Receiver Operating Curve Analysis Research Articles

Diagnostic accuracy of the Clear Cell Likelihood Score and selected MRI parameters in the characterization of indeterminate renal masses – a single-institution study

PurposeWe aimed to assess the diagnostic accuracy of the clear cell likelihood score (ccLS) and value of other selected magnetic resonance imaging (MRI) features in the characterization of indeterminate small renal masses (SRMs).MethodsFifty patients with indeterminate SRMs discovered on MRI between 2012 and 2023 were included. The ccLS for the characterization of clear cell renal cell carcinoma (ccRCC) was calculated and compared to the final diagnosis (ccRCC vs. ‘all other’ masses).ResultsThe ccLS = 5 had a satisfactory accuracy of 64.0% and a very high specificity of 96.3%; however, its sensitivity of 26.1% was relatively low. Receiver operating curve (ROC) analysis revealed that from the selected MRI features, only T1 ratio and arterial to delayed enhancement (ADER) were good discriminators between ccRCC and other types of renal masses (area under curve, AUC = 0.707, p = 0.01; AUC = 0.673, p = 0.03; respectively). The cut-off points determined in ROC analysis using the Youden index were 0.73 (p = 0.01) for T1 ratio and 0.99 for ADER (p = 0.03). The logistic regression model demonstrated that ccLS = 5 and T1 ratio (OR = 15.5 [1.1-218.72], p = 0.04; OR = 0.002 [0.00-0.81], p = 0.04) were significant predictors of ccRCC.ConclusionsThe ccLS algorithm offers an encouraging method for the standardization of imaging protocols to aid in the diagnosis and management of SRMs in daily clinical practice by enhancing detectability of ccRCC and reducing the number of unnecessary invasive procedures for benign or indolent lesions. However, its diagnostic performance needs multi-center large cohort studies to validate it before it can be incorporated as a diagnostic algorithm and will guide future iterations of clinical guidelines. The retrospective nature of our study and small patient population confined to a single clinical center may impact the generalizability of the results; thus, future studies are required to define whether employment of the T1 ratio or ADER parameter may strengthen the diagnostic accuracy of ccRCC diagnosis.Graphical

Deregulation of MMP-2 and MMP-9 in laryngeal cancer: A retrospective observational study.

Laryngeal carcinoma (LC) is reported to have a higher incidence rate among all types of head and neck cancers around the globe. Mechanisms resulting in the pathogenesis of LC are complicated due to involvement of invasion and metastasis and there is a need to understand this complicated multistep process. Numerous molecules including matrix metalloproteinases (MMPs) are involved in regulating metastatic mechanisms. Furthermore, activation and expression of different classes of MMPs have been observed in multiple pathological and physiological events including inflammation, invasion, and metastasis. Among all members of MMPs, matrix metalloproteinases-2 (MMP-2), and matrix metalloproteinases-9 (MMP-9) have been frequently reported to correlate with tumor pathogenesis. The present study is designed to check the involvement of MMP-2 and MMP-9 in LC pathogenesis. 184 laryngeal tumor samples along with adjacent uninvolved healthy sections were collected to check the expression deregulation of the above-mentioned gene in LC using real-time PCR and immunohistochemistry (IHC). Real-time PCR and IHC analyses showed the significant upregulation of MMP-2 (P < .0001) and MMP-9 (P < .0001) genes in laryngeal tumors compared to controls. Spearman correlation showed the positive correlation of expression deregulation of selected MMPs with advanced TNM stage [MMP-2, (P < .0001); MMP-9, P < .0001] and smoking status [MMP-2 (P < .0001); MMP-9 P < .0001] in laryngeal pathogenesis. Receiver operating curve (ROC) analysis showed the good diagnostic/prognostic value of said markers in laryngeal cancer patients. The present study showed that significant upregulation of selected MMPs was found associated with an increased risk of laryngeal cancer and can act as good diagnostic markers for the detection of said disease.

