Bland-Altman Research Articles

Repeatability of diffusion kurtosis tensor parameters in muscles of the lower legs.

The aim of this study was to provide measurements from and investigate the repeatability of diffusion kurtosis tensor parameters in the muscles of the lower legs. Test-retest acquisition of a kurtosis tensor sequence was performed in 13 healthy volunteers. Quantitative kurtosis tensor parameters were derived, and repeatability of each parameter was evaluated by muscle group and over the whole muscle through intraclass correlation coefficient (ICC) and within-subject coefficient of variation (wsCV). Bland-Altman analysis was also conducted. Differences in parameter values by muscle group were investigated through an analysis of variance. Axial kurtosis and radial kurtosis values from the test data were 0.63 ± 0.04 and 0.70 ± 0.05, respectively. Kurtosis tensor parameters from all muscle groups and over the whole muscle had wsCV below 15%. ICC for the parameters from most muscle groups was above 85%, with the lowest ICC over the whole muscle being 88.39%. The medial gastrocnemius and extensor digitorum longus showed highest repeatability. Mean, axial, and radial diffusivity had higher wsCV despite being lower-order terms than kurtosis. This study sought to examine the repeatability of diffusion kurtosis tensor-derived parameters in the legs and verify that they could potentially be used as longitudinal imaging metrics. wsCV values from test-retest data indicated high repeatability throughout all examined muscle groups. There were minimal differences in kurtosis and diffusivity parameters between muscle groups in this healthy volunteer cohort.

Balance assessment with decreased base of support for children with disabilities.

Children's ability to achieve an appropriate motor development is largely associated with their capacity to control balance. Furthermore, accomplishing balance tasks with a narrowed base of support is a necessary precursor to engaging in everyday functional activities and developing more complex balance abilities. To investigate the relationship between the tandem stance (TS) and the single-limb stance (SLS) items of the Pediatric Balance Scale (PBS) assessment tool with the PBS total score in children with impaired balance. Forty-two children (22 with neurological disabilities, 10.7±3.1 years; 20 typically developing [TD], 8.3±2.7 years) performed all 14 PBS items. Linear regressions separately determined the impact of TS and SLS on total PBS score in both groups. Bland-Altman plots expressed agreement between the balance measurements. For children with disabilities, only the SLS entered the model, explaining 64.5% of the variance in total PBS score. A high level of agreement was observed between the SLS and total PBS scores. For TD children, only the TS entered the model, explaining 45.2% of the variance in the total PBS score. A high level of agreement was observed between the TS and total PBS scores. Our findings support the practical and efficient use of a single balance task to assess balance ability in children with disabilities.

Comparison of BMI, triponderal mass index, and paediatric body adiposity Index for predicting body fat and screening obesity in preschool children.

Several novel anthropometric indices, including paediatric body adiposity index (BAIp) and triponderal mass index (TMI), have emerged as potential tools for estimating body fat in preschool children. However, their comparative validity and accuracy, particularly when compared to established indicators such as Body Mass Index (BMI), have not been thoroughly investigated. This cross-sectional study enrolled 2869 preschoolers aged 3-6 years in Wuhan, China. The nonparametric Bland-Altman analysis was employed to evaluate the agreement between BMI, BAIp, and TMI with percentage of body fat (PBF), determined by bioimpedance analysis (BIA), serving as the reference measure of adiposity. Additionally, Receiver Operating Characteristic Curve (ROC) analysis was conducted to assess the effectiveness of BMI, BAIp, and TMI in screening for obesity. BAIp demonstrated the least bias in estimating PBF, showing discrepancies of 3.64% (95%CI: 3.40% to 4.12%) in boys and 3.95% (95%CI: 3.79% to 4.23%) in girls. Conversely, BMI underestimated PBF by 3.89% (95%CI: 3.70% to 4.37%)in boys and 4.81% (95%CI: 4.59% to 5.09%) in girls, while TMI also underestimated PBF by 5.15% (95%CI: 4.90% to 5.52%) in boys and 5.68% (95%CI: 5.30% to 5.91%) in girls. BAIp exhibited the highest area under the curve (AUC) values (AUC=0.867-0.996) in boys, whereas in girls, there was no statistically significant difference between BMI (AUC = 0.936, 95% CI: 0.921-0.948) and BAIp(AUC = 0.901, 95% CI 0.883-0.916) in girls (P=0.054). In summary, when considering the identification of obesity, BAIp shows promise as a screening tool for both boys and girls.

