Fair Agreement Research Articles

A Comparison of GOLD and STAR Severity Stages in Individuals with Chronic Obstructive Pulmonary Disease Undergoing Pulmonary Rehabilitation.

BackgroundAlongside the recognized Global Initiative for Obstructive Lung Disease (GOLD) classification, the STaging of Airflow obstruction by Ratio (STAR) severity scheme has been proposed for categorizing chronic obstructive pulmonary disease (COPD). Study QuestionWhat is the agreement and utility of the GOLD and STAR classifications in severe COPD patients entering the rehabilitation setting? Study Design and MethodsMedical records were reviewed in this multicenter retrospective study, examining key functional variables and their changes in a large cohort of COPD patients undergoing pulmonary rehabilitation (PR). ResultsA total of 1,516 participants (33.7% females, median age 72.0 years) were included in the analysis. Compared to GOLD, the use of the STAR classification resulted in a different disease severity category for 53.4% of patients. An unweighted Cohen’s κ of 0.25 and a Bangdiwala B value of 0.24 revealed a fair agreement between the two classifications. Higher weighted agreement measures (0.47 and 0.78, respectively) suggested that discrepancies between the classifications mainly occurred for contiguous stages. GOLD demonstrated superior discrimination between stages for chronic respiratory failure, while STAR exhibited better performance in detecting hyperinflation. In terms of their application within PR settings, GOLD exhibited superior performance compared to STAR in identifying the minimal clinically important difference (MCID) in 6-minute walking distance and modified Medical Research Council (mMRC) score. Accordingly, GOLD but not STAR acted as an independent predictor for achieving a MCID in mMRC (OR: 1.48; 95% CI: 1.12-1.94; P=0.005) and also independently predicted changes in Braden score (β=0.154; P=0.004). Interpretation.STAR shows a more uniform gradation of disease severity and enhanced performance in detecting hyperinflation but our preliminary findings do not endorse its utilization in the rehabilitation setting.

The spatial relationship between leishmaniases and sand flies in Europe and neighboring countries

BackgroundLeishmania infantum is endemic in Europe (and elsewhere) while L. donovani s.s., L. tropica and L. major are not but are present in neighboring countries in North Africa, the Middle East, (the Asian part of) Turkey and the Southern Caucasus. Lists of sand fly vector species in the scientific literature vary with the criteria for vector incrimination, and criteria vary because, for some, evidence is difficult to generate. With minimal criteria, about 20 sand fly species are proven or suspected vectors of L. infantum in Europe and neighboring countries, while for L. tropica and L. major, there are seven and four proven or suspected vector species, respectively, in this area. For L. donovani s.s., present in Cyprus, the Middle East and (the Asian part of) Turkey, no local vectors have been incriminated so far. The aim was to assess the degree of spatial agreement between Leishmania spp. and various vectors species and their relative contribution to the explained variation.MethodsWe used multivariate regression modeling to analyze the spatial relationship between autochthonous Leishmania spp. and clinical forms in humans and animals and 14 Phlebotomus spp. in Europe and neighboring countries.ResultsThere was only fair agreement between parasite and vector distributions. The most parsimonious models describing the distribution of Leishmania spp. and clinical forms included three to six sand fly species and explained between 12% (L. infantum) and 37% (L. donovani) of the observed variation. Selected models included confirmed and suspected vector species as well as unexpected species.ConclusionsThe relatively low agreement between Leishmania and vector distributions highlights the need to improve leishmaniasis reporting and vector surveillance in areas where no information is available, both for a better understanding of the epidemiology of infection in endemic areas and to monitor possible spread of infection into non-endemic areas. While some of the unexpected sand fly-Leishmania spp. statistical associations might be spurious, for others, the existence of sporadic or recent reports of infections warrants further vector competence studies that consider strain variation.Graphical

Reliability and validity of the Paprosky classification for acetabular bone loss based on level of orthopedic training.

