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Sample records for adjusted d-dimer cut-off

  1. The performance of age-adjusted D-dimer cut-off in Chinese outpatients with suspected venous thromboembolism.

    Science.gov (United States)

    Han, Chengwu; Zhao, Yongqiang; Cheng, Wenli; Yang, Jing; Yuan, Jie; Zheng, Yuehong; Yu, Xueying; Zhu, Tienan

    2015-10-01

    D-dimer testing has been widely used in the exclusion of venous thromboembolism (VTE), but its clinical usefulness is limited in older patients because of a lower specificity. To evaluate the diagnostic performance of STA-Liatest D-dimer assay and validate the age-adjusted cut-off value in Chinese outpatients with suspected VTE in a prospective non-interventional study. Symptomatic patients suspected of having deep venous thrombosis or pulmonary embolism were recruited from 2 participating centers. STA-Liatest D-dimer assay, clinical pretest probability assessment and diagnostic imaging test including complete compression ultrasonography or computed tomography pulmonary angiography were performed among all participants. The performance of D-dimer test was assessed with an age-adjusted D-dimer cut-off (age×0.01μg/ml in patients aged>50years) and with conventional cut-off (0.5μg/ml at all ages). A total of 594 eligible outpatients were included in this study and VTE was diagnosed in 195 (32.8%) patients. In those patients with a low or moderate pretest probability (n=373), the increase in the proportion of patients with a D-dimer below the age-adjusted cut-off value compared with the conventional cut-off value was 5.9% (95% confidence interval; 3.8%-8.7%). The sensitivity, specificity and negative predictive value of STA-Liatest D-dimer test were 95.0% (83.5% - 98.6%), 84.1%(79.8%-87.6%) and 99.3%(97.5% - 99.8%), respectively, using the age-adapted diagnostic strategy. The application of age-adjusted cut-off of D-dimer test combined with clinical probability greatly increases the proportion of Chinese older outpatients in whom VTE can be safely excluded. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Age-adjusted D-dimer cut-off in the diagnostic strategy for deep vein thrombosis

    DEFF Research Database (Denmark)

    Nybo, Mads; Hvas, Anne-Mette

    2017-01-01

    Background. Studies have indicated that use of an age-adjusted D-dimer cut-off value for patients above 50 years increases utility of the diagnostic strategy for pulmonary embolism. Evidence for the same approach regarding diagnosis of deep vein thrombosis (DVT) is, however, unclear. Materials...

  3. [Potential utility of a renal function adjusted D-dimer cut-off value for improving the exclusion of pulmonary embolism].

    Science.gov (United States)

    Xi, Xin; Yang, Jinghua; Wang, Zengzhi; Zhu, Chenxi; Li, Jie; Liu, Shuang

    2015-08-11

    To evaluate the potential utility of a renal function adjusted D-dimer cut-off value for improving the exclusion of pulmonary embolism. Retrospective analyses were performed for 1 784 inpatients and outpatients with low and moderate probability of pulmonary embolism at Anzhen Hospital from January 2011 to June 2013. The Well's score was used. The diagnoses of pulmonary embolism were confirmed by computed tomography pulmonary angiogram and ventilation-perfusion scan. Based upon estimated glomerular filtration rate (GFR), they were divided into three subgroups of normal renal function, mild renal impairment and moderate renal impairment. Negative D-dimer was defined as a level of age-standardized D-dimer valuecut-off point in patients with renal impairment was developed by receiver operating characteristics (ROC) curves and the effect of diagnostic efficiency of ruling out pulmonary embolism with renal function adjusted D-dimer cut-off was assessed. The medians of D-dimer of three subgroups with normal renal function, mild renal impairment and moderate renal impairment were 291.5, 995.5 and 1 901.5 µg/L (Pcut-off value increased to 1.2 and 1.75 times of old one in patients with mild and moderate renal impairments and the proportion of patients with a negative D-dimer level rose from 48.7% to 53.0% as compared with old D-dimer cut-off value. The sensitivity and specificity of negative D-dimer for ruling out pulmonary embolism was 98% and 62% with the new cut-off value versus 99% and 57% with the old cut-off value and the NNT of D-dimer for ruling out pulmonary embolism declined from 3.52 to 3.34. The renal function adjusted D-dimer cut-off point can improve the diagnostic efficiency of D-dimer test for ruling out pulmonary embolism.

  4. [The value of age-adjusted D-dimer cut-off value in diagnosing deep vein thrombosis in elderly patients].

    Science.gov (United States)

    Zhang, Shun-xin; Li, Jun-lai; Liu, Cui; Tan, Guo-juan; Cao, Xiao-lin; Wang, Jie

    2013-11-01

    To validate the value of age-adjusted D-dimer combined with clinical probability to confirm or exclude deep vein thrombosis (DVT) in elderly patients. Elderly patients ( ≥ 65 years) suspected with DVT were evaluated by Wells score and D-dimer test. All patients underwent ultrasonography examination except for patients with Wells score cut-off value is 500 µg/L, while age-adjusted cut-off value is set as patient's age×10 µg/L. We compared the sensitivity and specificity using the 2 cut-off values in confirming or excluding the diagnoses of DVT. The study population consisted of 624 patients [mean age(76.4 ± 19.3) years], DVT was confirmed in 192 (30.8%) patients. Using Wells score model, 326 patients (52.2%) were scored as unlikely DVT and DVT was confirmed by ultrasonography in 44 patients (13.5%), and 298 patients as likely DVT patients and DVT was confirmed in 148 patients (55.0%). The sensitivity, specificity, positive predictive value, and negative predictive value by conventional and age-adjusted D-dimer cut-off value for diagnosing DVT in low-risk patients evaluated by Wells score model were 95.5%, 40.4%, 20.0%, 98.3% and 95.5%, 61.0%, 27.6%, 87.1%, respectively, and which were 89.9%, 67.3%, 73.1%, 87.1% and 89.2%, 89.3%, 89.2%, 89.3%, respectively, in high-risk patients evaluated by Wells score model. Thus, specificity increased about 20% using age-adjusted D-dimer cut-off value compared with conventional D-dimer cut-off value. The age-adjusted D-dimer cut-off value combined with clinical probability evaluation could increase diagnosing specificity of DVT in elderly patients.

  5. D-dimer cut-off adjusted to age performs better for exclusion of pulmonary embolism in patients over 75 years.

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    Laruelle, M; Descamps, O S; Lesage, V

    2013-01-01

    A D-dimer (DD) test improves the diagnosis of PE (PE) when combined with clinical scores. However, as DD levels increase physiologically with age, this testing has less specificity in older patients. Douma et al. (1). proposed the use of an age adjusted DD cut-off to increase the specificity of this test. We performed chart reviews of patients, older than 75 years, hospitalized for suspicion of PE in 2010-2011 (n = 165). PE was assessed with either pulmonary scintigraphy (PS, n = 64) and/or pulmonary computed tomography (PC, n = 101). We compared the specificity, sensitivity and false negatives rates of an age adjusted DD cut-off level ("ADC" = (patient's age x 0.01) microg/ml) with those of the conventional cut off level ("CDC" = 0.5 microg/ml). PE was confirmed in 45 cases. In the 120 patients with no PE (negative PS or PC), 7 cases had CDC below cut-off levels, while 28 cases had an ADC below cutoff level. The use of the ADC thus increased the specificity (ADC: 23% vs CDC: 6%, p = 0.0001), and this was obtained without significant loss of sensitivity (ADC: 96% vs CDC: 98%, ns). Patients were clinically assessed with the revised Geneva scores. In the negative PE group, the number of patients classified with low, moderate or high clinical probability of PE were 31, 81 and 8, respectively. The percentage of patients with DD values below cut-off values was 4%, 0.8% and 0.8%, respectively using the CDC and 9%, 12% and 2.5% using the ADC. In this age group, the specificity of ADC was found superior to that of the CDC. The clinical use of the ADC might be associated with less useless diagnosis procedures, without significant increase in rate of diagnosis failure.

  6. No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism.

    Science.gov (United States)

    van der Pol, L M; van der Hulle, T; Cheung, Y W; Mairuhu, A T A; Schaar, C G; Faber, L M; Ten Wolde, M; Hofstee, H M A; Hovens, M M C; Nijkeuter, M; van Klink, R C J; Kruip, M J H A; Middeldorp, S; Huisman, M V; Klok, F A

    2017-12-01

    Essentials Imaging is warranted in the majority of patients to confirm or rule out pulmonary embolism (PE). The age-adjusted D-dimer (ADJUST) reduced the number of required imaging tests in patients ≥ 50 years. The YEARS algorithm was designed to improve the efficiency in patients with suspected PE. There was no added value of implementing ADJUST in the YEARS algorithm in our cohort. Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonary embolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50 years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs of deep venous thrombosis, hemoptysis, 'PE most likely diagnosis') with simultaneous D-dimer testing using a pre-test dependent threshold. We performed a post hoc analysis in 3465 patients managed according to YEARS to compare the number of patients managed without CTPA scans and associated diagnostic failures in hypothetical scenarios with different YEARS-ADJUST combinations. Results Following the YEARS algorithm, 1651 patients (48%) were managed without CTPA; PE was diagnosed in 456 (13%) patients at baseline and 18 patients with initial normal testing suffered venous thromboembolism (VTE) during 3-month follow-up (failure rate 0.61%; 95% confidence interval [CI], 0.36-0.96). If ADJUST had been fully integrated in YEARS, 1627 patients (47%) would have been managed without CTPA (absolute decrease of 0.69%; 95% CI -1.7 to 3.0), at cost of four additional missed PE diagnoses at baseline, for a projected 3-month VTE failure rate of 0.75% (95% CI, 0.49-1.13). None of the other studied scenarios showed relevant improvements in efficiency as well, but all led to more missed diagnoses

  7. Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism.

    Science.gov (United States)

    Wilts, I T; Le Gal, G; Den Exter, P L; Van Es, J; Carrier, M; Planquette, B; Büller, H R; Righini, M; Huisman, M V; Kamphuisen, P W

    2017-04-01

    Cancer patients frequently present with suspected pulmonary embolism (PE). The D-dimer (DD) test is less useful in excluding PE in cancer patients due to the lower specificity. In the general population, the age-adjusted cutoff for DD combined with a clinical decision rule (CDR) improved specificity in the diagnosis of PE. To evaluate the safety and efficacy of the age-adjusted cutoff (defined as age∗10μg/L in patients >50years) combined with a CDR for the exclusion of PE in cancer patients. We conducted a prospective study to evaluate the age-adjusted cutoff in patients with suspected PE. Here we report a post-hoc analysis on the performance of the age-adjusted cutoff in patients with and without cancer. The primary outcome was the rate of venous thromboembolic events (VTE) during three-month follow-up. Of 3324 patients with suspected PE, 429 (12.9%) patients had cancer. The prevalence of PE was 25.2% in cancer patients and 18% in patients without cancer (p<0.001). Among cancer patients with an unlikely CDR, 9.9% had a DD <500μg/L as compared with 19.7% using the age-adjusted cutoff. In patients without cancer, these rates were 30.1% and 41.9%. The proportion of cancer patients in whom PE could be excluded by CDR and DD doubled from 6.3% to 12.6%. No VTE occurred during three-month follow-up (failure rate 0.0% (95% CI 0.0-6.9%)). Compared with the conventional cutoff, the age-adjusted D-dimer cutoff doubles the proportion of patients with cancer in whom PE can be safely excluded by CDR and DD without imaging. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. A retrospective evaluation of the age-adjusted D-dimer versus the conventional D-dimer for pulmonary embolism.

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    Sheele, Johnathan M; Tang, Annie; Farhan, Obada; Morris, Nathan

    2018-01-23

    : The conventional D-dimer cut-off value of at least 500 μg FEU/l has good sensitivity but poor specificity for identifying pulmonary embolism. An elevated age-adjusted D-dimer value (age in years × 10 μg FEU/l) for patients at least 50 years old has been recommended as a better cut-off with adequate sensitivity and improved specificity for identifying pulmonary embolism compared with the conventional value. We retrospectively reviewed 3117 patient encounters in which a D-dimer was ordered. The D-dimer value, age of the patient, and the computed tomography radiology report was evaluated. The sensitivity and specificity of the age-adjusted D-dimer was calculated using bootstrapping. With an assumed 99% sensitivity for the conventional D-dimer cut-off the specificity was 39.2% [95% confidence interval (CI): 37.5-41.0%]. The sensitivity of the age-adjusted D-dimer was 91.8% (95% CI: 83.8-97.2%) with a specificity of 51.0% (95% CI: 49.1-53.1%). The sensitivity of the age-adjusted D-dimer was unacceptably low compared with the conventional D-dimer cut-off.

  9. Age-dependent D-dimer cut-off to avoid unnecessary CT-exams for ruling-out pulmonary embolism; Altersangepasste Anhebung des D-Dimer-Grenzwertes zur Vermeidung unnoetiger CT-Untersuchungen bei Verdacht auf Lungenarterienembolie

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    Altmann, M.M.; Hoehne, M.; Herold, T. [HELIOS Klinikum Berlin-Buch (Germany). Radiology; Wrede, C.E. [HELIOS Klinikum Berlin-Buch (Germany). Emergency Department; Peetz, D. [HELIOS Klinikum Berlin-Buch (Germany). Laboratory Medicine; Stroszczynski, C. [University Medical Center, Radiology, Regensburg (Germany)

    2015-09-15

    To evaluate the effect of an age-dependent D-Dimer cut-off in patients who underwent a computed tomography pulmonary angiogram (CTPA) for suspected pulmonary embolism (PE). Retrospective application of an age-dependent D-dimer cut-off (age/100 in patients aged over 50) in 530 consecutive patients, both in- and outpatients, aged over 18, who underwent CTPA for suspected PE according to the guidelines. The application of an age-dependent D-dimer cut-off showed a now negative test-result in 17 of 530 patients (3.2 %). The proportion was 4.1 % (17 of 418) in patients aged over 50. None of these 17 cases was diagnosed with PE in CTPA, the false-negative rate was 0 %. The effect could be seen in outpatients (14 of 377 [3.7 %]) as well as in inpatients(3 of 153 [2.0 %]) with no statistically significant difference (p > 0.05). The application of an age-dependent D-dimer cut-off as part of the guideline-based algorithm for suspected PE reduced the number of necessary CTPA in outpatients as well as in inpatients.

  10. Validation of two age dependent D-dimer cut-off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care: retrospective, cross sectional, diagnostic analysis

    OpenAIRE

    Schouten, Henrike J; Koek, H L; Oudega, Ruud; Geersing, Geert-Jan; Janssen, Kristel J M; Johannes J M van Delden; Moons, Karel G.M.

    2012-01-01

    Objective To determine whether the use of age adapted D-dimer cut-off values can be translated to primary care patients who are suspected of deep vein thrombosis. Design Retrospective, cross sectional diagnostic study. Setting 110 primary care doctors affiliated with three hospitals in the Netherlands. Participants 1374 consecutive patients (936 (68.1%) aged >50 years) with clinically suspected deep vein thrombosis. Main outcome measures Proportion of patients with D-dimer values below two pr...

  11. Validation of two age dependent D-dimer cut-off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care: retrospective, cross sectional, diagnostic analysis

    Science.gov (United States)

    Koek, H L (Dineke); Oudega, Ruud; Geersing, Geert-Jan; Janssen, Kristel J M; van Delden, Johannes J M; Moons, Karel G M

    2012-01-01

    Objective To determine whether the use of age adapted D-dimer cut-off values can be translated to primary care patients who are suspected of deep vein thrombosis. Design Retrospective, cross sectional diagnostic study. Setting 110 primary care doctors affiliated with three hospitals in the Netherlands. Participants 1374 consecutive patients (936 (68.1%) aged >50 years) with clinically suspected deep vein thrombosis. Main outcome measures Proportion of patients with D-dimer values below two proposed age adapted cut-off levels (age in years×10 μg/L in patients aged >50 years, or 750 μg/L in patients aged ≥60 years), in whom deep vein thrombosis could be excluded; and the number of false negative results. Results Using the Wells score, 647 patients had an unlikely clinical probability of deep vein thrombosis. In these patients (at all ages), deep vein thrombosis could be excluded in 309 (47.8%) using the age dependent cut-off value compared with 272 (42.0%) using the conventional cut-off value of 500 μg/L (increase 5.7%, 95% confidence interval 4.1% to 7.8%). This exclusion rate resulted in 0.5% and 0.3% false negative cases, respectively (increase 0.2%, 0.004% to 8.6%).The increase in exclusion rate by using the age dependent cut-off value was highest in the oldest patients. In patients older than 80 years, deep vein thrombosis could be safely excluded in 22 (35.5%) patients using the age dependent cut-off value compared with 13 (21.0%) using the conventional cut-off value (increase 14.5%, 6.8% to 25.8%). Compared with the age dependent cut-off value, the cut-off value of 750 μg/L had a similar exclusion rate (307 (47.4%) patients) and false negative rate (0.3%). Conclusions Combined with a low clinical probability of deep vein thrombosis, use of the age dependent D-dimer cut-off value for patients older than 50 years or the cut-off value of 750 μg/L for patients aged 60 years and older resulted in a considerable increase in the proportion of patients in

  12. Age-Adjusted D-Dimer in the Prediction of Pulmonary Embolism: Does a Normal Age-Adjusted D-Dimer Rule Out PE?

    Directory of Open Access Journals (Sweden)

    Jacob Ortiz

    2017-01-01

    Full Text Available Risk assessment for pulmonary embolism (PE currently relies on physician judgment, clinical decision rules (CDR, and D-dimer testing. There is still controversy regarding the role of D-dimer testing in low or intermediate risk patients. The objective of the study was to define the role of clinical decision rules and D-dimer testing in patients suspected of having a PE. Records of 894 patients referred for computed tomography pulmonary angiography (CTPA at a University medical center were analyzed. The clinical decision rules overall had an ROC of approximately 0.70, while signs of DVT had the highest ROC (0.80. A low probability CDR coupled with a negative age-adjusted D-dimer largely excluded PE. The negative predictive value (NPV of an intermediate CDR was 86–89%, while the addition of a negative D-dimer resulted in NPVs of 94%. Thus, in patients suspected of having a PE, a low or intermediate CDR does not exclude PE; however, in patients with an intermediate CDR, a normal age-adjusted D-dimer increases the NPV.

  13. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study

    NARCIS (Netherlands)

    Righini, Marc; van Es, Josien; den Exter, Paul L.; Roy, Pierre-Marie; Verschuren, Franck; Ghuysen, Alexandre; Rutschmann, Olivier T.; Sanchez, Olivier; Jaffrelot, Morgan; Trinh-Duc, Albert; Le Gall, Catherine; Moustafa, Farès; Principe, Alessandra; van Houten, Anja A.; ten Wolde, Marije; Douma, Renée A.; Hazelaar, Germa; Erkens, Petra M. G.; van Kralingen, Klaas W.; Grootenboers, Marco J. J. H.; Durian, Marc F.; Cheung, Y. Whitney; Meyer, Guy; Bounameaux, Henri; Huisman, Menno V.; Kamphuisen, Pieter W.; Le Gal, Grégoire

    2014-01-01

    D-dimer measurement is an important step in the diagnostic strategy of clinically suspected acute pulmonary embolism (PE), but its clinical usefulness is limited in elderly patients. To prospectively validate whether an age-adjusted D-dimer cutoff, defined as age × 10 in patients 50 years or older,

  14. Age-adjusted high-sensitivity troponin T cut-off value for risk stratification of pulmonary embolism.

    Science.gov (United States)

    Kaeberich, Anja; Seeber, Valerie; Jiménez, David; Kostrubiec, Maciej; Dellas, Claudia; Hasenfuß, Gerd; Giannitsis, Evangelos; Pruszczyk, Piotr; Konstantinides, Stavros; Lankeit, Mareike

    2015-05-01

    High-sensitivity troponin T (hsTnT) helps in identifying pulmonary embolism patients at low risk of an adverse outcome. In 682 normotensive pulmonary embolism patients we investigate whether an optimised hsTnT cut-off value and adjustment for age improve the identification of patients at elevated risk. Overall, 25 (3.7%) patients had an adverse 30-day outcome. The established hsTnT cut-off value of 14 pg·mL(-1) retained its high prognostic value (OR (95% CI) 16.64 (2.24-123.74); p=0.006) compared with the cut-off value of 33 pg·mL(-1) calculated by receiver operating characteristic analysis (7.14 (2.64-19.26); pvalue of 45 pg·mL(-1) but not the established cut-off value of 14 pg·mL(-1) predicted an adverse outcome. An age-adjusted hsTnT cut-off value (≥14 pg·mL(-1) for patients aged risk (12.4% adverse outcome). Risk assessment of normotensive pulmonary embolism patients was improved by the introduction of an age-adjusted hsTnT cut-off value. A three-step approach helped identify patients at higher risk of an adverse outcome who might benefit from advanced therapy. Copyright ©ERS 2015.

  15. Age Adjusted D-Dimer for exclusion of Pulmonary Embolism: a retrospective cohort study.

    LENUS (Irish Health Repository)

    Monks, D

    2017-08-01

    D-Dimer (DD) will increase with age and recent studies have shown the upper limit of normal can be raised in those who are low risk and over 50. We studied age adjusted D-dimer (AADD) levels to assess whether pulmonary embolism (PE) could be safely excluded. This study analysed the Emergency Department (ED) Computed Tomographic Pulmonary Angiography (CTPA) requests. There were 756 requests. The parameters studied were; age, DD value, calculated AADD, CT result and Simplified Geneva Score (SGS). The primary outcome was the diagnostic performance of AADD. One hundred and eighty-five patients were included in the final cohort. Twenty-one patients had a negative DD after age adjustment. Of these one had a PE, corresponding to a failure rate of 4.76% (1 in 22). The sensitivity of AADD was 0.96 (95% CI 0.76 to 0.99) and its specificity was 0.12 (95% CI 0.08- 0.19). AADD demonstrated a reduction in false positives with one false negative, giving rise to a failure rate higher than that of other larger studies. Further study is indicated to accurately define the diagnostic characteristics for the Irish context.

  16. The Adjustment Disorder--New Module 20 as a Screening Instrument: Cluster Analysis and Cut-off Values.

    Science.gov (United States)

    Lorenz, L; Bachem, R C; Maercker, A

    2016-10-01

    Adjustment disorder (AjD) is a transient mental health condition emerging after stressful life events. Its diagnostic criteria have recently been under revision which led to the development of the Adjustment Disorder--New Module 20 (ADNM-20) as a self-report assessment. To identify a threshold value for people at high risk for AjD. As part of a randomized controlled trial evaluating a self-help manual for burglary victims, the baseline data of all participants (n=80) were analyzed. Besides the ADNM-20, participants answered self-report questionnaires regarding the external variables post-traumatic stress disorder symptomatology, depression, anxiety, and stress levels. We used cluster analysis and ROC analysis to identify the most appropriate cut-off value. The cluster analysis identified three different subgroups. They differed in their level of AjD symptomatology from low to high symptom severity. The same pattern of impairment was found for the external variables. The ROC analysis testing the ADNM-20 sum scoreagainst the theory-based diagnostic algorithm, revealed an optimal cut-off score at 47.5 to distinguish between people at high risk for AjD and people at low risk. The ADNM-20 distinguishes between people with low, moderate, and high symptomatology. The recommendation for a cut-off score at 47.5 facilitates the use of the ADNM-20 in research and practice.

  17. The Adjustment Disorder–New Module 20 as a Screening Instrument: Cluster Analysis and Cut-off Values

    Directory of Open Access Journals (Sweden)

    L Lorenz

    2016-10-01

    against the theory-based diagnostic algorithm, revealed an optimal cut-off score at 47.5 to distinguish between people at high risk for AjD and people at low risk. Conclusion: The ADNM-20 distinguishes between people with low, moderate, and high symptomatology. The recommendation for a cut-off score at 47.5 facilitates the use of the ADNM-20 in research and practice.

  18. D-Dimer and thrombus burden in acute pulmonary embolism.

    Science.gov (United States)

    Keller, Karsten; Beule, Johannes; Balzer, Jörn Oliver; Dippold, Wolfgang

    2018-01-17

    Thrombus burden in pulmonary embolism (PE) is associated with higher D-Dimer-levels and poorer prognosis. We aimed to investigate i) the influence of right ventricular dysfunction (RVD), deep venous thrombosis (DVT), and high-risk PE-status on D-Dimer-levels and ii) effectiveness of D-Dimer to predict RVD in normotensive PE patients. Overall, 161 PE patients were analyzed retrospectively, classified in 5 subgroups of thrombus burden according to clinical indications and compared regarding D-Dimer-levels. Linear regression models were computed to investigate the association between D-Dimer and the groups. In hemodynamically stable PE patients, a ROC curve was calculated to assess the effectiveness of D-Dimer for predicting RVD. Overall, 161 patients (60.9% females, 54.0% aged >70 years) were included in this analysis. The D-Dimer-level was associated with group-category in a univariate linear regression model (β 0.050 (95%CI 0.002-0.099), P = .043). After adjustment for age, sex, cancer, and pneumonia in a multivariate model we observed an association between D-Dimer and group-category with borderline significance (β 0.047 (95%CI 0.002-0.096), P = .058). The Kruskal-Wallis test demonstrated that D-Dimer increased significantly with higher group-category. In 129 normotensive patients, patients with RVD had significantly higher D-Dimer values compared to those without (1.73 (1.11/3.48) vs 1.17 (0.65/2.90) mg/l, P = .049). A ROC curve showed an AUC of 0.61, gender non-specific, with calculated optimal cut-off of 1.18 mg/l. Multi-variate logistic regression model confirmed an association between D-Dimer >1.18 mg/l and RVD (OR2.721 (95%CI 1.196-6.190), P = .017). Thrombus burden in PE is related to elevated D-Dimer levels, and D-Dimer values >1.18 mg/l were predictive for RVD in normotensive patients. D-Dimer levels were influenced by DVT, but not by cancer, pneumonia, age, or renal impairment. Copyright © 2018 Elsevier Inc. All rights reserved.

  19. [D-dimer testing in the emergency department: age adjustment, inappropriate use, and ability to predict the extension and severity of pulmonary embolism].

    Science.gov (United States)

    Berraondo Fraile, Javier; Juan Samper, Gustavo; Fernández-Fabrellas, Estrella; Konishi, Izumi; López Vazquéz, Ana; Bediaga Collado, Ana; Ramón Capilla, Mercedes

    2016-01-01

    To evaluate whether using D-dimer test results adjusted for age according to the formula proposed by Douma et al. improves diagnostic accuracy; to assess the appropriateness of ordering D-dimer tests on clinical suspicion of pulmonary embolism; and to explore the association of test results with the extension and severity of the embolism. Retrospective observational study of 1833 cases in which D-dimer testing was ordered for patients in our hospital's emergency department in the course of a year. We calculated sensitivity, specificity, and positive and negative predictive values using our hospital's D-dimer cutoff of 250 μg/mL adjusted for age with a modification of Douma et al.'s formula. When information about pulmonary embolism extension and severity was on record, we assessed the correlation with test results. Adjusting D-dimer level for age increased the number of true negatives and the specificity and positive predictive value of the test. D-dimer level correlated significantly with the extension of pulmonary embolism (r=0.41, P<.05) but not with clinical severity. Adjusting the D-dimer test result by age improves accuracy in the diagnosis of pulmonary embolism, even though clinical suspicion in Spain does not follow guideline recommendations. Our findings suggest that Ddimer level correlates with the extension but not the severity of pulmonary embolism.

  20. Re-adjusting the cut-off score of the Korean version of the Childhood Autism Rating Scale for high-functioning individuals with autism spectrum disorder.

    Science.gov (United States)

    Kwon, Hyuk-Jin; Yoo, Hee-Jeong; Kim, Joo-Hyun; Noh, Dong-Hyun; Sunwoo, Hyun-Jung; Jeon, Ye Seul; Lee, Sang-Youn; Jo, Ye-Ul; Bong, Gui-Young

    2017-10-01

    The current cut-off score of the Korean version of the Childhood Autism Rating Scale (K-CARS) does not seem to be sensitive enough to precisely diagnose high-functioning autism. The aim of this study was to identify the optimal cut-off score of K-CARS for diagnosing high-functioning individuals with autism spectrum disorders (ASD). A total of 329 participants were assessed by the Korean versions of the Autism Diagnostic Interview - Revised (K-ADI-R), Autism Diagnostic Observation Schedule (K-ADOS), and K-CARS. IQ and Social Maturity Scale scores were also obtained. The true positive and false negative rates of K-CARS were 77.2% and 22.8%, respectively. Verbal IQ (VIQ) and Social Quotient (SQ) were significant predictors of misclassification. The false negative rate increased to 36.0% from 19.8% when VIQ was >69.5, and the rate increased to 44.1% for participants with VIQ > 69.5 and SQ > 75.5. In addition, if SQ was >83.5, the false negative rate increased to 46.7%, even if the participant's VIQ was ≤69.5. Optimal cut-off scores were 28.5 (for VIQ ≤ 69.5 and SQ ≤ 75.5), 24.25 (for VIQ > 69.5 and SQ > 75.5), and 24.5 (for SQ > 83.5), respectively. The likelihood of a false negative error increases when K-CARS is used to diagnose high-functioning autism and Asperger's syndrome. For subjects with ASD and substantial verbal ability, the cut-off score for K-CARS should be re-adjusted and/or supplementary diagnostic tools might be needed to enhance diagnostic accuracy for ASD. © 2017 The Authors. Psychiatry and Clinical Neurosciences © 2017 Japanese Society of Psychiatry and Neurology.

  1. Global emergency medicine journal club: a social media discussion about the Age-Adjusted D-Dimer Cutoff Levels To Rule Out Pulmonary Embolism trial.

    Science.gov (United States)

    Rezaie, Salim R; Swaminathan, Anand; Chan, Teresa; Shaikh, Sam; Lin, Michelle

    2015-05-01

    Annals of Emergency Medicine collaborated with an educational Web site, Academic Life in Emergency Medicine (ALiEM), to host an online discussion session featuring the 2014 Journal of the American Medical Association publication on the Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism (ADJUST-PE) trial by Righini et al. The objective is to describe a 14-day (August 25 to September 7, 2014) worldwide academic dialogue among clinicians in regard to 4 preselected questions about the age-adjusted D-dimer cutoff to detect pulmonary embolism. Five online facilitators hosted the multimodal discussion on the ALiEM Web site, Twitter, and Google Hangout. Comments across the social media platforms were curated for this report, as framed by the 4 preselected questions, and engagement was tracked through various Web analytic tools. Blog and Twitter comments, as well as video expert commentary involving the ADJUST-PE trial, are summarized. The dialogue resulted in 1,169 page views from 391 cities in 52 countries on the ALiEM Web site, 502,485 Twitter impressions, and 159 views of the video interview with experts. A postdiscussion summary on the Journal Jam podcast resulted in 3,962 downloads in its first week of publication during September 16 to 23, 2014. Common themes that arose in the multimodal discussions included the heterogeneity of practices, D-dimer assays, provider knowledge about these assays, and prevalence rates in different areas of the world. This educational approach using social media technologies demonstrates a free, asynchronous means to engage a worldwide audience in scholarly discourse. Copyright © 2015 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

  2. D-dimer Test

    Science.gov (United States)

    ... Acidosis and Alkalosis Adrenal Insufficiency and Addison Disease Alcoholism Allergies Alzheimer Disease Anemia Angina Ankylosing Spondylitis Anthrax ... know? D-dimer concentrations may rise in the elderly, and false positives may be seen with high ...

  3. The performance of quantitative D-dimer assays in laboratory routine.

    Science.gov (United States)

    Spannagl, Michael; Haverkate, Frits; Reinauer, Hans; Meijer, Piet

    2005-09-01

    Assessment of D-dimer in plasma is routinely used for the exclusion of venous thrombosis and the monitoring of hypercoagulability. Little information is available about the performance of D-dimer assays in clinical laboratories examined by external quality assessment schemes. We obtained results from 423 laboratories measuring plasma pools from patients with elevated D-dimer levels mixed with human normal plasma. The results from five samples were reported containing D-dimer from the lower normal range up to a 20-fold increased level. In addition, information about the assignment of a cut-off point and the medical need to apply these assays was obtained by standardized questionnaire. Participants reported results and additional information from 20 different assays. Lack of standardization regarding the calibration concepts obstructs comparability of results. Results in one sample varied up to 20-fold between the assays applied. In addition, a high variability was reported around the cut-off values introduced for the exclusion of venous thrombosis and pulmonary embolism. As a consequence, generally accepted cut-off values cannot be established. For cut-off assignment, 62% of participants used the kit insert but also 14% used local validation. In conclusion, standardization or at least harmonization of D-dimer assays is necessary to ensure comparability of D-dimer plasma levels measured in clinical routine.

  4. Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation

    Energy Technology Data Exchange (ETDEWEB)

    Cervellin, Gianfranco, E-mail: gcervellin@ao.pr.it; Bonfanti, Laura; Picanza, Alessandra; Lippi, Giuseppe [1Academic Hospital of Parma (Italy)

    2015-03-15

    D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = −0.21; p < 0.001), even after adjustments for age and sex (beta coefficient −94.8; p = 0.001). The relative risk for a positive D-dimer value attributed to hypokalemia was 1.64 (95% CI, 1.02 to 2.63; p = 0.040). The correlation remained statistically significant in patients free from antihypertensive drugs (r = −0.25; p = 0.018), but not in those taking angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, or diuretics. The inverse correlation between values of potassium and D-dimer in patients with AAF provides important and complementary information about the thromboembolic risk of these patients.

  5. Age- and sex-dependent reference intervals for D-dimer

    DEFF Research Database (Denmark)

    Haase, Christine; Joergensen, Maja; Ellervik, Christina

    2013-01-01

    A low D-dimer is commonly used to exclude venous thromboembolism in low risk patients. However, the reference intervals are poorly defined and D-dimer has been shown to increase by patient age. We aimed to establish age- and sex-dependent D-dimer reference intervals and to test the consequence of...... of different cut-off limits.......A low D-dimer is commonly used to exclude venous thromboembolism in low risk patients. However, the reference intervals are poorly defined and D-dimer has been shown to increase by patient age. We aimed to establish age- and sex-dependent D-dimer reference intervals and to test the consequence...

  6. Defining obesity cut-off points for migrant South Asians.

    Directory of Open Access Journals (Sweden)

    Laura J Gray

    Full Text Available Body mass index (BMI and waist circumference (WC are used to define cardiovascular and type 2 diabetes risk. We aimed to derive appropriate BMI and WC obesity cut-off points in a migrant South Asian population.4688 White Europeans and 1333 South Asians resident in the UK aged 40-75 years inclusive were screened for type 2 diabetes. Principal components analysis was used to derive a glycaemia, lipid, and a blood pressure factor. Regression models for each factor, adjusted for age and stratified by sex, were used to identify BMI and WC cut-off points in South Asians that correspond to those defined for White Europeans.For South Asian males, derived BMI obesity cut-off points equivalent to 30.0 kg/m(2 in White Europeans were 22.6 kg/m(2 (95% Confidence Interval (95% CI 20.7 kg/m(2 to 24.5 kg/m(2 for the glycaemia factor, 26.0 kg/m(2 (95% CI 24.7 kg/m(2 to 27.3 kg/m(2 for the lipid factor, and 28.4 kg/m(2 (95% CI 26.5 kg/m(2 to 30.4 kg/m(2 for the blood pressure factor. For WC, derived cut-off points for South Asian males equivalent to 102 cm in White Europeans were 83.8 cm (95% CI 79.3 cm to 88.2 cm for the glycaemia factor, 91.4 cm (95% CI 86.9 cm to 95.8 cm for the lipid factor, and 99.3 cm (95% CI 93.3 cm to 105.2 cm for the blood pressure factor. Lower ethnicity cut-off points were seen for females for both BMI and WC.Substantially lower obesity cut-off points are needed in South Asians to detect an equivalent level of dysglycemia and dyslipidemia as observed in White Europeans. South Asian ethnicity could be considered as a similar level of risk as obesity (in White Europeans for the development of type 2 diabetes.

  7. Performance of semiquantitative and quantitative D-dimer assays in the ECAT external quality assessment program.

    Science.gov (United States)

    de Maat, M P; Meijer, P; Nieuwenhuizen, W; Haverkate, F; Kluft, C

    2000-01-01

    D-dimer levels are used in clinical practice as markers for the presence or exclusion of venous thrombosis. Therefore, it is important that the performance of the D-dimer tests is well controlled. One of the components of a laboratory quality program is external quality assessment (EQA). The main aim of EQA is to identify the degree of agreement among laboratories. In addition to identifying the individual laboratory performance, it also identifies the characteristics of the different reagents and methods that are used in different laboratories. Recently, the D-dimer test was included in the ECAT External Quality Assessment program. Eighty-one laboratories in four rounds applied semiquantitative and quantitative D-dimer assays to three samples (concentrations normal, slightly elevated, and elevated). Although the reported values varied widely, the classification of the samples was mostly correct for the normal and the elevated samples. The slightly elevated sample was classified as normal by all laboratories using semiquantitative methods and by 60% of the laboratories using quantitative methods, and this varied between 45% and 86% for the different methods. In conclusion, D-dimer methods show a large variation, and the quality of the D-dimer assessment could be improved by standardization and by using cut-off ranges.

  8. Use of a low cut-off value for the fecal immunochemical test enables better detection of proximal neoplasia.

    Science.gov (United States)

    Cha, Jae Myung; Lee, Joung Il; Joo, Kwang Ro; Shin, Hyun Phil; Jeun, Jung Won; Lim, Jun Uk

    2013-11-01

    The advantage of the quantitative fecal immunochemical test (FIT) is the flexibility to set the positivity threshold. However, the diagnostic success of the FIT has not been compared for standard and low cut-off thresholds. The purpose of this study was to compare the diagnostic success of FIT for standard and low cut-off thresholds. In 2009 and 2010 a standard cut-off threshold (20 μg Hb/g feces) was used as positivity criterion for the FIT; in 2012 a low cut-off (10 μg Hb/g feces) was used. Diagnostic success was compared between the two groups. Of the total of 14,289 participants, 195 (1.4 %) had positive FIT results. Positivity of the FIT was significantly higher in the low cut-off group than in the standard cut-off group (1.8 vs. 1.0 %, p = 0.000). Although detection of advanced neoplasia lesions was comparable, proximal neoplasia was more frequently detected in the low cut-off group (33.3 vs. 20.9 %, p = 0.016). With the low cut-off threshold, 39 (0.7 %) participants were also classified as having positive results, and 18 (46.2 %) of these had colorectal neoplasias. The number of positive results from the FIT was increased by 54.9 %, and detection of advanced neoplasia was increased by 60 % with the low cut-off threshold compared with the standard cut-off. A low cut-off threshold for the FIT resulted in better detection of proximal neoplasia in population-based screening. These results indicate the cut-off threshold for positive FIT should be properly chosen and adjusted in colorectal cancer screening.

  9. Design of non-polarizing cut-off filters based on dielectric-metal-dielectric stacks.

    Science.gov (United States)

    Cai, Qing-Yuan; Luo, Hai-Han; Zheng, Yu-Xiang; Liu, Ding-Quan

    2013-08-12

    Cut-off filters are usually operating at oblique incidence and exhibit polarization dependence properties. We propose a simple approach to design cut-off filters with low linear polarization sensitivity (LPS) based on dielectric-metal-dielectric (DMD) stacks. The designing method is derived from the theory of optical film characteristic matrix. The admittance loci of the film are adjusted to achieve similar spectral properties of s- and p-polarized light at oblique incidence. Different film structures are designed non-polarizing at different angles of incidence with the method. The results show that the designing method is efficient for designing non-polarizing cut-off filters, which are widely used in non-polarizing optical system.

  10. D-dimers (DD) in CVST.

    Science.gov (United States)

    Wang, Hui Fang; Pu, Chuan Qiang; Yin, Xi; Tian, Cheng Lin; Chen, Ting; Guo, Jun Hong; Shi, Qiang

    2017-06-01

    We were interested in further confirming whether D-dimers (DD) are indeed elevated in cerebral venous sinus thrombosis (CVST) as reported in those studies. CVST patients who had a plasma D-dimer test (139 cases) were included and divided into two groups: elevated D-dimer group (EDG) (>0.5 μg/mL; 65 cases) and normal D-dimer group (NDG) (≤0.5 μg/mL; 74 cases). The two groups were compared in terms of demographic data, clinical manifestation, laboratory and imaging data, using inferential statistical methods. The chi-squared and Fisher exact test showed that, compared to the NDG (74 cases), patients with elevated D-dimer levels were more likely to have a shorter symptom duration (SD) (30 ± 83.9 versus 90 ± 58.9 d, p = 0.003), more risk factors (75.4% versus 52.7%, p = 0.006), higher multiple venous sinus involvement (75.4% versus 59.5%, p = 0.037), increased fibrinogen (43.1% versus 18.9%, p = 0.037) and higher levels of blood glucose (18.3% versus 11%, p = 0.037). According to correlation analyses, D-dimer levels were positively correlated with number of venous sinuses involvement (NVS) (r = 0.321, p = 0.009) in the EDG. Multivariate logistic regression analysis showed that SD (OR, 0.025; 95% CI, 1.324-6.043; p = 0.000), NVS (OR, 1.573; 95% CI, 1.15-2.151; p = 0.005) and risk factors (OR, 3.321; 95% CI, 1.451-7.564; p = 0.004) were significantly different between the two groups. D-dimer is elevated in patients with acute/subacute CVST.

  11. D-dimer levels and cerebral infarction in critically ill cancer patients.

    Science.gov (United States)

    Ryu, Jeong-Am; Bang, Oh Young; Lee, Geun-Ho

    2017-08-30

    D-dimer levels have been used in the diagnosis of a variety of thrombosis-related diseases. In this study, we evaluated whether measuring D-dimer levels can help to diagnose cerebral infarction (CI) in critically ill cancer patients. We retrospectively evaluated all cancer patients who underwent brain magnetic resonance imaging (MRI) between March 2010 and February 2014 at the medical oncology intensive care unit (ICU) of Samsung Medical Center. Brain MRI scanning was performed when CI was suspected due to acute neurological deficits. We compared D-dimer levels between patients ultimately diagnosed as having or not having CI and analyzed diffusion-weighted imaging (DWI) lesion patterns. A total of 88 patients underwent brain MRI scanning due to clinical suspicion of CI; altered mental status and unilateral hemiparesis were the most common neurological deficits. CI was ultimately diagnosed in 43 (49%) patients. According to the DWI patterns, multiple arterial infarctions (40%) were more common than single arterial infarctions (9%). Cryptogenic stroke etiologies were more common (63%) than determined etiologies. There was no significant difference in D-dimer levels between patients with and without CI (P = 0.319). Although D-dimer levels were not helpful in diagnosing CI, D-dimer levels were associated with cryptogenic etiologies in critically ill cancer patients; D-dimer levels were higher in the cryptogenic etiology group than in the determined etiology group or the non-infarction group (P = 0.001). In multivariate analysis, elevated D-dimer levels (> 8.89 μg/mL) were only associated with cryptogenic stroke (adjusted OR 5.46; 95% confidence interval, 1.876-15.857). Abnormal D-dimer levels may support the diagnosis of cryptogenic stroke in critically ill cancer patients.

  12. The normative score and the cut-off value of the Oswestry Disability Index (ODI).

    Science.gov (United States)

    Tonosu, Juichi; Takeshita, Katsushi; Hara, Nobuhiro; Matsudaira, Ko; Kato, So; Masuda, Kazuhiro; Chikuda, Hirotaka

    2012-08-01

    The Oswestry Disability Index (ODI) is one of the most common scoring systems used for patients with low back pain (LBP). Although the normative score of the ODI was reported to be 10.19 in a review article, no study has calculated the normative score after adjusting the value based on the age distribution. In addition, none of the previous studies has estimated the cut-off value which separates LBP with disability from LBP without disability. The purpose of this study was to estimate the normative score by adjusting the data for age distribution in Japan, and to determine the cut-off value which separates LBP with disability from LBP without disability. We conducted an internet survey on LBP using the Japanese version of the ODQ. A total of 1,200 respondents, composed of 100 males and 100 females in each age group (from the 20s to 70s), participated in this study. We also asked them to provide information about their backgrounds. We estimated the normative score after correcting for the age distribution of Japan. We also estimated the ODI of those with or without disability, the factors associated with the ODI, and the cut-off value which separates LBP with disability from LBP without disability. The participants' backgrounds were similar to the national survey. The normative score of the ODI was estimated at 8.73. The ODI of the LBP with disability group was 22.07. Those with sciatica and obese subjects showed higher ODI than those without. The optimal cut-off value was estimated to be 12. We defined the normative score and the cut-off value of the ODI.

  13. Cut-off Grade Optimization for Maximizing the Output Rate

    Directory of Open Access Journals (Sweden)

    A. Khodayari

    2012-12-01

    Full Text Available In the open-pit mining, one of the first decisions that must be made in production planning stage, after completing the design of final pit limits, is determining of the processing plant cut-off grade. Since this grade has an essential effect on operations, choosing the optimum cut-off grade is of considerable importance. Different goals may be used for determining optimum cut-off grade. One of these goals may be maximizing the output rate (amount of product per year, which is very important, especially from marketing and market share points of view. Objective of this research is determining the optimum cut-off grade of processing plant in order to maximize output rate. For performing this optimization, an Operations Research (OR model has been developed. The object function of this model is output rate that must be maximized. This model has two operational constraints namely mining and processing restrictions. For solving the model a heuristic method has been developed. Results of research show that the optimum cut-off grade for satisfying pre-stated goal is the balancing grade of mining and processing operations, and maximum production rate is a function of the maximum capacity of processing plant and average grade of ore that according to the above optimum cut-off grade must be sent to the plant.

  14. Clinically Relevant Cut-off Points for the Diagnosis of Sarcopenia in Older Korean People.

    Science.gov (United States)

    Choe, Yu-Ri; Joh, Ju-Youn; Kim, Yeon-Pyo

    2017-11-09

    The optimal criteria applied to older Korean people have not been defined. We aimed to define clinically relevant cut-off points for older Korean people and to compare the predictive validity with other definitions of sarcopenia. Nine hundred and sixteen older Koreans (≥65 years) were included in this cross-sectional observational study. We used conditional inference tree analysis to determine cut-off points for height-adjusted grip strength (GS) and appendicular skeletal muscle mass (ASM), for use in the diagnosis of sarcopenia. We then compared the Korean sarcopenia criteria with the Foundation for the National Institutes of Health and Asian Working Group for Sarcopenia criteria, using frailty, assessed with the Korean Frailty Index, as an outcome variable. For men, a residual GS (GSre) of ≤ 0.25 was defined as weak, and a residual ASM (ASMre) of ≤ 1.29 was defined as low. Corresponding cut-off points for women were a GSre of ≤ 0.17 and an ASMre of ≤ 0.69. GSre and ASMre values were adjusted for height. In logistic regression analysis with new cut-off points, the adjusted odds ratios for pre-frail or frail status in the sarcopenia group were 3.23 (95% confidence interval [CI] 1.33-7.83) for the men and 1.74 (95% CI 0.91-3.35) for the women. In receiver operating characteristic curve analysis, the unadjusted area under the curve for Korean sarcopenia criteria in men and women were 0.653 and 0.608, respectively (p sarcopenia in older Korean people.

  15. High cut-off dialysis in chronic haemodialysis patients.

    Science.gov (United States)

    Girndt, Matthias; Fiedler, Roman; Martus, Peter; Pawlak, Michael; Storr, Markus; Bohler, Torsten; Glomb, Marcus A; Liehr, Kristin; Henning, Christian; Templin, Markus; Trojanowicz, Bogusz; Ulrich, Christof; Werner, Kristin; Zickler, Daniel; Schindler, Ralf

    2015-12-01

    Haemodialysis patients suffer from chronic systemic inflammation and high incidence of cardiovascular disease. One cause for this may be the failure of diseased kidneys to eliminate immune mediators. Current haemodialysis treatment achieves insufficient elimination of proteins in the molecular weight range 15-45 kD. Thus, high cut-off dialysis might improve the inflammatory state. In this randomized crossover trial, 43 haemodialysis patients were treated for 3 weeks with high cut-off or high-flux dialysis. Inflammatory plasma mediators, monocyte subpopulation distribution and leucocyte gene expression were quantified. High cut-off dialysis supplemented by a low-flux filter did not influence the primary end-point, expression density of CD162 on monocytes. Nevertheless, treatment reduced multiple immune mediators in plasma. Such reduction proved - at least for some markers - to be a sustained effect over the interdialytic interval. Thus, for example, soluble TNF-receptor 1 concentration predialysis was reduced from median 13·3 (IQR 8·9-17·2) to 9·7 (IQR 7·5-13·2) ng/mL with high cut-off while remaining constant with high-flux treatment. The expression profile of multiple proinflammatory genes in leucocytes was significantly dampened. Treatment was well tolerated although albumin losses in high cut-off dialysis would be prohibitive against long-term use. The study shows for the first time that a dampening effect of high cut-off dialysis on systemic inflammation is achievable. Earlier studies had failed due to short study duration or insufficient dialysis efficacy. Removal of soluble mediators from the circulation influences cellular activation levels in leucocytes. Continued development of less albumin leaky membranes with similar cytokine elimination is justified. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

  16. The need for re-defining cut-off values in heart failure: From obesity to iron deficiency.

    Science.gov (United States)

    Konishi, Masaaki; von Haehling, Stephan

    2017-01-01

    The health status of older people is frequently complicated by one or more chronic diseases. Some conditions might have a different meaning in certain groups of elderly subjects, like in frail people or older patients with heart failure. Cut-off values defining these conditions may require adjustment in such groups. Indeed, several such conditions (e.g. obesity and hypercholesterolemia) have been discussed recently in light of so-called paradoxical situations, which are - counter-intuitively - associated with better outcome instead of a negative impact on survival in the general population. Therefore, different cut-off values may be needed in some groups of older subjects. The pathophysiological mechanisms for these paradoxical situations need to be understood in at least two different ways, causal and non-causal. The aim of this review is to provide an overview of a variety of conditions (obesity, dyslipidaemia, hypertension, and diabetes) in which new cut-offs may have diagnostic, clinical, or prognostic value, focusing on heart failure as a chronic disease, which is frequently observed in older patients. Haemoglobin concentration may need a different cut-off in heart failure for a reason other than paradox. Namely, underlying iron deficiency itself, both in those with or without anaemia, can have effects on symptoms and quality of life. Further studies will be needed for re-defining cut-off values in heart failure and maybe in the other chronic illnesses. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Preoperative plasma D-dimer is a predictor of one-year survival in colorectal cancer patients: a prospective clinical cohort study

    DEFF Research Database (Denmark)

    Stender, Mogens; Larsen, Torben Bjerregaard; Frøkjær, J.B.

    thrombosis up to one year after surgery was 20 percent (95 percent confidence interval, 12 to 31 percent) in the positive D-dimer group compared with 5 percent (95 percent confidence interval, 2 to 12 percent) in the negative D-dimer group. The adjusted hazard ratio of deep venous thrombosis in the positive...... cancer and absence of preoperative deep venous thrombosis, we measured the preoperative plasma D-dimer levels and performed compression ultrasonography for deep venous thrombosis prior to surgery, as well as one week, one month, and one year after surgery. RESULTS: The cumulative incidence of deep venous...... vs. the negative D-dimer group was 6.53 (95 percent confidence interval, 1.58 to 27.0). CONCLUSIONS: A positive preoperative D-dimer was associated with a higher cumulated incidence of postoperative deep venous thrombosis. D-dimer might be useful in identifying those colorectal cancer patients who...

  18. A PROBLEM OF CUTTING OFF THE LAMINATED SEMIS TYPE PLATE

    Directory of Open Access Journals (Sweden)

    Florin Ciofu

    2012-11-01

    Full Text Available A problem often coped on many domains such as wood manufacturing, glass, plastics and metallic platework industry, is the shaping or cutting off a big plate in many pieces. With this purpose there are algorithms of optimizing for positioning the parts following to be cut off from a row plate. From mathematical point of view, in positioning the parts on a raw plate the number of solutions increase four times evrey time a new part is added, and in case of finding the best solution for about few hundreds of pieces or parts would require years of processing on the most performant computers nowadays – for an analogy remember the famous story with the rice beads which the King had to pay to the master teaching him the chess: twice more for each square of the chessboard; for the total quantity assessment, King ascertained that the crops in his whole life wouldn’t have been enough.

  19. Unusual Solar Decameter Radio Bursts with High Frequency Cut off

    Science.gov (United States)

    Brazhenko, A. I.; Melnik, V. M.; Frantsuzenko, A. V.; Rucker, H. O.; Panchenko, M.

    2015-03-01

    Solar bursts with high frequency cut off were observed by the URAN-2 radio telescope (Poltava, Ukraine) on 18 August, 2012 in the frequency range 8-32 MHz. Durations of these bursts changed from 30 to 70 s. It is much longer than that for standard type III bursts. Drift rates are much smaller than those of type III bursts are, though much larger than those for decameter type II bursts. In some cases, the drift rate sign changes from the negative to positive one. Some of these bursts have fine structures. Stripes of the fine structures have small drift rates of 20-40 kHz/s. Polarizations of these bursts made about 10 % that apparently indicates that they are generated at the second harmonic of the local plasma frequency. The connection of bursts with the high frequency cut off with compact ejections from the behind-limb active regions is confirmed.

  20. Cut-off nonlinearities in the low-temperature vibrations of glasses and crystals

    OpenAIRE

    Mizuno, Hideyuki; Silbert, Leonardo E.; Sperl, Matthias; Mossa, Stefano; Barrat, Jean-Louis

    2015-01-01

    We present a computer simulation study of glassy and crystalline states using the standard Lennard-Jones interaction potential that is truncated at a finite cut-off distance, as is typical of many computer simulations. We demonstrate that the discontinuity at the cut-off distance in the first derivative of the potential (corresponding to the interparticle force) leads to the appearance of cut-off nonlinearities. These cut-off nonlinearities persist into the very-low-temperature regime thereby...

  1. Energetics of southeastern Pacific cut-off lows

    Science.gov (United States)

    Gan, Manoel Alonso; Piva, Everson Dal

    2016-06-01

    The existence of cut-off lows (COLs) over South Pacific and South America is often associated with adverse weather events such as intense precipitation over the central region of South America, frost episodes in southern Brazil and the development of Andes lee cyclones and intense cyclones over the southern coast of Brazil. Despite this importance, the formation and maintenance mechanisms of the COLs are not well understood. To detail the significant variability in terms of the eddy kinetic energy equation for fifty cases of COLs that formed over the southeastern Pacific Ocean is the aim of this study. Only the cases of COLs that formed over the ocean and remained there during most of their life were chosen. The main terms of the equation [ageostrophic flux convergence (AFC), baroclinic conversion (BRC) and barotropic conversion (BRT)] were calculated using the 6-hourly gridded data from the National Centers for Environmental Prediction/Department of Energy reanalysis. The formation mechanism of the COLs was associated with BRC and AFC. During the midlife period, the BRC term converted eddy kinetic energy to eddy potential energy and the AFC had a positive contribution until 6 h after the midlife point. In the dissipation phase, the BRC term remained positive and AFC became negative. The BRT extracted kinetic energy from the COL during the entire life cycle. The AFC term was the most important in all phases of the cut-off lifetime, and it was the responsible for extending the cut-off lifetime while the others terms were negatives.

  2. Tentative Colistin Epidemiological Cut-Off Value for Salmonella spp

    DEFF Research Database (Denmark)

    Agersø, Yvonne; Torpdahl, Mia; Zachariasen, Camilla

    2012-01-01

    . Interestingly, Salmonella Dublin and Salmonella Enteritidis belong to the same O-group (O:1, 9,12), suggesting that surface lipopolysaccharides (LPS) of the cell (O-antigen) play a role in colistin susceptibility. The epidemiological cut-off value of >2 mg/L for colistin suggested by European Committee...... on Antimicrobial Susceptibility Testing (EUCAST) is placed inside the distribution for both Salmonella Dublin and Salmonella Enteritidis. All tested Salmonella Dublin isolates, regardless of MIC colistin value, had identical pmrA and pmrB sequences. Missense mutations were found only in pmrA in one Salmonella...

  3. Large D-Dimer Fluctuation in Normal Pregnancy

    DEFF Research Database (Denmark)

    Hedengran, Katrine K; Andersen, Malene R; Stender, Steen

    2016-01-01

    pregnancies were recruited. D-dimer was repeatedly measured during pregnancy, at active labor, and on the first and second postpartum days. Percentiles for each gestational week were calculated. Each individual D-dimer was normalized by transformation into percentiles for the relevant gestational age...... or delivery group. The range in percentage points during the pregnancy and the delivery was calculated, and reference intervals were calculated for each pregnancy trimester, during vaginal delivery and scheduled and emergency cesarean section, and for the first and second day postpartum. Results. D......-dimer increased during pregnancy; the maximal fluctuation was approximately 20 percentile points in approximately half of the women. In one out of ten women, the D-dimer values fluctuated by more than 50 percentile points. Conclusions. Due to the biological variation in D-dimer within each individual woman during...

  4. Determining Cut-Off Points for the Dental Fear Survey.

    Science.gov (United States)

    Oliveira, Maurício Antônio; Bendo, Cristiane Baccin; Paiva, Saul Martins; Vale, Miriam Pimenta; Serra-Negra, Júnia Maria

    2015-01-01

    To determine a high fear cut-off point score for the Dental Fear Survey (DFS) using a single-item self-report questionnaire. The DFS, a 20-item questionnaire assessing fear of dental treatment, was completed by 1,256 participants with a mean age of 22.3 years (SD = 5.1). Another self-report questionnaire was used to collect data on previous dental experiences. A high fear cut-off point score was determined by calculating the receiver operating characteristic (ROC) curve for the DFS. Descriptive statistics and multinomial logistic regression were calculated; a significance level of p sensitivity of 88.9% and a specificity of 92.5%. Most participants (n = 895; 71.5%) reported no fear of going to the dentist. There was significant association between DFS score and fear assessed with the question "Are you fearful of going to the dentist?" (p sensitivity and specificity and can be used to predict high dental fear.

  5. Physical and cut-off effects of heavy sea quarks

    CERN Document Server

    Knechtli, Francesco; Bruno, Mattia; Finkenrath, Jacob; Leder, Björn; Marinkovic, Marina; Sommer, Rainer

    2014-01-01

    We simulate a theory with two dynamical O($a$) improved Wilson quarks whose mass $M$ ranges from a factor eight up to a factor two below the charm quark mass and at three values of the lattice spacing ranging from 0.066 to 0.034 fm. This theory is a prototype to study the decoupling of heavy quarks. We measure the mass and cut-off dependence of ratios of gluonic observables defined from the Wilson flow or the static potential. The size of the 1/$M$ corrections can be determined and disentangled from the lattice artifacts. The difference with the pure gauge theory is at the percent level when two quarks with a mass of the charm quark are present.

  6. Separation-survivability--the elusive moral cut-off point?

    Science.gov (United States)

    de Roubaix, J A M; van Niekerk, A A

    2006-07-01

    Act 92 of 1996, the Choice on Termination of Pregnancy Act, seeks to promote female autonomy. The Act makes no reference to the nature of the abortus--implying its moral insignificance. Utilitarian arguments on the value of life strongly support this position. Utilitarians argue that neither belonging to the human species, nor possession of the potential to develop into a person, is a significant intrinsic characteristic in determining the value of life. For them the entrance requirement to any conception of moral significance is sentience--the ability to suffer. Full moral significance is only accorded to 'persons'. A person is someone who has attained a sufficient level of self-awareness to have an interest in the continuance of its existence. This develops some time after birth. 'Conservatives' argue for conception as the moral cut-off point after which termination is morally unacceptable; 'liberals' hold that there is no such prenatal point. Both of these notions are problematic, as is the notion of sentience. We argue that separation-survivability is the only morally acceptable cut-off point, based on four premises, viz. (i) a particular notion of potentiality; (ii) the inextricable, mutual relationship between human beings and their world (without either, the other cannot exist); (iii) the moral correspondence of the viable fetus and the neonate; and (iv) the moral unacceptability of infanticide. We support a graded position on the value of prenatal human life, and a 'moderate' stance on termination--that notwithstanding possessing some moral significance, other arguments may trump this up to the point of separation-survivability. This seriously problematises 'partial birth' abortion, and the utilitarian argument on the value of life.

  7. Association of D-dimer with microalbuminuria in patients with type 2 diabetes mellitus.

    Science.gov (United States)

    Wakabayashi, Ichiro; Masuda, Hiroshi

    2009-01-01

    Microalbuminuria has been reported to be related to incidence of cardiovascular complications in diabetes. No consistent findings have been obtained on the relationships of microalbuminuria with blood coagulation and fibrinolysis. The purpose of this study was to determine whether microalbuminuria is associated with blood markers reflecting coagulation and fibrinolysis activities in patients with type 2 diabetes. The relationships of albumin excretion rate (AER) with atherosclerosis-related variables, including blood coagulation and fibrinolysis markers, were investigated in patients with type 2 diabetes who showed normoalbuminuria (AER: less than 20 microg/min) and microalbuminuria (AER: 20 microg/min or higher and less than 200 microg/min). AER was significantly correlated with body mass index (BMI), maximum intima-media thickness of common carotid arteries, blood HDL cholesterol, uric acid, creatinine and D-dimer. On the other hand, AER showed no significant correlation with blood platelets, fibrinogen, thrombin-antithrombin III complex, plasmin-alpha2 plasmin inhibitor complex and plasminogen activator inhibitor-1. In multiple regression analysis, using age, sex, BMI, pulse pressure, hemoglobin A1c, HDL cholesterol, uric acid, creatinine, D-dimer and history of anti-thrombotic therapy as explanatory variables, only D-dimer showed a significant correlation with AER. The mean level of log-converted D-dimer after adjustment for age and sex was significantly higher in subjects with microalbuminuria than in those with normoalbuminuria. D-dimer is associated with microalbuminuria in patients with diabetes and this suggests that glomerular dysfunction is in part mediated by hypercoagulability.

  8. Explaining the use of attribute cut-off values in decision making by means of involvement

    DEFF Research Database (Denmark)

    Peschel, Anne O.; Grebitus, Carola; Colson, Gregory

    2016-01-01

    In order to lower the cognitive burden of decision making, consumers may apply attribute cut-off values to simplify decision strategies. Products with attributes that do not pass the cut-off values are either not being considered by the individual or are greatly discounted. This study provides new...... respondents’ attribute cut-off values and their validated Personal Involvement Inventory (PII). Evidence from the analysis indicates that consumers who are highly involved are more likely to exhibit attribute cut-off values and are less likely to violate their cut-off values. Further investigation using...... evidence on consumers’ heterogeneous use of attribute cut-offs with a unique focus on the relationship with consumer involvement, a key component in consumer choice theory. Behavioral data from an online choice experiment on beef steak employing shelf simulations are combined with questions defining...

  9. Validity of newly-developed BMI and waist cut-off values for Sri Lankan children.

    Science.gov (United States)

    Wickramasinghe, V P; Arambepola, C; Bandara, D M P S; Abeysekera, M; Kuruppu, S; Dilshan, P; Dissanayake, B S

    2013-05-01

    Excess body fat leads to obesity-related morbidity and population/ethnicity-specific cut-off values of anthropometric measures are useful for better diagnosis. This study assesses the suitability of newly-developed Sri Lankan anthropometric cut-off values in the diagnosis of obesity in Sri Lankan children. A cross-sectional study was conducted at University of Colombo, Sri Lanka involving 5-15 year old children. Height, weight, waist (WC), and hip (HC) circumferences were measured. Total body fat (FM) was measured using whole body BIA. WHR and WHtR were calculated. Validity of anthropometric measures in detecting childhood obesity (Sri Lankan BMI/WC; IOTF, WHO, British and CDC BMI and British WC cut-off values) were evaluated. Nine hundred and twenty children were assessed. FM showed significant associations with BMI (r = 0.92, p cut-off values under-estimated obesity. Sri Lankan WC and BMI cut-off values over-estimated obesity. International BMI based cut-off values had high specificity (>99%) but a low sensitivity (∼12-33%), while Sri Lankan BMI cut-off values had high sensitivity (>93.1) but low specificity (>79.7). Internationally available BMI cut-off values are poor in diagnosing obesity in Sri Lankan children. Newly developed Sri Lankan BMI cut-off values for children improved the diagnosis. WC can be used successfully as an alternative diagnostic tool of obesity.

  10. Serum D-dimer Levels Are Proportionally Associated with Left Atrial Enlargement in Patients with an Acute Ischemic Stroke due to Non-valvular Atrial Fibrillation.

    Science.gov (United States)

    Kim, Tae-Won; Song, In-Uk; Chung, Sung-Woo; Kim, Joong-Seok; Koo, Jaseong; Lee, Kwang-Soo

    2016-01-01

    Objective Left atrial enlargement (LAE) may predispose individuals to blood stasis in atrial fibrillation (AF), and thus play a crucial role in thrombogenesis. The D-dimer level is one of the surrogate markers for a hypercoagulable state and reflects thrombus formation in AF. Since the D-dimer level reflects hypercoagulability as well as thrombus and fibrin burdens, LAE could be associated with a D-dimer elevation. However, no studies have explored this association or which factors contribute to increases in the D-dimer levels in patients with AF. Therefore, we assessed whether the serum D-dimer levels are related to the left atrial volume index (LAVI) or other vascular risk factors and also evaluated the association between the D-dimer levels and the initial stroke severity. Methods Ninety-eight consecutive patients with an acute ischemic stroke and non-valvular AF (NVAF) who were anticoagulation-naïve were enrolled, and all patients were stratified into moderate-to-severe and mild neurologic deficit groups using the National Institutes of Health Stroke Scale on admission. The association between the initial serum D-dimer levels and the LAVI was evaluated in all enrolled patients, and the serum D-dimer levels were compared between the two groups. Results The patients were classified into two groups according to the severity of the neurologic deficit. In a partial correlation coefficient analysis adjusted for confounding factors, an increase in the initial serum D-dimer levels was significantly associated with LAVI (r=0.286; p=0.027). A linear regression analysis showed that a history of peripheral artery disease was the factor most strongly associated with the serum D-dimer level (t=3.90, pacute ischemic stroke and NVAF.

  11. D-dimer and BNP levels in acute aortic dissection.

    Science.gov (United States)

    Sbarouni, Eftihia; Georgiadou, Panagiota; Marathias, Aikaterini; Geroulanos, Stefanos; Kremastinos, Dimitrios Th

    2007-11-15

    Early diagnosis and treatment are pivotal for patients with acute aortic dissection (AAD). D-dimer is a rule-out diagnostic test for pulmonary embolism but there is evidence that it may also be applicable to AAD. We evaluated plasma D-dimer, white cell blood count (WBC), C-reactive protein (CRP) and N-terminal pro-B-type natriuretic peptide (BNP) in 18 consecutive patients with established AAD, 21 consecutive patients with dilated ascending aortas scheduled for elective surgery and 8 normal subjects. Patients with AAD had significantly higher elevated D-dimer, compared to chronic aneurysms and normal controls (pD-dimer level higher than 700 ng/ml had a sensitivity of 94% and specificity of 59% for diagnosis of AAD. The WBC count was also significantly increased compared to the other groups (pD-dimer can be used as a 'rule-out' test in patients with suspected AAD and seems useful in the discrimination between AAD and chronic uncomplicated aneurysms, unlike CRP and BNP plasma levels.

  12. Malnutrition Inflammation Score cut-off predicting mortality in maintenance hemodialysis patients.

    Science.gov (United States)

    Borges, Mariana Clementoni Costa; Vogt, Barbara Perez; Martin, Luis Cuadrado; Caramori, Jacqueline Costa Teixeira

    2017-02-01

    Malnutrition is a strong predictor of mortality on hemodialysis patients, especially when it is associated with inflammation. Malnutrition Inflammation Score (MIS) is a simple and low cost tool which assesses the presence of malnutrition associated with inflammation. Therefore, the aim is to evaluate if MIS is associated with mortality in patients on maintenance hemodialysis and establish a cut-off to predict mortality at different follow-up periods. Observational retrospective cohort study including 215 patients on hemodialysis between July 2012 and June 2014, censored until November 2015. MIS was used to assess patient's nutritional status at the moment they were enrolled in the study. They were followed for at least 18 months. At the end of 18 months, 38 (17.7%) deaths, 20 renal transplants (9.3%), four facilities transference (1.9%), three dialysis method change (1.4%) and one renal function recovery (0.5%) were observed. One hundred seventy one patients completed at least 24 months of follow-up, and during this additional period, there were five deaths and one renal transplant more. Score higher than 7 points was able to predict mortality for both follow-up periods using sensitivity and specificity analysis and ROC curves. Using this cut-off on Kaplan-Meier survival curve, it was possible to confirm the association of MIS with all-cause mortality at 18 months and 24 or more months of follow-up. Finally, Cox multivariate analysis adjusted for demographic, clinical and nutritional variables showed MIS as the only significant predictor of mortality. MIS is an independent predictor of mortality in hemodialysis patients. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  13. Cut-off frequencies of circumferential horizontal shear waves in various functionally graded cylinder shells.

    Science.gov (United States)

    Shen, Xiaoqin; Ren, Dawei; Cao, Xiaoshan; Wang, Ji

    2017-11-06

    In this study, cut-off frequencies of the circumferential SH waves in functionally graded piezoelectric-piezomagnetic material (FGPPM) cylinder shells with traction free, electrical and magnetic open boundary conditions are investigated analytically. The Wentzel-Kramers-Brillouin (WKB) method is employed for solving differential equations with variable coefficients for general cases. For comparison, Bessel functions and Kummer functions are used for solving cut-off frequency problems in homogenous and ideal FGPPM cylinder shells. It is shown that the WKB solution for the cut-off frequencies has good precise. The set of cut-off frequencies is a series of approximate arithmetic progressions, for which the difference is a function of the density and the effective elastic parameter. The relationship between the difference and the gradient coefficient is described. These results provide theoretical guidance for the non-destructive evaluation of curved shells based on the cut-off frequencies. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. The Optimal Cut-Off Value of Blood Stasis Syndrome Score in BSS Diagnosis in Korea

    Directory of Open Access Journals (Sweden)

    Byoung-Kab Kang

    2017-01-01

    Full Text Available Objective. In the traditional oriental medicine, it is sometimes difficult to diagnose Blood Stasis Syndrome (BSS in patients, because the diagnosis of BSS is based on the subjective signs and symptoms of patients. This study is aimed at developing the prediction tool of BSS using cut-off value for BSS score. The identification of a cut-off value for BSS score to diagnose BSS would be helpful. Methods. A total of 887 patients admitted to six traditional Korean medical hospitals in 2013 and three hospitals in 2014. All patients have an identical pattern as a result of diagnostic decision of two experts. The cut-off value for BSS score for BSS diagnosis was determined by the receiver-operating characteristic curve. Results. The area under the curve of this curve was 0.897. The optimal cut-off point for detection of BSS was 49.0. The sensitivity and specificity of this cut-off value were 80.8% and 83.2% in modelling data (2013 dataset and 84.6% and 83.1% in validation data (2014 dataset, respectively. Conclusion. Our study suggests that a BSS score cut-off value of 49.0 can be used to detect BSS in the traditional Korean medical hospitals. This cut-off value for diagnosis of BSS will make up the lack of objectivity.

  15. Human papillomavirus testing in primary cervical screening and the cut-off level for hybrid capture 2 tests

    DEFF Research Database (Denmark)

    Rebolj, Matejka; Bonde, Jesper; Njor, Sisse Helle

    2011-01-01

    To determine the trade-off between the sensitivity and the specificity for high grade cervical intraepithelial neoplasia at hybrid capture 2 cut-off values above the standard = 1 relative light units/cut-off level (rlu/co).......To determine the trade-off between the sensitivity and the specificity for high grade cervical intraepithelial neoplasia at hybrid capture 2 cut-off values above the standard = 1 relative light units/cut-off level (rlu/co)....

  16. Epidemiological cut-off values for Flavobacterium psychrophilum MIC data generated by a standard test protocol

    DEFF Research Database (Denmark)

    Smith, P.; Endris, R.; Kronvall, G.

    2016-01-01

    Epidemiological cut-off values were developed for application to antibiotic susceptibility data for Flavobacterium psychrophilum generated by standard CLSI test protocols. The MIC values for ten antibiotic agents against Flavobacterium psychrophilum were determined in two laboratories. For five...

  17. Body Mass Index and Obesity : Tailoring "cut-off" for an Asian Indian Male Population

    National Research Council Canada - National Science Library

    Singh, S P; Sikri, G; Garg, M K

    2008-01-01

    ... (Body Mass Index- BMI), a surrogate measure of fatness. The currently used BMI cut-offs to classify people as overweight or obese in Armed Forces have been defined in studies on Caucasian populations...

  18. Experimental research on the durability cutting tools for cutting-off steel profiles

    OpenAIRE

    Cristea Alexandru; Fetecău Cătălin; Stanciu Nicoleta Violeta

    2017-01-01

    The production lines used for manufacturing U-shaped profiles are very complex and they must have high productivity. One of the most important stages of the fabrication process is the cutting-off. This paper presents the experimental research and analysis of the durability of the cutting tools used for cutting-off U-shaped metal steel profiles. The results of this work can be used to predict the durability of the cutting tools.

  19. Experimental research on the durability cutting tools for cutting-off steel profiles

    Directory of Open Access Journals (Sweden)

    Cristea Alexandru

    2017-01-01

    Full Text Available The production lines used for manufacturing U-shaped profiles are very complex and they must have high productivity. One of the most important stages of the fabrication process is the cutting-off. This paper presents the experimental research and analysis of the durability of the cutting tools used for cutting-off U-shaped metal steel profiles. The results of this work can be used to predict the durability of the cutting tools.

  20. D-dimer measurements in acute aortic dissection

    Directory of Open Access Journals (Sweden)

    Vladyslava Bazylevska

    2016-07-01

    Full Text Available Acute aortic dissection (AAD is a medical emergency with significant morbidity and mortality. The diagnosis can be challenging due to the wide array of presenting symptoms and a broad differential diagnosis. Computed tomographic angiography is currently the gold standard for diagnosis of AAD. However, it carries the risk of contrast and radiation exposure and has a financial burden for patients. Multiple biomarkers have been evaluated as a screening tool for AAD. D-dimer has previously been suggested as a sole rule-out test for AAD. It is rapid and inexpensive, is widely available in the emergency rooms, and is highly sensitive for any thrombotic event. This review article evaluates the evidence for the use of D-dimer assays in the diagnosis of AAD, in differentiation of AAD from acute coronary syndromes, and in risk stratification of AAD patients.

  1. Determination of new anthropometric cut-off values for obesity screening in Indonesian adults.

    Science.gov (United States)

    Hastuti, Janatin; Kagawa, Masaharu; Byrne, Nuala M; Hills, Andrew P

    Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-stature ratio (WSR) have increasingly been used as screening tools for obesity. However, optimal cut-off values may be different between populations. The current study determined the optimum cut-off values for BMI, WC, WHR, and WSR for obesity screening in Indonesian adults using receiver-operating characteristic (ROC) analysis. Stature, body weight, waist and hip circumferences were measured on 600 Indonesians aged 18-65 years (males, n=292; females, n=308) and BMI, WHR, and WSR calculated. Percentage of body fat (%BF) was determined using the deuterium isotope (D2O) dilution technique. Some existing cut-off points for obesity determination were evaluated for sensitivity and specificity. The existing cutoff values showed low sensitivity in our sample (between 18.4 and 71.1%) and new proposed cut-offs increased the sensitivity to reach 66.7 to 88.5%. The new cut-offs for BMI, WC, WHR, and WSR for determination of obesity were 21.9 (kg/m2), 76.8 (cm), 0.86, and 0.48, respectively, for males and 23.6 (kg/m2), 71.7 (cm), 0.77, and 0.47, respectively, for females. WC and WSR are the most predictive both for males and females, and therefore are considered as better screening tools for obesity in this population.

  2. D-dimer: An Overview of Hemostasis and Fibrinolysis, Assays, and Clinical Applications.

    Science.gov (United States)

    Olson, John D

    2015-01-01

    D-dimer is the smallest fibrinolysis-specific degradation product found in the circulation. The origins, assays, and clinical use of D-dimer will be addressed. Hemostasis (platelet and vascular function, coagulation, fibrinolysis, hemostasis) is briefly reviewed. D-dimer assays are reviewed. The D-dimer is very sensitive to intravascular thrombus and may be markedly elevated in disseminated intravascular coagulation, acute aortic dissection, and pulmonary embolus. Because of its exquisite sensitivity, negative tests are useful in the exclusion venous thromboembolism. Elevations occur in normal pregnancy, rising two- to fourfold by delivery. D-dimer also rises with age, limiting its use in those >80 years old. There is a variable rise in D-dimer in active malignancy and indicates increased thrombosis risk in active disease. Elevated D-dimer following anticoagulation for a thrombotic event indicates increased risk of recurrent thrombosis. These and other issues are addressed. © 2015 Elsevier Inc. All rights reserved.

  3. Calculating broad neutron resonances in a cut-off Woods-Saxon potential

    Energy Technology Data Exchange (ETDEWEB)

    Baran, A.; Noszaly, Cs. [Faculty of Informatics, University of Debrecen, PO Box 12, Debrecen (Hungary); Salamon, P. [Hungarian Academy of Sciences (ATOMKI), Institute for Nuclear Research, PO Box 51, Debrecen (Hungary); Vertse, T. [Faculty of Informatics, University of Debrecen, PO Box 12, Debrecen (Hungary); Hungarian Academy of Sciences (ATOMKI), Institute for Nuclear Research, PO Box 51, Debrecen (Hungary)

    2015-07-15

    In a cut-off Woods-Saxon (CWS) potential with realistic depth S -matrix poles being far from the imaginary wave number axis form a sequence where the distances of the consecutive resonances are inversely proportional with the cut-off radius value, which is an unphysical parameter. Other poles lying closer to the imaginary wave number axis might have trajectories with irregular shapes as the depth of the potential increases. Poles being close repel each other, and their repulsion is responsible for the changes of the directions of the corresponding trajectories. The repulsion might cause that certain resonances become antibound and later resonances again when they collide on the imaginary axis. The interaction is extremely sensitive to the cut-off radius value, which is an apparent handicap of the CWS potential. (orig.)

