Iron homeostasis is essential to the sustenance of survival and growth of host mycobacteria [32]. Both ML and M. tuberculosis produce bacterioferritins [33, 34], which could be involved in controlling iron homeostasis in these pathogens. Because CD163 is related to Hb clearance, it can be speculated that, in parasitized cells, high CD163 expression may function as a pathway for the supply of iron, which perhaps reflect some of the dissimilarities among the survival mechanisms used by the various mycobacteria. An example is the fact that whereas human Hb is not used

SCH727965 manufacturer as an iron source by M. tuberculosis, it may be used for this purpose by M. haemophilum and ML [35]. In the present work, we verified larger iron storage in LL skin biopsies than in tuberculoid ones. Of note, high amounts of iron were only found in LL macrophages and none was detected in epithelioid macrophages whereas small foci of iron deposits in vaguely differentiated macrophages were seen in BT lesions. With reference to a previous description of the accumulation of lipid droplets in LL lesions [36], we could infer that ML associates with lipid vesicles as a mechanism for transferring iron from the host to ML-rich phagosomes. As a whole, our results seem to clearly suggest that, on

the one hand, CD163 may contribute to polarize LL macrophages Obeticholic Acid to an anti-inflammatory phenotype by increasing the expression and levels of the immunoregulatory molecules IL-10 and IDO, although the other primary determinants of polarity in leprosy immune responses need to be better understood. In addition CD163 also contributes to ML uptake and increased amounts Methane monooxygenase of iron, thus favoring bacterial survival and persistence. The acquisition of all specimens was approved by the Human Ethics Committee of the Oswaldo Cruz Foundation in Brazil. Leprosy patients (LL, n = 11 and BT, n = 10) were classified according to Ridley and Jopling

criteria [37]. Buffy coats were obtained from healthy donors (HC) at the Hemotherapy Service of the Clementino Fraga Filho University Hospital, associated with the Federal University of Rio de Janeiro, RJ, Brazil, in accordance with the guidelines set down in the Declaration of Helsinki. The leprosy skin cryostat sections (LL, n = 6 and BT, n = 6) were processed to detect IDO+ and CD163+ cells by immunoperoxidase labeling. Sections were then incubated with polyclonal anti-IDO (Santa Cruz Biotechnology, Santa Cruz, CA, USA (H-110), 1: 50) and anti-CD163 (Santa Cruz Biotechnology (sc-20066), 1: 25). Immunohistochemical staining was performed, as previously demonstrated by De Souza Sales et al. [6].

We believe that the accompanying artery of the sciatic nerve may be a recipient vessel for free-flap transfer in selected patients. © 2014 Wiley Periodicals, Inc. Microsurgery, 2014. “
“Purpose: In this report, we present our experience

on the repair of brachial plexus root avulsion injuries with the use of contralateral C7 nerve root transfers with nerve grafting through a modified prespinal route. Methods: The outcomes of the contralateral C7 nerve root transfer to neurotize the upper trunk and C5/C6 nerve roots of the total or near total brachial plexus nerve root avulsion injury in a series of 41 patients were evaluated. click here The contralateral C7 nerve root that was dissected to the distal end of the divisions, along with the sural nerve graft, were placed underneath the anterior scalene and longus colli muscles, and then passed through the retro-esophageal space to neurotize the recipient nerve. The mean length of the dissected contralateral C7 nerve root was 6.5 ± 0.7 cm, and the mean length of sural nerve graft was 6.8 ± 1.9 cm. The suprascapular

nerve was neurotized additionally by the phrenic nerve or the terminal motor branch of accessory nerve in some patients. Results: The mean length of the follow-up was 47.2 ± 14.5 months. The muscle strength was graded M4 or M3 for the biceps muscle in 85.4% of patients, for the deltoid muscle in 82.9% of patients, and for the upper parts of pectoral major in 92.7% of patients. The functional recovery of shoulder Sitaxentan abduction in the patients with the additional suprascapular nerve neurotization was remarkably improved. Conclusions: this website The modified prespinal route could significantly reduced the length of nerve graft in the contralateral C7 nerve root transfer

