Poor Agreement Research Articles

Comparison of Interobserver Variability Between Two Grading Systems Used for Urothelial Carcinoma

Background: Inter-observer variability among pathologists' reports has been a significant challenge in the diagnosis of diseases, especially cancers. Designing a grading system with minimal inter-observer variability can help achieve more accurate diagnoses. Objectives: We aimed to determine whether the grading system proposed by Cheng and colleagues (Cheng’s grading system) can improve inter-observer variability among pathologists in grading urothelial cancer, compared with the World Health Organization (WHO) grading system (2004/2016). Methods: Four pathologists examined all slides of bladder biopsy samples diagnosed as urothelial carcinoma, available in the archives of Imam Reza Hospital, Mashhad, Iran, from 2019 to 2022. Each pathologist reported the tumor grade based on both grading systems, independently of previous answers or the reports of their colleagues. Results: Of 132 samples, the majority were from men (84.1%); the mean age of patients was 66.56±11.31 years. For low and high grades of the WHO system and grade II in Cheng’s grading system, κ = 0.602; agreement was lower for grade III (κ = 0.439) and higher for grade IV (κ = 0.690) compared with the WHO grading system. There was significant agreement among the pathologists in all tumor characteristics, with excellent agreement for stromal invasion (κ = 0.790) and muscular invasion (κ = 0.884), fair to good agreement for WHO 2004/2016 grading (κ = 0.602) and Cheng’s grading (κ = 0.574) overall, and poor agreement for tumor heterogeneity (κ = 0.360). Conclusions: Both grading systems demonstrated favorable agreement among pathologists, without significant differences between the two systems. These results confirm the appropriateness of both grading systems.

Agreement between lacrimal fluid and serum for detecting urea nitrogen and creatinine in dogs.

To determine whether urea nitrogen and creatinine levels differ in lacrimal fluid (LF) and serum (SER) in nonazotemic (control) and azotemic dogs and whether there is an agreement between LF and SER. A prospective observational study was performed at the Auburn University Small Animal Teaching Hospital between May 2023 and March 2024. Forty control and 38 azotemic dogs were enrolled. Twenty microliters of LF per eye was collected with microcapillary tubes, and 3 mL of blood was drawn. Bland-Altman plot and intraclass correlation coefficient (ICC) were used to evaluate the agreement between LF and SER. There was good agreement between LF and SER levels of urea nitrogen in the control group (Bland-Altman plot mean bias of -0.8108 ± 2.407 mg/dL; ICC of 0.874 [95% CI, 0.773 to 0.934]) and the azotemic group (Bland-Altman plot mean bias of -9.681 ± 23.89 mg/dL; ICC of 0.82 [95% CI, 0.658 to 0.906]). There was poor agreement between LF and SER concentrations for creatinine in the control and azotemic groups, with only 26 dogs with creatinine detectable in LF. Lacrimal fluid and SER concentrations of urea nitrogen showed good agreement in both the control and azotemic groups, whereas poor agreement was found for creatinine in both groups. Measurement of urea nitrogen in LF may provide an alternative to blood for diagnosing uremia. However, additional research is necessary before substituting LF for SER.

Agreement Between Apple Watch and Actical Step Counts in a Community Setting: Cross-Sectional Investigation From the Framingham Heart Study.

Step counting is comparable among many research-grade and consumer-grade accelerometers in laboratory settings. The purpose of this study was to compare the agreement between Actical and Apple Watch step-counting in a community setting. Among Third Generation Framingham Heart Study participants (N=3486), we examined the agreement of step-counting between those who wore a consumer-grade accelerometer (Apple Watch Series 0) and a research-grade accelerometer (Actical) on the same days. Secondarily, we examined the agreement during each hour when both devices were worn to account for differences in wear time between devices. We studied 523 participants (n=3223 person-days, mean age 51.7, SD 8.9 years; women: n=298, 57.0%). Between devices, we observed modest correlation (intraclass correlation [ICC] 0.56, 95% CI 0.54-0.59), poor continuous agreement (29.7%, n=957 of days having steps counts with ≤15% difference), a mean difference of 499 steps per day higher count by Actical, and wide limits of agreement, roughly ±9000 steps per day. However, devices showed stronger agreement in identifying who meets various steps per day thresholds (eg, at 8000 steps per day, kappa coefficient=0.49), for which devices were concordant for 74.8% (n=391) of participants. In secondary analyses, in the hours during which both devices were worn (n=456 participants, n=18,760 person-hours), the correlation was much stronger (ICC 0.86, 95% CI 0.85-0.86), but continuous agreement remained poor (27.3%, n=5115 of hours having step counts with ≤15% difference) between devices and was slightly worse for those with mobility limitations or obesity. Our investigation suggests poor overall agreement between steps counted by the Actical device and those counted by the Apple Watch device, with stronger agreement in discriminating who meets certain step thresholds. The impact of these challenges may be minimized if accelerometers are used by individuals to determine whether they are meeting physical activity guidelines or tracking step counts. It is also possible that some of the limitations of these older accelerometers may be improved in newer devices.

