Highest Sum Of Sensitivity Research Articles

Optimization of diagnostic methods and criteria of endometritis for various postpartum days to evaluate infertility in dairy cows

Postpartum endometritis is the main cause of infertility in dairy cows, but there is a lack of critical diagnostic criteria. We aimed to 1) determine the optimal diagnostic method and criteria of endometritis for various postpartum days to evaluate infertility, and 2) assess the diagnostic accuracy of a combination of diagnostic methods. Holstein dairy cows (n = 441) from nine commercial dairy herds were examined at 42 ± 7 days postpartum by using 5 methods: 1) transrectal palpation measurement of the cervical diameter, 2) ultrasonographic measurement of the fluid in uterus (FIU) score, 3) vaginoscopic detection of external uterine orifice hyperemia, 4) vaginal discharge score (VDS), and 5) endometrial cytological percentage of polymorphonuclear leukocytes (PMN%). The clinical findings that were significant in the Pearson chisquare test and had the highest sum of sensitivity and specificity for infertility at 100, 125, 150, 175, and 200 days after parturition were determined the optimal criteria of endometritis. Logistic regression and the Cox proportional hazards model were used to compare the accuracies of the different diagnostic methods for infertility at various postpartum days. The combinations of methods which were significant in Pearson chisquare test and had the highest sum of sensitivity and specificity for infertility were proposed as the optimal combination for determination of endometritis status for various postpartum day. The optimal diagnostic criteria were PMN% ≥ 6.0, FIU ≥ 2 (continuous hyperechogenic or large amount of storage material), or VDS ≥ 2 (mucopurulent or worse vaginal discharge) for postpartum days 100 and 125; PMN% ≥ 8.0, FIU = 3 (large amount of storage material), VDS ≥ 2, or external uterine orifice hyperemia for day 150; PMN% ≥ 6.0, FIU = 3, VDS ≥ 2, or external uterine orifice hyperemia for day 175; and PMN% ≥ 5.0, FIU = 3, VDS ≥ 2, or external uterine orifice hyperemia for day 200. Only the results of endometrial cytology were related to infertility regardless of the postpartum days to evaluate infertility or statistical models. Compared with the sensitivity and specificity of a single diagnostic method, the sensitivity of a combination of methods improved but specificity decreased. We concluded that different diagnostic methods and criteria were required for postpartum days to evaluate infertility and diagnostic accuracy was improved by a combination of diagnostic methods rather than by a single method.

Assessment tools for functional independence and residual disability after stroke: Are they comparable?

The aim of this study was to investigate the correlations between the modified Rankin Scale (mRS) grades and Korean versions of the MBI (K-MBI) scores in assessing the residual functional status of stroke survivors. The Korean versions of the MBI and mRS scales were administered to 5759 ischemic stroke patients at 3 months after onset of stroke. The sensitivity and specificity were calculated at all possible K-MBI score cutoffs for each mRS grade in order to obtain the optimally corresponding K-MBI scores and mRS grades. Receiver operator characteristic (ROC) curves and the area under the curve (AUC) was calculated. The K-MBI cutoff points with the highest sum of sensitivity and specificity were 100 (sensitivity 0.940; specificity 0.612), 98 (sensitivity 0.904; specificity 0.838), 94 (sensitivity 0.885; specificity 0.937), 78 (sensitivity 0.946; specificity, 0.973), and 55 (sensitivity 937; specificity 0.986) for mRS grades 0, 1, 2, 3, and 4, respectively. The AUC for the ROC curve was 0.791 for mRS grade 0, 0.919 for mRS grade 1, 0.970 for mRS grade 2, 0.0 for mRS grade 3, and 0.991 for mRS grade 4. The K-MBI cutoff score ranges for representing mRS grades were variable. mRS grades 0, 1, and 2 had narrow K-MBI score ranges, while mRS grades 3, 4, and 5 showed broad K-MBI score ranges. mRS grade seemed to sensitively differentiate mild residual disability of stroke survivors, whereas K-MBI can provide more specific information of the functional status of stroke survivors with moderate to severe residual impairment.

