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Gatto F, Bratulic S, Maccari F, Galeotti F, Volpi N, Nielsen J, Lotan Y, Kjölhede H. Urinary Free Glycosaminoglycans Identify Adults at High Risk of Developing Early-stage High-grade Bladder Cancer. EUR UROL SUPPL 2024; 68:40-47. [PMID: 39263348 PMCID: PMC11387706 DOI: 10.1016/j.euros.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2024] [Indexed: 09/13/2024] Open
Abstract
Background and objective Screening for bladder cancer (BCa) could reduce mortality via early detection of early-stage high-grade (Ta/T1 N0 M0 grade 2-3) disease. Noninvasive biomarkers could aid in screening, but current markers lack the specificity required. The urinary free glycosaminoglycan profile (GAGome) is a promising biomarker for early detection of BCa metabolism. Methods In a prospective case-control development study, we included patients with BCa or no evidence of disease (NED) and measured the urinary GAGome. We then developed a score to predict the probability of BCa using GAGome features that correlated with BCa versus NED according to Bayesian regression. Next, in a retrospective, population-based, case-control study, we included adults from the Lifelines Cohort Study who were presumed healthy at baseline. All cases with BCa confirmed in the cancer registry by the 2-yr or 6-yr study visit were matched to randomly selected control subjects. We developed a reference logistic regression model using age and sex to predict BCa at 7 yr after baseline. We then added the GAGome score to the model and assessed model improvement using the likelihood ratio test. We dichotomized outputs for the reference model and saturated model (reference + GAGome score) into high-risk versus low-risk categories using a 99% specificity cutoff and estimated the sensitivity for association with BCa at 7 yr. Key findings and limitations We prospectively included 51 individuals with BCa and 38 with NED and observed alterations in three GAGome features compatible with BCa. We developed a score that discriminated BCa with an area under the receiver operating characteristic curve of 0.77 (95% confidence interval [CI] 0.67-0.87). We retrospectively selected a cohort of 1088 presumed healthy adults (median age 48 yr, 56% females), of whom 48 had developed BCa by 7 yr after baseline (median time to diagnosis 1.4 yr). The GAGome score was an independent predictor of BCa at 7 yr when added to the reference model (p < 0.001). The sensitivity for BCa at 7 yr for high-risk subjects was 31% (95% CI 20-43%) using the saturated model and 17% (95% CI 4.7-29%) using the reference model at 99% specificity (95% CI 98-99%). Conclusions and clinical implications The urinary free GAGome is specifically altered in BCa and can be used for noninvasive identification of adults at high risk of developing BCa, independent of age and sex. This information could be useful for the design of risk-stratified targeted screening programs for BCa. Patient summary We tested whether measurement of a class of sugars called glycosaminoglycans (GAGs) in urine could be used for early detection of bladder cancer. Our results show that GAG levels in urine can distinguish people at high risk of developing bladder cancer within 7 years, even if they are healthy at the time of the urine sampling.
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Affiliation(s)
- Francesco Gatto
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
- Elypta AB, Stockholm, Sweden
| | - Sinisa Bratulic
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
- Elypta AB, Stockholm, Sweden
| | - Francesca Maccari
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Galeotti
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Volpi
- Department of Life Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Jens Nielsen
- Department of Life Sciences, Chalmers University of Technology, Gothenburg, Sweden
- BioInnovation Institute, Copenhagen, Denmark
| | - Yair Lotan
- Department of Urology, UT Southwestern Medical Center at Dallas, Dallas, TX, USA
| | - Henrik Kjölhede
- Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Urology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Devran S, Gözübüyük ÖB, Dinçer Ş, Günver MG, Bayraktar B. Diagnostic value of shear-wave elastography for patellar tendinopathy in female volleyball and basketball athletes: a cross sectional case control study. PHYSICIAN SPORTSMED 2024; 52:470-477. [PMID: 38243396 DOI: 10.1080/00913847.2024.2308507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/18/2024] [Indexed: 01/21/2024]
Abstract
OBJECTIVES We aim to investigate the accuracy of shear-wave elastography (SWE) in diagnosing patellar tendinopathy in female volleyball and basketball players. In addition, we compared different parts of the patellar tendon and investigated the effects of different knee angles on elastography measurements. METHODS This cross-sectional case-control study evaluated 63 female athletes from professional basketball and volleyball teams (NCT06199583). Patellar tendinopathy diagnoses were made using clinical and ultrasonographic criteria. SWE measurements were taken at 30-degree knee flexion and extension. Rectangular regions of interest boxes were placed in three different parts of the tendon (proximal, middle, distal). The global SWE value was calculated by taking the mean of measurements in the three parts. Receiver operating characteristic (ROC) curves were used to identify significant cutoff points for SWE, and 2 × 2 tables were generated to determine sensitivity and specificity. RESULTS Thirteen (20.6%) of the 63 athletes were diagnosed with patellar tendinopathy. The ROC curves have identified different cutoff scores for SWE measurements. The SWE score of 130.75 from the proximal part showed the highest sensitivity of 89% and specificity of 80% (p < 0.001) with a 4.45 likelihood ratio at the 30-degree knee flexion. The likelihood ratio is 1.5 at a 30-degree angle and 1.65 at a 0-degree angle when measuring the entire tendon, whereas other portions indicate a ratio ranging from 1.12 to 1.73. CONCLUSIONS Shear-wave elastography is a reliable evaluation method for diagnosing patellar tendinopathy. It has more accuracy when applied to the proximal part and at 30-degree knee flexion compared to measurements taken at knee extension and other parts of the tendon.
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Affiliation(s)
- Sergen Devran
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | | | - Şensu Dinçer
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
| | - Mehmet Güven Günver
- Faculty of Medicine, Biostatistics Department, Istanbul University, Istanbul, Turkey
| | - Bülent Bayraktar
- Faculty of Medicine, Sports Medicine Department, Istanbul University, Istanbul, Turkey
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Huang Z, Zhang X, Ju Y, Zhang G, Chang W, Song H, Gao Y. Explainable breast cancer molecular expression prediction using multi-task deep-learning based on 3D whole breast ultrasound. Insights Imaging 2024; 15:227. [PMID: 39320560 PMCID: PMC11424596 DOI: 10.1186/s13244-024-01810-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/03/2024] [Indexed: 09/26/2024] Open
Abstract
OBJECTIVES To noninvasively estimate three breast cancer biomarkers, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) and enhance performance and interpretability via multi-task deep learning. METHODS The study included 388 breast cancer patients who received the 3D whole breast ultrasound system (3DWBUS) examinations at Xijing Hospital between October 2020 and September 2021. Two predictive models, a single-task and a multi-task, were developed; the former predicts biomarker expression, while the latter combines tumor segmentation with biomarker prediction to enhance interpretability. Performance evaluation included individual and overall prediction metrics, and Delong's test was used for performance comparison. The models' attention regions were visualized using Grad-CAM + + technology. RESULTS All patients were randomly split into a training set (n = 240, 62%), a validation set (n = 60, 15%), and a test set (n = 88, 23%). In the individual evaluation of ER, PR, and HER2 expression prediction, the single-task and multi-task models achieved respective AUCs of 0.809 and 0.735 for ER, 0.688 and 0.767 for PR, and 0.626 and 0.697 for HER2, as observed in the test set. In the overall evaluation, the multi-task model demonstrated superior performance in the test set, achieving a higher macro AUC of 0.733, in contrast to 0.708 for the single-task model. The Grad-CAM + + method revealed that the multi-task model exhibited a stronger focus on diseased tissue areas, improving the interpretability of how the model worked. CONCLUSION Both models demonstrated impressive performance, with the multi-task model excelling in accuracy and offering improved interpretability on noninvasive 3DWBUS images using Grad-CAM + + technology. CRITICAL RELEVANCE STATEMENT The multi-task deep learning model exhibits effective prediction for breast cancer biomarkers, offering direct biomarker identification and improved clinical interpretability, potentially boosting the efficiency of targeted drug screening. KEY POINTS Tumoral biomarkers are paramount for determining breast cancer treatment. The multi-task model can improve prediction performance, and improve interpretability in clinical practice. The 3D whole breast ultrasound system-based deep learning models excelled in predicting breast cancer biomarkers.
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Affiliation(s)
- Zengan Huang
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, 518055, China
| | - Xin Zhang
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, 518055, China
| | - Yan Ju
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Ge Zhang
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Wanying Chang
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China
| | - Hongping Song
- Department of Ultrasound, Xijing Hospital, Fourth Military Medical University, No. 127 Changle West Road, Xi'an, 710032, China.
| | - Yi Gao
- School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, 518055, China.
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Covelli V, Buonocore M, Grimaldi M, Scrima M, Santoro A, Marino C, De Simone V, van Baarle L, Biscu F, Scala MC, Sala M, Matteoli G, D'Ursi AM, Rodriquez M. Peptides as modulators of FPPS enzyme: A multifaceted evaluation from the design to the mechanism of action. Eur J Med Chem 2024; 279:116871. [PMID: 39303514 DOI: 10.1016/j.ejmech.2024.116871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 09/02/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
Bone diseases are medical conditions caused by the loss of bone homeostasis consecutive to increased osteoclast activity and diminished osteoblast activity. The mevalonate pathway (MVA) is crucial for maintaining this balance since it drives the post-translational prenylation of small guanosine triphosphatases (GTPases) proteins. Farnesyl pyrophosphate synthase (FPPS) plays a crucial role in the MVA pathway. Consequently, in the treatment of bone-related diseases, FPPS is the target of FDA-approved nitrogen-containing bisphosphonates (N-BPs), which have tropism mainly for bone tissue due to their poor penetration in soft tissues. The development of inhibitors targeting the FPPS enzyme has garnered significant interest in recent decades due to FPPS's role in the biosynthesis of cholesterol and other isoprenoids, which are implicated in cancer, bone diseases, and other conditions. In this study, we describe a multidisciplinary approach to designing novel FPPS inhibitors, combining computational modeling, biochemical assays, and biophysical techniques. A series of peptides and phosphopeptides were designed, synthesized, and evaluated for their ability to inhibit FPPS activity. Molecular docking was employed to predict the binding modes of these compounds to FPPS, while Surface Plasmon Resonance (SPR) and Nuclear Magnetic Resonance (NMR) spectroscopy experiments - based on Saturation Transfer Difference (STD) and an enzymatic NMR assay - were used to measure their binding affinities and kinetics. The biological activity of the most promising compounds was further assessed in cellular assays using murine colorectal cancer (CRC) cells. Additionally, genomics and metabolomics profiling allowed to unravel the possible mechanisms underlying the activity of the peptides, confirming their involvement in the modulation of the MVA pathway. Our findings demonstrate that the designed peptides and phosphopeptides exhibit significant inhibitory activity against FPPS and possess antiproliferative effects on CRC cells, suggesting their potential as therapeutic agents for cancer.
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Affiliation(s)
- Verdiana Covelli
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano, 49, 80131, Naples, Italy.
| | - Michela Buonocore
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy; Department of Chemical Sciences and Research Centre on Bioactive Peptides (CIRPEB), University of Naples Federico II, Strada Comunale Cintia, 80126, Naples, Italy.
| | - Manuela Grimaldi
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
| | - Mario Scrima
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
| | - Angelo Santoro
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy; Department of Pharmacy, Scuola di Specializzazione in Farmacia Ospedaliera, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
| | - Carmen Marino
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
| | - Veronica De Simone
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)-Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Herestraat, 49, 3000, Leuven, Belgium.
| | - Lies van Baarle
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)-Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Herestraat, 49, 3000, Leuven, Belgium.
| | - Francesca Biscu
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)-Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Herestraat, 49, 3000, Leuven, Belgium.
| | - Maria Carmina Scala
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
| | - Marina Sala
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
| | - Gianluca Matteoli
- Department of Chronic Diseases, Metabolism and Ageing (CHROMETA)-Translational Research Center for Gastrointestinal Disorders (TARGID), KU Leuven, Herestraat, 49, 3000, Leuven, Belgium.
| | - Anna Maria D'Ursi
- Department of Pharmacy, University of Salerno, Via Giovanni Paolo II, 132, 84084, Fisciano, SA, Italy.
| | - Manuela Rodriquez
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano, 49, 80131, Naples, Italy.
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Gill RR, Richards WG, Heiling H, Mazzola E, Hung YP, Seethamraju RT, Chirieac LR, Bueno R. Predictive potential of MRI in differentiating the predominant component in biphasic pleural mesothelioma. Eur J Radiol 2024; 176:111527. [PMID: 38810438 DOI: 10.1016/j.ejrad.2024.111527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To assess the potential of apparent diffusion coefficient (ADC) values derived from diffusion weighted (DW) MRI preoperatively to predict the predominant histologic component among biphasic pleural mesothelioma (PM) tumors. METHODS ADC maps were generated from DW MRI scans. Histology and predominant component of biphasic PM were confirmed following surgical resection. Statistical analyses were done with R (R Foundation for Statistical Computing, Vienna, Austria). Average ADC values corresponding to epithelioid- and sarcomatoid-predominant tumors were compared. ADC thresholding was accomplished by recursive partitioning and confirmed with ROC analysis. RESULTS Eighty-four patients with biphasic PM's, 69 (82 %) epithelioid-predominant (BE) and 15(18 %) sarcomatoid-predominant (BS) tumors were evaluated. Thirty-eight (45 %) patients underwent extrapleural pneumonectomy (EPP), 39 (46 %) had extended pleural decortication (ePDC) and 7 (8 %) had pleural decortication (PDC). ADC values ranged between 0.696 x 10-3 to 1.921 x 10-3 mm2/s. BE tumors demonstrated significantly higher ADC values than BS tumors (p = 0.026). ADC values above 0.94 x 10-3 mm2/s were associated with a significant increase of relative risk of being in group BE over group BS (relative risk: 1.47, 95 %CI: 1.05-2.06, p = 0.027) CONCLUSION: Average ADC values of BE tumors were higher than BS tumors and the two groups can be separated by a cut off value of 0.94 X 10-3 mm2/s.
