Experienced Technician Research Articles

Clinical Implications of Ultrasound-Based Morphology in Choroidal Melanoma

ObjectiveTo describe the frequency of different B-scan morphologies and their association with clinical features and outcomes. DesignCohort study of patients enrolled in the Prospective Ocular Tumor Study from January 2000 to January 2024 initially seen at Mayo Clinic Rochester. ParticipantsConsecutive inclusion of patients with posterior uveal melanoma. MethodsB-scan ultrasounds were performed by an experienced technician and treatment modalities were implemented by the attending oncologist. Main outcomes and measuresTumors were classified by shape as observed on B-scan. Enucleation-, metastasis, -and overall survival (EFS, MTS, and OS) rates were analyzed using Cox-regression models and Kaplan-Meier curves. ResultsAmong 1021 cases of uveal melanoma, 739 (72.4%) were dome-shaped, 119 (11.7%) mushroom-shaped, 85 (8.3%) multilobulated, 77 (7.5%) minimally elevated, and 1 (0.1%) diffuse. The median follow-up duration after presentation was 37 months (3-324). The macula was more commonly involved in minimally elevated tumors compared to the other groups (63.6% vs. 13.8%, p<0.001). These tumors also exhibited a larger proportion of high internal reflectivity (13% vs. 2.3%, p<0.001). The multilobulated group exhibited a significantly larger diameter at baseline (median 15 mm, IQR 6.1-30), whereas the mushroom-shaped group had greater thickness (median 7.9 mm, IQR 1.3 - 17.3) compared to the other groups (p<0.001). EFS at 36 months was lower for mushroom-shaped [60.1% (95% CI, 47.7-70.3)] and multilobulated tumors [71.1% (95% CI, 55.7-82.7)]. At 36 months, multilobulated tumors had lower MFS [68.2% (95%, CI 55-78.2)] and OS [73.9% (95%, CI 59.9-83.64)]. On multivariate analysis adjusted for tumor thickness and diameter, multilobulated melanomas had a higher risk of metastasis (HR 2.08, p=0.003) and death (HR 2.38, p<0.001). ConclusionChoroidal melanoma configuration by B-scan can vary from minimally elevated to dome-shaped to mushroom-shaped or multilobulated. Independent of presenting tumor size, multilobulated morphology was identified as a predictor for metastasis and death. Multilobulated melanomas, identified by a readily available tool such as ultrasonography, warrant a vigilant approach and close monitoring due to a potential association with poor prognosis.

P-038 Sperm head morphometric reference values of 1856 sperms in fertile Asian males

Abstract Study question To explore comprehensive normal sperm morphometric reference values by measuring 1856 sperms in fertile males using artificial intelligence (AI) technique. Summary answer Four novel describing parameters of sperm head (size, shape, area, and uniformity) and 14 other features for normal sperm head were extracted and characterized. What is known already Sperm head morphology is crucial for male factor infertility diagnosis and assessment of male reproductive potential. The human spermatozoon is one of the most diverse cell types known. However, most assessment criteria have only 3 morphometric parameters (Length, width, and length/width ratio) for sperm head morphometric measurement. We detailed the features of sperm head by defining and characterizing 14 parameters based on AI. Study design, size, duration This is a prospective observational study. The study included 1856 normal sperm images from 23152 stained sperm acquired by an Automated Sperm Morphology Analysis (ASMA) system. The measured sperm morphometry data were acquired from May 2020 to December 2021. Participants/materials, setting, methods All participants (54 fertile males) had fathered a child naturally during the past year. The measured sperm morphometry data were acquired from candidate donors of the Sichuan Province Human Sperm Bank (SPHSB, Chengdu, China). Images of 23,152 stained sperm captured by ASMA. All sperm images were assessed by three experienced technicians. Finally, we concluded 14 morphometric data from normal sperm by measuring sizes in pixels. Main results and the role of chance (1) Characteristics of sperm head size and shape: We present eight sperm head size and shape parameters for the 1856 visually normal spermatozoa. The median head size parameters included head length of 4.02 (95% CI: 4.01–4.05) μm, head width of 2.52 (95% CI: 2.52–2.54) μm, length to width ratio of 1.59 (95% CI: 1.59–1.62), and head girth of 11.18 (95% CI: 11.17–11.25) μm. The median head symmetry parameters included short axis symmetry (SAS) of 92.1% (95% CI: 88.3%–89.2%) and the long axis symmetry (LAS) of 94.3% (95% CI: 91.6%–92.3%). The median head shape parameters included median of ellipse intersection over union (EIoU) of 88.9% (95% CI: 85.4%–86.3%) and girth intersection over union (GIoU) of 102.4% (95% CI: 102.4%–102.5%). (2) Characteristics of sperm head area and acrosome uniformity: Descriptive analysis of the sperm head area characteristics included a median sperm head area of 7.72 (95% CI: 7.74–7.85) μm2, acrosome area of 3.67 (95% CI: 3.77–3.88) μm2, acrosome area ratio of 48.2% (95% CI: 47.8%–48.6%), post-acrosomal area of 3.95 (95% CI: 3.95–4.00) μm2, acrosome uniformity of 88.6% (95% CI: 88.6%–89.1%), and nuclear uniformity of 100.0% (95% CI: 99.8%–99.9%). Limitations, reasons for caution This study had several limitations that should be noted. The use of samples from a single center, covering relatively young participants from only seven provinces in China, could limit the usage of our findings. The use of only three technicians to assess the samples may have introduced a subjective bias. Wider implications of the findings The measurement technique was accurate, objective, and highly informative by AI. The data provide extremely detailed information for reference studies and comparison of sperm head parameters among different male groups. These new parameters can be applied in routine semen analysis when assessing sperm morphology and male fertility potential. Trial registration number not applicable

