Cut-off Point For Diagnosis Research Articles

#5181 MYOSTEATOSIS: A NEW MARKER OF MUSCLE QUALITY IN CHRONIC KIDNEY DISEASE STRONGLY ASSOCIATED WITH MORTALITY

Abstract Background and Aims Skeletal muscle composition disturbances, like sarcopenia and myosteatosis, are common in non-dialysis chronic kidney disease (ND-CKD) patients and seem to be associated with adverse clinical outcomes. Sarcopenia and myosteatosis can be evaluated by computed tomography (CT) by measuring skeletal muscle area (SMA) and muscular attenuation (MA) in Hounsfield units (HU) at the third lumbar vertebra, respectively, but the optimal cutoff points for diagnosis and outcome prediction are not established in chronic kidney disease (CKD) patients. We aimed to evaluate the prevalence of sarcopenia and myosteatosis in ND-CKD patients and to define the optimal cutoff values of SMA and MA to predict mortality. Method We conducted a retrospective cohort study including non-dialysis CKD patients referred to an outpatient clinic during a two-year period, who underwent a CT as part of clinical workup and with an available serum creatinine evaluation within a 90-days timeframe. Patients with a follow-up under 26 weeks after the CT were excluded. Area under the receiver operating characteristic curve (AuROC) analysis was used to evaluate the ability of SMA and MA to predict mortality and the Youden's index was used to determine the optimal cutoff point. Cox-regression analysis was employed to identify independent predictors of mortality. Results 167 patients (94% Caucasian, 50.9% male, 32.3% diabetics) with a mean age of 68.3 ± 16.4 years were included, most with CKD stage 3 and 4 (53.9%; mean estimated GFR 57.6 ± 33,1 ml/min/1.73m2 at baseline). During a median follow-up of 4.9 (4.2) years, 39 patients (23.4%) died. Median SMA was 127.7 (45.8) cm2 and there was a trend to increased mortality across lower SMA quartiles (1st quartile 32.6%, p = 0.026; 2nd quartile 26.8%, p = 0.095; 3rd quartile 21.4%, p = 0.261; 4th quartile 21.2% - reference). SMA showed a modest ability to predict mortality (AuROC 0.623) and the best cutoff found was 140.7 cm2. Median MA was 28.4 (13.8) HU and there was a statistically significant higher mortality across lower MA quartiles (1st quartile 42.9%, p<0.001; 2nd quartile 31.0%, p = 0.001; 3rd quartile 16.7%, p = 0.028; 4th quartile 2.4% - reference). MA showed a good ability to predict mortality (AuROC 0.733) and the best cutoff was 30 HU. Using the identified cutoff points, sarcopenia (SMA < 140.7 cm2) was present in 67.1% (n = 112) and myosteatosis (MA < 30 HU) in 56.3% (n = 94) of patients. In univariate Cox-regression both sarcopenia and myosteatosis were associated with increased mortality – Hazard ratio (HR) 4.34 (95% CI 1.68-11.19, p = 0.002) and 5.32 (95% CI 2.22-12.73, p<0.001), respectively. In multivariate Cox-regression models (adjusted for age, baseline estimated GFR and presence of diabetes) only myosteatosis kept its association with mortality – HR 2.87 (95% CI 1.15-7.16, p = 0.024). This association was also present when the model was adjusted for the presence of sarcopenia. Patients with myosteatosis were older (median age 77.3 [10.8] vs 62.7 [30.1], p<0.001) and had higher frequency of diabetes (42.6% vs 19.2%, p = 0.001), arterial hypertension (87.2% vs 57.5%, p<0,001), and heart failure (24.5% vs 6.8%, p<0.003). They had also higher BMI (29.3 [7.4] vs 25.1 [6.0] kg/m2, p<0,001), visceral obesity (77.7% vs 43.8%, p<0.001) and frequency of sarcopenia (75.5% vs 56.2%, p = 0.008). Myosteatosis was more frequent in CKD stage 3 to 5 patients, compared to CKD stage 1 or 2 (66.3% vs 42%, p = 0.002). Conclusion Sarcopenia and myosteatosis are prevalent in CKD patients, especially in advanced stages. However, reference values for this population are lacking. We found cutoff values for these muscle parameters using CT analysis in CKD patients, based on optimal stratification for mortality. Additionally, our study highlights that muscle quality (i.e., myosteatosis) may be more closely associated with mortality than muscle quantity (i.e., sarcopenia). Identifying patients at risk for these muscle abnormalities and early diagnosis are paramount for the subsequent implementation of therapeutic interventions.

