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Liu Y, Teng J, Mei J, Chen C, Xu QQ, Zhou C, Deng KL, Wang HW. Analysis of airway structural parameters in Han Chinese adults: a prospective cross-sectional study. Ann Med 2024; 56:2316258. [PMID: 38364214 PMCID: PMC10878341 DOI: 10.1080/07853890.2024.2316258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/13/2024] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Establishing reference ranges for central airway parameters and exploring their influencing factors in Han Chinese non-smoking adults. METHODS This prospective cross-sectional study was conducted on Han Chinese non-smoking adults who underwent chest CT scans at the Tongzhou Campus of Dongzhimen Hospital Affiliated with the Beijing University of Chinese Medicine between September 2022 and November 2022. The SYNAPSE 3D image analysis software was utilized, enabling the extraction of critical parameters such as central airway length, airway wall thickness (AWT), airway lumen area (ALA), and subcarinal angle (SCA). Pearson's correlation coefficient analysis and multiple linear regression analysis methods were employed to evaluate the relationship between central airway parameters and age, sex, weight, and height. RESULTS The study encompassed 888 Han Chinese non-smoking adults, comprising 456 females and 432 males. Significant sex differences were noted in central airway length, AWT, and ALA, with measurements in males exceeding those in females (p < 0.01) with no significant difference in SCA. Correlation analyses unveiled relationships between central airway parameters and age, sex, weight, and height. During multiple linear regression analyses, no conclusive evidence emerged to demonstrate the independent or combined explanatory or predictive capacity of the aforementioned variables for central airway length and SCA. Although sex has a significant impact on AWT and ALA, its capability in explanation or prediction remains limited. The conclusions drawn from the primary analysis receive reinforcement from the outcomes of sensitivity analyses. CONCLUSION Establishing the distribution range of central airway parameters in non-smoking Han Chinese adults. It observed significant sex differences in these parameters, except for the SCA. However, the study found that the predictive or explanatory power of age, sex, weight, and height for central airway parameters was either limited or non-significant.
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Affiliation(s)
- Yan Liu
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jun Teng
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Beijing University of Traditional Chinese Medicine, Beijing, China
| | - Jian Mei
- Department of Radiology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chao Chen
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qian-qian Xu
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Cui Zhou
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Quality Control Office, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Kang-li Deng
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hong-wu Wang
- Respiratory Disease Center, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
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Li A, Li L, Guo F, Zhou D, Yang W, Cui W, Wu S, Li L, Yu C, Lin H. The role of computed tomography in the diagnosis of encapsulating peritoneal sclerosis in patients undergoing peritoneal dialysis. Ren Fail 2024; 46:2312214. [PMID: 38344999 PMCID: PMC10863510 DOI: 10.1080/0886022x.2024.2312214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Affiliation(s)
- Aomei Li
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Longkai Li
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fujia Guo
- First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Dan Zhou
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wei Yang
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Wengting Cui
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Shuran Wu
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Lin Li
- Medical Innovation Research Division of Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Changqing Yu
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongli Lin
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Wang D, Han C, Zhang Z, Zhai T, Lin H, Yang B, Cui Y, Lin Y, Zhao Z, Zhao L, Liang C, Zeng A, Pan D, Chen X, Shi Z, Liu Z. FedDUS: Lung tumor segmentation on CT images through federated semi-supervised with dynamic update strategy. Comput Methods Programs Biomed 2024; 249:108141. [PMID: 38574423 DOI: 10.1016/j.cmpb.2024.108141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 02/27/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND AND OBJECTIVE Lung tumor annotation is a key upstream task for further diagnosis and prognosis. Although deep learning techniques have promoted automation of lung tumor segmentation, there remain challenges impeding its application in clinical practice, such as a lack of prior annotation for model training and data-sharing among centers. METHODS In this paper, we use data from six centers to design a novel federated semi-supervised learning (FSSL) framework with dynamic model aggregation and improve segmentation performance for lung tumors. To be specific, we propose a dynamically updated algorithm to deal with model parameter aggregation in FSSL, which takes advantage of both the quality and quantity of client data. Moreover, to increase the accessibility of data in the federated learning (FL) network, we explore the FAIR data principle while the previous federated methods never involve. RESULT The experimental results show that the segmentation performance of our model in six centers is 0.9348, 0.8436, 0.8328, 0.7776, 0.8870 and 0.8460 respectively, which is superior to traditional deep learning methods and recent federated semi-supervised learning methods. CONCLUSION The experimental results demonstrate that our method is superior to the existing FSSL methods. In addition, our proposed dynamic update strategy effectively utilizes the quality and quantity information of client data and shows efficiency in lung tumor segmentation. The source code is released on (https://github.com/GDPHMediaLab/FedDUS).
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Affiliation(s)
- Dan Wang
- School of Computers, Guangdong University of Technology, Guangzhou 510006, China
| | - Chu Han
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China; Medical Research Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Zhen Zhang
- Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, Hangzhou, Zhejiang, 310022, China
| | - Tiantian Zhai
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Huan Lin
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China
| | - Baoyao Yang
- School of Computers, Guangdong University of Technology, Guangzhou 510006, China
| | - Yanfen Cui
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China; Department of Radiology, Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, 030013, China
| | - Yinbing Lin
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Zhihe Zhao
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Lujun Zhao
- Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Changhong Liang
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China
| | - An Zeng
- School of Computers, Guangdong University of Technology, Guangzhou 510006, China.
| | - Dan Pan
- School of Electronics and Information, Guangdong Polytechnic Normal University, Guangzhou 510665, China.
| | - Xin Chen
- Department of Radiology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
| | - Zhenwei Shi
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China; Medical Research Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China.
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China.
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Abdulsalam AJ, Kara M, Özçakar L. Comment on: Sarcopenia in long-term survivors of cancer in childhood and adolescence: A cross-sectional study of calf muscle mass by peripheral quantitative computed tomography with an examination of the muscle-bone unit. Pediatr Blood Cancer 2024; 71:e30940. [PMID: 38472739 DOI: 10.1002/pbc.30940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Ahmad J Abdulsalam
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
- Department of Physical Medicine and Rehabilitation, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Murat Kara
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
| | - Levent Özçakar
- Department of Physical Medicine and Rehabilitation, Hacettepe University Medical School, Ankara, Turkey
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Zhu RT, Li Y, Zhang CX, Wang WJ, Liang RP, Li J, Bai K, Sun YL. Acute suppurative terminal cholangitis: Clinical characteristics of a new subtype of acute cholangitis. Hepatobiliary Pancreat Dis Int 2024; 23:293-299. [PMID: 36690523 DOI: 10.1016/j.hbpd.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 01/09/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute suppurative terminal cholangitis (ASTC) is rarer than acute obstructive cholangitis and is not well studied. To explore this subtype of acute cholangitis, we described our clinical experience with ASTC. METHODS We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020. We analyzed their clinical characteristics, including etiology, clinical manifestations, imaging features, treatment and prognosis. RESULTS A total of 32 ASTC patients were included in the analysis. The majority of the patients had a history of biliary operations, and clinical manifestations were occult and atypical. The positive rate of bacterial culture was 46.9%. All the patients had typical imaging features on computed tomography and magnetic resonance imaging. Treatment with effective antibiotics was provided as soon as diagnosis was established. After treatment, most patients had a good outcome. Elevated levels of total bilirubin, aspartate aminotransferase, procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis. CONCLUSIONS Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis, and that earlier diagnosis and more personalized treatments are needed.
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Affiliation(s)
- Rong-Tao Zhu
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Ye Li
- Department of Pathology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Chi-Xian Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Wei-Jie Wang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Ruo-Peng Liang
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Jian Li
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Kai Bai
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China
| | - Yu-Ling Sun
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Zhengzhou Key Laboratory of Hepatobiliary and Pancreatic Diseases, Zhengzhou 450052, China; Institute of Hepatobiliary and Pancreatic Diseases, Zhengzhou University, Zhengzhou 450052, China.
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Kunc V, Shrestha S, Benes M. Fracture of an aberrant os styloideum: a unique case report. Skeletal Radiol 2024; 53:1205-1209. [PMID: 37903997 DOI: 10.1007/s00256-023-04494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 11/01/2023]
Abstract
Several accessory bones can be found around the wrist, which may pose a diagnostic challenge. Hereby, we report a unique case of a traumatic fracture of an aberrant os styloideum in a 66-year-old male. The patient presented with a swollen dominant right hand and a hematoma on its anterior and posterior aspects, as a result of a fall on an outstretched hand. The diagnosis was based on a CT scan, which showed a fractured accessory bone between the distal portion of the capitate bone and the base of the third metacarpus. Due to its typical location, the ossicle was identified as os styloideum. The patient was treated conservatively and the symptoms subsided on a short forearm cast after 2 weeks. At a 12-month follow-up, no other episodes were declared. Strong anatomical knowledge and sharing of such cases is essential for proper diagnosis and treatment of this very rare condition.
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Affiliation(s)
- Vojtech Kunc
- Clinic of Trauma Surgery, Masaryk Hospital, Socialni pece 3316/12A, 400 111, Usti nad Labem, Czech Republic.
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
- Research Centre, Faculty of Health Studies, Jan Evangelista Purkyne University in Usti nad Labem, Ústí nad Labem, Czech Republic.
| | - Shilu Shrestha
- Orthopaedic and Hand Surgery Unit, National Trauma Center & National Academy of Medical Sciences, Kathmandu, Nepal
| | - Michal Benes
- Department of Anatomy, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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Meyer NK, In MH, Black DF, Campeau NG, Welker KM, Huston J, Halverson MA, Bernstein MA, Trzasko JD. Model-based iterative reconstruction for direct imaging with point spread function encoded echo planar MRI. Magn Reson Imaging 2024; 109:189-202. [PMID: 38490504 DOI: 10.1016/j.mri.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Echo planar imaging (EPI) is a fast measurement technique commonly used in magnetic resonance imaging (MRI), but is highly sensitive to measurement non-idealities in reconstruction. Point spread function (PSF)-encoded EPI is a multi-shot strategy which alleviates distortion, but acquisition of encodings suitable for direct distortion-free imaging prolongs scan time. In this work, a model-based iterative reconstruction (MBIR) framework is introduced for direct imaging with PSF-EPI to improve image quality and acceleration potential. METHODS An MBIR platform was developed for accelerated PSF-EPI. The reconstruction utilizes a subspace representation, is regularized to promote local low-rankedness (LLR), and uses variable splitting for efficient iteration. Comparisons were made against standard reconstructions from prospectively accelerated PSF-EPI data and with retrospective subsampling. Exploring aggressive partial Fourier acceleration of the PSF-encoding dimension, additional comparisons were made against an extension of Homodyne to direct PSF-EPI in numerical experiments. A neuroradiologists' assessment was completed comparing images reconstructed with MBIR from retrospectively truncated data directly against images obtained with standard reconstructions from non-truncated datasets. RESULTS Image quality results were consistently superior for MBIR relative to standard and Homodyne reconstructions. As the MBIR signal model and reconstruction allow for arbitrary sampling of the PSF space, random sampling of the PSF-encoding dimension was also demonstrated, with quantitative assessments indicating best performance achieved through nonuniform PSF sampling combined with partial Fourier. With retrospective subsampling, MBIR reconstructs high-quality images from sub-minute scan datasets. MBIR was shown to be superior in a neuroradiologists' assessment with respect to three of five performance criteria, with equivalence for the remaining two. CONCLUSIONS A novel image reconstruction framework is introduced for direct imaging with PSF-EPI, enabling arbitrary PSF space sampling and reconstruction of diagnostic-quality images from highly accelerated PSF-encoded EPI data.
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Affiliation(s)
- Nolan K Meyer
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Myung-Ho In
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - David F Black
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Norbert G Campeau
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Kirk M Welker
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - John Huston
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Maria A Halverson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Matt A Bernstein
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Joshua D Trzasko
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Yang M, Zhong N, Lou Y, Jiang D, Liu Y, Dai Z, Wan W, Jiao J, Yang X, Xiao J. A Novel and Reproducible Classification of Cervical Dumbbell Tumors to Inform Surgical Approach and Reconstruction Techniques. Spine (Phila Pa 1976) 2024; 49:715-725. [PMID: 38239008 DOI: 10.1097/brs.0000000000004927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/03/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN A retrospective case series. OBJECTIVE This study developed a novel classification system based on imaging and anatomy to select optimal surgical approaches and reconstruction strategies to achieve total resection of cervical dumbbell tumors and restore spinal stability. SUMMARY OF BACKGROUND DATA Total resection is necessary to decrease the recurrence rate of cervical dumbbell tumors. Previous cervical dumbbell tumor classifications are insufficient for determining surgical strategies; therefore, a practical classification is needed. MATERIALS AND METHODS This study included 295 consecutive patients with cervical dumbbell tumors who underwent total surgical resection. A novel classification of cervical dumbbell tumors was developed based on magnetic resonance imaging and computed tomography. Continuous variables were expressed as mean±SD and were compared using an unpaired two-tailed Student t test. The χ 2 test or the Fisher exact test was used for categorical variables. Kendall's W test assessed three independent raters' inter-rater and intrarater reliabilities on 140 cervical dumbbell tumors. RESULTS The inter-rater and intrarater consistency coefficient was 0.969 (χ 2 =404.3, P <0.001) and 0.984 (χ 2 =273.7, P <0.001). All patients with type I and II tumors underwent single-posterior surgeries to achieve total resection. Of the patients in this study, 86.1%, 25.9%, 75.9%, and 76.9% underwent posterior surgeries for types IIIa, IIIb, IVa, and V tumors, respectively. All patients with type IVb tumors underwent a combined anterior and posterior approach. Posterior internal fixation was used for all patients in posterior surgery. Anterior reconstruction was applied for patients with type IVb tumors (20/20, 100%) and some with type V tumors (3/13, 23.1%). The mean follow-up duration was 93.6±2.6 months. A recurrence was observed in 19 (6.4%) patients. CONCLUSION The authors describe a novel classification system that is of practical use for planning the complete resection of cervical dumbbell tumors.
