Cut-off Limit Research Articles

Evaluation of metabolic and oxidative profile in ovine pregnancy toxemia and to determine their association with diagnosis and prognosis of disease.

This study was conducted on ewes with pregnancy toxemia (PT) with an attempt to evaluate metabolic and oxidative profile in subclinical and clinical ovine pregnancy toxemia and to determine their association with diagnosis and prognosis of the disease. A total of 20 ewes having beta-hydroxy butyric acid (β-HBA) > 2.5mmol/L and proven clinical sings of PT, categorized as clinical PT (CPT); 12 ewes having β-HBA 0.8-2.5mmol/L and no clinical signs of PT, categorized at subclinical PT (SPT); and 10 ewes having β-HBA ≤ 0.8mmol/L, categorized as healthy control (CON) were enrolled. Among 20 CPT ewes, 11 had negative outcomes (non-survivors), six ewes had positive outcomes (survivors), and three were lost during follow-up. A significant increase in non-esterified fatty acid, β-HBA, triglycerides, gamma-glutamyl transferase, lactate dehydrogenase, and malondialdehyde levels and a significant decrease in fructosamine were observed in CPT and SPT compared to CON. A significant increase in cholesterol, aspartate amino transferase, and creatinine kinase and a significant decrease in albumin, potassium, calcium, superoxide dismutase, and catalase were observed in CPT only. Glucose was significantly decreased in SPT only. The highest area under the curve (AUC) was observed for fructosamine (89.7% and 87.5% for CPT and SPT, respectively) with the optimum cutoff point calculated on the basis of maximum sensitivity (SE) and specificity (SP) being 0.607mmol/L (SE: 89.3% and SP: 72.2%) and 1.005mmol/L (SE: 90.0% and SP: 75.3%) for CPT and SPT, respectively. At the cutoff limit of 0.607mmol/L and 1.005mmol/L, the odds ratio was 10.8 and 8.0 for CPT and SPT, respectively. A significant decrease in fructosamine and potassium and a significant increase in creatinine, lactate dehydrogenase, and malondialdehyde were observed in non-survivors compared to survivors. It was thus concluded that fructosamine was the best diagnostic indicator of both CPT and SPT followed by non-esterified fatty acid. Fructosamine, creatinine, potassium, lactate dehydrogenase, and malondialdehyde were the best prognostic indicators of PT.

Is (3599) Basov a large C-type super-fast rotator?

The rubble-pile model of asteroids deduced from the existence of a spin cutoff is an important paradigm in the interior structure of asteroids as a consequence of their collisional evolution. Many objects with size less than 200 ​m have been found to be rotating with a spin period less than 2.2 ​h but seldom so for bigger objects. Thus, asteroids with rotation periods significantly less than this spin cutoff limit are called super-fast rotators. Most often this picture of spin cutoff and hence the rubble-pile model has been applied to the S-type asteroids. In this study, we report the interesting case of (3599) Basov which is a member of the Themis family of C-class composition. The spin barrier of the Themis family asteroids has been shown to be P ​= ​3 ​h. What is unusual about (3599) Basov is that its rotation period has been confirmed to be P ​= ​2.157 ​± ​0.037 ​h which is significantly shorter than the critical value for centrifugal breakup. Furthermore, its size of 18 ​km is much larger than those of the S-class super-fast rotators. The physical property of (3599) Basov might therefore be quite unique. • C-type asteroids of rubble-pile structure should have a spin-cutoff at about 3 h • The rotation period of (3599) Basov is confirmed to be P=2.157±0.037 h and a C-type asteroid by photometry and spectroscopy observations. • If (3599) Basov has a rubble-pile structure, it should not have such a short rotation period unless it has a very large cohesive force.

Comparison of visual requirements and regulations for obtaining a driving license in different European countries and some open questions on their adequacy.