Diagnostic Accuracy of a Mobile AI-Based Symptom Checker and a Web-Based Self-Referral Tool in Rheumatology: Multicenter Randomized Controlled Trial.

The diagnosis of inflammatory rheumatic diseases (IRDs) is often delayed due to unspecific symptoms and a shortage of rheumatologists. Digital diagnostic decision support systems (DDSSs) have the potential to expedite diagnosis and help patients navigate the health care system more efficiently. The aim of this study was to assess the diagnostic accuracy of a mobile artificial intelligence (AI)-based symptom checker (Ada) and a web-based self-referral tool (Rheport) regarding IRDs. A prospective, multicenter, open-label, crossover randomized controlled trial was conducted with patients newly presenting to 3 rheumatology centers. Participants were randomly assigned to complete a symptom assessment using either Ada or Rheport. The primary outcome was the correct identification of IRDs by the DDSSs, defined as the presence of any IRD in the list of suggested diagnoses by Ada or achieving a prespecified threshold score with Rheport. The gold standard was the diagnosis made by rheumatologists. A total of 600 patients were included, among whom 214 (35.7%) were diagnosed with an IRD. Most frequent IRD was rheumatoid arthritis with 69 (11.5%) patients. Rheport's disease suggestion and Ada's top 1 (D1) and top 5 (D5) disease suggestions demonstrated overall diagnostic accuracies of 52%, 63%, and 58%, respectively, for IRDs. Rheport showed a sensitivity of 62% and a specificity of 47% for IRDs. Ada's D1 and D5 disease suggestions showed a sensitivity of 52% and 66%, respectively, and a specificity of 68% and 54%, respectively, concerning IRDs. Ada's diagnostic accuracy regarding individual diagnoses was heterogenous, and Ada performed considerably better in identifying rheumatoid arthritis in comparison to other diagnoses (D1: 42%; D5: 64%). The Cohen κ statistic of Rheport for agreement on any rheumatic disease diagnosis with Ada D1 was 0.15 (95% CI 0.08-0.18) and with Ada D5 was 0.08 (95% CI 0.00-0.16), indicating poor agreement for the presence of any rheumatic disease between the 2 DDSSs. To our knowledge, this is the largest comparative DDSS trial with actual use of DDSSs by patients. The diagnostic accuracies of both DDSSs for IRDs were not promising in this high-prevalence patient population. DDSSs may lead to a misuse of scarce health care resources. Our results underscore the need for stringent regulation and drastic improvements to ensure the safety and efficacy of DDSSs. German Register of Clinical Trials DRKS00017642; https://drks.de/search/en/trial/DRKS00017642.

Close Cardiovascular Monitoring during the Early Stages of Treatment for Patients Receiving Immune Checkpoint Inhibitors.

Background: There is an unmet medical need for the early detection of immune checkpoint inhibitor (ICI)-induced cardiovascular (CV) adverse events due to a lack of adequate biomarkers. This study aimed to provide insights on the incidence of troponin elevations and echocardiographic dynamics during ICI treatment in cancer patients and their role as potential biomarkers for submyocardial damage. In addition, it is the first study to compare hs-TnT and hs-TnI in ICI-treated patients and to evaluate their interchangeability in the context of screening. Results: Among 59 patients, the mean patient age was 68 years, and 76% were men. Overall, 25% of patients received combination therapy. Although 10.6% [95% CI: 5.0-22.5] of the patients developed troponin elevations, none experienced a CV event. No significant changes were found in 3D left ventricular (LV) ejection fraction nor in global longitudinal strain f (56 ± 6% vs. 56 ± 6%, p = 0.903 and -17.8% [-18.5; -14.2] vs. -17.0% [-18.8; -15.1], p = 0.663) at 3 months. There were also no significant changes in diastolic function and right ventricular function. In addition, there was poor agreement between hs-TnT and hs-TnI. Methods: Here, we present a preliminary analysis of the first 59 patients included in our ongoing prospective clinical trial (NCT05699915) during the first three months of treatment. All patients underwent electrocardiography and echocardiography along with blood sampling at standardized time intervals. This study aimed to investigate the incidence of elevated hs-TnT levels within the first three months of ICI treatment. Elevations were defined as hs-TnT above the upper limit of normal (ULN) if the baseline value was normal, or 1.5 ≥ times baseline if the baseline value was above the ULN. Conclusions: Hs-TnT elevations occurred in 10.6% of the patients. However, no significant changes were found on 3D echocardiography, nor did any of the patients develop a CV event. There were also no changes found in NT-proBNP. The study is still ongoing, but these preliminary findings do not show a promising role for cardiac troponins nor for echocardiographic dynamics in the prediction of CV events during the early stages of ICI treatment.

