The reliability of cephalometric tracing using AI

Introduction : L'objectif de cette étude est de comparer la différence entre l'analyse céphalométrique manuelle et l'analyse automatisée par l’intelligence artificielle afin de confirmer la fiabilité de cette dernière. Notre hypothèse de recherche est que la technique manuelle est la plus fiable des deux méthodes. Méthode : Un total de 99 radiographies céphalométriques latérales sont recueillies. Des tracés par technique manuelle (MT) et par localisation automatisée par intelligence artificielle (AI) sont réalisés pour toutes les radiographies. La localisation de 29 points céphalométriques couramment utilisés est comparée entre les deux groupes. L'erreur radiale moyenne (MRE) et un taux de détection réussie (SDR) de 2 mm sont utilisés pour comparer les deux groupes. Le logiciel AudaxCeph version 6.2.57.4225 est utilisé pour l'analyse manuelle et l'analyse AI. Résultats : Le MRE et SDR pour le test de fiabilité inter-examinateur sont respectivement de 0,87 ± 0,61mm et 95%. Pour la comparaison entre la technique manuelle MT et le repérage par intelligence artificielle AI, le MRE et SDR pour tous les repères sont respectivement de 1,48 ± 1,42 mm et 78 %. Lorsque les repères dentaires sont exclus, le MRE diminue à 1,33 ± 1,39 mm et le SDR augmente à 84 %. Lorsque seuls les repères des tissus durs sont inclus (excluant les points des tissus mous et dentaires), le MRE diminue encore à 1,25 ± 1,09 mm et le SDR augmente à 85 %. Lorsque seuls les points de repère des tissus mous sont inclus, le MRE augmente à 1,68 ± 1,89 mm et le SDR diminue à 78 %. Conclusion: La performance du logiciel est similaire à celles précédemment rapportée dans la littérature pour des logiciels utilisant un cadre de modélisation similaire. Nos résultats révèlent que le repérage manuel a donné lieu à une plus grande précision. Le logiciel a obtenu de très bons résultats pour les points de tissus durs, mais sa précision a diminué pour les tissus mous et dentaires. Nous concluons que cette technologie est très prometteuse pour une application en milieu clinique sous la supervision du docteur.Introduction: The objective of this study is to compare the difference between manual cephalometric analysis and automatic analysis by artificial intelligence to confirm the reliability of the latter. Our research hypothesis is that the manual technique is the most reliable of the methods and is still considered the gold standard. Method: A total of 99 lateral cephalometric radiographs were collected in this study. Manual technique (MT) and automatic localization by artificial intelligence (AI) tracings were performed for all radiographs. The localization of 29 commonly used landmarks were compared between both groups. Mean radial error (MRE) and a successful detection rate (SDR) of 2mm were used to compare both groups. AudaxCeph software version 6.2.57.4225 (Audax d.o.o., Ljubljana, Slovenia) was used for both manual and AI analysis. Results: The MRE and SDR for the inter-examinator reliability test were 0.87 ± 0.61mm and 95% respectively. For the comparison between the manual technique MT and landmarking with artificial intelligence AI, the MRE and SDR for all landmarks were 1.48 ± 1.42mm and 78% respectively. When dental landmarks are excluded, the MRE decreases to 1.33 ± 1.39mm and the SDR increases to 84%. When only hard tissue landmarks are included (excluding soft tissue and dental points) the MRE decreases further to 1.25 ± 1.09mm and the SDR increases to 85%. When only soft tissue landmarks are included the MRE increases to 1.68 ± 1.89mm and the SDR decreases to 78%. Conclusion: The software performed similarly to what was previously reported in literature for software that use analogous modeling framework. Comparing the software’s landmarking to manual landmarking our results reveal that the manual landmarking resulted in higher accuracy. The software operated very well for hard tissue points, but its accuracy went down for soft and dental tissue. Our conclusion is this technology shows great promise for application in clinical settings under the doctor’s supervision

Association between road vehicle collisions and recent medical contact in older drivers: a case‐crossover study

