Reliable Predictive Value Research Articles

Prognostic Value of Combined C-Reactive Protein, Body Mass Index, and Left Ventricular Ejection Fraction in Predicting Cardiovascular Events in Patients ≥80 Years of Age With Acute Myocardial Infarction

Elevated high-sensitivity C-reactive protein (hsCRP) and low body mass index (BMI) are linked to increased mortality in the elderly population. However, the combined value for predicting adverse cardiovascular events in the oldest-old (≥80 years old) with acute myocardial infarction (AMI) remains undetermined. A total of 463 AMI patients, who were ≥80 years old, were enrolled in this study between January 2012 and June 2017. A nested case-control study was implemented in 106 deaths and 212 controls, who were matched for age, gender, time of inclusion, and myocardial infarction type. Furthermore, the individual and additive values of hsCRP, BMI, and left ventricular ejection fraction (LVEF) were assessed using adjusted hazard ratio, unadjusted Kaplan-Meier analysis, and receiver-operating characteristic curve models. The median follow-up time was 19.15 months, and there were 106 deaths (33.3%). Furthermore, HsCRP, BMI, and LVEF were significantly associated with all-cause mortality (p <0.05, respectively). In addition, a negative correlation between BMI and LVEF, and the positive association of hsCRP with all-cause mortality in the fully adjusted Cox proportional hazards model were detected. The combination of hsCRP, BMI, and LVEF was found to exhibit an enhanced predictive value for all-cause mortality (0.733 in jointly vs 0.623 in cardiovascular risk factors, p = 0.0007) in these oldest-old AMI patients. HsCRP, BMI, and LVEF are the independent risk factors for all-cause mortality for the oldest-old patients with AMI, and this combination offers more appreciable and reliable predictive value for all-cause mortality.

A Validated Swallow Screener for Dysphagia and Aspiration in Patients with Stroke

Early detection of dysphagia is critical to reducing hospital complications and length of stay in patients with various types of strokes. The aim of this study was to develop and evaluate the DePaul Hospital Swallow Screener (DHSS) tool to assess for dysphagia in patients with stroke. This prospective observational study investigated patients admitted to a comprehensive stroke center. The DHSS is composed of a questionnaire containing 8 nonswallow items and a water swallow test. All patients admitted under a standard stroke protocol are screened by the nursing staff using the DHSS and then objectively evaluated by a speech-language pathologist using the Mann Assessment of Swallowing Ability (MASA). Validity measures and reliability through Cohen's κ-coefficient with associated 95% confidence intervals were calculated. A total of 224 patients completed the DHSS and had at least 1 MASA score. The overall Content Validity Index score for the DHSS was .92. Compared with the MASA dysphagia cutoff value, the DHSS had a specificity of 93% and a sensitivity of 69%, and compared with the MASA aspiration risk cutoff value, the DHSS had a specificity of 90% and a sensitivity of 70%. Stratified analysis for those with any documented stroke (ischemic or hemorrhagic) compared with those admitted with transient ischemic attack or no stroke yielded similar sensitivity and specificity in both dysphagia and aspiration risk. The DHSS is a valid and reliable swallow screening tool with moderate agreement, high specificity, and reliable predictive values when compared with the MASA.

Reliability of sonographic fetal weight estimation in triplet pregnancies: a retrospective cohort study

PurposeTo review our experience in ultrasound fetal weight estimation in our large population of triplet pregnancies.MethodsNinety-seven triplet pregnancies were retrospectively included between January 2003 and January 2017. Sonographic fetal weight estimation using Hadlock’s and Schild’s formulas was compared to actual birth weight in a tertiary-care center in Vienna, Austria. Statistical analyses were performed using a stepwise linear regression model and crosstabs.ResultsThe median discrepancy between the sonographically estimated fetal weight by Hadlock’s formula and the actual birth weight was 106 g (IQR 56–190). The percentage error and its standard deviation were − 2.5 ± 12.1%, and the median percentage error was − 3.6%. Concerning the use of Hadlock’s formula, estimated fetal weight was the most important factor predictive of actual birth weight with an estimate of 0.920 (p < 0.001). Female neonates had been overestimated by a mean of 50.473 g per fetus. The sonographic prediction of small-for-gestational-age neonates was significantly reliable (p < 0.001), with positive and negative predictive values ranging from 81.3 to 100.0%. Similar results were obtained for Schild’s formula.ConclusionEven if sonographically estimated fetal weight in triplet pregnancies has a high overall accuracy of fetal weight estimation, there are some limitations in prediction of intrauterine growth restrictions, especially in female fetuses.

