Application of computer-aided detection for NCCN-based follow-up recommendation in subsolid nodules: Effect on inter-observer agreement.

RATIONALE AND OBJECTIVES: Computer-aided detection (CAD) of pulmonary nodules reduces the impact of observer variability, improving the reliability and reproducibility of nodule assessments in clinical practice. Therefore, this study aimed to assess the impact of CAD on inter-observer agreement in the follow-up management of subsolid nodules. MATERIALS AND METHODS: A dataset comprising 60 subsolid nodule cases was constructed based on the National Cancer Center lung cancer screening data. Five observers independently assessed all low-dose computed tomography scans and assigned follow-up management strategies to each case according to the National Comprehensive Cancer Network (NCCN) guidelines, using both manual measurements and CAD assistance. The linearly weighted Cohen's kappa test was used to measure agreement between paired observers. Agreement among multiple observers was evaluated using the Fleiss kappa statistic. RESULTS: The agreement of the five observers for NCCN follow-up management categorization was moderate when measured manually, with a Fleiss kappa score of 0.437. Utilizing CAD led to a notable enhancement in agreement, achieving a substantial consensus with a Fleiss kappa value of 0.623. After using CAD, the proportion of major and substantial management discrepancies decreased from 27.5% to 15.8% and 4.8% to 1.5%, respectively (p < 0.01). In 23 lung cancer cases presenting as part-solid nodules, CAD significantly elevates the average sensitivity in detecting lung cancer cases presenting as part-solid nodules (overall sensitivity, 82.6% vs. 92.2%; p < 0.05). CONCLUSION: The application of CAD significantly improves inter-observer agreement in the follow-up management strategy for subsolid nodules. It also demonstrates the potential to reduce substantial management discrepancies and increase detection sensitivity in lung cancer cases presenting as part-solid nodules.

Hypertonic dextrose injection in retrodiscal tissue attachment for the management of chronic joint pain in patients with TMD / 实用口腔医学杂志

Objective:To observe the efficacy of hypertonic dextrose injection(prolotherapy)at retrodiscal tissue in the treatment of chronic joint pain in patients with temporomandibular disorders(TMD).Methods:From June 2012 to March 2022,244 patients(aged 16 to 75 years)underwent the treatment were included and classified according to DC/TMD.The treatment started from an anesthetic in-jection of 2％lidocaine(1.5-2 mL)into the retrodiscal tissue.The patients were then instructed to perform mandibular condylar exercise for 5-10 min,prior to the therapeutic injection of 50％dextrose(1-1.5 mL)by using the same method.Assessment of TMJ pain and jaw function was performed at 2 weeks,2,6 and 12 months after injection.Results:By March 2022,221 cases completed the final sur-vey(the rate of loss of follow-up was 9.4％),the average follow-up time was(75.7±25.1)months.2 weeks after treatment,there was significant relief of joint pain,and mandibular function was significantly improved in most patients by 2 month after treatment.Of these,186 cases achieved profound pain relief and faily normal jaw function,17 cases with recurrence of joint pain and jaw dysfunction and op-ted for occlusal splint treatment due to fear of injection,16 cases claimed no obvious therapeutic effect but rejected any further tratment,2 cases subsequently accepted TMJ surgery.There was no worsening of TMD or other complication as a result of the treatment.Conclu-sion:Hypertonic dextrose injection in retrodiscal tissue attachment is straightforward,safe and effective in the treatment of chronic joint pain and TMD.