Comparing pill counts and patient self-reports versus DBS tenofovir concentrations as ART adherence measurements with virologic outcomes and HIV drug resistance in a cohort of adolescents and young adults failing ART in Harare, Zimbabwe

BackgroundMonitoring adherence presents a challenge in adolescents and it is prudent to explore several options for determining their level of adherence. This study sought to determine ART adherence levels in adolescents and young adults (on a tenofovir-containing regimen) failing ART as measured by self-reports, pill counts and DBS tenofovir concentrations and to compare levels of agreement among the methods and determine the ability of each method to predict virological suppression. MethodsThis was a cohort study involving 107 adolescents and young adults between 10 and 24 years failing ART with viral load > 400copies/ml at enrolment. Pill count (PC) records, self-reports (SR) and DBS tenofovir concentrations (done by liquid Chromatography with tandem mass spectrometry (LC-MS/MS)) were used to determine adherence in adolescent participants failing ART in Harare. The latter was used as the reference method with a cut-off of 64 ng/ml. Determination of DBS tenofovir concentrations was also performed to rule out inadequate viral response due to low cumulative drug exposure despite high adherence (≥90 %). Longitudinal analysis was performed to determine the correlation of viral loads (VL) with adherence. The Kappa (k) coefficient was used to evaluate the level of agreement among the 3 methods. ResultsPoor level of agreement was found between PC records and DBS tenofovir concentrations (k = −0.115). Moderate agreement was found between DBS and SR methods (k = 0.0557). Slight agreement was found between PC and SR methods (k = 0.0078). Adherence was dependent on age at HIV diagnosis (p = 0.0184) and ART initiation (p = 0.0265). Participants who were adherent were six times more likely to be suppressed at end point than their non-adherent counterparts (OR=5.7 CI 2.1 – 16.5, p < 0.0001). ConclusionsSelf-reported measure of adherence and pill counts exhibited poor agreement with the reference method used i.e. DBS tenofovir concentrations and are thus not effective methods of predicting virological suppression. Trial identificationParticipants in the present study were a subset of those in the PESU intervention ClinicalTrials.gov Identifier: NCT02833441

Computational comparison of paratropicity trends in antiaromatic s‐indacene derivatives: Does the functional “make all the difference”?

AbstractA recent publication by Wu and co‐workers demonstrated that the workhorse functional B3LYP tends to overemphasize the delocalization in antiaromatic molecules, leading to poor agreement between the calculated proton NMR values and the experimentally obtained numbers. Rather, they showed that the M11 functional affords the best agreement between theory and experiment. We have computationally re‐examined our previously published NICS‐XY scan data using M11‐determined geometries and find that, aside from the placement of s‐indacene, the antiaromaticity trends for both sets of data are essentially identical.

Zero-echo time MRI: an alternative method for the diagnosis of urinary stones in children.

To evaluate the potential of zero-echo time-magnetic resonance imaging (ZTE-MRI) in the assessment of urolithiasis and compare ZTE-MRI with computed tomography (CT) in pediatric patients. This was a single-center, prospective cross-sectional study conducted between April 2023 and December 2023. 23 patients (12 girls, 11 boys; mean age: 12.3, range 1-18) with urinary tract stones detected on non-enhanced abdominal CT were enrolled. The images were evaluated independently by two radiologists for the presence, and number of stones in the kidneys, ureters, and bladder. In the second session, two radiologists evaluated whether urinary tract stones could be detected by MRI compared to CT, and the maximum diameter of the stones was measured. The CT and MRI results were compared with the Wilcoxon test. The agreement between the results of the observers was examined using Spearman's rho correlation coefficient and the intraclass correlation coefficient. A total of 58 urinary tract stones were detected by CT and 39 of these were detected by MRI. Most of the stones that MRI could not detect were < 5 mm and the detection sensitivity of MRI increased in correlation with stone size (p < 0.001). There was poor intermodality agreement for stones < 5 mm, substantial agreement for stones 5-10 mm, and almost perfect agreement for stones > 10 mm. Interobserver agreement for stone detection on MRI was almost perfect for stones > 10 mm and 5-10 mm and was substantial for stones < 5 mm. ZTE-MRI is a promising modality for detecting urinary stones without radiation exposure in children. Zero-echo time-magnetic resonance imaging is a potential method for identifying urinary stones in children and other populations who are particularly sensitive to radiation. Urinary system stone disease in children is increasing and imaging is needed for managing urolithiasis. Zero-echo time-magnetic resonance imaging (ZTE-MRI) had an accuracy of 81.8% and 93.7% for stones larger than 5 mm and 10 mm, respectively. ZTE-MRI is a potential non-irradiating method for the diagnosis and management of urolithiasis.

