Tag: nevin manimala

Radiol Med. 2025 Jan 26. doi: 10.1007/s11547-025-01957-5. Online ahead of print.

ABSTRACT

PURPOSE: To develop an artificial intelligence (AI) algorithm for automated measurements of spinopelvic parameters on lateral radiographs and compare its performance to multiple experienced radiologists and surgeons.

METHODS: On lateral full-spine radiographs of 295 consecutive patients, a two-staged region-based convolutional neural network (R-CNN) was trained to detect anatomical landmarks and calculate thoracic kyphosis (TK), lumbar lordosis (LL), sacral slope (SS), and sagittal vertical axis (SVA). Performance was evaluated on 65 radiographs not used for training, which were measured independently by 6 readers (3 radiologists, 3 surgeons), and the median per measurement was set as the reference standard. Intraclass correlation coefficient (ICC), mean absolute error (MAE), and standard deviation (SD) were used for statistical analysis; while, ANOVA was used to search for significant differences between the AI and human readers.

RESULTS: Automatic measurements (AI) showed excellent correlation with the reference standard, with all ICCs within the range of the readers (TK: 0.92 [AI] vs. 0.85-0.96 [readers]; LL: 0.95 vs. 0.87-0.98; SS: 0.93 vs. 0.89-0.98; SVA: 1.00 vs. 0.99-1.00; all p < 0.001). Analysis of the MAE (± SD) revealed comparable results to the six readers (TK: 3.71° (± 4.24) [AI] v.s 1.86-5.88° (± 3.48-6.17) [readers]; LL: 4.53° ± 4.68 vs. 2.21-5.34° (± 2.60-7.38); SS: 4.56° (± 6.10) vs. 2.20-4.76° (± 3.15-7.37); SVA: 2.44 mm (± 3.93) vs. 1.22-2.79 mm (± 2.42-7.11)); while, ANOVA confirmed no significant difference between the errors of the AI and any human reader (all p > 0.05). Human reading time was on average 139 s per case (range: 86-231 s).

CONCLUSION: Our AI algorithm provides spinopelvic measurements accurate within the variability of experienced readers, but with the potential to save time and increase reproducibility.

PMID:39864034 | DOI:10.1007/s11547-025-01957-5

Pediatr Surg Int. 2025 Jan 26;41(1):74. doi: 10.1007/s00383-025-05972-5.

ABSTRACT

PURPOSE: Initial recommendations for ECMO had relative contraindications for low birth weight (BW) or low gestational age (GA) babies. However, more recent literature has demonstrated improved and acceptable outcomes of ECMO in smaller neonates. The purpose of this study was to understand both utilization and survival in patients with lower GA and BW.

METHODS: All neonates captured in the Extracorporeal Life Support Organization (ELSO) registry who underwent a single ECMO run from 2009 to 2019 were included. The primary outcome measure was mortality and the secondary outcome measure was major adverse outcomes, defined as a composite outcome variable any severe ECMO complications. Univariate and multivariable statistical tests were performed to estimate the association between GA and BW with both outcome variables.

RESULTS: A total of 14,167 cases met inclusion criteria. Univariate analysis noted that birth weight, gestational age, ECMO mode, pulmonary support type, pH and ventilator settings were highly significant predictors of survival. Multivariable assessment noted significant linear relationship of mortality rates with increasing GA and BW (p < 0.001, OR = 0.82 GA, 0.51 BW). The highest ECMO-related mortality was observed in neonates with GA 30-31 weeks and BW 1.5-2.0 kg, with a 70-75% in-hospital mortality rate.

CONCLUSIONS: Decreasing GA and BW were strongly correlated with increasing odds of mortality and/or ECMO-related complications. However, even in low GA or BW neonates, survival may be possible in up to a quarter of patients put on ECMO.

PMID:39864029 | DOI:10.1007/s00383-025-05972-5

Orv Hetil. 2025 Jan 26;166(4):146-153. doi: 10.1556/650.2025.33211. Print 2025 Jan 26.

