A Pathogenic Variant Reclassified to the Pseudogene PMS2P1 in a Patient with Suspected Hereditary Cancer.

The PMS2 gene is involved in DNA repair by the mismatch repair pathway. Deficiencies in this mechanism have been associated with Lynch Syndrome (LS), which is characterized by a high risk for colorectal, endometrial, ovarian, breast, and other cancers. Germinal pathogenic variants of PMS2 are associated with up to 5% of all cases of LS. The prevalence is overestimated for the existence of multiple homologous pseudogenes. We report the case of a 44-year-old woman diagnosed with breast cancer at 34 years without a relevant cancer family history. The presence of pathogenic variant NM_000535.7:c.1A > T, (p.Met1Leu) in PMS2 was determined by next-generation sequencing analysis with a panel of 322 cancer-associated genes and confirmed by capillary sequencing in the patient. The variant was determined in six family members (brothers, sisters, and a son) and seven non-cancerous unrelated individuals. Analysis of the amplified region showed high homology of PMS2 with five of its pseudogenes. We determined that the variant is associated with the PMS2P1 pseudogene following sequence alignment analysis. We propose considering the variant c.1A > T, (p.Met1Leu) in PMS2 for reclassification as not hereditary cancer-related, given the impact on the diagnosis and treatment of cancer patients and families carrying this variant.

AFP score and metroticket 2.0 perform similarly and could be used in a "within-ALL" clinical decision tool.

Background & Aims: Two recently developed composite models, the alpha-fetoprotein (AFP) score and Metroticket 2.0, could be used to select patients with hepatocellular carcinoma (HCC) who are candidates for liver transplantation (LT). The aim of this study was to compare the predictive performance of both models and to evaluate the net risk reclassification of post-LT recurrence between them using each model's original thresholds. Methods: This multicenter cohort study included 2,444 adult patients who underwent LT for HCC in 47 centers from Europe and Latin America. A competing risk regression analysis estimating sub-distribution hazard ratios (SHRs) and 95% CIs for recurrence was used (Fine and Gray method). Harrell's adapted c-statistics were estimated. The net reclassification index for recurrence was compared based on each model's original thresholds. Results: During a median follow-up of 3.8 years, there were 310 recurrences and 496 competing events (20.3%). Both models predicted recurrence, HCC survival and survival better than Milan criteria (p <0.0001). At last tumor reassessment before LT, c-statistics did not significantly differ between the two composite models, either as original or threshold versions, for recurrence (0.72 vs. 0.68; p = 0.06), HCC survival, and overall survival after LT. We observed predictive gaps and overlaps between the model's thresholds, and no significant gain on reclassification. Patients meeting both models ("within-ALL") at last tumor reassessment presented the lowest 5-year cumulative incidence of HCC recurrence (7.7%; 95% CI 5.1-11.5) and higher 5-year post-LT survival (70.0%; 95% CI 64.9-74.6). Conclusions: In this multicenter cohort, Metroticket 2.0 and the AFP score demonstrated a similar ability to predict HCC recurrence post-LT. The combination of these composite models might be a promising clinical approach. Impact and implications: Composite models were recently proposed for the selection of liver transplant (LT) candidates among individuals with hepatocellular carcinoma (HCC). We found that both the AFP score and Metroticket 2.0 predicted post-LT HCC recurrence and survival better than Milan criteria; the Metroticket 2.0 did not result in better reclassification for transplant selection compared to the AFP score, with predictive gaps and overlaps between the two models; patients who met low-risk thresholds for both models had the lowest 5-year recurrence rate. We propose prospectively testing the combination of both models, to further optimize the LT selection process for candidates with HCC.