We reviewed the current state of knowledge regarding visual function and its suitability as part of medical examinations for driving licenses. We focused only on Group 1 drivers. According to previous studies, visual acuity, which is the most common test, is weakly associated with a higher risk of road accidents, with a greater role of visual field. The inclusion of the visual field test in medical examinations is therefore important, but the actual limit value is still unclear and further research in specific situations is needed. Color vision impairment was not found a threat to traffic safety. Contrast sensitivity decreases with age and is affected by abnormal eye conditions. Resulting glare can lead to an increased risk of traffic accidents during night driving in the elderly and others with conditions that impair contrast sensitivity. However, the universal cut-off limits have not been established either. The current European Union (EU) regulations therefore reflect minimum common denominator across the member states which may not entirely translate to optimal driving safety. Due to these open questions, standardized testing in simulators or on polygons that simulate real life conditions would be needed to better determine safe limits of visual function in different conditions. As there is a need to have better standardization across Europe regarding the requirements and rules regarding driving licenses in European countries, we first analyzed existing rules and compared them with each other, also in terms of deviations from the EU directive itself. We reviewed the literature in this field and prepared proposals for a more optimal regulation of the rules in the future. Particular attention is paid to the new method of examining the visual field that was created to respect the European directive. The paper can serve as a basis of information for research teams to design further protocols, as it gathers research findings to date on the importance and impact of various visual functions on driving safety, as well as a starting point for a debate on revising existing rules for obtaining and maintaining licenses, as it compares the current regulations in European countries and differences between them.

The High ‘Lipolytic Jump’ of Immobilized Amano A Lipase from Aspergillus niger in Developed ‘ESS Catalytic Triangles’ Containing Natural Origin Substrates

Lipase Amano A from Aspergillus niger (AA-ANL) is among the most commonly applied enzymes in biocatalysis processes, making it a significant scientific subject in the pharmaceutical and medical disciplines. In this study, we investigated the lipolytic activity of AA-ANL immobilized onto polyacrylic support IB-150A in 23 oils of natural origin containing various amounts of polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs). The created systems were expressed as an ‘ESS catalytic triangle’. A distinct ‘jump’ (up to 2400%) of lipolytic activity of immobilized AA-ANL compared to free lipase and hyperactivation in mostly tested substrates was observed. There was a ‘cutoff limit’ in a quantitative mutual ratio of ω-PUFAs/MUFAs, for which there was an increase or decrease in the activity of the immobilized AA-ANL. In addition, we observed the beneficial effect of immobilization using three polyacrylic supports (IB-150A, IB-D152, and IB-EC1) characterized by different intramolecular interactions. The developed substrate systems demonstrated considerable hyperactivation of immobilized AA-ANL. Moreover, a ‘lipolytic jump’ in the full range of tested temperature and pH was also observed. The considerable activity of AA-ANL-IB-150A after four reuse cycles was demonstrated. On the other hand, we observed an essential decrease in stability of immobilized lipase after 168 h of storage in a climate chamber. The tested kinetic profile of immobilized AA-ANL confirmed the decreased affinity to the substrate relative to lipase in the free form.

Evaluation of Random Plasma Glucose with Lowered Cutoff Limits for Screening of Diabetes and Prediabetes

Objective: To evaluate whether random plasma glucose (RPG) can be used as predictive marker and to determine lower cut off limits for screening of undiagnosed diabetes and prediabetes. Study Design: Cross-sectional study Place and Duration of Study: Department of Chemical Pathology, Rehman Medical Institute, Peshawar, Pakistan from 1st July, 2020 to 31st December, 2020. Methodology: Two hundred and sixty four subjects having RPG less than 200mg/dl were selected and then OGTT was done according to ADA guidelines. Enzymatic hexokinase method (reference method) using Cobas c501 ® analyzer was used for measurement of plasma glucose. Results: Mean age of patients was 39.92±12.49 years. There was significant difference (p=<0.001) between mean values of RPG in non-diabetics and diabetics at 95% confidence interval. Post-hoc analysis showed statistically significant difference between these groups. On applying ROC curve for prediabetics, it showed AUC of 0.777 while for diabetes it showed 0.922 at 95% CI. Diagnostic efficacy of RPG for prediabetics and diabetics at different cut off values was evaluated and it was found that sensitivity and specificity for prediabetics was good and for diabetics was excellent at cut off of 136mg/dl. Conclusion: Random plasma glucose can be used as a reliable screening tool for initial diagnosis of diabetes and prediabetes. A random cut off value of 136 mg/dl can be used as a reliable limit for screening purposes and can be confirmed by using OGTT. Keywords: Oral glucose tolerance test, Random plasma glucose, ROC curve, Diabetes, Prediabetes

Distinct spectral dynamics of implanted cardiac defibrillator signals in spontaneous termination of polymorphic ventricular tachycardia and fibrillation in patients with electrical and structural diseases.

