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Background: Several surgical techniques have been proposed for massive rotator cuff tears (MRCTs), but the failure rates remain high. The suture-spanning augmentation technique of single-row (SSA-SR) repair was shown to reduce failure rates in cadaveric studies, but the outcome in vivo remains unclear. Purpose: To determine if adding spanning sutures to SR repair during MRCT repairs can improve functional outcome and reduce failure rates. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: The study included 71 patients with a diagnosed MRCT. The study group (n = 35) received SSA-SR repair. The control (n = 36) received SR repair. The American Shoulder and Elbow Surgeons (ASES) score, Constant score, UCLA (University of California, Los Angeles) score, and visual analog scale for pain were assessed preoperatively and 24 months postoperatively. Magnetic resonance imaging was arranged at 6 months postoperatively to evaluate the rotator cuff. Results: At 6 months postoperatively, the overall retear rate was 31.0%. The retear rate was lower in the SSA-SR group (14.3%) than in the SR group (47.2%, P =.002). At 24 months, the SSA-SR group had markedly improved ASES, Constant, and UCLA scores in comparison with the SR group (P <.05). Within both groups, all scores had significant improvement as compared with the preoperative status (P <.05). Conclusion: The SSA-SR repair technique showed improved functional and radiologic results. Based on the superior postoperative outcome of this technique, the SSA-SR repair technique can be a potential treatment option for MRCT repair. Registration: NCT03609164 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Highlights: [•] F3 layer features at a low-latitude region of China are investigated first. [•] Comparison study of F3 layer characteristics under different solar activity conditions. [•] Some physical explanations about the discrepancy of F3 layer for different regions are given. [Copyright &y& Elsevier]

Abstract: The potential energy curves (PECs) of the ground state X1Σ+ and two low-lying excited states 13Σ+ and 13П of KRb molecule have been calculated using the multireference configuration interaction method and the effective core potential basis set. The PECs are fitted into analytical potential energy functions (APEFs) using the Morse long-range potential. The spectroscopic parameters for the states are determined using the analytical derivatives of APEFs. The vibrational energy levels have been calculated by solving the radial Schrödinger equation of nuclear motion based on the APEFs, and compared with the theoretical and experimental works available at present. [Copyright &y& Elsevier]

Obstructive sleep apnea (OSA) has become an important public health concern. Polysomnography (PSG) is traditionally considered an established and effective diagnostic tool providing information on the severity of OSA and the degree of sleep fragmentation. However, the numerous steps in the PSG test to diagnose OSA are costly and time consuming. This study aimed to apply the multiclass Mahalanobis-Taguchi system (MMTS) based on anthropometric information and questionnaire data to predict OSA. Implementation results showed that MMTS had an accuracy of 84.38% on the OSA prediction and achieved better performance compared to other approaches such as logistic regression, neural networks, support vector machine, C4.5 decision tree, and rough set. Therefore, MMTS can assist doctors in prediagnosis of OSA before running the PSG test, thereby enabling the more effective use of medical resources. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, Hamilton’s principle, Lagrange multiplier, geometric constraints, partitioning method and Baumgarte stabilization method (BSM) are employed to derive the dynamic equations of a spatial slider–crank mechanism that is driven by a servomotor. The formulation considers the effects of links masses, external forces and motor electric inputs. Comparing dynamic responses between the experimental results and numerical simulations, dynamic modeling gives a wonderful interpretation for the spatial slider–crank mechanism. In this paper, a new identification method based on real-coded genetic algorithm (RGA) is presented to identify the parameters of a spatial slider–crank mechanism. The method promotes the calculation efficiency very much, and is calculated by real-code without the operations of encoding and decoding. The results of numerical simulations and experimental results prove that the identification method is feasible. The contributions of this paper are that the comparison of mathematical modeling and identification between numerical simulations and experimental results are all realized. [Copyright &y& Elsevier]

