Specific Cut-off Points Research Articles

Waist-to-Height Ratio Cut-Off Points for Central Obesity in Individuals with Overweight Across Different Ethnic Groups in NHANES 2011–2018

Background: The identification of surrogate measures of central obesity is of clinical importance, and the waist-to-height ratio (WtHR) has recently attracted great interest as an alternative method. Objective: For this reason, we aimed to establish specific WtHR cut-off points for adiposity (i.e., central obesity) in four different ethnicity groups across both sexes based on data from the National Health and Nutrition Examination Survey (NHANES) population. Methods: Of the total 23,037 participants who completed four cycles of the survey between the years 2011 and 2018, anthropometric measures (i.e., body weight, waist circumference, and height) and dual X-ray absorptiometry-derived visceral adipose tissue (DXA-derived VAT) results were available for 3566 individuals who were assessed in this cross-sectional study. Participants with an overweight status defined according to the World Health Organization (WHO) body mass index (BMI) cut-off points (25–29.9 kg/m2) were included. The sample was then categorized by adiposity according to the DXA-derived VAT tertiles (highest), and based on the receiver operating characteristic (ROC) curve analysis, the best sensitivity and specificity were attained for predicting central obesity using the WtHR. Results: The following WtHR cut-offs were identified as having the best discriminating ability for central obesity: 0.57 for White males and 0.58 for White females; 0.55 for Black males and 0.57 for Black females; 0.56 for Asian males and 0.59 for Asian females; and 0.57 for Hispanic males and 0.59 for Hispanic females. Conclusions: These new WtHR cut-off points should be utilized in adults with overweight to screen for central adiposity based on their sex and ethnicity, and obesity guidelines therefore need to be revised accordingly.

The diagnostic accuracy of HE4 in the differential diagnosis of pleural effusions

BackgroundPleural effusions are challenging to diagnose, with approximately 20–50% of malignant effusions not diagnosed by cytology. Human epididymal protein 4 (HE4) may be useful in the differential diagnosis of pleural effusions. In serum, this biomarker shows false-positive results in some benign diseases. The aim of this study was to evaluate the diagnostic utility of HE4 in this setting and to identify false positives. MethodsConcentrations of HE4, adenosine deaminase, % polynuclear cells, and C-reactive protein, were determined in 238 pleural fluid samples and the estimated glomerular filtration rate (eGFr) in serum. ResultsHE4 values ​​differed significantly (p < 0.01) between malignant [median (IQR)] [1065 (2085)] pmol/L and benign effusions [699 (589)] pmol/L. HE4 concentrations in gynecological and pulmonary tumors were significantly higher than in other tumors.For a cut-off point of 3050 pmol/L, 22 % sensitivity and 100 % specificity were obtained.In patients with benign disease, significant increases in HE4 were identified only in those with eGFr < 30 mL/min/1.73 m2 [1050(596)] pmol/L, and not in those with eGFr > 30 mL/min/1.73 m2 [597(532)] pmol/L).Two cut-offs were established for maximum specificity, depending on the eGFr: 3050 pmol/L for eGFr < 30 mL/min/1.73 m2 and 1992 pmol/L for eGFr > 30 mL/min/1.73 m2. A sensitivity of 28.5 % was obtained for patients with eGFr > 30 mL/min/1.73 m2 and 36.3 % for patients with eGFr < 30 mL/min/1.73 m2. The sensitivity using a specific cut-off point was 29.7 %. ConclusionsThe determination of HE4 in pleural fluids demonstrates high specificity and low sensitivity. The use of specific cutoff points that are clinically adjusted improves sensitivity while maintaining maximum specificity.

