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1.
BJOG ; 127(1): 107-114, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31319445

RESUMO

OBJECTIVE: To evaluate the reproducibility of the Endometriosis Fertility Index (EFI). DESIGN: Single-cohort prospective observational study. SETTING: University hospital. POPULATION: Women undergoing laparoscopic resection of any rASRM-stage endometriosis. METHODS: Details of pre- and peroperative findings were collected into a coded research file. EFI scoring was performed en-bloc by three different raters (expert-1 [C.T.], expert-2 [C.M.], junior [C.B.]). Required sample size: 71. Definitions used for agreement: clinical (scores within same range: 0-4, 5-6, 7-10) and numerical (difference ≤1 EFI point). MAIN OUTCOME MEASURES: Primary outcome: rate of clinical agreement between two experts. SECONDARY OUTCOMES: expert numerical agreement, clinical and numerical agreement between expert-1 and junior, and within expert-1 (intra-observer), agreement of rASRM score and -stage. RESULTS: A near 'inter-expert' clinical agreement rate (1.000, 95% CI 0.956-1.000; P = 0.0149) was observed. The numerical agreement between two experts was also high (0.988, 95% CI 0.934-1.000); similarly, high agreement rates were observed for both 'junior-expert' comparisons (clinical 0 .963, 95% CI 0.897-0.992; numerical 0.988, 95% CI 0.934-1.000) and 'intra-expert' comparisons (clinical 0.988, 95% CI 0.934-1.000; numerical 1.000, 95% CI 0.956-1.000). Reasons for disagreements were different scoring of the least-function score and disagreements in rASRM scores. The reproducibility of the rASRM score was clearly inferior to that of the EFI for all comparisons. CONCLUSION: The EFI can be reproduced reliably by different raters, further supporting its use in daily clinical practice as the principal clinical tool for postoperative fertility counselling/management of women with endometriosis. TWEETABLE ABSTRACT: A study confirming the high reproducibility of the EFI substantiates its use in daily clinical practice.


Assuntos
Endometriose/complicações , Infertilidade Feminina/etiologia , Adolescente , Adulto , Endometriose/cirurgia , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
2.
Indian J Dent Res ; 30(5): 665-669, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31854354

RESUMO

Objectives: : The aim of this study was to assess, using the CDR Wireless®, the effect of different exposure times on caries detection and pixel intensity values. Materials and Methods: Forty teeth were x-rayed using a Schick CDR Wireless sensor at eight different exposure times - 0.06, 0.10, 0.13, 0.16, 0.20, 0.25, 0.30, and 0.32 s. Four observers evaluated the images for presence of carious lesions scoring proximal surfaces of each tooth on a 5-point scale. Scores were compared to histological sections of the teeth. Accuracy was evaluated by means of ROC curve analysis. Radiographs of an aluminum step wedge were obtained using the same eight exposure times. Pixel intensity measurements were obtained, and mean pixel values were statistically analyzed using linear regression. Results: The Az for each exposure time varied from 0.53 to 0.62. Two-way analysis of variance and Tukey test demonstrated that the exposure time of 0.25 s presented the best result and was significantly higher than 0.30 s and 0.35 s. In regard to mean pixel values, two different behaviors were observed, and the exposure time of 0.20 s presented mean pixel values in both phases. Conclusion: The performance of the exposure times from 0.06 s to 0.25 s was satisfactory for proximal caries detection, and 0.25 s is the best as indicated for this finality. Clinical Relevance: Considering that a reduction of exposure time represents a reduction of patient exposure dose, and this reduction cannot neglect image quality, the behavior of any digital system must be carefully evaluated.


Assuntos
Cárie Dentária , Radiografia Dentária Digital , Humanos , Dente Molar , Variações Dependentes do Observador , Curva ROC
3.
J Comput Assist Tomogr ; 43(6): 970-975, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738199

RESUMO

OBJECTIVE: The objective of this study was to determine the value of dual-energy computed tomography (DECT) for the diagnosis of cervical lymph node metastasis in papillary thyroid cancer. METHODS: The normalized iodine concentration (NIC) and the slope of the spectral Hounsfield unit curve (λHU) in the arterial and venous phases were measured using iodine-overlay images and spectral curves. Quantitative DECT data and qualitative conventional CT data were analyzed by radiologists. RESULTS: The best qualitative parameter for lymph node metastasis detection was obvious node enhancement, and the best quantitative parameter for detection was arterial-phase NIC, which showed high sensitivity, specificity, and accuracy values at an optimal threshold of 25.8%. The best combination of qualitative and quantitative parameters consisted of obvious enhancement and arterial-phase NIC; this combination showed a sensitivity of 90.8% and a specificity of 80.5%. CONCLUSIONS: The DECT quantitative parameters NIC and λHU can be an additional tool to diagnose cervical lymph node metastasis.