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Affiliation(s)
- Minglei Yang
- Department of Orthopedic Oncology, Spine Tumor Center, The Second Affiliated Hospital of Naval Medical University, Shanghai, China
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Huang CC, Sun PH, Wu PW, Huang CC, Chang PH, Fu CH, Lee TJ. Computed Tomographic Evaluations in Patients with Empty Nose Syndrome. Laryngoscope 2024; 134:2105-2110. [PMID: 38009472 DOI: 10.1002/lary.31204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/25/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE We aimed to evaluate computed tomography (CT) images of patients with empty nose syndrome (ENS), investigate the impact of reconstruction surgery on sinus inflammation, and identify the optimal airspace diameter after surgery. METHODS We conducted a retrospective case series analysis, identifying and enrolling patients with ENS with perioperative CT findings. The clinical characteristics of the participants were collected, and the modified Lund-Mackay (mLM) CT scores were determined. The anterior airspace diameter was evaluated by measuring the distance between the septum and the lateral nasal wall on the coronal plane at the level of the nasolacrimal duct. RESULTS Twenty patients with ENS and perioperative CT images were enrolled. The mean total mLM CT score and all subsite scores showed no significant changes after surgery. The Empty Nose Syndrome 6-item Questionnaire (ENS6Q) score, Sino-nasal Outcome Test-25 (SNOT-25) score, sleep symptoms domain, psychological domain, and empty nose symptoms domain were significantly associated with anterior airspace diameter in the regression analysis. CONCLUSION There was no significant difference in sinus inflammation between preoperative and postoperative CT evaluations. The anterior airspace diameters were significantly associated with ENS6Q and SNOT-25 scores. LEVEL OF EVIDENCE 4 Laryngoscope, 134:2105-2110, 2024.
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Affiliation(s)
- Chien-Chia Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ping Hsueh Sun
- Department of Medical Education, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Pei-Wen Wu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Che Huang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Chang
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Chia-Hsiang Fu
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Jen Lee
- Division of Rhinology, Department of Otolaryngology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Xiamen Chang Gung Hospital, Xiamen, China
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Sirén A, Nyman M, Syvänen J, Mattila K, Hirvonen J. Utility of brain imaging in pediatric patients with a suspected accidental spinal injury but no brain injury-related symptoms. Childs Nerv Syst 2024; 40:1435-1441. [PMID: 38279986 PMCID: PMC11026267 DOI: 10.1007/s00381-024-06298-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/20/2024] [Indexed: 01/29/2024]
Abstract
PURPOSE Imaging is the gold standard in diagnosing traumatic brain injury, but unnecessary scans should be avoided, especially in children and adolescents. Clinical decision-making rules often help to distinguish the patients who need imaging, but if spinal trauma is suspected, concomitant brain imaging is often conducted. Whether the co-occurrence of brain and spine injuries is high enough to justify head imaging in patients without symptoms suggesting brain injury is unknown. OBJECTIVE This study aims to assess the diagnostic yield of brain MRI in pediatric patients with suspected or confirmed accidental spinal trauma but no potential brain injury symptoms. METHODS We retrospectively reviewed the medical and imaging data of pediatric patients (under 18 years old) who have undergone concomitant MRI of the brain and spine because of acute spinal trauma in our emergency radiology department over a period of 8 years. We compared the brain MRI findings in patients with and without symptoms suggesting brain injury and contrasted spine and brain MRI findings. RESULTS Of 179 patients (mean age 11.7 years, range 0-17), 137 had symptoms or clinical findings suggesting brain injury, and 42 did not. None of the patients without potential brain injury symptoms had traumatic findings in brain MRI. This finding also applied to patients with high-energy trauma (n = 47) and was unrelated to spinal MRI findings. CONCLUSION Pediatric accidental trauma patients with suspected or confirmed spine trauma but no symptoms or clinical findings suggesting brain injury seem not to benefit from brain imaging.
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Affiliation(s)
- Aapo Sirén
- Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Mikko Nyman
- Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Johanna Syvänen
- Department of Pediatric Orthopedic Surgery, University of Turku and Turku University Hospital, Turku, Finland
| | - Kimmo Mattila
- Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
- Medical Imaging Center, Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
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11
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Su J, Luo Z, Lian S, Lin D, Li S. Mutual learning with reliable pseudo label for semi-supervised medical image segmentation. Med Image Anal 2024; 94:103111. [PMID: 38401271 DOI: 10.1016/j.media.2024.103111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 02/26/2024]
Abstract
Semi-supervised learning has garnered significant interest as a method to alleviate the burden of data annotation. Recently, semi-supervised medical image segmentation has garnered significant interest that can alleviate the burden of densely annotated data. Substantial advancements have been achieved by integrating consistency-regularization and pseudo-labeling techniques. The quality of the pseudo-labels is crucial in this regard. Unreliable pseudo-labeling can result in the introduction of noise, leading the model to converge to suboptimal solutions. To address this issue, we propose learning from reliable pseudo-labels. In this paper, we tackle two critical questions in learning from reliable pseudo-labels: which pseudo-labels are reliable and how reliable are they? Specifically, we conduct a comparative analysis of two subnetworks to address both challenges. Initially, we compare the prediction confidence of the two subnetworks. A higher confidence score indicates a more reliable pseudo-label. Subsequently, we utilize intra-class similarity to assess the reliability of the pseudo-labels to address the second challenge. The greater the intra-class similarity of the predicted classes, the more reliable the pseudo-label. The subnetwork selectively incorporates knowledge imparted by the other subnetwork model, contingent on the reliability of the pseudo labels. By reducing the introduction of noise from unreliable pseudo-labels, we are able to improve the performance of segmentation. To demonstrate the superiority of our approach, we conducted an extensive set of experiments on three datasets: Left Atrium, Pancreas-CT and Brats-2019. The experimental results demonstrate that our approach achieves state-of-the-art performance. Code is available at: https://github.com/Jiawei0o0/mutual-learning-with-reliable-pseudo-labels.
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Affiliation(s)
- Jiawei Su
- The Department of Artificial Intelligence, Xiamen University, Fujian, China
| | - Zhiming Luo
- The Department of Artificial Intelligence, Xiamen University, Fujian, China.
| | - Sheng Lian
- The College of Computer and Data Science, Fuzhou University, Fujian, China
| | - Dazhen Lin
- The Department of Artificial Intelligence, Xiamen University, Fujian, China
| | - Shaozi Li
- The Department of Artificial Intelligence, Xiamen University, Fujian, China
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12
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Qu J, Xiao X, Wei X, Qian X. A causality-inspired generalized model for automated pancreatic cancer diagnosis. Med Image Anal 2024; 94:103154. [PMID: 38552527 DOI: 10.1016/j.media.2024.103154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 02/29/2024] [Accepted: 03/20/2024] [Indexed: 04/16/2024]
Abstract
Pancreatic cancer (PC) is a severely malignant cancer variant with high mortality. Since PC has no obvious symptoms, most PC patients are belatedly diagnosed at advanced disease stages. Recently, artificial intelligence (AI) approaches have demonstrated promising prospects for early diagnosis of pancreatic cancer. However, certain non-causal factors (such as intensity and texture appearance variations, also called confounders) tend to induce spurious correlation with PC diagnosis. This undermines the generalization performance and the clinical applicability of the AI-based PC diagnosis approaches. Therefore, we propose a causal intervention based automated method for pancreatic cancer diagnosis with contrast-enhanced computerized tomography (CT) images, where a confounding effects reduction scheme is developed for alleviating spurious correlations to achieve unbiased learning, thereby improving the generalization performance. Specifically, a continuous image generation strategy was developed to simulate wide variations of intensity differences caused by imaging heterogeneities, where Monte Carlo sampling is added to further enhance the continuity of simulated images. Then, to enhance the pancreatic texture variability, a texture diversification method was introduced in conjunction with gradient-based data augmentation. Finally, a causal intervention strategy was proposed to alleviate the adverse confounding effects by decoupling the causal and non-causal factors and combining them randomly. Extensive experiments showed remarkable diagnosis performance on a cross-validation dataset. Also, promising generalization performance with an average accuracy of 0.87 was attained on three independent test sets of a total of 782 subjects. Therefore, the proposed method shows high clinical feasibility and applicability for pancreatic cancer diagnosis.
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Affiliation(s)
- Jiaqi Qu
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China
| | - Xiang Xiao
- Department of Medical Imaging, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, PR China
| | - Xunbin Wei
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China; Peking University Cancer Hospital & Institute, Beijing, 100142, PR China; Biomedical Engineering Department, Peking University, Beijing, 100081, PR China; Institute of Medical Technology, Peking University Health Science Center, Beijing, 100191, PR China; International Cancer Institute, Peking University, Beijing 100191, PR China.
| | - Xiaohua Qian
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200030, PR China.
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13
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Keeratiratwattana A, Saraya AW, Prakkamakul S. Computed tomography and magnetic resonance imaging findings in central nervous system listeriosis. Neuroradiology 2024; 66:717-727. [PMID: 38436702 DOI: 10.1007/s00234-024-03313-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE To describe the imaging findings and determine the incidence of a characteristic worm-like pattern along the white matter tracts in neurolisteriosis on CT/MRI. METHODS An IRB-approved retrospective study in 21 consecutive neurolisteriosis cases during January 2002-July 2020. At least one of the following is required: (1) Positive Listeria monocytogenes (LM) in blood with clinical signs of meningeal irritation and/or abnormal CSF profile, (2) positive LM in blood with signs of encephalitis, (3) positive LM in CSF, (4) positive LM from brain biopsy/aspiration. Six cases were excluded due to the lack of contrast-enhanced images, leaving a total of 15 cases for analysis (mean age 53.5 years ± 18.8 SD). The imaging studies were independently reviewed by two blinded readers. Demographic data, imaging findings, and incidence of the worm-like pattern were reported. The Cohen's kappa was used to calculate interrater reproducibility. RESULTS Of the 12 patients with relevant imaging findings, nine cases (75%) had parenchymal lesions (eight cases in supratentorial compartment and one case in infratentorial compartment), four cases (33.3%) had leptomeningeal enhancement and two cases (16.7%) had hydrocephalus. Brain abscesses were found in eight cases and nodules evocative of abscess in one case. Restricted diffusion in the central area and hemosiderin deposition were observed in all cases. The involvement of white matter tract in a worm-like pattern was demonstrated in eight of nine patients with parenchymal lesions (88.9%). CONCLUSION Abnormal findings in brain CT/MRI images are common in neurolisteriosis. The incidence of worm-like spread along the white matter tracts is high and may help diagnose suspicious patients.
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Affiliation(s)
- Aimpavee Keeratiratwattana
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand
| | - Abhinbhen W Saraya
- Division of Neurology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases and Health Science Centre (TRC-EID-HS), King Chulalongkorn Memorial Hospital - The Thai Red Cross Society, Bangkok, Thailand
| | - Supada Prakkamakul
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok, 10330, Thailand.
- Department of Radiology, King Chulalongkorn Memorial Hospital the Thai Red Cross Society, Bangkok, Thailand.
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14
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Fujii H, Hara Y, Obase Y, Haranaga S, Takahashi H, Shinkai M, Terada J, Ikari J, Katsura H, Yamamoto K, Suzuki T, Tagaya E, Mukae H, Kaneko T. Nationwide survey in Japan of the causative diseases of bloody sputum and hemoptysis in departments of respiratory medicine at university hospitals and core hospitals. Respir Investig 2024; 62:395-401. [PMID: 38484503 DOI: 10.1016/j.resinv.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/10/2024] [Accepted: 02/11/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND The Guidelines for the Management of Cough and Sputum (2019) of the Japanese Respiratory Society (JRS) were the first internationally published guidelines for the management of sputum. However, the data used to determine the causative diseases of bloody sputum and hemoptysis in these guidelines were not obtained in Japan. METHODS A retrospective analysis was performed using the clinical information of patients with bloody sputum or hemoptysis who visited the department of respiratory medicine at a university or core hospital in Japan. RESULTS Included in the study were 556 patients (median age, 73 years; age range, 21-98 years; 302 males (54.3%)). The main causative diseases were bronchiectasis (102 patients (18.3%)), lung cancer (97 patients (17.4%)), and non-tuberculous mycobacterial disease (89 patients (16%)). Sex and age differences were observed in the frequency of causative diseases of bloody sputum and hemoptysis. The most common cause was lung cancer in males (26%), bronchiectasis in females (29%), lung cancer in patients aged <65 years (19%), and bronchiectasis in those aged >65 years (20%). CONCLUSIONS The present study is the first to investigate the causative diseases of bloody sputum and hemoptysis using data obtained in Japan. When investigating the causative diseases of bloody sputum and hemoptysis, it is important to take the sex and age of the patients into account.
