Higher Cut-off Point Research Articles

The ability of NT-proBNP to detect chronic heart failure and predict all-cause mortality is higher in elderly Chinese coronary artery disease patients with chronic kidney disease

ObjectiveTo analyze the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) and renal function, and compare the ability and cut-off thresholds of NT-proBNP to detect chronic heart failure (CHF) and predict mortality in elderly Chinese coronary artery disease (CAD) patients with and without chronic kidney disease (CKD).MethodsThe study included 999 CAD patients older than 60 years. The endpoint was all-cause mortality over a mean follow-up period of 417 days.ResultsThe median age was 86 years (range: 60–104 years), and the median NT-proBNP level was 409.8 pg/mL. CKD was present in 358 patients. Three hundred and six patients were positive for CHF. One hundred and ten CKD patients and 105 non-CKD patients died. Not only CKD, but also estimated glomerular filtration rate independently affected NT-proBNP. NT-proBNP detected CHF with a cut-off value of 298.4 pg/mL in non-CKD patients and a cut-off value of 435.7 pg/mL in CKD patients. NT-proBNP predicted death with a cut-off value of 369.5 pg/mL in non-CKD patients and a cut-off value of 2584.1 pg/mL in CKD patients. The NT-proBNP level was significantly related to the prevalence of CHF and all-cause mortality in CAD patients with and without CKD; this effect persisted after adjustment. The crude and multiple adjusted hazard ratios of NT-proBNP to detect CHF and predict mortality were significantly higher in patients with CKD compared with the remainder of the population. The addition of NT-proBNP to the three-variable and six-variable models generated a significant increase in the C-statistic.ConclusionAmongst elderly Chinese CAD patients, there was an independently inverse association between NT-proBNP and renal function. With the higher cutoff points, NT-proBNP better detected CHF and better predicted mortality in CKD patients than in non-CKD patients.

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012

The Reliability and Validity of the Mini-Mental State Examination in the Elderly Croatian Population

Aim: The aim of this study was standardization and validation of the Mini-Mental State Examination (MMSE) in the general Croatian aging population. Methods: Three-hundred and forty-four participants underwent the MMSE test, 217 cognitively healthy subjects without neurological and psychiatric disorders and 127 patients with mild cognitive impairment (MCI) or dementia. Results: The optimal cutoff point for screening of the general Croatian population (cognitively healthy vs. MCI and dementia) is 26/27; in the Croatian population aged ≥65 years, the cutoff point is 24/25, whereas for screening of highly educated persons (≥14 years of education) aged ≥65 years a higher cutoff point should be used (26/27). Conclusions: MMSE results when standardized and validated in a certain population might better contribute to recognition of the individuals at risk that should be directed to dementia outpatient clinics.

¿Podemos utilizar la apolipoproteína B en la toma de decisiones para la intervención en el riesgo cardiovascular de pacientes con triglicéridos elevados?

ObjectiveTo analyse the predictive value of several approaches to cardiovascular risk prevention: measuring apolipoprotein B concentrations (apoB), estimation of fractionated LDL cholesterol (cLDLf) and non-HDL cholesterol (HDLc), to predict increases in LDL cholesterol. Material and MethodsCross-sectional multicentre study in which routine samples from 6094 consecutive patients were analysed. In each patient, LDLc was quantified by routine ultracentrifugation technique (LDLu) and apoB concentrations by a standard immunological method. We also estimated the LDLf and non-HDLc. The values obtained were used to analyse the predictive values of unfractionated LDL cholesterol (cLDLu) into three groups according to their triglyceride concentration (<200, between 200 and 400 and 400mg/dL) and risk groups as defined by the Adult Treatment Panel (ATP) III guidelines (LDL-C> 70, 100, 130 or 160mg/dL). Results and conclusionsWith all the variables analysed we obtained a good positive predictive value, which varied according to the triglyceride concentrations, with the highest values being obtained for apoB with high specificity cut-off points (AE). Calculations with LDLf values underestimate the patient's risk, while those using non-HDLc overestimate it. ConclusionThe Friedewald formula can be used practically without risk in patients with triglycerides below 200mg/dL. In patients with elevated triglycerides, apoB (AE cut-off points) is recommended as a positive predictor, and non-HDLc as a negative predictor.