Blueprint for a Semi-automated Image Processing Tool to Characterize Stent Features: Application to a Pediatric Growth-Adaptive Stent.

The goal of this work was to develop a general blueprint for a semi-automated image processing tool (SIPT) to measure small, complex features of stent prototypes that can replace the current gold standard of manual measurements. The stents were designed using CAD software and manufactured via laser cutting. Stent prototypes were imaged using a Keyence microscope in top and side view orientations. The SIPT algorithm was developed in MATLAB to extract and measure 4 dimensions of the stent (inner and outer diameter, spring bend outer radius, spring bend width). The same dimensions were also manually measured by an experienced metrology technician as a gold standard comparison. We successfully made over 5000 unique measurements across the 4 key dimensions of 15 stents using the SIPT algorithm. Compared to the gold standard manual method, SIPT reduced measurement time by nearly 90% and increased the total number of measurements captured by over 2300%. The two one-sided test and Bland-Altman analysis demonstrated that SIPT achieved equivalency against the manual method of measurement for all 4 dimensions. In summary, we found that our SIPT software could be used to replace manual measurements and provided substantial time savings with consistent accuracy. Overall, this paper presents a generalizable workflow to isolate and measure critical features of stent prototypes that we believe will provide a valuable, cost-effective tool to other medical device designers seeking to rapidly iterate on unique stent designs or other manufactured parts with small and complex structures.

IoT-Enabled Water Quality Monitoring and Alum Dose Determining System

The water treatment process involves a series of physical, chemical, and biological techniques and methods designed to remove contaminants, impurities, and undesirable substances from raw or untreated water to make it safe, clean, and usable. Adverse weather conditions, such as rainy seasons and floods, present significant challenges, and difficulties to the water treatment process. Alum is mainly used for reducing the turbidity of the water in the treatment process. In Sri Lanka, all water treatment plants use the Jar Test to determine the Alum dosage manually. They conduct Jar Tests to measure raw water quality in their laboratories. The Alum addition valve is set to a pre-determined quantity and the value is decided based on the experience of the technicians. Since there is no specific formula, the presence of an experienced technician is required to determine alum dosage using the Jar test. Thus, this study intends to propose an automated system for determining the optimum Alum quantity to be added to a given raw water sample. This is achieved by designing an Internet of Things (IoT)-enabled sensing device for measuring the water quality, which feeds data to a Machine Learning Model trained to predict the Alum quantity to be added. The task of the Machine learning model is to identify the pattern of raw water parameters and Alum dosage. By doing this, a could be provided a guideline for determining alum dosage instead of a manual Jar test and removed the necessity of experienced technician support always. A user-friendly web interface will allow the operators to customize the parameters according to the requirement and display a detailed analysis report. The predetermined quantity of Alum is transmitted to the output Alum adding value, to enhance its performance as an automated control rather than doing the addition process manually. This is a conceptual study on how to determine the Alum dosage using Raw water parameters and past experiment results.

The Effect of Blue-light Filtering Intraocular Lenses on the Development and Progression of Macular Atrophy in Eyes With Neovascular Age-related Macular Degeneration

PurposeTo assess the effect of blue-light filtering (BLF) intraocular lenses (IOLs) on the development and progression of macular atrophy (MA) in eyes with neovascular age-related macular degeneration (nAMD). DesignRetrospective clinical cohort study. MethodsnAMD patients with anti-vascular endothelial growth factor (VEGF) injections who underwent uneventful cataract surgery between 2007 and 2018 with follow-up until June 2023. Subsequent MA rates were compared between subjects who received a BLF IOL or a non-BLF IOL. All OCT scans were manually reviewed in a masked manner regarding patient baseline variables and IOL status by an experienced research technician. Using the Heidelberg software, the area of MA was manually evaluated and calculated (mm2) by the program. The overall risk of developing new-onset MA and the effect of IOL type on disease progression were assessed. Death was included as a censoring event. ResultsIncluded were 373 eyes of 373 patients (mean age 78.6±6.7 years at surgery, 67.4% females). 206 eyes were implanted with BLF IOLs and 167 with non-BLF IOLs with comparable follow-up times (3164±1420 days vs. 3180±1403 days, respectively, P=0.908), and other baseline parameters (age, gender, corrected distance visual acuity, macular thickness, cumulative number of anti-VEGF injections). Nine pre-existing and 77 new-onset MA cases were detected, with similar distribution between BLF and non-BLF eyes (P=0.598 and P=0.399, respectively). Both univariate Kaplan-Meier (P=0.366) and multivariate Cox regression analysis adjusted for age and gender showed that BLF-IOLs were comparable to non-BLF IOLs regarding hazard for new-onset MA (HR 1.236, 95% CI 0.784-1.949, P=0.363). Final MA area at the last visit was 5.14±4.71mm2 for BLF IOLs and 8.56±9.17mm2 for non-BLF IOLs (P=0.028), with the mean annual MA area increase of 0.78±0.84mm2 and 1.26±1.32mm2, respectively (P=0.042). ConclusionsBLF IOLs did not show added benefit over non-BLF IOLs in terms of MA-free survival but were associated with less progression over time in a cohort of nAMD patients.