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Affiliation(s)
- Ritu R Gill
- Beth Israel Deaconess Medical Center, Boston, MA, United States.
| | | | | | | | - Yin P Hung
- Masschussets General Hospital, Boston, MA, United States
| | | | | | - Raphael Bueno
- Brigham and Women's Hospital, Boston, MA, United States
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Zhang M, Zeng Y, Fang ZN, Wang YD, Zhang RN, Ye Z, Cao QH, Mao R, Sun C, Chen ZH, Huang B, Li XH. MRI radiomics enhances radiologists' ability for characterizing intestinal fibrosis in patients with Crohn's disease. Insights Imaging 2024; 15:165. [PMID: 38940988 PMCID: PMC11213838 DOI: 10.1186/s13244-024-01740-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 06/09/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES We aimed to develop MRI-based radiomic models (RMs) to improve the diagnostic accuracy of radiologists in characterizing intestinal fibrosis in patients with Crohn's disease (CD). METHODS This retrospective study included patients with refractory CD who underwent MR before surgery from November 2013 to September 2021. Resected bowel segments were histologically classified as none-mild or moderate-severe fibrosis. RMs based on different MR sequence combinations (RM1: T2WI and enhanced-T1WI; RM2: T2WI, enhanced-T1WI, diffusion-weighted imaging [DWI], and apparent diffusion coefficient [ADC]); RM3: T2WI, enhanced-T1WI, DWI, ADC, and magnetization transfer MRI [MTI]), were developed and validated in an independent test cohort. The RMs' diagnostic performance was compared to that of visual interpretation using identical sequences and a clinical model. RESULTS The final population included 123 patients (81 men, 42 women; mean age: 30.26 ± 7.98 years; training cohort, n = 93; test cohort, n = 30). The area under the receiver operating characteristic curve (AUC) of RM1, RM2, and RM3 was 0.86 (p = 0.001), 0.88 (p = 0.001), and 0.93 (p = 0.02), respectively. The decision curve analysis confirmed a progressive improvement in the diagnostic performance of three RMs with the addition of more specific sequences. All RMs performance surpassed the visual interpretation based on the same MR sequences (visual model 1, AUC = 0.65, p = 0.56; visual model 2, AUC = 0.63, p = 0.04; visual model 3, AUC = 0.77, p = 0.002), as well as the clinical model composed of C-reactive protein and erythrocyte sedimentation rate (AUC = 0.60, p = 0.13). CONCLUSIONS The RMs, utilizing various combinations of conventional, DWI and MTI sequences, significantly enhance radiologists' ability to accurately characterize intestinal fibrosis in patients with CD. CRITICAL RELEVANCE STATEMENT The utilization of MRI-based RMs significantly enhances the diagnostic accuracy of radiologists in characterizing intestinal fibrosis. KEY POINTS MRI-based RMs can characterize CD intestinal fibrosis using conventional, diffusion, and MTI sequences. The RMs achieved AUCs of 0.86-0.93 for assessing fibrosis grade. MRI-radiomics outperformed visual interpretation for grading CD intestinal fibrosis.
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Affiliation(s)
- Mengchen Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yinghou Zeng
- Medical AI Lab, School of Biomedical Engineering, Medical School, Shenzhen University, Shenzhen, People's Republic of China
| | - Zhuang-Nian Fang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yang-di Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ruo-Nan Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ziyin Ye
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Qing-Hua Cao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Canhui Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Zhi-Hui Chen
- Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Medical School, Shenzhen University, Shenzhen, People's Republic of China.
| | - Xue-Hua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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Aiello EN, Pucci V, Diana L, Corvaglia A, Niang A, Mattiello S, Preti AN, Durante G, Ravelli A, Consonni L, Guerra C, Ponti AD, Sangalli G, Difonzo T, Scarano S, Perucca L, Zago S, Appollonio I, Mondini S, Bolognini N. The Telephone Language Screener (TLS): standardization of a novel telephone-based screening test for language impairment. Neurol Sci 2024; 45:1989-2001. [PMID: 38010584 PMCID: PMC11021315 DOI: 10.1007/s10072-023-07149-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 10/19/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND This study aimed at developing and standardizing the Telephone Language Screener (TLS), a novel, disease-nonspecific, telephone-based screening test for language disorders. METHODS The TLS was developed in strict pursuance to the current psycholinguistic standards. It comprises nine tasks assessing phonological, lexical-semantic and morpho-syntactic components, as well as an extra Backward Digit Span task. The TLS was administered to 480 healthy participants (HPs), along with the Telephone-based Semantic Verbal Fluency (t-SVF) test and a Telephone-based Composite Language Index (TBCLI), as well as to 37 cerebrovascular/neurodegenerative patients-who also underwent the language subscale of the Telephone Interview for Cognitive Status (TICS-L). An HP subsample was also administered an in-person language battery. Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability were tested. Norms were derived via Equivalent Scores. The capability of the TLS to discriminate patients from HPs and to identify, among the patient cohort, those with a defective TICS-L, was also examined. RESULTS The TLS was underpinned by a mono-component structure and converged with the t-SVF (p < .001), the TBCLI (p < .001) and the in-person language battery (p = .002). It was internally consistent (McDonald's ω = 0.67) and reliable between raters (ICC = 0.99) and at retest (ICC = 0.83). Age and education, but not sex, were predictors of TLS scores. The TLS optimally discriminated patients from HPs (AUC = 0.80) and successfully identified patients with an impaired TICS-L (AUC = 0.92). In patients, the TLS converged with TICS-L scores (p = 0.016). DISCUSSION The TLS is a valid, reliable, normed and clinically feasible telephone-based screener for language impairment.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Veronica Pucci
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Lorenzo Diana
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessia Corvaglia
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Aida Niang
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Silvia Mattiello
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Alice Naomi Preti
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giorgia Durante
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Adele Ravelli
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Lucia Consonni
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Carolina Guerra
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
| | - Adriana Delli Ponti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Gaia Sangalli
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Teresa Difonzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Laura Perucca
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Stefano Zago
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milano, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Mondini
- Dipartimento di Filosofia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, SociologiaPadua, Italy
- Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Nadia Bolognini
- Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy.
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
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Turgut AO, Koca D, Ünver A. Comparison of blood ΒHBA measurement devices for diagnosis of subclinical pregnancy toxaemia in sheep: A field study. Reprod Domest Anim 2024; 59:e14589. [PMID: 38812426 DOI: 10.1111/rda.14589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/26/2024] [Accepted: 05/01/2024] [Indexed: 05/31/2024]
Abstract
Pregnancy toxaemia is a serious disease that occurs during the last trimester of pregnancy in sheep. Yet, in most cases, the disease may have a subclinical course. This study was aimed at comparing blood βHBA measurement devices for diagnosis of subclinical pregnancy toxaemia in late pregnant sheep. In the study, a total of 50 blood samples were collected from Romanov (n = 30) and cross-bred Hamdani (n = 20) sheep. Blood βHBA levels were measured using TaiDoc TD-4235 and CentriVet βHBA hand-held meter. Randox βHBA (Ranbut) assay was used as a reference laboratory method to compare hand-held meters. βHBA value of 0.8 mmol/L was set as the cut-off value for diagnosis of subclinical pregnancy toxaemia. Statistical analyses were carried out using Minitab 21 and Jamovi software. In the study, the correlation of Randox-TaiDoc TD-4235 and Randox-CentriVet was .822 (p < .001) and .728 (p < .001), respectively. Based on the Ranbut assay, nine ewes out of 50 were diagnosed with subclinical pregnancy toxaemia. Specificity (detection of healthy ewes) and sensitivity (detection of ewes with subclinical pregnancy toxaemia) for TaiDoc TD-4235 and CentriVet hand-held meters were 100%, 77.8%, and 100%, 66.7%, respectively. In the receiver operating characteristic (ROC) analysis, areas under the ROC curve (AUC) were 0.976 and 0.920 for TaiDoc and CentriVet, respectively. Bland-Altman analysis revealed a bias of 0.092 mmol/L for TaiDoc and a bias of 0.132 mmol/L for CentriVet. TaiDoc hand-held meter shows a better correlation with the Randox Ranbut assay and greater sensitivity compared to the CentriVet hand-held meter. In conclusion, both TaiDoc and CentriVet hand-held meters can be securely used in the diagnosis of subclinical pregnancy toxaemia in sheep. For these reasons, subclinical pregnancy toxaemia and these devices will be evaluated within the scope of herd management programme in the sheep industry. It should also be taken into account that these conditions will affect the future fertility of the mother and offspring.
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Affiliation(s)
- Ali Osman Turgut
- Department of Animal Science, Faculty of Veterinary Medicine, Siirt University, Siirt, Turkey
| | - Davut Koca
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Van Yuzuncu Yil University, Van, Turkey
| | - Ali Ünver
- Department of Obstetrics and Gynecology, Faculty of Veterinary Medicine, Siirt University, Siirt, Turkey
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9
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Ilardi CR, Menichelli A, Michelutti M, Cattaruzza T, Federico G, Salvatore M, Iavarone A, Manganotti P. On the Clinimetrics of the Montreal Cognitive Assessment: Cutoff Analysis in Patients with Mild Cognitive Impairment due to Alzheimer's Disease. J Alzheimers Dis 2024; 101:293-308. [PMID: 39150828 DOI: 10.3233/jad-240339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024]
Abstract
Background In the era of disease-modifying therapies, empowering the clinical neuropsychologist's toolkit for timely identification of mild cognitive impairment (MCI) is crucial. Objective Here we examine the clinimetric properties of the Montreal Cognitive Assessment (MoCA) for the early diagnosis of MCI due to Alzheimer's disease (MCI-AD). Methods Data from 48 patients with MCI-AD and 47 healthy controls were retrospectively analyzed. Raw MoCA scores were corrected according to the conventional Nasreddine's 1-point correction and demographic adjustments derived from three normative studies. Optimal cutoffs were determined while previously established cutoffs were diagnostically reevaluated. Results The original Nasreddine's cutoff of 26 and normative cutoffs (non-parametric outer tolerance limit on the 5th percentile of demographically-adjusted score distributions) were overly imbalanced in terms of Sensitivity (Se) and Specificity (Sp). The optimal cutoff for Nasreddine's adjustment showed adequate clinimetric properties (≤23.50, Se = 0.75, Sp = 0.70). However, the optimal cutoff for Santangelo's adjustment (≤22.85, Se = 0.65, Sp = 0.87) proved to be the most effective for both screening and diagnostic purposes according to Larner's metrics. The results of post-probability analyses revealed that an individual testing positive using Santangelo's adjustment combined with a cutoff of 22.85 would have 84% post-test probability of receiving a diagnosis of MCI-AD (LR+ = 5.06). Conclusions We found a common (mal)practice of bypassing the applicability of normative cutoffs in diagnosis-oriented clinical practice. In this study, we identified optimal cutoffs for MoCA to be allocated in secondary care settings for supporting MCI-AD diagnosis. Methodological and psychometric issues are discussed.
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Affiliation(s)
| | - Alina Menichelli
- Department of Medicine, Surgery and Health Sciences, Rehabilitation Unit, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Marco Michelutti
- Department of Medicine, Surgery and Health Sciences, Clinical Unit of Neurology, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Tatiana Cattaruzza
- Department of Medicine, Surgery and Health Sciences, Clinical Unit of Neurology, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | | | | | | | - Paolo Manganotti
- Department of Medicine, Surgery and Health Sciences, Clinical Unit of Neurology, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
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10
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Ye Y, Luo Z, Qiu Z, Cao K, Huang B, Deng L, Zhang W, Liu G, Zou Y, Zhang J, Li J. Radiomics Prediction of Muscle Invasion in Bladder Cancer Using Semi-Automatic Lesion Segmentation of MRI Compared with Manual Segmentation. Bioengineering (Basel) 2023; 10:1355. [PMID: 38135946 PMCID: PMC10740947 DOI: 10.3390/bioengineering10121355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/24/2023] Open
Abstract
Conventional radiomics analysis requires the manual segmentation of lesions, which is time-consuming and subjective. This study aimed to assess the feasibility of predicting muscle invasion in bladder cancer (BCa) with radiomics using a semi-automatic lesion segmentation method on T2-weighted images. Cases of non-muscle-invasive BCa (NMIBC) and muscle-invasive BCa (MIBC) were pathologically identified in a training cohort and in internal and external validation cohorts. For bladder tumor segmentation, a deep learning-based semi-automatic model was constructed, while manual segmentation was performed by a radiologist. Semi-automatic and manual segmentation results were respectively used in radiomics analyses to distinguish NMIBC from MIBC. An equivalence test was used to compare the models' performance. The mean Dice similarity coefficients of the semi-automatic segmentation method were 0.836 and 0.801 in the internal and external validation cohorts, respectively. The area under the receiver operating characteristic curve (AUC) were 1.00 (0.991) and 0.892 (0.894) for the semi-automated model (manual) on the internal and external validation cohort, respectively (both p < 0.05). The average total processing time for semi-automatic segmentation was significantly shorter than that for manual segmentation (35 s vs. 92 s, p < 0.001). The BCa radiomics model based on semi-automatic segmentation method had a similar diagnostic performance as that of manual segmentation, while being less time-consuming and requiring fewer manual interventions.
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Affiliation(s)
- Yaojiang Ye
- Department of Radiology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan 523059, China; (Y.Y.); (L.D.); (Y.Z.)
| | - Zixin Luo
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China; (Z.L.); (Z.Q.); (K.C.); (B.H.)
| | - Zhengxuan Qiu
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China; (Z.L.); (Z.Q.); (K.C.); (B.H.)
| | - Kangyang Cao
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China; (Z.L.); (Z.Q.); (K.C.); (B.H.)
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China; (Z.L.); (Z.Q.); (K.C.); (B.H.)
| | - Lei Deng
- Department of Radiology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan 523059, China; (Y.Y.); (L.D.); (Y.Z.)
| | - Weijing Zhang
- Imaging Department, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China;
| | - Guoqing Liu
- College of Physics and Optoelectronic Engineering, Shenzhen University, Shenzhen 518060, China;
| | - Yujian Zou
- Department of Radiology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan 523059, China; (Y.Y.); (L.D.); (Y.Z.)
| | - Jian Zhang
- Shenzhen University Medical School, Shenzhen University, Shenzhen 518060, China
- Shenzhen-Hong Kong Institute of Brain Science-Shenzhen Fundamental Research Institutions, Shenzhen 518060, China
| | - Jianpeng Li
- Department of Radiology, The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Dongguan 523059, China; (Y.Y.); (L.D.); (Y.Z.)
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11
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van der Straaten TFK, Burger AVM, Briaire JJ, Boermans PPBM, Vickers D, Frijns JHM. Diagnostic value of preoperative measures in selecting post-lingually deafened candidates for cochlear implantation - a different approach. Int J Audiol 2023; 62:983-991. [PMID: 35997570 DOI: 10.1080/14992027.2022.2106453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 07/21/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES We examined which preoperative diagnostic measure is most suited to serve as a selection criterion to determine adult cochlear implantation (CI) candidacy. DESIGN Preoperative diagnostic measures included pure tone audiometry (PTA; 0.5, 1, 2, 4 kHz), speech perception tests (SPT) unaided with headphones and with best-aided hearing aids (in quiet and in noise). Gain in speech perception was used as outcome measure. Performance of preoperative measures was analysed using the area under the curve (AUC) of receiver operating characteristic (ROC) curves. STUDY SAMPLE This retrospective longitudinal cohort study included 552 post-lingually deafened adults with CI in a tertiary referral centre in the Netherlands. RESULTS Best-aided SPT in quiet was the most accurate in defining which CI candidates improved their speech perception in quiet postoperatively. For an improvement in speech perception in noise, the best-aided SPT in noise was the most accurate in defining which adult would benefit from CI. PTA measures performed lower compared to the SPT measures. CONCLUSIONS SPT is better than PTA for selecting CI candidates who will benefit in terms of speech perception. Best-aided SPT in noise was the most accurate for indicating an improvement of speech perception in noise but was only evaluated in high performers with residual hearing. These insights will assist in formulating more effective selection criteria for CI.
