Interclass Correlation Research Articles

Performance of a prediction method for activities of daily living scores using influence coefficients in patients with stroke.

Recently, a method was developed to predict the motor Functional Independence Measure (FIM) score at discharge in patients with stroke by stratifying the effects of factors such as age and cognitive function and multiplying those by the influence coefficients of these factors. However, an evaluation of the predictive performance of the method is required for clinical application. The present study aimed to evaluate the predictive performance of this prediction method. Patients with stroke discharged from a rehabilitation ward between April 2021 and September 2022 were included. Predicted values of the motor FIM score at discharge were calculated after data collection from the hospital's patient database. The concordance between predicted and actual values was evaluated using the interclass correlation coefficient; moreover, the residual values were calculated. In total, 207 patients were included in the analysis. The median age was 79 (69-85) years, and 112 (54.1%) patients were male. The interclass correlation coefficient between predicted and actual values was 0.84 (95% confidence interval 0.75-0.89) for the motor FIM score at discharge. Meanwhile, the median residual value was 5.3 (-2.0-10.3) for the motor FIM score at discharge. The prediction method was validated with good performance. However, the residual values indicated that some cases deviated from the prediction. In future studies, it will be necessary to improve the predictive performance of the method by clarifying the characteristics of cases that deviate from the prediction.

Comparison of Four Different Scoring Methods for Ki-67 Percentage in Breast Carcinoma: A Cross-sectional Study

Introduction: In breast cancer, the prognostic role of Ki-67 has been comprehensively studied, and its usefulness has been proven. Ki-67 expression has a prognostic and predictive value in both adjuvant therapy response and neoadjuvant settings. However, the inter and the intraobserver variability in manual counting limits the accuracy of scoring Ki-67 and consequently its application in treatment. Aim: To examine four different methods of Ki-67 estimation to find the most reliable, reproducible and time-efficient scoring methods for Ki-67. Materials and Methods: The present cross-sectional study was conducted in the Department of Pathology, Sree Mookambika Institute of Medical Sciences, Nagercoil, Tamil Nadu, India, from May 2023 to August 2023. Ki-67 immunostained slides of 30 trucut biopsies of invasive breast carcinoma were retrieved and analysed by two observers in a blinded manner. The four different methods of analysis of Ki-67 expression carried out were the global method, the hotspot method, the Eye-10 method and the stepwise counting strategy. The parameters included in the present study were the mean age of the study population, the pre/postmenopausal status, the histopathological type of invasive breast carcinoma, Estrogen receptor (ER), Progesterone Receptor (PR), and Human Epidermal growth factor Receptor 2 (HER2)/neu status, as well as, the interobserver agreement and the mean time taken by the four methods to analyse the Ki-67 expression. Data entry was performed using Microsoft Office Excel 2013, and statistical analysis was conducted using Statistical Package for the Social Sciences (SPSS) software version 20.0. Descriptive statistics for qualitative variables and mean and Standard Deviation (SD) for quantitative variables were used for data analysis. Chi-square tests were used for bivariate analysis with a determined statistical significance of 5% (p-value<0.05). Results: The mean age of the study population was 52.9±9.1 years. The highest interobserver concordance was observed among the observers using the weighted global scoring method, with an Interclass Correlation Coefficient (ICC) of 0.967. This method was time consuming, with the first observer taking a mean±SD time of 5.5±0.8 minutes and the second observer taking 4.6±0.9 minutes. The least time was consumed for performing the Eye-10 scoring, with mean±SD time was 1±0.87 minutes. The stepwise counting and hotspot method demonstrated excellent inter-rater agreement, with a kappa of 0.8304 (p-value<0.001) between both observers. Conclusion: Although the Eye-10 method and stepwise counting took the least time, they are limited by a gray/intermediate zone for scoring compared to the global scoring method and the hotspot method. As a result, the global and/or hotspot method after proper training is a robust and reliable method of assessing Ki-67, with the hotspot method being the most reliable, as the global method is limited by the use of an online tool.

Validation of the Athens Insomnia Scale Among Young Chinese Male Population in a High-Altitude Situation.

