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Background: As global aging intensifies, the prevalence of ocular fundus diseases continues to rise. In China, the tense doctor-patient ratio poses numerous challenges for the early diagnosis and treatment of ocular fundus diseases. To reduce the high risk of missed or misdiagnosed cases, avoid irreversible visual impairment for patients, and ensure good visual prognosis for patients with ocular fundus diseases, it is particularly important to enhance the growth and diagnostic capabilities of junior doctors. This study aims to leverage the value of electronic medical record data to developing a diagnostic intelligent decision support platform. This platform aims to assist junior doctors in diagnosing ocular fundus diseases quickly and accurately, expedite their professional growth, and prevent delays in patient treatment. An empirical evaluation will assess the platform's effectiveness in enhancing doctors' diagnostic efficiency and accuracy. Methods: In this study, eight Chinese Named Entity Recognition (NER) models were compared, and the SoftLexicon-Glove-Word2vec model, achieving a high F1 score of 93.02%, was selected as the optimal recognition tool. This model was then used to extract key information from electronic medical records (EMRs) and generate feature variables based on diagnostic rule templates. Subsequently, an XGBoost algorithm was employed to construct an intelligent decision support platform for diagnosing ocular fundus diseases. The effectiveness of the platform in improving diagnostic efficiency and accuracy was evaluated through a controlled experiment comparing experienced and junior doctors. Results: The use of the diagnostic intelligent decision support platform resulted in significant improvements in both diagnostic efficiency and accuracy for both experienced and junior doctors (P < 0.05). Notably, the gap in diagnostic speed and precision between junior doctors and experienced doctors narrowed considerably when the platform was used. Although the platform also provided some benefits to experienced doctors, the improvement was less pronounced compared to junior doctors. Conclusion: The diagnostic intelligent decision support platform established in this study, based on the XGBoost algorithm and NER, effectively enhances the diagnostic efficiency and accuracy of junior doctors in ocular fundus diseases. This has significant implications for optimizing clinical diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: Chest x-rays are widely used for diagnosing chest pathology worldwide. Pediatricians frequently interpret chest radiographs in the emergency department, guiding patient management. This study aims to assess the competency of non-radiologists in interpreting emergency chest x-rays and compare it with trainees of different levels to determine the necessity of radiologist input. Methodology: A cross-sectional online survey was conducted in Saudi Arabia from September to October 2023, involving 385 participants, including pediatricians and medical interns from various regions. Carefully selected questions addressed a range of x-ray abnormalities in pediatric emergencies, assessing fundamental understanding of x-ray interpretation, such as inspiratory vs. expiratory and AP or PA films. Results: The study included 385 participants, primarily Saudi nationals in the eastern region, with an equal gender distribution and ages ranging from 20 to 29 years. Approximately 29.09% demonstrated fair knowledge, with 28% being Junior Pediatrics Residents, 18% Pediatric Consultants, and 15% Senior Pediatrics Residents. Fair knowledge was significantly associated with individuals aged 20–29 years, residents of the western region, and Junior Pediatrics Residents. Clinical knowledge varied among different groups, with 59% correctly identifying atypical pneumonia and 65% recognizing asymmetrical hyperinflation. However, rates for other conditions differed, with low identification of potential foreign body aspiration and film type. Accuracy in identifying tension pneumothorax and hyperlucency varied among clinicians. Pleural effusion films had a 65% identification rate for the diagnosis, but only 28% accurately described the X-ray and selected the correct answer for lung opacity. Conclusion: The study concluded that 29.9% of the participating physicians exhibited fair knowledge of common pediatric emergency radiological films. Junior pediatric residents showed the best knowledge, and Tetralogy of Fallot, asymmetrical hyperinflation, and pleural effusion had the highest recognition rates. In conclusion, there is still a need for radiologists in the pediatric emergency department to ensure optimal functioning. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to assess an original learning intervention to train students and paediatric dentistry teachers in radiographic diagnostic accuracy of pulpo‐periodontal complications in primary molars. Materials and Methods: The learning intervention was based on 250 different randomly ordered radiographs of primary molars within three quizzes (A, B and C) for 5 sessions (S): quiz A (50 X‐rays), B and C (100 X‐rays) were, respectively, completed in S1 to assess the extent of agreement with 5 experts' diagnoses, in S2 and S3 (B at days 8 and 23) and in S4 and S5 (C at days 90 and 105). During S1 and at the end of S3 and S5, the participants (48 students and 16 teachers) were informed of correct diagnoses. A satisfaction questionnaire was completed by all the students. Alongside the descriptive analyses, generalised linear mixed model (GLMM) analyses assessed the odds of participants' correct diagnosis over the study duration. Results: At S1, the odds of diagnostic accuracy among students were significantly lower than those among the teachers. After receiving feedback at S1, GLMM analyses showed that among all the participants, accuracy improved over time with the odds of correct diagnoses higher in S2‐5 than in S1; and there were similar increases across sessions between teachers and students, except in S3, where the improvement among teachers tended to be greater than that among the students. All students were satisfied though one‐third reported that quizzes with 100 radiographs felt too long. Conclusion: The online case‐based learning was a good training format for dental education. [ABSTRACT FROM AUTHOR]

