Imaging Evaluation Research Articles

Delayed Diagnosis and Misdiagnosis of Lacrimal Sac Tumors in Patients Presenting with Epiphora: Diagnosis, Treatment, and Outcomes

Background/Objectives: Epiphora, or excessive tearing, is a common symptom often attributed to benign conditions such as dry eye or nasolacrimal duct obstruction. However, it can also be an early indicator of lacrimal sac tumors, which are frequently misdiagnosed or diagnosed late due to their subtle presentation. This study aims to identify the clinical features that contribute to delays and misdiagnoses of lacrimal sac tumors in patients presenting with epiphora, with the goal of improving early detection and treatment outcomes. Methods: This retrospective study reviewed medical records from Taipei Veterans General Hospital between 2007 and 2023, focusing on patients who presented with epiphora and were later diagnosed with pathologically confirmed lacrimal sac tumors. Inclusion criteria were limited to cases that were initially misdiagnosed or had a delayed diagnosis, with imaging and clinical evaluations confirming tumor-related tear drainage obstruction. Patients with non-tumor causes of epiphora were excluded. Results: Eleven cases of lacrimal sac tumors were identified, including two benign and nine malignant tumors. The average duration from symptom onset to diagnosis was 22.4 months. Common symptoms included epiphora (100%), discharge (54.5%), and hemolacria (18.2%). Subtle clinical signs, such as asymmetry in the medial canthal region and non-tender swelling, were frequently noted. Despite receiving appropriate surgical and adjuvant treatments, the impact of delayed diagnosis was significant. Two patients succumbed to tumor-related disease; one developed lung metastasis 12 years after diagnosis, and another experienced recurrence during a six-year follow-up after undergoing extensive exenteration, adjuvant chemotherapy, and radiotherapy. Conclusions: Lacrimal sac tumors can present insidiously with symptoms often mistaken for benign conditions, leading to significant diagnostic delays. Thorough history taking, meticulous physical examination, and timely imaging are crucial for early detection. Increased clinician awareness and a high index of suspicion for lacrimal sac tumors in patients with atypical epiphora are essential to improve prognosis and reduce the risk of severe outcomes.

Application of resistance exercise training combined with CT image evaluation in postoperative functional rehabilitation and fracture risk prediction of elderly femurs

ObjectiveTo evaluate the overall functional recovery of femoral patients, improve recovery ability, and prevent fractures in the elderly. MethodsA group of elderly femoral postoperative participants were selected and randomly divided into resistance exercise training and routine rehabilitation training. Simultaneously, a control group (without a history of fractures) and a fracture group (with a history of fractures) were designed to predict fracture risk. Finally, computerized tomography was used to evaluate the functional rehabilitation status. ResultsThe resistance exercise training group showed significantly better performance in functional rehabilitation and fracture risk prediction than the control group, and the decrease in Barthel index at 12 weeks after surgery in this group was 6.25 (P > 0.001). The age, gender, and volumetric bone density between the control group and the fracture group showed P > 0.001, and the differences were statistically significant. The average age of the control group was significantly higher than that of the fracture group, and the proportion of males in the fracture group was significantly higher than that of the control group. The intramuscular fat content of the iliopsoas muscle in the fracture group was significantly lower than that in the control group, P = 0.004. This indicated that lower intramuscular fat content of the iliopsoas muscle was associated with higher fracture risk, as participants with lower intramuscular fat content of the iliopsoas muscle had less bone protection, resulting in an increased risk of fracture. The difference in body mass index between the two groups was not statistically significant, P = 0.737, indicating that the impact of this parameter on fracture risk was not significant in this study. ConclusionResistance exercise training combined with CT image evaluation is an effective rehabilitation strategy with high clinical application value. This study provides reliable empirical evidence for the application of resistance exercise training and the combination of CT image evaluation, and provides guidance for the optimization of clinical rehabilitation strategies.

Beyond the imaging evaluation of fractures of the lateral process of the talus: Let's not forget concomitant injuries.