Elevated myocardial extracellular volume fraction is associated with the development of conduction pathway defects following transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) has become an established method of aortic stenosis treatment but suffers from the risk of heart block and pacemaker requirement. Risk stratification for patients who may develop heart block remains imperfect. Simultaneously, myocardial fibrosis as measured by cardiac magnetic resonance imaging (CMR) has been demonstrated as a prognostic indicator of ventricular recovery and mortality following TAVR. However, the association of CMR-based measures of myocardial fibrosis with post-TAVR conduction disturbances has not yet been explored. We evaluated whether myocardial fibrosis, as measured by late gadolinium enhancement and extracellular volume (ECV) from CMR would be associated with new conduction abnormalities following TAVR. One hundred seventy patients who underwent CMR within 2 months before TAVR were retrospectively reviewed. Septal late gadolinium enhancement (LGE) and ECV measurements were made as surrogates for replacement and interstitial fibrosis respectively. New conduction abnormalities were defined by the presence of transient or permanent atrioventricular block, new bundle branch blocks, and need for permanent pacemaker. Association of myocardial fibrosis and new conduction derangements were tested using receiver operator curve (ROC) and regression analysis in patients with and without pre-existing conduction issues. Forty-six (27.1%) patients developed post-TAVR conduction deficits. ECV was significantly higher among patients who experienced new conduction defects (26.2 ± 3.45% vs. 24.7% ± 4.15%, p value: 0.020). A greater fraction of patients that had new conduction defects had an elevated ECV of ≥26% (54.3% vs. 36.3%, p value: 0.026). ECV ≥ 26% was independently associated with the development of new conduction defects (odds ratio [OR]: 2.364, p value: 0.030). ROC analysis revealed a significant association of ECV with new conduction defects with an area under the receiver operating characteristic curve (AUC) of 0.632 (95% confidence interval: 0.555-0.705, p value: 0.005). The combination of prior right bundle branch block (RBBB) and ECV revealed a greater AUC of 0.779 (0.709-0.839, p value: <0.001) than RBBB alone (Delong p value: 0.049). No association of LGE/ECV with new conduction defects was observed among patients with pre-existing conduction disease. Among patients without baseline conduction disease, ECV was independently associated with the development of new conduction deficits (OR: 3.685, p value: 0.008). The present study explored the association of myocardial fibrosis, as measured by LGE and ECV with conduction deficits post-TAVR. Our results demonstrate an association of ECV, and thereby interstitial myocardial fibrosis, with new conduction derangement post-TAVR and introduce ECV as a potentially new risk stratification tool to identify patients at higher risk for needing post-TAVR surveillance and/or permanent pacemaker.

Specificity of the short‐story task for autism diagnosis when controlling for depression

AbstractSecuring an accurate autism‐spectrum‐condition diagnosis, particularly among women, remains challenging for autistic adults. Building upon previous research highlighting the short‐story task (SST) as a promising tool for detecting fiction‐based mentalizing difficulties in autistic adults, this study expands its scope. We investigated the SST's discriminative capacity across three distinct groups: autistic individuals (n = 32), nonautistic individuals without mental health problems (n = 32), and nonautistic individuals with clinical depression (n = 30). All three groups differed significantly from each other in their SST mentalizing score with the nonautistic group having the highest scores, the nonautistic but depressed group having medium scores and the autistic group showing the lowest scores. Receiver operator curve (ROC) analysis reaffirmed the SST's efficacy as a discriminator. Moreover, a linear regression analysis identified the SST mentalizing score, the SST comprehension score, and the number of books read per month as significant predictors of autism‐spectrum‐condition diagnosis. These findings bolster the SST's potential as a valuable adjunct in autism diagnostics, highlighting its discriminatory ability across diverse samples.

Comparing scoring systems for Fournier gangrenes in predicting morbidity and mortality: Is FGSI still reliable?

IntroductionCompare scoring systems using Fournier gangrene severity index (FGSI), Uludag Fournier gangrene severity index (UFGSI), Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC), and neutrophil-lymphocyte ratio (NLR) to predict the outcome of patients with Fournier gangrene. Materials and methodsThis is a retrospective cohort study that includes FG patients from 2012 to 2021. NLR, FGSI, UFGSI, and LRINEC values were calculated and analyzed. Each scoring system was analyzed using a receiver-operating curve (ROC) analysis to determine its sensitivity, specificity, and area under the curve (AUC). Statistical analysis was performed using SPSS version 25. ResultsA total of 158 patients were included in this study. Regarding the mortality outcome, FGSI comprised the highest value of AUC with 80.9, with a sensitivity of 91.7% and specificity of 68.5%. LRINEC comprised the AUC value of 61.1, with 79.2% sensitivity and 64.2% specificity. NLR comprised an AUC value of 63.7, 91.7% of sensitivity, and 98.1% of specificity. In terms of length of stay, LRINEC and NLR were associated as significant predictor. ConclusionFGSI, UFGSI, and NLR are significant predictors associated with mortality in patients with Fournier gangrene. FGSI and UFGSI comprised the highest sensitivity and specificity value in predicting mortality prognosis. Moreover, this study highlighted the role of NLR and LRINEC as significant predictors for the length of hospitalization. This study shows that FGSI is still a reliable scoring system for predicting mortality in patients with Fournier Gangrene. Level of evidenceII.

Obstructive Urosepsis: Is It Possible to Personalize the Ureteral Endoscopic Treatment?

