Comparison Of ROC Curves Research Articles

Syntax Score I and II for Predicting Carotid Artery Stenosis in Patients with Multivessel Coronary Artery Disease: A Propensity Score Matching Analysis.

ObjectiveTo evaluate the predictive accuracy of SYNTAX score (SS) I and II for detecting significant carotid artery stenosis (CAS) in patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) surgery.MethodsThe study population consisted of 416 patients. Clinical, demographic, and radiological records were retrospectively reviewed. Characteristics of patients with CAS (n=66) and patients without CAS (n=350) were compared before and after propensity score matching analysis.ResultsPatients with significant CAS were older compared to those without significant CAS [(60 (53-65) vs. 63 (59-67); P=0.01]. However, atherosclerotic risk factors and SS I were similar between groups. SS II CABG and percutaneous coronary intervention (PCI) were significantly higher in patients with CAS [37.4 (30.9-43.5) vs. 33.8 (29.9-38.9); P=0.02]. After propensity score matching analysis (66 vs. 66), age, SS II PCI and CABG were significantly higher in patients with CAS than those without CAS [37.4 (30.9-43.5) vs. 33 (29.3-36.9); P=0.03]. Age, SS II PCI and CABG were associated with CAS in logistic regression analysis [OR=1.086, 95% CI (1.032-1.143), P<0.001; OR=1.054, 95% CI (1.010-1.101), P=0.02; OR=1.078, 95% CI (1.029-1.129), P<0.01].In ROC curve analysis, SS II PCI >33.1 had 68.2% sensitivity and 54.6% specificity [AUC=0.624, P=0.01, 95% CI (0.536-0.707)] whereas SS II CABG >26.1 had 81.8% sensitivity and 54.6% specificity [AUC=0.670, P<0.01, 95% CI (0.583-0.749)] to predict CAS. Pairwise comparison of ROC curves revealed similar statistical accuracy for prediction of CAS (z statistic: 0.683, P=0.49)ConclusionSS II is useful to predict asymptomatic CAS in patients with multivessel coronary artery disease.

Relevance of KFLC quantification to differentiate clinically isolated syndrome from multiple sclerosis at clinical onset

ObjectiveThe objective of the research was to evaluate diagnostic and predictive value for determination of KFLC in cerebrospinal fluid (CSF) compared to the qualitative procedure of OCB determination in patients with CIS who converted to MS during a two-year period. Patients and methodsKFLC, total immunoglobulin G (IgG), serum albumin and CSF albumin were determined with an immunonephelometric method in 151 patients with suspected MS who were admitted to the Neurology Clinic while CSF/serum quotients (QKFLC, QIgG and QAlb) and indexes were calculated with regards to albumin (QCSF/Qserum). Presence of OCBs was determined by isoelectric focusing with immunofixation. Based on their clinical, OCB and magnetic resonance imaging (MRI) findings, 50 patients were classified as other neurological disorder patients (OND), and 101 patients were classified as CIS, 50 of which converted to MS during the two-year period. ROC analysis, ROC curve comparisons and comparison of median KFLC parameters were used to find optimal cut-off with regards to CIS diagnosis and conversion to MS. ResultsCSF KFLC median was 2,01 mg/L in MS group contrary to 0,68 mg/L and 0,17 mg/L in CIS and OND group, and KFLC index was 33,52 mg/L contrary to 9,68 mg/L and 3,71 mg/L (p < 0,0001). ROC analysis for accuracy of detection of intrathecal synthesis for QKFLC and KFLC index showed an AUC of 0,891 and 0,839 and the cut-off of 0,027 and 8,82, respectively (sensitivity 73,2% and 71,3%; specificity 96,0% and 98,0%; +PV 97,4% and 98,6%). The diagnostic accuracy of KFLC index for conversion from CIS to MS showed AUC of 0,840 and a cut-off of 9,092 (sensitivity 90,0%; specificity 73,3%; -PV 93,7%). Life age correlates significantly with serum KFLC (r = 0,34; p < 0,0001) and through aging process lower KFLC indexes can be expected, i.e. likelihood of false negative diagnoses. ConclusionKFLC index showed diagnostic value, although it is not more specific and more sensitive than OCB. Application of KFLC might serve as a screening method while OCB could be used in uninterpretted cases only. Patients who converted to MS have significantly higher KFLC which can contribute to an early diagnosis and prompt therapy with its predictive role.

