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The Mini-Mental State Examination (MMSE) is widely used for dementia screening. The purpose of this study was twofold. First, to cross-culturally adapt the Moroccan Arabic version of MMSE (MA-MMSE) to screen dementia among literate and illiterate elderly Moroccans, and second to analyze its psychometric properties. The MA-MMSE was administered to 80 elderly patients, 28 were females and 52 were males. Among all the participants, 22 showed evidence of dementia. Receiver Operator Characteristic (ROC), internal consistency, and test–retest reliability were investigated. The test–retest reliability was assessed by Spearman correlation analysis. Cronbach's α coefficients for internal consistency between total scores and subscores of the test were calculated. Areas under the ROC curve in literate and illiterate elderly Moroccans participants corresponded to 0.932 and 0.936, respectively. The cutoff point of 21/22 on the MA-MMSE in literate elderly had the highest sensitivity (85.7%), specificity (94.7%), and a positive likelihood ratio of (16.29%), whereas the cutoff point of 18/19 of the screening test in illiterate elderly yielded the highest sensitivity (92.9%), specificity (95.0%), and a positive likelihood ratio of (18.57%). The Cronbach's α values of the MA-MMSE for literate and illiterate elderly Moroccans were higher than 0.7. Thirty subjects were randomly selected for participation in the test–retest protocol. Participants were retested after an interval of 4–6 weeks. The test–retest reliability for total scores was significant 0.78 (p < 0.01). The findings provide preliminary evidence that the MA-MMSE is a feasible instrument for dementia screening. [ABSTRACT FROM AUTHOR]

Introduction: Meniere's disease is an inner ear disorder not associated with central brain structure involvement. Although the ECochG test has been commonly used to diagnose Meniere's disease recently, it has not demonstrated high sensitivity. Therefore, it is recommended that other complementary tests alongside the ECochG test be used to diagnose Meniere's disease. The SVV test has gained popularity recently for this reason, and in this study, it was decided to use the SVV test in both static and dynamic modes, along with the ECochG test, as a tool for diagnosing Meniere's disease and evaluating its diagnostic features. Materials and Methods: The study was conducted on 53 patients with confirmed unilateral Meniere's disease and a normal group. Means were calculated with a 95% confidence interval for the groups, and the corresponding graphs were plotted. Independent t-tests were used to examine the difference in SVV results between the normal and Meniere's groups. The ROC curve was then used to determine the cutoff point and calculate. Results: After investigating the cutoff point for the three SVV conditions (tilted towards the lesion), a cutoff point of 2.1 degrees with a sensitivity and specificity of approximately 0.7 was identified as the best condition for distinguishing the Meniere's group from the healthy group. Conclusion: Finally, based on the findings, it can be concluded that the SVV test has relatively low sensitivity for diagnosing Meniere's disease. Therefore, more than relying solely on its results to identify Meniere's disease is required, and it is suggested that other measures alongside the ECochG and SVV tests be included in future studies for further investigation. [ABSTRACT FROM AUTHOR]

• The GAI-TC is a reliable and valid instrument for assessing older adults' anxiety symptoms. • The GAI-TC has three factors: cognition anxiety, impact of anxiety, and somatic anxiety. • The optimal cutoff point of the GAI-TC for detecting anxiety in older persons in the community is 9/10. The study aimed to translate the Geriatric Anxiety Inventory into traditional Chinese (GAI-TC), examine its psychometric properties, and identify the optimal cutoff point. This research recruited 337 older adults from two community activity centers. Structured questionnaires were used, including demographic information and characteristics, the GAI-TC, and the State-Trait Anxiety Inventory (STAI). Cronbach's α of the GAI-TC was 0.93. The intraclass correlation coefficient was 0.90. The content validity index was 1.0. An exploratory factor analysis revealed that three factors in the GAI-TC, including cognition anxiety, impact of anxiety, and somatic anxiety, explained 59.46 % of the variance. The criterion-related validity showed a significant positive correlation between the GAI-TC and STAI, with an optimal cutoff of 9/10 for detecting anxiety in older persons living in the community. The GAI-TC had good reliability and validity and can provide professionals with a tool for the early identification of anxiety among older adults. [ABSTRACT FROM AUTHOR]

Background Few small‐sample studies have quantified the T‐wave alternans (TWA) value by 24‐hour ambulatory recordings or exercise stress tests in patients with long QT syndrome (LQTS). The cutoff point of TWA ≥47 μV was based on patients with myocardial infarction. In our study, we aimed to (1) evaluate the association of TWA with life‐threatening arrhythmic events (LAEs); (2) compare the predictive model of LAEs according to the TWA value measured by 24‐hour ambulatory recordings and exercise stress tests; and (3) propose a cutoff point for the high risk of LAEs in patients with LQTS. Methods and Results The study cohort included 110 patients with LQTS referred to our hospital, and the primary outcome was LAEs. Thirty‐one patients with LQTS (31/110 [28.2%]) developed LAEs during the following 24 (12–47) months. Peak TWA value quantified from 12 leads by 24‐hour ambulatory recordings in patients with LQTS with LAEs (LQTS–LAEs group) was significantly higher than LQTS without LAEs (LQTS–non‐LAEs group) (64.0 [42.0–86.0] μV versus 43.0 [36.0–53.0] μV; P

Background: Although oral frailty is independently associated with an increased risk of mortality, evidence for the usefulness of screening tools for oral frailty is less than that for physical frailty screening tools. We aimed to investigate the relationship between oral frailty and mortality in older adults. Methods: This prospective cohort study included 11,374 adults aged ≥65 years, who provided valid responses to a baseline mail survey questionnaire from the Kyoto-Kameoka study. Oral frailty status was evaluated using the Oral Frailty Index-8 (range, 0 [best] to 10 [worst]). Participants were classified into four categories according to the Oral Frailty Index-8: robust (score, 0–2), oral pre-frailty (score, 3), oral frailty (score, 4–6), and oral severe frailty (score ≥ 7). Physical and psychological frailty were evaluated using the validated frailty-screening index and defined as a score of ≥3 out of a possible 5 points. Mortality data were collected from 30 July 2011 to 30 November 2016. Hazard ratios (HR) for all-cause mortality were calculated using a multivariable Cox proportional hazards model. Results: During the 5.3-year median follow-up period (57,157 person-years), 1184 deaths were recorded. After adjusting for confounders, including physical and psychological frailty, medical history, and lifestyle, in comparison with a robust oral status, oral pre-frailty (HR, 1.29; 95 % confidence interval [CI], 1.02–1.63), oral frailty (HR, 1.22; 95 % CI, 1.01–1.48), and oral severe frailty (HR, 1.43; 95 % CI, 1.16–1.76) were associated with higher HRs of mortality (p for trend = 0.002). Conclusion: Oral frailty is associated with mortality independent of physical and psychological frailty in older adults. The Oral Frailty Index-8 may be useful for identifying individuals at high risk of mortality.