The Athens Insomnia Scale (AIS) is a widely used and authorized questionnaire for evaluating insomnia symptoms. However, its reliability and validity at high altitudes are uncertain. Therefore, this study aimed to confirm the validity and reliability of AIS during a 3658 m altitude exposure. A total of 387 young Chinese males were enlisted in the acute high-altitude exposure group. They flew for about two hours, climbing from 400 m to 3658 m. The high-altitude-acclimated group consisted of 86 young Chinese men who had lived at least six months at 3658 m altitude. The sleep quality of the acute high-altitude exposure group was evaluated using the AIS before the ascent and after exposure to 3658 m for 24 hours, and one week. The sleep quality of the high-altitude-acclimated group was also assessed. The AIS's internal consistency, reliability, and validity were evaluated. The respondents' quality of sleep significantly decreased after being exposed to 3658 m as opposed to 400 m. Two factors comprised the AIS, according to an exploratory factor analysis: "sleep problem" (items 1-5) and "daytime dysfunction" (items 6-8). The Cronbach's α internal consistency coefficients exceeded 0.8, and the corrected item-total correlations were all greater than 0.5 when the subjects were exposed to 3658 m. The model fit index was well within the criterion. The average variance extracted and composite reliability were all higher than 0.5 and 0.7, respectively. The interclass correlation coefficient was deemed "fair to good" at 0.482, which is greater than the 0.4 threshold. The AIS has satisfactory discriminant validity, as shown by the Fornell-Larcker criterion and cross-loading results. The daytime dysfunction R-square values (>0.33) show that the frameworks have considerable predictive accuracy. The AIS exhibits strong consistency, reliability, and validity. The AIS's features and simplicity make it an essential psychometric tool for high-altitude sleep research.

Carotid plaque characteristics in the CREST-2 trial

BackgroundThe modest stroke prevention from surgery for asymptomatic carotid disease has prompted a search for predictors that may improve risk stratification beyond luminal stenosis. Plaque disruption and atheroembolization are associated with unique anatomical and histological changes. The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) collects information on duplex ultrasound (DUS) plaque biomarkers with the goal of evaluating their relationship to the periprocedural and long-term risks of stroke. In this study, we examine the reliability with which carotid plaque features can be measured from DUS images, and report baseline carotid DUS-derived stenosis and plaque features using semiautomated digital image analysis of patients enrolled in CREST-2. MethodsWe studied the first 503 patients in CREST-2. Patients underwent standardized carotid DUS evaluation pre-enrollment. B-Mode images were scaled linearly to normalize brightness. Plaques were outlined manually. Dedicated software automatically measured the longitudinal sectional area (mm2), grayscale median (GSM), Gray-Weale classification, and tissue composition (mm2) of intraplaque hemorrhage (IPH), lipid, fibrous tissue, muscle, and calcium. We present the mean, standard deviation, median, interquartile range, minimum and maximum range, and proportions of carotid peak systolic velocities (PSVs) and plaque morphological features. We tested for autocorrelation among plaque features and computed the proportion of potentially unstable plaques in the cohort. Reliability of the image analysis techniques was tested in 100 patients using Bland-Altman plots and intraclass and interclass correlation coefficients. ResultsMost patients were male (58.4%), older (mean age of 69.3 years), White (87.5%), and had a PSV of ≥230 cm/s (98.6%); the 1.4% with a PSV of <230 cm/s were enrolled based on catheter angiography. Plaques in this study were large; the mean longitudinal sectional area was 62 ± 37 mm2 (range, 6.2–256.5 mm2). The mean GSM was 58 ± 30 (unitless) (range, 0–168) and Gray-Weale classification was 3.5 ± 0.9 (range, 1–5). The mean areas of tissue types were IPH 5.3 ± 8.9 mm2, lipid 9.3 ± 8.6 mm2, fibrous tissue 10 ± 10 mm2, muscle 17 ± 12 mm2, and calcium 1.6 ± 4.1 mm2. The PSV of patients showed poor correlation with plaque features. The proportion of plaques with a GSM of ≤35 was 22.8%, IPH of ≥5 mm2 was 30.0%, and a lipid-rich necrotic core of ≥40% was 3.0% of the cohort. Plaque measurements could be performed with high reliability with good interobserver and intraobserver correlations. ConclusionsSite-generated, core laboratory-interpreted ultrasound examination provides a reliable way of characterizing carotid plaque morphological features across studies performed at many CREST-2 sites. The initial cohort of patients randomized in CREST-2 had heterogeneity of plaque features despite causing high-grade stenosis. Completion of the trial will provide an opportunity to assess whether plaque heterogeneity interacts with response to revascularization and medical management.

Assessment of inter-rater and intra-rater reliability of the Luna EMG robot as a tool for assessing upper limb proprioception in patients with stroke-a prospective observational study.

