Z-score Calculation Research Articles

THE DIFFERENCE BETWEEN THE ALTMAN Z-SCORE AND SPRINGATE MODELS IN ANALYZING THE BUSINESS SUSTAINABILITY OF PT. SRI REJEKI ISMAN TBK

The purpose of this study was to determine the difference between altman z-score and springate in predicting going concern and find out which model has the highest level of accuracy between the altman z-score and springate models at PT Sri Rejeki Isman Tbk. The type of data used by researchers in this study is the type of quantitative and qualitative. Data collection technique is with documentation. The data analysis techniques used are quantitative descriptive methods and inductive methods. The results of the calculation of the original altman z-score method from the 2019-2023 period show that PT Sri Rejeki Isman Tbk is in a state prone to bankruptcy in 2019 - 2020 and experienced bankruptcy in 2021 and then in 2022 - 2023 again in a state prone to bankruptcy. The result of the altman z-score and zmijewski models calculations from the period 2019 - 2023 show that PT Sri Rejeki Isman Tbk has a slight difference in the calculation results and interpretation where the altman z-score model shows that PT Sri Rejeki Isman Tbk is in a position prone to bankruptcy in 2019 – 2020 then in 2021 experienced bankruptcy and returned to bankruptcy prone in 2022-2023. Meanwhile, by using the Zmijewski model throughout the years 2019 - 2023, PT Sri Rejeki Isman Tbk is in an unhealthy state and has experienced bankruptcy

Metabolic syndrome severity z-score in non-diabetic non-obese Egyptian patients with chronic hepatitis c virus infection

BackgroundThe risks of heart disease, resistance of insulin, and diabetes mellitus type II are increased in individuals diagnosed with metabolic syndrome. Furthermore, there is an increase in the vascular and neurological effects. This study aimed to assess the isolated independent impact of hepatitis C virus (HCV) on metabolic syndrome, excluding obesity and diabetes mellitus as common risks, this impact was assessed using the metabolic syndrome Severity Z-score (MetS Z-Score) which was initially designed to assess metabolic disease severity itself. Fifty-one HCV patients non-obese and non-diabetic who visited the Tropical Medicine Department from July 2023 to June 2024 were included in our prospective cross sectional study.ResultsAfter calculation of MetS Z-Score, strong correlations were observed between MetS Z-score and the following data: HDL, fasting insulin, fasting blood sugar, HOMA-IR and hypertension (P value < 0.05). Moreover, The MetS Z-Score was found to have higher values in hypertensive patients. Jaundice shows a near to significance correlation with the MetS Z-Score. Anemia, hypoalbuminemia and thrombocytopenia were observed in the included HCV patients. Low density lipoprotein, alanine aminotransferase, aspartate aminotransferase, cholesterol and triglycerides have shown higher levels than normal in the included HCV patients.ConclusionThe MetS Z-score can be used for determining the severity of metabolic abnormalities in HCV patients who are neither diabetic nor obese.

Investigation of serum neurofilament light chain as a biomarker in Fabry disease

Fabry disease (FD) constitutes a rare, X-linked lysosomal storage disorder affecting multiple organ systems, most notably heart, kidneys, and the central nervous system. Neurofilament light chains (NfL) have emerged as a prime candidate for a body fluid biomarker reflecting neuro-axonal injury. We aimed to evaluate its addition to the diagnostic and monitoring armamentarium in FD. Serum NfL concentrations (sNfL) were measured in 50 people with FD (PwFD) and 30 healthy control subjects (HC) using the Simoa© technology, followed by calculation of Z-scores adjusted for age and body mass index. In addition, clinical disease severity in PwFD was measured using the FOS-MSSI (Fabry outcome study – Mainz severity score index), which comprises clinical and paraclinical parameters. PwFD show elevated sNfL Z-scores compared to HC (PwFD: 1.12 [SD 1.5], HC: 0.01 [SD 1.2], p < 0.001). In PwFD, males showed higher sNfL Z-scores than females (1.75 [SD 1.5] vs. 0.73 [SD 1.4]). Importantly, sNfL Z-scores were increased in PwFD with ischemic white matter lesions of the CNS (1.5, SD 2.2 vs. 0.5, SD 2.9, p = 0.03). In our small cohort, sNfL Z-scores correlated fairly with FOS-MSSI (Kendall’s-Tau [τ] = 0.25, p = 0.01), and, interestingly with serum creatinine (τ = 0.28, p = 0.005) and estimated glomerular filtration rate (eGFR, τ =-0.28, p = 0.005). Based on these exploratory results, sNfL might provide value as a biomarker of neuroaxonal damage in FD, possibly reflecting cerebrovascular injury. Additionally, the correlation of sNfL with renal function warrants further investigation.

