Visual Scoring System Research Articles

Rapid clinical assessment of the sublingual microcirculation - Visual scoring using microVAS in comparison to standard semi-automated analysis.

Alterations in human microcirculation occur in many disease states leading to morbidity and mortality, however assessing the microcirculation is not standard clinical practice. Standard microcirculation analysis using semi-automated analysis is expensive, time consuming, and expertise dependent making it unfeasible. We proposed a novel visual scoring system (microVAS) for the analysis of microcirculation videos that can be performed at the patient bedside in real time. Validate our microVAS score by training health professionals unfamiliar with the microcirculation field to use our microVAS score and compare their scores to the standard method of semi-automated analysis using AVA3 software. Using a prospective double-blind study design, we recruited and trained 20 participants to use our microVAS score. Participants scored 40 videos (from 22 healthy and 18 septic patients) for MFI and PPV. The same 40 videos were analysed by an expert using the gold standard semi-automated method of analysis. The results of the participants and the expert were analysed by Pearson's linear regression. Krippendorff's alpha was used to assess inter-rater reliability of the participants. Overall correlation of MFI was r = 0.33 (95% CI 0.27-0.39), p < 0.05; overall correlation of PPV was r = -0.11 (95% CI -0.18 to -0.04), p < 0.05. The Krippendorff's alpha for MFI was 0.56 (healthy videos: α= 0.34, sepsis videos: α= 0.31). For PPV Krippendorff's alpha was 0.43 (healthy videos: α= 0.56, sepsis videos: α= 0.17). Overall for both MFI and PPV, there was a small correlation between our microVAS score and AVA 3 scores. Regarding inter-rater reliability both MFI and PPV showed fair agreement between raters. Going forward multiple improvements to the microVAS scoring system as well as the training program are suggested to improve reliability and consistency.

The measurement of volatile organic compounds in faeces of piglets as a tool to assess gastrointestinal functionality

There is an increasing interest in developing innovative means to monitor animal health through precision farming. As part of this drive, we have targeted digestive health and in particular the microbiota. In this study, we investigated the effect of different dietary interventions in piglets, feeding these piglets with one of two different feeds (high protein and low protein). We then evaluated its effects by measuring the volatile organic compounds (VOC) that emanated from these faecal samples using various forms of Ion Mobility Spectrometry. Piglets were monitored for 19 days, with faecal samples collected on days 6, 12 and 19, providing a total of 69 samples. The statistical analysis attempted to separate the samples using either dietary intervention or faecal score. First, the faecal score was investigated using a value based on a visual faecal scoring system, from 0 to 3, with 0 being normal and 3 having diarrhoea. Then the VOCs were analysed in regard to dietary intervention (high vs low protein). Results indicated that our approach was able to separate the dietary intervention (area under the curve (AUC) 0.81) using VOC data. Furthermore, we were able to separate samples based on faecal score (AUC between 0.71 and 1, with six different comparisons undertaken). We believe that faeces volatiles hold potential as a future means to monitor animal health.

Development of visual scoring system with Tc-99m DMSA renal scintigraphy to predict the risk of recurrence of symptomatic urinary tract infections in pediatric patients.

Vesicoureteral reflux (VUR) is a major risk factor for recurrent symptomatic urinary tract infection (UTI) in pediatric patients. In addition, dimercaptosuccinic acid renal scintigraphy (DMSA) is an important diagnostic modality of VUR. However, the value of DMSA for predicting recurrent pediatric UTI has not been studied. Therefore, we aimed to develop visual scoring system (VSS) with DMSA to predict the risk of recurrence of symptomatic urinary tract infection in pediatric patient under the age of 24months. Pediatric UTI patients who visited our tertiary hospital emergency department and underwent DMSA for initial work-up from January 2006 to December 2014 were reviewed retrospectively. We developed a VSS with Tc-99m DMSA renal scintigraphy. We compared sensitivity and specificity between VSS with DMSA and other variables in predicting recurrent symptomatic UTI. Laboratory indices for systemic inflammation, abnormal finding on ultrasonography, VUR on voiding cystourethrogram (VCUG), and the VSS with DMSA were considered as variables. In addition, we used Kaplan-Meier estimator analyses and Cox proportional regression analyses to evaluate the predictive value of each variable for the recurrence of symptomatic UTI. A total of 338 patients were enrolled. During the follow-up period, 42 patients (12.4%) had UTI recurrence. Visual scoring with DMSA resulted in 69.1% sensitivity and 79.4% specificity with an optimal cut-off value of score 2 (AUC = 0.790, p < 0.001). Significant predictive factors associated with recurrent symptomatic UTI were CRP ≥ 67.0mg/L, VUR on VCUG and VSS with DMSA ≥ score 2. On multivariate analysis, the visual score with DMSA was the only independent prognostic factor for recurrent symptomatic UTI (p < 0.001; adjusted hazard ratio = 7.522; 95% CI = 2.799-20.224). High scores in VSS with DMSA were associated with frequent recurrence and short recurrence periods in pediatric UTI patients. VSS with DMSA can stratify risk of recurrence in pediatric UTI patients.