Assuntos
Linfonodos/patologia , Câncer Papilífero da Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Pescoço , Variações Dependentes do Observador , Interpretação de Imagem Radiográfica Assistida por Computador , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
4.
Medicine (Baltimore) ; 98(45): e17727, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702623

RESUMO

Conventional methods have limitations in measuring femoral neck torsion angle (FNTA) of patients with femoral deformities. A new method of three-dimensional (3D) reconstruction technology based on computer tomography (CT) was proposed to enhance measurement accuracy and applicability in this study.Bilateral FNTA of 50 developmental dysplasia of the hip (DDH) patients (DDH group) and 81 volunteers (normal group) were measured by Mimics software based on CT data with the marker lines determined by centerline and curvature. Each FNTA was measured by observer A and observer B for twice separately. 50 DDH patients were classified into 3 groups (group I, II, III) according to Hartofilakidis classification. The statistical analysis of the differences was made among the measurements of the FNTA.The FNTA values were 27.56°â€Š±â€Š12.48° in DDH group and 21.22°â€Š±â€Š8.14° in normal group with significant difference (t = 4.516, P < .001). The FNTA values were 24.53°â€Š±â€Š2.40° in group I, 29.78°â€Š±â€Š1.83° in group II and 39.08°â€Š±â€Š3.13° in group III, with significant difference (F = 7.568, P = .001).The accuracy, reliability and applicable scope of FNTA measurement can be improved by 3D reconstruction in clinical practice. The applicable scope of this method included normal people and patients with femoral deformities. The FNTA of DDH patients is significantly larger than normal volunteers with a positive correlation between the severity of classification. This study will also provide references for preoperative design of Chinese population.


Assuntos
Colo do Fêmur/anatomia & histologia , Colo do Fêmur/fisiologia , Imagem Tridimensional/métodos , China , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Período Pré-Operatório , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X , Torção Mecânica
5.
Medicine (Baltimore) ; 98(44): e17738, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689821

RESUMO

This study aimed to evaluate a novel real-time rotational optical coherence tomography (OCT) imaging system (OCTIS) with a fiber-optic probe to look at endometrium and to correlate the OCTIS images with standard histology. OCT could obtain real-time images resembling histological examination. With recent development of customized probes, it allows OCT to be used in the field of gynecology.This is a pilot, prospective, ex-vivo and observational study. Women underwent hysterectomy for various gynecological conditions were recruited and OCTIS images were obtained from endometrium of 15 fresh uterus specimens immediately after hysterectomy. The excised uterus was cut open and OCTIS imaging was obtained. The scanned region of endometrium was excised for histological examination and OCTIS images were precisely compared to corresponding histological images and ultrasound images. Blinded qualitative analysis on OCTIS images was performed by 2 assessors to determine inter-rating reliability on the histopathological diagnosis.Epithelium, glands, cysts, and stroma of endometrium were clearly seen by the OCTIS. Different phases of menstrual cycle of normal endometrium could be differentiated and pathological condition such as hyperplastic and dysplasic endometrium, which corresponded well with histological findings, could be identified. The inter-rater reliability between assessors on overall OCTIS endometrium and neoplastic OCTIS endometrium was moderate (Kendall τb of 0.58) and substantial (Kendall τb of 0.76), respectively.OCTIS can provide real-time, high-resolution and rotational imaging modality to view endometrial structure with high consistency with histological examination and satisfactory agreement between observers. It has a great potential to be developed in the clinical use of endometrial assessment for gynecological applications.


Assuntos
Hiperplasia Endometrial/diagnóstico por imagem , Endométrio/diagnóstico por imagem , Aumento da Imagem/métodos , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Endométrio/patologia , Feminino , Humanos , Histerectomia , Aumento da Imagem/instrumentação , Pessoa de Meia-Idade , Variações Dependentes do Observador , Projetos Piloto , Período Pós-Operatório , Estudos Prospectivos , Reprodutibilidade dos Testes , Método Simples-Cego , Tomografia de Coerência Óptica/instrumentação
6.
Br J Radiol ; 92(1104): 20190342, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31596119

RESUMO

OBJECTIVES: Standardised comparison of abdominal muscle and adipose tissue is often utilised in morphometric clinical research. Whilst measurements are traditionally standardised against the patient's height, this may not be always practically feasible. The aim of this study was to investigate the relationship between measurements of the vertebral body and patient height. METHODS: We analysed cross-sectional CT scans. Measurements of the vertebral body area (VBA), anteroposterior vertebral body diameter (APVBD) and lateral vertebral body diameter (LVBD) were made by two independent investigators by manual tracing. Patients were randomly divided into two groups: Group 1 standardisation and Group 2 validation. We compared height and vertebral body parameters from patients in Group 1 and mathematically modelled this relationship. We then utilised the model to predict the height of patients in Group 2 and compared this with their actual height. Observer variability was assessed using Bland-Altman plots and t-tests of differences. RESULTS: CT scans from 382 patients were analysed. No significant intraobserver or interobserver differences were apparent when measuring vertebral body parameters. We describe models which enable the prediction of the patients' height using the measured VBA, APVBD and LVBD. No significant differences were observed between the patients predicted and actual heights in the validation group. CONCLUSIONS: We demonstrate an important relationship between measurements of the patient's height and the vertebral body. This can be utilised in future research when the patient's height has not been measured. ADVANCES IN KNOWLEDGE: In the absence of the patient's height, we demonstrate that two-dimensional vertebral body parameters may be reliably used to standardise morphometric measurements.


