Weighted Kappa Analysis Research Articles

Automated AI-based coronary calcium scoring using retrospective CT data from SCAPIS is accurate and correlates with expert scoring.

Evaluation of the correlation and agreement between AI and semi-automatic evaluations of calcium scoring CT (CSCT) examinations using extensive data from the Swedish CardioPulmonary bio-Image study (SCAPIS). In total, 5057 CSCT examinations were performed on one CT system at Linköping University Hospital between October 8, 2015, and June 12, 2018. AI evaluations were compared to semi-automatic CSCT results from expert reader evaluations rendered within SCAPIS. Pearson correlation, intraclass correlation coefficients (ICC), and Bland-Altman analysis were applied for Agatston (AS), volume (VS), mass scores (MS), number of lesions and lesion location. Agreement of Agatston score classifications into cardiovascular (CV) risk categories was evaluated with weighted kappa analysis. The evaluation included 4567 subjects, 2229 (48.8%) male, 2338 (51.2%) female, 50-64 years of age (mean 57.3 ± 4.4). The AS ranged from 0 to 2871 in the cohort, with 2846 subjects having an AS of 0. Mean and median AS were 51.4 and 0.0, respectively. Total AS, VS, MS and number of lesions ICCs were 0.994, 0.994, 0.994, 0.960 (p < 0.001), respectively. Bland-Altman analyses rendered mean differences ± 1.96 SD upper and lower limits of agreement for AS -0.04, -52.5 to 52.4, VS -0.44, -46.51 to 45.63, and MS -0.07, -9.62 to 9.48. Weighted kappa analysis for CV risk category classifications was 0.913, and overall accuracy was 91.2%. There was excellent correlation and agreement between AI and semi-automatic evaluations for all calcium scores, number of lesions and lesion location. High degrees of agreement and accuracy were found for the CV risk categorization. Question Can AI function as a tool for enhancing the efficiency and accuracy of Coronary Artery Calcium Score (CACS) evaluations in clinical radiology practice? Findings This study confirms the robustness of AI-derived CACS results across extensive datasets, though its generalizability is limited by data acquisition from a single CT system. Clinical relevance This study suggests that AI holds significant promise as a tool for enhancing the efficiency and accuracy of CACS evaluations, with implications for improving patient diagnostics and reducing radiologist workload in clinical practice.

Postmastectomy Breast Reconstruction in Irradiated Patients: A 12-year follow-up of Deep Inferior Epigastric Perforator and Latissimus Dorsi Flap Outcomes

The aim of the current study was to conduct a 12-year follow-up on the authors´ previously evaluated group of irradiated patients who underwent postmastectomy breast reconstruction with deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD)-flaps with implant.The follow-up involved 67% of the patients from the original cohort (17 DIEP and 13 LD). Patient-reported outcome measures (PROMS) were measured using the BREAST-Q, SF-36, a satisfaction form, and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires. Aesthetics were evaluated by a board of independent plastic surgeons.The average follow-up time was 12.6 years (DIEP) and 11.8 years (LD). Contralateral symmetry procedures were performed on 15 DIEP and 9 LD patients. Both groups underwent an average of 2.5 reconstructive procedures. The BREAST-Q and satisfaction questionnaires showed no group difference. SF-36 showed no group difference but had significantly higher values in both groups compared to the general population with regard to the physical role limitations (p=0.034 and p=0.004, respectively). The DASH scores showed minimal shoulder function impact in the LD group.Aesthetic evaluations revealed a discrepancy between the opinions of the patients and surgeons, with patients valuing the size (p=0.015) and overall aesthetic (p=0.012) of the reconstructed breast higher in the DIEP group. The weighted kappa analysis showed poor agreement between patients and surgeons. Over time, the patients´ preferences shifted from LD to DIEP flaps, possibly due to the more natural aging process associated with autologous reconstruction. This underscores the importance of long term follow-up studies.

Optimal Magnetic Resonance Sequence for Assessment of Central Cartilage Tumor Scalloping