B-314 Utility of he4 in differential diagnosis of pleural effusions

Abstract Background The usefulness of tumor markers in the differential diagnosis of cancer in patients with pleural effusions (PE) remains controversial. Few studies have reported the measurement of human epididymal protein 4 (HE4) in pleural fluid. HE4 is a tumor marker associated with different types of cancer. An elevated serum concentration has been observed in ovarian and lung cancers. Other benign pathologies can increase HE4 levels, which can be detect with different laboratory tests identified with adenosine deaminase (ADA), C-reactive protein (CRP), % polynuclear cell count (%PMN) and glomerular filtration rate (GFR) can be used in order to detect possible false positives. The objective of this study was to assess the diagnostic usefulness of HE4 in malignant pleural effusions by comparing HE4 concentrations between benign and malignant samples, while considering the causes of HE4 false positives. Methods HE4, ADA, differential leukocyte count, CRP and GFR concentrations were determined in 238 pleural effusion samples. Diagnostic efficacy analysis using receiver operating curves (ROC) identified the ability of HE4 to detect malignancy, searching for cut-off points with 100% specificity. Results HE4 concentrations showed significant differences (P&amp;lt;0.01) between malignant (median 1065pmol/L) and benign (median 699pmol/L) pleural effusions. Significant differences (P&amp;lt;0.01) were found in HE4 concentrations for gynecological and lung cancer origin (median 7397 pmol/L and 5150 pmol/L respectively) and other malignant pleural effusions (median 1065 pmol/L). Patients with benign diseases with renal failure showed a higher HE4 concentration (median 964pmol/L) than in patients without these pathologies (median 696pmol/L) identified with GFR&amp;lt;30 mL/min. No differences were demonstrated in HE4 concentration levels using ADA, differential leukocyte count or CRP, so only glomerular filtration rate was considered cause of false positives. A sensitivity of 23% was obtained for HE4, with a cut-off point of 3050pmol/L and a specificity of 100% for the whole group. In the potential false positive group, the sensitivity of HE4 was 28% with a cutoff point of 3050 pmol/L with a specificity of 100%. In the group without potential false positives, we obtained a sensitivity of 30% with a specificity of 100% for a cutoff point of 1992pmol/L. When we used a specific cut-off point for each group, we obtained a sensitivity of 38% with a specificity of 100%. Conclusions HE4 levels are higher in malignant pleural effusions compared to other pathologies. HE4 levels allow the identification of malignant pleural effusions with moderate sensitivity and maximum specificity. HE4 levels can differentiate between tumors of gynecological or lung origin and others. Glomerular filtration rate (GFR&amp;lt;30 mL/min) was considered the main cause of false positives. If we identify possible false positives, we can use specific cut-offs and improve sensitivity up to 38% with maximum specificity compared to using a single cut-off for all effusions.

Sensitivity, specificity and clinical cut-off point of the Persian short form version of the Female Sexual Function Index (FSFI-6)

Sensitivity, specificity and clinical cut-off point of the Persian short form version of the Female Sexual Function Index (FSFI-6)

Exhaustive Search of Dietary Intake Biomarkers as Objective Tools for Personalized Nutrimetabolomics and Precision Nutrition Implementation.

To conduct an exhaustive scoping search of existing literature, incorporating diverse bibliographic sources to elucidate the relationships between metabolite biomarkers in human fluids and dietary intake. The search for biomarkers linked to specific dietary food intake holds immense significance for precision health and nutrition research. Using objective methods to track food consumption through metabolites offers a more accurate way to provide dietary advice and prescriptions on healthy dietary patterns by healthcare professionals. An extensive investigation was conducted on biomarkers associated with the consumption of several food groups and consumption patterns. Evidence is integrated from observational studies, systematic reviews, and meta-analyses to achieve precision nutrition and metabolism personalization. Tailored search strategies were applied across databases and gray literature, yielding 158 primary research articles that met strict inclusion criteria. The collected data underwent rigorous analysis using STATA and Python tools. Biomarker-food associations were categorized into 5 groups: cereals and grains, dairy products, protein-rich foods, plant-based foods, and a miscellaneous group. Specific cutoff points (≥3 or ≥4 bibliographic appearances) were established to identify reliable biomarkers indicative of dietary consumption. Key metabolites in plasma, serum, and urine revealed intake from different food groups. For cereals and grains, 3-(3,5-dihydroxyphenyl) propanoic acid glucuronide and 3,5-dihydroxybenzoic acid were significant. Omega-3 fatty acids and specific amino acids showcased dairy and protein foods consumption. Nuts and seafood were linked to hypaphorine and trimethylamine N-oxide. The miscellaneous group featured compounds like theobromine, 7-methylxanthine, caffeine, quinic acid, paraxanthine, and theophylline associated with coffee intake. Data collected from this research demonstrate potential for incorporating precision nutrition into clinical settings and nutritional advice based on accurate estimation of food intake. By customizing dietary recommendations based on individualized metabolic profiles, this approach could significantly improve personalized food consumption health prescriptions and support integrating multiple nutritional data.This article is part of a Nutrition Reviews special collection on Precision Nutrition.

Hyperandrogenism and anthropometric parameters in women with polycystic ovary syndrome