Background and aims: New image-enhanced endoscopy (IEE), blue Light Imaging (LED-BLI) is launched in USA and Europe, whereas Blue Laser Imaging (Laser-BLI) is available only Asian and some countries. No studies have directly compared the diagnostic accuracy of narrow band imaging (NBI), Laser-BLI and LED-BLI for colorectal tumors. The present study aimed to compare the diagnostic accuracy of the three methods for colorectal tumor using the NBI international colorectal endoscopic (NICE) classification and the Japanese NBI Expert Team (JNET) classifications. Methods: This was a multi-center evaluator-blinded, randomized control trial of patients who underwent endoscopic colorectal tumor resection. The patients were randomly assigned to NBI, Laser-BLI or LED-BLI. Cropped images were sent to blinded external evaluators and diagnosed according to NICE and JNET classifications. The diagnostic accuracy of each endoscopy system was compared with non-inferiority test. Results: A total of 619 colonic tumors were resected from 230 patients and evaluated by external four evaluators. The diagnostic accuracy of NBI for NICE 1, NICE 2, NICE 3 was 90.6%, 90.3% and 99.5%, respectively and for JNET 1, JNET 2A, JNET 2B and JNET 3, it was 94.6%, 72.0%, 79.2% and 99.1%, respectively. In non-inferiority test, Laser-BLI and LED-BLI revealed non-inferiority to NBI in all NICE and JNET categories (p<0.001). Conclusions: Laser-BLI and LED-BLI had high diagnostic accuracy and non-inferiority of NBI, especially for hyperplastic polyp/sessile serrated lesion and low-grade dysplasia. This is first trial to compare the diagnostic accuracy with NBI, Laser-BLI and LED-BLI and useful to understand the position of each IEE. This trial was registered as UMIN000032107. [ABSTRACT FROM AUTHOR]

Time and speed are vital aspects of clinical diagnosis decision-making. This study aimed to investigate the gaze patterns, diagnosis speed and accuracy with and without the assistance of clinical history while interpreting clinical findings. This cross-sectional study employed convenience sampling to recruit 28 normally sighted final year students with ongoing clinical training. Each student was shown six clinical findings, half of which accompanied a brief clinical history in prose, and the other half were not. First, the clinical history was presented to be read by the participants, followed by providing clinical findings regarding fundus picture images. The participants were asked to make a diagnosis based on a clinical finding presented to them. The Dikablis eye tracker was used to record and track the gaze patterns during the treatment. The assessment had no time restriction, and the gaze patterns (number of fixations, fixation duration, number of saccadic, and saccadic angles) were retrieved from the D-Lab software. Diagnostic speed was calculated based on the time taken for the students to provide a clinical diagnosis. Diagnosis accuracy was the score of correct or incorrect of the given diagnosis. Comparison of gaze patterns in interpreting clinical findings with clinical history and without clinical history showed no statistically significant difference for all gaze patterns including the number of fixation (p=0.20), fixation durations (p=0.98), number of saccadic (p=0.33) and saccadic angle (p=0.77). There was also no statistically significant difference in both diagnosis accuracy (p=0.14) and diagnosis speed (p= 0.20) between both conditions. However, there was a strong correlation between the number of fixations and diagnosis speed with (r = 0.708, p < 0.05) and without (r = 0.618, p < 0.05) clinical history. A moderate correlation was found between the number of saccades and diagnosis speed with (r = 0.578, p < 0.05) and without (r = 0.424, p < 0.05) clinical history. In conclusion, a brief clinical history does not appear to influence the gaze patterns, diagnosis speed and accuracy in evaluating the clinical findings. However, the gaze patterns highly correlated with the diagnosis speed in clinical decision-making. These findings indicate cognitive processing during clinical decision-making, which might benefit clinical educators in enhancing the clinical teaching approach and quality. [ABSTRACT FROM AUTHOR]

Purpose: Dural ossification (DO) is common in patients with ossification of the ligamentum flavum (OLF) and is the leading cause of dural tears. However, the methods used for DO diagnosis are limited. The purpose of this study was to propose a novel CT-based imaging sign, Banner cloud sign (BCs), and clarify its clinical characteristics and correlations with DO. Methods: 57 OLF patients who underwent thoracic spine decompression surgery in our single-center between January- and October-2018 were recruited and divided into two groups based on the presence of DO. Patient demographics and radiographic data were analyzed. Hematoxylin–eosin staining and micro-CT were used to detect the micro-morphological changes of DO. The diagnostic value of BCs for DO was assessed by sensitivity and specificity. Results: 12 patients with a total of 19 segments were diagnosed as DO. The incidence of DO was 21.1% (12/57) in OLF patients and 9.5% (19/200) in OLF segments. Patients with DO had a shorter disease duration and a higher incidence of cerebrospinal fluid leakage than those without DO. Hematoxylin–eosin staining and micro-CT showed that the dura mater was ossified and fused with ossified ligamentum flavum, and diffusion along the dura mater, like a banner cloud flying on the mountain. The sensitivity and specificity of BCs in DO diagnosis were 78.9 and 90.6%, respectively. Conclusion: BCs can vividly and intuitively describe the imaging features of DO and has high diagnostic accuracy. It could be a promising and valuable method for the diagnosis of DO. [ABSTRACT FROM AUTHOR]