Definition and Risk Factors for an ovulation Diagnosed at 50 Days in Milk in Dairy Cows

The objectives of this observational study were to determine the optimal progesteronemia threshold for defining anovulation at 50 days in milk (DIM) in dairy cows and to identify risk factors for this condition. A total of 3,776 cows from 100 Holstein dairy herds were enrolled in this cow-level study. During farm visits, cows were bled at 1-14DIM to quantify ketonemia and glycemia, examined at 30-43 DIM to diagnose purulent vaginal discharge, cytological endometritis, and leukocyte esterase endometritis, and were bled at a 14d interval to quantify progesteronemia. Multiple progesteronemia thresholds were tested to identify the one providing the highest sum of sensitivity and specificity to predict the pregnancy status at first service. The optimal threshold found for defining anovulation at 50DIM was ≤0.90 ng/mL. The final model for risk factors included parity group, season of calving, cytological endometritis, hyperketonemia, hypoglycemia, and the two-way interaction term of hyperketonemia and hypoglycemia. Overall, these results suggest that a progesteronemia threshold of ≤0.9ng/mL could be used to define anovulation at 50 days in milk in dairy cows.

Prognostic value of neutrophil-lymphocyte ratio during palliative chemotherapy in patients with unresectable gallbladder adenocarcinoma.

253 Background: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) is a valuable prognostic marker in several kinds of solid tumors. This study aimed to evaluate the NLR, PLR and change of NLR and PLR over time as a prognostic marker in unresectable gallbladder cancer (GBC) which is treated with palliative chemotherapy. Methods: A total of 163 patients with pathologically confirmed unresectable GBC were enrolled. Baseline and post 1-cycle chemotherapy NLR and PLR were used in analysis. The changes in NLR and PLR were defined as the ratio of post chemotherapy value to baseline value. The relation between survival time and NLR and PLR changes were analyzed. Results: NLR and PLR had AUC value of 0.679, 0.660 in predicting 1-year overall survival (OS) and NLR 1.96 and PLR 111 were the optimal cutoff value with the highest sum of sensitivity and specificity. NLR change and PLR change had AUC value of 0.517, 0.519 in predicting 1-year OS and NLR change 0.4, PLR change 0.6 were the optimal cutoff value. Patients with NLR lower than 1.96 had better OS (16.1 months vs. 9.5 months, p < 0.001) and similarly patients with PLR lower than 111 had better OS (17.3 months vs. 9.5 months, p < 0.001). However, NLR change lower than 0.4 didn’t show better OS (9.2 months vs. 11.6 months, p = 0.178), and the same with PLR change lower than 0.6 (8.5 months vs. 11.3 months, p = 0.138). Conclusions: Baseline NLR and PLR is a valuable predictor of overall survival in unresectable GBC undergoing palliative chemotherapy, whereas NLR and PLR change over time is not.

Incidence and predictors of vascular access site complications following transfemoral transcatheter aortic valve implantation

Introduction and ObjectivesVascular access site complications in transfemoral (TF) transcatheter aortic valve implantation (TAVI) are associated with increased morbidity and mortality; however, their incidence and predictors are conflicting between studies. This study sought to assess the incidence and predictors of vascular access site complications in patients undergoing TF TAVI. MethodsA total of 140 patients undergoing TF TAVI were included in the study. Minimum iliofemoral diameter and iliofemoral calcium score (CS) were estimated from contrast-enhanced multidetector computed tomography imaging, using different thresholds according to aortic luminal attenuation. To assess the impact of the learning effect, the first 50% of TF TAVI procedures were compared to the remainder. ResultsFifty-one patients presented access site complications (7.1% major, 29.3% minor), most of which were local bleeding or hematoma (11.4%), pseudoaneurysm (7.9%) or closure device failure (5.0%). In a multivariate logistic regression analysis that included sheath-to-iliofemoral artery ratio (SIFAR) (the ratio between the sheath outer diameter and minimum iliofemoral diameter), iliofemoral CS and center experience, SIFAR was the sole independent predictor of access site complications (hazard ratio 14.5, confidence interval [CI] 95% 1.75–120.12, p=0.013). The SIFAR threshold with the highest sum of sensitivity (71.4%) and specificity (53.4%) for access site complications was 0.92 (area under the curve 0.66, 95% CI 0.56–0.75, p=0.002). ConclusionsVascular access site complications are frequent in patients undergoing TF TAVI. SIFAR was the only independent predictor of access site complications and therefore should be systematically assessed during pre-procedural imaging study.