ObjectiveOne of the main features of polycystic ovary syndrome (PCOS) is increased adipose tissue, which can result in hormonal disturbances. In the present study, we aimed to investigate which indicator of obesity could better associate with hormonal disturbances in PCOS women.MethodsIn this cross-sectional analysis, women with PCOS were included according to the Rotterdam criteria. Fasting blood samples were analyzed for biochemical, metabolic, and hormonal parameters. Anthropometric measures comprised body composition indices (assessed by bioelectric impedance analysis [BIA]), waist circumference, body mass index (BMI), and waist-to-height ratio (WHtR). Linear regression modeling was used to assess the association between anthropometric indices and hormonal imbalance, adjusted for age, mensuration status, and the homeostasis model assessment-estimated insulin resistance (HOMA-IR). Receiver operating characteristics (ROC) curves were utilized to ascertain the sensitivity, specificity, and optimal cut-off points of various anthropometric indices in identifying hyperandrogenism.ResultsA total of 129 PCOS women with a median (interquartile range [IQR]) age of 32.0 (23.0–32.0) years and a median BMI of 26.3 (23.00-29.70) kg/m2 were enrolled. In the adjusted linear regression model, BMI (β = 0.053, P < 0.001), waist circumference (β = 0.021, P = 0.001), WHtR (β = 3.325, P = 0.002), total fat mass (β = 0.021, P = 0.002), trunk fat mass (β = 0.038, P = 0.006), and leg fat mass (β = 0.045, P = 0.004) were positively associated with free androgen index (FAI). In addition, BMI (β=−0.017, P = 0.003), waist circumference (β=−0.008, P = 0.002), WHtR (β=−1.167, P = 0.004), total fat mass (β=−0.008, P=0.003), trunk fat mass (β=−0.017, P=0.001), and leg fat mass (β=−0.018, P=0.004) were negatively associated with the serum level of sex hormone binding globulin (SHBG). WHtR showed the greatest area under the curve (AUC) value (AUC = 0.676, P = 0.001) for identifying hyperandrogenism (FAI ≥ 4.97 or total testosterone ≥ 0.7 ng/mL) in PCOS women with corresponding sensitivity of 87.30% and specificity of 39.70%.ConclusionsWHtR is related to hyperandrogenism in PCOS better than other anthropometric measures.

Association Between Glycemic Variability and Persistent Acute Kidney Injury After Noncardiac Major Surgery: A Multicenter Retrospective Cohort Study.

While the relationship between glycemic variability (GV) and acute kidney injury (AKI) has been a subject of interest, the specific association of GV with persistent AKI beyond 48 hours postoperative after noncardiac surgery is not well-established. This retrospective cohort study aimed to describe the patterns of different GV metrics in the immediate 48 hours after noncardiac surgery, evaluate the association between GV indices and persistent AKI within the 7-day postoperative window, and compare the risk identification capabilities of various GV for persistent AKI. A total of 10,937 patients who underwent major noncardiac surgery across 3 medical centers in eastern China between January 2015 and September 2023 were enrolled. GV was characterized using the coefficient of variations (CV), mean amplitude of glycemic excursions (MAGE), and the blood glucose risk index (BGRI). Multivariable logistic regression was used to examine the relationship between GV and AKI. Optimal cutoff values for GV metrics were calculated through the risk identification models, and an independent cohort from the INformative Surgical Patient dataset for Innovative Research Environment (INSPIRE) database with 7714 eligible cases served to externally validate the risk identification capability. Overall, 274 (2.5%) of the 10,937 patients undergoing major noncardiac surgery met the criteria of persistent AKI. Higher GV was associated with an increased risk of persistent AKI (CV: odds ratio [OR] = 1.26, 95% confidence interval [CI], 1.08-1.46; MAGE: OR = 1.31, 95% CI, 1.15-1.49; BGRI: OR = 1.18, 95% CI, 1.08-1.29). Compared to models that did not consider glycemic factors, MAGE and BGRI independently contributed to predicting persistent AKI (MAGE: areas under the curve [AUC] = 0.768, P = .011; BGRI: AUC = 0.764, P = .014), with cutoff points of 3.78 for MAGE, and 3.02 for BGRI. The classification of both the internal and external validation cohorts using cutoffs demonstrated good performance, achieving the best AUC values of 0.768 for MAGE in the internal cohort and 0.777 for MAGE in the external cohort. GV measured within 48 hours postoperative period is an independent risk factor for persistent AKI in patients undergoing noncardiac surgery. Specific cutoff points can be used to stratify at-risk patients. These findings indicate that stabilizing GV may potentially mitigate adverse kidney outcomes after noncardiac surgery, highlighting the importance of glycemic control in the perioperative period.

Medial opening wedge high tibial osteotomy performs similarly irrespective of body mass index.

