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Background and objectives Traditionally, the health-related quality of life (HRQoL) of patients with systemic lupus erythematosus (SLE) has been assessed using instruments that neglect the specific characteristics of the disease. This study determines the validity of the Lupus Quality of Life (LupusQoL) questionnaire as a psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela and establishes the cutoff points of the questionnaire for the Venezuelan population. Patients and methods A cross-sectional study was conducted that included patients with SLE from April to July 2018. Patients completed the LupusQoL and the “Generalitat de Catalunya” (GENCAT) scale; sociodemographic data, activity index (SLEDAI) and accumulated damage (SLICC), were obtained. Reliability was evaluated by internal consistency and the convergent validity of the LupusQoL was determined with the GENCAT scale. Results Of the 100 patients, 93% were women, the mean age was 42 years old (SD: 13) and the mean duration of the disease was 11 years (SD: 9); the mean of SLEDAI and SLICC was 3 and 1, respectively. The cutoff point that defined a “better” or “worse” HRQoL for LupusQoL was 64.55 points. A moderate convergence was found after grouping, according to the cutoff points, of the LupusQoL with the GENCAT scale (Cohen’s kappa coefficient = .556; p = .000). Conclusions The LupusQoL is a valid psychometrically stable instrument to measure the HRQoL of patients with SLE in Venezuela. Cutoff points were established to stratify the HRQoL in the Venezuelan population with LES, being useful to complement a comprehensive evaluation.

BACKGROUND F18-FET PET has an established diagnostic role in adult brain gliomas, here we analyzed image derived static & dynamic parameters with available conventional MRI, histological, clinical & follow up data in assessment of pediatric brain tumor patient at different stages of the disease. METHODS Forty-four pediatric patients with median age 7 years, diagnosed with brain tumors and underwent forty-seven 18F-FET PET scans either initially (20 scans) or post-therapy (27 scans) were enrolled. Standardized analysis of Summed FET PET images early from 10-20 min and late from 30-40 min post-injection were used for static (mean & maximum Tumor to Brain Ratio "TBR" & Biological Tumor Volume "BTV") parameters evaluation as well as the Time Activity Curve "TAC". RESULTS 19 out of 20 initially assessed patients had pathologically &/or clinico-radiologically proven neoplastic lesions and one patient had pathologically proven abscess. Receiver Operator Curve (ROC) marked early TBR max 2.95, early TBR mean 1.76, late TBR max 2.5 and late TBR mean 1.74 as discriminator points with diagnostic accuracy reaching 90% when TBR max was combined with dynamic parameters. Significant association was found between initial FET scans, early & late BTV & Event Free Survival "EFS" (P value =0.042 & 0.005 respectively). In post-therapy assessment, the diagnostic accuracy of conventional MRI was 81.48% when used alone and 96.30% when combined with F18-FET PET scan findings. A cutoff point of 3.2 cm3 for late BTV, in posttherapy scans, was successfully marked as a predictor for therapy response (P-value 0.042) and was significantly associated with EFS (P-value 0.002). In FET-avid / MRI non-enhancing lesions, early TBR max was able to detect highly malignant processes (high-grade tumors in initial scans & residue/recurrence in post-therapy scans) with 80% sensitivity & 100% specificity when cutoff value of 2.25 was used (P-value =0.024). In patients with FET-avid brainstem lesions, whether enhancing or non-enhancing in MRI scans, 81.8% were associated with high risk diagnoses and 68.2% of them were associated with poor therapy outcome. The degree of FET uptake matched tumor-grading, but did not show significant association with OS or EFS (P-value >0.05). CONCLUSIONS F18-FET PET seems to be an evolving pediatric neuroimaging technique with valuable diagnostic & prognostic information at initial and post-therapy evaluation.

Resumen Introducción. Los pacientes con cáncer presentan niveles significativos de malestar emocional. La National Comprehensive Cancer Network (NCCN) desarrolló un instrumento (Distress Management) para evaluarlo de forma rápida en pacientes oncológicos. Para su utilización en Colombia, se hizo la adaptación transcultural y se validó. Objetivo. Determinar las características operativas del instrumento de malestar emocional, versión 2.2018, en pacientes atendidos en el Instituto Nacional de Cancerología. Materiales y métodos. Previa autorización de la NCCN, se procedió a la traducción, adaptación transcultural y evaluación de las características operativas del instrumento. Se incluyeron 343 pacientes con diagnóstico de cáncer atendidos en el Instituto Nacional de Cancerología, quienes diligenciaron el instrumento adaptado transculturalmente. Se efectuó un estudio de prueba diagnóstica como patrón de referencia mediante una entrevista semiestructurada. Resultados. Los pacientes tenían una edad promedio de 49,7 años (DE=15) y la mayoría (67 %) eran mujeres. El instrumento tuvo un área bajo la curva ROC de 0,81 (IC95% 0,77- 0,86); el punto de corte óptimo fue de 3,5, el cual se aproximó a 4; la sensibilidad fue de 0,81 (IC95% 0,76-0,85) y la especificidad de 0,69 (IC95% 0,64-0,74). El porcentaje de acuerdo entre el resultado de la entrevista y el instrumento fue de 73 % (kappa=0,64; p

INTRODUCTION Kinesiophobia is a common symptom associated with high disability, and has been observed in patients with migraine. However, the association between kinesiophobia and clinical factors in this population is unknown. OBJECTIVE To assess the fear of falling, dizziness disability, and migraine disability in patients with migraine, considering the presence of kinesiophobia. METHODS Eighty patients with migraine completed the Tampa Scale for Kinesiophobia and were divided into two groups according to the questionnaire cutoff point: migraine without kinesiophobia (MoK, n = 39) and migraine with kinesiophobia (MK, n = 41). Fear of falling, dizziness disability, and migraine disability were assessed in both groups using validated questionnaires. RESULTS The MK group presented higher scores on dizziness disability, fear of falling, and migraine disability compared to the MoK (p

Background: Trans-arterial chemoembolization (TACE) is widely used as an interventional procedure in treatment of HCCs. ADC value can be used in evaluating its efficacy in order to rule out or in residual tumor tissue. Aim of Study: To assess the role of DWI and ADC value in evaluating HCCs post TACE. Patients and Methods: A retrospective analytical study on 25 patients with hepatocellular carcinoma (HCC); to assess therapeutic response of (HCC) cases after TACE by ADC mapping MRI technique in comparison to dynamic contrast study (DCE-MRI), to evaluate its accuracy, sensitivity and specificity in detecting treatment response/residual tumor. Results: Comparative study between the 2 groups revealed; highly significant increase in ADC value, in active group; compared to inactive group; with highly significant statistical difference (p 0.05). Spearman's correla-tion analysis shows that; AFP level had a highly significant negative correlation with ADC value; with highly significant statistical difference (p < 0.01). By using ROC-curve analysis, DWI/ADC value at a cutoff point (91.33) detected patients with residual active lesions, with good accuracy (84%), sensitivity 84% and specificity 83% (p=0.0001). Conclusion: ADC maps can be used as a quantitative value to differentiate between active and inactive tumors and in monitoring response to treatment in oncological patients.

BACKGROUND In Japanese high schools, understanding of school non-attendance and students with developmental disabilities, including autism spectrum disorder (ASD), is gradually improving. On the other hand, few people recognize social anxiety disorder (SAD), the onset of which commences during youth. Social anxiety disorder and ASD share various overlapping characteristics but have different diagnostic criteria. The anxiety caused by these disorders sometimes appears as school non-attendance. This study examines the relationship between SAD, ASD, and history of school non-attendance in high school students. METHODS One hundred and fifty-eight students at one Japanese high school that accepts school non- attending students were investigated. To understand the features of ASD and how it relates to SAD tendencies, the Liebowitz Social Anxiety Scale - Japanese (LSAS-J) and Autism-Spectrum Quotient - Japanese (AQ-J) were used. Based on the LSAS-J cutoff point, participants were divided into high and low anxiety groups and then data were compared between the two groups. Potential factors associated with a high-SAD trend were evaluated using multivariate logistic regression. RESULTS The results showed that students with high ASD scores were more likely to have SAD and that a lack of "social skill," a subscale of ASD, was closely associated with a social anxiety trend. However, the relationship between school non-attendance and social anxiety could not be confirmed. CONCLUSIONS Focusing on the lack of social skills in ASD may provide an opportunity to identify students with high SAD tendencies. This study will contribute to the understanding of high school students with high SAD tendencies in Japan.

