Epidemiology

Predicting Post-Heart Transplant Composite Renal Outcome Risk in Adults: A Machine Learning Decision Tool

Background. Chest injuries during combat operations occupy a prominent place and often become the cause of mortality. Before the widespread introduction of imaging methods into clinical practice, the mortality rate for chest combat injuries exceeded 50 %. Objective: a comparative assessment of radiography and ultrasonography options in the diagnosis of pneumothorax that occurred as a result of combat trauma. Materials and methods. A comparative analysis of the radiography and ultrasonography results was carried out in 76 patients with pneumothorax due to chest combat trauma. Results. During X-ray in the supine position, the sensitivity of the method was 58.1 %, specificity — 72.7 %, accuracy — 64.5 %, positive predictive value — 73.5 %, negative predictive value — 57.1 %. The sensitivity of the method in the sitting position of patients was 71.9 %, specificity — 89.5 %, accuracy — 76.3 %, positive predictive value — 95.3 %, negative predictive value — 51.5 %. Ultrasound diagnosis of pneumothorax was based on identifying the “barcode” sign due to the lack of sliding of the visceral pleura during the patient’s inspiration. The sensitivity of ultrasonography in B-mode was 90.8 %, specificity — 81.8 %, accuracy — 89.5 %, positive predictive value — 96.7 %, negative predictive value — 60.0 %, and in combined B + M modes — 94.0, 88.9, 93.4, 98.4, 66.7 %, respectively. In the diagnosis of large pneumothorax, the sensitivity of radiography was 96.8 %, specificity — 100.0 %, accuracy — 96.9 %, positive predictive value — 100.0 %, negative predictive value — 50.0 %, respectively, and of ultrasonography — 96.7, 100.0, 96.9, 100.0, 66.7 %, respectively. Conclusions. Ultrasonography has greater sensitivity for diagnosing small pneumothorax than conventional radiography, especially in bedridden patients. Ultrasonography in combined B + M modes can be both a primary and a clarifying method for diagnosing pneumothorax in combat trauma.

Objective To study the efficacy of intraoperative neuromonitoring with SEP, MEP and EMG to predict of spinal cord and nerve root injury during surgery for chronic cervical compressive myelopathy. Methods From October 2014 to June 2016, 107 patients (80 males, 27 females) who underwent surgery for chronic cervical compressive myelopathy and intra-operative neuromonitoring with SEP, MEP and EMG were enrolled in this study. The mean age was 53.36±11.35 years (24-79 years), and the mean follow-up time was 7.94±6.05 months (1-18 months). The monitoring method, abnormal alarm, treatment and outcome of intraoperative SEP, MEP and EMG were recorded in all patients. The preoperative, postoperative and last follow-up neurologic functions were compared. True positive, false positive, true negative and false negative cases were collected in all patients. Sensitivity, specificity, positive predictive value and negative predictive value were calculated, and the utility of monitor spinal cord and nerve root injury was analyzed. Results SEP, MEP and EMG baseline values of 107 patients were established at the end of exposure. A total of 8 patients with intraoperative neurophysiology monitoring were abnormal (4 cases of anterior surgery, 4 cases of posterior surgery), including 1 case with abnormal SEP and MEP, but EMG was normal, he became incomplete paralysis postoperatively; 4 cases with abnormal MEP and EMG, but SEP was normal, they suffered C5 nerve root palsy postoperatively; 2 cases with abnormal MEP, while SEP and EMG were normal, one was C5 nerve root palsy and another was incomplete paralysis for the right side of the limb postoperatively; 1 case with abnormal EMG, but SEP and MEP were normal, he was C5 nerve root palsy postoperatively. 1 patient with anterior surgery was false negative of intraoperative neurophysiology monitoring, it was not found abnormal during surgery, but the patient was C5 nerve root palsy after operation. The utility of monitor spinal cord injury, the sensitivity and specificity of SEP was 50% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 99.06%. The sensitivity and specificity of MEP were 100%, positive predictive value and negative predictive value were 100%. The effect of monitor nerve root injury, the sensitivity and specificity of SEP was 0 and 100%, respectively. The positive predictive value was 0 and the negative predictive value was 93.46%. The sensitivity and specificity of MEP was 71.43% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 98.04%. The sensitivity and specificity of EMG sensitivity was 71.43% and 100%, respectively. The positive predictive value was 100% and the negative predictive value was 98.04%. Conclusion During operation of chronic cervical compressive myelopathy, SEP and MEP for spinal cord injury monitoring, and MEP and EMG for nerve root injury monitoring were effective ways to promise comprehensive monitor the spinal cord and nerve root system. Key words: Cervical vertebrae; Spinal cord compression; Evoked potentials, somatosensory; Evoked potentials, motor; Electromyography