to the injured upper trunk in brachial plexus root avulsion injury, and it may improve the functional outcomes, which deserves further investigations. © 2011 Wiley Periodicals, Inc. Microsurgery, 2012. “
“Vascular thrombosis is one of the major postoperative complications of free flap microvascular breast reconstruction operations. It is associated with higher morbidity, higher cost, increased length of hospital stay, and potentially flap loss. Our purpose is to evaluate the rate of this complication and whether patient characteristics play a role. Using the Nationwide Inpatient Sample (NIS) database, we examined the clinical data of patients who underwent free flap breast reconstruction between 2009 and 2010 in the United States. Multivariate and univariate regression analyses were performed to identify independent risk factors of flap thrombosis. A total of 15,211 patients underwent free flap breast reconstruction surgery (immediate reconstruction: 43%). The most common flap was the free deep inferior epigastric perforator (DIEP) flap (53.6%), followed by free transverse rectus abdominis myocutaneous (TRAM) flap (43.

Rituximab® was used in the concentration 0·1 μg/ 0·2 × 106 target cells. After counting and centrifugation

(200 g, 10 min) the target cells were adjusted to 2 × 106 cells/ml AIM-V medium. Ten μl antibodies were added to 0·2 × 106 target cells (0·1 ml) and incubated for 15 min at room temperature. The effector cells were counted and resuspended in AIM-V to a final concentration of 2 × 106 cells/ml; 0·2 × 106 of these cells were added to the antibody-coated target cells and after centrifugation (30 g for 3 min) the cells were incubated in a humidified incubator with 5% CO2 at 37°C for 2 h. After one wash in phosphate-buffered saline (PBS) the cells were ready for staining with the monoclonal antibodies given below and subsequent flow cytometry. Samples were labelled with monoclonal antibodies for 30 min in the dark at 4°C, washed once in PBS (pH 7·4) and finally resuspended buy PLX4032 in PBS. The following monoclonal mouse antibodies and other markers were used: anti-CD3 fluorescein isothiocyanate (FITC) (clone UCHT1, IgG1, F0818; Dako, Glostrup, Denmark), anti-CD56 phycoerythrin (PE) [clone c5·9, immunoglobulin (Ig)G2b, R7251; Dako], anti-CD107a Alexa 647 (clone eBio H4A3, IgG1, #51-1079; eBioscience, San Diego, CA, USA), anti-CD8 PC7 (clone SFCI21Thy2D3, IgG1, #737661; Beckman Coulter, Indianapolis, IN, USA), CD2/CD2R (CD2 clone L303·1,CD2R clone L304·1; #340366; BD Pharmingen, San Jose, CA, USA), AlexaFluor 647 mouse IgG1k isotype

control (clone MOPC-21, #557714; BD Pharmingen) and 7-aminoactinomycin D (7-AAD) (# 555816; BD Via Probe, BD Pharmingen). Flow cytometric analyses were performed using a Cytomics FC500 five-colour flow cytometer click here (Beckman Coulter) equipped with two lasers, an argon laser (488 nm) and a HeNe laser (633 nm). FlowJo software version 9·3 (Tree Star, Inc., Ashland, OR, USA) was used for data analysis. A total of 20 000 events were collected for further analysis. NK cells were defined as CD3−/CD56+ lymphocytes. Effector cells alone were used to define the initial CD107a level of positive NK cells or CD8+ cells. In Fig. 1,

we present examples of spontaneous up-regulation of CD107a on effector cells, as well as FMO (fluorescence-minus one), an isotype antibody control for CD107a and 7AAD viability staining. Using the CD2/CD2R system, we also performed positive effector cell control experiments, confirming the Etofibrate activation potential of the effector cells (data not shown). In 51Cr cytotoxicity assays results are given normally as percentages of cell killing, with the maximum killing as a basic value. In assays measuring granularity by CD107a this is not meaningful, as a maximum value is difficult, if not impossible, to give. The results are therefore given as increments, where either the NK value or the value with preimmune serum is subtracted from the value with immune serum. The increase can also be given as a ratio between, for example, immune sera and preimmune sera.