Application Value of Random Urine Potassium-to-Creatinine Ratio in Diagnosing Renal Potassium Loss

To analyze the value of applying random urine potassium-to-creatinine ratio (rUK/Ucr) in diagnosing renal potassium loss. patients diagnosed with hypokalemia, including 373 cases of renal potassium loss, 83 cases of non-renal potassium loss , and 358 cases of normal serum potassium, between 2017 and 2021 were enrolled. The clinical data of the patients were collected and the correlation between rUK/Ucr and 24-hour urine potassium (24 hUK) in the three groups was analyzed. The receiver operating characteristic (ROC) curve was used to analyze the value of applying rUK/Ucr in diagnosing renal potassium loss. Serum potassium decreased in the normal serum potassium group, the renal potassium loss group, and the non-renal renal potassium loss group ( P<0.01). The 24 hUK and the rUK/Ucr of the renal potassium loss group were higher than those of the non-renal potassium loss group and normal serum potassium group ( P<0.01). rUK/Ucr showed low to moderate correlation with 24 hUK. The AUC of 24 hUK and rUK/Ucr for determining renal potassium loss were 0.73 and 0.71, respectively. When the optimal cutoff point of rUK/Ucr for determining renal potassium loss was 3.4, the sensitivity was 67.6% and the specificity was 67.5%. rUK/Ucr shows a moderate correlation with 24 hUK and its accuracy in determining renal potassium loss is comparable to that of 24 hUK. When 24-hour urine samples cannot be obtained, it is recommended that rUK/Ucr be used instead of 24 hUK to determine whether renal potassium loss exists, with the optimal cutoff point for diagnosis being 3.4.

Validity and reliability of handgrip dynamometry in older adults: A comparison of two widely used dynamometers.

BackgroundAmong older adults, decreased handgrip strength is associated with greater risk of frailty, and loss of physical function, mobility, lean mass, and overall muscular strength and power. Frailty is also associated with sarcopenia, for which handgrip strength measurement has been recommended for diagnostic purposes. Specific cutoff points for diagnosis have been identified, but use of different devices may affect measurement. Therefore to assess validity and reliability, we compared the two most frequently used devices, the Jamar hydraulic and Smedley spring handgrip dynamometers.MethodsSixty-seven older (76.2 ± 0.9 years) men (n = 34) and women (n = 33) completed two trials of handgrip strength measurement on sequential days (T1, T2) using both devices in random order. Intraclass correlations were used to assess test-retest reliability, and Bland-Altman analysis was used to assess validity as the level of agreement between devices.ResultsThere were significant (p < 0.001) relationships between devices at T1 (r = 0.94) and T2 (r = 0.94) and strong (p < 0.001) intraclass correlations were observed for both devices (Jamar = 0.98; Smedley = 0.96), indicating excellent reliability. However, there were significant differences between devices. Strength measured with Jamar was greater than Smedley at both T1 (27.4 ± 1.4 vs. 23.4 ± 1.1 kg, p < 0.001) and T2 (25.3 ± 1.4 vs. 21.8 ± 1.2 kg, p < 0.001). Bland-Altman analysis confirmed these differences. Subgroup analysis to evaluate the effect of gender and age indicated that in women and old-old (>75 years) participants, differences between devices were closer to zero for both measurements compared to men and young-old (65–75 years) participants.ConclusionsOur results demonstrate that despite excellent reliability, there is poor agreement between devices, indicating a lack of validity. For use as a diagnostic tool, standardization and device-specific cutoff points for handgrip dynamometry are needed.

The role of triphasic CT imaging and 18F FDG PET CT on detection of extrahepatic metastases and proper staging of HCC: a comparative study

BackgroundExtrahepatic metastases and proper staging of HCC are mandatory for proper assessment of the disease process and its exact extent. Subsequently, clinicians can put precise management and treatment strategies for patients with metastatic HCC. 18FFDG PET/CT is one of the best imaging modalities for the proper detection of metastases and staging. It can provide both functional information and high contrast resolution of CT.ResultsOn comparison between 18F FDG PET/CT and triphasic CT regarding metastases PET/CT showed greater sensitivity (92.3%) and specificity (84.4%), than triphasic CT (51.3%), (81/3%), and (76.9%), respectively. PET/CT revealed that the SUV max cutoff point for diagnosis of HCC was > 3.PET/CT revealed an SUV max cutoff point of > 5.57 for predicting that HCC has extrahepatic metastases. PET/CT revealed an SUV max cutoff point of > 3.35 for differentiating between metastatic and nonmetastatic lesions.ConclusionsPET/CT combines the advantages of the excellent functional information provided by PET and the contrast resolution of CT. It increases the rate of detection of extrahepatic metastases, so it is more sensitive than triphasic CT in the staging of HCC. Using the standard uptake value proved to be efficient in HCC diagnosis and staging being more related to the functional activity of the tumor cells.

