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1.
Isr Med Assoc J ; 23(9): 550-555, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34472229

RESUMO

BACKGROUND: Medical imaging and the resultant ionizing radiation exposure is a public concern due to the possible risk of cancer induction. OBJECTIVES: To assess the accuracy of ultra-low-dose (ULD) chest computed tomography (CT) with denoising versus normal dose (ND) chest CT using the Lung CT Screening Reporting and Data System (Lung-RADS). METHODS: This prospective single-arm study comprised 52 patients who underwent both ND and ULD scans. Subsequently AI-based denoising methods were applied to produce a denoised ULD scan. Two chest radiologists independently and blindly assessed all scans. Each scan was assigned a Lung-RADS score and grouped as 1 + 2 and 3 + 4. RESULTS: The study included 30 men (58%) and 22 women (42%); mean age 69.9 ± 9 years (range 54-88). ULD scan radiation exposure was comparable on average to 3.6-4.8% of the radiation depending on patient BMI. Denoising increased signal-to-noise ratio by 27.7%. We found substantial inter-observer agreement in all scans for Lung-RADS grouping. Denoised scans performed better than ULD scans when negative likelihood ratio (LR-) was calculated (0.04--0.08 vs. 0.08-0.12). Other than radiation changes, diameter measurement differences and part-solid nodules misclassification as a ground-glass nodule caused most Lung-RADS miscategorization. CONCLUSIONS: When assessing asymptomatic patients for pulmonary nodules, finding a negative screen using ULD CT with denoising makes it highly unlikely for a patient to have a pulmonary nodule that requires aggressive investigation. Future studies of this technique should include larger cohorts and be considered for lung cancer screening as radiation exposure is radically reduced.


Assuntos
Neoplasias Pulmonares/diagnóstico por imagem , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Exposição à Radiação
2.
Molecules ; 26(15)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34361749

RESUMO

Cefquinome and ceftiofur are ß-lactam antibiotics used for the treatment of bacterial infections in swine. Although these antimicrobials are administered intramuscularly, the exposure of the gut microbiota to these cephalosporins is not well described. This exposure can contribute to the emergence and spread of antimicrobials in the environment and to the possible spread of antimicrobial resistance genes. To assess the impact of drug administration on the intestinal excretion of these antimicrobials it is essential to measure the amounts of native compound and metabolites in feces. Two (ultra)-high-performance liquid chromatography-tandem mass spectrometry ((U)HPLC-MS/MS) methods were developed and validated, one for the determination of cefquinome and ceftiofur and the other for the determination of ceftiofur residues, measured as desfuroylceftiofuracetamide, in porcine feces. The matrix-based calibration curve was linear from 5 ng g-1 to 1000 ng g-1 for cefquinome (correlation coefficient (r) = 0.9990 ± 0.0007; goodness of fit (gof) = 3.70 ± 1.43) and ceftiofur (r = 0.9979 ± 0.0009; gof = 5.51 ± 1.14) and quadratic from 30 ng g-1 to 2000 ng g-1 for desfuroylceftiofuracetamide (r = 0.9960 ± 0.0020; gof = 7.31 ± 1.76). The within-day and between-day precision and accuracy fell within the specified ranges. Since ß-lactam antibiotics are known to be unstable in feces, additional experiments were conducted to adjust the sampling protocol in order to minimize the impact of the matrix constituents on the stability of the analytes. Immediately after sampling, 500 µL of an 8 µg mL-1 tazobactam solution in water was added to 0.5 g feces, to reduce the degradation in matrix.


Assuntos
Acetamidas/isolamento & purificação , Antibacterianos/isolamento & purificação , Cefalosporinas/isolamento & purificação , Cromatografia Líquida de Alta Pressão/normas , Furanos/isolamento & purificação , Espectrometria de Massas em Tandem/normas , Acetamidas/administração & dosagem , Animais , Antibacterianos/administração & dosagem , Calibragem , Cefalosporinas/administração & dosagem , Cromatografia Líquida de Alta Pressão/métodos , Fezes/química , Feminino , Furanos/administração & dosagem , Injeções Intramusculares , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Suínos , Espectrometria de Massas em Tandem/métodos , Tazobactam/química
3.
Am J Sports Med ; 49(11): 2955-2959, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34347536

