Agreement Coefficient Research Articles

Concordance between humans and GPT-4 in appraising the methodological quality of case reports and case series using the Murad tool

BackgroundAssessing the methodological quality of case reports and case series is challenging due to human judgment variability and time constraints. We evaluated the agreement in judgments between human reviewers and GPT-4 when applying a standard methodological quality assessment tool designed for case reports and series.MethodsWe searched Scopus for systematic reviews published in 2023–2024 that cited the appraisal tool by Murad et al. A GPT-4 based agent was developed to assess the methodological quality using the 8 signaling questions of the tool. Observed agreement and agreement coefficient were estimated comparing published judgments of human reviewers to GPT-4 assessment.ResultsWe included 797 case reports and series. The observed agreement ranged between 41.91% and 80.93% across the eight questions (agreement coefficient ranged from 25.39 to 79.72%). The lowest agreement was noted in the first signaling question about selection of cases. The agreement was similar in articles published in journals with impact factor < 5 vs. ≥ 5, and when excluding systematic reviews that did not use 3 causality questions. Repeating the analysis using the same prompts demonstrated high agreement between the two GPT-4 attempts except for the first question about selection of cases.ConclusionsThe study demonstrates a moderate agreement between GPT-4 and human reviewers in assessing the methodological quality of case series and reports using the Murad tool. The current performance of GPT-4 seems promising but unlikely to be sufficient for the rigor of a systematic review and pairing the model with a human reviewer is required.

Thermoelectric transport in molecular crystals driven by gradients of thermal electronic disorder.

Thermoelectric materials convert a temperature gradient into a voltage. This phenomenon is relatively well understood for inorganic materials but much less so for organic semiconductors (OSs). These materials present a challenge because the strong thermal fluctuations of electronic coupling between the molecules result in partially delocalized charge carriers that cannot be treated with traditional theories for thermoelectricity. Here, we develop a quantum dynamical simulation approach revealing in atomistic detail how the charge carrier wave function moves along a temperature gradient in an organic molecular crystal. We find that the wave function propagates from hot to cold in agreement with the experiment, and we obtain a Seebeck coefficient in good agreement with experimental measurements that are also reported in this work. Detailed analysis reveals that gradients in thermal electronic disorder play an important role in determining the magnitude of the Seebeck coefficient, opening unexplored avenues for the design of OSs with improved Seebeck coefficients.

Artificial intelligence-assisted delineation for postoperative radiotherapy in patients with lung cancer: a prospective, multi-center, cohort study

BackgroundPostoperative radiotherapy (PORT) is an important treatment for lung cancer patients with poor prognostic features, but accurate delineation of the clinical target volume (CTV) and organs at risk (OARs) is challenging and time-consuming. Recently, deep learning-based artificial intelligent (AI) algorithms have shown promise in automating this process.ObjectiveTo evaluate the clinical utility of a deep learning-based auto-segmentation model for AI-assisted delineating CTV and OARs in patients undergoing PORT, and to compare its accuracy and efficiency with manual delineation by radiation oncology residents from different levels of medical institutions.MethodsWe previously developed an AI auto-segmentation model in 664 patients and validated its contouring performance in 149 patients. In this multi-center, validation trial, we prospectively involved 55 patients and compared the accuracy and efficiency of 3 contouring methods: (i) unmodified AI auto-segmentation, (ii) fully manual delineation by junior radiation oncology residents from different medical centers, and (iii) manual modifications based on AI segmentation model (AI-assisted delineation). The ground truth of CTV and OARs was delineated by 3 senior radiation oncologists. Contouring accuracy was evaluated by Dice similarity coefficient (DSC), Hausdorff distance (HD), and mean distance of agreement (MDA). Inter-observer consistency was assessed by volume and coefficient of variation (CV).ResultsAI-assisted delineation achieved significantly higher accuracy compared to unmodified AI auto-contouring and fully manual delineation by radiation oncologists, with median HD, MDA, and DCS values of 20.03 vs. 21.55 mm, 2.57 vs. 3.06 mm, 0.745 vs. 0.703 (all P&amp;lt;0.05) for CTV, respectively. The results of OARs contours were similar. CV for OARs was reduced by approximately 50%. In addition to better contouring accuracy, the AI-assisted delineation significantly decreased the consuming time and improved the efficiency.ConclusionAI-assisted CTV and OARs delineation for PORT significantly improves the accuracy and efficiency in the real-world setting, compared with pure AI auto-segmentation or fully manual delineation by junior oncologists. AI-assisted approach has promising clinical potential to enhance the quality of radiotherapy planning and further improve treatment outcomes of patients with lung cancer.