6 Prognostic Value of qSOFA, SIRS and News in the Emergency Department for Predicting 7-Day Mortality: A Prospective Study

Sepsis is the primary cause of death from infection worldwide. In 2016, Sepsis-3, a new clinical concept termed “quick Sepsis-Related Organ Failure Assessment” (qSOFA) was introduced to identify high-risk patients with suspected infection (outside of critical care settings). The present study aimed to validate qSOFA for use in a university hospital emergency department in Hong Kong. Furthermore, we compared the prognostic value of qSOFA and the previous Systemic Inflammatory Response Syndrome (SIRS) criteria, along with a widely used early warning score, the National Early Warning Score (NEWS). This single-center prospective study was conducted in the ED of Prince of Wales Hospital in Hong Kong between July 2016 and June 2017. 1253 non-trauma general ED patients and triaged as category 2 (Emergency) and 3 (Urgent) were recruited. All variables for calculating qSOFA, SIRS and NEWS were collected. The outcome measure was 7-day mortality. Venous lactate was also measured to investigate whether lactate levels were incremental for the prediction of 7-day mortality. The prognostic value of qSOFA, SIRS and NEWS to predict 7-day mortality was studied. Receiver operating characteristic analyses were performed to determine the area under the curve (AUC), sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios for qSOFA≥2, SIRS≥2 and NEWS≥5. We recruited 1253 patients of median age 72 years (IQR: 59-84); 638 (50.9%) were male. Overall 7-day mortality in this cohort of general ED patients was 2.6%. The prognostic value for prediction of 7-day mortality, with AUCs for qSOFA≥2, SIRS≥2 and NEWS≥5 were 0.57 (95% CI 0.54-0.60), 0.70 (95% CI 0.67-0.72) and 0.68 (95% CI 0.66-0.71) respectively. Using pairwise comparison of ROC curves, the AUC of NEWS≥5 (p=0.0144) and SIRS≥2 (p=0.0116) were better than qSOFA≥2 to predict 7-day mortality in ED patients. The AUC of lactate ≥2mmol/L to predict 7-day mortality was 0.63 (95% CI 0.61-0.66). The combination of lactate level ≥2mmol/L with qSOFA≥2, SIRS≥2 and NEWS≥5, AUC were 0.56 (95% CI 0.53-0.59), 0.65 (95% CI 0.62-0.67) and 0.63 (95% CI 0.60-0.66) respectively. In addition, the positive likelihood ratios of qSOFA≥2, SIRS≥2 and NEWS≥5 to predict 7-day mortality were 14.17 (95% CI 5.37-37.38), 2.44 (95% CI 2.04-3.75) and 3.70 (95% CI 2.54-5.39). Among emergency and urgent patients presenting to the ED, NEWS and SIRS have greater prognostic value for 7-day mortality compared to qSOFA. Combinations of lactate level with qSOFA, SIRS or NEWS did not improve their prognostic value in predicting 7-day mortality in ED patients.

Are P Wave and QT Dispersions Related to Severe Peripheral Artery Disease?

BackgroundThe aim of this study was to evaluate the relationship between P wave and QT dispersions (PWD and QTD) during the course of severe peripheral artery disease (PAD).Material/MethodsWe recruited 163 patients who underwent peripheral angiography (PA) between August 2011 and March 2017, and they were divided into 2 groups according to the severity of PAD on PA. PWD and QTD were investigated using 12-lead electrocardiograms. Group One consisted of patients diagnosed with <70% stenosis on PA, who eventually received medical treatment; Group Two consisted of patients diagnosed with ≥70% stenosis on PA, who eventually underwent surgery.ResultsROC curve analysis of the 2 groups demonstrated that PWD was significantly higher in Group Two (AUC: 0.913505; 95% confidence interval (CI): 0.859365 to 0.951788; p<0.0001). The Youden index showed that a cut-off PWD value of >35 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 88.89% and a specificity of 85.37% (+LR: 6.07, −LR: 0.13). Moreover, QTD was significantly higher in Group Two (AUC: 0.884749; 95% CI: 0.825489 to 0.929391; p<0.0001). Youden index showed that a cut-off QTD value of >75 msn predicted a peripheral artery stenosis of ≥70% with a sensitivity of 76.54% and a specificity of 85.37% (+LR: 5.23, −LR: 0.27). Comparison of ROC curves showed no difference in terms of predicting peripheral artery stenosis of ≥70% between PWD and QTD (p=0.3308).ConclusionsInterpreting PWD and QTD offers a non-invasive and cost-effective assessment method for detecting patients at high risk for coronary artery disease in the context of severe PAD.