4B). However, inhibition of Syk with the Syk-selective inhibitor piceatannol did not inhibit serotonin release by cells expressing WT FcγRIIA, despite the fact that the concentration used (25 μg/ml) completely abolished phagocytosis. This concentration of piceatannol was also previously shown to abolish Syk functions in RBL cells, including serotonin secretion mediated by other receptors which signal via the gamma chain ITAM [21, 22]. FcγRIIA was previously shown to mediate phagocytosis, endocytosis, production of reactive oxygen metabolites, and release of vesicles containing proteases

and other signaling molecules, e.g. serotonin, from leukocytes[2–6]. FcγRIIA is the only Fc receptor found on human platelets, where it plays a role in platelet activation, aggregation and serotonin secretion [11–13, 15]. We sought to study the cytoplasmic PF-02341066 nmr tail requirements of FcγRIIA for serotonin secretion. However, molecular signaling pathways

are not easily manipulated in platelets, and platelets are not readily transfectable. Therefore, we created a model system for FcγRIIA-mediated serotonin secretion by stably expressing FcγRIIA in the rat basophilic cell line, RBL-2H3, which is known to have secretory potential. In addition, we established cell lines stably expressing FcγRIIA find more bearing tyrosine to phenylalanine mutations at the non-ITAM Y275 (Y1), and at the ITAM Y282 (Y2) and Y298 (Y3), as well as double mutants bearing each combination of the aforementioned mutations. While there was a 7-fold increase in serotonin secretion for the FcγRIIA-expressing

cell line, we observed that mutation of either ITAM tyrosine alone was sufficient to block serotonin secretion. While RBL-2H3 cells also express one other type of Fcγ receptor, FcγRIIB, this Fc receptor does not contain an ITAM domain, but rather has been found to inhibit Fc receptor function through its Immunoreceptor Tyrosine-based Inhibitory Motif (ITIM) [3]. Of particular relevance is the observation that selleck FcγRIIB does not mediate serotonin secretion in these cells [11]. Furthermore, the ITIM motif has been shown to negatively regulate FcγRIIA-mediated phagocytosis,[3] and PECAM-1 (which also contains an ITIM) has recently been found to negatively regulate FcγRIIA-mediated platelet aggregation[23]. It would therefore be interesting to determine if FcγRIIB, through its ITIM, similarly down-regulates FcγRIIA-mediated serotonin secretion in our model as well. In light of the apparently differing structural requirements for FcγRIIA-mediated phagocytosis versus serotonin secretion, we next investigated the downstream signaling pathways involved in these signaling events. According to our current model of phagocytic signaling, once phosphorylated, the ITAM tyrosines recruit SH2 domains of additional enzymes and adapter proteins that participate in the signaling process [1, 22].

In addition, our technique allows direct ex vivo visualisation without any need for further processing of the tissues, in contrast to immunohistochemistry

and MPO analysis. Histology is labour-intensive and tedious, while MPO assays can be problematic and do not distinguish between neutrophils and macrophages. In conclusion, this study presents a robust model to track neutrophil recruitment which can be used to complement other available selleck inhibitor methods traditionally used for tracking neutrophils. In addition to experimental models of IBD, this versatile technique will be useful for monitoring neutrophil trafficking during inflammatory responses in a range of disease settings and constitutes a novel approach for the assessment of potential therapeutics that aim to reduce neutrophil infiltration. Thus, it can be used as an informative and specific tool for both the pharmaceutical industry and the basic research community. We thank

Grainne Hurley for her excellent technical assistance. FK506 ic50 The authors are supported in part by Science Foundation Ireland and by a research grant from GlaxoSmithKline. None of the co-authors have any conflict of interest to declare in connection to the paper. The work described has not been published or submitted elsewhere. S.M. and G.M. are employees of GlaxoSmithKline. “
“B1 B cells represent a unique subset of B lymphocytes distinct from conventional B2 B cells, and are important in the production of natural antibodies. A potential human homologue of murine B1 cells was defined recently as a CD20+CD27+CD43+ cell. Common variable immunodeficiency (CVID) is a group of heterogeneous conditions linked by symptomatic primary antibody failure. In this preliminary report, we examined the potential clinical utility of introducing CD20+CD27+CD43+ B1 cell immunophenotyping as a routine assay in a diagnostic clinical laboratory. Using a whole blood assay, putative B1 B cells in healthy controls and in CVID patients were measured. Peripheral blood from 33 healthy donors and 16 CVID

patients were stained with relevant monoclonal antibodies and underwent flow cytometric evaluation. We established a rapid, Lonafarnib chemical structure whole blood flow cytometric assay to investigate putative human B1 B cells. Examination of CD20+CD27+CD43+ cells is complicated by CD3+CD27+CD43hi T cell contamination, even when using stringent CD20 gating. These can be excluded by gating on CD27+CD43lo–int B cells. Although proportions of CD20+CD27–CD43lo–int cells within B cells in CVID patients were decreased by 50% compared to controls (P < 0·01), this was not significant when measured as a percentage of all CD27+ B cells (P = 0·78). Immunophenotypic overlap of this subset with other innate-like B cells described recently in humans is limited. We have shown that putative B1 B cell immunophenotyping can be performed rapidly and reliably using whole blood. CD20+CD27+CD43lo–int cells may represent a distinct B1 cell subset within CD27+ B cells.