Entanglement Entropy and Deconfined Criticality: Emergent SO(5) Symmetry and Proper Lattice Bipartition.

We study the Rényi entanglement entropy (EE) of the two-dimensional J-Q model, the emblematic quantum spin model of deconfined criticality at the phase transition between antiferromagnetic and valence-bond-solid ground states. State-of-the-art quantum MonteCarlo calculations of the EE reveal critical corner contributions that scale logarithmically with the system size, with a coefficient in remarkable agreement with the form expected from a large-N conformal field theory with SO(N=5) symmetry. However, details of the bipartition of the lattice are crucial in order to observe this behavior. If the subsystem for the reduced density matrix does not properly accommodate valence-bond fluctuations, logarithmic contributions appear even for cornerless bipartitions. We here use a 45° tilted cut on the square lattice. Beyond supporting an SO(5) deconfined quantum critical point, our results for both the regular and tilted cuts demonstrate important microscopic aspects of the EE that are not captured by conformal field theory.

Electronic 1/f noise as a probe of dimensional effects on spin-glass dynamics

Over the past decade, spin-glass simulations have improved to the point that they now access time- and length-scales comparable to experiments at the mesoscale. A recent series of thin-film field-cooled/zero-field-cooled magnetization (FC/ZFC) experiments demonstrated activated spin dynamics, with a temperature-independent activation energy proportional to the logarithm of the film thickness and with coefficients in remarkable agreement with the simulation. These measurements require the application of small magnetic fields, which has been shown to affect the spin-glass energy landscape. Measurements of the 1/f noise in metallic spin-glasses have been previously shown to be a sensitive probe of the spin dynamics, and the measurements can be made without applying a magnetic field. In this mini-review, we review these techniques and discuss how transport measurements can fit into the current landscape of spin-glass measurements. We compare previous measurements to more recent measurements on similar films, made with ostensibly different cooling protocols, and compare both the previous and recent measurements to the magnetometry. The transport measurements—taken over a wider range of temperature than magnetometry—suggest that the maximum spin-glass energy barrier height is temperature-dependent, not fixed, possibly due to two-dimensional dynamics. We discuss this possibility, along with future measurements, which may be able to resolve this mystery.

Influence of Transperineal Ultrasound on the POP-Q System in the Surgical Indication of Symptomatic Pelvic Organ Prolapse.

Background/Objectives: The diagnostic capacity of the preoperative pelvic organ prolapse quantification (POP-Q) system to define surgical pelvic organ prolapse (POP) is sometimes limited. On the other hand, pelvic floor ultrasound can influence the surgical indication for patients with symptomatic POP. Therefore, our objective is to determine how transperineal ultrasound can influence the surgical indication for symptomatic POP. Methods: This is a prospective observational study conducted over two years including patients who underwent corrective surgery for symptomatic POP. All patients underwent a preoperative examination using the POP-Q system to assess POP. Patients in whom the pelvic floor specialist had diagnostic doubts about the stage of POP underwent an ultrasound examination of the POP. Before the surgical procedure and with the patient anesthetized, a new clinical examination was performed using the POP-Q system and surgical correction of the POP was executed when the patient had a decline to stage II or higher. Cohen's kappa coefficient of agreement was used to assess the agreement. Results: Of the 180 patients who met the inclusion criteria, 167 were included (99 with preoperative clinical examination and 68 with preoperative clinical examination and ultrasound study). The kappa index for the diagnosis of surgical uterine prolapse of the preoperative clinical examination (moderate correlation) was lower than the ultrasound examination (very good correlation) (0.493 p < 0.001 and 0.924 p < 0.001). The kappa index for the diagnosis of cervical elongation without surgical uterine prolapse also showed differences between the preoperative clinical examination (good correlation) and the ultrasound examination (very good correlation) (0.749 p < 0.001 and 0.853 p < 0.001). Conclusions: Transperineal ultrasound has a higher concordance than presurgical clinical examination, based on the POP-Q system, for detecting POP with central compartment surgical indication.

Evaluation of Fetal Heart Using Fetal Heart Quantification (fetalHQ) Technique in an Indian Cohort.

