Application value of regional oxygen saturation in prognosis evaluation of patients with acute lower limb ischemia / 中华急诊医学杂志

Objective:To explore the application value of regional oxygen saturation (rSO 2) level in the prognosis evaluation of patients with acute lower limb ischemia (ALLI). Methods:Retrospective analysis of clinical data of 82 ALLI patients admitted to the ICU of Xinjiang Uygur Autonomous Region People's Hospital from June 2021 to June 2022. The subjects were divided into event group and non-event group according to the incidence of adverse events during the follow-up. The general clinical data of the two groups were compared. Multiple stepwise linear regression was used to analyze the independent related factors of rSO 2. Multivariate Cox regression was used to analyze independent risk factors of adverse events. Receiver operating characteristic (ROC) curve was used to obtain the optimal cut-off value of rSO 2 prediction adverse events. The subjects were divided into high-value group and low-value group according to the optimal cut-off value. Kaplan-Meier curve was used to analyze the difference in survival rate between groups during the follow-up. Results:A total of 82 ALLI patients were included in this study, and the incidence of adverse events during follow-up was 25.6% (21 cases). The rSO 2 of four periods and maximum, minimum, average and ankle-brachial index in the event group were significantly lower than those in the non-event group. The troponin I, troponin T, myoglobin, creatine kinase, C-reactive protein, and lactate in the event group were significantly higher than those in the non event group ( P?0.05). Multiple stepwise linear regression analysis showed that: C-reactive protein ( β=-0.320, P=0.002), lactate ( β=-0.262, P=0.009), troponin Ⅰ ( β=-0.230, P=0.025), and smoking history ( β=-0.211, P=0.034) were all independent predictors of rSO 2. Multivariate Cox regression analysis showed that 24 h rSO 2 (mean) was an independent influencing factor for adverse events in ALLI patients (adjusted HR=0.67, 95% CI:0.54-0.83, P<0.001). The 24 h rSO 2 (mean) was good in predicting the incidence of adverse events at 30, 60, and 90 days in ALLI patients (AUC were 0.934, 0.867 and 0.823), and the corresponding optimal cut-off values of rSO 2 were 59.36, 59.03 and 59.03. The sensitivity and specificity to predict adverse events in ALLI patients were 85.7% and 85.3% when the 24 h rSO 2 (mean) was 59.36 as the best cut-off value. According to the optimal cut-off , the subjects were divided into high value group (rSO 2>59.36%, 59 cases) and low value group (rSO 2≤59.36%, 23 cases), Kaplan Meier survival curve analysis showed that there was significant difference in event free survival between the two groups ( P<0.001), the high value group significantly better than the low value group. Conclusion:The 24 h rSO 2 (mean) is an independent influencing factor for adverse events in ALLI patients, and has good predictive value for prognosis.

Screening threshold for congenital adrenal hyperplasia in preterm and full-term infants by an indirect method / 中华实用儿科临床杂志

Objective:To analyze the difference and reliability of blood 17-hydroxyprogesterone (17-OHP), an indirect screening index for congenital adrenal hyperplasia (CAH), between preterm and full-term infants.Methods:In this retrospective cross-sectional study, a total of 210 285 newborns who underwent CAH screening at the Neonatal Screening Center of Shanghai Children′s Hospital from January 2019 to December 2022 were collected, including 14 312 premature infants and 195 973 full-term infants.The concentration of 17-OHP in dried blood spots on filter paper was determined by an automatic fluorescence analyzer.The distribution of 17-OHP levels in preterm and full-term infants and its statistical index were analyzed.The Kolmogorov-Smirnov test was used for normal distribution.The skewed distribution data was converted into approximately normal distribution using Box-Cox.Outliers were eliminated by the interquartile range method.The cumulative frequency distribution map was drawn by R language programming.The 99.5 th percentile value was used as the screening threshold and compared with the reference value given by the manufacturer or laboratory and with the reference change value (RCV). Results:According to the threshold provided by the laboratory, 26.76‰ of premature infants were tested positive in preliminary screening, and 4 were confirmed with an incidence of 1∶3 578, while 0.79‰ of full-term infants were tested positive in preliminary screening, and 11 were confirmed with an incidence of 1∶17 816.The thresholds for CAH screening established indirectly were 20.35 nmol/L in preterm infants and 10.78 nmol/L in full-term infants.The relative deviations between the indirect CAH screening thresholds and the manufacturer′s or laboratory′s CAH screening thresholds were higher than the RCV, respectively.According to the indirect CAH screening thresholds, the negative and positive coincidence rates of 65 samples in 13 batches from the Centers for Disease Control and Prevention interlaboratory quality assessment program in the United States reached 100%.A retrospective analysis of 210 285 neonates showed that 17-OHP concentration was higher than the screening threshold in all CAH-positive neonates.The application of this screening threshold reduced the false positive rate of preterm infants by 59.79%.Conclusions:It is feasible to establish the CAH screening thresholds for premature and full-term infants by an indirect method, which can improve the efficiency of screening and provide better diagnostic basis for clinical practice.

