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Ruiz-Tarrazo X, Escalona-Marfil C, Pla-Campas G, Coda A. Validity and reliability of ultrasonographic assessment of femoral and tibial torsion in children and adolescents: a systematic review. Eur J Pediatr 2024; 183:3159-3171. [PMID: 38831134 PMCID: PMC11263233 DOI: 10.1007/s00431-024-05619-y] [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: 03/22/2024] [Revised: 05/04/2024] [Accepted: 05/17/2024] [Indexed: 06/05/2024]
Abstract
Torsional disorders of the lower limb are common in childhood, and they are one of the primary reasons parents seek consultation with healthcare providers. While clinical manoeuvres can assess femoral and tibial torsion, their reliability is medium to low. Various imaging-based techniques, including computed tomography, magnetic resonance imaging, fluoroscopy, biplanar radiology and ultrasonography, have been used to evaluate torsional alterations of the lower extremity. Among these, ultrasound assessment offers certain advantages: it is a low-cost, non-irradiating technique, which allows the follow-up of children's torsional development. However, to the best of the authors' knowledge, its validity and reliability have not been summarised in a systematic review. This study aims to analyse the validity and reliability of ultrasonography in determining femoral and tibial torsion in children and adolescents. A search from Medline (via PubMed), Web of Science, Scopus and CINAHL databases were performed from inception to 16 March 2023. No restrictions were placed on the publication year or language. The methodological quality of all eligible studies was independently reviewed by two authors using QUADAS and STARD checklists. Overall, 1546 articles were identified through the searches; 30 were considered eligible for full-text screening; and 8 studies were finally included in this review. The included studies were conducted in Germany, Norway and the UK. Among them, 7 studies analysed the validity of ultrasonography compared with other imaging techniques such as computed tomography, magnetic resonance imaging and biplanar X-ray, and 4 studies assessed intra- and inter-observer reliability. All the studies assessed femoral torsion, but only one of them also included tibial torsion. Conclusion: Ultrasound is a good alternative for routine evaluation and follow-up of femoral torsional alterations in children and adolescents due to its safety, accessibility and immediate results in the clinical examination room. Although ultrasound has good accuracy and reliability for routine evaluations, there is controversy about whether it is sufficient for surgical planning. In cases where greater accuracy is required, magnetic resonance imaging and biplanar radiography are the preferred imaging techniques. What is Known: • Several imaging-based techniques have been described for the assessment of torsional alterations of the lower extremity. • Computed tomography, magnetic resonance imaging, biplanar radiology and ultrasonography are the most used and studied methods. What is New: • Ultrasonography represents a good alternative for the assessment of femoral and tibial torsional alterations in children and adolescents, given its safety, accessibility and immediacy of results in the consultation room. • Its accuracy and reliability are good but not sufficient for surgical planning, in which case MRI and biplanar X-ray will be the preferred choices.
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Affiliation(s)
- Xavier Ruiz-Tarrazo
- Faculty of Health Sciences at Manresa, University of Vic - Central University of Catalonia (UVic-UCC), Av. Universitària, 4-6, 08242, Manresa, Spain.
| | - Carles Escalona-Marfil
- Faculty of Health Sciences at Manresa, University of Vic - Central University of Catalonia (UVic-UCC), Av. Universitària, 4-6, 08242, Manresa, Spain
- University of Girona, Girona, Spain
| | - Gil Pla-Campas
- Faculty of Education, Translation, Sport and Psychology at Vic, University of Vic - Central University of Catalonia (UVic-UCC), C/ Sagrada Família 7, 080500, Vic, Spain
| | - Andrea Coda
- Podiatry, School of Health Sciences, College of Health, Medicine and Wellbeing - The University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute (HMRI), New Lambton Heights, New South Wales, Australia
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Drommelschmidt K, Mayrhofer T, Hüning B, Stein A, Foldyna B, Schweiger B, Felderhoff-Müser U, Sirin S. Incidence of brain injuries in a large cohort of very preterm and extremely preterm infants at term-equivalent age: results of a single tertiary neonatal care center over 10 years. Eur Radiol 2024; 34:5239-5249. [PMID: 38279057 PMCID: PMC11255071 DOI: 10.1007/s00330-024-10592-z] [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: 08/17/2023] [Revised: 11/30/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
OBJECTIVES Cerebral magnetic resonance imaging (cMRI) at term-equivalent age (TEA) can detect brain injury (BI) associated with adverse neurological outcomes in preterm infants. This study aimed to assess BI incidences in a large, consecutive cohort of preterm infants born < 32 weeks of gestation, the comparison between very (VPT, ≥ 28 + 0 to < 32 + 0 weeks of gestation) and extremely preterm infants (EPT, < 28 + 0 weeks of gestation) and across weeks of gestation. METHODS We retrospectively analyzed cMRIs at TEA of VPT and EPT infants born at a large tertiary center (2009-2018). We recorded and compared the incidences of BI, severe BI, intraventricular hemorrhage (IVH), periventricular hemorrhagic infarction (PVHI), cerebellar hemorrhage (CBH), cystic periventricular leukomalacia (cPVL), and punctate white matter lesions (PWML) between VPTs, EPTs, and across weeks of gestation. RESULTS We included 507 preterm infants (VPT, 335/507 (66.1%); EPT, 172/507 (33.9%); mean gestational age (GA), 28 + 2 weeks (SD 2 + 2 weeks); male, 52.1%). BIs were found in 48.3% of the preterm infants (severe BI, 12.0%) and increased with decreasing GA. IVH, PVHI, CBH, cPVL, and PWML were seen in 16.8%, 0.8%, 10.5%, 3.4%, and 18.1%, respectively. EPT vs. VPT infants suffered more frequently from BI (59.3% vs. 42.7%, p < 0.001), severe BI (18.6% vs. 8.7%, p = 0.001), IVH (31.9% vs. 9.0%, p < 0.001), and CBH (18.0% vs. 6.6%, p < 0.001). CONCLUSION Brain injuries are common cMRI findings among preterm infants with a higher incidence of EPT compared to VPT infants. These results may serve as reference values for clinical management and research. CLINICAL RELEVANCE STATEMENT Our results with regard to gestational age might provide valuable clinical insights, serving as a key reference for parental advice, structured follow-up planning, and enhancing research and management within the Neonatal Intensive Care Unit. KEY POINTS • Brain injury is a common cMRI finding in preterm infants seen in 48.3% individuals. • Extremely preterm compared to very preterm infants have higher brain injury incidences driven by brain injuries such as intraventricular and cerebellar hemorrhage. • Reference incidence values are crucial for parental advice and structured follow-up planning.
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Affiliation(s)
- Karla Drommelschmidt
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Thomas Mayrhofer
- School of Business Studies, Stralsund, University of Applied Sciences, Stralsund, Germany
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Britta Hüning
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Anja Stein
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Borek Foldyna
- Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital - Harvard Medical School, Boston, MA, USA
| | - Bernd Schweiger
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ursula Felderhoff-Müser
- Department of Pediatrics I, Neonatology, Pediatric Intensive Care, and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (cTNBS), University Medicine Essen, Essen, Germany
| | - Selma Sirin
- Department of Diagnostic Imaging, University Children's Hospital Zürich, University of Zürich, Zürich, Switzerland.
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Oh HK, Park J, Sonstein WJ, Maher S, Kim MG. Development and Clinical Validation of a Hook Effect-Based Lateral Flow Immunoassay Sensor for Cerebrospinal Fluid Leak Detection. Neurosurgery 2024; 95:305-312. [PMID: 38578087 PMCID: PMC11219150 DOI: 10.1227/neu.0000000000002914] [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: 10/09/2023] [Accepted: 12/21/2023] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Rapid detection of cerebrospinal fluid (CSF) leaks is vital for patient recovery after spinal surgery. However, distinguishing CSF-specific transferrin (TF) from serum TF using lateral flow immunoassays (LFI) is challenging due to their structural similarities. This study aims to develop a novel point-of-care diagnostic assay for precise CSF leak detection by quantifying total TF in both CSF and serum. METHODS Capitalizing on the substantial 100-fold difference in TF concentrations between CSF and serum, we designed a diagnostic platform based on the well-known "hook effect" resulting from excessive analyte presence. Clinical samples from 37 patients were meticulously tested using the novel LFI sensor, alongside immunofixation as a reference standard. RESULTS The hook effect-based LFI sensor exhibited outstanding performance, successfully discriminating positive clinical CSF samples from negative ones with remarkable statistical significance (positive vs negative t -test; P = 1.36E-05). This novel sensor achieved an impressive 100% sensitivity and 100% specificity in CSF leak detection, demonstrating its robust diagnostic capabilities. CONCLUSION In conclusion, our study introduces a rapid, highly specific, and sensitive point-of-care test for CSF leak detection, harnessing the distinctive TF concentration profile in CSF compared with serum. This novel hook effect-based LFI sensor holds great promise for improving patient outcomes in the context of spinal surgery and postsurgical recovery. Its ease of use and reliability make it a valuable tool in clinical practice, ensuring timely and accurate CSF leak detection to enhance patient care.
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Affiliation(s)
- Hyun-Kyung Oh
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Jinhee Park
- GMD Biotech Inc., Cop., Gwangju, Republic of Korea
| | - William J. Sonstein
- Neurological Surgery, P.C., Hempstead, New York, USA
- Department of Neurosurgery, NYU Langone Hospital Long Island, Mineola, New York, USA
| | - Simon Maher
- Department of Electrical Engineering and Electronics, University of Liverpool, Liverpool, UK
| | - Min-Gon Kim
- Department of Chemistry, School of Physics and Chemistry, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
- GMD Biotech Inc., Cop., Gwangju, Republic of Korea
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Hu D, Yao Q. Using blood TNF-related apoptosis-inducing ligand levels to discriminate between viral and bacterial infections: A prospective observational study. Diagn Microbiol Infect Dis 2024; 110:116443. [PMID: 39032319 DOI: 10.1016/j.diagmicrobio.2024.116443] [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: 03/31/2024] [Revised: 06/10/2024] [Accepted: 07/12/2024] [Indexed: 07/23/2024]
Abstract
OBJECTIVE The aim of the investigation was to evaluate variations in blood TNF-related apoptosis-inducing ligand (TRAIL) levels between patients with viral and bacterial infections and the diagnostic performance of TRAIL for identifying viral and bacterial infections. METHODS The investigation included 169 adult (>18 years) patients presenting with medical signs of acute infections (inclusion criteria included a body temperature over 37.5 °C, an onset of symptoms no more than 12 days). Reference standard was based on a rigorous expert panel and the majority of the panel determined the infectious etiology. Finally, 104 patients with 78 bacterial and 26 viral reference standard outcomes were enrolled in this investigation (24 were eliminated depending on the exclusion criteria; 41 had indeterminate reference standard diagnosis). ELISA was employed to measure TRAIL levels in the group of 78 subjects with bacterial infections and 26 individuals with viral infections, and the diagnostic performance of TRAIL was identified by receiver operating characteristic (ROC) analysis. RESULTS The TRAIL level in individuals with bacterial infections was significantly lower than that in subjects with viral infections (16.59 (2.61-32.6) pg/mL vs. 97.39 (36.18-127.74) pg/mL, P < 0.05). The area under the ROC curve (AUC) of TRAIL was 0.86 (95 %CI:0.79 to 0.94) for identifying bacterial and viral infections. Combining TRAIL with C-reactive protein (CRP), the AUC was 0.94 (95 %CI:0.89 to 1.00). CONCLUSIONS TRAIL is diagnostic for discriminating between viral and bacterial infections. Combining TRAIL with CRP increases the AUC.
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Affiliation(s)
- Dandan Hu
- Geriatric Department, The First Affiliated Hospital of Ningbo University, Ningbo, PR China
| | - Qi Yao
- Geriatric Department, The First Affiliated Hospital of Ningbo University, Ningbo, PR China.
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de Bloeme CM, Jansen RW, Göricke S, Grauwels STL, van Elst S, Ketteler P, Brisse HJ, Galluzzi P, Cardoen L, Sirin S, Koob M, Maeder P, van der Valk P, Moll AC, de Graaf P, de Jong MC. Optic nerve thickening on high-spatial-resolution MRI predicts early-stage postlaminar optic nerve invasion in retinoblastoma. Eur Radiol 2024; 34:4638-4648. [PMID: 38087063 DOI: 10.1007/s00330-023-10471-z] [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: 05/18/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 06/29/2024]
Abstract
OBJECTIVES To assess the diagnostic accuracy of nerve thickening on MRI to predict early-stage postlaminar optic nerve invasion (PLONI) in retinoblastoma. Furthermore, this study aimed to incorporate measurements into a multiparametric model for radiological determination of PLONI. METHODS In this retrospective multicenter case-control study, high-spatial-resolution 3D T2-weighted MR images were used to measure the distal optic nerve. Histopathology was the reference standard for PLONI. Two neuroradiologists independently measured the optic nerve width, height, and surface at 0, 3, and 5 mm from the most distal part of the optic nerve. Subsequently, PLONI was scored on contrast-enhanced T1-weighted and 3D T2-weighted images, blinded for clinical data. Optic nerve measurements with the highest diagnostic accuracy for PLONI were incorporated into a prediction model for radiological determination of PLONI. RESULTS One hundred twenty-four retinoblastoma patients (median age, 22 months [range, 0-113], 58 female) were included, resulting in 25 retinoblastoma eyes with histopathologically proven PLONI and 206 without PLONI. ROC analysis of axial optic nerve width measured at 0 mm yielded the best area under the curve of 0.88 (95% confidence interval: 0.79, 0.96; p < 0.001). The optimal width cutoff was ≥ 2.215 mm, with a sensitivity of 84% (95% CI: 64, 95%) and specificity of 83% (95% CI: 75, 89%) for detecting PLONI. Combining width measurements with the suspicion of PLONI on MRI sequences resulted in a prediction model with an improved sensitivity and specificity of respectively up to 88% and 92%. CONCLUSION Postlaminar optic nerve thickening can predict early-stage postlaminar optic nerve invasion in retinoblastoma. CLINICAL RELEVANCE STATEMENT This study provides an additional tool for clinicians to help determine postlaminar optic nerve invasion, which is a risk factor for developing metastatic disease in retinoblastoma patients. KEY POINTS • The diagnostic accuracy of contrast-enhanced MRI for detecting postlaminar optic nerve invasion is limited in retinoblastoma patients. • Optic nerve thickening can predict postlaminar optic nerve invasion. • A prediction model combining MRI features has a high sensitivity and specificity for detecting postlaminar optic nerve invasion.
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Affiliation(s)
- Christiaan M de Bloeme
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands.
