Comparison Of ROC Curves Research Articles

Relationship Between Modified Systemic Immune- inflammatory Index and Contrast-Induced Nephropathy in Patients With ST-Segment Elevation Myocardial Infarction

Objective: Developing contrast induced nephropathy after primary PCI in patients with ST segment elevation myocardial infarction is a risky condition in terms of mortality and morbidity. Various studies have shown that the systemic inflammatory index predicts (SII) the development of CIN. Mean platelet volume (MPV) is an important indicator known to be associated with the platelet function and activation. Therefore, we revised SII and named it modified SII (mSII) by using NLR multiply MPV. Materials and Methods: This study includes patients who underwent pPCI due to STEMI in our cardiology department between February 2015 and February 2021. Modified SII was obtained by using MPV instead of platelet in the formula (mSII= NLR x MPV). Patients who underwent pPCI with STEMI were divided into two groups, those with CIN and those without CIN, and compared. Results: In the logistic regression analysis, it was observed that the mSII, NLR, GFR and contrast medium amount was independent predictor of CIN. The optimal threshold mSII for predicting CIN was >42.5, with a 78.1% sensitivity and 52.3% specificity ([AUC]: 0.639, 95%CI: 0.602- 0.674, p< 0.001). Pairwise comparison of ROC curves, it was observed that the predictive value of mSII for the development of CIN was better than NLR. (z-test = 3.144, P = 0.001) Conclusion: We think that mSII, which we have shown to be superior to SII in predicting the development of CIN and is very easy to calculate, is a parameter that can be considered in predicting the development of CIN after pPCI in STEMI patients.

The Aspergillus galactomannan Ag VIRCLIA® Monotest and the sõna Aspergillus galactomannan lateral flow assay show comparable performance for the diagnosis of invasive aspergillosis.

Rapid galactomannan tests, such as the sõna Aspergillus GM Lateral Flow Assay (GM-LFA) and the Aspergillus Galactomannan Ag VIRCLIA® Monotest (GM-Monotest), which are suitable for the analysis of single samples, have the potential to accelerate diagnosis of invasive aspergillosis (IA). To compare the performance of the GM-Monotest and the GM-LFA for the diagnosis of IA. Two patient cohorts were analysed: adults who had received an allogeneic haematopoietic stem-cell transplant (alloHSCT-cohort) and patients with proven/probable IA from a 5-year period (cross-sectional IA-cohort). In the alloHSCT-cohort, weekly serum samples were tested, whereas in the cross-sectional IA-cohort sera and bronchoalveolar lavage fluids were analysed. The diagnostic performance was calculated using two definitions for positivity: (1) a single positive GM result and (2) at least two positive GM results from consecutive samples. IA classification followed EORTC/MSG 2019. The alloHSCT-cohort included 101 patients. Four had proven/probable IA, 26 possible IA and 71 no IA. The specificity for one positive serum and two consecutively positive sera was 88.7% and 100% (GM-Monotest) and 85.9% and 98.6% (GM-LFA). Comparison of ROC curves in the alloHSCT-cohort showed no significant difference. The cross-sectional IA-cohort included 59 patients with proven/probable IA. The sensitivity for one positive sample and two consecutively positive samples was 83.1% and 55.1% (GM-Monotest) and 86.4% and 71.4% (GM-LFA). Both assays showed comparable diagnostic performance with a higher sensitivity for the GM-LFA if two consecutive positive samples were required for positivity. However, due to poor reproducibility, positive GM-LFA results should always be confirmed.

The potentially underestimated influence of atrial fibrillation on NT-proBNP in chest pain