International audienceOBJECTIVE: To estimate the association between past medical contacts and the risk of vehicle collision in a population of older drivers from the province of Quebec, Canada. DESIGN: Case-crossover study. SETTING: Quebec. PARTICIPANTS: 111 699 older drivers involved in at least one vehicle collision between January 1988 and December 2000. MAIN OUTCOME MEASURES: For each driver, the risk of having a vehicle collision while exposed and not exposed to a medical contact was compared. Separate conditional logistic regression analyses were conducted for all drivers and in four diagnostic-specific subgroups. RESULTS: The study found a weak but statistically significant increased risk of all collisions being associated with a medical contact within 1 month before the collision, for all drivers (OR=1.10, 95% CI 1.08 to 1.11) and for drivers with diabetes (OR=1.07, 95% CI 1.03 to 1.11). CONCLUSION: Older drivers who have a collision are more likely to have been in contact with a physician shortly before the collision. These findings suggest that there might be an opportunity to detect medical conditions that put older drivers at higher risk of collision; however, further research is needed to assess the potential effectiveness and practical modalities of screening

Which anti-tumour benefits to be expected from metformin?

With the better management of cardiovascular risk factors, cancer plays an increasing role in the causes of death among patients with type 2 diabetes. Numerous epidemiological cohort and case-control studies showed that type 2 diabetes is a risk factor for cancer and that metformin therapy is associated with a significant reduction in the incidence of cancer and cancer-related death when compared to other glucose-lowering agents (sulfonylureas, insulin). Such beneficial effect is observed almost whatever the type of cancer, but seems to be more prominent in case of gastrointestinal and breast cancers. Several studies showed a significant relationship between the amplitude of the protection against cancer, on the one hand, and the daily dose of metformin and the duration of exposure, on the other hand. In general, the protective effect was more evident in observational cohort studies (however, more exposed to bias due to confounding factors) than in case-control studies. Several meta-analyses recently confirmed that metformin therapy reduces the incidence of cancers and cancer-related mortality. However, the results of the rather rare controlled clinical trials available are not conclusive, but none of them was performed with the objective to specifically assess cancer risk. Considering all promising clinical information in patients with type 2 diabetes, further clinical trials are currently ongoing with the aim of assessing the role of metformin in oncology, independently of the presence of diabetes

Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data

Background: General anaesthesia (GA) during endovascular thrombectomy has been associated with worse patient outcomes in observational studies compared with patients treated without GA. We assessed functional outcome in ischaemic stroke patients with large vessel anterior circulation occlusion undergoing endovascular thrombectomy under GA, versus thrombectomy not under GA (with or without sedation) versus standard care (ie, no thrombectomy), stratified by the use of GA versus standard care. Methods: For this meta-analysis, patient-level data were pooled from all patients included in randomised trials in PuMed published between Jan 1, 2010, and May 31, 2017, that compared endovascular thrombectomy predominantly done with stent retrievers with standard care in anterior circulation ischaemic stroke patients (HERMES Collaboration). The primary outcome was functional outcome assessed by ordinal analysis of the modified Rankin scale (mRS) at 90 days in the GA and non-GA subgroups of patients treated with endovascular therapy versus those patients treated with standard care, adjusted for baseline prognostic variables. To account for between-trial variance we used mixed-effects modelling with a random effect for trials incorporated in all models. Bias was assessed using the Cochrane method. The meta-analysis was prospectively designed, but not registered. Findings: Seven trials were identified by our search; of 1764 patients included in these trials, 871 were allocated to endovascular thrombectomy and 893 were assigned standard care. After exclusion of 74 patients (72 did not undergo the procedure and two had missing data on anaesthetic strategy), 236 (30%) of 797 patients who had endovascular procedures were treated under GA. At baseline, patients receiving GA were younger and had a shorter delay between stroke onset and randomisation but they had similar pre-treatment clinical severity compared with patients who did not have GA. Endovascular thrombectomy improved functional outcome at 3 months both in patients who had GA (adjusted common odds ratio (cOR) 1·52, 95% CI 1·09–2·11, p=0·014) and in those who did not have GA (adjusted cOR 2·33, 95% CI 1·75–3·10, p<0·0001) versus standard care. However, outcomes were significantly better for patients who did not receive GA versus those who received GA (covariate-adjusted cOR 1·53, 95% CI 1·14–2·04, p=0·0044). The risk of bias and variability between studies was assessed to be low. Interpretation: Worse outcomes after endovascular thrombectomy were associated with GA, after adjustment for baseline prognostic variables. These data support avoidance of GA whenever possible. The procedure did, however, remain effective versus standard care in patients treated under GA, indicating that treatment should not be withheld in those who require anaesthesia for medical reasons