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Affiliation(s)
- Tirza F K van der Straaten
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anouk V M Burger
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Briaire
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Paul B M Boermans
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Deborah Vickers
- Clinical Neurosciences, University of Cambridge, Cambridge, The United Kingdom
| | - Johan H M Frijns
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University, Leiden, The Netherlands
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12
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Nomura Y, Hoshiyama M, Akita S, Naganishi H, Zenbutsu S, Matsuoka A, Ohnishi T, Haneishi H, Mitsukawa N. Computer-aided diagnosis for screening of lower extremity lymphedema in pelvic computed tomography images using deep learning. Sci Rep 2023; 13:16214. [PMID: 37758908 PMCID: PMC10533488 DOI: 10.1038/s41598-023-43503-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
Lower extremity lymphedema (LEL) is a common complication after gynecological cancer treatment, which significantly reduces the quality of life. While early diagnosis and intervention can prevent severe complications, there is currently no consensus on the optimal screening strategy for postoperative LEL. In this study, we developed a computer-aided diagnosis (CAD) software for LEL screening in pelvic computed tomography (CT) images using deep learning. A total of 431 pelvic CT scans from 154 gynecological cancer patients were used for this study. We employed ResNet-18, ResNet-34, and ResNet-50 models as the convolutional neural network (CNN) architecture. The input image for the CNN model used a single CT image at the greater trochanter level. Fat-enhanced images were created and used as input to improve classification performance. Receiver operating characteristic analysis was used to evaluate our method. The ResNet-34 model with fat-enhanced images achieved the highest area under the curve of 0.967 and an accuracy of 92.9%. Our CAD software enables LEL diagnosis from a single CT image, demonstrating the feasibility of LEL screening only on CT images after gynecologic cancer treatment. To increase the usefulness of our CAD software, we plan to validate it using external datasets.
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Affiliation(s)
- Yukihiro Nomura
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-ku, Chiba, 263-8522, Japan.
| | - Masato Hoshiyama
- Department of Medical Engineering, Faculty of Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-ku, Chiba, 263-8522, Japan
| | - Shinsuke Akita
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hiroki Naganishi
- Department of Plastic Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Konandai, Konan-ku, Yokohama City, Kanagawa, 234-0054, Japan
| | - Satoki Zenbutsu
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-ku, Chiba, 263-8522, Japan
| | - Ayumu Matsuoka
- Department of Gynecology and Maternal-Fetal Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Takashi Ohnishi
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1133 York Avenue, New York, NY, 10065, USA
| | - Hideaki Haneishi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-ku, Chiba, 263-8522, Japan
| | - Nobuyuki Mitsukawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
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13
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Kim DH, Park H, Choi YJ, Im K, Lee CW, Kim DS, Pack CG, Kim HY, Choi CM, Lee JC, Ji W, Rho JK. Identification of exosomal microRNA panel as diagnostic and prognostic biomarker for small cell lung cancer. Biomark Res 2023; 11:80. [PMID: 37705067 PMCID: PMC10500735 DOI: 10.1186/s40364-023-00517-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Small cell lung cancer (SCLC) has an exceptionally poor prognosis; as most of the cases are initially diagnosed as extensive disease with hematogenous metastasis. Therefore, the early diagnosis of SCLC is very important and may improve its prognosis. METHODS To investigate the feasibility of early diagnosis of SCLC, we examined exosomal microRNAs (miRNAs) present in serum obtained from patients with SCLC. First, exosomes were isolated in serum from patients with SCLC and healthy individuals and were characterized using particle size and protein markers. Additionally, miRNA array was performed to define SCLC-specific exosomal miRNAs. Second, the obtained miRNAs were further validated employing a large cohort. Finally, the ability to diagnose SCLC was estimated by area under the curve (AUC), and intracellular mRNA change patterns were verified through validated miRNAs. RESULTS From the miRNA array results, we selected 51-miRNAs based on p-values and top 10 differentially expressed genes, and 25-miRNAs were validated using quantitative reverse transcription-polymerase chain reaction. The 25-miRNAs were further validated employing a large cohort. Among them, 7-miRNAs showed significant differences. Furthermore, 6-miRNAs (miR-3565, miR-3124-5p, miR-200b-3p, miR-6515, miR-3126-3p and miR-9-5p) were up-regulated and 1-miRNA (miR-92b-5p) was down-regulated. The AUC value of each miRNA sets between 0.64 and 0.76, however the combined application of 3-miRNAs (miR-200b-3p, miR-3124-5p and miR-92b-5p) remarkably improved the diagnostic value (AUC = 0.93). Gene ontology analysis revealed that the 3-miRNA panel is linked to various oncogene pathways and nervous system development. When the 3-miRNAs were introduced to cells, the resulting changes in total mRNA expression strongly indicated the presence of lung diseases, including lung cancer. In addition, the 3-miRNA panel was significantly associated with a poorer prognosis, although individual miRNAs have not been validated as prognostic markers. CONCLUSION Our study identified SCLC-specific exosomal miRNAs, and the 3-miRNAs panel (miR-200b-3p, miR-3124-5p and miR-92b-5p) may serve as a diagnostic and prognostic marker for SCLC.
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Affiliation(s)
- Dong Ha Kim
- Asan Institute for Life Sciences, 05505, Seoul, South Korea
| | - Hyojeong Park
- Department of Biomedical Sciences, AMIST, 05505, Seoul, South Korea
| | - Yun Jung Choi
- Asan Institute for Life Sciences, 05505, Seoul, South Korea
| | - Kyungtaek Im
- Asan Institute for Life Sciences, 05505, Seoul, South Korea
| | - Chae Won Lee
- Department of Biomedical Sciences, AMIST, 05505, Seoul, South Korea
| | - Da-Som Kim
- Department of Biomedical Sciences, AMIST, 05505, Seoul, South Korea
| | - Chan-Gi Pack
- Department of Convergence Medicine, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Hyun-Yi Kim
- NGeneS Inc, Asan-Si, Gyeonggi-do, South Korea
| | - Chang-Min Choi
- Department of Pulmonary Critical and Care Medicine, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, South Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, South Korea
| | - Wonjun Ji
- Department of Pulmonary Critical and Care Medicine, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Jin Kyung Rho
- Department of Convergence Medicine, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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14
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Stahlmann K, Reitsma JB, Zapf A. Missing values and inconclusive results in diagnostic studies - A scoping review of methods. Stat Methods Med Res 2023; 32:1842-1855. [PMID: 37559474 PMCID: PMC10540494 DOI: 10.1177/09622802231192954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Most diagnostic studies exclude missing values and inconclusive results from the analysis or apply simple methods resulting in biased accuracy estimates. This may be due to the lack of availability or awareness of appropriate methods. This scoping review aimed to provide an overview of strategies to handle missing values and inconclusive results in the reference standard or index test in diagnostic accuracy studies. Conducting a systematic literature search in MEDLINE, Cochrane Library, and Web of Science, we could identify many articles proposing methods for addressing missing values in the reference standard. There are also several articles describing methods regarding missing values or inconclusive results in the index test. The latter encompass imputation, frequentist and Bayesian likelihood, model-based, and latent class methods. While methods for missing values in the reference standard are regularly applied in practice, this is not true for methods addressing missing values and inconclusive results in the index test. Our comprehensive overview and description of available methods may raise further awareness of these methods and will enhance their application. Future research is needed to compare the performance of these methods under different conditions to give valid and robust recommendations for their usage in various diagnostic accuracy research scenarios.
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Affiliation(s)
- Katharina Stahlmann
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Germany
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15
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Cabrera ODLC, Alsehibani R. Statistical modeling and evaluation of the impact of multiplicity classification thresholds on the COVID-19 pool testing accuracy. PLoS One 2023; 18:e0283874. [PMID: 37494364 PMCID: PMC10370739 DOI: 10.1371/journal.pone.0283874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/17/2023] [Indexed: 07/28/2023] Open
Abstract
Prior research on pool testing focus on developing testing methods with the main objective of reducing the total number of tests. However, pool testing can also be used to improve the accuracy of the testing process. The objective of this paper is to improve the accuracy of pool testing using the same number of tests as that of individual testing taking into consideration the probability of testing errors and pool multiplicity classification thresholds. Statistical models are developed to evaluate the impact of pool multiplicity classiffcation thresholds on pool testing accuracy using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The findings indicate that under certain conditions, pool testing multiplicity yields superior testing accuracy compared to individual testing without additional cost. The results reveal that selecting the multiplicity classification threshold is a critical factor in improving the pool testing accuracy and show that the lower the prevalence level the higher the gains in accuracy using multiplicity pool testing. The findings also indicate that performance can be improved using a batch size that is inversely proportional to the prevalence level. Furthermore, the results indicate that multiplicity pool testing not only improves the testing accuracy but also reduces the total cost of the testing process. Based on the findings, the manufacturer's test sensitivity has more significant impact on the accuracy of multiplicity pool testing compared to that of manufacturer's test specificity.
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Affiliation(s)
- Omar De La Cruz Cabrera
- Department of Mathematical Sciences, Kent State University, Kent, OH, United States of America
| | - Razan Alsehibani
- Department of Mathematical Sciences, Kent State University, Kent, OH, United States of America
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16
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Vicchietti ML, Ramos FM, Betting LE, Campanharo ASLO. Computational methods of EEG signals analysis for Alzheimer's disease classification. Sci Rep 2023; 13:8184. [PMID: 37210397 DOI: 10.1038/s41598-023-32664-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/30/2023] [Indexed: 05/22/2023] Open
Abstract
Computational analysis of electroencephalographic (EEG) signals have shown promising results in detecting brain disorders, such as Alzheimer's disease (AD). AD is a progressive neurological illness that causes neuron cells degeneration, resulting in cognitive impairment. While there is no cure for AD, early diagnosis is critical to improving the quality of life of affected individuals. Here, we apply six computational time-series analysis methods (wavelet coherence, fractal dimension, quadratic entropy, wavelet energy, quantile graphs and visibility graphs) to EEG records from 160 AD patients and 24 healthy controls. Results from raw and wavelet-filtered (alpha, beta, theta and delta bands) EEG signals show that some of the time-series analysis methods tested here, such as wavelet coherence and quantile graphs, can robustly discriminate between AD patients from elderly healthy subjects. They represent a promising non-invasive and low-cost approach to the AD detection in elderly patients.
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Affiliation(s)
- Mário L Vicchietti
- Department of Biodiversity and Biostatistics, Institute of Biosciences, São Paulo State University, Botucatu, 18618-689, Brazil
| | - Fernando M Ramos
- National Institute for Space Research, Earth System Science Center, São José dos Campos, 12227-010, Brazil
| | - Luiz E Betting
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University, Botucatu, 18618-687, Brazil
| | - Andriana S L O Campanharo
- Department of Biodiversity and Biostatistics, Institute of Biosciences, São Paulo State University, Botucatu, 18618-689, Brazil.
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17
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Silvestri V, Raspanti D, Guerrisi MG, Falco MD. Clinical implementation of a log file-based machine and patient QA system for IMRT and VMAT treatment plans. Phys Med 2023; 108:102570. [PMID: 36989974 DOI: 10.1016/j.ejmp.2023.102570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 03/04/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE To determine the error detection sensitivity of a commercial log file-based system (LINACWatch®, LW) for integration into clinical routine and to compare it with a measurement device (OCTAVIUS 4D, Oct4D) for IMRT and VMAT delivery QA. MATERIALS AND METHODS 76 VMAT/IMRT plans (H&N, prostate, rectum and breast) preliminarily classified according to their Modulation Complexity Score (MCS) calculated by LW, were considered. Receiver Operating Characteristic (ROC) Curves were used to establish gamma criteria for LW. 12 plans (3 for each site) were intentionally modified in order to introduce delivery errors regarding MLC, jaws, collimator, gantry and MU (for a total set of 168 incorrect plans) and irradiated on Oct4D; the corresponding log files were analysed by LW. Each incorrect plan was compared to the error-free plan using γ-index analysis for MLC, jaws and MU errors investigation and Root-Mean-Square (RMS) values for gantry and collimator errors investigation. RESULTS MCS ranges values were: 0.10-0.20 for H&N, 0.21-0.40 for prostate and rectum, 0.41-1.00 for breast. From ROC curves, the Gamma Passing Rate (GPR) thresholds were: 87%, 92%, 99% for H&N, prostate and rectum, and breast, respectively. The 1.5%/1.5 mm/local criteria were adopted for the γ-analysis. LW sensitivity in detecting the introduced errors was higher when compared to Oct4D: 48.5% vs 30.4% respectively. CONCLUSIONS LW can be considered useful complement to phantom-based delivery QA of IMRT/VMAT plans. The MCS tool is effective in detecting over or under modulated plans prior to pre-treatment QA. However, rigorous and routinely machine QCs are recommended.
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18
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Verweij LPE, van Iersel TP, van Deurzen DFP, van den Bekerom MPJ, Floor S. "Nearly off-track lesions" or a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track does not seem to be accurate in predicting recurrence after an arthroscopic Bankart repair in a military population: a case-control study. J Shoulder Elbow Surg 2023; 32:e145-e152. [PMID: 36368476 DOI: 10.1016/j.jse.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND On-track lesions with a short distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track (nearly off-track) may predispose recurrence after arthroscopic Bankart repair (ABR) in the general population. The aim of this study was to determine if a shorter distance between the medial edge of the Hill-Sachs lesion and the medial edge of the glenoid track could accurately predict recurrence after an ABR in a high-demand military population. It was hypothesized that a shorter distance would not accurately predict recurrence. MATERIALS AND METHODS A retrospective monocenter case-control study was performed at the Dutch Central Military Hospital. Patients with an on-track Hill-Sachs lesion who underwent a primary ABR between 2014 and 2019 with a minimal follow-up of 2 years and a preoperative magnetic resonance imaging (MRI) assessment received a questionnaire. The primary outcome was recurrence, defined as a complete dislocation or subluxation. Glenoid bone loss was assessed using a linear-based method on MRI. The distance from the medial edge of the Hill-Sachs lesion to the medial edge of the glenoid track was defined as the distance to dislocation (DTD). A receiver operating characteristic curve was created to determine the predictive value of the DTD for recurrence. Logistic regression was used to determine preoperative risk factors that predispose recurrence. Covariates were selected based on univariable analysis and included gender, body mass index, age at surgery and first dislocation, laterality, smoking habits, overhead shoulder activity during work, preoperative dislocations, sports type and level, bony or labral lesions on MRI, and DTD. RESULTS In total, 80 patients with an average follow-up of 4.8 ± 1.9 years completed the questionnaire and were included in the analyses. Seventeen patients (21%) experienced recurrence at the final follow-up. No difference in DTD was observed among patients who experienced recurrence (9 ± 4 mm) compared with patients who did not (9 ± 5 mm; P = .81). The receiver operating characteristic curve demonstrated no predictive power of DTD for recurrence (area under the curve = 0.49). Smoking at the time of surgery (odds ratio: 3.9; confidence interval: 1.2-12.7; P = .02) and overhead shoulder movement during work (odds ratio: 9.3; confidence interval: 1.1-78.0; P = .04) were associated with recurrence according to the logistic regression analysis. CONCLUSION A shorter DTD demonstrated no accuracy in predicting recurrence in a military population. Smoking at the time of surgery and overhead shoulder activity during work were associated with recurrence; however, these analyses were underpowered to draw valid conclusions.
