Nevin Manimala

Eur J Radiol. 2021 Nov 24;146:110069. doi: 10.1016/j.ejrad.2021.110069. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the general rules and future trajectories of deep learning (DL) networks in medical image analysis through bibliometric and hot spot analysis of original articles published between 2012 and 2020.

METHODS: Original articles related to DL and medical imaging were retrieved from the PubMed database. For the analysis, data regarding radiological subspecialties; imaging techniques; DL networks; sample size; study purposes, setting, origins and design; statistical analysis; funding sources; authors; and first authors’ affiliation was manually extracted from each article. The Bibliographic Item Co-Occurrence Matrix Builder and VOSviewer were used to identify the research topics of the included articles and illustrate the future trajectories of studies.

RESULTS: The study included 2685 original articles. The number of publications on DL and medical imaging has increased substantially since 2017, accounting for 97.2% of all included articles. We evaluated the rules of the application of 47 DL networks to eight radiological tasks on 11 human organ sites. Neuroradiology, thorax, and abdomen were frequent research subjects, while thyroid was under-represented. Segmentation and classification tasks were the primary purposes. U-Net, ResNet, and VGG were the most frequently used Convolutional neural network-derived networks. GAN-derived networks were widely developed and applied in 2020, and transfer learning was highlighted in the COVID-19 studies. Brain, prostate, and diabetic retinopathy-related studies were mature research topics in the field. Breast- and lung-related studies were in a stage of rapid development.

CONCLUSIONS: This study evaluates the general rules and future trajectories of DL network application in medical image analyses and provides guidance for future studies.

PMID:34847395 | DOI:10.1016/j.ejrad.2021.110069

Ann Diagn Pathol. 2021 Nov 25;56:151871. doi: 10.1016/j.anndiagpath.2021.151871. Online ahead of print.

ABSTRACT

Clear cell renal cell carcinoma (CCRCC) is well known for intratumor heterogeneity. An accurate mapping of the tumor is crucial for assessing prognosis, and perhaps this can be linked to potential success/failure of targeted therapies. We assembled a cohort of 7 CCRCCs with prominent vasculature and microvascular hyperplasia (ccRCCPV), resembling those seen in high grade gliomas. A control group of classic CCRCC with no variant morphologies was also included. Both groups were analyzed for clinicopathologic, morphologic, immunohistochemical, and molecular genetic features. No statistically significant differences in mRNA expression of studied genes between the two groups were found. Using NGS panel Trusight Oncology 500 (TSO500), only one clinically significant gene mutation, VHL c.263G > A, p. (Trp88Ter), was found. TMB (Tumor Mutation Burden) and MSI (MicroSatellite Instability) were low, and no copy number variations (CNVs) were detected in the study cohort. Prominent microvascular hyperplasia in CCRCC is a rare phenomenon. From molecular genetic point of view, these tumors do not appear to be different from classic CCRCC. Prognostically, they also demonstrated similar clinical behaviors.

PMID:34847388 | DOI:10.1016/j.anndiagpath.2021.151871

Neuro Endocrinol Lett. 2021 Nov 30;42(7). Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of acupuncture and moxibustion for bell’s palsy in the acute phase compared with the non-acute phase.

METHODS: Computer retrieval of PubMed, Embase, The Cochrane Library, Web of Science, China National Knowledge Internet (CNKI), Wanfang data, were conducted. According to the inclusion and exclusion criteria, the quality of literature was evaluated, and useful data was extracted. All statistical analyses were performed by RevMan5.3 software.

RESULTS: 17 eligible RCTs with a total of 2644 patients were included in this meta-analysis. The meta-analysis results demonstrated the cure rate of acupuncture and moxibustion for Bell’s palsy in the acute phase were lower than that in the non-acute phase (P<0.05). The time to cure of acupuncture and moxibustion for Bell’s palsy in the acute phase was shorter than that in the non-acute phase (P<0.05), and the incidence of sequelae during the treatment period of acupuncture and moxibustion for Bell’s palsy in the acute phase were lower than that in non-acute phase (P<0.05).

CONCLUSIONS: Acupuncture and moxibustion were safe and effective stimulation for Bell’s palsy in the acute phase compared with the non-acute phase, improving the cure rate of Bell’s palsy, shorten the time to cure, and reduce the occurrence of sequelae. However, more multicenter RCTs with a large sample number and high quality should verify the conclusion mentioned above.