Estado de la salud materna un análisis global a puertas de la endemia de la covid-19 / State of maternal health a global analysis on the point of the covid-19 endemia

Dentro de los cambios endémicos por la infección del SARSCoV-2, con efectos en el perfil epidemiológico de la mortalidad materna a nivel global, este articulo refleja los contraste en la accesibilidad a los servicios de salud, más evidente en países de ingresos bajos a medianos, con debilidades en los sistemas de vigilancia epidemiológica que se ven influenciados por la superposición de datos relevantes en la atención prenatal , el parto y atención al recién nacido, el puerperio, y el acceso a la planificación familiar. Siendo necesario identificar las tendencias de mortalidad y morbilidad materna, para reducir el impacto sobre todo en grupos prioritarios.

Within the endemic changes due to SARS-CoV-2 infection, with effects on the epidemiological profile of maternal mortality globally, this article reflects the contrasts in accessibility to health services, more evident in low-income countries. to medium, with weaknesses in the epidemiological surveillance systems that are influenced by the overlapping of relevant data in prenatal care, delivery and newborn care, the postpartum period, and access to family planning. It is necessary to identify trends of maternal mortality and morbidity, to reduce the impact, especially in priority groups

Reclassification of the Main Causal Agent of Glomerella Leaf Spot on Apple into Colletotrichum chrysophilum in Southern Brazil and Uruguay.

Glomerella leaf spot (GLS) is one of the most important diseases of apple, affecting a wide range of economically important cultivars, particularly Golden Delicious and its descendants. Caused mainly by species of the Colletotrichum gloeosporioides species complex (CGSC), C. fructicola has been described as the most prevalent and aggressive species associated with GLS and apple bitter rot (ABR) in Brazil and Uruguay. Recently, new CGSC species, closely related to C. fructicola, have been identified causing ABR. To verify the accuracy of species identification within the CGSC, we aimed to reevaluate the identity of representative GLS-causing isolates from Brazilian and Uruguayan populations, previously identified as C. fructicola. Multilocus phylogenetic analysis based on APN2, ApMAT, CAL, GAPDH, GS, ITS, and TUB2 allocated these isolates in a monophyletic clade with C. chrysophilum. This species was first described as the causal agent of anthracnose in banana fruits in Brazil, and recent reports indicate its association with ABR in the United States. This is the first report of C. chrysophilum causing GLS disease on apple worldwide.

Revisão de classificação de bactérias utilizando dados genômicos

Bioinformatics is an important tool in several areas of science, and it can be used for the reclassification of organisms from the Archaea and Bacteria kingdoms. Using tools to calculate the average nucleotide identity, gene annotation and pan-genome analysis, it can be identified possible inconsistencies in the classification of bacteria. It was made a massive analysis of genomic data from two bacterial genera of medical interest Brucella and Micrococcus responsible for causing chronic diseases and nosocomial infections, respectively. The methodology used was nucleotide similarity analysis, genomic annotation, pan-genome analysis and annotation of genes of interest. In this study we propose reclassifications for both genera studied and we point out proposals for new poorly classified species and others not yet identified.

A bioinformática é uma importante ferramenta em diversas áreas da ciência, podendo ser usada para a reclassificação de organismos dos reinos Archaea e Bacteria. A partir do uso de ferramentas de cálculo da identidade média de nucleotídeos, anotação de genes, análise pan-genoma podem ser identificadas possíveis inconsistências na classificação de bactérias. Nesse trabalho, foi realizada uma análise massiva de dados genômicos de dois gêneros bacterianos de interesse médico, Burcella e Micrococcus, responsáveis por causar doenças crônicas e infecções hospitalares, respectivamente. A metodologia utilizada foi a de análise de similaridade nucleotídica, anotação genômica, análise de pan-genoma e anotação de genes de interesse. Neste estudo propomos reclassificações para ambos os gêneros estudados e apontamos propostas de novas espécies classificadas erroneamente e de outras ainda não identificadas.

Early systolic lengthening by speckle tracking echocardiography predicts outcome after coronary artery bypass surgery.