Abstract Background The peritoneal cancer index (PCI) has been used to predict surgical outcomes for pseudomyxoma peritonei (PMP). The present study aimed to establish the optimal cutoff point for PCI to predict surgical resectability of PMP. Methods A total of 366 PMP patients were included. The patients were divided into low-grade and high-grade groups. Based on the completeness of the cytoreduction (CC) score, both low-grade and high-grade PMP patients were further divided into complete cytoreductive surgery (CRS) and maximal tumor debulking (MTD) subgroups. The ability to predict surgical resectability of total and selected PCI (regions 2 + 9 to 12) was analyzed through receiver operating characteristic (ROC) curves. Results Both total and selected PCI demonstrated excellent discriminative ability in predicting surgical resectability for low-grade PMP patients (n = 266), with the ROC-AUC of 0.940 (95% CI: 0.904–0.965) and 0.927 (95% CI: 0.889–0.955). The corresponding optimal cutoff point was 21 and 5, respectively. For high-grade PMP patients (n = 100), both total and selected PCI exhibited good performance in predicting surgical resectability, with the ROC-AUC of 0.894 (95% CI: 0.816–0.946) and 0.888 (95% CI: 0.810–0.943); correspondingly, the optimal cutoff point was 25 and 8, respectively. The discriminative ability between total and selected PCI in predicting surgical resectability did not show a statistical difference. Conclusions Both total and selected PCI exhibited good performance and similarity in predicting complete surgical resection for both low-grade and high-grade PMP patients. However, the selected PCI was simpler and time-saving in clinical practice. In the future, new imaging techniques or predictive models may be developed to better predict PCI preoperatively, which might assist in confirming whether complete surgical resection can be achieved.

Background: The peritoneal cancer index (PCI) has been used to predict surgical outcomes for pseudomyxoma peritonei (PMP). The present study aimed to establish the optimal cutoff point for PCI to predict surgical resectability of PMP. Methods: A total of 366 PMP patients were included. The patients were divided into low-grade and high-grade groups. Based on the completeness of the cytoreduction (CC) score, both low-grade and high-grade PMP patients were further divided into complete cytoreductive surgery (CRS) and maximal tumor debulking (MTD) subgroups. The ability to predict surgical resectability of total and selected PCI (regions 2 + 9 to 12) was analyzed through receiver operating characteristic (ROC) curves. Results: Both total and selected PCI demonstrated excellent discriminative ability in predicting surgical resectability for low-grade PMP patients (n = 266), with the ROC-AUC of 0.940 (95% CI: 0.904–0.965) and 0.927 (95% CI: 0.889–0.955). The corresponding optimal cutoff point was 21 and 5, respectively. For high-grade PMP patients (n = 100), both total and selected PCI exhibited good performance in predicting surgical resectability, with the ROC-AUC of 0.894 (95% CI: 0.816–0.946) and 0.888 (95% CI: 0.810–0.943); correspondingly, the optimal cutoff point was 25 and 8, respectively. The discriminative ability between total and selected PCI in predicting surgical resectability did not show a statistical difference. Conclusions: Both total and selected PCI exhibited good performance and similarity in predicting complete surgical resection for both low-grade and high-grade PMP patients. However, the selected PCI was simpler and time-saving in clinical practice. In the future, new imaging techniques or predictive models may be developed to better predict PCI preoperatively, which might assist in confirming whether complete surgical resection can be achieved. [ABSTRACT FROM AUTHOR]

Gaussian mixture models are widely employed in serological data analysis to discern between seropositive and seronegative individuals. However, serological populations often exhibit significant skewness, making symmetric distributions like Normal or Student-t distributions unreliable. In this study, we propose finite mixture models based on Skew-Normal and Skew-t distributions for serological data analysis. Although these distributions are well established in the literature, their application to serological data needs further exploration, with emphasis on the determination of the threshold that distinguishes seronegative from seropositive populations. Our previous work proposed three methods to estimate the cutoff point when the true serological status is unknown. This paper aims to compare the three cutoff techniques in terms of their reliability to estimate the true threshold value. To attain this goal, we conducted a Monte Carlo simulation study. The proposed cutoff points were also applied to an antibody dataset against four SARS-CoV-2 virus antigens where the true serological status is known. For this real dataset, we also compared the performance of our estimated cutoff points with the ROC curve method, commonly used in situations where the true serological status is known. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis of COVID-19 infection can prevent the lethal clinical course of the disease and result-instead-in a better outcome. Thus, there was an urging need for rapid and simple laboratory tests for early prediction of infection that will eventually improve morbidity and mortality of the disease. Objective: The study aimed to assess the predictive value of neutrophil/lymphocyte ratio in the diagnosis of COVID-19 infection in terms of sensitivity and specificity. Patients and Methods: In this retrospective study, we analyzed the clinical data of 150 participants divided into three equal groups; 50 patients with a positive reverse transcription polymerase chain reaction (RT-PCR) oronasopharyngeal swab for SARS-CoV-2 (Group I), 50 patients with non-COVID-19-related fevers and/or respiratory illness (negative swab and CT chest) (Group II) and 50 healthy controls (Group III). Results: There was a high statistically significant difference between the studied groups regarding absolute neutrophil count, absolute lymphocyte count, NLR, CRP and serum ferritin. In this study there was a significant correlation between NLR and CRP while, there were no significant correlations between NLR and other parameters like BMI, heart rate, Hb, platelet count and serum ferritin. Thus, the NLR can be considered as a dependable predictor of COVID-19 infection at a cutoff point of more than 3.06 with sensitivity 61% and specificity 86% Conclusion: NLR could be a useful, cheap, simple marker for early prediction of patients infected with COVID-19 with cutoff point more than 3.06. NLR could be used as a dependable risk predictor in the diagnosis of COVID-19 infections apart from its cut-off point. [ABSTRACT FROM AUTHOR]

Background: We aimed to investigate the clinical application value of Abbott Alinity analyzer in syphilis-specific antibody testing.

Aims: It is important to assess sleep quality during epidemiological surveillance of psychological and physical health among nonclinical adolescents. The Pittsburgh Sleep Quality Index (PSQI) is a self-report screening tool that measures sleep quality. This study aimed to assess the validity and reliability of the Chinese version of the PSQI among nonclinical adolescents. Methods: In total, 5,399 Chinese students (51.1% female) were included in the study (mean age = 15.13, SD = 1.56). Participants completed a comprehensive questionnaire including the PSQI. Statistical analyses to evaluate the reliability, structural validity, measurement invariance, criterion validity and optimal cutoff point of the PSQI were performed. Results: The internal consistency of the PSQI was moderate. Confirmatory factor analysis supported the three-dimensional model and the configural and metric invariance across gender and age. The correlations between scores on the PSQI and the Minneapolis-Manchester Quality of Life Instrument (as a measure of positive life aspects) as well as between scores on the PSQI and the Hospital Anxiety Depression Scale (as a measure of mental illness and distress) yielded support for criterion validity. The receiver operating characteristic analysis revealed that a score of 6.5 was the optimal cutoff point for the PSQI to diagnose sleep disturbance. Conclusion: The main findings of this study are consistent with many studies from other countries that evaluated the psychometric properties of the PSQI and support the use of this instrument in assessing sleep quality in Chinese nonclinical adolescents. Future studies should continue to verify the ability to monitor sleep quality across the lifespan using the PSQI. [ABSTRACT FROM AUTHOR]

Purpose: Meaningful thresholds are needed to interpret patient-reported outcome measure (PROM) results. This paper introduces a new method, based on item response theory (IRT), to estimate such thresholds. The performance of the method is examined in simulated datasets and two real datasets, and compared with other methods. Methods: The IRT method involves fitting an IRT model to the PROM items and an anchor item indicating the criterion state of interest. The difficulty parameter of the anchor item represents the meaningful threshold on the latent trait. The latent threshold is then linked to the corresponding expected PROM score. We simulated 4500 item response datasets to a 10-item PROM, and an anchor item. The datasets varied with respect to the mean and standard deviation of the latent trait, and the reliability of the anchor item. The real datasets consisted of a depression scale with a clinical depression diagnosis as anchor variable and a pain scale with a patient acceptable symptom state (PASS) question as anchor variable. Results: The new IRT method recovered the true thresholds accurately across the simulated datasets. The other methods, except one, produced biased threshold estimates if the state prevalence was smaller or greater than 0.5. The adjusted predictive modeling method matched the new IRT method (also in the real datasets) but showed some residual bias if the prevalence was smaller than 0.3 or greater than 0.7. Conclusions: The new IRT method perfectly recovers meaningful (interpretational) thresholds for multi-item questionnaires, provided that the data satisfy the assumptions for IRT analysis. [ABSTRACT FROM AUTHOR]

