Stability of proximal mandibular anatomical structures following bilateral sagittal split osteotomy.

The aim of this study was to investigate the stability of the proximal mandibular reference structures that have been proposed in the literature for superimposition. Forty proximal mandibular segments of 20 patients who underwent bilateral sagittal split osteotomy (BSSO) for advancement were reconstructed from a pair of pre- and postoperative (2 years) cone beam computed tomography scans, and spatially divided into the mandibular condyle, the coronoid process, and 20 mandibular ramus regions. To assess the stability of the anatomical regions, the volumetric and surface discrepancy between the superimposed pre- and postoperative regions were calculated. One-sample t-tests were applied to analyse the statistical stability of the individual regions. Two statistically stable (P < 0.05) structures in the proximal segment of the mandible following BSSO were identified: (1) the posterior part of the mandibular ramus above the gonial angle and below the condylar neck, and (2) the sub-coronoid area below the coronoid process/mandibular notch. Using these stable structures for superimposition resulted in an assessment discrepancy in the condylar displacement of up to 1.1 mm and in the volumetric change of up to 2.8%. Hence, it is suggested that these two identified stable structures are used as reference areas when assessing condylar displacement and change using superimposition.

Interpreter-mediated neuropsychological assessment: Clinical considerations and recommendations from the European Consortium on Cross-Cultural Neuropsychology (ECCroN).

OBJECTIVE: With increasing international migration, societies have become increasingly diverse worldwide. Although neuropsychological assessment is influenced by several diversity characteristics, language barriers have repeatedly been identified as one of the main challenges to cross-cultural neuropsychological assessment in migrant populations. Importantly, neuropsychologists are often required to conduct interpreter-mediated neuropsychological assessments without any graduate training or continuing education on the topic. To address this gap, the objective of this paper is to provide guidelines for interpreter-mediated neuropsychological assessment. METHOD: A European Consortium on Cross-Cultural Neuropsychology (ECCroN) task force conducted a conceptual literature review and provided recommendations for good practice and working principles to inform the preparation and administration of interpreter-mediated assessments. RESULTS: ECCroN takes the position that it is the responsibility of neuropsychologists, as well as the institutions or organizations that employ them, to ensure effective communication between themselves and their patients. This may be accomplished by preparing for an interpreter-mediated assessment by engaging an appropriate interpreter, which in most circumstances will be a professional in-person interpreter speaking the same language(s) or dialect(s) as the patient, and considering practical, language, and cross-cultural issues. During the assessment, reasonable steps should be taken to proactively manage the proceedings and adopt a communication style that facilitates effective patient-directed communication, and when interpreting test data and determining formulations and diagnoses, the limitations of interpreter-mediated assessment should be carefully considered. CONCLUSION: Adhering to the provided recommendations and working principles may help neuropsychologists provide competent interpreter-mediated neuropsychological assessments to linguistically diverse patients.

Diagnostic accuracy of BASIC-Q for detection of cognitive impairment in a primary care setting - a cross-validation study.

OBJECTIVES: This study aims to evaluate the diagnostic accuracy and reliability of a new, brief questionnaire, 'Brief Assessment of Impaired Cognition- Questionnaire' (BASIC-Q) for detection of cognitive impairment, primarily developed for use in primary care. BASIC-Q has three components: Self-report, Informant report, and Orientation. Self-report and Orientation are completed by the individual and Informant report is answered by a close relative. METHODS: We included 275 participants ≥ 70 years, without a prior diagnosis of dementia, and with a close relative who agreed to participate as an informant. Participants were included prospectively in 14 general practices in urban and rural Denmark using a convenience sampling method. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the informant-completed Functional Activities Questionnaire (FAQ) and reported memory concern were used as a reference standard for the classification of the participants' cognitive function. RESULTS: BASIC-Q demonstrated a fair to good diagnostic accuracy to differentiate between people with cognitive impairment and normal cognition with an area under the ROC curve (AUC) of 0.84 (95% CI 0.79-0.89) and a sensitivity and specificity of 0.80 (95% CI 0.72-0.87) and 0.71 (95% CI 0.63-0.78). A prorated BASIC-Q score derived from BASIC-Q without Informant report had significantly lower classification accuracy than the full BASIC-Q. The test-retest reliability of BASIC-Q was good with an intraclass correlation coefficient of 0.84. CONCLUSION: BASIC-Q is a brief, easy-to-use questionnaire for identification of cognitive impairment in older adults. It demonstrated fair to good classification accuracy in a general practice setting and can be a useful case-finding tool when suspecting dementia in primary health care.