Spatio-temporal motility MRI analysis of the stomach and colon.

MRI is increasingly used to objectively assess gastrointestinal motility. However, motility metrics often do not offer insights into the nature of contractile action. This study introduces a systematic method of making spatio-temporal measurements of contractions, based on changes in bowel lumen diameter. Two heterogeneous cohorts of subjects were selected displaying gastric (n=15) and colonic motility (n=20) on which to test the spatio-temporal motility MRI (STMM) technique. STMM involved delineating the bowel lumen along with inner and outer bowel wall along a section of the gastrointestinal tract. A series of diameter measurements were made automatically across the central axis of the lumen. Measurements were automatically propagated through the time series using a previously validated algorithm. Contractions were quantitatively summarized with two methods measuring (a) normalized contraction plot (NCP) and (b) combined velocity distance (CVD) both of which can be visualized as spatio-temporal motility maps. Both metrics were correlated against subjective visual scoring systems. Good correlation was seen between reader scores and both motility metrics (NCP, R=0.85, P<0.001, CVD, R=0.93, R<0.001) in the gastric data. Good correlation was also seen between the reader scores and the two metrics in the colonic data (NCP, R=0.82, P<0.001, CVD, R=0.78, R<0.001). Spatio-temporal motility MRI analysis of the stomach and colon correlates well with reader scores in a range of datasets and provides both a quantitative and qualitative means of assessing contractile activity in the gastrointestinal tract.

Infestation of Bagworms (Lepidoptera: Psychidae) in Shorea robusta Roth – The State Tree (SAL)

Bagworm (Lepidotera: Pyschidae) – a switching pest, is a polyphagous defoliator of economically and ecologically beneficial plants, ranging from ornamental plants to huge forest trees. The bagworms have huge potential to completely defoliate a host tree leading to deficit in net primary productivity. The larvae of bagworm species use varied and unique nesting patterns [1]. Among the tribes of Bastar the cases of bagworms made up of sticks are popular as rain gauge [2]. In this study an attempt wasmade for the first time to observe prevalence of bagworm infestations in Sal(ShorearubostaRoth) trees of Bastar region known as the Island of Sal. Result of the study based on visual score system categorized into S0,S1,S2,S3 and S4, reveals infestation level of bagworms in forest division of Bastar and Dantewada is at high level of S3. Thus, it appears urgent to initiate large scale study to enumerate infestation of bagworm on Sal and other tree species of Bastar region. This article for the first time reports infestation of bagworm in Sal (ShorearubostaRoth).

The effects of different PMSG doses on estrus behavior and pregnancy rate in Angora goats

Artificial insemination protocols depend on efficient behavioral estrus detection and insemination time in Angora goat. Therefore, we aim to determine the accuracy of an estrus scoring system in Angora goats with different PMSG doses during the breeding season. Does (n: 260) were randomly divided into three groups: group-1 (n: 93), group-2 (n: 85) and group-3 (n: 82). All animals received an intravaginal sponge on day 0 for 11 days, and on the day of sponge insertion 150 μg prostaglandin F2Α was administered. Pregnant mare’s serum gonadotropin was injected 300, 400 and 500 IU intramuscularly 24 h before sponge removal to groups 1, 2 and 3, respectively. Estrus signs were detected with a teaser buck, 24 h after sponge removal according to a visual scoring system. Artificial insemination was performed with 0.25 ml fresh diluted semen at 43 to 45 h after sponge removal. Differences were observed within PMSG groups in terms of standing, tail wagging, courtship behavior, vaginal discharge and vaginal hyperemia (P<0.001). Nevertheless, the most accurate indicators of estrus that result in pregnancy were tail wagging and courtship behavior followed by standing estrus (P<0.05). According to the results obtained, 300 IU PMSG dose is sufficient, both to inseminate at a fixed time (43 to 45 h after sponge removal) and to record the estrus behavior by teaser male 24 h after sponge removal. Higher PMSG doses (400 to 500 IU) altered the timing of ovulation; specifically, 500 IU dose shortened the duration of estrus behaviors. In conclusion, even though the different doses of PMSG displayed similar effects on estrus synchronization and pregnancy rates, we concluded that tail wagging, courtship behavior and standing heat are the most reliable estrus signs for artificial insemination in Angora goat.

