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Larner, Andrew J. "Optimising the Cutoffs of Cognitive Screening Instruments in Pragmatic Diagnostic Accuracy Studies: Maximising Accuracy or the Youden Index?" Dementia and Geriatric Cognitive Disorders 39, no. 3-4 (2015): 167–75. http://dx.doi.org/10.1159/000369883.
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Background/Aims: The optimal method of establishing test cutoffs or cutpoints for cognitive screening instruments (CSIs) is uncertain. Of the available methods, two base cutoffs on either the maximal test accuracy or the maximal Youden index. The aim of this study was to compare the effects of using these alternative methods of establishing cutoffs. Methods: Datasets from three pragmatic diagnostic accuracy studies which examined the Mini-Mental State Examination (MMSE), the Addenbrooke's Cognitive Examination-Revised (ACE-R), the Montreal Cognitive Assessment (MoCA), and the Test Your Memory (TYM) test were analysed to calculate test sensitivity and specificity using cutoffs based on either maximal test accuracy or the maximal Youden index. Results: For ACE-R, MoCA, and TYM, optimal cutoffs for dementia diagnosis differed from those in index studies when defined using either the maximal accuracy or the maximal Youden index method. Optimal cutoffs were higher for MMSE, MoCA, and TYM when using the maximal Youden index method and consequently more sensitive. Conclusion: Revision of the cutoffs for CSIs established in index studies may be required to optimise performance in pragmatic diagnostic test accuracy studies which more closely resemble clinical practice.
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Thiele, Christian, and Gerrit Hirschfeld. "Confidence intervals and sample size planning for optimal cutpoints." PLOS ONE 18, no. 1 (January 3, 2023): e0279693. http://dx.doi.org/10.1371/journal.pone.0279693.
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Various methods are available to determine optimal cutpoints for diagnostic measures. Unfortunately, many authors fail to report the precision at which these optimal cutpoints are being estimated and use sample sizes that are not suitable to achieve an adequate precision. The aim of the present study is to evaluate methods to estimate the variance of cutpoint estimations based on published descriptive statistics (‘post-hoc’) and to discuss sample size planning for estimating cutpoints. We performed a simulation study using widely-used methods to optimize the Youden index (empirical, normal, and transformed normal method) and three methods to determine confidence intervals (the delta method, the parametric bootstrap, and the nonparametric bootstrap). We found that both the delta method and the parametric bootstrap are suitable for post-hoc calculation of confidence intervals, depending on the sample size, the distribution of marker values, and the correctness of model assumptions. On average, the parametric bootstrap in combination with normal-theory-based cutpoint estimation has the best coverage. The delta method performs very well for normally distributed data, except in small samples, and is computationally more efficient. Obviously, not every combination of distributions, cutpoint optimization methods, and optimized metrics can be simulated and a lot of the literature is concerned specifically with cutpoints and confidence intervals for the Youden index. This complicates sample size planning for studies that estimate optimal cutpoints. As a practical tool, we introduce a web-application that allows for running simulations of width and coverage of confidence intervals using the percentile bootstrap with various distributions and cutpoint optimization methods.
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Husaiyin, Sulaiya, Zhen Jiao, Kailibinuer Yimamu, Reyilanmu Maisaidi, Lili Han, and Mayinuer Niyazi. "ThinPrep cytology combined with HPV detection in the diagnosis of cervical lesions in 1622 patients." PLOS ONE 16, no. 12 (December 2, 2021): e0260915. http://dx.doi.org/10.1371/journal.pone.0260915.
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The timely detection of precancerous lesions and early intervention can greatly reduce cervical cancer occurrence. The current study aimed to assess the diagnostic value and accuracy of different methods of cervical lesion screening. A total of 1622 females who visited the Outpatient Department of Xinjiang Uyghur Autonomous Region People’s Hospital between January and December 2018 were consecutively enrolled. All participants underwent separate high-risk human papilloma virus (HR-HPV) DNA detection, ThinPrep cytology testing (TCT) and colposcopic biopsy. Their medical records were retrospectively analyzed. While considering biopsy outcomes as the gold standard, the diagnostic values of TCT, HR-HPV testing, and TCT+HR-HPV testing for cervical cancer screening were compared. The sensitivity, specificity and Youden index of each method were calculated. Among the different methods, TCT+HR-HPV testing had the highest sensitivity (89.8%), followed by TCT (79.9%) and HR-HPV testing (49.2%). The combined method also had the highest Youden value, and its screening outcomes exhibited the highest consistency with those of biopsy. In addition, the combined method had the largest area under the receiver operating characteristic (ROC) curve, which was 0.673 (0.647, 0.699), compared with any other screening method. Compared with TCT or HR-HPV testing alone, TCT+HR-HPV testing serves as a better screening method for cervical cancer and precancerous lesions.
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Nyota, Passy Kimema, Dophie Tshibuela Beya, Placide Cyanga Ngandu, Aliocha Nkodila Natuhoyila, Blaise Sumbu Matondo Manzambi, Mamy Ngole Zita, Gustave Ilunga Ntita, et al. "Evaluation of the proteinuria - Creatininuria ratio for the diagnostic confirmation of preeclampsia in congolese pregnant women." Journal of Medical Research 7, no. 3 (June 10, 2021): 70–78. http://dx.doi.org/10.31254/jmr.2021.7303.
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Context: Preeclampsia is a multisystem endothelial disease characterized by hypertension of pregnancy and glomeruloendotheliosis resulting in significant proteinuria. These days, the weight determination of urinary proteins by 24-hour proteinuria (P24) remains the reference method for biologically confirming this condition. However, the completion of the exam appears to be very burdensome with a long waiting period for results. Hence the need to use a simple alternative method such as the proteinuria / creatininuria ratio (PCR). Aims: Improve the diagnosis and management of preeclampsia by using a simple, less restrictive but reliable diagnostic method. Methodology: The study compared the results obtained from P24 versus PCR in confirming the diagnosis of preeclampsia in 149 Congolese women in whom the disease was suspected thanks to the urine dipstick. The cut-off values used for the diagnosis of preeclampsia were, for P24, a proteinuria> 300 mg / 24 h and for PCR a value> 30 mg / mmol. Results: Of the 149 pregnant women in whom the diagnosis of preeclampsia was suspected using the urine dipstick, only 85.9% had a P24> 300 mg. This diagnostic confirmation rate was similar to that obtained with PCR (86.6%). A linear correlation was found between P24 and PCR in the quantification of proteinuria and in the diagnosis of preeclampsia (r² = 0.627, p <0.004). Comparing the pathological values diagnosed by the two methods, the agreement was 89.1% (kappa = 0.767). The PCR showed an excellent predictive performance of maternal-fetal complications at the optimal threshold of 30.8 mg / mmol corresponding to a sensitivity of 96.6% and a specificity of 95% (Youden index 0.866). This threshold was 323 mg / 24h corresponding to a sensitivity of 84% and a specificity of 61.9% (Youden index 0.459) for P24. Conclusion: PCR seems to be a good alternative to P24 in confirming the diagnosis of preeclampsia in the settings most affected by this pathology
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Curto Subirats, Juan José, Alba Fischer-Carles, and Anna Solé. "Automatic Detection of Sfe: A Step Forward." Atmosphere 13, no. 2 (January 26, 2022): 199. http://dx.doi.org/10.3390/atmos13020199.
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Solar flare effects (Sfe) are magnetic variations caused by solar flare events. They only show up in the illuminated hemisphere. Their detection is a difficult task because they do not have a definite pattern and, additionally, they must be separated from other magnetic perturbations. However, we attempted to automatize these detections by using two different strategies. The first strategy takes advantage of one of the Sfe characteristics, as they usually have a rapid rise, followed by a smooth decay, which typically produces a crochet-like shape in the magnetograms. Thus, we created several morphological models for each magnetic component. Then, we identified a definite Sfe time interval by setting the conditions for various parameters, such as the correlations of the measured data with the models, or the model similarities among the different components. In the second stage of this strategy, we observed clusters of time intervals. Each of these clusters were attributed to a timespan of event possibility. We found the statistical optimal value of the correlation parameters by using the ROC curve method and Youden index. The second strategy was based on some of the properties of Sfe ionospheric electric currents, such as their spherical symmetry around the vortex. Here, the algorithm calculated the derivative of the data in order to avoid contamination of the daily variation Sq, and, by means of trigonometric formulas, computed the magnetic radial component relative to the Sfe current vortex (the focus). It then created an Sfe index with this data. A prior assumption of the focus position in a preceding work is no longer needed since we made a wide patrol of the space area to find it. Through a progressive thresholding process, we found its statistical optimal value (0.4 nT min−1) again by using the ROC curve method and Youden index. For both of the strategies, we have made a large calculation of Sfe detection (for the period of 2000–2020), which included 33 Sfe. Finally, we combined the results of both methods—which in fact are complementary—and obtained a unified list that gave a higher hit ratio than those that were obtained separately. This unified method gave promising results towards the possibility of Sfe automatic detection.
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Sun, Xue, Runrun Ren, Xiaoqian Yu, Fang Peng, and Xia Gao. "Application of Color Doppler Ultrasound Combined with Magnetic Resonance Imaging in Placenta Accreta." Scanning 2022 (July 13, 2022): 1–7. http://dx.doi.org/10.1155/2022/1050029.
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In order to improve the diagnostic value of color Doppler ultrasonography in placenta accreta and make the diagnosis more accurate, a method to detect placenta accreta by combining color Doppler ultrasonography and magnetic resonance is proposed. The patients with placenta accreta were selected for color Doppler ultrasonography and MRI examination. Kappa test was used to analyze the consistency between the results of ultrasound and MRI examination alone and combined diagnosis and pathological examination results, and the receiver operating characteristic (ROC) was drawn. Price compliance, sensitivity, specificity, good estimate rate, negative bid success rate, and Youden index were chosen as the basis for measuring the value of our tests. The results showed that the Kappa combined test rate was 0.609, the equivalent efficiency was 80.90%, and the correlation was good; ROC curve analysis showed that the sensitivity and specificity of articular placenta accreta were 91.75% and 89.26%. The sensitivity, uniqueness, good estimate, negative predictive value, and Youden index of color Doppler ultrasound combined with magnetic resonance imaging>magnetic resonance imaging>color Doppler ultrasound in our laboratory were compared, and the difference was significant ( P < 0.05 ). The experimental results show that color Doppler ultrasound and MRI are effective in the diagnosis of placenta accreta, and each has advantages and disadvantages. Therefore, it has been improved in the diagnosis of placenta accreta, is helpful for the diagnosis of placenta accreta, and is suitable for popularization and use.
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Chiang, Charng-Yen, Chien-Fu Lin, Peng-Huei Liu, Fu-Cheng Chen, I.-Min Chiu, and Fu-Jen Cheng. "Clinical Validation of the Shock Index, Modified Shock Index, Delta Shock Index, and Shock Index-C for Emergency Department ST-Segment Elevation Myocardial Infarction." Journal of Clinical Medicine 11, no. 19 (October 1, 2022): 5839. http://dx.doi.org/10.3390/jcm11195839.
