Edema Grade Research Articles

The Incidence and Implication of Helicobacter pylori Infection in the Setting of Reinke's Edema.

To assess the prevalence of Helicobacter pylori in Reinke's edema patients. To evaluate and compare the disease severity of patients who are H. pylori positive with those who are H. pylori negative. In this prospective study, subjects were recruited at the time of Reinke's edema diagnosis using flexible laryngoscopy between March of 2022 through August of 2022. Participants completed a Voice Handicap Index (VHI-10) survey and then underwent a H. pylori IgG blood test to identify infection. The severity of Reinke's edema, grade, and type were determined by a fellowship trained laryngologist. Thirty one patients participated. The cohort was 19% male. 38.7% of the cohort had a positive H. pylori test. Men had significantly greater smoking exposure in pack years than women (P =0.003). Interestingly, the total VHI-10 score was significantly greater in patients negative for H. pylori (P =0.05). This was also true for four of the VHI-10 domains. Patients positive for H. pylori had significantly more severe Reinke's edema in terms of type (P =0.03) and grade (P =0.01). There is a significant relationship between H. pylori status and the severity of Reinke's edema, with patients H. pylori positive having a greater grade and type of Reinke's edema. There is also a significant inverse relationship between H. pylori status and dysphonia, a subjective Reinke's symptom. III.

Postoperative concurrent chemoradiotherapy plus apatinib for patients with high-grade glioma: a retrospective cohort study.

Radiotherapy plus temozolomide followed by adjuvant temozolomide was the standard treatment for high-grade gliomas. This study aimed to explore the effectiveness and safety of the addition of apatinib in patients with high-grade gliomas after surgery. In this retrospective cohort study, patients with high-grade glioma [World Health Organization (WHO) grade III or IV] treated with apatinib and concurrent chemoradiotherapy (cCRT) after surgery from October 2017 to February 2021 were reviewed. High-grade glioma patients used cCRT alone in the same period were reviewed as the control group. Progression-free survival (PFS), overall survival (OS), the grade of peritumoral brain edema (PTBE) and safety profiles were recorded. Cox regression analyses were used to determine the associated factors of PFS and OS. A total of 60 patients with high-grade glioma were reviewed, with 30 patients in the apatinib plus cCRT group and 30 patients in the cCRT group. The median PFS of the apatinib plus cCRT group compared with the cCRT group was 8.53 vs. 7.33 months (P=0.62), and the median OS was 13.70 vs. 14.30 months (P=0.93). Multivariate analysis revealed that only pathological grade was independently associated with PFS [hazard ratio (HR) =4.445, 95% confidence interval (CI): 1.857 to 10.641, P<0.001] and OS (HR =3.737, 95% CI: 1.530 to 9.123, P=0.004). The apatinib plus cCRT also improved PTBE (P=0.001), and decrease the corticosteroids use than cCRT alone (P=0.002). No grade 3 or higher adverse event was observed in both groups. Post-operative cCRT plus apatinib was feasible for patients with high-grade glioma, with manageable toxicities.

Coinciding Diabetic Retinopathy and Diabetic Macular Edema Grading With Rat Swarm Optimization Algorithm for Enhanced Capsule Generation Adversarial Network.

In the worldwide working-age population, visual disability and blindness are common conditions caused by diabetic retinopathy (DR) and diabetic macular edema (DME). Nowadays, due to diabetes, many people are affected by eye-related issues. Among these, DR and DME are the two foremost eye diseases, the severity of which may lead to some eye-related problems and blindness. Early detection of DR and DME is essential to preventing vision loss. Therefore, an enhanced capsule generation adversarial network (ECGAN) optimized with the rat swarm optimization (RSO) approach is proposed in this article to coincide with DR and DME grading (DR-DME-ECGAN-RSO-ISBI 2018 IDRiD). The input images are obtained from the ISBI 2018 unbalanced DR grading data set. Then, the input fundus images are preprocessed using the Savitzky-Golay (SG) filter filtering technique, which reduces noise from the input image. The preprocessed image is fed to the discrete shearlet transform (DST) for feature extraction. The extracting features of DR-DME are given to the ECGAN-RSO algorithm to categorize the grading of DR and DME disorders. The proposed approach is implemented in Python and achieves better accuracy by 7.94%, 36.66%, and 4.88% compared to the existing models, such as the combined DR with DME grading for the cross-disease attention network (DR-DME-CANet-ISBI 2018 IDRiD), category attention block for unbalanced grading of DR (DR-DME-HDLCNN-MGMO-ISBI 2018 IDRiD), combined DR-DME classification with a deep learning-convolutional neural network-based modified gray-wolf optimizer with variable weights (DR-DME-ANN-ISBI 2018 IDRiD).

