Receiver Operating Characteristic Curve Analysis Research Articles

Prognostic value of the preoperative systemic immune-inflammation nutritional index in patients with gastric cancer

BACKGROUND Gastric cancer (GC) is the fifth most common cancer and the third leading cause of cancer-related deaths in China. Many patients with GC frequently experience symptoms related to the disease, including anorexia, nausea, vomiting, and other discomforts, and often suffer from malnutrition, which in turn negatively affects perioperative safety, prognosis, and the effectiveness of adjuvant therapeutic measures. Consequently, some nutritional indicators such as nutritional risk index (NRI), prognostic nutritional index (PNI), and systemic immune-inflammatory-nutritional index (SIINI) can be used as predictors of the prognosis of GC patients. AIM To examine the prognostic significance of PNI, NRI, and SIINI in postoperative patients with GC. METHODS A retrospective analysis was conducted on the clinical data of patients with GC who underwent surgical treatment at the Guangxi Medical University Cancer Hospital between January 2010 and December 2018. The area under the receiver operating characteristic (ROC) curve was assessed using ROC curve analysis, and the optimal cutoff values for NRI, PNI, and SIINI were identified using the You-Review-HTMLden index. Survival analysis was performed using the Kaplan-Meier method. In addition, univariate and multivariate analyses were conducted using the Cox proportional hazards regression model. RESULTS This study included a total of 803 patients. ROC curves were used to evaluate the prognostic ability of NRI, PNI, and SIINI. The results revealed that SIINI had superior predictive accuracy. Survival analysis indicated that patients with GC in the low SIINI group had a significantly better survival rate than those in the high SIINI group (P < 0.05). Univariate analysis identified NRI [hazard ratio (HR) = 0.68, 95% confidence interval (CI): 0.52-0.89, P = 0.05], PNI (HR = 0.60, 95%CI: 0.46-0.79, P < 0.001), and SIINI (HR = 2.10, 95%CI: 1.64-2.69, P < 0.001) as prognostic risk factors for patients with GC. However, multifactorial analysis indicated that SIINI was an independent risk factor for the prognosis of patients with GC (HR = 1.65, 95%CI: 1.26-2.16, P < 0.001). CONCLUSION Analysis of clinical retrospective data revealed that SIINI is a valuable indicator for predicting the prognosis of patients with GC. Compared with NRI and PNI, SIINI may offer greater application for prognostic assessment.

Abstract 1915: A plasma biomarker panel of microRNAs miR-133-3p and miR-153-3p for diagnosis of prostate cancer

Abstract Prostate cancer is highly prevalent and the second-leading cause of cancer-related death among men in the United States. Its incidence rate has been rising by 3% per year overall and by about 5% per year for advanced-stage disease. Current diagnostic methods, particularly the PSA test, remain controversial due to variable sensitivity and limited specificity, highlighting the need for more precise and minimally invasive diagnostic tools. MicroRNAs (miRNAs)—19-24-nucleotide, non-coding RNAs—have emerged as critical regulators of gene expression and are frequently deregulated in cancer. These miRNAs exhibit cancer-specific dysregulation, high sensitivity, and stability, positioning them as strong candidates for blood-based biomarkers in early cancer detection and prognosis. Using computational miRNA target prediction analysis, we identified several miRNAs—namely, miR-133a/b, miR-144, miR-153, and miR-590—that could serve as highly sensitive and specific biomarkers for early prostate cancer detection. Our bioinformatics analysis further revealed that these miRNAs regulate glutathione S-transferase P1 (GSTP1), a gene often epigenetically silenced in early prostate cancer stages, suggesting their potential diagnostic value. To evaluate this, we analyzed miRNA levels in 84 human plasma samples from 56 prostate cancer patients and 28 non-cancer individuals served as controls using quantitative real-time PCR. Sensitivity and specificity were assessed through Receiver Operating Characteristic (ROC) curve analysis. The expression of miR-133-3p and miR-153-3p were significantly elevated in the plasma of prostate cancer patients compared to the control group, with p-values of 0.021 and 0.0006, respectively. Binary logistic regression and ROC analyses comparing these miRNAs to PSA showed significantly higher sensitivity and specificity, with p-values of 0.0001 and 0.0003. This two-miRNA panel exhibited near-perfect diagnostic accuracy, with an area under the curve (AUC) ranging from 0.98 to 1.0. Compared with previously identified miRNA biomarkers, this 2-miRNA panel demonstrated greater diagnostic stability and superior performance across public dataset cohorts. Our findings suggest that miR-133-3p and miR-153-3p could serve as reliable blood-based biomarkers for diagnosis of prostate cancer. Their association with GSTP1—a gene implicated in early prostate cancer through epigenetic silencing—underscores their biological relevance to the disease. The high sensitivity and specificity of this panel represent a significant improvement over PSA-based screening and indicate its promise for clinical application in prostate cancer diagnostics. Overall, this study supports the development of miRNA-based diagnostic tests to enable earlier detection, reduce unnecessary treatments, and ultimately improve outcomes for prostate cancer patients. Citation Format: Shiv Verma, Cheryl L. Thompson, Pingfu Fu, Gregory T. MacLennan, Sanjay Gupta. A plasma biomarker panel of microRNAs miR-133-3p and miR-153-3p for diagnosis of prostate cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1915.