  4. Qualitative point-of-care D-dimer testing compared with quantitative D-dimer testing in excluding pulmonary embolism in primary care

    NARCIS (Netherlands)

    Lucassen, W. A M; Erkens, P. M G; Geersing, G. J.; Büller, H. R.; Moons, K. G M; Stoffers, H. E J H; van Weert, H. C P M

    2015-01-01

    Background: General practitioners can safely exclude pulmonary embolism (PE) by using the Wells PE rule combined with D-dimer testing. Objective: To compare the accuracy of a strategy using the Wells rule combined with either a qualitative point-of-care (POC) D-dimer test performed in primary care

  5. Methodological issues in the design of a rheumatoid arthritis activity score and its cut-offs.

    Science.gov (United States)

    Collignon, Olivier

    2014-01-01

    Activity of rheumatoid arthritis (RA) can be evaluated using several scoring scales based on clinical features. The most widely used one is the Disease Activity Score involving 28 joint counts (DAS28) for which cut-offs were proposed to help physicians classify patients. However, inaccurate scoring can lead to inappropriate medical decisions. In this article some methodological issues in the design of such a score and its cut-offs are highlighted in order to further propose a strategy to overcome them. As long as the issues reviewed in this article are not addressed, results of studies based on standard disease activity scores such as DAS28 should be considered with caution.

  6. BANKRUPTCY PREDICTION MODEL WITH ZETAc OPTIMAL CUT-OFF SCORE TO CORRECT TYPE I ERRORS

    Directory of Open Access Journals (Sweden)

    Mohamad Iwan

    2005-06-01

    This research has successfully attained the following results: (1 type I error is in fact 59,83 times more costly compared to type II error, (2 22 ratios distinguish between bankrupt and non-bankrupt groups, (3 2 financial ratios proved to be effective in predicting bankruptcy, (4 prediction using ZETAc optimal cut-off score predicts more companies filing for bankruptcy within one year compared to prediction using Hair et al. optimum cutting score, (5 Although prediction using Hair et al. optimum cutting score is more accurate, prediction using ZETAc optimal cut-off score proved to be able to minimize cost incurred from classification errors.

  7. Generating elastic band gaps in square lattice grid by periodical cut-off operations

    Science.gov (United States)

    Han, Lin; Li, Xiao-mei; Zhang, Yan

    2017-09-01

    From periodically cutting off rods in square lattice grids, we give an easy and feasible way to generate elastic band gaps (BGs) in it. We define the model of the periodical cut-off (PCO) square lattice grid, and study the frequency dispersion relation and the motion modes of rods, as well as the frequency responses. On this basis, we confirm that the PCO operation is feasible to generate BGs in square lattice grids. Furthermore, the BGs generated in PCO square lattice grids are basically locally resonant BGs with low frequency ranges which attributes to the motions of exposed cantilevers.

  8. D-dimer testing for safe exclusion and risk stratification in patients with acute pulmonary embolism in primary care

    Directory of Open Access Journals (Sweden)

    Zhou Yin

    2015-01-01

    Full Text Available Background: Safe exclusion and risk stratification are currently recommended for the initial management of patients with acute pulmonary embolism (APE. The aim of this study was to assess the safe exclusion and risk stratification value of D-dimer (DD for APE when tested at the beginning of admission. Materials and Methods: All consecutive Chinese APE patients and controls were recruited from January 2010 to December 2012. All measurements of serum indexes were made in duplicate and blinded to the patients′ status. All the 40 patients with the first episode of APE were confirmed by multi-detector computed tomographic pulmonary angiography. The plasma prothrombin time (PT, activated partial thromboplastin time, thrombin time, fibrinogen, and DD levels were measured within 24 h of admission. We used the Mann-Whitney U-test to determine the differences between groups and drew receiver operator characteristic curve to evaluate the indexes′ value in the APE screening. Results: The PT and DD in the APE group were significantly higher than those in the disease control group (P 1820 μg/L as cut-off value, the sensitivity, specificity, positive and negative predictive value was 82.5%, 75.2%, 56.9%, and 91.6%, respectively. Conclusion: The patients with APE showed significant higher DD levels compared with disease controls, suggesting a negative qualitative DD test result can safely and efficiently exclude APE in primary care.

  9. A clinically based prognostic index for diffuse large B-cell lymphoma with a cut-off at 70 years of age significantly improves prognostic stratification

    DEFF Research Database (Denmark)

    Gang, Anne O.; Pedersen, Michael; d'Amore, Francesco

    2015-01-01

    subtypes. We applied IPI factors to a population-based rituximab-treated cohort of 1990 patients diagnosed 2000-2010 and explored new factors and the optimal prognostic age cut-off for DLBCL. Multivariate-analyses (MVA) confirmed the prognostic value of all IPI factors except the presence of > 1 extranodal...... lesion. The optimal age cut-off was 70 years. In a MVA of albumin, lymphocyte count, sex, immunoglobulin G, bulky disease, hemoglobin and B-symptoms, only albumin was prognostic. We propose: (1) a modified DLBCL prognostic index (DLBCL-PI) including: age (70 years), performance status (PS), lactate...... dehydrogenase (LDH), stage and albumin level, and (2) a separate age-adjusted DLBCL-PI for patients 1 extranodal lesion, however excluding stage....

  10. Systematic review of the evidence for Trails B cut-off scores in assessing fitness-to-drive

    OpenAIRE

    Roy, Mononita; Molnar, Frank

    2013-01-01

    Background Fitness-to-drive guidelines recommend employing the Trail Making B Test (a.k.a. Trails B), but do not provide guidance regarding cut-off scores. There is ongoing debate regarding the optimal cut-off score on the Trails B test. The objective of this study was to address this controversy by systematically reviewing the evidence for specific Trails B cut-off scores (e.g., cut-offs in both time to completion and number of errors) with respect to fitness-to-drive. Methods Systematic rev...

  11. Prevalensi Sarkopenia pada Lansia di Komunitas (Community Dwelling berdasarkan Dua Nilai Cut-off Parameter Diagnosis

    Directory of Open Access Journals (Sweden)

    Vitriana

    2016-09-01

    Full Text Available Sarcopenia, aging muscle mass loss, and function syndromes can lead to decreased quality of life and increased elderly mortality. The availability of various screening methods and operational definitions in different studies has produced different findings of sarcopenia prevalence. The purpose of this study was to discover the prevalence of sarcopenia in Indonesian community-dwelling elderly based on muscle mass measured by bioimpedance analysis, handgrip strength using hand dynamometer, and physical performance based on six minutes walking test with two different cut-off point parameters of sarcopenia, i.e. the cut-off point recommended by Asian Working Group for Sarcopenia (AWGS and the cut-off point based on the reference used in Taiwan elderly population reference due to the lack of references for Indonesian elderly population. A cross-sectional study was conducted to 229 participants (71 men and 158 women from the community-dwelling elderly population between August and December 2014 in Bandung and Jatinangor. The results of the study showed that the sarcopenia prevalence in this study based on AWGS was 9.1% (7.4% in men and 1.7% in women while the prevalence based on the Taiwan reference revealed a prevalence of 40.6% (20.1% in men and 20.5% in women. This highly different prevalences shows the importance of defining a specific cut-off point for elderly population in community-dwelling Indonesia to get a more accurate sarcopenia prevalence.

  12. Emission noise and high frequency cut-off of the Kondo effect in a quantum dot

    Science.gov (United States)

    Delagrange, R.; Basset, J.; Bouchiat, H.; Deblock, R.

    2018-01-01

    By coupling on chip via a resonant circuit a carbon nanotube to a quantum noise detector, a superconductor-insulator-superconductor junction we measure the emission noise of a carbon nanotube quantum dot in the Kondo regime. The signature of the Kondo effect in the current noise is measured for different ratios of the Kondo temperature over the measured frequency and for different asymmetries of the coupling to the contacts and compared to finite frequency quantum noise calculations. Our results point towards the existence of a high frequency cut-off of the electronic emission noise associated with the Kondo resonance. This cut-off frequency is on the order of a few times the Kondo temperature when the electronic system is close to equilibrium, which is the case for a strongly asymmetric coupling. On the other hand, this cut-off is shifted to lower frequencies in a symmetric coupling situation where the bias voltage drives the Kondo state out of equilibrium. We then attribute the low frequency cut-off to voltage-induced spin relaxation.

  13. Normal Limits of Electrocardiogram and Cut-Off Values for Left ...

    African Journals Online (AJOL)

    olayemitoyin

    Summary: This study assessed healthy young adults to determine the normal limits for electrocardiographic variables and cut-off values for left ventricular hypertrophy. It was a cross sectional descriptive study in which the participants were evaluated clinically by standard 12-lead resting electrocardiogram (ECG) at 25mm/s ...

  14. Cut-off values of distal forearm bone density for the diagnosis of ...

    African Journals Online (AJOL)

    Background: The objective of this study was to establish a triage cut-off point or threshold for peripheral bone mineral density (BMD), applicable to black postmenopausal women, and that could be used as a screening method to differentiate between women with normal BMD, and those with possible central osteoporosis.

  15. Cut-off values of distal forearm bone density for the diagnosis of ...

    African Journals Online (AJOL)

    2011-09-15

    Sep 15, 2011 ... Original Research: Cut-off values of distal forearm bone density for the diagnosis of central osteoporosis. 79. 2012 Volume 17 No 2. JEMDSA remain significantly higher.11 Furthermore, in addition to an increased life expectancy (osteoporosis risk factor), lifestyle behaviours generally associated with.

  16. Separation-survivability - the elusive moral cut-off point? | de ...

    African Journals Online (AJOL)

    Both of these notions are problematic, as is the notion of sentience. We argue that separation-survivability is the only morally acceptable cut-off point, based on four premises, viz. (i) a particular notion of potentiality; (ii) the inextricable, mutual relationship between human beings and their world (without either, the other ...

  17. Chronic kidney disease : Defining clinical cut-offs for albumin:creatinine ratio

    NARCIS (Netherlands)

    Bakker, Stephan J L

    2013-01-01

    Albuminuria is rapidly gaining recognition as a marker of the presence and of the progression of chronic kidney disease (CKD). In a new study, Naresh et al. attempt to define cut-off values for percentage change in urinary albumin:creatinine ratio that reflect changes in CKD status rather than

  18. Cosmic Rays In The Magnetosphere, 2. Apparent Cut-off Rigidities and Coupling Functions

    Science.gov (United States)

    Dorman, L. I.; Danilova, O. A.; Iucci, N.; Parisi, M.; Ptitsyna, N. G.; Tyasto, M. I.; Villoresi, G.

    We calculate the apparent cut-off rigidities along the survey Italy-Antarctica-Italy** on the basis of results of Danilova et al. (2001) on trajectory calculations for inclined cut- off rigidities at eight azimuths (through 45?) and five zeniths angles (through 15?) along the survey. For calculations of apparent cut-off rigidities we use also the infor- mation on integral multiplicities of secondary neutrons in dependence of zenith angle of incident primary cosmic ray particles, as theoretically computed. This information is based on the theoretical calculations of meson-nuclear cascades for primary protons with different rigidities arriving to the EarthSs atmosphere at different zenith angles (Dorman and Pakhomov, 1979). These results have been checked and normalized by using coupling functions obtained in the same survey [Dorman et al. (2000)]. The determined apparent cut-off rigidities have been compared with results obtained by Clem et al. (1997) and with those used by Dorman et al. (2000) computed by using vertical cut-off rigidities, for trajectories especially calculated for the survey. On the basis of the apparent cut-off rigidities along the latitude survey, the coupling functions for neutron monitor and bare neutron counters found by Dorman et al. (2000) are now determined more accurately. **Survey realized with logistic and financial support of the Italian Antarctic Program (PNRA) and with the co-operation of IFSI-CNR. REFERENCES: Clem, J.M., et al. J. Geophys. Res., 102, 26,919 (1997). Danilova, O.A., et al., Latitude survey in December 1996-March 1997, 1. Cut-off rigidities for different azimuth and zenith angles, Paper ST13, This issue (2001) Dorman L.I. and Pakhomov N.I., "The dependence of the integral generation multiplicity of neutron component at various depths in the atmosphere on zenith angle on primary particle in- cidence". Proc. 16-th ICRC, Kyoto, 4, 416-420 (1979) Dorman, L.I., et al., J. Geophys. Res. 105 , 21,047 (2000).

  19. [Cut-off values of waist circumference for central obesity in Chinese adults].

    Science.gov (United States)

    Wen, Xiaoxiao; Mai, Jinzhuang; Gao, Xiangmin; Guo, Min; Wu, Yong; Liu, Xiaoqing; Zhao, Liancheng

    2015-09-01

    To investigate the appropriate cut-off values of waist circumference(WC)for central obesity and severe central obesity in Chinese adults. A total of 10 265 participants aged 35-69 years from the cross-sectional survey of the PRC-USA Collaborative Study of Cardiovascular and Cardiopulmonary Epidemiology between 1993 and 1994 with integral data were included. Each integer unit in centimeters of WC in a given range was used as the cut-off point to detect clustering of risk factors, which was defined as an individual with 2 or more risk factors including hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia and low levels of high-density lipoprotein cholesterol. Sensitivity, specificity and distance from the receiver operating characteristic (ROC) curves to the upper left corner of the ROC graph were calculated. The WC value corresponding to the point on the ROC curve nearest to the upper left corner was considered as the optimal cut-off value for central obesity and the value corresponding to the point with specificity of 90% or more was considered as the optimal cut-off for severe central obesity. The mean WC was (80.5 ± 9.9) cm in men and (77.8 ± 10.0) cm in women; 18.1% (890/4 921) of men and 14.5% (776/5 344) of women were identified with two or more major risk factors. Based on the ROC curve analysis, the optimal value of WC to detect clustering of risk factors was ≥ 84 cm for men and ≥ 80 cm for women, and the shortest distance to the upper left corner was 0.430 and 0.450, respectively. The cut-off values of WC to detect clustering of risk factors with specificity of 90% or more were ≥ 93 cm and ≥ 91 cm for men and women, respectively. The cut-off points of WC for central obesity and severe central obesity in Chinese adults obtained from this study are equal or similar to the WC cut-off values proposed by the Guidelines for Prevention and Control of Overweight and Obesity in Chinese Adults.

  20. Factors associated with D-dimer levels in HIV-infected individuals

    DEFF Research Database (Denmark)

    Borges, Alvaro H; O'Connor, Jemma L; Phillips, Andrew N

    2014-01-01

    with measured D-dimer levels were included (N = 9,848). Factors associated with D-dimer were identified by linear regression. Covariates investigated were: age, gender, race, body mass index, nadir and baseline CD4+ count, plasma HIV RNA levels, markers of inflammation (C-reactive protein [CRP], interleukin-6......BACKGROUND: Higher plasma D-dimer levels are strong predictors of mortality in HIV+ individuals. The factors associated with D-dimer levels during HIV infection, however, remain poorly understood. METHODS: In this cross-sectional study, participants in three randomized controlled trials...... viruses, was positively correlated with D-dimer. Other factors independently associated with higher D-dimer levels were black race, higher plasma HIV RNA levels, being off ART at baseline, and increased levels of CRP, IL-6 and cystatin C. In contrast, higher baseline CD4+ counts and higher high...

  1. Raised BMI cut-off for overweight in Greenland Inuit – a review

    Directory of Open Access Journals (Sweden)

    Stig Andersen

    2013-08-01

    Full Text Available Background. Obesity is associated with increased morbidity and premature death. Obesity rates have increased worldwide and the WHO recommends monitoring. A steep rise in body mass index (BMI, a measure of adiposity, was detected in Greenland from 1963 to 1998. Interestingly, the BMI starting point was in the overweight range. This is not conceivable in a disease-free, physically active, pre-western hunter population. Objective. This led us to reconsider the cut-off point for overweight among Inuit in Greenland. Design and findings. We found 3 different approaches to defining the cut-off point of high BMI in Inuit. First, the contribution to the height by the torso compared to the legs is relatively high. This causes relatively more kilograms per centimetre of height that increases the BMI by approximately 10% compared to Caucasian whites. Second, defining the cut-off by the upper 90-percentile of BMI from height and weight in healthy young Inuit surveyed in 1963 estimated the cut-off point to be around 10% higher compared to Caucasians. Third, if similar LDL-cholesterol and triglycerides are assumed for a certain BMI in Caucasians, the corresponding BMI in Inuit in both Greenland and Canada is around 10% higher. However, genetic admixture of Greenland Inuit and Caucasian Danes will influence this difference and hamper a clear distinction with time. Conclusion. Defining overweight according to the WHO cut-off of a BMI above 25 kg/m2 in Greenland Inuit may overestimate the number of individuals with elevated BMI.

  2. Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy.

    Science.gov (United States)

    Grund, Birgit; Baker, Jason V; Deeks, Steven G; Wolfson, Julian; Wentworth, Deborah; Cozzi-Lepri, Alessandro; Cohen, Calvin J; Phillips, Andrew; Lundgren, Jens D; Neaton, James D

    2016-01-01

    Despite effective antiretroviral treatment (ART), HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers), perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk reduction in serious non-AIDS conditions or death from any cause that might be achieved with treatments that reduce inflammation and/or coagulation, we examined associations of interleukin-6 (IL-6), D-dimer, and high-sensitivity C-reactive protein (hsCRP) levels with serious non-AIDS conditions or death in 3 large cohorts. In HIV-positive adults on suppressive ART, associations of IL-6, D-dimer, and hsCRP levels at study entry with serious non-AIDS conditions or death were studied using Cox regression. Hazard ratios (HR) adjusted for age, gender, study, and regression dilution bias (due to within-person biomarker variability) were used to predict risk reductions in serious non-AIDS conditions or death associated with lower "usual" levels of IL-6 and D-dimer. Over 4.9 years of mean follow-up, 260 of the 3766 participants experienced serious non-AIDS conditions or death. IL-6, D-dimer and hsCRP were each individually associated with risk of serious non-AIDS conditions or death, HR = 1.45 (95% CI: 1.30 to 1.63), 1.28 (95% CI: 1.14 to 1.44), and 1.17 (95% CI: 1.09 to 1.26) per 2x higher biomarker levels, respectively. In joint models, IL-6 and D-dimer were independently associated with serious non-AIDS conditions or death, with consistent results across the 3 cohorts and across serious non-AIDS event types. The association of IL-6 and D-dimer with serious non-AIDS conditions or death was graded and persisted throughout follow-up. For 25% lower "usual" IL-6 and D-dimer levels, the joint biomarker model estimates a 37% reduction (95% CI: 28 to 46%) in the risk of serious non-AIDS conditions or death if the relationship is causal. Both IL-6 and D-dimer are independently associated with serious non

  3. Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy.

    Directory of Open Access Journals (Sweden)

    Birgit Grund

    Full Text Available Despite effective antiretroviral treatment (ART, HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers, perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk reduction in serious non-AIDS conditions or death from any cause that might be achieved with treatments that reduce inflammation and/or coagulation, we examined associations of interleukin-6 (IL-6, D-dimer, and high-sensitivity C-reactive protein (hsCRP levels with serious non-AIDS conditions or death in 3 large cohorts.In HIV-positive adults on suppressive ART, associations of IL-6, D-dimer, and hsCRP levels at study entry with serious non-AIDS conditions or death were studied using Cox regression. Hazard ratios (HR adjusted for age, gender, study, and regression dilution bias (due to within-person biomarker variability were used to predict risk reductions in serious non-AIDS conditions or death associated with lower "usual" levels of IL-6 and D-dimer.Over 4.9 years of mean follow-up, 260 of the 3766 participants experienced serious non-AIDS conditions or death. IL-6, D-dimer and hsCRP were each individually associated with risk of serious non-AIDS conditions or death, HR = 1.45 (95% CI: 1.30 to 1.63, 1.28 (95% CI: 1.14 to 1.44, and 1.17 (95% CI: 1.09 to 1.26 per 2x higher biomarker levels, respectively. In joint models, IL-6 and D-dimer were independently associated with serious non-AIDS conditions or death, with consistent results across the 3 cohorts and across serious non-AIDS event types. The association of IL-6 and D-dimer with serious non-AIDS conditions or death was graded and persisted throughout follow-up. For 25% lower "usual" IL-6 and D-dimer levels, the joint biomarker model estimates a 37% reduction (95% CI: 28 to 46% in the risk of serious non-AIDS conditions or death if the relationship is causal.Both IL-6 and D-dimer are independently associated with

  4. Optimal cut-off of obesity indices to predict cardiovascular disease risk factors and metabolic syndrome among adults in Northeast China.

    Science.gov (United States)

    Yu, Jianxing; Tao, Yuchun; Tao, Yuhui; Yang, Sen; Yu, Yaqin; Li, Bo; Jin, Lina

    2016-10-13

    CVD risk factors (hypertension, dyslipidemia and diabetes) and MetS are closely related to obesity. The selection of an optimal cut-off for various obesity indices is particularly important to predict CVD risk factors and MetS. Sixteen thousand seven hundred sixty-six participants aged 18-79 were recruited in Jilin Province in 2012. Five obesity indices, including BMI, WC, WHR, WHtR and BAI were investigated. ROC analyses were used to evaluate the predictive ability and determine the optimal cut-off values of the obesity indices for CVD risk factors and MetS. BMI had the highest adjusted ORs, and the adjusted ORs for hypertension, dyslipidemia, diabetes and MetS were 1.19 (95 % CI, 1.17 to 1.20), 1.20 (95 % CI, 1.19 to 1.22), 1.12 (95 % CI, 1.10 to 1.13), and 1.40 (95 % CI, 1.38 to 1.41), respectively. However, BMI did not always have the largest adjusted AUROC. In general, the young age group (18 ~ 44) had higher ORs and AUROCs for CVD risk factors and MetS than those of the other age groups. In addition, the optimal cut-off values for WC and WHR in males were relatively higher than those in females, whereas the BAI in males was comparatively lower than that in females. The appropriate obesity index, with the corresponding optimal cut-off values, should be selected in different research studies and populations. Generally, the obesity indices and their optimal cut-off values are: BMI (24 kg/m(2)), WC (male: 85 cm; female: 80 cm), WHR (male: 0.88; female: 0.85), WHtR (0.50), and BAI (male: 25 cm; female: 30 cm). Moreover, WC is superior to other obesity indices in predicting CVD risk factors and MetS in males, whereas, WHtR is superior to other obesity indices in predicting CVD risk factors and MetS in females.

  5. D-dimer as marker for microcirculatory failure: correlation with LOD and APACHE II scores.

    Science.gov (United States)

    Angstwurm, Matthias W A; Reininger, Armin J; Spannagl, Michael

    2004-01-01

    The relevance of plasma d-dimer levels as marker for morbidity and organ dysfunction in severely ill patients is largely unknown. In a prospective study we determined d-dimer plasma levels of 800 unselected patients at admission to our intensive care unit. In 91% of the patients' samples d-dimer levels were elevated, in some patients up to several hundredfold as compared to normal values. The highest mean d-dimer values were present in the patient group with thromboembolic diseases, and particularly in non-survivors of pulmonary embolism. In patients with circulatory impairment (r=0.794) and in patients with infections (r=0.487) a statistically significant correlation was present between d-dimer levels and the APACHE II score (PLOD, PLOD score. Taking all patients together, no correlations of d-dimer levels with single organ failure or with indicators of infection could be detected. In conclusion, d-dimer plasma levels strongly correlated with the severity of the disease and organ dysfunction in patients with circulatory impairment or infections suggesting that elevated d-dimer levels may reflect the extent of microcirculatory failure. Thus, a therapeutic strategy to improve the microcirculation in such patients may be monitored using d-dimer plasma levels.

  6. Diagnostic implication of fibrin degradation products and D-dimer in aortic dissection

    Science.gov (United States)

    Dong, Jian; Duan, Xianli; Feng, Rui; Zhao, Zhiqing; Feng, Xiang; Lu, Qingsheng; Jing, Qing; Zhou, Jian; Bao, Junmin; Jing, Zaiping

    2017-03-01

    Fibrin degradation products (FDP) and D-dimer have been considered to be involved in many vascular diseases. In this study we aimed to explore the diagnostic implication of FDP and D-dimer in aortic dissection patients. 202 aortic dissection patients were collected as the case group, 150 patients with other cardiovascular diseases, including myocardial infarction (MI, n = 45), pulmonary infarction (n = 51) and abdominal aortic aneurysm (n = 54) were collected as non-dissection group, and 27 healthy people were in the blank control group. The FDP and D-dimer levels were detected with immune nephelometry. Logist regression analysis was performed to evaluate the influence of FDP and D-dimer for the aortic dissection patients. ROC curve was used to determine the diagnostic value of FDP and D-dimer. The FDP and D-dimer levels were significantly higher in aortic dissection patients than in non-dissection patients and the healthy controls. FDP and D-dimer were both the risk factors for patients with aortic dissection. From the ROC analysis, diagnostic value of FDP and D-dimer were not high to distinguish aortic dissection patients from the non-dissection patients. However FDP and D-dimer could be valuable diagnostic marker to differentiate aortic dissection patients and healthy controls with both AUC 0.863.

  7. Serum Potassium Levels Inversely Correlate with D-Dimer In Patients with Acute-Onset Atrial Fibrillation.

    Science.gov (United States)

    Cervellin, Gianfranco; Bonfanti, Laura; Picanza, Alessandra; Lippi, Giuseppe

    2014-12-09

    Background: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared to subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. Objective: D-dimer values are frequently increased in patients with atrial fibrillation (AF) compared with subjects in sinus rhythm. Hypokalemia plays a role in several cardiovascular diseases, but little is known about the association with AF. The aim of this study was to investigate correlations between D-dimer and serum potassium in acute-onset AF (AAF). Methods: To investigate the potential correlation between the values of serum potassium and D-dimer in patients with AAF, we retrospectively reviewed clinical and laboratory data of all emergency department visits for AAF in 2013. Results: Among 271 consecutive AAF patients with D-dimer assessments, those with hypokalemia (n = 98) had significantly higher D-dimer values than normokalemic patients (139 versus 114 ng/mL, p = 0.004). The rate of patients with D-dimer values exceeding the diagnostic cut-off was higher in the group of patients with hypokalemia than in those with normal serum potassium (26.5% versus 16.2%; p = 0.029). An inverse and highly significant correlation was found between serum potassium and D-dimer (r = -0.21; p papel em várias doenças cardiovasculares, mas pouco se sabe sobre a associação com FA. Objetivo: As concentrações de D-dímero encontram-se frequentemente aumentadas em pacientes com FA, quando comparados com indivíduos em ritmo sinusal. A hipopotassemia desempenha um papel importante nas doenças cardiovasculares, porém, pouco é conhecido sobre sua associação com a FA. O objetivo deste estudo foi investigar a correlação entre os níveis séricos de D-dímero e potássio na FA aguda (FAA). Métodos: Para investigar a existência de uma potencial correlação entre os níveis séricos de potássio e D-dímero em pacientes com FAA

  8. The 'impact' of force filtering cut-off frequency on the peak knee abduction moment during landing: artefact or 'artifiction'?

    Science.gov (United States)

    Roewer, Benjamin D; Ford, Kevin R; Myer, Gregory D; Hewett, Timothy E

    2014-03-01

    Joint moments computed using inverse dynamic techniques are important estimators of net joint loads. Joints moments computed from marker position and ground reaction force data filtered using different cut-off frequencies may capture changes in moment magnitudes at a single joint that exceed normal physiological response. Peak external knee abduction moment (KAM) generated during landing (ie, the drop vertical jump, DVJ) predicts anterior cruciate ligament injury risk using marker and force data filtered at different cut-off frequencies. The purpose of the current investigation was to determine the effects of using the same low cut-off frequencies versus different cut-off frequencies on joint moment magnitudes to evaluate if artificial smoothing attenuates actual resultant joint loads related to injury risk. Twenty-two female, high school volleyball players performed three maximum DVJs in a laboratory setting. The average peak KAM was computed for each knee using marker and force data filtered with the same low cut-off frequencies and different cut-off frequencies. Peak KAMs were significantly larger using different cut-off frequencies. The order of athletes ranked based on the magnitude of their peak KAMs did not significantly change across all filtering cut-off frequencies. The magnitude of peak KAM may differ when the same low or different higher cut-off frequencies are used to filter marker and ground reaction forces (GRF) data collected using standard motion capture equipment. It is not clear to what extent the decrease in peak KAM reported when the same low cut-off frequencies were used was solely due to attenuation of the GRF signal.

  9. Denseness of Ashtekar Lewandowski states and a generalized cut-off in loop quantum gravity

    Science.gov (United States)

    Velhinho, J. M.

    2005-07-01

    We show that the set of states of the Ashtekar Isham Lewandowski holonomy algebra defined by elements of the Ashtekar Lewandowski Hilbert space is dense in the space of all states. We consider weak convergence properties of a modified version of the cut-off procedure currently in use in loop quantum gravity. This version is adapted to vector states rather than to general distributions.

  10. Determining the optimal cut-off scores for the Workplace Bullying Inventory.

    Science.gov (United States)

    Hutchinson, Marie; Bradbury, Joanne; Browne, Graeme; Hurley, John

    2017-12-18

    Over the past two decades, there has been considerable research into workplace bullying. One area that remains poorly developed is a tool with the capacity to accurately differentiate between exposed and unexposed employees. To determine optimal cut-off scores for the Workplace Bullying Inventory (WBI) that accurately classify cases of exposure to workplace bullying. Secondary analysis of data collected from Australian public sector employees ( n =2,197) was conducted. Receiver operator characteristic (ROC) curve analysis was used with a minimum sensitivity of 80%, to determine those scores on the WBI that corresponded with the highest accuracy of the tool to distinguish cases from non-cases. The results suggest using a cut score of 29 from the total score on the WBI (possible range: 18-90). When compared to a sum-score from a single dichotomous self-report variable, the cut-off score estimated a more conservative bullying rate. The single-item rate was potentially inflated by misconceptions about what constitutes bullying in the workplace. Employing validated cut-off points for exposure provides an objective threshold for establishing exposure to workplace bullying. The results of the analysis provide a more rigorous approach to quantifying exposure to workplace bullying, in a tool that has been designed and tested in the nursing workforce. This is the first such tool with empirically-derived, discriminant accuracy. It is common for nurse researchers to employ sum-scores from single items to identify exposure to workplace bullying. By providing reliable cut-off points for exposure, this study offers standardised, diagnostic accuracy for researchers, clinicians and managers. ©2017 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  11. Establishment of triglyceride cut-off values to detect chylous ascites and pleural effusions.

    Science.gov (United States)

    Thaler, Markus A; Bietenbeck, Andreas; Schulz, Christoph; Luppa, Peter B

    2017-02-01

    Lipoprotein electrophoresis is the gold standard for the detection of chylous ascites and pleural effusions. It is, however, not suitable as a front-line test and not widely available. Most clinicians must rely solely on the quantitative determination of lipids. The aim of this work was to establish lipid cut-off values for the presence of chylomicrons in pleural and peritoneal fluid. Triglyceride and cholesterol levels from 113 peritoneal and 154 pleural fluid samples investigated for chylomicrons via lipoprotein electrophoresis were considered. Receiver operating characteristic analyses were performed and cut-off levels determined. 54 peritoneal and 59 pleural fluid samples were positive for chylomicrons. In peritoneal fluid, triglycerides and triglycerides/cholesterol ratio exhibited areas under the curve (AUC) not significantly different from each other, but significantly larger than cholesterol alone. The AUC for triglycerides in pleural fluid was significantly larger than the AUCs for cholesterol and the triglycerides/cholesterol ratio. Triglyceride cut-offs with maximum Youden-Index, sensitivity >95%, and specificity >95% were calculated to be 187, 148, and 246mg/dl (2.13, 1.69, and 2.80mmol/l) for peritoneal fluid, and 240, 94, and 240mg/dl (2.74, 1.07, and 2.74mmol/l) for pleural fluid. Triglyceride levels are the best parameter to detect chylous body fluids when lipoprotein electrophoresis is not available. Single-point triglyceride cut-offs of 187 and 240mg/dl (2.13 and 2.74mmol/l) or alternatively equivocal ranges of 148-246 and 94-240mg/dl (1.69-2.80 and 1.07-2.74mmol/l) were established for peritoneal and pleural fluid, respectively. Copyright © 2016 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

  12. Introduction of a distance cut-off into structural alignment by the double dynamic programming algorithm.

    Science.gov (United States)

    Toh, H

    1997-08-01

    Two approximations were introduced into the double dynamic programming algorithm, in order to reduce the computational time for structural alignment. One of them was the so-called distance cut-off, which approximately describes the structural environment of each residue by its local environment. In the approximation, a sphere with a given radius is placed at the center of the side chain of each residue. The local environment of a residue is constituted only by the residues with side chain centers that are present within the sphere, which is expressed by a set of center-to-center distances from the side chain of the residue to those of all the other constituent residues. The residues outside the sphere are neglected from the local environment. Another approximation is associated with the distance cut-off, which is referred to here as the delta N cut-off. If two local environments are similar to each other, the numbers of residues constituting the environments are expected to be similar. The delta N cut-off was introduced based on the idea. If the difference between the numbers of the constituent residues of two local environments is greater than a given threshold value, delta N, the evaluation of the similarity between the local environments is skipped. The introduction of the two approximations dramatically reduced the computational time for structural alignment by the double dynamic programming algorithm. However, the approximations also decreased the accuracy of the alignment. To improve the accuracy with the approximations, a program with a two-step alignment algorithm was constructed. At first, an alignment was roughly constructed with the approximations. Then, the epsilon-suboptimal region for the alignment was determined. Finally, the double dynamic programming algorithm with full structural environments was applied to the residue pairs within the epsilon-suboptimal region to produce an improved alignment.

  13. D-Dimer assay as a non invasive test for the diagnosis of left atrial ...

    African Journals Online (AJOL)

    Background: Systemic embolism is a serious and sometime fatal complication of rheumatic MS. Objective: We assessed the predictive power of D-Dimer level to predict occurrence of left atrial (LA) thrombi in patients with rheumatic mitral stenosis (MS). Methods: D-dimer levels were analyzed for 24 patients with rheumatic ...

  14. High D-dimer levels increase the likelihood of pulmonary embolism

    NARCIS (Netherlands)

    Tick, L. W.; Nijkeuter, M.; Kramer, M. H. H.; Hovens, M. M. C.; Büller, H. R.; Leebeek, F. W. G.; Huisman, M. V.

    2008-01-01

    Objective. To determine the utility of high quantitative D-dimer levels in the diagnosis of pulmonary embolism. Methods. D-dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous

  15. Genetic predictors of fibrin D-dimer levels in healthy adults

    NARCIS (Netherlands)

    N.L. Smith (Nicholas); J.E. Huffman (Jennifer E.); D.P. Strachan (David); J. Huang (Jian); A. Dehghan (Abbas); S. Trompet (Stella); L.M. Lopez (Lorna M.); S.Y. Shin (So Youn); J. Baumert (Jens); V. Vitart (Veronique); J.C. Bis (Joshua); S.H. Wild (Sarah); A. Rumley (Ann); Q. Yang (Qiong Fang); A.G. Uitterlinden (André); D.J. Stott (David. J.); G. Davies (Gareth); A.M. Carter (Angela M.); B. Thorand (Barbara); O. Polašek (Ozren); B. McKnight (Barbara); H. Campbell (Harry); A.R. Rudnicka (Alicja); M.H. Chen (Min-hsin); B.M. Buckley (Brendan M.); S.E. Harris (Sarah); A. Peters (Annette); D. Pulanic (Drazen); T. Lumley (Thomas); A.J.M. de Craen (Anton J.M.); D.C. Liewald (David C.); C. Gieger (Christian); I. Ford (Ian); A.J. Gow (Alan J.); M. Luciano (Michelle); D.J. Porteous (David J.); X. Guo (Xiuqing); N. Sattar (Naveed); A. Tenesa (Albert); M. Cushman (Mary Ann); P.E. Slagboom (Eline); P.M. Visscher (Peter M.); T.D. Spector (Tim); T. Illig (Thomas); I. Rudan (Igor); E.G. Bovill (Edwin G.); A.F. Wright (Alan); W.L. McArdle (Wendy); G.H. Tofler (Geoffrey); A. Hofman (Albert); R.G.J. Westendorp (Rudi); J.M. Starr (John); P.J. Grant (Peter J.); M. Karakas (Mahir); N.D. Hastie (Nicholas D.); B.M. Psaty (Bruce); J.F. Wilson (James); G.D.O. Lowe (Gordon); C.J. O'Donnell (Christopher); J.C.M. Witteman (Jacqueline); J.W. Jukema (Jan Wouter); I.J. Deary (Ian); N. Soranzo (Nicole); W. Koenig (Wolfgang); C. Hayward (Caroline)

    2011-01-01

    textabstractBACKGROUND: Fibrin fragment D-dimer, one of several peptides produced when crosslinked fibrin is degraded by plasmin, is the most widely used clinical marker of activated blood coagulation. To identity genetic loci influencing D-dimer levels, we performed the first large-scale,

  16. The use of D-dimer in specific clinical conditions: a narrative review

    NARCIS (Netherlands)

    Bruinstroop, E.; van de Ree, M. A.; Huisman, M. V.

    2009-01-01

    The use of D-dimer in combination with a clinical decision rule has been widely investigated in pulmonary embolism and deep venous thrombosis. Although it has been shown to be safe in excluding venous thromboembolism, the clinician is often faced with specific situations in which the use of D-dimer

  17. Equilibrium properties of blackbody radiation with an ultraviolet energy cut-off

    Science.gov (United States)

    Mishra, Dheeraj Kumar; Chandra, Nitin; Vaibhav, Vinay

    2017-10-01

    We study various equilibrium thermodynamic properties of blackbody radiation (i.e. a photon gas) with an ultraviolet energy cut-off. We find that the energy density, specific heat etc. follow usual acoustic phonon dynamics as have been well studied by Debye. Other thermodynamic quantities like pressure, entropy etc. have also been calculated. The usual Stefan-Boltzmann law gets modified. We observe that the values of the thermodynamic quantities with the energy cut-off is lower than the corresponding values in the theory without any such scale. The phase-space measure is also expected to get modified for an exotic spacetime appearing at Planck scale, which in turn leads to the modification of Planck energy density distribution and the Wien's displacement law. We found that the non-perturbative nature of the thermodynamic quantities in the SR limit (for both unmodified and modified cases), due to nonanalyticity of the leading term, is a general feature of the theory accompanied with an ultraviolet energy cut-off. We have also discussed the possible modification in the case of Big Bang and the Stellar objects and have suggested a table top experiment for verification in effective low energy case.

  18. Correlation between Body Mass Index, Gender, and Skeletal Muscle Mass Cut off Point in Bandung

    Directory of Open Access Journals (Sweden)

    Richi Hendrik Wattimena

    2017-09-01

    Full Text Available Objective: To determine the average skeletal muscle mass (SMM value in young adults as a reference population; to analyze the correlation of gender, and body mass index to the cut off point; and to determine skeletal muscle mass cut off points of population in Bandung, Indonesia. Methods: This was a cross-sectional study involving 199 participants, 122 females and 77 males. The sampling technique used was the multistage random sampling. The participants were those who lived in four major regions in Bandung, Indonesia: Sukajadi, Cicadas, Buah Batu, and Cibaduyut. Results: The average appendicular skeletal mass index (ASMI in females and males based on body mass index (BMI were identified. The average ASMI values for normal BMI in females was 5.982±0.462 kg/m2 while the average ASMI values normal BMI for males was 7.581±0.744 kg/m2 Conclusions: A correlation between BMI and ASMI that was considered statistically significant was found in females (0.7712; p<0.05 and a very significant correlation was seen in males (0.870; p<0.05. The cut off points were defined by the normal BMI, which were 5.059 for females and 6.093 for males.

  19. Changes in fibrin D-dimer, fibrinogen, and protein S during pregnancy

    DEFF Research Database (Denmark)

    Hansen, Anette Tarp; Andreasen, Birgitte Horst; Salvig, Jannie Dalby

    2010-01-01

    Background. Pregnancy is a hypercoagulable state with a 5- to 10- fold higher risk of venous thromboembolism. Existing reference intervals for fibrin D-dimer (D-dimer), functional fibrinogen (fibrinogen) and protein S, free antigen (protein S) are based on non-pregnant patients and reference...... intervals for pregnant patients are warranted. Objectives. The aim of the present study was to contribute to the establishment of reference intervals for D-dimer, fibrinogen and protein S during pregnancy and to discuss the use of the analyses during pregnancy. Methods. We included 55 healthy pregnant women...... in gestational week 11–17, with normal current pregnancy. Blood samples were collected in gestational weeks 11–17, 21–27 and 34–37. The three plasma parameters D-dimer, fibrinogen and protein S were analysed by STA-R Evolution®. Results. A significant rise in D-dimer was found from first to second trimester (p...

  20. Systematic review of the evidence for Trails B cut-off scores in assessing fitness-to-drive.

    Science.gov (United States)

    Roy, Mononita; Molnar, Frank

    2013-01-01

    Fitness-to-drive guidelines recommend employing the Trail Making B Test (a.k.a. Trails B), but do not provide guidance regarding cut-off scores. There is ongoing debate regarding the optimal cut-off score on the Trails B test. The objective of this study was to address this controversy by systematically reviewing the evidence for specific Trails B cut-off scores (e.g., cut-offs in both time to completion and number of errors) with respect to fitness-to-drive. Systematic review of all prospective cohort, retrospective cohort, case-control, correlation, and cross-sectional studies reporting the ability of the Trails B to predict driving safety that were published in English-language, peer-reviewed journals. Forty-seven articles were reviewed. None of the articles justified sample sizes via formal calculations. Cut-off scores reported based on research include: 90 seconds, 133 seconds, 147 seconds, 180 seconds, and Trails B cut-offs of 3 minutes or 3 errors (the '3 or 3 rule'). Major methodological limitations of this body of research were uncovered including (1) lack of justification of sample size leaving studies open to Type II error (i.e., false negative findings), and (2) excessive focus on associations rather than clinically useful cut-off scores.

  1. Hair ethyl glucuronide concentrations in teetotalers: Should we re-evaluate the lower cut-off?

    Science.gov (United States)

    Crunelle, Cleo L; Yegles, Michel; De Doncker, Mireille; Cappelle, Delphine; Covaci, Adrian; van Nuijs, Alexander L N; Neels, Hugo

    2017-05-01

    Ethyl glucuronide in hair (hEtG) can be used to assess the retrospective consumption of alcohol. A lower cut-off of 7pg/mg hair in the 0-3cm proximal scalp hair segment has been used for repeated alcohol consumption in the previous three months. While a concentration below this cut-off is stated not to contradict self reported abstinence, it is often used to assess whether an individual has remained abstinent in the period prior to hair sampling. Here, we address hEtG concentrations in alcohol consuming individuals and critically evaluate this cut-off value. Ten individuals remained abstinent from alcohol for 12 weeks. A lock of hair was cut before the start of the study, and the regrown hairs were cut after twelve weeks of abstinence. Hair EtG concentrations were measured both at baseline and after 12 weeks of abstinence. Study compliance was assessed by urine analysis every 2-3 days by liquid chromatography-tandem mass spectrometry with a lower limit of quantification (LLOQ) of 0.1μg/mL. HEtG concentrations were assessed in the first 3cm hair using gas chromatography-tandem mass spectrometry with an LLOQ of 0.2pg/mg. At the beginning of the study, participants had hEtG concentrations ranging between low, but measurable hEtG concentrations (up to 4.5pg/mg hair), which was in the participant with the highest pre-study alcohol consumption. As only regrown hairs were cut, it is not likely that this was due to residual EtG from the pre-study period. Although the number of specimens was low, this study reports measurable hEtG concentrations following total abstinence, although not exceeding the current 7pg/mg cut-off for hair. A suitable sensitive method (GC-MS/MS) is preferred when assessing alcohol abstinence. We propose that the current cut-off of 7pg/mg should be discussed further, and, in view of the small study sample, evaluated using a larger sample size. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Accuracy of the WHO's body mass index cut-off points to measure gender- and age-specific obesity in middle-aged adults living in the city of Rio de Janeiro, Brazil.

    Science.gov (United States)

    Wollner, Materko; Paulo Roberto, Benchimol-Barbosa; Alysson Roncally, Silva Carvalho; Jurandir, Nadal; Edil, Luis Santos

    2017-09-21

    Obesity is defined by the World Health Organization (WHO) as a disease characterized by the excessive accumulation of body fat. Obesity is considered a public health problem, leading to serious social, psychological and physical problems. However, the appropriate cut-off point of body mass index (BMI) based on body fat percentage (BF%) for classifying an individual as obese in middle-aged adults living in Rio de Janeiro remains unclear. This was a prospective cross-sectional study comprising of 856 adults (413 men and 443 women) living in Rio de Janeiro, Brazil ranging from 30-59 years of age. The data were collected over a two year period (2010-2011), and all participants were underwent anthropometric evaluation. The gold standard was the percentage of body fat estimated by bioelectrical impedance analysis. The optimal sensitivity and specificity were attained by adjusting BMI cut-off values to predict obesity based on the WHO criteria: BF% >25% in men and >35% in women, according to the receiver operating characteristic curve (ROC) analysis adjusted for age and for the whole group. The BMI cut-offs for predicting BF% were 29.9 kg/m(2) in men and 24.9 kg/m(2) in women. The BMI that corresponded to a BF% previously defining obesity was similar to that of other Western populations for men but not for women. Furthermore, gender and age specific cut-off values are recommended in this population.

  3. Defining a BMI Cut-Off Point for the Iranian Population: The Shiraz Heart Study.

    Directory of Open Access Journals (Sweden)

    Mohammad Ali Babai

    Full Text Available In this study we evaluated and redefined the optimum body mass index (BMI cut-off point for the Iranian population based on metabolic syndrome (MeS risk factors. We further evaluated BMI cut-off points with and without waist circumference (WC as a cofactor of risk and compared the differences. This study is part of the largest surveillance programs conducted in Shiraz, Iran, termed the Shiraz Heart study. Our study sample included subjects between the ages of 20 to 65 years old. After excluding pregnant women, those with missing data and those with comorbid disease, a total of 12283 made up the study population. The participants underwent a series of tests and evaluations by trained professionals in accordance with WHO recommendations. Hypertension, abnormal fasting blood sugar (FBS, triglyceride (TG and high density lipoprotein cholesterol (HDL (in the context of the definition of metabolic syndrome were prevalent among 32.4%, 27.6%, 42.1 and 44.2% of our participants, respectively. Women displayed higher rates of overall obesity compared to men (based on the definition by the WHO as higher than 30 kg/m2. Regarding MeS, 38.9% of our population had the all symptoms of MeS which was more prevalent among women (41.5% vs. 36%. When excluding WC in the definition of MeS, results showed that males tend to show a higher rate of metabolic risk factors (19.2% vs. 15.6%. Results of multivariate analysis showed that parallel to an increase in BMI, the odds ratio (OR for acquiring each component of the metabolic syndrome increased (OR = 1.178; CI: 1.166-1.190. By excluding WC, the previous OR decreased (OR = 1.105; CI: 1.093-1.118. Receiver Operating Characteristic (ROC curve analysis showed that the optimum BMI cut-off point for predicting metabolic syndrome was 26.1 kg/m2 and 26.2 kg/m2 [Accuracy (Acc = 69% and 61%, respectively] for males and females, respectively. The overall BMI cut-off for both sexes was 26.2 kg/m2 (Acc = 65% with sensitivity and

  4. Determination of a saliva cotinine cut-off to distinguish pregnant smokers from pregnant non-smokers

    DEFF Research Database (Denmark)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F

    2007-01-01

    Objective validation of smoking status is necessary. Earlier studies have used saliva cotinine concentrations between 14.2 and 30 ng/ml as cut-off values to distinguish pregnant smokers from non-smokers. However, these cut-offs derive from studies including men and non-pregnant women. This consti....... This constitutes a problem, as recent studies have reported an accelerated metabolism in pregnant smokers. The aim of this study was to determine the optimum cut-off cotinine level distinguishing pregnant smokers from pregnant non-smokers....

  5. Detection of the high energy cut-off from the Seyfert 1.5 galaxy NGC 5273

    OpenAIRE

    Pahari, Mayukh; McHardy, Ian; Mallick, Labani; Dewangan, G. C.; Misra, R.

    2017-01-01

    We perform the NuSTAR and Swift/XRT joint energy spectral fitting of simultaneous observations from the broad-line Seyfert 1.5 galaxy NGC 5273. When fitted with the combination of an exponential cut-off power-law and a reflection model, a high energy cut-off is detected at 143$^{+96}_{-40}$ keV with 2-sigma significance. Existence of such cut-off is also consistent with the observed Comptonizing electron temperature when fitted with a Comptonization model independently. We observe a moderate ...

  6. Determination of a saliva cotinine cut-off to distinguish pregnant smokers from pregnant non-smokers

    DEFF Research Database (Denmark)

    Hegaard, Hanne K; Kjaergaard, Hanne; Møller, Lars F

    2007-01-01

    Objective validation of smoking status is necessary. Earlier studies have used saliva cotinine concentrations between 14.2 and 30 ng/ml as cut-off values to distinguish pregnant smokers from non-smokers. However, these cut-offs derive from studies including men and non-pregnant women....... This constitutes a problem, as recent studies have reported an accelerated metabolism in pregnant smokers. The aim of this study was to determine the optimum cut-off cotinine level distinguishing pregnant smokers from pregnant non-smokers....

  7. Accuracy of D-Dimers to Rule Out Venous Thromboembolism Events across Age Categories

    Directory of Open Access Journals (Sweden)

    G. Der Sahakian

    2010-01-01

    Full Text Available Background. Strategies combining pretest clinical assessment and D-dimers measurement efficiently and safely rule out venous thromboembolism events (VTE in low- and intermediate-risk patients. Objectives. As process of ageing is associated with altered concentrations of coagulation markers including an increase in D-dimers levels, we investigated whether D-dimers could reliably rule out VTE across age categories. Method. We prospectively assessed the test performance in 1,004 patients visiting the emergency department during the 6-month period with low or intermediate risk of VTE who also received additional diagnostic procedures. Results. 67 patients had VTE with D-dimers levels above the threshold, and 3 patients displayed D-dimers levels below the threshold. We observed that specificity of D-dimers test decreased in an age-dependent manner. However, sensitivity and negative predictive value remained at very high level in each age category including older patients. Conclusion. We conclude that, even though D-dimers level could provide numerous false positive results in elderly patients, its high sensitivity could reliably help physicians to exclude the diagnosis of VTE in every low- and intermediate-risk patient.

  8. D-dimer and histamine in early stage bacteremia: A prospective controlled cohort study.

    Science.gov (United States)

    Schwameis, Michael; Steiner, Margarete Maria; Schoergenhofer, Christian; Lagler, Heimo; Buchtele, Nina; Jilma-Stohlawetz, Petra; Boehm, Thomas; Jilma, Bernd

    2015-12-01

    Plasma histamine levels and D-dimer predict disease severity and mortality in advanced septic shock. We hypothesized that increased plasma histamine levels parallel coagulation activation and yield prognostic significance already at a very early stage of bacteremia. This prospective controlled cohort study enrolled 72 consecutive non-surgical non-ICU-ward inpatients with newly culture-diagnosed bacteremia and a Pitt Bacteremia score ≤2 to determine the extent of histamine and D-dimer release and their predictive role on outcome at the earliest stage of blood stream infection. Age-matched healthy adults served as internal controls (n=36). A binominal logistic regression and a Cox proportional hazards regression analysis were performed to ascertain the effects of D-dimer and histamine on in-hospital mortality. In contrast to plasma histamine, D-dimer levels were significantly higher within hours of culture-proven bacteremia. In-hospital mortality occurred in 17%. Histamine levels were neither associated with D-dimer level (r=0.04; p>0.05) nor with ICU admissions (r=0.06; p>0.05) and outcome (crude OR 0.8, 95% CI 0.3-1.9; p=0.6). In contrast, early-elevated D-dimer levels predicted mortality: the odds to die increased with the D-dimer level, and was 12.6 (crude OR, 95% CI 3-52; p=0.001) in patients with a D-dimer ≥4μg/mL (n=13). Histamine levels are elevated in only few patients (4%) with newly diagnosed bacteremia. Our findings suggest that D-dimer, but not plasma histamine, could be a promising marker of lethality already at a very early stage of blood stream infection. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

  9. The Evaluation of Pulmonary Embolism Diagnosis Using SPECT V/Q Imaging Combined with D-Dimer Assay

    Directory of Open Access Journals (Sweden)

    LU Xia;MENG Jing-jing;XIE Xiao-fen;WANG Qian

    2016-11-01

    patients with clinically suspected pulmonary embolism (PE referred to the Nuclear Medicine Department of Beijing Anzhen Hospital from January to July 2014, were enrolled in the study. The patients were divided into PE group (n=101 and non PE group (n=55. We compared the diagnostic performance of SPECT V/Q, D-dimer and SPECT V/Q combined with D-dimer measurement. The SPECT V/Q images were reconstructed by Oasis of Philips and interpreted by the attending nuclear physician using a diagnostic cut-off of one segmental or two subsegmental mismatches. D-dimer had good sensitivity of 70.3% and bad specificity of 61.8% in the 156 patients. SPECT V/Q had good performance both sensitivity (85.1% and specificity (90.9%. But when SPECT V/Q combined with D-dimer, there were best diagnostic sensitivity (91.1% and specificity (98.2% in PE detection, especially in embolization extent less than 15%. SPECT V/Q combined with D-dimer measurement are effective and safe diagnostic management.

  10. Child obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire.

    Science.gov (United States)

    Black, James A; Park, MinHae; Gregson, John; Falconer, Catherine L; White, Billy; Kessel, Anthony S; Saxena, Sonia; Viner, Russell M; Kinra, Sanjay

    2015-04-01

    Overweight children are at an increased risk of premature mortality and disease in adulthood. Parental perceptions and clinical definitions of child obesity differ, which may lessen the effectiveness of interventions to address obesity in the home setting. The extent to which parental and objective weight status cut-offs diverge has not been documented. To compare parental perceived and objectively derived assessment of underweight, healthy weight, and overweight in English children, and to identify sociodemographic characteristics that predict parental under- or overestimation of a child's weight status. Cross-sectional questionnaire completed by parents linked with objective measurement of height and weight by school nurses, in English children from five regions aged 4-5 and 10-11 years old. Parental derived cut-offs for under- and overweight were derived from a multinomial model of parental classification of their own child's weight status against school nurse measured body mass index (BMI) centile. Measured BMI centile was matched with parent classification of weight status in 2976 children. Parents become more likely to classify their children as underweight when they are at the 0.8th centile or below, and overweight at the 99.7th centile or above. Parents were more likely to underestimate a child's weight if the child was black or South Asian, male, more deprived, or the child was older. These values differ greatly from the BMI centile cut-offs for underweight (2nd centile) and overweight (85th). Clinical and parental classifications of obesity are divergent at extremes of the weight spectrum. © British Journal of General Practice 2015.

  11. Color filters including infrared cut-off integrated on CMOS image sensor.

    Science.gov (United States)

    Frey, Laurent; Parrein, Pascale; Raby, Jacques; Pellé, Catherine; Hérault, Didier; Marty, Michel; Michailos, Jean

    2011-07-04

    A color image was taken with a CMOS image sensor without any infrared cut-off filter, using red, green and blue metal/dielectric filters arranged in Bayer pattern with 1.75 µm pixel pitch. The three colors were obtained by a thickness variation of only two layers in the 7-layer stack, with a technological process including four photolithography levels. The thickness of the filter stack was only half of the traditional color resists, potentially enabling a reduction of optical crosstalk for smaller pixels. Both color errors and signal to noise ratio derived from optimized spectral responses are expected to be similar to color resists associated with infrared filter.

  12. Refining Game Addiction Questionnairs: Evidence for a natural cut-off point?

    OpenAIRE

    Nielsen, Rune Kristian

    2013-01-01

    This paper presents data from a pilot study, which was designed to illuminate critical flaws in the currently used instruments used to measure the prevalence of ‘computer game addiction’. The study found that the prevalence rate could be set anywhere between 23% and 0,6% depending on how the data set is scored. Thus demonstrating how an arbitrarily set of cut-off point in prevalence studies can yield wildly varying prevalence rates. The data further show that making implicit assumptions about...

  13. Detection of stratosphere troposphere exchange in cut-off low systems

    Science.gov (United States)

    Price, Jeremy D.; Vaughan, Geraint

    1994-01-01

    The Aberystwyth MST radar has been used as part of the TOASTE program to study the structure of the tropopause in cut-off-low system with an aim to identifying regions where stratosphere-troposphere exchange are taking place. Theory predicts that the vertical gradient in reflected power is proportional to the static stability of the reflecting region, and should therefore resolve tropopause structure. Comparisons of MST power profiles with radiosonde data are presented and show good agreement, revealing regions of indefinite tropopauses, where stratosphere-troposphere exchange is thought to take place. The continuous nature of MST data allows an estimation of the size of these regions.

  14. Influence of cut-off value on prevalence of short cervical length.

    Science.gov (United States)

    van Os, M A; Kleinrouweler, C E; Schuit, E; van der Ven, A J; Pajkrt, E; de Groot, C J M; Mol, B W J; Haak, M C

    2017-03-01

    To assess the distribution of cervical length (CL) in a large cohort of asymptomatic low-risk women with singleton pregnancy and no previous preterm birth and to explain the low prevalence of short CL ≤ 30 mm in this cohort. This was a secondary analysis of a multicenter cohort study with an embedded randomized controlled trial (Triple P trial; NTR-2078) on the prevention of preterm birth with progesterone. In the cohort study, CL was measured in asymptomatic low-risk women with singleton pregnancy to investigate its predictive capacity to identify those at increased risk for preterm birth. A short CL was defined by a cut-off value of ≤ 30 mm, based on existing literature. Women with a short CL were subsequently included in a randomized controlled trial evaluating the effect of progesterone, compared with placebo, on preterm birth. In total, 57 centers and 20 234 women participated in the study. Normal distributions for CL were simulated based on the mean and SD of the original data. The distribution of CL was assessed for each individual center and measurements were compared between levels of care: primary (29 ultrasound centers), secondary (21 general hospitals) and tertiary (seven university medical centers) care institutions. Comparison was also performed between centers with low, intermediate and high volume of CL measurements. CL distributions before (n = 12 284 women) and after (n = 7950 women) a national symposium, at which the prevalence of short CL measurements was addressed publicly, were analyzed. Between November 2009 and August 2013, 20 234 women had CL measurements, of whom 367 (1.8%) had a short CL. Mean ± SD CL was 44.2 ± 7.8 mm. A 'dip' in the distribution of CL measurements between 20 and 30 mm was observed, defined by a ratio of low prevalence of short CL (1.7% vs 2.0% of measurements were ≤ 30 mm, respectively; P cut-off value of 30 mm for CL was used to include women in a randomized clinical trial that was embedded in a cohort study

  15. Cut-off effect of radical TEMPO derivatives in olive oil-in-water emulsions.

    Science.gov (United States)

    Lopez de Arbina, Amaia; Rezende, Marcos Caroli; Aliaga, Carolina

    2017-06-01

    Three oil-in-water emulsions were prepared from mixtures of olive oil and Tween 20 in water. The effectiveness of a series of radical 2,2,6,6-tetramethylpiperidinoxyl (TEMPO) derivatives of variable lipophilicity in reactions with antioxidant Trolox, and as pyrene-fluorescence quenchers, was compared in the three emulsions. A "cut-off" effect was observed for the pyrene quenching by the probes, but not for their reaction with Trolox. The results were rationalized in terms of the amphiphobic nature of the probes, and the different locations of probe, pyrene and Trolox in the three-phase microheterogeneous systems. Copyright © 2016 Elsevier Ltd. All rights reserved.

  16. Seepage remediation by positive cut-off walls : a compendium and analysis of North American case histories

    Energy Technology Data Exchange (ETDEWEB)

    Bruce, D.A. [Geosystems LP, Venetia, PA (United States); Ressi di Cervia, A. [Treviicos Corp., North Dighton, MA (United States); Amos-Venti, J. [Merrimack College, North Andover, MA (United States)

    2006-07-01

    Reservoir leakage at major dams in North America is typically remediated through the use of positive cut-offs. Many dam owners and designers use cut-offs as an inexpensive means of addressing leakage. However, the use of cut-offs can lead to depressions and sinkholes, disturb trends from dam and foundation piezometers, and cause the presence of sediment or embankment materials in springs. This paper presented a summary of published literature relating to major North American seepage remediation. Twenty-two case histories were presented in tabulated and summarized form in which cut-offs were constructed from concrete and plastic concrete walls; cement-bentonite walls; and cut-offs using deep mixing methods (DMM). Key observations and relevant details were provided for each case study. The aim of the paper was to provide perspectives to potential users of the various techniques in relation to depth capability; geotechnical suitability; constructability; quality control and verification; and cost. It was concluded that further data input is needed to provide a better understanding of cut-off techniques. 39 refs., 2 tabs., 8 figs.

  17. Optimal BMI cut-off values for predicting diabetes, hypertension and hypercholesterolaemia in a multi-ethnic population.

    Science.gov (United States)

    Cheong, Kee Chee; Yusoff, Ahmad F; Ghazali, Sumarni M; Lim, Kuang H; Selvarajah, Sharmini; Haniff, Jamaiyah; Khor, Geok L; Shahar, Suzana; Rahman, Jamalludin Abd; Zainuddin, Ahmad A; Mustafa, Amal N

    2013-03-01

    To determine the optimal cut-offs of BMI for Malaysian adults. Population-based, cross-sectional study. Receiver operating characteristic curves were used to determine the cut-off values of BMI with optimum sensitivity and specificity for the detection of three cardiovascular risk factors: diabetes mellitus, hypertension and hypercholesterolaemia. Gender-specific logistic regression analyses were used to examine the association between BMI and these cardiovascular risk factors. All fourteen states in Malaysia. Malaysian adults aged ≥18 years (n 32 703) who participated in the Third National Health and Morbidity Survey in 2006. The optimal BMI cut-off value for predicting the presence of diabetes mellitus, hypertension, hypercholesterolaemia or at least one of these cardiovascular risk factors varied from 23.3 to 24.1 kg/m2 for men and from 24.0 to 25.4 kg/m2 for women. In men and women, the odds ratio for having diabetes mellitus, hypertension, hypercholesterolaemia or at least one cardiovascular risk factor increased significantly as BMI cut-off point increased. Our findings indicate that BMI cut-offs of 23.0 kg/m2 in men and 24.0 kg/m2 in women are appropriate for classification of overweight. We suggest that these cut-offs can be used by health professionals to identify individuals for cardiovascular risk screening and weight management programmes.

  18. [Study on the dynamic changes of D-dimer during pregnancy and early puerperium].

    Science.gov (United States)

    Xu, D; Cai, S P; Xu, J W; Liang, C; He, J

    2016-09-25

    Objective: To explore the dynamic changes of D-dimers during pregnancy and early puerperium(within 3 days postpartum). Methods: A retrospective study was performed among 8 367 healthy women who had term singleton delivery in Women's Hospital, School of Medicine, Zhejiang University from January 2007 to December 2014. D-dimers concentrations during pregnancy and early puerprium of all the cases were collected. Data of 21 065 D-dimers tests were assigned to 5 groups according to the time of sampling, including early pregnancy(≤12 gestation weeks), middle pregnancy(12-28 gestation weeks), late pregnancy(>28 gestation weeks), 1 postpartum(within 48 hours postpartum)and 2 postpartum(48- 72 hours postpartum). The D-dimers concentrations in different groups were compared. The effect of delivery mode on D-dimers of early pureperium was analyzed. The correlation between D-dimers and the thromboembolic disease was also explored. In this study, Student's t-test and Wilcoxon rank sum test were used for statistical analysis. D-dimers concentration ≤0.5 mg/L was used as the normal range. Results: (1)D-dimers concentrations during pregnancy were higher than the non-pregnant women(Pearly pregnancy and late pregnancy(P=0.820). D-dimers concentration in the 1 postpartum group was higher than that of early pregnancy group or late pregnancy group(Pearly pregnancy, late pregnancy and 1 postpartum groups.(2)D-dimers in cesarean section cases was significantly higher than in vaginal delivery cases in each period of pregnancy and early pueprium.(3)The 95%CI of D-dimers in early pregnancy, late pregnancy, 48 hours after vaginal delivery, 48- 72 hours after vaginal delivery, ≤48 hours after cesarean section, 48- 72 hours after cesarean section were 0.58-8.28, 0.47-11.52, 1.04-9.59, 0.87-5.22, 1.07-11.58 and 1.00-6.23 mg/L, respectively.(4)In 6 cases with thromboembolic disease, D-dimers was 6.89- 19.89 mg/L, with the mean value of 13.66 mg/L. It was significantly higher than normal

  19. Oscillation of solar radio emission at coronal acoustic cut-off frequency

    Science.gov (United States)

    Pylaev, O. S.; Zaqarashvili, T. V.; Brazhenko, A. I.; Melnik, V. N.; Hanslmeier, A.; Panchenko, M.

    2017-05-01

    Recent SECCHI COR2 observations on board STEREO-A spacecraft have detected density structures at a distance of 2.5-15 R0 propagating with periodicity of about 90 min. The observations show that the density structures probably formed in the lower corona. We used the large Ukrainian radio telescope URAN-2 to observe type IV radio bursts in the frequency range of 8-32 MHz during the time interval of 08:15-11:00 UT on August 1, 2011. Radio emission in this frequency range originated at the distance of 1.5-2.5 R0 according to the Baumbach-Allen density model of the solar corona. Morlet wavelet analysis showed the periodicity of 80 min in radio emission intensity at all frequencies, which demonstrates that there are quasi-periodic variations of coronal density at all heights. The observed periodicity corresponds to the acoustic cut-off frequency of stratified corona at a temperature of 1 MK. We suggest that continuous perturbations of the coronal base in the form of jets/explosive events generate acoustic pulses, which propagate upwards and leave the wake behind oscillating at the coronal cut-off frequency. This wake may transform into recurrent shocks due to the density decrease with height, which leads to the observed periodicity in the radio emission. The recurrent shocks may trigger quasi-periodic magnetic reconnection in helmet streamers, where the opposite field lines merge and consequently may generate periodic density structures observed in the solar wind.

  20. Proceedings from the Fissile Material Cut-off seminar in Stockholm

    Energy Technology Data Exchange (ETDEWEB)

    Arbman, G. [ed.

    1998-07-01

    The Swedish Defence Research Establishment hosted an international expert seminar on the subject of verifying a prohibition of the production of fissile material for nuclear weapons purpose (cut-off) in Stockholm, June 3-5 1998. The objective of the seminar was to provide an opportunity for informal discussions among scientific and technical experts on various technical matters relating to the verification of a future Fissile Material Cut-off Treaty (FMCT). A stated aim of the seminar was to keep issues of scope to a minimum. Invited speakers and commentators were given an opportunity to present their views as written contributions. The present seminar proceedings are essentially the result of these views. In addition, short summaries of the discussions following each session are included. Although an attempt was made to be as complete and accurate as possible in reproducing these discussions, the editors apologise if some important points or statements have been omitted. If so, the main reason is that the documentation of the discussions were based on written notes, not taped recordings. Eight longer contributions have been separately indexed.

  1. Open Skies and monitoring a fissile materials cut-off treaty

    Energy Technology Data Exchange (ETDEWEB)

    Allentuck, J.; Lemley, J.R.

    1995-09-01

    The Treaty on Open Skies (Open Skies) is intended among other things to provide, in the words of its preamble, means ``to facilitate the monitoring of compliance with existing or future arms control agreements.`` Open Skies permits overflights of the territory of member states by aircraft equipped with an array of sensors of various types. Their types and capabilities are treaty-limited. To find useful application in monitoring a cut-off treaty Open Skies would need to be amended. The number of signatories would need to be expanded so as to provide greater geographical coverage, and restrictions on sensor-array capabilities would need to be relaxed. To facilitate the detection of impending violations of a cut-off convention by Open Skies overflights, the data base provided by parties to the former should include among other things an enumeration of existing and former fuel cycle and research facilities including those converted to other uses, their precise geographic location, and a site plan.

  2. Low cut-off values increase diagnostic performance of protein S assays.

    Science.gov (United States)

    Mulder, René; Ten Kate, Min Ki; Kluin-Nelemans, Hanneke C; Mulder, André B

    2010-09-01

    Conflicting data have been reported on the accuracy of protein S (PS) assays for detection of hereditary PS deficiency. In this study we assessed the diagnostic performance of two total PS antigen assays, four free PS assays and three PS activity assays in a group of 28 heterozygous carriers of mutations in PROS1 and 165 control subjects. Several control groups were formed, one of healthy volunteers and - because PS levels are influenced by oral contraception and pregnancy, and assays measuring PS activity may be influenced by the presence of the factor V Leiden mutation -, we also investigated the influences of these factors. All nine PS assays detected significantly reduced PS levels in subjects with a PROS1 mutation. Eight out of nine PS assays showed a 100% sensitivity and 100% specificity to detect heterozygous carriers of mutations in PROS1 with values far below the lower limit of the reference values obtained from healthy volunteers. Low specificities were found in subjects with a factor V Leiden mutation and in pregnant women. At lower cut-off levels, equal to the highest PS value found in heterozygous carriers of mutations in PROS1, the specificity considerably increased in these subjects. When using low cut-off levels equal to the highest PS value found in heterozygous carriers of mutations in PROS1, ensuring 100% sensitivity, the specificity in all study groups increases considerably, by which misclassification can be maximally avoided.

  3. Memristor-capacitor passive filters to tune both cut-off frequency and bandwidth

    Science.gov (United States)

    Ali, Shawkat; Hassan, Arshad; Hassan, Gul; Bae, Jinho; Lee, Chong Hyun

    2017-04-01

    In various optical sensor applications, programmable analog filters are desirable to reduce the hardware requirement. Memristor is two state programmable nonvolatile resistor, which has a small size and low power consumption. Using these resistance switching characteristics of a memristor, we propose a novel memristor-capacitor (MC) based printed low pass and high pass filters for analog circuits to achieve tunable cut-off frequencies and bandwidth. The cut-off frequencies of filters are controlled through a memristor state switching (HRS/LRS), whereas the capacitor has a fixed value. The proposed MC filters utilize graphene/poly 4-vinlyphenol (G/PVP) for dielectric layer of capacitors and Graphene Quatum Dots (GQDs)/PVP for an active layer of memristor, and these layers are fabricated on ITO coated flexible PET substrate through electrohydrodynamic (EHD) technique. Both MC filters are designed as parameters of two state memristance and a capacitance. From comparison between designed and fabricated filters, we show that they are matched quite well.

  4. Impact of anthropometric cut-off values in determining the prevalence of metabolic alterations.

    Science.gov (United States)

    Almeda-Valdes, Paloma; Aguilar-Salinas, Carlos A; Uribe, Misael; Canizales-Quinteros, Samuel; Méndez-Sánchez, Nahum

    2016-11-01

    The prevalence of obesity has increased worldwide in parallel with associated metabolic disturbances such as diabetes and non-alcoholic fatty liver disease. The objective of this article is to underscore discrepancies in the standard anthropometric cut-off values and the presence of metabolic disturbances including diabetes and non-alcoholic fatty liver disease caused by biological and ethnic variations. We performed a literature review regarding the diagnosis and prevalence of obesity, diabetes, metabolic syndrome and non-alcoholic fatty liver disease and about the different available indicators to define obesity. There is an ongoing epidemic of these chronic diseases, partially attributed to the increased prevalence of obesity. The available markers to indicate adiposity are imperfect, and the selection of accurate cut-off points is still not clear. Methods to quantify adiposity that are useful in clinical practice should be developed to better classify individuals and to reflect metabolic risk more appropriately. © 2016 Stichting European Society for Clinical Investigation Journal Foundation.

  5. Physical activity cut-offs and risk factors for preventing child obesity in Japan.

    Science.gov (United States)

    Minematsu, Kazuo; Kawabuchi, Ryosuke; Okazaki, Hiromi; Tomita, Hiroyuki; Tobina, Takuro; Tanigawa, Takeshi; Tsunawake, Noriaki

    2015-01-01

    There is no official recommendations for physical activity level or steps for preventing and improving child obesity in Japan. Three hundred and two Japanese children aged 9-12 years were recruited wore 3-D speed sensors. Subjects were divided into two groups using the criteria for child obesity in Japan. Body composition was measured on bioelectrical impedance analysis. Physical fitness test was done to evaluate physical strength. Twenty-four hour total steps, energy expenditure, and metabolic equivalents (MET) from Monday to Sunday were consecutively measured. The cut-offs for steps and physical activity level for preventing child obesity were evaluated on receiver operating characteristic curves. Daily life-related risk factors for child obesity were assessed on logistic regression analysis. In both sexes, body volume; bodyweight, body mass index, fat mass, and percentage body fat in the obese group was significantly higher than in the normal group, but age and height were not different (P obese group were inferior to those in the normal group (P child obesity. Additionally, >2 h TV viewing per day is a significant risk factor for child obesity (OR, 3.43; 95%CI: 1.27-9.31). Cut-offs for physical activity and potential risk factors for child obesity have been identified. Recommendations for changes to daily lifestyle for school-aged Japanese children are given. © 2014 Japan Pediatric Society.

  6. Variability of cut-off values for the detection of lupus anticoagulants: results of an international multicenter multiplatform study.

    Science.gov (United States)

    Tripodi, A; Chantarangkul, V; Cini, M; Devreese, K; Dlott, J S; Giacomello, R; Gray, E; Legnani, C; Martinuzzo, M E; Pradella, P; Siegemund, A; Subramanian, S; Suchon, P; Testa, S

    2017-06-01

    Essentials Between-lab variations of cut-off values in lupus anticoagulant detection are unknown. Cut-off values were calculated in 11 labs each testing plasma from 120 donors with 3 platforms. Major variation was observed even within the same platform. Cut-off values determined in different labs are not interchangeable. Background Cut-off values for interpretation of lupus anticoagulant (LA) detection are poorly investigated. Aims (i) To assess whether results from healthy donors were normally distributed and (ii) the between-laboratories differences in cut-off values for screening, mixing and LA confirmation when calculated as 99th or 95th centiles, and (iii) to assess their impact on the detection rate for LA. Methods Each of 11 laboratories using one of the three widely used commercial platforms for LA detection was asked to collect plasmas from 120 healthy donors and to perform screening, mixing and LA confirmation with two methods (activated partial thromboplastin time [APTT] and dilute Russell viper venom [dRVV]). A common set of LA-positive or LA-negative freeze-dried plasmas was used to assess the LA detection rate. Results were centralized (Milano) for statistical analysis. Results and conclusions (i) Clotting times or ratios for healthy subjects were not normally distributed in the majority of cases. The take-home message is that cut-off values should be determined preferably by the non-parametric method based on centiles. (ii) There were relatively large inter-laboratory cut-off variations even within the same platform and the variability was marginally attenuated when results were expressed as ratios (test-to-normal pooled plasma). The take-home message is that cut-off values should be determined locally. (iii) There were differences between cut-off values calculated as 99th or 95th centiles that translate into a different LA detection rate (the lower the centile the greater the detection rate). The take-home message is that cut-off values determined

  7. High D-dimer levels after stopping anticoagulants in pulmonary embolism with sleep apnoea.

    Science.gov (United States)

    García Suquia, Angela; Alonso-Fernández, Alberto; de la Peña, Mónica; Romero, David; Piérola, Javier; Carrera, Miguel; Barceló, Antonia; Soriano, Joan B; Arque, Meritxell; Fernández-Capitán, Carmen; Lorenzo, Alicia; García-Río, Francisco

    2015-12-01

    Obstructive sleep apnoea is a risk factor for pulmonary embolism. Elevated D-dimer levels and other biomarkers are associated with recurrent pulmonary embolism. The objectives were to compare the frequency of elevated D-dimer levels (>500 ng·mL(-1)) and further coagulation biomarkers after oral anticoagulation withdrawal in pulmonary embolism patients, with and without obstructive sleep apnoea, including two control groups without pulmonary embolism.We performed home respiratory polygraphy. We also measured basic biochemical profile and haemogram, and coagulation biomarkers (D-dimer, prothrombin fragment 1+2, thrombin-antithrombin complex, plasminogen activator inhibitor 1, and soluble P-selectin).64 (74.4%) of the pulmonary embolism cases and 41 (46.11%) of the controls without pulmonary embolism had obstructive sleep apnoea. Plasmatic D-dimer was higher in PE patients with OSA than in those without obstructive sleep apnoea. D-dimer levels were significantly correlated with apnoea-hypopnoea index, and nocturnal hypoxia. There were more patients with high D-dimer after stopping anticoagulants in those with pulmonary embolism and obstructive sleep apnoea compared with PE without obstructive sleep apnoea (35.4% versus 19.0%, p=0.003). Apnoea-hypopnoea index was independently associated with high D-dimer.Pulmonary embolism patients with obstructive sleep apnoea had higher rates of elevated D-dimer levels after anticoagulation discontinuation for pulmonary embolism than in patients without obstructive sleep apnoea and, therefore, higher procoagulant state that might increase the risk of pulmonary embolism recurrence. Copyright ©ERS 2015.

  8. Is there a cut-off for high-quality guidelines? A systematic analysis of current guideline appraisals using the AGREE II instrument.

    Science.gov (United States)

    Hoffmann-Eßer, Wiebke; Siering, Ulrich; Neugebauer, Edmund A M; Lampert, Ulrike; Eikermann, Michaela

    2017-12-26

    To investigate whether AGREE II users apply a cut-off based on standardized domain scores or overall guideline quality in order to distinguish between high- and low-quality guidelines, as well as to investigate which criteria they use to generate this cut-off and which type of cut-off they apply. We conducted a systematic search in MEDLINE, EMBASE, DARE, and the HTA-Database for German- and English-language studies appraising guidelines with AGREE II. Information on cut-offs was extracted and analyzed descriptively. We identified 118 relevant publications. 39 (33%) used a cut-off, of which 24 (62%) used a 2-step and 13 (33%) used a 3-step approach. The cut-off for high quality lay between 50%-70% (2-step) and 60%-83% (3-step) of the highest possible rating. 24 (62%) publications applied a cut-off based on standardized domain scores and 7 (18%) based on overall guideline quality. 11 (28%) applied cut-offs to derive the recommendation for guideline use. A third of AGREE II users apply a cut-off to distinguish between high- and low-quality guidelines, often without clearly describing how the cut-off is generated. Many users might welcome a clear distinction between high- and low-quality guidelines; specifying a cut-off for this purpose might be useful. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Sensitivity and specificity of the Beck Depression Inventory in cardiologic inpatients: how useful is the conventional cut-off score?