Diagnostic accuracy of daytime polysomnography: a reappraisal during the COVID-19 era.

Level I conventional polysomnography (PSG), the gold standard for diagnosing obstructive sleep apnea (OSA), requires an overnight stay. This study evaluated the role of daytime PSG as an alternative diagnostic tool. A prospective cohort study was undertaken with consecutive patients with suspected OSA at a tertiary care sleep center. The primary objective was to evaluate the sensitivity and diagnostic accuracy of daytime PSG for diagnosing OSA. The secondary objective was to find out the factors associated with a falsely negative daytime PSG result. All individuals were subjected to level I daytime PSG, done in the sleep lab in the presence of an experienced sleep technician during the daytime from 12 PM to 4 PM. Out of 162 patients, 105 underwent daytime PSG. OSA was diagnosed on daytime PSG in 86.7 out of the 19 remaining patients refused a repeat PSG study. Out of the 12 individuals who underwent the nighttime PSG for confirmatory diagnosis, 10 were diagnosed as OSA (false negatives), and 2 were confirmed as not-OSA (true negatives). The sensitivity, diagnostic accuracy, and negative predictive value of daytime PSG were 89.58%, 89.80%, and 16.67%, respectively. The false negatives had a higher prevalence of mild OSA. Daytime PSG is sensitive in diagnosing OSA and can be considered in individuals with severe symptoms at centers with a high patient load or when the individual wishes to avoid a nighttime study. A negative result in daytime PSG must be followed by conventional overnight PSG for confirmatory diagnosis.

Comparison of 3D-Printed Single Crown Outcomes Among Different Computer-Aided Design Software Programs.

Low-cost resin 3D printers have been used to produce affordable interim single crowns in public and private dental practices. The purpose of this study was to assess the impact of different computer-aided design (CAD) software programs on 3D trueness, microscopic marginal and internal gaps, time to design, and interproximal contacts of low-cost 3D-printed single crowns. This in vitro study was performed on a total of 90 standardized resin-prepared teeth adapted to a dental manikin. For comparison among CAD software programs, 45 tooth preparations received 3D-printed crowns designed with one of three CAD software programs by an experienced technician and identified as groups TRIOS (n = 15), EXOCAD (n = 15), and ZZ (Zirkonzahn; n = 15). To assess interoperator reproducibility, 15 additional crowns were designed by a dental clinician (group ZZ-DENT) and 15 by a dental prosthetic technician (group ZZ-PROS), both with basic 1-week CAD/CAM training. Finally, as a control group, 15 crowns were milled using a high-end five-axis milling device (group ZZ-CONTROL). Statistically significant differences for 3D trueness, microscopic gaps, time to design, and interproximal contacts among groups were assessed with the Kruskal-Wallis test. No statistically significant differences in 3D trueness or marginal or internal gaps were found, either among different software programs or CAD operators (P > .05). However, Group TRIOS took significantly longer to design than EXOCAD and ZZ groups (P = .001). Less-experienced operators were significantly outperformed in time and interproximal contacts (P = .001) by the CAD technician using the same software program. Finally, control milled crowns (ZZ-CONTROL) significantly outperformed the respective 3D-printed copies (ZZ) in all assessed variables (P < .001). Different CAD software programs may affect the time required to design, but they do not significantly affect clinical outcomes of low-cost 3D-printed resin crowns if designed by an experienced CAD technician.

Artificial Intelligence: A New Frontier in Radiological Imaging

Artificial intelligence (AI) is the development of computer systems that perform tasks that traditionally require human intelligence. One of the applications of AI is to help technologists and radiologists select appropriate patient protocols. Using AI methods, the accuracy of radiologists' diagnosis improved significantly by 37%. Currently, research is underway on the use of artificial intelligence in diagnostic medical imaging, which has demonstrated high sensitivity and accuracy in the identification of imaging abnormalities. In addition, artificial intelligence has the potential to improve tissue detection and characterization. Although the terms “artificial intelligence” and “machine learning” are often used interchangeably, it is important to note that machine learning is a specific subset of AI focusing on the use of algorithms to learn from the acquired data, enabling prediction, classification and understanding generation. With machine learning, a formal set of methodologies is based on solid mathematical foundations. The study of inventing and implementing algorithms that can learn from prior experiences is known as machine learning (ML). If you've observed a pattern of behaviour before, you can predict whether or not it'll happen again. That is, no prognosis can be made if no past examples exist. The major benefits of using machine learning in radiology will be the reduction of professional time and the accuracy of diagnostic outcomes. When compared to well-trained and experienced radiologists and technicians, several Al-based image segmentation methods in radiology systems have exhibited equivalent, if not better, performance.