Validation of the FIB4 index in a Japanese nonalcoholic fatty liver disease population

BackgroundA reliable and inexpensive noninvasive marker of hepatic fibrosis is required in patients with nonalcoholic fatty liver disease (NAFLD). FIB4 index (based on age, aspartate aminotransferase [AST] and alanine aminotransferase [ALT] levels, and platelet counts) is expected to be useful for evaluating hepatic fibrosis. We validated the performance of FIB4 index in a Japanese cohort with NAFLD.MethodsThe areas under the receiver operating characteristic curves (AUROC) for FIB4 and six other markers were compared, based on data from 576 biopsy-proven NAFLD patients. Advanced fibrosis was defined as stage 3-4 fibrosis. FIB4 index was assessed as: age (yr) × AST (IU/L)/(platelet count (109/L) × √ALT (IU/L))ResultsAdvanced fibrosis was found in 64 (11%) patients. The AUROC for FIB4 index was superior to those for the other scoring systems for differentiating between advanced and mild fibrosis. Only 6 of 308 patients with a FIB4 index below the proposed low cut-off point (< 1.45) were under-staged, giving a high negative predictive value of 98%. Twenty-eight of 59 patients with a FIB4 index above the high cut-off point (> 3.25) were over-staged, giving a low positive predictive value of 53%. Using these cutoffs, 91% of the 395 patients with FIB-4 values outside 1.45-3.25 would be correctly classified. Implementation of the FIB4 index in the Japanese population would avoid 58% of liver biopsies.ConclusionThe FIB4 index was superior to other tested noninvasive markers of fibrosis in Japanese patients with NAFLD, with a high negative predictive value for excluding advanced fibrosis. The small number of cases of advanced fibrosis in this cohort meant that this study had limited power for validating the high cut-off point.

A Carotenoid Health Index Based on Plasma Carotenoids and Health Outcomes

While there have been many studies on health outcomes that have included measurements of plasma carotenoids, this data has not been reviewed and assembled into a useful form. In this review sixty-two studies of plasma carotenoids and health outcomes, mostly prospective cohort studies or population-based case-control studies, are analyzed together to establish a carotenoid health index. Five cutoff points are established across the percentiles of carotenoid concentrations in populations, from the tenth to ninetieth percentile. The cutoff points (mean ± standard error of the mean) are 1.11 ± 0.08, 1.47 ± 0.08, 1.89 ± 0.08, 2.52 ± 0.13, and 3.07 ± 0.20 µM. For all cause mortality there seems to be a low threshold effect with protection above every cutoff point but the lowest. But for metabolic syndrome and cancer outcomes there tends to be significant positive health outcomes only above the higher cutoff points, perhaps as a triage effect. Based on this data a carotenoid health index is proposed with risk categories as follows: very high risk: <1 µM, high risk: 1-1.5 µM, moderate risk: 1.5-2.5 µM, low risk: 2.5-4 µM, and very low risk: >4 µM. Over 95 percent of the USA population falls into the moderate or high risk category of the carotenoid health index.

Use of reagent test strips for diagnosis of endometritis in dairy cows

The use of leukocyte esterase (LE), protein, and pH tests were evaluated on widely available urinary test strips (Multistix 10 SG; Bayer Corporation, Elkart, IN, USA) on uterine lavage samples as a potential cow-side test for the diagnosis of cytologic endometritis. Uterine lavage samples of 563 lactating Holstein cows between 40 and 60 days postpartum from 28 herds were evaluated. Endometrial cytology was used as the reference for endometritis, with a cutoff point of ≥10% neutrophils. All three (LE, protein, and pH) were increased in cows with cytologic endometritis and the associations were highly significant. Optimal cutoff points determined by receiver operating characteristic analysis for LE, protein, and pH were ≥++, ≥300 mg/dL, and ≥7.0, respectively. Combining the results for LE and pH improved the performance of the test strip, but this resulted in a group of cows (20.6% of cows) which were approximately equally likely (46% with endometritis and 54% without endometritis) to have cytologic endometritis or not, and therefore could not be accurately classified. The direct relationship between reagent strip test and reproductive performance was also evaluated. Reproductive impairment due to endometritis was restricted to multiparous cows; significantly decreased reproductive performance was observed for multiparous cows with lavage fluid LE ≥+++ (154 vs. 115 median days not-pregnant), as well as cows with pH ≥ 7.0 (150.5 vs. 111.5 median days not-pregnant), but not in cows with high protein, even at the highest cutoff point. In conclusion, reagent strip test results were strongly associated with cytologic endometritis and reproductive impairment; however, in comparison with conventional cytology, the performance of reagent strip as an alternative test was relatively poor and may require further refinement.