Effects of healthy eating patterns based nutrition education and providing structured suplementary feeding on improving the nutritional status of stunted children

Nutrition education can improve mothers' knowledge in fulfilling nutritional needs among children under five years through provision of supplementary feeding. Local ingredients based supplementary feeding which had high nutritional value can contribute to improving the nutritional status of children. The aim of this study was to analyze the effect of healthy eating patterns nutritional education and provision of supplementary feeding on improving the nutritional status of stunted children under five years. This study used a quasi-experimental design with a pre-posttest with control group design carried out in Sidawangi Village in August-October 2023. The subjects were children under five years and their mothers (10 intervention group: 10 control group). The interventions were nutritional education and supplementary feeding for a month. Nutritional knowledge data was obtained from interviews using a questionnaire, and nutritional status data (Height-for-Age) was obtained based on z-score calculations. Data was analyzed using Wilxocon, Mann-Whitney, and independent t-test. The average difference in HAZ index in the intervention group (z-score: 0.81 SD) compared to the control group (z-score: -0.50 SD). There was a significant difference between the average difference in the HAZ index in the intervention group and the control group (p=0.001). Nutrition education improved nutritional knowledge of mothers in understanding nutrition education and supplementary feeding (p=0.042). In conclusion, nutritional education intervention can improve the nutritional knowledge of mothers and supplementary feeding can improve the nutritional status of children.

Spatial and temporal trend analysis of temperature extremes in Tanzania

This study examines the effects of extreme temperature events, defined explicitly as the 98th percentile temperature for heat, in Tanzania from 1981 to 2023. The study utilises percentile analysis, z-score calculations, and trend mapping to highlight the prevalence of extreme temperatures. The z-score analysis examines the occurrence of extreme temperatures and their distribution in terms of frequency and space. It identified Tanzania&amp;rsquo;s mid-eastern and north-western regions as areas with a high concentration of extreme temperatures over the previous 43 years. The study analyses the length of extreme occurrences and reveals changing patterns. In 2020, the events were shorter, while in 2021 and 2022, they became longer-lasting, and there was a notable concentration of extended anomalies near the northern coastline. In 2023, the highest temperatures ever recorded were observed, with more than half of the regions seeing prolonged periods of extreme temperatures lasting for a week and significant deviations from the norm staying for four weeks or more. This was particularly notable in the southern regions of Lindi and Mtwara. The harmonic trend analysis of temperature shows an upward temperature trend noticeably in regions such as Arusha, Kilimanjaro, Kagera, Morogoro, Simiyu, and Shinyanga and is somewhat inconspicuous in most areas.

Pencegahan Stunting Berbasis TI di posyandu Buah Hati Ibu Rawang Kecamatan Padang Selatan

Posyandu is a forum that can help the government monitor the health of its people so that it helps the government in determining appropriate policies. One of the most important programs from Posyandu is preventing stunting in toddlers. Stunting is a disorder of growth and development in children due to chronic malnutrition which is characterized by their length or height below the standard set by the Minister of Health. The definition of stunting according to the Ministry of Health (Kemenkes) is a toddler with a Z-Score value of less than -2.00 SD/standard deviation (stunted) and less than -3.00 SD (severely stunted). However, the manual process used in many Posyandu, including Posyandu Buah Hati Ibu in Rawang, Padang Selatan District, Padang City, is often time-consuming and prone to errors. This is a challenge for cadres in analyzing and reporting toddler data, which in turn hinders efforts to prevent stunting. Therefore, community service is needed by building a web-based Information Technology system that can facilitate the data collection process, automatic Z-Score calculations, and reporting results effectively and efficiently.

