Index Cutoff Value Research Articles

Relationship between skeletal muscle mass loss and metabolic dysfunction-associated fatty liver disease among Chinese patients with metabolic dysregulation.

The aim of this study was to explore the correlation between skeletal muscle content and the presence and severity of metabolic dysfunction-associated fatty liver disease in patients with metabolic dysregulation in China. A cross-sectional study was conducted among patients from the endocrinology outpatient department at Ningbo First Hospital, in Ningbo, China, in April 2021. Adult patients with metabolic dysregulation who accepted FibroScan ultrasound were included in the study. However, those without clinical data on skeletal muscle mass were excluded. FibroScan ultrasound was used to noninvasively evaluate metabolic dysfunction-associated fatty liver disease. The controlled attenuation parameter was used as an evaluation index for the severity of liver steatosis. Bioelectrical impedance analysis was used to measure the skeletal muscle index. A total of 153 eligible patients with complete data were included in the final analysis. As the grading of liver steatosis intensifies, skeletal muscle index decreases (men: Ptrend<0.001, women: Ptrend=0.001), while body mass index, blood pressure, blood lipid, uric acid, aminotransferase, and homeostatic model assessment of insulin resistance increase (Ptrend<0.01). After adjusting for confounding factors, a negative association between skeletal muscle index and the presence of metabolic dysfunction-associated fatty liver disease was observed in men (OR=0.691, p=0.027) and women (OR=0.614, p=0.022). According to the receiver operating characteristic curve, the best cutoff values of skeletal muscle index for predicting the metabolic dysfunction-associated fatty liver disease presence were 40.37% for men (sensitivity, 87.5%; specificity, 61.5%) and 33.95% for women (sensitivity, 78.6%; specificity, 63.8%). Skeletal muscle mass loss among patients with metabolic dysregulation was positively associated with metabolic dysfunction-associated fatty liver disease severity in both sexes. The skeletal muscle index cutoff value could be used to predict metabolic dysfunction-associated fatty liver disease.

Pulmonary function and sarcopenia as predictors of dysphagia in cervical spinal cord injury.

Retrospective cohort study. To determine the risk factors associated with dysphagia in individuals with cervical spinal cord injury (CSCI) and analyze the differences between individuals with improved penetration-aspiration (PA) and persistent PA on follow-up. Tertiary inpatient rehabilitation facilities. Medical records of individuals with CSCI admitted between December 2009 and February 2023 who underwent a videofluoroscopic swallowing study (VFSS) were retrospectively reviewed. Multivariate logistic regression analysis was performed to assess risk factors for dysphagia. Differences between individuals with improved PA and persistent PA were analyzed using an independent t-test. In total, 149 participants were enrolled. Age (odds ratio (OR) 1.08, 95% confidence interval (CI) 1.04-1.12), percentage of forced vital capacity to predicted normal (FVC (% predicted)) (OR 0.90, 95% CI 0.85-0.94), and skeletal muscle index (OR 0.89, 95% CI, 0.79-0.99) were significant factors associated with the risk of PA. Based on the receiver operating characteristic curve analysis, the cut-off values for age, FVC (% predicted), and skeletal muscle index were determined as 56.0, 45.7, and 41.0, respectively. A secondary analysis of the follow-up VFSS was conducted on 38 participants. The follow-up FVC (% predicted) and degree of weight loss differed significantly between the improved PA and persistent PA groups. Older age, low FVC (% predicted), and low skeletal muscle index can be predictors of dysphagia in patients with CSCI. On follow-up VFSS, individuals with improved PA demonstrated greater improvement in FVC (% predicted).

Immune Activation Mediates the Association of Advanced Hepatic Fibrosis With Adverse Outcomes in Patients With Coronary Artery Disease.

