Clinical Threshold Research Articles

Are Short Stems Associated With Higher Fracture Rates and Early Revision Rates in Primary Total Hip Arthroplasty? A Noninferiority Analysis

BackgroundThis study aimed to determine if “short” femoral stems were noninferior to (at least as good as) standard-length stems in regards to 90-day periprosthetic fracture and 1-year revision rates. MethodsUsing the MARCQI implant registry, a retrospective study of statewide data was carried out on 64,084 total hip arthroplasties (THAs) between 2012 and 2017. We noticed an increase in the use of “short” uncemented femoral hip stems during THA. Chi-square tests were used to test homogeneity of categorical variables. The covariates included in the analyses were identified using modern epidemiological methods. A Type I probability of 0.05 was used as the level of statistical significance. Inverse probability of treatment weighting (IPTW) was used to mitigate confounding variables. ResultsOne hundred and seven stems were implanted by surgeons in the state of Michigan. They were classified according to the Khanuja Classification System as Type 2A (trapezoidal, double-tapered calcar loading, n = 3,281), Type 3 (calcar loading with lateral flare, n = 1,898), and Type 4 (shortened, tapered, conventional, n = 19,580), and were compared to standard-length, type 5, stems (n = 33,322) in regards to the 2 outcomes (periprosthetic fractures and 1-year revision rates). Overall, 1-year revision and the 90-day fracture rates were 1.3% (791/57,853) and 1.1% (631/57,968), respectively. Noninferiority was established for all short stems at the clinical threshold of an odds ratio (OR) of 1.5 with P-values <0.05 for 90-day fractures. In regards to 1-year revision rates, noninferiority was also established for Type 3 and 4 stems (P < .05). ConclusionThe increased use of "short stems" in Michigan did not lead to increased 1-year revision or 90-day fracture rates.

Associations Between Parenting Stress and Quality Time in Families of Youth with Autism Spectrum Disorder.

Increased stress among parents of youth with ASD has been well-documented. However, research on aspects of the parent-child relationship and subsequent links to parenting stress is limited. We assessed parents (N = 511) of youth with ASD to examine relations between parenting stress and parent-child quality time (amount of quality time, shared enjoyment, synchronicity). Elevated parenting stress was associated with less time spent engaging with youth in shared activities and decreased parent and child enjoyment during shared interactions. Parents with elevated stress reported engaging in shared activities and experiencing synchronicity with their child less often than parents below the clinical threshold. Future research should emphasize longitudinal efforts examining the directionality of this relationship to better inform family-focused intervention.

Impact of an Urban Project ECHO: Safety-Net Clinician Self-Efficacy Across Conditions

To mitigate the lack of specialty healthcare, Project ECHO (Extension for Community Health Outcomes) trains community-based primary care clinicians to better prevent the progression of, manage, and treat common health conditions. ECHO-Chicago launched in 2010 as the first urban-centered ECHO program, focusing on safety-net clinicians, and has trained over 5,175 community clinicians across 34 topic areas. This paper examines self-efficacy among ECHO-Chicago participants across 11 clinical series, including a novel use of qualitative themes from self-efficacy questions. Five years of baseline and postseries survey data were collected from 2014 to 2019, resulting in 951 participants. Paired t-tests assessed change from baseline survey to postsurvey, and Cohen's d determined effect size. Change was assessed by individual series, adult or pediatric focus, participants' prescription privilege status, and across series by qualitative question theme. Metrics included total change, any improvement, a 10% target, and a clinical competency threshold. Analysis occurred from July 2020 to January 2022. All clinical series achieved statistically significant improvement in self-efficacy, and most had a large effect size. A total of 80% had any improvement, 65% met the 10% target of 0.7 points, and 52% met the competency threshold of 5.0 in the postsurvey. Prescribers had a significantly greater increase in their self-efficacy scores than nonprescribers. With a comparison across series, each theme achieved statistical significance, with most reaching large effect sizes. ECHO-Chicago successfully increased participants' self-efficacy. This inquiry adds an urban focus, years of data, multiple series, and a novel qualitative theme component to enable comparisons across rather than solely within the ECHO series.