BACKGROUND: Early systolic lengthening (ESL), a paradoxical stretch of myocardial fibers, has been linked to loss of myocardial viability and contractile dysfunction. We assessed the long-term prognostic potential of ESL in coronary artery bypass graft (CABG) patients. METHODS: We retrospectively included patients (n = 709; mean age 68 years; 85% men) who underwent speckle tracking echocardiography (median 15 days) prior to CABG. Endpoints were cardiovascular death (CVD) and all-cause mortality. We assessed amplitude of ESL (%), defined as peak positive strain, and duration of ESL (ms), determined as time from Q-wave on the ECG to peak positive strain. We applied Cox models adjusted for clinical risk assessed as EuroSCORE II. RESULTS: During median follow-up of 3.8 years [IQR 2.7-4.9 years], 45 (6%) experienced CVD and 80 (11%) died. In survival analyses adjusted for EuroSCORE II, each 1% increase in amplitude of ESL was associated with CVD (HR 1.35 [95%CI 1.09-1.68], P = 0.006) and all-cause mortality (HR 1.29 [95%CI 1.08-1.54], P = 0.004). Similar findings applied to duration of ESL (per 10ms increase) and CVD (HR 1.12 [95%CI 1.02-1.23], P = 0.016) and all-cause mortality (HR 1.09 [95%CI 1.01--1.17], P = 0.031). The prognostic value of ESL amplitude was modified by sex (P interaction < 0.05), such that the prognostic value was greater in women for both endpoints. When adding ESL duration to EuroSCORE II, the net reclassification index improved significantly for both CVD and all-cause mortality. CONCLUSIONS: Assessment of ESL provides independent and incremental prognostic information in addition to the EuroSCORE II for CVD and all-cause mortality in CABG patients.

Genome-based reclassification of Paenibacillus panacisoli DSM 21345T as Paenibacillus massiliensis subsp. panacisoli subsp. nov. and description of Paenibacillus massiliensis subsp. massiliensis subsp. nov.

Bacteria of the genus Paenibacillus are relevant to humans, animals and plants. The species Paenibacillus massiliensis and Paenibacillus panacisoli are Gram-stain-positive and endospore-forming bacilli isolated from a blood culture of a leukemia patient and from soil of a ginseng field, respectively. Comparative analyses of their 16S rRNA genes revealed that the two Paenibacillus species could be synonyms (99.3% sequence identity). In the present study we performed different genomic analyses in order to evaluate the phylogenetic relationship of these micro-organisms. Paenibacillus massiliensis DSM 16942T and P. panacisoli DSM 21345T presented a difference in their G+C content lower than 1 mol%, overall genome relatedness index values higher than the species circumscription thresholds (average nucleotide identity, 95.57 %; genome-wide ANI, =96.51 %; and orthologous ANI, 96.25 %), and a monophyletic grouping pattern in the phylogenies of the 16S rRNA gene and the proteome core. Considering that these strains present differential biochemical capabilities and that their computed digital DNA-DNA hybridization value is lower than the cut-off for bacterial subspecies circumscription, we suggest that each of them form different subspecies of P. massiliensis, Paenibacillus massiliensis subsp. panacisoli subsp. nov. (type strain DSM 21345T) and Paenibacillus massiliensis subsp. massiliensis subsp. nov. (type strain DSM 16942T).

Computed tomography calcium scoring association and reclassification of clinical cardiovascular risk in asymptomatic Mexican patients.