Reliability and validity of the Paprosky classification for acetabular bone loss have been debated. Additionally, the relationship between surgeon training level and Paprosky classification accuracy/treatment selection is poorly defined. This study aimed to: (1) evaluate the validity of preoperative Paprosky classification/treatment selection compared to intraoperative classification/treatment selection and (2) evaluate the relationship between training level and intra-rater and inter-rater reliability of preoperative classification and treatment choice. Seventy-four patients with intraoperative Paprosky types [I (N = 24), II (N = 27), III (N = 23)] were selected. Six raters (Residents (N = 2), Fellows (N = 2), Attendings (N = 2)) independently provided Paprosky classification and treatment using preoperative radiographs. Graders reviewed images twice, 14 days apart. Cohen's Kappa was calculated for (1) inter-rater agreement of Paprosky classification/treatment by training level (2), intra-rater reliability, (3) preoperative and intraoperative classification agreement, and (4) preoperative treatment selection and actual treatment performed. Inter-rater agreement between raters of the same training level was moderate (K range = 0.42-0.50), and mostly poor for treatment selection (K range = 0.02-0.44). Intra-rater agreement ranged from fair to good (K range = 0.40-0.73). Agreement between preoperative and intraoperative classifications was fair (K range = 0.25-0.36). Agreement between preoperative treatment selections and actual treatments was fair (K range = 0.21-0.39). Inter-rater reliability of Paprosky classification was poor to moderate for all training levels. Preoperative Paprosky classification showed fair agreement with intraoperative Paprosky grading. Treatment selections based on preoperative radiographs had fair agreement with actual treatments. Further research should investigate the role of advanced imaging and alternative classifications in evaluation of acetabular bone loss.

TAMie Force Field for Alkanethiols: Multifidelity Gaussian Processes for Dealing with Scarce Experimental Data.

This study extends the transferable anisotropic Mie potential (TAMie) to alkanethiols. The force field parameters are optimized by using an analytic equation of state as a surrogate model. Given the lack of experimental density data at elevated temperatures where Monte Carlo simulations have high statistical precision, the equation of state is supplemented by a linear multifidelity Gaussian process approach to bridge the temperature gap. Force field parameters are adjusted by minimizing squared deviations of calculated vapor pressures and liquid densities from experimental data of 1-propanethiol, 1-butanethiol and 1-pentanethiol leading to small mean absolute relative deviations in liquid densities and vapor pressures. The force field is transferable to higher 1-thiols, as shown for 1-hexanethiol and 1-octanethiol. Individual parameter sets are provided for methanethiol and ethanethiol. The shear viscosity of pure substances is predicted in fair agreement with experimental data, considering that it is not included in the parametrization. Further, the phase behavior of binary mixtures of alkanethiols with alkanes is studied, and predictions of the TAMie model are found in excellent agreement with experimental data.

CO2 uptake of cement by-pass dust via direct aqueous carbonation: an experimental design for time and temperature optimisation

The compositional characteristics of cement by-pass dust (CBPD), specifically its alkalinity and salt content, present significant limitations to its reinsertion in cement production. Furthermore, these characteristics give rise to considerable concerns regarding its disposal. The present study investigated the potential for treating CBPD through the application of a direct aqueous carbonation technique. The aim is to assess carbon capture potential of the material and to investigate the impact of the mineralisation process on its composition. The process was conducted under atmospheric pressure, at low temperature (20–60 °C) and for short duration (20–60 min). Different CO2 quantification techniques were employed to assess experiments efficiency and replicability of the adopted quantification techniques. A Design of Experiment was developed to identify the optimum carbonation conditions in terms of time and temperature. The conditions for CO2 content maximisation resulted in a fair agreement with the prediction of the response surface methodology. High values in CO2 uptake (25.1%) and carbonation degree (82%) were achieved, outperforming previous literature studies. Moreover, the mineralisation process significantly reduces the chloride content of CBPD, paving the way for its adoption as a supplementary cementitious material in integrated industrial processes for carbon capture and utilisation.

Evaluation of Saccadic Component Measure on Smooth Pursuit Tests.

