scholarly journals Quantitative CT lung densitometry for the diagnosis of bronchiolitis obliterans in children

2021 ◽  
Author(s):  
Hye Jin Lee ◽  
Seong koo Kim ◽  
Jae Wook Lee ◽  
Soo Ah Im ◽  
Nack Gyun Chung ◽  
...  
Keyword(s):  
Bronchiolitis Obliterans ◽  
Multivariate Logistic Regression Analysis ◽  
Retrospective Chart Review ◽  
Relative Volume ◽  
Chest Ct ◽  
Airflow Limitation ◽  
Quantitative Ct ◽  
Lung Density ◽  
Volume Percentage ◽  
The Difference

Background: The purpose of this study was to evaluate the quantitative diagnostic performance of computed tomography (CT) densitometry in pediatric bronchiolitis obliterans (BO) patients. Methods: A retrospective chart review was performed on 109 children under age 18 who underwent 3D chest CT from March 2019 to March 2021. We measured the mean lung density (MLD) and calculated the difference of MLD (MLDD) in expiratory and inspiratory phase, the expiratory to inspiratory ratio of mean lung density (E/I MLD), and the relative volume percentage of lung density at 50 HU intervals (E600 to E950). We calculated the sensitivity, specificity, and diagnostic accuracy of lung density indices for the diagnosis of BO. Results: A total of 81 patients, 51 BO patients and 30 controls, were included in this study (mean age: 12.7 vs 11.4 years). Expiratory (EXP) MLD, MLDD, E/I MLD, and E900 were all statistically significantly worse in the BO group. Multivariate logistic regression analysis showed that MLDD (odds ratio [OR] = 0.98, p < .001), E/I MLD (OR = 1.39, p < .001), and E850 (OR = 1.54, p = 0.003) were significant densitometry parameters for BO diagnosis. In ROC analysis, E900 (cut-off 1.4%; AUC = 0.920), E/I MLD (cut-off 0.87; AUC = 0.887), and MLDD (cut-off 109 HU; AUC = 0.867) showed high accuracy in diagnosis of BO. Conclusion: The quantification of lung density with chest CT complements the diagnosis by providing additional indications of expiratory airflow limitation in pediatric BO patients.

scholarly journals Risk Assessment Using Early Quantitative Chest CT Parameters for the Severity of COVID-19

2021 ◽  
Vol 18 (3) ◽  
Author(s):  
Xun Ding ◽  
Jia Xu ◽  
Haibo Xu ◽  
Jun Zhou ◽  
Qingyun Long
Keyword(s):  
Risk Assessment ◽  
Lung Volume ◽  
Roc Curve ◽  
Predictive Performance ◽  
Chest Ct ◽  
Critical Group ◽  
Quantitative Ct ◽  
Critical Stage ◽  
Volume Percentage ◽  
Risk Of Progression

Background: Today, the outbreak of coronavirus disease 2019 (COVID-19) is known as a public health emergency by the World Health Organization (WHO). Therefore, risk assessment is necessary for making a correct decision in disease management. Objectives: This study aimed to assess the risk of progression to the critical stage in COVID-19 patients, based on the early quantitative chest computed tomography (CT) parameters. Patients and Methods: In this case-control study, 39 laboratory-confirmed critical or expired COVID-19 cases (critical group), as well as 117 laboratory-confirmed COVID-19 patients including mild, moderate, and severe cases (non-critical group), were enrolled. Seven quantitative CT parameters, representing the lung volume percentages at different density intervals, were automatically calculated, using the artificial intelligence (AI) algorithms. Multivariable-adjusted logistic regression models, based on the quantitative CT parameters, were established to predict the adverse outcomes (critical vs. non-critical). The predictive performance was estimated using the receiver operating characteristic (ROC) curve analysis and by measuring the area under the ROC curve (AUC). The quantitative CT parameters in different stages were compared between the two groups. Results: No significant differences were found between the two groups regarding the lung volume percentages at different density intervals within 0 - 4 days (P = 0.596-0.938); however, this difference began to become significant within 5 - 9 days and persisted even after one month. Overall, the quantitative CT parameters could well predict the severity of COVID-19. The lung volume percentage of -7 Hounsfield units (-7 HUs) had the largest crude odds ratio (OR: 1.999; 95% CI, 1.453 ~ 2.750; P < 0.001) and adjusted OR (adjusted OR: 1.768; 95% CI, 1.114 ~ 2.808; P = 0.016). The lung volume percentage of -6 HU showed the best predictive performance with the largest AUC of 0.808; the cutoff value of 5.93% showed 71.79% sensitivity and 84.62% specificity. Conclusion: Early quantitative chest CT parameters can be measured to assess the risk of progression to the critical stage of COVID-19; this is of critical importance in the clinical management of this disease.

