Kappa Values For Agreement Research Articles

Extracting International Classification of Diseases Codes from Clinical Documentation using Large Language Models.

Large language models (LLMs) have shown promise in various professional fields, including medicine and law. However, their performance in highly specialized tasks, such as extracting ICD-10-CM codes from patient notes, remains underexplored. The primary objective was to evaluate and compare the performance of ICD-10-CM code extraction by different LLMs with that of human coder. We evaluated performance of six LLMs (GPT-3.5, GPT-4, Claude 2.1, Claude 3, Gemini Advanced, and Llama 2-70b) in extracting ICD-10-CM codes against human coder. We used deidentified inpatient notes from American Health Information Management Association Vlab authentic patient cases for this study. We calculated percent agreement and Cohen's kappa values to assess the agreement between LLMs and human coder. We then identified reasons for discrepancies in code extraction by LLMs in a 10% random subset. Among 50 inpatient notes, human coder extracted 165 unique ICD-10-CM codes. LLMs extracted significantly higher number of unique ICD-10-CM codes than human coder, with Llama 2-70b extracting most (658) and Gemini Advanced the least (221). GPT-4 achieved highest percent agreement with human coder at 15.2%, followed by Claude 3 (12.7%) and GPT-3.5 (12.4%). Cohen's kappa values indicated minimal to no agreement, ranging from -0.02 to 0.01. When focusing on primary diagnosis, Claude 3 achieved highest percent agreement (26%) and kappa value (0.25). Reasons for discrepancies in extraction of codes varied amongst LLMs and included extraction of codes for diagnoses not confirmed by providers (60% with GPT-4), extraction of non-specific codes (25% with GPT-3.5), extraction of codes for signs and symptoms despite presence of more specific diagnosis (22% with Claude-2.1) and hallucinations (35% with Claude-2.1). Current LLMs have poor performance in extraction of ICD-10-CM codes from inpatient notes when compared against the human coder.

Optimizing Heparin Quality Assurance Utilizing Electronic Data Abstraction.

Background: Heparin is a high-risk medication with significant variability across patients. Systematic data analysis can help hospitals improve heparin management, ensuring safe and effective anticoagulation. An opportunity exists to create a more efficient data collection process, allowing hospitals to streamline quality assurance programs. Objective: To assess the agreement between manual and electronic data abstraction for heparin quality assurance. Methods: This is a single-center, observational cohort study that evaluated patients who received therapeutic unfractionated heparin from September to November 20, 2023. Patients treated for less than 24 hours were excluded. Data were collected manually from pharmacist monitoring forms and the electronic medical record; electronic data abstraction was queried from an institutional data warehouse. The primary outcome was agreement in percentage of patients achieving a therapeutic aPTT within 24 hours. Secondary outcomes included agreement on time to therapeutic aPTT, agreement on time to therapeutic or supratherapeutic aPTT, and clinical outcomes. Results: The study included 288 patients. Manual data collection indicated 44.1% of patients were therapeutic within 24 hours, whereas electronic data collection showed 46.9% (kappa = 0.86). The kappa value for agreement of therapeutic or supratherapeutic aPTT within 24 hours was substantial (kappa = 0.69), with manual data showing 61.5% of patients therapeutic within 24 hours compared with 73.3% in electronic data. However, poor agreement was found when identifying subsequent heparin boluses (kappa = 0.13) and new venous thromboembolism cases (kappa = -0.01). Conclusions and Relevance: The metrics from the 2 data collection methods varied in reliability, ranging from highly consistent to poorly aligned. A hybrid approach, integrating manual and reliable electronic methods, has been implemented at our institution to improve efficiency. Further studies are needed to assess generalizability, and enhance electronic data capture for clinical outcomes.

Rectal Cancer and Lateral Lymph Node Staging: Interobserver Agreement and Success in Predicting Locoregional Recurrence.

Objectives: To evaluate the agreement among radiologists in the evaluation of rectal cancer staging and restaging (after neoadjuvant therapy) and assess whether locoregional recurrence can be predicted with this information. Materials and Methods: Pre-neoadjuvant and after-neoadjuvant therapy magnetic resonance imaging (MRI) examinations of 239 patients diagnosed with locally advanced rectal cancer were retrospectively reviewed by three radiologists. The agreement between the MRI findings (localization of tumor involvement, tumor coverage pattern, external sphincter involvement, mucin content of the mass and lymph node, changes in the peritoneum, MRI T stage, distance between tumor and MRF, submucosal sign, classification of locoregional lymph node, and EMVI) was discussed at the September 2023 meeting of the Society of Abdominal Radiology (SAR) and the interobserver and histopathological findings were examined. The patients were evaluated according to locoregional rectal cancer and lateral lymph node (LLN) staging, and re-staging was performed using MRI images after neoadjuvant treatment. The ability of the locoregional and LLN staging system to predict locoregional recurrence was evaluated. Results: Among the parameters examined, for the MRI T stage and distance between the tumor and the MRF, a moderate agreement (kappa values: 0.61-0.80) was obtained, while for all other parameters, the interobserver agreement was notably high (kappa values 0.81-1.00). LLNs during the restaging with an OR of 2.1 (95% CI = 0.33-4.87, p = 0.004) and a distance between the tumor and the MRF of less than 1 mm with an OR of 2.1 (95% CI = 1.12-3.94, p = 0.023) affected locoregional recurrence. A multivariable Cox regression test revealed that the restaging of lymph nodes among the relevant parameters had an impact on locoregional recurrence, with an OR of 1.6 (95% CI = 0.32-1.82, p = 0.047). With the LLN staging system, an increase in stage was observed in 37 patients (15.5%), and locoregional recurrence was detected in 33 of them (89.2%) (p < 0.001). Conclusions: LLN staging is not only successful in predicting locoregional recurrence among MRI parameters but is also associated with a very high level of interobserver agreement. The presence of positive LLN in the restaging phase is one of the most valuable MRI parameters for poor prognosis.