Abstract Introduction/Purpose NT-proBNP is a widely used diagnostic marker in the emergency department (ED). The main objective of the current study was to determine the association of NT-proBNP in patients with chest pain presenting with sinus rhythm (SR) compared to atrial fibrillation (AFib). Hereby, a focus was the evaluation of serum NT-proBNP head-to-head to urinary NT-proBNP. Methods In this study, urinary as well as blood concentrations of NT-proBNP were measured in a total of 601 patients, who presented with acute chest pain in the ED (mean age = 61.1 y, SD = 16.9 y). In the initial ECG 68 patients suffered from AFib and 533 showed SR. The participants were categorized according to their diagnosis into acute coronary syndrome (ACS, AFib n = 28, SR n = 261), acute decompensated heart failure (ADHF, AFib n= 16, SR n = 21), non-ischemic chest pain without congestion (NICP, AFib n = 24, SR n = 96) or chest-wall syndrome (CWS, SR n = 155). Results In the overall study cohort, patients with AFib showed significantly higher concentrations of urinary as well as blood NT-proBNP compared to those in sinus rhythm (each p < 0.001). Additionally, among patients with acute coronary syndrome (ACS), there were significantly increased biomarker concentrations in patients presenting with AFib compared to sinus rhythm (each p < 0.001, AUCblood = 0.801, AUCurine = 0.701), similarly for patients categorized into NICP (each p < 0.001, AUCblood = 0.833, AUCurine = 0.756). The same pattern was observed among the ACS subcategories (each p < 0.001). Regarding ROC analysis, promising predictive values were shown for detection of AFib: STEMI (AUCblood = 0.902, AUCurine = 0.867), NSTEMI (AUCblood = 0.757, AUCurine = 0.696) and UA (AUCblood = 0.821, AUCurine = 0.681). Comparing ROC curves, significant differences were noted in UA (p < 0.001), opposite to STEMI as well as NSTEMI (each p = n. s.). Regarding ADHF, paradoxically higher NT-proBNP concentrations were noted among patients showing sinus rhythms compared to AFib. Furthermore, a multivariate binary regression analysis showed blood NT-proBNP and age as independent predictors of atrial fibrillation (p < 0.05), opposite to urinary NT-proBNP, high-sensitivity troponin T and diabetes (each p = n. s.). Conclusion Urinary and to a larger extent blood NT-proBNP showed significantly higher concentrations in AFib. In conclusion, in ED patients elevated NT-proBNP may potentially be frequently caused by a coexisting AFib. Regarding ADHF patients, the effect of AFib might be consumed by other conditions that have a greater impact on NT-proBNP.

Comparison of conventional diffusion-weighted imaging and intravoxel incoherent motion in differentiating between chromophobe renal cell carcinoma and renal oncocytoma: a preliminary study.

Quantitative comparison of the diagnostic efficacy of conventional diffusion-weighted imaging (DWI) and intravoxel incoherent motion (IVIM) in differentiating between chromophobe renal cell carcinoma (ChRCC) from renal oncocytoma (RO). A total of 48 patients with renal tumours who had undergone DWI and IVIM were divided into two groups-ChRCC (n = 28) and RO (n = 20) groups, and the apparent diffusion coefficient (ADC), true diffusivity (D), pseudo-diffusion coefficient (D*), perfusion fraction (f) and their diagnostic efficacy were compared between the two groups. The D* values were higher in the ChRCCs group compared to the RO groups (0.019 ± 0.003 mm2/s vs 0.008 ± 0.002 mm2/s, P < .05). Moreover, the ADC, D and f values were higher in ROs compared to ChRCCs (0.61 ± 0.08 × 10-3 mm2/s vs 0.51 ± 0.06 × 10-3 mm2/s, 1.02 ± 0.15 × 10-3 mm2/s vs 0.86 ± 0.07 × 10-3 mm2/s, 0.41 ± 0.05 vs 0.28 ± 0.02, P < .05). The areas of the ADC, D, D* and f values under the ROC curves in differentiating ChRCCs from ROs were 0.713, 0.839, 0.856 and 0.906, respectively. The cut-off values of ADC, D, D* and f were 0.54, 0.91, 0.013 and 0.31, respectively. The AUC, sensitivity, specificity and accuracy of the f values were 0.906, 89.3%, 80.0% and 89.6%, respectively. For pairwise comparisons of ROC curves and diagnostic efficacy, IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCCs from ROs (P = .013, .016, and .008) with f having the highest diagnostic accuracy. IVIM parameters presented better performance than ADC in differentiating ChRCCs from ROs. (1) D* values of ChRCCs were higher, while ADC, D and f values were lower than those of RO tumours. (2) f values had the highest diagnostic efficacy in differentiating ChRCC from RO. (3) IVIM parameters, that is, D, D* and f offered better diagnostic accuracy than ADC in differentiating ChRCC from RO (P=.013, .016, and .008).

Key parameters that influence surgical strategy in localised kidney cancer.

423 Background: The goal of this studywas to select the key factors affecting choice between radical nephrectomy (RN) and partial nephrectomy (PN) for patients with localized RCC based on clinical and nephrometry data. Methods: A special retrospective cohort study was conducted in National Cancer Institute of Ukraine, which results were further validated on patient dataset in urological department of University Clinic of Cologne. The Institutional Review Boards and the local ethics committees of both high-volume centres approved the study. The main nephrometry parameters of tumor location in the kidney were analysed according to the R.E.N.A.L nephrometry score. The remaining functional parenchymal volume (RFPV) was calculated using the special formula. To determine the relationship between the risk of RN or PN, the multivariate predictive modelling method containing 12 parameters was used (Artificial Neural Networks [ANN]). Data validation based on referential centre experience using ROC-curve analysis to detect clinical applicability of the null hypothesis was performed. Results: Based on the analysis, for polary and laterally located tumors, the risk of RN was conditioned only by RFPV. The average critical value of RFPV for polar lesions was X6crit = 58% (in X6 &lt; X6crit, RN was predicted); for lateral tumors - X6crit = 67% (in X6 &lt; X6crit, RN was predicted). For medial location, the risk of RN only depended on the tumor size. Average critical value of the tumor size in the medial location was X7crit = 38 mm (in X7 &gt; X7crit, RN was predicted). Based on the ROC curve comparison, there were no statistically significant differences between the AUCLin_12 and AUCMLP_3 (p = 0.12); thus, the reduced amount of the factor indicators from 12 to 3 did not worsen the model predictive qualities. Designed during primary analysis hypothesis was successfully validated in a referent centre on the cohort of 300 patients. Out of the cohort - 14 (4.6%) patients experienced false positive/negative outcome, which resulted in a radical/partial nephrectomy out of the hypothesis margins. Predictive model is characterized by high sensitivity (95.2%) and specificity (95.4%) in selecting patients for partial nephrectomy. Conclusions: For the polar and lateral tumor locations, the functioning parenchymal volumes of over 58 and 67% respectively serve as PN indications. However, for the medial lesions, the primary PN indication is a tumor size less than 38 mm.

