Antenatal detection of congenital malformations by routine ultrasonography.

Performance of an artificial intelligence tool with real-time clinical workflow integration - Detection of intracranial hemorrhage and pulmonary embolism.

Background Nodular goiter is the most frequent disease of the thyroid gland, it may affect up to 50% of adults and elderly people, Although malignancy only occurs in about 5% of thyroid nodules, the detection rate of papillary thyroid carcinoma has increased consistently both in women and men and in all ethnic groups Thus, the task of differentiating malignant from benign nodules is necessary. Ultrasound elastography (USE) is a non-invasive, completely painless for the patient and can be easily performed even during routine ultrasound examinations. It assesses lesion stiffness by evaluating tissue distortion in response to stress. Objective Study the role of strain elastography in the characterization of benign and malignant nature of the thyroid nodule Compare the sensitivity and specificity of ultrasound elastography (USE) and fineneedle aspiration cytology (FNAC) as preoperative predictor of malignancy in order to decrease the need for FNAC. Cytology report is the gold standard/ histopathology report if available. Patients and Methods Type of Study: Cross-sectional study. Study Setting: The study was conducted at Ain Shams University Hospitals. Patients: 32 patients, 16 benign, and 16 malignant Patients with thyroid nodules proven by FNAC referred to Ain Shams University Radiology Unit. Results After analysis of strain index (SI) and the elasto score with FNAC we found the cut of point for thyroid malignancy was >1.4 and >2 respectively. The sensitivity and specificity of strain index (SI) for thyroid malignancy diagnosis were 100% and 75%, respectively. The positive and negative predictive values were 80% and 100%, respectively its p-value was 0.000, being a highly significant test.The US-elastography score’s sensitivity and specificity for thyroid malignancy diagnosis both were 81.25%. The positive and negative predictive values both were 81.2%, its pvalue was 0.000, being a highly significant test. After the Postoperative histopathology which is done to only ten patients of the 32 patients with available results (31.3%), 4 of them were benign (12.5%), and six were malignant (18.8%), We conclude that the Elasto ratio is the most sensitive diagnostic test with NPP (negative predictive value) of 100 % being the best screening test while the FNAC is the most specific test with PPV(positive predictive value) of 100 % being the best diagnostic test while the elasto score’s p-value was 0.065, being a a non-significant test. Despite this good diagnostic performance, USE with SI assessment not yet meets all requirements for an optimal diagnostic tool as its specificity is only 75%, while that of FNAC is almost reaching 100% compared to the postoperative histopathology Conclusion Strain elastography was highlighted as a good tool for pre-operative differentiation of benign from malignant lesions showing high sensitivity and moderate specificity compared to other studies, thus further decreasing thyroid biopsies and surgeries. The most reliable tool in our study was the elasto ratio having the highest sensitivity. Ultrasound examination in combination with elastography is a well-tolerated, non-invasive, and cost-effective diagnostic tool in the pre-operative assessment of thyroid nodules, which is able to enhance the accuracy of assessing the risk of malignancy in thyroid nodules and for selecting nodules for FNAC, thus can be used to postpone the FNAC to decrease the amount of the unnecessary FNAC.

Apathy in Dementia: An Examination of the Psychometric Properties of the Apathy Evaluation Scale

Ultrasound screening for fetal urinary tract malformations: a prospective study in general population

Vision Screening

This study assessed the sensitivity of routine ultrasound examination for the detection of abnormal chromosomes and structural malformations in fetuses in the second trimester in a non-selected population. Prenatal diagnoses of fetal abnormalities in 10 414 fetuses and newborns were reviewed and compared with all postnatal diagnoses of congenital abnormalities between 2006 and 2013. Overall, 243 fetuses and newborns had confirmed congenital abnormalities, with a prevalence of 2.3%. Of these fetuses and newborns, 23% (56/243) had chromosomal abnormalities (overall prevalence 0.5%), and 77% (187/243) had normal chromosomes with either major (44%; 82/187) or minor (56%; 105/187) structural malformations (overall prevalence 1.8%). One hundred and seven abnormalities were detected prenatally, yielding a total sensitivity for prenatal detection of fetal abnormalities of 44.0% (107/243; 95% CI 37.8-50.2), with specificity of 99.9%, a positive predictive value of 94.7%, and a negative predictive value of 98.7%. The sensitivity for prenatal detection before 22 weeks of gestation was 40.3% (98/243; 95% CI 34.1-46.5). The prenatal detection rate of chromosomal abnormalities was 60.7% (34/56) and, for structural malformations, was 39.0% (73/187). In a routine clinical setting at a county hospital with a non-selected population, half of the major structural malformations in chromosomally normal fetuses are detected by routine ultrasound examination in the second trimester. Chromosomal abnormalities have the highest probability for prenatal detection; the majority are diagnosed by amniocentesis before the routine ultrasound examination in high-risk women.