Despite the advancement of eye-tracking technology for smooth pursuit (SP) eye movement evaluation, qualitative observation offers much information that is not captured by computers; hence, both objective and qualitative information should be utilized to evaluate SP. This study examined the consistency among our clinicians when evaluating SP using normal (N), grossly normal (GN), mildly abnormal (MA), and abnormal (AB) as classifications. We then evaluated the effect of combining GN and MA into a single subclinical (SUBC) category. We also evaluated the computerized percent saccade (PS) metric by determining its sensitivity and specificity in classifying SP. Retrospective horizontal and vertical SP test videos and numerical data for 70 participants were obtained from the Neuro Kinetics Neuro-Otologic Test Center and de-identified. From this, eye-tracking videos, time plots of eye-tracking positional data, and tables of SP eye-tracking performance data were generated for 0.1, 0.3, and 0.5 Hz in both horizontal and vertical planes, totaling 6 tests per subject. Three clinicians rated each subject's SP performance as N, GN, MA, or AB for a total of 6 ratings (3 frequencies, horizontal and vertical). This process was repeated using N, SUBC, and AB as rating categories. Clinicians also provided an overall SP rating for each plane as follows: AB if the results were abnormal for 2 or more frequencies tested. Alternatively, if fewer than 2 frequencies presented with a rating of AB, then an overall rating of MA, GN, or N was determined at the respective clinician's discretion. When the 3 clinicians were tasked with classifying SP videos using 4 clinical categories, fair overall agreement was demonstrated. However, when MA and GN categories were combined into an SUBC category, the overall agreement for the 3 clinicians improved slightly for both horizontal SP (HSP) and vertical SP (VSP). This pattern of agreement did not differ considerably when comparing HSP versus VSP, and good consistency and reliability was observed across clinicians. Again, inter-rater consistency was smaller for VSP versus HSP despite the reduction in clinical categories. Cut-off values were generated for the PS metric and demonstrated good specificity and sensitivity when they were exceeded for 2 or more frequencies in a particular plane when evaluating a subject's SP test.

Probing the Local Rapidity Distribution of a One-Dimensional Bose Gas.

One-dimensional Bose gases with contact repulsive interactions are characterized by the presence of infinite-lifetime quasiparticles whose momenta are called the "rapidities." Here, we develop a probe of the local rapidity distribution, based on the fact that rapidities are the asymptotic momenta of the particles after a long one-dimensional expansion. This is done by performing an expansion of a selected slice of the gas. We first apply this idea to a cloud in the quasicondensate regime at equilibrium in a trap. We obtain an experimental picture of the position-dependent rapidity distribution which is in fair agreement with the theory prediction. The asymptotic regime is barely reached, but we show that finite expansion time can be taken into account using the generalized hydrodynamics theory. We then apply this local probe to an out-of-equilibrium situation where the local rapidity distribution is expected to be doubly peaked-a hallmark of a nonthermal state-even though the global rapidity distribution would possess no such distinctive feature. We observe the doubly peaked local rapidity distribution.

Development of 18F-Fluoromisonidazole Hypoxia PET/CT Diagnostic Interpretation Criteria and Validation of Interreader Reliability, Reproducibility, and Performance.

Tumor hypoxia, an integral biomarker to guide radiotherapy, can be imaged with 18F-fluoromisonidazole (18F-FMISO) hypoxia PET. One major obstacle to its broader application is the lack of standardized interpretation criteria. We sought to develop and validate practical interpretation criteria and a dedicated training protocol for nuclear medicine physicians to interpret 18F-FMISO hypoxia PET. Methods: We randomly selected 123 patients with human papillomavirus-positive oropharyngeal cancer enrolled in a phase II trial who underwent 123 18F-FDG PET/CT and 134 18F-FMISO PET/CT scans. Four independent nuclear medicine physicians with no 18F-FMISO experience read the scans. Interpretation by a fifth nuclear medicine physician with over 2 decades of 18F-FMISO experience was the reference standard. Performance was evaluated after initial instruction and subsequent dedicated training. Scans were considered positive for hypoxia by visual assessment if 18F-FMISO uptake was greater than floor-of-mouth uptake. Additionally, SUVmax was determined to evaluate whether quantitative assessment using tumor-to-background ratios could be helpful to define hypoxia positivity. Results: Visual assessment produced a mean sensitivity and specificity of 77.3% and 80.9%, with fair interreader agreement (κ = 0.34), after initial instruction. After dedicated training, mean sensitivity and specificity improved to 97.6% and 86.9%, with almost perfect agreement (κ = 0.86). Quantitative assessment with an estimated best SUVmax ratio threshold of more than 1.2 to define hypoxia positivity produced a mean sensitivity and specificity of 56.8% and 95.9%, respectively, with substantial interreader agreement (κ = 0.66), after initial instruction. After dedicated training, mean sensitivity improved to 89.6% whereas mean specificity remained high at 95.3%, with near-perfect interreader agreement (κ = 0.86). Conclusion: Nuclear medicine physicians without 18F-FMISO hypoxia PET reading experience demonstrate much improved interreader agreement with dedicated training using specific interpretation criteria.