Biventricular assessment of light-chain amyloidosis using 3D speckle tracking echocardiography: Differentiation from other forms of myocardial hypertrophy

BackgroundGiven that in patients with cardiac amyloidosis (CA), deposition of amyloid protein is not restricted to the left ventricular (LV) myocardium, it can be hypothesized that the diagnostic value of deformation mechanics would be enhanced by considering right ventricular (RV) strain measures. The aim of the present study was to examine the potential utility of left ventricular (LV) and right ventricular (RV) deformation and rotational parameters derived from three-dimensional speckle-tracking echocardiograph (3DSTE) to diagnose cardiac amyloidosis and differentiate this disease from other forms of myocardial hypertrophy. MethodsTwenty-three patients with biopsy-proven light-chain (AL) amyloidosis, 23 patients with systemic arterial hypertension (HTN), 23 patients with hypertrophic cardiomyopathy (HCM), 23 athletes and 23 normal controls were prospectively studied by conventional echocardiography and 3DSTE. LV longitudinal strain (LV LS), LV circumferential strain (LV CS), RV global longitudinal strain and RV free-wall longitudinal strain (RV FW LS) were obtained by 3DSTE, as well as LV rotation and rotational velocities. ResultsLV and RV longitudinal strains were reduced in cardiac amyloidosis (CA) patients compared to controls. By multivariate analysis, LV basal LS (p = 0.002), LV peak basal rotation (p = 0.003), and RV basal FW LS (p = 0.014) were independently associated with CA in the overall population. A significant improvement in global χ2 value was noted with RV 3D-strain parameters over only LV-3DSTE + conventional indices for detection of CA (p < 0.001). Comparison of ROC curves showed that the AUC using combined LV basal LS, LV basal rotation and RV basal FW LS had a higher discriminative value than the other echocardiographic parameters used for detecting CA (AUC 0.93, 95%CI 0.81–0.97). ConclusionsThree-dimensional speckle tracking echocardiography reveals regional and global biventricular dysfunction in CA. Assessment of RV ventricular dysfunction has an additive value in differentiating CA from other causes of myocardial wall thickening.

Pretransplant predictors of early mortality in adult recipients of liver transplantation in the MELD-Na Era.

To identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTR). An observational, retrospective, nested cases-controls study from a consecutive cohort of LTRs was carried out. University hospital. All consecutive LTR between January 2003 and December 2016 were eligible for inclusion. Patients with acute liver failure, previous graft dysfunction, simultaneous multiple organ transplantation, non-heart beating donors, and those needing urgent retransplantation during the study period were excluded. The analysis comprised 471 patients. Pretransplant characteristics were the main variables of interest. The LTR were grouped according to the dependent variable (early mortality). Multivariate logistic regression analysis was conducted to identify predictors of early mortality. The discriminating capacity of the models obtained was evaluated by comparing ROC curves (models versus MELD-Na). The MELD-Na score (OR = 1.069, 95% CI = 1.014-1.127), age > 60 years (OR = 2.479, 95% CI = 1.226-5.015), and LTR height < 163cm (OR = 4.092, 95% CI = 2.115-7.917) were identified as independent predictors of early mortality. The cause of transplantation (hepatocellular carcinoma or decompensated cirrhosis) was identified as a confounding factor. In LTR due to decompensated cirrhosis, the MELD-Na score, age > 60 years, and height < 163cm are independent predictors of early mortality. These factors provide a better classification model than the MELD-Na score for early post-transplant mortality.

BIOMARKERS OF MYOCARDIAL STRESS AND FIBROSIS FOR CLINICAL OUTCOMES ASSESSMENT IN POST MYOCARDIAL INFARCTION HEART FAILURE PATIENTS

Aim. To assess the prognostic significance of the ST2 and N-terminal pre-brain natriuretic peptide (NT-proBNP) in patients with chronic heart failure (CHF) of ischemic origin. Material and methods. The study included 127 patients with CHF, post myocardial infarction (age median 57 y. o., left ventricle ejection fraction — 54%), consequently admitted at Clinic. The biomarker concentrations representing myocardial stress (NT-proBNP) and fibrosis with remodeling of the ventricles (ST2) were measured with the immune enzyme assay. Endpoint was all-cause mortality and repeat hospitalizations during 9-month follow-up. Results. Levels of ST2 and NT-proBNP were higher in adverse outcome patients (n=19) comparing to the patients with no repeat cardiovascular events (р=0,004 and 0,001, respectively). Receiver operating characteristic (ROC) analysis for outcomes prediction defined the optimal threshold values of 43,6 ng/mL for ST2 and 285 pg/mL for NT-proBNP. In comparison of ROC-curves, biomarkers had comparable areas under the curves (p=0,659). In binary regression model, statistically significant predictors for combination endpoint were ST2, NT-proBNP and traditional risk factors (class by New York Heart Association, left ventricle aneurysm, stroke anamnesis, estimated glomerular filtration rate <90 mL/min/1,73 m 2 ). The model had the under-curve-area 0,900 (p<0,001). Conclusion. ST2 and NT-proBNP are significant predictors of adverse clinical outcomes in CHF patients post myocardial infarction.