Establishment of age-specific reference intervals for AMH in Indian women and enhancing its use as a diagnostic marker in PCOS

Background: Anti Mullerian hormone (AMH) level is a reliable marker of ovarian reserve. It is known to be influenced by factors like age, ethnicity, and ovarian pathology. Establishment of age-specific reference intervals for AMH, characteristic of different nationalities, is therefore of utmost importance. Serum AMH is known to be elevated in women with polycystic ovarian syndrome (PCOS). It is desirable to determine a population-specific cut-off of AMH, for it to be used as a diagnostic marker for PCOS.Methods: Serum AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), Estradiol, Progesterone and Testosterone assays were analyzed in 1978 Indian women, in the age range of 12–50 years. Age-specific reference intervals for AMH were derived for the study population. The cohort of study subjects were then divided into two groups, based on AMH values and clinical history: Control group, and patients with PCOS. The cut-off value of AMH in the study population, corresponding to the diagnosis of PCOS, was also established. Results: Upper 95th percentile limits of reference intervals for the 18-25 26–30, 31–35, and 36–40, 41-45 and >45 age groups were 9.69, 7.60, 6.50, 6.1, 4.80 and 4.5 ng/ml respectively. In the PCOS group the 5th percentile value was 7.80 ng/ml and the upper 95th percentile was 21.81 ng/ml. The median percentile in PCOS group was 10.40 ng/ml. ROC analysis was done to obtain optimal cutoff values for each age group with better discriminative power than the reference limits. The best cut-off point of AMH value for PCOS in our study population was 7.51ng/ml. The sensitivity and specificity were 99.4% and 95.5%, respectively. The calculated area under the Receiver operating characteristic (ROC) curve was 0.988 (95% CI: 0.984-0.991, P <0.001). AMH, LH, and LH/FSH ratio was significantly higher in the PCOS group than in the control group (p < 0.001 for all comparisons). LH/FSH ratio was more than 2 in the PCOS group compared to controls. Serum Testosterone was significantly higher in PCOS.Conclusions: The study aids to establish a biological reference interval for AMH, specific for different age groups in Indian women. 7.51ng/ml has been derived as a diagnostic cut-off of AMH for PCOS in our study population. The establishment of age-specific reference intervals, and syndrome-specific cut-offs in the Indian population will help overcome the influence of variables and broaden the use of AMH in women’s health.

Establishment of age-specific reference intervals for AMH in Indian women and enhancing its use as a diagnostic marker in PCOS

Background: Anti Mullerian hormone (AMH) level is a reliable marker of ovarian reserve. It is known to be influenced by factors like age, ethnicity, and ovarian pathology. Establishment of age-specific reference intervals for AMH, characteristic of different nationalities, is therefore of utmost importance. Serum AMH is known to be elevated in women with polycystic ovarian syndrome (PCOS). It is desirable to determine a population-specific cut-off of AMH, for it to be used as a diagnostic marker for PCOS.Methods: Serum AMH, luteinizing hormone (LH), follicle-stimulating hormone (FSH), Estradiol, Progesterone and Testosterone assays were analyzed in 1978 Indian women, in the age range of 12–50 years. Age-specific reference intervals for AMH were derived for the study population. The cohort of study subjects were then divided into two groups, based on AMH values and clinical history: Control group, and patients with PCOS. The cut-off value of AMH in the study population, corresponding to the diagnosis of PCOS, was also established. Results: Upper 95th percentile limits of reference intervals for the 18-25 26–30, 31–35, and 36–40, 41-45 and >45 age groups were 9.69, 7.60, 6.50, 6.1, 4.80 and 4.5 ng/ml respectively. In the PCOS group the 5th percentile value was 7.80 ng/ml and the upper 95th percentile was 21.81 ng/ml. The median percentile in PCOS group was 10.40 ng/ml. ROC analysis was done to obtain optimal cutoff values for each age group with better discriminative power than the reference limits. The best cut-off point of AMH value for PCOS in our study population was 7.51ng/ml. The sensitivity and specificity were 99.4% and 95.5%, respectively. The calculated area under the Receiver operating characteristic (ROC) curve was 0.988 (95% CI: 0.984-0.991, P <0.001). AMH, LH, and LH/FSH ratio was significantly higher in the PCOS group than in the control group (p < 0.001 for all comparisons). LH/FSH ratio was more than 2 in the PCOS group compared to controls. Serum Testosterone was significantly higher in PCOS.Conclusions: The study aids to establish a biological reference interval for AMH, specific for different age groups in Indian women. 7.51ng/ml has been derived as a diagnostic cut-off of AMH for PCOS in our study population. The establishment of age-specific reference intervals, and syndrome-specific cut-offs in the Indian population will help overcome the influence of variables and broaden the use of AMH in women’s health.