Quantifying Lower Extremity Blood Flow using Low-Dose CT Perfusion: Validation in a swine model

Abstract Background Quantitative assessment of blood flow in peripheral extremities in conjunction with simultaneous CT angiography measurements can improve risk assessment and provide a critical decision-making tool for patients across a wide spectrum of vascular disease severity. Purpose This study assessed the reproducibility and accuracy of lower extremity blood flow measurements with a low-dose first-pass analysis CT perfusion technique. Materials and Methods This prospective study utilized 16 Yorkshire Swine to obtain lower extremity blood flow CT measurements at baseline and under induced femoral stenosis using a vascular occluder. Thirty-three pairs of CT measurements evaluated reproducibility, and 43 CT measurements assessed accuracy against ultrasound flow probe references. Contrast agent and saline chaser were both injected peripherally at a rate of 5 mL/s. Bolus tracking was used, and a pre-contrast and post-contrast helical scan were acquired at the base and approximately the peak of the femoral enhancement (CT angiogram), respectively. The acquired data were then used as analytical inputs into a first-pass analysis model to derive perfusion in mL/min/g. The reproducibility and accuracy of lower extremity perfusion measurements were assessed via Mixed model regression and Bland-Altman analysis. Results Calculated CT perfusion measurements derived from first-pass analysis technique (PCT), and the reference standard ultrasound perfusion measurements (Pref) were related by PCT = 1.06 Pref + 0.00 (r2= 0.90, Root-Mean-Square Error = 0.01 mL/min/g). The first (P1) and second (P2) CT perfusion measurements were related by P2 = 0.98 P1 + 0.02 (r = 0.97, Root-Mean-Square Error = 0.11 mL/min/g). The average effective dose of perfusion measurement using first-pass analysis technique was calculated to be only 2.13 mSv. Conclusion : The low-dose quantitative CT perfusion technique can accurately measure lower extremity perfusion (mL/min/g) using only two helical scans. The CT angiogram and perfusion measurements can be used as a comprehensive technique for morphological and physiological assessment of limb ischemia.

Real-Life Diagnostic Accuracy and Clinical Utility of Hepatitis B Virus (HBV) Nucleic Acid Testing Using the GeneXpert Point-of-Care Test System from Fresh Plasma and Dry Blood Spot Samples in The Gambia

The GeneXpert HBV Viral Load test is a simplified tool to scale up screening and HBV monitoring in resource-limited settings, where HBV is endemic and where molecular techniques to quantify HBV DNA are expensive and scarce. However, the accuracy of field diagnostics compared to gold standard assays in HBV-endemic African countries has not been well understood. We aim to validate the diagnostic performance of the GeneXpert HBV Viral Load test in freshly collected and stored plasma and dried blood spot (DBS) samples to assess turn-around-time (TAT) for sample processing and treatment initiation, to map GeneXpert machines and to determine limitations to its use in The Gambia. Freshly collected paired plasma and DBS samples (n = 56) were analyzed by the GeneXpert test. Similarly, stored plasma and DBS samples (n = 306, n = 91) were analyzed using the GeneXpert HBV test, in-house qPCR and COBAS TaqMan Roche. The correlation between freshly collected plasma and DBS is r = 0.88 with a mean bias of −1.4. The GeneXpert HBV test had the highest quantifiable HBV DNA viremia of 81.4% (n = 249/306), and the lowest was detected by in-house qPCR at 37.9% (n = 116/306) for stored plasma samples. Bland–Altman plots show strong correlation between GeneXpert and COBAS TaqMan and between GeneXpert and in-house qPCR with a mean bias of +0.316 and −1.173 log10 IU/mL, respectively. However, paired stored plasma and DBS samples had a lower mean bias of 1.831 log10 IU/mL, which is almost significant (95% limits of agreement: 0.66–3.001). Patients (n = 3) were enrolled in the study within a TAT of 6 days. The GeneXpert HBV test displayed excellent diagnostic accuracy by detecting HBV viremia in less than 10 IU/mL.

Comparison of magnification corrected optic disc size by slit-lamp biomicroscopy, fundus photography, and optical coherence tomography

