Reproducibilidad de la densidad vascular peripapilar,cabeza del nervio óptico y área macular por OCT-A de acuerdo con la severidad del glaucoma

ObjectiveTo assess the reproducibility of peripapillary, optic nerve head (ONH-PP) and macular vessel density (VD) by spectral domain optical coherence tomography angiography (SD OCT-A) in glaucoma patients and healthy subjects.MethodsCross-sectional study assessing 63 eyes of 63 subjects, including 33 glaucoma patients and 30 healthy subjects. Glaucoma was classified in mild, moderate, or advanced. Two consecutive scans were acquired by spectralis module OCT-A (Heidelberg, Germany), and provided images of the superficial vascular complex (SVC), nerve fiber layer vascular plexus (NFLVP), superficial vascular plexus (SVP), deep vascular complex (DVC), intermediate capillary plexus (ICP) and deep capillary plexus (DCP). VD (%) was calculated by AngioTool. Intraclass correlation coefficients (ICCs) and coefficients of variation (CV) were calculated.ResultsAmong ONH-PP VD, better ICC presented advanced (0.86-0.96) and moderate glaucoma (0.83-0.97) compared with mild glaucoma (0.64-0.86). For the macular VD reproducibility, ICC results for superficial retinal layers were better for mild glaucoma (0.94-0.96) followed by moderated (0.88-0.93) and advanced glaucoma (0.85-0.91), and for deeper retinal layers ICC was better for moderate glaucoma (0,95-0,96) followed by advanced (0.80-0.86) and mild glaucoma (0.74-0.91). CVs ranged from 2.2%% to 10.94%. Among healthy subjects, ICCs for the ONH-PP VD measurements (0.91-0.99) and for the macular VD measurements (0.93-0.97) were excellent in all layers, with CVs from 1.65% to 10.33%.ConclusionsSD OCT-A used to quantify macular and ONH-PP VD showed excellent and good reproducibility in most layers of the retina, both in healthy subjects and in glaucoma patients regardless of the severity of the disease.     

超声剪切波弹性成像技术用于检测眼部及眼周组织弹性参数的重复性研究

目的：利用剪切波弹性成像（SWE）技术检测球后壁视网膜-脉络膜-巩膜复合体、视神经、球后脂肪垫和眼肌组织的弹性参数，并评价测量结果的可重复性。方法：选取健康成年志愿者33名，屈光近视者52名，利用SWE技术，由两名检查者于上午同时及10min后测量眼部视网膜-脉络膜-巩膜球后壁复合体、视神经、球后脂肪垫、内直肌、外直肌的弹性参数（Emean），并评价组间（不同检查者同一时间）的测量一致性。同一检测者于同日上、下午及一周后重复测量同一患者眼部弹性参数，评价组内（同一检查者不同时间）测量的一致性。结果：①同一检查者同一天两次测量值Emean差异无统计学意义（p＞0.05），球后壁视网膜-脉络膜-巩膜复合体、视神经、球后脂肪垫、内直肌、外直肌Emean值的ICC值分别为0.82、0.85、0.86、0.83、0.84，表明组内重复性较好；②同一检查者一周前后的两次测量值Emean差异无统计学意义（p＞0.05），球后壁视网膜-脉络膜-巩膜复合体、视神经、球后脂肪垫、内直肌、外直肌值的Emean值的ICC分别为0.79、0.82、0.82、0.80、0.78，组内重复性好；③两位检查者同一时间对相同患者的测量值Emean差异无统计学意义（p＞0.05），ICC分别为0.71、0.75、0.79、0.73、0.75，组间重复性好。Blant-Altman分析法显示组内及组间SWE技术测量值具有良好一致性。结论：SWE可定量获取球后壁视网膜-脉络膜-巩膜复合体、视神经、球后脂肪垫、内直肌、外直肌值的杨氏模量值，且重复性好。     

Defining Morphologic Features of Invasion in Pulmonary Nonmucinous Adenocarcinoma With Lepidic Growth: A Proposal by the International Association for the Study of Lung Cancer Pathology Committee

IntroductionSince the eight edition of the Union for International Cancer Control and American Joint Committee on Cancer TNM classification system, the primary tumor pT stage is determined on the basis of presence and size of the invasive components. The aim of this study was to identify histologic features in tumors with lepidic growth pattern which may be used to establish criteria for distinguishing invasive from noninvasive areas.MethodsA Delphi approach was used with two rounds of blinded anonymized analysis of resected nonmucinous lung adenocarcinoma cases with presumed invasive and noninvasive components, followed by one round of reviewer de-anonymized and unblinded review of cases with known outcomes. A digital pathology platform was used for measuring total tumor size and invasive tumor size.ResultsThe mean coefficient of variation for measuring total tumor size and tumor invasive size was 6.9% (range: 1.7%–22.3%) and 54% (range: 14.7%–155%), respectively, with substantial variations in interpretation of the size and location of invasion among pathologists. Following the presentation of the results and further discussion among members at large of the International Association for the Study of Lung Cancer Pathology Committee, extensive epithelial proliferation (EEP) in areas of collapsed lepidic growth pattern is recognized as a feature likely to be associated with invasive growth. The EEP is characterized by multilayered luminal epithelial cell growth, usually with high-grade cytologic features in several alveolar spaces.ConclusionsCollapsed alveoli and transition zones with EEP were identified by the Delphi process as morphologic features that were a source of interobserver variability. Definition criteria for collapse and EEP are proposed to improve reproducibility of invasion measurement.     