Background/Aims: Although balloon-assisted enteroscopy (BAE) enables endoscopic visualization of small bowel (SB) involvement in Crohn’s disease (CD), there is no data on the changes in outcomes over time. We therefore investigated the changes in BAE use on CD patients over different time periods in terms of its role and clinical outcomes. Methods: We used a multicenter enteroscopy database to identify CD patients with SB involvement who underwent BAE (131 procedures, 116 patients). We compared BAE-related factors and outcomes between the first period (70 procedures, 60 patients) and the second period (61 procedures, 56 patients). The specific cutoff point for dividing the two periods was 2007, when BAE guidelines were introduced. Results: Initial diagnosis of SB involvement in CD was the most common indication for BAE during each period (50.0% vs 31.1%, p=0.034). The largest change was in the number of BAE uses for stricture evaluation and/or treatment, which increased significantly in the latter period (2.9% vs 21.3%, p=0.002). The diagnostic yield in patients with suspected CD was 90.7% in the first period and 95.0% in the second (p=0.695). More endoscopic interventions were performed in the second period than in the first (5.1% vs 17.6%, p=0.041). Enteroscopic success rates were high throughout (100% in the first period vs 80.0% in the second period, p>0.999). In the first and second periods, therapeutic plans were adjusted in 62.7% and 61.4% of patients, respectively. Conclusions: The overall clinical indications, outcomes, and effectiveness of BAE were constant over time in CD patients with SB involvement, with the exception that the frequency of enteroscopic intervention increased remarkably. (Gut Liver 2021;15:375-382)

The occurrence of low birth weight (LBW) can be reduced by opti mizing gestational weight gain. However, the gestational weight cannot be monitored properly as there are a lot of mothers who receive Antenatal Care (ANC) less than four times as recommended by WHO. Therefore, this study ai med to determine whether early third trimester gestational weight could predict the incidence of LBW among new borns. A cross-sectional study was conducted using secondary data from Anny Rahardjo Maternity Clinic’s registry. A total of 278 eligible data of pregnant mothers who visited the clinic in 2017 – 2018 was chosen as study subjects. The mean for weight of birth was 3112.77 ± 384.40 g and early third trimester was 63.52 ± 11.07 kg. The prevalence of L BW was 3.2%. Early third trimester weight was found as the dominant factor of LBW after controlling the length of g estation. Early third trimester weight is signifi cantly correlated with LBW (p < 0.001). The optimum cutoff point was 59.8 kg with AUC = 0.68 (CI 95% = 0.52 – 0.83), sensitivity 67%, specifi city 63%, positive predictive value 5.66%, and negative predic tive value 98.2%. The early third trimester weight is able to predict LBW with optimal cutoff value 59.8 kg.

Background and purpose Rapidly recognizing patients with large-vessel occlusion stroke (LVOS) and transferring them to a center offering recanalization therapy is crucial of maximizing the benefits of early treatment. We therefore aimed to design an easy-to-use recognition instrument for identifying LVOS. Methods Prospective data were collected from emergency departments of 12 stroke-center hospitals in China during a 17-month study period. The Stroke Aid for Emergency (SAFE) scale is based on consciousness commands, facial palsy, gaze, and arm motor ability. Receiver operating characteristic analysis was used to obtain the area under the curve for the SAFE scale and previously established scales to predict LVOS. Results The SAFE scale could accurately predict LVOS at an accuracy rate comparable to that of the National Institutes of Health Stroke Scale (c-statistics: 0.823 versus 0.831, p = 0.4798). The sensitivity, specificity, positive predictive value, and negative predictive value for the SAFE scale were 0.6875, 0.8577, 0.6937, and 0.8542, respectively, with a cutoff point of 4. The SAFE scale also performed well in a subgroup analysis based on the patients' ages, occluded vessel locations, and the onset-to-door times. Conclusions The SAFE scale can accurately recognize LVOS at a rate comparable to those of other, similar scales.

Background: Ankylosing spondylitis (AS) has been afflicting humankind as far back as ancient Egypt. Macrophage migration inhibitory factor (MIF) appears to have the unique ability to drive both inflammation and new bone formation and could play an important role in the pathogenesis of AS. Objective: The study aimed to evaluate MIF as a diagnostic biomarker in AS. Patients and Methods: This study was conducted on 42 subjects; 21 AS cases and 21 controls. Patients were subjected to full medical history, general and musculoskeletal examinations, laboratory investigations including serum MIF level, sacroiliac X-ray, sacroiliac MRI with the Ankylosing Spondylitis Disease Activity Score (ASDAS) for disease activity. Results: Regarding gender of the patients, the majority (71.4%) of patients were males; while (28.6 %) were females. We found that; the mean disease duration of AS patients was (15.05 ± 6.69) years; while the mean ASDAS score was (2.78 ± 0.68). We also found that, (71.4%) of AS patients received NSAIDs, (95.2%) received disease-modifying anti-rheumatic drugs (DMARDs), (57.1%) received tumour necrosis factor inhibitors (TNFi). Regarding imaging findings in our study, (61.9 %) of AS patients had sacroiliitis in sacroiliac X-ray while (100 %) of AS patients had sacroiliitis in sacroiliac MRI. Conclusion: Serum MIF levels are elevated in AS patients. ROC-curve analysis showed that the best cutoff point of MIF was (>41.3) with area under curve (0.625), with fair accuracy (57.1%), sensitivity (80%) and specificity (50%).

[Objective] This study examined seasonal differences in continuous positive airway pressure (CPAP) therapy adherence among patients with obstructive sleep apnea (OSA). [Methods] Patients aged ≥20 years with OSA who had used CPAP devices on the automatic setting for >12 consecutive months (n = 141) were included in this retrospective study from December 2015–2016. The information of CPAP use (pressure, hours of actual use) was extracted from database downloaded from patients’ CPAP devices. Patients were divided into adherent and non-adherent groups using the cutoff point of 70% CPAP use for ≥4 h daily over the 1-year study period. CPAP use data were averaged for each season. [Results] Patients in the adherent group were significantly older than those in the non-adherent group (p < 0.001). In the adherent group, the rate of ≥4 h daily CPAP use was significantly lower, the daily duration of CPAP use was significantly shorter, and the residual apnea–hypopnea index (AHI; events/hour) was significantly higher in summer than in other seasons (all p < 0.001). In the non-adherent group, the duration of daily CPAP use and the AHI differed significantly between winter and summer (p = 0.008 and p < 0.001, respectively). [Conclusions] Seasonal changes were associated with the CPAP adherence of patients with OSA. The study findings suggest that there is possibility of increasing the duration of CPAP use by adjusting the bedroom environment in hot and humid seasons.