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - Robin W Jansen
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sophia Göricke
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Steven T L Grauwels
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sabien van Elst
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Petra Ketteler
- Department of Pediatric Oncology, University Hospital Essen, Essen, Germany
| | - Hervé J Brisse
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Department of Radiology, Institut Curie, Paris, France and Paris University, Paris, France
| | - Paolo Galluzzi
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Department of Neuroimaging Unit, Siena University Hospital, Siena, Italy
| | - Liesbeth Cardoen
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Department of Radiology, Institut Curie, Paris, France and Paris University, Paris, France
| | - Selma Sirin
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Department of Diagnostic and Interventional Radiology and Neuroradiology, Children's Hospital Zurich, Zurich, Switzerland
| | - Mériam Koob
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Philippe Maeder
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Paul van der Valk
- Department of Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Annette C Moll
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Department of Ophthalmology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim de Graaf
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marcus C de Jong
- European Retinoblastoma Imaging Collaboration (ERIC), Amsterdam, The Netherlands
- Cancer Center Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Walston SL, Seki H, Takita H, Mitsuyama Y, Sato S, Hagiwara A, Ito R, Hanaoka S, Miki Y, Ueda D. Data set terminology of deep learning in medicine: a historical review and recommendation. Jpn J Radiol 2024:10.1007/s11604-024-01608-1. [PMID: 38856878 DOI: 10.1007/s11604-024-01608-1] [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: 02/29/2024] [Accepted: 05/31/2024] [Indexed: 06/11/2024]
Abstract
Medicine and deep learning-based artificial intelligence (AI) engineering represent two distinct fields each with decades of published history. The current rapid convergence of deep learning and medicine has led to significant advancements, yet it has also introduced ambiguity regarding data set terms common to both fields, potentially leading to miscommunication and methodological discrepancies. This narrative review aims to give historical context for these terms, accentuate the importance of clarity when these terms are used in medical deep learning contexts, and offer solutions to mitigate misunderstandings by readers from either field. Through an examination of historical documents, including articles, writing guidelines, and textbooks, this review traces the divergent evolution of terms for data sets and their impact. Initially, the discordant interpretations of the word 'validation' in medical and AI contexts are explored. We then show that in the medical field as well, terms traditionally used in the deep learning domain are becoming more common, with the data for creating models referred to as the 'training set', the data for tuning of parameters referred to as the 'validation (or tuning) set', and the data for the evaluation of models as the 'test set'. Additionally, the test sets used for model evaluation are classified into internal (random splitting, cross-validation, and leave-one-out) sets and external (temporal and geographic) sets. This review then identifies often misunderstood terms and proposes pragmatic solutions to mitigate terminological confusion in the field of deep learning in medicine. We support the accurate and standardized description of these data sets and the explicit definition of data set splitting terminologies in each publication. These are crucial methods for demonstrating the robustness and generalizability of deep learning applications in medicine. This review aspires to enhance the precision of communication, thereby fostering more effective and transparent research methodologies in this interdisciplinary field.
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Affiliation(s)
- Shannon L Walston
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroshi Seki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hirotaka Takita
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Yasuhito Mitsuyama
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Shingo Sato
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Rintaro Ito
- Department of Radiology, Nagoya University, Nagoya, Japan
| | - Shouhei Hanaoka
- Department of Radiology, University of Tokyo Hospital, Tokyo, Japan
| | - Yukio Miki
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Daiju Ueda
- Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
- Department of Artificial Intelligence, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
- Center for Health Science Innovation, Osaka Metropolitan University, Osaka, Japan.
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Al-Lami BS, Al-Lami BS, Al-Lami YS. PET/CT in comparison with PET/MRI as an imaging modality in the management of Gliomas: A systematic review and meta analysis. J Med Imaging Radiat Sci 2024; 55:330-338. [PMID: 38490940 DOI: 10.1016/j.jmir.2024.02.008] [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: 09/25/2023] [Revised: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Gliomas are the most commonly occurring type of primary brain tumors. They account for 32% of all brain tumors and 80% of all malignant intracranial tumors. Gliomas are separated into four grades according to the World Health Organization. While low-grade gliomas generally have a favorable outlook, high-grade gliomas cause significant morbidity and mortality Given the lack of clarity about the causes of gliomas and their potential lethality, early diagnosis and identification is crucial. METHODS The systematic literature search was based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The electronic databases used were the following: Google Scholar, MEDLINE (PubMed), and EMBASE, and Cochrane Library. Medical subject headings (MeSH) and Boolean operators were used to find any relevant literature. To evaluate the quality of the studies used, a quality assessment was performed using the QUADAS-2. RESULTS Four papers concerning the PET/MR modality that included 122 patients while on the other hand we had five papers about the PET/CT modality that included 251 patients. On both sides, the patients were mostly male and the overall mean age 45 ± 10 years. The overall sensitivity and specificity of the PET/MR modality was found to be 89% (95% CI, p = 1.00) and 84% (95% CI, p = 1.00) respectively. In the four included studies revolving around PET/MR, the accuracy was found out to be: 78%, 96.4%, 100%, and N/R. CONCLUSION The PET/MR modality was deemed to be slightly diagnostically better than the PET/CT modality. More studies investigating the efficacy of using hybrid FDG PET/MR in gliomas are encouraged to shed light on its potential role in clinical use. Conducting prospective randomized studies that directly compare the sensitivity and specificity of PET/CT and PET/MR for glioma would help establish the role of imaging modalities for diagnosis of glioma.
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Affiliation(s)
- Bareq S Al-Lami
- Hawler Medical University - College of Medicine, Erbil, Kurdistan Region, Iraq.
| | - Baqer S Al-Lami
- Hawler Medical University - College of Medicine, Erbil, Kurdistan Region, Iraq
| | - Yasir S Al-Lami
- Hawler Medical University - College of Medicine, Erbil, Kurdistan Region, Iraq
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Solomou G, Bilyy A, Tadikonda P, Gurdas B, Pasapula C. Diagnostic accuracy of clinical, radiological and device-driven tests for the detection of First Ray Instability: A systematic review. Foot (Edinb) 2024; 59:102080. [PMID: 38484413 DOI: 10.1016/j.foot.2024.102080] [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: 08/23/2023] [Accepted: 03/08/2024] [Indexed: 06/17/2024]
Abstract
INTRODUCTION First Ray Instability (FRI) and especially hypermobility leads to the collapse of the medial longitudinal arch's structural framework, which reduces the foot's ability to become a rigid lever for propulsion, resulting in progressive foot deformities. Early detection of FRI with prompt intervention helps prevent degenerative foot deformities. Various manual, device-based and radiographic diagnostic tests for FRI quantification have been described in the literature. We aim to conduct an up-to-date, comprehensive, systematic review of the literature reporting on diagnostic tests to evaluate FRI. METHODOLOGY Electronic databases (Medline, Embase and PubMed) and bibliography lists were searched until May 2021 for studies evaluating diagnostic tests for FRI. MeSH terms were used to conduct the literature search. The authors screened all produced abstracts. Selected articles were further assessed in full based on inclusion and exclusion criteria. The relevant studies were qualitatively assessed and grouped into tables based on tests. RESULTS 18,176 studies were identified. Thirty-two full-text articles were included for assessment. Ten articles were excluded based on evaluation criteria. 18 studies were included for qualitative assessment: two studies describing manual diagnostic tests, three evaluating device-driven tests, six image-guided studies and seven comparison studies assessing a new test versus an established one. CONCLUSION Gold standard tests in defining FRI need to be improved. Manual tests exhibit significant subjective variability. Radiographic tests, while accurate, are complex and cumbersome to perform and, therefore, are not widely applied. Dorsal rulers have demonstrated mixed results and shown variability when compared to instruments. The focus has been on assessing FRI in hallux valgus (HV). More studies are needed to investigate FRI in the absence of HV.
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Affiliation(s)
- Georgios Solomou
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK; School of Clinical Medicine, University of Cambridge, Cambridge, UK.
| | - Andrey Bilyy
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Pranav Tadikonda
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Brian Gurdas
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
| | - Chandra Pasapula
- The Queen Elizabeth Hospital, Gayton Road, Kings Lynn, Norfolk, England PE30 4ET, UK
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Wang F, Yiu EM. Is Surface Electromyography (sEMG) a Useful Tool in Identifying Muscle Tension Dysphonia? An Integrative Review of the Current Evidence. J Voice 2024; 38:800.e1-800.e12. [PMID: 34903394 DOI: 10.1016/j.jvoice.2021.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This integrative review aims to determine the quality level of evidence on using surface electromyography (sEMG) as a diagnostic tool in identifying muscle tension dysphonia. METHOD Two independent reviewers used one search engine and five databases to identify sEMG studies published between January 1980 and December 2020, using a set of specified search terms related to muscle tension dysphonia. The selected articles were systematically evaluated by two independent raters using a modified critical appraisal of diagnostic evidence (m-CADE) form. RESULTS Nine articles that satisfied the inclusion criteria were selected from among 576 studies for evaluation. These nine studies showed varied methodological approaches in sEMG measurements, including electrode configuration and position, tasks used in sEMG data collection, outcome measure, and normalization procedures. Five studies showed relatively high m-CADE scores, which were indicative of "suggestive validity and compelling importance". Two studies were rated as "suggestive validity and importance", while two remaining studies were rated as "less suggestive or equivocal validity and importance". CONCLUSIONS The review found a moderate level of evidence that sEMG can be a potentially useful tool with diagnostic value in identifying muscle tension dysphonia. However, evidence is not yet available to determine the diagnostic accuracy of sEMG for muscle tension dysphonia. More studies are needed, and it is recommended that future studies involving sEMG and reference measurements should be undertaken using a blinding procedure in order to control any subjective biases. Details of the population that the sEMG has been tested on should be outlined clearly so that spectrum bias could be eliminated or minimized in the application process. Furthermore, it is suggested that a reliable and valid protocol in collecting sEMG data during speech should be developed to minimize the variability of sEMG measures in assessing muscle activities during speech.
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Affiliation(s)
- Feifan Wang
- School of Humanities, Shanghai Normal University, Shanghai, China.
| | - Edwin Ml Yiu
- Voice Research Laboratory, The University of Hong Kong, Pokfulam, Hong Kong
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10
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Park A, van Draanen J. Community-Partnered Research appraisal tool for conducting, reporting and assessing community-based research. BMJ Open 2024; 14:e081625. [PMID: 38670613 PMCID: PMC11057323 DOI: 10.1136/bmjopen-2023-081625] [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: 11/02/2023] [Accepted: 04/12/2024] [Indexed: 04/28/2024] Open
Abstract
Objective The aim of this study was to develop an appraisal tool to support and promote clear, accurate and transparent standards and consistency when conducting, reporting and assessing community-based research. Design Current recommendations for developing reporting guidelines was used with three key differences: (1) an analysis of existing guides, principles and published literature about community engagement, involvement and participation in research using situational and relational maps; (2) feedback and pilot-testing by a community-based research team; and (3) testing the utility and usability of the appraisal tool. Results After a series of iterative revisions, the resulting Community-Partnered Research (CPR) appraisal tool emerged into three products: an elaborate prospective format, a basic retrospective format, and a supplemental checklist format. All three versions of the CPR appraisal tool consist of 11 main question items with corresponding prompts aimed to facilitate awareness, accountability, and transparency about processes and practices employed by professional researchers and community co-researchers throughout four phases of research: (1) partnership and planning, (2) methods, (3) results and (4) sustainment. Conclusion We hope that introducing this tool will contribute to shifting individual and systematic processes and practices towards equitable partnerships, mutual trustworthiness and empowerment among professional researchers and community co-researchers and, in turn, improving the quality of co-created knowledge that benefits communities and creates social change.
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Affiliation(s)
- Avery Park
- University of Washington - Seattle Campus, Seattle, Washington, USA
| | - Jenna van Draanen
- Child, Family, and Population Health Nursing; Health Systems and Population Health, University of Washington, Seattle, Washington, USA
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11
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Mustafa HJ, Barbera JP, Sambatur EV, Pagani G, Yaron Y, Baptiste CD, Wapner RJ, Brewer CJ, Khalil A. Diagnostic yield of exome sequencing in prenatal agenesis of corpus callosum: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:312-320. [PMID: 37519216 DOI: 10.1002/uog.27440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/25/2023] [Accepted: 07/07/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To determine the incremental diagnostic yield of exome sequencing (ES) after negative chromosomal microarray analysis (CMA) in cases of prenatally diagnosed agenesis of the corpus callosum (ACC) and to identify the associated genes and variants. METHODS A systematic search was performed to identify relevant studies published up until June 2022 using four databases: PubMed, SCOPUS, Web of Science and The Cochrane Library. Studies in English reporting on the diagnostic yield of ES following negative CMA in prenatally diagnosed partial or complete ACC were included. Authors of cohort studies were contacted for individual participant data and extended cohorts were provided for two of them. The increase in diagnostic yield with ES for pathogenic/likely pathogenic (P/LP) variants was assessed in all cases of ACC, isolated ACC, ACC with other cranial anomalies and ACC with extracranial anomalies. To identify all reported genetic variants, the systematic review included all ACC cases; however, for the meta-analysis, only studies with ≥ three ACC cases were included. Meta-analysis of proportions was employed using a random-effects model. Quality assessment of the included studies was performed using modified Standards for Reporting of Diagnostic Accuracy criteria. RESULTS A total of 28 studies, encompassing 288 prenatally diagnosed ACC cases that underwent ES following negative CMA, met the inclusion criteria of the systematic review. We classified 116 genetic variants in 83 genes associated with prenatal ACC with a full phenotypic description. There were 15 studies, encompassing 268 cases, that reported on ≥ three ACC cases and were included in the meta-analysis. Of all the included cases, 43% had a P/LP variant on ES. The highest yield was for ACC with extracranial anomalies (55% (95% CI, 35-73%)), followed by ACC with other cranial anomalies (43% (95% CI, 30-57%)) and isolated ACC (32% (95% CI, 18-51%)). CONCLUSIONS ES demonstrated an incremental diagnostic yield in cases of prenatally diagnosed ACC following negative CMA. While the greatest diagnostic yield was observed in ACC with extracranial anomalies and ACC with other central nervous system anomalies, ES should also be considered in cases of isolated ACC. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- H J Mustafa
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children and Indiana University Health Fetal Center, Indianapolis, IN, USA
| | - J P Barbera
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA
| | - E V Sambatur
- Research Division, Houston Center for Maternal Fetal Medicine, Houston, TX, USA
| | - G Pagani
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST-Papa Giovanni XXIII, Bergamo, Italy
| | - Y Yaron
- Prenatal Genetic Diagnosis Unit, Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C D Baptiste
- Obstetrics and Gynecology, Reproductive Genetics, Columbia University Medical Center, New York, NY, USA
| | - R J Wapner
- Obstetrics and Gynecology, Reproductive Genetics, Columbia University Medical Center, New York, NY, USA
| | - C J Brewer
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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12
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Arya R, Jit BP, Kumar V, Kim JJ. Exploring the Potential of Exosomes as Biomarkers in Tuberculosis and Other Diseases. Int J Mol Sci 2024; 25:2885. [PMID: 38474139 DOI: 10.3390/ijms25052885] [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: 01/01/2024] [Revised: 02/23/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024] Open
Abstract
Tuberculosis (TB) is a major cause of morbidity and mortality and remains an important public health issue in developing countries worldwide. The existing methods and techniques available for the diagnosis of TB are based on combinations of laboratory (chemical and biological), radiological, and clinical tests. These methods are sophisticated and laborious and have limitations in terms of sensitivity, specificity, and accuracy. Clinical settings need improved diagnostic biomarkers to accurately detect biological changes due to pathogen invasion and pharmacological responses. Exosomes are membrane-bound vesicles and mediators of intercellular signaling processes that play a significant role in the pathogenesis of various diseases, such as tuberculosis, and can act as promising biomarkers for the monitoring of TB infection. Compared to conventional biomarkers, exosome-derived biomarkers are advantageous because they are easier to detect in different biofluids, are more sensitive and specific, and may be useful in tracking patients' reactions to therapy. This review provides insights into the types of biomarkers, methods of exosome isolation, and roles of the cargo (proteins) present in exosomes isolated from patients through omics studies, such as proteomics. These findings will aid in developing new prognostic and diagnostic biomarkers and could lead to the identification of new therapeutic targets in the clinical setting.
