Index Test Research Articles

Application of artificial intelligence to ultrasound imaging for benign gynecological disorders: systematic review.

Although artificial intelligence (AI) is increasingly being applied to ultrasound imaging in gynecology, efforts to synthesize the available evidence have been inadequate. The aim of this systematic review was to summarize and evaluate the literature on the role of AI applied to ultrasound imaging in benign gynecological disorders. Web of Science, PubMed and Scopus databases were searched from inception until August 2024. Inclusion criteria were studies applying AI to ultrasound imaging in the diagnosis and management of benign gynecological disorders. Studies retrieved from the literature search were imported into Rayyan software and quality assessment was performed using the Quality Assessment Tool for Artificial Intelligence-Centered Diagnostic Test Accuracy Studies (QUADAS-AI). Of the 59 studies included, 12 were on polycystic ovary syndrome (PCOS), 11 were on infertility and assisted reproductive technology, 11 were on benign ovarian pathology (i.e. ovarian cysts, ovarian torsion, premature ovarian failure), 10 were on endometrial or myometrial pathology, nine were on pelvic floor disorder and six were on endometriosis. China was the most highly represented country (22/59 (37.3%)). According to QUADAS-AI, most studies were at high risk of bias for the subject selection domain (because the sample size, source or scanner model was not specified, data were not derived from open-source datasets and/or imaging preprocessing was not performed) and the index test domain (AImodels were not validated externally), and at low risk of bias for the reference standard domain (the reference standard classified the target condition correctly) and the workflow domain (the time between the index test and the reference standard was reasonable). Most studies (40/59) developed and internally validated AI classification models for distinguishing between normal and pathological cases (i.e. presence vs absence of PCOS, pelvic endometriosis, urinary incontinence, ovarian cyst or ovarian torsion), whereas 19/59 studies aimed to automatically segment or measure ovarian follicles, ovarian volume, endometrial thickness, uterine fibroids or pelvic floor structures. The published literature on AI applied to ultrasound in benign gynecological disorders is focused mainly on creating classification models to distinguish between normal and pathological cases, and on developing models to automatically segment or measure ovarian volume or follicles. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Human-Centered Design of an mHealth Tool for Optimizing HIV Index Testing in Wartime Ukraine: Formative Research Case Study.

Assisted partner services (APSs; sometimes called index testing) are now being brought to scale as a high-yield HIV testing strategy in many nations. However, the success of APSs is often hampered by low levels of partner elicitation. The Computer-Assisted Self-Interview (CASI)-Plus study sought to develop and test a mobile health (mHealth) tool to increase the elicitation of sexual and needle-sharing partners among persons with newly diagnosed HIV. CASI-Plus provides client-facing information on APS methods and uses a standardized, self-guided questionnaire with nonjudgmental language for clients to list partners who would benefit from HIV testing. The tool also enables health care workers (HCWs) to see summarized data to facilitate partner tracking. The formative research phase of the CASI-Plus study aimed to gather client and HCW input on the design of the CASI-Plus tool to ensure its acceptability, feasibility, and usability. This study gathered input to prioritize features and tested the usability of CASI-Plus with HCWs and clients receiving HIV services in public health clinics in wartime Ukraine. The CASI-Plus study's formative phase, carried out from May 2023 to July 2024, adapted human-centered design (HCD) methods grounded in principles of empathy, iteration, and creative ideation. The study involved 3 steps: formative HCD, including in-depth individual interviews with clients, such as men who have sex with men and people who inject drugs, and internet-based design workshops with HCWs from rural and urban HIV clinics in Chernihiv and Dnipro; software platform assessment and heuristic evaluation, including assessment of open-source mHealth platforms against CASI-Plus requirements, prototype development, and testing of the REDCap (Research Electronic Data Capture) prototype based on usability heuristics; and usability walk-throughs, including simulated cases with HCWs and clients. The formative phase of the CASI-Plus study included in-depth individual interviews with 10 clients and 3 workshops with 22 HCWs. This study demonstrated how simplified HCD methods, adapted to the wartime context, gathered rich input on prioritized features and tool design. The CASI-Plus design reflected features that are both culturally sensitive and in alignment with the constraints of Ukraine's wartime setting. Prioritized features included information about the benefits of HIV index testing; a nonjudgmental, self-guided questionnaire to report partners; client stories; and bright images to accompany the text. Two-way SMS text messaging between clients and HCWs was deemed impractical based on risks of privacy breaches, national patient privacy regulations, and HCW workload. It was feasible to conduct HCD research in Ukraine in a wartime setting. The CASI-Plus mHealth tool was acceptable to both HCWs and clients. The next step for this research is a randomized clinical trial of the effect of the REDCap-based CASI-Plus tool on the number of partners named and the rate of partners completing HIV testing.

