Ultrasound Markers in Fetal Hydronephrosis to Predict Postnatal Surgery

2018 ◽  
Vol 41 (03) ◽  
pp. 278-285 ◽  
Author(s):  
Teresa Antonia Kiener ◽  
Christoph Wohlmuth ◽  
Christa Schimke ◽  
Martha Georgina Brandtner ◽  
Dagmar Wertaschnigg
Keyword(s):  
Prenatal Ultrasound ◽  
Grading System ◽  
Second Trimester ◽  
Operating Characteristics ◽  
Fetal Hydronephrosis ◽  
Antenatal Hydronephrosis ◽  
Outcome Group ◽  
Postnatal Outcome ◽  
Grade 3 ◽  
Postnatal Surgery

Abstract Purpose Parents confronted with the finding of antenatal hydronephrosis (ANH) are particularly interested in whether their baby will need postnatal surgery. The objective of this study was to predict ANH requiring surgery on the basis of the fetal anteroposterior renal pelvic diameter (APRPD) and the Society for Fetal Urology (SFU) grading system. Materials and Methods The medical records of 179 patients with the finding of ANH were reviewed retrospectively. ANH was graded according to the SFU grading system. Prenatal ultrasound examinations were correlated to postnatal outcome, which was divided into three groups: prenatal resolution, conservative management and surgical treatment. Results 58 (32.4 %) cases were classified as prenatal resolution, 89 (49.7 %) babies were assigned to the conservative outcome group and 32 (17.9 %) patients needed surgical repair. Postnatal surgery was best predicted in the second trimester (area under the receiver operating characteristics curve: 0.839) by an APRPD cut-off of 8.3 mm (sensitivity: 77.8 %; specificity: 85.7 %; PPV of 53.9 %, NPV of 94.7 %). The combination of the parameters “progression of SFU grade” and SFU grade 3 or 4 achieved a sensitivity of 84.4 % and a specificity of 80.3 % for the prediction of surgery. Conclusion Second-trimester APRPD is a useful parameter for predicting the risk for postnatal surgery. The SFU grade should be assessed in every prenatal ultrasound examination as some further risk estimates can be made based on its dynamics over time.

The case of prenatal ultrasound diagnosis of the fetal superior occipital encephalocele in the second trimester of gestation

2018 ◽  
Author(s):  
I.N. Daminov , S.F. Nasirova
Keyword(s):  
Prenatal Ultrasound ◽  
Ultrasound Diagnosis ◽  
Second Trimester ◽  
External Examination ◽  
Occipital Encephalocele

The case of prenatal ultrasound diagnosis of fetal superior occipital encephalocele at 19 weeks of gestation is presented. The pregnancy was terminated at 20 weeks of gestation. An external examination of the abortus confirmed the prenatal ultrasound diagnosis.

Prenatal ultrasound diagnosis of pulmonary atresia in combination with left atrial isomerism

2017 ◽  
Author(s):  
M Medvedev, M.V. Kubrina, O.S. Zarubina et all
Keyword(s):  
Left Atrial ◽  
Reverse Flow ◽  
Ductus Arteriosus ◽  
Pulmonary Atresia ◽  
Prenatal Ultrasound ◽  
Ultrasound Diagnosis ◽  
Right Atrial ◽  
Second Trimester ◽  
Left And Right ◽  
Atrial Isomerism

Two cases of prenatal ultrasound diagnosis of left atrial isomerism in the second trimester of gestation is presented. These two cases were in combination with pulmonary atresia and right aortic arch. Left atrial isomerism was identify by the digit-like shape of the left and right atrial appendages. The pulmonary atresia was identified on the basis of reverse flow in small pulmonary artery. A right aortic was identified by “U”-shaped confluence of aorta and ductus arteriosus in view of three vessels and trachea. The trachea was located between the vessels. The pregnancies were terminated and prenatal diagnosis was conformed at autopsy

The case of prenatal ultrasound diagnosis of fibular hemimelia, type I associated with oligodactyly of the foot in the second trimester of gestation

2020 ◽  
Author(s):  
I.N. Daminov
Keyword(s):  
Ultrasound Examination ◽  
Lower Extremities ◽  
Lower Leg ◽  
Prenatal Ultrasound ◽  
Ultrasound Diagnosis ◽  
Type I ◽  
Second Trimester ◽  
Prenatal Counseling ◽  
External Examination ◽  
Fibular Hemimelia

A case of prenatal ultrasound diagnosis of fibular hemimelia, type I associated with oligodactyly of the foot at 22 weeks of gestation is presented. Ultrasound examination at 22 weeks of gestation revealed hypoplasia of the left fibula and the foot oligodactyly. After prenatal counseling, the patient opted for termination of pregnancy. During external examination of the abortus asymmetry of the lower extremities due to shortening of the left lower leg and oligodactyly of the left foot were noted, those confirmed prenatal ultrasound data.

scholarly journals Automatic Grading of Stroke Symptoms for Rapid Assessment Using Optimized Machine Learning and 4-Limb Kinematics: Clinical Validation Study (Preprint)