Efficient detection of HCV RNA in serum is critical for the diagnosis of hepatitis C virus (HCV) infection. Various nucleic acid extraction methods have been used to extract viral RNA for real-time reverse transcription PCR (RT-PCR). However, the efficiencies of extraction methods for HCV RNA in sera collected from individuals with hyperlipidemia, hyperbilirubinemia and hyperglobulinemia have not been investigated. In the present study, the efficiencies of three extraction methods, i.e., Trizol, guanidine isothiocyanate and silica nanoparticles, were evaluated and compared. All serum samples were collected from HCV-infected patients. For serum samples in which bilirubin, lipids and globulins were all within the normal range, the medians of HCV RNA concentration with Trizol, guanidine isothiocyanate and silica method were 2.25 × 10 4 , 2.80 × 10 4 and 3.26 × 10 5 IU/ml HCV RNA respectively ( n = 180). For hyperlipidemia serum samples, the medians were 6.70 × 10 3 , 8.79 × 10 3 and 1.10 × 10 6 respectively ( n = 158). For hyperbilirubinemia serum samples, the medians were 5.71 × 10 4 , 1.59 × 10 5 and 1.09 × 10 6 respectively ( n = 107). For hyperglobulinemia serum samples, the medians were 3.44 × 10 4 , 3.10 × 10 4 and 3.06 × 10 5 respectively ( n = 71). The medians were highest with silica method from all these types of serum samples. The silica method is, therefore, efficient for HCV RNA extraction even for sera from hyperlipidemia, hyperbilirubinemia and hyperglobulinemia patients. [ABSTRACT FROM AUTHOR]

Model selection in the presence of interaction terms is challenging as the final model must maintain a hierarchy between main effects and interaction terms. This work presents two stagewise estimation approaches to appropriately select models with interaction terms that can utilize generalized estimating equations to model clustered data. The first proposed technique is a hierarchical lasso stagewise estimating equations approach, which is shown to directly correspond to the hierarchical lasso penalized regression. The second is a stagewise active set approach, which enforces the variable hierarchy by conforming the selection to a properly growing active set in each stagewise estimation step. The effectiveness in interaction selection and the superior computational efficiency of the proposed techniques are assessed in simulation studies. The new methods are applied to a study of hospitalization rates attributed to suicide attempts among 15 to 19 year old at the school district level in Connecticut. [ABSTRACT FROM AUTHOR]

Lung cancer is a major reason of mortalities. Estimating the survivability for this disease has become a key issue to families, hospitals, and countries. A conditional Gaussian Bayesian network model was presented in this study. This model considered 15 risk factors to predict the survivability of a lung cancer patient at 4 severity stages. We surveyed 1075 patients. The presented model is constructed by using the demographic, diagnosed-based, and prior-utilization variables. The proposed model for the survivability prognosis at different four stages performed R2 of 93.57%, 86.83%, 67.22%, and 52.94%, respectively. The model predicted the lung cancer survivability with high accuracy compared with the reported models. Our model also shows that it reached the ceiling of an ideal Bayesian network. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction (AMI) induces blood leukocytosis, which correlates inversely with patient survival. The molecular mechanisms leading to leukocytosis in the infarcted heart remain poorly understood. Using an AMI mouse model, we identified gasdermin D (GSDMD) in activated leukocytes early in AMI. We demonstrated that GSDMD is required for enhanced early mobilization of neutrophils to the infarcted heart. Loss of GSDMD resulted in attenuated IL-1β release from neutrophils and subsequent decreased neutrophils and monocytes in the infarcted heart. Knockout of GSDMD in mice significantly reduced infarct size, improved cardiac function, and increased post-AMI survival. Through a series of bone marrow transplantation studies and leukocyte depletion experiments, we further clarified that excessive bone marrow-derived and GSDMD-dependent early neutrophil production and mobilization (24 hours after AMI) contributed to the detrimental immunopathology after AMI. Pharmacological inhibition of GSDMD also conferred cardioprotection after AMI through a reduction in scar size and enhancement of heart function. Our study provides mechanistic insights into molecular regulation of neutrophil generation and mobilization after AMI, and supports GSDMD as a new target for improved ventricular remodeling and reduced heart failure after AMI. [ABSTRACT FROM AUTHOR]