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Background: ST-segment elevation myocardial infarction (STEMI) is a leading cause of death worldwide. A shock index (SI), modified SI (MSI), delta-SI, and shock index-C (SIC) are known predictors of STEMI. This retrospective cohort study was designed to compare the predictive value of the SI, MSI, delta-SI, and SIC with thrombolysis in myocardial infarction (TIMI) risk scales. Method: Patients > 20 years old with STEMI who underwent percutaneous coronary intervention (PCI) were included. Receiver operating characteristic (ROC) curve analysis with the Youden index was performed to calculate the optimal cutoff values for these predictors. Results: Overall, 1552 adult STEMI cases were analyzed. The thresholds for the emergency department (ED) SI, MSI, SIC, and TIMI risk scales for in-hospital mortality were 0.75, 0.97, 21.00, and 5.5, respectively. Accordingly, ED SIC had better predictive power than the ED SI and ED MSI. The predictive power was relatively higher than TIMI risk scales, but the difference did not achieve statistical significance. After adjusting for confounding factors, the ED SI > 0.75, MSI > 0.97, SIC > 21.0, and TIMI risk scales > 5.5 were statistically and significantly associated with in-hospital mortality of STEMI. Compared with the ED SI and MSI, SIC (>21.0) had better sensitivity (67.2%, 95% CI, 58.6–75.9%), specificity (83.5%, 95% CI, 81.6–85.4%), PPV (24.8%, 95% CI, 20.2–29.6%), and NPV (96.9%, 95% CI, 96.0–97.9%) for in-hospital mortality of STEMI. Conclusions: SIC had better discrimination ability than the SI, MSI, and delta-SI. Compared with the TIMI risk scales, the ACU value of SIC was still higher. Therefore, SIC might be a convenient and rapid tool for predicting the outcome of STEMI.
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Lim, Jayeon, SoYoun Bang, Jiyeon Kim, Cheolyong Park, JunSang Cho, and SungHwan Kim. "Integrative Deep Learning for Identifying Differentially Expressed (DE) Biomarkers." Computational and Mathematical Methods in Medicine 2019 (November 2, 2019): 1–10. http://dx.doi.org/10.1155/2019/8418760.
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As a large amount of genetic data are accumulated, an effective analytical method and a significant interpretation are required. Recently, various methods of machine learning have emerged to process genetic data. In addition, machine learning analysis tools using statistical models have been proposed. In this study, we propose adding an integrated layer to the deep learning structure, which would enable the effective analysis of genetic data and the discovery of significant biomarkers of diseases. We conducted a simulation study in order to compare the proposed method with metalogistic regression and meta-SVM methods. The objective function with lasso penalty is used for parameter estimation, and the Youden J index is used for model comparison. The simulation results indicate that the proposed method is more robust for the variance of the data than metalogistic regression and meta-SVM methods. We also conducted real data (breast cancer data (TCGA)) analysis. Based on the results of gene set enrichment analysis, we obtained that TCGA multiple omics data involve significantly enriched pathways which contain information related to breast cancer. Therefore, it is expected that the proposed method will be helpful to discover biomarkers.
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Poon, Michael T. C., Shivank Keni, Vineeth Vimalan, Chak Ip, Colin Smith, Sara Erridge, Christopher Weir, and Paul Brennan. "Extent of MGMT Promoter Methylation Modifies the Effect of Temozolomide on Overall Survival in Patients with Glioblastoma: A Regional Cohort Study." Neuro-Oncology 24, Supplement_4 (October 1, 2022): iv16—iv17. http://dx.doi.org/10.1093/neuonc/noac200.073.
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Abstract AIMS MGMT methylation in glioblastoma predicts response to temozolomide but dichotomizing methylation status may mask the true prognostic value of quantitative MGMT methylation. This study evaluated whether extent of MGMT methylation interacts with the effect of temozolomide on overall survival. METHOD We included consecutive glioblastoma patients aged ≥16 years diagnosed (April 2012–May 2020) at a neuro-oncology center. All patients had quantitative MGMT methylation measured using pyrosequencing. Those with MGMT methylated tumors were stratified into high and low methylation groups based on a cut-off using Youden index on 2-year survival. Our accelerated failure time survival models included extent of MGMT methylation, age, postoperative Karnofsky performance score, extent of resection, temozolomide regimen, and radiotherapy. RESULTS There were 414 patients. Optimal cut-off point using Youden index was 25.9% MGMT methylation. The number of patients in the unmethylated, low and high methylation groups was 223 (53.9%), 81 (19.6%), and 110 (26.6%), respectively. In the adjusted model, high (hazard ratio [HR] 0.60, 95% confidence intervals [CI] 0.46– 0.79, P=0.005) and low (HR 0.67, 95% CI 0.50–0.89, P<0.001) methylation groups had better survival compared to unmethylated group. There was no evidence for interaction between MGMT methylation and completed temozolomide regimen (interaction term for low methylation P=0.097; high methylation P=0.071). This suggests no strong effect of MGMT status on survival in patients completing temozolomide regimen. In patients not completing the temozolomide regimen, higher MGMT methylation predicted better survival (interaction terms P<0.001). CONCLUSION Quantitative MGMT methylation may provide additional prognostic value. This is important when assessing clinical and research therapies.
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Szmyd, Bartosz, Małgorzata Biedrzycka, Filip Franciszek Karuga, Magdalena Rogut, Iwona Strzelecka, and Maria Respondek-Liberska. "Interventricular Septal Thickness as a Diagnostic Marker of Fetal Macrosomia." Journal of Clinical Medicine 10, no. 5 (March 1, 2021): 949. http://dx.doi.org/10.3390/jcm10050949.
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Serious complications in both mother and newborn arising as a result of fetal macrosomia indicate the need for early diagnosis and prevention. Unfortunately, current predictors, such as fetal biometry, fundal height, and amniotic fluid index, appear to be insufficient. Therefore, we decided to assess the predictive potential of interventricular septal thickness (IVST), as measured at ≥33 weeks of gestation. Two hundred and ninety-nine patients met the inclusion criteria: complete medical history including all necessary measurements—namely, IVST obtained by M-mode echocardiography, fetal biometry, and birth weight. The Statistica 13.1 PL software was used to generate the receiver operating curve. The optimal cut-off point (IVST of 4.7 mm) was selected using the Youden index method. The analysis of fetal biometry abnormalities resulted in 46.6% of macrosomia cases being correctly predicted; however, IVST analysis detected 71.4% of cases. IVST at ≥4.7 mm appears to have a higher sensitivity and negative predictive value (NPV) than routine ultrasound.
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Xu, Yan, and Dan Xie. "Prediction of Factors Associated with Abnormal Uterine Bleeding by Transvaginal Ultrasound Combined with Bleeding Pattern." Computational and Mathematical Methods in Medicine 2022 (June 28, 2022): 1–8. http://dx.doi.org/10.1155/2022/5653250.
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In order to explore the ability of vaginal ultrasound combined with bleeding pattern to predict factors related to abnormal uterine bleeding (AUB), a total of 205 patients with abnormal uterine bleeding were selected as experimental subjects. According to the corresponding diagnostic criteria, patients were divided into the endometrial polyp group (56 cases), endometrial hyperplasia and canceration group (84 cases), and normal cycle endometrial group (65 cases). The efficiency of the method was determined by comparing the prediction efficiency of the single/joint model. The results showed that there were statistically significant differences in the body mass index, dysmenorrhea, endometrial thickness, diabetes, hypertension, and polycystic ovary syndrome among the three groups, P < 0.05 . The sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of endometrial polyp diagnosis were 86.89%, 88.12%, 83.54%, 90.11%, and 0.74, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and JordAn index in diagnosing endometrial hyperplasia and canceration were 96.71%, 98.40%, 96.54%, 98.24%, and 0.96, respectively. In summary, the body mass index, dysmenorrhea, endometrial thickness, diabetes, hypertension, and polycystic ovary syndrome were related factors, and the combination of vaginal ultrasound and bleeding pattern had a stronger predictive power for abnormal uterine bleeding.
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La Rosa, Stefano, Matteo Bonzini, Amedeo Sciarra, Sofia Asioli, Roberta Maragliano, Martina Arrigo, Maria Pia Foschini, et al. "Exploring the Prognostic Role of Ki67 Proliferative Index in Merkel Cell Carcinoma of the Skin: Clinico-Pathologic Analysis of 84 Cases and Review of the Literature." Endocrine Pathology 31, no. 4 (July 22, 2020): 392–400. http://dx.doi.org/10.1007/s12022-020-09640-3.
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AbstractThe exact prediction of outcome of patients with Merkel cell carcinoma (MCC) of the skin is difficult to determine, although several attempts have been made to identify clinico-pathologic prognostic factors. The Ki67 proliferative index is a well-known marker routinely used to define the prognosis of patients with neuroendocrine neoplasms. However, its prognostic value has been poorly investigated in MCC, and available published results are often contradictory mainly because restricted to small series in the absence of standardized methods for Ki67 evaluation. For this reason, we explored the potential prognostic role of Ki67 proliferative index in a large series of MCCs using the WHO standardized method of counting positive cells in at least 500 tumor cells in hot spot areas on camera-captured printed images. In addition, since MCC may be considered as the cutaneous counterpart of digestive neuroendocrine carcinomas (NECs), we decided to stratify MCCs using the available and efficient Ki67 threshold of 55%, which was found prognostic in digestive NECs. This choice was also supported by the Youden index analysis. In addition, we analyzed the prognostic value of other clinico-pathologic parameters using both univariate and multivariate analysis. Ki67 index appeared significantly associated with prognosis at univariate analysis together with stage IV, lack of MCPyV, and p63 expression, but not at the multivariate analysis, where survival resulted independently influenced by p63 expression and tumor stage, only.
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Lindahl, Jonas, and Rickard Danell. "The information value of early career productivity in mathematics: a ROC analysis of prediction errors in bibliometricly informed decision making." Scientometrics 109, no. 3 (August 8, 2016): 2241–62. http://dx.doi.org/10.1007/s11192-016-2097-9.
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AbstractThe aim of this study was to provide a framework to evaluate bibliometric indicators as decision support tools from a decision making perspective and to examine the information value of early career publication rate as a predictor of future productivity. We used ROC analysis to evaluate a bibliometric indicator as a tool for binary decision making. The dataset consisted of 451 early career researchers in the mathematical sub-field of number theory. We investigated the effect of three different definitions of top performance groups—top 10, top 25, and top 50 %; the consequences of using different thresholds in the prediction models; and the added prediction value of information on early career research collaboration and publications in prestige journals. We conclude that early career performance productivity has an information value in all tested decision scenarios, but future performance is more predictable if the definition of a high performance group is more exclusive. Estimated optimal decision thresholds using the Youden index indicated that the top 10 % decision scenario should use 7 articles, the top 25 % scenario should use 7 articles, and the top 50 % should use 5 articles to minimize prediction errors. A comparative analysis between the decision thresholds provided by the Youden index which take consequences into consideration and a method commonly used in evaluative bibliometrics which do not take consequences into consideration when determining decision thresholds, indicated that differences are trivial for the top 25 and the 50 % groups. However, a statistically significant difference between the methods was found for the top 10 % group. Information on early career collaboration and publication strategies did not add any prediction value to the bibliometric indicator publication rate in any of the models. The key contributions of this research is the focus on consequences in terms of prediction errors and the notion of transforming uncertainty into risk when we are choosing decision thresholds in bibliometricly informed decision making. The significance of our results are discussed from the point of view of a science policy and management.
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Larner, Andrew J. "Defining ‘optimal’ test cut-off using global test metrics: evidence from a cognitive screening instrument." Neurodegenerative Disease Management 10, no. 4 (August 2020): 223–30. http://dx.doi.org/10.2217/nmt-2020-0003.
