Ultrasonographic Transabdominal Measurement of Uterine Cervical Length for the Prediction of a Midtrimester Short Cervix

2020 ◽  
Author(s):  
Paul Guerby ◽  
Annie Beaudoin ◽  
Geneviève Marcoux ◽  
Mario Girard ◽  
Jean-Charles Pasquier ◽  
...  
Keyword(s):  
Roc Curve ◽  
False Positive Rate ◽  
Cervical Length ◽  
Ultrasound Measurement ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Nulliparous Women ◽  
Key Points ◽  
Positive Rate ◽  
The Mean

Objective This study was aimed to estimate the value of transabdominal (TA) ultrasound measurement of cervical length (CL), as an alternative of transvaginal (TV) ultrasound, for universal screening of short cervix in the midtrimester. Study Design We conducted a prospective cohort study of nulliparous women with singleton pregnancy at 20 to 24 weeks of gestation. All participants underwent TA ultrasound followed by TV ultrasound with acquisitions of images and videos of the uterine cervix. A second sonographer, blinded to the participants' data and pregnancy outcomes, measured the CL using TA and TV images and videos. Pearson's correlation test and receiver operating characteristic (ROC) curve analyses were performed. Results A total of 805 participants were recruited, including 780 (97%) where TA CL measurement was feasible. We observed a strong correlation of CL between TA and TV (correlation coefficient: 0.57; p < 0.0001) with a mean TA measurement being 4 mm (95% confidence interval [CI]: −6 to 14 mm) below the mean TV measurement (mean of differences: 5 ± 4 mm). We observed that a TA CL <30 mm was highly predictive of a short cervix defined as a TV CL ≤25 mm (area under the ROC curve: 0.97; 95% CI: 0.95–0.99; p < 0.0001) with a sensitivity of 100% and a false-positive rate of 22%. Conclusion Universal short cervix screening in nulliparous women could be performed using TA ultrasound, which could allow the avoidance of TV ultrasound in more than three quarter of women. In low-risk population, TV ultrasound could be reserved to women with TA CL <30 mm. Key Points

scholarly journals A soft cervix, categorized by shear-wave elastography, in women with short or with normal cervical length at 18–24 weeks is associated with a higher prevalence of spontaneous preterm delivery

2018 ◽  
Vol 46 (5) ◽  
pp. 489-501 ◽  
Author(s):  
Edgar Hernandez-Andrade ◽  
Eli Maymon ◽  
Suchaya Luewan ◽  
Gaurav Bhatti ◽  
Mohammad Mehrmohammadi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Preterm Delivery ◽  
Shear Wave ◽  
Wave Speed ◽  
Shear Wave Elastography ◽  
Cervical Length ◽  
Singleton Pregnancy ◽  
Short Cervix ◽  
Shear Wave Speed ◽  
Spontaneous Preterm Delivery

AbstractObjective:To determine whether a soft cervix identified by shear-wave elastography between 18 and 24 weeks of gestation is associated with increased frequency of spontaneous preterm delivery (sPTD).Materials and methods:This prospective cohort study included 628 consecutive women with a singleton pregnancy. Cervical length (mm) and softness [shear-wave speed: (SWS) meters per second (m/s)] of the internal cervical os were measured at 18–24 weeks of gestation. Frequency of sPTD <37 (sPTD<37) and <34 (sPTD<34) weeks of gestation was compared among women with and without a short (≤25 mm) and/or a soft cervix (SWS <25thpercentile).Results:There were 31/628 (4.9%) sPTD<37 and 12/628 (1.9%) sPTD<34 deliveries. The combination of a soft and a short cervix increased the risk of sPTD<37 by 18-fold [relative risk (RR) 18.0 (95% confidence interval [CI], 7.7–43.9); P<0.0001] and the risk of sPTD<34 by 120-fold [RR 120.0 (95% CI 12.3–1009.9); P<0.0001] compared to women with normal cervical length. A soft-only cervix increased the risk of sPTD<37 by 4.5-fold [RR 4.5 (95% CI 2.1–9.8); P=0.0002] and of sPTD<34 by 21-fold [RR 21.0 (95% CI 2.6–169.3); P=0.0003] compared to a non-soft cervix.Conclusions:A soft cervix at 18–24 weeks of gestation increases the risk of sPTD <37 and <34 weeks of gestation independently of cervical length.