Probability Sampling in Matched Case-Control Study in Drug Abuse

Although random sampling is generally considered to be the gold standard for population-based research, the majority of drug abuse research is based on non-random sampling despite the well-known limitations of this kind of sampling. We compared the statistical properties of two surveys of drug abuse in the same community: one using snowball sampling of drug users who then identified “friend controls” and the other using a random sample of non-drug users (controls) who then identified “friend cases”. Models to predict drug abuse based on risk factors were developed for each data set using conditional logistic regression. Bootstrap analysis of the random-sample data set showed less variation, and did not change the significance of the predictors when compared to the non-bootstrap analysis. Comparison of ROC curves using the model derived from the random-sample data set was similar when fitted to either data set (0.93 for random-sample data vs. 0.91 for snowball-sample data (p=0.35)); however, when the model derived from the snowball-sample data set was fitted to each of the data sets, the areas under the curve were significantly different (0.98 vs. 0.83, p&lt;.001). The proposed method of random sampling of controls appears to be superior from a statistical perspective to snowball sampling and may represent a viable alternative to snowball sampling.

Comparison of scoring tools for the prediction of in-hospital mortality in status epilepticus

PurposeSeveral scoring tools have been developed for the prognostication of outcome after status epilepticus (SE). In this study, we compared the performances of STESS (Status Epilepticus Severity Score), mSTESS (modified STESS), EMSE-EAL (Epidemiology-based Mortality Score in Status Epilepticus- Etiology, Age, Level of Consciousness) and END-IT (Encephalitis-NCSE-Diazepam resistance-Image abnormalities-Tracheal intubation) in predicting in-hospital mortality after SE. MethodData collected retrospectively from a cohort of 287 patients with SE were used to calculate STESS, mSTESS, EMSE-EAL, and END-IT scores. The differences between the scores’ performances were determined by means of area under the ROC curve (AUC) comparisons and McNemar testing. ResultsThe in-hospital mortality rate was 11.8%. The AUC of STESS (0.628; 95% confidence interval (CI), 0.529–0.727) was similar to that of mSTESS (0.620; 95% CI, 0.510–0.731), EMSE-EAL (0.556; 95% CI, 0.446–0.665), and END-IT (0.659; 95% CI, 0.550–0.768; p > .05 for each comparison) in predicting in-hospital mortality. STESS with a cutoff of 3 was found to have lowest specificity and number of correctly classified episodes. EMSE-EAL with a cutoff at 40 had highest specificity and showed a trend towards more correctly classified episodes while sensitivity tended to be low. END-IT with a cutoff of 3 had the most balanced sensitivity-specificity ratio. ConclusionsEMSE-EAL is as easy to calculate as STESS and tended towards higher diagnostic accuracy. Adding information on premorbid functional status to STESS did not enhance outcome prediction. END-IT was not superior to other scores in prediction of in-hospital mortality despite including information of diagnostic work-up and response to initial treatment.

Роль лімфоцитів та імуноглобулінів класу G в прогнозуванні розвитку місцевих ускладнень гострого панкреатиту

Мета роботи: визначити діагностичну та прогностичну цінність рівня лімфоцитів та імуноглобулінів класу G для прогно­зування розвитку місцевих ускладнень гострого панкреатиту, ризику їх інфікування та необхідності відповідної корекції лікувальної тактики.Матеріали і методи. Обстежено 30 пацієнтів. Лабораторні та імунологічні дослідження проводили тричі: 1 дослідження – при надходженні; 2 дослідження – на 7-му добу; 3 дослідження – перед виписуванням. Проведено імуноферментний аналіз субкласів IgG (G1, G2, G3, G4) в основній групі дослідження. Аналіз на однорідність основної групи та контрольної групи показав, що при розподілі хворих на групи залежно від віку та статі істотних відмінностей не виявлено (р&gt;0,05), що вказує на їх коректну зіставність та можливість порівняння для виявлення розбіжностей за іншими параметрами.Результати досліджень та їх обговорення. За даними проведеного ROC-аналізу отримано переконливий доказ щодо здатності прогнозування інтра- та перипанкреатичного скупчення рідини у хворих на гострий панкреатит субкласу імуноглобуліну IgG2. IgG1, IgG3 IgG4 та загальний IgG не мають достатньої прогностичної здатності (р&gt;0,05) і не можуть бути використані у клінічній практиці з даною метою. Площа під ROC кривою для прогностичної здатності IgG2 та рівня лімфоцитів має статистично достовірне значення (р&lt;0,05) та може бути оцінена як середня та добра відповідно. Парне порівняння ROC кривих IgG2 та рівня лімфоцитів між собою показало відсутність суттєвих розбіжностей між ними, отже, у них практично однакові діагностичні можливості. Парне порівняння ROC кривих IgG2 та рівня лімфоцитів стосовно прогнозування необхідності операційних втручань не показало суттєвих розбіжностей між ними та підтвердило найкращі операційні характеристики лімфоцитів.