Tooth morphology, internal fit, occlusion and proximal contacts of dental crowns designed by deep learning-based dental software: A comparative study

ObjectivesThis study compared the tooth morphology, internal fit, occlusion, and proximal contacts of dental crowns automatically generated via two deep learning (DL)-based dental software systems with those manually designed by an experienced dental technician using conventional software. MethodsThirty partial arch scans of prepared posterior teeth were used. The crowns were designed using two DL-based methods (AA and AD) and a technician-based method (NC). The crown design outcomes were three-dimensionally compared, focusing on tooth morphology, internal fit, occlusion, and proximal contacts, by calculating the geometric relationship. Statistical analysis utilized the independent t-test, Mann–Whitney test, one-way ANOVA, and Kruskal–Wallis test with post hoc pairwise comparisons (α = 0.05). ResultsThe AA and AD groups, with the NC group as a reference, exhibited no significant tooth morphology discrepancies across entire external or occlusal surfaces. The AD group exhibited higher root mean square and positive average values on the axial surface (P < .05). The AD and NC groups exhibited a better internal fit than the AA group (P < .001). The cusp angles were similar across all groups (P = .065). The NC group yielded more occlusal contact points than the AD group (P = .006). Occlusal and proximal contact intensities varied among the groups (both P < .001). ConclusionsCrowns designed by using both DL-based software programs exhibited similar morphologies on the occlusal and axial surfaces; however, they differed in internal fit, occlusion, and proximal contacts. Their overall performance was clinically comparable to that of the technician-based method in terms of the internal fit and number of occlusal contact points. Clinical significanceDL-based dental software for crown design can streamline the digital workflow in restorative dentistry, ensuring clinically-acceptable outcomes on tooth morphology, internal fit, occlusion, and proximal contacts. It can minimize the necessity of additional design optimization by dental technician.

Enhanced sleep staging with artificial intelligence: a validation study of new software for sleep scoring.

Manual sleep staging (MSS) using polysomnography is a time-consuming task, requires significant training, and can lead to significant variability among scorers. STAGER is a software program based on machine learning algorithms that has been developed by Medibio Limited (Savage, MN, USA) to perform automatic sleep staging using only EEG signals from polysomnography. This study aimed to extensively investigate its agreement with MSS performed during clinical practice and by three additional expert sleep technicians. Forty consecutive polysomnographic recordings of patients referred to three US sleep clinics for sleep evaluation were retrospectively collected and analyzed. Three experienced technicians independently staged the recording using the electroencephalography, electromyography, and electrooculography signals according to the American Academy of Sleep Medicine guidelines. The staging initially performed during clinical practice was also considered. Several agreement statistics between the automatic sleep staging (ASS) and MSS, among the different MSSs, and their differences were calculated. Bootstrap resampling was used to calculate 95% confidence intervals and the statistical significance of the differences. STAGER's ASS was most comparable with, or statistically significantly better than the MSS, except for a partial reduction in the positive percent agreement in the wake stage. These promising results indicate that STAGER software can perform ASS of inpatient polysomnographic recordings accurately in comparison with MSS.

Normal sperm head morphometric reference values in fertile Asian males.

Sperm head morphology is crucial for male factor infertility diagnosis and assessment of male reproductive potential. Several criteria are available to analyze sperm head morphology, but they are limited by poor methodology comparability and population applicability. This study aimed to explore comprehensive and new normal morphometric reference values for spermatozoa heads in fertile Asian males. An automated sperm morphology analysis system captured 23 152 stained spermatozoa from confirmed fertile males. Of these samples, 1856 sperm head images were annotated by three experienced laboratory technicians as "normal". We employed 14 novel morphometric features to describe sperm head size (head length, head width, length/width ratio, and girth), shape (ellipse intersection over union, girth intersection over union, short-axis symmetry, and long-axis symmetry), area (head, acrosome, postacrosomal areas, and acrosome area ratio), and degrees of acrosome and nuclear uniformity. This straight-forward method for the morphometric analysis of sperm by accurate visual measurements is clinically applicable. The measured parameters present valuable information to establish morphometric reference intervals for normal sperm heads in fertile Asian males. The presented detailed measurement data will be valuable for interlaboratory comparisons and technician training. In vitro fertilization and andrology laboratory technicians can use these parameters to perform objective morphology evaluation when assessing male fertilization potential.

Assessing the effectiveness of Compare Assistant for improving intra-rater reliability of ultrasound-measured muscle thickness.