This study investigates the effect of the body mass index (BMI) on the early (2 years) to midterm (5 years) results of medial opening wedge high tibial osteotomy (MOWHTO). A prospectively maintained single-centre database of 1138 knee osteotomies, between 2002 and2022, was retrospectively reviewed. Adult patients who underwent MOWHTO for symptomatic unicompartmental medial knee osteoarthritis (OA), with varus knee malalignment, having failed conservative management, were included. Patients were categorized into threegroups according to their BMI as per the classification from the National Institute for Health and Care Excellence (NICE): the healthy weight (HW) group (BMI of 18.5-24.9 kg/m2), the overweight (OW) (BMI of 25-29.9 kg/m2), and the obesity (OB) group (BMI ≥ 30 kg/m2). Multiple patient-reported outcome measures (n = 6) were recorded preoperatively and at 2 and 5 years postoperatively. Deformity analysis was undertaken preoperatively and postoperatively. The relative risk (RR) of the complications between the HW, OWand OB groups was calculated. The rate of conversion to arthroplasty, and 5and 10 years survivorship were recorded, as well as the hazard ratio (HR) of BMI on survivorship. A total of 574 cases were included in the study: the HW group (n = 96), the OW group (n = 233)and the OB group (n = 245), with a mean BMI of 23 ± 1.5 kg/m2, 27.4 ± 1.4 kg/m2 and 34.4 ± 3.8 kg/m2, respectively. The mean follow-up was 13.3 years (4.8-20.3). The mean mechanical tibiofemoral angle corrections were in the HW group: 7.1 ± 3°, OW group: 6.6 ± 3.5°and OB group: 7.1 ± 3.8°, with no intergroup significant difference (p = n.s.). Clinically, despite lower preoperative scores in the OW and OB groups, no difference was observed postoperatively amongst the three groups. The overall complication rate was 12.5% in the HW group, 6.8% in the OW group, and 9.8% in the OB group. There was no significant difference in the RR of complications between the HW and OW groups (RR = 0.6, 95% confidence interval [CI] = 0.3-1.3)(p = 0.2), and the HW and OB groups (RR = 0.8; 95% CI = 0.3-2.2)(p = 0.7). There was no overall significant difference in survival outcomes based on the BMI between the threegroups (p = 0.4). The HR of conversion to arthroplasty between the HW and OW groups was 1.4 [95% CI = 0.6-3.5](p = 0.5)and between the HW and OB groups was 1.8 [95% CI = 0.8-4.4] (p = 0.2). BMI has no significant effect on either the radiological corrections, clinical outcomes, complicationsor survivorship of MOWHTO at short- to medium-term follow-up. No specific cutoff point for BMI can be recommended as a contraindication to MOWHTO. Level IV, Retrospective cohort study.

Enhancing Liver Disease Detection and Management with Advanced Machine Learning Models

The prevalence of hearing loss has risen making it a significant public health issue. Hearing loss is caused by complicated pathophysiological pathways, with various risk factors identified, such as hereditary factors, inflammatory processes, systemic disorders, noise exposure, medicines, oxidative stress, and age. Metabolic syndrome is a medical condition characterized by the presence of hypertension, central obesity, hyperlipidemia, and diabetes. Metabolic syndrome has been linked to several clinical diseases, such as stroke, heart attack, cardiovascular disease-related death, and diabetes. A cross-sectional study was done on 100 patients with metabolic syndrome which used specific cut-off points of waist circumference, fasting glucose levels, blood pressure, triglyceride, and high-density lipoprotein cholesterol levels to diagnose the condition. Among these five criteria, at least three had to be met, and the presence of additional criteria indicated greater severity. Audiological evaluation with pure tone audiometry was done and recorded. Statistical analysis was performed to determine the significance of the results. The majority of the patients (62%) had unilateral hearing loss, amongst which sensory-neural type and moderately severe hearing loss were the most common type (67%) and severity (61%) of hearing loss respectively. Chi-square tests were done for the comparison of type, severity, and laterality of hearing loss with age, gender of the patients, and criteria fulfilled for metabolic syndrome. The severity of hearing loss had a statistically significant association with the age of the patients and the number of criteria fulfilled for metabolic syndrome with a p-value of 0.003. There was a statistically significant association between the severity of hearing loss and the age of the patients and the number of criteria fulfilled for metabolic syndrome with a p-value of 0.004. Metabolic syndrome affects the auditory system in several ways. It damages hearing and exacerbates presbycusis. Hearing loss worsens as components of the metabolic syndrome increase.

Systemic Inflammatory Index in Polycythemia Vera and Its Prognostic Implications.

Background: This study aimed to evaluate the clinical and prognostic associations of the systemic inflammatory index (SII) in polycythemia vera (PV) patients. SII integrates information on absolute neutrophil (ANC), lymphocyte (ALC), and platelet counts into one index (calculated as ANCxALC/platelet count) and was previously shown to predict thrombotic and mortality risks in the general population. Methods: A total of 279 PV patients treated in several hematologic centers in Croatia and Serbia was retrospectively evaluated. Results: The median SII for the overall cohort was 1960. Higher SII stratified at the specific cut-off points was significantly associated with shorter time to thrombosis (TTT; p = 0.004) driven by arterial thrombotic events, and shorter overall survival (OS; p < 0.001). Higher SII was able to refine the European Leukemia Net-defined high-risk patient subgroup for both thrombotic and survival risks, especially in individuals over 60 years of age. SII and all other evaluated CBC components and indices (leukocytes, ANC, ALC, platelets, neutrophil to lymphocyte ratio (NLR), and platelet to lymphocyte ratio (PLR)) demonstrated low-to-modest prognostic properties, whereas SII outperformed other parameters with respect to TTT and OS prognostications. Discussion: The presented results complement prior studies evaluating the prognostic performance of different CBC components for thrombotic and survival risk predictions and offer more options to personalize PV treatments.