Optic Nerve Sheath Fenestration: A Retrospective Review of Its Safety, Efficacy, and Impact on Optical Coherence Tomography.

This study aimed to evaluate the safety and efficacy of optic nerve sheath fenestration using visual acuity, perimetry, and optical coherence tomography. A retrospective review of patients who underwent an optic nerve sheath fenestration at an academic center between 2016 and 2021 was performed with institutional review board approval. Outcome measures included visual acuity, perimetric mean deviation, optic disc edema grade, improvement in symptoms, and intraoperative and postoperative complications. Optical coherence tomography data collected included macular ganglion cell volume and thickness, as well as retinal nerve fiber layer thickness. Preoperative baseline data and 1-, 6-, and 12-month postoperative data were collected. Repeated measures with a mixed-effects model were used for continuous data, and linear regression analyses were performed. A total of 55 patients (86 eyes) underwent optic nerve sheath fenestration, via a medial transconjunctival approach by the same orbital surgeon. After 12-month follow-up, visual acuity (P < 0.05), perimetric mean deviation (P < 0.05), and optic disc edema (P < 0.001) improved in the operative eye. Retinal nerve fiber layer thickness decreased from a mean of 165 to 92 µm (P < 0.001). Macular ganglion cell volume was found to have a small decrease from baseline and correlated well with visual acuity, contrast sensitivity testing, and perimetric mean deviation (P < 0.001). Optic nerve sheath fenestration performed via a medial transconjunctival approach is a safe and effective method to preserve vision in patients with papilledema, particularly in cases of fulminant or progressive idiopathic intracranial hypertension. Quantitative measurements of the macular ganglion cell layer can serve as a useful adjunct to other diagnostic testing.

A Comprehensive Approach for an Interpretable Diabetic Macular Edema Grading System Based on ConvUNext

Diabetic macular edema (DME) is a leading cause of vision impairment in diabetic patients, necessitating a timely and accurate diagnosis. This paper proposes a comprehensive system for DME grading using retinal fundus images. Our approach integrates multiple deep learning modules, each designed to address key aspects of the diagnostic process. The first module employs the ConvUNeXt model for segmenting hard exudates (HaEx), crucial indicators of DME. The second module uses RetinaNet for precise optic disc (OD) localization, which is essential for subsequent macula localization. The third module refines macula localization, leveraging preprocessing techniques to enhance image clarity. Finally, our system consolidates these results to provide interpretable DME grading. Experimental evaluations were conducted on the Messidor dataset, demonstrating the system’s robust performance. The HaEx segmentation module achieved a mean IoU of 70.5% and a Dice coefficient of 0.64. The OD localization module showed perfect accuracy, recall, and precision at 1.0. For macula localization, our method satisfied the 1R criterion with 99.38% accuracy. The DME grading module achieved an overall accuracy of 91.12%, with an AUC of 0.9334. Our method offers a balanced performance across accuracy, sensitivity, and specificity compared to other non-interpretable and partially interpretable methods.

Complications and Risk Factors in Patients with Soft Tissue Sarcoma of the Extremities Treated with Radiotherapy.

Soft tissue sarcomas of the extremities (ESTSs) pose significant challenges in treatment and management due to their diverse nature and potential complications. This study aimed to assess complications associated with multimodal treatments involving surgery and radiotherapy (RT) and to identify potential risk factors. We retrospectively analyzed nonmetastatic ESTS patients treated with surgery and pre- or post-operative RT between 2007 and 2020 in Strasbourg, France. Complications, including wound complications (WCs), lymphedema, acute and chronic RT-related complications, and fractures, were meticulously evaluated. A total of 169 patients diagnosed with localized ESTSs were included, with a median age of 64 years (range 21-94 years). ESTSs primarily occurred proximally (74.6%) and in the lower limbs (71%). The median follow-up was 5.5 years. WCs occurred in 22.5% of patients, with proximal and lower extremity tumors being significant risk factors. Acute RT-related complications included radiodermatitis, with grade ≥ 2 occurring in 43.1% of patients, which was associated with superficial tumors. Three patients had an edema grade ≥ 2. Chronic complications included telangiectasias (21.7%) and fibrosis (38.7%), with higher rates associated with larger PTVs and higher RT doses, respectively. Fractures occurred in 5 patients, mainly in the tibia (40%). Multimodal treatment of ESTSs demonstrated excellent tolerance, with manageable side effects. Numerous risk factors have been highlighted, providing insights for optimizing treatment strategies and enhancing patient care in this rare disease.

