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1.
Radiología (Madr., Ed. impr.) ; 65(1): 3-11, ene.-feb. 2023. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-ADZ-592

RESUMO

Introducción El objetivo del estudio fue determinar el desempeño diagnóstico de la ecografía pélvica transabdominal, la evaluación del desarrollo mamario por ecografía y la edad ósea en la identificación del inicio de la pubertad, en población pediátrica femenina de la Clínica Las Américas, Medellín, Colombia. Métodos Se incluyeron pacientes femeninas de 11 años o menos, remitidas entre marzo de 2016 y marzo de 2019 por la aparición de signos de inicio de la pubertad. Se usó como estándar de referencia para el diagnóstico de pubertad la medición basal de hormona luteinizante (LH) sérica, con la cual se comparó la ultrasonografía pélvica y mamaria, así como la edad ósea. Se realizaron cálculos de sensibilidad, especificidad, valores predictivos positivo y negativo (VPP y VPN), razones de verosimilitud (LR+y LR-) y análisis por subgrupos de edades. Se analizaron 43 pacientes. La evaluación ecográfica del desarrollo mamario demostró la sensibilidad más alta (94,1%) dentro de todos los parámetros de imagen evaluados, aunque con baja especificidad. No obstante, características como la longitud del cuerpo del útero mayor de 3,0cm y la presencia de eco endometrial fueron altamente específicas para la identificación del inicio de la pubertad, particularmente en pacientes de 8 años o menos. Conclusión La ecografía pélvica, la valoración ecográfica del Tanner mamario y la evaluación de la edad ósea son herramientas útiles para la confirmación por imagen del inicio de la pubertad. Los resultados de este estudio apoyan su utilización en la práctica clínica, en el abordaje de trastornos puberales en niñas. (AU)


Introduction This study aimed to determine the diagnostic performance of transabdominal pelvic ultrasonography and bone age in identifying the onset of puberty in girls at the Clínica Las Américas in Medellín, Colombia. Methods We included girls aged ≤ 11 years referred to our clinic between March 2016 and March 2019 for signs of puberty. We compared the findings on pelvic and breast ultrasonography and bone age versus the baseline measurement of luteinizing hormone (LH) in serum, used as the reference standard for identifying the onset of puberty. We calculated the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios, analyzing subgroups of patients of different ages. Results We analyzed 43 patients. Ultrasound assessment of breast development had the highest sensitivity (94.1%) of all the imaging parameters evaluated, but its specificity was low. However, characteristics such as the length of the body of the uterus> 3.0cm and the presence of endometrial echoes were highly specific for identifying the onset of puberty, particularly in patients aged ≤ 8 years. Conclusion Pelvic ultrasonography, ultrasonographic assessment of Tanner stage of breast development, and the evaluation of bone age are useful tools for the imaging confirmation of the onset of puberty. The results of this study support the use of these techniques in clinical practice in the workup for pubertal disorders in girls. (AU)


Assuntos
Humanos , Feminino , Puberdade/fisiologia , Biomarcadores/sangue , Determinação da Idade pelo Esqueleto/métodos , Mãos/diagnóstico por imagem , Endométrio/diagnóstico por imagem , Puberdade Precoce/diagnóstico , Estudos Transversais , Sensibilidade e Especificidade , Valor Preditivo dos Testes
2.
J Pediatr Hematol Oncol ; 45(1): e26-e30, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36598963

RESUMO

Children with cancer often present with general and nonspecific symptoms leading to initial diagnostic workup inclusive of clinical imaging. Various sequences of magnetic resonance imaging (MRI) are becoming more available for diagnostic imaging. However, there is currently a dearth of literature quantifying the sensitivity and specificity of whole-body MRI in identifying pediatric malignancy. In this study, a retrospective analysis was performed of pediatric whole-body MRI inclusive of short tau inversion recovery sequence conducted at an academic pediatric medical center from 2013 to 2018. Kappa statistics were used to evaluate the diagnostic agreement between MRI results and the gold standard diagnostic study of the respective final diagnosis. Sensitivity, specificity, false-positive, and false-negative estimates were provided with joint 90% confidence regions. One hundred forty-two patients received a whole-body MRI during the study period. The sensitivity of whole-body MRI in detecting malignancy was found to be 93.8% with a specificity of 93.4%. The positive and negative predictive values were determined to be 65.2% and 99.1%, respectively. Our findings suggest that whole-body MRI may be of value as an initial diagnostic tool for pediatric malignancy. Larger multicenter collaboration will be needed to further support these data.