Midtrimester Cervical Length in Low-Risk Nulliparous Women for the Prediction of Spontaneous Preterm Birth: Should We Consider a New Definition of Short Cervix?

2021 ◽  
Author(s):  
Paul Guerby ◽  
Mario Girard ◽  
Geneviève Marcoux ◽  
Annie Beaudoin ◽  
Jean-Charles Pasquier ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Health Care Providers ◽  
Gestational Age ◽  
Roc Curve ◽  
Transvaginal Ultrasound ◽  
Cervical Length ◽  
Care Providers ◽  
Operating Characteristics ◽  
Spontaneous Preterm Birth ◽  
Nulliparous Women

Objective The study aimed to estimate the predictive value of midtrimester cervical length (CL) and the optimal cut-off of CL that should be applied with asymptomatic nulliparous women for the prediction of spontaneous preterm birth (sPTB). Study Design This is a prospective cohort study of asymptomatic nulliparous women with a singleton gestation. Participants underwent CL measurement by transvaginal ultrasound between 20 and 24 weeks of gestation. The participants and their health care providers remained blinded to the results of CL measurement. The primary outcomes were sPTB before 35 weeks and sPTB before 37 weeks. Receiver operating characteristics (ROC) curve analyses were performed. Analyses were repeated by using multiples of median (MoM) of CL adjusted for gestational age. Results Of 796 participants, the mean midtrimester CL was 40 ± 6 mm with a 1st, 5th, and 10th percentile of 25, 29, and 32 mm, respectively. ROC curve analyses suggest that a cut-off of 30 mm was the optimal CL to predict sPTB before 35 weeks (area under the ROC curve [AUC]: 0.70, 95% confidence interval [CI]: 0.56–0.85) and before 37 weeks (AUC: 0.70, 95% CI: 0.59–0.80). Midtrimester CL <30 mm could detect 35% of all sPTB before 35 weeks at a false-positive rate of 5% (relative risk: 9.1, 95% CI: 3.5–23.5, p < 0.001). We observed similar results using a cut-off of CL <0.75 MoM adjusted for gestational age. Conclusion A midtrimester CL cut-off of 30 mm (instead of 25 mm), or CL less than 0.75 MoM, should be used to identify nulliparous women at high risk of sPTB. Key Points

An Alternative Approach for Evaluating the Binormal ROC Curve

2013 ◽  
Vol 4 (1) ◽  
pp. 1-17 ◽  
Author(s):  
R. Amala ◽  
R. Vishnu Vardhan
Keyword(s):  
Roc Curve ◽  
Error Function ◽  
False Positive Rate ◽  
True Positive Rate ◽  
Roc Curve Analysis ◽  
New Approach ◽  
Alternative Approach ◽  
Positive Rate ◽  
Almost All ◽  
Two Populations

In recent years the ROC curve analysis has got its attention in almost all diversified fields. Basing on the data pattern and its distribution various forms of ROC models have been derived. In this paper, the authors have assumed that the data of two populations (healthy and diseased) follows normal distribution, it is one of the most commonly used forms under parametric approach. The present paper focuses on providing an alternative approach for the tradeoff plot of ROC curve and the computation of AUC using a special function of sigmoid shape called Error function. It is assumed that the test scores of particular biomarker are normally distributed. The entire work has been carried out for providing a new approach for the construction of Binormal ROC curve, which makes use of Error function which can be called as ErROC curve. The summary measure AUC of the resulting ErROC curve has been estimated and defined as ErAUC. The authors have also focused on deriving the expression for obtaining the optimal cut-off point. The new ErROC curve model will provide the true positive rate value at each and every point of false positive rate unlike conventional Binormal ROC model.

