Low Sensitivity Research Articles

Ultrasonographic liver nodules are more often benign lesions in dogs with hemoperitoneum secondary to splenic tumor rupture.

To evaluate the reliability of preoperative abdominal ultrasonography as a staging tool for dogs with hemoperitoneum due to presumed splenic tumor rupture, focusing on the detection of metastatic lesions in the liver. 99 dogs from 20 emergency and specialty hospitals across the US. Dogs with nontraumatic hemoperitoneum secondary to splenic tumor rupture were included. A post hoc analysis was conducted on data from a nationwide prospective trial investigating novel treatments for canine hemangiosarcoma. The accuracy of preoperative staging was assessed by comparing ultrasonographic findings with intraoperative observations and histologic findings. On preoperative ultrasonography, there was a 20% incidence of liver lesions identified, with no association to liver lesions seen during operation. Notably, 22% of liver lesions observed during operation were missed on preoperative ultrasonography. The presence of liver lesions on preoperative ultrasonography was associated with a higher likelihood of a benign splenic tumor diagnosis. There was no association between the identification of liver lesions on preoperative ultrasonography and the presence of metastatic disease on liver biopsy, with a sensitivity and specificity of 19% and 82%, respectively. Additionally, ultrasound had low sensitivity in detecting intra-abdominal lesions beyond the liver and spleen, with 82% of these lesions missed preoperatively. This study challenges conventional perceptions around the approach to staging in dogs with hemoperitoneum. These findings advocate for a reevaluation of the staging approach, with more comprehensive modalities like whole-body CT or MRI potentially being more warranted.

Double network hydrogel confined MXene/Liquid metal by dynamic hydrogen bond for high-performance wearable sensors

Double-network (DN) hydrogels, which integrate long-chain and short-chain molecular structures, exhibit significant potential in wearable sensors due to their exemplary mechanical properties. However, conventional hydrogels often suffer from poor conductivity and low sensitivity. In this study, we develop a novel DN hydrogel (comprising polyacrylamide/sodium alginate) that encapsulates MXene (Ti3C2Tx) and liquid metal (LM). This configuration leverages the conductive properties of two-dimensional MXene and zero-dimensional liquid metal embedded within the DN hydrogel networks. The Ti3C2Tx MXene sheets enhance the binding capacity with LM by serving as a conductive bridge, thereby improving interfacial interactions and reducing hysteresis. The resultant strain sensor, fabricated from this composite DN hydrogel, achieves high sensitivity (gauge factor up to 12.84), a broad detection range (0 %-1500 %), rapid response time (262 ms), and excellent repeatability and stability. We have integrated this strain sensor into wearable flexible devices, such as contact lenses, enabling real-time monitoring of human physiological pressures.

Predictive nomograms and an algorithm for managing patients with probable Meniere's disease

PurposeTo explore the efficacy of diagnostic tests in accurately reclassifying patients initially diagnosed with probable Meniere's disease (MD) into either definite or non-MD categories. Materials and methodsA retrospective cohort study was conducted at a neurotology clinic between 1/2016 and 5/2022. Patients underwent a battery of tests, from which sensitivity, specificity, positive and negative predictive values, as well as positive and negative likelihood ratios, were calculated. Additionally, prediction nomograms were developed. ResultsOf the 69 patients, 25 (36.2 %) were initially classified as definite MD, 21 (30.4 %), probable MD, and 23 (33.4 %) non-MD. The mean follow-up was 3.5 years. The sensitivity of electrocochleography (ECochG) was the highest (92 %), with a negative likelihood ratio of 15 %. Magnetic resonance imaging (MRI) with MD-protocol had the highest specificity (100 %), with a positive likelihood ratio of 100 %. Videonystagmography, video head impulse test, and cervical vestibular-evoked myogenic potentials, had lower sensitivity and specificity. We were able to reclassify 18 (86 %) patients with probable MD: 12 (57 %) were diagnosed with definite MD, and 6 (29 %) were diagnosed with non-MD, consistent with their clinical course. ConclusionsThe combination of ECochG and MRI with MD-protocol provides the most reliable approach to reclassify patients with Probable MD, ensuring a precise and accurate diagnosis. Vestibular tests express the functional status of the labyrinth and may not be reliable. Our findings provide valuable insights into clinical decision-making for patients with Probable MD and raise the consideration of additional diagnostic tests as supplementary to the existing clinical-only diagnosis criteria.

Impact of virtual monochromatic images of different low-energy levels in dual-energy CT on radiomics models for predicting muscle invasion in bladder cancer.