RESUMO

BACKGROUND: In managing pediatric knee conditions, an accurate bone age assessment is often critical for diagnostic, prognostic, and treatment purposes. Historically, the Greulich and Pyle atlas (hand atlas) has been the gold standard bone age assessment tool. In 2013, a shorthand bone age assessment tool based on this atlas (hand shorthand) was devised as a simpler and more efficient alternative. Recently, a knee magnetic resonance imaging (MRI) bone age atlas (MRI atlas) was created to circumvent the need for a left-hand radiograph. PURPOSE: To create a shorthand version of the knee MRI atlas. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: A shorthand bone age assessment method was created utilizing the previously published MRI atlas, which utilizes several criteria that are visualized across a series of images. The MRI shorthand draws on characteristic criteria for each age that are best observed on a single MRI scan. For validation, we performed a retrospective assessment of skeletally immature patients. One reader performed the bone age assessment using the MRI atlas and the MRI shorthand on 200 patients. Then, 4 readers performed the bone age assessment with the hand atlas, hand shorthand, MRI atlas, and MRI shorthand on a subset of 22 patients in a blinded fashion. All 22 patients had a knee MRI scan and a left-hand radiograph within 4 weeks of each other. Interobserver and intraobserver reliability, as well as variability among observers, were evaluated. RESULTS: A total of 200 patients with a mean age of 13.5 years (range, 9.08-17.98 years) were included in this study. Also, 22 patients with a mean age of 13.3 years (range, 9.0-15.6 years) had a knee MRI scan and a left-hand radiograph within 4 weeks. The intraobserver and interobserver reliability of all 4 assessment tools were acceptable (intraclass correlation coefficient [ICC] ≥ 0.8; P < .001). When comparing the MRI shorthand with the MRI atlas, there was excellent agreement (ICC = 0.989), whereas the hand shorthand compared with the hand atlas had good agreement (ICC = 0.765). The MRI shorthand also had perfect agreement in 50% of readings among all 4 readers, and 95% of readings had agreement within 1 year, whereas the hand shorthand had perfect agreement in 32% of readings and 77% agreement within 1 year. CONCLUSION: The MRI shorthand is a simple and efficient means of assessing the skeletal maturity of adolescent patients with a knee MRI scan. This bone age assessment technique had interobserver and intraobserver reliability equivalent to or better than the standard method of utilizing a left-hand radiograph.


Assuntos
Taquigrafia , Adolescente , Determinação da Idade pelo Esqueleto , Criança , Estudos de Coortes , Humanos , Lactente , Imageamento por Ressonância Magnética , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 100(30): e26126, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397682

RESUMO

ABSTRACT: It was reported imperative on cervical sagittal alignment reconstruction after anterior multilevel procedures with self-locked stand-alone cage (SSC) or anterior cage-with-plate (ACP) system multilevel while there was little knowledge about the relationship on cervical alignment and clinical outcomes.To identify the importance of cervical sagittal alignment after 3-level anterior cervical discectomy and fusion on cervical spondylotic myelopathy with SSC and ACP system.Seventy-seven patients with SSC system (SSC group) and 52 cases with ACP system (ACP group) from February 2007 to September 2013 were enrolled with well-matched demographics. Cervical alignment included C2-7 lordosis (CL), operated-segment cervical lordosis (OPCL), upper and lower adjacent-segment cervical lordosis, range of motion of upper and lower adjacent segment at preoperation, immediate postoperation, and the final follow-up. Clinical outcomes contained the neck disability index (NDI), the Japanese Orthopaedic Association (JOA) score, visual analogous scale (VAS) of arm and neck and adjacent segment degeneration (ASD). Patients were then divided into CL improved subgroup (IM subgroup) and non-improved subgroup (NIM subgroup).There were improvements on CL and OPCL in both groups. The change of CL and OPCL larger in ACP group (P < .05) but upper adjacent-segment cervical lordosis/lower adjacent-segment cervical lordosis and range of motion of upper adjacent segment/range of motion of lower adjacent segment were of no significance. NDI, JOA, and VAS got improvement in both groups at immediate postoperation and the final follow-up while ASD was in no difference between SSC and ACP group. A total of 80 patients (39 vs 41) acquired CL improvement with a larger population in ACP group. There were no differences on the rate of ASD, NDI, JOA, VAS, and their change between IM and NIM subgroup. The changes of CL were not correlated to NDI, JOA, VAS, and their change.SSC and ACP group both provide improved OPCL and efficacy on 3-level cervical spondylotic myelopathy with little impact on adjacent segment. The change of CL is not correlated to clinical outcomes.


