Evaluation of the diagnostic performance and optimal cutoff value of a fourth-generation ELISA, VIDAS HIV-1/2 Duo Ultra assay, in a low-prevalence country

In this study, we described the largest analysis to date conducted with VIDAS® HIV Duo Ultra assay. Additionally, we analyzed the diagnostic performance and cutoff values (TV) of HIV Duo Ultra assay and total cost analysis for HIV testing. Of 11,642 enzyme-linked immunosorbent assay (ELISA)-positive samples referred to our center for confirmation, 2000 were positive with HIV Duo Ultra, and of these, 87% were HIV-1 positive and 0.6% were HIV-1 indeterminate with the confirmatory test. Overall, the false-positivity rate was 1.75% for HIV Duo Ultra assay. The sensitivity and specificity were 100% and 99.1%, respectively, when the TV was set at the recommended cutoff value. Even increasing the cutoff value four times, sensitivity and specificity remained high, pointing out that a TV of 0.99 is highly indicative of HIV positivity. Retesting samples with HIV Duo Ultra assay decreased 80% of the confirmatory tests, revealing a significant decrease of 78% in the total costs and reporting time.

Clinical relevance of different handgrip strength indexes and metabolic syndrome in Chinese community-dwelling elderly individuals

PURPOSE

Currently there is no consensus on the correlation between metabolic syndrome (MetS) and muscle strength. The objective of this study was to examine the associations between MetS and its components and different handgrip strength (HS) indexes among Chinese community-dwelling elderly individuals. In addition, we hoped to find an optimal cutoff point for the index most relevant to MetS.

METHODS

Data were obtained from 909 participants aged ≥ 60 years (385 men, average age, 68.0 ± 5.9 y). We used the International Diabetes Federation metabolic syndrome guidelines to define MetS. General data of all participants were collected through questionnaires and anthropometric data were measured. At the same time, blood samples were collected.

RESULTS

The prevalence of MetS was 26.8 % in men and 46.9 % in women. In all HS indexes, HS/body fat mass was most strongly correlated with MetS, and the areas under the receiver-operating characteristic curve were 0.723 (95 % confidence interval [CI] = 0.669-0.776) in men and 0.619 (95 % CI = 0.571-0.667) in women, and the optimal cutoffs were 1.92 in men and 1.25 in women. The adjusted odds ratios (ORs) of MetS for low HS/body fat mass were 5.38 (95 % CI = 3.03-9.56, p < 0.001) in men and 2.39 (95 % CI = 1.56-3.64, p < 0.001) in women.

CONCLUSIONS

HS/body fat mass appears to be the index best associated with MetS and its components, and in men it is more relevant than in women.

Ligand Based Pharmacophore Modeling Followed by Biological Screening Lead to Discovery of Novel PDK1 Inhibitors as Anticancer Agents

BACKGROUND

Phosphoinositide-Dependent Kinase-1 (PDK1) is a serine/threonine kinase, which belongs to AGC kinase family required by cancer cells.

METHODS

Pharmacophoric space of 86 PDK1 inhibitors using six diverse sets of inhibitors was explored to identify high-quality pharmacophores. The best combination of pharmacophoric models and physicochemical descriptors was selected by genetic algorithm-based QSAR analysis that can elucidate the variation of bioactivity within the training inhibitors. Two successful orthogonal pharmacophores emerged in the optimum QSAR equation (r2 69 = 0.90, r2 LOO= 0.86, F= 51.92, r2 PRESS against 17 test inhibitors = 0.79). Receiver Operating Characteristic (ROC) curve analyses were used to estimate the QSAR-selected pharmacophores.

RESULTS

5 out of 11 compounds tested had shown potential intracellular PDK1 inhibition with the highest inhibition percent for compounds 92 and 93 as follows; 90 and 92% PDK1 inhibition, respectively.

CONCLUSION

PDK1 inhibitors are potential anticancer agents that can be discovered by combination method of ligand based design with QSAR and ROC analysis.

Validation of a brief mental health screening tool for pregnant women in a low socio-economic setting

BACKGROUND

In South Africa, the prevalence of symptoms of common mental disorders (CMD), i.e. depression, anxiety and suicidal thoughts are high. This study aimed to use a cognitive interviewing technique to validate the content and structure of a 4-item screening tool, to adapt the tool accordingly, and to use receiver operating curve (ROC) analysis to determine the optimum cut-point for identifying pregnant women with symptoms of CMD.

METHODS

We conducted a mixed method study at a Midwife Obstetric Unit in Cape Town. Women attending the clinic for their first antenatal visit during the recruitment period, whose first language was English, Afrikaans or isiXhosa, were invited to participate. A 4-item screening tool was administered in the first language of the interviewee, after which a cognitive interviewing technique was used to examine the question-response processes and considerations used by respondents as they formed answers to the screening tool questions. The Edinburgh Postnatal Depression Scale (EPDS) was used to identify women with symptoms of CMD.

RESULTS

A 2-week recall period performed well. Questions about (1) being unable to stop worrying, or thinking too much, (2) feeling down, depressed or hopeless, and (3) having thoughts and plans to harm yourself, were well understood. The question that referred to feeling little interest or pleasure in doing things, was poorly understood across all languages. Using ROC analysis with the EPDS as the reference standard, and a cut-point of ≥13, we showed that a 3-item version of the screening tool was able to correctly classify 91% of the women screened.