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Affiliation(s)
- Hiroaki Fujii
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.
| | - Yasushi Obase
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-city, Nagasaki 852-8501, Japan
| | - Shusaku Haranaga
- Division of Infectious, Respiratory, and Digestive Medicine, First Department of Internal Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara, Nishihara, Nakagami-gun, Okinawa 903-0215, Japan; Comprehensive Health Professions Education Center, University Hospital, University of the Ryukyus, 207 Uehara, Nishihara, Nakagami-gun, Okinawa 903-0215, Japan
| | - Hidenori Takahashi
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo 140-8522, Japan
| | - Masaharu Shinkai
- Department of Respiratory Medicine, Tokyo Shinagawa Hospital, 6-3-22 Higashioi, Shinagawa-ku, Tokyo 140-8522, Japan
| | - Jiro Terada
- Department of Respiratory Medicine, Japanese Red Cross Narita Hospital, 90-1, Iida-cho, Narita-shi, Chiba 286-8523, Japan; Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Jun Ikari
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Hideki Katsura
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Kazuko Yamamoto
- Division of Infectious, Respiratory, and Digestive Medicine, First Department of Internal Medicine, University of the Ryukyus Graduate School of Medicine, 207 Uehara, Nishihara, Nakagami-gun, Okinawa 903-0215, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba 260-8670, Japan
| | - Etsuko Tagaya
- Department of Respiratory Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjyuku-ku, Tokyo 162-8666, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki-city, Nagasaki 852-8501, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
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Nakatani Y, Take Y, Takizawa R, Yoshimura S, Kaseno K, Yamashita E, Naito S. Catheter ablation of the left-sided variant of right top pulmonary vein in a case with persistent left superior vena cava. Pacing Clin Electrophysiol 2024; 47:661-663. [PMID: 37433156 DOI: 10.1111/pace.14780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/20/2023] [Accepted: 06/24/2023] [Indexed: 07/13/2023]
Abstract
A 50-year-old woman underwent catheter ablation for atrial fibrillation. Preoperative computed tomography revealed a left-sided variant of the right top pulmonary vein (PV) and a persistent left superior vena cava. The right top PV was successfully isolated through a wide antral circumferential ablation line simultaneously with the right PVs.
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Affiliation(s)
- Yosuke Nakatani
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Yutaka Take
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Ryoya Takizawa
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shingo Yoshimura
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Kenichi Kaseno
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Eiji Yamashita
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
| | - Shigeto Naito
- Division of Cardiology, Gunma Prefectural Cardiovascular Center, Gunma, Japan
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16
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Matsubara S, Sudo K, Kushimoto K, Yoshii R, Inoue K, Kinoshita M, Kooguchi K, Shikata S, Inaba T, Sawa T. Prediction of acute lung injury assessed by chest computed tomography, oxygen saturation/fraction of inspired oxygen ratio, and serum lactate dehydrogenase in patients with COVID-19. J Infect Chemother 2024; 30:406-416. [PMID: 37984540 DOI: 10.1016/j.jiac.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/10/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION In treating acute hypoxemic respiratory failure (AHRF) caused by coronavirus disease 2019 (COVID-19), clinicians choose respiratory therapies such as low-flow nasal cannula oxygenation, high-flow nasal cannula oxygenation, or mechanical ventilation after assessment of the patient's condition. Chest computed tomography (CT) imaging contributes significantly to diagnosing COVID-19 pneumonia. However, the costs and potential harm to patients from radiation exposure need to be considered. This study was performed to predict the quantitative extent of COVID-19 acute lung injury using clinical indicators such as an oxygenation index and blood test results. METHODS We analyzed data from 192 patients with COVID-19 AHRF. Multiple logistic regression was used to determine correlations between the lung infiltration volume (LIV) and other pathophysiological or biochemical laboratory parameters. RESULTS Among 13 clinical parameters, we identified the oxygen saturation/fraction of inspired oxygen ratio (SF ratio) and serum lactate dehydrogenase (LD) concentration as factors associated with the LIV. In the binary classification of an LIV of ≥20 % or not and with the borderline LD = 2.2 × [SF ratio]-182.4, the accuracy, precision, diagnostic odds ratio, and area under the summary receiver operating characteristic curve were 0.828, 0.818, 23.400, and 0.870, respectively. CONCLUSIONS These data suggest that acute lung injury due to COVID-19 pneumonia can be estimated using the SF ratio and LD concentration without a CT scan. These findings may provide significant clinical benefit by allowing clinicians to predict acute lung injury levels using simple, minimally invasive assessment of oxygenation capacity and biochemical blood tests.
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Affiliation(s)
- Shin Matsubara
- Department of General Medicine & Community Healthcare, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Kazuki Sudo
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Kohsuke Kushimoto
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Ryogo Yoshii
- Division of Intensive Care, The Hospital of Kyoto Prefectural University, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Keita Inoue
- Division of Intensive Care, The Hospital of Kyoto Prefectural University, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Mao Kinoshita
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Kunihiko Kooguchi
- Division of Intensive Care, The Hospital of Kyoto Prefectural University, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Satoru Shikata
- Department of General Medicine & Community Healthcare, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Tohru Inaba
- Division of Clinical Laboratory, Kyoto Prefectural University of Medicine Hospital, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
| | - Teiji Sawa
- Department of Anesthesiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan; The Hospital of Kyoto Prefectural University of Medicine, Kajiicho 465, Kawaramachi-Hirokoji, Kamigyo, Kyoto, 602-8566, Japan.
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17
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Ono R, Iwahana T, Kobayashi Y. Emphysematous cystitis with positive string test. Am J Med Sci 2024; 367:e53-e54. [PMID: 38191028 DOI: 10.1016/j.amjms.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/04/2024] [Indexed: 01/10/2024]
Affiliation(s)
- Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
| | - Togo Iwahana
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
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18
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Paul U, Koneru M, Siegler JE, Penckofer M, Nguyen TN, Khalife J, Oliveira R, Abdalkader M, Klein P, Vigilante N, Kamen S, Gold J, Thomas A, Patel P. A cortically-weighted versus total Alberta Stroke Program Early Computed Tomography Score in thrombectomy outcome models. J Stroke Cerebrovasc Dis 2024; 33:107607. [PMID: 38286160 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES Individual subcortical infarct scoring for the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) can be difficult and is subjected to higher inter-reader variability. This study compares performance of the 10-point ASPECTS with a new 7-point cortically-weighted score in predicting post-thrombectomy functional outcomes. MATERIALS AND METHODS Prospective registry data from two comprehensive stroke centers (Site 1 2016-2021; Site 2: 2019-2021) included patients with either M1 segment of middle cerebral artery or internal carotid artery occlusions who underwent thrombectomy. Two multivariate proportional odds training models utilizing either 10-point or 7-point ASPECTS predicting 90-day shift in modified Rankin score were generated using Site 1 data and validated with Site 2 data. Models were compared using multiclass receiver operator characteristics, corrected Akaike's Information Criterion, and likelihood ratio test. RESULTS Of 328 patients (Site 1 = 181, Site 2 = 147), median age was 71y (IQR 61-82), 119 (36%) had internal carotid artery occlusions, and median 10-point ASPECTS was 9 (IQR 8-10). There was no difference in performance between models using either total or cortically-weighted ASPECTS (p=0.14). Validation cohort data were correctly (i.e., predicting modified Rankin score within one point) classified 50% (cortically-weighted score model) and 56% (total score model) of the time. CONCLUSIONS The 7-point cortically-weighted ASPECTS was similarly predictive of post-thrombectomy functional outcome as 10-point ASPECTS. Given noninferior performance, the cortically-weighted score is a potentially reliable, but simplified, alternative to the traditional scoring paradigm, with potential implications in automated image analysis tool development.
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Affiliation(s)
- Umika Paul
- University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Manisha Koneru
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - James E Siegler
- Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper Neurological Institute, Camden, NJ, USA
| | - Mary Penckofer
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | - Jane Khalife
- Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper Neurological Institute, Camden, NJ, USA
| | - Renato Oliveira
- Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper Neurological Institute, Camden, NJ, USA
| | | | | | | | - Scott Kamen
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Justin Gold
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Ajith Thomas
- Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper Neurological Institute, Camden, NJ, USA
| | - Pratit Patel
- Cooper Medical School of Rowan University, Camden, NJ, USA; Cooper Neurological Institute, Camden, NJ, USA
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19
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Hsieh C. Expert Commentary on Management of Stercoral Colitis. Dis Colon Rectum 2024; 67:612-613. [PMID: 38595224 DOI: 10.1097/dcr.0000000000003295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Christine Hsieh
- Division of Colorectal Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California
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20
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Wang M, Peng M, Yang X, Zhang Y, Wu T, Wang Z, Wang K. Preoperative prediction of microsatellite instability status: development and validation of a pan-cancer PET/CT-based radiomics model. Nucl Med Commun 2024; 45:372-380. [PMID: 38312051 DOI: 10.1097/mnm.0000000000001816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
OBJECTIVE The purpose of this study is to verify the feasibility of preoperative prediction of patients' microsatellite instability status by applying a PET/CT-based radiation model. METHODS This retrospective study ultimately included 142 patients. Three prediction models have been developed. The predictive performance of all models was evaluated by the receiver operating characteristic curve and area under the curve values. The PET/CT radiological histology score (Radscore) was calculated to evaluate the microsatellite instability status, and the corresponding nomogram was established. The correlation between clinical factors and radiological characteristics was analyzed to verify the value of radiological characteristics in predicting microsatellite instability status. RESULTS Twelve features were retained to establish a comprehensive prediction model of radiological and clinical features. M phase of the tumor has been proven to be an independent predictor of microsatellite instability status. The receiver operating characteristic results showed that the area under the curve values of the training set and the validation set of the radiomics model were 0.82 and 0.75, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the training set were 0.72, 0.78, 0.83 and 0.66, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the validation set were 1.00, 0.50, 0.76 and 1.00, respectively. The risk of patients with microsatellite instability was calculated by Radscore and nomograph, and the cutoff value was -0.4385. The validity of the results was confirmed by the decision and calibration curves. CONCLUSION Radiological models based on PET/CT can provide clinical and practical noninvasive prediction of microsatellite instability status of several different cancer types, reducing or avoiding unnecessary biopsy to a certain extent.
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Affiliation(s)
- Menglu Wang
- Department of PET-CT, Harbin Medical University Cancer Hospital, Harbin and
| | - Mengye Peng
- Department of PET-CT, Harbin Medical University Cancer Hospital, Harbin and
| | - Xinyue Yang
- Department of PET-CT, Harbin Medical University Cancer Hospital, Harbin and
| | - Ying Zhang
- Department of PET-CT, Harbin Medical University Cancer Hospital, Harbin and
| | - Tingting Wu
- Department of PET-CT, Harbin Medical University Cancer Hospital, Harbin and
| | - Zeyu Wang
- The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Kezheng Wang
- Department of PET-CT, Harbin Medical University Cancer Hospital, Harbin and
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21
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Holmes JF, Yen K, Ugalde IT, Ishimine P, Chaudhari PP, Atigapramoj N, Badawy M, McCarten-Gibbs KA, Nielsen D, Sage AC, Tatro G, Upperman JS, Adelson PD, Tancredi DJ, Kuppermann N. PECARN prediction rules for CT imaging of children presenting to the emergency department with blunt abdominal or minor head trauma: a multicentre prospective validation study. Lancet Child Adolesc Health 2024; 8:339-347. [PMID: 38609287 DOI: 10.1016/s2352-4642(24)00029-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The intra-abdominal injury and traumatic brain injury prediction rules derived by the Pediatric Emergency Care Applied Research Network (PECARN) were designed to reduce inappropriate use of CT in children with abdominal and head trauma, respectively. We aimed to validate these prediction rules for children presenting to emergency departments with blunt abdominal or minor head trauma. METHODS For this prospective validation study, we enrolled children and adolescents younger than 18 years presenting to six emergency departments in Sacramento (CA), Dallas (TX), Houston (TX), San Diego (CA), Los Angeles (CA), and Oakland (CA), USA between Dec 27, 2016, and Sept 1, 2021. We excluded patients who were pregnant or had pre-existing neurological disorders preventing examination, penetrating trauma, injuries more than 24 h before arrival, CT or MRI before transfer, or high suspicion of non-accidental trauma. Children presenting with blunt abdominal trauma were enrolled into an abdominal trauma cohort, and children with minor head trauma were enrolled into one of two age-segregated minor head trauma cohorts (younger than 2 years vs aged 2 years and older). Enrolled children were clinically examined in the emergency department, and CT scans were obtained at the attending clinician's discretion. All enrolled children were evaluated against the variables of the pertinent PECARN prediction rule before CT results were seen. The primary outcome of interest in the abdominal trauma cohort was intra-abdominal injury undergoing acute intervention (therapeutic laparotomy, angiographic embolisation, blood transfusion, intravenous fluid for ≥2 days for pancreatic or gastrointestinal injuries, or death from intra-abdominal injury). In the age-segregated minor head trauma cohorts, the primary outcome of interest was clinically important traumatic brain injury (neurosurgery, intubation for >24 h for traumatic brain injury, or hospital admission ≥2 nights for ongoing symptoms and CT-confirmed traumatic brain injury; or death from traumatic brain injury). FINDINGS 7542 children with blunt abdominal trauma and 19 999 children with minor head trauma were enrolled. The intra-abdominal injury rule had a sensitivity of 100·0% (95% CI 98·0-100·0; correct test for 145 of 145 patients with intra-abdominal injury undergoing acute intervention) and a negative predictive value (NPV) of 100·0% (95% CI 99·9-100·0; correct test for 3488 of 3488 patients without intra-abdominal injuries undergoing acute intervention). The traumatic brain injury rule for children younger than 2 years had a sensitivity of 100·0% (93·1-100·0; 42 of 42) for clinically important traumatic brain injuries and an NPV of 100·0%; 99·9-100·0; 2940 of 2940), whereas the traumatic brain injury rule for children aged 2 years and older had a sensitivity of 98·8% (95·8-99·9; 168 of 170) and an NPV of 100·0% (99·9-100·0; 6015 of 6017). The two children who were misclassified by the traumatic brain injury rule were admitted to hospital for observation but did not need neurosurgery. INTERPRETATION The PECARN intra-abdominal injury and traumatic brain injury rules were validated with a high degree of accuracy. Their implementation in paediatric emergency departments can therefore be considered a safe strategy to minimise inappropriate CT use in children needing high-quality care for abdominal or head trauma. FUNDING The Eunice Kennedy Shriver National Institute of Child Health and Human Development.