Assuntos
Vértebras Cervicais/cirurgia , Radiografia/estatística & dados numéricos , Doenças da Medula Espinal/cirurgia , Fusão Vertebral/normas , Idoso , Vértebras Cervicais/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Radiografia/métodos , Estudos Retrospectivos , Doenças da Medula Espinal/diagnóstico por imagem , Doenças da Medula Espinal/fisiopatologia , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
5.
Bone Joint J ; 103-B(8): 1339-1344, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34334039

RESUMO

AIMS: This aim of this study was to assess the reliability and validity of the Unified Classification System (UCS) for postoperative periprosthetic femoral fractures (PFFs) around cemented polished taper-slip (PTS) stems. METHODS: Radiographs of 71 patients with a PFF admitted consecutively at two centres between 25 February 2012 and 19 May 2020 were collated by an independent investigator. Six observers (three hip consultants and three trainees) were familiarized with the UCS. Each PFF was classified on two separate occasions, with a mean time between assessments of 22.7 days (16 to 29). Interobserver reliability for more than two observers was assessed using percentage agreement and Fleiss' kappa statistic. Intraobserver reliability between two observers was calculated with Cohen kappa statistic. Validity was tested on surgically managed UCS type B PFFs where stem stability was documented in operation notes (n = 50). Validity was assessed using percentage agreement and Cohen kappa statistic between radiological assessment and intraoperative findings. Kappa statistics were interpreted using Landis and Koch criteria. All six observers were blinded to operation notes and postoperative radiographs. RESULTS: Interobserver reliability percentage agreement was 58.5% and the overall kappa value was 0.442 (moderate agreement). Lowest kappa values were seen for type B fractures (0.095 to 0.360). The mean intraobserver reliability kappa value was 0.672 (0.447 to 0.867), indicating substantial agreement. Validity percentage agreement was 65.7% and the mean kappa value was 0.300 (0.160 to 0.4400) indicating only fair agreement. CONCLUSION: This study demonstrates that the UCS is unsatisfactory for the classification of PFFs around PTS stems, and that it has considerably lower reliability and validity than previously described for other stem types. Radiological PTS stem loosening in the presence of PFF is poorly defined and formal intraoperative testing of stem stability is recommended. Cite this article: Bone Joint J 2021;103-B(8):1339-1344.


Assuntos
Fraturas do Fêmur/classificação , Prótese de Quadril , Fraturas Periprotéticas/classificação , Complicações Pós-Operatórias/classificação , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Fraturas Periprotéticas/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Desenho de Prótese , Radiografia , Reprodutibilidade dos Testes
6.
J Bodyw Mov Ther ; 27: 560-564, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34391287

RESUMO

INTRODUCTION: Although the pressure biofeedback unit (PBU) is used for muscular assessment and training, there is little evidence of its reproducibility and repeatability. OBJECTIVE: This study aims to assess intra- and inter-rater reproducibility and repeatability of the PBU in the assessment of the transverse abdominal (TrA), internal oblique (IO), low back multifidi, and deep neck flexors (DNF). METHODS: Fifty individuals had three muscular groups tested: TrA/IO, lower back multifidi, and DNF. For repeatability, one rater did three consecutive measures; for intra-rater reproducibility the same rater did two measures with seven-day intervals, and for inter-rater reproducibility, three raters, on the same day, did the measures. Data were analyzed with: Intraclass Correlation Coefficient (ICC), Standard Error of Measurement (SEM), and Minimal Detectable Change (MDC). (α = 0,05). RESULTS: Repeatability: TrA/IO (ICC = 0.847), Multifidi (ICC = 0.860), DNF (ICC = 0.831). Inter-rater reproducibility: TrA/IO (ICC = 0.876), Multifidi (ICC = 0.508), DNF (ICC = 0.442). Intra-rater reproducibility: TrA/IO (ICC = 0.747), Multifidi (ICC = 0.293), DNF (ICC = 0.685). Except for Multifidi, all the SEM values were less than 10 mmHg and the MDC values were less than 15 mmHg. CONCLUSIONS: The PBU can be used with reliability by different evaluators, although the evaluation of multifidi is not indicated.


Assuntos
Músculos Abdominais , Biorretroalimentação Psicológica , Músculos Abdominais Oblíquos , Humanos , Variações Dependentes do Observador , Músculos Paraespinais , Reprodutibilidade dos Testes
7.
Transl Vis Sci Technol ; 10(9): 1, 2021 08 02.
Artigo em Inglês | MEDLINE | ID: mdl-34338722

RESUMO

Purpose: This study aimed to determine the intra- and interobserver repeatability of the new LacryDiag Ocular Surface Analyzer and compare it to a similar all-in-one device, the OCULUS Keratograph 5M. Methods: Thirty healthy subjects aged 18 years and above were recruited for this study. All patients were free of any existing ocular pathology. The LacryDiag Ocular Surface Analyzer was used to evaluate tear meniscus height, interferometry, noninvasive tear break-up time (NIBUT), and meibography. The same or analogous exams were performed using the OCULUS Keratograph 5M. Test equivalation was used to compare data from corresponding examinations. Paired t-tests and coefficient of variation were used to determine inter- and intraobserver repeatability. Bland-Altman analysis was used to determine level of agreement between devices. Results: There were no differences in mean values for tear meniscus height, NIBUT, or tear film interferometry between observers for either device. Significant differences were found between observers for meibography when using the LacryDiag (P = 0.008 for percent loss calculation and P = 0.004 for grading scale). Intra-observer variability for NIBUT was significantly higher for the Keratograph (P = 0.0003 for observer A and P < 0.0001 for observer B). Conclusions: There was a good correlation but poor agreement between devices for a given observer. This was likely influenced by the use of repeated testing and the non-dry eye cohort. Translational Relevance: Both the repeatability of the testing device and the use of multiple outcome measures are essential for the diagnosis and monitoring of patients with dry eye disease (DED).