Mid-pregnancy cervical length as a risk factor for cesarean section in women with twin pregnancies

2018 ◽  
Vol 46 (7) ◽  
pp. 780-785 ◽  
Author(s):  
Su Jin Sung ◽  
Seung Mi Lee ◽  
Sohee Oh ◽  
Joo Hee Choi ◽  
Jee Yoon Park ◽  
...  
Keyword(s):  
Risk Factor ◽  
Cesarean Section ◽  
Cervical Length ◽  
Spontaneous Preterm Birth ◽  
Short Cervix ◽  
Trial Of Labor ◽  
Nulliparous Women ◽  
Increased Risk ◽  
Confounding Variables ◽  
Twin Pregnancies

Abstract Objective: It is well known that a short cervix at mid-pregnancy is a risk factor for spontaneous preterm birth in both singleton and twin gestations. Recent evidence also suggests that a long cervix at mid-pregnancy is a predictor of the risk of cesarean section (C/S) in singleton gestation. The purpose of this study was to determine whether a long cervix at mid-pregnancy was associated with an increased risk of C/S in women with twin pregnancies. Methods: We enrolled 746 women pregnant with twins whose cervical length was measured by trans-vaginal ultrasonography at a mean of 22 weeks of gestation and who delivered in our institution. Cases with a short cervix [cervical length (CL) <15 mm] were excluded. Cases were divided into four groups according to the quartile of CL. Results: The rate of C/S increased according to the quartile of CL (47% in the 1st quartile, 51% in the 2nd quartile, 56% in the 3rd quartile and 62% in the 4th quartile, P<0.005, χ2 for trend). CL was an independent risk factor for C/S even after adjustment for confounding variables. When confining analysis to women who delivered after a trial of labor (n=418), to nulliparous women (n=633) or to those who delivered at late preterm or full term (n=666), the rate of C/S also increased according to the quartile of CL, and the relationship between CL and the risk of C/S remained significant after adjustment in each group. Conclusion: In women pregnant with twins, long CL at mid-pregnancy was a risk factor for C/S.

scholarly journals Vitamin D assessment in perioperative medicine and critical care

2019 ◽  
Author(s):  
Paul Zajic ◽  
Stefan Heschl ◽  
Michael Schörghuber ◽  
Petra Srekl-Filzmaier ◽  
Tatjana Stojakovic ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
False Positive Rate ◽  
Fluid Loading ◽  
Vitamin D Levels ◽  
Positive Rate ◽  
25 Hydroxy Vitamin D ◽  
The Mean ◽  
Clinical Trials Registry ◽  
The Impact

Summary Background There is controversy about the impact of acute illness on vitamin D levels. This study was carried out to assess the influence of perioperative fluid loading on 25-hydroxy-vitamin D [25(OH)D] levels. The study evaluated the clinical utility of a commonly available chemiluminescence assay (ECLIA, IDS-iSYS) and liquid chromatography/mass spectrometry (LC-MS/MS) in the diagnosis of vitamin D deficiency in this setting. Methods In this prospective observational pilot study in adult patients undergoing cardiovascular surgery on cardiopulmonary bypass (CPB), blood samples drawn at preoperative baseline (t1), after weaning from CPB (t2), on intensive care unit (ICU) admission (t3) and on the first (t4) and second (t5) postoperative days were analyzed. Results A total of 26 patients (130 samples) were included in this study. Fluid loading by CPB led to a median reduction of 25(OH)D by −22.6% (range −54.5% to −19.5%) between t1 and t2. Cohen’s kappa (κ) for method agreement for vitamin D deficiency (tested cut-off values 20 ng/ml and 12 ng/ml), was κ = 0.291 (p < 0.001) and κ = 0.469 (p < 0.001), respectively. The mean difference between measurements by ECLIA and LC-MS/MS was 4.8 ng/ml (±5.7), Pearson’s r for correlation was 0.73 (p < 0.001). The biologically inactive C3-epimer did not contribute to 25(OH)D levels assessed by LC-MS/MS. Conclusion The 25(OH)D measurements by chemiluminescence assays can noticeably deviate from those measured by LC-MS/MS, which can be considered the unequivocal gold standard. These assays may still be acceptably reliable in the screening for vitamin D deficiency, especially in the setting of low vitamin D levels. Stricter definitions, e.g. serum 25(OH)D levels lower than 12 ng/ml, may be used to diagnose deficiency with low false positive rate. Trial Registration DRKS00009216, German Clinical Trials Registry (www.drks.de)

