The difficulty of diagnosing NCSE in clinical practice; external validation of the Salzburg criteria

To improve the diagnostic accuracy of electroencephalography (EEG) criteria for nonconvulsive status epilepticus (NCSE), external validation of the recently proposed Salzburg criteria is paramount. We performed an external, retrospective, diagnostic accuracy study of the Salzburg criteria, using EEG recordings from patients with and without a clinical suspicion of having NCSE. Of the 191 EEG recordings, 12 (12%) was classified as an NCSE according to the reference standard. In the validation cohort, sensitivity was 67% and specificity was 89%. The positive predictive value was 47% and the negative predictive value was 95%. Ten patients in the control group (n = 93) were false positive, resulting in a specificity of 89.2%. The interrater agreement between the reference standards and between the scorers of the Salzburg criteria was moderate; disagreement occurred mainly in patients with an epileptic encephalopathy. The Salzburg criteria showed a lower diagnostic accuracy in our external validation study than in the original design, suggesting that they cannot replace the current practice of careful weighing of both clinical and EEG information on an individual basis.     

Evaluation of two-dimensional lateral cephalogram and three-dimensional cone beam computed tomography superimpositions: a comparative study

Superimposition of radiographic imaging is used to evaluate patient growth and the effects of surgical and/or orthodontic treatment. The purpose of this study was to compare the outcomes of superimposition between two-dimensional (2D) and three-dimensional (3D) superimpositions. 2D lateral cephalograms were generated from the initial and final cone beam computed tomography scans (CBCT) of 18 patients and superimposed. Both 3D CBCT and 2D CBCT generated lateral cephalograms were oriented to the Frankfort horizontal plane and superimposed according to the American Board of Orthodontics recommendations. Changes in landmark position were quantified from the resulting superimposition outcomes via linear measurements made with Dolphin software. Differences between the two methods were analyzed using paired t-tests. Measurements were repeated twice for 10 randomly selected scans to assess reliability by intra-class correlation coefficient (ICC) analysis. Intra-examiner reliability was high for all measurements (ICC > 0.84). Agreement between 2D and 3D superimposition outcomes, as measured by P-values, was low for ANS (P = 0.026), B-point (P < 0.001), ST Upper lip (P = 0.019), U1 tip (P = 0.010), and U1 apex (P = 0.026). 2D measurements were significantly higher than 3D measurements for ANS, B-point, ST Upper lip, U1 tip, and U1 apex. Findings indicated that both methods of superimposition (2D and 3D) are highly reliable. Statistical differences between 2D and 3D superimposition outcomes were below the threshold of clinical significance.     

Sonodynamic Therapy: Advances and Challenges in Clinical Translation

Sonodynamic therapy (SDT) consists of the synergetic interaction between ultrasound and a chemical agent. In SDT, the cytotoxicity is triggered by ultrasonic stimuli, notably through cavitation. The unique features of SDT are relevant in the clinical context more than ever: the need for efficacy, accuracy, and safety while being noninvasive and preserving the patient's quality of life. However, despite the promising results of this technique, only a few clinical reports describe the use of SDT. The objective of this article is to provide an extensive overview of the clinical and preclinical research conducted in vivo on SDT, to identify the limitations, and to detail the developed strategies to overcome them.     

Advanced Age Is Not a Barrier to Total Knee Arthroplasty: A Detailed Analysis of Outcomes and Complications in an Elderly Cohort Compared With Average Age Total Knee Arthroplasty Patients

BackgroundLife expectancy and higher complication rates have made the routine use of total knee arthroplasty (TKA) in elderly patients disputed by some authors. The purpose of this study was to assess patient and implant survivorship, complication and revision rates, and patient-reported outcomes (PROMS) in a cohort of patients aged above 80 years undergoing TKA. A comparison with a propensity matched cohort of patients of average age within our database for TKA was performed.MethodsA retrospective review of prospectively collected data identified 644 patients over the age of 80 years undergoing a TKA within a 14-year period. After calculating the average age of all TKA patients within the reviewed database, a cohort deemed average age was created within 1 standard deviation of the average age and matched using the following criteria: gender, surgeon, diagnosis, procedure type, and year. The primary outcomes were survivorship of the implant and the patient. The secondary outcomes were complications, transfusion rates, discharge destination, and PROMS.ResultsThe revision rate was low for both groups (P = .051). Implant survivorship at 10 years was similar (P = .07). Mortality rate was higher in the elderly (P < .001). General complication rate was higher in the elderly (P = .031). Surgical complications rates were similar (P = .702). The PROMS at final follow-up were 4% lower in the elderly (P < .001).ConclusionTKA in the elderly is a safe procedure. With measures minimizing the perioperative complications and blood loss, the outcome can be expected to be similar to patients of average age. The projected implant and patient survivorship in the elderly cohort is long enough to suggest that TKA in the elderly could have a high impact on remaining quality of life.Level III retrospective study.