performance of aortic diameter (R2 = 0.26) and indexed aortic size (R2 = 0.32). An echocardiogram-derived stiffness metric was investigated on a smaller subcohort of 67 patients as an additional input, improving the correlative performance from R2 = 0.46 to R2 = 0.62. ConclusionsA preliminary set of models demonstrated the ability of a ML algorithm to improve prediction of the mechanical function of TAA tissue. This model can use clinical data to provide additional information for risk stratification.

Masked hypertension in a middle-aged population and its relation to manifestations of vascular disease.

Masked hypertension is associated with cardiovascular disease (CVD). However, previous large studies have not used the same device to measure office and home blood pressure (BP) and adhered to current home BP measurement recommendations of the European Society of Hypertension. We aimed to characterize masked hypertension and explore its relation to manifestations of CVD. A randomly selected cohort of 5057 participants aged 50-64 years from the Swedish CardioPulmonary BioImage Study (SCAPIS) was evaluated with office and home BP using the semi-automatic Omron M10-IT oscillometric device. Additional analyses included pulse wave velocity (PWV) and coronary artery calcium score (CACS). Of participants, 4122 did not have current antihypertensive treatment, and were thus included in our analyses. Of these, 2634 (63.9%) had sustained normotension, and 172 (4.2%) had masked hypertension. Participants with masked hypertension vs. sustained normotension were more often men (66.9 vs. 46.2%, P < 0.001). Those with masked hypertension had higher mean PWV [9.3 (95% confidence interval, 95% CI 9.1-9.5) vs. 8.3 (95% CI 8.2-8.4) m/s, P < 0.001] and odds ratio for CACS at least 100 [1.65 (95% CI 1.02-2.68), P = 0.040]. These associations were similar in a posthoc analysis of masked hypertension and sustained normotension, matched for age, sex and systolic office BP. Masked hypertension was associated with markers of CVD. This suggests that home BP is a better predictor of risk, even when the recordings are performed with the same measurement device, in a population-based setting with randomized recruitment.

Perspectives on Drug Development in Early ADPKD.

Perspectives on Drug Development in Early ADPKD.

Z Codes for Social Determinants of Health: A Better Predictor of Risk for Value-Based Care.

Z Codes for Social Determinants of Health: A Better Predictor of Risk for Value-Based Care.

Comparison of different obesity indicators with dyslipidemia and hypertension in adults of Guangxi Yao ethnic group

To investigate the relationship between obesity indicators and dyslipidemia and hypertension in the Yao population of Guangxi. In 2015, we examined the body composition data of 784 Yao residents aged 18 years or older in Guangxi using a multi-stage whole-group random sampling method, analyzed the association between 10 indicators responding to the degree of obesity and dyslipidemia and hypertension, and analyzed the predictive value of each obesity indicator for dyslipidemia and hypertension by receiver operating characteristic(ROC) curves. There were 58.80% of Yao adults with dyslipidemia, with no difference between men and women(χ~2=0.24, P&gt;0.05); 15.94% of Yao adults had hypertension, with a higher prevalence in men than in women(χ~2=4.76, P&lt;0.05). ROC curves plotted with dyslipidemia as the dependent variable showed that the best predictor of risk of dyslipidemia prevalence in the Yao adult population was waist-to-hip ratio(WHR)(AUC=0.62, 95% CI 0.56-0.68) with a cut point of 0.86 in men and waist circumference(AUC=0.64, 95% CI 0.59-0.69) with a cut point of 75.50 cm in women. The ROC curves were plotted with hypertension as the dependent variable, and the result showed that the best predictor of risk of hypertension in the Yao adult population was: visceral fat content(AUC=0.62, 95% CI 0.56-0.68) with a cut point of 0.65 kg in men and WHR(AUC=0.67, 95% CI 0.62-0.72) with a cut point of 0.82 in women. Compared with indicators reflecting general obesity such as body mass index and percentage of body fat, indicators reflecting abdominal obesity such as waist circumference, WHR and visceral fat content are more closely related to two metabolic diseases such as dyslipidemia and hypertension in the Yao population.

Does Patient-Applied Testosterone Replacement Therapy Pose Risk for Blood Pressure Elevation? Circadian Medicine Perspectives.