Background: Zoonotic leishmaniosis caused by Leishmania infantum is endemic in several countries of the Mediterranean Basin, Latin America, and Asia. Dogs are the main hosts and reservoirs of human infection. Thus, from a One Health perspective, early diagnosis of Leishmania infection in dogs is essential to control the dissemination of the parasite among other dogs and to humans. The aim of this study was to estimate the diagnosis accuracy of three serological tests to detect antibodies to Leishmania in dogs from two endemic settings using Bayesian latent class models (BLCM). Methods: A total of 378 dogs from two Portuguese and Brazilian endemic areas of leishmaniosis (194 animals from Portugal and 184 from Brazil) were screened. Detection of anti-Leishmania antibodies was performed using two commercial ELISA (L. infantum IgG-ELISA® and EIE-LVC®) and a rapid immunochromatographic test (DPP-LVC®). Bayesian latent class models were used to estimate Leishmania infection prevalence, together with sensitivities and specificities of the three diagnostic tests, in the two dog populations simultaneously. Predictive values were also calculated. Credibility intervals (CI) were obtained, considering different types of prior information. Results: A posterior median Leishmania seroprevalence of 13.4% (95% CI 9.0–18.7) and of 21.6% (15.0–28.3) was estimated to the Portuguese and Brazilian dog subpopulations, respectively. The Bayesian analysis indicated that all tests were highly specific (specificity above 90%), and that the DPP-LVC® was more sensitive (96.6%; 83.1–99.9) than both ELISAs in the Portuguese subpopulation, while in the Brazilian subpopulation, EIE-LVC® and L. infantum IgG-ELISA®, had the highest sensitivity (88.2%; 73.7–97.0) and specificity (98.7%; 95.1–99.9), respectively. Conclusions: In general, the levels of diagnosis accuracy of the three serological tests to detect Leishmania antibodies assessed by BLCM indicate their utility in canine epidemiological studies. The same approach should be used to assess the performance of these techniques in the clinical management of infected and sick dogs using representative samples from the wide spectrum of clinical situations, namely from subclinical infection to manifest disease. The low positive predictive value of the serological tests used in the current protocol of the Brazilian Ministry of Health suggests that they should not be used individually and may not be sufficient to target reservoir-based control interventions. [ABSTRACT FROM AUTHOR]

The objective of this review was to assess and evaluate whether the published diagnostic accuracy studies provide evidence to sustain the current diagnostic guidelines put forth by ACR/EULAR used for patients with suspected Sjögren's syndrome (SS). Literature databases, including Medline, Embase, and EBM Reviews, were searched for relevant studies on the correlation between ACR/EULAR criteria, particularly those with a direct comparison between their accuracy in diagnosing Sjögren's syndrome. We followed Cochrane, QUADAS-2, and STARD guidelines and the four-phase flow diagram by the PRISMA Statement. Reports in several languages, but only human studies were considered. Three studies assessed the accuracy of the current diagnostic tests, and these did not present adequate designs that would allow a well-supported conclusion with a high level of certainty. Due to significant clinical and methodological heterogeneity, a meta-analysis was not performed. A qualitative review of the papers was undertaken. Neither the comparative nor the non-comparative study designs permit conclusive recommendations regarding an alternative diagnostic pathway for SS. Well-designed studies of the diagnostic accuracy of SS tests are needed to validate current guidelines or to suggest changes to the current guidelines. [ABSTRACT FROM AUTHOR]

Objective: The main aim of this study was to ascertain the effectiveness of ultrasound-guided fine needle aspiration cytology (US-FNAC) in the diagnosis of para-aortic lymph node (PALN) metastasis in uterine cervical cancer and to establish its potential impact on clinical therapeutic decision making.Methods: We retrospectively reviewed clinical data from 92 patients diagnosed with cervical cancer with PALN enlargement between 2010 and 2018. Cytological results obtained with US-FNAC were classified by the same experienced cellular pathologists. Diagnostic indicators were determined on the basis of biopsy, imaging and clinical follow-up results. Univariate and multivariate analyses were used to assess the differences of influencing factors. The effect of US-FNAC on clinical decision making was evaluated.Results: Cytological results of US-FNAC were categorized as malignancy (n = 62; 67.4%), suspicious malignancy (n = 11; 12.0%), undetermined (n = 5; 5.4%), benign (n = 10; 10.9%), and inadequate (n = 4; 4.3%). Satisfactory biopsy samples were obtained from 95.7% of PALNs sampled (88/92). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of FNAC in distinguishing benign from malignant cases were 90.1% (95% CI: 0.809-0.953), 100% (95% CI: 0.561-1), 100% (95% CI: 0.938-1), 46.7% (95% CI: 0.223-0.726) and 90.9% (95% CI: 0.848-0.970), respectively. Univariate analysis indicated significant differences in experience of puncture physicians (radiologists) between the correct and wrong diagnosis groups (P < 0.05), which was further confirmed as an independent predictor of diagnostic accuracy in multivariate analysis (p = 0.031, OR = 0.077, 95% CI: 0.354-0.919). All patients tolerated the US-FNAC procedure well and only nine presented slight abdominal discomfort. The therapeutic strategies for 74 patients (80.4%) were influenced by US-FNAC findings.Conclusions: US-FNAC was a relatively safe and effective technique for examination of enlarged para-aortic lymph nodes and may therefore serve as a routine diagnostic tool to guide clinical decision making for management of cervical cancer. [ABSTRACT FROM AUTHOR]