Evaluating the Diagnosis of Malnutrition Based on Global Leadership Initiative on Malnutrition (GLIM) Criteria in Community-Dwelling Older Adults (Singapore Longitudinal Aging Study).

A minority of studies using the GLIM criteria for malnutrition diagnosis have performed formal empirical validation. To evaluate the concurrent and predictive validity of GLIM criteria with and without prior screening among community-dwelling older adults in Singapore. In the Singapore Longitudinal Aging Study (SLAS-2, n = 2477), malnutrition was diagnosed using single-step and two-step GLIM procedures using the Mini Nutritional Assessment Short Form (MNA-SF) and Elderly Nutritional Index for Geriatric Malnutrition Assessment (ENIGMA) for initial screening. Criterion validity was evaluated using MNA-Full Form (MNA-FF) as reference malnutrition diagnosis. Prognostic validity was evaluated using logistic and Cox regression analyses with respect to impaired quality of life (QoL) and 10-year mortality. GLIM malnutrition with and without MNA-SF or ENIGMA screening showed significant associations with known clinical correlates; single-step GLIM malnutrition: sensitivity = 80%, specificity = 83%; two-step MNA-SF-GLIM malnutrition: sensitivity = 80%, specificity = 85%; two-step ENIGMA-GLIM malnutrition: sensitivity = 74%, specificity = 88%; positive predictive values of around 20% and negative predictive values above 98%. Cohen's kappa values of agreement were uniformly low (0.26 to 0.32). All showed significant associations with about 50% increased odds of impaired QoL and 10-year mortality, adjusted for age, sex, ethnicity, education levels, and housing type, with the ENIGMA-GLIM malnutrition showing the highest risk estimates. Compared to MNA-FF malnutrition prevalence of 4.1%, GLIM-based malnutrition increased prevalence (14.6% to 19.7%) estimates. The GLIM criteria showed good construct and criterion validity. It increased the number of individuals diagnosed with malnutrition. The agreement between diagnoses of malnutrition was low. Diagnostic and prognostic accuracy vary with the screening instrument used. Early identification of malnutrition using appropriate tools can provide opportunities to delay or prevent the risk of important adverse outcomes such as impaired QoL and mortality.

Anti-SARS-CoV-2 IgM Antibody Levels Measured by an In-House ELISA in a Convalescent Latin Population Persist over Time and Exhibit Neutralizing Capacity to Several Variants of Concern.

The coronavirus, SARS-CoV-2, is the causative agent for COVID-19, first registered in Wuhan, China and responsible for more than 6 million deaths worldwide. Currently, RT-PCR is the gold-standard method for diagnosing COVID-19. However, serological tests are needed for screening acute disease diagnosis and screening large populations during the COVID-19 outbreak. Herein, we described the development and validation of an in-house enzyme-linked immunosorbent assay (ELISA) for detecting the levels of anti-spike-1-RBD IgM antibody (CovIgM-ELISA) in well-defined serum/plasma panel for screening and identifying subjects infected with SARS-CoV-2 in a Latin population. In-house CovIgM-ELISA has the format of an indirect ELISA. It was optimized by checkerboard titration using recombinant SARS-CoV-2 spike-S1-RBD protein as an antigen. We found that, compared to the RT-PCR as the standard method, the in-house CovIgM-ELISA displayed sensitivities of 96.15% and 93.22% for samples collected up to 30 or 60 days after infection, respectively, as well as 95.59% specificity with 97.3% accuracy. The agreement kappa value (κ) of our CovIgM-ELISA was substantial when compared to RT-PCR (κ = 0.873) and the anti-SARS-CoV-2 IgM ELISA (InBios Int) (κ = 0.684). The IgM levels detected in the population positively correlated with the neutralizing activity against the wild-type, Alpha and Delta variants of concern, but failed to neutralize Omicron. These data indicate that our in-house CovIgM-ELISA is a compatible performing assay for the detection of SARS-CoV-2 infection.