Relationship of Metabolic Syndrome With Hearing Loss

The prevalence of hearing loss has risen making it a significant public health issue. Hearing loss is caused by complicated pathophysiological pathways, with various risk factors identified, such as hereditary factors, inflammatory processes, systemic disorders, noise exposure, medicines, oxidative stress, and age. Metabolic syndrome is a medical condition characterized by the presence of hypertension, central obesity, hyperlipidemia and diabetes. Metabolic syndrome has been linked to several clinical diseases, such as stroke, heart attack, cardiovascular disease-related death, and diabetes. A cross-sectional study was done on 100 patients with metabolic syndrome which used specific cut-off points of waist circumference, fasting glucose levels, blood pressure, triglyceride, and high-density lipoprotein cholesterol levels to diagnose the condition. Among these five criteria, at least three had to be met, and the presence of additional criteria indicated greater severity. Audiological evaluation with pure tone audiometry was done and recorded. Statistical analysis was performed to determine the significance of the results. The majority of the patients (62%) had unilateral hearing loss, amongst which sensory-neural type and moderately severe hearing loss were the most common type (67%) and severity (61%) of hearing loss respectively. Chi-square tests were done for the comparison of type, severity, and laterality of hearing loss with age, gender of the patients, and criteria fulfilled for metabolic syndrome. The severity of hearing loss had a statistically significant association with the age of the patients and the number of criteria fulfilled for metabolic syndrome with a p-value of 0.003. There was a statistically significant association between the severity of hearing loss and the age of the patients and the number of criteria fulfilled for metabolic syndrome with a p-value of 0.004. Metabolic syndrome affects the auditory system in several ways. It damages hearing and exacerbates presbycusis. Hearing loss worsens as components of the metabolic syndrome increase.

Can Highly Specific Ultrasound Criteria Obviate the Need for Sentinel Lymph Node Biopsy in Breast Cancer Patients with Axillary Lymph Node Metastasis?

Background: Sentinel lymph node biopsy (SLNB) is primarily performed to detect axillary lymph node involvement and determine the need for surgical axillary lymph node dissection (ALND). However, the procedure is expensive and necessitates the use of radio-labelled colloids that are not readily available to a large number of patients. It also carries the risk of producing occasional false negative results. Objectives: This study aimed to define highly specific ultrasound parameters to ascertain axillary lymph node involvement as an alternative or complementary method to SLNB in selected patients who require ALND. Patients and Methods: In this prospective cross-sectional study, 256 patients with confirmed breast cancer were selected through non-probability purposive sampling. The selected patients were referred to Omid Hospital, a tertiary educational oncology center in Mashhad, Iran, from 2018 to 2022. This study identified highly specific cut-off points for ultrasound parameters to determine lymph node involvement in comparison with the histological diagnosis post-SLNB or ALND. Measurements were taken of the tumor size, the cortical thickness of the axillary lymph node, the short axis diameter of the node, and the count of lymph nodes with a cortical thickness of ≥ 3 mm. Results: Among 256 patients with a mean age of 46.41 ± 10.77 years, 202 (87.9%) had histologically confirmed metastatic adenopathy. The ultrasound cut-off values identified to define metastasis with high certainty were as follows: A tumor size &gt; 50.5 mm (with 97% specificity), a difference in cortical thickness of ≥ 4.5 mm (with 100% specificity), a short axis diameter of the node &gt; 12 mm (with 95% specificity), more than three lymph nodes with a cortical thickness of ≥ 3 mm (with 94.3% specificity), and a cortical thickness of ≥ 6 mm (with 95% specificity). Conclusion: Highly specific ultrasound findings can diagnose lymph node metastasis with a high degree of certainty and can used as an alternative method to SLNB. A difference of ≥ 4.5 mm between the cortical thickness of the suspected lymph node and the contralateral lymph node and a cortical thickness of ≥ 6 mm are ultrasound findings that can detect lymph nodes involvement, with a specificity ranging from 95% to 100%.

Recovery from Acute Kidney Injury and Long-Term Prognosis following Acute Myocardial Infarction.

We investigated the recovery pattern from acute kidney injury (AKI) following acute myocardial infarction (AMI) and its association with long-term mortality. The retrospective study included AMI patients (2002-2027), who developed AKI during hospitalization. Creatinine (Cr) measurements were collected and categorized into 24 h timeframes up to 7 days from AKI diagnosis. The following groups of recovery patterns were defined: rapid (24-48 h)/no rapid and early (72-144 h)/no early recovery. Specific cut-off points for recovery at each AKI stage and timeframe were determined through receiver operating characteristic (ROC) curves. The probability of long-term (up to 10 years) mortality as a post-AKI recovery was investigated using a survival approach. Out of 17,610 AMI patients, 1069 developed AKI. For stage 1 AKI, patients with a Cr ratio <1.5 at 24 h and/or <1.45 at 48 h were defined as 'rapid recovery'; for stages 2-3 AKI, a Cr ratio <2.5 at 96 h was defined as 'early recovery'. Mortality risk in stage 1 AKI was higher among the non-rapidly recovered: AdjHR = 1.407; 95% CI: 1.086-1.824; p = 0.010. Among stages 2-3 AKI patients, the risk for long-term mortality was higher among patients who did not recover in the early period: AdjHR = 1.742; 95% CI: 1.085-2.797; p = 0.022. The absence of rapid recovery in stage 1 AKI and lack of early recovery in stages 2-3 AKI are associated with higher long-term mortality.