The evolving landscape of publishing in the field of pain: An automated bibliometric analysis from 1975 to 2020.

BACKGROUND: The aims of this bibliometric analysis were (1) a longitudinal analysis of the publication landscape in the field of pain (1975-2020) and (2) to characterize the overall publication profiles for two selected journals: European Journal of Pain and PAIN® utilizing an automated approach. METHODS: Database searches in Scopus extracted all journals with 'pain' in their title. For the two specific journals, papers were manually/automatically profiled into preclinical, human and translational studies. RESULTS: A gross list of 64 journals in the field of pain consisting of both active and ceased journals in Scopus were included in this analysis which identified 62,565 papers with approximately 4000 papers published/year. These papers include 2759 and 9156 papers in Eur. J. Pain and PAIN®, respectively. Currently, there are 24 active 'pain' journals. Authors/paper increase from 2 to 7 indicating a development from mono-disciplinary to multi-disciplinary studies. The overall publication profiles assessing preclinical, human (experimental/clinical) and translational papers in Eur. J. Pain and PAIN® were almost similar (14%, 75% and 10% versus 26%, 63% and 10%). Papers have changed over the years from mono-disciplinary studies (e.g. behavioural studies) to multi-disciplinary studies (e.g. combined behavioural and cell studies). After optimization, the search model matched the manual screening by 100%, 98% and 96% for the preclinical, clinical and healthy volunteer categories. CONCLUSIONS: Over the last 45 years, more than 60,000 pain-related papers have been published. Papers develop over the years from mono-disciplinary to multi-disciplinary studies. The overall publication profile including preclinical, human (experimental/clinical) and translational papers was almost similar in Eur. J. Pain and PAIN®. SIGNIFICANCE: The bibliometric analysis of a pain journal provides information on which specific areas of research are published, how this may have changed over the years and how a journal is positioned compared with other journals in the field.

Diagnostic Accuracy of the Swedish Version of the Multicultural Cognitive Examination for Cognitive Assessment in Swedish Memory Clinics.

BACKGROUND: Cognitive assessment for foreign-born individuals is suboptimal. The Multicultural Cognitive Examination (MCE) was developed for use in culturally, linguistically and educationally diverse populations. The MCE includes the Rowland Universal Dementia Assessment Scale (RUDAS) and performs assessment of memory, verbal fluency, and visuospatial function. OBJECTIVE: To compare the psychometric properties of the Swedish version of the Multicultural Cognitive Examination (MCE-S) with the Swedish versions of the RUDAS (RUDAS-S), the Mini-Mental State Examination (MMSE-SR), and the Clock Drawing Test (CDT), and to explore the ability of the MCE-S test to differentiate patients with and without dementia in a multicultural population. METHODS: 117 outpatients at four memory clinics were tested using the MCE-S to complement the routine cognitive assessment. RESULTS: Significant differences between patients with and without dementia were observed for all MCE-S components. There were significant differences between foreign-born and Swedish-born patients in the MMSE-SR, but not in the MCE-S or the RUDAS-S. The MCE-S, had good diagnostic performance for detecting dementia (AUC, 0.82), and was at least as good as the RUDAS-S alone (AUC, 0.79). The MCE-S also distinguished Alzheimer's disease (AD) from non-AD dementia. Contrary to expectations, the MCE-S was also at least as good as the MMSE-SR among the Swedish-born patients. CONCLUSIONS: The MCE-S is adequate for detecting dementia in both foreign-born and Swedish-born populations. Based on the cultural diversity of general society, adapted cognitive tests that can be used for everyone are practical and beneficial for both patients and health-care professionals. Further studies are needed within primary care.

