High NPV Research Articles

Diagnostic performance of magnetic resonance imaging in preoperative local staging of rectal cancer after neoadjuvant chemoradiotherapy

This paper aims to investigate the diagnostic performance of magnetic resonance imaging (MRI) in predicting the pathologic stage of locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT) and the role of MRI in selecting patients with a pathologic complete response (ypCR). Restaging MRI (yMRI) examinations of 136 patients with LARC treated with neoadjuvant CRT followed by surgery were retrospectively analyzed by two radiologists. All examinations were performed on a 1.5 Tesla MRI machine with a pelvic phased-array coil. T2-weighted turbo spin-echo images and diffusion-weighted imaging were obtained. Histopathologic reports of the surgical specimens were the reference standard. The accuracy, sensitivity, specificity, positive and negative predictive values (PPV and NPV) of yMRI in predicting the pathologic T-stage (ypT), N-stage, and ypCR were calculated. The inter-observer agreement was evaluated using kappa statistics. The yMRI results showed 67% accuracy, 59% sensitivity, 80% specificity, 81% PPV, and 56% NPV in identifying ypT (ypT0-2 versus ypT3-4). In predicting the nodal status, the yMRI results revealed 63% accuracy, 60% sensitivity, 65% specificity, 47% PPV, and 75% NPV. In predicting ypCR, the yMRI results showed 84% accuracy, 20% sensitivity, 92% specificity, 23% PPV, and 90% NPV. The kappa statistics revealed substantial agreement between the two radiologists. Utilization of yMRI showed high specificity and PPV in predicting the tumor stage and high NPV in predicting the nodal stage; in addition, yMRI revealed moderate accuracy in the T and N classifications, mainly due to underestimating the tumor stage and overestimating the nodal status. Finally, yMRI revealed high specificity and NPV but low sensitivity in predicting the complete response.

PET/CT May Assist in Avoiding Pointless Thyroidectomy in Indeterminate Thyroid Nodules: A Narrative Review.

Indeterminate thyroid nodules (ITN) are commonly encountered among the general population, with a malignancy rate of 10 to 40%. However, many patients may be overtreated with futile surgery for benign ITN. To avoid unnecessary surgery, PET/CT scan is a possible alternative to help differentiate between benign and malignant ITN. In this narrative review, the major results and limitations of the most recent studies on PET/CT efficacy (from PET/CT visual assessment to quantitative PET parameters and recent radiomic features analysis) and on cost-effectiveness (compared to other alternatives (such as surgery)) are presented. PET/CT can reduce futile surgery with visual assessment (around 40%; if ITN ≥ 10 mm). Moreover, PET/CT conventional parameters and radiomic features extracted from PET/CT imaging can be associated together in a predictive model to rule out malignancy in ITN, with a high NPV (96%) when certain criteria are met. Even though promising results were obtained in these recent PET/CT studies, further studies are needed to enable PET/CT to become the definitive diagnostic tool once a thyroid nodule is identified as indeterminate.

A prospective observational study to assess serial salivary estriol measurements during third trimester of pregnancy as a marker for predicting spontaneous preterm labor in pregnant women

Introduction and Aim: Preterm labor is a matter of concern in developed and developing nations, rural and urban areas as well. In this context a relatively cheaper biochemical marker in a specimen which can be easily collected from pregnant women will be beneficial in rural areas. Hence, in this context salivary estriol was selected for studying its diagnostic potential. Materials and Methods: A prospective study was conducted in two sittings (1st sitting at 26 to 29 weeks and 2nd after 2-4 weeks of gestation) among pregnant women (n= 206) who attended T.D. Medical College for antenatal check-up. The salivary samples were collected and estriol (E3) assayed by ELISA. The pregnant women were followed up till delivery to know the type, as term (n=194) or preterm (n=12). MedCalc was used for statistical analysis. Results: Reference interval of increase in salivary E3 over a period of 2 - 4 weeks in pregnant women during 26 – 32 gestational weeks who delivered at term by nonparametric method was 16 to 1468 pg/ml. Gestational period wise reference intervals of salivary estriol at 26- 28, 29 – 30 and 31 to 32 weeks were 74-3227, 119 -3422 and 203-4346 pg/ml respectively. There was a statistically significant difference in the increase in salivary estriol among different time intervals (p=0.001). Diagnostic cut off values of single measurements of salivary E3 and increase in salivary estriol between 2-4 weeks were 492, 561 and 159 pg/ml without acceptable diagnostic accuracy. Conclusion: Serial rise in salivary estriol at 2-4 weeks interval can be utilized but not a single measurement to monitor fetoplacental wellbeing. The high NPV of serial rise in salivary estriol (E3) suggests its usefulness to exclude chances for preterm labor.