The predictive value of miR-28-5p and miR-424-5p in metabolic syndrome and their mechanism of action through regulation of Fras-1-related extracellular matrix protein 2.

The prevalence of metabolic syndrome (MS) is rising due to lifestyle changes. To investigate the pathogenesis of MS and identify potential biomarkers, bioinformatics tools were used to screen for MS-related genes, such as Fras-1-related extracellular matrix protein 2 (FREM2), and miRNAs, including miR-28-5p and miR-424-5p. An insulin resistance (IR) cell model was established by treating human liver cells with insulin. The roles of FREM2, miR-28-5p, and miR-424-5p in IR were examined through overexpression and silencing experiments. Transfection of miR-28-5p/miR-424-5p mimics and a dual-luciferase assay were performed to explore their regulation of FREM2. The diagnostic value of miR-28-5p/miR-424-5p in MS was assessed using the receiver operating characteristic (ROC) curve. Increased expression of FREM2 and suppression of miR-28-5p/miR-424-5p enhanced glucose uptake in IR cells. Transfection with miR-28-5p or miR-424-5p mimics reduced luciferase activity in cells transfected with the wild-type FREM2 reporter vector and suppressed FREM2 expression. The ROC curve analysis indicated that miR-28-5p and miR-424-5p serve as effective classifiers for MS, with their combined use offering higher reliability. In conclusion, miR-28-5p and miR-424-5p exacerbated IR progression in human liver cells (HHL-5) through the negative regulation of FREM2, and they are potential biomarkers for MS.

Histopathological biomarkers in squamous cell carcinoma of the vulva: the prognostic relevance of tumor-infiltrating lymphocytes (TILs)—a retrospective study of 157 cases

BackgroundThe prognostic relevance of tumor-infiltrating lymphocytes (TILs) has so far been recognized in several solid tumors like in breast, endometrial and ovarian cancer—nonetheless, the immune contexture of squamous cell carcinomas of the vulva, analyzed by means of stromal (s) and intratumoral (i) TILs, remains yet to be elucidated.Material and methodsIn this study, we examined the immunooncological biomarkers sTILs and iTILs in 157 vulvectomy specimens with histologically diagnosed vulvar squamous cell carcinoma (VSCC) according to the standardized methodology proposed by the International Immunooncology Biomarkers Working Group in 2017. In a next step, we evaluated the association of infiltrating lymphocytes to traditional histopathological parameters such as infiltration depth and HPV related tumorigenesis. After determining optimal cut-off values using Receiver Operating Characteristic (ROC) curve analysis, we assessed the prognostic relevance of sTILs and iTILs with regard to overall survival, local recurrence, and metastasis using the Log-rank (Mantel–Cox) test and Fisher's exact test.ResultsWe propose optimal cut-off values of 5% for iTILs and 20% for sTILs analysis, which identify patients with a distinct superior survival rate (sTILs: p = 0.0137; iTILs: p = 0.0226). Furthermore, a low number of iTILs was associated with a higher risk of local recurrence in our study collective (p = 0.0432).ConclusionThe fast and cost-effective determination of the histological biomarkers iTILs and sTILs yields prognostic relevance in vulvar cancer. A potential integration within the routine diagnostic workflow could be globally feasible, even in resource-poor settings.

Evaluation of blood-count-derived inflammatory markers in patients with idiopathic epiretinal membrane

BackgroundTo assess the role of inflammation in the pathogenesis of idiopathic epiretinal membrane (iERM) by evaluating blood-count-derived inflammatory marker levels.MethodsThe medical records of patients diagnosed with iERM and cataract patients with normal fundus examinations were analyzed retrospectively. Levels of neutrophils, monocytes, lymphocytes, and thrombocytes were obtained from blood samples. Systemic inflammatory markers, including neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI) were calculated and compared between the two groups. The receiver operating characteristic curve (ROC) analysis was performed to determine the best cutoff value of NLR, PLR, SII, and SIRI in iERM.ResultsIn total, 91 iERM cases and 95 controls were included in the study. iERM patients had significantly higher NLR (2.25 vs. 1.91, p = 0.003), PLR (117.22 vs. 113.33, p = 0.042), SII (529.45 vs. 472.57, p = 0.003), and SIRI (1.25 vs. 0.90, p < 0.001). The area under the curve of NLR, PLR, SII, and SIRI in differentiating patients with iERM and controls was 0.637, 0.608, 0.645 and 0.660, respectively, according to ROC analysis. The best cutoff values (with sensitivity and specificity) were 1.95 (60.4% and 52.6%) for NLR, 116.7 (54.9% and 55.7%) for PLR, 498.03 (58.2% and 58.9%) for SII, and 1.07 (62.6% and 64.6%) for SIRI.No significant differences in inflammatory markers were found across iERM stages.ConclusionPatients with iERM exhibit higher levels of blood-count-derived inflammatory markers, suggesting a link between systemic subclinical inflammation and iERM development. However, these markers do not correlate with iERM severity. Further research with larger cohorts and broader inflammatory marker analysis is needed to elucidate the role of systemic inflammation in iERM pathogenesis.

