Traditional Clinical Examination Research Articles

MSK ultrasound imaging-assisted clinical examination.

Musculoskeletal disorders are a significant global health concern, affecting over 1.71 billion individuals worldwide, with a considerable impact on quality of life and economic burden due to healthcare costs and productivity losses. In the United Kingdom, approximately one-third of the population suffers from musculoskeletal disorders, underscoring the need for effective diagnostic and management strategies. Musculoskeletal ultrasound imaging emerges as a preferred diagnostic modality, offering a balance between technical capabilities and cost-effectiveness, owing to its non-invasive nature, portability and lack of radiation exposure. However, the operator-dependent nature of musculoskeletal ultrasound imaging necessitates specialised training for medical and healthcare professionals. The integration of musculoskeletal ultrasound imaging into traditional clinical examinations, known as ultrasound imaging-assisted clinical examination (UIACE), enhances traditional diagnostic processes by providing immediate visual feedback, facilitating a more accurate and comprehensive assessment of musculoskeletal conditions. This approach not only refines diagnosis in cases with ambiguous symptoms or overlapping signs but also significantly improves patient reassurance and management strategies. In addition, incorporating musculoskeletal ultrasound imaging into medical education through ultrasound imaging-assisted clinical examination offers students a dynamic, interactive learning experience, fostering a deeper understanding of clinical anatomy and examination skills. By advocating for its systematic inclusion in the undergraduate medical curriculum, the study highlights the potential to enhance the competence and confidence of future professionals in utilising ultrasound imaging, ultimately improving patient outcomes in musculoskeletal care.

Hypothyroidism Revisited: Defining the Subgroups on Optimal Thyroxine Replacement Who Have Persisting Symptoms

Hypothyroid patients on optimal replacement but with persisting symptoms continue to be a challenge for their treating physicians. This commentary is based on a substantial clinical experience with this subpopulation. With the focus on laboratory tests to achieve a diagnosis, aspects of the traditional clinical examination have been overlooked. In particular the routine testing of tendon reflexes has lapsed. A delay in the relaxation phase of tendon reflexes (hypothyroid hyporeflexia), once known as a positive Woltman’s sign, has long been the hallmark sign of overt hypothyroidism. The majority will do well when treated with appropriate thyroxine replacement. This sign is also positive in those patients on thyroxine (T4) with normal T4 and Thyrotropin (TSH) levels if they have symptomatic intracellular Triiodothyronine (T3) deficiency. These patients will respond promptly to combination therapy (T4+T3). This subgroup accounts for more than half of the thyroxine-dissatisfied population. They should be described as having T3-hypothyroidism. The remaining symptomatic patients with normal reflexes have unrelated conditions. A small clearly defined subgroup with autoimmune symptoms and very high anti-Thyroperoxidase (anti-TPO) antibodies (>10 times the upper limit of normal) will respond to total thyroidectomy with a marked improvement that is maintained for 3-5 years. They can be categorised as having TPO-toxic hypothyroidism. Many patients can have persistent symptoms because of psycho-social issues and the burden of having a chronic disease. They have in-denial-hypothyroidism. There are very rare cases of thyroxine allergy. This nomenclature should assist physicians in their diagnosis and management of the several subgroups of patients on thyroxine with persistent symptoms.

Rapid Fingerprinting of Urinary Volatile Metabolites and Point-of-Care Diagnosis of Phenylketonuria on a Patterned Nanorod Sensor Array with Multiplexed Surface-Enhanced Raman Scattering Readouts.