CONCLUSIONS

Cognitive interviewing enabled testing and refining of the language and constructs of an ultra-brief screening tool. The shortened, 3-item tool is well understood and effective at identifying pregnant women with symptoms of CMD, across the three most commonly spoken languages and cultures in Cape Town.

Marker Systems Based on MicroRNA Gene Methylation for the Diagnosis of Stage I-II Breast Cancer

Groups of microRNA genes, methylation of which is associated with the initial (I-II) stages of breast cancer, are determined, and new markers and marker systems for the disease diagnosis were created on the basis of these data. A total of 14 genes in which methylation was associated with breast cancer were identified with the use of methyl-specific PCR on a representative sample of 70 tumor specimens. Analysis of 46 specimens from patients with clinical stages I and II detected 9 genes (MIR-124-1, MIR-124-3, MIR-125b-1, MIR-129-2, MIR-132, MIR-148a, MIR-193a, MIR-34b/c, and MIR-9-3), in which methylation was associated with the initial stages of the disease. Using ROC analysis, we formed two systems including 6 markers each and detecting breast cancer at stages I-II with high sensitivity (89 and 91%) and specificity (88%) at AUC=0.92-0.93. These sets were validated on the total sample of 70 specimens including all disease stages; they showed 93 and 94% sensitivities, 88% specificity, and AUC=0.95. Highly sensitive systems of markers, based on microRNA gene methylation, were created for the diagnosis of breast cancer at stages I-II.

The effect of the choice of patient model on the performance of in vivo 3D EPID dosimetry to detect variations in patient position and anatomy

PURPOSE

In vivo EPID dosimetry is meant to trigger on relevant differences between delivered and planned dose distributions and should therefore be sensitive to changes in patient position and patient anatomy. Three-dimensional (3D) EPID back-projection algorithms can use either the planning computed tomography (CT) or the daily patient anatomy as patient model for dose reconstruction. The purpose of this study is to quantify the effect of the choice of patient model on the performance of in vivo 3D EPID dosimetry to detect patient-related variations.

METHODS

Variations in patient position and patient anatomy were simulated by transforming the reference planning CT images (pCT) into synthetic daily CT images (dCT) representing a variation of a given magnitude in patient position or in patient anatomy. For each variation, synthetic in vivo EPID data were also generated to simulate the reconstruction of in vivo EPID dose distributions. Both the planning CT images and the synthetic daily CT images could be used as patient model in the reconstructions yielding e D pCT and e D dCT EPID reconstructed dose distributions respectively. The accuracy of e D pCT and e D dCT reconstructions was evaluated against absolute dose measurements made in different phantom setups, and against dose distributions calculated by the treatment planning system (TPS). The comparison was performed by γ-analysis (3% local dose/2 mm). The difference in sensitivity between e D pCT and e D dCT reconstructions to detect variations in patient position and in patient anatomy was investigated using receiver operating characteristic analysis and the number of triggered alerts for 100 volumetric modulated arc therapy plans and 12 variations.

RESULTS

e D dCT showed good agreement with both absolute point dose measurements (<0.5%) and TPS data (γ-mean = 0.52 ± 0.11). The agreement degraded with e D pCT , with the magnitude of the deviation varying with each specific case. e D dCT readily detected combined 3 mm translation setup errors in all directions (AUC = 1.0) and combined 3° rotation setup errors around all axes (AUC = 0.86) whereas e D pCT showed good detectability only for 12 mm translations (AUC = 0.85) and 9° rotations (AUC = 0.80). Conversely, e D pCT manifested a higher sensitivity to patient anatomical changes resulting in AUC values of 0.92/0.95 for a 6 mm patient contour expansion/contraction compared to 0.70/0.64 with e D dCT . Using |ΔPTV_D50 | > 3% as clinical tolerance level, the percentage of alerts for 6 mm changes in patient contour were 85%/27% with e D pCT / e D dCT .

CONCLUSIONS

With planning CT images as patient model, EPID dose reconstructions underestimate the dosimetric effects caused by errors in patient positioning and overestimate the dosimetric effects caused by changes in patient anatomy. The use of the daily patient position and anatomy as patient model for in vivo 3D EPID transit dosimetry improves the ability of the system to detect uncorrected errors in patient position and it reduces the likelihood of false positives due to patient anatomical changes.

Subsets of mononuclear phagocytes are enriched in the inflamed colons of patients with IBD

BACKGROUND

Myeloid cells, especially mononuclear phagocytes, which include monocytes, macrophages and dendritic cells (DC), play vital roles in innate immunity, and in the initiation and maintenance of adaptive immunity. While T cell-associated activation pathways and cytokines have been identified and evaluated in inflammatory bowel disease (IBD) patients (Neurath, Nat Rev Gastroenterol Hepatol 14:269-78, 1989), the role of mononuclear phagocytes are less understood. Recent reports support the crucial role of DC subsets in the development of acute colitis models (Arimura et al., Mucosal Immunol 10:957-70, 2017), and suggest they may contribute to the pathogenesis of ulcerative colitis (UC) by inducing Th1/Th2/Th17 responses (Matsuno et al., Inflamm Bowel Dis 23:1524-34, 2017).

