Thursday, January 7, 2021

Use of quantitative angiographic methods with a data-driven model to evaluate reperfusion status (mTICI) during thrombectomy

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Abstract

Purpose

Intra-procedural assessment of reperfusion during mechanical thrombectomy (MT) for emergent large vessel occlusion (LVO) stroke is traditionally based on subjective evaluation of digital subtraction angiography (DSA). However, semi-quantitative diagnostic tools which encode hemodynamic properties in DSAs, such as angiographic parametric imaging (API), exist and may be used for evaluation of reperfusion during MT. The objective of this study was to use data-driven approaches, such as convolutional neural networks (CNNs) with API maps, to automatically assess reperfusion in the neuro-vasculature during MT procedures based on the modified thrombolysis in cerebral infarction (mTICI) scale.

Methods

DSAs from patients undergoing MTs of anterior circulation LVOs were collected, temporally cropped to isolate late arterial and capillary phases, and quantified using API peak height (PH) maps. PH maps were normalized to reduce injection variability. A CNN was developed, trained, and tested to classify PH maps into 2 outcomes (mTICI 0,1,2a/mTICI 2b,2c,3) or 3 outcomes (mTICI 0,1,2a/mTICI 2b/mTICI 2c,3), respectively. Ensembled networks were used to combine information from multiple views (anteroposterior and lateral).

Results

The study included 383 DSAs. For the 2-outcome classification, average accuracy was 81.0% (95% CI, 79.0–82.9%), and the area under the receiver operating characteristic curve (AUROC) was 0.86 (0.84–0.88). For the 3-outcome classification, average accuracy was 64.0% (62.0–66.0), and AUROC values were 0.85 (0.83–0.87), 0.74 (0.71–0.77), and 0.78 (0.76–0.81) for the mTICI 0,1,2a, mTICI 2b, and mTICI 2c,3 classes, respectively.

Conclusion

This study demonstrated the feasibility of using hemodynamic information in API maps with data-driven models to autonomously assess intra-procedural reperfusion during MT.

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Reduced gray-white matter contrast localizes the motor cortex on double inversion recovery (DIR) 3T MRI

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Abstract

Purpose

Reduced gray-white matter contrast along the central sulcus has been described on T1- and T2-weighted magnetic resonance imaging (MRI). The purpose of this study was to assess the gray-white matter contrast of the motor cortex on double inversion recovery (DIR), a sequence with superior gray-white matter differentiation.

Methods

The gray-white matter signal on DIR was retrospectively compared to T1-weighted magnetization-prepared rapid gradient echo (T1-MPRAGE) using normal (n = 25) and abnormal (n = 25) functional MRI (fMRI) exams. Quantitative gray-white matter contrast ratios (CR) of the precentral and adjacent gyri were obtained on normal exams. Two neuroradiologists qualitatively rated reduced gray-white matter contrast of the hemispheres of both normal and abnormal exams. Hand motor functional mapping was used as a reference.

Results

In normal hemispheres (n = 50), the mean CR was significantly lower on DIR (0.44) vs T1-MPRAGE (0.63, p < 0.001). Reduced gray-white matter contrast was categorized as "definitely present" more frequently on DIR than T1-MPRAGE by reviewers in both normal (n = 50; reviewer 1 DIR 88% and MPRAGE 68%, p = 0.02; reviewer 2 DIR 86% and T1-MPRAGE 64%; p=0.01) and abnormal hemispheres (n = 50; reviewer 1 DIR 80% and T1-MPRAGE 38%, p < 0.001; reviewer 2 DIR 74% and T1-MPRAGE 46%, p = 0.005).

Conclusion

Reduced gray-white matter contrast of the motor cortex is more pronounced on DIR compared to T1-MPRAGE on quantitative and qualitative assessments of normal MRI exams. In abnormal cases, reviewers more definitively identified the motor cortex on DIR. In cases with distorted brain anatomy, DIR may be a useful adjunct sequence to localize the motor cortex.

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Concurrent chemoradiation in locally advanced primary middle ear lymphoepithelial carcinoma: an effective treatment modality case report

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Definitive treatment of primary middle ear lymphoepithelial carcinoma (LEC) is not well established owing to the rarity of this disease entity. We report a case of locally advanced primary middle ear LEC treat...
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Open synovectomy treatment for intra- and extraarticular localized pigmented villonodular synovitis of the knee: a case report

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Abstract

Background

Pigmented villonodular synovitis (PVNS) is a rare, benign, proliferative neoplastic process that commonly affects synovial-lined anatomic spaces. The diffuse type (DPVNS) is characterized by invasion of the entire joint synovium, while the localized type (LPVNS) is characterized by a relatively normal synovial appearance. This report describes a unique case of massive intraarticular LPVNS with an extraarticular extension through the lateral patellar retinaculum. No similar cases have been found in the literature.

