Diagnostic accuracy of cystatin C-based eGFR equations at different GFR levels in children

Background and objectives The diagnostic accuracy of cystatin C estimated GFR (eGFR) by various cystatin C equations have varied in different studies. We hypothesized that the GFR level of enrolled patients affects the diagnostic accuracy of a cystatin C equation. Design, setting, participants, & measurements We analyzed 240 consecutively enrolled children at a single Canadian center in a prospective and cross-sectional study. Cystatin C was analyzed with nephelometry, and cystatin C eGFR was estimated by the equations validated in children. GFR was measured by technetium- 99m-diethylene-triamine penta-acetic acid (99mTc DTPA). Results We compared various cystatin C equations across GFR strata \u3c60, \u3c90, ≥135, and ≥150 ml/min per 1.73 m2 for an accurate prediction and appropriate classification of the measured GFR. The CKiD, Zappitelli- CysEq, and Zappitelli-CysCrEq equations had a higher accuracy, estimated by eGFR values within 10% and 30% of the respective 99mTc DTPA, in the GFR categories \u3c60 and \u3c90 ml/min per 1.73 m2, whereas the Bökenkamp, Bouvet, and Filler equations had a greater accuracy in the GFR categories ≥135 and ≥150 ml/min per 1.73 m2. The Bouvet, CKiD, Filler, Zappitelli-CysEq, and Zappitelli-CysCrEq equations had a greater sensitivity to classify GFR \u3c60 and \u3c90 ml/min per 1.73 m2, whereas the Bökenkamp equation had a higher sensitivity for GFR ≥135 and ≥150 ml/min per 1.73 m2. Conclusions The diagnostic accuracy of various cystatin C equations varies with GFR. This issue needs consideration while applying these equations in clinical practice and for further research on eGFR equations. © 2011 by the American Society of Nephrology

Fibroblast growth factor-23 and calcium phosphate product in young chronic kidney disease patients: A cross-sectional study

Background: Fibroblast growth factor-23 (FGF-23), a novel marker of bone disease in chronic kidney disease (CKD) has been shown to correlate with vascular calcifications. We aimed to describe the effect of the calcium phosphate product (Ca*P) on FGF-23 concentrations in children and young adults without confounding cardiovascular disease. Methods. Pediatric and young adult patients with CKD stages I-V were recruited in this cross sectional study to measure FGF-23, cystatin C, vitamin D-metabolites and other serum markers of bone metabolism. FGF-23 levels were determined with an enzyme-linked immunosorbent assay. The association between FGF-23 and (Ca*P) was assessed using non-parametric methods. Patients were divided into two age groups, less than 13 years of age and greater than 13 years of age. Results: This cross-sectional study measured serum FGF-23, in 81 patients (42 females, 51.9%) at London Health Sciences Centre, aged 2 to 25 years, with various stages of CKD (Cystatin C estimated glomerular filtration rate, eGFR=10.7-213.0 ml/min). For the whole entire group of patients, FGF-23 levels were found to correlate significantly with age (Spearman r= 0.26, p=0.0198), Cystatin C eGFR (Spearman r=-0.40 p=0.0002), CKD stage (Spearman r=0.457, p\u3c0.0001), PTH (Spearman r=0.330, p=0.0039), ionized calcium (Spearman r=-0.330, p=0.0049), CysC (Spearman r= 0.404, p=0.0002) and 1,25-dihydroxyvitamin D (Spearman r=-0.345, p=0.0034) concentrations. No significant correlation was found between FGF-23 levels and calcium phosphate product (Spearman r= 0.164, p=0.142). Upon classification of patients into two age groups, less than 13 years of age and more than 13 years of age, correlational results differed significantly. FGF-23 correlated with CysC eGFR(Spearman r= -0.633, p\u3c0.0001), CKD stage (Spearman r=0.731, p\u3c0.0001), phosphate (Spearman r= 0.557, p\u3c0.0001), calcium phosphate product (Spearman r=0.534, p\u3c0.0001), 125(OH)2 Vit D (Spearman r=-0.631, p\u3c0.0001), PTH (Spearman r= 0.475, p=0.0017) and ionized calcium (Spearman r= -0.503, p=0.0015) only in the older group. The relationship between FGF-23 and Ca*P for the older group could be expressed by the exponential model FGF-23= 38.15 e§ssup§0.4625Ca*P§esup§. Conclusion: Abnormal values of FGF-23 in adolescents and young adults with CKD correlate with Ca* P in the absence of vascular calcifications, and may serve as a biomarker for the risk of cardiovascular calcifications. © 2013 Yasin et al; licensee BioMed Central Ltd