In 2018 EWGSOP2 has suggested low muscle strength as the primary parameter of sarcopenia. The consensus has recommended SARC-F questionnaire as a screening test to find cases with low muscle strength which has been designated as probable sarcopenia. We aimed to study the ability of SARC-F to find probable sarcopenia cases in older patients. Retrospective, cross-sectional. Istanbul University Istanbul Faculty of Medicine A total of 456 older adults (71.1% female, mean age: 74.6±6.6 years) We diagnosed probable sarcopenia by EWGSOP 2 criteria, i.e., presence of low handgrip strength (HGS). SARC-F questionnaire was performed by all participants. We used a receiver operating characteristics curve to obtain SARC-F cut-off values to detect probable sarcopenia and calculated the area under the curve and 95% confidence interval (CI). We included 456 participants (71.1% female; mean age: 74.6 ± 6.6 years). Probable sarcopenia was present in 58 (12.7%). SARC-F cut-off ≥ 2 presented the best balance between sensitivity and specificity (sensitivity: 64.9% vs specificity: 67.9%) to detect probable sarcopenia [the area under the receiver operating characteristics curve (AUC) = 0.710; 95% Cl: 0.660–0.752, p< 0.001]. SARC-F with a cutoff point ≥ 1 had sensitivity 84.2% and specificity 40.5% and SARC-F ≥ 4 had high specificity 88.2% with 40.3% sensitivity. SARC-F is a good screening tool for sarcopenia in practice. Our findings suggest SARC-F ≥ 1 cut-off point to be used as the probable sarcopenia screening tool regarding its high sensitivity. Consequently, SARC-F ≥ 4 cut-off is better to be used if one prefers to exclude probable sarcopenia.

Background Locomotive syndrome (LS) is a condition of decreased mobility caused by disorders of the locomotive organs. Lumbar spinal stenosis (LSS) is a LS disorder. The Japanese Orthopaedic Association score (JOA score) and the Zurich Claudication Questionnaire (ZCQ) are international evaluation tools for LSS. However, the relationship between LS and JOA score or ZCQ is unknown. This study aimed to clarify the correlations between LS progression and the values/parameters of the JOA score or ZCQ and to determine the critical cutoff point of the JOA score or ZCQ that indicates LS progression. Methods We recruited preoperative LSS patients (n = 82). Patients' mean age was 73.4 years. The study participants were evaluated using the 25-question Geriatric Locomotive Function Scale (GLFS), JOA score, and ZCQ (which consists of symptom severity and physical function), and the patients' health-related quality of life was assessed using EuroQoL-5 dimension (EQ-5D) utility values and the EuroQoL-visual analog scale (EQ-VAS). We investigated the correlations between the 25-question GLFS and each clinical variable and evaluated the critical cutoff point of each international evaluation tool to detect LS. Results There was a statistically significant correlation between 25-question GLFS and each clinical evaluation tool. LSS patients with LS showed significantly worse scores in the evaluation tools than LSS patients without LS. Moreover, we found that critical cutoff points of 17.5 on JOA score, 3.1 on ZCQ-symptom, and 2.3 on ZCQ-function could detect LS. Conclusions A statistically significant correlation exists between the 25-question GLFS and the JOA score or ZCQ. It might be important to perform decompression surgery for LSS patients before they reach the cutoff values of the several clinical evaluation tools to avoid LS progression. Study design Clinical prospective case–control study.

Aim Early differential diagnosis between patients with major depressive disorder (MDD) and bipolar disorder (BD), and subsequently providing appropriate treatments are essential. There has been increased interest regarding the association between affective temperaments and mood disorder diagnosis. Our aim was to analyze the diagnostic validity of affective temperaments assessed by the short version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego-autoquestionnaire version (TEMPS-A), in mood disorder patients. Methods Inpatients with MDD (n = 146) or BD (n =128) completed the short version of TEMPS-A, and their depressive and manic symptom severities were evaluated. Data of MDD and BD patients were compared by univariable and multivariable analyses. Results Of the 5 affective temperament dimensions, substantially higher hyperthymic, irritable, and cyclothymic temperament scores were found in BD patients than in MDD patients. Using a multivariable logistic regression model built using the severities of depressed and manic conditions, and the 5 affective temperament subscale scores as independent variables, we identified 2 factors statistically associated with BD diagnosis (anxious temperament and cyclothymic temperament). The recommended cutoff point for the 12 items evaluating cyclothymic temperament to differentiate BD from MDD was 8 or more "True" items (sensitivity: 35.9%, specificity: 87.7%). Limitations Our design was cross-sectional, and therefore, there was a possibility of longitudinal diagnostic conversion of patients from MDD to BD. Conclusion Cyclothymic and anxious temperaments on the short version of TEMPS-A, identified as diagnostic differentiating factors between MDD and BD, may play supplementary roles in the early identification of BD. This article is protected by copyright. All rights reserved.

The aim of study was to explore the correlation between shear wave elastography (SWE) and grade group (GG) of prostate cancer (PCa). This retrospective study involved prostate-specific antigen elevated patients with elevated prostate-specific antigen levels who underwent SWE before transrectal ultrasound-guided needle biopsy. A total of 49 PCa lesions were reviewed after radical prostatectomy; 3-7 regions of interest were placed within the cancerous area on axial view compared with the tumor foci outlined on the slides by pathologist. The maximum SWE value was measured, quantitative SWE parameters (Emax, Emean, Emin and standard deviation [SD]) were recorded and correlated with GG and then parameters were compared between indolent (≤2) and aggressive (≥3) GGs. The diagnostic value of each parameter was compared with the receiver operating characteristic curve. Forty-nine PCa foci were divided into two groups on the basis of their GGs. All SWE parameters exhibited a significant linear trend with GG. The area under the receiver operating characteristic curve (AUC) was 0.816 for Emax; with a cutoff point of 84 kPa, sensitivity and specificity were 81.3% and 82.4% to differentiate low and high GGs in PCa. The AUC was 0.776 for Emean; with a cutoff point of 71 kPa, sensitivity and specificity were 78.1% and 76.5%. For Emin, the AUC was 0.739; with a cutoff point of 60 kPa, sensitivity and specificity were 68.8% and 70.6%. For SD, the AUC was 0.681; with a cutoff point of 8.3 kPa, sensitivity and specificity were 46.9% and 94.1%. There were no significant differences between the four SWE parameters (p < 0.05 for all). SWE features were correlated with GGs, and this correlation may have excellent diagnostic performance in predicting high GG in PCa.

Introduction Diagnosis of very short-segment Hirschsprung's disease (vsHD) by rectal suction biopsy is challenging as its aganglionic zone (AZ) overlaps with physiologic hypoganglionic zone and calretinin-positive mucosal nerves may extend from the transition zone (TZ) into AZ. We studied whether an increasing trend/gradient of calretinin-positive mucosal nerves along the distance from AZ toward TZ aids in diagnosis of HD. Materials and Methods In this study, 46 rectal suction biopsies from non-HD and HD, and 15 pull-through specimens from short-segment HD were evaluated by mucosal calretinin immunostain (CI) and image processing and analysis (IPA) to measure pixel count (PC, the percentage of calretinin stained pixels in the mucosa). Consecutive longitudinal sections of proximal AZ toward distal TZ in HD pull-through specimens were utilized as a vsHD surrogate model. First, we studied variability of mucosal CI in non-HD biopsies along the distance from dentate line. Second, we determined a cutoff point of mucosal CI by IPA that separated non-HD versus HD and applied this cutoff to longitudinal sections from proximal AZ to distal TZ segments in HD pull-through specimens. Third, we studied whether an increasing trend of mucosal CI was universally observed in HD pull-through. Results Our findings included a significant variability in PC along the biopsy distance in non-HD cases. Positive mucosal CI was found in proximal AZ in 6 (43%) of 14 HD pull-through, among which 1 case lacked submucosal nerve hypertrophy in the proximal AZ. All 14 HD pull-through cases showed an increasing trend/gradient of PC from AZ toward TZ. Conclusion Based on our findings, the presence or absence of mucosal CI positivity and submucosal nerve hypertrophy may not reliably diagnose vsHD in rectal suction biopsy. While we acknowledge that the density of mucosal innervation in variable contexts and anatomical locations is unknown and yet to be explored, our study suggests that an increasing trend of positive mucosal CI from AZ toward TZ by IPA might prove to be a useful tool for the diagnosis of vsHD in the future.