C-reactive protein as a diagnostic marker of neonatal sepsis in association with blood culture a retrospective study at a tertiary care hospital

To evaluate the sensitivity and specificity of C-Reactive protein as a single diagnostic inflammatory biomarker of neonatal sepsis in association with the blood culture.In this study, we retrospectively reviewed the medical records of 330 neonates at a tertiary care hospital at Gurugram from Jan, 2015 to Dec, 2020. The study population included neonates &amp;#60;1month age. Neonates meeting the IPSC criteria (Sepsis 2.0)1 and with a positive culture were considered as neonates with proven sepsis. Neonates with congenital malformations and congenital infections associated with TORCH complex were excluded from the study.Of the 330 neonates screened for sepsis, 32 (10%) had a positive blood culture with raised CRP in 69 (21%) cases. Among the 32 cases with positive blood culture, CRP identified 29 cases. The sensitivity, specificity, positive predictive value, negative predictive values of CRP were 90.6%, 86.5%, 42% and 99% respectively. The area under the curve (AUC) for the CRP ROC analysis was 0.83 with sensitivity of 90.6% and specificity of 91.6% which showed CRP usefulness as the diagnostic inflammatory biomarker of neonatal sepsis.Prematurity (53%) in neonates was the most common risk factor associated with neonatal sepsis. Klebsiella pneumoniae 11 (34%) was the most common pathogen isolated with 73% susceptibility to Ciprofloxacin.C-Reactive protein was found to have a high diagnostic value in terms of sensitivity of 90.6% and specificity of 91.6% when 0.83 is used as a cut off point for diagnosis of neonatal sepsis. Therefore, CRP could be used as diagnostic inflammatory biomarker in resource poor settings.

Serum Soluble Endoglin Versus Serum Placental Growth Factor for Early Prediction of Preeclampsia

Aim: Evaluation of the predictive ability of serum soluble endoglin (sEng) and placental growth factor (PLGF) levels estimated at the 12th gestational week (GW) for discrimination of women liable to develop preeclampsia (PE).Materials and Methods: 102 PE women were diagnosed according to the American Society of Hypertension and categorized according to guidelines of American College of Obstetricians and Gynecologists. The severity of PE was judged by the difference between blood pressure (ΔBP) measures at time of PE diagnosis and at time of enrolment. Blood samples were obtained at the 12th GW for ELISA estimation of serum sEng and PLGF. Study outcomes included the predictive ability of these markers for development of PE and the relation between age, body mass index (BMI) and serum levels of studied biomarkers and ΔSBP and ΔDBP.Results: 29 and 73 women developed early- and late-onset PE, respectively and 18 women had severe, while 84 women had mild PE. At time of PE diagnosis, BP measures were increased significantly in PE women in comparison to enrolment measures and to control measures. Serum levels of sEng were significantly higher, while serum PLGF levels were significantly lower in PE women than in controls. Development of PE was positively correlated with serum sEng, while was negatively correlated with serum PLGF levels. Also, there was positive significant correlation between ΔBP and BMI and serum levels of sEng, and negative significant correlation with at enrolment BP and serum levels of PLGF. ROC curve analysis defined ΔSBP and ΔDBP by 33 and 10 mmHg as a cutoff point for diagnosis of PE and defined high serum sEng as the significant sensitive predictor for development of PE at both cutoff points.Conclusion: At 12th GW, estimated levels of sEng and PLGF could discriminate pregnant women vulnerable for development of PE. Statistical analyses defined high serum sEng levels estimated at the 12th GW as the significant early predictor for upcoming PE. Maternal obesity and old age are also related to PE severity and must be considered for prediction.

Reference Data and T-Scores of Lumbar Skeletal Muscle Area and Its Skeletal Muscle Indices Measured by CT Scan in a Healthy Korean Population.