Abstract PURPOSE: Optic disc size measurement is essential for determining landmarks, lesions, and distances of the retina. Due to the size variability in nature and when measured with different instruments, newer methods to compare sizes between different instruments are needed. We aimed to determine the comparability of slit lamp, fundus photography, and optical coherence tomography (OCT) measurements of optic disc size after correcting for both ocular and instrument magnification. MATERIALS AND METHODS: In this prospective, observational study, optic disc size was measured by slit-lamp biomicroscopy, fundus photography, and OCT. Instrument and ocular magnification was calculated, and the measured size was corrected for both using the Littman formula. The corrected values were analyzed using Bland–Altman plots and intra-class correlation (ICC) for agreeability and correlation, respectively. Linear regression analysis was conducted to estimate the systematic errors and interconvertibility in cases of high correlation. RESULTS: Fifty-six eyes were included for the analysis. Uncorrected and corrected values for each method had excellent correlation and agreeability (ICC absolute agreement >0.75, P < 0.01). Among magnification corrected values, slit lamp and OCT had excellent correlation and agreement (ICC consistency = 0.846, confidence interval 0.75–0.91, P < 0.01). This pair had R 2 = 0.73 on linear regression (P < 0.01). Linear regression formulas for interconverting uncorrected and corrected values for the three methods had variable accuracy (R 2 from 0.47 to 0.66). CONCLUSION: Uncorrected values of different methods for disc size measurement cannot be compared directly; they need ocular and instrument magnification correction. Among the three methods compared, the best interconvertible pairs of measurement were magnification corrected slit lamp and OCT values.

Neural network-based automated proptosis measurement using computed tomography images for patients with thyroid-associated orbitopathy

The purpose of this study was to evaluate the clinical feasibility and reliability of a neural network (NN)-based automated proptosis measurement system using computed tomography (CT) images. An automated proptosis measurement system was developed using the CT images of 200 eyes from 100 patients diagnosed with thyroid-associated orbitopathy. We compared the proptosis value obtained from the proposed automated system with the values obtained from the Hertel exophthalmometer and manual measurements of CT slices. The average measurement values were 17.77 ± 2.47 mm with the Hertel exophthalmometer, 18.87 ± 2.68 mm with the manual measurement of CT slices, and 19.30 ± 2.76 mm with the proposed automated system. There was no significant difference in the proptosis values measured using the manual and automated NN-based methods (p = 0.241). The values obtained from manual measurement and automated measurement using CT images showed excellent agreement with an intraclass correlation coefficient of 0.95. Based on the Bland-Altman plots, the 95% limits of agreement between manual CT and NN-based measurements were much smaller than those between Hertel exophthalmometer measurement and manual and NN-based measurements. In conclusion, automated NN-based measurements could provide a straightforward and efficient method for measuring proptosis using CT images.

Comparison of measurements obtained with TOF-Cuff placed on the arm and the TOF-Scan on the adductor pollicis muscle during general anaesthesia using mivacurium: a prospective observational clinical trial

Adequate neuromuscular monitoring of patients is essential to verify complete recovery of neuromuscular function before tracheal extubation. This study aimed to assess the correlation between the values acquired from the brachialis muscle using TOF-Cuff and those obtained from the adductor pollicis muscle with TOF-Scan during anaesthesia with mivacurium. Twenty-five patients were enrolled in the observational clinical trial, with the TOF-Cuff positioned on the upper arm and the TOF-Scan on the thumb. Train-of-four (TOF) values were simultaneously recorded by both devices at 30-second intervals before intubation. Subsequently, measurements were taken every 5 min until the removal of the endotracheal tube. Bland-Altman analyses were conducted to compare assessed endpoints obtained by using the TOF-Cuff and the TOF-Scan. The median onset time measured with TOF-Cuff was numerically longer compared to the TOF-Scan score (120 s vs. 90 s, P = 0.42). Spearman rank correlation revealed a significant positive correlation between onset times measured by TOF-Cuff and TOF-Scan (R = 0.73, P = 0.0001, 95% CI 0.446 to 0.875). For the time to recovery assessed with both methods, Spearman correlation coefficient was R = 0.35 and did not reach statistical significance (P = 0.1). Multiplying the time to recovery from the last dose (according to TOF-Scan) by 0.43 to 2.66, provided concordance with the TOF-Cuff result for the entire range of study group. Conclusion. The concordance between the TOF-Scan on the adductor pollicis and the TOF-Cuff on the upper limb was found to be good. However, both devices showed a false-negative result in patients with clinical symptoms of preterm recovery.