Takafumi Hattori,1,2 Satoshi Ohga,3 Kazuhiro Shimo,3 Yuto Niwa,1 Yuji Tokiwa,1 Takako Matsubara1,3 1Faculty of Rehabilitation, Kobe Gakuin University Graduate School, Kobe, Hyogo, Japan; 2Department of Rehabilitation, Maehara Orthopedics Rehabilitation Clinic, Obu, Aichi, Japan; 3Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University, Kobe, Hyogo, JapanCorrespondence: Takafumi Hattori, Faculty of Rehabilitation, Kobe Gakuin University Graduate School, 518 Arise, Ikawadani-cho, Nishi-ku, Kobe, Hyogo, 651-2180, Japan, Tel/Fax +81-78-974-2461, Email hattor91@gmail.comPurpose: Knee osteoarthritis (KOA) is a degenerative disease with inflammation, becoming persistent as it progresses, resulting in reduced quality of life. Exercise is the recommended treatment for KOA; however, the extent of pain reduction with exercise is heterogeneous and the prognostic implications of baseline factors in patients undergoing exercise are still unknown. This study examined the association between the response to exercise therapy and clinical outcomes, radiologic severity, and pain sensitization, and investigated the optimal predictive value for the effectiveness of exercise.Patients and Methods: Demographics, radiologic severity, pressure pain threshold (PPT), and temporal summation of pain (TSP) at the knee, tibia, and forearm were assessed at baseline. The pain numeric rating scale (NRS) was assessed before and after 12 weeks of exercise. Patients were divided into responder/non-responder groups according to recommended criteria: responder, ≥ 30% reduction in pain; non-responder, < 30% reduction in pain, and each variable was compared between the groups. The area under the curve (AUC) and cutoff points were determined by receiver operating characteristic curve analysis.Results: Sixty-five patients were categorized as responders and 26 as non-responders. In the non-responder group, baseline NRS (P< 0.01), pain duration (P< 0.01), and TSP at the knee (P< 0.001) and tibia (P< 0.05) were significantly higher, and PPT at the knee (P< 0.001), tibia (P< 0.001), and forearm (P< 0.001) were significantly lower, than those in the responder group; however, no significant differences between groups were found in other demographics and radiologic severity. The variables that showed moderate or better predictive ability (AUC≥ 0.7) were PPT at the knee (cutoff points: 241.5 kPa), tibia (307.5 kPa), forearm (318.5 kPa), and TSP at the knee (15.5 mm).Conclusion: Our findings suggest that pain sensitization is associated with the response to exercise therapy. Furthermore, we provide clinically predictive values for PPT and TSP in predicting the outcome to exercise in KOA.Keywords: pressure pain threshold, temporal summation of pain, cutoff point, prognostic prediction

Abstract Background and Aim Sarcopenia is a problem affecting inflammatory bowel disease (IBD) outcome and should be evaluated by measuring muscle mass (using dual‐energy X‐ray absorptiometry [DXA]), muscle strength, and physical performance. DXA has drawbacks as it is expensive, not covered by a national program, and requires a technician. Other inexpensive and simple examinations are needed. The objective is to explore cutoff point and diagnostic accuracy of thigh circumference (TC), calf circumference (CC), subjective global assessment (SGA), and handgrip strength (HGS) to identify sarcopenia in IBD patients. Methods The study was conducted in Cipto Mangunkusumo Hospital during November 2020–June 2021. Analysis was performed to discover the cutoff point and diagnostic accuracy of TC, CC, SGA, and HGS to identify sarcopenia. Results As assessed by DXA, 7 of 60 women (11.7%) with IBD had sarcopenia. Using CC cutoff ≤31 cm, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ration (PLR), and negative likelihood ratio (NLR) were 100%, 60.38%, 25%, 100%, 2.52, and 0, respectively. Using TC cutoff ≤50 cm, the sensitivity, specificity, PPV, NPV, PLR, and NLR were 100%, 83.02%, 43.75%, 100%, 5.90, and 0, respectively. SGA has sensitivity, specificity, PPV, NPV, PLR, and NLR of 42.86%, 84.91%, 27.27%, 91.84%, 2.84, and 0.67, respectively. The area under curve of HGS was 33.3%. Conclusion In this survey of Indonesian women with IBD, the frequency of sarcopenia was 11.7%. When compared with DXA, TC and CC values over 50 cm and 31 cm, respectively, were helpful to exclude the diagnosis of sarcopenia. SGA and HGS were of lesser value for the identification of a decrease in muscle mass.

Gaussian mixture models are widely employed in serological data analysis to discern between seropositive and seronegative individuals. However, serological populations often exhibit significant skewness, making symmetric distributions like Normal or Student-t distributions unreliable. In this study, we propose finite mixture models based on Skew-Normal and Skew-t distributions for serological data analysis. Although these distributions are well established in the literature, their application to serological data needs further exploration, with emphasis on the determination of the threshold that distinguishes seronegative from seropositive populations. Our previous work proposed three methods to estimate the cutoff point when the true serological status is unknown. This paper aims to compare the three cutoff techniques in terms of their reliability to estimate the true threshold value. To attain this goal, we conducted a Monte Carlo simulation study. The proposed cutoff points were also applied to an antibody dataset against four SARS-CoV-2 virus antigens where the true serological status is known. For this real dataset, we also compared the performance of our estimated cutoff points with the ROC curve method, commonly used in situations where the true serological status is known.

Abstract Background Diagnostic cutoff points for sarcopenia in chest computed tomography (CT) have not been established although CT is widely used for investigating skeletal muscles. This study aimed to determine reference values for sarcopenia of thoracic skeletal muscles acquired from chest CT scans and to analyse variables related to sarcopenia using the cutoff values determined in a general Asian population. Methods We retrospectively reviewed chest CT scans of 4470 participants (mean age 54.8 ± 9.9 years, 65.8% male) performed at a check‐up centre in South Korea (January 2016–August 2017). To determine cutoffs, 335 participants aged 19–39 years (mean age 35.2 ± 3.6 years, 75.2% male) were selected as the healthy and younger reference group, and 4135 participants aged ≥40 years (mean age 56.4 ± 8.4 years, 65.1% male) were selected as the study group. We measured the following: cross‐sectional area (CSA) of the pectoralis, intercostalis, paraspinal, serratus, and latissimus muscles at the 4th vertebral region (T4CSA); T4CSA divided by height2 (T4MI); pectoralis muscle area (PMCSA); and PMCSA divided by height2 (PMI) at the 4th vertebral region. Sarcopenia cutoff was defined as sex‐specific values of less than −2 SD below the mean from the reference group. Results In the reference group, T4CSA, T4MI, PMCSA, and PMI cutoffs for sarcopenia were 100.06cm2, 33.69cm2/m2, 29.00cm2, and 10.17cm2/m2 in male, and 66.93cm2, 26.01cm2/m2, 18.29cm2, and 7.31cm2/m2 in female, respectively. The prevalence of sarcopenia in the study group measured with T4CSA, T4MI, PMCSA and PMI cutoffs were 11.4%, 8.7%, 8.5%, and 10.1%, respectively. Correlations were observed between appendicular skeletal mass divided by height2 measured by bioelectrical impedance analysis (BIA) and T4CSA (r = 0.82; P