Intuiting or rationalising self-other agreement in leadership?

PurposeCongruent self-other agreement in leadership evaluations is associated with positive outcomes such as work unit performance. In contrast, poor self-other agreement in leadership evaluations is associated with negative outcomes such as leaders making ineffective job-relevant decisions. This study examined whether the extent of leaders’ preference for intuitive and rational thinking predicted self-other agreement in leadership evaluations.Design/methodology/approachSelf-ratings and follower ratings of transformational leadership were analysed for 160 dyad pairs of leaders and followers (n = 320). Leaders self-rated their preference for rational and intuitive thinking. Response surface analysis was used to model the relationship between self-other agreement and leaders’ thinking styles.FindingsAs ratings of transformational leadership increased in both leaders and followers, we observed higher scores on preferences for both rational and intuitive thinking. Leaders’ preference for intuitive thinking showed a curvilinear relationship with self-other agreement, such that more intuitive thinking was related to higher leader–follower congruence in ratings of transformational leadership. We further uncovered that higher leader preferences for rational thinking were related to increased leader–follower disagreement in transformational leadership ratings.Originality/valueResearch has focused more on the outcomes than antecedents of self-other agreement in leadership. Thinking styles have undergone limited examination as antecedents of self-other agreement in leadership evaluations. Thinking styles are semi-malleable traits that can be used for the selection of leadership potential and developed to improve leadership performance. The current research suggests that relationships between thinking styles and self-other agreement on leadership effectiveness are more complicated than first thought.

High triglyceride-glucose index and HOMA-IR are associated with different cardiometabolic profile in adults from the ELSA-Brasil study

Background and aimsInsulin resistance (IR) is a risk factor for several cardiometabolic disorders; however, there is conflicting evidence about the reliability of certain IR markers. In this context, the triglyceride-glucose index (TyG) has been proposed as a surrogate marker for IR. This study aimed to compare the TyG index and homeostasis model assessment of insulin resistance (HOMA-IR). Methods and resultsA cross-sectional analysis was conducted using baseline data from 11,314 adults (aged 35–74 years) from the ELSA-Brasil study. The correlation between TyG and HOMA-IR, their interrater reliability, and their predictive value in identifying metabolic syndrome (MetS) were assessed. The mean TyG and HOMA-IR in our sample were 8.81 ± 0.52 and 2.78 ± 1.58 for men, and 8.53 ± 0.48 and 2.49 ± 1.38 for women, respectively. TyG and HOMA-IR showed a weak to moderate correlation with each other (Pearson’s r for men: 0.395 and 0.409 for women, p-value <0.05) and other markers of glycemic metabolism. Additionally, the area under the curve for the prediction of MetS was greater for TyG than HOMA-IR, regardless of sex (TyG: 0.836 for men and 0.826 for women; HOMA-IR: 0.775 for men and 0.787 for women). The concordance between these markers was low (Coheńs kappa coefficient: 0.307 for men and 0.306 for women). Individuals with increased TyG exhibited mainly anthropometrical and glycemic metabolic alterations, whereas those with elevated HOMA-IR displayed mostly lipid-associated metabolic alterations. ConclusionTyG and HOMA-IR might indicate different profiles of cardiometabolic disorders, showing poor agreement in classifying individuals (normal vs. altered) and a weak correlation. Therefore, further studies are needed to investigate the role of TyG as a surrogate marker of IR.

What is the Utilization and Impact of Advanced Imaging for Tibial Tubercle Fractures? An Analysis of 598 Patients From the Tibial Tubercle Study (TITUS) Group.