Acute appendicitis it a quite common abdominal disorder and considered as a difficult diagnosis. An accurate diagnosis is essential to prevent any complication from delayed surgical intervention. Aim: To evaluate the diagnostic accuracy of ultrasound in acute appendicitis cases in Saudi Arabia compared with histopathology. Moreover, to determine whether there is a correlation between the accuracy of ultrasound in acute appendicitis and the sonographers' expertise. Methods: A retrospective study was conducted, including patients who admitted to the emergency room with clinical symptoms of suspected acute appendicitis and underwent ultrasound examinations. Diagnostic features, including diameter of the appendix ≥7 mm, free fluid, lack of compressibility, no appendix seen, normal appearance, and thick wall, were recorded for each patient. Results: Only 61 of the 132 patients in the study were accurately diagnosed with the use of ultrasound. Just 44 of them were diagnosed with appendicitis (true positives) and 17 without appendicitis (true negatives). However, 69 patients who had positive histopathologic results received a negative ultrasound diagnosis (false negatives), and 2 patients with negative histopathologic findings had a positive ultrasound diagnosis (false positives). There was no significant association between the accuracy of the ultrasound diagnosis and the years of experience of the sonographers. Conclusion: a low level of diagnostic accuracy was demonstrated when utilizing ultrasound to diagnose cases of acute appendicitis. In addition, no association was found between the years of experience of the sonographer conducting the examination and the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

We sought to evaluate the accuracy of periostin for the diagnosis of asthma through a systematic review and meta-analysis. we searched the electronic databases (PubMed, EMBASE, Web of science) to find relevant studies through December 31, 2018. Studies selecting, data extraction and quality assessment were conducted by two researchers independently according to inclusion and exclusion criteria. We used bivariate mixed effects model to conduct the meta-analysis. A total of 9 studies including 1448 subjects with asthma were analyzed. The pooled sensitivity, specificity, diagnostic odds ratio (DOR) were 0.68 (95% CI, 0.42–0.86), 0.87 (95% CI, 0.76–0.93) and 13.78 (95% CI, 4.64–40.93) respectively. The area under the summary receiver operating curves (SROC) was 0.87 (95% CI, 0.84–0.90). The Spearman correlation coefficient indicated that no threshold effect existed in the included studies. The study design had statistical significance for sensitivity results (p < 0.001) through regression analysis. Heterogeneity might be caused by non-threshold effect. Periostin has moderate accuracy in the diagnosis of asthma. [ABSTRACT FROM AUTHOR]

Background: This study was performed to determine the sensitivity and specificity of ultrasound in the diagnosis of traumatic ankle injury in comparison with magnetic resonance imaging (MRI). Materials and Methods: This cross-sectional study was performed on 31 patients with soft-tissue injury or fracture, referring to the MRI imaging center of Alzahra and Kashani Hospitals in Isfahan from October 2018 to March 2019. After an MRI, an ultrasound of the affected ankle was performed for all patients. Sonography and MRI were performed by two radiologists who were blinded to the results of each other's reports. The sensitivity, specificity, positive predictive value, and negative predictive value of sonography were determined. Results: In this study, 31 patients with ankle trauma were studied. The mean age of the patients was 30.73 ± 10.15 years; 32.3% were male and 67.7% were female. The sensitivity of ultrasound relative to MRI to detect damage to the anterior talofibular ligament (ATFL), posterior talofibular ligament (PTFL), and calcaneofibular ligament (CFL) was 66.67%, 50%, and 100%, respectively, and the corresponding specificity was 92.86%, 93.10%, and 93.10%, respectively. According to Kappa test, the agreement between ultrasound and MRI methods for detecting injury to ATFL (κ = 0.51), PTFL (κ = 0.35), and CFL (κ = 0.63) was statistically significant (P < 0.05). Conclusion: Ultrasound is an appropriate modality for the diagnosis of injuries to CFL and ATFL and has shown acceptable results for PTFL. It could be used as an alternative in cases where access to MRI is not available. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnosis accuracy of total leukocyte count in acute appendicitis keeping histopathology as gold standard. Material and Methods: The study was performed in Department of General Surgery Lady Reading Hospital, Peshawar from 16th February 2016 to 16th august 2016. In this study a total of 163 patients were observed. Complete history, physical examination, and investigations (KUB), ultrasound abdomen were performed. Decision regarding appendicectomy was made by a single consultant surgeon based on his clinical assessment. All the included patients were prepared for surgery to be operated on the elective list next day same consultant surgeon. Post operatively the appendix specimen was collected, preserved in formalin solution and sent to a single expert histopathologist. The patient's histopathology reports were followed up for in outpatient department. The exclusions criteria was strictly followed to control confounders and exclude bias in the study results. Results: Our study shows that mean age was 32 years with SD ± 7.84. 38% patients were male while 62% patients were female. Diagnostic accuracy of AP on total leukocyte count and histopathology as gold standard was analyzed as the sensitivity was 78%, specificity was 27%, Positive predictive value was 94%, Negative predictive value was 8% and the overall diagnostic accuracy was 75%. Conclusion: Our study concludes that total leukocyte count had sensitivity 78%, specificity 27%, Positive predictive value 94%, Negative predictive value was 8% and the overall diagnostic accuracy was 75% in the diagnosis of acute appendicitis. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Academic Research in Medicine is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Dermoscopic content‐based image retrieval (CBIR) systems provide a set of visually similar dermoscopic (magnified and illuminated) skin images with a pathology‐confirmed diagnosis for a given dermoscopic query image of a skin lesion. Although recent advances in machine learning have spurred novel CBIR algorithms, we have few insights into how end users interact with CBIRs and to what extent CBIRs can be useful for education and image interpretation. Materials and Methods: We developed an interactive user interface for a CBIR system with dermoscopic images as a decision support tool and investigated users' interactions and decisions with the system. We performed a pilot experiment with 14 non‐medically trained users for a given set of annotated dermoscopic images. Results: Our pilot showed that the number of correct classifications and users' confidence levels significantly increased with the CBIR interface compared with a non‐CBIR interface, although the timing also increased significantly. The users found the CBIR interface of high educational value, engaging and easy to use. Conclusion: Overall, users became more accurate, found the CBIR approach provided a useful decision aid, and had educational value for learning about skin conditions. [ABSTRACT FROM AUTHOR]