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Affiliation(s)
- Rakesh Arya
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea
| | - Bimal Prasad Jit
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Vijay Kumar
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Jong Joo Kim
- Department of Biotechnology, Yeungnam University, Gyeongsan 38541, Republic of Korea
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13
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Sánchez-Escudero JP, Galvis-Herrera AM, Sánchez-Trujillo D, Torres-López LC, Kennedy CJ, Aguirre-Acevedo DC, Garcia-Barrera MA, Trujillo N. Virtual Reality and Serious Videogame-Based Instruments for Assessing Spatial Navigation in Alzheimer's Disease: A Systematic Review of Psychometric Properties. Neuropsychol Rev 2024:10.1007/s11065-024-09633-7. [PMID: 38403731 DOI: 10.1007/s11065-024-09633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/26/2024] [Indexed: 02/27/2024]
Abstract
Over the past decade, research using virtual reality and serious game-based instruments for assessing spatial navigation and spatial memory in at-risk and AD populations has risen. We systematically reviewed the literature since 2012 to identify and evaluate the methodological quality and risk of bias in the analyses of the psychometric properties of VRSG-based instruments. The search was conducted primarily in July-December 2022 and updated in November 2023 in eight major databases. The quality of instrument development and study design were analyzed in all studies. Measurement properties were defined and analyzed according to COSMIN guidelines. A total of 1078 unique records were screened, and following selection criteria, thirty-seven studies were analyzed. From these studies, 30 instruments were identified. Construct and criterion validity were the most reported measurement properties, while structural validity and internal consistency evidence were the least reported. Nineteen studies were deemed very good in construct validity, whereas 11 studies reporting diagnostic accuracy were deemed very good in quality. Limitations regarding theoretical framework and research design requirements were found in most of the studies. VRSG-based instruments are valuable additions to the current diagnostic toolkit for AD. Further research is required to establish the psychometric performance and clinical utility of VRSG-based instruments, particularly the instrument development, content validity, and diagnostic accuracy for preclinical AD screening scenarios. This review provides a straightforward synthesis of the state of the art of VRSG-based instruments and suggests future directions for research.
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Affiliation(s)
| | | | | | | | - Cole J Kennedy
- Department of Psychology & Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | | | - Mauricio A Garcia-Barrera
- Department of Psychology & Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
| | - Natalia Trujillo
- National College of Public Health, University of Antioquia, Antioquia, Colombia
- Atlantic Fellowship in Equity in Brain Health, Global Brain Health Institute, University of California, San Francisco, CA, USA
- Stempel College of Public Health and Social Work, Florida International University, Miami, FL, USA
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14
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Blause S, Tirelli E, Wauquiez G, Raffard S, Didone V, Willems S. What Information Do Neuropsychologists Use to Guide their Clinical Decisions? A Survey on Knowledge and Application of Evidence-Based Practice in a French-Speaking Population. Arch Clin Neuropsychol 2024; 39:140-156. [PMID: 37551122 DOI: 10.1093/arclin/acad057] [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: 01/26/2023] [Revised: 06/01/2023] [Accepted: 06/29/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE Evidence-based practice (EBP) is an approach that encourages clinicians to base their practice on evidence to improve the quality of patient care and reduce uncertainty in their clinical decisions. However, the state of knowledge and practice of neuropsychologists in French-speaking countries is still unknown. This study aimed to find out what these neuropsychologists know about EBP and whether they use it. METHOD A questionnaire with 39 questions for French-speaking neuropsychologists was distributed. The questions focused on neuropsychologists' knowledge and use of EBP and information that guide their clinical decisions. RESULTS A total of 392 respondents started the survey. The data show that only 35% correctly defined EBP and there was confusion between this practice and the strict use of research data. In practice, their decisions are influenced by multiple factors, including the patient's difficulties and advice from peers. Regarding the research, a significant proportion of the sample stated that they did not search the scientific literature frequently. Barriers to accessing scientific information and ineffective article-reading behavior were highlighted. CONCLUSION A lack of knowledge of EBP among French-speaking neuropsychologists was observed. Furthermore, the factors influencing their decision-making do not clearly fit the definitions of EBP. Information-seeking behaviors show several weaknesses and barriers to the integration of scientific evidence into practice. These results are like those of other studies conducted among psychologists or in other health professions. We will discuss possible courses of action that could be implemented to improve the knowledge and use of EBP.
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Affiliation(s)
- Sacha Blause
- Department of Psychology, University of Liège, Liège, Belgium
| | - Ezio Tirelli
- Department of Psychology, University of Liège, Liège, Belgium
| | - Grégoire Wauquiez
- Rehabilitation Centre, University Hospital Centre Dijon, Dijon, France
| | - Stéphane Raffard
- Department of Psychology, University of Montpellier, Montpellier, France
| | - Vincent Didone
- Department of Psychology, University of Liège, Liège, Belgium
| | - Sylvie Willems
- Department of Psychology, University of Liège, Liège, Belgium
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Gabriel A, Konrad A, Herold N, Horstmann T, Schleip R, Paternoster FK. Testing the Posterior Chain: Diagnostic Accuracy of the Bunkie Test versus the Isokinetic Hamstrings/Quadriceps Measurement in Patients with Self-Reported Knee Pain and Healthy Controls. J Clin Med 2024; 13:1011. [PMID: 38398324 PMCID: PMC10889369 DOI: 10.3390/jcm13041011] [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: 12/18/2023] [Revised: 01/18/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: The isokinetic measurement (IM) of the leg muscles is well established but costly, whereas the Bunkie Test (BT) is a rarely investigated but easy-to-conduct functional test to evaluate the total posterior chain. Although the tests differ in aim and test structures, both have their justification in the assessment process. Therefore, this study evaluated the diagnostic accuracy of the BT and the IM. (2) Methods: 21 participants (9 female, 12 male; age, 26.2 ± 5.26 years; weight 73.8 ± 14.6 kg; height 176.0 ± 9.91 cm) and 21 patients (9 female, 12 male; age, 26.5 ± 5.56 years; weight, 72.6 ± 16.9 kg; height 177.0 ± 10.1 cm) with self-reported pain in the knee performed the IM and the BT. For IM, we calculated the ratio of the knee mean flexor/extensor peak torque (H/Q ratio) for 60°/s and 120°/s, and BT performance was measured in seconds. We classified the IM (<0.6 H/Q ratio) and the BT (leg difference ≥4 s) as binary results according to the literature. We calculated the sensitivity and specificity, which we compared with the Chi-Square test, and the 95% confidence intervals (CI). A p-value of ≤0.05 is considered significant. (3) Results: The sensitivity for the BT was 0.89, 95% CI [0.67, 0.99], and the specificity was 0.52 [0.30, 0.74]. For the IM, the sensitivity was 0.14 [0.03, 0.36] for 60°/s and 0.05 [0.00, 0.24] for 120°/s, and the specificity was 0.70 [0.46, 0.88] for 60°/s and 0.90 [0.68, 0.99] for 120°/s. The results of the Chi-Square tests were significant for the BT (χ2 (1) = 6.17, p = 0.01) but not for the IM (60°/s: χ2 (1) = 0.70, p = 0.40; 120°/s: χ2 (1) = 0.00, p = 0.97). (4) Conclusions: Patients were more likely to obtain a positive test result for the BT but not for the IM.
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Affiliation(s)
- Anna Gabriel
- Department of Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany; (A.G.); (R.S.)
| | - Andreas Konrad
- Institute of Human Movement Science, Sport and Health, Graz University, 8010 Graz, Austria
| | - Nadine Herold
- Department Sport and Health Sciences, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany;
| | - Thomas Horstmann
- Department of Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany; (A.G.); (R.S.)
| | - Robert Schleip
- Department of Conservative and Rehabilitative Orthopedics, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany; (A.G.); (R.S.)
- Department of Medical Professions, Diploma University of Applied Sciences, 37242 Bad Sooden-Allendorf, Germany
| | - Florian K. Paternoster
- Department of Biomechanics in Sports, School of Medicine and Health, Technical University of Munich, 80992 Munich, Germany;
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Boverhof BJ, Redekop WK, Bos D, Starmans MPA, Birch J, Rockall A, Visser JJ. Radiology AI Deployment and Assessment Rubric (RADAR) to bring value-based AI into radiological practice. Insights Imaging 2024; 15:34. [PMID: 38315288 PMCID: PMC10844175 DOI: 10.1186/s13244-023-01599-z] [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: 08/31/2023] [Accepted: 11/14/2023] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE To provide a comprehensive framework for value assessment of artificial intelligence (AI) in radiology. METHODS This paper presents the RADAR framework, which has been adapted from Fryback and Thornbury's imaging efficacy framework to facilitate the valuation of radiology AI from conception to local implementation. Local efficacy has been newly introduced to underscore the importance of appraising an AI technology within its local environment. Furthermore, the RADAR framework is illustrated through a myriad of study designs that help assess value. RESULTS RADAR presents a seven-level hierarchy, providing radiologists, researchers, and policymakers with a structured approach to the comprehensive assessment of value in radiology AI. RADAR is designed to be dynamic and meet the different valuation needs throughout the AI's lifecycle. Initial phases like technical and diagnostic efficacy (RADAR-1 and RADAR-2) are assessed pre-clinical deployment via in silico clinical trials and cross-sectional studies. Subsequent stages, spanning from diagnostic thinking to patient outcome efficacy (RADAR-3 to RADAR-5), require clinical integration and are explored via randomized controlled trials and cohort studies. Cost-effectiveness efficacy (RADAR-6) takes a societal perspective on financial feasibility, addressed via health-economic evaluations. The final level, RADAR-7, determines how prior valuations translate locally, evaluated through budget impact analysis, multi-criteria decision analyses, and prospective monitoring. CONCLUSION The RADAR framework offers a comprehensive framework for valuing radiology AI. Its layered, hierarchical structure, combined with a focus on local relevance, aligns RADAR seamlessly with the principles of value-based radiology. CRITICAL RELEVANCE STATEMENT The RADAR framework advances artificial intelligence in radiology by delineating a much-needed framework for comprehensive valuation. KEYPOINTS • Radiology artificial intelligence lacks a comprehensive approach to value assessment. • The RADAR framework provides a dynamic, hierarchical method for thorough valuation of radiology AI. • RADAR advances clinical radiology by bridging the artificial intelligence implementation gap.
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Affiliation(s)
- Bart-Jan Boverhof
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - W Ken Redekop
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Daniel Bos
- Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Martijn P A Starmans
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Andrea Rockall
- Department of Surgery & Cancer, Imperial College London, London, UK
| | - Jacob J Visser
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Barrios EL, Mazer MB, McGonagill PW, Bergmann CB, Goodman MD, Gould RW, Rao M, Polcz VE, Davis RJ, Del Toro DE, Dirain ML, Dram A, Hale LO, Heidarian M, Kim CY, Kucaba TA, Lanz JP, McCray AE, Meszaros S, Miles S, Nelson CR, Rocha IL, Silva EE, Ungaro RF, Walton AH, Xu J, Zeumer-Spataro L, Drewry AM, Liang M, Bible LE, Loftus TJ, Turnbull IR, Efron PA, Remy KE, Brakenridge SC, Badovinac VP, Griffith TS, Moldawer LL, Hotchkiss RS, Caldwell CC. Adverse outcomes and an immunosuppressed endotype in septic patients with reduced IFN-γ ELISpot. JCI Insight 2024; 9:e175785. [PMID: 38100268 PMCID: PMC10906237 DOI: 10.1172/jci.insight.175785] [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: 09/26/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUNDSepsis remains a major clinical challenge for which successful treatment requires greater precision in identifying patients at increased risk of adverse outcomes requiring different therapeutic approaches. Predicting clinical outcomes and immunological endotyping of septic patients generally relies on using blood protein or mRNA biomarkers, or static cell phenotyping. Here, we sought to determine whether functional immune responsiveness would yield improved precision.METHODSAn ex vivo whole-blood enzyme-linked immunosorbent spot (ELISpot) assay for cellular production of interferon γ (IFN-γ) was evaluated in 107 septic and 68 nonseptic patients from 5 academic health centers using blood samples collected on days 1, 4, and 7 following ICU admission.RESULTSCompared with 46 healthy participants, unstimulated and stimulated whole-blood IFN-γ expression was either increased or unchanged, respectively, in septic and nonseptic ICU patients. However, in septic patients who did not survive 180 days, stimulated whole-blood IFN-γ expression was significantly reduced on ICU days 1, 4, and 7 (all P < 0.05), due to both significant reductions in total number of IFN-γ-producing cells and amount of IFN-γ produced per cell (all P < 0.05). Importantly, IFN-γ total expression on days 1 and 4 after admission could discriminate 180-day mortality better than absolute lymphocyte count (ALC), IL-6, and procalcitonin. Septic patients with low IFN-γ expression were older and had lower ALCs and higher soluble PD-L1 and IL-10 concentrations, consistent with an immunosuppressed endotype.CONCLUSIONSA whole-blood IFN-γ ELISpot assay can both identify septic patients at increased risk of late mortality and identify immunosuppressed septic patients.TRIAL REGISTRYN/A.FUNDINGThis prospective, observational, multicenter clinical study was directly supported by National Institute of General Medical Sciences grant R01 GM-139046, including a supplement (R01 GM-139046-03S1) from 2022 to 2024.
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Affiliation(s)
- Evan L. Barrios
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Monty B. Mazer
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Patrick W. McGonagill
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Christian B. Bergmann
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- University Hospital Ulm, Clinic for Trauma Surgery, Hand, Plastic, and Reconstructive Surgery Albert-Einstein-Allee 23, Ulm, Germany
| | - Michael D. Goodman
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Robert W. Gould
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mahil Rao
- Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Valerie E. Polcz
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ruth J. Davis
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Drew E. Del Toro
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Marvin L.S. Dirain
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Alexandra Dram
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lucas O. Hale
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Mohammad Heidarian
- Interdisciplinary Program in Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Caleb Y. Kim
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Tamara A. Kucaba
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Jennifer P. Lanz
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ashley E. McCray
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Sandra Meszaros
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sydney Miles
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Candace R. Nelson
- Department of Anesthesiology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Ivanna L. Rocha
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Elvia E. Silva
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ricardo F. Ungaro
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Andrew H. Walton
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Julie Xu
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Leilani Zeumer-Spataro
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Anne M. Drewry
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Muxuan Liang
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
- Department of Biostatistics, University of Florida College of Public Health and Health Professions and the University of Florida College of Medicine, Gainesville, Florida, USA
| | - Letitia E. Bible
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Tyler J. Loftus
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Isaiah R. Turnbull
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Philip A. Efron
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kenneth E. Remy
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Scott C. Brakenridge
- Department of Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle, Washington, USA
| | - Vladimir P. Badovinac
- Interdisciplinary Program in Immunology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Experimental Pathology PhD Program, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Thomas S. Griffith
- Department of Urology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Center for Immunology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
- Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA
| | - Lyle L. Moldawer
- Sepsis and Critical Illness Research Center, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Richard S. Hotchkiss
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles C. Caldwell
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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18
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Collins GS, Whittle R, Bullock GS, Logullo P, Dhiman P, de Beyer JA, Riley RD, Schlussel MM. Open science practices need substantial improvement in prognostic model studies in oncology using machine learning. J Clin Epidemiol 2024; 165:111199. [PMID: 37898461 DOI: 10.1016/j.jclinepi.2023.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 10/30/2023]
Abstract
OBJECTIVE To describe the frequency of open science practices in a contemporary sample of studies developing prognostic models using machine learning methods in the field of oncology. STUDY DESIGN AND SETTING We conducted a systematic review, searching the MEDLINE database between December 1, 2022, and December 31, 2022, for studies developing a multivariable prognostic model using machine learning methods (as defined by the authors) in oncology. Two authors independently screened records and extracted open science practices. RESULTS We identified 46 publications describing the development of a multivariable prognostic model. The adoption of open science principles was poor. Only one study reported availability of a study protocol, and only one study was registered. Funding statements and conflicts of interest statements were common. Thirty-five studies (76%) provided data sharing statements, with 21 (46%) indicating data were available on request to the authors and seven declaring data sharing was not applicable. Two studies (4%) shared data. Only 12 studies (26%) provided code sharing statements, including 2 (4%) that indicated the code was available on request to the authors. Only 11 studies (24%) provided sufficient information to allow their model to be used in practice. The use of reporting guidelines was rare: eight studies (18%) mentioning using a reporting guideline, with 4 (10%) using the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis Or Diagnosis statement, 1 (2%) using Minimum Information About Clinical Artificial Intelligence Modeling and Consolidated Standards Of Reporting Trials-Artificial Intelligence, 1 (2%) using Strengthening The Reporting Of Observational Studies In Epidemiology, 1 (2%) using Standards for Reporting Diagnostic Accuracy Studies, and 1 (2%) using Transparent Reporting of Evaluations with Nonrandomized Designs. CONCLUSION The adoption of open science principles in oncology studies developing prognostic models using machine learning methods is poor. Guidance and an increased awareness of benefits and best practices of open science are needed for prediction research in oncology.