Assuntos
Imageamento por Ressonância Magnética , Neoplasias , Humanos , Criança , Estudos Retrospectivos , Imageamento por Ressonância Magnética/métodos , Sensibilidade e Especificidade , Neoplasias/diagnóstico por imagem , Valor Preditivo dos Testes , Imagem Corporal Total/métodos
3.
Clin Nucl Med ; 48(2): 112-118, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607361

RESUMO

PURPOSE: The aim of this study was to compare the diagnostic performance of the rabbit visual pattern versus the one endorsed by the EANM/SNMMI for the diagnosis of parkinsonian syndromes in PET/MRI. PATIENTS AND METHODS: The 18F-DOPA PET images of 129 consecutive patients (65 Park+ and 64 controls) with 1 year of clinical follow-up were reviewed independently by 5 experienced readers on the same imaging workstation, blinded to the final clinical diagnosis. Two visual methods were assessed independently, with several days to months of interval: the criteria endorsed by EANM/SNMMI and the "rabbit" shape of the striate assessed on 3D MIP images. The sensitivities, specificities, likelihood ratios, and predictive values of the 2 diagnostic tests were estimated simultaneously by using the "comparison of 2 binary diagnostic tests to a paired design" method. RESULTS: The estimated 95% confidence interval (CI) of sensitivities and specificities ranged from 49.4% to 76.5% and from 83.2% to 97.7%, respectively. The 95% CI estimates of positive and negative likelihood ratios ranged from 3.8 to 26.7 and from 0.26 to 0.56, respectively. The 95% CI estimates of the positive and negative predictive values ranged from 78.1% to 96.7% and from 60.3% to 81.4%, respectively. For all the parameters, no statistical difference was observed between the 2 methods (P > 0.05). The rabbit sign reduced the readers' discrepancies by 25%, while maintaining the same performance. CONCLUSIONS: The rabbit visual pattern appears at least comparable to the current EANM/SNMMI reference procedure for the assessment of parkinsonian syndromes in daily clinical practice, without the need of any image postprocessing. Further multicenter prospective studies would be of relevance to validate these findings.


Assuntos
Transtornos Parkinsonianos , Tomografia por Emissão de Pósitrons , Humanos , Coelhos , Animais , Estudos Prospectivos , Transtornos Parkinsonianos/diagnóstico por imagem , Imageamento por Ressonância Magnética , Sensibilidade e Especificidade , Di-Hidroxifenilalanina
4.
Clin Nucl Med ; 48(2): 132-142, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607362

RESUMO

PURPOSE: 18F-FDG is the dominant radiotracer in oncology; however, it has limitations. Novel labeled fibroblast activation protein (FAP) radiotracers have been developed and published in several studies. Thus, this meta-analysis aimed to compare the detection rates (DRs) of FDG and FAP, based on previous studies from a systematic review. METHODS: PubMed/MEDLINE and Cochrane library databases were used to perform a comprehensive and systematic search and are updated to April 30, 2022. The DR, relative risk, and the SUVmax were calculated between the FAP and FDG tracers. Finally, the sensitivity, specificity, diagnostic odds ratio, and summary receiver operating characteristic curve of FAP and FDG were analyzed using gold and reference standards. RESULTS: Thirty studies (1170 patients) were included in the meta-analysis. The relative risks of FAP DR for the primary tumor, recurrent tumor, lymph node metastasis, and distant metastasis were FDG 1.06- to 3.00-fold per patient and per lesion. For the primary tumor, FAP uptake was most intense in pancreatic cancer, followed by head and neck, cervical, colorectal, lung, gastric, and hepatocellular carcinoma, and was higher than FDG except for urological system cancer. The sensitivity (0.84-0.98), diagnostic odds ratio (19.36-358.47), and summary receiver operating characteristic curve (0.94-0.99) of FAP based on patient and lesion were better for primary tumors, LN metastasis, and distant metastasis than FDG. CONCLUSIONS: Fibroblast activation protein is an extremely potential radiotracer to replace most of the use of FDG in oncology. It is noteworthy that the FAP tracers for primary tumors had low specificity despite excellent sensitivity and had lower uptake than FDG in urological system cancer. In addition, the difference in detection between FAP and FDG for LN metastasis could not be certain in sarcoma.