Diagnostic and prognostic performance of serum GPC3 and PIVKA-II in AFP-negative hepatocellular carcinoma and establishment of nomogram prediction models

ObjectiveA significant proportion, ranging from 20 to 40%, of individuals with hepatocellular carcinoma (HCC) do not exhibit elevated Alpha-fetoprotein (AFP) levels. This study aimed to evaluate the utility of serum glypican-3 (GPC3) and protein induced by vitamin K absence or antagonist II (PIVKA-II) in an AFP-negative HCC (N-HCC) population, and to develop nomogram diagnostic and prognostic prediction models utilizing GPC3 and PIVKA-II.MethodsSerum GPC3 and PIVKA-II levels were measured in this case-control study, followed by the establishment of a receiver operating characteristic (ROC) curve, restricted cubic spline (RCS), and Kaplan-Meier survival curve. Additionally, a diagnostic prediction nomogram was constructed using univariate and multivariate logistic regression. Furthermore, we utilized least absolute shrinkage and selection operator (LASSO) regression and multivariate Cox regression to develop a prognostic prediction nomogram. The performance of these models was evaluated using ROC curve analysis and decision curve analysis (DCA).ResultsSerum GPC3 and PIVKA-II expression levels were significantly elevated in untreated patients with N-HCC (especially stageI and tumor size < 3 cm) compared to those with AFP-negative benign liver disease (N-BLD). Derived from ROC analysis, the diagnostic cutoff points for GPC3 and PIVKA-II were set at 0.100 ng/mL and 40.00 mAU/mL, respectively. PIVKA-II demonstrated sensitivity and specificity of 84.62% and 90.38%, surpassing GPC3’s 76.92% and 73.08%. The area under the ROC curve (AUC) for a diagnostic prediction nomogram incorporating GPC3, PIVKA-II, and gamma-glutamyltransferase (GGT) was 0.943 (95% CI: 0.912–0.974), superior to models using GPC3 or PIVKA-II alone. This model showed 95.20% sensitivity and 81.70% specificity in differentiating N-HCC from N-BLD. Stratifying patients into high-risk and low-risk groups using cutoff values established by RCS for GPC3 (0.124 ng/mL) and PIVKA-II (274 mAU/mL) revealed significant associations between these risk stratifications and patient survival. Finally, the use of GPC3-highrisk, cirrhosis, albumin (ALB), portal venous thrombosis (PVT), and surgical treatment as five parameters in the nomogram prognostic prediction model effectively differentiated between high- and low-risk prognostic patients with N-HCC with relatively high accuracy.ConclusionsSerum GPC3 and PIVKA-II demonstrate clinical significance in the timely detection and prognosis assessment of N-HCC. The application of nomogram prediction models based on GPC3 and PIVKA-II stands as an important adjunctive tool for diagnosing and prognosticating N-HCC.

Association of weight-adjusted waist index (WWI) with overactive bladder (OAB): a cross-sectional study from NHANES 2005–2018

The overactive bladder (OAB) is associated with obesity and inflammation. The weight-adjusted waist index (WWI) has emerged as a novel and more accurate measure of obesity compared to traditional indices, while the Dietary Inflammatory Index (DII) quantifies the inflammatory potential of one’s diet. However, the relationship between WWI, DII, and OAB remains unclear. This study aims to elucidate the association between WWI and OAB and to determine whether this relationship is mediated by dietary inflammation. Data from the National Health and Nutrition Examination Survey (NHANES) between 2005 and 2018, comprising 10,176 participants, were analyzed in this study. The association between WWI and OAB was examined using multivariate logistic regression models, smooth curve fitting, and subgroup analysis. Furthermore, the predictive capabilities of various anthropometric indices—including WWI, body roundness index (BRI), body mass index (BMI), waist circumference, body fat percentage (BF%), and weight—on OAB incidence were assessed using Receiver Operating Characteristic (ROC) curve analysis. Finally, a mediation analysis was conducted to explore whether the DII mediates the relationship between WWI and OAB. There was a significant positive association between WWI and OAB. After adjusting for covariates, for each unit increase in WWI, there was a 40% increase in the prevalence of OAB (OR 1.40, 95% CI 1.25–1.58, P < 0.001). This positive correlation persisted when WWI was categorized into quartiles. The dose–response curve showed a significant linear positive correlation between WWI and OAB. The correlation between WWI and OAB persisted in subgroup analysis. The ROC curve analysis revealed that WWI had a superior predictive capability compared to traditional obesity indices, with an area under the curve (AUC) of 0.661 (95% CI 0.648–0.674, all P < 0.001). The results of the mediation analysis showed that 5.02% of the association between WWI and OAB was mediated by DII (P = 0.016). Our findings suggest that individuals with higher WWI may have an increased risk of OAB. Additionally, an anti-inflammatory diet may be beneficial in preventing OAB. Given the cross-sectional nature of this study, we cannot establish a causal relationship. Future longitudinal studies are needed to validate this association and investigate the potential biological mechanisms underlying this relationship.

