scholarly journals Independent Inter- and Intra-Rater Reliability of the New AO and Leonetti/Tigani Systems for Pilon Fractures based on CT-Scan

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0023
Author(s):  
Benjamin Guiloff ◽  
Andres Villa ◽  
Joaquin Ananias ◽  
Pablo Mery ◽  
Gerardo Ledermann ◽  
...  
Keyword(s):  
Ct Scan ◽  
Classification System ◽  
Rater Reliability ◽  
Ao Classification ◽  
Observer Reliability ◽  
Tibial Plafond ◽  
Significant Difference ◽  
Preoperative Ct ◽  
Tibial Plafond Fractures ◽  
Different Levels

Category: Basic Sciences/Biologics; Trauma Introduction/Purpose: There is still no consensus regarding which is the best classification system for the management of tibial plafond fractures. The goal of this study is to perform a independent agreement evaluation to compare two recently published systems: Leonetti/Tigani and the new AO classification. Methods: Seventy-five patients with tibial plafond fracture and preoperative CT scan were included. Six raters with different level of expertise (two foot and ankle surgeons and three orthopedic surgery residents) classified the fractures using CT scans according to the morphological grading of both systems. The Leonetti/Tigani classification system considers four types (I, II, III and IV) and six subtypes (I, IIF, IIS, IIIF, IIIS, IV). The AO system considers three types (A, B, C) and nine subtypes (A1, A2, A3, B1, B2, B3, C1, C2, C3). After six weeks all cases were randomly re-evaluated by the same raters. The kappa coefficient (κ) was used to determine the degree of reliability. Results: Inter-observer reliability: strong using the Leonetti/Tigani classification system considering types, with a κ of 0,65 (0,60 - 0,69), and subtypes, with a κ of 0,62 (0,58 - 0,66). Reliability for the AO system was strong considering types with a κ of 0,72 (0,66 - 0,78), but moderate when including subtypes with a κ of 0,54 (0,50 - 0,57). Intra-rater reliability: Almost perfect using the Leonetti/Tigani classification considering both types and subtypes with a κ of 0,94 (0,88- 1,01) and 0,94 (0,89- 0,96), respectively. Reliability for the AO system was almost perfect considering types with a κ of 0,83 (0,75- 0,92), but strong when including subtypes with a κ of 0,61 (0,57- 0,66). No statistically significant difference between different levels of expertise. Conclusion: The system proposed by Leonetti/Tigani demonstrated a strong and almost perfect inter and intra-rater reliability, respectively. Although the new AO classification has a strong inter-rater reliability when including the main categories, it only reached a moderate reliability when including subtypes.

scholarly journals Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients

2020 ◽  
Vol 17 (02) ◽  
pp. 110-120
Author(s):  
Ramesh Chandra Vemula ◽  
B. C.M. Prasad ◽  
Venkat Koyalmantham ◽  
Kunal Kumar
Keyword(s):  
Ct Scan ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
Burr Hole ◽  
P Value ◽  
First Choice ◽  
Significant Difference ◽  
Preoperative Ct

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.

scholarly journals Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project

2020 ◽  
Vol 7 ◽  
Author(s):  
Alen Zabotti ◽  
Sara Zandonella Callegher ◽  
Annarita Tullio ◽  
Arso Vukicevic ◽  
Alojzija Hocevar ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Sjögren’S Syndrome ◽  
Sjögren's Syndrome ◽  
Scoring Systems ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Rater Reliability ◽  
Significant Difference ◽  
Different Levels ◽  
Sjögren‘S Syndrome

Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience.Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring.Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience.Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.