Literature suggests a bidirectional association between advanced hepatic fibrosis (AHF) and coronary artery disease (CAD). We evaluated the association of AHF with immune activation, systemic inflammation, and adverse outcomes in patients with CAD. A fibrosis-4 index cutoff value ≥2.67 was used to define AHF. Circulating levels of soluble urokinase plasminogen activator receptor and hsCRP (high-sensitivity C-reactive protein) were measured as markers for immune activation and systemic inflammation, respectively. The relationship of AHF with soluble urokinase plasminogen activator receptor, hsCRP, and adverse cardiovascular outcomes was evaluated. Among 3406 participants with CAD, 479 had AHF. Participants with AHF were older; were less likely to be Black individuals; and had a lower body mass index, worse renal function, and a prior history of heart failure. In multivariable linear regression models adjusted for clinical and demographic confounders, participants with AHF had 15.6% higher soluble urokinase plasminogen activator receptor and 24.0% higher hsCRP levels. They were more likely to experience the following adverse outcomes: all-cause death (adjusted hazard ratio [HR], 1.57 ([95% CI, 1.29-1.92]; P<0.001) and cardiovascular death: (subdistribution HR, 1.50 [95% CI, 1.14-1.95]; P=0.003). Mediation analysis showed that 47.0% (95% CI, 13.6%-81.2%]; P=0.006) of the indirect effect of AHF on cardiovascular death was mediated by circulating soluble urokinase plasminogen activator receptor levels. AHF is independently associated with immune activation, systemic inflammation, and adverse cardiovascular outcomes in patients with CAD. The association of AHF with adverse outcomes is partly mediated by immune activation, and targeting this pathway may help reduce the residual risk in patients with CAD.

Diagnostic Efficacy of Photostimulated Chemiluminescence Assay for Detecting Anti-HIV Antibodies: A Retrospective Study.

The transmission of human immunodeficiency virus (HIV) through blood poses a slightly increased risk. As a result, patients requiring blood transfusions should be screened for HIV antibodies. This study examined the diagnostic effectiveness of the photostimulated chemiluminescence assay in detecting anti-HIV antibodies and determined the cut-off value for this method. The performance of the fully automated photostimulated chemiluminescence assay system was validated according to CNAS-GL038:2019 (2020) and CNAS-GL037:2019 (2019) guidelines. A retrospective study was conducted at the Department of Medical Laboratory, Nanjing Tongren Hospital, affiliated with Southeast University, from January 2020 to December 2022. A total of 77,386 cases were tested for anti-HIV antibodies using the photostimulated chemiluminescence assay, with 79 cases initially testing positive. The method's performance in detecting anti-HIV antibodies was evaluated using the Receiver Operating Characteristic (ROC) curve and the average Coefficient of Variation (CV) value of 3-year in-house quality control. The precision, detection limit, coincidence rate, and critical value of the performance verification results met the requirements. Using Western blotting (WB) as the reference method, positive cases were initially screened using the light-induced chemiluminescence method to determine the cut-off index (COI) value and draw the ROC curve. The maximum area under the ROC curve using the chemiluminescence method was 0.997, with a cutoff value of < 28.56, sensitivity of 98%, specificity of 100%, Jordan index of 0.98, and an average CV value of 3.55%. In conclusion, the photostimulated chemiluminescence assay has good diagnostic efficacy in detecting anti-HIV antibodies and is suitable for rapid screening before blood transfusion and surgery.

Predictability of noninvasive liver fibrosis score for cardiac events in patients with nonalcoholic fatty liver disease

Abstract Background Patients with nonalcoholic fatty liver disease (NAFLD) have a higher risk of cardiac events. Although the severity of liver fibrosis is related to worsening prognosis in patients with NAFLD, it is unclear whether the noninvasive liver fibrosis score has a predictive value for cardiac events. Purpose To investigate the relationship between noninvasive liver fibrosis score and the future risk of cardiac events. Methods Among 13,368 patients with NAFLD diagnosed using ultrasonography, 4,071 patients were evaluated. Liver fibrosis was assessed and divided into three groups based on the Fibrosis-4 (FIB4) index (cut-off value of 1.30 and 2.67) and NAFLD fibrosis score (NFS) (cut-off values of -1.455 and 0.676), respectively. The primary outcome of this study was major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and revascularization due to coronary artery disease. Results The median age of the evaluated patients was 61 [52–69] years, and 2,201 [54.1%] were male. After a median follow-up period of 6.6 years, 179 (4.4%) patients experienced MACE. Kaplan–Meier survival analysis demonstrated that MACE increased progressively with theFIB4 index (log-rank, p &amp;lt; 0.001) and NFS (log-rank, p &amp;lt; 0.001). Multivariable analysis showed that the higher the FIB4 index, the higher the risk for MACE (compared to the group [reference] with low FIB4 index values, hazard ratio [HR] was 1.860 for the group with intermediate FIB4 index values [95% confidence interval (CI), 1.326–2.610; p&amp;lt;0.001] and 3.325 for the group with high FIB4 index values [95% CI, 2.017–5.479; p&amp;lt;0.001]), and the higher the NFS, the higher the risk for MACE (compared to the group [reference] with low NFSvalues, HR was 1.938 for the group with intermediate NFS values [95% CI, 1.391–2.699; p&amp;lt;0.001] and 3.492 for the group with high NFSvalues [95% CI, 1.997–6.105; p&amp;lt;0.001]). Conclusions The FIB4 index and NFS impacted the predictability of MACE in patients with NAFLD.Kaplan–Meier analysis for MACE

Effect of combined tobacco use and type 2 diabetes mellitus on prevalent fibrosis in patients with MASLD.