scholarly journals Data Mining Validation of Fluconazole Breakpoints Established by the European Committee on Antimicrobial Susceptibility Testing

2009 ◽  
Vol 53 (7) ◽  
pp. 2949-2954 ◽  
Author(s):  
Isabel Cuesta ◽  
Concha Bielza ◽  
Pedro Larrañaga ◽  
Manuel Cuenca-Estrella ◽  
Fernando Laguna ◽  
...  
Keyword(s):  
Machine Learning ◽  
Antimicrobial Susceptibility ◽  
Roc Curve ◽  
False Positive ◽  
Statistical Power ◽  
Susceptibility Testing ◽  
False Positive Rate ◽  
Antimicrobial Susceptibility Testing ◽  
European Committee ◽  
Positive Rate

ABSTRACT European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints classify Candida strains with a fluconazole MIC ≤ 2 mg/liter as susceptible, those with a fluconazole MIC of 4 mg/liter as representing intermediate susceptibility, and those with a fluconazole MIC > 4 mg/liter as resistant. Machine learning models are supported by complex statistical analyses assessing whether the results have statistical relevance. The aim of this work was to use supervised classification algorithms to analyze the clinical data used to produce EUCAST fluconazole breakpoints. Five supervised classifiers (J48, Correlation and Regression Trees [CART], OneR, Naïve Bayes, and Simple Logistic) were used to analyze two cohorts of patients with oropharyngeal candidosis and candidemia. The target variable was the outcome of the infections, and the predictor variables consisted of values for the MIC or the proportion between the dose administered and the MIC of the isolate (dose/MIC). Statistical power was assessed by determining values for sensitivity and specificity, the false-positive rate, the area under the receiver operating characteristic (ROC) curve, and the Matthews correlation coefficient (MCC). CART obtained the best statistical power for a MIC > 4 mg/liter for detecting failures (sensitivity, 87%; false-positive rate, 8%; area under the ROC curve, 0.89; MCC index, 0.80). For dose/MIC determinations, the target was >75, with a sensitivity of 91%, a false-positive rate of 10%, an area under the ROC curve of 0.90, and an MCC index of 0.80. Other classifiers gave similar breakpoints with lower statistical power. EUCAST fluconazole breakpoints have been validated by means of machine learning methods. These computer tools must be incorporated in the process for developing breakpoints to avoid researcher bias, thus enhancing the statistical power of the model.

scholarly journals Deep Learning Model Improves Radiologists’ Performance in Detection and Classification of Breast Lesions

2021 ◽  
Author(s):  
Ying-Shi Sun ◽  
Yu-Hong Qu ◽  
Dong Wang ◽  
Yi Li ◽  
Lin Ye ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Deep Learning ◽  
Roc Curve ◽  
False Positive ◽  
Large Scale ◽  
False Positive Rate ◽  
Training Dataset ◽  
Validation Dataset ◽  
Breast Lesions ◽  
Positive Rate