Combined Image Guidance and Intraoperative Computed Tomography in Facilitating Endoscopic Orientation within and around the Paranasal Sinuses

2008 ◽  
Vol 22 (6) ◽  
pp. 635-641 ◽  
Author(s):  
Sarah K. Wise ◽  
Richard J. Harvey ◽  
John C. Goddard ◽  
Patrick O. Sheahan ◽  
Rodney J. Schlosser
Keyword(s):  
Computed Tomography ◽  
Ct Scan ◽  
Paranasal Sinus ◽  
Image Guidance ◽  
Sinus Surgery ◽  
Intraoperative Ct ◽  
Intraoperative Computed Tomography ◽  
Significant Difference ◽  
Preoperative Ct ◽  
Anatomic Region

Background The utility of image guidance (image-guided surgery [IGS]) and intraoperative computed tomography (CT) scanning as a tool for less experienced endoscopic surgeons to aid in localization of paranasal sinus and skull base anatomic structures was evaluated. Methods Partial endoscopic dissection was performed on cadaver specimens by three fellowship trained rhinologists. Anatomic sites within and around the sinuses were tagged with radio-opaque markers. Otolaryngology residents identified tagged anatomic sites using four successive levels of technology: endoscopy alone (simulating outpatient clinic), endoscopy plus preoperative CT (simulating endoscopic sinus surgery [ESS] without IGS), endoscopy plus IGS registered to preoperative CT (simulating current ESS with IGS), and endoscopy plus IGS registered to real-time intraoperative CT. Responses were graded as follows: consensus rhinologist answer (4 points), close answer without clinically significant difference (3 points), within anatomic region but definite clinical difference (2 points), outside of anatomic region (1 point), no answer (0 points). Results Eleven residents participated. Of 20 specific anatomic sites, IGS-intraoperative CT provided the most accurate anatomic identification at 16 sites. For 8 sites, IGS-intraoperative CT had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.29-0.67). For 6 sites, IGS-preoperative CT scan had a significantly higher score than endoscopy alone (p < 0.05; eta2 = 0.30-0.67). All participants found that IGS-intraoperative CT scan made them most comfortable in identifying anatomy. Conclusion Combined IGS and intraoperative CT scan technology may be an instructional adjunct for less experienced paranasal sinus surgeons for dissection and evaluation of unfamiliar or distorted anatomy.

scholarly journals CLASSIFICATION OF ACL TEARS IN THE PEDIATRIC AND ADOLESCENT POPULATION

2020 ◽  
Vol 8 (4_suppl3) ◽  
pp. 2325967120S0025
Author(s):  
I Kushare ◽  
M Beran ◽  
K Klingele ◽  
E Ettia ◽  
A Elabd ◽  
...  
Keyword(s):  
Classification System ◽  
Pediatric Patients ◽  
Acl Injury ◽  
Meniscus Tear ◽  
Single Bundle ◽  
Kappa Statistics ◽  
Type I ◽  
Tissue Quality ◽  
Rater Reliability ◽  
Observer Reliability

Background: There have been previous imaging classification schemes in the literature that described ACL tears in adults and pediatric patients. More recent publications have described the epidemiology, injury mechanisms, and repair versus reconstruction techniques. None have proposed an arthroscopic classification for pediatric patients. Purpose: To describe our experience with a novel arthroscopic classification using 4 patterns of ACL tears depending on the type of tear and the tissue quality. Methods: An IRB approved prospective with 2 parts to this study: Part 1: Single center prospective case series using descriptive statistics of intraoperative findings. We included children ≤18 years old with an ACL tear who underwent surgery within 8 weeks of injury. Those with associated ligamentous injuries or revision surgery were excluded. We proposed a 4-stage classification as follows: I. Avulsion off femur II. <10% tear from femoral end III. Midsubstance tear IV. Single bundle tear. Part 2: Four fellowship-trained surgeons from two tertiary children’s hospitals classified ACL injury based on intraoperative video of 33 randomly selected surgeries. 2 rounds of classification were performed. Inter and intra-observer reliability studies were calculated using Kappa statistics. Results: 120 patients (73 males and 47 females) with mean age of 16 (9-20) years and mean BMI 26 (16-51) were included in this study. 59 patients (49%) had left sided injury while 61 (51%) had right sided injury. 29 (24%) patients reported contact injury while 91 (76%) reported non-contact. Isolated ACL injury was recorded in 49 patients only (41%) while concomitant injuries were recorded in 71 patients (59%). The most common associated injury was the lateral meniscus tear (33%), followed by lateral and medial meniscus tear (13.4%). According to our classification, 23 (19.2%) patients were type I, 15 (12.5%) were type II, 65 (54.2%) were type III, and 17 (14.2%) were type IV. The intra-rater reliability was excellent for 2 reviewers, good for 1 and marginal for another. The overall inter rater reliability for all 4 reviewers was marginal for both readings (k=0.35, 95% CI: 0.23-0.44; k=0.26, 95%CI: 0.16-0.35 respectively). Conclusion: With renewed interest in ACL repairs and techniques, a classification system for ACL tears can guide a proper surgical plan. Our classification system provides a step to achieve this goal. It showed overall good intra-observer reliability, with marginal inter-observer reliability.