The potential crosstalk genes and molecular mechanisms between systemic lupus erythematosus and periodontitis

BackgroundSeveral studies have demonstrated an increased risk of periodontitis (PD) among patients diagnosed with systemic lupus erythematosus (SLE). However, the underlying common mechanism between them remains incompletely understood. Accordingly, the aim of this study is to examine diagnostic biomarkers and potential therapeutic targets for SLE and PD by leveraging publicly accessible microarray datasets and transcriptome analysis.MethodDatasets pertaining to SLE and PD were retrieved from the Gene Expression Omnibus (GEO) database, and subsequently analyzed for differentially expressed genes (DEGs). Key gene modules were identified through weighted gene co-expression network analysis (WGCNA), and shared genes were obtained by overlapping key genes between DEGs and WGCNA. These shared genes were subsequently subjected to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analyses, leading to the establishment of a Protein-Protein Interaction (PPI) network. Random forest (RF) and Least Absolute Shrinkage and Selection Operator (Lasso) regression were employed to identify key hub genes. Receiver operating characteristic (ROC) curves were generated using a new validation dataset to evaluate the performance of candidate genes. Finally, levels of immune cell infiltration in SLE and PD were assessed using CIBERSORTx.ResultsA total of 50 core genes were identified between the genes screened by WGCNA and DEGs. Functional enrichment analysis revealed that these genes are primarily associated with the PI3K-Akt and B-cell receptor signaling pathways. Additionally, using machine learning algorithms and ROC curve analysis, a total of 8 key genes (PLEKHA1, CEACAM1, TNFAIP6, TCN2, GLDC, GNG7, LY96, VCAN) were identified Finally, immune infiltration analysis highlighted the significant roles of neutrophils, monocytes, plasma cells, and gammadelta T cells (γδ T cells) in the pathogenesis of both SLE and PD.ConclusionThis study identifies 8 hub genes that could potentially serve as diagnostic markers for both SLE and PD, highlighting the importance of VCAN and LY96 in diagnosis. Moreover, the involvement of the PI3K-Akt signaling pathway in both diseases suggests its significant role. These identified key genes and signaling pathways lay the groundwork for deeper comprehension of the interplay between SLE and PD.

Association between the plasma atherogenic index and type 2 diabetes in Chinese population: prospective cohort study based on 4C study

BackgroundCurrently, the plasma atherogenic index (AIP) is mainly used to predict atherosclerosis and cardiovascular diseases. Therefore, we aim to investigate the potential association between AIP and type 2 diabetes through a prospective cohort study.MethodsThe 4C study, a multicenter prospective cohort investigation, targets the Chinese population and initially enrolled 10,008 participants. Baseline data encompassing lifestyle, metabolic status, and various other factors were collected in 2011. A 10-year follow-up survey was subsequently conducted, ultimately including 9,092 participants. AIP, defined as the logarithmic transformation of the triglycerides to high-density lipoprotein ratio, was divided into quartiles. To explore the potential association between AIP and the risk of type 2 diabetes, Cox regression, restricted cubic spline, receiver operating characteristic curve(ROC), and subgroup analysis were employed.ResultsOver a 10-year follow-up period, 693 new cases of type 2 diabetes were identified. In a fully adjusted model, AIP demonstrated a positive association with type 2 diabetes (HR: 4.40; 95% CI: 3.21, 6.04). Compared to the Q1 group, the risk of type 2 diabetes increased progressively across the Q2, Q3, and Q4 groups, with a significant trend (p-value &amp;lt; 0.05). Restricted cubic spline (RCS) analysis revealed an inverse L-shaped association between AIP and the risk of type 2 diabetes, with a turning point at 0.45. The ROC analysis indicates that incorporating the AIP into the base model enhances its diagnostic performance for type 2 diabetes. Furthermore, similar patterns were observed in the subgroup analyses.ConclusionsAmong the Chinese population, elevated AIP levels are positively correlated with an increased risk of type 2 diabetes, indicating that AIP could potentially serve as a biomarker for assessing the risk of developing type 2 diabetes.

Relationship between skeletal muscle mass and strength with metabolic syndrome in children

