The Clinical Consistency and Utility of ICD-11 Diagnostic Guidelines for Gaming Disorder: A Field Study Among the Chinese Population

Purpose: As a new category proposed in the International Classification of Diseases (11th Revision) (ICD-11), the reliability and clinical utility of ICD diagnostic guidelines for gaming disorder (GD) in the Chinese population have not been studied. The purpose of this field study is to clarify the reliability, clinical utility, and cultural applicability of ICD diagnostic guidelines for GD in China and its comparability with Internet GD (IGD) in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5).Methods: Participants included 21 paired clinical raters consisting of seven psychiatrists and 200 gaming players aged from 15 to 18 years with different risk levels of Internet addiction based on the scores of Young's Internet Addiction Test. Each participant received a semi-structured face-to-face interview by paired clinical raters at the same time. Then clinical raters made the diagnosis and filled the clinical utility questionnaire independently according to the diagnostic guidelines for GD in both ICD-11 and DSM-5.Results: The diagnostic consistency coefficient (kappa value) between the paired clinical raters was 0.545 (0.490–0.600, p < 0.001) and 0.622 (0.553–0.691, p < 0.001) for ICD-11 and DSM-5 diagnostic guidelines, respectively, for GD. The diagnostic consistency was 0.847 (0.814–0.880, p < 0.001) between GD in ICD-11 and IGD in DSM-5. Meanwhile, 86.7% of responses that agreed with the ICD-11 diagnostic guidelines for GD provided enough detailed implementation characteristics and showed good overall clinical applicability (86.0%), specificity (94.4%), usefulness (84.1%), and acceptable cultural adaptation (74.8%). GD in ICD-11 was slightly more accepted than IGD in DSM-5 (p < 0.001), while the clinical efficiency of ICD-11 was inferior to that of DSM-5 (p < 0.001).Conclusion: This study indicates that the ICD-11 diagnostic guidelines for GD have acceptable clinical reliability and high consistency with IGD in DSM-5. Their clinical applicability and cultural adaption are comparable with those of DSM-5. Although the guidelines still need to be adjusted for better implementation in China, this is already a great step committed to reducing the serious consequences caused by excessive gaming behaviors through effective identification and normative diagnosis, especially for adolescents.

Diagnostic value of dynamic contrast-enhanced magnetic resonance imaging in Bell’s palsy

Background Bell’s palsy (BP) is the most common form of acute facial nerve disorder and is characterized by rapid onset peripheral facial palsy of unknown etiology. Purpose To explore the diagnostic value of dynamic contrast-enhanced (DCE) magnetic resonance imagine (MRI) in patients with BP particularly in involved segments. Material and Methods A retrospective analysis was performed on the patients with BP who underwent routine MRI examinations and volumetric interpolated breath-hold examination (VIBE) sequence-based DCE-MRI before surgery in our department from January 2015 to July 2020. DCE-MRI data postprocessing was performed on Siemens Workstation Extended MR Work Space 2.6.3.5. Statistical analyses were performed using SPSS®v.19.0. The inter-observer reliability was evaluated with kappa identity test and McNemar’s test. Results Twenty-three patients were included. On conventional contrast-enhanced MRI, the two observers were inconsistent in their diagnosis of lesion segments of facial nerve (Kappa 0.426, P = 0.009). Compared to the results of the surgery, the diagnostic consistency of both observers was general (Kappa 0.476, P < 0.001 and Kappa 0.430, P < 0.001, respectively). The diagnostic results of DCE-MRI for lesion segments of the facial nerve were consistent between the two observers (Kappa 0.929, P < 0.001). Compared to the results of the surgery, the diagnostic consistency of both observers was good (Kappa 0.753, P < 0.001 and Kappa 0.731, P < 0.001, respectively). Conclusion Compared to conventional MRI, DCE-MRI has good stability and repeatability in the diagnosis of the lesion segments of the facial nerve as well as a good specificity and accuracy.

Reliability of Endoscopic Ultrasound Using Miniprobes and Grayscale Histogram Analysis in Diagnosing Upper Gastrointestinal Subepithelial Lesions

Background. To assess the role of endoscopic ultrasound (EUS) in the diagnosis of upper gastrointestinal subepithelial lesions (SELs) and to investigate EUS combined with a grayscale histogram analysis for the differentiation of leiomyomas and gastrointestinal stromal tumors (GISTs). Methods. A retrospective study of 709 patients with upper gastrointestinal SELs was conducted by EUS before endoscopic resection. The EUS findings of SELs and pathological results after endoscopic resection were compared. The EUS images of SELs, particularly, leiomyoma and GIST, were further analyzed via a grayscale histogram to differentiate between the two tumors. Results. Of the 709 patients, 47 cases were pathologically undetermined. The diagnostic consistency of EUS with endoscopic resection was 88.2% (584/662), including 185 muscularis mucosa, 61 submucosa, and 338 muscularis propria, respectively. The diagnostic consistency of EUS with pathology was 80.1% (530/662). The gray value of GISTs was significantly higher than that of leiomyomas (58.9±8.3 vs. 39.5±5.9, t=57.0, P<0.0001). The standard deviation of leiomyomas was significantly lower than that of GISTs (20.6±7.0 vs. 39.8±9.3, t=23.7, P<0.0001). The grayscale histogram analysis of GISTs showed higher echo ultrasound, and the echo of leiomyoma was more uniform. Conclusion. EUS is the preferred procedure for the evaluation of upper gastrointestinal SELs. EUS combined with a grayscale histogram analysis is an effective method for the differentiation of leiomyomas and GISTs.