We reviewed medication package inserts, US Food and Drug Administration (FDA) reports, and journal publications concerning the 10 nonbiosimilar patient-applied (PA) testosterone (T) replacement therapies (TRTs) for intraday serum T patterning and blood pressure (BP) effects. Blood T concentration is circadian rhythmic in young adult eugonadal males, being highest around awakening and lowest before bedtime. T level and 24 h variation are blunted in primary and secondary hypogonadism. Utilized as recommended, most PA-TRTs achieve nonphysiologic T 24 h patterning. Only Androderm® , an evening PA transdermal patch, closely replicates the normal T circadian rhythmicity. Accurate determination of risk for BP elevation and hypertension (HTN) by PA-TRTs is difficult due to limitations of office BP measurements (OBPM) and suboptimal methods and endpoints of ambulatory BP monitoring (ABPM). OBPM is subject to "White Coat" pressor effect resulting in unrepresentative BP values plus masked normotension and masked HTN, causing misclassification of approximately 45% of trial participants, both before and during treatment. Change in guideline-recommended diagnostic thresholds over time causes misclassification of an additional approximately 15% of participants. ABPM is improperly incorporated into TRT safety trials. It is done for 24 h rather than preferred 48 h; BP is oversampled during wakefulness, biasing derived 24 h mean values; 24 h mean systolic and diastolic BP (SBP, DBP) are inappropriate primary outcomes, because of not being best predictors of risk for major acute cardiovascular events (MACE); "daytime" and "nighttime" BP means referenced to clock time are reported rather than biologically relevant wake-time and sleep-time BP means; most importantly, asleep SBP mean and dipping, strongest predictors of MACE, are disregarded. © 2022 American Physiological Society. Compr Physiol 12: 1-20, 2022.

Apolipoprotein B Displays Superior Predictive Value Than Other Lipids for Long-Term Prognosis in Coronary Atherosclerosis Patients and Particular Subpopulations: A Retrospective Study

Accumulating evidence that apolipoprotein B (apoB) plays a critical role in predicting coronary heart disease (CHD) and future outcomes. The 2019 European Society of Cardiology/European Atherosclerosis Society guidelines suggest that apoB can be an alternative to non-HDL-C or LDL-C in patients with high triglyceride levels, diabetes, obesity, metabolic syndrome, or very low LDL-C levels. This study explores whether apoB can also serve as predictive value for long-term major adverse cardiovascular events (MACEs) in normal people and specific coronary atherosclerosis patients. A total of 826 patients were followed up over 10 years, and the risk factors for MACEs were retrospectively analyzed in patients with CHD and particular subpopulations. All statistical analyses were performed in R software. Cox regressions were performed to assess independent risk factors of long-term MACEs in the atherosclerosis group and CHD subgroups. Kaplan-Meier survival curves were used to evaluate the survival rate for patients in different apoB quartiles, and receiver-operating characteristic curves were used to compare apoB and other lipids in predicting the presence of long-term MACE. apoB could be a "risk-enhancing factor" in patients with coronary atherosclerosis disease, whereas in the Normal population, LDL-C still acted as a major risk factor for predicting MACEs. apoB was a good risk predictor for long-term cardiovascular events in coronary atherosclerosis (AS) patients, including the AS group and CHD subpopulations (including CHD+triglyceride ≥2.3 mmol/L, CHD+diabetes mellitus, CHD+body mass index ≥25 kg/m2, or CHD+metabolic syndrome). In patients with CHD whose condition was complicated with diabetes, obesity, and metabolic syndrome, apoB performed better than other lipids in predicting the presence of myocardial infarction, hospitalization due to angina, and cardiac death. Despite achieving optimal LDL-C or non-HDL-C levels, patients with CHD are still at risk of worse survival if they are unable to reach a low apoB level (lower cut points such as 65 mg/dL). More attention should be paid to special populations with residual elevations of atherogenic particle numbers, and greater focus should be placed on lowering baseline apoB to achieve long-term benefits. However, given that this was an observational study, the association of baseline apoB level and long-term MACEs only was evaluated; it is unclear whether the emergence of MACEs would be influenced by the dynamic changes of apoB. Because this was a retrospective and observational analysis, bias in data analysis was unavoidable; thus, the results cannot be used to generalize implications to broader patient populations, and more large-scale clinical trials are required to verify these findings. (Clin Ther. 2022;44:1071-1092) © 2022 Elsevier HS Journals, Inc.