Fractures of the lateral process of the talus (FLPT) are uncommon fractures that represent a clinical challenge. Traditional radiological classification systems rely predominantly on radiographic findings. However, due to the high rate of FLPT misdiagnosis and the limited accuracy in evaluating concomitant talar injuries through plain radiographs, novel imaging classification systems have been developed that aim to enhance the diagnosis of concomitant talar injuries, thereby optimizing patient management and reducing the incidence of long-term complications.

Atypical Foreign Body Ingestion for Suicide

The ingestion of foreign bodies can cause severe health issues such as bleeding, perforations, and obstructions. The majority of gastrointestinal foreign bodies discovered in adults result from intentional ingestion, often found in patients with preexisting psychiatric conditions. In the literature, there are few similar cases of voluntary ingestion of a fork that has passed through the esophagus to the duodenum. We present a case of a 33-year-old man with a psychiatric disorder who presented to the emergency room five months after ingesting a fork, which was discovered incidentally during imaging evaluations. He had complained of epigastric pain lasting for a month, leading to the search for a cause. An abdominopelvic CT scan revealed a linear structure in the D2 and D3 segments, creating a metallic artifact, obstructing wall exploration, and measuring 9x136 mm. The patient underwent surgical extraction via laparotomy under general anesthesia, and the postoperative course was uneventful.

Transarterial embolization for anterior cranial fossa dural arteriovenous fistula based on multi-modal three-dimensional imaging

Background: Dural arteriovenous fistula (DAVF) in the anterior cranial fossa (ACF) is known to show a high risk of intracranial hemorrhage. Recently, multi-modal fusion imaging with computed tomography angiography, computed tomography venography, and three-dimensional (3D) rotation angiography have been used preoperatively to ensure anatomical safety. We report on endovascular treatment as a first-line approach for ACFDAVF based on the understanding of vascular anatomy obtained from multi-modal fusion imaging. Methods: All patients with ACF-DAVF treated endovascularly as a first-line approach were included in this study. Analyses took into account complications (particularly visual function), immediate angiographic outcomes, and follow-up findings in consecutive patients with ACF-DAVF treated with interventional treatment based on multi-modal fusion imaging. Results: Five patients with ACF-DAVF underwent six sessions of transarterial embolization (TAE) in our institution. The five male patients (mean age, 74.5 years; range, 60–84 years) were treated with liquid embolic agents (Onyx, four procedures; n-butyl 2-cyanoacrylate, two procedures). No difference was seen between preoperative image evaluation and image evaluation during the endovascular procedure, and in all cases, a microcatheter was navigated into a target artery assumed from preoperative multi-modal imaging, allowing treatment completion in a single procedure. In all cases, the shunt disappeared completely and visual function after procedure was maintained. At the last follow-up, all patients showed a modified Rankin scale score of 0 or 1 with no recurrences. Conclusion: Multi-modal fusion imaging facilitates a 3D understanding of the vascular anatomy, allowing TAE as the first-line treatment for ACF-DAVF.

Image evaluation and analysis of fabric with a geometric motif in dress style design

To explore the differences in sensory imagery produced by different geometric patterns and dress silhouettes, this study selected and extracted 4 different types of geometric patterns and 4 typical dress silhouettes as research carriers, determined the research samples through cross-combination, and used 8 pairs of sensory word pairs as research semantic space. Consumer sensory evaluations of the dress samples were collected through a survey questionnaire. The results were analysed using SPSS26.0 software, which showed that three sensory factors affect the appearance of the dress style. According to their main characteristics, they can be named as personality factor, temperament factor, and style factor. In terms of the silhouette of the dress, the neat and regular geometric pattern is most affected by the silhouette of the dress, while the other three types of geometric patterns are relatively weak. In terms of geometric pattern rules, different geometric patterns have different effects on the overall appearance of the dress after being combined with the silhouette of the dress, and some dresses play a certain role in all three factors.

Metal artifact reduction method based on single spectral CT (MARSS).

