Test Characteristic Curves Research Articles

Atheroprotective effect of myocardial bridge sustains in aging: Autopsy study on subjects with dual left anterior descending coronary artery type 3

BackgroundThe atheroprotective role of the myocardial bridge (MB) on a tunneled segment is already demonstrated in subjects with dual left anterior descending coronary artery (dual LAD) type 3 anomaly, but the dynamics of changes and whether this protective effect sustains during aging is unknown. MethodsThe retrospective autopsy study included cases of dual LAD type 3 anomaly identified over 18 years. The severity grade of atherosclerosis in branches of dual LAD was estimated by microscopy. The Spearman's correlation test and Receiver operator characteristics (ROC) curve analyses were performed to determine the relation of subjects' age with a degree of the protective role of the myocardial bridge. ResultsA total of 32 dual LAD type 3 cases were identified. The systematic heart examination revealed an anomaly prevalence of 2.1%. The age significantly positively correlated with the severity of atherosclerosis in the subepicardial dual LAD branch but not with the severity of atherosclerosis in the intramyocardial dual LAD branch. Subjects aged ≥38 years were likely to have a more severe degree of atherosclerosis in subepicardial than in intramyocardial LAD arteries (AUC 0.81 95% CI 0.59–1; sensitivity 100%, specificity 66.7%). In subjects aged ≥58 years, this difference was likely to be more pronounced (≥2 degree difference; AUC 0.75 95% CI 0.58–0.93; sensitivity 92.9%, specificity 66.7%). ConclusionThe atheroprotective effect of the myocardial bridge on tunneled segments usually becomes evident throughout the second half of the fourth decade of life and is most pronounced after about 60 years and ceases only in some.

Ultrafast DCE-MRI for discriminating pregnancy-associated breast cancer lesions from lactation related background parenchymal enhancement.

To investigate the utility of ultrafast dynamic-contrast-enhanced (DCE) MRI in visualization and quantitative characterization of pregnancy-associated breast cancer (PABC) and its differentiation from background-parenchymal-enhancement (BPE) among lactating patients. Twenty-nine lactating participants, including 10 PABC patients and 19 healthy controls, were scanned on 3-T MRI using a conventional DCE protocol interleaved with a golden-angle radial sparse parallel (GRASP) ultrafast sequence for the initial phase. The timing of the visualization of PABC lesions was compared to lactational BPE. Contrast-noise ratio (CNR) was compared between the ultrafast and conventional DCE sequences. The differences in each group's ultrafast-derived kinetic parameters including maximal slope (MS), time to enhancement (TTE), and area under the curve (AUC) were statistically examined using the Mann-Whitney test and receiver operator characteristic (ROC) curve analysis. On ultrafast MRI, breast cancer lesions enhanced earlier than BPE (p < 0.0001), enabling breast cancer visualization freed from lactation BPE. A higher CNR was found for ultrafast acquisitions vs. conventional DCE (p < 0.05). Significant differences in AUC, MS, and TTE values were found between the tumor and BPE (p < 0.05), with ROC-derived AUC of 0.86 ± 0.06, 0.82 ± 0.07, and 0.68 ± 0.08, respectively. The BPE grades of the lactating PABC patients were reduced as compared with the healthy lactating controls (p < 0.005). Ultrafast DCE MRI allows BPE-free visualization of lesions, improved tumor conspicuity, and kinetic quantification of breast cancer during lactation. Implementation of this method may assist in the utilization of breast MRI for lactating patients. The ultrafast sequence appears to be superior to conventional DCE MRI in the challenging evaluation of the lactating breast. Thus, supporting its possible utilization in the setting of high-risk screening during lactation and the diagnostic workup of PABC. • Differences in the enhancement slope of cancer relative to BPE allowed the optimal visualization of PABC lesions on mid-acquisitions of ultrafast DCE, in which the tumor enhanced prior to the background parenchyma. • The conspicuity of PABC lesions on top of the lactation-related BPE was increased using an ultrafast sequence as compared with conventional DCE MRI. • Ultrafast-derived maps provided further characterization and parametric contrast between PABC lesions and lactation-related BPE.

