Tag: pubmed

Cureus. 2024 May 24;16(5):e60988. doi: 10.7759/cureus.60988. eCollection 2024 May.

ABSTRACT

Background While two-dimensional (2D) turbo spin echo (TSE) sequences offer better through-plane resolution than three-dimensional (3D) isotropic TSE sequences images, with a narrower thickness of the slice, 3D isotropic TSE sequences are known to have a weaker in-plane resolution as well as blurring of the image. These elements may make it more difficult to distinguish between nearby structures that may affect nerve roots and small nerve roots during spinal imaging. This study aimed to analyze the accuracy of T2 TSE sequence and volumetric isotropic TSE acquisition in determining the indentation of nerve roots and perineural diseases such as nerve sheath tumors and Tarlov cysts. Methods Fifty patients who attended the Department of Radiodiagnosis for magnetic resonance (MR) spine participated in this prospective study. Routine MR lumbosacral (LS) spine sequences, such as survey, coronal T2 short-tau inversion recovery (STIR), sagittal T2 TSE, sagittal T1 TSE, and axial T2 TSE, were carried out after a localizer was acquired. More sequences from volume isotropic turbo spin echo acquisition (VISTA) were acquired. For both 2D and 3D sequences, the visibility ratings for perineural cysts, spinal canal stenosis, and nerve root indentation were evaluated. Visibility ratings ranged from zero to four. Results In the cases of perineural cyst, spinal canal stenosis, and nerve root impingement, the mean difference between the VISTA and T2 TSE visibility scores was 0.04, 0.54, and 0.56, respectively. The VISTA and T2 TS had standard deviation differences of 0.006, 0.026, and 0.06, respectively. The “t” values for nerve root impingement, spinal canal stenosis, and perineural cysts were, in order, 50, 180, and 70. Because the p-value was <0.01, a statistically significant variation has been observed. Conclusion In the diagnosis of neural and perineuronal disorders, the visibility scores for 3D T2 TSE (VISTA) were considerably better than those for 2D T2 TSE in identifying perineural cysts, spinal canal stenosis, and nerve root indentation.

PMID:38915957 | PMC:PMC11195522 | DOI:10.7759/cureus.60988

J Neurointerv Surg. 2024 Jun 24:jnis-2024-021782. doi: 10.1136/jnis-2024-021782. Online ahead of print.

ABSTRACT

BACKGROUND: Carotid web (CaW) is a risk factor for ischemic stroke, mainly in young patients with stroke of undetermined etiology. Its detection is challenging, especially among non-experienced physicians.

METHODS: We included patients with CaW from six international trials and registries of patients with acute ischemic stroke. Identification and manual segmentations of CaW were performed by three trained radiologists. We designed a two-stage segmentation strategy based on a convolutional neural network (CNN). At the first stage, the two carotid arteries were segmented using a U-shaped CNN. At the second stage, the segmentation of the CaW was first confined to the vicinity of the carotid arteries. Then, the carotid bifurcation region was localized by the proposed carotid bifurcation localization algorithm followed by another U-shaped CNN. A volume threshold based on the derived CaW manual segmentation statistics was then used to determine whether or not CaW was present.

RESULTS: We included 58 patients (median (IQR) age 59 (50-75) years, 60% women). The Dice similarity coefficient and 95th percentile Hausdorff distance between manually segmented CaW and the algorithm segmented CaW were 63.20±19.03% and 1.19±0.9 mm, respectively. Using a volume threshold of 5 mm³, binary classification detection metrics for CaW on a single artery were as follows: accuracy: 92.2% (95% CI 87.93% to 96.55%), precision: 94.83% (95% CI 88.68% to 100.00%), sensitivity: 90.16% (95% CI 82.16% to 96.97%), specificity: 94.55% (95% CI 88.0% to 100.0%), F1 measure: 0.9244 (95% CI 0.8679 to 0.9692), area under the curve: 0.9235 (95%CI 0.8726 to 0.9688).

CONCLUSIONS: The proposed two-stage method enables reliable segmentation and detection of CaW from head and neck CT angiography.