Urinary tract infection involves mortality rate when combined with ureteral obstruction. Lithotripsy has been contraindicated; however, it has been shown to be safe in selected situations. No specific criteria have been widely accepted to indicate which patients are suitable for definitive treatment. The objective of this study was to identify prognostic factors associated with poor outcome but also those patients whose definitive treatment can be performed. Observational cohort study from a prospectively maintained database of septic patients defined by the Sequential Organ Failure Assessment (SOFA). Univariate analysis was used to compare prognostic factors with Δ-SOFA score &lt;2 (group 1) and those with a Δ-SOFA ≥2 (group 2) obtained on day 3 and on admission. Different combinations of neutrophils, lymphocytes and platelets were tested as prognostic factors. Time to decompression calculated from the CT scan report to the end of surgery. A total of 229 patients were enrolled during 11 years. Two patients died. Time from CT scan to urinary tract decompression was higher in the Δ-SOFA≥2 (p = 0.04). Thrombocytopenia and the platelet-to-lymphocyte ratio were associated with Δ-SOFA≥2. Stones were disintegrated in 33.48% in group 1 and 48.84% in group 2. Platelet count and time to decompression were associated with a worse prognosis (p = 0.0008 and 0.0017). On receiver operator curve analysis, platelets count &lt;105,056 and time to decompression &gt;4.72 hours were linked to poorer outcomes. Personalized treatment, based on accessible biomarkers, can be achieved in most patients. Early surgical decompression was associated with better prognosis and definitive treatment can be performed in selected patients.

IMG-14. DIAGNOSTIC UTILITY OF THE T2-FLAIR MISMATCH SIGN FOR DNETS AND ITS ASSOCIATION WITH FGFR1 ALTERATIONS

Abstract BACKGROUND The T2-FLAIR mismatch sign, hyperintense T2-weighted signals with corresponding hypointensity on FLAIR sequence, has emerged as a potential diagnostic tool for identifying specific brain tumor subtypes. We tested the diagnostic utility of the sign in dysembryoplastic neuroepithelial tumors (DNETs) with and without FGFR1 alterations. METHODS We evaluated the T2-FLAIR mismatch sign in a cohort of 43 patients with definitive or probable DNET. Low-grade glioma patients with definite non-DNET diagnoses were chosen as control (n=43). Receiver operative curve analysis was performed, and the corresponding odds ratios were calculated. RESULTS Of the 43 DNET cases, 35 were definite, and 8 were probable DNETs. FGFR1 alterations were confirmed in 9 definitive DNETs. The area under the curve (AUC) for diagnosing DNET with the T2-FLAIR mismatch sign was 0.884 (DeLong CI: 0.2, 0.95) (Accuracy: 0.88, 95% CI: 0.80, 0.94; Sensitivity: 0.84; Specificity: 0.95); for definite DNET it was 0.891 (DeLong CI: 0.82, 0.96) (Accuracy: 0.90, 95% CI: 0.81, 0.95; Sensitivity: 0.87; Specificity: 0.94); for probable DNET it was 0.852 (DeLong CI: 0.69, 1;) (Accuracy 0.92, 95% CI: 0.81, 0.98; Sensitivity: 0.84; Specificity: 0.75), and for DNET with FGFR1 alterations was 0.977 (DeLong CI: 0.95, 1) (Accuracy 0.96, 95% CI: 0.87, 1; Sensitivity: 1; Specificity: 0.81). The odds of having DNET (definite +probable) if the T2-FLAIR mismatch sign was positive was 81.96 (CI: 16.25, 852.48, P&amp;lt;0.001), and DNET with FGFR1 is 315.4 (CI: 312.3, 318.5, P&amp;lt;0.001). CONCLUSION The T2-FLAIR mismatch sign is a reliable radiological biomarker for DNET and strongly predicts FGFR1 alterations in these tumors.

BIOM-07. DEVELOPING A CEREBROSPINAL FLUID-BASED BIOMARKER FOR MINIMAL RESIDUAL DISEASE AND RELAPSE IN PAEDIATRIC BRAIN TUMOURS USING METABOLOMIC METHODS

