scholarly journals Reproducibility of a new classification of the anterior clinoid process of the sphenoid bone

2020 ◽  
Vol 11 ◽  
pp. 281
Author(s):  
Feres Chaddad-Neto ◽  
Marcos Devanir Silva da Costa ◽  
Bruno Santos ◽  
Ricardo Lourenco Caramanti ◽  
Bruno Lourenco Costa ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Anatomical Variation ◽  
Ct Scans ◽  
Multiplanar Reconstruction ◽  
Kappa Index ◽  
Anterior Clinoid Process ◽  
Kappa Test ◽  
Optic Strut ◽  
The Difference

Background: Pneumatization of the anterior clinoid process (ACP) affects paraclinoid region surgery, this anatomical variation occurs in 6.6–27.7% of individuals, making its preoperative recognition essential given the need for correction based on the anatomy of the pneumatized process. This study was conducted to evaluate the reproducibility of an optic strut-based ACP pneumatization classification by presenting radiological examinations to a group of surgeons. Methods: Thirty cranial computer tomography (CT) scans performed from 2013 to 2014 were selected for analysis by neurosurgery residents and neurosurgeons. The evaluators received Google Forms with questionnaires on each scan, DICOM files to be manipulated in the Horos software for multiplanar reconstruction, and a collection of slides demonstrating the steps for classifying each type of ACP pneumatization. Interobserver agreement was calculated by the Fleiss kappa test. Results: Thirty CT scans were analyzed by 37 evaluators, of whom 20 were neurosurgery residents and 17 were neurosurgeons. The overall reproducibility of the ACP pneumatization classification showed a Fleiss kappa index of 0.49 (95% confidence interval: 0.49–0.50). The interobserver agreement indices for the residents and neurosurgeons were 0.52 (0.51–0.53) and 0.49 (0.48–0.50), respectively, and the difference was statistically significant (P < 0.00001). Conclusion: The optic strut-based classification of ACP pneumatization showed acceptable concordance. Minor differences were observed in the agreement between the residents and neurosurgeons. These differences could be explained by the residents’ presumably higher familiarity with multiplanar reconstruction software.

scholarly journals A morphometric survey of the parasellar region in more than 2700 skulls: emphasis on the middle clinoid process variants and implications in endoscopic and microsurgical approaches

2018 ◽  
Vol 129 (1) ◽  
pp. 60-70 ◽  
Author(s):  
Akshay Sharma ◽  
Gabrielle E. Rieth ◽  
Joseph E. Tanenbaum ◽  
James S. Williams ◽  
Nakao Ota ◽  
...  
Keyword(s):  
Sella Turcica ◽  
Significant Risk ◽  
Surgical Anatomy ◽  
Ct Scans ◽  
Anterior Clinoid Process ◽  
White Race ◽  
Explanatory Variables ◽  
Optic Strut ◽  
Parasellar Region ◽  
Data Points

OBJECTIVEThe middle clinoid process (MCP) is a bony projection that extends from the sphenoid bone near the lateral margin of the sella turcica. The varied prevalence and morphological features of the MCP in populations stratified by age, race, and sex are unknown; however, the knowledge of its anatomy and preoperative recognition on CT scans can aid greatly in complication avoidance and management. The aim of this study was to further illustrate the surgical anatomy of the parasellar region and to quantify the incidence of MCP and caroticoclinoid rings (CCRs) in dried preserved human anatomical specimens.METHODSThe presence, dimensions, morphological classification (incomplete, contact, and CCR), and intracranial relations of the MCP were measured in 2726 dried skull specimens at the Hamann-Todd Osteological Collection at the Cleveland Museum of Natural History. Specific morphometric data points were recorded from each of these hemiskulls, and categorized based on age, sex, and ethnicity. Linear and logistic regressions were used to determine associations between explanatory variables and MCP morphology. Computed tomography scans of the skull specimens were obtained to explore radiological landmarks for different types of MCPs. Illustrative intraoperative videos were also analyzed in the light of these crucial surgical landmarks.RESULTSThe sample included 2250 specimens from males and 476 from females. Specimens were classified as either “white” (60.5%) or “black” (39.2%). An MCP was found in 42% of specimens, with 60% of those specimens presenting bilaterally. Fully ossified CCR comprised 27% of all MCPs, and contact (defined as contact without ossification between MCP and anterior clinoid process) comprised 4% of all MCPs. White race (relative to black race) and increasing age were significant predictors of MCP presence (p < 0.001). White race was significantly associated with greater average MCP height (p < 0.001). Among skulls with CCR, both male sex and older age (> 70 years relative to < 50 years) were associated with increased CCR diameter (p < 0.001). No other significant predictors or associations were observed. The CT scans of skulls replicated and validated the authors’ morphometric observations on incomplete, contact, and CCR patterns adequately. The surgical strategies of clinoid bone removal are validated, with appropriate video illustrations.CONCLUSIONSVariations in the patterns of bony MCPs can pose a significant risk for injury to the internal carotid artery during parasellar procedures, especially those involving clinoidectomy and optic strut drilling. Understanding parasellar anatomy, especially on skull-base CT imaging, may be integral to surgical planning and preoperative risk counseling in both transcranial and extended endonasal procedures, as well as to preparing for complications management perioperatively.