PMID:34847316

Undersea Hyperb Med. 2021 Fourth-Quarter;48(4):425-430.

ABSTRACT

Central retinal artery occlusion (CRAO) is a condition that causes sudden vision loss due to obstruction of the retinal artery, typically from a thrombotic or embolic source. It is often associated with atherosclerotic risk factors, including cardiovascular disease, diabetes, hyperlipidemia, and a history of cerebrovascular disease. CRAO often leads to a poor visual outcome as well as neovascularization of the iris, retina, and optic disc, which can exacerbate vision loss and cause pain. While there are several treatment modalities for CRAO, few have been proven to be effective in decreasing the effects of neovascularization. The use of hyperbaric oxygen (HBO2) therapy is often used in the treatment of CRAO due to its ease of use and relatively benign side effect profile. This study aims to assess the degree of improvement in visual acuity (VA) and neovascularization following HBO2. Our data ultimately shows that 20% of patients developed neovascularization after HBO2 compared to 29.8% of those who did not undergo HBO2 (p<.05). Our findings suggest that HBO2 has a statistically significant protective effect against neovascularization and may improve long-term visual acuity.

PMID:34847306

Catheter Cardiovasc Interv. 2021 Nov 30. doi: 10.1002/ccd.30024. Online ahead of print.

ABSTRACT

OBJECTIVES: We aimed to compare clinical characteristics and procedural outcomes of left main percutaneous interventions (LM-PCI) by transradial (TRA) versus transfemoral (TFA) approach in the VA healthcare system.

BACKGROUND: TRA for percutaneous coronary intervention (PCI) is steadily increasing. However, the frequency and efficacy of TRA for LM-PCI remain less studied.

METHODS: All LM-PCIs performed in the VA healthcare system were identified for fiscal year 2008 through 2018. Patients’ baseline characteristics and procedure-related variables were compared by access site. Both short- and long-term clinical outcomes were analyzed using propensity score matching.

RESULTS: A total of 4004 LM-PCI were performed in the VA via either radial or femoral access from 2008 to 2018. Among these, 596 (14.9%) LM PCIs were performed via TRA. Use of TRA for LM-PCI increased from 2.2% to 31.5% over the study period. Propensity matched outcome analysis, comparing TRA versus TFA, showed a similar procedural success (98.4% for TRA vs. 97.8% for TFA; RR: 1.01 [0.98, 1.03]) and 1-year major adverse cardiovascular events (MACE) (25.9% for TRA vs. 26.8% TFA; RR: 0.96 [0.74, 1.25]). There were no statistically significant differences among secondary outcomes analyses including major bleeding.

CONCLUSION: Use of TRA for LM-PCI has been steadily increasing in the VA healthcare system. These findings demonstrate similar procedural success and 1-year MACE across access strategies, suggesting an opportunity to continue increasing TRA use for LM-PCI.

PMID:34847279 | DOI:10.1002/ccd.30024

Spine (Phila Pa 1976). 2021 Nov 29. doi: 10.1097/BRS.0000000000004296. Online ahead of print.

ABSTRACT

STUDY DESIGN: Prospective cohort study.

OBJECTIVE: Among patients with cervical spondylotic myelopathy (CSM), we aimed to evaluate the extent to which: (1) pre-operative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms; (2) surgery leads to changes in cervical sagittal alignment; and (3) post-operative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms at 12 months of follow-up.

SUMMARY OF BACKGROUND DATA: The importance of maintaining or improving cervical sagittal alignment in the surgical management of patients with CSM has not been established.

METHODS: We measured C2-C7 cobb angle, T1 slope, and C2-C7 cervical sagittal vertical axis (cSVA). We tested for associations with Neck Disability Index, Pain Scales for neck and arm pain, EuroQol 5D, Short Form 12 (SF-12) Physical and Mental Component Summaries (PCS and MCS), and modified Japanese Orthopaedic Association scores. We adjusted for potential confounders using multiple linear regression, and we performed various pre-specified subgroup (cSVA >40 mm, surgical approach) and sensitivity analyses.