Phenylketonuria (PKU) is one of the most common genetic metabolic diseases, especially among newborns. Traditional clinical examination of newborn blood samples for PKU is invasive, laborious, and limited to hospitals and healthcare facilities. We reported herein a SERS-based sensor array with three thiophenolic nanoreceptors built on a patterned nanorod vertical array for rapid and inexpensive detection of characteristic volatile biomarkers indicative of PKU in the urine and accurate classification of newborn baby patients all performed on a hand-held SERS spectrophotometer. The well-ordered array was generated from the volatility-driven assembly of gold nanorods (AuNRs) into an upright and closely packed hexagonal configuration. The uniformly distributed nanowells between AuNRs offered an intense and aspect-ratio-dependent plasmonic field for the molecular enhancement of SERS outputs. The SERS-based detector was integrated into a test chip for regular monitoring of volatile phenylketone bodies in the spiked solution or patients' urine within 5 min, allowing the quantification of a wide variety of normal or abnormal metabolites at their physiologically relevant concentration range. The detection limits for common biomarkers of PKU, including phenylpyruvic acid, 4-hydroxyphenylacetic acid, and phenylacetic acid, were at a few μM and well below the diagnostic thresholds. Moreover, the volatile headspace mixtures from a given urine sample could be fingerprinted by the sensor array and discriminated using machine-learning algorithms. Ultimately, the discrimination of baby patients among 26 cases of mild and classic PKU phenotypes and 17 cases of healthy volunteers could be realized with an overall accuracy of 97%. This hand-held SERS platform plays a pivotal role in advancing healthcare applications in quick screening of neonatal PKU through a facile urinary vapor test.

Diagnostic reproducibility of the 2018 Classification of Gingival Recessions: Comparing photographic and in-person diagnoses.

To assess how the diagnostic reproducibility of the 2018 Classification of Gingival Recession Defects (GRD) could be applied when comparing in-person chairside measurements with photographic measurements. Thirty-four GRD were photographed and evaluated by 4 masked operators. For each case, the operators measured twice recession type (RT), recession depth (RD), keratinized tissue width (KTW), gingival thickness (GT), detectability of the cemento-enamel junction (CEJ), and presence of root steps (RSs), chairside, and on photographs. Intraclass correlation coefficient (ICC) with 95% confidence intervals (CI) was calculated for RD and KTW; Kappa with 95% CI was used for GT, CEJ, and RS; quadratic weighted Kappa with 95% CI was used for RT. RD, KTW, and RT showed excellent overall intra-operator agreement (>0.93), and from good to excellent overall inter-operator agreement (>0.80), for both clinical and photographic measurements. Agreements were lower for GT, CEJ, and RS. Overall clinical and photographic agreements were within 0.1 difference for every variable, except for inter-operator agreement for RS which was 0.72 for clinical measurements and 0.45 for photographic measurements. The lowest overall agreement between clinical versus photographic measurements existed for CEJ (0.28) and RS (0.35). Variables composing the 2018 Classification of GRD are reproducible, both clinically and on photographs, with comparable agreements. The overall agreement was higher for KTW, RD, and RT, and lower for GT, CEJ, and RS, for both clinical and photographic measurements. The comparison between chairside and photographic evaluations indicated fair to excellent agreement for most variables, with CEJ and RS showing fair agreement. As digital diagnostics evolve to facilitate clinical diagnostic measurement, we aimed to assess the effectiveness of intraoral photography for diagnosing gingival recession defects (GRD) according to the 2018 Classification of GRD, compared to traditional clinical examination. Standardized photographs of thirty-four GRD cases were captured. Four masked operators evaluated the same gingival recessions twice in a clinical setting and twice using photographs. Measurement repeatability within and between operators was calculated for both clinical and photographic settings, and the two settings were compared. Continuous measurements such as recession depth and keratinized tissue width, as well as the evaluation of interproximal attachment height (recession type), showed excellent agreement both clinically and photographically. Agreement was lower for gingival thickness and the detectability of tooth anatomical landmarks, such as the cemento-enamel junction and the presence of root steps. Overall, the agreement between chairside and photographic evaluations was generally good, but lower when evaluating tooth anatomical landmarks. The variables composing the 2018 Classification of GRD are reproducible in both clinical and photographic settings, with comparable levels of agreement. However, there was consistently worse agreement for gingival thickness and when evaluating tooth anatomical landmarks.