Background and Aim 
\nOtoacoustic emissions (OAE) and auditory brainstem response (ABR) are the most common used methods to identify the childhood hearing impairment under the universal neonatal hearing screening programme. 
\nAccording to the American Academy of Paediatrics, both OAE and ABR are the recognized screening to identify the hearing impairment. Nowadays, ABR rather than OAE serves as the gold standard in identify the neonatal hearing impairment. This study was preformed to evaluate the sensitivity and specificity, positive predictive value and negative predictive value of the OAE by using the gold standard of AABR tests.
\nMethods 
\nA systematic review was performed to evaluate the diagnostic accuracy of the OAE compare with the ABR test. Research was conducted in the international database. The review was from Jan 1990 to May 2015. The quality of included studies was evaluated with the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. 
\nResults 
\nA total of 374 studies were found; 54 studies were investigated in full and 5 studies possessed the inclusion criteria. Result showed that the sensitivity value (0.45-0.88), specificity (0.38- 0.83), the positive predictive value (0.13-0.27), negative predictive value (0.71-0.98). The range of the sensitivity and specificity value is wide. However, OAE test showed a high significant sensitivity among the studies which performed the OAE test after 24 hours after birth. Evaluated the risk factors related to these results also discussed.

The diagnostic values of the aVR lead or "Vereckei algorithm," and the lead II R-wave peak time (RWPT) criterion, recently devised for the differential diagnosis of wide QRS complex tachycardias (WCTs), were compared. A total of 212 WCTs (142 ventricular tachycardias [VTs], 62 supraventricular tachycardias [SVT], and eight preexcitation SVTs) from 145 patients with proven electrophysiologic diagnoses were retrospectively analyzed by seven examiners blinded to the electrophysiologic diagnoses. The overall test accuracy of the Vereckei algorithm was superior to that of the RWPT criterion (84.3% vs. 79.6%; p = 0.0003). The sensitivity of the Vereckei algorithm for VT diagnosis was greater than that of RWPT criterion (92.4% vs. 79.1%; p < 0.0001). The negative predictive value (NPV) for the Vereckei algorithm was also greater (77.8%; 95% confidence interval [CI] = 73.6% to 82.1%) than that of the RWPT criterion (61.6%; 95% CI = 57.6% to 65.6%). The specificity of the Vereckei algorithm was lower than that of the RWPT criterion (64.7% vs. 80.9%; p < 0.0001). The positive predictive value (PPV) was also lower for the Vereckei algorithm (86.4%; 95% CI = 84.4% to 88.4%) than for the RWPT criterion (90.9%; 95% CI = 89.1% to 92.8%). Incorrect diagnoses made by the Vereckei algorithm were mainly due to misdiagnosis of SVT as VT (65.7% of cases), and those made by the RWPT criterion were due to the more dangerous misdiagnosis of VT as SVT (72.5% of cases). The Vereckei algorithm was superior in overall test accuracy, sensitivity, and NPV for VT diagnosis and inferior in specificity and PPV to the RWPT criterion. All of these parameters were lower in "real life" than those reported by the original authors for each of the particular electrocardiographic methods.

