The diagnosis of gallbladder (GB) lesions relies on imaging findings. Transpapillary cholangioscopy can potentially be used to diagnose GB lesions; however, the images obtained remain unclear. This study aimed to characterize the endoscopic findings of GB lesions. We examined the endoscopic features of GB lesions in 50 consecutive patients who underwent cholecystectomy. GB specimens were obtained immediately following cholecystectomy, opened on the side opposite the liver bed, and flushed with saline solution. Each lesion was assessed using a high-resolution endoscope equipped with white light and narrow-band imaging magnification. For elevated lesions, both the surface structure (classified as regular, irregular, or absent) and vascular structure (dilation, meandering, caliber change, non-uniformity, and loose vessel areas) were assessed. Twelve of the 50 patients had elevated lesions, including cholesterol polyp (n = 4), hyperplastic polyp (n = 1), xanthogranulomatous cholecystitis (n = 1), and GB carcinoma (n = 6). Advanced GB carcinoma, as opposed to T1 GB carcinoma, demonstrated a papillary surface with destructive areas and neovascularization on narrow-band imaging magnification. Endoscopic images of each GB lesion were characterized, and the differences between GB carcinomas and benign lesions were identified. This preliminary classification may contribute to innovative imaging diagnosis and targeted biopsy for diagnosing GB lesions under direct vision.

A 'gray color sign' (GCS) is a new endoscopic feature of fundic gland polyp associated with proton pump inhibitor (PPI-FGP). Here, we compare the ability of texture and color enhancement imaging (TXI) to white light imaging (WLI) with regard to the detection of GCS.

In this prospective study, 19 consecutive patients with PPI-FGP were enrolled at our hospital from April 2021 to October 2022. Endoscopic images of PPI-FGP using WLI, TXI mode1 (TXI-1), TXI mode2 (TXI-2), and narrow-band imaging (NBI) were collected and compared by 10 endoscopists. Visibility of GCS by each mode (Image enhancement endoscopy) was scored as follows: 5, improved; 4, somewhat improved; 3, equivalent; 2, somewhat decreased; and 1, decreased. The inter-rater reliability (intra-class correlation coefficient, ICC) was also evaluated. The images were objectively evaluated based on L* a* b* color values and the color difference (ΔE*) in the CIE LAB color space system.

Improved visibility of GCS compared with WLI was achieved for: TXI-1: 82.6%, TXI-2: 86.9%, and NBI: 0% for all endoscopists. Total visibility scores were: TXI-1, 44.9; TXI-2, 42.9; NBI, 17.4 for all endoscopists. Visibility scores were significantly higher using TXI-1 and TXI-2 compared with NBI (p < 0.01). The inter-rater reliability for TXI-1 and TXI-2 was "excellent" for all endoscopists. The use of ΔE* revealed statistically significant differences between WLI and TXI-1 (p < 0.01).

TXI is an improvement over WLI for the visualization of GCS, and can be used by both trainee and expert endoscopists with equal efficiency and accuracy.

Introduction: Research on internet-interventions for youth with post-traumatic stress symptoms (PTSS) is limited, despite promising results in adults. A non-randomised feasibility study of a therapist-guided trauma-focused internet- and mobile-based intervention (IMI) showed potential in reducing PTSS but revealed challenges with adherence and individual fit. Insights from qualitative studies can enhance intervention quality by addressing personal needs. This study explores participants' views on the feasibility of a therapist-guided trauma-focused IMI to improve digital trauma interventions.Methods: Semi-structured interviews based on theoretical models of acceptance and human support in IMIs were conducted with 17 of 32 participants from a self-help-based trauma-focused IMI with therapist guidance. Audio-recorded interviews were transcribed and analyzed using deductive-inductive content analysis. Independent coding resulted in good agreement (κ = .76).Results: 20 themes were identified and organised under nine dimensions: participation motivation and expectations; recruitment process; treatment adherence and everyday use of therapeutic exercises; trauma processing; non-trauma processing intervention components; technology, structure, and design of the IMI; human support; individual fit; and active factors and efficacy. The technology, structure, and design of the IMI and other non-trauma-focused components were rated positively. Trauma processing presented challenges for many but was still perceived as a helpful and relevant active factor. Some felt a lack of therapeutic support, and greater personalisation of guidance was a frequent suggestion for improving the individual fit. The IMI's efficacy was most often perceived in its effects on improved coping with trauma and symptoms.Discussion: The study identified key themes for the feasibility of a trauma-focused IMI for youth, showing general acceptance of its design, structure, and technology. While trauma processing in IMIs poses challenges similar to face-to-face therapy, these can be addressed by clarifying the therapy rationale, making trauma processing an important active factor. Further research is needed to improve individualisation and therapeutic support intensity.Trial registration: German Clinical Trials Register identifier: DRKS00023341..

Background: The International Trauma Interview (ITI) is a clinician-administered assessment that has been newly developed for the International Classification of Diseases (ICD-11) diagnoses of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD).Objective: The current study evaluated the psychometric properties of the ITI for treatment-seeking people with adverse childhood experiences (ACE) in South Korea, with the aims of verifying the validity and reliability of ITI as well as examining the differentiation of ICD-11 CPTSD and borderline personality disorder (BPD).Methods: In total, data of 103 people were analysed. Clinical psychologists conducted the ITI and the structured interview for BPD. Along with the International Trauma Questionnaire (ITQ), self-report measurements on ACE, adulthood trauma, emotion dysregulation, dissociation, depression, adult attachment, BPD symptoms, self-harm, self-compassion, and quality of life were collected. A confirmatory factor analysis (CFA) was conducted to examine the factorial validity and a structural equation model (SEM) was used to evaluate the convergent and discriminant validity.Results: The CFA supported the second-order two-factor model of ICD-11 CPTSD. However, we determined that the alternatively suggested second-order two-factor model of reexperience avoidance combined PTSD and DSO described the data the best. As was hypothesized, ITI PTSD and DSO showed convergent and discriminant validity, and ITI DSO also showed distinctive features with BPD. Interrater reliability and composite reliability were both found to be acceptable. Agreement and consistency between ITQ and ITI were also fair although tentative.Conclusions: The ITI is determined to be a valid and reliable method for the assessment and diagnosis of ICD-11 PTSD and CPTSD, and it is considered to be promising for the differential diagnosis of BPD in South Korean treatment-seeking people with ACE. Future research should aim to assess the agreement between ITI and ITQ while also seeking alternative criteria for ITI PTSD across variant trauma memory features.