Assuntos
Estatura , Vértebras Lombares/diagnóstico por imagem , Modelos Teóricos , Idoso , Feminino , Humanos , Vértebras Lombares/anatomia & histologia , Masculino , Variações Dependentes do Observador , Distribuição Aleatória , Tomografia Computadorizada por Raios X
7.
Br J Radiol ; 92(1104): 20181055, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31596129

RESUMO

OBJECTIVE: We proposed to determine whether the performance of inexperienced radiologists in determining extramural vascular invasion (EMVI) in rectal cancer on MRI can be promoted by means of targeted training. METHODS: 230 rectal cancer patients who underwent pre-operative chemoradiotherapy were included. Pre-therapy and post-therapy MR images and pathology EMVI evaluation were available for cases. 230 cases were randomly divided into 150 training cases and 80 testing cases, including 40 testing case A and 40 testing case B. Four radiologists were included for MRI EMVI evaluation, who were divided into targeted training group and non-targeted training group. The two groups evaluated testing case A at baseline, 3 month and 6 month, evaluated testing case B at 6 month. The main outcome was agreement with expert-reference for pre-therapy and post-therapy evaluation, the other outcome was accuracy with pathology for post-therapy evaluation. RESULTS: After 6 months of training, targeted training group showed statistically higher agreement with expert-reference than non-targeted training group for both pre-therapy and post-therapy MRI EMVI evaluation of testing case A and testing case B, all p < 0.05. Targeted training group also showed significantly higher accuracy with pathology than non-targeted training group for post-therapy evaluation of testing case A and testing case B after 6 months of training, all p < 0.05. CONCLUSION: The diagnostic performance for MRI EMVI evaluation could be promoted by targeted training for inexperienced radiologist. ADVANCES IN KNOWLEDGE: This study provided the first evidence that after 6 month targeted training, inexperienced radiologists demonstrated improved diagnostic performance, with a 20% increase in agreement with expert-reference for both pre-therapy and post-therapy MRI EMVI evaluation and also a 20% increase in or accuracy with pathology for post-therapy evaluation, while inexperienced radiologists could not gain obvious improvement in MRI EMVI evaluation through the same period of regular clinical practice. It indicated that targeted training may be necessary for helping inexperienced radiologist to acquire adequate experience for the MRI EMVI evaluation of rectal cancer, especially for radiologist who works in a medical unit where MRI EMVI diagnosis is uncommon.


Assuntos
Competência Clínica , Imagem por Ressonância Magnética , Radiologistas/educação , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Vasos Sanguíneos/diagnóstico por imagem , Vasos Sanguíneos/patologia , Quimiorradioterapia , Consenso , Endotélio Vascular/diagnóstico por imagem , Endotélio Vascular/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Variações Dependentes do Observador , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Radiologistas/normas , Distribuição Aleatória , Neoplasias Retais/irrigação sanguínea , Neoplasias Retais/terapia , Padrões de Referência , Estudos Retrospectivos , Fatores de Tempo
8.
Medicine (Baltimore) ; 98(42): e17075, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626080

RESUMO

Motion-induced artifacts have been a major drawback in bladder cancer imaging. This study is to evaluate the clinical utility of periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) acquisition in improving motion-induced artifacts in T2-weighted (T2W) magnetic resonance imaging (MRI) of bladder cancer at 3T.Sixteen patient MRI exams were included. Using a Likert scale, 2 radiologists independently scored T2W data without and with PROPELLER in terms of artifact severity and tumor visualization. Statistical analysis was done to assess the image quality improvement by PROPELLER and inter-observer variability.Without PROPELLER, the median scores of artifact severity and tumor visualization were 1.5 and 1.5 for reviewer 1, and 2.0 and 2.0 for reviewer 2. With PROPELLER, the scores increased to 3 and 3.5 for reviewer 1, and 3.5 and 3.5 for reviewer 2. Despite the inter-observer variability (κ scores < 0.2), both reviewers found significant improvement in artifacts and visualization (all P < .001).PROPELLER acquisition significantly improved the image quality of T2W-MRI. These initial findings indicate that this technique should be utilized in clinical MRI of the bladder.