Radiomics analysis in predicting vascular invasion in gastric cancer based on enhanced CT: a preliminary study

BackgroundVascular invasion (VI) is closely related to the metastasis, recurrence, prognosis, and treatment of gastric cancer. Currently, predicting VI preoperatively using traditional clinical examinations alone remains challenging. This study aims to explore the value of radiomics analysis based on preoperative enhanced CT images in predicting VI in gastric cancer.MethodsWe retrospectively analyzed 194 patients with gastric adenocarcinoma who underwent enhanced CT examination. Based on pathology analysis, patients were divided into the VI group (n = 43) and the non-VI group (n = 151). Radiomics features were extracted from arterial phase (AP) and portal venous phase (PP) CT images. The radiomics score (Rad-score) was then calculated. Prediction models based on image features, clinical factors, and a combination of both were constructed. The diagnostic efficiency and clinical usefulness of the models were evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA).ResultsThe combined prediction model included the Rad-score of AP, the Rad-score of PP, Ki-67, and Lauren classification. In the training group, the area under the curve (AUC) of the combined prediction model was 0.83 (95% CI 0.76–0.89), with a sensitivity of 64.52% and a specificity of 92.45%. In the validation group, the AUC was 0.80 (95% CI 0.67–0.89), with a sensitivity of 66.67% and a specificity of 88.89%. DCA indicated that the combined prediction model might have a greater net clinical benefit than the clinical model alone.ConclusionThe integrated models, incorporating enhanced CT radiomics features, Ki-67, and clinical factors, demonstrate significant predictive capability for VI. Moreover, the radiomics model has the potential to optimize personalized clinical treatment selection and patient prognosis assessment.

Effects of virtual reality OSCE on nursing students’ education: a study protocol for systematic review and meta-analysis

IntroductionVirtual objective structured clinical examination (OSCE) has been shown to influence the performance of nursing students. However, its specific effects, particularly students’ competence, stress, anxiety, confidence, satisfaction with virtual reality...

Monitoring the after-effects of ischemic stroke through EEG microstates.

Stroke may cause extensive after-effects such as motor function impairments and disorder of consciousness (DoC). Detecting these after-effects of stroke and monitoring their changes are challenging jobs currently undertaken via traditional clinical examinations. These behavioural examinations often take a great deal of manpower and time, thus consuming significant resources. Computer-aided examinations of the electroencephalogram (EEG) microstates derived from bedside EEG monitoring may provide an alternative way to assist medical practitioners in a quick assessment of the after-effects of stroke. In this study, we designed a framework to extract microstate maps and calculate their statistical parameters to input to classifiers to identify DoC in ischemic stroke patients automatically. As the dataset is imbalanced with the minority of patients being DoC, an ensemble of support vector machines (EOSVM) is designed to solve the problem that classifiers always tend to be the majority classes in the classification on an imbalanced dataset. The experimental results show EOSVM get better performance (with accuracy and F1-Score both higher than 89%), improving sensitivity the most, from lower than 60% (SVM and AdaBoost) to higher than 80%. This highlighted the usefulness of the EOSVM-aided DoC detection based on microstates parameters. Therefore, the classifier EOSVM classification based on features of EEG microstates is helpful to medical practitioners in DoC detection with saved resources that would otherwise be consumed in traditional clinic checks.

Seeing beyond skin deep: High-resolution ultrasound in dermatology-A comprehensive review and future prospects.

High-resolution ultrasound (HRUS), operating at frequencies of 20-25 MHz, is a non-invasive imaging tool that offers dermatologists the ability to visualize structures beneath the skin surface. The objective of this review is to present a comprehensive overview of HRUS applications, emphasising its utility in diagnosing, characterising and managing various dermatological conditions. We undertook a comprehensive literature review on the dermatological application of HRUS across Medline, Embase and Cochrane Library databases, while also incorporating our own clinical experience of over 16 years with the tool. In normal skin, the epidermis and dermis are hyperechoic, and the subcutaneous layer is hypoechoic. Basal cell carcinomas appear hypoechoic with irregular margins, while the presence of hyperechoic inclusion bodies suggests aggressive pathology. Squamous cell carcinomas pose challenges due to acoustic shadow artefacts from the thickened stratum corneum. Melanomas are homogenous hypoechoic lesions, with HRUS used to accurately predict Breslow thickness. HRUS provides dermatologists with a valuable adjunct to traditional clinical examination. Future advancement in image resolution and the standardisation of diagnostic parameters may further expand its utility.