scholarly journals The valid diagnostic parameters in static bilateral CT scan to predict unstable syndesmotic injury with ankle fracture

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0031
Author(s):  
Si Wook Lee
Keyword(s):  
Ct Scan ◽  
Surface Area ◽  
Ankle Fracture ◽  
Ct Scans ◽  
Syndesmotic Injury ◽  
Roc Curve Analysis ◽  
Uninjured Side ◽  
Significant Difference ◽  
Posterior Translation ◽  
Preoperative Ct

Category: Trauma Introduction/Purpose: The purpose of this study is to evaluate valid and reasonable parameters to predict syndesmotic injury in ankle fracture. Methods: Seventy patients who underwent preoperative bilateral CT scans were enrolled retrospectively. On preoperative x-ray, tibiofibular overlap (TFO) and tibiofibular clear space (TFCS) were measured. On preoperative CT scan, anterior fibular distance (AFD), posterior fibular distance (PFD), anterior translation distance (AT), fibular diastasis (FD), anterior-posterior translation (APT), fibular length (FL), surface area of syndesmosis (SAS), surface area of syndesmosis of 1.5 cm above the ankle joint line (SAS1.5) were measured. Those measured values were divided with those of uninjured side, in order to minimize the differences among the individuals. Results: Statistically significant differences has been shown between The measurements of ratio (Injured/Uninjured) of TFO, PFD, APT, Diastasis, and SAS of groups which required transfixation have shown statistically significant difference, compared to those of groups which did not require transfixation. Other measurements were not showing significant difference. Furthermore, using ROC curve analysis, a ratio of measurement which is the most reasonable to predict transfixation was SAS (95% confidence interval = 0.598 – 0.869, cut of value = 1.555) Conclusion: Measuring TFO, PFD, APT, Diastasis, and SAS from CT scans and comparing with uninjured side preoperatively can provide surgeon an reasonable evidence to perform transfixation intraoperatively

Attitudes toward the use of TELL tools in English language learning among Vietnamese Tertiary English majors

2019 ◽  
Vol 5 (5) ◽  
pp. 581-596
Keyword(s):  
Language Learning ◽  
Language Proficiency ◽  
English Language ◽  
English Language Learning ◽  
Guided Learning ◽  
Positive Attitudes ◽  
Significant Difference ◽  
English Majors ◽  
Very High ◽  
Different Levels

Technology plays a crucial role in the self-guided learning of a second language in general and English in particular. Nevertheless, many students in different contexts still ignore the application of technology-enhanced language learning (TELL) tools in enhancing their foreign language proficiency. Therefore, this study is conducted to investigate the attitudes towards the use of TELL tools in English-language learning (ELL) among English majors at one university in Vietnam. To collect data, 197 English majors participated in finishing the questionnaire, and 20 students were invited to join the interviews. The findings are that the majority of students have positive attitudes towards the use of TELL tools and the frequency of using these tools is very high. In addition, the results also reveal that there is no significant difference in attitudes towards and frequency of using TELL tools in learning English in terms of the year of study. However, students of different levels of academic achievements have different attitudes towards using TELL tools and use TELL tools to learn English differently. Received 2nd May 2019; Revised 16th July 2019, Accepted 20th October 2019