Characteristics of incidentally found thyroid nodules in computed tomography: comparison with thyroid scintigraphy

BackgroundIn our daily experience, the differentiation between a cold and hot nodule is a very important factor for further clinical management of the patient.In this study, we compared the characteristics of incidentally found thyroid nodules detected on computed tomography (CT) to thyroid scintigraphy (TS).MethodsDiagnostic reports from chest CT with intravenous contrast and TS examinations performed from January 2013 to January 2016 were analyzed retrospectively. We identified 70 subjects: 50 with thyroid nodules and 20 control subjects without thyroid nodules. The examination time of the TS was a minimum of two to four months after a chest CT. Chest CTs were performed in the arterial phase after the application of contrast media.ResultsPatients with a cold nodule had a significantly lower Hounsfield Unit (HU) Nodule(N)/Parenchyma (P) ratio values than the patients with a hot or warm nodule (P < 0.05). The cut-off HU N/P ratio value with the highest sum of sensitivity and specificity for the prediction of a functioning nodule was 69 (95% CI: 0.79–0.95).ConclusionsOur results imply that the HU N/P ratio of the thyroid nodule on the chest CT should be taken into account to assess the functionality of the nodule. A lower HU N/P ratio should alert the radiologist or nuclear medicine physician to the possibility that the nodule might be cold and thus more prone to malignancy.

Establishment of a bleeding score as a diagnostic tool for patients with rare bleeding disorders

IntroductionBleeding manifestations among patients with rare bleeding disorders (RBDs) vary significantly between disorders and patients, even when affected with the same disorder. In response to the challenge represented by the clinical assessment of the presence and severity of bleeding symptoms, a number of bleeding score systems (BSSs) or bleeding assessment tools (BATs) were developed. The majority of these were specifically developed for patients with more common bleeding disorders than RBDs. Few RBDs patients were evaluated with these tools and without conclusive results. MethodsA new BSS was developed using data retrieved from a large group of patients with RBDs enrolled in the EN-RBD database and from healthy subjects. These data included previous bleeding symptoms, frequency, spontaneity, extent, localization, and relationship to prophylaxis and acute treatment. The predictive power of this BSS was also compared with the ISTH-BAT and examined for the severity of RBDs based on coagulant factor activity. ResultsThis BSS was able to differentiate patients with RBDs from healthy individuals with a bleeding score value of 1.5 having the highest sum of sensitivity (67.1%) and specificity (73.8%) in discriminating patients with RBD from those without. An easy-to-use calculation was also developed to assess the probability of having a RBD. Its comparison with the ISTH-BAT confirmed its utility. Finally, in RBDs patients, there was a significant negative correlation between BS and coagulant factor activity level, which was strongest for fibrinogen and FXIII deficiencies. ConclusionThe use of this quantitative method may represent a valuable support tool to clinicians.

Incidence and predictors of vascular access site complications following transfemoral transcatheter aortic valve implantation

Introduction and ObjectivesVascular access site complications in transfemoral (TF) transcatheter aortic valve implantation (TAVI) are associated with increased morbidity and mortality; however, their incidence and predictors are conflicting between studies. This study sought to assess the incidence and predictors of vascular access site complications in patients undergoing TF TAVI. MethodsA total of 140 patients undergoing TF TAVI were included in the study. Minimum iliofemoral diameter and iliofemoral calcium score (CS) were estimated from contrast-enhanced multidetector computed tomography imaging, using different thresholds according to aortic luminal attenuation. To assess the impact of the learning effect, the first 50% of TF TAVI procedures were compared to the remainder. ResultsFifty-one patients presented access site complications (7.1% major, 29.3% minor), most of which were local bleeding or hematoma (11.4%), pseudoaneurysm (7.9%) or closure device failure (5.0%). In a multivariate logistic regression analysis that included sheath-to-iliofemoral artery ratio (SIFAR) (the ratio between the sheath outer diameter and minimum iliofemoral diameter), iliofemoral CS and center experience, SIFAR was the sole independent predictor of access site complications (hazard ratio 14.5, confidence interval [CI] 95% 1.75–120.12, p=0.013). The SIFAR threshold with the highest sum of sensitivity (71.4%) and specificity (53.4%) for access site complications was 0.92 (area under the curve 0.66, 95% CI 0.56–0.75, p=0.002). ConclusionsVascular access site complications are frequent in patients undergoing TF TAVI. SIFAR was the only independent predictor of access site complications and therefore should be systematically assessed during pre-procedural imaging study.