Introduction: Cultural backgrounds can influence the smell test because of the unfamiliarity of different populations with a number of odorants. The study aims to determine the cutoff points for hyposmia using the cultural adaptation of the Malaysian version of the Sniffin' Sticks identification smell test among different age groups. Methods: In this cross-sectional study, healthy participants were recruited from a hospital, senior citizen homes, and schools from 2019 until 2021. Participants were divided into 5 different age groups (A: children, B: adolescents, C: young adults, D: middle-aged adults, and E: older adults) and underwent the identification smell test. Scores below the 10th percentile in these age groups were used to determine the cutoff points for hyposmia. Results: The cutoff points for the smell identification scores for hyposmia at the 10th percentile in children, adolescents, and adults (young, middle-aged, and older) were less than 6, 9, and 11, respectively. Pairwise comparisons were made using the Bonferroni post hoc test, with p < 0.001. Scores showed a significant difference between males (mean [SD]: 11.43 [2.42]) and females (12.01 [1.98]); p = 0.005. Conclusion: Our study found that the cutoff points of the identification smell test for hyposmia were lower than those of other studies. It is important to use these cutoff points in our population to establish the correct integrity of olfaction function in the clinic setting and in future research. [ABSTRACT FROM AUTHOR]

Background and Aim: Sarcopenia is a problem affecting inflammatory bowel disease (IBD) outcome and should be evaluated by measuring muscle mass (using dual‐energy X‐ray absorptiometry [DXA]), muscle strength, and physical performance. DXA has drawbacks as it is expensive, not covered by a national program, and requires a technician. Other inexpensive and simple examinations are needed. The objective is to explore cutoff point and diagnostic accuracy of thigh circumference (TC), calf circumference (CC), subjective global assessment (SGA), and handgrip strength (HGS) to identify sarcopenia in IBD patients. Methods: The study was conducted in Cipto Mangunkusumo Hospital during November 2020–June 2021. Analysis was performed to discover the cutoff point and diagnostic accuracy of TC, CC, SGA, and HGS to identify sarcopenia. Results: As assessed by DXA, 7 of 60 women (11.7%) with IBD had sarcopenia. Using CC cutoff ≤31 cm, the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ration (PLR), and negative likelihood ratio (NLR) were 100%, 60.38%, 25%, 100%, 2.52, and 0, respectively. Using TC cutoff ≤50 cm, the sensitivity, specificity, PPV, NPV, PLR, and NLR were 100%, 83.02%, 43.75%, 100%, 5.90, and 0, respectively. SGA has sensitivity, specificity, PPV, NPV, PLR, and NLR of 42.86%, 84.91%, 27.27%, 91.84%, 2.84, and 0.67, respectively. The area under curve of HGS was 33.3%. Conclusion: In this survey of Indonesian women with IBD, the frequency of sarcopenia was 11.7%. When compared with DXA, TC and CC values over 50 cm and 31 cm, respectively, were helpful to exclude the diagnosis of sarcopenia. SGA and HGS were of lesser value for the identification of a decrease in muscle mass. [ABSTRACT FROM AUTHOR]

Although oral frailty is independently associated with an increased risk of mortality, evidence for the usefulness of screening tools for oral frailty is less than that for physical frailty screening tools. We aimed to investigate the relationship between oral frailty and mortality in older adults. This prospective cohort study included 11,374 adults aged ≥65 years, who provided valid responses to a baseline mail survey questionnaire from the Kyoto-Kameoka study. Oral frailty status was evaluated using the Oral Frailty Index-8 (range, 0 [best] to 10 [worst]). Participants were classified into four categories according to the Oral Frailty Index-8: robust (score, 0–2), oral pre-frailty (score, 3), oral frailty (score, 4–6), and oral severe frailty (score ≥ 7). Physical and psychological frailty were evaluated using the validated frailty-screening index and defined as a score of ≥3 out of a possible 5 points. Mortality data were collected from 30 July 2011 to 30 November 2016. Hazard ratios (HR) for all-cause mortality were calculated using a multivariable Cox proportional hazards model. During the 5.3-year median follow-up period (57,157 person-years), 1184 deaths were recorded. After adjusting for confounders, including physical and psychological frailty, medical history, and lifestyle, in comparison with a robust oral status, oral pre-frailty (HR, 1.29; 95 % confidence interval [CI], 1.02–1.63), oral frailty (HR, 1.22; 95 % CI, 1.01–1.48), and oral severe frailty (HR, 1.43; 95 % CI, 1.16–1.76) were associated with higher HRs of mortality (p for trend = 0.002). Oral frailty is associated with mortality independent of physical and psychological frailty in older adults. The Oral Frailty Index-8 may be useful for identifying individuals at high risk of mortality. • Oral Frailty Index-8 has moderate diagnostic accuracy for oral frailty defined from objectively measured mixing ability. • Oral frailty was independently associated with all-cause mortality, even after adjusting for physical and psychological frailty in older adults. • Oral Frailty Index-8 score > 6 has positive log-linear relationship with mortality. [ABSTRACT FROM AUTHOR]

The optimum cutoff point for a diagnostic test is the point along the ROC curve where the test performs best (has the best sensitivity and specificity available for that test). Keywords: ROC curve; receiver operating curve; statistics; cutoff point EN ROC curve receiver operating curve statistics cutoff point 163 167 5 03/24/22 20220401 NES 220401 In toxicology, we are often concerned with determining "cutoff points." The point of maximum sensitivity and specificity (the optimum cutoff point for a test), usually in the top upper left of the ROC curve, is identified using the Youden Index calculation. Consequently, both of these studies used ROC curves to obtain optimum cutoff points to help risk stratify patients for the development of clinically significant toxicity following a drug overdose. [Extracted from the article]

Purpose: No standardized execution or evidence demonstrates the area of the digit giving the most accurate capillary refill time (CRT). This study investigated the reliability and validity of CRT, and the relative merits of areas where the test could be performed. Methods: In all, 127 healthy volunteers were assessed for normal CRT at the fingernail, lateral paronychia, and proximal and distal pulps of the index finger. The predictive validity of the CRT for the diagnosis of compromised vascular perfusion was also investigated on 24 subjects, using an inflated tourniquet. Three raters assessed interobserver reliability. Results: The mean fingernail, lateral paronychia, proximal pulp, and distal pulp CRTs were 1.93, 1.78, 1.70, and 1.57 s, respectively. The tourniquet and non-tourniquet results demonstrated significant mean differences; however, the fingernail showed a subtle difference (1.22 s) compared with the proximal pulp (4.46 s). The CRT interobserver reliability was fair at the fingernail (intraclass correlation coefficient [ICC] = 0.51), but very poor in occluded limbs (ICC = 0.13). At the lateral paronychia and finger pulp, the interobserver reliability was reasonable (ICC = 0.75–0.81 [non-tourniquet] vs 0.62–0.68 [tourniquet]). In a receiver-operating characteristic curve analysis, the proximal pulp demonstrated better discrimination (area under the curve = 0.93, 95% CI 0.89–0.97, p < 0.0001); the best cutoff point was calculated to be 3 s at the proximal pulp. Conclusions: CRT use at appropriate areas is reliable. The most dependable site is the finger pulp, and the proposed cutoff is 3 s. [ABSTRACT FROM AUTHOR]