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Affiliation(s)
- Gary S Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom.
| | - Rebecca Whittle
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Garrett S Bullock
- Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom
| | - Patricia Logullo
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Paula Dhiman
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Jennifer A de Beyer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Richard D Riley
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Michael M Schlussel
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
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Das S, Dey MK, Devireddy R, Gartia MR. Biomarkers in Cancer Detection, Diagnosis, and Prognosis. SENSORS (BASEL, SWITZERLAND) 2023; 24:37. [PMID: 38202898 PMCID: PMC10780704 DOI: 10.3390/s24010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 01/12/2024]
Abstract
Biomarkers are vital in healthcare as they provide valuable insights into disease diagnosis, prognosis, treatment response, and personalized medicine. They serve as objective indicators, enabling early detection and intervention, leading to improved patient outcomes and reduced costs. Biomarkers also guide treatment decisions by predicting disease outcomes and facilitating individualized treatment plans. They play a role in monitoring disease progression, adjusting treatments, and detecting early signs of recurrence. Furthermore, biomarkers enhance drug development and clinical trials by identifying suitable patients and accelerating the approval process. In this review paper, we described a variety of biomarkers applicable for cancer detection and diagnosis, such as imaging-based diagnosis (CT, SPECT, MRI, and PET), blood-based biomarkers (proteins, genes, mRNA, and peptides), cell imaging-based diagnosis (needle biopsy and CTC), tissue imaging-based diagnosis (IHC), and genetic-based biomarkers (RNAseq, scRNAseq, and spatial transcriptomics).
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Affiliation(s)
| | | | | | - Manas Ranjan Gartia
- Department of Mechanical and Industrial Engineering, Louisiana State University, Baton Rouge, LA 70803, USA; (S.D.); (M.K.D.); (R.D.)
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20
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De Luca D, Loi B, Tingay D, Fiori H, Kingma P, Dellacà R, Autilio C. Surfactant status assessment and personalized therapy for surfactant deficiency or dysfunction. Semin Fetal Neonatal Med 2023; 28:101494. [PMID: 38016825 DOI: 10.1016/j.siny.2023.101494] [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: 11/30/2023]
Abstract
Surfactant is a pivotal neonatal drug used both for respiratory distress syndrome due to surfactant deficiency and for more complex surfactant dysfunctions (such as in case of neonatal acute respiratory distress syndrome). Despite its importance, indications for surfactant therapy are often based on oversimplified criteria. Lung biology and modern monitoring provide several diagnostic tools to assess the patient surfactant status and they can be used for a personalized surfactant therapy. This is desirable to improve the efficacy of surfactant treatment and reduce associated costs and side effects. In this review we will discuss these diagnostic tools from a pathophysiological and multi-disciplinary perspective, focusing on the quantitative or qualitative surfactant assays, lung mechanics or aeration measurements, and gas exchange metrics. Their biological and technical characteristics are described with practical information for clinicians. Finally, available evidence-based data are reviewed, and the diagnostic accuracy of the different tools is compared. Lung ultrasound seems the most suitable tool for assessing the surfactant status, while some other promising tests require further research and/or development.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France; Department of Pediatrics, Division of Neonatology, Stanford University, School of Medicine - Lucile Packard Children's Hospital, Palo Alto, CA, USA.
| | - Barbara Loi
- Division of Pediatrics and Neonatal Critical Care, "Antoine Béclère" Hospital, Paris Saclay University Hospitals, APHP, Paris, France; Physiopathology and Therapeutic Innovation Unit, INSERM U999, Paris Saclay University, Paris, France
| | - David Tingay
- Neonatal Research Unit, Murdoch Children's Research Institute, Parkville, Australia; Department of Pediatrics, University of Melbourne, Melbourne, Australia
| | - Humberto Fiori
- Division of Neonatology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Paul Kingma
- Perinatal Institute, Cincinnati Children's University Hospital Medical Center, Cincinnati, OH, USA
| | - Raffaele Dellacà
- Department of Electronics, Information and Bio-engineering, Polytechnical University of Milan, Milan, Italy
| | - Chiara Autilio
- Department of Biochemistry and Molecular Biology and Research Institute Hospital October 12 (imas12), Faculty of Biology, Complutense University, Madrid, Spain; Clinical Pathology and Microbiology Unit, San Carlo Hospital, Potenza, Italy
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21
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Onwuchekwa C, Atwell J, Moreo LM, Menon S, Machado B, Siapka M, Agarwal N, Rubbrecht M, Aponte-Torres Z, Rozenbaum M, Curcio D, Nair H, Kalina WV, Vroling H, Gessner B, Begier E. Pediatric Respiratory Syncytial Virus Diagnostic Testing Performance: A Systematic Review and Meta-analysis. J Infect Dis 2023; 228:1516-1527. [PMID: 37285396 PMCID: PMC10681870 DOI: 10.1093/infdis/jiad185] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/11/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Adding additional specimen types (eg, serology or sputum) to nasopharyngeal swab (NPS) reverse transcription polymerase chain reaction (RT-PCR) increases respiratory syncytial virus (RSV) detection among adults. We assessed if a similar increase occurs in children and quantified underascertainment associated with diagnostic testing. METHODS We searched databases for studies involving RSV detection in persons <18 years using ≥2 specimen types or tests. We assessed study quality using a validated checklist. We pooled detection rates by specimen and diagnostic tests and quantified performance. RESULTS We included 157 studies. Added testing of additional specimens to NP aspirate (NPA), NPS, and/or nasal swab (NS) RT-PCR resulted in statistically nonsignificant increases in RSV detection. Adding paired serology testing increased RSV detection by 10%, NS by 8%, oropharyngeal swabs by 5%, and NPS by 1%. Compared to RT-PCR, direct fluorescence antibody tests, viral culture, and rapid antigen tests were 87%, 76%, and 74% sensitive, respectively (pooled specificities all ≥98%). Pooled sensitivity of multiplex versus singleplex RT-PCR was 96%. CONCLUSIONS RT-PCR was the most sensitive pediatric RSV diagnostic test. Adding multiple specimens did not substantially increase RSV detection, but even small proportional increases could result in meaningful changes in burden estimates. The synergistic effect of adding multiple specimens should be evaluated.
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Affiliation(s)
| | | | | | - Sonia Menon
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Belen Machado
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | - Mariana Siapka
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
- Impact Epilysis, Thessaloniki, Greece
| | - Neha Agarwal
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
| | | | | | | | | | - Harish Nair
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Hilde Vroling
- P95 Epidemiology and Pharmacovigilance, Leuven, Belgium
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22
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Joseph JO, Ylade M, Daag JV, Aogo R, Crisostomo MV, Mpingabo P, Premkumar L, Deen J, Katzelnick L. High transmission of endemic human coronaviruses before and during the COVID-19 pandemic in adolescents in Cebu, Philippines. RESEARCH SQUARE 2023:rs.3.rs-3581033. [PMID: 38014070 PMCID: PMC10680936 DOI: 10.21203/rs.3.rs-3581033/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND SARS-CoV-2, the causative agent of COVID-19, is a betacoronavirus belonging to the same genus as endemic human coronaviruses (hCoVs) OC43 and HKU1 and is distinct from alpha hCoVs 229E and NL63. In a study of adolescents in the Philippines, we evaluated the seroprevalence to hCoVs, whether pre-pandemic hCoV immunity modulated subsequent risk of SARS-CoV-2 infection, and if SARS-CoV-2 infection affected the transmission of the hCoVs. METHODS From 499 samples collected in 2021 and screened by SARS-CoV-2 receptor binding domain (RBD) enzyme-linked immunosorbent assay (ELISA), we randomly selected 59 SARS-CoV-2 negative and 61 positive individuals for further serological evaluation. We measured RBD and spike antibodies to the four hCoVs and SARS-CoV-2 by ELISA in samples from the same participants collected pre-pandemic (2018-2019) and mid-pandemic (2021), before COVID-19 vaccination. RESULTS We observed over 72% seropositivity to the four hCoVs pre-pandemic. Binding antibodies increased with age to 229E and OC43, suggesting endemic circulation, while immunity was flat across ages for HKU1 and NL63. During the COVID-19 pandemic, antibody level increased significantly to the RBDs of OC43, NL63, and 229E and spikes of all four hCoVs in both SARS-CoV-2 negative and positive adolescents. Those aged 12-15 years old in 2021 had higher antibodies to RBD and spike of OC43, NL63, and 229E than adolescents the same age in 2019, further demonstrating intense transmission of the hCoVs during the pandemic. CONCLUSIONS We observe a limited impact of the COVID-19 pandemic on endemic hCoV transmission. This study provides insight into co-circulation of hCoVs and SARS-CoV-2.
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23
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Yaxley KL, Mulhem A, Godfrey S, Oke JL. The Accuracy of Computed Tomography Angiography Compared With Technetium-99m Labelled Red Blood Cell Scintigraphy for the Diagnosis and Localization of Acute Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. Curr Probl Diagn Radiol 2023; 52:546-559. [PMID: 37271638 DOI: 10.1067/j.cpradiol.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/26/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
Imaging tests are commonly used as an initial or early investigation for patients presenting with suspected acute gastrointestinal bleeding (AGIB). However, controversy remains regarding which of two frequently used modalities, computed tomography angiography (CTA) or technetium-99m labelled red blood cell scintigraphy (RBCS), is most accurate. This systematic review and meta-analysis was performed to compare the accuracy of CTA and RBCS for the detection and localization of AGIB. Five electronic databases were searched with additional manual searching of reference lists of relevant publications identified during the search. Two reviewers independently performed screening, data extraction and methodological assessments. Where appropriate, the bivariate model was used for meta-analysis of sensitivities and specificities for the detection of bleeding and Freeman-Tukey double-arcsine transformation used for meta-analysis of proportions of correctly localized bleeding sites. Forty-four unique primary studies were included: twenty-two investigating CTA, seventeen investigating RBCS and five investigating both modalities. Meta-analysis produced similar pooled sensitivities; 0.83 (95% CI 0.74-0.90) and 0.84 (0.68-0.92) for CTA and RBCS respectively. Pooled specificity for CTA was higher than RBCS; 0.90 (0.72-0.97) and 0.84 (0.71-0.91) respectively. However, differences were not statistically significant. CTA was superior to RBCS in correctly localizing bleeding; pooled proportions of 1.00 (0.98-1.00) and 0.90 (0.83-0.96) respectively (statistically significant difference, P < 0.001). There is no evidence that CTA and RBCS have different diagnostic performance with respect to the detection of AGIB. However, CTA is superior to RBCS in terms of correctly localising the bleeding site, supporting usage of CTA over RBCS as the first line imaging investigation.
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Affiliation(s)
- Kaspar L Yaxley
- University of Oxford, 1 Wellington Square, Oxford, OX1 2JA, UK; Department of Medical Imaging, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
| | - Ali Mulhem
- University of Oxford, 1 Wellington Square, Oxford, OX1 2JA, UK
| | - Sean Godfrey
- University of Oxford, 1 Wellington Square, Oxford, OX1 2JA, UK
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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24
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Aizpurua Galdeano P, González Rodríguez P, Aparicio Rodrigo M, Balado Insunza N, Pérez González E, Ruiz-Canela Cáceres J, Ortega Páez E. Reporting guidelines and a touch of critical appraisal. An Pediatr (Barc) 2023; 99:335-349. [PMID: 37914635 DOI: 10.1016/j.anpede.2023.10.003] [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: 06/13/2023] [Revised: 08/03/2023] [Accepted: 09/04/2023] [Indexed: 11/03/2023] Open
Abstract
The biomedical research process must follow certain quality criteria in its design and development to ensure that the results are credible and reliable. Once completed, the time comes to write an article for publication. The article must present in sufficient detail, and in a clear and transparent manner, all the information on the research work that has been carried out. In this way, readers, after a critical reading of the published content, will be able to judge the validity and relevance of the study and, if they so wish, make use of the findings. In order to improve the description of the research process for publication, a series of guidelines have been developed which, in a simple and structured way, guide authors in the preparation of a manuscript. They are presented in the form of a list, flowchart, or structured text, and are an invaluable aid when writing an article. This article presents the reporting guidelines for the most common designs along with the corresponding checklists.
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Affiliation(s)
| | | | | | | | | | | | - Eduardo Ortega Páez
- Atención Primaria, UGC Góngora, Distrito Granada Metropolitano, Granada, Spain
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25
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Tabatabaei A, Shahsaheb S, Seyyedi A, Salehi R, Pezeshk AF, Blandford L. Observational assessment for determining shoulder fault movements before and after corrective education in participants with chronic shoulder pain: Concurrent validity study. J Hand Ther 2023:S0894-1130(23)00134-5. [PMID: 37858502 DOI: 10.1016/j.jht.2023.09.008] [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: 02/09/2023] [Revised: 09/19/2023] [Accepted: 09/24/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Movement faults (MF), described as the alteration of joint position and motion, are an important factor associated with developing shoulder pathologies. However, determining or predicting the exact MF in participants with shoulder pain is limited by the absence of clinical tools and poor validity. PURPOSE The aim of the study was to determine the validity of using observational assessment to MFs or controlling MFs in subjects with chronic shoulder pain during shoulder elevation and external rotation. STUDY DESIGN Concurrent validity study METHODS: Twenty-seven people with chronic shoulder pain were examined. The index test represented three observational assessments of MF during shoulder external rotation, elevation in the frontal plane, and elevation in the sagittal plane. Three-dimensional motion analysis represented the reference test. The movements of both shoulder joints were evaluated simultaneously, and the index and reference tests were performed concurrently. RESULTS The sensitivity and specificity of observational detection were good to excellent (Se: 77.5%, Sp: 81.5%) for MF and excellent (Se: 85.7%, Sp: 100%) for controlling MF. The positive and negative predictive value was (PPV: 93.9, NPV: 57.1) for MF and (PPV: 100%, NPV: 82.8%) for controlling MF. The result of the positive and negative likelihood ratio was (PLR: 5.4, NLR: 0.26) for MF and (PLR: 0, NLR: 0.18) for controlling MF. CONCLUSIONS The results revealed that the validity of the observational detection approach for identifying MFs was good to excellent. Moreover, the accuracy of this approach in detecting the control of MFs after patient education was excellent. There was good to excellent accuracy in most MFs once classified by their motion trajectories, except for scapula anterior tilt during glenohumeral joint external rotation or elevation.