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Aim: To examine the variation of several global metrics of test accuracy with test cut-off for the diagnosis of dementia. These metrics included some based on the receiver operating characteristic curve, such as Youden index, and some independent of receiver operating characteristic curve, such as correct classification accuracy. Materials & methods: Data from a test accuracy study of Mini-Addenbrooke’s Cognitive Examination were used to calculate and plot each global measure against test cut-off. Results: Different ‘optimal’ cut-points were identified for the different global measures, with a spread of ten points in observed optimal cut-off in the 30-point Mini-Addenbrooke’s Cognitive Examination scale. Using these optima gave a large variation in test sensitivity from very high (diagnostic odds ratio) to very low (likelihood to be diagnosed or misdiagnosed), but all had high negative predictive value. Conclusion: The method used to determine the cut-off of cognitive screening instruments may have significant implications for test performance.
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Arsang-Jang, Shahram, Roya Kelishadi, Mohammad Esmail Motlagh, Ramin Heshmat, and Marjan Mansourian. "Temporal Trend of Non-Invasive Method Capacity for Early Detection of Metabolic Syndrome in Children and Adolescents: A Bayesian Multilevel Analysis of Pseudo-Panel Data." Annals of Nutrition and Metabolism 75, no. 1 (2019): 55–65. http://dx.doi.org/10.1159/000500274.
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Background: The aim of this study was to examine the ability of Noninvasive methods to early predictions of metabolic syndrome (MetS) among children and adolescents from 2003 to 2016. Methods: This was a repeated cross-sectional study based on 24,409 Iranian children and adolescents. The variables included anthropometric measures, serum lipid profiles, hypertension, and MetS. The receiver operating characteristic regression and Bayesian multilevel modeling conducted on data to comparison the power of anthropometric measures to early prediction of cardiometabolic risk factors. Results: The tri-ponderal body shape index (TBSI) in females and waist circumference (WC) percentile in males yielded a greater ability to predict lipid profiles and hypertension than the rest of anthropometric factors. The TBSI (β = 6.24, 95% credible interval [95% Crl] 3.9–8.7) followed by the WC percentile (β = 4.43, 95% Crl 3.5–5.4) were considered the better predictors of MetS compared with the body mass index (BMI), tri-ponderal mass index (TMI), WC, waist-to-height ratio, and WC to height5 in adolescents. The TBSI with Youden index J (JI) = 0.85 was significantly more accurate than the BMI (JI = 0.73), and TMI (JI = 0.7) for classifying individuals with MetS and in healthy groups. The predictability of early MetS was consistent for both TBSI and WC components throughout the study period. Conclusions: The TBSI including, both BMI and WC components, predicts MetS and cardiometabolic risk factors more accurately than BMI or WC alone in females. The TBSI ability was higher than other anthropometric factors for screening MetS and cardiometabolic risk factors among adolescents.
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Romero-Saldaña, Manuel, Pedro Tauler, Manuel Vaquero-Abellán, Angel-Arturo López-González, Francisco-José Fuentes-Jiménez, Antoni Aguiló, Carlos Álvarez-Fernández, Guillermo Molina-Recio, and Miquel Bennasar-Veny. "Validation of a non-invasive method for the early detection of metabolic syndrome: a diagnostic accuracy test in a working population." BMJ Open 8, no. 10 (October 2018): e020476. http://dx.doi.org/10.1136/bmjopen-2017-020476.
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ObjectivesA non-invasive method for the early detection of metabolic syndrome (NIM-MetS) using only waist-to-height ratio (WHtR) and blood pressure (BP) has recently been published, with fixed cut-off values for gender and age. The aim of this study was to validate this method in a large sample of Spanish workers.DesignA diagnostic test accuracy to assess the validity of the method was performed.SettingOccupational health services.ParticipantsThe studies were conducted in 2012–2016 on a sample of 60 799 workers from the Balearic Islands (Spain).InterventionsThe NCEP-ATP III criteria were used as the gold standard. NIM-MetS has been devised using classification trees (the χ2automatic interaction detection method).Main outcome measuresAnthropometric and biochemical variables to diagnose MetS. Sensitivity, specificity, validity index and Youden Index were determined to analyse the accuracy of the diagnostic test (NIM-MetS).ResultsWith regard to the validation of the method, sensitivity was 54.7%, specificity 94.9% and the Validity Index 91.2%. The cut-off value for WHtR was 0.54, ranging from 0.51 (lower age group) to 0.56 (higher age group). Variables more closely associated with MetS were WHtR (area under the curve (AUC)=0.85; 95% CI 0.84 to 0.86) and systolic BP (AUC=0.79; 95% CI 0.78 to 0.80)). The final cut-off values for the non-invasive method were WHtR ≥0.56 and BP ≥128/80 mm Hg, which includes four levels of MetS risk (very low, low, moderate and high).ConclusionsThe analysed method has shown a high validity index (higher than 91%) for the early detection of MetS. It is a non-invasive method that is easy to apply and interpret in any healthcare setting. This method provides a scale of MetS risk which allows more accurate detection and more effective intervention.
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Kim, Minah, Yeonju Lee, Jun Sik Yoon, Minjong Lee, So Shin Kye, Sun Woong Kim, and Yuri Cho. "The FIB-4 Index Is a Useful Predictor for the Development of Hepatocellular Carcinoma in Patients with Coexisting Nonalcoholic Fatty Liver Disease and Chronic Hepatitis B." Cancers 13, no. 10 (May 11, 2021): 2301. http://dx.doi.org/10.3390/cancers13102301.
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Background: The FIB-4 index, a noninvasive tool (FIB-4 index = age × aspartate transaminase (AST)/(platelet count × √alanine aminotransferase (ALT)), is a useful assessment for liver fibrosis. Patients with a high FIB-4 index were reported to have a high risk of developing hepatocellular carcinoma (HCC). This study analyzed the clinical association of the FIB-4 index with HCC development in patients with coexisting nonalcoholic fatty liver disease and chronic hepatitis B (NAFLD–CHB). Methods: This retrospective study analyzed 237 consecutive patients with NAFLD–CHB between January 2006 and December 2010 at the National Police Hospital in Korea. Patients with HCC at baseline and those diagnosed with HCC within 6 months from baseline were excluded. Propensity score matching analysis (PSM) was adopted to balance the baseline characteristics between patients with low and high FIB-4 index values. The cumulative rates of HCC development were compared between the two groups using the Kaplan–Meier method in the matched population. Results: The median follow-up duration was 13 years (interquartile range, 8.2–15.7). The optimal cutoff for the FIB-4 index of 1.77 was calculated based on the maximum Youden index value, with an AUC of 0.70. Among a total of 237 patients with NAFLD–CHB, HCC developed in 20 patients (8.4%) (14 of the 90 patients with a high FIB-4 index vs. 6 of the 147 patients (4.1%) with a low FIB-4 index; log-rank p = 0.003). Patients with a high FIB-4 index had a significantly and independently higher risk of HCC than those with a low FIB-4 index (adjusted hazard ratio, 4.35; 95%; confidence interval, 1.42–13.24; log-rank test, p = 0.006). Conclusion: A high FIB-4 index (≥1.77) might be a useful marker for predicting the development of HCC in patients with NAFLD–CHB.
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Lv, Zhongquan, Mingxin Zhang, Hui Zhang, and Xinxin Lu. "Utility of Real-Time Quantitative Polymerase Chain Reaction in DetectingMycobacterium tuberculosis." BioMed Research International 2017 (2017): 1–5. http://dx.doi.org/10.1155/2017/1058579.
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This study aimed to assess the value of real-time quantitative polymerase chain reaction (RT-qPCR) for the detection ofMycobacterium tuberculosis(MTB). Samples from 192 patients with suspected MTB were examined by RT-qPCR and an improved Löwenstein–Jensen (L-J) culture method. To evaluate the diagnostic usefulness of RT-qPCR in detecting MTB, a receiver operating characteristic (ROC) curve for RT-qPCR was generated, and the area under the curve (AUC) as well as a cutoff value was calculated. Using the L-J culture method as the gold standard, accuracy of the RT-qPCR method for detecting MTB was 92.7%, with sensitivity and specificity of 62.5% and 97.02%, respectively. In comparison with the improved L-J culture method, the AUC of RT-qPCR ROC curve was 0.957, which was statistically significant (p<0.001). The Youden Index reached the maximum value (0.88) for gene copy number of 794.5 IU/mL, which was used as the cutoff value. RT-qPCR detection of MTB yielded results consistent with those of the improved L-J culture method, with high accuracy. RT-qPCR may be used as an auxiliary method for etiological diagnosis of tuberculosis.
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Yu, Yao, Jingjiao Ma, Jie Chen, Ning He, Xiaohong Xu, Lingyu Wang, and Rongbo Lin. "T-cell inflamed gene expression to predict prognosis and response to immune checkpoint inhibitors." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e15264-e15264. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e15264.
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e15264 Background: To prove that T-cell-inflamed gene-expression profile (GEP) can predict prognosis and response to immune checkpoint inhibitors (ICIs) in the real-world study. Methods: 36 patients admitted from January 2018 to December 2018 were enrolled, including 15 patients with advanced NSCLC, 12 with advanced bladder cancer and 9 with advanced liver cancer. All patients were treated with nivolumab or pembrolizumab and provided informed written consent for analysis. Tumor total RNA was isolated from pretreatment FFPE samples and RNA-seq was performed on the Illumina NovaSeq 6000 system. GEP was calculated as a weighted sum of normalized expression values for 18 genes, as described in the article written by Ayer M, et al. in 2017. The data cutoff date was July 30, 2019. Primary end points were objective response rate (ORR) and disease control rate (DCR). Secondary end point was progression-free survival (PFS) assessed per RECIST v1.1. 95% CIs and P values for ORR and DCR were evaluated by the binomial exact method. Correlation between GEP and ORR, DCR and PFS was assessed by Wilcoxon rank sum test and Cox regression model, respectively. Survival curves were estimated by Kaplan-Meier methods. Cut-off value of GEP was confirmed by the Youden Index. The comparisons of DCR and PFS were performed by Fisher’s exact test and log-rank test, respectively. Results: ORR was 30.6% (95% CI, 16.3%-48.1%) and DCR was 50.0% (95% CI, 32.9%-67.1%). Median PFS was 3.9 months (95% CI, 0.8-NR). We found that GEP was higher in patients who achieved DCR and had longer PFS. And then GEP was significantly associated with DCR (p = 0.019) and PFS (p = 0.005), but not significantly with ORR (p = 0.42). Based on Youden Index, cut-off value of GEP was confirmed as -0.368, with 94.4% of sensitivity and 66.7% of specificity. According to cut-off value, 23 patients were evaluated as GEP-H. GEP-H group had higher DCR and longer PFS (DCR: 73.9% vs 7.69%, p = 0.0003; mPFS: 7.0m vs 2.1m, p = 0.00049). Conclusions: GEP can predict prognosis and response to ICIs in multiple cancers in our real-world study. Interpretation of these data may be limited by small sample sizes. Further studies are being conducted.
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Ali, Ahmad Hassan, Alhareth Al Juboori, Gregory F. Petroski, Alberto A. Diaz-Arias, Majid M. Syed-Abdul, Andrew A. Wheeler, Rama R. Ganga, et al. "The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study." Journal of Clinical Medicine 11, no. 5 (February 23, 2022): 1201. http://dx.doi.org/10.3390/jcm11051201.