Reproducibility of R-fMRI metrics on the impact of different strategies for multiple comparison correction and sample sizes.

Concerns regarding reproducibility of resting-state functional magnetic resonance imaging (R-fMRI) findings have been raised. Little is known about how to operationally define R-fMRI reproducibility and to what extent it is affected by multiple comparison correction strategies and sample size. We comprehensively assessed two aspects of reproducibility, test-retest reliability and replicability, on widely used R-fMRI metrics in both between-subject contrasts of sex differences and within-subject comparisons of eyes-open and eyes-closed (EOEC) conditions. We noted permutation test with Threshold-Free Cluster Enhancement (TFCE), a strict multiple comparison correction strategy, reached the best balance between family-wise error rate (under 5%) and test-retest reliability/replicability (e.g., 0.68 for test-retest reliability and 0.25 for replicability of amplitude of low-frequency fluctuations (ALFF) for between-subject sex differences, 0.49 for replicability of ALFF for within-subject EOEC differences). Although R-fMRI indices attained moderate reliabilities, they replicated poorly in distinct datasets (replicability < 0.3 for between-subject sex differences, < 0.5 for within-subject EOEC differences). By randomly drawing different sample sizes from a single site, we found reliability, sensitivity and positive predictive value (PPV) rose as sample size increased. Small sample sizes (e.g., < 80 [40 per group]) not only minimized power (sensitivity < 2%), but also decreased the likelihood that significant results reflect "true" effects (PPV < 0.26) in sex differences. Our findings have implications for how to select multiple comparison correction strategies and highlight the importance of sufficiently large sample sizes in R-fMRI studies to enhance reproducibility. Hum Brain Mapp 39:300-318, 2018. © 2017 Wiley Periodicals, Inc.

Clinical surrogate markers for predicting metabolic syndrome in middle-aged and elderly Chinese.

Aims/IntroductionThe present study evaluated the ability of lipid accumulation product (LAP), visceral adiposity index (VAI), and the product of triglycerides and glucose (TyG), three novel markers, in identifying metabolic syndrome (MetS) with different criteria in middle‐aged and elderly Chinese.Materials and MethodsDuring June 2012 to January 2013, 992 consecutive patients (age ≥40 years) were enrolled at Daping Hospital. The criteria of MetS were based on the International Diabetes Federation and the modified National Cholesterol Education Program's Adult Treatment Panel III. VAI, LAP and TyG were computed based on a published mathematical model.ResultsThe prevalence of MetS was 42.8%. The receiver operating characteristic curve found LAP, VAI and TyG were positively related to MetS in both criteria. The optimal cut‐offs of VAI, LAP and TyG for the modified National Cholesterol Education Program's Adult Treatment Panel III and International Diabetes Federation criteria were 2.015, 31.465 and 8.706, and 2.035, 37.99 and 8.697, respectively. After adjustment of potential confounding factors, VAI, LAP and TyG were significantly correlated with MetS in all criteria according to optimal cut‐offs. For MetS, reliable predictive value was observed in different subgroups (age and sex). LAP showed the greatest area under the curve in MetS with the International Diabetes Federation definition (area under the curve 0.887, 95% confidence interval 0.852–0.922).Conclusions AP, VAI and TyG were reliable surrogate markers for identifying MetS in middle‐aged and elderly Chinese. LAP could be a better parameter than VAI and TyG for predicting MetS in the present study.

A scoring model predicts hepatitis B e antigen seroconversion in chronic hepatitis B patients treated with nucleos(t)ide analogs: real-world clinical practice