Muscle thickness measured via ultrasound is commonly used to assess muscle size. The purpose of this study was to determine if the reliability of this measurement will improve if using the Compare Assistant tool, and whether this depends on technician experience and the muscle being assessed. Individuals came to the laboratory for two visits each separated by 24h. On day 1, two ultrasound images were taken on the individual's anterior upper arm (elbow flexors) and anterior lower leg (tibialis anterior) by two inexperienced and one experienced ultrasound technician. On day 2, three images were taken: (1) without looking at the previous images taken on day 1; (2) after re-examining the images taken on day 1, and (3) side-by-side with the images taken on day 1 via Compare Assistant. Bayes Factors (BF10) were used to provide evidence for the null (< 0.33) or alternative (> 3) hypotheses. There was no rater by measurement technique interaction (upper body: BF10 = 0.04, lower body: BF10 = 0.138), nor was there a main effect of measurement technique (upper body: BF10 = 0.052, lower body: BF10 = 0.331), indicating that reliability measures were not improved for either the upper body (CV%, no look: 2.92 vs. Compare Assistant: 2.87) or lower body (CV%, no look: 1.81 vs. Compare Assistant: 1.34) as a result of using Compare Assistant. The results of this study suggest that day-to-day reliability of muscle thickness measurement may be limited by random biological variability as opposed to technician error.

Discrepancies in the occlusal devices designed by an experienced dental laboratory technician and by 2 artificial intelligence-based automatic programs

Artificial intelligence (AI) models have been developed for different applications, including the automatic design of occlusal devices; however, the design discrepancies of an experienced dental laboratory technician and these AI automatic programs remain unknown. The purpose of this in vitro study was to compare the overall, intaglio, and occlusal surface discrepancies of the occlusal device designs completed by an experienced dental laboratory technician and two AI automatic design programs. Virtually articulated maxillary and mandibular diagnostic casts were obtained in a standard tessellation language (STL) file format. Three groups were created depending on the operator or program used to design the occlusal devices: an experienced dental laboratory technician (control group) and two AI programs, namely Medit Splints from Medit (Medit group) and Automate from 3Shape A/S (3Shape group) (n=10). To minimize the discrepancies in the parameter designs among the groups tested, the same printing material and design parameters were selected. In the control group, the dental laboratory technician imported the articulated scans into a dental design program (DentalCAD) and designed a maxillary occlusal device. The occlusal device designs were exported in STL format. In the Medit and 3Shape groups, the diagnostic casts were imported into the respective AI programs. The AI programs automatically designed the occlusal device without any further operator intervention. The occlusal device designs were exported in STL format. Among the 10 occlusal designs of the control group, a random design (shuffle deck of cards) was used as a reference file to calculate the overall, intaglio, and occlusal discrepancies in the specimens of the AI groups by using a program (Medit Design). The root mean square (RMS) error was calculated. Kruskal-Wallis, and post hoc Dwass-Steel-Critchlow-Fligner pairwise comparison tests were used to analyze the trueness of the data. The Levene test was used to assess the precision data (α=.05). Significant overall (P<.001), intaglio (P<.001), and occlusal RMS median value (P<.001) discrepancies were found among the groups. Significant overall RMS median discrepancies were observed between the control and the Medit groups (P<.001) and the control and 3Shape groups (P<.001). Additionally, significant intaglio RMS median discrepancies were found between the control and the Medit groups (P<.001), the Medit and 3Shape groups (P<.001), and the control and 3Shape groups (P=.008). Lastly, significant occlusal RMS median discrepancies were found between the control and the 3Shape groups (P<.001) and the Medit and 3Shape groups (P<.001). The AI-based software programs tested were able to automatically design occlusal devices with less than a 100-µm trueness discrepancy compared with the dental laboratory technician. The Levene test revealed significant overall (P<.001), intaglio (P<.001), and occlusal (P<.001) precision among the groups tested. The use of a dental laboratory technique influenced the overall, intaglio, and occlusal trueness of the occlusal device designs obtained. No differences were observed in the precision of occlusal device designs acquired among the groups tested.