BackgroundThe General Movements Assessment is a non-invasive and cost-effective tool with demonstrated reliability for identifying infants at risk for cerebral palsy. Early detection of cerebral palsy allows for the implementation of early intervention and is associated with better functional outcomes. No review to date has summarized the utility of the General Movements Assessment to predict cerebral palsy in term and late-preterm infants diagnosed with neonatal encephalopathy.MethodsWe conducted a scoping review involving infants born greater than or equal to 34 weeks gestational age to identify all available evidence and delineate research gaps. We extracted data on sensitivity, specificity, and positive and negative predictive values and described the strengths and limitations of the results. We searched five databases (MEDLINE, Embase, PsychINFO, Scopus, and CINAHL) and the General Movements Trust website. Two reviewers conducted all screening and data extraction independently. The articles were categorized according to key findings, and a critical appraisal was performed.ResultsOnly three studies, a cohort and two case series, met all of the inclusion criteria. The total number of participants was 118. None of the final eligible studies included late-preterm neonates. All three studies reported on sensitivity, specificity, and positive predictive and negative predictive values. An abnormal General Movement Assessment at 3–5 months has a high specificity (84.6–98%) for cerebral palsy with a similarly high negative predictive value (84.6–98%) when it was normal. Absent fidgety movements, in particular, are highly specific (96%) for moderate to severe cerebral palsy and carry a high negative predictive value (98%) when normal. In the time period between term and 4–5 months post-term, any cramped synchronized movements had results of 100% sensitivity and variable results for specificity, positive predictive value, and negative predictive value.ConclusionsA normal General Movements Assessment at 3 months in a term high-risk infant is likely associated with a low risk for moderate/severe cerebral palsy. The finding of cramped synchronized General Movements is a strong predictor for the diagnosis of cerebral palsy by 2 years of age in the term population with neonatal encephalopathy. The deficit of high-quality research limits the applicability, and so the General Movements Assessment should not be used in isolation when assessing this population.Systematic review registrationTitle registration with Joanna Briggs Institute. URL: http://joannabriggswebdev.org/research/registered_titles.aspx.

Objective To investigate the effect of impedance cardiography on rapid diagnosis of severe patients with dyspnea. Methods A blinded trial was conducted. All 80 cases of dyspnea in ICU were enrolled in the study from June 2014 to March 2016. Each patient will be routinely checked, such as routine blood test, liver and kidney function, electrolytes, electrocardiogram, chest X-ray, arterial blood gas analysis. According to the results of the examination, ICU physician diagnosed and treated the patients. All patients were treated with ICG hemodynamic monitoring, the person responsible for the ICG monitoring and recording the cardiac index (CI), stroke index (SI), systemic vascular resistance index (SVRI), systolic time ratio (STR), velocity index (VI) and thoracic fluid content (TFC), but ICU physicians blinded to the ICG data. After discharge from the hospital, the team of experts who did not participate in the treatment and did not know the results of the ICG integrated all the medical data, the final hospital diagnosis of each patient: cardiac or non cardiac dyspnea. To compare the time and results of ICG diagnosis and ICU physician diagnosis of dyspnea; According to the team′s final diagnosis, the sensitivity, specificity, positive predictive value and negative predictive value of ICG diagnosis and ICU physician diagnosis were calculated respectively, and the judgment ability of both cardiac and non cardiac dyspnea was analyzed. Results All 4 patients were excluded from the study because of unacquirable ICG data, and the final diagnosis of cardiac dyspnea was in 24 patients, and 52 were noncardiac dyspnea. The ICU physician diagnosed 20/24 patients correctly with final diagnosis of cardiac cause, and 40/52 with noncardiac cause. ICG correctly diagnosed 22/24 patients with cardiac cause, and 46/52 with noncardiac cause. Compared with the final diagnosis, the overall diagnostic accuracy by ICG was 89%(68/76) compared with 79% (60/76) for ICU physicians, with a statistically significant difference (P<0.05). ICG hemodynamic parameters showed low CI, SI and VI, high STR, SVRI and TFC in patients with cardiac dyspnea.There were significant differences in values of CI(2.00±0.95 vs. 3.00±0.72, P<0.001) STR(0.56±0.28 vs. 0.40±0.11, P<0.001), VI(31.8±14.7 vs. 42.2±15.8, P=0.008), TFC(40.6±14.4 vs. 32.4±14.0, P=0.021); SI(27.8±11.4 vs. 34.6±10.8, P=0.014), SVRI(2 952±1 191 vs. 2 124±801, P<0.001). between the cardiac and noncardiac groups, respectively. And there were significant differences in diagnosis time(0.47±0.34 vs. 1.57±1.14 h, P<0.00). ICG measurements demonstrated superior sensitivity (91.7% vs. 83.3%), specificity (88.5% vs. 76.9%), and positive and negative predictive values (78.6% vs. 62.5% and 95.8% vs. 90.9%, respectively) when compared with the ICU physician in the final diagnosis of cardiac vs. noncardiac cause of dyspnea. Conclusions ICG diagnosis of patients with severe dyspnea with superior sensitivity, specificity, positive predictive value and negative predictive value. ICU can help doctors quickly, effectively, accurately diagnose the cause of dyspnea as cardiac or noncardiac, to guide clinical treatment. Key words: Impedance cardiography; Severe patients; Dyspnea, cardiogenic; Noncardiac