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Patients with morbid obesity are at high risk for nonalcoholic fatty liver disease (NAFLD) complicated by liver fibrosis. The clinical utility of transient elastography (TE) by Fibroscan in patients with morbid obesity (body mass index (BMI) ≥ 40 kg/m2) is not well-defined. We examined the diagnostic accuracy of Fibroscan in predicting significant liver fibrosis (fibrosis stage ≥2) in morbidly obese patients (BMI ≥ 40 kg/m2). Patients scheduled for bariatric surgery were prospectively enrolled. Intraoperative liver biopsy, liver-stiffness measurement (LSM) by Fibroscan (XL probe), and biochemical evaluation were all performed on the same day. The endpoint was significant liver fibrosis defined as fibrosis stage ≥2 based on the Nonalcoholic Steatohepatitis Clinical Research Network. The optimal LSM cutoff value for detecting significant fibrosis was determined by using the Youden Index method. Routine clinical, laboratory, and elastography data were analyzed by stepwise logistic regression analysis to identify predictors of significant liver fibrosis and build a predictive model. An optimal cutoff point of the new model’s regression formula for predicting significant fibrosis was determined by using the Youden index method. One hundred sixty-seven patients (mean age, 46.4 years) were included, of whom 83.2% were female. Histological assessment revealed the prevalence of steatohepatitis and significant fibrosis of 40.7% and 11.4%, respectively. The median LSM was found to be significantly higher in the significant fibrosis group compared to those in the no or non-significant fibrosis group (18.2 vs. 7.7 kPa, respectively; p = 0.0004). The optimal LSM cutoff for predicting significant fibrosis was 12.8 kPa, with an accuracy of 71.3%, sensitivity of 73.7%, specificity of 70.9%, positive predictive value of 24.6%, negative predictive value of 95.5%, and ROC area of 0.723 (95% CI: 0.62–0.83). Logistic regression analysis identified three independent predictors of significant fibrosis: LSM, hemoglobin A1c, and alkaline phosphatase. A risk score was developed by using these three variables. At an optimal cutoff value of the regression formula, the risk score had an accuracy of 79.6% for predicting significant fibrosis, sensitivity of 89.5%, specificity of 78.4%, positive predictive value of 34.7%, negative predictive value of 98.3%, and ROC area of 0.855 (95% CI: 0.76–0.95). Fibroscan utility in predicting significant liver fibrosis in morbidly obese subjects is limited with accuracy of 71.3%. A model incorporating hemoglobin A1c and alkaline phosphatase with LSM improves accuracy in detecting significant fibrosis in this patient population.
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Allan, Kari, Jessica Crow, Jessica Chasler, Janhavi Athale, John Lindsley, Michael B. Streiff, and Kathryn Dane. "Predictors of Heparin-Induced Thrombocytopenia in Adult Cardiac Surgery Patients." Blood 134, Supplement_1 (November 13, 2019): 4705. http://dx.doi.org/10.1182/blood-2019-129587.
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Background: The 4Ts, HIT-Expert Probability (HEP), and Post-Cardiopulmonary Bypass (CPB) screening tools for heparin-induced thrombocytopenia (HIT) have not been validated in cardiac surgery patients. Evidence remains unclear regarding which screening tool most accurately predicts HIT in this population. Methods: HIT-positive and HIT-negative patients who underwent on-pump cardiac surgery within a six-year period were matched 1:2 in a case-control design. Each patient was scored with the 4Ts, HEP, and CPB tools. Sensitivities and specificities of each tool were calculated using standard cut-offs. The Youden method was utilized to determine optimal cut-offs in receiver operating characteristic (ROC) curves of each score, then sensitivities and specificities were recalculated. A multivariable logistic regression was performed to determine the association of scoring tool components and relevant clinical characteristics with HIT. Results: Using standard cut-offs for the scoring tools, sensitivities for the CPB, HEP, and 4Ts tools were 100%, 93.9%, and 69.4%, respectively. Specificities were 51%, 49%, and 71.4%, respectively. Using the Youden method-derived optimal cut-offs, sensitivity of the CPB score remained 100% with improved specificity to 88.9%. Sensitivity of the 4Ts score declined to 51% and specificity improved to 93.9%. Pattern of platelet decline, absence of clinically significant bleed, body mass index, coronary artery bypass graft surgery, and postoperative heparin duration were significantly associated with HIT. Conclusions: The 4Ts score has limited utility in cardiac surgery patients, whereas the CPB and HEP scores with standard cut-offs demonstrated high sensitivity but low specificity. A cut-off of 3 points or higher on the CPB score could increase specificity while preserving high sensitivity. Disclosures Crow: Research Point Global: Other: Clinical and coding data review services. Streiff:Pfizer: Consultancy, Honoraria; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Daiichi-Sankyo: Consultancy, Honoraria; Roche: Research Funding; Portola: Consultancy, Honoraria; Bayer: Consultancy, Honoraria.
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Tao, Hongmei, Xuedong Du, Xing Tang, Yue Lin, Da Lou, and Chris Chang Yu. "Investigations of breast cancer screening using a novel in vitro diagnostics technology." Journal of Clinical Oncology 33, no. 28_suppl (October 1, 2015): 13. http://dx.doi.org/10.1200/jco.2015.33.28_suppl.13.
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13 Background: A newly developed in-vitro diagnostic technology named Cancer Differentiation Analysis Technology (CDA) was investigated for breast cancer screening. The CDA technology is a blood-sample based, multi-level, multi-parameter diagnostic method which detects signals from both proteins and cells, in which multiple aspects and parameters of information were collected to improve diagnostic accuracy. Methods: Blood samples from breast cancer group (n = 222), and control subjects (n = 204) were collected in EDTA tubes. CDA values were measured using a CDA medical device. The results were shown in Table 1 and Figure 1 below. Results: The average CDA values of breast cancer and control groups were 50.43 and 34.03 (rel. units) respectively. The results indicated that breast cancer could be significantly distinguished from the control (p < 0.001). Area under ROC curve was 0.914. When Youden Index reached the maximum, sensitivity and specificity was 82.0% and 89.2% respectively. Conclusions: Initial results showed that CDA technology could be a potential candidate for breast cancer screening. [Table: see text]
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Chiappini, F., L. Fuso, and R. Pistelli. "Accuracy of a pulse oximeter in the measurement of the oxyhaemoglobin saturation." European Respiratory Journal 11, no. 3 (March 1, 1998): 716–19. http://dx.doi.org/10.1183/09031936.98.11030716.
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The aim of the present study was to evaluate the accuracy, in comparison with a reference method, of the Nellcor N-20P pulse oximeter in the assessment of oxyhaemoglobin saturation (Sa,O2). Sa,O2 was monitored at rest by the Nellcor N-20P pulse oximeter in 100 subjects (82 males, mean age 68+/-12 yrs) consecutively enroled. At the same time, an arterial blood sample was collected for the measurement of Sa,O2, carboxyhaemoglobin, and methaemoglobin by an IL-282 Co-oximeter. A significant difference was found between Sa,O2 values measured with the two methods (t=11.78, p<0.05), but the two series of measurements were significantly correlated (r=0.97). Both the level and the limits of agreement between the two methods were satisfactory when the more appropriate Bland and Altman method was applied. Nevertheless, a lack of accuracy of the pulse oximeter was found, but only for Sa,O2 values <82% and >94%, as demonstrated by the Youden index. In conclusion, these data show that Nellcor N-20P is sufficiently reliable for the assessment and monitoring of oxyhaemoglobin saturation. The lack of accuracy does not seem clinically relevant since it is appreciable only for values at the extremes of the oxyhaemoglobin saturation range.
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Valencia-Vera, Estefania, Ana Martinez-Escribano Garcia-Ripoll, Alfredo Enguix, Carmen Abalos-Garcia, and Maria Jesus Segovia-Cuevas. "Application of κ free light chains in cerebrospinal fluid as a biomarker in multiple sclerosis diagnosis: development of a diagnosis algorithm." Clinical Chemistry and Laboratory Medicine (CCLM) 56, no. 4 (March 28, 2018): 609–13. http://dx.doi.org/10.1515/cclm-2017-0285.
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Abstract Background: The determination of κ free light chains (KFLC) in cerebrospinal fluid (CSF) by nephelometry is a feasible alternative to immunoglobulin G oligoclonal bands (OCB) in the evaluation of intrathecal synthesis of immunoglobulin in multiple sclerosis (MS) and other demyelinating diseases. The aim of this study was to assess the diagnostic value of KFLC and its inclusion in a procedure algorithm along with OCB interpretation. Methods: A cross-sectional study, which included 123 patients with a CSF OCB request, was carried out. Isoelectric focusing followed by immunofixation was used to detect OCB, and nephelometry was used to analyze KFLC. The KFLC index was calculated using CSF/serum quotient of KFLC and albumin. The KFLC index was compared with MS diagnosis to find the optimal cutoff. It was obtained from the receiver operating characteristic (ROC) curves and the Youden method. Results: The CSF KFLC median was 1.66 mg/L in the MS group, whereas in other central nervous system diseases, KFLC showed generally no or only moderate increase in CSF (median 0.10 mg/L). KFLC index showed a significant difference between groups. ROC analysis for CSF KFLC concentration, and KFLC indexes were 91.88% and 93.94%, respectively. The best cutoff for the KFLC index was 2.91 for MS diagnosis (sensitivity: 83.78%; specificity: 85.88%). The proposed algorithm showed high sensitivity (89.19%) and specificity (84.71%). Conclusions: KFLC determination is rapid and automatized, but it has no higher sensitivity and specificity than OCB in MS diagnosis. Nevertheless, when used in screening, it could reduce the number of manual OCB tests.
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Akram, Jubran, Daniel Peter, and David Eaton. "A k-mean characteristic function for optimizing short- and long-term-average-ratio-based detection of microseismic events." GEOPHYSICS 84, no. 4 (July 1, 2019): KS143—KS153. http://dx.doi.org/10.1190/geo2018-0484.1.
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Event detection is an essential component of microseismic data analysis. This process is typically carried out using a short- and long-term-average-ratio (STA/LTA) method, which is simple and computationally efficient but often yields inconsistent results for noisy data sets. We have aimed to optimize the performance of the STA/LTA method by testing different input forms of 3C waveform data and different characteristic functions (CFs), including a proposed [Formula: see text]-mean CF. These tests are evaluated using receiver operating characteristic (ROC) analysis and are compared based on synthetic and field data examples. Our analysis indicates that the STA/LTA method using a [Formula: see text]-mean CF improves the detection sensitivity and yields more robust event detection on noisy data sets than some previous approaches. In addition, microseismic events are detected efficiently on field data examples using the same detection threshold obtained from the ROC analysis on synthetic data examples. We recommend the use of the Youden index based on ROC analysis using a training subset, extracted from the continuous data, to further improve the detection threshold for field microseismic data.
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Armanyous, Sherif, Yasushi Ohashi, Michael Lioudis, Jesse D. Schold, George Thomas, Emilio D. Poggio, and Joshua J. Augustine. "Diagnostic Performance of Blood Pressure Measurement Modalities in Living Kidney Donor Candidates." Clinical Journal of the American Society of Nephrology 14, no. 5 (April 4, 2019): 738–46. http://dx.doi.org/10.2215/cjn.02780218.