Assuntos
Artefatos , Carcinoma de Células de Transição/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Humanos , Processamento de Imagem Assistida por Computador/métodos , Movimento (Física) , Variações Dependentes do Observador , Estudos Prospectivos , Melhoria de Qualidade , Neoplasias da Bexiga Urinária/patologia
9.
Br J Radiol ; 92(1104): 20190401, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31573328

RESUMO

OBJECTIVE: To evaluate role of multiparametric MRI (mp-MRI) in differentiation between invasive and non-invasive bladder cancer and accuracy of vesical imaging reporting and data system (VI-RADS) score. METHODS AND MATERIALS: 50 patients diagnosed as cancer bladder were enrolled in this study, mp-MRI including conventional (T1 weighted imaging and high resolution T2 weighted imaging) and functional sequences (diffusion-weighted imaging and dynamic contrast enhanced-MRI) were done, all data were regrouped to evaluate the accuracy of each separate sequence and mp-MRI in distinguishing non-muscle invasive from muscle-invasive tumors, with VI-RADS score application and comparison with pathological findings, then interobserver agreement for detection of muscle invasion according to mp-MRI and VI-RADS scoring system findings was calculated. RESULTS: Diagnostic accuracy of mp-MRI in differentiation between muscle invasive and non-muscle invasive bladder cancer was (84%) with highest sensitivity (78%), very good agreement between mp-MRI and histopathological data (k = 0.87), and highest area under curve (AUC) reaching 0.83, dynamic contrast enhanced-MRI sequence showed the highest accuracy in muscle invasion detection by (88%), with highest AUC 0.83. Diagnostic accuracy of VI-RADS score in detection of muscle invasion was 84%, with specificity and negative predictive value of 88% and AUC was 0.83. Interobserver agreement was strong as regard diagnostic performance of mp-MRI and VI-RADS scoring for detection of muscle invasion reaching (K = 0.82, p < 0.001) and (K = 0.87, p < 0.001) respectively. CONCLUSION: mp-MRI is considered as comprehensive and effective tool for determination of muscle invasion in cases of urinary bladder cancer. Also VI-RADS scoring system can accurately differentiate between invasive and non-invasive bladder cancer. ADVANCES IN KNOWLEDGE: The VI-RADS system was recently suggested for the uniform evaluation of muscle invasion in cancer bladder by mp-MRI. In this paper, we applied this system to 50 cases to evaluate its ease and compared the results with the histopathological findings for evaluation of its accuracy.


Assuntos
Carcinoma de Células de Transição/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/diagnóstico por imagem , Adulto , Idoso , Área Sob a Curva , Carcinoma de Células de Transição/patologia , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Liso/diagnóstico por imagem , Músculo Liso/patologia , Invasividade Neoplásica , Estadiamento de Neoplasias , Variações Dependentes do Observador , Curva ROC , Sensibilidade e Especificidade , Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/patologia
10.
Bone Joint J ; 101-B(10): 1285-1291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564154

RESUMO

AIMS: Currently, periprosthetic fractures are excluded from the American Society for Bone and Mineral Research (ASBMR) definition of atypical femoral fracture (AFFs). This study aims to report on a series of periprosthetic femoral fractures (PFFs) that otherwise meet the criteria for AFFs. Secondary aims were to identify predictors of periprosthetic atypical femoral fractures (PAFFs) and quantify the complications of treatment. PATIENTS AND METHODS: This was a retrospective case control study of consecutive patients with periprosthetic femoral fractures between 2007 and 2017. Two observers identified 16 PAFF cases (mean age 73.9 years (44 to 88), 14 female patients) and 17 typical periprosthetic fractures in patients on bisphosphonate therapy as controls (mean age 80.7 years (60 to 86, 13 female patients). Univariate and multivariate analysis was performed to identify predictors of PAFF. Management and complications were recorded. RESULTS: Interobserver agreement for the PAFF classification was excellent (kappa = 0.944; p < 0.001). On univariate analysis compared with controls, patients with PAFFs had higher mean body mass indices (28.6 kg/m2 (sd 8.9) vs 21.5 kg/m2 (sd 3.3); p = 0.009), longer durations of bisphosphonate therapy (median 5.5 years (IQR 3.2 to 10.6) vs 2.4 years (IQR 1.0 to 6.4); p = 0.04), and were less likely to be on alendronate (50% vs 94%; p = 0.02) with an indication of secondary osteoporosis (19% vs 0%; p = 0.049). Duration of bisphosphonate therapy was an independent predictor of PAFF on multivariate analysis (R2 = 0.733; p = 0.05). Following primary fracture management, complication rates were higher in PAFFs (9/16, 56%) than controls (5/17, 29%; p = 0.178) with a relative risk of any complication following PAFF of 1.71 (95% confidence interval (CI) 0.77 to 3.8) and of reoperation 2.56 (95% CI 1.3 to 5.2). CONCLUSION: AFFs do occur in association with prostheses. Longer duration of bisphosphonate therapy is an independent predictor of PAFF. Complication rates are higher following PAFFs compared with typical PFFs, particularly of reoperation and infection. Cite this article: Bone Joint J 2019;101-B:1285-1291.