Association of Atheromatous Plaques in Aorta with waist-hip Ratio and Cardiac weight in Unnatural Deaths: A mortuary based study from West Bengal, India

Atherosclerosis is a pathological change that occurs in the arterial wall, wherein abnormal accumulation and deposition of atheromatous material occurs in their inner layer causing complete and partial blockage of the arteries. Ischemic heart disease is an important cause of morbidity and mortality in vulnerable people the world over. Atherosclerotic coronary artery disease is an important cause of sudden and unexpected death even in young individuals. It remains as one of the major cause of embolism. The abdominal obesity has also a major role in formation of atheromatous plaques leading to sudden cardiac death. The waist–hip ratio is a better predictor of risk of cardiovascular diseases as compared to BMI, as shown in various studies. The prevalence of coronary artery disease is also strongly associated with calcium intake quite common in many populations. Abdominal circumference above 102 cm in the case of men and above 88 cm in the case of women signifies central obesity and involves increased risk of cardiovascular disease. Awaist/hip ratio above 0.9 in the case of men and above 0.85 in the case of women indicates central obesity and is strong predictor of observable pathological changes in the coronary vessels. The current investigation was designed to find association of atheromatous plaques in aorta with waist hip ratio and cardiac weight in unnatural deaths done on 310 bodies came for Medico-legal autopsy in Burdwan Police morgue of Burdwan Medical College of West Bengal.

High Serum Atherogenicity and the Risk of Developing Type 2 Diabetes Mellitus

BackgroundEvidence sustained that lipid disorders may increase the risk of developing type 2 diabetes mellitus and its cardiovascular complications. Objective: The purpose of the study was to establish the correlation between lipid changes and atherogenic index in diabetes patients and to evaluate its utility as risk predictor. MethodsThe research was done on 69 senescent patients: 41 diabetes mellitus vs. 28 healthy control patients. Serum atherogenicity was assessed by atherogenic index, computed as log (TG/HDL), and the atherogenic risk was estimated in 3 categories: low, medium and high. ResultsData revealed an increase of triglycerides, cholesterol, LDL-cholesterol, non-HDL-cholesterol and a decrease of HDL-cholesterol at diabetes patients vs. control. Also, we noticed a significant increase of atherogenic index (p<0.0001) in diabetes patients vs. control. Prevalence of dyslipidemia at diabetes patients increased from 28.57% in the low risk atherogenic index group to 73.91% in the high risk atherogenic index group. Linear regression equation revealed that non-HDL-cholesterol is positively correlated with glucose (p<0.05) and atherogenic index (p<0.0001). Diagnostic test evaluation for atherogenic index indicated: 72.79% assay accuracy, 82.93% sensitivity, 57.14% specificity and relative risk estimate=2.42. Multivariate logistic regression analysis showed that patients with high atherogenic index had 6.47-fold risk for diabetes [OR 6.47, 95% CI: 2.14-19.56; p=0.0009]. Conclusion: Besides routine lipid panels, as alternative method to assess dyslipidemia, diabetes and its cardiovascular events, atherogenic index should be used as a good risk predictor. Also, non-HDL-cholesterol should be taking into account in guidelines and management of diabetes.

MON-497 Evaluation and Comparison of Ultrasonographic Features According to Histology of Thyroid Nodules