Comparison of likert and PI-RADS v2 scoring in the diagnosis of prostate cancer

Aim: We aimed to compare the inter- and intra-observer variability and diagnostic performance of PI-RADS v2 and Likert scoring in the evaluation of prostate cancer on multiparametric prostate MR imaging. Material and Methods: MRI findings of 53 patients who had histopathologic diagnosis of prostate cancer and 51 patients who had one or more negative transrectal ultrasound guided prostate biopsy were evaluated retrospectively. The images were assessed by three independent observers blinded to histopathologic results of the patients. Intra-observer and inter-observer variability were evaluated by CohenÂ’s Kappa coefficient for all possible pairs of observers. ROC curve analysis was used to determine AUC to evaluate diagnostic performance of Likert and PI-RADS v2 scoring with a 1.5T MR in the diagnosis of prostate cancer. Results: Kappa values for 4 or higher PI-RADS v2 scores were calculated and κ=0.59-0.71 for intra-observer and κ=0.48-0.67 for inter-observer variability were obtained. κ=0.54-0.69 for intra-observer and κ=0.42-0.75 for inter-observer reliability were obtained for 4 or higher Likert scoring. AUC was 72% for PI-RADS v2 scores and was 75.9% for Likert scores for determining Gleason 6 or higher prostate cancers. There was not a statistically significant difference in the comparison of Likert and PI-RADS v2 ROC curves. Conclusion: PI-RADS v2 has no significant superiority compared to Likert scoring in intra-observer and inter-observer reliability. Likert and PI-RADS v2 scoring has no difference in the terms of diagnostic capability of prostate cancers.

ОПРЕДЕЛЕНИЕ УРОВНЯ АНТИТРОМБИНА ПОЗВОЛЯЕТ ПРОГНОЗИРОВАТЬ КЛИНИЧЕСКИЕ ИСХОДЫ СЕПСИСА

Antithrombin is one of the key regulating factors of homeostasis, which activity significantly reduces in SIRS. The objective of the study : to investigate possibility and feasibility to test antithrombin level in blood plasma in order to predict treatment outcomes in patients with sepsis. Subjects. The level of antithrombin was tested in 83 patients by the start and at the peak of the disease. Predictive value was compared for antithrombin tests, some other parameters of coagulogram, and clinical severity scales in sepsis. Results. On the 5th day of the disease, the most significant predictors of the unfavorable outcome of sepsis were identified: fibrinogen level (Odds ratio – 2.42 [0.92–6.33]; p = 0.0722); and antithrombin level (Odds ratio – 26.4 [8.02 86.86]; p < 0.0001). Pair-wise comparison of ROC-curves of fibrinogen and antithrombin at the final point of the study demonstrated differences between areas under curve (AUC), which made 0.337 [95% CI 0.154–0.520] with p = 0.0003, which confirmed the assumption of the high predictive value of antithrombin level. With the cut-off point at ≤ 61% this test demonstrated the sensitivity and specificity of 79% and 88% respectively. Conclusion: In order to predict severity and potential outcome of sepsis, it is recommended to test antithrombin level at the peak of the disease.

COMPARATIVE ANALYSIS OF ACCURACY AMONG GLASGOW COMA SCALE, TRAUMA SCORE, AND REVISED TRAUMA SCORE AS PREDICTORS OF MORTALITY HEAD INJURY PATIENTS

Measurement of severity and mortality predictions in cases of head injury is an important step to support appropriate, effective and efficient clinical decision-making. Glasgow Coma Score, Trauma Score, and Revised Trauma Score are physiologycal scoring systems that can be used as predictors of mortality of head injury patients. The objective of the study was to know which scoring systems had the best accuracy as a predictor of mortality of head injured patients. The observational analytic study with this retrospective cohort design approach was carried out at dr. Iskak Tulungagung on Medical Record. Data taken from all patient medical records from January 2016 to July 2017 amounted to 150 medical records. Variables used were GCS, RTS, and TS scores when patients were admitted to hospital IGD as well as patient mortality data within 7 days of treatment. The data obtained is then processed with SPSS 20 using Mann Whitney Test, logistic regression and ROC curve comparison. Based on the results of multivariate logistic regression analysis, GCS accuracy results: sensitivity= 0.7586, specificity= 0.7934, PPV= 0.468, NPV= 0.932; RTS accuracy: sensitivity= 0.766, specificity= 0.8, PPV= 0.489, and NPV= 0.932; TS accuracy: sensitivity= 0.7, specificity= 0.783, PPV= 0.4468, NPV= 0.9126. The comparison graph analysis of ROC curve showed no significant difference of AUC between GCS, RTS, and TS because the difference was too low (&lt;15%). There was no significant difference of accuracy between RTS, GCS, and TS use in predicting head injury mortality

Inferior detection of information from collaborative versus individual crimes based on a P300 Concealed Information Test.