Abstract Background Magnetic resonance imaging (MRI) is key in evaluating central cartilage tumors. The BACTIP (Birmingham Atypical Cartilaginous Tumour Imaging Protocol) protocol assesses central cartilage tumor risk based on the tumor size and degree of endosteal scalloping on MRI. It provides a management protocol for assessment, follow-up, or referral of central cartilage tumors. Objective Our study compared four MRI sequences: T1-weighted (T1-w), fluid sensitive (Short Tau Inversion Recovery (STIR)- weighted, STIR-w), and grayscale inversions (T1-w GSI and short tau inversion recovery [STIR] GSI) to see how reliably endosteal scalloping was detected. Materials and Methods Two senior consultant musculoskeletal radiologists with experience reviewed randomly selected 60 representative central cartilage tumor cases with varying degree of endosteal scalloping to reflect a spectrum of BACTIP pathologies. The endosteal scalloping was graded as per the definition of BACTIP A, B, and C. They agreed on a consensus BACTIP grade for each of the 240 key images (60 cases × 4 sequences), which was considered the final “consensus” BACTIP grade. These 240 images were then randomized into a test set and given to two fellowship-trained consultant musculoskeletal radiologists for analysis. They assigned a BACTIP grade to each of the 240 selected images while being blinded to the final “consensus” BACTIP grade. The training set was further subdivided into three groups based on the MR image quality (good quality, average quality, and poor quality) to ascertain if the quality of the acquired images influenced intraobserver and interobserver agreements on the BACTIP grading. The two observers were blinded to the grade assigned to the image quality. Results Linearly weighted kappa analysis was performed to measure the agreement between the BACTIP grading answers by two observers and the “consensus” BACTIP grading answers, as well as the BACTIP grading agreement between the two observers themselves.The analysis revealed that T1-w and STIR-w sequences demonstrated more consistent and higher agreement across different image qualities. However, the T1-w GSI and STIR-w GSI sequences exhibited lower agreement, particularly for poor-quality images. T1-w imaging demonstrated substantial agreement between BACTIP gradings for poor-quality images, suggesting potential resilience of T1-w sequence in challenging imaging conditions. Conclusion T1-w imaging is the best sequence for BACTIP grading of endosteal scalloping, followed by fluid-sensitive STIR sequences.

Comparison between clinical and computerized methods for assessing gingival pigmentation.

Digital computerized assessment can provide objective values for the measurement of gingival pigmentation. This study aims to compare the Commission Internationale de l'Eclairage Lab color space (CIELAB) values and the computerized intensity values (CIVs) from digital imaging with clinical evaluations using the Dummett-Gupta Oral Pigmentation Index (DOPI) for assessing gingival pigmentation in a multi-ethnic population. Digital photographs of 188 participants were taken using standardized parameters. The buccal gingival pigmentation was evaluated using three methods (a) a clinical evaluation by two independent assessors using the DOPI, (b) the CIELAB values using the Adobe Photoshop® software (Version 23.1.1) and (c) the CIV calculated using the ImageJ software (Version 1.53k). A hierarchical clustering analysis was used to identify colour groups that clustered together. Agreement between the clinical and digital categorization of the pigmentation was carried out using weighted kappa analysis. Agreements between CIELAB and CIV were compared using intra-class correlation coefficient. There was a statistically significant difference in the DOPI, the L*, a*, and b* coordinates, and the CIV between the different ethnic groups of the participants. Cluster analysis for the CIELAB and CIV both identified four clusters. The gingival pigmentation categorization using the L*, a*, and b* values moderately agreed with the clinical evaluation using the DOPI index while the categorization with the CIV was in slight agreement with the clinical evaluations. This study identified four clusters of gingival pigmentation in 188 multi-ethnic participants. The clusters, determined by CIELAB values, align with the clinical assessment of gingival pigmentation. Digital measurements derived from clinical photographs can serve as an effective means of pigmentation measurement in dental clinics.

The relative validity of a semiquantitative food frequency questionnaire among pregnant women in the United Arab Emirates: The Mutaba'ah study.

Background: Food frequency questionnaire (FFQ) is the most frequently used dietary assessment method in estimating dietary intakes in epidemiological studies. Aim: This study aimed to assess the relative validity of a semiquantitative FFQ in evaluating dietary intake among pregnant women in the United Arab Emirates. Methods: Within the Mutaba'ah study, a subsample of 111 pregnant women completed a semiquantitative FFQ and a single 24-hour dietary recall (24-HDR) regarded as the reference method. Absolute and energy-adjusted nutrient and food intakes between the FFQ and 24-HDR were compared using the Wilcoxon signed ranks test, correlations, Bland-Altman analysis, cross-classification, and weighted kappa analysis. Results: There were no significant differences in reported absolute intakes between the FFQ and 24-HDR for carbohydrates, whole grains, white meat, beta-carotene, vitamin K, sodium, and selenium. Spearman's correlation coefficients between the FFQ and 24-HDR ranged from 0.09 (trans fatty acids) to 0.5 (potassium) for absolute intakes. Correlation decreased after energy adjustment. Bland-Altman analysis showed that the FFQ overestimated intakes compared with 24-HDR and that the limits of agreement were wide. The average percentage of pregnant women classified into the same or adjacent quartile of intake by both methods was 73%. Weighted kappa values ranged from -0.02 (white meat) to 0.33 (magnesium). Conclusion: Our findings showed that the semi-quantitative FFQ is a useful tool in ranking pregnant women from the Emirati population according to their dietary intake. However, the validity of some estimated intakes was poor; hence, certain intakes should be interpreted with caution.