Introduction: The prevalence of thyroid nodules identified by ultrasonography (US) may be up to 70%, with the majority being incidentalomas. Less than 15% of thyroid nodules will be malignant. Ultrasonography plays a key role in the diagnosis and management of thyroid diseases and US features have been described in way to predict the risk of malignancy. Aim: Evaluate and correlate US features with histological results, in our hospital, from January 2017 to December 2018. Materials and methods: Cross-sectional study. A total of 117 patients were evaluated, 77 had histology of nodular hyperplasia (benign) and 40 had histology of thyroid carcinoma (malign) after partial or total thyroidectomy. We described the size of the nodule (the largest diameter), the US features detailed in the ultrasound report (shape, margins, echogenicity, composition and microcalcifications), the EU-TIRADS score of each nodule and the histology of thyroid. The data were analysed using nonparametric statistical tests. The results are presented as median (interquartile range). The level of significance accepted was p<0.05. Results: Of the 117 patients, 82.1% were female, with a median age of 59.7 (25.0) years, nodule size in benign histology group was 35.0 (14.0) mm and in malign histology group was 20.0 (28.0) mm. Of malignant nodules, 90.0% (n=36) were papillary carcinomas. The prevalence of US features: 76.9% were solid, 35.0% had microcalcifications, 25.6% had irregular margins, 17.9% were markedly hypoechoic and 6.8% were taller-than-wide. Three characteristics were significantly related to malignancy: irregular margins (p=0.001), markedly hypoechoic (p=0.001) and microcalcifications (p=0.015). The taller-than-wide feature had the highest specificity of 94.8%; the marked hypoechogenicity with a specificity of 92.2%, had the highest positive likelihood ratio (LHR+: 4.81 (95% CI: 2.02–11.44)) and the highest diagnostic odds ratio (DOR: 7.10 (95% CI: 2.48–20.30)). The EU-TIRADS 5 category had a significant association with malignancy (p=0.001) and 80.0% of malignant nodules were classified in this category. The specificity was 62.3%, LHR+ was 2.12 (95% CI: 1.53–2.94) and DOR was 6.62 (95% CI: 2.69–16.31). Conclusion: In the evaluation of the US features, marked hypoechogenicity had the highest LHR+ and DOR. It was possible to verify that the EU-TIRADS 5 category was a good predictor of risk to malignancy, which reinforces the importance of categorizing the nodules for selective perform of fine needle aspiration.

Correlating Dose Variables with Local Tumor Control in Stereotactic Body Radiation Therapy for Early-Stage Non-Small Cell Lung Cancer: A Modeling Study on 1500 Individual Treatments

Large variation regarding prescription and dose inhomogeneity exists in stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer. The aim of this modeling study was to identify which dose metric correlates best with local tumor control probability to make recommendations regarding SBRT prescription. We combined 2 retrospective databases of patients with non-small cell lung cancer, yielding 1500 SBRT treatments for analysis. Three dose parameters were converted to biologically effective doses (BEDs): (1) the (near-minimum) dose prescribed to the planning target volume (PTV) periphery (yielding BEDmin); (2) the (near-maximum) dose absorbed by 1% of the PTV (yielding BEDmax); and (3) the average between near-minimum and near-maximum doses (yielding BEDave). These BED parameters were then correlated to the risk of local recurrence through Cox regression. Furthermore, BED-based prediction of local recurrence was attempted by logistic regression and fast and frugal trees. Models were compared using the Akaike information criterion. There were 1500 treatments in 1434 patients; 117 tumors recurred locally. Actuarial local control rates at 12 and 36 months were 96.8% (95% confidence interval, 95.8%-97.8%) and 89.0% (87.0%-91.1%), respectively. In univariable Cox regression, BEDave was the best predictor of risk of local recurrence, and a model based on BEDmin had substantially less evidential support. In univariable logistic regression, the model based on BEDave also performed best. Multivariable classification using fast and frugal trees revealed BEDmax to be the most important predictor, followed by BEDave. BEDave was generally better correlated with tumor control probability than either BEDmax or BEDmin. Because the average between near-minimum and near-maximum doses was highly correlated to the mean gross tumor volume dose, the latter may be used as a prescription target. More emphasis could be placed on achieving sufficiently high mean doses within the gross tumor volume rather than the PTV covering dose, a concept needing further validation.

Dyslipidemia Prevalence, Atherogenicity and Type 2 Diabetes Mellitus

Background: Lipid metabolism disorders increases the risk of developing diabetes mellitus type 2 and its cardiovascular complications. Objective: The purpose of the study was to establish the correlation between lipid changes and atherogenic indices in diabetes patients and to evaluate the utility of atherogenic index as risk predictor. Methods: The research was done on 69 senescent patients: 41 diabetes mellitus vs. 28 healthy control patients. Results: Data revealed an increase of triglycerides, cholesterol, LDL-cholesterol, non-HDL-cholesterol (p<0.001; p<0.05; p<0.05; p<0.001), and a decrease of HDL-cholesterol (p<0.0001) at diabetes patients vs. control. Also, we noticed a significant increase of all atherogenic indices (p<0.0001) in diabetes patients vs. control. Prevalence of dyslipidemia at DM patients increased from 28.57% in the low risk atherogenic index group to 73.91% in the high risk atherogenic index group. Linear regression equation revealed for glucose (as well as for glycated haemoglobin), a significant positive correlation with atherogenic status and a significant negative correlation with HDL-cholesterol. On the other hand, non-HDL-cholesterol is positively correlated with glucose (p<0.05) and all atherogenic indices (p<0.0001). Diagnostic test evaluation for atherogenic index indicated: 72.79% assay accuracy, 82.93% sensitivity, 57.14% specificity and relative risk estimate=2.42. Multivariate logistic regression analysis showed that patients with high atherogenic index had 6.47-fold risk for diabetes [OR 6.47, 95% CI: 2.14-19.56; p=0.0009]. Conclusion: Besides routine lipid panels, as alternative method to assess diabetes and dyslipidemia, atherogenic index should be used as a good risk predictor. Also, non-HDL-cholesterol should be taking into account in guidelines and management of diabetes.