Objective: To explore the correlation between skeletal muscle mass and strength with metabolic syndrome in children. Methods: This cross-sectional study was conducted involving 383 children aged 10 to 15 years who visited the Department of Child Health Care, Children's Hospital of Nanjing Medical University from June 2021 to December 2022. Their height, weight, waist circumference, body composition, grip strength and blood pressure were measured. Relative skeletal muscle mass, muscle-to-fat ratio, and grip strength-to-body weight index were calculated. The levels of fasting blood glucose, lipids and insulin were tested. Homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Children were divided into the metabolic syndrome group and the non-metabolic syndrome group. Independent t test or Mann-Whitney U test etc. used to compare the difference between groups. Spearman correlation analysis and binary Logistic regression were used to investigate the correlation between skeletal muscle mass and strength and metabolic syndrome. The area under the curve (AUC) of receiver operating characteristic (ROC) curve was used to compare the accuracy of the index of skeletal muscle in predicting metabolic syndrome in children. Results: Among the 383 children, 282 (73.6%) were male, at the age of 11.4 (10.6, 12.5) years. There were 216 children (56.4%) diagnosed with obesity and 90 children (23.5%) diagnosed with metabolic syndrome. Relative skeletal muscle mass, muscle-to-fat ratio, and grip strength-to-body weight index of the metabolic syndrome group were all lower than those in the non-metabolic syndrome group (all P<0.001). After adjusting for sex and age, relative skeletal muscle mass, muscle-to-fat ratio, and grip strength-to-body weight index were all negatively correlated with body mass index (r=-0.84, -0.38, -0.63), waist circumference (r=-0.76, -0.36, -0.70), systolic blood pressure (r=-0.42, -0.21, -0.38), diastolic blood pressure (r=-0.33, -0.18, -0.24), triglycerides (r=-0.29, -0.13, -0.23), fasting insulin (r=-0.28, -0.20, -0.29), and HOMA-IR (r=-0.26, -0.18, -0.26) (all P<0.05), and positively correlated with high-density lipoprotein cholesterol (r=0.38, 0.13, 0.31, all P<0.01). After adjusting for sex and age, high relative skeletal muscle mass, high muscle-to-fat ratio, and high grip strength-to-body weight index all decreased the risks of metabolic syndrome (OR=0.80, 0.55, 0.90), obesity (OR=0.53, 0.64, 0.82), hypertension (OR=0.86, 0.58, 0.92), low high-density lipoprotein cholesterol (OR=0.83, 0.62, 0.92), hypertriglyceridemia (OR=0.88, 0.78, 0.96). After adjusting for sex and age, high relative skeletal muscle mass and high grip strength-to-body weight index all decreased the risks of hyperglycemia (OR=0.93 and 0.95, all P<0.05). ROC curve analysis showed that the relative skeletal muscle mass, muscle-to-fat ratio, and grip strength-to-body weight index all had good predictive accuracy of metabolic syndrome in children (AUC=0.79, 0.71, 0.76), with optimal cutoff values of 40%, 1.2, and 35%, respectively. Conclusions: High relative skeletal muscle mass, high muscle-to-fat ratio, and high grip strength-to-body weight index are all protective factors for metabolic syndrome in children. Regular measurement of skeletal muscle mass and grip strength can aid in the early identification and prevention of obesity and metabolic syndrome during childhood.

Validation of a Mathematical Model for Rupture Status of Spherical Intracranial Aneurysms.

An accurate mathematical model of intracranial aneurysm (IA) mechanics is of great value for its potential utility in assessing probability of IA rupture. Such a model for spherical IAs has been developed which predicts a wall-thickness-to-IA-radius ratio (WTR) of 6.1×10-3 at which IAs rupture. To our knowledge, no further work has been done to validate this model with clinical data. We aim to assess the accuracy and utility of this model of spherical IA rupture mechanics. Aneurysm height, width, neck diameter, and vessel radius were measured on radiologic images of IAs of the basilar terminus, anterior communicating, and posterior communicating arteries. Geometric modeling was used to approximate IA wall thickness. Calculations were performed with and without accounting for changes in IA morphology which have been shown to occur post-rupture. Receiver operating characteristic (ROC) curves and positive likelihood ratios (LR) were produced for WTR, aspect ratio (AR), bottleneck factor (BF), and size ratio (SR). Logistic regression analysis was performed to determine the WTR where there is a 50% chance of presentation as a ruptured aneurysm in our cohort. 52 unruptured and 28 ruptured spherical IAs were included. ROC curve analysis revealed similar areas under the curve for WTR, AR, BF, and SR, ranging from 0.636 to 0.773 with overlapping confidence intervals. LRs ranged from 1.34 (95% CI 1.09-1.65) for AR calculated with post-rupture dimensional adjustments to 2.14 (95% CI 1.45-3.14) for WTR and BF calculated without post-rupture adjustments. Logistic regression revealed a strong association between decreased WTR and rupture status. The point at which there is a 50% chance of presentation as ruptured was found to be WTR = 7.9×10-3 when calculated without post-rupture adjustments and WTR' = 6.2×10-3 when calculated with post-rupture adjustments, from which the proposed 6.1×10-3 differs by 23% and 1.4%, respectively. The model for IA rupture mechanics assessed in this study agrees reasonably well with clinical data and could serve as a foundation for further investigation. It additionally performs well in discriminating between ruptured and unruptured aneurysms, though its performance in this dataset is similar to more conventional, simpler parameters. Most importantly, this study demonstrates that biomathematical models can provide valuable insight into the nature of aneurysmal lesions despite their simplifying assumptions.

The hypoperfusion volume has a strong predictive value for hemorrhagic transformation in acute ischemic stroke patients with anterior circulation occlusion after endovascular thrombectomy

ObjectiveIt remains unclear whether hypoperfusion volume elevates the risk of hemorrhagic transformation (HT) after endovascular thrombectomy (EVT) in patients with acute ischemic stroke (AIS). This study aims to investigate the association between hypoperfusion volume and HT after EVT.Materials and methodsWe retrospectively recruited AIS patients with anterior circulation occlusion after receiving EVT from January 2021 to May 2024. The pre-EVT hypoperfusion volume was assessed using computed tomography perfusion, with a hypoperfusion area defined as time-to-maximum > 6s. Multivariable analysis determined whether the hypoperfusion volume served as an independent predictor of symptomatic intracerebral hemorrhage (sICH) or intracerebral hemorrhage (ICH), and its predictive value was evaluated using receiver operating characteristic (ROC) curves.ResultsA total of 115 patients were analyzed, with 55 (47.8%) having ICH and 16 (13.9%) experiencing sICH. The median age was 67, and 28.6% were female. The median core infarct volume was 4.3 ml, and the median hypoperfusion volume was 112.8 ml. After adjusting for potential confounding factors, the hypoperfusion volume remained independently correlated with sICH (OR = 1.008, 95% CI = 1.001–1.015, P = 0.018) and ICH (OR = 1.006, 95% CI = 1.001–1.012, P = 0.033). ROC curve analysis demonstrated that the hypoperfusion volume effectively predicted sICH [(area under the curve (AUC) = 0.702] or ICH (AUC = 0.643).ConclusionThe hypoperfusion volume has a strong predictive value for sICH and ICH in AIS patients with anterior circulation occlusion after EVT. This underscores the necessity of assessing the hypoperfusion volume before EVT, particularly for patients with smaller core infarct volumes in AIS.