Predictive value and dynamic risk stratification of high sensitive basal or stimulated thyroglobulin assay in a long-term thyroid carcinoma cohort

PurposeTo evaluate the predictive value of the rhTSH thyroglobulin stimulation test (rhTSH-Tg) compared to basal high-sensitive thyroglobulin (hs-Tg) under TSH suppressive therapy at 12 months after the completion of initial treatment to predict the long-term response and Dynamic Risk Stratification (DRS) at the last follow-up visit in a long-term DTC cohort.MethodsProspective study in 114 DTC patients (77.2% women, mean age 46.4 ± 14.1 years old, median/IQR evolution 6.7[3.1–8.0] years) from 2013 to 2020 undergoing total thyroidectomy and radioiodine ablation in whom hs-Tg and rhTSH-Tg was performed 12 months after completing initial treatment. Pearson correlation, receiving operating characteristics (ROC) and DRS at initial and last follow-up visit were analyzed.Resultshs-Tg and rhTSH-Tg show a strong positive linear correlation (r = 0.864, p < 0.001). The diagnostic performance of initial hs-Tg and rhTSH-Tg levels were evaluated via ROC-AUC as a predictor of excellent response (ER) in the last follow-up visit. Hs-Tg showed a better AUC (0.969, 95%CI = 0.941–0.997) than rhTSH-Tg (0.944, 95%IC = 0.905–0.984; p < 0.001). The hs-Tg and rhTSH-Tg cutoff point of highest sensitivity (S) and specificity (E) was 0.110 and 0.815 ng/dl, respectively. Hs-Tg showed a higher diagnostic accuracy than rhTSH-Tg (S = 100% vs 96.8%, E = 84.3% vs 84.3%, NPV = 100% vs 98.6%, PPV = 70.5% vs 69.7%; p < 0.05). The DRS based on initial hs-Tg showed better ability to predict ER (93.3% vs 86.7%) and biochemical incomplete response (53.3%vs13.3%) in the last follow-up visit compared to rhTSH-Tg.ConclusionsBoth initial hs-Th and rhTSH-Tg were good predictors of long-term ER. In patients with hs-Tg, the rhTSH-test did not provide relevant prognosis information. An ER after initial treatment was associated with a very high NPV at subsequent follow-up.

Financial Feasibility and Prospects of Commercial Acid Lime Farming in Nepal

Research was conducted to assess the economics of commercial acid lime production and prospects of lime farming in Nepal. Morang, Sunsari, Chitwan and Nawalparasi districts of Nepal were selected as the study area after having consultation with concerned agricultural personnel. Altogether 70 farmers (19% of the sampling population) were randomly selected from the sampling frame to collect the primary information. The financial analysis of acid lime farming per hectare of land estimated NPV (12% discount rate) NRs. 4828734/ha, BCR 2.2, IRR 40% and the Pay-back period of 5 years, 5 months and 26 days. The BCR greater than one, IRR three times higher than discount rate, high NPV (return on investment more than cent percent) and payback period less than one-third of the total productive age of the lime orchard showed the financial feasibility of commercial acid lime farming in Nepal. The regression revealed that the import, production and productive area were found to be increased at the rate of 32, 6, and 8 percent per annum respectively while that of productivity was found to be decreased by 2.4 percent per annum (p&lt; 0.010). There is a huge opportunity for acid lime farming in Nepal as the demand is much higher than the domestic production resulting voluminous import. Agribusiness promotion strategies focusing on market development should be introduced that would contribute to enhance the national acid lime production and promote the domestic market.&#x0D; Int. J. Soc. Sc. Manage. Vol. 10, Issue-1: 10-15.

Anamnestic frailty phenotype and adverse outcomes in patients treated with direct oral anticoagulants: Validation and comparative performance with frailty phenotype