Assuntos
Síndromes do Olho Seco , Glândulas Tarsais , Síndromes do Olho Seco/diagnóstico , Humanos , Interferometria , Variações Dependentes do Observador , Lágrimas
8.
Psychol Assess ; 33(9): 904-910, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34197162

RESUMO

Teachers are uniquely placed to comment on the psychosocial functioning of their students. In particular, teacher report of symptoms and functional impairment is crucial in a diagnostic assessment of Attention-deficit Hyperactivity Disorder (ADHD). For adolescents, however, schooling structures and other factors can influence the reliability of teacher reports. Clarity is needed for both clinicians and researchers regarding the interteacher reliability across different domains in the assessment of adolescents. This study investigated interrater reliability of teacher reports of adolescents using data from the 72-month follow-up of the National Institute of Mental Health (NIMH) Collaborative Multisite Multimodal Treatment Study of Children with ADHD (MTA) when participants were 13-15.9 years old. For adolescents with a history of ADHD (MTA; N = 177-210), and a normative comparison group (Local Normative Control Group [LNCG]; N = 100-125), intraclass correlations (ICC) were examined between Math and English teacher reports of ADHD symptoms, externalizing behavior, scholastic competence, and social functioning. Results indicate poor to moderate reliability in the assessment of adolescents with a history of ADHD for core ADHD symptoms, social functioning and scholastic competence, and moderate to good reliability of externalizing behavior. Interteacher reliability was better for the normative comparison group in all domains except social functioning, which was also poor to moderate. Clinicians and researchers should be aware of potential inconsistencies in teacher reports and where possible collect multiple teacher reports to maximize reliability. Further implications for research and clinical practice are explored. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Professores Escolares , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Professores Escolares/psicologia
10.
Br J Radiol ; 94(1125): 20210197, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34233471

RESUMO

OBJECTIVES: The main standard of care for locally advanced cervix carcinoma (LACC) is radiochemotherapy (RCT) followed by brachytherapy. A surgical approach may still be discussed based on pelvic MRI-derived residual tumour evaluation. As no interobserver agreement study has ever been conducted to our knowledge, the aim of the present study was to report on pelvic MRI accuracy and interobserver agreement in LACC. METHODS: We carried out a retrospective study in a French university hospital. Medical records of all consecutive patients treated with curative intent for LACC by RCT followed by brachytherapy and completion pelvic surgery between January 2014 and January 2020 were reviewed. Local response was assessed through pelvis MRI and histological analysis after completion surgery. MRI data were independently evaluated by two radiologists with varying experience. The two main interobserving criteria we used were complete response and residual tumour. RESULTS: 23 patients fulfilled the inclusion criteria. Agreement between the junior and senior radiologist was moderate to strong. Indeed, regarding main criteria, κ was 0.65 for complete response and 0.57 for residual tumour. Interestingly, the present study shows a lower sensitivity whatever the radiologists than in the international literature. CONCLUSION: The present study highlights a low interobserver variability regarding pelvic MRI in the assessment of RCT followed by brachytherapy in LACC. Yet, sensitivity was lower than in literature. ADVANCES IN KNOWLEDGE: Radiology is part of treatment decision-making, the issue of heterogeneity regarding radiologists' training and experience to cancer (sensitivity and specificity) turns essential, so does MRI accuracy.


Assuntos
Imageamento por Ressonância Magnética/métodos , Neoplasias do Colo do Útero/diagnóstico por imagem , Neoplasias do Colo do Útero/terapia , Adulto , Idoso , Braquiterapia/métodos , Colo do Útero/diagnóstico por imagem , Quimiorradioterapia/métodos , Feminino , França , Humanos , Pessoa de Meia-Idade , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Resultado do Tratamento
11.
Ann Surg Oncol ; 28(10): 5663-5667, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34268635