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Affiliation(s)
- Abbas Tabatabaei
- Mobility and Falls Lab, Department of Physical Therapy, Rehabilitation Science, and Athletic Training, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, USA; Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Shahab Shahsaheb
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aisan Seyyedi
- Department of Physiotherapy, School of Rehabilitation Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Salehi
- Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Farjad Pezeshk
- Associate Professor in Sport Biomechanics, Faculty of Sport Sciences, University of Birjand, Birjand, Iran
| | - Lincoln Blandford
- Faculty of Sport, Allied Health, and Performance Science, St Mary's University, Twickenham, UK; Comera Movement Science, Bristol, UK
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Savva KV, Kawka M, Vadhwana B, Penumaka R, Patton I, Khan K, Perrott C, Das S, Giot M, Mavroveli S, Hanna GB, Ni MZ, Peters CJ. The Biomarker Toolkit - an evidence-based guideline to predict cancer biomarker success and guide development. BMC Med 2023; 21:383. [PMID: 37794461 PMCID: PMC10552368 DOI: 10.1186/s12916-023-03075-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND An increased number of resources are allocated on cancer biomarker discovery, but very few of these biomarkers are clinically adopted. To bridge the gap between Biomarker discovery and clinical use, we aim to generate the Biomarker Toolkit, a tool designed to identify clinically promising biomarkers and promote successful biomarker translation. METHODS All features associated with a clinically useful biomarker were identified using mixed-methodology, including systematic literature search, semi-structured interviews, and an online two-stage Delphi-Survey. Validation of the checklist was achieved by independent systematic literature searches using keywords/subheadings related to clinically and non-clinically utilised breast and colorectal cancer biomarkers. Composite aggregated scores were generated for each selected publication based on the presence/absence of an attribute listed in the Biomarker Toolkit checklist. RESULTS Systematic literature search identified 129 attributes associated with a clinically useful biomarker. These were grouped in four main categories including: rationale, clinical utility, analytical validity, and clinical validity. This checklist was subsequently developed using semi-structured interviews with biomarker experts (n=34); and 88.23% agreement was achieved regarding the identified attributes, via the Delphi survey (consensus level:75%, n=51). Quantitative validation was completed using clinically and non-clinically implemented breast and colorectal cancer biomarkers. Cox-regression analysis suggested that total score is a significant driver of biomarker success in both cancer types (BC: p>0.0001, 95.0% CI: 0.869-0.935, CRC: p>0.0001, 95.0% CI: 0.918-0.954). CONCLUSIONS This novel study generated a validated checklist with literature-reported attributes linked with successful biomarker implementation. Ultimately, the application of this toolkit can be used to detect biomarkers with the highest clinical potential and shape how biomarker studies are designed/performed.
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Affiliation(s)
- Katerina-Vanessa Savva
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - Michal Kawka
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Bhamini Vadhwana
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rahul Penumaka
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Imogen Patton
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Komal Khan
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Claire Perrott
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Saranya Das
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Maxime Giot
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stella Mavroveli
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - George B Hanna
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Melody Zhifang Ni
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christopher J Peters
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
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Sanyal AJ, Shankar SS, Yates KP, Bolognese J, Daly E, Dehn CA, Neuschwander-Tetri B, Kowdley K, Vuppalanchi R, Behling C, Tonascia J, Samir A, Sirlin C, Sherlock SP, Fowler K, Heymann H, Kamphaus TN, Loomba R, Calle RA. Diagnostic performance of circulating biomarkers for non-alcoholic steatohepatitis. Nat Med 2023; 29:2656-2664. [PMID: 37679433 PMCID: PMC10579051 DOI: 10.1038/s41591-023-02539-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/08/2023] [Indexed: 09/09/2023]
Abstract
There are no approved diagnostic biomarkers for at-risk non-alcoholic steatohepatitis (NASH), defined by the presence of NASH, high histological activity and fibrosis stage ≥2, which is associated with higher incidence of liver-related events and mortality. FNIH-NIMBLE is a multi-stakeholder project to support regulatory approval of NASH-related biomarkers. The diagnostic performance of five blood-based panels was evaluated in an observational (NASH CRN DB2) cohort (n = 1,073) with full spectrum of non-alcoholic fatty liver disease (NAFLD). The panels were intended to diagnose at-risk NASH (NIS4), presence of NASH (OWLiver) or fibrosis stages >2, >3 or 4 (enhanced liver fibrosis (ELF) test, PROC3 and FibroMeter VCTE). The prespecified performance metric was an area under the receiver operating characteristic curve (AUROC) ≥0.7 and superiority over alanine aminotransferase for disease activity and the FIB-4 test for fibrosis severity. Multiple biomarkers met these metrics. NIS4 had an AUROC of 0.81 (95% confidence interval: 0.78-0.84) for at-risk NASH. The AUROCs of the ELF test, PROC3 and FibroMeterVCTE for clinically significant fibrosis (≥stage 2), advanced fibrosis (≥stage 3) or cirrhosis (stage 4), respectively, were all ≥0.8. ELF and FibroMeter VCTE outperformed FIB-4 for all fibrosis endpoints. These data represent a milestone toward qualification of several biomarker panels for at-risk NASH and also fibrosis severity in individuals with NAFLD.
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Affiliation(s)
- Arun J Sanyal
- Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
| | | | - Katherine P Yates
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | | | - Raj Vuppalanchi
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cynthia Behling
- Department of Pathology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - James Tonascia
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony Samir
- Center for Ultrasound Research & Translation, Department of Radiology, Massachusetts General Hospital,Harvard Medical School, Boston, MA, USA
| | - Claude Sirlin
- Deptartment of Radiology, University of California San Diego School of Medicine, San Diego, CA, USA
| | | | - Kathryn Fowler
- Deptartment of Radiology, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Helen Heymann
- US Food and Drug Administration, Silver Springs, MD, USA
| | | | - Rohit Loomba
- NAFLD Research Center, Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
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Hamaguchi S, Takahashi S, Endo Y, Nakamoto Y, Aita T, Naganuma T, Nakagawa H, Takada T. Predictive Performance of MRI for Antibiotic Treatment Failure of Pyogenic Vertebral Osteomyelitis: A Validation Study. Cureus 2023; 15:e47933. [PMID: 37908692 PMCID: PMC10613752 DOI: 10.7759/cureus.47933] [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] [Accepted: 10/29/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Intravenous antibiotics are the primary treatment of choice for pyogenic vertebral osteomyelitis (PVO). Surgical intervention is required when the initial antibiotic treatment fails but is often difficult to perform, especially in older adults with multiple comorbidities, because of the reduced physical activity. The size of the infection signal in the spinal bone on magnetic resonance imaging (MRI) at the time of diagnosis was reported to have a high predictive accuracy for antibiotic treatment failure. However, the sample size was too small for this result to be adopted in clinical practice. Thus, we conducted a validation study of the previous research using a larger sample size. METHODS We conducted a retrospective review of electronic medical records of patients admitted to the orthopedic department of a university hospital with a diagnosis of PVO between 2006 and 2021, and consecutively included patients without planned PVO surgery on admission and with a sagittal view of T1-weighted spinal MRI at the time of diagnosis. The index test was the percentage involvement of the affected areas in one motion segment on sagittal MRI. We also evaluated other MRI findings, such as bone destruction, segmental instability, epidural abscesses, and multiple sites for their predictive accuracy for antibiotic treatment failure. RESULTS A total of 82 participants were eligible for the analysis. The presence of ≥90% affected area of one motion segment had a sensitivity of 16.7% and a specificity of 70.3% for future antibiotic treatment failure, resulting in poor predictive performance, with positive (LR+) and negative likelihood ratios of 0.56 and 1.19, respectively. The area under the receiver operating characteristic curve for a 10% increase in the affected area was 0.48. Among the other MRI findings, the presence of bone destruction had a significantly higher predictive accuracy (LR+ 3.11, 95% confidence interval 1.30-7.42). CONCLUSION An infection signal ≥90% on a T1-weighted MRI of one spinal motion segment did not show sufficient predictive performance for antibiotic treatment failure. Spinal bone destruction had a mild-to-moderate predictive accuracy.
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Affiliation(s)
- Sugihiro Hamaguchi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, JPN
| | - Sei Takahashi
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
- Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, JPN
| | - Yuji Endo
- Department of Orthopedic Surgery, Fukushima Medical University, Fukushima, JPN
| | - Yohei Nakamoto
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
| | - Tetsuro Aita
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
| | - Toru Naganuma
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
- Futaba Emergency and General Medicine Support Center, Fukushima Medical University, Fukushima, JPN
| | - Hiroaki Nakagawa
- Department of General Internal Medicine, Fukushima Medical University, Fukushima, JPN
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima, JPN
| | - Toshihiko Takada
- Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa, JPN
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Barrios EA, Mazer MB, McGonagill P, Bergmann CB, Goodman MD, Gould R, Rao M, Polcz V, Davis R, Del Toro D, Dirain M, Dram A, Hale L, Heidarian M, Kucaba TA, Lanz JP, McCray A, Meszaros S, Miles S, Nelson C, Rocha I, Silva EE, Ungaro R, Walton A, Xu J, Zeumer-Spataro L, Drewry A, Liang M, Bible LE, Loftus T, Turnbull I, Efron PA, Remy KE, Brakenridge S, Badovinac VP, Griffith TS, Moldawer LL, Hotchkiss RS, Caldwell CC. Adverse Long-Term Outcomes and an Immune Suppressed Endotype in Sepsis Patients with Reduced Interferon-γELISpot: A Multicenter, Prospective Observational Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.13.23295360. [PMID: 37745385 PMCID: PMC10516075 DOI: 10.1101/2023.09.13.23295360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Sepsis remains a major clinical challenge for which successful treatment requires greater precision in identifying patients at increased risk of adverse outcomes requiring different therapeutic approaches. Predicting clinical outcomes and immunological endotyping of septic patients has generally relied on using blood protein or mRNA biomarkers, or static cell phenotyping. Here, we sought to determine whether functional immune responsiveness would yield improved precision. METHODS An ex vivo whole blood enzyme-linked immunosorbent (ELISpot) assay for cellular production of interferon-γ (IFN-γ) was evaluated in 107 septic and 68 non-septic patients from five academic health centers using blood samples collected on days 1, 4 and 7 following ICU admission. RESULTS Compared with 46 healthy subjects, unstimulated and stimulated whole blood IFNγ expression were either increased or unchanged, respectively, in septic and nonseptic ICU patients. However, in septic patients who did not survive 180 days, stimulated whole blood IFNγ expression was significantly reduced on ICU days 1, 4 and 7 (all p<0.05), due to both significant reductions in total number of IFNγ producing cells and amount of IFNγ produced per cell (all p<0.05). Importantly, IFNγ total expression on day 1 and 4 after admission could discriminate 180-day mortality better than absolute lymphocyte count (ALC), IL-6 and procalcitonin. Septic patients with low IFNγ expression were older and had lower ALC and higher sPD-L1 and IL-10 concentrations, consistent with an immune suppressed endotype. CONCLUSIONS A whole blood IFNγ ELISpot assay can both identify septic patients at increased risk of late mortality, and identify immune-suppressed, sepsis patients.
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Lee OH, Roh JW, Kim Y, Heo SJ, Im E, Cho DK. Invasive physiologic assessment of coronary artery stenosis by resting full-cycle ratio and fractional flow reserve: a prospective observational study. Sci Rep 2023; 13:15783. [PMID: 37737284 PMCID: PMC10516888 DOI: 10.1038/s41598-023-43082-1] [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: 08/07/2023] [Accepted: 09/19/2023] [Indexed: 09/23/2023] Open
Abstract
Resting full-cycle ratio (RFR), an alternative to fractional flow reserve (FFR) for evaluating intermediate coronary artery stenosis, helps reduce patients' time, cost, and discomfort. However, the validation data for RFR and FFR are lacking. We aimed to assess the diagnostic accuracy of RFR and FFR and evaluate effective decision-making for revascularization using their values. Patients subjected to an invasive physiological study for intermediate coronary artery stenosis in Yongin Severance hospital between October 2020 and April 2022 were prospectively and consecutively recruited. We evaluated the correlation between RFR and FFR measurements and the diagnostic performance of RFR (≤ 0.89) versus FFR (≤ 0.80). In all, 474 intermediate coronary stenosis lesions from 400 patients were evaluated using RFR and FFR values. There was a strong linear relationship between RFR and FFR (r = 0.75, 95% CI 0.70-0.78, p < 0.01). Comparing diagnostic performance between RFR and FFR, RFR demonstrated diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 85.0%, 80.0%, 86.7%, 67.1%, and 92.7%, respectively. We analyzed the RFR value in the hyperemia zone (0.86-0.93) according to positive (RFR: 0.86-0.89) and negative (RFR: 0.90-0.93) areas. PPV in positive area is 47.8% (95% Confidence Interval [CI]: 33.8% to 62.0%) and NPV in negative area is 87.7% (95% CI: 80.3% to 93.1%). Excellent correlation exists between RFR and FFR and the diagnostic value of RFR without hyperemia compared with FFR in establishing the accurate functional significance of coronary artery stenosis was shown. RFR alone could evaluate the functional significance of coronary artery stenosis without unnecessary hyperemia, except in the positive area.Trial registration: URL: http://trialsearch.who.int ; Unique identifier: KCT0005255.
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Affiliation(s)
- Oh-Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Ji Woong Roh
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea.
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Eui Im
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea.
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Deng M, Zhao R, Guan R, Li S, Zuo Z, Lin W, Wei W, Guo R. Development of nomograms to predict recurrence after conversion hepatectomy for hepatocellular carcinoma previously treated with transarterial interventional therapy. Eur J Med Res 2023; 28:328. [PMID: 37689775 PMCID: PMC10492285 DOI: 10.1186/s40001-023-01310-4] [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: 01/13/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Lack of opportunity for radical surgery and postoperative tumor recurrence are challenges for surgeons and hepatocellular carcinoma (HCC) patients. This study aimed to develop nomograms to predict recurrence risk and recurrence-free survival (RFS) probability after conversion hepatectomy for patients previously receiving transarterial interventional therapy. METHODS In total, 261 HCC patients who underwent conversion liver resection and previously received transarterial interventional therapy were retrospectively enrolled. Nomograms to predict recurrence risk and RFS were developed, with discriminative ability and calibration evaluated by C-statistics, calibration plots, and the Area under the Receiver Operator Characteristic (AUROC) curves. RESULTS Univariate/multivariable logistic regression and Cox regression analyses were used to identify predictive factors for recurrence risk and RFS, respectively. The following factors were selected as predictive of recurrence: age, tumor number, microvascular invasion (MVI) grade, preoperative alpha-fetoprotein (AFP), preoperative carbohydrate antigen 19-9 (CA19-9), and Eastern Cooperative Oncology Group performance score (ECOG PS). Similarly, age, tumor number, postoperative AFP, postoperative protein induced by vitamin K absence or antagonist-II (PIVKA-II), and ECOG PS were incorporated for the prediction of RFS. The discriminative ability and calibration of the nomograms revealed good predictive ability. Calibration plots showed good agreement between the nomogram predictions of recurrence and RFS and the actual observations. CONCLUSIONS A pair of reliable nomograms was developed to predict recurrence and RFS in HCC patients after conversion resection who previously received transarterial interventional therapy. These predictive models can be used as guidance for clinicians to help with treatment strategies.
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Affiliation(s)
- Min Deng
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Rongce Zhao
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Renguo Guan
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Shaohua Li
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Zhijun Zuo
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Wenping Lin
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Wei Wei
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China
| | - Rongping Guo
- Department of Liver Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou, China.
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng East Road, Guangzhou, China.