RESULTS

We performed in silico analysis and evaluated the enrichment of immune cells, with a focus on mononuclear phagocytes in IBD patient colonic biopsies. Samples were from different gut locations, with different levels of disease severity, and with treatment response to current therapies. We observe enrichment of monocytes, M1 macrophages, activated DCs (aDCs) and plasmacytoid dendritic cells (pDCs) in inflamed tissues from various gut locations. This enrichment correlates with disease severity. Additionally, the same mononuclear phagocytes subsets are among the top enriched cell types in both infliximab and vedolizumab treatment non-responder samples. We further investigated the enrichment of selected DC and monocyte subsets based on gene signatures derived from a DC- and monocyte-focused single cell RNA-seq (scRNA-seq) study (Villani et al., Science 356:eaah4573, 2017), and verified enrichment in both inflamed tissues and those with treatment resistance. Moreover, we validated an increased mononuclear phagocyte subset abundance in a Dextran Sulphate Sodium (DSS) induced colitis model in C57Bl/6 mice representative of chronic inflammation.

CONCLUSIONS

We conducted an extensive analysis of immune cell populations in IBD patient colonic samples and identified enriched subsets of monocytes, macrophages and dendritic cells in inflamed tissues. Understanding how they interact with other immune cells and other cells in the colonic microenvironment such as epithelial and stromal cells will help us to delineate disease pathogenesis.

A new index of clinical utility for diagnostic tests

Clinical utility of a diagnostic test depends on its diagnostic accuracy, the pretest probability of disease and the clinical consequences of the test results. Tools for evaluating clinical utility are scarce. We propose a new clinical utility index (CUI), which is the expected gain in utility (EGU) of the test divided by the EGU of an ideal test, both adjusted for EGU of the optimal clinical action without testing. The index expresses the relative benefit of using the test compared to using an optimal test when making a clinical decision. To illustrate how the index may be used, we estimated CUI for fasting glucose, both as a continuous and as a dichotomous test, at several values of pretest probability of diabetes mellitus and at two levels of cost/benefit-ratio. In the same clinical situations we also estimated CUI for the 2 h glucose tolerance test. Hemoglobin A1c ≥ 48 mmol/mol was used as a reference standard for diabetes mellitus. In this model, fasting glucose was clinically more useful as a continuous test than as a dichotomous one, based on CUIs. At pretest probability above the treatment threshold, fasting glucose as a continuous test was even more useful than the complete glucose tolerance test. These results are not necessarily generalizable; however, they show how the CUI can be used to select the most useful test in certain clinical situations.

In silico characterization of hypothetical proteins from Orientia tsutsugamushi str. Karp uncovers virulence genes

Scrub typhus also known as bush typhus is a disease with symptoms similar to Chikungunya infection. It is caused by a gram-negative bacterium Orientia tsutsugamushi which resides in its vertebrate host, Mites. The genome of Orientia tsutsugamushi str. Karp encodes for 1,563 proteins, of which 344 are characterized as hypothetical ones. In the present study, we tried to identify the probable functions of these 344 hypothetical proteins (HPs). All the characterized hypothetical proteins (HPs) belong to the various protein classes like enzymes, transporters, binding proteins, metabolic process and catalytic activity and kinase activity. These hypothetical proteins (HPs) were further analyzed for virulence factors with 62 proteins identified as the most virulent proteins among these hypothetical proteins (HPs). In addition, we studied the protein sequence similarity network for visualizing functional trends across protein superfamilies from the context of sequence similarity and it shows great potential for generating testable hypotheses about protein structure-function relationships. Furthermore, we calculated toplogical properties of the network and found them to obey network power law distributions showing a fractal nature. We also identifed two highly interconnected modules in the main network which contained five hub proteins (KJV55465, KJV56211, KJV57212, KJV57203 and KJV57216) having 1.0 clustering coefficient. The structural modeling (2D and 3D structure) of these five hub proteins was carried out and the catalytic site essential for its functioning was analyzed. The outcome of the present study may facilitate a better understanding of the mechanism of virulence, pathogenesis, adaptability to host and up-to-date annotations will make unknown genes easy to identify and target for experimentation. The information on the functional attributes and virulence characteristic of these hypothetical proteins (HPs) are envisaged to facilitate effective development of novel antibacterial drug targets of Orientia tsutsugamushi.

Improving the diagnostic accuracy of a stratified screening strategy by identifying the optimal risk cutoff

BACKGROUND

The American Cancer Society (ACS) suggests using a stratified strategy for breast cancer screening. The strategy includes assessing risk of breast cancer, screening women at high risk with both MRI and mammography, and screening women at low risk with mammography alone. The ACS chose their cutoff for high risk using expert consensus.

METHODS

We propose instead an analytic approach that maximizes the diagnostic accuracy (AUC/ROC) of a risk-based stratified screening strategy in a population. The inputs are the joint distribution of screening test scores, and the odds of disease, for the given risk score. Using the approach for breast cancer screening, we estimated the optimal risk cutoff for two different risk models: the Breast Cancer Screening Consortium (BCSC) model and a hypothetical model with much better discriminatory accuracy. Data on mammography and MRI test score distributions were drawn from the Magnetic Resonance Imaging Screening Study Group.