A-158 Evaluation of Nucleated Red Blood Cells NRBC) Count on Mindray BC 6800Plus

Abstract Background The detection of NRBCs in the peripheral blood is a marker of many pathological conditions andhas significant prognostic value. Microscopy is the traditional method for NRBC count, but it’s time consuming and has low precision and efficacy and requires experienced technicians. TheMindray BC-6800 Plus is a hematological analyzer that brings SF Cube technology, whichquantifies NRBCs in the WNB channel. This channel differentiates basophils and NRBCs, andcounts white blood cells. The present study aims to evaluate if the automated method is preciseand comparable to the manual microscopy. Methods Blood samples from 40 patients with NRBC flag from the laboratory routine were evaluated bymicroscopy. Blood films were prepared automatically with a Mindray SC-120 slidemaker/stainer.NRBC were manually counted and reported as number of NRBC per 100 white cells, which wasconsidered the reference method. The results of microscopic counts were compared with thoseof the automated method and statistically analyzed using the F-test, T-test and Pearson’ scorrelation coefficient. Results The results show good correlation between the methods: F-test of 1.36 (below 1.69); t test (0,2791) below the critical T(2,0210) and Pearson’s correlation coefficient was 0.9, which isconsidered an adequate result. Samples used in this evaluation comprised mainly low results andfew samples with higher counts. The maximum observed value was 41%, which was confirmedby microscopy. It is important that samples with larger counts be evaluated to be sure of thelinearity value of the test. Conclusion The results demonstrated that the NRBC counts obtained by Mindray BC-6800 analyzer are inagreement with data from manual counts. However, it is necessary that the accuracy of sampleswith very high counts be investigated and compared with the reference method. Thisimplementation of the automatic release of NRBC can allow the laboratory to reduce the time forreleasing tests and optimize the productivity of microscopists.

Inter-reader variability and reproducibility of the PI-QUAL score in a multicentre setting

PurposeTo assess the inter-reader reproducibility of the Prostate Imaging Quality (PI-QUAL) score between readers with varying clinical experience and its reproducibility at assessing imaging quality between different institutions. MethodsFollowing IRB approval, we assessed 60 consecutive prostate MRI scans performed at different academic teaching and non-academic hospitals uploaded to our institutes’ PACS for second opinion or discussion in case conferences. Anonymized scans were independently reviewed using the PI-QUAL scoring sheet by three readers - two radiologists (with 1 and 12 years Prostate MRI reporting experience), and an experienced MRI technician with interest in image acquisition and quality. All readers were blinded to the site where scans were acquired. ResultsAgreement coefficients between the 3 readers in paired comparison for each individual PI-QUAL score was moderate. When the scans were clustered into 2 groups according to their ability to rule in or rule out clinically significant prostate cancer [i.e., PI-QUAL score 1–3 vs PI-QUAL score 4–5], the Gwet AC1 coefficients between the three readers in paired comparison was good to very good [Gwet AC 1:0.77, 0.67, 0.836 respectively] with agreement percentage of 88.3%, 83.3% and 91.7% respectively. Agreement coefficient was higher between the experienced radiologist and the experienced MRI technician than between the less experienced trainee radiologist and the other two readers.The mean PI-QUAL score provided by each reader for the scans was significantly higher in the academic hospitals (n = 32) compared to the community hospital (n = 28) [experienced radiologist 4.6 vs 2.9; trainee radiologist 4.5 vs 2.4; experienced technologist 4.4 vs 2.4; p value < 0.001]. ConclusionWe observed good to very good reproducibility in the assessment of each MRI sequence and when scans were clustered into two groups [PI-QUAL 1–3 vs PI-QUAL 4–5] between readers with varying clinical experience. However, the reproducibility for each single PI-QUAL score between readers was moderate. Better definitions for each PI-QUAL score criteria may further improve reproducibility between readers.Additionally, the mean PI-QUAL score provided by all three readers was significantly higher for scans performed at academic teaching hospitals compared to community hospital.

Variability of Replicates of Intraocular Inflammatory Biomarkers in Ocular Fluid Samples Analyzed with Multiplex Assays.

Certain factors such as instrumental and sample processing errors may contribute to variability of ocular biofluid samples when they are run as replicates with multiplex assays. There is a paucity of literature on the variability of replicates in multiplex assays. This study aims to evaluate whether there is significant variability in replicate analyses of multiplex assays. A total of 152 human ocular biofluid samples (51 aqueous humor and 101 vitreous) were collected and assayed for 27 cytokine biomarker concentrations (pg/mL). Samples were evaluated as replicates (duplicate analysis) at four different time points. Statistical methods including paired samples t-test, 3-way ANOVA, intraclass correlation coefficient (ICC; <0.5-0.75=poor-moderate, 0.75->0.90 =good-excellent reliability), and coefficients of variation (CV) were employed to evaluate for statistical significance, with Bonferroni corrected P=0.002. Among the 4104 biomarker replicate assays for aqueous humor and vitreous, two analytes (PDGF-BB and IL-7) had a statistically significant difference between the sampled concentrations of the replicates in vitreous samples (mean (diff)=2.05, P<0.001, mean (diff)=1.56, P<0.001, respectively). Majority of the ICC values fell within the good-excellent range (86% of samples) with a minority falling in the poor-moderate range (14% of samples). More variability was noted in the vitreous humour, with five analytes (IL-2, IL-10, IL-12(p70), IL-13, IL-17) demonstrating an average ICC of less than 0.5. The CV calculated for each set of replicates suggested that 93% of replicates had an acceptable level of quantitative assay variability (CV<20%). This study demonstrates that the analysis of most biomarkers in ocular fluids may not require the use of replicates. However, certain analytes such as PDGF-BB and IL-7 may require the use of replicates to ensure reliable results. Caution should be taken when applying these findings to other laboratory settings as our study was conducted by an experienced technician using a standardized protocol. In less standardized settings, replicates may be required in order to ensure accuracy of results. These findings may guide researchers with the design of their studies on ophthalmic biomarker analysis.