    Science.gov (United States)

    Forkmann, Thomas; Vehren, Thomas; Boecker, Maren; Norra, Christine; Wirtz, Markus; Gauggel, Siegfried

    2009-10-01

    The Beck Depression Inventory (BDI) is widely used for depression screening in various patient populations. However, there are still insufficient data about its sensitivity and specificity in nonpsychiatric patients. Furthermore, some research suggests that somatic BDI items heighten its sum score artificially in physically ill patients. The aim of the present study was to validate the conventional BDI cut-off score by examination of its sensitivity and specificity in a mixed sample of cardiac inpatients and compare it to a modified "cognitive-emotional" BDI (BDI(c/e)) after exclusion of somatic items. A total of 126 cardiologic inpatients were assessed. Receiver operating characteristic curves (ROC) were calculated for total BDI (BDI(t)) and BDI(c/e). Screening performance of cut-off scores was evaluated using the Youden Index (Y). With the application of the conventional BDI cut-off score, ROC analysis revealed a moderate overall screening performance with Y=52.6 and an area under the curve (AUC) of 0.83. In contrast, Y improved to 57.5 at a cut-off score of >9, but screening performance was still not optimal. BDI(c/e) showed also a moderate screening performance (AUC=.82); Y was maximized at a cut-off score of >8 (Y=0.53.5). Again, no cut-off score provided optimal screening performance. The BDI cannot be recommended as a formal screening instrument in cardiac inpatients since no cut-off score for either BDI(t) or BDI(c/e) combined both sufficiently high sensitivity and specificity. However, the shorter BDI(c/e) could be used as alternative to BDI(t) which may be confounded in physically ill patients. Generally, researchers should consider using alternative screening instruments (e.g., the Hospital Anxiety and Depression Scale) instead.

  10. Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer's disease and with probable cognitive impairment.

    Science.gov (United States)

    Bosco, Andrea; Spano, Giuseppina; Caffò, Alessandro O; Lopez, Antonella; Grattagliano, Ignazio; Saracino, Giuseppe; Pinto, Katia; Hoogeveen, Frans; Lancioni, Giulio E

    2017-12-01

    Montreal cognitive assessment (MoCA) is a test providing a brief screening for people with cognitive impairment due to aging or neurodegenerative syndromes. In Italy, as in the rest of the world, several validation studies of MoCA have been carried out. This study compared, for the first time in Italy, a sample of people with probable Alzheimer's Disease (AD) with healthy counterparts. The study also compared two community-dwelling groups of aged participants with and without probable cognitive impairment, as discriminated by two cut-off points of adjusted MMSE score. All the comparisons were carried out according to ROC statistics. Optimal cutoff for a diagnosis of probable AD was a MoCA score ≤14. Optimal cutoff for the discrimination of probable cognitive impairment was a MoCA score ≤17 (associated to MMSE cutoff of 23.8). Results confirm the substantial discrepancy in cut-off points existing between Italian and other international validation studies, showing that Italian performance on MoCA seems to be globally lower than that in other Countries. Characteristics of population might explain these results.

  11. The Cut-off Values of Triglycerides and Glucose Index for Metabolic Syndrome in American and Korean Adolescents.

    Science.gov (United States)

    Moon, Shinje; Park, Joon Sung; Ahn, Youhern

    2017-03-01

    The aim of this study was to establish ethnic- and gender-specific cut-off values of triglycerides and glucose index (TyG index) for clinical usefulness in a representative sample of Mexican American, Non-Hispanic White, Non-Hispanic Black, and Korean adolescents. The data were collected from datasets of the National Health and Nutrition Examination Survey between 1999 and 2012, and the Korean National Health and Nutrition Examination Survey between 2005 and 2013. Receiver operating characteristic curve analysis was used to find valid cut-off values of the TyG index for metabolic syndrome. The total number of eligible participants was 3,164 in the US and 4,873 in Korea. The optimal cut-off value with the Cook et al. definition revealed 8.55 in Mexican American, 8.55 in Non-Hispanic White, 8.35 in Non-Hispanic Black, and 8.45 in Korean, respectively. The cut-off value with the de Ferranti et al. definition was 8.45, 8.45, 8.15, and 8.35, and the cut-off value with the International Diabetes Federation definition was 8.65, 8.65, 8.15, and 8.55, respectively. These findings may be clinically useful for evaluating insulin resistance for determining metabolic abnormalities in adolescents.

  12. NEW METHODS OF ASSESSING THE LEVEL OF D-DIMER IN THE DIAGNOSIS OF PULMONARY E

    Directory of Open Access Journals (Sweden)

    A. G. Pronin

    2017-01-01

    Full Text Available Background Pulmonary embolism (PE is a pathological condition complicating the course of many diseases, which often remains unrecognized. An important role for its diagnosis is given to D-dimer concentration in blood. This marker has a low specificity and a high predictive value of a negative result. The normal level of D-dimer with low clinical probability of pulmonary embolism allows to exclude this diagnosis with an accuracy of 97%. According to the European Society of Cardiologists, the specificity of D-dimer may be improved by the correction of the upper reference values in patients of different age groups. The aim of the study was to calculate the correction coefficient of the normal D-dimer upper limit depending on age in order to improve the diagnosis of pulmonary embolism in patients with chronic heart failure (CHF. Material and method We surveyed 160 patients over 50 years with suspected pulmonary embolism on the background of CHF of III-IV functional class according to NYHA classification. All patients underwent clinical and biochemical blood tests, d-dimer, echocardiography, Doppler ultrasound, angiography of pulmonary arteries. Based on the results of examination, the diagnosis of pulmonary embolism was set in 102 patients with heart failure of III-IV functional class according to NYHA classification. The level of the proximal occlusion was distributed as follows: main pulmonary artery — 41%, lobar artery — 31%, segmental artery — 28% of patients. All patients had not a high risk of death from pulmonary embolism. In 58 patients with CHF of III–IV functional class and D-dimer above reference values, PE was excluded. Results and conclusion In patients with CHF of III–IV functional class (NYHA over 50 years, the correction of upper limit of D-dimer reference with a coefficient of 0.012 allows to increase the specificity of this marker in the diagnosis of pulmonary embolism by 40%

  13. Persistent elevation of fibrin D-dimer predicts longterm outcome in systemic juvenile idiopathic arthritis.

    Science.gov (United States)

    Bloom, Bradley J; Alario, Anthony J; Miller, Laurie C

    2009-02-01

    We previously demonstrated that levels of fibrin d-dimer correlate with disease activity and response to therapies in systemic juvenile idiopathic arthritis (sJIA). We hypothesized that persistence of D-dimer elevation in the patterns previously described, but over a longer followup period, would signal poor outcome. We studied 31 children identified from 2 centers. Subjects were assigned a risk category based on their first obtained D-dimer concentration. Risk categories were based on results of our initial study, where normalization of D-dimer in patients no longer taking immunosuppressive therapy predicted good short-term outcome, and persistent D-dimer elevation while taking immunosuppressives predicted bad outcome (radiographic abnormalities, joint replacement surgery, or poor functional class) or a severe systemic manifestation. Outcome was determined at the last followup visit, a minimum of 2 years after measurement of the initial d-dimer level. The 31 children were a mean 16.4 years old at an average of 8.8 years after their initial diagnosis. Ten children had a severe outcome during this period; all 10 had a study baseline risk category of "high." Of the 14 subjects who had a high risk category at study baseline, none had a mild outcome. Our study indicated that a paradigm of risk of severe disease based upon persistent elevation of fibrin d-dimer on first measurements (greater than a mean of 29 months in our initial study and at least 24 months in the additional subjects) is promising to predict poor longer-term outcome in sJIA. A larger prospective study is warranted to substantiate the preliminary data and assess the relative comparative value to other biomarkers and clinical endpoints.

  14. From Newton's Law to the Linear Boltzmann Equation Without Cut-Off

    Science.gov (United States)

    Ayi, Nathalie

    2017-03-01

    We provide a rigorous derivation of the linear Boltzmann equation without cut-off starting from a system of particles interacting via a potential with infinite range as the number of particles N goes to infinity under the Boltzmann-Grad scaling. More particularly, we will describe the motion of a tagged particle in a gas close to global equilibrium. The main difficulty in our context is that, due to the infinite range of the potential, a non-integrable singularity appears in the angular collision kernel, making no longer valid the single-use of Lanford's strategy. Our proof relies then on a combination of Lanford's strategy, of tools developed recently by Bodineau, Gallagher and Saint-Raymond to study the collision process, and of new duality arguments to study the additional terms associated with the long-range interaction, leading to some explicit weak estimates.

  15. Percentile curves for body fatness and cut-offs to define malnutrition in Russians

    Science.gov (United States)

    Nikolaev, D. V.; Rudnev, S. G.; Starunova, O. A.; Eryukova, T. A.; Kolesnikov, V. A.; Ponomareva, E. G.; Soboleva, N. P.; Sterlikov, S. A.

    2013-04-01

    Here, we report first results of the large-scale ongoing bioelectrical impedance body composition study in Russians. By the end of 2012, 216 out of 800 Russian Health Centres submitted raw bioimpedance data on 844,221 adults and children aged 5-80 years, representing nearly 0.6% of the Russian population, who were accessed cross-sectionally using the same type of bioimpedance meter, ABC-01 Medas. Estimates of overweight, obesity, and normal weight obesity prevalence in the general population, as well as characteristics of diagnostic sensitivity and specificity of the conventional WHO BMI-based criteria of obesity depending on age are obtained. The smoothed reference centile curves for percentage fat mass are constructed, and localized cut-offs for fatness and thinness are provided that can be used both at the individual and epidemiological levels.

  16. ELISA validation and determination of cut-off level for chloramphenicol residues in honey

    Directory of Open Access Journals (Sweden)

    Biernacki Bogumił

    2015-09-01

    Full Text Available An analytical validation of a screening ELISA for detection of chloramphenicol (CAP in honey was conducted according to the Commission Decision 2002/657/EC and Guidelines for the Validation of Screening Methods for Residues of Veterinary Medicines. The analyte was extracted from honey with a water and ethyl acetate mixture, and CAP concentrations were measured photometrically at 450 nm. The recovery rate of the analyte from spiked samples was 79%. The cut-off level of CAP in honey as the minimum recovery (0.17 units was established. Detection capability (CCβ was fixed at 0.25 μg kg−1. No relevant interferences between matrix effects and structurally related substances including florfenicol and thiamphenicol were observed. The ELISA method should be useful for determination of CAP residues in honey monitoring.

  17. Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia.

    Science.gov (United States)

    Fiorentino, Marion; Sophonneary, Prak; Laillou, Arnaud; Whitney, Sophie; de Groot, Richard; Perignon, Marlène; Kuong, Khov; Berger, Jacques; Wieringa, Frank T

    2016-01-01

    Early identification of children 5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition. To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011-2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children values of AUC, the cut-off with the highest sensitivity and a false positive rate ≤33% was selected as the optimal cut-off. Optimal cut-off values increased with age. Boys had higher cut-offs than girls, except in the 8-10.9 yrs age range. In children 80% with the new cut-offs in comparison with the current WHO cut-offs. Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level.

  18. The Association Between Epicardial Adipose Tissue and Coronary Artery Disease: an Echocardiographic Cut-off Point

    Directory of Open Access Journals (Sweden)

    Mehrnoush Toufan

    2012-09-01

    Full Text Available Introduction: EAT is an independent factor in coronary artery disease (CAD. The objective of the current study was to define an echocardiographic cut-off point for EAT and to determine its diagnostic value in predicting the increase in CAD risk. Methods: Two hundred patients underwent coronary artery angiography for diagnosis of CAD and transthoracic echocardiography for measurement of EAT on the right ventricle (RV, RV apex and RV outlet tract. Sensitivity, specificity, positive predictive value (PPV and negative predictive value (NPV of the EAT cut-off points in the three above-mentioned areas for predicting the severity of CAD were measured. The relation between the EAT and CAD risk factors was evaluated as well. Results: EAT was independent from gender, height, hypertension, diabetes, HDL, total cholesterol, ejection fraction, acute coronary syndrome, and the location of the coronary artery stenosis in the coronary artery in all three anatomical areas. EAT on RV and RV apex had a significant relation with CAD (P ≤ 0.05. Overall, RV EAT≥ 10 mm and RV apex EAT ≥ 8 mm had sensitivity and PPV of more than 70% in predicting coronary stenosis ≥ 50% and acute coronary syndrome (ACS and RVOT EAT ≥ 13 mm is of PPV=83.5% for predicting coronary stenosis ≥ 50%. Conclusion: EAT thickness has an acceptable diagnostic value for predicting severe coronary artery stenosis and ACS. Therefore, non-invasive EAT thickness measurement could be of great assistance to clinicians for detecting the patients at risk and helping them to undergo supplementary evaluations with invasive approaches.

  19. Cut-off values of waist circumference to predict metabolic syndrome in obese adolescents.

    Science.gov (United States)

    Masquio, Deborah Cristina Landi; Ganen, Aline de Piano; Campos, Raquel Munhoz da Silveira; Sanches, Priscila de Lima; Corgosinho, Flávia Campos; Caranti, Danielle; Tock, Lian; de Mello, Marco Túlio; Tufik, Sergio; Dâmaso, Ana R

    2015-04-01

    Metabolic syndrome (MetS) is a constellation of metabolic alteration related to abdominal obesity, inflammation and insulin resistance, which increase cardiovascular disease and mortality. The aims of the present study were to identify the prevalence of comorbidities and altered parameters in obese adolescents with and without MetS, and determine cut-off points of waist circumference to predict MetS. 195 obese adolescents were recruited and divided according to MetS diagnosis based on IDF criteria. Blood analyses of glucose, lipids, liver enzymes, adiponectin and leptin were measured. Insulin resistance was assessed by HOMA-IR, QUICKI and HOMA-AD. Visceral, subcutaneous and hepatic fat were ultrasonography obtained. Body composition was estimated by BOD POD system. We observed a prevalence of 25% of MetS (n=50). The MetS group presented significant higher body mass, BMI, body fat (kg), free-fat mass (kg), waist circumference, visceral fat, glucose, insulin, insulin resistance, total-cholesterol, LDL-c, VLDL-c, triglycerides, liver enzymes, non-alcoholic fatty liver disease (NAFLD) and blood pressure. Significant lower QUICKI and adiponectin in MetS group were noted. MetS girls presented significant higher leptin/adiponectin ratio compared to Non-MetS girls. Cut-off points of 111.5 cm for boys and 104.6 cm for girls of waist circumference were suggested to predict metabolic syndrome. Moreover, waist circumference was positive correlated with visceral fat and the number of metabolic syndrome parameters. MetS group presented significant higher metabolic alterations and inflammation compared to Non-MetS group. Waist circumference is considered an anthropometric measure predictor of metabolic syndrome in obese adolescents, being useful in clinical practice. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  20. Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy

    DEFF Research Database (Denmark)

    Grund, Birgit; Baker, Jason V; Deeks, Steven G

    2016-01-01

    BACKGROUND: Despite effective antiretroviral treatment (ART), HIV-positive individuals are at increased risk of serious non-AIDS conditions (cardiovascular, liver and renal disease, and cancers), perhaps due in part to ongoing inflammation and/or coagulation. To estimate the potential risk...... in 3 large cohorts. METHODS: In HIV-positive adults on suppressive ART, associations of IL-6, D-dimer, and hsCRP levels at study entry with serious non-AIDS conditions or death were studied using Cox regression. Hazard ratios (HR) adjusted for age, gender, study, and regression dilution bias (due...... biomarker model estimates a 37% reduction (95% CI: 28 to 46%) in the risk of serious non-AIDS conditions or death if the relationship is causal. CONCLUSIONS: Both IL-6 and D-dimer are independently associated with serious non-AIDS conditions or death among HIV-positive adults with suppressed virus...

  1. Fatigue life analysis of cracked gas receiver of emergency cut-off system in gas gathering station

    Science.gov (United States)

    Hu, Junzhi; Zhou, Jiyong; Li, Siyuan

    2017-06-01

    Small-scale air compressor and gas receiver are used as the driving gas of the emergency cut-off system in gas gathering station. Operation of block valve is ensured by starting and stopping compressor automatically. The frequent start-stop of compressor and the pressure fluctuation pose a threat to the service life of gas receiver, and then affect normal operation of the emergency cut-off system and security of gas gathering station. In this paper, the fatigue life of a pressure vessel with axial semi-elliptical surface crack in the inner wall is analyzed under the varying pressure by means of the theory of fracture mechanics. The influences of the amplitude of pressure fluctuation and the initial crack size on the residual life of gas receiver are discussed. It provides a basis for setting the working parameters of gas receiver of emergency cut-off system and determining the maintenance cycle.

  2. Sucrose hydrolysis by invertase using a membrane reactor: effect of membrane cut-off on enzyme performance

    Directory of Open Access Journals (Sweden)

    Francesco Di Addezio

    2014-04-01

    Full Text Available Sucrose hydrolysis by invertase [EC.3.2.1.26] produces inverted sugar syrup, an ingredient mainly used in the food industry. To properly catalyze hydrolysis, the enzyme should be reused after this reaction. It is advisable to maintain constant activity over a considerable period. Thus, sucrose hydrolysis was performed in a membrane bioreactor - a continuously stirred tank reactor coupled with an ultrafiltration membrane (UFM which provides good diffusion and high activity per unit volume. Molecular weight cut-off for soluble invertase UFMs was up to 100kDa. This study focused on the role of UFM invertase cut-off as it is the main element in the process. We demonstrated that both the cut-off and chemical nature of the UFM affected specific invertase activity.

  3. Measurements and modeling of multipath interference at wavelengths below cable cut-off in a G.654 optical fiber span.

    Science.gov (United States)

    Downie, John D; Hurley, Jason; DePedro, Hector; Garner, Steven; Blaker, Jeremy; Zakharian, Aramais; Ten, Sergey; Mills, Greg

    2017-04-17

    Transmission below the cable cut-off wavelength may be a concern in some systems, especially for an optical supervisory channel (OSC) operating below the signal transmission band in systems built with G.654 fiber. In this work, we constructed a cabled span of G.654-compliant fiber and measured the multipath interference (MPI) generated during propagation through the span at a range of wavelengths below the cable cut-offs of the constituent fibers. Measurements were made under a range of conditions including different splice losses and the presence or absence of higher order mode filters placed around the splices. MPI levels were found to be sufficiently low at wavelengths far below the average cable cut-off such that OSC transmission was penalty-free. We compare the experimental results to modeling predictions and find very good agreement.

  4. Beck Depression Inventory II: evaluation of the psychometric properties and cut-off points in a Turkish adult population.

    Science.gov (United States)

    Kapci, Emine Gul; Uslu, R; Turkcapar, H; Karaoglan, A

    2008-01-01

    Numerous studies have been previously conducted to assess the Beck Depression Inventory-II's [BDI II; Beck et al., 1996] psychometric properties. However, none of these studies has examined whether the original cut-off scores were applicable to other cultures. Thus, in addition to evaluating its psychometric properties, we also determined the cut-off scores of the BDI II for the Turkish population. Data from nonclinical (n = 362) and clinical psychiatric outpatients diagnosed as depressive disorder according to DSM-IV criteria (n = 176) were gathered. Analyses for internal consistency and test-retest reliabilities and for convergent and discriminant validities were computed. Two confirmatory factor analyses, one derived from the present exploratory factor analyses and the other proposed in the original study were conducted for both groups. A receiver operating characteristics curve was utilized to determine the cut-off scores for the Turkish population revealing 0-12 for minimal, 13-18 for mild, 19-28 for moderate and 29-63 for severe depression. The internal consistency for the nonclinical and clinical groups were .90 and .89, respectively; test-retest stability was also high (r = .94). Convergent and discriminant validity results were satisfactory. Findings confirmed the present model for the clinical group and equally confirmed both models for the nonclinical group. Furthermore, the cut-off scores to classify minimal, mild, moderate, and severe depression were quite akin to the cut-off points previously suggested for the American population. Taken as a whole our findings revealed that BDI II has sound psychometric properties and comparable cut-off scores for the Turkish population. Depression and Anxiety, 2008. (c) 2007 Wiley-Liss, Inc.

  5. Association between Von Willebrand factor, disintegrin and metalloproteinase with thrombospondin type 1 motif member 13, d-Dimer and cystatin C levels with retinopathy in type 1 diabetes mellitus.

    Science.gov (United States)

    Domingueti, Caroline Pereira; Fuzatto, Jéssica A; Fóscolo, Rodrigo B; Reis, Janice S; Dusse, Luci M; Carvalho, Maria das Graças; Gomes, Karina B; Fernandes, Ana Paula

    2016-08-01

    We evaluated the association between plasma levels of VWF, ADAMTS13 and d-Dimer, which consist on endothelial dysfunction and hypercoagulability biomarkers, and cystatin C with retinopathy in type 1 diabetic patients. Patients were classified according to presence (n=55) or absence (n=70) of retinopathy. Plasma levels of VWF, ADAMTS13, d-Dimer and cystatin C were evaluated by ELISA and ADAMTS13 activity was evaluated by FRET. Plasma levels of VWF (p=0.033), ADAMTS13 activity (p=0.014), d-Dimer (p=0.002) and cystatin C (p1) were elevated in diabetic patients with retinopathy compared to those without this complication. The multivariate logistic regression analysis showed that ADAMTS13 activity (p=0.031) d-Dimer (p=0.015) and cystatin C (p=0.001) remained associated with retinopathy after adjustment for age, diabetes duration, use of statin, use of ACEi or angiotensin antagonist, use of acetylsalicylic acid and glomerular filtration rate. ADAMTS13 activity, d-Dimer and cystatin C are associated with retinopathy in type 1 diabetic patients and are promising biomarkers for the diagnosis and monitoring of diabetic retinopathy. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju [Dept. of Radiology, Wonju Christian Hospital, Yensei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2012-01-15

    Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

  7. Cut-off points to identify sarcopenia according to European Working Group on Sarcopenia in Older People (EWGSOP) definition.

    Science.gov (United States)

    Bahat, Gulistan; Tufan, Asli; Tufan, Fatih; Kilic, Cihan; Akpinar, Timur Selçuk; Kose, Murat; Erten, Nilgun; Karan, Mehmet Akif; Cruz-Jentoft, Alfonso J

    2016-12-01

    The reported prevalence of sarcopenia ranges widely depending on its definition criterion. European Working Group on Sarcopenia in Older People (EWGSOP) developed a practical clinical definition and consensus diagnostic criteria. This definition recommends using normative data of the study population rather than other reference populations. We aimed to define the reference cut-off values for muscle mass, muscle strength and calf circumference in Turkey in order to improve general applicability of EWGSOP criteria. Healthy young adults between 18 and 39 years of age with no known chronic disease or chronic drug usage were included in our study to serve as reference population for assessing muscle mass. Community-dwelling older outpatients were prospectively recruited from the geriatrics outpatient clinics of a university hospital for assessing hand grip strength and calf circumference. Body composition was assessed by bioimpedance analysis. Muscle strength was assessed measuring hand grip strength with a Jamar hand dynamometer. The cut-off thresholds for muscle mass were defined as the mean-2SD of the values of the young reference study population; for grip strength were calculated from ROC analyses using cut-off values that predicted gait speed < 0.8 m/s; and for calf circumference were calculated from ROC analyses using cut-off values that predicted low muscle mass. The young reference group included a total of 301 participants (187 male, 114 female; mean age: 26.5 ± 4.6 years). The cut-off thresholds for skeletal muscle mass indexes were 9.2 kg/m(2) and 7.4 kg/m(2) in males and females, respectively. The older community dwelling group included 406 subjects (123 male, 283 female, mean age: 76.6 ± 6.7 years). The cut-off thresholds for hand grip strength were 32 kg and 22 kg for males and females. The cut-off threshold for calf circumference was 33 cm for both males and females. The cut-off thresholds for muscle mass, grip strength and calf

  8. Optimal Cut-Off Points for the Short-Negative Act Questionnaire and Their Association with Depressive Symptoms and Diagnosis of Depression

    DEFF Research Database (Denmark)

    Conway, Paul Maurice; Høgh (Hogh), Annie; Nabe-Nielsen, Kirsten

    2018-01-01

    , the present study aimed to: (i) identify optimal cut-off points, reflecting a possible subjectively experienced exposure to occasional and frequent workplace bullying, for the 9-item Short Negative Act Questionnaire (S-NAQ), and (ii) examine the criterion validity of these cut-off points in relation...... its criterion validity in relation to depressive symptoms (N = 4071) and diagnosis of depression (N = 4844). Results The S-NAQ cut-off points obtained were ≥12 and ≥16 when using occasional and frequent bullying as reference standards, respectively. Both cut-off points showed high classification...... The two cut-off points for the S-NAQ identified in this study showed a significant association with both depressive symptoms and diagnosis of depression. However, future prospective studies are needed to establish the predictive validity of the proposed cut-off points....

  9. Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia.

    Directory of Open Access Journals (Sweden)

    Marion Fiorentino

    Full Text Available Early identification of children 5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition.To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011-2013. Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC were calculated using wasting for children 80% with the new cut-offs in comparison with the current WHO cut-offs.Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score <-2 z-scores. International reference of MUAC cut-offs by age group and gender should be established to screen for acute malnutrition at the community level.

  10. N{sub f}=2+1+1 flavours of twisted mass quarks. Cut-off effects at tree-level of perturbation theory

    Energy Technology Data Exchange (ETDEWEB)

    Luschevskaya, Elena [ITEP, Moscow (Russian Federation); NIC/DESY, Zeuthen (Germany). John von Neumann-Inst. fuer Computing; Cichy, Krzysztof [Poznan Univ. (Poland). Faculty of Physics

    2010-12-15

    We present a calculation of cut-off effects at tree-level of perturbation theory for the K and D mesons using the twisted mass formulation of lattice QCD. The analytical calculations are performed in the time-momentum frame. The relative sizes of cut-off effects are compared for the pion, the kaon and the D meson masses. In addition, different realizations of maximal twist condition are considered and the corresponding cut-off effects are analyzed. (orig.)

  11. Elevation in D-dimer concentrations is positively correlated with gestation in normal uncomplicated pregnancy

    Directory of Open Access Journals (Sweden)

    Jeremiah ZA

    2012-08-01

    Full Text Available Zaccheaus A Jeremiah,1 Teddy C Adias,2 Margaret Opiah,3 Siyeoforiye P George,4 Osaro Mgbere,5 Ekere J Essien61Department of Medical Laboratory Sciences, Niger Delta University, Wilberforce Island, Nigeria; 2Bayelsa State College of Health Technology, Ogbia-Town, Nigeria; 3Department of Maternal and Child Health, Faculty of Nursing, Niger Delta University, Wilberforce Island, Nigeria; 4Postgraduate Hematology Unit, Rivers State University of Science and Technology, Port Harcourt, Nigeria; 5Houston Department of Health and Human Services, Houston, TX, USA; 6Institute of Community Health, University of Houston, Houston, TX, USABackground: D-dimer levels have been reported to increase progressively during pregnancy, but how this affects Nigerian women is not well known.Objective: This study aims to determine the D-dimer concentration and its relationship to other coagulation parameters among pregnant women in Port Harcourt, Nigeria.Method: In a cross-sectional observational study conducted in Port Harcourt, Nigeria, 120 pregnant women and 60 nonpregnant controls, drawn from a tertiary health institution in the Niger Delta, Nigeria, were assessed, using the standard procedures, for the following parameters: D-dimer concentration, prothrombin time, activated partial thromboplastin time, platelet count, hemoglobin, and packed cell volume.Results: The median D-dimer concentration of 153.1 ng/mL in the pregnant group was found to be significantly elevated when compared with the control value of 118.5 ng/mL (t = 2.348, P = 0.021. Conversely, there was a marked depression in the platelet count among pregnant women (193.5 × 109/L when compared with 229.0 × 109/L in the control group (t = 3.424; P = 0.001. There was no statistically significant difference in the values for the prothrombin time and the activated partial thromboplastin time between pregnant and nonpregnant women. D-dimer values correlated positively and significantly with gestation (r = 0

  12. Accuracy of the WHO’s body mass index cut-off points to measure gender- and age-specific obesity in middle-aged adults living in the city of Rio de Janeiro, Brazil

    Directory of Open Access Journals (Sweden)

    Wollner Materko

    2017-09-01

    Full Text Available Introduction. Obesity is defined by the World Health Organization (WHO as a disease characterized by the excessive accumulation of body fat. Obesity is considered a public health problem, leading to serious social, psychological and physical problems. However, the appropriate cut-off point of body mass index (BMI based on body fat percentage (BF% for classifying an individual as obese in middle-aged adults living in Rio de Janeiro remains unclear. Materials and methods. This was a prospective cross-sectional study comprising of 856 adults (413 men and 443 women living in Rio de Janeiro, Brazil ranging from 30-59 years of age. The data were collected over a two year period (2010-2011, and all participants were underwent anthropometric evaluation. The gold standard was the percentage of body fat estimated by bioelectrical impedance analysis. The optimal sensitivity and specificity were attained by adjusting BMI cut-off values to predict obesity based on the WHO criteria: BF% >25% in men and >35% in women, according to the receiver operating characteristic curve (ROC analysis adjusted for age and for the whole group.Results. The BMI cut-offs for predicting BF% were 29.9 kg/m2 in men and 24.9 kg/m2 in women. Conclusions. The BMI that corresponded to a BF% previously defining obesity was similar to that of other Western populations for men but not for women. Furthermore, gender and age specific cut-off values are recommended in this population.

  13. A model for the harmonisation of test results of different quantitative D-dimer methods.

    Science.gov (United States)

    Meijer, Piet; Haverkate, Frits; Kluft, Cornelis; de Moerloose, Philippe; Verbruggen, Bert; Spannagl, Michael

    2006-03-01

    The numerical test results of different D-dimer assays vary widely. Because of the complexity of the analyte of target as well as the variability in specificity of different D-dimer assays, only harmonisation of the test results seems to be feasible. The use of a single conversion factor does not take into account for several methods the lack of commutability between test results and consensus values at different D-dimer levels. This is probably related to the mutually different response of methods to high and low levels. We therefore designed a harmonisation model based on the transformation of a method-specific regression line to a reference regression line. We used the data for the measurement of a set of plasma samples with different D-dimer levels by 353 different laboratories using 7 of the most frequently used quantitative D-dimer methods. For each method we calculated the method-specific consensus value for each sample. The overall median value was also estimated. Per method linear regression was applied throughout the method-specific consensus values using the amount of patient pooled plasma added to the different plasma samples as the independent variable. The line through the overall median values of all 7 methods was used as the reference line. Harmonisation between the methods was obtained by transformation of the method-specific regression line to the reference line. This harmonisation resulted in a reduction of the variability between the method-specific consensus values from about 75% to about 5.5%. Clinical validation of this concept had shown significant improvement of the test result comparability. We conclude that this model is a feasible approach in the harmonisation of D-dimer methods. If the harmonisation procedure is included in the calibration procedure by the manufacturers, customers will automatically obtain harmonised test results.

  14. ANP, BNP and D-dimer predict right ventricular dysfunction in patients with acute pulmonary embolism

    DEFF Research Database (Denmark)

    Borgwardt, Henrik Gutte; Mortensen, Jann; Jensen, Claus V

    2010-01-01

    The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE).......The aim of this study was to predict right ventricular dysfunction (RVD) using plasma concentration of D-dimer, pro-atrial natriuretic peptide (pro-ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1) and cardiac troponin I (TNI) in patients with pulmonary embolism (PE)....

  15. Is stand-alone D-dimer testing safe to rule out acute pulmonary embolism?

    Science.gov (United States)

    van Es, N; van der Hulle, T; Büller, H R; Klok, F A; Huisman, M V; Galipienzo, J; Di Nisio, M

    2017-02-01

    Essentials A stand-alone D-dimer below 750 μg/L has been proposed to rule out acute pulmonary embolism (PE). This was a post-hoc analysis on data from 6 studies comprising 7268 patients with suspected PE. The negative predictive value of a D-dimer pulmonary embolism (PE), without additional imaging, but this approach needs validation. Objectives To evaluate stand-alone D-dimer testing at a positivity threshold of 750 μg L-1 to rule out PE. Methods Individual data from 7268 patients with suspected PE previously enrolled in six prospective management studies were used. Patients were assessed by the Wells rule followed by quantitative D-dimer testing in those with a 'PE unlikely' score. Patients were classified post hoc as having a negative (< 750 μg L-1 ) or positive (≥ 750 μg L-1 ) D-dimer. Using a one-stage meta-analytic approach, the negative predictive value (NPV) of stand-alone D-dimer testing was evaluated overall and in different risk subgroups. Results The pooled incidence of PE was 23% (range, 13-42%). Overall, 44% of patients had a D-dimer < 750 μg L-1 , of whom 2.8% were diagnosed with PE at baseline or during 3-month follow-up (NPV, 97.2%; 95% confidence interval [CI], 94.9-98.5). The NPV was highest in patients with a low probability of PE according to the Wells rule (99.2%; 95% CI, 98.6-99.5%) and lowest in those with a high probability of PE (79.3%; 95% CI, 53.0-92.8%). The NPVs in patients with active cancer, patients with previous venous thromboembolism and inpatients were 96.2% (95% CI, 85.6-99.1%), 94.7% (95% CI, 88.6-97.6%) and 92.7% (95% CI, 79.3-97.7%), respectively. Conclusions Our findings suggest that stand-alone D-dimer testing at a positivity threshold of 750 μg L-1 is not safe to rule out acute PE. © 2016 International Society on Thrombosis and Haemostasis.

  16. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation

    DEFF Research Database (Denmark)

    Krarup, L-H; Sandset, E C; Sandset, P M

    2011-01-01

    Krarup L-H, Sandset EC, Sandset PM, Berge E. D-dimer levels and stroke progression in patients with acute ischemic stroke and atrial fibrillation. Acta Neurol Scand: 2011: 124: 40-44. © 2010 John Wiley & Sons A/S. Background -  Patients with acute ischemic stroke and atrial fibrillation...... progression was defined as a ≥3-point worsening on the Scandinavian Stroke Scale during the first 48 h after randomization. Blood samples were analyzed for D-dimer, prothrombin fragment 1 + 2, soluble fibrin monomer, and C-reactive protein. Results -  A total of 382 patients were included in the analyses...

  17. T-cell assays for tuberculosis infection: deriving cut-offs for conversions using reproducibility data.

    Directory of Open Access Journals (Sweden)

    Anandharaman Veerapathran

    Full Text Available BACKGROUND: Although interferon-gamma release assays (IGRA are promising alternatives to the tuberculin skin test, interpretation of repeated testing results is hampered by lack of evidence on optimal cut-offs for conversions and reversions. A logical start is to determine the within-person variability of T-cell responses during serial testing. METHODOLOGY/PRINCIPAL FINDINGS: We performed a pilot study in India, to evaluate the short-term reproducibility of QuantiFERON-TB Gold In Tube assay (QFT among 14 healthcare workers (HCWs who underwent 4 serial QFT tests on day 0, 3, 9 and 12. QFT ELISA was repeated twice on the same sets of specimens. We assessed two types of reproducibility: 1 test-retest reproducibility (between-test variability, and 2 within-person reproducibility over time. Test-retest reproducibility: with dichotomous test results, extremely high concordance was noticed between two tests performed on the same sets of specimens: of the 56 samples, the test and re-test results agreed for all but 2 individuals (kappa = 0.94. Discordance was noted in subjects who had IFN-gamma values around the cut-off point, with both increases and decreases noted. With continuous IFN-gamma results, re-test results tended to produce higher estimates of IFN-gamma than the original test. Within-person reproducibility: when continuous IFN-gamma data were analyzed, the within-person reproducibility was moderate to high. While persons with negative QFT results generally stayed negative, positive results tended to vary over time. Our data showed that increases of more than 16% in the IFN-gamma levels are statistically improbable in the short-term. CONCLUSIONS: Conservatively assuming that long-term variability might be at least twice higher than short-term, we hypothesize that a QFT conversion requires two conditions to be met: 1 change from negative to positive result, and 2 at least 30% increase in the baseline IFN-gamma response. Larger studies are needed

  18. Setting up the cut-off level of a sensitive barcode lateral flow assay with magnetic nanoparticles.

    Science.gov (United States)

    Panferov, Vasily G; Safenkova, Irina V; Zherdev, Anatoly V; Dzantiev, Boris B

    2017-03-01

    A barcode lateral flow immunoassay (LFIA) based on magnetic nanoparticles with a controllable cut-off level was developed for the first time. The regulation of the cut-off levels was based on the changes in the position and concentration of three antibodies (two monoclonal and polyclonal) with different affinities (K D =4.22×10 -9 , 9.67×10 -9 , 1.05×10 -8 M), respectively. To obtain specific conjugates, monoclonal antibodies were covalently immobilized on the magnetic nanoparticles' surface. Potato virus X causing a reduction in the potato yield was used as a model polyvalent antigen. To detect potato virus X in the leaf extracts, a barcode LFIA with cut-off levels of 3, 30, and 150ng/mL was used for the analysis. The application of magnetic concentration leads to a six-fold reduction in the first cut-off level (0.5ng/mL) in comparison with magnetic LFIA without the concentration stage. Copyright © 2016. Published by Elsevier B.V.

  19. Screening for Internet Addiction: An Empirical Study on Cut-off Points for the Chen Internet Addiction Scale

    Directory of Open Access Journals (Sweden)

    Chih-Hung Ko

    2005-12-01

    Full Text Available The aim of this study was to establish the optimal cut-off points of the Chen Internet Addiction Scale (CIAS, to screen for and diagnose Internet addiction among adolescents in the community by using the well- established diagnostic criteria of Internet addiction. This survey of 454 adolescents used screening (57/58 and diagnostic (63/64 cut-off points of the CIAS, a self-reported instrument, based on the results of systematic diagnostic interviews by psychiatrists. The area under the curve of the receiver operating characteristic curve revealed that CIAS has good diagnostic accuracy (89.6%. The screening cut-off point had high sensitivity (85.6% and the diagnostic cut-off point had the highest diagnostic accuracy, classifying 87.6% of participants correctly. Accordingly, the screening point of the CIAS could provide a screening function in two-stage diagnosis, and the diagnostic point could serve as a diagnostic criterion in one-stage massive epidemiologic research.

  20. A general equation to obtain multiple cut-off scores on a test from multinomial logistic regression.

    Science.gov (United States)

    Bersabé, Rosa; Rivas, Teresa

    2010-05-01

    The authors derive a general equation to compute multiple cut-offs on a total test score in order to classify individuals into more than two ordinal categories. The equation is derived from the multinomial logistic regression (MLR) model, which is an extension of the binary logistic regression (BLR) model to accommodate polytomous outcome variables. From this analytical procedure, cut-off scores are established at the test score (the predictor variable) at which an individual is as likely to be in category j as in category j+1 of an ordinal outcome variable. The application of the complete procedure is illustrated by an example with data from an actual study on eating disorders. In this example, two cut-off scores on the Eating Attitudes Test (EAT-26) scores are obtained in order to classify individuals into three ordinal categories: asymptomatic, symptomatic and eating disorder. Diagnoses were made from the responses to a self-report (Q-EDD) that operationalises DSM-IV criteria for eating disorders. Alternatives to the MLR model to set multiple cut-off scores are discussed.

  1. Anthropometric parameters’ cut-off points and predictive value for metabolic syndrome in women from Cartagena, Colombia

    Directory of Open Access Journals (Sweden)

    Gustavo José Mora-García

    2014-03-01

    Full Text Available Objective. To estimate anthropometric parameters’ (APs cut-off points and association for metabolic syndrome (MetS. Materials and methods. A cross-sectional study was carried out with a total of 434 adult women from Cartagena de Indias, Colombia, in 2012. APs measured were waist circumference (WC, body mass index (BMI, body adiposity index (BAI, waist-hip ratio (WHR and waist-height ratio (WHtR. Cut-off points were estimated by a receiver operating characteristic curve (ROC. Logistic regression was applied to estimate possible associations. Results. Cut-off points for WC, BMI, BAI, WHR and WHtR were 85 cm, 28 kg/m2, 39%, 0.80 and 56, respectively. Only WHtR was associated to MetS (OR=1.11, CI95% [1.07-1.15]. Conclusion. WC cut-off point was higher than those proposed for Latin-American women by the Joint Interim Statement (JIS. WHtR had a low predictive value for MetS.

  2. Appropriate body mass index cut-offs to determine thinness, overweight and obesity in South Asian children in The Netherlands

    NARCIS (Netherlands)

    Wilde, J.A. de; Dommelen, P. van; Middelkoop, B.J.C.

    2013-01-01

    Background: Asian populations have an increased risk of developing cardiometabolic disorders at a lower body mass index (BMI) than other ethnic groups. Therefore, lower adult BMI cut-offs to determine overweight and obesity are recommended to assess the associated health risks for Asian (23 and 27.5

  3. Spectrally selective solar absorber with sharp and temperature dependent cut-off based on semiconductor nanowire arrays

    Science.gov (United States)

    Wang, Yang; Zhou, Lin; Zheng, Qinghui; Lu, Hong; Gan, Qiaoqiang; Yu, Zongfu; Zhu, Jia

    2017-05-01

    Spectrally selective absorbers (SSA) with high selectivity of absorption and sharp cut-off between high absorptivity and low emissivity are critical for efficient solar energy conversion. Here, we report the semiconductor nanowire enabled SSA with not only high absorption selectivity but also temperature dependent sharp absorption cut-off. By taking advantage of the temperature dependent bandgap of semiconductors, we systematically demonstrate that the absorption cut-off profile of the semiconductor-nanowire-based SSA can be flexibly tuned, which is quite different from most of the other SSA reported so far. As an example, silicon nanowire based selective absorbers are fabricated, with the measured absorption efficiency above (below) bandgap ˜97% (15%) combined with an extremely sharp absorption cut-off (transition region ˜200 nm), the sharpest SSA demonstrated so far. The demonstrated semiconductor-nanowire-based SSA can enable a high solar thermal efficiency of ≳86% under a wide range of operating conditions, which would be competitive candidates for the concentrated solar energy utilizations.

  4. Anthropometric parameters' cut-off points and predictive value for metabolic syndrome in women from Cartagena, Colombia.

    Science.gov (United States)

    Mora-García, Gustavo José; Gómez-Camargo, Doris; Mazenett, Enrique; Alario, Ángelo; Fortich, Álvaro; Gómez-Alegría, Claudio

    2014-04-01

    Objective. To estimate anthropometric parameters' (APs) cut-off points and association for metabolic syndrome (MetS). Materials and methods. A cross-sectional study was carried out with a total of 434 adult women from Cartagena de Indias, Colombia, in 2012. APs measured were waist circumference (WC), body mass index (BMI), body adiposity index (BAI), waist-hip ratio (WHR) and waist-height ratio (WHtR). Cut-off points were estimated by a receiver operating characteristic curve (ROC). Logistic regression was applied to estimate possible associations. Results. Cut-off points for WC, BMI, BAI, WHR and WHtR were 85 cm, 28 kg/m(2), 39%, 0.80 and 56, respectively. Only WHtR was associated to MetS (OR=1.11, CI95% [1.07-1.15]). Conclusion. WC cut-off point was higher than those proposed for Latin-American women by the Joint Interim Statement (JIS). WHtR had a low predictive value for MetS.

  5. Establishing the cut-off score for remission and severity-ranges on the Psychotic Depression Assessment Scale (PDAS)

    DEFF Research Database (Denmark)

    Østergaard, Søren D; Rothschild, Anthony J; Flint, Alastair J

    2016-01-01

    BACKGROUND: The Psychotic Depression Assessment Scale (PDAS) is a rating scale dedicated to the measurement of severity in psychotic depression (PD). The aim of this study was to establish the PDAS cut-off for remission of PD as well as PDAS score-ranges for mild, moderate, and severe PD. The sec...

  6. Interannual rainfall variability over the Cape south coast of South Africa linked to cut-off low associated rainfall

    CSIR Research Space (South Africa)

    Engelbrecht, CJ

    2014-10-01

    Full Text Available The influence of cut-off low (COL) associated rainfall on interannual rainfall variability over the Cape south coast region of South Africa for the period 1979-2011 is investigated. COLs are objectively identified and tracked on daily average 500 h...

  7. Observations on the Populations of Plankton and Microorganisms in an old Branch cut off from the River Waal

    NARCIS (Netherlands)

    Leentvaar, P.

    1957-01-01

    An inventarisation of the plankton living in an old branch cut off from the river Waal has been made on August 16, 19 and 23, 1955. In the deep part lake plankton (Limnoplankton) was found, and in the shallow parts pond plankton (Heleoplankton) occurs. Some rare plankters typical for oligotrophic

  8. Cut-off levels and diagnostic accuracy of infliximab trough levels and anti-infliximab antibodies in Crohn's disease

    DEFF Research Database (Denmark)

    Steenholdt, Casper; Bendtzen, Klaus; Brynskov, Jørn

    2011-01-01

    Reasons for infliximab failure in Crohn's disease and ulcerative colitis are debated. Serum levels of infliximab and anti-infliximab antibodies have been associated with loss of response. We aimed at determining cut-off levels for infliximab and anti-infliximab antibody concentrations associated...

  9. The Potential of Established Fitness Cut-off Points for Monitoring Women with Fibromyalgia : The al-Ándalus Project

    NARCIS (Netherlands)

    Castro-Piñero, José; Aparicio, Virginia A; Estévez-López, Fernando|info:eu-repo/dai/nl/412501031; Álvarez-Gallardo, Inmaculada C; Borges-Cosic, Milkana; Soriano-Maldonado, Alberto; Delgado-Fernández, Manuel; Segura-Jiménez, Víctor

    2017-01-01

    The aim of the present study was to determinate whether fitness cut-off points discriminate the severity of major fibromyalgia symptoms and health-related quality of life. Additionally, we investigated which American Colleague of Rheumatology (ACR) fibromyalgia criteria (1990 vs. modified 2010)

  10. Optimum binary cut-off threshold of a diagnostic test: comparison of different methods using Monte Carlo technique.

    Science.gov (United States)

    Reibnegger, Gilbert; Schrabmair, Walter

    2014-11-25

    Using Monte Carlo simulations, we compare different methods (maximizing Youden index, maximizing mutual information, and logistic regression) for their ability to determine optimum binary cut-off thresholds for a ratio-scaled diagnostic test variable. Special attention is given to the stability and precision of the results in dependence on the distributional characteristics as well as the pre-test probabilities of the diagnostic categories in the test population. Fictitious data sets of a ratio-scaled diagnostic test with different distributional characteristics are generated for 50, 100 and 200 fictitious "individuals" with systematic variation of pre-test probabilities of two diagnostic categories. For each data set, optimum binary cut-off limits are determined employing different methods. Based on these optimum cut-off thresholds, sensitivities and specificities are calculated for the respective data sets. Mean values and SD of these variables are computed for 1000 repetitions each. Optimizations of cut-off limits using Youden index and logistic regression-derived likelihood ratio functions with correct adaption for pre-test probabilities both yield reasonably stable results, being nearly independent from pre-test probabilities actually used. Maximizing mutual information yields cut-off levels decreasing with increasing pre-test probability of disease. The most precise results (in terms of the smallest SD) are usually seen for the likelihood ratio method. With this parametric method, however, cut-off values show a significant positive bias and, hence, specificities are usually slightly higher, and sensitivities are consequently slightly lower than with the two non-parametric methods. In terms of stability and bias, Youden index is best suited for determining optimal cut-off limits of a diagnostic variable. The results of Youden method and likelihood ratio method are surprisingly insensitive against distributional differences as well as pre-test probabilities of

  11. Solute removal capacity of high cut-off membrane plasma separators.

    Science.gov (United States)

    Ohkubo, Atsushi; Kurashima, Naoki; Nakamura, Ayako; Miyamoto, Satoko; Iimori, Soichiro; Rai, Tatemitsu

    2013-10-01

    In vitro blood filtration was performed by a closed circuit using high cut-off membrane plasma separators, EVACURE EC-2A10 (EC-2A) and EVACURE EC-4A10 (EC-4A). Samples were obtained from sampling sites before the plasma separator, after each plasma separator, and from the ultrafiltrate of each separator. The sieving coefficient (S.C.) of total protein (TP), albumin (Alb), IgG, interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), fibrinogen (Fib), antithrombin III (AT-III), and coagulation factor XIII (FXIII) were calculated. The S.C. of each solute using EC-2A and EC-A4 were as follows; TP: 0.25 and 0.56, Alb: 0.32 and 0.73, IgG: 0.16 and 0.50, IL-6:0.73 and 0.95, IL-8:0.85 and 0.82, TNF-α: 1.07 and 0.99, Fib: 0 and 0, FXIII: 0.07 and 0.17, respectively. When compared with the conventional type of membrane plasma separators, EVACURE could efficiently remove cytokines while retaining coagulation factors such as fibrinogen. Moreover, EC-2A prevented protein loss, whereas EC-4A could remove approximately 50% of IgG. © 2013 The Authors. Therapeutic Apheresis and Dialysis © 2013 International Society for Apheresis.

  12. Detection of cut-off point for rapid automized naming test in good readers and dyslexics

    Directory of Open Access Journals (Sweden)

    Zahra Soleymani

    2014-01-01

    Full Text Available Background and Aim: Rapid automized naming test is an appropriate tool to diagnose learning disability even before teaching reading. This study aimed to detect the cut-off point of this test for good readers and dyslexics.Methods: The test has 4 parts including: objects, colors, numbers and letters. 5 items are repeated on cards randomly for 10 times. Children were asked to name items rapidly. We studied 18 dyslexic students and 18 age-matched good readers between 7 and 8 years of age at second and third grades of elementary school; they were recruited by non-randomize sampling into 2 groups: children with developmental dyslexia from learning disabilities centers with mean age of 100 months, and normal children with mean age of 107 months from general schools in Tehran. Good readers selected from the same class of dyslexics.Results: The area under the receiver operating characteristic curve was 0.849 for letter naming, 0.892 for color naming, 0.971 for number naming, 0.887 for picture naming, and 0.965 totally. The overall sensitivity and specificity was 1 and was 0.79, respectively. The highest sensitivity and specificity were related to number naming (1 and 0.90, respectively.Conclusion: Findings showed that the rapid automized naming test could diagnose good readers from dyslexics appropriately.

  13. Impact of static pressure on transmembrane fluid exchange in high molecular weight cut off microdialysis.

    Science.gov (United States)

    Chu, Jiangtao; Hjort, Klas; Larsson, Anders; Dahlin, Andreas P

    2014-04-01

    With the interest of studying larger biomolecules by microdialysis (MD), this sampling technique has reached into the ultrafiltration region of fluid exchange, where fluid recovery (FR) has a strong dependence on pressure. Hence in this study, we focus on the fluid exchange across the high molecular weight cut off MD membrane under the influence of the static pressure in the sampling environment. A theoretical model is presented for MD with such membranes, where FR has a linear dependence upon the static pressure of the sample. Transmembrane (TM) osmotic pressure difference and MD perfusion rate decide how fast FR increases with increased static pressure. A test chamber for in vitro MD under static pressure was constructed and validated. It can hold four MD probes under controlled pressurized conditions. Comparison showed good agreement between experiment and theory. Moreover, test results showed that the fluid recovery of the test chamber MD can be set accurately via the chamber pressure, which is controlled by sample injection into the chamber at precise rate. This in vitro system is designed for modelling in vivo MD in cerebrospinal fluid and studies with biological samples in this system may be good models for in vivo MD.

  14. Attributes of cut-off low induced rainfall over the Eastern Cape Province of South Africa

    Science.gov (United States)

    Molekwa, S.; Engelbrecht, C. J.; Rautenbach, C. J. deW

    2014-10-01

    Cut-off low (COL) weather systems that are associated with rainfall over the Eastern Cape are considered in this study. COLs are objectively identified and tracked over a 31-year period. Daily rainfall data of 22 evenly distributed stations over the Eastern Cape are utilized. Only COLs with a minimum spatial distribution, defined as more than a third of the rainfall stations that need to report rainfall on at least 1 day of a COL event, are considered for analysis of rainfall attributes. These attributes include the occurrence of COL rain days of different magnitudes, the distribution of the depth and temperature of the COL centres for the rain days of different magnitudes, the associated spatial distribution of rainfall as well as the associated atmospheric circulation. The frequency of COLs over the Eastern Cape has a winter maximum and a summer minimum. COL rain days of small, medium and large magnitudes occur most frequently during the winter, while small- and medium-magnitude COL rain days experience peaks in autumn and spring, respectively. The low-level flow, and in particular the position of the low/trough, seems to be the determinant factor in the occurrence, magnitude and spatial extent of COL-induced rainfall.

  15. Transport into the troposphere in a tropopause fold/cut-off low system

    Science.gov (United States)

    Vaughan, G.; Price, J. D.; Howells, A.

    1994-01-01

    A tropopause fold developed on the western flank of a trough in the 300 mb flow on 6 Oct. 1990. Radiosonde ascents over western Europe showed very dry stable layers beneath the jet stream in the potential temperature range 310 to 315 K. These were evident on profiles from 12h on 6 Oct. to 00h on 8 Oct. ECMWF model assimilations were examined for this period to determine how well the model represented the radiosonde observations. Humidity fields were found to give better agreement than potential vorticity, probably because the PV is affected by the limited vertical resolution of the model. Isentropic trajectories were calculated for the air in the fold as represented by the ECMWF assimilation at 00h on 7 Oct. Those on the western edge of the fold split from the main flow and transferred to the troposphere, while those on the eastern side ended up in the cut-off low. A lower bound of 1.1 x 10(exp 14) kg is estimated for the amount of stratospheric air transferred into the troposphere by this fold.

  16. Establishing Streptomycin Epidemiological Cut-Off Values for Salmonella and Escherichia coli

    DEFF Research Database (Denmark)

    Migura, Lourdes Garcia; Sunde, Marianne; Karlsmose, Susanne

    2011-01-01

    This study was conducted to elucidate the accuracy of the current streptomycin epidemiological cut-off value (ECOFF) for Escherichia coli and Salmonella spp. A total of 236 Salmonella enterica and 208 E. coli isolates exhibiting MICs between 4 and 32 mg/L were selected from 12 countries. Isolates.......5% of the strains as belonging to the WT population, since this proportion of strains harbored resistance genes and exhibited MICs ≤32 mg/L. Out of 208 E. coli strains, 80 (38.5%) tested positive for aadA (n = 69), strA (n = 18), and strB (n = 31). Of the E. coli isolates exhibiting MICs of 4 mg/L, 8 mg/L, 16 mg....../L, and 32 mg/L, 3.6%, 17.6%, 53%, and 82.3%, respectively, harbored any of the three genes. Based on the European Committee on Antimicrobial Susceptibility Testing guidelines (ECOFF ≤16 mg/L), 25% of the E. coli strains presenting MIC ≤16 mg/L would have been incorrectly categorized as belonging to the WT...

  17. The Portuguese version of the Outcome Questionnaire (OQ-45): Normative data, reliability, and clinical significance cut-offs scores.

    Science.gov (United States)

    Machado, Paulo P P; Fassnacht, Daniel B

    2015-12-01

    The Outcome Questionnaire (OQ-45) is one of the most extensively used standardized self-report instruments to monitor psychotherapy outcomes. The questionnaire is designed specifically for the assessment of change during psychotherapy treatments. Therefore, it is crucial to provide norms and clinical cut-off values for clinicians and researchers. The current study aims at providing study provides norms, reliability indices, and clinical cut-off values for the Portuguese version of the scale. Data from two large non-clinical samples (high school/university, N = 1,669; community, N = 879) and one clinical sample (n = 201) were used to investigate psychometric properties and derive normative data for all OQ-45 subscales and the total score. Significant and substantial differences were found for all subscales between the clinical and non-clinical sample. The Portuguese version also showed adequate reliabilities (internal consistency, test-retest), which were comparable to the original version. To assess individual clinical change, clinical cut-off values and reliable change indices were calculated allowing clinicians and researchers to monitor and evaluate clients' individual change. The Portuguese version of the OQ-45 is a reliable instrument with comparable Portuguese norms and cut-off scores to those from the original version. This allows clinicians and researchers to use this instrument for evaluating change and outcome in psychotherapy. This study provides norms for non-clinical and clinical Portuguese samples and investigates the reliability (internal consistency and test-retest) of the OQ-45. Cut-off values and reliable change index are provided allowing clinicians to evaluate clinical change and clients' response to treatment, monitoring the quality of mental health care services. These can be used, in routine clinical practice, as benchmarks for treatment progress and to empirically base clinical decisions such as continuation of treatment or considering

  18. ELISA Cut-off Point for the Diagnosis of Human Brucellosis; a Comparison with Serum Agglutination Test

    Directory of Open Access Journals (Sweden)

    Anahita Sanaei Dashti

    2012-03-01

    Full Text Available Background: Brucellosis is a world-wide disease, which has a diverse clinical manifestation, and its diagnosis has to be proven by laboratory data. Serum agglutination test (SAT is the most-widely used test for diagnosing brucellosis. The enzyme linked immunosorbent assay (ELISA can also determine specific antibody classes against brucella. It is a sensitive, simple and rapid test, which could be an acceptable alternative to SAT with fewer limitations, however, like any other new test it should be further evaluated and standardized for various populations. This study was planned to determine an optimal cut-off point, for ELISA which would offer maximum sensitivity and specificity for the test when compared to SAT.Methods: Four hundred and seven patients with fever and other compatible symptoms of brucellosis were enrolled in the study. Serum agglutination test, 2-Mercaptoethanol test, and ELISA were performed on their sera. Results: The cut-off point of 53 IU/ml of ELISA-IgG yielded the maximal sensitivity and specificity comparing to the other levels of ELISA-IgG, and was considered the best cut off-point of ELISA-IgG to diagnose acute brucellosis. At this cut-off, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio were 84.09%, 85.38%, 62.20, 94.90, 5.75, 0.18, respectively.Conclusion: The best cut-off point of ELISA-IgG is 53 IU/ml, which yields the maximal sensitivity and specificity to diagnose acute brucellosis.

  19. Optimal waist circumference cut-off values for predicting cardiovascular risk factors in a multi-ethnic Malaysian population.

    Science.gov (United States)

    Cheong, Kee C; Ghazali, Sumarni M; Hock, Lim K; Yusoff, Ahmad F; Selvarajah, Sharmini; Haniff, Jamaiyah; Zainuddin, Ahmad Ali; Ying, Chan Y; Lin, Khor G; Rahman, Jamalludin A; Shahar, Suzana; Mustafa, Amal N

    2014-01-01

    Previous studies have proposed the lower waist circumference (WC) cutoffs be used for defining abdominal obesity in Asian populations. To determine the optimal cut-offs of waist circumference (WC) in predicting cardiovascular (CV) risk factors in the multi-ethnic Malaysian population. We analysed data from 32,703 respondents (14,980 men and 17,723 women) aged 18 years and above who participated in the Third National Health and Morbidity Survey in 2006. Gender-specific logistic regression analyses were used to examine associations between WC and three CV risk factors (diabetes mellitus, hypertension, and hypercholesterolemia). The Receiver Operating Characteristic (ROC) curves were used to determine the cut-off values of WC with optimum sensitivity and specificity for detecting these CV risk factors. The odds ratio for having diabetes mellitus, hypertension, and hypercholesterolemia, or at least one of these risks, increased significantly as the WC cut-off point increased. Optimal WC cut-off values for predicting the presence of diabetes mellitus, hypertension, hypercholesterolemia and at least one of the three CV risk factors varied from 81.4 to 85.5 cm for men and 79.8 to 80.7 cm for women. Our findings indicate that WC cut-offs of 81 cm for men and 80 cm for women are appropriate for defining abdominal obesity and for recommendation to undergo cardiovascular risk screening and weight management in the Malaysian adult population. © 2014 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.

  20. Detection of the high-energy cut-off from the Seyfert 1.5 galaxy NGC 5273

    Science.gov (United States)

    Pahari, Mayukh; McHardy, I. M.; Mallick, Labani; Dewangan, G. C.; Misra, R.

    2017-09-01

    We perform the NuSTAR and Swift/XRT joint energy spectral fitting of simultaneous observations from the broad-line Seyfert 1.5 galaxy NGC 5273. When fitted with the combination of an exponential cut-off power law and a reflection model, a high-energy cut-off is detected at 143^{+96}_{-40} keV with 2σ significance. Existence of such cut-off is also consistent with the observed Comptonizing electron temperature when fitted with a Comptonization model independently. We observe a moderate hard X-ray variability of the source over the time-scale of ∼12 yr using INTEGRAL/ISGRI observations in the energy range of 20-100 keV. When the hard-band count rate (6-20 keV) is plotted against the soft-band count rate (3-6 keV), a hard offset is observed. Our results indicate that the cut-off energy may not correlate with the coronal X-ray luminosity in a simple manner. Similarities in parameters that describe coronal properties indicate that the coronal structure of NGC 5273 may be similar to that of the broad-line radio galaxy 3C 390.3 and another galaxy MCG-5-23-16, where the coronal plasma is dominated by electrons, rather than electron-positron pairs. Therefore, the coronal cooling is equally efficient to the heating mechanism keeping the cut-off energy at low even at the low accretion rate.

  1. Extended characterization of a new class of membranes for blood purification: the high cut-off membranes.

    Science.gov (United States)

    Boschetti-de-Fierro, Adriana; Voigt, Manuel; Storr, Markus; Krause, Bernd

    2013-07-01

    High cut-off membranes are a new class of blood purification membranes whose particular characteristics present challenges for commonly-used characterization methods. Dextran sieving curves for representative blood purification membranes of the high-flux and high cut-off types were measured and compared to curves for the glomerular filtration barrier (GFB). The performance was also determined after blood exposure for the most permeable synthetic membranes. High cut-off membranes were observed to be more open than the GFB before blood exposure, but become tighter and more selective after the exposure, keeping the permeation for low and middle molecules while restraining the filtration of large species. Based on dextran sieving experiments for a variety of commercially available blood purification membranes, we present a novel method for classifying blood purification membranes. By using a well-established technique and introducing a new characteristic parameter for the sieving curve--the molecular weight retention onset (MWRO)--a graph of molecular weight cut-off versus molecular weight retention onset provides the landscape of dialysis membrane types. This meaningful representation is based on only one in vitro method, and allows the membrane classification by indirectly considering two structural parameters: pore size and pore size distribution. In this way, the families of low-flux, high-flux, protein leaking, and high cut-off membranes are clearly differentiated. The differentiation allows for the definition of MWCO/MWRO regions for the different types, so that further classification of newly developed membranes can be easily achieved.

  2. Serum D-dimer concentrations in nephrotic syndrome track with albuminuria, not estimated glomerular filtration rate.

    LENUS (Irish Health Repository)

    Sexton, D J

    2012-01-01

    The nephrotic syndrome is associated with an increased risk of venous and arterial thrombosis. There are little published data on the distribution, interpretation or determinants of serum D-dimer levels in patients with the nephrotic syndrome. We aimed to describe this relationship.

  3. Levels of plasma fibrinogen and D-dimer in subjects with subclinical hyperthyroidism.

    Science.gov (United States)

    Coban, Erkan; Aydemir, Mustafa

    2008-01-01

    During the last 15 years, several risk markers for atherosclerosis, such as fibrinogen and D-dimer, have been identified. The role of elevated fibrinogen levels as an independent risk factor for coronary, cerebral, and peripheral vascular disease is well established on the basis of clinical and epidemiological studies. Increased D-dimer levels are associated with increased risk of future myocardial infarction, stroke, and peripheral vascular disease. The aim of this study was to evaluate the alterations in fibrinogen and D-dimer, which indicates overall thrombotic activity, in subjects with subclinical hyperthyroidism. Thirty-six subclinical hyperthyroidic subjects and 36 euthyroidic control subjects matched for age, gender, and body mass index were selected. The levels of plasma fibrinogen and D-dimer in all subjects were measured. The level of fibrinogen was significantly higher in the subclinical hyperthyroidic group than in the euthyroidic group (296.9+/-74.3 mg/dl vs. 255.0+/-41.7 mg/dl, psubclinical hyperthyroidic group than in the euthyroidic group (261.9+/-47.8 mg/dl vs. 216.4+/-32.1 mg/dl, psubclinical hyperthyroidism present a relatively hypercoagulable state. This state could contribute to increased thromboembolic risk in subclinical hyperthyroidism.

  4. D-dimer test in cancer patients with suspected acute pulmonary embolism

    NARCIS (Netherlands)

    Di Nisio, M.; Sohne, M.; Kamphuisen, P. W.; Büller, H. R.

    2005-01-01

    Background: The safety of a D-dimer (DD) measurement in cancer patients with clinically suspected pulmonary embolism (PE) is unclear. Objectives: The aim of this study was to assess the accuracy of the DD test in consecutive patients with clinically suspected PE with and without cancer. Methods: The

  5. D-Dimer test in cancer patients with suspected acute pulmonary embolism.

    NARCIS (Netherlands)

    Nisio, M. Di; Sohne, M.; Kamphuisen, P.W.; Buller, H.R.

    2005-01-01

    BACKGROUND: The safety of a D-dimer (DD) measurement in cancer patients with clinically suspected pulmonary embolism (PE) is unclear. OBJECTIVES: The aim of this study was to assess the accuracy of the DD test in consecutive patients with clinically suspected PE with and without cancer. METHODS: The

  6. Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis*

    Science.gov (United States)

    Criado, Paulo Ricardo; Antinori, Lidi Che Leon; Maruta, Celina Wakisaka; dos Reis, Vitor Manoel Silva

    2013-01-01

    BACKGROUND It has been demonstrated that neutrophils, eosinophils and monocytes, under appropriated stimulus, may express tissue factor and therefore, activate the extrinsic pathway of coagulation. We performed a transversal and case-control study of patients with chronic urticaria and patients with psoriasis, in our outpatient clinic to evaluate the production of D-dimer. OBJECTIVE To evaluate D-dimer serum levels in patients with chronic urticaria and its possible correlation with disease activity. PATIENTS AND METHODS The study was conducted from October 2010 until March 2011. We selected 37 consecutive patients from our Allergy Unit and Psoriasis Unit, and divided them into three groups for statistical analysis: (i) 12 patients with active chronic urticaria (CU); (ii) 10 patients with chronic urticaria under remission and (iii) 15 patients with psoriasis (a disease with skin inflammatory infiltrate constituted by neutrophils, lymphocytes and monocytes). Another five patients with urticarial vasculitis were allocated in our study, but not included in statistical analysis. The serum levels of D-dimer were measured by Enzyme Linked Fluorescent Assay (ELFA), and the result units were given in ng/ml FEU. RESULTS Patients with active chronic urticaria had the highest serum levels of D-dimer (purticarial vasculitis. PMID:23793207

  7. Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis.

    Science.gov (United States)

    Criado, Paulo Ricardo; Antinori, Lidi Che Leon; Maruta, Celina Wakisaka; Reis, Vitor Manoel Silva dos

    2013-01-01

    It has been demonstrated that neutrophils, eosinophils and monocytes, under appropriated stimulus, may express tissue factor and therefore, activate the extrinsic pathway of coagulation. We performed a transversal and case-control study of patients with chronic urticaria and patients with psoriasis, in our outpatient clinic to evaluate the production of D-dimer. To evaluate D-dimer serum levels in patients with chronic urticaria and its possible correlation with disease activity. The study was conducted from October 2010 until March 2011. We selected 37 consecutive patients from our Allergy Unit and Psoriasis Unit, and divided them into three groups for statistical analysis: (i) 12 patients with active chronic urticaria (CU); (ii) 10 patients with chronic urticaria under remission and (iii) 15 patients with psoriasis (a disease with skin inflammatory infiltrate constituted by neutrophils, lymphocytes and monocytes). Another five patients with urticarial vasculitis were allocated in our study, but not included in statistical analysis. The serum levels of D-dimer were measured by Enzyme Linked Fluorescent Assay (ELFA), and the result units were given in ng/ml FEU. Patients with active chronic urticaria had the highest serum levels of D-dimer (purticarial vasculitis.

  8. The Objective Borderline Method (OBM): A Probability-Based Model for Setting up an Objective Pass/Fail Cut-Off Score in Medical Programme Assessments

    Science.gov (United States)

    Shulruf, Boaz; Turner, Rolf; Poole, Phillippa; Wilkinson, Tim

    2013-01-01

    The decision to pass or fail a medical student is a "high stakes" one. The aim of this study is to introduce and demonstrate the feasibility and practicality of a new objective standard-setting method for determining the pass/fail cut-off score from borderline grades. Three methods for setting up pass/fail cut-off scores were compared: the…

  9. Thirteen treated of acute renal failure secondary to multiple myeloma with high cut off filters.

    Science.gov (United States)

    Berni Wennekers, Ana; Martín Azara, María Pilar; Dourdil Sahun, Victoria; Bergasa Liberal, Beatriz; Ruiz Laiglesia, José Esteban; Vernet Perna, Patricia; Alvarez Lipe, Rafael

    2016-01-01

    Multiple myeloma (MM) is a haematological tumour that is characterised by uncontrolled proliferation of plasma cells and a significant volume of serum free light chains (sFLCs), which can cause acute renal failure due to intratubular precipitation, resulting in cast nephropathy. Acute renal failure is a complication that can arise in more than 20% of patients with multiple myeloma, half of which will require dialysis. We report our experience with 13 patients who were treated with dialysis using high cut off filters (HCO) between July 2011 and February 2015. A total of 6 consecutive 6-hour sessions were performed using a 2.1 m(2) HCO filter (Theralite® by Gambro®). Afterwards, further 6-hour sessions were continued on alternate days. A total of 151 sessions were conducted, with an average of 11.6 sessions per patient (range 6-27). The treatment proved to be effective in removing both kappa and lambda sFLCs, resulting in a 93.7% fall in sFLCs by the end of treatment. The average reduction was 57.7% per dialysis session. 10 out of the 13 cases recovered sufficient renal function to become independent of dialysis. There were no major changes in albumin levels using an infusion protocol of 2 50-mL vials of 20% albumin at the end of the dialysis session. Combination treatment with chemotherapy and long dialysis with HCO filters was effective in reducing the sFLC levels and recovering sufficient renal function in 77% of cases. With HCO filters, significant cost savings are achieved, contrary to what was previously believed. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  10. Scale-invariant neuronal avalanche dynamics and the cut-off in size distributions.

    Directory of Open Access Journals (Sweden)

    Shan Yu

    Full Text Available Identification of cortical dynamics strongly benefits from the simultaneous recording of as many neurons as possible. Yet current technologies provide only incomplete access to the mammalian cortex from which adequate conclusions about dynamics need to be derived. Here, we identify constraints introduced by sub-sampling with a limited number of electrodes, i.e. spatial 'windowing', for well-characterized critical dynamics-neuronal avalanches. The local field potential (LFP was recorded from premotor and prefrontal cortices in two awake macaque monkeys during rest using chronically implanted 96-microelectrode arrays. Negative deflections in the LFP (nLFP were identified on the full as well as compact sub-regions of the array quantified by the number of electrodes N (10-95, i.e., the window size. Spatiotemporal nLFP clusters organized as neuronal avalanches, i.e., the probability in cluster size, p(s, invariably followed a power law with exponent -1.5 up to N, beyond which p(s declined more steeply producing a 'cut-off' that varied with N and the LFP filter parameters. Clusters of size s≤N consisted mainly of nLFPs from unique, non-repeated cortical sites, emerged from local propagation between nearby sites, and carried spatial information about cluster organization. In contrast, clusters of size s>N were dominated by repeated site activations and carried little spatial information, reflecting greatly distorted sampling conditions. Our findings were confirmed in a neuron-electrode network model. Thus, avalanche analysis needs to be constrained to the size of the observation window to reveal the underlying scale-invariant organization produced by locally unfolding, predominantly feed-forward neuronal cascades.

  11. The ‘impact’ of force filtering cut-off frequency on the peak knee abduction moment during landing: artefact or ‘artifiction’?

    Science.gov (United States)

    Roewer, Benjamin D; Ford, Kevin R; Myer, Gregory D; Hewett, Timothy E

    2014-01-01

    Background Joint moments computed using inverse dynamic techniques are important estimators of net joint loads. Joints moments computed from marker position and ground reaction force data filtered using different cut-off frequencies may capture changes in moment magnitudes at a single joint that exceed normal physiological response. Peak external knee abduction moment (KAM) generated during landing (ie, the drop vertical jump, DVJ) predicts anterior cruciate ligament injury risk using marker and force data filtered at different cut-off frequencies. The purpose of the current investigation was to determine the effects of using the same low cut-off frequencies versus different cut-off frequencies on joint moment magnitudes to evaluate if artificial smoothing attenuates actual resultant joint loads related to injury risk. Methods Twenty-two female, high school volleyball players performed three maximum DVJs in a laboratory setting. The average peak KAM was computed for each knee using marker and force data filtered with the same low cut-off frequencies and different cut-off frequencies. Results Peak KAMs were significantly larger using different cut-off frequencies. The order of athletes ranked based on the magnitude of their peak KAMs did not significantly change across all filtering cut-off frequencies. Conclusions The magnitude of peak KAM may differ when the same low or different higher cut-off frequencies are used to filter marker and ground reaction forces (GRF) data collected using standard motion capture equipment. It is not clear to what extent the decrease in peak KAM reported when the same low cut-off frequencies were used was solely due to attenuation of the GRF signal. PMID:22893510

  12. [Screening for Anxiety in Cardiovascular Rehabilitation Patients: Concurrent Validity and Cut-off Values of the ACAT-cardio].

    Science.gov (United States)

    Müller, K; Baumeister, H; Abberger, B

    2016-08-01

    The computer adaptive test ACAT-cardio has been developed in order to screen cardiovascular rehabilitation patients for anxiety. This study aims at investigating the criterion validity, and identifying appropriate cut-off values for its use in cardiac rehabilitation. 106 cardiovascular rehabilitation patients were tested for anxiety disorders using the instruments ACAT-cardio and SKID-I. Receiver operating characteristics were employed to analyse the results of 3 stopping rules of the ACAT-cardio. ROC analyses for the stopping rules yielded areas under the curve (AUC) between 0.80 and 0.84. The ideal cut-off values of the ACAT-cardio (theta scores) were - 0.20 (sensitivity: 86%),-0.23 (sensitivity: 71%) and - 0.35 (sensitivity: 86%). The ACAT-cardio has proven to be a valid instrument that can be used for screening anxiety disorders in cardiac rehabilitation. © Georg Thieme Verlag KG Stuttgart · New York.

  13. Ordinary mode reflectometry. Modification of the scattering and cut-off responses due to the shape of localized density fluctuations

    Energy Technology Data Exchange (ETDEWEB)

    Fanack, C.; Boucher, I.; Heuraux, S.; Leclert, G. [Centre National de la Recherche Scientifique (CNRS), 54 - Nancy (France). Lab. de Physique du Solide; Clairet, F.; Zou, X.L. [Association Euratom-CEA, Centre d`Etudes de Cadarache, 13 - Saint-Paul-lez-Durance (France). Dept. de Recherches sur la Fusion Controlee

    1996-01-01

    Ordinary wave reflectometry in a plasma containing a localized density perturbation is studied with a 1-D model. The phase response is studied as a function of the wavenumber and position of the perturbation. It is shown that it strongly depends upon the perturbation shape and size. For a small perturbation wavenumber, the response is due to the oscillation of the cut-off layer. For larger wavenumbers, two regimes are found: for a broad perturbation, the phase response is an image of the perturbation itself; for a narrow perturbation, it is rather an image of the Fourier transform. For tokamak plasmas it turns out that, for the fluctuation spectra usually observed, the phase response comes primarily from those fluctuations that are localized at the cut-off. Results of a 2-D numerical model show that geometry effects are negligible for the scattering by radial fluctuations. (author). 18 refs.

  14. Optimal cut-off value of perfusion parameters for diagnosing prostate cancer and for assessing aggressiveness associated with Gleason score.

    Science.gov (United States)

    Cho, Eunkyung; Chung, Dong Jin; Yeo, Dong Myung; Sohn, Dongwan; Son, Yohan; Kim, Taejung; Hahn, Sung-Tae

    2015-01-01

    To determine cut-off value of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) parameters for differentiation of prostate malignant from benign and cancer with high-grade Gleason score (GS) (GS>7) from low-grade GS (GS≤7), 35 patients (24 malignant and 11 benign) who underwent DCE-MRI were included. Difference between malignant and benign was statistically significant for all magnetic resonance parameters except Ve. The cut-off values were K(trans)=0.184min(-1), Kep=0.695min(-1), iAUC=4.219mmol/l/min, and ADC=1340.5mm(2)/s. A significant difference in mean values of K(trans) and Kep between cancer with high-grade GS and low-grade GS was also observed. K(trans) and Kep showed a significant correlation with GS. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. The effect of pair cascades on the high-energy spectral cut-off in gamma-ray bursts

    Science.gov (United States)

    Gill, Ramandeep; Granot, Jonathan

    2018-03-01

    The highly luminous and variable prompt emission in gamma-ray bursts (GRBs) arises in an ultra-relativistic outflow. The exact underlying radiative mechanism shaping its non-thermal spectrum is still uncertain, making it hard to determine the outflow's bulk Lorentz factor Γ. GRBs with spectral cut-off due to pair production (γγ → e+e-) at energies Ec ≳ 10 MeV are extremely useful for inferring Γ. We find that when the emission region has a high enough compactness, then as it becomes optically thick to scattering, Compton downscattering by non-relativistic e±-pairs can shift the spectral cut-off energy well below the self-annihilation threshold, Esa = Γmec2/(1 + z). We treat this effect numerically and show that Γ obtained assuming Ec = Esa can underpredict its true value by as much as an order of magnitude.

  16. Seismic analysis of the frame structure reformed by cutting off column and jacking based on stiffness ratio

    Science.gov (United States)

    Zhao, J. K.; Xu, X. S.

    2017-11-01

    The cutting off column and jacking technology is a method for increasing story height, which has been widely used and paid much attention in engineering. The stiffness will be changed after the process of cutting off column and jacking, which directly affects the overall seismic performance. It is usually necessary to take seismic strengthening measures to enhance the stiffness. A five story frame structure jacking project in Jinan High-tech Zone was taken as an example, and three finite element models were established which contains the frame model before lifting, after lifting and after strengthening. Based on the stiffness, the dynamic time-history analysis was carried out to research its seismic performance under the EL-Centro seismic wave, the Taft seismic wave and the Tianjin artificial seismic wave. The research can provide some guidance for the design and construction of the entire jack lifting structure.

  17. Adiposity cut-off points for cardiovascular disease and diabetes risk in the Portuguese population: The PORMETS study

    Science.gov (United States)

    Severo, Milton; Santos, Ana Cristina

    2018-01-01

    Objectives The contribution of adiposity to cardiovascular and diabetes risk justifies the inclusion of an adiposity measure, usually waist circumference, in the definition of metabolic syndrome. However, waist circumference thresholds differ across populations. Our aim was to assess which adiposity measure performs the best in identifying the metabolic syndrome in a sample of Portuguese participants and to estimate cut-off values for these measures. Methods Data were obtained from a cross-sectional study (PORMETS study) conducted in Portugal between 2007 and 2009. A representative sample of non-institutionalized adults, comprising 3,956 participants, aged 18 years and older, was evaluated. A structured questionnaire was administered, collecting information on personal medical history, socio-demographics and behavioral characteristics. Anthropometrics, blood pressure and venous blood samples were also obtained. Metabolic syndrome was defined according to the Joint Interim Statement of the International Diabetes Federation Task Force on Epidemiology recommended criteria. Elevated cardiometabolic risk was considered when two or more of the four criteria of metabolic syndrome were present, excluding the waist circumference component. A receiver operating characteristic curve was used to estimate cut-off points. Results This study found that waist-to-height ratio, waist circumference and body adiposity index performed better than other adiposity measures, such as body mass index. The estimated cut-off points for waist-to-height ratio, waist circumference and body adiposity index in women and men were 0.564 / 89 cm / 27.4 and 0.571 / 93.5 cm / 25.5, respectively. Conclusion As waist circumference is currently used as the adiposity measure in the definition of metabolic syndrome and as no relevant differences were observed between this measure and waist-to-height ratio, it is likely that no modification to the metabolic syndrome definition needs to be proposed. Moreover

  18. Fourier phase analysis on equilibrium gated radionuclide ventriculography: Range of phase spread and cut-off limits in normal individuals.