PlaTform fOr Urinary tract infection diagnostiC evAluatioN (TOUCAN): a protocol for a prospective diagnostic accuracy study of point-of-care testing in patients suspected of acute uncomplicated urinary tract infection in primary care clinics in England

IntroductionAcute uncomplicated urinary tract infection (UTI) is a common condition with potentially serious sequelae that is mostly diagnosed and managed in primary care settings. Around half of all women have...

P-192. Evaluating the Association of Unnecessary Antibiotic Use with Hospital-Onset Clostridioides difficile Infection at a New York City Hospital

Abstract Background Hospital Onset-Clostridioides difficile infection (HO-CDI) is defined as collection of a positive C. difficile lab result on or after day 4 of a patient’s hospital admission. Reduction of HO-CDI remains a multidisciplinary effort. Prior studies have demonstrated frequent inappropriate antibiotic use among patients with CDI. The objective of this study is to evaluate unnecessary antibiotic use in patients with cases of National Healthcare Safety Network (NHSN)-defined HO-CDI compared to non-CDI controls. Methods This case-control study included inpatient adult patients, from 1/1/23 – 2/28/24. HO-CDI cases were selected from standard institutional review. Non-CDI controls were selected based on hospital admission and negative CDI test sent on or later than day 4 of their admission. Cases and controls were matched 2:1 using patient location and index tests within the same month. Antibiotic use (AU) rate of cefepime, ciprofloxacin, levofloxacin, ceftriaxone, and piperacillin-tazobactam 30 days prior to index test was calculated using NHSN definitions. Primary exposure of interest was inappropriate antibiotic use. Outcomes including hospital length of stay (LOS), all-cause mortality, and subsequent recurrent CDI were recorded. A secondary analysis assessed the relationship between race/ethnicity, inappropriate antibiotic use and HO-CDI. Results Two hundred ninety-six patients were included. AU rate was greater in controls compared to HO-CDI cases (p = 0.01) (Table 1). Inappropriate AU was observed in 24% of cases and 28% of controls (p = 0.48). The most common category of inappropriate AU was inappropriate spectrum, 55% in cases and 81% in controls (Fig 1). There were no statistically significant differences in outcomes. Conclusion HO-CDI cases did not have greater exposure to antibiotic therapy and did not have a higher proportion of inappropriate antibiotic use compared to patients who tested negative for C. difficile. This demonstrates an opportunity to improve antibiotic use, but does not show an association between inappropriate antibiotic use and C. difficile infection. Disclosures All Authors: No reported disclosures

Identification of major trauma using the simplified abbreviated injury scale to estimate the injury severity score: a diagnostic accuracy and validation study