Prevalence of metabolic syndrome in Murcia Region, a southern European Mediterranean area with low cardiovascular risk and high obesity

BackgroundMetabolic syndrome (MS) is associated with subsequent appearance of diabetes and cardiovascular disease. As compared to other Spanish regions, Murcia (southern Spain) registers increased obesity as well as cardiovascular morbidity and mortality. The aim of this study was to assess the prevalence of MS and its components, awareness of obesity as a health risk and associated lifestyles.MethodsA population-based, cross-sectional study was conducted in 2003, covering a sample of 1555 individuals 20 years and over. MS was defined according to the Revised National Cholesterol Education Program Adult Treatment Panel III (R-ATPIII), International Diabetes Federation (IDF) and Joint Interim Statement (JIS) criteria. Both low (94/80) and high (102/88) waist circumference (WC) thresholds were considered.ResultsPrevalence of MS was 27.2% (95%CI: 25.2-29.2), 32.2% (95%CI: 30.1-34.3) and 33.2% (95%CI: 31.2-35.3) according to the R-ATPIII, IDF and JIS94/80 respectively. It increased with age until reaching 52.6% (R-ATPIII) or 60.3% (JIS94/80) among persons aged 70 years and over, and was higher in persons with little or no formal education (51.7% R-ATPIII, 57.3% JIS94/80). The most common risk factors were hypertension (46.6%) and central obesity (40.7% and 66.1% according to high and low WC cut-off points respectively). Although most persons were aware that obesity increased health risks, regular exercise was very unusual (13.0% centrally obese, 27.2% non-centrally obese). Adherence to dietary recommendations was similar among centrally obese and non-centrally obese subjects.ConclusionsPrevalence of MS is high in our population, is comparable to that found in northern Europe and varies with the definition used. Adherence to preventive recommendations and to adequate weight promotion is very low. In the absence of a specific treatment for MS, integrated intervention based on a sustained increase in physical activity and changes in diet should be reinforced.

Predicting Acute Ischaemic Stroke Outcome Using Clinical and Temporal Thresholds

Background. Few studies have analysed the natural course of cerebral ischaemia for predicting outcome. We aimed to determine the early clinical findings and the thresholds for deficit severity and symptom duration that make it possible to stratify outcome. Methods. We included 154 patients with transient ischaemic attack or ischaemic stroke. Stroke profiles and neurological status were assessed from onset to 24 hrs, on admission, at 48 hrs, and at discharge. Outcomes were evaluated using the modified Rankin Scale. Positive and negative predictive values were calculated for the different thresholds. The model was subsequently evaluated on a new prospective cohort of 157 patients. Results. Initial National Institute of Health Stroke Scale (NIHSS) score <5 and symptoms regressing within 135 min were predictive of good outcome. Initial NIHSS score >22 and symptom stability after 1,230 min were predictive of physical dependency or death. Conclusions. Low and high NIHSS cut-off points are effective positive predictive values for good and poor outcomes. Thresholds for symptom duration are less conclusive.

Prevalence of the metabolic syndrome in Luxembourg according to the Joint Interim Statement definition estimated from the ORISCAV-LUX study

BackgroundThe prevalence of the metabolic syndrome (MS) has been determined in many countries worldwide but never in Luxembourg. This research aimed to 1) establish the gender- and age-specific prevalence of MS and its components in the general adult population of Luxembourg, according to the most recent Joint Interim Statement (JIS) definition, by using both the high and low cut-off points to define abdominal obesity, and 2) compare and assess the degree of agreement with the Revised National Cholesterol Education Programme-Adult Treatment Panel III (R-ATPIII) and the International Diabetes Federation (IDF) definitions.MethodsA representative stratified random sample of 1349 European subjects, aged 18-69 years, participated to ORISCAV-LUX survey. Logistic regression and odds ratios (OR) were used to study MS prevalence with respect to gender and age. The Framingham risk score (FRS) to predict the 10-year coronary heart disease (CHD) risk was calculated to compare the proportion of MS cases below or above 20%, according to both high and low waist circumference (WC) thresholds. Cohen's kappa coefficient (κ) was utilized to measure the degree of agreement between MS definitions.ResultsThe prevalence of the MS defined by the JIS was 28.0% and 24.7% when using the low (94/80) and the high (102/88) WC cut-off points, respectively. The prevalence was significantly higher in men than in women (OR = 2.6 and 2.3 for the low and high WC thresholds), as were all components of the MS except abdominal obesity measured by both thresholds. It also increased with age (OR values in age categories ranging from 2.7 to 28 when compared to the younger subjects for low WC and from 3.3 to 31 for the high WC cut-offs). The 10-year predicted risk of CHD by FRS did not depend on the threshold used. Globally, excellent agreement was observed between the three definitions of MS (κ= 0.89), in particular between JIS and IDF (κ = 0.93). Agreement was significantly higher in women than in men, and differed between age groups.ConclusionRegardless of the definition used, the adult population of Luxembourg reveals a high MS prevalence. Our findings contribute to build evidence regarding the definitive construct of the MS, to help selecting the waist circumference thresholds for Europid populations, and to support the need to revise the guidelines for abdominal obesity levels.