Assuntos
Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Humanos , Compostos Radiofarmacêuticos , Recidiva Local de Neoplasia , Tomografia por Emissão de Pósitrons , Sensibilidade e Especificidade
5.
J Appl Lab Med ; 8(1): 67-76, 2023 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-36610418

RESUMO

BACKGROUND: The performance requirements for hemoglobin (Hb) A1c analysis have been questioned as analytic methods have improved. We developed a statistical simulation that relates error to the clinical utility of an oft-used laboratory test, as a means of assessing test performance expectations. METHODS: Finite mixture modeling of the Centers for Disease Control and Prevention-National Health and Nutrition Examination Survey (NHANES) 2017-2020 Hb A1c data in conjunction with Monte Carlo sampling were used to model and simulate a population prior to the introduction of error into the results. The impact of error on clinical utility was assessed by categorizing the results using the American Diabetes Association (ADA) diagnostic criteria and assessing the sensitivity and specificity of Hb A1c under various degrees of error (bias and imprecision). RESULTS: With the current allowable total error threshold of 6% for Hb A1c measurement, the simulation estimated a worst case between 50% and 60% for both test sensitivity and specificity for the non-diabetic category. Similarly, sensitivity and specificity estimates for the pre-diabetic category were 30% to 40% and 60% to 70%, respectively. Finally, estimates for the diabetic category yielded values of 80% to 90% for sensitivity and >90% for specificity. CONCLUSIONS: Bias and imprecision greatly affect the clinical utility of Hb A1c for all patient groups. The simulated error demonstrated in this modeling impacts 3 critical applications of the Hb A1c in diabetes management: the capacity to reliably screen, diagnostic accuracy, and utility in diabetes monitoring.


Assuntos
Diabetes Mellitus , Estados Unidos , Humanos , Inquéritos Nutricionais , Diabetes Mellitus/diagnóstico , Testes Hematológicos , Sensibilidade e Especificidade
6.
Cancer Imaging ; 23(1): 3, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36611191

RESUMO

BACKGROUND: Early diagnosis of prostate cancer improves its prognosis, while it is essential to upgrade screening tools. This study aimed to explore the value of a novel functional magnetic resonance imaging (MRI) technique, namely amide proton transfer (APT)-weighted MRI, combined with serum prostate-specific antigen (PSA) levels to differentiate malignant prostate lesions from benign prostate lesions. METHODS: Data of patients who underwent prostate examinations at Chongqing University Cancer Hospital between July 2019 and March 2022 were retrospectively analyzed. All patients underwent T2-weighted imaging (T2WI), APT, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) MRI. Two radiologists analyzed the images independently. The ability of the quantitative parameters alone or in different combinations in differentiating malignant prostate lesions from benign prostate lesions were compared by using receiver operating characteristic (ROC) curves. According to the DeLong test, the combined parameters were significantly different from the corresponding single parameter (P < 0.05). RESULTS: A total of 79 patients were finally enrolled, including 52 patients in the malignant group and 27 patients in the benign group. The separate assessment of indexes revealed that APTmax, APTmean, mean apparent diffusion coefficient (ADCmean), ADCmax, ADCmin, tPAD, free prostate-specific antigen (FPSA), FPSA/total prostate-specific antigen (tPSA), and PSA density (PSAD) were significantly different between the two groups (P < 0.05), while APTmin was not significantly different between the two groups (P > 0.05). APTmax and APTmean had the high values of area under the ROC curve (AUC), which were 0.780 and 0.710, respectively. APTmax had a high sensitivity, and APTmean had a high specificity. The combination of APTmax, APTmean, ADCmean, and PSAD had the highest AUC value (AUC: 0.880, sensitivity: 86.540, specificity: 78.260). CONCLUSION: APTmax, APTmean, ADCmean, ADCmin, tPAD, FPSA, and PSAD showed to have a high value in differentiating malignant prostate lesions from benign prostate lesions in the separate assessment of indexes. The combination of APTmax, APTmean, ADCmean, and PSAD had the highest diagnostic value.


Assuntos
Antígeno Prostático Específico , Próstata , Masculino , Humanos , Estudos Retrospectivos , Prótons , Imageamento por Ressonância Magnética/métodos , Curva ROC , Imagem de Difusão por Ressonância Magnética/métodos , Amidas , Sensibilidade e Especificidade
7.
Int J Cardiovasc Imaging ; 39(1): 209-220, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36598690

RESUMO

Signal intensity (SI) drop has been proposed as an indirect stenosis assessment in non-contrast coronary MRA (NC-MRCA) but it uses unproven assumptions. We aimed to clarify the mechanisms that govern the SI in vitro and develop a stenosis detection method in vivo. Flow phantom tubes with/without stenosis were scanned under two spatial resolutions (0.5/1.0 mm3) on a 3.0 T MRI. Thirty-two coronary arteries from 11 volunteers were prospectively scanned with an EKG- and respiratory-gated 3D NC-MRCA with a resolution of 1.0 mm3, with coronary computed tomography angiography (CTA) as reference. The normalized SI along the centerline of the tubes or the coronary arteries was assessed against the distance from the orifice using a linear regression model. Its coefficient (SI decay slope) and goodness-of-fit (R2) were extracted to assess the effect of flow velocity and stenosis on the SI profile curve. The R2 was utilized for the stenosis detection. Phantom study: A slow flow velocity caused a steep SI decay slope. The SI drop revealed only at the inlet and outlet of stenosis due to the flow turbulence/vortex and yielded low R2, in which shape changed by the resolution. Clinical study: The R2 cutoff to detect ≥ 50% stenosis for the left and right coronary arteries were 0.64 and 0.20 with a sensitivity/specificity of 71.5/71.5 and 66.7/100 (%), respectively. The SI drop did not reflect the actual stenosis position and not suitable for the stenosis localization. The R2 cutoff represents an alternative method to detect stenoses on NC-MRCA at vessel level.Trial registration: ClinicalTrials.gov; NCT03768999, registered on December 7, 2018.


