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Sensitivity Decreased (sensitivity + decreased)
Selected AbstractsNuchal translucency measurement at different crown-rump lengths along the 10- to 14-week period for Down syndrome screeningPRENATAL DIAGNOSIS, Issue 5 2005Maria A. Zoppi Abstract Objectives To evaluate the screening accuracy for Down syndrome of nuchal translucency (NT) measurement at different crown-rump length (CRL) subgroups along the 10- to 14-week period. Methods NT was classified ,enlarged' if greater than or equal to 1.5 and 2.0 multiples of the regressed median. Accuracies for Down syndrome (formula = [(TP + TN)/(TP + TN + FP + FN)] × 100, where TP: true positive, TN: true negative, FP: false positive, FN: false negative) were evaluated in four classes of CRL: 38,44 mm, 45,54 mm, 55,70 mm, and 71,84 mm, and compared. Results Of 20 743 fetuses, 20 611 were with no chromosomal abnormalities and 132 were with Down syndrome. Down syndrome fetuses with enlarged NT were 99 (greater than or equal to 1.5 MoM) and 86 (greater than or equal to 2.0 MoM). Sensitivity decreased with gestation, while specificity increased, resulting in increasing likelihood ratios with gestation for each of the CRL groups (8.1, 14.1, 16.3, 17.1 with the use of the 1.5 MoM cut-off, and 13.2, 27.1, 50.1, 84.1 for the 2.0 MoM cut-off). The accuracy increased with gestation (89%, 95%, 95%, 96% with the use of the 1.5 MoM cut-off, and 94%, 97%, 98%, 99% for the 2.0 MoM cut-off, for each of the CRL groups), differences being statistically significant between periods in half of the comparisons. Conclusions Although sensitivity of NT assessment for Down syndrome screening decreased as gestation advanced from the 10th to the 14th week, accuracy showed a remarkable increase. These changes should be taken into account in defining and improving the Down syndrome screening policies. Copyright © 2005 John Wiley & Sons, Ltd. [source] Degradation in insulin sensitivity with increasing severity of the metabolic syndrome in obese postmenopausal womenDIABETES OBESITY & METABOLISM, Issue 3 2006A. D. Karelis Aim:, We investigated the relationship between insulin sensitivity and the graded increase in the number of features of the metabolic syndrome in a cross-sectional sample of obese postmenopausal women. We hypothesized that insulin sensitivity would deteriorate with an increased number of metabolic syndrome phenotypes. Methods:, Insulin sensitivity was measured in 75 obese postmenopausal women (age: 57.3 ± 5.3 years; BMI: 32.8 ± 4.5 kg/m2) by using both the hyperinsulinaemic,euglycaemic clamp and the homeostasis model assessment (HOMA-IR). Features of the metabolic syndrome included visceral fat (>130 cm2), HDL-cholesterol (<1.29 mmol/l), fasting triglycerides (,1.7 mmol/l), blood pressure (,130/,85 mmHg) and fasting glucose (,6.1 mmol/l). Participants were classified into three categories based on the presence of metabolic syndrome phenotypes: 0,1 vs. 2 vs. ,3 features of the metabolic syndrome. Results:, We found that insulin sensitivity decreased in a graded fashion (12.19 ± 3.2 vs. 11.80 ± 2.3 vs. 9.29 ± 2.6 mg/min/FFM) and HOMA-IR increased in a similar manner (2.95 ± 1.1 vs. 3.28 ± 1.3 vs. 4.65 ± 2.2), as the number of features of the metabolic syndrome increased from 0,1 to ,3. When insulin sensitivity was statistically adjusted for visceral fat (as measured by computed tomography) and plasma triglycerides, the differences among groups were abolished. Conclusions:, These findings suggest that a decreased insulin sensitivity is associated with increased features of the metabolic syndrome in obese postmenopausal women and that visceral fat as well as plasma triglyceride accumulation might be potential mediators of this relationship. [source] Gender-dependent effect of ageing on peripheral insulin actionINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2005A-M. Borissova Summary The aim of the present study was to investigate the effect of both gender and age on insulin secretion, peripheral insulin effectiveness and insulin-receptor binding. Eighty healthy volunteers, 40 females of mean age 38.47 ± 11.37 years and mean BMI 21.99 ± 2.06 kg/m2 and 40 males of mean age 34.87 ± 11.22 years and mean BMI 22.65 ± 2.31 kg/m2, with normal glucose tolerance participated in the study. Peripheral insulin effectiveness was measured by the artificial endocrine pancreas, using the euglycaemic hyperinsulinaemic clamp technique and insulin-receptor binding