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Affiliation(s)
- Lukas P E Verweij
- Amsterdam UMC, Location AMC, Department of Orthopedic Surgery and Sports Medicine, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Musculoskeletal Health Program, Amsterdam, the Netherlands; Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands.
| | - Theodore P van Iersel
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Derek F P van Deurzen
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands
| | - Michel P J van den Bekerom
- Amsterdam Shoulder and Elbow Centre of Expertise (ASECE), Amsterdam, the Netherlands; Shoulder and Elbow Unit, Department of Orthopedic Surgery, OLVG, Amsterdam, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Sebastiaan Floor
- Department of Orthopedic Surgery, Central Military Hospital, Utrecht, the Netherlands
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Ilardi CR, di Maio G, Villano I, Messina G, Monda V, Messina A, Porro C, Panaro MA, Gamboz N, Iavarone A, La Marra M. The assessment of executive functions to test the integrity of the nigrostriatal network: A pilot study. Front Psychol 2023; 14:1121251. [PMID: 37063521 PMCID: PMC10090354 DOI: 10.3389/fpsyg.2023.1121251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundParkinson’s disease (PD) is a chronic neurodegenerative disorder characterized by motor and non-motor symptoms. The latter mainly include affective, sleep, and cognitive deficits. Non-demented PD patients often demonstrate impairments in several executive domains following neuropsychological evaluation. The current pilot study aims at assessing the discriminatory power of the Frontal Assessment Battery-15 (FAB15) in differentiating (i) non-demented PD patients and healthy controls and (ii) PD patients with more and less pronounced motor symptoms.MethodsThirty-nine non-demented early-stage PD patients in the “on” dopamine state (26 females, mean age = 64.51 years, SD = 6.47, mean disease duration = 5.49 years, SD = 2.28) and 39 healthy participants (24 females, mean age = 62.60 years, SD = 5.51) were included in the study. All participants completed the FAB15. Motor symptoms of PD patients were quantified via the Unified Parkinson’s Disease Rating Scale-Part III (UPDRS-Part III) and Hoehn and Yahr staging scale (H&Y).ResultsThe FAB15 score, adjusted according to normative data for sex, age, and education, proved to be sufficiently able to discriminate PD patients from healthy controls (AUC = 0.69 [95% CI 0.60–0.75], SE = 0.06, p = 0.04, optimal cutoff = 11.29). Conversely, the battery lacked sufficient discriminative capability to differentiate PD patients based on the severity of motor symptoms.ConclusionThe FAB15 may be a valid tool for distinguishing PD patients from healthy controls. However, it might be less sensitive in identifying clinical phenotypes characterized by visuospatial impairments resulting from posteroparietal and/or temporal dysfunctions. In line with previous evidence, the battery demonstrated to be not expendable in the clinical practice for monitoring the severity of PD-related motor symptoms.
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Affiliation(s)
| | - Girolamo di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- *Correspondence: Ines Villano,
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Chiara Porro
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria Antonietta Panaro
- Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari, Bari, Italy
| | - Nadia Gamboz
- Laboratory of Experimental Psychology, Suor Orsola Benincasa University, Naples, Italy
| | | | - Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Yang L, Dempsey M, Brennan A, Whelan B, Erjiang E, Wang T, Egan R, Gorham K, Heaney F, Armstrong C, Ibarrola GM, Gsel A, Yu M, Carey JJ. Ireland DXA-FRAX may differ significantly and substantially to Web-FRAX. Arch Osteoporos 2023; 18:43. [PMID: 36939937 PMCID: PMC10027809 DOI: 10.1007/s11657-023-01232-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
Appropriate use of FRAX reduces the number of people requiring DXA scans, while contemporaneously determining those most at risk. We compared the results of FRAX with and without inclusion of BMD. It suggests clinicians to carefully consider the importance of BMD inclusion in fracture risk estimation or interpretation in individual patients. PURPOSE FRAX is a widely accepted tool to estimate the 10-year risk of hip and major osteoporotic fracture in adults. Prior calibration studies suggest this works similarly with or without the inclusion of bone mineral density (BMD). The purpose of the study is to compare within-subject differences between FRAX estimations derived using DXA and Web software with and without the inclusion of BMD. METHOD A convenience cohort was used for this cross-sectional study, consisting of 1254 men and women aged between 40 and 90 years who had a DXA scan and complete validated data available for analysis. FRAX 10-year estimations for hip and major osteoporotic fracture were calculated using DXA software (DXA-FRAX) and the Web tool (Web-FRAX), with and without BMD. Agreements between estimates within each individual subject were examined using Bland-Altman plots. We performed exploratory analyses of the characteristics of those with very discordant results. RESULTS Overall median DXA-FRAX and Web-FRAX 10-year hip and major osteoporotic fracture risk estimations which include BMD are very similar: 2.9% vs. 2.8% and 11.0% vs. 11% respectively. However, both are significantly lower than those obtained without BMD: 4.9% and 14% respectively, P < 0.001. Within-subject differences between hip fracture estimates with and without BMD were < 3% in 57% of cases, between 3 and 6% in 19% of cases, and > 6% in 24% of cases, while for major osteoporotic fractures such differences are < 10% in 82% of cases, between 10 and 20% in 15% of cases, and > 20% in 3% of cases. CONCLUSIONS Although there is excellent agreement between the Web-FRAX and DXA-FRAX tools when BMD is incorporated, sometimes there are very large differences for individuals between results obtained with and without BMD. Clinicians should carefully consider the importance of BMD inclusion in FRAX estimations when assessing individual patients.
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Affiliation(s)
- Lan Yang
- Insight SFI Research Centre for Data Analytics, Data Science Institute, University of Galway, IDA Business Park, Lower Dangan, Galway, H91 AEX4, Ireland.
| | - Mary Dempsey
- School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, College of Science and Engineering, University of Galway, Galway, Ireland
| | - Bryan Whelan
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - E Erjiang
- School of Management, Guangxi Minzu University, Nanning, China
| | - Tingyan Wang
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rebecca Egan
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Kelly Gorham
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Fiona Heaney
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | | | | | - Amina Gsel
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - John J Carey
- School of Medicine, College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Department of Rheumatology, Galway University Hospitals, Galway, Ireland
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Delfino JG, Pennello GA, Barnhart HX, Buckler AJ, Wang X, Huang EP, Raunig DL, Guimaraes AR, Hall TJ, deSouza NM, Obuchowski N. Multiparametric Quantitative Imaging Biomarkers for Phenotype Classification: A Framework for Development and Validation. Acad Radiol 2023; 30:183-195. [PMID: 36202670 PMCID: PMC9825632 DOI: 10.1016/j.acra.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 01/11/2023]
Abstract
This manuscript is the third in a five-part series related to statistical assessment methodology for technical performance of multi-parametric quantitative imaging biomarkers (mp-QIBs). We outline approaches and statistical methodologies for developing and evaluating a phenotype classification model from a set of multiparametric QIBs. We then describe validation studies of the classifier for precision, diagnostic accuracy, and interchangeability with a comparator classifier. We follow with an end-to-end real-world example of development and validation of a classifier for atherosclerotic plaque phenotypes. We consider diagnostic accuracy and interchangeability to be clinically meaningful claims for a phenotype classification model informed by mp-QIB inputs, aiming to provide tools to demonstrate agreement between imaging-derived characteristics and clinically established phenotypes. Understanding that we are working in an evolving field, we close our manuscript with an acknowledgement of existing challenges and a discussion of where additional work is needed. In particular, we discuss the challenges involved with technical performance and analytical validation of mp-QIBs. We intend for this manuscript to further advance the robust and promising science of multiparametric biomarker development.
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Affiliation(s)
- Jana G Delfino
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD.
| | - Gene A Pennello
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD
| | - Huiman X Barnhart
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | | | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Erich P Huang
- Biometric Research Program, Division of Cancer Treatment and Diagnosis - National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Dave L Raunig
- Data Science Institute, Statistical and Quantitative Sciences, Takeda Pharmaceuticals America Inc, Lexington, MA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health & Sciences University, Portland, OR
| | - Timothy J Hall
- Department of Medical Physics, University of Wisconsin, Madison, WI
| | - Nandita M deSouza
- Division of Radiotherapy and Imaging, the Insitute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom; European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology (ESR), Vienna, Austria
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences, Lerner Research Institute Cleveland Clinic, Cleveland, OH
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22
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Alonso CCG, de Freitas PB, Pires RS, De Oliveira DL, Freitas SMSF. Exploring the ability of strength and dexterity tests to detect hand function impairment in individuals with Parkinson's disease. Physiother Theory Pract 2023; 39:395-404. [PMID: 34895020 DOI: 10.1080/09593985.2021.2013371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Parkinson's disease (PD) can affect hand function since the beginning of the motor symptoms. OBJECTIVE To compare the ability of different hand function tests to: 1) distinguish individuals with PD from healthy controls; 2) differentiate stages of the disease; and 3) indicate changes over time due to disease progression. METHODS Twenty-four individuals with PD (Hoehn and Yahr: I-III) and 24 age- and sex-matched controls performed the Jebsen-Taylor Hand Function Test (JTHFT), the Nine-Hole Peg Test (9HPT), and the maximum grip and the maximum pinch strength tests using their right and left hands. Eight individuals with PD (six females and two males) were reassessed after 18 months. The ROC analyses and Mann-Whitney U tests (for disease progression) using the average performance of the hands were done. RESULTS Individuals with PD presented worse test performances than controls, except for the writing subtest of the JTHFT and the grip strength test. The JTHFT without the writing subtest (JTHFTnoW) was the most accurate to discriminate PD from controls (AUC = 0.899; sensitivity 75% and specificity 95.8%). The 9HPT and the simulated feeding and moving large, light objects JTHFT subtests were sensitive to distinguish stages, while the 9HPT, the moving small, common objects JTHFT subtest, and the grip strength were sensitive to changes with disease progression. CONCLUSION The JTHFTnoW was highly discriminative of the hand function impairments in PD. TwoJTHFT subtests were the most sensitives to distinguish PD stages (i.e. simulated feeding JTHFT subtest) and disease progression (i.e. moving small, common objects JTHFT subtest).
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Affiliation(s)
- Cintia C G Alonso
- Graduate Program Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
| | - Paulo B de Freitas
- Interdisciplinary Graduate Program in Health Sciences, Universidade Cruzeiro Do Sul, São Paulo, Brazil
| | - Raquel S Pires
- Graduate Program Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil
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Dercle L, Fronheiser M, Rizvi NA, Hellmann MD, Maier S, Hayes W, Yang H, Guo P, Fojo T, Schwartz LH, Zhao B, Leung DK. Baseline Radiomic Signature to Estimate Overall Survival in Patients With NSCLC. J Thorac Oncol 2023; 18:587-598. [PMID: 36646209 DOI: 10.1016/j.jtho.2022.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION We aimed to define a baseline radiomic signature associated with overall survival (OS) using baseline computed tomography (CT) images obtained from patients with NSCLC treated with nivolumab or chemotherapy. METHODS The radiomic signature was developed in patients with NSCLC treated with nivolumab in CheckMate-017, -026, and -063. Nivolumab-treated patients were pooled and randomized to training, calibration, or validation sets using a 2:1:1 ratio. From baseline CT images, volume of tumor lesions was semiautomatically segmented, and 38 radiomic variables depicting tumor phenotype were extracted. Association between the radiomic signature and OS was assessed in the nivolumab-treated (validation set) and chemotherapy-treated (test set) patients in these studies. RESULTS A baseline radiomic signature was identified using CT images obtained from 758 patients. The radiomic signature used a combination of imaging variables (spatial correlation, tumor volume in the liver, and tumor volume in the mediastinal lymph nodes) to output a continuous value, ranging from 0 to 1 (from most to least favorable estimated OS). Given a threshold of 0.55, the sensitivity and specificity of the radiomic signature for predicting 3-month OS were 86% and 77.8%, respectively. The signature was identified in the training set of patients treated with nivolumab and was significantly associated (p < 0.0001) with OS in patients treated with nivolumab or chemotherapy. CONCLUSIONS The radiomic signature provides an early readout of the anticipated OS in patients with NSCLC treated with nivolumab or chemotherapy. This could provide important prognostic information and may support risk stratification in clinical trials.
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Affiliation(s)
- Laurent Dercle
- Department of Radiology, Columbia University Medical Center, New York, New York.
| | | | - Naiyer A Rizvi
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Matthew D Hellmann
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | - Hao Yang
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Pingzhen Guo
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Tito Fojo
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Lawrence H Schwartz
- Department of Radiology, Columbia University Medical Center, New York, New York
| | - Binsheng Zhao
- Department of Radiology, Columbia University Medical Center, New York, New York
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Sackeim HA, Rush AJ, Greco T, Jiang M, Badejo S, Bunker MT, Aaronson ST, Conway CR, Demyttenaere K, Young AH, McAllister-Williams RH. Alternative metrics for characterizing longer-term clinical outcomes in difficult-to-treat depression: I. Association with change in quality of life. Psychol Med 2023; 53:1-13. [PMID: 36601813 PMCID: PMC10600942 DOI: 10.1017/s0033291722003798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/24/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND In difficult-to-treat depression (DTD) the outcome metrics historically used to evaluate treatment effectiveness may be suboptimal. Metrics based on remission status and on single end-point (SEP) assessment may be problematic given infrequent symptom remission, temporal instability, and poor durability of benefit in DTD. METHODS Self-report and clinician assessment of depression symptom severity were regularly obtained over a 2-year period in a chronic and highly treatment-resistant registry sample (N = 406) receiving treatment as usual, with or without vagus nerve stimulation. Twenty alternative metrics for characterizing symptomatic improvement were evaluated, contrasting SEP metrics with integrative (INT) metrics that aggregated information over time. Metrics were compared in effect size and discriminating power when contrasting groups that did (N = 153) and did not (N = 253) achieve a threshold level of improvement in end-point quality-of-life (QoL) scores, and in their association with continuous QoL scores. RESULTS Metrics based on remission status had smaller effect size and poorer discrimination of the binary QoL outcome and weaker associations with the continuous end-point QoL scores than metrics based on partial response or response. The metrics with the strongest performance characteristics were the SEP measure of percentage change in symptom severity and the INT metric quantifying the proportion of the observation period in partial response or better. Both metrics contributed independent variance when predicting end-point QoL scores. CONCLUSIONS Revision is needed in the metrics used to quantify symptomatic change in DTD with consideration of INT time-based measures as primary or secondary outcomes. Metrics based on remission status may not be useful.