Environmental and clinical mould spore risk thresholds

Escalating environmental pollution and urbanization is associated with a rise in fungal contamination, which contributes to a variety of health concerns, particularly respiratory tract ailments such as allergic rhinitis, asthma, bronchitis, and sick building syndrome. Spore trap testing serves as a straightforward method for evaluating the number of spores/m³ in the air. Multiple studies indicate that 1000 spores/m³ represents the upper threshold for normal levels of mould exposure, with levels above this linked to adverse health effects, thereby establishing the environmental threshold. According to the literature, the clinical threshold is 3000 spores/m³ for Cladosporium and 100 spores/m³ for Alternaria. This mini review provides an overview of the existing environmental and clinical thresholds for fungal contamination to assess risk. We examine fungal threshold levels in both outdoor and indoor settings, encompassing residential homes, libraries, buildings, workplaces, and hospitals. In conclusion, environmental scientists, microbiologists/mycologists, occupational hygienists, insurance assessors, the real estate sector, clinical healthcare staff, and others must use and apply both environmental and clinical threshold levels to assess fungal contamination risk in indoor environments to protect public health. And finally, this mini review highlights the need for increased focus and research to ensure that appropriate guidelines and industry standards are developed, applied, and enforced that incorporate objective spore thresholds to quantify risk from fungal mediated adverse health in various indoor environments.

Comparison of clinical categories, blood biomarkers and cycle threshold value in COVID-19

Comparison of clinical categories, blood biomarkers and cycle threshold value in COVID-19

Achievement of higher thresholds of clinical responses and lower levels of disease activity is associated with improvements in workplace and household productivity in patients with axial spondyloarthritis.

Patients with active axial spondyloarthritis (axSpA) exhibit more absences and lower levels of productivity in the workplace and household than the general population, which can improve upon treatment. The objective of this study is to determine the long-term impact of achieving different levels of clinical response or disease activity on workplace and household productivity in patients with axSpA. RAPID-axSpA (NCT01087762) was a 204-week phase III trial evaluating the safety and efficacy of certolizumab pegol (CZP) in adult patients with active axSpA. The impact of axSpA on workplace and household productivity was evaluated using the validated arthritis-specific Work Productivity Survey. Outcomes included the percentage of patients achieving Assessment of SpondyloArthritis International Society (ASAS) response and Ankylosing Spondylitis Disease Activity Score (ASDAS) thresholds. This post hoc study used a generalised estimating equations model to determine the association between the threshold of clinical response achieved and patient productivity. Of 218 CZP-randomised patients, 65.1% completed week 204. At baseline, 72.0% were employed outside the home. Of the patients who were unemployed, 42.6% were unable to work due to arthritis. Achievement of higher treatment response thresholds, such as clinical remission, was associated with fewer days affected by workplace absenteeism (ASAS-partial remission: 4.0 days, ASAS40: 8.6 days, ASAS20 but not reaching ASAS40 response: 29.4 days, ASAS20 non-response: 69.2 days; ASDAS-inactive disease: 5.0 days, ASDAS-low disease activity: 15.6 days, ASDAS-high disease activity: 32.7 days, ASDAS-very high disease activity: 93.4 days). Similar associations were found for workplace presenteeism, and household absenteeism and presenteeism. Over 4 years, achievement of higher clinical response thresholds and lower levels of disease activity was associated with fewer cumulative days affected by absenteeism or presenteeism, with clinical remission associated with the greatest improvements in productivity. This highlights the importance of targeting these thresholds to limit the burden of axSpA on society and on patients' daily lives.

Enhanced Place Specificity of the Parallel Auditory Brainstem Response: A Modeling Study.