ABSTRACT

Bevezetés: A szuicid viselkedés megelőzése szempontjából kiemelt jelentőséggel bír az akut szuicid veszély felismerése. Ugyanakkor kevés olyan adattal rendelkezünk, amelynek segítségével megbízhatóan felismerhető lenne a preszuicidális lelkiállapot. Célkitűzés: A Galynker és munkacsoportja által kidolgozott szuicid krízis szindróma alapján kifejlesztett szűrőteszt és kérdőív magyar adaptálása. Módszer: Az általános pszichiátriai vizsgálat mellett a szuicid krízis szindróma szűrésére alkalmas rövid Akut Szuicid Rizikó Teszt és a Rihmer-féle rizikóbecslő Rövid Szuicid Kérdőív felvételére került sor konszekutív módon minden olyan pácienssel, aki a vizsgálati időszakban klinikánk ambuláns vagy osztályos ellátásában részesült. A rövid szűrőtesztek pozitivitása esetén a szuicid krízis szindróma tüneteit felmérő részletes skála is kitöltésre került. Eredmények: 99 páciens 150 kérdőívének kitöltésére került sor, egyharmaduk (n = 35) ambuláns, kétharmaduk (n = 64) osztályos ellátásban részesült. A klinikai diagnózisok között a leggyakoribbak a depressziós (44,7%), az alkalmazkodási (34%), a pszichotikus (33,3%) és a szerhasználati (33,3%) zavarok voltak, és nagy volt a komorbiditás aránya. Az ambuláns ellátásban részesülők felében (n = 19; 54,3%), míg az osztályos felvételre kerülők háromnegyedében (n = 49; 76,6%) igazoltak a szűrőtesztek szuicid rizikót. Az osztályos kezelést követően ez az arány egyharmadra csökkent (n = 17; 33,3%). A szuicid krízis szindróma teljes diagnosztikai kritériumai azoknál teljesültek a leggyakrabban, akiknél az Akut Szuicid Rizikó Teszt pozitív volt, akár önmagában (74,2%), akár a Rövid Szuicid Kérdőívvel együtt (87,1%). E két kérdőív együttes pozitivitása esetén fordult elő a leggyakrabban súlyos szuicid krízis szindróma (29%). Megbeszélés: A szuicid krízis szindrómán alapuló rövid szűrőteszt jelentős arányban azonosítja az aktuális szuicid rizikót. A szuicid krízis szindróma koncepció és a módszer előnye, hogy akkor is lehetővé teszi az öngyilkossági veszély felismerését, amikor direkt szuicid szándékok nem kerülnek felszínre. Az akut szűrőteszt értékét tovább növeli az elsősorban az élettartamra vonatkozó szuicid rizikót felmérő Rihmer-féle Rövid Szuicid Kérdőív. Következtetés: Ezeknek a teszteknek az együttes alkalmazása támogatja az akut pszichiátriai osztályos felvételt megalapozó klinikai döntéshozatalt, és megelőzi a páciensek kezelésének korai lezárását, így szűrőmódszerünk fontos szuicidprevenciós jelentőséggel bír. Orv Hetil. 2025; 166(4): 146–153.

PMID:39864028 | DOI:10.1556/650.2025.33211

Orv Hetil. 2025 Jan 26;166(4):139-145. doi: 10.1556/650.2025.33221. Print 2025 Jan 26.