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Affiliation(s)
- Harold A. Sackeim
- Departments of Psychiatry and Radiology, Columbia University, New York, NY, USA
| | - A. John Rush
- Duke-NUS Medical School, Singapore
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Teresa Greco
- LivaNova PLC, Milan, Italy
- Jazz Pharmaceuticals PLC, Milan, Italy
| | - Mei Jiang
- LivaNova USA PLC, Minneapolis, MN, USA
| | | | | | - Scott T. Aaronson
- Department of Clinical Research, Sheppard Pratt Health System, Baltimore, MD, USA
| | - Charles R. Conway
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, USA
| | - Koen Demyttenaere
- Faculty of Medicine KU Leuven, University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - R. Hamish McAllister-Williams
- Northern Centre for Mood Disorders, Translational and Clinical Research Institute, Newcastle University, UK, and Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
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Ilardi CR, Menichelli A, Michelutti M, Cattaruzza T, Manganotti P. Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia. Neurol Sci 2023; 44:159-170. [PMID: 36169756 PMCID: PMC9816212 DOI: 10.1007/s10072-022-06422-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/20/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE In this phase II psychometric study on the Montreal cognitive assessment (MoCA), we tested the clinicometric properties of Italian norms for patients with mild cognitive impairment (PwMCI) and early dementia (PwD) and provided optimal cutoffs for diagnostic purposes. METHODS Retrospective data collection was performed for consecutive patients with clinically and biologically defined MCI and early dementia. Forty-five patients (24 PwMCI and 21 PwD) and 25 healthy controls were included. Raw MoCA scores were adjusted according to the conventional 1-point correction (Nasreddine) and Italian norms (Conti, Santangelo, Aiello). The diagnostic properties of the original cutoff (< 26) and normative cutoffs, namely, the upper limits (uLs) of equivalent scores (ES) 1, 2, and 3, were evaluated. ROC curve analysis was performed to obtain optimal cutoffs. RESULTS The original cutoff demonstrated high sensitivity (0.93 [95% CI 0.84-0.98]) but low specificity (0.44 [0.32-0.56]) in discriminating between patients and controls. Nominal normative cutoffs (ES0 uLs) showed excellent specificity (SP range = 0.96-1.00 [0.88-1.00]) but poor sensitivity (SE range = 0.09-0.24 [0.04-0.36]). The optimal cutoff for Nasreddine's method was 23.50 (SE = 0.82 [0.71-0.90]; SP = 0.72 [0.60-0.82]). Optimal cutoffs were 20.97, 22.85, and 22.29 (SE range = 0.69-0.73 [0.57-0.83], SP range = 0.88-0.92 [0.77-0.97]) for Conti's, Santangelo's, and Aiello's methods, respectively. CONCLUSION Using the 1-point correction, combined with a cutoff of 23.50, might be useful in ambulatory settings with a large turnout. Our optimal cutoffs can offset the poor sensitivity of Italian cutoffs.
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Affiliation(s)
- Ciro Rosario Ilardi
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy.
| | - Alina Menichelli
- Neuropsychology Service, Rehabilitation Unit, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Marco Michelutti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Tatiana Cattaruzza
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Trieste, Italy
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Meng J, Luo Z, Chen Z, Zhou J, Chen Z, Lu B, Zhang M, Wang Y, Yuan C, Shen X, Huang Q, Zhang Z, Ye Z, Cao Q, Zhou Z, Xu Y, Mao R, Chen M, Sun C, Li Z, Feng ST, Meng X, Huang B, Li X. Intestinal fibrosis classification in patients with Crohn's disease using CT enterography-based deep learning: comparisons with radiomics and radiologists. Eur Radiol 2022; 32:8692-8705. [PMID: 35616733 DOI: 10.1007/s00330-022-08842-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/13/2022] [Accepted: 04/25/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Accurate evaluation of bowel fibrosis in patients with Crohn's disease (CD) remains challenging. Computed tomography enterography (CTE)-based radiomics enables the assessment of bowel fibrosis; however, it has some deficiencies. We aimed to develop and validate a CTE-based deep learning model (DLM) for characterizing bowel fibrosis more efficiently. METHODS We enrolled 312 bowel segments of 235 CD patients (median age, 33 years old) from three hospitals in this retrospective study. A training cohort and test cohort 1 were recruited from center 1, while test cohort 2 from centers 2 and 3. All patients performed CTE within 3 months before surgery. The histological fibrosis was semi-quantitatively assessed. A DLM was constructed in the training cohort based on a 3D deep convolutional neural network with 10-fold cross-validation, and external independent validation was conducted on the test cohorts. The radiomics model (RM) was developed with 4 selected radiomics features extracted from CTE images by using logistic regression. The evaluation of CTE images was performed by two radiologists. DeLong's test and a non-inferiority test were used to compare the models' performance. RESULTS DLM distinguished none-mild from moderate-severe bowel fibrosis with an area under the receiver operator characteristic curve (AUC) of 0.828 in the training cohort and 0.811, 0.808, and 0.839 in the total test cohort, test cohorts 1 and 2, respectively. In the total test cohort, DLM achieved better performance than two radiologists (*1 AUC = 0.579, *2 AUC = 0.646; both p < 0.05) and was not inferior to RM (AUC = 0.813, p < 0.05). The total processing time for DLM was much shorter than that of RM (p < 0.001). CONCLUSION DLM is better than radiologists in diagnosing intestinal fibrosis on CTE in patients with CD and not inferior to RM; furthermore, it is more time-saving compared to RM. KEY POINTS • Question Could computed tomography enterography (CTE)-based deep learning model (DLM) accurately distinguish intestinal fibrosis severity in patients with Crohn's disease (CD)? • Findings In this cross-sectional study that included 235 patients with CD, DLM achieved better performance than that of two radiologists' interpretation and was not inferior to RM with significant differences and much shorter processing time. • Meaning This DLM may accurately distinguish the degree of intestinal fibrosis in patients with CD and guide gastroenterologists to formulate individualized treatment strategies for those with bowel strictures.
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Affiliation(s)
- Jixin Meng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Zixin Luo
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Block A2, Lihu Campus of Shenzhen University, 1066 Xueyuan Avenue, Shenzhen, 518000, People's Republic of China
| | - Zhihui Chen
- Department of Gastrointestinal and Pancreatic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, People's Republic of China
| | - Jie Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Yuancun Er Heng Road, NO.26, Guangzhou, 510655, People's Republic of China
| | - Zhao Chen
- Department of Medical Imaging Center, Nan Fang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Baolan Lu
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Mengchen Zhang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Yangdi Wang
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Chenglang Yuan
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Block A2, Lihu Campus of Shenzhen University, 1066 Xueyuan Avenue, Shenzhen, 518000, People's Republic of China
| | - Xiaodi Shen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Qinqin Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Block A2, Lihu Campus of Shenzhen University, 1066 Xueyuan Avenue, Shenzhen, 518000, People's Republic of China
| | - Zhuya Zhang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Block A2, Lihu Campus of Shenzhen University, 1066 Xueyuan Avenue, Shenzhen, 518000, People's Republic of China
| | - Ziyin Ye
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Qinghua Cao
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Zhiyang Zhou
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Yuancun Er Heng Road, NO.26, Guangzhou, 510655, People's Republic of China
| | - Yikai Xu
- Department of Medical Imaging Center, Nan Fang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, People's Republic of China
| | - Ren Mao
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
- Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Minhu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Canhui Sun
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Ziping Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China
| | - Xiaochun Meng
- Department of Radiology, The Sixth Affiliated Hospital, Sun Yat-sen University, Yuancun Er Heng Road, NO.26, Guangzhou, 510655, People's Republic of China
| | - Bingsheng Huang
- Medical AI Lab, School of Biomedical Engineering, Health Science Center, Shenzhen University, Block A2, Lihu Campus of Shenzhen University, 1066 Xueyuan Avenue, Shenzhen, 518000, People's Republic of China.
| | - Xuehua Li
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan II Road, Guangzhou, 510080, People's Republic of China.
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Chen P, Gao G, Xu Y, Jia P, Li Y, Li Y, Cao J, Du J, Zhang S, Zhang J. Novel gene signature reveals prognostic model in acute lymphoblastic leukemia. Front Cell Dev Biol 2022; 10:1036312. [PMID: 36407095 PMCID: PMC9669305 DOI: 10.3389/fcell.2022.1036312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Acute lymphoblastic leukemia (ALL) is a type of hematological malignancy and has a poor prognosis. In our study, we aimed to construct a prognostic model of ALL by identifying important genes closely related to ALL prognosis. We obtained transcriptome data (RNA-seq) of ALL samples from the GDC TARGET database and identified differentially expressed genes (DEGs) using the “DESeq” package of R software. We used univariate and multivariate cox regression analyses to screen out the prognostic genes of ALL. In our results, the risk score can be used as an independent prognostic factor to predict the prognosis of ALL patients [hazard ratio (HR) = 2.782, 95% CI = 1.903–4.068, p < 0.001]. Risk score in clinical parameters has high diagnostic sensitivity and specificity for predicting overall survival of ALL patients, and the area under curve (AUC) is 0.864 in the receiver operating characteristic (ROC) analysis results. Our study evaluated a potential prognostic signature with six genes and constructed a risk model significantly related to the prognosis of ALL patients. The results of this study can help clinicians to adjust the treatment plan and distinguish patients with good and poor prognosis for targeted treatment.
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Tainta M, Iriondo A, Ecay-Torres M, Estanga A, de Arriba M, Barandiaran M, Clerigue M, Garcia-Sebastian M, Villanua J, Izagirre A, Saldias J, Aramburu A, Taboada J, Múgica J, Barandiaran A, Arrospide A, Mar J, Martinez-Lage P. Brief cognitive tests as a decision-making tool in primary care. A population and validation study. Neurologia 2022:S2173-5808(22)00082-7. [PMID: 35963538 DOI: 10.1016/j.nrleng.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/24/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program. MATERIAL AND METHODS In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample. RESULTS 260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26. CONCLUSION BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.
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Affiliation(s)
- M Tainta
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain; Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain.
| | - A Iriondo
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Ecay-Torres
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Estanga
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M de Arriba
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Barandiaran
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain; Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - M Clerigue
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | | | - J Villanua
- Osatek SA, Hospital Donostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Izagirre
- Universidad del País Vasco (UPV-EHU), Facultad de Medicina y Enfermería, Donostia-San Sebastián, Guipúzcoa, Spain
| | - J Saldias
- CITA Alzheimer, Donostia-San Sebastián, Guipúzcoa, Spain
| | - A Aramburu
- Osakidetza, Organización Sanitaria Integrada (OSI) Debabarrena, Spain
| | - J Taboada
- Osakidetza, Organización Sanitaria Integrada (OSI) Bilbao Basurto, Spain
| | - J Múgica
- Osakidetza, Organización Sanitaria Integrada (OSI) Donostialdea, Spain
| | - A Barandiaran
- Osakidetza, Organización Sanitaria Integrada (OSI) Goierri-Urola Garaia, Spain
| | - A Arrospide
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain
| | - J Mar
- Osakidetza, Organización Sanitaria Integrada (OSI) Debagoiena, Spain; Instituto de Investigación Sanitaria Biodonostia, Donostia-San Sebastián, Guipúzcoa, Spain; Instituto de Investigación en Servicios Sanitarios Kronikgune, Barakaldo, Vizcaya, Spain
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Aiello EN, D’Iorio A, Montemurro S, Maggi G, Giacobbe C, Bari V, Di Tella GS, Pischedda F, Bolognini N, Appollonio I, Arcara G, Santangelo G. Psychometrics, diagnostics and usability of Italian tools assessing behavioural and functional outcomes in neurological, geriatric and psychiatric disorders: a systematic review. Neurol Sci 2022; 43:6189-6214. [PMID: 35932375 PMCID: PMC9616758 DOI: 10.1007/s10072-022-06300-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/18/2022] [Indexed: 11/05/2022]
Abstract
Background Psychometric instruments assessing behavioural and functional outcomes (BFIs) in neurological, geriatric and psychiatric populations are relevant towards diagnostics, prognosis and intervention. However, BFIs often happen not to meet methodological-statistical standards, thus lowering their level of recommendation in clinical practice and research. This work thus aimed at (1) providing an up-to-date compendium on psychometrics, diagnostics and usability of available Italian BFIs and (2) delivering evidence-based information on their level of recommendation. Methods This review was pre-registered (PROSPERO ID: CRD42021295430) and performed according to PRISMA guidelines. Several psychometric, diagnostic and usability measures were addressed as outcomes. Quality assessment was performed via an ad hoc checklist, the Behavioural and Functional Instrument Quality Assessment. Results Out of an initial N = 830 reports, 108 studies were included (N = 102 BFIs). Target constructs included behavioural/psychiatric symptoms, quality of life and physical functioning. BFIs were either self- or caregiver-/clinician-report. Studies in clinical conditions (including neurological, psychiatric and geriatric ones) were the most represented. Validity was investigated for 85 and reliability for 80 BFIs, respectively. Criterion and factorial validity testing were infrequent, whereas content and ecological validity and parallel forms were almost never addressed. Item response theory analyses were seldom carried out. Diagnostics and norms lacked for about one-third of BFIs. Information on administration time, ease of use and ceiling/floor effects were often unreported. Discussion Several available BFIs for the Italian population do not meet adequate statistical-methodological standards, this prompting a greater care from researchers involved in their development. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-022-06300-8.