AimsThe anamnestic frailty phenotype (AFP) is a quick, instrument-free tool derived from frailty phenotype (FP). We prospectively evaluated the discriminative capacity and prognostic value of AFP in ambulatory patients receiving DOACs for atrial fibrillation (AF) or venous thromboembolism (VTE), and compared AFP performance with that of FP. Methods and resultsSensitivity, specificity, positive and negative predictive value (PPV, NPV) with corresponding 95% confidence intervals (95%CI), were estimated for bleeding, thromboembolism, and all-cause mortality. Risk ratios (RRs) were calculated in frail versus non-frail patients. Of 236 patients (median age 78 years), 98 (42%) and 89 (38%) were classified as frail according to FP and AFP, respectively (Kappa= 0.76). Frailty, as assessed by AFP, was associated with higher risk of bleeding (RR 2.3; 95%CI, 1.2 to 4.6), and mortality (RR 4.4; 95%CI, 1.3 to 19.7). Similarly, to FP, AFP exhibited modest sensitivity and specificity, but high NPV that was 91% (95%CI, 85 to 95) for bleeding, 98% (95%CI, 94 to 100) for thromboembolism, and 98% (95%CI, 94 to 100) for mortality. ConclusionAmong patients receiving DOACs for AF or VTE, AFP was associated with an increased risk of adverse outcomes. AFP exhibited modest sensitivity and specificity, but excellent NPV. If confirmed, these findings suggest that AFP may represent a rapid, easy-to-use and unexpensive tool that may potentially help identify patients at lower risk for adverse outcomes and tailor anticoagulation management.

Neutrophil-to-lymphocyte ratio predicts nodal involvement in unfavourable, clinically nonmetastatic prostate cancer patients and overall survival in pN1 patients

The aim of our study was to determine the clinical utility of neutrophil-to-lymphocyte ratio (NLR) in predicting presence and prognosis of nodal involvement in patients treated with radical prostatectomy (RP) due to prostate cancer. This single-centre retrospective study included 205 patients treated with RP and lymphadenectomy between 2012 and 2018. Logistic regression and Kaplan–Meier analyses were performed to evaluate the prognostic value of preoperative NLR in terms of nodal spread and survival. Patients staged pN1 presented lower mean NLR (2.53 vs 3.86; p = 0.0025) compared to pN0 patients. On multivariable analysis of different haematological markers, only NLR exceeding the median (≥ 2.7) predicted pN1 (OR = 0.38; p = 0.0367) independently of biopsy grading and PSA. In internal validation (n = 31 pN1, n = 174 pN0) on the bootstrapped dataset using a spare cutoff of NLR ≥ 4.1 would allow sparing lymphadenectomy in 22.09% pN0 patients, missing 6.45% pN1 (NPV 92.66%; 95% CI 84.91–100%). Noticeably, in pN1 patients NLR ≥ 2.7 correlated with shorter overall survival (p = 0.0196), despite its association with reduced risk of pN1. High pre-prostatectomy NLR was negatively associated with pN1, yielding high NPV in internal validation. Simultaneously, high NLR in pN1 patients was associated with shorter survival.

Evaluation of Peripheral Arterial Disease Using Noncontrast Magnetic Resonance Angiography

Introduction: Peripheral arterial disease is common in older age group. PAD is evaluated using Doppler, contrast CT and MR angiography. Many PAD patients have comorbidities like diabetes, hypertension and renal dysfunction. CT and MR contrast administration is considered risky in patients with impaired renal function. CT contrast agents are nephrotoxic. Gadolinium-based MRI contrast are associated with nephrogenic systemic fibrosis in patients with severe renal dysfunction. Aims: The aim of our study was to evaluate the usefulness of non contrast enhanced MR angiography in imaging of peripheral arteries in patients with impaired renal function. Materials and Method: This prospective study was done using ECG-triggered 2D TOF MR Angiograpgy on 1.5 Tesla MR unit in PAD patients having renal dysfunction. We studied various arterial segments of lower limb for the degree of narrowing on MRA and compared the findings in all patients with duplex scan and in some patients with DSA. We determined accuracy, sensitivity, specificity, PPV and NPV of MRA compared to duplex scan for assessment of arterial luminal narrowing. Results: Our study results have demonstrated that in patients with high grade blockage (&gt;50% diameter reduction or arterial occlusion) NC MRA had almost 100 % accuracy, sensitivity, specificity, PPV and NPV when compared to duplex scan in iliac, femoro-popliteal and tibioperoneal segment. In patients with low grade blockage (&lt;50% diameter reduction) NC MRA had low sensitivity with high specificity and NPV. Conclusion: ECG-triggered non contrast-enhanced MR angiography (NCMRA) is safe and highly accurate in PAD patients having renal dysfunction.