Predictive validity and cut-off point of the Turkish version of the Infant Colic Scale in the diagnosis of colic

Abstract Objective: To investigate the predictive validity and cut-off point of the Turkish version of the Infant Colic Scale (ICS) in the diagnosis of colic. Methods: This methodological study was carried out in a pediatric outpatient clinic of a university hospital in Turkey with infants aged 6-16 weeks (n = 133). The data were collected using the Mother-Infant Description Form, the ICS, and the Rome IV criteria form. The scale is a 6-point Likert-type scale consisting of 19 items in total. A low total mean score obtained from it indicates that the probability of colic increases, while a high mean score indicates that the probability of colic decreases. The Rome IV criteria were used as the gold standard. Results: The mean score obtained from the ICS was 59.4 ± 13.7. According to the Rome IV criteria, 26.3% of the infants had colic. The area under the ROC curve was 87.4% (95% CI = 0.815-0.934, SE = 0.30, p = 0.001), and the cut-off point for the best sensitivity value (88.6%) and the best specificity value (70.5%) of the ICS was determined to be 60.5. According to the cut-off point, the positive predictive value was 51%, and the negative predictive value was 94%. Conclusion: The predictive validity of the Turkish version of the ICS was found to be at a good level with high sensitivity and acceptable specificity for a cut-off point of 60.5. Healthcare professionals working in the child field can use the ICS to exclude colic in infants.

Clinical difference analysis and solution of lipid target and goal cut-off point determination of blood lipid management from different detection systems / 中华检验医学杂志

Objective:The results of the three lipid detection systems were compared to analyze their influence on risk stratification and clinical treatment in lipid management, especially the target goal cut-off point determination, and to find ways to reduce the impact on target goal determination of various lipid measurement system.Methods:A total of 196 serum samples with triglyceride TG <4.5 mmol/L were collected from people undergoing physical examinations and in-patients in the Second Xiangya Hospital of Central South University from August to October 2022. Triglyceride (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were directly detected with Hitachi-Woke (HW), Roche and Mindray detection systems, respectively. The non high-density lipoprotein cholesterol (non HDL-C) was calculated by formula (TC-HDL-C) and LDL-C (F-LDL-C) was calculated by Friedewald formula, and results from various methodology were compared. The coefficient of variation ( CV) of these six indicators derived from the three detection systems were calculated to evaluate the consistency of the obtained results from different venders. In addition, the Pearson correlation coefficient was analyzed to evaluate the correlation of each indicator among different systems. According to the Chinese Guidelines for Blood Lipid Management, samples were divided into groups with LDL-C levels of <1.4, 1.4-<1.8, 1.8-<2.6, 2.6-<3.4 and ≥3.4 mmol/L according to the recommended LDL-C levels for different risk stratification levels. The sample size and percentage of LDL-C test results from different systems in the same group were counted to evaluate the impact of LDL-C differences between systems on clinical decision-making of blood lipid management. The correction factor was calculated through two methods: (1) The average deviation of LDL-C between systems was estimated by EP9-A3 method; (2) Multiple linear stepwise regression was used to establish the regression model of LDL-C difference and related indexes between systems. The two correction factors were used to correct the deviation of LDL-C value obtained from various systems, and Chi-square test was used to compare the difference of LDL-C grouping consistency rate before and after correction. Result:The average CV values of TG, TC, LDL-C, F-LDL-C, HDL-C, and non HDL-C among the three detection systems were 4.84%, 1.92%, 11.96%, 3.81%, 5.82% and 2.61%, respectively. Correlation analysis showed that when comparing the three systems in pairs, except for LDL-C derived from HW and Roche′s, and Mindray and Roche′s LDL-C ( R 2=0.938 and 0.947), the R 2 of other indicators were all greater than 0.97. The consistency rates of the three systems on LDL-C and F-LDL-C were 51.0% (100/196) and 90.8% (178/196), respectively, according to the risk stratification standard values and the difference was statistically significant ( P<0.05). When comparing in pairs, the consistency rates of Roche and HW, Mindray and HW, Mindray and Roche system LDL-C grouping were 60.7% (119/196), 82.7% (162/196), and 54.1% (106/196), respectively. After adjusting for mean deviation, the group consistency rate of Roche and HW increased to 73.7%-79.4% ( P<0.05), and the group consistency rate of Roche and Mindray increased to 72.3%-79.0% ( P<0.05). After adjusting for difference regression model, the group consistency rate of Roche and HW increased to 82.5%-84.0%, and the group consistency rate of Roche and Mindray increased to 81.0%-89.2%. However, there was no significant change in the group consistency rate of Mindray and HW after adjusting for both correction methods ( P>0.05) .Conclusions:There are significant differences in LDL-C derived from different detection systems, and the consistency rate of grouping according to the lipid-lowering standard value is relatively low, which may affect clinical decision-making in lipid management. Adjusted by the correction factor, the consistency rate of grouping between Roche and HW, Roche and Mindray systems with large differences in LDL-C can be improved. Using the difference multiple linear regression model as a correction factor is superior to the average deviation.