AimThis study developed and validated a non-invasive scoring model to predict 1-year hepatitis B e antigen (HBeAg) seroconversion in response to nucleos(t)ide analog (NA) treatment in NA-naïve patients with HBeAg-positive chronic hepatitis B (CHB). MethodsBaseline data from 1014 patients visiting the outpatient and inpatient clinics of Beijing Ditan Hospital, Capital Medical University, China between October 2008 and April 2015 were included. These patients received NAs for HBeAg-positive CHB. The patients were assigned randomly to the derivation (n=710) and validation (n=304) cohorts in a 7:3 ratio. A prediction scoring model was established based on univariate and multivariate Cox proportional hazards regression analyses to identify independent prediction factors. In the derivation cohort, the odds ratio of the predictors were converted to integer risk scores by rounding the quotient from dividing the odds ratio, and the final score was the sum of these values. The predictive accuracy of the scoring model was further assessed using Harrell’s concordance index (C-index). ResultsThe 1-year cumulative HBeAg seroconversion rates were 11.83% and 8.55% in the derivation and validation cohorts, respectively. In the derivation cohort, baseline pretreatment alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), globulin (GLO), and quantitative HBeAg (qHBeAg) levels were independently associated with HBeAg seroconversion and were included in the scoring system. The model had good discrimination in the derivation and validation cohorts (C-index=0.750, 95% confidence interval 0.694–0.806 and C-index=0.776, 95% confidence interval 0.698–0.855, respectively). The prediction scores ranged from 0 to 4; scores of 0–1 and 2–4 identified patients with lower and higher levels of HBeAg seroconversion, respectively. Kaplan–Meier analysis was used to determine the 1-year cumulative HBeAg seroconversion rates in the two groups (scores of 0–1 and 2–4) of the primary cohort, and log-rank tests revealed a significant difference (4.87% vs. 20.9%, p<0.0001). ConclusionsThe 1-year prediction scoring model based on baseline levels of ALT, GGT, GLO, and qHBeAg offered a reliable predictive value for the response to NA therapy in a Chinese cohort.

Predictive Value of Transvaginal Ultrasound in Diagnosis of Endometriosis: A Three Year Study

Background: To assess the predictive value of various transvaginal sonography findings in characterizing endometriosis. Methods: This prospective investigation was conducted at Royan Institute, Tehran, Iran, from April 2010 till March 2013. All infertile women presenting with clinical symptoms of endometriosis, who were booked for laparoscopy, underwent a preoperative trasvaginal sonography by an expert radiologist. Endometriosis was diagnosed on TVS according to detecting one or more of following findings: echogenic points on serosal surface of the ovaries, ovarian endometrioma and signs of pelvic adhesion (blurred ovary margins, fixation of ovaries, deviation of ovaries or decreased distance between them). A logistic regression analysis was performed to identify prognostic factors in detection of presence of endometriosis. Each parameter was entered sequentially into the model based on hosmer-lemeshow algorithm. Values were calculated by Stata12 software regarding laparoscopy as gold standard. Results: Totally, 101women were evaluated during the study. Endometriosis was present at laparoscopy in 58 patients. Mean age and the duration of infertility were calculated 30.78 4.79 and 4.2 2.91 years respectively. Frequencies of each sonographic finding were as follow: echogenic points (%31.68), ovarian endometrioma (%30.69), blurred ovary margin (%7.92), fixation of ovaries (%15.9), deviation of ovaries (%21.8), and decreased distance between ovaries (%8.9). As derived by logistic regression analysis, detection of ovarian endometrioma, fixation of ovaries and ovarian deviation strongly predicts endometriosis (odds ratio of 42.27, 46.89 and 14.78 respectively). Conclusions: Our study demonstrated that TVS has a reliable predictive value in diagnosis of endometriosis. Ovarian endometrioma, deviation of ovaries and ovarian fixation can be used as important criteria for radiologists and gynecologists.

The Predictive Value of Trans-Vaginal Ultrasound Measurements Compared with Bishop Score in Determining Successful Induction of Labor

Objectives: Determining the necessity of cesarean section (C/S) due to failure of induction of labor (IOL) is essential to avoid fetus distress. In this study, the performance of the Bishop score and trans-vaginal ultrasound measurements were compared to predict successful IOL, and the most useful cut-o points were estimated. Methods: Nulliparous women with gestation age of > 37 weeks with a live fetus in cephalic presentation were invited to participate in this study. Bishop score was assessed by digital examination, and trans-vaginal ultrasound was used to measure cervical length. Trans-abdominal ultrasound was utilized to determine the fetal head position. Results: One hundred women entered the study. Multiple regression analysis revealed that the Bishop score and cervical length had a reliable predictive value in determining successful IOL. The cut-o points for predicting successful induction were 16 mm for cervical length and 5 for the Bishop score, using receiver operating characteristic curves (ROC). Both cervical length and Bishop score were good predictors for vaginal delivery (sensitivity and specificity of 85% and 67%, respectively for cervical length; and 84% and 70%, respectively for Bishop score). Conclusions: Cervical length is a good predictor of successful IOL. Considering the painful process of digital exam, implementing trans-vaginal ultrasound is preferred.