Uloga 18F-FDG PET/CT u praćenju pacijenata sa laringealnim skvamocelularnim karcinomom nakon terapije

Introduction: The aim of this investigation was to estimate the diagnostic performance of positron emission tomography/computed tomography using fluorine-18 fluoro-deoxyglucose (18F-FDG PET/CT) in the follow-up of post-treatment laryngeal squamous cell carcinoma (SCC) and the survival rate. Material and methods: Fifty seven patients (50 males, 7 females), mean age (68.3±6.7), with post-treatment laryngeal SCC were investigated. Indications for 18F-FDG PET/CT were: post-surgery staging, post-therapy restaging with positive/uncertain CT, follow-up, suspected recurrence on CT. 18F-FDG PET/CT findings were compared to the clinical follow-up of up to 10 years after imaging. The degree of metabolic activity was analyzed visually and semi-quantitatively using the maximum standardized uptake value (SUVmax). Results: A high accumulation of radiopharmaceutical was found in 41 (71.9%) patients who were considered true positive, physiological in 14 patients (24.5%) and only two males (3.5%) were false positive. Overall sensitivity of 18F-FDG PET/CT was 95.3%, specificity 100.0%, positive predictive value 100.0%, negative predictive value 87.5% and accuracy 96.5%. In 19 cases (33.3%) PET/CT findings significantly influenced further management of the patients. Progression-free survival (PFS) in the 18F-FDG positive group was 41.1±12.7 months. Statistically significant correlation between SUVmax and PFS was not observed (p&gt;0.05). Conclusion: 18F-FDG PET/CT is a valuable tool for the follow-up of laryngeal SCC due to its high sensitivity, specificity, PPV, NPV and accuracy. It can influence the patients' management in a significant number of cases. Patients with negative 18F-FDG PET/CT findings had longer PFS than those with positive ones, but without statistical significance. SUVmax was not proven to be a strong predictor of patients' disease-free survival.

Using a bedside ultrasound (US), an emerging technology, to confirm endotracheal tube (ETT) location in adults in emergency department

Introduction: Airway management is the most important aspect of patient treatment in emergency medicine. Prompt confirmation of Endotracheal Tube (ETT) in larynx is imperative for avoiding complications in sick patient. With quick learning graph, Point of Care Ultrasound (POCUS) has high sensitivity and specificity for detection of ETT in place.&#x0D; &#x0D; Method: A prospective observational study was conducted at adult Emergency Department of Tribhuvan University Teaching Hospital among patients undergoing intubation for various reasons. Transtracheal POCUS was used to confirm the tube placement. Time to confirm tube by POCUS in trachea and by bilateral chest auscultation was noted.&#x0D; &#x0D; Result: Of the 71 intubations, 68 were correctly identified to be in trachea and 3 in esophagus, resulting in sensitivity and specificity of 100% each. Transtracheal POCUS was the fastest method to determine endotracheal intubation (8.08 ± 1.69 seconds) compared to bilateral chest auscultation (22.37 ± 3.45 seconds).&#x0D; &#x0D; Conclusion: With high sensitivity and NPV for confirmation of correct endotracheal tube intubation and early detection, transtracheal POCUS in emergency could be a useful tool for prompt localization of ETT and instant action needed before final confirmation by other means.

1070 PROGNOSTIC PERFORMANCE OF CARDIAC MAGNETIC RESONANCE IMAGING MARKERS VERSUS COMPLICATED CLINICAL PRESENTATION AFTER AN ACUTE MYOCARDITIS

Abstract Background Identifying markers associated with adverse events after acute myocarditis (AM) is clinically relevant to plan follow-up. We aimed to compare the prognostic performance of previously described cardiac magnetic resonance imaging (CMRI) markers: septal late gadolinium enhancement (LGE) localization and left ventricular ejection fraction (LVEF)&amp;lt;50% on baseline CMRI, versus complicated clinical presentation (CCP) of AM (defined as the presence of sustained ventricular arrhythmias or LVEF &amp;lt;50% on the first echocardiogram or fulminant presentation). Methods We retrospectively assessed 248 AM patients from 6 hospitals with onset of cardiac symptoms &amp;lt;30 days, increased troponin, and CMRI consistent with myocarditis. Results Patients had a median age of 34 years (male prevalence of 87.1%) and a median LVEF of 61% on baseline CMRI. Thirteen patients (5.2%) experienced at least one major cardiac event after a median follow-up of 1708 days. Among these 13 patients, 10 (76.9%) had septal LGE, 8 (61.5%) had LVEF&amp;lt;50%, and 12 (92.3%) had a CCP. The best performance was observed for CCP in terms of sensitivity (0.99), and for LVEF&amp;lt;50% in terms of specificity (0.90). The negative predictive value was at least 0.98 for all markers. Conclusions Major cardiac events after an AM are relatively low, and septal LGE, LVEF&amp;lt;50% on CMRI, and CCP are significantly associated with events. The most relevant finding is the high NPV of these markers to identify patients without events after an AM. This observation can help clinicians to monitor the patients after an AM, in fact, patients without these markers had an uneventful follow-up. Figure A] Acute Myocarditis with complicated clinical presentation (CCP AM) vs non-complicated clinical presentation (NO CCP AM); B] FE &amp;gt; 50% vs FE &amp;lt; 50% at basal cardiac MRI; C] Presence of septal late gadolinium enhancemnet (LGE) vs no septal LGE on basal cardiac MRI.