    Science.gov (United States)

    Ramaiah, Vijayaraghavan L; Harish, B; Sunil, Hv; Selvakumar, Job; Ravi, Kishore Ag; Nair, Gopinathan

    2011-07-01

    To define the range of phase spread on equilibrium gated radionuclide ventriculography (ERNV) in normal individuals and derive the cut-off limit for the parameters to detect cardiac dyssynchrony. ERNV was carried out in 30 individuals (age 53±23 years, 25 males and 5 females) who had no history of cardiovascular disease. They all had normal left ventricular ejection fraction (LVEF 55-70%) as determined by echocardiography, were in sinus rhythm, with normal QRS duration (≤120 msec) and normal coronary angiography. First harmonic phase analysis was performed on scintigraphic data acquired in best septal view. Left and right ventricular standard deviation (LVSD and RVSD, respectively) and interventricular mechanical delay (IVMD), the absolute difference of mean phase angles of right and left ventricle, were computed and expressed in milliseconds. Mean + 3 standard deviation (SD) was used to derive the cut-off limits. Average LVEF and duration of cardiac cycle in the study group were 62.5%±5.44% and 868.9±114.5 msec, respectively. The observations of LVSD, RVSD and right and left ventricular mean phase angles were shown to be normally distributed by Shapiro-Wilk test. Cut-off limits for LVSD, RVSD and IVMD were calculated to be 80 msec, 85 msec and 75 msec, respectively. Fourier phase analysis on ERNV is an effective tool for the evaluation of synchronicity of cardiac contraction. The cut-off limits of parameters of dyssynchrony can be used to separate heart failure patients with cardiac dyssynchrony from those without. ERNV can be used to select patients for cardiac resynchronization therapy.

  19. Sinus cut-off sign: A helpful sign in the CT diagnosis of diaphragmatic rupture associated with pleural effusion

    Energy Technology Data Exchange (ETDEWEB)

    Kaya, Seyda Ors [Pamukkale University Medical School, Department of Thoracic Surgery, Denizli (Turkey)]. E-mail: skaya@pamukkale.edu.tr; Karabulut, Nevzat [Pamukkale University Medical School, Department of Radiology, Denizli (Turkey); Yuncu, Gokhan [Pamukkale University Medical School, Department of Thoracic Surgery, Denizli (Turkey); Sevinc, Serpil [Pamukkale University Medical School, Department of Thoracic Surgery, Denizli (Turkey); Kiroglu, Yilmaz [Pamukkale University Medical School, Department of Radiology, Denizli (Turkey)

    2006-08-15

    The objective of our study was to describe the 'sinus cut-off' sign at CT in the diagnosis of diaphragmatic rupture in patients with blunt abdominal trauma complicated with pleural effusion, and evaluate its utility in an experimental model. Between January 2004 and March 2005, we observed an unusual interruption of costophrenic sinus at CT in three patients with blunt abdominal trauma accompanied with pleural effusion. This observation prompted us to evaluate the utility of this sign in an experimental model. Laparotomically, we created 2 cm diapragmatic lacerations at each hemidiaphragm in two rabbits and pushed up the abdominal viscera with omentum through the defect. To simulate hemothorax, we also injected 5-10 mL of diluted contrast material into the pleural space. Using a dual-slice helical CT scanner, limited thoracoabdominal CT examination was performed before and after injection of intrapleural contrast material. The images were analyzed for the presence of CT signs for diaphragmatic injury. The left posterior costophrenic sulcus was interrupted in all of the three patients with left pleural effusion. While it was associated with other findings of diaphragmatic injury, the 'sinus cut-off sign' was the sole finding in one patient. The sinus cut-off sign was observed on the CT scans of 100% of the rabbits with a left and right sided diaphragmatic rupture. The 'sinus cut-off sign' is useful and can increase the CT detection of acute diaphragmatic injury associated with pleural effusion.

  20. Appraisal and standardization of curvilinear velocity (VCL) cut-off values for CASA analysis of Japanese quail (Coturnix japonica) sperm.

    Science.gov (United States)

    Farooq, U; Malecki, I A; Mahmood, M; Martin, G B

    2017-06-01

    One of the basic steps in objective analysis of sperm motility is the subdivision of a motile sperm population into slow, medium and rapid categories based on their velocity. However, for CASA analysis of quail sperm, the velocity values for categorization of slow, medium and rapid sperm have not yet been standardized. To identify the cut-off values of "velocity curvilinear" (VCL) for quail sperm categorization, we captured and analysed 22,300 tracks of quail sperm using SCA® -CASA. The median and mean VCL values were 85 and 97 μm/s. To define the VCL cut-off values, we used two methods. In the first, we identified the upper (rapid sperm) and lower (slow sperm) cut-off values using: (i) median VCL ± 25% or ± 50% or ± 75% of median VCL value; (ii) first and third quartile values of VCL data (i.e. 25% cut-off setting); and (iii) 33% and 66% of VCL data. Among these settings, sperm categories and their corresponding motility characteristics recorded using the "25%" setting (i.e. slow ≤36 ≤ medium ≤154 ≤ rapid) were found the most realistic and coherent with male ranking by fertility. In the second method, we calculated heteroscedasticity in the total VCL data using PCA and the two-step clustering method. With this approach, the mean of the high and low clusters was 165 and 51 μm/s, respectively. Together, the mean from two methods suggested that, for SCA® -CASA categorization of quail sperm, sperm should be classed as "rapid" at VCL ≥160 μm/s and "slow" at VCL ≤45 μm/s. © 2017 Blackwell Verlag GmbH.

  1. Successful use of combined high cut-off haemodialysis and bortezomib for acute kidney injury associated with myeloma cast nephropathy.

    LENUS (Irish Health Repository)

    Ward, F

    2012-05-01

    We present the case of a 58-year old female with de novo dialysis-dependent acute kidney injury (AKI) secondary to myeloma cast nephropathy. The patient underwent extended high cut-off haemodialysis (HCO-HD), in conjunction with bortezomib-based chemotherapy, and soon became dialysis independent with normal renal function. To our knowledge, this is the first time this treatment strategy has been employed successfully in an Irish centre.

  2. Remote effects of tropical storm Cristobal upon a cut-off cyclone over Europe in August 2002

    Science.gov (United States)

    Enomoto, T.; Ohfuchi, W.; Nakamura, H.; Shapiro, M. A.

    2007-04-01

    In August 2002, many parts of central Europe were affected by heavy precipitation and flooding caused by a cut-off cyclone. This study shows that this cyclone developed as a result of the propagation of a Rossby wave packet. The wave-packet propagation along the relatively weak subtropical jet was accompanied by wave-breaking and re-emission in the subtropics. In particular, there was an interaction between the Rossby wave packet and a precipitation band along the east coast of North America associated with tropical storm Cristobal. This interaction had a significant influence upon the formation of the European cut-off low. Results from numerical simulations from two different initial conditions are investigated to study this interaction. Downstream influences from tropical storm Cristobal upon the development of this cyclone and associated flooding precipitation are confirmed by sensitivity analysis using ensemble forecasts. It is concluded from analysis and simulations that poor forecast skills of tropical storm Cristobal affected the predictability of the European cut-off low.

  3. Pharmacokinetics of lenalidomide during high cut-off dialysis in a patient with multiple myeloma and renal failure.

    Science.gov (United States)

    Dao, Kim; Lu, Yimin; Peer, Cody J; Figg, William D; Stadelmann, Raphael; Burnier, Michel; Buclin, Thierry; Kissling, Sebastien

    2017-01-01

    High cut-off dialysis, increasingly used in multiple myeloma patients, is susceptible to influence anticancer drug elimination. We report about lenalidomide disposition in a patient on high cut-off dialysis for renal failure secondary to myeloma cast nephropathy. The patient received a higher dosage of lenalidomide (5 mg b.i.d.), owing to concerns about a potential decrease in lenalidomide exposure during dialysis sessions. A set of blood samples was taken in order to develop a pharmacokinetic model accounting for lenalidomide concentrations in this setting. According to our model, the area under the curve was 3273 µg h/L, i.e., 60% higher than expected under usual dosage (25 mg q.d.) with normal renal function. Despite this, the patient did not develop major hematological toxicity. Lenalidomide doses of 5 mg b.i.d. led to high exposure in a patient with renal failure undergoing high cut-off dialysis. Yet, the dosage of 5 mg q.d. recommended in conventional dialysis would probably be adequate in such patients.

  4. A statistical model for intervertebral disc degeneration: determination of the optimal T2 cut-off values.

    Science.gov (United States)

    Nagy, S A; Juhasz, I; Komaromy, H; Pozsar, K; Zsigmond, I; Perlaki, G; Orsi, G; Schwarcz, A; Walter, N; Doczi, T; Bogner, P

    2014-12-01

    The aim of this study was to investigate the possibility of quantitative classification in intervertebral disc degeneration using spin-spin relaxation time (T2) cut-off values with regard to morphological classifications. Lumbar magnetic resonance (MR) imaging was performed on 21 subjects (a total of 104 lumbar disks). The T2 relaxation time was measured in the nucleus pulposus using a sagittal multi-echo spin-echo sequence. The morphological classification of disc degeneration was assessed independently by three experienced neuroradiologists according to the Pfirrmann and Schneiderman classifications. Receiver operating characteristic analysis was performed among grades to determine T2 cut-off values in each classification. Intra- and interobserver differences were calculated using kappa statistics. Moderate overall interobserver agreement was found between observers in both the Pfirrmann and Schneiderman classification schemes (kappa 0.46 and 0.51), while intraobserver reliability was substantial to almost perfect. The interobserver reliability was only fair in Pfirrmann grades III and IV (kappa 0.33 and 0.36), but the T2 cut-off values still indicated a significant difference between grades (pcut-off values seem to be a more reliable method to define the degree of disc degeneration, which may help staging intervertebral disc degeneration (IVDD) even if the interobserver reliability is low.

  5. Mean Hand Grip Strength and Cut-off Value for Sarcopenia in Korean Adults Using KNHANES VI.

    Science.gov (United States)

    Yoo, Jun Il; Choi, Hana; Ha, Yong Chan

    2017-05-01

    The purpose of this study was to report age- and gender-specific distribution of the hand grip strength (HGS) using data from the Korea National Health and Nutrition Examination Survey (KNHANES) VI-3 (2015) survey and determine cut-off values for low muscle strength of HGS of Koreans. Of a total of 7,380 participants, 4,553 were subjected to measurements of HGS, including 1,997 men and 2,556 women with a mean age of 49.3 years (range, 19-80 years). The mean ages of men and women were 49.0 and 49.5 years, respectively. HGS was measured using a digital hand dynamometer. It was defined as maximal measured grip strength of the dominant hand. The cut-off value for low muscle strength was defined as the lower 20th percentile of HGS of the study population. Maximum grip strength of men was significantly higher than that of women (40.2 kg in men vs. 24.2 kg in women, P cut-off values of HGS in male and female elderly healthy populations were 28.6 and 16.4 kg, respectively. These data might be used as reference values when evaluating sarcopenia and assessing hand injuries. © 2017 The Korean Academy of Medical Sciences.

  6. Ozone transport during a cut-off low event studied in the frame of the TOASTE program

    Science.gov (United States)

    Ancellet, G.; Beekmann, M.; Papayannis, A.; Megie, G.

    1994-01-01

    A study of ozone transfer to the troposphere has been performed during two phases of the evolution of a cut-off low using both ozone vertical profiles and objective analysis of the ECMWF to compute potential vorticity distributions and air mass trajectories. Ozone profiles were measured by a ground based lidar system at the Observatoire de Haute Provence (OHP, 43 deg 55 N, 5 deg 42 E). A stratospheric ozone transport into the troposphere has been observed during a tropopause fold which occurred at the beginning of the cut-off low formation and during the erosion phase of the cut-off low. From the estimate of the maximum ozone content transferred to the troposphere, both mechanisms have the same order of magnitude of influence on the ozone flux to the troposphere. On a time scale of a few days, the correlation is very good between the potential vorticity and the ozone time evolution in the vicinity of the upper level frontal system.

  7. The Potential of Established Fitness Cut-off Points for Monitoring Women with Fibromyalgia: The al-Ándalus Project.

    Science.gov (United States)

    Castro-Piñero, José; Aparicio, Virginia A; Estévez-López, Fernando; Álvarez-Gallardo, Inmaculada C; Borges-Cosic, Milkana; Soriano-Maldonado, Alberto; Delgado-Fernández, Manuel; Segura-Jiménez, Víctor

    2017-05-01

    The aim of the present study was to determinate whether fitness cut-off points discriminate the severity of major fibromyalgia symptoms and health-related quality of life. Additionally, we investigated which American Colleague of Rheumatology (ACR) fibromyalgia criteria (1990 vs. modified 2010) better discriminate fibromyalgia symptomatology. A total of 488 women with fibromyalgia and 200 non-fibromyalgia (control) women participated. All participants underwent both the 1990 and the modified 2010 ACR preliminary criteria (hereinafter 1990c and m-2010c, respectively). We used fitness cut-off points (Senior Fitness Tests Battery plus handgrip strength test) to discriminate between presence and absence of fibromyalgia. Additionally, we employed several instruments to assess fibromyalgia symptoms. Fitness cut-off points discriminated between high and low levels of the main symptoms the disease in all age groups (P from fibromyalgia diagnosis and monitoring. Moreover, the effect size of the differences in symptoms between women with fibromyalgia and controls were overall larger using the m-2010c compared with the 1990c, except for the tender points count, reflecting better the polysymptomatic distress condition of fibromyalgia. © Georg Thieme Verlag KG Stuttgart · New York.

  8. The Prevalence of Metabolic Syndrome Using Three Different Diagnostic Criteria among Low Earning Nomadic Kazakhs in the Far Northwest of China: New Cut-Off Points of Waist Circumference to Diagnose MetS and Its Implications.

    Science.gov (United States)

    Guo, Heng; Liu, Jiaming; Zhang, Jingyu; Ma, Rulin; Ding, Yusong; Zhang, Mei; He, Jia; Xu, Shangzhi; Li, Shugang; Yan, Yizhong; Mu, Lati; Rui, Dongsheng; Niu, Qiang; Guo, Shuxia

    2016-01-01

    Although the epidemic of metabolic syndrome (MetS) has aroused wide public concern, most studies on MetS tend to examine urban and high income settings, and few studies cover nomadic areas and low earning populations. This research aims to investigate the prevalence of MetS and explore the cut-off point of waist circumference in a nomadic minority typical of low income populations in the remote northwest region of China. A cross-sectional study was performed in a representative sample of 3900 Kazakh adults aged 18-84 years from 2009-2010. Three widely used criteria (ATP III\\IDF\\JIS) were employed to estimate the prevalence of MetS in Kazakhs to compare them with other populations. Receiver operator characteristic (ROC) curve analysis was used to explore the optimal cut-off values of waist circumference. The age-adjusted prevalence of MetS was 13.8%, 20.9%, and 24.8% based on the ATP III, IDF, and JIS criteria, respectively. The prevalence of MetS was higher in women and increased with age. Except for reduced HDL-cholesterol, the risk of other components of MetS increased with waist circumference enlargement. The cut-off point of waist circumference in screening at least two other components of MetS was 88 cm in men (Sensitivity = 61.1%, Specificity = 62.1%, ROC Curve Distance = 0.54) and 83 cm in women (Sensitivity = 60.0%, Specificity = 59.6%, ROC Curve Distance = 0.57). The prevalence of MetS in Kazakhs is higher than the national level of China and falls in between the Euro-American and Asia levels, as their cut-off points of waist circumference differ from that recommended for Chinese. We suggest a cost-effective strategy to screen for MetS and prevent cardiovascular disease using new cut-off points of waist circumference in low earning nomadic Kazakhs.

  9. Impact of Elevated D-Dimer on Diagnosis of Acute Aortic Dissection With Isolated Neurological Symptoms in Ischemic Stroke.

    Science.gov (United States)

    Yoshimuta, Tsuyoshi; Yokoyama, Hiroyuki; Okajima, Toshiya; Tanaka, Hiroshi; Toyoda, Kazunori; Nagatsuka, Kazuyuki; Higashi, Masahiro; Hayashi, Kenshi; Kawashiri, Masa-aki; Yasuda, Satoshi; Yamagishi, Masakazu

    2015-01-01

    Plasma D-dimer is known to be a useful clinical marker of thrombogenic status, and D-dimer is used as a diagnostic marker for acute aortic dissection (AAD). Little is known, however, regarding the clinical value of D-dimer for diagnosis of asymptomatic AAD in patients with ischemic stroke. We investigated whether D-dimer could be used for early diagnosis of AAD with isolated neurological symptoms in ischemic stroke patients. We evaluated a total of 1,236 consecutive patients with symptomatic ischemic stroke without chest or back pain who underwent either head computed tomography or magnetic resonance imaging. D-dimer was measured within 24 h after onset. There were 9 patients with Stanford type A AAD and they had significantly higher D-dimer than the patients without AAD (mean, 46.47±54.48 μg/ml; range, 6.9-167.1 μg/ml vs. 2.33±3.58 μg/ml, 0.3-57.9 μg/ml, Psymptoms in ischemic stroke patients. Whole-body contrast-enhanced computed tomography should be performed in ischemic stroke patients who have high D-dimer.

  10. [Assessment of mesopic and contrast vision for driving licences: which cut-off values, which methods are appropriate?].

    Science.gov (United States)

    Wilhelm, H; Peters, T; Durst, W; Roelcke, S; Quast, R; Hütten, M; Wilhelm, B

    2013-11-01

    Hitherto recommendations and thresholds for contrast tests are available for mesopic but not for photopic methods. While mesopic tests are widespread in ophthalmology, in occupational medicine photopic contrast tests are often used. With regard to the attachment 6 of the German Fahrerlaubnisverordnung (FeV) which is relevant since July 2011 we tested the specificity and sensitivity as well as the test-retest reliability of available test devices and defined cut-off values. We examined patients with medium opacities, healthy volunteers and a sample of employees. Optovist EU, Binoptometer 4P and Pelli-Robson charts with standardised illumination were applied for contrast sensitivity testing. All these methods were compared to the Mesotest II as gold standard. We followed the recommendations of the German Qualitätssicherungs-Kommission der Deutschen Ophthalmologischen Gesellschaft (DOG) for contrast vision testing and definition of cut-off values. 64 patients with cataract (age 42-70 years, median 62 years), 50 pilots (age 40-69 years, median 53.5 years) and 109 employees of a transportation company (age 40-59 years, median 50 years) were included in the trial. All contrast sensitivity tests showed a good sensitivity and specificity (AUC 0.86 to 0.99). For Optovist EU and Binoptometer 4P a threshold of 15 % Weber contrast is recommended for examinations according to FeV. The test-retest reliability was high in all methods with highly significant Pearson correlation coefficients of 0.77 to 0.94 and a repeatability coefficient between 0.08 und 0.4. The standard distance of 1 m common for the Pelli-Robson chart cannot be recommended for FeV examinations, while the results at 3 m distance are comparable to those of the other contrast vision tests. The preliminary cut-off for the Pelli-Robson chart at 3 m distance is 1.65. Cut-off values for the lawful assessment of applicants are now available. Both Binoptometer 4P and Optovist EU proved to be appropriate and

  11. Sensitive label-free electron chemical capacitive transducer signal for D-dimer electroanalyses

    OpenAIRE

    Simone M. Marquesa; Adriano Santosa; Gonçalves, Luís M.; Sousa, João Carlos; Bueno, Paulo R.

    2015-01-01

    Supplementary data associated with this article can be found, in the online version, at: http://dx.doi.org/10.1016/j.electacta.2015.09.169. D-dimer, an important biomarker in emergency medicine, was determined by applying a label-free electrochemical capacitive approach with an antibody-based selective biosensor consisting of an electroactive self-assembled monolayer mounted on a commercially available gold electrode. Electrochemical measurements were performed by an impedance-derived appr...

  12. d-dimer testing as an adjunct to ultrasonography in patients with clinically suspected deep vein thrombosis: prospective cohort study

    Science.gov (United States)

    Bernardi, Enrico; Prandoni, Paolo; Lensing, Anthonie W A; Agnelli, Giancarlo; Guazzaloca, Giuliana; Scannapieco, Gianluigi; Piovella, Franco; Verlato, Fabio; Tomasi, Cristina; Moia, Marco; Scarano, Luigi; Girolami, Antonio

    1998-01-01

    Objective To investigate the efficacy of using a rapid plasma d-dimer test as an adjunct to compression ultrasound for diagnosing clinically suspected deep vein thrombosis. Design d-dimer concentrations were determined in all patients with a normal ultrasonogram at presentation. Repeat ultrasonography was performed 1 week later only in patients with abnormal d-dimer test results. Main outcome measure Patients with normal ultrasonograms were not treated with anticoagulants and were followed for 3 months for thromboembolic complications. Setting University research and affiliated centres. Subjects 946 patients with clinically suspected deep vein thrombosis. Results Ultrasonograms were abnormal at presentation in 260 (27.5%) patients. Of the remaining 686 patients tested for d-dimer, 88 (12.8%) had abnormal concentrations. During follow up venous thromboembolic complications occurred in one of the 598 patients who were not treated with anticoagulants and who had an initial normal ultrasonogram and d-dimer concentration, whereas thromboembolic complications occurred in two of the 83 untreated patients who had abnormal d-dimer concentrations but a normal repeat ultrasonogram. The cumulative incidence of venous thromboembolic complications during follow up was 0.4% (95% confidence interval 0% to 0.9%). The rapid plasma d-dimer test used as an adjunct to compression ultrasonography resulted in a reduction in the mean number of repeat ultrasound examinations and additional hospital visits from 0.7 to 0.1 per patient. Conclusions Testing for d-dimer as an adjunct to a normal baseline ultrasound examination decreased the number of subsequent ultrasound examinations considerably without any increased risk of venous thromboembolic complications in patients not receiving anticoagulants. The use of ultrasound and testing for d-dimer enabled treatment decisions to be made at the time of presentation in most patients. Key messagesPatients with clinically suspected deep vein

  13. The optimal cut-off value of the preoperative prognostic nutritional index for the survival differs according to the TNM stage in hepatocellular carcinoma.

    Science.gov (United States)

    Okamura, Yukiyasu; Sugiura, Teiichi; Ito, Takaaki; Yamamoto, Yusuke; Ashida, Ryo; Uesaka, Katsuhiko

    2017-08-01

    To establish the optimal cut-off value of the preoperative prognostic nutritional index (PNI) for prognosis according to the Tumor Node Metastasis (TNM) stage of hepatocellular carcinoma (HCC) after curative resection. This retrospective study reviewed the records of 375 patients. The optimal cut-off value of the PNI was established according to the TNM stage, and overall survival was compared between the low and high PNI groups. The optimal cut-off value of the PNI decreased with increasing TNM stage, with 52, 47, and 43 patients having stage I, II, and III HCC, respectively. A low preoperative PNI predicted a poorer overall survival than did a high PNI for stage I (P cut-off value for the PNI for prognosis differs among the TNM stages and that the preoperative PNI is a favorable prognostic factor for stage I HCC.

  14. Values of the Wells and revised Geneva scores combined with D-dimer in diagnosing elderly pulmonary embolism patients.

    Science.gov (United States)

    Guo, Dan-Jie; Zhao, Can; Zou, Ya-Dan; Huang, Xu-Hang; Hu, Jing-Min; Guo, Lin

    2015-04-20

    Pulmonary embolism (PE) can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC) of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. Ninety-six cases (28.6%) were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3%) were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746) and 0.655 (95% CI: 0.584-0.722), respectively (P = 0.389). The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

  15. Negative D-dimer testing excludes pulmonary embolism in non-high risk patients in the emergency department.

    Science.gov (United States)

    Harringa, John B; Bracken, Rebecca L; Nagle, Scott K; Schiebler, Mark L; Pulia, Michael S; Svenson, James E; Repplinger, Michael D

    2017-06-01

    The purpose of this study was to assess the ability of d-dimer testing to obviate the need for cross-sectional imaging for patients at "non-high risk" for pulmonary embolism (PE). This is a retrospective study of emergency department patients at an academic medical center who underwent cross-sectional imaging (MRA or CTA) to evaluate for PE from 2008 to 2013. The primary outcome was the NPV of d-dimer testing when used in conjunction with clinical decision instruments (CDIs = Wells', Revised Geneva, and Simplified Revised Geneva Scores). The reference standard for PE status included image test results and a 6-month chart review follow-up for venous thromboembolism as a proxy for false negative imaging. Secondary analyses included ROC curves for each CDI and calculation of PE prevalence in each risk stratum. Of 459 patients, 41 (8.9%) had PE. None of the 76 patients (16.6%) with negative d-dimer results had PE. Thus, d-dimer testing had 100% sensitivity and NPV, and there were no differences in CDI performance. Similarly, when evaluated independently of d-dimer results, no CDI outperformed the others (areas under the ROC curves ranged 0.53-0.55). There was a significantly higher PE prevalence in the high versus "non-high risk" groups when stratified by the Wells' Score (p = 0.03). Negative d-dimer testing excluded PE in our retrospective cohort. Each CDI had similar NPVs, whether analyzed in conjunction with or independently of d-dimer results. Our results confirm that PE can be safely excluded in patients with "non-high risk" CDI scores and a negative d-dimer.

  16. Suggested Cut-Off Values for Vitamin D as a Risk Marker for Total and Cardiac Death in Patients with Suspected Acute Coronary Syndrome

    OpenAIRE

    Naesgaard, Patrycja A.; Ricardo A. León de la Fuente; Nilsen, Stein Tore; Pönitz, Volker; Brügger-Andersen, Trygve; Grundt, Heidi; Staines, Harry; Nilsen, Dennis W.T.

    2016-01-01

    Background Several studies have demonstrated an association between low vitamin D levels and cardiovascular risk. Vitamin D cut-off levels are still under debate. Objectives To assess two cut-off levels, 40 and 70 nmol/L, respectively, for vitamin D measured as 25-hydroxyvitamin D in chest pain patients with suspected acute coronary syndrome. Methods We investigated 1853 patients from coastal-Norway and inland Northern-Argentina. A similar database was used for pooling of d...

  17. Cut-off low monitoring by the French VHF-ST-radar network during the ESTIME campaign

    Science.gov (United States)

    Caccia, J.-L.; Bertin, F.; Campistron, B.; Klaus, V.; Pointin, Y.; van Baelen, J.; Wilson, R.

    2000-05-01

    In order to investigate mesoscale strato-tropospheric exchanges, the field campaign `Echanges Stratosphère-Troposphère: Investigations à Moyenne Echelle' was conducted in France from late 1993 to mid 1995 and focused on cut-off low events. It involved the French research network of five VHF (Very High Frequency) ST (Strato-Tropospheric) radars deployed in southern France. Observations corresponding to three Intensive Observing Periods are reported here. The radar data analyzed and discussed are time-height diagrams of the aspect ratio (AR), that is, the vertical to oblique beam-returned power ratio, used for monitoring three cut-off low events. In order to discuss the validity of the method, 506 h of radar AR data were compared with time-height diagrams of the static stability and the humidity obtained from synoptic European Center for Medium-range Weather Forecasts model analyses. A dataset corresponding to 297 h of observations is analyzed and discussed here. It is concluded that the AR is a good tracer to document cut-off low events, including tropopause folding identification and the detection of tropospheric air masses of enhanced stability, in dry or weakly humid cases. On the other hand, although the effects of the specific humidity and its gradients on VHF radar echo power could not be extensively investigated, our results suggest that the same parameter cannot be used at mid- and lower-tropospheric levels when the effects of specific humidity significantly reinforce the moist static stability. It is important to take into account these insights in the context of future observing campaigns in which a network of VHF-ST-radars will be involved, and where their role will be to observe and to document the evolution of upper-level features or potential vorticity streamers, or more generally stratospheric-tropospheric exchanges.

  18. Accurate cut-offs for predicting endoscopic activity and mucosal healing in Crohn's disease with fecal calprotectin

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    Juan María Vázquez-Morón

    Full Text Available Background: Fecal biomarkers, especially fecal calprotectin, are useful for predicting endoscopic activity in Crohn's disease; however, the cut-off point remains unclear. The aim of this paper was to analyze whether faecal calprotectin and M2 pyruvate kinase are good tools for generating highly accurate scores for the prediction of the state of endoscopic activity and mucosal healing. Methods: The simple endoscopic score for Crohn's disease and the Crohn's disease activity index was calculated for 71 patients diagnosed with Crohn's. Fecal calprotectin and M2-PK were measured by the enzyme-linked immunosorbent assay test. Results: A fecal calprotectin cut-off concentration of ≥ 170 µg/g (sensitivity 77.6%, specificity 95.5% and likelihood ratio +17.06 predicts a high probability of endoscopic activity, and a fecal calprotectin cut-off of ≤ 71 µg/g (sensitivity 95.9%, specificity 52.3% and likelihood ratio -0.08 predicts a high probability of mucosal healing. Three clinical groups were identified according to the data obtained: endoscopic activity (calprotectin ≥ 170, mucosal healing (calprotectin ≤ 71 and uncertainty (71 > calprotectin < 170, with significant differences in endoscopic values (F = 26.407, p < 0.01. Clinical activity or remission modified the probabilities of presenting endoscopic activity (100% vs 89% or mucosal healing (75% vs 87% in the diagnostic scores generated. M2-PK was insufficiently accurate to determine scores. Conclusions: The highly accurate scores for fecal calprotectin provide a useful tool for interpreting the probabilities of presenting endoscopic activity or mucosal healing, and are valuable in the specific clinical context.

  19. Relationship between childhood obesity cut-offs and metabolic and vascular comorbidities: comparative analysis of three growth standards.

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    Martínez-Costa, C; Núñez, F; Montal, A; Brines, J

    2014-04-01

    To compare the association between metabolic and vascular comorbidities and the body mass (BMI)-for-age cut-off criteria from three growth standards [Centers for Disease Control and Prevention (CDC), 2000; World Health Organization (WHO), 2007; Spanish Reference Criteria (Carrascosa Lezcano et al., 2008)] that are used to define being overweight and obese in childhood. A prospective study was conducted in 137 children (aged 8-16 years). Based on BMI-for-age Z-scores according to WHO cut-offs, 59 participants were obese, 35 were overweight and 43 were normal-weight. All participating children were subsequently reclassified applying the CDC and Spanish Reference Criteria. Blood pressure (BP), biochemical variables and vascular parameters (stiffness and intima-media thickness) were analysed. According to WHO and CDC references, 48% and 43% of the children, respectively, were categorised as obese, whereas 16% were considered as obese using the Spanish Reference Criteria. Applying WHO criteria, obese children showed significantly higher levels of insulin, homeostasis model assessment index and most vascular parameters, as well as lower high-density lipoprotein (HDL)-cholesterol than overweight children. Moreover, overweight children showed higher BP, insulin and uric acid, and lower HDL-cholesterol than normal weight children. The CDC criteria yielded similar results, although with fewer differences between obese and overweight children. Applying Spanish criteria, the differences between obese and overweight children disappeared. WHO and CDC BMI-for-age references and cut-offs are useful for defining obesity and being overweight in children because they clearly identify metabolic and vascular comorbidities. The Spanish Reference Criteria underdiagnose obesity because overweight children show comorbidities typical of the obese. © 2013 The British Dietetic Association Ltd.

  20. Cut-off scores of a brief neuropsychological battery (NBACE for Spanish individual adults older than 44 years old.

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    Montserrat Alegret

    Full Text Available The neuropsychological battery used in Fundació ACE (NBACE is a relatively brief, and easy to administer, test battery that was designed to detect cognitive impairment in the adulthood. The NBACE includes measures of cognitive information processing speed, orientation, attention, verbal learning and memory, language, visuoperception, praxis and executive functions. The aim of the present study was to establish the cut-off scores for impairment for different levels of age and education that could be useful in the cognitive assessment of Spanish subjects who are at risk for cognitive impairment, especially dementia. Data from 1018 patients with a mild dementia syndrome, and 512 cognitively healthy subjects, older than 44 years, from the Memory Clinic of Fundació ACE (Barcelona, Spain were analyzed. In the whole sample, cut-off scores and sensitivity/specificity values were calculated for six conditions after combining 3 age ranges (44 to 64; 65 to 74; and older than 74 years old by 2 educational levels (until Elementary school; and more than Elementary school. Moreover, general cut-offs are reported for Catalan and Spanish speakers. The results showed that most of NBACE tests reached good sensitivity and specificity values, except for Ideomotor praxis, Repetition and Verbal Comprehension tests, which had a ceiling effect. Word List Learning from the Wechsler Memory Scale-III and Semantic Verbal Fluency were the most useful tests to discriminate between cognitively healthy and demented subjects. The NBACE has been shown to be a useful tool able to detect cognitive impairment, especially dementia, in older than 44 years Spanish persons.

  1. Gestational Age-specific Cut-off Values Are Needed for Diagnosis of Subclinical Hypothyroidism in Early Pregnancy.

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    Kim, Hye Sung; Kim, Byoung Jae; Oh, Sohee; Lee, Da Young; Hwang, Kyu Ri; Jeon, Hye Won; Lee, Seung Mi

    2015-09-01

    During the first trimester of pregnancy, thyroid-stimulating hormone (TSH) >2.5 mIU/L has been suggested as the universal criterion for subclinical hypothyroidism. However, TSH levels change continuously during pregnancy, even in the first trimester. Therefore the use of a fixed cut-off value for TSH may result in a different diagnosis rate of subclinical hypothyroidism according to gestational age. The objective of this study was to obtain the normal reference range of TSH during the first trimester in Korean gravida and to determine the diagnosis rate of subclinical hypothyroidism using the fixed cut-off value (TSH >2.5 mIU/L). The study population consisted of pregnant women who were measured for TSH during the first trimester of pregnancy (n=492) and nonpregnant women (n=984). Median concentration of TSH in pregnant women was lower than in non-pregnant women. There was a continuous decrease of median TSH concentration during the first trimester of pregnancy (median TSH concentration: 1.82 mIU/L for 3+0 to 6+6 weeks; 1.53 mIU/L for 7+0 to 7+6 weeks; and 1.05 mIU/L for 8+0 to 13+6 weeks). Using the fixed cut-off value of TSH >2.5 mIU/L, the diagnosis rate of subclinical hypothyroidism decreased significantly according to the gestational age (GA) at TSH (25% in 3+0 to 6+6 weeks, 13% in 7+0 to 7+6 weeks, and 9% for 8+0 to 13+6 weeks, Phypothyroidism.

  2. Normal Limits of Electrocardiogram and Cut-Off Values for Left Ventricular Hypertrophy in Young Adult Nigerians.

    Science.gov (United States)

    Ayoka, A O; Ogunlade, O; Akintomide, A O; Akomolafe, R O; Ajayi, O E

    2014-06-19

    This study assessed healthy young adults to determine the normal limits for electrocardiographic variables and cut-off values for left ventricular hypertrophy. It was a cross sectional descriptive study in which the participants were evaluated clinically by standard 12-lead resting electrocardiogram (ECG) at 25 mm/s during quiet respiration. The heart rate, P wave duration, axis and amplitude, PR and QT intervals, QRS duration, axis and amplitude and T wave axis were assessed. Three hundred and twenty four (324) volunteers comprising of 175 males and 149 females aged 20 to 30 years (mean, 23.01 ± 2.88 years) participated in the study. The normal limits for heart rate, P wave duration, amplitude and axis in lead II, QRS duration and axis, T wave axis, PR interval, QT interval and QTc respectively were; 61-93 beats per minute,0.08-0.12s,1.00-2.00 mm,22.00-79.000,78.00-106.00 ms,15.50-81.000, 24.25-69.000,0.12-0.19s, 0.32-0.40s and 0.36-0.44s. The cut-off values for Sokolow-Lyon, Cornell and Araoye criteria for assessment of left ventricular hypertrophy (LVH) were higher than those previously in use in medical practice. Gender difference exists in some cut-off values for LVH. This study defined the normal limits for electrocardiographic variables for young adult Nigerians. Racial factor should be taken into consideration in interpretation of ECG.

  3. Bronchodilator response cut-off points and FEV 0.75 reference values for spirometry in preschoolers

    Science.gov (United States)

    Burity, Edjane Figueiredo; Pereira, Carlos Alberto de Castro; Jones, Marcus Herbert; Sayão, Larissa Bouwman; de Andrade, Armèle Dornelas; de Britto, Murilo Carlos Amorim

    2016-01-01

    ABSTRACT Objective: To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. Methods: This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. Results: We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Conclusions: Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children. PMID:27812631

  4. Evaluation of the Diagnostic Accuracy of Serum D-Dimer Levels in Pregnant Women with Adnexal Torsion

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    Hasan Onur Topçu

    2015-01-01

    Full Text Available We aimed to evaluate the diagnostic accuracy of serum D-dimer levels in pregnant women with adnexal torsion (AT. The pregnant women with ovarian cysts who suffered from pelvic pain were divided into two groups; the first group consisted of the cases with surgically proven as AT (n = 17 and the second group consisted of the cases whose pain were resolved in the course of follow-up period without required surgery (n = 34. The clinical characteristics and serum D-dimer levels were compared between the groups. Patients with AT had a higher rate of elevated serum white blood cell (WBC count (57% vs. 16%, p = 0.04 and serum D-dimer levels (77% vs. 21%, p < 0.01 on admission in the study group than in the control group. Elevated D-dimer and cyst diameter larger than 5 cm yielded highest sensitivity (82% for each; whereas the presence of nausea and vomiting and elevated CRP had the highest specificity (85% and 88%, respectively. This is the first study that evaluates the serum D-dimer levels in humans in the diagnosis of AT, and our findings supported the use of D-dimer for the early diagnosis of AT in pregnant women.

  5. The effect of a weak nonlinearity on the lowest cut-off frequencies of a cylindrical shell

    Science.gov (United States)

    Andrianov, I. V.; Kaplunov, J.; Kudaibergenov, A. K.; Manevitch, L. I.

    2018-02-01

    The plane strain problem for a thin circular cylindrical shell is considered within the framework of the Sanders-Koiter theory. The relative shell thickness and displacement amplitude are chosen to be of the same asymptotic order. The leading nonlinear correction to the lowest cut-off frequencies is derived using the method of multiple scales. In contrast to the traditional two-mode Galerkin expansions assuming inextensibility of the shell transverse cross section, the developed fourth-order asymptotic scheme operates with five angular modes. The obtained results reveal asymptotic inconsistency of previous approximate solutions to the problem.

  6. Detecting outliers and/or leverage points: a robust two-stage procedure with bootstrap cut-off points

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    Ettore Marubini

    2014-01-01

    Full Text Available This paper presents a robust two-stage procedure for identification of outlying observations in regression analysis. The exploratory stage identifies leverage points and vertical outliers through a robust distance estimator based on Minimum Covariance Determinant (MCD. After deletion of these points, the confirmatory stage carries out an Ordinary Least Squares (OLS analysis on the remaining subset of data and investigates the effect of adding back in the previously deleted observations. Cut-off points pertinent to different diagnostics are generated by bootstrapping and the cases are definitely labelled as good-leverage, bad-leverage, vertical outliers and typical cases. The procedure is applied to four examples.

  7. Determination of the optimal cut-off point for ELISA test for diagnosis of brucellosis in Iran

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    Soudbakhsh A

    2009-09-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Finding a reliable diagnostic method for brucellosis is the most challengeable problem. In this study we determined the optimal diagnostic cut-off point for ELISA test."n"nMethods: We gathered 56 confirmed cases of brucellosis. Furthermore blood samples from 126 controls including 73 healthy controls and 53 without brucellosis febrile patients were collected. In all of the cases and controls ELISA Ig G and ELISA Ig M levels were measured and compared with each other by Box plot graph and the Receiver Operating Characteristic (ROC curve. The sensitivity and specificity of ELISA Ig G and Ig M were fixed in different cut-off values and Ig G and Ig M levels yielding maximal sensitivity plus specificity were selected for determination of optimal cut-off point."n"nResults: The nineteen patients had positive blood cultures for Brucella melitensis. The standard agglutination test results were 1/160 or more in 54 patients. The Box plot graph indicated a high degree of dispersion for Ig G and Ig M data in patients with brucellosis compared with febrile patients without brucellosis and healthy controls. We observed partial overlap for Ig M data (not for Ig G between cases and controls. The area under ROC curve for

  8. Exploration of the optimal diameter cut-off value in patients with nonfunctional adrenal tumor suitable for surgery

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    Dan-dan LIU

    2016-12-01

    Full Text Available Objective  To analyze the pathology of the patients with nonfunctional adrenal tumor (NFA, and explore the optimal diameter cut-off value. Methods  The clinical data of 243 patients with NFA, evaluated in the Department of Endocrinology and operated in the Department of Urology of General Hospital of Chinese PLA from Feb. 1996 to Jan. 2016, were collected. The patients were divided into two groups according to pathology: those in real demand of surgery were classified to the surgery-need group (n=57, while the others were categorized as the surgery-unwanted group (n=186. The general situation, pathological type and tumor diameter of the two groups and the factors affecting the surgery were analyzed, and the ROC curve was used to explore the optimal surgery cut-off value, which represents the maximum value of the sum of sensitivity and specificity. Results  Of the 57 patients in surgery-need group (27 males and 30 females, the lesions were on the right in 31 cases, on the left in 25 cases, and on bilateral sides in 1 case; the median of lesion diameter was 4.5cm, and the average age was 41.5±12.1 years old. Of the 186 patients in surgery-unwanted group (87 males and 99 females, the lesions were on the right in 99 cases, on the left in 86 cases, and on bilateral sides in 1 case; the median of lesion diameter was 3.0cm, and the average age was 50.6±10.9 years old. Logistic regression revealed that lesion diameter might be a risk factor (OR=1.340, 95%CI 1.266-1.418, P=0.000 and age be a protective factor (OR=0.942, 95%CI 0.929-0.955, P=0.000 for real demand of surgery. The area under the ROC curve (AUC of lesion diameter was 0.757(95%CI 0.681-0.833. The optimal cut-off value was 4.1cm (sensitivity 60.7% and specificity 83.0%. Conclusions  Younger patients with bigger lesion diameter may have greater possibility for surgery. The optimal surgery cut-off value of the lesion diameter is 4.1cm. DOI: 10.11855/j.issn.0577-7402.2016.11.11

  9. Current MUAC Cut-Offs to Screen for Acute Malnutrition Need to Be Adapted to Gender and Age: The Example of Cambodia

    Science.gov (United States)

    Fiorentino, Marion; Sophonneary, Prak; Laillou, Arnaud; Whitney, Sophie; de Groot, Richard; Perignon, Marlène; Kuong, Khov; Berger, Jacques; Wieringa, Frank T.

    2016-01-01

    Background Early identification of children malnutrition is a priority. Acute malnutrition is defined by the World Health Organization as a mid-upper-arm circumference (MUAC) malnutrition in communities, but MUAC cut-offs currently recommended by WHO do not identify the majority of children with weight-for-height Z-score (5 yrs. Therefore, this study aimed at defining gender and age-specific cut-offs to improve sensitivity of MUAC as an indicator of acute malnutrition. Methods To establish new age and gender-specific MUAC cut-offs, pooled data was obtained for 14,173 children from 5 surveys in Cambodia (2011–2013). Sensitivity, false positive rates, and areas under receiver-operator characteristic curves (AUC) were calculated using wasting for children 80% with the new cut-offs in comparison with the current WHO cut-offs. Conclusion Gender and age specific MUAC cut-offs drastically increased sensitivity to identify children with WHZ-score malnutrition at the community level. PMID:26840899

  10. In Vitro Dialysis of Cytokine-Rich Plasma With High and Medium Cut-Off Membranes Reduces Its Procalcific Activity.

    Science.gov (United States)

    Willy, Kevin; Hulko, Michael; Storr, Markus; Speidel, Rose; Gauss, Julia; Schindler, Ralf; Zickler, Daniel

    2017-09-01

    Recently developed high-flux (HF) dialysis membranes with extended permeability provide better clearance of middle-sized molecules such as interleukins (ILs). Whether this modulation of inflammation influences the procalcific effects of septic plasma on vascular smooth muscle cells (VSMCs) is not known. To assess the effects of high cut-off (HCO) and medium cut-off (MCO) membranes on microinflammation and in vitro vascular calcification we developed a miniature dialysis model. Plasma samples from lipopolysaccharide-spiked blood were dialyzed with HF, HCO, and MCO membranes in an in vitro miniature dialysis model. Afterwards, IL-6 concentrations were determined in dialysate and plasma. Calcifying VSMCs were incubated with dialyzed plasma samples and vascular calcification was assessed. Osteopontin (OPN) and matrix Gla protein (MGP) were measured in VSMC supernatants. IL-6 plasma concentrations were markedly lower with HCO and MCO dialysis. VSMC calcification was significantly lower after incubation with MCO- and HCO-serum compared to HF plasma. MGP and OPN levels in supernatants were significantly lower in the MCO but not in the HCO group compared to HF. In vitro dialysis of cytokine-enriched plasma samples with MCO and HCO membranes reduces IL-6 levels. The induction of vascular calcification by cytokine-enriched plasma is reduced after HCO and MCO dialysis. © 2017 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  11. Taming cut-off induced artifacts in molecular dynamics studies of solvated polypeptides. The reaction field method.

    Science.gov (United States)

    Schreiber, H; Steinhauser, O

    1992-12-05

    In this paper we present a model system of a solvated polypeptide, which is a suitable reference platform for the systematic exploration of methods for taming artifacts introduced by an incorrect treatment of long-range Coulomb forces. The essential feature of the system composed of an alpha-helical peptide and 1021 water molecules is the strict neutrality of all charge groups. The dynamical properties of the peptide, i.e. unfolding or maintenance of the helix, already give first hints on the influence of boundary effects. A rigorous and deeper insight is gained, however, if analyzing the system by means of the generalized Kirkwood g-factor, which projects the net dipole moment of concentric spheres onto the respective dipole moment of the reference charge group. The g-factor is a global measure for, and a sensitive probe of, the orientational structure, which in its turn reflects even the smallest inconsistencies in the treatment of long-range forces. While the cut-off scheme failed the g-factor test, the "reaction field" method, the simplest cut-off correction scheme, enables a consistent description. In other words, with the aid of the reaction field, the correct orientational structure is restored. As a consequence, the helix stability is regained and we were able to calculate the dielectric constant epsilon approximately 55 to 60 for our system, which is slightly below the corresponding value epsilon SPC = 66 of the pure solvent.

  12. On the design of reflectors that produce a cut-off line with a given anisotropic source of light

    Science.gov (United States)

    Kloos, G.

    2006-08-01

    The problem of generating a cut-off line with a carefully calculated reflector contour has been treated in detail by Spencer et al. for the case of a cylindrical source of light mounted perpendicular to the optic axis. Because this geometry does not properly represent the geometry in which standard light sources are used in the illumination systems which we study, the attempt was made to extend this theory to anisotropic light sources. This case of lower symmetry is closer to the geometry of light sources encountered in headlamp design. Spencer et al. were able to obtain an implicit algebraic equation for the problem of high symmetry that they analyzed. After adopting their method to the problem under investigation, the method of analysis used was different insofar as an algebraic equation was not obtained and the corresponding ordinary differential equation and the corresponding initial-value problem were solved instead and the solutions are visualized with the aid of a computer-algebra system. In this context, the concept of a so-called polar line or surface proved helpful. This describes a set of points that connect the tangent lines that link a given point of the reflector contour to a given extended lightsource of low symmetry. The extension of the lightsource is assumed to be elliptical in the plane that contains the optic axis and the plane perpendicular to the cut-off line. The analysis extended to the anisotropic case gave some insight into the underlying scaling laws and geometrical constraints.

  13. Objective assessment of subjective tinnitus through contralateral suppression of otoacoustic emissions by white noise; suggested cut-off points.

    Science.gov (United States)

    Riga, M; Komis, A; Maragkoudakis, P; Korres, G; Danielides, V

    2016-12-01

    Normative otoacoustic emission (OAE) suppression values are currently lacking and the role of cochlear efferent innervation in tinnitus is controversial. The aim of this study was to investigate the association between tinnitus and medial olivocochlear bundle (MOCB) malfunction. Potential suppression amplitude cut-off criteria that could differentiate participants with tinnitus from those without were sought. Mean suppression amplitudes of transient evoked OAEs and distortion product OAEs by contralateral white noise (50 dBSL) were recorded. Six mean suppression amplitudes criteria were validated as possible cut-off points. The population consisted of normal hearing (n = 78) or presbycusic adults (n = 19) with tinnitus or without (n = 28 and 13, respectively) chronic tinnitus (in total, n = 138 78 females/60males, aged 49 ± 14 years). Participants with mean suppression values lower than 0.5-1 dBSPL seem to present a high probability to report tinnitus (specificity 88-97%). On the other hand, participants with mean suppression values larger than 2-2.5dBSPL seem to present a high probability of the absence of tinnitus (sensitivity 87-99%). Correlations were stronger among participants with bilateral presence or absence of tinnitus. This study seem to confirm an association between tinnitus and low suppression amplitudes (<1 dBSPL), which might evolve into an objective examination tool, supplementary to conventional audiological testing.

  14. STS-114: Engine Cut-Off Sensors Are a No-Go: Teaching Notes for NASA Case Study

    Science.gov (United States)

    Ransom, Khadijah S.; Johnson, Grace K.

    2013-01-01

    This case study format is intended to simulate the experience of facing the same difficult challenges and making the same critical decisions as managers, engineers, and scientists in the Space Shuttle Program. It has been designed for use in the classroom setting to help students develop skills related to decision-making. Students will read about the engine cut-off sensor anomaly which created challenges during the STS-114 mission and have the opportunity to make decisions as lead NASA engineers and Mission Management Team members. Included within this document are three case study presentation options - class discussion, group activity, and open-ended research. Please read the full case prior to in-class presentation to allow ample time for students' analysis and reflection, as well as to prepare additional questions. activities or exercises, material selection, etc. Depending upon the setting of your presentation and the number of participants, please choose at least one presentation format beforehand and plan accordingly. You may expect the following learning objectives by using the proposed formats. Learning Objectives: To enable students to experience the responsibilities of NASA management, engineers, and analysis; to discover possible procedures for investigating system anomalies; to become familiar with the liquid hydrogen low level engine cut-off sensor, including its function, connecting components, and location within the Space Shuttle; and to encourage critical analysis and stimulating discussion of Space Shuttle mission challenges.

  15. D-dimer as a biomarker for acute aortic dissection: a systematic review and meta-analysis.

    Science.gov (United States)

    Cui, Jia-sen; Jing, Zai-ping; Zhuang, Shun-jiu; Qi, Shao-hong; Li, Li; Zhou, Jun-wen; Zhang, Wang; Zhao, Yun; Qi, Ning; Yin, Yang-jun

    2015-01-01

    To perform a meta-analysis and examine the use of D-dimer levels for diagnosing acute aortic dissection (AAD). Medline, Cochrane, EMBASE, and Google Scholar were searched until April 23, 2014, using the following search terms: biomarker, acute aortic dissection, diagnosis, and D-dimer. Inclusion criteria were diagnosis of acute aortic dissection, D-dimer levels obtained, 2-armed study. Outcome measures were the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of D-dimer level for the diagnosis of AAD. Sensitivity analysis was performed using the leave-one-out approach. Of 34 articles identified, 5 met the inclusion criteria and were included in the analysis. The age of participants was similar between treatments within studies. The number of AAD patients ranged from 16 to 107 (total = 274), and the number of control group patients ranged from 32 to 206 (total = 469). The pooled sensitivity of D-dimer levels in AAD patients was 94.5% (95% confidence interval [CI] 78.1%-98.8%, P < 0.001), and the specificity was 69.1% (95% CI 43.7%-86.5%, P = 0.136). The pooled area under the receiver-operating characteristic curve for D-dimer levels in AAD patients was 0.916 (95% CI 0.863-0.970, P < 0.001). The direction and magnitude of the combined estimates did not change markedly with the exclusion of individual studies, indicating the meta-analysis had good reliability. D-dimer levels are best used for ruling out AAD in patients with low likelihood of the disease.

  16. D-Dimer Plasma Levels Parallel the Clinical Response to Omalizumab in Patients with Severe Chronic Spontaneous Urticaria.

    Science.gov (United States)

    Asero, Riccardo; Marzano, Angelo V; Ferrucci, Silvia; Cugno, Massimo

    2017-01-01

    Omalizumab is very effective in the majority of patients with severe chronic spontaneous urticaria (CSU), but its mechanism of action is still unclear. In CSU the coagulation cascade is activated with an intensity that parallels the disease severity, and elevated plasma D-dimer levels are associated with a poor response to both antihistamines and cyclosporin. We measured D-dimer plasma levels before and after the first administration of omalizumab in 32 patients with severe CSU. A number of clinical and laboratory parameters were recorded, including the urticaria activity score, presence of angioedema, disease duration, C-reactive protein, anti-nuclear, and anti-thyroid antibodies. Baseline D-dimer levels were elevated in 19 (59%) cases. Omalizumab induced a complete response in 25 patients (78%), in most cases already after the first administration. At baseline, 14/25 responders had increased D-dimer plasma levels versus 5/7 non-responders. All responders showed a dramatic decrease of D-dimer plasma levels after the first administration of the drug (from 1,024 ± 248 [mean ± SE] to 251 ± 30 ng/mL; p = 0.003). In contrast, non-responders did not show any reduction in D-dimer levels after omalizumab administration (from 787 ± 206 to 1,230 ± 429 ng/mL; p = ns). In conclusion, plasma levels of D-dimer are frequently elevated in patients with severe CSU before omalizumab administration and decrease according to the clinical response of the disease to the drug, suggesting a possible effect of omalizumab on coagulation activation and fibrin degradation in a subset of CSU patients. © 2017 S. Karger AG, Basel.

  17. Is there any gender-specific difference in the cut-off values of ankylosing spondylitis disease activity score in patients with axial spondyloarthritis?

    Science.gov (United States)

    Kilic, Gamze; Kilic, Erkan; Ozgocmen, Salih

    2017-09-01

    To assess the validity of Assessment in Spondyloarthritis International Society (ASAS) endorsed Ankylosing Spondylitis Disease Activity Score (ASDAS) C-reactive protein (-CRP) and ASDAS erythrocyte sedimentation rate (-ESR) in axial spondyloarthritis (axSpA) and to estimate the cut-off values for male and female patients with axSpA. Patients with axSpA were assessed for disease activity, functions, mobility and AS Quality of Life (ASQoL) and pain. The discriminant ability of ASDAS versions was assessed using standardized mean differences. Optimal cut-off values of ASDAS versions were calculated. Patients with axSpA were included (196 AS, 164 non-radiographic axSpA). ASDAS versions and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) had good correlations with patient's global (PtG) and physician's global (PhG) assessment in both groups; however, men had relatively higher coefficients. Women had significantly higher pain, ASQoL, ASDAS-ESR, BASDAI item scores, PtG, PhG and ESR. Discriminant abilities of ASDAS-CRP, ASDAS-ESR and BASDAI were similar in men and women regarding low and high disease activity. ASDAS cut-offs are quite similar in both genders and in accordance with predefined values. The cut-offs for ASDAS-ESR were relatively lower than ASDAS-CRP and women tend to have higher cut-offs than men. The construct validity of ASDAS-CRP to discriminate low and high disease activity and cut-off values are similar in male and female patients with axSpA; however, cut-offs for ASDAS-ESR need to be defined. © 2016 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.

  18. Optimal cut-off age in the TNM Staging system of differentiated thyroid cancer: is 55 years better than 45 years?

    Science.gov (United States)

    Kim, Mijin; Kim, Young Nam; Kim, Won Gu; Park, Suyeon; Kwon, Hyemi; Jeon, Min Ji; Ahn, Hyeon Seon; Jung, Sin-Ho; Kim, Sun Wook; Kim, Won Bae; Chung, Jae Hoon; Shong, Young Kee; Kim, Tae Hyuk; Kim, Tae Yong

    2017-03-01

    Age >45 years is included as a variable in the tumor, node, metastases (TNM) staging of differentiated thyroid cancer (DTC), but a higher cut-off value has been suggested to be more clinically relevant and prevent over-staging. We evaluated the optimal age cut-off to predict disease-specific survival (DSS) in patients with DTC. This cohort study included 6333 patients with DTC who underwent thyroid surgery at two tertiary referral centres between 1996 and 2005. The optimal age cut-off value between 45 and 65 years for prediction of DSS was assessed. The proportion of variation explained (PVE) and Harrell's c-index was calculated to compare the predictability of each model. The median age of patients was 46·0 years (IQR 37·8-54·6), and 5498 (87%) were female. Median follow-up period was 10·0 years, and 10-year DSS rate was 98%. Using TNM staging with 45 years as the cut-off (TNM45), 10-year DSS rates of stage I-IV were 99·4%, 96·1%, 97·7% and 85·9%, respectively (PVE = 3·0%, Harrell's c-index = 0·693); and using 55 years as the cut-off (TNM55), 99·4%, 92·2%, 95·3% and 79·7%, respectively (PVE = 4·3%, Harrell's c-index = 0·776). On receiver operating characteristic curve analysis, the optimal age cut-off for prediction of DSS was 55·4 years (area under the curve = 0·837, P cut-off age of 55 years was more appropriate for TNM staging to achieve better predictability for DSS in patients with DTC. This change would prevent over-staging in low-risk patients and prevent over-aggressive treatment. © 2016 John Wiley & Sons Ltd.

  19. Trend, projection, and appropriate body mass index cut-off point for diabetes and hypertension in Bangladesh.

    Science.gov (United States)

    Rahman, Md Mizanur; Akter, Shamima; Jung, Jenny; Rahman, Md Shafiur; Sultana, Papia

    2017-04-01

    Rapid increasing of high body mass index (BMI) is a global health concern. Population with high BMI predicts an increased risk of diabetes and hypertension. The objective of the present study is to estimate the trend and prediction of diabetes and hypertension in Bangladesh, to examine the association of BMI with risk of diabetes and hypertension, and to ascertain an appropriate BMI cut-off point for screening diabetes. We searched PubMed from inception to August 2016 and identified studies reporting diabetes and hypertension prevalence in Bangladesh. Bangladesh Demographic and Health Survey 2011 data was also included in this study. Bayesian model was used to estimate trend and projection in diabetes and hypertension prevalence by sex and residence. Receiver operating characteristic curves was used to determine the optimal BMI cut-off point for screening diabetes. Of 535 articles reviewed, 35 studies reported prevalence of diabetes and hypertension. Prevalence of diabetes (95% credible interval) increased between 1992 and 2015 from 3.2% (2.2-4.3) to 12.1% (9.1-15.4) in men, and from 2.5% (1.8-3.5) to 13.4% (9.7-17.6) in women. Diabetes prevalence in 2030 is expected to reach 23.6% (13.6-36.3) for men and 33.5% (19.9-50.9) for women. Hypertension prevalence increased between 1992 and 2015 from 11.0% (8.6-13.7) to 20.4% (18.4-22.4%) in 2015 in men, and from 14.0% (10.3-19.0) to 21.3% (19.0-23.6) in women. Annual average rate of change for diabetes prevalence was higher among women and in rural areas, while for hypertension prevalence it was higher in men and urban areas. Adults with BMI of 22.5kg/m 2 or above had a higher risk of diabetes and hypertension in this study. The optimal BMI cut-off point for screening diabetes was 23kg/m 2 for overall population, 22kg/m 2 for men, and 23kg/m 2 for women. Diabetes is more prevalent among women and rural population groups, while hypertension is more prevalent among men and urban population groups in Bangladesh. A BMI of 22

  20. Simplified scoring of the Actionable 8-item screening questionnaire for neurogenic bladder overactivity in multiple sclerosis: a comparative analysis of test performance at different cut-off points.

    Science.gov (United States)

    Jongen, Peter Joseph; Blok, Bertil F; Heesakkers, John P; Heerings, Marco; Lemmens, Wim A; Donders, Rogier

    2015-10-24

    The Actionable questionnaire is an 8-item tool to screen patients with multiple sclerosis (MS) for neurogenic bladder problems, identifying those patients who might benefit from urological referral and bladder-specific treatment. The original scoring yields a total score of 0 to 24 with cut-off point 6. A simplified scoring, yielding a total score of 0 to 8 with cut-off point 3, has been developed in urogynaecological patients, but has not been investigated in MS. One-hundred-and-forty-one MS patients completed the Actionable on two occasions. We compared the test performance of the simplified scoring with cut-off point 3 with that of cut-off point 2, using the original scoring with cut-off point 6 as a gold standard. The following measures were calculated: True Positives (TP), True Negatives (TN), False Positives (FP), False Negatives (FN), Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and Accuracy. The associations between positive test result and urological treatment, and bladder-specific drug treatment were calculated. For cut-off point 3 the outcomes (Test 1, Test 2) were: TP 43.26 %, 40.88 %; TN 29.79 %, 32.85 %; FP 0.00 %, 0.00 %; FN 26.95 %, 26.28 %; Sensitivity 0.62, 0.61; Specificity 1.00, 1.00; PPV 1.00, 1.00; NPV 0.53, 0.55; Accuracy 0.73, 0.74; and for cut-off point 2: TP 59.57 %, 59.85 %; TN 26.95 %, 31.39 %; FP 2.84 %, 1.46 %; FN 10.63 %, 7.30 %; Sensitivity 0.85, 0.89; Specificity 0.90, 0.96; PPV 0.95, 0.98; NPV 0.72, 0.81; Accuracy 0.87, 0.91. Cut-off 3 completely prevented FP outcomes, but wrongly classified 26 % of the patients as negative (FN). Cut-off 2 reduced the FN to 7-10 %, with low FP values (2.84-1.46 %). With cut-off 2, the percentage of patients screened positive was higher in the Progressive group (75.00 %) than in the Relapsing Remitting group (56.25 %) (P = 0.0331), which was not the case with cut-off 3. Only a positive test according to the original scoring was associated with both

  1. The impact of an underground cut-off wall on nutrient dynamics in groundwater in the lower Wang River watershed, China.

    Science.gov (United States)

    Kang, Pingping; Xu, Shiguo

    2017-03-01

    Underground cut-off walls in coastal regions are mainly used to prevent saltwater intrusion, but their impact on nutrient dynamics in groundwater is not clear. In this study, a combined analysis of multiple isotopes ([Formula: see text]) and nitrogen and phosphorus concentrations is used in order to assess the impact of the underground cut-off walls on the nutrient dynamics in groundwater in the lower Wang River watershed, China. Compared with the nitrogen and phosphorus concentrations in groundwater downstream of the underground cut-off walls, high [Formula: see text] and total dissolved nitrogen concentrations and similar concentration levels of [Formula: see text] and total dissolved phosphorus are found in groundwater upstream of the underground cut-off walls. The isotopic data indicated the probable occurrence of denitrification and nitrification processes in groundwater upstream, whereas the fingerprint of these processes was not shown in groundwater downstream. The management of fertilizer application is critical to control nitrogen concentrations in groundwater restricted by the underground cut-off walls.

  2. Suggested cut-off values for vitamin D as a risk marker for total and cardiac death in patients with suspected acute coronary syndrome

    Directory of Open Access Journals (Sweden)

    Patrycja Anna Naesgaard

    2016-02-01

    Full Text Available Background: Several studies have demonstrated an association between low vitamin D levels and cardiovascular risk. Vitamin D cut off levels are still under debate. Objectives: To assess two cut-off levels, 40 nmol/L and 70 nmol/L, respectively, for vitamin D measured as 25-hydroxyvitamin D [25(OHD] in chest pain patients with suspected acute coronary syndrome.Methods: We investigated 1853 patients from coastal-Norway and inland Northern-Argentina. A similar database was used for pooling of data. 2-year follow-up data including all-cause mortality, cardiac death and sudden cardiac death in the total patient population were analyzed, applying univariate and multivariable analysis. Results: 255 patients with known vitamin D concentrations died. In the multivariable analysis, there was a decrease in total mortality above a cut-off level of 40 nmol/L and a decrease in cardiac death above a cut-off level of 70 nmol/L, [HRs of 0.66 (95% CI, 0.50 – 0.88, p = 0.004 and 0.46 (95% CI, 0.22 – 0.94, p = 0.034, respectively].Conclusion: Vitamin D cut-off levels of 40 nmol/L and 70 nmol/L, were related to total mortality and cardiac death, respectively.

  3. Practical use of visual medial temporal lobe atrophy cut-off scores in Alzheimer's disease: Validation in a large memory clinic population

    Energy Technology Data Exchange (ETDEWEB)

    Claus, Jules J.; Holl, Dana C.; Roorda, Jelmen J. [Tergooi Hospital, Department of Neurology, Blaricum (Netherlands); Staekenborg, Salka S. [Tergooi Hospital, Department of Neurology, Blaricum (Netherlands); VU University Medical Center, Department of Neurology, Alzheimer Center, Amsterdam (Netherlands); Schuur, Jacqueline [Tergooi Hospital, Department of Geriatrics, Blaricum (Netherlands); Koster, Pieter [Tergooi Hospital, Department of Radiology, Blaricum (Netherlands); Tielkes, Caroline E.M. [Tergooi Hospital, Department of Medical Psychology, Blaricum (Netherlands); Scheltens, Philip [VU University Medical Center, Department of Neurology, Alzheimer Center, Amsterdam (Netherlands)

    2017-08-15

    To provide age-specific medial temporal lobe atrophy (MTA) cut-off scores for routine clinical practice as marker for Alzheimer's disease (AD). Patients with AD (n = 832, mean age 81.8 years) were compared with patients with subjective cognitive impairment (n = 333, mean age 71.8 years) in a large single-centre memory clinic. Mean of right and left MTA scores was determined with visual rating (Scheltens scale) using CT (0, no atrophy to 4, severe atrophy). Relationships between age and MTA scores were analysed with regression analysis. For various MTA cut-off scores, decade-specific sensitivity and specificity and area under the curve (AUC) values, computed with receiver operator characteristic curves, were determined. MTA strongly increased with age in both groups to a similar degree. Optimal MTA cut-off values for the age ranges <65, 65-74, 75-84 and ≥85 were: ≥1.0, ≥1.5, ≥ 2.0 and ≥2.0. Corresponding values of sensitivity and specificity were 83.3% and 86.4%; 73.7% and 84.6%; 73.7% and 76.2%; and 84.0% and 62.5%. From this large unique memory clinic cohort we suggest decade-specific MTA cut-off scores for clinical use. After age 85 years, however, the practical usefulness of the MTA cut-off is limited. (orig.)

  4. The dischargeable cut-off score of Oswestry Disability Index (ODI) in the inpatient care for low back pain with disability.

    Science.gov (United States)

    Park, Sang-Won; Shin, Ye-Sle; Kim, Hye-Jin; Lee, Jin-Ho; Shin, Joon-Shik; Ha, In-Hyuk

    2014-10-01

    The admission due to low back pain (LBP) became prevalent cause of international economic losses. Since LBP patients with disability are often subject to inpatient care, it is important to determine the appropriate time of discharge. The purpose of this study is to set the cut-off value of appropriate Oswestry Disability Index (ODI) at the time of discharge. Of 1,394 LBP patients admitted in hospital specialized in spinal disease, 774 eligible patients with disability were included in this study. And several clinical variables including numerical rating score, ODI, satisfaction level were observed during the hospital stay. We considered satisfaction level as an important factor for discharge, categorized patients into satisfied group and dissatisfied group. Through the statistical analysis, appropriate factor for determining dischargeable patients satisfied with their current condition and its cut-off value of ODI were found. And proper predictors for the cut-off value were extracted statistically and logically from a pool of several clinical indexes. The ODI at the time of discharge was most accurate in determining dischargeable patients. The cut-off value of ODI was 30. Predictors were ODI questions 4 and 6. We set the cut-off value of dischargeable ODI for LBP inpatient with disability and found its predictor.

  5. Suggested Cut-Off Values for Vitamin D as a Risk Marker for Total and Cardiac Death in Patients with Suspected Acute Coronary Syndrome.

    Science.gov (United States)

    Naesgaard, Patrycja A; León de la Fuente, Ricardo A; Nilsen, Stein Tore; Pönitz, Volker; Brügger-Andersen, Trygve; Grundt, Heidi; Staines, Harry; Nilsen, Dennis W T

    2016-01-01

    Several studies have demonstrated an association between low vitamin D levels and cardiovascular risk. Vitamin D cut-off levels are still under debate. To assess two cut-off levels, 40 and 70 nmol/L, respectively, for vitamin D measured as 25-hydroxyvitamin D in chest pain patients with suspected acute coronary syndrome. We investigated 1853 patients from coastal-Norway and inland Northern-Argentina. A similar database was used for pooling of data. Two-year follow-up data including all-cause mortality, cardiac death, and sudden cardiac death in the total patient population were analyzed, applying univariate and multivariable analysis. Two hundred fifty-five patients with known vitamin D concentrations died. In the multivariable analysis, there was a decrease in total mortality above a cut-off level of 40 nmol/L and a decrease in cardiac death above a cut-off level of 70 nmol/L [HRs of 0.66 (95% CI, 0.50-0.88), p = 0.004 and 0.46 (95% CI, 0.22-0.94), p = 0.034, respectively]. Vitamin D cut-off levels of 40 and 70 nmol/L were related to total mortality and cardiac death, respectively.

  6. Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study.

    Directory of Open Access Journals (Sweden)

    Hans U Gerth

    Full Text Available High-cut-off hemodialysis (HCO-HD can effectively reduce high concentrations of circulating serum free light chains (sFLC in patients with dialysis-dependent acute kidney injury (AKI due to multiple myeloma (MM. Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD or HCO-HD.The final cohort consisted of 59 patients treated with HCO-HD (n = 42 or conv. HD (n = 17. A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3% compared with conv. HD patients (29.4%; p = 0.007. The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014. Multivariate regression and decision tree analysis (recursive partitioning revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI 1.5-24.5], p = 0.011 and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0-1.7], p = 0.045 as independent and paramount variables associated with a favorable renal outcome.In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted.

  7. A cut-off in the TeV gamma-ray spectrum of the SNR Cassiopeia A

    Science.gov (United States)

    Ahnen, M. L.; Ansoldi, S.; Antonelli, L. A.; Arcaro, C.; Babić, A.; Banerjee, B.; Bangale, P.; Barres de Almeida, U.; Barrio, J. A.; Becerra González, J.; Bednarek, W.; Bernardini, E.; Berti, A.; Bhattacharyya, W.; Biasuzzi, B.; Biland, A.; Blanch, O.; Bonnefoy, S.; Bonnoli, G.; Carosi, R.; Carosi, A.; Chatterjee, A.; Colak, M.; Colin, P.; Colombo, E.; Contreras, J. L.; Cortina, J.; Covino, S.; Cumani, P.; Da Vela, P.; Dazzi, F.; De Angelis, A.; De Lotto, B.; de Oña Wilhelmi, E.; Di Pierro, F.; Doert, M.; Domínguez, A.; Dominis Prester, D.; Dorner, D.; Doro, M.; Einecke, S.; Eisenacher Glawion, D.; Elsaesser, D.; Engelkemeier, M.; Fallah Ramazani, V.; Fernández-Barral, A.; Fidalgo, D.; Fonseca, M. V.; Font, L.; Fruck, C.; Galindo, D.; García López, R. J.; Garczarczyk, M.; Gaug, M.; Giammaria, P.; Godinović, N.; Gora, D.; Guberman, D.; Hadasch, D.; Hahn, A.; Hassan, T.; Hayashida, M.; Herrera, J.; Hose, J.; Hrupec, D.; Inada, T.; Ishio, K.; Konno, Y.; Kubo, H.; Kushida, J.; Kuveždić, D.; Lelas, D.; Lindfors, E.; Lombardi, S.; Longo, F.; López, M.; Maggio, C.; Majumdar, P.; Makariev, M.; Maneva, G.; Manganaro, M.; Mannheim, K.; Maraschi, L.; Mariotti, M.; Martínez, M.; Mazin, D.; Menzel, U.; Minev, M.; Mirzoyan, R.; Moralejo, A.; Moreno, V.; Moretti, E.; Neustroev, V.; Niedzwiecki, A.; Nievas Rosillo, M.; Nilsson, K.; Ninci, D.; Nishijima, K.; Noda, K.; Nogués, L.; Paiano, S.; Palacio, J.; Paneque, D.; Paoletti, R.; Paredes, J. M.; Pedaletti, G.; Peresano, M.; Perri, L.; Persic, M.; Prada Moroni, P. G.; Prandini, E.; Puljak, I.; Garcia, J. R.; Reichardt, I.; Rhode, W.; Ribó, M.; Rico, J.; Righi, C.; Saito, T.; Satalecka, K.; Schroeder, S.; Schweizer, T.; Shore, S. N.; Sitarek, J.; Šnidarić, I.; Sobczynska, D.; Stamerra, A.; Strzys, M.; Surić, T.; Takalo, L.; Tavecchio, F.; Temnikov, P.; Terzić, T.; Tescaro, D.; Teshima, M.; Torres-Albà, N.; Treves, A.; Vanzo, G.; Vazquez Acosta, M.; Vovk, I.; Ward, J. E.; Will, M.; Zarić, D.

    2017-12-01

    It is widely believed that the bulk of the Galactic cosmic rays is accelerated in supernova remnants (SNRs). However, no observational evidence of the presence of particles of PeV energies in SNRs has yet been found. The young historical SNR Cassiopeia A (Cas A) appears as one of the best candidates to study acceleration processes. Between 2014 December and 2016 October, we observed Cas A with the MAGIC telescopes, accumulating 158 h of good quality data. We derived the spectrum of the source from 100 GeV to 10 TeV. We also analysed ∼8 yr of Fermi-LAT to obtain the spectral shape between 60 MeV and 500 GeV. The spectra measured by the LAT and MAGIC telescopes are compatible within the errors and show a clear turn-off (4.6σ) at the highest energies, which can be described with an exponential cut-off at E_c = 3.5(^{+1.6}_{-1.0})_{stat} (^{+0.8}_{-0.9})_{sys} TeV. The gamma-ray emission from 60 MeV to 10 TeV can be attributed to a population of high-energy protons with a spectral index of ∼2.2 and an energy cut-off at ∼10 TeV. This result indicates that Cas A is not contributing to the high energy (∼PeV) cosmic ray sea in a significant manner at the present moment. A one-zone leptonic model fails to reproduce by itself the multiwavelength spectral energy distribution. Besides, if a non-negligible fraction of the flux seen by MAGIC is produced by leptons, the radiation should be emitted in a region with a low magnetic field (B⪅180 μG) like in the reverse shock.

  8. Appropriate neck circumference cut-off points for metabolic syndrome in Turkish patients with type 2 diabetes.

    Science.gov (United States)

    Ozkaya, Ismail; Yardimci, Bulent; Tunckale, Aydin

    2017-12-01

    To investigate the association between neck circumference (NC), overweight, and metabolic syndrome (MS) in Turkish patients with type 2 diabetes. A total of 264 diabetic patients (mean age: 52.9±8.1 years) were recruited from two centers in Istanbul to perform anthropometric measurements, including waist and hip circumference, NC, and body mass index. Blood pressure, fasting glucose, and lipid profile (total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels) were determined. NC correlated with waist circumference, systolic blood pressure, and triglycerides in men, whereas NC only correlated with waist circumference in women. Additionally, NC was shown to negatively correlate with high-density lipoprotein cholesterol in both men and women. Receiver operating characteristic analysis showed that the area under the curve for NC and overweight was 0.95 for both men and women (P<0.001). Moreover, a NC of 38cm for men and 37cm for women was the best cut-off point for determining overweight. The area under the curve for NC and MS was 0.87 for men and 0.83 for women (P<0.001). A NC of 39cm for men and 37cm for women was the best cut-off point to determine participants with MS. Our findings suggest a positive correlation of NC with MetS in Turkish patients with type 2 diabetes, and could be a useful and accurate tool to identify MS. Copyright © 2017 SEEN y SED. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. A new perspective of the climatological features of upper-level cut-off lows in the Southern Hemisphere

    Science.gov (United States)

    Pinheiro, Henri Rossi; Hodges, Kevin Ivan; Gan, Manoel Alonso; Ferreira, Nelson Jesuz

    2017-01-01

    This study presents a detailed view of the seasonal variability of upper-level cut-off lows (COLs) in the Southern Hemisphere. The COLs are identified and tracked using data from a 36-year period of the European Centre for Medium Range Weather Forecast reanalysis (ERA-Interim). The objective identification of the COLs uses a new approach, which is based on 300 hPa relative vorticity minima, and three restrictive criteria of the presence of a cold-core, stratospheric potential vorticity intrusion, and cut-off cyclonic circulation. The highest COL activity is in agreement with previous studies, located near three main continental areas (Australia, South America, and Africa), with maximum frequencies usually observed in the austral autumn. The COL mean intensity values show a marked seasonal and spatial variation, with maximum (minimum) values during the austral winter (summer), a unique feature that has not been observed previously in studies based on the geopotential. The link between intensity and lysis is examined, and finds that weaker systems are more susceptible to lysis in the vicinity of the Andes Cordillera, associated with the topographic Rossby wave. Lysis and genesis regions are close to each other, confirming that COLs are quasi-stationary systems. Also, COLs tend to move eastward and are faster over the higher latitudes. The mean growth/decay rates coincide with the major genesis and lysis density regions, such as the significant decay values across the Andes all year. As a consequence of using vorticity for the tracking method a longer lifetime of COLs is detected than in other studies, but this does not affect the total frequency of occurrence. Comparisons with other studies suggest that the differences in seasonality are due to uncertainties in the reanalyses and the methods used to identify COLs.