To evaluate the intra- and interobserver reproducibility of parameters used to determine cardiac morphometry and deformation using FetalHQ in Indian population. Two operators blinded to each other performed FetalHQ analysis independently on 35 normal fetuses of gestational age between 18 + 0 and 37 + 0 weeks and days. Intra- and interobserver correlation coefficient and limits of agreement were ascertained for parameters obtained from HQ analysis. Excellent reproducibility (ICC > 0.9) was observed for global morphometric parameters. Ejection fraction, stroke volume, stroke volume/kg demonstrated excellent reliability (ICC > 0.9), cardiac output, fractional area change showed a lower correlation (ICC < 0.8), and right and left ventricular global strain showed no correlation. Twenty-four segment sphericity index of left ventricle (LV) and right ventricle (RV) showed low to moderate correlation (LV-ICC 0.48-0.79; RV-ICC 0.43-0.82). Fractional shortening (FS) showed poor intraobserver reliability in RV. FetalHQ provides reliable estimates of the global cardiac morphometry but not for global cardiac strain. Regional transverse contractility represented by FS has poor correlation in right ventricle, especially in the apical region, possibly due to moderator band. Nevertheless, it is a promising tool which requires technical advancements and validation to improve its accuracy and reliability.

Whole-body non-forensic fetal virtopsy using postmortem magnetic resonance imaging at 7 Tesla vs classical autopsy.

To determine the diagnostic accuracy of virtual autopsy using whole-body postmortem ultra-high field magnetic resonance imaging (MRI) at 7 Tesla (T), using a short T2-weighted imaging (T2-WI) protocol, compared with classical autopsy, for detecting structural abnormalities in small second-trimester fetuses. Thirty consecutive fetuses at 13-19 weeks' gestation (weight, 17-364 g) were included following spontaneous pregnancy loss or termination of pregnancy. After fixation in 10% formaldehyde solution (48 h to 1 week), all fetuses were scanned using a two-dimensional turbo high-resolution T2-WI protocol with multislice relaxation time, followed by an invasive autopsy. The diagnostic accuracy of virtual autopsy vs classical autopsy was calculated for 990 anatomical structures (30 fetuses × 33 items). Sensitivity, specificity, positive and negative predictive values and Cohen's κ coefficient of agreement, with their 95% CIs, as well as the McNemar test, were used to evaluate the accuracy and agreement of the two diagnostic methods. Analysis was stratified by anatomical segment (nervous, pulmonary, cardiovascular, digestive, renal, facial and skeletal) and across three gestational-age intervals (13-14, 15-16 and 17-19 weeks). Considering classical autopsy as the gold standard, virtual autopsy had a sensitivity of 92.04% (95% CI, 85.42-96.29%) and a specificity of 97.87% (95% CI, 94.64-99.42%), with a positive predictive value of 96.30% (95% CI, 90.78-98.56%) and a negative predictive value of 95.34% (95% CI, 91.61-97.45%), achieving a diagnostic accuracy of 95.68% (95% CI, 92.73-97.68%) for detecting structural abnormalities in second-trimester fetuses. Cohen's κ for virtual vs classical autopsy was 0.907. The diagnostic ability of virtual autopsy at 7 T for malformed fetuses was superior to that of classical autopsy for analyzing the nervous system in small fetuses with pronounced autolysis, equivalent to that of classical autopsy when analyzing pulmonary, cardiovascular and renal systems and inferior when evaluating the fetal intestines. The sensitivity of virtual autopsy at 7 T for describing structural abnormalities increased with gestational age. Virtual fetal autopsy using 7-T MRI and a turbo high-resolution T2-WI protocol with multislice relaxation time is a feasible postmortem diagnostic tool for the identification of fetal structural anomalies. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Quantifying Solar Radiation Over Northern India and Validating with Cropwat for Agricultural and Renewable Energy Applications

Precise computation of global solar energy is crucial for many fields of investigation such as renewable energy, meteorology, and agriculture especially crop water requirement and irrigation requirement. This paper presents the quantification of solar radiation using weather data during the years from 2020-21. The results obtained were validated with the solar radiation estimated with the help of CROPWAT during the year. Statistical and visual approaches were adopted to validate the quantified results. Analysis revealed the high degree of similarity between simulated and CROPWAT determined daily solar radiation during the year 2020-21 over the study area. Very high values of Willmot index of agreement (1.0), Nash-Sutcliffe efficiency (0.999), and Pearson correlation coefficient (0.998), and low values of mean absolute error (0.138), mean bias error (-0.024), and root mean square error (0.182) between them was observed during the year 2020-21 in the area. The minimum solar radiation reaching over the region were observed to be around 5.71 MJ/m2/day during winter season (January) with a normal value of 13.50 MJ/m2/day, while the maximum value of 24.5 MJ/m2/day was observed during the summer season (June) with a normal value of 24.13 MJ/m2/day over the region. The use of these data for further study is recommended as it is worthful quantification over the region.