RESUMO

BACKGROUND: Inter-rater reliability between breast surgical oncologists and reconstructive surgeons using cosmesis scales, and the correlation between their observations and patients' own subjective assessments, is poorly understood. METHODS: Patients undergoing BCS in a prospective trial rated their cosmetic outcome on a Likert scale (poor/fair/good/excellent) at the postoperative and 1-year time points; photographs were also taken. Three breast surgical oncologists (not involved in these cases) and two reconstructive surgeons were asked to independently rate cosmesis using the Harvard/NSABP/RTOG scale. RESULTS: Overall, 55 and 17 patients had photographs and Likert self-evaluations at the postoperative and 1-year time points, respectively. There was poor agreement between surgeon and patient ratings postoperatively [kappas - 0.042 (p = 0.659), 0.069 (p = 0.226), and 0.076 (p = 0.090) for the breast surgical oncologists; and 0.018 (p = 0.689) and 0.112 (p = 0.145) for the reconstructive surgeons], and poor interobserver agreement between surgeons of the same specialty (kappa - 0.087, 95% confidence interval [CI] - 0.091 to - 0.082, p = 0.223 for breast surgical oncologists; and kappa - 0.150, 95% CI - 0.157 to - 0.144, p = 0.150, for reconstructive surgeons). At 1 year, the interobserver agreement between breast surgical oncologists was better (kappa 0.507, 95% CI 0.501-0.512, p < 0.001); however, there was still poor correlation between the reconstructive surgeons (kappa - 0.040, 95% CI - 0.049 to - 0.031, p = 0.772). Agreement between surgeon and patient ratings remained poor at this time point [kappas - 0.115 (p = 0.477), 0.177 (p = 0.245), and 0.101 (p = 0.475) for breast surgical oncologists; and 0.335 (p = 0.037) and -0.118 (p = 0.221) for reconstructive surgeons]. CONCLUSION: Despite gradation scales for measuring cosmesis after BCS, high levels of agreement between surgeons is lacking and these do not always reflect patients' subjective assessments.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/cirurgia , Feminino , Humanos , Variações Dependentes do Observador , Avaliação de Resultados em Cuidados de Saúde , Estudos Prospectivos , Reprodutibilidade dos Testes
12.
BMC Health Serv Res ; 21(1): 750, 2021 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-34320964

RESUMO

BACKGROUND: There is a dearth of information about health education clinical file audits in the context of completeness of records and demonstrating program-wide competency achievement. We report on the reliability of an audit instrument used for electronic health record (EHR) audits in the clinics of a chiropractic college in Canada. METHODS: The instrument is a checklist built within an electronic software application designed to pull data automatically from the EHR. It consists of a combination of 61 objective (n = 20) and subjective (n = 41) elements, representing domains of standards of practice, accreditation and in-house educational standards. Trained auditors provide responses to the elements and the software yields scores indicating the quality of clinical record per file. A convenience sample of 24 files, drawn randomly from the roster of 22 clinicians, were divided into three groups of eight to be completed by one of three auditors in the span of 1 week, at the end of which they were transferred to another auditor. There were four audit cycles; audits from cycles 1 and 4 were used to assess intra-rater (test-retest) reliability and audits from cycles 1, 2 and 3 were used to assess inter-rater reliability. Percent agreement (PA) and Kappa statistics (K) were used as outcomes. Scatter plots and intraclass correlation (ICC) coefficients were used to assess standards of practice, accreditation, and overall audit scores. RESULTS: Across all 3 auditors test-retest reliability for objective items was PA 89% and K 0.75, and for subjective items PA 82% and K 0.63. In contrast, inter-rater reliability was moderate at PA 82% and K 0.59, and PA 70% and K 0.44 for objective and subjective items, respectively. Element analysis indicated a wide range of PA and K values inter-rater reliability of many elements being rated as poor. ICC coefficient calculations indicated moderate reliability for the domains of standards of practice, accreditation, and overall file scores. CONCLUSION: The file audit process has substantial test-retest reliability and moderate inter-rater reliability. Recommendations are made to improve reliability outcomes. These include modifying the audit checklist with a view of improving clarity of elements, and enhancing uniformity of auditor responses by increased training aided by preparation of an audit guidebook.


Assuntos
Quiroprática , Canadá , Lista de Checagem , Registros Eletrônicos de Saúde , Humanos , Variações Dependentes do Observador , Reprodutibilidade dos Testes
13.
J Comput Assist Tomogr ; 45(3): 367-373, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297508