The purpose of this study was to investigate the impact of different low-energy virtual monochromatic images (VMIs) in dual-energy CT on the performance of radiomics models for predicting muscle invasive status in bladder cancer (BCa). A total of 127 patients with pathologically proven muscle-invasive BCa (n = 49) and non-muscle-invasive BCa (n = 78) were randomly allocated into the training and test cohorts at a ratio of 7:3. Feature extraction was performed on the venous phase images reconstructed at 40, 50, 60 and 70-keV (single-energy analysis) or in combination (multi-energy analysis). Recursive feature elimination (RFE) and the least absolute shrinkage and selection operator(LASSO) were employed to select the most relevant features associated with BCa. Models were built using a support vector machine(SVM) classifier. Diagnostic performance was assessed through receiver operating characteristic curves, evaluating sensitivity, specificity, accuracy, precision, and the area-under-the curve (AUC) values. In the test cohort, the multi-energy model achieved the best diagnostic performance with AUC, sensitivity, specificity, accuracy, and precision of 0.917, 0.800, 0.833, 0.821, and 0.750, respectively. Conversely, the single-energy model exhibited lower AUC and sensitivity in predicting the muscle invasion status. By combining information from VMIs of various energies, the multi-energy model displays superior performance in preoperatively predicting the muscle invasion status of bladder cancer.

Livestock grazing strengthens the effect of vole activity on the soil microbial community

Livestock grazing may affect small mammalian herbivore-soil microbe interactions and their association with the structure and functions of the ecosystem. However, the role of factors such as vegetation and soil nutrients in regulating these impacts is not clear. Here we conducted a 9-year experiment in temperate steppe to study how Brandt’s vole (Lasiopodomys brandtii) affects the soil microbial community under different livestock grazing intensities. This experiment contained 12 field enclosures with three livestock grazing intensities: control (CK), light grazing (LG), and moderate grazing (MG). We found that vole activity does not significantly change soil microbial diversity under non-grazing conditions. However, under livestock grazing conditions, vole activity led to a significant reduction in soil bacterial diversity and an increase in fungal diversity, demonstrating the impacts of livestock grazing on rodents-soil microbe interactions. The activity of voles significantly altered soil bacterial community composition, with changes primarily attributed to variations in the relative abundance of the phyla Actinobacteria, Bacteroidetes, Firmicutes, Gemmatimonadetes, and Proteobacteria. The soil fungal community remained relatively stable despite vole activity, which can be attributed to the richness of fungal colonies in mycelium and their low sensitivity to changes in external conditions. Vole activity also influenced soil microbial functional groups, and the variations in these groups were further amplified by livestock grazing. Furthermore, the shift in the microbial community composition and diversity induced by vole activity were mainly associated with the reduction of plant aboveground biomass. Overall, our study suggested that livestock grazing enhanced the changes in the soil microbial community induced by rodents, underscoring the importance of managing livestock grazing regimes for grassland conservation.

Laser NIR Irradiation Enhances Antimicrobial Photodynamic Inactivation of Biofilms of Staphylococcus aureus.

Photodynamic inactivation (PDI) is a powerful technique for eradicating microorganisms, and our group previously demonstrated its effectiveness against planktonic cultures of Staphylococcus aureus bacteria using 5,10,15,20-tetrakis[4-(3-N,N-dimethylaminopropoxy)phenyl]porphyrin (TAPP) and visible light irradiation. However, biofilms exhibit a lower sensitivity to PDI, mainly due to limited penetration of the photosensitizer (PS). In the context of emerging antibacterial strategies, near-infrared treatments (NIRTs) have shown promise, especially for combating resistant strains. NIRT can act either through photon absorption by water, causing a thermal effect on bacteria, or by specific chromophores without a significant temperature increase. Our objective was to enhance biofilm sensitivity to TAPP-PDI by pretreatment with NIRT. This combined approach aims to disrupt biofilms and increase the efficacy of TAPP-PDI against bacterial biofilms. In vitro biofilm models of S. aureus RN6390 were utilized. NIRTs involved a 980 nm laser (continuous mode, 7.5 W/cm2, 30 s, totaling 225 J/cm2) post-TAPP exposure to enhance photosensitizer accumulation. Subsequent visible light irradiation at 180 J/cm2 was employed to perform PDI. Colony-forming unit counts evaluated the synergistic effect on bacterial viability. Scanning electron microscopy visualized the architectural changes in the biofilm structure. TAPP was extracted from bacteria to estimate the impact of NIRT on biofilm penetration. Using in vitro biofilm models, NIRT application following biofilm exposure to TAPP increased PS accumulation per bacteria. Under these conditions, NIRT induced a transient increase in the temperature of PBS to 46.0 ± 2.6°C (ΔT = 21.5°C). Following exposure to visible light, a synergistic effect emerged, yielding a substantial 4.4 ± 0.1-log CFU reduction. In contrast, the PDI and NIRT treatments individually caused a decrease in viability of 0.9 ± 0.1 and 0.8 ± 0.2-log respectively. Interestingly, preheating TAPP-PBS to 46°C had no significant impact on TAPP-PDI efficacy, suggesting the involvement of thermal and nonthermal effects of NIR action. In addition to the enhanced TAPP penetration, NIRT dispersed the biofilms and induced clefts in the biofilm matrix. Our findings suggest that NIR irradiation serves as a complementary treatment to PDI. This combined strategy reduces bacterial numbers at lower PS concentrations than standalone PDI treatment, highlighting its potential as an effective and resource-efficient antibacterial approach.