Normative data for executive function tests in an Ecuadorian Waranka minority population

Objective: To generate normative data (ND) for executive functions tests in the Waranka minority population of Ecuador. Method: Four-hundred participants aged 6–17 completed the Symbol-Digit Modalities Test (SDMT), Trail-Making Test (TMT), Modified-Wisconsin Card Sorting Test (M-WCST), and Test of Colors-Words (STROOP). Scores were normed using multiple linear regressions, including age, age2, natural logarithm of mean parent education (MPE), sex, bilingualism, and two-way interactions as predictors. Results: Age by MPE and Age2 by MPE interactions arose for SDMT, so that children with illiterate parents scored lower than those with literate parents. Girls scored higher in SDMT. All TMT and M-WCST scores were influenced by age2. Age by MPE interaction was found for TMT–A, so that children with higher MPE went faster; and age by bilingualism interaction for TMT–B, so that more bilingual children needed less time. Stroop-Word and Color were influenced by age2 by MPE interaction, so that children, while older, scored higher, especially those with higher MPE. Also, age2 by sex interaction arose, so that girls increased scores curvilinearly while boys linearly. Word-Color was influenced by age, while Stroop-interference by age2. Age by MPE interaction was found for MCST-Categories and Perseveration, so that perseverations decreased to then increased, especially in those with illiterate parents. M-WCST-Category scores increased to then decrease later on age in children with illiterate parents. Z-scores calculated through indigenous ND were significantly lower than generated through non-indigenous norms. Conclusions: ND for minority populations are critical since Waranka sample performed worse when using non-indigenous norms for z-score calculation.

Comprehensive Two-Dimensional Pediatric Echocardiographic Nomograms for Coronary Artery Sizes in Caucasian Children and Comparison among Major Nomograms.

Although coronary artery nomograms in children have been published, data on Caucasian children are lacking. The aim of this study is to provide: (i) a full dataset of coronary artery diameters in healthy children and (ii) a comparison among major previous nomograms. We prospectively evaluated 606 healthy subjects (age range, 1 days-<18 years; median age 8.7 years; 62.5% male). Coronary artery measurements in a short-axis view were performed. Age, heart rate, and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. To assess the accuracy of the predictive models of different studies, a Z-score calculator was created using Lopez's nomograms for comparison. The association with BSA was found to be stronger, and was used for normalization of our data. The best-fit models, satisfying the assumption of homoscedasticity and normality of residuals and showing the highest R2 scores, were logarithmic (ln[y] = a + b*ln[x]). Predicted values and Z-score boundaries by BSA are provided. Our ranges of normality are slightly lower than those, diverging from -0.22 to -0.59 Z-scores for the left main coronary artery and from -0.23 to -0.3 Z-scores for the right coronary artery. We report a complete dataset of normal echocardiography coronary artery diameter (including new measures of the proximal origin) values in a large population of healthy children. Our data were statistically like those of north American nomograms.