A composite of BMI and waist circumference may be a better obesity metric in Indians with high risk for type 2 diabetes: An analysis of NMB-2017, a nationwide cross-sectional study

AimsObesity measurement is a vital component of most type 2 diabetes screening tests; while studies had shown that waist circumference (WC) is a better predictor in South Asians, there is evidence that BMI is also effective. Our objective was to evaluate the efficacy of BMIWC, a composite measure, against BMI and WC. MethodsUsing data from a nationwide randomized cluster sample survey (NMB-2017), we analyzed 7496 adults at high risk for type 2 diabetes. WC, BMI, and BMIWC were evaluated using Odds Ratio (OR), and Classification scores (Sensitivity, Specificity, and Accuracy). These were validated using Indian Diabetes Risk Score (IDRS) by replacing WC with BMI and BMIWC, and calculating Sensitivity, Specificity, and Accuracy. ResultsBMIWC had higher OR (2·300) compared to WC (1·87) and BMI (2·26). WC, BMI, and BMIWC were all highly Sensitive (0·75, 0·81, 0·70 resp.). But BMIWC had significantly higher Specificity (0.36) when compared to WC and BMI (0.27 each). IDRSWC, IDRSBMI, and IDRSBMIWC were all highly Sensitive (0·87, 0·88, 0·82 resp.). But IDRSBMIWC had significantly higher Specificity (0·39) compared to IDRSWC and IDRSBMI (0·30, 0·31 resp.). ConclusionsBoth WC and BMI are good predictors of risk for T2DM, but BMIWC is a better predictor, with higher Specificity; this may indicate that Indians with high values of both central (high WC) and general (BMI > 23) obesity carry higher risk for type 2 diabetes than either one in isolation. Using BMIWC in IDRS improves its performance on Accuracy and Specificity.

Current Approaches to Risk Assessment and Prevention of Preterm Birth-A Continuing Public Health Crisis.

Background: Preterm birth remains a major cause of neonatal morbidity and mortality. Several potential pathways and pathophysiologic processes can lead to preterm birth, complicating efforts to screen for the risk of preterm birth and making implementation of prevention strategies difficult.Methods: Based on a review of the literature, this article addresses screening strategies for preterm birth risk stratification and interventions for preterm birth prevention.Results: In women with a history of a prior spontaneous preterm birth, cervical cerclage placement in the setting of short cervix reduces the rate of recurrent spontaneous preterm birth. Weekly injections of 17-hydroxyprogesterone caproate (17-P) have been used as standard treatment for the prevention of recurrent preterm birth since 2011. However, results of a replication study of 17-P published in 2020 have raised questions regarding the effectiveness of this drug, and it is under review by the US Food and Drug Administration. Among women with no history of preterm birth, cervical length appears to be the best predictor of risk for preterm birth in asymptomatic women. In women with a cervical length <25 mm, vaginal progesterone has been demonstrated to reduce the risk of preterm birth.Conclusion: Strategies including cervical length screening, vaginal progesterone administration, cervical cerclage placement, and, potentially, 17-P administration may help reduce rates of preterm birth when used in the appropriate patient populations. Development of protocols for patient evaluation and risk stratification will help identify patients at highest risk for preterm birth and allow use of the best available therapeutic interventions.