Objective To study the efficacy of intraoperative neuromonitoring with SEP, MEP and EMG to predict of spinal cord and nerve root injury during surgery for chronic cervical compressive myelopathy. Methods From October 2014 to June 2016, 107 patients (80 males, 27 females) who underwent surgery for chronic cervical compressive myelopathy and intra-operative neuromonitoring with SEP, MEP and EMG were enrolled in this study. The mean age was 53.36±11.35 years (24-79 years), and the mean follow-up time was 7.94±6.05 months (1-18 months). The monitoring method, abnormal alarm, treatment and outcome of intraoperative SEP, MEP and EMG were recorded in all patients. The preoperative, postoperative and last follow-up neurologic functions were compared. True positive, false positive, true negative and false negative cases were collected in all patients. Sensitivity, specificity, positive predictive value and negative predictive value were calculated, and the utility of monitor spinal cord and nerve root injury was analyzed. Results SEP, MEP and EMG baseline values of 107 patients were established at the end of exposure. A total of 8 patients with intraoperative neurophysiology monitoring were abnormal (4 cases of anterior surgery, 4 cases of posterior surgery), including 1 case with abnormal SEP and MEP, but EMG was normal, he became incomplete paralysis postoperatively; 4 cases with abnormal MEP and EMG, but SEP was normal, they suffered C5 nerve root palsy postoperatively; 2 cases with abnormal MEP, while SEP and EMG were normal, one was C5 nerve root palsy and another was incomplete paralysis for the right side of the limb postoperatively; 1 case with abnormal EMG, but SEP and MEP were normal, he was C5 nerve root palsy postoperatively. 1 patient with anterior surgery was false negative of intraoperative neurophysiology monitoring, it was not found abnormal during surgery, but the patient was C5 nerve root palsy after operation. The utility of monitor spinal cord injury, the sensitivity and specificity of SEP was 50% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 99.06%. The sensitivity and specificity of MEP were 100%, positive predictive value and negative predictive value were 100%. The effect of monitor nerve root injury, the sensitivity and specificity of SEP was 0 and 100%, respectively. The positive predictive value was 0 and the negative predictive value was 93.46%. The sensitivity and specificity of MEP was 71.43% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 98.04%. The sensitivity and specificity of EMG sensitivity was 71.43% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 98.04%. Conclusion During operation of chronic cervical compressive myelopathy, SEP and MEP for spinal cord injury monitoring, and MEP and EMG for nerve root injury monitoring were effective ways to promise comprehensive monitor the spinal cord and nerve root system. Key words: Cervical vertebrae; Spinal cord compression; Evoked potentials, somatosensory; Evoked potentials, motor; Electromyography

Fine-needle aspiration of clinically suspicious palpable breast masses with histopathologic correlation

To examine the accuracy of sonographic findings of routine ultrasound examinations in patients with a proven histological diagnosis of complete or partial hydatidiform mole referred to a supra-regional referral center, and to examine the relationship of sonographic findings to gestational age across the first and early second trimesters. Review of consecutive cases referred to a trophoblastic disease unit from June 2002 to January 2005 with a diagnosis of possible or probable hydatidiform mole in whom results of a pre-evacuation ultrasound examination were documented. Ultrasound detection rates for partial and complete hydatidiform moles were calculated and comparison of detection rates between complete and partial mole, and gestational age groups carried out. 1053 consecutive cases were examined. The median maternal age was 31 (range, 15-54) years and the median gestational age was 10 (range, 5-27) weeks. 859 had a final review diagnosis of partial or complete hydatidiform mole (82%), including 253 (29%) complete moles and 606 (71%) partial moles. Non-molar hydropic miscarriage was diagnosed following histological review in 194 (18%). Overall, 378 (44%) cases with a final diagnosis of complete or partial hydatidiform mole had a pre-evacuation ultrasound diagnosis suggesting hydatidiform mole, including 200 complete moles and 178 partial moles, representing 79% and 29%, respectively, of those with complete (253) or partial (606) moles in the final review diagnosis. The ultrasound detection rate was significantly better for complete versus partial hydatidiform moles (Z = 13.4, P < 0.001). There was a non-significant trend towards improved ultrasound detection rate with increasing gestational age, with an overall detection rate of 35-40% before 14 weeks' gestation compared to around 60% after this gestation. The sensitivity, specificity, positive predictive value and negative predictive value for routine pre-evacuation ultrasound examination for detection of hydatidiform mole of any type were 44%, 74%, 88% and 23%, respectively. Routine pre-evacuation ultrasound examination identifies less than 50% of hydatidiform moles, the majority sonographically appearing as missed or incomplete miscarriage. Detection rates are, however, higher for complete compared to partial moles, and improve after 14 weeks' gestation. Histopathological examination of products of conception remains the current gold standard for the identification of gestational trophoblastic neoplasia.