2020 ◽  
Author(s):  
Eunjeong Park ◽  
Kijeong Lee ◽  
Taehwa Han ◽  
Hyo Suk Nam
Keyword(s):  
Machine Learning ◽  
Medical Staff ◽  
Machine Learning Algorithms ◽  
Training Data ◽  
Support Vector ◽  
Grading System ◽  
Operating Characteristics ◽  
Stroke Patients ◽  
Motor Weakness ◽  
Automatic Grading

BACKGROUND Subtle abnormal motor signs are indications of serious neurological diseases. Although neurological deficits require fast initiation of treatment in a restricted time, it is difficult for nonspecialists to detect and objectively assess the symptoms. In the clinical environment, diagnoses and decisions are based on clinical grading methods, including the National Institutes of Health Stroke Scale (NIHSS) score or the Medical Research Council (MRC) score, which have been used to measure motor weakness. Objective grading in various environments is necessitated for consistent agreement among patients, caregivers, paramedics, and medical staff to facilitate rapid diagnoses and dispatches to appropriate medical centers. OBJECTIVE In this study, we aimed to develop an autonomous grading system for stroke patients. We investigated the feasibility of our new system to assess motor weakness and grade NIHSS and MRC scores of 4 limbs, similar to the clinical examinations performed by medical staff. METHODS We implemented an automatic grading system composed of a measuring unit with wearable sensors and a grading unit with optimized machine learning. Inertial sensors were attached to measure subtle weaknesses caused by paralysis of upper and lower limbs. We collected 60 instances of data with kinematic features of motor disorders from neurological examination and demographic information of stroke patients with NIHSS 0 or 1 and MRC 7, 8, or 9 grades in a stroke unit. Training data with 240 instances were generated using a synthetic minority oversampling technique to complement the imbalanced number of data between classes and low number of training data. We trained 2 representative machine learning algorithms, an ensemble and a support vector machine (SVM), to implement auto-NIHSS and auto-MRC grading. The optimized algorithms performed a 5-fold cross-validation and were searched by Bayes optimization in 30 trials. The trained model was tested with the 60 original hold-out instances for performance evaluation in accuracy, sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). RESULTS The proposed system can grade NIHSS scores with an accuracy of 83.3% and an AUC of 0.912 using an optimized ensemble algorithm, and it can grade with an accuracy of 80.0% and an AUC of 0.860 using an optimized SVM algorithm. The auto-MRC grading achieved an accuracy of 76.7% and a mean AUC of 0.870 in SVM classification and an accuracy of 78.3% and a mean AUC of 0.877 in ensemble classification. CONCLUSIONS The automatic grading system quantifies proximal weakness in real time and assesses symptoms through automatic grading. The pilot outcomes demonstrated the feasibility of remote monitoring of motor weakness caused by stroke. The system can facilitate consistent grading with instant assessment and expedite dispatches to appropriate hospitals and treatment initiation by sharing auto-MRC and auto-NIHSS scores between prehospital and hospital responses as an objective observation.

Observer variability in grading patients with subarachnoid hemorrhage

1982 ◽  
Vol 56 (5) ◽  
pp. 628-633 ◽  
Author(s):  
Kenneth W. Lindsay ◽  
Graham Teasdale ◽  
Robin P. Knill-Jones ◽  
Lilian Murray
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Condition ◽  
Systemic Disease ◽  
Observer Variation ◽  
Observer Agreement ◽  
Grading System ◽  
Kappa Statistics ◽  
Observer Variability ◽  
Content Type ◽  
Grade 3

✓ The management of individual patients with subarachnoid hemorrhage depends greatly on assessment of the patient's clinical condition. Difficulty in applying current grading systems prompted the authors to conduct studies of observer variability and to attempt to identify sources of inconsistency. Observers graded 15 patients by both the Hunt and Hess and Nishioka systems. Considerable observer variability was found, with up to four different grades being selected for the same patient. Kappa statistics were used to evaluate the data. This method determines observer agreement occurring in excess of chance. Kappa values for each grading system showed observer agreement to be significantly better than chance, yet revealed marked observer variation. Most variation occurred when Grade 3 was selected, irrespective of the system used. In a further study where observers graded clinical summaries, similar variation occurred; therefore, inconsistency was due mainly to difficulty in matching patients with levels described in the grading system, rather than to fluctuation in the patients' clinical condition or difference in the observers' examination technique. Variability was high when patients with systemic disease or vasospasm on angiography were graded with the Hunt and Hess system. The studies show that a simpler and more reliable grading system is required, and emphasize the need for caution when interpreting the results from different published series.

