Fully Automated Measurement of the Insall-Salvati Ratio with Artificial Intelligence.

Patella alta (PA) and patella baja (PB) affect 1-2% of the world population, but are often underreported, leading to potential complications like osteoarthritis. The Insall-Salvati ratio (ISR) is commonly used to diagnose patellar height abnormalities. Artificial intelligence (AI) keypoint models show promising accuracy in measuring and detecting these abnormalities.An AI keypoint model is developed and validated to study the Insall-Salvati ratio on a random population sample of lateral knee radiographs. A keypoint model was trained and internally validated with 689 lateral knee radiographs from five sites in a multi-hospital urban healthcare system after IRB approval. A total of 116 lateral knee radiographs from a sixth site were used for external validation. Distance error (mm), Pearson correlation, and Bland-Altman plots were used to evaluate model performance. On a random sample of 2647 different lateral knee radiographs, mean and standard deviation were used to calculate the normal distribution of ISR. A keypoint detection model had mean distance error of 2.57 ± 2.44 mm on internal validation data and 2.73 ± 2.86 mm on external validation data. Pearson correlation between labeled and predicted Insall-Salvati ratios was 0.82 [95% CI 0.76-0.86] on internal validation and 0.75 [0.66-0.82] on external validation. For the population sample of 2647 patients, there was mean ISR of 1.11 ± 0.21. Patellar height abnormalities were underreported in radiology reports from the population sample. AI keypoint models consistently measure ISR on knee radiographs. Future models can enable radiologists to study musculoskeletal measurements on larger population samples and enhance our understanding of normal and abnormal ranges.

Differences in performance in CAMCOG-R domains between old and oldest old patients with Alzheimer's disease.

The purpose of this study is to evaluate the neuropsychological performance in a ≥90-year-old population with Alzheimer disease (AD) in comparison with younger elderly patients. We retrospectively studied all patients with AD attended in a specialized clinic between 1999 and 2011. Age, sex, educational level, and sensory loss data were collected. Neuropsychological evaluation included Mini-Mental State Examination and Global Deterioration Scale. We used the eight Cambridge Cognitive Assessment (CAMCOG-R) domains to evaluate and compare the neuropsychological performance in the younger than 90 years old (<90) and older than 90 years old (≥90) groups. We selected 2931 patients, 2897 <90 (98.83%) and 34 ≥90 years old (1.17%). The ≥90 group had significant lower punctuations in memory, praxis, and abstract thinking CAMOCG-R domains with 1.49, 0.75, and 0.58 less points, respectively, (p < 0.05). Neuropsychological characteristics of cognitive decline seem to be different in ≥90 compared to <90 years old patients. According to age, the biggest differences in the CAMCOG-R performance are in the memory, praxis, and abstract thinking domains.

Prevalence of epilepsy in northeast Madrid.

During a period of 42 months, we studied the prevalence of epilepsy in a specific health district, composing by four towns with 98,405 inhabitants older than 10 years. This has been accomplished by a two-phase cross-sectional study. The prevalence rate observed was 4.12/1000 inhabitants for all types of epilepsy. No significant differences were found between the sexes. Sixty-three per cent of affected individuals had partial seizures, with a confirmed cause in 45%. Fifty-five patients with single unprovoked seizures, were also identified but not included in the prevalence rate.

Serum intralipid levels in neonates during parenteral nutrition: the relation to gestational age.

To detect hyperlipidemia, serum Intralipid levels have been monitored by nephelometry (light scanning index) in children on total parenteral nutrition with glucose, amino acids, and Intralipid during the past 2 yr. Sufficient data were available in 93 neonates to analyze the effect of an Intralipid dose on serum levels in infants of different gestational ages. Guided by monitoring, Intralipid was given by constant infusion at a dose varying between 0.5 to 6.0 g/kg/day. Median post natal age at the start of therapy was 7 days. Gestational age varied from 27 to 32 wk in 36 infants (Group I), 33 to 36 wk in 18 (Group II), and was more than 37 wk in 39 (Group III). Of Group I infants, 28% developed hyperlipidemia (Intralipid level greater than 100 mg/100 ml) as compared to an incidence of 7% in Groups II and III. Peak Intralipid levels were highest in Group I and regression analysis also indicated that Intralipid was least well tolerated by this group. The dose response during the first 48 hr of Intralipid therapy was not significantly different from dose response later. Similarly, diagnosis did not seem to affect the dose-response. Dose recommendations were based on analysis of dose response lines. Even using these guidelines monitoring of serum Intralipid is advisable to avoid hyperlipidemia during Intralipid therapy. It is recommended that measurements of serum Intralipid be made several times per week in very low birth weight infants (Group I), and weekly in more mature neonates after a safe maximum Intralipid dose is established.