Noninvasive Prenatal Test Raises Concern Over Screening Strategies and the Role of Ultrasound

Although prenatal ultrasound (US) is a common clinical undertaking today, little information is available about women's experience of the procedure from the perspective of women themselves. The objective of this study was to explore women's experience of undergoing a routine prenatal US examination associated with an unexpected fetal diagnosis. Qualitative methods were used to explore the prenatal US experience of 13 women. Five women were given unexpected news of multiple pregnancy and eight women were given unexpected news of congenital fetal abnormality. One in-depth audio-taped interview was conducted with each woman. Content analysis of interview data identified themes common to women's experience of US. Identified themes of women's experience of routine prenatal US examination associated with an unexpected fetal diagnosis are: experiencing the setting, sensing information, feeling connected/disconnected, the power of the image, and communication rules. Women's experience of prenatal US examination is influenced by physical and environmental factors and by the behaviors of the US examiner. Behaviors of the examiner contribute to a woman's labeling of the US experience as positive or negative. Women identify being objectified by the examination and experience poor communication patterns after a fetal US diagnosis. Women's description of the US screen image as a baby suggests it is a powerful influence on subsequent clinical and ethical decision-making about the pregnancy.

Many countries have seen a decline in recidivism rates over the past decades. These base rates are pertinent information for assessing the recidivism risk of offenders. They provide a foundation for clinical assessment and an empirical basis for risk assessment instrument norms, which inform expected recidivism rates. The present study explored the extent to which base rates influence the validity of risk assessment instruments. We systematically reviewed the available evidence on the discrimination ability of four well-established risk assessment instruments used to estimate the probability of recidivism for general (Level of Service Inventory-Revised [LSI-R]), violent (Violence Risk Appraisal Guide [VRAG]), sexual (Static-99R), and intimate partner violent offences (Ontario Domestic Assault Risk Assessment [ODARA]). We conducted a bivariate logit-normal random effects meta-analysis of sensitivity and false positive rates and modelled the positive and negative predictive values. We used base rates as reported in (a) the construction samples of each risk assessment instrument and (b) recent official statistics and peer-reviewed articles for different offence categories and countries. To assess the risk of bias, we used the Joanna Briggs Institute Critical Appraisal Checklist for Diagnostic Test Accuracy Studies. We screened 644 studies and subsequently analysed 102, of which 96 were included in the systematic review and 24 in the meta-analyses. Discrimination was comparable for all four instruments (median area under the curve = 0.68-0.71). The information needed to calculate summary statistics of sensitivity and false positive rate was often not reported, and a risk of bias may be present in up to half of the studies. The largest summary sensitivity and false positive rate were estimated for the ODARA, followed by the LSI-R, the VRAG, and the Static-99R. If base rates are low, positive predictive values tend to be relatively low, while negative predictive values are higher: positive predictive value = 0.032-0.133 and negative predictive value = 0.985-0.989 for sexual offences; positive predictive value = 188-0.281 and negative predictive value = 0.884-0.964 for intimate partner violence; positive predictive value = 0.218-0.241 and negative predictive value = 0.907-0.942 for violent offences; positive predictive value = 0.335-0.377 and negative predictive value = 0.809-0.810 for general offences. When interpreting the results of individual risk assessments, it is not sufficient to provide the discrimination of the instrument; the risk statement must also address the positive predictive value and discuss its implications for the specific case. As recidivism rates are neither stable over time nor uniform across countries or samples, the primary interpretation of risk assessment instruments should rely on the percentile rank. Expected recidivism rates should be interpreted with caution. However, our results are drawn from a limited database, as studies not reporting sufficient information were excluded from analyses and it was only possible to identify current base rates for modelling positive and negative predictive values for certain countries. International standards for consistently collecting and reporting base rates are important to better identify crime trends. Future research on the validity of risk assessment instruments should follow rigorous reporting standards.

