Cohen's Kappa Test Research Articles

Consistency Analysis Between SUDOSCAN Examinations and Electromyography Results in Patients with Diabetes.

To evaluate the consistency between SUDOSCAN examinations and electromyography (EMG) results in patients with diabetes. A total of 326 patients with diabetes (201 males and 125 females) who were hospitalized in the endocrinology ward of the Affiliated Hospital of Nanjing University of Chinese Medicine (Jiangsu Province Hospital of Chinese Medicine) from June 2020 to February 2021 were selected as participants. All the patients were tested using a SUDOSCAN conductance analyzer for electrical skin conductivities and EMG for nerve conduction. The differences and consistencies between the results of the two examinations were analyzed. McNemar's test was used to analyze the differences between the results, and Cohen's kappa test was utilized to test the consistencies. A total of 174 patients had abnormal SUDOSCAN results, and 152 patients had normal SUDOSCAN results. The EMG results of 299 patients were abnormal, and the EMG results of 27 patients were normal. The McNemar test result was P = 0.000, and the differences between the results of the SUDOSCAN and EMG examinations were statistically significant (P < 0.01). No significant consistency was found between the SUDOSCAN and EMG results, meaning that the consistency between the two examination results was not statistically significant (P = 0.868, P > 0.05). The difference between the results was statistically significant (P < 0.05), and the consistency was poor (kappa = 0.005). Differences existed between the SUDOSCAN examination and EMG results, and the results of the two examination methods were inconsistent, indicating that SUDOSCAN examinations cannot replace EMG examinations for DSPN.

Artificial intelligence-based algorithm for cervical vertebrae maturation stage assessment.

The aim of this study was to develop an artificial intelligence (AI) algorithm to automatically and accurately determine the stage of cervical vertebra maturation (CVM) with the main purpose being to eliminate the human error factor. Archives of the cephalometric images were reviewed and the data of 1501 subjects with fully visible cervical vertebras were included in this retrospective study. Lateral cephalometric (LC) that met the inclusion criteria were used in the training process, labeling was carried out using a computer vision annotation tool (CVAT), tracing was done by an experienced orthodontist as a gold standard and, in order to limit the effect of the uneven distribution of the training data set, maturation stage was classified with a modified Bachetti method by the operator who labelled them. The labelled data were split randomly into a training set (80%), a testing set (10%) and an validation set (10%), to measure intra-observer, inter-observer reliability, intraclass correlation coefficient (ICC) and weighted Cohen's kappa test was carried out. The ICC was valued at 0.973, weighted Cohen's kappa standard error was 0.870 ± 0.027 which shows high reliability of the observers and excellent level of agreement between them, the segmentation network achieved a global accuracy of 0.99 and the average dice score overall images was 0.93. The classification network achieved an accuracy of 0.802, class sensitivity of (pre-pubertal 0.78; pubertal 0.45; post-pubertal 0.98), respectively, per class specificity of (pre-pubertal 0.94; pubertal 0.94; post-pubertal 0.75), respectively. The developed algorithm showed the ability to determine the cervical vertebrae maturation stage which might aid in a faster diagnosis process by eliminating human intervention, which might lead to wrong decision-making procedures that might affect the outcome of the treatment plan. The developed algorithm proved reliable in determining the pre-pubertal and post-pubertal growth stages with high accuracy.

Differential subsampling with cartesian ordering: A high spatial-temporal resolution dixon imaging sequence for assessment of dural arteriovenous fistula.

To evaluate the accuracy of differential subsampling with cartesian ordering (DISCO) in comparison to time of flight (TOF) in detecting dural arteriovenous fistulas (DAVF), cerebral venous thrombosis (CVT) and hemodynamics. Sixty-two cases (24 female; aged 14-75; mean age, 51.3 years) were included in our study, with 42 positive and 20 negative cases via Digital Subtraction Angiography (DSA). Two neuroradiologists independently evaluated the DISCO and TOF. The sensitivity, specificity, and accuracy of the DISCO and TOF-MRA were individually calculated using DSA as the gold standard. Inter-observer reliability was assessed by using a weighted Cohen's kappa (κ) test; P < 0.05 was set as the threshold for statistical significance. Diagnostic sensitivities of DISCO and TOF for DAVF were 92.86 and 64.29%; specificities were 95.0% and 95.0%; while accuracies were 93.55 and 74.19% respectively. For detected CVT, sensitivities of DISCO and TOF were 100 and 92.31%; specificities were 96.55 and 93.10%; with accuracies 97.62 and 92.86% respectively. In hemodynamic analysis, sensitivity of DISCO for reflux was 95.45%; with a specificity of 95.0%; and accuracy 95.24%. The inter-observer kappa values were 0.857 for DISCO (P < 0.001). DISCO showed a high degree of sensitivity and specificity, suggesting its effectiveness in detecting DAVF with or without CVT. Intracranial hemodynamics can be identified using DISCO in DAVF patients, providing accurate evaluation of cerebral blood flow dynamics during the pre-treatment phase.