Background and Purpose: The minor stroke concept has not been analyzed in intracerebral hemorrhage (ICH) patients. Our purpose was to determine the optimal cut point on the NIH Stroke Scale (NIHSS) for defining a minor ICH (mICH) in patients with primary ICH. Methods: An ICH was considered minor if associated with a favorable 3-month outcome (modified Rankin Scale score ≤2). For supratentorial ICH, the discovery cohort consisted of 478 patients prospectively admitted at University Hospital del Mar. Association between NIHSS at admission and 3-month outcome was evaluated with area under the curve-receiver operating characteristics (AUC-ROC) and Youden’s index to identify the optimal NIHSS cutoff point to define mICH. External validation was performed in a cohort of 242 supratentorial ICH patients from University Hospital Sant Pau. For infratentorial location, patients from both hospitals ( n = 85) were analyzed together. Results: The best ­NIHSS cutoff point defining supratentorial-mICH was 6 (AUC-ROC = 0.815 [0.774–0.857] in the discovery cohort and AUC-ROC = 0.819 [0.756–0.882] in the external validation cohort). For infratentorial ICH, the best cutoff point was 4 (AUC-ROC = 0.771 [0.664–0.877]). Using these cutoff points, 40.5% of all primary ICH cases were mICH. Of these, 70.2% were living independently at 3-month follow-up (72% for supratentorial ICH and 56.1% for infratentorial ICH) and 6.5% had died (5.3% for supratentorial ICH, and 14.6% for infratentorial ICH). For patients identified as non-mICH, good 3-month outcome was observed in 11.3% of cases; mortality was 51%. Conclusions: The definition of mICH using the NIHSS cutoff point of 6 for supratentorial ICH and 4 for infratentorial ICH is useful to identify good outcome in ICH patients.

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.

Tumor size has an effect on decision making for the treatment rectal cancer. Transanal local excision can be selected to remove rectal cancer with favorable histopathological features. It is generally recognized that the risk of lymph node involvement and distant metastases increases as the tumor enlarges. However, the majority of the studies classified patients into two groups using concrete value as a cutoff point. The coarse classification was not sufficient to reveal a correlation between the tumor size and lymph node status or distant metastases across the full range of sizes examined. Between 1988 and 2015, a total of 77,746 patients were diagnosed with first primary rectal cancer who had not received neoadjuvant therapy. These subjects were identified using the Surveillance, Epidemiology and End Results (SEER) database. The association between tumor size, lymph node status, distant metastases and cancer-specific mortality was investigated. Tumor size was examined as a continuous (1-30 mm) and categorical variable (11 size groups; 10-mm intervals). A non-linear correlation between increasing tumor size and the prevalence of lymph node involvement was observed, while a near-positive correlation between tumor size and distant metastases was presented. In addition, the 5-year and 10-year rates of rectal cancer-specific mortality were increased as the tumor enlarged. For small tumors (under 30 mm), a positive correlation was noted between tumor size and lymph node involvement. The clinical value of the tumor size should be reevaluated by exact classification.

Background: Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (PEL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid. Methods: A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of PEL after the aspiration of 500 mL of fluid was done with “PEL 0.5” (cm H2O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The PEL values were compared with pleurodesis outcomes. Results: After 4-week of follow-up, the success rate of pleurodesis was 65%. The PEL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of PEL 0.5 >14.5 cm H2O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p

The aim of this study was to estimate a cut-off point in the time spent in sedentary behavior as a discriminator of the presence of diabetes mellitus in the elderly population. Methods: cross-sectional study, population-based, with data from 310 low-income elderly people from Ibicui-BA, Brazil, randomly selected. Sedentary behavior was assessed by time spend in sitting week and weekend, and diabetes was assed by self-reported. The data were analyzed using descriptive statistics, Received Operations Curve, and Poisson regression (p ≤ 0.05). The mean time spent in sedentary activities was 272.63 ± 163.71 min/day. The overall prevalence of diabetes was 13.5%. The sociodemographic characteristics, life habits and presence of diabetes have not been shown a statistically significant association (p> 0.05). The area under the ROC curve was 0.60, 95% CI (0.54-0.65) and p=0.003 and the cutoff point was >325 min/day which best discriminated the presence of diabetes mellitus between the elderly people. The raw and adjusted analysis for the association between sedentary behavior and diabetes revealed no association between the variables. It was identified that the time spent in sedentary behavior has a good discriminatory capacity for the presence of diabetes mellitus. On the other hand, there was no association between the first one and the presence of Diabetes, after adjustment for the intervening variables.

Background: When diagnosing premature rupture membranes is query, choosing the appropriate management needsadditional confirmatory test. Based on their metabolomics, some biochemical markers have been proposed as diagnosticaids. A perfect test could be composed of combining more than one marker. Combining markers is not arbitrary as somecombinations could inversely impact the diagnostic accuracy of the test.Aim: Improving sensitivity and specificity of diagnosis of preterm premature rupture of membranes by combining quantitativeinsulin like growth factor binding protein 1 (IGFBP-1) with quantitative βHCG and/or quantitative prolactin in cervicovaginalfluid.Materials and Methods: It is a cross sectional study. IGFBP-1, prolactin and β-HCG concentrations in vaginal fluid wereexamined in 180 patients with sure membrane state and the diagnostic accuracy of each marker and each combination wasdetermined. The study was conducted between January 2018 and September 2018 in Ain-Shams University MaternityHospital after the approval of the institutional ethics committee. Informed consent has been obtained from the patientsbefore participation.Results: The sensitivity, specificity, PPV, and NPV of Prolactin with cutoff point 11 μIU/ml are 84.4, 73.2, 73.8,and 79.5, respectively, gives accuracy percentage 75.4%. The sensitivity, specificity, PPV, and NPV of ILGFBP-1 withcutoff point 102 μIU/ml are 88.3, 93.5, 100, and 69.4 respectively gives accuracy percentage 81.5%. The sensitivity,specificity, PPV, and NPV of Β-HCG with cutoff point 104 mIU/mL are 85.1, 83.9, 96.2, and 72.8 respectively givesaccuracy percentage 79.9%. The sensitivity, specificity, PPV, and NPV of the combination of IGFBP-1 and β-HCGare 78.4, 100, 100 and 64 respectively gives accuracy percentage 89.7. The sensitivity, specificity, PPV, and NPV of thecombination of IGFBP-1 and prolactin are 78.4, 100, 100 and 68.7, respectively, gives accuracy percentage 84.2. Thesensitivity, specificity, PPV, and NPV of the combination of β-HCG and prolactin are 79.8, 100, 100 and 63.6 respectivelygives accuracy percentage 77.2.Conclusion:Combining IGFBP-1 and β-HCG is the best diagnostic combination to detect amniotic fluid presence invaginal fluid. Combined IGFBP-1 and prolactin offered very little improvement compared to IGFBP-1 alone. Addingprolactin to β-HCG decreased accuracy than each of the other two markers alone.

Objectives The need for a unified definition of weight loss (WL) after bariatric surgery has recently been highlighted. We aimed to evaluate the reliability of two clinically common WL indications including percentage of total WL (%TWL) and percentage of excess WL (%EWL) through comparing their performances in predicting metabolic syndrome (MetS) remission 1 year after bariatric surgery. Methods A total of 430 individuals with obesity who underwent bariatric surgery were enrolled. Participants were evaluated for changes in anthropometric parameters, metabolic indexes, MetS components and medications before and 1 year after surgery. MetS was defined using the criteria of the National Cholesterol Education Program Adult Treatment Panel III criteria for Asian-Americans. Results The prevalence of MetS is 92.3% (397) at baseline. One year after bariatric surgery, 337 individuals (84.9%) were in MetS remission. The multivariate adjusted ORs were 1.16 (95% confidence interval [CI] 1.10-1.22) for each 1% increase in %TWL for MetS remission and 1.18 (95% CI 1.11-1.25) for each 5% increase in %EWL. This association with MetS remission remained statistically significant for %TWL after additional adjustment for %EWL (P for trend 0.029), and disappeared for %EWL. Receiver operating curve (ROC) analyses showed that the %TWL was more predictive than the %EWL (AUC%TWL vs. AUC%EWL, 0.749 vs. 0.700, p = 0.023). The Youden index indicated that the optimal %TWL cutoff point to identify MetS remission was 25%. Conclusions We recommend that good responders to bariatric surgery should be defined as those exhibiting %TWL ≥ 25%.