Do normative data specific to Greek Australian older adults improve validity of neuropsychological assessment results?

OBJECTIVE: This study aimed to compare Greek Australian and English language normative data with regard to impairment rates yielded within a healthy Greek Australian older adult sample. We also examined whether optimal cut scores could be identified and capable of sensitively and specifically distinguishing between healthy Greek Australians from those with a diagnosis of Alzheimer's disease (AD). METHOD: Ninety healthy Greek Australian older adults and 20 demographically matched individuals with a diagnosis of AD completed a range of neuropsychological measures, including the Wechsler Adult Intelligence Scale-Fourth Edition, Greek Adaptation (WAIS-IV GR), verbal and visual memory, language and naming, and executive functions. Impairment rates derived from the use of either Greek Australian or English language normative data were calculated and compared, using a 1.5 standard deviation criterion to denote impairment. Receiver operating characteristics curve analysis was used to investigate the sensitivity and specificity of alternate cut scores. RESULTS: Impairment rates derived from the Greek Australian normative data showed that rates of impairment generally fell within the expected 7% range. In contrast, impairment rates for all tests derived using English language normative data were significantly higher and ranged from 11%-66%. Comparisons between healthy and AD participants with moderate dementia showed significant differences across all measures. Area under the curve results ranged from .721 to .999 across all measures, with most tests displaying excellent sensitivity and specificity. CONCLUSIONS: English language normative data were found to be inappropriate for use with Greek Australian elders, potentially leading to erroneous diagnostic outcomes. The use of minority group specific normative data and associated cut points appear to partially ameliorate this issue. Clinical implications are discussed alongside future research directions.

The copenhagen cross-linguistic naming test (C-CLNT): Development and validation in a multicultural memory clinic population.

OBJECTIVE: Despite recent advances in cross-cultural neuropsychological test development, suitable tests for cross-linguistic assessment of language functions are not widely available. The aims of this study were to develop and validate a brief naming test, the Copenhagen Cross-Linguistic Naming Test (C-CLNT), for the assessment of culturally, linguistically, and educationally diverse older adult populations in Europe. METHOD: The C-CLNT was based on a set of standardized color drawings. Items for the C-CLNT were selected by considering name agreement and frequency across five European and two non-European languages. Ambiguities in some of the selected items and scoring criteria were resolved after pilot testing in 10 memory clinic patients. The final 30-item C-CLNT was validated by verifying its psychometric properties in 24 controls and 162 diverse memory clinic patients with affective disorder, mild cognitive impairment, and with dementia. RESULTS: The C-CLNT had acceptable scale reliability (coefficient alpha = .67) and good construct validity, with moderate to strong correlations with traditional language tests (r = .42- .75). Diagnostic accuracy for dementia was good and significantly better than that of the Boston Naming Test (areas under the curve of .80 vs .64, p < .001), but was poor for mild cognitive impairment. Only 3% of the variance in C-CLNT test scores was explained by immigrant background, while 6% was explained by age and years of education. In comparison, these proportions were 34 and 22% for the BNT. CONCLUSIONS: The C-CLNT has promising clinical utility for cross-linguistic assessment of naming impairment in culturally, linguistically, and educationally diverse older adults.

Danish Prostate Registry (DanProst) - an Updated Version of the Danish Prostate Cancer Registry, Methodology, and Early Results.