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Affiliation(s)
- James F Holmes
- Department of Emergency Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA.
| | - Kenneth Yen
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Texas Southwestern, Dallas, TX, USA; Children's Health, University of Texas Southwestern, Dallas, TX, USA
| | - Irma T Ugalde
- Department of Emergency Medicine, McGovern Medical School, Houston, TX, USA
| | - Paul Ishimine
- Department of Emergency Medicine and Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nisa Atigapramoj
- Department of Emergency Medicine, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | - Mohamed Badawy
- Division of Pediatric Emergency Medicine, Department of Pediatrics, School of Medicine, University of Texas Southwestern, Dallas, TX, USA; Children's Health, University of Texas Southwestern, Dallas, TX, USA
| | | | - Donovan Nielsen
- Department of Emergency Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Allyson C Sage
- Department of Emergency Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Grant Tatro
- Virginia Commonwealth School of Medicine, Richmond, VA, USA
| | - Jeffrey S Upperman
- Department of Pediatric Surgery, Vanderbilt University, Nashville, TN, USA
| | - P David Adelson
- Department of Neurosurgery, School of Medicine and Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, USA
| | - Daniel J Tancredi
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, School of Medicine, University of California Davis, Sacramento, CA, USA; Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA, USA
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Liu L, Lei K, Du D, Lin Y, Pan Z, Guo L. Functional knee phenotypes appear to be more suitable for the Chinese OA population compared with CPAK classification: A study based on 3D CT reconstruction models. Knee Surg Sports Traumatol Arthrosc 2024; 32:1264-1274. [PMID: 38488258 DOI: 10.1002/ksa.12130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE The aim of this study was to investigate the distribution of coronal plane alignment of the knee (CPAK) classification and functional knee phenotypes in a Chinese osteoarthritis (OA) population and to compare different lower limb alignment targets according to the distribution characteristics to find suitable total knee arthroplasty (TKA) bone cut strategies for the Chinese OA patients. METHODS The computed tomography (CT) images were retrospectively collected and the three-dimensional (3D) models were reconstructed from 434 Chinese OA patients, including 93 males and 341 females, with a mean age of 66.4 ± 9.3 years. Femoral mechanical angle (FMA), tibial mechanical angle (TMA) and mechanical hip-knee-ankle angle (mHKA) were measured on the 3D models. Arithmetic hip-knee-ankle angle (aHKA) was calculated using FMA plus TMA, and joint line obliquity was calculated as 180 + TMA-FMA. The CPAK according to MacDessi and the functional knee phenotypes according to Hirschmann were performed. In addition, the suitable TKA bone cut strategies were explored according to the phenotypes and based on the characteristics of different alignment targets, such as mechanical alignment, anatomic alignment (AA), kinematic alignment, restricted KA (rKA) and adjusted MA (aMA). Statistical differences were determined using the independent-samples t-test or the two independent-samples Wilcoxon test, with p < 0.05 considered statistically significant. RESULTS The Chinese OA population showed a varus alignment tendency (mHKA = 172.1° ± 7.2°), to which the TMA was a major contributor (TMA = 84.7° ± 4.4° vs. FMA = 91.3° ± 3.2°). The mHKA was on average 3.9° more varus than the aHKA. A total of 140 functional knee phenotypes were found and 45.6% were concentrated in VARFMA3°-NEUFMA0° to VARTMA3°-NEUTMA0°. More than 70% of patients had different FMA and TMA phenotypes. There were 92.9% of CPAK distributed in types I to IV, with type I accounting for 53.9%. The FMA phenotypes were less changed if the aMA and rKA were chosen, and the TMA phenotypes were less changed if the AA and rKA were chosen. CONCLUSION Compared with the CPAK, the functional knee phenotypes were more suitable for the Chinese OA population with a wide distribution and a varus tendency, and it seemed more appropriate to choose aMA and rKA as TKA alignment targets for resection. LEVEL OF EVIDENCE Level Ⅲ.
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Affiliation(s)
- LiMing Liu
- Department of Joint Surgery, PLA Army 80th Group Military Hospital, Weifang City, Shandong Province, China
| | - Kai Lei
- Sports Medicine Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dekai Du
- Department of Joint Surgery, PLA Army 80th Group Military Hospital, Weifang City, Shandong Province, China
| | - Yong Lin
- Department of Joint Surgery, PLA Army 80th Group Military Hospital, Weifang City, Shandong Province, China
| | - Zhaoxun Pan
- Department of Joint Surgery, PLA Army 80th Group Military Hospital, Weifang City, Shandong Province, China
| | - Lin Guo
- Sports Medicine Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Smith MC, Medvecz AJ, Smith MR, Streams JR, Dennis BM. Computed tomography scanning is feasible in select patients with REBOA catheter deployment. Injury 2024; 55:111387. [PMID: 38360518 DOI: 10.1016/j.injury.2024.111387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Rapidly localizing and controlling bleeding is central to treating hemorrhagic shock. While REBOA allows temporary control, identifying the source of bleeding remains challenging. CT imaging with REBOA in place may provide information to direct hemorrhage control. The purpose of this study is to provide a descriptive summary of data comparing patients who did and did not undergo CT scan following REBOA deployment. Our hypothesis was that performing CT scan after REBOA placement in select patients is safe and can guide management of hemorrhagic shock. METHODS We queried the AAST AORTA registry for patients receiving REBOA at our level 1 trauma center from May 2017 to December 2021. Clinical data was obtained through the Trauma Registry of the American College of Surgeons (TRACS). Comparison groups were those who underwent CT scan after REBOA deployment versus those who did not undergo CT scan after REBOA deployment. The primary outcome was inhospital mortality, and secondary outcomes included hospital-, ICU-, and ventilator-free days. RESULTS 61 patients underwent CT scan with REBOA in place; 25 patients proceeded directly to hemorrhage control. Patients with REBOA prior to CT were more likely to have blunt mechanism, higher ISS, pelvic bleeding, and zone 3 REBOA placement. Mortality was not significantly different (51 % vs. 64 %). Patients who underwent CT with REBOA were more likely to undergo hemorrhage control in interventional radiology (43 % vs. 0 %). There was no difference in hospital-, ICU-, and ventilator-free days. DISCUSSION We demonstrate the feasibility of performing CT in select trauma patients who undergo REBOA. We describe a pathway to enable expeditious workup and management of these patients. Optimal hemorrhage control management is impacted by CT scans when it can be performed. It is important to note that this is a severely injured patient population, and mortality is high even when hemorrhage is controlled. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael C Smith
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA.
| | - Andrew J Medvecz
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
| | - Melissa R Smith
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
| | - Jill R Streams
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
| | - Bradley M Dennis
- Vanderbilt University Medical Center, Division of Acute Care Surgery 404 Medical Arts Building, 1211 21st Avenue South, Nashville, TN 37212, USA
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Mower WR, Akie TE, Morizadeh N, Gupta M, Hendey GW, Wilson JL, Leonid Duvergne LP, Ma P, Krishna P, Rodriguez RM. Blunt Head Injury in the Elderly: Analysis of the NEXUS II Injury Cohort. Ann Emerg Med 2024; 83:457-466. [PMID: 38340132 DOI: 10.1016/j.annemergmed.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/06/2023] [Accepted: 01/02/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Changes with aging make older patients vulnerable to blunt head trauma and alter the potential for injury and the injury patterns seen among this expanding cohort. High-quality care requires a clear understanding of the factors associated with blunt head injuries in the elderly. Our objective was to develop a detailed assessment of the injury mechanisms, presentations, injury patterns, and outcomes among older blunt head trauma patients. METHODS We conducted a planned secondary analysis of patients aged 65 or greater who were enrolled in the National Emergency X-Radiography Utilization Study (NEXUS) Head Computed Tomography validation study. We performed a detailed assessment of the demographics, mechanisms, presentations, injuries, interventions, and outcomes among older patients. RESULTS We identified 3,659 patients aged 65 years or greater, among the 11,770 patients enrolled in the NEXUS validation study. Of these older patients, 325 (8.9%) sustained significant injuries, as compared with significant injuries in 442 (5.4%) of the 8,111 younger patients. Older females (1,900; 51.9%) outnumbered older males (1,753; 47.9%), and occult presentations (exhibiting no high-risk clinical criteria beyond age) occurred in 48 (14.8%; 95% confidence interval (CI) 11.1 to 19.1) patients with significant injuries. Subdural hematomas (377 discreet lesions in 299 patients) and subarachnoid hemorrhages (333 discreet instances in 256 patients) were the most frequent types of injuries occurring in our elderly population. A ground-level fall was the most frequent mechanism of injury among all patients (2,211; 69.6%), those sustaining significant injuries (180; 55.7%), and those who died of their injuries (37; 46.3%), but mortality rates were highest among patients experiencing a fall from a ladder (11.8%; 4 deaths among 34 cases [95% CI 3.3% to 27.5%]) and automobile versus pedestrian events (10.7%; 16 deaths among 149 cases [95% CI 6.3% to 16.9%]). Among older patients who required neurosurgical intervention for their injuries, only 16.4% (95% CI 11.1% to 22.9%) were able to return home, 32.1% (95% CI 25.1% to 39.8%) required extended facility care, and 41.8% (95% CI 34.2% to 49.7%) died from their injuries. CONCLUSIONS Older blunt head injury patients are at high risk of sustaining serious intracranial injuries even with low-risk mechanisms of injury, such as ground-level falls. Clinical evaluation is unreliable and frequently fails to identify patients with significant injuries. Outcomes, particularly after intervention, can be poor, with high rates of long-term disability and mortality.
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Affiliation(s)
- William R Mower
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
| | - Thomas E Akie
- Department of Emergency Medicine, UMass Chan Medical School, Worcester, MA
| | | | - Malkeet Gupta
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Emergency Medicine, Antelope Valley Medical Center, Lancaster, CA
| | - Gregory W Hendey
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Jake L Wilson
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Phillip Ma
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pravin Krishna
- Department of Emergency Medicine, Antelope Valley Medical Center, Lancaster, CA
| | - Robert M Rodriguez
- Department of Emergency Medicine, UCSF School of Medicine, San Francisco, CA
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Donaldson LB, Deeb RH, Momin S, Eide JG, Craig JR. Cadaveric and Computed Tomography Analysis of the Anterior Ethmoidal Artery Flap. Laryngoscope 2024; 134:2100-2104. [PMID: 37950636 DOI: 10.1002/lary.31162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/09/2023] [Accepted: 10/17/2023] [Indexed: 11/13/2023]
Abstract
BACKGROUND The anterior ethmoidal artery (AEA) flap has been successful in repairing anterior nasal septal perforations and has been presumed to be axially based on AEA branches coursing through or around the cribriform plate (CP). However, limited evidence supports the flap's axial supply. The purposes of this cadaveric and computed tomography (CT) study were to assess the arterial anatomy from the CP to the septum, and to determine AEA flap length to predict ideal flap base width. METHODS Ten fresh latex-injected cadavers were utilized for endoscopic dissection to identify arteries traversing the CPs on each side. First, arterial trajectories along the dorsal septum were recorded. Measurements were then made bilaterally along the septum from the middle turbinate (MT) axilla to the nasal branch of the AEA (NBAEA) traversing the CP. Additionally, 100 sinus CTs were reviewed to measure AEA flap lengths bilaterally. RESULTS From 10 cadavers, 20 sides were utilized for measurements. In all cadavers, the AEA septal branches coursed diagonally or horizontally along the dorsal septum, and never directly vertically. The mean distance from the MT axilla to the NBAEA was 1.24 ± 1.93 cm (range = 1-1.5 cm). Based on CTs, the mean AEA flap length was 6.40 ± 0.60 cm. CONCLUSIONS Based on the non-vertical courses of AEA septal branches, the AEA flap is more likely a random transposition flap than an axial flap. Average AEA flap length ranged from 6.0 to 7.0 cm. Assuming 3:1 length:width ratios, AEA flap base widths should be about 2.0-2.3 cm. LEVEL OF EVIDENCE NA Laryngoscope, 134:2100-2104, 2024.