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Aiello EN, Preti AN, Pucci V, Diana L, Corvaglia A, Barattieri di San Pietro C, Difonzo T, Zago S, Appollonio I, Mondini S, Bolognini N. The Italian telephone-based Verbal Fluency Battery (t-VFB): standardization and preliminary clinical usability evidence. Front Psychol 2022; 13:963164. [PMID: 35992426 PMCID: PMC9384842 DOI: 10.3389/fpsyg.2022.963164] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed at standardizing and providing preliminary evidence on the clinical usability of the Italian telephone-based Verbal Fluency Battery (t-VFB), which includes phonemic (t-PVF), semantic (t-SVF) and alternate (t-AVF) verbal fluency tasks. Methods Three-hundred and thirty-five Italian healthy participants (HPs; 140 males; age range = 18-96 years; education range = 4-23 years) and 27 individuals with neurodegenerative or cerebrovascular diseases were administered the t-VFB. Switch number and cluster size were computed via latent semantic analyses. HPs underwent the telephone-based Mental State Examination (MMSE) and Backward Digit Span (BDS). Construct validity, factorial structure, internal consistency, test-retest and inter-rater reliability and equivalence with the in-person Verbal Fluency tasks were assessed. Norms were derived via Equivalent Scores. Diagnostic accuracy against clinical populations was assessed. Results The majority of t-VFB scores correlated among each other and with the BDS, but not with the MMSE. Switch number correlated with t-PVF, t-SVF, t-AVF scores, whilst cluster size with the t-SVF and t-AVF scores only. The t-VFB was underpinned by a mono-component structure and was internally consistent (Cronbach's α = 0.91). Test-retest (ICC = 0.69-0.95) and inter-rater reliability (ICC = 0.98-1) were optimal. Each t-VFB test was statistically equivalent to its in-person version (equivalence bounds yielding a p < 0.05). Education predicted all t-VFB scores, whereas age t-SVF and t-AVF scores and sex only some t-SVF scores. Diagnostic accuracy against clinical samples was optimal (AUC = 0.81-0.86). Discussion The t-VFB is a valid, reliable and normed telephone-based assessment tool for language and executive functioning, equivalent to the in-person version; results show promising evidence of its diagnostic accuracy in neurological populations.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Alice Naomi Preti
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Veronica Pucci
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padua, Italy
- Human Inspired Technology Research Centre, University of Padova, Padua, Italy
| | - Lorenzo Diana
- Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Alessia Corvaglia
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Milan, Italy
| | - Chiara Barattieri di San Pietro
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Teresa Difonzo
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Stefano Zago
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Mondini
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padua, Italy
- Human Inspired Technology Research Centre, University of Padova, Padua, Italy
| | - Nadia Bolognini
- Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
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Tainta M, Iriondo A, Ecay-Torres M, Estanga A, de Arriba M, Barandiaran M, Clerigue M, Garcia-Sebastian M, Villanua J, Izagirre A, Saldias J, Aramburu A, Taboada J, Múgica J, Barandiaran A, Arrospide A, Mar J, Martinez-Lage P. Test cognitivos breves como herramienta de decisión en Atención Primaria. Estudio poblacional y de validación. Neurologia 2022. [DOI: 10.1016/j.nrl.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Currie BM, McLaughlin SW, Jones L, Neff P, Shlansky-Goldberg R. Periprocedural imaging compared to endometrial biopsy: is biopsy required prior to uterine artery embolisation? Clin Radiol 2022; 77:694-700. [PMID: 35811155 DOI: 10.1016/j.crad.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
AIM To compare the detection rate of magnetic resonance imaging (MRI) and ultrasound relative to endometrial biopsy for endometrial abnormalities in both pre- and post-menopausal women. MATERIALS AND METHODS The present study was an institutional review board-approved, single-institution retrospective analysis of patients who underwent pelvic MRI within 1 year of diagnostic-quality biopsies from 2008-2018 (n=668). There were 303 patients who received uterine artery embolisation (UAE) and 478 patients who received pelvic ultrasound within the study period. Medical records were evaluated for radiological-histopathological correlation, demographics, laboratory studies, and clinical follow-up. RESULTS In this cohort of 668 patients, there were 37 biopsies positive for malignancy; women with malignancy were older (58 versus 47 years, p<0.0001) and more likely to be post-menopausal (66% versus 12%, p<0.0001). There were 303 patients who underwent UAE and underwent a diagnostic-quality endometrial biopsy during the pre-procedural evaluation, none of whom were post-menopausal and had a mean age of 45 years. In women with abnormal uterine bleeding (AUB) or post-menopausal bleeding (PMB), the sensitivity of MRI for detecting endometrial cancer was 96.2%, with a negative predictive value (NPV) of 99.8%, compared to 68% and 97% for ultrasound, respectively. The receiver operating characteristic (ROC) curve of pre-biopsy MRI in identifying pre-malignant and malignant endometrial pathology demonstrated an AUC of 0.8920 (p<0.0001). CONCLUSION In women with AUB or PMB, MRI has a 99.8% NPV in ruling out endometrial cancer. Further consideration should be made towards optimising pre-procedural evaluation for UAE.
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Affiliation(s)
- B M Currie
- Department of Radiology, Weill Cornell Medicine, 525 E 68(th) Street, New York, NY 10065, USA.
| | - S W McLaughlin
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - L Jones
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - P Neff
- Department of Obstetrics and Gynecology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - R Shlansky-Goldberg
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Luong TV, Ebbehoj A, Kjaerulff MLG, Nielsen R, Nielsen PH, Christiansen EH, Tolbod LP, Søndergaard E, Gormsen LC. Clinical use of cardiac 18 F-FDG viability PET: a retrospective study of 44 patients undergoing post-test revascularization. Int J Cardiovasc Imaging 2022; 38:2447-2458. [DOI: 10.1007/s10554-022-02661-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/25/2022] [Indexed: 11/05/2022]
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Morakul S, Prachanpanich N, Permsakmesub P, Pinsem P, Mongkolpun W, Trongtrakul K. Prediction of Fluid Responsiveness by the Effect of the Lung Recruitment Maneuver on the Perfusion Index in Mechanically Ventilated Patients During Surgery. Front Med (Lausanne) 2022; 9:881267. [PMID: 35783653 PMCID: PMC9247540 DOI: 10.3389/fmed.2022.881267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionExcessive or inadequate fluid administration during perioperative period affects outcomes. Adjustment of volume expansion (VE) by performing fluid responsiveness (FR) test plays an important role in optimizing fluid infusion. Since changes in stroke volume (SV) during lung recruitment maneuver (LRM) can predict FR, and peripheral perfusion index (PI) is related to SV; therefore, we hypothesized that the changes in PI during LRM (ΔPILRM) could predict FR during perioperative period.MethodsPatients who were scheduled for elective non-laparoscopic surgery under general anesthesia with a mechanical ventilator and who required VE (250 mL of crystalloid solution infusion over 10 min) were included. Before VE, LRM was performed by a continuous positive airway pressure of 30 cm H2O for 30 sec; hemodynamic variables with their changes (PI, obtained by pulse oximetry; and ΔPILRM, calculated by using [(PI before LRM—PI after LRM)/PI before LRM]*100) were obtained before and after LRM. After SV (measured by esophageal doppler) and PI had returned to the baseline values, VE was infused, and the values of these variables were recorded again, before and after VE. Fluid responders (Fluid-Res) were defined by an increase in SV ≥10% after VE. Receiver operating characteristic curves of the baseline values and ΔPILRM were constructed and reported as areas under the curve (AUC) with 95% confidence intervals, to predict FR.ResultsOf 32 mechanically ventilated adult patients included, 13 (41%) were in the Fluid-Res group. Before VE and LRM, there were no differences in the mean arterial pressure (MAP), heart rate, SV, and PI between patients in the Fluid-Res and fluid non-responders (Fluid-NonRes) groups. After LRM, SV, MAP, and, PI decreased in both groups, ΔPILRM was greater in the Fluid-Res group than in Fluid-NonRes group (55.2 ± 17.8% vs. 35.3 ± 17.3%, p < 0.001, respectively). After VE, only SV and cardiac index increased in the Fluid-Res group. ΔPILRM had the highest AUC [0.81 (0.66–0.97)] to predict FR with a cut-off value of 40% (sensitivity 92.3%, specificity 73.7%).ConclusionsΔPILRM can be applied to predict FR in mechanical ventilated patients during the perioperative period.
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Aiello EN, Pucci V, Diana L, Niang A, Preti AN, Delli Ponti A, Sangalli G, Scarano S, Tesio L, Zago S, Difonzo T, Appollonio I, Mondini S, Bolognini N. Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases. Aging Clin Exp Res 2022; 34:1635-1644. [PMID: 35699839 PMCID: PMC9194888 DOI: 10.1007/s40520-022-02155-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/13/2022] [Indexed: 12/18/2022]
Abstract
Background Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB). Methods The t-FAB (ranging 0–12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18–96 years; education range = 4–23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test–retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores. Results In HPs, t-FAB measures yielded high inter-rater/test–retest reliability (ICC = .78–.94), were internally related (p ≤ .005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤ .0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds < .001). Education predicted all t-FAB scores (p < .001), whereas age only the t-FAB-M score (p ≤ .004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (rs = .43–.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC = .73-.76). Discussion The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02155-3.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Veronica Pucci
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy.,Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Lorenzo Diana
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Aida Niang
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Alice Naomi Preti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Adriana Delli Ponti
- Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Gaia Sangalli
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Luigi Tesio
- Department of Neurorehabilitation Sciences, IRCCS Istituto Auxologico Italiano, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Stefano Zago
- Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Teresa Difonzo
- Neurology Unit, Ospedale Maggiore Policlinico, Fondazione IRCCS Cà Granda, Milan, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Sara Mondini
- Dipartimento di Filosofia, Sociologia, Pedagogia e Psicologia Applicata (FISPPA), University of Padova, Padua, Italy.,Human Inspired Technology Research Centre (HIT), University of Padova, Padua, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Chen YJ, Chen BL, Liang MJ, Chen SL, Li XH, Qiu Y, Pang LL, Xia QQ, He Y, Zeng ZR, Chen MH, Mao R, Xie XY. Longitudinal Bowel Behavior Assessed by Bowel Ultrasound to Predict Early Response to Anti-TNF Therapy in Patients With Crohn's Disease: A Pilot Study. Inflamm Bowel Dis 2022; 28:S67-S75. [PMID: 34984455 DOI: 10.1093/ibd/izab353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Early changes in bowel behavior during anti-tumor necrosis factor (anti-TNF) induction therapy in Crohn's disease (CD) are relatively unknown. We determined (1) the onset of changes in bowel behavior in CD patients receiving anti-TNF therapy by ultrasound and (2) the feasibility of shear wave elastography (SWE) in predicting early response to anti-TNF therapy. METHODS Consecutive ileal or ileocolonic CD patients programmed to initiate anti-TNF therapy were enrolled. Bowel ultrasound was performed at baseline and at weeks 2, 6, and 14. Changes in bowel wall thickness, Doppler signals of the bowel wall (Limberg score), and SWE values were compared using a linear mixed model. Early response to anti-TNF therapy was based on a composite strategy of clinical and colonoscopy assessment at week 14. RESULTS Of the 30 patients enrolled in this study, 20 patients achieved a response to anti-TNF therapy at week 14. The bowel wall thickness and SWE value of the response group showed a significant downward trend compared with the nonresponse group (P = .003 and P = .011, respectively). Bowel wall thickness, the Limberg score, and SWE values were significantly reduced as early as week 2 compared with baseline (P < .001, P < .001, and P = .003, respectively) in the response group. Baseline SWE values (21.3 ± 8.7 kPa vs 15.3 ± 4.7 kPa; P = .022) and bowel wall thickness (8.5 ± 2.3 mm vs 6.9 ± 1.5 mm; P = .027) in the nonresponse group were significantly higher than in the response group. CONCLUSIONS This pilot study suggested that changes in bowel ultrasound behavior could be assessed as early as week 2 after starting anti-TNF therapy. Bowel ultrasound together with elasticity imaging could predict early response to anti-TNF therapy.
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Affiliation(s)
- Yu-Jun Chen
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bai-Li Chen
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mei-Juan Liang
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shu-Ling Chen
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue-Hua Li
- Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lan-Lan Pang
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Qing Xia
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Rong Zeng
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min-Hu Chen
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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The Tibial Tubercle-Trochlear Groove Distance/Trochlear Dysplasia Index Quotient Is the Most Accurate Indicator for Determining Patellofemoral Instability Risk. Arthroscopy 2022; 38:1608-1614. [PMID: 34450216 DOI: 10.1016/j.arthro.2021.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/02/2021] [Accepted: 08/10/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of our study was to evaluate diagnostic accuracy of the tibial tubercle-trochlear groove (TT-TG) distance relative to associated quotients produced from trochlear width (TT-TG distance/TW) and trochlear dysplasia index (TT-TG distance/TDI) for detecting patellofemoral instability. Secondary aims included identifying thresholds for risk and comparing differences between cases and controls. METHODS Consecutive sampling of electronic medical records produced 48 (21 males, 27 females) patellofemoral instability cases (19 ± 7 years old) and 79 (61 males, 18 females) controls (23 ± 4 years old) who had a history of isolated meniscal lesion, as evaluated by magnetic resonance imaging. Standardized methods were employed with measurements executed in a blinded and randomized manner. A receiver operating characteristic curve assessed accuracy by area under the curve (AUC). The index of union (IU) was employed to identify a threshold for risk. Two-sample t-tests examined group differences. P < .05 denoted statistical significance. RESULTS The AUC values were .69 (.60, .79) for TT-TG distance, .81 (.73, .88) for TT-TG distance/TW, and .85 (.78, .91) for TT-TG distance/TDI. Thresholds were 14.7 mm for TT-TG distance, .36 for TT-TG distance/TW, and 1.88 for TT-TG distance/TDI. Cases demonstrated statistically significant (P < .001) greater values for each measure compared with controls: TT-TG distance (15.8 ± 4.2 mm vs 12.9 ± 3.6 mm, [1.4, 4.3]); TT-TG distance/TW (.51 ± .24 vs .31 ± .09, [.13, .27]); TT-TG distance/TDI (3.07 ± 1.55 vs 1.7 ± .7, [.9, 1.84]). CONCLUSION The TT-TG distance, TT-TG distance/TW, and TT-TG distance/TDI measures were 69%, 81%, and 85%, respectively, accurate for determining patellofemoral instability risk. Thresholds for risk were 14.7 mm for TT-TG distance, .36 for TT-TG distance/TW, and 1.88 for TT-TG distance/TDI. The thresholds reported in this study may help in advancing clinical decision-making. LEVEL OF EVIDENCE Level III, diagnostic retrospective comparative observatory trial.