Identification of a Novel Vascular Endothelial Growth Factor Receptor-3-Targeting Peptide for Molecular Imaging of Metastatic Lymph Nodes.

Because of the insidious nature of lymphatic metastatic cancer, accurate imaging tracing is very difficult to achieve in the clinic. Previous studies have developed the LARGR peptide (named TMVP1) as a radiotracer for vascular endothelial growth factor receptor-3 (VEGFR-3) imaging in cancer. However, its affinity for the target remains insufficient, resulting in low imaging sensitivity. In this study, we identified a high-affinity VEGFR-3 targeting peptide, named TMVP1446, using a multiplex screening platform. TMVP1446 demonstrated a dissociation constant of 8.97 × 10-8 M. Both in vitro and in vivo assays confirmed that fluorescently labeled TMVP1446 specifically bound to VEGFR-3. In a 4T1-luciferase tumor mouse model, cyanine 7-labeled TMVP1446 effectively discriminated between contralateral normal lymph nodes (c-LN) and cancer-metastatic sentinel lymph nodes (m-SLN). To evaluate the potential of TMVP1446, we developed a novel VEGFR-3 positron emission tomography radiotracer ([68Ga]Ga-DOTA-TMVP1446) for cancer-m-SLN imaging. [68Ga]Ga-DOTA-TMVP1446 accurately detected and assessed the status of lymph node metastasis, even in micrometastatic tumors, in the B16-F10 mouse tumor model. These findings suggest that TMVP1446 has great potential for advancing VEGFR-3 molecular imaging and metastatic sentinel lymph node imaging.

Rare transthyretin gene variants (p.Ala45Thr, p.Val91Ala, p.Phe53Cys, p.Ala101Val, p.Glu109Lys and p.Phe53Leu): diagnostic pitfalls and clinical characteristics of Polish patients with transthyretin cardiac amyloidosis.

The knowledge about clinical features of Polish patients with hereditary type of transthyretin cardiac amyloidosis (ATTR-CA) is scant. We present rare transthyretin (TTR) gene variants and diagnostic difficulties among patients with hereditary ATTR-CA. In 2018-2024, 252 consecutive patients with suspected cardiac amyloidosis were evaluated, including blood tests, standard 12-lead electrocardiography, transthoracic echocardiography and [99mTc]Tc-DPD scintigraphy. TTR gene sequencing was performed, if mandatory. Hereditary ATTR-CA was confirmed in 14 patients (including one female). Most of them had pathogenic or likely pathogenic TTR gene variants, which are very uncommon in the hereditary transthyretin amyloidosis population: p.Ala45Thr, p.Val91Ala, p.Phe53Cys, p.Ala101Val, p.Glu109Lys and p.Phe53Leu. Of note, patients with p.Ala101Val and p.Phe53Cys variants had inconclusive [99mTc]Tc-DPD scintigraphy results, which may be due to the low sensitivity of [99mTc]Tc-DPD bone scintigraphy for these variants. Cardiac biomarkers did not reflect the intensity of cardiac uptake on [99mTc]Tc-DPD bone scintigraphy - two patients with intense cardiac uptake of tracer had normal or borderline hs-cTnT and NT-proBNP levels. During follow-up, four patients died, two patients underwent combined heart and liver transplantation. This study enriches our knowledge regarding genotype-phenotype correlations of specific TTR variants, broadens the spectrum of identified TTR variants among Polish population, and shows limited value of [99mTc]Tc-DPD scintigraphy in some patients with hereditary ATTR-CA. In cases with strong suspicion of ATTR-CA and inconclusive [99mTc]Tc-DPD scintigraphy results, genetic testing should be considered.

Nurse led assessment of congestion in outpatient heart failure patients: remote dielectric sensing versus lung ultrasound comparison