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Background and objectivesPrecise BP measurement to exclude hypertension is critical in evaluating potential living kidney donors. Ambulatory BP monitoring is considered the gold standard method for diagnosing hypertension, but it is cumbersome to perform. We sought to determine whether lower BP cutoffs using office and automated BP would reduce the rate of missed hypertension in potential living donors.Design, setting, participants, & measurementsWe measured BP in 578 prospective donors using three modalities: (1) single office BP, (2) office automated BP (average of five consecutive automated readings separated by 1 minute), and (3) ambulatory BP. Daytime ambulatory BP was considered the gold standard for diagnosing hypertension. We assessed both the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) and the American College of Cardiology/American Heart Association (ACC/AHA) definitions of hypertension in the cohort. Empirical thresholds of office BP and automated BP for the detection of ambulatory BP–diagnosed hypertension were derived using Youden index, which maximizes the sum of sensitivity and specificity and gives equal weight to false positive and false negative values.ResultsHypertension was diagnosed in 90 (16%) prospective donors by JNC-7 criteria and 198 (34%) prospective donors by ACC/AHA criteria. Masked hypertension was found in 3% of the total cohort by JNC-7 using the combination of office or automated BP, and it was seen in 24% by ACC/AHA guidelines. Using Youden index, cutoffs were derived for both office and automated BP using JNC-7 (<123/82 and <120/78 mm Hg) and ACC/AHA (<119/79 and <116/76 mm Hg) definitions. Using these lower cutoffs, the sensitivity for detecting hypertension improved from 79% to 87% for JNC-7 and from 32% to 87% by ACC/AHA definition, with negative predictive values of 95% and 87%, respectively. Missed (masked) hypertension was reduced to 2% and 4% of the entire cohort by JNC-7and ACC/AHA, respectively.ConclusionsThe prevalence of hypertension was higher in living donor candidates using ACC/AHA compared JNC-7 definitions. Lower BP cutoffs in the clinic improved sensitivity and led to a low overall prevalence of missed hypertension in prospective living kidney donors.
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El Sayed, Mohamed, and Kamis Gaballah. "Postanesthetic Cold Sensibility Test as an Indicator for the Efficacy of Inferior Alveolar Nerve Block in Patients with Symptomatic Irreversible Pulpitis of Mandibular Molars." International Journal of Dentistry 2021 (June 21, 2021): 1–11. http://dx.doi.org/10.1155/2021/9913221.
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Aim of the Work. The goal of the current study was to investigate the capability of the cold test to predict the profound pulpal anesthesia before starting the endodontic treatment of mandibular first molars with symptomatic irreversible pulpitis (SIP). Materials and Methods. This study was conducted on the mandibular first molars of 54 patients (35 males and 19 females) with signs and symptoms of SIP. To anesthetize the affected molars, all patients received a single carpule of 2% lidocaine with 1 : 100000 epinephrine using a standardized inferior alveolar nerve block (IANB) technique. The cold test was conducted before beginning the endodontic procedures and after gaining lip numbness, and the results were reported as either positive or negative response. The root canal preparation (RCP) was then initiated and the patients’ responses were documented (Gold standard test). True pulpal anesthetic failure was described as a pain perception during the access cavity and pulp tissue removal. True pulpal anesthesia was defined as no pain or discomfort during the access cavity and pulp extirpation. The qualitative variables frequencies and percentages of patients with true/false positive and negative responses were determined and then compared using the Chi-square test. The pain perception of male and female patients during the cold test and gold standard was compared using the Fisher exact test. The following diagnostic parameters were calculated using an online statistical calculator: sensitivity, specificity, predictive values, accuracy, and Youden index. In addition, a receiver operating characteristic curve (ROC) was constructed and the area under the curve (AUC) was calculated. Results. The overall percentage of actual failure of pupal anesthesia was 57%. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and Youden index for the cold test were 0.87, 0.91, 0.93, 0.84, 0.89, and 0.78, respectively. There was no statistically significant difference between male and female patients regarding their responses to cold testing and the gold standard test ( P > 0.05 ). Besides, the patients’ reactions to the cold test were significantly matched with their reactions to the gold standard test ( P < 0.05 ). The area under the ROC was mostly 0.9. Conclusion. The cold test could be a valuable and accurate method for predicting the potential pupal anesthesia before beginning the endodontic treatment of mandibular molars with symptomatic irreversible pulpitis, particularly after obtaining postanesthetic soft tissue numbness.
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Ting, Shuo-Yen, Tsuo-Hung Lan, Lih-Jong Shen, Chun-Yuan Lin, Shih-Kai Lee, and Wei-Fen Ma. "The Chinese Mandarin Version of the Crisis Triage Rating Scale for Taiwanese with Mental Illness to Compulsory Hospitalization." International Journal of Environmental Research and Public Health 18, no. 24 (December 20, 2021): 13392. http://dx.doi.org/10.3390/ijerph182413392.
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Background: A controversial issue of the need to protect human rights and ensure public safety still remains a conflict in Taiwan. The purpose of this study was to translate the Crisis Triage Rating Scale to Chinese Mandarin (CMCTRS). Method: A cross-sectional design with convenient sampling was employed in this study. The CMCTRS was tested on 302 Taiwanese individuals with mental illness who were admitted to the emergency room (ER) of a psychiatric center. A higher score indicated a greater need for mandatory psychiatric admission. Psychiatrists rated the patients’ status according to three scale criteria and six action plans of recommendations. Results: Five specialists evaluated the content validity index to be 0.8. A total of 210 participants (69.5%) were deemed suitable for compulsory hospitalization or admission for observation in ER. The optimal cut-off score was 8, with a Youden Index of 1.46, a sensitivity of 0.748, and a specificity of 0.712 in deciding the need for hospitalization or observation. Conclusions: The CMCTRS exhibited an acceptable criterion validity with psychiatrists in a population of 302 patients at the ER of a psychiatric center. A cut-off point of 8 is recommended for determining hospitalization or a minimum 24 h stay at emergency for observation.
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Sireci, Anthony, Robert Schlaberg, and Alexander Kratz. "A Method for Optimizing and Validating Institution-Specific Flagging Criteria for Automated Cell Counters." Archives of Pathology & Laboratory Medicine 134, no. 10 (October 1, 2010): 1528–33. http://dx.doi.org/10.5858/2009-0531-oa.1.
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Abstract Context.—Automated cell counters use alerts (flags) to indicate which differential white blood cell counts can be released directly from the instrument and which samples require labor-intensive slide reviews. The thresholds at which many of these flags are triggered can be adjusted by individual laboratories. Many users, however, use factory-default settings or adjust the thresholds through a process of trial and error. Objective.—To develop a systematic method, combining statistical analysis and clinical judgment, to optimize the flagging thresholds on automated cell counters. Design.—Data from 502 samples flagged by Sysmex XE-2100/5000 (Sysmex, Kobe, Japan) instruments, with at least 1 of 5 user-adjustable, white blood cell count flags, were used to change the flagging thresholds for maximal diagnostic effectiveness by optimizing the Youden index for each flag (the optimization set). The optimized thresholds were then validated with a second set of 378 samples (the validation set). Results.—Use of the new thresholds reduced the review rate caused by the 5 flags from 6.5% to 2.9% and improved the positive predictive value of the flagging system for any abnormality from 27% to 37%. Conclusions.—This method can be used to optimize thresholds for flag alerts on automated cell counters of any type and to improve the overall positive predictive value of the flagging system at the expense of a reduction in the negative predictive value. A reduced manual review rate helps to focus resources on differential white blood cell counts that are of clinical significance and may improve turnaround time.
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Abarca, Mario, Pablo Besa, Joaquin Palma, Eduardo Mora, Pablo Mery, Andres Villa, and Jorge Filippi. "A New Intraoperative Measurement that Predicts Ankle Syndesmotic Joint Malreduction." Foot & Ankle Orthopaedics 4, no. 4 (October 1, 2019): 2473011419S0007. http://dx.doi.org/10.1177/2473011419s00079.
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Category: Ankle, Trauma Introduction/Purpose: Distal tibio-fibular syndesmotic reduction (SR) is an independent predictor of good functional outcome following ankle surgery. Classic intraoperative fluoroscopic parameters have shown to be poor predictors of distal SR. Syndesmotic malreduction (S-MR) has been reported up to 52% of surgically treated patients. Grenier et al proposed the Anteroposterior Tibio Fibular Ratio (APTF) to evaluate normal sagittal syndesmotic anatomy, showing good interobserver agreement and high correlation between both sides in normal ankles. We propose the use of the comparative APTF index (cAPTF), calculated as the absolute difference of APTF index between the normal and surgically treated ankle, to guide intraoperative sagittal SR. The aim of this study was to determine the capability of the intraoperative cAPTF to predict S-MR. Methods: Prospective observational study. Patients who required syndesmotic fixation for an unstable ankle fracture and who had a contralateral healthy ankle were prospectively enrolled. Intraoperative APTF was measured under fluoroscopy in both ankles according to Grenier et al and the cAPTF was calculated. No surgeons were informed of APTF measurements during the procedure. Bilateral postoperative CT was obtained, and quality of SR was evaluated using the method described by Dikos et al. To estimate the discriminatory power of the cAPTF, a receiver operative characteristic (ROC) curve was obtained and the area under the curve was calculated. Youden index was used to determine the ideal cAPTF cut-off value for S-MR and its sensitivity, specificity, positive likelihood ratio (LR+) and negative probability (LR-) were calculated. Results: Forty-seven patients were enrolled. Sixteen (34%) had S-MR on the postoperative CT. The cAPTF varied between 0.005 and 0.435. The cAPTF cut-off value to predict S-MR was 0.161. A cAPTF value greater than 0.161 had Sensitivity 100%; specificity 94%; LR+ 15.50; and LR- 0.06, for predicting malreduction of the syndesmosis. The area under the ROC curve was 0.99. Conclusion: Intraoperative cAPTF index demonstrated excellent discriminatory power for predicting syndesmotic malreduction. We propose the routine use of this new method to improve the results of syndesmotic reduction.
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Gao, Jie, Zhongwei Yu, Fukang Sun, Bilin Xu, Cuiping Zhang, Hongping Wang, Jun Lu, and Tao Lei. "The Relationship Between Baseline Cortisol Levels and Surgery Method of Primary Bilateral Macronodular Adrenal Hyperplasia." Hormone and Metabolic Research 54, no. 06 (June 2022): 354–60. http://dx.doi.org/10.1055/a-1850-2169.
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AbstractAim was to explore the associations between baseline cortisol levels and surgery method of primary bilateral macronodular adrenal hyperplasia (PBMAH). We retrospectively reviewed the clinical features and management of 30 patients (18 females and 12 males) who were diagnosed with PBMAH in our center between 2005 and 2019. Based on surgery method, we divided the patients into two groups: unilateral adrenalectomy (UA) group; and bilateral adrenalectomy (BA) group. Serum cortisol rhythm and 24-hour urinary free cortisol (UFC/24 h) levels were assayed using chemiluminescence method. Associations between baseline cortisol levels and BA were assessed using logistic regression. The predictive value of baseline cortisol levels for BA was calculated using receiver operating characteristic (ROC) curves. Twenty patients (66.7%) underwent UAs and ten patients (33.3%) underwent BAs. After adjusting for age, sex, BMI, SBP, and adrenal volume, the concentrations of baseline serum cortisol (8 AM, 4 PM, and 0 AM) and UFC/24 h were associated with bilateral adrenalectomy (all p<0.05). The area under the ROC curve based on 8 AM serum cortisol level model was larger than that in models based on 4 PM, 0 AM serum cortisol levels and UFC/24 h, but the differences were non-significant (all p>0.05). According to maximum Youden index criteria, the optimal cutoffs of 8 AM serum cortisol level and UFC were 26.89 μg/dl and 406.65 μg/24 h, respectively, for BA. The baseline cortisol levels are positively associated with BA. Increased levels of baseline cortisol levels may predict higher possibility of BA, which should be confirmed by prospective studies.
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Huang, Chumei, Zhuangjian Ye, Jianxin Wan, Jianbo Liang, Min Liu, Xiangdong Xu, and Laisheng Li. "Secreted Frizzled-Related Protein 2 Is Associated with Disease Progression and Poor Prognosis in Breast Cancer." Disease Markers 2019 (March 3, 2019): 1–7. http://dx.doi.org/10.1155/2019/6149381.
