Urine Test Results Research Articles

Urine dipstick for screening plasma glucose and bilirubin in low resource settings: a proof-of-concept study.

The purpose of this proof-of-concept study was to investigate whether a commercially available urine dipstick may provide potentially useful information for screening plasma glucose and bilirubin in human plasma samples. Glucose and bilirubin were assayed in 60 anonymized lithium-heparin residual plasma samples using the Roche COBAS 8000 or after pipetting 10 µL of plasma onto the pads of a commercial urine dipstick. Semiquantitative urine test results obtained with the dipstick were directly compared to paired test results obtained with COBAS. Median plasma glucose values between COBAS and dipstick were slightly different (5.8 vs. 5.6 mmol/L; p=0.040), while no significant difference was found in bilirubin values between COBAS and dipstick (11.2 vs. 8.6 μmol/L; p=0.090). The Spearman's correlation between COBAS and dipstick was 0.83 (95% CI, 0.73-0.90; p<0.001) for plasma glucose and 0.78 (95% CI, 0.66-0.87; p<0.001) for plasma bilirubin, respectively. Cumulative agreement between COBAS and dipstick was high for both glucose (88%; kappa statistic statistics, 0.75; 95% CI, 0.58-0.92; p<0.001) and bilirubin (88%; kappa statistics, 0.76; 95% CI, 0.60-0.92; p<0.001). The results of this proof-of-concept study indicate that the commercial urine test strip used in our study provides acceptable performance for screening plasma glucose and bilirubin levels compared with reference laboratory assays.

دراسة مبنية على المجتمع لانتشار البلهارسيا البولية وعوامل اختطارها في مديرتين موبؤتين في محافظة تعز-اليمن

Background: Schistosomiasis is still a major public health problem despite launching preventive chemotherapy campaigns (using Praziquantel) through yearly treatment of school-age children since 2008. Objective: To conclude: prevalence, contributing factors, intensity for Schistosoma Haematobium in Al-Shmaytin &amp; Al-Mwaset districts-Taiz, Yemen. Methods: a cross-sectional study, data on age, sex, marital status, income, education, location, water contact, medical history (MH), urine test results (filtration method used to detect S. haematobium &amp;concentration methods for the detection of infection intensities), were gathered using structured questionnaires between March &amp; April 2021. Sample size calculated using appropriate formula. 298 individuals selected by systematic random sampling. Informed consent obtained. For statistical analysis, SPSS version 24 is used. For “p”-values, the statistical significance was set at 0.05. Results: S. haematobium was found in 17 of 273 respondents, with a prevalence of 6.2%, higher in Al-Shmaytin (9.2%) than in Al-Mwaset (3.5%), and a light-intensity 59%. Adjusted Odds Ratio (AOR) for the following variables (95% confidence interval (CI)): district 3.7 (12 cases from Al-Shmaytin 9.2%), age 1.0 (13 cases from 6-18 years 7.8%), sex 2.8 (13 cases from female 7.4%), marital 0.3 (15 cases from single 8%), educational status 1.3 (15 cases from Illiterate/Essential School 6%), swimming/bathing 2.0 (13 cases 8.6%), wear shoes 0.4 (15 cases from those who do not wear shoes 8.1%), urinate near water 1.7 (8 cases 9.8%), family member with disease 1.0 (5 cases 7.1%), dysuria 1.7 (8 cases 8.3%), and receiving anti-schistosomiasis drugs 0.9 (9 cases among those didn’t receiving drugs 7%). All had low monthly incomes and no sanitation. Prevalent among: secondary school and higher (2, 8.7%), unaware of schistosomiasis (15, 7.4%), and unaware of prophylaxis (16, 7.1%). Conclusions: Hypo-endemic urinary schistosomiasis in study areas. Most patients from Alsafiah, females, 6-18 years, light-intensity, swimming/bathing, single, didn't receive Praziquantel®, urinated near water, had dysuria, didn't wear shoes, had diseased family members, lacked sanitation, were unaware of schistosomiasis and its prevention, lived near water sources, and had low monthly income.

Analysis of Clinical Characteristics of Patients with Different Types of Primary Hyperuricemia