Background: Although physical activity is associated with mortality in patients with idiopathic pulmonary fibrosis (IPF), reference values to interpret levels of physical activity are lacking. Objectives: This study aimed to investigate the prognostic significance of physical activity assessed by step count and its cutoff points for all-cause mortality. Methods: We measured physical activity (steps per day) using an accelerometer in patients with IPF at the time of diagnosis. Relationships among physical activity and mortality, as well as cutoff points of daily step count to predict all-cause mortality were examined. Results: Eighty-seven patients (73 males) were enrolled. Forty-four patients (50.1%) died during the follow-up (median 54 months). In analysis adjusting for Gender-Age-Physiology stage and 6-min walk distance, daily step count was an independent predictor of all-cause mortality (hazard ratio (HR) = 0.820, 95% confidence interval (CI) = 0.694–0.968, p = 0.019). The optimal cutoff point (receiving operating characteristic analysis) for 1-year mortality was 3,473 steps per day (sensitivity = 0.818 and specificity = 0.724). Mortality was significantly lower in patients with a daily step count exceeding 3,473 steps than in those whose count was 3,473 or less (HR = 0.395, 95% CI = 0.218–0.715, p = 0.002). Conclusions: Step count, an easily interpretable measurement, was a significant predictor of all-cause mortality in patients with IPF. At the time of diagnosis, a count that exceeded the cutoff point of 3,473 steps/day more than halved mortality. These findings highlight the importance of assessing physical activity in this patient population. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary embolism (PE) is the third most common cardiovascular syndrome with an average annual incidence rate of 77 per 100,000 population in the worldwide. The diagnose algorithms for suspected PE are generally include clinical scoring assessment and plasma D-dimer evaluation, patients with high risk of PE require computed tomographic pulmonary angiogram (CTPA) detection for confirmation. Methods In this retrospective analysis, 1035 patients with suspected PE were recruited. All the patients were clinically received simplified Geneva score (SGS) pre-test, determination of plasma D-dimer level, and CTPA detection. All enrolled patients were grouped according to the CTPA results: PE patients and non-PE patients. Then, receiver operating characteristic (ROC) curve were constructed to determine the optimal D-dimer cutoff point value which is based on Yonden’s index (YI). Results 294 (28.4%) patients were confirmed with PE and 741(71.6%) individuals were regarded as non-PE cases by CTPA detection. Using the SGS pre-test, 829 (80.1%) patients were classified PE-unlikely (SGS ≤ 2) and 206 (19.9%) patients were PE-likely (SGS ≥ 3). Patients with D-dimer levels above 1.96 mg/L had a significant risk to suffer from PE (area under curve (AUC), 0.707; 95% CI, 0.678–0.735; p

Background: Few small-sample studies have quantified the T-wave alternans (TWA) value by 24-hour ambulatory recordings or exercise stress tests in patients with long QT syndrome (LQTS). The cutoff point of TWA ≥47 μV was based on patients with myocardial infarction. In our study, we aimed to (1) evaluate the association of TWA with life-threatening arrhythmic events (LAEs); (2) compare the predictive model of LAEs according to the TWA value measured by 24-hour ambulatory recordings and exercise stress tests; and (3) propose a cutoff point for the high risk of LAEs in patients with LQTS., Methods and Results: The study cohort included 110 patients with LQTS referred to our hospital, and the primary outcome was LAEs. Thirty-one patients with LQTS (31/110 [28.2%]) developed LAEs during the following 24 (12-47) months. Peak TWA value quantified from 12 leads by 24-hour ambulatory recordings in patients with LQTS with LAEs (LQTS-LAEs group) was significantly higher than LQTS without LAEs (LQTS-non-LAEs group) (64.0 [42.0-86.0] μV versus 43.0 [36.0-53.0] μV; P <0.01). There was no statistical difference in TWA value measured by exercise stress tests between the 2 groups (69.0 [54.5-127.5] μV versus 68.5 [53.3-99.8] μV; P =0.871). The new cutoff point of the peak TWA value measured by 24-hour ambulatory recordings was 55.5 μV, with a sensitivity of 75.0% and a specificity of 78.6%. A univariate Cox regression analysis revealed that TWA value ≥55.5 μV was a strong predictor of LAEs (hazard ratio [HR], 4.5 [2.1-9.6]; P <0.001]. A multivariate Cox regression analysis indicated that TWA value ≥55.5 μV remained significant (HR, 2.7 [1.1-6.8]; P =0.034)., Conclusions: Peak TWA measured by 24-hour ambulatory recordings was a more favorable risk stratification marker than exercise stress tests for patients with LQTS.

Background: The viral neutralization assay is the gold standard to estimate the level of immunity against SARS-CoV-2. This study analyzes the correlation between the quantitative Anti-SARS-CoV-2 QuantiVac ELISA (IgG) and the NeutraLISA neutralization assay. Methods: 650 serum samples were tested for both SARS-CoV-2 anti-spike (anti-S) immunoglobulin G (IgG) and neutralizing antibodies (nAbs) using kits by EUROIMMUN, Germany. Results: There was a significant correlation between levels of anti-S and nAbs (Spearman’s rho = 0.913). Among the positive samples for anti-S, 77.0% (n = 345) were positive for nAbs. There was a substantial agreement between anti-S and nAbs (Cohen’s kappa coefficient = 0.658; agreement of 83.38%). Considering NeutraLISA as a gold standard, anti-S had a sensitivity of 98.57%, specificity of 65.66%, NPV of 97.5%, and PPV of 77.0%. When the anti-S titer was greater than 18.1 RU/mL (57.9 BAU/mL), nAbs were positive, with a sensitivity of 90.0% and specificity of 91%. Conclusions: A titer of SARS-CoV-2 anti-S IgG can be correlated with levels of nAbs.

Purpose: The purpose of this study is to investigate whether there are predictors and cutoff points that can predict the acceptable lung dose using intensity-modulated radiation therapy (IMRT) and volume-modulated arc therapy (VMAT) in radiotherapy for upper ang middle esophageal cancer. Material and Methods: Eighty-two patients with T-shaped upper-middle esophageal cancer (UMEC) were enrolled in this retrospective study. Jaw-tracking IMRT plan (JT-IMRT), full-arc VMAT plan (F-VMAT), and pactial-arc VMAT plan (P-VMAT) were generated for each patient. Dosimetric parameters such as MLD and V20 of total lung were compared among the three plannings. Ten factors such as PCTVinferior length and PCTVinferior length/total lung length were calculated to find the predictors and cutoff points of the predictors. All patients were divided into two groups according to the cutoff points, and the dosimetric differences between the two groups of the three plans were compared. ANOVA, receiver operating characteristic (ROC) analysis, and Mann–Whitney U-test were performed for comparisons between datasets. A p <0.05 was considered statistically significant. Result: The quality of the targets of the three plannings was comparable. The total lung dose in P-VMAT was significantly lower than that in JT IMRT and F-VMAT. Monitor unit (MU) of F-VMAT and P-VMAT was significantly lower than that of JT IMRT. ROC analysis showed that among JT IMRT, F-VMAT, and P-VMAT, PCTVi-L, and PCTVi-L/TLL had diagnostic power to predict the suitability of RT plans according to lung dose constraints of our department. For JT IMRT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 16.6 and 0.59. For F-VMAT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 16.75 and 0.62. For P-VMAT, the cutoff points of PCTVi-L and PCTVi-L/TLL were 15.15 and 0.59. After Mann–Whitney U-test analysis, it was found that among the three plannings, the group with lower PCTVi-L and PCTVi-L/TLL could significantly reduce the dose of total lung and heart (p <0.05). Conclusion: PCTVi-L <16.6 and PCTVi-L/TLL <0.59 for JT IMRT, PCTVi-L <16.75 and PCTVi-L/TLL <0.62 for F-VMAT and PCTVi-L <15.15, and PCTVi-L/TLL <0.59 for P-VMAT can predict whether patients with T-shaped UMEC can meet the lung dose limits of our department. [ABSTRACT FROM AUTHOR]