For patients with metal implants, computed tomography (CT) imaging results suffer from metal artifacts, which seriously affect image evaluation and even lead to misdiagnosis. Because spectral CT technology has the advantage of quantitative imaging, basis material decomposition, and so on, the current metal artifact reduction methods are utilizing spectral information to reduce metal artifacts with good results. However, they usually require projection data from multiple spectra or energy-windows, which is difficult to realize in conventional CT. To satisfy the status quo, the aim of this work is to propose a metal artifact reduction (MAR) method based on single spectral CT (MARSS). By incorporating prior information, the average density of some base materials, and a constrained image reconstruction model is established. It forces the solution spaces of the materials to be discrete and finite, making the model easier tosolve. The MARSS method uses the idea of discrete tomography to establish a constrained reconstruction model. By incorporating priori knowledge, the constraint forces the solution spaces of some materials to be discrete, which can effectively downsize the solution space and reduce the ill-posedness of this problem. Then, an iteration algorithm is developed to solve this model. This algorithm iterates alternately between reconstruction and discretization. It ensures that the solution spaces are discrete while the polychromatic projection of the reconstructed image converges to that of the scannedobject. The MRASS method significantly reduces artifacts and restores structures near metal to a large extent. Unlike the comparison MAR methods, it effectively prevents the introduction of new artifacts and distortion of thestructure. The MARSS method can achieve MAR based on single spectral CT. Subjective and quantitative evaluation of the results show that the method significantly improves image quality compared to competingmethods.

Toward the Application of Dual-Energy Computed Tomography with Virtual Non-Hydroxyapatite Color-Coded Maps to Identify Traumatic Fractures in Daily Emergency Settings

To evaluate the advantages of dual-energy computed tomography (DECT) virtual non-hydroxyapatite color mapping (VNHAP) in combination with standard bone CT (BCT) in the identification of subtle or occult traumatic fractures referred to emergency and acceptance departments (DEAs). Forty patients (22 men; mean age 83 ± 23.7 y) with suspected traumatic fractures referred to our emergency department and examined with a fast kilovoltage-switching single-source spectral CT scan between January and October 2023 were retrospectively reviewed. The BCT and VNHAP images were blindly evaluated by two radiologists with >10 years and <2 years of experience in musculoskeletal imaging. Both techniques were evaluated in terms of sensitivity (SE), specificity (SP), positive and negative predictive values (PPVs and NPVs) and accuracy for fracture detection, as confirmed at a 3-month clinical–instrumental follow-up. Inter-observer agreement and examination times were also analyzed. Fractures were confirmed in 18/40 cases. The highest values of diagnostic performance for VNHAP images were obtained in terms of SP (90.9% and 95%) and PPV (87.5% and 92.8%) and for the less experienced operator. No statistically significant differences were observed between the diagnostic accuracy of the two readers in the evaluation of VNHAP images. Inter-observer agreement was moderate (κ = 0.536) for BCT and substantial (κ = 0.680) for VNHAP. Comparing the two operators, a significantly longer examination time for BCT and no significant difference for VNHAP were registered. Our preliminary experience may encourage the employment of VNHAP maps in combination with BCT images in emergency settings. Their use could be time-saving and valuable in terms of diagnostic performance, especially for less experienced operators.

Early Diagnosis of Liver Injury and Real-Time Evaluation of Photothermal Therapy Efficacy with a Viscosity-Responsive NIR-II Smart Molecule.

The early diagnosis of liver injury and in situ real-time monitoring of tumor therapy efficacy are important for the enhancement of personalized precision therapy but remain challenging due to the lack of reliable in vivo visualization tools with integrated diagnostic, therapeutic, and efficacy monitoring functions. Herein, a smart second near-infrared window (NIR-II) molecule (BITX-OH) is rationally designed for diagnosis and therapy by vinyl-bridging hydroxyl diphenyl xanthine unit and benzo[cd]indolium skeleton. BITX-OH exhibits high selectivity and sensitivity toward viscosity, exhibiting a significant enhancement (1167-fold) in NIR-II fluorescence at 962nm. With the assistance of BITX-OH and NIR-II fluorescence imaging, early diagnosis and therapeutic evaluation of non-alcoholic fatty liver (NAFL), as well as in-site real-time monitoring of hepatic fibrosis (HF) in live mice have been successfully achieved, which is at least several hours earlier than the typical clinical test. Notably, BITX-OH displays excellent photothermal conversion efficiency when exposed to an 808nm laser, which can induce tumor ablation and increase viscosity, thereby enhancing NIR-II fluorescence for the real-time evaluation of photothermal therapy (PTT). This viscosity-based "self-monitoring" strategy provides a convenient and reliable platform for timely obtaining therapeutic feedback to avoid over- or under-treatment, thus enabling personalized precision therapy.

