Distal Medium Vessel Occlusions Can Be Accurately and Rapidly Detected Using Tmax Maps.

Background and Purpose: Distal medium vessel occlusions (DMVOs) are increasingly considered for endovascular thrombectomy but are difficult to detect on computed tomography angiography (CTA). We aimed to determine whether time-to-maximum of tissue residue function (Tmax) maps, derived from CT perfusion, can be used as a triage screening tool to accurately and rapidly identify patients with DMVOs. Methods: Consecutive code stroke patients who underwent multimodal CT were screened retrospectively. Two experienced readers evaluated all patients' Tmax maps in consensus for presence of delay in an arterial territory (territorial Tmax delay). The diagnostic accuracy of this surrogate for identifying DMVOs was determined using receiver-operating characteristic analysis. CTA, interpreted by 2 experienced neuroradiologists with access to all imaging data, served as the reference standard. Diagnostic performance of 4 other readers with different levels of experience for identifying DMVOs on Tmax versus CTA was also assessed. These readers independently assessed patients' Tmax maps and CTAs in 2 separate timed sessions, and areas under the receiver-operating characteristic curves were compared using the DeLong algorithm. The Wilcoxon signed-rank test was used to comparatively assess diagnostic speed. Results: Three hundred seventy-three code stroke patients (median age, 70 years; 56% male, 70 with a DMVO) were included. Territorial Tmax delay had a sensitivity of 100% (CI95, 94.9%­100%) and specificity of 87.8% (CI95, 83.6%­91.3%) for presence of a DMVO, yielding an area under the receiver-operating characteristic curves of 0.939 (CI95, 0.920­0.957). All 4 readers achieved sensitivity >95% and specificity >84% for detecting DMVOs using Tmax maps, with diagnostic accuracy (area under the receiver-operating characteristic curves) and speed that were significantly (P<0.001) higher than on CTA. Conclusions: Territorial Tmax delay had perfect sensitivity and high specificity for a DMVO. Tmax maps were accurately and rapidly interpreted by even inexperienced readers, and causes of false positives are easy to recognize and dismiss. These findings encourage the use of Tmax to identify patients with DMVOs.

Invisalign treatment from the patient perspective: A Twitter content analyses.

BACKGROUND: Understanding patient perspective is a key factor in improving treatment satisfaction. The aim of the present study is to qualitatively describe the content of Twitter posts related to the treatment with Invisalign in order to get a better understanding of patient experience. MATERIAL AND METHODS: Tweets were prospectively collected during a period of four weeks from public available posts on Twitter using Awario™ a bespoke social media monitoring tool. After applying the pertinent inclusion and exclusion criteria the selected posts were analysed by three investigators using thematic analysis. Specific themes and subthemes were developed. RESULTS: A total of 1564 tweets were analysed; three mayor themes were identified: Pre-treatment related, Treatment related and Patient/clinician relationship. Pre-treatment posts were mainly positive and underlined patients' expectations, while in the treatment phase an almost equal number of positive and negative posts were found. The positive post were about the satisfaction with treatment and the improvement of self-esteem. The negative ones were related to pain, compliance, the impact on diet and pronunciation. CONCLUSIONS: The present study provides a better understanding of patients' experience during clear aligners treatment. Increasing the awareness of the clinicians can improve their ability to face problems related to the orthodontic treatment and to provide to their patients better professional advices and counselling. Key words:Social media, twitter, clear aligners, Invisalign, orthodontics.

The online attention to orthodontic research: an Altmetric analysis of the orthodontic journals indexed in the journal citation reports from 2014 to 2018.

BACKGROUND: To describe the impact of research, beyond the limits of the academic environment, Altmetric, a new social and traditional media metric was proposed. The aims of this study were to analyze the online activity related to orthodontic research via Altmetric and to assess if a correlation exists among citations, Mendeley reader count, and the AAS (Altmetric Attention Score). METHOD: The Dimensions App was searched for articles published in the orthodontic journals listed in the Journal Citation Reports (JCR) throughout the years 2014 to 2018. The articles with a positive AAS were collected and screened for data related to publication and authorship. The articles with an AAS higher than 5 were screened for research topic and study design. Citation counts were harvested from Web of Science (WOS) and Scopus. RESULTS: The best performing journals were Progress in Orthodontics and the European Journal of Orthodontics with a mean AAS per published item of 1.455 and 1.351, respectively and the most prevalent sources were Tweets and Facebook mentions. The most prevalent topic was Oral Health-Related Quality of Life (OHRQOL) and the study design was systematic reviews. The correlation between the AAS and the citations in both WOS and Scopus was poor (r = 0.1463 and r = 0.1508, p < .05). The correlation between citations count and Mendeley reader (r = 0.6879 and r = 0.697, p < .05) was moderate. CONCLUSIONS: Few journals displayed a high level of web activity. Journals and editors should enhance online dissemination of the scientific outputs. The authors should report the impact of the findings to the general public in a convenient way to facilitate online dissemination but to avoid an opportunistic use of the research outputs. Despite the lack of correlation, a combination of the citation count and the AAS can give a more comprehensive assessment of research impact.

Obtuse marginal coronary artery aneurysm on CT coronary angiogram.

Coronary artery aneurysms are rare. We present an unusual case of an isolated coronary artery aneurysm in the obtuse marginal artery detected on a computed tomographic coronary angiogram, which is unlikely to be significant for the patient. A Medline literature search did not find a similar case.