Given the rare nature of tibial tubercle fractures, previous studies are mostly limited to small, single-center series. This results in practice variation. Previous research has shown poor surgeon agreement on utilization of advanced imaging, but improved evidence-based indications may help balance clinical utility with resource utilization. The purpose of this study is to quantify diagnostic practices for tibial tubercle fractures in a large, multicenter cohort, with attention to the usage and impact of advanced imaging. This is a retrospective series of pediatric tibial tubercle fractures from 7 centers between 2007 and 2022. Exclusion criteria were age above 18 years, missing demographic and pretreatment data, closed proximal tibial physis and tubercle apophysis, or a proximal tibia fracture not involving the tubercle. Demographic and injury data were collected. Fracture classifications were derived from radiographic evaluation. The utilization of advanced imaging was recorded as well as the presence of findings not identified on radiographs. Standard descriptive statistics were reported, and χ2 tests were performed (means reported±SD). A total of 598 patients satisfied the inclusion criteria, of which 88.6% (530/598) were male with a mean age of 13.8±1.9 years. Internal oblique x-rays were obtained in 267 patients (44.6%), computed tomography (CT) in 158 (26.4%), and magnetic resonance imaging (MRI) in 64 (10.7%). There were significant differences in the frequency at which CT (7.2% to 79.4%, P<0.001) and MRI were obtained (1.5% to 54.8%, P<0.001). CT was obtained most frequently for Ogden type IV fractures (50/99, 50.5%), and resulted in novel findings that were not visualized on radiographs in a total of 37/158 patients (23.4%). The most common finding on CT was intra-articular fracture extension (25/37). MRI was obtained most frequently for Ogden type V fractures (13/35, 37.1%), and resulted in novel findings in a total of 31/64 patients (48.4%). The most common finding was patellar tendon injury (11/64), but only 3 of these patients required tendon repair. Substantial variation exists in the diagnostic evaluation of tibial tubercle fractures. CT was most helpful in clarifying intra-articular involvement, while MRI can identify patellar tendon injury, periosteal sleeve avulsion, or a nondisplaced fracture. This study quantifies variation in diagnostic practices for tibial tubercle fractures, highlighting the need for evidence-based indications for advanced imaging. Level III.

Accuracy of Healthcare Professionals' Estimations of Health Literacy and Numeracy of Patients Visiting Metabolic Bariatric Surgery Clinic.

To effectively support patients through their weight loss journey, it is vital that healthcare professionals (HCPs) understand the health literacy skills of their patients and communicate in a way that meets these needs. This is the first study looking at the accuracy of HCPs' estimations of their patients' health literacy and numeracy attending a metabolic bariatric surgery (MBS) clinic. A cross-sectional study was completed at a tertiary-level MBS clinic in London. Patients completed a demographic questionnaire and a validated measure of health literacy and numeracy, the Medical Term Recognition Test (METER) and General Health Numeracy Test-Short Form (GHNT-6), respectively. HCPs provided estimations of their patient's health literacy and numeracy based on each questionnaire's scoring categories. Data was collected for 31 patients. A 80.6% of patients had functional health literacy based on METER. HCPs estimated patients' health literacy correctly 61.1% of the time; inter-rater agreement was poor (ICC = 0.14; 95% CI = - 0.19, 0.443; p = 0.202). A total of 22.6% of patients scored 0 out of 6 on GHNT-6. HCPs estimated health numeracy correctly 13.9% of the time and were more likely to overestimate than underestimate health numeracy. Inter-rater agreement for health numeracy was poor (ICC = - 0.2; 95% CI = - 0.49, 0.14; p = 0.878). There is poor agreement between HCPs' perception of their patients' health literacy and numeracy and their assessed ability. HCPs' understanding of their patient's health literacy and numeracy skills is vital in ensuring HCPs can support patients through the challenging bariatric surgical pathway, consenting process and post-operative course.

Radiologic Decision-Making for Imaging in Pulmonary Embolism: Accuracy and Reliability of Large Language Models—Bing, Claude, ChatGPT, and Perplexity

Abstract Background Artificial intelligence chatbots have demonstrated potential to enhance clinical decision-making and streamline health care workflows, potentially alleviating administrative burdens. However, the contribution of AI chatbots to radiologic decision-making for clinical scenarios remains insufficiently explored. This study evaluates the accuracy and reliability of four prominent Large Language Models (LLMs)—Microsoft Bing, Claude, ChatGPT 3.5, and Perplexity—in offering clinical decision support for initial imaging for suspected pulmonary embolism (PE). Methods Open-ended (OE) and select-all-that-apply (SATA) questions were crafted, covering four variants of case scenarios of PE in-line with the American College of Radiology Appropriateness Criteria. These questions were presented to the LLMs by three radiologists from diverse geographical regions and setups. The responses were evaluated based on established scoring criteria, with a maximum achievable score of 2 points for OE responses and 1 point for each correct answer in SATA questions. To enable comparative analysis, scores were normalized (score divided by the maximum achievable score). Result In OE questions, Perplexity achieved the highest accuracy (0.83), while Claude had the lowest (0.58), with Bing and ChatGPT each scoring 0.75. For SATA questions, Bing led with an accuracy of 0.96, Perplexity was the lowest at 0.56, and both Claude and ChatGPT scored 0.6. Overall, OE questions saw higher scores (0.73) compared to SATA (0.68). There is poor agreement among radiologists' scores for OE (Intraclass Correlation Coefficient [ICC] = −0.067, p = 0.54), while there is strong agreement for SATA (ICC = 0.875, p &lt; 0.001). Conclusion The study revealed variations in accuracy across LLMs for both OE and SATA questions. Perplexity showed superior performance in OE questions, while Bing excelled in SATA questions. OE queries yielded better overall results. The current inconsistencies in LLM accuracy highlight the importance of further refinement before these tools can be reliably integrated into clinical practice, with a need for additional LLM fine-tuning and judicious selection by radiologists to achieve consistent and reliable support for decision-making.

