Assessment of Radiological and Morphological Grading Systems of Intervertebral Disc Degeneration

Introduction: Intervertebral disc (IVD) degeneration is considered to be one of the main pathophysiological causes of low back pain. Several grading systems have been developed for both morphological and radiological assessment. The aim of this study was to assess the morphological and radiological characteristics of IVD degeneration and validate popular radiological Pfirrmann scale against morphological Thompson grading system. Methodology: Full spinal columns (vertebrae L1-S1 and IVD between them) were harvested from cadavers through an anterior dissection. MRI scans of all samples were conducted. Then, all vertebral columns were cut in the midsagittal plane and assessed morphologically. Result: A total of 100 lumbar spine columns (446 IVDs) were included in the analysis of the degeneration grade. Morphologic Thompson scale graded the majority of discs as grade 2 and 3 (44.2% and 32.1%, respectively), followed by grade 4 (16.8%), grade 1 (5.8%), and grade 5 (1.1%). The Radiologic Pfirrmann grading system classified 44.2% of discs as grade 2, 32.1% as grade 3, 16.8% as grade 4, 5.8% as grade 1, and 1.1% as grade 5. The analysis on the effect of age on degeneration revealed significant, although moderate, positive correlation with both scales. Analysis of the agreement between scales showed weighted Cohen’s kappa equal to 0.61 (p < 0.001). Most of the disagreement occurred due to a 1-grade difference (91.5%), whereas only 8.5% due to a 2-grade difference. Conclusion: With the increase in the prevalence of IVD disease in the population, reliable grading systems of IVD degeneration are crucial for spine surgeons in their clinical assessment. While overall there is an agreement between both grading systems, clinicians should remain careful when using Pfirmann scale as the grades tend to deviate from the morphological assessment.

Exploration of the methods of establishing the minimum clinical important difference based on anchor and its application in the quality of life measurement scale QLICP-ES (V2.0) for esophageal cancer

Background The development of the minimum clinical important difference (MCID) can make it easier for researchers or doctors to judge the significance of research results and the effect of intervention measures, and improve the evaluation system of efficacy. This paper is aimed to calculate the MCID based on anchor and to develop MCID for esophageal cancer scale (QLICP-ES). Methods The item Q29 (How do you evaluate your overall health in the past week with 7 grades answers from 1 very poor to 7 excellent)of EORTC QLQ-C30 was used as the subjective anchor to calculate the score difference between each domain at discharge and admission. MCID was established according to two standards, "one grade difference"(A) and "at least one grade difference"(B), and developed by three methods: anchor-based method, ROC curve method and multiple linear regression models. In terms of anchor-based method, the mean of the absolute value of the difference before and after treatments is MCID. The point with the best sensitivity and specificity-Yorden index at the ROC curve is MCID for ROC curve method. In contrast, the predicted mean value based on a multiple linear regression model and the parameters of each factor is MCID. Results Most of the correlation coefficients of Q29 and various domains of the QLICP-ES were higher than 0.30. The rank of MCID values determined by different methods and standards were as follows: standard B > standard A, anchor-based method > ROC curve method > multiple linear regression models. The recommended MCID values of physical domain, psychological domain, social domain, common symptom and side-effects domain, the specific domain and the overall of the QLICP-ES were 7.8, 9.7, 4.7, 3.6, 4.3, 2.3 and 2.9, respectively. Conclusion Different methods have their own advantages and disadvantages, and also different definitions and standards can be adopted according to research purposes and methods. A lot of different MCID values were presented in this paper so that it can be easy and convenient to select by users.