A single-center case study series assessing the effect of selumetinib use in patients with neurofibromatosis-related plexiform neurofibromas

Abstract Background Neurofibromatosis type 1 (NF1) is a common genetic disorder of phenotypic variability with age-dependent penetrance. This study describes the diagnosis, clinical characterization, management, and outcomes of a large patient cohort with plexiform neurofibroma (PN) treated with selumetinib in a real-world clinical setting. Methods This single-center observational study consecutively enrolled patients with NF1-PN treated with selumetinib from April 2018 to April 2023. Data on clinical features, tumor types and locations, and results from genetic tests were recorded at baseline; details of disease management with selumetinib and surgical intervention and disease evolution including imaging data and evaluations of pain and function were documented. Results Overall, 54 patients with a median age (range) of 16.4 (4.5–58.0) years were enrolled. Most had cutaneous manifestations (88.9%), including cutaneous neurofibromas and PN. Patients underwent [18F]fluorodeoxyglucose (FDG)-PET/CT imaging before treatment to rule out malignant lesions. Initial evaluations included directed MRI, which facilitated future comparisons and allowed for the assessment of PN resectability. Pharmacological treatment with selumetinib (with surgery, without surgery) resulted in the following proportion of patients achieving stable disease (58.8%, 54.3%), partial response (29.4%, 28.6%), and improved pain (58.8%, 37.1%), deformity (17.6%, 20.0%), and functional (17.6%, 20.0%) outcomes, respectively. Conclusions Results from this study demonstrate that NF1-PN can be managed effectively with selumetinib with surgical intervention in some patients. Most patients achieved tumor stability and improved symptom control, and the majority of patients continue under treatment. Effective diagnosis and management were achieved through individualized utility of FDG-PET/CT and MRI imaging and targeted resource allocation.

Evaluating efficacy and safety of ocrelizumab biosimilar (Xacrel) compared to the originator (Ocrevus) in relapsing multiple sclerosis: a phase III, randomized, equivalency, clinical trial

Multiple sclerosis is an inflammatory demyelinating disease and represents a global health concern. Ocrelizumab, a humanized IgG monoclonal antibody, selectively targets CD20 on B cells and CD20-expressing T cells. This study aimed to compare the efficacy and safety of the biosimilar ocrelizumab candidate (Xacrel) to the originator product (Ocrevus) in Relapsing Multiple Sclerosis (RMS) patients. In this randomized trial, patients received either Xacrel or Ocrevus for 96 weeks. The primary endpoint was the equivalency of the medications in reducing the annualized relapse rate (ARR) at week 48. The secondary endpoints included time to the onset of disability progression confirmed at 12 and 24 weeks, the proportion of relapse-free patients, magnetic resonance imaging (MRI) evaluations, safety assessments, and immunogenicity over 96 weeks. A total of 170 patients were randomized (1:1 ratio). In the per protocol analysis, the upper and lower limits of 95% two-sided confidence intervals of difference between treatments in the 48-week ARR rate were in the predefined margin of − 0.2 to 0.2 (− 0.002; 95% CI − 0.080 to 0.075). The two products were also comparable in terms of other efficacy parameters, safety, and immunogenicity. The results confirmed that Xacrel is equivalent to Ocrevus in terms of 48-week ARR in RMS patients, with no considerable difference in other efficacy parameters and the safety profile during the 96 weeks. The trial was registered in Iranian registry of clinical trials (IRCT) on 10/06/2019 with the registration number of IRCT20150303021315N13 and in Clinicaltrials.gov on 19/07/2021 with the registration code of NCT04966338.