RESUMO

OBJECTIVE: The objective of this study was to compare the image quality and apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) with modified reduced field of view (FOV) based on 2-dimensional (2D)-selective radiofrequency excitations by tilting the excitation plane in prostate with reduced FOV using parallel-transmit-accelerated 2D-selective radiofrequency excitation and single-shot echo planar imaging (ssEPI). METHODS: Fifty patients who underwent multiparametric magnetic resonance imaging including 3 DWIs were included. Two observers independently performed qualitative image analyses using 5-point scale. Apparent diffusion coefficient measurements were performed for quantitative analysis. RESULTS: Modified reduced FOV provided the highest qualitative scores for all categories compared with reduced FOV and ssEPI (P < 0.000). Both reduced FOV DWIs showed higher ADC values compared with ssEPI (P < 0.001); however, the ADC ratios between the lesion and peripheral zone were not significantly different (all P > 0.05). CONCLUSIONS: The modified reduced FOV DWI showed better overall image quality, differentiability of anatomic regions, and lesion conspicuity with fewer artifacts compared with DWI with reduced FOV and ssEPI.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Próstata/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Imagem Ecoplanar , Humanos , Masculino , Pessoa de Meia-Idade , Imageamento por Ressonância Magnética Multiparamétrica , Variações Dependentes do Observador , Estudos Retrospectivos , Razão Sinal-Ruído
14.
J Comput Assist Tomogr ; 45(3): 383-388, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297509

RESUMO

OBJECTIVE: This study aimed to determine the feasibility of diffusion-weighted imaging for detecting endometrial fibrosis in patients with intrauterine injury. METHODS: This prospective study included 34 patients with endometrial fibrosis and 34 healthy controls. All participants underwent T2-weighted and diffusion-weighted magnetic resonance imaging with b values of 0 and 1000 s/mm2 during the periovulatory phase with a dominant follicle. The endometrial apparent diffusion coefficient (ADC) and uterine anatomical parameters (endometrial thickness [EMT], length of the uterine cavity [LUC], and junctional zone thickness [JZT]) were measured and compared. Performance of the uterine endometrial ADC and anatomical parameters in diagnosing endometrial fibrosis was evaluated. RESULTS: Patients with endometrial fibrosis showed a lower endometrial ADC, lower EMT, shorter LUC, and higher JZT than did healthy controls (all, P < 0.001). Endometrial ADC value and uterine anatomical parameters showed good performance in diagnosing endometrial fibrosis, with the areas under the receiver operating characteristic curves of 0.976, 0.870, 0.883, and 0.864, respectively. The area under the curve of ADC was significantly higher than those of EMT (z = 1.973, P = 0.0485), LUC (z = 2.059, P = 0.0395), and JZT (z = 2.484, P = 0.0130). Intraobserver and interobserver agreements of endometrial ADC value measurements were excellent for both patients (intraclass correlation coefficient = 0.987 and 0.983, respectively) and healthy women (intraclass correlation coefficient = 0.986 and 0.989, respectively). CONCLUSIONS: Our preliminary results suggest that diffusion-weighted imaging has the potential to be a noninvasive imaging tool for the quantitative assessment of endometrial fibrosis.


Assuntos
Imagem de Difusão por Ressonância Magnética/métodos , Endométrio/diagnóstico por imagem , Endométrio/patologia , Endométrio/cirurgia , Adulto , Estudos de Casos e Controles , Competência Clínica , Estudos de Viabilidade , Feminino , Fibrose , Humanos , Histerectomia , Variações Dependentes do Observador , Projetos Piloto , Estudos Prospectivos , Curva ROC , Interpretação de Imagem Radiográfica Assistida por Computador , Sensibilidade e Especificidade
15.
Med Sci Monit ; 27: e931277, 2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34274938

RESUMO

BACKGROUND The chest X-ray is the most available imaging modality enabling semi-quantitative evaluation of pulmonary involvement. Parametric evaluation of chest radiographs in patients with SARS-CoV-2 infection is crucial for triage and therapeutic management. The CXR Score (Brixia Score), SARI CXR Severity Scoring System, and Radiographic Assessment of Lung Edema (RALE), proposed to evaluate SARS-CoV-2 infiltration of the lungs, were analyzed for interobserver agreement. MATERIAL AND METHODS This study analyzed 200 chest X-rays from 200 consecutive patients with confirmed SARS-CoV-2 infection, hospitalized at the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw. Radiographs were evaluated by 2 radiologists according to 3 scales: SARI, RALE, and CXR Score. RESULTS The overall interobserver agreement for SARI ratings was good (kappa=0.755; 95% CI, 0.817-0.694), for RALE scale assessments it was very good (kappa=0.818; 95% CI, 0.844-0.793), and for CXR scale assessments it was very good (kappa=0.844; 95% CI, 0.846-0.841). A moderate correlation was found between the radiological image assessed using each of the scales and the clinical condition of the patient in MEWS (Modified Early Warning Score) (r=0.425-0.591). CONCLUSIONS The analyzed scales are characterized by good or very good interobserver agreement of assessments of the extent of pulmonary infiltration. Since the CXR Score showed the strongest correlation with the clinical condition of the patient as expressed using the MEWS scale, it is the preferred scale for chest radiograph assessment of patients with COVID-19 in the light of data provided.