HAND GRIP STRENGTH IS ASSOCIATED WITH CLINICAL SYMPTOM BURDEN IN CROHN'S DISEASE

Abstract INTRODUCTION Inflammatory bowel disease (IBD) is a chronic inflammatory condition that may result in malnutrition and alteration of body composition, such as the development of sarcopenia. Sarcopenia is a known component of frailty, which is a driver of poor health outcomes and a significant independent predictor of mortality in patients with IBD. The purpose of this study was to determine whether grip strength, as a predictor of sarcopenia and frailty, is associated with clinical symptoms, endoscopic disease activity and disease-related disability in patients with IBD. METHODS This is a prospective cohort study performed at a single tertiary care center. Outpatient adults aged 18 to 89-years-old with a diagnosis of ulcerative colitis (UC) or Crohn’s disease (CD), were consented and enrolled at the time of an outpatient colonoscopy. Study participants were asked to complete two paper surveys addressing clinical symptoms and IBD Disability Index. Grip strength measurements were obtained using a Jamar dynamometer and adjusted for age and sex by Z-score calculation. RESULTS There was a total of 74 patients, with a mean age of 47.06 years, 51.4% male and 48.6% female with a diagnosis of either UC (38%) or CD (62%). The mean disease duration was 15.7 years (0.5-50.7). Mean hand grip Z-score amongst all patients was lower in patients not in clinical remission compared to those in clinical remission (–0.160 vs 0.480, p = 0.025), though in subgroup analysis based on diagnosis, statical significance only maintained in the CD, but not the UC group (-0.230 vs 0.610, p=0.044; 0.020 vs 0.340, p=0.544 respectively). Mean hand grip Z-score was not associated with IBD Disability Index (–0.070 vs 0.250, p= 0.669) or endoscopic disease activity (UC 0.210 vs 0.070, p=0.513; CD –0.108 vs 0.274, p=0.638). CONCLUSION Low hand grip strength is associated with clinical disease activity in patients with CD but not UC. Our study does not suggest hand grip strength to be associated with IBD-related disability or endoscopic disease activity in either patients with UC or CD. Data on clinical outcomes at 6-months will be collected. DISCUSSION From the findings in our study, hand grip measurements alone may not be the best predictor of disease activity or related disability. There is a lack of validated diagnostic criteria for sarcopenia and frailty in the IBD population and additional diagnostic modalities may be required. While our study suggests that hand grip may be correlated with clinical disease activity in patients with CD, additional studies with a large population size and wider representation of disease severity, such as including hospitalized IBD populations, are needed to further validate these findings.

Am I big boned? Bone length scaled reference data for HRpQCT measures of the radial and tibial diaphysis in White adults

Cross-sectional size of a long bone shaft influences its mechanical properties. We recently used high-resolution peripheral quantitative computed tomography (HRpQCT) to create reference data for size measures of the radial and tibial diaphyses. However, data did not take into account the impact of bone length. Human bone exhibits relatively isometric allometry whereby cross-sectional area increases proportionally with bone length. The consequence is that taller than average individuals will generally have larger z-scores for bone size outcomes when length is not considered. The goal of the current work was to develop a means of determining whether an individual's cross-sectional bone size is suitable for their bone length. HRpQCT scans performed at 30 % of bone length proximal from the distal end of the radius and tibia were acquired from 1034 White females (age = 18.0 to 85.3 y) and 392 White males (age = 18.4 to 83.6 y). Positive relationships were confirmed between bone length and cross-sectional areas and estimated mechanical properties. Scaling factors were calculated and used to scale HRpQCT outcomes to bone length. Centile curves were generated for both raw and bone length scaled HRpQCT data using the LMS approach. Excel-based calculators are provided to facilitate calculation of z-scores for both raw and bone length scaled HRpQCT outcomes. The raw z-scores indicate the magnitude that an individual's HRpQCT outcomes differ relative to expected sex- and age-specific values, with the scaled z-scores also considering bone length. The latter enables it to be determined whether an individual or population of interest has normal sized bones for their length, which may have implications for injury risk. In addition to providing a means of expressing HRpQCT bone size outcomes relative to bone length, the current study also provides centile curves for outcomes previously without reference data, including tissue mineral density and moments of inertia.

Corporate Governance Mechanism and Financial Ratios on the Indonesia Stock Exchange: How do they Affect Financial Distress?

Aims: The purpose of this study was to determine the effect of institutional ownership, board of directors, audit committee, company size, and sales growth on financial distress.&#x0D; Study Design: The population of this study consisted of 41 retail subsector companies listed on the Indonesia Stock Exchange (IDX) for the 2019-2022 period. The total observation data is 164 and obtained 64 data samples that meet the criteria and 100 data samples that do not meet the criteria (Loss, Gray Area, Incomplete variables). This research data comes from the company's annual financial statements.&#x0D; Methodology: The data collection method is purposive sampling and the analysis technique is model fit test, coefficient of determination test, and logistic regression. Financial distress is calculated using the Altman Z-Score calculation, and hypothesis testing is tested using the SPSS 26 analysis tool.&#x0D; Results: The results showed that good corporate governance proxied by the board of directors and audit committee has no effect on financial distress, while institutional ownership affects financial distress. Company size variables affect financial distress. While sales growth has no effect on financial distress.&#x0D; Conclusion: Based on this study, it is known that institutional ownership has an effect on financial distress, meaning that the greater the percentage of institutional ownership will reduce the possibility of the company experiencing financial distress. The board of directors has no effect on financial distress, meaning that the number of directors in a company does not affect the occurrence of financial distress. The audit committee has no effect on financial distress, meaning that the number of audit committee members is not able to reduce the problem of financial distress. Company size has an effect on financial distress, meaning that a higher total asset value owned by company would reduce the probability of financial distress. Sales growth has no effect on financial distress, meaning that the high or low level of sales growth does not reflect that it can be followed by an increase in profits earned by the company. To avoid financial distress, it is done by higher percentage of institutional ownership, as well higher total asset value owned by the company properly.

