scholarly journals Measurement of Intraoperative Graft Flow Predicts Radiological Hyperperfusion during Bypass Surgery in Patients with Moyamoya Disease

2020 ◽  
Vol 10 (2) ◽  
pp. 66-75
Author(s):  
Akikazu Nakamura ◽  
Akitsugu Kawashima ◽  
Shunsuke Nomura ◽  
Takakazu Kawamata
Keyword(s):  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Effective Means ◽  
Area Under The Curve ◽  
Quantitative Measure ◽  
Pressure Control ◽  
Characteristic Analysis ◽  
Main Trunk ◽  
Graft Flow ◽  
The Relationship

Introduction: Moyamoya disease (MMD) is a rare cerebrovascular disease associated with cerebral infarction or hemorrhage. Hyperperfusion is the most significant complication of direct bypass surgery. Previous research has shown that an increase in cerebral blood flow (CBF) is strongly related to symptomatic hyperperfusion and highlighted the importance of postoperative assessment of CBF. Objective: The principal aims of this study were to quantitatively analyze the relationship between intraoperative graft flow and increase in CBF and to evaluate the effectiveness of intraoperative graft flow measurement during bypass surgery for patients with MMD. Methods: This study included 91 surgeries in 67 consecutive adult patients with MMD who underwent direct revascularization surgery at our institution between November 2013 and September 2018. Intraoperative graft flow of the branches and main trunk was measured in all patients, after anastomosis had been established. Postoperative CBF measurements were performed under sedation, immediately after surgery. Radiological hyperperfusion was defined as focal high uptake, as determined by CBF imaging immediately after surgery. Patients were divided into two groups (radiological hyperperfusion and nonradiological hyperperfusion groups), and the relationship between intraoperative graft flow and radiological hyperperfusion was analyzed. Results: Significant differences were observed between the radiological hyperperfusion and nonradiological hyperperfusion groups in terms of intraoperative graft flow of both the branch (median 72 vs. 42 mL/min, respectively; p < 0.01) and main trunk (median 113 vs. 68 mL/min, respectively; p < 0.01). A receiver-operating characteristic analysis was performed to test the utility of intraoperative flow as a quantitative measure. We set the cutoff values for the intraoperative branch and main trunk flow at 57 mL/min (sensitivity: 0.707, specificity: 0.702; area under the curve [AUC]: 0.773; 95% confidence interval [CI]: 0.675–0.871) and 84 mL/min (sensitivity: 0.667, specificity: 0.771; AUC: 0.78; 95% CI: 0.685–0.875), respectively. Conclusions: Measuring intraoperative graft flow during bypass surgery may be an effective means of predicting hyperperfusion and could serve to facilitate early therapeutic intervention such as strict blood pressure control.

scholarly journals Measuring the palpable pulsatility length as a physical examination test in defining the severity of inflow stenosis for hemodialysis fistulas

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Matt Chiung-Yu Chen ◽  
Mei-Jui Weng ◽  
Misoso Yi-Wen Wu ◽  
Yi-Chun Liu ◽  
Wen-Che Chi
Keyword(s):  
Operating Characteristic ◽  
Area Under The Curve ◽  
High Sensitivity ◽  
Characteristic Analysis ◽  
Main Trunk ◽  
Arteriovenous Fistulas ◽  
Cannulation Site ◽  
Before And After ◽  
Physical Examinations ◽  
Hemodialysis Fistulas

Abstract Background Pulsatility is an important property of hemodialysis arteriovenous fistulas (AVF) and can be perceived by the fingers as a gradual decrease in strength downstream from the anastomosis along the main trunk of the fistula. The distance from the point at which the pulse becomes imperceptible to the anastomosis is termed the palpable pulsatility length (PPL); we considered this length may play a role in assessing the severity of inflow stenosis for hemodialysis fistulas. Methods This study was performed by retrospective analysis of routinely collected data. Physical examinations and fistula measurements were performed in a selected population of 76 hemodialysis patients with mature fistulas during half a year. Fistula measurements included the PPL before and after treatment and the distance between the anastomosis and the arterial cannulation site (aPump length). The aPump index (API) was calculated by dividing the PPL by the aPump length. Angiograms were reviewed to determine the location and severity of stenosis. PPL and API were used to detect the critical inflow stenosis, which indicates severe inflow stenosis of an AVF. Results Receiver operating characteristic analysis showed that the area under the curve was 0.895 for API and 0.878 for PPL. A cutoff value of API < 1.29 and PPL < 11.0 cm were selected to detect the critical inflow stenosis. The sensitivity was 96.0% versus 80.0% and specificity was 84.31% versus 84.31% for API and PPL, respectively. Conclusions PPL and API are useful tools in defining the severity of pure inflow stenosis for mature AVFs in the hands of trained examiners with high sensitivity and specificity.

