Sensitivity, specificity and other diagnostic measures with multiple sites per unit

Intelligent salivary biosensors for periodontitis: in vitro simulation of oral oxidative stress conditions

ASTRACT

One of the most common oral diseases affecting millions of people worldwide is periodontitis. Usually, proteins in body fluids are used as biomarkers of diseases. This study focused on hydrogen peroxide, lipopolysaccharide (LPS), and lactic acid as salivary non-protein biomarkers for oxidative stress conditions of periodontitis. Electrochemical analysis of artificial saliva was done using Gamry with increasing hydrogen peroxide, bLPS, and lactic acid concentrations. Electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV) were conducted. From EIS data, change in capacitance and CV plot area were calculated for each test condition. Hydrogen peroxide groups had a decrease in CV area and an increase in percentage change in capacitance, lipopolysaccharide groups had a decrease in CV area and a decrease in percentage change in capacitance, and lactic acid groups had an increase of CV area and an increase in percentage change in capacitance with increasing concentrations. These data showed a unique combination of electrochemical properties for the three biomarkers. Scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS) employed to observe the change in the electrode surface and elemental composition data present on the sensor surface also showed a unique trend of elemental weight percentages. Machine learning models using hydrogen peroxide, LPS, and lactic acid electrochemical data were applied for the prediction of risk levels of periodontitis. The detection of hydrogen peroxide, LPS, and lactic acid by electrochemical biosensors indicates the potential to use these molecules as electrochemical biomarkers and use the data for ML-driven prediction tool for the periodontitis risk levels.

Clinical evaluation of Artificial Intelligence Driven Remote Monitoring technology for assessment of patient oral hygiene during orthodontic treatment

INTRODUCTION

This study aimed to clinically evaluate the accuracy of Dental Monitoring's (DM) artificial intelligence (AI) image analysis and oral hygiene notification algorithm in identifying oral hygiene and mucogingival conditions.

METHODS

Twenty-four patients seeking orthodontic therapy were monitored by DM oral hygiene protocol during their orthodontic treatment. During the bonding appointment and at each of 10 subsequent adjustment visits, a total of 232 clinical oral examinations were performed to assess the presence of the 3 oral hygiene parameters that DM monitors. In each clinical timepoint, the subjects took an oral DM scan and received a notification regarding their current oral status at that moment in time. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated to evaluate AI and clinical assessment of plaque, gingivitis, and recession.

RESULTS

A total of 232 clinical time points have been evaluated clinically and by the DM AI algorithm. For DM's AI detection of plaque and calculus, gingivitis, and recession, the sensitivity was 0.53, 0.35, and 0.22; the specificity was 0.94, 0.96, and 0.99; and the accuracy was 0.60, 0.49, and 0.72, respectively.

CONCLUSIONS

DM's oral hygiene notification algorithm has low sensitivity, high specificity, and moderate accuracy. This indicates a tendency of DM to underreport the presence of plaque, gingivitis, and recession.

Serial Ottawa 3DY assessments to detect delirium in older emergency department community dwellers

BACKGROUND

delirium is associated with increased morbidity and mortality among older emergency department (ED) patients. When using physician gestalt, delirium is missed in the majority of patients. The Ottawa 3DY (O3DY) has been validated to detect cognitive dysfunction among older ED patients.

OBJECTIVES

to determine the sensitivity and specificity of serial O3DY assessments to detect delirium in older ED patients.

DESIGN

a prospective observational multicenter cohort study.

SETTING

four Quebec EDs.

PARTICIPANTS

independent or semi-independent older patients (age ≥ 65 years) with an ED stay of at least 8 hours that required hospitalisation.

MEASUREMENTS

eligible patients were evaluated using serial O3DY assessments at least 6 hours apart. The primary outcome was delirium after at least 8 hours in the ED. The reference standard for delirium assessment was the confusion assessment method (CAM). The sensitivity and specificity of the serial O3DY to detect delirium were calculated.

RESULTS

we enrolled 301 patients (mean age 77 years, 49.5% male, 3.0% with a history of mild dementia). Thirty patients (10.0%) were CAM positive for delirium. Patients had a median of three O3DY assessments. Serial O3DY evaluations to detect delirium among patients with at least one abnormal O3DY had a sensitivity of 86.7% (95% confidence interval-CI 69.3-96.2%) and a specificity of 44.3% (95%; CI 38.3-50.4%).

CONCLUSION

serial O3DY testing demonstrates good sensitivity as a screening tool to detect delirium among older adult patients with prolonged ED lengths of stay. Emergency physicians should consider the use of the serial O3DY over clinician gestalt to improve delirium detection.

Ability of the Multisensory Jawbone UP3 to Quantify and Classify Sleep in Patients With Suspected Central Disorders of Hypersomnolence: A Comparison Against Polysomnography and Actigraphy

STUDY OBJECTIVES

To evaluate the ability of a multisensory fitness tracker, the Jawbone UP3 (JB3), to quantify and classify sleep in patients with suspected central disorders of hypersomnolence.

METHODS

This study included 43 patients who completed polysomnography (PSG) and a Multiple Sleep Latency Test (MSLT) with concurrent wrist-worn JB3 and Actiwatch 2 (AW2) recordings for comparison. Mean differences in nocturnal sleep architecture variables were compared using Bland-Altman analysis. Sensitivity, specificity, and accuracy were derived for both devices relative to PSG. Ability of the JB3 to detect sleep onset rapid eye movement periods (SOREMPs) during MSLT naps was also quantified.