The aim of the study was to assess the inter-rater and intra-rater agreement of measurements performed with the Luna EMG (electromyography) multifunctional robot, a tool for evaluation of upper limb proprioception in individuals with stroke. The study was conducted in a group of patients with chronic stroke. A total of 126 patients participated in the study, including 78 women and 48 men, on average aged nearly 60 years (mean = 59.9). Proprioception measurements were performed using the Luna EMG diagnostic and rehabilitation robot to assess the left and right upper limbs. The examinations were conducted by two raters, twice, two weeks apart. The results were compared between the raters and the examinations. High consistency of the measurements performed for the right and the left hand was reflected by the interclass correlation coefficients (0.996-0.998 and 0.994-0.999, respectively) and by Pearson's linear correlation which was very high (r = 1.00) in all the cases for the right and the left hand in both the inter-rater and intra-rater agreement analyses. Measurements performed by the Luna EMG diagnostic and rehabilitation robot demonstrate high inter-rater and intra-rater agreement in the assessment of upper limb proprioception in patients with chronic stroke. The findings show that Luna EMG is a reliable tool enabling effective evaluation of upper limb proprioception post-stroke.

Adaptation and Validation of the Mandarin Chinese Version of the Pediatric Voice Handicap Index-10 (pVHI-10).

The purpose of this study was to adapt and validate the Mandarin Chinese version of the pediatric Voice Handicap Index-10 (pVHI-10). A cross-sectional study was conducted from January 2018 to December 2019. A total of 422 parents completed the questionnaire, including 283 parents of children with voice disorders (dysphonic group) and 139 parents of children without voice disorders (control group). Internal consistency, test-retest reliability, clinical effectiveness, and cut-off value were evaluated. In the dysphonic group, the internal consistency of the Mandarin Chinese version of pVHI-10 was excellent (Cronbach's α=0.95). The test-retest reliability was excellent for the total score of the Mandarin Chinese version of pVHI-10 (interclass correlation coefficient=0.916). The total scores as well as scores on individual items were significantly higher in the dyphonic group compared to those in the control group (P <0.001). In addition, the optimum cut-off value for the Mandarin Chinese version of pVHI-10 was 6.5 (87% sensitivity and 86.3% specificity, respectively). The Mandarin Chinese version of the pVHI-10 is a valid tool that evaluates the quality of life of children with voice disorders from the parents' perspective.

Design and Validation of an integrated Objective Structured Clinical Examination (i-OSCE) for a non-surgical aesthetics postgraduate program.

Introduction: The Objective Structured Clinical Examination (OSCE) is a popular and practical method for evaluating future clinicians’ competence and suitability for independent clinical practice. The present study aimed to develop and validate an integrated objective structured clinical examination to assess aesthetic physicians’ critical thinking and clinical competency. Methods: Initially, an expert panel consisting of five Aesthetic Practitioners with over 15 years of experience and a senior clinical academic were invited to develop a blueprint for the integrated objective structured clinical examination. Through this blueprint, the essential qualities and skills were identified for assessment. In addition, training workshops for examiners and simulated patients were organized to ensure process standardization. The final integrated objective structured clinical examination consisted of 12 stations (four clinical, four critical thinking, and four rest stations lasting 180 min). Results: The Interclass correlation coefficient between the station checklist items was 0.946 (average upper bound 0.916, lower bound 0.968; p&lt;0.00), which was considered significant. The Inter-Item Correlation Matrix among the clinical station and critical thinking checklist items also showed statistical significance. The Pearson correlation coefficient (PCC) was used to ascertain the correlation between the checklist and global ratings, yielding a high correlation (0.80 0.934). Conclusion: The integrated objective structured clinical examination is a valuable and reliable tool for assessing trainees’ aesthetic physicians’ clinical competence and critical thinking.