Differential Item Functioning of the Jaw Functional Limitation Scale

To assess the differential item functioning (DIF) of the Jaw Functional Limitation Scale (JFLS) due to gender, age, and language (English vs Spanish). JFLS data were collected from a consecutive sample of 2,115 adult dental patients from HealthPartners dental clinics in Minnesota. Participants with missing data were excluded, and analyses were performed using data from 1,678 participants. Whether the item response theory (IRT) model assumptions of essential unidimensionality and local independence held up for the JFLS was examined. Then, using Samejima's graded response model, the IRT log-likelihood ratio approach was used to detect DIF. The magnitude and impact of DIF based on Raju's noncompensatory DIF (NCDIF) cutoff value of 0.096, Cohen's effect sizes, and test (or scale) characteristic curves were also assessed. Essential unidimensionality was confirmed, but locally dependent items were found on the JFLS. A few items were flagged with statistically significant DIF after adjustment for multiple comparisons. The NCDIF indices associated with all DIF items were < 0.096, and they had small effect sizes of ≤ 0.2. The differences between the expected scores shown in the test characteristic curves were little to none. The present results support the use of the JFLS summary score to obtain psychometrically robust score comparisons across English- and Spanish-speaking, male and female, and younger and older dental patients. Overall, the magnitude of DIF was relatively small, and the practical impact minimal.

Analysis of Risk Factors for Urinary Tract Infection in Children and Construction and Validation of a Prediction Model.

To analyse the risk factors for urinary tract infection (UTI) in children and construct and validate a risk prediction model. The study selected 258 children with suspected UTI in the paediatric department of our hospital from August 2019 to August 2021. Identified as the subjects in this research, paediatric patients' clinical data were used for retrospective analysis. Based on the counting results of urinary leucocytes and bacteria, children were divided into the UTI group (n = 67) and non-UTI group (n = 191). Univariate analysis and multivariate logistic regression analysis were used to screen the independent risk factors for UTI in children, and a prediction model was constructed according to the results. The Hosmer-Lemeshow goodness-of-fit (GOF) test and receiver operator characteristic (ROC) curve analysis were used to validate the calibration and application value of prediction model. Logistic regression analysis identified length of hospitalisation ≥10 days (OR = 3.611, 95% CI: 1.781-7.325), indwelling ureter (odds ratio (OR) = 3.203, 95% CI: 1.615-6.349), history of infection (OR = 4.827, 95% CI: 2.424-9.612), congenital malformation/dysplasia (OR = 4.212, 95% CI: 2.079-8.531), constipation (OR = 4.021, 95% CI: 1.315-12.299) and anaemia (OR = 2.275, 95% CI: 1.236-4.186) as risk factors for UTI in children (p < 0.05). The formulation method was adopted to construct the following prediction model of UTI in children: Z = 2.066 × (length of hospitalisation ≥10 days) + 1.164 × (indwelling ureter) + 1.574 × (history of infection) + 1.438 × (congenital malformation/dysplasia) + 1.392 × (constipation) + 0.882 × (anaemia). The test results revealed the good GOF and high calibration (χ2 = 9.077, p = 0.336) of prediction model. Furthermore, the area under the ROC curve was 0.825 (95% CI: 0.766-0.884, p < 0.001), indicating the good discrimination and prediction efficiency of model. Based on clinical results, further attention should be given to high-risk children with UTI, and intervention measures should be taken immediately. The application and popularisation of prediction model will allow us to provide strategic guidance for preventing and treating UTIs in clinics.

Diagnosis of Acute Appendicitis using Alvarado Score, Ultrasound Abdomen, and C-Reactive Protein in Different Combinations: A Prospective Observational Study