Case presentation

A 58-year-old woman had a history of hyperuricemia and knee trauma and presented with unilateral knee acute swelling and pain symptoms with sudden onset. Recent expansion of the LPVNS caused the development of a tender palpable soft tissue mass in the anterolateral aspect of the knee and acute reduced mobility. Preoperative magnetic resonance imaging of the knee revealed the presence of only the soft tissue mass and mild degenerative changes. Open synovectomy was performed successfully to excise the mass. Intraoperatively, macroscopic features of the bright brown inflamed synovium suggested LPVNS, which was confirmed histopathologically. Postoperatively, the symptoms of limited mobility and pain were appreciably relieved. Recurrence was not observed during the clinical follow-up at 1, 6 or 18 months after surgery.

Conclusions

Here, we report the unique case of localized pigmented villonodular synovitis of the knee in a misdiagnosed patient with intra- and extraarticular lesion, which might be attributed to the history of knee trauma and the focal defect of the lateral patellar retinaculum. Open synovectomy effectively relieved the symptoms of limited mobility and pain and no recurrence was observed prior to 18 months postoperatively. To reduce misdiagnosis, MRI examinations are recommended for all patients suspected of having PVNS, including those who have a history of hyperuricemia.

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Patient-reported outcomes in young adults with osteonecrosis secondary to developmental dysplasia of the hip - a longitudinal and cross-sectional evaluation

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Abstract

Background

Osteonecrosis of the femoral head is a common complication in the treatment of developmental dysplasia of the hip (DDH). While functional outcomes of affected patients are good in childhood, it is not clear how they change during the transition to young adulthood. This study determined the relationship between osteonecrosis and hip function, physical function and health status in adolescents and young adults.

Methods

We performed a cross-sectional study of 169 patients with a mean age of 19.7 ± 3.8 years with and without osteonecrosis following an open or closed reduction (1995–2005). We also performed a separate longitudinal evaluation of an historical cohort of 54 patients with osteonecrosis, embedded in this sample. All completed patient-reported outcome measures in 2015/2016 to quantify hip function (maximum score 100); physical function (maximum score 100); and general health status (maximum score 1). We graded all radiographs for subtype of osteonecrosis (Bucholz-Ogden); acetabular dysplasia (centre-edge angle); subluxation (Shenton's line); and osteoarthritis (Kellgren-Lawrence). Analyses were adjusted for the number of previous surgical procedures on the hip and for the severity of residual hip dysplasia.

Results

In 149 patients (186 hips) with and without osteonecrosis, the mean differences (95% confidence interval) in hip function, physical function and quality of life were − 4.7 (− 10.26, 0.81), − 1.03 (− 9.29, 7.23) and 0.10 (− 1.15, 1.18), respectively. Adjusted analyses stratified across types of osteonecrosis showed that only patients with Bucholz-Odgen grade III had reduced hip function (p < 0.01) and physical function (p < 0.05) but no difference in health-related quality of life when compared to no osteonecrosis.

Conclusion

Osteonecrosis secondary to DDH is a relatively benign disorder in adolescents and young adulthood. Affected patients demonstrated minimal physical disability, a normal quality of life but reduced hip function.

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The association between keloid and osteoporosis: real-world evidence

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Abstract

Background

Keloids are characterized by disturbance of fibroblast proliferation and apoptosis, deposition of collagen, and upregulation of dermal inflammation cells. This benign dermal fibro-proliferative scarring condition is a recognized skin inflammation disorder. Chronic inflammation is a well-known contributor to bone loss and its sequelae, osteoporosis. They both shared a similar pathogenesis through chronic inflammation. We assessed whether keloids increase osteoporosis risk through using National Health Insurance Research Database.

Methods

The 42,985 enrolled patients included 8597 patients with keloids but no history of osteoporosis; 34,388 controls without keloids were identified from the general population and matched at a one-to-four ratio by age, gender. Kaplan-Meier method was applied to determine cumulative incidence of osteoporosis. Cox proportional hazard regression analysis was performed after adjustment of covariates to estimate the effect of keloids on osteoporosis risk.