RESULTS

A risk model with an excellent discriminatory accuracy (c-statistic [Formula: see text]) yielded a reasonable cutoff where only about 20% of women had dual screening. However, the BCSC risk model (c-statistic [Formula: see text]) lacked the discriminatory accuracy to differentiate between women who needed dual screening, and women who needed only mammography.

CONCLUSION

Our research provides a general approach to optimize the diagnostic accuracy of a stratified screening strategy in a population, and to assess whether risk models are sufficiently accurate to guide stratified screening. For breast cancer, most risk models lack enough discriminatory accuracy to make stratified screening a reasonable recommendation.

Comparison of standard-dose and half-dose dual-source abdominopelvic CT scans for evaluation of acute abdominal pain

Background

With the increasing number of computed tomography (CT) scans used for evaluation of acute abdominal pain, patient radiation exposure has increased rapidly.

Purpose

To determine whether the diagnostic performance of half-dose abdominopelvic CT is non-inferior to that of standard-dose CT for patients with acute abdominal pain.

Material and Methods

Ninety-eight patients with acute abdominal pain underwent dual-source abdominopelvic CT. Three sets of CT images were reconstructed: standard-dose filtered back projection (FBP); half-dose FBP; and half-dose sinogram-affirmed iterative reconstruction (SAFIRE3). Diagnostic performance of the standard-dose scan was compared with that of the half-dose scans by using a non-inferiority test with a 10% margin. The overall image quality was subjectively measured.

Results

Diagnostic performance for overall disease diagnosis with half-dose scans (area under the receiver operating characteristic curve [AUC] = 0.835 for FBP, 0.881 for SAFIRE3) was non-inferior to that of standard-dose FBP (AUC = 0.891) (95% confidence interval lower limit difference = −5.6% [half-dose FBP], −1.2% [half-dose SAFIRE3]). The diagnostic sensitivity for detection of neoplastic disease was lower with half-dose (75.0%) than with standard-dose FBP (91.7%). Effective dose and dose-length product with standard-dose imaging were 7.99 ± 2.55 mSv and 533.1 ± 170.3 mGy·cm, respectively; those of half-dose imaging were 3.99 ± 1.28 mSv and 266.6 ± 85.2 mGy·cm, respectively. The image quality was lower with half-dose than with standard-dose FBP scans ( P < 0.01).

Conclusion

Diagnostic performance of half-dose CT is non-inferior to that of standard-dose scan for evaluation of acute abdominal pain, despite inferior image quality.

Investigation of Binding Characteristics of Phosphoinositide-dependent Kinase-1 (PDK1) Co-crystallized Ligands Through Virtual Pharmacophore Modeling Leading to Novel Anti-PDK1 Hits

BACKGROUND

3-Phosphoinositide Dependent Protein Kinase-1 (PDK1) is being lately considered as an attractive and forthcoming anticancer target. A Protein Data Bank (PDB) cocrystallized crystal provides not only rigid theoretical data but also a realistic molecular recognition data that can be explored and used to discover new hits.

OBJECTIVE

This incited us to investigate the co-crystallized ligands' contacts inside the PDK1 binding pocket via a structure-based receptor-ligand pharmacophore generation technique in Discovery Studio 4.5 (DS 4.5).

METHODS

Accordingly, 35 crystals for PDK1 were collected and studied. Every single receptorligand interaction was validated and the significant ones were converted into their corresponding pharmacophoric features. The generated pharmacophores were scored by the Receiver Operating Characteristic (ROC) curve analysis.

RESULTS

Consequently, 169 pharmacophores were generated and sorted, 11 pharmacophores acquired good ROC-AUC results of 0.8 and a selectivity value above 8. Pharmacophore 1UU3_2_01 was used in particular as a searching filter to screen NCI database because of its acceptable validity criteria and its distinctive positive ionizable feature. Several low micromolar PDK1 inhibitors were revealed. The most potent hit illustrated anti-PDK1 IC50 values of 200 nM with 70% inhibition against SW480 cell lines.

CONCLUSION

Eventually, the active hits were docked inside the PDK1 binding pocket and the recognition points between the active hits and the receptor were analyzed that led to the discovery of new scaffolds as potential PDK1 inhibitors.

[Application of brain electrical activity burst analysis method for detection of EEG characteristics in the early stage of Parkinson's disease]

AIM

To develop a mathematical method of analysis and visualization of EEG based on the ROC analysis of burst electrical activity in the cerebral cortex.

MATERIAL AND METHODS

Using a new method of analysis of EEG burst activity, the frequency parameters of brain electrical activity have been investigated in patients in the first stage of Parkinson's disease (PD) defined by the Hoehn and Yahr scale. Patients were right-handed, with disease onset in either the right or the left side. The burst term is used in neurophysiology for the description of wave activity in EEG signals. Bursts are reflected in the local peaks of wavelet spectrograms, some of the parameters of which have been analyzed. Electrical activity of the left and right central cortex areas was investigated. The results were compared with those obtained from healthy volunteers.

RESULTS

In PD patients, burst activity was changed in alpha- and beta bands. Compared to healthy volunteers, it was higher in alpha band 8-9 Hz and lower in upper alpha band 11-13 Hz and beta band 18-24 Hz. With regard to asymmetry of the brain in PD patients, there was the change in burst activity in both brain hemispheres. Diagrams of burst activity showed the difference between the patients with tremor onset in the left hand and tremor onset in the right hand.