Background: To determine the diagnostic performance of elevated serum Immunoglobulin G4 (IgG4) in the diagnosis of autoimmune pancreatitis (AIP) and its ability to distinguish AIP from pancreatic cancer. Methods: We retrospectively analyzed serum IgG4 levels in 865 patients with suspected AIP. There were 57 patients with confirmed AIP, 146 with pancreatic cancer, 9 with idiopathic pancreatitis, 104 with acute pancreatitis, 106 with chronic pancreatic disease, and 443 with other pancreatic conditions, including benign enlargement of pancreas, abdominal pain, or obstructive jaundice. Results: The median serum IgG4 level was significantly greater in AIP patients than in patients with other pancreatic diseases (442.0 vs. 73.8 mg/dL, p＜0.001). Based on an IgG4 cutoff value of 132 mg/dL (determined by receiver operating curve analysis), the sensitivity, specificity, and positive predictive values in the differential diagnosis of AIP and pancreatic cancer were 94.7%, 78.8%, and 63.5% respectively. Use of an IgG4 cutoff of 132 mg/dL meant that 31 of 146 patients (21.2%) with pancreatic cancer had elevated serum IgG4, 3 of 57 patients with AIP (5.2%) did not have elevated serum IgG4, and the positive and negative predictive values for diagnosis of AIP were 63.5% and 97.5% respectively. Conclusion: Serum IgG4 concentrations were significantly greater in AIP patients than in patients with other pancreatic diseases. A serum concentration of IgG4 that is more than 2 times the upper limit of normal is highly suggestive of AIP, but does not totally rule out pancreatic cancer. Mild (＜2-fold) elevations in serum IgG4 were present in many subjects without AIP, including 16.4% of subjects with pancreatic cancer. IgG4 elevation in a patient with a low pretest probability of having AIP is likely to represent a false positive. However, the high predictive value and high positive likelihood ratio confirm the good performance of 2-fold cutoff value in the differential diagnosis of AIP and pancreatic cancer.Background: To determine the diagnostic performance of elevated serum Immunoglobulin G4 (IgG4) in the diagnosis of autoimmune pancreatitis (AIP) and its ability to distinguish AIP from pancreatic cancer. Methods: We retrospectively analyzed serum IgG4 levels in 865 patients with suspected AIP. There were 57 patients with confirmed AIP, 146 with pancreatic cancer, 9 with idiopathic pancreatitis, 104 with acute pancreatitis, 106 with chronic pancreatic disease, and 443 with other pancreatic conditions, including benign enlargement of pancreas, abdominal pain, or obstructive jaundice. Results: The median serum IgG4 level was significantly greater in AIP patients than in patients with other pancreatic diseases (442.0 vs. 73.8 mg/dL, p＜0.001). Based on an IgG4 cutoff value of 132 mg/dL (determined by receiver operating curve analysis), the sensitivity, specificity, and positive predictive values in the differential diagnosis of AIP and pancreatic cancer were 94.7%, 78.8%, and 63.5% respectively. Use of an IgG4 cutoff of 132 mg/dL meant that 31 of 146 patients (21.2%) with pancreatic cancer had elevated serum IgG4, 3 of 57 patients with AIP (5.2%) did not have elevated serum IgG4, and the positive and negative predictive values for diagnosis of AIP were 63.5% and 97.5% respectively. Conclusion: Serum IgG4 concentrations were significantly greater in AIP patients than in patients with other pancreatic diseases. A serum concentration of IgG4 that is more than 2 times the upper limit of normal is highly suggestive of AIP, but does not totally rule out pancreatic cancer. Mild (＜2-fold) elevations in serum IgG4 were present in many subjects without AIP, including 16.4% of subjects with pancreatic cancer. IgG4 elevation in a patient with a low pretest probability of having AIP is likely to represent a false positive. However, the high predictive value and high positive likelihood ratio confirm the good performance of 2-fold cutoff value in the differential diagnosis of AIP and pancreatic cancer.