As the first DSM-5 based, multidimensional screening tool of Internet gaming disorder (IGD) designed for Chinese gamers, the Chinese Internet Gaming Disorder Checklist (C-IGDC) has shown satisfactory psychometric properties among Chinese young adults. Given the high vulnerability to IGD among adolescents, the present study aimed to examine the applicability of C-IGDC to Chinese adolescents to address shortfalls in the existing literature regarding the assessment of adolescent IGD screening. Through a two-stage sampling method in a cross-sectional survey, we obtained a sample of 1,253 Chinese past-year adolescent gamers (43.8% female; M age = 14.49 years, SD age = 1.60 years) from local junior or senior high schools in Macao, China for data analysis. Our results confirmed a good model fit of the original two-level, nine-subfactor structure of the 27-item C-IGDC, and indicated adequate internal consistency and test–retest reliability, as well as good concurrent validity as evidenced by expected associations with IGD functioning impairments, gameplay characteristics, and depressive symptoms. An optimal screening cutoff score (≥20) was proposed to identify probable disordered gamers among Chinese adolescents with past-year gaming experience. The findings support the extended use of C-IGDC to Chinese adolescents as a reliable and valid assessment tool for evaluating IGD severity levels and screening for probable IGD cases. Its use can facilitate a proper screening procedure for probable IGD cases in both school and clinical settings. [ABSTRACT FROM AUTHOR]

PurposeThe purpose of this study is to investigate whether there are predictors and cutoff points that can predict the acceptable lung dose using intensity-modulated radiation therapy (IMRT) and volume-modulated arc therapy (VMAT) in radiotherapy for upper ang middle esophageal cancer.Material and MethodsEighty-two patients with T-shaped upper-middle esophageal cancer (UMEC) were enrolled in this retrospective study. Jaw-tracking IMRT plan (JT-IMRT), full-arc VMAT plan (F-VMAT), and pactial-arc VMAT plan (P-VMAT) were generated for each patient. Dosimetric parameters such as MLD and V20 of total lung were compared among the three plannings. Ten factors such as PCTVinferior length and PCTVinferior length/total lung length were calculated to find the predictors and cutoff points of the predictors. All patients were divided into two groups according to the cutoff points, and the dosimetric differences between the two groups of the three plans were compared. ANOVA, receiver operating characteristic (ROC) analysis, and Mann–Whitney U-test were performed for comparisons between datasets. A p

As the first DSM-5 based, multidimensional screening tool of Internet gaming disorder (IGD) designed for Chinese gamers, the Chinese Internet Gaming Disorder Checklist (C-IGDC) has shown satisfactory psychometric properties among Chinese young adults. Given the high vulnerability to IGD among adolescents, the present study aimed to examine the applicability of C-IGDC to Chinese adolescents to address shortfalls in the existing literature regarding the assessment of adolescent IGD screening. Through a two-stage sampling method in a cross-sectional survey, we obtained a sample of 1,253 Chinese past-year adolescent gamers (43.8% female; Mage = 14.49 years, SDage = 1.60 years) from local junior or senior high schools in Macao, China for data analysis. Our results confirmed a good model fit of the original two-level, nine-subfactor structure of the 27-item C-IGDC, and indicated adequate internal consistency and test–retest reliability, as well as good concurrent validity as evidenced by expected associations with IGD functioning impairments, gameplay characteristics, and depressive symptoms. An optimal screening cutoff score (≥20) was proposed to identify probable disordered gamers among Chinese adolescents with past-year gaming experience. The findings support the extended use of C-IGDC to Chinese adolescents as a reliable and valid assessment tool for evaluating IGD severity levels and screening for probable IGD cases. Its use can facilitate a proper screening procedure for probable IGD cases in both school and clinical settings.

Aim: To define the optimal cutoff point for determining methylation status of O6-methylguanine-DNA methyltransferase (MGMT) by pyrosequencing in glioblastoma. Patients & methods: A retrospective study of 109 glioblastoma patients was performed to determine the optimal cutoff point for MGMT methylation status. Results: Receiver operating characteristic (ROC) analysis revealed 21% as the optimal cutoff (sensitivity: 68%; specificity: 59%) for MGMT methylation corresponding with the highest likelihood ratio of 1.66 and accuracy of 0.65. Methylation status (hazard ratio: 0.453; 95% CI: 0.279–0.735; p = 0.001) was associated with better overall survival. The crude model indicated linearity between methylation percent and survival rate; an increase of 10% of methylation resulted in a reduction of risk of death by 20% (p = 0.004). Conclusion: ROC analysis determined 21% as the optimal cutoff point for MGMT methylation status by pyrosequencing.

We analyze the influence of a cutoff point on a Coulomb-type potential that stems from the interaction of an electron with electric fields. This cutoff point establishes a forbidden region for the electron. Then, we search for bound state solutions to the Schrödinger equation. In addition, we consider a rotating reference frame. We show that the effects of rotation break the degeneracy of the energy levels. Further, we discuss the Aharonov–Bohm effect for bound states. [ABSTRACT FROM AUTHOR]

Background: Frailty is a common geriatric syndrome and is characterized by decreased physiological reserve and increased vulnerability towards adverse health outcomes including falls. Turning is a challenging task and is reported to be one of the daily activities that leads to falling in older populations.Research Question: Does 180° walking turns and 360° turning on the spot differ among frail, pre-frail, and non-frail older adults? Can 180° walking turns and 360° turning on the spot cutoffs discriminate older adults with frailty from those without?Methods: A cross-sectional study was conducted on community-dwelling older adults aged over 65 years. Frailty was assessed using Fried's phenotype method, and turning tasks were measured by inertial sensors. The turn duration (s) and angular velocity (°/s) were recorded for analysis.Results: In total, 109 participants were enrolled including 50 pre-frail and 12 frail individuals. Frail older adults took significantly longer and had slower angular velocities to complete the 180° and 360° turning than did either pre-frail (p = 0.002 and p < 0.001, respectively) or non-frail (p = 0.03 and p < 0.001, respectively) older adults. Cutoff times of 2.45 and 3.46 s were found to best discriminate frail people from those without frailty in both the 180° (sensitivity 83.3 %, specificity 71.1 %, area under the receiver operating characteristic curve (AUC) 0.796) and 360° (sensitivity 91.7 %, specificity 74.2 %, AUC 0.857) turn tasks.Significance: Older individuals with frailty syndrome had difficulty turning as evidenced by a longer turning duration and a slower angular velocity. The turn duration could be a potential biomarker of frailty in older populations. Assessing the turning performance can facilitate early detection of the onset of frailty and inform early prevention and rehabilitation interventions in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Abdominal ultrasonography has been proposed to screen for infantile hepatic hemangioma (IHH) in patients with multiple cutaneous infantile hemangiomas (IHs).Objectives: The aim of this study was to establish the optimal cutoff point for the number of cutaneous IHs needed to screen for IHH.Methods: We performed a prospective, multicenter study to screen for IHH in patients younger than 9 months who had multiple cutaneous IHs (n ≥ 3) on ultrasonography. For comparison, a group of patients with 1 or 2 focal cutaneous IHs was also recruited.Results: In total, 676 patients with at least 3 cutaneous IHs and 980 patients with 1 or 2 focal cutaneous IHs were enrolled. Thirty-one patients were found to have IHH. A higher number of cutaneous IHs was associated with an increased risk of IHH (R = 0.973; P < .001). Receiver operating characteristic curve analysis showed that 5 cutaneous IHs was the optimal cutoff point to screen for IHH, with an area under the curve of 0.872 (P < .001; 95% confidence interval, 0.789-0.955).Limitations: This was an uncontrolled study.Conclusions: Screening for IHH is recommended in patients younger than 9 months who present with 5 or more cutaneous IHs. [ABSTRACT FROM AUTHOR]