Assuntos
Artroplastia de Quadril/efeitos adversos , Difosfonatos/efeitos adversos , Osteoporose/tratamento farmacológico , Fraturas Periprotéticas/induzido quimicamente , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Estudos de Casos e Controles , Intervalos de Confiança , Difosfonatos/uso terapêutico , Relação Dose-Resposta a Droga , Feminino , Fraturas do Fêmur/induzido quimicamente , Fraturas do Fêmur/cirurgia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Osteoporose/complicações , Fraturas Periprotéticas/diagnóstico por imagem , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Estados Unidos
11.
Bone Joint J ; 101-B(10): 1300-1306, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31564159

RESUMO

AIMS: The primary aim of this study was to develop a reliable, effective radiological score to assess the healing of humeral shaft fractures, the Radiographic Union Score for HUmeral fractures (RUSHU). The secondary aim was to assess whether the six-week RUSHU was predictive of nonunion at six months after the injury. PATIENTS AND METHODS: Initially, 20 patients with radiographs six weeks following a humeral shaft fracture were selected at random from a trauma database and scored by three observers, based on the Radiographic Union Scale for Tibial fractures system. After refinement of the RUSHU criteria, a second group of 60 patients with radiographs six weeks after injury, 40 with fractures that united and 20 with fractures that developed nonunion, were scored by two blinded observers. RESULTS: After refinement, the interobserver intraclass correlation coefficient (ICC) was 0.79 (95% confidence interval (CI) 0.67 to 0.87), indicating substantial agreement. At six weeks after injury, patients whose fractures united had a significantly higher median score than those who developed nonunion (10 vs 7; p < 0.001). A receiver operating characteristic curve determined that a RUSHU cut-off of < 8 was predictive of nonunion (area under the curve = 0.84, 95% CI 0.74 to 0.94). The sensitivity was 75% and specificity 80% with a positive predictive value (PPV) of 65% and a negative predictive value of 86%. Patients with a RUSHU < 8 (n = 23) were more likely to develop nonunion than those with a RUSHU ≥ 8 (n = 37, odds ratio 12.0, 95% CI 3.4 to 42.9). Based on a PPV of 65%, if all patients with a RUSHU < 8 underwent fixation, the number of procedures needed to avoid one nonunion would be 1.5. CONCLUSION: The RUSHU is reliable and effective in identifying patients at risk of nonunion of a humeral shaft fracture at six weeks after injury. This tool requires external validation but could potentially reduce the morbidity associated with delayed treatment of an established nonunion. Cite this article: Bone Joint J 2019;101-B:1300-1306.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Radiografia/métodos , Adulto , Fatores Etários , Tratamento Conservador/métodos , Bases de Dados Factuais , Feminino , Seguimentos , Fixação de Fratura/métodos , Fraturas não Consolidadas/cirurgia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Curva ROC , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Fatores de Tempo
12.
Prog Orthod ; 20(1): 40, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31631241

RESUMO

OBJECTIVE: Since the introduction of cone-beam computed tomography (CBCT) in dentistry, this technology has enabled distortion-free three-dimensional cephalometric analysis for orthodontic and orthognathic surgery diagnosis. However, CBCT is associated with significantly higher radiation exposure than traditional routine bidimensional examinations for orthodontic diagnosis, although low-dose protocols have markedly reduced radiation exposure over time. The objective of this preliminary feasibility study is to compare the accuracy and diagnostic capabilities of an already-validated three-dimensional cephalometric analysis on CBCT to those of an analysis on 3-T magnetic resonance imaging (3T-MRI) to assess whether the latter can deliver a comparable quality of information while avoiding radiation exposure. MATERIALS AND METHODS: In order to test the feasibility of three-dimensional cephalometry on 3T-MRI, 18 subjects (4 male; 14 female) with mean age 37.8 ± SD 10.2, who had undergone both maxillofacial CBCT and maxillofacial 3T-MRI for various purposes within 1 month, were selected from the archive of the Department of Dentistry and Maxillofacial Surgery of Fondazione Ospedale Policlinico Maggiore, IRCCS, Milano, Italy. A three-dimensional cephalometric analysis composed of ten midsagittal and four bilateral landmarks and 24 measurements (11 angular, 13 linear) was performed on both scans using Mimics Research® v. 17.0 (NV, Technologielaan 15, 3001 Leuven, Belgium). Cephalometric analysis was performed twice by two independent orthodontists for each scan, and each orthodontist repeated the measurements 3 weeks later. Statistical analysis was performed with SPSS® 20.00 for Windows (IBM® Corporation, Sommers, NY, USA). A Bland-Altman test for each cephalometric value was performed to assess the agreement between the procedures. The intraclass correlation coefficient (ICC) was used to assess interobserver and intraobserver reliability. The coefficient of variation was used to evaluate precision. RESULTS: Both procedures showed good reliability, with mean intraobserver ICCs of 0.977/0.971 for CBCT and 0.881/0.912 for MRI. The average interobserver ICCs were 0.965 for CBCT and 0.833 for MRI. A Bland-Altman analysis for the cephalometric tracing revealed a similar range of agreement between the two modalities; the bias range (mean ± SD) was - 0.25-0.66 mm (0.174 ± 0.31) for distances and - 0.41-0.54° (0.12 ± 0.33) for angles. CONCLUSIONS: Within the main limitation of this pilot study, that is, the small sample, it is possible to state that cephalometric measurements on 3T-MRI seem to possess adequate reliability and repeatability and that they show satisfying agreement with values measured on CBCTs. An MRI examination does not expose patients to ionizing radiation and could provide an alternative to CBCT for three-dimensional cephalometrics in the future.