OBJECTIVES: To establish tailored preventive treatment, we studied the ability of coronary artery calcium scoring to reclassify patients with intermediate cardiovascular risk and its association with additional risk factors in our Mexican preventive care center. MATERIALS AND METHODS: In this retrospective cohort study, we analyzed 520 asymptomatic patients from a Mexican primary prevention population between 2014 and 2018. Coronary artery calcium scoring, laboratory results, and anthropometric measurements (abdominal circumference and body mass index) were assessed. The Framingham risk score and American Heart Association/American College of Cardiology (AHA/ACC) atherosclerotic cardiovascular disease risk algorithm were calculated. Correlations between coronary artery calcium scoring, anthropometric measurements, and clinical cardiovascular risk scores were assessed. We assessed the ability of coronary artery calcium scoring to reclassify patients recommended for statin therapy compared with the cardiovascular risk scores. RESULTS: Patients had a mean age of 67.5 years (SD ± 9.8) and 294 subjects (56.5%) were male. Coronary artery calcium scoring has a positive correlation with age, AHA/ACC atherosclerotic cardiovascular disease risk algorithm, and Framingham risk score (p < 0.001 for all). Coronary artery calcium scoring was prevalent, occurring in 63.2% of patients with a median Agatston score of 22 with and interquartile range of 178. Male gender, older age, smoking habit, diabetes, and abdominal circumference were independent predictors of coronary artery calcium scoring (p < 0.001). Coronary artery calcium scoring downwardly reclassified 44.9% of patients in intermediate cardiovascular risk categories by the AHA/ACC atherosclerotic cardiovascular disease risk algorithm and 43.9% by the Framingham risk score. Coronary artery calcium scoring upwardly reclassified 46.8% of patients in intermediate risk categories by the AHA/ACC atherosclerotic cardiovascular disease risk algorithm and 56% by the Framingham risk score. CONCLUSION: Coronary artery calcium scoring is prevalent in this Mexican primary prevention cohort and has the ability to reclassify a significant percentage of intermediate cardiovascular risk patients.

Genomic metrics analyses indicate that Paenibacillus azotofixans is not a later synonym of Paenibacillus durus.

Paenibacillus durusand Paenibacillus azotofixans, both Gram-stain-positive and endospore-forming bacilli, have been considered to be a single species. However, a preliminary computation of their average nucleotide identity (ANI) values suggested that these species are not synonyms. Given this, the taxonomic attributions of these species were evaluated through genomic and phylogenomic approaches. Although the identity of 16S rRNA gene sequences of P. durus DSM 1735T and P. azotofixans ATCC 35681T are above the circumscription species threshold, genomic metrics analyses indicate otherwise. ANI, gANI and OrthoANI values computed from their genome sequences were around 92 %, below the species limits. Digital DNA-DNA hybridization and MUMi estimations also corroborated these observations. In fact, in all metrics, Paenibacillus zanthoxyli JH29T seemed to be more similar to Paenibacillus azotofixans. ATCC 35681T than P. durus DSM 1735T. Phylogenetic analyses based on concatenated core-proteome and concatenated gyrB, recA, recN and rpoB genes confirmed that P. zanthoxyli is the closest Paenibacillus species to P. azotofixans. A review of the phenotypic profiles from these three species revealed that their biochemical repertoires are very similar, although P. azotofixans ATCC 35681T can be differentiated from P. durus DSM1735T in 13 among more than 90 phenotypic traits. Considering phylogenetic and genomic analyses, Paenibacillus azotofixans should be considered as an independent species, and not as a later synonym of Paenibacillus durus.

Identification of Diabetic Patients through Clinical and Para-Clinical Features in Mexico: An Approach Using Deep Neural Networks.

Diabetes is a chronic and noncommunicable but preventable disease that is affecting the Mexican population at worrying levels, being the first place in prevalence worldwide. Early diabetes detection has become important to prevent other health conditions that involve low organ yield until the patient death. Based on this problem, this work proposes the architecture of an Artificial Neural Network (ANN) for the automated classification of healthy patients from diabetics patients. The analysis was performed used a set of 19 para-clinical features to determine the health status of the patients. The developed model was evaluated through a statistical analysis based on the calculation of the loss function, accuracy, area under the curve (AUC) and receiving operating characteristics (ROC) curve. The results obtained present statistically significant values, with accuracy of 0.94 and AUC values of 0.98. Based on these results, it is possible to conclude that the ANN implemented in this work can classify patients with presence of diabetes from controls with significant accuracy, presenting preliminary results for the development of a diagnostic tool that can be supportive for health specialists.

Genome-based reclassification of Paenibacillus dauci as a later heterotypic synonym of Paenibacillus shenyangensis.