Results

Of the 8597 patients with keloids, 178 (2.07%) patients were diagnosed with osteoporosis while in the 34,388 controls, 587 (1.71%) were diagnosed with osteoporosis. That is, the keloids patients had 2.64-fold higher risk of osteoporosis compared to controls after adjustment for age, gender, Charlson Comorbidity Index and related comorbidities. The association between keloids and osteoporosis was strongest in patients younger than 50 years (hazard ratio = 7.06%) and in patients without comorbidities (hazard ratio = 4.98%). In the keloids patients, a high incidence of osteoporosis was also associated with advanced age, high Charlson Comorbidity Index score, hyperlipidemia, chronic liver disease, stroke, and depression.

Conclusions

Osteoporosis risk was higher in patients with keloids compared to controls, especially in young subjects and subjects without comorbidities.

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Outcomes of diverticulitis

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Abstract

Background

Recent data shows a significantly increased risk of diverticulosis among smokers. There is limited data on the association between tobacco smoking and diverticulitis. We aim to determine in-hospital outcomes, length of hospital stay, and resource utilization in a contemporary cohort of diverticulitis patients based on tobacco smoking status.

Methods

A retrospective analysis was performed by utilizing the National Inpatient Sample database (2016 and 2017) and the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of diverticulitis and smoking. We assessed all-cause in-hospital mortality, morbidity, length of hospital stay (LOS), and total costs between propensity-matched groups of tobacco smokers vs. nonsmokers with diverticulitis.

Results

We identified 442,273 diverticulitis patients, of whom 96,864 were tobacco smokers, and 345,409 were nonsmokers. Between the two groups, in-hospital mortality was not significant (OR 1.09, 95% CI 0.38–2.6; P = 0.98). Tobacco smokers with diverticulitis have higher odds of lower gastrointestinal bleeding (LGIB) (OR 1.6, 95% CI 1.4–3.8; P = 0.01), peritonitis (OR 1.5, 95% CI 1.9–3.3; P = 0.00), intestinal obstruction (OR 1.6, 95% CI 2.8–7.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05–4.4; P = 0.03), and shock requiring vasopressor (OR 1.5, 95% CI 1.2–2.2; P = 0.00). In tobacco smokers with complicated diverticulitis, there were higher odds of LGIB (OR 1.4, 95% CI 1.2–1.6; P = 0.00), sepsis (OR 2.1, 95% CI 1.05–4.4; P = 0.03), and colectomy (OR 1.2, 95% CI 1.1–1.2; P = 0.00). In-hospital mortality was not significant in smokers with co mplicated diverticulitis (OR 1.2, 95% CI 0.78–1.9; P = 0.3).

Conclusions

In this propensity-matched analysis, there was no difference in in-hospital mortality between tobacco smokers vs. nonsmokers with diverticulitis. Smoking has been associated with an increased incidence of complications in diverticulitis with a higher length of hospital stay and resource utilization.

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Poorer prognosis for neuroendocrine carcinoma than signet ring cell cancer of the colon and rectum (CRC-NEC): a propensity score matching analysis of patients from the Surveillance, Epidemiology, and End Results (SEER) database

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Abstract

Purpose

Colorectal neuroendocrine carcinomas (CRC-NECs) are rare, comprising < 1% of colorectal cancers. This study aimed to assess the incidence, clinicopathologic characteristics, prognostic factors, and treatment outcomes of CRC-NEC.

Methods

We analysed the Surveillance, Epidemiology, and End Results (SEER) database to identify patients from 20 to 74 years old diagnosed with CRC-NEC or common CRC (non-NEC) during 2004–2013. Log-rank testing was conducted to assess survival differences. A competing-risks regression model was used to adjust for covariate effects in the propensity score-matched (PSM) cohort, and adjusted hazard ratios (HRs) were calculated for the raw and PSM cohorts.

Results

We identified 67,484 patients (344 CRC-NEC and 67,140 non-NEC). Lymph node metastasis (LNM) was more common in CRC-NEC (75.29%, n = 259) than in non-NEC (51.53%, n = 34,600) (P < 0.001); 56.40% (n = 194) of CRC-NECs were located on the right side, while 18.31% (n = 63) were located on the left side, with a statistically significant difference in distribution (P < 0.001) compared to that in non-NEC CRC. Multivariate analysis indicated that a left-side location was an independent adverse prognostic factor for CRC-NEC (P = 0.043). CRC-NEC had the poorest cancer-specific survival (median CSS, 9.0 months) among assessed cancers, even poorer than that of signet ring cell cancer (median CSS, 24.0 months). However, both radical operation (P = 0.007) and chemotherapy (P = 0.008) were beneficial for CSS.