ABSTRACT

Bevezetés: A minimálinvazív műtéteknek és a hatékony perioperatív protokolloknak köszönhetően a colorectalis műtétek utáni morbiditás és kórházi tartózkodás csökkenthető, elektív colorectalis műtétek után a betegek egy része 72 órán belül elbocsátható. A korai emisszió nem rutingyakorlat, kritériumai nem egyértelműek. Módszer: Retrospektív kohorszvizsgálatot végeztünk 2022. 03. 01. és 2024. 05. 01. között anastomosissal járó elektív colorectalis műtéten átesett páciensek körében. Elemeztük a korai elbocsátás (<72 óra) összefüggését a 30 napos morbiditással és nem tervezett kórházi újrafelvétellel. A sikeres korai emissziót befolyásoló tényezők azonosítására demográfiai, anamnesztikus, intraoperatív és posztoperatív adatokat elemeztünk. Eredmények: Összesen 109 betegen végeztünk elektív colorectalis műtétet. A beavatkozások közül 85 laparoszkópos, 8 robotasszisztált és 4 nyitott műtét volt, 12 stomazárás történt. A 30 napos morbiditás 8,25% (n = 9), ebből súlyos (Clavien–Dindo 3b) morbiditás 4,6% (n = 5) volt. A 72 órán belül komplikációval járó eseteket (n = 9) kizártuk. Eseménytelen posztoperatív szak mellett korai elbocsátás 30, ennél hosszabb tartózkodás 70 betegnél történt (ápolási idő: 67,5 ± 4,13 vs. 99,8 ± 2,06 óra; p = 0,0001). A csoportok homogének voltak az életkor (57,17 ± 5,27 vs. 61,94 ± 2,75 év; p = 0,09), a nem (p = 0,83), a testtömegindex (p = 0,13) és a kísérő betegség (p = 0,85) tekintetében. A bélműködés helyreállása sem különbözött a csoportok között (31,0 ± 3,84 vs. 34,5 ± 3,49 óra; p = 0,26). A korai és a normál csoportban azonos arányban voltak jobb és bal oldali resectiók (p = 0,28), több stomazárás történt a korai csoportban (11 vs. 1; p<0,00001). Egyik csoportban sem volt 30 napon belül újrafelvétel, morbiditás vagy mortalitás. Következtetés: Nem szövődményes elektív colorectalis resectio és stomazárás után a korai (72 órán belüli) elbocsátás biztonságos. Orv Hetil 2025; 166(4): 139–145.

PMID:39864024 | DOI:10.1556/650.2025.33221

EJNMMI Phys. 2025 Jan 26;12(1):8. doi: 10.1186/s40658-025-00718-7.

ABSTRACT

BACKGROUND: System calibration is essential for accurate SPECT/CT dosimetry. However, count losses due to dead time and pulse pileup may cause calibration errors, in particular for ¹³¹I, where high count rates may be encountered. Calibration at low count rates should also be avoided to minimise detrimental effects from e.g. background counts and statistical fluctuations. This paper aims to present experimental data illustrating count-rate dependencies and to propose practical routines to mitigate errors in the ¹³¹I calibration procedure without needing advanced analysis tools.

RESULTS: The sensitivities of two General Electric (GE) Discovery 670 Pro systems were assessed using two Jaszczak phantom geometries. SPECT/CT data were collected over two months, starting with an initial ¹³¹I content of > 2 GBq, decaying to approximately 20 MBq. This allowed for a detailed analysis of count losses due to dead time and pulse pileup. From the sensitivity analysis, it was shown that robust calibration was obtained for ¹³¹I phantom activities ranging between 250 and 1500 MBq.

CONCLUSIONS: The results show that adequate corrections for dead-time and pulse-pileup counting losses are essential for accurate calibration. It is argued that loss corrections should be based on total spectrum count rates in projections and not only on the 364.5 keV energy window data. The measurement campaigns presented in this paper, using basic tools and equipment, may serve as a model for establishing routines for count-loss corrections as well as for system calibration and regular control of system sensitivity. The data suggest that analysis of source and count concentration in a homogeneous Jaszczak phantom offers robust calibration, whereas analysis of source strength and counts in a delineated phantom insert offers a practical and robust method for regular quality control.

PMID:39864022 | DOI:10.1186/s40658-025-00718-7

Int J Radiat Oncol Biol Phys. 2025 Jan 24:S0360-3016(24)03705-2. doi: 10.1016/j.ijrobp.2024.11.098. Online ahead of print.