An updated probabilistic causality assessment method and the Liverpool algorithm presented as an improved version of the Naranjo algorithm, one of the most used and accepted causality assessment methods, have recently been proposed. In order to test the validity of the probabilistic method in routine pharmacovigilance, results provided by the Naranjo and Liverpool algorithms, as well as the updated probabilistic method, were each compared with a consensual expert judgement taken as reference. A sample of 59 drug-event pairs randomly sampled from spontaneous reports to the French pharmacovigilance system was assessed by expert judgement until reaching consensus and by members of a pharmacovigilance unit using the updated probabilistic method, the Naranjo and Liverpool algorithms. Probabilities given by the probabilistic method, and categories obtained by both the Naranjo and the Liverpool algorithms were compared as well as their sensitivity, specificity, positive and negative predictive values. The median probability for drug causation given by the consensual expert judgement was 0.70 (inter-quartile range, IQR 0.54-0.84) versus 0.77 (IQR 0.54-0.91) for the probabilistic method. For the Naranjo algorithm, the 'possible' causality category was predominant (61%), followed by 'probable' (35%), 'doubtful', and 'almost certain' categories (2% each). Category distribution obtained with the Liverpool algorithm was similar to that obtained by the Naranjo algorithm with a majority of 'possible' (61%) and 'probable' (30%) followed by 'definite' (7%) and 'unlikely' (2%). For the probabilistic method, sensitivity, specificity, positive and negative predictive values were 0.96, 0.56, 0.92 and 0.71, respectively. For the Naranjo algorithm, depending on whether the 'possible' category was considered in favour or in disfavour of drug causation, sensitivity was, respectively, 1 or 0.42, specificity 0.11 or 0.89, negative predictive value 1 or 0.22 and positive predictive value 0.86 or 0.95; results were identical for the Liverpool algorithm. The logistic probabilistic method gave results closer to the consensual expert judgment than either the Naranjo or Liverpool algorithms whose performance were strongly dependent on the meaning given to the 'possible' category. Owing to its good sensitivity and positive predictive value and by providing results as continuous probabilities, the probabilistic method seems worthy to use for a trustable assessment of adverse drug reactions in routine practice.