Validity of Self-Reported Psoriasis in a General Population: The HUNT Study, Norway

Objective To investigate the application value of two-dimensional combined four-dimensional ultrasound in the diagnosis of prenatal fetal malformation. Methods A total of 1 532 pregnant women from January 2013 to February 2018 in Huozhou People’s Hospital were selected for retrospective analysis on prenatal ultrasound examination data. A total of 1 532 pregnant women were screened by two-dimensional ultrasound for prenatal screening, two-dimensional ultrasound and four-dimensional ultrasound examination were performed on those suspected fetal malformation, and the examination results were compared with the results of induction or delivery. The diagnostic effect of two-dimensional ultrasound and two-dimensional combined with four-dimensional ultrasound fetal malformation was companed. Results In 1 532 pregnant women, 40 cases of malformed fetuses were confirmed by childbirth or induction of labor. Two-dimensional combined with four-dimensional ultrasound checked out 39 cases of malformed fetus. The diagnostic sensitivity of two-dimensional combined with four-dimensional ultrasound (95.00%) was higher than that of two-dimensional ultrasound (75.00%), and the positive predictive value (97.44%) was higher than that of two-dimensional ultrasound (43.48%), The difference was significant (P<0.05). After delivery or induction of labor, the number of deformities was 52, two-dimensional combined with four-dimensional ultrasound diagnosis missed 4 cases of fetal malformation, and misdiagnosed 2 cases; two-dimensional ultrasound diagnosis missed 12 cases of fetal malformation, misdiagnosed 71 cases. Conclusions Two-dimensional combined with four-dimensional ultrasound has higher diagnostic sensitivity and positive predictive value for prenatal fetal malformation, which has less missed diagnosis and misdiagnosis, and can detect fetal malformation in time. So it is beneficial to the quality of birth population in China. Key words: Two-dimensional ultrasound; Four-dimensional ultrasound; Fetal malformation

Objective: To investigate the diagnostic role of ^99mTc-tetrofosmin in the detection of primary breast cancer and axillary lymph node metastasis and to compare the findings with those of ^99mTc-MIBI. Methods: Forty-eight patients with clinically palpable masses or abnormal radiologic findings had ^99mTc-MIBI and ^99mTc-tetrofosmin scintimammographies (SMMs) after intravenous injections of 925 MBq of radiopharmaceuticals. The SMMs were correlated with histopathologic findings. Results: Thirty-three patients were diagnosed with breast cancer and 15 patients with benign breast diseases. The number of true positive, true negative, false positive, and false negative cases of ^99mTc-tetrofosmin SMM were 31, 10, 5, and 2, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of ^99mTc-tetrofosmin SMM were 93.9, 66.7, 86.1 and 73.3%, respectively. The number of true positive, true negative, false positive, and false negative cases of ^99mTc-MIBI SMM was 29, 10, 5, and 4, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of ^99mTc-MIBI SMM were 87.8, 66.7, 85.3 and 73.3%, respectively. In assessment of axillary lymph node involvement, ^99mTc tetrofosmin SMM demonstrated 31.8, 100, 100, and 42.3% sensitivity, specificity, positive and negative predictive values, respectively. The sensitivity and specificity of ^99mTc-MIBI SMM was 22.7 and 100%. Positive and negative predictive values were 100 and 39.3%, respectively. One patient was false negative in both ^99mTc-MIBI and ^99mTc-tetrofosmin SMMs with a tumor size of 0.5 cm. Conclusion:^99mTc-tetrofosmin and ^99mTc-MIBI SMMs were noninvasive and useful in the detection of primary breast cancer and ^99mTc tetrofosmin was comparable to ^99mTc-MIBI in the detection of primary breast cancer. However, both radiopharmaceuticals had limited values in the assessment of axillary lymph node involvement.