Abstract BACKGROUND Many paediatric brain tumours have poor outcomes due to relapse (50% in ependymoma and 30% in medulloblastoma) following treatment. Most of these occur within two years, suggesting persistent minimal residual disease (MRD) below the imaging detection threshold. Diagnosing MRD at the end-of-treatment or early relapse using a sensitive, minimally-invasive liquid biopsy could improve outcomes. Extracting metabolites arising from aberrant cancer metabolism, from cerebrospinal fluid (CSF) is promising because of the proximity of tumour to CSF. METHODS Liquid chromatography coupled with tandem high-resolution mass spectrometry (LC-MS/MS) using 25µl CSF extracted with 75µl methanol was shown to differentiate malignant paediatric brain tumours (n=47;day 14 samples) from controls (n=49). RESULTS Ependymomas (n=33) differed from medulloblastomas (n=14). Eighteen metabolites were identified as differentially abundant between tumours and controls with 14 metabolites being increased in abundance in tumours. These included amino acids and derivatives (n=8), metabolites in one carbon metabolism (n=1), carnitine cycle (n=2), aerobic glycolysis (n=2), purine catabolism (n=2), ascorbate degradation (n=1) and creatinine synthesis (n=2). From those, betaine/creatinine ratio gave an area under the curve (AUC) of 0.96 (excellent) in receiver operating curve analysis. Using a cut-off ratio of 0.1775 for discriminating brain tumours from controls, had sensitivity and specificity of 92% and 89%. Medulloblastomas were largely similar to ependymomas; nevertheless, three metabolites could discriminate between them, and met the criteria of corrected p&amp;lt;0.05. A ratio of glutarate semialdehyde/malic acid had AUC of 0.85 (good). With a cut-off ratio of 0.0422, the sensitivity and specificity were 79% and 82%. CONCLUSION This is the first CSF-based metabolomics study in ependymoma and third in medulloblastoma. Ratios of CSF metabolites can be used as biomarkers to detect brain tumours sensitively and specifically. This work will further be developed into a liquid biopsy test for the detection of MRD and early tumour recurrence.

DIPG-42. PHASE 1/2 CLINICAL TRIAL OF OMBIPEPIMUT-S IN JAPANESE PEDIATRIC PATIENTS WITH RECURRENT/REFRACTORY DIFFUSE INTRINSIC PONTINE GLIOMA, GLIOBLASTOMA, OR HIGH-GRADE GLIOMA

Abstract BACKGROUND Pediatric patients with recurred/relapsed diffuse intrinsic pontine glioma (DIPG), glioblastoma, or high-grade gliomas (HGGs) have a dismal prognosis. The present study investigated the impacts of 1) the absolute count of Wilms tumor 1 (WT1)-specific cytotoxic T cells (CTLs) at the initiation of WT-1 specific peptide vaccine (Ombipepimut-S) consisting of a killer peptide—adegramotide, a helper peptide—nelatimotide, and adjuvant MontanideTM ISA 51 VG and of 2) cumulative steroid dose on patients’ survival. We aimed to explore the optimal timing for initiating this cancer immunotherapy for them. METHODS The absolute counts of WT1-specific CTLs and lymphocytes were examined at the initiation of vaccination. This first-in-child phase 1/2 study investigated survival (overall survival [OS] and progression-free survival [PFS]), as well as cumulative steroid dose until day 28 after vaccination initiation and immune responses according to the Kaplan-Meier method and receiver-operating curve (ROC) analysis, respectively. RESULTS 18 patients (median age: 8.9 years [range: 2.8–18.7]), 11 (61.1%), 5 (27.8%), and 2 (11.1%) had DIPG, glioblastoma, and HGG, respectively) were intradermally injected with ombipepimut-S. WT1-specific immune responders accounted for 70.6% of patients. Median OS was significantly longer (P = 0.024) in WT1-specific immune responders (9.9 months [6.0−33.4]) than in nonresponders (4.9 months [2.2−16.5]). Under a low cumulative steroid dose (&amp;lt; 0.66 mg/kg body weight), ombipepimut-S significantly extended both OS (P=0.0015) and PFS (P=0.007). Immune responders tended to show the higher absolute counts of WT1-specific CTLs (P=0.091) and lymphocytes (P=0.087) at the initiation of vaccination. CONCLUSIONS Ombipepimut-S exhibited antitumor activity, and this cancer immunotherapy appeared to be preferably initiated when the patient’s immunity is relatively preserved immediately after the completion of standard therapy for primary disease or before the tumor recurs or relapses.

Can step count be used to identify older adults with high sedentary time and low moderate-to-vigorous physical activity?