To determine the spectral dynamics of early spontaneous polymorphic ventricular tachycardia and ventricular fibrillation (PVT/VF) in humans. Fifty-eight self-terminated and 173 shock-terminated episodes of spontaneously initiated PVT/VF recorded by Medtronic implanted cardiac defibrillators (ICDs) in 87 patients with various cardiac pathologies were analyzed by short fast Fourier transform of shifting segments to determine the dynamics of dominant frequency (DF) and regularity index (RI). The progression in the intensity of DF and RI accumulations further quantified the time course of spectral characteristics of the episodes. Episodes of self-terminated PVT/VF lasted 8.6 s [95% confidence interval (CI): 8.1-9.1] and shock-terminated lasted 13.9 s (13.6-14.3) (P < 0.001). Recordings from patients with primarily electrical pathologies displayed higher DF and RI values than those from patients with primarily structural pathologies (P < 0.05) independently of ventricular function or antiarrhythmic drug therapy. Regardless of the underlying pathology, the average DF and RI intensities were lower in self-terminated than shock-terminated episodes [DF: 3.67 (4.04-4.58) vs. 4.32 (3.46-3.93) Hz, P < 0.001; RI: 0.53 (0.48-0.56) vs. 0.63 (0.60-0.65), P < 0.001]. In a multivariate analysis controlled by the type of pathology and clinical variables, regularity remained an independent predictor of self-termination [hazard ratio: 0.954 (0.928-0.980)]. Receiver operating characteristic (ROC) curve analysis of DF and RI intensities demonstrated increased predictability for self-termination in time with 95% CI above the 0.5 cut-off limit at about t = 8.6 s and t = 6.95 s, respectively. Consistent with the notion that fast organized sources maintain PVT/VF in humans, reduction of frequency and regularity correlates with early self-termination. Our findings might help generate ICD methods aiming to reduce inappropriate shock deliveries.

Performance characteristics of the direct spray oil cooling system for a driving motor of an electric vehicle

In the present work, the performance characteristics of direct spray oil cooling system with spiral, and two full cone nozzles and three cooling oils of mineral oil, dielectric oil and transmission oil are experimentally investigated. The temperature, temperature uniformity, injection pressure, spray resistance, heat transfer coefficient, Nusselt number and spray power consumption are evaluated as the performance characteristics of direct spray oil cooling system. The influences of heating capacities of 1.3 kW and 2.6 kW, nozzle to heating surface distances of 3 cm, 5 cm and 8 cm and cooling oil flow rates of 2 LPM, 3 LPM and 4 LPM are studied on the performance characteristics of direct spray oil cooling system. The lowest maximum surface temperature is obtained for spiral nozzle with 5 cm distance and both full cone nozzles with 8 cm distance. The maximum temperature is maintained within 140 °C at low heating capacity of 1.3 kW and different combinations of nozzles and cooling oils are tested considering flow rate range of 2 LPM to 4 LPM to maintain the maximum temperature within cut-off limit of 200 °C at high heating capacity of 2.6 kW. The maximum performance characteristics are obtained at 4 LPM flow rate followed by 3 LPM and 2 LPM flow rates, respectively in decreasing order. The dielectric oil shows superior performance characteristics compared to mineral oil and transmission oil for all nozzles. Furthermore, in each case of cooling oil, the performance characteristics are excellent for full cone-1 nozzle compared to spiral and full cone-2 nozzles. The combination of dielectric oil and full cone-1 nozzle shows superior performance characteristics of direct spray oil cooling system with heat transfer coefficient of 67420.20 W/m2-K, Nusselt number of 2385.64, spray resistance of 0.0132 K/W and spray power consumption of 29.73 W. The data base generated for a direct spray oil cooling system will be implemented for cooling of an electric vehicle driving motor.