Abstract Introduction Congestion stands as a primary driver behind exacerbating heart failure (HF), leading to hospitalizations and increased mortality rates. Despite the evident significance of congestion as a prognostic indicator, there exists a pressing need for a straightforward, trustworthy assessment method that caters to various healthcare providers' needs. Aims To assess the feasibility and compare the accuracy of nurse-led congestion assessment using radar based dielectric sensing (ReDS) to a "gold-standard" point of care assessment using lung ultrasound (LUS). Methods A retrospective analysis of consecutive patient visits at the ambulatory advanced HF clinic was used in which both exams (ReDS and LUS) were conducted. Study population included heart failure patients (Stage C, NYHA II-IV). ReDS, an objective non-invasive, transcutaneous measurement of lung fluid status, was assessed by HF nurse and LUS, evaluated using 6 measurement zones, was performed by HF cardiologist. Results During 17-month period and 174 clinic visits (103 patients), ReDS and LUS were recorded simultaneously. Mean ReDS reading was 33%±6% vs. mean LUS of 2.3±3.2 B-lines. Pearson correlation coefficient between the readings was moderate r= 0.41 (p<0.05). For LUS cutoff of 3 B-lines, ReDS sensitivity was 55.5% and specificity was 70% (p<0.01). ReDS negative predictive value (NPV) was 88% with positive predictive value (PPV) of 27%. ReDS overall accuracy was 68%. Conclusion Despite its low sensitivity, nurse-led ReDS assessment is feasible and possess a relatively high NPV allowing to rule out congestion at point-of-care. The simplicity of use empowers more health providers to assess congestion.

The correlation between left atrium voltage mapping and 3D late gadolinium enhancement cardiac magnetic resonance imaging findings in naive AF ablation candidate

Abstract Introduction The extent of the efficacy of late gadolinium enhancement cardiac MR (LGE-CMR) in depicting left atrial (LA) fibrosis in atrial fibrillation (AF) patients, compared to invasive Electroanatomical Mapping (EAM), is ongoing research field, while the highest degree of accuracy found when using ADAS program. Earlier studies focused mainly on post-ablation patients, employing segmentation (quality) and point-by-point (PBP) comparison methods. The non-invasive LGE-CMR-based fibrosis map shows promise for preprocedural planning and real-time guidance. Aim Evaluate LGE-CMR-based LA fibrosis precision in ablation-naïve AF patients using ADAS software, comparing it to the gold standard EAM using CARTO-3, in both qualitative and quantitative methods. Methods Patients planned for first CARTO-based AF ablation, undergoing pre-ablation LGE-CMR. 3D substrate atrial maps were generated via ADAS based on LGE-CMR (CMR-fib) and via CARTO as EAM. Normal range LA voltage was defined by Image Intensity Ratio of 1.2-1.32 on ADAS and by 0.2-0.5mV on Carto. Comparison methods, qualitative segmentation and PBP quantitative, with EAM serving as the gold standard. Results 24 naive patients included in the study (mean age 63.5 ± 10.9 yrs; 7 females, 15 paroxysmal AF, 17 maps during sinus). Segmental qualitative analysis (384 segments) showed 77% scarred segments, predominantly small scars (up to ⅓ segment). Compared with EAM, the CMR had 68.4% agreement, with 80.4% sensitivity, 78% PPV, 36.6% specificity, 32.6% NPV , kappa 0.139 AUC 0.567. Better agreement was found for dense scar. PBP quantitative comparison (41,345 points) demonstrated 50% scarred points, with 89% accuracy between EAM and CMR, with 49.6% sensitivity, 99.7% specificity, 99.5% PPV, and 73.5% NPV kappa 0.53, AUC 0.747. In both methods, agreement was worse for LA roof and best for AP and septal wall. Conclusion LGE-CMR tends to underestimate scar presence in naive patients compared to EAM, potentially due to baseline voltage scars, which are less dense compared to iatrogenic scar, the voltage criteria for scar in literature. Sensitivity is higher in segmental comparison, while specificity is superior in PBP, consistent with expectations of minimizing the size of comparison (from a segment to point). Hence, qualitative segmental method is better when assessing overall scarring, while PBP for assessing smaller specific areas. PBP comparisons exhibit less bias than segmental comparisons, which are overly sensitive to small scars. The diminished reliability of the LA roof is probably due to the margin of the CMR scan. Our study result regarding low sensitivity and high specificity of PBP aligns with a prior study investigating naïve patients through PBP comparisons, highlighting the need for a larger-scale study to assess LGE-CMR accuracy, considering various wall thicknesses and establishing scar thresholds on ADAS and CARTO software, for ablation-naïve patients with LA body scars.PBP projection on LA bodyAUC for PBP comprasion

Exploring the Discriminant Validity of the Modified Arm Care Screen (MACS), Designed for Overhead Athletes, in Detecting Musculoskeletal Risk Factors in the General Population