The Clinical Utility of Large Language Models in Diagnosing Neurocognitive Disorders among NACC Participants

Abstract Objective Our study aimed to investigate ChatGPT’s ability to diagnose neurocognitive disorders in older adults based on neuropsychological interviews and test results and compare its accuracy with neuropsychologist consensus diagnosis. Methods We prompted ChatGPT-4 to provide provisional diagnoses (normal changes, mild cognitive impairment, or dementia) for each case. We also asked ChatGPT to diagnose the underlying etiology. We evaluated interrater reliability (IRR) with Cohen’s kappa and a chi-square test. Receiver operating characteristic (ROC) curves and area-under-the-curve (AUC) values were computed to explore measures predicting diagnostic agreement. Results Participants were 15,048 older adults (Mage = 69.13, 56.7% female) assessed in Alzheimer’s Disease Core Centers across the United States. For cognitive diagnoses, Cohen’s kappa demonstrated fair agreement (κ = 0.42; p < 0.001). The chi-square test [χ2 (6) = 7896.51, p < 0.001] revealed a significant and strong association (Cramer’s V = 0.51, p < 0.001) between ChatGPT and clinicians’ diagnoses. For the underlying etiology, Cohen’s kappa demonstrated fair agreement on specific diagnoses (κ = 0.38; p < 0.001). The chi-square test [χ2 (24) = 5353.04, p < 0.001] revealed a significant and strong association (Cramer’s V = 0.30, p < 0.001) between ChatGPT and clinicians’ diagnoses. ROC curves demonstrate that no variables predicted diagnostic agreement at above chance. Conclusion Our findings demonstrate the potential clinical utility of integrating LLMs into neuropsychology. While significant IRR was found between ChatGPT and the neuropsychologist diagnosis, further research is needed prior to the adoption of LLMs into clinical practice, given ongoing developments of artificial intelligence in the field of medicine.

A - 133 The Clinical Utility of Large Language Models in Diagnosing Neurocognitive Disorders among NACC Participants

Abstract Objective Our study aimed to investigate ChatGPT’s ability to diagnose neurocognitive disorders in older adults based on neuropsychological interviews and test results and compare its accuracy with neuropsychologist consensus diagnosis. Methods We prompted ChatGPT-4 to provide provisional diagnoses (normal changes, mild cognitive impairment, or dementia) for each case. We also asked ChatGPT to diagnose the underlying etiology. We evaluated interrater reliability (IRR) with Cohen’s kappa and a chi-square test. Receiver operating characteristic (ROC) curves and area-under-the-curve (AUC) values were computed to explore measures predicting diagnostic agreement. Results Participants were 15,048 older adults (Mage = 69.13, 56.7% female) assessed in Alzheimer’s Disease Core Centers across the United States. For cognitive diagnoses, Cohen’s kappa demonstrated fair agreement (κ = 0.42; p < 0.001). The chi-square test [χ2 (6) = 7896.51, p < 0.001] revealed a significant and strong association (Cramer’s V = 0.51, p < 0.001) between ChatGPT and clinicians’ diagnoses. For the underlying etiology, Cohen’s kappa demonstrated fair agreement on specific diagnoses (κ = 0.38; p < 0.001). The chi-square test [χ2 (24) = 5353.04, p < 0.001] revealed a significant and strong association (Cramer’s V = 0.30, p < 0.001) between ChatGPT and clinicians’ diagnoses. ROC curves demonstrate that no variables predicted diagnostic agreement at above chance. Conclusion Our findings demonstrate the potential clinical utility of integrating LLMs into neuropsychology. While significant IRR was found between ChatGPT and the neuropsychologist diagnosis, further research is needed prior to the adoption of LLMs into clinical practice, given ongoing developments of artificial intelligence in the field of medicine.