Radiographic findings of space-occupying lesions in sialo-CBCT of the major salivary glands.

When performing CBCT sialography (sialo-CBCT), space-occupying lesions may be identified incidentally. The objective was to describe their radiologic-clinical-histopathologic correlations. The archive of sialo-CBCT scans was retrospectively searched for suspected space-occupying lesions. Based on the scan and clinical-histopathologic data, the cases were divided into "pathologic" vs "normal," "intra-parenchymal" vs "extra-parenchymal," and "benign" vs "malignant." Two precalibrated, blinded radiologists performed a survey of the radiographic features of each scan. Cohen kappa, chi-square, Kruskal-Wallis, and Mann-Whitney tests assessed inter-observer agreement and radiologic-clinical-histopathologic correlations. In total, 27 (1.5%) suspected space-occupying lesions were found in 1,758 reports. Full follow-up data were available for 15 cases: four were "malignant," six were "benign," and the remaining five were "normal." Kappa showed substantial inter-observer agreement (0.8 to 1.0). Constant swelling correlated with "pathologic" cases (P = .003). Lesion diameter was greater in "pathologic" than "normal" (P < .001) cases, with a cut-off of 12.6 mm. Clinical and radiographic features were similar in "benign" and "malignant" lesions. "Intra-parenchymal" and "extra-parenchymal" space-occupying lesions correlated with "no-fill-region" (P = .01) and "main-duct-displacement" (P = .002), respectively. Suspected space-occupying lesions in sialo-CBCT with a diameter greater than 12.6 mm are likely to be "pathologic." No radiographic features were able to differentiate between "malignant" and "benign" space-occupying lesions.

Impact of photon counting detector CT derived virtual monoenergetic images and iodine maps on the diagnosis of pleural empyema

PurposeThe purpose of this study was to evaluate the impact of virtual monoenergetic image (VMI) energies and iodine maps on the diagnosis of pleural empyema with photon counting detector computed tomography (PCD-CT). Materials and methodsIn this IRB-approved retrospective study, consecutive patients with non-infectious pleural effusion or histopathology-proven empyema were included. PCD-CT examinations were performed on a dual-source PCD-CT in the multi-energy (QuantumPlus) mode at 120 kV with weight-adjusted intravenous contrast-agent. VMIs from 40-70 keV obtained in 10 keV intervals and an iodine map was reconstructed for each scan. CT attenuation was measured in the aorta, the pleura and the peripleural fat (between autochthonous dorsal muscles and dorsal ribs). Contrast-to-noise (CNR) and signal-to-noise (SNR) ratios were calculated. Two blinded radiologists evaluated if empyema was present (yes/no), and rated diagnostic confidence (1 to 4; not confident to fully confident, respectively) with and without using the iodine map. Sensitivity, specificity and diagnostic confidence were estimated. Interobserver agreement was estimated using an unweighted Cohen kappa test. A one-way ANOVA was used to compare variables. Differences in sensitivity and specificity between the different levels of energy were searched using McNemar test. ResultsSixty patients (median age, 60 years; 26 women) were included. A strong negative correlation was found between image noise and VMI energies (r = -0.98; P = 0.001) and CNR increased with lower VMI energies (r = -0.98; P = 0.002). Diagnostic accuracy (96%; 95% CI: 82–100) as well as diagnostic confidence (3.4 ± 0.75 [SD]) were highest at 40 keV. Diagnostic accuracy and confidence at higher VMI energies improved with the addition of iodine maps (P ≤0.001). Overall, no difference in CT attenuation of peripleural fat between patients with empyema and those with pleural effusion was found (P = 0.07). ConclusionLow VMI energies lead to a higher diagnostic accuracy and diagnostic confidence in the diagnosis of pleural empyema. Iodine maps help in diagnosing empyema only at high VMI energies.