  10. Molecular Weight Cut-Off and Structural Analysis of Vacuum-Assisted Titania Membranes for Water Processing

    Directory of Open Access Journals (Sweden)

    Siti Nurehan Abd Jalil

    2016-11-01

    Full Text Available This work investigates the structural formation and analyses of titania membranes (TM prepared using different vacuum exposure times for molecular weight (MW cut-off performance and oil/water separation. Titania membranes were synthesized via a sol-gel method and coated on macroporous alumina tubes followed by exposure to a vacuum between 30 and 1200 s and then calcined at 400 °C. X-ray diffraction and nitrogen adsorption analyses showed that the crystallite size and particle size of titania increased as a function of vacuum time. All the TM membranes were mesoporous with an average pore diameter of ~3.6 nm with an anatase crystal morphology. Water, glucose, sucrose, and polyvinylpyrrolidone with 40 and 360 kDa (PVP-40 kDa and PVP-360 kDa were used as feed solutions for MW cut-off and hexadecane solution for oil filtration investigation. The TM membranes were not able to separate glucose and sucrose, thus indicating the membrane pore sizes are larger than the kinetic diameter of sucrose of 0.9 nm, irrespective of vacuum exposure time. They also showed only moderate rejection (20% of the smaller PVP-40 kDa, however, all the membranes were able to obtain an excellent rejection of near 100% for the larger PVP-360 kDa molecule. Furthermore, the TM membranes were tested for the separation of oil emulsions with a high concentration of oil (3000 ppm, reaching high oil rejections of more than 90% of oil. In general, the water fluxes increased with the vacuum exposure time indicating a pore structural tailoring effect. It is therefore proposed that a mechanism of pore size tailoring was formed by an interconnected network of Ti–O–Ti nanoparticles with inter-particle voids, which increased as TiO2 nanoparticle size increased as a function of vacuum exposure time, and thus reduced the water transport resistance through the TM membranes.

  11. Embolic Stroke Diagnosed by Elevated D-Dimer in a Patient With Negative TEE for Cardioembolic Source

    Directory of Open Access Journals (Sweden)

    Irina Y. Sazonova PhD

    2014-12-01

    Full Text Available We report a case of cerebrovascular accident with thromboembolic stroke etiology in a patient who had atrial flutter and negative transesophageal echocardiography (TEE results. The increased D-dimer levels (1877 ng/mL initiated referral for magnetic resonance imaging and magnetic resonance angiography of the brain that showed classic recanalization of an embolic thrombus in the angular branch of the left middle cerebral distribution. The D-dimer level of this patient was normalized after 3 months of anticoagulation therapy. Although TEE is considered the gold standard for evaluation of cardiac source of embolism, exclusion of intracardiac thrombus with TEE alone does not eliminate the risk of thromboembolic events. This case highlights the utility of D-dimer as a potential adjunct in the decision-making process to guide investigation of thromboembolism, determine subsequent therapy, and hence reduce the risk of embolic stroke recurrence.

  12. Values of the Wells and Revised Geneva Scores Combined with D-dimer in Diagnosing Elderly Pulmonary Embolism Patients

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    Dan-Jie Guo

    2015-01-01

    Full Text Available Background: Pulmonary embolism (PE can be difficult to diagnose in elderly patients because of the coexistent diseases and the combination of drugs that they have taken. We aimed to compare the clinical diagnostic values of the Wells score, the revised Geneva score and each of them combined with D-dimer for suspected PE in elderly patients. Methods: Three hundred and thirty-six patients who were admitted for suspected PE were enrolled retrospectively and divided into two groups based on age (≥65 or <65 years old. The Wells and revised Geneva scores were applied to evaluate the clinical probability of PE, and the positive predictive values of both scores were calculated using computed tomography pulmonary arteriography as a gold standard; overall accuracy was evaluated by the area under the curve (AUC of receiver operator characteristic curve; the negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were calculated. Results: Ninety-six cases (28.6% were definitely diagnosed as PE among 336 cases, among them 56 cases (58.3% were ≥65 years old. The positive predictive values of Wells and revised Geneva scores were 65.8% and 32.4%, respectively (P < 0.05 in the elderly patients; the AUC for the Wells score and the revised Geneva score in elderly was 0.682 (95% confidence interval [CI]: 0.612-0.746 and 0.655 (95% CI: 0.584-0.722, respectively (P = 0.389. The negative predictive values of D-dimer, the Wells score combined with D-dimer, and the revised Geneva score combined with D-dimer were 93.7%, 100%, and 100% in the elderly, respectively. Conclusions: The diagnostic value of the Wells score was higher than the revised Geneva score for the elderly cases with suspected PE. The combination of either the Wells score or the revised Geneva score with a normal D-dimer concentration is a safe strategy to rule out PE.

  13. New guidelines for lupus anticoagulant: sensitivity and specificity of cut-off values calculated with plasmas from healthy controls in mixing and confirmatory tests.

    Science.gov (United States)

    Martinuzzo, M E; Cerrato, G S; Varela, M L I; Adamczuk, Y P; Forastiero, R R

    2012-04-01

    The updated guidelines for lupus anticoagulant (LA) diagnosis indicate locally calculate the cut-off values of the index of circulating anticoagulant (ICA) and the clotting time in seconds (s) for mixing studies and % of correction (%C) for confirmatory tests. We assess sensitivity (SEN) and specificity (SPC) of the cut-off values obtained as the 99th percentile from 60 plasmas of healthy individuals. We analysed 647 plasmas from patients studied in the last 3 years, and results were revaluated according to the new criteria and cut-off values. Four hundred and three had LA, and 75 of them were under oral anticoagulants (OA). We performed three screening tests: activated partial thromboplastin time (APTT), diluted Russell viper venom time (dRVVT) and dilute prothrombin time (dPT), and previous diagnosis was carried out using our home-made cut-off calculated by receiver operating characteristics curves. We reanalysed the mixing and confirmatory data of APTT/dRVVT, the tests selected in the new guidelines. To evaluate SPC, 244 plasmas (160 OA and 84 congenital deficient patients) were studied. Considering mixing studies, the cut-off values demonstrate that SEN of ICA-APTT was 94% and of clotting time in second (s) 83%, with an SPC of 77% and 84%, respectively. For ICA-dRVVT, SEN was 72% and for clotting time in second (s) 77%, with SPC of 98% and 84%, respectively. The cut-off values for %C for confirmatory APTT show good SEN 82% and high SPC 96%; for confirmatory dRVVT lower SEN 77%, but a SPC of 100%. The combination of mixing and confirmatory tests interpreted according to the new guidelines can clearly differentiate LA from other coagulopathies. © 2011 Blackwell Publishing Ltd.

  14. Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis.

    Directory of Open Access Journals (Sweden)

    Isidoro González-Álvaro

    Full Text Available To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI in patients with chronic polyarthritis.Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR] including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC analysis. The areas under ROC (AUC were compared to those of validated indexes (SDAI, CDAI, DAS28. ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI.The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5, moderate if >5 and <9 and high if ≥9. HUPI's AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28's AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756 and CDAI (AUCs: 0.789 and 0.728. HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values.The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis.

  15. Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis.

    Science.gov (United States)

    González-Álvaro, Isidoro; Castrejón, Isabel; Ortiz, Ana M; Toledano, Esther; Castañeda, Santos; García-Vadillo, Alberto; Carmona, Loreto

    2016-01-01

    To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI's AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28's AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis.

  16. HPV self-sampling in CIN2+ detection: sensitivity and specificity of different RLU cut-off of HC2 in specimens from 786 women.

    Science.gov (United States)

    Bottari, F; Igidbashian, S; Boveri, S; Tricca, A; Gulmini, C; Sesia, M; Spolti, N; Sideri, M; Landoni, F; Sandri, M T

    2017-04-01

    Mortality for cervical cancer varies between the different regions of the world, with high rates in low-income countries where screening programmes are not present and organised. However, increasing screening coverage is still a priority in all countries: one way to do that is to base screening on self-sampled screening. The success of a self-sampling screening strategy depends on capacity to recruit unscreened women, on the performance and acceptability of the device and on the clinical performance of the high-risk human papillomavirus (HPV) test. This study based on 786 enrolled women investigates the best cut-off value of Hybrid Capture 2 HPV test (HC2) for self-sampled specimens in terms of sensitivity and specificity. In this population, we found that the sensitivity and the specificity for cervical intraepithelial neoplasia grade 2 or more detection of HC2 performed on self-sampled specimens were 82.5% and 82.8%, respectively considering the relative light units (RLU) cut-off value of 1. Increasing the cut-off value the sensitivity decreases and the specificity raises and the best area under the curve for the RLU cut-off value is 1. Our results confirm that the cut-off value of 1 suggested by Qiagen for PreservCyt specimen is the best cut-off value also for self-sampled specimens. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  17. Prospective Study of Optimal Obesity Index Cut-Off Values for Predicting Incidence of Hypertension in 18–65-Year-Old Chinese Adults

    Science.gov (United States)

    Ren, Qian; Su, Chang; Wang, Huijun; Wang, Zhihong; Du, Wenwen; Zhang, Bing

    2016-01-01

    Background Overweight and obesity increase the risk of elevated blood pressure; most of the studies that serve as a background for the debates on the optimal obesity index cut-off values used cross-sectional samples. The aim of this study was to determine the cut-off values of anthropometric markers for detecting hypertension in Chinese adults with data from prospective cohort. Methods This study determines the best cut-off values for the obesity indices that represent elevated incidence of hypertension in 18–65-year-old Chinese adults using data from the China Health and Nutrition Survey (CHNS) 2006–2011 prospective cohort. Individual body mass index (BMI), waist circumference (WC), waist:hip ratio (WHR) and waist:stature ratio (WSR) were assessed. ROC curves for these obesity indices were plotted to estimate and compare the usefulness of these obesity indices and the corresponding values for the maximum of the Youden indices were considered the optimal cut-off values. Results Five-year cumulative incidences of hypertension were 21.5% (95% CI: 19.4–23.6) in men and 16.5% (95% CI: 14.7–18.2) in women, and there was a significant trend of increased incidence of hypertension with an increase in BMI, WC, WHR or WSR (P for trend Obesity in China (WGOC), the cut-off values for WHR that were developed by the World Health Organization (WHO), and a global WSR cut-off value of 0.50 may be the appropriate upper limits for Chinese adults. PMID:26934390

  18. Prospective Study of Optimal Obesity Index Cut-Off Values for Predicting Incidence of Hypertension in 18-65-Year-Old Chinese Adults.

    Science.gov (United States)

    Ren, Qian; Su, Chang; Wang, Huijun; Wang, Zhihong; Du, Wenwen; Zhang, Bing

    2016-01-01

    Overweight and obesity increase the risk of elevated blood pressure; most of the studies that serve as a background for the debates on the optimal obesity index cut-off values used cross-sectional samples. The aim of this study was to determine the cut-off values of anthropometric markers for detecting hypertension in Chinese adults with data from prospective cohort. This study determines the best cut-off values for the obesity indices that represent elevated incidence of hypertension in 18-65-year-old Chinese adults using data from the China Health and Nutrition Survey (CHNS) 2006-2011 prospective cohort. Individual body mass index (BMI), waist circumference (WC), waist:hip ratio (WHR) and waist:stature ratio (WSR) were assessed. ROC curves for these obesity indices were plotted to estimate and compare the usefulness of these obesity indices and the corresponding values for the maximum of the Youden indices were considered the optimal cut-off values. Five-year cumulative incidences of hypertension were 21.5% (95% CI: 19.4-23.6) in men and 16.5% (95% CI: 14.7-18.2) in women, and there was a significant trend of increased incidence of hypertension with an increase in BMI, WC, WHR or WSR (P for trend Obesity in China (WGOC), the cut-off values for WHR that were developed by the World Health Organization (WHO), and a global WSR cut-off value of 0.50 may be the appropriate upper limits for Chinese adults.

  19. Amputee locomotion: Frequency content of prosthetic vs. intact limb vertical ground reaction forces during running and the effects of filter cut-off frequency.

    Science.gov (United States)

    Kiernan, Dovin; Miller, Ross H; Baum, Brian S; Kwon, Hyun Joon; Shim, Jae Kun

    2017-07-26

    Compared to intact limbs, running-specific prostheses have high resonance non-biologic materials and lack active tissues to damp high frequencies. These differences may lead to ground reaction forces (GRFs) with high frequency content. If so, ubiquitously applying low-pass filters to prosthetic and intact limb GRFs may attenuate veridical high frequency content and mask important and ecologically valid data from prostheses. To explore differences in frequency content between prosthetic and intact limbs we divided signal power from transtibial unilateral amputees and controls running at 2.5, 3.0, and 3.5m/s into Low (25Hz) frequency bandwidths. Faster speeds tended to reduce the proportion of signal power in the Low bandwidth while increasing it in the High and Non-biologic bandwidths. Further, prostheses had lower proportions of signal power at the High frequency bandwidth but greater proportions at the Non-biologic bandwidth. To evaluate whether these differences in frequency content interact with filter cut-offs and alter results, we filtered GRFs with cut-offs from 1 to 100Hz and calculated vertical impact peak (VIP). Changing cut-off had inconsistent effects on VIP across speeds and limbs: Faster speeds had significantly larger changes in VIP per change in cut-off while, compared to controls, prosthetic limbs had significantly smaller changes in VIP per change in cut-off. These findings reveal differences in GRF frequency content between prosthetic and intact limbs and suggest that a cut-off frequency that is appropriate for one limb or speed may be inappropriate for another. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Cut-Offs and Response Criteria for the Hospital Universitario La Princesa Index (HUPI) and Their Comparison to Widely-Used Indices of Disease Activity in Rheumatoid Arthritis

    Science.gov (United States)

    Castrejón, Isabel; Ortiz, Ana M.; Toledano, Esther; Castañeda, Santos; García-Vadillo, Alberto; Carmona, Loreto

    2016-01-01

    Objective To estimate cut-off points and to establish response criteria for the Hospital Universitario La Princesa Index (HUPI) in patients with chronic polyarthritis. Methods Two cohorts, one of early arthritis (Princesa Early Arthritis Register Longitudinal [PEARL] study) and other of long-term rheumatoid arthritis (Estudio de la Morbilidad y Expresión Clínica de la Artritis Reumatoide [EMECAR]) including altogether 1200 patients were used to determine cut-off values for remission, and for low, moderate and high activity through receiver operating curve (ROC) analysis. The areas under ROC (AUC) were compared to those of validated indexes (SDAI, CDAI, DAS28). ROC analysis was also applied to establish minimal and relevant clinical improvement for HUPI. Results The best cut-off points for HUPI are 2, 5 and 9, classifying RA activity as remission if ≤2, low disease activity if >2 and ≤5), moderate if >5 and <9 and high if ≥9. HUPI’s AUC to discriminate between low-moderate activity was 0.909 and between moderate-high activity 0.887. DAS28’s AUCs were 0.887 and 0.846, respectively; both indices had higher accuracy than SDAI (AUCs: 0.832 and 0.756) and CDAI (AUCs: 0.789 and 0.728). HUPI discriminates remission better than DAS28-ESR in early arthritis, but similarly to SDAI. The HUPI cut-off for minimal clinical improvement was established at 2 and for relevant clinical improvement at 4. Response criteria were established based on these cut-off values. Conclusions The cut-offs proposed for HUPI perform adequately in patients with either early or long term arthritis. PMID:27603313

  1. Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine: a cross-sectional study.

    Science.gov (United States)

    Aurrekoetxea, Juan J; Murcia, Mario; Rebagliato, Marisa; López, María José; Castilla, Ane Miren; Santa-Marina, Loreto; Guxens, Mónica; Fernández-Somoano, Ana; Espada, Mercedes; Lertxundi, Aitana; Tardón, Adonina; Ballester, Ferran

    2013-01-24

    To estimate the prevalence and factors associated with smoking and misclassification in pregnant women from INMA (INfancia y Medio Ambiente, Environment and Childhood) project, Spain, and to assess the optimal cut-offs for urinary cotinine (UC) that best distinguish daily and occasional smokers with varying levels of second-hand smoke (SHS) exposure. We used logistic regression models to study the relationship between sociodemographic variables and self-reported smoking and misclassification (self-reported non-smokers with UC >50 ng/ml). Receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off point for discriminating smokers. The cut-offs were also calculated after stratification among non-smokers by the number of sources of SHS exposure. The cut-off points used to discriminate smoking status were the level of UC given by Youden's index and for 50 and 100 ng/ml for daily smokers, or 25 and 50 ng/ml for occasional smokers. At the third trimester of pregnancy, 2263 pregnant women of the INMA Project were interviewed between 2004 and 2008 and a urine sample was collected. Prevalence of self-reported smokers at the third trimester of pregnancy was 18.5%, and another 3.9% misreported their smoking status. Variables associated with self-reported smoking and misreporting were similar, including born in Europe, educational level and exposure to SHS. The optimal cut-off was 82 ng/ml (95% CI 42 to 133), sensitivity 95.2% and specificity 96.6%. The area under the ROC curve was 0.986 (95% CI 0.982 to 0.990). The cut-offs varied according to the SHS exposure level being 42 (95% CI 27 to 57), 82 (95% CI 46 to 136) and 106 ng/ml (95% CI 58 to 227) for not being SHS exposed, exposed to one, and to two or more sources of SHS, respectively. The optimal cut-off for discriminating occasional smokers from non-smokers was 27 ng/ml (95% CI 11 to 43). Prevalence of smoking during pregnancy in Spain remains high. UC is a reliable biomarker for classifying

  2. Definition of new cut-offs of BMI and waist circumference based on body composition and insulin resistance: differences between children, adolescents and adults.

    Science.gov (United States)

    Hübers, M; Pourhassan, M; Braun, W; Geisler, C; Müller, M J

    2017-09-01

    This study aims to determine associations between anthropometric traits, regional fat depots and insulin resistance in children, adolescents and adults to define new cut-offs of body mass index (BMI) or waist circumference (WC). Cross-sectional data were assessed in 433 children, adolescents and adults (aged: 6-60 years, BMI: 23.6 [21.0-27.7] kg m-2). Total adipose tissue (TAT), regional subcutaneous adipose tissue (SATtotal, SATtrunk) and visceral adipose tissue (VAT) were determined by whole-body magnetic resonance imaging, fat mass by air-displacement plethysmography. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). Bivariate as well as partial correlations and regression analyses were used. Cut-off values of BMI and WC related to regional fat depots and HOMA-IR were analysed by receiver operating characteristics curve. In adults, TAT, SATtotal and SATtrunk increased linearly with increasing BMI and WC, whereas they followed a cubic function in children and adolescents with a steep increase at BMI and WC ≥1 standard deviation score and VAT at WC ≥2 standard deviation score. Sex differences were apparent in adults with women having higher masses of TAT and SAT and men having higher VAT. Using established BMI or WC cut-offs, correspondent masses of TAT, SATtotal, SATtrunk and VAT increased from childhood to adulthood. In all age groups, there were positive associations between BMI, WC, SATtrunk, VAT and HOMA-IR. When compared with normative cut-offs of BMI or WC, HOMA-IR-derived cut-offs of regional fat depots were lower in all age groups. Associations between BMI, WC and regional fat depots varied between children, adolescents, young and older adults. When compared with BMI-derived and WC-derived values, an insulin resistance-derived cut-off corresponded to lower masses of regional fat depots. Thus, established BMI and WC cut-offs are not appropriate to assess metabolic disturbances associated with obesity

  3. The cut-off values of anthropometric variables for predicting mild cognitive impairment in Malaysian older adults: a large population based cross-sectional study

    Directory of Open Access Journals (Sweden)

    Won H

    2017-02-01

    Full Text Available Huiloo Won,1 Zahara Abdul Manaf,2 Arimi Fitri Mat Ludin,3 Mohd Azahadi Omar,4 Rosdinom Razali,5 Suzana Shahar2 1Nutrition Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 2Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 3Biomedical Science Program, School of Diagnostic and Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 4Centre for Burden of Disease Research, Institute for Public Health, Ministry of Health Malaysia, 5Department of Psychiatry, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia Purpose: Older adults are at risk of mild cognitive impairment (MCI, and simple anthropometric measurements can be used to screen for this condition. Thus, the aim of this study was to explore the cut-off values of body mass index (BMI and waist circumference (WC for predicting the risk of MCI in older Malaysian adults.Methods: A total of 2,240 Malaysian older adults aged ≥60 years were recruited using multistage random sampling in a population based cross-sectional study. Receiver operating characteristic (ROC curve was used to determine the cut-off values of BMI and WC with optimum sensitivity and specificity for the detection of MCI. Age, gender, years of education, smoking habit, alcohol consumption, depression, and medical conditions were used as confounding factors in this analysis.Results: A BMI cut-off value of 26 kg/m2 (area under the receiver operating characteristic curve [AUC] 0.725; sensitivity 90.5%; specificity 38.8% was appropriate in identifying the risk of getting MCI in both men and women. The optimum WC cut-offs for likelihood of MCI were 90 cm (AUC 0.745; sensitivity 78.0%; specificity 59.8% for men and 82 cm (AUC 0.714; sensitivity 84.3%; specificity 49.7% for women. The optimum calf circumference (CC cut-off values for identifying MCI were 29 cm (AUC 0.731; sensitivity 72.6%; specificity

  4. [The optimal cut-off value of waist-to-height ratio for detecting severe central obesity and low body weight adult Chinese population].

    Science.gov (United States)

    Peng, Ya-guang; Li, Ying; Guo, Min; Tian, Ye; Li, Xiang; Li, Shu-hong; Wu, Yang-feng; Zhao, Lian-cheng

    2013-07-01

    To explore the optimal cut-off values of waist-to-height ratio (WHtR) for detecting the severe central obesity and low body weight in adult Chinese population. A total of 30 630 participants aged 35-59 years from different areas in mainland China were surveyed for cardiovascular diseases risk factors in two independent cross-sectional studies that carried out in 1992-1994 and 1998, respectively. Indices, such as sensitivity, specificity for hypertension, abnormal glucose, high serum total cholesterol, low serum high density lipoprotein cholesterol and clustering of risk factors (number ≥ 2) were calculated to evaluate the efficacy individual cut-off point of WHtR. The cut-off point value for obvious central obesity was fixed on the point whose specificity of the point was gathered more than 90%. And the cut-off point value to indicate low weight was determined by the percentile distribution of WHtR, at which the 5th percentile of point, both in male and female population. Based on the principle of convenient and practical for use, the optimal cut-off point values of WHtR for low weight and obvious central obesity were determined. The cut-off values of WHtR to detect severe central obesity were 0.54 and 0.57 for men and women, respectively. Additionally, the cut-off points of WHtR for each of the 4 cardiovascular risk factors to evaluate the severity separately ranged from 0.54 to 0.55 in male, and ranged from 0.57 to 0.58 in female. The 5th percentile of WHtR, which was the point value of WHtR to indicate low body weight, was 0.40 in both male and female population. Our data suggest that the optimal cut-off value of WHtR for defining severe central obesity and low body weight should be 0.57 and 0.40, respectively.

  5. Simplified scoring of the Actionable 8-item screening questionnaire for neurogenic bladder overactivity in multiple sclerosis: a comparative analysis of test performance at different cut-off points

    OpenAIRE

    Jongen, Peter; Blok, Bertil; Heesakkers, John P.; Heerings, Marco; Lemmens, Wim A.; Donders, Rogier

    2015-01-01

    textabstractBackground: The Actionable questionnaire is an 8-item tool to screen patients with multiple sclerosis (MS) for neurogenic bladder problems, identifying those patients who might benefit from urological referral and bladder-specific treatment. The original scoring yields a total score of 0 to 24 with cut-off point 6. A simplified scoring, yielding a total score of 0 to 8 with cut-off point 3, has been developed in urogynaecological patients, but has not been investigated in MS. Meth...

  6. Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine: a cross-sectional study

    Science.gov (United States)

    Aurrekoetxea, Juan J; Murcia, Mario; Rebagliato, Marisa; López, María José; Castilla, Ane Miren; Santa-Marina, Loreto; Guxens, Mónica; Fernández-Somoano, Ana; Espada, Mercedes; Lertxundi, Aitana; Tardón, Adonina; Ballester, Ferran

    2013-01-01

    Objectives To estimate the prevalence and factors associated with smoking and misclassification in pregnant women from INMA (INfancia y Medio Ambiente, Environment and Childhood) project, Spain, and to assess the optimal cut-offs for urinary cotinine (UC) that best distinguish daily and occasional smokers with varying levels of second-hand smoke (SHS) exposure. Design We used logistic regression models to study the relationship between sociodemographic variables and self-reported smoking and misclassification (self-reported non-smokers with UC >50 ng/ml). Receiver operating characteristic (ROC) curves were used to calculate the optimal cut-off point for discriminating smokers. The cut-offs were also calculated after stratification among non-smokers by the number of sources of SHS exposure. The cut-off points used to discriminate smoking status were the level of UC given by Youden's index and for 50 and 100 ng/ml for daily smokers, or 25 and 50 ng/ml for occasional smokers. Participants At the third trimester of pregnancy, 2263 pregnant women of the INMA Project were interviewed between 2004 and 2008 and a urine sample was collected. Results Prevalence of self-reported smokers at the third trimester of pregnancy was 18.5%, and another 3.9% misreported their smoking status. Variables associated with self-reported smoking and misreporting were similar, including born in Europe, educational level and exposure to SHS. The optimal cut-off was 82 ng/ml (95% CI 42 to 133), sensitivity 95.2% and specificity 96.6%. The area under the ROC curve was 0.986 (95% CI 0.982 to 0.990). The cut-offs varied according to the SHS exposure level being 42 (95% CI 27 to 57), 82 (95% CI 46 to 136) and 106 ng/ml (95% CI 58 to 227) for not being SHS exposed, exposed to one, and to two or more sources of SHS, respectively. The optimal cut-off for discriminating occasional smokers from non-smokers was 27 ng/ml (95% CI 11 to 43). Conclusions Prevalence of smoking during pregnancy in

  7. D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda.

    Science.gov (United States)

    Okello, Samson; Asiimwe, Stephen B; Kanyesigye, Michael; Muyindike, Winnie R; Boum, Yap; Mwebesa, Bosco B; Haberer, Jessica E; Huang, Yong; Williams, Kenneth; Burdo, Tricia H; Tracy, Russell P; Bangsberg, David R; Mocello, A Rain; Martin, Jeffrey N; Hunt, Peter W; Siedner, Mark J

    2016-12-01

    We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda. We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension. In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio. BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population.

  8. Bronchodilator response cut-off points and FEV 0.75 reference values for spirometry in preschoolers.

    Science.gov (United States)

    Burity, Edjane Figueiredo; Pereira, Carlos Alberto de Castro; Jones, Marcus Herbert; Sayão, Larissa Bouwman; Andrade, Armèle Dornelas de; Britto, Murilo Carlos Amorim de

    2016-01-01

    To determine the cut-off points for FEV1, FEV0.75, FEV0.5, and FEF25-75% bronchodilator responses in healthy preschool children and to generate reference values for FEV0.75. This was a cross-sectional community-based study involving children 3-5 years of age. Healthy preschool children were selected by a standardized questionnaire. Spirometry was performed before and after bronchodilator use. The cut-off point of the response was defined as the 95th percentile of the change in each parameter. We recruited 266 children, 160 (60%) of whom were able to perform acceptable, reproducible expiratory maneuvers before and after bronchodilator use. The mean age and height were 57.78 ± 7.86 months and 106.56 ± 6.43 cm, respectively. The success rate for FEV0.5 was 35%, 68%, and 70% in the 3-, 4-, and 5-year-olds, respectively. The 95th percentile of the change in the percentage of the predicted value in response to bronchodilator use was 11.6%, 16.0%, 8.5%, and 35.5% for FEV1, FEV0.75, FEV0.5, and FEF25-75%, respectively. Our results provide cut-off points for bronchodilator responsiveness for FEV1, FEV0.75, FEV0.5, and FEF25-75% in healthy preschool children. In addition, we proposed gender-specific reference equations for FEV0.75. Our findings could improve the physiological assessment of respiratory function in preschool children. Determinar os pontos de corte de resposta ao broncodilatador do VEF1, VEF0,75, VEF0,5 e FEF25-75% em crianças pré-escolares saudáveis e gerar valores de referência para o VEF0,75. Foi realizado um estudo transversal de base comunitária em crianças de 3-5 anos de idade. Pré-escolares saudáveis foram selecionados por um questionário padronizado. Foi realizada espirometria antes e depois do uso de broncodilatador. Foram definidos os pontos de corte dessa resposta como o percentil 95 de variação em cada parâmetro. Foram recrutadas 266 crianças, e 160 (60,0%) foram capazes de gerar manobras expiratórias aceitáveis e reprodut

  9. Normal D-dimer ved dyb venøs trombose i en overekstremitet hos to patienter med pacemaker

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat; Christensen, Jan Kim

    2015-01-01

    Danish guidelines recommend the use of D-dimer to exclude deep venous thrombosis (DVT) in the lower extremities. However, guidelines are lacking for DVT in the upper extremities. We describe two young women with transvenous pacemaker electrodes and symptomatic DVT in related veins. Despite a normal...

  10. Normal D-dimer ved dyb venøs trombose i en overekstremitet hos to patienter med pacemaker

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat; Christensen, Jan Kim

    2015-01-01

    D-dimer, DVT was verified by colour Doppler ultrasound in both cases. The guidelines of American College of Chest Physicians recommend initial evaluation using colour Doppler ultrasound as front-line examination. Accordingly, we suggest a similar revision of Danish guidelines incorporating upper...

  11. Normal D-dimer ved dyb venøs trombose i en overekstremitet hos to patienter med pacemaker

    DEFF Research Database (Denmark)

    Byrne, Christina; Abdulla, Jawdat; Christensen, Jan Kim

    2015-01-01

    Danish guidelines recommend the use of D-dimer to exclude deep venous thrombosis (DVT) in the lower extremities. However, guidelines are lacking for DVT in the upper extremities. We describe two young women with transvenous pacemaker electrodes and symptomatic DVT in related veins. Despite a norm...

  12. Analysis of 2014 Post UTME Score of Candidates in the University of Ibadan with Two Methods of Standard Setting to Set Cut Off Points

    Science.gov (United States)

    Oladele, Babatunde

    2017-01-01

    The aim of the current study is to analyse the 2014 Post UTME scores of candidates in the university of Ibadan towards the establishment of cut off using two methods of standard settings. Prospective candidates who seek admission to higher institution are often denied admission through the Post UTME exercise. There is no single recommended…

  13. Estimation of Saliva Cotinine Cut-Off Points for Active and Passive Smoking during Pregnancy—Polish Mother and Child Cohort (REPRO_PL)

    Science.gov (United States)

    Polanska, Kinga; Krol, Anna; Kaluzny, Pawel; Ligocka, Danuta; Mikolajewska, Karolina; Shaheen, Seif; Walton, Robert; Hanke, Wojciech

    2016-01-01

    A reliable assessment of smoking status has significant public health implications and is essential for research purposes. The aim of this study was to determine optimal saliva cotinine cut-off values for smoking during pregnancy. The analyses were based on data from 1771 women from the Polish Mother and Child Cohort. Saliva cotinine concentrations were assessed by high performance liquid chromatography coupled with tandem mass spectrometry (HPLC-ESI + MS/MS). The saliva cotinine cut-off value for active smoking was established at 10 ng/mL (sensitivity 96%, specificity 95%) and for passive smoking at 1.5 ng/mL (sensitivity 63%, specificity 71%). About 5% of the self-reported non-smoking women were classified as smokers based on the cotinine cut-off value. Significantly more younger, single, and less educated self-reported non-smokers had a cotinine concentration higher than 10 ng/mL compared to those who were older, married, and who had a university degree. Close to 30% of the non-smokers who indicated that smoking was not allowed in their home could be classified as exposed to passive smoking based on the cut-off value. The study suggests that self-reported smoking status is a valid measure of active smoking, whereas in the case of passive smoking, a combination of questionnaire data and biomarker verification may be required. PMID:27941658

  14. Estimation of Saliva Cotinine Cut-Off Points for Active and Passive Smoking during Pregnancy-Polish Mother and Child Cohort (REPRO_PL).

    Science.gov (United States)

    Polanska, Kinga; Krol, Anna; Kaluzny, Pawel; Ligocka, Danuta; Mikolajewska, Karolina; Shaheen, Seif; Walton, Robert; Hanke, Wojciech

    2016-12-08

    A reliable assessment of smoking status has significant public health implications and is essential for research purposes. The aim of this study was to determine optimal saliva cotinine cut-off values for smoking during pregnancy. The analyses were based on data from 1771 women from the Polish Mother and Child Cohort. Saliva cotinine concentrations were assessed by high performance liquid chromatography coupled with tandem mass spectrometry (HPLC-ESI + MS/MS). The saliva cotinine cut-off value for active smoking was established at 10 ng/mL (sensitivity 96%, specificity 95%) and for passive smoking at 1.5 ng/mL (sensitivity 63%, specificity 71%). About 5% of the self-reported non-smoking women were classified as smokers based on the cotinine cut-off value. Significantly more younger, single, and less educated self-reported non-smokers had a cotinine concentration higher than 10 ng/mL compared to those who were older, married, and who had a university degree. Close to 30% of the non-smokers who indicated that smoking was not allowed in their home could be classified as exposed to passive smoking based on the cut-off value. The study suggests that self-reported smoking status is a valid measure of active smoking, whereas in the case of passive smoking, a combination of questionnaire data and biomarker verification may be required.

  15. Criteria to interpret cancer biomarker increments crossing the recommended cut-off compared in a simulation model focusing on false positive signals and tumour detection time

    DEFF Research Database (Denmark)

    Lund, Flemming; Hyltoft Petersen, Per; Pedersen, Merete Frejstrup

    2014-01-01

    BACKGROUND: Several criteria have been proposed to interpret increments in serological cancer biomarker concentrations starting from low baseline concentrations crossing the cut-off. None of the criteria have been compared for their ability to signal tumour growth when ≤2% false positive results ...

  16. Prevalence of the metabolic syndrome and determination of optimal cut-off values of waist circumference in university employees from Angola

    Science.gov (United States)

    Magalhães, Pedro; Capingana, Daniel P; Mill, José G

    2014-01-01

    Summary Background Estimates of the prevalence of the metabolic syndrome in Africans may be inconsistent due to lack of African-specific cut-off values of waist circumference (WC). This study determined the prevalence of the metabolic syndrome and defined optimal values of WC in Africans. Methods This cross-sectional study collected demographic, anthropometric and clinical data of 615 Universitary employees, in Luanda, Angola. The metabolic syndrome was defined using the third report of the National Cholesterol Education Program Adult Treatment Panel (ATPIII) and the Joint Interim Statement (JIS) criteria. Receiver operating characteristics curves were constructed to assess cut-off values of WC. Results The crude prevalence of the metabolic syndrome was higher with the JIS definition (27.8%, age-standardised 14.1%) than with the ATP III definition (17.6%, age-standardised 8.7%). Optimal cut-off values of WC were 87.5 and 80.5 cm in men and women, respectively. Conclusions There was a high prevalence of the metabolic syndrome among our African subjects. Our data suggest different WC cut-off values for Africans in relation to other populations. PMID:24626517

  17. Should the cut-off values of the lymphocyte to monocyte ratio for prediction of prognosis in diffuse large B-cell lymphoma be changed in elderly patients?

    Science.gov (United States)

    Koh, Young Wha; Park, Chan-Sik; Yoon, Dok Hyun; Suh, Cheolwon; Huh, Jooryung

    2014-10-01

    A recent study suggested a prognostic role for the peripheral blood absolute lymphocyte/monocyte ratio (LMR) at diagnosis of diffuse large B-cell lymphoma (DLBCL). Here, we investigated the significance of LMR in DLBCL patients in relation to advanced age. We examined the prognostic impact of LMR in 603 DLBCL treated with rituximab plus CHOP, using the receiver operating characteristic curve analysis for optimal cut-off values, and performed a subgroup analysis according to age. In elderly groups (age ≥ 70), absolute monocyte count was significantly increased, whereas LMR was significantly decreased compared to younger groups. Patients under 70 yr of age with LMR cut-off value (P = 0.059). Therefore, a new LMR cut-off value of 2.36 was selected in elderly patients, having observed that elderly patients with LMR cut-off value of LMR in elderly patients to distinguish high-risk from low-risk groups. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain

    NARCIS (Netherlands)

    Boonstra, Anne M.; Schiphorst Preuper, Henrica R. Schiphorst; Balk, Gerlof A.; Stewart, Roy E.

    2014-01-01

    The aim of this study was to find the cut-off points on the visual analogue scale (VAS) to distinguish among mild, moderate, and severe pain, in relation to the following: pain-related interference with functioning; verbal description of the VAS scores; and latent class analysis for patients with

  19. Afkapwaarden van de 'body-mass index' (BMI) voor ondergewicht van Nederlandse kinderen [Body-mass index cut-off values for underweight in Dutch children

    NARCIS (Netherlands)

    Buuren, S. van

    2004-01-01

    Objective. To determine the cut-off values for the body-mass index (BMI) for underweight and serious underweight in children up to 18 years of age based on the Dutch growth standards of 1980, and to determine the prevalence of underweight and serious underweight in the 1997 Dutch growth-study

  20. D-dimer for the exclusion of cerebral venous thrombosis : A meta-analysis of low risk patients with isolated headache

    NARCIS (Netherlands)

    Alons, Imanda M E; Jellema, Korné; Wermer, Marieke J H; Algra, Ale

    2015-01-01

    Background: Patients with isolated headache may have cerebral venous thrombosis (CVT). D-dimers are proven sensitive in excluding deep venous thrombosis (DVT) and pulmonary embolism (PE) in low risk patients. We aimed to determine whether D-dimer may play the same role in low risk CVT patients with

  1. Establishing cut-off values for apolipoprotein B and non-HDL-C according to LDL-C values in a South European population.

    Science.gov (United States)

    Martinez-Hervas, S; Real, J T; Priego, M A; Carratalá, A; Sniderman, A D; Carmena, R; Ascaso, J F

    2013-01-01

    Low-density lipoprotein cholesterol (LDL-C) remains the primary target of therapy in most strategies of dyslipidaemia management focused on cardiovascular disease prevention. Different guidelines have identified specific LDL-C cut-off points as targets for therapeutic intervention. Many clinical situations characterised by dyslipidaemia and elevated triglycerides are common in our environment and in overall industrialised countries. Thus, lipid goals based only on LDL-C could misclassify an important percentage of subjects. The objective of the present study was to establish cut-off point values for apoB and non-HDL-C in relation to the identified LDL-C cut-off points for cardiovascular risk in a South European population. We performed a cross-sectional study including 1501 subjects (770 women and 731 men) between 18 and 80 years of age. Samples were collected after 12-14 h of fasting. Cholesterol, HDL-C, triglycerides and apoB levels were measured using direct methods. LDL-C was calculated by the Friedewald formula. Non-HDL-C was calculated as total cholesterol minus HDL-C. The Spearman's rank correlations between apoB and LDL-C (r 0.86, p cut-off points for apoB, according to LDL-C goals (70, 100, 130 and 160 mg/dl) in our population are 70, 80, 100 and 115 mg/dl respectively. The proposed cut-off values for non-HDL-C are 100, 120, 150 and 190 mg/dl respectively. The established LDL-C cut-off values could not be accurate to estimate cardiovascular risk in subjects with mild hypertriglyceridaemia, as frequently occurs in our Mediterranean population. To take into consideration the burden of atherogenic particles and better classify patients at risk we propose cut-off values for apoB or the equivalent for non-HDL-C. Prospective trials including cardiovascular variables are needed to validate our assumption. © 2012 Blackwell Publishing Ltd.

  2. Urinary hepcidin identifies a serum ferritin cut-off for iron supplementation in young athletes: a pilot study.

    Science.gov (United States)

    Borrione, P; Spaccamiglio, A; Rizzo, M; Termine, A; Chierto, E; Campostrini, N; Quaranta, F; Di Gianfrancesco, A; Pigozzi, F

    2011-01-01

    The use of iron supplements should be a judicious choice, primarily when considering the possible risks deriving from an unjustified treatment. In trained athletes, levels of ferritin between 15 and 30 microg/L are frequently observed. Within this ferritin range, the usefulness of iron supplementation is still controversial. The aim of the present study is to evaluate the clinical usefulness of hepcidin assessment in the analysis of the iron status of young non-anemic athletes. Fifty young athletes were enrolled. The subjects were divided into 4 groups according to their ferritin levels. No statistically significant difference was found regarding hepcidin levels between athletes with ferritin lower than 15 microg/L and those in the 15-30 microg/L range. Similarly, no difference was found between athletes with ferritin higher than 50 microg/L and those in the 30-50 microg/L range. On the contrary, statistically significant differences were found between athletes with ferritin levels ranging from 15 to 30 microg/L and those in the 30-50 microg/L range. The present study suggests that serum ferritin levels below 30 microg/L indicate an asymptomatic iron deficiency status inhibiting hepcidin expression and that 30 microg/L should be considered the ferritin cut-off when considering an iron supplementation in young athletes.

  3. Optimal Waist Circumference Cut-Off Point for Multiple Risk Factor Aggregation: Results from the Maracaibo City Metabolic Syndrome Prevalence Study

    Directory of Open Access Journals (Sweden)

    Valmore Bermúdez

    2014-01-01

    Full Text Available Context and Objective. The purpose of this study was to determine optimal waist circumference (WC cut-off values for the detection of multiple risk factor aggregation in individuals from Maracaibo, Venezuela. Participants and Methods. A total of 1,902 adult individuals of both genders belonging to MMSPS were included. Complete physical, laboratory, and anthropometric examination were done to evaluate Metabolic Syndrome (MS components and insulin resistance. ROC curves were plotted for risk factor aggregation in order to assess WC cut-off point. Logistic regression models were constructed to assess risk factors associated with the WC. Results. There were 52.2% females and 47.8% males, with WC of 90.7±13.7 cm and 98.2±15.9 cm, respectively. ROC curves exhibited a WC cut-off point for women of 90.25 cm (68.4% sensitivity, 65.8% specificity and 95.15 cm (71.1% sensitivity, 67.4% specificity for men. HOMA2-IR and high blood pressure were associated with a WC over these cut-off points, as well as 2.5-fold risk increase for multiple risk factor aggregation (OR 2.56; CI 95%: 2.05–3.20; P<0.01. Conclusions. These population-specific WC cut-offs are readily applicable tools for detection of risk factor aggregation. Insulin resistance is closely associated with this definition of abdominal obesity, which may serve as a surrogate for its assessment.

  4. Cut-Off Levels of Anti-Mullerian Hormone for The Prediction of Ovarian Response, In Vitro Fertilization Outcome and Ovarian Hyperstimulation Syndrome.

    Science.gov (United States)

    Salmassi, Ali; Mettler, Liselotte; Hedderich, Jurgen; Jonat, Walter; Deenadayal, Anupama; von Otte, Soeren; Eckmann-Scholz, Christel; Schmutzler, Andreas Gerd

    2015-01-01

    Evaluation of anti-mullerian hormone (AMH) cut-off levels in as- sisted reproductive technology (ART) as predictive factor for individualization of stimulation protocols and to avoid ovarian hyperstimulation syndrome (OHSS). In a retrospective study, 177 infertile patients were as- sessed for AMH in serum and follicular fluid (FF) on the day of follicular puncture (FP), between 2012 and 2013 in Kiel, Germany. AMH levels and pregnancy rates were compared between low, moderate and high responders and cut-off levels of low and high responders. AMH cut-off levels in pathological cases were evaluated in analysis 1 (OHSS) and in analysis 2 [polycystic ovarian syndrome, (PCOS)] and compared in analysis 3 to normal endocrinological parameters. AMH levels in FF were higher than in serum (Plow through moderate to high responders (Pcut-off level for poor responders was 0.61 ng/ml in serum with a pregnancy rate of 13.8 and 37.1% for below and above of this level, respectively. For FF, it was 1.43 ng/ml. AMH levels in analysis 1 and 2 were significantly higher than in analysis 3 (P=0.001). AMH cut-off level for OHSS was 1.5 ng/ml in serum with OHSS rates of 80.8 and 19.2 % for above and below of the level, respectively. For FF, it was 2.7 ng/ml. PCOS patients had an AMH cut-off level of 3.9 ng/ml in serum and 6.8 ng/ml in FF, resulting in a PCOS rate of 100% above this level. AMH levels can help to assess ovarian response potential and guide ovarian stimulation while avoiding OHSS.

  5. Optimal cut-off points for two-step strategy in screening of undiagnosed diabetes: a population-based study in China.

    Science.gov (United States)

    Ye, Zhen; Cong, Liming; Ding, Gangqiang; Yu, Min; Zhang, Xinwei; Hu, Ruying; Wu, Jianjun; Fang, Le; Wang, Hao; Zhang, Jie; He, Qingfang; Su, Danting; Zhao, Ming; Wang, Lixin; Gong, Weiwei; Xiao, Yuanyuan; Liang, Mingbin; Pan, Jin

    2014-01-01

    To identify optimal cut-off points of fasting plasma glucose for two-step strategy in screening of undiagnosed diabetes in Chinese people, data were selected from two cross-sectional studies of Metabolic Syndrome in Zhejiang Province of China, Zhejiang Statistical Yearbook (2010), and published literatures. Two-step strategy was used among 17437 subjects sampled from population to screen undiagnosed diabetes. Effectiveness (proportion of cases identified), costs (including medical and non-medical costs), and efficiency (cost per case identified) of these different two-step screening strategies were evaluated. This study found the sensitivities of all the two-step screening strategies with further Oral Glucose Tolerance Test (OGTT) at different Fasting Plasma Glucose (FPG) cut-off points from 5.0 to 7.0 (mmol/L) ranged from 0.66 to 0.91. For the FPG point of 5.0 mmol/L, 91 percent of undiagnosed cases were identified. The total cost of detecting one undiagnosed diabetes case ranged from 547.1 to 1294.5 CNY/case, and the strategy with FPG at cut-off point of 6.1 (mmol/L) resulted in the least cost. Considering both sensitivity and cost of screening diabetes, FPG cut-off point at 5.4 mmol/L was optimized for the two-step strategy. In conclusion, different optimal cut-off points of FPG for two-step strategy in screening of undiagnosed diabetes should be used for different screening purposes.

  6. Adherence to a standardized protocol for measuring grip strength and appropriate cut-off values in adults over 65 years with sarcopenia: a systematic review protocol.

    Science.gov (United States)

    Fox, Benjamin; Henwood, Tim; Schaap, Laura; Bruyère, Olivier; Reginster, Jean-Yves; Beaudart, Charlotte; Buckinx, Fanny; Roberts, Helen; Cooper, Cyrus; Cherubini, Antonio; dellʼAquilla, Giuseppina; Maggio, Marcello; Volpato, Stefano

    2015-10-01

    The objective of this review is to examine the use of grip strength analysis in well and unwell populations in adults 65 years and over as a tool to establish muscle strength in sarcopenia.More specifically, the main review question is:1. What protocol, if any, is most commonly used among older adults with sarcopenia and does this match the standardized protocol suggested in 2011 by Roberts et al.1?Secondary review questions are:2. What are the reported cut-off values being used to determine sarcopenia in older adults, with consideration for ethnic and gender variability?3. Is grip strength, as a tool to measure muscle strength, suitable for people with common comorbidities and geriatric syndromes, such as osteoarthritis, often associated with sarcopenia? Sarcopenia, a commonly used concept in geriatrics and gerontology, is characterized by a loss of muscle mass, muscle strength and/or physical functioning. Prevalence rates vary between 1-39% in community dwelling older populations and 14-33% in long-term care populations. Several epidemiological studies have shown the association of sarcopenia with adverse health outcomes such as falls, disability, hospitalization and mortality. Originally, sarcopenia refers to the loss of muscle mass with aging, which was later complemented with loss of muscle strength and physical functioning.In 2010, the European Working Group on Sarcopenia in Older People (EWGSOP) reported a consensus definition of sarcopenia, which included measurement of low muscle mass and low muscle function (strength or physical performance). This consensus definition can be used to identify sarcopenia patients in clinical practice and to select individuals for clinical trials. Well-designed clinical trials could ultimately lead to effective treatment and prevention strategies for sarcopenia. Since the publication of the consensus report, many studies have adopted this definition, which could potentially lead to better comparison of results between

  7. BMI and waist circumference cut-offs for corresponding levels of insulin sensitivity in a Middle Eastern immigrant versus a native Swedish population – the MEDIM population based study

    Directory of Open Access Journals (Sweden)

    Louise Bennet

    2016-12-01

    Full Text Available Abstract Background The aim of this study was to identify corresponding body mass index (BMI and waist circumference cut-offs for equivalent levels of insulin sensitivity in a Middle Eastern immigrant population compared with native Swedes. Methods Citizens of Malmö, Sweden aged 30 to 75 years, who were born in Iraq or Sweden, were in 2010–2012 invited to participate in a health examination including anthropometrics, oral glucose tolerance test, fasting samples and interviews concerning sociodemographic factors and lifestyle behaviours. Results In total, 1176 individuals born in Iraq and 688 born in Sweden, without previously diagnosed type 2 diabetes, participated in the study. In normal weight participants (BMI < 25 kg/m2, 21.2% of Iraqis vs 9.3% of Swedes were insulin resistant. Corresponding figures in participants without abdominal obesity (waist circumference, men < 94 cm, women < 80 cm were 28.2% of Iraqis vs 9.4% of Swedes. The age-adjusted insulin sensitivity index (ISI for obese Swedes (BMI 30 kg/m2 corresponded in Iraqi men with BMI of 28.5 kg/m2, and in Iraqi women with BMI of 27.5 kg/m2. The ISI level in abdominally obese Swedes corresponded with waist circumference cut-offs of 84.0 cm and 71.0 cm in Iraqi men and women, respectively. In men only, larger waist circumference (Pinteraction = 0.026 presented a stronger association with impaired ISI in Iraqis as compared to Swedes. Conclusions Our data shows that the impact of BMI and waist circumference on ISI is ethnic- and gender-specific, indicating a disturbed fat metabolism in Iraqi males in particular. Our data suggests that 10 cm lower cut-off values for abdominal obesity, than is currently recommended by major organisations, should be considered when estimating diabetes risk in Middle Eastern populations.

  8. Increased tissue factor, MMP-8, and D-dimer expression in diabetic patients with unstable advanced carotid atherosclerosis

    Directory of Open Access Journals (Sweden)

    Jerzy Krupinski

    2007-09-01

    Full Text Available Jerzy Krupinski1,2, Marta M Turu1,2, M Angels Font1, Nesser Ahmed3, Matthew Sullivan3, Ana Luque1,2, Francisco Rubio1, Lina Badimon2, Mark Slevin31Department of Neurology, Stroke Unit, University Hospital of Bellvitge (HUB, Fundacio IDIBELL, Barcelona, Spain; 2Cardiovascular Research Centre, IIBB/CSIC-HSCSP-UAB, Barcelona, Spain; 3School of Biology, Chemistry and Health Science, Manchester Metropolitan University, Manchester, United KingdomAbstract: Advanced atherogenesis is characterized by the presence of markers of enhanced prothrombotic capacity, attenuated fibrinolysis, and by clinical conditions associated with defective coagulation. Diabetes may be associated with enhanced lesion instability and atherosclerotic plaque rupture. Plaques obtained from 206 patients undergoing carotid endarterectomy were divided into diabetic (type 2 and nondiabetic and analyzed by Western blotting and immunohistochemistry to detect tissue factor (TF, metalloproteinases (MMP-2, -8, -9, and fibrin/fibrinogen related antigens, and in situ zymography to detect MMP activity. Plasma samples were quantified for TF procoagulant activity, C-reactive protein, fibrinogen and D-dimer. Diabetic and symptomatic patients with hypoechogenic plaques had increased plasma TF activity and D-dimer, compared with those with hyperechogenic plaques (p = 0.03, p = 0.007, respectively. Diabetic, symptomatic patients had higher plasma D-dimer levels than asymptomatic patients (p = 0.03. There was a significant correlation between intramural TF levels and D-dimer in diabetic patients with symptomatic disease (p = 0.001, r2 = 0.4. In diabetic patients, plasma fibrinogen levels were higher in patients with hypoechogenic plaques (p = 0.007. Diabetic patients with ulcerated plaques had higher plasma D-dimer and MMP-8 levels than those with fibrous plaques (p = 0.02, p = 0.01, respectively. This data suggests that currently available circulating markers may be clinically useful to select

  9. D-D dimer levels in patients with sickle cell disease during bone pain crises and in the steady state

    Directory of Open Access Journals (Sweden)

    Fakunle EE

    2012-05-01

    Full Text Available Eyitayo Emmanuel Fakunle,1 Kapoona Iwara Ibiang Eteng,2 Wuraola Adebola Shokunbi21Department of Pathology, King Edward VII Memorial Hospital, Bermuda; 2Department of Hematology, University College Hospital, Ibadan, NigeriaObjective: To determine the presence of ongoing thrombosis by measuring the D-D dimer levels in bone pain crises (BPCs and in the steady state of patients with sickle cell disease, comparing these levels with those in individuals with normal hemoglobin (HbAA in southwest Nigeria.Study design, patients, and methods: The study design involved 38 patients with homozygous sickle cell anemia (HbSS and 78 adults with the HbAA phenotype, seen at the Hematology Day Care and Accident and Emergency units of the University College Hospital, Ibadan, Nigeria. The TintElize kit was used to quantitatively determine human D-D dimer levels in the plasma with enzyme immunoassay.Results: The mean D-D dimer level measured of the 78 individuals with HbAA was 73.59 ng/mL. The mean D-D dimer level of the patients with HbSS during BPCs was 4002.40 ng/mL, while the mean level in the same patients in the steady state measured 6 weeks after their BPCs, with no other painful crisis episode before the sample was collected, was 1320.00 ng/mL.Conclusion: This study demonstrated a significant increase in the D-D dimer levels of patients with HbSS in the steady state, when compared with those of individuals with HbAA of the same age and sex distribution. There was also an approximate threefold increase in the D-D dimer levels in the same patients with HbSS during BPCs. This confirms the activation of coagulation and fibrinolytic systems in patients with HbSS in the steady state, which is further escalated during BPCs. A multicenter study on the use of anticoagulants in BPCs in patients with sickle cell disease is required.Keywords: anticoagulant, dimer, sickle cell disease, BPC, Nigeria, chronic hemolytic anemia

  10. Evaluation of an Optimal Cut-Off Point for the Ki-67 Index as a Prognostic Factor in Primary Breast Cancer: A Retrospective Study.

    Directory of Open Access Journals (Sweden)

    Rumiko Tashima

    Full Text Available The Ki-67 index is an important biomarker for indicating the proliferation of cancer cells and is considered to be an effective prognostic factor for breast cancer. However, a standard cut-off point for the Ki-67 index has not yet been established. Therefore, the aim of this retrospective study was to determine an optimal cut-off point in order to establish it as a more accurate prognostic factor. Immunohistochemical analysis of the Ki-67 index was performed on 4329 patients with primary breast cancer from August 1987 to March 2012. Out of this sample, there were 3186 consecutive cases from September 1997 with simultaneous evaluations of ER, PgR and HER2 status. Cox's proportional hazard model was used to perform univariate and multivariate analyses of the factors related to OS. The hazard ratios (HR and the p values were then compared to determine the optimal cut-off point for the Ki-67 index. The median Ki-67 index value was 20.5% (mean value 26.2%. The univariate analysis revealed that there was a statistically significant negative correlation with DFS and OS and the multivariate analysis revealed that the Ki-67 index value was a significant factor for DFS and OS. The top seven cut-off points were then carefully chosen based on the results of the univariate analysis using the lowest p-values and the highest HR as the main selection criteria. The multivariate analysis of the factors for OS showed that the cut-off point of 20% had the highest HR in all of the cases. However, the cutoff point of 20% was only a significant factor for OS in the Luminal/HER2- subtype. There was no correlation between the Ki-67 index value and OS in any of the other subtypes. These data indicate that the optimal cut-off point of 20% is the most effective prognostic factor for Luminal/HER2- breast cancer.

  11. Modelling the Turbocharger Cut Off Application Due to Slow Steaming Operation 12RTA96C-B Engine

    Directory of Open Access Journals (Sweden)

    Karsten Wehner

    2017-09-01

    Full Text Available Out of the total operational costs of a ship, fuel costs account for by far the highest proportion. In view of the global economic situation and the rising oil prices, shipowners and charterers are looking for solutions to cut costs by reducing fuel consumption. Low load operation, also well-known as “slow steaming”, represents the currently most effective and popular measure to cut fuel costs and, in consequence, the total operational costs for increased competitiveness in the market. Low load operation is possible and there is an increasing trend to operate in these very low engine load ranges. As the engines were not designed for this operational condition, various retrofit modifications to the engine can compensate for this. By using low load operation, the reduction of the RPM gives problems when sailing at low speed.  A turbocharger (TC compresses inlet air to a high pressure and after cooling this compressed air it results in higher mass of air in the cylinder. But when running at a low power load this air reaches temperatures that are too low for an optimal combustion process. One of the solution comes from the company Wärtsilä. They install so called “low steam engine kits”. When this kit is installed it allows the engine operators to cut off one turbocharger of the engine, this result’s in a higher RPM for the operating turbochargers. When the remaining TC’s have a higher RPM their efficiency improves and gives the engine more air for combustion.The goal of this Bachelor thesis is to make a calculation modelling and prove that by switching off one or more turbocharger on the system will improve the efficiency in slow steaming operation. Beside that, this thesis is aims to estimated the performance of the engine in both operation condition.

  12. Combined Effect of an Atmospheric River and a Cut-off Low in Hiroshima Flooding Event on August 19, 2014

    Science.gov (United States)

    Takayabu, Y. N.; Hirota, N.; Kato, M.; Arakane, S.

    2015-12-01

    An extraordinary precipitation over 100 mmhr-1in Hiroshima on August 19, 2014, caused a flash flood which resulted in 74 fatalities and collapse of 330 houses. In order to examine the meteorological background of this flooding event, we carried out a detailed analysis utilizing rain gauge data, satellite precipitation dataset, and a meso scale and a global scale objective analyses provided from the Japan Meteorological Agency. Then, we performed numerical experiments using a nonhydrostatic compressible equation model called the Cloud-Resolving Storm Simulator (CReSS). As a result, a combined effect of an atmospheric river (AR) and a cut-off low (COL) in this flooding event was elucidated. During the event, a filamentary transport of moisture extending from the Indochina Peninsula to the Japanese Islands was observed along the southern side of the subtropical jet, forming an AR. This AR had a deep structure with an amount of free tropospheric moisture comparable to that of the boundary layer. Concurrently, there was a COL, detached from the Mid-Pacific Trough, moving northwestward toward the Japanese Archipelago. With various sensitivity experiments, we concluded that a mid-tropospheric instability associated with the cold core of the COL and a dynamical ascent induced in its foreside, collaboratively worked with the anomalous moisture in the free troposphere associated with the AR, to extraordinarily enhance the precipitation over Hiroshima region. An orographic effect to concentrate the precipitation in this region was also confirmed. An implication on a difference in effects of AR in this event with a climatologically moist boundary layer, from those in the US west coast with a very dry environment, was also obtained. Acknowledgment: This study is supported by the Environment Research and Technology Development Fund (2-1503) of the Ministry of the Environment, Japan, and by the Ministry of Education, Culture, Sports, Science and Technology, Japan.

  13. Impact of donor age in donation after cardiac death liver transplantation: Is the cut-off "60" still of relevance?

    Science.gov (United States)

    Schlegel, Andrea; Scalera, Irene; Thamara, M; Perera, P R; Kalisvaart, Marit; Mergental, Hynek; Mirza, Darius F; Isaac, John; Muiesan, Paolo

    2017-09-08

    Background Advanced donor age has been identified as risk factor, when combined with donor warm ischemia, e.g. in donation after circulatory death (DCD). In several countries DCD livers, older than 60 years are not considered suitable due to concerns related to poor graft function and development of ischaemic cholangiopathy. We evaluate in this study outcome after DCD liver transplantation using grafts from donors older than 60 years. Methodology We analysed outcome after DCD liver transplantation (n=315), comparing donors >60 years (n=93) and donors ≤60 years (n=222) from our centre between 2005 and 2015. Endpoints included graft function and complications, patient and graft survival. Multivariate risk analysis was performed to define further key factors that predicted inferior outcome. Results Donor age at the cut-off 60 years failed to stratify patient and graft survival. The rate of vascular, biliary and overall complications was comparably low in both cohorts and the median CCI was 42,7 points, independent from the donor age. Secondly, donor BMI above a threshold of 25 kg/m2 significantly impacted on graft and patient survival, at any donor age, while donor warm and cold ischemia times were not predictive for graft loss. Conclusion Older DCD donors can be successfully used for liver transplantation with good long-term outcomes, when further risk factors are limited. Additional risk is transmitted by an increased donor BMI, regardless of donor age. This article is protected by copyright. All rights reserved. © 2017 by the American Association for the Study of Liver Diseases.

  14. D-dimer testing for safe exclusion and risk stratification in patients with acute pulmonary embolism in primary care

    OpenAIRE

    Zhou Yin; Yiyi Chen; Qiong Xie; Zhexin Shao

    2015-01-01

    Background: Safe exclusion and risk stratification are currently recommended for the initial management of patients with acute pulmonary embolism (APE). The aim of this study was to assess the safe exclusion and risk stratification value of D-dimer (DD) for APE when tested at the beginning of admission. Materials and Methods: All consecutive Chinese APE patients and controls were recruited from January 2010 to December 2012. All measurements of serum indexes were made in duplicate and blinded...

  15. Predictive Value of the Number of Harvested Lymph Nodes and Cut-Off for Lymph Node Ratio in the Prognosis of Stage II and III Colorectal Cancer Patients.

    Science.gov (United States)

    Li Destri, Giovanni; Barchitta, Martina; Pesce, Antonio; Latteri, Saverio; Bosco, Dorotea; Di Cataldo, Antonio; Agodi, Antonella; Puleo, Stefano

    2017-10-03

    Purpose/aim: The appropriate staging of colorectal cancer requires at least 12 lymph nodes to be sampled. We evaluated whether lymph node sampling (LNS) and lymph node ratio (LNR) can predict the prognosis of stage II-III patients. This is a retrospective study on 432 patients classified in LNS ≥12 and LNS test, p < 0.001). In the patients with LNS ≥ 12, the cut-off of 0.257 could predict recurrence (specificity 86%). Stage II patients with LNS < 12 tend to have shorter DFS than stage II patients with LNS ≥ 12. In stage III patients, an appropriate LNR cut-off is a better prognostic predictor than LNR quartile, especially in patients with LNS ≥ 12.

  16. Discordant Diagnoses of Acute Myocardial Infarction due to the Different Use of Assays and Cut-Off Points of Cardiac Troponins

    DEFF Research Database (Denmark)

    Lyck Hansen, Maria; Saaby, Lotte; Nybo, Mads

    2012-01-01

    receiving patients with suspected acute MI to gather information about the assay and cut-off value used. cTn was measured in blood samples from 574 patients enrolled into the Odense Chest Pain Biobank with 3 different assays: the 4th generation cTnT (cTnT(4th)), high-sensitivity cTnT (cTnT(hs); Roche...

  17. Addenbrooke’s Cognitive Examination and Individual Domain Cut-Off Scores for Discriminating between Different Cognitive Subtypes of Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Dagmar Berankova

    2015-01-01

    Full Text Available Objective. The main aim of this study was to verify the sensitivity and specificity of Addenbrooke’s Cognitive Examination-Revised (ACE-R in discriminating between Parkinson’s disease (PD with normal cognition (PD-NC and PD with mild cognitive impairment (PD-MCI and between PD-MCI and PD with dementia (PD-D. We also evaluated how ACE-R correlates with neuropsychological cognitive tests in PD. Methods. We examined three age-matched groups of PD patients diagnosed according to the Movement Disorder Society Task Force criteria: PD-NC, PD-MCI, and PD-D. ROC analysis was used to establish specific cut-off scores of ACE-R and its domains. Correlation analyses were performed between ACE-R and its subtests with relevant neuropsychological tests. Results. Statistically significant differences between groups were demonstrated in global ACE-R scores and subscores, except in the language domain. ACE-R cut-off score of 88.5 points discriminated best between PD-MCI and PD-NC (sensitivity 0.68, specificity 0.91; ACE-R of 82.5 points distinguished best between PD-MCI and PD-D (sensitivity 0.70, specificity 0.73. The verbal fluency domain of ACE-R demonstrated the best discrimination between PD-NC and PD-MCI (cut-off score 11.5; sensitivity 0.70, specificity 0.73 while the orientation/attention subscore was best between PD-MCI and PD-D (cut-off score 15.5; sensitivity 0.90, specificity 0.97. ACE-R scores except for ACE-R language correlated with specific cognitive tests of interest.

  18. Cerebrospinal fluid neopterin analysis in neuropediatric patients: establishment of a new cut off-value for the identification of inflammatory-immune mediated processes.

    Directory of Open Access Journals (Sweden)

    Marta Molero-Luis

    Full Text Available OBJECTIVE: A high level of cerebrospinal fluid (CSF neopterin is a marker of central nervous system inflammatory-immune mediated processes. We aimed to assess data from 606 neuropediatric patients, describing the clinical and biochemical features of those neurological disorders presenting CSF neopterin values above a new cut-off value that was defined in our laboratory. METHODS: To establish the new CSF neopterin cut-off value, we studied two groups of patients: Group 1 comprised 68 patients with meningoencephalitis, and Group 2 comprised 52 children with a confirmed peripheral infection and no central nervous system involvement. We studied 606 CSF samples from neuropediatric patients who were classified into 3 groups: genetic diagnosis (A, acquired/unknown etiologic neurologic diseases (B and inflammatory-immune mediated processes (C. RESULTS: The CSF neopterin cut-off value was 61 nmol/L. Out of 606 cases, 56 presented a CSF neopterin level above this value. Group C had significantly higher CSF neopterin, protein and leukocyte values than the other groups. Sixteen of twenty-three patients in this group had a CSF neopterin level above the cut-off, whereas three and seven patients presented increased leukocyte and protein values, respectively. A significant association was found among CSF neopterin, proteins and leukocytes in the 606 patients. White matter disturbances were associated with high CSF neopterin concentrations. CONCLUSIONS: Although children with inflammatory-immune mediated processes presented higher CSF neopterin values, patients with other neurological disorders also showed increased CSF neopterin concentrations. These results stress the importance of CSF neopterin analysis for the identification of inflammatory-immune mediated processes.

  19. Survival functions for defining a clinical management Lost To Follow-Up (LTFU) cut-off in Antiretroviral Therapy (ART) program in Zomba, Malawi.

    Science.gov (United States)

    Rachlis, Beth; Cole, Donald C; van Lettow, Monique; Escobar, Michael

    2016-05-05

    While, lost to follow-up (LTFU) from antiretroviral therapy (ART) can be considered a catch-all category for patients who miss scheduled visits or medication pick-ups, operational definitions and methods for defining LTFU vary making comparisons across programs challenging. Using weekly cut-offs, we sought to determine the probability that an individual would return to clinic given that they had not yet returned in order to identify the LTFU cut-off that could be used to inform clinical management and tracing procedures. Individuals who initiated ART with Dignitas International supported sites (n = 22) in Zomba, Malawi between January 1 2007-June 30 2010 and were ≥ 1 week late for a follow-up visit were included. Lateness was categorized using weekly cut-offs from ≥1 to ≥26 weeks late. At each weekly cut-off, the proportion of patients who returned for a subsequent follow-up visit were identified. Cumulative Distribution Functions (CDFs) were plotted to determine the probability of returning as a function of lateness. Hazard functions were plotted to demonstrate the proportion of patients who returned each weekly interval relative to those who had yet to return. In total, n = 4484 patients with n = 7316 follow-up visits were included. The number of included follow-up visits per patient ranged from 1-10 (median: 1). Both the CDF and hazard function demonstrated that after being ≥9 weeks late, the proportion of new patients who returned relative to those who had yet to return decreased substantially. We identified a LTFU definition useful for clinical management. The simple functions plotted here did not require advanced statistical expertise and were created using Microsoft Excel, making it a particularly practical method for HIV programs in resource-constrained settings.

  20. Cut-off value for normal versus abnormal right-to-left shunt percentages using (99m)Tc-macroaggregated albumin.

    Science.gov (United States)

    Ito, Kimiteru; Kurihara, Kyoko; Ishibashi, Akihiko; Morooka, Miyako; Mitsumoto, Takuya; Minamimoto, Ryogo; Kubota, Kazuo

    2011-10-01

    To determine the cut-off value for distinguishing a normal versus an abnormal right-to-left shunt percentage on lung perfusion scintigraphy using (99m)Tc-macroaggregated albumin (MAA). Fifty-three patients (eight patients with a right-to-left shunt and 45 without a right-to-left shunt) who underwent MAA whole-body imaging for the evaluation of right-to-left shunts were divided into group 1 (eight patients with brain MAA uptake) and group 2 (45 patients without brain MAA uptake). Moreover, group 2 was subdivided into two categories (groups 2a and 2b) based on the results of lung computed tomography, electrocardiography examinations, and pulmonary function tests. The average and standard deviation (SD) of each group were compared. In addition, we estimated the cut-off value for a normal right-to-left shunt percentage using whole-body imaging. The average right-to-left shunt percentage values and SD were 23.67±12.17% in group 1, 6.68±1.04% in group 2a, and 6.60±0.84% in group 2b. The shunt percentages of groups 2a and 2b were not significantly different (P=0.77). The estimated normal value (mean±2 SD) of group 2 was 6.64±0.94%. Meanwhile, the cut-off value was estimated as 10% based on the distributions of MAA shunt percentages for groups 1 and 2. The normal range (mean±2 SD) was 6.64±1.88%. The cut-off value for the normal right-to-left shunt percentage in MAA scintigraphy was 10%.

  1. Determining the cut-off point of osteoporosis based on the osteoporosis self-assessment tool, body mass index and weight in Taiwanese young adult women.

    Science.gov (United States)

    Chang, Shu Fang; Yang, Rong Sen

    2014-09-01

    To examine the cut-off point of the osteoporosis self-assessment tool, age, weight and body mass index for osteoporosis among young adult Taiwanese women, using a large-scale health examination database containing bone mineral density tests. The cut-off points of osteoporosis risk factors identified earlier focus on menopausal or senior Caucasian and Asian women. However, young adult Asian women have seldom been identified. A retrospective historical cohort study. Using the 2009-2011 health examination database of a large-scale medical centre in northern Taiwan, this study investigated young adult Asian women (i.e. range in age from 30-49 years) in Taiwan who had received dual-energy X-ray absorptiometry test. This study also explored the cut-off point, sensitivity, specificity and diagnostic accuracy of receiver operating characteristics of osteoporosis among young adult females in Taiwan. This study collected 2454 young adult Asian women in Taiwan. Cochran-Armitage analysis results indicated that the prevalence of osteoporosis increased with decreasing weight, body mass index and osteoporosis self-assessment method quartiles. According to the results of receiver operating characteristics, weight, body mass index and osteoporosis self-assessment tool approaches can generally be used as indicators to predict osteoporosis among young adult Asian women. Results of this study demonstrate that Taiwanese women contracting osteoporosis tend to be young and underweight, as well as having a low body mass index and osteoporosis self-assessment scores. Those results further suggest that the assessment indicators for cut-off points are appropriately suitable for young adult women in Taiwan. Early detection is the only available means of preventing osteoporosis. Professional nurses should apply convenient and accurate assessment procedures to help young adult women to adopt preventive strategies against osteoporosis early, thus eliminating the probability of osteoporotic

  2. Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic musculoskeletal pain.

    Science.gov (United States)

    Boonstra, Anne M; Schiphorst Preuper, Henrica R; Balk, Gerlof A; Stewart, Roy E

    2014-12-01

    The aim of this study was to find the cut-off points on the visual analogue scale (VAS) to distinguish among mild, moderate, and severe pain, in relation to the following: pain-related interference with functioning; verbal description of the VAS scores; and latent class analysis for patients with chronic musculoskeletal pain. A total of 456 patients were included. Pain was assessed using the VAS and verbal rating scale; functioning was assessed using the domains of the Short Form (36) Health Survey (SF-36). Eight cut-off point schemes were tested using multivariate analysis of variance (MANOVA), ordinal logistic regression, and latent class analysis. The study results showed that VAS scores ⩽ 3.4 corresponded to mild interference with functioning, whereas 3.5 to 6.4 implied moderate interference, and ⩾ 6.5 implied severe interference. VAS scores ⩽ 3.4 were best described for patients with chronic musculoskeletal pain as mild pain, 3.5 to 7.4 as moderate pain, and ⩾ 7.5 as severe pain. Latent class analysis found that a 3-class solution fitted best, resulting in the classes 0.1 to 3.8, 3.9 to 5.7, and 5.8 to 10 cm. Findings from our study agree with those of some other studies, although many other studies found different optimal cut-off point schemes. As there appear to be no universally accepted cut-off points, and in view of the low-to-moderate associations between VAS scores and functioning and between VAS and verbal rating scale scores, the correct classification of VAS scores as mild, moderate. or severe in clinical practice seems doubtful. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  3. Cut-off points of quadriceps strength, declines and relationships of sarcopenia-related variables among Thai community-dwelling older adults.

    Science.gov (United States)

    Assantachai, Prasert; Muangpaisan, Weerasak; Intalapaporn, Somboon; Sitthichai, Kobkul; Udompunturak, Suthipol

    2014-02-01

    To define quadriceps strength cut-off points for both sexes to be used in the working diagnosis of sarcopenia in older Asian people, and to investigate the age-related declines of sarcopenia-related variables and correlations between those variables among community-dwelling older adults. The present 3-year prospective study was a part of the Bangkok Longitudinal Study by Siriraj Hospital for Older Men and Women. Data on 2149 participants aged ≥ 60 years were included in this analysis. The quadriceps strength cut-off points, identified based on mobility decline over 2 years of follow up, were 18.0 kg for men and 16.0 kg for women. When these cut-off points were applied to the whole population aged ≥ 60 years (n = 950), the low quadriceps strength group had poorer results on all clinical variables when compared with the normal quadriceps strength group. Although nearly all of the sarcopenia-related variables declined over 2 years of follow up in both older men and women, more significant differences between age groups were seen in older women. Quadriceps strength had the highest degree of correlation with total lean body mass in all age groups (r = 0.550-0.584, P cut-off points of 18.0 kg for older men and 16.0 kg for older women would be useful as a muscle strength measurement for use in any diagnostic algorithm; for example, sarcopenia diagnosis in older Asian people. © 2014 Japan Geriatrics Society.

  4. Prognostic value of different cut-off levels of Ki-67 in breast cancer: a systematic review and meta-analysis of 64,196 patients.

    Science.gov (United States)

    Petrelli, Fausto; Viale, G; Cabiddu, M; Barni, S

    2015-10-01

    A proliferative marker, expressed as the percentage of cells in a cell cycle, has been developed and used as a discriminant of more aggressive malignant phenotypes in early breast cancer (BC). The marker is usually expressed by the immunohistochemical staining of the cell cycle antigen Ki-67. It has not, however, yet been definitely evaluated, due to methodological concerns, which specific Ki-67 cut-off provide the strongest prognostic information in resected BC. We conducted a meta-analysis to explore the prognostic value of different cut-off levels of Ki-67 in terms of overall survival (OS) and disease-free survival (DFS) in early BC. The databases of PubMed, the ISI Web of Science, EMBASE, SCOPUS, the Cochrane Central Register of Controlled Trials, and CINHAL were used to identify the relevant literature. Data from studies reporting a hazard ratio (HR) and a 95 % confidence interval (CI) calculated as a multivariate analysis were pooled in a meta-analysis, with metaregression used to test for trends in predefined subgroups. All the statistical tests were 2-sided. Forty-one studies encompassing 64,196 BC patients were included in the analysis. Overall, n = 25 studies were available for the OS analysis. The pooled HR for high versus low Ki-67 was 1.57 (95 % CI 1.33-1.87, P low Ki-67 was 1.50 (95 % CI 1.34-1.69, P cut-off of Ki-67 staining ≥ 25 % was used, the pooled HR for OS was 2.05 (95 % CI 1.66-2.53, P low Ki-67 was similar and significant (HR = 1.51, 95 % CI 1.25-1.81, P cut-off >25 % is associated with a greater risk of death compared with lower expression rates.

  5. Cut-off optimization for (13)C-urea breath test in a community-based trial by mathematic, histology and serology approach.

    Science.gov (United States)

    Li, Zhe-Xuan; Huang, Lei-Lei; Liu, Cong; Formichella, Luca; Zhang, Yang; Wang, Yu-Mei; Zhang, Lian; Ma, Jun-Ling; Liu, Wei-Dong; Ulm, Kurt; Wang, Jian-Xi; Zhang, Lei; Bajbouj, Monther; Li, Ming; Vieth, Michael; Quante, Michael; Zhou, Tong; Wang, Le-Hua; Suchanek, Stepan; Soutschek, Erwin; Schmid, Roland; Classen, Meinhard; You, Wei-Cheng; Gerhard, Markus; Pan, Kai-Feng

    2017-05-18

    The performance of diagnostic tests in intervention trials of Helicobacter pylori (H.pylori) eradication is crucial, since even minor inaccuracies can have major impact. To determine the cut-off point for (13)C-urea breath test ((13)C-UBT) and to assess if it can be further optimized by serologic testing, mathematic modeling, histopathology and serologic validation were applied. A finite mixture model (FMM) was developed in 21,857 subjects, and an independent validation by modified Giemsa staining was conducted in 300 selected subjects. H.pylori status was determined using recomLine H.pylori assay in 2,113 subjects with a borderline (13)C-UBT results. The delta over baseline-value (DOB) of 3.8 was an optimal cut-off point by a FMM in modelling dataset, which was further validated as the most appropriate cut-off point by Giemsa staining (sensitivity = 94.53%, specificity = 92.93%). In the borderline population, 1,468 subjects were determined as H.pylori positive by recomLine (69.5%). A significant correlation between the number of positive H.pylori serum responses and DOB value was found (rs = 0.217, P mathematical approach such as FMM might be an alternative measure in optimizing the cut-off point for (13)C-UBT in community-based studies, and a second method to determine H.pylori status for subjects with borderline value of (13)C-UBT was necessary and recommended.

  6. Ability of cervical length to predict spontaneous preterm delivery in twin pregnancies using the receiver-operating characteristic curve analysis and an a priori cut-off value.

    Science.gov (United States)

    Pasquini, Lucia; Sisti, Giovanni; Nasioudis, Dimitrios; Kanninen, Tomi; Sorbi, Flavia; Fambrini, Massimiliano; Turrini, Irene; Seravalli, Viola; Di Tommaso, Mariarosaria

    2017-07-01

    In this retrospective study based on cervical length (CL) measurements between 20 and 24 + 6 weeks, we examined the ability of CL to predict spontaneous preterm birth (SPTB) in 222 twin pregnancies using the receiver-operating curve (ROC) analysis and an a priori cut-off. CL predicted SPTB before 34 weeks. Using the ROC the selected cut-off was 37.5 mm. Positive predictive value (PPV) and negative predictive value (NPV) regarding SPTB before 34 weeks for 37.5 mm were 15.7% and 5.3% respectively. Using the 5th percentile, PPV and NPV regarding SPTB before 34 weeks for 24 mm were 41.7% and 91.4%, respectively. The 5th centile of CL measurements should be employed in clinical practice. CL measurement is an adequate screening tool for SPTB since it has a high NPV. Studies on CL measurement and SPTB should explain which methodology they adopted to obtain a cut-off value and the rationale of their choice.

  7. Clinical cut-offs for HIV-1 phenotypic resistance estimates: update based on recent pivotal clinical trial data and a revised approach to viral mixtures.