Several studies have investigated the independent effect of cigarette smoking or type 2 diabetes mellitus (T2DM) on MASLD. However, the interaction effect between tobacco consumption and T2DM on MASLD severity remains underexplored. In this study, we assessed the combined effect of tobacco use and T2DM on hepatic fibrosis in MASLD. We conducted a single-center retrospective cross-sectional analysis of eligible participants from the Mass General Brigham Fibroscan© database. The participants were divided into 3 groups: those with T2DM and a history of tobacco use (primary exposure group), those with T2DM but no history of tobacco use (secondary exposure group), and those without T2DM and no history of tobacco use (reference group). An additional model was developed, which included a fourth group, participants with a history of tobacco use but no T2DM. The likelihood of fibrosis was determined using a defined fibrosis-4 index cutoff value of 1.3. In addition, we computed the estimated marginal means for liver stiffness measurement and compared the values among the exposure groups. Bivariable and multivariable logistic regression models were used to explore the associations between the exposure groups and the risk for hepatic fibrosis. Overall, 598 individuals were enrolled in the study. The bivariable logistic regression model revealed a significant independent association between T2DM, combined smoking and T2DM, and the outcome of interest, fibrosis. Age, sex, metabolic syndrome, aspirin use, statin use, hemoglobin A1C (A1C), and total bilirubin level were also significantly associated with fibrosis. In the adjusted fibrosis-4 multivariable model (comparing exposure groups to controls), cigarette smoking and T2DM interaction had higher odds of prevalent fibrosis (aOR, 3.04; 95% CI, 1.62-5.76), compared to those with T2DM alone (aOR 2.28; 95% CI, 1.37-3.85). The continuous liver stiffness measurement comparison across the exposure group showed an estimated marginal means of 6.26 (95% CL: 5.58-6.94), 7.54 (95% CL: 6.78-8.30), and 7.88 (6.78-8.99) for the reference group, T2DM only group, and tobacco-T2DM group, respectively. The diabetes-only group and the combined tobacco-T2DM group had statistically significant associations with liver stiffness measurement (p values: 0.013 and 0.014, respectively). Although diabetes is independently associated with hepatic fibrosis in patients with MASLD, the combination of tobacco consumption and diabetes is associated with a higher prevalence of fibrosis. Therefore, lifestyle change through tobacco use cessation in patients with diabetes could be beneficial in reducing the incidence of liver fibrosis among individuals with MASLD.

Analysis of correlation between insulin resistance and severity of acne vulgaris

Blood glucose levels in the disease activate the free IGF-1 which promotes lipogenesis of sebaceous glands thus leading to acne formation. The study was aimed to analyze the correlation between insulin resistance and the severity of acne vulgaris. A total of 100 patients clinically diagnosed with acne vulgaris were enrolled in the study. The severity of the acne was evaluated using the GAGS system. The HOMA-IR index was used for the analysis of insulin resistance. The mean age of the patients was 22.13 years with a predominance of females i.e., 76%. GAGS score revealed 89% of patients had mild acne, 9% of patients had moderate acne and 2% of patients had severe acne. As per the HOMA-IR index cutoff value of 2.5, 35% of patients in our study had insulin resistance. A significant positive correlation was observed between the acne vulgaris and insulin resistance. Early treatment of insulin resistance can help evaluate a patient’s metabolic aspects that should be helpful in the diagnosis and treatment of various other skin conditions associated with it apart from acne vulgaris such as acanthosis nigricans, acrochordons, etc., and improving the health and the quality of care for these patients.

SYSTEMIC IMMUNE-INFLAMMATION INDEX IS A PREDICTOR OF LEFT VENTRICULAR THROMBUS FORMATION FOLLOWING ANTERIOR MYOCARDIAL INFARCTION