Rate of Vaginal Cuff Dehiscence When Using Vicryl (Poliglactyn 910) Compared to PDS (Polydioxanone) for Vaginal Cuff Closure in Laparoscopic Hysterectomy.

Objective: To compare the vaginal cuff dehiscence (VCD) rates using Vicryl (Poliglactyn 910) and Polydioxanone (PDS) in patients who underwent laparoscopic hysterectomy. Materials and methods: A retrospective, monocentric study was conducted, including all patients undergoing laparoscopic hysterectomy at the Department of Obstetrics and Gynaecology, Azienda di Rilievo Nazionale e di Alta Specializzazione (ARNAS) Garibaldi Nesima, Catania, between January 2014 and December 2021. Patients underwent hysterectomy for benign gynecologic pathologies (endometriosis, leiomyomas, or benign pelvic pathologies) or malignant gynecologic pathologies (endometrium cancer, complex endometrial hyperplasia, ovarian cancer, cervix cancer, or uterine carcinosarcoma). The Z-score calculation was performed to find eventual statistically significant differences between the two populations regarding VCD rates. Results: Laparoscopic vaginal cuff closure was performed, with Vicryl sutures in 202 patients and PDS sutures in 184 women. Demographic and baseline characteristics were not significantly different in the two groups. VCD occurred in three patients in the Vicryl group and did not occur in the PDS group. The three cases of VCD were precipitated by intercourses that occurred within 90 days of surgery. However, there was not a significant statistical difference between the two groups regarding VCD (p = 0.09). Conclusions: Vicryl and PDS sutures seem to be similar for vaginal cuff closure in laparoscopic hysterectomy. The VCD rate was low, and the observed differences between the Vicryl and PDS groups did not reach statistical significance. Further research through prospective studies is essential.

Association of Insulin Resistance with Hepatitis B and Hepatitis C Infection: A Cross-sectional Study

Introduction: Hepatitis B and C viruses (HBV and HCV) are the most common causes of chronic viral hepatitis in the United States and worldwide. As several studies have shown that some viral infections promote Insulin Resistance (IR), it becomes imperative to investigate the effect of HBV and HCV on the same. Aim: To investigate the association between IR and Hepatitis C and Hepatitis B infection. Materials and Methods: The present cross-sectional study was conducted in the Department of Paramedical and Health Sciences, Parul Institute of Paramedical and Health Sciences, Faculty of Medicine, Parul University, Vadodara, Gujarat, India, from November 2022 to June 2023. The study comprised 100 consecutive patients, with 55% testing positive for Hepatitis B and 45% for Hepatitis C. Biochemical parameters such as fasting blood sugar, fasting insulin and IR via the Homeostasis Model Assessment (HOMA-IR) were determined. Statistical analysis was performed using International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 26.0. The z-test of proportion was calculated and a Z-score calculator was used for p-value. Results: In the present study, out of 100 consecutive patients, 76 were males and 24 were females. The mean insulin level for HBV patients was found to be high, with values of 28.94±2.22 mU/L in 23.63% of cases, whereas in HCV cases, 68.8% of patients were found to have higher levels, with mean values of 34.52±9.00 mU/L. The mean HOMA-IR values for HBV patients were found to be high, at 4.84±2.32 in 47.27% of cases, whereas in HCV cases, 77.7% of patients were found to have higher values of HOMA-IR, with a mean of 7.94±4.83. Conclusion: Insulin resistance can be a consequence of the inability of insulin to induce the appropriate effect on glucose metabolism and is the principal indication for the development of metabolic syndrome and diabetes mellitus. In the current study, HCV-positive patients showed more IR compared to HBV-positive cases.