Evaluation and optimization of pre-pregnancy and pregnancy thalassaemia screening programmes in Hainan Province / 中国热带医学

@#Abstract: Objective　To evaluate the free thalassaemia screening programme for preconception and pregnancy in Hainan Province, and to provide a theoretical basis for optimizing the screening process for thalassaemia. Methods From November 2020 to July 2021, a survey was conducted on 10 396 adults with Hainan household registration who participated in the Epidemiological Survey of Thalassemia in Hainan Residents in 19 cities and counties of Hainan Province. All of them underwent routine blood tests, haemoglobin electrophoresis tests and genetic tests for thalassaemia. The optimal diagnostic cut-off values for mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and haemoglobin adult type 2 (HbA2) were determined using screening test indexes such as receiver operating characteristic curve and sensitivity. The diagnostic effectiveness of different primary screening programs for thalassemia gene carriers was evaluated. Results Using the existing MCV single-indicator thalassemia primary screening protocol in Hainan Province, where individuals with MCV<82 fL undergo thalassemia gene testing, resulted in a high missed diagnosis rate (34.06%) and low sensitivity (65.94%). The optimal cut-off values for MCV screening for alpha-and beta-thalassaemia were 84.45 fL and 79.05 fL, respectively; the optimal cut-off values for MCH screening for alpha-and beta-thalassaemia were 27.95 pg and 25.15 pg, respectively. The optimal cut-off value for HbA2 screening for alpha-thalassaemia was less than 2.55% and greater than 3.35% for beta-thalassaemia. The "combined HbA2 or MCH or MCV screening protocol" with the cut-off values recommended in this study had a better performance in primary screening for thalassemia, with the highest sensitivity (92.96%) and negative predictive value (92.67%) and the lowest underdiagnosis rate (7.04%), statistically significant differences compared with the existing protocol (P<0.05). Conclusions The current process of screening for thalassemia in Hainan Province may lead to missed diagnoses. The combined use of MCV, MCH and HbA2 for thalassemia screening, adopting locally suitable cutoff values for primary screening indicators, can improve the incidence of missed reporting of thalassemia and enhance diagnostic effectiveness.

Exploration of cut-off values of amino acid levels in premature infants in Sichuan / 中华实用儿科临床杂志

Objective:To detective the cut-off values of amino acid levels in premature infants in Sichuan.Methods:Data of newborns screening for inherited metabolic diseases (IMD) by tandem mass spectrometry in Sichuan Province from January 2018 to December 2019 were retrospectively analyzed.They were divided into premature infant group ( n=2 264, 1 312 males and 952 females) and full-term infant group ( n=53 275, 28 269 males and 25 006 females). The cut-off values of amino acids in dry blood spots were expressed as percentage ( P0.5 - P99.5), and rank sum test was used for comparison between preterm and full-term infants. Results:(1) The distribution of 11 amino acids [alanine (ALA), arginine (ARG), citrulline (CIT), glycine(GLY), leucine (LEU), methionine (MET), ornithine (ORN), phenylalanine (PHE), proline (PRO), tyrosine (TYR) and valine (VAL)] in premature infants were abnormal.(2) The cut-off values of amino acids in premature infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.34-47.04 μmol/L, CIT: 5.66-32.02 μmol/L, GLY: 181.48-909.93 μmol/L, LEU : 71.10-283.29 μmol/L, MET: 4.21-34.51 μmol/L, ORN: 40.58-293.76 μmol/L, PHE: 23.60-106.30 μmol/L, PRO: 77.76-358.24 μmol/L, TYR: 27.52-352.91 μmol/L, VAL: 53.74-228.37 μmol/L.(3) The cut-off values of amino acid in full-term infants were as follows: ALA: 135.20-552.33 μmol/L, ARG: 1.30-42.73 μmol/L, CIT: 5.92-30.35 μmol/L, GLY: 208.17-980.09 μmol/L, LEU: 72.91-287.49 μmol/L, MET: 4.27-33.90 μmol/L, ORN: 48.40-305.59 μmol/L, PHE: 27.63-92.27 μmol/L, PRO: 97.38-372.75 μmol/L, TYR: 40.19-276.54 μmol/L, VAL: 65.75-237.92 μmol/L.(4) Except for PHE ( Z=-0.58, P>0.05), the other indicators were significantly different between 2 groups [ALA ( Z=-15.32, P<0.05), ARG ( Z=-5.62, P<0.05), CIT ( Z=-5.86, P<0.05), GLY ( Z=-14.52, P<0.05), LEU ( Z=-5.62, P<0.05), MET ( Z=-5.22, P<0.05), ORN ( Z=-13.01, P<0.05), PRO ( Z=-22.09, P<0.05), TRY ( Z=-2.09, P<0.05), VAL ( Z=-17.82, P<0.05)]. Conclusions:The establishment of the cut-off values of amino acids in premature infants in Sichuan provides a theoretical basis for laboratory diagnosis of IMD screening, which enhances the accuracy of diagnosis and avoids excessive medical treatment.