Background: The International Trauma Interview (ITI) is a structured clinician-administered measure developed to assess posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined in the 11th version of the International Classification of Diseases (ICD-11). This study aimed to investigate a psychometric evaluation of the ITI and to finalise the English language version.Method: The latent structure, internal consistency, interrater agreement, and convergent and discriminant validity were evaluated with data from a convenience sample, drawn from an existing research cohort, of 131 trauma exposed participants from the United Kingdom reporting past diagnosis for PTSD or who had screened positively for traumatic stress symptoms. A range of self-report measures evaluating depression, panic, insomnia, dissociation, emotion dysregulation, negative cognitions about self, interpersonal functioning and general wellbeing were completed.Results: Confirmatory factor analysis supported an adjusted second-order two-factor model of PTSD and disturbances in self-organisation (DSO) symptoms, allowing affect dysregulation to also load onto the PTSD factor, over alternative models. The ITI scores showed acceptable internal consistency, and interrater reliability was strong. Findings for convergent and discriminant validity were mostly as predicted for PTSD and DSO domains. Correlations with the ITQ were good but coefficients for the level of agreement of PTSD diagnosis and CPTSD diagnosis between the ITI and the ITQ were weaker, and item level agreement was variable.Conclusion: Results provide support for the reliability and validity of the ITI as a measure of ICD-11 PTSD and CPTSD. Final revisions of the ITI are described.

Achieving optimal implant position and orientation during total knee arthroplasty (TKA) is a pivotal factor in long-term survival. Computer-assisted navigation (CAN) has been recognized as a trusted technology that improves the accuracy and consistency of femoral and tibial bone cuts. Imageless CAN offers advantages over image-based CAN by reducing cost, radiation exposure, and time. The purpose of this study was to evaluate the accuracy of an imageless optical navigation system for TKA in a clinical setting. Forty-two consecutive patients who underwent primary TKA with CAN were retrospectively reviewed. Femoral and tibial component coronal alignment was assessed via post-operative radiographs by two independent reviewers and compared against coronal alignment angles from the CAN. The primary outcome was the mean absolute difference of femoral and tibial varus/valgus angles between radiograph and intra-operative device measurements. Bland-Altman plots were used to assess agreement between the methods and statistically analyze potential systematic bias. The mean absolute differences between navigation-guided cut measurements and post-operative radiographs were 1.16 ± 1.03° and 1.76 ± 1.38° for femoral and tibial alignment respectively. About 88% of coronal measurements were within ±3°, while 99% were within ±5°. Bland-Altman analysis demonstrated a bias between CAN and radiographic measurements with CAN values averaging 0.52° (95% CI: 0.11°-0.93°) less than their paired radiographic measurements. This study demonstrated the ability of an optical imageless navigation system to measure, on average, femoral and tibial coronal cuts to within 2.0° of post-operative radiographic measurements in a clinical setting.

Digital vaginal examination (DVE) is a commonly used method in delivery wards to monitor the progress of labor, but it is considered uncomfortable by pregnant women and can lead to infectious complications, such as chorioamnionitis. At the same time, the performance of intrapartum ultrasonography (IPU) is increasing. IPU has a higher inter-observer and intra-observer agreement than DVE. In this study, we evaluated the agreement between IPU and DVE measurements performed by midwives trained in ultrasonography and a specialist obstetrician. Using these data, we assessed the feasibility of midwives administering IPU in delivery rooms for fetal head station and position and cervical dilation.

This prospective study was conducted on the delivery ward at a tertiary healthcare hospital between 1 March and 1 May 2021. The study included women with low-risk pregnancies with a singleton vertex presentation who were admitted to the delivery ward after 37 weeks of gestation. The two midwives underwent a theoretical and practical training program on patients led by an expert obstetric consultant. Cervical dilation, fetal head station and position were recorded through IPU and DVE measurements conducted by two midwives and one expert obstetrician. Cohen's kappa with squared weights was used to assess the agreement between observers. The discomfort score during the examinations was also obtained from the pregnant women and recorded (0 = no discomfort, 10 = very uncomfortable).

The study included 196 pregnant women. There was mostly moderate or substantial agreement between the midwives and obstetric consultant in the variables of cervical dilation, fetal head level and position determined by DVE. In all IPU measurements, these agreements were perfect among all observers. While the intra-observer agreement of the obstetric consultant in IPU and DVE was perfect, in midwives, it was analyzed as substantial in cervical dilation, fair and moderate in the head station, and moderate and perfect in head position. The mean discomfort scores of the pregnant women due to IPU and DVE were 2.89 ± 1.49 and 5.98 ± 2.02, respectively. The differences in discomfort scores between the two examinations were detected to be statistically significant (p < 0.001).

IPU can be used by midwives in delivery wards to accurately determine the fetal head position and station and cervical dilation without causing discomfort to pregnant women.

Individuals born preterm are at increased risk for bone deficits given that the majority of skeletal mineral accrual occurs during the final gestational trimester. It is unclear how preterm birth affects bone density with aging or if individuals born preterm have increased rates of osteoporosis. This systematic review and meta-analysis summarizes the current data on bone mineral content and density measured by dual-energy x-ray absorptiometry (DXA) at any time across the lifespan after preterm birth in generally healthy, appropriate size for gestational age individuals. Three databases, including PubMed, Scopus, and CINAHL, were searched using keywords related to preterm birth and skeletal mineralization. Total body, lumbar spine, and femoral neck were the most frequently reported DXA measurement sites. A total of 39 studies (145 comparisons) were included in the meta-analyses, with bone outcomes measured within days of birth through about 30 years of age, depending on the measurement site. Preterm birth was associated with reduced bone mineral content and density. The largest total body bone deficits were observed in preterm individuals who were less than one year of age, with greater variability observed during childhood and adolescence. Individuals born preterm in the oldest cohort (17-30 years) maintained deficits in bone mineral density as they approached the age of peak bone mass. Importantly, there were no DXA studies of preterm individuals beyond 30 years of age, so it remains unclear how preterm birth affects the skeleton with advanced aging.

Our purpose is to assess the inter-rater agreement between digital mammography (DM) and contrast-enhanced spectral mammography (CESM) in evaluating the Breast Imaging Reporting and Data System (BI-RADS) grading.

This retrospective study included 326 patients recruited between January 2019 and February 2021. The study protocol was pre-registered on the Open Science Framework platform. Two expert radiologists interpreted the CESM and DM findings. Pathological data are used for radiologically suspicious or malignant-appearing lesions, whereas follow-up was considered the gold standard for benign-appearing lesions and breasts without lesions.

For intra-device agreement, both imaging modalities showed "almost perfect" agreement, indicating that different radiologists are expected to report the same BI-RADS score for the same image. Despite showing a similar interpretation, a paired t -test showed significantly higher agreement for CESM compared with DM ( p < 0.001 ). Subgrouping based on the side or view did not show a considerable difference for both imaging modalities. For inter-device agreement, "almost perfect" agreement was also achieved. However, for proven malignant lesions, an overall higher BI-RADS score was achieved for CESM, whereas for benign or normal breasts, a lower BI-RADS score was reported, indicating a more precise BI-RADS classification for CESM compared with DM.

Our findings demonstrated strong agreement among readers regarding the identification of DM and CESM findings in breast images from various views. Moreover, it indicates that CESM is equally precise compared with DM and can be used as an alternative in clinical centers.