Assuntos
COVID-19/diagnóstico por imagem , Pulmão/patologia , Variações Dependentes do Observador , Radiografia , Humanos , Estudos Retrospectivos
16.
Anticancer Res ; 41(7): 3429-3438, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34230138

RESUMO

BACKGROUND/AIM: This study aimed to develop a new pathological finding, namely, invasion front grade and verify its clinical usefulness. MATERIALS AND METHODS: We re-examined haematoxylin-eosin-stained specimens in 162 stage II-III colorectal cancer patients who underwent radical resection. We assessed the desmoplastic reaction, Klintrup grade, and poorly differentiated cluster. These three findings were combined to form the invasion front grade (good prognosis group; Grade A, poor prognosis group; Grade B), and its reproducibility and prognostic stratification ability were statistically analysed. RESULTS: Invasion front grade was Grade A in 116 cases and Grade B in 46 cases, and its kappa coefficient was 0.81 for interobserver and 0.74 for intraobserver variability. The 3-year recurrence-free survival rates of Grade A and Grade B were 90.4% and 55.9%. Multivariate analysis showed that invasion front grade was an independent prognostic factor. CONCLUSION: Invasion front grade is useful as a prognostic stratification factor for stage II-III colorectal cancer.


Assuntos
Neoplasias Colorretais/patologia , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Estadiamento de Neoplasias/métodos , Variações Dependentes do Observador , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Taxa de Sobrevida
17.
Pol Merkur Lekarski ; 49(291): 176-181, 2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34218234

RESUMO

The Glasgow Coma Scale (GCS) is a widely adopted clinical scale which fails to assess a verbal component in intensive care units (ICUs) patients who are ventilated mechanically. AIM: The aim of the study was to evaluate the validity of the FOUR scale (Full Outline of UnResponsivness) when applied by staff of an ICU. MATERIALS AND METHODS: This prospective cohort study included 65 consecutive intubated patients treated in the ICU with brain damage. The study design included the simultaneous assessment of the patients' consciousness by two scales - the FOUR scale and the GCS. All assessments were made under strict inclusion and exclusion criteria. The patients were assessed by a randomly selected staff pairs (neurointensivist/ nurse, neurointensivist/resident, neurointensivist/neurointensivists). The assessments made by experienced neurointensivists were regarded as basic examinations and by other members as control examinations. The study design allowed for the assessment of the interrater reliability. RESULTS: In 65 enrolled patients, a total of 763 double assessments were made using the FOUR score and by the GCS. It has been shown that in 751 out of 763 assessments the patients' consciousness was accurately assessed, representing 98.43 % accuracy of the FOUR scale. In contrast, the patients' consciousness was reliably assessed by the GCS in only 88 assessments, representing 11.5 % of accuracy. CONCLUSIONS: The study showed excellent interrater reliability among the groups of examiners for the FOUR scale as well as the GCS. The main advantage of the FOUR scale in intubated patients is excellent accuracy. The FOUR scale is easy to learn. It is functional and it has no limitations typical of verbal scales. It is a valuable and recommended clinical tool for the assessment of consciousness of the ICU patients.


Assuntos
Estado de Consciência , Unidades de Terapia Intensiva , Humanos , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes
18.
J Forensic Leg Med ; 81: 102187, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34214896

RESUMO

INTRODUCTION: Because earlier research showed that inaccuracies were observed in the interpretation and handling of deaths by forensic physicians, peer consultation among forensic physicians was introduced before advice was given to treating physicians calling for advice. In addition, peer consultation was introduced as a means to improve the correctness of conclusions concerning the manner of death when performing external post-mortem examinations. METHOD: In the period of November 2017 until April 2018 all reports of external postmortem examinations (n = 498) and all telephonic consultations between treating physicians with forensic physicians, concerning postmortem examinations (n = 167), were analyzed retrospectively. RESULTS: Peer consultation among forensic physicians took place in 70% of the 167 telephonic consultations initiated by treating physicians. In 92% of all cases of telephonic consultation, the accurateness of advice to treating physicians was deemed accurate. In 67% (n = 498) of all external postmortem examinations in the study period, peer consultation between forensic physicians took place. The conclusion regarding the manner of death after external postmortem examination was accurate in 99% of all cases (n = 491 out of 498). CONCLUSION: The advices given by forensic physicians to treating physicians have improved after the introduction of peer consultation among forensic physicians. Peer consultation therefore should be recommended as a means for quality assurance.