Patient Satisfaction with Anterior Interim CAD-CAM Rehabilitations Designed by CAD Technician versus Trained Dentist—A Clinical Preliminary Study

The objective of this study was to assess the impact of digital waxing expertise on patient satisfaction with anterior interim computer-aided design and computer-aided manufacturing (CAD-CAM) prosthetic rehabilitations designed either by a CAD and dental technician or by a dental clinician with basic CAD-CAM training. This in vivo preliminary study was conducted on a total of 18 patients receiving anterior CAD-CAM rehabilitations (at least from canine to canine) with fixed bridges and/or single crowns. Only patients that had conventional chairside temporary restorations were enrolled. Three within-patient groups were defined at different time points: group CONTROL refers to all 18 patients at their first appointment, when they were using their initial temporary conventional prostheses; group DENT refers to all patients immediately after trying in a set of CAD-CAM prostheses designed by a dental clinician (with basic one-week CAD-CAM training); and group CAD refers to all patients after trying in a set of CAD-CAM prostheses for the same tooth elements but designed by an experienced CAD technician (who was also an experienced dental prosthetic technician). All CAD-CAM restorations were milled in polymethyl methacrylate (PMMA) with high translucency and strength properties (Prime, Zirkonzahn). Satisfaction with comfort and esthetics was assessed for all patients for the three different time points (groups CONTROL, DENT and CAD). Statistically significant differences among groups were assessed with the Friedmann’s test. Group CAD significantly outperformed the other groups in both assessed variables (p = 0.001). The group DENT, in turn, outperformed group CONTROL for satisfaction with esthetics (p = 0.006) but not for comfort (p &gt; 0.05). In conclusion, CAD operator background and expertise level significantly affect patient self-reported outcomes for anterior CAD-CAM rehabilitations. Single crowns and fixed bridges digitally designed by an experienced professional trained in both CAD-CAM and dental technology will likely offer high satisfaction and comfort to patients receiving anterior prosthetic rehabilitations.

Evaluation of community-based vector surveillance system for routine entomological monitoring under low malaria vector densities and high bed net coverage in western Kenya

BackgroundEntomological surveillance is traditionally conducted by supervised teams of trained technicians. However, it is expensive and limiting in the number of sites visited. Surveillance through community-based collectors (CBC) may be more cost-effective and sustainable for longitudinal entomological monitoring. This study evaluated the efficiency of CBCs in monitoring mosquito densities compared to quality-assured sampling conducted by experienced entomology technicians.MethodsEntomological surveillance employing CBCs was conducted in eighteen clusters of villages in western Kenya using indoor and outdoor CDC light traps and indoor Prokopack aspiration. Sixty houses in each cluster were enrolled and sampled once every month. Collected mosquitoes were initially identified to the genus level by CBCs, preserved in 70% ethanol and transferred to the laboratory every 2 weeks. Parallel, collections by experienced entomology field technicians were conducted monthly by indoor and outdoor CDC light traps and indoor Prokopack aspiration and served as a quality assurance of the CBCs.ResultsPer collection, the CBCs collected 80% fewer Anopheles gambiae sensu lato (s.l.) [RR = 0.2; (95% CI 0.14–0.27)] and Anopheles coustani [RR = 0.2; (95% CI 0.06–0.53)] and 90% fewer Anopheles funestus [RR = 0.1; (95% CI 0.08–0.19)] by CDC light traps compared to the quality assured (QA) entomology teams. Significant positive correlations were however observed between the monthly collections by CBCs and QA teams for both An. gambiae and An. funestus. In paired identifications of pooled mosquitoes, the CBCs identified 4.3 times more Anopheles compared to experienced technicians. The cost per person-night was lower in the community-based sampling at $9.1 compared to $89.3 by QA per collection effort.ConclusionUnsupervised community-based mosquito surveillance collected substantially fewer mosquitoes per trap-night compared to quality-assured collection by experienced field teams, while consistently overestimating the number of Anopheles mosquitoes during identification. However, the numbers collected were significantly correlated between the CBCs and the QA teams suggesting that trends observed by CBCs and QA teams were similar. Further studies are needed to evaluate whether adopting low-cost, devolved supervision with spot checks, coupled with remedial training of the CBCs, can improve community-based collections to be considered a cost-effective alternative to surveillance conducted by experienced entomological technicians.

Influence of body mass index and waist-hip ratio on male semen parameters in infertile men in the real world: a retrospective study.