In Vitro Research Methods Used to Evaluate Shaping Ability of Rotary Endodontic Files-A Literature Review.

In this article, we present a literature review of methods used to measure the shaping ability of endodontic rotary files, including the selection of endodontic sample type (extracted teeth versus simulated blocks) and an imaging evaluation method. This review was conducted as background research to identify concerns that arise when designing research studies in this domain and propose how the field can plan more systematic studies going forward. A literature search was conducted using PubMed, MEDLINE, Embase, ScienceDirect, Scopus, and e B-on databases, including studies published in English from January 2010 to June 2024. Only studies that specified in vitro or ex vivo methods for evaluating the endodontic performance of NiTi rotary files on canal transportation and centering ability were considered. A total of 86 studies met the inclusion criteria from an initial pool of 651. Of these, 67 studies used extracted teeth, while 20 utilized simulated root canals in resin blocks. For evaluation methods, 55 studies employed Micro-Computed Tomography and Cone-Beam Computed Tomography (MCT + CBCT), 30 used Double Digital Images/Radiographs/Photographs (DDIR + DDIP) with software analysis, 1 used both DDIR and MCT, 1 used high-precision nano-CT, and 1 used a digital single-lens reflex (DSLR) camera. The findings indicate that the MCT method and its advanced variations appear superior in many cases for evaluating the quality of root canal instrumentation due to their ability to provide detailed three-dimensional images. We also discuss the pros and cons of other evaluation methods, including CBCT and DDIR. Finally, we identify important factors to consider for optimizing future cross-study comparisons. This work highlights the importance of being familiar with shaping ability assessment methods as new instruments are introduced to the market.

Visualization of “subclinical consequence” after successful and uneventful surgical intervention for unruptured cerebral aneurysms

There are many studies on post-operative cognitive function after surgical clipping (SC) and endovascular coiling (EC) for unruptured cerebral aneurysms, but few reports focusing on possible subclinical damage. The aim of the present study was to detect the subclinical damage after surgical intervention. Patients with anterior circulation aneurysms who underwent either SC (SC group) or EC (EC group) were recruited. Imaging studies and evaluation of cognitive function were performed within 1 month preoperatively and at 6 months and 2 years postoperatively. The ipsilateral/contralateral cerebral blood flow (CBF) ratio (I/C ratio) calculated from values in four regions of interest (ROIs) placed on N-isopropyl-p-[123I] iodoamphetamine (123I-IMP)-single photon emission computed tomography (SPECT) was used to detect "subclinical consequence". "Subclinical consequence" was defined as post-operative CBF reduction without abnormality in other radiological examinations and cognitive tests. There were 14 patients in the SC group (mean age, 60.6±11.7 years) and 33 patients in the EC group (mean age, 67.5±7.2 years). All cognitive assessment results showed no significant reduction through the survey period. However, I/C ratios were restored by 2 years in the EC group not but in the SC group. I/C ratios at 6 months and 2 years were significantly lower in the SC group than the EC group (P<0.01). 123IMP-SPECT revealed a statistically significant reduction in ipsilateral CBF in patients who had an uneventful clinical course and no cognitive problems. The subclinical consequence could persist for at least 2 years following SC, and was less pronounced following EC.

Magnetic Resonance Imaging Evaluation of Carcinoma of the Cervix With Histopathological Correlation in a Tertiary Care Center: Emphasizing the Rise of Adenocarcinoma in the Indian Context

Magnetic Resonance Imaging Evaluation of Carcinoma of the Cervix With Histopathological Correlation in a Tertiary Care Center: Emphasizing the Rise of Adenocarcinoma in the Indian Context

Tomographic and ultrasound evaluation of the thyroid gland in pet guinea pigs.