Depression, pain, and site:

1999 ◽  
Vol 15 (1) ◽  
pp. 10-17
Author(s):  
Molina Omar Franklin ◽  
Tavares Gimenes Pablo ◽  
Aquilino Raphael ◽  
Rank Rise ◽  
Coelho Santos Zeila ◽  
...  
Keyword(s):  
Visual Analogue Scale ◽  
Beck Depression Inventory ◽  
Temporomandibular Disorders ◽  
Analogue Scale ◽  
Epidemiological Data ◽  
Depression Severity ◽  
Internal Joint ◽  
The Difference ◽  
Biomechanical Tests

Objective: To assess the level of depression, severity of pain and pain in single/multiple sites in patients with different severity of bruxing behavior and Temporomandibular Disorders (TMDs). Methods: We evaluated 131 patients with bruxism and TMDs: 20 patients with mild bruxism, 42 patients with moderate bruxism, 45 patients with severe bruxism and 24 patients with extreme bruxism. We used the Beck Depression Inventory (BDI), clinical examination, a questionnaire of clinical epidemiological data, criteria for TMDs and bruxism, palpation of muscles and joints, the Visual Analogue Scale for pain, classification of the occlusion and biomechanical tests to assess for internal joint derangements. Results: The level of depression increased from the mild, to the moderate, severe and extreme bruxing behavior groups, but the difference was significant only from the mild to the extreme group (p<0.001). Pain levels increased from the mild and moderate to the severe and extreme subgroups, but were not statistically significant. Mean number of pain sites increased from the mild, to the moderate, severe and extreme subgroup and the difference was extremely significant (p<0.0001). Conclusion: Levels of depression, severity of pain and pain sites increased with severity of bruxing behavior. A higher number of pain sites with more severe bruxism indicates somatization in bruxers, but a further study using the same protocol and a psychological test for somatization would be indicated to further substantiate these findings.

scholarly journals Interobserver agreement of the Paris and simplified classifications of superficial colonic lesions: a Western study

2021 ◽  
Vol 09 (03) ◽  
pp. E388-E394
Author(s):  
Francesco Cocomazzi ◽  
Marco Gentile ◽  
Francesco Perri ◽  
Antonio Merla ◽  
Fabrizio Bossa ◽  
...  
Keyword(s):  
Interobserver Agreement ◽  
Classification Systems ◽  
Sensitivity Analyses ◽  
Size Estimation ◽  
Rater Agreement ◽  
Staff Members ◽  
Video Clips ◽  
Paris Classification ◽  
Level Of Agreement

Abstract Background and study aims The Paris classification of superficial colonic lesions has been widely adopted, but a simplified description that subgroups the shape into pedunculated, sessile/flat and depressed lesions has been proposed recently. The aim of this study was to evaluate the accuracy and inter-rater agreement among 13 Western endoscopists for the two classification systems. Methods Seventy video clips of superficial colonic lesions were classified according to the two classifications, and their size estimated. The interobserver agreement for each classification was assessed using both Cohen k and AC1 statistics. Accuracy was taken as the concordance between the standard morphology definition and that made by participants. Sensitivity analyses investigated agreement between trainees (T) and staff members (SM), simple or mixed lesions, distinct lesion phenotypes, and for laterally spreading tumors (LSTs). Results Overall, the interobserver agreement for the Paris classification was substantial (κ = 0.61; AC1 = 0.66), with 79.3 % accuracy. Between SM and T, the values were superimposable. For size estimation, the agreement was 0.48 by the κ-value, and 0.50 by AC1. For single or mixed lesions, κ-values were 0.60 and 0.43, respectively; corresponding AC1 values were 0.68 and 0.57. Evaluating the several different polyp subtypes separately, agreement differed significantly when analyzed by the k-statistics (0.08–0.12) or the AC1 statistics (0.59–0.71). Analyses of LSTs provided a κ-value of 0.50 and an AC1 score of 0.62, with 77.6 % accuracy. The simplified classification outperformed the Paris classification: κ = 0.68, AC1 = 0.82, accuracy = 91.6 %. Conclusions Agreement is often measured with Cohen’s κ, but we documented higher levels of agreement when analyzed with the AC1 statistic. The level of agreement was substantial for the Paris classification, and almost perfect for the simplified system.