Early survival and duration of hospital admission in rhabdomyolysis: ICNARC Case Mix Programme Database

New therapeutic measures are available for the management of rhabdomyolysis. To enable the design of future studies that will assess the clinical benefi t of these interventions, we sought to fi rst determine the current clinical outcomes of patients with rhabdomyolysis admitted to ICUs within England, Wales and Northern Ireland. We describe the duration of intensive care and hospital admissions associated with rhabdomyolysis, and the early survival measures for this population. Acute kidney injury secondary to high serum myoglobin levels is a frequent cause of morbidity and mortality for patients with rhabdomyolysis [1]. Th eoretically the severity and duration of the tubulointerstitial lesion that results could be reduced if rapid removal of myoglobin from the circulation was undertaken to reduce the tubules’ exposure to myoglobin [2]. Recent case reports have highlighted that dialysis membranes with high molecular weight cut-off points (50 kDa) are able to provide signifi cantly higher clearance rates of myoglobin compared with standard high-fl ux dialysis membranes [3,4]. To determine the clinical benefi t of providing rapid removal of myoglobin in patients with rhabdomyolysis, randomised controlled trials are now required to determine whether the procedure improves outcomes compared with standard care. Possible clinical outcomes for these studies would be the duration of hospital stay, rates of renal recovery and survival. To allow the design of these studies, current clinical outcomes for this population are required. We therefore interrogated a national database to determine the clinical outcomes for patients with rhabdomyolysis admitted to ICUs. Th e Case Mix Programme is the national clinical audit of adult, general critical care units in England, Wales and

Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

BackgroundHyaluronic acid (HA) serum levels correlate with the histological stages of liver fibrosis in hepatitis C virus (HCV) monoinfected patients, and HA alone has shown very good diagnostic accuracy as a non-invasive assessment of fibrosis and cirrhosis. The aim of this study was to evaluate serum HA levels as a simple non-invasive diagnostic test to predict hepatic fibrosis in HIV/HCV-coinfected patients and to compare its diagnostic performance with other previously published simple non-invasive indexes consisting of routine parameters (HGM-1, HGM-2, Forns, APRI, and FIB-4).MethodsWe carried out a cross-sectional study on 201 patients who all underwent liver biopsies and had not previously received interferon therapy. Liver fibrosis was determined via METAVIR score. The diagnostic accuracy of HA was assessed by area under the receiver operating characteristic curves (AUROCs).ResultsThe distribution of liver fibrosis in our cohort was 58.2% with significant fibrosis (F≥2), 31.8% with advanced fibrosis (F≥3), and 11.4% with cirrhosis (F4). Values for the AUROC of HA levels corresponding to significant fibrosis (F≥2), advanced fibrosis (F≥3) and cirrhosis (F4) were 0.676, 0.772, and 0.863, respectively. The AUROC values for HA were similar to those for HGM-1, HGM-2, FIB-4, APRI, and Forns indexes. The best diagnostic accuracy of HA was found for the diagnosis of cirrhosis (F4): the value of HA at the low cut-off (1182 ng/mL) excluded cirrhosis (F4) with a negative predictive value of 99% and at the high cut-off (2400 ng/mL) confirmed cirrhosis (F4) with a positive predictive value of 55%. By utilizing these low and high cut-off points for cirrhosis, biopsies could have theoretically been avoided in 52.2% (111/201) of the patients.ConclusionsThe diagnostic accuracy of serum HA levels increases gradually with the hepatic fibrosis stage. However, HA is better than other simple non-invasive indexes using parameters easily available in routine clinical practice only for the diagnosing of cirrhosis.