A Comparative, Individual Values-Based Scoring Approach to the Secure Flourish Index Among Clinical Health Professions Students

Abstract Purpose The purpose of this study was to investigate flourishing among medical (MD), physician assistant (PA), and nurse practitioner (NP) students, using the novel Secure Flourish Index (SFI). Method MD, PA, and NP students from two institutions completed the traditional SFI (tSFI), then applied a percentage weight to each of the six domains (maximum total 100%) based on perceived relative importance to their overall flourishing, creating a novel self-weighted SFI score (swSFI). The Bland–Altman (BA) plot was used to assess the magnitude of agreement between scores. Results The BA plot (n = 281) revealed a mean bias of .07(95% CI -.50,.63). Eighteen participants (6.4%) fell outside of the calculated BA limits of agreement [-9.31 [95% CI - 10.27,-8.45] and 9.45 [95% CI 8.49,10.41]]. Linear regression revealed the mean BA score is predictive of the mean difference between scores [R2 = 0.07, F(1,280) = 21.1, p < .001] indicating bias in agreement between the scoring systems as mean flourishing score changes. Conclusion Accounting for individual values is important when measuring student flourishing but is missing from current operant definitions. The overall mean difference (bias) in tSFI and swSFI scores is minimal (.07, possible range 0–120). However, the bias becomes larger as individual mean flourishing scores move towards both the high and low ends of the flourishing spectrum. This indicates that the influence of weighting flourishing domains is larger for individuals with high or low flourishing than those with moderate flourishing.

The Agreement of Intraocular Pressure Measurement in Healthy Merinos Sheep Using Rebound Tonometer (Tonovet®) and Applanation Tonometer (Tono-Pen VetTM)

The assessment of intraocular pressure (IOP) holds significant importance in ophthalmology as a crucial diagnostic tool for various ocular disorders. In the realm of comparative ophthalmology research, investigating ocular examination in sheep, particularly Merinos, is of considerable interest. This study aimed to evaluate the agreement between rebound (TonoVet®, TV) and applanation (Tono-Pen Vet™, TPV) tonometers in measuring IOP in healthy Merino sheep. 155 healthy Merinos (80 males, 75 females) with a mean weight of 54.4 ± 8.7 kg, aged 24 ± 6 months, were included in the study. IOP was measured between 9:00 and 11:00 am using both the rebound and applanation tonometers. The rebound tonometer was utilized first, followed by the applanation tonometer. A total of 620 readings (310 readings per eye) were obtained from the two devices. No statistical differences were noted between the mean IOP measurements of the right and left eyes for both tonometers (P > 0.05). However, there was a significant difference in the mean IOP measurements between the TV (11.8 ± 2.3 mmHg) and the TPV (13.9 ± 2.9 mmHg) tonometers (P < 0.001). The concordance correlation coefficient indicated weak agreement strength (ρc = 0.319, CI 95% = -0.169 to 0.455) between the TV and TPV. The mean difference in bias and the 95% limits of agreement for the differences between TV and TPV were -2.1 mmHg (-9.0 to 3.5 mmHg). The regression equation derived from a Bland-Altman plot, describing the relationship between the two tonometers, was Y = 1.43 - 0.33X (Y = TV and X = TPV). In conclusion, the TPV measured higher IOP values compared to the TV, and due to the significant bias and limits of agreement, the two tonometers should not be used interchangeably for IOP measurement in Merino sheep.

Reliability and Validity of the L Test in Persons With Multiple Sclerosis.

The L Test has been developed to assess balance and gait disorders. Our aim in this study was to estimate the test-retest reliability and validity of the L Test when used with 82 persons with multiple sclerosis (PwMS). For these participants, we examined the degree of agreement between the results of a first and second administration of the L Test (separated by one day), using Bland-Altman analysis and intra-class correlation coefficients (ICCs). We computed minimal detectable change (MDC) and standard error of measurement (SEM) values for the L Test and evaluated concurrent validity by correlating L Test results with the Timed Up and Go test (TUG) and the 10-minute Walk Test (10MWT). Prior to administering these measurements, we randomized the sequence of the test administrations to our participants. The Bland-Altman analysis showed that L Test was reproducible, with upper and lower limits of agreement of 0.99 and -1.45 seconds, respectively. The L Test demonstrated excellent test-retest reliability, with an ICC value of 0.996 (95% CI: 0.994-0.998). Cronbach's alpha coefficient was 0.996. The performance of the L Test is measured by seconds required to complete the task, and we found the L Test SEM value to be 0.35 seconds, and its MDC value to be 0.97 seconds. The L Test showed a strong correlation with both the TUG test (rho = 0.936; p < .001) and the 10MWT (rho = 0.925; p < .001). We concluded that the L Test is a reliable and valid \ tool for assessing functional mobility and balance in PwMS.

Fatty acid composition evaluation of abdominal adipose tissue using chemical shiftencoded MRI: Association with diabetes.