scholarly journals Events, Time and the Simple Form

2009 ◽  
Vol 17 (1) ◽  
pp. 85-105 ◽  
Author(s):  
Walter H. Hirtle
Keyword(s):  
Simple Form ◽  
Point Of View ◽  
Event Time ◽  
The Difference ◽  
Time Required ◽  
English Verb

Abstract This is an attempt to discern more clearly the underlying or POTENTIAL meaning of the simple form of the English verb, described in Hirtle 1967 as 'perfective'. Vendler's widely accepted classification of events into ACCOMPLISHMENTS, ACHIEVEMENTS, ACTIVITIES, and STATES is examined from the point of view of the time necessarily contained between the beginning and end of any event, i.e. EVENT TIME as represented by the simple form. This examination justifies the well known dynamic/stative dichotomy by showing that event time is evoked in two different ways, that, in fact, the simple form has two ACTUAL significates. Further reflection on the difference between the two types thus expressed—developmental or action-like events and non-developmental or state-like events—leads to the conclusion that the simple form provides a representation of the time required to situate all the impressions involved in the notional or lexical import of the verb.

Radiation exposure during the treatment of spinal deformities

2021 ◽  
pp. 1-7
Author(s):  
Jwalant S. Mehta ◽  
Kirsten Hodgson ◽  
Lu Yiping ◽  
James Swee Beng Kho ◽  
Ravindra Thimmaiah ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Ionizing Radiation ◽  
Effective Dose ◽  
Spinal Deformity ◽  
Background Radiation ◽  
Ct Scans ◽  
Intraoperative Fluoroscopy ◽  
The Difference ◽  
Risk Of Cancer ◽  
Surgical Group

Aims To benchmark the radiation dose to patients during the course of treatment for a spinal deformity. Methods Our radiation dose database identified 25,745 exposures of 6,017 children (under 18 years of age) and adults treated for a spinal deformity between 1 January 2008 and 31 December 2016. Patients were divided into surgical (974 patients) and non-surgical (5,043 patients) cohorts. We documented the number and doses of ionizing radiation imaging events (radiographs, CT scans, or intraoperative fluoroscopy) for each patient. All the doses for plain radiographs, CT scans, and intraoperative fluoroscopy were combined into a single effective dose by a medical physicist (milliSivert (mSv)). Results There were more ionizing radiation-based imaging events and higher radiation dose exposures in the surgical group than in the non-surgical group (p < 0.001). The difference in effective dose for children between the surgical and non-surgical groups was statistically significant, the surgical group being significantly higher (p < 0.001). This led to a higher estimated risk of cancer induction for the surgical group (1:222 surgical vs 1:1,418 non-surgical). However, the dose difference for adults was not statistically different between the surgical and non-surgical groups. In all cases the effective dose received by all cohorts was significantly higher than that from exposure to natural background radiation. Conclusion The treatment of spinal deformity is radiation-heavy. The dose exposure is several times higher when surgical treatment is undertaken. Clinicians should be aware of this and review their practices in order to reduce the radiation dose where possible.

Abstract 82: Differences Between Caucasians and Asians in Intracranial Arterial Stenosis Among TIA and Minor Stroke Patients: Comparisons of Two Contemporary Cohorts

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Xinyi Leng ◽  
Robert Hurford ◽  
Xueyan Feng ◽  
Ka Lung Chan ◽  
Linxin Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ct Angiography ◽  
Interobserver Agreement ◽  
Arterial Stenosis ◽  
Minor Stroke ◽  
Intracranial Arterial Stenosis ◽  
Stroke Patients ◽  
Stroke Registry ◽  
The Difference ◽  
Ischemic Attack

Background: Despite numerous reports indicating ethnic difference in intracranial arterial stenosis (ICAS) between Caucasians and Asians, there has been no direct comparison in disease burden and clinical correlates of ICAS in stroke patients in the two populations with the same criteria to define ICAS. Methods: Acute minor stroke or transient ischemic attack patients who received cerebral MR/CT angiography exam in two cohorts were analyzed: Oxford Vascular Study (OXVASC, 2011-2018) with predominantly Caucasians, and the Chinese University of Hong Kong (CUHK) stroke registry (2011-2015) with predominantly Chinese. ICAS was defined as ≥50% stenosis in any major intracranial artery in MR/CT angiography. Interobserver agreement between 2 investigators for presence of ICAS was assessed in 50 cases with Cohen’s kappa. We compared the burden and risk factors of ICAS in the two cohorts. Results: Overall, 1,287 patients from OXVASC (mean age 69 years) and 640 from the CUHK cohort (mean age 66 years) were analyzed. Interobserver agreement for presence of ICAS was good (kappa=0.82). Prevalence of ICAS was significantly higher in Chinese than in Caucasians: 43.6% in the CUHK cohort versus 20.0% in OXVASC (crude OR 3.10; age-adjusted OR 3.81, 95% CI 3.06-4.75; p<0.001). Mean ages of patients with ICAS in the two cohorts were 75 and 68 years, respectively. The difference between Caucasians and Chinese in ICAS prevalence was smaller in those aged ≥70 years (28.1% versus 51.9%) than those <70 years (9.8% versus 38.0%) (Figure). ICAS shared similar risk factors in the two cohorts, including older age, and history of hypertension and diabetes. Conclusions: Chinese are more susceptible to ICAS, with an earlier onset age than Caucasians, but the ICAS burden in Caucasians was higher than previously estimated, especially in older patients.