Paraguay’s Tekoporã programme for cash transfers: Debating targeting methods for beneficiaries

This article analyses alternative targeting methods for Paraguay’s conditional cash transfer programme, Tekoporã. The major practical choice is currently between a multidimensional quality-of-life index, which has been used since the programme started, and a proxy means test. This note evaluates the relative performance of these two alternatives. The simulations conducted herein suggest that changing the targeting mechanism from the quality-of-life index to proxy means does not offer any gains in either the efficiency or the efficacy of the programme. If the intention of policymakers is to improve efficacy in reaching the poor, then maintaining the current targeting mechanism with a higher cut-off point is the best option. If the intention is to alleviate extreme poverty, the most efficient impact is also given by the quality-of-life index, but with a lower cut-off point. However, a higher threshold may provide a considerable gain in coverage without a substantial increase in leakage.

Usefulness of an index score as a predictor of hepatic fibrosis in obese patients undergoing bariatric surgery

To evaluate the usefulness of a non-invasive clinical score to predict liver fibrosis in the steatosis associated with morbid obesity. We included 88 patients, who underwent bariatric surgery in the Sanitary Area of León, Spain, and who showed a liver biopsy with steatosis greater than 5%. This is a retrospective study in which the rate of fibrosis is calculated from tests performed during the preoperative period, and is then compared to data from intraoperative hepatic biopsies. The analysis population was grouped according to the presence of advanced fibrosis in the liver biopsy (grade 3-4) or its absence (grade 0-2). The cutoff used for diagnosing advanced fibrosis was 0.676 (high cutoff point), and the cutoff point to exclude advanced fibrosis was -1.455 (low cutoff). The prevalence of advanced fibrosis in the histological samples was 5.5%, and 65.9% of patients had no fibrosis. The cutoff for a low negative predictive value was 100%, and sensitivity was 100%. The cutoff point for a high positive predictive value was 1.7%, and specificity was 31.3%. This scoring system for morbidly obese patients eligible for bariatric surgery allows to identify those without advanced fibrosis, but cannot predict who may have advanced fibrosis.

Hypoglycemia Rates in the First Days of Life among Term Infants Born to Diabetic Mothers

Objectives: To discover the risk factors for developing hypoglycemia in newborns born to diabetic mothers and to characterize the rates of glucose concentrations in the first two days of life. Methods: Retrospective recordings of medical charts of 576 healthy term infants of diabetic mothers during an 18-month period. We determined the following pre-feeding glucose concentrations: ‘normoglycemia’ (≥47 mg/dl = 2.6 mmol/l), ‘mild hypoglycemia’ (40–46 mg/dl = 2.2– 2.5 mmol/l), ‘moderate hypoglycemia’ (30–39 mg/dl = 1.7–2.1 mmol/l) and ‘severe hypoglycemia’ (<30 mg/dl = 1.7 mmol/l). Results: Glucose concentrations below ‘normoglycemia’ and ‘severe hypoglycemia’ were observed in 280 (48.6%) and 23 (4%) of the infants, respectively. The main risk factors for developing glucose concentrations below ‘normoglycemia’ in the first day of life were large size for gestational age and maternal insulin-dependent diabetes mellitus. ‘Severe hypoglycemia’ was more common among infants born to mothers who needed insulin (either type A2 or insulin-dependent diabetes mellitus). Infants born to mothers with insulin-dependent diabetes mellitus were less mature, heavier, large for their gestational age and exhibited more ‘severe and moderate hypoglycemia’ in the first day of life as compared to infants born to diabetes type A1 and A2 mothers. In addition, infants who were large for gestational age tended to have more ‘moderate hypoglycemia’ when born to diabetes type A1 mothers compared to small and appropriate-for-gestational-age infants. Thirty infants (5%) still had hypoglycemia on the second day of life. This subgroup of infants did not differ with regard to maternal-type diabetes. Conclusions: Infants born to diabetic mothers tend to have a high rate of hypoglycemia on the first day of life when a relatively high cut-off point (≥47 mg/dl = 2.6 mmol/l) is used. Infants born large for gestational age as well as those born to mothers with juvenile diabetes mellitus are at higher risk and should be closely monitored.