Using ChatGPT to Provide Patient-Specific Answers to Parental Questions in the PICU.

To determine if ChatGPT can incorporate patient-specific information to provide high-quality answers to parental questions in the PICU. We hypothesized that ChatGPT would generate high-quality, patient-specific responses. In this cross-sectional study, we generated assessments and plans for 3 PICU patients with respiratory failure, septic shock, and status epilepticus and paired them with 8 typical parental questions. We prompted ChatGPT with instructions, an assessment and plan, and 1 question. Six PICU physicians evaluated the responses for accuracy (1-6), completeness (yes/no), empathy (1-6), and understandability (Patient Education Materials Assessment Tool, PEMAT, 0% to 100%; Flesch-Kincaid grade level). We compared answer quality among scenarios and question types using the Kruskal-Wallis and Fischer's exact tests. We used percent agreement, Cohen's Kappa, and Gwet's agreement coefficient to estimate inter-rater reliability. All answers incorporated patient details, utilizing them for reasoning in 59% of sentences. Responses had high accuracy (median 5.0, [interquartile range (IQR), 4.0-6.0]), empathy (median 5.0, [IQR, 5.0-6.0]), completeness (97% of all questions), and understandability (PEMAT % median 100, [IQR, 87.5-100]; Flesch-Kincaid level 8.7). Only 4/144 reviewer scores were <4/6 in accuracy, and no response was deemed likely to cause harm. There was no difference in accuracy, completeness, empathy, or understandability among scenarios or question types. We found fair, substantial, and almost perfect agreement among reviewers for accuracy, empathy, and understandability, respectively. ChatGPT used patient-specific information to provide high-quality answers to parental questions in PICU clinical scenarios.

Correlation of Radiological and Pedobarographic Evaluations in the Presence of Foot Sole Pain

Objective: One of the reasons for foot pain is the changes in the structure of the medial longitudinal arch. Assessment of medial longitudinal arch height is often made with foot radiographs and pedobarographic measurements. The relationship between these methods in the presence of foot sole pain has not been examined yet. This study aims to investigate the relationship among these measurement methods in adults with foot sole pain. Materials and Methods: 60 adults with foot sole pain were included in this study. The talohorizontal, talocalcaneal, talo1.metatarsal, and calcaneal inclination angles were measured in the lateral weight bearing foot radiographs. The arch index was calculated in static, dynamic pedobarographic measurements. The agreement of radiological and pedographic measurements among themselves and with each other was determined. Results: The mean age of 60 participants was 45.32 ±13.64. Agreement among foot classifications of radiologic measurements was poor Gwet’s agreement coefficient =-0.198 with a 95% confidence interval (-0.315,-0.080); percent agreement = 0.167 with a 95% confidence interval (0.099,0.234) and Kappa =-0.047 with a 95% confidence interval (-0.083,-0.01) were found. The agreement between pedobarographic classifications was fair Gwet’s agreement coefficient =0.486 with a 95% confidence interval (0.355,0.617); percent agreement =0.65 with 95% confidence interval (0.563,0.737) and Kappa=0.453 with a 95% confidence interval (0.324,0.583) were found. Among radiological measurements, the calcaneal inclination angle showed the highest coefficients of agreement with pedobarographic measurements. The extent of its agreement was fair. Conclusion: Pedobarography is a simple, reliable, inexpensive, and noninvasive method. The calcaneal inclination angle which is used in radiological imaging can give an idea about the height of the medial longitudinal arch.

A-231 A modified Sampson LDL-C equation to improve concordance with the reference method at low levels of LDL-C