OVARIAN ASCORBIC ACID DEPLETION TEST FOR LUTEINIZING HORMONE

1967 ◽  
Vol 56 (4) ◽  
pp. 619-625 ◽  
Author(s):  
Hans Jacob Koed ◽  
Christian Hamburger
Keyword(s):  
Ascorbic Acid ◽  
Luteinizing Hormone ◽  
Dose Response ◽  
Response Curve ◽  
Dose Response Curve ◽  
Human Origin ◽  
Response Curves ◽  
Significant Difference ◽  
The Mean ◽  
Different Levels

ABSTRACT Comparison of the dose-response curves for LH of ovine origin (NIH-LH-S8) and of human origin (IRP-HMG-2) using the OAAD test showed a small, though statistically significant difference, the dose-response curve for LH of human origin being a little flatter. Two standard curves for ovine LH obtained with 14 months' interval, were parallel but at different levels of ovarian ascorbic acid. When the mean ascorbic acid depletions were calculated as percentages of the control levels, the two curves for NIH-LH-S8 were identical. The use of standards of human origin in the OAAD test for LH activity of human preparations is recommended.

The Y-shaped trabecular bone structure in the odontoid process of the axis: a CT scan study in 54 healthy subjects and biomechanical considerations

2019 ◽  
Vol 30 (5) ◽  
pp. 585-592 ◽  
Author(s):  
Nicola Montemurro ◽  
Paolo Perrini ◽  
Vittoriano Mangini ◽  
Massimo Galli ◽  
Andrea Papini
Keyword(s):  
Ct Scan ◽  
Healthy Subjects ◽  
Bone Structure ◽  
Cone Beam Ct ◽  
Odontoid Process ◽  
Trabecular Structure ◽  
Anatomical Entity ◽  
Significant Difference ◽  
Axial Ct ◽  
The Mean

OBJECTIVEOdontoid process fractures are very common in both young and geriatric patients. The axial trabecular architecture of the dens appears to be crucial for physiological and biomechanical function of the C1–2 joint. The aim of this study is to demonstrate the presence of a Y-shaped trabecular structure of the dens on axial CT and to describe its anatomical and biomechanical implications.METHODSFifty-four C2 odontoid processes in healthy subjects were prospectively examined for the presence of a Y-shaped trabecular structure at the odontocentral synchondrosis level with a dental cone beam CT scan. Length, width, and axial area of the odontoid process were measured in all subjects. In addition, measurements of the one-third right anterior area of the Y-shaped structure were taken.RESULTSThe Y-shaped trabecular structure was found in 79.6% of cases. Length and width of the odontoid process were 13.5 ± 0.6 mm and 11.2 ± 0.9 mm, respectively. The mean area of the odontoid process at the odontocentral synchondrosis was 93.5 ± 4.3 mm2, whereas the mean one-third right anterior area of the odontoid process at the same level was 29.3 ± 2.5 mm2. The mean area of the odontoid process and its length and width were similar in men and women (p > 0.05). No significant difference was found in the mean area of the odontoid process in people older than 65 years (94 ± 4.2 mm2) compared to people younger than 65 years (93.3 ± 4.4 mm2; p > 0.05).CONCLUSIONSThe authors identified a new anatomical entity, named the Y-shaped trabecular structure of the odontoid process, on axial CT scans. This structure appears to be the result of bone transformation induced by the elevated dynamic loading at the C1–2 level. The presence of the Y-shaped structure provides new insights into biomechanical responses of C2 under physiological loading and traumatic conditions.