Comparison of Influence of Susceptibility Artifact due to Metallic Embolic Material in MRA Image

To identify the influence of susceptibility artifact caused by commonly used trans-catheter embolic devices for vascular lesions in the body on the images of various magnetic resonance angiography (MRA) techniques as an aid to patient screening after endovascular embolization. We constructed vascular phantoms in which three embolic materials; platinum coil, Inconel coil, and vascular plug, were placed. Each phantom was imaged with three types of MRA techniques as follows: ultra-short echo time magnetic resonance imaging (UTE), three-dimensional fast advanced spin echo (3D-FASE), time-resolved contrast MRA with key hole technique (Key hole). For each embolic material, four reviewers compared the visual capabilities of the vessel lumen and surrounding area of each MRA technique by using a four-point visual scoring system. The quantitative values of susceptibility artifacts generated from each embolic material were compared between each MRA technique. For all MRA techniques, the platinum coil showed the highest visual score (median=four-point) among all the embolic materials (p<0.05). In the platinum coil, the MR signal in the coil was clearly depicted in UTE. For all MRA technique, the quantitative values of the susceptibility artifacts were the lowest in platinum coil among all the embolic materials (p<0.05). UTE is less susceptible to susceptibility artifact of embolic materials.

High-Resolution Magnetic Resonance Imaging Using Compressed Sensing for Intracranial and Extracranial Arteries: Comparison with Conventional Parallel Imaging.

ObjectiveTo compare conventional sensitivity encoding (SENSE) to compressed sensing plus SENSE (CS) for high-resolution magnetic resonance imaging (HR-MRI) of intracranial and extracranial arteries.Materials and MethodsHR-MRI was performed in 14 healthy volunteers. Three-dimensional T1-weighted imaging (T1WI) and proton density-weighted imaging (PD) were acquired using CS or SENSE under the same total acceleration factors (AFt)-5.5, 6.8, and 9.7 for T1WI and 3.2, 4.0, and 5.8 for PD-to achieve reduced scanning times in comparison with the original imaging sequence (SENSE T1WI, AFt 3.5; SENSE PD, AFt 2.0) using the 3-tesla system. Two neuroradiologists measured signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and used visual scoring systems to assess image quality. Acceptable imaging was defined as a visual score ≥ 2. Repeated measures analysis of variance and Cochran's Q test were performed.ResultsCS yielded better image quality and vessel delineation than SENSE in T1WI with AFt of 5.5, 6.8, and 9.7, and in PD with AFt of 5.8 (p < 0.05). CS T1WI with AFt of 5.5 and CS PD with AFt of 3.2 and 4.0 did not differ significantly from original imaging (p > 0.05). SNR and CNR in CS were higher than they were in SENSE, but lower than they were in the original images (p < 0.05). CS yielded higher proportions of acceptable imaging than SENSE (CS T1WI with AFt of 6.8 and PD with AFt of 5.8; p < 0.0167).ConclusionCS is superior to SENSE, and may be a reliable acceleration method for vessel HR-MRI using AFt of 5.5 for T1WI, and 3.2 and 4.0 for PD.