In the field of transformer failure diagnosis, the potential correlation between different characteristic parameters and failures is difficult to detect using traditional methods. Further, the quantities of inspection data have not been fully utilized. To improve the accuracy of transformer diagnosis, this study establishes a diagnosis model based on fuzzy association rules combined with case‐based reasoning (CBR) to evaluate the failure types, fault locations, and cause of breakdown in power transformers. First, the inspection data of transformers are collected from several substations over 10 years. Then, the pre‐processed data are randomly separated into training and testing sets. For the training set, fuzzy association rules are built for multiple parameters to narrow the search scope of base case preliminarily. Next, CBR is applied to determine the most similar cases. The failure information of the target transformer can be obtained in detail along with the most similar base case. Finally, the accuracy of the model is validated shown in case studies using the testing data set. The result demonstrates that the diagnosis model provides a higher accuracy than the classic IEC 60599 three‐ratio method used in the current industry, which means that this diagnosis model has better performance on diagnosis accuracy. [ABSTRACT FROM AUTHOR]

Copyright of Imaging Science & Photochemistry is the property of Imaging Science & Photochemistry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To evaluate feasibility, safety, and clinical efficiency of optometrists in conducting diabetic retinopathy screening and ocular health screening. Methods: This was a prospective observational trial study of newly developed optometric service pathways established at a community health clinic for diabetic retinopathy screening and a hospital ophthalmology clinic for ocular health screening. The study was carried out to assess the feasibility and safety of eye examinations conducted by optometrists. Patients were examined by optometrists using a standard eye examination at both clinics and re-examined by ophthalmologists as the reference standard. Optometrists recorded diagnoses of ocular conditions and classified referral urgency for each patient and these were compared with the diagnoses made by ophthalmologists, who were masked to the optometrists' findings. Results: There was a high concordance of 87.0% (95% CI 80.4%-93.6%) for the diagnoses between the optometrists and ophthalmologists. Of 26 patients considered by the optometrists to need ophthalmology referral, 23 were agreed as such by the ophthalmologists, giving good agreement, ê = 0.76 (95% CI 0.53 -0.94) between the optometrists and ophthalmologists on referral classification. Agreement by the ophthalmologists for referral urgency classifications (very urgent/urgent or non-urgent) was very good (K = 0.85, 95%CI 0.62-1.00). Conclusions: Ocular health examination by optometrists using optometric-eye care pathways is feasible and safe. Optometrists showed strong agreement with ophthalmologists when diagnosing patients who had a range of ocular conditions. Optometrists were also able to triage referrals and their urgency accurately, suggesting that they could play an extensive role as primary eye care providers, thus reducing unnecessary referrals to ophthalmology clinics. [ABSTRACT FROM AUTHOR]

The aims of the present study were to examine the potential role of microRNA-233-3p (miR)-223-3p in the tumorigenesis of hepatocellular carcinoma (HCC), and to investigate its diagnostic accuracy and potential molecular mechanisms. The expression data of miR-223-3p in HCC were obtained from the Gene Expression Omnibus (GEO). Data for the precursor miR-223 were obtained from The Cancer Genome Atlas (TCGA). The diagnostic role of miR-223-3p was identified by the receiver operating curve (ROC), and the diagnostic value of miR-223-3p in HCC was calculated from qualified reports in the literature. In addition, associated data from the GEO, TCGA and qualified experiments were pooled for comprehensive meta-analysis. Genes, which intersected between online prediction databases, natural language processing and differentially expressed genes from TCGA were regarded as potential targets of miR-223-3p in HCC. The Gene Ontology enrichment analysis and the Kyoto Encyclopedia of Genes and Genomes pathways of potential targets were performed using the Database for Annotation, Visualization and Integrated Discovery. The protein-protein interactions were mapped using the Search Tool for the Retrieval of Interacting Genes. Among 15 qualified microarray data sets from GEO, seven showed that a significantly lower level of miR-223-3p was present in the HCC tissues, compared with that in non-cancerous tissues (P<0.05). In addition, five GEO data sets revealed diagnostic values of miR-223-3p, with an area under the curve (AUC) of >0.80 (P<0.05). The diagnostic accuracy of the precursor miR-223 in TCGA was also calculated (AUC=0.78, P<0.05). Similarly, the precursor miR-223 showed a higher level of downregulation in HCC tissues, compared with that in healthy controls in TCGA (P<0.001). A summary ROC was also calculated as 0.89 (95% CI, 0.85-0.91) in the meta-analysis. A total of 72 potential targets were extracted, mainly involved in the terms 'microRNAs in cancer', 'ATP binding' and 'prostate cancer'. Five potential target genes were considered the hub genes of miR-223-3p in HCC, including checkpoint kinase 1, DNA methyltransferase 1, baculoviral IAP repeat containing 5, kinesin family member 23, and collagen, type I, a1. Based on TCGA, the hub genes were significantly upregulated in HCC (P<0.05). Collectively, these results showed that miR-223-3p may be crucial in HCC carcinogenesis showing high diagnostic accuracy, and may be mediated by several hub genes. [ABSTRACT FROM AUTHOR]