THE INCIDENCE OF BETA-THALASSEMIA MINOR IN PREGNANT FEMALES BY MEASURING HBA2 THROUGH HIGH PERFORMANCE LIQUID CHROMATOGRAPHY

Objectives: The aim of the study was to study the incidence of thalassemia minor by determining HbA2 levels in pregnant females attending Obstetrics and Gynaecology OPD and HbA2 levels of husbands of positive females for beta-thalassemia trait. Methods: The prospective study spanning over 1½ years was conducted in the Department of Pathology in 1020 pregnant females who attended the Gynaecology and Obstetrics OPD of Government Medical College, Patiala for antenatal check-up. The pregnant females of any trimester without any specific sign and symptoms whose Hb level was &lt;10 g/dL were screened in the study. Levels of HbA2 and HbF were determined by high performance liquid chromatography (HPLC) and the cases with raised HbA2 value above the cutoff limit (&gt;3.5%) were labeled as BTT. Husbands of BTT positive females were also screened for the trait. Incidence of all these cases was calculated and analyzed statistically. Results: The majority of the females were in the age group of 21–30 years. In present study, we found that total 134 (13.1%) patients were having beta thalassemia trait. Husbands of all these positive patients were also screened for BTT and only 2 (1.49%) of them were found to be positive. Conclusion: HPLC has the advantage for screening and detection of various hemoglobinopathies by providing rapid and accurate results. HPLC can detect and measure HbF and HbA2 in a single system. Early diagnosis and management of thalassemia can help in reduction of burden on society as well as government.

Community Screening of Probable Dementia at Primary Care Center in Western India: A Pilot Project.

Introduction Timely detecting dementia is an important goal of clinicians and public health professionals alike for better management and prevention of complications. Community screening of dementia could be a powerful strategy. Facilities for dementia screening at primary care level are virtually nonexistent and are a prominent implementation gap. Hence, a study was done to assess the feasibility of dementia screening at primary care using General Practitioner Assessment of Cognition (GPCoG) scale among older adults with subjective memory complaints. It was further aimed to assess the frequency of cardiovascular risk factors in those who met screening criteria for cognitive impairment. Materials and Methods Older adults coming to three urban primary care centers in western India for screening of noncommunicable diseases such as diabetes and hypertension (opportunistic screening) with subjective memory complaints were enrolled and screened for dementia using GPCoG. A Mini-Mental State Examination (MMSE) was done in patients who came alone for referral purpose in case the score levels in GPCoG examination met cutoff limits for informant interview. Written medical records were examined to assess status of comorbid vascular risk factors such as diabetes, hypertension, coronary artery disease, and cerebrovascular accidents. Results A total of 350 older adults (M:F = 276: 74; mean age ± 68 ± 6.7 years) were screened out of 3,000 older adults who reported during the study period. There were 161 older adults with GPCoG score less than or equal to 5 (56.14%) and 149 subjects with MMSE less than or equal to 24 indicating significant cognitive impairment (42.5%). There were very few ( n = 11, 3.14%) out of 350 people who came with caregivers; hence, MMSE was done along with for referral to healthcare providers. A total of 142 had comorbid diabetes/and or hypertension (40.5%). A total of 86 had diabetes alone (24.5%) and a total of 128 had hypertension (36.5%). Conclusion Current study results indicate that using a simple screening tool such as GPCoG, community screening of probable dementia, is feasible in primary care settings, as is indicated by significant yield of probable dementia cases (42.5%). These cases can be referred to appropriate centers for further workup, confirmation of diagnosis, and treatment. Also, detection of comorbid cardiovascular conditions, for example, diabetes and hypertension, that can be managed along with cognitive impairment/dementia for potential prevention/further deterioration, which can strengthen noncommunicable disease screening.

Determinants of Tax Compliance among Small and Medium Enterprises in Tanzania: Insights from Ilala Municipality

This study investigated on Determinant of tax compliance among Small and Medium Enterprises in Tanzania specifically Ilala municipality, Particular objectives included evaluating the influence of economic factors and taxpayer personal demographics on tax compliance. The descriptive cross-sectional survey design and quantitative research approach were used in the current study. The study's population consisted of 5324 Small and Medium Enterprises from Ilala Municipality, from where a random sample of 98 respondents was drawn. Structured questionnaires were used to collect data, which was then analyzed using The Multiple Linear Regression, which provided a comprehensive proof that helped to answer the research questions. The study's findings demonstrated a positive and statistically significant association between the study independent variables and the dependent variable. Taxpayer, economic, and institutional factors all influence taxpayers' willingness to engage in tax evasion, according to the regression analysis. Study findings reveal that all taxpayer predictors, including economic and institutional factors, have a significant impact on tax compliance since all have mean of above 3.0. Furthermore, regression analysis supports the findings, since all three factors were found to have a significant impact on tax compliance, with p-values less than the 0.05 cutoff limit. The study concludes Tax morality can help increase voluntary tax compliance on the country through this taxpayer will have a positive perception toward government spending. Maintaining tax fairness, appropriate and moderate levels of penalty, and keeping tax rates as low as possible can all foster taxpayers' voluntary compliance. Fairness in the execution of tax regulations should be enshrined, and tough measures to combat tax revenue corruption should be implemented.