BackgroundThe Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS) grade the severity of injuries and are useful for trauma audit and benchmarking. However, AIS coding is complex and requires specifically trained staff. A simple yet reliable scoring system is needed. The aim of this study was two-fold. First, to develop and validate a simplified AIS (sAIS) chart centred on the most frequent injuries for use by non-trained healthcare professionals. Second, to evaluate the diagnostic accuracy of the sAIS (index test) to calculate the simplified ISS (sISS) to identify major trauma, compared with the reference AIS (rAIS) to calculate the reference ISS (rISS).MethodsThis retrospective study used data (2013–2014) from the Northern French Alps Trauma Registry to develop and internally validate the sAIS. External validation was performed with data from the Trauma Registry of Acute Care of Lausanne University Hospital, Switzerland (2019–2021). Both datasets comprised a random sample of 100 injured patients. Following the Standards for Reporting of Diagnostic Accuracy Studies 2015 guidelines, all patients completed the rAIS and the sAIS. The sISS and the rISS were calculated using the sAIS and the rAIS, respectively. Accuracy was evaluated with the mean difference between the sISS and the rISS and the Pearson correlation coefficient. A clinically relevant equivalence limit was set at ± 4 ISS points. Precision was analyzed using Bland-Altmann plots with 95% limits of agreement.ResultsAccuracy was good. The mean ISS difference of 0.97 (95% CI, −0.03 to 1.97) in the internal validation dataset and − 1.77 (95% CI, − 3.04 to 0.50) in the external validation dataset remained within the equivalence limit. The Pearson correlation coefficient was 0.93 in the internal validation dataset (95% CI, 0.90–0.95) and 0.82 in the external validation dataset (95% CI, 0.75–0.88). The limits of agreement were wider than the predetermined relevant range.ConclusionsThe sAIS is accurate, but slightly imprecise in calculating the ISS. The development of this scale increases the possibilities to use a scoring system for severely injured patients in settings with a reduced availability of the AIS.Trial registration: Retrospectively registered.

Impact of hospital formulary intervention on carbapenem use: a segmented time-series analysis of consumption and a propensity score-matched non-inferiority study of treatment efficacy

BackgroundPharmaceutical formularies play a crucial role in guiding medication use by balancing clinical effectiveness and cost efficiency. Although formulary implementation has been increasing in Japan, comprehensive evaluations of its impact on both clinical and economic outcomes are limited. This study aimed to assess the effect of introducing an antimicrobial formulary at Yokohama City University Hospital on antibiotic usage and treatment outcomes in intra-abdominal infections.MethodsWe conducted a segmented time-series analysis to evaluate changes in carbapenem usage, including doripenem, before and after formulary implementation in October 2018. Monthly antibiotic consumption was measured by antibiotic use density (AUD). The primary outcomes were changes in doripenem use and treatment efficacy for intra-abdominal infections. To assess treatment efficacy, we used non-inferiority analysis with propensity score matching based on age, sex, body mass index, cancer status, and baseline blood test results. The treatment outcomes were evaluated using predefined clinical indicators.ResultsFollowing the formulary intervention, doripenem use significantly decreased from 10.8 to 4.9%, meropenem use slightly increased, and imipenem/cilastatin usage remained stable. Overall, carbapenem use significantly decreased during the study period. Treatment effectiveness for intra-abdominal infections remained non-inferior, with a higher proportion of patients classified as having an “effective” response post-intervention (86.6% vs. 79.4% pre-intervention). The confidence interval confirmed the non-inferiority margin, indicating no clinically significant reduction in treatment effectiveness following the formulary introduction.ConclusionsThe introduction of an antibiotic formulary at Yokohama City University Hospital effectively reduced the use of doripenem without compromising the effectiveness of treatment of intra-abdominal infections. These findings suggest that formulary management can be a valuable strategy for optimizing antibiotic use while maintaining clinical outcomes and contributing to improved antimicrobial stewardship in healthcare settings. Further research is warranted to explore the broader implications of formulary implementation in Japanese healthcare practices.

Language Mapping With rTMS in Healthy Pediatric Patients.