PMID:38914461 | DOI:10.1136/jnis-2024-021782

BMJ. 2024 Jun 24;385:q1397. doi: 10.1136/bmj.q1397.

NO ABSTRACT

PMID:38914441 | DOI:10.1136/bmj.q1397

AJNR Am J Neuroradiol. 2024 Jun 24:ajnr.A8393. doi: 10.3174/ajnr.A8393. Online ahead of print.

ABSTRACT

BACKGROUND AND PURPOSE: A cleft-like non-enhancing hypointensity was observed repeatedly in the pituitary gland at the adenohypophysis/neurohypophysis border on contrast-enhanced 3D-Fat-Saturated T1-MPRAGE (C+3D-FS-T₁ MPRAGE) using clinical 7T MRI. Our primary goal is to assess the prevalence of this finding. The secondary goals are to evaluate the frequency of other incidental pituitary lesions, MRI artifacts, and their effect on pituitary imaging on the C+3D-FS-T₁ MPRAGE at 7T.

MATERIALS AND METHODS: 100 patients who underwent 7T neuroimaging between 10/27/2021 and 8/10/23 were included. Each case was evaluated for cleft-like pituitary hypointensity, pituitary masses, and artifacts on C+3D-FS-T₁ MPRAGE. Follow-up exams were evaluated if present. The average prevalence for each finding was calculated, as were descriptive statistics for age and sex.

RESULTS: A cleft-like hypointensity was present in 66% of 7T MRIs. There were no significant differences between the “cleft-like present” and “cleft-like absent” groups regarding sex (P = .39) and age (P = .32). The cleft-like hypointensity was demonstrated in follow-up MRIs in 3/3 patients with 7T, 1/12 with 3T, and 1/5 with 1.5T. A mass was found in 22%, while 75% had no mass, and 3% were indeterminate. A mass was found in 18 (27%) of the “cleft-like present” and 4 (13%) of the “cleft-like absent” groups. The most common mass types were Rathke cleft cyst (RCC) in 7 (31.8%) patients, “RCC vs. entrapped CSF” in 6 (27.3%), and microadenoma in 6 (22.2%) in the “cleft-like present” group. There were no significant differences in the mass types between the “cleft-like present” and “cleft-like absent” groups (P = .23). Susceptibility and/or motion artifacts were frequent in general using C+3D-FS-T₁ MPRAGE (54%). Artifact-free scans were significantly more frequent in the “cleft-like present” group (P =.03).

CONCLUSIONS: A cleft-like non-enhancing hypointensity was frequently seen on the C+3D-FS-T1 MPRAGE at 7T MRI, which most likely represents a normal embryological Rathke’s cleft remnant and cannot be seen in lower field strength MRIs. Susceptibility and motion artifacts are common in the sella. They may affect image quality, and the artifacts at 7T may lead to an underestimation of the prevalence of Rathke cleft and other incidental findings.

ABBREVIATIONS: C+3D-FS-T ₁MPRAGE = Contrast-Enhanced 3D-Fat-Saturated T₁-Magnetization Prepared Rapid Gradient Echo Imaging; RCC = Rathke’s Cleft Cyst.

PMID:38914432 | DOI:10.3174/ajnr.A8393

BMJ. 2024 Jun 24;385:q1353. doi: 10.1136/bmj.q1353.

NO ABSTRACT

PMID:38914429 | DOI:10.1136/bmj.q1353

Clin Exp Optom. 2024 Jun 24:1-5. doi: 10.1080/08164622.2024.2371360. Online ahead of print.

ABSTRACT

CLINICAL RELEVANCE: Isotretinoin has been the best treatment option for moderate and severe acne vulgaris since the 1980s. Some studies have shown evidence of subclinical anterior segment involvement of the eye in patients treated with isotretinoin.

BACKGROUND: This study aimed to evaluate lens clarity with the densitometry software of Scheimpflug tomography in patients treated with isotretinoin and to compare with healthy control subjects.

METHODS: Thirty-seven acnepatients treated with isotretinoin who met the inclusion criteria (24 males and 13 females, mean age 22.94 ± 4.21 years) and 39 healthy control subjects were included in the study. Clinical characteristics of the isotretinoin and control subjects were recorded. Lens density was evaluated with the densitometry software of the Scheimpflug tomography device (PentacamHR, Oculus, Wetzlar, Germany).