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Purpose. Secreted frizzled-related protein 2 (sFRP2) is a secreted protein associated with cancer drug resistance and metastasis. However, few studies have reported serum sFRP2 levels in breast cancer. We evaluated serum sFRP2 as a potential biomarker for breast cancer. Methods. Serum sFRP2 concentrations were detected in 274 breast cancer patients along with 147 normal healthy controls by enzyme-linked immunosorbent assay (ELISA). Diagnostic significance was evaluated by area under the curve (AUC) analysis and the Youden index. Prognostic significance was determined by Kaplan-Meier survival method and univariate and multivariate Cox proportional hazard regression model analyses. Results. Serum sFRP2 was elevated in breast cancer patients compared to normal healthy controls (P<0.001). The sensitivity of sFRP2 in diagnosing breast cancer was 76.9% at a specificity of 76.6%. Elevated serum sFRP2 levels are associated with primary tumor size, TNM stage, and lymph node metastases. The Kaplan-Meier curves showed a significant association of serum sFRP2 with progression-free survival. The multivariate Cox analysis confirmed that high serum sFRP2 was an independent prognostic factor for poor prognosis (HR=3.89, 95% CI=1.95-7.68, P=0.001). Conclusions. In conclusion, serum sFRP2 may serve as a potential biomarker for breast cancer diagnosis and prognostic evaluation.
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Hoffmann, Manuela A., Jonas Müller-Hübenthal, Florian Rosar, Nicolas Fischer, Finn Edler von Eyben, Hans-Georg Buchholz, Helmut J. Wieler, and Mathias Schreckenberger. "Primary Staging of Prostate Cancer Patients with [18F]PSMA-1007 PET/CT Compared with [68Ga]Ga-PSMA-11 PET/CT." Journal of Clinical Medicine 11, no. 17 (August 29, 2022): 5064. http://dx.doi.org/10.3390/jcm11175064.
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Background: Hybrid imaging with prostate-specific membrane antigen (PSMA) is gaining importance as an increasingly meaningful tool for prostate cancer (PC) diagnostics and as a guide for therapy decisions. This study aims to investigate and compare the performance of [18F]PSMA-1007 (18F-PSMA) and [68Ga]Ga-PSMA-11 positron emission tomography/computed tomography (68Ga-PSMA) in the initial staging of PC patients. Methods: The data of 88 biopsy-proven patients were retrospectively evaluated. PSMA-avid lesions were compared with the histopathologic Gleason Score (GS) for prostate biopsies, and the results were plotted by receiver operating characteristic (ROC)-curve. Optimal maximum standardized uptake value (SUVmax) cut-off values were rated using the Youden index. Results: 18F-PSMA was able to distinguish GS ≤ 7a from ≥7b with a sensitivity of 62%, specificity of 85%, positive predictive value (PPV) of 92%, and accuracy of 67% for a SUVmax of 8.95, whereas sensitivity was 54%, specificity 91%, PPV 93%, and accuracy 66% for 68Ga-PSMA (SUVmax 8.7). Conclusions: Both methods demonstrated a high concordance of detected PSMA-avid lesions with histopathologically proven PC. 18F-PSMA and 68Ga-PSMA are both suitable for the characterization of primary PC with a comparable correlation of PSMA-avid lesions with GS. Neither method showed a superior advantage. Our calculated SUVmax thresholds may represent valuable parameters in clinical use to distinguish clinically significant PC (csPC) from non-csPC.
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Meng, Zhilan, Jie Shi, Chenyan Zhu, Jiangang Gu, and Chen Zhou. "Automated Quantification of DNA Aneuploidy by Image Cytometry as an Adjunct for the Cytologic Diagnosis of Malignant Effusion." Analytical Cellular Pathology 36, no. 3-4 (2013): 107–15. http://dx.doi.org/10.1155/2013/501284.
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DNA aneuploidy is a cancer biomarker, which may have a potential diagnostic value in body effusion specimen. DNA aneuploidy is determined by measuring the DNA content of tested cells and comparing them with diploid cells (2c). In order to assess the value of automated DNA image cytometry (DNA-ICM) in the cytologic diagnosis of effusion, we measured DNA ploidy using an automated DNA-ICM analysis system in 126 consecutive effusion specimens and followed the cases for histologic diagnosis. Half of each effusion specimen was used to prepare cytologic smears for conventional cytologic diagnosis, while the other half was used to prepare a monolayer slide stained by Feulgen stain for automated ICM. By using Youden index, we found that 4 cells exceeding 2.5c is the optimal cut off value for aneuploidy, which has a sensitivity of 88.3% and specificity of 100% for diagnosis of malignant effusion. We also found that the DNA aneuploidy thresholds used for other types of cytologic specimens cannot be used in the diagnosis of effusion specimens. Our study demonstrated that automated DNA image cytometry is a simple, practical and cost-effective method for adjunct diagnosis of malignant effusion.
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Chen, Hui, Yiming Yu, Xuechan Yu, Sha Li, Lin Zheng, Shuya Zhang, Qidong Zhuang, Zaichun Deng, and Zhongbo Chen. "An Innovative Method: Predicting the Visibility of Radial Endobronchial Ultrasound for Peripheral Pulmonary Nodules by Virtual Bronchoscopic Navigation." Technology in Cancer Research & Treatment 21 (January 2022): 153303382211417. http://dx.doi.org/10.1177/15330338221141790.
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Background: The diagnosis of peripheral pulmonary nodules (PPNs) still is the key and difficult point. Previous studies have demonstrated that the diagnostic yield of radial endobronchial ultrasound (rEBUS) visible nodules is significantly higher than that of invisible nodules. The traditional method of predicting the rEBUS-visibility of nodules is based on the CT-bronchus signs, but its effectiveness may be unsatisfactory. Objective: We innovate a valuable predictive model based on virtual bronchoscopic navigation to identify beforehand which PPNs are likely to be successfully visualized by rEBUS. The innovative predictor is the ratio of the size of lesions (S) to the shortest straight-line distance (D) from the terminal point of the virtual navigation path to the localization point of the nodule. Methods: This is a retrospective study. On the training dataset of 214 patients, a receiver operating characteristic curve was drawn to understand the utility of the predictive model and get the optimal cut-off points. Ninety-two cases were enrolled in the validation dataset to validate the external predictive accuracy of the predictor. Results: The optimal cut-off point of the curve was 1.84 with the Youden index of 0.65, at which point the area under the curve was 0.85 (95% CI: 0.76-0.95). The predictor has a good performance in the validation dataset with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 81%, 100%, 100%, 71%, and 87%, respectively. Conclusion: The S/D ratio is a valuable and innovative method to identify beforehand which PPNs are likely to be successfully visualized by rEBUS. If the S/D ratio of the nodule is greater than 1.84, it will be visualized by rEBUS.
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Shen, Junyi, Tianfu Wen, Chuan Li, Lvnan Yan, Bo Li, and Jiayin Yang. "The Prognostic Prediction Role of Preoperative Serum Albumin Level in Patients with Intahepatic Cholangiocarcinoma Following Hepatectomy." Digestive Diseases 36, no. 4 (2018): 306–13. http://dx.doi.org/10.1159/000487479.
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Background: There is little information regarding the role of preoperative serum albumin (ALB) in intrahepatic cholangiocarcinoma (ICC) patients who underwent liver resection. Methods: Clinicopathological characteristics and survival rate of 91 ICC patients who underwent surgery between 2009 and 2013 were included in this study. The optimal cut-off for ALB were determined by plotting the receiver operating characteristics curves of ALB in predicting overall survival (OS) and utilizing the Youden index. Long-term outcome was calculated by Kaplan-meire method. Results: The pathological characteristics were similar in both groups. The 1- and 3-year disease-free survival (DFS) rates between the high ALB group and the lower ALB group were 62.7 vs. 25.5% and 27.0 vs. 11.1% respectively (p < 0.001). The 1- and 3-year OS rates between the high ALB group and the lower ALB group were 78.4 vs. 57.5% and 42.6 vs. 6.7% respectively (p < 0.001). The ALB level as continuous variable in multivariate analysis remained a favorable factor for DFS and OS (p < 0.05). Furthermore, ALB could distinguish the prognoses in non-cirrhotic patients. Multivariate analysis showed other pathological risk factors like lymph node involvement, positive surgical margin, satellite lesions, and carbohydrate antigen 19-9 were associated with DFS and OS (p < 0.05 for all). Conclusions: A higher preoperative serum ALB level is associated with better long-term survival in ICC patients.
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Wang, Junling, Xia Li, Zhijie Zhang, Chao Jing, and Jie Li. "Clinical Research of Combined Application of DCEUS and Dynamic Contrast-Enhanced MSCT in Preoperative cT Staging of Gastric Cancer." Journal of Oncology 2021 (October 19, 2021): 1–7. http://dx.doi.org/10.1155/2021/9868585.
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Purpose. To investigate the clinical value of double contrast-enhanced ultrasound (DCEUS) combined with dynamic contrast-enhanced multislice CT (MSCT) in preoperative T staging of gastric cancer (GC). Methods. 206 patients with GC confirmed by preoperative gastroscopy from February 2019 to February 2021 were collected, all patients were examined by DCEUS and dynamic contrast-enhanced MSCT before operation, and the invasion depth (T staging) of GC was evaluated. The diagnosis results of DCEUS, dynamic contrast-enhanced MSCT, and combined diagnosis of DCEUS and MSCT methods (D&M method) were compared with the pathological staging results (gold standard). Results. The correct diagnosis rate of MSCT was 27.27% in T1 staging, 55.56% in T2 staging, 42.11% in T3 staging, 59.29% in T4 staging, and 55.34% in summation. The correct diagnosis rate of DCEUS was 90.91% in T1 staging, 88.89% in T2 staging, 78.95% in T3 staging, 82.86% in T4 staging, and 83.98% in summation. The correct diagnosis rate of the D&M method was 100.00% in T1 staging, 94.44% in T2 staging, 89.47% in T3 staging, 93.57% in T4 staging, and 93.69% in summation. The D&M method had higher correct diagnosis rate than MSCT or DCEUS alone, the correct diagnosis rate of the D&M method in T1, T2, T3, and T4 staging was significantly higher than that of MSCT ( P < 0.05 ). The correct diagnosis rate of the D&M method in T1, T3, and T4 was significantly higher than that of DCEUS ( P < 0.05 ). The Youden index of preoperative T1, T2, T3, and T4 staging of GC by the D&M method was 99.49%, 94.44%, 84.13%, and 90.54%, respectively, and the Kappa values of these were 0.954, 0.966, 0.707, and 0.881, respectively. Conclusions. Dynamic contrast-enhanced MSCT combined with DCEUS in the diagnosis of preoperative cT staging of GC has more validity, reliability, and revenue than the using of MSCT or DCEUS alone, which is an image evaluation method worthy of clinical promotion.
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Zhao, Lina, Chengyu Liu, Shoushui Wei, Qin Shen, Fan Zhou, and Jianqing Li. "A New Entropy-Based Atrial Fibrillation Detection Method for Scanning Wearable ECG Recordings." Entropy 20, no. 12 (November 26, 2018): 904. http://dx.doi.org/10.3390/e20120904.