Fibroblast growth factor-23 and calcium phosphate product in young chronic kidney disease patients: A cross-sectional study

Background: Fibroblast growth factor-23 (FGF-23), a novel marker of bone disease in chronic kidney disease (CKD) has been shown to correlate with vascular calcifications. We aimed to describe the effect of the calcium phosphate product (Ca*P) on FGF-23 concentrations in children and young adults without confounding cardiovascular disease. Methods. Pediatric and young adult patients with CKD stages I-V were recruited in this cross sectional study to measure FGF-23, cystatin C, vitamin D-metabolites and other serum markers of bone metabolism. FGF-23 levels were determined with an enzyme-linked immunosorbent assay. The association between FGF-23 and (Ca*P) was assessed using non-parametric methods. Patients were divided into two age groups, less than 13 years of age and greater than 13 years of age. Results: This cross-sectional study measured serum FGF-23, in 81 patients (42 females, 51.9%) at London Health Sciences Centre, aged 2 to 25 years, with various stages of CKD (Cystatin C estimated glomerular filtration rate, eGFR=10.7-213.0 ml/min). For the whole entire group of patients, FGF-23 levels were found to correlate significantly with age (Spearman r= 0.26, p=0.0198), Cystatin C eGFR (Spearman r=-0.40 p=0.0002), CKD stage (Spearman r=0.457, p\u3c0.0001), PTH (Spearman r=0.330, p=0.0039), ionized calcium (Spearman r=-0.330, p=0.0049), CysC (Spearman r= 0.404, p=0.0002) and 1,25-dihydroxyvitamin D (Spearman r=-0.345, p=0.0034) concentrations. No significant correlation was found between FGF-23 levels and calcium phosphate product (Spearman r= 0.164, p=0.142). Upon classification of patients into two age groups, less than 13 years of age and more than 13 years of age, correlational results differed significantly. FGF-23 correlated with CysC eGFR(Spearman r= -0.633, p\u3c0.0001), CKD stage (Spearman r=0.731, p\u3c0.0001), phosphate (Spearman r= 0.557, p\u3c0.0001), calcium phosphate product (Spearman r=0.534, p\u3c0.0001), 125(OH)2 Vit D (Spearman r=-0.631, p\u3c0.0001), PTH (Spearman r= 0.475, p=0.0017) and ionized calcium (Spearman r= -0.503, p=0.0015) only in the older group. The relationship between FGF-23 and Ca*P for the older group could be expressed by the exponential model FGF-23= 38.15 e§ssup§0.4625Ca*P§esup§. Conclusion: Abnormal values of FGF-23 in adolescents and young adults with CKD correlate with Ca* P in the absence of vascular calcifications, and may serve as a biomarker for the risk of cardiovascular calcifications. © 2013 Yasin et al; licensee BioMed Central Ltd

Diagnostic accuracy of cystatin C-based eGFR equations at different GFR levels in children