Predictive value of XPG rs2296147T>C polymorphism on clinical outcomes of cancer patients.

The Xeroderma pigmentosum complementation group G (XPG) rs2296147T>C polymorphism is suspected to associate with the clinical outcomes of cancer patients. However, the results are inconsistent. This meta-analysis aimed to evaluate the reliable predictive value of XPG rs2296147T>C polymorphism on clinical outcomes of cancer patients. A total of 11 eligible studies were enrolled in this meta-analysis. Our results indicated that the cancer patients with TT and CT genotypes were significantly associated with better respond rates when compared with the CC genotype (TT versus (vs.) CC: odds ratio (OR) = 2.05, 95% confidence intervals (CIs), 1.32-3.20, P = 0.002; TT+CT vs. CC: OR= 1.57, 95% CI, 1.14-2.17, P = 0.005). The TT genotype and/or T allele might be associated with higher survival time for cancer patients than the CC genotype and/or C allele. The cumulative meta-analyses showed an apparent beneficial objective response of TT genotype on cancer patients. In conclusion, this meta-analysis suggests that the XPG rs2296147T>C polymorphism is associated with the clinical outcomes of cancer patients. The XPG rs2296147T>C polymorphism might be a predictive factor of prognosis in cancers patients and contribute to individual treatment in the future.

Reliability, Validity, and Injury Predictive Value of the Functional Movement Screen: A Systematic Review and Meta-analysis

Background: The Functional Movement Screen (FMS) is utilized by professional and collegiate sports teams and the military for the prevention of musculoskeletal injuries. Hypothesis: The FMS demonstrates good interrater and intrarater reliability and validity and has predictive value for musculoskeletal injuries. Study Design: Systematic review and meta-analysis. Methods: A systematic review and meta-analysis were conducted using a computerized search of the electronic databases MEDLINE and ScienceDirect in adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Extracted relevant data from each included study were recorded on a standardized form. The Cochran Q statistic was utilized to evaluate study heterogeneity. Pooled quantitative synthesis was performed to measure the intraclass correlation coefficient (ICC) for interrater and intrarater reliability, along with 95% CIs, and odds ratios with 95% CIs for the injury predictive value for a score of ≤14. Results: Eleven studies for reliability, 5 studies for validity, and 9 studies for the injury predictive value were identified that met inclusion and exclusion criteria; of these, 6 studies for reliability and 9 studies for the injury predictive value were pooled for quantitative synthesis. The ICC for intrarater reliability was 0.81 (95% CI, 0.69-0.92) and for interrater reliability was 0.81 (95% CI, 0.70-0.92). The odds of sustaining an injury were 2.74 times with an FMS score of ≤14 (95% CI, 1.70-4.43). Studies for validity demonstrated flaws in both internal and external validity of the FMS. Conclusion: The FMS has excellent interrater and intrarater reliability. Participants with composite scores of ≤14 had a significantly higher likelihood of an injury compared with those with higher scores, demonstrating the injury predictive value of the test. Significant concerns remain regarding the validity of the FMS.

Assessment of flavanol stereoisomers and caffeine and theobromine content in commercial chocolates

Assessment of the flavanol composition of 41 commercial chocolates was by HPLC-DAD. Among individual flavonols ranged from 0.095 to 3.264mgg−1, epicatechin was the predominant flavanol accounting for 32.9%. Contrary to catechin, epicatechin was a reliable predictive value of the polyphenol content. Conversely the percentage of theobromine used as a proxy measure for nonfat cocoa solids (NFCS) was not a good predictor of epicatechin or flavanol content. In a further chiral analysis, the naturally occurring forms of cocoa flavanols, (−)-epicatechin and (+)-catechin, was determined joint the occurrence of (+)-epicatechin and (−)-catechin due to the epimerization reactions produced in chocolate manufacture. (−)-Epicatechin, the most bioactive compound and predominant form accounted of 93%. However, no positive correlation was found with% cocoa solids, the most significant quality parameter.