Concordance of Proteinuria Examination Results using Dipstick Urine, Albumin-Creatinine Ratio, and Immunoassay in Diabetes Mellitus Type-2

Periodic examination of proteinuria for DM patients is important for the prevention of diabetic nephropathy complications. The most commonly used methods for checking proteinuria today are urine dipstick, albumin-creatinine ratio, and immunoassays. To analyze the suitability of proteinuria examination using a urine Dipstick, Albumin-Creatinine Ratio, and immunoassay. An observational analytic study, cross sectional, conducted in July 2020 - October 2020 at the Dr. Soetomo Surabaya, using urine samples (n = 57) that met the inclusion and exclusion criterias. The suitability test was carried out between the AIM urine dipstick, urine sysmex dipstick, AIM immunoassay and the Sysmex UC 3500 AC Ratio which were analyzed by the Cohen's kappa test. Immunoassay detected the highest proteinuria in 85.96% of type 2 DM patients, followed by AC Ratio (68.42%), AIM Dipstick (52.6%), and Sysmex Dipstick (49.12%). There was a very strong agreement between the AIM Dipstick and the Sysmex Dipstick, κ = 0.86 (p&lt;0.05), a weak agreement between AIM immunoassay examination and Sysmex AC ratio, κ = 0.37 (p&lt;0.05). There is no agreement between the Sysmex urine disptick and AIM immunoassay. There is a low agreement between the AIM Dipstick and the Sysmex AC Ratio. The AIM immunoassay detected microalbuminuria in 10(55.6%) of 18 subjects with negative results on Sysmex. Most immunoassay examinations detect proteinuria in type 2 DM patients. It is advisable to screen proteinuria using an immunoassay examination in type 2 DM patients1. Immunoassay examination can be relied on in screening proteinuria in DM patients. The results showed a very strong agreement using the AIM and the Sysmex dipstick examination. However, there was a weak agreement between the immunoassay examination and the AC ratio.

Space-time characterization of droughts in the Mae Klong River Basin, Thailand, using rainfall anomaly index

Abstract Drought is a slow-onset natural hazard that has major social, economic, and environmental consequences. This study examined the temporal and spatial characteristics of meteorological droughts in the Mae Klong River Basin, Thailand, during 1971–2015. The rainfall anomaly index (RAI) was calculated for 3, 6, and 12 months using monthly observed rainfall data from eight stations. The RAI results showed the presence of multiple drought events ranging from moderate to severe conditions over the study period. Trend analysis was carried out for the drought duration, magnitude, and intensity using the Mann-Kendall test and the Sen's slope method. Increasing trends were found for drought intensity for both the 6- and 12-month time scales. The performance of RAI was assessed by comparison with the standardized precipitation index (SPI). In general, a high correlation (Pearson's coefficient r&amp;gt;0.93) was found between RAI and SPI. Cohen's Kappa test indicated fair agreement between the results of the two drought indices. The findings of this study are expected to help decision-makers better manage the basin's water resources.

Comparison between 3D-FLAIR and 3D-real IR MRI sequences with visual classification method in the imaging of endolymphatic hydrops in Meniere's disease

BackgroundClinically, the evidence of endolymphatic hydrops (EH) in Meniere's disease (MD) primarily relies on audiological examinations, such as glycerol tests and electrocochleography, to suggest the presence of EH indirectly. However, these techniques lack sensitivity and specificity, and they do not sufficiently assess the degree of EH. This study aims to explore the application of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and three-dimensional real inversion recovery (3D-real IR) sequence imaging of EH in MD and to assess the image quality and grading of EH. MethodsThe study included 50 patients with definite MD. The 3D-FLAIR and 3D-real IR sequence images were performed 24 h after bilateral intratympanic injection of gadolinium. The image quality of both sequences was reviewed by two experienced radiologists. The vestibular and cochlear EH grades of both sequences were reviewed by two experienced otologists using a visual grading method. The Cohen's kappa and Pearson tests were used to analyze the data. ResultsThe reliability of image quality between the two radiologists was excellent (0.7 < kappa < 0.9). There were significant statistical differences in the image quality between the 3D-real IR and 3D-FLAIR sequences (p = 0.023 and p = 0.035, respectively). The reliability for the grading of vestibular and cochlear EH between the two otologists was excellent (0.7 < kappa < 0.9). The 3D-real IR sequence detected more severe hydrops than did the 3D-FLAIR sequence (p < 05). ConclusionThe image quality of the 3D-real IR sequence is better than that of the 3D-FLAIR sequence, and there are differences in the vestibular and cochlear EH grades of both sequences. The sensitivity of the 3D-real IR sequence in the cochlea is higher. The method of visual grading can be applied to both technologies when combined with 3D-real IR.