Repetitive transcranial magnetic stimulation (rTMS) is a potentially effective, noninvasive tool for language mapping. However, there is a paucity of data in pediatric patients. In this study, we aimed to map language sites in healthy pediatric participants with navigated rTMS. Children aged 5 to 18 years underwent bilateral language mapping. Stimulation was delivered at 5 Hz during visual-naming and auditory verb-generation tasks in 1 to 2 second bursts. We targeted 33 standardized sites per hemisphere. In total, 34 participants completed the visual-naming task, and 27 participants completed the verb-generation task. Lateralization index (LI) and Wilcoxon signed-rank test were used to assess language lateralization. A difference of least squares means model was developed to determine the prevalence of visual-naming and verb-generation errors within lobar and hemispheric regions. Weak left lateralization was observed for visual naming (LI 0.14; p = 0.038), and no lateralization was observed for verb generation (LI 0.08; p = 0.269). Using multiple least squares regression, left hemisphere errors were more likely to occur than right hemisphere errors for visual naming (OR 1.23; 95% CI 1.06-1.44), but no lateralization effect was observed for verb-generation errors (OR 1.11; 95% CI 0.93-1.27). rTMS is likely to identify bilateral or weakly left-lateralized language sites in pediatric patients during language tasks. Although rTMS can be a useful noninvasive method for identifying potential language-positive sites, our results in healthy controls suggest that it cannot be used as a singular method for language mapping in the preoperative setting.

Flame‐Retardant Rigid Polyurethane Foam Composites Based on Piperazine Pyrophosphate/Steel Slag: A New Strategy for Utilizing Metallurgical Solid Waste

ABSTRACTIn this work, piperazine pyrophosphate (PAPP) and metallurgical solid steel slag (SS) are used to fabricate flame‐retardant rigid polyurethane foam (RPUF) composites through a one‐step all‐water foaming technology. The thermal stability, combustion properties, and flame retardancy of the PAPP/SS composite were investigated by thermogravimetric (TG) analysis, cone calorimetry, limiting oxygen index testing (LOI), and UL‐94 vertical burn testing. RPUF‐3 showed a char residue of 28.6 wt% at 750°C compared with 24.9 wt% of the pure sample, indicating better thermal stability of the FRPRUF composites. RPUF‐3 possessed an LOI of 21.5 vol% and achieved a V‐0 level in the UL‐94 test. Cone calorimetry displayed the peak heat release rate and fire growth rate index of RPUF‐3 were decreased by 12.66% and 41.6%, respectively, compared with those of pure RPUF. PAPP/SS incorporation led to the formation of compact char layer structures during combustion. Pyrophosphoric acid, generated from the decomposition of PAPP, promotes the formation of esters, ethers, and alcohols, whereas metal oxides in SS enhance the compactness of the char layer. This enhanced structural integrity obstructs mass and heat transmission in the combustion zone, effectively improving condensed‐phase flame retardancy. This approach offers a novel strategy for the fabrication of high‐performance RPUF composites and the high‐value utilization of SS.

303. The A-Stop Study: Rapid Tests for Candida Infection in Non-neutropenic Critically-ill Patients - A Multicentre Diagnostic Test Accuracy Study

Abstract Background Among critically-ill patients, antifungal therapy is usually driven by risk rather than a confirmed diagnosis. This leads to overtreatment, due to both low confidence in culture-based diagnostics and the time-critical nature of antifungal treatment. Such overtreatment undermines antimicrobial stewardship which could be improved if rapid, non-culture, tests reliably exclude disease. Methods This was a prospective multicentre diagnostic test accuracy study of three rapid tests for Candida infection: beta-D-glucan (BDG), Associates of Cape Cod, and two PCR-based tests (Fungiplex Candida, Bruker Corporation; & T2Candida, T2 Biosystems). In brief, patients were eligible for recruitment within 24hr of being started empirically on antifungal therapy for suspected Candida infection if they were not neutropenic. In the primary analysis, diagnostic accuracy metrics were derived by comparing index test results to the EORTC/MSGERC definition of proven Candida disease for patients in intensive care units (ICU). In a secondary analysis, the tests were compared with a constructed reference standard for proven + probable Candida disease. Since the purpose of these tests was to rule-out disease, sensitivity and negative predictive value (NPV) were the focus. Results Of 4005 patients screened for eligibility, 1251 participants were recruited from 57 UK ICUs between 2018-2023. Of these, 1223 were evaluable against the definition of proven disease and 54 met that definition. In total, 1215, 1217, and 507 participants had an evaluable BDG, Fungiplex, and T2Candida test, respectively. For proven disease, the most sensitive test was BDG (69%), followed by T2Candida (44%) and Fungiplex (28%); the NPV of each of these three tests was 97%. The sensitivity was predictably lower for the proven + probable disease group (N=124), ranging from 18%-58%, yet NPV remained above 90% for all three tests. Conclusion There is an opportunity to reduce unnecessary antifungal prescribing in this patient group. Each of the tests evaluated had lower sensitivity than previously reported but, because of low disease prevalence, they had high NPV. Modelling the effects of using the tests to stop empiric treatment may further guide how best to apply the tests in practice. Disclosures All Authors: No reported disclosures