Comparison of two asynchronous QCT methods

2020 ◽  
Vol 24 (4) ◽  
pp. 108-118
Author(s):  
A. V. Petraikin ◽  
A. K. Smorchkova ◽  
N. D. Kudryavtsev ◽  
K. A. Sergunova ◽  
Z. R. Artyukova ◽  
...  
Keyword(s):  
Bone Densitometry ◽  
Pearson Correlation ◽  
Calibration Data ◽  
Mineral Density ◽  
Quantitative Ct ◽  
Short Period ◽  
Potassium Hydrogen ◽  
Patients At Risk ◽  
Ray Density ◽  
The Difference

Rationale. Quantitative CT (QCT) bone densitometry with asynchronous calibration not require a phantom during the scan procedure. Based on calibration data it converts X-ray density in HU to bone mineral density (BMD). Given the large number of CT studies performed on patients at risk of osteoporosis, there is a need for a hands-on method capable of assessing BMD in a short period of time without tailored software or protocols.Goal. To develop a method for QCT bone densitometry using an PHK (PHantom Kalium), to compare the volume BMD measurements with the QCT data with asynchronous calibration provided by software from a reputable developer.Methods. The studies were performed at 64-slice CT unit with body scanning parameters. The BMD was measured using two techniques: 1) QCT with asynchronous calibration using software from a reputable developer; 2) QCT using a PHK phantom (QCT-PHK). For convert the HU to BMD values, we scanned the PHK phantom and calculate correction factor. Phantom contains “vertebrae” filled with potassium hydrogen phosphate in different concentrations. In both methods, the BMD values measured for LI–II, and sometimes for ThXII, LIII.Results. The study enrolled 65 subjects (11 male and 54 female patients); median age 69.0 years. A comparison of the vertebrae BMD measured by QCT and QCT-PHK revealed a significant linear Pearson correlation r = 0.977 (p < 0.05). The Bland–Altman analysis demonstrated a lack of relationship between the difference in measurements and the average BMD and a systematic BMD; bias of +4.50 mg/ml in QCT vs. QCT-PHK. Differences in the division into groups osteoporosis / osteopenia / norm according to the ACR criteria for the two methods were not significant.Conclusion. The developed asynchronous QCT-PHK method measure BMD comparable to the widely used QCT with asynchronous calibration. This method can be used for opportunistic screening for osteoporosis.

scholarly journals Outcomes of Femtosecond Laser Assisted Cataract Surgery Performed by Resident and Attending Surgeons

2021 ◽  
Vol 13 (01) ◽  
pp. e26-e31
Author(s):  
Spencer C. Cleland ◽  
Daniel W. Knoch ◽  
Jennifer C. Larson
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Cataract Surgery ◽  
Retrospective Chart Review ◽  
Dissipated Energy ◽  
Independent Practice ◽  
Postoperative Visual Acuity ◽  
Included Patient ◽  
Duration Of Surgery ◽  
The Difference