Can chatbots enhance the management of pediatric sialadenitis in clinical practice?

The purpose of this study was to assess how well ChatGPT, an AI-powered chatbot, performed in helping to manage pediatric sialadenitis and identify when sialendoscopy was necessary. 49 clinical cases of pediatric sialadenitis were retrospectively reviewed. ChatGPT was given patient data, and it offered differential diagnoses, proposed further tests, and suggested treatments. The decisions made by the treating otolaryngologists were contrasted with the answers provided by ChatGPT. Analysis was done on ChatGPT response consistency and interrater reliability. ChatGPT showed 78.57% accuracy in primary diagnosis, and 17.35% of cases were considered likely. On the other hand, otolaryngologists recommended fewer further examinations than ChatGPT (111 vs. 60, p < 0.001). For additional exams, poor agreement was found between ChatGPT and otolaryngologists. Only 28.57% of cases received a pertinent and essential treatment plan via ChatGPT, indicating that the platform's treatment recommendations were frequently lacking. For treatment ratings, judges' interrater reliability was greatest (Kendall's tau = 0.824, p < 0.001). For the most part, ChatGPT's response constancy was high. Although ChatGPT has the potential to correctly diagnose pediatric sialadenitis, there are a number of noteworthy limitations with regard to its ability to suggest further testing and treatment regimens. Before widespread clinical use, more research and confirmation are required. To guarantee that chatbots are utilized properly and effectively to supplement human expertise rather than to replace it, a critical viewpoint is required.

Reference Ranges and Comparison of Pepsinogen by Chemiluminescence Immunoassay and Enzyme-Linked Immunosorbent Assay in Chinese Population.

Serum pepsinogen (PG) is a good indicator of atrophic changes in the gastric mucosa. Gastric mucosal atrophy is a high-risk factor for gastric cancer. Serological testing for PG combined with endoscopy can help to improve gastric cancer screening. In this study, we established the reference ranges of serum PG-I, PG-II, and the PG-I/II ratio (PGR) in the Chinese population by chemiluminescence immunoassay (CLIA) and enzyme-linked immunosorbent assay (ELISA). Besides, in the real world, doctors are often confused by the results of different testing platforms. Thus, a comparison of methods CLIA and ELISA was performed. 2904 individuals were enrolled from six regions in China as part of the Chinese Adult Digestive Diseases Surveillance (2016) program. The individuals completed questionnaires and volunteered to undergo examinations, including gastroscopy, urea breath test, abdominal ultrasound examination and routine serologic tests. Serum was collected to measure PGs (including PG-I, PG-II and PGR) by CLIA and ELISA. Participants who were found obvious abnormalities or absent from the examinations were excluded. Ultimately, 747 healthy individuals were enrolled in this study. The Kolmogorov-Smirnov test was used to assess the distribution of variables. The Kruskal-Wallis H or Mann-Whitney U-tests were used to compare different sex, age, and geographical groups. The 95% reference ranges of PGs obtained by the two methods were established according to document CLSI-EP28-A3, with covariates of sex, age, and region. Spearman correlation analysis, linear regression analysis and allowable total error (ATE) zone analysis were utilized for comparing the two methods. On overall, the 95% reference ranges of PG-I, PG-II, and PGR measured by CLIA were 23.00-110.64 ng/mL, 2.50-19.13 ng/mL, and 3.87-13.30, respectively. Meanwhile, the reference ranges of PG-I, PG-II, and PGR measured by ELISA were 36.93-205.06 ng/mL, 1.65-17.96 ng/mL, and 7.50-33.60, respectively. Both PG-I and PG-II levels measured by the two platforms were found to be influenced by sex and age. PGR measured by CLIA was influenced by age but not by sex, while PGR measured by ELISA was not affected by either age or sex. Regional factors did not significantly impact the PG results, except for PG-I detected by ELISA. Ultimately, reference ranges for PGs were established based on age and sex stratification. Additionally, the Spearman correlation analysis revealed that the correlation coefficients for PG-I, PG-II, and PGR detected by the two methods were 0.899, 0.887, and 0.777, respectively, indicating a strong correlation between the two methods. The regression equation for the PG levels detected by two methods was obtained through linear regression analysis. The ATE analysis provided a visual depiction of the consistency between the two methods, clearly indicating the poor agreement between them. This study established the reference ranges of PGs by strict and intact enrollment standard. In addition, the results indicated a strong linear relationship between the two methods, yet with a clear bias, which was valuable for laboratory interpretation.