Artificial intelligence derived large language model in decision-making process in uveitis

BackgroundUveitis is the ophthalmic subfield dealing with a broad range of intraocular inflammatory diseases. With the raising importance of LLM such as ChatGPT and their potential use in the medical field, this research explores the strengths and weaknesses of its applicability in the subfield of uveitis.MethodsA series of highly clinically relevant questions were asked three consecutive times (attempts 1, 2 and 3) of the LLM regarding current uveitis cases. The answers were classified on whether they were accurate and sufficient, partially accurate and sufficient or inaccurate and insufficient. Statistical analysis included descriptive analysis, normality distribution, non-parametric test and reliability tests. References were checked for their correctness in different medical databases.ResultsThe data showed non-normal distribution. Data between subgroups (attempts 1, 2 and 3) was comparable (Kruskal-Wallis H test, p-value = 0.7338). There was a moderate agreement between attempt 1 and attempt 2 (Cohen’s kappa, ĸ = 0.5172) as well as between attempt 2 and attempt 3 (Cohen’s kappa, ĸ = 0.4913). There was a fair agreement between attempt 1 and attempt 3 (Cohen’s kappa, ĸ = 0.3647). The average agreement was moderate (Cohen’s kappa, ĸ = 0.4577). Between the three attempts together, there was a moderate agreement (Fleiss’ kappa, ĸ = 0.4534). A total of 52 references were generated by the LLM. 22 references (42.3%) were found to be accurate and correctly cited. Another 22 references (42.3%) could not be located in any of the searched databases. The remaining 8 references (15.4%) were found to exist, but were either misinterpreted or incorrectly cited by the LLM.ConclusionOur results demonstrate the significant potential of LLMs in uveitis. However, their implementation requires rigorous training and comprehensive testing for specific medical tasks. We also found out that the references made by ChatGPT 4.o were in most cases incorrect. LLMs are likely to become invaluable tools in shaping the future of ophthalmology, enhancing clinical decision-making and patient care.

Reproducibility of daytime hypertension, night-time hypertension, and nocturnal blood pressure dipping patterns in young to middle age patients with stage 1 hypertension.

To investigate the reproducibility of ambulatory BP sub-periods and nocturnal dipping phenotypes assessed twice 3 months apart in young-to-middle-age untreated individuals screened for stage 1 hypertension. We investigated 1096, 18-to-45-year old participants from the HARVEST. Their office BP was 145.8 ± 10.4/93.7 ± 5.7 mmHg. Office BP and 24 h BP were measured at baseline and after 3 months. Office, 24-h, daytime and night-time hypertensions, and nocturnal dipping patterns were defined according to the 2023 ESH guidelines. Between-recording agreement was evaluated with kappa statistics. Reproducibility evaluated with weighted kappa was moderate for both 24 h hypertension (K = 0.48) and daytime hypertension (K = 0.50) and was only fair for night-time hypertension (K = 0.36). Between-measurement agreement was even worse for isolated night-time hypertension (K = 0.24), and was poor for office hypertension (K = 0.14). The better reproducibility of daytime than night-time period was confirmed by the analysis of BP as continuous variable (all between-period differences, P < 0.001). Nondipping was present in 31.8%, and showed a fair agreement (K = 0.28,). Poorer agreement was shown by extreme dipping (K = 0.18) and reverse dipping (K = 0.07). These data show that within the ambulatory sub-periods, daytime hypertension has a better reproducibility than night-time hypertension. This suggests that the better association with adverse outcomes shown by sleep BP compared to wake BP in observational studies is not due to a better reproducibility of the former. The between-measurement agreement is even worse for isolated nocturnal hypertension and dipping patterns, especially for extreme and reverse dipping. Thus, these BP phenotypes should be confirmed with repeat ambulatory BP monitoring.

Reproducibility of the AGREE II Tool for Assessing the Methodological Quality of Clinical Practice Guidelines for the Management of Antithrombotic Agents in Patients Undergoing GI Endoscopy.