Community directed assessment of pain in a northern Saskatchewan Cree community

ABSTRACT Indigenous Elder advisors in Pelican Narrows, a Cree community in Northern Saskatchewan, have indicated that Western pain scales may not be responsive tools for pain assessments within their community. This study employed a mixed methods research design that involved two phases. Phase one was the development of a pain scale in collaboration with an Elder and a Knowledge Keeper. Phase two was a pilot of the CDPS utilised during virtual physiotherapy sessions for chronic back pain. Twenty-seven participants completed the pre-physiotherapy treatment questionnaires, and 10 participants engaged in semi-structured interviews (9 community members; 1 healthcare provider). A weighted kappa analysis yielded k = 0.696, indicating a good agreement between the CDPS and Faces Pain Scale-Revised in terms of documenting participants’ pain. Qualitative data from interviews with community members revealed three major themes: 1) Learnings Regarding Pain Scales, 2) Patient Centered Care; and 3) Strength-Based Solutions for Improving Pain Communication. Two themes were uncovered through conversations with the HCP: 1) Perspectives on CDPS and 2) Healthcare Provider Experiences Communicating about Pain. Moreover, a patient-centredcentred approach is important to ensure comprehensive pain assessments.

The Role of Artificial Intelligence in Coronary Calcium Scoring in Standard Cardiac Computed Tomography and Chest Computed Tomography With Different Reconstruction Kernels.

To assess the correlation of coronary calcium score (CS) obtained by artificial intelligence (AI) with those obtained by electrocardiography gated standard cardiac computed tomography (CCT) and nongated chest computed tomography (ChCT) with different reconstruction kernels. Seventy-six patients received standard CCT and ChCT simultaneously. We compared CS obtained in 4 groups: CS CCT , by the traditional method from standard CCT, 25 cm field of view, 3 mm slice thickness, and kernel filter convolution 12 (FC12); CS AICCT , by AI from the standard CCT; CS ChCTsoft , by AI from the non-gated CCT, 40 cm field of view, 3 mm slice thickness, and a soft kernel FC02; and CS ChCTsharp , by AI from CCT image with same parameters for CS ChCTsoft except for using a sharp kernel FC56. Statistical analyses included Spearman rank correlation coefficient (ρ), intraclass correlation (ICC), Bland-Altman plots, and weighted kappa analysis (κ). The CS AICCT was consistent with CS CCT (ρ = 0.994 and ICC of 1.00, P < 0.001) with excellent agreement with respect to cardiovascular (CV) risk categories of the Agatston score (κ = 1.000). The correlation between CS ChCTsoft and CS ChCTsharp was good (ρ = 0.912, 0.963 and ICC = 0.929, 0.948, respectively, P < 0.001) with a tendency of underestimation (Bland-Altman mean difference and 95% upper and lower limits of agreements were 329.1 [-798.9 to 1457] and 335.3 [-651.9 to 1322], respectively). The CV risk category agreement between CS ChCTsoft and CS ChCTsharp was moderate (κ = 0.556 and 0.537, respectively). There was an excellent correlation between CS CCT and CS AICCT , with excellent agreement between CV risk categories. There was also a good correlation between CS CCT and CS obtained by ChCT albeit with a tendency for underestimation and moderate accuracy in terms of CV risk assessment.

Inter-grader reliability in the Danish screening programme for diabetic retinopathy.

The Danish Registry of Diabetic Retinopathy includes information from >200 000 patients who attends diabetic retinopathy (DR) screening in Denmark. Screening of patients with uncomplicated type 2 diabetes is often performed by practicing ophthalmologists, while patients with type 1 and complicated type 2 diabetes attends screening at hospitals. We performed a clinical reliability study of retinal images from Danish screening facilities to explore the inter-grader agreement between the primary screening ophthalmologist and a blinded, certified grader. Invitations to participate were sent to screening facilities across Denmark. The primary grader uploaded fundus photographs with information on estimated level of DR (International Clinical Diabetic Retinopathy scale as 0 [no DR], 1-3 [mild, moderate or severe nonproliferative DR {NPDR}], or 4 [proliferative DR {PDR}]), region of screening, image style, and screening facility. Images were then regraded by a blinded, certified, secondary grader. Weighted kappa analysis was performed to evaluate agreement. Fundus photographs from 230 patients (458 eyes) were received from practicing ophthalmologists (52.6%) and hospital-based grading centres (47.4%) from all Danish regions. Reported levels of DR by the primary graders were 66.8%, 12.2%, 13.1%, 1.3% and 5.5% for DR levels 0-4. The overall agreement between primary and secondary graders was 93% (κ = 0.83). Based on screening facility agreement was 96% (κ = 0.89) and 90% (κ = 0.76) for practicing ophthalmologists and hospital-based graders. In this nationwide study, we observed a high overall inter-grader agreement and based on this, it is reasonable to assume that reported DR gradings in the screening programme in Denmark, accurately reflect the truth.