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Mustafa HJ, Sambatur EV, Barbera JP, Pagani G, Yaron Y, Baptiste CD, Wapner RJ, Khalil A. Diagnostic yield with exome sequencing in prenatal severe bilateral ventriculomegaly: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:101048. [PMID: 37311485 DOI: 10.1016/j.ajogmf.2023.101048] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/05/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study aimed to determine the incremental diagnostic yield of prenatal exome sequencing after negative chromosomal microarray analysis results in prenatally diagnosed bilateral severe ventriculomegaly or hydrocephalus; another objective was to categorize the associated genes and variants. DATA SOURCES A systematic search was performed to identify relevant studies published until June 2022 using 4 databases (Cochrane Library, Web of Science, Scopus, and MEDLINE). STUDY ELIGIBILITY CRITERIA Studies in English reporting on the diagnostic yield of exome sequencing following negative chromosomal microarray analysis results in cases of prenatally diagnosed bilateral severe ventriculomegaly were included. METHODS Authors of cohort studies were contacted for individual participant data, and 2 studies provided their extended cohort data. The incremental diagnostic yield of exome sequencing was assessed for pathogenic/likely pathogenic findings in cases of: (1) all severe ventriculomegaly; (2) isolated severe ventriculomegaly (as the only cranial anomaly); (3) severe ventriculomegaly with other cranial anomalies; and (4) nonisolated severe ventriculomegaly (with extracranial anomalies). To be able to identify all reported genetic associations, the systematic review portion was not limited to any minimal severe ventriculomegaly case numbers; however, for the synthetic meta-analysis, we included studies with ≥3 severe ventriculomegaly cases. Meta-analysis of proportions was done using a random-effects model. Quality assessment of the included studies was performed using the modified STARD (Standards for Reporting of Diagnostic Accuracy Studies) criteria. RESULTS A total of 28 studies had 1988 prenatal exome sequencing analyses performed following negative chromosomal microarray analysis results for various prenatal phenotypes; this included 138 cases with prenatal bilateral severe ventriculomegaly. We categorized 59 genetic variants in 47 genes associated with prenatal severe ventriculomegaly along with their full phenotypic description. There were 13 studies reporting on ≥3 severe ventriculomegaly cases, encompassing 117 severe ventriculomegaly cases that were included in the synthetic analysis. Of all the included cases, 45% (95% confidence interval, 30-60) had positive pathogenic/likely pathogenic exome sequencing results. The highest yield was for nonisolated cases (presence of extracranial anomalies; 54%; 95% confidence interval, 38-69), followed by severe ventriculomegaly with other cranial anomalies (38%; 95% confidence interval, 22-57) and isolated severe ventriculomegaly (35%; 95% confidence interval, 18-58). CONCLUSION There is an apparent incremental diagnostic yield of prenatal exome sequencing following negative chromosomal microarray analysis results in bilateral severe ventriculomegaly. Although the greatest yield was found in cases of nonisolated severe ventriculomegaly, consideration should also be given to performing exome sequencing in cases of isolated severe ventriculomegaly as the only brain anomaly identified on prenatal imaging.
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Affiliation(s)
- Hiba J Mustafa
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN (Dr Mustafa); Fetal Center at Riley Children's Health, Indiana University Health, Indianapolis, IN (Dr Mustafa).
| | - Enaja V Sambatur
- Research Division, Houston Center for Maternal Fetal Medicine, Houston, TX (Ms Sambatur)
| | - Julie P Barbera
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA (Ms Barbera)
| | - Giorgio Pagani
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST Papa Giovanni XXIII, Bergamo, Italy (Dr Pagani)
| | - Yuval Yaron
- Prenatal Genetic Diagnosis Unit, Genetics Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (Dr Yaron); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (Dr Yaron)
| | - Caitlin D Baptiste
- Division of Women's Genetics, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Baptiste and Wapner)
| | - Ronald J Wapner
- Division of Women's Genetics, Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY (Drs Baptiste and Wapner)
| | - Asma Khalil
- Fetal Medicine Unit, St George's Hospital, St George's University of London, London, United Kingdom (Dr Khalil); Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom (Dr Khalil)
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Phua QS, Lu L, White SJ, To MS. Systematic review of adherence to the standards for reporting of diagnostic accuracy studies (STARD) 2015 reporting guideline in cerebral aneurysm imaging diagnostic accuracy studies. J Clin Neurosci 2023; 115:89-94. [PMID: 37541083 DOI: 10.1016/j.jocn.2023.07.021] [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: 03/12/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Diagnostic neuroimaging plays an essential role in guiding clinical decision-making in the management of patients with cerebral aneurysms. Imaging technologies for investigating cerebral aneurysms constantly evolve, and clinicians rely on the published literature to remain up to date. Reporting guidelines have been developed to standardise and strengthen the reporting of clinical evidence. Therefore, it is essential that radiological diagnostic accuracy studies adhere to such guidelines to ensure completeness of reporting. Incomplete reporting hampers the reader's ability to detect bias, determine generalisability of study results or replicate investigation parameters, detracting from the credibility and reliability of studies. OBJECTIVE The purpose of this systematic review was to evaluate adherence to the Standards for Reporting of Diagnostic Accuracy Studies (STARD) 2015 reporting guideline amongst imaging diagnostic accuracy studies for cerebral aneurysms. METHODS A systematic search for cerebral aneurysm imaging diagnostic accuracy studies was conducted. Journals were cross examined against the STARD 2015 checklist and their compliance with item numbers was recorded. RESULTS The search yielded 66 articles. The mean number of STARD items reported was 24.2 ± 2.7 (71.2% ± 7.9%), with a range of 19 to 30 out of a maximum number of 34 items. CONCLUSION Taken together, these results indicate that adherence to the STARD 2015 guideline in cerebral aneurysm imaging diagnostic accuracy studies was moderate. Measures to improve compliance include mandating STARD 2015 adherence in instructions to authors issued by journals.
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Affiliation(s)
- Qi Sheng Phua
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Lucy Lu
- College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
| | - Samuel J White
- Robinson Research Institute, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia.
| | - Minh-Son To
- South Australia Medical Imaging, Flinders Medical Centre, Bedford Park, SA 5042, Australia; Flinders Health and Medical Research Institute, Flinders University, Bedford Park, SA 5042, Australia
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Ochwo S, Perez AM, Pérez Aguirreburualde MS. Beyond accuracy: leveraging ASSURED criteria for field evaluation of point-of-care tests for food animal diseases. Front Vet Sci 2023; 10:1239111. [PMID: 37720479 PMCID: PMC10500061 DOI: 10.3389/fvets.2023.1239111] [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: 03/14/2023] [Accepted: 08/18/2023] [Indexed: 09/19/2023] Open
Abstract
The growing availability of point-of-care tests (POCTs) for food-animal diseases offers opportunities for timely diagnosis, facilitating the efficient implementation of control measures. However, field assessment of new POCTs are yet to be standardized. This paper discusses the opportunity of expanding the current approach for the evaluation and validation of POCTs in food animal disease diagnosis, highlighting the limitations of traditional practice that primarily relies on estimating diagnostic accuracy (sensitivity and specificity). Here, the use of a protocol referred to as FIT-REASSURED, a modified framework combining the ASSURED and REASSURED criteria, is proposed to comprehensively assess POCTs. FIT-REASSURED encompasses key criteria such as fitness for purpose, real-time connectivity, ease of specimen collection, affordability, sensitivity, specificity, user-friendliness, rapidity and robustness, equipment-free operation, and deliverability. By incorporating these attributes, FIT-REASSURED provides a customizable approach to assess the accuracy, affordability, and utility of POCTs. Through collaborative efforts among stakeholders, the implementation of a standardized scorecard based on these FIT-REASSURED criteria can improve the reliability and practicality of POCTs in food-animal health.
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Affiliation(s)
- Sylvester Ochwo
- Center for Animal Health and Food Safety, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
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Mori H, Harada-Shirado K, Kawano N, Hayakawa M, Seki Y, Uchiyama T, Yamakawa K, Ishikura H, Irie Y, Nishio K, Yada N, Okamoto K, Ikezoe T. Net reclassification index in comparison of prognostic value of disseminated intravascular coagulation diagnostic criteria by Japanese Society on Thrombosis and Hemostasis and International Society on Thrombosis and Haemostasis: a multicenter prospective cohort study. Thromb J 2023; 21:84. [PMID: 37544993 PMCID: PMC10405497 DOI: 10.1186/s12959-023-00523-1] [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: 01/10/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND We compared the prognostic value of the Japanese Society on Thrombosis and Hemostasis (JSTH) disseminated intravascular coagulation (DIC) diagnostic criteria with that of the International Society on Thrombosis and Haemostasis (ISTH) DIC diagnostic criteria for 28-day in-hospital mortality. METHODS We conducted a multicenter prospective cohort study involving two hematology departments, four emergency departments, and one general medicine department in Japan between August 2017 and July 2021. We assessed three ISTH DIC diagnostic criteria categories using low cutoff levels of D-dimer (low D-dimer), high cutoff levels of D-dimer (high D-dimer), and fibrinogen/fibrin degradation products (FDP) as fibrin-related markers. The main outcome was diagnosis-based category additive net reclassification index (NRI). RESULTS A total of 222 patients were included: 82 with hematopoietic disorders, 86 with infections, and 54 with other diseases. The 28-day in-hospital mortality rate was 14% (n = 31). The DIC rates diagnosed by the JSTH, ISTH-low D-dimer, high D-dimer, and FDP DIC diagnosis were 52.7%, 47.3%, 42.8%, and 27.0%, respectively. The overall category additive NRI by JSTH DIC diagnosis vs. ISTH-low D-dimer, high D-dimer, and FDP DIC diagnosis were - 10 (95% confidence interval [CI]: -28 to 8, p = 0.282), - 7.8 (95% CI: -26 to 10, p = 0.401), and - 11 (95% CI: -26 to 3, p = 0.131), respectively. CONCLUSIONS JSTH criterion showed the highest sensitivity for DIC diagnosis that did not improve but reflected the same prognostic value for mortality evaluated using ISTH DIC diagnosis criteria. This finding may help clinicians to use JSTH DIC criterion as an early intervention strategy in patients with coagulopathy.
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Affiliation(s)
- Hirotaka Mori
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295 Fukushima Japan
| | - Kayo Harada-Shirado
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295 Fukushima Japan
| | - Noriaki Kawano
- Department of Hematology, Miyazaki Prefectural Miyazaki Hospital, 5-30 Kita Takamatsu- machi, Miyazaki, 880-8510 Miyazaki Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, N14W5, Kita-ku, Sapporo, 060-8648 Hokkaido Japan
| | - Yoshinobu Seki
- Department of Hematology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Urasa, Minamiuonuma-shi, Niigata, 4132, 949-7302 Japan
| | - Toshimasa Uchiyama
- Department of Laboratory Medicine, National Hospital Organization Takasaki General Medical Center, 36 Takamatsu-cho, Takasaki, 370-0829 Gunma Japan
| | - Kazuma Yamakawa
- Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686 Osaka Japan
| | - Hiroyasu Ishikura
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180 Fukuoka Japan
| | - Yuhei Irie
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Fukuoka University, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180 Fukuoka Japan
| | - Kenji Nishio
- Department of General Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Nara Japan
| | - Noritaka Yada
- Department of General Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522 Nara Japan
| | - Kohji Okamoto
- Department of Surgery, Kitakyushu City Yahata Hospital, 2-6-2 Ogura Yahatahigashi-ku, Kitakyushu, 805-8534 Fukuoka Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295 Fukushima Japan
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Sanyal AJ, Castera L, Wong VWS. Noninvasive Assessment of Liver Fibrosis in NAFLD. Clin Gastroenterol Hepatol 2023; 21:2026-2039. [PMID: 37062495 DOI: 10.1016/j.cgh.2023.03.042] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/06/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) has emerged as a leading cause of liver-related morbidity and mortality worldwide, afflicting approximately a billion individuals. NAFLD is a slowly progressive disease that may evolve in a subset of patients toward cirrhosis, hepatocellular carcinoma, and end-stage liver disease. Liver fibrosis severity is the strongest predictor of clinical outcomes. The emergence of effective therapeutics on the horizon highlights the need to identify among patients with NAFLD, those with severe fibrosis or cirrhosis, who are the most at risk of developing complications and target them for therapy. Liver biopsy has been the reference standard for this purpose. However, it is not suitable for large-scale population evaluation, given its well-known limitations (invasiveness, rare but severe complications, and sampling variability). Thus, there have been major efforts to develop simple noninvasive tools that can be used in routine clinical settings and in drug development. Noninvasive approaches are based on the quantification of biomarkers in serum samples or on the measurement of liver stiffness, using either ultrasound- or magnetic resonance-based elastography techniques. This review provides a roadmap for future development and integration of noninvasive tools in clinical practice and in drug development in NAFLD. We discuss herein the principles for their development and validation, their use in clinical practice, including for diagnosis of NAFLD, risk stratification in primary care and hepatology settings, prediction of long-term liver-related and non-liver-related outcomes, monitoring of fibrosis progression and regression, and response to future treatment.
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Affiliation(s)
- Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia.
| | - Laurent Castera
- UMR1149 (Center of Research on Inflammation), French Institute of Health and Medical Research, Université Paris Cité, Paris, France; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France.
| | - Vincent Wai-Sun Wong
- State Key Laboratory of Digestive Disease, Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China; Medical Data Analytics Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
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Sharif-Nia H, Froelicher ES, Hejazi S, Moshtagh M, Goudarzian AH, Ebrahimi F. Cross-Cultural Evaluation of the Psychometric Properties of the Spiritual Well-Being Scale: A Systematic Review. JOURNAL OF RELIGION AND HEALTH 2023; 62:2226-2251. [PMID: 36864237 DOI: 10.1007/s10943-023-01778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 06/19/2023]
Abstract
Since spiritual well-being has a significant role in individual and social health, using a valid scale to identify these properties is essential. Comparing factor structure and differences in the number of dimensions and items of subscales could be an indicator of differences in individuals' attitudes toward spirituality among diverse cultures. The present review was performed for psychometric evaluation of the spiritual well-being measures. A systematic review of international databases and Iranian databases was conducted to evaluate studies published between January 1, 1970, and October 1, 2022. QUADAS-2, STARD, and COSMIN scales were used for risk of bias assessment. Following two rounds of screening, 14 articles entered quality assessment. According to the results, studies examining the factor structure of the spiritual well-being scale (SWBS) instrument have been conducted for the years 1998 to 2022. The mean age of the participants in these studies ranged from 20.8 to 79.08 years. During the process of exploratory factor analysis, the researchers reported the presence of two to five latent factors, and the range of explained variance was between 35.6 and 71.4%. However, most of the reports indicated the existence of two or three latent factors. The findings of the present study provide an image of the psychometric status of the SWBS for researchers and clinicians in this field and can help them make optimum decisions in selecting a scale or conducting additional psychometric studies or adopting this scale for studies in new populations.
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Affiliation(s)
- Hamid Sharif-Nia
- Traditional and Complementary Medicine Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran
- Department of Nursing, Amol Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Erika Sivarajan Froelicher
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sima Hejazi
- Department of Nursing, Bojnurd Faculty of Nursing, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mozhgan Moshtagh
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Faezeh Ebrahimi
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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Mariani A, Zaanan A, Rebibo L, Martin G, Taieb J, Karoui M. A systematic review of minimal length of lroximal margin in gastric adenocarcinoma resection. Langenbecks Arch Surg 2023; 408:172. [PMID: 37133626 DOI: 10.1007/s00423-023-02910-8] [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: 11/29/2022] [Accepted: 04/24/2023] [Indexed: 05/04/2023]
Abstract
For early distal gastric cancers, a proximal margin (PM) > 2-3 cm might probably be sufficient. For advanced tumors, many confounding factors have a prognostic impact on survival and recurrence and negative margin involvement may be more relevant than negative margin length. INTRODUCTION In gastric cancer surgery, microscopic positive margin is a poor prognostic factor whereas complete resection with tumor-free margins remains a challenging issue. European guidelines recommended a macroscopic margin of 5 or even 8 cm for diffuse-type cancers to achieve R0 resection. However, it is unclear if the length of negative proximal margin (PM) could have a prognostic impact on survival. We aimed to perform a systematic review of the literature analyzing PM length and its prognostic impact in gastric adenocarcinoma. MATERIAL AND METHODS Pubmed and Embase databases were searched for "gastric cancer" or "gastric adenocarcinoma," combined with "proximal margin," between January 1990 and June 2021. English-written studies that specified PM length were included. Survival data, in relation to PM, were extracted. RESULTS Twelve retrospective studies, with a total number of 10,067 patients, met inclusion criteria and were analyzed. Mean length of proximal margin on the whole population varied from 2.6 to 5.29 cm. Three studies found minimal PM cut-off to improve overall survival in univariate analysis. Concerning recurrence-free survival analysis, only 2 series showed better results with PM > 2 or > 3 cm, using Kaplan-Meier method. Multivariate analysis demonstrated an independent impact of PM on overall survival in 2 studies. CONCLUSION For early distal gastric cancers, a PM > 2-3 cm might probably be sufficient. For advanced or proximal tumors, many confounding factors have a prognostic impact on survival and recurrence and negative margin involvement may be more relevant than negative margin length.