Association of high-density lipoprotein particle concentration with cardiovascular risk following acute coronary syndrome: A case-cohort analysis of the dal-Outcomes trial

High-density lipoprotein cholesterol (HDL-C) concentration is inversely related to risk of major adverse cardiovascular events (MACE) in epidemiologic studies but is a poorer predictor of MACE in patients with established coronary heart disease. HDL particle concentration (HDLP) has been proposed as a better predictor of risk. We investigated whether HDLP is associated with risk of MACE after acute coronary syndrome (ACS). The dal-Outcomes trial compared the CETP inhibitor dalcetrapib with placebo in patients with recent ACS. In a nested case-cohort analysis, total, large, medium, and small HDLPs were measured by nuclear magnetic resonance spectroscopy at baseline (4-12 weeks after ACS) in 476 cases with MACE and 902 controls. Hazard ratios (HRs; case-control) for 1-SD increment of HDLP or HDL-C at baseline were calculated with and without adjustment for demographic, clinical, laboratory, and treatment variables. Similarly, HRs for MACE were calculated for changes in HDLP or HDL-C from baseline to month 3 of assigned treatment. Over median follow-up of 28 months, the risk of MACE was not associated with baseline HDLP (adjusted HR = 0.98, 95% CI = 0.84-1.15, P = .81), any HDLP subclass, or HDL-C. Dalcetrapib increased HDL-C and total, medium, and large HDLP and decreased small HDLP but had no effect on MACE compared with placebo. There were no association of risk of MACE with change in HDLP or HDL-C and no interaction with assigned study treatment. Neither baseline HDLP nor the change in HDLP on treatment with dalcetrapib or placebo was associated with risk of MACE after ACS.

Systemic immune-inflammation index acts as a novel diagnostic biomarker for postmenopausal osteoporosis and could predict the risk of osteoporotic fracture.

BackgroundPostmenopausal osteoporosis (PMOP) is a bone metabolism disorder involving systematic inflammation activation. Blood routine examination is easily available in clinical practice and contains abundant information reflecting the systematic inflammation level. Thus, it is attractive to achieve early diagnosis of PMOP and predict osteoporotic fracture risk just based on the biomarkers in blood routine examination.MethodsA multi‐centric prospective cohort study was designed and enrolled postmenopausal women from two independent institutions. All participants underwent the dual‐energy X‐ray absorptiometry (DEXA) scanning for diagnosing PMOP. Blood routine examination was conducted, and the key inflammatory biomarkers such as neutrophil‐to‐lymphocyte ratio (NLR) and systemic immune‐inflammation index (SII) were calculated. PMOP patients were followed up to observe osteoporotic fracture and identify the related risk predictors.ResultsA total of 92 participants out of 238 enrolled postmenopausal women were diagnosed with PMOP, with a prevalence of 38.66%. The main risk factors identified for PMOP included older age (OR = 2.06, 95% CI = 1.14‐3.72), longer menopause duration (OR = 3.14, 95% CI = 2.06‐4.79), higher NLR (OR = 2.11, 95% CI = 1.37‐3.25), and higher SII (OR = 3.02, 95% CI = 1.98‐4.61). Besides age and menopause duration, SII ≥834.89 was newly identified as a prominent risk factor for discriminating osteoporotic fracture risk in PMOP patients (HR = 3.66, 95% CI = 1.249‐10.71).ConclusionAs an easy and economical biomarker calculated from blood routine examination, SII not only acts as a good risk predictor for PMOP diagnosis but also well discriminates the osteoporotic fracture risk, which deserves further investigation and application in clinical practice.

Single-Cell Analysis Reveals that Chronic Silver Nanoparticle Exposure Induces Cell Division Defects in Human Epithelial Cells.

Multiple organizations have urged a paradigm shift from traditional, whole animal, chemical safety testing to alternative methods. Although these forward-looking methods exist for risk assessment and predication, animal testing is still the preferred method and will remain so until more robust cellular and computational methods are established. To meet this need, we aimed to develop a new, cell division-focused approach based on the idea that defective cell division may be a better predictor of risk than traditional measurements. To develop such an approach, we investigated the toxicity of silver nanoparticles (AgNPs) on human epithelial cells. AgNPs are the type of nanoparticle most widely employed in consumer and medical products, yet toxicity reports are still confounding. Cells were exposed to a range of AgNP doses for both short- and-long term exposure times. The analysis of treated cell populations identified an effect on cell division and the emergence of abnormal nuclear morphologies, including micronuclei and binucleated cells. Overall, our results indicate that AgNPs impair cell division, not only further confirming toxicity to human cells, but also highlighting the propagation of adverse phenotypes within the cell population. Furthermore, this work illustrates that cell division-based analysis will be an important addition to future toxicology studies.