Arithmetic Optimization for Coinciding Diabetic Retinopathy and Diabetic Macular Edema Grading based on Self-Attention Convolutional Neural Network

This paper proposes a Self-Attention Convolutional Neural Network (SACNN) optimized with Arithmetic Optimization Algorithm (AOA) for coinciding Diabetic Retinopathy (DR) and Diabetic Macular Edema Grading (DMEG) (SACNN-AOA-DR-DMEG). Initially, the input image is collected from 2 openly available benchmark datasets, namely Messidor and ISBI 2018 IDRiD. Then the input image is pre-processing using Altered Phase Preserving Dynamic Range Compression (APPDRC) for reducing noise from the imageries. SACNN receives the pre-processed imageries. The SACNN has three modules: (i) plane attention module, (ii) depth attention module, (iii) Attention Fusion Module. DR and DME features are extracted by plane attention module and depth attention module of SACNN. Attention Fusion Module receives extracted characteristics for categorizing and grading DR and DME disorders. SACNN does not adopt any optimization techniques to guarantee accurate DR and DME grading disorders. That’s why, Arithmetic Optimization Algorithm (AOA) is deemed to optimize the SACNN weight parameters. The proposed technique is implemented in Python. The proposed SACNN-AOA-DR-DMEG method provides 11.18%, 18.99% and 23.76% higher accuracy for diabetic retinopathy grading; 11.52%, 29.62% and 20.38% higher accuracy for DMEG; 33.39%, 22%, 39.26% lower computation time on Messidor data compared with the existing methods, such as AMGNN-DR-DMEG, LCNN-DR-DMEG, and FFN-DR-DMEG respectively.

Value of radiomics-based automatic grading of muscle edema in polymyositis/dermatomyositis based on MRI fat-suppressed T2-weighted images.

The precise and objective assessment of thigh muscle edema is pivotal in diagnosing and monitoring the treatment of dermatomyositis (DM) and polymyositis (PM). Radiomic features are extracted from fat-suppressed (FS) T2-weighted (T2W) magnetic resonance imaging (MRI) of thigh muscles to enable automatic grading of muscle edema in cases of polymyositis and dermatomyositis. A total of 241 MR images were analyzed and classified into five levels using the Stramare criteria. The correlation between muscle edema grading and T2-mapping values was assessed using Spearman's correlation. The dataset was divided into a 7:3 ratio of training (168 samples) and testing (73 samples). Thigh muscle boundaries in FS T2W images were manually delineated with 3D-Slicer. Radiomics features were extracted using Python 3.7, applying Z-score normalization, Pearson correlation analysis, and recursive feature elimination for reduction. A Naive Bayes classifier was trained, and diagnostic performance was evaluated using receiver operating characteristic (ROC) curves and comparing sensitivity and specificity with senior doctors. A total of 1198 radiomics parameters were extracted and reduced to 18 features for Naive Bayes modeling. In the testing set, the model achieved an area under the ROC curve of 0.97, sensitivity of 0.85, specificity of 0.98, and accuracy of 0.91. The Naive Bayes classifier demonstrated grading performance comparable to senior doctors. A significant correlation (r = 0.82, P <0.05) was observed between Stramare edema grading and T2-mapping values. The Naive Bayes model, utilizing radiomics features extracted from thigh FS T2W images, accurately assesses the severity of muscle edema in cases of PM/DM.

Return to Sports Activity After Microfracture for Osteochondral Lesion of the Talus in Skeletally Immature Children.

Osteochondral lesions of the talus (OLTs) are among the common sports-related injuries. However, there are few reports on the return to sports after OLT surgery in skeletally immature children. This study was performed to evaluate the return to sports after microfracture for OLTs in skeletally immature children. This study involved 17 ankles of 16 patients (mean age, 13.2 years; range, 10-16 years) with open tibial epiphyses on magnetic resonance imaging (MRI) who underwent microfracture for OLTs <10 mm in diameter and confirmation of lesion instability under arthroscopy. Nine of 17 ankles had additional lateral ankle ligament stabilization. All patients were participating in some form of sports. The Japanese Society for Surgery of the Foot (JSSF) score, Ankle Activity Score (AAS), return to sports rate, lesion size, grade of subchondral bone marrow edema, and Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score on MRI were evaluated after microfracture. The mean postoperative follow-up period was 53.5 months. The mean JSSF score significantly improved from 76.1 points preoperatively to 94.9 points at the final follow-up (P < .01). The mean AAS showed no change from preoperative state to final follow-up. The return to sports rate was 100%. The lesion size significantly decreased from 76.3 to 56.7 mm2 in area (P = .02) and from 283.2 to 185.6 mm3 in volume (P = .05). The bone marrow edema grade decreased in 8 of 17 ankles. The total MOCART score showed a significant improvement from 6 months to 1 year postoperatively (P = .05). All skeletally immature children who underwent microfracture for OLTs in this study were able to return to sports activity and showed improvements in clinical scores and MRI parameters. Microfracture may be considered an effective first-line treatment for OLTs <10 mm in diameter in skeletally immature athletes. Level IV, retrospective case-control study.