Conclusion

NEC is a rare and extremely aggressive tumour with a poor prognosis. Right-side NEC has a better prognosis than left-side NEC. Early diagnosis, radical surgery, and chemotherapy are imperative for improving survival.

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Numerical joint invariant level set formulation with unique image segmentation result

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Abstract

The level set method is one of the most widely used and powerful techniques in image science such as image/motion segmentation, object tracking, etc. This paper brings up an unstudied issue with discretized level set algorithms about 'the non-uniqueness' of segmentation results which is different from the problem of 'the existence' of a result. Our solution is to numerically approximate the level set formulation based on suitable combination of some visual joint invariants, leading to the unique segmentation results, therefore unique visual joint invariant numerical signatures—independent of contour initialization and what visual group is applied. To figure out 'the cause' of resulting unique segmentations in this scheme, we utilize the level set algorithm to introduce three energy features—called fingerprints, flows, and stem charts. Our experimental results indicate that curvature-based energies can be classified in terms of these characterist ics—depending merely on the nature of each energy. Besides, the energies generated by the current discretization are 'positive,' while the visual joint invariant curvature-based energies sketch charts with 'negative' values.

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Deblur and deep depth from single defocus image

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Abstract

In this paper, we tackle depth estimation and blur removal from a single out-of-focus image. Previously, depth is estimated, and blurred is removed using multiple images; for example, from multiview or stereo scenes, but doing so with a single image is challenging. Earlier works of monocular images for depth estimated and deblurring either exploited geometric characteristics or priors using hand-crafted features. Lately, there is enough evidence that deep convolutional neural networks (CNN) significantly improved numerous vision applications; hence, in this article, we present a depth estimation method that leverages rich representations learned from cascaded convolutional and fully connected neural networks operating on a patch-pooled set of feature maps. Furthermore, from this depth, we computationally reconstruct an all-focus image, i.e., removing the blur and achieve synthetic re-focusing, all from a single image. Our method is fast, and it substan tially improves depth accuracy over the state-of-the-art alternatives. Our proposed depth estimation approach can be utilized for everyday scenes without any geometric priors or extra information. Furthermore, our experiments on two benchmark datasets consist images of indoor and outdoor scenes, i.e., Make3D and NYU-v2 demonstrate superior performance in comparison with other available depth estimation state-of-the-art methods by reducing the root-mean-squared error by 57% and 46%, and state-of-the-art blur removal methods by 0.36 dB and 0.72 dB in PSNR, respectively. This improvement in-depth estimation and deblurring is further demonstrated by the superior performance using real defocus images against images captured with a prototype lens.

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MiR-501-3p promotes osteosarcoma cell proliferation, migration and invasion by targeting BCL7A

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Abstract

Increasing numbers of evidences have demonstrated that microRNAs (miRNAs) play an important role in osteosarcoma (OS) cell functions. MiR-501-3p has been reported to play an important role in several types of tumors, including prostate cancer and hepatocellular carcinoma. However, the biological function and potential mechanism of miR-501-3p in OS have not been well investigated until now. Here, we analyzed the expression of miR-501-3p in OS tissues and cell lines and its clinical significance in OS patients. Quantitative reverse transcription PCR showed miR-501-3p was significantly up-regulated in OS tissues and cell lines. Up-regulated miR-501-3p expression was associated with TNM stage, distal metastasis and worse prognosis in OS patients. MiR-501-3p knockdown and overexpression were achieved by miR-501-3p inhibitor and mimics transfection, respectively. CCK-8, colony formation and transwell assays showed that miR-501-3p knockdown in U2OS and Saos-2 cells supp ressed, while miR-501-3p overexpression in Saos-2 cells promoted cell proliferation, migration and invasion. Moreover, luciferase reporter assay supporting BCL7A was a target of miR-501-3p and its expression was increased by miR-501-3p inhibitor, but inhibited by miR-501-3p mimics. By performing rescue experiments, we further demonstrated that BCL7A was a downstream functional regulator involved in miR-501-3p promoting OS cell functions. In summary, our findings suggest that miR-501-3p targets BCL7A may provide novel therapeutic targets for the treatment of OS.

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