Background: Despite the fact that only one-third of chest pains occur due to heart diseases, still physicians have tendency to admit most of these patients to reduce risk of negligence and its consequences.Clinical decision support systems (CDSS) enable physicians to distinguish better cardiac from non-cardiac chest pain. This study reviewed articles which focused on this issue. Materials and Methods: Google scholar and PubMed database were targeted for search. Out of ninety primary matching articles based on the title, abstract and keywords, 28 full texts were relevant which were included in this study. Results: Included articles were classified into two categories such as managing hospital resources and increasing the accuracy of diagnosis. Study results in the first categoryshowed decrease in both reception and referral time up to 30% and length of hospital stay up to 26% using CDSS. In the second category, the highest reported accuracy of diagnosis was 97% and the maximum sensitivity and specificity were 100% and 89.43% respectively. Even though, the results of a study revealed that the accuracy of decision support system in diagnosing cardiac chest pain was better than the compared cardiologists. Conclusion: Considering the role of CDSS in managing hospital resources and improving accuracy of diagnosing cardiac chest pain, it is suggested that emergency wards and cardiac screening centers equipped by these systems. [ABSTRACT FROM AUTHOR]

Background: EtCO variation has been advocated replacing cardiac output measurements to evaluate fluid responsiveness (FR) during sepsis. The ability of EtCO variation after a fluid challenge to detect FR in the context of general anaesthesia has not been investigated. Forty patients were prospectively studied. They underwent general anaesthesia for major surgeries. CO was measured by transoesophageal Doppler, and EtCO was recorded as well as other haemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), pulse pressure (PP)] at baseline, after 100-ml fluid load over 1 min, and at the end of the 500-ml fluid load. We measured the variation of EtCO at 100 (ΔEtCO100) and 500 ml (ΔEtCO500), and ROC curves were generated. A threshold for ΔEtCO to predict FR was determined with receiver operating curves (ROC) analysis. The primary end point was the ability of EtCO variation after a 500-ml fluid load to diagnose FR. Results: Fifteen patients (38 %) were fluid responders. ROC analysis showed that for a threshold of 5.8 % (ΔEtCO500), sensitivity was 0.6 IC 95 % [0.33; 0.86] and specificity was 1.0 IC 95 % [1.0; 1.0]. An absolute increase of more than 2 mmHg of EtCO is specific to diagnose fluid responsiveness (spe = 96 [88-100] %, sens = 60 [33-88] %, AUC = 0.80 [0.96-0.65]). HR, MAP, and PP variations and ΔEtCO100 did not bring information to predict or diagnose FR. During fluid challenge, the correlation between CI variation and EtCO variation was r = 0.566, p < 0.001. Conclusions: During surgery, when alveolar ventilation and CO production are constant, ΔEtCO500 is fairly reliable to assess FR. When the variation of EtCO is >5.8 %, all patients were responders, but no conclusion could be done when this variation was <5.8 %. ΔEtCO100 failed to predict FR. Trial registration CPP Lyon Sud Est III ref: 2013-027 B, Number ID RCB: 2013-A00729-36 delivered by the ANSM). [ABSTRACT FROM AUTHOR]

Objectives: To assess the accuracy of liver iron content (LIC) quantification and grading ability associated with clinical LIC stratification using virtual iron concentration (VIC) imaging on dual-energy CT (DECT) in an iron overload rabbit model. Methods: Fifty-one rabbits were prepared as iron-loaded models by intravenous injection of iron dextran. DECT was performed at 80 and 140 kVp. VIC images were derived from an iron-specific algorithm. Postmortem LIC assessments were conducted on an inductively coupled plasma (ICP) spectrometer. Correlation between VIC and LIC was analyzed. VIC were stratified according to the corresponding clinical LIC thresholds of 1.8, 3.2, 7.0, and 15.0 mg Fe/g. Diagnostic performance of stratification was evaluated by receiver operating characteristic analysis. Results: VIC linearly correlated with LIC (r = 0.977, P < 0.01). No significant difference was observed between VIC-derived LICs and ICP ( P > 0.05). For the four clinical LIC thresholds, the corresponding cutoff values of VIC were 19.6, 25.3, 36.9, and 61.5 HU, respectively. The highest sensitivity (100 %) and specificity (100 %) were achieved at the threshold of 15.0 mg Fe/g. Conclusions: Virtual iron concentration imaging on DECT showed potential ability to accurately quantify and stratify hepatic iron accumulation in the iron overload rabbit model. Key Points: • Virtual iron concentration (VIC) linearly correlates with liver iron content (LIC). • VIC accurately quantifies LIC. • VIC accurately grades LIC based on clinical LIC stratification. [ABSTRACT FROM AUTHOR]