Prevalence and associated factors of drug-drug interactions in elderly outpatients in a tertiary care hospital: a cross-sectional study based on three databases.

Drug-drug interactions (DDIs) are factors of adverse drug reactions and are more common in elderly patients. Identifying potential DDIs can prevent the related risks. Fewer studies of potential DDIs in prescribing for elderly patients in outpatient clinics. This study aimed to investigate the prevalence and associated factors with potential DDIs and potentially clinically significant DDIs (csDDIs) among elderly outpatients based on 3 DDIs databases. A cross-sectional study was carried out on outpatients (≥65 years old) of a tertiary care hospital in China between January and March 2022. Patients' prescriptions, including at least 1 systemic drug, were consecutively collected. The potential DDIs were identified by Lexicomp®, Micromedex®, and DDInter. Patient-related clinical parameter recorded at the prescriptions and DDIs with higher risk rating was analyzed. Variables showing association in univariate analysis (P<0.2) were included in logistic regression analysis. Weighted kappa analysis was used to analyze the consistencies of different databases. A total of 19,991 elderly outpatients were involved in the study, among whom 21,527 drug combinations including 486 drugs occurred. Lexicomp®, Micromedex®, and DDInter respectively identified 32.22%, 32.93%, and 22.62% of patients have at least one potential DDIs, meanwhile, 9.16%, 14.53%, and 4.56% of patients have at least one potential csDDIs. Under any evaluation criteria, polypharmacy and neurology visits were risk factors for csDDIs. Lexicomp® has the highest coverage rate (87.86%) for drugs. Micromedex® identified the most csDDIs (740 drug combinations). Drugs used in diabetes and psycholeptics were frequently found in the csDDIs of 2 commercial databases. The consistency between Lexicomp® and Micromedex® was moderate (weighted kappa 0.473). DDInter had fair consistencies with the other databases. This study showed the prevalence of potential DDIs is high in elderly outpatients and potential csDDIs were prevalent. Considering the relative risk, pre-warning of potential DDIs before outpatient prescribing is necessary. As the consistencies among identification criteria are not good, more research is needed to focus on actual adverse outcomes to promote accurate prevention of csDDIs.

Deep learning reconstruction for the evaluation of neuroforaminal stenosis using 1.5T cervical spine MRI: comparison with 3T MRI without deep learning reconstruction.

To compare image quality and interobserver agreement in evaluations of neuroforaminal stenosis between 1.5T cervical spine magnetic resonance imaging (MRI) with deep learning reconstruction (DLR) and 3T MRI without DLR. In this prospective study, 21 volunteers (mean age: 42.4 ± 11.9 years; 17 males) underwent cervical spine T2-weighted sagittal 1.5T and 3T MRI on the same day. The 1.5T and 3T MRI data were used to reconstruct images with (1.5T-DLR) and without (3T-nonDLR) DLR, respectively. Regions of interest were marked on the spinal cord to calculate non-uniformity (NU; standard deviation/signal intensity × 100), as an indicator of image noise. Two blinded radiologists evaluated the images in terms of the depiction of structures, artifacts, noise, overall image quality, and neuroforaminal stenosis. The NU value and the subjective image quality scores were compared between 1.5T-DLR and 3T-nonDLR using the Wilcoxon signed-rank test. Interobserver agreement in evaluations of neuroforaminal stenosis for 1.5T-DLR and 3T-nonDLR was evaluated using Cohen's weighted kappa analysis. The NU value for 1.5T-DLR was 8.4, which was significantly better than that for 3T-nonDLR (10.3; p < 0.001). Subjective image scores were significantly better for 1.5T-DLR than 3T-nonDLR images (p < 0.037). Interobserver agreement (95% confidence intervals) in the evaluations of neuroforaminal stenosis was significantly superior for 1.5T-DLR (0.920 [0.916-0.924]) than 3T-nonDLR (0.894 [0.889-0.898]). By using DLR, image quality and interobserver agreement in evaluations of neuroforaminal stenosis on 1.5T cervical spine MRI could be improved compared to 3T MRI without DLR.

Diagnostic Value of Fully Automated Artificial Intelligence Powered Coronary Artery Calcium Scoring from 18F-FDG PET/CT.