The breadth and depth of Uncrewed Aerial Vehicle (UAV) operations are expanding at a considerable rate. With expansion comes challenges for the design of automation to support decision making. This research takes the perceptual cycle model (PCM) and the derived trust version of the Schema World Action Research Method (T-SWARM), to identify the issues and challenges of pilot intervention in UAVs operating during highly automated states. Nine UAV pilots with current experience operating medium to large UAVs were interviewed, using T-SWARM, about incidents in which they initiated an intervention in system operation (i.e. to avoid weather or collision) and an event where the system initiated the intervention (i.e. due to system failure). The coded responses highlighted the challenges with what information is displayed, how it is displayed and how it influences decision-making in the UAV context. In addition, the responses also identified aspects that influence trust in the system, including personal disposition, affect interventions with the automation. Against each of the key factors identified recommendations are made to increase safety and operational efficiency of UAV operations. This research adds to the growing body of literature that supports the application of T-SWARM for eliciting knowledge in the aviation domain and specifically within the UAV domain.

Career resources are receiving increasing attention in the context of career development. This paper utilizes M. E. Ford's (1992) ten components of effective functioning to provide a comprehensive typology of factors likely to act as career resources and test this proposition in a context of career shock with a narrative design. In the weeks following the first COVID-19 lockdown, 42 participants were asked to complete a questionnaire about their well-being, perceived employability, and emotional anticipation of their career future, as well as to write three stories about their experience with the lockdown. M. E. Ford's categories were used to identify and code the resources and obstacles mentioned in the stories. Results show the relevance of such a taxonomy to classify both career resources and obstacles. Additionally, the type of story (general story, positive or negative story) in which career resources and obstacles were mentioned played a significant role in their association with the quantitative measures. Conceptual and practical implications are discussed.

This systematic review aimed to evaluate whether the use of posts reduces failure rates in endodontically treated teeth compared to restorations without posts.

The systematic review followed the Cochrane Handbook of Systematic Reviews of Interventions and adhered to the PRISMA checklist. The study was registered in the PROSPERO (CRD42021258906).

Electronic database searches were conducted in MEDLINE/PubMed, Embase, Scopus, and Web of Science up to October 2024, with supplementary searches in the grey literature (ProQuest and ClinicalTrials.gov). The risk of bias was assessed using the RoB 2.0 tool, and certainty of the evidence was performed using GRADE. A meta-analysis was performed using the RevMan 5.4 program, with the significance level set at P < .05.

The search identified 2352 articles, of which 23 articles were selected for full-text analysis, and 13 randomized clinical trials were included in the synthesis. Overall, restorations with posts showed significantly lower failure rates compared to those without posts (P = .001; Risk Ratio [RR]: 0.61). Subgroup analysis demonstrated favorable outcomes for post-use in indirect restorations (P < .001; RR: 0.44). whereas no significant differences were observed for direct restorations (P = .74; RR: 1.10). Further analysis revealed significant benefits only for prefabricated fiber posts (P < .001; RR: 0.54) and customizable fiberglass posts (P = .001; RR: 0.66). In contrast, cast post and core (P = .66; RR: 0.84) and prefabricated metallic posts (P = .67; RR: 1.19), showed no significant difference compared to restorations without posts. Five of the included studies had a low risk of bias, while seven were rated as having some concerns. The overall certainty of the evidence was classified as low due to the risk of bias, indirectness, and imprecision.

Prefabricated or customized fiber posts effectively reduce failure risk in endodontically treated teeth in cases of indirect restorations. For direct restoration, the use of posts appears optional and should be determined based on case-specific factors. However, further well-designed randomized clinical trials are needed to confirm these findings due to the low certainty of evidence.

Prefabricated or customized fiber posts are recommended for supporting coronal reconstruction in indirect restorations of endodontically treated teeth. In contrast, direct restorations allow for dental reconstruction without the use of intraradicular posts.

This prospective cohort study investigated the effect of dental and salivary gland radiation dose on the incidence and severity of caries among post-radiotherapy head and neck cancer (HANC) patients.

The study commenced in December 2018. Eligible patients were assessed and rendered dentally fit pre-radiotherapy. Patients were followed-up at 6-months and 12-months post-radiotherapy. Data regarding oral health (including caries, xerostomia, and oral health-related quality of life) were collected via clinical assessment and validated questionnaires. The radiation doses of the teeth and salivary glands were determined by a blinded assessor.

Data from 151 patients is presented (n=151). The mean age of the cohort was 59.3 (SD 10.4) years. Approximately half (49.0%) of patients presented with new carious lesions 6-12 months post-radiotherapy. The mean number of carious teeth was 3.7 (SD 4.1). Multivariate statistical testing revealed that patients with: (i) continued intake of high-sugar dietary supplements (p≤0.020), (ii) daily consumption of tea/coffee with added sugar (p≤0.023), and (iii) the presence of pre-radiotherapy caries (p≤0.012), had an increased odds of post-radiotherapy caries. At the dental-sextant level (n=644), a 10-unit increase in mean (p≤0.027) and maximum (p≤0.006) dental radiation doses (Gray) were associated with a 26-32% increase in the odds of post-radiotherapy caries after adjusting for other variables. The radiation dose exposure of the parotid glands was found to have no effect on the incidence or severity of post-radiotherapy caries.

Increased dental radiation dose, previous caries experience, and the continued intake of dietary supplements may increase patients' risk of post-radiotherapy caries.

This clinical research study demonstrated an association between post-radiotherapy dental caries and radiotherapy dose to the dentition, however, the radiation dose exposure of the parotid glands was found to have no effect on the incidence or severity of disease. Poor compliance with oral hygiene and dietary advice was also found to increase the risk and severity of post-radiotherapy dental caries.

Sepsis affects approximately 50 million people worldwide, resulting in 11 million deaths annually. Conflicting results and insufficient evidence comparing performance biomarkers exist. The study aimed to comprehensively compare available biomarkers and clinical scores for detecting sepsis since its redefinition in 2016 with this systematic review and Bayesian diagnostic test accuracy network meta-analysis.

We conducted searches in the PubMed, EMBASE, and Scopus databases between January 2016 and December 2023. Eligible studies assessed the diagnostic accuracies of biomarkers, the quick Sequential Organ Failure Assessment (qSOFA) score, or Systemic Inflammatory Response Syndrome (SIRS) criteria in detecting sepsis. Bivariate hierarchical random effects arm-based beta-binomial models were used for quantitative synthesis (PROSPERO Registration Number: CRD42018086545).

We included 78 studies representing 34,234 patients and compared qSOFA score, SIRS criteria alongside seven of the most studied biomarkers: procalcitonin, C-reactive protein (CRP), interleukin-6 (IL-6), presepsin (cluster of differentiation 14 subtypes), CD64, soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), and lipopolysaccharide-binding protein (LBP). CD64 demonstrated the highest superiority index, followed by sTREM-1 and presepsin (diagnostic odds ratio: 20.17 vs 18.73 and 10.04, 95 % credible interval [CrI]: 8.39-38.61 vs 1.31-83.98 and 6.71-14.24; quality of evidence: moderate vs low and low). Multivariable meta-regression analysis identified significant sources of heterogeneity, including study design, proportion of sepsis, sample size, and the risk of bias (patient selection).