Paenibacillus shenyangensis and Paenibacillus dauci are Gram-stain-positive, rod-shaped and endospore-forming bacteria originally isolated from soil and carrot samples, respectively, in China. Preliminary comparative genomic analysis showed that these bacteria could constitute a single species. Therefore, in this study, their taxonomic statuses were clarified through distinct genomic metrics and phylogenetic analyses. Paenibacillus shenyangensis A9T and P. dauci H9T presented values of average nucleotide identity (ANI) and its derivative metrics (gANI and OrthoANI) ranging from 97.88 to 98.08 %, and digital DNA-DNA hybridization equal to 89.08 %. Furthermore, the identities of 16S rRNA, gyrB, rpoB, recA and recN genes were all equal or higher than 98.7 %. Phylogenies of these marker genes and the concatenated core proteome were congruent in the sense that P. shenyangensis A9T and P. dauci H9T are the closest type-strains of the genus Paenibacillus. A review of their profiles revealed that these strains do not present pronounced differences at the phenotypic and chemotaxonomic levels. Considering phylogenetic, genomic, phenotypic and chemotaxonomic data, P. dauci should be reclassified as a later heterotypic synonym of P. shenyangensis.

A Case⁻Control Study of Socio-Economic and Nutritional Characteristics as Determinants of Dental Caries in Different Age Groups, Considered as Public Health Problem: Data from NHANES 2013⁻2014.

One of the principal conditions that affects oral health worldwide is dental caries, occurring in about 90% of the global population. This pathology has been considered a challenge because of its high prevalence, besides being a chronic but preventable disease which can be caused by a series of different demographic, dietary" among others. Based on this problem, in this research a demographic and dietary features analysis is performed for the classification of subjects according to their oral health status based on caries, according to the age group where the population belongs, using as feature selector a technique based on fast backward selection (FBS) approach for the development of three predictive models, one for each age range (group 1: 10⁻19; group 2: 20⁻59; group 3: 60 or more years old). As validation, a net reclassification improvement (NRI), AUC, ROC, and OR values are used to evaluate their classification accuracy. We analyzed 189 demographic and dietary features from National Health and Nutrition Examination Survey (NHANES) 2013⁻2014. Each model obtained statistically significant results for most features and narrow OR confidence intervals. Age group 2 obtained a mean NRI = -0.080 and AUC = 0.933; age group 3 obtained a mean NRI = -0.024 and AUC = 0.787; and age group 4 obtained a mean NRI = -0.129 and AUC = 0.735. Based on these results, it is concluded that these specific demographic and dietary features are significant determinants for estimating the oral health status in patients based on their likelihood of developing caries, and the age group could imply different risk factors for subjects.

Carcinoma diferenciado de tiroides: reclasificación del riesgo de recurrencia según la respuesta al tratamiento inicial / Differentiated Thyroid Cancer: Reclassification of the Risk of Recurrence Based on the Response to Initial Treatment