Sentiment analysis of art and design works using deep learning

Abstract Deep learning technology has the characteristics of automatic learning, nonlinear modeling, etc., which makes the machine algorithm better adapt to the data so as to better complete the task of sentiment analysis. The purpose of this paper is to explore the application of deep learning technology in the emotional analysis of art design works. After combining the emotion construction mechanism of art design works, based on the superior performance of convolutional neural network image recognition, it is introduced into the emotion analysis of art design works, combined with the attention mechanism model, to construct the emotion analysis model of art design works based on deep learning. Art design works are collected as the experimental dataset. The emotion analysis effect of this paper’s model for art design works is evaluated through the comparison of emotion classification indexes. The comparison of ROC curves of different models, and the emotion instance analysis of art design works is carried out. The experiments show that the experimental accuracy, precision, recall, and F1 value of this paper’s model range from 81% to 86%, and the F1 and ROC values are improved by 2.3% to 7.0% and 1.7% to 4.2% compared with the comparison model, which reflects the high accuracy and precision of this paper’s model for the sentiment analysis of art design works. Seven emotional patterns were found in tea art design works, and the model can be used to analyze the emotions of art design works.

The prognostic value of left atrial strain in patients with low-flow, low-gradient aortic stenosis

Abstract Background Left atrial (LA) function is known to be an independent prognostic parameter in patients undergoing transcatheter aortic valve replacement (TAVR). However, the impact of LA function on postinterventional outcomes in patients with severe low-flow, low-gradient aortic stenosis (LFLG AS) is unknown. Objectives We aimed to evaluate postinterventional changes and prognostic value of LA strain in patients with LFLG AS who underwent TAVR. Methods We retrospectively included 88 patients (79.66 ± 6.33, 37.5% female) with symptomatic LFLG AS who underwent TAVR at the Heart Center Bonn. LA global function and strain were comprehensively assessed by the postprocessing left atrial phasic strain analysis – LA reservoir strain, LA conduit strain, and LA contractile strain ­– using a commercially available postprocessing software at baseline and three years after the procedure. The apical four-, two-, and three-chamber views with sufficient image quality were used for strain analysis. Results Baseline LA strain was found to be impaired in all patients (reservoir: 13.17 ± 7.62 %; conduit: 6.7 ± 6.4 %; contractile: -1.7 ±1.5 %). All-cause mortality was 41 % three years after the procedure. In the overall collective, LA reservoir strain was increased at follow-up (13.17 ± 7.62 % to 15.21 ± 10.13 %, p= 0.049), whereas conduit and contractile strain remained unchanged (p &amp;gt; 0.05). According to the survival at follow-up, we divided the cohort into survivors and non-survivors. Baseline reservoir (14.55 ± 8.14 % vs 9.59 ± 5.23 %, p= 0.002) and conduit (7.66 ± 7.14 % vs 4.44 ± 4.1 %, p= 0.017) strain were significantly higher in survivors. All LA strain parameters were significantly improved in survivors at follow-up. In contrast, non-survivors showed no relevant changes in LA strain parameters. In comparison of ROC curves, reservoir strain was found to be the best predictor for postinterventional survival after TAVR (reservoir AUC: 0.677, cutoff: 10 %, p = 0.007; conduit AUC: 0.642, cutoff: 3.7 %, p = 0.037; contractile AUC: 0.672, cutoff: -1,3 %, p = 0.008). Concordantly, we found that all LA strain parameters are independent predictors for three-year all-cause mortality after TAVR in cox regression analysis (reservoir OR: 0.89, p=0.005; conduit OR: 0.90, p=0.03, contractile OR: 0.71, p=0.029) in cox regression analysis. According to multivariate analysis, reservoir strain (OR: 0.91, p=0.05) and conduit strain (OR: 0.94, p=0.04) were found to be independent predictors for postinterventional survival. According to log-rank analysis, patients with a baseline reservoir strain &amp;lt; 10 % and a baseline conduit strain &amp;lt; 4 %) showed significantly higher mortality (p = 0.048). Conclusion Using LA strain parameters might optimize risk stratification and better decision-making with sufficient patient selection in this vulnerable cohort.