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Entropy-based atrial fibrillation (AF) detectors have been applied for short-term electrocardiogram (ECG) analysis. However, existing methods suffer from several limitations. To enhance the performance of entropy-based AF detectors, we have developed a new entropy measure, named EntropyAF, which includes the following improvements: (1) use of a ranged function rather than the Chebyshev function to define vector distance, (2) use of a fuzzy function to determine vector similarity, (3) replacement of the probability estimation with density estimation for entropy calculation, (4) use of a flexible distance threshold parameter, and (5) use of adjusted entropy results for the heart rate effect. EntropyAF was trained using the MIT-BIH Atrial Fibrillation (AF) database, and tested on the clinical wearable long-term AF recordings. Three previous entropy-based AF detectors were used for comparison: sample entropy (SampEn), fuzzy measure entropy (FuzzyMEn) and coefficient of sample entropy (COSEn). For classifying AF and non-AF rhythms in the MIT-BIH AF database, EntropyAF achieved the highest area under receiver operating characteristic curve (AUC) values of 98.15% when using a 30-beat time window, which was higher than COSEn with AUC of 91.86%. SampEn and FuzzyMEn resulted in much lower AUCs of 74.68% and 79.24% respectively. For classifying AF and non-AF rhythms in the clinical wearable AF database, EntropyAF also generated the largest values of Youden index (77.94%), sensitivity (92.77%), specificity (85.17%), accuracy (87.10%), positive predictivity (68.09%) and negative predictivity (97.18%). COSEn had the second-best accuracy of 78.63%, followed by an accuracy of 65.08% in FuzzyMEn and an accuracy of 59.91% in SampEn. The new proposed EntropyAF also generated highest classification accuracy when using a 12-beat time window. In addition, the results from time cost analysis verified the efficiency of the new EntropyAF. This study showed the better discrimination ability for identifying AF when using EntropyAF method, indicating that it would be useful for the practical clinical wearable AF scanning.
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Mitchell, Alex J. "Pooled Results From 38 Analyses of the Accuracy of Distress Thermometer and Other Ultra-Short Methods of Detecting Cancer-Related Mood Disorders." Journal of Clinical Oncology 25, no. 29 (October 10, 2007): 4670–81. http://dx.doi.org/10.1200/jco.2006.10.0438.
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Ultra-short screening tools involving fewer than five questions have been recommended as a simple method of detecting distress, anxiety, or depression in cancer settings. Such methods have practical appeal, but their diagnostic accuracy is unclear. A literature search limited to diagnostic validity studies of ultra-short screening in cancer settings identified 38 analyses, including 19 assessing the Distress Thermometer alone, involving a total of 6,414 unique patients. The pooled ability of ultra-short methods to detect depression was given by a sensitivity of 78.4%, a specificity of 66.8%, a positive predictive value (PPV) of 34.2%, and a negative predictive value (NPV) of 93.4%. Thus these tools were very good at excluding possible cases of depression but poor at confirming a suspected diagnosis. The pooled ability of ultra-short methods to detect anxiety was given by a sensitivity of 77.3% and a specificity of 56.6% (PPV, 55.2%; NPV, 80.25%) and for distress a sensitivity of 78.3% and a specificity of 66.5% (PPV, 59.7%; NPV, of 82.8%). Results using the Distress Thermometer alone were similar. Scores of integrated accuracy, using the Youden index and diagnostic odds ratio, suggested modest overall accuracy with least success in diagnosing anxiety disorders. Ultra-short methods were modestly effective in screening for mood disorders. Their rule-in ability was poorer than their rule-out ability. Ultra-short methods cannot be used alone to diagnose depression, anxiety, or distress in cancer patients but they may be considered as a first-stage screen to rule out cases of depression.
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Fan, Yunzhou, Yanyan Wu, Xiongjing Cao, Junning Zou, Ming Zhu, Di Dai, Lin Lu, Xiaoxv Yin, and Lijuan Xiong. "Automated Cluster Detection of Health Care–Associated Infection Based on the Multisource Surveillance of Process Data in the Area Network: Retrospective Study of Algorithm Development and Validation." JMIR Medical Informatics 8, no. 10 (October 23, 2020): e16901. http://dx.doi.org/10.2196/16901.
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Background The cluster detection of health care–associated infections (HAIs) is crucial for identifying HAI outbreaks in the early stages. Objective We aimed to verify whether multisource surveillance based on the process data in an area network can be effective in detecting HAI clusters. Methods We retrospectively analyzed the incidence of HAIs and 3 indicators of process data relative to infection, namely, antibiotic utilization rate in combination, inspection rate of bacterial specimens, and positive rate of bacterial specimens, from 4 independent high-risk units in a tertiary hospital in China. We utilized the Shewhart warning model to detect the peaks of the time-series data. Subsequently, we designed 5 surveillance strategies based on the process data for the HAI cluster detection: (1) antibiotic utilization rate in combination only, (2) inspection rate of bacterial specimens only, (3) positive rate of bacterial specimens only, (4) antibiotic utilization rate in combination + inspection rate of bacterial specimens + positive rate of bacterial specimens in parallel, and (5) antibiotic utilization rate in combination + inspection rate of bacterial specimens + positive rate of bacterial specimens in series. We used the receiver operating characteristic (ROC) curve and Youden index to evaluate the warning performance of these surveillance strategies for the detection of HAI clusters. Results The ROC curves of the 5 surveillance strategies were located above the standard line, and the area under the curve of the ROC was larger in the parallel strategy than in the series strategy and the single-indicator strategies. The optimal Youden indexes were 0.48 (95% CI 0.29-0.67) at a threshold of 1.5 in the antibiotic utilization rate in combination–only strategy, 0.49 (95% CI 0.45-0.53) at a threshold of 0.5 in the inspection rate of bacterial specimens–only strategy, 0.50 (95% CI 0.28-0.71) at a threshold of 1.1 in the positive rate of bacterial specimens–only strategy, 0.63 (95% CI 0.49-0.77) at a threshold of 2.6 in the parallel strategy, and 0.32 (95% CI 0.00-0.65) at a threshold of 0.0 in the series strategy. The warning performance of the parallel strategy was greater than that of the single-indicator strategies when the threshold exceeded 1.5. Conclusions The multisource surveillance of process data in the area network is an effective method for the early detection of HAI clusters. The combination of multisource data and the threshold of the warning model are 2 important factors that influence the performance of the model.
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Harbuwono, Dante Saksono, Dicky Levenus Tahapary, Tri Juli Edi Tarigan, and Em Yunir. "New proposed cut-off of waist circumference for central obesity as risk factor for diabetes mellitus: Evidence from the Indonesian Basic National Health Survey." PLOS ONE 15, no. 11 (November 18, 2020): e0242417. http://dx.doi.org/10.1371/journal.pone.0242417.
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Background Waist circumference (WC) measurement is practical to define central obesity. However, WC cut-off point might be differ based on different race or ethnicity. This study aims to analyze the optimal WC cut-off point to identify T2DM risk among Indonesian population. Method We analyzed the secondary data of national based cross-sectional study of the Indonesian Basic National Health Research 2013, comprising 24,660 adults aged ≥ 18 years who were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT). The new proposed cut-off point for WC was calculated using ROC curve analysis and Youden index. The odds ratio of having T2DM was calculated using logistic regression analysis. Results Increased WC was associated with worsening dysglycemia status among men and women (p<0.001). The optimal cut-off point of WC for detecting T2DM from ROC analysis was 76 for men and 80 for women. Based on this WC cut-off point, the odds ratio for having T2DM was 1.64 [95% CI 1.45–1.86, p<0.01] for men and 1.90 [95% CI 1.71–2.11 p<0.01] for women. Conclusion The newly proposed WC cut-off point of 76 for men and 80 women can be used to screen the risk of T2DM among Indonesian population.
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Sarraff, Thamires Da Fonseca de Souza, Claudia Maria Simões Martinez, and Jair Lício Ferreira Santos. "Specificity and sensitivity of the DCDQ for children aged 8 to 10 years in Brazil." Revista de Terapia Ocupacional da Universidade de São Paulo 29, no. 2 (December 31, 2018): 135–43. http://dx.doi.org/10.11606/issn.2238-6149.v29i2p135-143.
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Objectives: To evaluate the sensitivity and specificity of the Developmental Coordination Disorder Questionnaire (DCDQ) – Brazil for a group of children aged 8, 9 and 10 years, using the Movement Assessment Battery for Children (Mabc-2) as the gold standard, and to identify the cut-off point for each specific age. Method: We evaluated the motor skills of 100 students through DCDQ-Brazil and Mabc-2. The collected data were submitted to statistical analysis of association; cut-off points were defined through the Youden index and Roc curve (Receiver Operator Characteristic). This survey was submitted and approved by the Ethics Committee of Research on Human Beings of the Federal University of São Carlos (CEP-UFSCar). Results: The data revealed that DCDQ-Brazil does not show satisfactory validity for the analyzed Brazilian context in the sample of children aged 8 and 10, because the cut-off points are higher than what was defined in this research, in a ratio that varies from 4 to 7 points. Conclusions: there is need for future investigations on the data regarding the age of 9 years in order to use the DCDQ adapted to Brazilian children aged 8-10 years, in order to favor the early identification of DCD.
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Tazón-Varela, Manuel Antonio, Jon Ortiz de Salido-Menchaca, Pedro Muñoz-Cacho, Enara Iriondo-Bernabeu, María Josefa Martos-Almagro, Emma Lavín-López, Ander Vega-Zubiaur, et al. "High-Sensitivity Troponin T: A Potential Safety Predictive Biomarker for Discharge from the Emergency Department of Patients with Confirmed Influenza." Journal of Personalized Medicine 12, no. 4 (March 23, 2022): 520. http://dx.doi.org/10.3390/jpm12040520.
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The purpose of the study was to analyze the relationship between the high-sensitivity troponin T levels in patients with confirmed influenza virus infection and its severity determined by mortality during the care process. In addition, a high-sensitivity troponin T cut-off value was sought to allow us to a safe discharge from the emergency department. An analytical retrospective observational study was designed in which high-sensitivity troponin T is determined as an exposure factor, patients are followed until the resolution of the clinical picture, and the frequency of mortality is analyzed. We included patients ≥ 16 years old with confirmed influenza virus infection and determination of high-sensitivity troponin T. One hundred twenty-eight patients were included (96.9% survivors, 3.1% deceased). Mean and median blood levels of high-sensitivity troponin T of survivors were 26.2 ± 58.3 ng/L and 14.5 ng/L (IQR 16 ng/L), respectively, and were statistically different when compared with those of the deceased patients, 120.5 ± 170.1 ng/L and 40.5 ng/L (IQR 266.5 ng/L), respectively, p = 0.012. The Youden index using mortality as the reference method was 0.76, and the cut-off value associated with this index was 24 ng/L (sensitivity 100%, specificity 76%, NPV 100%, PPV 4%) with AUC of 88,8% (95% CI: 79.8–92.2%), p < 0.001. We conclude that high-sensitivity troponin T levels in confirmed virus influenza infection are a good predictor of mortality in our population, and this predictor is useful for safely discharging patients from the emergency department.
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Zhidkova, Elena A., Ekaterina M. Gutor, Konstantin G. Gurevich, Nikita V. Makogon, Zaur Kh Shugushev, Denis O. Orlov, Ol’ga N. Dzhioyeva, and Oksana M. Drapkina. "Analysis of Causes of Sudden Death Among Russian Railway Workers." I.P. Pavlov Russian Medical Biological Herald 30, no. 4 (December 28, 2022): 497–506. http://dx.doi.org/10.17816/pavlovj110985.
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INTRODUCTION: Health protection of railway workers of various professional groups increases the safety of railway transport, the prestige of the profession and reduces morbidity and mortality from the most common causes in this group of patients.
AIM: To analyze the risk factors of sudden death among Russian Railways workers.