Aortic Angulation Attenuates Procedural Success Following Self-Expandable But Not Balloon-Expandable TAVR

ObjectivesThe aim of this study was to evaluate the impact of increased aortic angulation (AA) on acute procedural success following transcatheter aortic valve replacement (TAVR). BackgroundThe degree of angulation between the aorta and the heart can make accurate positioning of the bioprosthesis during TAVR more demanding, particularly in instances of an extremely angulated or horizontal aortic root. Nonetheless, there are limited data on the impact of AA on the acute success of TAVR. MethodsWe assessed 582 patients who underwent TAVR at our institute and had contrast computed tomography available for AA evaluation. TAVR endpoints, device success, and adverse events were considered according to the Valve Academic Research Consortium-2 definitions. ResultsThe mean angulation of the aorta was 47.3 ± 8.7°. Patients were therefore divided into 2 groups: AA <48° and AA ≥48°. AA in the 480 patients who underwent balloon-expandable (BE) TAVR did not influence acute procedural success or short-term clinical outcome. In contrast, increased AA among the 102 patients who underwent self-expandable (SE) TAVR was found to significantly attenuate procedural success (area under the curve: 0.73; 95% confidence interval: 0.61 to 0.85; p = 0.008). The numerical cutoff for AA with the highest sum of sensitivity and specificity for device success was ≥48° (sensitivity 85%, specificity 61%). Moreover, patients whose AA was ≥48° were also associated with an increased need for a second valve and post-dilation, had increased fluoroscopy time and increased valve embolization, and had increased post-procedural paravalvular regurgitation greater than or equal to mild following SE TAVR. Major complications at 30 days, including mortality were similar between AA groups. Six-month mortality was also similar between both AA groups. ConclusionsIncreased aortic root angulation adversely influences acute procedural success following SE but not BE TAVR. Because of these data, BE valves may be preferred when evaluating patients with high AA before TAVR.

Aortic Valve Calcium Volume Predicts Paravalvular Regurgitation and the Need for Balloon Post-Dilatation After Transcatheter Aortic Valve Implantation.

This study sought to evaluate the impact of aortic valve (AV) and left ventricle outflow tract (LVOT) calcium on paravalvular regurgitation (PVR) and need for balloon post-dilatation (BPD) during transcatheter aortic valve implantation (TAVI). The overall study population comprised 152 patients. Calcium mass and volume of AV and LVOT were estimated from contrast-enhanced multislice computed tomography imaging, using 3 thresholds for calcium detection [650, 850, and 1,050 Hounsfield units (HU)]. A self-expandable prosthesis was implanted in 67.8% of patients and a balloon-expandable prosthesis in the remaining. Eleven patients required BPD and 82 patients presented post-procedural PVR, which was mild in 44.1% and moderate in 9.9%. The greatest discriminatory value for PVR ≥ mild was seen for calcium volume using 850 HU threshold, with an area under the curve of 0.72 (95%CI 0.64-0.80, P < 0.001) for AV and of 0.63 (95%CI 0.54-0.72, P = 0.008) for LVOT. For 850 HU threshold, the calcium volume cut-off with the highest sum of sensitivity and specificity for PVR was 157 mm(3) for AV and 0.6 mm(3) for LVOT. In multivariate logistic regression analysis, the presence of AV calcium ≥157 mm(3) (OR 3.83, 95%CI 1.81-8.10, P < 0.001) and ≥267 mm(3) (OR 11.3, 95%CI 1.2-103.1, P = 0.03) were the only independent predictors of PVR and BPD, respectively. AV calcium volume was an independent predictor of PVR and BPD in patients submitted to TAVI. Our results support a systematic assessment of AV calcium volume to identify patients at increased risk of post-procedural PVR.

Different Thresholds of Serum Ferritin Levels for Prediction of Liver Iron Concentration in Hemoglobinopathies