Determining the amyloid PET and CSF inclusion criteria for the SKYLINE secondary prevention study with gantenerumab

AbstractBackgroundSKYLINE is a secondary prevention study in Alzheimer's disease (AD) enrolling amyloid‐positive, cognitively normal (CN) individuals at risk for clinical AD between 60–80 years and treating them with gantenerumab or placebo for 4 years. There is no gold standard for determining amyloid positivity for this purpose. Thresholds for amyloid positivity used in trials in symptomatic AD may be suboptimal in a secondary prevention setting, where amyloid positivity prevalence is lower. We compared various amyloid‐positive definitions in a CN elderly population based on how well they enrich for clinical progression over 4 years and operational feasibility.MethodFour cohorts (ADNI, BioFINDER‐1, AIBL, and HABS) were used to explore the relationship between amyloid PET visual read, centiloid values and CSF pTau/Abeta42 values in a CN population. For amyloid PET, we compared visual read with centiloid thresholds by evaluating the amyloid positivity prevalence, magnitude and variability of endpoint progression, and positive and negative predictive value (PPV and NPV). Operational advantages of CSF motivated a comparison of elevated CSF pTau/Abeta42 thresholds with amyloid PET. We interrogated which CSF thresholds were robust to preanalytical differences, had a high PPV and NPV compared with amyloid PET, and resulted in an acceptable degree of cognitive decline and variability.ResultHigher centiloid thresholds (≥40 CL) showed good agreement with visual read, but visual read resulted in a lower coefficient of variation (CV) for change from baseline in PACC5, the primary endpoint in SKYLINE (CV=118–210 vs. CV=150–336). An elevated CSF pTau/Abeta42 threshold resulted in a similar amyloid positivity prevalence to amyloid PET (14–17% vs. 10–20%), had acceptable NPV (95–97%), PPV (69–87%), sensitivity (71–82%), and specificity (95–98%) for visual read, and resulted in a similar CV for change from baseline in PACC5.ConclusionThere is no gold standard for determining the optimal amyloid positivity threshold in a secondary prevention trial. Determining patients to be amyloid‐positive if they are amyloid PET visual read‐positive or have elevated CSF pTau/Abeta42 offers not only operational advantages but also likely results in a trial population that has an acceptable level of endpoint progression and variability over the trial duration.

Blood‐based biomarker prescreening in the SKYLINE secondary prevention study with gantenerumab

AbstractBackgroundSKYLINE is a new secondary prevention study in Alzheimer's disease (AD) enrolling amyloid‐positive, cognitively normal individuals at risk for clinical AD between 60 and 80 years and treating them with gantenerumab or placebo for 4 years. Based on available data from other studies, we expect only 15% of individuals to be amyloid‐positive in this screening population. We developed a blood‐based biomarker (BBBM) prescreening test to screen out participants who have a low likelihood of amyloid positivity by positron emission tomography (PET) or cerebrospinal fluid (CSF) testing before entering the main screening of SKYLINE.MethodWe explored multiple individual key AD BBBMs (measured with Elecsys® prototype assays) and combinations in three large cohorts (BioFINDER‐1, AIBL, A4) of cognitively unimpaired and subjective cognitive decline/mild cognitive impairment participants. We used predefined thresholds for amyloid PET and/or CSF pTau/Abeta42 as the reference standard for amyloid positivity. The performance of the BBBM was assessed by evaluating the positive and negative predictive value (PPV and NPV) for amyloid positivity, and screen‐out proportions based on a range of potential thresholds. Those metrics were translated into the total number of participants that need to be screened and the reduction of the number of participants that need to be screened with PET or CSF testing to reach the target sample size.ResultWe identified a combination of two key AD biomarkers expected to enable a high NPV at moderate PPV, screening out 40–50% of participants, amongst whom are only 3–5% true amyloid positives (falsely ruled out). This BBBM prescreening would reduce the need for PET or CSF testing by 40% while requiring screening of 8% more participants to compensate for the wrongly excluded amyloid positives.ConclusionThe implementation of Elecsys® blood‐based prescreening in SKYLINE will significantly reduce site and participant burden, accelerate the study enrollment, and save screening costs by reducing unnecessary downstream screening assessments such as cognitive batteries, magnetic resonance imaging, and PET or CSF testing.