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Affiliation(s)
- Lane B Donaldson
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Robert H Deeb
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Suhael Momin
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - Jacob G Eide
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
| | - John R Craig
- Department of Otolaryngology-Head and Neck Surgery, Henry Ford Health, Detroit, Michigan, U.S.A
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Smesseim I, Mets OM, Daniels JMA, Bahce I, Senan S. Diagnosis and management of pneumonitis following chemoradiotherapy and immunotherapy in stage III non-small cell lung cancer. Radiother Oncol 2024; 194:110147. [PMID: 38341099 DOI: 10.1016/j.radonc.2024.110147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND In inoperable stage III NSCLC, the standard of care is chemoradiotherapy and adjuvant durvalumab (IO) for 12 months. Pneumonitis is the commonest toxicity leading to discontinuation of IO. A failure to distinguish between expected radiation-induced changes, IO pneumonitis and infection can lead to unnecessary durvalumab discontinuation. We investigated the use of a structured multidisciplinary review of CT-scans, radiation dose distributions and clinical symptoms for the diagnosis of IO pneumonitis. METHODS A retrospective study was conducted at an academic medical center for patients treated for stage III NSCLC with chemoradiotherapy and adjuvant durvalumab between 2018 and 2021. An experienced thoracic radiologist reviewed baseline and follow-up chest CT-scans, systematically scored radiological features suspected for pneumonitis using a published classification system (Veiga C, Radioth Oncol 2018), and had access to screenshots of radiation dose distributions. Next, two experienced thoracic oncologists reviewed each patients' case record, CT-scans and radiation fields. A final consensus diagnosis incorporating views of expert clinicians and the radiologist was made. RESULTS Among the 45 included patients, 14/45 (31.1%) had a pneumonitis scored in patient records and durvalumab was discontinued in 11/45 cases (24.4%). Review by the radiologist led to a diagnosis of immune-related pneumonitis only in 6/45 patients (13.3%). Review by pulmonary oncologists led to a diagnosis of immune-related pneumonitis in only 4/45 patients (8.9%). In addition a suspicion of an immune-related pneumonitis was rejected in 3 separate patients (6.7%), after the thoracic oncologists had reviewed the patients' radiation fields. CONCLUSIONS In patients treated using the PACIFIC regimen, multidisciplinary assessment of CT-scans, radiation doses and patient symptoms, resulted in fewer diagnoses of immune-related pneumonitis (8.9%). Our study underscores the challenges in accurately diagnosing either IO-related or radiation pneumonitis in patients undergoing adjuvant immunotherapy after chemoradiotherapy and highlights the need for multidisciplinary review in order to avoid inappropriate cessation of adjuvant IO.
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Affiliation(s)
- I Smesseim
- Department of Thoracic Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
| | - O M Mets
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - J M A Daniels
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - I Bahce
- Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - S Senan
- Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Kok D, Oud S, Giannakópoulos GF, Scheerder MJ, Beenen LFM, Halm JA, Treskes K. Delayed diagnosed injuries in trauma patients after initial trauma assessment with a total-body computed tomography scan. Injury 2024; 55:111304. [PMID: 38171970 DOI: 10.1016/j.injury.2023.111304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/03/2023] [Accepted: 12/27/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Even when using the Advanced Trauma Life Support (ATLS) guidelines and other diagnostic protocols for the initial assessment of trauma patients, not all injuries will be diagnosed in this early stage of care. The aim of this study was to quantify how many, and assess which type of injuries were diagnosed with delay during the initial assessment of trauma patients including a total-body computed tomography (TBCT) scan in a Level 1 Trauma Center in the Netherlands. METHODS We conducted a retrospective cohort study of 697 trauma patients who were assessed in the trauma bay of the Amsterdam University Medical Center (AUMC), using a TBCT. A delayed diagnosed injury was defined as an injury sustained during the initial trauma and not discovered nor suspected upon admission to the Intensive Care Unit (ICU) or surgical ward following the initial assessment, diagnostic studies, or during immediate surgery. A clinically significant delayed diagnosis of injury was defined as an injury requiring follow-up or further medical treatment. We aimed to identify variables associated with delayed diagnosed injuries. RESULTS In total, 697 trauma patients with a median age of 46 years (IQR 30-61) and a median Injury Severity Score (ISS) of 16 (IQR 9-25) were included. Delayed diagnosed injuries were found in 97 patients (13.9 %), of whom 79 injuries were clinically significant (81.4 %). Forty-eight of the delayed diagnosed injuries (49.5 %) were within the TBCT field. Ten delayed diagnosed injuries had an Abbreviated Injury Scale (AIS) of ≥3. Most injuries were diagnosed before or during the tertiary survey (60.8 %). The median time of delay was 34.5 h (IQR 17.5-157.3). Variables associated with delayed diagnosed injuries were primary ICU admission (OR 1.8, p = 0.014), an ISS ≥ 16 (OR 1.6, p = 0.042), and prolonged hospitalization (40+ days) (OR 8.5, p < 0.001). CONCLUSION With the inclusion of the TBCT during the primary assessment of trauma patients, delayed diagnosed injuries still occurs in a significant number of patients (13.9 %). Factors associated with delayed diagnosed injuries were direct admission to ICU and an ISS ≥ 16.
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Affiliation(s)
- D Kok
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands.
| | - S Oud
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - G F Giannakópoulos
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - M J Scheerder
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - J A Halm
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
| | - K Treskes
- Trauma Unit, Department of Surgery, Amsterdam University Medical Centers, Location AMC, Meibergdreef 9, 1105, AZ Amsterdam, the Netherlands
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Lin W, Huang Y, Zhu J, Sun H, Su N, Pan J, Xu J, Chen L. Machine learning improves early prediction of organ failure in hyperlipidemia acute pancreatitis using clinical and abdominal CT features. Pancreatology 2024; 24:350-356. [PMID: 38342660 DOI: 10.1016/j.pan.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND This study aimed to investigate and validate machine-learning predictive models combining computed tomography and clinical data to early predict organ failure (OF) in Hyperlipidemic acute pancreatitis (HLAP). METHODS Demographics, laboratory parameters and computed tomography imaging data of 314 patients with HLAP from the First Affiliated Hospital of Wenzhou Medical University between 2017 and 2021, were retrospectively analyzed. Sixty-five percent of patients (n = 204) were assigned to the training group and categorized as patients with and without OF. Parameters were compared by univariate analysis. Machine-learning methods including random forest (RF) were used to establish model to predict OF of HLAP. Areas under the curves (AUCs) of receiver operating characteristic were calculated. The remaining 35% patients (n = 110) were assigned to the validation group to evaluate the performance of models to predict OF. RESULTS Ninety-three (45.59%) and fifty (45.45%) patients from the training and the validation cohort, respectively, developed OF. The RF model showed the best performance to predict OF, with the highest AUC value of 0.915. The sensitivity (0.828) and accuracy (0.814) of RF model were both the highest among the five models in the study cohort. In the validation cohort, RF model continued to show the highest AUC (0.820), accuracy (0.773) and sensitivity (0.800) to predict OF in HLAP, while the positive and negative likelihood ratios and post-test probability were 3.22, 0.267 and 72.85%, respectively. CONCLUSIONS Machine-learning models can be used to predict OF occurrence in HLAP in our pilot study. RF model showed the best predictive performance, which may be a promising candidate for further clinical validation.
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Affiliation(s)
- Weihang Lin
- Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Yingbao Huang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Jiale Zhu
- School of the First Clinical Medical Sciences, Wenzhou Medical University, China
| | - Houzhang Sun
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Na Su
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China
| | - Jingye Pan
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, China; Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Province, China; Collaborative Innovation Center for Intelligence Medical Education, China; Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, China
| | - Junkang Xu
- Intensive Care Unit, The First Affiliated Hospital of Wenzhou Medical University, China; Key Laboratory of Intelligent Treatment and Life Support for Critical Diseases of Zhejiang Province, China; Collaborative Innovation Center for Intelligence Medical Education, China; Zhejiang Engineering Research Center for Hospital Emergency and Process Digitization, China
| | - Lifang Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, China.
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Santini A, Protti A, Pennati F, Dalla Corte F, Martinetti N, Pugliese L, Picardo G, Chiurazzi C, Ferrari M, Costantini E, Aliverti A, Cecconi M. Effect of decreasing PEEP on hyperinflation and collapse in COVID-19: A computed tomography study. Acta Anaesthesiol Scand 2024; 68:626-634. [PMID: 38425207 DOI: 10.1111/aas.14401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 01/24/2024] [Accepted: 02/11/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND High positive end-expiratory pressure (PEEP>10 cmH2O) is commonly used in mechanically ventilated hypoxemic patients with COVID-19. However, some epidemiological and physiological studies indirectly suggest that using a lower PEEP may primarily and beneficially decrease lung hyperinflation in this population. Herein we directly quantified the effect of decreasing PEEP from 15 to 10 cmH2O on lung hyperinflation and collapse in mechanically ventilated patients with COVID-19. METHODS Twenty mechanically ventilated patients with COVID-19 underwent a lung computed tomography (CT) at PEEP of 15 and 10 cmH2O. The effect of decreasing PEEP on lung hyperinflation and collapse was directly quantified as the change in the over-aerated (density below -900 HU) and non-aerated (density above -100 HU) lung volumes. The net response to decreasing PEEP was computed as the sum of the change in those two compartments and expressed as the change in the "pathologic" lung volume. If the pathologic lung volume decreased (i.e., hyperinflation decreased more than collapse increased) when PEEP was decreased, the net response was considered positive; otherwise, it was considered negative. RESULTS On average, the ratio of arterial tension to inspiratory fraction of oxygen (PaO2:FiO2) in the overall study population was 137 (119-162) mmHg. In 11 (55%) patients, the net response to decreasing PEEP was positive. Their over-aerated lung volume decreased by 159 (98-186) mL, while the non-aerated lung volume increased by only 58 (31-91) mL. In nine (45%) patients, the net response was negative. Their over-aerated lung volume decreased by 46 (18-72) mL, but their non-aerated lung volume increased by 107 (44-121) mL. CONCLUSION In 20 patients with COVID-19 the net response to decreasing PEEP, as assessed with lung CT, was variable. In approximately half of them it was positive (and possibly beneficial), with a decrease in hyperinflation larger than the increase in collapse.
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Affiliation(s)
- Alessandro Santini
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Alessandro Protti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Francesca Pennati
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Francesca Dalla Corte
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Nicolò Martinetti
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Luca Pugliese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giorgio Picardo
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Chiara Chiurazzi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Michele Ferrari
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Elena Costantini
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Andrea Aliverti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, Milan, Italy
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Goncalves FG, Mahecha-Carvajal ME, Desa A, Yildiz H, Talbeya JK, Moreno LA, Viaene AN, Vossough A. Imaging of supratentorial intraventricular masses in children: a pictorial review-part 2. Neuroradiology 2024; 66:699-716. [PMID: 38085360 PMCID: PMC11031612 DOI: 10.1007/s00234-023-03253-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/13/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE This article is the second in a two-part series aimed at exploring the spectrum of supratentorial intraventricular masses in children. In particular, this part delves into masses originating from cells of the ventricular lining, those within the septum pellucidum, and brain parenchyma cells extending into the ventricles. The aim of this series is to offer a comprehensive understanding of these supratentorial intraventricular masses, encompassing their primary clinical findings and histological definitions. METHODS We conducted a review and analysis of relevant epidemiological data, the current genetics/molecular classifications as per the fifth edition of the World Health Organization (WHO) Classification of Tumors of the Central Nervous System (WHO CNS5), and imaging findings. Each supratentorial intraventricular mass was individually evaluated, with a detailed discussion on its clinical and histological features. RESULTS This article covers a range of supratentorial intraventricular masses observed in children. These include colloid cysts, subependymal giant cell astrocytomas, ependymomas, gangliogliomas, myxoid glioneuronal tumors, central neurocytomas, high-grade gliomas, pilocytic astrocytomas, cavernous malformations, and other embryonal tumors. Each mass type is characterized both clinically and histologically, offering an in-depth review of their individual imaging characteristics. CONCLUSION The WHO CNS5 introduces notable changes, emphasizing the vital importance of molecular diagnostics in classifying pediatric central nervous system tumors. These foundational shifts have significant potential to impact management strategies and, as a result, the outcomes of intraventricular masses in children.