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Affiliation(s)
- Antoine Mariani
- Université Paris Cité, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Georges Pompidou University Hospital, Paris, France.
| | - Aziz Zaanan
- Department of Digestive Oncology, Georges Pompidou University Hospital, Paris, France
| | - Lionel Rebibo
- Université Paris Cité, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Georges Pompidou University Hospital, Paris, France
| | - Grégory Martin
- Université Paris Cité, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Georges Pompidou University Hospital, Paris, France
| | - Julien Taieb
- Department of Digestive Oncology, Georges Pompidou University Hospital, Paris, France
| | - Mehdi Karoui
- Université Paris Cité, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Georges Pompidou University Hospital, Paris, France
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Toure A, Toure L, Acapovi-Yao GL, Senin CBV, Kone N, Kachani M, Couacy-Hymann E. Diagnostic accuracy of swine echinococcosis cytopathological tests and challenges for a differential diagnosis: slaughterhouse data. Helminthologia 2023; 60:52-62. [PMID: 37305668 PMCID: PMC10251756 DOI: 10.2478/helm-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/12/2022] [Indexed: 06/13/2023] Open
Abstract
Echinococcosis disease shows clinical signs similar to many diseases. Hence we report cases that need to be confirmed using appropriate tests. A confirmatory study has been conducted to assess the accuracy of two cytopathological tests, with the histopathology test as the reference standard. The first cytopathological test evaluates the Ziehl Neelsen staining with an epifluorescence microscope (cytopath 1). The second cytopathological test uses the same staining followed by a transmitted light microscope examination (cytopath 2). Of a total of 2524 inspected pigs, 101 suspected cases of echinococcosis were detected, of which 67 were found positive with the two cytopathological tests and the histopathological one. The specificity of cytopath 1 (100 % [95 % CI 100 - 100]) and cytopath 2 (100 % [95 % CI 100;100]) were similar, as well as their respective positive predictive values: 100 % [95 % CI 100 - 100] vs. 100 % [95 % CI 100 - 100]. The sensitivity of cytopath 1 is 79.66 % [95 % CI 69.39 - 89.93], while cytopath 2 equals 66.10 % [95 % CI 54.02 - 78.18]. The difference in sensitivity of both tests was not significant. Negative predictive values found for cytopath 1, and cytopath 2 were 40 [95 % CI 18.53 - 61.47] and 28.57 [95 % CI 11.84 - 45.3], leading to the Generalized Estimating Equations (GEE) Model estimate for an odds ratio of 1.4 [95 % CI 0.41 - 5.2], p = 0.06. Cytopath 1 and cytopath 2 are equivalent in terms of specificity (100 % [95 % CI 100 - 100] vs. 100 % [95 % CI 100;100]) and positive predictive value (100 % [95 % CI 100 - 100]. Cytopath 1 is more sensitive than cytopath 2 but not significant (79.66 % [ 95 % CI 69.39 - 89.93] vs. 66.10 % [95 % CI 54.02 - 78.18]). However, the negative predictive value of cytopath 1 is better than that of cytopath 2: 40 % [95 % CI 18.53 - 61.47] vs. 28.57 % [95 % CI 11.84 - 45.3].
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Affiliation(s)
- A Toure
- LANADA: Laboratoire Central Vétérinaire de Bingerville. Bp: 206 Bingerville, Côte d'Ivoire; Current affiliation of the first author: Université Nangui Abrogoua / UFR Sciences de la Nature, 02 Bp 801 Abidjan 02, Côte d'Ivoire
| | - L Toure
- Université Felix Houphouët Boigny/ UFR Biosciences, Abidjan, Côte d'Ivoire, 22 Bp 582 Abidjan 22, Abidjan, Côte d'Ivoire
| | - G L Acapovi-Yao
- Université Felix Houphouët Boigny/ UFR Biosciences, Abidjan, Côte d'Ivoire, 22 Bp 582 Abidjan 22, Abidjan, Côte d'Ivoire
| | - C B V Senin
- SIVAC: Société Ivoirienne d'Abattage et de Charcuterie 22 Bp 1147 Abidjan 22, Abidjan, Côte d'Ivoire
| | - N Kone
- Université Felix Houphouët Boigny/ UFR Biosciences, Abidjan, Côte d'Ivoire, 22 Bp 582 Abidjan 22, Abidjan, Côte d'Ivoire
| | - M Kachani
- Current address: Western University, United States of America
| | - E Couacy-Hymann
- LANADA: Laboratoire Central Vétérinaire de Bingerville. Bp: 206 Bingerville, Côte d'Ivoire; Current affiliation of the first author: Université Nangui Abrogoua / UFR Sciences de la Nature, 02 Bp 801 Abidjan 02, Côte d'Ivoire
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O’Caoimh R. Validation of the Risk Instrument for Screening in the Community ( RISC) among Older Adults in the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3734. [PMID: 36834429 PMCID: PMC9966437 DOI: 10.3390/ijerph20043734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Although several short-risk-prediction instruments are used in the emergency department (ED), there remains insufficient evidence to guide healthcare professionals on their use. The Risk Instrument for Screening in the Community (RISC) is an established screen comprising three Likert scales examining the risk of three adverse outcomes among community-dwelling older adults at one-year: institutionalisation, hospitalisation, and death, which are scored from one (rare/minimal) to five (certain/extreme) and combined into an Overall RISC score. In the present study, the RISC was externally validated by comparing it with different frailty screens to predict risk of hospitalisation (30-day readmission), prolonged length of stay (LOS), one-year mortality, and institutionalisation among 193 consecutive patients aged ≥70 attending a large university hospital ED in Western Ireland, assessed for frailty, determined by comprehensive geriatric assessment. The median LOS was 8 ± 9 days; 20% were re-admitted <30 days; 13.5% were institutionalised; 17% had died; and 60% (116/193) were frail. Based on the area under the ROC curve scores (AUC), the Overall RISC score had the greatest diagnostic accuracy for predicting one-year mortality and institutionalisation: AUC 0.77 (95% CI: 0.68-0.87) and 0.73 (95% CI: 0.64-0.82), respectively. None of the instruments were accurate in predicting 30-day readmission (AUC all <0.70). The Overall RISC score had good accuracy for identifying frailty (AUC 0.84). These results indicate that the RISC is an accurate risk-prediction instrument and frailty measure in the ED.
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Affiliation(s)
- Rónán O’Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland; ; Tel.: +353-21-420-5976
- Clinical Research Facility Cork, Mercy University Hospital, University College Cork, T12 WE28 Cork, Ireland
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Liu Q, Song H, Yan M, Ding Y, Wang Y, Chen L, Yin H. Virtual reality technology in the detection of mild cognitive impairment: A systematic review and meta-analysis. Ageing Res Rev 2023; 87:101889. [PMID: 36806377 DOI: 10.1016/j.arr.2023.101889] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 02/07/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND In recent years, virtual reality technology has developed the potential to help in the early detection of mild cognitive impairment (MCI). However, integrative evidence of its detection performance for mild cognitive impairment is lacking, and meta-analysis or systematic reviews are required to further determine the effectiveness of virtual reality technology in screening for MCI. METHODS Literature searches were performed for MCI screening tests in the Cochrane Library, Web of Science, PsycINFO, PubMed, EMBASE, CINAHL, and Scopus. The primary outcome was the performance of VR tests for MCI detection. A protocol for this systematic review was registered in PROSPERO (Registration number: CRD42022302139). RESULTS A total of 14 studies in 13 reports were eventually included. The combined data with the bivariate random-effects model gave a summary point of 0.89 sensitivity (95 % confidence interval [CI]: 0.82-0.94) and 0.91 specificity (95 % CI: 0.82-0.96). The SROC curve was plotted, the DOR was 79.25 (95 % CI: 22.59-277.99), and the AUC was 0.95 (95 % CI: 0.93-0.97). CONCLUSIONS Virtual reality-based tests have shown considerable detection performance in detecting MCI, and therefore, virtual reality-based tests can serve as recommended screening methods. Future studies can consider longitudinal assessment and follow-up programs to identify progressive changes.
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Affiliation(s)
- Qian Liu
- Jilin University School of Nursing, Changchun, China.
| | - Huali Song
- The First Hospital of Jilin University, Changchun, China.
| | - Mingli Yan
- Jilin University School of Nursing, Changchun, China.
| | - Yiwen Ding
- Jilin University School of Nursing, Changchun, China.
| | - Yinuo Wang
- Jilin University School of Nursing, Changchun, China.
| | - Li Chen
- Jilin University School of Nursing, Changchun, China.
| | - Huiru Yin
- Jilin University School of Nursing, Changchun, China.
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Mavragani A, Ozoude MM, Williams KS, Sadiq-Onilenla RA, Ojo SA, Wasarme LB, Walsh S, Edomwande M. The Need to Prioritize Model-Updating Processes in Clinical Artificial Intelligence (AI) Models: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e37685. [PMID: 36795464 PMCID: PMC9982723 DOI: 10.2196/37685] [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: 03/02/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND With an increase in the number of artificial intelligence (AI) and machine learning (ML) algorithms available for clinical settings, appropriate model updating and implementation of updates are imperative to ensure applicability, reproducibility, and patient safety. OBJECTIVE The objective of this scoping review was to evaluate and assess the model-updating practices of AI and ML clinical models that are used in direct patient-provider clinical decision-making. METHODS We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist and the PRISMA-P protocol guidance in addition to a modified CHARMS (Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies) checklist to conduct this scoping review. A comprehensive medical literature search of databases, including Embase, MEDLINE, PsycINFO, Cochrane, Scopus, and Web of Science, was conducted to identify AI and ML algorithms that would impact clinical decision-making at the level of direct patient care. Our primary end point is the rate at which model updating is recommended by published algorithms; we will also conduct an assessment of study quality and risk of bias in all publications reviewed. In addition, we will evaluate the rate at which published algorithms include ethnic and gender demographic distribution information in their training data as a secondary end point. RESULTS Our initial literature search yielded approximately 13,693 articles, with approximately 7810 articles to consider for full reviews among our team of 7 reviewers. We plan to complete the review process and disseminate the results by spring of 2023. CONCLUSIONS Although AI and ML applications in health care have the potential to improve patient care by reducing errors between measurement and model output, currently there exists more hype than hope because of the lack of proper external validation of these models. We expect to find that the AI and ML model-updating methods are proxies for model applicability and generalizability on implementation. Our findings will add to the field by determining the degree to which published models meet the criteria for clinical validity, real-life implementation, and best practices to optimize model development, and in so doing, reduce the overpromise and underachievement of the contemporary model development process. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37685.
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Affiliation(s)
| | | | | | | | - Soji Akin Ojo
- Pharmaceutical Product Development (PPD), Thermo Fisher Scientific, Wilmington, NC, United States
| | | | - Samantha Walsh
- Levy Library, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Stahl AC, Tietz AS, Kendziora B, Dewey M. Has the STARD statement improved the quality of reporting of diagnostic accuracy studies published in European Radiology? Eur Radiol 2023; 33:97-105. [PMID: 35907025 PMCID: PMC9362582 DOI: 10.1007/s00330-022-09008-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 06/19/2022] [Accepted: 06/30/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To investigate whether encouraging authors to follow the Standards for Reporting Diagnostic Accuracy (STARD) guidelines improves the quality of reporting of diagnostic accuracy studies. METHODS In mid-2017, European Radiology started encouraging its authors to follow the STARD guidelines. Our MEDLINE search identified 114 diagnostic accuracy studies published in European Radiology in 2015 and 2019. The quality of reporting was evaluated by two independent reviewers using the revised STARD statement. Item 11 was excluded because a meaningful decision about adherence was not possible. Student's t test for independent samples was used to analyze differences in the mean number of reported STARD items between studies published in 2015 and in 2019. In addition, we calculated differences related to the study design, data collection, and citation rate. RESULTS The mean total number of reported STARD items for all 114 diagnostic accuracy studies analyzed was 15.9 ± 2.6 (54.8%) of 29 items (range 9.5-22.5). The quality of reporting of diagnostic accuracy studies was significantly better in 2019 (mean ± standard deviation (SD), 16.3 ± 2.7) than in 2015 (mean ± SD, 15.1 ± 2.3; p < 0.02). No significant differences in the reported STARD items were identified in relation to study design (p = 0.13), data collection (p = 0.87), and citation rate (p = 0.09). CONCLUSION The quality of reporting of diagnostic accuracy studies according to the STARD statement was moderate with a slight improvement since European Radiology started to recommend its authors to follow the STARD guidelines. KEY POINTS • The quality of reporting of diagnostic accuracy studies was moderate with a mean total number of reported STARD items of 15.9 ± 2.6. • The adherence to STARD was significantly better in 2019 than in 2015 (16.3 ± 2.7 vs. 15.1 ± 2.3; p = 0.016). • No significant differences in the reported STARD items were identified in relation to study design (p = 0.13), data collection (p = 0.87), and citation rate (p = 0.09).
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Affiliation(s)
- Ann-Christine Stahl
- Department of Radiology, Charité - Universitätsmedizin Berlin, joint Medical Faculty of Humboldt-Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Anne-Sophie Tietz
- Department of Radiology, Charité - Universitätsmedizin Berlin, joint Medical Faculty of Humboldt-Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
| | - Benjamin Kendziora
- Department of Dermatology and Allergy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Marc Dewey
- Department of Radiology, Charité - Universitätsmedizin Berlin, joint Medical Faculty of Humboldt-Universität zu Berlin and Freie Universität Berlin, Berlin, Germany
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Schmidt F, Kohlbrenner D, Malesevic S, Huang A, Klein SD, Puhan MA, Kohler M. Mapping the landscape of lung cancer breath analysis: A scoping review (ELCABA). Lung Cancer 2023; 175:131-140. [PMID: 36529115 DOI: 10.1016/j.lungcan.2022.12.003] [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: 10/19/2022] [Revised: 11/23/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022]
Abstract
Lung cancer is the leading cause of cancer death worldwide due to its late-stage detection. Lung cancer screening, including low-dose computed tomography (low-dose CT), provides an initial clinical solution. Nevertheless, further innovations and refinements would help to alleviate remaining limitations. The non-invasive, gentle, and fast nature of breath analysis (BA) makes this technology highly attractive to supplement low-dose CT for an improved screening algorithm. However, BA has not taken hold in everyday clinical practice. One reason might be the heterogeneity and variety of BA methods. This scoping review is a comprehensive summary of study designs, breath analytical methods, and suggested biomarkers in lung cancer. Furthermore, this synthesis provides a framework with core outcomes for future studies in lung cancer BA. This work supports future research for evidence synthesis, meta-analysis, and translation into clinical routine workflows.