Zhenyu Pan,1–3,* Qingting Bu,4,* Haisheng You,5 Jin Yang,1,2 Qingqing Liu,1,2 Jun Lyu1,2 1Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 2School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, People’s Republic of China; 3Department of Pharmacy, The Affiliated Children Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China; 4Department of Genetics, Northwest Women’s and Children’s Hospital, Xi’an, Shaanxi, People’s Republic of China; 5Department of Pharmacy, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China *These authors contributed equally to this work Objective: Previous studies showed that the lymph node density (LND) was a predictor of survival in Wilms’ tumor (WT). However, the optimal LND cutoff point is controversial due to methodological shortcomings of previous studies, and no studies have shown the effect of LND on survival in children with WT. The purpose of this study was to remedy this situation.Methods: We identified 376 children with WT. LND cutoff point was determined using the median value, the X-tile program, the survival-tree algorithm, and the time-dependent ROC curve analysis. Survival functions were estimated by the Kaplan–Meier method. We used Cox regression analysis to determine the impact of LND on survival. Smooth curve fitting between relative mortality risk and LND was performed.Results: The LND cutoff point was 0.44, 0.65, 0.65, and 0.64 according to the median value, the X-tile program, the survival-tree algorithm, and the time-dependent ROC curve analysis, respectively. The 5-, 10-, and 20-year overall survival rates were 86.9%, 86.9%, and 84.7%, respectively, in the

Voice Handicap Index (VHI) has been used extensively in research and clinical settings. It has been suggested to be used as a diagnostic tool in the literature. However, little is known if it could be applied as a diagnostic tool to the Cantonese-speaking population. The study aims to establish cutoff points and the diagnostic accuracy for VHI-30 and VHI-10 to discriminate between Cantonese-speaking dysphonic and nondysphonic individuals. Data from 256 adults from Hong Kong were extracted from a database at a local institution. There were a total of 91 nondysphonic individuals and 165 dysphonic individuals. Receiver operating characteristics curve analysis was conducted to establish cutoff points for VHI-30 and VHI-10. Diagnostic accuracy statistics such as sensitivity, specificity, positive, and negative predicted values (PPV and NPV) and likelihood ratios (LRs) were also reported. The dysphonic group scored higher than the nondysphonic group on the mean scores of both versions of VHI. Receiver operating characteristics curve analysis revealed a moderate to strong area under curve of 0.89 in both VHI-30 and VHI-10. A cutoff point of 18.5 point was yielded for VHI-30 (Sensitivity = 86.1%, Specificity = 81.3%, PPV = 89.3%, NPV = 76.3%, LR+ = 4.60, LR- = 0.17) and a cutoff point of 7.5 point was yielded for VHI-10 (Sensitivity = 80.6%, Specificity = 87.9%, PPV = 92.4%, NPV = 71.4%, LR+ = 6.66, LR- = 0.22). Both the Chinese VHI-30 and VHI-10 for Cantonese speakers showed promising diagnostic accuracy. VHI can be used as adjunct to clinical diagnosis and treatment outcome measures for voice disorders in the Cantonese-speaking population. [ABSTRACT FROM AUTHOR]

Keywords: acoustic rhinometry; cutoff point; diagnostic accuracy; nasal allergen challenge; rhinitis EN acoustic rhinometry cutoff point diagnostic accuracy nasal allergen challenge rhinitis 371 375 5 01/09/21 20210101 NES 210101 The nasal allergen challenge (NAC) is a safe and reproducible method to identify the allergic triggers of rhinitis1 in both atopic and nonatopic patients; besides, it can guide the composition and monitor the effect of allergen immunotherapy.2,3 Nevertheless, NAC is scarcely implemented in the clinic due to the lack of standardized protocols, among other factors. We prospectively recruited 1165 and 369 adults with allergic rhinitis (AR) and nonallergic rhinitis (NAR), respectively, based on the results of skin prick test, serum allergen-specific IgE, and NAC (Table S1 and Table S2). [Extracted from the article]

Serum thyroglobulin is used as part of the early postoperative assessment of differentiated thyroid cancer (DTC) since there is a clear relationship between an increased risk of recurrence and persistent disease after initial treatment and high postoperative stimulated thyroglobulin (ps-Tg) values. Thus, although ps-Tg above 10–30 ng/mL is considered an independent predictor of worse prognosis, the value that is associated with distant metastases is not defined. Thus, this was our objective. We selected 655 DTC patients from a nuclear medicine department database (Irmandade Santa Casa de Misericórdia de São Paulo, Brazil). All patients had received total thyroidectomy and radioactive iodine (RAI) therapy and had ps-Tg values higher than 10 ng/mL with negative anti-thyroglobulin antibodies. Then, we selected patients who presented post-therapy whole-body scan with pulmonary and/or bone uptake but with no mediastinum or cervical uptake. Patients with negative findings on functional imaging or any doubt on lung/bone uptake were submitted to additional exams to exclude another non-thyroid tumor. Of the 655 patients, 14.3% had pulmonary and 4.4% bone metastases. There was a significant difference in ps-Tg levels between patients with and without metastases (P

Background: The discontinuance of mechanical ventilatory support (MVS) is identified as weaning and weaning process is started whenever escalating factor for respiratory failure resolves. Although all weaning criteria were fulfilled, 20% of weaning attempts were unsuccessful. The Rapid Shallow Breathing Index is one of the most studied indices. In this study, we aimed to find out the optimal cutoff point of the RSBI measured in MVS. Methods: This retrospective, non-interventional cohort study was conducted at a tertiary care hospital in Ankara, Türkiye. After collecting all data, the study population was divided into two group according to weaning failure (WF). Statistical analysis included Mann Whitney U-test, Youden index, and ROC-curves to predict WF. Results: 46 patients fulfilled the inclusion criteria, and nine patients could not tolerate extubation and required reintubation [WF (+)group, 19.5%] within 72 hours. Not only the RSBI but also the other parameters like Static compliance (Cstat) and PaO2/FiO2 differed among groups. In this study, the discriminative power which was appraised using the AUC was high enough with RSBI (AUC= 0.962). Conclusion: MVS may decrease RSBI and lower predictive value in classical original cutoff point (105). However, the discriminative power with 40 as the threshold level was proven to be effective in our study. [ABSTRACT FROM AUTHOR]

Background: Pulmonary embolism (PE) is the third most common cardiovascular syndrome with an average annual incidence rate of 77 per 100,000 population in the worldwide. The diagnose algorithms for suspected PE are generally include clinical scoring assessment and plasma D-dimer evaluation, patients with high risk of PE require computed tomographic pulmonary angiogram (CTPA) detection for confirmation.Methods: In this retrospective analysis, 1035 patients with suspected PE were recruited. All the patients were clinically received simplified Geneva score (SGS) pre-test, determination of plasma D-dimer level, and CTPA detection. All enrolled patients were grouped according to the CTPA results: PE patients and non-PE patients. Then, receiver operating characteristic (ROC) curve were constructed to determine the optimal D-dimer cutoff point value which is based on Yonden's index (YI).Results: 294 (28.4%) patients were confirmed with PE and 741(71.6%) individuals were regarded as non-PE cases by CTPA detection. Using the SGS pre-test, 829 (80.1%) patients were classified PE-unlikely (SGS ≤ 2) and 206 (19.9%) patients were PE-likely (SGS ≥ 3). Patients with D-dimer levels above 1.96 mg/L had a significant risk to suffer from PE (area under curve (AUC), 0.707; 95% CI, 0.678-0.735; p < 0.05). Meanwhile, in patients with SGS ≥ 3, the D-dimer cutoff point value moved to 2.2 mg/L (AUC, 0.644; 95% CI, 0.574-0.709; p < 0.05).Conclusion: D-dimer test in combination with SGS pre-test could improve the accuracy of PE diagnosis. Patients with D-dimer levels over 1.96 mg/L (4 times of the normal level) have a significant risk for PE. In patients with SGS ≥ 3, the D-dimer cutoff point concentration for PE risk moves to the levels of 2.2 mg/L. [ABSTRACT FROM AUTHOR]