We introduced a method to measure the extent of myocardial ischemia and steal with SPECT MBF quantitation. Eighty-seven patients who received rest/Dipyridamole-stress 99mTc-Sestamibi (MIBI) dynamic SPECT scans and coronary angiography were included. Dynamic SPECT images were reconstructed with full physical corrections. The one-tissue kinetic model was utilized to quantify K1 and further converted to MBF with required corrections. Rest MBF, stress MBF and myocardial flow reserve (MFR) were converted to a flow status polar map by a flow diagram. Extents of 7 flow statuses were verified their cutoff points for detecting stenoses. The diagnostic performance (DP) was compared to that of MFR. Cutoff point of the extent to detect ≥ 50% stenosis was 3.01% for ischemia–steal status and 20.3% for the combined status of ischemia–steal and moderate. Using these criteria, sensitivity, specificity and accuracy to detect ≥ 50% stenosis were (80%, 75%, 79%) and (86%, 68%, 80%) for ≥ 70% stenosis. The DP was superior to that of MFR

The aim of the study was to evaluate the reliability of 7 anthropometric indices in predicting cardiovascular risk markers (CRMs) and metabolic syndrome (MetS) in Brazilian adolescents.A cross-sectional study conducted with 1,069 participants of the Cardiovascular Risk in Adolescents Study aged 12-17 years. Receiver operating characteristics curves were plotted, and area under curve (AUC) was calculated for body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHR), conicity index (CoI), body shape index (BSI), adjusted BSI for adolescents (adjusted BSI), and body roundness index (BRI).In girls, reliability of BMI, WC, WHR, and BRI was sufficient (≥.6 AUC.7) only to predict high blood pressure. Among boys, reliability of BMI, WC, WHR, BRI, and adjusted BSI ranged from good to sufficient (≥6 AUC.8) to predict insulin resistance and high blood pressure, but poor to sufficient (≥.5 AUC.7) for high total cholesterol, triglycerides, and low-density lipoprotein. For both sexes, CoI and BSI presented AUC ≤.5 for all CRM. A majority of the anthropometric indices showed AUC ≥.9 for MetS.Reliability of CoI, BSI, adjusted BSI, and BRI is not superior to BMI, WC, and WHR in predicting CRM and MetS. All the anthropometric indices had excellent predictive capacity for MetS, but limited accuracy for CRM. Among the evaluated indices, we recommend the use of cutoff point WHR ≥.55 to screening MetS in girls and boys because of its easy to measure and interpretation.

In carpal tunnel volume measurements, the angle of the hamatum curvature is not considered a variable, and its effect on carpal tunnel volume has not been investigated. We hypothesize that a change in the anatomical angle of the hamatum curvature changes the carpal tunnel volume. To prove our hypothesis, we used a mathematical simulation model considering the carpal tunnel as a truncated cone. We reviewed the wrist CT scans of 91 adults (>18 years of age), including 51 men and 40 women. We measured the angle of the hamatum curvature in the CT scans. We measured cross-sectional areas at the outlet of the carpal tunnel at the level of the trapezium and hook of hamate (r1) and at the inlet at the level of the scaphoid and pisiform (r2) and the length (h) of the carpal tunnel. We attempted to calculate the effect of 2 degree by 2-degree changes in the angle of the hamatum curvature between the angles of 98° and 140° on the carpal tunnel volume. The mean angle of the hook of hamatum of the subjects was 122.55° ± 8.20° (range, 97.20° − 139.31°). No suitable cutoff point was found for the angle values. There was no difference between the gender groups according to the angle value. The data clearly show that there is a high correlation between carpal tunnel volume and the angle of hamatum curvature. The results of our study emphasize the importance of taking into account the anatomical features of the hamatum bone, especially the angle of curvature, which may play a predisposing role in idiopathic carpal tunnel syndrome.

Purpose We investigated the prevalence of generalized tonic-clonic seizures (GTCSs) in patients with idiopathic generalized epilepsy (IGE) and the risk factors associated with them. We also studied the seizure outcome in patients with IGEs. Methods In this retrospective study, all patients with a diagnosis of IGE were recruited at the epilepsy clinic at Shiraz University of Medical Sciences, from 2008 through 2019. Age, gender, age at seizure onset, seizure type(s), EEG findings, and seizure outcome of all patients were registered. Results A total of 601 patients with IGE were studied; 516 patients (86%) had GTCSs. The ROC curve showed that reporting GTCSs was significantly associated with the time since the start of the disease (P = .0001; area under the curve = 0.71 [95% CI: 0.66-0.76]; a cutoff point of 4 years [sensitivity = 61% and specificity = 76%]). Age at onset was 3.3 years later in patients with GTCSs compared with that in patients without GTCSs. Generalized spike-wave complexes during interictal EEG recording were more frequently observed among patients without GTCSs. Generalized tonic-clonic seizures were significantly associated with experiencing seizure-related injuries. Valproate reduced the risk of experiencing GTCSs significantly (OR: 0.58; 95% CI: 0.34-0.99; P = .04). Conclusion Generalized tonic-clonic seizures do not affect the seizure outcome in patients with IGEs per se, but how we manage them significantly affects the seizure outcome in these patients. Failure to prescribe valproate for women with IGE, particularly when another first-line treatment has failed, may not be in a patient's best interests.

Background To date, anatomic tumor length is a key criterion for cancer staging and can be used to evaluate the effectiveness of therapies. This article describes growth pattern that can be used as a new characteristic to represent disease burden and tumor features and predict lymphatic metastasis. Methods Patients with breast cancer were included in this 10-year (1999–2008) hospital-based multicenter retrospective study. The pathologic length/height ratio was used to illustrate the correlation between tumor features, behaviors and treatments in breast malignancies. The most appropriate ratio was chosen based on the comprehensive evaluation of p value and changing trend of each characteristic. Results The sample consisted of 4211 women diagnosed with breast cancer. Among them, 2037 patients with complete pathologic length, width and height information were included in the final analysis. There were 2.34 ± 4.77 metastatic lymph nodes for spheroid tumors and 3.21 ± 5.82 for ellipsoid tumors when the cutoff point was 2. In addition, the proportion of ellipsoidal tumors gradually increased from 54.36 to 56.67% in the upper outer quadrant (UOQ) and from 6.7 to 9.03% in the central region with an increase in the cutoff point. The proportion of ER + PR + ellipsoid tumors significantly decreased from 50.1 to 45.35% and that of ER–PR ellipsoid tumors significantly increased from 32.73 to 36.24% with an increase in the cutoff point. Additionally, the best length/weight ratio to distinguish spheroid and ellipsoid tumors was 2. Conclusion This study described for the first time how growth pattern is correlated with tumor malignancy and how it influences the selection of therapeutic strategies for patients.