Objective: This paper aims to study the clinical characteristics of patients with different types of primary hyperuricemia (HUA). Methods: Using a retrospective research method, 200 patients with primary HUA in the hospital from June 2020 to January 2023 were selected as the research objects. Patients were grouped according to the detection results of 24-hour urinary uric acid excretion (UUE) and fractional excretion of uric acid (FEUA) (renal insufficiency type, renal overload type, mixed type, and other types). The general information of patients in the four groups (gender, age, body mass index, living habits, etc.), underlying diseases (hypertension, diabetes), blood test results [uric acid (UA), creatinine (Cre)], urine test results (24-hour urine UA, 24-hour urine Cre) were summarized and the differences between the groups were analyzed. Results: The 200 cases of HUA patients were divided into 54.00% with renal insufficiency type, 38.50% with mixed type, 6.00% with renal overload type, and 1.50% with other types. The age of patients with mixed HUA was younger than that of patients with other types, renal overload type, and renal insufficiency type, and the difference was statistically significant (P &lt; 0.05). The UA level of patients with other types of HUA was lower than that of patients with mixed type HUA, and there was statistical significance (P &lt; 0.05). The Cre level of patients with mixed type HUA was lower than that of patients with renal insufficiency type and renal overload type, and the difference was statistically significant (P &lt; 0.05). The 24-hour urinary UA level in patients with renal insufficiency type HUA was lower than that in patients with renal overload type and mixed type HUA, and the difference was statistically significant (P &lt; 0.05). The 24-hour urinary Cre level of patients with other types of HUA was lower than that of patients with renal overload type and mixed HUA, the difference was statistically significant (P &lt; 0.05). The estimated glomerular filtration rate (eGFR) level of patients with other types of HUA was lower than that of patients with mixed type HUA, and the difference was statistically significant (P &lt; 0.05). There was no significant difference in the proportions of hypertension, diabetes, coronary heart disease, and urinary calculi among patients with renal insufficiency type, renal overload type, mixed type, and other types of HUA (P &gt; 0.05). Conclusion: The primary HUA patients are mainly of renal insufficiency type, followed by mixed type. There are significant differences in the clinical characteristics of patients with different types of HUA. Among them, patients with other types of HUA are the oldest and have the lowest uric acid levels. Patients with mixed HUA had the best renal function but the highest 24-hour urine creatinine level. This study can be used as a basis for rational selection of urate-lowering drugs for different HUA patients.

Recovery incentives program: California's contingency management benefit

ObjectiveThe role of methamphetamine and cocaine use in California's drug poisoning (overdose) crisis has dramatically increased in the past five (5) years and has disproportionately affected American Indian, Alaska Native, and Black Californians. No FDA-approved medications currently exist for the treatment of individuals with stimulant use disorder (StimUD). Outside the Veteran's Administration, the Recovery Incentives Program: California's Contingency Management Benefit is the first large scale implementation of contingency management (CM). CM is the behavioral treatment with the most evidence and largest effect sizes for StimUD. MethodsThe Program uses a CM protocol where participants can receive a maximum of $599 over a six-month period, contingent upon 36 stimulant-negative urine test results. Urine tests are conducted using a set of approved, CLIA-waived, point-of-care urine drug tests (UDTs). To ensure fidelity to the CM protocol and to prevent fraud, waste, and abuse, all aspects of incentive accounting and distribution are managed electronically via a custom-developed software system. Incentive distribution utilizes electronic gift cards. A significant innovation of the project is the conceptualization of the CM Coordinator, a designated and highly trained and supervised individual responsible for all aspects of CM operation in a specific site. Results and conclusionsThe California Department of Health Care Services contracted with UCLA to develop and implement a robust evaluation of the Program; goals include evaluating the effectiveness of real-world implementation and facilitating quality improvement. The project will likely significantly impact the use of CM for StimUD nationally and may well reduce stimulant-related drug poisoning deaths.

Chatbot-assisted therapy for patients with methamphetamine use disorder: a preliminary randomized controlled trial.

Methamphetamine (MA) use disorder is associated with a large public health burden. Despite the therapeutic effects of psychosocial interventions based on current evidence, finding an approach to retain patients in treatment remains a real-world challenge. The rapid development of mobile health (mHealth) systems suggests the potential to provide real-time personalized care at any time and from any location, minimize barriers to treatment, maximize use, and promote the dissemination of accessible therapeutic tools in at-risk populations. Our study aimed to investigate the feasibility and effectiveness of chatbots for the treatment of MA use disorder. The inclusion criteria were (a) a diagnosis of MA use disorder as defined by the DSM-5, (b) age between 18 and 65 years, (c) no acute exacerbation of severe mental illness during the initial assessment, such as schizophrenia or bipolar I disorder, (d) willingness to participate in standard outpatient treatment for ≥ 6 months, and (e) an Android phone. Participants were randomly allocated to either a chatbot-assisted therapy via smartphone (CAT) group or a control group following simple randomization procedures (computerized random numbers) without blinding. All participants were followed up for 6 months. Treatment retention and monthly urine test results were analyzed as outcome measures. Participants' satisfaction with CAT was also assessed. In total, 50 and 49 participants were allocated to the CAT and control groups, respectively. There were no significant differences in retention time between the two treatment groups (df = 1, p = 0.099). The CAT group had fewer MA-positive urine samples than the control group (19.5% vs. 29.6%, F = 9.116, p = 0.003). The proportion of MA-positive urine samples was positively correlated with the frequency of MA use (r = 0.323, p = 0.001), severity of MA use disorder (r = 0.364, p < 0.001), and polysubstance use (r = 0.212, p = 0.035), and negatively correlated with readiness to change (r = -0.330, p = 0.001). Totally 55 participants completed the study at the 6-month follow-up and 60% reported relative satisfaction. Participants in this study had favorable acceptance and generally positive outcomes, which indicates that chatbot is feasible for treating people who use MA.