Introduction: Appendicitis is the most commonly encountered surgical emergency worldwide. Numerous diagnostic methods, including clinical scoring systems, radiological modalities, and laboratory markers have been suggested over time to diagnose appendicitis correctly, but a Negative Appendectomy Rate (NAR) of 20-30% is still maintained. Aim: To determine the effect of using all three modalities together i.e., a clinical modality {The Alvarado Score}, a radiological modality {Ultrasound (US)}, and a laboratory parameter {C-Reactive Protein (CRP)} in diagnosing acute appendicitis. Materials and Methods: This was a hospital-based, prospective observational study, carried out in the Department of General Surgery, SMS Medical College, Jaipur, Rajasthan, India, from March 2019 to June 2020. The three diagnostic modalities were arbitrarily categorised into different combinations: Combination 1: Alvarado score ≥5 with C-Reactive Protein (CRP) ≥0.8; Combination 2: Alvarado score ≥5 with US grade 4 with CRP ≥0.8; Combination 3: Alvarado score ≥5 with US grade 4 with CRP ≥4); and the individual modalities i.e., the alvarado score and the US abdomen were also categorised into four categories each. Each of the individual modalities along with their different combinations were tested for their sensitivities, specificities, Positive and Negative Predictive Values (PPV, NPV) etc. Chi-square and t-test, sensitivity test and Receiver Operating Characteristic curve (ROC) and, Analysis of Variance (ANOVA) was used. Results: Total 200 cases were analysed in this study with mean age 32.33±15.78 years. Alvarado score had a sensitivity and specificity of 95.83% and 75%, respectively. US had a sensitivity and specificity of 71.35% and 75%, respectively while CRP had the highest sensitivity with 98.96%, but very low specificity (37.5%). The sensitivity, specificity, PPV and NPV of the combination 1 were found to be 98.96, 37.50, 97.44, 60.00, and of combination 2 was found to be 70.83, 87.50, 99.27,11.11 and for combination 3 was 56.77, 100, 100, 8.79, respectively. Combination 2 also had the highest Area Under Curve (AUC) in Receiver Operating Characteristic (ROC) curve. (Combination 1- 0.661; combination 2- 0.742; combination 3- 0.727). Conclusion: The Combination 2 of three modalities proved to be the best diagnostic tool in the present study. It can pave the way, for a better diagnostic scoring system and future studies in this field.

Hypovitaminosis D Implicated in the Development of Stress, Metabolic Syndrome and Hepatic Steatosis among Health Science Undergraduates attending a Tertiary Care Institute in Tamil Nadu, India

Introduction: Vitamin D deficiency is prevalent worldwide and its association with stress has become an emerging problem. A collection of linked physiological, biochemical, clinical, and metabolic risk factors is known as the Metabolic Syndrome (MS). High stress level is found associated with vitamin D deficiency and features of metabolic syndrome symptoms. Aim: To estimate the prevalence of vitamin D deficiency, perceived stress, metabolic syndrome and hepatic steatosis among health science Undergraduate (UG) students and also to evaluate the association of vitamin D with percieved stress score, calcium, phosphorus, components of metabolic syndrome and indicators of liver steatosis. Materials and Methods: This cross-sectional study was conducted in SRM Medical College, Hospital and Research Centre, Chennai, India, from February 2022 to August 2022. A total of 80 health science UG students in the age group of 19-25 years were included. The parameters included Fasting plasma glucose, Triglycerides (TGL), High Density Lipoprotein Cholesterol (HDLC), Gamma-glutamyl Transferase (GGT), phosphorus, calcium, and a Perceived Stress Scale (PSS) score scale. Data were statistically analysed using Pearson’s correlation test and Receiver Operating Characteristic (ROC) curve was used to assess the relationship of vitamin D with stress, metabolic syndrome and liver steatosis. Results: In the present study, majority 56 (70%) had vitamin D deficiency, 23 (28.75%) had insufficiency and 1 (1.25%) had sufficiency. An estimated 6 (7.5%) of students experienced low stress, 63 (78.75%) experienced moderate stress and 11 (13.75%) experienced high perceived stress. Indicators of metabolic syndrome occurred in 13 (16.25%) of the population. Nearly 6 (7.5%) of the participants displayed manifestation of fatty liver. A negative association was found between vitamin D with stress score, Body Mass Index (BMI), waist circumference, Blood Pressure (BP), phosphorus, fasting plasma glucose, TGL, HDLC, GGT, Fatty Liver Index (FLI) score. Conclusion: In the present study, vitamin D deficiency was most prevalent (70%), followed by metabolic syndrome, high stress and hepatic steatosis. Vitamin D showed a negative correlation with stress score, BMI, waist circumference, BP, phosphorous, fasting plasma glucose, TGL, HDLC, GGT and FLI score.