scholarly journals Pressure–volume loop validation of TAPSE/PASP for right ventricular arterial coupling in heart failure with pulmonary hypertension

2020 ◽  
Author(s):  
Alexander Schmeisser ◽  
Thomas Rauwolf ◽  
Thomas Groscheck ◽  
Siegfried Kropf ◽  
Blerim Luani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Cox Regression ◽  
Area Under The Curve ◽  
Characteristic Analysis ◽  
Reduced Ejection Fraction ◽  
Prognostic Assessment ◽  
Relationship Of ◽  
The Relationship

Abstract Aims The aim of this study was to validate the tricuspid annular plane systolic excursion/systolic pulmonary artery (PA) pressure (TAPSE/PASP) ratio with the invasive pressure–volume (PV) loop-derived end-systolic right ventricular (RV) elastance/PA elastance (Ees/Ea) ratio in patients with heart failure with reduced ejection fraction (HFREF) and secondary pulmonary hypertension (PH). Methods and results The relationship of TAPSE and TAPSE/PASP with RV-PV loop (single-beat)-derived contractility Ees, afterload Ea, and Ees/Ea was assessed in 110 patients with HFREF with and without secondary PH. The results were compared with other surrogate parameters such as the fractional area change/PASP ratio. The association of the surrogates with all-cause mortality was evaluated. In patients with PH (n = 74, 67%), TAPSE significantly correlated with Ees (r = 0.356), inverse with Ea (r = −0.514) but was most closely associated with Ees/Ea (r = 0.77). Placing TAPSE in a ratio with PASP slightly reduced the relationship to Ees/Ea (r = 0.71) but was more closely related to the parameters of PA vascular load, diastolic RV function, and RV energetics. The area under the curve of TAPSE/PASP and TAPSE for discriminating overall survival in receiver operating characteristic analysis was not different (P = 0.78. Prognostic relevant cut-offs were 17 mm for TAPSE and 0.38 mm/mmHg for TAPSE/PASP. Both parameters in multivariate cox regression remained independently prognostically relevant. Conclusion TAPSE is an easily and reliably obtainable and valid surrogate parameter for RV–PA coupling in PH due to HFREF. Putting TAPSE into a ratio with PASP did not further improve the coupling information or prognostic assessment. Trial Identifier DRKS—German Clinical Trials Register (DRKS00011133; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011133).

scholarly journals Serum TNFα levels at 24 h after certolizumab pegol predict effectiveness at week 12 in patients with rheumatoid arthritis from TSUBAME study

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Yusuke Miyazaki ◽  
Kazuhisa Nakano ◽  
Shingo Nakayamada ◽  
Satoshi Kubo ◽  
Shigeru Iwata ◽  
...  
Keyword(s):  
Operating Characteristic ◽  
Certolizumab Pegol ◽  
Area Under The Curve ◽  
Serum Levels ◽  
Trial Registration ◽  
Clinical Parameters ◽  
Characteristic Analysis ◽  
Clinical Trial Registration ◽  
Registration Number ◽  
The Relationship

Abstract Objective To estimate the relationship between serum TNFα, IL-6, and serum CZP levels and the clinical response to CZP in RA patients in the TSUBAME study. Methods One hundred patients with RA who received CZP were enrolled and multiple clinical parameters, serum TNFα, IL-6, and CZP levels, were assessed at 0, 24, and 48 h and 12 weeks after first administration of CZP. Results The CZP therapy significantly improved the DAS28(ESR) at 12 weeks. Serum TNFα and IL-6 levels significantly decreased from baseline at 24 h after the first administration of CZP. Serum TNFα levels at baseline were not related to clinical parameters at baseline and improvement in DAS28(ESR) at week 12 of the CZP therapy. However, serum levels of CZP at 24 h were strongly and negatively correlated with TNFα levels at 24 h, which were negatively correlated with improved rate in DAS28(ESR) at week 12. Only serum levels of TNFα, but not IL-6, at 24 h had a negative correlation with achievement of DAS28(ESR)<2.6 at week 12 by the multivariate analysis (odds ratio 0.01, 95% confidence interval 0.04e−2–0.22, p < 0.01). A receiver operating characteristic analysis was conducted to estimate the achievement of DAS28(ESR)<2.6 at week 12 after the CZP therapy and cut-off value of 0.76 pg/ml for serum levels of TNFα at 24 h was yielded (area under the curve=0.75). DAS28(ESR)<2.6 was achieved at week 12 significantly more patients with lower serum TNF levels (≦0.76 pg/ml) at 24 h than those with higher TNF levels. Conclusions CZP was highly effective in RA patients who had low serum TNFα levels at 24 h after the initial administration of CZP. Therefore, we propose that serum TNFα levels at 24 h could serve as a biomarker predicting effectiveness to CZP at week 12 in patients with RA. Trial registration Clinical trial registration number: UMIN ID:000022831