Evaluation of Serum Kallistatin in Patients with Hepatocellular Carcinoma

Abstract Background Liver cirrhosis is the most frequent long-term consequence of all chronic liver diseases. Cirrhosis is often asymptomatic and unsuspected until complications. The annual incidence rates of liver cirrhosis and hepatocellular carcinoma is related with chronic hepatitis B or C all over the world. The majority of patients with liver cirrhosis or hepatocellular carcinoma die from complications, which happened relatively early in the course of the disease. Thus, the early diagnosis of liver diseases is the only solution for this great problem. Aim of the Work In the current study we aimed to evaluate serum kallistatin in Egyptian patients with hepatitis C virus related liver cirrhosis and hepatocellular carcinoma. Patients and Methods This case control study enrolled 90 Egyptian subjects aged ≥ 18 years old at Ain shams university hospitals, participants were classified into 3 groups as follow: Group 1: 30 patients with hepatocellular carcinoma (patients have been diagnosed with triphasic CT). Group 2: 30 patients with hepatitis C virus related liver cirrhosis (patients diagnosed according to clinical, laboratory and radiological findings. Group 3: 30 healthy subjects serving as a control group. Results This study found that patients with liver cirrhosis and HCC have lower levels of serum Kallistatin compared to a control group. In the HCC group, patients with more severe liver disease (Child class C) had lower Kallistatin levels than those with less severe disease (Child class A and B). Kallistatin was negatively correlated with certain markers of liver disease and inflammation in both groups, and positively correlated with hemoglobin and albumin. The study also tested the diagnostic accuracy of Kallistatin for detecting liver cirrhosis and HCC, and found that it had 66.5% accuracy for cirrhosis and 98% accuracy for HCC at specific cutoff points. Conclusion Serum Kallistatin has a potential rule as a new biomarker for the diagnosis and evaluation of liver cirrhosis and HCC. The present study was limited by the small sample size. Also, all participants were from the Egyptian population with liver disease induced by HCV- infection with no information if our findings would be valid for other population with different etiologies. Thus, further investigation should be carried out in order to validate these findings

When are You Recovered? Defining Cutoff Points Using the Acute Respiratory Tract Infection Questionnaire

ObjectivesAcute respiratory tract infections (ARTIs) are a heterogenous group of diseases. Often, it is difficult to obtain a precise diagnosis in general practice but also difficult to determine when the patient is recovered. The lack of a precise definition of recovery after ARTI complicates scientific research aiming to optimize diagnostics and compare treatments. The study aimed to define cutoff points to determine the end of an ARTI as a proxy for recovery in patients diagnosed with ARTI in general practice using a validated patient-reported outcome instrument; The ARTI Questionnaire (ARTIQ). MethodsA total of 259 participants was divided in 2 groups—1 with ARTI and 1 without. Histograms and area under the curve were calculated for each of the 5 dimensions within the ARTIQ to evaluate the discriminative effect. For the most discriminative dimensions receiver operating comparison curves were performed to determine relevant cutoff points for having or not having ARTI symptoms and serve as a proxy for recovery in clinical research. ResultsThe highest discriminative effect was found in 2 dimensions: “physical—upper airways” and “physical—lower airways.” When combining these dimensions, the area under the curve was 0.97. Sensitivity, specificity, and predictive values were calculated for selected cutoff points. ConclusionCutoff points serving as proxy for recovery from ARTI using a patient-reported outcome were identified. The specific cutoff point for a certain research project must be selected considering the specific clinical situation of interest.

Diagnostic Accuracy of DSI and AVQI v.02.03 in Discriminating across the Perceptual Levels of Dysphonia in Kannada Speaking Population

The present study investigated and compared the diagnostic accuracy of DSI and AVQI in Indian adults in the age range of 18-40 years across different levels of dysphonia severity.Normophonic individuals (n=163) and individuals with dysphonia (n=134) were selected using purposive sampling in the age range of 18-40 years. For DSI, Computerized Speech Lab 4500 and for AVQI, Praat 6.1.03 was used for recording. The results of ROC analysis for DSI have revealed that DSI can discriminate the normophonic vs. mild, mild vs. moderate, and moderate versus severe dysphonic with cut-off values of 1.36, -1.83 and -4.07 respectively. The sensitivity and specificity reported for mild vs. moderate and moderate vs. severe is slightly lower for obtained threshold points. For AVQI v.02.03, ROC analysis revealed that high sensitivity and specificity cut-off points for normophonic vs. mild, mild vs. moderate and moderate vs. severe dysphonic are 2.50, 3.86 and 6.21 respectively. AVQI is a more effective technique than DSI for distinguishing between dysphonia severities levels, particularly when it comes to mild vs. moderate and moderate vs. severe, according to comparisons of AROC curves made using the DeLang method.