B-207 Clinical Evaluation of ExiStation™ FA 96 RV for the detection of human respiratory viruses in human nasopharyngeal swab specimen

Abstract Background There has been growing demand for fully automated multiplex testing of respiratory viruses in molecular diagnostics following the COVID-19 pandemic. ExiStation™ FA 96 RV developed by BIONEER is a multiplex real-time RT-PCR assay. It is designed for the simultaneous detection and differentiation of SARS-CoV-2, Influenza A, Influenza B, and RSV RNA in human nasopharyngeal swab specimens from individuals showing signs and symptoms of respiratory viral infection. ExiStation™ FA 96 automates the entire process from RNA extraction to real-time RT-PCR for up to 96 samples at once within 100 minutes. Moreover, the system is equipped to decap sample tubes, eliminating the need for handling sample transport media. In this study, the clinical performance of the ExiStation™ FA 96 RV assay was evaluated using nasopharyngeal swab samples. Methods Nasopharyngeal swab samples, totaling 859 samples, are collected according to the procedures by the clinical institution in France and preserved in Virus transport media. Once anonymized and randomly allocated, the swab transport media tube, without capping procedure, are directly placed onto the ExiStation™ FA 96. Subsequently, both extraction and real-time RT-PCR are automatically processed. Clinical sensitivity, specificity, and agreement are analyzed by comparing results with confirmatory reagents SARS-CoV-2 RT-qPCR Reagent Kit, PKAmp™ Respiratory SARS-CoV-2 RT-PCR Panel Kit, and Bosphore SARS-CoV-2/Flu/RSV Panel Kit, as well as comparator reagent Allplex™ Respiratory Panel 1 and Allplex™ SARS-CoV-2 Assay. Results The comparison between confirmatory reagents and the ExiStation™ FA 96 RV resulted in a clinical sensitivity of at least 96.4% (164/164 for SARS-CoV-2, 64/65 for Influenza A, 74/75 for Influenza B, and 53/55 for RSV) and a clinical specificity of 100% (500/500 for all targets). When compared with the comparator reagent, the overall agreement and Cohen's kappa value were both determined to be above 99.1% and 0.989, respectively (664/664 for SARS-CoV-2, 564/565 for Influenza A, 573/575 for Influenza B, and 550/555 for RSV). Additionally, any discrepant samples identified in comparison with the comparator reagent were verified through sequencing analysis. Upon sequencing analysis on a total of 8 samples and aligning the confirmed results with the analysis content, no alterations observed in the analysis of clinical sensitivity and specificity. Conclusions The evaluation of the ExiStation™ FA 96 RV assay showed outstanding clinical performance in detecting four respiratory viruses, SARS-CoV-2, Influenza A, Influenza B, and RSV, with high sensitivity and specificity. This study supports that the ExiStation™ FA 96 RV assay is a reliable tool for simultaneous molecular diagnostics of various respiratory infections in clinical laboratories.

Application value of individualized tube voltage, contrast injection, and adaptive statistical iterative reconstruction V algorithm based on body mass index in renal computed tomography angiography for radiation and iodinated contrast dose reduction.

To explore the application value of body mass index (BMI)-based kilovoltage peak (kVp) selection and contrast injection protocol combined with different adaptive statistical iterative reconstruction V (ASIR-V) strengths in renal computed tomography angiography (CTA) in reducing radiation and contrast medium (CM) doses. One-hundred renal CTA patients were prospectively enrolled and were divided into individualized kVp group (group A, n = 50) and conventional 100kVp group (group B, n = 50), both with automatic tube current modulation and CM of Iohexol at 350mgI/mL concentration. Group A: 70kVp, noise index (NI) of 18 and CM dose rate of 17mgI/kg/s for 10 s for BMI <25kg/m2 patients; 80kVp, NI = 17, and CM dose rate of 19mgI/kg/s for 10 s for 25 kg/m2≤BMI≤30kg/m2 patients. Group B: 100kVp, 50 mL of CM at the flow rate of 4.5 mL/s. The objective image quality, effective radiation dose, CM dose, injection rate, and image quality were compared between the 2 groups. There was no significant difference in patient characteristics between the 2 groups (P > .05). Compared to group B, group A significantly reduced effective radiation dose by 28.4%, CM dose by 27.2%, and injection rate by 22.7% (all P < .001). The 2 groups had similar SD values in erector spine (P > .05). Group A had significantly higher CT values, SNR, and CNR values of the renal arteries than group B (all P < .001). The 2 radiologists had excellent agreement (Kappa value > 0.8) in the subjective scores of renal CTA images and showed no statistically significant difference between the 2 groups (4.57 ± 0.42 vs 4.41 ± 0.49) (P > .05). BMI-based scan and reconstruction protocol in renal CTA significantly reduces radiation and contrast doses while maintaining diagnostic image quality. (i) BMI-based individualized tube voltage selection and contrast injection protocol in renal CTA reduces both radiation and contrast doses over conventional protocol. (ii) The combination of lower kVp and higher weight ASIR-V maybe used to improve image quality in terms of contrast enhancement and image noise under lower radiation and contrast dose conditions. (iii) Renal CTA of normal size (BMI ≤ 30kg/m2) patients acquired at low radiation dosage and low iodine contrast dose through the combination of low tube voltage and ASIR-V algorithm achieves excellent diagnostic image quality with a good inter-rater agreement.