There has been increasing interest in the literature on primary thyroid diseases in guinea pigs, which are believed to be underdiagnosed. This study describes the size and characteristics of the thyroid gland on ultrasound (US) and CT examinations in the guinea pig (Cavia porcellus) without evidence of thyroid pathology and examines the possible use of US as a routine examination for thyroid diseases. This prospective and anatomical study included 20 guinea pigs that underwent CT for dental pathologies and US for thyroid gland (TG) examination. Based on US and CT images, this study evaluated the thyroid lobe dimensions (length, height, and width) and shape. Echogenicity and homogeneity were assessed on US images, and attenuation values (HU) and homogeneity were evaluated on CT images. All animals underwent CT and US examinations under anesthesia. Thyroid lobes appeared more frequently as fusiform on CT (65%) and oval on US scans (67.5%). The attenuation values on CT scans were homogeneous. On the US scans, the TG was more frequently hypoechoic. No statistically significant differences were found between the size of the right and left thyroid lobes, both with CT and US. A statistically significant difference was found between the length values on CT and US. The US and CT thyroid gland dimensions, shape, and appearance were described. Both CT and US are useful techniques for evaluating the TG in guinea pigs.

A risk prediction stratification for non-mass breast lesions, combining clinical characteristics and imaging features on ultrasound, mammography, and MRI

ObjectivesGiven the inevitable trend of domestic imaging center mergers and the current lack of comprehensive imaging evaluation guidelines for non-mass breast lesions, we have developed a novel BI-RADS risk prediction and stratification system for non-mass breast lesions that integrates clinical characteristics with imaging features from ultrasound, mammography, and MRI, with the aim of assisting clinicians in interpreting imaging reports.MethodsThis study enrolled 350 patients with non-mass breast lesions (NMLs), randomly assigning them to a training set of 245 cases (70%) and a test set of 105 cases (30%). Radiologists conducted comprehensive evaluations of the lesions using ultrasound, mammography, and MRI. Independent predictors were identified using LASSO logistic regression, and a predictive risk model was constructed using a nomogram generated with R software, with subsequent validation in both sets.ResultsLASSO logistic regression identified a set of independent predictors, encompassing age, clinical palpation hardness, distribution and morphology of calcifications, peripheral blood supply as depicted by color Doppler imaging, maximum lesion diameter, patterns of internal enhancement, distribution of non-mass lesions, time–intensity curve (TIC), and apparent diffusion coefficient (ADC) values. The predictive model achieved area under the curve (AUC) values of 0.873 for the training group and 0.877 for the testing group. The model’s positive predictive values were as follows: BI-RADS 2 = 0%, BI-RADS 3 = 0%, BI-RADS 4A = 6.25%, BI-RADS 4B = 26.13%, BI-RADS 4C = 80.84%, and BI-RADS 5 = 97.33%.ConclusionThe creation of a risk-predictive BI-RADS stratification, specifically designed for non-mass breast lesions and integrating clinical and imaging data from multiple modalities, significantly enhances the precision of diagnostic categorization for these lesions.

Emergency management and perioperative strategies for intra-tumoral hemorrhage in neurofibromatosis type 1-related giant plexiform neurofibroma

To review the emergency management and perioperative strategies for ruptured neurofibromatosis type 1 (NF1)-related giant plexiform neurofibroma (PNF), providing a systematic treatment protocol to improve the therapeutic outcomes and quality of life for patients with giant PNF. The literature on the management of giant PNF rupture and hemorrhage was reviewed, and the diagnosis, treatment, and perioperative management were summarized based on clinical experiences. By implementing an integrated diagnostic and treatment strategy that includes early diagnosis, imaging evaluation, emergency ultra-selective arterial embolization combined with surgical excision, acute hemorrhage can be effectively controlled while also reducing the risk of major intraoperative bleeding and minimizing postoperative complications. As a result, this approach significantly improves treatment success rates and patient quality of life. For ruptured NF1-related giant PNF, employing emergency ultra-selective arterial embolization combined with surgical excision, under the collaboration of a multidisciplinary team, can effectively improve treatment success rates, rapidly control bleeding, reduce tumor size, and lower mortality. Future research should focus on assessing the long-term quality of life of patients treated for ruptured and hemorrhaging giant PNF and on further optimizing treatment protocols.