A visual quality control scale for clinical arterial spin labeling images

BackgroundImage-quality assessment is a fundamental step before clinical evaluation of magnetic resonance images. The aim of this study was to introduce a visual scoring system that provides a quality control standard for arterial spin labeling (ASL) and that can be applied to cerebral blood flow (CBF) maps, as well as to ancillary ASL images.MethodsThe proposed image quality control (QC) system had two components: (1) contrast-based QC (cQC), describing the visual contrast between anatomical structures; and (2) artifact-based QC (aQC), evaluating image quality of the CBF map for the presence of common types of artifacts. Three raters evaluated cQC and aQC for 158 quantitative signal targeting with alternating radiofrequency labelling of arterial regions (QUASAR) ASL scans (CBF, T1 relaxation rate, arterial blood volume, and arterial transient time). Spearman correlation coefficient (r), intraclass correlation coefficients (ICC), and receiver operating characteristic analysis were used.ResultsIntra/inter-rater agreement ranged from moderate to excellent; inter-rater ICC was 0.72 for cQC, 0.60 for aQC, and 0.74 for the combined QC (cQC + aQC). Intra-rater ICC was 0.90 for cQC; 0.80 for aQC, and 0.90 for the combined QC. Strong correlations were found between aQC and CBF maps quality (r = 0.75), and between aQC and cQC (r = 0.70). A QC score of 18 was optimal to discriminate between high and low quality clinical scans.ConclusionsThe proposed QC system provided high reproducibility and a reliable threshold for discarding low quality scans. Future research should compare this visual QC system with an automatic QC system.

Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases

To explore the clinical effect of percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases. The clinical data of 44 elder patients with lumbar disc herniation and systemic diseases treated from June 2013 to June 2017 were retrospectively analyzed. Including 26 males and 18 females, aged 70 to 86 years old with an average of(77.5±3.5) years, course of disease was 3 weeks to 6 months. Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia was performed in the patients. Postoperative straight leg-raising degree change and Nakai criteria were used to evaluate the operative effect. Visual analogue scale(VAS) and JOA scoring system were used to compare the symptom improvement between preoperative and postoperative. No serious complications occurred during and after the operation, and the coexisting medical diseases were not aggravated. All patients safely survived the perioperative period. All the 44 cases were followed up from 6 to 30 months with an average of 20 months. Postoperative straight leg raising angle was obviously improved. At final follow-up, according to Nakai standard, 41 cases got excellent results, 3 good. VAS scores were significantly decreased and JOA scores were significantly increased in final follow-up(P<0.01). Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia is a safe, effective, less invasive technique for the treatment of lumbar disc herniation in elder with systemic diseases. Multidisciplinary collaboration and perioperative well controlled disease are essential for early rehabilitation of such patients.

Postoperative Pain Management Strategies and Delirium After Transapical Aortic Valve Replacement: A Randomized Controlled Trial

This study was designed to compare 2 different perioperative analgesia strategies with respect to the incidence of postoperative delirium after a transapical approach for transcatheter aortic valve replacement (TAVR). The authors hypothesized that perioperative thoracic paravertebral analgesia with a local anesthetic would decrease opioid consumption and in turn reduce the incidence of postoperative delirium when compared with systemic opioid-based analgesia after a transapical TAVR procedure. Prospective, randomized controlled clinical trial. Tertiary referral center, university hospital. The study comprised 44 patients undergoing a transapical TAVR procedure. Patients with a history of serious mental illness, delirium, and severe dementia and/or patients with contraindications to regional anesthesia were excluded. Patients were randomly assigned to either the paravertebral group (perioperative continuous thoracic paravertebral block with local anesthetic) or the patient-controlled analgesia group (systemically administered opioids) using a computer-generated randomization code in blocks of four patients. Assessment of postoperative delirium was performed by trained research staff using the confusion assessment method for intensive care unit preoperatively and postoperatively every 12 hours or more often if needed according to the patient's condition during the first 7 postoperative days or until discharge. Pain was assessed with a 10 cm Visual Analog Scale pain score system during the 48 hours postoperatively. The sedation level was assessed using the Sedation Agitation Scale during the same period. Overall postoperative delirium was detected in 12/44 (27%) patients, with 7/22 (32%) in the patient-controlled analgesia and 5/22 (23%) in the paravertebral groups, respectively (p = 0.73). Both groups were similar with respect to demographic data, preoperative medications, and comorbidities. Paravertebral analgesia was associated with an opioid-sparing effect during surgery and during the 48-hour postoperative period. Sedation and pain scores were similar between the 2 groups. In addition, paravertebral analgesia was associated with earlier extubation times; however, the overall morbidity and mortality were similar between the 2 groups. Paravertebral analgesia in patients undergoing transapical TAVR procedures appears to have an opioid-sparing effect. However, it did not translate into a statistically significant decrease in the rate of postoperative delirium.

Abstract 17257: Does Repeat Imaging Validate Visual Coronary Artery Calcium Scoring on Non-Electrocardiogram Gated Chest Computed Tomography?