Prognostic value of humoral markers in patients with anthracycline-related cardiac dysfunction

Aim. To carry out a 12-month study on the prognostic role of humoral markers responsible for the main mechanisms of initiation of cardiotoxic myocardial damage (endothelin-1, soluble Fas-L, N-terminal pro-brain natriuretic peptide (NT-proBNP), tumor necrosis factor-α, interleukin (IL)-1β, matrix metalloproteinase (MMP)-2 and MMP9, soluble form of the ST2 protein (sST2), a tissue inhibitor of metalloproteinase-1, and tetranectin) in assessing the risk of progression of anthracycline-related left ventricular dysfunction.Materials and methods. The study included a total of 114 women aged 48.0 (46.0; 52.0) years without concomitant cardiovascular diseases and risk factors who received chemotherapy with anthracyclines in the past. The levels of serum biomarkers were determined using the enzyme immunoassay. Transthoracic echocardiography was performed at baseline and at 12 months of follow-up.Results. After 12 months of follow-up, all patients were retrospectively divided into 2 groups: group 1 (n = 54) included patients with an unfavorable course of anthracycline-related cardiac dysfunction (ARCD), group 2 (n = 60) encompassed patients with a favorable course of the disease. According to the ROC analysis, MMP-2 ≥ ≥ 338.8 pg / ml (sensitivity 57%, specificity 78%; AUC = 0.629; p = 0.025), MMP-9 ≥ 22.18 pg / ml (sensitivity 89%, specificity 87%; AUC = 0.886; p &lt; 0.001), sST2 ≥ 32.4 ng / ml (sensitivity 64%, specificity 70.5%; AUC = 0.691; p = 0.002), and tetranectin ≤ 15.4 pg / ml (sensitivity 69%, specificity 72%; AUC = 0.764; p &lt; 0.001) were identified as predictors of an adverse course of ARCD. When comparing ROC curves, it was found that the concentration of MMP-9 (p = 0.002) was the most significant predictor of the progression of ARCD.Conclusion. MMP-2 and -9, soluble ST2, and tetranectin can be considered as non-invasive markers for assessing the risk of ARCD progression. At the same time, an increased level of MMP-9 is the most significant predictor of ARCD progression.

Association between pan-immune-inflammation value and no-reflow in patients with ST elevation myocardial infarction undergoing percutaneous coronary intervention

Noreflow is a condition associated with a poor prognosis in ST segment elevation myocardial infarction patients. It has been shown that many inflammatory markers and index such as procalcitonin, C-reactive protein, neutrophil to lymphocyte ratio, systemic immune inflammatory index (SII), are associated with noreflow. We used a brand-new index pan-immune-inflammation value (PIV) to retrospectively evaluate the relationship between PIV and noreflow. A total of 1212 patients were included for analysis. Noreflow was observed in 145 patients. In multivariate analysis, PIV (odds ratio (OR): 1.025; [1.002–1.115], p < 0.001), baseline ejection fraction (OR: 0.963; [0.934–0.993], p = 0.015), stent length (OR: 1.032; [1.010–1.054], p = 0.004), age (OR: 1.034; [1.014-1.053], p = 0.001) and pain to PCI time (OR: 1.003 [1.002–1.005], p < 0.001) were observed to be the independent predictors of noreflow. ROC curve analysis showed that the best cut off value of PIV for predicting noreflow was ≥889 with 77.2% sensitivity and 77.5% specificity (AUC, 0.828; 95% CI [0.806-0.849]). A ROC curve comparison analysis was performed to compare PIV and SII. The predictive power of PIV was higher than SII (differences between areas: 0.154; p < 0.001). According to our findings, an increase in PIV is an independent predictor of noreflow in patients with STEMI.

Comparative study on landslide susceptibility mapping based on different ratios of training samples and testing samples by using RF and FR-RF models