Photometric study and absolute parameters of four short period W UMa binary stars of late spectral classes

We present the first CCD complete light curves for the W Ursae Majoris systems NSVS 870615, NSVS 0912043, NSVS 5049537 and LINEAR 3636597. The observations were performed at the IRIDA South dome of the NAO Rozhen–Bulgaria and they confirm and revise the short-period (0.22-0.25 days) for these objects. In particular two of them show periods near to the cut-off limit. The modeling of the light curves was done using the Wilson–Devinney code and the elements obtained from this analysis are used to compute the physical parameters of the system in order to study its evolutionary status. From a reasonable synthetic fit of the original data we can derive that all components of the systems are of K spectral types (T1< 5000K), one of the secondaries is of M spectral type. All targets are contact binary systems of W-subtype, which is a common feature of K spectral type contact binaries, and two of them, having 1/q> 0.72, belong to the class of the high mass ratio binaries (H/W type). One, with a total mass of about 0.73(M⊙) can be considered as Low Mass Contact Binary system (LMCB). The degrees of contact (fill-out factors) f are shallow for three of our targets, while for NSVS 0912043 the analyzes return an important high value of f = 80.7%. The O’Connell effect in the light curves is well explained by employing star spots on the binary surface, which confirms that the systems are active at present. The four systems are in good thermal contact with ΔT between 170K and 420K. The absolute elements of the systems are estimated and the positions of the components is shown in the logarithmic diagrams.

The influence of substrate systems on the enantioselective and lipolytic activity of immobilized Amano PS from Burkholderia cepacia lipase (APS-BCL)

In this study, Amano lipase PS from Burkholderia cepacia (APS-BCL) was immobilized onto polyacrylic support IB-150A, which allowed to improve immobilized lipase activity in nonaqueous media compared with the free (native) form. The enantioselectivity of the immobilized APS-BCL (8 mg/mL) in the kinetic resolution of (R,S)−1-phenylethanol was evaluated. High values of catalytic parameters with isopropenyl acetate (E =775.4, C =49 % ± 0.4) and vinyl acetate (E =206.6, C = 50 % ± 0.3) as acyl donors were achieved after a reaction time of 12 h. The effects of 7 different non-aqueous solvents on catalyst enantioselectivity in the kinetic resolution of (R,S)−1−phenylethanol were also assessed. Diisopropyl ether and n-hexane were selected as the optimal reaction media. A novel lipolytic activity study of immobilized APS-BCL (7.9–9.3 mg/mL) with the application of the developed multicomponent unsaturated fatty acids (MC-UFAs) method using 13 vegetable oils in an aqueous medium has been proposed (pH =7, T =37 °C). The effect of the ratio of polyunsaturated fatty acids (PUFAs) to monounsaturated fatty acids (MUFAs) on lipase activity was demonstrated and a cut-off limit (ω6/ω9 =2.3) was determined. Hyperactivation of immobilized APS-BCL in peanut oil (Arec=104.85 %, Aret=110.19 %) as the substrate was observed.

Fetal weight projection model to define growth velocity and validation against pregnancy outcome in a cohort of serially scanned pregnancies.