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Affiliation(s)
| | | | - Aishwary Desa
- Drexel University College of Medicine Philadelphia, Philadelphia, PA, USA
| | - Harun Yildiz
- Department of Radiology, Dortcelik Children's Hospital, Bursa, Turkey
| | | | - Luz Angela Moreno
- Pediatric Imaging, Department of Radiology, Fundación Hospital La Misericordia, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Angela N Viaene
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Pathology Department, Children´s Hospital of Philadelphia, Philadelphia, USA
| | - Arastoo Vossough
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Radiology Department, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Jud L, Hartmann M, Vlachopoulos L, Zimmermann SM, Ackermann J, Fucentese SF. Increased tibial tuberosity torsion has the greatest predictive value in patients with patellofemoral instability compared to other commonly assessed parameters. Knee Surg Sports Traumatol Arthrosc 2024; 32:1179-1186. [PMID: 38504510 DOI: 10.1002/ksa.12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE The multifactorial nature of patellofemoral instability requires a comprehensive assessment of the affected patients. While an association between tibial tuberosity (TT) torsion and patellofemoral instability is known, its specific effect has not yet been investigated. This study investigated the effect of TT torsion on patellofemoral instability. METHODS This retrospective cohort study compared patients who underwent surgical intervention for patellofemoral instability and asymptomatic controls. TT torsion was measured in addition to other commonly assessed risk factors for patellofemoral instability using standardised computed tomography (CT) data of the lower extremities. The diagnostic performances of the assessed parameters were evaluated using receiver operating characteristic curve analysis and odds ratios (ORs) were calculated. RESULTS The patellofemoral instability group consisted of 79 knees, compared to 72 knees in the asymptomatic control group. Both groups differed significantly in all assessed parameters (p < 0.001), except for tibial torsion (n.s.). Among all parameters, TT torsion presented the best diagnostic performance for predicting patellar instability with an area under the curve of 0.95 (95% confidence interval [CI], 0.91-0.98; p < 0.001). A cut-off value of 17.7° yielded a 0.87 sensitivity and 0.89 specificity to predict patellar instability (OR, 55.2; 95% CI, 20.5-148.6; p < 0.001). CONCLUSION Among the evaluated risk factors, TT torsion had the highest predictive value for patellofemoral instability. Patients with TT torsions ≥ 17.7° showed a 55-fold increased probability of patellofemoral instability. Therefore, TT torsion should be included in the assessment of patients with patellofemoral instability. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Hartmann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan M Zimmermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Huang Y, Li X, Niu L, Zhang H, Zhang C, Feng Y, Wang Z, Zhang F, Luo X. CT venography combined with ultrasound-guided minimally invasive treatment for recurrent varicose veins: a pilot paired-design clinical trial. Clin Radiol 2024; 79:363-370. [PMID: 38290939 DOI: 10.1016/j.crad.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 09/26/2023] [Accepted: 12/24/2023] [Indexed: 02/01/2024]
Abstract
AIM To compare 1-year outcomes of computed tomography venography (CTV) combined with ultrasound-guided minimally invasive treatment with ascending phlebography and ultrasound-guided treatment for recurrent varicose veins. MATERIALS AND METHODS Consecutive patients with unilateral recurrent varicose veins were matched by gender, age, C classification, and degree of obesity, and randomised in a 1:1 ratio to receive either CTV (CTV group) or ascending phlebography (control group) combined with ultrasound-guided minimally invasive treatment. Patients were followed up by clinical and ultrasound examination. Follow-up was scheduled at 1 week, and 3, 6, and 12 months. The primary outcome measure was the Venous Clinical Severity Score (VCSS) at 12 months. Measures of secondary outcome included Chronic Insufficiency Venous International Questionnaire-20 (CIVIQ-20) score, recurrence of varicose vein or ulcer during 12 months, ulcer healing time, detection and location of treated veins. RESULTS Eighty patients were enrolled. Median VCSS in the CTV group was lower than it in the control group (p=0.04) and the CIVIQ-20 score was higher than the control group (p=0.02). By 12 months, no symptomatically recurrent varicose veins or ulcers had occurred. The ulcer healing time in CTV group was shorter (p<0.01). A greater number of patients had treated veins detected using CTV than by ascending venography (p=0.01), especially among patients with recurrence reflux veins in the groin, perineum, and vulva (p<0.01). CONCLUSION CTV combined with ultrasound may be more helpful than ascending phlebography combined with ultrasound to improve treatment efficacy for recurrent varices. These results should be verified by an future study with more patients and long-term follow-up.
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Affiliation(s)
- Y Huang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - X Li
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - L Niu
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - H Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - C Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Y Feng
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Z Wang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - F Zhang
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - X Luo
- Department of Vascular Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
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Suzuki J, Miyoshi T, Tane K, Onodera K, Koike Y, Sakai T, Samejima J, Aokage K, Tsuboi M. The significance of regular chest computed tomography in postoperative surveillance for surgically resected non-small cell lung cancer based on TNM 8th staging system. Gen Thorac Cardiovasc Surg 2024; 72:346-354. [PMID: 38143254 DOI: 10.1007/s11748-023-01991-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 11/05/2023] [Indexed: 12/26/2023]
Abstract
OBJECTIVES Although several societies recommend regular chest computed tomography (CT) scans for the surveillance of surgically resected non-small cell lung cancer (NSCLC), there is paucity of evidence to support these statements. This study aimed to clarify whether regular CT scans improved the prognosis of patients with surgically resected NSCLC based on TNM 8th classification. METHODS Patients with pathologic Stage 0-III NSCLC who underwent complete surgical resection other than sublobar resection procedures were enrolled in the study. For these patients, clinicopathological data and postoperative surveillance data were collected by the retrospective review of medical records. Patients were categorized into the chest X-ray (CXR) group or the CT group according to whether they were followed-up with basic examinations including CXR or basic examinations plus regular chest CT. Postoperative overall survival was compared between the two groups. RESULTS Six hundred sixty five patients were categorized into the CXR (n = 245) and CT (n = 420) groups. The clinicopathological backgrounds did not differ to a statistically significant extent. Recurrence was seen in 68 (27.3%) patients in the CXR group and 117 (27.8%) patients in the CT group. The 5-year overall survival rates of the two groups did not differ to a statistically significant extent (CXR, 76.5%; CT, 78.3%, P = 0.22). CONCLUSION Regular chest CT scans may not improve the prognosis of surgically resected NSCLC. Further study is warranted to precisely evaluate the benefit of CT-based postoperative surveillance of NSCLC.
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Affiliation(s)
- Jun Suzuki
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Tomohiro Miyoshi
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Kenta Tane
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Ken Onodera
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Yutaro Koike
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Sakai
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
- Division of Chest Surgery, Department of Surgery, School of Medicine, Toho University, Tokyo, Japan
| | - Joji Samejima
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masahiro Tsuboi
- Department of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
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Chen T, Chan HHL, de Almeida J, Goldstein DP, Gilbert RW, Yao CMKL, Irish JC, Davies JC. A 3D Analysis of Plating Strategies in Mandibular Reconstruction: A Randomized Control Pilot Study. Laryngoscope 2024; 134:2182-2186. [PMID: 37962081 DOI: 10.1002/lary.31171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 06/03/2023] [Accepted: 09/22/2023] [Indexed: 11/15/2023]
Abstract
OBJECTIVE(S) The purpose of this study was to compare computer-assisted mandibular plating to conventional plating using quantitative metrics. METHODS Patients scheduled to undergo mandibular reconstruction were randomized to three-dimensional modelling for preoperative plate bending or intraoperative freehand bending. Preoperative and postoperative head and neck computed tomography scans were obtained to generate computer models of the reconstruction. The overall plate surface contact area, mean plate-to-bone distance, degree of conformance, and position of the condylar head within the glenoid fossa between pre- and post-operative scans were calculated. RESULTS Twenty patients were included with a mean age of 57.8 years (standard deviation [SD] = 13.6). The mean follow-up time was 9.8 months (range = 1.6-22.3). Reconstruction was performed with fibular (25%) or scapular free flaps (75%). The percentage of surface contact between the reconstructive plate and mandible was improved with three-dimensional models compared to freehand bending (93.9 ± 7.7% vs. 78.0 ± 19.9%, p = 0.04). There was improved overall plate-to-bone distance (3D model: 0.7 ± 0.31 mm vs. conventional: 1.3 ± 0.8 mm, p = 0.06). Total intraoperative time was non-significantly decreased with the use of a model (3D model: 726.5 ± 89.1 min vs. conventional: 757.3 ± 84.1 min, p = 0.44). There were no differences in condylar head position or postoperative complications. CONCLUSION Computer-assisted mandibular plating can be used to improve the accuracy of plate contouring. LEVEL OF EVIDENCE 2 Laryngoscope, 134:2182-2186, 2024.
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Affiliation(s)
- Tanya Chen
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Harley H L Chan
- Guided Therapeutics (GTx) Program, University of Toronto, Toronto, Ontario, Canada
| | - John de Almeida
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ralph W Gilbert
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Christopher M K L Yao
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Joel C Davies
- Department of Otolaryngology - Head & Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
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Provan SA, Ahlfors F, Bakland G, Hu Y, Kristianslund EK, Ikdahl E, Kvien TK, Aaløkken TM, Hoffmann-Vold AM. A validation of register-derived diagnoses of interstitial lung disease in patients with inflammatory arthritis: data from the NOR-DMARD study. Scand J Rheumatol 2024; 53:173-179. [PMID: 38314728 DOI: 10.1080/03009742.2024.2306716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE There is a lack of knowledge concerning the validity of the interstitial lung disease (ILD) diagnoses used in epidemiological studies on rheumatic diseases. This paper seeks to verify register-derived ILD diagnoses using chest computed tomography (CT) and medical records as a gold standard. METHOD The Norwegian Anti-Rheumatic Drug Register (NOR-DMARD) is a multicentre prospective observational study of patients with inflammatory arthritis who start treatment with disease-modifying anti-rheumatic drugs. NOR-DMARD is linked to the Norwegian Patient Registry (NPR) and Cause of Death Registry. We searched registers for ILD coded by ICD-10 J84 or J99 among patients with rheumatoid arthritis, psoriatic arthritis, or spondyloarthritis. We extracted chest CT reports and medical records from participating hospitals. Two expert thoracic radiologists scored examinations to confirm the ILD diagnosis. We also searched medical records to find justifications for the diagnosis following multidisciplinary evaluations. We calculated the positive predictive values (PPVs) for ILD across subsets. RESULTS We identified 71 cases with an ILD diagnosis. CT examinations were available in 65/71 patients (91.5%), of whom ILD was confirmed on CT in 29/65 (44.6%). In a further 10 patients, medical records confirmed the diagnosis, giving a total of 39/71 verified cases. The PPV of a register-derived ILD diagnosis was thus 54.9%. In a subset of patients who had received an ILD code at two or more time-points and had a CT scan taken within a relevant period, the PPV was 72.2%. CONCLUSION The validity of register-based diagnoses of ILD must be carefully considered in epidemiological studies.
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Affiliation(s)
- S A Provan
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Section for Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - F Ahlfors
- Department of Radiology, Sahlgrenska universitetssykehus, Göteborg, Sweden
| | - G Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
| | - Y Hu
- Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - E K Kristianslund
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - T K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - T M Aaløkken
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Radiology, Oslo University Hospital, Oslo, Norway
| | - A M Hoffmann-Vold
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Yoshikawa K, Shibata T, Iba Y, Ogura K, Misumi S, Kawaharada N. Simultaneous delineation of collateral circulation to Adamkiewicz artery via internal thoracic artery and endoleak with an ultrahigh-resolution computed tomography. J Vasc Surg 2024; 79:1233-1234. [PMID: 37777941 DOI: 10.1016/j.jvs.2023.08.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Kenta Yoshikawa
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan.
| | - Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Yutaka Iba
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Keishi Ogura
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Shogo Misumi
- Division of Radiology and Nuclear Medicine, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Hokkaido, Japan
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Holcombe SA, Huang Y, Derstine BA. Population trends in human rib cross-sectional shapes. J Anat 2024; 244:792-802. [PMID: 38200705 PMCID: PMC11021607 DOI: 10.1111/joa.13999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024] Open
Abstract
Rib fractures remain the most frequent thoracic injury in motor vehicle crashes. Computational human body models (HBMs) can be used to simulate these injuries and design mitigation strategies, but they require adequately detailed geometry to replicate such fractures. Due to a lack of rib cross-sectional shape data availability, most commercial HBMs use highly simplified rib sections extracted from a single individual during original HBM development. This study provides human rib shape data collected from chest CT scans of 240 females and males across the full adult age range. A cortical bone mapping algorithm extracted cross-sectional geometry from scans in terms of local periosteal position with respect to the central rib axis and local cortex thickness. Principal component analysis was used to reduce the dimensionality of these cross-sectional shape data. Linear regression found significant associations between principal component scores and subject demographics (sex, age, height, and weight) at all rib levels, and predicted scores were used to explore the expected rib cross-sectional shapes across a wide range of subject demographics. The resulting detailed rib cross-sectional shapes were quantified in terms of their total cross-sectional area and their cortical bone cross-sectional area. Average-sized female ribs were smaller in total cross-sectional area than average-sized male ribs by between 20% and 36% across the rib cage, with the greatest differences seen in the central portions of rib 6. This trend persisted although to smaller differences of 14%-29% when comparing females and males of equal intermediate weight and stature. Cortical bone cross-sectional areas were up to 18% smaller in females than males of equivalent height and weight but also reached parity in certain regions of the rib cage. Increased age from 25 to 80 years was associated with reductions in cortical bone cross-sectional area (up to 37% in females and 26% in males at mid-rib levels). Total cross-sectional area was also seen to reduce with age in females but to a lesser degree (of up to 17% in mid-rib regions). Similar regions saw marginal increases in total cross-sectional area for male ribs, indicating age affects rib cortex thickness moreso than overall rib cross-sectional size. Increased subject height was associated with increased rib total and cortical bone cross-sectional areas by approximately 25% and 15% increases, respectively, in mid-rib sections for a given 30 cm increase in height, although the magnitudes of these associations varied by sex and rib location. Increased weight was associated with approximately equal changes in both cortical bone and total cross-sectional areas in males. These effects were most prominent (around 25% increases for an addition of 50 kg) toward lower ribs in the rib cage and had only modest effects (less than 12% change) in ribs 2-4. Females saw greater increases with weight in total rib area compared to cortical bone area, of up to 21% at the eighth rib level. Results from this study show the expected shapes of rib cross-sections across the adult rib cage and across a broad range of demographics. This detailed geometry can be used to produce accurate rib models representing widely varying populations.