Introduction: Left ventricular thrombus (LVT) formation following anterior ST-elevation myocardial infarction (STEMI), is a serious complication and is associated with an increased risk of cardiovascular morbidity and mortality. Recently introduced the systemic immune-inflammation index (SII) is a reliable indicator of adverse events in various cardiovascular conditions. Herein, we aimed to explore the role of SII in the prediction of LVT formation in anterior STEMI patients following primary percutaneous coronary intervention (PCI). Methods: Medical records of 124 anterior STEMI patients who developed LVT following primary PCI and 124 age and sex-matched anterior STEMI patients without formation of LVT following primary PCI were analyzed. For each group, patient demographics, comorbidities, laboratory parameters, ECG and echocardiographic findings were analyzed. The SII was measured using the following formula: SII= total peripheral platelets count x neutrophil/lymphocyte ratio. Results: According to our study, reduced left ventricular ejection fraction and increased SII were identified as independent predictors of LVT formation following anterior STEMI. To determine the SII index cut-off value for predicting LVT formation, the ROC curve was drawn and the best cut-off value was determined as 676.27 (AUC:0.778, 95% CI:0.699-0.858, p&lt;0.001). Above this cut-off value, LVT formation could be predicted with a sensitivity of 66.1% and a specificity of 74.2%. Conclusion: SII is may be used as an independent predictor of LVT formation for anterior STEMI patients following primary PCI.

Impact of non-obese metabolic dysfunction-associated fatty liver disease on risk factors for the recurrence of esophageal squamous cell carcinoma treated with endoscopic submucosal dissection: A multicenter study.

Metabolic dysfunction is a risk factor for esophageal squamous cell carcinoma (ESCC). We investigated the impact of the recently proposed metabolic dysfunction-associated fatty liver disease (MAFLD) and its subtypes on ESCC recurrence after endoscopic treatment. This multicenter observational cohort study enrolled consecutive patients newly diagnosed with ESCC after endoscopic treatment. Patients were classified into MAFLD or non-MAFLD groups. The MAFLD group was further classified into non-obese and obese MAFLD groups with a body mass index cutoff value of 25kg/m2 . The impact of MAFLD on the recurrence of ESCC was evaluated using a decision tree algorithm and random forest analysis. A total of 147 patients (average age 69years; male:female, 127:20; observational period, 2.4years) were enrolled. The 1-, 3-, and 5-year recurrence rates were 2.0%, 21.1%, and 33.7%, respectively. Independent risk factors for the recurrence of ESCC were MAFLD (HR 2.2812; 95% confidence interval 1.0497-4.9571; p=0.0373), drinking status, and smoking status. Metabolic dysfunction-associated fatty liver disease was identified as the second most important classifier for recurrence, followed by drinking status. The cumulative incidence of ESCC recurrence was higher in the MAFLD group than in the non-MAFLD group. In a subanalysis, the cumulative incidence of recurrence was significantly higher in the non-obese than in the obese MAFLD group among abstainers/non-drinkers. Directed acyclic graphs revealed that MAFLD directly contributes to ESCC recurrence. MAFLD was independently and directly associated with ESCC recurrence after endoscopic treatment; a high recurrence rate was observed in patients with non-obese MAFLD. Metabolic dysfunction-associated fatty liver disease may identify patients at high risk for ESCC recurrence.

Cutoff values for appendicular skeletal muscle mass using dual-energy x-ray absorptiometry in a reference group of Turkish adults.

The aim of this study is to determine cutoff values for different appendicular skeletal muscle mass index (ASMI) methods measured by dual-energy x-ray absorptiometry (DXA) in a reference group of the Turkish population. Body composition analyses were performed with DXA, and appendicular skeletal muscle mass (ASM) was adjusted to body size as ASMI using height squared (ASM/ht2), weight (ASM/wt), and body mass index (BMI) (ASM/BMI). Sex-specific cutoff values were obtained as 1 and 2 standard deviations (SDs) below the mean values of ASM/ht2, ASM/wt, and ASM/BMI. A total of 207 (106 women and 101 men) healthy adults were enrolled. Sex-specific cutoff values based on 1 SD below the mean values of ASM, ASM/ht2, ASM/BMI, and ASM/wt were 14.44, 5.45, 0.61, and 24.07 in women and 22.63, 7.22, 0.90, and 29.04 in men, respectively; 2 SDs below the mean values of ASM, ASM/ht2, ASM/BMI, and ASM/wt were 11.96, 4.65, 0.51, and 21.75 in women and 19.26, 6.40, 0.78, and 26.55 in men, respectively. ASM, ASM/BMI, ASM/ht2, and ASM/wt were statistically significant positively correlated with handgrip strength (r = 0.81, r = 0.78, r = 0.73, and r = 0.67, respectively; P < 0.001). In this study, ASM/BMI was found to be the most suitable ASM adjustment method to predict muscle strength.

Optimal Cut-Off Values for Body Mass Index and Fat Mass Index Based on Age in Physically Active Males Using Receiver Operating Characteristic Curve.