MATERIALS AND METHODS: The design of the study is made according to the case-control type. Analysis was carried out of all cases of sudden death (SD) of employees of JSCo Russian Railways (RR) in the period from 2009 to 2021 (n = 412). The comparison group consisted of 411 employees of RR who were undergoing periodical medical examination. The groups were formed on the basis of age, employment period, gender, profession. To assess the diagnostic significance of the quantitative signs in predicting a certain outcome, the method of analysis of ROC curves was used.
RESULTS: The chances of death for workers of RR increased in case of past myocardial infarction, and also depended on the type of intervention (p 0.001). The threshold value of the BMI index in the cut-off point, which corresponded to the highest value of Youden index, was 27.1 kg/m2. In the group of sudden deaths, there were 1.8 times more smokers and 2 times less individuals with total cholesterol level exceeding 5 mmol/l than in the comparison group (p 0.001). A prognostic model was developed by ROC-analysis to determine the probability of mortality. The sensitivity and specificity of the model were 79.5% and 91.9%, respectively.
CONCLUSION: A prognostic model was developed to determine the probability of sudden death in Russian railway workers, with the sensitivity and specificity 79.5% and 91.9%, respectively. However, the present study did not permit to reveal predictors of sudden death specific of the workers of RR.
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Dakay, Daryl, Faith Tangcalagan, Emilio Villanueva III, Joshua Abejero, and Gerard Saranza. "Cross-cultural validation of the Cebuano version of a screening questionnaire for Parkinson's disease." Arquivos de Neuro-Psiquiatria 80, no. 12 (December 2022): 1239–45. http://dx.doi.org/10.1055/s-0042-1758652.
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Abstract Background In the Philippines, the exact prevalence of Parkinson's disease (PD) has not yet been determined. Although cases can be extrapolated from medical registries, this method may undermine actual case rates. A reliable screening tool for PD is essential for a timely diagnosis and community-based epidemiological studies. The most widely used screening questionnaire for PD diagnosis was developed by Tanner et al., which consists of nine questions about the motor symptoms of PD. Although this questionnaire has been translated to several languages, the translated version must be validated for use in our local setting. Objective To determine the validity of the Cebuano version of a PD screening questionnaire. Method The questionnaire was translated from English to Cebuano by a hired language specialist. Each item was supplied with a yes, no, or don't know answer. A total of 73 patients with PD and 244 control subjects completed the study. Results The overall Cronbach alpha for internal consistency of the questionnaire was 0.9410. The item on tremor had the highest sensitivity (97.26%), while the item on problems with buttoning had the highest specificity (100.00%). A cut-off score ≥ 3 obtained the best Youden index (99.18%), with a sensitivity of 100.00% and a specificity of 99.18%. The questionnaire had an almost perfect predictive ability to diagnose PD (AUC of 0.9994). Conclusion The translated version of the Tanner questionnaire is a validated instrument to identify PD in a literate Cebuano population.
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Menke, James Michael, Md Shahidul Ahsan, and Suan Phaik Khoo. "More Accurate Oral Cancer Screening with Fewer Salivary Biomarkers." Biomarkers in Cancer 9 (January 1, 2017): 1179299X1773200. http://dx.doi.org/10.1177/1179299x17732007.
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Signal detection and Bayesian inferential tools were applied to salivary biomarkers to improve screening accuracy and efficiency in detecting oral squamous cell carcinoma (OSCC). Potential cancer biomarkers are identified by significant differences in assay concentrations, receiver operating characteristic areas under the curve (AUCs), sensitivity, and specificity. However, the end goal is to report to individual patients their risk of having disease given positive or negative test results. Likelihood ratios (LRs) and Bayes factors (BFs) estimate evidential support and compile biomarker information to optimize screening accuracy. In total, 26 of 77 biomarkers were mentioned as having been tested at least twice in 137 studies and published in 16 summary papers through 2014. Studies represented 10 212 OSCC and 25 645 healthy patients. The measure of biomarker and panel information value was number of biomarkers needed to approximate 100% positive predictive value (PPV). As few as 5 biomarkers could achieve nearly 100% PPV for a disease prevalence of 0.2% when biomarkers were ordered from highest to lowest LR. When sequentially interpreting biomarker tests, high specificity was more important than test sensitivity in achieving rapid convergence toward a high PPV. Biomarkers ranked from highest to lowest LR were more informative and easier to interpret than AUC or Youden index. The proposed method should be applied to more recently published biomarker data to test its screening value.
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Hsu, Ming-En, Yu-Ting Cheng, Chih-Hsiang Chang, Yi‐Hsin Chan, Victor Chien-Chia Wu, Kuo-Chun Hung, Chia-Pin Lin, Kuo-Sheng Liu, Pao-Hsien Chu, and Shao-Wei Chen. "Level of serum soluble lumican and risks of perioperative complications in patients receiving aortic surgery." PLOS ONE 16, no. 3 (March 4, 2021): e0247340. http://dx.doi.org/10.1371/journal.pone.0247340.
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Objective Several serum biomarkers have been investigated for their potential as diagnostic tools in aortic disease; however, no study has investigated the association between serum biomarkers and outcomes after aortic surgery. This study explored the predictive ability of serum soluble lumican in postoperative outcomes after aortic surgery. Methods In total, 58 patients receiving aortic surgery for aortic dissection or aneurysm at Linkou Chang Gung Memorial Hospital in Taiwan in December 2011–September 2018 were enrolled. Blood samples were collected immediately upon patients’ arrival in the intensive care unit after aortic surgery. The diagnostic properties of soluble lumican levels were assessed by performing receiver operating characteristic (ROC) curve analysis. The confidence interval (CI) of the area under the ROC curve (AUC) was measured using DeLong’s nonparametric method and the optimal cutoff was determined using the Youden index. Results The serum soluble lumican level distinguished prolonged ventilation (AUC, 73.5%; 95% CI, 57.7%–89.3%) and hospital stay for >30 days (AUC, 78.2%; 95% CI, 61.6%–94.7%). The optimal cutoffs of prolonged ventilation and hospital stay for >30 days were 1.547 and 5.992 ng/mL, respectively. The sensitivity and specificity were respectively 100% (95% CI, 71.5%–100%) and 40.4% (95% CI, 26.4%–55.7%) for prolonged ventilation and 58% (95% 27.7%–84.8%) and 91.3% (95% CI, 79.2%–97.6%) for hospital stay for >30 days. Conclusions The serum soluble lumican level can be a potential prognostic factor for predicting poor postoperative outcomes after aortic surgery. However, more studies are warranted in the future.
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Zeike, Sabrina, Lena Ansmann, Lara Lindert, Christina Samel, Christoph Kowalski, and Holger Pfaff. "Identifying cut-off scores for job demands and job control in nursing professionals: a cross-sectional survey in Germany." BMJ Open 8, no. 12 (December 2018): e021366. http://dx.doi.org/10.1136/bmjopen-2017-021366.
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ObjectivesNurses are generally found to be vulnerable to burnout, but nurses working in cancer care are even more so, since this profession is characterised by continuous confrontation with suffering and death. This study was designed to identify cut-off scores for job strain, that is, low job control and high job demands, for a sample of nurses working in breast cancer care. The main goal was to find cut-off scores, which predict the risk of nurses of developing a mental disorder from high job strain.DesignThe design was a cross-sectional survey study.SettingThe study is based on an employee survey in breast cancer centres in Germany.Participants688 nurses received a questionnaire; 329 nurses from 33 hospitals participated in the survey (return rate: 50.2%).Primary and secondary outcome measuresDependent variable: psychological well-being, measured by the WHO-5 Well-being Index; independent variables: job control and job demands, measured by the Job Content Questionnaire (JCQ).ResultsMultivariable analysis indicates that low job control and high job demands are prognostic factors for low well-being. In a receiver operating curve (ROC) analysis, the cut-off scores, which demonstrated a maximum Youden index, were 34.5 for job control and 31.4 for job demands. The combination of both scales from a logistic regression analysis resulted in an area under the curve of 0.778. Sensitivity and specificity are 70.3% and 74.2%, respectively. The total of correct classification was 63.3%.ConclusionThe determined cut-off scores indicate that there is a risk of becoming psychologically ill from a high workload when an individual reaches a score of ≤34.5 for job control and ≥31.4 for job demands. The described method of establishing risk-based cut-off scores is promising for nursing practice and for the field of occupational health. Transferability and generalisability of the cut-off scores should be further analysed.
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Lam, Athene Hoi-Ying, Ka-Yi Leung, Ruiqi Zhang, Danlei Liu, Yujing Fan, Anthony Raymond Tam, Cyril Chik-Yan Yip, et al. "Evaluation of an Antigen Detection Rapid Diagnostic Test for Detection of SARS-CoV-2 in Clinical Samples." COVID 1, no. 4 (December 17, 2021): 775–83. http://dx.doi.org/10.3390/covid1040062.
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Antigen detection rapid diagnostic tests have been developed for first-line large-scale screening given their rapidity, simplicity, and accuracy. This study evaluates the diagnostic performance of an antigen detection rapid diagnostic test (BLOK BioScience, London, UK) detecting SARS-CoV-2 nucleocapsid protein. Serially diluted SARS-CoV-2 isolate and 110 NPS from COVID-19 patients were tested to determine the test’s sensitivity, and other viral isolates and 20 NPS from non-infected individuals were, for specificity, also tested. Ten clinical samples from COVID-19 patients with SARS-CoV-2 variants, including alpha, beta, gamma, delta, and eta variants, were collected to evaluate the test’s potential application in detecting emerging variants. Overall sensitivity was 92%, and stratifying into viral loads yielded 100% for Ct < 25 samples including SARS-CoV-2 variants, but 11.11% for Ct ≥ 30 samples. The analytical sensitivity of log10 TCID50/mL 2.0 was identified for SARS-CoV-2. Ninety-seven percent specificity with only SARS-CoV cross-reactivity lead to the Youden index of 0.89. The rapid diagnostic test has a high sensitivity for detecting SARS-CoV-2 in high viral load samples, possibly including emerging SARS-CoV-2 variants, but reduced sensitivity in low viral load samples suggests its optimized usage as a complementary testing method to other tests, including RT-PCR or a point-of-care test for large-scale screening, particularly for pandemic areas or airport border infection control.
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Aslam, Nida. "Explainable Artificial Intelligence Approach for the Early Prediction of Ventilator Support and Mortality in COVID-19 Patients." Computation 10, no. 3 (February 28, 2022): 36. http://dx.doi.org/10.3390/computation10030036.
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Early prediction of mortality and risk of deterioration in COVID-19 patients can reduce mortality and increase the opportunity for better and more timely treatment. In the current study, the DL model and explainable artificial intelligence (EAI) were combined to identify the impact of certain attributes on the prediction of mortality and ventilatory support in COVID-19 patients. Nevertheless, the DL model does not suffer from the curse of dimensionality, but in order to identify significant attributes, the EAI feature importance method was used. The DL model produced significant results; however, it lacks interpretability. The study was performed using COVID-19-hospitalized patients in King Abdulaziz Medical City, Riyadh. The dataset contains the patients’ demographic information, laboratory investigations, and chest X-ray (CXR) findings. The dataset used suffers from an imbalance; therefore, balanced accuracy, sensitivity, specificity, Youden index, and AUC measures were used to investigate the effectiveness of the proposed model. Furthermore, the experiments were conducted using original and SMOTE (over and under sampled) datasets. The proposed model outperforms the baseline study, with a balanced accuracy of 0.98 and an AUC of 0.998 for predicting mortality using the full-feature set. Meanwhile, for predicting ventilator support a highest balanced accuracy of 0.979 and an AUC of 0.981 was achieved. The proposed explainable prediction model will assist doctors in the early prediction of COVID-19 patients that are at risk of mortality or ventilatory support and improve the management of hospital resources.