on circulating mononuclear blood cells. Peripheral insulin sensitivity was significantly higher in females as compared to males (p < 0.001), while males demonstrated higher total number of insulin receptors (p < 0.0001) and number of high-affinity receptors (p < 0.01). Peripheral insulin sensitivity decreased with ageing in both males and females, the reduction in females being more pronounced (p < 0.05). In the group under 40 years, the females demonstrated significantly higher insulin sensitivity as compared to males (p < 0.001) and lower insulin-receptor binding. Over 40 years, females presented higher peripheral insulin sensitivity and higher insulin-receptor binding. The percentage of specifically bound insulin increased significantly with ageing in females and decreased in males. We consider that probably the higher androgen level in males affects the post-receptor processes in insulin action and despite the higher insulin-receptor binding, males have lower insulin sensitivity. The androgen levels in females increase with ageing, which could probably affect peripheral insulin sensitivity at the post-receptor level. In conclusion, our results demonstrate that when analysing peripheral insulin effectiveness and insulin-receptor binding, one should always consider both gender and age. [source] Accuracy of Spirometry in Diagnosing Pulmonary Restriction in Elderly PeopleJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2009Simone Scarlata MD OBJECTIVES: To compare the accuracy of a diagnosis of pulmonary restriction made using forced vital capacity (FVC) less than the lower limit of normal (LLN) with the criterion standard diagnosis made using total lung capacity (TLC) less than the LLN in an elderly population. DESIGN: Retrospective analysis. SETTING: A teaching hospital. PARTICIPANTS: Five hundred sixty-four ambulatory and acute care hospital patients aged 65 to 96 underwent complete pulmonary function evaluation. MEASUREMENTS: Sensitivity, specificity, positive and negative predictive values (PPV, NPV) of diagnosis of pulmonary restriction defined as FVC less than the LLN were calculated in the overall sample and after stratification according to bronchial obstruction. Expected PPV and NPV at different background prevalence of true pulmonary restriction (5% and 15%) were calculated using the Bayes theorem. RESULTS: Low sensitivity (0.32) and high specificity (0.95) were found, with an area under the receiver operating characteristic curve (AUC) of 0.89. In participants without bronchial obstruction, specificity was even higher, although sensitivity decreased to 0.28 (AUC=0.92). The PPV was good (0.81), whereas with a low to moderate a priori probability (prevalence from 5% to 15%) the NPV was fair (,0.89). CONCLUSION: A reduction in FVC below LLN cannot reliably identify true pulmonary restriction in elderly people, confirming previous findings in the adult population. Normal FVC, instead, can effectively exclude pulmonary restriction regardless of the presence of bronchial obstruction when the a priori probability is low or moderately high. [source] Identification of colorectal adenomas by a quantitative immunochemical faecal occult blood screening test depends on adenoma characteristics, development threshold used and number of tests performedALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2009P. ROZEN Summary Background Faecal occult blood tests (FOBT) are faulted by low sensitivity for advanced adenomatous polyps (AAP). Quantified, immunochemical, haemoglobin (Hb)-specific immunochemical FOBT (I-FOBT) measurements are now used for colorectal screening. Aims To correlate adenoma characteristics to amount of faecal Hb lost and to evaluate sensitivity and specificity for AAP by faecal Hb development threshold used and number of I-FOBTs collected. Methods Three daily I-FOBTs were collected and analysed in 1221 patients scheduled for colonoscopy. Faecal Hb was analysed as ngHb/mL of buffer and the highest result related to colonoscopy findings. Results In 1204 patients without cancer, colonoscopy identified adenomas in 294, 99 with AAPs. Adenoma patients had elevated faecal Hb increasing with advanced histology, size, pedunculated shape and multiplicity (P < 0.001 for all). At 50 ngHb/mL threshold, sensitivity and specificity for AAPs were 54.5% (95%CI 44.7, 64.7) and 88.1% (95%CI 86.2, 90.1) for three tests. At higher thresholds, sensitivity decreased, but was significantly higher with more samples