MOG‐Ab prevalence in optic neuritis and clinical predictive factors for diagnosis

AbstractPurpose: What is the proportion of MOG‐Ab among optic neuritis (ON) in adults and what would be the ON presentation for which MOG‐Ab should be tested?Methods: Multicentric prospective study conducted during one year on all patients diagnosed with acute ON in all ophthalmologic units in hospitals of a region in western France.Results: Sixty‐five patients were included. MOG‐Ab prevalence was 14% (9/65) during an acute ON and 13% (7/55) after exclusion of patients already diagnosed as multiple sclerosis (MS) (8) or MOG + ON (2). Compared to multiple sclerosis (MS) and clinically isolated syndrome (CIS), MOG + ON had no female preponderance (respectively 67% of men versus 22%, p &lt; 0.05), were more often bilateral (44% versus 3%, p &lt; 0.005) and associated with optic disc swelling (ODS) (78% versus 14%, p &lt; 0.001). To predict MOG + ON, the combined factor “ODS or bilateral or recurrent ON” was the best compromise between positive predictive value (31% 95% CI [14;48]) and negative predictive value (100% [100;100]).Discussion: These results corroborate other studies that estimated MOG‐Ab prevalence among ON: between 10 to 31% in four retrospective studies and 4% (2/51) in a prospective study. AQP4‐Ab prevalence is higher in Asia (36 to 42%) than in Europe (5%). Furthermore, our study supports the clinical findings of large retrospective collections of MOG + ON patients: MOG + ON occurs in similar age as MS without female preponderance, optic disc swelling and bilateral involvement are common, response to corticosteroid treatment is good and most patients retain functional vision. We found that longitudinal optic nerve lesions and optic nerve perineuritis were significantly associated with MOG + ON. These results corroborate findings of Chen et al. Among ON, Jarius et al. recommended testing MOG‐Ab only in cases of ODS, bilateral ON, severe ON, steroid dependent symptoms and frequent relapses. This expert advice is based on retrospective studies that are unable to evaluate the predictive value of such features. In our series, we validated predictive value of ODS and bilateral involvement. Their PPV is middling but their high NPV make them relevant. We could not validate the other features. Our study highlights the importance of determining ODS in cases of initial ON, in particular as this feature could be absent due to optic disc atrophy due to recurrence. Notably, the two MOG+ patients who did not have ODS during this study were recurrent ON; however, subsequent review of their records revealed ODS during their 1st episode. Testing MOG‐Ab only in the case of ODS or bilateral or recurrent ON would limit MOG‐Ab testing to 29 among 65 patients (45%) and would ensure that MOG + ON would not be missed.Conclusion: Among ON episode, MOG‐Ab were found in 14% of cases. MOG + ON occurred without female preponderance and was significantly associated with ODS and/or bilateral ON. Testing MOG‐Ab only in patients presenting with ODS or bilateral or recurrent ON would limit MOG‐Ab tests to fewer than half of all patients without the risk of missing any MOG + ON cases.

Skin advanced glycation end products as a screening tool of neuropathy in type 2 diabetes mellitus

Aim of the studyTo examine the diagnostic utility of skin advanced glycation end products (AGEs) as screening tool of neuropathy in type 2 diabetes mellitus (T2DM). Patients and methodsWe included 132 participants (88 men) with a mean age of 64.57 years and median T2DM duration of 14.5 years. Skin AGEs were measured with AGE reader mu connect (Diagnoptics) on the dominant arm and were interpreted as normal vs. elevated. Distal sensorimotor polyneuropathy (DSPN) was diagnosed by the Neuropathy Disability Score. Cardiovascular autonomic neuropathy (CAN), sympathetic and parasympathetic nervous system impairment were diagnosed by cardiovascular autonomic reflex tests. ResultsFor DSPN, AGEs yielded high sensitivity (82.8%) and NPV (80.4 %) with moderate specificity (55.4 %). For CAN, they yielded relatively high sensitivity (75.0 %) and NPV (74.5 %) with low specificity (48.7 %). For sympathetic nervous system impairment, AGEs yielded relatively high sensitivity (75.0 %) and high NPV (84.3 %) with low specificity (43.9 %). For parasympathetic nervous system impairment, they yielded high PPV (81.0 %) with moderately high sensitivity (66.7 %) and moderate specificity (55.9 %). ConclusionsIn a simplified approach, skin AGEs may be used as a screening tool of DSPN and CAN (including sympathetic and parasympathetic nervous system impairment) in T2DM.