78. Diagnostic accuracy of neurophysiological tests (EEG and SEP) in comatose patients after cardiac arrest: Protocol presentation of Italian Multicentric Study (ProNeCA)

The prediction of neurologic outcome in comatose patients after cardiac arrest (CA) has been investigated and the findings were summarized in a practice parameter of the American Academy of Neurology (1). These guidelines did not include the EEG as a reliable outcome indicator but recent studies on continuous EEG recorded during TH have re-evaluated the role of EEG (2–4). These studies underline the utility of a simplified classification system of EEG patterns and point to which pattern attains reliable predictive value both for good and bad outcomes. These reports are of high clinical relevance because, until today, the possibility of identifying early prognostic indicators of good outcome in patients surviving to CA has not been investigated. At the best of our knowledge, only few multicentre prospective studies (4–6) analyzed the prognostic value of EEG and SEP recorded in the same patient after CA as single predictor but none analyzed the diagnostic accuracy of the association of these two tests. We present the study protocol of Italian Multicentre Study about prognostic value of EEG and SEP in comatose patients after CA (ProNeCA) proposed by study group of “Intraoperative and Intensive Care Clinical Neurophysiology” of the Italian Society of Clinical Neurophysiology.

Development and Evaluation of an Online Fall-Risk Questionnaire for Nonfrail Community-Dwelling Elderly Persons: A Pilot Study.

Introduction. Falls are frequent in older adults and may have serious consequences but awareness of fall-risk is often low. A questionnaire might raise awareness of fall-risk; therefore we set out to construct and test such a questionnaire. Methods. Fall-risk factors and their odds ratios were extracted from meta-analyses and a questionnaire was devised to cover these risk factors. A formula to estimate the probability of future falls was set up using the extracted odds ratios. The understandability of the questionnaire and discrimination and calibration of the prediction formula were tested in a cohort study with a six-month follow-up. Community-dwelling persons over 60 years were recruited by an e-mail snowball-sampling method. Results and Discussion. We included 134 persons. Response rates for the monthly fall-related follow-up varied between the months and ranged from low 38% to high 90%. The proportion of present risk factors was low. Twenty-five participants reported falls. Discrimination was moderate (AUC: 0.67, 95% CI 0.54 to 0.81). The understandability, with the exception of five questions, was good. The wording of the questions needs to be improved and measures to increase the monthly response rates are needed before test-retest reliability and final predictive value can be assessed.

MAP3K8/TPL-2/COT is a potential predictive marker for MEK inhibitor treatment in high-grade serous ovarian carcinomas.

Ovarian cancer is a silent disease with a poor prognosis that urgently requires new therapeutic strategies. In low-grade ovarian tumours, mutations in the MAP3K BRAF gene constitutively activate the downstream kinase MEK. Here we demonstrate that an additional MAP3K, MAP3K8 (TPL-2/COT), accumulates in high-grade serous ovarian carcinomas (HGSCs) and is a potential prognostic marker for these tumours. By combining analyses on HGSC patient cohorts, ovarian cancer cells and patient-derived xenografts, we demonstrate that MAP3K8 controls cancer cell proliferation and migration by regulating key players in G1/S transition and adhesion dynamics. In addition, we show that the MEK pathway is the main pathway involved in mediating MAP3K8 function, and that MAP3K8 exhibits a reliable predictive value for the effectiveness of MEK inhibitor treatment. Our data highlight key roles for MAP3K8 in HGSC and indicate that MEK inhibitors could be a useful treatment strategy, in combination with conventional chemotherapy, for this disease.

The Combination of D-Dimer and Peritoneal Irritation Signs as a Potential Indicator to Exclude the Diagnosis of Intestinal Necrosis.