Differential item functioning of the Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA) by race/ethnicity

BackgroundAcculturation is a complex multidimensional construct that plays an important role in various outcomes across many domains (e.g., psychological, behavioral, social, and developmental). While there are many acculturation measures for specific racial/ethnic groups, few multigroup measures exists. Even fewer have been psychometrically evaluated for differential item functioning (DIF; e.g., measurement invariance). This is a critical step in determining whether item properties are equivalent across groups and thus, whether scores obtained from different groups are in fact comparable. MethodsThe Acculturation, Habits, and Interests, Multicultural Scale for Adolescents (AHIMSA) was completed by first and second generation participants identifying as White, Hispanic, or Asian (n = 1399). The scale can be used to compute scores on four acculturation orientation subscales: Assimilated, Separated, Integrated, and Marginalized. Racial/ethnic DIF was evaluated for the Assimilation, Integration, and Separation subscales. ResultsAnalyses revealed racial/ethnic DIF was present for two items on the Separation scale based on McFadden’s pseudo R2. No DIF was identified for the Assimilation and Integration scales. Supplemental analyses revealed no evidence of longitudinal DIF or by generation status and some DIF by sex for Assimilation and Integration. Based on evaluation of test characteristic curves and DIF plots, it was determined that DIF was trivial and could likely be ignored. ConclusionsPsychometric properties were generally equivalent across the three racial/ethnic groups for each of the subscales evaluated. This indicates that scores obtained from each subscale could be compared across racial/ethnic groups. By establishing cross-group usability of the scale, racial/ethnic differences in acculturation orientation can be examined, and, more importantly, used in the context of research on related mental, physical, and behavioral health outcomes.

Ultrasound of peripheral nerves distinguishes inherited sensory neuronopathy of cerebellar ataxia with neuropathy and vestibular areflexia syndrome from inherited axonopathy.

Introduction/Aims Recent studies have shown that ultrasound of peripheral nerves can distinguish inherited sensory neuronopathy from acquired axonopathy with a high degree of accuracy. In this study we aimed to determine whether ultrasound can also distinguish inherited sensory neuronopathy from inherited axonopathy. Methods We compared the ultrasound cross-sectional areas (CSAs) of the median, ulnar, sural, and tibial nerves of retrospectively recruited patients with cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS), in whom sensory neuronopathy is a cardinal feature, with Charcot-Marie-Tooth type 2 (CMT2) disease patients, who have an inherited axonopathy, using the Kruskal-Wallis test and receiver-operating characteristic curves. Results There were 17 patients with CANVAS and 18 with CMT2. The upper limb nerve CSAs were significantly smaller in CANVAS than in CMT2 (P < .001), with the CSAs of the median nerve at mid-forearm and ulnar nerve at mid-arm being a third or less the size of those of the CMT2 patients. Nerve ultrasound reliably distinguished CANVAS from CMT2 with ROC areas under the curve between 0.97 and 0.99. The lower limb CSAs of the two patient groups were not significantly different. Discussion Ultrasound of the upper limb nerves distinguishes CANVAS sensory neuronopathy from inherited axonopathy with high accuracy and can therefore be proposed as a reliable additional tool in the investigation of these diseases.

Association of fatal and non-fatal adverse health outcomes with urinary peptides reflecting collagen I turnover

Abstract Background Imbalance of collagen I (COL1) turnover, featured by increased synthesis and decreased degradation of collagen fibers, is a hallmark of fibrosis in the heart and blood vessels that associates with poor cardiovascular outcomes. Such as imbalance of COL1 turnover could be reflected in urine and serve as fingerprint for future adverse outcomes in general population, and high risk subjects. Purpose We hypothesize that imbalance of proteomic signatures of urinary peptides (UPs) reflecting COL1 turnover relate to adverse health outcomes in participants from a general population Methods We randomly recruited 776 participants (51.2% women; 50.5 years) from the Flemish Study on Environment, Genes and Health Outcomes cohort and measured UPs proteome by capillary electrophoresis coupled with mass spectrometry. Our analyses focused on 148 peptides of COL1 alpha-1 (COL1A1) chain that retained ≥70% signal in the whole sample. The primary endpoint included fatal and nonfatal cardiovascular endpoints. Secondary endpoints consisted of total mortality, fatal and nonfatal cardiac, coronary, and heart failure endpoints. Multivariate Cox proportional models, partial least squares analysis (PLS), log-likelihood test, and receiver operating characteristics (ROC) curve were applied. Results Over a median follow up of 12.4 years, 110 primary endpoints occurred, 61 participants died, 81, 41 and 24 experienced cardiac, coronary, and heart failure endpoints; respectively. In PLS analyses, upregulation of UPs signatures closer to C- and N-terminal locations of the COL1A1 chain whereas downregulation of mid-region UPs were associated with lower risk of adverse health outcomes. This pattern was inverted in subjects with cardiovascular disease, as upregulation of terminal and downregulation of mid region UPs increased risk. Adding UPs to a basic model including sex, age and usual cardiovascular risk factors significantly improved model performance between 2.54% to 4.93% (P≤0.001) for prediction of adverse health outcomes. In ROC plots, adding UPs to the basic model increased the area under the curve up to 4.00% (P&amp;lt;0.012). Conclusions UPs reflecting COL1 turnover predicted adverse health outcomes. The inverted up- and down regulations of UPs in between participants with and without previous cardiovascular diseases might be explained by a shift in the UPs signatures of COL1 fragments linked to distinct fibrotic processes. Urinary proteomic might have clinical importance in documenting the extent of collagen accumulation that relates to adverse health outcomes. In patients at high cardiovascular risk, modification of collagen I fibers turnover might be a potential treatment target Funding Acknowledgement Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The European Union the European Research Council and the European Research Area Net for Cardiovascular Diseases.

