Comparison of Angiographic Dissection Classification Systems in the Femoropopliteal Arteries Using IVUS Validation and Reliability Testing

2021 ◽  
pp. 152660282110479
Author(s):  
Richard Barry Allan ◽  
Nadia Clare Wise ◽  
Yew Toh Wong ◽  
Christopher Luke Delaney
Keyword(s):  
Objective Assessment ◽  
Classification Systems ◽  
Observer Agreement ◽  
Lumen Area ◽  
Blood Institute ◽  
Severity Grade ◽  
Observer Reliability ◽  
Consensus Score ◽  
National Heart Lung ◽  
Ivus Imaging

Purpose: Objective assessment of dissection severity is difficult. Recognition of this has led to the creation of classification systems. This study investigated the performance of the National Heart Lung and Blood Institute (NHLBI) and Kobayashi systems at differentiating severity of femoropopliteal dissection using intravascular ultrasound (IVUS) as the reference standard. Comparison between the 2 systems and the inter- and intra-observer reliability were also investigated. Materials and Methods: Angiographic and IVUS imaging was assessed in 51 cases sourced from a RCT investigating the use of IVUS in femoropopliteal disease. A total of 2 readers independently scored the angiography images according to NHLBI and Kobayashi dissection classification systems and a consensus score was obtained for each system in each case. The NHLBI classification was condensed into 3 grades of dissection to allow comparison between systems. Dissection length, dissection arc, minimum lumen area, and lumen area stenosis were obtained from the IVUS imaging. IVUS parameters were compared between grades of severity for both systems. Agreement in grading between the systems was assessed and IVUS parameters for each level of dissection severity were compared between systems. Inter and intra-observer agreement tested for each system. Results: Dissection was present on IVUS in 92.2% (47/51) of cases and angiography identified 78.7% (37/47) of these. No difference was present in any IVUS parameters between mild and severe dissections with either classification system. No difference in IVUS findings was present for the same grades of dissection between systems. The 2 systems agreed on severity grade in 47 of 51 cases. The inter-observer agreement was for NHLBI was k=0.549 and k=0.627 for Kobayashi. Intra-observer agreement for NHLBI was k=0.633 and k=0.633 and for Kobayashi was k=0.657 and k=0.297. Conclusion: The lack of difference in IVUS parameters between mild and severe dissection for the NHLBI and Kobayashi systems raises doubts about their ability to effectively differentiate dissection severity. Weak to moderate reliability suggests that variability in interpreting dissection may be higher than acceptable. IVUS imaging is more sensitive for detecting dissection than angiography and research is required to establish the value of adding IVUS to dissection classification systems.

The Reliability of Ultrasound in the Assessment of Hyaline Cartilage in Rheumatoid Arthritis and Healthy Metacarpal Heads

2020 ◽  
Author(s):  
Edoardo Cipolletta ◽  
Emilio Filippucci ◽  
Andrea Di Matteo ◽  
Giulia Tesei ◽  
Micaela Ana Cosatti ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Scoring System ◽  
Quantitative Assessment ◽  
Hyaline Cartilage ◽  
Scoring Systems ◽  
Thickness Measurement ◽  
Cartilage Thickness ◽  
Observer Agreement ◽  
Very High Frequency ◽  
Observer Reliability

Abstract Purpose i) To assess the inter- and intra-observer reliability of ultrasound (US) in the evaluation of the hyaline cartilage (HC) of the metacarpal head (MH) in patients with rheumatoid arthritis (RA) and in healthy subjects (HS) both qualitatively and quantitatively. ii) To calculate the smallest detectable difference (SDD) of the MH cartilage thickness measurement. iii) To correlate the qualitative scoring system and the quantitative assessment. Materials and Methods US examination was performed on 280 MHs of 20 patients with RA and 15 HS using a very high frequency probe (up to 22 MHz). HC status was evaluated both qualitatively (using a five-grade scoring system) and quantitatively (using the average value of the longitudinal and transverse measures). The HC of MHs from II to V metacarpophalangeal joint of both hands were scanned independently on the same day by two rheumatologists to assess inter-observer reliability. All subjects were re-examined using the same scanning protocol and the same US setting by one sonographer after a week to assess intra-observer reliability. Results The inter-observer agreement and intra-observer agreement were moderate to substantial (k = 0.66 and k = 0.73) for the qualitative scoring system and high (ICC = 0.93 and ICC = 0.94) for the quantitative assessment. The SDD of the MH cartilage thickness measurement was 0.09 mm. A significant correlation between the two scoring systems was found (r = –0.35; p < 0.001). Conclusion The present study describes the main methodological issues of HC assessment. Using a standardized protocol, both the qualitative and the quantitative scoring systems can be reliable.