Background: To our knowledge, there have been no studies that have examined affective temperament traits in offspring of parents with bipolar disorder (BD). The aim of this study was to identify affective temperamental characteristics and their relationships with cognitive functions in BD offspring.Methods: A group of BD offspring were enrolled in this study. Subthreshold symptoms were used to categorize participants as either symptomatic offspring (SO) (n=60) or asymptomatic offspring (AO) (n=52). Healthy controls (HCs; n=48) were also enrolled for comparison. We used the Chinese Short Version of Temperament Evaluation of Memphis, Pisa, Paris, and San Diego, Auto-questionnaire (TEMPS-A) to measure temperament traits, and MATRICS Consensus Cognitive Battery (MCCB) to measure cognitive functions.Results: We observed higher cyclothymic, irritable, depressive and anxious temperament scores in SO than AO when compared to HCs. In BD offspring (SO and AO), cyclothymic individuals performed better in processing speed and verbal learning than depressive individuals and better in attention/vigilance than irritable and anxious individuals; hyperthymic individuals performed better in processing speed than depressive individuals. We also observed that a higher cyclothymic score was associated with better verbal learning and verbal fluency, a higher hyperthymic score was associated with better processing speed and verbal learning; while a higher depressive score was associated with worse processing speed, verbal learning and verbal fluency and a higher irritable score was associated with worse attention/vigilance.Conclusions: The relationships between cognitive functions and measures of temperament suggest that these features may share neurobiological substrates and appear to be heritable. [ABSTRACT FROM AUTHOR]

Objectives: The characteristics and efficacy of epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) in advanced EGFR-mutant lung adenocarcinoma patients with primary tumor resection (PTR) is not yet clear. Methods: We enrolled advanced EGFR-mutant lung adenocarcinoma patients with EGFR-TKI as first-line therapy to access the impact of PTR on the outcomes. Results: A total of 466 patients were enrolled with 76 patients (16.3%) undergoing PTR; 59 patients recurred after curative surgery, while 17 patients underwent surgery as diagnostic purposes. PTR patients displayed a better performance status, a lower metastatic burden, and much less measurable diseases (30.3 vs. 97.4%, p < 0.001). PTR patients experienced a significantly longer progression-free survival (25.1 [95% CI 16.6–33.7] vs. 9.4 [95% CI 8.4–10.4] months; aHR 0.40 [95% CI 0.30–0.54], p < 0.001) and overall survival (56.8 [95% CI 36.3–77.2] vs. 31.8 [95% CI 28.2–35.4] months; aHR 0.57 [95% CI 0.39–0.84], p = 0.004). Survival advantage was still observed while comparing PTR patients with the better performance and lower metastatic burden subgroup found within the non-resection group. Moreover, the progression-free survival and overall survival of 11 patients who were found having pleural metastases during surgery and underwent PTR plus pleural biopsy, were also longer than those with pure N0--1/M1a-malignant pleural effusion disease in the non-resection group (n = 19) (p < 0.001 and p = 0.002, respectively). Conclusion: PTR was associated with significantly better outcomes in advanced lung adenocarcinoma patients treated with EGFR-TKI. Further studies are needed to evaluate the biological role of PTR among these patients. [ABSTRACT FROM AUTHOR]

Objective: Cataplexy is a pathognomonic symptom of narcolepsy type 1. This study was conducted to clarify the clinical characteristics of cataplexy by staging, and to further analyse the correlations of clinical features and cataplectic stages in patients with narcolepsy type 1 (NT1).Methods: We experimentally triggered patients with NT1 into cataplexy while under video-polysomnography (v-PSG) monitoring in the sleep lab. The most serious cataplectic attack from each patient was analysed. Each cataplectic episode was segmented into four stages according to the v-PSG. Correlations were analysed between cataplectic stages in pairs, and between cataplectic stages and other clinical features.Results: We observed 81 cataplectic episodes in 21 patients with diverse triggers, including humorous or exciting videos, tickling, recalling horrible memories and exercising. Nine patients (43%) went through complete cataplectic attacks while the others experienced partial attacks. Four cataplectic stages (ie, triggering, resisting, atonic, and recovering) were identified according to clinical and electromyograms characteristics. Resisting stage is predominant (56.4%) in cataplexy, while atonic stage is most related with the total duration of cataplexy. The Epworth Sleepiness Scale score (ESS) has a positive correlation with the total duration of cataplexy. Both duration of cataplexy and ESS score are negatively correlated with disease course. However, medication history seems have no influence on either cataplexy duration or ESS score.Conclusion: Four-stage segmentation shows the dynamic process of the cataplectic attack, which is different from the traditional classification of complete or partial cataplexy. Resisting stage is necessary for every cataplexy and might reflect the compensation mechanism, while atonic stage may be omitted in some patients. The severity of narcolepsy reduces with the extension of natural course regardless of medication history. [ABSTRACT FROM AUTHOR]