This study investigated the association between the fatty acid composition of abdominal adipose tissue in NAFLD patients using chemical shift-encoded MRI and the development of insulin resistance and T2DM. We enrolled 231 subjects with NAFLD who underwent both abdominal magnetic resonance spectroscopy and chemical shift-encoded MRI: comprising of 49 T2DM patients and 182 subjects without. MRI- and MRS-based liver fat fraction was measured from a circular region of interest on the right lobe of the liver. The abdominal fatty acid compositions were measured at the umbilical level with chemical shift-encoded MRI. Bland-Altman analysis, Student's t test, Mann-Whitney U test, and Spearman correlation analysis were performed. The logistic regression was applied to identify the independent factors for T2DM. Then, the predictive performance was assessed by Receiver operating characteristic curve analyses. An excellent agreement was found between liver fat fraction measured by MRS and MRI. (slope = 0.8; bias =-0.92%). In, patients with T2DM revealed lower fractions of mono-unsaturated fatty acid (Fmufa) (33.68 ± 10.62 vs 38.62 ± 12.21, P =.0089) and higher fractions of saturated fatty acid (Fsfa) (34.11 ± 9.746 vs 31.25 ± 8.66, P =.0351) of visceral fat tissue compared with patients without. BMI, HDL-c, Fmufa and Fsfa of visceral fat were independent factors for T2DM. Furthermore, Fsfa-S% was positively correlated with liver enzyme levels (P =.003 and 0.04). However, Fmufa-V% was negatively correlated with fasting blood glucose, HbA1c and HOMA-IR (P =.004, P =.001 and P =.03 respectively). Hence, the evaluation of fatty acid compositions of abdominal fat tissue using chemical shift-encoded MRI may have a predictive value for T2DM in patients with NAFLD.

Comparison of the ability between dual-energy X-ray absorptiometry and bioelectrical impedance analysis for diagnosing low skeletal muscle mass and sarcopenia in patients with chronic liver disease.

Sarcopenia and osteoporosis adversely impact the clinical outcomes of patients with chronic liver disease (CLD). The Japan Society of Hepatology (JSH) sarcopenia criteria utilize bioelectrical impedance analysis (BIA) for assessing muscle mass rather than dual-energy X-ray absorptiometry (DXA), which can simultaneously diagnose these comorbidities. We investigated the correlations and interchangeability between the appendicular skeletal muscle mass index (ASMI) values determined using BIA and DXA and evaluated the diagnostic ability of DXA for sarcopenia and osteosarcopenia in patients with CLD. This cross-sectional study included 173 patients with CLD. Sarcopenia was defined as low ASMIBIA according to the JSH and Asian Working Group for Sarcopenia (AWGS) criteria (ASMIBIA cutoff) or low ASMIDXA according to the AWGS criteria (ASMIDXA cutoff) and low handgrip strength. For women, a provisional cutoff value was set for ASMIDXA using the ASMIBIA cutoff (ASMIDXA-altered cutoff). We found that ASMIBIA and ASMIDXA were significantly correlated (r=0.921; P<0.001). The Bland-Altman plots demonstrated substantial agreement between ASMIBIA and ASMIDXA, with a mean difference of 0.0116kg/m2. The prevalence rates of sarcopenia and osteosarcopenia diagnosed using the ASMIBIA cutoff were 26.0% and 17.3%, respectively. The kappa coefficients for the prevalence of sarcopenia and osteosarcopenia were 0.759 and 0.775 between ASMIBIA cutoff and ASMIDXA cutoff and 0.780 and 0.806 between ASMIBIA cutoff and ASMIDXA-altered cutoff, respectively. The utilization of DXA can facilitate the comprehensive assessment and management of musculoskeletal comorbidities in patients with CLD.

Reliability and utility of blood glucose levels in the periodontal pockets of patients with type 2 diabetes mellitus: a cross-sectional study.