Application of Magnetic Resonance Imaging Report Combined With VI-RADS Bi-Parametric and Multi-Parametric Scoring Systems in Bladder Cancer Diagnosis

To verify by retrospective analysis the performance of applying dual-parametric (T2 weighted image [T2WI] and diffusion weighted image [DWI]) and multi-parametric (T2WI, DWI, and dynamic contrast enhance [DCE]) evaluation systems of Vesical Imaging-Reporting and Data System (VI-RADS) in the magnetic resonance imaging (MRI) diagnosis of bladder cancer. The imaging and clinical data of bladder cancer patients who underwent bladder MRI examination in the Department of Urology of our hospital between January 2020 and December 2021 were collected. A total of 215 bladder cancer patients, among whom there were 183 males and 32 females with an average age of (67.60±11.42) years, were included. The bladder cancer diagnosis of all the cases was verified by pathology analysis of tissue samples. Two radiologists, who were double-blinded, scored multiple sequences separately. Then, a comparative analysis was made on the diagnostic performance of dual-parametric and multi-parametric VI-RADS diagnostic scores. The diagnostic test with receiver operator characteristic (ROC) curves and Cohen's Kappa were used to evaluate the diagnostic efficacy and consistency. The area under the curve (AUC) and 95% confidence interval (CI) of the multi-parametric VI-RADS evaluation system by the two radiologists in the overall population were 0.878 (0.830-0.925) and 0.856 (0.805-0.907), while those for the bi-parametric VI-RADS evaluation system were 0.889 (0.844-0.934) and 0.856 (0.805-0.907), showing no statistically significant difference. No significant difference was observed in the subgroup analysis of patients who underwent transurethral resection of bladder tumor (TURBT). Furthermore, the Kappa values for inter-rater agreement between of the two radiologists were 0.694 and 0.546 (with the VI-RADS score≥3 defined as being positive) and 0.693 and 0.712 (with the VI-RADS score≥4 defined as being positive) in multi-parametric and bi-parametric evaluation, respectively (all P<0.001). The bi-parametric VI-RADS scoring system can achieve a diagnostic efficacy comparable to that of the multi-parametric scoring system, offering an alternative to patients who are unable to undergo contrast-enhanced MRI due to allergic reaction to contrasts.

The value of multimodal imaging fusion in preoperative visualization assessment of neurovascular relationship in hemifacial spasm: a single-center retrospective study.

The neurovascular conflict (NVC) at the brainstem exit zone of the facial nerve is considered the primary etiology of primary hemifacial spasm (HFS). Therefore, microvascular decompression (MVD) has become the preferred treatment for HFS. Successful neurovascular decompression can achieve significant therapeutic effects, and accurately identifying the site of compression is crucial for the success of this surgery. Detailed diagnostic neuroimaging plays an important role in accurately identifying the site of compression.The purpose of this study is to explore the feasibility and predictive value of preoperative visualization assessment of the neurovascular relationship in HFS using 3D Slicer software based on multimodal imaging fusion. This aims to reduce the omission of responsible vessels and lower the incidence of postoperative complications, thereby potentially improving the efficacy and safety of the surgery. This study retrospectively analyzed 80 patients with HFS who underwent MVD surgery. All patients underwent preoperative cranial MRI scans, including the 3D-FIESTA and the 3D-TOF MRA sequences. Three-dimensional models were reconstructed from the multimodal MRI images using 3D Slicer software. Independent observers, who were blinded to the surgical outcomes, evaluated the neurovascular relationships using both the three-dimensional models and multimodal MRI images. The assessment results were compared with intraoperative findings, and statistical analysis was conducted using SPSS 22.0 software. The agreement between preoperative assessment using the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence and intraoperative findings was represented by a Kappa value of 0.343, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.637. There was a statistically significant difference between the two methods ( X2 = 18.852, P = 0.001 ). The sensitivity and specificity of the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence for evaluating neurovascular relationships were 92.4% and 100%, respectively, while for three-dimensional reconstruction, both were 100%. The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence prediction of offending vessels and intraoperative findings was 0.625, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.938, showing a statistically significant difference ( X2 = 317.798, P = 0.000 ). The Kappa value for agreement between preoperative the 3D-TOF MRA sequence combined with the 3D-FIESTA sequence assessment of the anatomical location of facial nerve involvement in neurovascular compression and intraoperative findings was 0.608, while the Kappa value for agreement between three-dimensional reconstruction and intraoperative findings was 0.918, also showing a statistically significant difference ( X2 = 504.647, P = 0.000 ). The preoperative visualization assessment of neurovascular relationships in HFS using 3D Slicer software based on multimodal imaging fusion has been demonstrated to be reliable. It is more accurate than combining the 3D-TOF MRA sequence with the 3D-FIESTA sequence and shows higher consistency with intraoperative findings. This method provides guidance for surgical procedures and thereby potentially enhances the efficacy and safety of surgeries to a certain extent.