▪Introduction. This was a cross-sectional study of patients with hemoglobinopathies attending 13 Italian centers participating in the LICNET (Liver Iron Cutino Network) network promoted from Piera Cutino partnership and instituted by our center (Campus of Haematology Franco e Piera Cutino-A.O.O.R. Villa Sofia Cervello, Italy) on February 2013. LICNET is addressed to the diagnostics of iron overload in liver by R2 MRI (Ferriscan®) in patients with hemoglobinopathies. Ferriscan is a rapid scan method now available (10 minutes). This tool is crucial to have accurate and reliable measures for iron body burden control in hemoglobinopathies.Methods. Data included patients with β-thalassemia major (TM) (regularly transfused) (TX), β-thalassemia intermedia (TI) (both TX and non-transfused) (non-TX), and sickle cell disease (SCD) (both TX and non-TX). The main aim of the study was to evaluate how serum ferritin levels (SFLs) predict liver iron concentration (LIC) in different hemoglobinopathies, and to have valuable information about prognosis and response to therapy. In particular, to identify SFLs that best predict LIC thresholds of clinical significance (7 and 15 mg Fe/g dw) by identifying levels with highest sum of sensitivity and specificity was used the receiver operating characteristic (ROC) curve analysis.Results. A total of 363 patients were evaluated in this analysis, with a mean age of 35.6 ± 13.0 years (range: 6-76) and including 160 (44.1%) males. The underlying diagnosis were β-TM (n=204, 56.2), β-TI (n=102, 28.1%), and SCD (n=57, 15.7%). Among β-TI patients, 60 (58.8%) were on transfusion therapy. Similarly, in patients with SCD 34 (59.6%) were on transfusion therapy. The mean LIC in the study population was 7.8 ± 9.6 mg Fe/g dw and the median was 4.0 mg Fe/g dw.Across underlying diseases, LIC distribution was as follows: β-TM (mean: 9.0 ± 10.7, median: 4.9 mg Fe/g dw), TX β-TI (mean: 7.1 ± 7.3, median: 5.0 mg Fe/g dw), non-TX β-TI (mean: 5.1 ± 6.0, median: 3.2 mg Fe/g dw), TX SCD (mean: 8.5 ± 11.0, median: 4.5 mg Fe/g dw), and non-TX SCD (mean: 3.1 ± 1.9, median: 2.4 mg Fe/ g dw). It was apparent that TX patients irrespective of underlying diagnosis have a comparable proportion of patients with high LIC risk categories (>7 mg Fe/g dw) (p=0.627).Among chelated patients, LIC distribution was as follows: Deferoxamine (DFO) (mean: 7.3 ± 8.5, median: 4.7 mg Fe/g dw), Deferiprone (DFP) (mean: 11.6 ± 11.4, median: 8.4 mg Fe/g dw), Deferasirox (DFX) (mean: 7.8 ± 10.3, median: 3.2 mg Fe/g dw), DFO+DFP (mean: 8.2 ± 10.6, median: 4.5 mg/ Fe g dw), and other combinations (mean: 6.5 ± 4.0, median: 5.1 mg Fe/ g dw), with a statistically significant difference noted between groups (p =0.009) with the highest median among chelated patients noted in DFP treated patients and lowest median noted in DFX treated patients.For underlying disease groups, ROC curve analysis showed that SFLs that best predict LIC thresholds of 7 and 15 mg Fe/g dw varied, although patients with β-TI showed lowest SFLs to predict these thresholds especially non-TX patients (Fig. 1, Fig.2).Discussion. This study suggest as high values of LIC are present even in patients with TI or SCD, confirming that gastro-intestinal iron absorption is one of the main mechanism for secondary iron overloading. Moreover, close to 20% of patients with non-TX β-TI continue to have high LIC thresholds, while none of non-TX patients with SCD have LIC values > 7 mg Fe/g dw. The evidence that SFLs of 900 ng/mL are related in β-TI with LIC > 15 mg Fe/g dw (Fig. 2) suggests as chelation treatment could be reconsidered earlier in this cohort of patients. Finally, these findings suggest as LIC is predicted by different SFLs according to the different types of hemoglobinopathy. [Display omitted] [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

NIMG-70DEVELOPMENT OF A POTENTIAL PRE-OPERATIVE RISK STRATIFICATION TOOL OF CEREBELLAR MUTISM SYNDROME IN CHILDREN WITH POSTERIOR FOSSA TUMOUR - A PRELIMINARY RISK SCORING SCHEME

BACKGROUND: Despite identification of numerous pre-operative cerebellar mutism syndrome (CMS) clinical and radiological predictors, a unifying pre-operative risk stratification model for use during surgical consent is currently lacking. We have previously assembled a cohort of posterior fossa tumour patients and developed a pre-operative risk stratification model using classification algorithms. Our aim is to further develop a preliminary risk-scoring scheme to flag patients at higher risk of post-operative CMS. METHODS: The combined cohort consists of 89 patients from two major treatment centres (age: 2-23yrs, gender 28M,61F, MRI pathology estimate 36 medulloblastoma, 40 pilocytic astrocytoma, 12 ependymoma, 1 non-committal). Post-operative CMS status was ascertained from clinical notes and pre-operative MRI scans, blinded to CMS status, underwent structured evaluation. Multiple logistic regression coefficients for the six predictors selected by decision tree (cerebellar hemisphere invasion, bilateral invasion at middle cerebellar peduncle, dentate nucleus invasion, pathology estimate ependymoma, middle cerebellar peduncle compression and age > 12.4 years) were converted into risk scores. Predicted CMS probability, diagnostic and predictive values were calculated to explore the potential cut-off points. RESULTS: Of the 89 patients, 26 (29%) developed post-operative CMS. Patient's total risk score ranged from -57 to 263, with a greater number being associated with increased risk of CMS. The cut-off with the highest sum of sensitivity and specificity was total score ≥1, with sensitivity 92%, specificity 86%, positive predictive value 73% and negative predictive value 96%. Using cut-off of 0 and 15 allowed separation of the cohort into low (46/89, predicted probability 50%). CONCLUSIONS: A risk stratification model for post-operative CMS could flag patients at increased risk pre-operatively and may influence strategies for surgical treatment of cerebellar tumours. Following future testing and prospective validation, this risk scoring scheme may be utilised during the surgical consenting process.

