Gastrostomy tube check radiographs: performance of an alternative diagnostic exam

Reports of radiographic exam evaluation for G-tube malposition in children are limited. Evaluate effectiveness of a new 2-view abdominal radiograph exam protocol instituted to provide 24/7 coverage at 2 affiliated hospitals and replace the prior fluoroscopic G-tube contrast check exam. G-tube radiographic exams performed between December 2019 and May 2022 at 2 affiliated hospitals were identified and retrospective chart review was performed to delineate exam test yield, accuracy, sensitivity, specificity. Additional data collected included exam adherence to protocol, years of experience of the reporting pediatric radiologist, reporting time, and 30-day adverse events. 227 exams were performed in 186 patients. 2-view radiograph protocol was followed in 81.9% (186/227); Additional radiograph views were performed in 18.1% (41/227); additional contrast volume in 9.3% (21/227). Reporting time under 1 hour occurred in 79.7% (181/227). 5.7% (13/227) exams were reported as indeterminate adding a median time delay of 40 minutes (IQR 90). Indeterminate exam reporting did not correlate with years of experience of the reporting pediatric radiologist (p=0.19); reporting time over 1 hour occurred more often in the after-hours group (p= 0.032). Fluoroscopic G-tube contrast check was requested in 8 of 13 indeterminate readings. Following reclassification of indeterminate exams based on clinical suspicion, test performance: yield 94.3%, accuracy 97.3%, sensitivity 81.8%, specificity 98.2%, PPV 69.2%, NPV 99.1%. This new diagnostic exam performed well with high test yield, accuracy, specificity and negative predictive value. The exam mostly followed protocol, allowed timely resumption of G-tube use, and provided a needed 24/7 remote coverage option for the new affiliated hospital.

The purpose of this study was to examine the utility of direct immunofluorescence (DIF) testing for the characteristic immunoglobulin A deposits of dermatitis herpetiformis (DH) in patients stratified into high and low clinical suspicion subgroups. We retrospectively analyzed the results of H&E and DIF testing in 77 cases of suspected DH and separated them into high and low clinical suspicion subgroups based on clinical impression at the time of biopsy. The overall sensitivity and specificity of routine (H&E) histologic evaluation were 0.75 and 0.951, respectively. Although there were 13 cases of DH (of 36 total cases) in the high clinical suspicion subgroup, there were only three (of 41 total cases) in the low clinical suspicion subgroup. In the high clinical suspicion subgroup, the positive predictive value (PPV) was 0.9, and the negative predictive value (NPV) was 0.846. Alternatively, the PPV was 0.6 and the NPV was 1.0 for the low clinical suspicion subgroup. Histologic false negatives did occur, but all were in patients within the high clinical suspicion subgroup. It is anticipated that the NPV and PPV will vary due to differing clinical practice characteristics; however, in patients with a low clinical suspicion for DH, these data argue that it may be reasonable to first perform a biopsy for routine histologic evaluation before requesting DIF analysis.

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

Influence of Age on the Outcome of the Atopy Patch Test with Food in Children with Atopic Dermatitis

The Impact of B-Type Natriuretic Peptide in Addition to Troponin I, Creatine Kinase-MB, and Myoglobin on the Risk Stratification of Emergency Department Chest Pain Patients With Potential Acute Coronary Syndrome

The diagnostic values of the aVR lead or "Vereckei algorithm," and the lead II R-wave peak time (RWPT) criterion, recently devised for the differential diagnosis of wide QRS complex tachycardias (WCTs), were compared. A total of 212 WCTs (142 ventricular tachycardias [VTs], 62 supraventricular tachycardias [SVT], and eight preexcitation SVTs) from 145 patients with proven electrophysiologic diagnoses were retrospectively analyzed by seven examiners blinded to the electrophysiologic diagnoses. The overall test accuracy of the Vereckei algorithm was superior to that of the RWPT criterion (84.3% vs. 79.6%; p = 0.0003). The sensitivity of the Vereckei algorithm for VT diagnosis was greater than that of RWPT criterion (92.4% vs. 79.1%; p < 0.0001). The negative predictive value (NPV) for the Vereckei algorithm was also greater (77.8%; 95% confidence interval [CI] = 73.6% to 82.1%) than that of the RWPT criterion (61.6%; 95% CI = 57.6% to 65.6%). The specificity of the Vereckei algorithm was lower than that of the RWPT criterion (64.7% vs. 80.9%; p < 0.0001). The positive predictive value (PPV) was also lower for the Vereckei algorithm (86.4%; 95% CI = 84.4% to 88.4%) than for the RWPT criterion (90.9%; 95% CI = 89.1% to 92.8%). Incorrect diagnoses made by the Vereckei algorithm were mainly due to misdiagnosis of SVT as VT (65.7% of cases), and those made by the RWPT criterion were due to the more dangerous misdiagnosis of VT as SVT (72.5% of cases). The Vereckei algorithm was superior in overall test accuracy, sensitivity, and NPV for VT diagnosis and inferior in specificity and PPV to the RWPT criterion. All of these parameters were lower in "real life" than those reported by the original authors for each of the particular electrocardiographic methods.