The diagnostic accuracy and feasibility of paediatric visual field tests: A systematic review.

Alternative non-standard paediatric visual field (VF) tests have been developed to address the challenges associated with standard approaches. However, diagnostic accuracy of these new VF tests has not yet been rigorously evaluated. This systematic review aims to explore diagnostic accuracy and feasibility of non-standard VF tests in paediatric patients. The following databases were searched for English language studies comparing a non-standard paediatric VF test to standard methods, such as standard automated perimetry (SAP), manual kinetic perimetry (MKP) and confrontation testing (CT): EMBASE, PubMed, Ovid MEDLINE, Web of Science, Scopus, VisionCite, Cochrane Library, ClinicalTrials.gov, African Index Medicus, LILACS, Trip and grey literature databases. Studies included were of children ≤18 years old with suspected or known VF defects (n > 3). Case reports, case series, editorials and letters were excluded. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Thirty studies (n = 2074 children, age range: 2 months to 18 years) published between 1990 and 2023 met the inclusion/exclusion criteria. Twenty index tests were reported, sorted into four categories of methods: behavioural/observational (5), electrophysiological (2), modifications of standard perimetry (11) and eye tracking (2). Risk of bias, based on the QUADAS-2 results, was unclear or high for most studies. Sensitivities of 10 studies (behavioural/observational [2]; electrophysiological [2]; modifications of standard perimetry [2] and eye tracking [4]) were 60%-100%, 75%, 80%-94% and 70%-100%, and specificities were 98%-100%, 86%-88%, 68%-100% and 50%-100%, respectively. Alternative non-standard paediatric VF tests, and behavioural/observational methods in particular, show potential for adequate diagnostic accuracy and feasibility, although limited to certain conditions and ages. Studies with complete reporting and low risk of bias are needed to determine the diagnostic accuracy and feasibility of non-standard paediatric VF tests.

Translingual neural stimulation induced changes in intra- and inter-network functional connectivity in mild-moderate traumatic brain injury patients

IntroductionMild-to-moderate traumatic brain injury (mmTBI) that lead to deficits in balance and gait are difficult to resolve through standard therapy protocols, and these deficits can severely impact a patient's quality of life. Recently, translingual neural stimulation (TLNS) has emerged as a potential therapy for mmTBI-related balance and gait deficits by inducing neuroplastic changes in the brain gray matter structure. However, it is still unclear how interactions within and between functional networks in brain are affected by TLNS. The current study aimed to extend our previous resting-state functional connectivity (RSFC) study investigating the effects of TLNS intervention on outcome measures related to gait and balance.MethodsAn experimental PoNS device was utilized to deliver the TLNS. The 2-week TLNS intervention program, specifically stimulation during focused physical therapy focused on recovery of gait and balance, included twice-daily treatment in the laboratory and the same program at home during the intervening weekend. The resting-state fMRI datasets at pre- and post-interventions were collected by 3T MRI scanner with nine mmTBI patients. All participants also received both Sensory Organization Test (SOT) and Dynamic Gait Index (DGI) testing pre- and post-intervention as part of the behavioral assessment.ResultsCompared to baseline, TLNS intervention led to statistically significant improvements in both the SOT [t(8) = 2.742, p = 0.028] and the DGI [t(8) = 2.855, p = 0.024] scores. Moreover, significant increases in intra- and inter-network RSFC were observed, particularly within the visual, default mode, dorsal attention, frontoparietal (FPN), and somatosensory (SMN) networks. Additionally, there were significant correlations between the SOT and inter-network FC [between FPN and SMN, r(9) = –0.784, p = 0.012] and between the DGI and intra-network FC [within SMN, r(9) = 0.728, p = 0.026].DiscussionThese findings suggest that TLNS intervention is an effective in increasing somatosensory processing, vestibular-visual interaction, executive control and flexible shifting, and TLNS may be an effective approach to inducing brain network plasticity and may serve as a potential therapy for mmTBI-related gait and balance deficits.