Definition of prepartum hyperketonemia in dairy goats

A prospective cohort study was conducted on 1,081 dairy goats from 10 commercial herds in Québec (Canada) to define prepartum hyperketonemia based on optimal blood β-hydroxybutyrate acid threshold values for the early prediction of pregnancy toxemia (PT) and mortality in late-gestation dairy goats. All pregnant goats had blood sampled weekly during the last 5wk of pregnancy. The blood was analyzed directly on the farm for β-hydroxybutyrate acid quantification using a Precision Xtra meter (Abbott Diabetes Care, Saint-Laurent, QC, Canada). Body condition scores on the lumbar region and sternum were noted. Each goat was classified as being at low (n=973) or high risk (n=108) of having PT by producers based on a standardized definition. The optimal threshold for predicting a PT diagnosis or mortality for each week before kidding was determined based on the highest sum of sensitivity and specificity. The association between hyperketonemia and subsequent PT was tested using a multivariable logistic regression model considering hyperketonemia at wk 4 prepartum, litter size, and body condition score at wk 4 prepartum as covariates, and herd and parturition cohort as random effects. The association between mortality and hyperketonemia was also tested using a logistic regression model accounting for the presence or absence of treatment during the last month of pregnancy. The hyperketonemia definition based on PT varied between ≥0.4 and ≥0.9mmol/L during the last 5wk prepartum. Goats affected by hyperketonemia at wk 4 prepartum and with a large litter size (≥3 fetuses) had 2.1 and 40.5 times the odds, respectively, of subsequent PT than other goats. Hyperketonemia definitions based on mortality varied between ≥0.6 and ≥1.4mmol/L during the last 4wk prepartum, and was ≥1.7mmol/L during the first week postpartum. Goats affected by hyperketonemia and treated by producers had 3.4 and 11.8 times the odds, respectively, of subsequent mortality than did other goats. These results showed that prepartum hyperketonemia could be defined in dairy goats using subsequent risks of PT or mortality during the last month of pregnancy.

Real-time shear wave elastography may predict autoimmune thyroid disease.

To evaluate and compare the values of the elasticity index as measured by shear wave elastography in healthy subjects and in patients with autoimmune thyroid disease, in order to establish if this investigation can predict the occurrence of autoimmune thyroid disease. A total of 104 cases were included in the study group: 91 women (87.5%), out of which 52 (50%) with autoimmune thyroid disease diagnosed by specific tests and 52 (50%) healthy volunteers, matched for age and gender. For all the subjects, three measurements were performed on each thyroid lobe and a mean value was calculated. The data were expressed in kPa. The investigation was performed with an Aixplorer system (SuperSonic Imagine, France), using a linear high-resolution 15-4 MHz transducer. The mean value for the elasticity index was similar in the right and the left thyroid lobes, both in normal subjects and in patients with autoimmune thyroid disease: 19.6 ± 6.6 vs. 19.5 ± 6.8 kPa, p = 0.92, and 26.6 ± 10.0 vs. 25.8 ± 11.7 kPa, p = 0.71, respectively. This parameter was significantly higher in patients with autoimmune thyroid disease than in controls (p < 0.001). For a cut-off value of 22.3 kPa, which resulted in the highest sum of sensitivity and specificity, the elasticity index assessed by shear wave elastography had a sensitivity of 59.6% and a specificity of 76.9% (AUROC = 0.71; p < 0.001) for predicting the presence of autoimmune thyroid disease. Quantitative elasticity index measured by shear wave elastography was significantly higher in autoimmune thyroid disease than in normal thyroid parenchyma and may predict the presence of autoimmune thyroid disease.