Combined high sedentary time (ST) and low moderate-to-vigorous physical activity (MVPA) has been associated with adverse cardiovascular events. However, accurately assessing ST and MVPA in older adults is challenging in clinical practice. To investigate whether step count can identify older adults with unhealthier movement behavior (high ST/low MVPA) and poorer cardiometabolic profile. Cross-sectional study (n = 258; 66 ± 5 years). Step count, ST, and MVPA were assessed by hip accelerometry during 7 days. The cardiometabolic profile was assessed using a continuous metabolic syndrome score (cMetS), including blood pressure, HDL-cholesterol, triglycerides, fasting glucose, and waist circumference. Receiving operating curve analysis was used to test the performance of step count in identifying older adults with unhealthier movement behavior (highest tertile of ST/lowest tertile of MVPA). Healthier movement behavior was defined as lowest tertile of ST/highest tertile of MVPA, with neutral representing the remaining combinations of ST/MVPA. A total of 40 participants (15.5%) were identified with unhealthier movement behavior (ST ≥ 11.4 h/day and MVPA ≤ 10 min/day). They spent ~73% and 0.4% of waking hours in ST and MVPA, respectively. Step count identified those with unhealthier movement behavior (area under the curve 0.892, 0.850-0.934; cutoff: ≤5263 steps/day; sensitivity/specificity: 83%/81%). This group showed a higher cMetS compared with neutral (β = .25, p = .028) and healthier movement behavior groups (β = .41, p = .008). Daily step count appears to be a practical, simple metric for identifying community-dwelling older adults with concomitant high ST and low MVPA, indicative of unhealthier movement behavior, who have a poorer cardiometabolic profile.

The Depression Anxiety Stress Scale 8: investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers

The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers’ wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82–0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness—in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.

Evaluation of time to sputum smear conversion and its association with treatment outcomes among drug-resistant tuberculosis patients: a retrospective record-reviewing study.

Background: This study examined the time to sputum smear and culture conversion and determinants of conversion, as well as variables associated with treatment outcomes among drug-resistant pulmonary tuberculosis (DR-PTB) cases. Methods: The electronic database and written medical records of patients were utilized to assess the sociodemographic, clinical, microbiological, and treatment characteristics and outcomes of study participants. Results: Among 736 patients with pulmonary tuberculosis (PTB), the mean age was 36.5 ± 16.5years, with males comprising 53.4% and a mean weight of 47.76 ± 11.97kg. The median time period for sputum smear conversion and sputum culture conversion was a month. The first-month culture conversion (p < 0.001, aOR = 5.817, and 95% CI = 3.703-9.138) was the determinant of sputum smear conversion and receiver operating curve analysis with AUC = 0.881, 95% CI = 0.855-0.907, and p < 0.001, which showed a high level of predictive ability for the regression model for the initial sputum smear conversion. However, the first-month sputum conversion (p < 0.001, aOR = 7.446, and 95% CI = 4.869-11.388) was attributed to sputum culture conversion, and the model has shown excellent predictive ability for regression with ROC curve analysis demonstrating AUC = 0.862, 95% CI = 0.835-0.889, and p < 0.001. A total of 63.2% of patients showed favorable treatment outcomes, with 63.1% of cases achieving treatment-cured status. The previous use of SLD, history of smoking, duration of illness ≤ 1 year, extensively drug-resistant tuberculosis, and first-month sputum conversion were the variables attributed to favorable treatment outcomes observed in drug-resistant pulmonary tuberculosis cases. ROC curve analysis with AUC = 0.902, 95% CI = 0.877-0.927, and p < 0.001) has shown outstanding ability for regression model prediction for the variables influencing treatment outcomes. Conclusions: Within 2months of treatment, most patients had converted their sputum cultures and sputum smears. The determinants of early sputum smear and sputum culture conversion, as well as favorable treatment outcomes, were identified. These factors should be considered during the design and implementation of effective strategies for drug-resistant tuberculosis control programs.

Association between body roundness index (BRI) and gallstones: results of the 2017–2020 national health and nutrition examination survey (NHANES)

BackgroundGallstones are associated with obesity, and the BRI is a new obesity index that more accurately reflects body fat and visceral fat levels. The relationship between BRI and gallstone risk is currently unknown, and we aimed to explore the relationship between BRI and gallstone prevalence.MethodsA cross-sectional study was conducted utilizing data from the 2017–2020 NHANES involving a total of 5297 participants. To assess the association between BRI and gallstones, we used logistic regression analysis, subgroup analysis, and interaction terms. In addition, we performed restricted cubic spline (RCS) analysis and threshold effects analysis to characterize nonlinear relationships. We assessed the ability of BRI and Body mass index (BMI) to identify gallstones using receiver operating curve (ROC) analysis and area under the curve (AUC), and compared them using the Delong test.ResultsOf the 5297 participants aged 20 years and older included in the study, 575 had gallstones. In fully adjusted models, a positive association between BRI and gallstone prevalence was observed (OR = 1.16, 95% CI: 1.12–1.20, P < 0.0001). Individuals in the highest quartile of BRI had a 204% increased risk of gallstones compared with those in the lowest quartile (OR = 3.04, 95% CI: 2.19–4.22, P < 0.0001). The correlation between BRI and gallstones persisted in subgroup analyses. RCS analyses showed a nonlinear relationship between BRI and gallstones. The inflection point was further found to be 3.96, and the correlation between BRI and gallstones was found both before and after the inflection point. ROC analysis showed that BRI (AUC = 0.667) was a stronger predictor of gallstones than BMI (AUC = 0.634).ConclusionsElevated BRI is associated with an increased risk of gallstones in the U.S. population, and BRI is a stronger predictor of gallstones than BMI. Maintaining an appropriate BRI is recommended to reduce the incidence of gallstones.