The tumor necrosis factor receptor-associated factor 7 (TRAF7) is a component of the tumor necrosis factor alpha (TNF-α)/nuclear factor kappa B (NF-κB) pathway and is a putative E3-ubiquitin ligase. Based on importance of chronic inflammation in hepatocellular carcinoma (HCC), we investigated the biological effects and the molecular mechanisms of deregulated TRAF7 signaling in HCC. Our results showed that high TRAF7 expression in HCC samples was inversely associated with Krüppel-like factor 4 (KLF4) expression and the prognosis of HCC patients. TRAF7 could degrade KLF4 protein through ubiquitin by interacting with its N-terminus. The up-regulation of TRAF7 promoted HCC cell migration and invasion in vivo and in vitro, and TRAF7 knockdown had the opposite effects. Restoration of KLF4 abrogated the motility promotion induced by TRAF7. TRAF7 promotes HCC cell motility through inducing KLF4 protein turnover. [ABSTRACT FROM AUTHOR]

This paper examines production efficiency of coastal region and non-coastal region in Mainland China between 2000 and 2010 using one-step stochastic frontier analysis and two-step metafrontier model. Unlike previous studies, this study not only discusses production efficiencies but also considers differences in production patterns. The empirical results indicate that coastal region has better production performance in metafrontier technology efficiency (MTE) and technology gap ratio (TGR). In addition, this study finds that the gap of MTE and TGR between coastal region and non-coastal region is increasing for the past years. [ABSTRACT FROM AUTHOR]

Background: Current knowledge on objective and specific neural markers for bipolar risk and resilience-related processes is lacking, partly due to not subdividing high-risk individuals manifesting different levels of subclinical symptoms who possibly possess different levels of resilience.Methods: We delineated grey matter markers for bipolar illness, genetic high risk (endophenotype) and resilience, through comparing across 42 young non-comorbid bipolar patients, 42 healthy controls, and 72 diagnosis-free, medication-naive high-genetic-risk individuals subdivided into a combined-high-risk group who additionally manifested bipolar risk-relevant subsyndromes (N = 38), and an asymptomatic high-risk group (N = 34). Complementary analyses assessed the additional predictive and classification values of grey matter markers beyond those of clinical scores, through using logistic regression and support vector machine analyses.Results: Illness-related effects manifested as reduced grey matter volumes of bilateral temporal limbic-striatal and cerebellar regions, which significantly differentiated bipolar patients from healthy controls and improved clinical classification specificity by 20%. Reduced bilateral cerebellar grey matter volume emerged as a potential endophenotype and (along with parieto-occipital grey matter changes) separated combined-high-risk individuals from healthy and high-risk individuals, and increased clinical classification specificity by approximately 10% and 27%, respectively, while the relatively normalized cerebellar grey matter volumes in the high-risk sample may confer resilience.Limitations: The cross-validation procedure was not performed on an independent sample using independently-derived features. The BD group had different age and sex distributions than some other groups which may not be fully addressable statistically.Conclusions: Our framework can be applied in other measurement domains to derive complete profiles for bipolar patients and at-risk individuals, towards forming strategies for promoting resilience and preclinical intervention. [ABSTRACT FROM AUTHOR]