Additions to the saprobic fungi (Ascomycota) associated with macadamia trees from the Greater Mekong Subregion

Macadamia trees, the most economically important Proteaceae perennial crop, are globally renowned for their edible nuts. During our surveys of microfungi associated with macadamia in China and Thailand, we isolated three saprobic fungi from dead macadamia branches. Our multigene phylogenetic analyses (ITS, LSU, SSU, tef1-α, TUB2, and ACT loci), genealogical concordance phylogenetic species recognition (GCPSR) with a pairwise homoplasy index (PHI) test, and morphological characteristics led to the discovery of two new species, Dothiorella macadamiae and Phaeoacremonium chiangmaiense, and one new record, Melomastia puerensis. We provide morphological descriptions, photo plates, phylogenetic analysis results, and PHI test results of the two new species, along with comparisons with closely related taxa. These findings have global implications for understanding the diversity of microfungi associated with macadamia trees.

Diagnostic accuracy of point-of-care ultrasound of the posterior fatpad in elbow fractures

BackgroundPoint-of-care ultrasound (POCUS) can potentially be used in the triage of patients with elbow injuries. However, the diagnostic accuracy of POCUS performed by non-radiologists for the exclusion of elbow fractures...

Improving Gait Ability and Cognition Function through Action Observation Training in Elderly with Dementia

Objective This study aimed to investigate the effect of Action observation training (AOT) on gait ability and cognition in older individuals with dementia. Methods A total of 36 participants were randomly assigned to the experimental (n=18) or control (n=18) group. The 5-week intervention involved 45-min sessions. The participants engaged in general group exercises for 30 min. The experimental group watched a training video for 5 min, while the control group watched a scenic video. Subsequently, both groups underwent functional training for 10 min. All participants were assessed using a gait analyzer (G-walk), Dynamic Gait Index (DGI), timed up and go (TUG) test, and the Korean version of the Montreal Cognitive Assessment (MoCA-K) before and after the intervention. Results The two groups showed significant within-group changes in gait velocity, cadence, stride length, DGI, and MoCA-K scores (p<0.05). However, the TUG test showed a significant differences only in the experimental group (p<0.05). A significant difference was observed between the experimental and control groups regarding the changes in gait velocity, cadence, DGI, TUG test, and MoCA-K score after the intervention (p<0.05). Conclusions The study suggest that AOT is effective in improving the gait and cognitive abilities of older individuals with dementia.

Engineering and Design Considerations for Steel Furnace Slag Aggregates in Concrete Pavements

The use of steel furnace slag (SFS) aggregates is limited in the United States and abroad, primarily because of the inherent expansion potential of the material, which results from the hydration of the free calcium and magnesium oxides present from the slagging process. When used in concrete, the literature presents contradictory findings, such as that the strength can increase or decrease with the addition of SFS aggregates. Microstructural investigations of the SFS aggregates as well as the interfacial transition zone (ITZ) in mortars revealed that the mechanical properties are strongly dependent on the SFS type and source. Certain SFS types can develop with a porous interior and/or a porous outer layer of different composition, both of which act as weaknesses in the bulk concrete. Depending on the SFS type, the ITZ may also be more porous, which can lead to further weakening of the concrete. Given the potential deleterious expansion of SFS, there are rapid screening protocols, which can quantify both the free lime content (complexometric titration) and expansion potential (autoclave index test) of the SFS. While the literature currently presents limits for the SFS to be used as a base material, no limits are defined for the use of SFS in bound applications, despite the fact that low expansion SFS aggregates are being used in several countries for certain applications.