This study aims to redefine obesity cut-off points for body mass index (BMI) and fat mass index (FMI) according to the different age groups of physically active males. Healthy physically active volunteers (N = 1442) aged 18-57 years (y), with a mean BMI = 22.7 ± 2.8 kg/m2, and mean FMI = 4.3 ± 1.7 kg/m2 were recruited from various fitness centers. BMI was calculated and individuals were categorized according to the Asia-Pacific BMI criterion of ≤22.9 kg/m2 and the previous WHO-guided BMI criterion of ≤24.9 kg/m2. FMI was also calculated for the study participants with a cut-off of 6.6 kg/m2. Redefining of BMI and FMI cut-off values was carried out based on different age groups categorized with a difference of 10 y and 5 y using the receiver operating characteristic (ROC) curve and Youden's index. For the entire study population, BMI redefined cut-off points for overweight and obesity were 23.7 kg/m2 and 24.5 kg/m2, respectively, while FMI redefined cut-off points for overweight and obesity were 4.6 kg/m2 and 5.7 kg/m2, respectively. With 10 y of age group difference, a constant BMI and FMI values were observed, while with 5 y of age group difference, a constant increase in the BMI cut-offs was observed as the age group increased, i.e., from 23.3 kg/m2 in 20-24 y to 26.6 kg/m2 in ≥45 y and a similar trend was seen in FMI cut-offs. To conclude, our study suggests that age-dependent BMI and FMI cut-off points may provide appropriate measurements for physically active males as the age group increases.

Noninvasive Indices of MASLD Are Associated With Hypogonadism in Male Patients With Type 2 Diabetes Mellitus.

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease, affecting one-fourth of the adult population worldwide. Recent data found an association between MASLD and hypogonadism, but this relation in patients with type 2 diabetes mellitus (T2DM) is still unclear. To evaluate in men with T2DM the association between total testosterone (TT) and noninvasive indices of hepatic steatosis (Fatty Liver Index [FLI], Hepatic Steatosis Index [HSI], Dallas Steatosis Index [DSI]) and fibrosis (AST to Platelet Ratio Index [APRI], Fibrosis-4 Index [FIB-4]), and their predictive cutoff values in identifying hypogonadism. Cross-sectional study on 189 men with T2DM, without history of liver diseases and alcoholism, recruited on an outpatient basis. Interventions were andrological evaluation, metabolic parameters, TT, and liver indices. The main outcome measures were comparison of steatosis and fibrosis indices with testosterone levels and presence of hypogonadism. Receiver operating characteristic curves were used to identify cutoff values of liver indices in predicting low testosterone (<12 nmol/L). FLI, HSI, and DSI were negatively related with TT and were higher in the low-testosterone group than in the normal-testosterone group (FLI: 74.1 [61.4-93.5] vs 56.5 [32.1-78.2], P < .001; HSI: 41.5 [39.2-45.9] vs 40.1 [36.6-43.2], P = .005; DSI: 0.45 [-0.08-+1.04] vs -0.07 [-1.02-+0.58], P < .001). FLI and DSI also correlated with clinical symptoms of hypogonadism. No differences between groups were observed for APRI and FIB-4. FLI ≥63 was the best parameter as predictive index of low TT (sensitivity 73%, specificity 64%). We found an association between noninvasive indices of steatosis and hypogonadism in patients with T2DM. These indices could be used to direct the patients to andrological evaluation.

THU314 Diagnosis Performance Of Insulin Surrogate Indices For Predicting Insulin Resistance In Young Men Defining As Reference The Matsuda Index - An Exploratory Case-Control Study Conducted In Latin America Population