Introducción: la clasificación de la American Thyroid Association (ATA) para carcinoma diferenciado de tiroides (CDT) aporta una visión estática del paciente al inicio y no está diseñada para ser modificada. El Memorial Sloan-Kettering Cancer Center (MS-KCC) diseñó una reclasificación a 2 años del tratamiento inicial (TI), permitiendo tener una óptica más dinámica. Objetivo: comunicar nuestra experiencia con la reclasificación del riesgo de recurrencia de los pacientes con CDT según el sistema del MS-KCC. Material y métodos: estudio observacional retrospectivo descriptivo de los resultados de la reclasificación del riesgo de recurrencia de los pacientes con CDT a 2 años del TI. Los clasificamos al inicio según la ATA y los reclasificamos a 2 años del TI según el MS-KCC. Resultados: clasificamos 31 pacientes según ATA: riesgo bajo 17 (54,8 %), riesgo intermedio 13 (42 %) y riesgo alto 1 (3,2 %) y reclasificación según MS-KCC: respuesta excelente 25 (80,6 %), respuesta aceptable 6 (19,4 %) y respuesta incompleta 0 (0 %). De los riesgo bajo, 14 (82,4 %) tuvieron una respuesta excelente y 3 (17,6 %) respuesta aceptable; los de riesgo intermedio, 11 (84,6 %) respuesta excelente y 2 (15,4 %) respuesta aceptable y los de riesgo alto, 1 (100 %) respuesta aceptable. Estado clínico a 2 años del TI: libre de enfermedad (LE) 25 (80,6 %) y persistencia bioquímica (PB) 6 (19,4 %). Al final del seguimiento a largo plazo, los pacientes con respuesta excelente, 24 (96 %) permanecieron LE y 1 (4 %) sin datos por falta de seguimiento. Conclusiones: 1) la reclasificación fue de gran utilidad principalmente en el grupo de riesgo intermedio, 2 la reclasificación nos permitirá optimizar el seguimiento de los pacientes y 3) hubo buena correlación entre el estado clínico a 2 años del TI y al final del seguimiento a largo plazo. Rev Argent Endocrinol Metab 51:8-14, 2014 Los autores declaran no poseer conflictos de interés.

Introduction: differentiated thyroid cancer (DTC) is the most frequent endocrine tumor generally showing a favourable outcome. The American Thyroid Association (ATA) classification system is not only useful to assess the risk of recurrence but also guides tumor follow-up. However, this system shows a static image of the patient at the beginning of treatment based on clinical and pathological features, and it has not been designed to be modified along the clinical course of disease. Therefore, the Memorial Sloan-Kettering Cancer Center (MS-KCC) has designed a reclassification system after 2 years of the initial treatment (IT) thus providing a dynamic perspective of each patient. Objective: to report our experience with the MS-KCC risk of recurrence reclassification system on DTC patients. Materials and methods: retrospective observational descriptive study of the results of the reclassification system of the DCT patients after two years of IT with surgery and radioiodine ablation, between October 2004 and April 2011. Data was obtained by reviewing the charts of patients. All surgeries, laboratory determinations and nuclear medicine procedures took place at our Hospital. Patients were classified according to initial risk of recurrence based on the ATA system and they were reclassified following the system proposed by the MS-KCC 2 years after IT. Patients with antithyroglobulin antibodies > 12 IU/ml were excluded due to interference with thyroglobulin determination. Results: we reviewed data of 31 patients diagnosed with DTC. They were classified according to the ATA system as: low risk 17 (54.8 %), intermediate risk 13 (42 %) and high risk 1 (3.2 %) and they were reclassified following the MS-KCC system as having: excellent response 25 (80.6 %), acceptable response 6 (19.4 %) and incomplete response 0 (0 %). An excellent response was observed in 14 (82.4 %) and an acceptable response was observed in 3 (17.6 %) of the low-risk classified patients; an excellent response was observed in 11 (84.6 %) and an acceptable response was observed in 2 (15.4 %) of the intermediate-risk classified patients and in the high-risk group 1 patient (100 %) presented an acceptable response. Clinical status of patients after 2 years of IT: 25 (80.6 %) with no evidence of disease (NED), 6 (19.4 %) with biochemical persistence (BP) and 0 (0 %) with structural persistence (EP), recurrence (R) or death (D). After a mean long-term follow-up period of 51.3 months, the clinical status was: 25 (80.6 %) with NED, 4 (12.9 %) with BP and (0 %) with EP, R or D; for the remaining 2 (6.5 %) no long-term follow-up data was available (ND). At the end of the long-term follow-up period, 24 (96 %) patients with excellent response after 2 years of IT remained NED, whereas 1 (4 %) was reported as ND and 1 (16.7 %) patient with acceptable response after 2 years of IT remained NED (initially this was a low-risk patient), 4 (66.6 %) remained BP, 1 (16.7 %) was reported as ND and no EP, R or D was observed. Conclusions: 1) reclassification of patients was particularly useful in the intermediate risk group because 84.6 % of these patients had an excellent response after two years of IT, 2) reclassification of patients based on the response to IT, allows us to optimize their follow-up and 3) although the mean long-term follow-up period was 51.3 months, there was a good correlation between clinical status after two years of IT and after the long-term follow-up period, mainly in the excellent response group. Rev Argent Endocrinol Metab 51:8-14, 2014 No financial conflicts of interest exist.