Effect of &lt;italic&gt;Hwanggigyejiomul-tang&lt;/italic&gt; on Postoperative Breast Cancer-related Lymphedema (BCRL): A Systematic Review and Meta-analysis

Objectives: This study assessed the effectiveness of &lt;i&gt;Hwanggigyejiomul-tang&lt;/i&gt; for postoperative breast cancer-related lymphedema (BCRL) by a systematic review and meta-analysis of randomized controlled trials (RCTs).Methods: A search was conducted using keywords such as “breast cancer”, “lymphedema”, “edema”, “Huangqi Guizhi Wuwu decoction”, “Huangqi Guizhi Wuwu tang”, and “Hwanggigyejiomul tang” in 10 databases (PubMed, Cochrane, ScienceDirect, CNKI, CiNii, RISS, KISS, ScienceON, OASIS, DBpia) on February 11, 2024. There were no limits on the publication period and language, and the quality of the studies was evaluated using Cochrane’s risk of bias tool. A meta-analysis was performed based on the outcome measurements, such as total effective rate (TER), increase in shoulder joint mobility (flexion, extension, abduction, adduction), Fugl-Meyer assessment (FMA), and visual analog scale (VAS) using Review Manager Web.Results: Eleven RCTs were selected. The treatment group (&lt;i&gt;Hwanggigyejiomul-tang-gagambang&lt;/i&gt; or &lt;i&gt;hapbang&lt;/i&gt; with control group intervention) showed a more statistically significant effect compared with the control group (physical therapy or western medicine) in TER (upper limb circumference change), TER (upper limb edema grade change), increase in flexion angle, increase in extension angle, increase in adduction angle, FMA, and VAS.Conclusions: &lt;i&gt;Hwanggigyejiomul-tang&lt;/i&gt; is effective in treating postoperative BCRL. However, because of the low quality of the included studies, more clinical studies are required to increase the possibility of clinical use.

Role of substance P in cerebral edema and association with an estimated specific gravity of the brain and an outcome prediction in post-traumatic cerebral edema

PurposeThe study aims to evaluate the role of substance P in cerebral edema and outcomes associated with acute TBI. MethodPatients with acute TBI who presented within 6 h and a CT scan showed predominantly cerebral edema were included in the study. Substance P level was assessed from a serum sample collected within 6 h of trauma. We also evaluated the brain-specific gravity using the Brain View software. ResultA total of 160 (128 male) patients were recruited. The median serum substance P concentration was 167.89 (IQR: 101.09–238.2). Substance P concentration was high in the early hours after trauma (p = 0.001). The median specific gravity of the entire brain was 1.04. Patients with a low Glasgow coma scale (GCS) at admission had a high concentration of the substance P. In the univariate analysis, low GCS, elevated serum concentrations of substance P level, high Rotterdam grade, high cerebral edema grade, a high international normalized ratio value, and high blood sugar levels were associated with poor outcomes at six months. In logistic regression analysis, low GCS at admission, high cerebral edema grade, and elevated blood sugar level were strongly associated with poor outcomes at six months. The area under the receiver operating characteristic curve was 0.884 (0.826–0.941). ConclusionSerum substance P is strongly associated with the severity of cerebral edema after TBI. However, brain-specific gravity does not directly correlate with posttraumatic cerebral edema severity. Serum substance P does not influence the clinical outcome of traumatic brain injury.

Diabetic retinopathy screening using MII Ret Cam assisted smartphone-based fundus imaging