RESULTS: There was no statistically significant difference between the groups in age, gender distribution, spherical equivalent, or anterior segment parameters measured by the Pentacam system (p > 0.05 for all). Lens density values in zones 2 and 3 were significantly higher in the isotretinoin group (p = 0.042, p < 0.001) and positively correlated with cumulative isotretinoin dose (zone 2: r = 0.384, p = 0.032; zone 3: r = 0.384, p = 0.005).

CONCLUSION: Zone 2 and zone 3 lens density are higher in patients treated with isotretinoin when compared to healthy controls.

PMID:38914426 | DOI:10.1080/08164622.2024.2371360

J Dermatolog Treat. 2024 Dec;35(1):2365820. doi: 10.1080/09546634.2024.2365820. Epub 2024 Jun 24.

ABSTRACT

PURPOSE: Providers who treat patients with psoriasis are unevenly distributed across the United States, with more in urban than rural areas. This retrospective claims analysis characterized disparities in access to care for US patients with psoriasis using data from the STATinMED database.

MATERIALS AND METHODS: Patients (≥18 years) had ≥1 claim with a psoriasis diagnosis and ≥1 claim for advanced psoriasis therapy (apremilast or biologics) between January 2015 and December 2019. Access to psoriasis care was determined using the proportion of patients with 0, 1-2, 3-4, or ≥5 providers in their local area.

RESULTS: Overall, 179,688 patients were included in the analysis, 80.0% in urban areas. The access ratio was highest for internal medicine physicians (97.1 per 1000 patients) and lowest for dermatologists (4.4 per 1000 patients) and family practice physicians (3.9 per 1000 patients). In urban areas, 41% of patients had access to ≥5 dermatologists versus 7% in rural areas. Whereas 2% of patients in urban areas sought care outside of their local area, 75% in rural areas did so. Use of advanced therapies was low in all states (<17%).

CONCLUSION: Access to psoriasis-treating providers varied widely. Regardless of access, utilization of advanced treatments was low, suggesting the need for effective, easy-to-administer therapy.

PMID:38914420 | DOI:10.1080/09546634.2024.2365820

J Stroke Cerebrovasc Dis. 2024 Jun 22:107832. doi: 10.1016/j.jstrokecerebrovasdis.2024.107832. Online ahead of print.

ABSTRACT

BACKGROUND: Stroke is a leading cause of death and disability in Nigeria. Effective stroke management is essential to reduce morbidity and mortality. Few trained neurologists in Nigeria are mostly concentrated in the cities, making non-specialists the backbone of acute stroke management in Nigeria. Physicians-related factors have been identified as one of the factors leading to sub-optimal stroke care. This study aimed to describe the knowledge of medical doctors in acute stroke care and the factors responsible for the disparity in their skills.

METHODS: A descriptive cross-sectional survey was conducted among 404 medical doctors across all the six geo-political zones in Nigeria using the Acute Stroke Management Questionnaire (ASMaQ). Data were analysed using descriptive statistics and simple logistics regression to predict the relationship between independent variables and the outcome variable (good knowledge vs poor knowledge).

RESULTS: 67% (95% CI =63% – 72%) of respondents had good overall knowledge of stroke management. Most respondents [88.6%, 95% CI =85% – 92%] had good knowledge of General Stroke Knowledge (GSK) followed by Hyperacute Stroke Management (HSM) [52.5%, 95% CI=47.3% – 57.7%] and Advanced Stroke Management (ASM) [49.5%, 95%CI= 49.5% -54.4%]. Working in a primary healthcare center (PHCs) and government hospital were significant predictor of overall poor knowledge of stroke. Physicians at PHCs had 2.29 times the odds of poor knowledge compared to those in tertiary hospital CONCLUSIONS: It is essential to retrain doctors on stroke management regularly, as part of their professional development.

PMID:38914357 | DOI:10.1016/j.jstrokecerebrovasdis.2024.107832

Sci Total Environ. 2024 Jun 22:174209. doi: 10.1016/j.scitotenv.2024.174209. Online ahead of print.