Evaluation of landslide susceptibility is essential to planning of land and space utilization. For this purpose, the paper presents a case study from Fugu County, Shaanxi Province, China. Firstly, the geological environment and current state of landslides in Fugu County were investigated. Then, slope, aspect, terrain relief, curvature, lithology, land type, and normalized difference vegetation index (NDVI) were considered as the landslide susceptibility condition factors, and the correlation between these carried out by using Multicollinearity Analysis method. Next, landslide and non-landslide samples were divided into training samples and testing samples according to the sample ratios of 8/2, 7/3, 6/4, and 5/5, respectively. The landslide susceptibility mapping was carried out by using Random Forest (RF) model and Frequency Ratio coupled with Random Forest (FR-RF) model, respectively. Lastly, the landslide density (LD), landslide frequency ratio (LFR), the area under the curve (AUC) of the receiver operator, and other indicators were used to validate the rationality, accuracy, and performance of the landslide susceptibility maps produced from different models and ratios. The results indicated that all maps are reasonable, except the map when ratio is 5/5. For each map, regardless of ratios, the LD and LFR are the greatest in the zones classed as having a very high susceptibility, followed by those with a high, moderate, low, and very low classes.In the Random Forest (RF) model, when the training test set is not at the same time its in the area of extremely high sensitivity of LD and the size of the FR value respectively 7/3 (201.026) ​> ​8/2 (154.440) ​> ​6/4 (93.696) >5/5 (136.364) and 7/3 (4.806) ​> ​8/2 (3.692) ​> ​6/4 (3.260) ​> ​5/5 (2.240); in the Frequency Ratio coupled with Random Forest (FR-RF) model, Inall the training test sets the size of the proportion of LD and FR value respectively 7/3 (145.693) ​> ​6/4 (127.151) ​> ​5/5 (122.857) ​> ​8/2 (113.263) and 7/3 (3.334) ​> ​6/4 (3.073) ​> ​5/5 (2.811) ​> ​8/2 (2.592). What else, from the comparison of ROC curves, when ratio is 7/3, the accuracy of the two models is higher than that of other ratios. Similarly, the results of the ensemble model (A combination of two models with different learning abilities.) are not more reasonable than the results of the single model, which reflects that the combination of a weaker learner model (Frequency Ratio model here) with a stronger learner model (Random Forest model here) can diminish the performance of the stronger model.

Diffusion-weighted and diffusion kurtosis imaging analysis of microstructural differences in clear cell renal cell carcinoma: a comparative study.

To quantitatively compare the diagnostic values of conventional diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) analysis of microstructural differences for clear cell renal cell carcinoma (CRCC). A total of 108 patients with pathologically confirmed CRCC, including 38 Grade I, 37 Grade II, 18 Grade III and 15 Grade IV, were enrolled and divided into groups according to tumor grade [low grade (Ⅰ+Ⅱ, n = 75) and high grade (Ⅲ+Ⅳ, n = 33)]. Apparent diffusion coefficient (ADC), mean diffusivity (MD), mean kurtosis (MK), kurtosis anisotropy (KA) and radial kurtosis (RK) were performed. Both the ADC (r = -0.803) and MD (-0.867) values showed a negative correlation with tumor grading (p < 0.05) and MK (r = 0.812), KA (0.816) and RK (0.853) values a positive correlation with tumor grading (p < 0.05). Mean FA values showed no significant differences among CRCC grades (p > 0.05). ROC curve analyses showed that MD values had the highest diagnostic efficacy in differentiating low/high and Ⅱ/Ⅲ tumor grading. MD values gave AUC: 0.937 (0.896); sensitivity: 92.0% (86.5%); specificity: 78.8% (77.8%) and accuracy: 90.7% (87.3%). ADC performed worse than MD, MK, KA or RK (all p < 0.05) during pair-wise comparisons of ROC curves to show diagnostic efficacy. DKI analysis performs better than ADC in differentiating CRCC grading. Both the ADC and MD values correlated negatively with CRCC grading.The MK, KA and RK values correlated positively with CRCC grading.MD values had the highest diagnostic efficacy in differentiating low/high and Ⅱ/Ⅲ CRCC grading.

Diagnostic utility of total NT-proBNP testing by immunoassay based on antibodies targeting glycosylation-free regions of NT-proBNP.

The N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a widely used heart failure (HF) biomarker. Commercial NT-proBNP immunoassays detect only a subfraction of endogenous NT-proBNP, as the antibodies target a region of NT-proBNP that could be glycosylated at Ser44. The diagnostic utility of immunoassays measuring total NT-proBNP remains unclear. NT-proBNP was measured in 183 HF and 200 non-HF patients diagnosed by two independent cardiologists blinded to NT-proBNP results. Plasma samples either non-treated or treated with a mixture of glycosidases were analyzed by the Elecsys proBNP II assay (Roche Diagnostics, based on antibodies targeting a glycosylated region of NT-proBNP) and the SuperFlex NT-proBNP assay (PerkinElmer, based on antibodies targeting regions of NT-proBNP that are free of O-glycans). The diagnostic accuracy of the two assays was analyzed by comparison of ROC curves. The ROC-AUC for the proBNP II assay was 0.943(95% CI 0.922-0.964) for NT-proBNP measured in untreated samples and 0.935 (0.913-0.958) for NT-proBNP measured in glycosidase-treated samples. The SuperFlex NT-proBNP assay in untreated samples gave a ROC-AUC of 0.930 (95% CI 0.907-0.954). The median percentage of non-glycosylated NT-proBNP to total NT-proBNP was 1.5-1.6-fold lower in the non-HF group compared to that in the HF group. The clinical value of total NT-proBNP for HF diagnosis was similar to the subfraction of NT-proBNP that was non-glycosylated at Ser44. The lower percentage of non-glycosylated NT-proBNP to total NT-proBNP in non-HF patients suggests that total NT-proBNP might be more sensitive in individuals without current or prior symptoms of HF.