Background: Atypical lymphocytes (AL), or reactive lymphocyte, exist in peripheral blood when stimulated by viral infection, drugs, inflammatory signals or allergens. Studies have shown that specific changes in peripheral blood (PB) analysis can predict morphological changes in blood cells. The objective of this study was to explore the value of the peripheral blood lymphocyte count in predicting the presence of AL. Methods: One hundred ninety-nine outpatients were selected from Beijing Chao-Yang Hospital, Capital Medical University from January to April 2015 and underwent manual cell classification with evaluation of complete clinical data. The results of manual classification of peripheral blood leukocytes and peripheral blood routine analysis were assessed, and the correlation between peripheral blood lymphocyte counts and presence of atypical lymphocytes evaluated using receiver operating characteristic (ROC) curves for each subject. Results: Peripheral blood lymphocytes ≥ 2.375 x 109/L was found to be the optimal cutoff point for predicting atypical lymphocytes. The area under the curve (AUC), 95% confidence interval (CI), sensitivity and specificity were 0.7984, 0.7121 - 0.8846, 68.42%, and 82.8%, respectively, while the accuracy was moderate. When the proportion of peripheral blood lymphocytes was greater than 35.90%, the AUC, 95% CI, sensitivity, and specificity were 0.8729, 0.8092 - 0.9366, 89.47%, and 76.34%, respectively, while the accuracy was moderate. Conclusions: The peripheral blood lymphocyte count of a patient has good predictive value for the existence of atypical lymphocytes, which is helpful for clinical diagnosis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Obesity and high body fat are related to metabolic syndrome (MetS) risk factors in all ethnic groups. OBJECTIVE: The present study aimed to determine optimal cutoff points for the Fat Mass Index (FMI), Body Fat Percentage (BF%), and Visceral Fat Area (VFA) in the prediction of MetS. METHODS: This cross-sectional study was performed on 10063 individuals aged from 35–65 years, recruited in Ravansar Non-Communicable Diseases (RaNCD) cohort. The anthropometric indices were measured using an appropriate validated methods and body composition was measured using Bio-Impedance Analyzer (Inbody 770, Inbody Co, Seoul, Korea). The receiver operating characteristic curve analysis was used to compare the predictive validity and determine optimal cutoff values. RESULTS: The optimal cutoff points for FMI, BF% and VFA were 7.2 kg/m2, 26.7 and 91.6 cm2 respectively in men for the prediction of MetS, but they were 11.3 kg/m2, 39.8 and 139.1cm2 respectively in women. Cutoff points were lower in rural populations than urban populations. In men and women with FMIs of higher than the optimal cutoff point, the risk of MetS was respectively 4.01 and 1.85 times higher than those with FMIs of lower than the cutoff point. In men and women with BF% of higher than the optimal cutoff point, the risk was respectively 3.62 and 1.70 times higher than those with BF% of lower than the cutoff point. CONCLUSION: The present study revealed that the FMI, BF%, and VFA indices were appropriate predictors of risk of MetS. The diagnostic power of the indicators was better in men and villagers. [ABSTRACT FROM AUTHOR]

Diagnostic accuracy and optimal cutoff points of risk factors is one of the important issues in medical decisions. In order to reassess the cutoff points of markers, longitudinal and time-to-event data of elderly individuals were collected repeatedly through 3 follow-up stages in the Tehran Lipid and Glucose Study. Time-dependent area under the ROC (receiver operating characteristic) curves (AUCs) based on the joint modeling of longitudinal and time-to-event data technique were measured. AUCs were considered to evaluate the discriminative potential of the models. The joint model produced higher AUC values than the Cox model; therefore, accuracy was improved although it is computationally complicated. The results had some differences with the thresholds reported in guidelines due to specificity to the population and/or the means of estimation methods. The estimated cutoff points with regard to sex can be used as a guideline for the Iranian elderly population. [ABSTRACT FROM AUTHOR]

Anatomic skeletal features of the shoulder play important roles in anterior shoulder dislocation. However, studies on the effect of the humeral structure are few. This case-control study aimed to analyze the risk factors of anterior shoulder instability, including glenoid and humeral factors. Anterior shoulder instability was found in 64 of 10,035 individuals who underwent magnetic resonance imaging. Propensity score matching was used to select controls matched for age, sex, height, and weight. We analyzed the glenoid and humeral structural data using conditional logistic regression analysis and identified cutoff points using receiver operating characteristic curve analysis. Significant differences were found between the control and dislocation groups in the depth-to-width ratio (0.119 ± 0.034 vs. 0.105 ± 0.037, P =.021), height-to-width ratio (1.51 ± 0.13 vs. 1.67 ± 0.16, P <.001), humeral head diameter-to-glenoid fossa diameter ratio (1.56 ± 0.11 vs. 1.64 ± 0.20, P <.001), and humeral containing angle (67.3° ± 5.9° vs. 60.4° ± 5.9°, P <.001). The humeral containing angle (odds ratio, 0.95; P =.024) and the glenoid height-to-width ratio (odds ratio, 7.88; P =.002), adjusted for the depth-to-width ratio and diameter ratio, were associated with anterior shoulder instability. The cutoff point for the humeral containing angle was 64° and for the height-to-width ratio was 1.60. This study revealed significant risk factors for shoulder instability in the Chinese Han population. The humeral containing angle and the glenoid height-to-width ratio were risk factors for anterior shoulder instability. [ABSTRACT FROM AUTHOR]

The receiver operating characteristic (ROC) curve and their associated summary indices, such as the Youden index, are statistical tools commonly used to analyze the discrimination ability of a (bio)marker to distinguish between two populations. This paper presents the concept of Youden index in the context of the generalized ROC (gROC) curve for non-monotone relationships. The interval estimation of the Youden index and the associated cutoff points in a parametric (binormal) and a non-parametric setting is considered. Monte Carlo simulations and a real-world application illustrate the proposed methodology. [ABSTRACT FROM AUTHOR]

Background: The Depression and Somatic Symptoms Scale (DSSS), which is a free scale that includes a depression subscale (DS) and a somatic subscale (SS), was developed to evaluate depression and somatic symptoms simultaneously. This study aimed to examine the reliability and validity of the DSSS among patients with chronic low back pain (CLBP). Methods: Two-hundred and twenty-five patients with CLBP were enrolled. Psychiatric diagnoses were made based on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision. The DSSS, Oswestry Disability Index, Hospital Anxiety and Depression Scale (HADS), and Short Form 36 (SF-36) were administered. Cronbach's alpha was used to test internal consistency. Receiver operating characteristic (ROC) analysis was used to identify cutoff scores for a major depressive episode (MDE). Results: Subjects with an MDE (N=21) had greater severities of depression, anxiety, somatic symptoms, and disability as compared with those without an MDE. The Cronbach's alpha values of the DS and SS were 0.90 and 0.83, respectively. The DS and SS were significantly correlated with the Oswestry Disability Index, the HADS, and the SF-36 subscales. The DS had the greatest area under the receiver operating characteristic curve (0.96) as compared with the SS and the HADS subscales. The cutoff score for an MDE was a DS score ≥15 (sensitivity and specificity: 100% and 88.7%, respectively). Conclusion: The DSSS subscales were of acceptable reliability and validity. The DS can be used as a tool for evaluating the severity of depression and detecting an MDE in patients with CLBP. [ABSTRACT FROM AUTHOR]