Aim: To investigate if estimation of the amount of calcium in the coronary system utilizing a visual coronary artery calcium scoring (CACS) system (Kirsch et al. Detection of coronary calcium during standard chest computed tomography correlates with multi-detector computed tomography coronary artery calcium score) in non - electrocardiogram (ECG) gated chest computed tomography (CT) scans maintains its strong correlation with the Agatston CACS on dedicated ECG gated cardiac CT exams across two or more points in time per patient. Methods: A visual scoring system (Weston score, WCS) was previously developed assigning a score (0-3, total score 0-12) for each coronary vessel including the left main trunk. Predetermined score cutoffs in both Agatston and Weston scoring methods were designated for risk stratification. Following institutional review board approval, we retrospectively analyzed 127 total body CT scans on 53 low-risk patients referred by executive health who had received repeat CT scans between 2007 and 2018 and compared the traditional Agatston CACS with the Weston score. Analysis: The data were gathered from a total of 53 executive health patients ages 33 to 71, with an average age of 51. 83.6% were male and 16.4% were female. 118 scans were examined, taken between 307 and 2,792 days apart, with an average of 937 days between scans. The Weston and Agatston scores predicted the same risk classification for 79.7% of the first set of scans, with 10.2% uprisked and 10.2% downrisked by their Weston scores. For the second set of scans, 78.0% had the same classification, with 10.2% uprisked and 11.9% downrisked by their Weston scores. Weston scores predicted 100% of scans within one risk classification of the corresponding Agatston score across all pairs of scans.The average CACS utilizing the Agatston scoring method was 54.3, with a standard deviation of 148.6 due to a large positive skew in the data. The corresponding Weston scores had an average of 1.1, with a standard deviation of 2.14. Conclusion: A visual CACS system (WCS) performed on non-gated CT scans allows risk stratification for cardiac events in a similar manner as the Agatston CACS on ECG-gated CT scans even at separate points in time.

Coronary Artery Calcium Scoring: Current Status and Review of Literature.

Coronary artery calcium is a marker of overall atherosclerotic plaque burden, corresponding to approximately 20% overall atherosclerotic plaque burden. Coronary artery calcium screening, most commonly performed using the Agatston score, has been shown to be a predictor of future cardiovascular risk independent of conventional risk scores such as the Framingham risk score. Coronary artery calcium screening is also recommended on routine nongated, noncontrast chest computed tomography scans using several ordinal and visual scoring systems.

Extended Venous Thromboembolism Prophylaxis After Elective Surgery for IBD Patients: Nomogram-Based Risk Assessment and Prediction from Nationwide Cohort

Identification of risk factors for postoperative venous thromboembolism is an important step to reduce the morbidity associated with this potentially preventable complication after elective surgery for patients with IBD. This study aimed to determine the risk factors for 30-day venous thromboembolism after abdominal surgery for patients with venous thromboembolism, identify potential indications for extended thromboprophylaxis, and develop a nomogram for prediction of risk. This is a retrospective cohort study from a prospectively collected database. The American College of Surgeons National Surgical Quality Improvement Program Participant User File from 2005 to 2016 was used for data analysis. All patients with IBD undergoing elective abdominopelvic bowel surgery were included. The primary outcomes were the incidence of in-hospital and postdischarge venous thromboembolism within 30 days of the index abdominopelvic surgery. A total of 24,182 patients met the inclusion criteria. Thirty-day total and postdischarge rates of venous thromboembolism were 2.5% (n = 614) and 1% (n =252). Forty-one percent (252/614) of venous thromboembolism events occurred after hospital discharge. Univariate analysis assessed 37 variables for association with study outcomes. On multivariate logistic regression analysis, older age, steroid use, bleeding disorders, open surgery, hypertension, longer operative time, and preoperative hospitalization were associated with venous thromboembolism before discharge and also postoperative transfusion, steroid use, pelvic and enterocutaneous fistula surgery, and longer operative time were associated with venous thromboembolism after discharge. A nomogram was constructed for each outcome, translating multivariate model parameter estimates into a visual scoring system where the estimated probability of venous thromboembolism can be calculated. This study was limited by its retrospective nature and the limitations inherent to a database. Given the higher risk of venous thromboembolism in patients with IBD after elective abdominopelvic surgery compared with other indications, an accurate prediction of venous thromboembolism before and after discharge using the proposed nomogram can facilitate decision making for individualized extended thromboprophylaxis in the preoperative setting as a screening tool. See Video Abstract at http://links.lww.com/DCR/A711.