Distribution characteristics of choroidal thickness in normal population and the diagnostic cut-off value for pachychoroid / 中华实验眼科杂志

Objective:To characterize the distribution characteristics of choroidal thickness in healthy normal subjects and to define the diagnostic cut-off value for pachychoroid.Methods:A cross-sectional study design was carried out.Four hundred and forty-six eyes of 230 healthy subjects from the pachychoroid disease spectrum (PCD) cohort in Beijing Tongren Hospital from April 2018 to June 2021, were enrolled for the choroidal thickness distribution analysis.Three hundred and fourteen eyes of 274 patients with PCD including 149 eyes of 113 patients with central serous chorioretinopathy, 95 eyes of 81 patients with polypoid choroidal vasculopathy, 70 eyes of 60 patients with neovascular age-related macular degeneration, along with 382 eyes of 199 normal subjects matched for refractive error, age and gender with PCD were selected for likelihood ratio analysis.Routine eye examinations including the best corrected visual acuity, intraocular pressure, slit-lamp microscopy, dilated fundus examination and color fundus photography were performed in all subjects.Swept-source optical coherence tomography (SS-OCT) of 9 mm×9 mm scanning mode was used to measure the subfoveal choroidal thickness (SFCT) automatically in nine macular regions according to the Early Treatment Diabetic Retinopathy Study classification system using TOPCON Advanced Boundary Segmentation (TABS) software.Pearson linear correlation analysis and Spearman rank correlation analysis were adopted to evaluate the correlations between SFCT and age, diopter.Multiple linear regression was employed to analyze the factors affecting SFCT.After age and refractive error adjustment, the likelihood ratio test was used to determine the diagnostic cut-off value for pachychoroid.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Beijing Tongren Hospital (No.TRECKY2016-054). Written informed consent was obtained from each subject prior to entering the cohort.Results:A negative correlation was found between SFCT and age in normal eyes ( r=-0.34, P<0.001), in both normal male and female subjects ( r=-0.43, P<0.001; r=-0.38; P<0.001). A weak positive correlation was found between SFCT and diopter ( rs=0.19, P<0.001). It was found that age and diopter were strongly correlated with SFCT (both at P<0.001). The cut-off values for pachychoroid in 20-39 years group, 40-59 years group, 60-79 years group and ≥80 years group were 320-330 μm, 330-340 μm, 250-275 μm and 200-225 μm, respectively.The percentages of eyes with pachychoroid in 20-39 years group, 40-59 years group and ≥60 years group were 14.71%(10/68), 24.48%(47/192) and 28.89%(55/184), respectively, showing statistically significant differences among them ( χ2=6.170, P=0.046; LR=6.579, P=0.037). The proportion of pachychoroid in ≥60 years group was significantly higher than that of 20-39 years group, showing a statistically significant difference ( χ2=5.982, P=0.014; LR=6.479, P=0.011). Conclusions:The distribution characteristics of pachychoroid vary in normal subjects over age.Age and diopter are the independent influencing factors of SFCT.