Objectives: The objective of this study was to assess the feasibility and accuracy of a fully automated artificial intelligence (AI) powered coronary artery calcium scoring (CACS) method on ungated CT in oncologic patients undergoing 18F-FDG PET/CT. Methods: A total of 100 oncologic patients examined between 2007 and 2015 were retrospectively included. All patients underwent 18F-FDG PET/CT and cardiac SPECT myocardial perfusion imaging (MPI) by 99mTc-tetrofosmin within 6 months. CACS was manually performed on non-contrast ECG-gated CT scans obtained from SPECT-MPI (i.e., reference standard). Additionally, CACS was performed using a cloud-based, user-independent tool (AI-CACS) on ungated CT scans from 18F-FDG-PET/CT examinations. Agatston scores from the manual CACS and AI-CACS were compared. Results: On a per-patient basis, the AI-CACS tool achieved a sensitivity and specificity of 85% and 90% for the detection of CAC. Interscore agreement of CACS between manual CACS and AI-CACS was 0.88 (95% CI: 0.827, 0.918). Interclass agreement of risk categories was 0.8 in weighted Kappa analysis, with a reclassification rate of 44% and an underestimation of one risk category by AI-CACS in 39% of cases. On a per-vessel basis, interscore agreement of CAC scores ranged from 0.716 for the circumflex artery to 0.863 for the left anterior descending artery. Conclusions: Fully automated AI-CACS as performed on non-contrast free-breathing, ungated CT scans from 18F-FDG-PET/CT examinations is feasible and provides an acceptable to good estimation of CAC burden. CAC load on ungated CT is, however, generally underestimated by AI-CACS, which should be taken into account when interpreting imaging findings.

Three-dimensional ultrashort echo time magnetic resonance imaging in assessment of idiopathic pulmonary fibrosis, in comparison with high-resolution computed tomography.

BackgroundWe aimed to evaluate the image quality, feasibility, and diagnostic performance of three-dimensional ultrashort echo time magnetic resonance imaging (3D UTE-MRI) to assess idiopathic pulmonary fibrosis (IPF) compared with high-resolution computed tomography (HRCT) and half-Fourier single-shot turbo spin-echo (HASTE) MRI.MethodsA total of 36 patients with IPF (34 men; mean age: 62±8 years, age range: 43 to 78 years) were prospectively included and underwent HRCT and chest MRI on the same day. Chest MRI was performed with a free-breathing 3D spiral UTE pulse sequence and HASTE sequence on a 1.5 T MRI. Two radiologists independently evaluated the image quality of the HRCT, HASTE, and 3D UTE-MRI. They assessed the representative imaging features of IPF, including honeycombing, reticulation, traction bronchiectasis, and ground-glass opacities. Image quality of the 3D UTE-MRI, HASTE, and HRCT were assessed using a 5-point visual scoring method. Kappa and weighted kappa analysis were used to measure intra- and inter-observer and inter-method agreements. Sensitivity (SE), specificity (SP), and accuracy (AC) were used to assess the performance of 3D UTE-MRI for detecting image features of IPF and monitoring the extent of pulmonary fibrosis. Linear regressions and Bland-Altman plots were generated to assess the correlation and agreement between the assessment of the extent of pulmonary fibrosis made by the 2 observers.ResultsThe image quality of HRCT was higher than that of HASTE and UTE-MRI (HRCT vs. UTE-MRI vs. HASTE: 4.9±0.3 vs. 4.1±0.7 vs. 3.0±0.3; P<0.001). Interobserver agreement of HRCT, HASTE, and 3D UTE-MRI when assessing pulmonary fibrosis was substantial and excellent (HRCT: 0.727≤ κ ≤1, P<0.001; HASTE: 0.654≤ κ ≤1, P<0.001; 3D UTE-MRI: 0.719≤ κ ≤0.824, P<0.001). In addition, reticulation (SE: 97.1%; SP: 100%; AC: 97.2%; κ =0.654), honeycombing (SE: 83.3%; SP: 100%; AC: 86.1%; κ =0.625) patterns, and traction bronchiectasis (SE: 94.1%; SP: 100%; AC: 94.4%, κ =0.640) were also well-visualized on 3D UTE-MRI, which was significantly superior to HASTE. Compared with HRCT, the sensitivity of 3D UTE-MRI to detect signs of pulmonary fibrosis (n=35) was 97.2%. The interobserver agreement in elevation of the extent of pulmonary fibrosis with HRCT and 3D UTE-MRI was R2=0.84 (P<0.001) and R2=0.84 (P<0.001), respectively. The extent of pulmonary fibrosis assessed with 3D UTE-MRI [median =9, interquartile range (IQR): 6.25 to 10.00] was lower than that from HRCT (median =12, IQR: 9.25 to 13.00; U=320.00, P<0.001); however, they had a positive correlation (R=0.72, P<0.001).ConclusionsAs a radiation-free non-contrast enhanced imaging method, although the image quality of 3D UTE-MRI is inferior to that of HRCT, it has high reproducibility to identify the imaging features of IPF and evaluate the extent of pulmonary fibrosis.

Accuracy and Reliability of Whole Blood Bilirubin Measurements Using a Roche Blood Gas Analyzer for Neonatal Hyperbilirubinemia Screening and Risk Stratification.