AI-Assisted Body Composition Assessment Using CT Imaging in Colorectal Cancer Patients: Predictive Capacity for Sarcopenia and Malnutrition Diagnosis.

(1) Background: The assessment of muscle mass is crucial in the nutritional evaluation of patients with colorectal cancer (CRC), as decreased muscle mass is linked to increased complications and poorer prognosis. This study aims to evaluate the utility of AI-assisted L3 CT for assessing body composition and determining low muscle mass using both the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for sarcopenia in CRC patients prior to surgery. Additionally, we aim to establish cutoff points for muscle mass in men and women and propose their application in these diagnostic frameworks. (2) Methods: This retrospective observational study included CRC patients assessed by the Endocrinology and Nutrition services of the Regional University Hospitals of Malaga, Virgen de la Victoria of Malaga, and Vall d'Hebrón of Barcelona from October 2018 to July 2023. A morphofunctional assessment, including anthropometry, bioimpedance analysis (BIA), and handgrip strength, was conducted to apply the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia. Body composition evaluation was performed through AI-assisted analysis of CT images at the L3 level. ROC analysis was used to determine the predictive capacity of variables derived from the CT analysis regarding the diagnosis of low muscle mass and to describe cutoff points. (3) Results: A total of 586 patients were enrolled, with a mean age of 68.4 ± 10.2 years. Using the GLIM criteria, 245 patients (41.8%) were diagnosed with malnutrition. Applying the EWGSOP2 criteria, 56 patients (9.6%) were diagnosed with sarcopenia. ROC curve analysis for the skeletal muscle index (SMI) showed a strong discriminative capacity of muscle area to detect low fat-free mass index (FFMI) (AUC = 0.82, 95% CI 0.77-0.87, p < 0.001). The identified SMI cutoff for diagnosing low FFMI was 32.75 cm2/m2 (Sn 77%, Sp 64.3%; AUC = 0.79, 95% CI 0.70-0.87, p < 0.001) in women, and 39.9 cm2/m2 (Sn 77%, Sp 72.7%; AUC = 0.85, 95% CI 0.80-0.90, p < 0.001) in men. Additionally, skeletal muscle area (SMA) showed good discriminative capacity for detecting low appendicular skeletal muscle mass (ASMM) (AUC = 0.71, 95% CI 0.65-0.76, p < 0.001). The identified SMA cutoff points for diagnosing low ASMM were 83.2 cm2 (Sn 76.7%, Sp 55.3%; AUC = 0.77, 95% CI 0.69-0.84, p < 0.001) in women and 112.6 cm2 (Sn 82.3%, Sp 58.6%; AUC = 0.79, 95% CI 0.74-0.85, p < 0.001) in men. (4) Conclusions: AI-assisted body composition assessment using CT is a valuable tool in the morphofunctional evaluation of patients with colorectal cancer prior to surgery. CT provides quantitative data on muscle mass for the application of the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia, with specific cutoff points established for diagnostic use.

Observations on Gender Variance in Chinese Community Children Measured by the Gender Identity Questionnaire for Children.

Few studies have examined how gender variance (GV), broadly defined as gender identity and behaviors (e.g., activities and preferences) that do not correspond with culturally defined gender norms, manifests in community samples, particularly in children and outside Western contexts. We present data based on the Gender Identity Questionnaire for Children (GIQC; Johnson et al., 2004) among 461 Chinese community children (4-12years old) to gauge how well the GIQC serves as a measure of GV and the prevalence of GV. We examined the descriptive scores of GV, its relationship to a gender-typing measure that has been validated in Chinese children (the Child Play Behavior and Activity Questionnaire, CPBAQ), the scores on the GIQC of children whose gender is incongruent with birth-assigned sex, and the binned category distributions (from gender-variant to gender-conforming) in comparison to a Canadian community sample (van der Miesen et al., 2018). The Chinese children on average scored toward the gender-conforming end and children assigned female at birth showed more GV than children assigned male at birth. More importantly, the GIQC appears to be a reliable and sensitive measure of GV in the Chinese sample. GIQC scores correlated significantly with CPBAQ scores and showed a very similar reliability coefficient, gender difference effect size, and bin distribution pattern as the Canadian reference sample. Also, children reported as gender/sex incongruent had the most gender-variant GIQC scores. Although clinically gender-referred Chinese children are required to establish culturally specific cutoff points, these findings provide initial evidence for the characteristics of GV, the applicability of the GIQC as a measure of GV in Chinese community children, and the comparisons of GIQC categories between Chinese and Canadian community samples.