In 2016, we introduced the Danish Prostate Cancer Registry (DaPCaR) which was built on the National Pathology Register from 1995 to 2011. DaPCaR was laborious to use as most data had to be manually imputed with no regular updates. In here we present a new comprehensive centralized prostate registry called the Danish Prostate Registry (DanProst), which includes all men having undergone any histological evaluation of prostate tissue merged with laboratory-, treatment-, prescription data as well as vital status. Here the data included and the methodology of DanProst are described. DanProst is built upon all men with a histological assessment of the prostate from the Danish National Registry for Pathology. The primary histology and potential prostate cancer histological diagnosis for each unique individual is extracted and translated by newly made algorithms for topography, procedure, diagnostic conclusion, and pathological staging. Further information is added from DaPCaR, the CPR Registry, the Danish Cause of Death Registry, the Danish Cancer Registry, the National Patient Registry, the Danish Register of Laboratory Results for Research, and the Danish National Prescription Registry. The translation algorithms were validated based on the comparison with DaPCaR in the period 2010-2016. DanProst includes 190,422 men. A total of 95,152 (50%) men are diagnosed with prostate cancer until 2021. Median diagnostic PSA was 11 ng/ml, most men are diagnosed by ultrasound-guided biopsy (N = 63,751; 67%), and most frequently defined primary treatment was radical prostatectomy (N = 14,778; 19%). DanProst to DaPCaR coherency was > 99%, 95%, and 94% for the primary histological procedure, primary histological conclusion, and diagnostic histological conclusion, respectively. DanProst is a continuously updated, centrally kept, validated registry with automatic integration of data from other national registries, allowing for contemporary nationwide analysis in men with histological assessment of the prostate.

The ileal and total tract digestibility fibre and nutrients in pigs fed high-fibre cereal-based diets provided without and with a carbohydrase complex.

The effect of carbohydrase can be variable according to the complexity of cereal grains and co-products. Studies on the effect of carbohydrase on cereal diets varying in complexity are scarce. This study was conducted to investigate the apparent ileal (AID) and total tract digestibility (ATTD) of energy, fibre and nutrients in pigs fed diets based on cereal grains and co-products without and with supplementation with a carbohydrase complex in the form of xylanase, arabinofuranosidase and ß-glucanase. The experiment was carried out as an 8 × 4 Youden Square design (eight diets and four periods by two blocks) using 16 growing pigs (33.3 ± 0.8 kg) surgically fitted with a T-cannula in the terminal ileum. The pigs were fed eight experimental diets based on either - maize, wheat, rye, or a wheat and rye mix that were provided with or without enzyme supplementation. The AID and ATTD of DM, organic matter, energy, CP, fat, starch, and soluble and insoluble non-starch polysaccharides (NSPs) were studied using titanium dioxide as an indigestible marker. There was a cereal type effect (P < 0.05) of the AID of most of the nutrients investigated but ash and NSP and some of its constituents but with no interactions between cereal types and carbohydrase supplementation (P > 0.05). The ATTD of nutrients in the large intestine was mainly influenced by the fibre composition and was significantly lower (P < 0.001) for NSP, protein and energy for the Maize than the other diets. Supplementation of the cereal diets with the carbohydrase complex partially degrades arabinoxylan (AX) and ß-glucan giving rise to a generally higher AID of high-molecular weight arabinoxylan (P = 0.044), starch (P = 0.042), a tendency (P < 0.10) of higher AID of non-cellulosic polysaccharide glucose residue (ß-glucan) and soluble arabinoxylan (AX) whereas none of the other components were affected (P > 0.05). Collectively, the results indicate that the carbohydrase complex degrades AX in the stomach and small intestine, leading to a higher AID but with no influence on the ATTD of fibres, nutrients, and energy.

Effect of postweaning feed intake on performance, intestinal morphology, and the probability of diarrhoea in piglets.