Characterization and z-score calculation of cardiovascular magnetic resonance imaging parameters in patients after the Fontan operation: A Fontan Outcome Registry using Cardiovascular Magnetic Resonance Examinations study

BackgroundCardiac magnetic resonance (CMR) offers valuable hemodynamic insights post-Fontan, but is limited by the absence of normative single ventricle data. The Fontan Outcomes Registry using CMR Examinations (FORCE) is a large international Fontan-specific CMR registry. This study used FORCE registry data to evaluate expected CMR ventricular size/function and create Fontan-specific z-scores adjusting for ventricular morphology (VM) in healthier Fontan patients. Methods“Healthier” Fontan patients were defined as patients free of adverse outcomes, who are New York Heart Association Class I, have mild or less valve disease, and <30% aortopulmonary collateral burden. General linear modeling was performed on 70% of the dataset to create z-scores for volumes and function. Models were tested using the remainder (30%) of the data. The z-scores were compared between children and adults. The z-scores were also compared between “healthier” Fontan and patients with adverse outcomes (death, listing for transplantation or multiorgan disease). ResultsThe “healthier” Fontan population included 885 patients (15.0 ± 7.6 years) from 18 institutions with 1,156 CMR examinations. Patients with left ventricle morphology had lower volume, mass and higher ejection fraction (EF) compared to right or mixed (two-ventricles) morphology (p<0.001 for all pairwise comparisons). Gender, BSA and VM were used in z-scores. Of the “healthier” Fontan patients, 647 were children <18 years and 238 were adults. Adults had lower ascending aorta flow (2.9 ± 0.7 vs 3.3 ± 0.8L/min/m2, p<0.001) and ascending aorta flow z-scores (-0.16 ± 1.23 vs 0.05 ± 0.95, 0.02) compared to children. Additionally, there were 1595 patients with adverse outcomes who were older (16.1 ± 9.3 vs 15.0 ± 7.6, p<0.001) and less likely to have LV morphology (35 vs 47%, p<0.001). Patients with adverse outcomes had higher z-scores for ventricular volume and mass and lower z-scores for EF and ascending aorta flow compared to the “healthier” Fontan cohort. ConclusionThis is the first study to generate CMR z-scores post-Fontan. Importantly the z-scores were generated and tested in “healthier” Fontan patients and both pediatric and adult Fontan patients. These equations may improve CMR-based risk stratification after the Fontan operation.

The Using Of Information Systems To Calculate Z-Score And To Determination Of Stunting Categories In Toddlers

Information technology is an inseparable part of human work today. It is growing very rapidly along with the human need for the speed at which information is processed until it is displayed to the user. Information systems are now widely used in all sectors, ranging from: economy, agriculture, health and so on. In the health sector, many health facilities have used information systems to improve services, one of which is Posyandu. Posyandu is the front line in providing family health services at the village level. Currently, Posyandu focus is preventing malnutrition or stunting. Standardization of stunt calculation data often changes. In addition, the calculation and documentation of toddler examination data is also still done manually. This has an impact on the efficiency of the performance of staff in determining toddlers who are affected by stunting. Data integration with the Ministry of Health is also a problem when recorded manually. Therefore, it is proposed that an information system that functions to perform Z-Score calculations and classify them into stunting or non-stunting groups. The existence of this information system can also support the government to encourage data integration between local governments and the center regarding stunting data. It is hoped that this information system can help the work efficiency of health cadres to record toddlers who fall into the Stunting category. In addition, it is also possible for the government to access data stored in the system to support data integration.