Non-Pathological Opacification of the Cavernous Sinus on Brain CT Angiography: Comparison with Flow-Related Signal Intensity on Time-of-Flight MR Angiography

Purpose: To investigate the non-pathological opacification of the cavernous sinus (CS) on brain computed tomography angiography (CTA) and compare it with flow-related signal intensity (FRSI) on time-of-flight magnetic resonance angiography (TOF-MRA). Methods: Opacification of the CS was observed in 355 participants who underwent CTA and an additional 77 participants who underwent examination with three diagnostic modalities: CTA, TOF-MRA, and digital subtraction angiography (DSA). Opacification of the CS, superior petrosal sinus (SPS), inferior petrosal sinus (IPS), and pterygoid plexus (PP) were also analyzed using a five-point scale. The Wilcoxon test was used to determine the frequencies of the findings on each side. Additionally, the findings on CTA images were compared with those on TOF-MRA images in an additional 77 participants without dural arteriovenous fistula (DAVF) using weighted kappa (κ) statistics. Results: Neuroradiologists identified non-pathological opacification of the CS (n = 100, 28.2%) on brain CTA in 355 participants. Asymmetry of opacification in the CS was significantly correlated with the grade difference between the right and left CS, SPS, IPS, and PP (p < 0.0001 for CS, p < 0.0001 for SPS, p < 0.0001 for IPS, and p < 0.05 for PP). Asymmetry of the opacification and FRSI in the CS was observed in 77 participants (CTA: n = 21, 27.3%; TOF-MRA: n = 22, 28.6%). However, there was almost no agreement between CTA and TOF-MRA (κ = 0.10, 95% confidence interval: −0.12–0.32). Conclusion: Asymmetry of non-pathological opacification and FRSI in the CS may be seen to some extent on CTA and TOF-MRA due to anatomical variance. However, it shows minimal reliable association with the FRSI on TOF-MRA.

Exploration of the Development of Children's Empathy

Empathy is an important social skill. It is believed to play an essential role in socioemotional and moral development. The current study aimed to explore empathy development during childhood especially among students in the primary and middle schools located in Southern Vietnam. Bryant's Empathy Index for children and adolescents was administrated on 403 children, including 210 boys and 193 girls. The results showed that there was no significant difference between boys and girls in affective empathy. The results further indicated that there is a significant grade difference on affective empathy with the fourth-grade students being placed higher than those of the second and the sixth grades. A separate analysis was conducted for each of the dependent variables. It was found that the fourth graders were significantly higher than the second and the sixth graders on Understanding Feelings, Feelings of Sadness and Bryant's Empathy Index respectively. The result also showed that the Vietnamese version of Bryant's Empathy Index has acceptable reliability and can be used for future research.

Exploration of the Methods of Establishing the Minimum Clinical Important Difference Based on Anchor and Its Application in the Quality of Life Measurement Scale QLICP-ES (V2.0) for Esophageal Cancer

Background: The development of the minimum clinical important difference (MCID) can make it easier for researchers or doctors to judge the significance of research results and the effect of intervention measures, and improve the evaluation system of efficacy. This paper is aimed to calculate the MCID based on anchor and to develop MCID for esophageal cancer scale (QLICP-ES). Methods: Q29 of EORTC QLQ-C30 was used as the subjective anchor to calculate the score difference between each domain at discharge and admission. MCID was established according to two standards, "one grade difference"(A) and "at least one grade difference"(B), and developed by three methods: anchor-based method, ROC curve method and multiple linear regression model. Results: Most of the correlation coefficients of Q29 and various domains of the QLICP-ES were higher than 0.30. The rank of MCID values determined by different methods and standards were as follows: standard B> standard A, anchor-based method >ROC curve method > multiple linear regression model. The recommended MCID values of physical domain, psychological domain, social domain, common symptom and side-effects domain, the specific domain and the overall of the QLICP-ES were 7.8, 9.7, 4.7, 3.6, 4.3, 2.3 and 2.9, respectively. Conclusion: Different methods have their own advantages and disadvantages, and also different definitions and standards can be adopted according to research purposes and methods. A lot of different MCID values were presented in this paper so that it can be easy and convenient to select by users.