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Affiliation(s)
- Felix Schmidt
- University of Zurich, Faculty of Medicine, Zurich, Switzerland; University Hospital Zurich, Department of Pulmonology, Zurich, Switzerland.
| | - Dario Kohlbrenner
- University of Zurich, Faculty of Medicine, Zurich, Switzerland; University Hospital Zurich, Department of Pulmonology, Zurich, Switzerland
| | - Stefan Malesevic
- University of Zurich, Faculty of Medicine, Zurich, Switzerland; University Hospital Zurich, Department of Pulmonology, Zurich, Switzerland
| | - Alice Huang
- University Hospital Zurich, Department of Medical Oncology and Hematology, Zurich, Switzerland
| | - Sabine D Klein
- University of Zurich, University Library, Zurich, Switzerland
| | - Milo A Puhan
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zurich, Switzerland
| | - Malcolm Kohler
- University of Zurich, Faculty of Medicine, Zurich, Switzerland; University Hospital Zurich, Department of Pulmonology, Zurich, Switzerland; University of Zurich, Zurich Centre for Integrative Human Physiology, Zurich, Switzerland
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Dalic LJ, Warren AEL, Spiegel C, Thevathasan W, Roten A, Bulluss KJ, Archer JS. Paroxysmal fast activity is a biomarker of treatment response in deep brain stimulation for Lennox-Gastaut syndrome. Epilepsia 2022; 63:3134-3147. [PMID: 36114808 PMCID: PMC10946931 DOI: 10.1111/epi.17414] [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: 06/18/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Epilepsy treatment trials typically rely on seizure diaries to determine seizure frequency, but these are time-consuming and difficult to maintain accurately. Fast, reliable, and objective biomarkers of treatment response are needed, particularly in Lennox-Gastaut syndrome (LGS), where high seizure frequency and comorbid cognitive and behavioral issues are additional obstacles to accurate diary-keeping. Here, we measured generalized paroxysmal fast activity (GPFA), a key interictal electrographic feature of LGS, and correlated GPFA burden with seizure diaries during a thalamic deep brain stimulation (DBS) treatment trial (Electrical Stimulation of the Thalamus in Epilepsy of Lennox-Gastaut Phenotype [ESTEL]). METHODS GPFA and electrographic seizure counts from intermittent, 24-h electroencephalograms (EEGs) were compared to 3-month diary-recorded seizure counts in 17 young adults with LGS (mean age ± SD = 24.9 ± 6.6) in the ESTEL study, a randomized clinical trial of DBS lasting 12 months (comprising a 3-month baseline and 9 months of postimplantation follow-up). RESULTS Baseline median seizures measured by diaries numbered 2.6 (interquartile range [IQR] = 1.4-5) per day, compared to 284 (IQR = 120.5-360) electrographic seizures per day, confirming that diaries capture only a small fraction of seizure burden. Across all patient EEGs, the average number of GPFA discharges per hour of sleep was 138 (IQR =72-258). GPFA duration and frequency, quantified over 2-h windows of sleep EEG, were significantly associated with diary-recorded seizure counts over 3-month intervals (p < .001, η2 p = .30-.48). For every GPFA discharge, there were 20-25 diary seizures witnessed over 3 months. There was high between-patient variability in the ratio between diary seizure burden and GPFA burden; however, within individual patients, the ratio was similar over time, such that the percentage change from pre-DBS baseline in seizure diaries strongly correlated with the percentage change in GPFA. SIGNIFICANCE When seeking to optimize treatment in patients with LGS, monitoring changes in GPFA may allow rapid titration of treatment parameters, rather than waiting for feedback from seizure diaries.
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Affiliation(s)
- Linda J. Dalic
- Department of Medicine, Austin HealthUniversity of MelbourneHeidelbergVictoriaAustralia
- Department of Neurology, Austin HealthHeidelbergVictoriaAustralia
| | - Aaron E. L. Warren
- Department of Medicine, Austin HealthUniversity of MelbourneHeidelbergVictoriaAustralia
- The Florey Institute of Neuroscience and Mental HealthHeidelbergVictoriaAustralia
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
| | - Chloe Spiegel
- Department of Neurology, Austin HealthHeidelbergVictoriaAustralia
| | - Wesley Thevathasan
- Department of Medicine, Austin HealthUniversity of MelbourneHeidelbergVictoriaAustralia
- Bionics InstituteEast MelbourneVictoriaAustralia
- Department of MedicineUniversity of Melbourne, and Department of Neurology, Royal Melbourne HospitalParkvilleVictoriaAustralia
| | - Annie Roten
- Department of Neurology, Austin HealthHeidelbergVictoriaAustralia
| | - Kristian J. Bulluss
- Bionics InstituteEast MelbourneVictoriaAustralia
- Department of Neurosurgery, Austin HealthHeidelbergVictoriaAustralia
- Department of SurgeryUniversity of MelbourneParkvilleVictoriaAustralia
| | - John S. Archer
- Department of Medicine, Austin HealthUniversity of MelbourneHeidelbergVictoriaAustralia
- Department of Neurology, Austin HealthHeidelbergVictoriaAustralia
- The Florey Institute of Neuroscience and Mental HealthHeidelbergVictoriaAustralia
- Murdoch Children's Research InstituteParkvilleVictoriaAustralia
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Altenbernd JC, Fischer S, Scharbrodt W, Schimrigk S, Eyding J, Nordmeyer H, Wohlert C, Dörner N, Li Y, Wrede K, Pierscianek D, Köhrmann M, Frank B, Forsting M, Deuschl C. CT and DSA for evaluation of spontaneous intracerebral lobar bleedings. Front Neurol 2022; 13:956888. [PMID: 36262835 PMCID: PMC9574012 DOI: 10.3389/fneur.2022.956888] [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: 05/30/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose This study retrospectively examined the extent to which computed tomography angiography (CTA) and digital subtraction angiography (DSA) can help identify the cause of lobar intracerebral bleeding. Materials and methods In the period from 2002 to 2020, data from patients who were >18 years at a university and an academic teaching hospital with lobar intracerebral bleeding were evaluated retrospectively. The CTA DSA data were reviewed separately by two neuroradiologists, and differences in opinion were resolved by consensus after discussion. A positive finding was defined as an underlying vascular etiology of lobar bleeding. Results The data of 412 patients were retrospectively investigated. DSA detected a macrovascular cause of bleeding in 125/412 patients (33%). In total, sixty patients had AVMs (15%), 30 patients with aneurysms (7%), 12 patients with vasculitis (3%), and 23 patients with dural fistulas (6%). The sensitivity, specificity, positive and negative predictive values, and accuracy of CTA compared with DSA were 93, 97, 100, and 97%. There were false-negative CTA readings for two AVMs and one dural fistula. Conclusion The DSA is still the gold standard diagnostic modality for detecting macrovascular causes of ICH; however, most patients with lobar ICH can be investigated first with CTA, and the cause of bleeding can be found. Our results showed higher sensitivity and specificity than those of other CTA studies.
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Affiliation(s)
- Jens-Christian Altenbernd
- Department of Radiology, Gemeinschaftskrankenhaus, Herdecke, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
- *Correspondence: Jens-Christian Altenbernd
| | | | | | | | - Jens Eyding
- Department of Neurology, Gemeinschaftskrankenhaus, Herdecke, Germany
| | | | - Christine Wohlert
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Nils Dörner
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Yan Li
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | | | - Martin Köhrmann
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Benedikt Frank
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
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Dalic LJ, Warren AE, Malpas CB, Thevathasan W, Roten A, Bulluss KJ, Archer JS. Cognition, adaptive skills and epilepsy disability/severity in patients with Lennox–Gastaut syndrome undergoing deep brain stimulation for epilepsy in the ESTEL trial. Seizure 2022; 101:67-74. [DOI: 10.1016/j.seizure.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/25/2022] [Accepted: 07/24/2022] [Indexed: 11/28/2022] Open
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Murphy RM, Tasoulas J, Porrello A, Carper MB, Tsai YH, Coffey AR, Kumar S, Zeng PYF, Schrank TP, Midkiff BR, Cohen S, Salazar AH, Hayward MC, Hayes DN, Olshan A, Gupta GP, Nichols AC, Yarbrough WG, Pecot CV, Amelio AL. Tumor Cell Extrinsic Synaptogyrin 3 Expression as a Diagnostic and Prognostic Biomarker in Head and Neck Cancer. CANCER RESEARCH COMMUNICATIONS 2022; 2:987-1004. [PMID: 36148399 PMCID: PMC9491693 DOI: 10.1158/2767-9764.crc-21-0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 04/15/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022]
Abstract
Over 70% of oropharyngeal head and neck squamous cell carcinoma (HNSC) cases in the United States are positive for human papillomavirus (HPV) yet biomarkers for stratifying oropharyngeal head and neck squamous cell carcinoma (HNSC) patient risk are limited. We used immunogenomics to identify differentially expressed genes in immune cells of HPV(+) and HPV(-) squamous carcinomas. Candidate genes were tested in clinical specimens using both quantitative RT-PCR and IHC and validated by IHC using the Carolina Head and Neck Cancer Study (CHANCE) tissue microarray of HNSC cases. We performed multiplex immunofluorescent staining to confirm expression within the immune cells of HPV(+) tumors, receiver operating characteristic (ROC) curve analyses, and assessed survival outcomes. The neuronal gene Synaptogyrin-3 (SYNGR3) is robustly expressed in immune cells of HPV(+) squamous cancers. Multiplex immunostaining and single cell RNA-seq analyses confirmed SYNGR3 expression in T cells, but also unexpectedly in B cells of HPV(+) tumors. ROC curve analyses revealed that combining SYNGR3 and p16 provides more sensitivity and specificity for HPV detection compared to p16 IHC alone. SYNGR3-high HNSC patients have significantly better prognosis with five-year OS and DSS rates of 60% and 71%, respectively. Moreover, combining p16 localization and SYNGR3 expression can further risk stratify HPV(+) patients such that high cytoplasmic, low nuclear p16 do significantly worse (Hazard Ratio, 8.6; P = 0.032) compared to patients with high cytoplasmic, high nuclear p16. SYNGR3 expression in T and B cells is associated with HPV status and enhanced survival outcomes of HNSC patients.
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Affiliation(s)
- Ryan M. Murphy
- Graduate Curriculum in Pharmacology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jason Tasoulas
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alessandro Porrello
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Miranda B. Carper
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yi-Hsuan Tsai
- Bioinformatics Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Alisha R. Coffey
- Bioinformatics Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Sunil Kumar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Technology Development, Naveris Inc., Natick, Massachusetts
| | - Peter YF. Zeng
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada
| | - Travis P. Schrank
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Bentley R. Midkiff
- Pathology Services Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stephanie Cohen
- Pathology Services Core, Lineberger Comprehensive Cancer Center, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ashley H. Salazar
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michele C. Hayward
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - D. Neil Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Center for Cancer Research, University of Tennessee Health Sciences, Memphis, Tennessee
| | - Andrew Olshan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gaorav P. Gupta
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Radiation Oncology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Anthony C. Nichols
- Department of Otolaryngology - Head and Neck Surgery, University of Western Ontario, London, Ontario, Canada
- Department of Oncology, University of Western Ontario, London, Ontario, Canada
| | - Wendell G. Yarbrough
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Otolaryngology/Head and Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
- Department of Pathology and Lab Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Chad V. Pecot
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Antonio L. Amelio
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Cancer Cell Biology Program, Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Du J, Shao MM, Yi FS, Huang ZY, Qiao X, Chen QY, Shi HZ, Zhai K. Interleukin 32 as a Potential Marker for Diagnosis of Tuberculous Pleural Effusion. Microbiol Spectr 2022; 10:e0255321. [PMID: 35880892 PMCID: PMC9430160 DOI: 10.1128/spectrum.02553-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 07/08/2022] [Indexed: 01/13/2023] Open
Abstract
Accurate differential diagnosis is the key to choosing the correct treatment for pleural effusion. The present study aimed to assess whether interleukin 32 (IL-32) could be a new biomarker of tuberculous pleural effusion (TPE) and to explore the biological role of IL-32 in TPE. IL-32 levels were evaluated in the pleural effusions of 131 patients with undetermined pleural effusion from Wuhan and Beijing cohorts using an enzyme-linked immunosorbent assay method. Macrophages from TPE patients were transfected with IL-32-specific small interfering RNA (siRNA), and adenosine deaminase (ADA) expression was determined by real-time PCR and colorimetric methods. With a cutoff value of 247.9 ng/mL, the area under the curve of the receiver operating characteristic (ROC) curve for IL-32 was 0.933 for TPE, and the sensitivity and specificity were 88.4% and 93.4%, respectively. A multivariate logistic regression model with relatively good diagnostic performance was established. IL-32-specific siRNA downregulated ADA expression in macrophages, and IL-32γ treatment significantly induced ADA expression. Our results indicate that IL-32 in pleural effusion may be a novel biomarker for identifying patients with TPE. In addition, our multivariate model is acceptable to rule in or rule out TPE across diverse prevalence settings. Furthermore, IL-32 may modulate ADA expression in the tuberculosis microenvironment. (This study has been registered at ChiCTR under registration number ChiCTR2100051112 [https://www.chictr.org.cn/index.aspx].) IMPORTANCE Tuberculous pleural effusion (TPE) is a common form of extrapulmonary tuberculosis, with manifestations ranging from benign effusion with spontaneous absorption to effusion with pleural thickening, empyema, and even fibrosis, which can lead to a lasting impairment of lung function. Therefore, it is of great significance to find a rapid method to establish early diagnosis and apply antituberculosis therapy in the early stage. This study indicates that interleukin 32 (IL-32) in pleural effusion is a new high-potency marker to distinguish TPE from pleural effusions with other etiologies. A multivariate model combining age, adenosine deaminase (ADA), lactic dehydrogenase, and IL-32 may reliably rule in TPE in intermediate- or high-prevalence areas. Additionally, we observed that IL-32 might regulate ADA expression in macrophages in the tuberculosis microenvironment. Therefore, this study provides new insights into the role of IL-32 in the tuberculosis microenvironment.
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Affiliation(s)
- Juan Du
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
| | - Ming-Ming Shao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
| | - Feng-Shuang Yi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
| | - Zhong-Yin Huang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
| | - Xin Qiao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
| | - Qing-Yu Chen
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
| | - Huan-Zhong Shi
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
| | - Kan Zhai
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Clinical Center for Pleural Diseases, Capital Medical University, Beijing, China
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Determining the correct resection level in patients with Hirschsprung disease using contrast enema and full thickness biopsies: Can the diagnostic accuracy be improved by examining submucosal nerve fiber thickness? J Pediatr Surg 2022:S0022-3468(22)00555-3. [PMID: 36180266 DOI: 10.1016/j.jpedsurg.2022.08.019] [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: 06/20/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intraoperative resection level in patients with Hirschsprung disease (HD) is determined by contrast enema, surgeon's intraoperative judgement and full thickness biopsy (FTB) identifying ganglia. This study aims to evaluate diagnostic accuracy of contrast enema and FTB in determination of resection level and whether this can be improved by measuring submucosal nerve fiber diameter. METHODS We retrospectively analyzed contrast enema and intraoperative FTBs obtained in our center, determining diagnostic accuracy for level of resection. Gold standard was pathological examination of resection specimen. Secondly, we matched transition zone pull-through (TZPT) patients with non-TZPT patients, based on age and length of resected bowel, to blindly compare nerve fibers diameters between two groups using group comparison. RESULTS From 2000-2021, 209 patients underwent HD surgery of whom 180 patients (138 males; median age at surgery: 13 weeks) with 18 TZPTs (10%) were included. Positive predictive value of contrast enema was 65.1%. No caliber change was found in patients with total colon aganglionosis (TCA). Negative predictive value of surgeon's intraoperative judgement and FTB in determining resection level was 79.0% and 90.0% (91.2% single-stage, 84.4% two-stage surgery) respectively. Mean nerve fiber diameter in TZPT was 25.01 µm (SD= 5.63) and in non-TZPT 24.35 µm (SD= 6.75) (p = 0.813). CONCLUSION Determination of resection level with combination of contrast enema, surgeon's intraoperative judgement and FTB results in sufficient diagnostic accuracy in patients with HD. If no caliber change is seen with contrast enema, TCA should be considered. Resection level or transition zone cannot be determined by assessment of submucosal nerve fiber diameter in FTB. TYPE OF STUDY clinical research paper.
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