Background and objectives The diagnostic accuracy of cystatin C estimated GFR (eGFR) by various cystatin C equations have varied in different studies. We hypothesized that the GFR level of enrolled patients affects the diagnostic accuracy of a cystatin C equation. Design, setting, participants, & measurements We analyzed 240 consecutively enrolled children at a single Canadian center in a prospective and cross-sectional study. Cystatin C was analyzed with nephelometry, and cystatin C eGFR was estimated by the equations validated in children. GFR was measured by technetium- 99m-diethylene-triamine penta-acetic acid (99mTc DTPA). Results We compared various cystatin C equations across GFR strata \u3c60, \u3c90, ≥135, and ≥150 ml/min per 1.73 m2 for an accurate prediction and appropriate classification of the measured GFR. The CKiD, Zappitelli- CysEq, and Zappitelli-CysCrEq equations had a higher accuracy, estimated by eGFR values within 10% and 30% of the respective 99mTc DTPA, in the GFR categories \u3c60 and \u3c90 ml/min per 1.73 m2, whereas the Bökenkamp, Bouvet, and Filler equations had a greater accuracy in the GFR categories ≥135 and ≥150 ml/min per 1.73 m2. The Bouvet, CKiD, Filler, Zappitelli-CysEq, and Zappitelli-CysCrEq equations had a greater sensitivity to classify GFR \u3c60 and \u3c90 ml/min per 1.73 m2, whereas the Bökenkamp equation had a higher sensitivity for GFR ≥135 and ≥150 ml/min per 1.73 m2. Conclusions The diagnostic accuracy of various cystatin C equations varies with GFR. This issue needs consideration while applying these equations in clinical practice and for further research on eGFR equations. © 2011 by the American Society of Nephrology

Cystatin C reduction ratio depends on normalized blood liters processed and fluid removal during hemodialysis

Background and objectives: A negative correlation between the weekly standard Kt/V (urea) and serum cystatin C level (CysC) in functionally anephric dialysis patients has been previously demonstrated. Our objective was to measure the per dialysis CysC reduction ratio (CCRR) and to compare it with other indices of dialytic functions. Design, setting, participants, & measurements: In a pilot cross-sectional study of 15 functionally anephric patients on conventional high-flux high-efficiency hemodialysis three times per week, CysC levels were drawn pre-, mid-, and postdialysis over 1 week. CCRR was compared with single-pool Kt/V (Sp Kt/V) using urea kinetic modeling, urea reduction ratio (URR), creatinine reduction ratio (CRR), normalized liters processed (LP/kg), and ultrafiltration volume (UF). Normally distributed data (Shapiro-Wilks test) were described as mean ± SD, otherwise as median and interquartile range. Results: The mean pre- and post-CysC levels were 6.0 ± 1.0 and 4.7 ± 1.1 mg/L. The Sp Kt/V and Std Kt/V were 1.5 ± 0.2 and 2.6. The URR, CRR, and CCRR were 70.2% ± 9.0%, 64.5% ± 8.2%, and 26.1% ± 11.8%, respectively. There was no correlation between the CCRR, and the Sp Kt/V, URR, and CRR, whereas CCRR correlated with LP/kg and UF. Multiple regression analysis with these two parameters provided a model that explained 81% of the variance. Conclusions: Our data suggest that normalized liters processed and ultrafiltration volume explain most of the variance of CCRR. Therefore, CCRR may be an excellent method to monitor dialysis efficiency of low molecular weight proteins. Copyright © 2011 by the American Society of Nephrology

Ontario children have outgrown the broselow tape

Objective: The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a well-established length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood obesity, the BT may no longer accurately estimate weight. We therefore studied the BT in children from Ontario in a large recent patient cohort. Methods: Actual height and weight were obtained from an urban and a rural setting. Children were prospectively recruited between April 2007 and July 2008 from the emergency department and outpatient clinics at the London Health Science Centre. Rural children from junior kindergarten to grade 4 were also recruited in the spring of 2008 from the Avon Maitland District School Board. Data for preschool children were obtained from three daycare centres and the electronic medical record from the Maitland Valley Medical Centre. The predicted weight from the BT was compared to the actual weight using Spearman rank correlation; agreement and percent error (PE) were also calculated. Results: A total of 6,361 children (46.2% female) were included in the study. The median age was 3.9 years (interquartile range [IQR] 1.56-7.67 years), weight was 17.2 kg (IQR 11.6-25.4 kg), and height was 103.5 cm (IQR 82-124.4 cm). Although the BT weight estimate correlated with the actual weight (r = 0.95577, p \u3c 0.0001), the BT underestimated the actual weight by 1.62 kg (7.1% ± 16.9% SD, 95% CI -26.0-40.2). The BT had an ≥ 10% PE 43.7% of the time. Conclusions: Although the BT remains an effective method for estimating pediatric weight, it was not accurate and tended to underestimate the weight of Ontario children. Until more accurate measurement tools for emergency departments are developed, physicians should be aware of this discrepancy. © Canadian Association of Emergency Physicians 2010

Big Mother or Small Baby: Which Predicts Hypertension?