Abstract Objective The study aimed to evaluate the safety and efficacy of resident surgeons performing femtosecond laser assisted cataract surgery (FLACS). Methods A retrospective chart review was conducted at the University of Wisconsin-Madison from postgraduate year four residents performing FLACS between 2017 and 2019. Data were also collected from residents performing manual cataract surgery, and attending surgeons performing FLACS for comparison. Recorded data included patient demographics, pre- and postoperative visual acuity, pre- and postoperative spherical equivalent, nuclear sclerotic cataract grade, ocular and systemic comorbidities, intraocular lens, duration of surgery, cumulative dissipated energy (CDE), and intraoperative and postoperative complications. Results A total of 90 cases were reviewed with 30 resident manual cases, 30 resident FLACS cases, and 30 attending FLACS cases. Resident manual (25.5 ± 6.8 minutes) and resident FLACS (17.5 ± 7.1 minutes) cases took a significantly longer time to complete compared with attending FLACS cases (13.6 ± 4.4 minutes; p < 0.001). There was higher CDE in resident FLACS and resident manual cases compared with attending FLACS cases, but the difference was not statistically significant (p = 0.06). Postoperative visual acuity was not statistically different at 1-day and 1-month after surgery among the three groups. Resident FLACS complications, which included one case requiring an intraoperative suture to close the wound, two cases with intraoperative corneal abrasions, two cases with postoperative ocular hypertension, and one case with cystoid macular edema, were not significantly greater than attending FLACS complications (p = 0.30). Conclusion The FLACS performed by resident surgeons had comparable visual acuity outcomes to FLACS performed by attending surgeons, and to manual cataract surgery performed by resident surgeons. However, resident FLACS cases took significantly longer time to complete, and they were associated with a higher CDE and minor complication rate compared with attending FLACS cases. Introducing advanced technologies into surgical training curricula improves resident preparedness for independent practice, and this study suggests FLACS can be incorporated safely and effectively into resident education.

scholarly journals Computed tomography based measurements to evaluate lung density and lung growth after congenital diaphragmatic hernia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Timm Stoll-Dannenhauer ◽  
Gregor Schwab ◽  
Katrin Zahn ◽  
Thomas Schaible ◽  
Lucas Wessel ◽  
...  
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Contralateral Side ◽  
Chest Ct ◽  
Control Group ◽  
P Value ◽  
Lung Density ◽  
Ipsilateral Lung ◽  
Contralateral Lung ◽  
Pediatric Chest

AbstractEmphysema-like-change of lung is one aspect of lung morbidity in children after congenital diaphragmatic hernia (CDH). This study aims to evaluate if the extent of reduced lung density can be quantified through pediatric chest CT examinations, if side differences are present and if emphysema-like tissue is more prominent after CDH than in controls. Thirty-seven chest CT scans of CDH patients (mean age 4.5 ± 4.0 years) were analyzed semi-automatically and compared to an age-matched control group. Emphysema-like-change was defined as areas of lung density lower than − 950 HU in percentage (low attenuating volume, LAV). A p-value lower than 0.05 was regarded as statistically significant. Hypoattenuating lung tissue was more frequently present in the ipsilateral lung than the contralateral side (LAV 12.6% vs. 5.7%; p < 0.0001). While neither ipsilateral nor contralateral lung volume differed between CDH and control (p > 0.05), LAV in ipsilateral (p = 0.0002), but not in contralateral lung (p = 0.54), was higher in CDH than control. It is feasible to quantify emphysema-like-change in pediatric patients after CDH. In the ipsilateral lung, low-density areas are much more frequently present both in comparison to contralateral and to controls. Especially the ratio of LAV ipsilateral/contralateral seems promising as a quantitative parameter in the follow-up after CDH.

Introducing a flipped classroom in a pharmacology course

2021 ◽  
Vol 30 (5) ◽  
pp. 296-300
Author(s):  
Sehrish Sajjad ◽  
Ambreen Gowani
Keyword(s):  
Nursing Students ◽  
Test Scores ◽  
Flipped Classroom ◽  
Retrospective Chart Review ◽  
Continuous Assessment ◽  
Assessment Scores ◽  
School Of Nursing ◽  
The Difference ◽  
Traditional Pedagogy ◽  
Pharmacology Knowledge

Background: Flipped classroom pedagogy has been shown to improve nursing students' academic performance. Aim: The study aimed to determine the effect of a flipped classroom approach on students' pharmacology assessment scores in a school of nursing in Karachi, Pakistan. Methods: A retrospective chart review was performed. The pharmacology test scores of the BSc nursing cohort of 2020, when flipped classroom pedagogy was used, was compared with those of the BSc nursing cohort of 2019, where traditional pedagogy was employed. Students' summative evaluation for the course and their verbal feedback were analysed. Results: The median continuous assessment test score of the 2019 cohort was 35 (interquartile range (IQR) 32–38), while that of the 2020 cohort was 38 (IQR 35–41). The difference in the score was statistically significant (P<0.001). Conclusion: The study gives an insight into a relatively novel pedagogy that was found to improve pharmacology knowledge test scores among nursing students.