Identifying KCNJ5 Mutation in Aldosterone-Producing Adenoma Patients With Baseline Characteristics Using Machine Learning Technology

BackgroundPrimary aldosteronism is characterized by inappropriate aldosterone production, and unilateral aldosterone-producing adenoma (uPA) is a common type of PA. KCNJ5 mutation is a protective factor in uPA; however, there is no preoperative approach to detect KCNJ5 mutation in patients with uPA. ObjectivesThis study aimed to provide a personalized surgical recommendation that enables more confidence in advising patients to pursue surgical treatment. MethodsWe enrolled 328 patients with uPA harboring KCNJ5 mutations (n = 158) or not (n = 170) who had undergone adrenalectomy. Eighty-seven features were collected, including demographics, various blood and urine test results, and clinical comorbidities. We designed 2 versions of the prediction model: one for institutes with complete blood tests (full version), and the other for institutes that may not be equipped with comprehensive testing facilities (condensed version). ResultsThe results show that in the full version, the Light Gradient Boosting Machine outperformed other classifiers, achieving area under the curve and accuracy values of 0.905 and 0.864, respectively. The Light Gradient Boosting Machine also showed excellent performance in the condensed version, achieving area under the curve and accuracy values of 0.867 and 0.803, respectively. ConclusionsWe simplified the preoperative diagnosis of KCNJ5 mutations successfully using machine learning. The proposed lightweight tool that requires only baseline characteristics and blood/urine test results can be widely applied and can aid personalized prediction during preoperative counseling for patients with uPA.

Hair testing applied to the assessment of in utero exposure to drugs: Critical analysis of 51 cases of the University Hospital of Verona.

The work discusses the results of hair and urine testing performed in 51 cases of suspected in utero drug exposure handled at the University Hospital of Verona from 2016 to 2022. On the day of birth or the day after birth, urine from mother and newborn (UM and UN) and hair from mother (HM), newborn (HN) and father (HF), if possible, were collected. Urine underwent immunoassay and GC-MS analysis, whereas hair underwent LC-MS/MS and GC-MS/MS analysis. In 50 out of 51 cases, HM and/or HN were available. In 92% of them, hair testing resulted in a positive, often (>50% cases) for more than one class of substance. The most detected substances were cocaine, opiates, methadone and cannabinoids. Maternal segmental analysis showed a prevalent decreasing concentration trend during pregnancy in case of positivity for one class of substances, whereas, as expected, a neatly prevalent increasing trend in the case of positivity for more than one class of substances. In nine cases, HF was also available, resulting in all being positive, usually for the same classes of substances identified in HM, thus questioning parental responsibility. In 33 cases, urine samples from the mother or newborn were also collected. Of them, 27 cases (82%) tested positive, showing peri-partum drug consumption and then confirming the severity of the addiction. Hair testing showed to be a reliable diagnostic tool to investigate in utero drug exposure because of the possibility of obtaining a complete picture of maternal addictive behaviour and family background, thanks to segmental maternal hair analysis and father hair testing.

Building a nomogram plot based on the nanopore targeted sequencing for predicting urinary tract pathogens and differentiating from colonizing bacteria.

The identification of uropathogens (UPBs) and urinary tract colonizing bacteria (UCB) conduces to guide the antimicrobial therapy to reduce resistant bacterial strains and study urinary microbiota. This study established a nomogram based on the nanopore-targeted sequencing (NTS) and other infectious risk factors to distinguish UPB from UCB. Basic information, medical history, and multiple urine test results were continuously collected and analyzed by least absolute shrinkage and selection operator (LASSO) regression, and multivariate logistic regression was used to determine the independent predictors and construct nomogram. Receiver operating characteristics, area under the curve, decision curve analysis, and calibration curves were used to evaluate the performance of the nomogram. In this study, the UPB detected by NTS accounted for 74.1% (401/541) of all urinary tract microorganisms. The distribution of ln(reads) between UPB and UCB groups showed significant difference (OR = 1.39; 95% CI, 1.246-1.551, p < 0.001); the reads number in NTS reports could be used for the preliminary determination of UPB (AUC=0.668) with corresponding cutoff values being 7.042. Regression analysis was performed to determine independent predictors and construct a nomogram, with variables ranked by importance as ln(reads) and the number of microbial species in the urinary tract of NTS, urine culture, age, urological neoplasms, nitrite, and glycosuria. The calibration curve showed an agreement between the predicted and observed probabilities of the nomogram. The decision curve analysis represented that the nomogram would benefit clinical interventions. The performance of nomogram with ln(reads) (AUC = 0.767; 95% CI, 0.726-0.807) was significantly better (Z = 2.304, p-value = 0.021) than that without ln(reads) (AUC = 0.727; 95% CI, 0.681-0.772). The rate of UPB identification of nomogram was significantly higher than that of ln(reads) only (χ2=7.36, p-value = 0.009). NTS is conducive to distinguish uropathogens from colonizing bacteria, and the nomogram based on NTS and multiple independent predictors has better prediction performance of uropathogens.