Assuntos
Angiografia por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Constrição Patológica , Angiografia por Ressonância Magnética/métodos , Valor Preditivo dos Testes , Impressão Tridimensional , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X/métodos
8.
PLoS One ; 18(1): e0280243, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36622844

RESUMO

The importance of air purifiers has increased in recent years, especially with the "coronavirus disease 2019" pandemic. The efficacy of air purifiers is usually determined under laboratory conditions before widespread application. The standard procedure for testing depends on virus cultivation and titration on cell culture. This, however, requires several days to deliver results. The aim of this study was to establish a rapid molecular assay which can differentiate between intact infectious and distorted non-infectious virus particles. Feline Coronavirus was selected as model for screening. First the samples were pretreated with enzymes (universal nuclease and RNase cocktail enzyme mixture) or viability dye (propidium monoazide) to eliminate any free nucleic acids. The ribonucleic acid (RNA) from intact virus was released via magnetic beads-based extraction, then the amount of the RNA was determined using real-time reverse transcription polymerase chain reaction (RT-PCR) or reverse transcription recombinase-aided amplification (RT-RAA). All results were compared to the infectivity assay based on the calculation of the 50% tissue culture infectious dose (TCID50). The nuclease has eliminated 100% of the free Feline Coronavirus RNA, while propidium monoazide underperformed (2.3-fold decrease in free RNA). Both RT-RAA and real-time RT-PCR produced similar results to the infectivity assay on cell culture with limit of detection of 102 TCID50/mL. Two UV-C air purifiers with prosperities of 100% inactivation of the viruses were used to validate the established procedure. Both real-time RT-PCR and RT-RAA were able to differentiate between intact virus particles and free RNA. To conclude, this study revealed a promising rapid method to validate the efficacy of air purifiers by combining enzymatic pretreatment and molecular assays.


Assuntos
Filtros de Ar , Azidas , Transcrição Reversa , Reação em Cadeia da Polimerase em Tempo Real/métodos , RNA , Sensibilidade e Especificidade , Técnicas de Amplificação de Ácido Nucleico/métodos
9.
J Coll Physicians Surg Pak ; 33(1): 73-78, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36597239

RESUMO

OBJECTIVE: To investigate the effectiveness of diffusion-weighted imaging (DWI) in the differentiation of benign and malignant endometrial pathologies by measuring the apparent diffusion coefficient (ADC) values and performing a visual evaluation. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Radiology, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey, from January 2017 to September 2019. METHODOLOGY: The inclusion criteria were women over 45 years of age with availability of the pelvic MRI in the PACS and the presence of pathological diagnosis by endometrial D and C or hysterectomy. Exclusion criteria were patients under 45 years of age, absence of histopathological results, hematoma or intrauterine device in the endometrial cavity, and endometrial thickness less than 5 mm. Quantitative ADC values were measured on ADC maps created automatically based on DWI data. DWI and ADC maps were also evaluated visually to differentiate between benign and malignant pathologies. RESULTS: Endometrial pathology was detected in a total of 88 patients, 36 of which were malignant and 52 benign lesions. The mean ADC values for both observers and the sensitivity and specificity in the differentiation of benign and malignant endometrial lesions were 81% - 75% and 88% - 90%, respectively (p<0.001 for both observers). The visual evaluation of b values and ADC map on DWI was also performed together, and the sensitivity and specificity in the differentiation of benign and malignant endometrial lesions were 81% - 86% and 69% - 56% for both observers, respectively (p <0.001 for both observers). CONCLUSION: ADC measurements are useful in differentiating benign and malignant endometrial pathologies, and visual evaluation of the ADC map and b values in DWI together also provides positive results. KEY WORDS: Diffusion-weighted imaging, Endometrial pathologies, ADC, Visual evaluation.