Intestinal necrosis is a life-threatening disease, and its prompt and accurate diagnosis is very important. This study aimed to evaluate the value of d-dimer as a marker for early diagnosis of bowel necrosis.From 2009 to 2013, patients undergoing operation due to acute intestinal obstruction were retrospectively analyzed. Clinicopathologic characteristics were compared among no ischemia group, reversible ischemia group, and bowel necrosis group.There were totally 274 patients being included for analyses. Patients with bowel necrosis had a significant highest level of d-dimer compared with other 2 groups (P = 0.007) when FEU unit was applied. The optimal cutoff value of d-dimer levels as an indicator in diagnosing bowel necrosis was projected to be 1.965 mg/L, which yielded a sensitivity of 84.0%, a specificity of 45.6%, a positive predictive value of 60.7%, and a negative predictive value of 74.0%. And the sensitivity of 84.0% and specificity of 70.0% were detected, when 1.65 mg/L of d-dimer was set as the cutoff value to distinguish the reversible ischemia and bowel necrosis. The corresponding results in patients with no or slight peritoneal irritation signs were 85.2%, 44.7%, 35.4% and 89.5% respectively. The sensitivity and negative predictive value were 96.0% and 91.7%, respectively, when d-dimer and peritoneal irritation signs were combined to perform the parallel analysis.The combination of d-dimer and peritoneal irritation signs could generate a reliable negative predictive value, which is helpful to exclude the diagnosis of intestinal necrosis. However, it should also be proved in well-designed large-scale prospective study.

External validation of termination of resuscitation guidelines in the setting of intra-arrest cold saline, mechanical CPR, and comprehensive post resuscitation care

BackgroundThe development of advanced life support (ALS) termination of resuscitation (TOR) guidelines for out-of-hospital cardiac arrest (OHCA) seeks to improve the efficiency of scarce pre-hospital resources. However, as pre-hospital treatment for OHCA evolves and survival improves, these TOR guidelines must be reevaluated in the contemporary context of emergency medical services (EMS) providing access to advanced resuscitation care. MethodsRetrospective review of all adult (>18 years old), non-traumatic, OHCA patients (defined as patients with absence of pulse who received either CPR and/or defibrillation) treated by EMS in Richmond, VA, from January 1, 2009 to December 31, 2010. In addition to standard ALS, intra-arrest cold saline, mechanical CPR, and transportation to a comprehensive post-resuscitation center (CPRC) was provided. Patient treatment and outcomes were recorded via prehospital patient care reports and data were evaluated against previously established criteria for termination of resuscitation in an ALS EMS system. According to the aforementioned previously described criteria for TOR, patients meeting a single criterion for transport are recommended to be transported emergently to a comprehensive post-resuscitation care facility. Conversely, patients failing to meet any of the TOR criteria can be presumed to be expired without exception. Survival at 180 days was presumed when death could not be verified from publically reportable sources. ResultsOf the 322 OHCA patients enrolled, the majority were male (59%), unwitnessed (52%), received no bystander CPR (67%), and presented in a non-shockable initial rhythm (79%), with an average age of 62.5 years. Overall survival was 17%, 14%, 12%, and 11% at 7, 14, 30, and 180 days, respectively. Of the 75 patients for which TOR guidelines recommended termination, none survived yielding both 100% specificity (95% CI 100–92.8%) and positive predictive value (95% CI 100–94.1%). However, TOR guidelines recommended transport of 208 of the 283 patients who died within 30 days, resulting in a sensitivity of 26.5% (95% CI 34.5–23.4%). ConclusionThe TOR guidelines continue to have a reliable positive predictive value for death even in the setting of advanced EMS resuscitation methods and access to a CPRC. However, as the potential for survival from OHCA improves, the efficiency gained from their use is impacted greatly.

The Reliability of VCUG Performed Within 24 Hours After Injection of Dextranomer/Hyaluronic Acid in Patients With Vesico-ureteral Reflux

To assess the reliability and negative predictive value of voiding cystourethrogram (VCUG) performed within 24 hours postoperatively. Forty patients (56 ureters) who underwent first injection of dextranomer/hyaluronic acid (Dx/HA) because of vesicoureteral reflux (VUR) were enrolled. Patients with previous reflux operation or neurogenic disorders were excluded. All patients underwent the hydrodistention implantation technique (HIT). Patients underwent VCUG within 24 hours postoperatively and after 6 months. Grade 0 and grade 1 were considered to be cured. Negative predictive values of VCUG performed within 24 hours postoperatively were assessed. The mean age of the patient was 98 ± 45.8 months. Twenty-seven patients were male and 13 patients were female. The number of refluxing ureters was 4, 12, 14, 12, and 14 in ascending order of VUR grade. Overall success rate of single injection therapy was 66.07%. Only 2 ureters with grade IV and 1 patient with grade V VUR showed failure on 24-hour VCUG. The success rates on 6 months VCUG were 100%, 83.3%, 78.57%, 50%, and 42.85% according to ascending order of VUR grade.The negative predictive value of 24-hour VCUG were 100%, 83.3%, 78.57%, 60.0%, and 46.15% according to ascending order of VUR grade. VUR grade was the only factor associated with the discrepancy. Positive but weak correlation was noted between the preoperative grade of VUR and the rate of discrepancy on Spearman correlation analysis (Spearman correlation coefficient= 0.303, P value= .018). Twenty-four hour VCUG cannot replace follow-up VCUG usually performed beyond 3 months postoperatively. Further studies are needed for confirmation of cure.