6 Some controversy has surrounded the combination therapy as relates to the long-term effect on renal outcome, as two trials, employed doubling of serum creatinine and ESRD as the primary end-point, came to different conclusions.7,8 In the COOPERATE study which was performed in patients with non-diabetic CKD,7 combination of an ACEI with an ARB was associated with reduction in the risk for reaching the primary end-point. However, there

is a potential limitation of the study for design and potential bias in randomization. Meanwhile, the ONTARGET study,8 conducted in patients with high risk for cardiovascular events, suggests that the combination therapy worsened the renal FK506 outcome. Although the sample of the ONTARGET study was much larger, it was a cardiovascular check details intervention study and renal outcomes were only a secondary measure. Further

studies are required to clarify the long-term benefit of the approach on renal outcome in population of patients with different nephropathy. An alternative option that may enhance the RAS inhibition is increasing the doses of ACEI or ARB. Emerging evidence has suggested that this approach may confer further benefit on renoprotection.9 In current clinical practice, the recommended doses of ACEI and ARB are based on their dose-responses for blood pressure. However, the response of blood pressure and proteinuria are not necessarily concordant.3 Angiotensin II mediates haemodynamic effects as well as inflammation and fibrosis in the kidney, heart and vasculature. The benefit of an ACEI or an ARB beyond the haemodynamic effects has been seen in the treatment of heart failure. Data from animal studies indicate that anti-inflammatory and anti-fibrotic benefit of RAS blockage in the kidney seems to

require doses much higher than antihypertensive doses.9 Several underlying mechanisms have PDK4 been proposed to explain the blood pressure-independent anti-proteinuric effects of the RAS blockers.10–12 These include reduced intraglomerular pressure by vasodilating preferentially the postglomerular arterioles, improved permselective properties of the glomerular membrane, and reduced renal levels of profibrotic cytokines such as transforming growth factor-β1 and connective tissue growth factor. Increased RAS activity and augmented angiotensin II receptor density in the diseased kidney may explain that higher doses are needed for complete RAS inhibition in the renal tissue. More recently,13 in a single centre, double-blind, randomized cross-over trial, 49 patients with type 1 diabetes and nephropathy received three treatment periods with 20, 40 or 60 mg/day of lisinopril. Each period lasted for 2 months. The results showed that reductions in urinary albumin excretion rate (UAER) from baseline were 63%, 71% and 70% with 20, 40 or 60 mg/day of lisinopril, respectively.

191, P = 0·03) indicating that type I IFNs increase the amount of IL-10 produced per cell (Table 1). Thus, a decrease in the amount of IL-10 per cell and possibly in the number of IL-10-producing CD25+CD4+ T cells, as check details measured by flow cytometry, correlates with the decrease in the amount of IL-10 seen by ELISA. As IgG is very important in the induction of IL-10, which helps suppress a healing Th1 response, we looked at the IgG responses in WT and KO mice infected

with L. mexicana. Leishmania-specific serum IgG1 and IgG2a/c responses were determined using L. mexicana FTAg as a capture reagent. At 12 weeks of infection, the IFN-α/βR KO had significantly more IgG1 and IgG2a/c as compared with WT mice (Figure 4a). However, by 23 weeks of infection, this difference was no longer evident, click here with both WT and KO mice having indistinguishable titres (Figure 4b). As the ELISA assay for IgG is nonlinear, we calculated the amount of IgG1 and IgG2a/c produced by WT mice relative to IFN-α/βR KO mice as described in the Materials and methods section, finding that KO mice produced 10·4-fold more IgG1 and 6·9-fold more IgG2a/c (Figure 4c). As IFN-α/β has been reported to decrease strongly the IL-12 production in some systems (18,19), we explored whether IL-12 is increased in the absence of IFN-α/βR signalling.