Clinical practice guidelines (CPGs) exist for the management of antithrombotic agents in the periendoscopic period; however, their methodological qualities vary. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool has been validated for the assessment of the methodological quality of CPGs; however, its reproducibility has not been assessed. The goal of this study was to assess the reproducibility of the AGREE II tool for CPGs published within the last 6 years for the management of antithrombotic agents in the periendoscopic period. A systematic search of PubMed and Embase databases was performed to identify eligible CPGs published between January 1, 2016 and April 14, 2022. The quality of the CPG was independently assessed by 6 reviewers using the AGREE II instrument. The reproducibility was summarized as weighted κ statistic and intraclass correlation coefficient using the SPSS statistical analysis package. The search yielded 343 citations with 7 CPGs from Europe, Asia, and the United States included in the critical appraisal. The overall mean weighted κ score across all guidelines was 0.300 (range, 0.093 to 0.384) indicating a fair agreement. The overall intraclass correlation coefficient was 0.462 (range, 0.175 to 0.570) for single measures and 0.837 (range, 0.560 to 0.888) for average measures indicating moderate reliability. Our study shows only a fair overall interobserver agreement in the methodological quality of the included CPGs. The results suggest the need for education and training of CPG raters to enhance the application of the AGREE II tool to improve its reproducibility.

Numerical heat transfer analysis of steam injection into subcooled water

Steam direct contact condensation (DCC) into subcooled water may be encountered in different important industrial process applications, such as steam jet pumps, steam ejectors, pressurizers, and emergency cooling systems of nuclear reactor core. In this work, a numerical simulation study has been done for injection of steam into a tank full of subcooled water. In the simulations, the Eulerian multiphase flow in addition to a realizable k-epsilon turbulence model has been utilized. Moreover, a DCC model has been used for condensation capturing. Fluent software with a user-defined function (UDF) for the DCC model was employed for simulations. The results obtained from simulations were validated with experimental results, and a fair agreement was observed. This study considered the local Nusselt number (LNN) the most suitable parameter for investigating the heat transfer rate (HTR) at the computational cell level. Therefore, the contours of the LNN, its axial distribution, and radial distribution were studied with respect to the inlet pressure of injected steam, temperature of tank water, and location along the axis of the nozzle. The results reveal the fact that the value of the LNN reaches a maximum at the nozzle exit along the axis of the nozzle at 323 K tank water temperature. LNN decreases by increasing or decreasing the tank water temperature beyond 323 K. It is claimed that the heat transfer (HT) study at such a local scale has been conducted for the first time to the best of our knowledge, and it unfolds various crucial facts regarding steam-water interaction.

Benchmarking the effective temperature scale of red giant branch stellar models: The case of the metal-poor halo giant HD 122563

Context. There is plenty of evidence in the literature of significant discrepancies between the observations and models of metal-poor red giant branch stars, in particular regarding the effective temperature Teff scale. Aims. We revisit the benchmark star HD 122563 using the most recent observations from Gaia Data Release 3, to investigate if these new constraints may help in resolving this discrepancy. Methods. We review the most recent spectroscopic determinations of the metallicity [Fe/H] of HD 122563, and provide a new assessment of its fundamental parameters, specifically, bolometric luminosity, Teff, surface gravity, plus a photometric determination of its metal content. Using these constraints, we compare the position of the star in the Hertzsprung-Russell (H–R) diagram with various recent sets of stellar evolution tracks. Results. The H-R diagram analysis reveals a significant disagreement between observed and theoretical Teff values, when adopting the most recent spectroscopic estimate of [Fe/H]. On the other hand, by using the photometric determination of [Fe/H], some of the selected sets of stellar tracks appear in fair agreement with observations. The sets with discrepant Teff can be made to agree with observations either by modifying the prescription adopted to calculate the models’ outer boundary conditions, and/or by reducing the adopted value of the mixing length parameter with respect to the solar-calibration. Conclusions. A definitive assessment of whether the Teff scale of metal-poor stellar red giant branch models is consistent with observations requires a more robust determination of the fundamental parameters of HD 122563 and also a larger sample of calibrators. From the theoretical side, it is crucial to minimise the current uncertainties in the treatment (boundary conditions, temperature gradient) of the outer layers of stellar models with convective envelopes.

Prognostic significance of diffuse increased fluorine-18-fluorodeoxyglucose (18F-FDG) uptake within the reticuloendothelial system in lymphoma patients.