Abstract Background: Computer-aided diagnosis using deep learning algorithms has been initially applied in the field of mammography, but there is no large-scale clinical application.Methods: This study proposed to develop and verify an artificial intelligence model based on mammography. Firstly, retrospectively collected mammograms from six centers were randomized to a training dataset and a validation dataset for establishing the model. Secondly, the model was tested by comparing 12 radiologists’ performance with and without it. Finally, prospectively multicenter mammograms were diagnosed by radiologists with the model. The detection and diagnostic capabilities were evaluated using the free-response receiver operating characteristic (FROC) curve and ROC curve.Results: The sensitivity of model for detecting lesion after matching was 0.908 for false positive rate of 0.25 in unilateral images. The area under ROC curve (AUC) to distinguish the benign from malignant lesions was 0.855 (95% CI: 0.830, 0.880). The performance of 12 radiologists with the model was higher than that of radiologists alone (AUC: 0.852 vs. 0.808, P = 0.005). The mean reading time of with the model was shorter than that of reading alone (80.18 s vs. 62.28 s, P = 0.03). In prospective application, the sensitivity of detection reached 0.887 at false positive rate of 0.25; the AUC of radiologists with the model was 0.983 (95% CI: 0.978, 0.988), with sensitivity, specificity, PPV, and NPV of 94.36%, 98.07%, 87.76%, and 99.09%, respectively.Conclusions: The artificial intelligence model exhibits high accuracy for detecting and diagnosing breast lesions, improves diagnostic accuracy and saves time.Trial registration: NCT, NCT03708978. Registered 17 April 2018, https://register.clinicaltrials.gov/prs/app/ NCT03708978

An evaluation of tail paint as an aid or alternative to oestrus detection

1983 ◽  
Vol 37 (2) ◽  
pp. 221-227 ◽  
Author(s):  
M. J. Ducker ◽  
Rosemary A. Haggett ◽  
W. J. Fisher ◽  
Glenys A. Bloomfield ◽  
S. V. Morant
Keyword(s):  
False Positive ◽  
Detection Rate ◽  
False Positive Rate ◽  
Critical Time ◽  
Successful Pregnancy ◽  
Service Period ◽  
Significant Difference ◽  
Positive Rate ◽  
The Mean ◽  
Paint Removal

ABSTRACTOne hundred Friesian heifers were tail-painted between 14 and 21 days after calving. Once a week the paint strip was renewed if any paint had been removed. Over the whole period of observation the ovulation detection rate by definite signs of oestrus was high (0·79), whilst the proportion of silent ovulations detected by tail paint removal was low (0·10). In addition, tail paint was not removed on 0·28 of the occasions when definite oestrus with ovulation occurred and on 0·26 of the occasions when all the paint was removed it was not associated with any reproductive event. In practice, the critical time for tail paint to be effective is during the service period. Again, tail paint identified fewer (P < 0·001) ovulations than definite signs of oestrus (0·66) and had a significantly higher false positive rate (P < 0·001). Month of calving did not affect these results but the accuracy of tail paint declined as the season progressed (P < 0·001). False positive indications were not associated with individual animal characteristics. In a second trial 43 cows were tail-painted and 43 were not. There was no significant difference in the mean number of days from calving to first insemination or successful pregnancy between the two groups. It is concluded that in these trials tail paint was not an effective or reliable aid or alternative to oestrus detection.