Agreement of a Pyramidal Wavefront-Based Autorefraction with Dry, Cycloplegic, and Subjective Refraction in Myopic Refractive Surgery Candidates

Abstract Purpose: To evaluate the repeatability of a pyramidal wavefront-based refraction (WFR) measurement and its agreement with dry autorefraction (DR), cycloplegic autorefraction (CR), and subjective refraction (SR) in myopic refractive surgery candidates. Methods: One hundred eighty-nine eyes from 189 participants were evaluated. PERAMIS aberrometry (PERAMIS; SCHWIND eye-tech-solutions, Kleinostheim, Germany), DR, and CR, as well as SR, were completed for all candidates. The repeatability of PERAMIS measurements was assessed, and the Bland–Altman plots were used to test the agreement between different methods. Results: Repeatability of the PERAMIS aberrometer was very high in the measurement of all refractive elements (Sphere, cylinder, spherical equivalent [M], J0, and J45) (interclass correlation coefficient &gt;0.980 for all). A significant myopic shift was found with WFR compared to CR (0.45 diopter [D]) and SR (0.28 D) (P &lt; 0.05). For the M component, there was a significant difference between WFR and CR (P &lt; 0.05). J0 component measured with WFR was significantly different from SR and CR (P &lt; 0.05). For the J45 variable, all three refraction methods were comparable (all, P &gt; 0.05). In M &gt; 5.00 D, a difference of 0.79 D (limit of agreement: −3.50–1.90) was found between WFR and CR. Conclusions: In lower degrees of myopia, WFR was in good agreement with the manifest autorefraction. WFR, CR, and SR techniques were comparable in measuring astigmatism, especially in oblique astigmatism.

Reliability of Three Landmine-Punch-Throw Variations and Their Load-Velocity Relationships Performed With the Dominant and Nondominant Hands.

This study assessed the reliability and load-velocity profiles of 3 different landmine-punch-throw variations (seated without trunk rotation, seated with trunk rotation, and standing whole body) with different loads (20, 22.5, and 25.0kg), all with the dominant hand and nondominant hand. In a quasi-randomized order, 14 boxers (24.1 [4.3]y, 72.6 [10.1]kg) performed 3 repetitions of each variation with their dominant hand and theirnondominant hand, with maximal effort and 3minutes of interset rest. Peak velocity was measured via the GymAware Power Tool (Kinetic Performance Technologies). The interclass correlation coefficients and their 95% CIs were used to determine the intrasession reliability of each variation × load × hand combination. Additionally, a 2 (hand) × 3 (variation) repeated-measures analysis of variance assessed the load-velocity profile slope, and a 3 (variation) × 2 (hand) × 3 (load) repeated-measures analysis of variance assessed the peak velocity of each variation. Most variations were highly reliable (intraclass correlation coefficient > .91), with the nondominant hand being as reliable or more reliable than the dominant hand. Very strong linear relationships were observed for the group average for each variation (R2 ≥ .96). However, there was no variation × hand interaction for the slope, and there was no main effect for variation or hand. Additionally, there was no interaction for the peak velocity, but there were main effects for variation, hand, and load (P < .01). Each variation was reliable and can be used to create upper-body ballistic unilateral load-velocity profiles. However, as with other research onload-velocity profile, individual data allowed for more accurate profiling than group average data.

Translation, Cross-Cultural Adaptation, and Psychometric Properties of the Revised Fibromyalgia Impact Questionnaire (FIQR) for Use in Arabic-Speaking Patients in Saudi Arabia.

Fibromyalgia (FM) is a complex and debilitating condition that significantly impacts patients' daily lives. The continuous assessment of the impact and severity of FM is essential to manage the condition effectively. Assessment tools in Arabic are lacking for use in Saudi Arabia, which might lead to ineffective management. This study aimed to translate and cross-culturally adapt and validate the Arabic version of the Revised Fibromyalgia Impact Questionnaire (FIQR). Following translation guidelines, 2 Arabic translators and 2 English-certified translators performed forward and backward translations of the FIQR. In a cross-sectional study design, the questionnaire was piloted with 5 participants and then subjected to cognitive interviews and psychometric analysis. Participants were FM patients recruited from a University Hospital in Riyadh and FM support groups in Saudi Arabia. The internal consistency, and reliability using the Cronbach α and interclass correlation coefficient (ICC) of 2-week test-retest, and criterion validity were evaluated. The results included a total of 42 participants with FM. Six minor modifications were made during the stepwise translation of the questionnaire. The Arabic version of the FIQR had good internal consistency and test-retest reliability, with a Cronbach α of 0.855 for the physical functioning domain, 0.663 for overall well-being, 0.803 for symptoms, and 0.895 for the total FIQR, and the Pearson correlation coefficient of the ICC for physical functioning was 0.769 (95% confidence interval (CI), 0.541-0.884) for the overall well-being domain, 0.555 (95% CI, 0.129-0.772) for the symptoms domain, and 0.720 (95% CI, 0.370-0.868) and 0.794 (95% CI, 0.579-0.899) for the total FIQR score (p < 0.001), respectively. The Arabic version of the FIQR is a valid, reliable, and practical tool for assessing the impact of FM on Arabic-speaking patients and potentially contributing to the improvement of FM outcomes.

