Multimodal Testing Reveals Subclinical Neurovascular Dysfunction in Prediabetes, Challenging the Diagnostic Threshold of Diabetes

2021 ◽  
Author(s):  
Varo Kirthi ◽  
Kate I. Reed ◽  
Komeil Alattar ◽  
Benjamin P. Zuckerman ◽  
Catey Bunce ◽  
...  
Keyword(s):  
Diagnostic Threshold ◽  
Neurovascular Dysfunction

Neurovascular Dysfunction in Alzheimer Disease

2019 ◽  
Vol 33 (3) ◽  
pp. 212-219
Author(s):  
Virginia Cipollini ◽  
Giuliano Sette ◽  
Paola Bossù ◽  
Antonio Ciaramella ◽  
Francesca Salani ◽  
...  
Keyword(s):  
Alzheimer Disease ◽  
Neurovascular Dysfunction

scholarly journals The diagnostic threshold of Cornell assessment of pediatric delirium in detection of postoperative delirium in pediatric surgical patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Hong ◽  
Chao Guo ◽  
Zhi-Hua Liu ◽  
Bo-Jie Wang ◽  
Shu-Zhe Zhou ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Assessment Instrument ◽  
Surgical Patients ◽  
Reference Standard ◽  
Diagnostic And Statistical Manual ◽  
Diagnostic Thresholds ◽  
Diagnostic Threshold ◽  
Effective Instrument ◽  
Sensitivity Specificity ◽  
Selective Surgery

Abstract Background Cornell assessment of pediatric delirium (CAPD) showed advantage in diagnosis of pediatric delirium in Chinese critically ill patients. But its performance in surgical patients is still unclear. The present study was designed to validate the diagnostic performance of CAPD in surgical pediatric patients. Methods This is a prospective validation study. Pediatric patients who underwent selective surgery and general anesthesia were enrolled. Primary outcome was the incidence of delirium within postoperative three days. CAPD Chinese version was used to evaluate if the patient had delirium one time per day. At the meantime, a psychiatrist employed Diagnostic and Statistical Manual of Mental Disorders fifth edition to diagnose delirium, which was the “gold standard”, and the result was considered as reference standard. Sensitivity, specificity and area under receiver operating characteristic (ROC) curve were calculated to investigate the performance of CAPD. Results A total of 170 patients were enrolled. Median age was 4 years old. As diagnosed by psychiatrist, 23 (13.5 %) patients experienced at least one episode of delirium during the follow-up period. When diagnostic threshold was set at 9, CAPD showed the optimal sensitivity (87.0 %, 95 %CI 65.3 %-96.6 %) and specificity (98.0 %, 95 %CI 93.7 %-99.5 %) in comparison with other diagnostic thresholds. ROC analysis showed that CAPD was a good delirium assessment instrument with area under curve of 0.911 (95 % CI 0.812 to 1.000, P < 0.001). Agreement between CAPD and reference standard was 0.849 (Kappa coefficient, P < 0.001). Conclusions This study found that Cornell assessment of pediatric delirium could be used as an effective instrument in diagnosis of delirium in pediatric surgical patients. Trial registration www.chictr.org.cn Identifier: ChiCTR-DDD-17,012,231, August 3, 2017.

ESR and CRP Diagnostic Thresholds for Prosthetic Joint Infection in Hip Hemiarthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 187-192
Author(s):  
Jared A. Warren ◽  
Oliver Scotting ◽  
Hiba K. Anis ◽  
James Bircher ◽  
Alison K. Klika ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Roc Curves ◽  
Musculoskeletal Infection ◽  
Hip Hemiarthroplasty ◽  
Diagnostic Thresholds ◽  
Diagnostic Threshold ◽  
Prosthetic Joint ◽  
The Mean