Assessing the Accuracy and Reliability of Cone-Beam Computed Tomography (CBCT) in Diagnosing Grade II and III Furcation Involvement Compared to Traditional Clinical Examination Methods.

Introduction Chronic periodontal diseases can lead to bone defects and tooth loss, making accurate diagnosis essential for treatment. Various methods are used for diagnosing furcation involvement, with clinical examination and cone-beam computed tomography (CBCT) being the most effective. CBCTproduces reliable images with submillimeter resolution, revealing marginal bone contours and furcation defects. Limited studies show that CBCTis more precise than clinical detection for diagnosing furcation involvement. Therefore, CBCTtechnology can be considered as an adjunct method for furcation involvement detection. This study tests the accuracy and efficiency of CBCTand clinical examination in detecting furcation involvement. Material and methods The study included 25 patients (68 molars) with generalized periodontitis of stage II to IV, Grade B and C. Inclusion criteria required at least two intrabony defects with probing depth > 6mm in both jaws and criteria of periodontitis in at least 30% of the teeth present. Results The study compared clinical examination and CBCTreadings for measuring maxillary and mandibular teeth furcation involvement. The results show significant differences between clinical and CBCT measurements of maxillary teeth furcation involvement, particularly in specific areas and types of furcation involvement. In contrast, there were significant differences between clinical and CBCTreadings for only a few measurements of mandibular teeth furcation involvement. Therefore, the study suggests that CBCTimaging may be beneficial for accurate diagnosis and treatment planning in cases of furcation involvement in maxillary teeth. Conclusion CBCTimaging is a reliable adjunct method for detecting furcation involvement in maxillary teeth, while clinical examination alone may not be sufficient. Therefore, the use of CBCTtechnology should be considered in cases where accurate detection of furcation involvement is necessary for successful treatment outcomes. However, further studies with larger sample sizes are needed to confirm these findings.

Al-Based Detection of Dental Caries: Comparative Analysis with Clinical Examination

ABSTRACT Dental caries pose a significant public health concern, affecting a vast population globally. Traditional clinical examination methods, although reliable, can be subject to human error and time-consuming. Artificial intelligence (AI) technologies have emerged as promising tools to enhance diagnostic accuracy and efficiency. This study explores the potential of AI in revolutionizing dental caries detection. Materials and Methods: A cohort of 50 patients with varying degrees of dental caries participated in this comparative analysis. Clinical examination by dental professionals served as the gold standard for caries detection. AI algorithms were trained using dental images, and their performance was evaluated against the clinical examination results. Results: The AI-based detection system demonstrated a sensitivity of 92% and a specificity of 85% in identifying dental caries, with an overall accuracy of 88%. The clinical examination yielded a sensitivity of 86% and a specificity of 90%, resulting in an overall accuracy of 88%. Statistical analysis indicated no significant difference between AI-based detection and clinical examination (P > 0.05). Conclusion: AI technology exhibits promise as an adjunctive tool for dental practitioners, potentially reducing diagnostic errors and improving efficiency. Integrating AI into routine dental practice may aid in early caries detection and promote better oral health outcomes.

The role of interleukin-6 in the development of protein-energy deficiency in patients on program hemodialysis

The development of protein-energy malnutrition (PEM) in patients on program hemodialysis is one of the significant problems of modern hemodialysis. Despite the relevance of this problem, there is no single point of view on the mechanisms of development of PEM in this cohort of patients. Objective. To assess the change in the level of interleukin-6 (IL6) in the blood of patients on program hemodialysis, and also to study the relationship between the level of IL6 in the blood serum and PEM indicators in this group of patients. Material and methods. The study involved 645 patients receiving treatment with program hemodialysis (300 men and 345 women; mean age – 56.8±12.8 years). All patients underwent a traditional clinical and laboratory examination. Results. In 66% of patients on hemodialysis, a significant increase in the level of IL6 in the blood was detected. Moreover, in patients with signs of PEM, the level of IL6 in the blood was statistically significantly higher compared to patients without signs of PEM. Also, patients with elevated IL6 levels had statistically significantly lower values of total protein, albumin, prealbumin, total cholesterol, transferrin and blood lymphocyte levels compared to patients with normal IL6 levels. Also, patients with elevated IL6 levels had statistically significantly lower values of body mass index, skeletal muscle mass and body fat mass compared to patients with normal IL6 levels. Conclusion. The data obtained suggest that an increase in the level of IL6 in the blood may be an important pathogenetic link in the development of PEM in patients receiving treatment with program hemodialysis.