Analysis of Cut Off Value or Reference Interval of / 中国医疗器械杂志

The cut off value or reference interval is significant in clinical testing and diagnosis. If there is no scientific and reasonable cut off value or reference interval for

Valor de corte de los índices de ajuste en el análisis factorial confirmatorio

Resumen En las investigaciones psicológicas resulta de amplia relevancia conocer si los cuestionarios utilizados miden los constructos latentes de interés. A tal efecto, el Análisis Factorial Confirmatorio se emplea frecuentemente en la literatura especializada para aportar evidencias de validez a las escalas empleadas. Sin embargo, en la actualidad existe cierta disparidad de criterios respecto de los puntos de corte que deben tenerse en consideración. Por este motivo, el presente trabajo se propone revisar la literatura en torno a los diferentes puntos de corte tradicionales de los índices de ajuste más utilizados. Se concluye que para seleccionar los indices e interpretar los resultados se debe tener en cuenta que estos puntos de corte pueden cambiar por diferentes motivos, tales como el tamaño de la muestra.

Abstract In psychological research, it is of great relevance to know whether the questionnaires used measure the latent constructs of interest. For this purpose, Confirmatory Factor Analysis is frequently used in the specialized literature to provide evidence of validity to the scales used. However, there is currently a certain disparity in the criteria regarding the cut-off points to be taken into consideration. For this reason, this paper aims to review the literature on the different cut-off points for the most commonly used fit indexes. It is concluded that to select the indexes and interpret the results, it should be should take into account that these cut-off points may change for different reasons, such as sample size.

Utility of triple tumor markers CA19-9, CA125 and CEA in predicting advanced stage of carcinoma gallbladder: a retrospective study

Background: A combination of serum tumor markers are used in the evaluation and prognosis of carcinoma gallbladder (GBC). Aim of the study was to find the significance of combined use of CA19-9, CA125 and CEA in advanced stage of GBC and to find the cut-off value of each of these tumor markers in metastatic GBC.   Methods: This was a retrospective observational cohort study over 1 year, which was carried out in 42 cases of advanced GBC. The patients were grouped in to locally advanced and metastatic stage on the basis of CECT scan findings. CA19-9, CA125 and CEA were assayed in all patients. These tumor markers were analysed with these two groups of GBCs. Statistical analysis was performed using R statistical software v3.6.2.Results: Out of 42 cases CA19-9 was elevated in 18 (78%), CA125 in 16 (70%) and CEA in 9 (39%) patients with metastatic disease. The cut-off value of CA19-9, CA125 and CEA was determined by ROC curve were >109 U/ml, 55.4 U/ml and 2.56 μg/l respectively. CA19-9 had the highest sensitivity 78.3% followed by CA125 69.6% and CEA has the highest specificity 68.4% for the diagnosis of metastatic stage of the disease. Specificity of these tumor markers were highest when used in combination.Conclusions: Combined use of triple tumor markers increases its specificity in the diagnosis of advanced stage of GBC but their cut-off level is statistically not significant in predicting metastatic GBC.

Effects of different thyroid stimulating hormone cut-off values on the screening of congenital hypothyroidism in newborns in Guangxi / 中华地方病学杂志

Objective To analyze the effects of different thyroid stimulating hormone (TSH) cut-off values on the screening of congenital hypothyroidism (CH) in newborns in Guangxi.Methods The TSH results of 83 608 newborns tested by Genetic Screening Processor (GSP) from the Genetic Metabolism Center of the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region from May 2017 to April 2018 were collected.Using the percentile method and the receiver operating characteristic (ROC) curve method,the TSH cut-off values were calculated and compared with the assumed cut-off values 9.00 or 10.00 mU/L,to analyze the effects of four different TSH cut-off values on CH screening.Results Using GSP,the TSH results of 83 608 newborns showed a positive skewed distribution,TSH cut-off value of the percentile method (P99) was 7.96 mU/L,836 cases were suspicious,43 cases were diagnosed with CH (6 cases were missed diagnosis),and 65 cases were high TSH (21 cases were missed diagnosis);TSH cut-off value of the ROC curve method was 6.45 mU/L,1 480 case were suspicious,49 cases were diagnosed with CH,and 86 cases were high TSH,both were no missed diagnosis;when TSH cut-off values were 9.00 or 10.00 mU/L,the suspicious were 478 and 305 cases,respectively,and the confirmed CH were 37 and 35 cases (missed diagnosis were 12 and 14 cases,respectively),high TSH were 46 and 33 cases (missed diagnosis were 40 and 53 cases,respectively).The CH incidence of the ROC curve method was compared with the percentile method and using the cut-off values 9.00 and 10.00 mU/L,the differences were statistically significant (P ＜ 0.05).Conclusions The GSP and ROC curve method were used to successfully establish the TSH cut-off value on the screening of CH in newborns in Guangxi.The cut-off value can not only ensure the accuracy of screening,but also avoid missed diagnosis and reduce birth defects.