Abstract Background Patients at high risk for Atherosclerotic Cardiovascular Disease (ASCVD), who do not achieve adequate lowering of LDL-cholesterol (LDL-C) with maximally tolerated statins or who are statin-intolerant, are often treated with proprotein convertase subtilisin/kexin (type 9) serine protease inhibitor (PCSK9-inh) therapy. The LDL-C reference method, Beta-Quantitation (BQ), is not routinely performed in these patients. Because low values are measured less accurately with current methods, a variety of equations have been developed to calculate LDL-C from the standard lipid panel test results (total cholesterol (TC), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C)). We further modified the Sampson LDL-C (S-LDL-C) equation by a novel approach by combining logistic regression (LR) and linear regression to minimize errors when compared to BQ for low LDL-C. Methods A dataset of BQ results from Mayo Medical Labs was divided randomly into a training set (TG ≤ 1500 mg/dL, TC ≤ 1050 mg/dL, n=19,639) and a validation set (TG ≤ 800 mg/dL, BQ-LDL-C ≤ 130 mg/dL, n=12,910). The training dataset was analyzed by LR, using BQ-LDL-C to classify patients as being above or below the 70 mg/dL cut-point. Dependent variables in the LR model were the S-LDL-C, HDL-C, TC, TG and an interaction term (TG x NonHDL-C). The sum of the exponential terms in the trained LR equation for the dependent variables were then fitted by least squares linear regression to match BQ-LDL-C to develop the modified S-LDL-C equation (mS-LDL-C). We used the validation dataset to compare Friedewald (F-LDL-C), extended Martin (eM-LDL-C), Sampson (S-LDL-C) and modified Sampson (mS-LDL-C) equations by Cohen’s kappa coefficient for agreement with BQ-LDL-C and normalized Matthew’s correlation coefficient (MCC), which considers any imbalances in the number of false high versus false low results. Results The mS-LDL-C equation (mS-LDL-C = (TC/0.9423 - HDL-C/0.9582 - TG/9.397 - ((TGxNonHDL-C)/1305) + TG2/8569) - 5.688), primarily differs from the S-LDL-C equation in the value of the coefficients that include TG as a variable. For S-LDL-C ≤100 mg/dL, mS-LDL-C had the best concordance with BQ-LDL-C in terms of the total percent of patients misclassified as either high or low (mS-LDL-C: 21.4%, S-LDL-C: 24.4%, eM-LDL-C: 25.4% F-LDL-C: 30.8%). mS-LDL-C also had the best kappa score when compared to BQ (mS-LDL-C: 0.833, S-LDL-C: 0.810, eM-LDL-C: 0.789, F-LDL-C: 0.743). MCC was also the highest for mS-LDL-C (mS-LDL-C: 0.916, S-LDL-C: 0.906, eM-LDL-C: 0.894, F-LDL-C: 0.879). Finally, mS-LDL-C also showed the best concordance with BQ-LDL-C when an alternative lower LDL-C therapeutic decision cut-point of 55 mg/dL is used (kappa of 0.766 versus 0.724) but showed an increasingly poorer performance than S-LDL-C for higher LDL-C whenever it exceeded 150 mg/dL. Conclusions A strategy to maximize the overall accuracy of estimated LDL-C could provide an automatic reflex in a laboratory information system to the mS-LDL-C equation whenever S-LDL-C is &amp;lt;100 mg/dL. By doing so, the use of the more accurate mS-LDL-C equation for low LDL-C should improve PCSK9-inh therapeutic decision making over the other LDL-C equations.

Physical mechanism-based simulation methods for soil and ground heat flux from observations at multi-sites

It is important to obtain the soil heat flux at a specific depth (Gz) and at the ground’s surface (G0) to understand the surface energy balance and climate change. However, previous evaluations of Gz and G0 simulations based on multiple sites have been relatively insufficient. We evaluated the accuracy of using physical mechanism-based gradient and calorimetry methods to simulate Gz and changes in heat storage (ΔS) based on observations collected at 28 sites. Three methods for simulating G0 were also evaluated using triple collocation (TC) and extended triple collocation (ETC) metrics. The ability of the gradient method to simulate Gz was strong, particularly for the lower soil layer, with a median Nash-Sutcliffe efficiency (NSE), correlation coefficient (CC), and index of agreement for the evaluated sites of 0.76, 0.86, and 0.91, respectively. The accuracy of the calorimetry method for simulating ΔS was generally lower than that of the gradient method for determining Gz. Overall, the combination of gradient analysis and calorimetry showed the best performance in simulating G0. The TC evaluation showed that the combination of gradient and calorimetry had a strong ability to simulate G0 in most land cover types (root mean square error (RMSE) <4 W/m2) but this ability was lost in the snow cover type (RMSE > 10 W/m2). When evaluated by ETC, the three methods had strong effects only on alpine meadow, floodland, and shrub types (CC > 0.70). Appropriate evaluation indices were recommended based on the application of the model.