BackgroundAccurate bilirubin measurements are essential for appropriate management of neonatal hyperbilirubinemia. This study aimed to evaluate the accuracy and reliability of whole blood bilirubin measurements obtained using a Roche blood gas analyzer (Roche TBiL), with total serum bilirubin (TSB) measurements determined by the Ortho VITROS 4600 chemistry system (Ortho TSB) serving as a reference.Materials and MethodsMedical records of hospitalized neonates that underwent simultaneous Roche TBiL and Ortho TSB measurements were reviewed for eligibility selection and data collection. The correlations and differences between two sets of results were determined using Passing–Bablok regression analysis and a Bland–Altman plot, respectively. For eligible newborns, the risk of developing severe hyperbilirubinemia was assessed using the Bhutani nomogram. Weighted kappa analysis was used to evaluate the agreement between risk prediction by the two methods.ResultsWe obtained 618 paired Roche TBiL and Ortho TSB results from 309 neonates. Roche TBiL and Ortho TSB measurements showed a good correlation (r = 0.923; 95% CI: 0.905–0.938). Passing–Bablok regression analysis yielded the following equation: Roche TBiL = 0.794 × Ortho TSB + 1.255 mg/dL, with a slope of 0.794 (95% CI: 0.763–0.825) and intercept of 1.255 (95% CI: 1.042–1.417). The average difference between the two methods was 0.1 ± 1.448 mg/dL. A total of 207 neonates were eligible for evaluation of the agreement between the risk-grading methods. Although kappa analysis showed good agreement between the methods, with a weighted kappa of 0.681 (95% CI: 0.610–0.751) across all populations, the values for approximately half of the neonates at intermediate and high risk of hyperbilirubinemia (33/72) were underestimated by Roche TBiL.ConclusionOur results indicate that Roche TBiL and Ortho TSB measurements in the neonatal population are not consistent. As a point-of-care and trace blood assay, Roche blood gas bilirubin measurements can facilitate primary screening of neonatal hyperbilirubinemia, but it seems to lack accuracy regarding risk stratification, particularly for high-risk newborn individuals.

The Impact of COVID-19 on the Choice of Treatment for Hand Fractures: A Single-Centre Concordance Study.

Background: Management of hand trauma has evolved to incorporate assessment, treatment and rehabilitation of patients in a 'one-stop' clinic on initial presentation. Our aim was to evaluate the effect of coronavirus disease 2019 (COVID-19) on the choice of treatment for hand fractures using inter-rater agreement between surgeons. Methods: All patients with hand fractures during the COVID-19 lockdown from March to May 2020 were included in the study. Two experienced hand surgeons blinded to management and outcomes independently reviewed radiographic images and relevant clinical history to provide their opinion on optimal treatment. Weighted kappa analysis was performed to determine concordance and inter-rater agreement between the two surgeons and actual management. Results: The study included 82 patients (62 men and 20 women) with a mean age of 40.3 (SD 19.7). The injuries occurred most often at home following an accident (34%) or a fall (28%). Fractures involved the metacarpals in 29 patients and the distal phalanx in 22 patients. Thirty-five patients underwent surgery, whereas 47 were managed conservatively. Overall agreement between actual management and consultant A and consultant B was moderate (κ = 0.55, p < 0.0001 and κ = 0.63, p < 0.0001, respectively). Subgroup analysis showed a weak agreement between actual management of metacarpal fractures and consultant A and consultant B (κ = 0.22, p = 0.29 and κ = 0.47, p = 0.02, respectively). Inter-rater agreement was substantial for management of metacarpal fractures (κ = 0.73, p < 0.0001), but weak for distal phalanx fractures (κ = 0.29, p = 0.03). Conclusion: Our study has shown that overall management of hand fractures remained optimised throughout the pandemic. However, a lack of concordance was observed in the management of metacarpals. Level of Evidence: Level IV (Therapeutic).

Oxygen desaturation index as alternative parameter in screening patients with severe obstructive sleep apnea.

ObjectivesAssess reliability of oxygen desaturation index (ODI) as an alternative parameter to apnea hypopnea index (AHI) in screening patients with severe obstructive sleep apnea (OSA).Material and MethodsRetrospectively two-year data on demography, anthropometric features, polysomnography (PSG) parameters [AHI, ODI, minimum oxygen saturation (SpO2), mean SpO2], and Epworth sleepiness score (ESS) were collected and analyzed.ResultsStudy showed significant correlation of ESS with AHI, ODI, apnea-hypopnea percentage of sleep period time (AH%SPT), mean SpO2 and minimum SpO2 with highest correlation being with AHI. A Cohen’s weighted Kappa analysis showed good concordance of 87.32% between AHI and ODI in classifying severity of OSA, with a significant R2 correlation of 0.84 on linear regression. An ODI>20 has a sensitivity of 96.6% and specificity of 69.6% in diagnosing severe OSA.ConclusionGood concordance between AHI and ODI makes nocturnal oximetry a less expensive tool to confdently screen patients with severe OSA.