Russia and EU Countries: Partnership for Modernization

2013 ◽  
pp. 54-61
Author(s):  
T. Romanova ◽  
E. Pavlova
Keyword(s):  
Rule Of Law ◽  
New Classification ◽  
Member States ◽  
The Rule Of Law ◽  
Normative Power ◽  
Eu Member States ◽  
The World ◽  
The Difference ◽  
The Eu

The article examines how the normative power, which the EU puts forward as an ideological basis of its actions in the world, manifests itself in the national partnerships for modernization between Russia and EU member states. The authors demonstrate the influence of the EU’s normativity on its approach to modernization as well as the difference in the positions of its member countries. It is concluded that there is no unity in the EU’s approach to democracy, human rights and the rule of law, and the new classification of EU member states, which is based on their readiness to act in accordance with the Union’s concept of normative power, is offered.

Simple Rules, Not So Simple: The Use of International Ovarian Tumor Analysis (IOTA) Terminology and Simple Rules in Inexperienced Hands in a Prospective Multicenter Cohort Study

2017 ◽  
Vol 38 (06) ◽  
pp. 633-641 ◽  
Author(s):  
Evelyne Meys ◽  
Iris Rutten ◽  
Roy Kruitwagen ◽  
Brigitte Slangen ◽  
Sandrina Lambrechts ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ovarian Tumor ◽  
Interobserver Agreement ◽  
Tumor Type ◽  
Kappa Index ◽  
Multicenter Cohort Study ◽  
Multicenter Cohort ◽  
Simple Rules ◽  
Level Of Agreement ◽  
Ovarian Masses

Abstract Objectives To analyze how well untrained examiners – without experience in the use of International Ovarian Tumor Analysis (IOTA) terminology or simple ultrasound-based rules (simple rules) – are able to apply IOTA terminology and simple rules and to assess the level of agreement between non-experts and an expert. Methods This prospective multicenter cohort study enrolled women with ovarian masses. Ultrasound was performed by non-expert examiners and an expert. Ultrasound features were recorded using IOTA nomenclature, and used for classifying the mass by simple rules. Interobserver agreement was evaluated with Fleiss’ kappa and percentage agreement between observers. Results 50 consecutive women were included. We observed 46 discrepancies in the description of ovarian masses when non-experts utilized IOTA terminology. Tumor type was misclassified often (n = 22), resulting in poor interobserver agreement between the non-experts and the expert (kappa = 0.39, 95 %-CI 0.244 – 0.529, percentage of agreement = 52.0 %). Misinterpretation of simple rules by non-experts was observed 57 times, resulting in an erroneous diagnosis in 15 patients (30 %). The agreement for classifying the mass as benign, malignant or inconclusive by simple rules was only moderate between the non-experts and the expert (kappa = 0.50, 95 %-CI 0.300 – 0.704, percentage of agreement = 70.0 %). The level of agreement for all 10 simple rules features varied greatly (kappa index range: -0.08 – 0.74, percentage of agreement 66 – 94 %). Conclusion Although simple rules are useful to distinguish benign from malignant adnexal masses, they are not that simple for untrained examiners. Training with both IOTA terminology and simple rules is necessary before simple rules can be introduced into guidelines and daily clinical practice.

scholarly journals Slovene-English Contrastive Phraseology: Lexical Collocations

2010 ◽  
Vol 7 (2) ◽  
pp. 57-73
Author(s):  
Primož Jurko
Keyword(s):  
English Language ◽  
Focal Point ◽  
Systematic Classification ◽  
Lexical Collocations ◽  
The Difference ◽  
Translation Errors ◽  
Language Pair

Phraseology is seen as one of the key elements and arguably the most productive part of any language. %e paper is focused on collocations and separates them from other phraseological units, such as idioms or compounds. Highlighting the difference between a monolingual and a bilingual (i.e. contrastive) approach to collocation, the article presents two distinct classes of collocations: grammatical and lexical. %e latter, treated contrastively, represent the focal point of the paper, since they are an unending source of translation errors to both students of translation and professional translators. %e author introduces a methodology of systematic classification of lexical collocations applied on the Slovene-English language pair and based on structural (lexical congruence) and semantic (translational predictability) criteria.

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