RESULTS

JB3 demonstrated a significant overestimation of total sleep time (39.6 min, P < .0001) relative to PSG, but performed comparably to AW2. Although the ability of the JB3 to detect epochs of sleep was relatively good (sensitivity = 0.97), its ability to distinguish light, deep, and REM sleep was poor. Similarly, the JB3 did not correctly identify a single SOREMP during any MSLT nap opportunity.

CONCLUSIONS

The JB3 did not accurately quantify or classify sleep in patients with suspected central disorders of hypersomnolence, and was particularly poor at identifying REM sleep. Thus, this device cannot be used as a surrogate for PSG or MSLT in the assessment of patients with suspected central disorders of hypersomnolence.

Real-time three-dimensional transesophageal echocardiography for assessment of mitral valve functional anatomy in patients with prolapse-related regurgitation

The aim of the study was to evaluate the additional diagnostic value of real-time 3-dimensional transesophageal echocardiography (RT3D-TEE) for surgically recognized mitral valve (MV) prolapse anatomy compared to 2-dimensional transthoracic echocardiography (2D-TTE), 2D-transesophageal echocardiography (2D-TEE), and real-time 3D-transthoracic echocardiography (RT3D-TTE). We preoperatively analyzed 222 consecutive patients undergoing repair for prolapse-related mitral regurgitation using RT3D-TEE, 2D-TEE, RT3D-TTE, and 2D-TTE. Multiplanar reconstruction was added to volume-rendered RT3D-TEE for quantitative prolapse recognition. The echocardiographic data were compared to the surgical findings. Per-patient analysis of RT3D-TEE identified prolapse in 204 patients more accurately (92%) than 2D-TEE (78%), RT3D-TTE (80%), and 2D-TTE (54%). Even among those 60 patients with complex prolapse (>1 segment localization or commissural lesions), RT3D-TEE correctly identified 58 (96.5%) compared to 42 (70%), 31 (52%), and 21 (35%) detected by 2D-TEE, RT3D-TTE, and 2D-TTE (p < 0.0001). Multiplanar reconstruction enabled RT3D-TEE to differentiate dominant (≥5-mm displacement) and secondary (2 to <5-mm displacement) prolapsed segments in agreement with surgically recognized dominant lesions (100%), but with a low predictive value (34%) for secondary lesions. In addition, owing to the identification of clefts and subclefts (indentations of MV tissue that extended ≥50% or <50% of the total leaflet height, respectively), RT3D-TEE accurately characterized the MV anatomy, including that which deviated from the standard nomenclature. In conclusion, RT3D-TEE provided more accurate mapping of MV prolapse than 2D imaging and RT3D-TTE, adding quantitative recognition of dominant and secondary lesions and MV anatomy details.

Evaluation of peripheral arterial disease with nonenhanced quiescent-interval single-shot MR angiography

PURPOSE

To assess the diagnostic performance of quiescent-interval single-shot (QISS) magnetic resonance (MR) angiography, a nonenhanced two-dimensional electrocardiographically gated single-shot balanced steady-state free precession examination for the evaluation of symptomatic chronic lower limb ischemia.

MATERIALS AND METHODS

For this prospective institutional review board-approved, HIPAA-compliant study, the institutional review board waived the requirement for informed patient consent. The QISS nonenhanced MR angiography technique was evaluated in a two-center trial involving 53 patients referred for lower extremity MR angiography for suspected or known chronic peripheral arterial disease (PAD), with contrast material-enhanced MR angiography serving as the noninvasive reference standard. The accuracy of stenosis assessments performed with the nonenhanced MR angiography sequence was evaluated relative to the reference standard. Per-segment, per-region, and per-limb sensitivities and specificities were calculated, and assessments were considered correct only if they were in exact agreement with the reference standard-derived assessments. Generalized estimating equation (GEE) modeling with use of an unstructured binomial logit analysis was used to account for clustering of multiple measurements per case. The sensitivity and specificity of QISS MR angiography for the determination of nonsignificant (<50%) versus significant (50%-100%) stenosis were compared with the sensitivity and specificity of the reference standard.

RESULTS

The diagnostic performance of nonenhanced MR angiography was found to be nearly equivalent to the diagnostic performances of contrast-enhanced MR angiography and digital subtraction angiography. Non-GEE segment-based analysis revealed that for the two reviewers, nonenhanced MR angiography had sensitivities of 89.7% (436 of 486 segments) and 87.0% (423 of 486 segments) and specificities of 96.5% (994 of 1030 segments) and 94.6% (973 of 1028 segments).

CONCLUSION

QISS nonenhanced MR angiography offers an alternative to currently used imaging tests for symptomatic chronic lower limb ischemia, for which the administration of iodinated or gadolinium-based contrast agents is contraindicated.

The role of plain radiographs in management of bone metastases

Approximately 50% of patients with cancer will develop skeletal metastases, which often lead to significant pain. When a patient complains of pain, a bone scan and/or plain x-rays are ordered as investigations. X-rays necessitate a 1-cm diameter mass and 50% bone mineral loss at minimum for detection. Up to 40% of lesions will be unidentified by x-rays, presenting false-negative results. Computed tomography (CT) scans can recognize a bony metastatic lesion up to 6 months earlier than an x-ray. However, plain x-rays can also lead to rare false-positive results. We present a case with a false-positive result in a patient with lung cancer.