EPIAMNE: A New Scoring System for Differentiating Transient EPIleptic AMNEsia from Transient Global Amnesia.

Transient epileptic amnesia (TEA) is a rare cause of acute amnestic syndromes (AAS), often misdiagnosed as transient global amnesia (TGA). We proposed a scoring system-the EPIlepsy AMNEsia (EPIAMNE) score-using quantitative EEG (qEEG) analysis to obtain a tool for differentiating TEA from TGA. We retrospectively reviewed clinical information and standard EEGs (stEEG) of 19 patients with TEA and 21 with TGA. We computed and compared Power Spectral Density, demonstrating an increased relative theta power in TGA. We subsequently incorporated qEEG features in EPIAMNE score, together with clinical and stEEG features. ROC curve models and pairwise ROC curve comparison were used to evaluate and compare the diagnostic accuracy for TEA detection of EPIAMNE score, presence of symptoms atypical for TGA (pSymAT) and identification of anomalies (interictal epileptiform or temporal focal spiky transients) at stEEG (PosEEG). Area Under the Curve (AUC) of EPIAMNE score revealed to be higher than PosEEG and pSymAT (AUCEPIAMNE = 0.95, AUCpSymAT = 0.85, AUCPosEEG = 0.67) and this superiority proved to be statistically significant (p-valueEPIAMNE-PosEEG and p-valueEPIAMNE-pSymAT &lt; 0.05). In conclusion, EPIAMNE score classified TEA with higher accuracy than PosEEG and pSymAT. This approach could become a promising tool for the differential diagnosis of AAS, especially for early TEA detection.

Accuracy and feasibility with AI-assisted OCT in retinal disorder community screening.

Objective: To evaluate the accuracy and feasibility of the auto-detection of 15 retinal disorders with artificial intelligence (AI)-assisted optical coherence tomography (OCT) in community screening. Methods: A total of 954 eyes of 477 subjects from four local communities were enrolled in this study from September to December 2021. They received OCT scans covering an area of 12 mm × 9mm at the posterior pole retina involving the macular and optic disc, as well as other ophthalmic examinations performed using their demographic information recorded. The OCT images were analyzed using integrated software with the previously established algorithm based on the deep-learning method and trained to detect 15 kinds of retinal disorders, namely, pigment epithelial detachment (PED), posterior vitreous detachment (PVD), epiretinal membranes (ERMs), sub-retinal fluid (SRF), choroidal neovascularization (CNV), drusen, retinoschisis, cystoid macular edema (CME), exudation, macular hole (MH), retinal detachment (RD), ellipsoid zone disruption, focal choroidal excavation (FCE), choroid atrophy, and retinal hemorrhage. Meanwhile, the diagnosis was also generated from three groups of individual ophthalmologists (group of retina specialists, senior ophthalmologists, and junior ophthalmologists) and compared with those by the AI. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated, and kappa statistics were performed. Results: A total of 878 eyes were finally enrolled, with 76 excluded due to poor image quality. In the detection of 15 retinal disorders, the ROC curve comparison between AI and professors' presented relatively large AUC (0.891-0.997), high sensitivity (87.65-100%), and high specificity (80.12-99.41%). Among the ROC curve comparisons with those by the retina specialists, AI was the closest one to the professors' compared to senior and junior ophthalmologists (p < 0.05). Conclusion: AI-assisted OCT is highly accurate, sensitive, and specific in auto-detection of 15 kinds of retinal disorders, certifying its feasibility and effectiveness in community ophthalmic screening.

C-Reactive Protein, Procalcitonin, and a Novel Pathogenesis and Therapeutic Target of Thrombocytopenia in Sepsis.

Objective The aim of the study is to analyze the clinical characteristics, pathogen distribution, and drug sensitivity information of adult sepsis, and to provide reference for empirical clinical use; to explore the relationship between C-reactive protein (CRP) and calcitonin (PCT) The clinical value in the diagnosis of adult sepsis. Methods We collected 455 cases of hospitalized patients with positive blood culture, including 352 cases with sepsis and 103 cases without sepsis; 1609 cases of hospitalized patients with suspected infection and negative blood culture, including 287 cases of sepsis, and 518 cases of non-infectious systemic inflammatory response syndrome (SIRS) and 804 cases of local infection. Age, gender, route of admission, admission status, CRP, PCT, and white blood cell (WBC) levels were collected from the patients. The differences between the factors were statistically analyzed, and the receiver operating characteristic curve (ROC curve) was plotted to obtain the optimal cut-off values of CRP and PCT and their area under the curve (AUC), and to compare the CRP, PCT and PCT, and the CRP + PCT tandem to diagnose sepsis sensitivity and specificity. Results (1) 387 pathogenic strains were isolated from blood cultures of patients with sepsis, 71.06% Gram-negative, 26.87% Gram-positive and 2.07% fungi. (2) Among Gram-positive bacteria, Staphylococcus aureus was 87.5% resistant to penicillin and sensitive to vancomycin, milantropine, and teicoplanin; among Gram-negative bacteria, Escherichia coli was resistant to piracillin The resistance rate was 73.1%, fully susceptible to viraemia (100%) and resistant to imipenem, amikacin, and lacillin/tazole. (3) Among patients with positive blood cultures, CRP and PCT levels were higher in patients with sepsis than in those without sepsis. Pairwise comparison of ROC curves showed that the diagnostic value of PCT was greater than that of CRP (P=0.016). Conclusion CRP and PCT have a good reference value for diagnosis of sepsis patients and determination of the degree of infection in septic patients, especially PCT is more valuable for diagnosis of sepsis.