According to the Barker hypothesis, intrauterine growth restriction and premature delivery adversely affect cardiovascular health in adult life. The association of childhood hypertension as a cardiovascular risk factor and birth weight has been understudied. In a prospective cohort study, the authors evaluated the effect of birth weight, gestational age, maternal prepregnancy body mass index (BMI), and child BMI z score at the time of enrollment on the systolic and diastolic blood pressure (BP) z score in 3024 (1373 women) consecutive outpatient clinic patients aged 2.05 to 18.58 years. The latest National Health and Nutrition Examination Survey (NHANES III) was used to calculate the age-dependent z scores. The median z scores of BMI (+0.48, range -6.96-6.64), systolic BP (+0.41, range -4.50-6.73), and diastolic BP (+0.34, range -3.15-+6.73) were all significantly greater than the NHANES III reference population. Systolic BP z score did not correlate with birth weight or gestational age, but did correlate with maternal prepregnancy BMI (r=090, P\u3c.0001) and BMI z score (r=209, P\u3c.0001). Diastolic BP z score positively correlated with birth weight (0.037, P=044), gestational age (r=052, P=005), BMI z score(r=106, P\u3c.0001), and maternal prepregnancy BMI (r=062, P=0007). In contrast to what would be expected from the Barker hypothesis, the authors found no negative correlation between BP z score and birth weight or gestational age. This study suggests that a high BMI, a big mom, and a high birth weight are more important risk factors for hypertension during childhood than low birth weight or gestational age. © 2010 Wiley Periodicals, Inc

Big Mother or Small Baby: Which Predicts Hypertension?

According to the Barker hypothesis, intrauterine growth restriction and premature delivery adversely affect cardiovascular health in adult life. The association of childhood hypertension as a cardiovascular risk factor and birth weight has been understudied. In a prospective cohort study, the authors evaluated the effect of birth weight, gestational age, maternal prepregnancy body mass index (BMI), and child BMI z score at the time of enrollment on the systolic and diastolic blood pressure (BP) z score in 3024 (1373 women) consecutive outpatient clinic patients aged 2.05 to 18.58 years. The latest National Health and Nutrition Examination Survey (NHANES III) was used to calculate the age-dependent z scores. The median z scores of BMI (+0.48, range -6.96-6.64), systolic BP (+0.41, range -4.50-6.73), and diastolic BP (+0.34, range -3.15-+6.73) were all significantly greater than the NHANES III reference population. Systolic BP z score did not correlate with birth weight or gestational age, but did correlate with maternal prepregnancy BMI (r=090, P\u3c.0001) and BMI z score (r=209, P\u3c.0001). Diastolic BP z score positively correlated with birth weight (0.037, P=044), gestational age (r=052, P=005), BMI z score(r=106, P\u3c.0001), and maternal prepregnancy BMI (r=062, P=0007). In contrast to what would be expected from the Barker hypothesis, the authors found no negative correlation between BP z score and birth weight or gestational age. This study suggests that a high BMI, a big mom, and a high birth weight are more important risk factors for hypertension during childhood than low birth weight or gestational age. © 2010 Wiley Periodicals, Inc

Malware Detection in Internet of Things (IoT) Devices Using Deep Learning

Internet of Things (IoT) devices usage is increasing exponentially with the spread of the internet. With the increasing capacity of data on IoT devices, these devices are becoming venerable to malware attacks; therefore, malware detection becomes an important issue in IoT devices. An effective, reliable, and time-efficient mechanism is required for the identification of sophisticated malware. Researchers have proposed multiple methods for malware detection in recent years, however, accurate detection remains a challenge. We propose a deep learning-based ensemble classification method for the detection of malware in IoT devices. It uses a three steps approach; in the first step, data is preprocessed using scaling, normalization, and de-noising, whereas in the second step, features are selected and one hot encoding is applied followed by the ensemble classifier based on CNN and LSTM outputs for detection of malware. We have compared results with the state-of-the-art methods and our proposed method outperforms the existing methods on standard datasets with an average accuracy of 99.5%.publishedVersio