Background: The most concerning consequences of iron deficiency in children are the alterations of cognitive, motor, and behavioral performance. Persistent neurocognitive changes despite iron repletion have increased the importance of prevention and early detection of iron deficiency.&#x0D; Objectives: To evaluate the cut off value of red cell distribution width (RWD) in the screening and diagnosis of iron deficiency anemia (IDA) and â thalassemia trait (BTT).&#x0D; Methods: It is a cross sectional study performed at Dhaka Shishu (Children) Hospital from July 2006 to July 2008. Total 52 patients, age ranged from 1-12 years were included in the study. Among them 27 cases were IDA and 25 cases were BTT. Complete blood count (CBC), serum ferritin and hemoglobin (HB) electrophoresis were measured. The sensitivity, specificity, positive and negative predictive value of differential and cutoff value for RDW discrimination index in differentiation between IDA and BTT were performed.&#x0D; Results: Age ranged from 1-12 years. In IDA group male were found 16(59%), female were 11(41%) and in BTT group male were 15(60%), female were 10(40%). The Hb% value in IDA group was significantly (p&lt;0.0001) lower than value for BTT. An elevation of RBC distribution width (&gt;14.6) in IDA had a sensitivity of 81%, specificity of 84%, positive predictive value (PPV) of 85% and negative predictive value (NPV) of 81%; value of RBC distribution width (&lt;14.6) in BTT had a sensitivity of 84%, specificity of 81%, positive predictive value (PPV) of 81% and negative predictive value (NPV) of 85%. An elevation of RBC distribution width (&gt;16) had a sensitivity of 67%, specificity of 92%, and positive predictive value (PPV) of 90% in distinguishing iron deficiency anemia from thalassemia trait. Moreover, eleven (11) of 27 patients with iron deficiency had RBC distribution width values greater than 18 compared to one (1) of the patients with thalassemia trait. An elevation of RBC distribution width ³18 specificity of 96% and positive predictive value (PPV) of 92%.&#x0D; Conclusion: The rersult of the study, in patients with microcytic hypochromic anemia, RDW value e³14.6% and Hb level&lt; 10gm/dl, iron deficiency is the most likely diagnosis. RDW value (&gt;16) is a reliable diagnostic tool in differentiation between IDA and BTT. Red cell distribution width (RDW) above 16% is the best index of IDA.&#x0D; DS (Child) H J 2021; 37(1): 51-58

55P Comparison of BiomeOne and PD-L1 expression tests as a predictor for response to immune checkpoint inhibitors (ICI) in patients with non-small cell lung cancer (NSCLC)

The purpose of this study was to assess the value of Time of Flight FDG-PET/CT in detecting of infection and inflammation. This study is a retrospective analysis of the data from 115 patients (m = 71, f = 44) with a suspected diagnosis of infection or inflammation examined with 18F-FDG-PET/CT in the nuclear medicine department of the University Medical Centre Göttingen (UMG) during 2009 to 2012. The results of 18F-FDG-PET/CT scans were compared with the results of histological, bacteriological, serological, radiological and endoscopic techniques and the final clinical diagnosis. Follow-up for 3 months was mandatory for inclusion into the retrospective analysis. All patients were examined with FDG-PET/CT (Gemini TF, Philips, Germany). 72 patients received additional contrast-enhanced CT. The sensitivity in the total patient group was 83% and the specificity 89 %, respectively. The positive predictive value was 94 % and the negative predictive value 72 %. In 52 patients (45 %) the FDG-PET/CT was helpful in establishing the final diagnosis. Sensitivity and specificity in patients with prolonged fever of unknown origin (n = 32) were 70 % and 100 %. The positive predictive value was 100 % and the negative predictive value 56 %. In 12 patients (38 %) the FDG-PET/CT was helpful in establishing the final diagnosis. The sensitivity and specificity in patients with inflammation of unknown origin (n = 44) were 88 % and 70 %. The positive predictive value was 91 % and the negative predictive value 64 %. In 23 patients (52 %) the FDG-PET/CT was helpful in establishing the final diagnosis. In the group of patients with large vessel vasculitis (n = 15) was a sensitivity of 67 % and a specificity of 100 % found. The positive predictive value was 100 % and the negative predictive value 82 %. In 6 patients (40 %) the FDG-PET/CT was helpful in establishing the final diagnosis. In the group of patients with musculoskeletal infections (n = 24) the sensitivity was 100 % and the specificity 89 %. The positive predictive value was 94 % and the negative predictive value 100 %. In 11 patients (46 %) the FDG-PET/CT was helpful in establishing the final diagnosis. Conclusions: FDG-PET/CT is a valuable imaging technique in patients with fever and inflammation of unknown origin and in the diagnosis of vasculitis and musculoskeletal infections. In comparison to the published FDG-PET data the number of conclusive findings was tendentially higher.