Although computed tomography (CT) is considered the gold standard for investigating skeletal muscles, diagnostic cutoff points for sarcopenia have not been established. We therefore suggested clinically relevant diagnostic cutoff points for sarcopenia based on reference values of skeletal muscle area (SMA) measured by CT scan in a large-sized healthy Asian population. This cross-sectional analysis included 11,845 subjects (7,314 men, 4,531 women) who underwent abdominal CT scans in South Korea. SMA including all muscles on the selected axial images of the L3 lumbar vertebrae level was demarcated using predetermined thresholds (-29 to +150 Hounsfield units). SMA indices (height-, weight-, and body mass index [BMI]-adjusted) were calculated. When T-score < -2.0 was used as the cutoff for defining sarcopenia, the sex-specific cutoff points of SMA, SMA/height2, SMA/weight, and SMA/BMI were 119.3 and 74.2 cm2, 39.8 and 28.4 cm2/m2, 1.65 and 1.38 cm2/kg, and 4.97 and 3.46 in men and women, respectively. In both sexes, the SMA/BMI values peaked in the 20s and decreased gradually. The SMA/BMI yielded the highest diagnostic rate of sarcopenia (4.2% in men, 8.7% in women), while SMA/height2 provided the lowest yield (2.8% in men, 1.0% in women). This is the first study to report the reference values of SMA and skeletal muscle indices (SMIs) measured on CT scans and to suggest cutoff points for diagnosis of sarcopenia based on T-score in Asian subjects. BMI-adjusted index (SMA/BMI) was the best index of CT-measured SMA to reflect the age-related muscle changes and to maximize the diagnostic yield for sarcopenia.

1,3 β-D-Glucan versus blood culture for the diagnosis of invasive fungal infection in formula-fed preterm neonates

Abstract Background 1,3 β-D-Glucan is an important marker for diagnosis of invasive fungal infection (IFI).Its value in comparison to blood culture is not yet established in neonates. Aim primary aim is to study the value of 1,3 β-D-Glucan in comparison with culture on Sabouraud dextrose agar in diagnosis of IFI, Secondary aim is to study the prevalence of IFI in preterm neonates. Subjects and methods a prospective observational study carried on 75 non-exclusively breast fed preterm neonates ≤34 weeks gestational age. Tollner and Rodwell sepsis scores, SNAPII and blood culture were done to all neonates initially and on day 10&amp;17 of life. 1,3 β-D-Glucan was done for all neonates on day 10 of life. Results fungal growth was found in 9.3% of included preterm neonates.1,3β-D-Glucan was higher in culture proven fungal sepsis compared to culture proven bacterial sepsis and culture negative preterm neonates (83.28±26.22 pg\ µl, 51.42±16.71 pg\ µl, 43.07±12.87 pg\ µl respectively). 1,3 β-D-Glucan was related to Tollner (r = 0.286,p=0.013), Rodwell (r = 0.317,p=0.006) sepsis scores and to SNAPII score (r = 0.331,p=0.04). Its cut off point for diagnosis of IFI is 79pg\µl with sensitivity of 71% and specificity of 98%. Conclusion 1,3β-D-Glucan is an easy, rapid and specific marker for diagnosis of IFI in neonates. Further studies are needed to evaluate it as a therapeutic monitoring for IFI.

Human Brucellosis: Methods of Diagnosis and Risk Factors among Egyptian Patients admitted at Assiut Fever Hospital .

Background: Human brucellosis, a common zoonotic disease, is major public health problem in many countries worldwide including Egypt. Objectives: To define brucellosis patients’ risk-factors and to assess diagnostic lab methods of brucellosis at Assiut Fever Hospital. Patients and Methods: The study recruited 98 patients with brucellosis and an equal number of controls. All participants were subjected to interview, clinical examination, and lab investigations. Results: Older age, males, rural residence, low socioeconomic status were significant risk-factors (OR=3.76, 2.04, 2.86, 2.72; respectively). Occupations had animals’ contact were significant risk-factor (OR=4.7); the most risky were butchers/slaughter workers (OR=8.0) and farmers/dairy workers (OR=3.59). Longer occupational exposure was risk-factor (OR=15.57). The main significant presenting symptoms were fever and muscloskeletal affections. The main significant signs were high temperature and hepato- and spleno-megaly. Standard agglutination test (SAT) titer 1/320 was the cut-off point for diagnosis and significantly lies in area under the ROC curve, sensitivity=96.4% and specificity=100.0%. Blood culture was positive in 58.2% of cases with no significant differences between SAT titer and blood culture positivity. ELISA IgM and IgG results were positive in 69.4% and 65.3% of the cases with no significant differences between SAT titer and IgM and IgG results. Conclusions: Human brucellosis has many preventable risk-factors; its diagnosis depends mainly on presence of risk-factors, clinically suspected, and SAT titer ≥1/320.