Diagnostic performance of ultrasound in assessing the extension of disease in advanced ovarian cancer

Surgical exploration remains the gold standard for evaluating the extension of disease and predicting resectability. A laparoscopy-based scoring model was developed by Fagotti and colleagues in 2006 and updated in 2015, based on the intraoperative presence or absence of some specific cancer features. The model proved an overall accuracy rate of 77% to 100% and is considered the reference test for assessing resectability in our institution. The primary aim of the study was to analyze the agreement between preoperative ultrasound examination and laparoscopic findings in assessing the extension of intraabdominal disease using 6 parameters described by Fagotti's score. This was a prospective single-center observational study. Between January 2019 and June 2020, consecutive patients with clinical or radiological suspicion of ovarian or peritoneal cancer were assessed with preoperative ultrasound examination and assigned a score based on the 6 Fagotti score parameters (great omentum, liver surface, lesser omentum/stomach/spleen, parietal peritoneum, diaphragms, bowel disease). Presence of mesenteral retraction of the small bowel and miliary carcinomatosis on the serosa were also evaluated. Each parameter was correlated with laparoscopic findings. Concordance was calculated between ultrasound and laparoscopic parameters using Cohen's kappa. Cohen's kappa ranged from 0.70 to 0.90 for carcinomatosis on the small or large bowel, supracolic omentum, liver surface, and diaphragms. Cohen's kappa test was lower for carcinomatosis on the parietal peritoneum (k=0.63) and on the lesser omentum or lesser curvature of the stomach or spleen (k=0.54). The agreement between ultrasound and surgical predictive index value (score) was k=0.74. For the evaluation of mesenteral retraction and miliary carcinomatosis, the agreement was low (k=0.57 and k=0.36, respectively). The results of ultrasound and laparoscopy in the assessment of intraabdominal tumor spread were in substantial agreement for almost all the parameters. Ultrasound examination can play a useful role in the preoperative management of patients with ovarian cancer when used in dedicated referral centers.

The diagnostic value of pepsin concentration in saliva for laryngopharyngeal reflux disease.

To explore the diagnostic efficacy of pepsin concentration in saliva for laryngopharyngeal reflux (LPR) disease. In this study, we recruited 40 participants with abnormal sensation of throat into the study who visited our hospital from March 2020 to December 2020. The 24h multichannel intraluminal impedance and pH monitoring (24h MII-pH), reflux symptom index (RSI) and reflux finding score (RFS), pepsin concentration in saliva were collected. The Cohen's kappa test and receiver-operating characteristic (ROC) curves were performed to determine and compare the sensitivity and specificity of five diagnostic methods: RSI; RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration. The area under the curve (AUC) of RSI, RFS, pepsin concentration, RSI + RFS, RSI + RFS + pepsin concentration were 0.767, 0.733, 0.870, 0.750,0.867, respectively. That is, the pepsin concentration has maximum AUC (the cutoff point is 219.47 (ng/mL); the sensitivity and 1-specificity is 0.300, 0.933, respectively.). The positive predictive value was 90.3% (28/31), and the negative predictive value was 77.8% (7/9). The Cohen's kappa coefficients of the five diagnostic subgroups were: RSI 0.486 (95% CI 0.207-0.764, P = 0.001); RFS 0.333 (95% CI 0.021-0.644, P = 0.032); RSI + RFS: 0.517 (95% CI 0.205-0.829, P = 0.001); pepsin concentration: 0.699 (95% CI 0.379-0.931, P = 0.001); RSI + RFS + pepsin concentration: 0.500 (95% CI 0.181-0.819, P < 0.001). The pepsin concentration has the maximum AUC area and highest consistency with the 24h MII-pH. Therefore, it has certain value in the screening and diagnosis of diseases related to LPR disease.