AbstractDiagnostic thresholds used to standardize the definition for prosthetic joint infection (PJI) have largely focused on total joint arthroplasty (TJA). Established PJI thresholds exist for serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in TJA; however, they do not exist for revision hip hemiarthroplasty (rHHA). The purpose of this study was to establish thresholds for (1) ESR and (2) CRP to diagnose PJI in rHHA. Data were collected on a prospective cohort of 69 rHHA patients undergoing orthopaedic surgery between 1/2017 and 2/2019 in a single health care system. Procedures were categorized as septic or aseptic revisions using Musculoskeletal Infection Society (MSIS) criteria (2013). There were 44 ESRs (n = 28 aseptic, n = 16 septic) and 46 CRPs (n = 29 aseptic, n = 17 septic) available for analysis. Two tailed t-tests were performed to compare the mean ESR and CRP in aseptic and septic cases. Receiver operator characteristic (ROC) curves were generated to obtain diagnostic cutoff thresholds using the Youden's Index (J) for ESR and CRP. The mean ESR was 50.3 ± 30.6 mm/h versus 15.4 ± 17.7 mm/h (p < 0.001), while the mean CRP was 29.9 ± 24.8 mg/L versus 4.1 ± 8.2 mg/L (p < 0.001) for septic and aseptic revisions, respectively. The diagnostic threshold for PJI determined by the ROC curve was 44 mm/h for ESR (sensitivity = 56.3%; specificity = 100.0%; J = 0.563; area under the curve (AUC) = 0.845), while it was 12.5 mg/L for CRP (sensitivity = 70.6%; specificity = 96.6%; J = 0.672; AUC = 0.896). For patients with HHA, an ESR of 44 mm/h was and a CRP of 12.5 mg/L was highly specific for PJI. The thresholds are similar to the MSIS thresholds currently published. Larger prospective trials are needed to establish more robust and conclusive diagnostic criteria for PJI in HHA, including investigations not only of ESR and CRP but synovial white blood cell count and synovial polymorphonuclear leukocytes % as well.

scholarly journals Do changes in pulse pressure variation and inferior vena cava distensibility during passive leg raising and tidal volume challenge detect preload responsiveness in case of low tidal volume ventilation?

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Temistocle Taccheri ◽  
Francesco Gavelli ◽  
Jean-Louis Teboul ◽  
Rui Shi ◽  
Xavier Monnet
Keyword(s):  
Cardiac Output ◽  
Inferior Vena Cava ◽  
Tidal Volume ◽  
Pulse Pressure ◽  
Pulse Pressure Variation ◽  
Inferior Vena ◽  
Vena Cava ◽  
Pressure Variation ◽  
Diagnostic Threshold ◽  
Preload Responsiveness

Abstract Background In patients ventilated with tidal volume (Vt) < 8 mL/kg, pulse pressure variation (PPV) and, likely, the variation of distensibility of the inferior vena cava diameter (IVCDV) are unable to detect preload responsiveness. In this condition, passive leg raising (PLR) could be used, but it requires a measurement of cardiac output. The tidal volume (Vt) challenge (PPV changes induced by a 1-min increase in Vt from 6 to 8 mL/kg) is another alternative, but it requires an arterial line. We tested whether, in case of Vt = 6 mL/kg, the effects of PLR could be assessed through changes in PPV (ΔPPVPLR) or in IVCDV (ΔIVCDVPLR) rather than changes in cardiac output, and whether the effects of the Vt challenge could be assessed by changes in IVCDV (ΔIVCDVVt) rather than changes in PPV (ΔPPVVt). Methods In 30 critically ill patients without spontaneous breathing and cardiac arrhythmias, ventilated with Vt = 6 mL/kg, we measured cardiac index (CI) (PiCCO2), IVCDV and PPV before/during a PLR test and before/during a Vt challenge. A PLR-induced increase in CI ≥ 10% defined preload responsiveness. Results At baseline, IVCDV was not different between preload responders (n = 15) and non-responders. Compared to non-responders, PPV and IVCDV decreased more during PLR (by − 38 ± 16% and − 26 ± 28%, respectively) and increased more during the Vt challenge (by 64 ± 42% and 91 ± 72%, respectively) in responders. ∆PPVPLR, expressed either as absolute or as percent relative changes, detected preload responsiveness (area under the receiver operating curve, AUROC: 0.98 ± 0.02 for both). ∆IVCDVPLR detected preload responsiveness only when expressed in absolute changes (AUROC: 0.76 ± 0.10), not in relative changes. ∆PPVVt, expressed as absolute or percent relative changes, detected preload responsiveness (AUROC: 0.98 ± 0.02 and 0.94 ± 0.04, respectively). This was also the case for ∆IVCDVVt, but the diagnostic threshold (1 point or 4%) was below the least significant change of IVCDV (9[3–18]%). Conclusions During mechanical ventilation with Vt = 6 mL/kg, the effects of PLR can be assessed by changes in PPV. If IVCDV is used, it should be expressed in percent and not absolute changes. The effects of the Vt challenge can be assessed on PPV, but not on IVCDV, since the diagnostic threshold is too small compared to the reproducibility of this variable. Trial registration: Agence Nationale de Sécurité du Médicament et des Produits de santé: ID-RCB: 2016-A00893-48.