The best diagnostic accuracy for sepsis was shown by CD64, with a moderate quality of evidence. Compared to CD64, sTREM-1 and presepsin provided suboptimal and low evidence. These biomarkers were more effective at identifying updated sepsis than clinical scores. We recommend re-considering the addition of biomarkers in screening for sepsis or sepsis-related conditions, as this could lead to more accurate and timely decisions for future clinical interventions.

To propose a revised bone reporting and data system (Bone-RADS) and evaluate its diagnostic performance and inter-reader reliability compared to the original Bone-RADS for solitary bone lesions on CT.

This retrospective study included 159 adult patients (mean age: 56 ± 19 years; 88 men) who underwent bone biopsy for solitary bone lesions between March 2005 and September 2021. Two radiologists (R1/2) independently categorized the lesions twice, once using the original Bone-RADS and once using the revised version. Lesions were classified as follows: (1, benign; 2, incompletely assessed; 3, indeterminate; 4, malignancy or requiring treatment). The revised Bone-RADS excluded the original criteria for lesion related pain and history of malignancy. Diagnostic performance was assessed using histopathology as the reference standard, and inter-reader reliability was analyzed.

The bone lesions included 96 lucent and 63 sclerotic/mixed lesions. Sensitivity showed no significant difference between the original and revised Bone-RADS for both readers across lucent and sclerotic/mixed lesions (all P ≥ .05). However, the specificity of the revised Bone-RADS was significantly higher than that of the original (lucent: 11% vs. 50% [R1], 11% vs. 46% [R2]; sclerotic/mixed: 32% vs. 92% [R1], 32% vs. 86% [R2]). Other performance metrics, including positive/negative predictive value and accuracy, were also higher in the revised Bone-RADS. Inter-reader reliability was higher for the revised Bone-RADS compared to the original (κ = .744 vs .854).

The revised Bone-RADS significantly improved specificity while maintaining sensitivity compared to the original version.

To evaluate CT imaging findings in symptomatic patients with and without revision surgery (RS) after reverse shoulder arthroplasty (RSA).

In this retrospective study, two radiologists assessed CT imaging findings in symptomatic patients with RSA over 5 years, including material fracture and loosening of the peg, baseplate, screws, and humeral stem, screw positioning, prosthesis dislocation, glenoid notching, fractures, and deltoid muscle quality. The primary outcome parameter was RS. Patients were assigned Group 1 (RS) or Group 2 (No RS).

Ninety-nine patients (mean age 70.4 ± 10.3 years, 61 females) met the inclusion criteria. Fifty-two patients (29 females) received RS after 34.0 ± 38.3 months. The only CT imaging finding significantly associated with RS was prosthesis dislocation (P = .007, odds ratio (OR) 10.95, 95% CI 1.34-89.24). All other evaluated CT imaging findings were not associated with RS. Yet, loosening of the peg (30% vs. 16%), baseplate (15% vs. 6%), and superior screw (18% vs. 7%) and periprosthetic humeral fractures (29% vs. 13%)-as common reasons for RS-were more frequent in patients with RS than in those without, however not reaching significance (P ≥ .11). The large majority of patients had glenoid notching (79% vs. 94%), irrespective of RS.

In this cohort of symptomatic patients after RSA, prosthesis dislocation was the only CT imaging finding associated with RS. Besides, there was a trend with higher numbers of loosening of the peg, baseplate, and superior screw, as well as periprosthetic humeral fractures in patients with RS, though not reaching significance.

Non-suicidal self-injury (NSSI) is associated with increased suicide risk and is prevalent among patients with mood disorders, including major depressive disorder (MDD) and bipolar disorder (BD). Structural alterations in cortical regions involved in emotional processing are linked to NSSI as well as suicide risk in mood disorders. Few studies have investigated the neurobiological substrates of NSSI and suicidal thoughts and behaviors (STB), particularly comparing youth with BD to those with MDD. There is a critical need to examine NSSI and STB in the context of MDD and BD separately, as risks differ between these populations.

This study investigated the relationship between anterior cingulate cortex (ACC) cortical thickness and volume and NSSI and STB in youth with mood disorders. One-hundred thirty-seven youth (86 with MDD and 51 with BD), ages 13 to 21, completed a diagnostic interview, clinical assessments, and 3 T magnetic resonance imaging. Morphometric analysis of brain images was performed to evaluate differences in cingulate regions of interest.

Seventy-five youth reported a NSSI. Youth with BD were more likely to report NSSI than youth with MDD. In addition, youth with BD and NSSI were more likely to have a suicide attempt and had significantly lower cortical thickness in the right caudal ACC (p = .009, η2 = 0.050) compared to youth with MDD and NSSI.

These structural alterations in the ACC, which impact emotional regulation and pain processing, may be linked to the increased NSSI and suicide risk observed in BD.

Climate change negatively impacts several dimensions of education (including student achievement, educational infrastructure, school readiness, and other factors). Further, climate change may act as a threat multiplier for existing educational disparities. While theory links climate change to educational disparities, empirical research remains scarce and there is no current weight-of-evidence review examining climate change and education. This weight of evidence scoping review evaluates the current state of evidence assessing the effect of climate change exposures on aspects of education for youth. Studies were categorized and evaluated using the CHANGE (Climate Health ANalysis Grading Evaluation) tool for weight-of-evidence reviews and adaptions of frameworks developed for previous systematic reviews on associations between climate change and education. Thirty-one studies met review criteria and were grouped into five thematic categories based on reported outcomes: Student Learning in the Humanities, Student Learning in Math and Science, Executive Function and Cognition, Attendance and School Closures, and Educational Advancement Milestones. All studies in this review suggest that climate change exposures during childhood negatively impact aspects of education; however, in some instances the mechanisms and ways in which these climate change exposures impacted aspects of education varied by country or geographic setting. The geographic distribution of studies revealed that the United States accounted for the highest number of studies (n = 6), followed by China, India, Nigeria, Cameroon, and South Africa (n = 2 each), with 18 other countries contributing only one study each, highlighting disparities in global research coverage. Twelve of the studies included in this review examined the concept of climate change as a threat multiplier of educational disparities, but no study had it as a primary focus. Future research directions include extending studies beyond traditional test metrics, integrating diverse academic disciplines, exploring a broader array of geographic regions, delving into place-specific nuances, incorporating indigenous and community knowledge, and focusing explicitly on climate change as a threat multiplier for educational disparities.

Borderline personality disorder (BPD) is characterised by deficient regulation of emotions and is associated with reduced pain sensitivity, which has been related to self-injury and dissociation. BPD can therefore be used as a model to better understand pain-modulating mechanisms and their association with affective processing. However, studies assessing pain-modulating processes in BPD are sparse.

This study investigated temporal summation (TS) of pain intensity and unpleasantness, as well as TS of the RIII-reflex as a marker for spinal nociceptive processing in 24 participants with BPD compared to 24 non-clinical controls (NCC).