Sentencing Narcotics Cases below the Statutory Minimum

Law number 35/2009 on Narcotics establishes a specific minimum punishment. Despite this, instances occur where judges impose sentences below these mandated minimums, leading to concerns about legal certainty and the potential for undermining justice. This article investigates how judges account for legal certainty when imposing sentences below the stipulated minimum for narcotics offenses. The research adopts both normative and empirical legal methodologies, utilizing literature reviews, document analysis, case studies, and interviews with key informants. The findings suggest that judges often justify lesser sentences based on several factors: the defendant's status as a drug user rather than a distributor, negative urine test results, possession of only a small amount of narcotics, and lack of evidence proving involvement in narcotics sales or intermediary activities. In their rulings, judges integrate these considerations with the applicable narcotics laws and the factual circumstances presented during the trial. Consequently, such decisions to impose sentences below the statutory minimum are grounded in well-considered legal reasoning, contributing to legal certainty in the judicial process.

Levels and determinants of quality antenatal care in Bangladesh: Evidence from the Bangladesh Demographic and Health Survey.

Assessing the quality of antenatal care (ANC) is imperative for improving care provisions during pregnancy to ensure the health of mother and baby. In Bangladesh, there is a dearth of research on ANC quality using nationally representative data to understand its levels and determinants. Thus, the current study aimed to assess ANC quality and identify the sociodemographic factors associated with the usage of quality ANC services in Bangladesh. Secondary data analysis was conducted using the last two Bangladesh Demographic and Health Surveys (BDHSs) from 2014 and 2017-18. A total of 8,277 ever-married women were included in the analysis (3,631 from 2014 and 4,646 from 2017-18). The quality ANC index was constructed using a principal component analysis on the following ANC components: weight and blood pressure measurements, blood and urine test results, counselling about pregnancy complications and completion of a minimum of four ANC visits, one of which was performed by a medically trained provider. Multinomial logistic regression was used to determine the strength of the association. The percentage of mothers who received all components of quality ANC increased from about 13% in 2014 to 18% in 2017-18 (p < 0.001). Women from the poorest group, those in rural areas, with no education, a high birth order and no media exposure were less likely to receive high-quality ANC than those from the richest group, those from urban areas, with a higher level of education, a low birth order and media exposure, respectively. Although the quality of ANC improved from 2014 to 2017-18, it remains poor in Bangladesh. Therefore, there is a need to develop targeted interventions for different socio-demographic groups to improve the overall quality of ANC. Future interventions should address both the demand and supply-side perspectives.

Abstract 6729: Urea cycle metabolism is disturbed in Fibrolamellar carcinoma

Abstract In fibrolamellar hepatocellular carcinoma (FLC), hyperammonemic encephalopathy is a common occurrence and occasionally causes death. Using mass spectrometry, we quantitatively analyzed the proteomes of FLC patient’s tumor and adjacent normal, to find pathways that are changed in FLC. These data identified multiple proteins that were altered in the proteome, among these, enzymes involved in metabolism of ammonia. These results were confirmed with immunofluorescence demonstrating that these alterations occur in all tumor cells. These results suggest that FLC cells have defects in the two primary ammonia detoxification pathways in the liver, which are responsible for detoxification of 70% of the ammonia in the body: 1) consumption of ammonia by glutamine synthetase (GLUL), and 2) addition of ammonia by ornithine carbamoyltransferase (OTC) to the urea cycle. Additionally, they also generate extra ammonia because of upregulation of glutaminase (GLS). This was tested with a targeted metabolomics of the reactants and products of these enzymes. The results were consistent with both a loss of the two pathways for consumption of ammonia activation of a pathway for generating ammonia. This production of ammonia is consistent with the observation that surgical resection of fibrolamellar reduces the ammonia in patients. All FLC patients with hyperammonemic encephalopathy and documented urine test results showed increased urinary orotic acid, evidence of blockage of the OTC pathway. This study implies that hyperammonemic encephalopathy in FLC may require alternatives to commonly used therapies. Citation Format: Mahsa Shirani, Solomon Levin, Michael D. Tomasini, James Knox, Bassem Shebl, David Requena, Jackson Clark, Søren Heissel, Hanan Alwaseem, Rodrigo Surjan, Ron Lahasky, Henrik Molina, Barbara Lyons, Rachael D. Migler, Philip Coffino, Sanford M. Simon. Urea cycle metabolism is disturbed in Fibrolamellar carcinoma. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6729.