CONCLUSION

This suggests differences in brain electrical activity changes in patients with left-sided and right-sided disease onset. The initial results of the study demonstrate that the method of analysis and visualization based on the evaluation of certain parameters of EEG bursts is promising for the analysis of EEG features in PD patients.

The Usefulness of Auditory Perceptual Assessment and Acoustic Analysis for Classifying the Voice Severity

OBJECTIVE

The aims of this study were to (1) to determine the cut-off values of parameters related to auditory perceptual assessment (visual analog scale) and acoustic analysis (cepstral peak prominence, low frequency/high frequency ratio, cepstral peak prominence standard deviation, low frequency/high frequency ratio standard deviation, acoustic voice quality index, and cepstral spectral index of dysphonia) for predicting the voice severity within a Korean population; and (2) to verify the discriminative power of these cut-off values.

METHODS

Voice samples of 1,029 subjects who visited Pusan National University Hospital, South Korea to be treated for swallowing or voice evaluation from January 2018 to December 2018 were analyzed in this retrospective study. The acoustic analysis of cepstral parameters, cepstral spectral index of dysphonia, and acoustic voice quality index were calculated using the Computerized Speech Lab and Praat software. The cut-off values of parameters predicting the voice severities were obtained using receiver operating characteristic analysis. Through this analysis, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were measured.

RESULTS

High reliabilities of auditory perceptual assessments were observed for the auditory perceptual assessment. The cut-off values of parameters predicting voice severities had high sensitivity, specificity, and area under the curve.

CONCLUSIONS

The cut-off values of parameters predicting the voice severities demonstrated a high power to discriminate for classifying the voice severities within a Korean population. The results of this study could be used as objective criteria to screen for severities of voice disorders.

Diagnostic accuracy of capnovolumetry for the identification of airway obstruction - results of a diagnostic study in ambulatory care

BACKGROUND

One of the known weaknesses of spirometry is its dependence on patients' cooperation, which can only partially be alleviated by educational efforts. Therefore, procedures less dependent on cooperation might be of value in clinical practice. We investigated the diagnostic accuracy of ultrasound-based capnovolumetry for the identification of airway obstruction.

METHODS

Consecutive patients from a pulmonary outpatient clinic were included in the diagnostic study. As reference standard, the presence of airway obstruction was evaluated via spirometry and bodyplethysmography. Capnovolumetry was performed as index test with an ultrasound spirometer providing a surrogate measure of exhaled carbon dioxide. Receiver operating characteristic (ROC) analysis was performed using the ratio of slopes of expiratory phases 3 and 2 (s3/s2) ≥ 0.10 as primary capnovolumetric parameter for the recognition of airway obstruction. Logistic regression was performed as secondary analysis to identify further useful capnovolumetric parameters. The diagnostic potential of capnovolumetry to identify more severe degrees of airway obstruction was evaluated additionally.

RESULTS

Of 1400 patients recruited, 1287 patients were included into the analysis. Airway obstruction was present in 29% of patients. The area under the ROC-curve (AUC) of s3/s2 was 0.678 (95% CI 0.645, 0.710); sensitivity of s3/s2 ≥ 0.10 was 47.7 (95% CI 42.7, 52.8)%, specificity 79.0 (95% CI 76.3, 81.6)%. When combining this parameter with three other parameters derived from regression analysis (ratio area/volume phase 3, slope phase 3, volume phase 2), an AUC of 0.772 (95% CI 0.743, 0.801) was obtained. For severe airway obstruction (FEV₁ ≤ 50% predicted) sensitivity of s3/s2 ≥ 0.10 was 75.9 (95% CI 67.1, 83.0)%, specificity 75.8 (95% CI 73.3, 78.1)%; for very severe airway obstruction (FEV₁ ≤ 30% predicted) sensitivity was 86.7 (95% CI 70.3, 94.7)%, specificity 72.8 (95% CI 70.3, 75.2)%. Sensitivities increased and specificities decreased considerably when the combined capnovolumetric score was used as index test.

CONCLUSIONS

Capnovolumetry by way of an ultrasound spirometer had a statistically significant albeit moderate potential for the recognition of airway obstruction in a heterogeneous population of patients typically found in clinical practice. Diagnostic accuracy of the capnovolumetric device increased with the severity of airway obstruction.

TRIAL REGISTRATION

The study is registered under DRKS00013935 at German Clinical Trials Register (DRKS).