The validity and reliability of CT scan based tibial plateau mapping for tibial plateau fractures

Introduction The Schatzker and computed tomography (CT)-based three-column classifications are the most used for tibial plateau fractures. The newer “10-segment classification” suggested to have better fracture identification and more accurate planning. This study aimed to assess the interobserver and intraobserver reliability of this new classification and to clarify its validity in clinical practice. Patients and methods A retrospective analysis of 30 patients with tibial plateau fractures who were admitted to a university hospital through the period between January 2020 and December 2022 was done. Patients with complete preoperative imaging, including radiographs, CT scans with three-dimensional reconstruction, and postoperative radiographs were included. Missing imaging, open fractures, pathological fractures, conservative management, or definitive fixation by circular external fixator were excluded. Data were reviewed independently by three expert trauma surgeons twice with 2-week intervals with randomization of case sequencing to evaluate their interobserver and intraobserver reliability for the Schatzker, CT-based three-column, and the new 10-segment classifications. The validity of the 10-segment classification was assessed by the agreement on the approach and implant position suggested by the observers. Results Good interobserver and intraobserver reliability was found as regards the Schatzker and CT-based three-column classifications on both intervals. Moderate and poor interobserver reliability “on both intervals respectively” and poor intraobserver reliability was found for the 10-segment classification. As regards the agreement on surgical approach on both time intervals, moderate and good interobserver agreements were found. For the implant position, poor interobserver agreement on both intervals was found. Intraobserver agreement for the surgical approach was good, while the intraobserver agreement for the implant position was moderate. Conclusion The Schatzker and CT-based three-column classifications are still more reliable than the newer 10-segment classification. This may be explained as it is still not familiar to surgeons and needs more training to be applied in clinical practice.

Repeatability of Automatic Measurements by an Anterior Segment Swept-Source OCT Biometer in Patients With Keratoconus.

To evaluate the repeatability of automatic measurements of a new anterior segment optical coherence tomographer (ANTERION; Heidelberg Engineering) and their agreement with an anterior segment optical coherence tomography device combined with Placido disc corneal topography (MS-39; CSO) in patients affected by keratoconus. Fifty-four consecutive patients were included. Three measurements were performed with the ANTERION and one with the MS-39. Repeatability was assessed by means of within-subject standard deviation, coefficient of variation (CoV), and intraclass correlation coefficient (ICC). Agreement was investigated with the 95% limits of agreement. The paired t-test and Wilcoxon matched-pairs test were performed to compare the measurements of the different devices. Repeatability of ANTERION measurements was high, with an ICC greater than 0.98 for all parameters. Many parameters revealed a CoV of less than 1% and a CoV within 5% was obtained for astigmatism measurements. The ANTERION measured a significantly higher corneal power and the MS-39 more negative posterior keratometric values. These differences were mirrored by a moderate agreement for mean simulated keratometry and poor agreement for total corneal power and posterior keratometry. The ANTERION revealed high repeatability of automatic measurements and good agreement with the MS-39 for many parameters in patients affected by keratoconus, but for most parameters the two instruments cannot be considered interchangeable. [J Refract Surg. 2024;40(7):e445-e452.].

EVALUATION OF EFFICACY OF COLOUR CORRECTED LIGHT SOURCE IN DETERMINING THE ACCURACY OF SHADE MATCHING DONE WITH A COMMONLY USED SHADE GUIDE SYSTEM BY CONVENTIONAL VISUAL METHOD AND AN INTRA ORAL SPECTROPHOTOMETER

Aim: The objective of this study was to evaluate the efficiency of colour corrected light source in shade matching and to determine accuracies and inter-rater agreement of three shade matching methods (conventional visual method, visual method using colour corrected light source and spectrophotometric method). Methodology: In the conventional visual method and the visual method using colour corrected light source, four examiners with normal colour vision matched five target control shade tabs taken from the VITAPAN 3D MasterTM shade guide, with other full set of the same shade guide. Shade matching with the colour corrected light source was done under daylight mode simulating 5500K or natural daylight. Each tab was matched three times to determine repeatability of visual examiners. In the spectrophotometric method, two independent examiners matched the control tabs with three repetitions for each tab. The data was collected and statistical analysis was performed. Results: Visual method using colour corrected light source produced more accurate results (80%) than the conventional visual method (68.3%) and spectrophotometric method (0%), thus proving the efficacy of colour corrected light source (p&lt;0.05). All three methods exhibited poor inter-rater agreement. Conclusion: The question is whether handheld light correcting devices and digital assessments are clinically useful or are they unreliable andunnecessary costly. Even though visual shade matching is subjective, it is not inferior and should not be underrated. The low accuracy value obtained for the spectrophotometer may be a misrepresentation of the machines capabilities due to its inability to measure any reading asclose to the correct value. If both analyses are combined, digital determination of the basic shade and visual determination of the effects, can provide the best possible esthetic outcome. Although human eye will be the finalarbitrator, success can best be achieved by combining traditional artistic techniques with advancements in technology, complemented with innovations in colour-related research, education, and training of dental professionals.