Assessment of the Financial Stability of the Diagnostic-consultative Centres in Varna

The Diagnostic-Consultative centres' management teams can benefit from applying financial analysis methods. One of these methods is the calculation of Altman's Z-score. This analysis can be vital in guiding management decisions to improve financial stability and thus contribute to high-quality medical services. Our study aims to assess the financial stability of the diagnostic-consultative centres in Varna based on the calculation of their Altman Z-score. The study design includes all nine Diagnostic-Consultative centres (DCC) in Varna- 6 of which are municipally owned, two are privately owned, and one is state-owned. The study period is 2018-2021, and for each year of the period and each of the medical institutions, based on information from their financial reports, Altman Z-score was calculated. For one of the DCCs, with private ownership of the capital, the necessary information to calculate the indicator is missing, so it is excluded from the study. The results show that the DCCs with a Z-score lower than 1.8 for 2018 are five, four for 2019, and three for 2020 and 2021. For six of the eight analysed healthcare centres, the indicator's value increased over the period, and the financial situation improved and stabilised. The average value of the indicator for the whole group of medical institutions increases from 0.25 in 2018 to 2.84 in 2021. The indicators used in calculating the Z-score are critical in determining the financial health of medical institutions, so the dynamic of the Z-score is an essential indicator that the management of medical institutions should monitor.

Serum levels of bone turnover markers including calculation of Z-scores: Data from a Dutch healthy reference cohort

IntroductionBone turnover markers (BTM) are biochemical compounds reflecting different stages of bone metabolism. Their levels change with age and differ between males and females. This makes clinical interpretation and comparison more difficult. Therefore, our aim was to establish BTM reference values which can be used to calculate Z-scores for use in daily clinical practice. MethodsSerum markers of collagen resorption, bone formation/regulation, collagen formation and bone mineralization (sCTX, OC, PINP and BALP, respectively) were measured in non-fasting volunteers without bone-related abnormalities. Raw data was plotted and gender-specific age cohorts were established with their respective means and standard deviations (SD). Z-scores can be calculated using these reference values to correct for the influence of age and gender on BTM. ResultsIn total, 856 individuals were included of which 486 (57 %) were female. Individuals were aged between 7 and 70 years. Highest serum levels of BTM were found in childhood and puberty. Peak levels are higher in boys than girls and prevail at later ages. In adults, BTM levels decrease before reaching stable nadir levels. In adults, 10-year reference cohorts with means and SD were provided to calculate Z-scores. ConclusionWith our data, Z-scores of sCTX, OC, PINP and BALP can be calculated using reference categories (for age and gender) of Caucasian healthy volunteers. Clinicians can use BTM Z-scores to determine whether there are changes in bone turnover physiology beyond those expected during aging. BTM Z-scores facilitate harmonization of data interpretation in daily clinical practice and research.

LMS-based continuous pediatric reference values for soluble receptor activator of nuclear factor kappa B ligand (sRANKL) and osteoprotegerin (OPG) in the HARP cohort

SummarySoluble RANKL (sRANKL) and osteoprotegerin (OPG) are regulators of osteoclast differentiation and activation, but adequate pediatric reference values are lacking. Here we provide LMS (Lambda-Mu-Sigma)-based continuous pediatric reference percentiles for sRANKL, OPG and sRANKL/OPG ratio that will allow calculation of standardized patient z-scores to assess bone modeling in children.PurposeSoluble receptor activator of nuclear factor kappa B ligand (sRANKL) and osteoprotegerin (OPG) are regulators of osteoclast differentiation and activation and thus bone metabolic turnover in children. Adequate pediatric reference values for their serum/plasma concentrations are lacking. The development of Lambda-Mu-Sigma (LMS)-based continuous reference percentiles for laboratory parameters allow improved data interpretation in clinical practice.MethodsA total of 300 children aged 0.1–18 years (166 boys) were enrolled in the HAnnover Reference values for Pediatrics (HARP) study. sRANKL and OPG were assessed by ELISA. LMS-based continuous reference percentiles were generated using RefCurv software.ResultsLMS-based percentiles were established for sRANKL, OPG and sRANKL/OPG ratio, which were all found to be age-dependent. sRANKL and sRANKL/OPG associated with sex. In boys, sRANKL percentiles were highest during infancy, followed by a continuous decline until the age of 7 years and a second peak around age 12–13 years. In girls, a continuous, slow decline of sRANKL percentiles was noticed from infancy onwards until the age of 13 years, followed by a rapid decline until adulthood. OPG percentiles continuously declined from infancy to adulthood. The percentiles for sRANKL/OPG ratio paralleled those of sRANKL. Serum concentrations of sRANKL correlated with OPG and serum phosphate z-scores, while OPG concentrations inversely associated with standardized body weight, BMI, and urinary phosphate to creatinine ratio (each p < 0.05).ConclusionThis is the first report of LMS-based continuous pediatric reference percentiles for sRANKL, OPG and sRANKL/OPG ratio that allows calculation of standardized patient z-scores to assess bone metabolic turnover in children.