Our main result showed that TS of pain unpleasantness, but not TS of pain intensity, was significantly increased in BPD compared to NCC, whereas we replicated higher pain thresholds in BPD compared to NCC. There was no significant correlation between pain threshold and TS of pain intensity or TS of pain unpleasantness in BPD. Moreover, correlative findings suggest a mutual dependence of spinal processing, temporal summation of pain and stimulus intensity in NCC, but not in participants with BPD.

The combination of reduced pain sensitivity in terms of heightened pain threshold and enhanced TS of pain unpleasantness might explain the so-called pain paradox, describing that individuals with BPD are both hyposensitive to acute pain and more prone to develop chronic pain. Different mechanisms might underlie heightened pain thresholds and increased TS of pain unpleasantness based on a complex interaction of altered ascending and descending mechanisms.

The results of this study provide evidence that temporal summation of pain unpleasantness is increased in individuals with borderline personality disorder compared to non-clinical controls. These data suggest that altered pain perception in BPD is composed of several processes, extending beyond well-known pain insensitivity.

To assess the diagnostic performance and the reproducibility of the American College of Radiology (ACR) Bone-RADS score for the radiographic evaluation of bone lesions.

Patients with histologically proven bone lesion of the extremities and radiographs performed within three months prior to biopsy/surgery were retrospectively enrolled. All radiographs were evaluated using ACR Bone-RADS scoring system by two musculoskeletal radiologists (Readers 1 and 2, with 10 and 3 years of experience in bone tumors imaging, respectively), and one junior general radiologist (Reader 3). Percent agreement, Cohen's Kappa and Conger's Kappa were calculated for all score categories. Weighted-kappa and intraclass correlation coefficient (ICC) were computed for the final Bone-RADS score. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated based on the expert radiologist's diagnosis, using histology as the reference standard.

Final cohort consisted of 285 patients. Substantial to almost perfect agreement was found on almost all Bone-RADS categories. Moderate agreement was found for "endosteal scalloping" between Readers 1-3 (K = 0.59) and Readers 2-3 (K = 0.55). The score showed good diagnostic performance in discriminating between benign and potentially aggressive lesions (AUC = 0.82). Suboptimal sensitivity and NPV were found using a Bone-RADS ≥ 3 cut-off; if enchondroma and atypical cartilaginous tumors were excluded, diagnostic performance significantly improved (AUC = 0.92).

The ACR Bone-RADS score showed high reproducibility and good accuracy in identifying benign lesions. In cases of cartilaginous tumors, the score may underestimate the disease, suggesting that additional imaging, rather than radiographic follow-up, could be considered for Bone-RADS-2 chondroid lesions.

Pediatric obstructive sleep apnea (OSA) involves repeated breathing interruptions during sleep and is linked to neurocognitive impairment and cardiovascular issues. Early diagnosis is crucial, but the current gold-standard -overnight polysomnography-is expensive, complex, and scarce, causing long wait times. This underscores the need for a more efficient screening tool for pediatric OSA.

This cross-sectional study recruited children aged 3-18 years referred for polysomnography for suspected OSA (2019-2024). Parents recorded 3-min videos of their children sleeping. Two blinded pediatric sleep physicians scored videos for OSA using clinical impressions and the Monash score. Inter-rater reliability was evaluated with Cohen's Kappa. Monash score's ability to predict OSA was evaluated with receiver operating characteristic (ROC) analysis.

109 children (median age: 7.2 years, 61 % male) participated, including 66 healthy children, 21 with Down syndrome, 9 with obesity, and 13 with autism. Inter-rater reliability was high for both Monash score severity and dichotomized Monash score (kappa 0.94 and 0.79, both p < 0.001), with strong agreement on clinician impression of OSA presence and severity (kappa 0.84 and 0.70, both p < 0.001). Inter-rater reliability was highest in healthy children, with no significant differences between groups. The Monash score effectively discriminated OSA presence (area under curve 0.99 (95 % CI: 0.98, 1.00), with excellent performance across groups.

Video assessments showed high inter-rater reliability for OSA presence and severity. Although videos are promising for OSA screening, further research comparing them to polysomnography is needed to confirm clinical validity.

Conflicting results from different cephalometric analyses is a common problem with broader implications but has not received due attention. This study evaluated the agreement between common cephalometric analyses in diagnosing the essential dento-skeletal characteristics of malocclusion.

A total of 125 lateral cephalograms were analyzed digitally using Downs, Steiner, Wits, Tweed, Bjork, Ricketts, and McNamara analysis. The diagnosis of sagittal jaw relation (Class 1/2/3), maxillary and mandibular positions (Orthognathic/Prognathic/Retrognathic), growth pattern (Normodivergent/Hypodivergent/Hyperdivergent), and upper and lower incisors positions (Normal/Proclined/Retroclined) were established based on each analysis. The extent of agreement between the analyses was assessed using Kappa statistics.

The overall agreement between analyses was moderate for sagittal jaw relationship [k = 0.41 (0.37-0.45)], fair for growth pattern [k = 0.24 (0.20-0.27)], mandibular position [k = 0.25, (0.20-0.30)], upper incisor (k = 0.38, CI = 0.32-0.44) and lower incisor [k = 0.21 (0.17-0.25)] positions, and only slight for maxillary position [k = 0.18 (0.13-0.23)]. For pairwise comparisons of analyses, the agreement was moderate to substantial for the sagittal jaw relationship (except for comparisons involving McNamara analysis) and slight to moderate for other variables. Also, the diagnosis of normal dentofacial relationships (Class 1 and normodivergent skeletal pattern, orthognathic jaw positions, and normal incisor positions) was less consistent than those of deviant subgroups.

The agreement between the cephalometric analyses evaluated was moderate for sagittal jaw relation and only fair for most other dento-skeletal characteristics. McNamara's analysis showed less agreement with others. These highlight the need for a more cautious and scientific approach to Cephalometrics.

Whilst insulin therapy errors are commonly reported in hospital and can cause significant negative outcomes for people with diabetes, there is no standardised approach to identifying when and why these errors occur within complex inpatient settings.

This scoping review was conducted to explore and map the types and classification of reported insulin errors in the care of people with diabetes in hospital inpatient settings and to identify potential interacting components/factors associated with these errors.

The review followed the methodological approach of the Joanna Briggs Institute for scoping reviews. Published and unpublished literature (grey) in the English language were searched from January 2000 to July 2024 on Medline, CINAHL, Embase and other relevant websites. Eligible studies were those reporting insulin errors occurring in hospital during the treatment of people who had diabetes. A new framework was developed for examining insulin errors (RESILIENT - interacting-components-in-insulin-use-in-hospital). This was applied to categorise incidents and interacting components identified. Results were summarised graphically and descriptively.