PD34-05 A NOVEL MACHINE-LEARNING ALGORITHM TO PREDICT STONE RECURRENCE WITH 24-HOUR URINE DATA

You have accessJournal of UrologyCME1 Apr 2023PD34-05 A NOVEL MACHINE-LEARNING ALGORITHM TO PREDICT STONE RECURRENCE WITH 24-HOUR URINE DATA Kevin Shee, Carter Chan, Andrew Liu, Heiko Yang, Wilson Sui, Sunita Ho, Thomas Chi, and Marshall Stoller Kevin SheeKevin Shee More articles by this author , Carter ChanCarter Chan More articles by this author , Andrew LiuAndrew Liu More articles by this author , Heiko YangHeiko Yang More articles by this author , Wilson SuiWilson Sui More articles by this author , Sunita HoSunita Ho More articles by this author , Thomas ChiThomas Chi More articles by this author , and Marshall StollerMarshall Stoller More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003327.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are limited predictive markers of stone recurrence, which poses a challenge for the clinical management of stone disease. Furthermore, inability to predict stone events is a significant limitation for clinical trials, where many patients must be enrolled to obtain sufficient stone events for analysis. In this study, we sought to use machine learning methods to identify a novel algorithm to predict stone recurrence. METHODS: Patients enrolled in the Registry for Stones of the Kidney and Ureter (ReSKU), a multi-institutional registry of nephrolithiasis patients collected between 2015-2020, with at least one prospectively collected 24-hour urine test (Litholink) were included in the training set. A test set of stone patients not enrolled in ReSKU with 24-hour urine test results were collected. Stone events were defined as either an office visit where a patient reported symptomatic passage of stone(s) or surgery for stone removal. Seven prediction classification methods were evaluated: Decision Tree, Logistic regression with ElasticNet, Extra Trees, kNeighbors, LightGBM, Logistic Regression, and Random Forest. Probability of Recurrent Nephrolithiasis (PRN) score ranging from 0-1 was generated from the models. Predictive analyses and ROC curve generation was performed in R. RESULTS: A training set of 423 kidney stone patients with stone event data and 24-hour urine samples were trained using the prediction classification methods. The highest performing prediction model was a Logistic Regression with ElasticNet machine learning model (AUC=0.65; Figure 1A). Selecting for high confidence predictions (PRN 0-0.15, 0.8-1.0) improved model accuracy (AUC=0.82; Figure 1B). The model was validated on a test set of 172 stone patients. Patients predicted to have high likelihood of stone recurrence had an increase in the average number of stone events compared to those with low likelihood (3.6 vs 1.7 events; p=2e-7). Prediction accuracy in the test set demonstrated moderate discriminative ability (AUC=0.64; Figure 1C). CONCLUSIONS: Using machine-learning trained on 24-hour urine and stone outcome data, a novel algorithm was developed to predict stone recurrence. Initial validation studies suggest ability of algorithm to identify patients with higher likelihood of stone events and warrants further study. Source of Funding: n/a © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e921 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Shee More articles by this author Carter Chan More articles by this author Andrew Liu More articles by this author Heiko Yang More articles by this author Wilson Sui More articles by this author Sunita Ho More articles by this author Thomas Chi More articles by this author Marshall Stoller More articles by this author Expand All Advertisement PDF downloadLoading ...

Minimal change nephrotic syndrome diagnosed with acute femoral thromboembolism and successfully salvaged limb: a case report.

A 64-year-old man visited the outpatient department of our hospital for the first time due to bilateral lower limb edema, which he noticed 1week before the visit. Pain suddenly developed in the left lower limb while the patient was in the waiting room. Nephrotic syndrome was suspected based on blood and urine test results. Acute arterial thromboembolism in the left lower limb associated with hypercoagulation due to nephrotic syndrome was suspected, and a diagnosis was made using computed tomography angiography. Arterial thrombectomy was urgently performed, and the limb was salvaged without sequelae. Based on renal biopsy, minimal change nephrotic syndrome was diagnosed, and the patient underwent remission induction with steroid therapy. Heparin was drip infused and apixaban was orally administered to prevent recurrent thrombosis. Nephrotic syndrome in the acute phase is often complicated by thrombosis. Particularly, arterial thromboembolism requires prompt treatment, and prophylactic anticoagulation therapy needs to be considered.