Test and Item Information of Oral Health Literacy Adult Questionnaire

Context: Item response theory (IRT), is a psychometric measure of trait considering each response positioned on a continuum. Aim: Assessment of item and test information Oral Health Literacy Adults Questionnaire (OHL-AQ) using IRT in the patient visiting the tertiary institution of Himachal Pradesh. Settings and Design: A descriptive cross-sectional study conducted on patients visiting the outpatient department. Methods: Data were obtained from the participant and recorded on a structured schedule using OHL-AQ. Statistical Analysis: The two-assumption essential for IRT are unidimensionality and local independence of items. Unidimensional dichotomous IRT consists of three models and three parameters of difficulty discrimination and guessing. Item response interpretation is based on item characteristic curves, test characteristic curve (TCC), and test information function, and analyses were conducted using the statistical software package STATA version 14. Results: The selection of 3PL model is based on the likelihood ratio test which is higher (χ 2 = 133.62, P &lt; 0.0001) than other models (χ 2 = 130.41, P &lt; 0.0001). The parameter estimate of pseudo-guessing is 0.02 indicating mild degree of guessing and represent the smallest probability of correct response. The TCC of the study shows that 95% of the randomly selected respondent scored between 3.23 and 14. The median probability of correct response is 8.16 when both difficulty and discrimination parameter is equal. Conclusion: IRT is an estimated probability of a response to a given item. Our study showed that OHL-AQ measures higher levels of OHL more precisely compared to lower levels. The OHL-AQ scale is the precise measure of both high and low levels of OHL.

Correlation of Biochemical Abnormalities with the Severity of Hospitalized Covid-19 Patients

Background: Coronavirus Disease-19 (COVID-19) has a global impact. The laboratory assessments in Covid-19 illness help in better understanding the disease pathophysiology useful in screening asymptomatic individuals to diagnosis, prognosis and monitoring the affected patients. The aim of the study:To observe the association between biochemical and inflammatory parameters among the hospitalised COVID-19 patients of different clinical severity. Materials and methods: This was a retrospective study carried out with the approval of the Institutional Ethics Committee. The study included patients over 18 years, hospitalised with COVID-19 infection, grouped into three severity groups, admitted to ward, high dependency unit or intensive care unit between May to September 2020. Data collection was carried out by manual perusal of inpatient case sheets, computerised patient data system and transcription database for discharge summaries. The biochemical and inflammatory markers like plasma glucose, renal function tests, serum electrolytes, liver function tests, erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), d-dimer, ferritin, Lactate dehydrogenase (LDH) at the time of admission were collected. Data was expressed as mean and standard deviation or median and range. ANOVA test followed by post hoc (Tukey) test, Pearson correlation and Receiver Operating Characteristics (ROC) Curve analysis were performed. Results: Significant correlations were observed between the mild and moderate-severe illness groups with respect to fasting plasma glucose, blood urea nitrogen, creatinine, direct bilirubin, total protein, albumin, ferritin and LDH. The AUC was the highest for LDH at 0.64 followed by blood urea nitrogen to creatinine ratio at 0.62. Conclusion: High levels of renal function parameters were potential predictors of acute kidney injury among patients with COVID-19. Fasting plasma glucose, serum albumin, LDH, Blood urea nitrogen (BUN) and BUN-creatinine ratio are better indicators of the severity of the disease with multiorgan dysfunction.

The diagnostic value of pepsin concentration in saliva for laryngopharyngeal reflux disease.