A survey for screening situation of glucose-6-phosphate deficiency in Zhejiang province / 临床检验杂志

Objective@#To explore the epidemiological distribution characteristics of glucose-6-phosphate dehydrogenase (G6PD) activity, incidence of G6PD deficiency in neonates and the cut-off values. @*Methods@#About 1.44 million newborns in 10 districts of Zhejiang province from March 2015 to September 2017 were included in this study. Fluorescence analysis was used to determine the G6PD activity in dried blood spots. Those with initial screening positive results were recalled and confirmed by direct ratio of G6PD to 6PGD (6-phosphogluconate dehydrogenase) to confirm the diagnosis. The results were analyzed by using nonparametric and chi-square tests. @*Results@#Significant differences of G6PD levels were found among the groups of different genders, gestational age, birth weight, blood sampling age, blood sampling season and districts (P＜0.01). The male incidence of G6PD deficiency was significantly higher than female incidence. In different regions of Zhejiang province, the highest prevalence was in Lishui (0.38%) and the lowest was in Zhoushan (0.11%), The trend of high prevalence in the south and low prevalence in the north was basically showed. When the cut-off value of G6PD activity ranged from 2.60 to 2.80 U/g Hb, the sensitivity of G6PD deficiency screening for male and female newborns was 100% and the Youden index was the highest (about 0.99). @*Conclusion@#The level of G6PD activity may be relevant to the factors of population group and period. The incidence of G6PD deficiency may be affected by different genders and different regions. The cut-off values for screening may initially set at 2.60 U/g Hb and 2.80 U/g Hb for male and female respectively.

Is It Necessary to Repeat Fecal Occult Blood Tests with Borderline Results for Colorectal Cancer Screening?

The fecal immunochemical test (FIT) is the initial non-invasive investigation of choice for population-based colorectal cancer (CRC) screening. We evaluated the positivity rate in repeated tests using the same fecal specimen that showed borderline results in the FIT. A total of 6,465 patients were tested with the FIT in a tertiary-care hospital from July to December 2016. FIT was done using OC-Sensor PLEDIA (Eiken Chemical Co., Tokyo, Japan). Among 6,465 patients, 364 (5.6%) patients showed a positive FIT result of over 20 µg Hb/g feces. A total of 112 (1.7%) patients showed borderline scores of 10.2–20 µg Hb/g feces, and 5,989 (92.6%) patients showed negative results of less than 10 µg Hb/g feces. Among the 101 repeat-tested patients, 19 (18.8%) of the patients' scores converted to levels above the positive cut-off threshold. Repeated results of 19 patients showed score elevations from 20.2 to 68 µg Hb/g feces. These results suggest that it is most important to analyze properly prepared samples, even if only once. Therefore, the laboratory staff should ensure the proper preparation of stool specimens for FIT. Laboratory directors should choose the best cut-off value for detecting CRC at their respective institutions.

Establishing the cut off values of androgen markers in the assessment of polycystic ovarian syndrome

Introduction: Hyperandrogenism remains as one of the key features in Polycystic Ovarian Syndrome (PCOS) and can be assessed clinically or determined by biochemical assays. Hirsutism is the most common clinical manifestation of hyperandrogenism. The clinical assessment is subjected to wide variability due to poor interobserver agreement and multiple population factors such as ethnic variation, cosmetic procedures and genetic trait. The difficulty in resolving the androgen excess biochemically is due to a lack of consensus as to which serum androgen should be measured for the diagnosis of PCOS. The aim of the study was to compare and establish the diagnostic cut off value for different androgen biomarker for the diagnosis of PCOS. Materials and Methods: A total of 312 patients classified to PCOS (n = 164) and non PCOS (n = 148) cohorts were selected from the Laboratory Information System (LIS) based on serum total testosterone (TT) and sex hormone binding globulin (SHBG) from the period of 1st April 2015 to 31st March 2016. PCOS was diagnosed based on Rotterdam criteria. Clinical hyperandrogenism and ultrasound polycystic ovarian morphology were obtained from the clinical records. The other relevant biochemical results such as serum luteinizing hormone (LH), follicle stimulating hormone (FSH) and albumin were also obtained from LIS. Free androgen index (FAI), calculated free testosterone (cFT) and calculated bioavailable testosterone (cBT) were calculated for these patients. Receiver Operating Characteristic (ROC) curve analysis were performed for serum TT, SHBG, FAI, cFT, cBT and LH: FSH ratio to determine the best marker to diagnose PCOS. Results: All the androgen parameters (except SHBG) were significantly higher in PCOS patients than in control (p<0.0001). The highest area under curve (AUC) curve was found for cBT followed by cFT and FAI. TT and LH: FSH ratio recorded a lower AUC and the lowest AUC was seen for SHBG. cBT at a cut off value of 0.86 nmol/L had the highest specificity, 83% and positive likelihood ratio (LR) at 3.79. This is followed by FAI at a cut off value of 7.1% with specificity at 82% and cFT at a cut off value of 0.8 pmol/L with specificity at 80%. All three calculated androgen indices (FAI, cFT and cBT) showed good correlation with each other. Furthermore, cFT, FAI and calculated BT were shown to be more specific with higher positive likelihood ratio than measured androgen markers. Conclusions: Based on our study, the calculated testosterone indices such as FAI, cBT and cFT are useful markers to distinguish PCOS from non-PCOS. Owing to ease of calculation, FAI can be incorporated in LIS and can be reported with TT and SHBG. This will be helpful for clinician to diagnose hyperandrogenism in PCOS.