A hematologic key for bovine leukemia virus screening in Japanese black cattle

The European Community's leukosis key (EC key) is a well-known hematologic method for detecting bovine leukemia virus (BLV) infection in dairy cattle. The key identifies infected cattle with persistent lymphocytosis via a combination of lymphocyte count (LC) and age. Using the EC key to identify BLV-infected Japanese black (JB) cattle is problematic, however, given the inherently lower LCs of JB cattle compared to dairy cattle. We analyzed the LC in BLV-positive and -negative JB cattle and estimated LC cutoff values by age using receiver operating characteristic curve analysis. Among the 716 JB blood samples collected, 452 (63%) JB cattle were confirmed as BLV-positive by an antibody ELISA for ≥1-y-old cattle and by real-time PCR for <1-y-old cattle. The cutoff values for the LC in each age group were calculated as 6.3 × 10⁹/L for <1 y, 5.9 × 10⁹/L for 1 to <2 y, 5.5 × 10⁹/L for 2 to <3 y, 4.5 × 10⁹/L for 3 to <6 y, 4.3 × 10⁹/L for 6 to ≤10 y, and 3.7 × 10⁹/L for >10 y. The sensitivity and specificity of the estimated cutoff values were 0.49 (95% confidence interval: 0.44-0.53) and 0.81 (0.75-0.85), whereas those of the EC key were 0.20 (0.16-0.24) and 0.99 (0.97-1.00). Our LC cutoff values for screening JB cattle for BLV infection appear to be preferable to those of the EC key.

Comparison of the utility of the PHQ and CES-D for depression screening among youth with HIV in an integrated care setting

BACKGROUND

Depressive symptoms are well documented among people living with HIV and some evidence suggests that youth living with HIV (YLWH) are more affected than their adult counterparts. Therefore, screening for depression is imperative among YLWH to ensure optimal health. The objective of this study is to compare the utility of the Center for Epidemiological Studies-Depression (CES-D) and the Patient Health Questionnaire (PHQ) as depression screeners in an integrated care setting serving YLWH in the southeastern United States.

METHODS

As a part of standard care, the CES-D and the PHQ were administered to YLWH. A Retrospective review of patient records was conducted. Using receiver operating characteristic (ROC) curve analysis and reports from mental health providers, researchers compared the utility of the screeners.

RESULTS

The sample consisted of 121 cases from 2017. Youth ranged in age from 12-25 (M = 20.68, SD = 2.75). Most were Black/African American (59.5%) males (56.2%) who acquired HIV behaviorally (51.2%). Sexual orientation was nearly evenly split between heterosexual (37.2%) and homosexual (34.7%). The CES-D demonstrated higher specificity and sensitivity for identifying clinical depression, yet, this was not significantly different from the PHQ, p = .09.

LIMITATIONS

Generalizability of findings may be limited as the study sample included youth from a single integrated care setting.

CONCLUSION

Both the PHQ and the CES-D demonstrate utility for depression screening among YLWH. However, the PHQ may be preferable for use within a clinical setting.

New evidence-based A1, A2, A3 alarm time zones for transferring thrombolysed patients to hyper-acute stroke units: faster is better

OBJECTIVES

The National Institute of Health and Clinical Excellence and The Royal College of Physicians recommend transferring thrombolysed patients with stroke to a hyperacute stroke unit (HASU) within 4 h from hospital arrival (T_Arrival-HASU), but there is paucity of evidence to support this cut-off. We assessed if a shorter interval within this target threshold conferred a significant improvement in patient mortality.

DESIGN

We conducted a retrospective analysis of prospectively collected data from the Sentinel Stroke National Audit Programme.

SETTING

Four major UK hyperacute stroke centres between 2014 and 2016.

PARTICIPANTS

A total of 183 men (median age = 75 years, IQR = 66-83) and 169 women (median age = 81 years, IQR = 72.5-88) admitted with acute ischaemic stroke.

MAIN OUTCOME MEASURES

We evaluated T_Arrival-HASU in relation to inpatient mortality, adjusted for age, sex, co-morbidities, stroke severity, time between procedures, time and day on arrival.

RESULTS

There were 51 (14.5%) inpatient deaths. On ROC analysis, the AUC (area under the curve) was 61.1% (52.9-69.4%, p = 0.01) and the cut-off of T_Arrival-HASU where sensitivity equalled specificity was 2 h/15 min (intermediate range = 30 min to 3 h/15 min) for predicting mortality. On logistic regression, compared with the fastest T_Arrival-HASU group within 2 h/15 min, the slowest T_Arrival-HASU group beyond upper limit of intermediate range (≥ 3 h/15 min) had an increased risk of mortality: 5.6% vs. 19.6%, adjusted OR = 5.6 (95%CI:1.5-20.6, p = 0.010).

CONCLUSIONS

We propose three new alarm time zones (A1, A2 and A3) to improve stroke survival: "A1 Zone" (T_Arrival-HASU < 2 h/15 min) indicates that a desirable target, "A2 Zone" (T_Arrival-HASU = 2 h/15 min to 3 h/15 min), indicates increasing risk and should not delay any further, and "A3 Zone" (T_Arrival-HASU ≥ 3 h/15 min) indicates high risk and should be avoided.