Abstract Disclosure: V.M. Soriano: None. C. Espinel Pachon: None. Diagnosis performance of insulin surrogate indices for predicting insulin resistance in young men defining as reference the Matsuda index – An exploratory case-control study conducted in Latin America population Víctor Antonio Malagón – Soriano1, Álvaro Javier Burgos – Cárdenas1, Maria Fernanda Garcés2, Cristian Felipe Espinel – Pachon1, Roberto Franco – Vega3, Jorge Andres Rubio – Romero4, Sofia Alexandra Caminos – Cepeda5, Ezequiel Lacunza6, Ariel Iván Ruiz – Parra4, Jorge Eduardo Caminos2 1Department of Internal Medicine, 2Department of Physiology, 3Endocrinology Unit - Department of Internal Medicine, 4Department of Obstetrics &amp; Gynecology, School of Medicine Universidad Nacional de Colombia, Bogotá 11001, Colombia. 5School of Medicine, Universidad Pompeu Fabra; Barcelona 08002, Spain.6Centro de Investigaciones Inmunológicas Básicas y Aplicadas (CINIBA), Facultad de Ciencias Médicas, Universidad Nacional de La Plata, La Plata 1900, Argentina. Correspondence: Jorge Eduardo Caminos, MSc. PhD., Department of Physiology, School of Medicine, Universidad Nacional de Colombia, Carrera 30 No. 45-03, Edificio 471 Oficina 406, Bogotá, Colombia, E-mail: jecaminosp@unal.edu.coRunning title: Diagnosis performance of Insulin Surrogate Indices using as reference the Matsuda index. Key words: Insulin surrogate indices, diagnosis performance, Matsuda index, healthy and insulin resistant young men Abstract Insulin plays an essential role in glucose and lipid homeostasis. Changes in insulin sensitivity in adipose tissue, liver and muscle occur in the course of different metabolic disorders, and have been proposed to be a potential contributor to obesity and type 2 diabetes. The euglycemic-hyperinsulinemic clamp technique is the gold standard approach for assessing insulin sensitivity in humans, with the disadvantages of being expensive, labor intensive, and time consuming. Therefore, this study aimed to investigate the diagnosis performance of insulin surrogate indices using as reference the Matsuda index, in healthy and insulin resistant young men in Latin America population. Thus, the current cross-sectional study was conducted in healthy (n=48) and insulin resistant (n=45) young adult men (18–31 year old) using the Matsuda index cut-off value as reference to determine insulin sensitivity/resistance. Receivers operating characteristic curves (ROC) were used to determine the cut-off, sensitivity, and specificity values for QUICKI, HOMA-IR, TG/HDL-C, TyG, TyG-WC, TyG-BMI, LAP and VAI. TyG-WC (AUC=1.0) and TyG-BMI (AUC=1.0) indices showed the highest diagnostic performance with high sensitivity and specificity to predict insulin resistance in young men. In addition, TyG-BMI index showed a statistically significant stronger correlation with waist circumference (WC), when compared with HOMA-IR, Matsuda and QUICKY indices. In conclusion, we were able to diagnose insulin resistance with high sensitivity and specificity in young individuals -supposedly metabolically healthy- who do not meet the criteria for metabolic syndrome diagnosis, using widely available, low-cost, and reliable surrogate indices. Additionally, the TyG-WC and TyG-BMI indices were the better predictors of insulin resistance. The cut-off values used to define insulin resistance in our Latin America population studied were similar to recent studies in the United States population, despite clinical and racial/ethnic differences. Presentation: Thursday, June 15, 2023

Early inadequate venous flow volume after technically successful balloon angioplasty of radiocephalic arteriovenous fistula: causes and follow-up results.

The objective of this study was to investigate the causes of inadequate venous flow volume, which may lead to re-dysfunction in the early period after technically successful percutaneous transluminal angioplasty (PTA), and the results after one-week follow-up with or without medical treatment. This prospective case-control study included dysfunctional radiocephalic arteriovenous fistula (AVF) cases treated with PTA between December 2021-2022. After PTA, a residual stenosis of less than 30% was considered technically successful. Based on venous flow volume measured 1-2 hours after angioplasty, post-procedural doppler ultrasound (DUS) classified patients as cases (≤400 mL/min) or controls (>400 mL/min). Between groups, pre-post and control DUS parameters were compared. The correlation between fistulography lesion measurements and DUS values was investigated. The pre-procedural DUS resistive index (RI) cut-off value was determined to discriminate groups. A total of 42 patients, 21 cases and 21 controls, were included in the study. Before PTA, 67% of cases had total venous thrombosis, and 71% of controls had stenosis. Lesion measurements and residual stenosis were similar between groups (p>0.05). After PTA, 48% of cases had a free-floating thrombus in the vein, and 10% had a peri-vein hematoma. In pre-procedural DUS, flow volume was the only spectral analysis parameter paired between groups (p=0.057). In post-procedural and control DUS, controls had higher peak systolic velocity (PSV), end-diastolic velocity (EDV), and flow volume, whereas cases had a higher RI (p<0.05). Lesion length and degree of stenosis correlated positively with pre-procedural RI in both groups (p<0.05). The pre-procedural RI cut-off of 0.76 discriminated groups with 76% sensitivity, 67% specificity, 70% positive predictive value (PPV), and 74% negative predictive value (NPV). Low venous flow after PTA has been primarily associated with free-floating thrombi. Routine post-procedural DUS detects low venous flow, high RI, and small thrombi, providing evidence to initiate medical treatment that may prevent early AVF re-dysfunction.