Quantitation of 99mTc-DPD uptake in patients with transthyretin-related cardiac amyloidosis

Purpose: Transthyretin (ATTR) amyloidosis is a rare but serious infiltrative disease associated with a wide spectrum of morphologic and functional cardiac involvement. 99mTc-labelled 3,3-diphosphono-1,2-propanodicarboxylic acid (DPD), initially developed as a bone-seeking radiotracer, is remarkably sensitive for imaging cardiac ATTR amyloid deposits. Our aim was to investigate the feasibility and utility of estimating 99mTc-DPD uptake in myocardial tissue; this has the potential to yield reliable quantitative information on cardiac amyloid burden, which is urgently required to monitor disease progression and response to novel treatments.Methods: Three methods of quantitation were developed and tested on 74 patients with proven cardiac ATTR amyloidosis who had recently undergone 99mTc-DPD planar whole-body imaging and SPECT-CT. Quantitative results were compared to measurements of extracellular volume fraction (ECV) by cardiac magnetic resonance imaging, a validated technique for measuring amyloid burden.Results: An experienced clinician graded uptake using a widely-used visual scoring system as 1 (n = 15), 2 (n = 39) or 3 (n = 20). Linear correlations between the SPECT and ECV data (p < .001) were demonstrated. None of the methods showed that 99mTc-DPD uptake in the heart was significantly greater in patients with grade-3 uptake than in those with grade-2 uptake.Conclusions: Quantitation of 99mTc-DPD uptake in cardiac transthyretin amyloid deposits is complex and is hindered by competition for radiotracer with amyloid in skeletal muscle. The latter underlies differences in uptake between grade-2 and grade-3 patients, not cardiac uptake.

Reliability of Self-Reporting by Parents using Visual Analog Scale Scoring System in Non-Plastic Surgical Hospital Based Setting An Analysis of Outcome in Cleft Lip andor Palate Patients

Reliability of Self-Reporting by Parents using Visual Analog Scale Scoring System in Non-Plastic Surgical Hospital Based Setting An Analysis of Outcome in Cleft Lip andor Palate Patients

Correlation of scopoletin-induced fluorescence with visible PPD symptoms in greenhouse cassava

Post-harvest physiological deterioration (PPD) is spoilage of cassava storage roots characterized by browning of parenchyma tissue and vascular streaking. A striking feature of PPD is an accumulation of hydroxycoumarins, such as scopoletin, scopolin, esculetin and esculin, which are products of phenylpropanoid pathway. PPD, which renders the roots unpalatable and unmarketable, leads to significant yield loss in global cassava production. Extensive studies have been conducted to understand the biochemical activities and pathways involved in PPD in which the result requires an evaluation of PPD symptoms which is usually based on a visual scoring system. However, high variations are consistently observed between biological replicates making analysis difficult. Therefore, there is urgent need to find a reliable marker since the generation of reliable data that can be shared or compared between institutions is desirable. The use of scopoletin-induced fluorescence as a PPD marker was tested in greenhouse-grown cassava storage roots by comparing fluorescence measurements and the PPD scores generated from normal light photographs of the harvested roots. It was found that all freshly harvested root samples lacked fluorescent but after 24 h they considerably fluoresced to a high level. However, the occurrence of intense fluorescence was not accompanied by intense PPD symptoms as fluorescence level declined when visible PPD symptoms developed. Hence, the use of fluorescence or scopoletin as an alternative marker for PPD remain unconvincing, mainly because it did not parallel with PPD symptom accumulation observed.

Technical note: Evaluation of a sonographic overbagging edema scoring system for show cows: Comparison with visual inspection