    Science.gov (United States)

    Winters, Bart; Van Craenenbroeck, Elke; Van der Borght, Koen; Lecocq, Pierre; Villacian, Jorge; Bacheler, Lee

    2009-12-01

    The clinical utility of HIV-1 resistance testing is dependent upon accurate interpretation and application of results. The development of clinical cut-offs (CCOs) for most HIV antiretroviral drugs assessed by the vircoTYPE HIV-1 resistance test has been described previously. Updated CCOs based on new methodology and new data from clinical cohorts and pivotal clinical studies are presented in this communication. Data for analysis included the original records for CCO derivation from eight clinical trials and two cohort studies plus new records from the clinical cohorts and from the TITAN, POWER, and DUET clinical studies. Drug-specific linear regression models were developed to describe the relationship between baseline characteristics (phenotypic resistance as estimated by virtualPhenotype-LM using methods revised recently for handling mixed viral sequences; viral load; and treatment history), new treatment regimen, and 8-week virologic outcome. The clinical cut-offs were defined as the estimated phenotypic resistance levels (fold change, FC) associated with a 20% and 80% loss of drug activity. The development dataset included 6550 records with an additional 2299 reserved for validation. The updated, v.4.2 CCOs were generally close to the v4.1 values, with a trend observed toward marginally higher cut-offs for the NRTIs. These results suggest that the updated CCOs provide a relevant tool for estimating the contribution to virological response of individual antiviral drugs in antiretroviral drug combinations as used currently in clinical practice.

  8. The absolute percent deviation of IGHV mutation rather than a 98% cut-off predicts survival of chronic lymphocytic leukaemia patients treated with fludarabine, cyclophosphamide and rituximab.

    Science.gov (United States)

    Jain, Preetesh; Nogueras González, Graciela M; Kanagal-Shamanna, Rashmi; Rozovski, Uri; Sarwari, Nawid; Tam, Constantine; Wierda, William G; Thompson, Philip A; Jain, Nitin; Luthra, Rajyalakshmi; Quesada, Andres; Sanchez-Petitto, Gabriela; Ferrajoli, Alessandra; Burger, Jan; Kantarjian, Hagop; Cortes, Jorge; O'Brien, Susan; Keating, Michael J; Estrov, Zeev

    2018-01-01

    The degree of somatic hypermutation, determined as percent deviation of immunoglobulin heavy chain gene variable region sequence from the germline (IGHV%), is an important prognostic factor in chronic lymphocytic leukaemia (CLL). Currently, a cut-off of 2% deviation or 98% sequence identity to germline in IGHV sequence is routinely used to dichotomize CLL patients into mutated and unmutated groups. Because dissimilar IGHV% cut-offs of 1-5% were identified in different studies, we wondered whether no cut-off should be applied and IGHV% treated as a continuous variable. We analysed the significance of IGHV% in 203 CLL patients enrolled on the original frontline fludarabine, cyclophosphamide and rituximab (FCR) trial with a median of 10 years follow-up. Using the Cox Proportional Hazard model, IGHV% was identified as a continuous variable that is significantly associated with progression-free (PFS) and overall survival (OS) (P < 0·001). Furthermore, we validated this finding in 323 patients treated with FCR off-protocol and in the total cohort (n = 535). Multivariate analysis revealed a continuous trend. Higher IGHV% levels were incrementally associated with favorable PFS and OS in both FCR-treated cohorts (P < 0·001, both cohorts). Taken together, our data suggest that IGHV% is a continuous variable in CLL patients treated with FCR. © 2017 John Wiley & Sons Ltd.

  9. Validation of a BMI cut-off point to predict an adverse cardiometabolic profile with adiposity measurements by dual-energy X-ray absorptiometry in Guatemalan children.

    Science.gov (United States)

    Redondo, Olga; Villamor, Eduardo; Valdés, Javiera; Bilal, Usama; Caballero, Benjamín; Roche, Dina; Kroker, Fernanda; Ramírez-Zea, Manuel; Franco, Manuel

    2015-04-01

    To identify a body fat percentage (%BF) threshold related to an adverse cardiometabolic profile and its surrogate BMI cut-off point. Cross-sectional study. Two public schools in poor urban areas on the outskirts of Guatemala City. A convenience sample of ninety-three healthy, prepubertal, Ladino children (aged 7-12 years). Spearman correlations of cardiometabolic parameters were higher with %BF than with BMI-for-age Z-score. BMI-for-age Z-score and %BF were highly correlated (r=0·84). The %BF threshold that maximized sensitivity and specificity for predicting an adverse cardiometabolic profile (elevated homeostasis model assessment-insulin resistance index and/or total cholesterol:HDL-cholesterol ratio) according to receiver operating characteristic curve analysis was 36 %. The BMI-for-age Z-score cut-off point that maximized the prediction of BF ≥ 36 % by the same procedure was 1·5. The area under the curve (AUC) for %BF and for BMI data showed excellent accuracy to predict an adverse cardiometabolic profile (AUC 0·93 (sd 0·04)) and excess adiposity (AUC 0·95 (sd 0·02)). Since BMI standards have limitations in screening for adiposity, specific cut-off points based on ethnic-/sex- and age-specific %BF thresholds are needed to better predict an adverse cardiometabolic profile.

  10. External validation of cut-off points for foveal thickness taking into account the intraretinal fluid using optical coherence tomography to diagnose diabetic macular oedema.

    Science.gov (United States)

    Hernández-Martínez, Carmen; Palazón-Bru, Antonio; Azrak, Cesar; Navarro-Navarro, Aída; Baeza-Díaz, Manuel Vicente; Martínez-Toldos, José Juan; Gil-Guillén, Vicente Francisco

    2017-01-01

    In late 2015, cut-off points were published for foveal thickness to diagnose diabetic macular oedema taking into account the presence of intraretinal fluid using optical coherence tomography (OCT) in primary care patients (90 µm in the presence of intraretinal fluid and 310 µm otherwise). This cross-sectional observational study was carried out on 134 eyes of diabetic patients treated in specialised ophthalmology services in a Spanish region in 2012-2013, to externally validate the aforementioned cut-off points. The main variable (Clinical Standard) was the diagnosis of macular oedema through indirect ophthalmoscopy and posterior segment slit-lamp biomicroscopy. As validation variables, both the foveal thickness and the presence of intraretinal fluid obtained by OCT were used. Validation was performed using bootstrapping by calculating the area under the ROC curve (AUC), sensitivity, specificity, positive likelihood ratio (PLR) and negative likelihood ratio (NLR). Forty-one eyes presented diabetic macular oedema (30.6%). The bootstrapping validation parameters were: AUC, 0.88; sensitivity, 0.75; specificity, 0.95; PLR, 14.31; NLR, 0.26. These values were very similar to those of the original publication. We have externally validated in specialised care patients the cut-off points published for the diagnosis of diabetic macular oedema. We suggest that others carry out validation studies in their communities.

  11. Prevalence of body mass index and body weight cut-off points for in vitro fertilization treatment at U.S. clinics and current clinic weight loss strategy recommendations.

    Science.gov (United States)

    Turner-McGrievy, Gabrielle M; Grant, Breănna L

    2015-09-01

    The goal of this study was to determine how many clinics providing in vitro fertilization (IVF) in the United States require a body mass index (BMI) or body weight cut-off point to determine treatment eligibility. US clinics listed as members on the Society of Assisted Reproduction website in late 2013 were contacted by phone between January and March 2014. Clinic personnel were asked if a BMI or body weight cut-off points was used to determine IVF treatment eligibility and what strategies they recommended for their patients to achieve a healthy body weight. Of the 379 clinics contacted, 347 responded (92% response rate) and 35% (n = 120) reported using a BMI or body weight cut-off points to determine eligibility for IVF treatment. Mean BMI (± SD) cut-off points was 38.4 ± 5.2 kg/m(2) and mean body weight (± SD) cut-off points was 130.2 ± 14.8 kg. Of the clinics using a set cut-off points, half (46%) provided no weight loss recommendations for patients. A sizable portion of US IVF clinics report a required or preferred BMI or body weight cut-off points for treatment. Despite this, most clinics did not provide a recommended program or approach for weight loss with very few clinics reporting an in-house program.

  12. Determining a Cut-Off Point for Scores of the Breastfeeding Self-Efficacy Scale-Short Form: Secondary Data Analysis of an Intervention Study in Japan.

    Directory of Open Access Journals (Sweden)

    Keiko Nanishi

    Full Text Available Breastfeeding self-efficacy can be measured with the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF. Mothers with low BSES-SF scores stop exclusive breastfeeding prematurely, but specific interventions can prevent that undesirable outcome. Because those interventions can be expensive, often one must decide which mothers will receive them. For that purpose, a cut-off BSES-SF score would be useful, but none is available. Therefore, we aimed to assess the overall accuracy of BSES-SF scores as predictors of not practicing post-discharge exclusive breastfeeding, and to choose an appropriate cut-off score for making that prediction.This is a secondary data analysis of an intervention study. Data from 378 women in two non-Baby-Friendly Hospitals were analyzed. Participants were women in their third trimester who were 16 years of age or older, were able to read and write Japanese, were expected to have a singleton birth, and had completed the BSES-SF before discharge. BSES-SF scores were measured before discharge. Breastfeeding status was assessed 4 weeks and 12 weeks postpartum. Receiver Operating Characteristic (ROC curves were used to assess the predictive ability of the BSES-SF and to inform the choice of a cut-off point.For both of the ROC curves (4 and 12 weeks postpartum the area under the curve was 0.74. To obtain a high sensitivity, a cut-off score of 50 was chosen. With that cut-off score the sensitivity was 79% and the specificity was 52% 4 weeks postpartum, and they were 77% and 52%, respectively, 12 weeks postpartum.In conclusion, the BSES-SF has moderate overall accuracy to distinguish women who will not practice exclusive breastfeeding after discharge from those who will. At non-Baby-Friendly hospitals in Japan, interventions to support exclusive breastfeeding might be considered for new mothers who have BSES-SF scores that are less than or equal to 50.

  13. Prognostic impact of proliferation for resected early stage 'pure' invasive lobular breast cancer: Cut-off analysis of Ki67 according to histology and clinical validation.

    Science.gov (United States)

    Carbognin, Luisa; Sperduti, Isabella; Fabi, Alessandra; Dieci, Maria Vittoria; Kadrija, Dzenete; Griguolo, Gaia; Pilotto, Sara; Guarneri, Valentina; Zampiva, Ilaria; Brunelli, Matteo; Orvieto, Enrico; Nortilli, Rolando; Fiorio, Elena; Parolin, Veronica; Manfrin, Erminia; Caliò, Anna; Nisticò, Cecilia; Pellini, Francesca; Scarpa, Aldo; Pollini, Giovanni Paolo; Conte, Pierfranco; Tortora, Giampaolo; Bria, Emilio

    2017-10-01

    The intent of this analysis was to investigate and validate the prognostic potential of Ki67 in a multi-center series of patients affected by early stage 'pure' invasive lobular carcinoma (ILC). Clinical-pathological data of patients affected by ILC were correlated with overall survival and disease-free survival (OS/DFS); data from a parallel invasive ductal carcinoma (IDC) patients' cohort were gathered as well. The maximally selected Log-Rank statistics analysis was applied to Ki67 continuous variable to estimate the appropriate cut-off. The Subpopulation Treatment Effect Pattern Plot (STEPP) analysis was performed as well. Data from overall 1097 (457/222 ILC: training/validation set; 418 IDC) patients were gathered. The identified optimal Ki67 cut-offs were 4% and 14% for DFS in ILC and IDC cohort, respectively. In ILC patients, the Ki67 cut-off was an independent OS predictor. Ten-years OS and DFS were 89.9% and 77.2% (p = 0.007) and 79.4% and 69.2% (p = 0.03) for patients with Ki67 ≤ 4% and >4%, respectively. In IDC patients, 10-years OS was 93.8% and 71.7%, p = 0.02, DFS was 84.0% and 52.6%, p = 0.0003, for patients with Ki67 ≤ 14% and >14%, respectively. In the validation set, the optimal Ki67 OS cut-off was 5%. The STEPP analysis showed that in the presence of low Ki67 values, IDC patients have a better DFS than ILC patients, while with the increase of values the prognosis tends to overlap. Despite the retrospective design of the study, the prognostic relevance of Ki67 (as well as its optimal cut-off) seems to significantly differ according to breast cancer histology. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. The Cut-Off Point and Boundary Values of Waist-to-Height Ratio as an Indicator for Cardiovascular Risk Factors in Chinese Adults from the PURE Study.

    Science.gov (United States)

    Peng, Yaguang; Li, Wei; Wang, Yang; Bo, Jian; Chen, Hui

    2015-01-01

    To explore a scientific boundary of WHtR to evaluate central obesity and CVD risk factors in a Chinese adult population. The data are from the Prospective Urban Rural Epidemiology (PURE) China study that was conducted from 2005-2007. The final study sample consisted of 43 841 participants (18 019 men and 25 822 women) aged 35-70 years. According to the group of CVD risk factors proposed by Joint National Committee 7 version and the clustering of risk factors, some diagnosis parameters, such as sensitivity, specificity and receiver operating characteristic (ROC) curve least distance were calculated for hypertension, diabetes, high serum triglyceride (TG), high serum low density lipoprotein cholesterol (LDL-C), low serum high density lipoprotein cholesterol (HDL-C) and clustering of risk factors (number≥2) to evaluate the efficacy at each value of the WHtR cut-off point. The upper boundary value for severity was fixed on the point where the specificity was above 90%. The lower boundary value, which indicated above underweight, was determined by the percentile distribution of WHtR, specifically the 5th percentile (P5) for both males and females population. Then, based on convenience and practical use, the optimal boundary values of WHtR for underweight and obvious central obesity were determined. For the whole study population, the optimal WHtR cut-off point for the CVD risk factor cluster was 0.50. The cut-off points for severe central obesity were 0.57 in the whole population. The upper boundary values of WHtR to detect the risk factor cluster with specificity above 90% were 0.55 and 0.58 for men and women, respectively. Additionally, the cut-off points of WHtR for each of four cardiovascular risk factors with specificity above 90% in males ranged from 0.55 to 0.56, whereas in females, it ranged from 0.57 to 0.58. The P5 of WHtR, which represents the lower boundary values of WHtR that indicates above underweight, was 0.40 in the whole population. WHtR 0.50 was an

  15. Determining a Cut-Off Point for Scores of the Breastfeeding Self-Efficacy Scale-Short Form: Secondary Data Analysis of an Intervention Study in Japan.

    Science.gov (United States)

    Nanishi, Keiko; Green, Joseph; Taguri, Masataka; Jimba, Masamine

    2015-01-01

    Breastfeeding self-efficacy can be measured with the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Mothers with low BSES-SF scores stop exclusive breastfeeding prematurely, but specific interventions can prevent that undesirable outcome. Because those interventions can be expensive, often one must decide which mothers will receive them. For that purpose, a cut-off BSES-SF score would be useful, but none is available. Therefore, we aimed to assess the overall accuracy of BSES-SF scores as predictors of not practicing post-discharge exclusive breastfeeding, and to choose an appropriate cut-off score for making that prediction. This is a secondary data analysis of an intervention study. Data from 378 women in two non-Baby-Friendly Hospitals were analyzed. Participants were women in their third trimester who were 16 years of age or older, were able to read and write Japanese, were expected to have a singleton birth, and had completed the BSES-SF before discharge. BSES-SF scores were measured before discharge. Breastfeeding status was assessed 4 weeks and 12 weeks postpartum. Receiver Operating Characteristic (ROC) curves were used to assess the predictive ability of the BSES-SF and to inform the choice of a cut-off point. For both of the ROC curves (4 and 12 weeks postpartum) the area under the curve was 0.74. To obtain a high sensitivity, a cut-off score of 50 was chosen. With that cut-off score the sensitivity was 79% and the specificity was 52% 4 weeks postpartum, and they were 77% and 52%, respectively, 12 weeks postpartum. In conclusion, the BSES-SF has moderate overall accuracy to distinguish women who will not practice exclusive breastfeeding after discharge from those who will. At non-Baby-Friendly hospitals in Japan, interventions to support exclusive breastfeeding might be considered for new mothers who have BSES-SF scores that are less than or equal to 50.

  16. Determining a Cut-Off Point for Scores of the Breastfeeding Self-Efficacy Scale–Short Form: Secondary Data Analysis of an Intervention Study in Japan

    Science.gov (United States)

    Nanishi, Keiko; Green, Joseph; Taguri, Masataka; Jimba, Masamine

    2015-01-01

    Background Breastfeeding self-efficacy can be measured with the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Mothers with low BSES-SF scores stop exclusive breastfeeding prematurely, but specific interventions can prevent that undesirable outcome. Because those interventions can be expensive, often one must decide which mothers will receive them. For that purpose, a cut-off BSES-SF score would be useful, but none is available. Therefore, we aimed to assess the overall accuracy of BSES-SF scores as predictors of not practicing post-discharge exclusive breastfeeding, and to choose an appropriate cut-off score for making that prediction. Methods This is a secondary data analysis of an intervention study. Data from 378 women in two non-Baby-Friendly Hospitals were analyzed. Participants were women in their third trimester who were 16 years of age or older, were able to read and write Japanese, were expected to have a singleton birth, and had completed the BSES-SF before discharge. BSES-SF scores were measured before discharge. Breastfeeding status was assessed 4 weeks and 12 weeks postpartum. Receiver Operating Characteristic (ROC) curves were used to assess the predictive ability of the BSES-SF and to inform the choice of a cut-off point. Results For both of the ROC curves (4 and 12 weeks postpartum) the area under the curve was 0.74. To obtain a high sensitivity, a cut-off score of 50 was chosen. With that cut-off score the sensitivity was 79% and the specificity was 52% 4 weeks postpartum, and they were 77% and 52%, respectively, 12 weeks postpartum. Conclusion In conclusion, the BSES-SF has moderate overall accuracy to distinguish women who will not practice exclusive breastfeeding after discharge from those who will. At non-Baby-Friendly hospitals in Japan, interventions to support exclusive breastfeeding might be considered for new mothers who have BSES-SF scores that are less than or equal to 50. PMID:26107382

  17. Examination of the cut-off scores determined by the Ages and Stages Questionnaire in a population-based sample of 6 month-old Norwegian infants

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    Alvik Astrid

    2011-12-01

    Full Text Available Abstract Background Few population-based samples have previously published performance on the Ages and Stages Questionnaire (ASQ, a recommended screening tool to detect infant developmental delay. The aim of the study was to investigate performance on the ASQ in a population-based sample of 6-month-old infants. Methods In this population-based questionnaire study from Oslo, Norway, the 30 item ASQ 6 month Questionnaire (N = 1053 were included, however without the pictograms, and compared to the Norwegian reference sample (N.ref (N = 169 and to US cut-off values. Exclusion criteria were maternal non-Scandinavian ethnicity, infant age 7.0 months (corrected age, twins, and birth weight Results The reported ASQ scores were lower on all but one of the 10 significantly different items, and in all areas except Personal social, compared to the N.ref sample. The estimated cut-off values for suspected developmental delay (Communication 25, Gross motor 15, Fine motor 18, Problem solving 25 and Personal social 20 were lower than the recommended American (US values in all areas, and lower than the Norwegian values in two areas. Scores indicating need for further assessment were reached by 13.8% or 20.5% of the infants (missing items scored according to the US or the Norwegian manual, and by 33.8% or 30.3% of the infants using the recommended US or the Norwegian cut-off values, in this population-based sample. The Fine motor area demonstrated a large variability depending on the different cut-off and scoring possibilities. Both among the items excluding pictograms and the items that do not have pictograms, approximately every third item differed significantly compared to the N.ref sample. Conclusion The psychomotor developmental scores were lower than in the reference samples in this study of ASQ 6 month Questionnaire; to our knowledge the first study to be both representative and comparatively large. Approximately every third child with birth weight above 2

  18. Prothrombin Time, Activated Partial Thromboplastin Time, Fibrinogen, dan D-dimer Sebagai Prediktor Decompensated Disseminated Intravascular Coagulation Sisseminated pada Sepsis

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    Fenny

    2011-03-01

    Full Text Available Sepsis is a systemic response to infection especially in pneumonia case. Sepsis can cause complications such as disseminated intravascular coagulation (DIC which can be divided into compensated and decompensated DIC. The purpose of this study was to assess whether the value of prothrombin time (PT, activated partial thromboplastin time (aPTT, fibrinogen, and D-dimer levels can be used as predictors of decompensated DIC in sepsis patients. This study was conducted at the Laboratory of Clinical Pathology Rumah Sakit Hasan Sadikin Bandung since September 2008 to June 2010. Subjects were patients with sepsis caused by pneumonia. PT and aPTT values, fibrinogen, and D-dimer levels was recorded from all sepsis patients then patients were observed until diagnosed decompensated or non-decompensated DIC, then the value of PT, aPTT, fibrinogen and D-dimer levels in the group of decompensated DIC and non-decompensated DIC were analysed. This study used cohort design. Subjects were 39 sepsis patients (58% with outcome decompensated DIC and 28 sepsis patients (42% with outcome non-decompensated DIC. From the hemostasis parameter test out, it was found that PT, aPTT, and fibrinogen were the predictor of decompensated DIC in patients with sepsis with relative risk 240.500, 7.157, and 6.421; respectively. Conclusions, prothrombin time, aPTT, fibrinogen are the test to know coagulation activation. Hemostasis parameter to predict decompensated DIC in sepsis patients are the shorten PT, aPTT, and the increased fibrinogen

  19. Role of Plasma D-Dimers in the Diagnosis of Thrombotic Events in Patients with Chronic Coronary Heart Disease

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    Yu. V. Nikiforov

    2006-01-01

    Full Text Available Objecive: to estimate hemostatic parameters in 15 cardiosurgical patients with chronic coronary heart disease. Ten parameters of the hemostatic system were determined at 4 stages. The patients were divided into 2 groups in relation to the baseline level of D-dimers. The study demonstrated that hypercoagulation and depressed fibrinolysis retained despite the baseline coagulative potential and the performed therapy in all the patients before discharge. It is obvious that the standard approaches to diagnosing hemostatic disorders and correcting them should be revised. 

  20. Wert der klinischen Symptome und D-Dimere für die Verdachtsdiagnose "Lungenembolie" in der Computertomographie

    OpenAIRE

    Sarigiannis, Konstantinos

    2014-01-01

    Methode und Patienten: Es wurden 278 Patienten im Zeitraum vom 01.01.2009 bis zum 31.12.2009 unter der Verdachtsdiagnose "Lungenembolie" im CT untersucht. Dabei handelte es sich um 139 Männer im Alter von 26 bis 97 und 139 Frauen im Alter von 43 bis 93. Ergebnisse: Eine Lungenembolie wurde bei 55 Patienten festgestellt. Ausschließlich erhöhte D-Dimere wurden bei 7 von den insgesamt 55 Patienten mit LE nachgewiesen, während 43 Patienten eine Kombination aus klinischen Symptomen und...

  1. Discussion about different cut-off values of conventional hamstring-to-quadriceps ratio used in hamstring injury prediction among professional male football players.

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    Monika Grygorowicz

    Full Text Available To measure the sensitivity and specificity of differences cut-off values for isokinetic Hcon/Qcon ratio in order to improve the capacity to evaluate (retrospectively the injury of hamstring muscles in professional soccer screened with knee isokinetic tests.Retrospective study.Medical and biomechanical data of professional football players playing for the same team for at least one season between 2010 and 2016 were analysed. Hamstring strain injury cases and the reports generated via isokinetic testing were investigated. Isokinetic concentric(con hamstring(H and quadriceps(Q absolute strength in addition with Hcon/Qcon ratio were examined for the injured versus uninjured limbs among injured players, and for the injured and non-injured players. 2 x 2 contingency table was used for comparing variables: predicted injured or predicted uninjured with actual injured or actual uninjured. Sensitivity, specificity, accuracy, positive and negative predictive values, and positive and negative likelihood ratio were calculated for three different cut-off values (0.47 vs. 0.6 vs. 0.658 to compare the discriminative power of an isokinetic test, whilst examining the key value of Hcon/Qcon ratio which may indicate the highest level of ability to predispose a player to injury. McNemar's chi2 test with Yates's correction was used to determine agreement between the tests. PQStat software was used for all statistical analysis, and an alpha level of p <0.05 was used for all statistical comparisons.340 isokinetic test reports on both limbs of 66 professional soccer players were analysed. Eleven players suffered hamstring injuries during the analysed period. None of these players sustained recurrence of hamstring injury. One player sustained hamstring strain injury on both legs, thus the total number of injuries was 12. Application of different cut-off values for Hcon/Qcon significantly affected the sensitivity and specificity of isokinetic test used as a tool for

  2. The role of d-dimer as first marker of thrombophilia in women affected by sterility: implications in pathophysiology and diagnosis of thrombophilia induced sterility

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    Di Micco Pierpaolo

    2004-11-01

    Full Text Available Abstract Background D-dimer is considered a marker of hypercoagulable state and of endogenous fibrinolysis, so increased d-dimer is detectable in patients affected by thrombosis. Yet, several studies showed that also infertility, in particular secondary infertility due to recurrent fetal losses, has been often related to thrombotic events, in particular in women carrying thrombotic risk factors such as inherited thrombophilia (MTHFRC677T, PTHRA20210G, Factor V Leiden polimorphisms and/or inhAfter this screening we selected 39erited protein C, protein S, AT III deficiency or acquired thrombophilia (primary antiphospholipid syndrome, acquired protein C, protein S, AT III deficiency, drugs induced thrombophilia. However, because its high predictive negative value in case of suspected thrombosis, increased d-dimer has been often associated to subclinical thrombophilia. The aim of this study is to investigate the role of d-dimer as first marker of thrombophilia in women affected by unexplained infertility and subsequently to search the cause of increased d-dimer, such as inherited and/or acquired thrombophilia. Patients and Methods We selected 79 patients with unexplained primary or secondary infertility. We excluded 40 patients affected by hydrosalpinx, uterine fibroids, uterine malformations, endocrinological and immunological diseases, luteal insufficiency, cytogenetical alterations. All remaining 39 patients were tested for d-dimer and divided in two groups: the patients of group A (25 patients showed increased plasma d-dimer, in group B were included 14 patients with normal plasma level of d-dimer. After this step all 39 patients were screened for MTHFRC677T, PTHRA20210G, Factor V Leiden polimorphisms, protein C, protein S, AT III, anticardiolipin IgM and IgG, lupus anticoagulant. In the control group were included 15 age matched women without sterility problems referred to our outpatient's section of vascular medicine for suspected deep venous

  3. Different cut-off values of the insulin tolerance test, the high-dose short Synacthen test (250 μg) and the low-dose short Synacthen test (1 μg) in assessing central adrenal insufficiency.

    Science.gov (United States)

    Cho, Hwa Y; Kim, Jung H; Kim, Sang W; Shin, Chan S; Park, Kyong S; Kim, Seong W; Jang, Hak-Chul; Kim, Seong Y

    2014-07-01

    The short Synacthen test (SST) is widely used as alternative test to the insulin tolerance test (ITT) to investigate central adrenal insufficiency (CAI), but the methodology and cut-off values of the SST are controversial. Our aim was to evaluate the cut-off value of the ITT in normal subjects and to assess the different cut-off values of the high-dose SST (250 μg, HDT) and the low-dose SST (1 μg, LDT) in subjects with suspected CAI. We conducted ITTs in 208 normal subjects to establish the cut-off value for the ITT, and 28 of those subjects underwent the HDT and LDT. From 1999 to 2007, 182 patients with suspected CAI were recruited and underwent ITTs, LDTs and HDTs to establish cut-off values and compare the diagnostic accuracy between the LDT and HDT. The 95th percentile of the peak cortisol level during the ITT in the normal control subjects was 14·8 μg/dl. Receiver operator characteristics (ROC) analysis revealed that the optimal cut-off values of peak cortisol in the LDT and HDT in patients with suspected CAI were 15·8 and 17·4 μg/dl, respectively. However, the cut-off values from normative data (mean - 2 SD) were 18·3 μg/dl for the LDT and 20·5 μg/dl for the HDT in normal control. The optimal cut-off values of SSTs needed to be individualized according to the type of SST and tested patient population. © 2014 John Wiley & Sons Ltd.

  4. A cut-off of 2150 cytokeratin 19 mRNA copy number in sentinel lymph node may be a powerful predictor of non-sentinel lymph node status in breast cancer patients.

    Science.gov (United States)

    Terrenato, Irene; D'Alicandro, Valerio; Casini, Beatrice; Perracchio, Letizia; Rollo, Francesca; De Salvo, Laura; Di Filippo, Simona; Di Filippo, Franco; Pescarmona, Edoardo; Maugeri-Saccà, Marcello; Mottolese, Marcella; Buglioni, Simonetta

    2017-01-01

    Since 2007, one-step nucleic acid amplification (OSNA) has been used as a diagnostic system for sentinel lymph node (SLN) examination in patients with breast cancer. This study aimed to define a new clinical cut-off of CK19 mRNA copy number based on the calculation of the risk that an axillary lymph node dissection (ALND) will be positive. We analyzed 1529 SLNs from 1140 patients with the OSNA assay and 318 patients with positive SLNs for micrometastasis (250 copies) and macrometastasis (5000 copies) underwent ALND. Axillary non-SLNs were routinely examined. ROC curves and Youden's index were performed in order to identify a new cut-off value. Logistic regression models were performed in order to compare OSNA categorical variables created on the basis of our and traditional cut-off to better identify patients who really need an axillary dissection. 69% and 31% of OSNA positive patients had a negative and positive ALND, respectively. ROC analysis identified a cut-off of 2150 CK19 mRNA copies with 95% sensitivity and 51% specificity. Positive and negative predictive values of this new cut-off were 47% and 96%, respectively. Logistic regression models indicated that the cut-off of 2150 copies better discriminates patients with node negative or positive in comparison with the conventional OSNA cut-off (ppatients really need an ALND and which patients can avoid one. This is why we suggest that the negative cut-off should be raised from 250 to 2150. Furthermore, we propose that for patients with a copy number that ranges between 2150 and 5000, there should be a multidisciplinary discussion concerning the clinical and bio-morphological features of primary breast cancer before any decision is taken on whether to perform an ALND or not.

  5. Bovine Tuberculosis in Cattle in the Highlands of Cameroon: Seroprevalence Estimates and Rates of Tuberculin Skin Test Reactors at Modified Cut-Offs

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    J. Awah-Ndukum

    2012-01-01

    Full Text Available The aim of this study was to obtain epidemiological estimates of bovine tuberculosis (TB prevalence in cattle in the highlands of Cameroon using two population-based tuberculin skin test (TST surveys in the years 2009 and 2010. However, prior to the TST survey in 2010, blood was collected from already chosen cattle for serological assay. Anti-bovine TB antibodies was detected in 37.17% of tested animals and bovine TB prevalence estimates were 3.59%–7.48%, 8.92%–13.25%, 11.77%–17.26% and 13.14%–18.35% for comparative TST at ≥4 mm, ≥3 mm and ≥2 mm cut-off points and single TST, respectively. The agreement between TST and lateral flow was generally higher in TST positive than in TST negative subjects. The K coefficients were 0.119, 0.234, 0.251 and 0.254 for comparative TST at ≥4 mm, ≥3 mm and ≥2 mm cut-off points and the single TST groups, respectively. Chi square statistics revealed that strong (P48 associations existed between seroprevalence rates and TST reactors. The study suggested that using lateral flow assay and TST at severe interpretations could improve the perception of bovine TB in Cameroon. The importance of defining TST at modified cut-offs and disease status by post-mortem detection and mycobacterial culture of TB lesions in local environments cannot be overemphasised.

  6. Using a 3% Proton Density Fat Fraction as a Cut-Off Value Increases Sensitivity of Detection of Hepatic Steatosis, Based on Results From Histopathology Analysis.

    Science.gov (United States)

    Nasr, Patrik; Forsgren, Mikael F; Ignatova, Simone; Dahlström, Nils; Cedersund, Gunnar; Leinhard, Olof Dahlqvist; Norén, Bengt; Ekstedt, Mattias; Lundberg, Peter; Kechagias, Stergios

    2017-07-01

    It is possible to estimate hepatic triglyceride content by calculating the proton density fat fraction (PDFF), using proton magnetic resonance spectroscopy ( 1 H-MRS), instead of collecting and analyzing liver biopsy specimens to detect steatosis. However, the current PDFF cut-off value (5%) used to define steatosis by magnetic resonance was derived from studies that did not use histopathology as the reference standard. We performed a prospective study to determine the accuracy of 1 H-MRS PDFF in the measurement of steatosis using histopathology analysis as the standard. We collected clinical, serologic, 1 H-MRS PDFF, and liver biopsy data from 94 adult patients with increased levels of liver enzymes (≥6 mo) referred to the Department of Gastroenterology and Hepatology at Linköping University Hospital in Sweden from 2007 through 2014. Steatosis was graded using the conventional histopathology method and fat content was quantified in biopsy samples using stereologic point counts (SPCs). We correlated the 1 H-MRS PDFF findings with SPCs (r = 0.92; P histopathology results (ρ = 0.87; P histopathology results (ρ = 0.88; P histopathology findings (100% specificity for PDFF). However, of 69 subjects with PDFF values less than 5.0% (negative result), 22 were determined to have steatosis based on histopathology findings (53% sensitivity for PDFF). Reducing the PDFF cut-off value to 3.0% identified patients with steatosis with 100% specificity and 79% sensitivity; a PDFF cut-off value of 2.0% identified patients with steatosis with 94% specificity and 87% sensitivity. These findings might be used to improve noninvasive detection of steatosis. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

  7. Diagnostic Accuracy of Transient Elastography for Detecting Liver Fibrosis After Liver Trannsplantation: A Specific Cut-Off Value Is Really Needed?

    Science.gov (United States)

    Della-Guardia, B; Evangelista, A S; Felga, G E; Marins, L V; Salvalaggio, P R; Almeida, M D

    2017-01-01

    Liver transplant recipients often perform liver biopsy (LB), specially in the context of potentially recurring diseases, such as hepatitis C infection. However, the LB has risks of complications, despite being the gold standard. Transient elastography (TE) is a noninvasive method comparable to the LB to evaluate liver fibrosis in various settings, but its accuracy among transplant recipients is not fully understood. To determine the accuracy of TE in liver transplant recipients compared with LB to successfully predict liver fibrosis. Patients who underwent liver transplantation at Hospital Israelita Albert Einstein from 2010 to 2012 and presented with LB indication were also subjected to TE at the time of LB. The medium value of ten successful measurements was kept as a representative of the liver stiffness. The definition of cut-off points was made to ensure specificity of ≥90 % for all fibrosis stages (F0-F4). LB was performed in 267 patients. TE was not analyzed in only 8 (3 %) due to an elevated body mass index. The optimal liver stiffness cut-off value and diagnostic performance were 8.1 kPa for F ≥ 1, 12.3 kPa for F ≥ 2, 15.1 for F ≥ 3, and 16.7 for F = 4 for all patients and were 8.1 kPa for F ≥ 1, 12.3 kPa for F ≥ 2, 16.5 for F ≥ 3, and 17.6 for F = 4 for patients with hepatitis C. TE demonstrated good performance in defining cut-off points for fibrosis on liver histology observed in transplant recipients. The TE can be considered an alternative to LB in post-liver transplantation.

  8. Low birth weight in a sub-urban area of Cameroon: an analysis of the clinical cut-off, incidence, predictors and complications.

    Science.gov (United States)

    Njim, Tsi; Atashili, Julius; Mbu, Robinson; Choukem, Simeon-Pierre

    2015-11-04

    The World Health Organisation recommends that each country adopts its own cut-off value of low birth weight (LBW) for clinical use. The aims of this study were to establish a clinical cut-off point for LBW and to determine its incidence, predictors and complications in a sub-urban area's hospital of Cameroon. We conducted a study in two phases: a 6-year retrospective phase during which we collected demographic and clinical information from the records of the maternity of the Buea Regional Hospital (BRH) and a 3-month prospective phase during which data were collected from consenting pregnant women using a structured questionnaire, and newborns were examined and followed after birth. A total of 4941 records were reviewed during the retrospective phase and the 10(th) centile of birth weights was 2600 g. In the 200 pregnant women enrolled during the prospective phase, using this cut-off yielded an incidence of LBW of 19.0 %. Independent predictors of LBW were preterm delivery, hypertensive disorders in pregnancy, HIV infection, maternal age >36 years, maternal height <150 cm and pre-delivery BMI < 25 kg/m(2). Neonates with LBW were more likely to have neonatal asphyxia, foetal distress, respiratory distress and neonatal death. Our results suggest that newborns under 2600 g have LBW in sub-urban Cameroon. They represent one out of every five babies, and they deserve close care. Preventive measures targeting the predictors described here are warranted to reduce the incidence and complications. Similar studies in urban areas are required in order to generalize the results.

  9. Optimal cut-off points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety.

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    Erik Hedman

    Full Text Available Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI, the Illness Attitude Scales (IAS and the Whiteley Index (WI. Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis.We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule.Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates.The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.

  10. Evaluation of serum galactomannan enzyme immunoassay at two different cut-offs for the diagnosis of invasive aspergillosis in patients with febrile neutropenia

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    Ritin Mohindra

    2017-01-01

    Full Text Available Background: Invasive aspergillosis (IA is an increasingly common and fatal opportunistic fungal infection in patients with haematological diseases. Early diagnosis is difficult as mycological culture techniques have low sensitivity and the radiological tools have low specificity. Galactomannan enzyme immunoassay (GEI detects galactomannan in the human serum with a reported sensitivity and specificity between 30% and 100%. Aims: The aim of this study was to analyse the role of GEI in diagnosis of IA in patients with febrile neutropenia and to evaluate the role of GEI in the diagnosis of IA as per the revised (2008 European Organization for Research and Treatment of Cancer–Mycoses Study Group (EORTC–MSG criteria at two different optical density (OD cut-offs of 0.5 and 1.0. Setting: This prospective study was conducted in Safdarjung Hospital, New Delhi, India. Methods: GEI testing was performed in adult patients of febrile neutropenia with evidence of IA. Results at two different OD indices (ODIs of 0.5 and 1.0 were analysed. The evaluation of the diagnostic parameter, that is, GEI was measured in terms of sensitivity, specificity and positive and negative predictive value and was validated with the revised (2008 EORTC–MSG diagnostic criteria of IA. Results: One hundred and eleven patients had evidence of IA, of which 79 patients were GEI positive when cut-off ODI was 0.5, whereas with cut-off ODI 1.0, 55 patients were GEI positive. Conclusion: ODI of 1.0 should be considered as positive while in patients with OD between 0.5 and 1.0, repeat sampling from the patient is recommended.

  11. Power of resting echocardiographic measurements to classify pulmonary hypertension patients according to European society of cardiology exercise testing risk stratification cut-offs.

    Science.gov (United States)

    Rehman, Michaela B; Garcia, Rodrigue; Christiaens, Luc; Larrieu-Ardilouze, Elisa; Howard, Luke S; Nihoyannopoulos, Petros

    2018-01-17

    Right ventricular function is the major determinant of morbidity and mortality in pulmonary arterial hypertension (PAH). The ESC risk assessment strategy for PAH is based on clinical status, exercise testing, NTproBNP, imaging and haemodynamics but does not include right ventricular function. Our aims were to test the power of resting echocardiographic measurements to classify PAH patients according to ESC exercise testing risk stratification cut-offs and to determine if the classification power of echocardiographic parameters varied in chronic thrombo-embolic pulmonary hypertension (CTEPH). We prospectively and consecutively recruited 46 PAH patients and 42 CTEPH patients referred for cardio-pulmonary exercise testing and comprehensive transthoracic echocardiography. Exercise testing parameters analyzed were peak oxygen consumption, percentage of predicted maximal oxygen consumption and the slope of ventilation against carbon dioxide production. Receiver operator characteristic curves were used to determine the optimal diagnostic cut-off values of echocardiographic parameters for classifying the patients in intermediate or high risk category according to exercise testing. Measurements of right ventricular systolic function were the best for classifying in PAH (area under the curve 0.815 to 0.935). Measurements of right ventricular pressure overload (0.810 to 0.909) were optimal for classifying according to exercise testing in CTEPH. Measurements of left ventricular function were of no use in either group. Measurements of right ventricular systolic function can classify according to exercise testing risk stratification cut-offs in PAH. However, this is not the case in CTEPH where pressure overload, rather than right ventricular function seems to be linked to exercise performance. Copyright © 2018 Elsevier B.V. All rights reserved.

  12. Determination of sensitivity, specificity and cut off point of visual- Motor Bender Gestalt Test in the diagnosis of traumatic brain injury

    Directory of Open Access Journals (Sweden)

    tayebeh Rezaie nasab

    2013-02-01

    Results: In this study, cut-off point was calculated as 6.5%, sensitivity as 55.8%, characteristic as 81.2%, and the area under the Roc curve as 0.69. Moreover, positive predictive value, negative predictive value and efficiency were 95.08%, 22.03%, and 59.17%, respectively. Conclusion: Results of this study revealed that Bender Gestalt Test is relatively weak in diagnosis of mild TBI. Hence, its characteristic is high and it was successful in diagnosing healthy individuals.

  13. Retrospective analysis of insulin responses to standard dosed oral glucose tests (OGTs) via naso-gastric tubing towards definition of an objective cut-off value.

    Science.gov (United States)

    Warnken, Tobias; Delarocque, Julien; Schumacher, Svenja; Huber, Korinna; Feige, Karsten

    2018-01-19

    Insulin dysregulation (ID) with basal or postprandial hyperinsulinemia is one of the key findings in horses and ponies suffering from the equine metabolic syndrome (EMS). Assessment of ID can easily be performed in clinical settings by the use of oral glucose challenge tests. Oral glucose test (OGT) performed with 1 g/kg bodyweight (BW) glucose administered via naso-gastric tube allows the exact administration of a defined glucose dosage in a short time. However, reliable cut-off values have not been available so far. Therefore, the aim of the study was to describe variations in insulin response to OGT via naso-gastric tubing and to provide a clinical useful cut-off value for ID when using the insulin quantification performed with an equine-optimized insulin enzyme-linked immunosorbent assay. Data visualization revealed no clear separation in the serum insulin concentration of insulin sensitive and insulin dysregulated horses during OGT. Therefore, a model based clustering method was used to circumvent the use of an arbitrary limit for categorization. This method considered all data-points for the classification, taking into account the individual insulin trajectory during the OGT. With this method two clusters were differentiated, one with low and one with high insulin responses during OGT. The cluster of individuals with low insulin response was consistently detected, independently of the initialization parameters of the algorithm. In this cluster the 97.5% quantile of insulin is 110 µLU/mL at 120 min. We suggest using this insulin concentration of 110 µLU/mL as a cut-off value for samples obtained at 120 min in OGT. OGT performed with 1 g/kg BW glucose and administration via naso-gastric tubing can easily be performed under clinical settings. Application of the cut-off value of 110 µLU/mL at 120 min allows assessment of ID in horses.

  14. Optimal cut-off points of fasting plasma glucose for two-step strategy in estimating prevalence and screening undiagnosed diabetes and pre-diabetes in Harbin, China.

    Science.gov (United States)

    Bao, Chundan; Zhang, Dianfeng; Sun, Bo; Lan, Li; Cui, Wenxiu; Xu, Guohua; Sui, Conglan; Wang, Yibaina; Zhao, Yashuang; Wang, Jian; Li, Hongyuan

    2015-01-01

    To identify optimal cut-off points of fasting plasma glucose (FPG) for two-step strategy in screening abnormal glucose metabolism and estimating prevalence in general Chinese population. A population-based cross-sectional study was conducted on 7913 people aged 20 to 74 years in Harbin. Diabetes and pre-diabetes were determined by fasting and 2 hour post-load glucose from the oral glucose tolerance test in all participants. Screening potential of FPG, cost per case identified by two-step strategy, and optimal FPG cut-off points were described. The prevalence of diabetes was 12.7%, of which 65.2% was undiagnosed. Twelve percent or 9.0% of participants were diagnosed with pre-diabetes using 2003 ADA criteria or 1999 WHO criteria, respectively. The optimal FPG cut-off points for two-step strategy were 5.6 mmol/l for previously undiagnosed diabetes (area under the receiver-operating characteristic curve of FPG 0.93; sensitivity 82.0%; cost per case identified by two-step strategy ¥261), 5.3 mmol/l for both diabetes and pre-diabetes or pre-diabetes alone using 2003 ADA criteria (0.89 or 0.85; 72.4% or 62.9%; ¥110 or ¥258), 5.0 mmol/l for pre-diabetes using 1999 WHO criteria (0.78; 66.8%; ¥399), and 4.9 mmol/l for IGT alone (0.74; 62.2%; ¥502). Using the two-step strategy, the underestimates of prevalence reduced to nearly 38% for pre-diabetes or 18.7% for undiagnosed diabetes, respectively. Approximately a quarter of the general population in Harbin was in hyperglycemic condition. Using optimal FPG cut-off points for two-step strategy in Chinese population may be more effective and less costly for reducing the missed diagnosis of hyperglycemic condition.

  15. Use of CT Angiography in a Country with Low Pulmonary Embolism Prevalence: Correlation with Clinical Pretest Probability and D-dimer Values

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Gee Won; Jeong, Yeon Joo; Kim, Chang Won [Dept. of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institutute, Pusan (Korea, Republic of); Chun, Sung Won; Kim, Yeong Dae [Dept. of Cardiovascular and Thoracic Surgery, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institutute, Pusan (Korea, Republic of); Kim, Kun Il [Dept. of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine and Medical Research Institutute, Yangsan (Korea, Republic of); Song, Jong Woon [Dept. of Radiology, Haeundae Paik Hospital, Inje University School of Medicine, Pusan (Korea, Republic of)

    2011-05-15

    To assess the use of CT angiography (CTA) in the diagnostic evaluation of pulmonary thromboembolism (PE) in a country with low PE prevalence and correlate the diagnostic performance of CTA with the clinical pretest probability and D-dimer values. The institutional review board approved this retrospective study. The observers reviewed all 660 CTAs and calculated the PE clot burden scores. The pretest probability of PE according to the Wells criteria and D-dimer values were calculated (clinical data were available for 371 of the 660 patients). We correlated the PE positivity rates of CTA and a PE clot burden score with the D-dimer values and pretest probability using Pearson's correlation coefficient. Of the 371 patients whose clinical data were available, 122 (32.8%) had PEs. None of the patients with both a normal D-dimer value and a low clinical probability had a PE. PE positivity rates of CTA were correlated with clinical pretest probability (r = 0.164, p = 0.002) and D-dimer values (r = 0.361, p < 0.001). PE clot burden scores were correlated with D-dimer values (r = 0.296, p < 0.001). Although PE positivity rates of CTA in a country with low prevalence were higher than those in a country with a higher prevalence, approximately 30% of the yield still represents an overuse of CTA. CTA should be performed after the pretest probability has been assigned and if the result of a D-dimer assay is abnormal.

  16. An analysis of deep vein thrombosis in burn patients (Part 1): Comparison of D-dimer and Doppler ultrasound as screening tools.

    Science.gov (United States)

    Ahuja, Rajeev B; Bansal, Priya; Pradhan, Gaurav S; Subberwal, Manju

    2016-12-01

    The high prevalence of deep vein thrombosis (DVT) reported in prospective studies and the unreliability of clinical diagnosis mandates prospective screening for DVT in burn patients. Our study seeks to compare D-dimer and Doppler ultrasound (DUS) in search for a practical, inexpensive and a reliable screening tool. One hundred burn patients (inclusion criteria: 30-60% TBSA burn, >18 years of age, admitted within 48h of burn) were computer randomized into two equal groups. The study (prophylaxis) group received low molecular weight heparin (LMWH) (0.5mg/kg, twice daily-max 60mg/day) from day one, till discharge. Screening D-dimer assays and DUS of the lower extremities were performed on all 100 patients on day five, and then weekly, till discharge. Signs and symptoms simulating DVT (pain, swelling, redness, warmth, positive Homans' and Moses' sign) were present in majority of patients with lower limb burns. 43/50 patients (86%) in the control group and 38/50 patients (76%) in the study (prophylaxis) group had positive D-dimer values (>0.5μg/ml) on the 5th post-burn day. D-dimer was positive in all the four patients identified with DVT. However, only 4/100 patients enrolled in the study demonstrated DVT on DUS. Thus, the specificity of the D-dimer assay was only 20% with a positive predictive value of 5%. Absolute D-dimer values were found to have no correlation to the extent of burns. We conclude that D-dimer is not a useful screening tool for DVT in burns contrary to its accepted value in general trauma and medical patients. Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.

  17. Extracorporeal light chain elimination: high cut-off (HCO) hemodialysis parallel to chemotherapy allows for a high proportion of renal recovery in multiple myeloma patients with dialysis-dependent acute kidney injury.

    Science.gov (United States)

    Heyne, Nils; Denecke, Barbara; Guthoff, Martina; Oehrlein, Katharina; Kanz, Lothar; Häring, Hans-Ulrich; Weisel, Katja C

    2012-05-01

    Acute kidney injury (AKI) is frequent in multiple myeloma (MM) patients and strongly affects prognosis, with particularly poor outcomes in patients requiring hemodialysis. Introduction of the novel therapeutic agents to MM therapy has improved myeloma response and renal outcome. This case series reviews the efficacy of combined systemic and extracorporeal therapy to further optimize time to light chain (serum-free light chain (sFLC)) reduction and renal recovery in MM patients with dialysis-dependent AKI (n = 19). High cut-off (HCO) hemodialysis for extracorporeal sFLC removal was initiated in parallel to chemotherapy. Combined therapy resulted in early sFLC response after a median of 13 (range 4-48) days and 6 (3-22) HCO hemodialysis sessions. Time to sFLC response was shorter in patients recovering renal function. Median time to dialysis independence was 15 (4-64) days. By intent-to-treat analysis, sustained renal recovery was achieved in 73.7% (77.8% adjusted for death) of patients. In multivariate analysis, duration of AKI prior to initiation of therapy was an independent predictor of renal functional outcome. Combining HCO hemodialysis for extracorporeal sFLC elimination and effective chemotherapy is a novel treatment strategy allowing for early and sustained sFLC reduction and a high proportion of renal recovery in these patients. Timely diagnosis and onset of therapy is essential for improving renal outcome.

  18. The value of combined elevation of D-dimer and neopterin as a predictive parameter for early stage acute mesenteric ischemia: An experimental study.

    Science.gov (United States)

    Coskun, Ali Kagan; Halici, Zekai; Oral, Akgun; Bayir, Yasin; Deniz, Ferhat; Caycı, Tuncer; Mentes, Oner; Oz, Bilgehan Savas; Harlak, Ali; Yigit, Taner; Kozak, Orhan; Peker, Yusuf

    2017-04-01

    Background The diagnosis of acute mesenteric ischemia is variable. Early diagnosis is important for reducing the mortality and morbidity rates. Aim This experimental study aims to investigate the diagnostic utility of D-dimer and neopterin as a marker for the early stage of acute mesenteric ischemia caused by occlusion of superior mesenteric artery. Methods The levels of D-dimer and neopterin were measured using an animal acute mesenteric ischemia model in 21 male rabbits. Superior mesenteric artery occlusion (Group 1, n = 14) and control (Group 2, n = 7) groups were identified. Blood samples at different times are collected from each rabbits. Blood samples from superior mesenteric artery occlusion group were taken 30 min after anesthesia but before laparotomy, 1, 2, and 3 h after superior mesenteric artery ligation. Blood samples from control group were taken 1 h before, 1 and 3 h after anesthesia and laparotomy. The D-dimer and neopterin levels of each blood sample were measured. Results The probability of acute mesenteric ischemia was found to be 36 times higher when the D-dimer level was over 0.125 ng/L, whereas the probability was 19.2 times higher when the neopterin level was over 1.25 nmol/L. Conclusions In this experimental study, the combined elevation of two significant markers, D-dimer and neopterin, may be helpful for the early diagnosis of acute mesenteric ischemia.

  19. Evaluation of serum D-dimer, fibrinogen, and CA19-9 for postoperative monitoring and survival prediction in resectable pancreatic carcinoma.

    Science.gov (United States)

    Cao, Junli; Fu, Zhanzhao; Gao, Liming; Wang, Xin; Cheng, Shaohui; Wang, Xiuchao; Ren, He

    2017-02-20

    We sought to investigate the efficacy of serum D-dimer, fibrinogen, and CA19-9 for postoperative monitoring and prediction of survival in patients with resectable pancreatic carcinoma (PC). One hundred and nineteen patients with resectable PC were enrolled. Serum D-dimer, fibrinogen, and CA19-9 values were analyzed before surgery and at the stages of relapse-free and progression disease. D-dimer, fibrinogen, and CA19-9 were significantly higher at the active stage of PC than those at the relapse-free stage [1059.2 (1690.1) ng/ml vs 485.18 (289.84) ng/ml, (3.71 ± 0.83) g/l vs (2.75 ± 0.52) g/l, 207.2 (681.8) U/ml vs 24.5 (30) U/ml, respectively, p monitoring of patients with resectable PC, D-dimer, fibrinogen, and CA19-9 may be used as markers for monitoring disease relapse, but only preoperative D-dimer could predict survival.

  20. Triceps and Subscapular Skinfold Thickness Percentiles and Cut-Offs for Overweight and Obesity in a Population-Based Sample of Schoolchildren and Adolescents in Bogota, Colombia

    Directory of Open Access Journals (Sweden)

    Robinson Ramírez-Vélez

    2016-09-01

    Full Text Available The assessment of skinfold thickness is an objective measure of adiposity. The aims of this study were to establish Colombian smoothed centile charts and LMS L (Box–Cox transformation, M (median, and S (coefficient of variation tables for triceps, subscapular, and triceps + subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic (ROC analysis based on a population-based sample of children and adolescents in Bogotá, Colombia. A cross-sectional study was conducted in 9618 children and adolescents (55.7% girls; age range of 9–17.9 years. Triceps and subscapular skinfold measurements were obtained using standardized methods. We calculated the triceps + subscapular skinfold (T + SS sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived using the LMS method. ROC curve analyses were used to evaluate the optimal cut-off point of skinfold thickness for overweight and obesity, based on the International Obesity Task Force definitions. Subscapular and triceps skinfolds and T + SS were significantly higher in girls than in boys (p < 0.001. The ROC analysis showed that subscapular and triceps skinfolds and T + SS have a high discriminatory power in the identification of overweight and obesity in the sample population in this study. Our results provide sex- and age-specific normative reference standards for skinfold thickness values from a population from Bogotá, Colombia.

  1. Triceps and Subscapular Skinfold Thickness Percentiles and Cut-Offs for Overweight and Obesity in a Population-Based Sample of Schoolchildren and Adolescents in Bogota, Colombia

    Science.gov (United States)

    Ramírez-Vélez, Robinson; López-Cifuentes, Mario Ferney; Correa-Bautista, Jorge Enrique; González-Ruíz, Katherine; González-Jiménez, Emilio; Córdoba-Rodríguez, Diana Paola; Vivas, Andrés; Triana-Reina, Hector Reynaldo; Schmidt-RioValle, Jacqueline

    2016-01-01

    The assessment of skinfold thickness is an objective measure of adiposity. The aims of this study were to establish Colombian smoothed centile charts and LMS L (Box–Cox transformation), M (median), and S (coefficient of variation) tables for triceps, subscapular, and triceps + subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic (ROC) analysis based on a population-based sample of children and adolescents in Bogotá, Colombia. A cross-sectional study was conducted in 9618 children and adolescents (55.7% girls; age range of 9–17.9 years). Triceps and subscapular skinfold measurements were obtained using standardized methods. We calculated the triceps + subscapular skinfold (T + SS) sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived using the LMS method. ROC curve analyses were used to evaluate the optimal cut-off point of skinfold thickness for overweight and obesity, based on the International Obesity Task Force definitions. Subscapular and triceps skinfolds and T + SS were significantly higher in girls than in boys (p Colombia. PMID:27669294

  2. Triceps and Subscapular Skinfold Thickness Percentiles and Cut-Offs for Overweight and Obesity in a Population-Based Sample of Schoolchildren and Adolescents in Bogota, Colombia.

    Science.gov (United States)

    Ramírez-Vélez, Robinson; López-Cifuentes, Mario Ferney; Correa-Bautista, Jorge Enrique; González-Ruíz, Katherine; González-Jiménez, Emilio; Córdoba-Rodríguez, Diana Paola; Vivas, Andrés; Triana-Reina, Hector Reynaldo; Schmidt-RioValle, Jacqueline

    2016-09-24

    The assessment of skinfold thickness is an objective measure of adiposity. The aims of this study were to establish Colombian smoothed centile charts and LMS L (Box-Cox transformation), M (median), and S (coefficient of variation) tables for triceps, subscapular, and triceps + subscapular skinfolds; appropriate cut-offs were selected using receiver operating characteristic (ROC) analysis based on a population-based sample of children and adolescents in Bogotá, Colombia. A cross-sectional study was conducted in 9618 children and adolescents (55.7% girls; age range of 9-17.9 years). Triceps and subscapular skinfold measurements were obtained using standardized methods. We calculated the triceps + subscapular skinfold (T + SS) sum. Smoothed percentile curves for triceps and subscapular skinfold thickness were derived using the LMS method. ROC curve analyses were used to evaluate the optimal cut-off point of skinfold thickness for overweight and obesity, based on the International Obesity Task Force definitions. Subscapular and triceps skinfolds and T + SS were significantly higher in girls than in boys (p Colombia.

  3. What is the optimal cut-off point for low coronary artery calcium score assessed by computed tomography? Multi-Detector Computed Tomography ANIN Registry.

    Science.gov (United States)

    Kaczmarska, Edyta; Kępka, Cezary; Dzielińska, Zofia; Pracoń, Radosław; Kryczka, Karolina; Petryka, Joanna; Pręgowski, Jerzy; Kruk, Mariusz; Demkow, Marcin

    2013-01-01

    This prospective study was conducted to evaluate the incidence and predictors of coronary artery disease (CAD) in relation to the low coronary artery calcium (CAC) score among patients with intermediate probability of CAD. A total of 1132 consecutive patients were included in the analysis (58.7 ±10.9 years, 46.7% males). Coronary computed tomography (CCT) angiography was performed in a multi-detector computed tomography scanner. Coronary artery calcium score was calculated by the Agatston method. Obstructive CAD was defined as the presence of coronary artery stenosis ≥ 50% on CCT angiography. Coronary artery disease was diagnosed in nearly one-fourth of patients (n = 272, 24%). In the receiver operating characteristics (ROC) curve analysis a CAC score of 10 was used as an optimal cut-off point for discriminating obstructive CAD (sensitivity: 0.79, specificity: 0.75, p cut-off point of 10 for CAC score determined patients with CAD with the best sensitivity and specificity. Therefore, a total CAC score low". In patients with a low CAC score obstructive high risk plaques prone to rupture are presented and are associated with increasing age and male gender.

  4. Thyroid dysfunction in pregnancy: definition of TSH cut-off should precede the decision of screening in low-risk pregnant women.

    Science.gov (United States)

    Rosario, Pedro W; Purisch, Saulo

    2011-03-01

    To evaluate the frequency of elevated TSH in pregnant women of low risk for thyroid dysfunction. TSH was measured in 838 pregnant women during the first trimester of gestation (from 6 to 14 weeks, median 9 weeks) and who were considered to be of low risk for thyroid dysfunction because they did not meet any of the following criteria: known or clinically suspected thyroid disease; history of head and neck radiotherapy; personal history of autoimmune diseases; family history of thyroid disease; history of abortion or prematurity. The frequency of elevated TSH was 0.25%, 1.2% and 5.5% at cut-off values of 4, 3 and 2.5?mIU/l, respectively. These rates increase to 1.43%, 2.4% and 6.2% if cases of TSH> 2 mIU/l with TPOAb are included. TSH was undetectable in 18 women (2.1%), but only six (0.71%) had elevated T4. The definition of a TSH cut-off that defines subclinical hypothyroidism (SCH) should precede the decision of screening pregnant women without any risk factors for thyroid dysfunction.

  5. Serum cortisol concentration with exploratory cut-off values do not predict the effects of hydrocortisone administration in children with low cardiac output after cardiac surgery.

    Science.gov (United States)

    Verweij, E J; Hogenbirk, Karin; Roest, Arno A W; van Brempt, Ronald; Hazekamp, Mark G; de Jonge, Evert

    2012-10-01

    Low cardiac output syndrome is common after paediatric cardiac surgery. Previous studies suggested that hydrocortisone administration may improve haemodynamic stability in case of resistant low cardiac output syndrome in critically ill children. This study was set up to test the hypothesis that the effects of hydrocortisone on haemodynamics in children with low cardiac output syndrome depend on the presence of (relative) adrenal insufficiency. A retrospective study was done on paediatric patients who received hydrocortisone when diagnosed with resistant low cardiac output syndrome after paediatric cardiac surgery in the period from 1 November 2005 to 31 December 2008. We studied the difference in effects of treatment with hydrocortisone administration between patients with adrenal insufficiency defined as an exploratory cut-off value of total cortisol of cortisol of ≥ 100 nmol/l. A total of 62 of patients were enrolled, meeting the inclusion criteria for low cardiac output syndrome. Thirty-two patients were assigned to Group 1 (cortisol concentration and those with normal baseline cortisol levels. A cortisol value using an exploratory cut-off value of 100 nmol/l for adrenal insufficiency should not be used as a criterion to treat these patients with hydrocortisone.

  6. Combined use of clinical pre-test probability and D-dimer test in the diagnosis of preoperative deep venous thrombosis in colorectal cancer patients

    DEFF Research Database (Denmark)

    Stender, Mogens; Frøkjaer, Jens Brøndum; Hagedorn Nielsen, Tina Sandie

    2008-01-01

    clinical pre-test probability (PTP) can be safely used to rule out the tentative diagnosis of DVT in cancer patients. However, the accuracy in colorectal cancer patients is uncertain. This study assessed the diagnostic accuracy of a quantitative D-dimer assay in combination with the PTP score in ruling out....... The negative predictive value, positive predictive value, sensitivity and specificity were 99% (95% confidence interval (CI), 95-100%), 17% (95% CI, 9-26), 93% (95% CI, 68-100%) and 61% (95% CI, 53-68%), respectively. In conclusion, the combined use of pre-test probability and D-dimer test may be useful......The preoperative prevalence of deep venous thrombosis (DVT) in patients with colorectal cancer may be as high as 8%. In order to minimize the risk of pulmonary embolism, it is important to rule out preoperative DVT. A large study has confirmed that a negative D-dimer test in combination with a low...

  7. Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction.

    Science.gov (United States)

    Satilmisoglu, Muhammet Hulusi; Ozyilmaz, Sinem Ozbay; Gul, Mehmet; Ak Yildirim, Hayriye; Kayapinar, Osman; Gokturk, Kadir; Aksu, Huseyin; Erkanli, Korhan; Eksik, Abdurrahman

    2017-01-01

    To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE) and Thrombolysis in Myocardial Infarction (TIMI) risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI). A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males) hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality. Median D-dimer levels were 349.5 (48.0-7,210.0) ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118) in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01) and TIMI scores (r=0.504, P=0.000). Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059-322.084, P=0.046) constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality. Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer assay, GRACE or TIMI scores for predicting the risk of mortality in NSTEMI patients.

  8. Preoperative plasma D-dimer is a predictor of postoperative deep venous thrombosis in colorectal cancer patients: a clinical, prospective cohort study with one-year follow-up

    DEFF Research Database (Denmark)

    Stender, Mogens T; Frøkjaer, Jens B; Larsen, Torben B

    2009-01-01

    PURPOSE: The study examined if preoperative plasma D-dimer level was associated with the postoperative cumulative incidence of deep venous thrombosis in patients with colorectal cancer admitted for intended curative surgery. METHODS: In 176 consecutive patients with newly-diagnosed colorectal...... vs. the negative D-dimer group was 6.53 (95 percent confidence interval, 1.58 to 27.0). CONCLUSIONS: A positive preoperative D-dimer was associated with a higher cumulated incidence of postoperative deep venous thrombosis. D-dimer might be useful in identifying those colorectal cancer patients who...

  9. Yield and Water Productivity Responses to Irrigation Cut-off Strategies after Fruit Set Using Stem Water Potential Thresholds in a Super-High Density Olive Orchard.

    Science.gov (United States)

    Ahumada-Orellana, Luis E; Ortega-Farías, Samuel; Searles, Peter S; Retamales, Jorge B

    2017-01-01

    An increase in the land area dedicated to super-high density olive orchards has occurred in Chile in recent years. Such modern orchards have high irrigation requirements, and optimizing water use is a priority. Moreover, this region presents low water availability, which makes necessary to establish irrigation strategies to improve water productivity. An experiment was conducted during four consecutive growing seasons (2010-2011 to 2013-2014) to evaluate the responses of yield and water productivity to irrigation cut-off strategies. These strategies were applied after fruit set using midday stem water potential (Ψstem) thresholds in a super-high density olive orchard (cv. Arbequina), located in the Pencahue Valley, Maule Region, Chile. The experimental design was completely randomized with four irrigation cut-off treatments based on the Ψstem thresholds and four replicate plots per treatment (five trees per plot). Similar to commercial growing conditions in our region, the Ψstem in the T1 treatment was maintained between -1.4 and -2.2 MPa (100% of actual evapotranspiration), while T2, T3 and T4 treatments did not receive irrigation from fruit set until they reached a Ψstem threshold of approximately -3.5, -5.0, and -6.0 MPa, respectively. Once the specific thresholds were reached, irrigation was restored and maintained as T1 in all treatments until fruits were harvested. Yield and its components were not significantly different between T1 and T2, but fruit yield and total oil yield, fruit weight, and fruit diameter were decreased by the T3 and T4 treatments. Moreover, yield showed a linear response with water stress integral (SΨ), which was strongly influenced by fruit load. Total oil content (%) and pulp/stone ratio were not affected by the different irrigation strategies. Also, fruit and oil water productivities were significantly greater in T1 and T2 than in the T3 and T4. Moreover, the T2, T3, and T4 treatments averaged 37, 51, and 72 days without

  10. Cut-off value of initial serum β-hCG level predicting a successful MTX therapy in tubal ectopic pregnancy: a retrospective cohort study.

    Science.gov (United States)

    Helmy, S; Bader, Y; Pablik, E; Tiringer, D; Pils, S; Laml, T; Kölbl, H; Koch, M

    2014-08-01

    To determine the optimal serum β-hCG cut-off level to predict MTX treatment success in tubal ectopic pregnancy (EP). Data of 240 women, who presented between 2003 and 2011 at the Department of Gynecology and Obstetrics, Medical University of Vienna, with tubal EP and who received MTX as primary treatment, were retrieved from the hospital information system (KIS). 198 patients could be included for final evaluation. Statistical analysis included area under the ROC curve, maximal Euclidean and Youden index, chi-squared and a five-fold cross validation. The serum β-hCG level cut-off value was calculated at 2121mlU/ml with a specificity of 76.54% and sensitivity of 80.56% (AUC 0.789; phCG level below 2121mlU/ml (n=131) experienced MTX treatment failure in 5.3% (n=7), compared to 43.3% (n=29) of patients with an initial serum β-hCG level equal to or above 2121mlU/ml (n=67). There was no statistically significant correlation between clinical symptoms and the MTX therapy outcome (p=0.580; likelihood quotient p=0.716). The correct decision of therapy in patients with tubal ectopic pregnancy still represents a challenge. In this study we can conclude that, according to our results there is no endpoint of initial serum β-hCG levels, which can be clearly used as cut-off value for the optimal management of tubal EP. However, an initial serum β-hCG level of less than 2121mlU/ml seems to be a good value to expect a successful MTX treatment. Limitations are the retrospective study design and the inability of classifying clinical symptoms like pain as an objective parameter. Wider implications of the findings may include more detailed patient information and more accurate selection of suitable patients for MTX therapy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Yield and Water Productivity Responses to Irrigation Cut-off Strategies after Fruit Set Using Stem Water Potential Thresholds in a Super-High Density Olive Orchard

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    Luis E. Ahumada-Orellana

    2017-07-01

    Full Text Available An increase in the land area dedicated to super-high density olive orchards has occurred in Chile in recent years. Such modern orchards have high irrigation requirements, and optimizing water use is a priority. Moreover, this region presents low water availability, which makes necessary to establish irrigation strategies to improve water productivity. An experiment was conducted during four consecutive growing seasons (2010–2011 to 2013–2014 to evaluate the responses of yield and water productivity to irrigation cut-off strategies. These strategies were applied after fruit set using midday stem water potential (Ψstem thresholds in a super-high density olive orchard (cv. Arbequina, located in the Pencahue Valley, Maule Region, Chile. The experimental design was completely randomized with four irrigation cut-off treatments based on the Ψstem thresholds and four replicate plots per treatment (five trees per plot. Similar to commercial growing conditions in our region, the Ψstem in the T1 treatment was maintained between -1.4 and -2.2 MPa (100% of actual evapotranspiration, while T2, T3 and T4 treatments did not receive irrigation from fruit set until they reached a Ψstem threshold of approximately -3.5, -5.0, and -6.0 MPa, respectively. Once the specific thresholds were reached, irrigation was restored and maintained as T1 in all treatments until fruits were harvested. Yield and its components were not significantly different between T1 and T2, but fruit yield and total oil yield, fruit weight, and fruit diameter were decreased by the T3 and T4 treatments. Moreover, yield showed a linear response with water stress integral (SΨ, which was strongly influenced by fruit load. Total oil content (% and pulp/stone ratio were not affected by the different irrigation strategies. Also, fruit and oil water productivities were significantly greater in T1 and T2 than in the T3 and T4. Moreover, the T2, T3, and T4 treatments averaged 37, 51, and 72 days

  12. Yield and Water Productivity Responses to Irrigation Cut-off Strategies after Fruit Set Using Stem Water Potential Thresholds in a Super-High Density Olive Orchard

    Science.gov (United States)

    Ahumada-Orellana, Luis E.; Ortega-Farías, Samuel; Searles, Peter S.; Retamales, Jorge B.

    2017-01-01

    An increase in the land area dedicated to super-high density olive orchards has occurred in Chile in recent years. Such modern orchards have high irrigation requirements, and optimizing water use is a priority. Moreover, this region presents low water availability, which makes necessary to establish irrigation strategies to improve water productivity. An experiment was conducted during four consecutive growing seasons (2010–2011 to 2013–2014) to evaluate the responses of yield and water productivity to irrigation cut-off strategies. These strategies were applied after fruit set using midday stem water potential (Ψstem) thresholds in a super-high density olive orchard (cv. Arbequina), located in the Pencahue Valley, Maule Region, Chile. The experimental design was completely randomized with four irrigation cut-off treatments based on the Ψstem thresholds and four replicate plots per treatment (five trees per plot). Similar to commercial growing conditions in our region, the Ψstem in the T1 treatment was maintained between -1.4 and -2.2 MPa (100% of actual evapotranspiration), while T2, T3 and T4 treatments did not receive irrigation from fruit set until they reached a Ψstem threshold of approximately -3.5, -5.0, and -6.0 MPa, respectively. Once the specific thresholds were reached, irrigation was restored and maintained as T1 in all treatments until fruits were harvested. Yield and its components were not significantly different between T1 and T2, but fruit yield and total oil yield, fruit weight, and fruit diameter were decreased by the T3 and T4 treatments. Moreover, yield showed a linear response with water stress integral (SΨ), which was strongly influenced by fruit load. Total oil content (%) and pulp/stone ratio were not affected by the different irrigation strategies. Also, fruit and oil water productivities were significantly greater in T1 and T2 than in the T3 and T4. Moreover, the T2, T3, and T4 treatments averaged 37, 51, and 72 days without

  13. The proportions of people living with HIV in low and middle-income countries who test tuberculin skin test positive using either a 5 mm or a 10 mm cut-off: a systematic review.

    Science.gov (United States)

    Kerkhoff, Andrew D; Gupta, Ankur; Samandari, Taraz; Lawn, Stephen D

    2013-07-08

    A positive tuberculin skin test (TST) is often defined by skin induration of ≥10 mm in people who are HIV-seronegative. However, to increase sensitivity for detection of Mycobacterium tuberculosis infection in the context of impaired immune function, a revised cut-off of ≥5 mm is used for people living with HIV infection. The incremental proportion of patients who are included by this revised definition and the association between this proportion and CD4+ cell count are unknown. The literature was systematically reviewed to determine the proportion of people living with HIV (PLWH) without evidence of active tuberculosis in low and middle-income countries who tested TST-positive using cut-offs of ≥5 mm and ≥10 mm of induration. The difference in the proportion testing TST-positive using the two cut-off sizes was calculated for all eligible studies and was stratified by geographical region and CD4+ cell count. A total of 32 studies identified meeting criteria were identified, providing data on 10,971 PLWH from sub-Saharan Africa, Asia and the Americas. The median proportion of PLWH testing TST-positive using a cut-off of ≥5 mm was 26.8% (IQR, 19.8-46.1%; range, 2.5-81.0%). Using a cut-off of ≥10 mm, the median proportion of PLWH testing TST-positive was 19.6% (IQR, 13.7-36.8%; range 0-52.1%). The median difference in the proportion of PLWH testing TST-positive using the two cut-offs was 6.0% (IQR, 3.4-10.1%; range, 0-37.6%). Among those with CD4+ cell counts of cut-off that were between 5.0 and 9.9 mm in diameter was similar (12.5%, 12.9% and 10.5%, respectively). There is a small incremental yield in the proportion of PLWH who test TST-positive when using an induration cut-off size of ≥5 mm compared to ≥10 mm. This proportion was similar across the range of CD4+ cell strata, supporting the current standardization of this cut-off at all levels of immunodeficiency.

  14. Novel high-sensitivity troponin assay requires higher cut-off value to separate acute myocardial infarction from non-acute myocardial infarction in a high-risk population.

    Science.gov (United States)

    Wassef, Anthony Wafik Aziz; Hiebert, Brett; Saeed, Mahwash F; Tam, James W

    2015-10-01

    The novel high-sensitivity troponin T assay (hs-cTnT) has been validated for diagnosing AMI in the emergency room. However its utility in high-risk in-patient populations is unknown. We retrospectively reviewed admissions to a general cardiology unit that had 2 hs-cTnT measurements in the first 12 h of presentation. We assessed 8 diagnostic algorithms that used hs-cTnT concentration and changes in concentration (including the 99th percentile cut-off of 14 ng/L) for their diagnostic utility in separating AMI patients from cardiac/nonACS and non-cardiac chest-pain patients. UA was excluded. There were 233 patients (mean age 67 years, 153 were males (66%)) admitted over a 2 month period, with AMI diagnosed in 118 of these patients (51%). The recommended 99th percentile cut-off had modest accuracy (65%), good sensitivity (88%), and poor specificity (25%); a higher cut-off of 75 ng/L had a better diagnostic accuracy of 73%, p < 0.05. While some hs-cTnT algorithms were either highly sensitive or specific, none were both. In high-risk cardiology in-patients, no hs-cTnT concentration cut-off or change more accurately diagnosed and excluded AMI, although higher cut-offs had better diagnostic utility.

  15. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods.

    Science.gov (United States)

    Gerbershagen, H J; Rothaug, J; Kalkman, C J; Meissner, W

    2011-10-01

    Cut-off points (CPs) of the numeric rating scale (NRS 0-10) are regularly used in postoperative pain treatment. However, there is insufficient evidence to identify the optimal CP between mild and moderate pain. A total of 435 patients undergoing general, trauma, or oral and maxillofacial surgery were studied. To determine the optimal CP for pain treatment, four approaches were used: first, patients estimated their tolerable postoperative pain intensity before operation; secondly, 24 h after surgery, they indicated if they would have preferred to receive more analgesics; thirdly, satisfaction with pain treatment was analysed, and fourthly, multivariate analysis was used to calculate the optimal CP for pain intensities in relation to pain-related interference with movement, breathing, sleep, and mood. The estimated tolerable postoperative pain before operation was median (range) NRS 4.0 (0-10). Patients who would have liked more analgesics reported significantly higher average pain since surgery [median NRS 5.0 (0-9)] compared with those without this request [NRS 3.0 (0-8)]. Patients satisfied with pain treatment reported an average pain intensity of median NRS 3.0 (0-8) compared with less satisfied patients with NRS 5.0 (2-9). Analysis of average postoperative pain in relation to pain-related interference with mood and activity indicated pain categories of NRS 0-2, mild; 3-4, moderate; and 5-10, severe pain. Three of the four methods identified a treatment threshold of average pain of NRS≥4. This was considered to identify patients with pain of moderate-to-severe intensity. This cut-off was indentified as the tolerable pain threshold.

  16. EARLY APPLICATION OF HIGH CUT-OFF HAEMODYALISIS FOR DE-NOVO MYELOMA NEPHROPATHY IS ASSOCIATED WITH LONG-TERM DIALYSIS-INDEPENDENCY AND RENAL RECOVERY

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    Alhossain A. Khalafallah

    2013-01-01

    Full Text Available Background Multiple myeloma (MM is a haematological malignancy associated with kidney injury resulting from cast nephropathy, which can be caused by monoclonal free light chains (FLC. It has been demonstrated that reduction of FLC can lead to a higher proportion of patients recovering renal function with a better outcome, especially if extended high cut-off haemodialysis (HCO-HD combined with chemotherapy is used. Patients and Methods In this study, four cases of MM nephropathy were treated with HCO-HD and chemotherapy at a single institution during the period from August 2009 to August 2011. All of the patients presented with acute renal failure and high serum FLC. All patients underwent a bone marrow biopsy to confirm the diagnosis of MM, according to the WHO criteria. Three patients had de-novo MM and one patient had relapsed light chain myeloma disease. All patients underwent HCO-HD concomitantly with specific myeloma therapy once the diagnosis or relapse of MM was established. Results After a median follow up of 26 months, (range, 13-36 our data showed that all patients had a significant decrease in serum FLC through HCO-HD, proving the effectiveness of HCO-HD in managing MM. De-novo MM patients restored their renal function and achieved low-level FLC early on the treatment and become dialysis-independent. One patient with relapsed myeloma remained dialysis dependant. Conclusion Our study suggests that if myeloma nephropathy associated with light-chain disease, HCO-HD should be initiated as early as possible. At the same time a specific MM treatment should be initiated to gain control of the disease and salvage the kidneys in order to achieve dialysis-independency. Further trials to confirm our results are warranted. Key Words: Multiple myeloma, renal failure, High cut-off haemodialysis, chemotherapy, outcome.

  17. Profiles of body mass index and the nutritional status among children and adolescents categorized by waist-to-height ratio cut-offs.