Increased B-type natriuretic peptide is a better predictor of hospital mortality then increased troponin in patients with acute pulmonary embolism

Abstract Background Both elevated troponin (Tn) and B-type natriuretic peptide (BNP) or N-terminal pro BNP (NT-proBNP) are recognized as markers of increased right ventricular overload in acute PE. However, among these biomarkers, only elevated Tn is suggested in the current guideline for estimation of early mortality risk in acute PE. Purpose To compare the values of the increase above the upper limit of normal (ULN) for both Tn and BNP markers in terms of their predictive value for hospital mortality in acute PE patients. Patients and methods This is a multi-centric retrospective cross-sectional study of consecutive PE patients during the 6 years (2015–2021). BNP and Tn were measured on admission to the hospital. BNP or Tn values were then divided with ULN provided by the laboratory for each biomarker, and the results thus obtained were used in ROC curve comparison analysis to compare the prediction values for all-cause hospital mortality in PE patients. Results Overall 758 patients were included in the study, and among them, 72 (9.5%) died. The cut-off value for the increase of BNP was 2.3 times ULN and had 81.2% sensitivity and 55.5% specificity. Positive predictive value (PPV) and negative predictive value (NPV) were 15.3% and 96.8%, respectively. The cut-off value for the increase of Tn was 1.5 times ULN, with 77.3% and 45.6% of sensitivity and specificity, respectively (NPV 95.3% and PPV 12.3%). in the comparison of ROC curves, AUC for BNP increase was 0.716 and the AUC for Tn increase was 0.625, p=0.03 (Fig. 1). Conclusion The increase of BNP above the upper limit of normal is a better predictor of early mortality among acute PE patients than the increase of Tn in the same patients. Funding Acknowledgement Type of funding sources: None.

Detection of Soft Tissue Sarcoma Recurrence: Feasibility of Ultrafast 3D Gradient-Echo Sequence in Addition to Conventional Contrast-Enhanced MRI to Provide Early-Phase Postcontrast Information.

Objectives:Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been investigated to better detect recurrent tumors of malignant soft tissue sarcoma (STS), however, DCE-MRI is time-consuming and not available at all medical centers. This study aims to evaluate the feasibility of dual-phase postcontrast MRI sequences (early 3D spoiled gradient-echo [GRE] and delayed fast spin-echo [FSE] T1WI) for the differentiation of recurrent tumor from nonneoplastic lesions.Materials and methods:A total of 297 patients under postoperative surveillance for malignant STS were included in this retrospective study and divided into three subgroups, as follows: group A, recurrent tumors (n = 82); group B, pseudomasses (n = 55); and group C, postoperative inflammation (n = 160). All MRI examinations included dual-phase post-contrast sequences. The contrast-to-noise ratio (CNR) and the signal-intensity ratio (SIR) were used to evaluate the degree of contrast enhancement in target lesions. ROC curve analysis was performed to assess the diagnostic performance for recurrent tumor.Results:In the early phase, all mean CNR and SIR values were significantly higher in group A (all, p < 0.05). However, the difference of the CNR between early and delayed post-contrast MRI showed a significantly lesser increase in group A than in the other groups when muscle was used as the reference tissue (p = 0.026). A comparison of ROC curves showed that dual-phase MRI had significantly better diagnostic performance than conventional postcontrast MRI.Conclusion:The addition of an early postcontrast 3D GRE to conventional FSE-T1WI is useful to detect recurrent tumors by providing additional information on early enhancement.

Neutrophil-to-Lymphocyte Ratio (NLR) Is a Promising Predictor of Mortality and Admission to Intensive Care Unit of COVID-19 Patients.