scholarly journals FRI0431 PROFILE OF INFECTIOUS SPONDYLODISCITIS ACCORDING TO THE SITE: UNIFOCAL VERSUS MULTIFOCAL

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 814.3-814
Author(s):  
A. Ben Tekaya ◽  
L. Ben Ammar ◽  
M. Ben Hammamia ◽  
O. Saidane ◽  
S. Bouden ◽  
...  
Keyword(s):  
Current Problem ◽  
Common Factor ◽  
Cord Compression ◽  
Posterior Arch ◽  
Significant Difference ◽  
Infectious Spondylodiscitis ◽  
Vertebral Biopsy ◽  
Inflammatory Syndrome ◽  
Different Levels ◽  
A Current

Background:Infectious spondylodiscitis is a therapeutic emergency and is a current problem. It can affect the different levels of the spine. Multifocal forms, touching several floors, however remain rare.Objectives:To compare the clinical, biological, radiological and therapeutic aspects of unifocal versus multifocal spondylodiscitis.Methods:This is a retrospective study of 113 patients admitted to our service over a period of 20 years [1998-2018]. The diagnosis of spondylodiscitis was made on the basis of clinical, biological, radiological and bacteriological data. We have divided our population into two groups: unifocal and multifocal spondylodiscitis.Results:Spondylodiscitis was more frequently unifocal (75.2%) than multifocal (24.8%). The average age of the patients was 55.8 years. There were 62 men and 51 women. There was no difference in age and sex between the two groups (p=0.5 and p=0.8, respectively).Diabetes was more frequent in the group of multifocal spondylodiscitis but with no statistically significant difference (p=0.4). No statistically significant difference between the two groups regarding the start mode (p=0.7), the schedule (p=0.3), the presence of neurological signs (p=0.7), fever (p = 0.2), impaired general condition (p=0.6) and biological inflammatory syndrome (p=0.6).Cervical and dorsal spine involvement was more common in multifocal spondylodiscitis (p = 0.02 and p = 0.01; respectively). There were 11 spondylodiscitis involving 2 floors (cervical and dorsal: 2 cases, cervical and lumbar: 3 cases, dorsal and lumbar: 6 cases) and 3 spondylodiscitis involving 3 floors.Radiologically, the presence of vertebral fracture and involvement of the posterior arch was more frequent during the multifocal form (p=0.03 and p=0.001; respectively). The frequency of para-vertebral abscesses, epiduritis and the presence of spinal cord compression were similar in the two groups (p=0.6; p=0.7 and p=0.2, respectively).Tuberculosis was more frequent during the multifocal form (p = 0.05) and brucellosis during the unifocal form (p = 0.03). Disco-vertebral biopsy was performed in 79 cases. It was more often contributory during multifocal spondylodiscitis (p = 0.03).The occurrence of immediate complications was more frequent in multifocal spondylodiscitis but with no statistically significant difference (p=0.2).Conclusion:Multifocal sppondylodiscitis is seen mainly in immunocompromised subjects. Our study found that diabetes is the most common factor in immunosuppression. Note also the predominance of involvement of the posterior elements, tuberculous origin and immediate complications.Disclosure of Interests:None declared

scholarly journals The morality of abusing a robot

2020 ◽  
Vol 11 (1) ◽  
pp. 271-283
Author(s):  
Christoph Bartneck ◽  
Merel Keijsers
Keyword(s):  
Mediation Analysis ◽  
Aggressive Behaviour ◽  
Video Clips ◽  
Significant Difference ◽  
Abusive Behaviour ◽  
Different Levels ◽  
Identical Behaviour

AbstractIt is not uncommon for humans to exhibit abusive behaviour towards robots. This study compares how abusive behaviour towards a human is perceived differently in comparison with identical behaviour towards a robot. We showed participants 16 video clips of unparalleled quality that depicted different levels of violence and abuse. For each video, we asked participants to rate the moral acceptability of the action, the violence depicted, the intention to harm, and how abusive the action was. The results indicate no significant difference in the perceived morality of the actions shown in the videos across the two victim agents. When the agents started to fight back, their reactive aggressive behaviour was rated differently. Humans fighting back were seen as less immoral compared with robots fighting back. A mediation analysis showed that this was predominately due to participants perceiving the robot’s response as more abusive than the human’s response.

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