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Affiliation(s)
- Sven A. Holcombe
- Morphomics Analysis GroupUniversity of MichiganAnn ArborMichiganUSA
| | - Yuan Huang
- Morphomics Analysis GroupUniversity of MichiganAnn ArborMichiganUSA
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Shah NR, Weadock WJ, Williams KM, Moreci R, Stoll T, Joshi A, Petroze R, Newman EA. Use of modern three-dimensional imaging models to guide surgical planning for local control of pediatric extracranial solid tumors. Pediatr Blood Cancer 2024; 71:e30933. [PMID: 38430473 DOI: 10.1002/pbc.30933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION In complex pediatric surgical oncology, surgical planning is contingent upon data gathered from preoperative imaging. Three-dimensional (3D) modeling and printing has been shown to be beneficial for adult presurgical planning, though pediatric literature is less robust. The study reviews our institutional experience with the use of 3D image segmentation and printed models in approaching resection of extracranial solid tumors in children. METHODS This is a single institutional series from 2021 to 2023. Models were based on computed tomography and magnetic resonance imaging studies, optimized for 3D imaging. The feasibility and creation of the models is reviewed, including specific techniques, software, and printing materials from our institution. Clinical implications for surgical planning are also described, along with detailed preoperative and intraoperative images. RESULTS 3D modeling and printing was performed for four pediatric patients diagnosed with extracranial solid tumors. Diagnoses included Ewing sarcoma, hepatoblastoma, synovial sarcoma, and osteosarcoma. No intraoperative complications or discrepancies with the preoperative 3D-printed model were noted. No evidence of local recurrence was identified in any patient thus far. CONCLUSION Our institutional series demonstrates a wide spectrum of clinical application for 3D modeling and printing technology within pediatric surgical oncology. This technology may aid in surgical planning for both resection and reconstruction, can be applied to a diverse breadth of diagnoses, and may potentially augment patient and/or family education about their condition.
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Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - William J Weadock
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Keyonna M Williams
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Rebecca Moreci
- Center for Surgical Training and Research, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Tammy Stoll
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Aparna Joshi
- Department of Radiology, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Robin Petroze
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Erika A Newman
- Section of Pediatric Surgery, Michigan Medicine, Ann Arbor, Michigan, USA
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Singh S, Dehghani Firouzabadi F, Chaurasia A, Homayounieh F, Ball MW, Huda F, Turkbey EB, Linehan WM, Malayeri AA. CT-derived radiomics predict the growth rate of renal tumours in von Hippel-Lindau syndrome. Clin Radiol 2024; 79:e675-e681. [PMID: 38383255 DOI: 10.1016/j.crad.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/26/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
AIM To predict renal tumour growth patterns in von Hippel-Lindau syndrome by utilising radiomic features to assist in developing personalised surveillance plans leading to better patient outcomes. MATERIALS AND METHODS The study evaluated 78 renal tumours in 55 patients with histopathologically-confirmed clear cell renal cell carcinomas (ccRCCs), which were segmented and radiomics were extracted. Volumetric doubling time (VDT) classified the tumours into fast-growing (VDT <365 days) or slow-growing (VDT ≥365 days). Volumetric and diametric growth analyses were compared between the groups. Multiple logistic regression and random forest classifiers were used to select the best features and models based on their correlation and predictability of VDT. RESULTS Fifty-five patients (mean age 42.2 ± 12.2 years, 27 men) with a mean time difference of 3.8 ± 2 years between the baseline and preoperative scans were studied. Twenty-five tumours were fast-growing (low VDT, i.e., <365 days), and 53 tumours were slow-growing (high VDT, i.e., ≥365 days). The median volumetric and diametric growth rates were 1.71 cm3/year and 0.31 cm/year. The best feature using univariate analysis was wavelet-HLL_glcm_ldmn (area under the receiver operating characteristic [ROC] curve [AUC] of 0.80, p<0.0001), and with the random forest classifier, it was log-sigma-0-5-mm-3D_glszm_ZonePercentage (AUC: 79). The AUC of the ROC curves using multiple logistic regression was 0.74, and with the random forest classifier was 0.73. CONCLUSION Radiomic features correlated with VDT and were able to predict the growth pattern of renal tumours in patients with VHL syndrome.
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Affiliation(s)
- S Singh
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - F Dehghani Firouzabadi
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - A Chaurasia
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - F Homayounieh
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - M W Ball
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - F Huda
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - E B Turkbey
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - W M Linehan
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA
| | - A A Malayeri
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892, USA.
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Liang Z, Li W. Uptake of 99m Tc-DTPA in Bone Metastases From Follicular Thyroid Carcinoma. Clin Nucl Med 2024; 49:e227-e229. [PMID: 38377373 DOI: 10.1097/rlu.0000000000005100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
ABSTRACT A 53-year-old man with follicular thyroid carcinoma (FTC) was referred for renal scintigraphy using 99m Tc-DTPA to assess the kidney function. Unexpectedly, the images showed an abnormal uptake of radiotracer in the right pelvic region. It corresponded to the site of metastasis in the right ilium revealed on 131 I SPECT/CT images. The biopsy pathology of the ilium lesion demonstrated follicular thyroid cancer.
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Affiliation(s)
- Zhiying Liang
- From the Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, Guangdong Province, China
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Alzein MM, Patel A, Abdalla RN, Cantrell DR, Shaibani A, Ansari SA. MR Vessel Wall Imaging for Atherosclerosis and Vasculitis. Neuroimaging Clin N Am 2024; 34:251-260. [PMID: 38604709 DOI: 10.1016/j.nic.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Conventional imaging modalities, such as computed tomography angiography, MR angiography, transcranial Doppler ultrasonography, and digital subtraction angiography, are utilized in evaluating intraluminal or intravascular pathology of the intracranial vessels. Limitations of luminal imaging techniques can lead to inaccurate diagnosis, evaluation, and risk stratification, as many cerebrovascular pathologies contain an extrinsic vessel wall component. Furthermore, vessel wall imaging can provide information regarding extent, treatment response, and biopsy targets for vasculitis cases. Overall, while vessel wall imaging can provide robust data regarding intracranial pathologies, further prospective, multicenter studies are required to improve diagnostic application and accuracy.
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Affiliation(s)
- Mohamad M Alzein
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Abhinav Patel
- Department of Radiology, Northwestern University, Feinberg School of Medicine
| | - Ramez N Abdalla
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Radiology, Ain Shams University, Faculty of Medicine
| | - Donald R Cantrell
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital
| | - Ali Shaibani
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Feinberg School of Medicine; Department of Radiology, Lurie Children's Hospital; Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine; Department of Neurology, Northwestern University, Feinberg School of Medicine.
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Aydeniz E, Weberndorfer V, Brandts L, Smulders MW, van Herpt TT, Martens B, Vernooy K, Linz D, van der Horst IC, Wildberger JE, van Bussel BC, Driessen RG, Mihl C. Pericardial Fat Is Associated With Less Severe Multiorgan Failure Over Time in Patients With Coronavirus Disease-19: The Maastricht Intensive Care COVID Cohort. J Thorac Imaging 2024; 39:W32-W39. [PMID: 37624050 PMCID: PMC11027979 DOI: 10.1097/rti.0000000000000732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
PURPOSE Pericardial fat (PF) and epicardial adipose tissue (EAT) may enhance the proinflammatory response in corona virus-19 (COVID-19) patients. Higher PF and EAT volumes might result in multiorgan failure and explain unfavorable trajectories.The aim of this study was to examine the association between the volume of PF and EAT and multiorgan failure over time. MATERIALS AND METHODS All mechanically ventilated COVID-19 patients with an available chest computed tomography were prospectively included (March-June 2020). PF and EAT volumes were quantified using chest computed tomography scans. Patients were categorized into sex-specific PF and EAT tertiles. Variables to calculate Sequential Organ Failure Assessment (SOFA) scores were collected daily to indicate multiorgan failure. Linear mixed-effects regression was used to investigate the association between tertiles for PF and EAT volumes separately and serial SOFA scores over time. All models were adjusted. RESULTS Sixty-three patients were divided into PF and EAT tertiles, with median PF volumes of 131.4 mL (IQR [interquartile range]: 115.7, 143.2 mL), 199.8 mL (IQR: 175.9, 221.6 mL), and 318.8 mL (IQR: 281.9, 376.8 mL) and median EAT volumes of 69.6 mL (IQR: 57.0, 79.4 mL), 107.9 mL (IQR: 104.6, 115.1 mL), and 163.8 mL (IQR: 146.5, 203.1 mL). Patients in the highest PF tertile had a statistically significantly lower SOFA score over time (1.3 [-2.5, -0.1], P =0.033) compared with the lowest PF tertile. EAT tertiles were not significantly associated with SOFA scores over time. CONCLUSION A higher PF volume is associated with less multiorgan failure in mechanically ventilated COVID-19 patients. EAT volumes were not associated with multiorgan failure.
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Affiliation(s)
- Eda Aydeniz
- Departments of Intensive Care Medicine Maastricht
- Department of Intensive Care Medicine, Laurentius Hospital Roermond, Roermond, The Netherlands
| | - Vanessa Weberndorfer
- Cardiology
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Lloyd Brandts
- Clinical Epidemiology and Medical Technology Assessment
| | - Martijn W. Smulders
- Cardiology
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Thijs T.W. van Herpt
- Departments of Intensive Care Medicine Maastricht
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Bibi Martens
- Radiology and Nuclear Medicine, Maastricht University Medical Center+
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Kevin Vernooy
- Cardiology
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Dominik Linz
- Cardiology
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Iwan C.C. van der Horst
- Departments of Intensive Care Medicine Maastricht
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Joachim E. Wildberger
- Radiology and Nuclear Medicine, Maastricht University Medical Center+
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Bas C.T. van Bussel
- Departments of Intensive Care Medicine Maastricht
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht
| | - Rob G.H. Driessen
- Departments of Intensive Care Medicine Maastricht
- Cardiology
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
| | - Casper Mihl
- Radiology and Nuclear Medicine, Maastricht University Medical Center+
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University
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Goffin JSO, Rankin IA, Robinson JDD. The use of digital tomosynthesis in suspected scaphoid fractures. J Hand Surg Eur Vol 2024; 49:630-631. [PMID: 38000013 DOI: 10.1177/17531934231215769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
We report a retrospective observational series of patients undergoing digital tomosynthesis (DTS) for suspected scaphoid fractures. With a specificity and sensitivity of 100%, DTS demonstrates the potential to be an excellent tool in the diagnosis of occult scaphoid fractures.
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Ud Din R, Yang H. Editorial for "Comparing CT-Like Images Based on Ultra-Short Echo Time and Gradient Echo T1-Weighted MRI Sequences for the Assessment of Vertebral Disorders Using Histology and True CT as the Reference Standard". J Magn Reson Imaging 2024; 59:1553-1554. [PMID: 37530548 DOI: 10.1002/jmri.28928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 08/03/2023] Open
Affiliation(s)
- Rahman Ud Din
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
| | - Haisheng Yang
- Department of Biomedical Engineering, Faculty of Environment and Life, Beijing University of Technology, Beijing, China
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Wu H, Zhang B, Li Z, Qin J, Lee TY. 3DSN-Net: A 3-D Scale-Aware convNet With Nonlocal Context Guidance for Kidney and Tumor Segmentation From CT Volumes. IEEE Trans Cybern 2024; 54:3299-3312. [PMID: 37471181 DOI: 10.1109/tcyb.2023.3291369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Automatic kidney and tumor segmentation from CT volumes is a critical prerequisite/tool for diagnosis and surgical treatment (such as partial nephrectomy). However, it remains a particularly challenging issue as kidneys and tumors often exhibit large-scale variations, irregular shapes, and blurring boundaries. We propose a novel 3-D network to comprehensively tackle these problems; we call it 3DSN-Net. Compared with existing solutions, it has two compelling characteristics. First, with a new scale-aware feature extraction (SAFE) module, the proposed 3DSN-Net is capable of adaptively selecting appropriate receptive fields according to the sizes of targets instead of indiscriminately enlarging them, which is particularly essential for improving the segmentation accuracy of the tumor with large scale variation. Second, we propose a novel yet efficient nonlocal context guidance (NCG) mechanism to capture global dependencies to tackle irregular shapes and blurring boundaries of kidneys and tumors. Instead of directly harnessing a 3-D NCG mechanism, which makes the number of parameters exponentially increase and hence the network difficult to be trained under limited training data, we develop a 2.5D NCG mechanism based on projections of feature cubes, which achieves a tradeoff between segmentation accuracy and network complexity. We extensively evaluate the proposed 3DSN-Net on the famous KiTS dataset with many challenging kidney and tumor cases. Experimental results demonstrate our solution consistently outperforms state-of-the-art 3-D networks after being equipped with scale aware and NCG mechanisms, particularly for tumor segmentation.