collected. Conversely, specificity increased at higher thresholds, but decreased with more samples. Conclusions Faecal Hb loss from adenomas is significantly associated with size, number and advanced features. Sensitivity and specificity for AAPs are determined by test threshold chosen and number of samples collected; these determine the number of colonoscopies needed for positive tests. [source] Scotopic spatiotemporal sensitivity differences between young and old adultsOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 4 2010Cynthia L. Clark Abstract Background:, Our lab has previously demonstrated losses in contrast sensitivity to low spatial frequencies under scotopic conditions with older adults. It is not clear, however, whether the temporal frequency of a stimulus alters the relation between age and the spatial contrast sensitivity function (sCSF) under scotopic conditions. Methods:, A maximum-likelihood, two-alternative, temporal forced-choice QUEST procedure was used to measure threshold to spatially and temporally modulated stimuli in both young (mean = 26 years) and old (mean = 75 years) adults. Results:, In general, the shapes of the spatial and temporal CSFs were low-pass for both young and old observers; contrast sensitivity decreased at approximately the same rate with increasing spatial frequency and temporal frequency for both age groups, although the overall sensitivity of the old group was lower than that of the young group. The high-frequency resolution limit was lower for the old group compared to the young group. Conclusions:, The differences in contrast sensitivity between the young and old groups suggest a uniform loss in sensitivity of the channels mediating spatial and temporal vision. Because of this loss, the spatial and temporal window of visibility for the older adults is compromised relative to the younger adults. [source] Analysis of basophil activation by flow cytometry in pediatric house dust mite allergyPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 4 2008Miguel González-Muñoz Detection of allergen-induced basophil activation by flow cytometry has been shown to be a useful tool for allergy diagnosis. The aim of this study was to assess the potential of this technique for the diagnosis of pediatric house dust mite allergy. Quantification of total and specific IgE and basophil activation test were performed to evaluate mite allergic (n = 24), atopic (n = 23), and non-allergic children (n = 9). Allergen-induced basophil activation was detected as a CD63-upregulation. Receiver operating characteristics (ROC) curve analysis was performed to calculate the optimal cut-off value of activated basophils discriminating mite allergic and non-allergic children. ROC curve analysis yielded a threshold value of 18% activated basophils when mite-sensitized and atopic children were studied [area under the curve (AUC) = 0.99, 95% confidence interval (CI) = 0.97,1.01, p < 0.001] with a sensitivity and specificity of 96% for 16 ,g/ml mite extract. Analysis of the data obtained with 1.6 ,g/ml mite extract defined a cut-off value of 8% activated basophils (AUC = 0.96, 95% CI = 0.91,1.01; p < 0.001) with a sensitivity of 82% and specificity of 100%. Comparison between mite allergic and non-allergic children produced a cut-off of 8% activated basophils (AUC = 1.0) with 16 ,g/ml allergen extract and a sensitivity and specificity of 100%. The same threshold and specificity values were obtained with 1.6 ,g/ml extract (AUC = 97%, 95% CI = 0.92,1.02; p < 0.001) but sensitivity decreased to 83%. Two atopic children showed negative skin prick and basophil activation tests and high specific IgE (>43 kU/l) values for Dermatophagoides pteronyssinus allergen. They also showed positive prick (wheal diameter >1.0 cm) and basophil activation (>87%) tests and high specific IgE (>100 kU/l) with shrimp allergen. Shrimp sensitization was demonstrated by high levels of Pen a 1-specific IgE (>100 kU/l). Cross-reactivity between mite and shrimp was confirmed by fluorescence enzyme immunoassay (FEIA-CAP) inhibition study in these two cases. This study demonstrated that the analysis of allergen-induced CD63 upregulation by flow cytometry is a reliable tool for diagnosis of mite allergy in pediatric patients, with sensitivity similar to routine diagnostic tests and a higher specificity. Furthermore, this method can provide additional information in case of disagreement between in vivo and in vitro test results. [source] | ||||||||||