Background: Shoulder pain is the third most common musculoskeletal issue in primary care, affecting up to 50% of patients six months post-consultation, leading to significant functional impairments and societal costs, especially due to sick leave. Shoulder injuries are particularly prevalent among ‘overhead athletes’ in sports like swimming, volleyball, and handball, with high injury rates reported annually. Screening tools like the Arm Care Screen (ACS) have been used to effectively identify athletes at risk of shoulder injuries. However, their applicability to the general population is less understood. This study aimed to assess the discriminant validity of a modified ACS (MACS) in detecting musculoskeletal risk factors among non-athletes. Methods: A prospective cross-sectional study was conducted with 30 asymptomatic subjects over 18, excluding those with a history of shoulder injuries or surgeries. The MACS, comprising four tests, was administered, and its diagnostic performance was evaluated through sensitivity, specificity, predictive values, and likelihood ratios. Results: The results indicated low sensitivity (0–47.62%) and variable specificity (55.56–100%), suggesting that the MACS may not effectively identify risk factors in the general population. Positive and negative predictive values were inconsistent (ranging from 0 to 100), as well as positive and negative likelihood ratios (ranging from 0 to 3.47), highlighting the need for non-athlete-specific screening tools. Conclusion: While the MACS shows promise in athletes, its application in the general population requires further refinement. This study underscores the necessity for tailored screening methods to enhance the early detection and prevention of musculoskeletal issues in diverse populations.

Using anginal symptoms to predict underlying etiology in patients with angina and no obstructive coronary disease (ANOCA)

Abstract Background Patients with angina with no obstructive coronary disease (ANOCA) can present with exertional anginal symptoms or angina at rest. Invasive coronary functional angiography (CFA) is used to diagnose endothelial-dependent and independent coronary microvascular dysfunction (CMD), microvascular spasm, and epicardial spasm. Historically, the type of anginal symptoms has been thought to be suboptimal in predicting the etiology of ANOCA. However, the sensitivity, specificity, predictive value, and correlation of angina type related to CFA abnormalities are unknown. We hypothesize that patients with predominantly exertional angina are more likely to have endothelial-independent and dependent CMD, and patients with angina at rest are more likely to have microvascular or epicardial spasm. Objective To explore sensitivity, specificity, predictive value, and correlation of angina type with underlying etiology of ANOCA as diagnosed by CFA. Methods A prospective registry-based cohort study of consecutive CFA performed in 197 ANOCA patients between 2020 and 2023 using the Doppler-tipped guidewire method. ANOCA was defined as <50% stenosis in any major epicardial artery at time of CFA. Patients were classified based on CFA diagnosis: (1) endothelial-independent CMD (coronary flow reserve [CFR] < 2.5 in response to adenosine), (2) endothelial-dependent CMD (coronary blood flow [CBF] < 50% or no change in vessel diameter in response to 54mcg intracoronary acetylcholine), (3) microvascular (<90% constriction) and epicardial spasm (>90% constriction) to 108 mcg intracoronary acetylcholine. Patients were categorized based on anginal symptoms (exertional angina or at rest angina) documented at cardiologist visit prior to CFA. McNemar’s test and Spearman correlations were performed for both types of angina and the 3 ANOCA underlying diagnoses. Results Among 197 ANOCA patients, the average age was 56.5 ± 11.9 years and 91% were female. Angina at rest had a high specificity (91.3%) but a low sensitivity (25.2%) for the diagnosis of spasm with a PPV of 90.5 (Table 1). There was a significant correlation between angina at rest and spasm (p=0.012). Angina at rest had a similarly intermediate sensitivity and specificity for endothelial independent and dependent CMD. Exertional angina had similar sensitivity, specificity, and a high PPV for endothelial independent and dependent CMD. There was a significant correlation between exertional angina and endothelial dependent CMD (p=0.025). McNemar’s test was statistically significant (p<0.001) for all analyses. Conclusion ANOCA patients with symptoms of angina at rest had a significant correlation with coronary spasms and exertional angina correlates with endothelial-dependent CMD. We demonstrate that angina at rest can be 90% specific for the diagnosis of spasm. Our findings warrant further investigation but suggest that empiric therapy based on angina type is a reasonable first step before invasive testing.

Predictive power of the eTBI score for 30 day outcome in elderly patients with traumatic brain Injury

Traumatic brain injury (TBI) is a common problem in elderly individuals, with significant morbidity and mortality. The elderly Traumatic Brain Injury (eTBI) score, a novel tool for predicting outcomes in elderly patients with TBI, has shown promising results in previous studies. This study aimed to validate the eTBI score in a larger cohort of elderly patients with TBI in the Middle East. We conducted a retrospective study on 337 TBI patients with a mean age of 73.04 ± 8.73, admitted to a tertiary care hospital between March 2021 and November 2022. Within 30 days of admission, the patients’ conditions, including mortality and entering a vegetative state, were evaluated. The study population was split into three groups based on eTBI score: low, medium, and high risk; then patients were divided into two subgroups based on their Glasgow Outcome Scale (GOS ≤ 2, GOS > 2) in 30 days from hospital admission. Poor outcomes (mortality and entering a vegetative state) occurred in 24.3% of the study population. Within 30 days of hospital admission, 88% of low-risk patients experienced some degree of improvement, while 100% of high-risk patients died or fell into a vegetative state. In the medium-risk group, there was a significant correlation between unresponsive pupil (P = 0.006), initial GCS score (P = 0.003), need for a ventilator device (P = 0.015), need for surgical treatment (P = 0.031) and poor outcomes. Despite having a low sensitivity (21% vs. 57%), the eTBI score performed well in terms of accuracy (81% vs. 88%), specificity (100 vs. 98%), positive predictive value (100% vs. 90%), and negative predictive value (80% vs. 88%) for both eTBI ≤ 0 and eTBI ≤ 3 thresholds. The eTBI score is a reliable tool for predicting outcomes in elderly patients with TBI. This scoring system has a positive predictive value of 100% in the eTBI ≤ 0 group, which shows that 100% of the patients who are predicted by the eTBI score to have a poor outcome will indeed have a poor outcome. Patients in the high-risk group should be closely monitored and provided with intensive care, while those in the low-risk group can be reassured about their prognosis. The eTBI score can also be used in conjunction with other clinical factors to inform treatment decisions for patients in the medium-risk group.

Leveraging ChatGPT for systematic reviews: how accurate is it for screening by title and abstract?

Abstract Background Systematic reviews are at the top of the evidence pyramid, but the whole process can be labor-intensive, especially in the screening by title and abstract of retrieved records. Large language models (LLMs), such as ChatGPT, are proficient in natural language processing tasks and offer potential for accelerating this phase. The aim of this study is to assess ChatGPT’s performance in screening records for an already published systematic review (doi: 10.1080/21645515.2023.2300848). Methods 1601 records with title and abstract were evaluated with ChatGPT 4, using two different prompts to instruct the model: one asking the model to classify each record as included or excluded (Prompt A), and one asking the model to rate each record from 1 to 5 based on inclusion confidence (Prompt B), to compute the model’s performance metrics. Results The review included 64 records after title and abstract screening, of which 18 after full text screening. Using records included by title and abstract as a reference, prompt B with a rating cut-off of 3 provided 82% sensitivity, 88% specificity and 99% negative predictive value (NPV). With articles included by full text as a reference, 100% sensitivity, 86% specificity, and 100% NPV. An 85% workload saving was reached. Prompts A showed higher workload savings (∼93%), high NPVs (∼100%) and specificity (∼96%), but lower sensitivity (62-72%). Conclusions Prompts with a rating cut-off of 3 achieved a better performance, and still relevant workload savings compared to binary classification prompts. These findings can inform prompt-engineering strategies to instruct LLMs and reach both high sensitivity and workload savings. Key messages • Systematic reviews provide evidence synthesis to guide policy and decision-making in healthcare and public health. Such process can be time-consuming, and need for timely evidence is often stringent. • LLMs can help reduce workload and speed up the title and abstract screening phase of a systematic review, which is considered a major bottleneck in the review process.

A comparative analysis of the sensitivity and BOLD contamination of the VASO response at 3 Tesla: ME-DEPICTING vs. ME-EPI readouts

Abstract ‘Non-BOLD fMRI’ data acquired at non-zero echo time (TE) suffer from contamination by the Blood Oxygenation Level Dependent (BOLD) signal due to the unavoidable signal decay caused by transverse relaxation. This contamination further reduces their already low inherent functional sensitivities and makes their correction essential. The Slice-Saturation Slab-Inversion Vascular Space Occupancy (SS-SI–VASO), for instance, cancels out BOLD contributions from VASO data, reflecting cerebral blood volume (CBV) changes, via a dynamic division approach. Alternatively, multi-echo (ME) data provide the possibility of extrapolating to TE=0. Acquisitions at very short TE would minimize the need for such corrections. The center-out EPI variant (‘DEPICTING’) is one such readout which allows for short TE. The ME 2D DEPICTING was compared here against a traditional ME 2D EPI for its sensitivity to functional changes in the VASO signal. The two BOLD-correction schemes were also evaluated. Clear differences in functional sensitivity were observed for the uncorrected VASO data obtained from the first echo, TE1, of the two readouts. VASO data corrected by ME extrapolation were, however, found to be almost identical in their sensitivity for detecting CBV changes for both readouts. An excessively high increase in VASO signal sensitivity observed with the dynamic division correction for both readouts revealed a near-perfect linear dependence on TE of VASO signal changes. This could be attributed to the substantial intravascular BOLD contributions at 3 T. In the present data, extravascular ΔR2* fraction was found to be around ~50–60%. ME extrapolation is, hence, recommended to avoid overestimation of functional CBV changes at commonly used TEs.

Technoference in infant feeding: the impact of maternal digital media use during breastfeeding on maternal attention and mother-infant interactions

IntroductionParents' sensitivity and responsiveness to their infants may be affected by the widespread availability and use of mobile devices. The present study examined the impact of maternal digital media use on maternal attention and the quality of mother-infant interaction during breastfeeding.MethodsMothers and infants (n = 25 dyads) participated in a within-subject experiment. Mothers breastfed their infants under one experimental and one control condition, counterbalanced across two laboratory visits. During the Digital Media condition, mothers watched a television show on a tablet. During the Control condition, mothers listened to classical music at ambient levels. Video records were later coded to assess maternal attention to the infant, tablet, or elsewhere and evaluate the quality of mother-infant interaction.ResultsThere were more disruptions in maternal attention to the infant during the Digital Media (M = 3.7, S.E. = 0.2 per minute) vs. Control condition (M = 1.7, S.E. = 0.2 per minute, p < 0.001). The proportion of the meal duration mothers spent focused on their infant was significantly lower during the Digital Media (M = 52.5%, S.E. = 3.9) vs. Control condition (M = 83.9%, S.E. = 4.0%, p < 0.001). Lower maternal attention to the infant was associated with lower maternal sensitivity to cues (p = 0.03) and cognitive growth fostering (p = 0.002), as well as lower infant clarity of cues (p = 0.001). Lower maternal attention was also associated with less socioemotional growth fostering (p < 0.001) and lower infant responsiveness to the mother (p < 0.001) regardless of whether digital media was present or absent, but during the Digital Media condition, mothers engaged in more socioemotional growth fostering (p = 0.004) and infants were more responsive to mothers (p = 0.03).DiscussionThe presence of digital media during infant feeding led to more interruptions to mothers' attention to their infants and the time mothers spent focused on digital media displaced time spent focused on their infants. The degree to which mothers were attentive to their infants vs. digital media was a more important predictor of most aspects of interaction quality than the mere presence of digital media.

The use of a point of care high sensitivity troponin in the investigation of patients presenting to the Emergency Department with undifferentiated chest pain

Abstract Background In 2012 in a hospital, New Zealand, a chest pain pathway was instituted for the use in patients presenting to the Emergency Department (ED) with undifferentiated chest pain. This reduced hospital admissions and ED length of stay (LOS) without adversely affecting outcomes. The pathway consists of risk stratification combined with ECG and troponin testing. The pathway suggests, but does not enforce, that low risk patients can be discharged after a single troponin, intermediate risk patients are for serial troponins (which can be done in ED or the next day in the community), with further testing if appropriate, and high risk patients are reviewed by Cardiology or General medicine. In August 2023, Siemens point of care high sensitivity troponin I (POC-hsTnI) was introduced for the use in ED, although Beckman laboratory troponin I (Lab–hsTnI) is still available. A POC test reduces result turnaround times but until recently there has been a lack of POC assays fulfilling criteria for "high sensitivity". Purpose To ascertain whether the availability of a POC-hsTnI in the ED is a viable option for use in the chest pain pathway Methods A 1 month "snap shot" of all consecutive patients presenting to the ED with chest pain was undertaken and the patients followed for adverse events using electronic notes review. October 2023 was selected for the post POC-hsTnI period and compared with April 2022. Results There were 688 patients presenting to ED with undifferentiated chest pain during October 2023 with a type 1 acute myocardial infarction (AMI) rate of 80 (11.6%), median age 58 (41-72), female 335 (48.7%). POC-hsTnI was used in isolation in 377 (54.8%), in conjunction with Lab-hsTnI in 218 (31.7%) and Lab-hsTnI was used alone in 93 (13.5%). The median turnaround time for POC-hsTnI was 11 minutes (10-11) compared with Lab-hsTnI 87 minutes (61-129). The POC-hsTnI was less sensitive for AMI than the Lab-hsTnI on presentation using the upper reference limit, 72.1% (60.6-81.6) versus 91.5% (83.0-96.4). However, when used with risk stratification, there were no excess adverse events (cardiac death or AMI) at 4 months in patients discharged with a diagnosis of non-cardiac chest pain – 7 (1.4%) (n=495) versus 5 (1.2%), (n=424) in 2022. Median LOS in the ED was 4.4 hours (2.9-6.2) versus 4.0h (3.0-5.9) in 2022. However, a higher proportion of patients had a second cTn: 414 (60.2%) versus 309 (48.4%) and a lower proportion had their second troponin the next day in the community, 28 (6.7%) versus 56 (18.1%). Conclusion The use of a POC-hsTnI is a practical solution to reduce turnaround times for troponin results and has the potential to reduce LOS or allow serial troponins to be measured in a timely manner during their ED visit, obviating the need for a next day community troponin. Whilst POC-hsTnI has a lower early sensitivity for AMI, the use of POC-hsTnI as part of a pathway does not adversely affect outcomes.