GW24-e1871 A survey of anticoagulation therapy of nonvalvular atrial fibrillation in elderly patients

ObjectivesTo investigate the current status of antithrombotic treatment in elderly patients with nonvalvular atrial fibrillation. The general feature were recorded and risk factors of stroke thromboembolism were estimated in order...

653 URINARY FLOW PATTERN ASSOCIATED WITH STATUS OF VESICOURETERAL REFLUX IN CHILDREN

due to biodegradability of the substance. This study was performed to assess the reliability and negative predictive value of VCUG performed within 24hours postoperatively and factors associated with the discrepancy in the outcome. METHODS: From January 2010 to July 2012, a total of 40 patients (53 ureters) who underwent first injection of Dextranomer/ Hyaluronic acid (Deflux) due to VUR were enrolled. Patients with previous reflux operation, neurogenic disorders were excluded. All patients underwent modified STING methods developed by Kirsch et al. Patients underwent VCUG within 24 hours postoperatively and after 6months. Grade 0 and grade 1 were considered to be cure. Negative predictive values of VCUG performed within 24hours postoperatively were assessed. RESULTS: The mean age of was 98 45.8 months. 27 patients were male and 13 patients were female. The number of refluxing ureters according to grade was was 4,12,14,11 and 13 in ascending order of VUR grade. Overall success rate of single injection therapy was 69.8%. Only 2 ureters with grade IV, 1 patient in grade V VUR showed failure on 24 hour VCUG. The success rates on 6 months VCUG were 100%, 90.9%, 84.61%, 50% and 46.15% and negative predictive value of 24 hour VCUG were 100%, 83.3%, 69.2%, 60% and 46.15% according to ascending order of VUR grade. Positive correlation was noted between grades of VUR and the rate of discrepancy in linear by linear association test (p value 0.016). CONCLUSIONS: 24 hour VCUG cannot replace follow up 6months VCUG. Absorption of the injection material maybe the key factor in association with VUR grades are associated with failure of injection therapy.

Empirical chemosensitivity testing in a spheroid model of ovarian cancer using a microfluidics-based multiplex platform

The use of biomarkers to infer drug response in patients is being actively pursued, yet significant challenges with this approach, including the complicated interconnection of pathways, have limited its application. Direct empirical testing of tumor sensitivity would arguably provide a more reliable predictive value, although it has garnered little attention largely due to the technical difficulties associated with this approach. We hypothesize that the application of recently developed microtechnologies, coupled to more complex 3-dimensional cell cultures, could provide a model to address some of these issues. As a proof of concept, we developed a microfluidic device where spheroids of the serous epithelial ovarian cancer cell line TOV112D are entrapped and assayed for their chemoresponse to carboplatin and paclitaxel, two therapeutic agents routinely used for the treatment of ovarian cancer. In order to index the chemoresponse, we analyzed the spatiotemporal evolution of the mortality fraction, as judged by vital dyes and confocal microscopy, within spheroids subjected to different drug concentrations and treatment durations inside the microfluidic device. To reflect microenvironment effects, we tested the effect of exogenous extracellular matrix and serum supplementation during spheroid formation on their chemotherapeutic response. Spheroids displayed augmented chemoresistance in comparison to monolayer culturing. This resistance was further increased by the simultaneous presence of both extracellular matrix and high serum concentration during spheroid formation. Following exposure to chemotherapeutics, cell death profiles were not uniform throughout the spheroid. The highest cell death fraction was found at the center of the spheroid and the lowest at the periphery. Collectively, the results demonstrate the validity of the approach, and provide the basis for further investigation of chemotherapeutic responses in ovarian cancer using microfluidics technology. In the future, such microdevices could provide the framework to assay drug sensitivity in a timeframe suitable for clinical decision making.