ABSTRACT

PURPOSE: Standard therapy for breast cancer after breast-conserving surgery is radiation therapy (RT) plus hormone therapy (HT). For patients with a low-risk of recurrence, there is an interest in deescalating therapy.

METHODS AND MATERIALS: A retrospective study was carried out for patients treated at the Swedish Cancer Institute from 2000 to 2015, aged 70 years or older, with pT1N0 or pT1NX estrogen receptor-positive and ERBB2-negative unifocal breast cancer without positive surgical margins, high nuclear grade, or lymphovascular invasion.

RESULTS: Patient numbers were sufficient to carry out analyses for RT + HT (n = 307) and RT alone (n = 148). The median follow-up was 9.6 years. There were no statistically significant differences in adjusted overall survival (OS), disease-specific death, progression-free survival (PFS), distant recurrence, and second primary cancers with RT monotherapy compared with RT + HT. Cumulative rates of all of these outcomes were <5%, even at 15 years of follow-up, regardless of treatment, greatly outweighed by the incidence of death from other causes in this elderly population. In matched analysis, we calculated a hazard ratio of 1.12 (95% CI, 0.82-1.53) for RT versus RT + HT for OS and a hazard ratio of 1.12 (95% CI, 0.82-1.53) for RT versus RT + HT for PFS.

CONCLUSIONS: Our data suggest that elderly, low-risk breast cancer patients have similarly high OS and PFS with low rates of local recurrence, distant recurrence, and death from breast cancer with much higher rates of death from competing causes, whether treated with RT or HT + RT. These patients are likely to die of other causes without disease recurrence, regardless of which of these treatments is used. Thus, they may benefit from the administration of more modern forms of breast irradiation without the need for adjuvant systemic hormone therapy. A detailed analysis of which clinical, pathologic, genomic, and comorbidity variables are needed to select these patients.

PMID:39864014 | DOI:10.1016/j.ijrobp.2024.11.098

J Hand Surg Am. 2025 Jan 24:S0363-5023(24)00608-7. doi: 10.1016/j.jhsa.2024.11.022. Online ahead of print.

ABSTRACT

PURPOSE: We compared the radiographic union and magnitude of humpback deformity correction when using different vascularized bone grafts (VBGs) and nonvascularized bone grafts (NVBGs) in the treatment of unstable scaphoid nonunions (USNUs).

METHODS: This was a retrospective radiographic review of 93 patients with an USNU treated between 2013 and 2022 at a single center by a single surgeon. Inclusion criteria included skeletally mature patients with radiographic evidence of an USNU resulting from failure of either nonsurgical or operative treatment. There were three treatment groups. Two groups were treated with either a palmar radiocarpal artery (PRCA) VBG or a 1,2 intercompartmental supraretinacular (1,2 IC-SRA) VBG. The third group comprised patients who were treated with a heterogeneous mix of NVBGs. Patients were followed radiographically at regular intervals until they were deemed healed or underwent a salvage procedure because of treatment failure. Measurements of carpal and scaphoid alignment were then repeated on the final imaging series and compared to preoperative measurements.

RESULTS: Ninety patients were included in the final analysis. PRCA VBG had the highest radiographic union rate, followed by 1,2 IC-SRA VBG and finally NVBGs. PRCA VBG had a significantly higher rate of union than NVBGs. Scapholunate angle change and scaphoid length change were greatest with PRCA VBG. These differences were statistically significant for the former when compared with 1,2 IC-SRA VBG and NVBGs and for the latter when compared with the 1,2 IC-SRA VBG in both univariate and multivariable analyses.

CONCLUSIONS: PRCA VBG had the highest radiographic union rate compared with alternative grafts as well as providing the greatest degree of humpback deformity correction in the treatment of USNUs.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

PMID:39864012 | DOI:10.1016/j.jhsa.2024.11.022

J Adolesc Health. 2025 Jan 23:S1054-139X(24)00447-6. doi: 10.1016/j.jadohealth.2024.09.017. Online ahead of print.