Assuntos
Imagem de Difusão por Ressonância Magnética , Imageamento por Ressonância Magnética , Humanos , Feminino , Masculino , Estudos Transversais , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Sensibilidade e Especificidade , Estudos Retrospectivos
10.
Egypt J Immunol ; 30(1): 14-19, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36588449

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is our time's major global health crisis and the greatest health challenge. Reverse transcription-polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus (SARS-CoV-2) is the gold standard technique for diagnosis of symptomatic cases and asymptomatic carriers. By 2020, antigen rapid tests have been approved for use in Covid-19 testing by regulatory bodies all over the world owing to their benefits as they are rapid and cost effective. This work aimed to determine the diagnostic sensitivity and accuracy of the SARS-CoV-2 rapid antigen test in the detection of SARS-CoV-2 infection compared to RT-PCR data. The study included 111 symptomatic COVID-19 patients and 20 control subjects. Of the 111 study patients, 91 patients (81.98%) were positive by RT-PCR and 20 patients negative. The BIOZEK antigen COVID-19 Ag rapid test device was evaluated using sera from the 111 symptomatic COVID-19 patients. Of the 91 RT-PCR positive patients, 81 (90.1%) were positive by the antigen rapid diagnostic test (Ag-RDT). The control subjects were negative by both tests. The overall sensitivity, specificity, PPV, NPV, and accuracy of the Ag-RDT were 91.11%, 100%, 100%, 68.9%, and 91.8%, respectively and these increased as the level of viremia increased. In conclusion, the used Ag-RDT showed high sensitivity and accuracy for detecting of a SARS-CoV-2 infection, especially when the viral load was high. However, the test lacks sensitivity particularly in those with low viral load.


Assuntos
COVID-19 , Humanos , COVID-19/diagnóstico , Teste para COVID-19/métodos , SARS-CoV-2 , Sensibilidade e Especificidade , Carga Viral
11.
BMC Cancer ; 23(1): 37, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36624425

RESUMO

BACKGROUND: As a first-line imaging modality, whole-body fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) and 18F-FDG PET/magnetic resonance imaging (MRI) had been widely applied in clinical practice. However, 18F-FDG PET/MRI may be superior to PET/CT for the diagnosis of distant metastases in patients with advanced-stage. Therefore, it is timely and important to systematically determine the diagnostic accuracy of 18F-FDG PET/MRI compared with that of 18F-FDG PET/CT for the diagnosis of distant metastases. METHODS: This study aimed to compare the diagnostic accuracy of 18F-FDG PET/CT and PET/MRI for the diagnosis of distant metastases in patients with malignant tumors. Relevant studies using both 18F-FDG PET/CT and PET/MRI for assessment of distant metastases in patients with malignant tumors were searched in PubMed, Embase, The Cochrane Library, and Scopus from January 2010 to November 2023. Two reviewers independently selected studies according to the inclusion and exclusion criteria. A reviewer extracted relevant data and assessed the quality of the eligible studies. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the summary receiver operating characteristic curve (AUC) for 18F-FDG PET/CT and PET/MRI were analyzed. Subgroup analysis was performed. RESULTS: Across 14 studies (1042 patients), 18F-FDG PET/MRI had a higher sensitivity (0.87 versus 0.81), AUC value (0.98 versus 0.95), and similar specificity (0.97 versus 0.97), than PET/CT for detecting distant metastases. In 3 studies of breast cancer (182 patients), 18F-FDG PET/MRI had a higher sensitivity (0.95 versus 0.87) and specificity (0.96 versus 0.94) than PET/CT. In 5 studies of lung cancer (429 patients), 18F-FDG PET/CT had a higher sensitivity (0.87 versus 0.84) and a lower specificity (0.95 versus 0.96) to PET/MRI. CONCLUSIONS: 18F-FDG PET/MRI and PET/CT both performed well as detectors of distant metastases in patients with malignant tumors, and the former has higher sensitivity. The subgroup analysis highlights that 18F-FDG PET/MRI and PET/CT hold different advantages for distant metastases staging in different tumors, PET/MRI has a higher accuracy in patients with breast cancer patients, while PET/CT has a higher accuracy in patients with lung cancer.


Assuntos
Neoplasias da Mama , Neoplasias Pulmonares , Humanos , Feminino , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Tomografia por Emissão de Pósitrons , Imageamento por Ressonância Magnética/métodos , Neoplasias Pulmonares/patologia , Neoplasias da Mama/patologia , Sensibilidade e Especificidade , Estadiamento de Neoplasias
12.
Biochem Med (Zagreb) ; 33(1): 010101, 2023 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-36627979

RESUMO

Diagnostic tests are important clinical tools. To assess the sensitivity and specificity of a new test, its results should be compared against a gold standard. However, the gold-standard test is not always available. Herein, I show that we can compare the new test against a well-established diagnostic test (not a gold-standard test, but with known sensitivity and specificity) and compute the sensitivity and specificity of the new test if we would have compared it against the gold-standard test. The technique presented is useful for situations where the gold standard is not readily available.