As constituents of the reticuloendothelial system, the spleen and bone marrow (BM) have been recognized as integral components of the systemic inflammatory response in cancer contexts, thereby serving as predictive indicators for assessing cancer prognosis. Fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) has attained widespread utilization for staging, assessing treatment response, and prognostication in lymphoma patients. Several investigations have proposed that focal increased 18F-FDG uptake in the BM or spleen may correlate with malignant involvement in lymphoma. However, scant data exist regarding the implications of diffuse BM and splenic uptake. This study aimed to explore the relationships between metabolic parameters of the spleen and BM on 18F-FDG PET/CT and inflammatory markers, and to assess their prognostic value in patients with lymphoma. A retrospective analysis was conducted on 118 patients newly diagnosed with malignant lymphoma, who underwent 18F-FDG PET/CT and exhibited diffuse increased splenic or BM uptake in 18F-FDG PET/CT imaging. The mean standardized uptake value (SUV) of the spleen, BM, and liver was calculated. The association between metabolic variables and systemic inflammatory markers was investigated, and the prognostic significance of clinicopathological and PET parameters was assessed using overall survival (OS) and progression-free survival (PFS). A statistically significant correlation was found between the spleen-to-liver SUV ratio (SLR) and inflammatory markers such as C-reactive protein (r=0.264, P=0.007) and platelet-to-lymphocyte ratio (r=0.227, P=0.021). No significant correlation was observed between BM-to-liver SUV ratio (BLR) and hematologic parameters, while concordance analysis revealed a fair agreement between BLR and bone marrow biopsy (BMB) (Cohen's Kappa-κ =0.271, P=0.002). In patients with aggressive non-Hodgkin lymphoma, both SLR [P=0.017, HR 2.715, 95% confidence interval (CI): 0.875-8.428] and BLR (P=0.044, HR 0.795, 95% CI: 0.348-1.813) were significantly linked to OS, while SLR (P=0.019, HR 2.223, 95% CI: 1.139-4.342) emerged as a significant prognostic factor for PFS. This study highlighted that diffuse increased splenic 18F-FDG uptake in lymphoma patients was closely associated with inflammation, whereas diffuse BM uptake was likely attributable to BM infiltration rather than inflammatory changes. Furthermore, both parameters held promise as prognostic indicators for patients with aggressive lymphoma.

Analytical, computational, and experimental investigations on the impact of side outlet on the simple expansion chamber with axial outlet

In this study, an investigation on the acoustic performance of a simple expansion chamber muffler with side outlet has been presented. The investigation for the muffler is done in the 10–2400 Hz frequency range. The muffler is analyzed analytically, computationally, and experimentally. The computational and analytical modellings of the muffler have been done by using the finite element and transfer matrix methods, respectively for the determination of transmission loss. As the transfer matrix method is unable to capture the higher order modes above the cut-off frequency of the muffler, the finite element method has been adopted as the computational method. Additionally, the accuracy in the analytical and computational modelling of the muffler is checked with the experimental investigation. The two-load method is used in this study for muffler to determine the transmission loss and band power. The side outlet of the muffler introduces an extra impedance due to the shunt element and hence the effectiveness of the muffler can be improved. This muffler shows an overall improvement of 24.73 dB in the transmission loss when compared with the transmission loss of the simple expansion chamber muffler with an axial outlet in 10–2400 Hz frequency range. Specifically, the simple expansion chamber muffler with side outlet is more effective than the simple expansion chamber muffler with an axial outlet in 350–680 Hz, 1040–1350 Hz, 1570–1590 Hz, and 1850–2400 Hz frequency ranges. The comparison among the different techniques shows a fair agreement in the results. The transmission loss, variation of the band power in the 1/3rd octave band, and sound pressure level contours for the muffler at the selected frequencies have been presented. This study offers an advantage in the design of the automotive mufflers.

Ghost Sign on Diffusion-Weighted Imaging Generated Apparent Diffusion Coefficient Map: Additional MRI Diagnostic Marker for Extremity Osteomyelitis

Objective The aim of this study was to determine the sensitivity and specificity and inter-reader reliability of previously known “ghost sign” and “penumbra sign” on T1-weighted (T1W) imaging and “ghost sign” on apparent diffusion coefficient (ADC) map in osteomyelitis (OM) of the extremities. Materials and Methods In this cross-sectional retrospective study, two fellowship-trained musculoskeletal readers blinded to final diagnosis of OM versus no OM were asked to report the penumbra sign and ghost sign on T1W images and ghost sign on ADC map, as well as diagnosis of OM. Cohen's kappa was used. Diagnostic performance measures including sensitivity, specificity, and accuracy were calculated. Results A sample of 178 magnetic resonance imaging (MRI) scans of pathology-proven cases were included in this study, with 41 being positive for OM and 137 being negative for OM. There was a fair inter-reader agreement for imaging signs, and moderate agreement of 0.60 for OM. The sensitivities of the penumbra sign on T1W imaging, ghost sign on T1W imaging, and ghost sign on ADC map for OM are 3.7, 9.8, and 19.5%, respectively, while their respective specificities are 98.9, 97.8, and 94.5%, respectively. All three imaging signs showed a similar (good) accuracy of 76 to 78%. Conclusion The ghost sign on ADC can be used as an additional marker for OM and is a similarly highly specific but a more sensitive sign for OM than the conventionally used penumbra sign and ghost sign on T1W imaging. Key Points