The prognostic value of pre-operative and post-operative B-type natriuretic peptides in patients undergoing noncardiac surgery: B-type natriuretic peptide and N-terminal fragment of pro-B-type natriuretic peptide: a systematic review and individual patient data meta-analysis.

OBJECTIVES: The objective of this study was to determine whether measuring post-operative B-type natriuretic peptides (NPs) (i.e., B-type natriuretic peptide [BNP] and N-terminal fragment of proBNP [NT-proBNP]) enhances risk stratification in adult patients undergoing noncardiac surgery, in whom a pre-operative NP has been measured. BACKGROUND: Pre-operative NP concentrations are powerful independent predictors of perioperative cardiovascular complications, but recent studies have reported that elevated post-operative NP concentrations are independently associated with these complications. It is not clear whether there is value in measuring post-operative NP when a pre-operative measurement has been done. METHODS: We conducted a systematic review and individual patient data meta-analysis to determine whether the addition of post-operative NP levels enhanced the prediction of the composite of death and nonfatal myocardial infarction at 30 and ≥180 days after surgery. RESULTS: Eighteen eligible studies provided individual patient data (n = 2,179). Adding post-operative NP to a risk prediction model containing pre-operative NP improved model fit and risk classification at both 30 days (corrected quasi-likelihood under the independence model criterion: 1,280 to 1,204; net reclassification index: 20%; p < 0.001) and ≥180 days (corrected quasi-likelihood under the independence model criterion: 1,320 to 1,300; net reclassification index: 11%; p = 0.003). Elevated post-operative NP was the strongest independent predictor of the primary outcome at 30 days (odds ratio: 3.7; 95% confidence interval: 2.2 to 6.2; p < 0.001) and ≥180 days (odds ratio: 2.2; 95% confidence interval: 1.9 to 2.7; p < 0.001) after surgery. CONCLUSIONS: Additional post-operative NP measurement enhanced risk stratification for the composite outcomes of death or nonfatal myocardial infarction at 30 days and ≥180 days after noncardiac surgery compared with a pre-operative NP measurement alone.

Adolescence metabolic syndrome or adiposity and early adult metabolic syndrome.

OBJECTIVE: To investigate the predictive role of adolescent metabolic syndrome (MetS) in development of early adult MetS, independent of adult body mass index (BMI). STUDY DESIGN: 1424 adolescents (639 boys), participants of the Tehran Lipid and Glucose Study, followed for 10.4 years, were analyzed and logistic regression models were developed. Using the areas under the receiver operating characteristic curve, the discriminatory ability of adolescent MetS and overweight or obesity was evaluated. Net reclassification improvement was calculated to determine the accuracy of classification by adolescent MetS in place of overweight or obesity. RESULTS: The mean ± SD of age and BMI were 14.6 ± 2.2 years and 20.3 ± 4.2 kg/m(2), respectively. The prevalence of MetS was 13.3% and 14.6% at baseline and after follow-up, respectively. The risk of developing early adult MetS among subjects who were overweight or obese in adolescence but nonobese as adults (OR: 1.65) was lower than the risk among subjects who were obese as adults but nonobese as adolescents (OR: 8.45). After adjustment for adult BMI, adolescent MetS and overweight or obesity did not show any association with the risk of adult MetS. Area under the receiver operating characteristic curve was higher for obesity (0.619) than MetS (0.589) and the net reclassification improvement value for MetS was 1.5% (P = .398). CONCLUSION: Adolescent MetS or adiposity did not predict early adult MetS independent of adult BMI. The addition of adolescent MetS to obesity does not improve the predictive power for early adult MetS.