Diagnostic value of aMMP-8 and azurocidin in peri-implant sulcular fluid as biomarkers of peri-implant health or disease.

The objective of this study was to investigate the effectiveness of testing for active matrix metalloproteinase-8 (aMMP-8) by a quantitative point-of-care (PoC), chairside lateral flow immunotest and azurocidin, in the peri-implant sulcular fluid (PISF), as biomarkers for the presence or absence of peri-implant diseases. Current research indicates that proinflammatory cytokines and extracellular matrix-degrading enzymes may be of value to diagnose and predict peri-implant disease initiation and progression, but more data are needed. Eighty patients with implants were recruited. PISF samples were collected and quantitatively analyzed for aMMP-8 (chairside) and azurocidin with ELISA. Radiographic assessments and clinical indices (probing depth, probing attachment level, bleeding on probing, and plaque) were recorded after sampling. Kruskal-Wallis test and pairwise post hoc Dunn-Bonferroni test were used to relate aMMP-8 levels and azurocidin levels to clinical parameters. The diagnostic ability of aMMP-8 (ng/mL) and azurocidin was analyzed by receiver operator curve analysis. Area under the curve (AUC) was calculated and the Spearman's rho, and the coefficient of determination (R2) were used to calculate the correlations between aMMP-8, azurocidin, and periodontal parameters. Statistically significant differences were observed for aMMP-8 levels but not for azurocidin between healthy implants, implants with mucositis, and those with peri-implantitis (13.65 ± 7.18, 32.33 ± 21.20, and 73.07 ± 43.93 ng/mL, respectively), (Kruskall-Wallis test p < .05). The aMMP-8 test with a threshold of 20 ng/mL has a sensitivity of 71.7% and a specificity of 77.8% to identify peri-implantitis and healthy implants, respectively. AUC was found to be 0.814, and the accuracy of the method reaches 73.8%. Above a cutoff value of 33.7 ng/mL of aMMP-8, the accuracy of the test to detect peri-implantitisreaches 77.5% in relation to 62.5% of BoP from the same site. Taken collectively, present data indicate that the aMMP-8 PoC lateral flow immunotest can be a beneficial, adjunctive diagnostic quantitative tool for real-time screening for peri-implant diseases.

I-FABP protein/mRNA and IL-6 as biomarkers of intestinal barrier dysfunction in neonates with necrotizing enterocolitis and SPF BALB/c mouse models.

Neonatal necrotizing enterocolitis (NEC) is a serious intestinal inflammatory disease. We investigated intestinal fatty acid binding protein (I-FABP), I-FABP mRNA, and interleukin-6 (IL-6) as potential diagnostic biomarkers in NEC. Forty mice were subjected to hypoxic-ischemic intestinal injury, and then serum I-FABP protein and mRNA levels were quantified. Ileal tissue pathological scores were determined by hematoxylin and eosin staining. I-FABP expression levels and translocation in these tissues were detected using western blotting and immunofluorescence, respectively. Samples from 30 human neonates with NEC and 30 healthy neonates had serum I-FABP protein/mRNA and IL-6 levels measured. The mouse ileal tissue pathological score and I-FABP levels, as well as serum I-FABP and I-FABP mRNA levels, were significantly higher in the model group than in the control group. Serum I-FABP, I-FABP mRNA, and IL-6 levels were significantly higher in human neonates with NEC than in the healthy group. Logistic regression and receiver operating curve analyses revealed that I-FABP protein/mRNA and IL-6 levels could be diagnostic biomarkers for NEC. I-FABP protein/mRNA and IL-6 levels are useful biomarkers of intestinal ischemic injury in neonates with NEC. The combined detection of I-FABP protein/mRNA and IL-6 is recommended rather than using a single biomarker.