To evaluate the diagnostic value of 3.0T high-resolution MRI in mesorectal lymph node metastasis of rectal cancer. The images and postoperative pathological data of patients with pathologically diagnosed rectal cancer who underwent prospective 3.0T two dimensional high-resolution MRI rectal examinations and surgery within two weeks after MRI examination at the First Affiliated Hospital, Sun Yat-sen University from November 2015 to November 2016 were retrospectively collected. Patients who received preoperative neoadjuvant therapy and those who did not undergo operation after MRI examination were excluded. The MRI sequences included high-resolution sagittal, coronal and oblique axial T2 weighted image (T2WI) (repetition time/echo time, 3000-4000 ms/77-87 ms; slice thickness/gap, 3 mm/0 mm; field of view, 18-22 cm). Two abdominal MRI radiologists independently assessed the morphology, margin, signal of all visible mesorectal nodes, measured their minor axes (three times for each radiologist) and gave estimation of the malignancy. The criteria of metastatic nodes on high-resolution MRI T2WI were nodes with irregular shape, ill-defined border and/or heterogeneous signal. The results of MRI diagnosis were compared with postoperative pathology. The sensitivity, specificity, accuracy, positive predictive value(PPV) and negative predictive value(NPV) of mesorectal nodes and nodes with different short-axis diameter ranges were calculated to evaluate the diagnostic efficiency of high-resolution MRI. Kappa statistics was used to evaluate the agreement for per node and for per patient between high-resolution MRI and pathological results. A Kappa value of 0-0.20 indicated poor agreement; 0.21-0.40 fair agreement; 0.41-0.60 moderate agreement; 0.61-0.80 good agreement; and 0.81-1.00 excellent agreement. A total of 81 patients were enrolled in the retrospective cohort study, including 50 males and 31 females with age of (59.3±11.1) years. Histopathology showed 1 case of well differentiated adenocarcinoma, 63 of moderately differentiated adenocarcinoma, 9 of moderately to poorly differentiated adenocarcinoma, 2 of poorly differentiated adenocarcinoma, 3 of mucinous adenocarcinoma and 3 of tubulovillous adenocarcinoma. Histopathological staging showed 2 cases in T1 stage, 20 in T2 stage, 45 in T3 stage and 14 in T4 stage; 34 in N0 stage, 40 in N1 stage and 7 in N2 stage; 76 in M0 stage and 5 in M1 stage. A total of 377 nodes were included in the node-by-node evaluation, of which 168 (44.6%) nodes were metastatic from 58.0% (47/81) patients. The median short-axis diameter was 5.4(2.4-18.6) mm in metastatic nodes, which was significantly larger than 3.8 (2.0-8.7) mm in non-metastatic nodes[Z=10.586, P=0.000]. The sensitivity, specificity, accuracy, PPV and NPV were 74.4% (125/168), 94.7% (198/209), 85.7% (323/377), 91.9% (125/136) and 82.2% (198/241), respectively. The Kappa values between high-resolution MRI and histopathological diagnosis for node-by-node and patient-by-patient were 0.71 and 0.70 respectively, indicating good agreements. Fourteen nodes >10 mm were all metastatic. The results of high-resolution MRI for nodal status were consistent with the results of histopathological diagnosis, and the sensitivity, accuracy and PPV were all 100.0%. Among 124 nodes with short-axis diameter of 5-10 mm, 95 (76.6%) were metastatic, and the sensitivity, specificity, accuracy, PPV and NPV were 78.9% (75/95), 86.2% (25/29), 80.6% (100/124), 94.9% (75/79) and 55.6% (25/45), respectively. The agreement was fair (Kappa value 0.55) between high-resolution MRI and histopathological diagnosis. Among 239 nodes with short-axis diameter ≤5 mm, 59(24.7%) were metastatic, and the sensitivity, specificity, accuracy, PPV and NPV were 61.0% (36/59), 96.1%(173/180), 87.4%(209/239), 83.7%(36/43) and 88.3%(173/196), respectively. The agreement was good (Kappa value 0.63) between high-resolution MRI and histopathological diagnosis. Rectal high-resolution MRI has good diagnostic value for estimating metastatic mesorectal nodes by evaluating the morphology, margin and signal of nodes.