Anthropometric and Performance Parameters of Japanese High School American Football Players: A Case Study of Selection for International Matches

This study aimed to compare the anthropometric and performance parameters between American football players from different high school grades and to compare their physical characteristics to the normative values for U.S. and Japanese players from previous studies. The analysis included 240 grade 10 and 11 American football players. The testing included height, body mass, broad jump, 40-yard dash, and pro-agility shuttle. The analysis was stratified by position: linemen (offensive and defensive), big skill players (fullbacks, tight ends, and linebackers), and skill players (wide receivers, running backs, and defensive backs). The only between-grade difference was body mass for linemen (Cohen’s d>0.6), with no moderate effects for all other measured variables (|d| ≦0.6). No Japanese players were better in both mass and performance measures than U.S. elite high school players. The strength and conditioning program for long-term athlete development should be established for American football players in Japan.

Joint Developmental Trajectories of Bullying and Victimization from Childhood to Adolescence: A Parallel-Process Latent Class Growth Analysis

Previous studies have shown that bullying and victimization can be experienced simultaneously by an individual and can change over time. Understanding the joint longitudinal development of the two is of great significance. We conducted a 4-year longitudinal study to examine the joint developmental trajectories of bullying and victimization, gender and grade differences in trajectory group membership, and changes in specific forms of bullying and victimization (verbal, relational, and physical bullying /victimization) in each trajectory group. A total of 775 children from China participated in our study. The average age of participants at the first wave was 10.90 years ( SD = 1.12), and boys accounted for 69.5% of the sample. Based on mean scores, four distinct joint developmental trajectories of bullying and victimization were found: the involvement group (both bullying and victimization increased from low to high over time, accounting for 7.6% of the total), the desisted group (both bullying and victimization decreased from high to low over time, 6.1%), the victimization group (victimization remained at a high level, whereas bullying remained at a low level for 3 years, 13.2%), and the noninvolved group (bullying and victimization remained at a stable low level, 73.1%). Boys were more likely than girls to belong to the involvement group, desisted group, and victimization group, whereas girls were more likely than boys to belong to the noninvolved group. There was no significant grade difference in the trajectory group. All forms of bullying/victimization were consistent with the overall trend and showed similar levels. These results have important implications for the prevention of and interventions for school bullying.

Exploring the Vast Choice of Question Prompt Lists Available to Health Consumers via Google: Environmental Scan

Background There is increasing interest in shared decision making (SDM) in Australia. Question prompt lists (QPLs) support question asking by patients, a key part of SDM. QPLs have been studied in a variety of settings, and increasingly the internet provides a source of suggested questions for patients. Environmental scans have been shown to be useful in assessing the availability and quality of online SDM tools. Objective This study aimed to assess the number and readability of QPLs available to users via Google.com.au. Methods Our environmental scan used search terms derived from literature and reputable websites to search for QPLs available via Google.com.au. Following removal of duplicates from the 4000 URLs and 22 reputable sites, inclusion and exclusion criteria were applied to create a list of unique QPLs. A sample of 20 QPLs was further assessed for list length, proxy measures of quality such as a date of review, and evidence of doctor endorsement. Readability of the sample QPL instructions and QPLs themselves was assessed using Flesch Reading Ease and Flesch-Kincaid Grade Level scores. Results Our environmental scan identified 173 unique QPLs available to users. Lists ranged in length from 1 question to >200 questions. Of our sample, 50% (10/20) had a listed date of creation or update, and 60% (12/20) had evidence of authorship or source. Flesch-Kincaid Grade Level scores for instructions were higher than for the QPLs (grades 10.3 and 7.7, respectively). There was over a 1 grade difference between QPLs from reputable sites compared with other sites (grades 4.2 and 5.4, respectively). Conclusions People seeking questions to ask their doctor using Google.com.au encounter a vast number of question lists that they can use to prepare for consultations with their doctors. Markers of the quality or usefulness of various types of online QPLs, either surrogate or direct, have not yet been established, which makes it difficult to assess the value of the abundance of lists. Doctor endorsement of question asking has previously been shown to be an important factor in the effectiveness of QPLs, but information regarding this is not readily available online. Whether these diverse QPLs are endorsed by medical practitioners warrants further investigation.