Reduction of FXIII during myelosuppression in acute leukemia after chemotherapy and adverse relation with bleeding events

目的探讨急性白血病患者化疗后骨髓抑制期外周血凝血因子XIII（FXIII）浓度与出血事件的关系。方法纳入2017年8月至2018年3月期间55例PLT<50×109/L的化疗后骨髓抑制期急性白血病患者（非急性早幼粒细胞性急性髓系白血病35例，急性淋巴细胞白血病20例），以35例非血液疾病患者作为对照组。用ELISA方法检测外周血FXIII浓度，分析急性白血病患者化疗后骨髓抑制期外周血FXIII水平与出血事件的关系。结果急性白血病患者化疗后骨髓抑制期FXIII水平明显低于对照组（P<0.001），FXIII水平与出血评分呈负相关（Spearman相关系数为-0.761）。当FXIII浓度的临界值为103.9 µg/L时，诊断化疗后骨髓抑制期急性白血病患者出血的敏感性为0.939，特异性为0.909。结论化疗后骨髓抑制期急性白血病患者外周血FXIII水平减低，且与出血事件及严重程度呈负相关，是急性白血病化疗后骨髓抑制期患者出血的独立影响因素之一。

Serum microRNA-135a as a diagnostic biomarker in non-small cell lung cancer.

The purpose of our research was to evaluate diagnostic performance of serum microRNA-135a (miR-135a) in non-small cell lung cancer (NSCLC).Quantitative real time-polymerase chain reaction was employed to detect the expression serum of miR-135a in NSCLC patients and controls. The influence of serum miR-135a level on clinical characteristics of NSCLC patients was explored through the Chi-square test. Serum carcinoembryonic antigen (CEA) level was estimated via enzyme-linked immunosorbent assay. Receiver operating characteristic (ROC) curve was plotted to elucidate diagnostic roles of serum miR-135a and CEA in NSCLC.The expression level of serum miR-135a was significantly lower in NSCLC patients than in healthy controls (0.40 ± 0.29 vs 1.00 ± 0.40, P < .001). Moreover, miR-135a expression was related to lymph node metastasis (P = .021), tumor differentiation (P = .020), and tumor node metastasis stage (P = .031). ROC curve showed serum miR-135a level could discriminate NSCLC patients from healthy controls (P < .0001) with a corresponding cutoff value of 0.665, and a sensitivity and specificity of 81.3% and 83.1%, respectively. The area under the curve was 0.888. In diagnosis analysis on the combination of miR-135a and CEA, when its specificity was maintained at 90%, diagnosis cut-off point reached 0.678.Serum miR-135a level is significantly downregulated in NSCLC and serves as a potential diagnostic biomarker for the disease.

P3104Complementary impact of glycated haemoglobin and B-natriuretic peptide on cardiopulmonary exercise capacity in patients with ischemic heart disease

Abstract Background Glycemic control, even in non-diabetes mellitus (DM) patients, has been associated with ventilation pump inefficiency leading to an impaired aerobic capacity. Brain natriuretic peptide (BNP) levels have also been correlated with exercise capacity, particularly in patients with heart failure. Purpose Assess the complementary impact of glycated haemoglobin (HbA1c) and BNP levels on cardiopulmonary exercise capacity in patients with ischemic heart disease (IHD). Methods Retrospecive cohort of 91 consecutive patients (57±10 years, 90% men; 29% type 2 DM) who underwent a cardiopulmonary exercise testing (CPX) at the beginning of an standard phase-II cardiac rehabilitation program, 2–3 months after an acute coronary syndrome. Results HbA1c and BNP levels correlated with peak oxygen uptake (VO2), anaerobic threshold (AT) and pulse O2 trajectory (Table). HbA1c correlated with ventilation CPX parameters (Table) and independently predicted minute ventilation (VE) and tidal volume (VT), regardless of age, waist circumference and β-blocker therapy. BNP levels correlated with echocardiographic (LVEF, left atrium size and pulmonary artery systolic pressure) and ventilation-perfusion (V/Q) mismatch parameters (Table), and independently predicted VE/VCO2-slope (P=0.037) regardless of age, echocardiographic parameters and β-blocker therapy. Patients were divided into three groups according to HbA1c levels above or below the DM diagnosis cut-off point (6.5%) and median value of BNP levels (44.6 pg/mL). VO2 and AT significantly decreased with elevated HbA1c and/or BNP levels (Figure). CPX parameters HbA1c (%) BNP (pg/mL) r P value r P value Peak VO2 (mL/min/kg) −0.421 &lt;0.001 −0.295 0.005 VO2 at AT (mL/min/kg) −0.352 0.001 −0.271 0.009 O2 pulse trajectory (mL/beat) −0.345 0.001 −0.235 0.025 Minute ventilation (VE) (L/min)* −0.377 &lt;0.001 – NS Tidal volume (VT) (L)* −0.348 0.001 – NS VE/VCO2-slope – NS 0.375 &lt;0.001 PETCO2 at AT (mmHg) – NS −0.315 0.002 HR/VO2-slope – NS 0.307 0.003 *At peak exercise. NS: Non-significant. Conclusions HbA1c and BNP levels were associated with a reduced cardiopulmonary capacity in IHD patients, mediated by a ventilation impairment and a ventilation-perfusion mismatching, respectively. HbA1c and BNP are independent and additive predictors of cardiopulmonary capacity.