Diagnostic Performance of Clinicopathological Analytes in Otostrongylus circumlitis-Infected Rehabilitating Juvenile Northern Elephant Seals (Mirounga angustirostris)

The nematode lungworm, Otostrongylus circumlitis (OC), is a significant cause of northern elephant seal (NES; Mirounga angustirostris) mortality at The Marine Mammal Center (TMMC, Sausalito, CA). The current lack of specific antemortem diagnostic tests for pre-patent OC infection in NES makes diagnosis, proper treatment, and assessment of efficacy of medications challenging. Severe inflammation and disseminated intravascular coagulation (DIC) develop rapidly and are difficult to treat once clinical signs develop. Certain blood inflammatory and hemostasis biomarkers for early diagnosis have recently been investigated. The objective of this study was to investigate the diagnostic performance of complete blood count, serum chemistry, acute phase proteins, protein electrophoresis, and coagulation parameters for diagnosis of OC clinical infection in NES. Samples from NES with OC infection confirmed by gross pathology with blood collected antemortem during clinical disease (n = 9) and NES initially admitted for malnutrition and sampled shortly before release after successful rehabilitation (n = 20) were included in the study. Using Receiver operator characteristic (ROC) curve analysis, the diagnostic performances (area under the curve [AUC]) of albumin (0.994), albumin:globulin ratio (0.983), serum amyloid A (0.972), activated partial thromboplastin time (0.936), total bilirubin (0.975), and gamma-glutamyl transferase (0.939) were high (AUC > 0.9). These results confirm systemic inflammation and DIC, and support previously reported clinical and gross pathological findings in NES infected with OC. In addition to AUC values, this study produced cut-off points, sensitivity, specificity, confidence intervals, and predictive values for analytes with high diagnostic performance. This data will be useful in the diagnosis and clinical management of OC-infected NES and will aid in assessment of treatment efficacy.

Synovial C-reactive protein features high negative predictive value but is not useful as a single diagnostic parameter in suspected periprosthetic joint infection (PJI)

OBJECTIVES

Synovial fluid C-reactive protein (syCRP) has been recently described as a new biomarker in preoperative diagnostics to identify periprosthetic joint infections (PJI). The aim of this study was to evaluate syCRP in a large cohort of patients with suspected PJI and to calculate the optimal cut-off to diagnose PJI.

METHODS

Between September 2015 and June 2017, we prospectively included patients with suspected PJI, in which syCRP was additionally measured along with routine preoperative diagnostic serum and synovial biomarkers. We analysed the sensitivity and specificity of syCRP using receiver operating characteristic curves.

RESULTS

We included 192 cases (hip n = 80, knee n = 91, shoulder n = 21) with a final diagnosis of PJI in 26 cases (14.0%). Combined for all joints, the syCRP values were significantly higher in the PJI group than in the no PJI group (median: 13.8 vs. 0 mg/l; p < 0.001). The optimal cut-off (Youden Index: 0.71) for the PJI diagnosis combined for all joints was at a syCRP value of 2.9 mg/l with a sensitivity of 88%, a specificity of 82%, and a negative predictive value of 98%.

CONCLUSIONS

SyCRP features high negative predictive value but is not useful as a single diagnostic parameter in suspected periprosthetic joint infection (PJI).

Statistical evaluation of diagnostic tests: A primer for pediatric surgeons

BACKGROUND/PURPOSE

Diagnostic tests are of paramount importance for informing decision making in the surgical setting. Certain statistical methods are necessary to properly analyze data for diagnostic or prognostic tests involving biomarkers and risk factor data. Our goal is to provide a useful primer for the surgical researcher when performing a diagnostic research study in order to best analyze their data.

METHODS

We present the key concepts and statistics for diagnostic tests and receiver operating characteristic (ROC) curve analysis, and we illustrate each with hypothetical surgery research examples. We use hypothetical data regarding CT imaging and WBC count in their diagnostic ability in predicting acute appendicitis, an extremely common surgical condition, while reviewing the statistical concepts of sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, relative risk, odds ratio, and ROC curves. Then we will consider a hypothetical a risk factor analysis on 30-day readmission to illustrate how multiple predictors can be combined.

CONCLUSIONS

The statistical concepts presented are useful to the pediatric surgeon researcher in assessing the ability of diagnostic tests, which will translate into decision making and patient management implications in the clinical setting.

TYPE OF STUDY

Review Article LEVEL OF EVIDENCE: N/A.

A Receiver Operating Characteristic Framework for Non-adherence Detection Using Drug Concentration Thresholds-Application to Simulated Risperidone Data in Schizophrenic Patients

Non-adherence to antipsychotic medication is a primary factor in disease relapse in schizophrenic patients. We sought to evaluate if plasma concentrations of the antipsychotic risperidone can be used as a predictor of treatment adherence and to identify the optimal plasma concentration threshold to reliably distinguish between adherent and non-adherent patients. A population pharmacokinetic model was used to simulate plasma risperidone steady-state trough concentrations in 1000 virtual patients, where 60% of the patients were 100% adherent to their medication, while 40% of the patients were non-adherent to their medication. The probability of adherence was assessed by receiver operating characteristic (ROC) analysis on C_trough. The area under the ROC curve (AUC_ROC) was used to identify the optimal C_trough threshold. Single vs multiple C_trough at steady state was also evaluated. After a single risperidone C_trough measurement, the AUC_ROC (95% CI) was estimated to be 0.71 (0.69-0.72) and the optimal C_trough threshold accounting for the lowest number of adherent and non-adherent misclassifications was estimated to be 11.9 ng/mL. After multiple C_trough measurements, the AUC_ROC (95% CI) increased up to 0.85 (0.84-0.87) for three C_trough measurements. The optimal probability threshold to reliably discriminate between adherent and non-adherent patients was estimated to be 0.51. Using this model which is reflective of typical adherence to antipsychotic medication, we found that three consecutive steady-state C_trough measurements are needed for an accurate and precise diagnostic test to discriminate between patients who are adherent or non-adherent to treatment.