Clinical study of Cross-Union surgery for treatment of pseudarthrosis of tibia with neurofibromatosis type 1 in children

To evaluate the effectiveness of Cross-Union surgery for the treatment of pseudarthrosis of the tibia (PT) with neurofibromatosis type 1 (NF1). The clinical data of 8 children of PT with NF1 who met the selection criteria between January 2018 and December 2023 was retrospectively analyzed. There were 5 boys and 3 girls, and the operative age ranged from 1.8 to 13.3 years with a median age of 3.5 years. According to Paley classification, there were 2 cases of type 2a, 2 cases of type 3, 2 cases of type 4a, and 2 cases of type 4c. There were 5 cases of first operation and 3 cases of re-fracture after previous operation. Six cases had leg length discrepancy before operation, and 2 of them had shortening over 2.0 cm. Except for 1 case of ankle fusion, the other 7 cases had ankle valgus. Preoperative coronal/sagittal angulation was recorded. Postoperative pseudarthrosis healing and refracture were observed. Leg length discrepancy and tibiotalar angle were measured and recorded before operation and at last follow-up. Inan imaging evaluation criteria was used to evaluate the imaging effect. All patients were followed up 12-37 months (mean, 23.5 months). One pseudarthrosis failed to heal at 12 months after operation and healed at 3 months after reoperation, while the other pseudarthrosis healed with a healing rate of 87.5% and a healing time of 4-8 months (mean, 5.3 months). No refracture occurred during the follow-up. At last follow-up, there were 2 new cases with leg length discrepancy, which were 0.7 cm and 1.3 cm, respectively. In 2 cases with the leg length discrepancy more than 2.0 cm before operation, the improvement was from 4.1 cm and 12.6 cm to 2.1 cm and 9.0 cm, respectively. There was no significant difference in leg length discrepancy between pre- and post-operation in 8 cases ( P>0.05). At last follow-up, 6 patients still had ankle valgus, and there was no significant difference in the tibiotalar angle between pre- and post-operation ( P>0.05); the tibial coronal/sagittal angulation significantly improved when compared with that before operation ( P<0.05). According to Inan imaging evaluation criteria, 1 case was good, 6 cases were fair, and 1 case was poor. Cross-Union surgery is an effective method for the treatment of PT with NF1 in children, can achieve good bone healing results with a low risk of re-fracture. The surgery may not have significant effects on leg length discrepancy and ankle valgus, and further treatment may be required.

Underwater Optical Imaging: Methods, Applications and Perspectives

Underwater optical imaging is essential for exploring the underwater environment to provide information for planning and regulating underwater activities in various underwater applications, such as aquaculture farm observation, underwater topographical survey, and underwater infrastructure monitoring. Thus, there is a need to investigate the underwater imaging process and propose clear and long-range underwater optical imaging methods to fulfill the demands of academia and industry. In this manuscript, we classify the eighteen most commonly used underwater optical imaging methods into two groups regarding the imaging principle, (1) hardware and (2) software-based methods, each with an explanation of the theory, features, and applications. Furthermore, we also discuss the current challenges and future directions for improving the performance of current methods, such as improving the accuracy of underwater image formation model estimation, enlarging the underwater image dataset, proposing comprehensive underwater imaging evaluation metrics, estimating underwater depth and integrating different methods (e.g., hardware- and software-based methods for computational imaging) to promote the imaging performance not only in the laboratory but also in practical underwater scenarios.

Breast and axillary marking in the neoadjuvant setting: survey results from experts of the Brazilian society of mastology.

The precise location of the tumor site is essential for the success of surgical treatment. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor and node localization. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached. This was an online survey conducted between June and December 2022. All 1,742 active mastologists affiliated to the SBM were invited anonymously. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program version 26.0. Post hoc analysis was performed when appropriate and the significance level was set at p < 0.05. Polychoric regression analyses were conducted using `VGAM` package. In total, 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%). Most professionals were board-certified (84,8%). The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree). However, there was consensus that the clinical and imaging evaluation was insufficient for staging the axilla as N1 (71.6%). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. When <3 lymph nodes were retrieved 41.0% of mastologists performed axillary lymphadenectomy. Among the 28 questions, consensus was reached on only 11 (39.3%). The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking.