Negative Predictive Value Values Research Articles

Automated echolocation classifiers vary in accuracy for northeastern U.S. bat species.

Acoustic surveys of bat echolocation calls are an important management tool for determining presence and probable absence of threatened and endangered bat species. In the northeastern United States, software programs such as Bat Call Identification (BCID), Kaleidoscope Pro (KPro), and Sonobat can automatically classify ultrasonic detector sound files, yet the programs' accuracy in correctly classifying calls to species has not been independently assessed. We used 1,500 full-spectrum reference calls with known identities for nine northeastern United States bat species to test the accuracy of these programs using calculations of Positive Predictive Value (PPV), Negative Predictive Value (NPV), Sensitivity (SN), Specificity (SP), Overall Accuracy, and No Information Rate. We found that BCID performed less accurately than other programs, likely because it only operates on zero-crossing data and may be less accurate for recordings converted from full-spectrum to zero-crossing. NPV and SP values were high across all species categories for SonoBat and KPro, indicating these programs' success at avoiding false positives. However, PPV and SN values were relatively low, particularly for individual Myotis species, indicating these programs are prone to false negatives. SonoBat and KPro performed better when distinguishing Myotis species from non-Myotis species. We expect less accuracy from these programs for acoustic recordings collected under normal working conditions, and caution that a bat acoustic expert should verify automatically classified files when making species-specific regulatory or conservation decisions.

Role of diffusion weighted imaging with background body signal suppression (DWIBS) in diagnosis of breast masses and correlation with histopathological findings

BackgroundDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is the important tool in breast imaging. However, two major limitations are represented by its specificity and by the injection of contrast material. Diffusion weighted imaging (DWI) provides important functional information without the need for contrast material. A newly introduced diffusion weighted imaging with background suppression (DWIBS) sequence is an accurate and rapid tool for the identification and characterization of breast lesions, with its short examination time, high lesion-to-background contrast and lack of need for intravenous contrast agents.ObjectiveTo assess the role of DWIBS sequence in the evaluation of indeterminate and suspicious breast masses and to compare its accuracy with DCE-MRI in correlation with histopathological findings.MethodsThirty-five patients were included in the study, referred from sono-mammography clinic to MRI unit for further MRI assessment of probably benign, suspicious and malignant looking breast masses (BIRADS 3, BIRADS 4 & BIRADS 5) on sono-mammography imaging results. MRI breast protocol which included DCE-MRI and DWIBS sequences were obtained for characterization and were verified by core needle biopsy or excisional biopsy. The results were statistically analyzed. Sensitivity, specificity, diagnostic accuracy (DA), positive predictive value (PPV) and negative predictive value (NPV) were calculated for DCE-MRI and DWIBS. Apparent diffusion co-efficient (ADC) values were calculated with ADC ≤ 1.2 × 10−3 mm2/s was considered suspicious for malignancy. The results were then compared with the histological findings.ResultsThirty-five female patients had 39 breast masses included in our study. By DCE-MRI, 8 (20.5%) masses were categorized as benign and 31(79.5%) masses were categorized as malignant. By DWIBS sequence, 7 (17.9%) masses were categorized as benign and 32 (82.1%) masses were categorized as malignant. By histopathology, 14 (35.9%) masses were benign and 25 (64.1%) masses were malignant. DCE-MRI obtained accuracy, sensitivity, specificity, PPV and NPV values of 84.6, 100, 57.1, 80.6 and 100%, respectively. DWIBS sequences obtained accuracy, sensitivity, specificity, PPV and NPV values of 82.1, 100, 50, 78.1and 100%, respectively.ConclusionsDWIBS can be added to DCE-MRI, as complementary tool to make radiologist more confident about the diagnosis. It can also be used instead of DCE-MRI sequences in certain circumstances such as in cases of renal impairment.

Evaluation of a fully automated high-throughput serology assay for detection of Hepatitis D virus antibodies

BackgroundHDV antibody testing is recommended for universal screening and as the first line in an HDV double reflex testing strategy for effectively identifying patients with active infection for therapeutic treatments. ObjectiveThe aim of this study is to evaluate the performance of a newly developed ARCHITECT HDV Total Ig (ARCHITECT HDV Ig) prototype assay. Study designPerformance characteristics were determined for the ARCHITECT HDV Ig and a reference test, LIAISON XL Anti-HDV using a well-characterized specimen panel, comprising HDV RNA positive (n = 62) and negative (n = 70) samples, and healthy US blood donors. ResultsHealthy US blood donors (n=200) showed 99.5% (199/200, 95%CI=97.65–99.98) specificity with ARCHITECT HDV Ig and 98.5 % (197/200, 95 %CI = 96.10–99.64) with LIAISON Anti-HDV. Among known HDV RNA positive samples, ARCHITECT HDV Ig detected 59/62 demonstrating 95.2 % sensitivity while LIAISON Anti-HDV sensitivity was 90.3 % (56/62). Among 101 HBV positive samples, 70 were reactive in the ARCHITECT test, 59 of which tested positive for HDV RNA for a positive predictive value (PPV) for the presence of HDV RNA was 84.3 %. For LIAISON Anti-HDV, 79 specimens were reactive and 56 contained HDV RNA: PPV for HDV RNA was 70.9 %. Among 70 HDV RNA negative samples, 39 were HBV positive. ARCHITECT HDV Ig negative predictive value (NPV) was 71.8 % and LIAISON Anti-HDV NPV was 41 % for the HBV positive group, respectively. ConclusionWhen compared to the LIASON Anti-HDV test, the ARCHITECT HDV Ig assay demonstrated enhanced sensitivity and specificity and better NPV and PPV values for HDV RNA status. The ARCHITECT HDV Ig assay represents a promising tool for universal screening of all HBsAg-positive persons.

Association of Low Levels of Placental Growth Factor and Fetal Growth Restriction in a Setting With a High Prevalence of Diabetes [ID 2683431

INTRODUCTION: Placental growth factor (PlGF) is a glycosylated protein from the vascular endothelial growth factor (VEGF) family that is involved in placental angiogenesis. In cases of placental dysfunction, decreased maternal serum PlGF levels predict the development of pregnancy complications such as preeclampsia, fetal growth restriction (FGR), and stillbirth. METHODS: Datasets from 114 high-risk patients who had clinical indication for PlGF testing from 2021 to 2023 were collected retrospectively. The anonymized dataset comprises PlGF test results categorized by gestational age-specific ranges and FGR categorized by percentile. Chi-squared analysis of 114 patients was used to assess the association between PlGF levels and FGR (less than 10th percentile). This study was approved by REb-USask #Bio3702. RESULTS: Of the 114 patients, 21 (18.4%) with low/very low PlGF and 8 (7.1%) with borderline/normal PlGF had fetuses with FGR less than 10th percentile. There was a significant difference between groups with a low/very low PlGF and normal PlGF levels (P<.001). The negative predictive value (NPV) for development of FGR less than 10% was 97.54%. CONCLUSION: Data collection is ongoing; however, in our patient population with a high prevalence of diabetes, preliminary data from 114 patients suggest that gestational age-stratified maternal serum PlGF levels have high NPV value for development of FGR less than 10th percentile. The implementation of this simple laboratory test in rural and remote communities would allow for earlier identification of pregnancies that require more intensive surveillance at a high-risk center of care.

Development and validation of a clinico-biological score to predict outcomes in patients with drowning-associated cardiac arrest

BackgroundWhile several scoring systems have been developed to predict short-term outcome in out-of-hospital cardiac arrest patients, there is currently no dedicated prognostic tool for drowning-associated cardiac arrest (DACA) patients. MethodsPatients experiencing DACA from two retrospective multicenter cohorts of drowning patients were included in the present study. Among the patients from the development cohort, risk-factors for day-28 mortality were assessed by logistic regression. A prediction score was conceived and assessed in patients from the validation cohort. ResultsAmong the 103 included patients from the development cohort, the day-28 mortality rate reached 51% (53/103). Identified independent early risk-factors for day-28 mortality included cardiopulmonary resuscitation duration longer than 20 min (OR 6.40 [95% CI 1.88–23.32]; p = 0.003), temperature at Intensive Care Unit admission <34 °C (OR 8.84 [95% CI 2.66–32.92]; p < 0.001), need for invasive mechanical ventilation (OR 6.83 [95% CI 1.47–40.87]; p = 0.02) and lactate concentration > 7 mmol/L (OR 3.56 [95% CI 1.01–13.07]; p = 0.04). The Area Under the ROC Curve (AUC) of the developed score based on those variables reached 0.91 (95% CI, 0.86–0.97). The optimal cut-off for predicting poor outcomes was 4 points with a sensitivity of 92% (95% CI, 82–98%), a specificity of 82% (95% CI, 67–91%), a positive predictive value (PPV) of 84% (95% CI, 72–95%) and a negative predictive value (NPV) of 91% (95% CI, 79–96%). The assessment of this score on the validation cohort of 81 patients exhibited an AUC of 0.82. Using the same 4 points threshold, sensitivity, specificity, PPV and NPV values of the validation cohort were: 81%, 67%, 72% and 77%, respectively. ConclusionIn patients suffering from drowning induced initial cardiac arrest admitted to ICU with a DACA score ≥ 4, the likelihood of survival at day-28 is significantly lower. Prospective validation of the DACA score and assessment of its usefulness are warranted in the future.

The Value of Warning Signs From the WHO 2009 Dengue Classification in Detecting Severe Dengue in Children.

World Health Organization proposed 7 warning signs to identify the risk of severe dengue in 2009. This study aimed to evaluate the value of these warning signs in detecting severe dengue in children. A cross-sectional study was conducted utilizing data of children with clinical dengue infection obtained from medical records between January 2009 and December 2018 in Jakarta. Children with confirmed dengue were analyzed and stratified into 3 age groups: infants less than 1 year old, children 1-14 years and adolescents 15-18 years of age. Positive predictive value, negative predictive value (NPV), sensitivity and specificity of each warning sign present or absent on admission in detecting severe dengue were computed. Six hundred ninety-nine children with clinical dengue infection were enrolled, among whom 614 (87.8%) had confirmed dengue infection, either by antigen or antibody serological tests. Severe dengue occurred in 211/614 (34.4%) cases. In infants, important warning signs on admission to detect or exclude severe dengue were liver enlargement (NPV 80.8%) and clinical fluid accumulation (NPV 75%). In children and adolescents, warning sign with highest NPV (in children 76.6% and in adolescents 91.9%) was increase in hematocrit concurrent with a rapid decrease in platelet count. Other warning signs with high NPV values in children were abdominal pain (72%), vomiting (70%), clinical fluid accumulation (69.3%), and in adolescents' abdominal pain (80.7%), vomiting (75.7%), clinical fluid accumulation (82.7%). NPVs increase with more than 1 warning sign in all age groups. In infants, liver enlargement or clinical fluid accumulation are important warning signs for severe dengue, when both are absent, severe dengue is unlikely. In older children and adolescents, an increase in hematocrit with the concurrent rapid decrease in platelet count is most discriminative; followed by the absence of abdominal pain, vomiting or fluid accumulation are unlikely severe dengue.

Diagnostic Accuracy of Heart Type Fatty Acid Binding Protein and Conventional Cardiac Troponin I in Early Diagnosis of Acute Myocardial Infarction

Background: Acute myocardial infarction (AMI) remains a leading cause of global morbidity and mortality, with early diagnosis being crucial for effective treatment and improved patient outcomes. The search for reliable early biomarkers to supplement traditional cardiac markers has been ongoing, with heart-type fatty acid-binding protein (H-FABP) emerging as a potential candidate due to its rapid post-ischemic release into the bloodstream. Objective: This study aimed to evaluate the diagnostic accuracy of H-FABP in comparison to conventional cardiac troponin I for the early detection of AMI in patients presenting with acute chest pain. Methods: A descriptive cross-sectional study was conducted at the Chemical Pathology Department of Combined Military Hospital Lahore from December 21, 2022, to April 21, 2023. Eighty patients presenting with symptoms suggestive of AMI were enrolled. Serum concentrations of H-FABP and cardiac troponin I were measured using the sandwich ELISA method. Diagnostic performance was assessed in terms of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver operating characteristic (ROC) curves. Statistical analysis was performed using SPSS version 25. Results: H-FABP demonstrated a sensitivity of 96.2%, specificity of 60.0%, PPV of 91.3%, and NPV of 81.8%. In contrast, cardiac troponin I had a sensitivity of 81.3% and a specificity of 60.0%, with PPV and NPV values of 91.3% and 81.8%, respectively. The area under the ROC curve (AUC) for H-FABP was 0.640 (p=0.031), slightly higher than that for cardiac troponin I, which was 0.624 (p=0.057). Conclusion: H-FABP shows promise as a more sensitive early biomarker for AMI compared to cardiac troponin I, suggesting its potential utility in enhancing early diagnosis and improving patient care. However, its lower specificity highlights the need for its combined use with traditional markers for a more accurate diagnosis.

Clinical application of CT-based radiomics model in differentiation between laryngeal squamous cell carcinoma and squamous cell hyperplasia.

To evaluate the clinical application of the CT-based radiomics prediction model for discriminating SCC and SCH. A total of 254 clinical samples were selected from 291 patients with larynx-occupying lesions who underwent primary surgery. All lesions were validated via histopathological examination at The Second Hospital of Jilin University between June 2004 and December 2019. All patients were randomly allocated to the training (n = 177) and validation (n = 77) cohorts. After the acquisition of CT images, manual 3D tumor segmentation was performed using the CT images of the arterial, venous, and non-contrast phases via ITK-SNAP software. Subsequently, radiomics features were extracted using A.K. software. Based on the above features, three different diagnostic models (CTN, CTA+CTV, and CTN+CTA+CTV) were constructed to classify squamous cell carcinoma (SCC) and squamous cell hyperplasia (SCH). Additionally, receiver operating characteristic (ROC) and decision curve analysis (DCA) curves were measured to evaluate the diagnostic characteristics and clinical safety of the proposed three prognostic models. In the radiomic prediction Model 1 (CTN), the area under the curve (AUC), accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the training cohorts in differentiating SCC and SCH were 0.883, 0.785, 0.645, 1.000, 1.000, and 0.648, while in the testing cohorts, these values were 0.852, 0.792, 0.66, 1.000, 1.000, and 0.652, respectively. In the radiomic prediction Model 2 (CTA+CTV), the AUC, accuracy, sensitivity, specificity, PPV, and NPV values of the training cohorts were 0.965, 0.91, 0.916, 0.9, 0.933, and 0.875, respectively, while in the testing cohorts, the corresponding values were 0.902, 0.805, 0.851, 0.733, 0.833, and 0.759, respectively. In the radiomic prediction Model 3(CTN+CTA+CTV), the AUC, accuracy, sensitivity, specificity, PPV, and NPV values of the training cohorts were 0.985, 0.944, 0.953, 0.929, 0.953, and 0.929, while in the testing cohorts, the corresponding values were 0.965, 0.857, 0.894, 0.8, 0.875, and 0.828, respectively. The radiomic prediction Model 3, based on the arterial-venous-plain combined scan phase of CT, achieved promising diagnostic performance, expected to be regarded as a preoperative imaging tool in classifying SCC and SCH to guide clinicians to develop individualized treatment programs.

Transfer learning with CNNs for efficient prostate cancer and BPH detection in transrectal ultrasound images

Early detection of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) is crucial for maintaining the health and well-being of aging male populations. This study aims to evaluate the performance of transfer learning with convolutional neural networks (CNNs) for efficient classification of PCa and BPH in transrectal ultrasound (TRUS) images. A retrospective experimental design was employed in this study, with 1380 TRUS images for PCa and 1530 for BPH. Seven state-of-the-art deep learning (DL) methods were employed as classifiers with transfer learning applied to popular CNN architectures. Performance indices, including sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), Kappa value, and Hindex (Youden’s index), were used to assess the feasibility and efficacy of the CNN methods. The CNN methods with transfer learning demonstrated a high classification performance for TRUS images, with all accuracy, specificity, sensitivity, PPV, NPV, Kappa, and Hindex values surpassing 0.9400. The optimal accuracy, sensitivity, and specificity reached 0.9987, 0.9980, and 0.9980, respectively, as evaluated using twofold cross-validation. The investigated CNN methods with transfer learning showcased their efficiency and ability for the classification of PCa and BPH in TRUS images. Notably, the EfficientNetV2 with transfer learning displayed a high degree of effectiveness in distinguishing between PCa and BPH, making it a promising tool for future diagnostic applications.

Loop-Mediated Isothermal Amplification (LAMP): Potential Point-of-Care Testing for Vulvovaginal Candidiasis.

The aim of this study is to establish a loop-mediated isothermal amplification (LAMP) method for the rapid detection of vulvovaginal candidiasis (VVC). We developed and validated a loop-mediated isothermal amplification (LAMP) method for detecting the most common Candida species associated with VVC, including C. albicans, N. glabratus, C. tropicalis, and C. parapsilosis. We evaluated the specificity, sensitivity, positive predictive value (PPV), negative predictive value (NPV), and Kappa value of the LAMP method to detect different Candida species, using the conventional culture method and internal transcribed spacer (ITS) sequencing as gold standards and smear Gram staining and real-time Rolymerase Chain Reaction (PCR) as controls. A total of 202 cases were enrolled, of which 88 were VVC-positive and 114 were negative. Among the 88 positive patients, the fungal culture and ITS sequencing results showed that 67 cases (76.14%) were associated with C. albicans, 13 (14.77%) with N. glabratus, 5 (5.68%) with C. tropicalis, and 3 (3.41%) with other species. Regarding the overall detection rate, the LAMP method presented sensitivity, specificity, PPV, NPV, and Kappa values of 90.91%, 100%, 100%, 93.4%, and 0.919, respectively. Moreover, the LAMP had a specificity of 100% for C. albicans, N. glabratus, and C. tropicalis, with a sensitivity of 94.03%, 100%, and 80%, respectively. Moreover, the microscopy evaluation had the highest sensitivity, while the real-time PCR was less specific for C. albicans than LAMP. In addition, CHROMagar Candida was inferior to LAMP in detecting non-albicans Candida (NAC) species. Based on the cost-effective, rapid, and inexpensive characteristics of LAMP, coupled with the high sensitivity and specificity of our VVC-associated Candida detection method, we provided a possibility for the point-of-care testing (POCT) of VVC, especially in developing countries and some laboratories with limited resources.

The relationship between temporal muscle thickness and triglyceride glucose index in sarcopenia with mortality and third-month functional outcomes in patients after acute stroke.

Especially in recent years, temporal muscle thickness has been used as an important parameter for sarcopenia in neurological disorders. In addition, triglyceride glucose index was evaluated separately in studies conducted in terms of coronary diseases, diabetes, high blood pressure, body mass index and acute stroke. In this clinical study, unlike the others, both temporal muscle thickness and triglyceride glucose index were evaluated together in acute stroke patients in terms of sarcopenia. We aimed to investigate the relationship between temporal muscle thickness and triglyceride glucose index, which is atherosclerotic index, with mortality and 3rd month functional outcomes in acute stroke patients. In this retrospective study, 147 patients admitted to Ankara City Hospital with the diagnosis of acute ischemic stroke between January 2021 and September 2022 were evaluated. Fasting triglyceride glucose indexes of the patients were calculated. The temporal muscle thickness measurement of the patients was performed by the radiologist using computed tomography images. Those who scored 3 or higher on the modified Rankin Scale (mRS) at the third month were considered to have poor functional outcome. A significant cutoff point was found for estimating mortality for the temporal muscle thickness parameter [area under the curve for a receiver operating characteristic curve (AUC) = 0.636; P = .012]. The cutoff point was obtained as ≤ 5.2. Sensitivity value was 65%, specificity value was 65%, the positive predictive value (PPV) value was 42.62% and the negative predictive value (NPV) value was 82.28%. Similarly, for the triglyceride glucose index parameter, there was a significant cutoff point in estimating mortality (AUC = 0.673; P = .003). The cutoff point was obtained as ≥ 8.23. Sensitivity value was 91.18%, specificity value was 13%, PPV value was 26.96% and NPV value was 81%. Temporal muscle thickness and triglyceride glucose index parameters were found to be statistically important parameters of sarcopenia. It was concluded that the evaluation of these 2 parameters in terms of both mortality and sarcopenia in acute stroke patients is important in the evaluation of neurological and cardiac disorders.

Validation of the Swedish version of the safe environment for every kid (SEEK) parent screening questionnaire

BackgroundPsychosocial risk factors in the home may impair children’s health and development and increase the risk of maltreatment. The Safe Environment for Every Kid (SEEK) model was developed to provide pediatric primary care professionals with a structured way to identify common psychosocial problems. The SEEK model includes use of the Parent Screening Questionnaire (SEEK-PSQ) at routine preventive child health visits, discussion with parents about their responses and, when indicated, referral to relevant services. The SEEK-PSQ has not previously been available in Swedish. The aim of the present study was to evaluate the psychometric properties of an adapted Swedish version of the SEEK-PSQ (PSQ-S).MethodsThis study is part of a cluster-randomised controlled trial of SEEK in the Swedish child health services. To validate the PSQ-S, parents (n = 852) with children 0–18 months of age were invited to complete a survey including the PSQ-S as well as evidence-based standardized instruments for the targeted psychosocial risk factors: economic worries, depressive symptoms, parental stress, alcohol misuse and intimate partner violence (IPV). Baseline data from 611 (72%) parents were analysed regarding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each risk factor.ResultsAs a whole, the PSQ-S had a sensitivity of 93%, specificity of 52%, PPV of 67% and NPV of 87%. For mothers and fathers combined, sensitivity was 80% for economic worries, 89% for depressive symptoms, 78% for parental stress, 47% for intimate partner violence (IPV) and 70% for alcohol misuse. Specificity was highest for IPV and alcohol misuse (91%) and lowest for depressive symptoms (64%). NPV values were high (81–99%) and PPV values were low to moderate (22–69%) for the targeted problems. Sensitivity was higher for mothers compared to fathers for economic worries, depressive symptoms and IPV. This difference was particularly evident for IPV (52% for mothers, 27% for fathers).ConclusionThe SEEK-PSQ-S demonstrated good psychometric properties for identifying economic worries, depressive symptoms, parental stress and alcohol misuse but low sensitivity for IPV. The PSQ-S as a whole showed high sensitivity and NPV, indicating that most parents with or without the targeted psychosocial risk factors were correctly identified.Trial registrationISRCTN registry, study record 14,429,952 (https://doi.org/10.1186/ISRCTN14429952) Registration date 27/05/2020.

Pediatric Utilization of Methicillin-resistant Staphylococcus aureus Nasal Swabs for Antimicrobial Stewardship.

Methicillin-resistant Staphylococcus aureus (MRSA) can cause serious infections and empiric treatment regimens in children frequently include an anti-MRSA antibiotic. Studies in adults have demonstrated a high negative predictive value (NPV) of MRSA nasal swabs (MNS) in a variety of infectious syndromes. Negative MNS have been utilized as a tool to guide de-escalation of anti-MRSA antibiotics in adults, especially in those with lower respiratory tract infections, but data in children is minimal. The primary objective of this study was to determine the NPV and positive predictive value (PPV) of MNS in children hospitalized for treatment of an infection. This was a single-site, retrospective cohort study of pediatric patients admitted with a suspected infectious diagnosis who had an MNS performed during their hospitalization between June 1, 2018 and November 25, 2022. This study identified 172 patients who met the inclusion criteria. Eleven (6.4%) nasal swabs were positive for MRSA and 10 (5.8%) microbiological cultures from suspected sources of infection were identified to be positive for MRSA. The MNS was found to have a sensitivity of 20%, specificity of 94%, PPV of 18% and NPV of 95% for all sites of infection. MNS has a high NPV and low PPV in children. MNS can be utilized as an antimicrobial stewardship tool to guide the safe de-escalation of anti-MRSA antibiotics in children.

HPV16 E7 oncoprotein test as a triage strategy for HPV16-positive women in cervical cancer screening: long-term follow-up outcome.

Colposcopy is recommended once human papillomavirus (HPV)16/18 infection is detected. However, not all HPV16/18-positive women will necessarily develop cervical lesions. Therefore, this study aimed to investigate the application of quantitative HPV16 E7 oncoprotein detection as a cervical cancer screening method for more efficient screening while minimizing unnecessary colposcopy. E7 oncoprotein (HPV16) was quantitatively detected in cervical exfoliated cells of HPV16-positive women. The levels of HPV16 E7 oncoprotein in different degrees of cervical lesions were compared, and the optimal cut-off value for identifying HSIL+ was determined by receiver operating characteristic (ROC) curve analysis. With a pathological diagnosis as the gold standard, the sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), and Kappa value were calculated to verify the diagnostic value of the method. Women diagnosed with low-grade squamous intraepithelial lesions (LSIL) and normal women were followed up for 5 years to evaluate the predictive value of HPV16 E7 protein for disease progression/persistent infection. The expression level of HPV16 E7 oncoprotein was positively correlated with the degree of the cervical lesion (r = 0.589, P < 0.01). The area under the ROC curve (AUC) was 0.817 (confidence interval: 0.729-0.904). The cut-off value of E7 oncoprotein for identifying HSIL+ was 8.68 ng/ml. The SEN, SPE, PPV, NPV, and Kappa values of HPV16 E7 oncoprotein for the identification of HSIL+ were 87.1%,70.0%, 87.1%, 70.0%, and 0.571, respectively, which were higher than those of ThinPrep cytology test (TCT). The SEN, SPE, PPV, and NPV of HPV16 E7 oncoprotein in predicting disease progression/persistent infection were 93.75%, 91.30%, 88.24%, and 95.45%, respectively. The quantitative detection of HPV 16 E7 oncoprotein can not only accurately screen cervical lesions but also achieve efficient colposcopy referral. Additionally, HPV16 E7 oncoprotein can accurately predict the progression of cervical lesions and persistent HPV infection.

Utility of the continuous intraoperative neuromonitoring in the prevention of the recurrent laryngeal nerve paralysis during thyroid surgery. A prospective observational study

BackgroundThe continuous intraoperative neuromonitoring (C-IONM) of the recurrent laryngeal nerve (RLN) could help reducing the incidence of nerve paralysis after thyroid surgery, in comparison with the mere anatomical visualization of the RLN. The objective is to assess the efficacy and utility of C-IONM as a predictive test for recurrent laryngeal nerve paralysis after thyroidectomy. MethodsA prospective observational study was performed in 248 patients who underwent thyroid surgery where C-IONM was applied, between September 2018 and December 2019, in a high-volume center. A previous and later laryngoscopy was performed, which allowed to evaluate the reliability of the C-IONM as a predictive test for recurrent paralysis. Sensitivity (SE), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) were studied. ResultsA total number of 171 thyroidectomies, 62 hemithyroidectomies, 15 totalization thyroidectomies and 27 thyroidectomy with cervical dissections were performed. Postoperative laryngoscopy was altered in 40 patients (16.12%). The SE, SP, PPV and NPV values ​​were 65%, 94.7%, 70.2% and 93.4% respectively. ConclusionsC-IONM is a safe technique that provides real-time information about anatomical and functional integrity of the RLN and can improve the results of thyroid surgery.

A cross-sectional study: a hypertension screening model using digital tensimeter as the gold standard at public health centre in Gianyar Regency, Bali Province, Indonesia

The number of patients with hypertension in Gianyar Regency tent to increase in recent years. Hypertension is the first among the tenth rank from the most common diseases, with 23% cases according to the priority scale. Hypertension treatment and management include prevention, early diagnosis, diagnosis with therapy, and screening to detect early hypertension disease. This screening includes elderly &gt;40 years old who come to Public Health Centre in September 2021. The screening uses a questionnaire to uphold the diagnosis of hypertension disease by using a digital tensimeter as the gold standard. Based on World Health Organisation in 2018, which said it would be confirmed as hypertension if systolic ≥140 mmHg or diastolic ≥90 mmHg. 86% of 255 respondents were diagnosed with hypertension, that’s 40% were &gt;65 years old, 75% were female, and 31% worked as housewives. The screening tool with a question list of dizziness has a sensitivity value of 99%, a specificity value of 73% with a Positive Predictive Value (PPV), and each value of Negative Predictive Value (NPV) is 96% and 89%, respectively. Headache contains a sensitivity value of 90%, a specificity of 100%, with PPV value of 100% and NPV value of 61%. The combination of symptoms of dizziness and headache has a sensitivity value of 76%, and a specificity value of 82%, with PPV of 96% and NPV of 36%. Clinical symptoms are considered an early diagnosis of hypertension. If people who experience complaints of dizziness, headaches, or a combination of the two should immediately check their blood pressure as early as possible.

Diagnostic performance of magnetic resonance imaging for diagnosing acute appendicitis during pregnancy.

This retrospective study evaluated the diagnostic efficacy of magnetic resonance imaging (MRI) for identifying acute appendicitis during pregnancy. This retrospective study enrolled a total of 46 pregnant patients with clinically suspected acute appendicitis who underwent 1.5 T MRI and received a final pathological diagnosis. We evaluated the imaging characteristics associated with patients diagnosed with acute appendicitis, including the appendix diameter, the appendix wall thickness, intra-appendiceal fluid collection, and peri-appendiceal fat infiltration. A bright appendix on T1-weighted 3-dimensional imaging was identified as a negative sign for appendicitis. Peri-appendiceal fat infiltration had the highest specificity of 97.1% for diagnosing acute appendicitis, whereas increasing appendiceal diameter had the highest sensitivity of 91.7%. The cut-off values for increasing appendiceal diameter and appendiceal wall thickness were 6.55 mm and 2.7 mm, respectively. Using these cut-off values, appendiceal diameter had a sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of 91.7%, 91.2%, 78.4%, and 96.9%, respectively, whereas these values for appendiceal wall thickness were 75.0%, 91.2%, 75.0%, and 91.2%. The combination of increasing appendiceal diameter and appendiceal wall thickness resulted in an area under the receiver operating characteristic curve value of 0.958 with Se, Sp, PPV, and NPV values of 75.0%, 100.0%, 100.0%, and 91.9%, respectively. All five MRI signs examined in this study had significant diagnostic value for detecting acute appendicitis during pregnancy, with p-values <0.01. The combined use of increasing appendiceal diameter and appendiceal wall thickness displayed the excellent ability to diagnose acute appendicitis in pregnant women.

Evaluation of Endoscopic Response Using Deep Neural Network in Esophageal Cancer Patients Who Received Neoadjuvant Chemotherapy.

We previously reported that endoscopic response evaluation can preoperatively predict the prognosis and distribution of residual tumors after neoadjuvant chemotherapy (NAC). In this study, we developed artificial intelligence (AI)-guided endoscopic response evaluation using a deep neural network to discriminate endoscopic responders (ERs) in patients with esophageal squamous cell carcinoma (ESCC) after NAC. Surgically resectable ESCC patients who underwent esophagectomy following NAC were retrospectively analyzed in this study. Endoscopic images of the tumors were analyzed using a deep neural network. The model was validated with a test data set using 10 newly collected ERs and 10 newly collected non-ER images. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the endoscopic response evaluation by AI and endoscopists were calculated and compared. Of 193 patients, 40 (21%) were diagnosed as ERs. The median sensitivity, specificity, PPV, and NPV values for ER detection in 10 models were 60%, 100%, 100%, and 71%, respectively. Similarly, the median values by the endoscopist were 80%, 80%, 81%, and 81%, respectively. This proof-of-concept study using a deep learning algorithm demonstrated that the constructed AI-guided endoscopic response evaluation after NAC could identify ER with high specificity and PPV. It would appropriately guide an individualized treatment strategy that includes an organ preservation approach in ESCC patients.