Predicting Walking Function of Patients One Month Poststroke Using Modified Rivermead Mobility Index on Admission

Being able to predict walking ability of patients with stroke at an early stage is useful in formulating realistic rehabilitation goals and facilitating early discharge planning, which are beneficial not only to the patients but their family members and health care providers. This study aimed to use the modified Rivermead mobility index (MRMI) of the stroke patients on day 3 of their admission to predict their independent walking ability on day 28 postadmission. A total of 232 patients with acute stroke who were admitted to the acute hospital were recruited. Fifty-three percent of them (n = 123) were able to achieve independent walking ability after 28 days of admission whereas 47.0% of them (n = 109) failed to do so. The receiver operating characteristics curve analysis was performed. The optimal cutoff score with the highest sum of sensitivity and specificity was found to be 18.5 (sensitivity, 85.0%; specificity, 75.0%) and the area under the curve was .880. In conclusion, MRMI on day 3 of admission maybe useful in predicting independent walking ability 1 month after stroke.

Impact of Electrocardiogram-Gated Multi-Slice Computed Tomography-Based Aortic Annular Measurement in the Evaluation of Paravalvular Leakage Following Transcatheter Aortic Valve Replacement: The Efficacy of the OverSized AortiC Annular Ratio (OSACA Ratio)

Even mild paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is associated with increased late mortality. Electrocardiogram-gated multi-slice computed tomography (MSCT) enables detailed aortic annulus assessment. We describe the impact of MSCT for PVL following TAVR. Congruence between the prosthesis and annulus diameters affects PVL; therefore, we calculated the OverSized AortiC Annular ratio (OSACA ratio) and OSACA (transesophageal echocardiography, TEE) ratio as prosthesis diameter/annulus diameter on MSCT or TEE, respectively, and compared their relationship with PVL ≤ trace following TAVR. Of 36 consecutive patients undergoing TAVR (Group A), the occurrence of PVL ≤ trace (33.3%) was significantly related to the OSACA ratio (p = 0.00020). In receiver-operating characteristics analysis, the cutoff value of 1.03 for the OSACA ratio had the highest sum of sensitivity (75.0%) and specificity (91.7%; AUC = 0.87) with significantly higher discriminatory performance for PVL as compared to the OSACA (TEE) ratio (AUC = 0.69, p = 0.028). In nine consecutive patients (Group B) undergoing TAVR based on guidelines formulated from our experience with Group A, PVL ≤ trace was significantly more frequent (88.9%) than that in Group A (p = 0.0060). The OSACA ratio has a significantly higher discriminatory performance for PVL ≤ trace than the OSACA (TEE) ratio, and aortic annular measurement from MSCT is more accurate than that from TEE.

Major depressive disorder in patients with rheumatoid arthritis

Objective To investigate the point prevalence of major depressive disorder (MDD) as diagnosed by the Mini-International Neuropsychiatric Interview (M.I.N.I) in patients with rheumatoid arthritis (RA) and to determine whether MDD is related to features of RA disease, such as disease activity or physical dysfunction.Methods Of the patients with RA who participated in the IORRA survey conducted in October 2005, 162 were evaluated using the M.I.N.I., the Center for Epidemiologic Studies-Depression (CES-D) scale, and the two-question depression screen for MDD. RA clinical features were obtained from the concomitant IORRA cohort database. Relationships between MDD and RA disease features were analyzed by the Wilcoxon rank sum test and Pearson’s chi-square test.Results The point prevalence of MDD as diagnosed by the M.I.N.I. was 6.8 % in our Japanese patients with RA. The percentage of depressive patients was determined to be 23.5, 17.3, or 7.4 % according to the CES-D scale with cut-off points of 16, 19, or 27, respectively, and 14.2 % according to the two-question depression screen. The best cut-off point for CES-D for risk of MDD diagnosed by M.I.N.I. in this study was determined to be 23, with 11.7 % depressive patients having the highest sum of sensitivity and specificity. No relationship between MDD and RA disease activity was detected.Conclusion By using the well-established structural interview instrument M.I.N.I., we determined the point prevalence of MDD in the RA patients enrolled in this study to be 6.8 %, leading to the conclusion that concomitant MDD does not seem to influence disease activity in RA patients.