scholarly journals Reduced glutathione peroxidase activity predicts increased cardiovascular risk following an acute coronary syndrome.

2016 ◽  
Vol 6 ◽  
Author(s):  
Ana S Holley ◽  
Scott A Harding ◽  
Alexander Sasse ◽  
John H Miller ◽  
Peter D Larsen
Keyword(s):  
Glutathione Peroxidase ◽  
Area Under The Curve ◽  
Major Adverse Cardiovascular Events ◽  
Diabetic Patients ◽  
Characteristic Analysis ◽  
Coronary Syndrome ◽  
Cardiovascular Damage ◽  
Increased Risk ◽  
The Relationship ◽  
Gpx Activity

<p><em>Background:</em>  Glutathione peroxidase (GPx) is an antioxidant enzyme that comprises a primary defence against oxidative stress.  Deficiencies in GPx have been associated with progression of atherosclerosis and arterial thrombosis.  However, the relationship between GPx activity and clinical outcomes in acute coronary syndromes (ACS) remains controversial.  This study examined the relationship between plasma GPx activity and subsequent major adverse cardiovascular events (MACE) in ACS patients.</p><p><em>Method:</em>  In this prospective cohort study, 262 ACS patients had their plasma GPx activity measured using a colourimetric enzyme assay.  Patient demographics, clinical variables and MACE, a composite of death, non-fatal myocardial infarction, ischaemic stroke and acute heart failure, were collected.</p><p><em>Results:</em>  At 1 year follow-up, 34 (13%) patients experienced MACE.  When the MACE rate was examined by quartiles of GPx activity, a significant decrease in MACE was demonstrated with increasing quartiles of GPx activity (<em>P </em>= 0.04).  The event rate for patients in the lowest quartile of GPx activity was 19.6% compared to 7.9% for the upper quartile.  Levels of GPx activity were significantly lower in diabetic patients compared to non-diabetic patients (<em>P</em> = 0.02), and lower in males compared to females (<em>P </em>= 0.03).  GPx activity was a moderate predictor of MACE by receiver operator characteristic analysis with an area under the curve of 0.62 (<em>P </em>= 0.02).</p><em>Conclusion:</em>  We have demonstrated that lower levels of GPx activity are associated with an increased risk of MACE at 1 year following an ACS.  Low levels of GPx activity may represent a decreased defence against oxidant-mediated cardiovascular damage.

Ascertaining an efficient eligibility cut-off for extended Medicare items for eating disorders

2021 ◽  
pp. 103985622110286
Author(s):  
Tracey Wade ◽  
Jamie-Lee Pennesi ◽  
Yuan Zhou
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
False Positive Rate ◽  
Area Under The Curve ◽  
Rate Sensitivity ◽  
True Positive Rate ◽  
Eating Disorder Examination Questionnaire ◽  
Eating Disorder Examination ◽  
Positive Rate ◽  
The Relationship

Objective: Currently eligibility for expanded Medicare items for eating disorders (excluding anorexia nervosa) require a score ⩾ 3 on the 22-item Eating Disorder Examination-Questionnaire (EDE-Q). We compared these EDE-Q “cases” with continuous scores on a validated 7-item version of the EDE-Q (EDE-Q7) to identify an EDE-Q7 cut-off commensurate to 3 on the EDE-Q. Methods: We utilised EDE-Q scores of female university students ( N = 337) at risk of developing an eating disorder. We used a receiver operating characteristic (ROC) curve to assess the relationship between the true-positive rate (sensitivity) and the false-positive rate (1-specificity) of cases ⩾ 3. Results: The area under the curve showed outstanding discrimination of 0.94 (95% CI: .92–.97). We examined two specific cut-off points on the EDE-Q7, which included 100% and 87% of true cases, respectively. Conclusion: Given the EDE-Q cut-off for Medicare is used in conjunction with other criteria, we suggest using the more permissive EDE-Q7 cut-off (⩾2.5) to replace use of the EDE-Q cut-off (⩾3) in eligibility assessments.