The Determination of Cut-off Value of TSH during Screening of Congenital Hypothyroidism in 6 Prefecture/City of Yunnan Province / 昆明医科大学学报

Objective To explore the positive cut-off value in neonatal screening for congenital hypothyroidism(CH)in the center of Neonatal Screening , so as to improve screening efficiency and reduce false positive rate. Methods Heel blood samples were taken from the newborns born after72 hours,dropped in special S&S903 filter paper and delivered to the neonatal screening center within the prescribed period of time.DELFIA was applied to detect the concentration of thyroid-stimulating hormone(TSH).Result Totally 529918 blood sample were screened from the 2012 to the 2016.Among them 529645 newborns were normal, 203 neonates were diagnosed with CH, 70 with high TSH hyperlipidemia, the total detection rate was 1:1941, and the incidence of CH was 1:2610. According to the results, the cut-off value of the screening of CH in the center of Neonatal Screening was 9.0 mIU/L, the sensitivity was 100％and specifility was 98.38％, misdiagnosis rate was 0％. Conclusion The cut-off value of CH was 9.0 mIU/L in the center of Neonatal Screening ,which is suitable for the people in 6 Prefecture/City of Yunnan Province , and also provides the basis for neonatal scree of CH in the future.

Validation and proposal for cut-off values of an abbreviated version of the Alcohol Use Disorder Identification Test using the Korean National Health and Nutrition Examination Survey

OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and are widely used in clinical settings. In this study, we provide evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, we applied the cut-off value of at-risk drinking proposed by the World Health Organization and divided the study sample into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions increased from one to four. The differences in AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four items, the AUROC increased to a statistically significant level. Cut-off values for abbreviated versions of AUDIT are similar in South Korea to other countries.

Validation and proposal for cut-off values of an abbreviated version of the Alcohol Use Disorder Identification Test using the Korean National Health and Nutrition Examination Survey

OBJECTIVE: Several abbreviated versions of the Alcohol Use Disorder Identification Test (AUDIT) have been developed and used widely in clinical settings. This paper provides evidence supporting the use of abbreviated versions of AUDIT by comparing the utility of various abbreviated versions and determining the cut-off values for the population of South Korea. METHODS: Data were obtained from the 4th to 6th Korean National Health and Nutrition Examination Surveys. After calculating the whole AUDIT score, the cut-off value of at-risk drinking proposed by the World Health Organization was applied and the study sample was divided into normal and at-risk drinking groups. Receiver operating characteristic curves were drawn for the AUDIT-3rd question (Q3) alone, AUDIT-quantity and frequency (QF), AUDIT-consumption (C), AUDIT-4, and AUDIT-primary clinic (PC), and the optimal cut-off values were obtained for each group. RESULTS: A total of 46,450 subjects were analyzed. The at-risk drinking group comprised 29.2% of all subjects. The area under the receiver operating characteristic curve (AUROC) of the abbreviated versions of AUDIT increased from 0.954 to 0.991 as the number of questions was increased from one to four. The differences in the AUROC between the abbreviated versions of AUDIT were statistically significant. The most appropriate cut-off values for AUDIT-Q3 alone, AUDIT-QF, AUDIT-C, AUDIT-4, and AUDIT-PC for adults over age 19 were 2, 4, 5, 6, and 4 points, respectively. CONCLUSION: As the number of items analyzed increased from one to four, the AUROC increased to a statistically significant level. The cut-off values for the abbreviated versions of AUDIT were similar in South Korea to other countries.

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

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 < 0.001). The mean HGS was increased from the age of 19 to 39 years. It was peaked in the age of 35 to 39 years range for both men and women. It was then decreased after 39 years. The 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.