Several studies have measured gingival blood glucose (GBG) levels, but few have confirmed systematic bias using Bland-Altman analysis. This study compared the effectiveness of GBG levels with that of fingertip blood glucose (FTBG) levels using Bland-Altman and receiver operating characteristic (ROC) analyses. A total of 15 healthy volunteers and 15 patients with type 2 diabetes were selected according to inclusion and exclusion criteria. Each group comprised eight male and seven female participants. The GBG and FTBG levels were measured using a self-monitoring blood glucose device after periodontal examination. Pearson's product‒moment correlation and simple linear regression analyses were performed. In addition, Bland‒Altman analysis was also performed to assess the degree of agreement between the two methods. ROC analysis was conducted to determine the sensitivity, specificity, and cutoff values for patients with diabetes. The area under the ROC curve (AUC) was used to identify significant differences. The mean GBG and FTBG levels were 120 ± 44.8 mg/dL and 137 ± 45.1, respectively, for the whole sample. The mean GBG and FTBG levels were 145 ± 47.2 mg/dL and 163 ± 49.1, respectively, in the diabetes group. The mean GBG and FTBG levels in the nondiabetes group were 95.3 ± 25.2 and 111 ± 18.8, respectively. Patients with diabetes were more likely to have a probing pocket depth (PPD) of ≥4 mm at the sampled site. Pearson's product‒moment correlation and simple linear regression analyses revealed a significant correlation between the GBG and FTBG measurements. Bland-Altman analysis revealed that GBG and FTBG measurements differed significantly among all participants; however, no significant differences were observed among the patients with diabetes (mean difference (MD) ± standard deviation (SD) = -18.1 ± 34.2, 95% confidence interval (CI) [-37.0 to 0.88]) or among the participants with a PPD of ≥4 mm (MD ± SD = -15.2 ± 30.4, 95% CI [-30.8 to 0.43]). The sensitivity, specificity, and cutoff values of the GBG measurements for detecting diabetes were 80%, 93%, and 123.5 mg/dL, respectively. The sensitivity, specificity, and cutoff values of the FTBG measurements for detecting diabetes were 73%, 87%, and 134.0 mg/dL, respectively. No significant differences were observed between the AUCs (0.078, 95% CI [-0.006 to 0.161]). The GBG measurements aligned with the FTBG measurements in the patients with diabetes and among the participants with a PPD of ≥4 mm. Patients with diabetes were more likely to have a PPD of ≥4 mm at the sampled site, GBG levels can be used to screen for type 2 diabetes in dental clinics.

Interrater reliability of RheuMetric checklist scales for Physician Global Assessment, inflammation, damage and patient distress

Abstract Objective To analyze interrater reliability of four RheuMetric checklist 0–10 visual numerical scales (VNS) of physician global assessment (DOCGL), inflammation or reversible findings (DOCINF), organ damage or irreversible findings (DOCDAM), and patient distress or findings explained by fibromyalgia and/or depression (DOCDIS). Methods A retrospective study was performed of data from a rheumatology fellows’ continuity clinic at Rush University. Each rheumatology patient with any diagnosis seen in routine care completed a multidimensional health assessment questionnaire (MDHAQ). Both the rheumatology fellow and attending rheumatologist independently completed RheuMetric estimates at the same visit for DOCGL, DOCINF, DOCDAM, DOCDIS, and the proportion of DOCGL explained by each subglobal estimate (totaling 100%). Agreement between the two assessors was compared using paired t-tests, Spearman correlation coefficients, intraclass correlation coefficients (ICC), Lin’s concordance correlation coefficients (LCCC), and Bland-Altman plots. Results In 112 patients, mean levels of DOCINF were highest in inflammatory diseases, DOCDAM in osteoarthritis (OA), and DOCDIS in primary fibromyalgia (FM). However, mean DOCDAM was as high as DOCINF in inflammatory diseases. No statistically significant differences were seen between scores from attending rheumatologists and fellows. Agreement within 2/10 units ranged from 60% for DOCGL to 71% for DOICINF and DOCDAM. Spearman correlations were 0.49-0.65, ICCs were 0.46-0.63, LCCC were 0.46-0.62 between rheumatologist and fellow, indicating moderate agreement; reliability was slightly higher for each sub-global VNS than DOCGL. Conclusion RheuMetric 0–10DOCGL, DOCINF, DOCDAM, and DOCDIS have moderate interrater reliability and are feasible in routine care to estimate patient status beyond DOCGL for improved management decisions.

Repeatability of quantitative MR fingerprinting for T1 and T2 measurements of metastatic bone in prostate cancer patients.