Assuntos
Tomografia Computadorizada de Feixe Cônico Espiral , Adulto , Cefalometria , Tomografia Computadorizada de Feixe Cônico , Feminino , Humanos , Imagem Tridimensional , Itália , Imagem por Ressonância Magnética , Masculino , Variações Dependentes do Observador , Projetos Piloto , Reprodutibilidade dos Testes
13.
Rev Saude Publica ; 53: 91, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644722

RESUMO

OBJECTIVE: To develop and assess the reliability of an instrument that enables auditing information on consumer food environment indicators, such as availability, price, promotional and advertising strategies, and quantity of brands available, using the food recommendations adopted by the Dietary Guidelines for the Brazilian Population as a theoretical basis. METHODS: This is a methodological study in two phases: 1. development of the audit instrument and 2. assessment of its reliability and reproducibility . The Content Validity Index was estimated for each instrument item (>0.80 satisfactory). Inter-rater and test-retest reliability were assessed by percentage agreement and Kappa coefficients. Pearson's correlation coefficient and Scatter-plots were used to measure the degree of linear correlation between two quantitative variables. RESULTS: The Content Validity Index was 0.91. Inter-rater and test-retest reliability were mostly high (Kappa> 0.80), for food availability indicators. Among the items that measure advertising, Kappa values for inter-rater reliability ranged from 0.57 to 1.00 and for the test-retest ranged from 0.18 to 0.90. Prices and quantity of brands showed a positive linear correlation between measurements performed by researcher 1 and 2 and between visits 1 and 2. CONCLUSIONS: AUDITNOVA is reliable for measuring aspects such as availability, price, quantity of brands, and advertising of foods available in the consumer food environment.


Assuntos
Comércio/estatística & dados numéricos , Abastecimento de Alimentos/estatística & dados numéricos , Alimentos/estatística & dados numéricos , Inquéritos e Questionários/normas , /estatística & dados numéricos , Brasil , Abastecimento de Alimentos/normas , Humanos , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes
14.
J Frailty Aging ; 8(4): 176-179, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637402

RESUMO

The preponderance of studies on frailty assessment in critically ill adults have used the Clinical Frailty Scale (CFS) to quantify frailty and previous research suggests that surrogates were more likely to be optimistic than physicians in their CFS scores. Whether discordance between surrogates and physicians was relevant to prognosis has been underexplored. Therefore, in a prospective observational cohort of 298 critically ill older adults, we aimed 1) to describe factors related to discordance and 2) to estimate the relationship between such discordance and hospital mortality and other short-term outcomes. Discordance between surrogates and physician was present in 89/298 (29.9%) and independently associated with a higher risk of hospital mortality. Discordance was not associated with markers of intensity of treatment such as intubation, blood transfusion, incident dialysis for acute renal failure and prolonged hospital length of stay. Understanding factors relevant to discordance between physicians and surrogates may lend further insights into short-term prognosis for older adults with critical illness.


Assuntos
Estado Terminal/mortalidade , Fragilidade/diagnóstico , Mortalidade Hospitalar/tendências , Idoso , Humanos , Variações Dependentes do Observador , Prognóstico , Estudos Prospectivos
15.
Br J Radiol ; 92(1104): 20190470, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31559857