NO ABSTRACT

PMID:39864002 | DOI:10.1016/j.jadohealth.2024.09.017

J Adolesc Health. 2025 Jan 24:S1054-139X(24)00563-9. doi: 10.1016/j.jadohealth.2024.11.011. Online ahead of print.

ABSTRACT

PURPOSE: There is a paucity of evidence examining clinician experiences with structured health-care transition (HCT) programs. Among HCT Learning Collaborative participants, this study describes clinician experiences with implementation of a structured HCT process: Got Transition’s 6 Core Elements.

METHODS: Representative members from 6 health systems designed a survey to collect clinician feedback regarding HCT and demographic and practice information. The survey included adapted Got Transition Current Assessment of HCT Activities Level 4 and Clinician Feedback surveys as well as the following factors: clinical role, care setting, status, time involved in HCT process implementation, presence of champion, and partnership between pediatric and adult systems. Surveys were distributed across pediatric and adult clinical settings to 855 clinicians involved in HCT process implementation efforts during August and September 2022. Statistical analysis was performed to identify relationships between key clinician demographic data and responses on the survey.

RESULTS: A total of 272 clinicians provided feedback (31% response rate) on implementing a structured HCT process. About two-thirds reported that fidelity to a structured HCT process was present. The 6 Core Elements most implemented processes included transition policy, tracking, and transition planning. The majority of clinicians agreed that a structured HCT process improves safety and quality of care, as well as both patient and clinician experiences. Time invested in HCT processes was significantly associated with securing senior leadership buy-in. Presence of an identifiable institutional HCT process improvement champion was significantly associated with positive clinician experiences.

DISCUSSION: Clinicians found positive benefits in providing a structured HCT process using the 6 Core Elements and having a champion in their health system. They acknowledge that added time and continued investment in practice-wide HCT processes are needed.

PMID:39864000 | DOI:10.1016/j.jadohealth.2024.11.011

J Perianesth Nurs. 2025 Jan 23:S1089-9472(24)00518-5. doi: 10.1016/j.jopan.2024.10.010. Online ahead of print.

ABSTRACT

PURPOSE: The aim in the present study was to evaluate the effects of chewing postoperative xylitol gum on gastrointestinal functional recovery after laparoscopic cholecystectomy.

DESIGN: A three-arm randomized controlled trial.

METHODS: After a baseline assessment, participants were randomly assigned in three groups. The random assignment was performed by using a computer program (Microsoft Excel 2016). Afterward, participants were categorized into three subgroups. Group 3 was the control group that consisted of participants who had no intervention for chewing gum (n = 25). Group 2 was xylitol-free gum chewing group (n = 25), whereas Group 1 was xylitol gum chewing group (n = 24). In later phases, the time to first postsurgical flatus, time to first bowel sound after surgery, time to first postsurgical defecation, time to first mobilization after surgery, and discharge time from hospital were recorded. Nausea and vomiting, which are among the postoperative symptoms, were also evaluated.

FINDINGS: The duration of the control group from the end of surgery to the flatulence and bowel sounds was statistically higher than the xylitol group and xylitol-free group (all P < .05). Also, first postoperative flatulence time of xylitol-free group was higher than the xylitol group (P < .05). The duration from the end of surgery to defecation was longer in the control group compared with the xylitol group and the xylitol-free group, with a statistically significant difference between the groups (P < .05). In this study, a statistically significant difference was observed in terms of the time to first postsurgical flatus, time to first bowel sound after surgery, and time to first postsurgical defecation (all P < .000). No significant difference was found between the xylitol group, xylitol-free group, and control group when discharge from hospital and mobilization times were analyzed (all of them are P > .05).

CONCLUSIONS: Chewing xylitol gum facilitates postoperative gastrointestinal recovery after laparoscopic cholecystectomy. Further studies are recommended to confirm these findings and investigate the underlying mechanisms.

PMID:39863997 | DOI:10.1016/j.jopan.2024.10.010