BackgroundDiabetes Mellitus is a tremendous health implication and is proposed to be the seventh leading cause of death in 2030 by WHO. Diabetic retinopathy is one of the top complications of diabetes leading to preventable blindness. This investigation highlights the importance of timely screening and counseling using MII Ret cCam-assisted smartphone-based fundus imaging. Our study is a boon for bed-ridden and seriously ill patients who could not be evaluated on a fundus camera. MethodsThis is an observational prospective study conducted at the Ophthalmology unit, wards, and intensive care unit (ICU) of a single tertiary teaching hospital between 1 May to 31 November 2022. A total of 268 subjects with diabetes were included. The fundus of all the diabetic patients during the study period were examined by a single-trained ophthalmologist. Those diagnosed with diabetic retinopathy were taken for acquisition of fundus picture with MII Ret Cam. Images were captured using Apple iPhone 5s and 20D mounted in MII Ret Cam device. ResultsOut of 268 subjects (536 eyes) screened during the study period,86 patients (154 eyes) were found to have DR. Maleto Female ratio was 1.4:1. The mean age was 56.37 ± 15.26 years and the mean duration of diabetes was 10.60 ± 6.97 years. Grading of DR revealed proliferative diabetic retinopathy (PDR) to be the topmost (n=84 eyes, 54.5%), followed by mild non-proliferative diabetic retinopathy (NPDR) in 26 eyes (16%) and moderate NPDR in 24 eyes (15%) while severe NPDR was seen in 10 eyes (6.5%) and very severe NPDR was found in 8 eyes (5.2%) and diabetic papillopathy in 2 eyes. Grading of vitreous hemorrhage revealed Grade 1 in one eye (1.8%); Grade 2 in 19 eyes (34.54%); Grade 3 in 33 eyes (60%) and Grade 4 in 2 eyes (3.63%). Grading of macular edema according to the distribution of hard exudates as Grade 1(No Clinically significant macular edema) in 33 eyes (34.37%) and Grade 2 (Clinically significant macular edema) in 63 eyes (65.62%). The duration of diabetes had a direct association with the occurrence of DR, 13patients (15.1%) had a duration of diabetes less than five years; 31patients(36%) had a duration of diabetes between 6 years to 10 years; 28 patients (32.6%) had a duration between 11 years to 20 years. 14 patients (16.3%) had a duration of more than twenty years. The Mean duration of diabetes in Group I was 11.40+/- 7.09 years and was 9.10+/- 6.48 in Group II. The mean HbA1c in Group I is 7.44+/- 1.24 and 6.54 +/- 1.09 in Group II. The mean fasting blood sugar in Group I was 130.87 +/- 29.57 and 106.62+/- 29.85 in Group II. The mean of random blood sugar was 202.15 +/- 60.84 in Group I and 155.13 +/- 55.95 in Group II. Results are suggestive of the association of DR occurrence with fasting, random blood sugar, duration of diabetes, and HbA1c. ConclusionsDiabetic Retinopathy Screening using MII Ret Cam assisted Smartphone-based fundus imaging may be a useful device to screen for referable and vision-threatening diabetic retinopathy. MII Ret Cam is portable equipment and is easily accessible to counsel patients in resource-limited countries.

The Effect of Cold Saline Irrigation of Dissection Planes in Rhinoplasty on Postoperative Edema and Ecchymosis

Periorbital edema and ecchymosis are frequently encountered after rhinoplasty and may be distressing to patients. Cold therapy is frequently employed in rhinoplasty to reduce postoperative edema and ecchymosis. The aim of this study was to evaluate the effect of cold saline irrigation (CSI) of dissection planes in rhinoplasty on postoperative edema and ecchymosis. The investigators designed a retrospective cohort study. The data of patients who underwent rhinoplasty in our clinic between January 2021 and January 2023 were scanned. Patients who underwent primary open rhinoplasty from the same surgeon and standard rhinoplasty steps were applied in the same way and order were included in the study. Patients who had systemic diseases and previous nose surgery, and patients whose photographs could not be accessed from the photograph archive were excluded. According to whether CSI was applied to the dissection plans during rhinoplasty, the patients were divided into the CSI group and the control group (without CSI). Patients' grades of periorbital edema and ecchymosis were the main outcome variables. The differences of outcome variables were compared between the 2 groups. Demographics (age, sex), and surgical detail (duration of surgery) were collected as covariates. The numerical variables were compared between the two groups using the student's t-test and Mann-Whitney U test, whereas the categorical variables were compared using Pearson's χ2 and Fisher's exact tests. P<.05 was considered statistically significant. Among the 167 patients who met the inclusion criteria, 60 patients were randomly selected, 30 patients in each group. No statistically significant difference was found between the two groups in terms of age (P=.45) and sex (P=.27). The mean ecchymosis grade was statistically significant lower in the CSI group than in the control group for all evaluation times (P<.05). Similarly, the mean edema grade was statistically significant lower in the CSI group than in the control group for all evaluation times, with the exception of the 10th and 15th day (P<.05). CSI of the dissection planes in rhinoplasty reduced the development of periorbital edema and ecchymosis. This procedure is straightforward, inexpensive, and effective.

Optical Coherence Tomography-Based Grading of Diabetic Macular Edema Is Associated with Systemic Inflammatory Indices and Imaging Biomarkers