To explore the diagnostic efficacy of pepsin concentration in saliva for laryngopharyngeal reflux (LPR) disease. In this study, we recruited 40 participants with abnormal sensation of throat into the study who visited our hospital from March 2020 to December 2020. The 24h multichannel intraluminal impedance and pH monitoring (24h MII-pH), reflux symptom index (RSI) and reflux finding score (RFS), pepsin concentration in saliva were collected. The Cohen's kappa test and receiver-operating characteristic (ROC) curves were performed to determine and compare the sensitivity and specificity of five diagnostic methods: RSI; RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration. The area under the curve (AUC) of RSI, RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration were 0.767, 0.733, 0.870, 0.750,0.867, respectively. That is, the pepsin concentration has maximum AUC (the cutoff point is 219.47 (ng/mL); the sensitivity and 1-specificity is 0.300, 0.933, respectively.). The positive predictive value was 90.3% (28/31), and the negative predictive value was 77.8% (7/9). The Cohen's kappa coefficients of the five diagnostic subgroups were: RSI 0.486 (95% CI 0.207-0.764, P = 0.001); RFS 0.333 (95% CI 0.021-0.644, P = 0.032); RSI + RFS: 0.517 (95% CI 0.205-0.829, P = 0.001); pepsin concentration: 0.699 (95% CI 0.379-0.931, P = 0.001); RSI + RFS + pepsin concentration: 0.500 (95% CI 0.181-0.819, P < 0.001). The pepsin concentration has the maximum AUC area and highest consistency with the 24h MII-pH. Therefore, it has certain value in the screening and diagnosis of diseases related to LPR disease.

Relevance between Proximal Humeral Migration and Rotator Cuff Tears.

BackgroundProximal humeral migration is common in patients with rotator cuff tears. In this study, we aimed to evaluate the relevance between proximal humeral migration and some rotator cuff tear-related factors.MethodsA total of 75 patients with unilateral rotator cuff tears were retrospectively included from August 2016 to January 2018 who underwent magnetic resonance imaging and X-ray examinations before enrollment. We introduced the upward migration index (UMI) to stratify the patients into three groups, Group A: 1 < UMI ≤ 1.3; Group B: 1.3 < UMI ≤ 1.4; and Group C: UMI > 1.4. Pearson correlation analysis and logistic regression analysis were used to evaluate the relationship between UMI and age, sex, body mass index, pain, fatty degeneration grade, tear size, and thickness of ruptured tendon. Then, the χ2 test and receiver operator characteristic curve were applied to measure the diagnostic value of UMI.ResultsThe average UMI was 1.34 ± 0.07, ranging from 1.16 to 1.48. For the Pearson correlation analysis, there was a negative correlation between UMI and tear size (R = −0.68, p < 0.01), and also, there was a negative correlation between UMI and the visual analogue scale score (R = 0.342, p < 0.01). What is more, there was a negative correlation between UMI and the fatty degeneration grade (R = −0.373, p < 0.01). Ordinal multinomial logistic regression analysis indicated that tear size (β = −1.825, p < 0.001) was the independent predictor of UMI, which was a risk factor for humeral upward migration. The cutoff points of UMI were 1.38 and 1.3 to determine tears and distinguish large tears from small ones.ConclusionsUMI is a good predictor for humeral upward migration, which is related to the tear size of posterosuperior cuff tears. When the UMI is <1.3, a large tear should be alerted. Combining physical examination and X-ray is helpful for evaluating rotator cuff tears.

Comparative Evaluation of Three Diagnostic Tools for the Detection of Hepatitis C Virus among High-risk Individuals in a Tertiary Care Centre of Northeast India