New Comprehensive Score for Predicting Difficulties in Revision Total Hip Arthroplasty

BackgroundRevision total hip arthroplasty (THA) can be complex, and assessing possible difficulties is important to predict the operative time. No simple score for predicting difficulties has been assessed prospectively. We therefore developed an original score for the pre-operative evaluation of extraction and reconstruction difficulties. The objectives of this prospective study were to (1) assess correlations between score values and operative time, (2) determine whether the score predicted the need for revision implants and/or filling material, (3) determine whether the score predicted intra-operative and post-operative complications, and (4) evaluate the inter-observer and intra-observer reproducibility of the score. HypothesisThe score is reproducible and correlates well with the operative time, thereby allowing prediction of this parameter before surgery. Material and methodsA prospective study of 103 revision THA procedures performed between March 2018 and August 2023 was conducted. The primary outcome was operative time and the secondary outcomes were use of a revision implant, use of filling material, and intra-operative and post-operative complications. The score was determined by four observers to allow evaluation of inter-observer agreement. Intra-observer agreement was assessed by having one of the observers determine the score a second time after inclusion of the last patient. The score has a maximum value of 20 and allows classification of the procedure as very difficult, difficult, and moderately difficult. ResultsMean operative time correlated with the score value: 136.0 ± 33.9 min in the very difficult group, 102.0 ± 34.8 min in the difficult group, and 75.4 ± 65.5 min in the moderately difficult group (p = 0.0002). The score predicted the use of a reinforcement ring (40 procedures: 12/17 [70%], 11/25 [44%], and 17/61 [28%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.01) and of a long stem (20 procedures: 8/17 [47%], 7/25 [28%], and 5/61 [8%] patients in the very difficult, difficult, and moderately difficult groups, respectively; p < 0.001). The score did not predict the use of filling material (42 procedures: 10/17 [59%], 9/25 [36%], and 23/61 [37%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.250). The score predicted both intra-operative complications (5/17 [29%], 4/25 [16%], and 4/61 [6%] procedures in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.028) and post-operative complications (4/17 [23%], 0/25 [0%], and 6/61 [9%] in the very difficult, difficult, and moderately difficult groups, respectively; p = 0.15). Inter-observer agreement was strong according to Landis-Koch criteria, with kappa values ranging from 0.70 to 0.79 [0.57–0.90]. The kappa value for intra-observer agreement was 0.74 [0.63–0.85]. DiscussionThis score predicts surgical difficulties by adding criteria to bone destruction, in contrast to widely used classifications for revision THA. Moreover, the score is reproducible and predicts the operative time, thus potentially playing an important role during pre-operative planning. Level of evidenceIV; prospective observational non-comparative study

Assessing triage efficiency in Italy: a comparative study using simulated cases among nurses.

Emergency Departments (EDs) across Italy use different triage systems, which vary from region to region. This study aimed to assess whether nurses working in different EDs assign triage codes in a similar and standardized manner. A multicenter observational simulation study involved the EDs of Bolzano Hospital, Merano Hospital, Pisa University Hospital, and Rovereto Hospital. All participating nurses were given 30 simulated clinical cases (vignettes) and asked to assign triage codes according to the triage systems used in their EDs. Subsequently, we assessed inter-rater agreement and evaluated if code assignment had different performance among hospitals in relation to different clinical outcomes. Eighty-seven nurses participated in this study. There was marked variation in assigned triage codes both across hospitals and among individual operators. The kappa values for inter-rater agreement were 0.632 for Bolzano Hospital, 0.589 for Merano Hospital, 0.464 for Pisa University Hospital, and 0.574 for Rovereto Hospital. Sensitivity and specificity levels varied considerably for the same outcomes when comparing different hospitals. There is a high degree of subjectivity in triage code assignment by ED nurses. In the interest of equitable care for patients, this variability within the same country is hardly acceptable.

Diagnostic Accuracy of Non-Contrast-Enhanced Time-Resolved MR Angiography to Assess Angioarchitectural Classification Features of Brain Arteriovenous Malformations.

This study aims to assess the diagnostic accuracy of non-contrast-enhanced 4D MR angiography (NCE-4D-MRA) compared to contrast-enhanced 4D MR angiography (CE-4D-MRA) for the detection and angioarchitectural characterisation of brain arteriovenous malformations (bAVMs). Utilising a retrospective design, we examined 54 MRA pairs from 43 patients with bAVMs, using digital subtraction angiography (DSA) as the reference standard. Both NCE-4D-MRA and CE-4D-MRA were performed using a 3-T MR imaging system. The primary objectives were to evaluate the diagnostic performance of NCE-4D-MRA against CE-4D-MRA and DSA and to assess concordance between imaging modalities in grading bAVMs according to four main scales: Spetzler-Martin, Buffalo, AVM embocure score (AVMES), and R2eDAVM. Our results demonstrated that NCE-4D-MRA had a higher accuracy and specificity compared to CE-4D-MRA (0.85 vs. 0.83 and 95% vs. 85%, respectively) and similar agreement, with DSA detecting shunts in bAVMs or residuals. Concordance in grading bAVMs was substantial between NCE-4D-MRA and DSA, particularly for the Spetzler-Martin and Buffalo scales, with CE-4D-MRA showing slightly higher kappa values for interobserver agreement. The study highlights the potential of NCE-4D-MRA as a diagnostic tool for bAVMs, offering comparable accuracy to CE-4D-MRA while avoiding the risks associated with gadolinium-based contrast agents. The safety profile of imaging techniques is a significant concern in the long-term follow up of bAVMs, and further prospective research should focus on NCE-4D-MRA protocol improvement for clinical use.