MR fingerprinting (MRF) has the potential to quantify treatment response. This study evaluated the repeatability of MRF-derived T1 and T2 relaxation times in bone metastasis, bone, and muscle in patients with metastatic prostate cancer. This prospective single-centre study included same-day repeated MRF acquisitions from 20 patients (August 2019-October 2020). Phantom and human data were acquired on a 1.5-T MR scanner using a research MRF sequence outputting T1 and T2 maps. Regions of interest (ROIs) across three tissue types (bone metastasis, bone, muscle) were drawn on two separate acquisitions. Repeatability of T1 and T2 was assessed using Bland-Altman plots, together with repeatability (r) and intraclass correlation (ICC) coefficients. Mean T1 and T2 were reported per tissue type. Twenty patients with metastatic prostate cancer (mean age, 70 years ± 8 (standard deviation)) were evaluated and bone metastasis (n = 44), normal-appearing bone (n = 14), and muscle (n = 20) ROIs were delineated. Relative repeatability of T1 measurements was 6.9% (bone metastasis), 32.6% (bone), 5.8% (muscle) and 21.8%, 32.2%, 16.1% for T2 measurements. The ICC of T1 was 0.97 (bone metastasis), 0.94 (bone), 0.96 (muscle); ICC of T2 was 0.94 (bone metastasis), 0.94 (bone), 0.91 (muscle). T1 values in bone metastasis were higher than in bone (p < 0.001). T2 values showed no difference between bone metastasis and bone (p = 0.5), but could separate active versus treated metastasis (p < 0.001). MRF allows repeatable T1 and T2 measurements in bone metastasis, bone, and muscle in patients with primary prostate cancer. Such measurements may help quantify the treatment response of bone metastasis. Question MR fingerprinting has the potential to characterise bone metastasis and its response to treatment. Findings Repeatability of MRF-based T1 measurements in bone metastasis and muscle was better than for T2. Clinical relevance MR fingerprinting allows repeatable T1 and T2 quantitative measurements in bone metastasis, bone, and muscle in patients with primary prostate cancer, which makes it potentially applicable for disease characterisation and assessment of treatment response.

Comparison of Scheimpflug tomography, Placido disc, and combined Placido Scheimpflug in the measurement of pupil offset in myopic population

IntroductionThis study aimed to compare the consistency of pupil offset measurements obtained using the Pentacam, Keratron Scout, and Sirius devices.MethodsThis retrospective cross-sectional study included 146 young myopic individuals (292 eyes) scheduled for refractive surgery at Dalian Third People’s Hospital between January 2023 and December 2023. Three devices were utilized to measure the chord mu of the pupil deviation along with the Cartesian distances of the X and Y coordinates (Px, Py) associated with the pupil offset. Repeated-measures analysis of variance was used to compare differences in pupil offset acquisition across various devices. Additionally, the intraclass correlation coefficient (ICC) and Bland–Altman plot were utilized to assess the consistency among the three devices.ResultsChord mu, measured using the Pentacam, Keratron Scout, and Sirius devices, were 0.18 ± 0.10, 0.21 ± 0.11, and 0.18 ± 0.11, respectively. The Px values were 0.00 ± 0.14, -0.02 ± 0.16, and -0.01 ± 0.13, respectively, while the Py values were 0.09 ± 0.13, 0.10 ± 0.15, and 0.10 ± 0.13. The ICCs for the three device measurements, chord mu, Px, and Py, were 0.817, 0.900, and 0.855, respectively. When comparing the three devices, the 95% limits of agreement (LoA) for mu and Px measured using the Sirius and Keratron Scout were the narrowest, ranging from −0.15 to 0.08 and −0.11 to 0.13, respectively. Additionally, the 95% LoA for Py measured using the Sirius and Pentacam was the narrowest, ranging from −0.13 to 0.15. The pupil centers in both eyes were predominantly located above the apex of the cornea.ConclusionSirius, Keratron Scout, and Pentacam have good consistency in pupil shift measurement in young myopic patients, and the three devices can be used as references in clinical practice.

Capnodynamic assessment of mixed venous oxygen saturation in a porcine experimental endotoxemic model.

Sepsis continues to be a major cause of death and illness globally, posing significant challenges for healthcare professionals. In the pursuit of more accurate and timely monitoring tools, the concept of capnodynamically derived mixed venous oxygen saturation (Capno-SvO2) has emerged as a promising method. Capno-SvO2 provides a non-invasive way to assess and track SvO2 and could serve as an additional tool alongside more invasive methods like the pulmonary artery catheter. This could potentially be of great value in the care of critically ill patients with sepsis, where alternative minimal invasive monitoring methods may vary in reliability. The aim of the current study was to compare capno-SvO2 against values obtained through pulmonary artery blood sample CO-oximetry and continuous fiberoptic SvO2 monitoring, using a well-established porcine experimental sepsis model. Anesthetized pigs were exposed to a standardized endotoxin infusion sepsis protocol, followed by a series of maneuvers typically applied in sepsis care. Simultaneous recordings were done throughout the experiment for all three monitoring methods. Bland-Altman analysis corrected for repeated measurements was used to assess the agreement of absolute values between the paired recording of CO-oximetry and Capno-SvO2 as well as between CO-oximetry and fiberoptic SvO2. The ability of Capno-SvO2 and fiberoptic SvO2 to track changes was assessed by concordance rate. A total of 10 animals and 275 paired datapoints were included in the study. The majority of the animals displayed pronounced hemodynamical instability in response to endotoxin exposure and subsequent treatment interventions. Analysis of all paired data points showed a bias between Capno-SvO2 and CO-oximetry SvO2 of + 1% with 95% limits of agreement of -14% to + 17%. The corresponding numbers for fiberoptic SvO2 and CO-oximetry SvO2 were -4% and -15% to + 8%. The concordance rate as compared to CO-oximetry, were 97% and 93% for Capno-SvO2 and fiberoptic SvO2, respectively. In this experimental sepsis model, continuous, non-invasive Capno-SvO2 generates average absolute values comparable to the gold standard CO-oximetry albeit with relatively wide limits of agreement. Capno-SvO2 displayed a concordance rate of 97% against CO-oximetry and exhibits better trending ability compared to invasive fiberoptic SvO2.