Tailored electrocardiographic-based criteria for different pacing locations within the left bundle branch

Abstract Background QRS morphology transition criteria are the current gold-standard for the confirmation of LBB capture during LBBAP, but they are seen in less than 40% of procedures. Thus, physiologic ECG-based criteria are widely used to confirm LBBP. Current CSP guidelines recommend 100% specific cut-off points (V6-RWPT&amp;lt; 75 ms or V6-V1 interpeak interval &amp;gt; 44 ms) to confirm LBB capture but these values were never validated for different pacing locations. Purpose To describe diagnostic performance of paced V6-RWPT, V6-V1 interpeak interval and paced aVL-RWPT for different pacing sites within the LBB and to determine 100% specific values at each pacing location. Methods Consecutive patients with an attempt of LBBAP procedure were screened at our institution. Only patients with unequivocal LBB capture according to QRS transition criteria were selected. The study population was divided into subgroups according to the site of pacing (left bundle trunk pacing (LBTP), left septal fascicular pacing (LSFP), left posterior fascicular pacing (LPFP) and left anterior fascicular pacing (LAFP)). Results 147 patients with unequivocal LBB capture were analyzed (mean age 77.5±10.4 years, 50.3% male, 95.2% preserved LVEF, and 94.6% with bradycardia pacing indication. Non-diseased LBB (narrow QRS complex or isolated RBBB) was present in 70.7% of patients (n=104). Left fascicular pacing was the most common type of LBB capture achieved (82.8%) while LBTP accounted for 17.2% of cases. LFSP was the most frequent fascicular capture (54.1%), followed by LPFP (36%) and LAFP (9.9%). The ROC curves of paced V6-RWPT for the differential diagnosis of LBBP and LVSP showed good diagnostic performance among different pacing locations (figure 1). The highest AUC were found in patients with LSFP and LAFP (94.9% and 93.2%, respectively). The 100% V6-RWPT specific cut-off value was 68 ms (SN) 25%) in LPFP, 75 ms (SN 56.5%) in LBTP, 79.5 ms (SN 75%) in LSFP and 81 ms (SN 90.9%) in LAFP (figure 1). The diagnostic performance of V6-V1 interpeak interval was also good among study subgroups (figure 2). The highest AUC were found in patients with LBTP and LSFP (89% and 89.4%, respectively). The 100% V6-V1 interpeak interval specific cut-off value was 35.5 ms (SN 65.2%) in LBTP, 53.5 ms (SN 32.5%) in LPFP, 46 ms (SN 44.1%) in LSFP and 41 ms (SN 63.6%) in LAFP (figure 2). Diagnostic performance of paced aVL-RWPT was good among study subgroups (AUC of 93% in LAFP, 80.1% in LBTP, 84% in LSFP and 77.5% in LPFP). The 100% specific cut-off values for LBBP confirmation were 74 ms, 74.5 ms and 73.5 ms for LBTP, LSFP and LPFP patients, respectively, but it was 68 ms in patients with LAFP (SN 66.7%). Conclusions Diagnostic performance of the physiologic ECG-based criteria for the discrimination of LBBP, was good among different pacing locations within the LBB. Tailored cut-off values depending on the site of pacing might be useful additional tools for better LBB capture confirmation.Figure 1Figure 2

Identification of an Objective Cut-Off Point to Define the Clinical Stage T4a in Colon Cancer

Introduction: The current state of pathology practice and the variability in diagnosing pT4a colon cancer have been underexplored in existing studies. Our objective was to establish a specific cutoff point to distinguish between the pathological stages of pT3 and pT4a in colon cancer. Methods: We conducted a cross-sectional study involving pT3 and pT4 (pN0-2, cM0) colon cancers, measuring the distance to the serosa. Patients were categorized and analyzed based on this distance and the peritoneal reaction, with the aim being to ascertain their prognostic implications. Results: A total of 384 patients were analyzed. Patients with a distance between the invading front of cancer and the serosa ≥ 1 mm without a peritoneal reaction exhibited a median survival of 118 months, contrasting the amount of 70 months for those with &lt;1 mm plus peritoneal reaction. Only lengths &lt;1 mm with peritoneal reaction showed a significant correlation with mortality (p &lt; 0.001). Conclusion: Our study revealed that patients in whom neoplastic cells were less than 1 mm from the serosal surface, accompanied by a peritoneal reaction (hemorrhage, inflammation, neovascularization, fibrin), had significantly lower survival rates compared to those with more than 1 mm distance and without peritoneal response (70 vs. 118 months, p &lt; 0.001). Hence, such cases should be considered within the pT4a stage.