Development of two novel on-site detection visualization methods for murine hepatitis virus based on the multienzyme isothermal rapid amplification

Murine hepatitis virus (MHV) infection is one of the most prevalent types of mice infection in laboratory. MHV could cause death in mice and even interfere with the results in animal experiments. Herein, we developed two isothermal approaches based on the Multienzyme Isothermal Rapid Amplification (MIRA), for rapid detection of MHV in conserved M gene. We designed and screened several pairs of primers and probes and the isothermal fluorescence detector was applied for the exonuclease Ⅲ reverse transcription MIRA (exo-RT-MIRA) assay. To further simplify the workflow, the portable fluorescence visualization instrument, also as a palm-sized handheld system, was used for the naked-eye exo-RT-MIRA assay. The amplification temperature and time were optimized. The assay could be processed well at 42 °C 20 min for the exo-RT-MIRA and the naked-eye exo-RT-MIRA assay. The limit of detection (LoD) of the exo-RT-MIRA assay was 43.4 copies/μL. The LoD of the naked-eye exo-RT-MIRA assay was 68.2 copies/μL. No nonspecific amplifications were observed in the two assays. A total of 107 specimens were examined by qPCR and two assays developed. The experimental results statistical analysis demonstrated that the exo-RT-MIRA assay with the qPCR yielded sufficient agreement with a kappa value of 1.000 (p < 0.0001). The results also exhibited a good agreement (kappa value, 0.961) (p < 0.0001) between the naked-eye exo-RT-MIRA assay and the qPCR assay. In our study, the exo-RT-MIRA assay and the naked-eye exo-RT-MIRA assay presented the possibility of new methods in MHV point-of-testing diagnosis.

Quality of cementing in hemiarthroplasty for elderly neck of femur fractures does not affect short term functional outcomes.

Cemented hip hemiarthroplasty is a routine surgical option for elderly neck of femur (NOF) fractures. It is uncertain if quality of cementing has any effect on functional outcomes. The aim of this study was to determine if the quality of cementing would affect short term functional outcomes in elderly neck of femur fractures. Retrospective analysis of 637 single-centre cemented hip hemiarthroplasties from 2014 to 2021 was performed. Each post-operative radiograph was double-read by 2 authors (1 resident and 1 fellowship trained surgeon) to determine quality of cementing via the Barrack grading. Disagreements were reviewed by a third reader. Cement grades were grouped as Optimal (Barrack grade A-B), or Suboptimal (Barrack grade C-D). Functional outcomes were compared using mobility (community- or home-ambulant), assistance required for mobility, and Modified Barthel Index (MBI). Surgical parameters were compared between the groups. There were 429 Optimal and 208 Suboptimal cases of cementing performed. There was no difference in age, American Society of Anesthesiologists score, mobility, assistance required, and MBI score pre-operatively (p > 0.05). Patients in the "Suboptimal" cementing group had a higher Charlson Comorbidity Index (CCI) score (p < 0.001). At 1year post-operation, there was no significant difference between "Optimal" and "Suboptimal" cementing with regards to the proportion of community ambulators (30.2% vs. 25.7%, p = 0.252), walking independence (independent walkers (19.8% vs.17.3%), independent walkers with aids (41.3%vs.42.1%), walker with caregiver assistance (29.2%vs.33.7%), wheelchair-bound (9.6%vs.6.9%), p = 0.478), and distribution of MBI score (81.1%vs.82.2% achieving MBI > 60, p = 0.767). There was no significant difference in the proportion of patients with postoperative delirium (7.9% vs. 5.8, p = 0.324) or 1-year mortality rates (3.5% vs. 2.9%, p = 0.685). Except for stem design (12.2% tapered vs 20.1% collared; p = 0.011), no other surgical parameters were significantly different. The kappa value for inter-reader agreement was "substantial" at 0.727 (95% CI 0.682-0.772) (p < 0.001). Quality of cementing in cemented hip hemiarthroplasty for elderly NOF fractures does not affect the short-term functional outcomes. In low demand patients and patients at risk of BCIS, optimal cementing may not be necessary to achieve similar short-term functional outcomes. Further studies should be conducted to determine the effect of sub-optimal cementing on long-term functional outcomes.