The diagnostic value of susceptibility-weighted imaging for identifying acute intraarticular hemorrhages.

To evaluate the diagnostic performance of susceptibility-weighted imaging (SWI) in identifying acute intraarticular hemorrhages and differentiating blood from other types of joint effusions. Thirty-two patients (21 men, 11 women; mean age 38.7 ± 16.5 SD) clinically suspected of having joint effusion were prospectively included. All the patients underwent both conventional MRI and SWI. Two radiologists independently reviewed the conventional MRI images and scored the likelihood of intraarticular hemorrhage using a 5-level scoring system. Immediately thereafter, SWI images of each patient were also provided for the radiologists, and the scoring was repeated evaluating the conventional MRI and SWI images together. The patients underwent joint aspiration or surgical operation as the reference standard. The area under the curve (AUC) of conventional MRI and conventional MRI + SWI methods were calculated and compared. The weighted kappa analysis was used to evaluate the interobserver agreement. Traumatic knee injury comprised the majority of study sample. Eighteen out of 32 of the patients were proven to have intraarticular hemorrhage. Using the conventional MRI, reader 1 and 2 achieved AUCs of 0.67 (p = 0.09) and 0.53 (p = 0.76), respectively. Following the addition of SWI, reader 1 and 2 achieved AUCs of 0.96 (p = 0.0001) and 0.95 (p = 0.0001), respectively, and interobserver agreement improved from Κ = 0.61 to Κ = 0.93. Accordingly, difference between the AUCs was 0.28 (p = 0.003) and 0.42 (p = 0.0001) for reader 1 and 2, respectively. If confirmed by future studies, SWI enables the reliable and accurate diagnosis of acute intraarticular hemorrhages.

Verification of Atellica 1500 and comparison with Iris urine analyser and urine culture.

IntroductionThe aims of study were to assess: 1) performance specifications of Atellica 1500, 2) comparability of Atellica 1500 and Iris, 3) the accuracy of both analysers in their ability to detect bacteria.Materials and methodsCarryover, linearity, precision, reproducibility, and limit of blank (LoB) verification were evaluated for erythrocyte and leukocyte counts. ICSH 2014 protocol was used for estimation of carryover, CLSI EP15-A3 for precision, and CLSI EP17 for LoB verification. Comparison for quantitative parameters was evaluated by Bland-Altman plot and Passing-Bablok regression. Qualitative parameters were evaluated by Weighted kappa analysis. Sixty-five urine samples were randomly selected and sent for urine culture which was used as reference method to determine the accuracy of bacteria detection by analysers.ResultsAnalytical specifications of Atellica 1500 were successfully verified. Total of 393 samples were used for qualitative comparison, while 269 for sediment urinalysis. Bland-Altman analysis showed statistically significant proportional bias for erythrocytes and leukocytes. Passing-Bablok analysis for leukocytes pointed to significant constant and minor proportional difference, while it was not performed for erythrocytes due to significant data deviation from linearity. Kappa analysis resulted in the strongest agreements for pH, ketones, glucose concentrations and leukocytes, while the poorest agreement for bacteria. The sensitivity and specificity of bacteria detection were: 91 (59-100)% and 76 (66-87)% for Atellica 1500 and 46 (17-77)% and 96 (87-100)% for Iris.ConclusionThere are large differences between Atellica 1500 and Iris analysers, due to which they are not comparable and can not be used interchangeably. While there was no difference in specificity of bacteria detection, Iris analyser had greater sensitivity.

Free-breathing radial 3D fat-suppressed T1-weighted gradient echo (r-VIBE) sequence for assessment of pulmonary lesions: a prospective comparison of CT and MRI

PurposeTo determine whether the pulmonary MR imaging with free-breathing radial 3D fat-suppressed T1-weighted gradient echo (r-VIBE) sequence can detect lung lesions and display lesion profiles with an accuracy comparable to that of computed tomography (CT), which is the reference standard in this study.PopulationSixty-three consecutive patients were prospectively enrolled between October, 2016 and March, 2017. All the patients received both 3T MRI scanning with a free-breathing r-VIBE sequence and chest standard CT. Morphologic features of lesions were evaluated by two radiologists with a 5-point system. Chest standard CT were used as reference standard. Weighted kappa analysis and chi-squared test were used to determine both inter-observer agreement and inter-method agreement.ResultsA total of 210 solid pulmonary nodules or masses and 1 ground-glass nodule were detected by CT. Compared to CT, r-VIBE correctly detected 95.7% of pulmonary nodules, including 100% of detection rate with diameter greater than 6 mm, 92.3% of pulmonary nodules with diameter between 4 and 6 mm, and 83.3% of pulmonary nodules with diameter less than 4 mm The inter-method agreements between r-VIBE and standard-dose CT were either “substantial” or “excellent” in the evaluation of following features of pulmonary nodules with diameter more than 10mm: including lobulation, spiculation, convergence of vessels, bubble-like attenuation, cavitation and mediastinal lymph node enlargement (0.605≤K≤1.000; P<0.0001). However, K values for inter-method agreements were significant but “moderate” or “poor” for evaluating pleural tag, halo, and calcification (0.355≤ K≤0.451; P<0.0001).ConclusionThe use of pulmonary MR imaging with r-VIBE showed high detection rate of pulmonary nodules and inter-method agreement with CT. It is also useful for nodule morphologic assessment.