La reparación aislada presenta mayor altura patelar postoperatoria según el índice de Insall-Salvati en comparación con la aumentación biológica en roturas agudas del tendón rotuliano

Background and objectivePatellar tendon ruptures (PTR) are rare but highly disabling injuries. Surgical treatment is the standard approach. Postoperative patellar height (PH) is used to determine the success of the intervention, with various indices described in the literature. The objective of the study was to determine if there are differences in PH according to the Insall-Salvati index in the immediate postoperative period and at 4 months, between two groups of patients operated on for acute PTR: The first group underwent isolated repair techniques (IR) and the second group had biological augmentation with autograft or allograft added to the repair (BAR). Our hypothesis was that the BAR group would have lower PH in the immediate postoperative period and at 4 months. Materials and methodsAll patients with acute PTR treated at our center between 2016 and 2022 were reviewed retrospectively. Patients with re-rupture of the operated tendon and those with non-biological augmentation were excluded. PH according to the Insall-Salvati index was measured in radiographs taken the day after surgery and at 4 months postoperatively by three orthopedic surgeons with a subspecialty in knee surgery, independently. A fourth blind evaluator analyzed the measurement results, determining the average PH and the intraclass correlation coefficient for absolute agreement among the three evaluators. The primary outcome was the difference in PH between both groups the day after surgery and at 4 months. The secondary outcome was the difference in PH between the immediate postoperative measurement and at 4 months in both groups. ResultsThis was a retrospective observational study. Thirty-one operated knees were included. IR was performed on 15 knees (48.38%), and biological augmentation was added in 16. The intraclass correlation coefficient between observer 1 and 2 was 0.88; between 2 and 3 it was 0.89; and between observers 1 and 3 it was 0.92, showing at least substantial agreement among observers. The average Insall-Salvati index the day after surgery and at 4 months was 1.15 and 1.21 for the IR group, and 0.97 and 1.07 for the BAR group, respectively. A statistically significant difference in the Insall-Salvati index was found between the two groups, both in the measurement taken the day after surgery (p<0.0001) and at 4 months (p=0.0002). Additionally, significant differences were observed indicating an increase in average PH when comparing the immediate postoperative measurement and at 4 months in each study group (for IR p=0.0016 and for BAR p<0.0001). ConclusionsThe Insall-Salvati index was significantly lower in BAR cases both the day after surgery and at 4 months postoperatively. Additionally, a significant increase in PH was observed at 4 months, regardless of the surgical technique used. Substantial inter-observer agreement was achieved for PH measurement in this cohort.

MRI-based Zero Echo Time and Black Bone Pseudo-CT Compared with Whole-Body CT to Detect Osteolytic Lesions in Multiple Myeloma.

Background MRI is highly sensitive for assessing bone marrow involvement in multiple myeloma (MM) but does not enable detection of osteolysis. Purpose To assess the diagnostic accuracy, repeatability, and reproducibility of pseudo-CT MRI sequences (zero echo time [ZTE], gradient-echo black bone [BB]) in detecting osteolytic lesions in MM using whole-body CT as the reference standard. Materials and Methods In this prospective study, consecutive patients were enrolled in our academic hospital between June 2021 and December 2022. Inclusion criteria were newly diagnosed MM, monoclonal gammopathy of undetermined significance at high risk for MM, or suspicion of progressive MM. Participants underwent ZTE and BB sequences covering the lumbar spine, pelvis, and proximal femurs as part of 3-T whole-body MRI examinations, as well as clinically indicated fluorine 18 fluorodeoxyglucose PET/CT examination within 1 month that included optimized whole-body CT. Ten bone regions and two scores (categorical score = presence/absence of osteolytic lesion; semiquantitative score = osteolytic lesion count) were assessed by three radiologists (two experienced and one unfamiliar with pseudo-CT reading) on the ZTE, BB, and whole-body CT images. The accuracy, repeatability, and reproducibility of categorical scores (according to Gwet agreement coefficients AC1 and AC2) and differences in semiquantitative scores were assessed at the per-sequence, per-region, and per-patient levels. Results A total of 47 participants (mean age, 67 years ± 11 [SD]; 27 male) were included. In experienced readers, BB and ZTE had the same high accuracy (98%) in the per-patient analysis, while BB accuracy ranged 83%-100% and ZTE accuracy ranged 74%-94% in the per-region analysis. An increase of false-negative (FN) findings in the spine ranging from +17% up to +23%, according to the lumbar vertebra, was observed using ZTE (P < .013). Regardless of the region (except coxal bones), differences in the BB score minus the ZTE score were positively skewed (P < .021). Regardless of the sequence or region, repeatability was very good (AC1 ≥0.87 for all), while reproducibility was at least good (AC2 ≥0.63 for all). Conclusion Both MRI-based ZTE and BB pseudo-CT sequences of the lumbar spine, pelvis, and femurs demonstrated high diagnostic accuracy in detecting osteolytic lesions in MM. Compared with BB, the ZTE sequence yielded more FN findings in the spine. ClinicalTrials.gov Identifier: NCT05381077 Published under a CC BY 4.0 license. Supplemental material is available for this article.

Nutritional risk assessment using the Nutritional Prognostic Index predicts mortality in Advanced Chronic Liver Disease patients.