RESUMO

OBJECTIVE: The aim of this study was to investigate via computer simulation a proposed improvement to clinical practice by deriving an optimized tube voltage (kVp) range for digital radiography (DR) chest imaging. METHODS: A digitally reconstructed radiograph algorithm was used which was capable of simulating DR chest radiographs containing clinically relevant anatomy. Five experienced image evaluators graded clinical image criteria, i.e. overall quality, rib, lung, hilar, spine, diaphragm and lung nodule in images of 20 patients at tube voltages across the diagnostic energy range. These criteria were scored against corresponding images of the same patient reconstructed at a specific reference kVp. Evaluators were blinded to kVp. Evaluator score for each criterion was modelled with a linear mixed effects algorithm and compared with the score for the reference image. RESULTS: Score was dependent on tube voltage and image criteria in a statistically significant manner for both. Overall quality, hilar, diaphragm and spine criteria performed poorly at low and high tube voltages, peaking at 80-100 kVp. Lung and lung nodule demonstrated little variation. Rib demonstrated superiority at low kVp. CONCLUSION: A virtual clinical trial has been performed with simulated chest DR images. Results indicate mid-range tube voltages of 80-100 kVp are optimum for average adults. ADVANCES IN KNOWLEDGE: There are currently no specific recommendations for optimized tube voltage parameters for DR chest imaging. This study, validated with images containing realistic anatomical noise, has investigated and recommended an optimal tube voltage range.


Assuntos
Algoritmos , Simulação por Computador , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Diafragma/diagnóstico por imagem , Humanos , Pulmão/diagnóstico por imagem , Variações Dependentes do Observador , Intensificação de Imagem Radiográfica , Costelas/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem
16.
Rev Bras Epidemiol ; 22: e190045, 2019 Sep 02.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31482984

RESUMO

INTRODUCTION: The study assessed interobserver reliability in the classification of record pairs formed during probabilistic linkage of health-related databases, a key step in the methodology validation to be used in a larger on-going study on inequalities in the access to breast and cervical cancer control activities in Brazil (DAAC-SIS). METHODOLOGY: The RecLink software was used to link two databases of the Breast Cancer Control Information System (SISMAMA) in the state of Minas Gerais, Brazil: a reference database, which included 301 screening mammograms with probable benign diagnosis (BI-RADS 3 category) recorded in October 2010, and a database comprising 158,517 mammograms registered in 2011. Subsequently, the 215 pairs of records that were not assigned the maximum RecLink score were independently classified as being true or false by ten independent evaluators from four participating centers. RESULTS: The Kappa coefficient ranged from 0.87 to 1.00. Six evaluators were in perfect agreement with one or more evaluators from the other centers. The global Kappa was 0.96 (95% confidence interval - 95%CI 0.94 - 0.99). DISCUSSION: Assessment of interobserver reliability is key to ensuring the quality of the record linkage, and it should be routine practice in studies of this nature. The disclosure of such results contributes to transparency in the conduct of such studies and in the reporting of their findings. CONCLUSION: Interobserver reliability in this study was excellent, indicating satisfactory team consistency in the classification of record pairs.


Assuntos
Neoplasias da Mama/prevenção & controle , Sistemas de Informação em Saúde , Registro Médico Coordenado , Brasil , Bases de Dados Factuais , Feminino , Humanos , Mamografia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Integração de Sistemas
17.
Int Heart J ; 60(5): 1154-1160, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484855

RESUMO

In-stent neoatherosclerosis is an important problem after percutaneous coronary intervention. To explore the mechanisms and treatment of in-stent neoatherosclerosis, an animal model is needed. To avoid the disadvantages of current animal models, such as excessive use of X-rays and a high mortality rate, we attempted to develop an improved animal model. We explored a method that uses a short time interval to establish a rabbit model of in-stent neoatherosclerosis with a high survival rate and to evaluate its indicators. Sixty rabbits were divided into three equal groups: group A, the traditional method; group B, the standard intervention method; and group C, the improved method. In group C, we made two small incisions in each rabbit's neck, separated the common carotid, punctured it, and implanted a stent. The incision was then sutured. Four weeks later, we used optical coherence tomography (OCT) to scan all rabbits for neoatherosclerosis. We found no significant differences in OCT data between our new animal model and the traditional and interventional groups (P > 0.05). The technological success rate was higher in the new animal model (P < 0.001). We developed a new method to establish an animal model of neoatherosclerosis, which had similar results to the traditional and interventional methods.


Assuntos
Reestenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Stents/efeitos adversos , Tomografia de Coerência Óptica/métodos , Animais , Reestenose Coronária/mortalidade , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/mortalidade , Modelos Animais de Doenças , Humanos , Masculino , Neointima/diagnóstico por imagem , Neointima/patologia , Variações Dependentes do Observador , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/mortalidade , Falha de Prótese , Coelhos , Distribuição Aleatória , Fatores de Risco , Estatísticas não Paramétricas , Taxa de Sobrevida
18.
Int Heart J ; 60(5): 1091-1097, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484865