Assuntos
Testes Diagnósticos de Rotina , Humanos , Sensibilidade e Especificidade , Testes Diagnósticos de Rotina/métodos
13.
Sci Rep ; 13(1): 558, 2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36631567

RESUMO

Studies using machine learning (ML) approaches have reported high diagnostic accuracies for glaucoma detection. However, none assessed model performance across ethnicities. The aim of the study is to externally validate ML models for glaucoma detection from optical coherence tomography (OCT) data. We performed a prospective, cross-sectional study, where 514 Asians (257 glaucoma/257 controls) were enrolled to construct ML models for glaucoma detection, which was then tested on 356 Asians (183 glaucoma/173 controls) and 138 Caucasians (57 glaucoma/81 controls). We used the retinal nerve fibre layer (RNFL) thickness values produced by the compensation model, which is a multiple regression model fitted on healthy subjects that corrects the RNFL profile for anatomical factors and the original OCT data (measured) to build two classifiers, respectively. Both the ML models (area under the receiver operating [AUC] = 0.96 and accuracy = 92%) outperformed the measured data (AUC = 0.93; P < 0.001) for glaucoma detection in the Asian dataset. However, in the Caucasian dataset, the ML model trained with compensated data (AUC = 0.93 and accuracy = 84%) outperformed the ML model trained with original data (AUC = 0.83 and accuracy = 79%; P < 0.001) and measured data (AUC = 0.82; P < 0.001) for glaucoma detection. The performance with the ML model trained on measured data showed poor reproducibility across different datasets, whereas the performance of the compensated data was maintained. Care must be taken when ML models are applied to patient cohorts of different ethnicities.


Assuntos
Glaucoma , Células Ganglionares da Retina , Humanos , Estudos Transversais , Reprodutibilidade dos Testes , Estudos Prospectivos , Pressão Intraocular , Curva ROC , Sensibilidade e Especificidade , Glaucoma/diagnóstico , Aprendizado de Máquina , Tomografia de Coerência Óptica/métodos
14.
PLoS One ; 18(1): e0280178, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36634049

RESUMO

Cognitive screening is often a first step to document cognitive status of patients suspected having Alzheimer's disease (AD). Unfortunately, screening neuropsychological tests are often insensitivity in the detection. The goal of this study was to develop a simple and sensitive screening neuropsychological test to facilitate early detection of AD. This study recruited 761 elderly individuals suspected of having AD and presenting various cognitive statuses (mean age: 77.69 ± 8.45 years; proportion of females: 65%; cognitively unimpaired, CU, n = 133; mild cognitive impairment, MCI, n = 231; dementia of Alzheimer's type, DAT, n = 397). This study developed a novel screening neuropsychological test incorporating assessments of the core memory deficits typical of early AD and an interview on memory function with an informant. The proposed History-based Artificial Intelligence-Show Chwan Assessment of Cognition (HAI-SAC) was assessed in terms of psychometric properties, test time, and discriminative ability. The results were compared with those obtained using other common screening tests, including Cognitive Abilities Screening Instrument (CASI), Montreal Cognitive Assessment (MoCA), and an extracted Mini-Mental State Examination score from CASI. HAI-SAC demonstrated acceptable internal consistency. Factor analysis revealed two factors: memory (semantic and contextual) and cognition-related information from informants. The assessment performance of HAI-SAC was strongly correlated with that of the common screening neuropsychological tests addressed in this study. HAI-SAC outperformed the other tests in differentiating CU individuals from patients with MCI (sensitivity: 0.87; specificity: 0.58; area under the curve [AUC]: 0.78) or DAT (sensitivity: 0.99; specificity: 0.89; AUC: 0.98). Performance of HAI-SAC on differentiating MCI from DAT was on par with performances of other tests (sensitivity: 0.78; specificity: 0.84; AUC: 0.87), while the test time was less than one quarter that of CASI and half that of MoCA. HAI-SAC is psychometrically sound, cost-effective, and sensitive in discriminating the cognitive status of AD.