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Jacquet-Lagrèze M, Acker A, Hentzen J, Didier C, De Lamer S, Chardonnal L, Bouhamri N, Portran P, Schweizer R, Lilot M, Fellahi JL. Preload Dependence Fails to Predict Hemodynamic Instability During a Fluid Removal Challenge in Children. Pediatr Crit Care Med 2022; 23:296-305. [PMID: 35190504 DOI: 10.1097/pcc.0000000000002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Fluid overload increases morbidity and mortality in PICU patients. Active fluid removal improves the prognosis but may worsen organ dysfunction. Preload dependence in adults does predict hemodynamic instability induced by a fluid removal challenge (FRC). We sought to investigate the diagnostic accuracy of dynamic and static markers of preload in predicting hemodynamic instability and reduction of stroke volume during an FRC in children. We followed the Standards for Reporting of Diagnostic Accuracy statement to design conduct and report this study. DESIGN Prospective noninterventional cohort study. SETTINGS From June 2017 to April 2019 in a pediatric cardiac ICU in a tertiary hospital. PATIENTS Patients 8 years old or younger, with symptoms of fluid overload after cardiac surgery, were studied. INTERVENTIONS We confirmed preload dependence by echocardiography before and during a calibrated abdominal compression test. We then performed a challenge to remove 10-mL/kg fluid in less than 120 minutes with an infusion of diuretics. Hemodynamic instability was defined as a decrease of 10% of mean arterial pressure. MEASUREMENT AND MAIN RESULTS We compared patients showing hemodynamic instability with patients remaining stable, and we built receiver operative characteristic (ROC) curves. Among 58 patients studied, 10 showed hemodynamic instability. The area under the ROC curve was 0.55 for the preload dependence test (95% CI, 0.34-0.75). Using a threshold of 10% increase in stroke volume index (SVi) during calibrated abdominal compression, the specificity was 0.30 (95% CI, 0.00-0.60) and the sensitivity was 0.77 (95% CI, 0.65-0.88). Mean arterial pressure variation and SVi variation were not correlated during fluid removal; r = 0.19; 95% CI -0.07 to 0.43; p = 0.139. CONCLUSIONS Preload dependence is not accurate to predict hemodynamic instability during an FRC. Our data do not support a reduction in intravascular volume being mainly responsible for the reduction in arterial pressure during an FRC in children.
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Affiliation(s)
- Matthias Jacquet-Lagrèze
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
- Laboratoire de recherche en Cardiovasculaire, Métabolisme, diabétologie et Nutrition (CarMeN), Inserm U1060, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
| | - Amélie Acker
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Julie Hentzen
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Capucine Didier
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Sabine De Lamer
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Laurent Chardonnal
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Noureddine Bouhamri
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Philippe Portran
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Rémi Schweizer
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
| | - Marc Lilot
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
| | - Jean-Luc Fellahi
- Hospices Civils de Lyon, Hôpital Louis Pradel, Service d'Anesthésie-Réanimation, Lyon, France
- Laboratoire de recherche en Cardiovasculaire, Métabolisme, diabétologie et Nutrition (CarMeN), Inserm U1060, Lyon, France
- Université Claude Bernard Lyon 1, Faculté de médecine Lyon-Est, Lyon, France
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Cifci D, Foersch S, Kather JN. Artificial intelligence to identify genetic alterations in conventional histopathology. J Pathol 2022; 257:430-444. [PMID: 35342954 DOI: 10.1002/path.5898] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/09/2022] [Accepted: 03/23/2022] [Indexed: 11/10/2022]
Abstract
Precision oncology relies on the identification of targetable molecular alterations in tumor tissues. In many tumor types, a limited set of molecular tests is currently part of standard diagnostic workflows. However, universal testing for all targetable alterations, especially rare ones, is limited by the cost and availability of molecular assays. From 2017 to 2021, multiple studies have shown that artificial intelligence (AI) methods can predict the probability of specific genetic alterations directly from conventional hematoxylin and eosin (H&E) tissue slides. Although these methods are currently less accurate than gold-standard testing (e.g. immunohistochemistry, polymerase chain reaction or next-generation sequencing), they could be used as pre-screening tools to reduce the workload of genetic analyses. In this systematic literature review, we summarize the state of the art in predicting molecular alterations from H&E using AI. We found that AI methods perform reasonably well across multiple tumor types, although few algorithms have been broadly validated. In addition, we found that genetic alterations in FGFR, IDH, PIK3CA, BRAF, TP53 and DNA repair pathways are predictable from H&E in multiple tumor types, while many other genetic alterations have rarely been investigated or were only poorly predictable. Finally, we discuss the next steps for the implementation of AI-based surrogate tests in diagnostic workflows. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Didem Cifci
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
| | - Sebastian Foersch
- Institute of Pathology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Jakob Nikolas Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany.,Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Medical Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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40
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Attwood K, Hou S, Hutson A. Application of the skew exponential power distribution to ROC curves. J Appl Stat 2022; 50:1709-1724. [PMID: 37260468 PMCID: PMC10228349 DOI: 10.1080/02664763.2022.2037528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
The bi-Normal ROC model and corresponding metrics are commonly used in medical studies to evaluate the discriminatory ability of a biomarker. However, in practice, many clinical biomarkers tend to have skewed or other non-Normal distributions. And while the bi-Normal ROC model's AUC tends to be unbiased in this setting, providing a reasonable measure of global performance, the corresponding decision thresholds tend to be biased. To correct this bias, we propose using an ROC model based on the skew exponential power (SEP) distribution, whose additional parameters can accommodate skewed, heavy tailed, or other non-Normal distributions. Additionally, the SEP distribution can be used to evaluate whether the bi-Normal model would be appropriate. The performance of these ROC models and the non-parametric approach are evaluated via a simulation study and applied to a real data set involving infections from Klebsiella pneumoniae. The SEP based ROC-model provides some efficiency gains with respect to estimation of the AUC and provides cut-points with improved classification rates. As such, in the presence non-Normal data, we suggest using the proposed SEP ROC model.
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Affiliation(s)
- Kristopher Attwood
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Surui Hou
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Department of Biostatistics, University at Buffalo, Buffalo, NY, USA
| | - Alan Hutson
- Department of Biostatistics & Bioinformatics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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41
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Soto-Mota A, Marfil-Garza BA, Castiello-de Obeso S, Martinez Rodriguez EJ, Carrillo Vazquez DA, Tadeo-Espinoza H, Guerrero Cabrera JP, Dardon-Fierro FE, Escobar-Valderrama JM, Alanis-Mendizabal J, Gutierrez-Mejia J. Prospective predictive performance comparison between clinical gestalt and validated COVID-19 mortality scores. J Investig Med 2022; 70:415-420. [PMID: 34620707 PMCID: PMC8507412 DOI: 10.1136/jim-2021-002037] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/04/2022]
Abstract
Most COVID-19 mortality scores were developed at the beginning of the pandemic and clinicians now have more experience and evidence-based interventions. Therefore, we hypothesized that the predictive performance of COVID-19 mortality scores is now lower than originally reported. We aimed to prospectively evaluate the current predictive accuracy of six COVID-19 scores and compared it with the accuracy of clinical gestalt predictions. 200 patients with COVID-19 were enrolled in a tertiary hospital in Mexico City between September and December 2020. The area under the curve (AUC) of the LOW-HARM, qSOFA, MSL-COVID-19, NUTRI-CoV, and NEWS2 scores and the AUC of clinical gestalt predictions of death (as a percentage) were determined. In total, 166 patients (106 men and 60 women aged 56±9 years) with confirmed COVID-19 were included in the analysis. The AUC of all scores was significantly lower than originally reported: LOW-HARM 0.76 (95% CI 0.69 to 0.84) vs 0.96 (95% CI 0.94 to 0.98), qSOFA 0.61 (95% CI 0.53 to 0.69) vs 0.74 (95% CI 0.65 to 0.81), MSL-COVID-19 0.64 (95% CI 0.55 to 0.73) vs 0.72 (95% CI 0.69 to 0.75), NUTRI-CoV 0.60 (95% CI 0.51 to 0.69) vs 0.79 (95% CI 0.76 to 0.82), NEWS2 0.65 (95% CI 0.56 to 0.75) vs 0.84 (95% CI 0.79 to 0.90), and neutrophil to lymphocyte ratio 0.65 (95% CI 0.57 to 0.73) vs 0.74 (95% CI 0.62 to 0.85). Clinical gestalt predictions were non-inferior to mortality scores, with an AUC of 0.68 (95% CI 0.59 to 0.77). Adjusting scores with locally derived likelihood ratios did not improve their performance; however, some scores outperformed clinical gestalt predictions when clinicians' confidence of prediction was <80%. Despite its subjective nature, clinical gestalt has relevant advantages in predicting COVID-19 clinical outcomes. The need and performance of most COVID-19 mortality scores need to be evaluated regularly.
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Affiliation(s)
- Adrian Soto-Mota
- Metabolic Diseases Research Unit, National Institute of Medical Sciences and Nutrition Salvador Zubirán, Mexico City, Mexico
- Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico
| | - Braulio Alejandro Marfil-Garza
- Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico
- CHRISTUS-LatAm Hub - Excellence and Innovation Center, Monterrey, Mexico
| | - Santiago Castiello-de Obeso
- Experimental Psychology, University of Oxford, Oxford, UK
- Universidad de Guadalajara, Guadalajara, Jalisco, Mexico
| | | | | | - Hiram Tadeo-Espinoza
- Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico
| | | | | | | | - Jorge Alanis-Mendizabal
- Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico
| | - Juan Gutierrez-Mejia
- Internal Medicine, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Mexico
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Nahm FS. Receiver operating characteristic curve: overview and practical use for clinicians. Korean J Anesthesiol 2022; 75:25-36. [PMID: 35124947 PMCID: PMC8831439 DOI: 10.4097/kja.21209] [Citation(s) in RCA: 367] [Impact Index Per Article: 183.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Using diagnostic testing to determine the presence or absence of a disease is essential in clinical practice. In many cases, test results are obtained as continuous values and require a process of conversion and interpretation and into a dichotomous form to determine the presence of a disease. The primary method used for this process is the receiver operating characteristic (ROC) curve. The ROC curve is used to assess the overall diagnostic performance of a test and to compare the performance of two or more diagnostic tests. It is also used to select an optimal cut-off value for determining the presence or absence of a disease. Although clinicians who do not have expertise in statistics do not need to understand both the complex mathematical equation and the analytic process of ROC curves, understanding the core concepts of the ROC curve analysis is a prerequisite for the proper use and interpretation of the ROC curve. This review describes the basic concepts for the correct use and interpretation of the ROC curve, including parametric/nonparametric ROC curves, the meaning of the area under the ROC curve (AUC), the partial AUC, methods for selecting the best cut-off value, and the statistical software to use for ROC curve analyses.
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Accuracy of radiographer preliminary clinical evaluation of skeletal trauma radiographs, in clinical practice at a district general hospital. Radiography (Lond) 2022; 28:312-318. [PMID: 35012880 DOI: 10.1016/j.radi.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Error in interpretation of trauma radiographs by referrers is a problem which has detrimental effects on the patient and causes unnecessary repeat attendances. Radiographers can reduce errors by offering their opinion at the time of imaging. The Society and College of Radiographers have a longstanding recommendation that Red Dot (RD) schemes should be replaced by Preliminary Clinical Evaluation (PCE). The purpose of the study was to evaluate radiographer interpretation of skeletal trauma radiographs in clinical practice, determine if there was any difference in ability to interpret appendicular and axial studies, and evaluate appropriateness of PCE implementation. METHODS A convenience sample of 23 self-selecting radiographers provided RD and PCE on 762 examinations. Each case was compared against the verified report and assigned a true negative/positive or false negative/positive value. Accuracy, sensitivity and specificity were calculated and performance measures between RD versus PCE, and appendicular versus axial were compared using Two-sample Z-Tests. Error analysis was performed and inter-observer consistency determined. RESULTS Overall RD and PCE accuracy, sensitivity and specificity for the study were 90%, 72% and 97% (RD), and 92%, 80% and 97% (PCE) respectively. Significant difference was demonstrated for sensitivity with PCE more sensitive than RD (p-value 0.03) and appendicular more sensitive than axial (RD p-value <0.02, PCE p-value <0.0001). Most errors were false negatives. Inter-observer consistency was evaluated by review of 128 cases and no difference between reviewers was established. CONCLUSION Radiographers without specific training were able to provide RD and PCE to a high standard. Radiographers interpreted positive findings more accurately using PCE than RD, and positive findings on appendicular cases were interpreted more accurately than those on axial cases. IMPLICATIONS FOR PRACTICE This study supports local PCE implementation, contributes to the wider evidence base to justify transition towards PCE and identifies the necessity for local axial image interpretation training.
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Evaluation of reader performance during interpretation of breast cancer screening: the Recall and detection Of breast Cancer in Screening (ROCS) trial study design. Eur Radiol 2022; 32:7463-7469. [PMID: 35482123 PMCID: PMC9668759 DOI: 10.1007/s00330-022-08820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/24/2022] [Accepted: 04/15/2022] [Indexed: 01/03/2023]
Abstract
The magnitude of the tradeoff between recall rate (RR) and cancer detection rate (CDR) in breast-cancer screening is not clear, and it is expected to depend on target population and screening program characteristics. Multi-reader multi-case research studies, which may be used to estimate this tradeoff, rely on enriched datasets with artificially high prevalence rates, which may bias the results. Furthermore, readers participating in research studies are subject to "laboratory" effects, which can alter their performance relative to actual practice. The Recall and detection Of breast Cancer in Screening (ROCS) trial uses a novel data acquisition system that minimizes these limitations while obtaining an estimate of the RR-CDR curve during actual practice in the Dutch National Breast Cancer Screening Program. ROCS involves collection of at least 40,000 probability-of-malignancy ratings from at least 20 radiologists during interpretation of approximately 2,000 digital mammography screening cases each. With the use of custom-built software on a tablet, and a webcam, this data was obtained in the usual reading environment with minimal workflow disruption and without electronic access to the review workstation software. Comparison of the results to short- and medium-term follow-up allows for estimation of the RR-CDR and receiver operating characteristics curves, respectively. The anticipated result of the study is that performance-based evidence from practice will be available to determine the optimal operating point for breast-cancer screening. In addition, this data will be useful as a benchmark when evaluating the impact of potential new screening technologies, such as digital breast tomosynthesis or artificial intelligence. KEY POINTS: • The ROCS trial aims to estimate the recall rate-cancer detection rate curve during actual screening practice in the Dutch National Breast Cancer Screening Program. • The study design is aimed at avoiding the influence of the "laboratory effect" in usual observer performance studies. • The use of a tablet and a webcam allows for the acquisition of probability of malignancy ratings without access to the review workstation software.