Effectiveness of Ultrasound Imaging in Assessing the Palpation Skills of Rotating Physicians.

As an important means of physical examination, palpation is usually limited to the physical examination before surgery and used as an auxiliary method for disease diagnosis in the field of surgery. In practice, palpation is also used in every aspect of the surgical procedure, and its application is of great significance to surgery. The purpose of this study was to investigate the ability of ultrasound imaging to assess the ability of rotating physicians to locate musculoskeletal structures by palpation. Rotating physicians were asked to palpate and locate the long head tendon of the biceps (LHB), posterior tibialis (TPT), acromioclavicular joint (ACJ), and medial tibiofemoral joint (TFJ) spaces on two volunteer models. After positioning, a truncated steel needle was attached to the skin and parallel to the palpable structure, and the position of the steel needle relative to the designated structure was assessed by ultrasound imaging, using the Cohen kappa test to study the inter-rater agreement. The results showed that the assessor’s Kappa coefficient for judging the location of all structures was 0.816, LHB was 1.00, TPT was 0.912, ACJ gap was 0.796, and TFJ medial space was 0.844, and the success rate of palpation for TPT was 62.2%, TFJ medial space was 37.8%, ACJ clearance was 24.3%, and LHB was 8.1%. In conclusion, the teaching methods of anatomy and palpation skills need further improvement, and ultrasound imaging is an effective tool for assessing palpation skills.

Cone-Beam Computed Tomography versus Rendered Panoramic Images in Determination of Dens Invaginatus Characteristics: Retrospective Cohort Study

Background: "Dens in Dente" is another name for Dens invaginatus. It's an uncommon developmental aberration that comes in a range of shapes and sizes. Invagination begins in the crown and may go to the root. The goal of this study was to use CBCT and panoramic pictures created from CBCT scans to evaluate the existence, kind, and features of DI in full-mouth surveys in Saudi patients presenting to Qassim dental college, and to compare the findings of the imaging modalities.&#x0D; Methods: This retrospective cohort study was performed by using 302 previously obtained CBCT records of patients from the database of the oral and maxillofacial radiology department of Qassim University, Saudi Arabia from yer 2016 to 2021. The research was ethically approved by the ethical approval committee of Qassim university (Code #: F-2019-3005).&#x0D; Results: In the present study, the age of the patients ranged from 9 to 80 years (mean age was 44 years). Out of 302 scans, 153 patients were female, and 149 were found to be male. According to the Cohen kappa test, the inter-examiner agreement was high between the 2 assessments of the observers: k = 0.795, P &lt; .000 for CBCT and k = 0.915, P &lt; .000 for panoramic images rendered from CBCT images. On the basis of the CBCT images, DI was observed in 98 of the 302 patients (frequency, 32.5%). Type I DI was the most commonly observed type of invaginatus (93.9%), followed by type II (6.1%). However, type III was not being observed.&#x0D; Conclusion: We can deduce that there is no special relationship between gender and the presence of dens invagnatus. When it comes to diagnosing and classifying dens invaginatus, CBCT images outperform rendered panoramic images. Because it provides an accurate representation of the external and internal dental anatomy, as well as appropriate visualization of associated characteristics with such cases that would be absolutely necessary in their treatment phases, CBCT can be recommended as an effective diagnostic device for identifying DI.

Criteria for Treatment Response in Myasthenia Gravis: Comparison Between Absolute Change and Improvement Percentage in Severity Scores.