It is suggested that body mass index (BMI) can affect male semen quality; however, the results remain controversial. In addition, most studies have focused on the effect of obesity on semen quality. Evidence on the relationship of underweight or waist-hip ratio (WHR) with semen quality is rare. This study aimed to assess the association of BMI and WHR with semen quality. Data, including BMI and WHR, was collected from 715.00 men who underwent a fertility evaluation. BMI (kg/m2) was categorized as <18.50 (underweight), 18.50-24.90 (normal), 25.00-27.90 (overweight), and ≥28.00 (obese) kg/m2 for analysis. WHR was categorized as <0.81 (normal) and ≥0.81 (high). Semen volume, sperm concentration, progressive motility, and total motile sperm count were detected by experienced clinical technicians. Spearman's correlation showed that BMI was weakly associated with sperm progressive motility (r = 0.076, P < 0.05), while WHR showed no relationship with semen parameters. The azoospermia rate was significantly higher (33.33% vs. 2.10%, P < 0.001) and the sperm concentration was lower (P < 0.05) in the underweight group. The nonlinear correlation analysis showed that BMI was negatively associated with sperm concentration while BMI was more than 22.40 kg/m2 (P < 0.05), while WHR was negatively related to sperm progressive motility within 0.82 to 0.89 (P < 0.05). Furthermore, the multivariate logistic analysis showed that follicular stimulating hormone (FSH) was an independent risk factor for normal sperm concentration (odds ratio [OR]: 0.791, P = 0.001) and morphology (OR: 0.821, P = 0.002), BMI was an independent risk factor for normal sperm progressive motility, and testosterone was an independent risk factor for sperm morphology (OR: 0.908, P = 0.023). BMI and WHR were significantly associated with semen parameters, while BMI was an independent risk factor for normal sperm progressive motility. Reproductive hormones, including FSH and testosterone, had a significant influence on sperm concentration and sperm morphology.

PD22-08 ACOUSTIC RADIATION FORCE IMPULSE IMAGE FOR EVALUATION OF PARENCHYMA ELASTICITY IN ACUTE HYDRONEPHROTIC KIDNEY: A PRELIMINARY REPORT

You have accessJournal of UrologyCME1 Apr 2023PD22-08 ACOUSTIC RADIATION FORCE IMPULSE IMAGE FOR EVALUATION OF PARENCHYMA ELASTICITY IN ACUTE HYDRONEPHROTIC KIDNEY: A PRELIMINARY REPORT Jen-Chieh Chen, Shih-Yen Lu, Tzu-Ping Lin, and William J. Huang Jen-Chieh ChenJen-Chieh Chen More articles by this author , Shih-Yen LuShih-Yen Lu More articles by this author , Tzu-Ping LinTzu-Ping Lin More articles by this author , and William J. HuangWilliam J. Huang More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003295.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The acoustic radiation force impulse (ARFI) imaging is a new technique with great promise in the field of elastography. It had been used widely in evaluation of various disease involving tissue stiffness, such as liver fibrosis, thyroid nodules, subcutaneous lymph nodes, and breast lesions. However, in kidney, the blood flow is thought to affect the elasticity more than tissue stiffness. To date, the utility of ARFI imaging in acute hydronephrotic kidney remains unexplored. In this study, we aim to compare the shear wave velocity (SWV) measured by ARFI ultrasound elastography of hydronephrotic kidneys caused by ureteral stones and the normal contralateral kidneys. METHODS: A total of 31 patients presented to our emergency room (ER) due to unilateral renal colic caused by ureteral stone with hydronephrosis from April 2020 to September 2022 were prospectively recruited. The patient’s character was recorded. The kidney ultrasound with ARFI imaging of the affected kidney and the contralateral side was performed by a single experienced technician immediately after the diagnosis was made. The SWV value, expressed as speed (m/sec.) of wave propagation through the tissue, was calculated for each kidney in its outer renal cortex. To each of the kidney, the SWV value was assigned through the average of ten different measurements. The Wilconxon signed rank test was used to compare the SWV value of affected and contralateral kidney in an individual. All P values less than 0.05 were considered statistically significant. RESULTS: Among 31 patients, 16 patients presented to our ER at acute/intermediate phase (<24 hours of symptoms onset) and 15 patients at late phase (≥ 24 hours). The SWV value showed variable changes between the affected and contralateral kidneys in patients who came to our ER within 24 hours of symptoms onset. However, in patients who presented to our ER at late phase, the SWV value was significantly lower in their affected kidney (p=0.043). Subsequent analysis found that the SWV value did not showed any significant correlations with age, side of the affected kidney, pain score, stone size, degree of hydronephrosis, presence of urinary tract infection, or presence of acute kidney injury. All patients received stone management successfully afterward. After a mean follow-up of 3 months, there was no evidence of significant sequelae. CONCLUSIONS: The SWV value showed variable changes in patients whose interval between the onset of the symptoms and the kidney stiffness measurement was less than 24 hours. However, SWV value decreased significantly in patients whose interval was greater than 24 hours. This finding may compatible with the concept that the renal blood flow decreases after 24 hours of obstructive uropathy. To our knowledge, this is the first study to evaluate the ARFI image in acute hydronephrotic kidney. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e667 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jen-Chieh Chen More articles by this author Shih-Yen Lu More articles by this author Tzu-Ping Lin More articles by this author William J. Huang More articles by this author Expand All Advertisement PDF downloadLoading ...