While each place on the cochlea is most sensitive to a specific frequency, it will generally respond to a sufficiently high-level stimulus over a wide range of frequencies. This spread of excitation can introduce errors in clinical threshold estimation during a diagnostic auditory brainstem response (ABR) exam. Off-frequency cochlear excitation can be mitigated through the addition of masking noise to the test stimuli, but introducing a masker increases the already long test times of the typical ABR exam. Our lab has recently developed the parallel ABR (pABR) paradigm to speed up test times by utilizing randomized stimulus timing to estimate the thresholds for multiple frequencies simultaneously. There is reason to believe parallel presentation of multiple frequencies provides masking effects and improves place specificity while decreasing test times. Here, we use two computational models of the auditory periphery to characterize the predicted effect of parallel presentation on place specificity in the auditory nerve. We additionally examine the effect of stimulus rate and level. Both models show the pABR is at least as place specific as standard methods, with an improvement in place specificity for parallel presentation (vs. serial) at high levels, especially at high stimulus rates. When simulating hearing impairment in one of the models, place specificity was also improved near threshold. Rather than a tradeoff, this improved place specificity would represent a secondary benefit to the pABR's faster test times.

Direct detection of neuron-specific enolase using a spectrometer-free colorimetric plasmonic biosensor.

Sensitive detection of a tumor marker, neuron-specific enolase (NSE), was performed by a label-free direct immunoassay based on a colorimetric plasmonic biosensor. Reflective plasmonic colors of silver nanodome arrays provided a way for a sensitive refractive index sensor based on spectrometer-free colorimetric detection. The direct detection of NSE was demonstrated by a combination of a sensitive sensor substrate and image processing. The limit of detection (LOD) for NSE was determined to be 270 pM, which is lower than the clinical threshold value of NSE used for medical diagnostics of small-cell lung cancer. Since our substrate-based colorimetric plasmonic biosensor is compatible with smartphone detection, we believe that the presented biosensor will open up a way for biosensor technology for point-of-care testing as well as mobile health applications.

Retrospective evaluation of epidemiological, clinical and Real-time PCR cycle threshold of SARS-CoV-2 infection positive pediatric patients

Amaç: COVID-19’un yol açtığı şiddetli klinik sonuçlara neden olan risk faktörleri yetişkin hastalarda çocuk hasta grubuna göre daha iyi tanımlanmıştır. Bu çalışmada hastanemize COVID-19 şüphesi ile başvuran ve SARS-CoV-2 testi pozitif saptanan çocuk hastalarda sosyo-demogrofik özellikler, klinik bulgular ve eşik değeri “cycle threshold” (Ct) değeri arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Yöntem: Çalışmada 1 Mayıs 2020-31 Ekim 2021 tarihleri arasında Mersin Üniversitesi Hastanesi COVID-19 laboratuvarında SARS-CoV-2 RT-qPCR testi pozitif saptanan 2971 çocuk hasta çalışmaya dahil edilmiştir. SARS-CoV-2 RT-qPCR testi, nazofarengeal ve orofarengeal sürüntü örneklerinden yapılmıştır. RT-qPCR sonucundan elde edilen Ct değerleri düşük, orta, yüksek şeklinde sınıflandırılmıştır. Bulgular: SARS-CoV-2 enfeksiyonu pozitif olan çocuk hastalarda en sık görülen semptomlar sırasıyla ateş %41.5, öksürük %28.6 ve boğaz ağrısı %24.4 olarak belirlenmiştir. SARS-CoV-2 pozitif asemptomatik ve semptomatik çocuk hastaların Ct değerleri düşüktür (&amp;lt;24) ve hastalar yüksek risk grubunda yer almaktadır. SARS-CoV-2 pozitif çocuklarda semptomlar ve Ct grupları arasındaki ilişki değerlendirildiğinde özellikle ateş (%43.1), halsizlik (%18.8) ve baş ağrısı (%16.3) semptomu gösteren hastaların yüksek viral yük grubunda olduğu saptanmıştır. Sonuç: Çalışmamızda yer alan temaslı hastaların çoğunun COVID-19’lu aile üyelerinden birine maruz kalması nedeniyle Ct değerinin düşük olduğu düşünülmektedir. Bundan dolayı potansiyel bulaştırıcılıkları yüksek olan bu temaslı grubunun takibi, kontrolü ve izolasyonu halk sağlığı açısından önemli bir noktadır.