Emerging evidence has suggested that microRNAs (miRNAs) may be promising novel biomarkers for the diagnosis of renal cell carcinoma (RCC). However, the results of current studies are still conflicting. Hence, we undertake the current meta-analysis to comprehensively assess the diagnostic potential of miRNAs in RCC. The bivariate meta-analysis model was employed to summarize the sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Summary receiver operating characteristic (SROC) curve and area under the curve (AUC) were used to evaluate the diagnostic accuracy. Subgroup analyses and meta-regression were used to explore the between-study heterogeneity. Deeks' funnel plot asymmetry test was used to test the potential of publication bias. All analyses were performed using STATA software (version 12.0). The pooled sensitivity and specificity of miRNAs for the diagnosis of RCC were 0.85 (95 % confidence interval (CI), 0.77-0.90) and 0.84 (95 % CI, 0.70-0.92). The value of AUC was 0.91 (95 % CI, 0.88-0.93), suggesting that the diagnostic accuracy of miRNAs achieved a relatively high level. Furthermore, subgroup analyses showed that tissue-based miRNA assay is recommended to improve the diagnostic accuracy. In conclusion, the high degree of diagnostic accuracy suggests that miRNA in RCC patients may serve as next-generation biomarkers for detection of the disease. However, large-scale investigations and additional improvements are urgently needed to confirm our results and verify the feasibility of routine clinical utilization. [ABSTRACT FROM AUTHOR]

Electroencephalogram (EEG) remains the most immediate, simple, and rich source of information for understanding phenomena related to brain electrical activities. It is certainly a source of basic and interesting information to be extracted using specific and appropriate techniques. The most important aspect in processing EEG signals is to use less co-lateral assets and instrumentation in order to carried out a possible diagnosis; this is the approach of early diagnosis. Advanced estimate spectral analysis can reveal new information encompassed in EEG signals by means of specific parameters or indices. The research proposes a multidimensional approach with a combined use of decimated signal diagonalization (DSD) as basis from which it is possible to work by finding appropriate signal windows for revealing expected information and overcoming signal processing limitations encountered in quantitative EEG. Important information, about the state of the patient under observation, must be extracted from calculated DSD bispectrum. For this aim, it is useful to define an assessment index about the dynamic process associated with the analyzed signal. This information is measured by means of entropy, since the degree of order/disorder of the recorded EEG signal will be reflected in the obtained DSD bispectrum. The general advantage of multidimensional approach is to reveal eventual stealth frequencies “in space and in time” giving a topological vision to be correlated to physical areas which these frequencies emerge from. Long term and sleeping EEG recorded are analyzed, and the results obtained are of interest for an accurate diagnosis of the patient's clinical condition. [ABSTRACT FROM PUBLISHER]

Background The shortage in human resources for health affects most dramatically developing countries which frequently use community health workers (CHW) as the basis for health programmes and services. The traditional definition refers CHWs as members of the community who are recruited and trained in health prevention and promotion to provide services within their community. In Guinea-Bissau, CHWs play a fundamental role in the diagnosis and treatment of childhood diarrheal diseases - one of the main health problems in the country. Methods This study is based on 22 CHW, 79% of the total number of CHW in the Sanitary Region of Bolama. The main goal was to assess how training CHW on diarrheal diseases impacted the accuracy of the diagnosis and treatment of these diseases in children under the age of 5 years. A longitudinal study was undertaken and three evaluations were made throughout time - one evaluation before the training and two follow-up evaluations (1 and 3 months after the training). An observation grid was developed to evaluate the identified signs, symptoms, diagnosis and treatments prescribed by the CHW in consultations to children with a suspicion of diarrhoeal disease. A similar grid was filled by a medical doctor who took the role of the external validation standard. Friedman's variance analysis and Cochran's Q test were performed in order to compare the accuracy depicted by CHWs in identifying items in the different moments of the study. A logistic regression model was also used to check the possible influence of socio-demographic characteristics of CHWs on the accuracy of the diagnosis and treatment prescribed by the CHW. Results The results show that CHWs improve significantly their performance in identifying the correct diagnosis in the first follow-up moment after the training (P = 0.001, n = 22) but, 3 months later, the effectiveness decreases. No statistical evidence was found for the logistic regression models applied. This progressive loss of performance after training may occur because CHWs fail to apply treatment algorithms and guidelines over time. A limited set of socio-demographic characteristics of the CHWs can influence their performance and should not be disregarded when selecting CHW candidates. Conclusion The selection, supervision, support and continuous training of CHW are as important as the training provided. [ABSTRACT FROM AUTHOR]

Background Since the initial outbreak in March 2009, the novel pandemic (H1N1) 2009 virus has affected individuals worldwide and caused over 18 138 deaths. There is an urgent need for the development of an easy, accurate and simple method for the diagnosis of this novel pandemic virus. Design Reverse transcription loop-mediated isothermal amplification assay (RT-LAMP) with primers targeting the M segment was established for the rapid differential diagnosis of pandemic (H1N1) 2009 virus. The performance of this assay was characterized using 111 clinic nasopharyngeal swabs, and the diagnosis accuracy was compared with real-time reverse transcription PCR (RRT-PCR) and virus isolation, the latter being the reference standard. Results This method successfully detected pandemic (H1N1) 2009 virus with a detection limit of approximately 20 copies of the target RNA per reaction, which is a comparably sensitivity to the RRT-PCR assay. Furthermore, this assay was able to discriminate pandemic (H1N1) 2009 virus from seasonal influenza viruses, such as H1N1 and H3N2, and other respiratory viruses (parainfluenza type 2 and 3, adenovirus, echovirus 7, and coxsackievirus A10). Based on validation by virus isolation, the specificity and sensitivity of this M-specific RT-LAMP assay were 100% and 98.25%, respectively. Moreover, the RT-LAMP amplification of most positive samples (46 out of 56) was achieved in < 20 min. Conclusions This is an accurate and fast analysis system suitable for general diagnostic laboratories with only limited equipment, e.g. first-line health care centre. This assay will help clinicians and public health officials to react effectively during an outbreak. [ABSTRACT FROM AUTHOR]