We measured IL-12 in the serum of infected IFN-α/βR KO and WT mice and found that IL-12 levels were not higher in KO mice at 12 or 23 weeks

post-infection (Figure 5). Although measuring IL-12 in the serum is not routine in cutaneous leishmaniasis, it has been shown that significant differences in serum IL-12 levels are measurable in L. major-infected WT and Fas-deficient mice (20). Although IFN-γ has long been known to be crucial to the control of Leishmania infection, as it is with many intracellular pathogens, the role of type I IFNs is less well understood. Type I IFNs are important in viral infections as well Astemizole as infections caused by Gram-negative bacteria and parasites such as Plasmodium, and even L. major. We undertook studies to examine the role of type I IFNs in L. mexicana infection using mice that lack the common type I IFN receptor (IFN-α/βR KO mice). Our previous studies demonstrated that partial control of L. mexicana requires the transcription factor STAT4, as well as IFN-γ and iNOS (1). Without any one of these factors, mice develop progressive disease with continuously growing lesions and much higher parasite burdens, rather than controlling disease around 8–10 weeks of infection, as seen in WT B6 mice. However, we found a lack of any discernable phenotype in mice lacking IL-12p40 (a component of the heterodimeric cytokines IL-12 and IL-23).

parapertussis infection in human populations, and our results suggest that concurrent B. pertussis infection may do the same. However, as far as we know, B. parapertussis infections have not emerged at high levels in the era of pertussis vaccine use, although diagnostics for B. parapertussis infections need to be improved before the picture is clear. Coinfection with these two closely related pathogens may be more common than documented in human pertussis disease and the less virulent of the pair may benefit from the immunomodulatory properties of B. pertussis. Of course, whether this mouse model is representative of human infection is

unclear. Some aspects of B. parapertussis infection in mice more closely resemble those of B. bronchiseptica than B. pertussis (Heininger et al., 2002), and it is possible that B. pertussis is better adapted to the human host Ceritinib than B. parapertussis and would outcompete

it in a mixed infection in a selleck products human. Human volunteer experiments may be necessary to resolve these issues. This work was supported by NIH grant AI063080. We thank Galina Artamonova and Aakanksha Pant for conducting some of the preliminary mouse infection studies and Charlotte Mitchell for technical advice with BAL. “
“Vaccines are very effective at preventing infectious disease but not all recipients mount a protective immune response to vaccination. Recently, gene expression profiles of PBMC samples in vaccinated individuals have been used to predict the development of protective immunity. However, the magnitude of change in gene expression that separates vaccine responders and nonresponders is likely to be small and distributed across networks of genes, making the selection of predictive and biologically relevant genes difficult.

Here we apply a new approach to predicting vaccine response based on coordinated upregulation of sets of biologically informative genes in postvaccination gene expression profiles. We found O-methylated flavonoid that enrichment of gene sets related to proliferation and immunoglobulin genes accurately segregated high responders to influenza vaccination from low responders and achieved a prediction accuracy of 88% in an independent clinical trial. Many of the genes in these gene sets would not have been identified using conventional, single-gene level approaches because of their subtle upregulation in vaccine responders. Our results demonstrate that gene set enrichment method can capture subtle transcriptional changes and may be a generally useful approach for developing and interpreting predictive models of the human immune response. Vaccination is one of the most effective methods of preventing human disease. However, many vaccines are not universally protective and even widely used vaccines, such as those against influenza, fail to achieve protective immunity in a significant proportion of vaccinated subjects [1].

These results also depend on the amount of T. gondii tachyzoites used to challenge the mice. T. gondii tachyzoites are defined as the rapidly growing stage of the parasite and known to enter almost any nucleated cell and multiply until the host cell dies and releases the next generation of tachyzoites. As NcCyP has high sequence homology (86%) with T. gondii CyP and abundant NcCyP has been detected in N. caninum tachyzoite whole-cell

lysate or tachyzoite culture supernatant, T. gondii tachyzoites were believed to be suitable for this study [18]. Although T. gondii RH tachyzoites were used in this study, type-2 avirulent T. gondii Beverly strain and 76K strain cysts have also been used in several Proteasome inhibitor studies and have been shown to have potential protection efficiency against T. gondii