Changes in gastrointestinal architecture, high incidence of diarrhoea, and low feed intake (FI) are commonly observed around weaning of pigs, but the relationship between postweaning FI and diarrhoea is unclear. This study aimed to determine the effect of low or high FI during the first days after weaning on growth performance, diarrhoea probability, intestinal permeability, and morphology in pigs until postweaning day (PWD) 28. A total of 120 pigs (7.20 ± 0.26 kg) weaned at 28 days of age (PWD 0) were randomly allocated to five diets and housed individually until PWD 28. Two diets differed in CP and three diets differed in threonine and tryptophan levels. At PWD 4, pigs with the 25% lowest accumulated FI (LOW; n = 30) and 25% highest accumulated FI (HIGH; n = 30) were selected for the study. Faecal consistency was evaluated daily using a 4-scale visual scoring system. Blood was collected at PWD 4, 14, 21 and 28, and small intestinal and colonic tissue was obtained at slaughter on PWD 28. Until PWD 4, LOW pigs consumed approximately 20% (35.7 ± 5.9 g/day) of the FI of HIGH pigs (181 ± 5.75 g/day; P < 0.05) and their average daily gain (ADG) was -103 ± 15.1 g/day. At PWD 28, average daily feed intake, ADG, and feed conversion ratio were still negatively affected by the FI level (P < 0.05) and pigs in the LOW group were on average 4.4 kg lighter than HIGH pigs. Pigs in the HIGH group showed a 55% higher probability of diarrhoea compared with LOW pigs during PWD 0-28. The number of antibiotic treatment days against diarrhoea was 2.38 days higher for HIGH compared with LOW pigs (P = 0.04). The intestinal permeability markers diamine oxidase and D-lactate in plasma were unaffected by the level of FI (P > 0.10). The systemic inflammatory markers haptoglobin and C-reactive protein were higher for HIGH pigs at PWD 4 (P = 0.005), but not affected in the following periods (P > 0.10). Pigs in the HIGH group had an increased area of acidic mucin-producing cells in the small intestine compared with LOW pigs (P < 0.05), but other intestinal morphology measurements at PWD 28 were unaffected by the level of FI. In conclusion, high FI just after weaning was associated with higher growth performance but also higher probability of diarrhoea and more frequent use of antibiotics until PWD 28.

Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities-focused research.

Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.

Potential for prevention of dementia in Denmark.

INTRODUCTION: According to previous estimates, 40% of dementia cases globally may be attributed to 12 potentially modifiable risk factors. METHODS: We calculated national population attributable fractions (PAFs) for each risk factor and modeled the effects of proportional reductions in risk factor prevalence on dementia prevalence by calculating potential impact fractions (PIFs) for each factor. RESULTS: The overall adjusted PAF for all risk factors was 35.2%. Physical inactivity, hearing loss, hypertension, and obesity accounted for 64% of the total prevention potential. The overall adjusted PIF was 4.1% at 10% risk factor prevalence reduction and 8.1% at 20% risk factor reduction. DISCUSSION: Estimates of the potential for the prevention of dementia should be based on country-specific data on risk factor prevalence, as estimates based on global risk factor prevalence have limited relevance from a national perspective. Physical inactivity, hearing loss, hypertension, and obesity could be primary targets for prevention of dementia in Denmark. HIGHLIGHTS: Overall adjusted PAF for potentially modifiable dementia risk factors was 35%. Physical inactivity, hearing loss, hypertension, and obesity had the largest prevention potential. Estimates of prevention potential should be based on national risk factor prevalence.

Cognitive assessment of literacy learning difficulties in adult non- or low-literate second language learners.

The population of non- or low-literate adult immigrants studying a new language is large and growing in many countries. The aim of this study was to develop and validate a new instrument for the assessment of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners, the Cognitive Assessment of Literacy Learning Difficulties (CALL), in a language center setting. This was a case-control study in which the CALL was validated in adult non- or low-literate students, or students who were not literate in the Latin alphabet, in nine Danish language centers. Educator classification of students with very slow progression in learning basic Danish literacy was used as a benchmark for literacy learning difficulties. Classification was further based on the number of lessons participants had required to pass tests during Danish language program levels. An acceptable discriminative validity (AUC 0.76; specificity 0.94, sensitivity 0.64) for literacy learning difficulties (n = 32) versus schooling and sex matched control participants (n = 28) was found. In comparison, years of formal schooling had an AUC of 0.58. Age had a small effect on the ability of the CALL to predict literacy learning difficulties (OR = 1.097, p = 0.013), whereas sex and years of schooling did not. CALL was found to be a valid instrument for identification of cognitive impairment that may hinder literacy learning in adult non- or low-literate L2 learners in a Danish language center setting.