The neutrophil-to-lymphocyte ratio (NLR) is an inflammatory marker predicting the prognosis of several diseases. We aimed to assess its role as a predictor of mortality or admission to the intensive care unit in COVID-19 patients. We retrospectively evaluated a cohort of 411 patients with COVID-19 infection. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) of patients with COVID-19 were compared. The median age of our sample was 72 years (interquartile range: 70–75); 237 were males. Hypertension, diabetes and ischemic heart disease were the most common comorbidities. The study population was subdivided into three groups according to NLR tertiles. Third-tertile patients were older, showing significantly higher levels of inflammatory markers; 133 patients (32%) died during hospitalization, 81 of whom belonged to the third tertile; 79 patients (19%) were admitted to ICU. NLR showed the largest area under the curve (0.772), with the highest specificity (71.9%) and sensitivity (72.9%), whereas CRP showed lower sensitivity (60.2%) but slightly higher specificity (72.3%). Comparisons between NLR and CRP ROC curves were significantly different (p = 0.0173). Cox regression models showed that the association between NLR and death was not weakened after adjustment for confounders. Comparisons of ROC curves showed no significant differences between NLR, PLR, and CRP. Cox regression analysis showed that NLR predicted the risk of admission to ICU independently of demographic characteristics and comorbidities (HR: 3.9597, p < 0.0001). These findings provide evidence that NLR is an independent predictor of mortality and a worse outcome in COVID-19 patients and may help identify high-risk individuals with COVID-19 infection at admission.

Comparative validity of informant tools for assessing pre-stroke cognitive impairment.

ObjectivesVarious informant‐based questionnaires are used in clinical practice to screen for pre‐stroke cognitive problems. However, there is no guidance on which tool should be preferred. We compared the validity of the two most commonly used informant‐based tools.MethodsWe recruited consecutively admitted stroke patients. Patients' informants completed the Informant Questionnaire for Cognitive Decline in the Elderly Short Form (IQCODE‐SF, 16‐item) and Ascertain Dementia 8 (AD8). We assessed construct validity (accuracy) against a semi‐structured clinical interview for dementia or mild cognitive impairment (MCI), describing test accuracy metrics and comparing area under ROC curves (AUROC). We described criterion validity by evaluating associations between test scores and neuroimaging markers of dementia and overall ‘brain frailty’. Finally, we described prognostic validity comparing ROC curves for 18‐month clinical outcomes of dementia, death, stroke, and disability.ResultsOne‐hundred‐thirty‐seven patient‐informant dyads were recruited. At usual clinical cut‐points, the IQCODE‐SF had comparable sensitivity to the AD8 (both = 92%) for pre‐stroke dementia, but superior specificity (IQCODE‐SF: 82% vs. AD8: 58%). Youden index suggested that the optimal AD8 threshold for diagnosis of dementia is ≥4. The IQCODE‐SF demonstrated stronger associations with markers of generalised and medial‐temporal lobe atrophy, neurovascular disease, and overall brain frailty. IQCODE‐SF also demonstrated greater accuracy for predicting future dementia (IQCODE‐SF AUROC = 0.903, 95% CI = 0.798–1.00; AD8 AUROC = 0.821, 95% CI = 0.664–0.977).ConclusionsBoth IQCODE‐SF and AD8 are valid measures of pre‐stroke dementia. Higher cut points for AD8 may improve performance in the acute stroke setting. Based on consistent superiority across a range of validity analyses, IQCODE‐SF may be preferable to AD8 for pre‐stroke dementia screening.

Comparison of 5 acute pulmonary embolism mortality risk scores in patients with COVID-19.

ObjectivePulmonary embolism (PE) is a common complication of SARS-CoV-2 infection. We aimed to explore the short-term outcomes among patients with acute PE and COVID-19 and to further determine and compare the performance of the different prognostic scores (PESI, sPESI, BOVA, FAST and ESC scores) for risk-stratification in this scenario.MethodsRetrospective single-centre study of 85 patients with SARS-CoV-2 infection and PE admitted to the Emergency Department (ED). The diagnostic accuracy of each above-mentioned prognostic score was calculated post hoc, and their discriminative power was evaluated through an AUC curve.ResultsAmong the 85 patients, all-cause death occurred within 7 days for 6 patients (7.1%) and within 30 days for 14 patients (16.5%). Despite being older and having a higher percentage of altered mental status on presentation, non-survivors patients did not differ from survivors regarding comorbidities, traditional risk factors for venous thromboembolism and signs and symptoms at the ED presentation.Each risk stratification tool had modest discriminative power for 7-day mortality (AUC range, 0.601–0.730) with slightly lower discrimination for 30-day mortality (AUC range, 0.543–0.638). The pair-wise comparison of ROC curves showed that PESI had better predictive value for short-term mortality than ESC score (z test = 3.92, p = 0.001) and sPESI (z test = 2.43, p = 0.015); there is no significant difference between PESI and BOVA score (z test = 1.05, p = 0.295) and FAST score (z test = 0.986, p = 0.324).ConclusionThe most common risk-stratification tools for PE had modest discriminative power to predict short-term mortality in patients with acute PE and COVID-19.