DIAGNOSTIC PARAMETERS OF CAT EXTRACTS FOR SKIN PRICK TESTING AGAINST GOLD STANDARD NASAL PROVOCATION TESTING

<h3>Introduction</h3> Cat allergen is a pervasive perennial allergen that evokes nasal symptoms in sensitive subjects. Diagnosis of IgE-mediated hypersensitivity is important for patient management. The objective of this study was to evaluate the diagnostic capabilities of 10,000 BAU/mL Cat Hair and Cat Pelt Allergen Extracts for Skin Prick Testing (SPT). <h3>Methods</h3> Thirty-two subjects were enrolled in a phase I single-center, double-blinded study. Subjects were assigned to one of three groups, Positive Responder (Low (11), High (11)) or Non-Responder (10), based on their responsiveness to Nasal Provocation Test (NPT) using Cat Pelt reference. Subjects underwent SPT using Cat Hair, Cat Pelt, and positive/negative controls. SPT diagnostic parameters were calculated relative to the NPT results (gold standard). <h3>Results</h3> Cat Hair used for SPT demonstrated high sensitivity, specificity, PPV and NPV of 95.45%, 80.00%, 91.30%, 88.89%, respectively. Cat Hair elicited a robust positive response, with a mean (SE) maximum wheal diameter of 7.8 (0.63) mm and erythema diameter of 18.7 (2.44) mm. Cat Pelt used for SPT also demonstrated high sensitivity, specificity, PPV and NPV of 95.45%, 70.00%, 87.50%, and 87.50%, respectively. Cat Pelt elicited a robust positive response, with a mean (SE) wheal diameter of 6.3 (0.54) mm. For Cat Hair and Cat Pelt, there was a discernible difference in wheal and erythema diameters for cat allergen positive subjects compared to cat allergen negative subjects. <h3>Conclusions</h3> The data show strong diagnostic performance for both Cat Hair and Cat Pelt when used for SPT. NPT using Cat Pelt was an appropriate gold standard for identifying cat allergy.

A prediction model for difficult intubation using skeletal features in patients affected by apnea-hypopnea syndrome.

Obstructive sleep apnea-hypopnea syndrome (OSAHS) has been linked to increased risk of perioperative morbidity and mortality because of difficult intubation (DI). However, there is a lack of clinically validated tools to identify OSAHS patients who are likely to have an increased the risk of DI. For model development, a prospective cohort study included patients with OSAHS who underwent elective surgery between September 2018 to December 2020. The outcome was DI and classified according to the Cormack-Lehane grading. Conventional airway assessment tests, skeletal features, and the severity of OSAHS were recorded, and LASSO regression was used. Validation was performed on an external sample of patients from the same hospital between January 2021 and December 2021. The development (prevalence of DI: 44%) and validation cohorts (prevalence of DI: 32%) included 247 and 82 patients, respectively. Based on the result of LASSO, age and four skeletal features (thyromental height, maximum mandibular protrusion, mandibulohyoid distance, and neck hypokinesis grade) were included in the final model. Discrimination and calibration of the model were satisfactory with high AUC (0.97), sensitivity (88.5%), specificity (94.6%), accuracy (92.7%), PPV (88.5%) and NPV (94.6%) from external validation. Our study developed and externally validated a DI prediction model using skeletal features in OSAHS patients. The final model had an NPV of nearly 95%, suggesting that a simple nomogram including only five predictors was quite helpful for ruling out the presence of difficult intubation in OSAHS patients who underwent elective surgery.

Serial quantification of CRP and total leukocyte count as a complementary tool in neonatal sepsis.