Clinical Utility of WAIS-IV Matrix Reasoning Among Adult Low Educated Recent Immigrants; A Note of Caution.

OBJECTIVE: To examine the clinical utility of Wechsler Adult Intelligence Scale-IV (WAIS-IV) Matrix Reasoning in limited educated recently arrived immigrants in Denmark. METHOD: Participants were 64 limited educated (0-9 years' education) independently living adult immigrants primarily from Middle Eastern and Sub-Saharan African countries who completed WAIS-IV Matrix Reasoning as well as demographic, and medical questionnaires. RESULTS: Thirty-eight participants (59%) scored more than two standard deviations below the Scandinavian mean (scaled score < 4). Performances were significantly associated with years of education but not with occupational status, years of residence in Denmark, or Danish language skills. The most common error types were repetition errors (15.84%) and incomplete correlate errors (10.47%), with a strong trend for a higher proportion of repetition errors in participants with <5 years of education. CONCLUSIONS: The findings indicate that WAIS-IV Matrix Reasoning underestimates cognitive functioning in limited educated recently arrived immigrants, thus calling its clinical utility into question.

Validity of Visuoconstructional Assessment Methods within Healthy Elderly Greek Australians: Quantitative and Error Analysis.

AIMS: Visuospatial skills are frequently assessed with drawing tests. Research has suggested that the use of drawing tasks in low educated groups may lack the ability to discriminate healthy individuals from clinical populations. The aims of this study were to investigate the validity of visuoconstructional tests in a sample of older Greek Australian immigrants and compare their performances to a matched sample of patients with Alzheimer's disease (ad). METHOD: We assessed visuoconstructional performances in a sample of 90 healthy older Greek Australians, with a primary school level of education, and compared performances to a demographically matched sample of 20 Greek Australians with a diagnosis of ad on four visuoconstructional drawing tests: Greek cross, four-pointed star, intersecting pentagons, and the Necker Cube. RESULTS: While healthy participants tended to outperform the ad group on most copy tasks, high fail rates within the healthy sample were observed for the intersecting pentagons and Necker cube (78% and 73% fail rates, respectively) when using established clinical cut-off scores. High rates of curved angle, omission, distorted relation between elements, spatial disorganization and three-dimensional design errors were found across the four-pointed star, intersecting pentagons, and the Necker cube in both healthy participants and those with ad. Exploratory receiver operating characteristic curve analysis revealed that, with perhaps the exception of the Greek cross, meaningful sensitivity and specificity could not be reached for the four-pointed star, intersecting pentagons, and Necker cube. CONCLUSION: Cognitively healthy immigrants with low education appear to be at a disadvantage when completing visuoconstructional drawing tests, as their performance may be misinterpreted as indicating cognitive impairment. Future research is needed to identify alternative approaches to assess visuoconstructional ability in culturally and linguistically diverse older cohorts with limited education.

Cognitive Assessment in Culturally, Linguistically, and Educationally Diverse Older Populations in Europe.

Due to increasing cultural, linguistic, and educational diversity in older populations across Europe, accurate assessment of cognitive functioning in people from diverse backgrounds becomes increasingly important. This paper aims to provide a state-of-the-art review of cognitive assessment in culturally, linguistically, and educationally diverse older populations in Europe, focusing on challenges and recent advances in cross-cultural assessment. Significant work has been carried out on the identification of challenges in cognitive assessment in culturally, linguistically, and educationally diverse older populations and on development and validation of cross-cultural cognitive tests. Most research has addressed the influences of language barriers, education and literacy, and culture and acculturation and in particular, the European Cross-Cultural Neuropsychological Test Battery (CNTB) and the Rowland Universal Dementia Assessment Scale (RUDAS) are well-validated across European countries. However, cross-cultural cognitive assessment is largely still a developing field in Europe, and there is a continuing need for developments within the field.