To find if there is any potential benefit of serum Sphingosine-1-Phosphate (S1P) level in the diagnosis of Bladder Pain Syndrome/Interstitial Cystitis (BPS/IC). Patients newly or previously diagnosed with BPS/IC between September 2017 and December 2018 were included. Healthy individuals who volunteered to enter the study were included as control group. The measurements of serum S1P in both groups were compared. Multiple regression analysis was conducted to find out the significant factors affecting S1P results. A total of 47 BPS/IC patients and 47 healthy controls were included. BPS/IC patients were older than controls (48.5 ± 12.4 vs 38.9 ± 8.1 years, p

Background The generation of subclonal (low-frequency) mutations is driven by tumor mutations and the relationship between the heterogeneity of tumor mutation abundance and non-small cell lung cancer (NSCLC) remains unknown. We investigate the role of allele frequency heterogeneity (AFH) defined by circulating tumor DNA (ctDNA) profiling in predicting prognosis in advanced NSCLC patients. Methods Publicly available data set of POPLAR (N=211) and OAK (N=642) trials were used for analyzing. A low ratio of allele frequency (AF) of a mutation to the maximum-somatic-allele-frequency (MSAF) was used to define the presence of AFH. The prognostic value of AF/MSAF ratio that was below a defined cutoff point in overall survival (OS) was evaluated using Cox-proportional hazards regression; and the structural break point was determined by LOESS regression and Chow test. The derived AFH was also explored in an independent cohort (N=259) of advanced NSCLC receiving first-line EGFR-TKIs from the First Affiliated Hospital of Guangzhou Medical University. Results In the POPLAR and OAK cohort, low AF/MSAF ratio was found to be significantly associated with unfavorable OS in univariate and multivariate analysis. The structural break point analysis demonstrated that AF/MSAF

Background aVR lead is often neglected in routine clinical practice largely because of its undefined clinical utility specifications. Nevertheless, positive T-wave in aVR lead has been reported to be associated with poor clinical outcomes in some cardiovascular diseases. This study aimed to prospectively investigate the prognostic value and clinical utility of T-wave amplitude in aVR lead in patients with acute ST-elevation myocardial infarction (STEMI). Methods A total of 340 STEMI patients admitted to a tertiary heart center were consecutively included. Patients were categorized into four strata, based on T wave amplitude in aVR lead in their admission ECG (i.e. Results In-hospital mortality, re-hospitalization, and six-month-mortality significantly varied among four T wave strata and were higher in patients with a T wave amplitude of ≥ 0 mV (p 0.001–0.002). The groups of patients with higher T wave amplitude in aVR, had progressively increased relative risk (RR) of in-hospital mortality (RRs ≤ 0.01, 0.07, 1.00, 2.30 in four T wave strata, respectively). T wave amplitude in the cutoff point of − 1 mV exhibited a sensitivity and specificity of 95.83 (95% CI 78.88–99.89) and 49.68 (95% CI 44.04–55.33). Conclusion Our study demonstrated a significant association of positive T wave in aVR lead and adverse clinical outcomes in STEMI patients. Nevertheless, the clinical utility of T-wave amplitude at aVR lead is limited by its low discriminative potential toward prognosis of STEMI.

Introduction and Objectives: Most multi-biomarker strategies in acute heart failure (HF) have only measured biomarkers in a single-point time. This study aimed to evaluate the prognostic yielding of NT-proBNP, hsTnT, Cys-C, hs-CRP, GDF15, and GAL-3 in HF patients both at admission and discharge. Methods: We included 830 patients enrolled consecutively in a prospective multicenter registry. Primary outcome was 12-month mortality. The gain in the C-index, calibration, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) was calculated after adding each individual biomarker value or their combination on top of the best clinical model developed in this study (C-index 0.752, 0.715-0.789) and also on top of 4 currently used scores (MAGGIC, GWTG-HF, Redin-SCORE, BCN-bioHF). Results: After 12-month, death occurred in 154 (18.5%) cases. On top of the best clinical model, the addition of NT-proBNP, hs-CRP, and GDF-15 above the respective cutoff point at admission and discharge and their delta during compensation improved the C-index to 0.782 (0.747-0.817), IDI by 5% (p < 0.001), and NRI by 57% (p < 0.001) for 12-month mortality. A 4-risk grading categories for 12-month mortality (11.7, 19.2, 26.7, and 39.4%, respectively; p < 0.001) were obtained using combination of these biomarkers. Conclusion: A model including NT-proBNP, hs-CRP, and GDF-15 measured at admission and discharge afforded a mortality risk prediction greater than our clinical model and also better than the most currently used scores. In addition, this 3-biomarker panel defined 4-risk categories for 12-month mortality., & nbsp;This work was supported by grants from Redes Tematicas de Investigacion Cooperativa en Salud del Instituto de Salud Carlos III (REDINSCOR), Madrid, Spain (grant no. RD06-0003-0000) and Red de Investigacion Cardiovascular del Instituto de Salud Carlos III (RIC), Madrid, Spain (grant no. RD12/0042/0002).

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 ResultThe 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 ConclusionPCTVi-L <16.6 and PCTVi-L/TLL i-L <16.75 and PCTVi-L/TLL i-L <15.15, and PCTVi-L/TLL

The accurate identification of mastitis‐causing bacteria assists in effective management by both dairy farmers and veterinarians and can be used to implement the selective use of antimicrobials for treatment. The purpose of this study was to evaluate the ability of our developed anti–ribosomal protein-L7/L12 antibody–coated immunochromatographic strip (ICS) test to detect coliforms in milk by comparing the results with the bacteriological culture method. We investigated the performance of the ICS test as compared with the bacteriological culture method using 308 milk samples from clinical bovine mastitis. First, to determine the optimal ICS test cutoff point for detecting coliform mastitis, we developed a receiver-operating characteristic curve. The result showed that the cutoff point was at 0.5 of our index. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the ICS test were 81.3%, 84.8%, 69.2%, and 91.54%, respectively. As the clinical signs increased in severity, the F-measure, a weighted harmonic mean of the sensitivity and overall PPV performance, increased. Because it is especially important to treat clinical mastitis appropriately in the early stages of detection, the ICS test, which can be used by both dairy farmers and veterinarians on dairy farms, is considered to be a useful tool for detecting coliform mastitis, which often presents with severe signs.

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., Lay abstract Glioblastoma is a highly aggressive cancer with less than 6% of patients surviving at 2 years from diagnosis. Patients with hypermethylation of the MGMT gene promoter have improved survival compared with those with unmethylated MGMT. There is considerable debate regarding the ideal cutoff value for calling MGMT promoter hypermethylated or not. The authors performed a retrospective study of 109 patients diagnosed with glioblastoma from 2000 to 2018 to determine the optimal cutoff point. Using receiver operating characteristic (ROC) analysis, the researchers determined that 21% is the optimal cutoff for MGMT methylation. Methylation status and total surgical resection were associated with better survival. Further, the crude model indicates linearity between methylation percent and survival rate; an increase of 10% methylation resulted in a reduction of risk of death by 20% (p = 0.004).

This study examined how higher body mass index (BMI) affects the work hours of men and women and how the impact varies by gender and the value of BMI. Using a longitudinal dataset of 1603 British adults (men: n = 775, women: n = 828) and a panel threshold regression model, this study estimated that BMI has significant impacts on work hours but the pattern is different by gender and BMI groups. BMI is positively associated with work hours up to the estimated BMI threshold of 30, which corresponds to the clinical cutoff point of obesity, above this point, additional increases in BMI is associated with reduced work hours. The asymmetric nonlinear relationship between BMI and work hours was more evident among women, particularly female low-skilled workers. The results imply reduced work capacity and lower labor income for women with a higher BMI above an obesity threshold, highlighting a practical role of BMI’s obesity cutoff value. The findings of this study provide a new perspective regarding the economic burden of workplace obesity and point out the need to design gender-specific and BMI-based strategies to tackle productivity loss from obesity.