Vision Screening

Urinary IL-18 is an early predictive biomarker of acute kidney injury after cardiac surgery

Objective To determine the prevalent herpes simplex virus (HSV) strain in patients with genital herpes (GH),and to evaluate the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of anti-herpes simplex virus type 2 (HSV2) IgG and IgM antibodies in the diagnosis of genital herpes (GH) before in vitro fertilization (IVF).Methods Totally,193 HSV2 clinical strains isolated in cell culture from the lesions of patients with GH in the Department of Dermatology,First Affiliated Hospital,Sun Yat-sen University between 2009 and 2011 were typed by using type-specific fluorescein isothiocyanate (FITC)-labelled anti-HSV monoclonal antibodies.Serum samples were obtained from 57 anti-HSV2 IgM/IgG antibody-positive females with suspected GH as well as their husbands (clinical observation group),68 HSV culture-positive patients diagnosed with GH (positive control group),and 120 children aged 8-12 years (negative control group).Enzyme-linked immunosorbent assay (ELISA) was performed to detect anti-HSV1/HSV2 IgG/IgM antibodies in these serum samples.Statistical analysis was carried out using chi-square test.Results There was a significant difference between the positive control group and negative control group in the positivity rate of anti-HSV1 IgG (89.71％ (61/68) vs.40.80％ (49/120),P ＜ 0.01) and anti-HSV2 IgG (91.18％ (62/68) vs.0,P ＜ 0.01),but not in that of anti-HSV1 IgM (20.59％ (14/68) vs.21.70％ (26/120),P ＞ 0.05) or anti-HSV2 lgM (13.24％ (9/68)vs.13.30％ (16/120),P ＞ 0.05).In the clinical observation group,the positivity rate of anti-HSV1 and anti-HSV2 IgM antibodies,anti-HSV1 and anti-HSV2 IgG antibodies was 80.70％ (46/57),91.23％ (52/57),84.21％ (48/57) and 14.04％ (8/57) respectively in the females,19.30％ (11/57),8.77％ (5/57),87.71％ (50/57),12.28％ (7/57)respectively in the males,with significant differences in the positivity rate of anti-HSV1 and-HSV2 IgM antibodies (both P ＜ 0.01),but not in that of anti-HSV 1 or-HSV2 IgG antibodies (both P ＞ 0.05).The sensitivity,specificity,PPV and NPV were 13.24％ (9/68),86.67％ (104/120),36.00％ (9/25) and 63.80％ (104/163) respectively for anti-HSV2 IgM antibody in the diagnosis of GH,91.18％ (62/68),100.00％ (120/120),100.00％ (62/62),and 95.24％ (120/126) respectively for anti-HSV2 IgG antibody.Conclusions HSV2 prevails in the patients with GH in this region,while HSV1 only amounts to 5.18％.The type-specific anti-HSV2 IgG antibody shows a higher specificity,sensitivity,PPV and NPV in the diagnosis of GH than anti-HSV2 IgM antibody,hence,the type-specific anti-HSV2 IgG antibody is superior to anti-HSV2 IgM antibody in diagnosing GH before assisted reproduction. Key words: Herpes genitalis; Simplex virus; Immunoglobulin G; Immunoglobulin M

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.

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

Non-invasive diagnosis of acute rejection in kidney transplants with delayed graft function

The diagnostic efficacy of the umbilical arterial systolic/ diastolic ratio as a screening tool: A prospective blinded study

To evaluate the impact of coronary artery disease (CAD) prevalence on the predictive values of coronary CT angiography. We performed a meta-regression based on a generalised linear mixed model using the binomial distribution and a logit link to analyse the influence of the prevalence of CAD in published studies on the per-patient negative and positive predictive values of CT in comparison to conventional coronary angiography as the reference standard. A prevalence range in which the negative predictive value was higher than 90%, while at the same time the positive predictive value was higher than 70% was considered appropriate. The summary negative and positive predictive values of coronary CT angiography were 93.7% (95% confidence interval [CI] 92.8-94.5%) and 87.5% (95% CI, 86.5-88.5%), respectively. With 95% confidence, negative and positive predictive values higher than 90% and 70% were available with CT for a CAD prevalence of 18-63%. CT systems with >16 detector rows met these requirements for the positive (P < 0.01) and negative (P < 0.05) predictive values in a significantly broader range than systems with ≤16 detector rows. It is reasonable to perform coronary CT angiography as a rule-out test in patients with a low-to-intermediate likelihood of disease.