Overbagged udders are commonly seen at dairy cow shows due to prolonged milking intervals. The aims of this study were to describe the prevalence of udder edema in dairy cows at shows as determined by sonography and to suggest a sonographic scoring system, which was evaluated for reproducibility and repeatability. At 4 highly competitive Swiss dairy cow shows, 319 cows of various breeds were examined. Sonographic scans-1 from each fore quarter and 1 from the rear, representing both hind quarters-were collected by 3 experienced veterinarians at defined positions predisposed to overbagging edema. Sonographic scans were scored with the aid of a newly suggested scoring system (score 0 = no edema, grade 1 = slight edema, grade 2 = moderate edema, grade 3 = severe edema). Further, 139 video sequences from behind while the cows were walking and the same number of photographs of the udder each from the left, right, and behind were selected. The photographs and video sequences were visually scored for different parameters as 0 = not present or 1 = present except for abduction, which was scored on a visual analog scale (0 = no abduction; 100 = maximal imaginable abduction). Visual scores were then compared with the sonographic scoring (Pearson's chi-squared). The prevalence of udder edema scores 1, 2, and 3 was 14.0, 6.5, and 2.3%, respectively. Interobserver reliability for objective sonographic scoring (κ = 0.815) and intraobserver agreement (κ = 0.90 and 0.85 for 2 different observers) was estimated as "almost perfect." Interobserver agreements for visual parameters were κ = 0.40 or less except for teat shape (κ = 0.52). Classification of the videos resulted in better interobserver agreement; when rating hind limb abduction, Spearman correlation coefficient was 0.61, whereas κ = 0.61 for absence of udder movement. Udder movement and teat shape were significantly associated with the edema score. The higher inter- and intraobserver reliability of the sonographic edema scoring compared with the visual scoring system indicates that the newly suggested scoring system might be used in the future to objectively identify udder edema in cows at dairy shows.

Analysis of Multichannel EEG Patterns During Human Sleep: A Novel Approach.

Classic visual sleep stage scoring is based on electroencephalogram (EEG) frequency band analysis of 30 s epochs and is commonly performed by highly trained medical sleep specialists using additional information from submental EMG and eye movements electrooculogram (EOG). In this study, we provide the proof-of-principle in 40 subjects that sleep stages can be consistently differentiated solely on the basis of spatial 3-channel EEG patterns based on root-mean-square (RMS) amplitudes. The polysomnographic 3-channel EEG data are pre-processed by RMS averaging over intervals of 30 s leading to spatial cortical activity patterns represented by 3-dimensional vectors. These patterns are visualized using multidimensional scaling (MDS), allowing a comparison of the spatial cortical activity patterns with the conventional visual sleep scoring system according to the American Academy of Sleep Medicine (AASM). Spatial cortical activity patterns based on RMS amplitudes naturally divide into different clusters that correspond to visually scored sleep stages. Furthermore, these clusters are reproducible between different subjects. Especially the cluster associated with the REM sleep stage seems to be very different from the one associated with the wake state. This study provides a proof-of-principle that it is possible to separate sleep stages solely by analyzing spatially distributed EEG RMS amplitudes reflecting cortical activity and without classical EEG feature extractions like power spectrum analysis.

First approach validating a scoring system for foot-pad dermatitis in broiler chickens developed for application in practice

Measuring the severity of foot-pad dermatitis is an accepted tool monitoring the quality of animal husbandry and welfare. Up to now, a variety of scoring schemes have been used, most of them based on visual evaluation. However, a standardisation and validation of scoring systems is beneficial, not only to compare different studies, but to provide objective indicators in poultry welfare. In this study, we validated one visual scoring system, widely used in Northern Germany, by using additional information of histological measurements. Therefore, feet of broiler chickens (ROSS 308) from one flock were visually scored at the slaughter plant (4-point score). Ten feet per score level (n = 40) were sampled and analysed macroscopically and microscopically. Data were analysed using cluster analysis, providing a classification based on these histopathological findings. Validity of the visual scoring system was analysed by (1) testing the interobserver reliability between different observers and (2) by comparing both, visual and cluster classification types using the McNemar’s test. In a last step Kendall tau correlations were calculated in order to find suitable parameters to judge the severity in a visual score more reliably. Results could show that most agreement was found for the score levels 1 and 2, whereas results for score levels 3 and 4 were more divergent. These results were found in both, interobserver reliability and comparison of classification types (visual vs. cluster). Results revealed interaction effects of classification type and scoring level for the width of ulcers (p = 0.0044) and the size of the lesion (p = 0.0081). In the cluster classification, higher values in both, width of ulcer and size of lesion could be found in score level 3. Furthermore, a positive correlation of the size of lesion with the depth of the ulcer was found (0.73). In conclusion, we found that histological findings coincided well with the less severe visual scores (1; 2), whereas the differentiation between the severe scores (3; 4) seemed to be less valid. For practical purposes we therefore recommend keeping visual scoring systems simple. Furthermore, as the correlation coefficient between both was quite high, the size of the lesion might serve as an indirect indicator of the depth.