BackgroundThe absolute change in the severity score between the baseline and pre-specified time frame (absolute criterion) was recommended as a criterion for myasthenia gravis (MG) treatment response. But heterogeneity of disease severity might dilute major changes in individual patients. The rationality of relative criterion (improvement percentage) had not been evaluated in treatment response in patients with MG.ObjectivesTo investigate the consistency between an absolute criterion and a relative criterion in the evaluation of treatment response in patients with MG.MethodsWe retrospectively analyzed the treatment response to a 3-month standardized treatment protocol with only glucocorticoid in 257 MG patients native to immunological treatments. With the commonly used absolute criterion, cut-offs of relative criteria were generated with the receiver operating characteristic (ROC) curve in the whole cohort and in patients with different degrees of baseline severity stratified by pre-treatment quantitative myasthenia gravis score (QMGS). The consistency between absolute and relative criteria was examined with Cohen's Kappa test and Venn diagrams.ResultsThe absolute and relative criteria had an overall substantial consistency (Kappa value, 0.639, p < 0.001) in the cohort. The Kappa values were substantial to almost perfect in mild and moderate groups and moderate in severe groups between the absolute and relative criteria (all p ≤ 0.001). More patients were classified as responsive with an absolute criterion while as unresponsive with a relative criterion in the moderate and severe groups.ConclusionsThe overall consistency between absolute and relative criteria was substantial in the whole cohort. The inconsistency between the two criteria was mainly from the moderate or severe patients at the baseline.

ASSOCIATION OF PULP CALCIFICATIONS AND CARDIOVASCULAR DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS.

This systematic review and meta-analysis was performed to evaluate the association between pulp calcifications (PC) and cardiovascular disease (CVD). Five databases (PubMed, Scopus, Embase, Web of Science and ProQuest) were searched to identify articles. Quality assessment of the selected articles was done using Joanna Briggs Institute critical appraisal tool and the inter-examiner agreement was calculated using the Cohen-Kappa test. The random-effects maximum likelihood model was used to evaluate the association between the conditions. Trim-and-fill funnel plot was used to evaluate the presence of publication bias. The level of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. A total of 2487 articles were identified from the initial search. Ten articles were included in this review of which 7 were cross-sectional and 3 were case-control studies. Eight articles had a low risk of bias (RoB), one article each had a moderate and high RoB. Inter-examiner reliability score was 0.8592. Seven articles reported a statistically significant positive association between CVD patients and PC. Two articles reported a non-significant positive association and one article reported no association between the same. A significant difference was observed in favor of CVD patients to possess more PC in comparison to non-CVD patients with an OR of 4.30 (95% confidence interval (CI): 2.19, 8.46; p = .000). Asymmetry in the Trim-and-fill funnel Plot suggested the presence of publication bias. GRADE analysis demonstrated low certainty of the evidence for the overall sample. There exists a low level of evidence to show that CVD patients are more prone to have PC in comparison to non-CVD patients.

Cytologic features of micropapillary variant urothelial carcinoma in urinary tract cytology: Case series and review of literature.

The micropapillary variant of urothelial carcinoma (MPVUC) is rare and aggressive. Surgical specimens often show atypical micro-clusters (AMCs) of cells with hyperchromatic, pyknotic, peripheral, irregular nuclei with variable nuclear to cytoplasmic ratios. We reviewed urinary tract cytology (UTC) from patients with MPVUC and hypothesized that AMCs would be present similar to those in surgical specimens. The archives were searched from 2000 to 2020 for patients with surgical cases with either MPVUC or conventional high-grade urothelial carcinoma (HGUC) and with prior abnormal UTC. Two pathologists reviewed UTC cases and controls in a blinded manner for AMCs, with quantitation of none, low, moderate, and high. Interrater reliability was compared by quadratic weighted Cohen's Kappa test. The association between numerical average score and MPVUC status was determined by logistic regression. Five patients with invasive MPVUC, one patient with a noninvasive micropapillary component, and 15 control patients with conventional HGUC were included. All patients had prior or concurrent abnormal UTC samples. Increasing category of quantities of AMCs on cytology was associated with micropapillary status (OR 7.9, 95% CI 2.7-118, p= .045), with moderate agreement between raters (Cohen's Kappa 0.54, 95% CI 0.19-0.89, p= .004). In patients with MPVUC on surgical specimen, AMCs were frequently observed on cytology. Similar atypical clusters were observed in patients with nonmicropapillary HGUC, albeit at lower frequency. However, given the WHO recommendation to diagnose micropapillary only if an invasive micropapillary component is present, a specific diagnosis of MPVUC on UTC cannot be based solely on the presence of AMCs.

Long-Term Clinical and Aesthetic Results of a Systematic Fat Transfer Protocol for Total Breast Reconstruction after Nipple-Sparing Mastectomy.