Caries Lesion Assessment Using 3D Virtual Models by Examiners with Different Degrees of Clinical Experience.

Background and Objectives: Dental caries is a preventable, reversible disease in its early stages. This study evaluated the intra-rater agreement of International Caries Assessment and Detection System (ICDAS) scores with Medit i500® and Omnicam® scanners versus traditional clinical examinations and the inter-rater agreement using the Omnicam® among senior dentists and dental students and between these two groups. Materials and Methods: A total of 24 patients aged between 21 and 34 years, randomly selected from dental students and interns, underwent four examinations (three intraoral scans and one clinical examination), and the corresponding ICDAS scores were recorded by a randomly selected rater out of the 31 available examiners. The examination team consisted of dental students, dentists with less than 3 years, and dentists with more than 5 years of clinical experience. The following inter- and intra-rater agreement tests for the ordinal data were chosen: Fleiss' kappa coefficient, Cohen's weighted kappa, and inter-class correlations. Results: For all examination techniques, there was statistically significant agreement for the experienced raters (p < 0.05). The highest positive interclass correlation was obtained for inter-rater agreement tests of 288 observations recorded by senior dentists: ICC = 0.969 (95% CI 0.949-0.981). Conclusions: Intra-rater reliability was excellent for Omnicam compared to clinical exams conducted by senior dentists but moderate for Medit i500. Although inter-rater agreement using Omnicam was poor between students and between senior dentists and students, it was excellent among senior dentists.

Automated detection of abnormal respiratory sound from electronic stethoscope and mobile phone using MobileNetV2

Auscultation, a traditional clinical examination method using a stethoscope to quickly assess airway abnormalities, remains valuable due to its real-time, non-invasive, and easy-to-perform nature. Recent advancements in computerized respiratory sound analysis (CRSA) have provided a quantifiable approach for recording, editing, and comparing respiratory sounds, also enabling the training of artificial intelligence models to fully excavate the potential of auscultation. However, existing sound analysis models often require complex computations, leading to prolonged processing times and high calculation and memory requirements. Moreover, the limited diversity and scope of available databases limits reproducibility and robustness, mainly relying on small sample datasets primarily collected from Caucasians. In order to overcome these limitations, we developed a new Chinese adult respiratory sound database, LD-DF RSdb, using an electronic stethoscope and mobile phone. By enrolling 145 participants, 9,584 high quality recordings were collected, containing 6,435 normal sounds, 2,782 crackles, 208 wheezes, and 159 combined sounds. Subsequently, we utilized a lightweight neural network architecture, MobileNetV2, for automated categorization of the four types of respiratory sounds, achieving an appreciable overall performance with an AUC of 0.8923. This study demonstrates the feasibility and potential of using mobile phones, electronic stethoscopes, and MobileNetV2 in CRSA. The proposed method offers a convenient and promising approach to enhance overall respiratory disease management and may help address healthcare resource disparities.

Deep learning prediction model for central lymph node metastasis in papillary thyroid microcarcinoma based on cytology.