Background Vitamin D status is associated with muscle strength and maintenance of muscle fibers. However, which serum vitamin D biomarker better reflects sarcopenia remains unclear. The aim of this study was to investigate associations between various serum vitamin D biomarkers (total 25‐hydroxy vitamin D [25(OH)D], bioavailable 25(OH)D, 24,25‐dihydroxyvitamin D [24,25(OH)2D], and vitamin D metabolite ratio [VMR]) and sarcopenia. Methods The data for 83 hip fracture patients were finally included in the analysis. Sarcopenia was defined according to the Asia Working Group for Sarcopenia (AWGS) criteria. Measurements of 24,25(OH)2D and 25(OH)D were made using solid‐phase extraction (SPE) and subsequent liquid chromatography‐tandem mass spectrometry (LC‐MS/MS). Vitamin D binding protein (VDBP) concentration was measured using an enzyme‐linked immunosorbent assay. The VMR was calculated by dividing serum 24,25(OH)2D by serum 25(OH)D and then multiplying by 100. Based on total 25(OH)D, VDBP, and albumin concentrations, bioavailable 25(OH)D concentrations were calculated using the equations from the other previous studies. Results Bioavailable 25(OH)D levels were significantly (p = 0.030) decreased in the sarcopenia group compared with the non‐sarcopenia group. Results of ROC analysis for the diagnosis of sarcopenia using serum level of bioavailable of 25(OH)D revealed that the cutoff point for bioavailable 25(OH)D was 1.70 ng/ml (AUC = 0.649, p, We demonstrated that bioavailable 25(OH)D was associated with sarcopenia among the various serum vitamin D biomarkers. Bioavailable vitamin D might be helpful for assessing the risk of sarcopenia.

Visceral adipose tissue (VAT) has high metabolic activity and secretes a larger number of adipokines that are related to the inflammatory process. Quantifying VAT could estimate the risk of developing Metabolic Syndrome (MetS). This study was designed to determine the VAT cut-off points assessed by DXA associated with MetS in military men. In total, 270 (37.5 ± 6.9 years) military men from the Brazilian Army (BA) participated in the study. Anthropometric measurements, assessment of body composition by dual X-ray absorptiometry (DXA), hemodynamics and biochemical tests were performed. The Student’s t test, independent samples, Person’s correlation, ROC curve, Youden Index and positive (PPV) and negative predictive value (NPV) were used. The MetS prevalence was 27.4%, which means that 74 (38.0 ± 7.3 years) military men had at least three risk factors of MetS present. The cutoff point of VAT with the highest balance between sensitivity (77.0%) and specificity (69.9%) was 1025.0 cm3 (1086.0 g). An area on the ROC curve was 0.801 (p &lt, 0.000), which was very good precision. VAT ≥ 1025.0 cm3 (1086.0 g) is associated with the risk factors of MetS and is, therefore, a predictor of the disease with good indicators of sensitivity and specificity and a robust indicator of MetS.

Introduction There is no data on the number as well as the prevalence of congenital hypothyroidism (CH) in the Fars province. Hence, we designed this study to analyze the latest data and the possible predictive factors on transient and permanent CH in this province. Method This cross sectional study is based on the Fars province screening data from 2013 to 2016. A total of 294,214 newborns were screened with 938 confirmed cases of CH, which were included in this study. After recall and completion of the missing data, follow-up data for 642 CH cases with thyroid stimulating hormone (TSH) concentrations and levothyroxine doses for ten outpatient visits and final transient vs. permanent CH diagnosis were included. Results The incidence rate was 1:313.66, and out of the 642 CH cases, 66.04 % had permanent CH, while 33.96 % had transient CH. TSH level trend during the outpatient visits were not statistically different between the two groups (P = 0.312). A cutoff point of > 2.25 levothyroxine µg/kg (sensitivity: 76.11 %, specificity: 58.52 %) at the third year and a TSH concentration of > 43.35 mIU/L at the venous sampling (initial TSH) (sensitivity: 31.66 %, specificity: 90.32 %) were the predictive factors for permanent CH. Conclusion Fars province has one of the highest incidence rate of CH in Iran. Levothyroxine dose at the 3rd year and the 1st venous TSH sample are the predictive factors for permanent CH in the Iranian population; however, TSH concentrations during follow ups are unreliable predictors.

Objectives: Appendicitis is a common abdominal emergency in children. It is difficult for clinicians to distinguish between simple appendicitis (SA), gangrenous appendicitis (GA), and ruptured appendicitis (RA) in children based on physical and current laboratory tests. Abdominal computed tomography with the disadvantage of excess radiation exposure is usually used in the emergency room for appendicitis surveys. Serum soluble CD40 ligand (sCD40L) is an inflammatory biomarker. This study aimed to use sCD40L to distinguish SA, GA, and RA.Methods: All patients aged Results: Of 116 patients, 42 patients had SA, 20 GA, 44 RA, and 10 NA. We found six subgroups with significant p-values of sCD40L predicting appendicitis as follows: SA on day 2, GA on days 2 and 3, and RA on days 1–3. The sensitivity and specificity of sCD40L at the best cutoff point with 178 pg/mL in these six subgroups range from 0.75 to 1.00 and 0.90, respectively.Conclusions: SCD40L is a good predictor of pediatric appendicitis. Clinicians can use sCD40L to distinguish from SA, GA, and RA in children with suspected appendicitis.

Background and Purpose: The systemic immune–inflammation index (SII) is a novel prognostic index in various diseases. We evaluated the predictive value of SII in patients with intracerebral hemorrhage (ICH).Methods: Patients with primary spontaneous ICH were enrolled. SII was constructed based on peripheral platelet (P), neutrophil (N), and lymphocyte (L) and defined as P*N/L. In addition to admission testing, acute phase SII was collected to analyze the potential dynamic change. Poor outcome was defined as modified Rankin Scale of more than 3 at 90 days.Results: We included 291 patients; 98 (34%) achieved favorable functional outcomes. Day-1 SII was higher and was more related to poor outcome than was admission SII. Median time of day-1 SII was 29 h from onset. Day-1 SII had an OR in outcome (mRS >3) 1.74 (95% CI = 1.03–3.00, p = 0.04). The binary cutoff point of SII calculated using the area under the curve (AUC) method was 1,700 × 109/L, AUC 0.699 (95% CI = 0.627–0.774) (sensitivity 53.3%, specificity 77.3%) (OR = 2.36, 95% CI = 1.09–5.26, p = 0.03).Conclusions: SII, especially day-1 SII, was highly associated with 90-day functional outcome in patients with ICH and could be used to predict outcomes.

Background: End stage renal disease patients on regular hemodialysis patients have higher rate of mortality and morbidity compared to the general population. Objective: This study aimed to study the association between neutrophil-to-lymphocytic ratio and other inflammatory markers (IL-6, high sensitive CRP, PLR, etc) in hemodialysis patients. Patients and methods: This study was designed to assess inflammation in hemodialysis patients and study the association between high sensitive CRP (hs-CRP) and the other inflammatory markers in those patients. Initially, forty two patients with end stage renal disease (ESRD), on regular hemodialysis in dialysis unit, Internal Medicine Department, AL-Hussien Hospital, Faculty of Medicine, Al-Azhar University-Egypt. Results: We calculated the cut off point for IL-6 that best indicates the presence of inflammation in hemodialysis patients, we found that it was value more than 30 ng/l with sensitivity 96.6, specificity 69.2%, with AUC: 00.77 and P < 0.004. Moreover, we calculated the cutoff point for PLR that is consistent with presence of inflammation in hemodialysis patients, we found that it was more than 180.2 with sensitivity 82.2%, specificity 92.3% with AUC .087 and p value equals 0.0001. In addition to calculating the cut off point for NLR that best indicates the presence of inflammation, we found that it was ≥1.6 with sensitivity 93.1%, specificity 92.3%, with AUC: 0.92 and P < 0.001. Conclusion: We can assess cardiovascular condition of our hemodialysis patients along with their morbidity and mortality with measuring these inflammatory markers which are nonexpensive and has high sensitivity and specificity.