Effectiveness of Rose Bengal test and fluorescence polarization assay in the diagnosis of Brucella spp. infections in free range cattle reared in endemic areas in Zambia

The effectiveness of Rose Bengal test (RBT) and fluorescence polarization assay (FPA) in diagnosing cattle brucellosis in endemic areas was assessed and RBT and FPA test agreement was compared (n = 319). The sensitivity of RBT and FPA in detecting low Brucella titres were evaluated in paired sera (n = 34). A logistic regression model was constructed to predict cattle test result in FPA using RBT as the main predictor and incorporating bio-data and animal history. There was 79.3% agreement between the RBT and FPA (Kappa = 0.59; Std error = 0.05; p = 0.000) and a high correspondence between high RBT scores and positive FPA results suggesting that sera with high RBT score may not require confirmation with tests such as competitive-ELISA or CFT. High FPA cut-off points were more likely to miss animals with low antibody titres. The RBT had a reduced ability in detecting low antibody titres compared to the FPA. FPA test interpretation was improved if a priori information, such as sex and age was used. Under the challenging disease surveillance conditions prevailing in rural Africa, field-testing methods that are sensitive and specific; allow single animal contact, low technical skills in data interpretation are suitable.

Validation of the NAFLD Fibrosis Score in a Chinese Population With Low Prevalence of Advanced Fibrosis

Nonalcoholic fatty liver disease (NAFLD) is increasing in prevalence worldwide. This study aimed to validate the NAFLD fibrosis score in the Chinese population. NAFLD patients were prospectively recruited for liver biopsy and blood tests. The NAFLD fibrosis score was calculated as -1.675 + 0.037 x age (yr) + 0.094 x BMI (kg/m(2)) + 1.13 x impaired fasting glucose/diabetes (yes = 1, no = 0) + 0.99 x AST/ALT ratio-0.013 x platelet (x10(9)/L)-0.66 x albumin (g/dL). Advanced fibrosis was defined as stage 3 to 4 fibrosis. One hundred sixty-two patients (age 46 +/- 10 yr, male 59%) were included in the study. Advanced fibrosis was found in 18 (11%) patients. Only 11 of 128 patients with the NAFLD fibrosis score below the proposed low cutoff point (<-1.455) were under-staged, resulting in a high negative predictive value of 91%. Only two patients exceeded the proposed high cutoff point (>0.676), but neither had advanced fibrosis. If the NAFLD fibrosis score was implemented in the Chinese population, 79% of liver biopsies could be avoided. The NAFLD fibrosis score has high negative predictive value in excluding advanced fibrosis in the Chinese population, and can reduce the burden of liver biopsy in the vast majority of cases. Since there were few cases of advanced fibrosis in this cohort, this study had limited power in validating the high cutoff point.

Body mass index, waist circumference and waist-to-hip ratio cut-off points for categorisation of obesity among Omani Arabs

There are no data on optimal cut-off points to classify obesity among Omani Arabs. The existing cut-off points were obtained from studies of European populations. To determine gender-specific optimal cut-off points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) associated with elevated prevalent cardiovascular disease (CVD) risk among Omani Arabs. A community-based cross-sectional study. The survey was conducted in the city of Nizwa in Oman in 2001. The study contained a probabilistic random sample of 1421 adults aged > or =20 years. Prevalent CVD risk was defined as the presence of at least two of the following three risk factors: hyperglycaemia, hypertension and dyslipidaemia. Logistic regression and receiver-operating characteristic (ROC) curve analyses were used to determine optimal cut-off points for BMI, WC and WHR in relation to the area under the curve (AUC), sensitivity and specificity. Over 87% of Omanis had at least one CVD risk factor (38% had hyperglycaemia, 19% hypertension and 34.5% had high total cholesterol). All three indices including BMI (AUC = 0.766), WC (AUC = 0.772) and WHR (AUC = 0.767) predicted prevalent CVD risk factors equally well. The optimal cut-off points for men and women respectively were 23.2 and 26.8 kg m-2 for BMI, 80.0 and 84.5 cm for WC, and 0.91 and 0.91 for WHR. To identify Omani subjects of Arab ethnicity at high risk of CVD, cut-off points lower than currently recommended for BMI, WC and WHR are needed for men while higher cut-off points are suggested for women.