In‐situ measurement of dissolved organic carbon and total organic carbon in fresh surface waters: Lab validation of a portable field meter

AbstractNonliving organic matter, including organic carbon, in freshwater systems provides energy inputs to food webs and supports various ecosystem functions. Unusually high organic carbon levels can occur naturally in aquatic habitats such as wetlands and blackwater rivers and streams. However, values may also be high due to anthropogenic influences. In recent years, increasing levels of organic carbon have been observed and suggested as drivers of brownification and increased observation of foam on surface waters. Total organic carbon (TOC) and dissolved organic carbon (DOC) are not commonly included in field studies of aquatic ecosystems because of sampling logistics and resources required for laboratory measurement. As a potential alternative to laboratory analysis, we evaluated the effectiveness of a portable field meter by comparing laboratory results to data collected in situ. Comparisons were made at 43 surface water sites across northern West Virginia. At each of these sites, a field measurement was recorded using a Real TOC/DOC Field Meter, and a water sample was collected and transported for laboratory measurement using a Shimadzu TOC‐V analyzer. Data from the laboratory and field for each site were compared using bivariate analysis and concordance correlation on matched pairs. Poor agreement existed between field and lab measurements, so a novel data model was created using laboratory‐derived data for further comparison. Substantial accuracy was achieved using the new data model. This suggests that the Real TOC/DOC Field Meter is a viable instrument for field measurement of organic carbon in aquatic ecosystems and may aid in monitoring and management decisions.

Dedicated Photon-Counting CT for Detection and Classification of Microcalcifications: An Intraindividual Comparison With Digital Breast Tomosynthesis.

Clinical experience regarding the use of dedicated photon-counting breast CT (PC-BCT) for diagnosis of breast microcalcifications is scarce. This study systematically compares the detection and classification of breast microcalcifications using a dedicated breast photon-counting CT, especially designed for examining the breast, in comparison with digital breast tomosynthesis (DBT). This is a prospective intraindividual study on women with DBT screening-detected BI-RADS-4/-5 microcalcifications who underwent PC-BCT before biopsy. PC-BCT images were reconstructed with a noninterpolated spatial resolution of 0.15 × 0.15 × 0.15 mm (reconstruction mode 1 [RM-1]) and with 0.3 × 0.3 × 0.3 mm (reconstruction mode 2 [RM-2]), plus thin-slab maximum intensity projection (MIP) reconstructions. Two radiologists independently rated the detection of microcalcifications in direct comparison with DBT on a 5-point scale. The distribution and morphology of microcalcifications were then rated according to BI-RADS. The size of the smallest discernible microcalcification particle was measured. For PC-BCT, the average glandular dose was determined by Monte Carlo simulations; for DBT, the information provided by the DBT system was used. Between September 2022 and July 2023, 22 participants (mean age, 61; range, 42-85 years) with microcalcifications (16 malignant; 6 benign) were included. In 2/22 with microcalcifications in the posterior region, microcalcifications were not detectable on PC-BCT, likely because they were not included in the PC-BCT volume. In the remaining 20 participants, microcalcifications were detectable. With high between-reader agreement (κ > 0.8), conspicuity of microcalcifications was rated similar for DBT and MIPs of RM-1 (mean, 4.83 ± 0.38 vs 4.86 ± 0.35) (P = 0.66), but was significantly lower (P < 0.05) for the remaining PC-BCT reconstructions: 2.11 ± 0.92 (RM-2), 2.64 ± 0.80 (MIPs of RM-2), and 3.50 ± 1.23 (RM-1). Identical distribution qualifiers were assigned for PC-BCT and DBT in 18/20 participants, with excellent agreement (κ = 0.91), whereas identical morphologic qualifiers were assigned in only 5/20, with poor agreement (κ = 0.44). The median size of smallest discernible microcalcification particle was 0.2 versus 0.6 versus 1.1 mm in DBT versus RM-1 versus RM-2 (P < 0.001), likely due to blooming effects. Average glandular dose was 7.04 mGy (PC-BCT) versus 6.88 mGy (DBT) (P = 0.67). PC-BCT allows reliable detection of in-breast microcalcifications as long as they are not located in the posterior part of the breast and allows assessment of their distribution, but not of their individual morphology.