Autologous fat transfer can be safely offered for total breast reconstruction after nipple-sparing mastectomy. The aim of this study was to extend a fat transfer protocol to smokers and compare the long-term results among them and irradiated and nonirradiated patients. One hundred seventeen breasts after nipple-sparing mastectomy were prospectively enrolled and stratified in group A (25 irradiated), group B (21 smokers), or group C (71 controls). A standardized fat transfer protocol was used. Data collected were patient demographics, surgery information, and aesthetic analysis. Continuous and categorical variables were analyzed with the Kruskal-Wallis test, and the Cohen Kappa test was used to test interrater variability for the aesthetic analysis. Groups were homogeneous for demographics ( p > 0.05) but significantly different in number of fat transfer sessions ( p < 0.001), mean volume of the first two treatments ( p = 0.003), and mean total volume of injected fat ( p = 0.002). Volume, shape, position of the breast mound, inframammary fold, and scar location subscales obtained high score evaluations without a significant difference among groups ( p > 0.05), whereas skin texture subscale showed a lower score evaluation in group A ( p = 0.003). Although a significant difference for total subscales was worse in group A ( p = 0.004), the global score had a high rate evaluation in all groups ( p = 0.145). Interrater reliability showed substantial agreement among all categories. Although further investigation is required, the authors confirm the efficacy of their fat transfer protocol for both irradiated and nonirradiated nipple-sparing mastectomy patients and propose its indication to smokers with comparable clinical and aesthetic results. Risk, II.

Post-MRI transrectal micro-ultrasonography of transition zone PI-RADS > 2 lesions for biopsy guidance.

To prospectively determine the value of post-MRI micro-ultrasonography (microUS) in the diagnosis of transition zone (TZ) significant prostate cancer (sPCa). Eighty-four consecutive men (66 ± 6.3 years) with a mean PSA level of 10.2 ± 7.4 ng/mL and at least one TZ-PI-RADS > 2 lesion were included. All patients had MRI-directed microUS and biopsy. Sensitivity and specificity of post-MRI microUS to visualize PI-RADS > 2 TZ lesions, the cancer detection rate of TZ-sPCa, and tumor characteristics according to their visibility on microUS were evaluated. Interreader agreement for detecting microUS+ lesions was evaluated using Cohen's kappa test. Of the 92 PI-RADS > 2 lesions, 71 (71/92; 77%) were visible on microUS and biopsy was performed without image fusion, which was required for the 21 invisible lesions (21/92; 22.8%). TZ-sPCa detection rate was 51.1% (47/92). Sensitivity and specificity of MRI-directed microUS were 83% (39/47; 95% CI: 69.2-92.4%) and 28.9% (13/45; 95% CI: 16.4-44.3%), on a per-lesion basis and 86.4% (38/45; 95% CI: 72.6-94.8%) and 27.5% (11/40; 95% CI: 14.6-43.9%) on a per-patient basis. Visible tumors on microUS exhibited a larger volume and a lower mean ADC value than non-visible tumors (15.8 ± 5.1 vs. 12.5 ± 3.6 mm and 0.82 ± 1.1 × 103 vs. 0.9 ± 1.4 × 10-3 mm2/s) (p = 0.02). Non-visible tumors showed a heterogeneous non-specific echotexture or were masked by the shadowing caused by corpora amylacea. Interreader agreement was almost perfect (kappa = 0.88; 95% CI: 0.79-0.95). The main limitation is the single-center feature of the study. MRI-targeted transrectal microUS is effective to detect TZ-sPCa. TRUS-MRI image fusion helps overcome limitations due to TZ tissue heterogeneity. microUS can visualize the majority of MRI-detected PI-RADS > 2 TZ lesions (sensitivity = 83%). Interreader agreement of MRI-directed microUS in the detection of TZ lesions appears excellent (kappa = 0.88). In 77% of PI-RADS > 2 TZ lesions, biopsy was performed under microUS visual control. MRI fusion system was only used to overcome limitations due to tissue heterogeneity of benign prostatic hyperplasia.