Controversy exists regarding whether patients with low-risk papillary thyroid microcarcinoma (PTMC) should undergo surgery or active surveillance; the inaccuracy of the preoperative clinical lymph node status assessment is one of the primary factors contributing to the controversy. It is imperative to accurately predict the lymph node status of PTMC before surgery. We selected 208 preoperative fine-needle aspiration (FNA) liquid-based preparations of PTMC as our research objects; all of these instances underwent lymph node dissection and, aside from lymph node status, were consistent with low-risk PTMC. We separated them into two groups according to whether the postoperative pathology showed central lymph node metastases. The deep learning model was expected to predict, based on the preoperative thyroid FNA liquid-based preparation, whether PTMC was accompanied by central lymph node metastases. Our deep learning model attained a sensitivity, specificity, positive prediction value (PPV), negative prediction value (NPV), and accuracy of 78.9% (15/19), 73.9% (17/23), 71.4% (15/21), 81.0% (17/21), and 76.2% (32/42), respectively. The area under the receiver operating characteristic curve (value was 0.8503. The predictive performance of the deep learning model was superior to that of the traditional clinical evaluation, and further analysis revealed the cell morphologies that played key roles in model prediction. Our study suggests that the deep learning model based on preoperative thyroid FNA liquid-based preparation is a reliable strategy for predicting central lymph node metastases in thyroid micropapillary carcinoma, and its performance surpasses that of traditional clinical examination.

Staging of Prostate Cancer: Role of Multiparametric Magnetic Resonance Imaging in Different Risk Classes.

Using multiparametric magnetic resonance imaging, it is now possible to diagnose prostate cancer and categorize its risk. As it can accurately determine the extracapsu- lar extension of the tumor, invasion of seminal vesicles, involvement of lymph nodes, and the potential presence of bone metastases, multiparametric magnetic resonance imaging plays a crucial role not only in the diagnosis but also in the local staging of prostate cancer. The patients with a history of negative biopsy/increasing prostate- specific antigen and the existence of further data supporting its use in biopsy-naive patients and active surveillance are the most blatant indications for multiparametric magnetic resonance imaging in guidelines. The traditional clinical examination, pros- tate-specific antigen tests, and systematic biopsy are all enhanced by multiparametric magnetic resonance imaging, which will miss certain cancers due to insufficient size or changes in tissue density. The use of multiparametric magnetic resonance imaging is expected to rise, and further advances in the method will be crucial for the secure adoption of targeted therapeutic ideas. Here, we give a succinct overview of multipa- rametric magnetic resonance imaging's application to the identification and risk clas- sification of prostate cancer.

Comparative Evaluation of Dental Caries Score Between Teledentistry Examination and Clinical Examination: A Systematic Review and Meta-Analysis.

Dental caries is a common dental health problem affecting all age groups across the globe. Accurate detection and assessment of dental caries are crucial for effective treatment and preventive measures. Teledentistry, which involves remote dental assessment using digital technologies, has shown promise as a potential tool for caries screening. This systematic review and meta-analysis aims to compare the dental caries scores obtained from clinical examinations and teledentistry assessments. Literature searches were conducted across databases such as PubMed, Embase, the Cochrane Library, Scopus, the Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO by using predefined search terms and inclusion criteria. Two reviewers separately extracted the data. The study designs, evaluation techniques, dentition types, mean scores, and follow-up times of the included studies were examined. The New Castle-Ottawa Scale was used to assess the risk of bias. Review Manager (RevMan) (computer program) Version 5.4, The Cochrane Collaboration 2020, was used for the quantitative assessment of the data. Eight studies met the inclusion criteria and were included in the review. The findings revealed that teledentistry assessments (based on intraoral photographs captured using smartphones or intraoral cameras) demonstrated comparable accuracy to traditional clinical examinations in detecting and assessing dental caries. Among the four studies that were quantitatively analysed, no significant difference was noted at p = 0.09. A mean difference of 0.64 (95% confidence interval (CI): -0.10; 1.38) suggested that clinical examination and teledentistry-based checkup were on par with each other for the detection of dental caries. The New Castle-Ottawa scale (NOS) grading indicated that the studies were of good quality. Teledentistry may be an effective approach for identifying and evaluating dental caries. However, further research is required to substantiate the findings observed in the present review.