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Attwood K, Tian L. Confidence Interval Estimation of the Youden index and corresponding cut-point for a combination of biomarkers under normality. COMMUN STAT-THEOR M 2022; 51:501-518. [PMID: 35399822 PMCID: PMC8991305 DOI: 10.1080/03610926.2020.1751852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In prognostic/diagnostic medical research, it is often the goal to identify a biomarker that differentiates between patients with and without a condition, or patients that will have good or poor response to a given treatment. The statistical literature is abundant with methods for evaluating single biomarkers for these purposes. However, in practice, a single biomarker rarely captures all aspects of a disease process; therefore, it is often the case that using a combination of biomarkers will improve discriminatory ability. A variety of methods have been developed for combining biomarkers based on the maximization of some global measure or cost-function. These methods usually create a score based on a linear combination of the biomarkers, upon which the standard single biomarker methodologies (such as the Youden's index) are applied. However, these single biomarker methodologies do not account for the multivariable nature of the combined biomarker score. In this article we present generalized inference and bootstrap approaches to estimating confidence intervals for the Youden's index and corresponding cut-point for a combined biomarker. These methods account for inherent dependencies and provide accurate and efficient estimates. A simulation study and real-world example utilize data from a Duchene Muscular Dystrophy study are also presented.
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Affiliation(s)
- Kristopher Attwood
- Dept. of Biostatistics and Bioinformatics, Roswell Park Comprehensive Cancer Center
| | - Lili Tian
- Dept. of Biostatistics, University at Buffalo
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Polilli E, Frattari A, Esposito JE, Stanziale A, Giurdanella G, Di Iorio G, Carinci F, Parruti G. Monocyte distribution width (MDW) as a new tool for the prediction of sepsis in critically ill patients: a preliminary investigation in an intensive care unit. BMC Emerg Med 2021; 21:147. [PMID: 34809558 PMCID: PMC8607630 DOI: 10.1186/s12873-021-00521-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
Background Monocyte Distribution Width (MDW), a simple proxy marker of innate monocyte activation, can be used for the early recognition of sepsis along with Procalcitonin. This study explored the added value of MDW as an early predictor of ensuing sepsis in patients hospitalised in an Intensive Care Unit. Methods We performed an observational prospective monocentric study to estimate the analytical performance of MDW in detecting ensuing sepsis in a sample of consecutive patients assisted in an Intensive Care Unit for > 48 h for any reason. Demographic and clinical characteristics, past medical history and other laboratory measurements were included as potential predictors of confirmed sepsis in multivariate logistic regression. Results A total of 211 patients were observed, 129 of whom were included in the final sample due to the suspect of ensuing sepsis; of these, 74 (57%) had a confirmed diagnosis of sepsis, which was best predicted with the combination of MDW > 23.0 and PCT > 0.5 ng/mL (Positive Predictive Value, PPV: 92.6, 95% CI: 82.1–97.9). The best MDW cut-off to rule out sepsis was ≤20.0 (Negative Predictive Value, NPV: 86.4, 95% CI: 65.1–97.1). Multivariate analyses using both MDW and PCT found a significant association for MDW > 23 only (OR:17.64, 95% CI: 5.53–67.91). Conclusion We found that values of MDW > 23 were associated with a high PPV for sepsis, whereas values of MDW ≤ 20 were associated with a high NPV. Our findings suggest that MDW may help clinicians to monitor ICU patients at risk of sepsis, with minimal additional efforts over standard of care.
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Affiliation(s)
- Ennio Polilli
- Clinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | | | | | - Andrea Stanziale
- Postgraduate School of Clinical Pathology, University of Chieti, Chieti, Italy
| | | | | | - Fabrizio Carinci
- Department of Statistical Sciences, University of Bologna, Bologna, Italy
| | - Giustino Parruti
- Infectious Diseases Unit, Pescara General Hospital, Pescara, Italy.
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Cochran G, Brown J, Yu Z, Frede S, Bryan MA, Ferguson A, Bayyari N, Taylor B, Snyder ME, Charron E, Adeoye-Olatunde OA, Ghitza UE, Winhusen T. Validation and threshold identification of a prescription drug monitoring program clinical opioid risk metric with the WHO alcohol, smoking, and substance involvement screening test. Drug Alcohol Depend 2021; 228:109067. [PMID: 34610516 PMCID: PMC8612015 DOI: 10.1016/j.drugalcdep.2021.109067] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prescription drug monitoring programs (PDMPs) are critical for pharmacists to identify risky opioid medication use. We performed an independent evaluation of the PDMP-based Narcotic Score (NS) metric. METHODS This study was a one-time, cross-sectional health assessment within 19 pharmacies from a national chain among adults picking-up opioid medications. The NS metric is a 3-digit composite indicator. The WHO Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was the gold-standard to which the NS metric was compared. Machine learning determined optimal risk thresholds; Receiver Operating Characteristic curves and Spearman (P) and Kappa (K) coefficients analyzed concurrent validity. Regression analyses evaluated participant characteristics associated with misclassification. RESULTS The NS metric showed fair concurrent validity (area under the curve≥0.70; K=0.35; P = 0.37, p < 0.001). The ASSIST and NS metric categorized 37% of participants as low-risk (i.e., not needing screening/intervention) and 32.3% as moderate/high-risk (i.e., needing screening/intervention). Further, 17.2% were categorized as low ASSIST risk but moderate/high NS metric risk, termed false positives. These reported disability (OR=3.12), poor general health (OR=0.66), and/or greater pain severity/interference (OR=1.12/1.09; all p < 0.05; i.e., needing unmanaged-pain screening/intervention). A total of 13.4% were categorized as moderate/high ASSIST risk but low NS metric risk, termed false negatives. These reported greater overdose history (OR=1.24) and/or substance use (OR=1.81-12.66; all p < 0.05). CONCLUSIONS The NS metric could serve as a useful initial universal prescription opioid-risk screener given its: 1) low-burden (i.e., no direct assessment); 2) high accuracy (86.5%) of actionable data identifying low-risk patients and those needing opioid use/unmanaged pain screening/intervention; and 3) broad availability.
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Affiliation(s)
- Gerald Cochran
- University of Utah, Department of Internal Medicine, 295 Chipeta Way Salt Lake City, UT 84132, USA.
| | - Jennifer Brown
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 260 Stetson Street Cincinnati, OH 45267-0559, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
| | - Ziji Yu
- University of Utah, Department of Internal Medicine, 295 Chipeta Way Salt Lake City, UT 84132, USA.
| | - Stacey Frede
- Kroger Pharmacy, 1014 Vine Street, Cincinnati, OH 45202, USA.
| | - M Aryana Bryan
- University of Utah, Department of Internal Medicine, 295 Chipeta Way Salt Lake City, UT 84132, USA.
| | - Andrew Ferguson
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 260 Stetson Street Cincinnati, OH 45267-0559, USA.
| | - Nadia Bayyari
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 260 Stetson Street Cincinnati, OH 45267-0559, USA.
| | - Brooke Taylor
- Kroger Pharmacy, 1014 Vine Street, Cincinnati, OH 45202, USA.
| | - Margie E Snyder
- Purdue University, College of Pharmacy, 575 Stadium Mall Drive West Lafayette, IN 47907, USA.
| | - Elizabeth Charron
- University of Utah, Department of Internal Medicine, 295 Chipeta Way Salt Lake City, UT 84132, USA.
| | | | - Udi E Ghitza
- National Institute on Drug Abuse, Center for Clinical Trials Network, 3 White Flint North MSC 6022, 301 North Stonestreet Avenue, North Bethesda, MD 20852, USA.
| | - T Winhusen
- University of Cincinnati, Department of Psychiatry and Behavioral Neuroscience, 260 Stetson Street Cincinnati, OH 45267-0559, USA; Center for Addiction Research, University of Cincinnati College of Medicine, 3230 Eden Avenue, Cincinnati, OH 45267, USA.
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48
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E E, Wang T, Yang L, Dempsey M, Brennan A, Yu M, Chan WP, Whelan B, Silke C, O'Sullivan M, Rooney B, McPartland A, O'Malley G, Carey JJ. Utility of Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Irish Men and Women: Results of the DXA-HIP Project. J Clin Densitom 2021; 24:516-526. [PMID: 33789806 DOI: 10.1016/j.jocd.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/11/2022]
Abstract
Many algorithms have been developed and publicised over the past 2 decades for identifying those most likely to have osteoporosis or low BMD, or at increased risk of fragility fracture. The Osteoporosis Self-assessment Tool index (OSTi) is one of the oldest, simplest, and widely used for identifying men and women with low BMD or osteoporosis. OSTi has been validated in many cohorts worldwide but large studies with robust analyses evaluating this or other algorithms in adult populations residing in the Republic of Ireland are lacking, where waiting times for public DXA facilities are long. In this study we evaluated the validity of OSTi in men and women drawn from a sampling frame of more than 36,000 patients scanned at one of 3 centres in the West of Ireland. 18,670 men and women aged 40 years and older had a baseline scan of the lumbar spine femoral neck and total hip available for analysis. 15,964 (86%) were female, 5,343 (29%) had no major clinical risk factors other than age, while 5,093 (27%) had a prior fracture. Approximately 2/3 had a T-score ≤-1.0 at one or more skeletal sites and 1/3 had a T-score ≤-1.0 at all 3 skeletal sites, while 1 in 5 had a DXA T-score ≤-2.5 at one or more skeletal sites and 5% had a T-score ≤-2.5 at all 3 sites. OSTi generally performed well in our population with area under the curve (AUC) values ranging from 0.581 to 0.881 in men and 0.701 to 0.911 in women. The performance of OSTi appeared robust across multiple sub-group analyses. AUC values were greater for women, proximal femur sites, those without prior fractures and those not taking osteoporosis medication. Optimal OSTi cut-points were '2' for men and '0' for women in our study population. OSTi is a simple and effective tool to aid identification of Irish men and women with low BMD or osteoporosis. Use of OSTi could improve the effectiveness of DXA screening programmes for older adults in Ireland.
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Affiliation(s)
- Erjiang E
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Tingyan Wang
- Department of Industrial Engineering, Tsinghua University, Beijing, China; Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lan Yang
- Department of Industrial Engineering, Tsinghua University, Beijing, China; School of Engineering, National University of Ireland, Galway, Ireland
| | - Mary Dempsey
- School of Engineering, National University of Ireland, Galway, Ireland
| | - Attracta Brennan
- School of Computer Science, National University of Ireland, Galway, Ireland
| | - Ming Yu
- Department of Industrial Engineering, Tsinghua University, Beijing, China
| | - Wing P Chan
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Bryan Whelan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Carmel Silke
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Miriam O'Sullivan
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Bridie Rooney
- Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - Aoife McPartland
- Department of Rheumatology, Our Lady's Hospital, Manorhamilton, Co. Leitrim, Ireland
| | - Gráinne O'Malley
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Geriatric Medicine, Sligo University Hospital, Sligo, Ireland
| | - John J Carey
- School of Medicine, National University of Ireland, Galway, Ireland; Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
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Automatic detection of actionable radiology reports using bidirectional encoder representations from transformers. BMC Med Inform Decis Mak 2021; 21:262. [PMID: 34511100 PMCID: PMC8436473 DOI: 10.1186/s12911-021-01623-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/23/2021] [Indexed: 01/27/2023] Open
Abstract
Background It is essential for radiologists to communicate actionable findings to the referring clinicians reliably. Natural language processing (NLP) has been shown to help identify free-text radiology reports including actionable findings. However, the application of recent deep learning techniques to radiology reports, which can improve the detection performance, has not been thoroughly examined. Moreover, free-text that clinicians input in the ordering form (order information) has seldom been used to identify actionable reports. This study aims to evaluate the benefits of two new approaches: (1) bidirectional encoder representations from transformers (BERT), a recent deep learning architecture in NLP, and (2) using order information in addition to radiology reports. Methods We performed a binary classification to distinguish actionable reports (i.e., radiology reports tagged as actionable in actual radiological practice) from non-actionable ones (those without an actionable tag). 90,923 Japanese radiology reports in our hospital were used, of which 788 (0.87%) were actionable. We evaluated four methods, statistical machine learning with logistic regression (LR) and with gradient boosting decision tree (GBDT), and deep learning with a bidirectional long short-term memory (LSTM) model and a publicly available Japanese BERT model. Each method was used with two different inputs, radiology reports alone and pairs of order information and radiology reports. Thus, eight experiments were conducted to examine the performance. Results Without order information, BERT achieved the highest area under the precision-recall curve (AUPRC) of 0.5138, which showed a statistically significant improvement over LR, GBDT, and LSTM, and the highest area under the receiver operating characteristic curve (AUROC) of 0.9516. Simply coupling the order information with the radiology reports slightly increased the AUPRC of BERT but did not lead to a statistically significant improvement. This may be due to the complexity of clinical decisions made by radiologists. Conclusions BERT was assumed to be useful to detect actionable reports. More sophisticated methods are required to use order information effectively.
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50
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Xu L, Xu K, Xiang L, Yan J. Circular RNA OMA1 regulates the progression of breast cancer via modulation of the miR‑1276/SIRT4 axis. Mol Med Rep 2021; 24:728. [PMID: 34414449 PMCID: PMC8383036 DOI: 10.3892/mmr.2021.12367] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 09/25/2020] [Indexed: 12/24/2022] Open
Abstract
Mounting evidence has indicated that circular RNAs (circRNAs) serve essential roles in the tumorigenesis and development of various types of cancer. However, the biological functions and the underlying mechanisms of circRNAs in breast cancer (BC) remain largely elusive. In the present study, the expression pattern of circRNAs in three pairs of BC tissues and adjacent normal tissues was determined using a circRNA microarray. The expression and prognostic value of circOMA1 were evaluated by reverse transcription‑quantitative PCR in 64 pairs of BC tissues and adjacent normal tissues. Survival curves were generated by the Kaplan‑Meier method, and statistical significance was estimated using the log‑rank test. A series of in vitro functional experiments were then performed to investigate the role of circOMA1 in the tumorigenesis of BC. The results revealed that the expression levels of circOMA1 were upregulated in BC tissues, and its expression was markedly associated with tumor size and lymph node metastasis. Receiver operating characteristic analysis demonstrated that the expression of circOMA1 could be used to discriminate between BC tissues and adjacent normal tissues. Functionally, overexpression of circOMA1 promoted the viability, migration and invasion of BC cells, whereas circOMA1 knockdown had the opposite effect. Mechanistic investigations showed that circOMA1 promoted the progression of BC by sponging microRNA (miR)‑1276 and upregulating sirtuin 4 (SIRT4) expression. In conclusion, circOMA1 may act as an oncogenic circRNA in BC via regulation of the miR‑1276/SIRT4 axis.
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Affiliation(s)
- Lingli Xu
- Department of Ultrasound, Ningbo Zhenghai Longsai Hospital, Ningbo, Zhejiang 315200, P.R. China
| | - Ke Xu
- Department of Radiology, Ningbo Zhenghai Traditional Chinese Medicine Hospital, Ningbo, Zhejiang 315200, P.R. China
| | - Lijun Xiang
- Department of Ultrasound, Ningbo Zhenghai Longsai Hospital, Ningbo, Zhejiang 315200, P.R. China
| | - Jiamei Yan
- Department of Ultrasound, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang 315040, P.R. China
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