    Science.gov (United States)

    Zhang, Ying-Xiu; Wang, Zhao-Xia; Chu, Zun-Hua; Zhao, Jin-Shan

    2016-11-15

    Waist-to-height ratio (WHtR) is proposed as a simple, valid and convenient measure of abdominal obesity and health risks in practice. The present study examined the distribution of nutritional status among children and adolescents categorized by WHtR cut-offs. A total of 30,459 students (15,249 boys and 15,210 girls) aged 7-18years participated in the study. Height, weight and waist circumference (WC) of all subjects were measured, body mass index (BMI) and WHtR were calculated. The grades of nutritional status (thinness, normal weight, overweight and obesity) was defined by the international BMI cut-offs. All subjects were divided into three groups (low, moderate and high) according to their WHtR, BMI level and the distribution of nutritional status among the three groups were compared. In both boys and girls, significant differences in BMI level and the nutritional status were observed among the three groups. Children and adolescents aged 7-18years in the 'high WHtR group' (≥0.5) had higher BMI than those in the 'low WHtR group' (nutritional status is found in the 'moderate WHtR group' (between 0.4 and 0.5) with the highest proportion of normal weight and low prevalence of thinness and obesity. WHtR is associated with nutritional status, which could be an indicator of nutritional status and early health risk. It is necessary to develop optimal boundary values in the future. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Prevalence of impaired glucose tolerance and diabetes after gestational diabetes mellitus comparing different cut-off criteria for abnormal glucose tolerance during pregnancy.

    Science.gov (United States)

    Anderberg, Eva; Landin-Olsson, Mona; Kalén, Johan; Frid, Anders; Ursing, Dag; Berntorp, Kerstin

    2011-11-01

    To determine the prevalence of diabetes and impaired glucose tolerance after gestational diabetes mellitus in relation to different categories of glucose tolerance during pregnancy. Prospective study. Four delivery departments and three hospitals in southern Sweden took part in recruitment and follow-up. Women undergoing a 75g oral glucose tolerance test during pregnancy delivering in 2003-2005. At first follow-up, one to two years after delivery, 29% of eligible women with abnormal glucose tolerance during pregnancy had an oral glucose tolerance test - 160 with gestational diabetes and 309 with gestational impaired glucose tolerance - in addition to 167 control women. Cut-off levels defining gestational diabetes and impaired glucose tolerance were two-hour capillary blood glucose levels of 9.0 and 7.8mmol/l or plasma glucose 10.0 and 8.6mmol/l, respectively. Frequency of abnormal test results at follow-up. Diabetes was diagnosed in 11% and impaired glucose tolerance in 24% of women with gestational diabetes vs. 4 and 23% in those with gestational impaired glucose tolerance, respectively. Combining women with abnormal test results during pregnancy revealed diabetes or impaired glucose tolerance in 29% as compared to 10% among controls; the odds ratio (95% confidence interval) for having abnormal test results was 3.3 (1.8-5.9) in a multivariate logistic regression analysis. Lowering the cut-off level for gestational diabetes to include the category of impaired glucose tolerance would identify a high percentage of women with diabetes and impaired glucose tolerance postpartum, who constitute target groups for intervention and/or diabetes prevention. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica© 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  19. High levels of D-dimer correlated with disease status and poor prognosis of inoperable metastatic colorectal cancer patients treated with bevacizumab

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    Liming Zhu

    2014-01-01

    Conclusion: High levels of plasma baseline D-dimer correlated with high tumor load, advanced disease status and poor prognosis of inoperable mCRC patients treated with bevacizumab. However, clinical research on a much larger cohort of patients will be required to verify these findings.

  20. Lipid ratios and appropriate cut off values for prediction of diabetes: a cohort of Iranian men and women

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    Hadaegh Farzad

    2010-08-01

    Full Text Available Abstract Background Dyslipidemia is a risk factor for incident type 2 diabetes; however, no study has specifically assessed the lipid ratios (i.e. total cholesterol (TC/high density lipoprotein cholesterol (HDL-C and triglyceride (TG/HDL-C as predictors of diabetes. We aimed to compare the independent association between the different lipid measures with incident diabetes over a median follow up of 6.4 years in Iranian men and women. Method The study population consisted of 5201 non diabetic (men = 2173, women = 3028 subjects, aged ≥20 years. The risk factor adjusted odds ratios (ORs for diabetes were calculated for every 1 standard deviation (SD change in TC, log-transformed TG, HDL-C, non-HDL-C, TC/HDL-C and log-transformed TG/HDL-C using multivariate logistic regression analysis. Receiver operator characteristic (ROC curve analysis was used to define the points of the maximum sum of sensitivity and specificity (MAXss of each lipid measure as a predictor of diabetes. Result We found 366 (146 men and 220 women new diabetes cases during follow-up. The risk-factor-adjusted ORs for a 1 SD increase in TG, TC/HDL-C and TG/HDL-C were 1.23, 1.27 and 1.25 in men; the corresponding risks in females were 1.36, 1.14, 1.39 respectively (all p Conclusion TC/HDL-C and TG/HDL-C showed similar performance for diabetes prediction in men population however; among women TG/HDL-C highlighted higher risk than did TC/HDL-C, although there was no difference in discriminatory power. Importantly, HDL-C had a protective effect for incident diabetes only among women.

  1. Predictive values of D-dimer assay, GRACE scores and TIMI scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction

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    Satilmisoglu MH

    2017-03-01

    Full Text Available Muhammet Hulusi Satilmisoglu,1 Sinem Ozbay Ozyilmaz,1 Mehmet Gul,1 Hayriye Ak Yildirim,2 Osman Kayapinar,3 Kadir Gokturk,4 Huseyin Aksu,1 Korhan Erkanli,5 Abdurrahman Eksik1 1Department of Cardiology, 2Department of Biochemistry, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, 3Department of Cardiology, Duzce University Faculty of Medicine, Duzce, 4Department of Infectious Diseases, 5Department of Thoracic and Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey Purpose: To determine the predictive values of D-dimer assay, Global Registry of Acute Coronary Events (GRACE and Thrombolysis in Myocardial Infarction (TIMI risk scores for adverse outcome in patients with non-ST-segment elevation myocardial infarction (NSTEMI.Patients and methods: A total of 234 patients (mean age: 57.2±11.7 years, 75.2% were males hospitalized with NSTEMI were included. Data on D-dimer assay, GRACE and TIMI risk scores were recorded. Logistic regression analysis was conducted to determine the risk factors predicting increased mortality.Results: Median D-dimer levels were 349.5 (48.0–7,210.0 ng/mL, the average TIMI score was 3.2±1.2 and the GRACE score was 90.4±27.6 with high GRACE scores (>118 in 17.5% of patients. The GRACE score was correlated positively with both the D-dimer assay (r=0.215, P=0.01 and TIMI scores (r=0.504, P=0.000. Multivariate logistic regression analysis revealed that higher creatinine levels (odds ratio =18.465, 95% confidence interval: 1.059–322.084, P=0.046 constituted the only significant predictor of increased mortality risk with no predictive values for age, D-dimer assay, ejection fraction, glucose, hemoglobin A1c, sodium, albumin or total cholesterol levels for mortality.Conclusion: Serum creatinine levels constituted the sole independent determinant of mortality risk, with no significant values for D-dimer

  2. The Optimal Ethnic-Specific Waist-Circumference Cut-Off Points of Metabolic Syndrome among Low-Income Rural Uyghur Adults in Far Western China and Implications in Preventive Public Health.

    Science.gov (United States)

    He, Jia; Ma, Rulin; Liu, Jiaming; Zhang, Mei; Ding, Yusong; Guo, Heng; Mu, Lati; Zhang, Jingyu; Wei, Bin; Yan, Yizhong; Ma, Jiaolong; Pang, Hongrui; Li, Shugang; Guo, Shuxia

    2017-02-08

    Background: Metabolic syndrome is pandemic; however, the cut-off values for waist circumference (WC) vary widely depending on the ethnic groups studied and the criteria applied for WC measurement. Previous studies for defining optimal WC cut-off points included high-income and urban settings, and did not cover low-income, rural settings, especially for ethnic minorities. This study aimed at defining optimal ethnic-specific WC cut-off points in a low-income, rural population comprising the largest inhabitant minority group residing in far Western China. Methods: Questionnaire-based surveys, physical examinations, and blood testing of 3542 individuals were conducted in 2010, using a stratified cluster random sampling method in rural Uyghur residents (≥18 years old) from 12 villages in Xinjiang, China, approximately 4407 km away from the capital city, Beijing. Metabolic syndrome was defined according to the International Diabetes Federation (IDF) criteria. Optimal, ethnic-specific WC cut-off values for diagnosing metabolic syndrome were determined using receiver operator characteristic (ROC) curve analysis. Results: As WC increased, there was a significant, increasing trend of detection and risk in rural Uyghur adults, regardless of the presence of ≥1 or ≥2 components of metabolic syndrome by IDF criteria. The optimal ethnic-specific WC cut-off point to predict the presence of metabolic syndrome was 85 cm for men and 82 cm for women. With these cut-off points, the prevalence rates of metabolic syndrome among men, women, and overall population in Uyghur adults were 19.5%, 23.0%, and 21.3%, respectively. Conclusions: We report a high prevalence of metabolic syndrome, especially in women, among rural Uyghurs in Western China. A WC cut-off of 85 cm in men and 82 cm in women was the best predictor of metabolic syndrome in this population. Because of the cost-effectiveness in measuring WC, we recommend that these WC cut-off points be integrated into local preventive

  3. Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing.

    Science.gov (United States)

    Boonstra, Anne M; Stewart, Roy E; Köke, Albère J A; Oosterwijk, René F A; Swaan, Jeannette L; Schreurs, Karlein M G; Schiphorst Preuper, Henrica R

    2016-01-01

    Objectives: The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the variability of the optimal cut-off points, and to determine the influence of patients' catastrophizing and their sex on these cut-off points. Methods: 2854 patients were included. Pain was assessed by the NRS, functioning by the Pain Disability Index (PDI) and catastrophizing by the Pain Catastrophizing Scale (PCS). Cut-off point schemes were tested using ANOVAs with and without using the PSC scores or sex as co-variates and with the interaction between CP scheme and PCS score and sex, respectively. The variability of the optimal cut-off point schemes was quantified using bootstrapping procedure. Results and conclusion: The study showed that NRS scores ≤ 5 correspond to mild, scores of 6-7 to moderate and scores ≥8 to severe pain in terms of pain-related interference with functioning. Bootstrapping analysis identified this optimal NRS cut-off point scheme in 90% of the bootstrapping samples. The interpretation of the NRS is independent of sex, but seems to depend on catastrophizing. In patients with high catastrophizing tendency, the optimal cut-off point scheme equals that for the total study sample, but in patients with a low catastrophizing tendency, NRS scores ≤ 3 correspond to mild, scores of 4-6 to moderate and scores ≥7 to severe pain in terms of interference with functioning. In these optimal cut-off schemes, NRS scores of 4 and 5 correspond to moderate interference with functioning for patients with low catastrophizing tendency and to mild interference for patients with high catastrophizing tendency. Theoretically one would therefore expect that among the patients with NRS scores 4 and 5 there would be a higher average PDI score for those with low

  4. Setting appropriate pass or fail cut-off criteria for tests to reflect real life listening difficulties in children with suspected auditory processing disorder.

    Science.gov (United States)

    Ahmmed, Ansar U; Ahmmed, Afsara A

    2016-05-01

    This paper explores the pass or fail cut-off criteria, the number of test fails, and the nature of tests that are most appropriate in predicting listening difficulties (LiD) in children with suspected APD (SusAPD). One hundred and nine English-speaking children (67 males, 42 females) aged between 6 and 11 years with SusAPD were assessed. The Children's Auditory Performance Scale (CHAPS) scores 2 SD below the mean were taken as markers of LiD in different listening conditions. Binary logistic regression analyses were carried out to evaluate the cut-off criterion (2 SD or 1.5 SD or 1 SD below the mean) of failing at least two tests, from the SCAN-C and IMAP test batteries, which significantly predicted LiD. Analyses were also carried out to assess if the group of auditory processing (AP) or cognitive or combination of AP plus cognitive tests were significant in predicting LiD. Receiver Operative Characteristic (ROC) curves were also explored to evaluate how the sensitivity and specificity in confirming LiD varied with the number of test fails. Filtered Words, Competing Words, Competing Sentences, VCV in ICRA noise, Digit Span, Sight Word Reading and the Cued Auditory Attention tests correlated with one or more of the CHAPS domains. Failing at least two of these tests 1.5 SD below the mean significantly predicted (p<.05) CHAPS Ideal scores 2 SD below the mean, and failing at least two of the tests 1 SD below the mean significantly predicted (p<.05) CHAPS Memory and CHAPS Attention scores 2 SD below the mean. The combination of AP plus cognitive tests had significantly higher ability to predict CHAPS Ideal, Memory and Attention scores, compared to the group of AP or cognitive tests separately. ROC curves showed that failing at least two of the tests was associated with the best sensitivity and specificity in predicting LiD. Of the different CHAPS domains only the CHAPS Ideal, Memory and Attention correlated with the APD tests. Failing at least two APD tests from a

  5. Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain: Variability and Influence of Sex and Catastrophizing

    NARCIS (Netherlands)

    Boonstra, A.M.; Stewart, R.; Koke, A.J.A.; Oosterwijk, R.F.A.; Swaan, J.L.; Schreurs, Karlein Maria Gertrudis; Schiphorst Preuper, H.R.

    2016-01-01

    Objectives: The 0–10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the

  6. Cut-Off Points for Mild, Moderate, and Severe Pain on the Numeric Rating Scale for Pain in Patients with Chronic Musculoskeletal Pain : Variability and Influence of Sex and Catastrophizing

    NARCIS (Netherlands)

    Boonstra, Anne M; Stewart, Roy E; Köke, Albère J A; Oosterwijk, René F A; Swaan, Jeannette L; Schreurs, Karlein M G; Schiphorst Preuper, Henrica R

    2016-01-01

    Objectives: The 0-10 Numeric Rating Scale (NRS) is often used in pain management. The aims of our study were to determine the cut-off points for mild, moderate, and severe pain in terms of pain-related interference with functioning in patients with chronic musculoskeletal pain, to measure the

  7. Validity of the rheumatoid arthritis impact of disease (RAID) score and definition of cut-off points for disease activity states in a population-based European cohort of patients with rheumatoid arthritis.

    Science.gov (United States)

    Salaffi, Fausto; Di Carlo, Marco; Vojinovic, Jelena; Tincani, Angela; Sulli, Alberto; Soldano, Stefano; Andreoli, Laura; Dall'Ara, Francesca; Ionescu, Ruxandra; Simić Pašalić, Katarina; Balčune, Ineta; Ferraz-Amaro, Iván; Tlustochowicz, Malgorzata; Butrimienė, Irena; Punceviciene, Egle; Toroptsova, Natalia; Grazio, Simeon; Morović-Vergles, Jadranka; Masaryk, Pavol; Otsa, Kati; Bernardes, Miguel; Boyadzhieva, Vladimira; Cutolo, Maurizio

    2017-05-24

    To assess the validity of the rheumatoid arthritis impact of disease (RAID) for measuring disease activity of rheumatoid arthritis (RA) and to determine cut-off values for defining the disease activity states. A total of 622 RA patients from an European database have been included. Cross-validation was based on assessment of convergent and discriminant validity. Optimal cut-offs were determined against external criteria by calculating the respective 25th and 75th percentiles mean values of RAID. External criteria included definitions for remission (REM), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA), cut-offs of the 28-joint disease activity score-C-reactive protein (DAS28-CRP) score. The RAID showed a moderate degree of correlation with respect to DAS28-CRP (rho=0.417; Pcut-off values for REM: RAID ≤3; for LDA: RAID >3 and ≤4; for MDA: RAID >4 and ≤6; for HDA: RAID >6. Mean RAID differed significantly between patients classified as REM, LDA, MDA or HDA (P=0.001). The cut-offs revealed good measurement characteristics in cross-validation analysis, had great discriminatory performance in distinguishing patients with different levels of disease activity and are suited for widespread use in everyday practice application and research. Copyright © 2017 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  8. Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR) for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007).

    Science.gov (United States)

    Esteghamati, Alireza; Ashraf, Haleh; Khalilzadeh, Omid; Zandieh, Ali; Nakhjavani, Manouchehr; Rashidi, Armin; Haghazali, Mehrdad; Asgari, Fereshteh

    2010-04-07

    We have recently determined the optimal cut-off of the homeostatic model assessment of insulin resistance for the diagnosis of insulin resistance (IR) and metabolic syndrome (MetS) in non-diabetic residents of Tehran, the capital of Iran. The aim of the present study is to establish the optimal cut-off at the national level in the Iranian population with and without diabetes. Data of the third National Surveillance of Risk Factors of Non-Communicable Diseases, available for 3,071 adult Iranian individuals aging 25-64 years were analyzed. MetS was defined according to the Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) criteria. HOMA-IR cut-offs from the 50th to the 95th percentile were calculated and sensitivity, specificity, and positive likelihood ratio for MetS diagnosis were determined. The receiver operating characteristic (ROC) curves of HOMA-IR for MetS diagnosis were depicted, and the optimal cut-offs were determined by two different methods: Youden index, and the shortest distance from the top left corner of the curve. The area under the curve (AUC) (95%CI) was 0.650 (0.631-0.670) for IDF-defined MetS and 0.683 (0.664-0.703) with the ATPIII definition. The optimal HOMA-IR cut-off for the diagnosis of IDF- and ATPIII-defined MetS in non-diabetic individuals was 1.775 (sensitivity: 57.3%, specificity: 65.3%, with ATPIII; sensitivity: 55.9%, specificity: 64.7%, with IDF). The optimal cut-offs in diabetic individuals were 3.875 (sensitivity: 49.7%, specificity: 69.6%) and 4.325 (sensitivity: 45.4%, specificity: 69.0%) for ATPIII- and IDF-defined MetS, respectively. We determined the optimal HOMA-IR cut-off points for the diagnosis of MetS in the Iranian population with and without diabetes.

  9. Optimal cut-off of homeostasis model assessment of insulin resistance (HOMA-IR for the diagnosis of metabolic syndrome: third national surveillance of risk factors of non-communicable diseases in Iran (SuRFNCD-2007

    Directory of Open Access Journals (Sweden)

    Rashidi Armin

    2010-04-01

    Full Text Available Abstract Aim We have recently determined the optimal cut-off of the homeostatic model assessment of insulin resistance for the diagnosis of insulin resistance (IR and metabolic syndrome (MetS in non-diabetic residents of Tehran, the capital of Iran. The aim of the present study is to establish the optimal cut-off at the national level in the Iranian population with and without diabetes. Methods Data of the third National Surveillance of Risk Factors of Non-Communicable Diseases, available for 3,071 adult Iranian individuals aging 25-64 years were analyzed. MetS was defined according to the Adult Treatment Panel III (ATPIII and International Diabetes Federation (IDF criteria. HOMA-IR cut-offs from the 50th to the 95th percentile were calculated and sensitivity, specificity, and positive likelihood ratio for MetS diagnosis were determined. The receiver operating characteristic (ROC curves of HOMA-IR for MetS diagnosis were depicted, and the optimal cut-offs were determined by two different methods: Youden index, and the shortest distance from the top left corner of the curve. Results The area under the curve (AUC (95%CI was 0.650 (0.631-0.670 for IDF-defined MetS and 0.683 (0.664-0.703 with the ATPIII definition. The optimal HOMA-IR cut-off for the diagnosis of IDF- and ATPIII-defined MetS in non-diabetic individuals was 1.775 (sensitivity: 57.3%, specificity: 65.3%, with ATPIII; sensitivity: 55.9%, specificity: 64.7%, with IDF. The optimal cut-offs in diabetic individuals were 3.875 (sensitivity: 49.7%, specificity: 69.6% and 4.325 (sensitivity: 45.4%, specificity: 69.0% for ATPIII- and IDF-defined MetS, respectively. Conclusion We determined the optimal HOMA-IR cut-off points for the diagnosis of MetS in the Iranian population with and without diabetes.

  10. Logarithmic Entropy-Corrected Holographic Dark Energy in Hořava-Lifshitz cosmology with Granda-Oliveros cut-off

    Science.gov (United States)

    Pasqua, Antonio; Chattopadhyay, Surajit

    2013-12-01

    In this work, we studied the Logarithmic Entropy-Corrected Holographic Dark Energy (LECHDE) model in a spatially non-flat universe and in the framework of Hořava-Lifshitz cosmology. As infrared cutoff of the system we considered the cut-off recently proposed by Granda and Oliveros which contains two terms, one proportional to H 2 and one to . For the two cases containing non-interacting and interacting Dark Energy (DE) and Dark Matter (DM), we obtained the exact differential equation that determines the evolution of the density parameter. Moreover, we derived the expressions of the deceleration parameter q and, using a parametrization of the equation of state (EoS) parameter ω D of our model as ω D ( z)= ω 0+ ω 1 z, we derived both the expressions of ω 0 and ω 1 for both non-interacting and interacting cases. All derivations made in this work are done in small redshift approximation and for low redshift expansion of the equation of state (EoS) parameter.

  11. Principle proportionality when cutting off a district heating supply; Prinzip der Verhaelnismaessigkeit gemaess paragraph 33 II AVBFernwaermeV. Einstellung der Versorgung mit Fernwaerme

    Energy Technology Data Exchange (ETDEWEB)

    Fricke, N. [Jena Univ. (Germany)

    2003-06-01

    The law on cutting off supply under paragraph 33 II has been drafted with two objectives. Firstly, the district heating utility is to have a safeguard against future arrears of payment and be provided with a means of applying pressure for obtaining arrears of payment for previous supplies. Secondly, the consumer is to be protected from the serious consequences of loss of supply by additional formal requirements, i.e. formal notice, a notice of restriction of supply and a two-week deadline. In order to achieve a fair balance between the interests of the district heating utility and those of the consumer, the proportionality of the consequences of deprivation of supply and the utility's objectives must always be examined. The circumstances of each individual case must always be considered. (orig.) [German] Die Ausgestaltung des Rechts zur Einstellung der Versorgung gemaess Paragraph 33 II AVBFernwaermeV verfolgt zwei Zielrichtungen: Zum einen soll das FVU vor kuenftigen Zahlungsrueckstaenden gesichert werden und ihm ein Druckmittel zur Verfuegung gestellt werden, um Zahlungsrueckstaende aus vorherigen Lieferungen auszugleichen. Zum anderen wird der Kunde vor schwerwiegenden Folgen der Liefersperre geschuetzt. Der Autor stellt anhand des Verhaeltnismaessigkeitsprinzips dar, wie die Interessen des FVU und des Kunden angemessen beruecksichtigt werden koennen. (orig.)

  12. The significance of body mass index in calculating the cut-off points for low muscle mass in the elderly: methodological issues.

    Science.gov (United States)

    Krzymińska-Siemaszko, Roma; Czepulis, Natasza; Suwalska, Aleksandra; Dworak, Lechoslaw B; Fryzowicz, Anna; Madej-Dziechciarow, Beata; Wieczorowska-Tobis, Katarzyna

    2014-01-01

    Cut-off points (COPs) for appendicular lean mass (ALM) index, essential to define low muscle mass (LMM) in the elderly, have never been officially defined for Poland. The aim of the study was to establish them. Additionally, the significance of body mass index (BMI) for correctly defining the COPs in a young, healthy reference group was assessed. The study was composed of reference group (n = 1113) and the elderly group (n = 200). In all subjects, body composition was assessed by bioimpedance analysis, and ALM index was calculated. Next, COPs (kg/m(2)) were set up for the whole reference group and for particular subgroups with different BMIs separately. They were used to diagnose sarcopenia in the elderly. COP for all young females was 5.37 (COP-F), while it was equal to 5.52 (COP-F2) when only those with a recommended BMI (18.50-24.99 kg/m(2)) were taken into consideration. For males, it was 7.32 and 7.29, respectively. Only 7% of elderly females had LMM based on COP-F and 15% had LMM based on COP-F2 (P low muscle mass.

  13. The Effect of Irrigation Cut-off in Flowering Stage and Foliar Application of Spermidine on Essential Oil Quantity and Quality of Three Ecotypes of Cumin

    Directory of Open Access Journals (Sweden)

    Sarah Bakhtari

    2017-03-01

    Full Text Available Introduction Cumin (Cuminum cyminum L. is an annual plant that commonly cultivated in arid and semiarid regions of Iran. The crop has a wide range of uses including medicinal, cosmetic and food industry. Cumin occupies about 26% of total area devoted to medicinal plants in Iran. However, cumin is seriously affected by the Fusarium wilt and blight diseases. The diseases usually increase under warm and wet conditions. Control of the diseases incidence is a crucial factor for cumin production. Limited control of the diseases is provided by seed pre-sowing with certain fungicides such as benlate. Soil fumigation with methyle bromide can provide a control measure against the disease but may be limited application value for large scale production systems in the open field. In addition, methyle bromide is considered an ozone-depleting compound and has potential risk on the living environment and human health. Considering the environmental limitations of chemical fungicides, it seems appropriate to search for a supplemental control strategy .It was demonstrated that peak of the diseases incidence is occurred at flowering stage and irrigation cut-off in this time may be reduced the diseases density. Materials and methods This experiment was conducted in a split-split-plot arrangement in randomized complete block design with three replications in research farm of Shahid Bahonar University of Kerman at 2014. The experimental treatments were irrigation (complete irrigation and cut-off the irrigation in flowering stage assigned to main plots, foliar application of spermidine (0, 1 and 2 Mm as subplot and cumin ecotypes (Kerman, Khorasan and Esfahan that was randomized in sub-subplot. The seedbed preparation was made based on common practices at the location. Plots size under the trial was 4 m×3 m so as to get 50 cm inter row spacing in six rows. The ideal density of the crops was considered as 120 plant.m-2. As soon as the seeds were sown, irrigation

  14. UV Filtering of Dye-Sensitized Solar Cells: The Effects of Varying the UV Cut-Off upon Cell Performance and Incident Photon-to-Electron Conversion Efficiency

    Directory of Open Access Journals (Sweden)

    Matthew Carnie

    2012-01-01

    Full Text Available With current technology, UV filters are essential to ensure long-term dye-sensitized solar cell (DSC stability. Blocking photons, however, will have an obvious effect on device performance and upon its incident photon-to-current conversion efficiency (IPCE. Filters have been applied to DSC devices with a range of cut-off wavelengths in order to assess how different levels of filtering affect the performance and IPCE of devices made with three different dyes, namely N719, Z907, and N749. It is shown that dyes that extend their IPCE further into the NIR region suffer lesser relative efficiency losses due to UV filtering than dyes with narrower action spectra. Furthermore, the results are encouraging to those working towards the industrialisation of DSC technology. From the results presented it can be estimated that filtering at a level intended to prevent direct band gap excitation of the TiO2 semiconductor should cause a relative drop in cell efficiency of no more than 10% in forward illuminated devices and no more than 2% in reverse illuminated devices.

  15. Evaluation of epidemiological cut-off values indicates that biocide resistant subpopulations are uncommon in natural isolates of clinically-relevant microorganisms.

    Directory of Open Access Journals (Sweden)

    Ian Morrissey

    Full Text Available To date there are no clear criteria to determine whether a microbe is susceptible to biocides or not. As a starting point for distinguishing between wild-type and resistant organisms, we set out to determine the minimal inhibitory concentration (MIC and minimal bactericidal concentration (MBC distributions for four common biocides; triclosan, benzalkonium chloride, chlorhexidine and sodium hypochlorite for 3319 clinical isolates, with a particular focus on Staphylococcus aureus (N = 1635 and Salmonella spp. (N = 901 but also including Escherichia coli (N = 368, Candida albicans (N = 200, Klebsiella pneumoniae (N = 60, Enterobacter spp. (N = 54, Enterococcus faecium (N = 53, and Enterococcus faecalis (N = 56. From these data epidemiological cut-off values (ECOFFs are proposed. As would be expected, MBCs were higher than MICs for all biocides. In most cases both values followed a normal distribution. Bimodal distributions, indicating the existence of biocide resistant subpopulations were observed for Enterobacter chlorhexidine susceptibility (both MICs and MBCs and the susceptibility to triclosan of Enterobacter (MBC, E. coli (MBC and MIC and S. aureus (MBC and MIC. There is a concern on the potential selection of antibiotic resistance by biocides. Our results indicate however that resistance to biocides and, hence any potential association with antibiotic resistance, is uncommon in natural populations of clinically relevant microorganisms.

  16. Audiograms of three subterranean rodent species (gen. Fukomys) determined by auditory brainstem responses reveal extremely low high-frequency cut-offs.

    Science.gov (United States)

    Gerhardt, Patricia; Henning, Yoshiyuki; Begall, Sabine; Malkemper, E Pascal

    2017-10-12

    Life underground has shaped the auditory sense of subterranean mammals, shifting their hearing range to low frequencies. Mole-rats of the genus Fukomys have, however, been suggested to hear up to 18.5 kHz, unusually high for a subterranean rodent. We present audiograms of three mole-rat species, Fukomys anselli, Fukomys micklemi and the giant mole-rat Fukomys mechowii, based on evoked auditory brainstem potentials. All species showed low sensitivity and restricted hearing ranges at 60 dB SPL extending from 125 Hz to 4 kHz (5 octaves) with most sensitive hearing between 0.8 kHz and 1.4 kHz. The high frequency cut-offs are the lowest found in mammals to date. In contrast to predictions from middle ear morphology, F. mechowii did not show higher sensitivity in the low frequency range than F. anselli These data suggest that the hearing range of Fukomys mole-rats is highly restricted to low frequencies and similar to other subterranean mammals. © 2017. Published by The Company of Biologists Ltd.

  17. Calculation of cut-off values based on the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Pemphigus Disease Area Index (PDAI) pemphigus scoring systems for defining moderate, significant and extensive types of pemphigus.

    Science.gov (United States)

    Boulard, C; Duvert Lehembre, S; Picard-Dahan, C; Kern, J S; Zambruno, G; Feliciani, C; Marinovic, B; Vabres, P; Borradori, L; Prost-Squarcioni, C; Labeille, B; Richard, M A; Ingen-Housz-Oro, S; Houivet, E; Werth, V P; Murrell, D F; Hertl, M; Benichou, J; Joly, P

    2016-07-01

    Two pemphigus severity scores, Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Pemphigus Disease Area Index (PDAI), have been proposed to provide an objective measure of disease activity. However, the use of these scores in clinical practice is limited by the absence of cut-off values that allow differentiation between moderate, significant and extensive types of pemphigus. To calculate cut-off values defining moderate, significant and extensive pemphigus based on the ABSIS and PDAI scores. In 31 dermatology departments in six countries, consecutive patients with newly diagnosed pemphigus were assessed for pemphigus severity, using ABSIS, PDAI, Physician's Global Assessment (PGA) and Dermatology Life Quality Index (DLQI) scores. Cut-off values defining moderate, significant and extensive subgroups were calculated based on the 25th and 75th percentiles of the ABSIS and PDAI scores. The median ABSIS, PDAI, PGA and DLQI scores of the three severity subgroups were compared in order to validate these subgroups. Ninety-six patients with pemphigus vulgaris (n = 77) or pemphigus foliaceus (n = 19) were included. The median PDAI activity and ABSIS total scores were 27·5 (range 3-84) and 34·8 points (range 0·5-90·5), respectively. The respective cut-off values corresponding to the first and third quartiles of the scores were 15 and 45 for the PDAI, and 17 and 53 for ABSIS. The moderate, significant and extensive subgroups were thus defined, and had distinguishing median ABSIS (P < 0·001), PDAI (P < 0·001), PGA (P < 0·001) and DLQI (P = 0·03) scores. This study suggests cut-off values of 15 and 45 for PDAI and 17 and 53 for ABSIS, to distinguish moderate, significant and extensive pemphigus forms. Identifying these pemphigus activity subgroups should help physicians to classify and manage patients with pemphigus. © 2016 British Association of Dermatologists.

  18. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Shazia Awan

    2017-03-01

    Full Text Available Objectives: Pulmonary embolism (PE is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG analysis and D-dimer in predicting PE in cancer patients. Methods: Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE and CTPA negative (PE excluded. Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. Results: Of the total of 104 individuals who had CTPAs, 33 (31.7% were positive for PE and 71 (68.3% were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030. Clinical prediction rules showed good sensitivities (88−100% and negative predictive values (93−100%. An alveolar-arterial (A-a gradient > 20 had 100% sensitivity and negative predictive values. Conclusions: CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results.

  19. Usefulness of Clinical Prediction Rules, D-dimer, and Arterial Blood Gas Analysis to Predict Pulmonary Embolism in Cancer Patients

    Science.gov (United States)

    Karamat, Asifa; Awan, Shazia; Hussain, Muhammad Ghazanfar; Al Hameed, Fahad; Butt, Faheem; Wahla, Ali Saeed

    2017-01-01

    Objectives Pulmonary embolism (PE) is seven times more common in cancer patients than non-cancer patients. Since the existing clinical prediction rules (CPRs) were validated predominantly in a non-cancer population, we decided to look at the utility of arterial blood gas (ABG) analysis and D-dimer in predicting PE in cancer patients. Methods Electronic medical records were reviewed between December 2005 and November 2010. A total of 177 computed tomography pulmonary angiograms (CTPAs) were performed. We selected 104 individuals based on completeness of laboratory and clinical data. Patients were divided into two groups, CTPA positive (patients with PE) and CTPA negative (PE excluded). Wells score, Geneva score, and modified Geneva score were calculated for each patient. Primary outcomes of interest were the sensitivities, specificities, positive, and negative predictive values for all three CPRs. Results Of the total of 104 individuals who had CTPAs, 33 (31.7%) were positive for PE and 71 (68.3%) were negative. There was no difference in basic demographics between the two groups. Laboratory parameters were compared and partial pressure of oxygen was significantly lower in patients with PE (68.1 mmHg vs. 71 mmHg, p = 0.030). Clinical prediction rules showed good sensitivities (88−100%) and negative predictive values (93−100%). An alveolar-arterial (A-a) gradient > 20 had 100% sensitivity and negative predictive values. Conclusions CPRs and a low A-a gradient were useful in excluding PE in cancer patients. There is a need for prospective trials to validate these results. PMID:28439386

  20. Safe exclusion of pulmonary embolism using the Wells rule and qualitative D-dimer testing in primary care: prospective cohort study

    Science.gov (United States)

    Erkens, Petra M G; Lucassen, Wim A M; Büller, Harry R; Cate, Hugo ten; Hoes, Arno W; Moons, Karel G M; Prins, Martin H; Oudega, Ruud; van Weert, Henk C P M; Stoffers, Henri E J H

    2012-01-01

    Objective To validate the use of the Wells clinical decision rule combined with a point of care D-dimer test to safely exclude pulmonary embolism in primary care. Design Prospective cohort study. Setting Primary care across three different regions of the Netherlands (Amsterdam, Maastricht, and Utrecht). Participants 598 adults with suspected pulmonary embolism in primary care. Interventions Doctors scored patients according to the seven variables of the Wells rule and carried out a qualitative point of care D-dimer test. All patients were referred to secondary care and diagnosed according to local protocols. Pulmonary embolism was confirmed or refuted on the basis of a composite reference standard, including spiral computed tomography and three months’ follow-up. Main outcome measures Diagnostic accuracy (sensitivity and specificity), proportion of patients at low risk (efficiency), number of missed patients with pulmonary embolism in low risk category (false negative rate), and the presence of symptomatic venous thromboembolism, based on the composite reference standard, including events during the follow-up period of three months. Results Pulmonary embolism was present in 73 patients (prevalence 12.2%). On the basis of a threshold Wells score of ≤4 and a negative qualitative D-dimer test result, 272 of 598 patients were classified as low risk (efficiency 45.5%). Four cases of pulmonary embolism were observed in these 272 patients (false negative rate 1.5%, 95% confidence interval 0.4% to 3.7%). The sensitivity and specificity of this combined diagnostic approach was 94.5% (86.6% to 98.5%) and 51.0% (46.7% to 55.4%), respectively. Conclusion A Wells score of ≤4 combined with a negative qualitative D-dimer test result can safely and efficiently exclude pulmonary embolism in primary care. PMID:23036917

  1. Effect of marathon run and air travel on pre- and post-run soluble d-dimer, microparticle procoagulant activity, and p-selectin levels.

    Science.gov (United States)

    Parker, Beth A; Augeri, Amanda L; Capizzi, Jeffrey A; Ballard, Kevin D; Kupchak, Brian R; Volek, Jeffrey S; Troyanos, Christopher; Kriz, Peter; D'Hemecourt, Pierre; Thompson, Paul D

    2012-05-15

    D-dimer, microparticles, and p-selectin are venous thrombotic risk markers. Elevated p-selectin is associated with increased cardiovascular events. We examined the effects of exercise and air travel on the markers of vascular risk in marathon runners. Forty-one persons participating in the 114th Boston Marathon (April 19, 2010) were divided into travel (n = 23) and nontravel "control" (n = 18) groups according to whether they lived more than a 4-hour plane flight or less than a 2-hour car trip from Boston. The subjects provided venous blood samples the day before, immediately after, and after returning home the day after the marathon. The blood was analyzed for soluble d-dimer, microparticle procoagulant activity, and p-selectin. D-dimer levels increased more before to immediately after (142 ± 83 to 387 ± 196 ng/mL) in the travel group than in the controls (85 ± 26 to 233 ± 95 ng/mL; p = 0.02). Moreover, 6 travel subjects versus 0 controls had d-dimer values >500 ng/mL after returning home the day after the marathon, the clinical threshold for excluding venous thrombosis (p = 0.03). P-selectin increased with exercise (p marathon (r(2) = 0.16, p = 0.01). In conclusion, the combination of exercise and travel increases venous and arterial thrombotic risk. Moreover, the p-selectin levels at rest and after exercise were greater with age. These results might explain the reports of venous thrombosis with air travel after athletic events and the reports of cardiac events in older participants running marathons. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. Combined use of the National Early Warning Score and D-dimer levels to predict 30-day and 365-day mortality in medical patients.

    Science.gov (United States)

    Nickel, Christian H; Kellett, John; Cooksley, Tim; Bingisser, Roland; Henriksen, Daniel P; Brabrand, Mikkel

    2016-09-01

    To investigate the combined use of NEWS and D-dimer levels to predict the 30-day and 365-day mortality rates of a cohort of Danish patients with complete follow-up. Post-hoc retrospective observational study of acutely admitted medical patients aged 18 years or older who had D-dimer measured within 6h after arrival to two medical admission units in Denmark. The final study population consisted of 1201 patients with a median age of 65.0 years (range 18.0-107.0 years), and 44.7% were of male sex. Four patients (0.3%) died within 24h of admission, 69 (5.7%) within 30 days and 198 (16.5%) within 365 days. On admission, 576 (48%) patients had a NEWS≥3 - of these 441 had a D-dimer≥0.50mgL(-1): 55 (12.5%) of these patients died within 30 days, compared with 5 (3.7%) of the 135 patients with a D-dimerscore<3 and D-dimer levels below 0.50mgL(-1) appears to identify patients of low risk of mortality within 30 days and, therefore, may prove to be a powerful risk assessment tool for acutely ill medical patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  3. Dual energy CT pulmonary blood volume assessment in acute pulmonary embolism - correlation with D-dimer level, right heart strain and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Bauer, Ralf W.; Frellesen, Claudia; Schell, Boris; Lehnert, Thomas; Jacobi, Volkmar; Vogl, Thomas J.; Kerl, J.M. [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Renker, Matthias [Clinic of the Goethe University, Department of Diagnostic and Interventional Radiology, Frankfurt (Germany); Medical University of South Carolina, Heart and Vascular Center, Ashley River Tower, Charleston, SC (United States); Ackermann, Hanns [Clinic of the Goethe University, Department of Biostatistics and Mathematical Modelling, Frankfurt (Germany); Schoepf, U.J. [Medical University of South Carolina, Heart and Vascular Center, Ashley River Tower, Charleston, SC (United States)

    2011-09-15

    To investigate the role of perfusion defect (PD) size on dual energy CT pulmonary blood volume assessment as predictor of right heart strain and patient outcome and its correlation with d-dimer levels in acute pulmonary embolism (PE). 53 patients with acute PE who underwent DECT pulmonary angiography were retrospectively analyzed. Pulmonary PD size caused by PE was measured on DE iodine maps and quantified absolutely (VolPD) and relatively to the total lung volume (RelPD). Signs of right heart strain (RHS) on CT were determined. Information on d-dimer levels and readmission for recurrent onset of PE and death was collected. D-dimer level was mildly (r = 0.43-0.47) correlated with PD size. Patients with RHS had significantly higher VolPD (215 vs. 73 ml) and RelPD (9.9 vs. 2.9%) than patients without RHS (p < 0.003). There were 2 deaths and 1 readmission due of PE in 18 patients with >5% RelPD, while no such events were found for patients with <5% RelPD. Pulmonary blood volume on DECT in acute PE correlates with RHS and appears to be a predictor of patient outcome in this pilot study. (orig.)

  4. Combined use of the National Early Warning Score and D-dimer levels to predict 30-day and 365-day mortality in medical patients

    DEFF Research Database (Denmark)

    Nickel, Christian H; Kellett, John; Cooksley, Tim

    2016-01-01

    AIM: To investigate the combined use of NEWS and D-dimer levels to predict the 30-day and 365-day mortality rates of a cohort of Danish patients with complete follow-up. METHODS: Post-hoc retrospective observational study of acutely admitted medical patients aged 18 years or older who had D......-dimer measured within 6h after arrival to two medical admission units in Denmark. RESULTS: The final study population consisted of 1201 patients with a median age of 65.0 years (range 18.0-107.0 years), and 44.7% were of male sex. Four patients (0.3%) died within 24h of admission, 69 (5.7%) within 30 days...... and 198 (16.5%) within 365 days. On admission, 576 (48%) patients had a NEWS≥3 - of these 441 had a D-dimer≥0.50mgL(-1): 55 (12.5%) of these patients died within 30 days, compared with 5 (3.7%) of the 135 patients with a D-dimer

  5. Cut off from supplies - sulfate exhaustion and implications for methane emissions in a brackish rewetted peatland after separation from the coast

    Science.gov (United States)

    Koebsch, Franziska; Liu, Bo; Schmiedinger, Iris; Spitzy, Alejandro; Köhler, Stefan; Koch, Marian; Jurasinski, Gerald; Gehre, Matthias; Sachs, Torsten; Böttcher, Michael

    2016-04-01

    Coastal ecosystems are at the interface between marine and freshwater and exhibit a special geochemistry. We investigate the S and C geochemistry of a coastal, degraded fen peatland. The site has been cut off from the Baltic Sea since 1995 and was rewetted with freshwater from the surrounding catchment in 2010. Despite of locally high pore water sulfate (SO42-) concentrations, the fen turned into a strong source for methane (CH4) with annual budgets up to 0.26±0.06 kg m-2 (Hahn et al. 2015). To reconcile this apparent contradiction we use concentration patterns and stable isotope signatures of water, SO42-, pyrite, dissolved carbon, and CH4 (δ2H, δ13C, δ18O, δ34S) along a transect with increasing distance to the Baltic coastline (300-1500 m). The current peatland geochemistry is characterized by a combination of relict signals reflecting former brackish water intrusion events and indicators of recent human activities such as internal eutrophication and increasing freshwater contribution. The shallow peat layer (depth mostly ≤ 55 cm) exhibited a pronounced vertical gradient with a freshwater-front lying on top of the brackish water layer. S geochemistry was decoupled from present brackish water distribution as marine SO42- was almost completely biotically reduced and converted to pyrite. The remaining pore water SO42- pool was remarkably 34S-enriched in relation to Baltic Sea SO42- (up to +86.4 and +21‰, respectively) and also δ34S-values of pyrite were comparatively high (+4.8‰), thereby demonstrating a distinct reservoir effect under closed-system conditions. However, one of the profiles situated 1150 m from the Baltic Sea coast line exhibited a contrasting S pattern with pronounced excess of isotopically lighter SO42- at depth (up to 32.8 mM and +22.7‰). We hypothesize, that local groundwater seeps might provide electron acceptors such as NO3- for the contemporary oxidation of pyrite. δ13C in DIC exhibited a pronounced vertical shift from -23.9

  6. Specific cut-off points for waist circumference and waist-to-height ratio as predictors of cardiometabolic risk in Black subjects: a cross-sectional study in Benin and Haiti

    Directory of Open Access Journals (Sweden)

    EL Mabchour A

    2015-10-01

    Full Text Available Asma EL Mabchour,1 Hélène Delisle,1 Colette Vilgrain,2 Philippe Larco,2 Roger Sodjinou,3 Malek Batal1 1Transition Nutritionnelle (TRANSNUT, WHO Collaborating Centre on Nutrition Changes and Development, Department of Nutrition, Faculty of Medicine, University of Montreal, Montreal, QC, Canada; 2Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC, Port-au-Prince, Haiti; 3West Africa Health Organization (WAHO, Bobo-Dioulasso, Burkina Faso Purpose: Waist circumference (WC and waist-to-height ratio (WHtR are widely used as indicators of abdominal adiposity and the cut-off values have been validated primarily in Caucasians. In this study we identified the WC and WHtR cut-off points that best predicted cardiometabolic risk (CMR in groups of African (Benin and African ancestry (Haiti Black subjects. Methods: This cross-sectional study included 452 apparently healthy subjects from Cotonou (Benin and Port-au-Prince (Haiti, 217 women and 235 men from 25 to 60 years. CMR biomarkers were the metabolic syndrome components. Additional CMR biomarkers were a high atherogenicity index (total serum cholesterol/high density lipoprotein cholesterol ≥4 in women and ≥5 in men; insulin resistance set at the 75th percentile of the calculated Homeostasis Model Assessment index (HOMA-IR; and inflammation defined as high-sensitivity C-reactive protein (hsCRP concentrations between 3 and 10 mg/L. WC and WHtR were tested as predictors of two out of the three most prevalent CMR biomarkers. Receiver operating characteristic (ROC curves, Youden's index, and likelihood ratios were used to assess the performance of specific WC and WHtR cut-offs. Results: High atherogenicity index (59.5%, high blood pressure (23.2%, and insulin resistance (25% by definition were the most prevalent CMR biomarkers in the study groups. WC and WHtR were equally valid as predictors of CMR. Optimal WC cut-offs were 80 cm and 94 cm in men and women, respectively, which is exactly

  7. Comparing the Cervista HPV HR test and Hybrid Capture 2 assay in a Dutch screening population: improved specificity of the Cervista HPV HR test by changing the cut-off.

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    Aniek Boers

    Full Text Available The diagnostic performance of the widely-used Cervista HPV HR test was compared to the Hybrid Capture 2 (HC2 test in a Dutch population-based cervical cancer screening program. In 900 scrapings of women with normal cytomorphology, specificity was 90% (95%CI: 87.84-91.87 for the Cervista HPV HR test and 96% (95%CI: 94.76-97.37 for the HC2 test with 93% agreement between both tests (κ = 0.5, p<0.001. The sensitivity for CIN2+ using 65 scrapings of women with histological-confirmed CIN2+ was 91% (95%CI: 80.97-96.51 for the Cervista HPV HR test and 92% (95%CI: 82.94-97.43 for the HC2 test with 95% agreement between both tests (κ = 0.7, p<0.001. Fifty-seven of 60 HC2 negative/Cervista positive cases tested HPV-negative with PCR-based HPV assays; of these cases 56% were defined as Cervista triple-positive with FOZ values in all 3 mixes higher than the second cut-off of 1.93 (as set by manufacturer. By setting this cut-off at 5.0, specificity improved significantly without affecting sensitivity. External validation of this new cut-off at 5.0 in triple-positive scrapings of women selected from the SHENCCASTII database revealed that 22/24 histological normal cases now tested HPV-negative in the Cervista HPV HR test, while CIN2+ lesions remained HPV-positive. The intra-laboratory reproducibility of the Cervista HPV HR test (n = 510 showed a concordance of 92% and 93% for cut-off 1.93 and 5.0 (κ = 0.83 and κ = 0.84, p<0.001 and inter-laboratory agreement of the Cervista HPV HR test was 90% and 93% for cut-off 1.93 and 5.0 (κ = 0.80 and κ = 0.85, p<0.001. In conclusion, the specificity of the Cervista HPV HR test could be improved significantly by increasing the second cut-off from 1.93 to 5.0, without affecting the sensitivity of the test in a population-based screening setting.

  8. Relationship between glycated hemoglobin and glucose concentrations in the adult Galician population: selection of optimal glycated hemoglobin cut-off points as a diagnostic tool of diabetes mellitus.

    Science.gov (United States)

    Botana López, Manuel Antonio; López Ratón, Mónica; Tomé, María Ausencia; Fernández Mariño, Alexis; Mato Mato, José Antonio; Rego Iraeta, Antonia; Pérez Fernández, Román; Cadarso Suárez, Carmen

    2012-10-01

    To analyze the relationship between glucose and glycated hemoglobin (HbA(1c)) in the adult Galician population, evaluate the use of HbA(1c) for the screening and diagnosis of diabetes, and calculate the diagnostic threshold required for this purpose. We analyzed data on 2848 subjects (aged 18-85 years) drawn from a study undertaken in 2004 to assess the prevalence of diabetes in Galicia. For study purposes, diabetes was defined using the criteria recommended in 2002. Participants were classified into four glucose-based groups. The relationship between glucose and HbA(1c) was described using linear regression models, generalized additive models and Spearman's correlation. Diagnostic capacity was assessed, and optimal HbA(1c) cut-off points were calculated as a diabetes marker using the receiver operating characteristic curve. Prevalence of pre-diabetes, unknown diabetes and known diabetes was 20.86, 3.37 and 4.39%, respectively. The correlations between HbA(1c) and fasting glucose were higher than those obtained for HbA(1c) and glycemia at 2h of the oral glucose overload (0.344 and 0.270, respectively). Taking glucose levels as the gold standard, a greater discriminatory capacity was obtained for HbA(1c) (area under de cruve: 0.839, 95% confidence intervals: 0.788-0.890). Based on the study criteria, the optimal minimum and maximum HbA(1c) values were 5.9% and 6.7%, respectively. HbA(1c) did not prove superior to glycemia for diagnosis of diabetes in the adult Galician population, and cannot therefore be used to replace the oral glucose tolerance test for screening and diagnosis purposes. Indeed, determination of glucose is essential to verify the diagnosis in the majority of cases. Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.

  9. Application of the fracture risk assessment tool (FRAX(®)) and determination of suitable cut-off values during primary screening in specific health check-ups in Japan.

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    Nakatoh, Shinichi; Takemaru, Yuki

    2013-11-01

    Specific health check-ups, which do not include osteoporosis screening, are conducted more frequently than periodic osteoporosis screening in Japan. In this study, we investigated the usefulness of the fracture risk assessment tool (FRAX(®)) during specific health check-ups, evaluated the variations in its usefulness for 2 consecutive years, and determined FRAX(®) cut-off values for osteoporosis screening. FRAX(®) questionnaires were distributed to subjects who underwent specific health check-ups in 2009 and 2010 at Asahi-machi. Subjects who exhibited FRAX(®) cut-off values of ≥10 % were advised to be screened at a medical institution. Bone mineral densities (BMDs) were measured in 201 subjects in 2009 and 105 subjects in 2010 after specific health check-ups, and treatment was initiated for 79 subjects in 2009 and 24 subjects in 2010. The number of subjects examined and the rate of treatment initiation following specific health check-ups were higher than those in subjects following periodic osteoporosis screening in 2009. However, the number and the rate following specific health check-ups dropped in 2010. According to receiver operating characteristic curves analyses, the sensitivity and specificity of FRAX(®) to determine osteoporosis treatment were highest when the cut-off values were 8 % for men and 10.5 % for women. In conclusion, the combination of FRAX(®) and specific health check-ups was more useful than periodic osteoporosis screening to narrow down the subjects and to motivate them to seek follow-up. Cut-off values for specific health check-up using FRAX(®) should be approximately 8 % for men and 10.5 % for women.

  10. Glycolipid metabolic status of overweight/obese adolescents aged 9- to 15-year-old and the BMI-SDS/BMI cut-off value of predicting dyslipidemiain boys, Shanghai, China: a cross-sectional study.

    Science.gov (United States)

    Gong, Chun-dan; Wu, Qiao-ling; Chen, Zheng; Zhang, Dan; Zhao, Zheng-yan; Peng, Yong-mei

    2013-08-28

    The prevalence of adolescents' obesity and overweight has dramatically elevated in China. Obese children were likely to insulin resistance and dyslipidemia, which are risk factors of cardiovascular diseases. However there was no cut-off point of anthropometric values to predict the risk factors in Chinese adolescents. The present study was to investigate glycolipid metabolism status of adolescents in Shanghai and to explore the correlations between body mass index standard deviation score (BMI-SDS) and metabolic indices, determine the best cut-off value of BMI-SDS to predict dyslipidemia. Fifteen schools in Shanghai's two districts were chosen by cluster sampling and primary screening was done in children aged 9-15 years old. After screening of bodyweight and height, overweight and obese adolescents and age-matched children with normal body weight were randomly recruited in the study. Anthropometric measurements, biochemical measurements of glycolipid profiles were done. SPSS19.0 was used to analyze the data. Receiver operating characteristic (ROC) curves were made and the best cut-off values of BMI-SDS to predict dyslipidemia were determined while the Youden indices were maximum. Five hundred and thirty-eight adolescents were enrolled in this research, among which 283 have normal bodyweight, 115 were overweight and 140 were obese. No significant differences of the ages among 3 groups were found. There were significant differences of WC-SDS (plow density lipoprotein cholesterol (pcut-off value of BMI-SDS was 1.22 to predict dyslipidemia in boys. The BMI cut-off was 21.67 in boys. Overweight and obese youths had reduced insulin sensitivity and high prevalence of dyslipidemia.When BMI-SDS elevated up to 1.22 and BMI was higher than 21.67 in boys, dyslipidemia may happen.

  11. The value of plasma D-dimer level on admission in predicting no-reflow after primary percutaneous coronary intervention and long-term prognosis in patients with acute ST segment elevation myocardial infarction.

    Science.gov (United States)

    Erkol, Ayhan; Oduncu, Vecih; Turan, Burak; Kılıçgedik, Alev; Sırma, Dicle; Gözübüyük, Gökhan; Karabay, Can Yücel; Guler, Ahmet; Dündar, Cihan; Tigen, Kürşat; Pala, Selçuk; Kırma, Cevat

    2014-10-01

    D-dimer is a final product of fibrin degradation and gives an indirect estimation of the thrombotic burden. We aimed to investigate the value of plasma D-dimer levels on admission in predicting no-reflow after primary percutaneous coronary intervention (p-PCI) and long-term prognosis in patients with ST segment elevation myocardial infarction (STEMI). We retrospectively involved 569 patients treated with p-PCI for acute STEMIs. We prospectively followed up the patients for a median duration of 38 months. Angiographic no-reflow was defined as postprocedural thrombolysis in myocardial infarction (TIMI) flow grade grade admission D-dimer levels in the highest quartile (Q4), compared to the rates in other quartiles. However, Cox proportional hazard model revealed that high D-dimer on admission (Q4) was not an independent predictor of mortality or MACE. In contrast, electrocardiographic no-reflow was independently predictive of both mortality [Hazard ratio (HR) 2.88, 95% confidence interval (CI) 1.04-8.58, p = 0.041] and MACE [HR 1.90, 95% CI 1.32-4.71, p = 0.042]. In conclusion, plasma D-dimer level on admission independently predicts no-reflow after p-PCI. However, D-dimer has no independent prognostic value in patients with STEMI.

  12. Antimicrobial Susceptibility of Flavobacterium psychrophilum from Chilean Salmon Farms and their Epidemiological Cut-off Values using Agar Dilution and Disk Diffusion Methods

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    Claudio D Miranda

    2016-11-01

    Full Text Available Flavobacterium psychrophilum is the most important bacterial pathogen for freshwater farmed salmonids in Chile. The aims of this study were to determine the susceptibility to antimicrobials used in fish farming of Chilean isolates and to calculate their epidemiological cut-off (COWT values. A number of 125 Chilean isolates of F. psychrophilum were isolated from reared salmonids presenting clinical symptoms indicative of flavobacteriosis and their identities were confirmed by 16S rRNA polymerase chain reaction. Susceptibility to antibacterials was tested on diluted Mueller-Hinton by using an agar dilution MIC method and a disk diffusion method. The COWT values calculated by Normalised Resistance Interpretation (NRI analysis allow isolates to be categorized either as wild-type fully susceptible (WT or as manifesting reduced susceptibility (NWT. When MIC data was used, NRI analysis calculated a COWT of ≤ 0.125 μg mL-1, ≤ 2 μg mL-1 and ≤ 0.5 μg mL-1 for amoxicillin, florfenicol and oxytetracycline, respectively. For the quinolones, the COWT were ≤1 μg mL-1, ≤ 0.5 μg mL-1 and ≤ 0.125 μg mL-1 for oxolinic acid, flumequine and enrofloxacin respectively. The disc diffusion data sets obtained in this work were extremely diverse and were spread over a wide range. For the quinolones there was a close agreement between the frequencies of NWT isolates calculated using MIC and disc data. For oxolinic acid, flumequine and enrofloxacin the frequencies were 45, 39 and 38% using MIC data, and 42, 41 and 44%, when disc data were used. There was less agreement with the other antimicrobials, because NWT frequencies obtained using MIC and disc data respectively, were 24% and 10% for amoxicillin, 8% and 2% for florfenicol and 70% and 64% for oxytetracycline. Considering that the MIC data was more precise than the disc diffusion data, MIC determination would be the preferred method for susceptibility testing for this species and the NWT frequencies

  13. Optimal waist circumference cut-off points and ability of different metabolic syndrome criteria for predicting diabetes in Japanese men and women: Japan Epidemiology Collaboration on Occupational Health Study.

    Science.gov (United States)

    Hu, Huanhuan; Kurotani, Kayo; Sasaki, Naoko; Murakami, Taizo; Shimizu, Chii; Shimizu, Makiko; Nakagawa, Tohru; Honda, Toru; Yamamoto, Shuichiro; Okazaki, Hiroko; Nagahama, Satsue; Uehara, Akihiko; Yamamoto, Makoto; Tomita, Kentaro; Imai, Teppei; Nishihara, Akiko; Kochi, Takeshi; Eguchi, Masafumi; Miyamoto, Toshiaki; Hori, Ai; Kuwahara, Keisuke; Akter, Shamima; Kashino, Ikuko; Kabe, Isamu; Liu, Weiping; Mizoue, Tetsuya; Kunugita, Naoki; Dohi, Seitaro

    2016-03-03

    We sought to establish the optimal waist circumference (WC) cut-off point for predicting diabetes mellitus (DM) and to compare the predictive ability of the metabolic syndrome (MetS) criteria of the Joint Interim Statement (JIS) and the Japanese Committee of the Criteria for MetS (JCCMS) for DM in Japanese. Participants of the Japan Epidemiology Collaboration on Occupational Health Study, who were aged 20-69 years and free of DM at baseline (n = 54,980), were followed-up for a maximum of 6 years. Time-dependent receiver operating characteristic analysis was used to determine the optimal cut-off points of WC for predicting DM. Time-dependent sensitivity, specificity, and positive and negative predictive values for the prediction of DM were compared between the JIS and JCCMS MetS criteria. During 234,926 person-years of follow-up, 3180 individuals developed DM. Receiver operating characteristic analysis suggested that the most suitable cut-off point of WC for predicting incident DM was 85 cm for men and 80 cm for women. MetS was associated with 3-4 times increased hazard for developing DM in men and 7-9 times in women. Of the MetS criteria tested, the JIS criteria using our proposed WC cut-off points (85 cm for men and 80 cm for women) had the highest sensitivity (54.5 % for men and 43.5 % for women) for predicting DM. The sensitivity and specificity of the JCCMS MetS criteria were ~37.7 and 98.9 %, respectively. Data from the present large cohort of workers suggest that WC cut-offs of 85 cm for men and 80 cm for women may be appropriate for predicting DM for Japanese. The JIS criteria can detect more people who later develop DM than does the JCCMS criteria.

  14. Optimal waist circumference cut-off points and ability of different metabolic syndrome criteria for predicting diabetes in Japanese men and women: Japan Epidemiology Collaboration on Occupational Health Study

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    Huanhuan Hu

    2016-03-01

    Full Text Available Abstract Background We sought to establish the optimal waist circumference (WC cut-off point for predicting diabetes mellitus (DM and to compare the predictive ability of the metabolic syndrome (MetS criteria of the Joint Interim Statement (JIS and the Japanese Committee of the Criteria for MetS (JCCMS for DM in Japanese. Methods Participants of the Japan Epidemiology Collaboration on Occupational Health Study, who were aged 20–69 years and free of DM at baseline (n = 54,980, were followed-up for a maximum of 6 years. Time-dependent receiver operating characteristic analysis was used to determine the optimal cut-off points of WC for predicting DM. Time-dependent sensitivity, specificity, and positive and negative predictive values for the prediction of DM were compared between the JIS and JCCMS MetS criteria. Results During 234,926 person-years of follow-up, 3180 individuals developed DM. Receiver operating characteristic analysis suggested that the most suitable cut-off point of WC for predicting incident DM was 85 cm for men and 80 cm for women. MetS was associated with 3–4 times increased hazard for developing DM in men and 7–9 times in women. Of the MetS criteria tested, the JIS criteria using our proposed WC cut-off points (85 cm for men and 80 cm for women had the highest sensitivity (54.5 % for men and 43.5 % for women for predicting DM. The sensitivity and specificity of the JCCMS MetS criteria were ~37.7 and 98.9 %, respectively. Conclusion Data from the present large cohort of workers suggest that WC cut-offs of 85 cm for men and 80 cm for women may be appropriate for predicting DM for Japanese. The JIS criteria can detect more people who later develop DM than does the JCCMS criteria.

  15. Von Willebrand Factor, ADAMTS13 and D-Dimer Are Correlated with Different Levels of Nephropathy in Type 1 Diabetes Mellitus.

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    Caroline Pereira Domingueti

    Full Text Available We have investigated whether von Willebrand factor, ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motif, member 13, and D-Dimer were associated with different levels of renal function in patients with type 1 diabetes. Patients were classified according to level of renal function through estimated glomerular filtration rate: ≥90 and <130mL/min/1,73m2, n=52 (control group, ≥60 and <90mL/min/1,73m2, n=29 (mild renal dysfunction group, <60mL/min/1,73m2, n=28 (severe renal dysfunction group; and through urinary albumin excretion: normoalbuminuria, microalbuminuria and macroalbuminuria. Von Willebrand factor, ADAMTS13, and D-Dimer plasma levels were determined by enzyme-linked immunosorbent assay. ADAMTS13 activity was determined by fluorescence resonance energy transfer assay. Von Willebrand factor levels were increased in patients with mild (P=0.001 and severe (P<0.001 renal dysfunction as compared to the control group. ADAMTS13 levels were also increased in mild (P=0.029 and severe (P=0.002 renal dysfunction groups in comparison to the control group, while ADAMTS13 activity was increased only in the severe renal dysfunction group as compared to the control group (P=0.006. No significant differences were observed among the groups regarding von Willebrand factor/ADAMTS13 ratio. ADAMTS13 activity/ADAMTS13 levels ratio was reduced in patients with mild (P=0.013 and severe (P=0.015 renal dysfunction as compared to the control group. D-Dimer levels were increased in patients with mild (P=0.006 and severe (P<0.001 renal dysfunction as compared to the control group; it was also higher in patients with severe renal dysfunction as compared to the mild renal dysfunction group (P=0.019. Similar results were found for albuminuria classification. Increased von Willebrand factor, ADAMTS13, and D-Dimer levels and decreased ADAMTS13 activity/ADAMTS13 levels ratio are associated with renal dysfunction in patients with type 1 diabetes

  16. Determination of D-Dimers in condition of emergency: the D-Di Liatest. Threshold value in elimination of pulmonary emboli (PE); Determination en urgence des D-Dimeres: le liatest D-DI. Valeur seuil permettant d`eliminer une embolie pulmonaire (EP)

    Energy Technology Data Exchange (ETDEWEB)

    Duet, M. [Service de Medecine Nucleaire (France); Soria, C. [Service de Hematologie (France); Elkarrat, D. [Service de Urgences (France); Benelhadj, S. [Service de Medecine Nucleaire (France); Bailliard, O.; Kedra, A.W. [Service de Explorations Founctionnelles, Hopital Lariboisiere, Paris (France); Drouet, L. [Service de Hematologie (France); Mundler, O. [Service de Medecine Nucleaire (France)

    1997-12-31

    Several studies have shown that a low rate of D-Dimers (products of fibrin decay) measured by Elisa technique can eliminate the diagnosis of thrombo-embolic disease. However, the conventional Elisa technique is not adapted to emergency conditions. A new agglutination test of latex microparticles (D-Di Liatest) has been developed by Diagnostica Stago with a sensitivity of 100 ng/ml. Our goal was to determine the threshold of PE exclusion. Ninety six patients suspected of PE were included. The pulmonary perfusion scintigraphy (PPS), as a reference examination the positivity of which has been confirmed by clinical follow-up, has been carried out in association with the determination of plasmatic rates of D-Dimers by the techniques Elisa and Liatest based on different antibodies. A table is given containing the D-Di threshold rates obtained by these techniques. In conclusion, our results showed that the rate of D-Dimers which eliminate a PE is {<=} 500 ng/ml by Elisa and {<=} 400 ng/ml by Liatest with a VPN of 100%. However, the PPS remains necessary in 77% of cases. This work stresses the necessity of clinical validations for the new biological tests

  17. A study of disseminated intravascular coagulation in acute leukemia reveals markedly elevated D-dimer levels are a sensitive indicator of acute promyelocytic leukemia.

    Science.gov (United States)

    Shahmarvand, N; Oak, J S; Cascio, M J; Alcasid, M; Goodman, E; Medeiros, B C; Arber, D A; Zehnder, J L; Ohgami, R S

    2017-08-01

    While the presence of disseminated intravascular coagulation (DIC) has been implicated in worse clinical outcome in acute leukemia, the relationship between different subtypes of acute leukemia and the clinicopathologic features of DIC has not been systematically well studied. In this study, we retrospectively reviewed 149 cases of newly diagnosed acute leukemia and assessed the utility of evaluating red blood cell morphologic features, and coagulation parameters in determining the presence of DIC as well as differentiating subtypes of acute leukemia. Review of our cohort demonstrates a novel finding, that elevated D-dimer concentrations ≥19 000 ng/mL fibrinogen equivalent units (FEU) are a sensitive diagnostic indicator of acute promyelocytic leukemia (APL) with moderate specificity, sensitivity 96%, specificity 92% in acute leukemia subtyping. Similar to other studies, APL showed an increased incidence of DIC (P acute leukemia. Surprisingly, the presence of schistocytes on the peripheral blood smear was not a statistically significant indicator of DIC, sensitivity of 36% and specificity of 89%. Finally, the presence of DIC was not a significant indicator of poorer prognosis amongst all patients with AML. Overall we identify elevated D-dimer concentrations ≥19 000 ng/mL FEU are a sensitive indicator of acute promyelocytic leukemia (APL), with a sensitivity of 96% and specificity of 92% in the subtyping of acute leukemias, and that the presence of schistocytes in peripheral blood smears is not a diagnostically sensitive screening test for DIC with a sensitivity of 36%. © 2017 John Wiley & Sons Ltd.

  18. Which are the cut-off values of 2D-Shear Wave Elastography (2D-SWE) liver stiffness measurements predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method?

    Science.gov (United States)

    Sporea, Ioan; Bota, Simona; Gradinaru-Taşcău, Oana; Sirli, Roxana; Popescu, Alina; Jurchiş, Ana

    2014-03-01

    To identify liver stiffness (LS) cut-off values assessed by means of 2D-Shear Wave Elastography (2D-SWE) for predicting different stages of liver fibrosis, considering Transient Elastography (TE) as the reference method. Our prospective study included 383 consecutive subjects, with or without hepatopathies, in which LS was evaluated by means of TE and 2D-SWE. To discriminate between various stages of fibrosis by TE we used the following LS cut-offs (kPa): F1-6, F2-7.2, F3-9.6 and F4-14.5. The rate of reliable LS measurements was similar for TE and 2D-SWE: 73.9% vs. 79.9%, p=0.06. Older age and higher BMI were associated for both TE and 2D-SWE with the impossibility to obtain reliable LS measurements. Reliable LS measurements by both elastographic methods were obtained in 65.2% of patients. A significant correlation was found between TE and 2D-SWE measurements (r=0.68). The best LS cut-off values assessed by 2D-SWE for predicting different stages of liver fibrosis were: F≥1: >7.1 kPa (AUROC=0.825); F≥2: >7.8 kPa (AUROC=0.859); F≥3: >8 kPa (AUROC=0.897) and for F=4: >11.5 kPa (AUROC=0.914). 2D-SWE is a reliable method for the non-invasive evaluation of liver fibrosis, considering TE as the reference method. The accuracy of 2D-SWE measurements increased with the severity of liver fibrosis. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  19. {sup 18}F-FDG PET/CT for detection of malignant peripheral nerve sheath tumours in neurofibromatosis type 1: tumour-to-liver ratio is superior to an SUV{sub max} cut-off

    Energy Technology Data Exchange (ETDEWEB)

    Salamon, Johannes [University Medical Centre Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); University Hospital Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Veldhoen, Simon [University Medical Centre Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); University Medical Centre Wuerzburg, Department of Diagnostic and Interventional Radiology, Wuerzburg (Germany); Apostolova, Ivayla [Otto-von-Guericke University, Department of Radiology and Nuclear Medicine, Magdeburg (Germany); Bannas, Peter; Yamamura, Jin; Herrmann, Jochen; Adam, Gerhard; Derlin, Thorsten [University Medical Centre Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Friedrich, Reinhard E. [University Medical Centre Hamburg-Eppendorf, Department of Oral and Maxillofacial Surgery, Hamburg (Germany); Mautner, Victor F. [University Medical Centre Hamburg-Eppendorf, Department of Neurology, Hamburg (Germany)

    2014-02-15

    To evaluate the usefulness of normalising intra-tumour tracer accumulation on {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) to reference tissue uptake for characterisation of peripheral nerve sheath tumours (PNSTs) in neurofibromatosis type 1 (NF1) compared with the established maximum standardised uptake value (SUVmax) cut-off of >3.5. Forty-nine patients underwent FDG PET/CT. Intra-tumour tracer uptake (SUVmax) was normalised to three different reference tissues (tumour-to-liver, tumour-to-muscle and tumour-to-fat ratios). Receiver operating characteristic (ROC) analyses were used out to assess the diagnostic performance. Histopathology and follow-up served as the reference standard. Intra-tumour tracer uptake correlated significantly with liver uptake (r{sub s} = 0.58, P = 0.016). On ROC analysis, the optimum threshold for tumour-to-liver ratio was >2.6 (AUC = 0.9735). Both the SUVmax cut-off value of >3.5 and a tumour-to-liver ratio >2.6 provided a sensitivity of 100 %, but specificity was significantly higher for the latter (90.3 % vs 79.8 %; P = 0.013). In patients with NF1, quantitative {sup 18}F-FDG PET imaging may identify malignant change in neurofibromas with high accuracy. Specificity could be significantly increased by using the tumour-to-liver ratio. The authors recommend further evaluation of a tumour-to-liver ratio cut-off value of >2.6 for diagnostic intervention planning. (orig.)

  20. [Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy for treating spastic cerebral paralysis of the upper limbs caused by cerebral palsy].

    Science.gov (United States)

    Zhang, Peng; Hu, Wei; Cao, Xu; Xu, Shi-gang; Li, De-kui; Xu, Lin

    2009-10-01

    To explore the feasibility and the result for the surgical treatment of spastic cerebral paralysis of the upper limbs in patients who underwent the selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy. From March 2004 to April 2008, 27 patients included 19 boys and 8 girls, aging 13-21 years with an average of 15 years underwent selective cervical dorsal root cutting off part of the vertebral lateral mass fixation with exercise therapy. The AXIS 8 holes titanium plate was inserted into the lateral mass of spinous process through guidance of the nerve stimulator, choosed fasciculus of low-threshold nerve dorsal root and cut off its 1.5 cm. After two weeks, training exercise therapy was done in patients. Training will include lying position, turning body, sitting position, crawling, kneeling and standing position, walking and so on. Spastic Bobath inhibiting abnormal pattern was done in the whole process of training. The muscular tension, motor function (GMFM), functional independence (WeeFIM) were observed after treatment. All patients were followed up from 4 to 16 months with an average of 6 months. Muscular tension score were respectively 3.30 +/- 0.47 and 1.25 +/- 0.44 before and after treatment;GMFM score were respectively 107.82 +/- 55.17 and 131.28 +/- 46.45; WeeFIM score were respectively 57.61 +/- 25.51 and 87.91 +/- 22.39. There was significant improvement before and after treatment (P cerebral paralysis of the upper limbs is safe and effective method, which can decrease muscular tension and improve motor function, which deserves more wide use.

  1. Optimal Cut-Offs of Homeostasis Model Assessment of Insulin Resistance (HOMA-IR to Identify Dysglycemia and Type 2 Diabetes Mellitus: A 15-Year Prospective Study in Chinese.

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    C H Lee

    Full Text Available The optimal reference range of homeostasis model assessment of insulin resistance (HOMA-IR in normal Chinese population has not been clearly defined. Here we address this issue using the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS, a prospective population-based cohort study with long-term follow-up.In this study, normal glucose tolerance (NGT, impaired fasting glucose (IFG, impaired glucose tolerance (IGT and type 2 diabetes mellitus (T2DM were defined according to the 1998 World Health Organization criteria. Dysglycemia referred to IFG, IGT or T2DM. This study comprised two parts. Part one was a cross-sectional study involving 2,649 Hong Kong Chinese subjects, aged 25-74 years, at baseline CRISPS-1 (1995-1996. The optimal HOMA-IR cut-offs for dysglycemia and T2DM were determined by the receiver-operating characteristic (ROC curve. Part two was a prospective study involving 872 subjects who had persistent NGT at CRISPS-4 (2010-2012 after 15 years of follow-up.At baseline, the optimal HOMA-IR cut-offs to identify dysglyceia and T2DM were 1.37 (AUC = 0.735; 95% confidence interval [CI] = 0.713-0.758; Sensitivity [Se] = 65.6%, Specificity [Sp] = 71.3%] and 1.97 (AUC = 0.807; 95% CI = 0.777-0.886; Se = 65.5%, Sp = 82.9% respectively. These cut-offs, derived from the cross-sectional study at baseline, corresponded closely to the 75th (1.44 and 90th (2.03 percentiles, respectively, of the HOMA-IR reference range derived from the prospective study of subjects with persistent NGT.HOMA-IR cut-offs, of 1.4 and 2.0, which discriminated dysglycemia and T2DM respectively from NGT in Southern Chinese, can be usefully employed as references in clinical research involving the assessment of insulin resistance.

  2. Use of clinical prediction rules and D-dimer tests in the diagnostic management of pregnant patients with suspected acute pulmonary embolism.

    Science.gov (United States)

    Van der Pol, L M; Mairuhu, A T A; Tromeur, C; Couturaud, F; Huisman, M V; Klok, F A

    2017-03-01

    Because pregnant women have an increased risk of venous thromboembolism (VTE) and at the same time normal pregnancy is associated with symptoms, mimicking those present in the setting of acute pulmonary embolism (PE), the latter diagnosis is frequently suspected in this patient category. Since imaging tests expose both mother and foetus to ionizing radiation, the ability to rule out PE based on non-radiological diagnostic tests is of paramount importance. However, clinical decision rules have only been scarcely evaluated in the pregnant population with suspected PE, while D-dimer levels lose diagnostic accuracy due to a physiological increase during normal pregnancy. Consequently, clinical guidelines provide contradicting and weak recommendations on this subject and the optimal diagnostic strategy remains highly debated. With this systematic review, we aimed to summarize current evidence on the safety and efficacy of clinical decision rules and biomarkers used in the diagnostic management of suspected acute PE in pregnant patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Interleukin 6 Is a Stronger Predictor of Clinical Events Than High-Sensitivity C-Reactive Protein or D-Dimer During HIV Infection

    DEFF Research Database (Denmark)

    Borges, Alvaro Humberto Diniz; O'Connor, Jemma L; Phillips, Andrew N

    2016-01-01

    BACKGROUND: Interleukin 6 (IL-6), high-sensitivity C-reactive protein (hsCRP), and D-dimer levels are linked to adverse outcomes in human immunodeficiency virus (HIV) infection, but the strength of their associations with different clinical end points warrants investigation. METHODS: Participants...... receiving standard of care in 2 HIV trials with measured biomarker levels were followed to ascertain all-cause death, non-AIDS-related death, AIDS, cardiovascular disease (CVD), and non-AIDS-defining malignancies. Hazard ratios (HRs) and 95% confidence intervals (CIs) of each end point for quartiles and log......-dimer (P = .20) as a predictor for different end points. CONCLUSIONS: IL-6 is a stronger predictor of fatal events than of CVD and non-AIDS-defining malignancies. Adjuvant antiinflammatory and antithrombotic therapies should be tested in HIV-infected individuals....

  4. A direct correlation between the antioxidant efficiencies of caffeic acid and its alkyl esters and their concentrations in the interfacial region of olive oil emulsions. The pseudophase model interpretation of the "cut-off" effect.

    Science.gov (United States)

    Costa, Marlene; Losada-Barreiro, Sonia; Paiva-Martins, Fátima; Bravo-Díaz, Carlos; Romsted, Laurence S

    2015-05-15

    Recently published results for a series of homologous antioxidants, AOs, of increasing alkyl chain length show a maximum in AO efficiency followed by a significant decrease for the more hydrophobic AOs, typically called the "cut-off" effect. Here we demonstrate that in olive oil emulsions both antioxidant efficiencies and partition constants for distributions of AOs between the oil and interfacial regions, PO(I), show a maximum at the C8 ester. A reaction between caffeic acid, CA, and its specially synthesised C1-C16 alkyl esters, and a chemical probe is used to estimate partition constants for AO distributions and interfacial rate constants, kI, in intact emulsions based on the pseudophase kinetic model. The model provides a natural interpretation for both the maximum and the "cut-off" effect. More than 70% of the CA esters are in the interfacial region even at low surfactant volume fraction, ΦI=0.005. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. Evaluation of sera with a low signal to cut-off ratio using two chemiluminescent assays for detecting Hepatitis C Virus, and their correlation with the detection of Viral RNA.

    Science.gov (United States)

    López-Fabal, M ª Fátima; Pérez-Rivilla, Alfredo; Gómez-Garcés, José Luis

    2017-02-23

    All commercial assays used to measure the presence of Hepatitis C virus (HCV) antibodies set cut-off points to categorise the results, but the problem of false positive results in screening hepatitis C sera is well known. The aim of this study was to evaluate the results obtained by two chemiluminescent assays in selected sera, and compare these results with the detection of viral RNA in the specimens studied. Two hundred reactive sera (positive) were selected, although with a low signal to cut-off ratio (S/CO), were selected, using two chemiluminescent assays and were then subjected to genome amplification. Viral RNA could be only be detected in 8 (4%) of the selected specimens. Taking these results into account, we believe that the design of the current chemiluminescent assays do not provide sufficient specificity when they are used as the only tests for the diagnosis of hepatitis C. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

  6. An approach for the delineation of a generic cut-off value for local respiratory tract irritation by irritating or corrosive substances as a pragmatic tool to fulfill REACH requirements.