A total of 124 peer-reviewed publications and reports were included. Only forty-nine studies attempted to classify the type of errors reported and they varied considerably in terminology and focus. Insulin errors were most frequently reported at the prescribing, administration, communication/documentation and medication review stages. Common factors associated with reported insulin errors included: time-critical coordination of insulin related tasks (for example coordination of glucose monitoring, meal delivery and mealtime insulin administration; prescribing and medication review; intravenous insulin infusion management); capability at point of care, staff knowledge, non-adherence to guidelines/recommendations; teamwork, communication gaps or errors; patient factors; organisational processes/systems, education and training; equipment (e.g. lack off system integration, right equipment at point of care).

The review highlighted considerable heterogeneity in approaches to identifying and classifying insulin errors in the literature. This review identified incidents occurring in areas of the insulin process which have been previously rarely explored. Further studies are needed, using standardised approaches which capture the complexity of insulin errors within the hospital system, to support the development of interventions which improve insulin safety. Use of RESILIENT Framework could offer a more standardised method of data collection and analysis of insulin errors.

The protocol was registered at the Centre for Open Science (https://osf.io/nmd8a).

A novel approach to identifying, classifying & exploring insulin errors for people with diabetes in hospital @_ChristinaLange.

To evaluate the image quality and lung nodule detectability of ultralow-dose CT (ULDCT) with adaptive statistical iterative reconstruction-V (ASiR-V) post-processed using a deep learning image reconstruction (DLIR)-based image domain compared to low-dose CT (LDCT) and ULDCT without DLIR.

A total of 210 patients undergoing lung cancer screening underwent LDCT (mean ± SD, 0.81 ± 0.28 mSv) and ULDCT (0.17 ± 0.03 mSv) scans. ULDCT images were reconstructed with ASiR-V (ULDCT-ASiR-V) and post-processed using DLIR (ULDCT-DLIR). The quality of the three CT images was analyzed. Three radiologists detected and measured pulmonary nodules on all CT images, with LDCT results serving as references. Nodule conspicuity was assessed using a five-point Likert scale, followed by further statistical analyses.

A total of 463 nodules were detected using LDCT. The image noise of ULDCT-DLIR decreased by 60% compared to that of ULDCT-ASiR-V and was lower than that of LDCT (p < 0.001). The subjective image quality scores for ULDCT-DLIR (4.4 [4.1, 4.6]) were also higher than those for ULDCT-ASiR-V (3.6 [3.1, 3.9]) (p < 0.001). The overall nodule detection rates for ULDCT-ASiR-V and ULDCT-DLIR were 82.1% (380/463) and 87.0% (403/463), respectively (p < 0.001). The percentage difference between diameters > 1 mm was 2.9% (ULDCT-ASiR-V vs. LDCT) and 0.5% (ULDCT-DLIR vs. LDCT) (p = 0.009). Scores of nodule imaging sharpness on ULDCT-DLIR (4.0 ± 0.68) were significantly higher than those on ULDCT-ASiR-V (3.2 ± 0.50) (p < 0.001).

DLIR-based image domain improves image quality, nodule detection rate, nodule imaging sharpness, and nodule measurement accuracy of ASiR-V on ULDCT.

Question Deep learning post-processing is simple and cheap compared with raw data processing, but its performance is not clear on ultralow-dose CT. Findings Deep learning post-processing enhanced image quality and improved the nodule detection rate and accuracy of nodule measurement of ultralow-dose CT. Clinical relevance Deep learning post-processing improves the practicability of ultralow-dose CT and makes it possible for patients with less radiation exposure during lung cancer screening.

Probe-based confocal laser endomicroscopy (pCLE) enables real-time microscopic visualization of the duodenal mucosa and has shown acute food-triggered disruption of the duodenal epithelial barrier of patients with irritable bowel syndrome (IBS). The interpretation of the recordings is subjective, with unknown agreement rates. The aim of this study was to investigate the intra- and interobserver variability of this technique.

An international multicenter study was performed, including pCLE recordings from three centers. Recordings were randomized and re-evaluated by five blinded experienced assessors. Low-quality recordings were excluded. The mucosa was considered altered if both fluorescein leakage and luminal particles were observed. Agreement was quantified using Fleiss' and Cohen's kappa (κ). Reference videos (i.e., videos with 100% agreement) were used to assess the optimal characteristics of videos needed to make a judgment based on the optimal receiver operating characteristic curve cutoff.

Of the 119 individual recordings, 87 could be used for analyses (total of 86,408 frames). Intraindividual agreement rate was 80%-100%, whereas the interindividual agreement rate was 85% (κ = 0.68). The agreement rate with the endoscopist ranged 54%-95% (κ = 0.15-0.89). The optimal cutoff to distinguish altered from unaltered was by observing alterations in ≥ 2 out of 6 mucosal spots (100% sensitivity and specificity).

Our study showed a substantial to perfect intraobserver agreement and a substantial interobserver agreement for the judgment of acute food-triggered disruption of the duodenal epithelial barrier by pCLE, confirming that this real-time readout is reliable and reproducible.

The relationship between shot type and court surface in technical-tactical continuity actions was analyzed, considering player sex and competition level in padel.

One hundred eighty amateur games (90 male and 90 female) and 180 professional games (90 male and 90 female) were observed, ensuring intraobserver and interobserver reliability using Cohen κ. Descriptive (frequency and percentage) and inferential (chi-square, Cramer V, and corrected standard residuals) analyses were conducted.

Results revealed a significant association (P < .001) between shot type, court area, player sex, and competition level. Specifically, differences in technical-tactical actions and their court location were evident across player categories and sexes. In amateur men's padel, forehands, back-wall forehands, contraparedes, and powerful smashes are performed more frequently. Professional men's padel features more fence shots, backhand volleys, drop shots, viboras, and fake smashes. In amateur women's padel, forehands, back-wall forehands, forehand bajadas, drop shots, slow smashes, and powerful smashes are more common. Professional women's padel, however, sees more backhands, double walls, bandejas, and fake smashes. Furthermore, in men's padel, amateurs hit more continuation shots from zone 6, whereas professionals hit more from zone 1. In women's padel, amateurs hit more continuation shots from zones 1, 4, 5, and 6, whereas professionals hit more from zones 2 and 3.

These findings highlight the necessity for players to adapt their playing strategies based on their level and sex to optimize point construction and increase competitive success. Consequently, coaches should design targeted training programs that align with the demands of their players' sex and skill level.

The effectiveness of nonsurgical periodontal treatment is related to patient- and tooth-related factors. To overcome the limitations of the conventional approach, probiotics are one of the adjunct therapies that have been studied.

This umbrella review answered the focused question: in adult patients with periodontal diseases or peri-implant diseases, does the use of probiotic therapy as an adjuvant to nonsurgical periodontal treatment when compared with nonsurgical periodontal treatment alone affect treatment effectiveness and clinical disease parameters?

A systematic electronic search to identify systematic reviews according to PICOS criteria, defined a priori, was used, and 5 electronic databases were searched (Medline, LILACS, Cochrane Central Registry of Controlled Trials, Google Scholar, and DANS EASY). Included systematic reviews were rated using quality assessment tools by 2 independent reviewers.