ABSTRACTObjectiveFetal growth assessment is central to good antenatal care, yet there is a lack of definition of normal and abnormal fetal growth rate which can identify pregnancies at risk of adverse outcome. The aim of this study was to develop and test a model for defining normal limits of growth velocity which are specific to the fetal weight measurement interval.MethodsThe cohort consisted of 102 138 singleton pregnancies which underwent at least two third‐trimester measurements of ultrasound estimated fetal weight (EFW), usually carried out because routine early‐pregnancy risk assessment had indicated an increased risk of fetal growth restriction. We projected the EFW from the first of each consecutive measurement pair along its own centile rank to the gestational age of the second scan. Normal growth was defined as the second EFW being within a weight range based on limits derived by partial receiver‐operating‐characteristics‐curve (pROC) analyses for small‐for‐gestational‐age (SGA; < 10th centile) and large‐for‐gestational‐age (LGA; > 90th centile) birth weight. The limits were measurement‐interval specific and calculated for a fixed false‐positive rate (FPR) of 10%. The resultant normal, slow and accelerated growth rates calculated from consecutive EFW pairs were evaluated against the following predefined perinatal outcome measures: stillbirth, neonatal death, SGA and LGA at birth, 5‐min Apgar score < 7 and admission to the neonatal intensive care unit. Slow growth based on the last two scans was compared with SGA fetal weight (EFW < 10th centile) at the last scan and association with stillbirth risk was assessed, expressed as relative risk (RR) with 95% CI.ResultsThe optimal cut‐off limits for normal growth rate between consecutive scans varied according to the length of the measurement interval, with an average of –8.0% for slow growth and + 9.3% for accelerated growth at a fixed FPR of 10%. Slow growth between random consecutive scan pairs was associated significantly with all predefined outcome measures including stillbirth (RR, 2.19; 95% CI, 1.84–2.53) and neonatal death (RR, 2.28; 95% CI, 1.60–3.13). Accelerated growth was associated with LGA at birth (RR, 2.15; 95% CI, 2.10–2.20), while normal growth was protective of all adverse outcome measures. Slow growth between the last two scans (which were performed at a median gestational age of 33 + 1 to 36 + 4 weeks) and SGA at the last scan were each predictors of stillbirth, and stillbirth risk was highest when both were present (RR, 2.65; 95% CI, 1.67–4.20). However, 66.2% of pregnancies with slow growth were not SGA at the last scan and these cases also had an increased risk of stillbirth (RR, 2.07; 95% CI, 1.40–3.05).ConclusionFetal growth velocity defined by projected, measurement‐interval specific fetal weight limits is associated independently with perinatal outcome and should be used for antenatal surveillance in addition to assessment by fetal size. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Incidence of primary congenital hypothyroidism over 24 years in Finland

BackgroundA rise in the incidence of congenital hypothyroidism (CH) has been reported worldwide. This nationwide study aimed to describe the secular trends and current incidence of CH in Finland.MethodsTwo independent study cohorts, a national and a regional, were collected from national registers and patient records. The national cohort represents all CH cases born in Finland between 1994 and 2017. Birth data, results of the screening test, and the incidence of CH were reviewed.ResultsBetween 1994 and 2017, 1,400,028 children were born in Finland. Of these children, 503 were diagnosed with primary CH (incidence 1:2783). Male-to-female sex ratio was 1:2.0. The nationwide incidence was 33 cases per 100,000 live births between 1994 and 1999, 38 cases per 100,000 live births between 2000 and 2005, 40 cases per 100,000 live births between 2006 and 2011, and 33 cases per 100,000 live births between 2012 and 2017. In the regional cohort (n = 139), the incidence of transient CH was 3.6%. The incidence of mild, moderate, and severe CH remained constant.ConclusionsIn Finland, the incidence of CH has not changed during the 24-year study period.ImpactAs opposed to recent reports worldwide, the incidence of congenital hypothyroidism has not changed between 1994 and 2017 in Finland.The proportions of mild, moderate, and severe congenital hypothyroidism did not change significantly over the study period.Lowering the TSH cut-off limit or increasing immigration did not affect the incidence rate of primary congenital hypothyroidism in Finland.