Comparing video examinations with physical clinical examinations using finishing pigs with umbilical outpouchings as a model

BackgroundVeterinary telemedicine has only been adopted to some degree. One aspect that needs to be evaluated is clinical examinations using video. The objective of this study was to evaluate agreement between a traditional physical clinical examination and a clinical examination using recorded video using finishing pigs with umbilical outpouchings (umbilical hernias, cysts, and abscesses) as the study unit. A total of 102 finisher pigs with umbilical outpouchings were clinically examined and recorded on video. Four experienced pig veterinarians were allowed to examine each pig for approximately 10 min and were individually asked to fill out a predesigned clinical record. Approximately 1 month after the physical examinations, the veterinarians individually reexamined all 102 pigs in a blinded manner, utilizing the video recordings and filling in a predesigned clinical record.ResultsFor all measurements using a ruler, a high Pearson correlation coefficient was observed between physical and video examinations (range 0.69–0.95). In comparison, the visual bodyweight estimation had a lower Pearson correlation coefficient (range 0.57–0.64). Substantial to almost perfect agreement was observed between the physical and video examinations for abnormal weight distribution on any leg, restricted gait movements, lameness, signs of pain, fitness for transportation, presence of wounds, and categorization of the number of wounds > 4 cm2 on the umbilical outpouching (mean Kappa range 0.67–0.87). Fair agreement was observed for the presence of perineal soiling, ear wounds, pendulation of umbilical outpouching, umbilical outpouching touching the legs, skin not movable over the umbilical outpouching, and umbilical outpouching wound characteristics: type, presence of crusts, active bleeding, thick wound edges, connective tissue (mean Kappa range 0.21–0.40). Slight agreement was observed for umbilical outpouching characteristics: shape, macroscopic vascularization of the skin covering the outpouching, and the presence of scars, excoriations, and fistulas (mean Kappa range 0.10–0.20). Poor agreement was observed for the presence of granulation tissue (mean Kappa = − 0.05).ConclusionsThe agreement between a physical clinical examination and a clinical examination using recorded video of the same pig varies from poor to almost perfect, depending on the clinical sign and the executing veterinarian.

Features of coronary calcification in patients receiving renal replacement therapy with program hemodialysis

Objective: to study the features of coronary calcification in patients with chronic kidney disease receiving renal replacement therapy with program hemodialysis. Materials and methods: in the process of an open clinical trial, a group of patients (n = 43) with end-stage chronic kidney disease (23 women and 20 men) was formed. The average age of patients was 54±13 years, the median length of dialysis therapy was 11 [6; 16] months. All patients received renal replacement therapy with program hemodialysis. The procedures were carried out on artificial kidney devices according to the standard scheme 3 times a week for 4 hours. Patients underwent traditional clinical and laboratory examination. All patients were assessed for coronary calcification by multispiral computed tomography. On the Agatston scale, the severity of coronary calcification was assessed taking into account the density and area of calcium deposition. Results: on the results of multispiral computed tomography to determine the degree of calcification of the coronary arteries, we found that 48% of patients had low and minimal calcification, 16% — insignificant calcification, 36% — measured and pronounced calcification. When comparing laboratory parameters in the groups of patients with different calcification of the coronary arteries, the level of inorganic phosphorus (1,64±0,07 mmol/L) was significantly higher in patients with insignificant, moderate and severe calcification than in patients with minimal and low calcinosis (1,35±0,12 mmol/L) (p=0.04). There was a pronounced direct correlation between age and calcium index (r=0,52, p=0,0011). With an increase in dialysis experience, an increase in calcium index is noted (r = 0,14; p = 0,045). Conclusion: in 52% of patients with end-stage chronic kidney disease receiving renal replacement therapy with program hemodialysis, coronary calcification is determined from the results of multispiral computed tomography of the coronary arteries. Patients with moderate to severe coronary calcinosis have significantly higher levels of serum phosphorus compared to patients with minimal to low calcinosis. At the same time, the age of patients and the length of dialysis therapy affect the severity of coronary calcinosis