Linggui Yangyuan paste for patients with male infertility: a study protocol for a multicenter, double-blind, double-dummy, randomized controlled trial

Male infertility affects millions of men worldwide and is increasing in prevalence, with asthenozoospermia (AS) and oligoasthenozoospermia (OA) being the most frequent causes, and current treatments are limited. A previous research reported that Linggui Yangyuan paste (LGYY) enhanced sperm viability and motility, but there is a lack of multicenter, rigorous, randomized and controlled studies on its efficacy. Wuzi Yanzong oral solution (WZYZ), a traditional Chinese herbal formula, is one of the most important and first-line drugs for AS and OA in China. We designed a direct comparison of LGYY’s effectiveness and safety against WZYZ in treating male infertility, specifically AS and OA. We propose a multicenter, double-blind, double-dummy, randomized controlled trial, which is planned to recruit 162 participants with AS or OA from five centers and will randomize them into two groups, whereby the treatment group will receive intervention with LGYY and WZYZ mimetics, while the control group will receive intervention with WZYZ and LGYY mimetics. The medications will be administered twice daily for 12 weeks, followed by a 12-week follow-up. The primary outcome will be total progressive motile sperm count (TPMSC), and the secondary outcomes will be semen parameters, including semen volume, sperm concentration, total sperm count, progressive motility (PR), PR + nonprogressive motility (NP), Chinese Medicine Symptoms Score (CMSS), spouse pregnancy rate and time to pregnancy. The safety outcomes will be based on the results of routine blood and urine tests, liver and kidney function tests and electrocardiography. Overall, this study aims to provide valuable insights into the potential efficacy and safety of LGYY compared to WZYZ for male infertility (AS or OA), which could guide clinicians to an alternative drug approach to treat patients with AS or OA. This clinical trial is registered at ClinicalTrials.org under the identifier NCT05792813.

A Comparative Study of Urinary Tests and Cultures for the Effectiveness of Fosfomycin in Catheter-Related Urinary Tract Infections

As the elderly population increases due to an aging society, the number of patients with catheters is increasing, and treatment for urinary infections is needed. The current study analyzed the effectiveness of fosfomycin, the primary antibiotic used to treat urinary tract infections (UTIs), in these patients. Patients who received fosfomycin as the primary antibiotic for a UTI were selected, and the results of urine tests and cultures before and after fosfomycin administration were compared and analyzed. The degree of UTI in patients with a catheter was found to be more severe (p = 0.020), and the infecting strains were found to be different depending on whether a catheter was present (p = 0.014). There was a difference in the treatment success rate depending on whether or not a catheter was present (53.6% vs. 70.4%), but it was found that the treatment rate was more than 50% regardless of whether a catheter was present. The bacterial type, as well as the treatment rate based on the bacterium, differed depending on the presence of a catheter. Fosfomycin has a success rate of more than 50%, even in patients with catheters; therefore, it can be considered the primary antibiotic for treating UTIs.

Diagnostic capabilities of self-reported psychoactive substance use among patients admitted to psychiatric consultations in Benin, West Africa

BackgroundThere is a high prevalence of psychoactive substance use among patients with mental health disorders. The optimal treatment of patients with mental health disorders requires an awareness of their history pertaining substance use. Several methods are used to assess the use of substance. Each of them embodies its limitations. This study aimed at assessing the diagnostic capability of a self-report psychoactive substance use among patients at the National Psychiatric University Hospital of Cotonou, Benin.MethodsA cross-sectional survey was conducted from August 1, 2021 to November 24, 2021. A total of 157 consenting patients admitted to psychiatric consultations were successively enrolled in the ongoing study. They were screened for the use of psychoactive substance with Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), followed by urine test using the NarcoCheck® kit for qualitative detection of substances or its metabolites. To assess the diagnostic capability, the participants’ self-responses were compared with their urine test results. The sensitivity, specificity, positive and negative predictive values, and kappa coefficient were also calculated.ResultsThe frequency of lifetime psychoactive substance use according to self-report was 81.5% (95% CI: 0.746–0.873), while over the past three months (recent use) was 52.2% (95% CI: 0.441–0.603) and 58.6% based on the urine test. Alcohol, tobacco and cannabis were the most prevalent psychoactive substance used. The overall concordance between self-reported psychoactive substance use and the urine test (gold standard) was moderate (sensitivity = 66%; kappa = 0.46). Self-report cocaine use compared with urine test showed the highest concordance (sensitivity = 100%; kappa = 79%), followed by tobacco (sensitivity = 58%, kappa = 41%). On an average 70% of urine test results were consistent with self-report (VPP). Participants’ were more accurate when they were reporting no psychoactive substance use as suggested by the high negative predictive value (NPV).ConclusionDiagnostic capability of self-reporting of psychoactive substance use among patients admitted to psychiatric consultations was moderate. Therefore self-reporting may not estimate the exact prevalence of psychoactive substance use. Optimal identification of psychoactive substances use in psychiatric patients requires both history and urine testing. The integration of these two approaches is an excellent method to find out the level, frequency and nature of drug used.