OUTCOME-BASED THRESHOLD FOR CAROTID-FEMORAL PULSE WAVE VELOCITY: THE IDCARS STUDY

Objective: Guidelines recommend a &gt; 10m/s threshold of carotid-femoral pulse wave velocity (cf-PWV) to detect hypertension mediated organ damage. However, the &gt; 10m/s threshold was derived from the cf-PWV distribution across cross-sectional studies with limited contribution of prospective cohort studies. Using data from the International Database of Central Arterial Properties for Risk Stratification (IDCARS), we aimed to determine an outcome-based threshold for cf-PWV. Design and method: Adults (&gt; = 18 years) recruited by eight IDCARS centres and followed up for 6 months or longer qualified for inclusion in the current subject-level meta-analysis. Cf PWV was measured using the Sphygmocor device (Itasca, IL). Pulse transit distance was determined by subtracting the distance between the carotid sampling site and the suprasternal notch from the distance between the carotid and femoral sample sites. The primary endpoint consisted of fatal and nonfatal cardiovascular events. Total and cardiovascular mortality and fatal and nonfatal coronary events were secondary endpoints. The cf-PWV threshold was determined by multivariable Cox regression with average risk based on established risk factors in the whole cohort as reference. Results: After 5.0 years of follow-up (median), of 3494 participants (mean age: 52.2 years; women: 55.3%; mean cf-PWV: 7.8 m/s), 156 (4.5%) experienced the primary endpoint, and 104 (3.0%) died, 25 (0.7%) of cardiovascular disease and 77 (2.2%) had a coronary event. After whole adjusting for sex, age, systolic blood pressure, heart rate and other cardiovascular risk factors, the outcome-driven cf-PWV thresholds were 8.6, 9.1, 8.7 and 8.6 m/s for a composite cardiovascular endpoint, all-cause and cardiovascular mortality and a coronary event, respectively. A cf-PWV &gt; = 9 m/s (n = 752, 21.5%), compared with slower velocities, had an increased risk of a composite cardiovascular endpoint (HR: 1.75; 95% CI: 1.20–2.54, P = 0.004). Conclusions: The outcome-based threshold of &gt; = 9 m/s for cf-PWV, which was present in 20% of the IDCARS participants, is close to the cut-off limit proposed by guidelines based on other approaches.

Tensiomyography Allows to Discriminate between Injured and Non-Injured Biceps Femoris Muscle.

Simple SummaryThe hamstring muscle group is the most frequently injured muscle group in non-contact muscle injuries involving high-speed running sports. The biceps femoris (BF) muscle has the highest injury incidence. Clinical assessments and magnetic resonance imaging (MRI) are routinely used to diagnose a given injury. We tested the possibilities of a new technology—tensiomyography—as a potential screening test (diagnostic and classification purposes) to assess the functional differences between injured and non-injured BF muscles. The results show that tensiomyography has a high predictive ability to discriminate between injured and non-injured BF non-invasively and functionally and that it can be reliably used as a complementary screening test in the diagnosis of BF injuries.The hamstring muscle group is the most frequently injured muscle group in non-contact muscle injuries in sports involving high-speed running. A total of 84% of hamstring injuries affect the biceps femoris (BF) muscle. Clinical assessments and magnetic resonance imaging (MRI) are routinely used for diagnosis and plan management. MRI-negative scans for clinically diagnosed hamstring injuries range from 14% to 45%. We tested the hypothesis that the functional differences between injured and non-injured BF assessed by tensiomyography can be used for diagnostic and classification purposes. We compared an injured group of 53 international-level soccer players and sprinters with 53 non-injured international-level soccer players and sprinters of both sexes. Comparing the injured vs. non-injured athletes and the left vs. right side in all of the athletes, we used the percentage of absolute differences in the BF contraction time (Tc) to classify non-injured and injured BF muscles. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) and the precision–recall curve (PRC) were used to measure the classification accuracy and to identify cut-off limits using the Tc differences. There was a very high ROC AUC value of 0.981 (SE = 0.009, p < 0.000), with 98.11% of the injured muscles being correctly classified (cut-off point 12.50% on Tc differences), and an AUPRC value of 0.981, with association classification criteria at >9.87. Tensiomyography has a high predictive ability to discriminate between injured and non-injured BF non-invasively and functionally.

The cut-off limits of GH response to GHRH + arginine test related to body mass index for the diagnosis of adult GH deficiency: do we need to review our diagnostic criteria?

The cut-off limits of GH response to GHRH + arginine test related to body mass index for the diagnosis of adult GH deficiency: do we need to review our diagnostic criteria?