The use of the decision tree method was recommended as a classification tool in diagnosing electric power apparatus because it provides the visible if-then rule, making it possible to connect the physical phenomena with the observed signals. Using a variety of feature variables extracted from the partial discharge patterns and others, the misclassification rates were found to be as small as 2% if results were obtained using training data only. In this paper, we assess the diagnosing accuracy of the classification methods using test data; we have found that the small values of the misclassification rates remain even when test data are applied. The appropriate methods perform fairly well, with misclassification rates of less than 5%. We conclude that although the misclassification rates by the decision tree are not as small as the values obtained by effective ensemble classifiers such as bagging and boosting, the decision tree is still useful and attractive because the method provides explicit rules, and the variability of the misclassification rates is not very large. [ABSTRACT FROM AUTHOR]

Cardiac sarcoidosis is potentially fatal and hence requires a precise diagnosis. We performed dual 67Ga (Ga)-99mTc-sestamibi (Tc) single-photon emission CT (SPECT) scans by superimposing a Ga-SPECT image on the myocardial outline traced with Tc. The usefulness of this imaging technique in the diagnosis of cardiac sarcoidosis was studied. The subjects in this study were 14 patients with sarcoidosis (mean [± SD] age, 52 ± 16 years; 5 men and 9 women). An IV dose of Tc (74 MBq per 2 mL) was injected into patients 72 h after an IV dose of Ga (111 MBq per 3 mL) was injected. The dual SPECT scan was performed 30 min after the Tc dose was administered. The energy used for collection was 93 keV for Ga and 140 keV for Tc. The myocardial outline was successfully traced in all subjects, allowing us to check for myocardial Ga uptake and to identify its location. Abnormal Ga uptake in the myocardium was observed in 9 of the 14 subjects. In seven of these nine subjects, the location of the abnormal myocardial Ga uptake was identical to the location of reduced Tc uptake. Abnormal Ga uptake disappeared in all cases following steroid therapy. Of the five subjects who were free of abnormal Ga uptake, two showed reduced Tc uptake, and these two subjects had been receiving steroid therapy. These re- suits suggest that dual SPECT scanning using Ga and Tc represents a very useful diagnostic imaging technique since it improves the diagnostic capability of Ga-SPECT to allow the highly specific diagnosis of cardiac sarcoidosis. [ABSTRACT FROM AUTHOR]

Background: There have been many reports on midkine as a promising marker in the diagnosis of hepatocellular carcinoma (HCC). However, the results are inconsistent and even conflicting. Methods: This meta‐analysis was performed to investigate the accuracy of midkine in the diagnosis of HCC. Meta‐DiSc 1.4 software was used to extract data and to calculate the overall sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR). Data are presented as forest plots and summary receiver operating characteristic (SROC) curve analysis was used to summarize the overall test performance. Results: Ten studies with a total of 753 HCC patients and 977 non‐HCC patients were included. The overall pooled diagnostic data were as follows: the pooled sensitivity of 0.86 (95% confidence interval [CI]: 083–0.88), the pooled specificity of 0.75 (95% CI: 0.73–0.78), the pooled PLR of 4.71 (95% CI: 2.80–7.90), the pooled NLR of 0.18 (95% CI: 0.11–0.30), and the pooled DOR of 36.83 (95% CI: 13.56–100.05). The area under curve value was 0.9266 in the overall SROC curve. Conclusion: Midkine has moderate diagnostic accuracy for HCC. Due to the design limitations, results inpublished studies should be carefully interpreted. In addition, more well‐designed studies with large sample sizes should be performed to rigorously evaluate the diagnostic accuracy of the MDK. [ABSTRACT FROM AUTHOR]

Background: Because conventional prostate biopsy has some limitations, optimal variations of prostate biopsy strategies have emerged to improve the diagnosis rate of prostate cancer. We conducted the systematic review to compare the diagnosis rate and complications of transperineal versus transrectal prostate biopsy. We searched for online publications published through June 27, 2018, in PubMed, Scopus, Web of Science, and Chinese National Knowledge Infrastructure databases. The relative risk and 95% confidence interval were utilized to appraise the diagnosis and complication rate. The condensed relative risk of 11 included studies indicated that transperineal prostate biopsy has the same diagnosis accuracy of transrectal prostate biopsy; however, a significantly lower risk of fever and rectal bleeding was reported for transperineal prostate biopsy. No clue of publication bias could be identified. Short conclusion: To conclude, this review indicated that transperineal and transrectal prostate biopsy have the same diagnosis accuracy, but the transperineal approach has a lower risk of fever and rectal bleeding. More studies are warranted to confirm these findings and discover a more effective diagnosis method for prostate cancer. [ABSTRACT FROM AUTHOR]

Recently, the classification study is accelerated, especially in machine learning expertise. Although the decision tree was still recommended as a classification tool in diagnosing electric power apparatus because of the property having the visible if-then rule, the recent development in classification methods, especially those using the ensemble methods, suggests us to apply these methods to condition diagnosis area. In this paper, we report that the new ensemble methods show extremely high accuracy in classification of the electric power apparatus diagnosis, although rule visibility is sacrificed. [ABSTRACT FROM AUTHOR]