    Science.gov (United States)

    Messinger, H

    2014-04-01

    Under the current European legislation for the Registration, Evaluation, Authorisation and restriction of Chemicals (REACHs) a Derived No Effect Level (DNEL) has to be delineated for acute and chronic inhalation effects. The majority of available experimental studies are performed by the oral route of exposure. Route to route extrapolation poses particular problems for irritating or corrosive substances but the necessity for additional animal studies with inhalation exposure needs to be balanced with the regulatory information requirements. Existing occupational exposure limits (OEL) as surrogate for cut-off limits representing safe exposure under working conditions were grouped under certain criteria for substances that are legally classified in Europe as irritating or corrosive. As a result, it was shown that the OEL for irritating substances in this dataset is not lower than 10mg/m(3) and for corrosives not lower than 1mg/m(3). Under certain conditions these generic limits could be applied as a pragmatic, but still sufficiently reliable and protective upper cut-off limit approach to avoid additional animal tests with irritating or corrosive chemicals. The respective systemic toxicity profiles and physical-chemical properties need to be considered. Specific exclusion criteria for the discussed concept apply. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Is it acceptable to use coagulation plasma samples stored at room temperature and 4°C for 24 hours for additional prothrombin time, activated partial thromboplastin time, fibrinogen, antithrombin, and D-dimer testing?

    Science.gov (United States)

    Rimac, V; Coen Herak, D

    2017-10-01

    Coagulation laboratories are faced on daily basis with requests for additional testing in already analyzed fresh plasma samples. This prompted us to examine whether plasma samples stored at room temperature (RT), and 4°C for 24 hours can be accepted for additional prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen (Fbg), antithrombin (AT), and D-dimer testing. We measured PT, aPTT, Fbg in 50 and AT in 30 plasma samples with normal and pathological values, within 4 hours of blood collection (baseline results) and after 24-hours storage at RT (primary tubes), and 4°C (aliquots). D-dimer stability was investigated in 20 samples stored in primary tubes at 4°C. No statistically significant difference between baseline results and results in samples stored at RT and 4°C was observed for PT (P=.938), aPTT (P=.186), Fbg (P=.962), AT (P=.713), and D-dimers (P=.169). The highest median percentage changes were found for aPTT, being more pronounced for samples stored at 4°C (13.0%) than at RT (8.7%). Plasma samples stored both at RT and 4°C for 24 hours are acceptable for additional PT, Fbg, and AT testing. Plasma samples stored 24 hours in primary tubes at 4°C are suitable for D-dimer testing. © 2017 John Wiley & Sons Ltd.

  8. Determination of decisional cut-off values for the optimal diagnosis of bovine tuberculosis with a modified IFNγ assay (Bovigam®) in a low prevalence area in France.

    Science.gov (United States)

    Faye, Sandy; Moyen, Jean-Louis; Gares, Hélène; Benet, Jean-Jacques; Garin-Bastuji, Bruno; Boschiroli, María-Laura

    2011-07-05

    The Bovigam(®) gamma interferon (IFNγ) assay was used to complement official skin-test screening in a low bovine tuberculosis (bTB) prevalence region in France. The aim of our work was to determine decisional cut-off values for protein purified derivatives (PPD) and ESAT6-CFP10 antigens (R) in order to optimize the efficacy of the modified Bovigam(®) test, in this low-prevalence area, for optimal classification of infected or non-infected herds following positive skin tests. The sensitivity of the IFNγ assay relative to post-mortem bTB-positive animals (Se(r)) was studied in 60 cattle from 20 bTB-infected herds. Its absolute specificity (Sp) was studied in 492 cattle from 25 bTB-free herds from a bTB-free zone. Its operational specificity (relative to the positive skin test) (Sp(r)) was also studied in 547 skin-test positive cattle from 172 bTB-free herds from an infected zone. Using normalized interpretations for individual (PPD or R) results, the cut-off values at 0.02 for PPD and 0.01 for R were obtained with a view to employ them in low prevalence areas with no previously observed non-specific reactions to SITT. Concerning its use after positive skin tests, cut-off values were set at 0.05 for PPD and at 0.03 for R. The choice of an interpretation method considering positive results with PPD and/or R (PPDUR), justified in a high risk context, provided a test Se(r) of 93% [84-98] and Sp(r) of 71.8% [67.9-75.6]. Analysis of positive results with PPD and R (PPDUR), ideal for low-risk contexts, provided a test Sp(r) of 94.3% [92.0-96.1] and Se(r) of 77% [64-87]. Thus, adapting the criteria to the region's infection status and to the conditions for its application is essential for the appropriate use of the IFNγ assay. Copyright © 2011 Elsevier B.V. All rights reserved.

  9. Determination of a cut-off value of antral area measured in the supine position for the fast diagnosis of an empty stomach in the parturient: A prospective cohort study.

    Science.gov (United States)

    Jay, Lucille; Zieleskiewicz, Laurent; Desgranges, François-Pierrick; Cogniat, Bérengère; Pop, Marius; Boucher, Pierre; Bellon, Amandine; Léone, Marc; Chassard, Dominique; Bouvet, Lionel

    2017-03-01

    Ultrasound measurement of the antral cross-sectional area of the stomach, performed in the supine position, has been described for preoperative assessment of gastric content in the adult, but, to date, no study has determined the cut-off value of the antral area for the diagnosis of an empty stomach in the parturient. Nevertheless, previous studies in parturients have reported that the use of a simple qualitative grading scale (0 to 2) was reliable for the estimation of the gastric fluid volume. However, this qualitative grading score requires turning the parturient into the right lateral decubitus position for the ultrasound examination, something which may not be easily feasible, particularly in the case of an obstetric emergency. To calculate the cut-off value of the antral area, measured in the supine position during established labour, for the diagnosis of 'empty' stomach. A prospective cohort study. Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon, France. Seventy-three women in established labour. For each parturient, ultrasound assessment of gastric contents was performed in the supine and right lateral decubitus position and scored 0 to 3 on a qualitative grading scale. This assessment was followed by ultrasound measurement of the antral cross-sectional area in both the supine and right lateral positions. To assess the performance of the antral area measured in the supine position for the diagnosis of an 'empty' stomach (gastric antrum grade 0), a receiver operating characteristic curve was plotted, and the area under the receiver operating characteristic curve was calculated. Data from 73 women were analysed. For the diagnosis of grade 0, the cut-off value for the antral area measured in the supine position was 381 mm (sensitivity, 81%; specificity, 76% and negative predictive value, 80%). With a parturient lying in the supine position, a single assessment of the antral cross-sectional area may be used for the fast diagnosis of an empty

  10. Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy?

    Science.gov (United States)

    Godino, Cosmo; Mendolicchio, Loredana; Figini, Filippo; Latib, Azeem; Sharp, Andrew Sp; Cosgrave, John; Calori, Giliola; Cera, Michela; Chieffo, Alaide; Castelli, Alfredo; Maseri, Attilio; Ruggeri, Zaverio M; Colombo, Antonio

    2009-05-06

    Dual anti-platelet therapy with aspirin and a thienopyridine (DAT) is used to prevent stent thrombosis after percutaneous coronary intervention (PCI). Low response to clopidogrel therapy (LR) occurs, but laboratory tests have a controversial role in the identification of this condition. We studied LR in patients with stable angina undergoing elective PCI, all on DAT for at least 7 days, by comparing: 1) Flow cytometry (FC) to measure platelet membrane expression of P-selectin (CD62P) and PAC-1 binding following double stimulation with ADP and collagen type I either in the presence of prostaglandin (PG) E1; 2) VerifyNow-P2Y12 test, in which results are reported as absolute P2Y12-Reaction-Units (PRU) or % of inhibition (% inhibition). Thirty controls and 52 patients were analyzed. The median percentage of platelets exhibiting CD62P expression and PAC-1 binding by FC evaluation after stimulation in the presence of PG E1 was 25.4% (IQR: 21.4-33.1%) and 3.5% (1.7-9.4%), respectively. Only 6 patients receiving DAT (11.5%) had both values above the 1st quartile of controls, and were defined as LR. Evaluation of the same patients with the VerifyNow-P2Y12 test revealed that the area under the receiver-operating-characteristic (ROC) curve was 0.94 (95% CI: 0.84-0.98, p Cut-off values of ≤ 15% inhibition or > 213 PRU gave the maximum accuracy for the detection of patients defined as having LR by FC. In conclusion our findings show that a cut-off value of ≤ 15% inhibition or > 213 PRU in the VerifyNow-P2Y12 test may provide the best accuracy for the identification of patients with LR.

  11. Improving thermal and electrochemical performances of LiCoO{sub 2} cathode at high cut-off charge potentials by MF{sub 3} (M=Ce, Al) coating

    Energy Technology Data Exchange (ETDEWEB)

    Aboulaich, Abdelmaula, E-mail: a.aboulaich@managemgroup.com; Ouzaouit, Khalid; Faqir, Hakim; Kaddami, Abderrahman; Benzakour, Intissar; Akalay, Ismail

    2016-01-15

    Highlights: • Fluoride metal is successfully coated on the surface of LiCoO{sub 2}. • Easy and scalable method is adopted for the synthesis of coated-LiCoO{sub 2}. • Appropriate amount of AlF{sub 3} or CeF{sub 3} is beneficial to reduce cation disorder. • The electrochemical performances of coated LiCoO{sub 2} is significantly enhanced at higher potential (cycling efficiency and reversible capacity). • The coated cathode exhibits excellent thermal stability highlighted by calorimetric technique. - Abstract: Surface coating of LiCoO{sub 2} remained one of the efficient methods to enhance its electrochemical and thermal performances, especially at high cut-off potential. In this work, MF{sub 3} (M = Ce, Al) coated LiCoO{sub 2} was synthesized via co-precipitation method followed by a solid state reaction at 400 °C. The morphology and structure of the modified cathode material were characterized by scanning electron microscopy (SEM), X-ray diffraction (XRD) and transmission electron microscopy (TEM). The results show that the fluoride compound MF{sub 3} is successfully coated on the surface of LiCoO{sub 2} cathode particles with an average layer thickness about 12 nm and 40 nm for AlF{sub 3} and CeF{sub 3}, respectively. The electrochemical tests show that the AlF{sub 3}-coating layer significantly enhances the cycling performance of LiCoO{sub 2} cathode material, even at high cut-off potential. While the bare LiCoO{sub 2} cathode displays fast fading at 4.6 V vs. Li{sup +}/Li cutoff potential, the surface-modified electrode exhibits the great capacity of 160 mAh g{sup −1} with excellent capacity retention on several cycles. We concluded that the electrochemical and the thermal enhancement at high potential are ascribed to the presence of MF{sub 3} coating layer which prevent the side reaction during the charge discharge process, alleviate the attack by the acidic electrolyte and reduce the damage of electrode structure.

  12. Selection of a cut-off for high- and low-methane producers using a spot-methane breath test: results from a large north American dataset of hydrogen, methane and carbon dioxide measurements in breath.

    Science.gov (United States)

    Gottlieb, Klaus; Le, Chenxiong; Wacher, Vince; Sliman, Joe; Cruz, Christine; Porter, Tyler; Carter, Stephen

    2017-08-01

    Levels of breath methane, together with breath hydrogen, are determined by means of repeated collections of both, following ingestion of a carbohydrate substrate, at 15-20 minutes intervals, until 10 samples have been obtained. The frequent sampling is required to capture a rise of hydrogen emissions, which typically occur later in the test: in contrast, methane levels are typically elevated at baseline. If methane emissions represent the principal objective of the test, a spot methane test (i.e. a single-time-point sample taken after an overnight fast without administration of substrate) may be sufficient. We analysed 10-sample lactulose breath test data from 11 674 consecutive unique subjects who submitted samples to Commonwealth Laboratories (Salem, MA, USA) from sites in all of the states of the USA over a one-year period. The North American Consensus (NAC) guidelines criteria for breath testing served as a reference standard. The overall prevalence of methane-positive subjects (by NAC criteria) was 20.4%, based on corrected methane results, and 18.9% based on raw data. In our USA dataset, the optimal cut-off level to maximize sensitivity and specificity was ≥4 ppm CH4, 94.5% [confidential interval (CI): 93.5-95.4%] and 95.0% (CI: 94.6-95.5%), respectively. The use of a correction factor (CF) (5% CO2 as numerator) led to reclassifications CH4-high to CH4-low in 0.7 % and CH4-low to CH4-high in 2.1%. A cut-off value for methane at baseline of either ≥4 ppm, as in our USA dataset, or ≥ 5 ppm, as described in a single institution study, are both highly accurate in identifying subjects at baseline that would be diagnosed as 'methane-positive' in a 10-sample lactulose breath test for small intestinal bacterial overgrowth. © The Author(s) 2017. Published by Oxford University Press and Sixth Affiliated Hospital of Sun Yat-Sen University.

  13. Diagnostic and prognostic value of brain natriuretic peptide (BNP) concentrations in very elderly heart disease patients: specific geriatric cut-off and impacts of age, gender, renal dysfunction, and nutritional status.

    Science.gov (United States)

    Blondé-Cynober, F; Morineau, G; Estrugo, B; Fillie, E; Aussel, C; Vincent, J-P

    2011-01-01

    Confirming the presence of heart failure (HF) in geriatric patients is made difficult by the overlapping symptoms with other diseases and by limited access to investigative techniques such as echography, and the clinical signs are either non-constant or difficult to interpret. In this context, BNP measurement could prove highly useful. We determined a cut-off value of BNP for diagnosing HF in geriatric patients and gauged its predictive power in terms of cardiovascular events, dependence and death within a 6-month timeframe. This clinical and biological study was performed in patients, 44 women and 20 men, age>65 years with suspected HF hospitalized in the geriatric unit at Emile-Roux hospital. Echography was performed at baseline examination. BNP concentrations were determined at baseline examination and at 2 and 6 months later. Renal function was assessed via the Cockroft-Gault formula. Nutritional status was assessed using the geriatric nutritional risk index (GNRI). Final reference diagnosis was established by both cardiologist and geriatrician. The diagnostic value of BNP was assessed by area under the ROC curve. The average age of the 64 patients was 84.3±7.4 years. The final diagnosis was HF in 26 patients (41%). A BNPnutritional and renal dysfunctions. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  14. Measurements of developing teeth, and carpals and epiphyses of the ulna and radius for assessing new cut-offs at the age thresholds of 10, 11, 12, 13 and 14 years.

    Science.gov (United States)

    Cameriere, R; De Luca, S; Cingolani, M; Ferrante, L

    2015-08-01

    The minimum age of criminal responsibility is the youngest age at which children may be held liable for infringements of penal laws. New cut-offs at the age thresholds of 10, 11, 12, 13 and 14 years were determined by applying three different methods: measurement of open apices in tooth roots (T); the ratio between the total area of carpal bones and epiphyses of the ulna and radius (HW); and the combined method (THW). The sample consisted of 291 Italian children (152 boys, 139 girls), aged between 5 and 15 years. The sensitivity and specificity were established. As regards THW, specificity reached the maximum of 95% in boys aged 10, and the minimum of 87% in boys aged 11. The best score of the Positive Predictive Value (PPV) was obtained in boys at 10 years with the THW method and the worst in girls of 12 with the HW method. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  15. Cutting off Mediation. Agamben as Master Thinker

    Directory of Open Access Journals (Sweden)

    Astrid Deuber-Mankowsky

    2015-02-01

    Full Text Available Agamben’s Homo Sacer turns centrally upon “bare life”. However, the following subjects are not thematized: natality, gender, sexuality, the relation of the sexes, the heterosexual character of the symbolic order and political culture, the interest of women in the reproduction of life. The entire question of sexual difference —like that of the difference between victim and perpetrator, between witnesses and those born afterwards— is banned from Agamben’s horizon. Thus a deep unease remains, which this paper is intended to explore. It will first present the methodological and theoretical inspirations, which Homo Sacer owes to the thought of Carl Schmitt. Secondly it will show that Schmitt’s concepts of nomos and the state of exception cannot provide a suitable basis for rewriting Foucault’s concept of biopolitics.

  16. Comparison of VerifyNow-P2Y12 test and Flow Cytometry for monitoring individual platelet response to clopidogrel. What is the cut-off value for identifying patients who are low responders to clopidogrel therapy?

    Directory of Open Access Journals (Sweden)

    Castelli Alfredo

    2009-05-01

    Full Text Available Abstract Background Dual anti-platelet therapy with aspirin and a thienopyridine (DAT is used to prevent stent thrombosis after percutaneous coronary intervention (PCI. Low response to clopidogrel therapy (LR occurs, but laboratory tests have a controversial role in the identification of this condition. Methods We studied LR in patients with stable angina undergoing elective PCI, all on DAT for at least 7 days, by comparing: 1 Flow cytometry (FC to measure platelet membrane expression of P-selectin (CD62P and PAC-1 binding following double stimulation with ADP and collagen type I either in the presence of prostaglandin (PG E1; 2 VerifyNow-P2Y12 test, in which results are reported as absolute P2Y12-Reaction-Units (PRU or % of inhibition (% inhibition. Results Thirty controls and 52 patients were analyzed. The median percentage of platelets exhibiting CD62P expression and PAC-1 binding by FC evaluation after stimulation in the presence of PG E1 was 25.4% (IQR: 21.4–33.1% and 3.5% (1.7–9.4%, respectively. Only 6 patients receiving DAT (11.5% had both values above the 1st quartile of controls, and were defined as LR. Evaluation of the same patients with the VerifyNow-P2Y12 test revealed that the area under the receiver-operating-characteristic (ROC curve was 0.94 (95% CI: 0.84–0.98, p 213 PRU gave the maximum accuracy for the detection of patients defined as having LR by FC. Conclusion In conclusion our findings show that a cut-off value of ≤ 15% inhibition or > 213 PRU in the VerifyNow-P2Y12 test may provide the best accuracy for the identification of patients with LR.

  17. Comparison of PCT, CRP, D-Dimer, Lactate, TNF-α, IL-1β, IL-6 and lL-10 in Development of Systemic Inflammatory Response Syndrome and Sepsis on Patients with Isolated Head Trauma and Polytrauma

    Directory of Open Access Journals (Sweden)

    Emine Dağlı

    2012-12-01

    Full Text Available Objective: In this study, it was aimed to compare the relationship between Glasgow Coma Scale (GKS, ISS values, PCT, CRP, D-Dimer, laktat, TNF-α, IL-1β, IL-6, IL-10 in patients with polytrauma and isolated head trauma in conjunction with SIRS and sepsis. Material and Method: Total of 68 patients (32 polytrauma, 36 isolated head trauma aged between 18-65 years were enrolled in the study. For 7 days of follow up, the biochemical parameters were analysed on the days 0, 1, 3, 5, 7 and the ISS, GCS score and growth rates of SIRS and sepsis were recorded. Results: It was demonstrated that for patients with isolated head trauma, SIRS (80.6%, sepsis (38.9% and mortality values (71.4% were higher and there is a statistically important linear and inverse relationship between ISS and GCS values (p<0.05. During sepsis and SIRS phases, CRP elevated in both groups, whereas PCT only in the polytrauma group. D-Dimer values were investigated high in both groups, but atypically decreased on day 3 in isolated head trauma group. Lactate, TNF-α and, IL-1β were within reference values, IL-6 and IL-10 values were elevated in both groups but were higher in the polytrauma group. Conclusion: Although multiple variations were detected in serum markers of pro-inflamatory and acute phase proteins, we thought that these are inadequate in predicting mortality and complications such as SIRS and sepsis.

  18. Role of signal-to-cut-off ratios of anti-hepatitis C virus antibody by enzyme immunoassays along with ID-NAT for screening of whole blood donors in India

    Directory of Open Access Journals (Sweden)

    Satyam Arora

    2016-01-01

    Full Text Available Background: The use of elevated signal-to-cut off ratios (S/CO as an alternate to further supplemental testing (i.e., RIBA has been included in the guidelines provided by the Centres for Disease Control and Prevention for HCV diagnostic purposes since 2003. With availability of screening by NAT and non availability of RIBA, further confirmation of HCV infection has been possible at the molecular level (RNA. Aims: To study the role of S/CO ratios of anti hepatitis C virus antibody detection by enzyme immunoassays (EIA along with ID-NAT for screening of whole blood donors. Methods: In this study we reviewed the donor screening status for anti HCV from January 2013 to May 2014. All the donations were screened for anti HCV with fourth generation ELISA (BioRad Monolisa Ag-Ab Ultra as well as with ID NAT (Procleix Ultrio. The S/CO ratio of all the anti-HCV reactive samples were analysed for their presence of HCV RNA. Results: On screening 21,115 donors for HCV, 83 donors (0.39% were found reactive on pilot tube and repeat plasma bag testing (S/Co ratio ≥1 by ELISA. 41 donors were HCV RNA reactive with ID-NAT. 4 samples out of 41 were NAT yields and 37 were concordant reactive with ELISA. The S/Co ratio of anti-HCV reactive samples ranged from 0.9-11.1 [mean = 5.1; SD ΁ 2.9] whereas S/Co ratio of anti HCV and NAT reactive samples (concordant positives ranged from 4.1-11.1 [mean 7.3]. In our analysis we found that S/CO ratio of 4 showed positive predictive value (PPV and sensitivity of 100%. Summary/Conclusions: Our study showed that S/CO of 4 for anti HCV on ELISA would have maximum positive predictive value of having donor with HCV RNA. S/CO ratio of 4 is very close to 3.8 which was the CDC guideline. The presence of anti-HCV does not distinguish between current or past infections but a confirmed anti-HCV-positive result indicates the need for counseling and medical evaluation for HCV infection.

  19. [Structural adjustment, cultural adjustment?].

    Science.gov (United States)

    Dujardin, B; Dujardin, M; Hermans, I

    2003-12-01

    Over the last two decades, multiple studies have been conducted and many articles published about Structural Adjustment Programmes (SAPs). These studies mainly describe the characteristics of SAPs and analyse their economic consequences as well as their effects upon a variety of sectors: health, education, agriculture and environment. However, very few focus on the sociological and cultural effects of SAPs. Following a summary of SAP's content and characteristics, the paper briefly discusses the historical course of SAPs and the different critiques which have been made. The cultural consequences of SAPs are introduced and are described on four different levels: political, community, familial, and individual. These levels are analysed through examples from the literature and individual testimonies from people in the Southern Hemisphere. The paper concludes that SAPs, alongside economic globalisation processes, are responsible for an acute breakdown of social and cultural structures in societies in the South. It should be a priority, not only to better understand the situation and its determining factors, but also to intervene and act with strategies that support and reinvest in the social and cultural sectors, which is vital in order to allow for individuals and communities in the South to strengthen their autonomy and identify.

  20. D-Dimer Use and Pulmonary Embolism Diagnosis in Emergency Units: Why Is There Such a Difference in Pulmonary Embolism Prevalence between the United States of America and Countries Outside USA?

    Science.gov (United States)

    Pernod, Gilles; Caterino, Jeffrey; Maignan, Maxime; Tissier, Cindy; Kassis, Jeannine; Lazarchick, John

    2017-01-01

    Although diagnostic guidelines are similar, there is a huge difference in pulmonary embolism (PE) prevalence between the United States of America (US) and countries outside the USA (OUS) in the emergency care setting. In this study, we prospectively analyze patients' characteristics and differences in clinical care that may influence PE prevalence in different countries. An international multicenter prospective diagnostic study was conducted in a standard-of-care setting. Consecutive outpatients presenting to the emergency unit and suspected for PE were managed using the Wells score, STA-Liatest® D-Dimers and imaging. The prevalence of PE in the study was 7.9% in low and moderate risk patients. Among the 1060 patients with low or moderate pre-test probability (PTP), PE prevalence was four times higher in OUS (10.7%) than in the US (2.5%) (P < 0.0001). The mean number of imaging procedures performed for one new PE diagnosis was 3.3 in OUS vs 17 in the US (P < 0.001). Stopping investigation in the case of negative D-dimers (DD combined) with low/moderate PTP was more frequent in OUS (92.7%) than in the US (75.7%) (P < 0.01). Moreover, the use of imaging was much higher in the US (44.4% vs 19.2% in OUS) in the case of moderate PTP combined with negative DD. Differences between US and OUS PE prevalence in emergency setting might be explained by differences in patients' characteristics and mostly in care patterns. US physicians performed computed tomographic pulmonary angiography more often than in Europe in cases of low/moderate PTP combined with negative DD. ClinicalTrials.gov NCT01221805.

  1. The Brazilian hazard-based cut-off criteria for pesticide registration: a critical appraisal / Critérios de exclusão baseados em perigo adotados no Brasil para registro de pesticidas: Uma avalição crítica

    Directory of Open Access Journals (Sweden)

    Francisco José Roma Paumgartten

    2013-02-01

    Full Text Available Brazil, the world’s top consumer of agricultural pesticides, adopts a unique hazard-based cut-off approach to pesticide registration. Cut-off criteria for mutagenicity, carcinogenicity, teratogenicity, hormonal disturbances and damage to reproductive organs were introduced by the Pesticide Law enacted in 1989. As far as health is concerned, law enforcement is additionally regulated by rules issued by the federal health authority (National Agency for Health Surveillance – ANVISA. Contrasting to the European Union’s hazard-based cut-off criteria for pesticides, Brazilian rules do not make an exception for “negligible” exposures. Moreover, Brazilian regulations have shortcomings (e.g. no reference to relevance of Mode of Action to humans that make cut-off criteria difficult to be put into effect. The deficiencies of regulations and difficulties to consistently apply the hazard-based cut-off criteria are appraised in this article. Adoption of a risk assessment approach or cut-off criteria based on classification into the Globally Harmonized System’s hazard categories 1A and 1B is suggested. Resumo O Brasil, líder mundial do consumo de agro-químicos, adota uma singular abordagem para registro de agrotóxicos que é baseada em critérios de exclusão quanto à periculosidade. Critérios de exclusão para mutagenicidade, carcinogenicidade, teratogenicidade, distúrbios hormonais e dano a órgãos reprodutivos foram introduzidos pela Lei de Agrotóxicos promulgada em 1989. Em relação à saúde, a aplicação da lei é também regulada por portarias publicadas pela autoridade sanitária federal (Agência Nacional de Vigilância Sanitária – ANVISA. Em contraste com os critérios de exclusão baseados na periculosidade que a União Européia usa para agrotóxicos, a regulamentação brasileira não faz exceção para exposições insignificantes. Além disso, a regulamentação brasileira apresenta deficiências (e.g., não faz men

  2. Convexity Adjustments

    DEFF Research Database (Denmark)

    M. Gaspar, Raquel; Murgoci, Agatha

    2010-01-01

    A convexity adjustment (or convexity correction) in fixed income markets arises when one uses prices of standard (plain vanilla) products plus an adjustment to price nonstandard products. We explain the basic and appealing idea behind the use of convexity adjustments and focus on the situations o...

  3. Burden of road traffic injuries: Disability-adjusted life years in relation to hospitalization and the maximum abbreviated injury scale.

    Science.gov (United States)

    Polinder, Suzanne; Haagsma, Juanita; Bos, Niels; Panneman, Martien; Wolt, Karin Klein; Brugmans, Marco; Weijermars, Wendy; van Beeck, Ed

    2015-07-01

    The consequences of non-fatal road traffic injuries (RTI) are increasingly adopted by policy makers as an indicator of traffic safety. However, it is not agreed upon which level of severity should be used as cut-off point for assessing road safety performance. Internationally, within road safety, injury severity is assessed by means of the maximum abbreviated injury scale (MAIS). The choice for a severity cut-off point highly influences the measured disease burden of RTI. This paper assesses the burden of RTI in terms of disability adjusted life years (DALYs) by hospitalization status and MAIS cut-off point in the Netherlands. Hospital discharge register (HDR) and emergency department (ED) data for RTI in the Netherlands were selected for the years 2007-2009, as well as mortality data. The incidence, years lived with disability (YLD), years of life lost (YLL) owing to premature death, and DALYs were calculated. YLD for admitted patients was subdivided by MAIS severity levels. RTI resulted in 48,500 YLD and 27,900 YLL respectively, amounting to 76,400 DALYs per year in the Netherlands. The largest proportion of DALYs is related to fatalities (37%), followed by admitted MAIS 2 injuries (25%), ED treated injuries (16%) and admitted MAIS 3+ injuries (18%). Admitted MAIS 1 injuries only account for a small fraction of DALYs (4%). In the Netherlands, the diseases burden of RTI is highest among cyclists with 39% of total DALYs. One half of all bicycle related DALYs are attributable to admitted MAIS 2+ injuries, but ED treated injuries also account for a large proportion of DALYs in this group (28%). Car occupants are responsible for 26% of all DALYs, primarily caused by fatalities (66%), followed by admitted MAIS 2+ injuries (25%). ED treated injuries only account for 5% of DALYs in this group. When using admitted MAIS 3+ or admitted MAIS 2+ as severity cut-off point, 54% and 80% of all DALYs are captured respectively. Assessing the influence of different severity cut-off

  4. Determining the Optimum Cut-Off Grades in Sulfide Copper Deposits / Określanie Optymalnej Wartości Odcięcia Zawartości Procentowej Pierwiastka Użytecznego W Złożach Siarczku Miedzi

    Science.gov (United States)

    Rahimi, Esmaeil; Oraee, Kazem; Shafahi, Zia Aldin; Ghasemzadeh, Hasan

    2015-03-01

    Optimum cut-off grades determination in mining life affects production planning and ultimate pit limit and it is also important from social, economical and environmental aspects. Calculation of optimum cut-off grades has been less considered for mines containing various mineral processing methods. In this paper, an optimization technique is applied to obtain optimum cut-off grades for both concentration and heap leaching processes. In this technique, production costs and different recoveries of heap leaching method directed into modeling different annual cash flows in copper mines. Considering the governing constraints, the Lagrange multiplier method is practiced to optimize the cut-off grades in which the objective function is supposed to maximize Net Present Value. The results indicate the effect of heap leaching process on the optimum cut-off grades of primary and secondary sulfide deposits. Określanie optymalnego poziomu odcięcia dla zawartości procentowej pierwiastka użytecznego ma poważny wpływ na planowanie produkcji, określanie ostatecznych limitów zasobów złoża; jest to także ważna kwestia z punktu widzenia kwestii społecznych, ekonomicznych i środowiskowych. Obliczanie optymalnego poziomu odcięcia dla zawartości procentowej pierwiastka użytecznego nie było zwykle szeroko rozważane w przypadku kopalni prowadzących ciągły system przeróbki. W pracy tej przedstawiono technikę optymalizacji określania poziomu zawartości procentowej pierwiastka użytecznego z uwzględnieniem zarówno procesów koncentracji jak i ługowania. W metodzie uwzględniono koszty produkcji i różne wskaźniki odzysku rudy, wielkości te wykorzystane zostały do modelowania rocznych przepływów gotówki w kopalniach miedzi. Uwzględniając narzucone ograniczenia, zastosowano metodę mnożników Lagrange'a w celu optymalizacji określania poziomu zawartości procentowej pierwiastka użytecznego, gdzie przyjętą funkcją celu jest maksymalizacja wartości bie

  5. Psychopathology and psychosocial adjustment in patients with HIV-associated lipodystrophy

    Directory of Open Access Journals (Sweden)

    Anna Barata

    Full Text Available OBJECTIVE: To study whether patients with HIV-1 associated lipodystrophy (LD on highly active antiretroviral treatment (HAART have more psychopathology and worse psychosocial adjustment than a similar group without this syndrome. METHODS: In a cross-sectional, observational study we compared 47 HIV-1 infected patients with LD (LD group with 39 HIV-1 infected patients without LD (non-LD group. All participants were on HAART. The Beck Depression Inventory (BDI, the State and Trait Anxiety Inventory (STAI and the Goldberg Health Questionnaire (GHQ-60 were administered. Levels of familial, work and social adjustment and adjustment to stressful events were evaluated in a semi-structured interview. Clinical information was extracted from the clinical records. RESULTS: In the univariate analysis patients with LD showed higher state anxiety scores (p = 0.009 and worse work adjustment (p = 0.019 than those without LD. A total of 45.3% of LD patients scored above the cut-off point on the trait anxiety scale, and over 33.3% scored above the cut-off point on the BDI, GHQ and state anxiety scales. However, in multivariate analyses LD was not independently associated with psychopathology or with worse adjustment in the studied areas. CONCLUSIONS: The finding that LD was not a predictor of greater psychopathology or worse psychosocial adjustment in HIV-1 infected patients, despite the high scores found, suggests that factors not taken into account in this study, such as LD severity and self-perception should have been included in the analysis. Further studies including a greater number of variables and a larger sample size will advance our understanding of this complex condition.

  6. Influence of different body mass index cut-off values in assessing the nutritional status of adolescents in a household survey Influência de distintos valores críticos do índice de massa corporal na avaliação do estado nutricional de adolescentes em inquérito domiciliar

    Directory of Open Access Journals (Sweden)

    Fabio da Silva Gomes

    2009-08-01

    Full Text Available The purpose of this study was to evaluate the anthropometric nutritional status of the adolescent population of Niterói, Rio de Janeiro State, Brazil, and the influence of changes in the adopted body mass index (BMI cut-offs in the nutritional status assessment of the adolescent population. A population-based survey conducted in 2003 obtained data from a probabilistic sample of 1,734 households and 523 adolescents. The multiple proportions test and prevalence ratios were used to analyze differences between estimates obtained from different BMI cut-offs. Changes in cut-off values from the old to the new recommendation of the World Health Organization (WHO resulted in a significant increase in overweight prevalence among total, male and female adolescent population (25%, 27% and 23%, respectively (p Este artigo tem por objetivo avaliar o estado nutricional antropométrico da população adolescente residente em Niterói, Rio de Janeiro, Brasil, bem como a influência das mudanças nos valores críticos de índice de massa corporal (IMC na avaliação do estado nutricional dessa população. Uma pesquisa amostral probabilística de base populacional conduzida em 2003 obteve dados de 1.734 domicílios e 523 adolescentes. Testes para múltiplas proporções e razões de prevalência foram utilizados para analisar as diferenças entre estimativas obtidas segundo distintos valores críticos de IMC. Mudanças nos pontos de corte da antiga para a atual recomendação da Organização Mundial da Saúde (OMS resultaram em aumentos significativos nas prevalências de sobrepeso entre o total de adolescentes, meninos e meninas (25%, 27% e 23%, respectivamente (p < 0,05. A proposta da International Obesity Task Force resultou em uma redução significativa de 29% e 39% na prevalência de baixo-IMC-para-idade entre o total de adolescentes e meninos, respectivamente, quando comparada à recomendação atual da OMS (p < 0,05. Foi evidenciado que uma simples

  7. Chiropractic Adjustment

    Science.gov (United States)

    ... Results Chiropractic adjustment can be effective in treating low back pain, although much of the research done shows only a modest benefit — similar to the results of more conventional treatments. Some studies suggest that spinal manipulation also may ...

  8. Imaging of deep venous thrombosis in patients using a radiolabelled anti-D-dimer Fab' fragment ({sup 99m}Tc-DI-DD3B6/22-80B3): results of a phase I trial

    Energy Technology Data Exchange (ETDEWEB)

    Macfarlane, David [University of Queensland, School of Medicine, Brisbane (Australia); Socrates, Angelides; Larcos, George [University of Sydney, Department of Medicine, Sydney (Australia)]|[Westmead Hospital, Department of Nuclear Medicine and Ultrasound, Westmead (Australia)]|[Westmead Hospital, Centre for Biomedical Imaging and Research, Westmead (Australia); Eisenberg, Paul [Amgen Inc, Thousand Oaks, CA (United States); Roach, Paul [University of Sydney, Department of Medicine, Sydney (Australia)]|[Royal North Shore Hospital, Nuclear Medicine, St. Leonards (Australia); Gerometta, Michael [Agen Biomedical Pty Ltd, Brisbane (Australia); Smart, Richard; Tsui, Wendy [St. George Hospital, Nuclear Medicine Department, Sydney (Australia)]|[University of New South Wales, Department of Medicine, Sydney (Australia); Scott, Andrew M. [Austin Hospital, Centre for PET, Melbourne (Australia)]|[Ludwig Institute, Melbourne (Australia)

    2009-02-15

    {sup 99m}Tc-DI-DD3B6/22-80B3 (ThromboView registered, hereafter abbreviated to {sup 99m}Tc-DI-80B3 Fab') is a radiolabelled humanised monoclonal Fab' fragment with affinity and specificity for D-dimer domains of cross-linked fibrin. Detection of thromboembolic events has been demonstrated in canine models. The study objectives were evaluation of safety and characterisation of biodistribution, immunogenicity and pharmacokinetic profile of increasing doses of {sup 99m}Tc-DI-80B3 Fab' in subjects with acute lower-limb DVT. Twenty-six patients with acute lower limb DVT were enrolled. Of these, 21 received a single intravenous dose of 0.5 mg (n = 6), 1.0 mg (n = 9) or 2 mg (n = 6) {sup 99m}Tc-DI-80B3 Fab'. Blood and urine samples and gamma camera images were collected to 24 h after administration for pharmacokinetic and dosimetry analysis. Vital signs, electrocardiography, hematological and biochemical data and human anti-human antibody (HAHA) levels were monitored for up to 30 days following administration. Patients were assigned to either planar or single photon emission computed tomographic (SPECT) imaging of the thorax at 4 h following injection. Thirty-five adverse events were reported in 15 of the 21 subjects. Those deemed possibly related to administration of {sup 99m}Tc-DI-80B3 Fab' included mild hypertension, mild elevation of LD (lactate dehydrogenase) and moderate elevation of ALT (alanine transaminase). HAHA assays remained negative. Pharmacokinetics and organ dosimetry were comparable to prior normal volunteer data. Localisation of Thromboview registered to sites of known thrombus was evident as early as 30 min post-injection. In subjects with acute DVT, {sup 99m}Tc-DI-80B3 Fab' was well tolerated with favourable characteristics for the detection of acute venous thrombosis. (orig.)

  9. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, following elements do not increase: a) Family Allowance, Child Allowance and Infant Allowance (Annex R A 3). b) Reimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be implemented, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and the rounding effects. Human Resources Department Tel. 73566

  10. Salary adjustments

    CERN Multimedia

    HR Department

    2008-01-01

    In accordance with decisions taken by the Finance Committee and Council in December 2007, salaries are adjusted with effect from 1 January 2008. Scale of basic salaries and scale of stipends paid to fellows (Annex R A 5 and R A 6 respectively): increased by 0.71% with effect from 1 January 2008. As a result of the stability of the Geneva consumer price index, the following elements do not increase: a)\tFamily Allowance, Child Allowance and Infant Allowance (Annex R A 3); b)\tReimbursement of education fees: maximum amounts of reimbursement (Annex R A 4.01) for the academic year 2007/2008. Related adjustments will be applied, wherever applicable, to Paid Associates and Students. As in the past, the actual percentage increase of each salary position may vary, due to the application of a constant step value and rounding effects. Human Resources Department Tel. 73566

  11. Parâmetros diretos do duplex scan no diagnóstico da estenose da artéria renal: estudo de validação e otimização dos pontos de corte Direct duplex scanning parameters in the diagnosis of renal artery stenosis: a study to validate and optimize cut-off points

    Directory of Open Access Journals (Sweden)

    Carla Motta Cardoso

    2006-09-01

    Full Text Available OBJETIVO: Testar o desempenho dos parâmetros diretos do duplex scan no diagnóstico da estenose da artéria renal (EAR e verificar se os pontos de corte recomendados pela literatura são os mais adequados para se discriminar a gravidade da lesão. MÉTODOS: Estudo prospectivo, incluindo 62 pacientes portadores de EAR, submetidos ao duplex scan, seguido da arteriografia seletiva. O pico de velocidade sistólico (PVS e a relação renal-aorta (RRA foram mensurados. A análise estatística incluiu a curva ROC (receiver operating characteristic curve, t test student não pareado a sensibilidade, especificidade, os valores preditivos positivo e negativo, e a acurácia. RESULTADOS: A arteriografia revelou EAR 0-59% em 31 artérias (24%; EAR 60-99% em 91 artérias (72% e 5 oclusões (4%. A análise de ROC mostrou que o PVS e a RRA apresentaram desempenho semelhante na detecção da lesão, cujas áreas sob as curvas foram 0,96 e 0,95, respectivamente. Considerando os pontos de corte recomendados pela literatura, o PVS de 180 cm/s apresentou sensibilidade de 100% e especificidade de 81%, enquanto que a RRA de 3,5 apresentou sensibilidade de somente 79%, com 93% de especificidade. Estes parâmetros foram analisados de forma conjugada (critério direto, revelando 79% de sensibilidade e 97% de especificidade. Os pontos de corte otimizados foram: PVS de 189 cm/s e RRA de 2,6, demonstrando 100%, 87%, 96% e 87% de sensibilidade e especificidade para o PVS e para a RRA, respectivamente. CONCLUSÃO: O uso isolado do PVS otimizado apresentou o melhor desempenho na detecção e na graduação da EAR.OBJECTIVE: To test the efficiency of the direct duplex scanning parameters in the diagnosis of renal artery stenosis (RAS, and verify whether or not the cut-off points recommended by medical literature are the most appropriate means to distinguish lesion severity. METHODS: Prospective study, including 62 patients with RAS, submitted to a duplex ultrasound scan and

  12. Screening for cognitive dysfunction in ALS: validation of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) using age and education adjusted normative data.

    Science.gov (United States)

    Pinto-Grau, Marta; Burke, Tom; Lonergan, Katie; McHugh, Caroline; Mays, Iain; Madden, Caoifa; Vajda, Alice; Heverin, Mark; Elamin, Marwa; Hardiman, Orla; Pender, Niall

    2017-02-01

    Cognitive and behavioural changes are an important aspect in Amyotrophic Lateral Sclerosis (ALS). The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) briefly assesses these changes in ALS. To validate the ECAS against a standardised neuropsychological battery and assess its sensitivity and specificity using age and education adjusted cut-off scores. 30 incident ALS cases were assessed on both, ECAS and neuropsychological battery. Age and education adjusted cut-off scores were created from a sample of 82 healthy controls. ECAS composite scores (Total, ALS Specific and Non-Specific) were highly correlated with battery composite scores. High correlations were also observed between ECAS and full battery cognitive domains and subtests. The ECAS Total, ALS Specific and Non-Specific scores were highly sensitive to cognitive impairment. ECAS ALS-Specific cognitive domains also evidenced high sensitivity. Individual subtest sensitivity was medium to low, suggesting that caution should be used when interpreting these scores. Low positive predictive values indicated the presence of false positives. Psychometric properties of the ECAS using age and education adjusted norms indicate that the ECAS, when used as an overall measure of cognitive decline, is highly sensitive. Further comprehensive assessment is required for patients that present as impaired on the ECAS.

  13. Psychological Adjustment of Siblings of Children with Autism Spectrum Disorder in Hong Kong.

    Science.gov (United States)

    Chan, J Yn; Lai, K Yc

    2016-12-01

    Findings about the psychological adjustment of siblings of children with autism spectrum disorder have been inconsistent in western literature and little is known among non-western societies. This study explored the psychological adjustment of siblings of children with autism spectrum disorder in Hong Kong. A total of 116 families with siblings of children with autism spectrum disorders co-morbid with learning disability were included in the study. Parents completed questionnaires about sibling emotional and behavioural adjustment, and their own mental well-being, quality of life, and family functioning. Siblings completed a questionnaire on their relationship with the autistic proband. Parent ratings did not reveal any significant negative impact on the emotional and behavioural adjustment of the typically developing siblings of children with autism spectrum disorder, but there were concerns about their peer relationships and weak prosocial behaviours. When cut-off scores were used to screen for risk of mental health problems, a quarter of the siblings warranted further assessment. Parents' quality of life and family functioning were significant predictors of sibling adjustment. In managing children with autism spectrum disorder, it is necessary to bear in mind the adjustment of their siblings, especially their peer relationships and prosocial behaviour. Adopting a holistic approach to address the psychosocial needs of the parents can facilitate sibling adjustment.

  14. Avaliação do dímero D (D-Di na doença hipertensiva específica da gravidez (DHEG D-dimer plasma levels assessment in preeclampsia

    Directory of Open Access Journals (Sweden)

    Luci Maria Sant'Ana Dusse

    2003-09-01

    Full Text Available A doença hipertensiva específica da gravidez (DHEG, na sua forma pura, caracteriza-se pelo aparecimento, em grávida normotensa, após a vigésima semana de gestação, da tríade sintomática: hipertensão, proteinúria e edema. A DHEG está associada a vasoconstrição generalizada, anormalidades da coagulação e deposição de fibrina na microcirculação da placenta. A fibrina compromete a perfusão adequada da placenta, contribuindo para a prematuridade, o baixo peso fetal e a mortalidade neonatal. Os dímeros D (D-Di constituem os menores fragmentos dos produtos de degradação da fibrina (pdf e são produzidos após a lise, pela plasmina, da ligação cruzada da fibrina. Níveis plasmáticos aumentados de D-Di indicam tanto uma exacerbação da formação de fibrina como um aumento da ação da plasmina. O presente trabalho teve por objetivo avaliar e comparar os níveis plasmáticos de D-Di, obtido por Elisa (Stago em gestantes-controle (n = 26, gestantes com DHEG nas formas leve e moderada (n = 23 e gestantes com DHEG na forma grave (n = 20, visando a investigar a possível utilização desse marcador laboratorial para diagnóstico e/ou prognóstico da doença. As médias e os desvios padrões obtidos para os três grupos avaliados foram 1.146,6 ± 311,2; 1.060,3 ± 259,2 e 1.497,8 ± 435,3ng/ml, respectivamente. A análise estatística das médias dos resultados obtidos revelou um aumento significativo de D-Di plasmático no grupo com DHEG grave, comparando-se aos grupos com DHEG leve/moderada (p Preeclampsia is associated to a generalized vasoconstriction, clot abnormalities and fibrin deposition within placenta microcirculation. The presence of fibrin hampers the placenta perfusion contributing to prematurity, fetal low weight and neonates' mortality. D-Dimers (D-Di are the products of degradation of cross-linked fibrin by plasmin. Increased plasma levels of D-Di may indicate either an exacerbated fibrin formation or an increase

  15. Modern cutting tools for grooving and cutting-off

    OpenAIRE

    MATOUŠEK, Jan

    2015-01-01

    Předkládaná diplomová práce pojednává o vlivu geometrie řezného nástroje s nenulovým úhlem r a řezných podmínek na změnu celkové deformace řezného nástroje při procesu upichování a zapichování. Při experimentech bylo měřeno silové zatížení řezného nástroje, na základě naměřených dat byl vytvořen jednoduchý 3D model řezného nástroje, byla provedena deformační analýza řezného nástroje pomoci simulačního programu ANSYS a na základě zjištěných skutečností byl vyvozen závěr o chování řezného nástr...

  16. Measuring Underemployment: Establishing the Cut-off Point

    OpenAIRE

    Sugiyarto, Guntur

    2007-01-01

    Unemployment and underemployment are the most pressing problems in Asia today, which is reflected in the widespread underutilization rate of about 29% of the total labor force. In addition to the fact that most of the labor force in developing countries cannot afford to be completely unemployed, the standard labor force framework currently in use worldwide is biased toward counting labor force as employed rather than as unemployed. This systematically undervalues the full extent of the unempl...

  17. Characteristics Of Fused Couplers Below Cut-Off

    Science.gov (United States)

    Meyer, T. J.; Tekippe, V. J.

    1989-02-01

    A number of different architectures are being explored for the utilization of optical fiber in the subscriber loop. In addition to reliability and maintainability, cost is a prime consideration since full implementation of fiber in the local loop will not occur until it is economically viable. It is becoming increasingly clear that in order to accommodate a number of ISDN applications, including high definition television (HDTV), singlemode fiber with a singlemode laser at the terminal end will be required. The situation at the subscriber end is quite different, however. The data rates are expected to be low on the return path to allow for POTS ( plain old telephone service) and some data transfer. When this requirement is combined with cost and reliability considerations, the inexpensive lasers developed for the CD (compact disk) market become quite attractive. The biggest disadvantage of this source is that the fiber which is optimized for singlemode operation at 1300nm tends to be multimode in the 800nm band where these lasers operate. Previous papers have considered such effects as modal noise and pulse dispersion when using these lasers with fiber that is singlemode in the 1300nm band.[1] Another consideration is the passive components required to implement such an architecture. Figure 1 shows a typical bidirectional design with full duplex operation on a single fiber. The key component is the 800/1300 wavelength division multiplexer/demultiplexer (WDM). Because of the multimode nature of the fiber in the 800nm band, all fiber approaches to fabricating the WDM, such as the fused beconical taper (FBT) approach, raise new issues which are not encountered, for example, with 1300/1500nm WDM's.[2] In this paper we discuss the effects of the multimode behavior of the fiber on the performance of fused couplers and WDM's.

  18. Adjusting CA19-9 values to predict malignancy in obstructive jaundice: Influence of bilirubin and C-reactive protein

    Science.gov (United States)

    La Greca, Gaetano; Sofia, Maria; Lombardo, Rosario; Latteri, Saverio; Ricotta, Agostino; Puleo, Stefano; Russello, Domenico

    2012-01-01

    AIM: To find a possible relationship between inflammation and CA19-9 tumor marker by analyzing data from patients with benign jaundice (BJ) and malignant jaundice (MJ). METHODS: All patients admitted for obstructive jaundice, in the period 2005-2009, were prospectively enrolled in the study, obtaining a total of 102 patients. On admission, all patients underwent complete standard blood test examinations including C-reactive protein (CRP), bilirubin, CA19-9. Patients were considered eligible for the study when they presented obstructive jaundice confirmed by instrumental examinations and increased serum bilirubin levels (total bilirubin > 2.0 mg/dL). The standard cut-off level for CA19-9 was 32 U/mL, whereas for CRP this was 1.5 mg/L. The CA19-9 level was adjusted by dividing it by the value of serum bilirubin or by the CRP value. The patients were divided into 2 groups, MJ and BJ, and after the adjustment a comparison between the 2 groups of patients was performed. Sensitivity, specificity and positive predictive values were calculated before and after the adjustment. RESULTS: Of the 102 patients, 51 were affected by BJ and 51 by MJ. Pathologic CA19-9 levels were found in 71.7% of the patients. In the group of 51 BJ patients there were 29 (56.9%) males and 22 (43.1%) females with a median age of 66 years (range 24-96 years), whereas in the MJ group there were 24 (47%) males and 27 (53%) females, with a mean age of 70 years (range 30-92 years). Pathologic CA19-9 serum level was found in 82.3% of MJ. CRP levels were pathologic in 66.6% of the patients with BJ and in 49% with MJ. Bilirubin and CA19-9 average levels were significantly higher in MJ compared with BJ (P = 0.000 and P = 0.02), while the CRP level was significantly higher in BJ (P = 0.000). Considering a CA19-9 cut-off level of 32 U/mL, 82.3% in the MJ group and 54.9% in the BJ group were positive for CA19-9 (P = 0.002). A CA19-9 cut-off of 100 U/mL increases the difference between the two groups: 35.3% in

  19. Height-adjusted percentiles evaluated central obesity in children and adolescents more effectively than just waist circumference.

    Science.gov (United States)

    Hosseini, Mostafa; Kelishadi, Roya; Yousefifard, Mahmoud; Qorbani, Mostafa; Bazargani, Behnaz; Heshmat, Ramin; Motlagh, Mohammad Esmail; Mirminachi, Babak; Ataei, Neamatollah

    2017-01-01

    We compared the prevalence of obesity based on both waist circumference for height and body mass index (BMI) in Iranian children and adolescents. Data on 13 120 children with a mean age of 12.45 ± 3.36 years (50.8% male) from the fourth Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease study were included. Measured waist circumference values were modelled according to age, gender and height percentiles. The prevalence of obesity was estimated using the 90th percentiles for both unadjusted and height-adjusted waist circumferences and compared with the World Health Organization BMI cut-offs. They were analysed further for short, average and tall children. Waist circumference values increased steadily with age. For short and average height children, the prevalence of obesity was higher when height-adjusted waist circumference was used. For taller children, the prevalence of obesity using height-adjusted waist circumference and BMI was similar, but lower than the prevalence based on measurements unadjusted for height. Height-adjusted waist circumference and BMI identified different children as having obesity, with overlaps of 69.47% for boys and 68.42% for girls. Just using waist circumference underestimated obesity in some Iranian children and measurements should be adjusted for height. ©2016 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  20. Determinação de escore e nota de corte do módulo de asma do International Study of Asthma and Allergies in Childhood para discriminação de adultos asmáticos em estudos epidemiológicos Determining the score and cut-off point that would identify asthmatic adults in epidemiological studies using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire

    Directory of Open Access Journals (Sweden)

    Elayne de Fátima Maçãira

    2005-12-01

    Full Text Available OBJETIVO: Validar o questionário padronizado escrito do International Study of Asthma and Allergies in Childhood, módulo sobre asma, para pesquisa de prevalência de asma, estabelecendo seu escore e a nota de corte para discriminação de adultos asmáticos. MÉTODOS: Entrevistamos pacientes ambulatoriais adultos, 40 asmáticos e 38 controles, pareados por sexo e idade, utilizando o módulo de asma do International Study of Asthma and Allergies in Childhood, composto por oito aspectos dicotômicos de asma. Determinamos o escore e a nota de corte para discriminação de asmáticos, definindo sua sensibilidade, especificidade e índice de Youden. Validamos o método em contraposição ao diagnóstico clínico e funcional. A reprodutibilidade das questões individuais foi testada por meio de reentrevistas de metade dos pacientes após algumas semanas. RESULTADOS: O escore variou de 0 a 14 pontos. Um escore = 5 pontos permitiu discriminar pacientes asmáticos (sensibilidade = 93%, especificidade = 100% e índice de Youden = 0,93. A maioria das questões apresentou boa reprodutibilidade, observada em reentrevista após 48,2 ± 11,1 dias (Kappa e Kappa ponderado variando de 0,43 a 1,00 para as questões individuais. CONCLUSÃO: A validação de uma nota de corte permite uma interpretação alternativa às informações fornecidas pelo módulo de asma do International Study of Asthma and Allergies in Childhood, levando em conta o conjunto das informações e não somente as respostas individuais de cada questão em estudos de prevalência de asma em adultos.OBJECTIVE: To validate, for use in asthma prevalence studies, the asthma module of the standardized written questionnaire developed for use in the International Study of Asthma and Allergies in Childhood, establishing the score and cut-off point that would identify asthmatic adults. METHODS: We interviewed 78 adult outpatients (40 adult asthmatics and 38 age-matched and gender-matched controls

  1. Assessing clinical probability of pulmonary embolism: prospective validation of the simplified Geneva score.

    Science.gov (United States)

    Robert-Ebadi, H; Mostaguir, K; Hovens, M M; Kare, M; Verschuren, F; Girard, P; Huisman, M V; Moustafa, F; Kamphuisen, P W; Buller, H R; Righini, M; Le Gal, G

    2017-09-01

    Essentials The simplified Geneva score allows easier pretest probability assessment of pulmonary embolism (PE). We prospectively validated this score in the ADJUST-PE management outcome study. The study shows that it is safe to manage patients with suspected PE according to this score. The simplified Geneva score is now ready for use in routine clinical practice. Background Pretest probability assessment by a clinical prediction rule (CPR) is an important step in the management of patients with suspected pulmonary embolism (PE). A limitation to the use of CPRs is that their constitutive variables and corresponding number of points are difficult to memorize. A simplified version of the Geneva score (i.e. attributing one point to each variable) has been proposed but never been prospectively validated. Aims Prospective validation of the simplified Geneva score (SGS) and comparison with the previous version of the Geneva score (GS). Methods In the ADJUST-PE study, which had the primary aim of validating the age-adjusted D-dimer cut-off, the SGS was prospectively used to determine the pretest probability in a subsample of 1621 study patients. Results Overall, PE was confirmed in 294 (18.1%) patients. Using the SGS, 608 (37.5%), 980 (60.5%) and 33 (2%) were classified as having a low, intermediate and high clinical probability. Corresponding prevalences of PE were 9.7%, 22.4% and 45.5%; 490 (30.1%) patients with low or intermediate probability had a D-dimer level below 500 μg L-1 and 653 (41.1%) had a negative D-dimer test according to the age-adjusted cut-off. Using the GS, the figures were 491(30.9%) and 650 (40.9%). None of the patients considered as not having PE based on a low or intermediate SGS and negative D-dimer had a recurrent thromboembolic event during the 3-month follow-up. Conclusions The use of SGS has similar efficiency and safety to the GS in excluding PE in association with the D-dimer test. © 2017 International Society on Thrombosis and

  2. [Pharmacokinetic principles and drug-dosing adjustments during continuous renal replacement therapies (CRRT)].

    Science.gov (United States)

    Morabito, S; Guzzo, I; Vitaliano, E; Muzi, L; Solazzo, A; Pistolesi, V; Pierucci, A

    2006-01-01

    In the critically ill, acute renal failure (ARF) and "Multiple Organ Dysfunction Syndrome" (MODS) can be associated with significant modifications of many pharmacokinetic parameters, such as protein binding, volume of distribution and total body clearance. The start of renal replacement therapy (RRT) represents an additional variable to take in consideration for drug-dosing adjustments. Drugs significantly eliminated by the kidney are likely to be removed during RRT and a supplemental dose or further dosing adjustments are required if extracorporeal clearance is more than 25-30% of total body clearance. The impact of RRT on plasma drug concentrations can be substantially different in relation to the type of treatment (diffusive, convective or both), membrane characteristics (low-flux or high-flux), filter surface area and prescribed dialysis dose. The molecular weight cut-offs of high-flux membrane are much higher than the molecular weight of most drugs. Therefore, molecular size will not be a limitation for the removal of the unbound fraction of the drugs most commonly used in the critically ill undergoing continuous renal replacement therapy (CRRT). However, diffusive clearance could be significantly lower than convective clearance for drugs in the middle molecular weight range. In any case, the extracorporeal clearances report-ed with the use of high-volume CRRT (>50-60 L/2 h) are often surprisingly elevated and can lead to drug underdosing in clinical conditions where adequate antibiotic treatment is essential.

  3. Annual Adjustment Factors

    Data.gov (United States)

    Department of Housing and Urban Development — The Department of Housing and Urban Development establishes the rent adjustment factors - called Annual Adjustment Factors (AAFs) - on the basis of Consumer Price...

  4. Evaluation of D-dimer serum levels among patients with chronic urticaria, psoriasis and urticarial vasculitis Avaliação dos níveis séricos de D-dímeros entre doentes com urticária crônica, psoríase e urticária vasculite

    Directory of Open Access Journals (Sweden)

    Paulo Ricardo Criado

    2013-06-01

    Full Text Available BACKGROUND: It has been demonstrated that neutrophils, eosinophils and monocytes, under appropriated stimulus, may express tissue factor and therefore, activate the extrinsic pathway of coagulation. We performed a transversal and case-control study of patients with chronic urticaria and patients with psoriasis, in our outpatient clinic to evaluate the production of D-dimer. OBJECTIVE: To evaluate D-dimer serum levels in patients with chronic urticaria and its possible correlation with disease activity. PATIENTS AND METHODS: The study was conducted from October 2010 until March 2011. We selected 37 consecutive patients from our Allergy Unit and Psoriasis Unit, and divided them into three groups for statistical analysis: (i 12 patients with active chronic urticaria (CU; (ii 10 patients with chronic urticaria under remission and (iii 15 patients with psoriasis (a disease with skin inflammatory infiltrate constituted by neutrophils, lymphocytes and monocytes. Another five patients with urticarial vasculitis were allocated in our study, but not included in statistical analysis. The serum levels of D-dimer were measured by Enzyme Linked Fluorescent Assay (ELFA, and the result units were given in ng/ml FEU. RESULTS: Patients with active chronic urticaria had the highest serum levels of D-dimer (p FUNDAMENTOS: Tem sido demonstrado que os neutrófilos, eosinófilos e monócitos, sob estímulo apropriado, podem expressar fator tecidual e, portanto, ativar a via extrínseca da coagulação. Realizamos um estudo transversal e caso-controle de pacientes com urticária crônica e pacientes com psoríase em nosso ambulatório para avaliar a produção de dímero-D. OBJETIVO: Avaliar níveis de dímero-D em pacientes com urticária crônica e sua possível correlação com a atividade da doença. PACIENTES E MÉTODOS: O estudo foi conduzido de outubro de 2010 até março de 2011. Nós selecionamos 37 pacientes consecutivos da Unidade de Alergia e Unidade de

  5. Adjustable suture strabismus surgery

    Science.gov (United States)

    Nihalani, B R; Hunter, D G

    2011-01-01

    Surgical management of strabismus remains a challenge because surgical success rates, short-term and long-term, are not ideal. Adjustable suture strabismus surgery has been available for decades as a tool to potentially enhance the surgical outcomes. Intellectually, it seems logical that having a second chance to improve the outcome of a strabismus procedure should increase the overall success rate and reduce the reoperation rate. Yet, adjustable suture surgery has not gained universal acceptance, partly because Level 1 evidence of its advantages is lacking, and partly because the learning curve for accurate decision making during suture adjustment may span a decade or more. In this review we describe the indications, techniques, and published results of adjustable suture surgery. We will discuss the option of ‘no adjustment' in cases with satisfactory alignment with emphasis on recent advances allowing for delayed adjustment. The use of adjustable sutures in special circumstances will also be reviewed. Consistently improved outcomes in the adjustable arm of nearly all retrospective studies support the advantage of the adjustable option, and strabismus surgeons are advised to become facile in the application of this approach. PMID:21760626

  6. Theory of adaptive adjustment

    Directory of Open Access Journals (Sweden)

    Weihong Huang

    2000-01-01

    Full Text Available Conventional adaptive expectation as a mechanism of stabilizing an unstable economic process is reexamined through a generalization to an adaptive adjustment framework. The generic structures of equilibria that can be stabilized through an adaptive adjustment mechanism are identified. The generalization can be applied to a broad class of discrete economic processes where the variables interested can be adjusted or controlled directly by economic agents such as in cobweb dynamics, Cournot games, Oligopoly markets, tatonnement price adjustment, tariff games, population control through immigration etc.

  7. ADJUSTABLE CHIP HOLDER

    DEFF Research Database (Denmark)

    2009-01-01

    An adjustable microchip holder for holding a microchip is provided having a plurality of displaceable interconnection pads for connecting the connection holes of a microchip with one or more external devices or equipment. The adjustable microchip holder can fit different sizes of microchips with ...

  8. University students' adjustment problems.

    Science.gov (United States)

    Cherian, V I; Cherian, L

    1998-06-01

    Considerable information is available on the adjustment problems of first-year university students in developed countries, but comparatively little is known about such problems in Asia and Africa. This study of a representative sample of 1257 first-year students conducted at the University of the North showed that 33 to 85% of the first-year students experienced various adjustment problems.

  9. LC Filter Design for Wide Band Gap Device Based Adjustable Speed Drives

    DEFF Research Database (Denmark)

    Vadstrup, Casper; Wang, Xiongfei; Blaabjerg, Frede

    2014-01-01

    This paper presents a simple design procedure for LC filters used in wide band gap device based adjustable speed drives. Wide band gap devices offer fast turn-on and turn-off times, thus producing high dV/dt into the motor terminals. The high dV/dt can be harmful for the motor windings and bearings...... and must therefore be reduced. This may be accomplished by a sine LC filter with DC link feedback, which reduces both the differential mode and common mode dV/dt. Wide band gap devices are capable of switching at frequencies much higher than traditional Si based devices. This makes it possible to design...... the LC filter with a higher cut off frequency and without damping resistors. The selection of inductance and capacitance is chosen based on capacitor voltage ripple and current ripple. The filter adds a base load to the inverter, which increases the inverter losses. It is shown how the modulation index...

  10. Adjusting wheal size measures to correct atopy misclassification

    Directory of Open Access Journals (Sweden)

    Zhang H

    2011-08-01

    Full Text Available Hongmei Zhang1,*, Wilfried Karmaus1,*, Jianjun Gan2, Weichao Bao1,*, Yan D Zhao3, Dewi Rahardja3, John W Holloway5, Martha Scott4,5, Syed Hasan Arshad4,51Department of Epidemiology and Biostatistics, The University of South Carolina, Columbia, SC, USA; 2GlaxoSmithKline, Research Triangle Park, NC, USA; 3Department of Clinical Science and Simmons Cancer Center, UT Southwestern Medical Center, Dallas, TX, USA; 4The David Hide Asthma and Allergy Research Center, St Mary’s Hospital, Newport, Isle of Wight, UK; 5School of Medicine, University of Southampton, Southampton, UK *These authors contributed equally to this articlePurpose: Skin prick testing (SPT is fundamental to the practice of clinical allergy identifying relevant allergens and predicting the clinical expression of disease. Wheal sizes on SPT are used to identify atopic cases, and the cut-off value for a positive test is commonly set at 3 mm. However, the measured wheal sizes do not solely reflect the magnitude of skin reaction to allergens, but also skin reactivity (reflected in the size of histamine reaction and other random or non-random factors. We sought to estimate wheal sizes exclusively due to skin response to allergens and propose gender-specific cutoff points of atopy.Methods: We developed a Bayesian method to adjust observed wheal sizes by excluding histamine and other factor effects, based on which revised cutoff points are proposed for males and females, respectively. The method is then applied to and intensively evaluated using a study population aged 18, at a location on the Isle of Wight in the United Kingdom. To evaluate the proposed approach, two sample t-tests for population means and proportion tests are applied.Results: Four common aeroallergens, house dust mite (HDM, grass pollen, dog dander, and alternaria are considered in the study. Based on 3 mm cutoff, males tend to be more atopic than females (P-values are between 0.00087 and 0.062. After applying the

  11. Adjustment of macroeconomic imbalances

    Directory of Open Access Journals (Sweden)

    Georgeta Barbulescu

    2013-03-01

    Full Text Available The global financial and economic crisis was the factor that triggered the adjustment of macroeconomic imbalances accumulated in Romania. The current account deficit and budget deficit were two major structural imbalances that have created a high vulnerability for the economy and explained the extent of economic contraction in Romania during the economic crisis. This article identifies the main causes that lead to the need for fiscal adjustment both in the EU and in Romania, as well as main effects of adjustments in respect of their experience in recent years. The article deals with this topic, because the current topical debate in the field of fiscal adjustments implemented both in the EU and our country, and their need for economic activity aimed at economic recovery.

  12. Remotely Adjustable Hydraulic Pump

    Science.gov (United States)

    Kouns, H. H.; Gardner, L. D.

    1987-01-01

    Outlet pressure adjusted to match varying loads. Electrohydraulic servo has positioned sleeve in leftmost position, adjusting outlet pressure to maximum value. Sleeve in equilibrium position, with control land covering control port. For lowest pressure setting, sleeve shifted toward right by increased pressure on sleeve shoulder from servovalve. Pump used in aircraft and robots, where hydraulic actuators repeatedly turned on and off, changing pump load frequently and over wide range.

  13. Weighted triangulation adjustment

    Science.gov (United States)

    Anderson, Walter L.

    1969-01-01

    The variation of coordinates method is employed to perform a weighted least squares adjustment of horizontal survey networks. Geodetic coordinates are required for each fixed and adjustable station. A preliminary inverse geodetic position computation is made for each observed line. Weights associated with each observed equation for direction, azimuth, and distance are applied in the formation of the normal equations in-the least squares adjustment. The number of normal equations that may be solved is twice the number of new stations and less than 150. When the normal equations are solved, shifts are produced at adjustable stations. Previously computed correction factors are applied to the shifts and a most probable geodetic position is found for each adjustable station. Pinal azimuths and distances are computed. These may be written onto magnetic tape for subsequent computation of state plane or grid coordinates. Input consists of punch cards containing project identification, program options, and position and observation information. Results listed include preliminary and final positions, residuals, observation equations, solution of the normal equations showing magnitudes of shifts, and a plot of each adjusted and fixed station. During processing, data sets containing irrecoverable errors are rejected and the type of error is listed. The computer resumes processing of additional data sets.. Other conditions cause warning-errors to be issued, and processing continues with the current data set.

  14. Adjustment of International Students.

    Science.gov (United States)

    Stafford, Thomas H., Jr.; And Others

    1980-01-01

    International students (N=747) completed a questionnaire to obtain information about their adjustment so that special services could be developed for them. Homesickness was their greatest area of concern, as well as housing, social relationships, the English language, and finances. (RC)

  15. Adjustment to Retirement

    NARCIS (Netherlands)

    van Solinge, H.; Krauss Withbourne, S.

    2016-01-01

    Retirement is an important life course event that marks the start of a new life stage in which work is no longer dominant. Thus, employees have to adjust to the significant life changes that accompany the transition and seek to achieve psychological comfort with their retirement life. This entry

  16. Rural to Urban Adjustment

    Science.gov (United States)

    Abramson, Jane A.

    Personal interviews with 100 former farm operators living in Saskatoon, Saskatchewan, were conducted in an attempt to understand the nature of the adjustment process caused by migration from rural to urban surroundings. Requirements for inclusion in the study were that respondents had owned or operated a farm for at least 3 years, had left their…

  17. Psychosocial adjustment following ostomy.

    Science.gov (United States)

    Follick, M J; Smith, T W; Turk, D C

    1984-01-01

    Ostomy patients have been identified as a chronic illness population frequently experiencing adjustment difficulties. The present study, based on the biopsychosocial model (Engel, 1977) of chronic illness, examined a range of post-surgical adjustment difficulties in a sample of 131 ostomy patients. The patient population reported experiencing a significant number of technical, emotional, social, marital/family, and sexual difficulties post-surgically. Technical difficulties were associated with impaired emotional, social, and marital/family functioning. Emotional difficulties were also associated with problematic social, marital/family adjustment, and impaired sexual functioning. Technical problems, emotional difficulties, and social problems were all associated with the patient's perception of having received inadequate preparatory information. Marital/family and sexual maladjustment, on the other hand, were associated with low levels of perceived social support. The results of this investigation are interpreted as supporting the biopsychosocial model of chronic illness, and the clinical implications of these findings are discussed as well as their relation to previous research on adjustment to stressful medical procedures.

  18. Environmentally Adjusted Elasticity Measures

    OpenAIRE

    Shaik, Saleem

    2005-01-01

    Here, using input, output and nitrogen pollution data related to one state, we propose to extend the elasticity concept to include environmental pollution treated as undesirable output to provide the environmentally adjusted elasticity measures for the period, 1936-1997 in a two-step procedure.

  19. Incisor adjustment in rabbits.

    Science.gov (United States)

    Brown, Cyndi

    2009-06-01

    Rabbit incisor teeth are open-rooted and, in healthy animals, grow continuously. Incisor adjustments are often necessary to maintain the health and well-being of rabbits with incisor malocclusion. This column will describe some techniques used to manage incisor malocclusion in the rabbit.

  20. [Quantification of microangiopathic lesions in brain parenchyma and age-adjusted mean scores for the diagnostic separation of normal from pathological values in senile dementia].

    Science.gov (United States)

    Hentschel, F; Kreis, M; Damian, M; Krumm, B; Frölich, F

    2005-06-01

    To quantify microangiopathic lesions in the cerebral white matter and to develop age-corrected cut-off values for separating normal from dementia-related pathological lesions. In a memory clinic, 338 patients were investigated neuropsychiatrically by a psychological test battery and by MRI. Using a FLAIR sequence and a newly developed rating scale, white matter lesions (WMLs) were quantified with respect to localization, number and intensity, and these ratings were condensed into a score. The WML scores were correlated with the mini-mental state examination (MMSE) and clinical dementia rating (CDR) score in dementia patients. A non-linear smoothing procedure was used to calculate age-related mean values and confidence intervals, separate for cognitively intact subjects and dementia patients. The WML scores correlated highly significantly with age in cognitively intact subjects and with psychometric scores in dementia patients. Age-adjusted WML scores of cognitively intact subjects were significantly different from those of dementia patients with respect to the whole brain as well as to the frontal lobe. Mean value and confidence intervals adjusted for age significantly separated dementia patients from cognitively intact subjects over an age range of 54 through 84 years. A rating scale for the quantification of WML was validated and age-adjusted mean values with their confidence intervals for a diagnostically relevant age range were developed. This allows an easy to handle, fast and reliable diagnosis of the vascular component in senile dementia.

  1. Metric adjusted skew information

    DEFF Research Database (Denmark)

    Hansen, Frank

    2008-01-01

    establish a connection between the geometrical formulation of quantum statistics as proposed by Chentsov and Morozova and measures of quantum information as introduced by Wigner and Yanase and extended in this article. We show that the set of normalized Morozova-Chentsov functions describing the possible...... quantum statistics is a Bauer simplex and determine its extreme points. We determine a particularly simple skew information, the "¿-skew information," parametrized by a ¿ ¿ (0, 1], and show that the convex cone this family generates coincides with the set of all metric adjusted skew informations.......We extend the concept of Wigner-Yanase-Dyson skew information to something we call "metric adjusted skew information" (of a state with respect to a conserved observable). This "skew information" is intended to be a non-negative quantity bounded by the variance (of an observable in a state...

  2. Sustainable urban regime adjustments

    DEFF Research Database (Denmark)

    Quitzau, Maj-Britt; Jensen, Jens Stissing; Elle, Morten

    2013-01-01

    The endogenous agency that urban governments increasingly portray by making conscious and planned efforts to adjust the regimes they operate within is currently not well captured in transition studies. There is a need to acknowledge the ambiguity of regime enactment at the urban scale. This directs...... attention to the transformative implications of conscious strategic maneuvering by incumbent regime actors, when confronting regime structurations. This article provides insight to processes of regime enactment performed by local governments by applying a flow-oriented perspective on regime dynamics......, inspired by Actor-Network Theory to demonstrate that regime incumbent actors can induce gradual regime adjustments at the urban scale. This is done through a case study of an urban development project, where the Municipality of Egedal in Denmark has successfully promoted energy efficient buildings through...

  3. Adjustable Autonomy Testbed

    Science.gov (United States)

    Malin, Jane T.; Schrenkenghost, Debra K.

    2001-01-01

    The Adjustable Autonomy Testbed (AAT) is a simulation-based testbed located in the Intelligent Systems Laboratory in the Automation, Robotics and Simulation Division at NASA Johnson Space Center. The purpose of the testbed is to support evaluation and validation of prototypes of adjustable autonomous agent software for control and fault management for complex systems. The AA T project has developed prototype adjustable autonomous agent software and human interfaces for cooperative fault management. This software builds on current autonomous agent technology by altering the architecture, components and interfaces for effective teamwork between autonomous systems and human experts. Autonomous agents include a planner, flexible executive, low level control and deductive model-based fault isolation. Adjustable autonomy is intended to increase the flexibility and effectiveness of fault management with an autonomous system. The test domain for this work is control of advanced life support systems for habitats for planetary exploration. The CONFIG hybrid discrete event simulation environment provides flexible and dynamically reconfigurable models of the behavior of components and fluids in the life support systems. Both discrete event and continuous (discrete time) simulation are supported, and flows and pressures are computed globally. This provides fast dynamic simulations of interacting hardware systems in closed loops that can be reconfigured during operations scenarios, producing complex cascading effects of operations and failures. Current object-oriented model libraries support modeling of fluid systems, and models have been developed of physico-chemical and biological subsystems for processing advanced life support gases. In FY01, water recovery system models will be developed.

  4. Automatic temperature adjustment apparatus

    Science.gov (United States)

    Chaplin, James E.

    1985-01-01

    An apparatus for increasing the efficiency of a conventional central space heating system is disclosed. The temperature of a fluid heating medium is adjusted based on a measurement of the external temperature, and a system parameter. The system parameter is periodically modified based on a closed loop process that monitors the operation of the heating system. This closed loop process provides a heating medium temperature value that is very near the optimum for energy efficiency.

  5. Adjustable Reeds For Weaving

    Science.gov (United States)

    Farley, Gary L.

    1994-01-01

    Local characteristics of fabrics varied to suit special applications. Adjustable reed machinery proposed for use in weaving fabrics in various net shapes, widths, yarn spacings, and yarn angles. Locations of edges of fabric and configuration of warp and filling yarns varied along fabric to obtain specified properties. In machinery, reed wires mounted in groups on sliders, mounted on lengthwise rails in reed frame. Mechanisms incorporated to move sliders lengthwise, parallel to warp yarns, by sliding them along rails; move sliders crosswise by translating reed frame rails perpendicular to warp yarns; and crosswise by spreading reed rails within group. Profile of reed wires in group on each slider changed.

  6. Continuously adjustable Pulfrich spectacles

    Science.gov (United States)

    Jacobs, Ken; Karpf, Ron

    2011-03-01

    A number of Pulfrich 3-D movies and TV shows have been produced, but the standard implementation has inherent drawbacks. The movie and TV industries have correctly concluded that the standard Pulfrich 3-D implementation is not a useful 3-D technique. Continuously Adjustable Pulfrich Spectacles (CAPS) is a new implementation of the Pulfrich effect that allows any scene containing movement in a standard 2-D movie, which are most scenes, to be optionally viewed in 3-D using inexpensive viewing specs. Recent scientific results in the fields of human perception, optoelectronics, video compression and video format conversion are translated into a new implementation of Pulfrich 3- D. CAPS uses these results to continuously adjust to the movie so that the viewing spectacles always conform to the optical density that optimizes the Pulfrich stereoscopic illusion. CAPS instantly provides 3-D immersion to any moving scene in any 2-D movie. Without the glasses, the movie will appear as a normal 2-D image. CAPS work on any viewing device, and with any distribution medium. CAPS is appropriate for viewing Internet streamed movies in 3-D.

  7. Adjustment disorder: current perspectives

    Directory of Open Access Journals (Sweden)

    Zelviene P

    2018-01-01

    Full Text Available Paulina Zelviene, Evaldas Kazlauskas Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania Abstract: Adjustment disorder (AjD is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11. A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1 preoccupation and 2 failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians. Keywords: adjustment disorder, review, diagnosis, prevalence, treatment, DSM, ICD

  8. Adjusting to the Emergent

    DEFF Research Database (Denmark)

    Revsbæk, Line

    In her doctoral thesis Line Revsbæk explores newcomer innovation related to organizational entry processes in a changing organization. She introduces process philosophy and complexity theory to research on organizational socialization and newcomer innovation. The study challenges assumptions...... in standardized induction programs where newcomers are cast in roles as insecure novices needing to be “taught the ropes” of the organizational culture. Linked with this, it is suggested that the prevailing dichotomy of ‘newcomer assimilation’ versus ‘organizational accommodation’ is replaced with a notion...... of ‘adjusting to the emergent’. Newcomer innovation is portrayed as carrying a variety