scholarly journals Measles Virus IgG Avidity Assay for Use in Classification of Measles Vaccine Failure in Measles Elimination Settings

2012 ◽  
Vol 19 (11) ◽  
pp. 1810-1817 ◽  
Author(s):  
Sara Mercader ◽  
Philip Garcia ◽  
William J. Bellini
Keyword(s):  
Measles Virus ◽  
Area Under The Curve ◽  
Epidemiological Data ◽  
Diagnostic Tools ◽  
High Avidity ◽  
Characteristic Analysis ◽  
Vaccine Failure ◽  
Avidity Assay ◽  
Igg Avidity

ABSTRACTIn regions where endemic measles virus has been eliminated, diagnostic assays are needed to assist in correctly classifying measles cases irrespective of vaccination status. A measles IgG avidity assay was configured using a commercially available measles-specific IgG enzyme immunoassay by modifying the protocol to include three 5-min washes with diethylamine (60 mM; pH 10.25) following serum incubation; serum was serially diluted, and the results were expressed as the end titer avidity index. Receiver operating characteristic analysis was used for evaluation and validation and to establish low (≤30%) and high (≥70%) end titer avidity thresholds. Analysis of 319 serum specimens expected to contain either high- or low-avidity antibodies according to clinical and epidemiological data indicated that the assay is highly accurate, with an area under the curve of 0.998 (95% confidence interval [CI], 0.978 to 1.000), sensitivity of 91.9% (95% CI, 83.2% to 97.0%), and specificity of 98.4% (95% CI, 91.6% to 100%). The assay is rapid (<2 h) and precise (standard deviation [SD], 4% to 7%). In 18 samples from an elimination setting outbreak, the assay identified 2 acute measles cases with low-avidity results; both were IgM-positive samples. Additionally, 11 patients (15 samples) with modified measles who were found to have high-avidity IgG results were classified as secondary vaccine failures; one sample with an intermediate-avidity result was not interpretable. In elimination settings, measles IgG avidity assays can complement existing diagnostic tools in confirming unvaccinated acute cases and, in conjunction with adequate clinical and epidemiologic investigation, aid in the classification of vaccine failure cases.

Comparing the Effects of Immersed Versus Land-Based High-Intensity Interval Cycling on Energy Intake, Appetite Sensations and Perceived Exertion Among Healthy Men

2021 ◽  
pp. 003151252110073
Author(s):  
Lore Metz ◽  
Laurie Isacco ◽  
Maud Miguet ◽  
Pauline Genin ◽  
David Thivel ◽  
...  
Keyword(s):  
Energy Intake ◽  
High Intensity ◽  
Perceived Exertion ◽  
Area Under The Curve ◽  
Macronutrient Intake ◽  
Healthy Men ◽  
High Intensity Interval ◽  
Interval Cycling ◽  
Desire To Eat ◽  
The Relationship

Immersed exercise has been shown to induce higher energy expenditure and no difference or increase in food intake compared with similar exercise on land. In this study, we compared the effects of acute high-intensity cycling performed on land versus when immersed on subsequent energy intake (EI), appetite sensations and perceived exertion (RPE) in healthy men. Ten participants in a postprandial condition completed three experimental visits in a randomized order: a control condition (CONT); a high-intensity interval cycling exercise performed on land (HIIE-L) and the same exercise while immersed in water (HIIE-A) with a similar targeted heart rate. We observed no difference in energy and macronutrient intake and in area under the curve (AUC) for appetite sensations between sessions. The RPE at the end of HIIE-L was negatively correlated with EI (r=–0.67; p < 0.05), AUC for hunger (r=–0.86, p < 0.01), desire to eat (r=–0.78, p < 0.05) and prospective food consumption (r=–0.86, p < 0.01). Conversely, the RPE at the end of HIIE-L was positively correlated with AUC for fullness (r = 0.76 , p < 0.05). No such correlations were observed for HIIE-A. The present study was the first to observe that immersion did not influence EI after HIIE cycling, but immersion blunted the relationship between session RPE and subsequent energy intake and appetite sensations relative to HIIE on land.

scholarly journals Head-to-Head Comparison of Two Nomograms Predicting Probability of Lymph Node Invasion in Prostate Cancer and the Therapeutic Impact of Higher Nomogram Threshold