NEUTROPHILE/LYMPHOCYTE INDEX (IN/L), CREATININE (Cr), AND PROCALCITONIN (PROCAL) AS PREDICTORS OF AMEBIAN LIVER ABSCESS.

There is growing interest in the use of circulating plasma tumor human papillomavirus (HPV) DNA for diagnosis and surveillance of patients with HPV-associated oropharyngeal squamous cell carcinoma (OPSCC). Recent advances in the assays, combining the identification of circulating HPV tumor DNA and tumor DNA fragment analysis (tumor tissue-modified viral [TTMV]-HPV DNA), have been shown to be highly accurate. However, use of these newer techniques has been limited to small cohort studies and clinical trials. To establish the clinical efficacy of plasma TTMV-HPV DNA testing in the diagnosis and surveillance of HPV-associated OPSCC in a contemporary clinical setting. This retrospective observational cohort study included patients with OPSCC who underwent TTMV-HPV DNA testing between April 2020 and September 2022 during the course of routine clinical care. For the diagnosis cohort, patients with at least 1 TTMV-HPV DNA measurement prior to initiation of primary therapy were included. Patients were included in the surveillance cohort if they had at least 1 TTMV-HPV DNA test performed after completion of definitive or salvage therapy. Per-test performance metrics, including sensitivity, specificity, positive predictive value, and negative predictive value, for TTMV-HPV DNA testing. Of 399 patients included in the analysis, 163 were in the diagnostic cohort (median [IQR] age, 63 [56-68.5] years; 142 [87.1%] male), and 290 were in the surveillance cohort (median [IQR] age, 63 [57-70] years; 237 [81.7%] male). Of the 163 patients in the diagnostic cohort, 152 (93.3%) had HPV-associated OPSCC while 11 (6.7%) had HPV-negative OPSCC. The TTMV-HPV DNA sensitivity in pretreatment diagnosis was 91.5% (95% CI, 85.8%-95.4% [139 of 152 tests]), and the specificity was 100% (95% CI, 71.5%-100% [11 of 11 tests]). In the surveillance cohort, 591 tests conducted in 290 patients were evaluated. A total of 23 patients had molecularly confirmed pathologic recurrences. The TTMV-HPV DNA test demonstrated sensitivity of 88.4% (95% CI, 74.9%-96.1% [38 of 43 tests]) and specificity of 100% (95% CI, 99.3%-100% [548 of 548 tests]) in detecting the recurrences. Positive predictive value was 100% (95% CI, 90.7%-100% [38 of 38 tests]), and negative predictive value was 99.1% (95% CI, 97.9%-99.7% [548 of 553 tests]). The median (range) lead time from positive TTMV-HPV DNA test to pathologic confirmation was 47 (0-507) days. This cohort study demonstrated that when evaluated in a clinical setting, the TTMV-HPV DNA assay demonstrated 100% specificity in both diagnosis and surveillance. However, the sensitivity was 91.5% for the diagnosis cohort and 88.4% for the surveillance cohort, signifying that nearly 1 in 10 negative tests among patients with HPV-associated OPSCC was a false negative. Additional research is required to validate the assay's performance and, if validated, then further research into the implementation of this assay into standard clinical practice guidelines will be required.

Many beginning writers, especially medical residents, feel difficulties in writing journal articles. However, illogical and unscientific papers are not accepted for publication even if their topics are creative and interesting. The authors should do their best to convince reviewers and readers of their opinions using evidence through reasoning, explanation, and data interpretation.