Significance of the Pee-Value: Relevance of Urine Studies for Patients with Myeloma Undergoing Transplantation

INTRODUCTION: International Myeloma Working Group (IMWG) criteria require 24-hour urine specimens as part of response assessments, which can be cumbersome for patients to collect. This requirement is particularly onerous before autologous stem cell transplantation (ASCT), a period relatively soon after diagnosis with many concurrent testing requirements. The necessity of urine testing to complete response (CR) determinations and its prognostic impact on progression-free survival (PFS) have been questioned in subgroup analyses of clinical trials (Dejoie 2016; Lahuerta 2019). However, the real-world importance of urine testing to IMWG response criteria more broadly has not been ascertained. METHODS: We analyzed all patients with multiple myeloma (MM), excluding those with oligosecretory disease or progressive disease during induction, who underwent first ASCT at our institution between 2016-2019. Patients with measurable serum M-protein (>1 g/dL) and light-chain (LC)-only disease were included. Patients with missing diagnostic or pre-ASCT data precluding IMWG response assessments were excluded. Evaluable urine studies were defined as a documented urine immunofixation (UIFE) value or, if UIFE was missing, a presumptive +UIFE if urine protein electrophoresis showed a paraprotein. For patients with a documented negative UIFE at diagnosis, -UIFE was presumed if urine studies were not repeated before ASCT. For patients with evaluable baseline and pre-ASCT urine testing, we assessed responses using both traditional IMWG criteria and 'urine-free’ IMWG criteria, whereby urine testing results were systematically removed as options or requirements to achieve any given response depth. We hypothesized that urine-free criteria would yield discordant responses in <10% of patients, a proportion we determined a priori to be clinically irrelevant. RESULTS: Of 347 screened patients, 66 (19%) were excluded due to missing data precluding pre-ASCT response assessments by traditional IMWG criteria. Compared to patients (n=281) with sufficient data, these 66 excluded patients were more likely to have LC-only disease and to have been transplanted before 2018. Of 281 patients evaluable for responses by both traditional and urine-free IMWG criteria, 11 patients (4%) had discordant responses (Figure 1). Discordance rates were 14% (9/63) among patients with LC-only disease and 1% (2/218) among patients with measurable serum M-proteins. Of these 11 discordant responses, 7 were superior with urine-free criteria while 4 were inferior (Table 1). DISCUSSION: In our retrospective study, response depths changed in only 4% of patients when urine requirements were systematically removed from IMWG criteria. Rates of discordance varied by paraprotein biology: 1% of patients with a measurable serum M-protein had discordant responses, versus 14% of patients with LC-only disease. This calls into question the common practice of requiring repeat 24-hour urine assessments for all patients prior to ASCT, since its utility may be practically limited to patients with LC-only disease. Interestingly, omitting urine from IMWG response criteria did not uniformly shift responses in either direction. Limitations of our data include missing data in 66 patients (who had predominantly LC-only disease) as well as lack of generalizability to ASCT-ineligible patients. However, our study is important in demonstrating that 24-hour pre-ASCT urine testing may be unnecessary for many patients with MM, particularly those with a measurable serum M-protein at diagnosis. Further research is needed to assess whether urine-free or traditional response criteria better reflect underlying disease biology in terms of their ability to prognosticate PFS. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Combination of PI-RADS score and mRNA urine test-A novel scoring system for improved detection of prostate cancer.

Available tests to detect clinically significant prostate cancer frequently lead to overdiagnosis and overtreatment. Our study assessed the feasibility of combining a urinary biomarker-based risk score (SelectMDx®) and multiparametric MRI outcomes in order to identify patients with prostate cancer on prostate biopsy with increased accuracy and reliability. Samples of 74 men with suspicion of prostate cancer and available multiparametric MRI were analysed in a prospective cross-sectional study design. First-voided urine for determination of HOXC6 and DLX1 mRNA levels was collected after digital rectal examination and prior to MRI/ultrasound fusion-guided prostate biopsy. All multiparametric MRI images were centrally reviewed by two experienced radiologists blinded for urine test results and biopsy outcome. The PI-RADS v2 was used. SelectMDx® score, PI-RADS and Gleason Sore were obtained. Associations between Gleason Score, PI-RADS scores and SelectMDx® were assessed using ANOVA and t-test. Sensitivity and specificity were assessed and evaluated as area-under-the-curve of the receiver operating characteristic. Upon biopsy, 59.5% of patients were diagnosed with prostate cancer, whereby 40.6% had high-grade prostate cancer (GS ≥ 7a). SelectMDx® scores were significantly higher for patients with positive biopsy findings (49.07 ± 25.99% vs. 22.00 ± 26.43%; p < 0.001). SelectMDx® scores increased with higher PI-RADS scores. Combining SelectMDx®, history of prior biopsy with benign histology and PI-RADS scores into a novel scoring system led to significant prostate cancer detection rates with tiered detection rate of 39%, 58%, 81% and 100% for Gleason grade group II, III, IV, and V, respectively. The area-under-the-curve for our novel sum score in receiver operating characteristic analysis was 0.84. The synergistic combination of two non-invasive tests into a sum score with increased sensitivity may help avoiding unnecessary biopsies for initial prostate cancer diagnosis. For confirmation, further prospective studies with larger sample sizes and univariate and multivariate regression analyses and decision curve analyses are required.