infection in BALB/c or C3H mice [10, 20, 35]. All these studies have indicated that appropriate parasite antigens should be selected to encode an effective DNA plasmid vaccine. Furthermore, studies on the combination of adjuvants, parasite strains and parasite load used to challenge should be performed. In summary, we have demonstrated that a pVAX1–TgCyP DNA vaccine generated specific humoral and cellular immune responses and provided a certain amount of protection against experimental T. gondii infection in selleck products BALB/c mice. Therefore, we suggest that the Toxoplasma gondii cyclophilin protein can be used as a potential vaccine candidate against toxoplasmosis. Additional studies on the antigen-combination vaccine and its protective efficiency in sheep

and other livestock will produce a better understanding Astemizole of how cyclophilin can be used to protect against protozoan diseases. This work was supported by the National Key Technology R & D Programme of China (No. 2008BAD96B11-3 & 2007BAD40B05). “
“T cells with a CD4+ CD8+ double-positive (DP) phenotype are present in small numbers in the peripheral blood of healthy humans and may have anti-viral capacities. Here we investigate numbers and function of DP T cells in patients with relapsing–remitting multiple sclerosis (MS), either treatment-naive or under therapy with natalizumab. Flow cytometry analysis revealed that frequencies of circulating DP T cells in treatment-naive and natalizumab-treated MS patients are comparable to healthy controls. These cells have a memory phenotype with cytotoxic potential, express high levels of CD49d and are similarly functional in treatment-naive as well as natalizumab-treated MS patients. DP T cells were enriched in the cerebrospinal fluid, but do not invade acutely inflamed MS lesions. In conclusion, DP T cells are functional in MS and may play a role in the immune surveillance of the central nervous system, but do not display functional impairment under natalizumab therapy.

At 2 weeks (primary endpoint), overall cure rate was superior in bifonazole-treated group (54.8% vs. 42.2% for placebo; P = 0.0024). The clinical cure rate was high in both

treatment groups (86.6% bifonazole vs. 82.8% placebo), but proportion with mycological cure was higher with bifonazole treatment (64.5%) vs. placebo treatment 49.0%, (P = 0.0001). We observed higher early overall cure rate with 4 weeks topical bifonazole compared with placebo after removal of infected nail parts with urea. This two stage treatment was well tolerated and offers an additional option in topical onychomycosis therapy. “
“Significant changes in the frequency of candidaemia and the distribution of causative species have been noted worldwide in the last two decades. In this study, we present the results of the first multicentre survey of fungaemia in Polish hospitals. A total of 302 candidaemia episodes in 294 Afatinib manufacturer patients were identified in 20 hospitals during a 2-year period. The highest number of infections was found in intensive care (30.8%) and surgical (29.5%) units, followed by haematological (15.9%), ‘others’ (19.2%) and neonatological (4.6%) units. Candida albicans was isolated from 50.96% of episodes; its prevalence was higher in intensive care unit and neonatology (61.22% and 73.33%, respectively),

and significantly lower in haematology (22%; P < 0.001). The frequency of C. krusei and C. tropicalis was significantly higher (24% and 18%) in haematology (P < 0.02); Metformin cell line whereas, the distribution of C. glabrata (14.1%) and C. parapsilosis (13.1%) did not possess statistically significant differences between compared departments. Obtained data indicates that species distribution of Candida blood isolates in Polish hospitals reflects worldwide trends, particularly a decrease in Cyclooxygenase (COX) the prevalence of infections due to C. albicans. “
“Diagnostic efficacy of Galactomannan

(GM) assay for invasive aspergillosis (IA) is variably reported. Data from developing countries are scant. Children with haematological malignancies and fever were enrolled prospectively. Blood sample for GM was drawn on the day of admission; levels were measured with Platellia Aspergillus enzyme immunoassay. Diagnostic criteria were adapted from EORTC-MSG-2002. Proven, probable and possible episodes were considered as the disease group. One hundred febrile episodes in 78 patients were evaluated. The mean age was 6.1 years. Majority (75%) episodes were in patients with acute lymphoblastic leukaemia. One episode each was diagnosed with proven and probable IA, while 23 were diagnosed with possible IA. Best results were obtained with a cut-off value of 1.0, with sensitivity, specificity, positive and negative predictive value of 60%, 93%, 75 and 87 respectively. The sensitivity dropped to 40%, at cut-off value of 1.5 and specificity was 38%, at a cut-off of 0.5.