Diagnostic Accuracy of Shear Wave Elastography in Predicting Malignant Origins of Pleural Effusions in Emergency Departments.

Objective: Ultrasound is a valuable diagnostic tool in the diagnostic work-up of dyspnea and can identify even small pleural effusions. The incorporation of shear wave elastography (SWE) represents a possible tool in stratifying pleural effusions by the risk of underlying malignancy. No previous studies on ultrasound with the incorporation of SWE have been conducted in an emergency department (ED), where such stratification might have a clinical impact by hastening referrals for the diagnostic work-up of underlying malignancy. The objective of this study was to appraise the diagnostic accuracy of ultrasonographic findings associated with thoracic malignancy as well as to calculate the optimal cutoff values for SWE in this regard. Methods: Patients with a unilateral pleural effusion of unknown origin were included in the ED and subjected to a thoracic ultrasound (TUS) scan during their first 48 h after admittance. Two index tests were applied: (i) traditional B-mode TUS examination registering the presence of diaphragmatic nodules, pleural thickenings and other findings associated with malignancy and (ii) an SWE examination of different regions of interest. The reference test was defined as the subsequent diagnosis of malignant pleural effusion (MPE) in the three months following inclusion. Results: In total, 39 patients were included. The B-mode TUS index test yielded a sensitivity of 28.57% (95%CI 3.67-70.96%) and a specificity of 90.62% (95%CI 74.98-98.02%). The SWE max of the intercostal space yielded a sensitivity of 100% (95%CI 47.82-100%) and a specificity of 59.09% (95%CI 36.35-79.29%). Conclusions: A TUS with integrated SWE may aid in identifying MPEs and improving referrals for the diagnostic work-up of underlying malignancy. Larger, adequately powered studies are warranted.

Effectiveness of Four Rootstocks against Fusarium wilt, Yield and Quality in Cucumber

Fusarium crown root rot caused by F. solani is one of the most important diseases that limiting cucumber cultivation all around the world. There is more than one way to deal with this disease, but sometimes these practises may be insufficient. For this reason, the use of resistant varieties and rootstocks gains importance in the control of soil-borne diseases. The objectives of this study are to determine the resistance of breeding materials to fusarium and to evaluate their rootstock performance and to reveal their effects on fruit yield and quality. To determine the Fusarium resistance level, 48 breeding materials were tested and four moderate resistant materials were grafted onto the hybrid Gordion variety. The effects of grafted plants on fruit yield and vegetative growth were evaluated. Early yield was also significantly higher in grafted plants than in the ungrafted control. Strongtosa had the highest fruit per plant, followed by RS 841 and 13×18 hybrid rootstock. Although higher yields were generally obtained in grafted plants compared to the control group. Additinally fruit length, fruit diameter, fruit shape index, fruit firmness and panel test were evaluated in grafted plants. These materials used as rootstocks increased plant growth and yield.

The diagnostic accuracy of EyeGuide Focus testing for concussion in elite male Rugby players

ABSTRACT Introduction Smooth pursuit eye movements may be affected by head impacts. The EyeGuide Focus system is a simple, portable, test of visual tracking. This study investigated the diagnostic accuracy of EyeGuide measurements for detection of concussion during elite Rugby matches. Methods A prospective diagnostic case–control study was performed in the elite 2021/2022 United Rugby Championship competition. The study population comprised consecutive players identified with match-related head impact events during the World Rugby Head Injury Assessment process, randomly chosen uninjured players, and players with match-related musculoskeletal injuries. The index test was blinded EyeGuide assessment performed by independent assessors. The reference standard was concussion diagnosed by the team doctor. Distributions of EyeGuide scores were compared between concussed and non-concussed players and receiver operator characteristic curves constructed. Results EyeGuide testing was performed in 262 cases, comprising 55 concussed players and 207 non concussed players (33 head impact events, 97 uninjured controls, and 79 musculoskeletal injury controls). The distributions of EyeGuide score were similar between concussed and non-concussed cases (medians 20,120 Vs 21,522, p = 0.3; difference −1,402, 95% CI −5,332–3,865). The c-index for the receiver operating characteristic curve was 0.46 (95% CI 0.36–0.55). Conclusions EyeGuide Focus scores did not appear to discriminate between concussed and non-concussed players in a cohort of elite Rugby players.