A Preliminary Study to Classify Corn Silage for High or Low Mycotoxin Contamination by Using near Infrared Spectroscopy

Mycotoxins should be monitored in order to properly evaluate corn silage safety quality. In the present study, corn silage samples (n = 115) were collected in a survey, characterized for concentrations of mycotoxins, and scanned by a NIR spectrometer. Random Forest classification models for NIR calibration were developed by applying different cut-offs to classify samples for concentration (i.e., μg/kg dry matter) or count (i.e., n) of (i) total detectable mycotoxins; (ii) regulated and emerging Fusarium toxins; (iii) emerging Fusarium toxins; (iv) Fumonisins and their metabolites; and (v) Penicillium toxins. An over- and under-sampling re-balancing technique was applied and performed 100 times. The best predictive model for total sum and count (i.e., accuracy mean ± standard deviation) was obtained by applying cut-offs of 10,000 µg/kg DM (i.e., 96.0 ± 2.7%) or 34 (i.e., 97.1 ± 1.8%), respectively. Regulated and emerging Fusarium mycotoxins achieved accuracies slightly less than 90%. For the Penicillium mycotoxin contamination category, an accuracy of 95.1 ± 2.8% was obtained by using a cut-off limit of 350 µg/kg DM as a total sum or 98.6 ± 1.3% for a cut-off limit of five as mycotoxin count. In conclusion, this work was a preliminary study to discriminate corn silage for high or low mycotoxin contamination by using NIR spectroscopy.

Neurological intact survival with rescue mechanical circulatory support for refractory out-of-hospital cardiac arrest despite long low-flow times

Abstract Funding Acknowledgements Type of funding sources: None. Background The potential window for using mechanical circulatory support (MCS) for refractory out-of-hospital cardiac arrest (OHCA) remain unsettled. It has been proposed that a cut-off limit defined as the golden hour may produce higher survival with good neurological outcome. Purpose The present study analyzed the association of low-flow time and neurological intact survival (Cerebral Performance Categories 1-2) at discharge between patients receiving conventional cardiopulmonary resuscitation (CCPR) and MCS. Methods The present retrospective, observational, single centre study from 2015-2019 included all consecutive OHCA patients, who were treated with MCS for refractory OHCA or received CCPR. Low-flow time was defined as the time from CPR to deployment of either veno-arterial extracorporeal membrane oxygenation or Impella support for the MCS group. Time from CPR to return of spontaneous circulation or termination of treatment was recorded for the CCPR group. Rate of neurological intact survival at discharge were analyzed for both groups. Results A total of 101 patients were treated with MCS and 914 patients received CCPR. The MCS group was significantly younger with a median age of 56 (IQR, 46-62) years compared to 67 (IQR, 57-74) years, p &amp;lt; 0.001. In the CCPR group, short low-flow times (0-20 minutes) were associated with high survival with good neurological outcome at discharge. There were no survivors with low-flow times exceeding 70 minutes. All patients receiving MCS survived at low-flow times 31-60 minutes, however neurological intact survival dropped to 21% at low-flow times &amp;gt; 80 minutes. Conclusion Patients treated with MCS with low-flow time 70-80 minutes did show similar favorable neurological outcome at discharge as patients receiving CCPR with low-flow &amp;lt; 10 minutes. Despite, low-flow times exceeding 80 minutes, patients treated with MCS still presented high survival rate of 21%. Hence, the data in this study does not support a golden hour for MCS.

Indications and complications of blood transfusion

Blood transfusion is a common procedure in the realm of medicine and surgery to treat hematological disorders such as iron and hemoglobin deficiency, during and after major surgical or invasive procedures, and in the event of trauma. However, this life saving procedure does not come without adverse complications and risks. In this review we will extensively discuss the indications of blood transfusion and the complications associated with blood transfusion. An extensive literature search was conducted in online databases such as PubMed, Google Scholar to include various publications such as narrative reviews, editorials and clinical practice guidelines on the indications of blood transfusion and its associated complications. After numerous large scale clinical trials and studies, the transfusion trigger for hemoglobin has been readjusted to a lower threshold thus preventing excessive transfusions and thereby limiting complications. There are a wide range of complications and adverse events associated with blood transfusions. Non-infectious transfusion reactions can contribute to significant morbidity and mortality and occur more commonly as compared to infectious transfusion reactions. Non-infectious reactions can be immune mediated and non-immune mediated and can also be subdivided based on their timing and occurrence after transfusion as acute occurring within 24 hours of transfusion and delayed as occurring 24 hours after transfusion. Further studies are warranted to create more precision on indications of blood transfusion especially for blood components such as platelets, fresh frozen plasma and cryoprecipitate are still undefined and need further trials to set cut-off limits to indicate transfusion.