Congenital lung malformations in the second trimester: Prenatal ultrasound diagnosis and pathologic findings

2007 ◽  
Vol 35 (5) ◽  
pp. 250-255 ◽  
Author(s):  
Ágnes Harmath ◽  
Ákos Csaba ◽  
Erik Hauzman ◽  
Júlia Hajdú ◽  
Barbara Pete ◽  
...  
Keyword(s):  
Prenatal Ultrasound ◽  
Ultrasound Diagnosis ◽  
Second Trimester ◽  
Pathologic Findings ◽  
Congenital Lung Malformations

scholarly journals Reliability of Hallux Rigidus Radiographic Grading System

2015 ◽  
Vol 8 (4) ◽  
pp. 125-134
Author(s):  
Ryan C. Pate ◽  
John W. Fanning ◽  
Naomi N. Shields ◽  
Alexander C.M. Chong
Keyword(s):  
Weight Bearing ◽  
Hallux Rigidus ◽  
Observer Agreement ◽  
Grading System ◽  
Foot And Ankle ◽  
Substantial Agreement ◽  
Radiographic Images ◽  
Observer Reliability ◽  
Grade 3 ◽  
Radiographic Grading

Introduction. The purpose of this study was to determine the inter- and intra-observer reliability of a clinical radiographic scale for hallux rigidus. Methods. A total of 80 patients were retrospectively selected from the patient population of two foot and ankle orthopaedic surgeons. Each corresponding series of radiographic images (weight-bearing anteroposterior, weight-bearing lateral, and oblique of the foot) was randomized and evaluated. Re-randomization was performed and the corresponding radiograph images re-numbered. Four orthopaedic foot and ankle surgeons graded each patient, and each rater reclassified the re-randomized radiographic images three weeks later. Results. Sixty-one out of 80 patients (76%) were included in this study. For intra-observer reliability, most of the raters showed “excellent” agreement except one rater had a “substantial” agreement. For inter-observer reliability, only 14 out of 61 cases (23%) showed total agreement between the eight readings from the four surgeons, and 11 out of the 14 cases (79%) were grade 3 hallux rigidus. One of the raters had a tendency to grade at a higher grade resulting in poorer agreement. If this rater was excluded, the results demonstrated a “substantial” agreement by using this classification. Conclusion. The hallux rigidus radiographic grading system should be used with caution. Although there is an “excellent” level of intra-observer agreement, there is only “moderate” to “substantial” level of inter-observer reliability.

Validation of a financial toxicity (FT) grading system.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6615-6615 ◽  
Author(s):  
Jonas A. De Souza ◽  
Kristen Wroblewski ◽  
Ellie Proussaloglou ◽  
Laura Nicholson ◽  
Andrew Hantel ◽  
...  
Keyword(s):  
Cancer Diagnosis ◽  
Stage Iv ◽  
Effect Sizes ◽  
Grading System ◽  
Evidence Based ◽  
Financial Toxicity ◽  
Validation Set ◽  
Grade 3 ◽  
Objectively Measured ◽  
The Cost

6615 Background: FT is an important adverse event (AE) that should be objectively measured in clinical practice. We previously developed an evidence-based FT grading system based on differences in HRQoL, analogous to the NCI-Common Terminology Criteria for Adverse Events (grade 1, mild AE; grade 2, moderate AE; grade 3, severe AE ,de Souza et al - ASCO 2015). We aimed to validate this grading system using a new sample of cancer patients (pts) and report its association with bankruptcy. Methods: FT was assessed by the COST (COmprehensive Score for financial Toxicity) in 2 sets of cancer pts. In the previously reported Development Set (DS), gradations of FT were determined by ROC analyses based on conventions for clinically meaningful small (0.2), medium (0.5) and large (0.8) effect sizes (e.s.) for independent FACT-G differences attributable to FT in pts with Stage IV cancers on chemotherapy. In the Validation Set (VS), differences in HRQoL and the odds ratio for a pt to have declared bankruptcy after the cancer diagnosis were assessed in a larger cohort of cancer pts on chemotherapy. Results: The grading system was developed in 888 cancer pts with cancer (233 pts in the DS and 655 in the VS). In the DS, ROC analyses produced 4 FT grades (G): G0, no FT, COST ≥26 (99 pts, 42%); G1, mild FT: ≥ 14-26 (71 pts, 31%); G2, moderate FT: > 0-14 (58 pts, 25%); and G3, severe FT: COST = 0 (5 pts, 2%). Applying the FT grading to the 655 pts in VS, we had: G0, 146 pts (22%); G1, 281 (43%); G2, 215 (33%); and G3, 13 (2%). The decreases in FACT-G HRQoL measured in e.s. per FT grading in comparison with G0 were small for G1: -0.4 (95%CI: -0.6 – -0.25); large for G2: -0.9 (95%CI: -1.1 – -0.7); and even larger for G3: -1.5 (95%CI: -2.0 – -0.9), all with p < 0.001. In the VS, 23 pts (4%) had declared bankruptcy after their cancer diagnosis. Compared to FT G0, the odds of having declared bankruptcy were 8.6 (95%CI: 1.1 – 67, p = 0.04) times higher for pts with FT G2, and 29 times higher (95% CI: 2.4 – 355, p = 0.008) for those with G3 FT. Conclusions: We developed a FT grading system anchored on independent differences in HRQoL. We applied the system in a different set of cancer pts and it retained its validity. We also found an larger incidence of bankruptcy after the cancer diagnosis in higher grades of FT, adding to the grading’s meaningful use.

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