Thirty systematic reviews were identified evaluating the effectiveness of probiotics in periodontal and peri-implant disease treatment. A quantitative analysis of the results was not possible due to the high heterogeneity of clinical data. Seventeen of 31 reviews reported clinically relevant benefits of probiotic therapy as an adjuvant to scaling and root planning. Twenty-two reviews had a low risk of bias, 7 had a moderate risk, and 2 had a high risk.

The evidence from the available studies is conflicting, which means that no definitive conclusions can be made about the effectiveness of probiotic therapy as an adjuvant to nonsurgical periodontal treatment. High-quality primary research studies are needed that control for known confounding variables.Knowledge Transfer Statement:This umbrella review provides some evidence regarding the efficacy of probiotics as an adjunct to nonsurgical periodontal therapy, despite some equivocal findings. However, short-term probiotic use alongside therapy appears to be advantageous; there is currently no evidence supporting their long-term benefits. We have also identified that probiotic research is primarily constrained by its origins in gastrointestinal applications, resulting in a lack of approved probiotics for dental use. This review highlights the need for extensive clinical research to ascertain their effectiveness in the oral environment. Nevertheless, the utilization of probiotics alongside periodontal treatment seems safe, with no reported adverse effects in patients. Thus, further clinical validations in oral health care settings are crucial.

Respiratory viral testing often uses invasive nasopharyngeal (NP) swabs, which can be painful and require trained personnel. Anterior nasal swabs (NS) are less invasive and can be self-collected. The sensitivity of NS compared to NP specimens for detecting multiple respiratory viruses in children are not well described. Hospitalized children in Kansas City, MO, from January 2023 to February 2024, who had NP specimens obtained for standard of care multiplex respiratory viral testing in the previous 72 h, were enrolled. NS specimens were collected and tested alongside salvaged NP specimens for adenovirus, seasonal coronaviruses, human metapneumovirus, respiratory syncytial virus, influenza, rhinovirus/enterovirus, SARS-CoV-2, and parainfluenza viruses using multiplex molecular testing. Concordance, sensitivity, and specificity of NS compared to NP specimens were assessed. A total of 147 paired NP/NS specimens were analyzed. Overall, 114 (77.6 %) NP/NS pairs were concordant, including 86 (58.5 %) virus-positive and 28 (19.1 %) virus-negative pairs. NS sensitivity was 84.3 % compared to NP, increasing to 95.7 % when collected within 24 h of NP specimens. Sensitivity for seasonal coronavirus was poor (36.4 %), but was over 75 % for other viruses, and 100 % for adenovirus, influenza, parainfluenza, RSV, and SARS-CoV-2 within 24 h of NP specimens. Virus cycle threshold counts were similar among paired specimens. NS specimens showed good concordance with NP specimens and high sensitivity for most viruses, except seasonal coronavirus. NS testing may enable respiratory virus monitoring outside medical settings.

Endometriosis may manifest through various pain symptoms, such as dysmenorrhea, dyspareunia, dyschezia, dysuria and abdominal pain. While retrospective evaluation of these pain symptoms is less expensive and time-consuming compared to a prospective evaluation, there is potential for recall bias, and the reliability of such data needs to be assessed. We aimed to evaluate the reliability of questions on past endometriosis-related pain.

We conducted a reliability study within ComPaRe-Endometriosis, an ongoing prospective e-cohort including patients with endometriosis. We assessed past endometriosis-related pain over a lifetime using the WERF-EPHect Patient Questionnaire-Standard (EPQ-S). Participants rated the worst intensity of dysmenorrhea, dyspareunia, dyschezia, dysuria and abdominal pain that they experienced at ≤ 15, 16-20, 21-30, 31-40 and > 40 years using a numeric-rating scale (NRS). We asked the same questions about 1 year later and measured the agreement between participant responses by calculating intraclass correlation coefficients (ICC) (continuous NRS level) and weighted kappa coefficients (κw) (pain intensity categories).

A total of 1752 participants completed both surveys. The global reliability was close to the 'good' and 'substantial' thresholds for dysmenorrhea (ICC = 0.74; κw = 0.57) and dyspareunia (ICC = 0.72; κw = 0.57), 'moderate' and close to the 'substantial' threshold for dysuria (ICC = 0.68; κw = 0.59), and 'moderate' for dyschezia (ICC = 0.62; κw = 0.54) and abdominal pain (ICC = 0.58; κw = 0.49).

In this population, questions on worst pain intensity over the life course showed moderate-to-good reliability depending on the type of pain, with higher reliability when pain level was considered as a continuous variable.

While prospective measures are the most robust approach in epidemiological research, longitudinal data with pain recorded since childhood or adolescence are scarce. This study shows that the worst level of pelvic and abdominal pain over the life course are reliably reported by endometriosis patients after a 1-year interval. These findings suggest that retrospective pain assessment may reliably be used to assess trajectories of pain over the life course in order to gain insights into the progression of pain-related conditions such as endometriosis.

Large language models (LLMs) have shown promise in various medical applications, but their potential as decision support tools in emergency ophthalmology remains unevaluated using real-world cases.

We assessed the performance of state-of-the-art LLMs (GPT-4, GPT-4o, and Llama-3-70b) as decision support tools in emergency ophthalmology compared to human experts.

In this prospective comparative study, LLM-generated diagnoses and treatment plans were evaluated against those determined by certified ophthalmologists using 73 anonymized emergency cases from the University Hospital of Split. Two independent expert ophthalmologists graded both LLM and human-generated reports using a 4-point Likert scale.

Human experts achieved a mean score of 3.72 (SD = 0.50), while GPT-4 scored 3.52 (SD = 0.64) and Llama-3-70b scored 3.48 (SD = 0.48). GPT-4o had lower performance with 3.20 (SD = 0.81). Significant differences were found between human and LLM reports (P < 0.001), specifically between human scores and GPT-4o. GPT-4 and Llama-3-70b showed performance comparable to ophthalmologists, with no statistically significant differences.

Large language models demonstrated accuracy as decision support tools in emergency ophthalmology, with performance comparable to human experts, suggesting potential for integration into clinical practice.

The presence of full-thickness cartilage in the lateral compartment on valgus stress radiography is a criterion for medial mobile-bearing unicompartmental knee arthroplasty (UKA). However, the appropriateness of medial UKA is uncertain when preoperative MRI shows extrusion of the lateral meniscus. We therefore assessed how preoperative MRI-detected lateral meniscus extrusion affects mid-term functional outcomes after mobile-bearing UKA.

We retrospectively reviewed the records of our patients that underwent mobile-bearing medial UKA between January 2017 and December 2019. Crema's classification system was used to assess MRI of the lateral meniscus, categorizing patients as either grade 0 or ≥ grade 1. We preoperatively evaluated patient-reported outcomes using the Oxford knee score and Knee Society functional score, and then again at the latest follow-up. We also measured range of motion pre- and postoperatively. We compared preoperative individual data with outcome data obtained for at least three years.