Diagnostic utility of fluorodeoxyglucose positron emission tomography in prosthetic joint infection based on MSIS criteria

2019 ◽  
Vol 101-B (8) ◽  
pp. 910-914 ◽  
Author(s):  
M. Kiran ◽  
T D. Donnelly ◽  
C. Armstrong ◽  
B. Kapoor ◽  
G. Kumar ◽  
...  
Keyword(s):  
Prosthetic Joint Infection ◽  
False Positive ◽  
Fdg Pet ◽  
Preoperative Evaluation ◽  
Joint Infection ◽  
False Positive Rate ◽  
Prosthetic Joint ◽  
Positron Emission ◽  
Positive Rate ◽  
The Mean

Aims Prosthetic joint infection (PJI) and aseptic loosening in total hip arthroplasty (THA) can present with pain and osteolysis. The Musculoskeletal Infection Society (MSIS) has provided criteria for the diagnosis of PJI. The aim of our study was to analyze the utility of F18-fluorodeoxyglucose (FDG) positron emission tomography (PET) CT scan in the preoperative diagnosis of septic loosening in THA, based on the current MSIS definition of prosthetic joint infection. Patients and Methods A total of 130 painful unilateral cemented THAs with a mean follow-up of 5.17 years (sd 1.12) were included in this prospective study. The mean patient age was 67.5 years (sd 4.85). Preoperative evaluation with inflammatory markers, aspiration, and an F18 FDG PET scan were performed. Diagnostic utility tests were also performed, based on the MSIS criteria for PJI and three samples positive on culture alone. Results The mean erythrocyte sedimentation rate, C-reactive protein, and white cell count were 47.83 mm/hr, 25.21 mg/l, and 11.05 × 109/l, respectively. The sensitivity, specificity, accuracy, negative predictive value, and false-positive rate of FDG PET compared with MSIS criteria were 94.87%, 38.46 %, 56.38%, 94.59 %, and 60.21%, respectively. The false-positive rate of FDG PET compared with culture alone was 77.4%. Conclusion FDG PET has a definitive role in the preoperative evaluation of suspected PJI. This the first study to evaluate its utility based on MSIS criteria and compare it with microbiology results alone. However, FDG PET has a high false-positive rate. Therefore, we suggest that F18 FDG PET is useful in confirming the absence of infection, but if positive, may not be confirmatory of PJI. Cite this article: Bone Joint J 2019;101-B:910–914.

Prediction of Preterm Delivery by Late Cervical Length Measurement after 24 Weeks

2015 ◽  
Vol 38 (3) ◽  
pp. 200-204 ◽  
Author(s):  
Ioannis Papastefanou ◽  
Athanasios Pilalis ◽  
Makarios Eleftheriades ◽  
Athena P. Souka
Keyword(s):  
Preterm Delivery ◽  
Transvaginal Ultrasound ◽  
False Positive Rate ◽  
Cross Sectional Study ◽  
Cervical Length ◽  
Low Risk ◽  
Cross Sectional ◽  
Spontaneous Preterm Delivery ◽  
Positive Rate ◽  
Singleton Pregnancies

Objective: To examine the value of the cervical length (CL) measurement at 24-30 gestational weeks in the prediction of spontaneous preterm delivery (SPD) between 30 and 34 weeks (SPD34) and between 34 and 37 weeks (SPD37). Methods: We performed a prospective cross-sectional study. CL was measured once by transvaginal ultrasound examination between 24 and 30 weeks. Results: The study sample consisted of 1,180 low-risk singleton pregnancies. 10 women (0.85%) had a SPD34 and 60 (5.08%) had a SPD37. CL was shorter (p < 0.001) in the women who had a SPD34 (median 11 mm) compared to the women who delivered after 34 weeks (median 31 mm). CL was shorter (p < 0.001) in the women who had a SPD37 (median 22 mm) compared to the women who delivered after 37 weeks (median 31 mm). CL predicted SPD34 (OR = 0.837, R2 = 0.2768, AUC = 0.9406, p < 0.001) and SPD37 (OR = 0.907, R2 = 0.1085, AUC = 0.7584, p < 0.001). The model achieved a sensitivity of 70.0 and 38.3% for 10% false-positive rate for SPD34 and SPD37, respectively. Conclusions: CL after 24 weeks is significantly shorter in women destined to have a SPD. In low-risk singleton pregnancies CL performs very well in predicting SPD34 and adequately in predicting SPD37.

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