A Highly Efficacious Electrical Biofilm Treatment System for Combating Chronic Wound Bacterial Infections.

Biofilm infection has a high prevalence in chronic wounds and can delay wound healing. Current treatment using debridement and antibiotic administration imposes a significant burden on patients and healthcare systems. To address their limitations, a highly efficacious electrical antibiofilm treatment system is described in this paper. This system uses high-intensity current (75mA cm-2 ) to completely debride biofilm above the wound surface and enhance antibiotic delivery into biofilm-infected wounds simultaneously. Combining these two effects, this system uses short treatments (≤2h) to reduce bacterial count of methicillin-resistant S.aureus (MRSA) biofilm-infected ex vivo skin wounds from 1010 to 105.2 colony-formingunits(CFU) g-1 . Taking advantage of the hydrogel ionic circuit design, this system enhances the in vivo safety of high-intensity current application compared to conventional devices. The in vivo antibiofilm efficacy of the system is tested using a diabetic mouse-based wound infection model. MRSA biofilm bacterial count decreases from 109.0 to 104.6 CFU g-1 at 1 day post-treatment and to 103.3 CFU g-1 at 7 days post-treatment, both of which are below the clinical threshold for infection. Overall, this novel technology provides a quick, safe, yet highly efficacious treatment to chronic wound biofilm infections.

Comparative efficacy of tezepelumab to mepolizumab, benralizumab, and dupilumab in eosinophilic asthma: A Bayesian network meta-analysis

It is unclear how the efficacy of tezepelumab, approved for the treatment of type 2 high and low asthma, compares to the efficacy of other biologics for type 2-high asthma. We sought to conduct an indirect comparison of tezepelumab to dupilumab, benralizumab, and mepolizumab in the treatment of eosinophilic asthma. The investigators conducted a systematic review and Bayesian network meta-analyses. They identified randomized controlled trials indexed in PubMed, Embase, or Cochrane Central Register of Controlled Trials (CENTRAL) between January 1, 2000, and August 12, 2022. Outcomes included exacerbation rates, prebronchodilator FEV1, and the Asthma Control Questionnaire. Ten randomized controlled trials (n= 9201) met eligibility. Tezepelumab (relative risk: 0.63; 95% credible interval [CI]: 0.46-0.86) was associated with significantly lower exacerbation rates than benralizumab and larger improvements in FEV1 compared to mepolizumab (mean difference [MD]: 66; 95% CI: -33 to 170) and benralizumab (MD: 62; 95% CI: -22 to 150), though the 95% CI crossed the null value of 0. Mepolizumab improved the Asthma Control Questionnaire score the most, but this improvement was not significantly different from that of tezepelumab (tezepelumab vs mepolizumab; MD: 0.14; 95% CI: -0.10 to 0.38). For efficacy by clinically important thresholds, tezepelumab, mepolizumab, and dupilumab achieved a >99% probability of reducing exacerbation rates by ≥50% compared to placebo, but benralizumab had only a 66% probability of doing so. Tezepelumab and dupilumab had a probability of 1.00 of improving prebronchodilator FEV1 by ≥100 mL above placebo. Compared to mepolizumab, dupilumab had >90% chance for improving FEV1 by ≥50 mL, but none of the differences between biologics exceeded 100 mL. In individuals with eosinophilic asthma, tezepelumab and dupilumab were associated with greater improvements (although below clinical thresholds) in exacerbation rates and lung function than benralizumab or mepolizumab.