High Cut-off Point Membranes in Septic Acute Renal Failure: A Systematic Review

To review the literature on the experimental, physiological and clinical effects of blood purification with high cut-off (HCO) point membranes in septic acute renal failure (ARF). MEDLINE and PubMed database search combining relevant terms and integrating data from studies on the use of HCO membranes. Ex vivo studies of endotoxemia, animal studies of bacteremia and clinical studies using HCO membranes in patients with septic ARF. Original data from primary publications. HCO membrane-based hemodialysis, hemodiafiltration or hemofiltration. Plasma cytokine clearance, immunological and physiological effects and safety parameters of HCO membranes. HCO membranes effectively remove cytokines from blood. Treatment using HCO membranes has beneficial effects on immune cell function and increases survival in animal models of sepsis. Preliminary clinical studies show that HCO membranes decrease plasma cytokine levels and the need for vasopressor therapy. HCO membrane-based blood purification has now been applied in four pilot randomized controlled studies of 70 patients with septic ARF with no reports of serious adverse effects. Because of substantial heterogeneity, no formal quantitative analysis could be performed. The available evidence on HCO blood purification justifies larger randomized controlled trials in patients with septic ARF.

Bone Metabolism and Endocrine Function in Children with Chronic Myeloid Leukemia (CML) Treated with Imatinib during Puberty.

Imatinib, a BCR-ABL tyrosine kinase inhibitor, is an effective treatment for adults and children with CML. However, the in vivo inhibition of the PDGF receptor and c-kit in normal cells may have clinical side effects: altered bone and mineral metabolism, reduction of testosterone and gynecomastia have been reported in adults treated with imatinib. To evaluate bone and mineral metabolism and puberal development, we studied 4 consecutive prepuberal patients (median age 10.6; range 9–12 years) with Ph+ CML treated with imatinib (340mg/sqm/day) in complete cytogenetic response. To evaluate puberal development we used the Tanner staging and serum concentrations of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), free testosterone (fT), inhibin-B, progesterone (P), 17a-hydroxyprogesterone (17a-OH-P) dihydrotestosterone (DHT), prolactin (Prl), growth hormone (GH), insulin-like growth factor-1 (IGF-1); to evaluate mineral metabolism, we tested osteocalcin levels, C-terminal telopeptides of type I collagen (CTX), parathyroid hormone (PTH), serum and urinary calcium, serum and urinary phosphate levels; bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DEXA). Table 1 reports the serum concentration results at different time points during treatment. The bone resorption marker CTX was up to 2.6 times over the highest reference interval for age matched normal boys and was accompanied by a reduction of BMD for chronologic age (mean z-score -1.3). The longitudinal growth, between the 50th and the 10th percentile before imatinib, slowed below the 10th percentile, although TSH, GH and IGF-1 were within the normal range. All males had progesterone and 17a-OH-P above the highest cut-off point and one (case 2) developed gynecomastia, pubertal delay, low BMD for chronologic age (z-score -2.9), serum calcium in the upper normal limits, urinary calcium higher than normal (896 mg/day, n.v. 100–300 mg/day), while serum PTH, 25-OH-D, urinary phosphate, BAP and osteocalcin were within the normal range. This patient during therapy presented an increase of FSH with a simultaneous decrease of inhibin-B; the decrease inhibin-B/FSH ratio is predictive of a spermatogenesis failure. In conclusion, the reduced BMD, the growth swiftness delay, gynecomastia and the inhibin-B/FSH ratio in our adolescents are probably due to imatinib. To better understand the safety profile of imatinib, it is important to investigate larger series of CML children treated with targeted therapies involving the PDGF receptor and c-kit.FSHLHTInhibin-BP17a-OH-PCTXAge(yrs)/Imatinib (mos)mlU/ml(1–14)mlU/ml(1.5–9.2)ng/ml(2.4–8.2)pg/ml(50–250)ng/dl(0.1–0.9)ng/dl(0.4–3.6)ng/ml(0.23–1.7)Case 1(male)13.9/204.141.6118311.92.5514.9/324.84.63.821771.074.63.5816.1/461.76.04.491032613.73.55Case 2(male)13.0/174.41.9<0.1770.590.491.8315.0/413.93.13.15571.572.94.4516.0/5313.41.53.4094.24.63.22Case 3(male)10.5/174.31.90.12800.720.551.3411.5/294.22.40.621591.122.31.4812.6/422.63.72.67691.523.22.35Case 4(female)11.5/1761.1<0.1390.260.421.9412.6/305.91.6<0.1510.50.351.7514.1/467.21.11.07230.750.681.62