Evaluation of calcium to phosphorus ratio in spot urine samples as a practical method to monitor phosphorus intake adequacy in sows.

The objective of this study was to evaluate the reliability of using Ca to P ratio measured in spot urine samples to assess P intake adequacy in gestating and lactating sows. A total of 36 sows were fed one of six concentrations of dietary total P (0.40%, 0.48%, 0.56%, 0.64%, 0.72%, and 0.80%) from day 7.5 ± 1 after breeding until the end of lactation (day 26.6 ± 1). Dietary Ca to P ratio was maintained constant across treatments at 1.25:1. Total 24-h urine samples were collected in mid- and late gestation (days 77.1 ± 2 and 112.4 ± 1), and early and late lactation (days 4.5 ± 1 and 18.2 ± 1). In parallel to 24-h collections, spot urine samples were collected at three different times (early morning, late morning, and late afternoon) in late gestation and late lactation. Urine Ca and P concentrations were measured and Ca to P ratio was calculated. Sows were classified as P-adequate or P-deficient according to dietary P intake. Urine Ca to P ratio was greater in sows fed P-deficient diets than sows fed P-adequate diets (P < 0.001). Receiver operating characteristic (ROC) curves were used to determine the cutoff values for urine Ca to P ratio to predict P intake adequacy. Three different categories of P intake were defined according to urine Ca to P ratio: deficient, adequate, and excessive. The area under the ROC for Ca to P ratio was 0.88 (95% CI 0.81 to 0.95). Best cutoff value of urine Ca to P ratio was 1.5 (sensitivity 94% and specificity 68%) to identify sows fed P-deficient diets and 0.5 for P-excessive diets (sensitivity 82% and specificity 82%). A strong relationship between Ca to P ratio in 24-h and spot urine samples was determined (r = 0.93, P < 0.01), independent of physiological state and collection time of spot samples (adjusted-R2 = 0.86, P < 0.01). The degree of agreement between spot and 24-h urine for P intake adequacy, assessed by Cohen's weighted kappa analysis, was substantial (0.78, 95% CI 0.69 to 0.88). We conclude that urinary Ca to P ratio provides a reliable prediction of the adequacy of P intake in reproducing sows. Urinary Ca to P ratio measurements in random spot urinary offers a practical method to determine dietary P adequacy.

The Patient Health Questionnaire-9 vs. the Hamilton Rating Scale for Depression in Assessing Major Depressive Disorder.

Background: The Hamilton Rating Scale for Depression (HAMD-17) has been used for several decades to assess the severity of depression. Multiple studies have documented defects in this scale and deemed it unsuitable for clinical evaluation. The HAMD-6, which is the abbreviated version of HAMD-17, has been shown to be effective in assessing the core symptoms of depression with greater sensitivity than HAMD-17. And the Patient Health Questionnaire-9 (PHQ-9) is suggested as an effective alternative to the HAMD-17 because of its simplicity and ease-of-use.Methods: Research was completed involving 1,741 participants having major depressive disorder. Cronbach's alpha, intraclass correlation coefficient (ICC) and weighted Kappa analysis was used to determine the reliability of the scales. Pearson correlation analysis and factor analysis were used to analyze validity. Item response theory (IRT) was used to analyze psychological characteristics of items in both the HAMD-17 and PHQ-9.Results: Reliability analysis showed that the Cronbach's alpha of the HAMD-17, HAMD-6 and PHQ-9 were 0.829, 0.764, and 0.893 respectively, and the ICC of the three scales ranged from 0.606 to 0.744. The Kappa score of the consistency of depression severity assessment was 0.248. Validity analysis showed that the PHQ-9 was a single factor structure, and the total score of the scale was strongly correlated with the HAMD-17 (r = 0.724, P < 0.001). The IRT analysis showed that the discrimination parameters of the PHQ-9 were higher than that of the HAMD-17 in all dimensions. The HAMD-6 had the lowest measurement accuracy in distinguishing the severity of depression, while the PHQ-9 had the highest measurement accuracy.Conclusion: Results showed that the PHQ-9 was satisfactory in terms of reliability, validity and distinguishing the severity of depression. It is a simple, rapid, effective and reliable tool which can be used as an alternative to the HAMD-17 to assess the severity of depression.