99mTc-MAG3 diuresis renography in differentiating renal obstruction: Using statistical parameters as new quantifiable indices

ObjectiveThe aim of this study was to research, develop and assess the feasibility of using basic statistical parameters derived from renogram, “mean count value (MeanCV) and “median count value (MedianCV)”, as novel indices in the diagnosis of renal obstruction through diuresis renography. Subjects and MethodsFirst, we re-digitalized and normalized 132 renograms from 74 patients in order to derive the MeanCV and MedianCV. To improve the performance of the parameters, we extrapolated renograms by a two-compartmental modeling. After that, the cutoff points for diagnosis using each modified parameter were set and the sensitivity and specificity were calculated in order to determine the best variants of MeanCV and MedianCV that could differentiate renal obstruction status into 3 distinct classes – i) unobstructed, ii) slightly obstructed, and iii) heavily obstructed. ResultsThe modified MeanCV and MedianCV derived from extended renograms predicted the severity of the renal obstruction. The most appropriate variants of MeanCV and MedianCV were found to be the MeanCV50 and the MedianCV60. The cutoff points of MeanCV50 in separating unobstructed and obstructed classes as well as slightly and heavily obstructed classes were 0.50 and 0.72, respectively. The cutoff points of MedianCV60 in separating unobstructed and obstructed classes as well as slightly and heavily obstructed classes were 0.35 and 0.69, respectively. Notably, MeanCV50 and MedianCV60 were not significantly influenced by either age or gender. ConclusionsThe MeanCV50 and the MedianCV60 derived from a renogram could be incorporated with other quantifiable parameters to form a system that could provide a highly accurate diagnosis of renal obstructions.

SAS score: Targeting high-specificity for efficient population-wide monitoring of obstructive sleep apnea.

ProposalThis paper investigates a novel screening tool for Obstructive Sleep Apnea Syndrome (OSAS), which aims at efficient population-wide monitoring. To this end, we introduce SASscore which provides better OSAS prediction specificity while maintaining a high sensitivity.MethodsWe process a cohort of 2595 patients from 4 sleep laboratories in Western Romania, by recording over 100 sleep, breathing, and anthropometric measurements per patient; using this data, we compare our SASscore with state of the art scores STOP-Bang and NoSAS through area under curve (AUC), sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV). We also evaluate the performance of SASscore by considering different Apnea–Hypopnea Index (AHI) diagnosis cut-off points and show that custom refinements are possible by changing the score’s threshold.ResultsSASscore takes decimal values within the interval (2, 7) and varies linearly with AHI; it is based on standardized measures for BMI, neck circumference, systolic blood pressure and Epworth score. By applying the STOP-Bang and NoSAS questionnaires, as well as the SASscore on the patient cohort, we respectively obtain the AUC values of 0.69 (95% CI 0.66-0.73, p < 0.001), 0.66 (95% CI 0.63-0.68, p < 0.001), and 0.73 (95% CI 0.71-0.75, p < 0.001), with sensitivities values of 0.968, 0.901, 0.829, and specificity values of 0.149, 0.294, 0.359, respectively. Additionally, we cross-validate our score with a second independent cohort of 231 patients confirming the high specificity and good sensitivity of our score. When raising SASscore’s diagnosis cut-off point from 3 to 3.7, both sensitivity and specificity become roughly 0.6.ConclusionsIn comparison with the existing scores, SASscore is a more appropriate screening tool for monitoring large populations, due to its improved specificity. Our score can be tailored to increase either sensitivity or specificity, while balancing the AUC value.

Opportunistic screening for osteoporosis in abdominal computed tomography for Chinese population.