Consequences Assessment of Destructive Informational Effects on the Basis of Complex Analysis of Biomarker System and its Overcoming

2021 ◽  
Vol 4 (5) ◽  
Author(s):  
Yuriy Danyk
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Effective Treatment ◽  
Posttraumatic Stress ◽  
Biological Markers ◽  
Complex Analysis ◽  
Stress Disorder ◽  
Clinical Symptoms ◽  
Negative Effects ◽  
Diagnostic Threshold ◽  
Crisis Situations

The article is based on the concept of forming various stress-related disorders in crisis situations. It is proved that destructive informational effects in modern conditions are an integral part in the formation of crisis situation syndromes and posttraumatic stress disorder. In the course of research, the possibility of using the system of biological markers for timely detection and effective treatment of stress-associated and informational disorders was established (before other clinical symptoms or their reaching diagnostic threshold). It also allows timely assessment of the subjective adaptation threshold of people at risk, to identify and reduce the negative effects of stress-related disorders. The use of the biomarkers was also researched for the diagnosis, treatment, rehabilitation, prevention of stress-related disorders among participants of crisis situations.

Platelet Behavior Contributes to Neuropathologies: A Focus on Alzheimer's and Parkinson's Disease

2021 ◽  
Author(s):  
Martin J. Page ◽  
Etheresia Pretorius
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Vascular Dysfunction ◽  
Surface Receptors ◽  
Initiation Factors ◽  
Physiological Processes ◽  
Vascular Regulation ◽  
Inflammatory Mechanism ◽  
Neuro Inflammation ◽  
Neurovascular Dysfunction

AbstractThe functions of platelets are broad. Platelets function in hemostasis and thrombosis, inflammation and immune responses, vascular regulation, and host defense against invading pathogens, among others. These actions are achieved through the release of a wide set of coagulative, vascular, inflammatory, and other factors as well as diverse cell surface receptors involved in the same activities. As active participants in these physiological processes, platelets become involved in signaling pathways and pathological reactions that contribute to diseases that are defined by inflammation (including by pathogen-derived stimuli), vascular dysfunction, and coagulation. These diseases include Alzheimer's and Parkinson's disease, the two most common neurodegenerative diseases. Despite their unique pathological and clinical features, significant shared pathological processes exist between these two conditions, particularly relating to a central inflammatory mechanism involving both neuroinflammation and inflammation in the systemic environment, but also neurovascular dysfunction and coagulopathy, processes which also share initiation factors and receptors. This triad of dysfunction—(neuro)inflammation, neurovascular dysfunction, and hypercoagulation—illustrates the important roles platelets play in neuropathology. Although some mechanisms are understudied in Alzheimer's and Parkinson's disease, a strong case can be made for the relevance of platelets in neurodegeneration-related processes.

scholarly journals Evaluating Kupferstein’s claims of the relationship of behavioral intervention to PTSS for individuals with autism

2018 ◽  
Vol 4 (3) ◽  
pp. 122-129 ◽  
Author(s):  
Justin Barrett Leaf ◽  
Robert K. Ross ◽  
Joseph H. Cihon ◽  
Mary Jane Weiss
Keyword(s):  
Stress Disorder ◽  
Service Providers ◽  
Extreme Caution ◽  
Content Type ◽  
Diagnostic Threshold ◽  
Indirect Measures ◽  
Methodological Rigor ◽  
Relationship Of ◽  
The Relationship ◽  
Selection Of

Purpose Kupferstein (2018) surveyed 460 respondents and found that 46 percent of respondents met the diagnostic threshold for posttraumatic stress disorder after exposure to applied-behavior-analysis-based intervention. The purpose of this paper is to provide an evaluation a critical analysis of Kupferstein (2018) including the experimental methods and discussion of the results. Design/methodology/approach The authors evaluated the Kupferstein’s methodological rigor with respect to the use of hypothesis testing, use of indirect measures, selection of respondents, ambiguity in definitions, measurement system, and framing of the experimental question when conducting the correlational analysis in addition to Kupferstein’s analysis and discussion of the results. Findings Based upon the analysis, Kupferstein’s results should be viewed with extreme caution due to several methodological and conceptual flaws including, but not limited to, leading questions used within a non-validated survey, failure to confirm diagnosis, and incomplete description of interventions. Originality/value It is the authors’ hope that this analysis provides caregivers, clinicians, and service providers with a scientific lens which will useful in viewing the limitations and methodological flaws of Kupferstein.

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