Hematological characteristics of COVID-19 patients with fever infected by the Omicron variant in Shanghai: A retrospective cohort study in China.

A wave of the Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has rapidly spread in Shanghai, China. Hematological abnormalities have been reported in coronavirus disease 2019 (COVID-19) patients; however, the difference in hematological parameters between COVID-19 patients with fever and patients who are febrile from other causes remains unexplored. This retrospective cohort study enrolled 663 SARS-CoV-2 positive patients identified by RT-PCR. Clinical parameters, including age, sex, and threshold cycle values of all COVID-19 patients, and hematological parameters of COVID-19 patients in the fever clinic were abstracted for analysis. Overall, 60.8% of COVID-19 patients were male, and the median age was 45 years. Most of COVID-19 patients were asymptomatic, while 25.8% of patients showed fever and 10.9% of patients had other emergencies. COVID-19 patients with fever had significantly lower white blood cells (WBCs), neutrophils, lymphocytes, platelets and C-reactive protein (CRP), and significantly higher monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and mean platelet volume-to-platelet ratio (MPR) levels, compared with those in SARS-CoV-2 negative patients with fever from other causes (p < 0.05). Neutrophil-to-lymphocyte ratio (NLR), PLR, and systemic inflammatory index (SII) levels were significantly higher in COVID-19 patients with emergencies (p < 0.05). WBCs showed the best performance with an area under the curve (0.756), followed by neutrophils (0.730) and lymphocytes (0.694) in the diagnosis of COVID-19 in the fever clinic. WBCs, neutrophils, lymphocytes, platelets, CRP and MLR, PLR, and MPR may be useful in early diagnosis of COVID-19 in the fever clinic.

Phosphorylated α-Synuclein Deposits in Cutaneous Nerves of Early Parkinsonism.

The role of peripheral phosphorylated-α-Synuclein (p-α-syn) deposition on nerve degeneration in synucleinopathies is still unknown. To assess the cutaneous neural distribution of p-α-Syn deposits and its correlation with clinical data and with morphology and function of cutaneous sensory and autonomic nerves in early Parkinson's disease (PD) and multiple system atrophy-parkinson type (MSA-p). We recruited 57 PD (F/M = 21/36; age 63.5±9.4 years) and 43 MSA-p (F/M = 16/27; age 62.3±9.0 years) patients within 2 years from motor symptoms. We applied questionnaires and clinical scales, sensory thresholds, and sudomotor testing to assess severity of motor and non-motor involvement and sensory and autonomic dysfunction. We quantified, in skin biopsy from thigh, leg, and fingertip, epidermal, pilomotor, and sudomotor nerve fibers, Meissner corpuscles and intrapapillary myelinated endings and the neural distribution of p-α-syn deposits. Compared to controls, we found a cutaneous denervation paralleling functional and clinical impairment. Sensory and autonomic denervation was more severe in MSA-p than in PD. Deposits of p-α-syn were found in the majority of patients, with no significant differences among sites in both groups. Higher occurrence of p-α-syn deposits in autonomic nerves differentiated (p < 0.01) PD from MSA-p. p-α-syn deposits correlated positively with sudomotor function, epidermal, pilomotor and sudomotor nerve densities, and inversely with non-motor symptoms and disease progression. Our work demonstrated an early peripheral sensory and autonomic involvement in synucleinopathies, more severe in MSA-p than in PD. Higher p-α-syn deposits in autonomic nerves differentiated PD from MSA-p. p-α-syn deposits were associated with preserved innervation and slower disease progression.

High Rates of Symptoms of Major Depressive Disorder and Panic Disorder in a Canadian Sample of Adolescents With Juvenile Idiopathic Arthritis.