The suspicion for osteoporosis can be raised in diagnostic computed tomography of the abdomen performed for other indications. We derived cutoff thresholds for the attenuation value of the lumbar spinal vertebrae (L1-5) in Hounsfield units (HU) in a Chinese patient population to facilitate implementation of opportunistic screening in radiologists. We included 109 Chinese patients who concomitantly underwent abdominal CT and dual X-ray absorptiometry (DXA) within 6months between July 2014 and July 2017 at a university hospital in Hong Kong. Images were retrospectively reviewed on sagittal reformats, and region-of-interest (ROI) markers were placed on the anterior portion of each of the L1-L5 vertebra to measure the HU. The mean values of CT HU were then compared with the bone mineral density (BMD) and T-score obtained by DXA. Receiver operator characteristic (ROC) curves were generated to determine diagnostic cutoff thresholds and their sensitivity and specificity values. The mean CT HU differed significantly (p < 0.01) for the three DXA-defined BMD categories of osteoporosis (97HU), of osteopenia (135HU), and of normal individuals (230HU). There was good correlation between the mean CT HU and BMD and T-score (Pearson coefficient of 0.62 and 0.61, respectively, p < 0.001). The optimal cutoff point for exclusion of osteoporosis or osteopenia was HU ≥ 175 with negative predictive value as 98.9% and with area under curve (AUC) of ROC curve as 0.97. The optimal cutoff point for diagnosis of osteoporosis was HU ≤ 136 with positive predictive value as 81.2% and with AUC of ROC curve as 0.86. This is the first study on osteoporosis diagnosis with routine CT abdominal scans in Chinese population. The cutoff values were comparable with previous studies in Caucasian populations suggesting generalizability. Radiologists should consider routinely reporting these opportunistic findings to facilitate early detection and treatment of osteoporosis to prevent fractures and related complications.

Serum markers for asymptomatic atherosclerosis in Egyptian psoriatic patients: study controlled by Doppler estimation of carotid intima-media thickness.

BackgroundThe aim of the study was to measure serum levels of endocan, myeloperoxidase (MPO), pentraxin 3 (PTX3) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) in psoriatic patients and to study their correlations with carotid intima-media thickness (CIMT) in trial to evaluate predictability of these parameters in diagnosing asymptomatic atherosclerosis (AAS).Patients and methodsSeventy-five psoriasis patients and 75 control subjects underwent complete clinical examination and Doppler estimation of CIMT using thickness of 0.9 mm as cutoff point for diagnosis of AAS. Blood samples were collected for determination of fasting blood glucose, lipid profile and serum C-reactive protein (CRP), endocan, MPO, PTX3 and 1,25(OH)2D3.ResultsEstimated blood low-density lipoprotein cholesterol (LDL-c) and serum CRP, PTX3, MPO and endocan levels were significantly higher, while blood high-density lipoprotein cholesterol (HDL-c) and serum 1,25(OH)2D3 levels were significantly lower in patients than in controls. CIMT showed significant positive correlation with disease severity and duration; patients’ age; and endocan, MPO, LDL-c, PTX3 and CRP levels, and significant negative correlation with HDL-c and 1,25(OH)2D3 levels. Regression analysis defined high serum endocan and MPO, low serum 1,25(OH)2D3 and increased disease severity as significant predictors of high CIMT.ConclusionElevated serum levels of endocan and MPO and low 1,25(OH)2D3 levels may underlie the development of psoriasis-related cardiac manifestations. Elevated serum endocan and low 1,25(OH)2D3 levels could be used as early predictors of increased CIMT, which is a pathognomonic feature of AAS.

Selection of clinical diagnosic cut point of HbA1C in Chongming rural areas of Shanghai

Objective To investigate the optimal HbA1C threshold to be used for the diagnosis of diabetes mellitus in Chongming rural area, and further to evaluate the optimal HbA1C cutoff values in different age stratifications and body mass index classifications. Methods Data from 9, 981 individuals aged greater than 40 years who participated in a population-based cross-sectional survey in Shanghai, China, were analyzed. A 2 h 75 g oral glucose tolerance test(OGTT)value was used to diagnose diabetes. The performance of HbA1C was evaluated against the results of the OGTTs by using receiver operating characteristic(ROC)curve analysis. Results At the optimal HbA1C cutoff point of 6.15% for newly diagnosed diabetes, sensitivity was 69.73%, and specificity was 89.71%. The optimal HbA1C cutoff points for diabetes were 6.05% in subject with age less than 60 years(sensitivity was 72.88%, and specificity was 90.25%), and 6.25% in subjects with age≥60 years(sensitivity was 70.89%, and specificity was 92.34%). The optimal HbA1C cutoff points for diabetes were 6.05% in normal-weight(with sensitivity 70.94%, and specificity 89.93%), 6.25% in overweight(with sensitivity 70.21%, and specificity 90.32%), and 6.35% in obese population(with sensitivity 72.33%, and specificity 92.75%). Conclusion An HbA1C threshold of 6.15% was highly specific for detecting undiagnosed diabetes. The HbA1C diagnosis cutoff point can be affected by age and overweight/obesity status. (Chin J Endocrinol Metab, 2018, 34: 223-227) Key words: Diabetes mellitus; HbA1C; Obesity; Age

Optimal Glycated Hemoglobin Cutoff Point for Diagnosis of Type 2 Diabetes in Iranian Adults