Evaluation of root and canal morphologies of permanent canines in a Saudi Arabian sub population using cone-beam computed tomography

Background/purposeFailure to identify and treat the root canal system in its entirety has been known to be one of the leading causes of unsuccessful root canal treatment (RCT). This study aims to retrospectively assess the permanent canines in a Saudi Arabian sub population for the number of roots, root canal morphologies and the presence of symmetry among them using cone-beam computed tomography (CBCT). Materials and methodsCBCT scans belonging to 945 patients were screened. A total of 1880 permanent canines, 928 pertaining to maxilla and 952 pertaining to mandible were analyzed for the number of roots, root canal morphologies and the presence of symmetry among them. Comparative evaluation between genders was done using Fisher's exact test, since majority of the groups had expected count of less than 5. A calculated P-value of less than 0.05 was considered significant. Chi square test was used for statistical analysis of the data. Intra operator variability was observed using Cohen's Kappa test. ResultsSingle root was observed in 100% and 98.7% of the maxillary and mandibular canines respectively. Two roots were identified in 1.3% of the MnC's. Type I (97.48%), Type II (0.21%), Type III (1.05%) and Type V (1.26%) Vertucci canal configurations (VC) were observed in MnC's. Statistical significant difference was observed concerning the number of roots and canal morphology according to Vertucci in the mandibular canines. No difference was observed according to Ahmed et al. classification system. Moreover, there was no gender based difference seen among them. ConclusionMore variable root and canal morphologies are observed in MnC's, although single root with Type I VC is the most common.

Performance assessment of a new indirect rapid diagnostic test for plague detection in humans and other mammalian hosts

Plague is a flea-borne zoonosis that affects a wide range of mammals and still causes outbreaks in human populations yearly across several countries. While crucial for proper treatment, early diagnosis is still a major challenge in low- and middle-income countries due to poor access to laboratory infrastructure in rural areas. To tackle this issue, we developed and evaluated a new Fraction 1 capsular antigen (F1)-based rapid diagnostic test (RDT) as an alternative method for plague serological diagnosis and surveillance in humans and other mammals. In this study, 187 serum samples from humans, dogs, rodents and rabbits were retrospectively assessed using the plague RDT method. To calculate its performance, results were compared to those obtained by traditional hemagglutination (HA) and ELISA, which are well-established methods in the plague routine serodiagnosis. Remarkably, the results from RDT were in full agreement with those from the ELISA and HA assays, resulting in 100% (CI 95% = 95.5–100%) of sensitivity and 100% (CI 95% = 96.6–100%) of specificity. Accordingly, the Cohen's Kappa test coefficient was 1.0 (almost perfect agreement). Moreover, the RDT showed no cross-reaction when tested with sera from individuals positive to other pathogens, such as Y. pseudotuberculosis, Yersinia enterocolitica, Anaplasma platys, Ehrlichia canis and Leishmania infantum. Although preliminary, this study brings consistent proof-of-concept results with high performance of the Plague RDT when compared to HA and ELISA. Although further human and animal population-based studies will be necessary to validate these findings, the data presented here show that the plague RDT is highly sensitive and specific, polyvalent to several mammal species and simple to use in field surveillance or point-of-care situations with instant results.

A novel rapid and accurate method for detecting Helicobacter Pylori: the modified antigen test.

We aim to assess the diagnostic accuracy of the gastric biopsy Helicobacter pylori (H. pylori) antigen stool test as a novel method for detecting H. pylori, comparing this test with the histopathological evaluation of H. pylori and H. pylori antigen stool test as the reference standards. The study involves patients who are scheduled for an upper gastrointestinal endoscopy. Gastric biopsies were endoscopically obtained from all patients, and H. pylori antigen stool tests were performed for all patients. Results from the gastric biopsies that were studied using the H. pylori antigen stool test in terms of the novel method were obtained and recorded. The inter-rater agreement between the H. pylori tests in determining positive and negative results was investigated using Fleiss' and Cohen's kappa tests. The capacity of applied tests in predicting the presence of H. pylori was analyzed using a receiver operating characteristic (ROC) curve analysis. A total of 55 patients were studied (32 females and 23 males). The strongest coherence was obtained between the gastric biopsy test and histopathological evaluation with a kappa value of 0.664 in Cohen's kappa analysis of overall coherence between tests. The most accurate sensitivity and specificity values were obtained for the gastric biopsy test and histopathological evaluation crosstabulation for both overall comparisons at 90.5% sensitivity and 79.4% specificity. With this new, rapid, and easy-to-apply method, patients' endoscopies and gastric biopsies looking for the presence of H. pylori would be determined with more sensitive and more specific accuracy rates than current antigen stool tests, and H. pylori can be eradicated immediately without waiting for the histopathological evaluation period.