RESULTS: Among 250 patients, adjusted analyses yielded significant inverse associations prior to surgery between each of cSVA and T1 slope with SF12 PCS (T1 slope: -0.14, 95% CI -0.26 to -0.01, p = 0.03; C2-C7 cSVA: -0.13, 95% CI -0.21 to -0.05 p < 0.01). Surgery was associated with a small but statistically significant increase in cSVA across the cohort (+5.8 mm (SD 11.7), p < 0.01) but no change in cobb angle or T1 slope. At 12-months after surgery, there were no significant associations between alignment parameters or change in alignment and any measures of health-related quality of life, function, or symptoms. Results were consistent across subgroup and sensitivity analyses.

CONCLUSIONS: Increased cSVA and T1 slope were associated with inferior health-related quality of life at presentation among patients with CSM, but no significant associations were observed following surgical treatment.Level of Evidence: 3.

PMID:34845179 | DOI:10.1097/BRS.0000000000004296

Curr Opin Allergy Clin Immunol. 2021 Nov 29. doi: 10.1097/ACI.0000000000000801. Online ahead of print.

ABSTRACT

PURPOSE OF REVIEW: The development and progression of chronic respiratory diseases are impacted by a complex interplay between genetic, microbial, and environmental factors. Here we specifically summarize the effects of environmental exposure on asthma, allergic rhinitis, and chronic rhinosinusitis. We furthermore discuss how digital health technology may aid in the assessment of the environmental exposure of patients and how it may be of added value for them.

RECENT FINDINGS: It is well established that one gets allergic symptoms if sensitized and exposed to the same allergen. Viruses, bacteria, pollutants, irritants, and lifestyle-related factors modify the risk of getting sensitized and develop symptoms or may induce symptoms themselves. Understanding these processes and how the various factors interact with each other and the human body require big data and advanced statistics. Mobile health technology enables integration of multiple sources of data of the patients’ exposome and link these to patient outcomes. Such technologies may contribute to the increased understanding of the development of chronic respiratory disease.

SUMMARY: Implementation of digital technologies in clinical practice may in future guide the development of preventive strategies to tackle chronic respiratory diseases and eventually improve outcomes of the patient.

PMID:34845137 | DOI:10.1097/ACI.0000000000000801

Ann Hepatobiliary Pancreat Surg. 2021 Nov 30;25(4):472-476. doi: 10.14701/ahbps.2021.25.4.472.

ABSTRACT

BACKGROUNDS/AIMS: Hepaticojejunostomy (HJ) for bilioenteric continuity is generally performed with interrupted sutures. This study compares the safety, economics, short- and long-term outcomes of continuous suture hepaticojejunostomy (CSHJ) and interrupted suture hepaticojejunostomy (ISHJ).

METHODS: A retrospective cohort analysis involving all HJs between January 2014 and December 2018 was conducted. Patients with type IV or V biliary strictures, duct diameter < 8 mm and/or associated vascular injury, and liver transplant recipients were excluded. Patient demographics, preoperative parameters including diagnosis, intra-operative parameters including type and number of sutures, suture time, and postoperative morbidity (based on Clavien-Dindo classification) were recorded. Patients were followed up to 60 months. McDonald’s Grade A and B outcomes were considered favorable. Cost according to suture type and number (polydioxanone 3-0/5-0 mean cost, US$ 9.26/length; polyglactin 3-0/4-0 mean cost, US$ 6.56/length), and operation room charge (US$ 67.47/hour) were compared between the two techniques. Statistical analysis was performed using IBM SPSS ver. 22 software.

RESULTS: A total of 556 eligible patients (468 patients undergoing ISHJ and 88 undergoing CSHJ; 47% [n = 261] with malignant and 53% [n = 295] with benign pathology) were analyzed. The two groups were similar. Number of sutures, cost, time, and postoperative bile leak were significantly higher in the ISHJ group. Bile leak occurred in 54 patients (6 CSHJ, 48 ISHJ). Septic shock-induced death occurred in 16 cases (3 CSHJ, 13 ISHJ). Morbidity and the anastomotic stricture rates were comparable in both groups.

CONCLUSIONS: CSHJ is a safe, economical, and worthy of routine use.