Construction of Predictive Model for Type 2 Diabetic Retinopathy Based on Extreme Learning Machine.

PurposeThe common cause of blindness in people with type 2 diabetes (T2D) is diabetic retinopathy (DR). Early fundus examinations have been shown to prevent vision loss, but routine ophthalmic screenings for patients with diabetes present significant financial and material challenges to existing health-care systems. The purpose of this study is to build a DR prediction model based on the extreme learning machine (ELM) and to compare the performance with the DR prediction models based on support machine vector (SVM), K proximity (KNN), random forest (RF) and artificial neural network (ANN).MethodsFrom January 1, 2020 to November 31, 2021, data were collected from electronic inpatient medical records at Lu’an Hospital of Anhui Medical University in China. An extreme learning machine (ELM) algorithm was used to develop a prediction model based on demographic data and blood testing and urine test results. Several metrics were used to evaluate the model’s performance: (1) classification accuracy (ACC), (2) sensitivity, (3) specificity, (4) Precision,(5) Negative predictive value (NPV), (6) Training time and (7) area under the receiver operating characteristic (ROC) curve (AUC).ResultsIn terms of ACC, Sensitivity, Specificity, Precision, NPV and AUC, DR prediction model based on SVM and ELM is better than DR prediction model based on ANN, KNN and RF. The prediction model for diabetic retinopathy based on elm is the best among them in terms of ACC, Precision, Specificity, Training time and AUC, with 84.45%, 83.93%, 93.16%,1.24s, and 88.34%, respectively. The DR prediction model based on SVM is the best in terms of sensitivity and NPV, which are, respectively, 70.82% and 85.60%.ConclusionAccording to the findings of this study, the model based on the extreme learning machine presents an outstanding performance in predicting diabetic retinopathy thus providing technological assistance for screening of diabetic retinopathy.

Subclinical Hypothyroidism in Advanced Chronic Kidney Disease Patients: Prevalence and Associated Factors.

Introduction Renal function and thyroid metabolism are tightly related. However, evidence about subclinical hypothyroidism prevalence in patients with chronic kidney disease and its related factors is scarce. Objectives Our aim is to analyze subclinical hypothyroidism prevalence and its related factors in patients with advanced chronic kidney disease. Materials and methods. Nondialysis-dependent patients with chronic kidney disease at stages 3 to 5 were included. Other inclusion criteria were age above 18 years and clinical stability. Patients with diagnosed thyroid illnesses were excluded. Subclinical hypothyroidism was defined as thyroid stimulating hormone (TSH) > 5.3 mU/L, with free thyroxine 4 (FT4) between 0.54 and 1.24 ng/dl. Filiation data, comorbidities, and routine blood and urine test results were registered. Results A total of 299 patients were included. Of them, 184 (61.5%) were men. The mean age was 71 ± 13 years old. The mean glomerular filtration rate (CKD-EPI) was 22 ± 9 ml/min/1.73 m2. According to chronic kidney disease stages, global distribution of patients was as follows: Stage 3, 67 patients (22.4%); Stage 4, 155 patients (51.8%); and Stage 5, 77 patients (25.8%). We found subclinical hypothyroidism in 54 (18.1%) patients. According to chronic kidney disease stages, distribution of affected patients was as follows: Stage 3, 9 patients (13%); Stage 4, 25 patients (16.1%); and Stage 5, 20 patients (26%). Differences among stages were statistically significant. By univariate analysis, factors related with subclinical hypothyroidism were as follows: age RR 1.048 (95% CI 1.019–1.078; p=0.001), hypertension RR 2.705 (95% CI 1.026–7.130; p=0.04), glomerular filtration rate RR 0.962 (95% CI 0.929–0.996; p=0.03), and proteinuria higher than 1 gram/day RR 2.387 (95% CI 1.303–4.374; p=0.005). By multivariate analysis adjusted by age, hypertension, glomerular filtration rate, proteinuria, diabetes, and cardiovascular disease history, only age RR 1.016 (95% CI 1.009–1.028; p=0.04) and glomerular filtration rate RR 0.963 (95% CI 0.930–0.997; p=0.03) preserved their independent association with subclinical hypothyroidism. Conclusions Subclinical hypothyroidism prevalence in patients with chronic kidney disease is high and increases with renal disease severity. Factors independently related to subclinical hypothyroidism are age and glomerular filtration rate.