Assuntos
Doença de Alzheimer , Disfunção Cognitiva , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/psicologia , Inteligência Artificial , Cobre , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/psicologia , Testes Neuropsicológicos , Cognição , Sensibilidade e Especificidade
15.
BMC Emerg Med ; 23(1): 2, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36635632

RESUMO

BACKGROUND: Pre-hospital blood transfusion (PHBT) is a safe and gradually expanding procedure applied to trauma patients. A proper decision to activate PHBT with the presently limited diagnostic options at the site of an incident poses a challenge for pre-hospital crews. The purpose of this study was to compare the selected scoring systems and to determine whether they can be used as valid tools in identifying patients with PHBT requirements. METHODS: A retrospective single-center study was conducted between June 2018 and December 2020. Overall, 385 patients (aged [median; IQR]: 44; 24-60; 73% males) were included in this study. The values of five selected scoring systems were calculated in all patients. To determine the accuracy of each score for the prediction of PHBT, the Receiver Operating Characteristic (ROC) analysis was used and to measure the association, the odds ratio with 95% confidence intervals was counted (Fig. 1). RESULTS: Regarding the proper indication of PHBT, shock index (SI) and pulse pressure (PP) revealed the highest value of AUC and sensitivity/specificity ratio (SI: AUC 0.88; 95% CI 0.82-0.93; PP: AUC 0.85 with 95% CI 0.79-0.91). CONCLUSION: Shock index and pulse pressure are suitable tools for predicting PHBT in trauma patients.


Assuntos
Transfusão de Sangue , Ferimentos e Lesões , Masculino , Humanos , Idoso , Feminino , Estudos Retrospectivos , Sensibilidade e Especificidade , Pressão Sanguínea , Hospitais , Ferimentos e Lesões/terapia
16.
World J Surg Oncol ; 21(1): 4, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624456

RESUMO

BACKGROUND: It is known that specimen collection followed by histopathological workup is the core of evidence-based medical therapy of musculoskeletal tumors. There exist many controversies about how a biopsy should be performed. While some centers recommend minimal invasive biopsy procedures, mostly the core needle biopsy (CNB), others prefer the incisional biopsy. PURPOSE OF THE STUDY: This study aimed to determine the accuracy of incisional biopsy for malignant tumors in the musculoskeletal system. Moreover, advantages and disadvantages to other biopsy methods are discussed. METHODS: This retrospective, single-center study about 844 incisional biopsies (benign and malignant) analysis the diagnostic accuracy of 332 malignant tumors, concerning the final histopathological result. In addition, surgical complications are analyzed to find the best way to plan and treat patients timely and correct. Secondary endpoints are the patients age, the pure operation time, as well as the type of tumor, and the subsequent therapy. RESULTS: In summary, incisional biopsy corresponded a sensitivity of 100% for malignancy in 844 incisional biopsies and a specificity of 97.6% in 332 malignant tumors, but it features greater operative expense (incision/suture 23.5 min) and the risk of general anesthesia. CONCLUSION: The method of biopsy should be tailored to the individual patient and the experience of the center performing the procedure.


Assuntos
Sistema Musculoesquelético , Neoplasias de Tecidos Moles , Humanos , Estudos Retrospectivos , Neoplasias de Tecidos Moles/patologia , Biópsia/métodos , Sistema Musculoesquelético/patologia , Biópsia com Agulha de Grande Calibre , Sensibilidade e Especificidade
17.
J Orthop Surg Res ; 18(1): 23, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627651

RESUMO

OBJECTIVE: Fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) and PET/CT have been suggested for confirming or excluding musculoskeletal infection but the diagnostic value of this tool for pyogenic spondylitis remains to be confirmed. This meta-analysis was performed to verify the accuracy of 18F-FDG PET and PET/CT in diagnosing suspected pyogenic spondylitis by performing a systematic review and meta-analysis. METHODS: We conducted a comprehensive literature search of PubMed, Embase and Cochrane Library to retrieve diagnostic accuracy studies in which suspected pyogenic spondylitis was assessed with 18F-FDG PET or PET/CT. The pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), summarized receiver operating characteristic curve (sROC) and the area under the sROC (AUC) were calculated by using Stata software. RESULTS: A total of 18 eligible studies (660 patients) with suspected pyogenic spondylitis were included in the quantitative analysis. 18F-FDG PET and PET/CT illustrated relatively high sensitivity (0.91, 95% CI: 0.84-0.95) and specificity (0.90, 95% CI: 0.79-0.95) for the diagnosis of pyogenic spondylitis. The pooled DOR and AUC were 86.00 (95% CI, 31.00-240.00) and 0.96 (95% CI, 0.94-0.97), respectively. For diagnosing pyogenic spondylitis without previous spine surgery, the pooled sensitivity, specificity, DOR and AUC were 0.93 (95% CI, 0.85-0.97), 0.91 (95% CI, 0.77-0.97), 136 (95% CI, 35-530) and 0.97 (95% CI, 0.95-0.98), respectively. For diagnosing postoperative pyogenic spondylitis, the pooled sensitivity, specificity, DOR and AUC were 0.85 (95% CI, 0.71 to 0.93), 0.87 (95% CI, 0.66 to 0.96), 38 (95% CI, 9 to 167) and 0.92 (95% CI, 0.89 to 0.94), respectively. CONCLUSION: 18F-FDG PET and PET/CT presented satisfactory accuracy for diagnosing pyogenic spondylitis. The diagnostic effect of this nuclear imaging method for pyogenic spondylitis without previous spine surgery seems to be better than that for the postoperative ones. However, whether 18F-FDG PET and PET/CT could become a routine in patients with suspected pyogenic spondylitis remains to be confirmed. LEVEL OF EVIDENCE: Level I evidence, a summary of meta-analysis.