Diagnostic reproducibility of the 2018 Classification of Gingival Recessions: Comparing photographic and in-person diagnoses.

To assess how the diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects (GRD) could be applied when comparing in-person chairside measurements with photographic measurements. Thirty-four GRD were photographed and evaluated by 4 masked operators. For each case, the operators measured twice recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RSs), chairside, and on photographs. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) was calculated for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT. RD, KTW, and RT showed excellent overall intra-operator agreement (>0.93), and from good to excellent overall inter-operator agreement (>0.80), for both clinical and photographic measurements. Agreements were lower for GT, CEJ, and RS. Overall clinical and photographic agreements were within 0.1 difference for every variable, except for inter-operator agreement for RS which was 0.72 for clinical measurements and 0.45 for photographic measurements. The lowest overall agreement between clinical versus photographic measurements existed for CEJ (0.28) and RS (0.35). Variables composing the 2018 Classification of GRD are reproducible, both clinically and on photographs, with comparable agreements. The overall agreement was higher for KTW, RD, and RT, and lower for GT, CEJ, and RS, for both clinical and photographic measurements. The comparison between chairside and photographic evaluations indicated fair to excellent agreement for most variables, with CEJ and RS showing fair agreement. As digital diagnostics evolve to facilitate clinical diagnostic measurement, we aimed to assess the effectiveness of intraoral photography for diagnosing gingival recession defects (GRD) according to the 2018 Classification of GRD, compared to traditional clinical examination. Standardized photographs of thirty-four GRD cases were captured. Four masked operators evaluated the same gingival recessions twice in a clinical setting and twice using photographs. Measurement repeatability within and between operators was calculated for both clinical and photographic settings, and the two settings were compared. Continuous measurements such as recession depth and keratinized tissue width, as well as the evaluation of interproximal attachment height (recession type), showed excellent agreement both clinically and photographically. Agreement was lower for gingival thickness and the detectability of tooth anatomical landmarks, such as the cemento-enamel junction and the presence of root steps. Overall, the agreement between chairside and photographic evaluations was generally good, but lower when evaluating tooth anatomical landmarks. The variables composing the 2018 Classification of GRD are reproducible in both clinical and photographic settings, with comparable levels of agreement. However, there was consistently worse agreement for gingival thickness and when evaluating tooth anatomical landmarks.

How to Tackle Discordance in Adjuvant Chemotherapy Recommendations by Using Oncotype DX Results, in Early-Stage Breast Cancer.

The use of the Oncotype DX test reduces the rate of adjuvant chemotherapy recommendations. Few in-depth analyses have been performed on this decision-making process. We retrospectively analyzed patient data based on available Oncotype DX test results (RS) irrespective of nodal status at a single center. We collected recommendations from six oncologists, first without RS (pre-RS) and then with RS results (post-RS). We investigated changes in recommendations, agreement between oncologist decisions, and the effect of different National Comprehensive Cancer Network (NCCN) recommendation categories (for, against, and considering chemotherapy). Data from 201 patients were included in the analysis. Recommendation of chemotherapy decreased by an average of 39.5%. Agreement improved substantially with RS, with a kappa value pre-RS of 0.37 (fair agreement) and post-RS of 0.75 (substantial agreement). Discordance remained substantial in cases where the NCCN recommendations considered chemotherapy only (32%). Pre-RS consensus against chemotherapy predicted low RS results (50 out of 51 patients). Post-RS consensus was highest in the NCCN chemotherapy recommendation group. The Oncotype DX test substantially improves decision accuracy in recommending adjuvant chemotherapy. It may be further improved with a consensus decision. In the case of pre-RS consensus against chemotherapy, the test can be spared.