Background: The fecal immunochemical test (FIT) has been widely used in preliminary screening for colorectal cancer (CRC). The high-risk factor questionnaire (HRFQ) and quantitative risk-assessment method (QRAM) are recommended for estimating the risk of CRC qualitatively and quantitatively in China.Aim: We aimed to prospectively compare the diagnostic values of CRC preliminary screening methods to identify which method is preferable as a screening strategy.Methods: Individuals aged 40-74 years old were enrolled in a mass CRC screening program from January 1, 2007 to December 31, 2014, in Jiashan County, Zhejiang Province, China. FIT of two stool specimens at 1-week intervals was performed by laboratory personnel and face-to-face interviews were conducted by trained investigators. Screening data in the program were linked to a CRC surveillance and registry system, and CRC cases reported in the system were regarded as true patients.Results: A total of 96,043 subjects were included. The sensitivity and specificity of FIT for detecting CRC cases were 75.49% (95% CI 69.84-80.39) and 90.36% (95% CI 90.17-90.54), respectively. QRAM was more sensitive (p < 0.001) and less specific (p < 0.001) than HRFQ. The sensitivity and specificity of FIT along with HRFQ were 86.56% (95% CI 81.81-90.22) and 81.37% (95% CI 81.12-81.62), and those of FIT along with QRAM were 88.93% (95% CI 84.47-92.23) and 73.95% (95% CI 73.67-74.23).Conclusions: Our findings suggest that CRC preliminary screening with FIT and QRAM in parallel has high sensitivity and satisfactory specificity, and is a useful strategy in mass screening programs. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the effects of water regime/soil condition (continuous flooding, saturated, and aerobic), cultivar (‘Cocodrie’ and ‘Rondo’), and soil texture (clay and sandy loam) on rice grain yield, yield components and water productivity using a greenhouse trial. Rice grain yield was significantly affected by soil texture and the interaction between water regime and cultivar. Significantly higher yield was obtained in continuous flooding than in aerobic and saturated soil conditions but the latter treatments were comparable to each other. For Rondo, its grain yield has decreased with soil water regimes in the order of continuous flooding, saturated and aerobic treatments. The rice grain yield in clay soil was 46% higher than in sandy loam soil averaged across cultivar and water regime. Compared to aerobic condition, saturated and continuous flooding treatments had greater panicle numbers. In addition, panicle number in clay soil was 25% higher than in sandy loam soil. The spikelet number of Cocodrie was 29% greater than that of Rondo, indicating that rice cultivar had greater effect on spikelet number than soil type and water management. Water productivity was significantly affected by the interaction of water regime and cultivar. Compared to sandy loam soil, clay soil was 25% higher in water productivity. Our results indicated that cultivar selection and soil texture are important factors in deciding what water management option to practice. [ABSTRACT FROM AUTHOR]

We aimed to evaluate the long-term efficacy of the hepatitis B vaccine in China. In an initial efficacy study, participants were collected from a cluster-randomized clinical trial conducted in 1983-90 in Qidong. All the participants in the vaccination group were vaccinated at birth, 1 and 6 months of age, and no intervention was implemented to the control group. In this 37-year extended follow-up study, the Poisson regression method was employed to derive rates per 105 person-years. The frailty Cox proportional hazard regression models obtained the hazard ratio (HR). Cumulative incidence/mortality rates were calculated and compared with log-rank tests. 41,136 in the vaccination and 41,730 in the control group were recorded. The incidence rate of liver cancer was significantly lower in the vaccinated group than in the control group [HR, 0.28; 95% confidence interval (CI) 0.11-0.70, P = 0.007]. The vaccine offers 72% (95% CI, 30-89) protection to prevent the occurrence of liver cancer. There is 70% (95% CI, 23-88) protective efficacy against liver cancer deaths and 64% (95% CI, 27-82) benefits in the prevention of deaths associated with liver diseases. Hepatitis B vaccine given at birth shows excellent protective effects in preventing the development of liver cancer and reducing mortality from liver cancer and liver diseases. [ABSTRACT FROM AUTHOR]

Background: NAD(H) kinase (NADK) is the key enzyme that catalyzes de novo synthesis of NADP(H) from NAD(H) for NADP(H)-based metabolic pathways. In plants, NADKs form functional subfamilies. Studies of these families in Arabidopsis thaliana indicate that they have undergone considerable evolutionary selection; however, the detailed evolutionary history and functions of the various NADKs in plants are not clearly understood. Principal Findings: We performed a comparative genomic analysis that identified 74 NADK gene homologs from 24 species representing the eight major plant lineages within the supergroup Plantae: glaucophytes, rhodophytes, chlorophytes, bryophytes, lycophytes, gymnosperms, monocots and eudicots. Phylogenetic and structural analysis classified these NADK genes into four well-conserved subfamilies with considerable variety in the domain organization and gene structure among subfamily members. In addition to the typical NAD_kinase domain, additional domains, such as adenylate kinase, dual-specificity phosphatase, and protein tyrosine phosphatase catalytic domains, were found in subfamily II. Interestingly, NADKs in subfamily III exhibited low sequence similarity (∼30%) in the kinase domain within the subfamily and with the other subfamilies. These observations suggest that gene fusion and exon shuffling may have occurred after gene duplication, leading to specific domain organization seen in subfamilies II and III, respectively. Further analysis of the exon/intron structures showed that single intron loss and gain had occurred, yielding the diversified gene structures, during the process of structural evolution of NADK family genes. Finally, both available global microarray data analysis and qRT-RCR experiments revealed that the NADK genes in Arabidopsis and Oryza sativa show different expression patterns in different developmental stages and under several different abiotic/biotic stresses and hormone treatments, underscoring the functional diversity and functional divergence of the NADK family in plants. Conclusions: These findings will facilitate further studies of the NADK family and provide valuable information for functional validation of this family in plants. [ABSTRACT FROM AUTHOR]