Routine application of cardiac magnetic resonance imaging in patients with suspected myocarditis from immune checkpoint inhibitor therapy

Abstract Background Cardiovascular adverse events including myocarditis associated with immune checkpoint inhibitor (ICI) therapy remain a challenge in clinical practice. Diagnostic assessment of ICI-related myocarditis (ICI-M) is challenging due to a variable phenotype, confounding effects and limited sensitivity of diagnostic tools. Cardiac magnetic resonance imaging (CMR) is used to diagnose non-ICI myocarditis, but evidence on diagnostic sensitivity is low, particularly in patients with a discrete phenotype. Here, we aim to assess the impact of CMR in patients with suspected ICI-related myocarditis and relate to final diagnosis including endomyocardial biopsy findings. Methods All consecutive patients receiving CMR for suspected ICI-M between September 2019 and January 2024 were included and retrospectively analysed. CMR parameters were correlated with clinical, laboratory and echocardiographic parameters and stratified for presence or absence of myocarditis as per final diagnosis. Results A total of 55 patients who received CMR for suspected ICI-related myocarditis were analysed, including 25 patients with confirmed ICI-M as per final diagnosis and 30 patients with cardiotoxicity other than myocarditis or no cardiotoxicity (ICI-O). The mean age (ICI-M versus ICI-O) was 65.7±13.6 versus (vs.) 67.3±9.9 (p=0.61) years, 32.0% vs. 26.7% (p=0.67) were female, and 40.0% vs. 26.7% (p=0.29) had pre-existing coronary heart disease. Cardiac biomarkers and echocardiographic data did not differ between the groups. In CMR analysis, presence of late gadolinium enhancement (LGE) was associated with ICI-M (56.0% vs. 26.7%, p=0.027). Myocardial oedema was generally rare and not associated with ICI-M. Endomyocardial biopsy (EMB) was used in 6 out of 55 patients (10.9%) with suspected ICI-M. In 4 of these 6 patients (66.7%) EMB confirmed ICI-M diagnosis. Of note, only 2/4 patients with EMB-confirmed myocarditis showed abnormal CMR findings. Conclusion The diagnostic assessment of ICI-M is challenged by low sensitivity of common diagnostic measures, often requiring a multimodal approach. Presence of LGE in CMR was associated with ICI-M, but sensitivity and specificity are low. Our data emphasize the high value of EMB in patients with clinically suspected ICI-M despite inconspicuous CMR. Prospective data to improve diagnostic criteria are needed.

Measles cluster in Northern Portugal: enhancing surveillance strengths

Abstract Although measles was declared eliminated in Portugal in 2015, outbreaks persist, despite high vaccination coverage. The last outbreak in the northern region was in 2017. Portugal has a Surveillance System implemented for mandatory communicable diseases (SINAVE) integrating clinical, epidemiological and laboratory data. In 2021, WHO expressed concern about the low sensitivity of measles surveillance and urged Portugal to strengthen its surveillance practices. Our study aims to describe a measles cluster in northern Portugal during the first trimester of 2024. Data from measles cases from the first trimester of 2024 were collected from SINAVE. Contact tracing and Public Health (PH) intervention data was sent by Local Public Health Authorities through a survey designed for that purpose. A total of 70 suspected cases were reported and investigated: 6 cases were laboratory confirmed and 64 were discarded. The confirmed cases had a mean age of 28 years (all adults), with 50% female. The mean notification time was 0,3 days. The index case was imported (Mauritania) and unvaccinated, leading to 2 secondary cases. Five cases had 2 doses of a measles vaccine, with 1 case being a health professional. Additionally, 1 case was imported from France. For 2 cases the source of infection could not be unequivocally identified and no travel history during incubation period. A total of 851 contacts of confirmed cases were identified. Although sustainable transmission is not evident in our region, measles is being introduced through migration and tourism. Despite clinical awareness, strengthening early case detection is essential to enforce effective control measures. PH teams have been working tirelessly to trace clusters origins, gathering large number of contacts and adapting strategies for sustained control. In a globalized world, ensuring surveillance sensitivity is paramount. Integrating other data sources in surveillance routine is crucial for upholding Measles-Free Status compliance. Key messages • Measles must take centre stage on our agenda. • Reinforcing surveillance, integrating additional data sources, is crucial for heightened sensitivity and prompt response.

A hybrid variational level set model based on double Gaussian distribution fitting energy for image segmentation and bias correction

AbstractThe variational level set model has been widely used in image segmentation. However, its performance is significantly hindered by bias fields and noise within the images. To address these limitations, we introduce a novel hybrid variational level set model based on dual Gaussian distribution fitting (DGDF) energy in this paper. The DGDF energy integrates both local and global Gaussian distributions. The local energy is derived from the original image, while the global energy employs the corrected image, enabling effective segmentation of images with intensity inhomogeneity. Furthermore, the model demonstrates low sensitivity to weighting parameters and robust performance for noisy images. We develop an alternating iteration algorithm that combines variational methods with gradient descent to efficiently solve the proposed model. Experimental results validate the effectiveness of the model and the algorithm. In addition, the proposed model shows competitiveness on test images and three datasets compared to several state‐of‐the‐art models, including other variational level set models and deep learning‐based techniques.