Deep Learning for Improved Precision and Reproducibility of Left Ventricular Strain in Echocardiography: A Test-Retest Study

Graphical abstract: Study design and main results: Two test-retest data sets were collected at 2 different centers (data set I and data set II). For both data sets, 2 different echocardiographers acquired separate recordings in immediate succession in each patient to create a test-retest pair of images (upper panel). For each patient, these test-retest recordings were analyzed by 4 readers who measured global longitudinal strain (GLS) using a commercially available semiautomatic method. This resulted in 12 interreader and 4 intrareader scenarios. In addition, GLS was measured using an artificial intelligence (AI) method based on deep learning. The test-retest measurement bias and minimal detectable change for all inter- and intrareader scenarios and the AI scenario are presented for both data sets (lower panels). Artificial intelligence–based measurements eliminated test-retest bias between readers and resulted in reduced test-retest variability.

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Validity of ultrasonography in detecting enthesitis in children: A systematic literature review

ObjectiveA systematic review to assess the value of ultrasonography (US) for detecting enthesitis in juvenile idiopathic arthritis (JIA).MethodsPubMed and Embase databases were searched for articles published from January 1966 to May 2021; we selected those meeting the inclusion criteria according to the US definition of enthesitis and metric properties studied. We assessed the clinical features of the population, study design, the type and number of entheses examined, the definition and scoring system of US enthesitis and metric properties according to the OMERACT filter (truth, discrimination and feasibility). The quality of the studies was evaluated with the Quality Assessment of Diagnostic Accuracy Studies 2.ResultsFive publications met the inclusion criteria (26 to 146 patients and 1 to 10 bilaterally examined entheses). All studies focused on lower-limb entheses. The elementary lesions included in the definition of adult enthesitis were generally assessed. Few studies reported US reliability and none evaluated sensitivity to change of US. US revealed entheseal abnormalities in 9.4 to 53% of JIA patients and 20 to 83% of enthesitis-related arthritis cases. No significant abnormalities were found in healthy children. US findings were poorly correlated with clinical examination. The overall quality of the studies was low, mainly because of the lack of a reference standard.ConclusionUS is a sensitive tool to detect entheseal abnormalities in JIA. The current evidence highlights that a standardized US definition of enthesitis in children is lacking and US criteria and discriminant validity have not been established.     

Adaptation of the Signal Noise Quotient MRI classification for graft ligamentization analysis following ATFL and CFL anatomical reconstruction: Validation of the SNQA

BackgroundChronic ankle instability is the most frequent clinical sign of an antero tibiofibular (ATFL) and/or calcaneo fibular ligament (CFL) tear. One common surgical technique is to use the distal tendon of the gracilis muscle to reconstruct both the ATFL and CFL. In the knee, the hamstring tendons used in anterior cruciate ligament (ACL) reconstruction may go through structural modifications called "ligamentization ". A noninvasive MRI technique has been developed using the Signal/Noise Quotient to compare the signal of the graft following reconstruction to that of the posterior cruciate ligament. To our knowledge no studies have ever evaluated radiographic changes in the graft over time. The main goal of this study was to develop a specific MRI protocol to evaluate graft remodeling following ATFL and CFL reconstruction over time.MethodsA prospective study of the changes in the MRI signal of the ATFL-CFL graft 3-months postoperatively was performed in 20 patients. The main outcome was a comparison of the graft signal to that of the peroneal fibular tendon and the surrounding noise to determine the Ankle SNQ (SNQA). MRI images were evaluated by two senior radiologists to assess inter-rater reliability and then 2 weeks later for the intra-rater reproducibility.ResultsThe intraclass correlation (ICC) showed excellent inter- and intra rater reliability for the ATFL SNQA (0.96 and 0.91, respectively); and for the CFL SNQA, the ICC was 0.97 and 0.99, respectively. Bland-Altman analysis showed very limited bias in the interpretation of SNQA.ConclusionThis preliminary study confirmed the inter- and intra- rater reliability of a new tool using the SNQA.     

Measurement Properties of Clinical Instruments for Assessing Manual Wheelchair Mobility in Individuals With Spinal Cord Injury: Systematic Review

ObjectiveTo evaluate the measurement properties of clinical instruments used to assess manual wheelchair mobility in individuals with spinal cord injury (SCI).Data SourcesThis systematic review was conducted according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted up to December 2021 on MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Biblioteca Regional de Medicina, and Cumulative Index to Nursing and Allied Health databases without time restriction.Study SelectionPeer-reviewed original research articles that examined any clinical wheelchair mobility and/or skill assessment instrument among adults with SCI and reported data on at least one measurement property or described the development procedure were evaluated independently by two reviewers.Data ExtractionData were independently extracted according to Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Measurement property results from each study were independently rated by two reviewers as sufficient, insufficient, indeterminate, or inconsistent. The evidence for each measurement property was rated as high, moderate, low, or very low (Grading of Recommendations, Assessment, Development, and Evaluation). Recommendations for highly-rated instruments were performed.Data SynthesisTwenty-nine studies with 21 instruments were identified. The methodological quality of studies ranged from insufficient to sufficient, and the quality of evidence ranged from very low to high. Six instruments reported content validity. Reliability and construct validity were the most studied measurement properties. Structural validity and invariance for cross-cultural measurement were not reported. The highly rated instruments were the Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire.ConclusionsAlthough numerous instruments for assessing wheelchair mobility and/or skills among individuals with SCI were identified, not many measurement properties have been sufficiently established. The Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire show the current best potential to be recommended for clinical and research use. Further studies are needed to strengthen or change these recommendations.