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Ma D, Li C, Du T, Qiao L, Tang D, Ma Z, Shi L, Lu G, Meng Q, Chen Z, Grzegorzek M, Sun H. PHE-SICH-CT-IDS: A benchmark CT image dataset for evaluation semantic segmentation, object detection and radiomic feature extraction of perihematomal edema in spontaneous intracerebral hemorrhage. Comput Biol Med 2024; 173:108342. [PMID: 38522249 DOI: 10.1016/j.compbiomed.2024.108342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/05/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND AND OBJECTIVE Intracerebral hemorrhage is one of the diseases with the highest mortality and poorest prognosis worldwide. Spontaneous intracerebral hemorrhage (SICH) typically presents acutely, prompt and expedited radiological examination is crucial for diagnosis, localization, and quantification of the hemorrhage. Early detection and accurate segmentation of perihematomal edema (PHE) play a critical role in guiding appropriate clinical intervention and enhancing patient prognosis. However, the progress and assessment of computer-aided diagnostic methods for PHE segmentation and detection face challenges due to the scarcity of publicly accessible brain CT image datasets. METHODS This study establishes a publicly available CT dataset named PHE-SICH-CT-IDS for perihematomal edema in spontaneous intracerebral hemorrhage. The dataset comprises 120 brain CT scans and 7,022 CT images, along with corresponding medical information of the patients. To demonstrate its effectiveness, classical algorithms for semantic segmentation, object detection, and radiomic feature extraction are evaluated. The experimental results confirm the suitability of PHE-SICH-CT-IDS for assessing the performance of segmentation, detection and radiomic feature extraction methods. RESULTS This study conducts numerous experiments using classical machine learning and deep learning methods, demonstrating the differences in various segmentation and detection methods on the PHE-SICH-CT-IDS. The highest precision achieved in semantic segmentation is 76.31%, while object detection attains a maximum precision of 97.62%. The experimental results on radiomic feature extraction and analysis prove the suitability of PHE-SICH-CT-IDS for evaluating image features and highlight the predictive value of these features for the prognosis of SICH patients. CONCLUSION To the best of our knowledge, this is the first publicly available dataset for PHE in SICH, comprising various data formats suitable for applications across diverse medical scenarios. We believe that PHE-SICH-CT-IDS will allure researchers to explore novel algorithms, providing valuable support for clinicians and patients in the clinical setting. PHE-SICH-CT-IDS is freely published for non-commercial purpose at https://figshare.com/articles/dataset/PHE-SICH-CT-IDS/23957937.
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Affiliation(s)
- Deguo Ma
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Chen Li
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China.
| | - Tianming Du
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Lin Qiao
- Shengjing Hospital, China Medical University, Shenyang, China
| | - Dechao Tang
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Zhiyu Ma
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Liyu Shi
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Guotao Lu
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Qingtao Meng
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Zhihao Chen
- Microscopic Image and Medical Image Analysis Group, College of Medicine and Biological Information Engineering, Northeastern University, China
| | - Marcin Grzegorzek
- Institute of Medical Informatics, University of Luebeck, Luebeck, Germany
| | - Hongzan Sun
- Shengjing Hospital, China Medical University, Shenyang, China.
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Tejani A, Dowling T, Sanampudi S, Yazdani R, Canan A, Malja E, Xi Y, Abbara S, Peshock RM, Kay FU. Deep Learning for Detection of Pneumothorax and Pleural Effusion on Chest Radiographs: Validation Against Computed Tomography, Impact on Resident Reading Time, and Interreader Concordance. J Thorac Imaging 2024; 39:185-193. [PMID: 37884394 DOI: 10.1097/rti.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE To study the performance of artificial intelligence (AI) for detecting pleural pathology on chest radiographs (CXRs) using computed tomography as ground truth. PATIENTS AND METHODS Retrospective study of subjects undergoing CXR in various clinical settings. Computed tomography obtained within 24 hours of the CXR was used to volumetrically quantify pleural effusions (PEfs) and pneumothoraxes (Ptxs). CXR was evaluated by AI software (INSIGHT CXR; Lunit) and by 3 second-year radiology residents, followed by AI-assisted reassessment after a 3-month washout period. We used the area under the receiver operating characteristics curve (AUROC) to assess AI versus residents' performance and mixed-model analyses to investigate differences in reading time and interreader concordance. RESULTS There were 96 control subjects, 165 with PEf, and 101 with Ptx. AI-AUROC was noninferior to aggregate resident-AUROC for PEf (0.82 vs 0.86, P < 0.001) and Ptx (0.80 vs 0.84, P = 0.001) detection. AI-assisted resident-AUROC was higher but not significantly different from the baseline. AI-assisted reading time was reduced by 49% (157 vs 80 s per case, P = 0.009), and Fleiss kappa for Ptx detection increased from 0.70 to 0.78 ( P = 0.003). AI decreased detection error for PEf (odds ratio = 0.74, P = 0.024) and Ptx (odds ratio = 0.39, P < 0.001). CONCLUSION Current AI technology for the detection of PEf and Ptx on CXR was noninferior to second-year resident performance and could help decrease reading time and detection error.
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Affiliation(s)
- Ali Tejani
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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Zhu Z, Wang J, Du W, Xu M, Xue T, Lai Y, Chen F. CT analysis of frontal recess air cell and fluid dynamics simulation of frontal sinus in people with different frontal sinus development after Draf1-3 surgery. Eur Arch Otorhinolaryngol 2024; 281:2463-2475. [PMID: 38189971 PMCID: PMC11023981 DOI: 10.1007/s00405-023-08433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To explore the effects of Draf1-3 on frontal sinus airflow and frontal sinus irrigation in people with different frontal sinus development METHODS: The development of the frontal sinus and the distribution of the frontal recess cells were evaluated by CT scan in 150 adults (300 sides). The airflow changes into the frontal sinus and frontal recess after Draf were analyzed by Fluent software under a steady state and quiet inspiratory state. Nasal irrigation after Draf in adults with well-developed frontal sinus was simulated using 120 mL saline at a rate of 12 mL/s in a position at 45° to observe the changes in transient flow distribution. RESULTS The moderately developed type of the frontal sinus was the most common. The airflow patterns in the frontal sinus and frontal recess in the moderate development group were laminar, while several large vortexes were formed between the frontal sinus and frontal recess in the well-development group. The Draf exerted more significant effects on the patterns, pressure, and velocity of the airflow in the frontal sinus and frontal recess in the well development group than in the moderate development group. The volume fraction of saline in the frontal sinus increased significantly from Draf1 to Draf3, and the time required for a complete infiltration of saline in the frontal sinus mucosa was significantly reduced. CONCLUSIONS Draf1-3 has different effects on the airflow field of the frontal sinus with different developmental types; and Draf1-3 can significantly improve the postoperative flushing of the frontal sinus.
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Affiliation(s)
- Zhengru Zhu
- Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Jian Wang
- Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Weijia Du
- Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Min Xu
- Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Tao Xue
- Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Yubing Lai
- Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China
| | - Fuquan Chen
- Department of Otorhinolaryngology Head and Neck Surgery, Xijing Hospital, Air Force Medical University, Fourth Military Medical University, 127 West Changle Road, Xi'an, 710032, Shaanxi, China.
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Trumble BC, Schwartz M, Ozga AT, Schwartz GT, Stojanowski CM, Jenkins CL, Kraft TS, Garcia AR, Cummings DK, Hooper PL, Eid Rodriguez D, Buetow K, Beheim B, Irimia A, Thomas GS, Thompson RC, Gatz M, Stieglitz J, Finch CE, Gurven M, Kaplan H. Poor Oral Health Is Associated With Inflammation, Aortic Valve Calcification, and Brain Volume Among Forager-Farmers. J Gerontol A Biol Sci Med Sci 2024; 79:glae013. [PMID: 38291985 DOI: 10.1093/gerona/glae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 02/01/2024] Open
Abstract
Poor oral health is associated with cardiovascular disease and dementia. Potential pathways include sepsis from oral bacteria, systemic inflammation, and nutritional deficiencies. However, in post-industrialized populations, links between oral health and chronic disease may be confounded because the lower socioeconomic exposome (poor diet, pollution, and low physical activity) often entails insufficient dental care. We assessed tooth loss, caries, and damaged teeth, in relation to cardiovascular and brain aging among the Tsimane, a subsistence population living a relatively traditional forager-horticulturalist lifestyle with poor dental health, but minimal cardiovascular disease and dementia. Dental health was assessed by a physician in 739 participants aged 40-92 years with cardiac and brain health measured by chest computed tomography (CT; n = 728) and brain CT (n = 605). A subset of 356 individuals aged 60+ were also assessed for dementia and mild cognitive impairment (n = 33 impaired). Tooth loss was highly prevalent, with 2.2 teeth lost per decade and a 2-fold greater loss in women. The number of teeth with exposed pulp was associated with higher inflammation, as measured by cytokine levels and white blood cell counts, and lower body mass index. Coronary artery calcium and thoracic aortic calcium were not associated with tooth loss or damaged teeth. However, aortic valve calcification and brain tissue loss were higher in those who had more teeth with exposed pulp. Overall, these results suggest that dental health is associated with indicators of chronic diseases in the absence of typical confounds, even in a population with low cardiovascular and dementia risk factors.
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Affiliation(s)
- Benjamin C Trumble
- School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Arizona State University, Tempe, Arizona, USA
| | - Matthew Schwartz
- School of Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Andrew T Ozga
- Department of Biological Sciences, Halmos College of Arts and Sciences, Fort Lauderdale, Florida, USA
| | - Gary T Schwartz
- School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Arizona State University, Tempe, Arizona, USA
| | - Christopher M Stojanowski
- School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Arizona State University, Tempe, Arizona, USA
| | - Carrie L Jenkins
- School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Arizona State University, Tempe, Arizona, USA
| | - Thomas S Kraft
- Department of Anthropology, University of Utah, Salt Lake City, Utah, USA
| | - Angela R Garcia
- School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Arizona State University, Tempe, Arizona, USA
| | - Daniel K Cummings
- Economic Science Institute, Chapman University, Orange, California, USA
| | - Paul L Hooper
- Economic Science Institute, Chapman University, Orange, California, USA
| | | | - Kenneth Buetow
- School of Human Evolution and Social Change, Center for Evolution and Medicine, Institute of Human Origins, Arizona State University, Tempe, Arizona, USA
| | - Bret Beheim
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
| | - Andrei Irimia
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Gregory S Thomas
- Heart & Vascular Institute, MemorialCare Health System, Fountain Valley, CA and University of California Irvine, Orange, California, USA
| | - Randall C Thompson
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - Margaret Gatz
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Jonathan Stieglitz
- Insititue for Advanced Study, Toulouse School of Economics, Toulouse, France
| | - Caleb E Finch
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Michael Gurven
- Integrative Anthropological Sciences, University of California Santa Barbara, Santa Barbara, California, USA
| | - Hillard Kaplan
- Economic Science Institute, Chapman University, Orange, California, USA
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Chen L, Mercan E, Massenburg BB, Hopper RA, Susarla SM, Lee A, Ellenbogen RG, Birgfeld CB. Comparison of Morphometric Outcomes following Open Posterior Expansion versus Endoscopic Strip Craniectomy for Sagittal Synostosis. Plast Reconstr Surg 2024; 153:1095-1106. [PMID: 37199432 DOI: 10.1097/prs.0000000000010679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Open middle and posterior cranial vault expansion (OPVE) or endoscopic (ES) strip craniectomy are two surgical techniques for normalization of head shape in isolated sagittal synostosis. This study aims to compare 2-year cranial morphometrics after these two approaches. METHODS The authors performed morphometric analysis on preoperative [time (T) 0], immediately postoperative (T1), and 2-year (T2) postoperative computed tomographic scans of patients who underwent OPVE or ES before 4 months of age. Perioperative data and morphometrics were compared between the two groups and age-matched controls. RESULTS Nineteen patients were included in the ES cohort, 19 age-matched patients were included in the OPVE cohort, and 57 were included as controls. Median surgery time and blood transfusion volume were less for the ES approach (118 minutes and 0 cc, respectively) compared with OPVE (204 minutes and 250 cc, respectively). Anthropometric measurements after OPVE were closer in normal controls at T1 compared with ES, but the skull shapes were comparable at T2. In the midsagittal plane, anterior vault was higher after OPVE at T2 compared with both ES and controls, but the posterior length was shorter and closer to controls than in the ES cohort. Cranial volumes were like controls for both cohorts at T2. There was no difference in complication rate. CONCLUSIONS Both OPVE and ES techniques result in normalization of cranial shape in patients with isolated sagittal synostosis after 2 years with minimal morphometric differences. Family decision-making between the two approaches should be based on age at presentation, avoidance of blood transfusion, scar pattern, and availability of helmet molding and not on expected outcome. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Leah Chen
- From the University of Washington School of Medicine
| | - Ezgi Mercan
- Craniofacial Center, Seattle Children's Hospital
| | | | - Richard A Hopper
- Craniofacial Center, Seattle Children's Hospital
- Division of Plastic Surgery, Department of Surgery
| | - Srinivas M Susarla
- Craniofacial Center, Seattle Children's Hospital
- Division of Plastic Surgery, Department of Surgery
| | - Amy Lee
- Craniofacial Center, Seattle Children's Hospital
- Department of Neurological Surgery, University of Washington
| | - Richard G Ellenbogen
- Craniofacial Center, Seattle Children's Hospital
- Department of Neurological Surgery, University of Washington
| | - Craig B Birgfeld
- Craniofacial Center, Seattle Children's Hospital
- Division of Plastic Surgery, Department of Surgery
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