Correlation of four-dimensional ultrasound strain analysis with computed tomography angiography wall stress simulations in abdominal aortic aneurysms

ObjectiveBiomechanical modeling of infrarenal aortic aneurysms seeks to predict ruptures in advance, thereby reducing aneurysm-related deaths. As individual methods focusing on strain and stress analysis lack adequate discretization power, this study aims to explore multifactorial characterization for progressive aneurysmal degeneration. The study’s objective is to compare stress- and strain-related parameters in infrarenal aortic aneurysms. MethodsTwenty-two patients with abdominal aortic aneurysms (AAAs) (mean maximum diameter, 53.2 ± 7.2 mm) were included in the exploratory study, examined by computed tomography angiography (CTA) and three-dimensional real-time speckle tracking ultrasound (4D-US). The conformity of aneurysm anatomy in 4D-US and CTA was determined with the mean point-to-point distance (MPPD). CTA was employed for each AAA to characterize stress-related indices using the semi-automated A4-clinics RE software. Five segmentations from one 4D-US examination were fused into one averaged model for strain analysis using MATLAB and the Abaqus solver. ResultsThe mean MPPD between the adjacent points of the 4D-US and CTA-derived geometry was 1.8 ± 0.4 mm. The interclass correlation coefficients for all raters and all measurements for the maximum AAA diameter in 2D, 4D ultrasound, and CTA indicate moderate to good reliability (interclass correlation coefficient1 0.69 with 95% confidence interval [CI], 0.49-0.84; P < .001). The peak wall stress (PWS) correlates fairly with the maximum AAA diameter in 2D-US (r = 0.54; P < .01) and 4D-US (r = 0.53; P < .05) and moderately strongly with the maximum exterior AAA diameter (r = 0.63; P < .01). The peak wall rupture risk index shows a strong correlation with the PWS (ρ > 0.9; P < .001) and is influenced by anatomical parameters with equal strength. Isolated observation of the intraluminal thrombus does not provide significant information in the determination of PWS. The maximum AAA diameter in 2D-US shows a fair negative correlation with the mean circumferential, longitudinal and in-plane shear strain (ρ = −0.46; r = −0.45; ρ = −0.47; P < .05 for all). The circumferential strain ratio as an indicator of wall motion heterogeneity increases with the aneurysm diameter (r = 0.47; P < .05). The direct comparison of wall strain and wall stress indices shows no quantitative correlation. ConclusionsThe strain and stress analyses provide independent biomechanical information of AAAs. At the current stage of development, the two methods are considered complementary and may optimize a more patient-specific rupture risk prediction in the future.

Impact of training data composition on the generalizability of convolutional neural network aortic cross-section segmentation in four-dimensional magnetic resonance flow imaging

BackgroundTime-resolved, three-dimensional phase-contrast magnetic resonance imaging (4D flow MRI) plays an important role in assessing cardiovascular diseases. However, the manual or semi-automatic segmentation of aortic vessel boundaries in 4D flow data introduces variability and limits reproducibility of aortic hemodynamics visualization and quantitative flow-related parameter computation. This paper explores the potential of deep learning to improve 4D flow MRI segmentation by developing models for automatic segmentation and analyzes the impact of the training data on the generalization of the model across different sites, scanner vendors, sequences, and pathologies. MethodsThe study population consists of 260 4D flow MRI datasets, including subjects without known aortic pathology, healthy volunteers, and patients with bicuspid aortic valve (BAV) examined at different hospitals. The dataset was split to train segmentation models on subsets with different representations of characteristics such as pathology, gender, age, scanner model, vendor, and field strength. An enhanced 3D U-net convolutional neural network (CNN) architecture with residual units was trained for 2D+t aortic cross-sectional segmentation. The model performance was evaluated using Dice score, Hausdorff distance, and average symmetric surface distance on test data, datasets with characteristics not represented in the training set (model-specific), and an overall evaluation set. Standard diagnostic flow parameters were computed and compared with manual segmentation results using Bland-Altman analysis and interclass correlation. ResultsThe representation of technical factors such as scanner vendor and field strength in the training dataset had the strongest influence on the overall segmentation performance. Age had a greater impact than gender. Models solely trained on BAV patients’ datasets performed well on datasets of healthy subjects but not vice versa. ConclusionThis study highlights the importance of considering a heterogeneous dataset for the training of widely applicable automatic CNN segmentations in 4D flow MRI, with a particular focus on the inclusion of different pathologies and technical aspects of data acquisition.