BaSIQS - basic scale on insomnia complaints and quality of sleep: reliability, norms, validity, and accuracy studies, based on clinical and community samples

This research focused on the Basic Scale on Insomnia Symptoms and Quality of Sleep (BaSIQS), formerly validated in undergraduates using the Pittsburgh Sleep Quality Index (PSQI), and aimed to expand internal consistency analysis, examine thoroughly its validity, and determine its clinical accuracy. Considering objective and subjective measures, recruiting non-clinical and clinical samples, this research implemented a comprehensive approach to examine convergent and discriminant validity, confirmatory factor analyses, and the BaSIQS sensitivity and specificity. The BaSIQS was filled out along with the Insomnia Severity Index (ISI), questions on sleep-wake schedules, Composite Scale of Morningness (CSM) and Brief Symptom Inventory-18 (BSI-18) by 1198 adults, 18-64 years old, plus another 30 who wore actimeters, recruited in community settings. A clinical group of 30 chronic insomnia disorder patients also participated. Cronbach alpha coefficient was 0.80. A two-factor structure was confirmed. The association between BaSIQS and ISI was large, whereas actigraphy correlations were medium or small. Medium to non-significant correlations were found concerning conceptually different self-report measures. Comparing the clinic and control groups, the former showed poorer sleep, with a large effect size. Receiver operating characteristic analysis revealed an area under curve = 0.9, and an optimal cut-off score >15. In conclusion, results on reliability, validity, and accuracy provide support to the utility of the BaSIQS both in community and clinical settings, for research and practical purposes.

Objective physical measures and their association with subjective functional limitations in a representative study population of older Thais

Background

In this study, we analyzed elderly people in Thailand to identify the validity of suggested cutoff points of physical measures, handgrip strength, usual walking speed, and a composite score of both measures to predict functional limitations. Moreover, we examined whether these physical performance measures are accurate indicators of the investigated health outcomes.

Methods

Using Receiver Operating Characteristics (ROC) analysis, we investigated a sample of 8272 respondents aged 60 to 79 years. All data were based on the 2009 National Health Examination Survey (NHES IV) of Thailand.

Results

For males aged 60 to 69 years, handgrip strength was used as an indicator of functional limitations. The cutoff point for disabilities in the activities of daily living (ADLs) was 29.5 kg, while in other limitations it ranged from 28.7 to 31.3 kg. In contrast, usual walking speed was able to indicate ADL disabilities at 0.7 m per second (m/s). As one might expect, the cutoff points for males aged 70 to 79 years were lower than for males in the 60 to 69 age group. For females, handgrip strength was able to indicate ADL disabilities at 16.5 kg for both the 60 to 69, and 70 to 79 age groups. Likewise, walking speed was indicative of ADL disabilities at 0.6 m/s for both age groups. Interestingly, the composite measure increases the ability to detect ADL disabilities in the younger group but not in the older group. The area under the curve (AUC) of cutoffs measuring the detection power of a diagnostic test was varied, ranging from 0.535 to 0.7386.

Conclusions

The cutoff points of three measures varied according to sex and type of functional limitations. Our findings also showed that physical performance measures were useful for identifying people with an increased risk of functional limitations, particularly for ADL disabilities. However, although the AUC of the cutoffs of other functional limitations were relatively low, they should be considered with caution.

Electronic supplementary material

The online version of this article (10.1186/s12877-019-1093-3) contains supplementary material, which is available to authorized users.

Sensitivity and specificity of standardised allergen extracts in skin prick test for diagnoses of IgE-mediated respiratory allergies

Background

Skin prick tests (SPTs) are essential for the diagnosis of IgE-mediated allergy and are influenced by extract quality, biological potency and concentration of allergen.

Methods

In this open multicentre study 431 patients, aged 18-64 years were enrolled. Patients had a history of IgE-mediated allergy and a sensitisation (previous positive SPT of any manufacturer) against at least one of the investigated allergens: 6-grass pollen, house dust mite, birch and mugwort pollen. In our study, these allergens were tested in five concentrations each. To establish the optimal trade-off between sensitivity and specificity, the area under the receiver operating characteristic (ROC) curve was estimated by comparing the outcome of the SPT with three methods referred to as 'reference methods' (specific IgE, clinical case history and a previous SPT).

Results

For all allergens and reference methods, the area under the ROC curves were highly significant (p < 0.001). Specific IgE reference method resulted in the largest area under the curve (AUC) for all allergens (0.80-0.90) followed by previous SPT (0.70-0.87) and case history (0.65-0.74). Sensitivity of SPT increased with increasing concentration and specificity decreased. For all allergens, compared to specific IgE, the highest sensitivity (specificity at least 80%) was observed for the SPT solution of 50,000 Standardised Units (SU)/mL (grass pollen, birch pollen, house dust mite and mugwort).

Conclusion

In this study, with a large number of patients, it was demonstrated that clinical case history, previous SPT and specific IgE measurement could all be used as reference methods for the assessment of sensitivity/specificity of SPT solutions. The comparison of SPT with specific IgE resulted in the largest AUC. The highest sensitivity was observed for the SPT solution of 50,000 SU/mL.Trial registration EudraCT: 2006-005304-14.