Diagnostic Accuracy Comparison between Automatic and Conventional Blood Pressure Measuring Devices in Adults with Hypertension

Background Blood pressure measurement is a main clinical procedure used for the detection of Systemic Arterial Hypertension. Mercury sphygmomanometer, in combination with auscultation technique, is still recognized as the gold standard for non-invasive blood pressure measurement. Objective The objective of this study is to compare the diagnostic accuracy between automatic non-invasive blood pressure measurement devices versus mercury sphygmomanometers in hospitalized patients. Methods A prospective, analytical and cross-sectional diagnostic method study was designed to compare the concordance, positive and negative predictive value, the sensitivity and specificity of automatic non-invasive blood pressure measurement devices and the mercury sphygmomanometer. The devices were divided into two groups: the reference standard which was mercury sphygmomanometer (n=150), versus the index tests, that were wrist device (n=150), semi-automatic sphygmomanometer (n=150) and vital signs monitor (n=150). Results The monitor detected more cases (69%) of systemic arterial hypertension (p 0.0019, OR 5.3). The semiautomatic sphygmomanometer identified more true positives (n=22) and true negatives (n=113). It also showed a higher diagnostic accuracy: 67% sensitivity (p 0.0576, OR 0.5) and 97% specificity (p 0.088, OR 3.2). A mean arterial pressure variation <5mmHg of 65% was found with the semiautomatic sphygmomanometer (p <0.0001, OR 0.02) and 61% with the vital signs monitor (p <0.0001, OR 0.12). Best concordance of blood pressure between reference standard versus index test was obtained in the following order: Semi-automatic sphygmomanometer, Vital signs monitor, and Wrist device. Conclusion The use of vital signs monitor to measure blood pressure is recommended in all patients, although semiautomatic sphygmomanometer is more sensitive for the detection of systemic arterial hypertension.

Application of Orofacial Muscle Strength Measurement to Screen for Penetration/Aspiration Risk in Older Adults With Sarcopenia: A Diagnostic Accuracy Study.

Early identification of penetration/aspiration (P/A) risk in older adults with sarcopenia is crucial to prevent complications and maintain quality of life. To evaluate the diagnostic utility of orofacial muscle strength measurements for predicting the risk of P/A in older adults with sarcopenia. In this observational and prospective study, we collated consecutive data from community-dwelling older adults diagnosed with sarcopenia at a musculoskeletal disorder clinic. Altogether, 54 participants underwent orofacial muscle strength measurements (the index test) using the Iowa Oral Performance Instrument and a videofluoroscopic swallowing study (VFSS) (the reference test) to evaluate for the presence of P/A. Receiver operating characteristic (ROC) curve analysis was performed to determine orofacial muscle strength based on P/A. Overall, 34 patients showed penetration in the VFSS, although none of the patients showed signs of aspiration. The cut-off for tongue strength to identify the risk of P/A was ≤ 20.5 kPa, with a sensitivity and specificity of 0.75 and 0.74, respectively; the area under the curve (AUC) was 0.88. The cut-off for buccinator strength was ≤ 19.5 kPa, with a sensitivity and specificity of 0.65 and 0.68, respectively, with an AUC of 0.69. The cut-off for lip muscle strength was ≤ 18.5 kPa, with a sensitivity and specificity of 0.65 and 0.71, respectively, with an AUC of 0.69. The evaluation of buccinator and lip muscle strength did not demonstrate sufficient diagnostic utility for detecting the risk of P/A in older patients with sarcopenia; however, tongue strength showed reliable diagnostic utility for identifying the risk of P/A.