Ab. No. 60 Translation and Cross-Cultural Adaptation of Health Literacy Instrument for Adults in Hindi

Introduction: Physiotherapists play a significant role in health promotion and wellness. Health literacy can help people prevent health problems, protect health and better manage diseases when they arise. To Translate and Cross Culturally Adapt Health Literacy Instrument for Adults (HELIA) and Determine the Reliability and Validity. Methods: Adults aged 18-65 years were included. Methodological study was done where permission to translate the scale was taken from the author. The health literacy instrument for adults was translated into Hindi using forward-backward translation method given by WHO. Forward translation of the scale was done by a Hindi professor such as to preserve meaning of the questions in original questionnaire. There was expert panel of five experts (2 physiotherapists, 2 doctors, 1 engineer). Following their suggestions, validated Hindi version 1 was made. Backward translation was done by an independent translator. Version 1 of Hindi version was pilot tested with 10 adults whose mean age was (42.3 ± 9.75) years. Few suggestions given by them were done and final version 2 was given to 20 participants for reliability. One therapist performed scale twice on the same participants for intra-rater reliability and two therapists performed it on same participants for inter-rater reliability, both with two days of gap. Result: There is strong positive correlation between English and Hindi version of HELIA with intraclass correlation (ICC=0.89) and interclass correlation (ICC=0.84). Scale content validity index (SCVI) is 0.91. Conclusion: The Hindi version of HELIA is reliable and valid for assessing health literacy in adults. Implications: Hindi version of HELIA can be used for assessing health literacy in Hindi speaking community dwelling Indian adults. Clinical management and research may benefit from the availability of a self-administered scale in native language.

Label Embedding Based on Interclass Correlation Mining for Remote Sensing Image Scene Classification

Label Embedding Based on Interclass Correlation Mining for Remote Sensing Image Scene Classification

DEVELOPMENT AND FEASIBILITY OF MENTAL HEALTH AND REPRODUCTION-BASED PESYCOEDUCATION SERIES FOR PREVENTING CHILD MARRIAGE

Background: child marriage can have an impact on mental and reproductive health. Psychoeducation is a form of health promotion with a life skills approach and understanding knowledge. Film as a health promotion medium is one form of media that currently has a big influence on those who see it.&#x0D; Objective: Develop and test the feasibility of the Psychoeducational film series “Nyiapno Tradisi Kembar Mayang” as a medium for promoting mental and reproductive health in preventing child marriages&#x0D; Method: this type of research is development and feasibility testing by 6 experts. The stages consist of writing the film script and producing the film. The measuring tool used is a questionnaire that assesses the script and film media. The analysis technique uses the Aiken's V formula and the reliability test uses the ICC (Interclass Correlation Coefficent) formula.&#x0D; Results: the development of this film was carried out using literature review, script writing, film production, feasibility testing of the script and film. Feasibility test with validation results with a minimum value of 0.80 for film scripts and 0.79 for film media. Meanwhile, the reliability value for film media is 0.982 and film media is 0.786.&#x0D; Conclusion: the development of the film goes through the stage of writing a script with a service value and very good and a film production with a decent and good value. So that this media can become a health promotion media.

Three-Dimensional Magnetic Resonance Imaging Fast Field Echo Resembling a Computed Tomography Using Restricted Echo-Spacing Sequence Is Equivalent to 3-Dimensional Computed Tomography in Quantifying Bone Loss and Measuring Shoulder Morphology in Patients With Shoulder Dislocation