ВЗАИМОСВЯЗЬ ТИПА ЛИЧНОСТИ D И НАРУШЕНИЯ ФУНКЦИИ ЭНДОТЕЛИЯ У ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА

Introduction. Major psychosocial risk factors for acute myocardial infarction include depression, anxiety (various anxiety syndromes and disorders), pessimistic D personality type, work and family stress, anger/hostility, lack of social support, and low socioeconomic status. There are few studies evaluating the association between psychological factors and myocardial infarction. Aim. The aim of the study was to study the relationship of personality type D with the development of endothelial dysfunction in patients with acute myocardial infarction. Material and methods. The study included 158 patients, mean age 58.2±2.5 years, who were admitted to the hospital for ST-segment elevation myocardial infarction. The diagnosis was established according to the clinical guidelines of the Russian Society of Cardiology, 2020. In addition to the traditional clinical and instrumental examination, on the 3rd–7th day after the development of myocardial infarction, patients underwent an assessment of plasma concentrations of inflammatory biomarkers and psychological testing using anxiety and depression rating scales. In the group of patients, individuals with and without personality type D were identified. Results and discussion. Personality type D was found in 29.1% of patients with acute myocardial infarction. Patients with personality type D were significantly younger, employed and married, had a higher body mass index and a significantly greater hereditary burden of arterial hypertension. In patients with personality type D, the values of pro-inflammatory markers were statistically significantly different from the comparison group, which indicates the intensity of subclinical inflammation and cytokine imbalance. Personality type D was significantly associated with total inflammation score and total endothelial dysfunction score. Significant differences were found in the ratio of patients with depressive conditions in subgroups of patients with personality type D. The values of echocardiographic parameters were also associated with the presence of personality type D. Conclusion. Personality type D was associated with impaired endothelial function in men with acute myocardial infarction, they were more likely to have depressive disorders. An adverse effect of personality type D on the cardiovascular system in patients with myocardial infarction was revealed.

A NEw MOdel of individualized and patient-centered follow-up for women with gynecological cancer (the NEMO study)—protocol and rationale of a randomized clinical trial

BackgroundFollow-up programs for gynecological cancer patients are currently under revision. There is limited evidence that traditional follow-up and clinical examinations improve survival in an early-stage gynecological setting. Further, traditional follow-up programs fail to accommodate the patient’s need for psychosocial and sexual supportive care and to actively involve patients and their relatives in the follow-up process. Individualized programs may replace traditional routine follow-up with fixed intervals and length. Focusing on alarm-symptoms and self-reporting may ensure detection of recurrence while allowing a continuous attention to the patient’s well-being and return to daily life.In this study, a nurse-led, individualized, and need-based intervention with a specific focus on patient empowerment is tested against a standard physician-led model primarily focusing on the detection of recurrence.MethodsThe study is designed as a clinical, randomized trial conducted in one of four national onco-gynecological centers in Denmark. Patients with early-stage cervical or endometrial cancer are eligible for inclusion. The intervention group undergoes individualized, nurse-led follow-up supporting patient empowerment including repeated use of electronic patient-reported outcome measures (ePROMs) before each contact as a dialogue support tool. The follow-up contacts are mainly conducted by telephone. All project nurses attended a special training program before project start and are all well-educated and dedicated onco-gynecological nurses. The control group receives standard, physician-led, follow-up without use of ePROMs or specific focus on empowerment.The effect of the intervention is evaluated by questionnaires completed by patients at baseline (3 months after surgery) and 12, 18, and 36 months after surgery. Outcomes include empowerment using the Skill and technique subscale of the HEI-Q questionnaire as the primary outcome while fear of cancer recurrence and health-related quality of life as well as the remaining subscales of the HEI-Q represent secondary outcomes. Data is collected by use of the REDCap technology, which also provides a customized visual support function for the dialogue tool.DiscussionThis study will provide new information about follow-up in early-stage gynecological cancer settings and thereby contribute to improvement of future follow-up programs. Importantly, the study will provide knowledge about the impact of specific focus on patient empowerment in follow-up programs and, further, how to facilitate empowerment among patients.Trial registrationThe study is registered at clinicaltrials.gov: ID no. NCT03838861. Registered on 6 February 2019.Protocol version 2, issue date 21 November 2022.