Assuntos
Autopsia/normas , Atestado de Óbito , Medicina Legal/normas , Médicos , Encaminhamento e Consulta , Humanos , Países Baixos , Variações Dependentes do Observador , Melhoria de Qualidade , Estudos Retrospectivos
19.
Otol Neurotol ; 42(7): 1089-1094, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-34260513

RESUMO

OBJECTIVES: Evaluate intra-rater and inter-rater variabilities of the Sunnybrook Facial Grading System (SFGS) and explore potential factors of variability. STUDY DESIGN: Prospective test of hypothesis. SETTING: University tertiary referral center. PARTICIPANTS/METHODS: Facial video recordings of 20 patients with variable degrees of peripheral facial palsy (PFP) were anonymized then presented to 31 independents raters in 2 trials. The raters were senior and junior professionals involved in the management of PFP: ENT specialists, physiotherapists, and speech therapists. The SFGS was used for grading paralysis. MAIN OUTCOME MEASURE: Intra-rater and inter-rater variabilities were estimated by intraclass correlation coefficient (ICC [95% confidence interval]) for the composite score and the three subscores of the SFGS. Factors of variability studied were: rater professions and rater experience (senior vs junior). RESULTS: For the total population, the intra-rater ICC was 0.915[0.900-0.929] for the composite score considered to represent almost perfect repeatability. Repeatability was important for symmetry at rest (0.694[0.646-0.737]), almost perfect for voluntary movements (0.903[0.886-0.918]), and important to almost perfect for synkinesis (0.810[0.778-0.838]). The inter-rater ICC for the composite score was 0.847[0.755-0.923] indicating important to almost perfect agreement between all raters. Agreement between raters was important to almost perfect for voluntary movements (0.839[0.746-0.919]), but moderate to important for symmetry at rest (0.553[0.408-0.730]) and weak to important for synkinesis (0.476[0.333-0.666]). Some variability was found between raters groups; however, repeatability and agreement were good for all raters. CONCLUSIONS: The SFGS is a reproducible scale. It can be used with good reproducibility by both novices and experts, and by all professionals involved in the management of PFP.


Assuntos
Paralisia Facial , Face , Paralisia Facial/diagnóstico , Humanos , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Gravação em Vídeo
20.
Am J Surg Pathol ; 45(7): 988-996, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34105519

RESUMO

Atypical endometrial hyperplasia (AEH) is considered a precursor of endometrioid carcinoma. The 2020 World Health Organization (WHO) classification divides endometrial hyperplasia into 2 categories: hyperplasia without atypia and atypical hyperplasia/endometrioid intraepithelial neoplasia (EIN); however, this classification does not consider the degree of nuclear atypia. We graded nuclear atypia for estimating the risk of finding carcinoma at hysterectomy. Also, we investigated genes involved in endometrial carcinogenesis including mismatch repair (MMR) genes and ARID1A, PIK3CA, PTEN, KRAS, and CTNNB1. We reviewed 79 biopsies of AEH from 79 patients who underwent hysterectomy within a 1-year interval. Intraobserver and interobserver agreement of grading nuclear atypia and the relationship between the grade of nuclear atypia at biopsy and the findings at hysterectomy were evaluated. Immunohistochemistry for MMR status was performed in all cases and targeted sequencing in 11. Using low-grade versus high-grade nuclear atypia, κ values ranged from 0.74 to 0.91 (89% to 96%) and from 0.72 to 0.81 (87% to 91%) for the intraobserver and the interobserver agreement, respectively. The degree of nuclear atypia at biopsy was highly predictive of the findings at hysterectomy (P=1.6×10-15). Of 53 patients with low-grade AEH, none had carcinoma at hysterectomy, whereas 6 (6/26; 23%) with high-grade AEH in the biopsy also had high-grade AEH in the uterus and 16 (16/26; 61%) had FIGO grade 1 carcinoma. MMR deficiency was found in 3 of the 79 patients. None of the genes showed a mutational load significantly associated with the degree of nuclear atypia. In summary, our data show high reproducibility within and between observers for the diagnosis of low-grade and high-grade AEH. Most cases of AEH had low-grade nuclear atypia and neither high-grade AEH nor carcinoma was encountered in the corresponding hysterectomy specimens.


Assuntos
Carcinoma Endometrioide/patologia , Núcleo Celular/patologia , Hiperplasia Endometrial/patologia , Neoplasias do Endométrio/patologia , Adulto , Idoso , Biomarcadores Tumorais/genética , Biópsia , Carcinoma Endometrioide/genética , Carcinoma Endometrioide/cirurgia , Estudos de Casos e Controles , Núcleo Celular/genética , Reparo de Erro de Pareamento de DNA , Hiperplasia Endometrial/genética , Hiperplasia Endometrial/cirurgia , Neoplasias do Endométrio/genética , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Mutação , Gradação de Tumores , Variações Dependentes do Observador , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento
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