The lateral meniscus extrusion group included 19 knees, and the remainder included 98 knees. Clinical outcomes were similar between these groups (p > 0.05). No progression of lateral arthritis was observed in either group during the follow-up period.

Excluding UKA as an option for cases with lateral meniscus extrusion findings on preoperative MRI may require reconsideration.

We aimed to compare subjective assessment of image quality and rater agreement of magnetic resonance (MR) images of the temporomandibular joint (TMJ) acquired with dental-dedicated 0.55 T and clinical 1.5 T magnetic field strengths.

Six blinded raters evaluated randomized TMJ MR images from 5 healthy participants imaged with 3 pulse sequences on 2 scanners: a 0.55 T system using a custom-built surface coil for dental-dedicated applications and a clinical 1.5 T system using a standard head/neck coil. TMJ anatomy and image quality parameters were assessed using a three-point scale (0 = unacceptable, 1 = acceptable, and 2 = excellent). Data was pooled across participants, pulse sequences, and sides. Kappa coefficients were calculated for intra- and inter-rater agreement. Chi-square tests were applied to explore differences between scanners. Significance was established at P<0.05.

Four different raters preferred 0.55 T images for visualizing hard and/or soft tissue anatomy (P≤.02). One rater preferred the 0.55 T system regarding contrast. No other differences were detected regarding qualitative ratings. Kappa values for intra-rater agreement ranged from 0.49 to 0.70 for 0.55 T images and 0.42 to 0.71 for 1.5 T images. Inter-rater kappa values ranged from 0.02 to 0.29 for 0.55 T images and 0.02 to 0.23 for 1.5 T images.

Images from the two systems were rated similarly. Further research is needed to assess diagnostic performance in patients.

To assess the influence of a handheld X-ray unit in the diagnosis of proximal caries lesions using different digital systems by comparing with a wall-mounted unit.

Radiographs of 40 human teeth were acquired using the Eagle X-ray handheld unit (Alliage, São Paulo, Brazil) set at 2.5 mA, 60 kVp and an exposure time of 0.45 s. Then, new radiographs of the teeth were acquired using the Focus X-ray wall-mounted unit (Instrumentarium, Tuusula, Finland) set at 7 mA, 60 kVp, and exposure time of 0.16 s. Three digital systems were used: a photostimulable phosphor plate receptor (Express system) and two complementary metal oxide semiconductor sensors (Digora Toto and SnapShot systems). Five oral and maxillofacial radiologists individually assessed the radiographs. Area under the receiver-operating characteristic curve (AUC), sensitivity, and specificity were calculated from the responses of the examiners and compared using Analysis of Variance at a significance level of 5%. The weighted Kappa index evaluated the intra- and inter-examiner agreements for caries lesions diagnosis.

The handheld X-ray unit did not influence on the diagnostic metrics for the three digital systems used when compared with the wall-mounted unit (p > 0.05). The SnapShot showed higher AUC value than Digora Toto (p < 0.05). The mean values of intra- and inter-examiner agreements were 0.654 (substantial) and 0.365 (fair), respectively.

The diagnostic accuracy for detecting proximal caries lesions is not influenced by the use of a handheld X-ray unit, regardless of the digital system used.

We hypothesized that semiquantitative visual scoring of lung MRI is suitable for GOLD-grade specific characterization of parenchymal and airway disease in COPD and that MRI scores correlate with quantitative CT (QCT) and pulmonary function test (PFT) parameters.

Five hundred ninety-eight subjects from the COSYCONET study (median age = 67 (60-72)) at risk for COPD or with GOLD1-4 underwent PFT, same-day paired inspiratory/expiratory CT, and structural and contrast-enhanced MRI. QCT assessed total lung volume (TLV), emphysema, and air trapping by parametric response mapping (PRMEmph, PRMfSAD) and airway disease by wall percentage (WP). MRI was analyzed using a semiquantitative visual scoring system for parenchymal defects, perfusion defects, and airway abnormalities. Descriptive statistics, Spearman correlations, and ANOVA analyses were performed.

TLV, PRMEmph, and MRI scores for parenchymal and perfusion defects were all higher with each GOLD grade, reflecting the extension of emphysema (all p < 0.001). Airway analysis showed the same trends with higher WP and higher MRI large airway disease scores in GOLD3 and lower WP and MRI scores in GOLD4 (p = 0.236 and p < 0.001). Regional heterogeneity was less evident on MRI, while PRMEmph and MRI perfusion defect scores were higher in the upper lobes, and WP and MRI large airway disease scores were higher in the lower lobes. MRI parenchymal and perfusion scores correlated moderately with PRMEmph (r = 0.61 and r = 0.60) and moderately with FEV1/FVC (r = -0.56).

Multi-center semiquantitative MRI assessments of parenchymal and airway disease in COPD matched GOLD grade-specific imaging features on QCT and detected regional disease heterogeneity. MRI parenchymal disease scores were correlated with QCT and lung function parameters.

Question Do MRI-based scores correlate with QCT and PFT parameters for GOLD-grade specific disease characterization of COPD? Findings MRI can visualize the parenchymal and airway disease features of COPD. Clinical relevance Lung MRI is suitable for GOLD-grade specific disease characterization of COPD and may serve as a radiation-free imaging modality in scientific and clinical settings, given careful consideration of its potential and limitations.

To enhance patient outcomes, we previously developed "Hibilog", an app that allows patients to report symptoms electronically. The paper-based Symptom Illustration Scale (SIS) was adapted using stickers and emojis to evaluate patient-reported outcomes (PROs). This study aimed to validate SIS within an electronic PRO monitoring environment for metastatic breast cancer patients undergoing chemotherapy.

The patients used the Electronic Patient-Reported Outcomes Monitoring (ePROM) "Hibilog" application to answer a questionnaire consisting of 18 items selected from the Patient-Reported Outcome-Common Terminology Criteria for Adverse Events (PRO-CTCAE), focusing on symptoms related to breast cancer treatment, along with the corresponding SIS questionnaire. Symptom monitoring began upon registration and continued every two weeks until the completion of the study. The primary outcome was the criterion-related validity of the SIS against PRO-CTCA using the ePROM. The secondary endpoints included the response rate, response time, and missing rates for each item.

Patients (n = 75) were registered between September 2019 and March 2020. For criterion validity, the Spearman rank correlation coefficients between the PRO-CTCAE and SIS items showed high correlations (rs ≥ 0.41) for all 18 items. The κ correlation coefficient indicated a high correlation (κ > 0.41) in 11 of the 18 items (61.1%), unlike the correlation with continuous variables. In terms of response and missing rates, the SIS in ePROM demonstrated similarly high performance as our results. Additionally, the average response time was 3.0 min (SD 4.2) for SIS, with a substantially shorter response time.

We conclude that SIS is a useful tool in an ePROM environment for patients with MBC undergoing chemotherapy. The clinical utility of SIS in an ePRO environment needs to be validated to develop a more accurate scale for capturing patient symptoms.