Correlation of factor XIII subunit A with factor XIII activity in a population of parturient women.

The role of factor XIII in acute bleeding situations is gaining more and more importance. It has previously been shown that prepartum factor XIII activity has a significant impact on postpartum blood loss. Whether factor XIII antigen behaves in a similar manner is unknown. As postpartum hemorrhage is one of the leading causes of maternal morbidity and mortality worldwide and factor XIII antigen determination might be available more readily in some centers as compared to factor XIII activity, this is an important question to answer, especially in the emergency situation of a postpartum hemorrhage. To assess the correlation of prepartum factor XIII antigen with prepartum factor XIII activity and to evaluate the correlation between prepartum factor XIII antigen on measured postpartum blood loss. This is a secondary analysis of a prospective cohort study which analyzed the impact of prepartum blood coagulation factor XIII activity on postpartum blood loss in 1300 women at the University Hospital Zurich, Switzerland between October 2015 and November 2016 ("PPH-1300 study"). Blood loss was quantified using a previously validated technique. The association of factor XIII activity and factor XIII antigen was assessed by means of a Spearman rank correlation and differences were displayed using Bland-Altman plot and Passing-Bablok regression. The effect of the prepartum factor XIII antigen on blood loss was estimated by continuous outcome logistic regression. Prepartum factor XIII activity significantly correlated with prepartum factor XIII antigen (Spearman rank correlation coefficient for prepartum values 0.89, p < 0.001 and postpartum values 0.902, p < 0.001). Elevated values of prepartum factor XIII antigen showed a trend toward lower measured postpartum blood loss. The correlation of factor XIII activity with factor XIII antigen (subunit A) in a large real-world sample as well as an association of prepartum factor XIII antigen and postpartum blood loss is observed. Factor XIII antigen determination, a highly automatable test, could be useful in emergency situations such as a PPH (as well as other bleeding situations) if the determination of factor XIII activity is not possible. To evaluate whether FXIII replenishment reduces blood loss is the focus of ongoing studies.

High-Sensitivity and Conventional Cardiac Troponin-I Assays in AL Amyloidosis.

Circulating cardiac troponin-I (cTnI) plays a crucial role in biomarker staging systems, offering important information for prognostification and risk stratification of patients with AL amyloidosis. High-sensitivity cTnI (HS-cTnI) assays have been introduced in practice; however, the data on the concordance between conventional and HS-cTnI and the utility of HS-cTnI in cardiac biomarker staging are lacking. Seventy-eight consecutive patients with AL amyloidosis who were prospectively evaluated at the Boston University Amyloidosis Center from October 2022 through March 2023 were included. cTnI was measured using the Abbott Architect cTnI chemiluminescent microparticle immunoassay (CMIA) and HS-cTnI using the Abbott Alinity HS-cTnI CMIA assay. Assay results were compared by Deming regression and Bland-Altman analyses, and cardiac biomarker stages were assigned and compared using both assay results. Median cTnI and HS-cTnI concentrations were 13.0 and 7.0 ng/L, respectively. Bland-Altman analysis demonstrated a negative bias with HS-cTnI results (mean percent difference between assays: -49.8%) and the greatest variance occurring below 50 ng/L. Deming regression supported this negative discordance (slope, 0.66; intercept, -1.9). The use of HS-cTnI assay downgraded cardiac biomarker staging assignments from stage IIIA to stage II (n = 3) and from stage IIIB to stage II (n = 1). Overall agreement was demonstrated; however, a negative bias for HS-cTnI assay was noted at low concentrations. The application of the conventional cTnI threshold of >100 ng/L to HS-cTnI-based Boston University cardiac staging showed a trend toward downgraded staging assignments. The prognostic utility of HS-cTnI assay in biomarker staging warrants further investigation in patients with AL amyloidosis.