Validation of a deep neural network-based algorithm supporting clinical management of adnexal mass.

Conservative management of adnexal mass is warranted when there is imaging-based and clinical evidence of benign characteristics. Malignancy risk is, however, a concern due to the mortality rate of ovarian cancer. Malignancy occurs in 10-15% of adnexal masses that go to surgery, whereas the rate of malignancy is much lower in masses clinically characterized as benign or indeterminate. Additional diagnostic tests could assist conservative management of these patients. Here we report the clinical validation of OvaWatch, a multivariate index assay, with real-world evidence of performance that supports conservative management of adnexal masses. OvaWatch utilizes a previously characterized neural network-based algorithm combining serum biomarkers and clinical covariates and was used to examine malignancy risk in prospective and retrospective samples of patients with an adnexal mass. Retrospective data sets were assembled from previous studies using patients who had adnexal mass and were scheduled for surgery. The prospective study was a multi-center trial of women with adnexal mass as identified on clinical examination and indeterminate or asymptomatic by imaging. The performance to detect ovarian malignancy was evaluated at a previously validated score threshold. In retrospective, low prevalence (N = 1,453, 1.5% malignancy rate) data from patients that received an independent physician assessment of benign, OvaWatch has a sensitivity of 81.8% [95% confidence interval (CI) 65.1-92.7] for identifying a histologically confirmed malignancy, and a negative predictive value (NPV) of 99.7%. OvaWatch identified 18/22 malignancies missed by physician assessment. A prospective data set had 501 patients where 106 patients with adnexal mass went for surgery. The prevalence was 2% (10 malignancies). The sensitivity of OvaWatch for malignancy was 40% (95% CI: 16.8-68.7%), and the specificity was 87% (95% CI: 83.7-89.7) when patients were included in the analysis who did not go to surgery and were evaluated as benign. The NPV remained 98.6% (95% CI: 97.0-99.4%). An independent analysis set with a high prevalence (45.8%) the NPV value was 87.8% (95% CI: 95% CI: 75.8-94.3%). OvaWatch demonstrated high NPV across diverse data sets and promises utility as an effective diagnostic test supporting management of suspected benign or indeterminate mass to safely decrease or delay unnecessary surgeries.

The Diagnostic Value of BRAF V600E Gene Detection Combined with DNA Ploidy Analysis in Thyroid Cancer.

The thyroid cancer incidence has been experimenting an accelerated growth all over the world. The serine/threonine-protein kinase (BRAF) V600E gene detection or the DNA ploidy analysis has been employed in the identification of thyroid cancer type. This study aimed to evaluate the diagnostic value of the BRAF V600E gene integrated with DNA ploidy analysis in thyroid cancer. From August 2022 to May 2023, 400 individuals from the thyroid surgery outpatient department of our hospital were enrolled in this study. The participants were divided into low-risk groups (Ⅰ+Ⅱ+Ⅲ group; n = 200) and high-risk groups (Ⅳ+Ⅴ group; n = 200) based on the Thyroid Imaging Reporting and Data System (TI-RADS). A total of the patients were subjected to the DNA ploidy analysis, the BRAF V600E gene detection, or the combination of both techniques. We evaluated the diagnostic value of the above techniques and considered the postoperative pathology results as gold standard for cancer diagnosis. The negative predictive value (NPV), accuracy, specificity, sensitivity, and positive predictive value (PPV) of TI-RADS, BRAF V600E gene detection, DNA ploidy analysis, and BRAF V600E gene detection joined with DNA ploidy analysis were calculated. Among 400 subjects, 238 presented thyroid cancer and 162 had benign lesions, according to the postoperative pathology results. The obtained sensitivity, specificity, accuracy, PPV, and NPV values of TI-RADS were 55.88%, 58.64%, 57.00%, 66.50%, 47.50%, respectively; of BRAF V600E gene detection were 81.93%, 69.75%, 77.00%, 79.92%, 72.44%, respectively; of DNA ploidy analysis were 83.19%, 72.84%, 79.00%, 81.82%, 74.68%, respectively; of BRAF V600E gene combined with DNA ploidy analysis were 90.34%, 76.54%, 84.75%, 84.98%, 84.35%, respectively. Compared with TI-RADS, the sensitivity, specificity, accuracy, PPV, and NPV values of DNA ploidy analysis, BRAF V600E gene detection, and the conjunction of these last two methods were increased (p < 0.05). The combination of DNA ploidy analysis and BRAF V600E gene detection had the highest values among them all. BRAF V600E gene detection in conjunction with DNA ploidy analysis showed a better diagnostic value than both methods separately or TI-RADS.