2021 ◽  
Vol 10 (5) ◽  
pp. 999
Author(s):  
Zilvinas Venclovas ◽  
Tim Muilwijk ◽  
Aivaras J. Matjosaitis ◽  
Mindaugas Jievaltas ◽  
Steven Joniau ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Area Under The Curve ◽  
Pelvic Lymph Node ◽  
Cancer Center ◽  
Study Cohort ◽  
Net Benefit ◽  
Characteristic Analysis ◽  
Therapeutic Impact ◽  
Mskcc Nomogram

Introduction: The aim of the study was to compare the performance of the 2012 Briganti and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with pelvic lymph node dissection (PLND), to examine their performance and to analyse the therapeutic impact of using 7% nomogram cut-off. Materials and Methods: The study cohort consisted of 807 men with clinically localised prostate cancer (PCa) who underwent open RP with PLND between 2001 and 2019. The area under the curve (AUC) of the receiver operator characteristic analysis was used to quantify the accuracy of the 2012 Briganti and MSKCC nomograms to predict LNI. Calibration plots were used to visualise over or underestimation by the models and a decision curve analysis (DCA) was performed to evaluate the net benefit associated with the used nomograms. Results: A total of 97 of 807 patients had LNI (12%). The AUC of 2012 Briganti and MSKCC nomogram was 80.6 and 79.2, respectively. For the Briganti nomogram using the cut-off value of 7% would lead to reduce PLND in 47% (379/807), while missing 3.96% (15/379) cases with LNI. For the MSKCC nomogram using the cut-off value of 7% a PLND would be omitted in 44.5% (359/807), while missing 3.62% (13/359) of cases with LNI. Conclusions: Both analysed nomograms demonstrated high accuracy for prediction of LNI. Using a 7% nomogram cut-off would allow the avoidance up to 47% of PLNDs, while missing less than 4% of patients with LNI.

scholarly journals Red cell distribution width as a predictor for bronchopulmonary dysplasia in premature infants

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hayato Go ◽  
Hitoshi Ohto ◽  
Kenneth E. Nollet ◽  
Kenichi Sato ◽  
Hirotaka Ichikawa ◽  
...  
Keyword(s):  
Blood Cell ◽  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Red Blood Cell ◽  
Area Under The Curve ◽  
Cell Distribution ◽  
Characteristic Analysis ◽  
Distribution Width ◽  
Potential Biomarker ◽  
Rbc Transfusion

AbstractBronchopulmonary dysplasia (BPD) is the most common morbidity complicating preterm birth. Red blood cell distribution width (RDW), a measure of the variation red blood cell size, could reflect oxidative stress and chronic inflammation in many diseases such as cardiovascular, pulmonary, and other diseases. The objectives of the present study were to evaluate perinatal factors affecting RDW and to validate whether RDW could be a potential biomarker for BPD. A total of 176 preterm infants born at < 30 weeks were included in this study. They were categorized into BPD (n = 85) and non-BPD (n = 91) infants. RDW at birth and 14 days and 28 days of life (DOL 14, DOL 28) were measured. Clinical data were obtained from all subjects at Fukushima Medical University (Fukushima, Japan). The mean RDW at birth, DOL 14 and DOL 28 were 16.1%, 18.6%, 20.1%, respectively. Small for gestational age (SGA), chorioamnionitis (CAM), hypertensive disorders of pregnancy (HDP), gestational age and birth weight were significantly associated with RDW at birth. SGA, BPD and red blood cell (RBC) transfusion before DOL 14 were associated with RDW at DOL 14. BPD and RBC transfusion before DOL 14 were associated with RDW at DOL 28. Compared with non-BPD infants, mean RDW at birth DOL 14 (21.1% vs. 17.6%, P < 0.001) and DOL 28 (22.2% vs. 18.2%, P < 0.001) were significantly higher in BPD infants. Multivariate analysis revealed that RDW at DOL 28 was significantly higher in BPD infants (P = 0.001, odds ratio 1.63; 95% CI 1.22–2.19). Receiver operating characteristic analysis for RDW at DOL 28 in infants with and without BPD yielded an area under the curve of 0.87 (95% CI 0.78–0.91, P < 0.001). RDW at DOL 28 with mild BPD (18.3% vs. 21.2%, P < 0.001), moderate BPD (18.3% vs. 21.2%, P < 0.001), and severe BPD (18.3% vs. 23.9%, P < 0.001) were significantly higher than those with non-BPD, respectively. Furthermore, there are significant differences of RDW at DOL 28 between mild, moderate, and severe BPD. In summary, we conclude that RDW at DOL 28 could serve as a biomarker for predicting BPD and its severity. The mechanism by which RDW at DOL 28 is associated with the pathogenesis of BPD needs further elucidation.

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