PurposeTo evaluate the equivalence of 3D-MRI (Fast field echo Resembling A CT Using Restricted Echo-spacing,FRACTURE) and 3D-CT in quantifying bone loss in patients with shoulder dislocation and measuring morphological parameters of the shoulder. MethodsFrom July 2022 to June 2023,patients with anterior shoulder dislocation who were over 18 years of age and underwent both MRI and CT within 1 week were included in the study.The MRI protocol included an additional FRACTURE sequence.3D reconstructions of MRI(FRACTURE) and CT were completed by two independent observers using Mimics 21.0 software through simple threshold-based segmentation.For bone defect cases, two independent observers evaluated glenoid defect, percentage of glenoid defect,glenoid track(GT), Hill-Sachs Interval (HSI), and "on-track/off-track".For all cases,glenoid width, glenoid height,humeral head fitting sphere radius,Critical Shoulder Angle(CSA),glenoid version,vault depth, and post-processing time were assessed.Paired t-test was utilized to assess the difference between 3D-CT and 3D-MRI (FRACTURE).Bland-Altman plot was constructed to evaluate the consistency between 3D-CT and 3D-MRI (FRACTURE). Inter- and intra-observer agreement was evaluated by Interclass Correlation Coefficient (ICC). Paired chi-square test and Cohen’s kappa statistic were used for binary variable("on-track/off-track"). ResultsA total of 56 patients(16 bipolar bone defect, 5 only Hill-Sachs lesion,35 without bone defect) were eventually enrolled in the study.The measurements of 21 bone defect cases showed no statistical difference between 3D-CT and 3D-MRI.Glenoid defect,3D-CT(4.05±1.44mm) vs 3D-MRI(4.16±1.39mm,P=0.208);Percentage of glenoid defect,3D-CT(16.21±5.95%) vs 3D-MRI(16.61±5.66%, P=0.199);Glenoid Track,3D-CT (18.02±2.97mm) vs 3D-MRI(18.08±2.98mm, P=0.659);Hill-Sachs Interval,3D-CT (14.29±1.93mm) vs 3D-MRI(14.35±2.07mm, P=0.668).No significant difference was found between 3D-CT and 3D-MRI in the diagnosis of "on-track/off-track"(P=1.000), and the diagnostic agreement was perfect (Kappa=1.00,P=0.000). There was no statistical difference between two examination methods in the measurements of all 56 cases,except that the post-processing time of 3D-MRI was obviously longer than that of 3D-CT.Glenoid height,3D-CT(34.56±1.98mm) vs 3D-MRI (34.67±2.01mm, P=0.139).Glenoid width,3D-CT(25.32±1.48mm) vs 3D-MRI(25.45±1.47mm, P=0.113).Humeral head fitting sphere radius,3D-CT(22.91±1.70mm) vs 3D-MRI(23.00±1.76mm, P=0.211).Critical Shoulder Angle,3D-CT(33.49°±2.55°) vs 3D-MRI (33.57°±2.51°, P=0.328). Glenoid version, 3D-CT(-3.25°±2.57°) vs 3D-MRI (-3.18°±2.57°, P=0.322).Vault depth,3D-CT(37.43±1.68mm) vs 3D-MRI(37.58±1.75mm, P=0.164).Post-processing time,3D-CT(89.66±10.20s) vs 3D-MRI (360.93±26.76s, P=0.000).For all assessments, the Bland-Altman plots demonstrated excellent consistency between two examination methods,and the ICCs revealed excellent inter-observer and intra-observer agreement. Conclusions3D-MRI (FRACTURE) is equivalent to 3D-CT in quantifying bone loss in patients with shoulder dislocation and measuring shoulder morphological parameters.

Comparison and analysis of multiple machine learning models for discriminating benign and malignant testicular lesions based on magnetic resonance imaging radiomics.

Accurate identification of testicular tumors through better lesion characterization can optimize the radical surgical procedures. Here, we compared the performance of different machine learning approaches for discriminating benign testicular lesions from malignant ones, using a radiomics score derived from magnetic resonance imaging (MRI). One hundred fifteen lesions from 108 patients who underwent MRI between February 2014 and July 2022 were enrolled in this study. Based on regions-of-interest, radiomics features extraction can be realized through PyRadiomics. For measuring feature reproducibility, we considered both intraclass and interclass correlation coefficients. We calculated the correlation between each feature and the predicted target, removing redundant features. In our radiomics-based analysis, we trained classifiers on 70% of the lesions and compared different models, including linear discrimination, gradient boosting, and decision trees. We applied each classification algorithm to the training set using different random seeds, repeating this process 10 times and recording performance. The highest-performing model was then tested on the remaining 30% of the lesions. We used widely accepted metrics, such as the area under the curve (AUC), to evaluate model performance. We acquired 1,781 radiomic features from the T2-weighted maps of each lesion. Subsequently, we constructed classification models using the top 10 most significant features. The 10 machine-learning algorithms we utilized were capable of diagnosing testicular lesions. Of these, the XGBoost classification emerged as the most superior, achieving the highest AUC value of 0.905 (95% confidence interval: 0.886-0.925) on the testing set and outstripping the other models that typically scored AUC values between 0.697-0.898. Preoperative MRI radiomics offers potential for distinguishing between benign and malignant testicular lesions. An ensemble model like the boosting algorithm embodied by XGBoost may outperform other models.