The present study used a P300-based Concealed Information Test (CIT) to detect individual and collaborative crimes and to explore whether or not the P300 index is effective in identifying collaborative crime members. Participants were divided into two groups to either steal a ring alone (individual group) or collaboratively with another companion participant (collaborative group) before taking the Complex Trial Protocol test that is regarded as an accurate version of the P300-based CIT. The ERP results revealed that both groups showed significantly larger P300s to probe (the ring) than to all irrelevant stimuli (other jewelery), but the P300 amplitude difference of probe stimulus versus irrelevant stimuli in the collaborative group was significantly less than that in the individual group. For the individual diagnosis, using P300 index, the detection rate was significantly inferior for collaborative crime than individual crime, probably related to weakness of collaborative encoding. The ROC curve comparisons showed the individual guilty was effectively discriminated from the simulated-innocent (AUC = .84) and from the collaborative guilty (AUC = .83), but the collaborative guilty was not discriminable from the simulated-innocent (AUC = .66). These findings suggest that collaborative encoding of crime-related information impacts the efficiency of the P300 index, and that the P300-based CIT is not applicable when used to identify collaborative crime perpetrators.

Values of serum IgG4, IgG4/IgG ratio, and IgG4/IgG1 ratio in the diagnosis of Mikulicz′s disease

Objective To evaluate values of Serum IgG4, IgG4/IgG ratio, and IgG4/IgG1 ratio for distinguishing Mikulicz′s disease (MD) from primary Sjogren′s syndrome (pSS). Methods It retrospectively analyzed 186 patients subjected to serum IgG subclass testing to differentiate MD from primary Sjogren′s syndrome (pSS) at Peking University People′s Hospital from July 2012 to July 2016. This sample included 42 MD patients and 144 pSS patients. Serum IgG subclass concentrations were measured using Siemens reagents with nephelometry and BNⅡ instrument. In partial patients, serum antinuclear antibodies (ANA) were detected by indirect immunofluorescence assay, and serum anti-SSA antibodies and anti-SSB antibodies were detected by Western blot. Serum IgG subclass test results, ANA test results, serum anti-SSA antibody, and anti-SSB antibody test results were collected. The quantitative data were represented by median (quantile range). The Mann-Whitney U test was used to compare the medians between the two groups. Categorical variables were analyzed with a χ2 test and were shown as percentages. The ROC curve was constructed to identify the optimal cut-off values and the area under the curve (AUC) values of the serum IgG4, IgG4/IgG ratio, and IgG4/IgG1 ratio for distinguishing MD patients from pSS patients. Results The medians of serum IgG4, IgG4/IgG ratio and IgG4/IgG1 ratio in MD patients were 11 200 mg/L (17 330), 0.444 (0.314) and 1.318 (1.920), as compared with 329 mg/L (490) , 0.016 (0.025) and 0.023 (0.039) respectively in pSS patients (Z=-9.368, -9.560, and -9.571, respectively, P<0.001). For distinguishing MD from pSS, the optimal cut-off values of serum IgG4, IgG4/IgG ratio, and IgG4/IgG1 ratio were 1 870 mg/L, 0.111, and 0.206, respectively. The corresponding AUC values were 0.976, 0.985, and 0.986, respectively. Comparison of the ROC curves showed that there was no significant difference between AUC of serum IgG4/IgG ratio and IgG4/IgG1 ratio (Z=0.283, P=0.777). But AUC of serum IgG4/IgG ratio and IgG4/IgG1 ratio were significantly higher than AUC of serum IgG4 (Z=2.360 and 1.975, repectively, P=0.018 and 0.048, respectively). The positive rates of serum ANA in MD and pSS group were 10% and 85.8%, respectively (χ2=71.340, P<0.001). The positive rates of anti-SSA antibody and anti-SSB antibody in MD were 6.7% and 0%, respectively. Compared to 72.3% and 38.3% in pSS group, they were lower (χ2 =44.773 and 16.792, P<0.001). Conclusions Measurements of serum IgG4 concentration, IgG4/IgG ratio, and IgG4/IgG1 ratio were of important values in differentiating MD from pSS. Serum IgG4/IgG ratio or IgG4/IgG1 ratio was superior to serum IgG4.(Chin J Lab Med, 2017, 40: 805-809) Key words: Mikulicz′ disease; Sjogren′s syndrome; Immunoglobulin G; Odds ratio; Reference values

Моделирование вероятности дефолта в строительном секторе: факторы корпоративного построения