ABSTRACT

The coming decades are likely to see of extreme weather events becoming more intense and frequent across Europe as a whole and around the Mediterranean in particular. The reproduction rate of some microorganisms, including the bacteria that cause foodborne diseases, will also be affected by these events. The aim of this study was thus to ascertain whether there might be a statistically significant relationship between emergency hospital admissions due to the principal bacterial foodborne diseases (BFDs) and the various meteorological variables, including heatwaves. We conducted a time-series study, with daily observations of both the dependent variable (emergency hospital admissions due to BFDs) and the independent variables (meteorological variables and control variables of chemical air pollution) across the period 2013-2018 in the Madrid Region (Spain), using Generalised Linear Models with Poisson regression, in which control and lag variables were included for the purpose of fitting the models. We calculated the threshold value of the maximum daily temperature above which such admissions increased statistically significantly, analysed data for the whole year and for the summer months alone, and estimated the relative and attributable risks. The estimated attributable risk was 3.6 % for every one-degree rise in the maximum daily temperature above 12 °C throughout the year, and 12.21 % for every one degree rise in temperature above the threshold heatwave definition temperature (34 °C) in summer. Furthermore, different meteorological variables displayed a statistically significant association. Whereas hours of sunlight and mean wind speed proved significant in the analyses of both the whole year and summer, the variables “rain” and “relative humidity”, only showed a significant relationship in the analysis for the whole year. High ambient temperature is a risk factor that favours the increase in emergency hospitalisations attributable to the principal BFDs, with a greater impact being observed on days coinciding with heatwave periods. The results yielded by this study could serve as a basis for implementing BFD prevention strategies, especially on heatwave days.

PMID:38914322 | DOI:10.1016/j.scitotenv.2024.174209

Arthroscopy. 2024 Jun 22:S0749-8063(24)00459-6. doi: 10.1016/j.arthro.2024.06.024. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate the efficacy of arthroscopic subacromial balloon placement for massive rotator cuff tear (MRCT), assessing patient satisfaction, outcomes, shoulder functionality, pain scores, and revision-free survivorship up to eight years post the initial surgery.

METHODS: In this retrospective study with prospective data collection, patients with MRCTs undergoing balloon placement from 2014 to 2017 were prospectively enrolled. Their outcomes were analyzed retrospectively over a minimum 5-year follow-up. Demographics, patient satisfaction, reoperations, and complications were documented. Minimal clinically important differences (MCIDs) were calculated for SF-12 scores and Constant-Murley score (CMS) sub-scores. Pre- and post-surgery measures statistically compared for anatomical and functional evaluations.

RESULTS: In a study with 61 participants initially, 10 were lost to follow-up over 3 years. Of the remaining 51, 9 were lost at the latest follow-up. The cohort (42 participants, mean age 63.17 ± 7.66 years) was monitored for 83.98 ± 9.50 months. Seven participants required revisions within two years, resulting in an 83.33% revision-free survival rate. Significant improvements were observed from preoperative to latest follow-up: acromiohumeral interval decreased (7.83 to 6.56, p = 0.004), critical shoulder angle increased (36.10 to 38.24, p = 0.001), osteoarthritis grade increased (1.45 to 2.81, p = 0.001), SF-12 physical score improved (27.40 to 37.69, p = 0.001), and Constant-Murley total scores increased (26.50 to 68.69, p = 0.001). MCID for total Constant-Murley scores was 11.78 points. Among those without revisions, satisfaction rates were 11.43% excellent, 57.14% satisfied, and 31.43% dissatisfied.

CONCLUSIONS: Employing a balloon spacer for MRCTs yielded moderate satisfaction at the 5-year follow-up, with stable revision rates within the first 2 years. Notably, low revision surgery rates, high revision-free survival, and significant shoulder functionality improvements were observed at a minimum 5-year follow-up with arthroscopic subacromial balloon placement in conjunction with biceps tenotomy and subacromial bursectomy for MRCT.

PMID:38914297 | DOI:10.1016/j.arthro.2024.06.024