Interrelation between cardiac and brain small-vessel disease: a pilot quantitative PET and MRI study

BackgroundSmall-vessel disease (SVD) plays a crucial role in cardiac and brain ischemia, but little is known about potential interrelation between both. We retrospectively evaluated 370 patients, aiming at assessing the interrelation between cardiac and brain SVD by using quantitative 82Rb cardiac PET/CT and brain MRI.ResultsIn our population of 370 patients, 176 had normal myocardial perfusion, 38 had pure cardiac SVD and 156 had obstructive coronary artery disease. All underwent both a cardiac 82Rb PET/CT and a brain 1.5T or 3T MRI. Left-ventricle myocardial blood flow (LV-MBF) and flow reserve (LV-MFR) were recorded from 82Rb PET/CT, while Fazekas score, white matter lesion (WMab) volume, deep gray matter lesion (GMab) volume, and brain morphometry (for z-score calculation) using the MorphoBox research application were derived from MRI. Groups were compared with Kruskal–Wallis test, and the potential interrelation between heart and brain SVD markers was assessed using Pearson’s correlation coefficient. Patients with cardiac SVD had lower stress LV-MBF and MFR (P < 0.001) than patients with normal myocardial perfusion; Fazekas scores and WMab volumes were similar in those two groups (P > 0.45). In patients with cardiac SVD only, higher rest LV-MBF was associated with a lower left-putamen (rho = − 0.62, P = 0.033), right-thalamus (rho = 0.64, P = 0.026), and right-pallidum (rho = 0.60, P = 0.039) z-scores and with a higher GMab volume. Lower stress LV-MBF was associated with lower left-caudate z-score (rho = 0.69, P = 0.014), while lower LV-MFR was associated with lower left (rho = 0.75, P = 0.005)- and right (rho = 0.59, P = 0.045)-putamen z-scores, as well as higher right-thalamus GMab volume (rho = − 0.72, P = 0.009).ConclusionSignificant interrelations between cardiac and cerebral SVD markers were found, especially regarding deep gray matter alterations, which supports the hypothesis of SVD as a systemic disease.

LMS-Based Pediatric Reference Values for Parameters of Phosphate Homeostasis in the HARP Cohort.

The assessment of phosphate homeostasis in children is challenging due to the marked changes in laboratory parameters during growth and development, and the lack of adequate reference values. To develop Lambda-Mu-Sigma (LMS)-based continuous pediatric reference percentiles for 7 key laboratory parameters of phosphate homeostasis. This cross-sectional, single-center study, the HAnnover Reference values for Pediatrics (HARP) study, included 455 children aged 0.1-18 years (254 boys) from outpatient hospital clinics and a secondary school program. Main outcome measures were LMS-based continuous reference percentiles for serum phosphate, plasma intact fibroblast growth factor 23 (iFGF23), and its cofactor soluble Klotho (sKlotho), tubular maximum phosphate reabsorption per glomerular filtration rate (TmP/GFR), fractional tubular reabsorption of phosphate (TRP), and urinary calcium/creatinine (Ca/Crea) and phosphate/creatinine (Pi/Crea) ratios. LMS-based percentiles and z-scores were established for 7 key laboratory parameters of phosphate homeostasis, which were all found to be age-dependent. Serum phosphate, TmP/GFR, and sKlotho associated with sex. Serum phosphate, TmP/GFR, and urinary Ca/Crea and Pi/Crea levels were highest in infancy and declined until age 18 years, while phosphate and TmP/GFR values reached adult levels earlier in girls compared to boys. iFGF23 concentrations are highest in infancy and fall to a stable plateau by 4 years of age, while sKlotho peaks during adolescence. This is the first report of LMS-based continuous pediatric reference percentiles for key laboratory parameters of phosphate homeostasis that allow calculation of standardized patient z-scores to facilitate test result interpretation in children and adolescents.