В данной работе оценка вероятности дефолта крупных строительных компаний России осуществлялась на основе классического для этих целей метода - логистической регрессии. Главный вопрос исследования: улучшит ли прогнозную силу модели включение факторов корпоративного построения и последующая регуляризация модели (Lasso и Ridge)? В качестве зависимой переменной нами было опробовано четыре определения дефолта и проведено их сравнение. Моделирование производилось на основе информации базы данных СПАРК, Росста- та и Банка России за период 2007-2015 гг. - анализируемая выборка после устранения выбросов включала 4761 строительную компанию. В целях разработки прогнозной модели и последующего тестирования ее предсказательной силы подготовленные годовые данные были разделены на две выборки: обучающую (2007-2013 гг.) и контрольную (2014-2015 гг.). Одним из параметров модели является годовой временной лаг, что соответствует рекомендациям Базельского комитета по банковскому надзору. Изменение прогнозного качества модели при последовательном включении факторов корпоративного построения проверяется на основе площади под ROC-кривыми (AUC) и ошибок I и II рода. На основе международного и отечественного опыта был сформирован ряд гипотез, некоторые из них получили свое статистическое подтверждение. В частности, при прочих равных вероятность дефолта строительной компании ниже, если ее генеральный директор является также совладельцем (имеет долю в уставном капитале). Если компания является дочерней (т.е. блокирующий пакет находится у юридического лица) - вероятность ее дефолта выше. С финансовыми трудностями (отрицательной рентабельностью активов по итогам года) в строительном бизнесе России лучше справляются небольшие по численности советы директоров. Не получила устойчивого подтверждения гипотеза о том, что чем дольше существует компания, тем меньше у нее вероятность дефолта. Результаты показывают, что учет корпоративного построения компании улучшает прогностическую способность модели, а методы регуляризации подтвердили их устойчивость. С помощью теста на переобучаемость (cross-validation) подтверждена робастность коэффициентов финальной спецификации. Результаты работы в большей степени могут представлять интерес для банков, коммерческих инвесторов и партнеров-подрядчиков.

Improving the efficiency of Auditory Brainstem Responses in newborns, using a 60 clicks/s stimulation rate

Recent evidence suggests that Auditory Brainstem Responses (ABR), in neonates with risk factors for neurological damage, may show auditory brainstem abnormalities, even in patients with normal hearing. To compare the recording and diagnostic accuracy of neonatal Auditory Brainstem Responses (ABR), using 10 and 60clicks/s stimulation rates, two groups of neonates were prospectively studied: 30 healthy full-term neonates, with no peri- or postnatal complications; and 30 high-risk newborns with two or more of the following conditions: hyperbilirubinemia, use of ototoxic drugs, birth weight inferior to 1500g, perinatal sepsis, intraventricular hemorrhage, and/or mechanical ventilation. Correlation between ABR trials, recording duration, and the absolute and interpeak latencies of ABR waves I, III and V, were measured. ROC-curve analysis assessed the diagnostic accuracy of both stimulation rates. The correlations between ABRs trials were significantly higher at 60clicks/s than at 10clicks/s (F(1,116)=14.5, p<0.0002). Recording duration at 60clicks/s was significantly lower (t=20.9, p<0.0001). ROC-curve comparisons showed increased diagnostic accuracy at the stimulation rate of 60clicks/s, for waves I (D=2.04, p=0.04), V (D=2.02, p=0.04), interpeak latencies III-V (D=2.2, p=0.02), and I-V (D=2.86, p=0.004). In neonates, the use of 60clicks/s stimulation rate permits a substantial shortening of the ABR recording, with greater diagnostic accuracy and replicability.

Could dysnatremias play a role as independent factors to predict mortality in surgical critically ill patients?

Several studies have demonstrated the impact of dysnatremias on mortality of intensive care unit (ICU) patients. The objective of this study was to assess whether dysnatremia is an independent factor to predict mortality in surgical critically ill patients admitted to ICU in postoperative phase.One thousand five hundred and ninety-nine surgical patients (58.8% males; mean age of 60.6 ± 14.4 years) admitted to the ICU in the postoperative period were retrospectively studied. The patients were classified according to their serum sodium levels (mmol/L) at admission as normonatremia (135–145), hyponatremia (<135), and hypernatremia (>145). APACHE II, SAPS III, and SOFA were recorded. The capability of each index to predict mortality of ICU and hospital mortality of patients was analyzed by multiple logistic regression.Hyponatremia did not have an influence on mortality in the ICU with a relative risk (RR) = 0.95 (0.43–2.05) and hospital mortality of RR = 1.40 (0.75–2.59). However, this association was greater in patients with hypernatremia mortality in the ICU (RR = 3.33 [95% confidence interval, CI 1.58–7.0]) and also in hospital mortality (RR = 2.9 [ 95% CI = 1.51–5.55). The pairwise comparison of ROC curves among the different prognostic indexes (APACHE II, SAPS III, SOFA) did not show statistical significance. The comparison of these indexes with serum sodium levels for general population, hyponatremia, and normonatremia was statistically significant (P < .001). For hypernatremia, the AUC and 95% CI for APACHE II, SAPS III, SOFA, and serum sodium level were 0.815 (0.713–0.892), 0.805 (0.702–0.885), 0.885 (0.794–0.945), and 0.663 (0.549–0.764), respectively. The comparison among the prognostic indexes was not statistically significant. Only SOFA score had a statistic difference compared with hypernatremia (P < .02).The serum sodium levels at admission, especially hypernatremia, may be used as an independent predictor of outcome in the surgical critically ill patients.