The aim of this study was to evaluate the capability of glycated hemoglobin (A1C) levels to be a tool for identifying Iranian adults with diabetes and prediabetes. In a cross-sectional population-based study, 1,813 adults, men and women 35 to 75 years of age and without a history of diabetes and hemoglobinopathies, were included. Fasting blood glucose and A1C levels were obtained. According to the criteria of the American Diabetes Association, participants were categorized into 3 groups: newly diagnosed diabetes, prediabetes and healthy subjects. The optimal cutoff point for A1C in diabetes and prediabetes diagnosis was determined by studying the sensitivity and specificity of different cutoff points for A1C, while using different levels of fasting blood glucose as the gold standard. Participants with newly diagnosed diabetes were significantly older than subjects with prediabetes and healthy subjects (mean [± SD] 47.3±12.9, 44.6±13.0 and 39.2±14.1 years, respectively) and also had higher body mass indexes. As expected, the levels of fasting blood glucose (8.79±2.24, 6.01±0.38 and 4.97±0.4 mmol/L) and A1C (6.55±1.4%, 5.61±0.61% and 5.28±0.59%) were significantly different in the groups (p<0.001). The optimal cutoff point for A1C to predict prediabetes was 5.5% (sensitivity of 60.5% and specificity of 63.1%) and for diabetes was 5.9% (sensitivity of 66.7% and specificity of 81.2%). ADA cutoff points for prediabetes and diabetes detection yielded a sensitivity of 45.2% and 39.8%, respectively. The findings suggest the necessity of determining the A1C cutoffs for detecting diabetes or prediabetes in each region's population. They also suggest that the combination of these A1C cutoffs with fasting blood glucose levels are required to determine diabetes and prediabetes more accurately.

Biomarkers, myocardial fibrosis and co-morbidities in heart failure with preserved ejection fraction: an overview.

The prevalence of heart failure with preserved ejection fraction (HFpEF) is steadily increasing. Its diagnosis remains difficult and controversial and relies mostly on non-invasive echocardiographic detection of left ventricular diastolic dysfunction and elevated filling pressures. The large phenotypic heterogeneity of HFpEF from pathophysiologic al underpinnings to clinical manifestations presents a major obstacle to the development of new therapies targeted towards specific HF phenotypes. Recent studies suggest that natriuretic peptides have the potential to improve the diagnosis of early HFpEF, but they still have significant limitations, and the cut-off points for diagnosis and prognosis in HFpEF remain open to debate. The purpose of this review is to present potential targets of intervention in patients with HFpEF, starting with myocardial fibrosis and methods of its detection. In addition, co-morbidities are discussed as a means to treat HFpEF according to cut-points of biomarkers that are different from usual. Biomarkers and approaches to co-morbidities may be able to tailor therapies according to patients’ pathophysiological needs. Recently, soluble source of tumorigenicity 2 (sST2), growth differentiation factor 15 (GDF-15), galectin-3, and other cardiac markers have emerged, but evidence from large cohorts is still lacking. Furthermore, the field of miRNA is a very promising area of research, and further exploration of miRNA may offer diagnostic and prognostic applications and insight into the pathology, pointing to new phenotype-specific therapeutic targets.

Evaluation of the cardiac function in patients with breast cancer before and after receiving anthracycline by three-dimensional speckle tracking imaging

Objective To probe the clinical value of three-dimensional speckle tracking echocardiography in evaluating the early ventricular myocardial dysfunction in breast cancer patients treated with anthracycline. Methods A group of 40 breast cancer postoperative patients were received a epirubicin-based chemotherapy. Conventional and 3D dynamic echocardiography were measured before chemotherapy and 2 cycles and 4 cycles after chemotherapy during 24 hours, and to compare the change of the parameters before and after the chemotherapy. Results Left ventricular global area strain(LVGAS), left ventricular global longitudinal strain(LVGLS), right ventricular global longitudinal strain(RVGLS), right ventricular global circular strain(RVGCS) and right ventricular global radial strain(RVGRS) were significantly lower after the chemotherapy than those before the chemotherapy, and negatively correlated to cumulative anthracycline dose, in which the area under the ROC curve of LVGAS was 0.897(P=0.000). If -30.55% was selected as the diagnosis cut-off point, the sensitivity was 0.857, and the specificity was 0.917; some of right ventricular strain parameters were earlier than those of the left. Conclusions 3D-STI is useful to find the early left and right ventricular myocardial dysfunction in breast cancer patients treated with anthracycline and early access the subclinical cardiactoxicity, and right ventricular dysfunction may emerge earlier than the left, which can provide diagnosis basis to intervene timely for the clinical. Key words: Echocardiography, three-dimensional; Anthracycline; Breast neoplasms; Ventricular function; Speckle tracking image