scholarly journals Repeatability, Completion Time, and Predictive Ability of Four Diabetes-Related Foot Ulcer Classification Systems

2021 ◽  
pp. 193229682098654
Author(s):  
Chanika Alahakoon ◽  
Malindu Fernando ◽  
Charith Galappaththy ◽  
Peter Lazzarini ◽  
Joseph V. Moxon ◽  
...  
Keyword(s):  
Foot Ulcer ◽  
Predictive Ability ◽  
Classification Systems ◽  
The Other ◽  
Observer Agreement ◽  
Foot Ulcers ◽  
Substantial Agreement ◽  
University Of Texas ◽  
Trained Observers ◽  
Completion Times

Introduction: The inter and intra-observer reproducibility of measuring the Wound Ischemia foot Infection (WIfI) score is unknown. The aims of this study were to compare the reproducibility, completion times and ability to predict 30-day amputation of the WIfI, University of Texas Wound Classification System (UTWCS), Site, Ischemia, Neuropathy, Bacterial Infection and Depth (SINBAD) and Wagner classifications systems using photographs of diabetes-related foot ulcers. Methods: Three trained observers independently scored the diabetes-related foot ulcers of 45 participants on two separate occasions using photographs. The inter- and intra-observer reproducibility were calculated using Krippendorff’s α. The completion times were compared with Kruskal-Wallis and Dunn’s post-hoc tests. The ability of the scores to predict 30-day amputation rates were assessed using receiver operator characteristic curves and area under the curves. Results: There was excellent intra-observer agreement (α >0.900) and substantial agreement between observers (α=0.788) in WIfI scoring. There was moderate, substantial, or excellent agreement within the three observers (α>0.599 in all instances except one) and fair or moderate agreement between observers (α of UTWCS=0.306, α of SINBAD=0.516, α of Wagner=0.374) for the other three classification systems. The WIfI score took significantly longer ( P<.001) to complete compared to the other three scores (medians and inter quartile ranges of the WIfI, UTWCS, SINBAD, and Wagner being 1.00 [0.88-1.00], 0.75 [0.50-0.75], 0.50 [0.50-0.50], and 0.25 [0.25-0.50] minutes). None of the classifications were predictive of 30-day amputation ( P>.05 in all instances). Conclusion: The WIfI score can be completed with substantial agreement between trained observers but was not predictive of 30-day amputation.

scholarly journals Mentoring upcoming researchers for non-communicable diseases’ research and practice in Malawi

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Adamson S. Muula ◽  
Mina C. Hosseinipour ◽  
Martha Makwero ◽  
Johnstone Kumwenda ◽  
Prosper Lutala ◽  
...  
Keyword(s):  
Research Capacity ◽  
Communicable Diseases ◽  
Lessons Learned ◽  
National Institutes Of Health ◽  
Non Communicable Diseases ◽  
Mentorship Program ◽  
Research And Practice ◽  
Blood Institute ◽  
Research Mentorship ◽  
National Heart Lung

AbstractThe Malawi College of Medicine and its partners are building non-communicable diseases’ (NCDs’) research capacity through a grant from the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. Several strategies are being implemented including research mentorship for junior researchers interested to build careers in NCDs’ research. In this article, we present the rationale for and our experiences with this mentorship program over its 2 years of implementation. Lessons learned and the challenges are also shared.