Clinical utility of complete blood count indices in pediatric MOG antibody-associated disease.

Clinical utility of complete blood count indices in pediatric MOG antibody-associated disease.

Integration of amide proton transfer-weighted imaging and methionine positron emission tomography histogram parameters enhances the prediction of isocitrate dehydrogenase mutations in adult diffuse gliomas

BackgroundTo evaluate whether the combination of amide proton transfer-weighted imaging (APT-WI) and methionine positron emission tomography (MET-PET) enhances the non-invasive prediction of isocitrate dehydrogenase (IDH) mutation status in adult diffuse gliomas.ResultsWe retrospectively analysed 28 adult patients with histologically confirmed diffuse gliomas who underwent preoperative APT-WI and MET-PET imaging at our institution. Histogram analyses were conducted for both imaging modalities, extracting parameters such as the 10th, 50th, 70th, and 90th percentiles, mean, variance, skewness, and kurtosis. Parameters between IDH-mutant and IDH-wildtype gliomas were compared using the Mann–Whitney U test. Diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis, and combined models of the two parameters were constructed using multivariable logistic regression. IDH-wildtype gliomas exhibited significantly higher APT-WI 90th percentile (APT90) values (median: 3.51%, interquartile range [IQR]: 1.92–4.23%) compared to IDH-mutant gliomas (median: 2.24%, IQR: 1.52–2.85%, p = 0.039). Similarly, IDH-wildtype gliomas showed elevated MET-PET maximum tumour-to-normal ratios (TNRmax) (median: 2.51, IQR: 2.13–3.41) compared to IDH-mutant gliomas (median: 1.62, IQR: 1.30–2.77, p = 0.020). ROC curve analysis indicated that the combined model of APT90 and TNR kurtosis achieved an area under the curve of 0.85, demonstrating superior diagnostic accuracy compared to that of single-parameter models.ConclusionsCombining histogram-derived parameters from APT-WI and MET-PET significantly improves the diagnostic accuracy for predicting IDH mutation status in diffuse gliomas. This non-invasive approach may serve as a valuable adjunct for preoperative evaluation and the development of personalised treatment strategies in patients with gliomas.

Raising the bar: Preliminary investigation of alternative MSVT cutoffs for adults referred for ADHD

This study investigated the classification accuracy of alternative cutoffs for three Medical Symptom Validity Test (MSVT) indices, Immediate Recall (IR), Delayed Recall (DR), and Consistency (CNS). Study 1 included 83 college students randomized into two simulated ADHD groups (Incentivized simulator n = 25; Non-incentivized simulator n = 28) and one control group (n = 30). Study 2 included cross-sectional data from 114 ADHD referrals at a university-based clinic (n = 91 valid group; n = 23 invalid group) who completed the MSVT and at least two additional performance validity tests. Receiver Operator Characteristic (ROC) curves in study 1 revealed significant areas under the curve for IR, DR, and CNS (AUC = .81 − .86), high to perfect specificity (.93 − .10), and moderate to high sensitivity (.45 − .75) using cutoffs of ≤85, ≤90, and ≤95. ROC curve analyses in study 2 yielded significant areas under the curve for IR (AUC = .73), DR (AUC = .74), and CNS (AUC = .78). An optimal cut score of ≤90 across all three subtests yielded modest sensitivity (.35 − .52) while still maintaining adequate specificity (.91 − .96). The manual-recommended cutoff for invalidity (IR, DR, or CNS ≤85) demonstrated high specificity (95%) but only modest sensitivity (35%) whereas the modified cutoff (IR, DR, or CNS ≤90) increased sensitivity substantially (56%) while maintaining adequate specificity (90%). This study provides preliminary support for alternative MSVT cutoffs in adult ADHD assessments. However, additional research is warranted before utilizing these alternative cutoffs in clinical contexts.

Systemic immune-inflammation index is associated with adverse outcomes in patients hospitalized for AECOPD: A multicenter cohort study.

Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are associated with increased morbidity and mortality. The novel inflammatory biomarker, systemic immune-inflammation index (SII), may have prognostic value. This study aimed to assess the association between SII and short-term and long-term adverse outcomes among AECOPD inpatients. This was a multicenter, retrospective analysis of a prospectively collected cohort of AECOPD inpatients. We initially compared SII and other clinical characteristics between survivors and non-survivors during hospitalization, adjusting for primary comorbidities using propensity score matching (PSM). We assessed the short-term and long-term adverse outcomes, particularly focusing on in-hospital mortality and 2-year all-cause mortality, across different levels of SII. Multivariate Cox analysis was employed to evaluate the associations of SII, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) with in-hospital mortality of AECOPD patients. Restricted cubic spline (RCS) models investigated the nonlinear relationships between these biomarkers and in-hospital mortality. To compare the predictive values of SII, NLR, and PLR for in-hospital mortality, receiver operating characteristic (ROC) curve analysis was performed. Subgroup analysis was carried out to further determine the predictive capacity of SII among diverse subgroups. The study included 12,551 AECOPD inpatients, among whom 180 (1.4%) died in hospital. Whether before or after PSM adjusting for comorbidities, the levels of SII, NLR, and PLR in non-survivors were significantly higher than those in survivors (all P < 0.001). Elevated SII levels (divided into quartiles) were associated with increased in-hospital mortality (Q1 vs. Q2 vs. Q3 vs. Q4: 0.6% vs. 0.8% vs. 1.5% vs. 2.8%) and 2-year all-cause mortality (15.4% vs. 22.6% vs. 22.2% vs. 27.8%), as well as other adverse outcomes (all P < 0.05). After adjusting for covariates, higher levels of SII and NLR consistently remained associated with increased in-hospital mortality. RCS analysis revealed a consistent linear relationship between SII and in-hospital mortality, while NLR and PLR exhibited nonlinear relationships. Furthermore, ROC curve analysis indicated that SII showed inferiority to NLR but superiority to PLR in predicting in-hospital mortality among AECOPD patients (area under the curve for SII vs. NLR vs. PLR: 0.670 vs. 0.731 vs. 0.609). Subgroup analysis revealed that the association between SII and in-hospital mortality varied across different subgroups. Elevated SII is associated with increased risks of short-term and long-term adverse outcomes in AECOPD inpatients, making it potential prognostic factor used to identify high-risk patients and guide the management of AECOPD.

Association between weight-adjusted waist index and carotid atherosclerotic plaque in patients with type 2 diabetes in the Chinese population

PurposeThe purpose of this study is to investigate the relationship between the weight-adjusted waist index (WWI) and the incidence of carotid atherosclerotic plaque in patients with type 2 diabetes (T2DM) in the Chinese population.MethodsA retrospective cross sectional analysis was conducted on data from 801 adult patients from May 2018 to January 2024. Spearman’s correlation analysis was used to determine the correlation between WWI and carotid atherosclerotic plaque and analyzed the factors influencing carotid atherosclerotic plaque through binary logistic regression. Additionally, the area under the receiver operating characteristic (ROC) curve (AUC) was calculated to analyze the optimal cut-off point for WWI to predict carotid atherosclerotic plaque.ResultsCompared with the non-carotid atherosclerotic plaque group, the incidence of hypertension, systolic blood pressure, in the carotid atherosclerotic plaque group were higher than in the non-carotid plaque group(P < 0.05). Correlation analysis showed that WWI was positively correlated with carotid atherosclerotic plaque (r = 0.263)(P < 0.05). Binary logistic regression analysis showed that WWI was an independent risk factor for carotid atherosclerotic plaque in patients with T2DM. The ROC curve analysis for the WWI yielded an AUC of 0.65 (95% CI = 0.611–0.69, P < 0.05) for predicting the presence of carotid atherosclerotic plaque.ConclusionWWI was independently associated with the occurrence of carotid atherosclerotic plaque in patients with T2DM. Given its simplicity and widespread use, WWI emerges as a novel and practical predictor for assessing the risk of developing carotid atherosclerotic plaque in Chinese patients with T2DM.

Incremental diagnostic value of coronary computed tomography angiography derived fractional flow reserve to detect ischemia

Over the past decade, coronary computed tomographic angiography (CCTA) has been the most robust non-invasive method for evaluating significant coronary stenosis. Thanks to new technologies, it is now possible to determine the fractional flow reserve (FFR) non-invasively using computed tomographic (CT) images. The aim of this work was to evaluate the incremental diagnostic value of CT-derived FFR for ischemia detection. In this retrospective monocentric study, we investigated 421 patients who underwent CCTA and subsequent ischemia testing between 04/2009 and 06/2020. Endpoint was ischemia on a coronary vessel level assessed by CMR (n = 20), SPECT (n = 225), invasive angiography (stenosis ≥ 90%; n = 80) or invasive FFR (positive if ≤ 0.8; n = 96). CT-FFR was derived from CCTA images by a machine learning (ML) based software prototype. Patients averaged 66.5 [58.2–73.6] years of age and 72.7% (n = 306) were male. Overall, 52.5% (n = 221) had hypertension and 67.9% (n = 286) had hypercholesteremia. Logistic regression analysis on a per vessel base showed that the diagnostic model with CT-FFR plus CCTA had significantly better-fit criteria than the diagnostic model with CCTA alone (log-likelihood χ2 230.21 vs. 192.17; p for difference < 0.001). In particular, the area under curve (AUC) by receiver operating characteristics curve (ROC) analysis for CT-FFR plus CCTA (0.87) demonstrated greater discrimination of hemodynamic ischemia compared to CCTA alone (0.83; p for difference < 0.0001). Combined CCTA and CT-FFR have improved diagnostic accuracy compared to CCTA alone in detecting ischemia on the coronary vessel level and thus could reduce the use of invasive coronary angiography in the future.