Feasibility study on evaluating right ventricular diastolic function by new Tei’-Index

ObjectiveDoppler-derived myocardial performance index (Tei) has been used in the evaluation of right ventricular (RV) function. However, the usage in isolated diastolic dysfunction is limited.We sought to find a new Tei’-index that is more appropriate for evaluating isolated diastolic dysfunction (IDD) based on the symmetry of cardiac structure and function. Methods21 patients with impaired RV relaxation were compared to 44 control subjects. Tei and Tei’ including their components, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), the ejection time (ET), and RV rapid filling time (RFT) were measured from RV outflow and tricuspid inflow Doppler velocity profiles. ResultsTei-index have no change between IDD group and control subjects (0.21 ± 0.08 vs 0.23 ± 0.07 PNS). The Tei’-index was significantly shortened in IDD group(0.24 ± 0.09 vs 0.32 ± 0.12,p＜0.05).The decrease in Tei’-index was due to the prolongation of both IRT and RFT, and in the abbreviation of ICT. Tei’-index cutoff value of ≥0.31 identified impaired RV relaxation with a sensitivity of 50 % and specificity of 86 %.We also find that the Tei’-index correlated well with doppler measures of diastolic parameters like E/A, E/e’, DT, which suggests its potential use as a noninvasive indicator of the right ventricular (RV) relaxation in patients with heart failure of different causes. ConclusionNew Tei's index is highly effective and specific in the evaluation of early diastolic dysfunction of right ventricle, and can be used as an indicator for the detection of IDD in clinic.

Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors.

We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

Ki-67 Index as an Adjunct Histological Marker for Grading Cartilage Tumors: A Pilot Study

Objectives Distinguishing enchondromas (grade 0) from grade 1 chondrosarcomas, recently classified as atypical cartilaginous tumors (ACT), is challenging due to histologic and radiographic similarity. However, diagnostic ambiguity poses a management dilemma: enchondromas are observed, while ACTs are excised. Protein Ki-67 is a cellular proliferation nuclear marker used as a proxy for aggressiveness in other tumors. This retrospective pilot study aimed to characterize the association between grade and Ki-67 index and evaluate its ability to aid differentiation between critical cartilage tumor grades. Methods Tissue blocks from 26 patients treated for enchondromas or chondrosarcomas within the past ten years were exposed to anti-Ki-67 rabbit monoclonal antibody and hematoxylin counterstain. Counting two high-power fields per sample yielded a Ki-67 index. Results There was a strong positive correlation between tumor grade and the Ki-67 index (r = 0.704, P&lt;0.001). One-way analysis of variance (ANOVA) showed significant differences in the Ki-67 index between grades (P&lt;0.001). Tukey’s post-hoc test demonstrated that enchondroma Ki-67 indexes were not significantly different from ACT Ki-67 indexes (P=0.094). Receiver operator curve cutoff index value of 13.4% differentiated enchondroma vs. ACT with 67.9% sensitivity and 42.9% specificity. Conclusion Ki-67 index is correlated with cartilage tumor grade. Although our study did not show a significant difference in the Ki-67 index between enchondromas from ACTs, this study provided a protocol for future investigations. Study limitations include small sample size and reliance on historical tissue blocks of variable preservation quality.

Improving the efficiency of free kappa light chains as diagnostic biomarker of Multiple Sclerosis by using a novel algorithm