We aimed to evaluate the rate of depressive and/or anxiety symptoms in adolescents with juvenile idiopathic arthritis (JIA) and to explore the association with demographic and disease activity measures. Depressive and anxiety symptoms were assessed in adolescents with JIA aged 12 to 18 years at a Canadian tertiary care hospital, using the Revised Child Anxiety and Depression Scale (RCADS). The RCADS includes 6 subscales: separation anxiety, social phobia, generalized anxiety, panic disorder, obsessive-compulsive, and major depressive disorder. Scores above clinical threshold on the RCADS subscales indicate that an individual's responses reflect symptoms similar to those diagnosed with the corresponding mental health disorder. Fisher exact test and Mann-Whitney U test were used to compare demographic and disease-related variables between participants who scored above and below clinical threshold on each of the subscales. There were 32/80 (40%) of participants who scored above clinical threshold on at least 1 subscale. Scores above clinical threshold were most frequent for major depressive disorder (23.8%) and panic disorder (22.5%) subscales. Social phobia and separation anxiety followed with 16.3% and 13.8%, respectively. Females were more likely to have scores above clinical threshold on the panic disorder subscale. Participants with higher self-reported disease activity were more likely to have scores above clinical threshold for all anxiety subscales except separation anxiety. We report high rates of symptoms of depression and anxiety (panic in particular) in adolescents with JIA. This highlights the ongoing need for mental health screening protocols and services. The relationships between concomitant mental health disorders, disease activity, and patient-reported outcomes requires further research.

190. Performance of urinalysis parameters in predicting significant bacteriuria: Making the case for a population-specific approach to diagnostic stewardship

Abstract Background Clinicians and laboratories routinely use urinalysis (UA) results to help determine if urine cultures and/or antimicrobials are indicated. Yet, the performance of individual UA parameters and common clinical thresholds for action are not well defined and may vary across different patient populations. Our objective was to compare the performance of different UA parameters in predicting significant bacteriuria irrespective of symptoms, and to assess performance of pyuria based on age, sex, and presence of indwelling catheter. Methods This retrospective review of UA and urine culture data from the Duke University Health System included all UAs ordered within 24 hours of a urine culture between 2015 and 2020 (no reflex urine cultures included). We defined significant bacteriuria as a urine culture with ≥1 uropathogen growing at ≥100,000 colony forming units/mL. Then, we used this definition to evaluate the performance of relevant UA parameters and result thresholds including sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV). We also combined 18 different UA criteria (as shown in Figure) and used receiver operating characteristic (ROC) curves to identify the top 5 performing models for predicting significant bacteriuria (sensitivity and specificity). 18 Different Combinations of UA Parameters for Predicting Significant Bacteriuria on Urine Cultures Results Of 240,195 encounters during the 6-year study period, 38% were outpatient and 62% were inpatient. Twenty-nine percent had a urine culture with significant bacteriuria; 30.7% had a negative urine culture. No single UA parameter had both - high sensitivity and high specificity in predicting bacteriuria. Trace leukocyte esterase and low-level pyuria had a high NPV for significant bacteriuria (Table 1A). Combined UA parameters did not perform better than pyuria alone (Table 1B). The high NPV &amp;gt;=0.90 of pyuria was maintained among most patient age and sex subgroups with the exception of females ≥65 and patients with indwelling catheters (Table 2). Table 1A:Performance of UA parameters in predicting significant bacteriuria, Table 1B: Best performing models by AUROC after testing 18 models Conclusion UA parameters should be leveraged for their NPV instead of sensitivity, when used as a part of diagnostic workup. Future reflex urine culture workflows and diagnostic stewardship algorithms should incorporate population-specific UA criteria and/or focus on populations where NPV of pyuria is high. Disclosures Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant Nicholas A. Turner, MD, MHSc, Aperio: Advisor/Consultant Rebekah W. Moehring, MD, MPH, FIDSA, FSHEA, UpToDate, Inc.: Author Royalties Valerie Vaughn, MD, MSc, Thermo Fisher Scientific: Honoraria.