Reference Values for Lung Density and Structure Measured by Quantitative CT

1994 ◽  
pp. 290-298 ◽  
Author(s):  
W. A. Kalender ◽  
H. Fichte ◽  
W. Bautz ◽  
A. Zwick ◽  
R. Rienmüller ◽  
...  
Keyword(s):  
Reference Values ◽  
Quantitative Ct ◽  
Lung Density

Airflow limitation as a risk factor for vascular stiffness

2020 ◽  
Vol 24 (6) ◽  
pp. 577-584
Author(s):  
S. S. Sheen ◽  
H. J. Kim ◽  
D. Singh ◽  
S. C. Hwang ◽  
K. J. Park ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Multivariate Logistic Regression Analysis ◽  
Density Lipoprotein ◽  
Forced Expiratory Volume ◽  
Vascular Stiffness ◽  
University Hospital ◽  
Airflow Limitation ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Health Examination

BACKGROUND: Cardiovascular disease is one of the main causes of mortality in patients with chronic obstructive pulmonary disease (COPD), and atherosclerosis is a cause of cardiac comorbidities in COPD. However, it is not clear whether airflow limitation is associated with atherosclerosis irrespective of smoking.OBJECTIVE: To investigate whether airflow limitation is independently associated with vascular stiffness.METHODS: We enrolled 18 893 participants (male 70.5%; mean age 47.5 ± 9.8 years; never smokers 44.2%) who underwent spirometry and brachial-ankle pulse wave velocity (baPWV) as part of a standard health examination at Ajou University Hospital, Suwon, South Korea, from January 2010 to December 2015.We defined vascular peripheral atherosclerosis as baPWV ≥ 1400 cm/s and airflow limitation as pre-bronchodilator ratio of forced expiratory volume in 1 sec (FEV1) to forced vital capacity (FVC) <70%.RESULTS: Mean baPWV was higher in subjects with airflow limitation (1477.6 ± 331.7 cm/sec, n = 638) than in those without airflow limitation (1344.1 ± 231.8 cm/sec, n = 18255, P < 0.001). In multivariate logistic regression analysis, the following were independent predictors associated with peripheral atherosclerosis (P < 0.05): age, male sex, fasting serum glucose, mean blood pressure, serum leukocyte count, serum low density lipoprotein level and FEV1.CONCLUSION: Airflow limitation was an independent predictor of vascular stiffness irrespective of smoking history, which suggests that airflow limitation is linked with atherosclerosis.

scholarly journals The prevalence of headaches, pain, and other associated symptoms in different Persian Gulf deployment periods and deployment durations

2019 ◽  
Vol 7 ◽  
pp. 205031211987141 ◽  
Author(s):  
Karen Lei ◽  
Valerie Metzger-Smith ◽  
Shahrokh Golshan ◽  
Jennifer Javors ◽  
Albert Leung
Keyword(s):  
Persian Gulf ◽  
Retrospective Chart Review ◽  
Gulf War ◽  
Chi Square ◽  
Associated Symptoms ◽  
The Difference ◽  
Human Subject Committee ◽  
The Persian Gulf ◽  
Pain Symptoms ◽  
Analgesic Use

Objectives: This study aims to assess (1) the difference in the prevalence of headaches, pain, and other associated symptoms between Gulf War I (1990–1991) and Post-Gulf War I (1992–2015) veterans who served as active military personnel in the Persian Gulf and (2) how the durations of deployment may affect the prevalence of those symptoms. Methods: With institutional human subject committee approval, veterans who were accepted to the Gulf War Registry at the VA San Diego Healthcare System between July 2013 and June 2015 ( N = 367) were included in this retrospective chart review study and grouped according to the Gulf War period they served under or how long they were deployed to the Persian Gulf. Chi-square was used for categorical data analyses and analysis of variance was conducted for continuous outcomes. All analyses were two-tailed, where applicable, with α = 0.05 and Bonferroni for pairwise group comparisons. Results: Veterans who served during Post-Gulf War I or both Gulf War I and Post-Gulf War I exhibited more pain and neurological symptoms than Gulf War I veterans ( p = 0.005, p = 0.003). In addition, veterans who served ⩾12 months reported more overall pain symptoms and analgesic use than those who served less time ( p < 0.001, p = 0.024). Conclusion: The findings suggest that the length of deployment and Persian Gulf deployment period may play a role in acquiring headaches, pain, and other associated symptoms with increased analgesic consumption.

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