Assuntos
Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Espondilite , Humanos , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Tomografia por Emissão de Pósitrons/métodos , Espondilite/diagnóstico por imagem
18.
Int J Mol Sci ; 24(1)2023 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-36614336

RESUMO

Loop-mediated isothermal amplification (LAMP) is the most popular technology for point-of-care testing applications due its rapid, sensitive and specific detection with simple instrumentation compared to PCR-based methods. Many systems for reading the results of LAMP amplifications exist, including real-time fluorescence detection using fluorophore-labelled probes attached to oligonucleotide sequences complementary to the target nucleic acid. This methodology allows the simultaneous detection of multiple targets (multiplexing) in one LAMP assay. A method for multiplexing LAMP is the amplification by release of quenching (DARQ) technique by using a 5'-quencher modified LAMP primer annealed to 3'-fluorophore-labelled acting as detection oligonucleotide. The main application of multiplex LAMP is the rapid and accurate diagnosis of infectious diseases, allowing differentiation of co-infecting pathogens in a single reaction. Schistosomiasis, caused among other species by Schistosoma mansoni and strongyloidiasis, caused by Strongyloides stercoralis, are the most common helminth-parasite infections worldwide with overlapping distribution areas and high possibility of coinfections in the human population. It would be of great interest to develop a duplex LAMP to detect both pathogens in the same reaction. In this study, we investigate the use of our two previously developed and well-stablished LAMP assays for S. mansoni and Strongyloides spp. DNA detection in a new duplex real-time eight-primer system based on a modified DARQ probe method that can be performed in a portable isothermal fluorimeter with minimal laboratory resources. We also applied a strategy to stabilize the duplexed DARQ-LAMP mixtures at room temperature for use as ready-to-use formats facilitating analysis in field settings as point-of-care diagnostics for schistosomiasis and strongyloidiasis.


Assuntos
Esquistossomose , Strongyloides stercoralis , Estrongiloidíase , Animais , Humanos , Schistosoma mansoni/genética , Sistemas Automatizados de Assistência Junto ao Leito , DNA de Helmintos/genética , Técnicas de Amplificação de Ácido Nucleico/métodos , Strongyloides stercoralis/genética , Oligonucleotídeos , Corantes Fluorescentes , Sensibilidade e Especificidade
19.
Cancer Imaging ; 23(1): 10, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36691077

RESUMO

Contrast-enhanced mammography (CEM) is becoming a widely adopted modality in breast imaging over the past few decades and exponentially so over the last few years, with strong evidence of high diagnostic performance in cancer detection. Evidence is also growing indicating comparative performance of CEM to MRI in sensitivity with fewer false positive rates. As application of CEM ranges from potential use in screening dense breast populations to staging of known breast malignancy, increased familiarity with the modality and its implementation, and disease processes encountered becomes of great clinical significance. This review emphasizes expected normal findings on CEM followed by a focus on examples of the commonly encountered benign and malignant pathologies on CEM.


Assuntos
Neoplasias da Mama , Mamografia , Humanos , Feminino , Mamografia/métodos , Neoplasias da Mama/patologia , Densidade da Mama , Meios de Contraste , Mama/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Sensibilidade e Especificidade
20.
Emerg Infect Dis ; 29(2): 456-459, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36692499

RESUMO

We assessed serum samples collected in Cauca Department, Colombia, from 486 persons for Orientia seroreactivity. Overall, 13.8% showed reactive IgG by indirect immunofluorescence antibody assay and ELISA. Of those samples, 30% (20/67) were confirmed to be positive by Western blot, showing >1 reactive band to Orientia 56-kD or 47-kD antigens.


Assuntos
Orientia tsutsugamushi , Infecções por Rickettsia , Tifo por Ácaros , Humanos , Tifo por Ácaros/epidemiologia , Colômbia/epidemiologia , População Rural , Sensibilidade e Especificidade , Imunoglobulina M , Anticorpos Antibacterianos , Ensaio de Imunoadsorção Enzimática , Orientia
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