Repeatability and agreement of swept-source optical coherence tomography and partial coherence interferometry biometers in myopes

ABSTRACT Clinical relevance Biometric measurements in the context of myopia are fundamental to detect eyes at risk of developing myopia and during the follow-up of patients with myopia control treatment. Thus, the accuracy of biometers has high clinical relevance. Background The Myopia Master is a new biometer based on partial coherence interferometry especially dedicated to the follow-up of myopic patients. This study aims to assess the repeatability of the Myopia Master and evaluate its agreement with a swept-source optical coherence interferometry biometer (IOL Master 700). Methods This cross-sectional prospective study assessed the biometric parameters of two groups of myopes (age range: 8–16 years old), spectacle corrected (n = 60) and orthokeratology contact lens wearers (n = 60). One senior optometrist performed two consecutive measurements per instrument, which included axial length, mean keratometry and horizontal visible iris diameter (HVID). The repeatability of each device and the agreement between devices were assessed by the dispersion of the measurement differences, for AL, mean keratometry, corneal astigmatism and HVID. Results The two biometers measured approximately the same value in both measurements. Test–retest repeatability tended to be lower than clinical significant thresholds, in particular, for AL and mean keratometry. Corneal-related parameters tended to have lower repeatability in the orthokeratology group, especially mean keratometry. The agreement between instruments revealed statistically significant differences between devices with the SS-OCT measuring longer eyes, steeper corneas and larger HVID. Conclusions In a paediatric population, the Myopia Master showed clinically acceptable repeatability levels, but the IOL Master 700 demonstrated superior repeatability. Eyes treated with orthokeratology may compromise the repeatability of the corneal-related parameters. The Myopia Master and the IOL Master 700 are repeatable devices appropriate for monitoring myopia progression, but the differences observed do not allow their use interchangeably.

Quantification of Significant Aortic Stenosis by Echocardiography versus Four-Dimensional Cardiac Computed Tomography: A Multi-Modality Imaging Study.

Transthoracic echocardiography (TTE) grading of aortic stenosis (AS) is challenging when parameters are discrepant, and four-dimensional cardiac computed tomography (4D-CCT) is increasingly utilized for transcatheter intervention workup. We compared TTE and 4D-CCT measures contributing to AS quantification. AS patients (n = 80, age 86 ± 10 years, 71% men) referred for transcatheter replacement in 2014-2017 were retrospectively studied, 20 each with high-gradient AS (HG-AS), classical and paradoxical low-flow low-gradient AS (CLFLG-AS and PLFLG-AS), and normal-flow low-gradient AS (NFLG-AS). Correlation and Bland-Altman analyses were performed between TTE and 4D-CCT parameters. There were moderate-to-high TTE versus 4D-CCT correlations for left ventricular volumes, function, mass, and outflow tract dimensions (r = 0.51-0.88), though values were mostly significantly higher by 4D-CCT (p &lt; 0.001). Compared with 4D-CCT planimetry of aortic valve area (AVA), TTE estimates had modest correlation (r = 0.37-0.43) but were significantly lower (by 0.15-0.32 cm2). The 4D-CCT estimate of LVSVi lead to significant reclassification of AS subtype defined by TTE. In conclusion, 4D-CCT quantified values were higher than TTE for the left ventricle and AVA, and the AS subtype was reclassified based on LVSVi by 4D-CCT, warranting further research to establish its clinical implications and optimal thresholds in severe AS management.