INTER- AND INTRA- OBSERVER RELIABILITY OF MAGNATIC RESONANCE IMAGING FOR DIAGNOSIS OF LUMBAR FAR LATERAL DISC HERNIATION

Objective: To determine the inter- and intra- observer reliability of MRI for diagnosis of lumbar far lateral disc herniation. Method: 27 patients in whom lumbar far lateral disc herniation was definitely diagnosed by operative findings at our department between May 2018 and December 2022 were included. The magnetic resonance images consisting of T1- and T2-weighted axial and sagittal images, and these were reviewed blindly and independently by three orthopaedic spine surgeons in a random manner. The images were interpreted as positive or negative for far lateral disc herniation on 2 different occasions 3 months apart. Results were analyzed using Cohen's kappa statistic, and strengths of agreements were determined using the Landis and Koch criteria. Result: The kappa values for inter-reader agreement averaged 0.234 (0.282, 0.111, and 0.308 respectively) on the first occasion, and 0.166 (0.249, 0.111, and 0.137 respectively) on the second occasion, with an overall mean value of 0.200. Thus, the strength of agreement was only slight-to-fair according to the Landis and Koch criteria. Kappa values for intra-reader agreement averaged 0.479 (0.488, 0.491, and 0.459 respectively), indicating moderate agreement. Conclusion: The present study indicates that magnetic resonance imaging is not a reliable imaging modality for diagnosing lumbar lateral disc herniation. It is necessary to carefully evaluate the intra-foramina and extra-foramina of lumbar spine region on MRI of these patients and the spine surgeon should pay attention to the correlation between the clinical symptoms and MRI findings of these patients.

Multi-contrast echo-planar imaging sequence (Echo-planar imaging mix) in clinical situations demanding faster MRI-brain scans.

The excellent resolution offered by magnetic resonance imaging (MRI) has a trade-off in the form of scan duration. The purpose of the present study was to assess the clinical utility of echo-planar imaging mix (EPIMix), an echo-planar imaging-based MRI sequence for the brain with a short acquisition time. This was a retrospective observational study of 50 patients, who could benefit from faster MRI brain scans. The T1, T2, fluid attenuated inversion recovery, diffusion-weighted imaging (DWI), and T2*/susceptibility-weighted imaging sequences were acquired, conventionally and with EPIMix. Conventional and EPIMix images were assessed by two radiologists for overall quality, motion, and susceptibility artifacts and scored on a Likert scale. The scores given for conventional and EPIMix images were compared. The diagnostic performance of EPIMix was also assessed by the ability to detect clinically relevant findings. The acquisition time for conventional MRI was 11 min and 45 s and for EPIMix 1 min and 15 s. All EPIMix images were sufficient for diagnostic use. On assessment of the diagnostic performance, it was excellent for ischemic and hemorrhagic strokes. Smaller lesions, lesions adjacent to bone, and post-operative tumors were difficult to identify. Moderate to perfect agreement (Kappa values 0.41-1) was seen between radiologists for all categories except skull base, calvarial, and orbital lesions. Image quality, artifact assessment showed excellent interobserver agreement (>90%) for the scores. All EPIMix images showed reduced motion artifacts. The EPIMix-DWI was comparable to conventional-DWI in terms of quality and artifacts. The remaining sequences showed reduced quality and increased susceptibility. The EPIMix has a significantly reduced acquisition time than conventional MRI and could be used instead of conventional MRI in situations demanding faster scans such as suspected acute ischemic or hemorrhagic stroke. In other clinical scenarios, it could help tailor the MRI examination for each patient.

Development of Critical Thinking Skills Instruments : Cases for Essay Tests

This research aims to develop a rubric used to assess students’ critical thinking. This rubric refers to aspects of Ennis' critical thinking. The research method begins with determining the scope of the rubric so that an initial version of the rubric can be prepared. An initial version of the rubric received peer review. Next, the rubric was tested to assess critical thinking tests with essay-type questions. Data analysis was carried out using Cohen's kappa, while aspects of the critical thinking rubric were analyzed descriptively. The research results show that each aspect of critical thinking has been equipped with descriptors that can be used by raters. The level of reliability based on the kappa value of agreement is quite good, which means that different raters can use the rubric consistently. The value of agreement in the basic clarification aspect is 0.33 (fair), bases for a decision (0.571 in the moderate category), inference (0.455, moderate category), advanced clarification (0.250, fair category, supposition and integration (0.250, fair category), and strategies and tactics (0.182, poor category). Then, it can be concluded that the critical thinking rubric developed can be used to assess critical thinking abilities. As a recommendation, of course, this rubric cannot fulfill all types of critical thinking questions tested. It is also necessary to develop rubrics for question types other than essays to accommodate the wider need for critical thinking rubrics.