747 Suicidal Ideation Associated with Cognitive Hyperarousal, Rumination and Insomnia in Depressed Perinatal Women

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A291-A292
Author(s):  
Lily Arnett ◽  
David Kalmbach ◽  
Brian Ahmedani ◽  
Bizu Gelaye ◽  
Christopher Drake ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Cognitive Activity ◽  
Late Pregnancy ◽  
Future Research ◽  
Blood Institute ◽  
Cognitive Arousal ◽  
Early Postpartum ◽  
National Heart Lung ◽  
Perseverative Thinking ◽  
Perinatal Women

Abstract Introduction This prospective study explored associations among clinical insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with mild-to-moderate depression. Methods From late pregnancy through early postpartum, 39 women with depression completed 17 weekly surveys assessing insomnia, depression, suicidal ideation, perceived stress, and three cognitive arousal indices. Results Women with nocturnal cognitive hyperarousal at baseline, relative to those with low nocturnal cognitive arousal, were at greater risk for developing new onset SI in late pregnancy or early postpartum (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR=5.66, p=.037) or perinatal-focused rumination (OR=11.63, p=.018). Daytime perseverative thinking was not uniquely associated with SI. Conclusion Cognitive hyperarousal and perinatal-focused rumination at night are uniquely associated with SI among perinatal women with depression. Moreover, insomnia augments the suicidogenicity of nighttime cognitive activity. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression. Support (if any) This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23-HL13866, PI: Cheng).

Genetic variations of SCNA7 and blood pressure potassium interaction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Delgado ◽  
M Delgado-Lelievre ◽  
D Lelievre ◽  
A Delgado-Almeida
Keyword(s):  
Blood Pressure ◽  
Strong Correlation ◽  
Genetic Variations ◽  
Sodium Potassium ◽  
Blood Institute ◽  
Urine Creatinine ◽  
National Heart Lung ◽  
Gated Channel ◽  
K Concentration ◽  
The Relationship

Abstract Introduction The sodium voltage-gated channel alpha subunit 7 (SCN7A) has been associated to renal Na regulation and hypertension. This study explores the relationship between blood pressure (BP) and urinary overnight Na/K ratio (UONaK) in hypertensives (HT) and normotensive (NT) subjects from from National Heart, Lung and Blood Institute funded, Family Blood Pressure Program (FBPP) that were genotyped for 3 SNPs for SCN7A: CV2161217, CV 356958 and CV433036. Hypothesis Genetic variations in the SCNA7 are differently associated to BP and UONaK in HT and NT. Methods 1,749 subjects genotyped for SCN7A SNPs CV2161217, CV 356958 and CV433036 were analyzed from FBPP. Subjects with diastolic BP (DBP) ≥80 or systolic BP (SBP) ≥130 mmHg were classified HTN; subjects with SBP &lt;130 and DBP &lt;80 mmHg were classified as NT. UONAK was calculated by dividing overnight Na by K concentration. Correlation analysis done with partial variables (use of antihypertensive drug, use of diuretics, overnight urine creatinine). Results For the CV2161217, HTN group (n=1,030), 52% had C/C, 39% C/T and 9% T/T. In NT group (n=719), 52% had C/C, 38% C/T and 10% T/T. In the HT group, subjects with CC genotype showed strong correlation between DBP and UONaK (Fig 1a) while no significant correlation with SBP. Those with CT genotype maintained the correlation between SBP and UONaK (r=0.10, p=0.03) with no correlation with SBP. The TT showed no correlation between UONaK and SBP or DBP. In the NT, subjects with TT genotype showed strong correlation between DBP and UONaK (Fig 1b) and with SB (r=0.256, p=0.03). Those with CT or TT genotypes showed no correlation between UONaK and SBP or DBP. Similar finding were obtained for CV356958 SNP; no similar association was observed in the CV433036 SNP. Conclusions Subjects with the genetic variations in the SCNA7, such as CV2161217 and CV 356958 SNPs, showed significant correlation between blood pressure and overnight urinary sodium potassium. This finding could have important implications in non dipping status observed in some hypertensive patients. Funding Acknowledgement Type of funding source: None

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