BACKGROUND: In clinical trials, combined 5-fluorouracil (5FU) plus oxaliplatin improves the survival of patients who have resected, stage III colon cancer with manageable toxicity. However, the tolerability of this in the general population of patients with colon cancer is uncertain. METHODS: Adverse outcomes were compared in patients with stage III colon cancer who received either 5FU or 5FU/oxaliplatin within 120 days of undergoing resection versus a control group of patients with stage II colon cancer who did not receive chemotherapy in the Surveillance, Epidemiology, and End Results (SEER)-Medicare database and in data from the New York State Cancer Registry linked to Medicare and Medicaid. Hospitalizations, emergency room (ER) visits, and outpatient adverse events (AEs) were measured in claims from 30 days to 9 months after patients underwent resection. Multiple logistic regression was used to calculate adjusted odds ratios of events by treatment. Propensity score matching was used to minimize selection bias. RESULTS: Adverse outcomes were more frequent for chemotherapy recipients. AE rates were higher in patients who received 5FU/oxaliplatin (81%) compared with patients who received 5FU alone (72%), in the SEER-Medicare data. The effect of oxaliplatin on AEs was greater in older patients: The odds ratio was 2.10 (95% confidence interval, 1.53-2.87) for patients aged ≥75 years versus 1.75 (95% confidence interval, 1.39-2.21) for patients aged <75 years. ER use was high in Medicaid patients (83% of those who received chemotherapy), but neither ER use nor hospitalization was increased by oxaliplatin. The 60-day mortality rate was 1% to 3% for patients who received 5FU alone and 1% to 2% for patients who received combined 5FU/oxaliplatin. CONCLUSIONS: The incremental harms of adjuvant chemotherapy with 5FU/oxaliplatin versus 5FU alone were modest in patients with stage III colon cancer who were insured by Medicare and Medicaid. The additional harms in patients aged ≥75 years largely were restricted to outpatient events and did not extend to an increased rate of hospitalization or early death. Cancer 2012. © 2012 American Cancer Society [ABSTRACT FROM AUTHOR]

Our aim in this study was to analyze the footprint measurements of flatfoot in a population of preschool-aged children. Three footprint measurements, the Clarke's angle (CA), Chippaux-Smirak index (CSI), and Staheli arch index (AI), were used for comparison with clinical diagnosis. A total of 2,638 static footprints of children aged from 3 to 6 years were recorded. The clinical diagnosis as a gold standard compared with the results of the CA, CSI, and AI and displayed in a receiver operating characteristic (ROC) curve. In order to illustrate the diagnostic accuracy in clinical settings, their likelihood ratios were calculated given their cutoff points, and their pretest/posttest probabilities were plotted as the Fagan nomogram. The optimal cutoff points for CA, CSI, and AI were 14.04°, 62.70%, and 107.42%, respectively, and all of them showed high sensitivity. The areas under curves were 0.91, 0.95, and 0.92, respectively. The positive predictive values were 0.84, 0.91, and 0.85, and the negative predictive values were 0.82, 0.85, and 0.85, respectively. The positive likelihood ratio values for CA, CSI, and AI were 4.09, 7.52, and 4.61, and the negative likelihood ratio values were 0.18, 0.14, and 0.13, respectively. In conclusion, this study demonstrated that footprint analysis methods are suitable for diagnosing flatfoot in preschool-aged children, and that the most appropriate cutoffs are as follows: CA ≤ 14.04°, CSI > 62.70%, and AI > 107.42%. The CSI had a predictive probability of more than 90% and is recommended in screening for flatfoot in preschool-aged children. [ABSTRACT FROM AUTHOR]