Introduction: Hepatitis C virus (HCV) has posed a major public health problem globally. Since majority of HCV infected patients are asymptomatic, diagnosis of HCV infection is mainly based on the detection of anti-HCV antibodies by the Enzyme Linked Immunosorbent Assay (ELISA) or Rapid Diagnostic Tests (RDTs) and HCV Ribonucleic Acid (RNA) by real time Polymerase Chain Reaction (PCR) of serum or plasma samples. Aim: To assess the performance of RDT and 4th generation ELISA against real time reverse transcriptase PCR for the detection of HCV. Materials and Methods: A hospital-based cross-sectional study was carried out in the Virology Section, Department of Microbiology, Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Imphal, Manipur, India, for a period of two years from June 2019 to May 2021. The study included 3,254 plasma samples from suspected cases of HCV monoinfection, and HCV/HIV co-infection. The plasma samples were subjected to anti-HCV antibodies by RDT (SD BIOLINE, South Korea) and 4th generation ELISA (Monolisa™ HCV Ag-Ab ULTRA, BioRad, France), and HCV RNA by real time PCR. Data analysis was done using descriptive statistics, and performance of the assays was evaluated by using Cohen kappa test (κ) and Receiver Operating Characteristic (ROC) curve. Results: PCR is considered as the gold standard test. HCV was detected by RDT in 453 (13.92%), ELISA in 413 (12.69%) and RT-PCR in 367 (11.28%) samples. The present study demonstrated sensitivity of 97.55% and specificity of 96.71% with Positive Predictive Value (PPV) of 79.03% by HCV-RDT. The 4th generation ELISA showed high sensitivity of 99.46% and specificity of 98.34%. Using ROC curve, the area under the curve was 81% for ELISA with diagnostic accuracy of 98.46%. Conclusion: 4th generation ELISA is more sensitive and specific than RDT for the detection of HCV infection. Confirmatory HCV-RNA assay could be performed to clear doubts related to false-positive and false-negative findings of the primary screening assays.

A retrospective review of MRI features associated with metastasis-free survival in women with breast cancer: focusing on skin thickening and skin enhancement.

To identify associations between MRI-detected skin thickening and enhancement and metastasis-free survival (MFS) given recent reports of skin thickening on ultrasound being a poorer prognostic indicator. Interrogation of a prospectively collected database of ultrasound-visible breast lesions showed 214 lesions with pre-treatment MRIs available for analysis in a single centre. Data on MFS was prospectively collected. Retrospective MRI review was performed blinded to outcome. Imaging factors recorded were presence of skin thickening and enhancement, non-mass-enhancement (NME) and abnormal nodes, mass characteristics, perilesional oedema and background parenchymal enhancement. Statistical analysis used chi-squared test, Kaplan-Meier survival curves, the Log-rank test and receiver-operator characteristic (ROC) curves. During a median follow-up period of 5.6 years, 21 (10%) of 212 patients developed distant metastases. Skin thickening [24 of 30 (80%) vs 169 of 184 (92%), p = 0.043] and skin enhancement [15 of 20 (75%) vs 178 of 194 (92%), p = 0.016] were associated with poorer MFS. Large index lesion size [p < 0.001, AUC 0.823], large sum of masses [p < 0.001, AUC 0.813], increasing total lesion extent including NME [p < 0.001, AUC 0.749] and abnormal axillary nodes [55 of 66 (83%) vs 138 of 148 (93%), p = 0.024] were also associated with poorer MFS. Skin thickening and enhancement on breast MRI are associated with poorer MFS. These findings should be taken into account when managing patients with invasive breast cancer. Skin enhancement on breast MRI at diagnosis is associated with metastases development. Skin thickening on breast MRI is associated with future metastatic disease.

Study of the effect of the cross-sectional area of a loaded plunger spool on the outlet flow of a plunger pump

In this paper, a simulation model of the K3VDT63 axial piston pump variable is established using AMESim simulation software, and the new load plunger spool is studied and analysed on this simulation model. The load plunger spool of the studied axial plunger pump variable regulator was tested and the corresponding test data were obtained, and the obtained test characteristic curve and the characteristic simulation curve were compared and analysed.

Pleura Fluid Leukocyte Levels Test in Establish of Pleura Tuberculosis Effusion in Exudative Pleural Effusion Patients at H. Adam Malik General Hospital Medan in 2018

Background: Tuberculous pleural effusion is an accumulation of fluid in the pleural cavity produced by Mycobacterium tuberculosis (MTB). The gold standard of TB pleural effusion diagnosis is to obtain TB bacilli in pleural fluid or pleural tissue. However, this is often constrained due to the low identification level of these bacilli and the slow growth of MTB cultures. This study aimed to assess the pleural fluid leukocyte level in establishing a diagnosis of pleural effusion caused by TB. Methods: This was a diagnostic study conducted on 111 patients with pleural effusion, caused by TB, malignancy or non-TB infections that were assigned by supporting examinations obtained from medical records, which then assessed for pleural fluid leukocytes. Statistical analysis was performed using Kruskal Wallis Test and Receiver Operating Characteristic (ROC) curve to attain the cut-off point of pleural fluid leukocyte level. Results: Pleural fluid leukocyte levels in TB cases were significantly different when compared to pleural effusion caused by malignancy and non-TB infections (P&lt;0.001). Pleural fluid leukocyte level ≥1100 cell/mm3 was a cut-off diagnostic test for tuberculous pleural effusion with a sensitivity of 77% and specificity of 60.3%. Conclusion: Pleural fluid leukocyte level ≥1100 cell/mm3 could assist in diagnosing tuberculous pleural effusion.