Introduction: Objectives of the study were to investigate the correlation between optical coherence tomography (OCT)-based grading of diabetic macular edema (DME) and systemic inflammatory indices, imaging biomarkers, and early anti-vascular endothelial growth factor (VEGF) treatment response. Methods: A total of 111 eyes from 111 patients with DME treated with intravitreous anti-VEGF therapy for 3 consecutive months every month were enrolled in this retrospective study. According to a protocol termed “TCED,” DME was divided into early, advanced, severe, and atrophic stages. The best-corrected visual acuity (BCVA), subretinal fluid (SRF), and the number of hyperreflective foci (HRF) in the whole retinal layers were analyzed at baseline and 3 months after the first injection. Peripheral blood inflammatory indices were calculated, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet (PLT)-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and C-reactive protein (CRP). Statistical analysis was performed to compare the visual and anatomical results and evaluate HRF and SRF in different stages of DME before and after treatment. Results: There were significant differences in systemic inflammatory indices among the four groups, including NLR, PLR, MLR, SII, and CRP (all p < 0.05). The CRP, NLR, PLR, MLR, and SII were significantly higher in the atrophic stage compared to the advanced stage (all p < 0.05). Conversely, the CRP, NLR, PLR, MLR, and SII were significantly lower in the advanced stage compared to the early stage (all p < 0.05). Except for the atrophic stage, BCVA and central retinal thickness (CRT) were significantly improved after treatment in early, advanced and severe stages (all p < 0.05), especially in the severe stage. The decline in the proportion of SRF and HRF ≥20 was the most significant in the advanced stage after anti-VEGF treatment (p < 0.001, p = 0.016), but not in the early and severe stages (all p > 0.05). Conclusion: Systemic inflammatory indices and the decline in the proportion of SRF and HRF ≥20 were closely associated with different stages of DME based on “TCED.” Meanwhile, the “TCED” grading system can predict visual and anatomical prognosis of DME after anti-VEGF treatment, which may be a biomarker for identifying risk stratification and management of DME.

Evaluation of a STAT MRI Protocol for Patients with Optic Disc Edema.

Evaluating patients with potentially sight-threatening conditions frequently involves urgent neuroimaging, and some providers recommend expediting emergency department (ED) evaluation. However, several factors may limit the practicality of ED evaluation. This pilot study assessed the feasibility and safety of a STAT magnetic resonance imaging (MRI) protocol, designed to facilitate outpatient MRI within 48 hours of referral, compared with ED evaluation for patients with optic disc edema. A retrospective chart review was performed. Demographics, clinical data, and baseline ophthalmic measures were compared between patients in STAT and ED groups using the t test or Fisher exact test. Multivariate analyses compared changes in visual acuity (VA), visual field mean deviation (VF MD), retinal nerve fiber layer thickness, and edema grade between presentation and follow-up using a mixed-effects model adjusting for age, sex, and baseline measures. A total of 70 patients met the study criteria-24 (34.3%) in the STAT MRI cohort and 46 (65.7%) in the ED cohort. Demographic variables were similar between groups. Patients referred to the ED had worse VA ( P < 0.001), larger VF MD ( P < 0.001), and higher edema grade ( P = 0.002) at presentation. Four patients in the ED group and none in the STAT group were found to have space-occupying lesions. Multivariate analyses showed that follow-up measures were significantly associated with their baseline values (all P < 0.001) but not with referral protocol (all P > 0.099). The STAT MRI protocol was associated with lower average patient charges and hospital costs. The STAT MRI protocol did not result in inferior visual outcomes or delay in life-threatening diagnoses. Urgent outpatient evaluation, rather than ED referral, seems safe for some patients with optic disc edema. These findings support continued utilization of the protocol and ongoing improvement efforts.

Limited Duration Loncastuximab Tesirine with Rituximab Induces High Complete Metabolic Response Rate in High-Risk Relapsed/Refractory Follicular Lymphoma - a Phase 2 Study