Establishing Apolipoprotein-B and non-high-density-lipoprotein-C goals in Indian population: A Cross-sectional study

BackgroundDefining lipid goals solely on low-density lipoprotein-cholesterol (LDL-C) levels in Indian population may cause misclassification due to high prevalence of hypertriglyceridemia and small dense LDL-C particles. International guidelines now recommend Apoliporotein-B (Apo-B) and non-high-density lipoprotein-cholesterol (non-HDL-C) levels as alternative targets. In this study, we used a cross-sectional representative population database to determine Apo-B and non-HDL-C cut-offs corresponding to identified LDL-C targets and compared them to international guidelines. MethodsA community-based survey carried out in urban Delhi and adjacent rural Ballabhgarh provided lipid values for 3047 individuals. The Spearman correlation coefficient was used to evaluate the degree of relationship between Apo-B and LDL-C and non-HDL-C. Cut-off values for Apo-B and non-HDL-C were established using receiver operator curve analysis correlating with guideline-recommended LDL-C targets. ResultsSpearman's rank correlations between Apo-B and LDL-C (0.82) and non-HDL-C and LDL-C (0.93) were significant (p < 0.05). Proposed corresponding cut-off values for LDL-C of 55, 70,100,130 and 160 mg/dl for Apo-B and non-HDL-C in our population were 75.3, 75.5, 91.3, 107.6, 119.4 mg/dL and 92.5,96.5, 123.5, 154.5, 179.5 mg/dL respectively. However, in those with triglycerides >150 mg/dl the corresponding Apo-B and non-HDL-C values were 85.1, 92.7, 103.5, 117.5 and 135 mg/dL and 124.5, 126.5, 147.5, 167.5 and 190.5 mg/L respectively. ConclusionBased on this study we provide Apo-B and non-HDL cut-offs corresponding to target LDL-C values in Indian patients with and without high triglycerides. It is noted that in individuals with triglycerides ≥ 150 mg/dl, the Apo-B levels are much higher than the values recommended by guidelines.

Using the Equatorial Talar Line as a Radiographic Predictor of Sanders Type 3 and 4 Calcaneus Fractures and Lateral Wall Blowout.

To assess the equatorial talar line (ETL) as a sensitive radiographic parameter to predict Sanders type III and IV fractures and the presence of lateral wall blowout. Reliability of the ETL was assessed using the intraclass correlation coefficient (ICC) and receiver operating curve (ROC) to predict sensitivity. Using lateral ankle radiographs, raters determined whether the calcaneal tuberosity was "above" (predicting Sanders type I or II) or "below" (predicting Sanders type III or IV and lateral wall blowout). In determining the "above" or "below" location of the ETL, the calculated ICC was 1.0 for each session. As a predictor of Sanders fracture classification type, the calculated ICC was 0.93 for the first session and 0.89 for the second session for an overall ICC of 0.91. As a predictor of Sanders fracture type, ROC analysis yielded an overall sensitivity of 0.82. As a predictor of lateral wall blowout, ROC analysis yielded an overall sensitivity of 0.81. The ETL is a reproducible radiographic parameter that can be reliably used to crudely predict between Sanders type I or II (ETL is "above") and Sanders type III or IV (ETL is "below") calcaneus fractures as well as the presence of lateral wall blowout.

Serial neutrophils count as a stratifying tool for early follicular tonsilitis remission

Background/Aim: This study examines the correlation between sequential serum neutrophil levels and the overall improvement status or reduction rate of intravenous antibiotic administration. This study seeks to identify a cost-effective and easily accessible biomarker that can accurately predict the need for hospitalisation in patients with acute tonsillitis who are receiving intravenous broad-spectrum antibiotics. The goal is to determine the patients' suitability for early discontinuation of intravenous antibiotics and discharge. Methods: This study was conducted at the King Hussein Medical Centre in Jordan, focusing on patients with severe acute tonsillitis who did not respond to oral antibiotics. Data was collected from the electronic medical record system (Hakeem) from January 2018 to May 2021. The study classified serial serum neutrophil measurements during the first week of hospital admission into four categories. The levels were compared between the non-penicillin Cohort (Group I) and penicillin Cohort (Group II) using an Independent-T Test. The outcomes of interest included a drop in neutrophil counts exceeding 50%, a decrease in the use of intravenous antibiotics in favor of oral antibiotics, and early eligibility for discharge. The study also examined serial neutrophil counts over the tested days and compared to the outcomes of positive and negative states using receiver operating curve analyses. The optimal cutoff operating point for each ROC curve was determined by selecting the highest Youden's index of each prognosticator day level. The analysis of all results was conducted using SPSS version 20 with a significance level set at p-value &lt;0.05. Results: This study analyzed 1638 adult and elderly patients admitted to KHMC, RMS, Amman, Jordan between January 2018 and May 2021. The average age was 51.88±16.22 years, with patients dependent on intravenous penicillin being slightly older. The distribution of males and females was significant, with males making up 2.55 times the number of females. The odds ratio for positive outcomes was 4.12, with a high rate of poor outcomes in 1318 out of all eligible patients. A total of 994 (60.7%) medical patients were treated with intravenous administration, while 644 (39.3%) surgical patients were scheduled for a tonsillectomy procedure. The risk estimate for patients admitted from medical wards compared to surgical wards was an odds ratio of 0.562. The study also provided sensitivity analysis for the four tested serial neutrophil prognosticators at different day levels. Conclusion: The study supports the use of Somatic Nucleated Cell (SNC) as a reliable measure for evaluating EFR in cases of catarrhal acute tonsillitis. The maximum SNC count in Group one was 11,269 cells per cubic millimeter. Acute streptococcal infection often exhibits an ESR higher than 40, but this may be concealed by other complications. The SNC test has advantages like simplicity, quickness, and cost-effectiveness, but lacks specificity. Monitoring SNC and EFR fluctuations can initiate treatment cessation, preventing relapse and severe complications during recovery.