PMID:34845118 | DOI:10.14701/ahbps.2021.25.4.472

BMJ Open. 2021 Nov 29;11(11):e056191. doi: 10.1136/bmjopen-2021-056191.

ABSTRACT

INTRODUCTION: Partial pancreatoduodenectomy (PD) is the treatment of choice for various benign and malignant tumours of the pancreatic head or the periampullary region. For reconstruction of the gastrointestinal passage, two stomach-preserving PD variants exist: pylorus preservation PD (ppPD) or pylorus resection PD (prPD) with preservation of the stomach. In pancreatic surgery, delayed gastric emptying (DGE) remains a serious complication after PD with an incidence varying between 4.5% and 45%, potentially delaying hospital discharge or further treatment, for example, adjuvant chemotherapy. Evidence is lacking to assess, which variant of PD entails fewer postoperative DGE.

METHODS AND ANALYSIS: The protocol of a large-scale, multicentre, pragmatic, two-arm parallel-group, registry-based randomised controlled trial (rRCT) using a two-stage group-sequential design is presented. This patient-blind rRCT aims to demonstrate the superiority of prPD over ppPD with respect to the overall incidence of DGE within 30 days after index surgery in a German real-world setting. A total of 984 adults undergoing elective PD for any indication will be randomised in a 1:1 ratio. Patients will be recruited at about 30 hospitals being members of the StuDoQ|Pancreas registry established by the German Society of General and Visceral Surgery. The postoperative follow-up for each patient will be 30 days. The primary analysis will follow an intention-to-treat approach and applies a binary logistic random intercepts model. Secondary perioperative outcomes include overall severe morbidity (Clavien-Dindo classification), blood loss, 30-day all-cause mortality, postoperative hospital stay and operation time. Complication rates and adverse events will be closely monitored.

ETHICS AND DISSEMINATION: This protocol was approved by the leading ethics committee of the Medical Faculty of the Ludwig-Maximilians-Universität, Munich (reference number 19-221). The results will be published in a peer-reviewed journal and presented at international conferences. Study findings will also be disseminated via the website (http://www.dgav.de/studoq/pylorespres/).

TRIAL REGISTRATION NUMBER: DRKS-ID: DRKS00018842.

PMID:34845079 | DOI:10.1136/bmjopen-2021-056191

BMJ Open. 2021 Nov 29;11(11):e055227. doi: 10.1136/bmjopen-2021-055227.

ABSTRACT

OBJECTIVES: To analyse the prevalence of sexual violence (SV) and associated factors in Spanish young adults in the last year and before, during and after the COVID-19 lockdown.

DESIGN: Cross-sectional study based on the online ‘SV in Young People Survey’ (2020).

SETTING: Non-institutionalised population residing in Spain.

PARTICIPANTS: 2515 men and women aged 18-35 years old. The participants were obtained from a probability based, online closed panel of adults aged 16 or older that is representative of the non-institutionalised population. The sample designed includes quotas by sex, age, region and country of origin.

OUTCOMES MEASURES AND ANALYSES: SV victimisation by sociodemographics, sexual attraction and couple-related characteristics during the past year and before, during and after the COVID-19 lockdown (March-June 2020). Prevalence ratios were calculated using robust Poisson regression models.

RESULTS: In Spain, 8.5% of young people experienced SV during the past year. The greatest prevalence was observed in women with bisexual attraction (17.5%) and in men with homosexual attraction (14.2%). During the COVID-19 lockdown, the prevalence of SV victimisation was lower (1.9%), but unwanted intercourses increased, affecting 64.4% of those exposed to SV during the period. People with homosexual or bisexual attraction were more likely to experience SV in all of the studied periods (PRbefore: 2.01; p<0.001; PRduring: 2.63 p=0.002; PRafter: 2.67; p<0.001). Women were more likely than men to experience SV prior to the lockdown, while no cohabitation increased the likelihood to experience SV after this period CONCLUSIONS: SV victimisation in Spanish youth is high. During COVID-19, there were changes in the magnitude of factors associated with SV. It seems that SV events decreased in people who did not live with their partners, but unwanted intercourses increased. The development of prevention strategies to address SV in youth should take into account social inequalities by sex, sexual orientation and origin.

PMID:34845078 | DOI:10.1136/bmjopen-2021-055227