Full automation of total metabolic tumor volume from FDG-PET/CT in DLBCL for baseline risk assessments.

BACKGROUND: Current radiological assessments of 18fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging data in diffuse large B-cell lymphoma (DLBCL) can be time consuming, do not yield real-time information regarding disease burden and organ involvement, and hinder the use of FDG-PET to potentially limit the reliance on invasive procedures (e.g. bone marrow biopsy) for risk assessment. METHODS: Our aim is to enable real-time assessment of imaging-based risk factors at a large scale and we propose a fully automatic artificial intelligence (AI)-based tool to rapidly extract FDG-PET imaging metrics in DLBCL. On availability of a scan, in combination with clinical data, our approach generates clinically informative risk scores with minimal resource requirements. Overall, 1268 patients with previously untreated DLBCL from the phase III GOYA trial (NCT01287741) were included in the analysis (training: n = 846; hold-out: n = 422). RESULTS: Our AI-based model comprising imaging and clinical variables yielded a tangible prognostic improvement compared to clinical models without imaging metrics. We observed a risk increase for progression-free survival (PFS) with hazard ratios [HR] of 1.87 (95% CI: 1.31-2.67) vs 1.38 (95% CI: 0.98-1.96) (C-index: 0.59 vs 0.55), and a risk increase for overall survival (OS) (HR: 2.16 (95% CI: 1.37-3.40) vs 1.40 (95% CI: 0.90-2.17); C-index: 0.59 vs 0.55). The combined model defined a high-risk population with 35% and 42% increased odds of a 4-year PFS and OS event, respectively, versus the International Prognostic Index components alone. The method also identified a subpopulation with a 2-year Central Nervous System (CNS)-relapse probability of 17.1%. CONCLUSION: Our tool enables an enhanced risk stratification compared with IPI, and the results indicate that imaging can be used to improve the prediction of central nervous system relapse in DLBCL. These findings support integration of clinically informative AI-generated imaging metrics into clinical workflows to improve identification of high-risk DLBCL patients. TRIAL REGISTRATION: Registered clinicaltrials.gov number: NCT01287741.

Diagnostic Accuracy of the Swedish Version of the Rowland Universal Dementia Assessment Scale (RUDAS-S) for Multicultural Cognitive Screening in Swedish Memory Clinics.

BACKGROUND: The number of people with a migration background and dementia is increasing in Europe. All patients with suspected dementia have the right to an appropriate cognitive assessment and correct diagnosis for optimal treatment and support. Rowland Universal Dementia Assessment Scale (RUDAS) cognitive screening instrument is less affected by language, culture, and educational background, and adapted for use in multicultural populations. OBJECTIVE: To compare the diagnostic accuracy of RUDAS-S to the Swedish version of Mini-Mental State Examination (MMSE-SR) for detecting dementia in a multicultural group of outpatients in Swedish memory clinics. METHODS: We tested 123 outpatients (36 nonnative Swedish), in 4 memory clinics in Southern Sweden with RUDAS-S to supplement the usual cognitive assessment. RESULTS: RUDAS-S had moderate to good diagnostic performance for detecting dementia in a multicultural population in Sweden, with an area under the receiver operating characteristic curve (AUC) of 0.81. At a cutoff score <25 its sensitivity was 0.92, specificity 0.60, and accuracy 76%. The AUC for the MMSE-SR was 0.79. At a cutoff score <23 its sensitivity was 0.65, specificity 0.81, and accuracy 73%. CONCLUSION: RUDAS-S is at least as accurate as MMSE-SR for detecting dementia in memory clinics in Sweden and can be used for all patients undergoing a cognitive assessment, irrespective of their cultural, language, and educational background. However, there is a need for other cross-cultural cognitive tests to complement RUDAS-S to extend cognitive examination.