Predictors of low-voltage areas in the left atrium in patients with atrial fibrillation

Abstract Background Low-voltage areas (LVA) in the left atrium (LA) electroanatomical map are potent predictors of the efficacy of atrial fibrillation (AF) ablation. Clinical factors predicting the presence of LVA have moderate accuracy. The aim of the study was to find clinical and echocardiographic factors predicting the presence of LVA in patients undergoing AF ablation. Methods Consecutive unselected patients undergoing AF ablation were included in the retrospective analysis. All patients underwent transthoracic (including LA strains) and transesophageal echocardiography, pulmonary vein isolation and LA electroanatomical mapping using multipolar catheter. LVA were defined as an area greater than 2cm2 with a voltage below 0.5mV (or 0.3mV when measured during AF). Results A total of 432 patients were included in the analysis, 107 (24.8%) had LVA. The mean age of the study population was 62.8 years, 185 patients had nonparoxysmal AF (42.8%). In the univariate logistic regression analysis numerous clinical parameters (age, female sex, presence of heart failure, diabetes, coronary artery disease, AF during examination), echocardiographic parameters (LA reservoir strain - LASr, LA emptying fraction, LA volume index, E/e’, LA appendage velocity - LAAV) and mean LA pressure (measured invasively) were significant predictors of the presence of LVA. In the multivariate logistic regression analysis age (HR 1.11 per 1 year increase, p&amp;lt;0.001), LASr (HR 0.89 per 1% increase, p=0.014) and LAAV (HR 0.93 per 1cm/s increase, p&amp;lt;0.001) were significant predictors of the presence of LVA. In receiver-operator curve (ROC) analysis LASr and LAAV were potent predictors of LVA in patients tested on sinus rhythm (AUC 0.86 and 0.87 respectively), while they had moderate predictive value in patients tested on AF (LASr AUC 0.67, LAAV AUC 0.77). Conclusions Age, LASr, and LAAV were significant predictors of LVA in patients undergoing AF ablation. The predictive value of LASr and LAAV was better in patients examined during sinus rhythm than in patients examined during AF.

Electrocardiogram predictors of leadless pacemaker implantation in the right ventricular free wall

Abstract Background Leadless pacemakers (LLP) carry the potential risk of cardiac injury, especially when implanted in the free wall of the right ventricle. Purpose To investigate the ECG criteria for distinguishing free wall implantation of LLP, further clarification is needed. Methods We conducted a retrospective study involving 17 patients who underwent LLP implantation, followed by chest computed tomography to confirm the implantation site. Patients were categorized into three groups based on the location of implantation (septum [Sep], apex [Apex], and free wall [FW]), and we compared the morphology of the 12-lead ECG during LLP pacing. Results Among the implantation sites, nine were in the Sep (52.9%), five in the Apex (29.4%), and three in the FW (15.8%). In terms of pacing QRS morphology, the FW group exhibited significantly longer QRS duration (Sep: 145.6±15.2 vs. Apex: 161.6±3.6 vs. FW: 175.3±16.6, P&amp;lt;0.01), a notched QRS complex in lead III (Sep: 0.0% vs. Apex: 0.0% vs. FW: 100.0%, P&amp;lt;0.01), and a shorter peak deflection index (PDI) in lead V1 (Sep: 0.59±0.07 vs. Apex: 0.55±0.06 vs. FW: 0.40±0.02, P&amp;lt;0.01) than the other two groups. Receiver operating curve analysis to predict FW implantation revealed that a PDI of 0.42 in lead V1 (Area under the curve [AUC]=1.00, specificity=100.0%, sensitivity=100.0%, P&amp;lt;0.01) and a QRS duration of 173 msec (AUC=0.89, specificity=100%, sensitivity=66.7%, P&amp;lt;0.01) were the optimal cutoff values. Conclusion The LLP FW implantation group had a longer QRS duration, a notched QRS complex in lead III, and a shorter PDI in lead V1 compared to the other pacing sites.