Introduction: There is no standard-of-care for treatment of relapsed/refractory (rel/ref) follicular lymphoma (FL) with worse prognosis in those demonstrating progression of disease within 24 months (POD24) from frontline immunochemotherapy. Loncastuximab tesirine (loncastuximab) is an antibody-drug conjugate comprising a monoclonal antibody directed against CD19 and a DNA cross-linking pyrrolobenzodiazepine. Preclinical data demonstrated synergistic activity between rituximab-induced cytotoxicity and loncastuximab. Here we report pre-specified initial results of a single-institution investigator-initiated study evaluating this combination for the first time in FL (NCT04998669). Methods: Adult patients with rel/ref FL previously treated with ≥1 line of systemic therapy presenting GELF criteria or POD24 at enrollment were eligible.Primary study endpoint was complete response (CR) by week 12 PET/CT based on Lugano 2014 criteria. Bone marrow biopsy was required at screening and repeated at week 12 if initial involvement. The initial 21 weeks of therapy consisted of 4 weekly doses of rituximab i.v. 375mg/m 2 followed by 1 dose every 8 weeks for a total of 5 doses in association with loncastuximab i.v. 0.15mg/kg every 3 weeks for 2 doses followed by 0.075mg/kg every 3 weeks for a total of 7 doses. Patients achieving CR by week 21 PET/CT discontinued loncastuximab and received two more doses of rituximab every 8 weeks. Premedication with dexamethasone 4 mg twice daily for 3 days was required with loncastuximab. No antibiotic or growth factor prophylaxis was mandated by study protocol. Enrollment occurred according to a Simon's minimax two-stage design with a total sample size of 39 patients based upon a projected CR rate ≥50% vs ≤30% (H0), type I error alpha 5%, power 80%. In stage 1, 19 patients enrolled and 7 or more CRs were required to proceed with stage II. In stage II, an additional 20 patients will be enrolled. Based on n=39, a total of ≥17 CRs are required for rejecting the H0. Results: Twenty-six patients have been enrolled from January 2022 to July 2023, 25 evaluable for toxicity (1 patient has not yet initiated treatment) and 21 for response. Median age was 68 years (range 47 to 89). Most were women (n=14; 54%), with advanced-stage (n=20; 77%), high-risk FLIPI score (n=13; 50%), and 12 (46%) demonstrating POD24 after immunochemotherapy. Median lines of prior therapy were 1 (range 1 to 6). R-CHOP was most common first-line therapy (n=14; 54%) followed by bendamustine with rituximab and single-agent rituximab (n=6; 23%; each). Most common grade 1 adverse events (AEs) included alkaline-phosphatase (48%), ALT (44%), AST (36%) elevation; maculo-papular rash (44%), fatigue (28%), thrombocytopenia (28%), photosensitivity (28%), leg edema (24%), and anasarca (20%). Grade 2 AEs were alkaline phosphatase elevation (12%), anasarca (8%) and leg edema (4%) Grade 3 AEs included neutropenia (n=2; 8%), and one case each (4%) of cellulitis and pleural effusion. Neutropenia was the only grade 4 AE in a patient post-CAR T-cell. All toxicities resolved with supportive management and dose delays (n= 4); no treatment-related deaths occurred during study period. CR was observed in 7 of the initial 10 patients meeting pre-specified criteria to proceed to stage II. Among 21 patients evaluable for response, the overall response rate at week 12 was 95.2% [CR rate of 66.7% (n=14), partial response (PR) rate of 28.6% (n=6)]. All CR were maintained and 4 of the 6 PR (2 patient have not yet re-evaluated) improved to CR at week 21 for a best CR rate of 86% (n= 18). Baseline bone marrow involvement by FL resolved in all patients (n=5) at week 12 reassessment. Two patients were removed from the study. One patient due to disease progression on week 12 PET/CT with biopsy-proven diffuse large B-cell lymphoma in a kidney mass and another with cholangiocarcinoma, who achieved CR with respect to known lymphoma involvement. Both lesions were present before study enrollment but radiologically considered FL. All seven patients who completed the study remained in CR after end of treatment for a median follow up of 4.8 months (range 3.2 to 6.7) ( Figure 1). Updated analysis will be presented at the meeting. Conclusion: A limited duration program combining loncastuximab with rituximab in patients with rel/ref FL is well tolerated and highly effective with a metabolic CR rate of 86% including high-risk patients with POD24 and/or high disease burden.

Hyaluronidase Injection to Reduce Periorbital Edema after Surgery for Unruptured Intracranial Aneurysms

Background: In the era of endovascular treatment for intracranial aneurysms, microsurgical treatment might necessitate the minimization of postoperative discomforts such as headache, nausea, vomiting, and edema. The current study aimed to evaluate the effectiveness of hyaluronidase on the reduction of periorbital edema after clipping surgery for unruptured intracranial aneurysms. Methods: From July 2016 to March 2018, the patients who underwent elective surgery for unruptured intracranial aneurysms were included. A mixture of 4500 IU hyaluronidase was injected subcutaneously on the sectional plane of the scalp incision. The photographs of patients’ faces were obtained on postoperative day 1, 3, and 7. The degree of periorbital edema was judged on the grading system based on the vertical palpebral aperture. The thickness of the scalp, temporalis muscle, and soft tissue was measured on a preoperative computed tomography (CT) scan, and other variables (e.g., intraoperative input and output, serum albumin level) were Results: A total of 60 patients were included in this study, and a hyaluronidase mixture was injected in 30 patients. The periorbital edema tended to resolve in 7 days after surgery, but notable differences between the two groups was observed at day three after surgery in this study. On the ordinal logistic regression analysis on the grade of periorbital edema, hyaluronidase injection is significantly associated with the reduction of periorbital edema throughout the postoperative period. (p value &lt; 0.05)Conclusion: Hyaluronidase injection might be helpful in reducing periorbital edema after surgery for unruptured intracranial aneurysms.