Clinical Value of Radiofrequency Ultrasonic Local Estimators in Classifying Breast Lesions

We sought to summarize the features of radiofrequency ultrasonic local estimator (RULES) images of benign and malignant masses and to explore the diagnostic value of RULES scores to identify breast lumps. A total of 81 women with a mean age ± SD of 41.33 ± 12.03 years (range, 19-68 years) with 82 lesions seen at our hospital were included in this study. Inclusion criteria were Breast Imaging Reporting and Data System grade 2 to 5 breast lesions, preoperative 2-dimensional (2D) ultrasound (US) examinations and RULES image acquisition, no treatment before the US examinations, surgical resection in our hospital, and histopathologic results. Each RULES characteristic was scored on the basis of expected values for malignant characteristics, and this RULES scoring system was assessed by a receiver operating characteristic curve. Of the 82 lesions, 45 were benign, and 37 were malignant. Malignancy was associated with multiple colors, red as the main color, colors distributed in 3 or more locations, aggregated colors, and more than half of the area filled with colors. A RULES score of 7 had the highest sum of sensitivity (67.6%) and specificity (95.6%) and the highest accuracy (82.9%) for diagnosis of malignancy. When 2D US imaging a Breast Imaging Reporting and Data System category of 4 was combined with a RULES score of 4 to detect breast cancer, the sensitivity was 83.8%; the specificity was 93.3%; and the accuracy increased to 89.0%. The use of RULES images and characteristics is helpful in differentiating benign and malignant breast lesions. Diagnostic accuracy can be improved by combining 2D US imaging and RULES.

856 – Early detection of depression in children and adolescents: the new children's depression screener (child-s) and the depression screener for teenagers (desteen)

Introduction Depression in children and adolescents is still underdiagnosed. Valid and brief screening-tools for these age groups are missing. Objective For children and adolescents in particular, we developed the screening-tools ChilD-S and DesTeen and assessed their validity as opposed to established instruments. Methods Both screeners were validated in a paediatric (228 children, 316 adolescents) and a clinical sample (77 children, 87 adolescents). Gold standard for validation were ICD-10 diagnoses of a depressive episode or dysthymia based on a structured interview. Using receiver operating characteristic analyses, the area under the curve (AUC) and the cut-offs with the highest sum of sensitivity and specificity were computed. In addition, it was examined whether the instruments differed significantly in validity measures. Results Point-prevalences were 5.3% (children) and 9.8% (adolescents) in paediatric care and 23.5% and 26.1% in clinical care.The 8-item ChilD-S yielded AUCs of 98% and 93% in the paediatric and in the clinical sample. Sensitivities were 100% and 94%, with specificities of 87% and 78%.The abbreviated 6-item DesTeen showed an AUC of 95% in both settings. Sensitivities were 100% and 91% in the paediatric and in the clinical sample, specificities were 82% and 89%. Being even shorter, the two screening-tools performed equally well or better than the established instruments. Conclusions The ChilD-S and the DesTeen discriminate well between depression and depression-like symptoms in somatic diseases as well as between depression and other forms of mental disorders. Valid and brief, they can both be recommended for usage in paediatric and clinical settings.

Major depressive disorder in patients with rheumatoid arthritis

To investigate the point prevalence of major depressive disorder (MDD) as diagnosed by the Mini-International Neuropsychiatric Interview (M.I.N.I) in patients with rheumatoid arthritis (RA) and to determine whether MDD is related to features of RA disease, such as disease activity or physical dysfunction. Of the patients with RA who participated in the IORRA survey conducted in October 2005, 162 were evaluated using the M.I.N.I., the Center for Epidemiologic Studies-Depression (CES-D) scale, and the two-question depression screen for MDD. RA clinical features were obtained from the concomitant IORRA cohort database. Relationships between MDD and RA disease features were analyzed by the Wilcoxon rank sum test and Pearson's chi-square test. The point prevalence of MDD as diagnosed by the M.I.N.I. was 6.8 % in our Japanese patients with RA. The percentage of depressive patients was determined to be 23.5, 17.3, or 7.4 % according to the CES-D scale with cut-off points of 16, 19, or 27, respectively, and 14.2 % according to the two-question depression screen. The best cut-off point for CES-D for risk of MDD diagnosed by M.I.N.I. in this study was determined to be 23, with 11.7 % depressive patients having the highest sum of sensitivity and specificity. No relationship between MDD and RA disease activity was detected. By using the well-established structural interview instrument M.I.N.I., we determined the point prevalence of MDD in the RA patients enrolled in this study to be 6.8 %, leading to the conclusion that concomitant MDD does not seem to influence disease activity in RA patients.