Transcriptomic sequencing of multiple salivary glands combined with bioinformatics analysis reveals key genes in primarySjögren's syndrome.

Reveal key genes involved in the pathogenesis of Primary Sjögren's Syndrome (pSS) and identify new potential biomarkers and therapeutic targets. mRNA transcriptome data from pSS patients'and healthy controls'parotid and minor salivary glands were collected from the Gene Expression Omnibus (GEO) database. mRNA sequencing was performed on pSS mouse model submandibular glands. Differentially expressed genes (DEGs) were identified and core genes were screened using protein-protein interaction (PPI)networks. Validation was done through Gene Ontology (GO),Kyoto Encyclopedia of Genes and Genomes (KEGG), immune cell infiltration, heatmap, and Receiver Operating Characteristic (ROC) curve analyses, followed by external validation. Finally, review the clinical studies of drugs targeting these genes. A total of 113 DEGs were identified, yielding 15core DEGs CD8 A, LCK, SYK, CD2, CD247, CD3D, LCP2, CD3G, CCR7, ITK, CXCR4, B2M, CXCL10, CXCL13, and CXCL9.These core genes were enriched in antigen receptor-mediated and T cell receptor signaling pathways, as well as in the chemokine signaling pathway. Immunocell infiltration analysis revealed that, except for B2M, the expression of other core genes is correlated with the proportion of immune cells. Genes like, CXCL13, CXCL9, CXCR4,CD2,CCR7,and ITK exhibited high diagnostic accuracy for distinguish in pSS patients. Core DEGs such as LCK, SYK, LCP2, and ITK was validated in salivary gland data from pSS patients and mouse models. Drugs targeting LCK, SYK, ITK, and other core genes, with their clinical status, were identified. This study identified key genes in pSS, providing novelinsights into pathogenesis, promising biomarkers, and potential therapeutictargets. Key Points • mRNA transcriptomic sequencing was conducted on submandibular gland specimens from NOD mice simulating pSS and normal mice. • Commonly dysregulated core genes were identified across the minor and parotid salivary glands of pSS patients and healthy controls, as well as in the submandibular glands of NOD and normal mice. • ROC analysis was employed to evaluate their predictive value in the diagnosis of pSS.Genes such as CXCL13, CXCL9, CXCR4, CD2, CCR7, and ITK exhibited high diagnostic accuracy for distinguishing pSS patients. • Genes such as LCK, SYK, and ITK have been validated through external verification and qPCR, and have been identified as targets for clinical drugs.

Association between uric acid to high-density lipoprotein cholesterol ratio and chronic kidney disease in Chinese patients with type 2 diabetes mellitus: a cross-sectional study

ObjectivesTo examine the association between uric acid (UA) to high-density lipoprotein cholesterol (HDL-C) ratio (UHR) and chronic kidney disease (CKD) in type 2 diabetes mellitus (T2DM) patients in China.MethodsThe investigation stems from a survey conducted in the eastern Chinese province of Zhejiang, spanning from March to November 2018. A multivariable logistic regression model was employed to assess the relationship between UHR and CKD, while restricted cubic spline (RCS) analysis was used to evaluate the dose–response relationship. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal UHR cut-off value and assess its diagnostic performance for CKD. Model performance was further evaluated using net reclassification improvement (NRI) and integrated discrimination improvement (IDI) metrics. Sensitivity analyses, including propensity score matching (PSM) and k-means clustering, were conducted to enhance the robustness of the findings. Subgroup analyses were performed across various demographic and clinical categories to examine the consistency of the UHR-CKD association.ResultsThis cross-sectional study included 1,756 Chinese patients with T2DM, among whom 485 (27.62%) were identified with CKD. Multivariable logistic regression analysis revealed a significant positive association between UHR and CKD. Per standard deviation (SD) increase in UHR was associated with a 40% higher odds of CKD (OR = 1.40, 95% CI: 1.23–1.60) after adjusting for potential covariates. When analyzed categorically, participants in the highest UHR tertile (T3) had 1.82-fold higher odds of CKD compared to the lowest tertile (T1) (95% CI: 1.32–2.50). RCS analysis demonstrated a consistent linear dose–response relationship between UHR and CKD across all models (all p for nonlinearity &amp;gt;0.05). ROC curve analysis identified an optimal UHR cut-off value of 12.28 for CKD prediction, with an area under the curve (AUC) of 0.710 (95% CI: 0.683–0.737) in the fully adjusted model. Subgroup analyses confirmed the robustness of the UHR-CKD association across most demographic and clinical variables, except for younger age groups (18–44 and 45–59 years) and smokers. Notably, BMI significantly modified the UHR-CKD relationship, with a nonlinear association observed in individuals with lower BMI (&amp;lt;24 kg/m2) and a linear association in those with higher BMI (≥24 kg/m2).ConclusionThis study demonstrates a significant dose–response relationship between the UHR and CKD in Chinese patients with T2DM, highlighting UHR as a promising biomarker for CKD risk assessment. The identified UHR cut-off of 12.28 offers a practical threshold for early renal monitoring and targeted interventions. Future research should explore UHR-targeted therapies and its integration into personalized risk stratification models to improve CKD management in T2DM.