Skeletal facial asymmetry: reliability of manual and artificial intelligence-driven analysis.

To compare artificial intelligence (AI)-driven web-based platform and manual measurements for analysing facial asymmetry in craniofacial CT examinations. The study included 95 craniofacial CT scans from patients aged 18-30 years. The degree of asymmetry was measured based on AI platform-predefined anatomical landmarks: sella (S), condylion (Co), anterior nasal spine (ANS), and menton (Me). The concordance between the results of automatic asymmetry reports and manual linear 3D measurements was calculated. The asymmetry rate (AR) indicator was determined for both automatic and manual measurements, and the concordance between them was calculated. The repeatability of manual measurements in 20 randomly selected subjects was assessed. The concordance of measurements of quantitative variables was assessed with interclass correlation coefficient (ICC) according to the Shrout and Fleiss classification. Erroneous AI tracings were found in 16.8% of cases, reducing the analysed cases to 79. The agreement between automatic and manual asymmetry measurements was very low (ICC < 0.3). A lack of agreement between AI and manual AR analysis (ICC type 3 = 0) was found. The repeatability of manual measurements and AR calculations showed excellent correlation (ICC type 2 > 0.947). The results indicate that the rate of tracing errors and lack of agreement with manual AR analysis make it impossible to use the tested AI platform to assess the degree of facial asymmetry.

Evaluating ChatGPT as a self-learning tool in medical biochemistry: A performance assessment in undergraduate medical university examination.

The emergence of ChatGPT as one of the most advanced chatbots and its ability to generate diverse data has given room for numerous discussions worldwide regarding its utility, particularly in advancing medical education and research. This study seeks to assess the performance of ChatGPT in medical biochemistry to evaluate its potential as an effective self-learning tool for medical students. This evaluation was carried out using the university examination question papers of both parts 1 and 2 of medical biochemistry which comprised theory and multiple choice questions (MCQs) accounting for a total of 100 in each part. The questions were used to interact with ChatGPT, and three raters independently reviewed and scored the answers to prevent bias in scoring. We conducted the inter-item correlation matrix and the interclass correlation between raters 1, 2, and 3. For MCQs, symmetric measures in the form of kappa value (a measure of agreement) were performed between raters 1, 2, and 3. ChatGPT generated relevant and appropriate answers to all questions along with explanations for MCQs. ChatGPT has "passed" the medical biochemistry university examination with an average score of 117 out of 200 (58%) in both papers. In Paper 1, ChatGPT has secured 60 ± 2.29 and 57 ± 4.36 in Paper 2. The kappa value for all the cross-analysis of Rater 1, Rater 2, and Rater 3 scores in MCQ was 1.000. The evaluation of ChatGPT as a self-learning tool in medical biochemistry has yielded important insights. While it is encouraging that ChatGPT has demonstrated proficiency in this area, the overall score of 58% indicates that there is work to be done. To unlock its full potential as a self-learning tool, ChatGPT must focus on generating not only accurate but also comprehensive and contextually relevant content.

Extraction of the pull force from inertial sensors during the pull test for Parkinson's disease: A reliability study.

To examine the inter- and intra-rater reliability of the pull test in patients with Parkinson's disease (PD) using the extracted pull force. In this inter- and intra-rater reliability study, two raters performed a pull test on 30 patients with PD. The pull force was quantified using inertial sensors attached to the rater's right hand and the patient's lower trunk. In this study, the pull force was calculated as an extracted three-dimensional vector quantity, the resultant acceleration, and was expressed in m/s2. Inter- and intra-rater reliabilities were analyzed using the interclass correlation coefficient (ICC) for the pull force and Cohen's weighted kappa (κw) for the pull test score. Furthermore, Bland-Altman analysis was used to investigate systematic errors. The inter- and intra-rater reliability of the pull force was very poor (ICC = 0.033-0.214). Bland-Altman analysis revealed no systematic errors in the pull forces between the two test points. Conversely, κw for the pull test scores ranged from 0.763 to 0.920, indicating substantial to almost perfect agreement. The pull test score was reliable despite variations in the quantified pull force for inter- and intra-rater reliability. Our findings suggest that the pull test is a robust tool for evaluating postural instability in patients with PD and that the pull force probably does not affect scoring performance.