IntroductionEarly clinical prognosis and mortality reduction remains a challenge in Chronic Liver Disease (CLD). The full potential of the Nutritional Prognostic Index (NPI) for nutritional assessment and management in CLD patients remains unexplored. AimTo establish an NPI cutoff point for identification of nutritional risk in advanced CLD (ACLD) patients, and to assess the NPI's ability to predict ACLD-associated mortality. MethodThis ethically approved prospective cohort study investigated malnutrition risk using both the NPI and the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) in patients hospitalized for ACLD. NPI reference values were determined using Receiver Operating Characteristic curve. Associations between nutritional risk identified by RFH-NPT and by NPI were assessed using Fisher's exact test, and agreement between tools assessed using the Kappa index. Association between NPI-defined nutritional risk and 12-month mortality was examined using Pearson Chi-square test. ResultsThe sample population consisted of 120 adults, 84 (70%) male and 57 (50.9%) of alcoholic aetiology, presenting Child-Pugh A, B or C at admission. The identified cutoff point for NPI was <41, identifying nutritional risk in 82.5% of patients. NPI presented a statistically significant association with RFH-NPT, with substantial agreement coefficient of 0.34. Association between NPI <41 cutoff and mortality were observed, with 82.1% of the sample below cutoff experiencing mortality within 12 months. ConclusionNPI is a valuable nutritional marker for identification of nutritional risk in ACLD. The NPI is a simple and effective assessment tool which can aid in CLD early diagnosis. Validation however remains necessary in other CLD populations of different aetiologies.

Validation of the International REM Sleep Behavior Disorder Study Group Symptoms Severity Scale (IRBD-SSS): a new tool to assess RBD clinical severity.

Currently, no standard scale has been validated to assess overall severity of RBD symptoms in the home environment. We aimed to evaluate the psychometric properties of the International RBD Severity Scale (IRBD-SSS), a new tool designed by the International RBD Study Group. Two versions of the IRBD-SSS were created, one for the patient (IRBD-SSS-PT) and another for the bedpartner (IRBD-SSS-BP), both consisting of 3 components, namely vocalizations, body movements and injury, with a fourth component (patient version only) evaluating dream content. To score each dimension, the frequency and severity/impact of behaviors during the previous month are multiplied. Psychometric properties of the IRBD-SSS were assessed, including reproducibility. A total of 188 subjects including n = 132 RBD patients (n = 94 isolated RBD and n = 38 symptomatic RBD) and n = 52 bedpartners were enrolled from eight Sleep centers across France and Italy. Participants completed the scale at baseline and after one week. Acceptability of the scale was excellent in patients (97%) and bedpartners (98%). Internal consistency was acceptable for IRBD-SSS-PT (Cronbach α = 0.75) while slightly low for IRBD-SSS-BP (Cronbach α = 0.49). Concurrent validity was good for both patient (r = 0.70;p < 0.001, see Figure) and bedpartner (r = 0.69;p < 0.001) IRBD-SSS. Reproducibility was high for IRBD-SSS-PT (Lin's coefficient of agreement = 0.85 [0.81;0.90]) and good for the IRBD-SSS-BP (0.79 [0.68;0.90] (p < 0.001). Both the patient and bedpartner versions of the IRBD-SSS showed excellent acceptability, acceptable internal consistency, good external validity and high reproducibility. IRBD-SSS is a useful tool to test the severity of RBD symptoms in clinical settings and clinical trials. NCT04071899.

A comparative study of the application of three digital imaging techniques to assess the thickness of the palatal mucosa of the maxillary anterior teeth

BackgroundThis study highlights the need for precise and efficient methods to measure palatal mucosal thickness in the maxillary anterior teeth, particularly for soft tissue augmentation in the aesthetic zone. The research evaluates three digital imaging techniques, suggesting that Cone Beam Computed Tomography (CBCT) combined with intraoral scanners (IOS) is a promising approach for reliable clinical assessment.MethodsTen volunteers with healthy periodontium were selected, and three methods were employed: CBCT-based indirect gingival imaging, modified soft tissue CBCT (ST-CBCT), and CBCT combined with IOS. Measurements of palatal mucosal thickness were taken at multiple points along the palatal gingival margin. Statistical analysis included Bland-Altman plots for method agreement and intraclass Correlation Coefficient (ICC) analysis for reliability. All measurements were standardized, repeated for consistency, and accurate to 0.01 mm to ensure reliability.ResultsThe Bland-Altman plots showed that less than 5% of the points for palatal mucosal thickness differences measured by the gingival indirect radiographic method, modified ST-CBCT, and CBCT combined with IOS were located outside the 95% limits of agreement (LoA). The mean value of the differences was within 0.2 mm, indicating good clinical agreement among the three methods. The inter- and intra-study ICC values for palatal mucosal thickness measurements of the maxillary anterior teeth using the three CBCT methods were greater than 0.75 (P < 0.001), demonstrating reproducibility.ConclusionsBased on the evaluation of three digital imaging techniques, this study indicates that the combination of CBCT with IOS is a feasible method for measuring palatal mucosal thickness in the maxillary anterior teeth and demonstrates good reproducibility.