Contrast-Enhanced Magnetic Resonance Imaging with Magnetic Transfer Effect in Differential Diagnosis of Hemangiomas and Metastases of Liver

Objective: to investigate the operating characteristics of contrast MRI of the liver using magnetization transfer effect in the differential diagnosis of hemangiomas and metastatic lesions in comparison with dynamic contrast.Material and methods. The material of the study were dynamic contrast MRI images of 25 patients with diagnosis of direction of focal liver lesion. Inclusion criteria were detection of typical MR-semiotic for hemangioma (n = 10 to 40% of cases) or multiple liver metastases (n = 15 to 60% of cases).In the group with metastases exclusion criteria was the primary detection of obscure single focal lesions, as well as the diagnosis of other primary tumors, in particular cholangiocellular cancer (n = 1). All MRI studies were performed using MRI Toshiba Titan Octave with of 1.5 Tesla magnetic field. T1-weighted static contrast MRI investigation of liver performed after 3–5 minutes after a series of dynamic contrast MRI with modes: T1-FE-FSat and T1-TSEMTS (Δf = -210 Hz, FA = 600°). The magnevist at a dose of 0.1 mmol/kg was used as a contrast agent. Each focal liver lesion differentiated between hemangiomaand metastasis with the calculation of contrast ratio (CR) for each lesion. Statistical analysis of CR was performed using T-test and T-test Welch. The sensitivity and specificity parameters were compared during the ROC-analysis.Results. In our statistical analysis groups formed not from patients, because we were compared results about focal lesions of a liver referred to metastasis or hemangiomas. All the patients included in a research had focal lesions mostly multiple and in the comparative analysis of contrast ratio in the T1-FE-FSat and T1-TSE-MTC was carried out on 21 (20%) hemangiomas and 84 (80%) metastasises. The significant (p &lt; 10–4) contrast enhancement using T1-TSE-MTS, as in the case of hemangiomas and in metastatic lesions relative to T1-FE-FSat revealed by comparing the CRs. No significant differences were found in the differentiation of hemangiomas and liver metastases in modes T1-FE-FSat and T1-TSE-MTS when paired comparison of ROC-curves (p &gt; 0.18). No significant differences were found when paired comparison of CRs between hemangiomas in T1-FE-FSat mode and metastases in T1-TSEMTSimages (p &gt; 0.8). An additive effect (sensitivity and specificity – 98.8% and 85.7%) occurs when we used to CRcomm=35.7% in T1-FE-FSat modes and T1-TSE-MTS.Conclusions. 1. Contrast MRI using magnetization transfer effect allows significantly increase the contrast of focal liver formations on the type of hemangiomas and metastases. 2. The achieved contrast level in 2D TSE images with magnetization transfer effect of liver metastatic foci corresponds to that of hemangiomas in 2D FE mode. 3. Maximum parameters of sensitivity and specificity in the differential diagnosis of hemangiomas and liver metastases obtained by using 2D-FE-FSat and 2D-TSE-MTC in post contrast phase.

A predictive test for difficult intubation in laryngeal microsurgery. Validation study

Abstract Background In 2003 a simple test to detect difficult intubation (DI) in patients underwent laryngeal microsurgery was described. The present study was conducted to validate the test. Methods Patients with laryngeal disease scheduled for laryngeal microsurgery were included. The variables evaluated were eleven parameters: Mallampati Score ≥ III, thyromental distance iii – iv and/or if auxiliary equipment was required to achieve orotracheal intubation. A comparison of ROC curves was conducted to estimate the best predicting cut-off, as well as differences between the index described in 2003 and the rapid assessment by an expert anaesthesiologist. Results One hundred and five patients were included in the study. The incidence of DI according to the predefined criteria was 45% (47 patients). The score at the cut-off of 5 provides a sensitivity of 89% and a specificity of 55%. The fast-evaluation by an expert anaesthesiologist obtained similar sensitivity (89%) and better specificity (81%). Area under curve (AUC) was 0.87, similar to a fast evaluation (AUC: 0.85; P = .71). Conclusion The index was validated at a cut-off of ≥5, being a useful and reliable test to predict DI in patients with laryngeal diseases and it is a useful tool for anaesthesiologists with conventional training.