BackgroundIntrathecal immunoglobulin synthesis (ITS) plays a crucial role in the diagnosis of multiple sclerosis (MS). Traditionally, the gold standard method for detecting ITS has been through the analysis of oligoclonal bands (OCB). However, the paradigm has shifted with the introduction of the free kappa light chains (FKLC) method. In fact, a recent consensus recommends evaluating FKLC index (FKLCi) as the primary approach and reserving oligoclonal bands with borderline results. The objective of our study is to investigate the diagnostic efficiency of combining FKLC with other methods to predict ITS while minimizing the reliance on OCB. MethodsA total of 192 patients were included in the study, consisting of 145 individuals diagnosed with multiple sclerosis (pwMS) and 46 with other neurological diseases (controls). Among the MS cases, 100 patients were assigned to the Training Cohort (TC), while an external Validation Cohort (VC) comprised of 45 MS patients was established. Diagnostic efficiency was assessed for FKLCi, OCB, Link index, and the Reiber formula for IgG and FKLC. Optimal cutoff values for Link index and FKLCi were also determined. The last procedure was developed for diverse algorithms using the parameters mentioned above, which included the optimal cutoffs previously obtained. The calculations were conducted independently for both the TC and the VC, as well as for a composite cohort formed by combining data from all patients (OC) ResultsOne algorithm, named KRO, was developed based on the determination of FKLCi and Reiber Formula as the primary diagnostic parameters. For cases where the FKLCi result was mildly increased, OCB was utilized as a supplementary test. The KRO algorithm demonstrated superior diagnostic accuracy in the OC (89%), resulting in a reduction of OCB consumption by 91%. DiscussionThe KRO algorithm demonstrated superior sensitivity and accuracy although lower specificity and NPV compared to the use of FKLCi and OCB alone. The present research aligns with the new consensus recommendations regarding the diagnostic approach. Our findings indicate that employing a combined marker approach via KRO could prove to be a proficient screening tool for multiple sclerosis. This approach also holds the potential to address inherent limitations associated with each individual marker. However, to further validate and solidify the efficacy of our algorithm, additional studies involving larger cohorts are warranted.

Development of an Electronic Health Record-Based Algorithm for Predicting Lung Cancer Screening Eligibility in the Population-Based Research to Optimize the Screening Process Lung Research Consortium.

Lung cancer screening (LCS) guidelines in the United States recommend LCS for those age 50-80 years with at least 20 pack-years smoking history who currently smoke or quit within the last 15 years. We tested the performance of simple smoking-related criteria derived from electronic health record (EHR) data and developed and tested the performance of a multivariable model in predicting LCS eligibility. Analyses were completed within the Population-based Research to Optimize the Screening Process Lung Consortium (PROSPR-Lung). In our primary validity analyses, the reference standard LCS eligibility was based on self-reported smoking data collected via survey. Within one PROSPR-Lung health system, we used a training data set and penalized multivariable logistic regression using the Least Absolute Shrinkage and Selection Operator to select EHR-based variables into the prediction model including demographics, smoking history, diagnoses, and prescription medications. A separate test data set assessed model performance. We also conducted external validation analysis in a separate health system and reported AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy metrics associated with the Youden Index. There were 14,214 individuals with survey data to assess LCS eligibility in primary analyses. The overall performance for assigning LCS eligibility status as measured by the AUC values at the two health systems was 0.940 and 0.938. At the Youden Index cutoff value, performance metrics were as follows: accuracy, 0.855 and 0.895; sensitivity, 0.886 and 0.920; specificity, 0.896 and 0.850; PPV, 0.357 and 0.444; and NPV, 0.988 and 0.992. Our results suggest that health systems can use an EHR-derived multivariable prediction model to aid in the identification of those who may be eligible for LCS.

FIB-4 is closer to FibroScan screen results to detecting advanced liver fibrosis and maybe facilitates NAFLD warning.

To assess the relationship between clinical biochemical characteristics and steatosis or fibrosis by Fibroscan in non-alcoholic fatty liver disease (NAFLD) patients in order to seek the simple effective screening method closed to the results of the fibroScan measurement. A cross-sectional study was conducted on 188 patients with NAFLD who underwent FibroScan examinations. Demographic data and clinical biochemical characteristics were collected and analyzed. The result showed elevated serum uric acid (SUA) (P = .023, odds ratio [OR = 1.005, 95% CI (1.001-1.009) and metabolic syndrome (MetS) (P = .000, OR = 4.549, 95%CI (1.974-10.484) were associated with severe steatosis (controlled attenuation parameter, CAP ≥ 300 dB/m). The magnitude of liver stiffness measured using FibroScan was positively correlated with aspartate transaminase/alanine aminotransferase (AST/ALT) ratio (R = 0.419, P = .000), AST to platelet ratio index (APRI) score (R = 0.309, P = .000), and Fibrosis-4 score (FIB-4) (R = 0.507, P = .000). The areas under the receiver operating curve (ROC) of AST/ALT, APRI, and FIB-4 for mild or severe fibrosis were 0.563, 0.696, and 0.728, respectively, and those for advanced fibrosis were 0.648, 0.750, and 0.821, respectively. The FIB-4 index cutoff value was 1.65 with a sensitivity of 68.3% and specificity of 89.8% during the diagnosis of advanced fibrosis. MetS and elevated SUA are associated with severe steatosis according to the CAP value screen, whereas FIB-4, as the fibrosis score method, is closer to the liver stiffness measurement results from FibroScan, which may facilitate early warning of NAFLD in the community or in remote areas.