Prediction of bowel necrosis by reduced bowel wall enhancement in closed-loop small bowel obstruction: Quantitative methods

PurposeTo assess diagnostic performance and reproducibility of reduced bowel wall enhancement evaluated by quantitative methods using CT to identify bowel necrosis among closed-loop small bowel obstruction (CL-SBO) patients. MethodsThis retrospective single-center study included patients who diagnosed with CL-SBO caused by adhesion or internal hernia during January 2016 and May 2022. Patients were divided into necrotic group (n = 41) and non-necrotic group (n = 67) according to surgical exploration and postoperative pathology. Two doctors independently measured the attenuation of bowel wall and consensus was reached through panel discussion with a third gastrointestinal radiologist. Reduced bowel wall enhancement was assessed by four quantitative methods. Univariate analyses were used to evaluate the association between each method and bowel necrosis, and kappa/intraclass correlation coefficient values were used to assess interobserver agreement. Diagnostic performance parameters were calculated for each method. ResultsReduced bowel wall enhancement in arterial phase (OR 8.98, P < 0.0001), reduced bowel wall enhancement in portal phase (OR 16.84, P < 0.001), adjusted reduced bowel wall enhancement in arterial phase (OR 29.48, P < 0.001), adjusted reduced bowel wall enhancement in portal phase (OR 145.69, P < 0.001) were significantly associated with bowel necrosis. Adjusted reduced bowel wall enhancement in portal phase had the best diagnostic performance (AUC: 0.92; Youden index: 0.84; specificity: 94.03 %) and interobserver agreement (kappa value of 0.59–0.73) to predict bowel necrosis. ConclusionWhen assessing reduced bowel enhancement to predict bowel necrosis among CL-SBO patients, using unenhanced CT images and proximal dilated loop as standard references in portal phase is the most accurate quantitative method among those tested.

The Japanese Version of the Daily Record of Severity of Problems for Premenstrual Symptoms: Reliability and Validity Among the General Japanese Population.

The validity and reliability of the Japanese version of the Daily Record of Severity of Problems (DRSP-J) have already been confirmed in a population with premenstrual symptoms. This study aimed to assess the validity and reliability of the DRSP-J in the general population. We analyzed data from 113 Japanese women with regular menstrual cycles who applied to participate in an ongoing study. Participants were recruited regardless of the severity of premenstrual symptoms, and their menstrual cycles were monitored using the DRSP-J for two cycles. Reliability was examined using Cronbach's α, a measure of internal consistency, and test-retest reliability. Structural validity was assessed using a principal component analysis (PCA). The Hospital Anxiety and Depression Scale (HADS) and EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) were used to examine concurrent validity. The agreement between the clinical diagnoses based on the diagnostic criteria for premenstrual syndrome/premenstrual dysphoric disorder and that based on the DRSP-J score was examined using the kappa coefficient. Cronbach's α for DRSP-J total score was 0.96. The DRSP-J total score showed high test-retest reliability. The PCA showed a two-factor model describing "Mood" and "Behavior/Physical" symptoms. The DRSP-J total score was highly correlated with the HADS total and EQ-5D-5L scores. The classification of "moderate to severe premenstrual syndrome" and "premenstrual dysphoric disorder" by clinical methods and the criteria based on the DRSP-J were in good agreement (kappa values = 0.78). The DRSP-J is a reliable and valid measure of premenstrual symptoms in the general Japanese population, including those with few or no symptoms.

A novel detection method based on MIRA-CRISPR/Cas13a-LFD targeting the repeated DNA sequence of Trichomonas vaginalis

BackgroundTrichomonas vaginalis is a protozoan parasite, widely recognized as the most prevalent non-viral sexually transmitted infection (STI) globally. This infection is linked to various complications, including pelvic inflammatory disease, adverse pregnancy outcomes, and an increased risk of acquiring HIV. Current molecular detection methods for T. vaginalis are often costly and technically challenging.MethodsWe developed a novel detection method for T. vaginalis using a multi-enzyme isothermal rapid amplification–clustered regularly interspaced short palindromic repeats (MIRA-CRISPR)/Cas13a-lateral flow device (LFD). This assay targets the repeated DNA sequence (GenBank: L23861.1) of T. vaginalis and is performed at a constant temperature of 37 °C for approximately 1 hour.ResultsThe detection limit of genomic DNA (gDNA) using our protocol was 1 × 10–4 ng/μl. Specificity was confirmed by the absence of cross-reaction with gDNA from various other microorganisms such as Staphylococcus aureus, Lactobacillus taiwanensis, Escherichia coli, Monilia albicans, Giardia lamblia, or Toxoplasma gondii. Among 30 clinical samples tested, the positive rates of T. vaginalis detection were 33.33% (10/30) by wet mount microscopy, 40% (12/30) by nested polymerase chain reaction (PCR), 40% (12/30) by MIRA-CRISPR/Cas13a-LFD, and 40% (12/30) by the culture method. Compared with the culture method, the gold standard for diagnosing trichomoniasis, wet mount microscopy showed a sensitivity of 83.3% and moderate diagnostic agreement (kappa value = 0.87). Both nested PCR and MIRA-CRISPR/Cas13a-LFD exhibited 100% sensitivity and excellent diagnostic agreement (kappa value = 1).ConclusionsThe MIRA-CRISPR/Cas13a-LFD method is a convenient, rapid, stable, and accurate diagnostic tool for detecting T. vaginalis. This method has the potential to enhance the diagnosis and management of vaginitis, offering a significant improvement over existing diagnostic techniques.Graphical