Linguistic Distance and Translation Differential Item Functioning on Trends in International Mathematics and Science Study Mathematics Assessment Items

The 2015 Trends in International Mathematics and Science Study (TIMSS) involved 57 countries and 43 different languages to assess students’ achievement in mathematics and science. The purpose of this study is to evaluate whether items and test scores are affected as the differences between language families and cultures increase. Using differential item functioning (DIF) procedures, we compared the consistency of students’ performance across three combinations of languages and countries: (a) same language but different countries, (b) same countries but different languages, and (c) different languages and different countries. The analyses consisted of the detection of the number of DIF items for all paired comparisons within each condition, the direction of DIF, the magnitude of DIF, and the differences between test characteristic curves. As the countries were more distant with respect to cultures and language families, the presence of DIF increased. The magnitude of DIF was greatest when both language and country differed, and smallest when the languages were same, but the countries were different. Results suggest that when TIMSS results are compared across countries, the language- and country-specific differences which could reflect cultural, curriculum, or other differences should be considered.

Examinee Characteristics and their Impact on the Psychometric Properties of a Multiple Choice Test According to the Item Response Theory (IRT)

The aim of the current study is to provide improvement evaluation practices in the educational process. A multiple choice test was developed, which was based on content analysis and the test specification table covered some of the vocabulary of the applied statistics course. The test in its final form consisted of 18 items that were reviewed by specialists in the field of statistics to determine their validity. The results determine the relationship between individual responses and the student ability. Most thresholds span the negative section of the ability. Item information curves show that the items provide a good amount of information about a student with lower or moderate ability compared to a student with high ability. In terms of precision, most items were more convenient with lower ability students. The test characteristic curve was plotted according to the change in the characteristics of the examinees. The information obtained by female students appeared to be more than the information obtained by male students and the test provided more information about students who were not studying statistics in an earlier stage compared with students who did. This test clearly indicated that, based on the level of the statistics course, there should be a periodic review of the tests in line with the nature and level of the course materials in order to have a logical judgment about the level of the students’ progress at the level of their ability.

Linking the Spinal Cord Injury–Functional Index (SCI-FI) to the PROMIS Physical Functioning Item Bank

ObjectiveTo link 3 Spinal Cord Injury–Functional Index (SCI-FI) item banks (Basic Mobility, Fine Motor Function, Self-Care) to the Patient-Reported Outcome Measurement Information System (PROMIS) Physical Function (PF) metric. DesignObservational study SettingSix SCI Model Systems rehabilitation hospitals in the United States. ParticipantsAdults with SCI (n=855) and healthy individuals (n=730) (N=1585). InterventionsNot applicable. Main Outcome MeasuresThree SCI-FI item banks (Basic Mobility, Fine Motor Function, Self-Care), PROMIS PF v1.0 item bank. ResultsSCI-FI item banks (including 30 items from the PROMIS PF item bank) were administered to 855 adults with SCI as part of the original SCI-FI development study. The data were used to attempt to link 3 SCI-FI banks to the PROMIS PF metric via 2 item-response theory methods: fixed-parameter calibration and separate calibration. Sixteen items common to SCI-FI and PROMIS and verified as free of differential item functioning were used as anchor items to implement the methods. Of the 3 banks, only SCI-FI Basic Mobility could be linked with sufficient precision to PROMIS PF. Comparisons of actual vs linked PROMIS PF scores and test characteristic curves suggested the fixed-parameter method provided slightly more precision than the separate calibration method. ConclusionsThe linkage between PROMIS PF and SCI-FI Basic Mobility was considered satisfactory for group-level usage. Score equivalents computed from SCI-FI Basic Mobility will be useful for researchers comparing functional levels in SCI to those observed in other clinical and nonclinical groups (eg, in comparative effectiveness research).