A Case Report of Korean Medicine Treatment on Clinical Symptoms in a Patient with Post-stroke Deep Vein Thrombosis

This case report shows the effect of Korean medicine treatment in a patient with deep vein thrombosis (DVT) after cerebral infarction who is suspected of having post-thrombotic syndrome (PTS) due to the loss of thrombus after receiving new oral anticoagulant (NOAC) treatment. The patient was treated with Korean medicine (&lt;i&gt;Boyanghwano-tang&lt;/i&gt; and &lt;i&gt;Hyulbuchuko-tang&lt;/i&gt;) three times a day. Acupuncture, moxibustion, infrared, and extra-physical therapy were given to the patient for 24 days. Clinical assessment - grading of edema and circumference of the left lower extremity were observed twice a week until the end of the treatment. NOAC treatment was continued for 24 days. After treatment, the patient’s edema grade and circumference of the extremity improved. On the 24th day, the patient’s chief complaints improved, and she requested termination of treatment. The results suggest that Korean medicine treatments, including &lt;i&gt;Boyanghwano-tang&lt;/i&gt;, &lt;i&gt;Hyulbuchuko-tang&lt;/i&gt;, and acupuncture therapy, can be effective in improving the clinical symptoms of DVT and PTS.

New-Generation 0.55 T MRI of the Knee-Initial Clinical Experience and Comparison With 3 T MRI.

The aim of this study was to compare the detection rate of and reader confidence in 0.55 T knee magnetic resonance imaging (MRI) findings with 3 T knee MRI in patients with acute trauma and knee pain. In this prospective study, 0.55 T and 3 T knee MRI of 25 symptomatic patients (11 women; median age, 38 years) with suspected internal derangement of the knee was obtained in 1 setting. On the 0.55 T system, a commercially available deep learning image reconstruction algorithm was used (Deep Resolve Gain and Deep Resolve Sharp; Siemens Healthineers), which was not available on the 3 T system. Two board-certified radiologists reviewed all images independently and graded image quality parameters, noted MRI findings and their respective reporting confidence level for the presence or absence, as well as graded the bone, cartilage, meniscus, ligament, and tendon lesions. Image quality and reader confidence levels were compared ( P < 0.05 = significant), and clinical findings were correlated between 0.55 T and 3 T MRI by calculation of the intraclass correlation coefficient (ICC). Image quality was rated higher at 3 T compared with 0.55 T studies (each P ≤ 0.017). Agreement between 0.55 T and 3 T MRI for the detection and grading of bone marrow edema and fractures, ligament and tendon lesions, high-grade meniscus and cartilage lesions, Baker cysts, and joint effusions was perfect for both readers. Overall identification and grading of cartilage and meniscal lesions showed good agreement between high- and low-field MRI (each ICC > 0.76), with lower agreement for low-grade cartilage (ICC = 0.77) and meniscus lesions (ICC = 0.49). There was no difference in readers' confidence levels for reporting lesions of bone, ligaments, tendons, Baker cysts, and joint effusions between 0.55 T and 3 T (each P > 0.157). Reader reporting confidence was higher for cartilage and meniscal lesions at 3 T (each P < 0.041). New-generation 0.55 T knee MRI, with deep learning-aided image reconstruction, allows for reliable detection and grading of joint lesions in symptomatic patients, but it showed limited accuracy and reader confidence for low-grade cartilage and meniscal lesions in comparison with 3 T MRI.

Genome-wide association study of treatment-related toxicity two years following radiotherapy for breast cancer

Background and purposeUp to a quarter of breast cancer patients treated by surgery and radiotherapy experience clinically significant toxicity. If patients at high risk of adverse effects could be identified at diagnosis, their treatment could be tailored accordingly. This study was designed to identify common single nucleotide polymorphisms (SNPs) associated with toxicity two years following whole breast radiotherapy. Materials and MethodsA genome-wide association study (GWAS) was performed in 1,640 breast cancer patients with complete SNP, clinical, treatment and toxicity data, recruited across 18 European and US centres into the prospective REQUITE cohort study. Toxicity data (CTCAE v4.0) were collected at baseline, end of radiotherapy, and annual follow-up. A total of 7,097,340 SNPs were tested for association with the residuals of toxicity endpoints, adjusted for clinical, treatment co-variates and population substructure. ResultsQuantile-quantile plots showed more associations with toxicity above the p < 5 × 10-5 level than expected by chance. Eight SNPs reached genome-wide significance. Nipple retraction grade ≥ 2 was associated with the rs188287402 variant (p = 2.80 × 10-8), breast oedema grade ≥ 2 with rs12657177 (p = 1.12 × 10-10), rs75912034 (p = 1.12 × 10-10), rs145328458 (p = 1.06 × 10-9) and rs61966612 (p = 1.23 × 10-9), induration grade ≥ 2 with rs77311050 (p = 2.54 × 10-8) and rs34063419 (p = 1.21 × 10-8), and arm lymphoedema grade ≥ 1 with rs643644 (p = 3.54 × 10-8). Heritability estimates across significant endpoints ranged from 25% to 39%. Our study did not replicate previously reported SNPs associated with breast radiation toxicity at the pre-specified significance level. ConclusionsThis GWAS for long-term breast radiation toxicity provides further evidence for significant association of common SNPs with distinct toxicity endpoints.