Early detection and appropriate treatment of newborn sepsis reduce mortality and morbidity. A rapid, inexpensive laboratory approach is needed to assess newborn sepsis, even though blood culture is the gold standard for diagnosis. To compare serial CRP and Total Leukocyte Count (WBC) with blood culture, this study aimed to evaluate the role of newborn sepsis. A total 148 neonates with clinical symptoms of sepsis were included .CRP was measured by quantitative immuno turbidimetric method andotal leukocyte count (WBC) was measured by automated cell counter. CRP1 and WBC1 were measured within 6 hours of clinical symptoms. CRP2 and WBC2 were measured after 48 hours of clinical symptoms. Sensitivity, specificity, PPV, NPV of CRP1 and CRP2,WBC 1and WBC 2 were compared with culture positive and negative sepsis.CRP 2 showed high sensitivity 96% and high NPV95% with significant p value <0.0001. WBC2 has high sensitivity (90.57%) and NPV (91%) with significant p value <0.0001. CRP 1 has sensitivity 83%and NPV 82.3%, with p value < 0.001.WBC1 has lowest sensitivity (62.2%) and NPV (71.4%) compared to all other parameters. Serial CRP and WBC measurements are useful in the diagnosis of neonatal sepsis. Measurement of CRP and Total Leukocyte Count (WBC) after 48 hours of clinical symptoms were considered promptly for diagnose neonatal sepsis.

The value of preoperative FDG PET/CT in detecting groin metastases in vulvar cancer patients

Objective: This retrospective study aimed to evaluate the diagnostic value of preoperative18F-Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) in detecting groin Lymph Node (LN) metastases in newly diagnosed vulvar cancer patients. Methods: In the period 01.01.2014 to 31.12.2018, we retrospectively collected data by reviewing the medical record of 237 patients with diagnosed vulvar cancer referred to Aarhus University Hospital. In the study, 108 patients were included for final analysis. Inclusion criteria was that all women should have histology from the groin with either Inguinofemoral Lymph Node (IFLN) dissection, Sentinel Lymph Node (SLN) procedure or Ultrasound (US)-guided biopsy. In addition, all included patients underwent FDG PET/CT for primary staging of vulvar cancer before operation. Sensitivity, specificity, Positive and Negative Predictive Values (PPV and NPV) in predicting LN metastases were calculated in the overall study population. Results from FDG PET/CT were compared with histopathology as reference standard. Results: All included women underwent a standardized patient investigation program. This included a thorough gynecological examination, a Magnetic Resonance Imaging (MRI) and FDG PET/CT scan. We found that PET/CT had a sensitivity of 90.9% (95% CI 70.8-98.9%), specificity of 67.4% (95% CI 56.5-77.2%), PPV of 41.7% (95%CI 27.6-56.8%) and a NPV of 96.7% (95% CI 88.5-99.6%). Conclusion: In this relatively large single-center study, we found that FDG PET/CT has a high sensitivity and a high NPV in detecting LN metastasis in the groin. This supports, that FDG PET/CT is a valuable imaging modality in the management of vulvar cancer patients.

Urgency for bowel movements is a highly discriminatory symptom of active disease in persons with IBD (the Manitoba Living with IBD study).

The Inflammatory Bowel Disease Symptom Inventory (IBDSI) is a validated patient self-reported measure used to assess IBD disease activity. There have yet to be more granular analyses on which symptoms are most associated with active disease. To assess the prevalence of symptoms, and to examine which are most associated with disease activity as measured by a symptom index and objective measure of inflammation METHODS: The Manitoba Living with IBD Study is a prospective study of 156 participants with confirmed IBD who completed bi-weekly IBDSI. Relative risks (RR) and predictive values (NPV and PPV) were reported for each symptom to predict active disease defined as active IBDSI, self-reported flare and elevated faecal calprotectin (FCAL) (>250 μg/g). Analyses were undertaken following stratification based on sex, and disease type (Crohn's disease [CD] and ulcerative colitis [UC]). In total, 69.2% were female; 64.7% had CD. Fatigue was the most prevalent symptom in both inactive and active disease, across all three disease measures (IBDSI: 24.5% and 75.1%, self-reported flare: 42.2% and 72.2%, FCAL: 46.0% and 60.6%). The absence of fatigue had a high NPV for active IBDSI and self-reporting a flare in both CD and UC. Urgency had a consistently strong NPV and RR across all three disease measures in both IBD subtypes and sexes. The number of loose/liquid bowel movements predicted elevated FCAL in UC (RR males=3.5, 95% CI 1.2-9.9, RR females=1.8, 95% CI 1.2-2.7), as did blood in stool in UC females (RR=1.8, 95% CI 1.2-2.7). In males with CD, excessive bowel gas (RR=2.0, 95% CI 1.2-3.4) and urgency (RR=3.9, 95% CI 1.6-9.3) best predicted an elevated FCAL. No symptom was strongly predictive of an elevated FCAL in CD females. Urgency was consistently associated with disease activity, irrespective of the disease measure. Fatigue was the most prevalent symptom irrespective of disease activity measure. Individual symptoms have different impacts on subjective (IBDSI) and objective (FCAL) measures in IBD.