Thorough design and pre-trial quality assurance (QA) decrease dosimetric impact of delineation and dose planning variability in the STRICTLUNG and STARLUNG trials for stereotactic body radiotherapy (SBRT) of central and ultra-central lung tumours.

INTRODUCTION: SBRT of central lung tumours implies significant risk of toxicity. We are initiating two phase II trials prescribing 56 Gy/eight fractions to PTV, allowing for dose escalation of GTV. We prioritize organs at risk (OAR) constraints over target coverage, making the treatment plans very sensitive to OAR delineation variations. The aim of this study is to quantify the dosimetric impact of contouring variations and to provide a thorough description of pre-trial quality assurance to be used in upcoming trials to provide consistent clinical care. MATERIALS AND METHODS: Delineation: Seven physicians delineated OAR in three rounds, with evaluations in-between. For each patient case, seven treatment plans, repeatedly using each of the OAR structure sets from the seven physicians, were made and compared to evaluate the dosimetric effect of delineation variability. Treatment planning: Treatment plans for seven cases were made at six departments in two rounds, with discussion in-between. RESULTS: OAR delineation variation between centres resulted in high variabilities in OAR dose for simulated plans and led to potential overdosage of the lobar bronchus (constraint: D0.03cc < 45 Gy), with maximum doses ranging between 58 Gy (first round), and 50 Gy (third round). For mediastinal tissue, the constraint (D0.03cc < 45 Gy) was violated for the majority of the delineations in all three rounds, with maximum doses of 84 Gy (first round), and 72 Gy (third round).For the treatment planning study, the range of the standard deviation for GTV mean dose was 12.8-18.5 Gy (first round) and 2.8-3.5 Gy (second round). CONCLUSIONS: Even small variations in OAR delineation led to high OAR overdosage. The study demonstrates the importance of having extensive QA procedures in place before initiating clinical trials on dose escalation in SBRT.

Age-dependent development in protein digestibility and intestinal morphology in weaned pigs fed different protein sources.

Today, weaner diets are optimised using digestibility coefficients obtained from grower-finisher pigs, which may overestimate the digestibility in weaners. The aim of this study was to evaluate the standardised ileal digestibility (SID) of CP and amino acids (AAs), and the intestinal morphology in pigs 0-4 weeks postweaning when fed different protein sources. The experiment included 128 pigs weaned at day 28 and the protein sources were wheat, soybean meal (SBM), enzyme-treated soybean meal (ESBM), hydrothermally treated rapeseed meal (HRSM) and casein. The experiment was conducted as a difference method study including wheat in all diets. Eight pigs were slaughtered on the day of weaning (day 0) and six pigs/treatment were slaughtered at days 7, 14, 21, and 28 postweaning. The SID of CP and AA, as average over the four weeks, was lowest for ESBM and highest for wheat and casein, with SBM and HRSM being intermediate. The SID of CP and AA increased (both linear and quadratic, P < 0.05) over time after weaning. The average SID of CP for all protein sources postweaning was 0.38, 0.59, 0.76, and 0.71 on days 7, 14, 21, and 28, respectively. These differences were significant (P < 0.05) between days 7 and 21, and between days 7 and 28 (P < 0.05), whereas there tended to be a difference between days 7 and 14 (P = 0.06). Protein source did not affect the small intestinal morphology response parameters, whereas time after weaning did. Villous height and villous height to crypt depth ratio differed (P < 0.05) between the days 0 and 7, with shorter villi and a higher ratio at day 7. Crypt depth was not altered between days 0 and 7, or between days 7 and 14. For villi density, crypt density and small intestinal length, a significant increase from days 7 to 14 was observed, but there was no further increase to or difference between days 21 and 28. In conclusion, the low SID of CP in casein on day 7 (0.50) illustrates the challenges related to protein digestion in weanling pigs. The SID of CP and AA is very low during the first two weeks postweaning and time after weaning is more important for protein digestibility, than the source of protein. Fewer mature epithelial cells and less absorptive area in the small intestine in the early postweaning period may partly explain the poor protein digestibility.