RESUMO

Low-voltage computed tomographic angiography (CTA) is a highly effective technique to reduce contrast media volume. We sought to examine the suitability of low tube voltage CTA with a reduced contrast media volume protocol using third-generation 192-slice dual-source CT in patients undergoing transcatheter aortic valve implantation (TAVI). CTA was performed to aid TAVI planning for 40 consecutive patients with severe aortic stenosis. For the first 10 patients (120/100 kV group), we used a conventional tube voltage combined CTA protocol (an ECG-gated helical scan; 120 kV, non-gated helical scan; 100 kV). For the subsequent 30 patients (70-kV group), we adopted a low tube voltage CTA protocol. We evaluated vascular attenuation, image noise, contrast-to-noise ratio (CNR), and renal function. The mean contrast media (CM) volume was 77.7 ± 17.7 mL in the 120/100-kV group and 30.9 ± 6.3 mL in the 70-kV group (P < 0.001). In the images of the aortic valve complex, the mean attenuation was not significant difference for both groups. In the images of the aorto-femoral arteries, mean attenuation was > 250 Hounsfield Units and CNR was > 10 in all vascular segments for both groups. There was no significant difference in the change of renal function in the 70-kV group, but renal function in the 120/100-kV group decreased within 1-3 months after CTA. Low tube voltage CTA using third-generation dual-source CT is suitable to assess procedural planning for TAVI. This approach maintains image quality and reduces the required CM volume.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Doses de Radiação , Exposição à Radiação/prevenção & controle , Substituição da Valva Aórtica Transcateter/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos de Coortes , Meios de Contraste , Feminino , Seguimentos , Hospitais Universitários , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
19.
Medicine (Baltimore) ; 98(37): e17142, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517856

RESUMO

Morphological data of talus are important for the design of talar prostheses. The talar morphology of Chinese population has been rarely reported. This study adopted a three-dimensional (3D) measurement approach to provide accurate data for the anatomical morphology of talus in Northeast Chinese population and compared it with that of foreigners.One hundred forty-six healthy subjects form Northeast China underwent computed tomography (CT) arthrography. 3D digital talar model was reconstructed and thirteen morphological parameters were measured through Mimics and Magics software. Length and breadth indexes of total talus, trochlea, medial and lateral malleolus articular surface were mainly selected. Statistical analysis was conducted by independent-samples and paired-samples t test through SPSS software.All the indexes were normally distributed. No significant difference between left and right talus was identified in either males or females (P > .05). Most of the indexes showed significant sexual differences except the radian of lateral malleolus articular surface and the posterior breadth of trochlea (P < .05). The talar anatomy of Chinese subjects is different from the published data in other populations.The promising approach adopted in this study addresses some inconvenience with previous conventional methods on cadaver specimens. The geometric parameters of talus in Chinese population differ from those in other populations. The talar measurements and morphology analysis in this study suggest that population characteristics should be taken into account. This study will provide references for the design of talar prostheses in Chinese population.


Assuntos
Imagem Tridimensional , Ossos do Tarso/anatomia & histologia , Ossos do Tarso/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , China , Feminino , Humanos , Imagem Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Tamanho do Órgão , Reprodutibilidade dos Testes , Caracteres Sexuais , Software , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
20.
Br J Radiol ; 92(1103): 20181030, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398062

RESUMO

OBJECTIVE: The purpose of this study was to explore the feasibility of T1 and T2-mapping techniques in evaluating early Type 2 diabetic cataracts. METHODS: Totally, 28 patients with Type 2 diabetes was prospectively collected, and 28 non-diabetic patients were collected as control group. All patients included had ophthalmological exploration and all patients underwent orbital MRI examination with T1 and T2-mapping on a Siemens-Skyra 3.0T scanner. T1 and T2 values of the lens nucleus were measured by region of interest (ROI) method based on Siemens-Syngo workstation. Two sample t-test was used to analyze the differences between groups. Pearson correlations were calculated between relaxation time (T1, T2) and clinical variables, such as fasting glucose, glycosylated hemoglobin etc. p < 0.01 was used to determine statistical significance. RESULTS: In Type 2 diabetes group, the T1 value was 626.7 ± 56.8, T2 value was 29.4 ± 5.6. In non-diabetic group, the T1 value was 581.6 ± 64.7, T2 value was 24.8 ± 8.6. The T1 and T2 values of the lens in diabetic group were significantly higher than those in control group (p < 0.01, T1 value: 626.7 ± 56.8 vs 581.6 ± 64.7; T2 value: 29.4 ± 5.6 vs 24.8 ± 8.6). The T1 and T2 values of lens in diabetic patients were significantly correlated with glycosylated hemoglobin (HbA1c), and the correlation coefficients were 0.502 and 0.396, respectively. CONCLUSION: T1 and T2-mapping technique can sensitively reflect the alterative relaxation time of lens in diabetic patients. This technique can find abnormal changes earlier than slit lamp, and may be effective diagnostic methods for early lens disease. ADVANCES IN KNOWLEDGE: T1 and T2-mapping techniques may be effective diagnostic methods for early lens disease, which can detect abnormal changes earlier than slit lamp examination.


Assuntos
Catarata/diagnóstico , Complicações do Diabetes/diagnóstico , Diabetes Mellitus Tipo 2/diagnóstico , Estudos de Casos e Controles , Estudos de Viabilidade , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos
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