Objectives of the study were the prevalence and clinical consequences of balloon rupture with compliant balloons in balloon aortic valvuloplasty (BAV). Compliant low-profile balloons have been developed to reduce access site complications. Made by thinner materials, these balloons are more prone to rupture. This is a single-center retrospective analysis (2016–2018) of patients undergoing BAV with compliant balloons. Baseline echocardiography and computed tomography (CT) were analyzed. Best cutoff point for calcium score was assessed. Long-term mortality was analyzed with Kaplan–Maier. In vitro test was performed. Rupture occurred in 30/90 (33%) of BAVs independent of risk factors, surgical risk and frailty scores. Patients experiencing rupture had increased mean gradient [53.5 (44–64) vs 44 (35–49) mmHg, p 2686 AU was more frequent in the rupture group (41% vs 10%, p

Kaya, Eda/0000-0002-9293-2811; Demirtas, Coskun/0000-0002-0004-2740; Keklikkiran, Caglayan/0000-0001-6304-5554; Yilmaz, Yusuf/0000-0003-4518-5283; BAKIR, Alev/0000-0003-0664-5822 WOS:000550767400012 PubMed ID: 31530739 Background/Aims: Advanced fibrosis (F >= 3) indicates poor outcomes in nonalcoholic fatty liver disease (NAFLD). Here, we examined the diagnostic performance of the fibrosis-4 index (FIB-4) and NAFLD fibrosis score (NFS) for detecting (or excluding) advanced fibrosis in patients with biopsy-proven NAFLD. Methods The diagnostic performance of each non-invasive test according to previously identified cutoff points indicating low and high risk for advanced fibrosis was determined in 463 patients with NAFLD. Patients who scored 2.67 on the FIB-4 were considered at low and high risk for advanced fibrosis, respectively. Patients who scored 0.676 on the NFS were considered at low and high risk for advanced fibrosis, respectively. Results: Eighty-one patients (17.5%) had biopsy-proven advanced fibrosis (F >= 3). The published FIB-4 cutoff values for low and high risk were able to exclude advanced fibrosis with negative predictive values (NPVs) of 0.907 and 0.843 and specificities of 74% and 97%, respectively. The published NFS cutoff values for low and high risk were able to exclude advanced fibrosis with NPVs of 0.913 and 0.842 and specificities of 63% and 96%, respectively. If biopsies were performed in only patients with a FIB-4 above the low cutoff point (>= 1.3), 67.1% could be avoided. Conversely, if biopsies were performed in only patients with an NFS above the low cutoff point (>=-1.455), 57.0% could be avoided. Conclusions: The main clinical utility of the FIB-4 and NFS in patients with NAFLD lies in the ability to exclude, not identify, advanced fibrosis.

BACKGROUND: Alpha-l-fucosidase (AFU) not only detects hepatocellular carcinoma (HCC) early but also is used as a clinical prognostic indicator of several malignant tumors. However, no study has investigated the prognostic significance of AFU in a cohort of patients with esophageal squamous cell carcinomas (ESCCs). METHODS: A retrospective dataset that included 160 consecutive patients with early stage (pT1N0) ESCC who received surgery between January 2005 and December 2012 was analyzed to identify the prognostic value of serum AFU for overall survival (OS) by using Kaplan-Meier analysis and Cox multivariate regression modeling. RESULTS: The level of serum AFU ranged from 6.2 to 77.0 U/L with a median of 19.9 U/L, and the best cutoff point for OS was 17.95 U/L. Analysis by Pearson’s correlation showed that the levels of serum ALT and GGT were both positively correlated with the level of serum AFU (r=0.403, P

Background: Intra cytoplasmic sperm injection (ICSI) is one of the effective treatments in women with fertility problems; however, there are no approved predictors for pregnancy till the present moment. We aimed to evaluate the role of progesterone and endometrium pattern in predicting pregnancy in ICSI cycles.Patients and Methods: The study included 200 women who were treated in Al-Shatby Hospital in (ICSI) Unit from January 2017 to October 2018. They underwent one super ovulation protocol which was gonadotrophin in which releasing hormone progesterone was measured in the 14th day; while ultrasound was performed in the 3rd day and in the day of HCG administration.Results and Conclusion: Progesterone with a cutoff point of 27 ng/mol is a significant predictor of pregnancy in ICSI cycle. However, neither endometrial thickness nor pattern was a significant predictor of pregnancy

Platelet to lymphocyte ratio (PLR) is a candidate prognostic marker for metastatic castration‐resistant prostate cancer patients receiving abiraterone acetate and evidence demonstrates that a high PLR is associated with poor survival. More studies are required to verify current findings and establish a definite cutoff point.

Necrotizing fasciitis is a severe soft-tissue infection with a high mortality rate. There is little literature on the relationship between the ultrasonographic finding of fluid accumulation along the deep fascia and the diagnosis and prognosis of necrotizing fasciitis. This retrospective study showed that when fluid accumulation was present along the deep fascia, patients with clinically suspected necrotizing fasciitis had a higher probability of having necrotizing fasciitis. The ultrasonographic finding of fluid accumulation with a cutoff point of more than 2 mm of depth had the best accuracy (72.7%) for diagnosing necrotizing fasciitis. In regard to the prognosis of necrotizing fasciitis, when fluid accumulation was present along the deep fascia, patients with necrotizing fasciitis had a longer length of hospital stay and were at risk of amputation or mortality. Ultrasonography is a point-of-care imaging tool that facilitates the diagnosis and prognosis of necrotizing fasciitis.

Introduction: Children with functional constipation frequently present with alterations in rectal compliance and the urge-to-defecate sensation that can be evaluated through anorectal manometry (ARM). In the present study, we evaluated the usefulness of the parameters obtained through ARM in children with retentive fecal incontinence (RFI). Materials and methods: Children with functional constipation, aged 4 to 17 years, that underwent ARM were included in the study. Results: Of the 35 children evaluated, 21 presented with functional constipation and 14 had functional constipation and RFI. The children with both constipation and RFI tolerated greater volumes of air insufflation for triggering the urge to defecate and reaching maximum tolerance of pain, compared with the children that did not have RFI. We identified the cutoff point of 135 ml of air as the maximum tolerance sensation for distinguishing children with RFI. Conclusions: Maximum tolerance of pain was the most useful parameter for evaluating RFI in children with functional constipation. Resumen: Introducción: Los niños con estreñimiento funcional presentan frecuentemente alteraciones de la distensibilidad y sensación defecatoria, que se pueden valorar mediante manometría anorrectal (MAR). En este estudio evaluamos la utilidad de los parámetros que se obtienen en la MAR en niños con incontinencia fecal retentiva (IFR). Material y métodos: Incluimos a niños de 4 a 17 años con estreñimiento funcional a quienes se realizó MAR. Resultados: Un total de 35 niños fueron incluidos: 21 presentaban estreñimiento funcional y 14, estreñimiento con IFR. Los niños con estreñimiento funcional e IFR toleraron mayores volúmenes en la insuflación de aire para desencadenar urgencia defecatoria y dolor a la máxima tolerabilidad, en comparación con quienes no presentan IFR. Identificamos un punto de corte de 135 ml de aire de máxima tolerabilidad para discriminar niños con IFR. Conclusiones: La máxima tolerabilidad fue el parámetro más útil para evaluar IFR en niños con estreñimiento funcional. Keywords: Fecal incontinence, Functional constipation, Anorectal manometry, Palabras clave: Incontinencia fecal, Estreñimiento funcional, Manometría anorrectal

Background: Instruments for measuring functional disability of the elderly, such as the Functional Activities Questionnaire, can be used for the detection and prediction of dementia. Objective: To evaluate the accuracy of the Brazilian version of the Functional Activities Questionnaire (FAQ-BR) in dementia screening. Methodology: Cross-sectional study with 265 elderly and their respective informants. The performance of the FAQBR was compared to the clinical diagnosis of dementia and their score compared to screening instruments for cognitive decline/dementia. The receiver operating curve (ROC curve) was used to determine the sensitivity and specificity of the best cutoff. Results: The area under the ROC curve indicated an accuracy of 79.7% with cutoff point ≥ 14, which showed the highest sensitivity (80.0%) and specificity (72.0%). The FAQ-BR score showed high correlations with the scores of the cognitive decline/dementia screening instruments. Conclusion: The area under the ROC curve, sensitivity and specificity of the FAQ-BR were found to be inappropriate, and it was not possible to recommend its use in dementia screening