Comparison of Risk Stratification by CanAssist Breast Test Performed on Core Needle Biopsies Versus Surgical Specimens in Hormone Receptor-Positive, Her2-Negative Early Breast Cancer.

Introduction Core needle biopsies (CNB) are being increasingly utilized for biomarker, prognostic, and predictive testing in breast cancer (BC).CanAssist Breast (CAB) is a prognostic test performed to assess the 'risk of breast cancer recurrence' in early-stage hormone receptor-positive, Her2-negative BC patients. CAB segregates tumors as 'low risk' or 'high risk' for distant recurrence.Risk assessment done by CAB aids in planning and making adjuvant chemotherapy or hormone therapy decisions.CAB is typically performed on surgical specimens (SS).However, performing it on CNB does offer additional insights into tumor biology leading to different strategies for treatment planning; hence, we aimed to compare the risk stratification performance of CAB using CNB versus SS. Method We analyzed 103 paired formalin-fixed paraffin-embedded CNB and SS samples from hormone receptor-positive, Her2-negative early BC tissue samples submitted for performing CAB at OncoStem Diagnostics between November 2021 and September 2023. Concordance on 'risk categories' of CAB performed on CNB versus SS was reported using overall percentage agreement and Pearson correlation coefficient. Results We found excellent overall concordance of 92.2% for CAB risk stratification between paired CNB and SS tumor samples with a strong Pearson correlation coefficient of r= 0.8351 (p< 0.0001) when either SS or CNB was used as the gold standard.In prognostic testing patients with a 'low risk' of recurrence may avoid chemotherapy and hence it is crucial to assess the accuracy of CAB in the low-risk category. Additionally, in a real-world scenario, it is more likely that CAB will be performed on CNB first. Conclusion CAB when performed on CNB samples showed high concordance with SS thus demonstrating that CNB was a suitable sample for the CanAssist Breast test.The accuracy in the low-risk category is 97.5%, which ensures that physicians can reliably use prognostic information by testing CNB to guide adjuvant therapy decisions.

Noninvasive Method Using Mechanical Extensometer for the Estimation of Intracranial Compliance by Repeated Measures Agreement Analysis.

Intracranial compliance refers to the relationship between changes in volume and the resultant changes in intracranial pressure (ICP). This study aimed to assess the agreement of a noninvasive ICP waveform device for the estimation of compliance compared with invasive ICP monitoring employing three distinct methods. We conducted a retrospective analysis of ICP waveform morphology recorded through both invasive (external ventricular drain) and noninvasive (mechanical extensometer) methods in adult patients with acute brain injury admitted to a neurointensive care unit between August 2021 and August 2022. Compliance was calculated as the amplitude of the fundamental component of cerebral arterial blood volume (estimated with concurrent Transcranial Doppler [TCD] recordings), divided by the amplitude of the fundamental component of the invasive and noninvasive ICP waveforms. Subsequently, we assessed the agreement between invasive and noninvasive intracranial compliance by repeated measures correlation coefficient analysis using three methods: TCD-derived, P2/P1 ratio, and time-to-peak (TTP). A linear mixed-effects model was used to compute the concordance correlation coefficient, total deviation index, and coefficient of individual agreement. Coverage probability plot was calculated to estimate the percent of observations within different cut points for each of the three methods. A total of 21 patients were identified for this study. Repeated measures correlation analysis showed a strong correlation (R = 0.982, 95% confidence interval [0.980-0.984], p < 0.0001) between log-transformed noninvasive and invasive compliance. Agreement statistics for TCD, P2/P1 ratio, and TTP indicated that although the concordance correlation coefficient was highest for log(TCD) values, TTP and P2:P1 ratio measures had better agreement with total deviation index and coverage probability plot analyses. Repeated measures correlations suggest that ICP waveform analyses may offer a more accurate estimate of compliance than TCD-derived methods for noninvasive ICP monitoring. Further validations studies are warranted to confidently establish this method as an indicator of intracranial compliance.