Color Distribution of Maxillary Permanent Incisors in Korean Pediatric Patients Using a Spectrophotometer

This study aims to analyze the color distribution of maxillary permanent incisors in Korean pediatric patients and determine the effects of age and root developmental stage on tooth color. The L*a*b* values of 404 sound and fully erupted maxillary incisors without dental caries, restorations, trauma history or discoloration from 101 Korean patients between ages 7 and 15, with a mean age 10.0 ± 1.5, were analyzed with a spectrophotometer. CIE L*a*b* values were 84.01, 0.17, and 24.07 in maxillary central incisors, and 82.33, 0.31, and 25.99 in maxillary lateral incisors. L* values of maxillary central incisors were higher, and b* values of maxillary central incisors were lower than those of maxillary lateral incisors (&lt;i&gt;p&lt;/i&gt; &lt; 0.001). The color differences among the subregions exceeded the clinical perceptibility threshold in both of the maxillary central and lateral incisors. L* value for children at age 10 and younger was 84.13 in maxillary central incisors and 84.04 in maxillary lateral incisors, and those of older patients were 80.62 and 80.56, respectively. L* value of maxillary incisors of children at age 10 and younger was significantly higher than that of older patients. The root developmental stage did not affect tooth color. This study suggests that the color differences between maxillary central and lateral incisors and among the subregions of a tooth and the effects of age should be considered for aesthetic restorations of permanent incisors in pediatric patients.

Rapid simultaneous SERS detection of dual myocardial biomarkers on single-track finger-pump microfluidic chip

Acute myocardial infarction (AMI) is a serious disease with high mortality that afflicts many people around the world. The main cause of death from AMI was the inaccurate early diagnosis, which resulted from the medical treatment might be a delay. Therefore, it is crucial to achieve the rapid detection of AMI. The cardiac troponin I (cTnI) level in human serum may significantly increase as the myocardial membrane ruptured, and the creatine kinase-MB (CK-MB) was also associated with the AMI recurrence and the infarct size of myocardial infarction. Both of them are regarded as important cardiac biomarkers for the early diagnosis of AMI. Therefore, we chose these two cardiac biomarkers as indicators for simultaneous detection. We proposed a single-track finger-pump microfluidic chip for simultaneous surface-enhanced Raman scattering (SERS) detection of cTnI and CK-MB. The entire detection process takes only 5 min without the cumbersome syringe pump. Meanwhile, it enables multiple reagent additions and removals of the unbonded reactants. This microfluidic sensor employed "sandwich" immunoassays based on SERS nanoprobes, AMI biomarkers, and magnetic beads. It is possible to detect two cardiac biomarkers simultaneously in a single measurement, greatly simplifying the detection process and reducing the detection time. Magnetic beads with SERS nanoprobes were separated and captured in the microchamber by a round magnet integrated into the chip. Our results showed that the detection limits of cTnI and CK-MB could reach to 0.01 ng mL−1, respectively. The limit of detections (LODs) match with the clinical threshold values for AMI biomarkers. It is believed that the proposed single-track finger-pump microfluidic chip can be used as an effective tool for determining early AMI.

The Future Proofing Study: Design, methods and baseline characteristics of a prospective cohort study of the mental health of Australian adolescents.

The Future Proofing Study (FPS) was established to examine factors associated with the onset and course of mental health conditions during adolescence. This paper describes the design, methods, and baseline characteristics of the FPS cohort. The FPS is an Australian school-based prospective cohort study with an embedded cluster-randomized controlled trial examining the effects of digital prevention programs on mental health. Data sources include self-report questionnaires, cognitive functioning, linkage to health and education records, and smartphone sensor data. Participants are assessed annually for 5years. The baseline cohort (N=6388, M=13.9years) is broadly representative of the Australian adolescent population. The clinical profile of participants is comparable to other population estimates. Overall, 15.1% of the cohort met the clinical threshold for depression, 18.6% for anxiety, 31.6% for psychological distress, and 4.9% for suicidal ideation. These rates were significantly higher in adolescents who identified as female, gender diverse, sexuality diverse, or Aboriginal and/or Torres Strait Islander (all ps<0.05). This paper provides current and comprehensive data about the status of adolescent mental health in Australia. The FPS cohort is expected to provide significant insights into the risk, protective, and mediating factors associated with development of mental health conditions during adolescence.